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Caring wisely

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https://www.readbyqxmd.com/read/28539863/pulmonary-aspergillosis-as-opportunistic-mycoses-in-a-cohort-of-human-immunodeficiency-virus-infected-patients-report-from-a-tertiary-care-hospital-in-north-india
#1
Ravinder Kaur, Bhanu Mehra, Megh Singh Dhakad, Ritu Goyal, Richa Dewan
OBJECTIVE: The incidence of pulmonary aspergillosis in human immunodeficiency virus (HIV)-infected persons is rising. This study was designed to determine the prevalence of pulmonary aspergillosis in a cohort of HIV-positive patients (n = 71) presenting with lower respiratory tract infection at a tertiary care medical center in India. METHODS: Sputum samples were collected, and potassium hydroxide mount, cultural characteristics, and lactophenol cotton blue preparations were employed to aid in the identification of Aspergillus species...
April 2017: International Journal of Health Sciences
https://www.readbyqxmd.com/read/28534186/modifiable-and-non-modifiable-factors-associated-with-functional-impairment-during-the-inter-episodic-periods-of-bipolar-disorder
#2
Andrea Murru, Isabella Pacchiarotti, Norma Verdolini, Maria Reinares, Carla Torrent, Pierre-Alexis Geoffroy, Frank Bellivier, Pierre-Michel Llorca, Eduard Vieta, Ludovic Samalin
The chronic, long-term evolution of bipolar disorder (BD) requires a careful clinical characterization with prognostic implications in terms of symptom and functional control. The OPTHYMUM multicenter study was conducted in France with the objective of evaluating residual symptoms on overall functioning of BD patients during inter-episodic period. The aims of the present study were to identify the potentially modifiable (e.g., treatable) and non-modifiable variables associated with functional impairment during the inter-episodic periods of BD...
May 22, 2017: European Archives of Psychiatry and Clinical Neuroscience
https://www.readbyqxmd.com/read/28506865/protocol-driven-neurological-prognostication-and-withdrawal-of-life-sustaining-therapy-after-cardiac-arrest-and-targeted-temperature-management
#3
Irina Dragancea, Matthew P Wise, Nawaf Al-Subaie, Julius Cranshaw, Hans Friberg, Guy Glover, Tommaso Pellis, Rebecca Rylance, Andrew Walden, Niklas Nielsen, Tobias Cronberg
BACKGROUND: Brain injury is reportedly the main cause of death for patients resuscitated after out-of-hospital cardiac arrest (OHCA). However, the majority may actually die following withdrawal of life-sustaining therapy (WLST) with a presumption of poor neurological recovery. We investigated how the protocol for neurological prognostication was used and how related treatment recommendations might have affected WLST decision-making and outcome after OHCA in the Targeted Temperature Management (TTM) trial...
May 12, 2017: Resuscitation
https://www.readbyqxmd.com/read/28501250/hereditary-colorectal-cancer-syndromes
#4
REVIEW
Katerina Wells, Paul E Wise
Awareness of hereditary colorectal cancer syndromes is important to facilitate their identification because affected patients are at increased risk for early onset, synchronous, and metachronous colorectal malignancies, and certain extracolonic malignancies depending on the syndrome. Identification of an affected individual allows for screening and early interventions for patients and their at-risk kindred. Genetic counseling and testing is important to the care of these patients. As knowledge of the genetic basis of these syndromes grows, unique genotype-phenotype profiles allow clinicians to tailor surveillance and treatment strategies based on individual risk...
June 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28500639/comparison-of-transfusion-thresholds-during-neonatal-extracorporeal-membrane-oxygenation
#5
Alexandra A Sawyer, Linda Wise, Santu Ghosh, Jatinder Bhatia, Brian K Stansfield
BACKGROUND: The objective of this study was to assess complications and patient outcomes associated with a lower reflexive red blood cell (RBC) transfusion threshold for neonates undergoing extracorporeal membrane oxygenation (ECMO) for hypoxic respiratory failure. STUDY DESIGN AND METHODS: A retrospective cohort study was conducted at a single tertiary neonatal intensive care unit of neonates undergoing ECMO support for refractory hypoxic respiratory failure for more than 24 hours between December 2009 and December 2014...
