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Caring wisely

Charles L Francoeur, Stephan A Mayer
For patients who survive the initial bleeding event of a ruptured brain aneurysm, delayed cerebral ischemia (DCI) is one of the most important causes of mortality and poor neurological outcome. New insights in the last decade have led to an important paradigm shift in the understanding of DCI pathogenesis. Large-vessel cerebral vasospasm has been challenged as the sole causal mechanism; new hypotheses now focus on the early brain injury, microcirculatory dysfunction, impaired autoregulation, and spreading depolarization...
October 14, 2016: Critical Care: the Official Journal of the Critical Care Forum
Ira L Leeds, Anne Fabrizio, Sara E Cosgrove, Elizabeth C Wick
Antibiotic resistance continues to receive national attention as a leading public health threat. In 2015, President Barack Obama proposed a National Action Plan to Combat Antibiotic-Resistant Bacteria to curb the rise of "superbugs," bacteria resistant to antibiotics of last resort. Whereas many antibiotics are prescribed appropriately to treat infections, there continue to be a large number of inappropriately prescribed antibiotics. Although much of the national attention with regards to stewardship has focused on primary care providers, there is a significant opportunity for surgeons to embrace this national imperative and improve our practices...
October 4, 2016: Annals of Surgery
Anthony T Gerlach, Danielle M Blais, G Morgan Jones, Pamela K Burcham, Stanislaw P Stawicki, Charles H Cook, Claire V Murphy
BACKGROUND: Dexmedetomidine is commonly used for sedation in the Intensive Care Unit (ICU), and its use may be associated with hypotension. We sought to determine predictors of dexmedetomidine-associated hypotension. METHODS: Retrospective, single-center study of 283 ICU patients in four adults ICUs over a 12 month period. Univariate analyses were performed to determine factors associated with dexmedetomidine-related hypotension. Risk factors significant at the 0...
July 2016: International Journal of Critical Illness and Injury Science
Zoë M McLaren, Amanda A Milliken, Amanda J Meyer, Alana R Sharp
BACKGROUND: Tuberculosis (TB) now ranks alongside HIV as the leading infectious disease cause of death worldwide and incurs a global economic burden of over $12 billion annually. Directly observed therapy (DOT) recommends that TB patients complete the course of treatment under direct observation of a treatment supporter who is trained and overseen by health services to ensure that patients take their drugs as scheduled. Though the current WHO End TB Strategy does not mention DOT, only "supportive treatment supervision by treatment partners", many TB programs still use it despite the fact that the has not been demonstrated to be statistically significantly superior to self-administered treatment in ensuring treatment success or cure...
October 4, 2016: BMC Infectious Diseases
Bojan B Petrovic, Tamara O Peric, Dejan L J Markovic, Branislav B Bajkin, Djorde Petrovic, Duska B Blagojevic, Sanja Vujkov
The aim of this study was to examine the factors affecting oral health status among intellectually disabled individuals in Serbia. The sample population was categorized according to age, sex, living arrangements, general health and the level of intellectual disability (ID). The diagnosis of dental caries was performed using the DMFT/dmft criteria. The oral hygiene and gingival health were assessed with the plaque index (Silness&Löe) and gingival index (Löe&Silness), respectively. Descriptive analysis, step-wise and logistic regression were performed to analyze related influential factors for caries presence, number of extracted teeth, teeth restored, the oral hygiene level and the extent of gingival inflammation...
September 30, 2016: Research in Developmental Disabilities
William Johnson, Momodou K Darboe, Fatou Sosseh, Patrick Nshe, Andrew M Prentice, Sophie E Moore
Prenatal supplementation with protein-energy (PE) and/or multiple-micronutrients (MMNs) may improve fetal growth, but trials of lipid-based nutritional supplements (LNSs) have reported inconsistent results. We conducted a post-hoc analysis of non-primary outcomes in a trial in Gambia, with the aim to test the associations of LNS with fetal growth and explore how efficacy varies depending on nutritional status. The sample comprised 620 pregnant women in an individually randomized, partially blinded trial with four arms: (a) iron and folic acid (FeFol) tablet (usual care, referent group), (b) MMN tablet, (c) PE LNS, and (d) PE + MMN LNS...
October 2, 2016: Maternal & Child Nutrition
Jos L T Blank, Bart L van Hulst, Vivian G Valdmanis
In this paper, we address the issue of whether it is economically advantageous to concentrate emergency rooms (ERs) in large hospitals. Besides identifying economies of scale of ERs, we also focus on chain economies. The latter term refers to the effects on a hospital's costs of ER patients who also need follow-up inpatient or outpatient hospital care. We show that, for each service examined, product-specific economies of scale prevail indicating that it would be beneficial for hospitals to increase ER services...
September 30, 2016: Health Economics
David J Klein, Adalsteinn D Brown, Allan S Detsky
No abstract text is available yet for this article.
September 29, 2016: JAMA: the Journal of the American Medical Association
Michael Jones, Julie Gassaway
OBJECTIVE: Peer support is an important adjunct to clinical care for people with disabilities, and may help address barriers to community reintegration. Peers offer positive role models and the benefit of learning from shared experiences of living with disability. Despite potential benefits, peer support is not consistently integrated in the rehabilitation process. This presentation describes three interventions recommended by patients, and directed by peer mentors, to promote successful community transition after rehabilitation for traumatic spinal cord injury (SCI)...
