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https://www.readbyqxmd.com/read/29901547/a-multifaceted-intervention-to-reduce-pediatric-acid-suppressant-prescriptions-for-ger-what-have-we-learned
#1
Nina F Steutel, Miranda W Langendam, Marc A Benninga, Minke E P Jansen, Merit M Tabbers
OBJECTIVE: Acid-suppressant prescriptions for children have increased over past decades, despite guideline recommendations to prescribe prudently. Acid-suppressants are often ineffective and may lead to side-effects. We aimed to reduce inappropriate acid-suppressant prescriptions for gastro-esophageal reflux (GER) in a tertiary care setting through active implementation of national guideline recommendations and to evaluate intervention effect. METHODS: Implementation consisted of two steps...
June 12, 2018: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/29900575/group-regularization-for-zero-inflated-negative-binomial-regression-models-with-an-application-to-health-care-demand-in-germany
#2
Saptarshi Chatterjee, Shrabanti Chowdhury, Himel Mallick, Prithish Banerjee, Broti Garai
In many biomedical applications, covariates are naturally grouped, with variables in the same group being systematically related or statistically correlated. Under such settings, variable selection must be conducted at both group and individual variable levels. Motivated by the widespread availability of zero-inflated count outcomes and grouped covariates in many practical applications, we consider group regularization for zero-inflated negative binomial regression models. Using a least squares approximation of the mixture likelihood and a variety of group-wise penalties on the coefficients, we propose a unified algorithm (Gooogle: Group Regularization for Zero-inflated Count Regression Models) to efficiently compute the entire regularization path of the estimators...
June 14, 2018: Statistics in Medicine
https://www.readbyqxmd.com/read/29900388/the-availability-of-health-information-system-for-decision-making-with-evidence-based-medicine-approach-a-case-study-kermanshah-iran
#3
Ameneh Safari, Yahya Safari
Evidence-based medicine (EBM) is defining proper and wise use of the best evidence in clinical decision for patient׳s care. This study have done with the aim of evaluating health information system for decision-making with EBM approach in educational hospital of Kermanshah city. The statistical population include all the specialist and specialty, and also head nurses of educational hospitals in Kermanshah city. The data collected by researcher made questionnaire. The content validities of the questionnaire were confirmed by experts to complete the questions of the questionnaire...
August 2018: Data in Brief
https://www.readbyqxmd.com/read/29899264/the-late-stages-of-melanogenesis-exploring-the-chemical-facets-and-the-application-opportunities
#4
REVIEW
Lucia Panzella, Atsuko Ebato, Alessandra Napolitano, Kenzo Koike
In the last decade, the late stages of melanin biosynthesis involving the oxidative polymerization of 5,6-dihydroxyindole (DHI) and 5,6-dihydroxyindole-2-carboxylic acid (DHICA) have been extensively investigated. Most of the information derived from a biomimetic approach in which the oxidation of melanogenic indoles was carried out under conditions mimicking those occurring in the biological environment. Characterization of the early oligomers allowed for drawing a structural picture of DHI and DHICA melanins, providing also an interpretative basis for the different properties exhibited by these pigments, e...
June 13, 2018: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29885709/fostering-collegial-collaboration-between-labor-nurses-and-doulas
#5
Renece Waller-Wise
Nurses and doulas do not always have positive views of each other. When labor nurses face challenges in their ability to provide continuous labor support, one might believe that a doula would be welcomed, yet this is not always true. Conflicts can arise between nurses and doulas, often because of overlapping roles. However, an optimal health care system is one for which there is an integrated system that fosters collegial interprofessional collaboration. This commentary explores the role of doulas and the care they provide and describes strategies to promote collegial relationships between nurses and doulas...
