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https://www.readbyqxmd.com/read/28346597/association-of-risk-of-viremia-immunosuppression-serious-clinical-events-and-mortality-with-increasing-age-in-perinatally-human-immunodeficiency-virus-infected-youth
#1
Anne M Neilan, Brad Karalius, Kunjal Patel, Russell B Van Dyke, Mark J Abzug, Allison L Agwu, Paige L Williams, Murli Purswani, Deborah Kacanek, James M Oleske, Sandra K Burchett, Andrew Wiznia, Miriam Chernoff, George R Seage, Andrea L Ciaranello
Importance: As perinatally human immunodeficiency virus-infected youth (PHIVY) in the United States grow older and more treatment experienced, clinicians need updated information about the association of age, CD4 cell count, viral load (VL), and antiretroviral (ARV) drug use with risk of opportunistic infections, key clinical events, and mortality to understand patient risks and improve care. Objective: To examine the incidence or first occurrence during follow-up of key clinical events (including Centers for Disease Control and Prevention stage B [CDC-B] and stage C [CDC-C] events) and mortality among PHIVY stratified by age, CD4 cell count, and VL and ARV status...
March 27, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28294880/-results-of-monitoring-of-the-plan-of-measures-directed-to-reduction-of-ischemic-heart-disease-in-north-caucasus-republics-analysis-of-dynamics-of-cardio-vascular-mortality
#2
M N Mamedov
Comparative analysis of dynamics of cardiovascular mortality in Russia and foreign countries as well as main directions of development of cardiological service in Russia are presented in this review article. Plan of measures for reduction of mortality from ischemic heart disease (IHD) was created in 2015. This plan comprises 4 blocks of assessment of the following measures: directed at improvement of primary IHD prevention (1), directed at secondary prevention of complications of IHD (2); directed at improvement of efficacy of medical care of patients with IHD (3), and directed at monitoring of some demographic parameters (4)...
May 2016: Kardiologiia
https://www.readbyqxmd.com/read/28282654/approach-to-human-immunodeficiency-virus-sexually-transmitted-infection-testing-for-men-at-an-urban-urgent-care-center
#3
Sarah B Schechter, Dina L Romo, Alwyn T Cohall, Natalie M Neu
BACKGROUND AND OBJECTIVES: Sexually transmitted infection (STI) rates have increased among men. Urgent care centers are increasingly common sites for medical care. The objectives of this study are to describe practices surrounding STI testing at an urban urgent care center. METHODS: Electronic medical record data were analyzed for men ages 20 to 55 years seen at the urgent care center of a large urban hospital from June 7, 2011, to April 30, 2015 (n = 10,983). A subset of charts was reviewed to assess sexual history documentation (n = 906)...
April 2017: Sexually Transmitted Diseases
https://www.readbyqxmd.com/read/28282377/before-the-bombing-high-burden-of-traumatic-injuries-in-kunduz-trauma-center-kunduz-afghanistan
#4
Hamayoun Hemat, Safieh Shah, Petros Isaakidis, Mrinalini Das, Nang Thu Thu Kyaw, Sattar Zaheer, Abdul Qayeum Qasemy, Mutallib Zakir, Gbane Mahama, Catherine Van Overloop, Lynette Dominguez
BACKGROUND: Médecins Sans Frontières (MSF) has been providing healthcare in Afghanistan since 1981 including specialized health services for trauma patients in Kunduz Trauma Center (KTC) from 2011. On October 3rd, 2015, a US airstrike hit the KTC, killing 42 people including 14 MSF staff. This study aims to demonstrate the impact on healthcare provision, after hospital destruction, by assessing the extent of care provided for trauma and injuries by the MSF KTC and to report on treatment outcomes from January 2014 to June 2015, three months prior to the bombing...
