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https://www.readbyqxmd.com/read/29232349/management-of-intussusception-in-the-pediatric-emergency-department-risk-factors-for-recurrence
#1
Andrea Vo, Terry L Levin, Benjamin Taragin, Hnin Khine
BACKGROUND: The standard treatment for intussusception is air reduction enema (ARE) with inpatient observation for 24 to 48 hours to monitor for recurrence. More recent but limited observations suggest that patients who have undergone successful ARE can safely be discharged after 4 to 6 hours of observation. Our primary objective was to identify risk factors associated with early recurrence. Our secondary objectives included validating risk criteria from prior studies and identifying risk factors for ARE failures...
December 11, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29231131/impact-of-accountable-care-organizations-on-utilization-care-and-outcomes-a-systematic-review
#2
Brystana G Kaufman, B Steven Spivack, Sally C Stearns, Paula H Song, Emily C O'Brien
Since 2010, more than 900 accountable care organizations (ACOs) have formed payment contracts with public and private insurers in the United States; however, there has not been a systematic evaluation of the evidence studying impacts of ACOs on care and outcomes across payer types. This review evaluates the quality of evidence regarding the association of public and private ACOs with health service use, processes, and outcomes of care. The 42 articles identified studied ACO contracts with Medicare ( N = 24 articles), Medicaid ( N = 5), commercial ( N = 11), and all payers ( N = 2)...
December 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29230625/systemic-lupus-erythematosus-and-the-risk-of-perioperative-major-adverse-cardiovascular-events
#3
Nathaniel R Smilowitz, Gregory Katz, Jill P Buyon, Robert M Clancy, Jeffrey S Berger
Systemic lupus erythematosus (SLE) is a significant risk factor for cardiovascular disease. The relationship between SLE and perioperative cardiovascular risks following non-cardiac surgery is uncertain. We investigated associations between a diagnosis of SLE and outcomes following major non-cardiac surgery in a large national database from the United States. Patients age ≥ 18 years requiring major non-cardiac surgery were identified from Healthcare Cost and Utilization Project's National Inpatient Sample data from 2004 to 2014...
December 11, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29230540/preventing-future-fractures-effectiveness-of-an-orthogeriatric-fracture-liaison-service-compared-to-an-outpatient-fracture-liaison-service-and-the-standard-management-in-patients-with-hip-fracture
#4
Antonio Naranjo, Sonia Fernández-Conde, Soledad Ojeda, Laura Torres-Hernández, Carolina Hernández-Carballo, Idoia Bernardos, Sinforiano Rodríguez, Pedro Laynez
An observational study was carried out in two hospitals in patients > 65 years admitted for hip fracture. At 6 months, 15% of patients in the hospital with orthogeriatric standard care and 75% in the hospital with fracture liaison service were receiving bisphosphonates. PURPOSE: Many patients with fractures are discharged without preventive therapy against further fractures. We sought to compare the effectiveness of an orthogeriatric fracture liaison service (FLS), outpatient FLS, and the standard care after hip fractures in prevention of future fractures...
December 11, 2017: Archives of Osteoporosis
https://www.readbyqxmd.com/read/29230124/oncology-and-palliative-medicine-providing-comprehensive-care-for-patients-with-cancer
#5
REVIEW
Laura Finn, Alva Roche Green, Sonia Malhotra
Background: Despite the evidence for the fundamental need for palliative medicine services in the practice of oncology, integration of these medical specialties remains a clinical challenge. Methods: We reviewed the current literature regarding the practice of palliative medicine in the field of oncology, examining randomized clinical trials of palliative medicine services in advanced cancer, models of palliative medicine delivery, studies of cost effectiveness, and national palliative medicine practice and referral guidelines...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/29229108/infection-control-genetic-assessment-of-drug-resistance-and-drug-susceptibility-testing-in-the-current-management-of-multidrug-extensively-resistant-tuberculosis-m-xdr-tb-in-europe-a-tuberculosis-network-european-trialsgroup-tbnet-study
#6
Graham H Bothamley, Christoph Lange
AIM: Europe has the highest documented caseload and greatest increase in multidrug and extensively drug-resistant tuberculosis (M/XDR-TB) of all World Health Organization (WHO) regions. This survey examines how recommendations for M/XDR-TB management are being implemented. METHODS: TBNET is a pan-European clinical research collaboration for tuberculosis. An email survey of TBNET members collected data in relation to infection control, access to molecular tests and basic microbiology with drug sensitivity testing...
