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https://www.readbyqxmd.com/read/29045684/lean-management-to-support-choosing-wisely-in-healthcare-the-first-evidence-from-a-systematic-literature-review
#1
Maria Crema, Chiara Verbano
Purpose: Choosing Wisely (CW) is an emergent approach to identify and reduce unnecessary care, such as tests and treatments that do not add value for patients and may even cause harm. The purpose of this paper is to investigate whether and how Lean Healthcare Management (LHM) can support CW objectives, focusing on customer needs and on waste elimination. Data sources: A systematic literature review has been performed in Scopus, PubMed and Web of Science. Study selection: Peer reviewed articles published in English language have been selected...
October 17, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29044068/needle-stick-injuries-in-a-tertiary-eye-care-hospital-incidence-management-outcomes-and-recommendations
#2
Ekta Rishi, B Shantha, Abhinav Dhami, Pukhraj Rishi, Hannah C Rajapriya
PURPOSE: The purpose of this study is to assess the incidence, management, and outcomes for needle stick injuries (NSIs) in a tertiary eye-care hospital and provide appropriate recommendations for its prevention. METHODS: This was a retrospective database review of NSI recorded between 2010 and 2015 at a tertiary eye care center. All staff members who had NSI were managed with standard treatment protocol. The mode, location, health-care workers affected and/or at risk for NSI were analyzed...
October 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/29042233/trends-of-device-utilization-ratios-in-intensive-care-units-over-10-year-period-in-south-korea-device-utilization-ratio-as-a-new-aspect-of-surveillance
#3
Eun Jin Kim, Yee Gyung Kwak, Sun Hee Park, Sung Ran Kim, Myoung Jin Shin, Hyeon Mi Yoo, Su Ha Han, Dong Wook Kim, Young Hwa Choi, Jin-Hong You
BACKGROUND: Device-associated healthcare-associated infection is an important issue related to safety of patients. It is important to reduce unnecessary device utilization in order to decrease device associated infection (DAI) rates. AIM: To investigate the time trend of device utilization ratios (DURs) of voluntarily participating hospitals, collected over a 10-year period through the Korean National Healthcare-associated Infections Surveillance System (KONIS)...
October 14, 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/29037112/peer-led-transformative-learning-approaches-increase-classroom-engagement-in-care-self-management-classes-during-inpatient-rehabilitation-of-individuals-with-spinal-cord-injury
#4
Julie Gassaway, Michael L Jones, W Mark Sweatman, Tamara Young
OBJECTIVE: Evaluate effects of revised education classes on classroom engagement during inpatient rehabilitation for individuals with spinal cord injury/disease (SCI/D). DESIGN: Multiple-baseline, quasi-experimental design with video recorded engagement observations during conventional and revised education classes; visual and statistical analysis of difference in positive engagement responses observed in classes using each approach. PARTICIPANTS/SETTING: 81 patients (72% male, 73% white, mean age 36 SD 15...
October 16, 2017: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/29025145/online-physician-ratings-fail-to-predict-actual-performance-on-measures-of-quality-value-and-peer-review
#5
Timothy J Daskivich, Justin Houman, Garth Fuller, Jeanne T Black, Hyung L Kim, Brennan Spiegel
Objective: Patients use online consumer ratings to identify high-performing physicians, but it is unclear if ratings are valid measures of clinical performance. We sought to determine whether online ratings of specialist physicians from 5 platforms predict quality of care, value of care, and peer-assessed physician performance. Materials and Methods: We conducted an observational study of 78 physicians representing 8 medical and surgical specialties. We assessed the association of consumer ratings with specialty-specific performance scores (metrics including adherence to Choosing Wisely measures, 30-day readmissions, length of stay, and adjusted cost of care), primary care physician peer-review scores, and administrator peer-review scores...
September 8, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29024983/24-7-consultant-working-in-the-nhs-12%C3%A2-years-experience-in-intensive-care
#6
P J Frost, M P Wise
No abstract text is available yet for this article.
July 14, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/29021995/tumor-induced-osteomalacia
#7
Pablo Florenzano, Rachel I Gafni, Michael T Collins
Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome clinically characterized by bone pain, fractures and muscle weakness. It is caused by tumoral overproduction of fibroblast growth factor 23 (FGF23) that acts primarily at the proximal renal tubule, decreasing phosphate reabsorption and 1α-hydroxylation of 25 hydroxyvitamin D, thus producing hypophosphatemia and osteomalacia. Lesions are typically small, benign mesenchymal tumors that may be found in bone or soft tissue, anywhere in the body...
December 2017: Bone Reports
https://www.readbyqxmd.com/read/28983476/from-population-databases-to-research-and-informed-health-decisions-and-policy
#8
Yossy Machluf, Orna Tal, Amir Navon, Yoram Chaiter
BACKGROUND: In the era of big data, the medical community is inspired to maximize the utilization and processing of the rapidly expanding medical datasets for clinical-related and policy-driven research. This requires a medical database that can be aggregated, interpreted, and integrated at both the individual and population levels. Policymakers seek data as a lever for wise, evidence-based decision-making and information-driven policy. Yet, bridging the gap between data collection, research, and policymaking, is a major challenge...
