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https://www.readbyqxmd.com/read/28842518/formalization-of-an-antimicrobial-stewardship-program-in-a-small-community-hospital
#1
Alexa R Lockwood, Nicole S Bolton, Mark D Winton, Jean T Carter
PURPOSE: Results of a study to formalize an antimicrobial stewardship program (ASP) in a small community hospital are presented. METHODS: The formalization process began with a gap analysis of the hospital's antimicrobial services, followed by the development of a fully integrated, multipharmacist ASP. The impact was studied with an institutional review board-approved study design. Retrospective pre-ASP data were pulled from March 1 to June 30, 2012 and 2013 patient records; prospective post-ASP data were collected for March 1 to June 30, 2015...
September 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28795300/five-years-two-surgeons-and-over-500-bariatric-procedures-what-have-we-learned
#2
Brian Shea, William Boyan, James Botta, Syed Ali, Yaniv Fenig, Ethan Paulin, Steven Binenbaum, Frank Borao
BACKGROUND: Bariatric surgery has become an increasingly popular method for weight loss and mitigation of co-morbidities in the obese population. Like any field, there is a desire to standardize and accelerate the postoperative period while maintaining safe outcomes. METHODS: All laparoscopic sleeve gastrectomies (LSG) and gastric bypasses (LGB) were performed over a 5-year period were logged along with several aspects of postoperative care. Trends were followed in aspects of postoperative care over years as well as any documentation of complications or re-admissions...
August 9, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28683047/the-pii-solution-to-mental-healthcare-delivery-prevention-intervention-and-integration
#3
Mira A King
In this essay, the author proposes a new, integrated model for mental healthcare delivery called the PII solution, which builds on the successes of federal government programs and state initiatives. The PII solution includes prevention, intervention, and integration. As a community-centered approach, PII leverages existing programs in concert with new approaches to meet the diverse needs of patients with the spectrum of mental health disorders, from low risk to high risk. The PII solution can be applied to any subgroup in society to create a comprehensive plan to combat mental illness...
July 2017: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/28630629/the-cedar-study-a-longitudinal-study-of-the-clinical-effects-of-conventional-dmards-and-biologic-dmards-in-australian-rheumatology-practice
#4
Lynden Roberts, Kathleen Tymms, Julien de Jager, Geoffrey Littlejohn, Hedley Griffiths, Dave Nicholls, Paul Bird, Jennifer Young, Julie Hill, Jane Zochling
OBJECTIVES: To observe the choices of conventional disease modifying antirheumatic drugs (cDMARDs) and biologic DMARDs (bDMARDs) in the management of rheumatoid arthritis (RA) in Australian routine clinical practice, to assess treatment survival and determine the effect of cDMARDs/bDMARDs on disease activity. METHODS: Routinely collected, deidentified clinical data was sourced from 20 Australian rheumatology practices. RA patients aged ≥18 years, who had received cDMARDs/bDMARDs and a recorded subsequent visit, were included...
2017: International Journal of Rheumatology
https://www.readbyqxmd.com/read/28559767/st-gallen-vienna-2017-a-brief-summary-of-the-consensus-discussion-about-escalation-and-de-escalation-of-primary-breast-cancer-treatment
#5
REVIEW
Michael Gnant, Nadia Harbeck, Christoph Thomssen
For the second time, the St. Gallen Consensus Conference on early breast cancer treatment standards took place in Vienna, Austria, where it will remain for the foreseeable future (next date: March 20-23, 2019). With the probably most prominent line-up of global breast cancer experts and more than 3,000 participants from over 100 countries, the 2017 St. Gallen/Vienna conference again was a huge success. A generation change took place with respect to the Conference Co-Chairpersons. Traditionally, the experts from all continents reviewed publications from the past 2 years, and discussed whether new diagnostic or therapeutic means were ready for routine everyday practice...