September 2016: Annals of Physical and Rehabilitation Medicine
Alykhan Lalani, P Benson Ham, Linda J Wise, John M Daniel, K Christian Walters, Walter L Pipkin, Brian Stansfield, Robyn M Hatley, Jatinder Bhatia
Treatment of gastroschisis often requires multiple surgical procedures to re-establish abdominal domain, reduce abdominal contents, and eventually close the abdominal wall. In patients who have concomitant respiratory failure requiring extracorporeal membrane oxygenation (ECMO), this process becomes further complicated. This situation is rare and only five such cases have been reported in the ECMO registry database. Management of three of the five patients along with results and implications for future care of similar patients is discussed here...
September 2016: American Surgeon
Khaid I Khoshhal, Salman Y Guraya
OBJECTIVES: To elaborate the desired qualities, traits, and styles of physician's leadership with a deep insight into the recommended measures to inculcate leadership skills in physicians.   METHODS: The databases of MEDLINE, EMBASE, CINAHL, and the Cochrane Library were searched for the full-text English-language articles published during the period 2000-2015. Further search, including manual search of grey literature, was conducted from the bibliographic list of all included articles...
October 2016: Saudi Medical Journal
A G Radhika, Garima Pandey, Nilanchali Singh, Anju Sinha
BACKGROUND: Cochrane reviews aim to produce evidence for health care practice globally including India. We wanted to assess the contribution of Indian origin studies in developing these systematic reviews in the field of obstetrics and gynecology. OBJECTIVE: The objective of this study is to determine the number of Indian origin studies in obstetrics and gynecology which provided conclusive data and hence contributed toward formulating Cochrane Reviews in Obstetrics and Gynecology...
October 2016: Journal of Obstetrics and Gynaecology of India
Jacqui Wise
No abstract text is available yet for this article.
2016: BMJ: British Medical Journal
Marc H Willis, L Alexandre Frigini, Jay Lin, David M Wynne, Karla A Sepulveda
RATIONALE AND OBJECTIVES: We have been called to reform radiology undergraduate medical education (UME) curricula. Clinically available clinical decision support provides an opportunity to improve education regarding appropriate imaging utilization, patient safety, and cost-effective care. MATERIAL AND METHODS: We created an education simulation portal utilizing integrated clinical decision support. The portal was then piloted with 34 volunteer medical students at our institution in a blended learning environment...
October 2016: Academic Radiology
Jann Arends, Patrick Bachmann, Vickie Baracos, Nicole Barthelemy, Hartmut Bertz, Federico Bozzetti, Ken Fearon, Elisabeth Hütterer, Elizabeth Isenring, Stein Kaasa, Zeljko Krznaric, Barry Laird, Maria Larsson, Alessandro Laviano, Stefan Mühlebach, Maurizio Muscaritoli, Line Oldervoll, Paula Ravasco, Tora Solheim, Florian Strasser, Marian de van der Schueren, Jean-Charles Preiser
Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment...
August 6, 2016: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Daniel Wolfson, Anthony Suchman
Choosing Wisely began at a time when a polarized national debate on healthcare reform stymied effective conversation on effective and efficient resource use. The ABIM Foundation sought to change attitudes and culture and promote the idea that removing waste is an integral component of providing high quality care by using an approach of constructive engagement to persuade specialty societies to identify five wasteful tests or treatments within their field.
September 2016: Healthcare
William Encinosa, Amy J Davidoff
Importance: Antiemetics are used to prevent chemotherapy-induced nausea and vomiting in patients with cancer. Newer antiemetic agents (serotonin and neurokinin-1 receptor antagonists) have increased efficacy but are expensive. The American Society of Clinical Oncology's first guideline in the 2013 Choosing Wisely (CW) campaign discouraged overuse of expensive antiemetics in patients with low risk of chemotherapy-induced nausea and vomiting. However, little is known about patterns or trends in antiemetic overuse or whether any change has occurred with the publication of the CW recommendations...
September 15, 2016: JAMA Oncology
Jacqui Wise
No abstract text is available yet for this article.
2016: BMJ: British Medical Journal
Javier Valero-Elizondo, Joseph A Salami, Chukwuemeka U Osondu, Oluseye Ogunmoroti, Alejandro Arrieta, Erica S Spatz, Adnan Younus, Jamal S Rana, Salim S Virani, Ron Blankstein, Michael J Blaha, Emir Veledar, Khurram Nasir
BACKGROUND: Physical activity (PA) has an established favorable impact on cardiovascular disease (CVD) outcomes and quality of life. In this study, we aimed to estimate the economic effect of moderate-vigorous PA on medical expenditures and utilization from a nationally representative cohort with and without CVD. METHODS AND RESULTS: The 2012 Medical Expenditure Panel Survey data were analyzed. Our study population was limited to noninstitutionalized US adults ≥18 years of age...
2016: Journal of the American Heart Association
Adamasco Cupisti, Claudia D'Alessandro, Biagio Di Iorio, Anna Bottai, Claudia Zullo, Domenico Giannese, Massimiliano Barsotti, Maria Francesca Egidi
BACKGROUND: Dietary treatment is helpful in CKD patients, but nutritional interventions are scarcely implemented. The main concern of the renal diets is its feasibility with regards to daily clinical practice especially in the elderly and co-morbid patients. This study aimed to evaluate the effects of a pragmatic, step-wise, personalized nutritional support in the management of CKD patients on tertiary care. METHODS: This is a case-control study. It included 823 prevalent out-patients affected by CKD stage 3b to 5 not-in-dialysis, followed by tertiary care in nephrology clinics; 305 patients (190 males, aged 70 ± 12 years) received nutritional support (nutritional treatment Group, NTG); 518 patients (281 males, aged 73 ± 13 years) who did not receive any dietary therapy, formed the control group (CG)...
2016: BMC Nephrology
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