June 2018: Nursing for Women's Health
https://www.readbyqxmd.com/read/29878655/optimizing-bleed-prevention-throughout-the-lifespan-womb-to-tomb
#6
REVIEW
S Gupta, A D Shapiro
The focus of care providers, patients and families is the ability to tailor care for persons with haemophilia (PWH) across the lifespan. Care requires knowledge of the bleeding disorder and age-related complications, risk of therapeutic interventions, and evaluation of individual characteristics that contribute to outcomes. The ultimate goal is to live a normal life without the burden of bleeding, for PWH and carriers. A wide range of therapeutic options is required to achieve personalized care. Over the last decade, substantial therapeutic advantages have been achieved in the treatment of haemophilia that include the development of a robust array of factor concentrates, novel haemostatic agents, and increased knowledge and awareness of disease associated outcomes and risk factors...
May 2018: Haemophilia: the Official Journal of the World Federation of Hemophilia
https://www.readbyqxmd.com/read/29868894/eliminating-inappropriate-telemetry-monitoring-an-evidence-based-implementation-guide
#7
Raymond Y Yeow, Garth W Strohbehn, Calvin M Kagan, Christopher M Petrilli, Jamuna K Krishnan, Karli Edholm, L Scott Sussman, Jaime F Blanck, Remus I Popa, Amit K Pahwa
In-hospital continuous electrocardiographic monitoring, commonly referred to as telemetry, has allowed for rapid recognition of life-threatening conditions, including complex arrhythmias and myocardial ischemia. However, inappropriate use can lead to unnecessary downstream testing from "false alarms," which in turn affects clinician efficiency and increases health care costs without benefiting patients. For these reasons, the Society of Hospital Medicine's Choosing Wisely campaign recommended use of a protocol-driven discontinuation of telemetry...
June 4, 2018: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29801906/novel-management-strategies-for-medically-refractory-vasospasm-following-aneurysmal-subarachnoid-hemorrhage
#8
REVIEW
Fawaz Al-Mufti, Krishna Amuluru, Nitesh Damodara, Mohammad El-Ghanem, Rolla Nuoman, Naveed Kamal, Sarmad Al-Marsoummi, Nicholas A Morris, Neha S Dangayach, Stephan A Mayer
Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) is an important cause of further morbidity and mortality after an already devastating condition. Though traditionally attributed to vasospasm of large capacitance arteries and the resulting down-stream disruption of cerebral blood flow, the pathogenesis of DCI has proven to be more complex with early brain injury, blood-brain barrier disruption, microthrombosis, cortical spreading depolarizations, and the failure of cerebral autoregulation as newly elucidated factors...
July 15, 2018: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29782693/multidomain-intervention-for-the-prevention-of-cognitive-decline-after-stroke-a-pooled-patient-level-data-analysis
#9
Yvonne Teuschl, Hege Ihle-Hansen, Karl Matz, Alexandra Dachenhausen, Paulina Ratajczak, Jaakko Tuomilehto, Marie Helene Ursin, Guri Hagberg, Bente Thommessen, Anne Rita Øksengård, Michael Brainin
BACKGROUND: The aim of this pooled patient-level data analysis was to test if multidomain interventions, addressing several modifiable vascular risk factors simultaneously, is more effective than usual post-stroke care for the prevention of cognitive decline after stroke. METHODS: This pooled patient-level data analysis includes two randomised controlled trials using a multidomain approach to target vascular risk factors in stroke patients and cognition as primary outcome...
May 21, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29779675/utilization-of-head-ct-during-injury-visits-to-united-states-emergency-departments-2012-2015
#10
Brian J Yun, Pierre Borczuk, Kori S Zachrison, Joshua N Goldstein, Yosef Berlyand, Ali S Raja
INTRODUCTION: Studies have shown increasing utilization of head computed tomography (CT) imaging of emergency department (ED) patients presenting with an injury-related visit. Multiple initiatives, including the Choosing Wisely™ campaign and evidence-based clinical decision support based on validated decision rules, have targeted head CT use in patients with injuries. Therefore, we investigated national trends in the use of head CT during injury-related ED visits from 2012 to 2015. METHODS: This was a secondary analysis of data from the annual United States (U...