November 2017: Respiratory Medicine
https://www.readbyqxmd.com/read/29228837/feeling-inadequate-residents-stress-and-learning-at-primary-care-clinics-in-the-united-states
#7
Joanna Veazey Brooks, Sara J Singer, Meredith Rosenthal, Alyna T Chien, Antoinette S Peters
BACKGROUND: Educators hope that residents' experiences in primary care continuity clinics will influence more trainees to enter primary care careers. Unfortunately, evidence shows that outpatient primary care training in the United States is stressful and fails to promote primary care careers. We conducted qualitative interviews with residents to understand the source of stress and to explain this failure. METHODS: In-person individual interviews were conducted with 37 primary care residents training at outpatient clinics in the US...
December 11, 2017: Medical Teacher
https://www.readbyqxmd.com/read/29227054/auditing-surgical-service-provision-at-a-south-african-tertiary-institution-implications-for-the-development-of-district-services
#8
G L Laing, D L Skinner, J L Bruce, C Aldous, V Govindasamy, S R Thomson, D L Clarke
BACKGROUND: The optimal management of resources within South African state hospitals has been hampered by a paucity of data due to a lack of robust auditing information systems. This study reviews the use of a Hybrid Electronic Medical Record (HEMR) system to capture and aggregate data pertaining to the inpatient service demands on a South African tertiary surgical service. This dataset was used to analyse the appropriateness of tertiary surgical resource utilisation. METHOD: The HEMR system was implemented at Greys Hospital, in the city of Pietermaritzburg, Kwa-Zulu Natal, South Africa on 1 January 2013...
November 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/29225797/seasonal-clustering-of-sinopulmonary-mucormycosis-in-patients-with-hematologic-malignancies-at-a-large-comprehensive-cancer-center
#9
Shobini Sivagnanam, Dhruba J Sengupta, Daniel Hoogestraat, Rupali Jain, Zach Stednick, David N Fredricks, Paul Hendrie, Estella Whimbey, Sara T Podczervinski, Elizabeth M Krantz, Jeffrey S Duchin, Steven A Pergam
Background: Invasive Mucorales infections (IMI) lead to significant morbidity and mortality in immunocompromised hosts. The role of season and climatic conditions in case clustering of IMI remain poorly understood. Methods: Following detection of a cluster of sinopulmonary IMIs in patients with hematologic malignancies, we reviewed center-based medical records of all patients with IMIs and other invasive fungal infections (IFIs) between January of 2012 and August of 2015 to assess for case clustering in relation to seasonality...
2017: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/29224990/the-shift-to-same-day-outpatient-joint-arthroplasty-a-systematic-review
#10
REVIEW
Jeffrey D Hoffmann, Nicholas A Kusnezov, John C Dunn, Nicholas J Zarkadis, Gens P Goodman, Richard A Berger
BACKGROUND: Hip and knee arthroplasties length of stay continues to shorten after advances in perioperative and intraoperative management, as well as financial incentives. Some authors have demonstrated good results with outpatient arthroplasty, but safety and general feasibility of such procedures remain unclear. Our hypothesis is that outpatient arthroplasty would demonstrate higher readmission and complication rates than inpatient arthroplasty. METHODS: We performed a systematic review of all publications on outpatient arthroplasty between January 1, 2000 and June 1, 2016...