2017: Frontiers in Public Health
https://www.readbyqxmd.com/read/28979565/protective-ventilation-with-veno-venous-lung-assist-in-respiratory-failure-a-protocol-for-a-multicentre-randomised-controlled-trial-of-extracorporeal-carbon-dioxide-removal-in-patients-with-acute-hypoxaemic-respiratory-failure
#9
J J McNamee, M A Gillies, N A Barrett, A M Agus, R Beale, A Bentley, A Bodenham, S J Brett, D Brodie, S J Finney, A J Gordon, M Griffiths, D Harrison, C Jackson, C McDowell, C McNally, G D Perkins, W Tunnicliffe, A Vuylsteke, T S Walsh, M P Wise, D Young, D F McAuley
One of the few interventions to demonstrate improved outcomes for acute hypoxaemic respiratory failure is reducing tidal volumes when using mechanical ventilation, often termed lung protective ventilation. Veno-venous extracorporeal carbon dioxide removal (vv-ECCO2R) can facilitate reducing tidal volumes. pRotective vEntilation with veno-venouS lung assisT (REST) is a randomised, allocation concealed, controlled, open, multicentre pragmatic trial to determine the clinical and cost-effectiveness of lower tidal volume mechanical ventilation facilitated by vv-ECCO2R in patients with acute hypoxaemic respiratory failure...
May 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/28975616/percutaneous-feeding-tubes-in-individuals-with-advanced-dementia-are-physicians-choosing-wisely
#10
Marzena Gieniusz, Liron Sinvani, Andrzej Kozikowski, Vidhi Patel, Christian Nouryan, Myia S Williams, Nina Kohn, Renee Pekmezaris, Gisele Wolf-Klein
OBJECTIVES: To evaluate physician knowledge and perceptions about the American Board of Internal Medicine/American Geriatrics Society (ABIM/AGS) Choosing Wisely recommendations regarding percutaneous endoscopic gastrostomy (PEG) in individuals with advanced dementia. DESIGN: Multicenter, mixed-mode, anonymous questionnaire. SETTING: Three tertiary and four community hospitals in New York. PARTICIPANTS: Internal medicine physicians (N = 168)...
October 4, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28974349/step-down-therapy-for-asthma-well-controlled-on-inhaled-corticosteroid-and-long-acting-beta-agonist-a-randomized-clinical-trial
#11
Linda Rogers, Elizabeth A Sugar, Kathryn Blake, Mario Castro, Emily Dimango, Nicola A Hanania, Kyle I Happel, Stephen P Peters, Joan Reibman, Joy Saams, W Gerald Teague, Robert A Wise, Janet T Holbrook
BACKGROUND: Stepping down therapy when asthma is well controlled on combination inhaled corticosteroids (ICSs) and long-acting beta-agonists (LABAs) is recommended, but it is not known whether lowering the ICS dose or stopping LABA is superior. OBJECTIVE: To evaluate whether step-down therapy with LABA is superior to one without; and, secondarily, to evaluate whether reducing the ICS dose while maintaining LABA is noninferior to remaining on stable-ICS/LABA. METHODS: The study was a randomized, double-masked 3-arm parallel group trial in participants aged 12 years or older...
September 30, 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28969823/editorial-commentary-leveraging-the-literature-what-can-a-half-century-s-worth-of-studies-tell-us-about-recurrent-instability-following-primary-shoulder-dislocation
#12
EDITORIAL
Mark P Cote
A benefit of systematic review (SR) research methods is that well-performed reviews allow authors and readers to identify weaknesses and variability in the orthopaedic literature. An SR on the topic of recurrence rates after conservative treatment of first-time shoulder dislocation provides an excellent example. The example reviews studies covering more than one-half century of time and employing varying methodological designs; the results include estimates of recurrence of shoulder dislocation ranging widely (from 4% to 94...
October 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28966490/care-bundle-approach-to-reduce-device-associated-infections-in-a-tertiary-care-teaching-hospital-south-india
#13
Suman Susan Prakash, Deepashree Rajshekar, Anusha Cherian, Apurba Sankar Sastry
CONTEXT: The care bundle approach is a set of evidence-based practices that when performed collectively and reliably have been shown to improve the patient outcome. AIMS: To evaluate the impact of the bundle care approach on reducing device-associated infections (DAIs). SETTINGS AND DESIGN: The study was conducted at a tertiary care hospital, South India. The study period was from January 2016 to September 2016 which was divided into three phases, each comprising 3 months...