May 12, 2017: Transfusion
https://www.readbyqxmd.com/read/28498197/overuse-of-health-care-services-in-the-management-of-cancer-a-systematic-review
#6
Shrujal S Baxi, Minal Kale, Salomeh Keyhani, Benjamin R Roman, Annie Yang, Antonio P Derosa, Deborah Korenstein
BACKGROUND: Overuse, the provision of health services for which harms outweigh the benefits, results in suboptimal patient care and may contribute to the rising costs of cancer care. We performed a systematic review of the evidence on overuse in oncology. METHODS: We searched Medline, EMBASE, the Cochrane Library, Web of Science, SCOPUS databases, and 2 grey literature sources, for articles published between December 1, 2011 and March 10, 2017. We included publications from December 2011 to evaluate the literature since the inception of the ABIM Foundation's Choosing Wisely initiative in 2012...
May 11, 2017: Medical Care
https://www.readbyqxmd.com/read/28497469/prognostic-models-for-identifying-adults-with-intellectual-disabilities-and-mealtime-support-needs-who-are-at-greatest-risk-of-respiratory-infection-and-emergency-hospitalisation
#7
C M Perez, A P Wagner, S L Ball, S R White, I C H Clare, A J Holland, M Redley
BACKGROUND: Among adults with intellectual disabilities (ID), problems with eating, drinking and swallowing (EDS), and an associated need for mealtime support, are common, with an estimated 15% of adults known to specialist ID services requiring mealtime support. We set out to identify which adults with ID who receive mealtime support are at an increased risk of respiratory infections and emergency hospitalisation related to EDS problems. METHOD: An exploratory, prospective cohort study was undertaken in the East of England...
May 11, 2017: Journal of Intellectual Disability Research: JIDR
https://www.readbyqxmd.com/read/28493229/-general-treatment-principles-coordination-of-care-and-patient-education-in-fibromyalgia-syndrome-updated-guidelines-2017-and-overview-of-systematic-review-articles
#8
F Petzke, W Brückle, U Eidmann, P Heldmann, V Köllner, T Kühn, H Kühn-Becker, M Strunk-Richter, M Schiltenwolf, M Settan, M von Wachter, M Weigl, W Häuser
BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest...
May 10, 2017: Der Schmerz
https://www.readbyqxmd.com/read/28492993/-choosing-wisely-at-the-end-of-life-recommendations-of-the-german-society-for-palliative-medicine-dgp
#9
REVIEW
B Alt-Epping
In addition to an overuse of unnecessary or no longer indicated diagnostic or therapeutic procedures at the end of life in the sense of overtreatment, there is often also a lack of therapeutic awareness in terms of a healthcare deficit, for example concerning the recognition and treatment of symptoms and complex burden of the disease. Sticking closely to the methodology of the German S3 "Palliative Medicine" guideline, the Choosing wisely recommendations of the German Society for Palliative Medicine address various examples of over- and underuse of healthcare services and treatment at the end of life, and thus also mirror basic principles of palliative medical care...
May 10, 2017: Der Internist
https://www.readbyqxmd.com/read/28492992/-choosing-wisely-recommendations-in-gastroenterology
#10
REVIEW
H Koop, P Lynen Jansen, S Zeuzem
The Choosing wisely initiative of the German Society of Internal Medicine addresses procedures which are inadequately implemented (deficits in patient care) as well as those which are performed too often but without proven benefits for patients (misuse or overuse of health services). Based on their guidelines, The German Society of Gastroenterology, Digestive and Metabolic Diseases has identified such aspects and incorporated them into the respective recommendations.
