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Emergency medicine practice

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https://www.readbyqxmd.com/read/29218907/emergence-of-pathway-level-composite-biomarkers-from-converging-gene-set-signals-of-heterogeneous-transcriptomic-responses
#1
Samir Rachid Zaim, Qike Li, A Grant Schissler, Yves A Lussier
Recent precision medicine initiatives have led to the expectation of improved clinical decisionmaking anchored in genomic data science. However, over the last decade, only a handful of new single-gene product biomarkers have been translated to clinical practice (FDA approved) in spite of considerable discovery efforts deployed and a plethora of transcriptomes available in the Gene Expression Omnibus. With this modest outcome of current approaches in mind, we developed a pilot simulation study to demonstrate the untapped benefits of developing disease detection methods for cases where the true signal lies at the pathway level, even if the pathway's gene expression alterations may be heterogeneous across patients...
2018: Pacific Symposium on Biocomputing
https://www.readbyqxmd.com/read/29214389/using-real-world-data-in-health-technology-assessment-hta-practice-a-comparative-study-of-five-hta-agencies
#2
Amr Makady, Ard van Veelen, Páll Jonsson, Owen Moseley, Anne D'Andon, Anthonius de Boer, Hans Hillege, Olaf Klungel, Wim Goettsch
BACKGROUND: Reimbursement decisions are conventionally based on evidence from randomised controlled trials (RCTs), which often have high internal validity but low external validity. Real-world data (RWD) may provide complimentary evidence for relative effectiveness assessments (REAs) and cost-effectiveness assessments (CEAs). This study examines whether RWD is incorporated in health technology assessment (HTA) of melanoma drugs by European HTA agencies, as well as differences in RWD use between agencies and across time...
December 6, 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/29214027/to-what-extent-do-prescribing-practices-for-hypertension-in-the-private-sector-in-zimbabwe-follow-the-national-treatment-guidelines-an-analysis-of-insurance-medical-claims
#3
Victor Basopo, Paschal N Mujasi
Background: Hypertension is the most prevalent cardiovascular disease in Zimbabwe. The prevalence of Hypertension in the country is above 30% regardless of the cut off used. Currently, majority of patients in Zimbabwe seek health care from the private sector due to limited government funding for the public health sector. However, Standard treatment guidelines for hypertension are only available in the public sector and are optional in the private sector. This study assesses compliance of private sector prescribing to Standard Treatment guidelines for hypertension...
2017: Journal of Pharmaceutical Policy and Practice
https://www.readbyqxmd.com/read/29212137/review-article-idle-just-in-case-peripheral-intravenous-cannulas-in-the-emergency-department-is-something-wrong
#4
REVIEW
Lynne Gledstone-Brown, Douglas McHugh
Peripheral intravenous cannula (PIVC) placement is often an essential emergency medicine precursor to lifesaving treatment, but it is not harmless. Patients frequently and without proper consideration of the consequences receive a 'just-in-case' PIVCs as part of their assessment and admission, which, in a not insignificant number of patients, remains unused or idle in situ. We reviewed the literature and performed a thematic analysis of data collated from 21 articles published in the past 24 years regarding redundant PIVCs...
December 6, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29210889/does-specialty-training-and-practice-setting-affect-adherence-to-the-pediatric-emergency-care-applied-research-network-criteria-for-pediatric-head-trauma
#5
Maria Tama, Neel Andharia, Collin Bufano, Josh Greenstein, Boris Khodorkovsky
OBJECTIVE: The goal was to determine the effects of specialty training and practice settings on the adherence to the Pediatric Emergency Care Applied Research Network (PECARN) criteria. METHODS: A retrospective study was conducted on a 2-campus hospital. Chart documentation was used to determine adherence to PECARN criteria. Inclusion criteria were any traumatic head injury within 24 hours in patients younger than 18 years over a 1-year period. Specialty training was subdivided into 3 groups: pediatric emergency medicine, emergency medicine (EM), and general pediatrics...
November 27, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29200789/pharmacovigilance-a-public-health-priority-for-south-africa
#6
Ushma Mehta, Emma Kalk, Andrew Boulle, Portia Nkambule, Joey Gouws, Helen Rees, Karen Cohen
South Africa has been engaged in pharmacovigilance (PV) activities to assess the impact of adverse drug reactions on public safety and health for 40 years. Activities have evolved from passive regulatory reporting to encompass active surveillance systems. The HIV and AIDS and TB epidemics stimulated pharmacoepidemiological research into the risks associated with medicines used in the standardised regimens of mass treatment programmes. Specific safety concerns, supported by robust local cohort data, have prompted major changes to national and international treatment policies...
2017: South African Health Review
https://www.readbyqxmd.com/read/29200245/management-of-inflammatory-bowel-disease-flares-in-the-emergency-department-digest
#7
Michael D Burg, Steven T Riccoboni, Jeffrey Nusbaum, Nachi Gupta
Because of the chronic relapsing nature of inflammatory bowel disease (IBD), emergency clinicians frequently manage patients with acute flares and complications. IBD patients present with an often-broad range of nonspecific signs and symptoms, and it is essential to differentiate a mild flare from a life-threatening intra-abdominal process. Recognizing extraintestinal manifestations and the presence of infection are critical. This issue reviews the literature on management of IBD flares in the emergency department, including laboratory testing, imaging, and identification of surgical emergencies, emphasizing the importance of coordination of care with specialists on treatment plans and offering patients resources for ongoing support...