May 2017: Breast Care
https://www.readbyqxmd.com/read/28372033/behavioral-emergency-response-team-implementation-improves-patient-safety-staff-safety-and-staff-collaboration
#6
Cdr Jennifer M Zicko, Lcdr Rebecca A Schroeder, Cdr William S Byers, Lt Adam M Taylor, Cdr Dennis L Spence
BACKGROUND: Staff members working on our nonmental health (non-MH) units (i.e., medical-surgical [MS] units) were not educated in recognizing or deescalating behavioral emergencies. Published evidence suggests a behavioral emergency response team (BERT) composed of MH experts who assist with deescalating behavioral emergencies may be beneficial in these situations. Therefore, we sought to implement a BERT on the inpatient non-MH units at our military treatment facility. AIMS: The objectives of this evidence-based practice process improvement project were to determine how implementation of a BERT affects staff and patient safety and to examine nursing staffs' level of knowledge, confidence, and support in caring for psychiatric patients and patients exhibiting behavioral emergencies...
April 3, 2017: Worldviews on Evidence-based Nursing
https://www.readbyqxmd.com/read/28174295/optimizing-local-control-in-high-grade-uterine-sarcoma-adjuvant-vaginal-vault-brachytherapy-as-part-of-a-multimodal-treatment
#7
Pierre Annede, Sébastien Gouy, Renaud Mazeron, Enrica Bentivegna, Pierre Maroun, Claire Petit, Isabelle Dumas, Alexandra Leary, Catherine Genestie, Catherine Lhommé, Eric Deutsch, Philippe Morice, Patricia Pautier, Christine Haie-Meder, Cyrus Chargari
PURPOSE: The phase III European Organization for Research and Treatment of Cancer 55874 study has shown that external beam radiotherapy (EBRT) given as adjuvant treatment decreased locoregional recurrences from 40% to 20% in patients (pts) with localized uterine sarcomas (US). No data exist, however, on the place of brachytherapy (BT). MATERIAL AND METHODS: We conducted a single-center retrospective analysis of pts receiving adjuvant BT of the vaginal vault based on the vaginal mold technique as part of their multimodal adjuvant treatment for a high-grade US from 1985 to 2015...
February 2017: Oncologist
https://www.readbyqxmd.com/read/28146385/deescalating-antibiotics-in-pneumonia-laying-the-foundation
#8
Eric M Mortensen
No abstract text is available yet for this article.
February 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27955899/nasa-model-of-threat-and-error-in-pediatric-cardiac-surgery-patterns-of-error%C3%A2-chains
#9
Edward Hickey, Eric Pham-Hung, Yaroslavna Nosikova, Fredrik Halvorsen, Michael Gritti, Steven Schwartz, Christopher A Caldarone, Glen Van Arsdell
BACKGROUND: We introduced the National Aeronautics and Space Association threat-and-error model to our surgical unit. All admissions are considered flights, which should pass through stepwise deescalations in risk during surgical recovery. We hypothesized that errors significantly influence risk deescalation and contribute to poor outcomes. METHODS: Patient flights (524) were tracked in real time for threats, errors, and unintended states by full-time performance personnel...
April 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27918781/the-role-of-adjuvant-chemotherapy-in-surgically-managed-p16-positive-oropharyngeal-squamous-cell-carcinoma
#10
COMPARATIVE STUDY
S Andrew Skillington, Dorina Kallogjeri, James S Lewis, Jay F Piccirillo
Importance: Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) has a favorable prognosis, and p16 immunohistochemistry is a surrogate marker of high-risk HPV infection and strong prognosticator. Given this favorable prognosis, treatment de-escalation for p16-positive OPSCC is now being considered with the goal of decreasing treatment-associated morbidity without compromising tumor control. The role of adjuvant chemotherapy in this setting is becoming increasingly unclear...