May 18, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29778601/diagnosis-classification-and-management-of-fourth-ventriculomegaly-in-adults-report-of-9-cases-and-literature-review
#11
Kaveh Barami, Indro Chakrabarti, James Silverthorn, Jeremy Ciporen, Paul T Akins
OBJECTIVE: An enlarged fourth ventricle otherwise known as fourth ventriculomegaly (4th VM) has been previously reported in the pediatric population yet literature on adults is scant. We report our experience with 4th VM in adults over an 11 year period and review the literature. MATERIAL/METHODS: retrospective chart review of adult patients with the diagnosis of 4th VM admitted to the ICU in a tertiary care center RESULTS: 9 patients were identified with 4th VM...
May 17, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29777402/a-national-study-of-the-use-of-asymptomatic-systemic-imaging-for-surveillance-following-breast-cancer-treatment-aft-01
#12
Jessica R Schumacher, Heather B Neuman, George J Chang, Benjamin D Kozower, Stephen B Edge, Menggang Yu, David J Vanness, Yajuan Si, Elizabeth A Jacobs, Amanda B Francescatti, Patricia A Spears, Jeffrey Havlena, Taiwo Adesoye, Daniel McKellar, David Winchester, Elizabeth S Burnside, Caprice C Greenberg
BACKGROUND: Although not guideline recommended, studies suggest 50% of locoregional breast cancer patients undergo systemic imaging during follow-up, prompting its inclusion as a Choosing Wisely measure of potential overuse. Most studies rely on administrative data that cannot delineate scan intent (prompted by signs/symptoms vs. asymptomatic surveillance). This is a critical gap as intent is the only way to distinguish overuse from appropriate care. OBJECTIVE: Our aim was to assess surveillance systemic imaging post-breast cancer treatment in a national sample accounting for scan intent...
May 17, 2018: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29776654/defining-and-measuring-a-standard-set-of-patient-relevant-outcomes-in-coronary-artery-disease
#13
Edgar J Daeter, Marijke J C Timmermans, Alexander Hirsch, Eric Lipsic, Saskia Houterman, Dennis van Veghel, Paul B van der Nat
Systematic outcome measurement enables to continuously improve treatment results and stimulates dissemination of best practices. For patients with coronary artery disease, no examples yet exist of standard sets of patient-relevant outcome measures that have already been fully implemented at a large scale in clinical care. The aim of this paper is twofold: (1) to share the standard set of outcome measures as developed by Meetbaar Beter, and (2) to show how the standard set is presented and published to support improvement of cardiac care...
April 20, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29770910/creation-and-implementation-of-an-environmental-scan-to-assess-cancer-genetics-services-at-three-oncology-care-settings
#14
Erica M Bednar, Michael T Walsh, Ellen Baker, Kimberly I Muse, Holly D Oakley, Rebekah C Krukenberg, Cara S Dresbold, Sandra B Jenkinson, Amanda L Eppolito, Kelly B Teed, Molly H Klein, Nichole A Morman, Elizabeth C Bowdish, Pauline Russ, Emaline E Wise, Julia N Cooper, Michael W Method, John W Henson, Andrew V Grainger, Banu K Arun, Karen H Lu
An environmental scan (ES) is an efficient mixed-methods approach to collect and interpret relevant data for strategic planning and project design. To date, the ES has not been used nor evaluated in the clinical cancer genetics setting. We created and implemented an ES to inform the design of a quality improvement (QI) project to increase the rates of adherence to national guidelines for cancer genetic counseling and genetic testing at three unique oncology care settings (OCS). The ES collected qualitative and quantitative data from reviews of internal processes, past QI efforts, the literature, and each OCS...
May 16, 2018: Journal of Genetic Counseling
https://www.readbyqxmd.com/read/29768480/internal-medicine-trainees-knowledge-and-confidence-in-using-the-american-society-of-hematology-choosing-wisely-guidelines-in-hemostasis-thrombosis-and-non-malignant-hematology
#15
Ariela L Marshall, Sarah Jenkins, Amy S Oxentenko, Alfred I Lee, Mark D Siegel, Joel T Katz, Jatin M Vyas, John Del Valle, Joseph R Mikhael
BACKGROUND: Several specialty societies participate in the Choosing Wisely (CW) campaign in an attempt to reduce waste in health care spending. We surveyed internal medicine (IM) residents with an objective of classifying knowledge of and confidence in using the American Society of Hematology (ASH) CW principles in hemostasis, thrombosis, and non-malignant hematology. METHODS: Multi-institutional study of IM residents at 5 academic training programs in the United States...