October 2017: Journal of Laboratory Physicians
https://www.readbyqxmd.com/read/28955609/a-highly-sensitive-electrochemical-biosensor-based-on-aunp-modified-gold-electrodes-for-selective-determination-of-serum-levels-of-crosslaps
#14
Patricia Khashayar, Ghassem Amoabediny, Bagher Larijani, Morteza Hosseini, Rik Verplancke, Michel De Keersmaecker, Annemie Adriaens, Stefan Goemaere, Tom Fiers, Jan Vanfleteren
This article explains a step-wise protocol to develop an electrochemical sensor to quantify serum levels of C-telopeptide (CTX) crosslinks also known as crosslaps in a matter of minutes and with high level of accuracy. The technique needs only one-step (incubation) and can thus be used for point of care screening. Due to the excellent electrical properties of the as-prepared immunosensor, CTX levels were successfully measured from 1 to 1000 pg/mL. This is while the normal reference of the marker is 50-450 pg/mL, suggesting that the sensor can acceptably detect CTX...
October 2017: 3 Biotech
https://www.readbyqxmd.com/read/28952827/screening-for-anal-cancer-in-hiv-positive-patients-should-we-make-it-a-standard-of-care
#15
Jian Xu, Haiyang Zhou
Anal cancer is biological similar to cervical cancer, and is preceded by anal intraepithelial neoplasia (AIN). Screening for AIN and treatments to reduce the risk of anal cancer are not established as guidelines of care for HIV-infected patients. It is mainly because screening and treating of AIN is not yet proven to reduce the incidence of anal cancer. The present study preliminarily demonstrated that a successful screening program in preventing squamous cell anal cancer in HIV positive patients. The authors achieved their purpose of controlling the evolution of all abnormalities identified during the anal cancer screening, preventing AIN to progress towards anal cancer, and reversing any form of AIN by surgery, ablation or medical therapy...
September 27, 2017: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
https://www.readbyqxmd.com/read/28946805/questions-and-answers-in-health-care-and-education
#16
Jill E Thistlethwaite
Questions and answers are integral to the practice of health professionals and their education. Health professionals are taught to ask questions and we expect that patients will answer them. We may also invite patients to ask questions without considering that this may be difficult due to many factors including professional hierarchies. Choosing Wisely is a global initiative that frames questions for patients to ask in relation to tests and treatments. The same concept has been applied to health professional education with students and trainees also being encouraged to question their seniors about their choice of investigations and management...
September 26, 2017: Education for Primary Care
https://www.readbyqxmd.com/read/28943321/a-randomized-pilot-study-comparing-the-role-of-peep-o2-flow-and-high-flow-air-for-weaning-of-ventilatory-support-in-very-low-birth-weight-infants
#17
Chang-Yo Yang, Mei-Chin Yang, Shih-Ming Chu, Ming-Chou Chiang, Reyin Lien
BACKGROUND: There is a lack of evidence to guide step-wise weaning of positive pressure respiratory support for premature infants. This study sought to compare the efficacy of three weaning protocols we designed to facilitate weaning of very low birth weight (VLBW, less than 1500 g) preterm infants from nasal continuous positive airway pressure (NCPAP) support. METHODS: This was a prospective, randomized, controlled trial of VLBW preterm infants who received positive pressure ventilatory support in our neonatal intensive care unit (NICU) from April 2008 through March 2009...
September 6, 2017: Pediatrics and Neonatology
https://www.readbyqxmd.com/read/28940423/the-patient-protection-and-affordable-care-act-dependent-coverage-expansion-disparities-in-impact-among-young-adult-oncology-patients
#18
Elysia M Alvarez, Theresa H Keegan, Emily E Johnston, Robert Haile, Lee Sanders, Paul H Wise, Olga Saynina, Lisa J Chamberlain
BACKGROUND: Private health insurance is associated with improved outcomes in patients with cancer. However, to the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE), which extended private insurance to young adults (to age 26 years) beginning in 2010, on the insurance status of young adults with cancer. METHODS: The current study was a retrospective, population-based analysis of hospitalized young adult oncology patients (aged 22-30 years) in California during 2006 through 2014 (11,062 patients)...
September 22, 2017: Cancer
https://www.readbyqxmd.com/read/28940387/adaptive-designs-for-the-one-sample-log-rank-test
#19
Rene Schmidt, Andreas Faldum, Robert Kwiecien
Traditional designs in phase IIa cancer trials are single-arm designs with a binary outcome, for example, tumor response. In some settings, however, a time-to-event endpoint might appear more appropriate, particularly in the presence of loss to follow-up. Then the one-sample log-rank test might be the method of choice. It allows to compare the survival curve of the patients under treatment to a prespecified reference survival curve. The reference curve usually represents the expected survival under standard of the care...
September 22, 2017: Biometrics
https://www.readbyqxmd.com/read/28939983/-drug-therapy-for-older-people-choosing-wisely
#20
REVIEW
Martin Wehling
Elderly people are the most rapidly growing sector of our society. Due to their multimorbidity they are exposed to a multitude of medications, which are accompanied by chances and risks. The problem of inappropriate medication in the elderly is exacerbated by the fact that only a holistic view can help these patients and that this is predominantly the responsibility of the general practitioner. The closely measured paid contact time is often insufficient to optimize complex medications. Clinically successfully tested aids in the form of lists give reason for hope: in particular, the positive/negative assessment of limitations of the elderly with respect to drugs by the STOPP/START criteria and the FORTA classification are clinically successful aids...
September 22, 2017: Zeitschrift Für Gerontologie und Geriatrie
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