May 10, 2017: Der Internist
https://www.readbyqxmd.com/read/28492122/critical-care-admission-of-south-african-sa-surgical-patients-results-of-the-sa-surgical-outcomes-study
#11
David Lee Skinner, Kim De Vasconcellos, Robert Wise, Tonya Marianne Esterhuizen, Cate Fourie, Akhter Goolam Mahomed, P Dean Gopalan, Ivan Joubert, Hyla-Louise Kluyts, L Rudo Mathivha, Busisiwe Mrara, Jan P Pretorius, Guy Richards, Ollie Smith, Maryke Geertruida Louise Spruyt, Rupert M Pearse, Thandinkosi E Madiba, Bruce M Biccard, On Behalf Of The South African Surgical Outcomes Study Sasos Investigators
BACKGROUND: Appropriate critical care admissions are an important component of surgical care. However, there are few data describing postoperative critical care admission in resource-limited low- and middle-income countries. OBJECTIVE: To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical care units in South Africa (SA). METHODS: The SA Surgical Outcomes Study (SASOS) was a 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 government-funded hospitals...
April 25, 2017: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/28488056/-choosing-wisely-recommendations-in-intensive-care-medicine
#12
REVIEW
R Riessen, S Kluge, U Janssens, H Kierdorf, K F Bodmann, H-J Busch, S John, M Möckel
Intensive care medicine is an important and integral part of internal medicine. Modern intensive care medicine permits survival of many patients with severe and life-threatening internal diseases in acute situations. Decisive for therapeutic success is often not the application of complicated and expensive medical technologies, but rather the rapid diagnosis and identification of core issues, with immediate and competent initiation of standard treatment regimens. An adequately staffed, well-organized interprofessional team is of central importance...
May 9, 2017: Der Internist
https://www.readbyqxmd.com/read/28474488/a-q-methodology-study-to-investigate-the-experiences-of-head-and-neck-cancer-patients-from-diagnosis-to-1%C3%A2-year
#13
K J Reid, A Swift, H Mehanna
The experiences of disease and treatment for patients diagnosed with head and neck cancer (H&NC) are known to be important indicators of the quality of care but are represented poorly in the literature. Survival is a major outcome measure to which health-related quality of life (HRQoL) adds detail but outcomes are not fully representative of the patients' experiences because quality of care and reality of treatment are overlooked. This study explored the HRQoL, quality of care and reality of treatment themes using a mixed-methods approach, Q Methodology...
May 4, 2017: European Journal of Cancer Care
https://www.readbyqxmd.com/read/28474048/reform-revolution-and-disruption-in-mental-health-care-a-consumer-s-perspective
#14
Jackie Crowe
Mental health leaders, policy makers and successive national and state governments have tried countless incremental reforms. Yet, for decades in Australia, independent inquiries and reports have concluded that our mental health 'system of care' is a misnomer. It is fragmented, ineffective, inefficient and unfair. For far too long, people, families and communities have paid a heavy price for this. Reform in itself will not be the solution that we can hang all our hopes on. Disruptive innovations are now sneaking into the mental health sector and beginning to be taken up en masse...
April 27, 2017: Public Health Research & Practice
https://www.readbyqxmd.com/read/28473306/using-a-medical-intranet-of-things-system-to-prevent-bed-falls-in-an-acute-care-hospital-a-pilot-study
#15
Henri U Balaguera, Diana Wise, Chun Yin Ng, Han-Wen Tso, Wan-Lin Chiang, Aimee M Hutchinson, Tracy Galvin, Lee Hilborne, Cathy Hoffman, Chi-Cheng Huang, C Jason Wang
BACKGROUND: Hospitalized patients in the United States experience falls at a rate of 2.6 to 17.1 per 1000 patient-days, with the majority occurring when a patient is moving to, from, and around the bed. Each fall with injury costs an average of US $14,000. OBJECTIVE: The aim was to conduct a technology evaluation, including feasibility, usability, and user experience, of a medical sensor-based Intranet of things (IoT) system in facilitating nursing response to bed exits in an acute care hospital...