2017: PloS One
https://www.readbyqxmd.com/read/28281893/universal-adolescent-suicide-screening-in-a-pediatric-urgent-care-center
#5
Aimy Patel, Catherine Watts, Sheri Shiddell, Karla Couch, Amber M Smith, Michael J Moran, Gregory P Conners
OBJECTIVES: The aim of this article is to describe the implementation of a two-question suicide screening tool in a pediatric urgent care center to identify patients at risk of suicide. METHODS: Adolescents presenting during a 12-month period completed the screening tool. Positive response to either question triggered further social work evaluation, including a Columbia-Suicide Severity Rating Scale. RESULTS: Of 4786 patients screened, 95 (2%) responded positively...
March 10, 2017: Archives of Suicide Research: Official Journal of the International Academy for Suicide Research
https://www.readbyqxmd.com/read/28273502/ruptured-berry-aneurysm-with-minimal-subarachnoid-hemorrhage
#6
Tyler J Gardner, Joseph A Prahlow
Cerebral artery aneurysm rupture is usually associated with significant subarachnoid hemorrhage; however, there are rare cases where there is a lack of hemorrhage into the subarachnoid space. While subdural hemorrhage can occur with ruptured aneurysms, isolated subdural hemorrhage is more often associated with trauma. In this case, a 51-year-old obese woman, who recently visited an Urgent Care Center for elevated blood pressure, was found dead roughly a month later. She had been complaining of headaches, and received medication for her blood pressure at the visit...
February 28, 2017: Journal of Forensic and Legal Medicine
https://www.readbyqxmd.com/read/28262320/comparing-utilization-and-costs-of-care-in-freestanding-emergency-departments-hospital-emergency-departments-and-urgent-care-centers
#7
Vivian Ho, Leanne Metcalfe, Cedric Dark, Lan Vu, Ellerie Weber, George Shelton, Howard R Underwood
STUDY OBJECTIVE: We compare utilization, price per visit, and the types of care delivered across freestanding emergency departments (EDs), hospital-based EDs, and urgent care centers in Texas. METHODS: We analyzed insurance claims processed by Blue Cross Blue Shield of Texas from 2012 to 2015 for patient visits to freestanding EDs, hospital-based EDs, or urgent care centers in 16 Texas metropolitan statistical areas containing 84.1% of the state's population. We calculated the aggregate number of visits, average price per visit, proportion of price attributable to facility and physician services, and proportion of price billed to Blue Cross Blue Shield of Texas versus out of pocket, by facility type...
February 15, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28260440/vascular-complications-after-renal-transplant-a-single-center-experience
#8
Ebru H Ayvazoglu Soy, Aydincan Akdur, Mahir Kirnap, Fatih Boyvat, Gokhan Moray, Mehmet Haberal
OBJECTIVES: Despite surgical and medical advances, vascular complications are still among the major concerns after renal transplant, with a reported incidence of 3% to 15%. We evaluated the incidence and management of our transplant team 's vascular complications over 40 years. MATERIALS AND METHODS: From November 1975 to the present, we have performed a total of 2594 renal transplant procedures. Of these, 1997 grafts (76%) were obtained from living donors, and 597 grafts (24%) were obtained from deceased donors...
February 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28256327/st-segment-elevation-myocardial-infarction-systems-of-care-an-urgent-need-for-policies-to-co-ordinate-care-in-order-to-decrease-in-hospital-mortality
#9
Ali Osama Malik, Oliver Abela, Gayle Allenback, Subodh Devabhaktuni, Calvin Lui, Aditi Singh, Jimmy Diep, Takashi Yamashita, Ji Won Yoo, Sanjay Malhotra, Chowdhury Ahsan
BACKGROUND: Regional trends for ST-segment elevation myocardial infarction (STEMI) treatment is not known in the state of Nevada. HYPOTHESIS: Great disparity exists for treatment for STEMI in different geographical areas of Nevada. There is a great potential to improve treatment and outcomes of STEMI patients in the State of Nevada. METHODS: Admissions to non-federal hospitals in the state of Nevada, using 2011 to 2013 discharge data from the Nevada State Inpatient Data Base (acquired from Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), were analyzed...