March 1, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/27900398/-dyspnea-and-skin-rash-in-a-49-year-old-male-patient
#11
I El-Battrawy, U Ansari, M Behnes, W Kirschstein, S Britsch, C Jabbour, C Fastner, V Bill, M Borggrefe, I Akin
We report on the case of a 49-year-old man who presented with increasing dyspnea and a skin rash. The community-acquired pneumonia was initially treated with broad spectrum antibiotics. The patient's respiratory condition rapidly worsened and the clinical picture of Waterhouse-Friderichsen syndrome developed with disseminated intravasal coagulopathy and necrosis of the toes. An infection with Capnocytophaga canimorsus, which had been caused by an initially unmentioned dog bite was confirmed. In view of the fulminant course and the high risk of operative treatment of the ubiquitous necroses in all limbs, a joint decision for deescalation of therapy was made together with relatives...
March 2017: Der Internist
https://www.readbyqxmd.com/read/27895527/phase-ii-trial-of-angiotensin-1-7-for-the-treatment-of-patients-with-metastatic-sarcoma
#12
Paul D Savage, James Lovato, K Bridget Brosnihan, Antonius A Miller, W Jeffrey Petty
Background. Angiotensin-(1-7) [Ang-(1-7)] is an endogenous antiangiogenic hormone with anticancer activity. In a phase I study of Ang-(1-7), two of three patients with metastatic sarcoma experienced disease stabilization. This phase II study examined clinical and biomarker outcomes for patients with metastatic sarcoma. Methods. Ang-(1-7) was administered by subcutaneous injection at a dose of 20 mg daily. If excessive toxicities occurred in the first cohort, a dose deescalation cohort was allowed. Blood samples were obtained to measure changes in biomarkers...
2016: Sarcoma
https://www.readbyqxmd.com/read/27816113/temporal-trends-in-the-prevalence-of-infective-endocarditis-in-germany-between-2005-and-2014
#13
Karsten Keller, Ralph S von Bardeleben, Mir A Ostad, Lukas Hobohm, Thomas Munzel, Stavros Konstantinides, Mareike Lankeit
Infective endocarditis (IE) is a potentially life-threatening disease. Little is known about temporal trends in its prevalence in Germany. In 2009, recommendations for antibiotic prophylaxis were deescalated in the revised European Society of Cardiology guideline to include only patients at high risk of IE. We selected patients with the discharge diagnosis of IE based on the International Classification of Diseases code I33 in the nationwide database of the Federal Statistical Office of Germany. We identified 94,364 patients with a diagnosis of IE from January 2005 to December 2014...
January 15, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/27815082/translating-a-prognostic-dna-genomic-classifier-into-the-clinic-retrospective-validation-in-563-localized-prostate-tumors
#14
Emilie Lalonde, Rached Alkallas, Melvin Lee Kiang Chua, Michael Fraser, Syed Haider, Alice Meng, Junyan Zheng, Cindy Q Yao, Valerie Picard, Michele Orain, Helène Hovington, Jure Murgic, Alejandro Berlin, Louis Lacombe, Alain Bergeron, Yves Fradet, Bernard Têtu, Johan Lindberg, Lars Egevad, Henrik Grönberg, Helen Ross-Adams, Alastair D Lamb, Silvia Halim, Mark J Dunning, David E Neal, Melania Pintilie, Theodorus van der Kwast, Robert G Bristow, Paul C Boutros
BACKGROUND: Localized prostate cancer is clinically heterogeneous, despite clinical risk groups that represent relative prostate cancer-specific mortality. We previously developed a 100-locus DNA classifier capable of substratifying patients at risk of biochemical relapse within clinical risk groups. OBJECTIVE: The 100-locus genomic classifier was refined to 31 functional loci and tested with standard clinical variables for the ability to predict biochemical recurrence (BCR) and metastasis...