November 22, 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/29200244/management-of-airway-obstruction-and-stridor-in-pediatric-patients-digest
#8
Ashley Marchese, Melissa L Langhan, Kathryn H Pade
Stridor is a result of turbulent air-flow through the trachea from upper airway obstruction, and although in children it is often due to croup, it can also be caused by noninfectious and/or congenital conditions as well as life-threatening etiologies. The history and physical examination guide initial management, which includes reduction of airway inflammation, treatment of bacterial infection, and, less often, imaging, emergent airway stabilization, or surgical management. This issue discusses the most common as well as the life-threatening etiologies of acute and chronic stridor and its management in the emergency department...
November 22, 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/29199930/lechebnaia-pedagogika-the-concept-and-practice-of-therapy-in-russian-defectology-c-%C3%A2-1880-1936
#9
Andy Byford
Therapy is not simply a domain or form of medical practice, but also a metaphor for and a performance of medicine, of its functions and status, of its distinctive mode of action upon the world. This article examines medical treatment or therapy (in Russian lechenie), as concept and practice, in what came to be known in Russia as defectology (defektologiia) - the discipline and occupation concerned with the study and care of children with developmental pathologies, disabilities and special needs. Defectology formed an impure, occupationally ambiguous, therapeutic field, which emerged between different types of expertise in the niche populated by children considered 'difficult to cure', 'difficult to teach', and 'difficult to discipline'...
January 2018: Medical History
https://www.readbyqxmd.com/read/29194620/pharmacogenetics-a-strategy-for-personalized-medicine-for-autoimmune-diseases
#10
REVIEW
S Tavakolpour, M Darvishi, M Ghasemiadl
For many years, a considerable number of patients with autoimmune diseases (ADs) have suffered from a lack of drug response and drug-related toxicity. Despite the emergence of new therapeutic options such as biological agents, patients continue to struggle with these problems. Unfortunately, new challenges, including the paradoxical effects of biological drugs, have complicated the situation. In recent decades, efforts have been made to predict drug response as well as drug-related side-effects. Thanks to the many advances in genetics, evaluation of markers to predict drug response/toxicity before the initiation of treatment may be an avenue toward personalizing treatments...
November 30, 2017: Clinical Genetics
https://www.readbyqxmd.com/read/29191247/the-implication-of-the-shortage-of-health-workforce-specialist-on-universal-health-coverage-in-kenya
#11
Mumbo Hazel Miseda, Samuel Odhiambo Were, Cirindi Anne Murianki, Milo Peter Mutuku, Stephen N Mutwiwa
BACKGROUND: Globally, there is an acute shortage of human resources for health (HRH), and the greatest burden is borne by low-income countries especially in sub-Saharan Africa and some parts of Asia. This shortage has not only considerably constrained the achievement of health-related development goals but also impeded accelerated progress towards universal health coverage (UHC). Like any other low-income country, Kenya is experiencing health workforce shortage particularly in specialized healthcare workers to cater for the rapidly growing need for specialized health care (MOH Training Needs Assessment report (2015))...
December 1, 2017: Human Resources for Health
https://www.readbyqxmd.com/read/29191229/medical-students-as-health-coaches-and-more-adding-value-to-both-education-and-patient-care
#12
Raymond H Curry
New ways of thinking about medicine and health care demand new methods in medical education. Over the past two decades, as both the practice and the study of medicine have become increasingly concerned with demonstrable outcomes, medical schools have developed new curricula in health systems science and are increasingly emphasizing students' development and demonstration of skills essential to a systems-based, outcomes-oriented practice environment.Polak and colleagues recently reported the development in Israel of one such curriculum, in lifestyle medicine, that includes opportunities for students to adopt the role of health coach...
November 30, 2017: Israel Journal of Health Policy Research
https://www.readbyqxmd.com/read/29189596/procedural-training-and-assessment-for-pediatric-emergency-medicine-physicians-within-the-united-states-and-canada-a-survey-study
#13
Rebekah A Burns, Neil G Uspal
OBJECTIVES: The aims of this study were to determine current practices in procedural training and skill assessment for attending physicians working in pediatric emergency departments within the United States and Canada and identify barriers to providing training and assessment. METHODS: This was a cross-sectional survey study. Members of the pediatric emergency medicine fellowship program directors and associate program directors Listserv were invited to participate in an anonymous survey about attending physician training and assessment practices for 9 specific procedures and barriers to training and assessment...