February 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28245880/pre-hospital-ct-diagnosis-of-subarachnoid-hemorrhage
#10
Maren Ranhoff Hov, Annette Ryen, Katrine Finsnes, Janne Storflor, Thomas Lindner, Jostein Gleditsch, Christian Georg Lund
BACKGROUND: Subarachnoid hemorrhage (SAH) is associated with higher mortality in the acute phase than other stroke types. There is a particular risk of early and devastating re-bleeding. Patients therefore need urgent assessment in a neurosurgical department, and the shorter the time from symptom onset to diagnosis the better. CASE PRESENTATION: The Norwegian Acute Stroke Pre-hospital Project (NASPP) has developed a Mobile Stroke Unit (MSU) model, which is staffed with anesthesiologists also trained in pre-hospital clinical assessment of acute stroke patients and interpretation of computerized tomography (CT)...
February 28, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28242966/over-the-counter-mtp-pills-and-its-impact-on-women-s-health
#11
Sarojini, T R Ashakiran, B T Bhanu, Radhika
OBJECTIVES: To study the complications and consequences including maternal morbidity and mortality following indiscriminate self-consumption of abortion pills reporting to a tertiary care center. METHODOLOGY: This is an observational study conducted at Vanivilas hospital between January 2012 to December 2013 for 24 months. After applying inclusion and exclusion criteria, 104 women were studied with respect to period of gestation, parity, clinical features at presentation and management in the institution...
February 2017: Journal of Obstetrics and Gynaecology of India
https://www.readbyqxmd.com/read/28238501/is-tachycardia-at-discharge-from-the-pediatric-emergency-department-a-cause-for-concern-a%C3%A2-nonconcurrent-cohort-study
#12
Paria M Wilson, Todd A Florin, Guixia Huang, Matthew Fenchel, Matthew R Mittiga
STUDY OBJECTIVE: We evaluate the association between discharge tachycardia and (1) emergency department (ED) and urgent care revisit and (2) receipt of clinically important intervention at the revisit. METHODS: The study included a nonconcurrent cohort of children aged 0 to younger than 19 years, discharged from 2 pediatric EDs and 4 pediatric urgent care centers in 2013. The primary exposure was discharge tachycardia (last recorded pulse rate ≥99th percentile for age)...
February 23, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28228138/current-management-practices-for-patients-presenting-with-low-back-pain-to-a-large-emergency-department-in-canada
#13
Matthew L Nunn, Jill A Hayden, Kirk Magee
BACKGROUND: Low back pain (LBP) is one of the leading causes of disability. Presentations to the emergency department (ED) are common and consume significant healthcare resources. However, treatment of patients with LBP is variable and highly physician dependent. Our study objective was to describe the demographic and clinical characteristics of patients presenting to the ED with LBP, the diagnostic strategies employed by ED physicians, and the subsequent management. METHODS: We conducted a retrospective study using clinical and electronic health data at the Queen Elizabeth II Health Science Center's Charles V...
February 23, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28213342/virtual-visits-for-acute-nonurgent-care-a-claims-analysis-of-episode-level-utilization
#14
Aliza S Gordon, Wallace C Adamson, Andrea R DeVries
BACKGROUND: Expansion of virtual health care-real-time video consultation with a physician via the Internet-will continue as use of mobile devices and patient demand for immediate, convenient access to care grow. OBJECTIVE: The objective of the study is to analyze the care provided and the cost of virtual visits over a 3-week episode compared with in-person visits to retail health clinics (RHC), urgent care centers (UCC), emergency departments (ED), or primary care physicians (PCP) for acute, nonurgent conditions...
February 17, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28169982/effect-of-an-asthma-guideline-in-2-pediatric-emergency-departments-and-an-urgent-care-center
#15
Jennifer J Dilts, Sharon G Humiston, Brian R Lee, Nancy H Allen, Jeffrey G Michael
OBJECTIVES: The objective of this study was to evaluate ordering of albuterol via metered-dose inhaler with spacer (MDI-spacer), length of stay (LOS), and 72-hour return rates before and after publication of an internally developed pediatric asthma clinical practice guideline (CPG). METHODS: The internally developed CPG reflected national recommendations. It was explained at faculty meetings by a respected clinician and published on the intranet on February 6, 2012...