July 2017: European Urology
https://www.readbyqxmd.com/read/27689223/-autonomy-and-welfare-in-intensive-care-medicine-practical-approach-in-difficult-situations
#15
REVIEW
M Gruß, F Salomon
In intensive care units far-reaching decisions are often made at short notice that require the consent of the informed patient. If this is not possible due to the patient's condition, physicians and legal representatives must ascertain the previously expressed or presumed will of the patient and act accordingly. The legal principles are specified in the Patient Advance Directives Act and the Patient Rights Act. Any indications for medical treatment need a clearly defined aim of the therapy, which can be questioned during the progress of the disease...
November 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27565837/ambulatory-cardiology-network-in-greece-clinical-and-therapeutic-implications-in-the-outpatient-setting-the-teve-ssf-study
#16
Konstantinos E Panagiotopoulos, Eleni E Panagiotopoulou, Konstantinos Katsaros, Georgios Noikokirakis, Maria Mpouziou, Angeliki Stamelou, Savvas Toumanidis
BACKGROUND: Community based registries are particularly valuable tools to Preventive Cardiology as they summarize epidemiological data of ischemic heart disease risk factors, medications and lifestyle characteristics. METHODS: We enrolled 1191 patients, from an outpatient community based cardiology network, dedicated to cover medically, office based professionals. We recorded demographic and lifestyle characteristics, risk factors for ischemic heart disease, all clinical entities diagnosed and therapies which were prescribed for hypertension and lipid disorders specifically...
November 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27524373/police-responses-to-persons-with-mental-illness-going-beyond-cit-training
#17
Henry J Steadman, David Morrissette
Since 1988, a major development to reduce lethal encounters between police and persons displaying signs of mental illness has been the adoption by many police departments of crisis intervention teams (CITs). Created in Memphis, Tennessee, CIT programs incorporate deescalation training, police-friendly drop-off centers, and linkage to community treatment programs. The authors summarize issues discussed at a recent Substance Abuse and Mental Health Services Administration workshop at which participants highlighted the importance of going beyond CIT training to most effectively include police in a crisis care continuum model...
October 1, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/27493799/determinants-of-deescalation-failure-in-critically-ill-patients-with-sepsis-a-prospective-cohort-study
#18
Nawal Salahuddin, Lama Amer, Mini Joseph, Alya El Hazmi, Hassan Hawa, Khalid Maghrabi
Introduction. Deescalation refers to either discontinuation or a step-down of antimicrobials. Despite strong recommendations in the Surviving Sepsis Guidelines (2012) to deescalate, actual practices can vary. Our objective was to identify variables that are associated with deescalation failure. Methods. In this prospective study of patients with sepsis/septic shock, patients were categorized into 4 groups based on antibiotic administration: no change in antibiotics, deescalation, escalation (where antibiotics were changed to those with a broader spectrum of antimicrobial coverage), or mixed changes (where both escalation to a broader spectrum of coverage and discontinuation of antibiotics were carried out)...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27270833/deescalation
#19
Stanley Cohen
No abstract text is available yet for this article.
January 5, 2016: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27027530/poor-prognosis-in-human-papillomavirus-positive-oropharyngeal-squamous-cell-carcinomas-that-overexpress-hypoxia-inducible-factor-1%C3%AE
#20
Justin Egidius Swartz, Ajit Joe Pothen, Pauline Maria Wilhelmina van Kempen, Inge Stegeman, Fleurieke Karlijn Formsma, Ellen Maria Van Cann, Stefan Martin Willems, Wilko Grolman
BACKGROUND: Hypoxia induces stabilization of the transcription factor HIF-1alpha (HIF-1α), associated with (chemo-)radiotherapy resistance in oropharyngeal squamous cell carcinoma (SCC). We investigated the effect of HIF-1α expression on survival in relation to human papillomavirus (HPV) status in oropharyngeal SCC. METHODS: We conducted an immunohistochemical analysis of HIF-1α protein expression and downstream targets carbonic anhydrase-IX (CA-IX) and glucose transporter-1 (GLUT-1) in 274 patients with oropharyngeal SCC...
September 2016: Head & Neck
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