November 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29188915/-occupational-aspects-of-emergency-medicine-practice-in-catalonia-the-opencat-opinion-survey
#14
Javier Jacob, Emili Gené, Gilberto Alonso, Pere Rimbau, José Zorrilla, Francesc Casarramona, Cristina Netto, Pere Sánchez, Ricard Hernández, Xavier Escalada, Òscar Miró
OBJECTIVES: To gather information on the contracting and training of members of the Catalan Society of Emergency Medicine (SoCMUE) who work in emergency medicine and services in Catalonia. To survey their opinions on certain aspects of resource availability and working conditions. MATERIAL AND METHODS: Cross-sectional descriptive study based on a survey sent to SoCMUE members. We studied the opinions of 5 types of respondent: hospital physicians, out-of-hospital physicians, hospital nurses, out-of-hospital nurses, and emergency medical technicians...
2017: Emergencias: Revista de la Sociedad Española de Medicina de Emergencias
https://www.readbyqxmd.com/read/29186996/an-assessment-of-innovative-pricing-schemes-for-the-communication-of-value-is-price-discrimination-and-two-part-pricing-a-way-forward
#15
Peter Hertzman, Paul Miller, Keith Tolley
With the introduction of new expensive medicines, traditional pricing schemes based on constructs such as price per pill/vial have been challenged. Potential innovative schemes could be either financial-based or performance-based. Within financial-based schemes the use of price discrimination is an emerging option, which we explore in this assessment. Areas covered: In the short term the price per indication approach is likely to become more prevalent for high cost, high benefit new pharmaceuticals, such as those emerging in oncology (e...
November 30, 2017: Expert Review of Pharmacoeconomics & Outcomes Research
https://www.readbyqxmd.com/read/29186210/when-reducing-low-value-care-in-hospital-medicine-saves-money-who-benefits
#16
Joshua M Liao, Amol S Navathe, Marilyn M Schapira, Arlene Weissman, Nandita Mitra, David A Asch
One emerging policy solution for deterring low-value care is to financially penalize physicians who prescribe it. However, physicians' willingness to support such policies may depend on whether they perceive that benefits accrue to patients or to insurers and hospitals. We surveyed physicians practicing hospital medicine to evaluate the association between policy support and physician beliefs about who benefits from the money saved through reducing low-value services in hospital medicine. Overall, physicians believed that more of any money saved would go to profits and leadership salaries for insurance companies and hospitals and/or health systems rather than to patients...
November 22, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29179708/comparing-doctors-legal-compliance-across-three-australian-states-for-decisions-whether-to-withhold-or-withdraw-life-sustaining-medical-treatment-does-different-law-lead-to-different-decisions
#17
Ben P White, Lindy Willmott, Colleen Cartwright, Malcolm Parker, Gail Williams, Juliet Davis
BACKGROUND: Law purports to regulate end-of-life care but its role in decision-making by doctors is not clear. This paper, which is part of a three-year study into the role of law in medical practice at the end of life, investigates whether law affects doctors' decision-making. In particular, it considers whether the fact that the law differs across Australia's three largest states - New South Wales (NSW), Victoria and Queensland - leads to doctors making different decisions about withholding and withdrawing life-sustaining treatment from adults who lack capacity...
November 28, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/29178120/awareness-attitudes-and-knowledge-about-evidencebased-medicine-among-doctors-in-gaza-a-crosssectional-survey
#18
Loai Albarqouni, Khamis Elessi
Evidence-based medicine (EBM) has emerged as a strategy to integrate research evidence within clinical decision-making. We have explored awareness, knowledge and attitudes about EBM among doctors in the Gaza Strip. In 2014, we conducted a cross-sectional survey among doctors working in health centres in Gaza, using a 20 item, web-based self-administered questionnaire. Approximately two thirds of the respondents welcomed EBM in principle, and believed that it could improve patient care. However, they had a relatively low level of knowledge about EBM...
November 19, 2017: Eastern Mediterranean Health Journal, la Revue de Santé de la Méditerranée Orientale
https://www.readbyqxmd.com/read/29177177/does-intradisciplinary-conflict-influence-to-outcomes-of-emergency-medicine-residency-program-a-mixed-methods-study
#19
Mohammadreza Maleki, Seyyed Meysam Mousavi, Mina Anjomshoa, Nasrin Shaarbafchizadeh, Zeinab Naimi Taleghani
Objective: To explore impact of emergency medicine residency program on patient waiting times in emergency department (ED) and determine the associated factors. Methods: A two-phased sequential exploratory mixed-methods approach was used. The first phase was comprised of retrospective before-after design of ED encounters for a 3-month period, six months before and six months after the introduction of an emergency medicine residency program in an Iranian teaching hospital...
October 2017: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/29177130/sleep-disordered-breathing-and-spinal-cord-injury-challenges-and-opportunities
#20
Abdulghani Sankari, Jennifer L Martin, M Safwan Badr
Purpose of review: This paper focuses on the sleep disorders in patients with spinal cord injury (SCI/D), particularly mechanism of sleep disordered breathing (SDB) and challenges in diagnosis and management. Based on a review of recent literatures and studies the paper summarizes some main challenges with respect to management of SDB in patients with SCI; and what are the responsible mechanisms of disease? What are the barriers in diagnosing and treating SDB using standard treatment such as positive airway pressure (CPAP)?...
December 2017: Current Sleep Medicine Reports
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