February 4, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28158876/predictors-of-the-need-for-therapeutic-intervention-in-older-adult-patients-with-a-nonvariceal-gastrointestinal-bleed
#16
Khalid Abusaada, Xiaoping He, Fnu Asad-Ur-Rahman, Umair Majeed, Evgeny Idrisov, Sameen Khalid, Xiang Zhu, Vladimir Pech, George Everett
OBJECTIVE: Gastrointestinal bleeding (GIB) is a common cause of hospitalization in the older adult population. The aim of the study was to identify factors that are associated with the need for a therapeutic intervention in patients older than 65 years with nonvariceal GIB. METHODS: This is a retrospective cohort study of older adult patients admitted to a tertiary care center between 2009 and 2011 with nonvariceal GIB. The primary outcome was a composite endpoint of inpatient mortality or need for an endoscopic, surgical, or radiologic procedure to control the bleed or to treat the underlying source of the bleed...
February 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28152929/safer-transitions-of-care-at-a-major-cancer-center-the-emergency-center-to-hospitalist-experience
#17
Carmen E Gonzalez, Norman Brito-Dellan, David Rubio, Mohamed Ait Aiss, Terry Rice, Karen Chen, Diane C Bodurka, Carmelita P Escalante
247 Background: Failures in communication lead to serious medical errors particularly during transitions of care. A standardized handoff of patients requiring admission to the inpatient setting between the Emergency Center (EC) and the Hospitalist Inpatient Service (HIS) at a comprehensive cancer center was lacking during this vulnerable time. METHODS: A quality pilot study using Plan, Do, Study, Act methodology was conducted. First, root cause analysis and process mapping of the current state was performed to identify pitfalls of the handoff process between the EC and the Hospitalist Service...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152927/reducing-wait-time-wt-in-the-infusion-center-ic
#18
Lianne Lopez, Angela Aschian, Betty Chan, Martha Inofuentes, Zoraida Truax, Sally Golingay, Gwendoyn Lynch, Peggy Matsuura, Afsaneh Barzi
249 Background: Lengthy WT is the primary source of dis-satisfaction with IC services. We created a patient (PT) flow diagram outlining each step beginning from PT check-in to discharge and plotted the impact of multiple disciplines on the WT. A team of nurses, pharmacists, physicians, and administrators, analyzed the flow and identified ways to improve efficiencies. METHODS: First attempt was to improve communications between pharmacy and nursing, coordinating the preparation of medications with patient's check-in time; use of a simple clipboard facilitated this task and improved the efficiency of the system...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152833/understanding-total-cost-of-cancer-care-to-determine-strategic-interventions-to-improve-value
#19
Salimah Velji, Kavita Patel, Basit Chaudhry, Sonia Grizzle, Catherine A Lyons, Rogerio Lilenbaum
3 Background: Cancer centers across the country are largely unprepared to move toward value-based payment. Total cost of care data is not readily available and centers do not know how much of their patients' care is received at other hospitals, when in the trajectory of illness greatest cost is incurred, or the elements of care that present the greatest opportunity for savings. A previous examination of practice patterns Smilow Cancer Hospital (SCH) demonstrated that our patients had high rates of ED visits, hospital admissions and ICU use in their last month of life...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152800/acute-hospitalizations-in-cancer-patients-treated-with-definitive-radiotherapy-a-retrospective-cohort-study-with-implications-for-an-urgent-care-clinic
#20
Peter Edward Gabriel, Daniel Owen, Melody Ju Xu, Charles B Simone, John Peter Plastaras, John Paul Christodouleas, Wei-Ting Hwang, Neha Vapiwala
312 Background: Reasons for hospitalizations in patients undergoing curative-intent radiotherapy (RT) have not been well characterized previously. Implementation of urgent cancer care clinics could decrease rates of hospitalization, but the reasons for acute visits must be better understood. This retrospective cohort study investigates emergency department (ED) visits or admissions in patients treated with definitive RT. METHODS: Under an IRB-approved protocol, the cohort was defined as all consecutive patients >=18 yo who began RT (RTSTART) between 7/1/11 and 12/31/13 for nonmetastatic disease with curative intent...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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