2018: PloS One
https://www.readbyqxmd.com/read/29768294/a-pilot-study-to-reduce-computed-tomography-utilization-for-pediatric-mild-head-injury-in-the-emergency-department-using-a-clinical-decision-support-tool-and-a-structured-parent-discussion-tool
#16
Rakesh S Engineer, Seth R Podolsky, Baruch S Fertel, Purva Grover, Heather Jimenez, Erin L Simon, Courtney M Smalley
INTRODUCTION: The American College of Emergency Physicians embarked on the "Choosing Wisely" campaign to avoid computed tomographic (CT) scans in patients with minor head injury who are at low risk based on validated decision rules. We hypothesized that a Pediatric Mild Head Injury Care Path could be developed and implemented to reduce inappropriate CT utilization with support of a clinical decision support tool (CDST) and a structured parent discussion tool. METHODS: A quality improvement project was initiated for 9 weeks to reduce inappropriate CT utilization through 5 interventions: (1) engagement of leadership, (2) provider education, (3) incorporation of a parent discussion tool to guide discussion during the emergency department (ED) visit between the parent and the provider, (4) CDST embedded in the electronic medical record, and (5) importation of data into the note to drive compliance...
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29765244/an-echo-to-choosing-wisely-%C3%A2-in-switzerland
#17
Lionel Chok, Johann Debrunner, Sandra Jaeggli, Karmen Kusic, Esther B Bachli
Background: Inspired by the US Choosing Wisely® , in 2016 the Swiss Society of General Internal Medicine released a list of five treatments or diagnostic tests used in the hospital and considered unnecessary based on not improving patient care and adding to health care costs. These "Smarter Medicine" recommendations were implemented in the Department of Internal Medicine, Uster Hospital, in August 2016. They were supported by lectures and weekly email communications. We analyzed the number of blood draws before and after implementation of the recommendation aimed at reducing blood tests...
2018: International Journal of General Medicine
https://www.readbyqxmd.com/read/29761482/timing-of-onset-of-gastrointestinal-bleeding-in-the-icu-protocol-for-a-preplanned-observational-study
#18
A Granholm, T Lange, C T Anthon, S Marker, M Krag, T S Meyhoff, M P Wise, M Borthwick, S Bendel, F Keus, A B Guttormsen, J C Schefold, J Wetterslev, A Perner, M H Møller
BACKGROUND: Critically ill patients are at risk of gastrointestinal bleeding, but clinically important gastrointestinal bleeding is rare. The majority of intensive care unit (ICU) patients receive stress ulcer prophylaxis (SUP), despite uncertainty concerning the balance between benefit and harm. For approximately half of ICU patients with gastrointestinal bleeding, onset is early, ie within the first two days of the ICU stay. The aetiology of gastrointestinal bleeding and consequently the balance between benefit and harm of SUP may differ between patients with early vs late gastrointestinal bleeding...
May 14, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29760252/choosing-wisely-in-primary-care-moving-from-recommendations-to-implementation
#19
Kimberly Wintemute, Lynn Wilson, Wendy Levinson
No abstract text is available yet for this article.
May 2018: Canadian Family Physician Médecin de Famille Canadien
https://www.readbyqxmd.com/read/29757788/the-primary-care-provider-and-the-patient-living-in-poverty-applying-the-bridges-to-health-and-healthcare-model-to-np-practice
#20
Barbara Wise, Terie Dreussi-Smith
BACKGROUND AND PURPOSE: There is a much recent emphasis on the social determinants of health, and poverty is the most influential of these. It is not enough merely to understand the influence of poverty on health-the primary care provider must understand how to effectively treat patients who live in poverty. METHODS: This article applies the Bridges to Health and Healthcare model for understanding poverty to primary care practice from an individual provider's perspective...
April 2018: Journal of the American Association of Nurse Practitioners
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