November 22, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29224796/residents-impressions-of-the-impact-of-advanced-practice-providers-on-surgical-training
#11
Ravinder Kang, Jesse A Columbo, Samuel T Kunkel, Ryland S Stucke, Matthew J Sabatino, Austin Tang, Philip P Goodney, Kari M Rosenkranz
BACKGROUND: To ensure that residents are appropriately trained in the era of the 80-hour work-week, training programs have restructured resident duties and hired advanced practice providers (APPs). However, the effect of APPs on surgical training remains unknown. STUDY DESIGN: We created a survey using a modified Delphi technique to examine the interaction between residents and APPs across practice settings (inpatient, outpatient, and operating room (OR)). We identified four domains: administrative tasks, clinical experience, operative experience, and overall impressions...
December 7, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29224234/an-observational-study-of-benzodiazepine-prescription-during-inpatient-alcohol-detoxification-for-patients-with-versus-without-chronic-pretreatment-with-high-dosage-baclofen
#12
Laura Martinez, Florence Vorspan, Xavier Declèves, Julien Azuar, Maeva Fortias, Franck Questel, Alexandra Dereux, Leslie Grichy, Hélène Barreteau, Frank Bellivier, Jean-Pierre Lépine, Vanessa Bloch
High dose baclofen is prescribed as a maintenance treatment to reduce alcohol use in patients with alcohol use disorder. Nevertheless, some patients still have massive alcohol intakes and require inpatient alcohol withdrawal. AIM: to compare the oral dose of benzodiazepine prescribed to manage alcohol withdrawal symptoms in patients with versus without steady state pre-treatment with high dose baclofen. METHODS: Retrospective chart review study. Prescribed benzodiazepine dose expressed in diazepam-equivalent was compared between groups...
December 10, 2017: Fundamental & Clinical Pharmacology
https://www.readbyqxmd.com/read/29223321/is-there-value-in-retrospective-90-day-bundle-payment-models-for-shoulder-arthroplasty-procedures
#13
Susan M Odum, Nady Hamid, Bryce A Van Doren, Leo R Spector
BACKGROUND: The Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative was implemented as part of the Affordable Care Act. We implemented a retrospective payment model 2 for a 90-day total shoulder arthroplasty (TSA) episode to assess the value of TSA BPCI at our private practice. METHODS: Expenditures and postacute event rates of 132 fee-for-service (FFS) patients who underwent a TSA operation between 2009 and 2012 were compared with 333 BPCI patients who had a TSA operation in 2015...
December 7, 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/29222260/should-we-diagnose-and-treat-distal-deep-vein-thrombosis
#14
REVIEW
Helia Robert-Ebadi, Marc Righini
Ultrasound series report that isolated distal deep vein thrombosis (DVT), also known as calf DVT, represents up to 50% of all lower-limb DVTs and, therefore, is a frequent medical condition. Unlike proximal DVT and pulmonary embolism, which have been studied extensively and for which management is well standardized, much less is known about the optimal management of isolated calf DVT. Recent data arising from registries and nonrandomized studies have suggested that most distal DVTs do not extend to the proximal veins and have an uneventful follow-up when left untreated...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29222135/ambulatory-versus-inpatient-management-of-severe-nausea-and-vomiting-of-pregnancy-a-randomised-control-trial-with-patient-preference-arm
#15
Nicola Mitchell-Jones, Jessica Alice Farren, Aurelio Tobias, Tom Bourne, Cecilia Bottomley
OBJECTIVE: To determine whether ambulatory (outpatient (OP)) treatment of severe nausea and vomiting of pregnancy (NVP) is as effective as inpatient (IP) care. DESIGN: Non-blinded randomised control trial (RCT) with patient preference arm. SETTING: Two multicentre teaching hospitals in London. PARTICIPANTS: Women less than 20 weeks' pregnant with severe NVP and associated ketonuria (>1+). METHODS: Women who agreed to the RCT were randomised via web-based application to either ambulatory or IP treatment...
December 5, 2017: BMJ Open
https://www.readbyqxmd.com/read/29221522/barriers-to-smoking-cessation-among-drug-resistant-tuberculosis-patients-in-south-africa
#16
Zifikile Phindile Shangase, Joyce Mahlako Tsoka-Gwegweni, Catherine O Egbe
BACKGROUND: Drug-resistant tuberculosis (DR-TB) remains a significant cause of morbidity and mortality. The long-term health effects of smoking and the risk of adverse TB outcomes, including increased periods of infectiousness, have been reported among DR-TB patients in South Africa. OBJECTIVES: This study aimed to identify the barriers to smoking cessation among DR-TB inpatients at a hospital in Durban, South Africa. METHODS: A qualitative design using in-depth interviews with a purposive sample of 20 DR-TB inpatients was employed...