May 4, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28465306/high-adherence-to-the-wise-list-treatment-recommendations-in-stockholm-a-15-year-retrospective-review-of-a-multifaceted-approach-promoting-rational-use-of-medicines
#16
Jaran Eriksen, Lars L Gustafsson, Kristina Ateva, Pia Bastholm-Rahmner, Marie-Louise Ovesjö, Malena Jirlow, Maria Juhasz-Haverinen, Gerd Lärfars, Rickard E Malmström, Björn Wettermark, Eva Andersén-Karlsson
OBJECTIVES: To present the 'Wise List' (a formulary of essential medicines for primary and specialised care in Stockholm Healthcare Region) and assess adherence to the recommendations over a 15-year period. DESIGN: Retrospective analysis of all prescription data in the Stockholm Healthcare Region between 2000 and 2015 in relation to the Wise List recommendations during the same time period. SETTING: All outpatient care in the Stockholm Healthcare Region...
May 2, 2017: BMJ Open
https://www.readbyqxmd.com/read/28458973/improved-outcomes-with-pedicled-nipple-sparing-mastectomies-using-a-new-surgical-delay-mastectomy-through-wise-incisions
#17
Jean-Claude D Schwartz, Piotr P Skowronksi
Nipple-sparing mastectomy (NSM) is challenging in patients with significant ptosis and skin excess. We previously described the first use of a surgical delay (a supraareolar incision with undermining off the breast mound) to facilitate a second-stage pedicled NSM and reconstruction. Here, we present an improvement in our surgical delay technique-a total skin and NSM through Wise incisions. This technique obviates concerns regarding delays in cancer care and more aggressively delays the nipple, allowing for more reliable and extreme NAC transpositions...
March 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28453605/outlier-practice-patterns-in-mohs-micrographic-surgery-defining-the-problem-and-a-proposed-solution
#18
Aravind Krishnan, Tim Xu, Susan Hutfless, Angela Park, Thomas Stasko, Allison T Vidimos, Barry Leshin, Brett M Coldiron, Richard G Bennett, Victor J Marks, Rebecca Brandt, Martin A Makary, John G Albertini
Importance: Outlier physician practices in health care can represent a significant burden to patients and the health system. Objective: To study outlier physician practices in Mohs micrographic surgery (MMS) and the associated factors. Design, Setting, and Participants: This retrospective analysis of publicly available Medicare Part B claims data from January 2012 to December 2014 includes all physicians who received Medicare payments for MMS from any practice performing MMS on the head and neck, genitalia, hands, and feet region of Medicare Part B patients...
April 28, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/28452710/excavating-meningoencephaloceles-a-newly-recognized-entity
#19
Patricia A Loftus, Sarah K Wise, Pedram Daraei, Kristen Baugnon, John M DelGaudio
BACKGROUND: Spontaneous cerebrospinal fluid (CSF) leaks are largely attributed to idiopathic intracranial hypertension and typically present as skull base defects with or without prolapse of intracranial contents. However, in our practice, we have encountered a distinct type of spontaneous CSF leak that presents in a different manner. OBJECTIVE: To discuss a newly-classified, difficult to treat, subset of spontaneous CSF leaks that present as excavation of the bone of the skull base in a tunnel- or canal-like fashion by a meningocele or meningoencephalocele instead of as a localized area of bony dehiscence...
March 1, 2017: American Journal of Rhinology & Allergy
https://www.readbyqxmd.com/read/28445354/a-prospective-randomized-trial-comparing-the-effects-of-lidocaine-in-breast-reduction-surgery
#20
Brian M Christie, Sahil Kapur, Steve J Kempton, Summer E Hanson, Yue Ma, Venkat K Rao
BACKGROUND: Use of dilute epinephrine tumescent solution in breast reduction surgery has been shown to significantly decrease operative blood loss without increasing perioperative complications. Lidocaine is commonly added to epinephrine to decrease postoperative pain. Evidence supporting this practice, however, is limited, and lidocaine toxicity has been reported. METHODS: With institutional review board approval, patients undergoing bilateral breast reduction surgery were assigned to receive either tumescent saline solution with epinephrine (1:1 million) (group 1), or tumescent saline solution with epinephrine (1:1 million) and lidocaine (0...
May 2017: Plastic and Reconstructive Surgery
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