May 2017: Annals of Global Health
https://www.readbyqxmd.com/read/29219128/economic-burden-of-managing-type-2-diabetes-mellitus-analysis-from-a-teaching-hospital-in-malaysia
#17
Aniza Ismail, Leny Suzana Suddin, Saperi Sulong, Zafar Ahmed, Nor Azmi Kamaruddin, Norlela Sukor
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic disease that consumes a large amount of health-care resources. It is essential to estimate the cost of managing T2DM to the society, especially in developing countries. Economic studies of T2DM as a primary diagnosis would assist efficient health-care resource allocation for disease management. OBJECTIVE: This study aims to measure the economic burden of T2DM as the primary diagnosis for hospitalization from provider's perspective...
October 2017: Indian Journal of Public Health
https://www.readbyqxmd.com/read/29217285/outcomes-and-palliative-care-utilization-in-patients-with-dementia-and-acute-abdominal-emergency-opportunities-for-surgical-quality-improvement
#18
Ana Berlin, Franchesca Hwang, Ranbir Singh, Sri Ram Pentakota, Roshansa Singh, Brad Chernock, Anne C Mosenthal
BACKGROUND: When patients with dementia develop acute surgical abdomen, patients, surrogates, and surgeons need accurate prognostic information to facilitate goal-concordant decision making. Palliative care can assist with communication, symptom management, and family and caregiver support in this population. We aimed to characterize outcomes and patterns of palliative care utilization among patients with dementia, presenting with abdominal surgical emergency. METHOD: We retrospectively queried the National Inpatient Sample for patients aged >50 years with dementia and acute abdominal emergency who were admitted nonelectively 2009-2013, utilizing ICD-9-CM codes for dementia and surgical indication...
December 4, 2017: Surgery
https://www.readbyqxmd.com/read/29216183/presentation-of-life-threatening-invasive-nontyphoidal-salmonella-disease-in-malawian-children-a-prospective-observational-study
#19
Calman A MacLennan, Chisomo L Msefula, Esther N Gondwe, James J Gilchrist, Paul Pensulo, Wilson L Mandala, Grace Mwimaniwa, Meraby Banda, Julia Kenny, Lorna K Wilson, Amos Phiri, Jenny M MacLennan, Elizabeth M Molyneux, Malcolm E Molyneux, Stephen M Graham
Nontyphoidal Salmonellae commonly cause invasive disease in African children that is often fatal. The clinical diagnosis of these infections is hampered by the absence of a clear clinical syndrome. Drug resistance means that empirical antibiotic therapy is often ineffective and currently no vaccine is available. The study objective was to identify risk factors for mortality among children presenting to hospital with invasive Salmonella disease in Africa. We conducted a prospective study enrolling consecutive children with microbiologically-confirmed invasive Salmonella disease admitted to Queen Elizabeth Central Hospital, Blantyre, in 2006...
December 7, 2017: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/29215499/post-operative-emergency-department-utilization-and-hospital-readmission-after-cervical-spine-arthrodesis-rates-trends-causes-and-risk-factors
#20
Peter B Derman, Lukas P Lampe, Ting Jung Pan, Stephan N Salzmann, Janina Kueper, Federico P Girardi, Stephen Lyman, Alexander P Hughes
STUDY DESIGN: Retrospective state database analysis. OBJECTIVE: To quantify the 30-day and 90-day emergency department (ED) utilization and inpatient readmission rates after primary cervical arthrodesis, to stratify these findings by surgical approach and to describe risk factors and conditions precipitating these events. SUMMARY OF BACKGROUND DATA: Limited data exist on ED utilization and hospital readmission rates after cervical spine arthrodesis...
December 5, 2017: Spine
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