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Caring wisely

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https://www.readbyqxmd.com/read/29228939/the-ethics-of-caring-for-hospital-dependent-patients
#1
Calvin Sung, Jennifer L Herbst
BACKGROUND: Hospital-dependent patients are individuals who are repeatedly readmitted to the hospital because their acute medical needs cannot be met elsewhere. Unlike the chronically critically ill, these patients do not have a continuous need for life-sustaining equipment and can experience periods of relative stability where they have a good quality of life. However, some end up spending months or even years in the hospital receiving resource-intensive care because they are unable to be safely discharged, despite an initial optimistic prognosis...
December 11, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/29226106/elevated-liver-enzymes-in-asymptomatic-patients-what-should-i-do
#2
REVIEW
Mazyar Malakouti, Archish Kataria, Sayed K Ali, Steven Schenker
Elevated liver enzymes are a common scenario encountered by physicians in clinical practice. For many physicians, however, evaluation of such a problem in patients presenting with no symptoms can be challenging. Evidence supporting a standardized approach to evaluation is lacking. Although alterations of liver enzymes could be a normal physiological phenomenon in certain cases, it may also reflect potential liver injury in others, necessitating its further assessment and management. In this article, we provide a guide to primary care clinicians to interpret abnormal elevation of liver enzymes in asymptomatic patients using a step-wise algorithm...
December 28, 2017: Journal of Clinical and Translational Hepatology
https://www.readbyqxmd.com/read/29224044/pattern-of-care-and-impact-of-prognostic-factors-on-the-outcome-of-head-and-neck-extramedullary-plasmacytoma-a-systematic-review-and-individual-patient-data-analysis-of-315-cases
#3
Bhanuprasad Venkatesulu, Supriya Mallick, Prashanth Giridhar, Ashish Dutt Upadhyay, Goura K Rath
INTRODUCTION: Head and neck extramedullary plasmacytoma is a rare localized plasma cell neoplasm. We intended to perform this review of the published literature to assess the demographic profile, pattern of care and survival outcomes. METHODS: Two authors independently searched PubMed, Google search and Cochrane library for eligible studies from 1950 till July 1, 2016, published in English language. RESULTS: Median age of the cohort was 57 years (range 11-85)...
December 9, 2017: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/29217853/comprehensive-cardiopulmonary-life-support-ccls-for-cardiopulmonary-resuscitation-by-trained-paramedics-and-medics-inside-the-hospital
#4
Rakesh Garg, Syed Moied Ahmed, Mukul Chandra Kapoor, Ssc Chakra Rao, Bibhuti Bhusan Mishra, M Venkatagiri Kalandoor, Baljit Singh, Jigeeshu Vasishtha Divatia
The cardiopulmonary resuscitation (CPR) guideline of comprehensive cardiopulmonary life support (CCLS) for management of the patient with cardiopulmonary arrest in adults provides an algorithmic step-wise approach for optimal outcome of the patient inside the hospital by trained medics and paramedics. This guideline has been developed considering the infrastructure of healthcare delivery system in India. This is based on evidence in the international and national literature. In the absence of data from the Indian population, the extrapolation has been made from international data, discussed with Indian experts and modified accordingly to ensure their applicability in India...
November 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/29212631/disruptive-technologies-making-cancer-care-more-patient-centred
#5
Jacqui Wise
No abstract text is available yet for this article.
December 6, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/29210839/cataract-surgery-in-ocular-surface-diseases-clinical-challenges-and-outcomes
#6
Virender S Sangwan, Swati Gupta, Shilpa Das
PURPOSE OF REVIEW: Cataracts are a significant cause of blindness and visual impairment worldwide. With the recent advances in cataract surgery techniques, outcomes have improved significantly in uncomplicated cases. This article discusses the challenges and outcomes of cataract surgery in complex cases targeting eyes with ocular surface diseases like Stevens-Johnson syndrome, ocular cicatricial pemphigoid, Mooren's ulcer, vernal keratoconjunctivitis and limbal stem cell deficiency. RECENT FINDINGS: Ocular surface diseases are commonly associated with corneal scarring and vascularization, conjunctival inflammation, symblepharon and forniceal shortening...
January 2018: Current Opinion in Ophthalmology
https://www.readbyqxmd.com/read/29208063/unusually-high-illness-severity-and-short-incubation-periods-in-two-foodborne-outbreaks-of-salmonella-heidelberg-infections-with-potential-coincident-staphylococcus-aureus-intoxication
#7
J H Nakao, D Talkington, C A Bopp, J Besser, M L Sanchez, J Guarisco, S L Davidson, C Warner, M G McINTYRE, J P Group, N Comstock, K Xavier, T S Pinsent, J Brown, J M Douglas, G A Gomez, N M Garrett, H A Carleton, B Tolar, M E Wise
We describe the investigation of two temporally coincident illness clusters involving salmonella and Staphylococcus aureus in two states. Cases were defined as gastrointestinal illness following two meal events. Investigators interviewed ill persons. Stool, food and environmental samples underwent pathogen testing. Alabama: Eighty cases were identified. Median time from meal to illness was 5·8 h. Salmonella Heidelberg was identified from 27 of 28 stool specimens tested, and coagulase-positive S. aureus was isolated from three of 16 ill persons...
December 6, 2017: Epidemiology and Infection
https://www.readbyqxmd.com/read/29207702/nagging-presence-of-clostridium-difficile-associated-diarrhoea-in-north-india
#8
Rama Chaudhry, Nidhi Sharma, Nitin Gupta, Kamla Kant, Tej Bahadur, Trupti M Shende, Lalit Kumar, Sushil K Kabra
Introduction: Clostridium Difficile Associated Diarrhoea (CDAD) is a significant cause of morbidity in hospitalised patients worldwide. The data on clinical epidemiology of this disease in Indian subcontinent is scarce. Aim: To evaluate the risk factors and clinical course of patients with CDAD. Materials and Methods: A cross-sectional study was planned at our tertiary care centre, All India Institute of Medical Sciences, whereby, all patients who had nosocomial diarrhea between 2010 and 2014 were included in the study...
September 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/29203979/young-vs-old-colorectal-cancer-in-indian-subcontinent-a-tertiary-care-center-experience
#9
Ashish B Pokharkar, Manish Bhandare, Prachi Patil, Shaesta Mehta, Reena Engineer, Avanish P Saklani
This study aims to compare patient, tumor, treatment-related factors and survival between young (<45 years) and old (>45 years) Indian colorectal cancer (CRC) patients. Total 778 patients of CRC were registered at tertiary cancer center in India between 1 August 2013 and 31 July 2014. Patients were followed up for median period of 27.73 months. Data regarding patient, tumor, treatment and survival-related factors were collected. Patients were divided in young (≤45 years) and old (>45 years) age groups...
December 2017: Indian Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29202258/the-spice-iii-study-protocol-and-analysis-plan-a-randomised-trial-of-early-goaldirected-sedation-compared-with-standard-care-in-mechanically-ventilated-patients
#10
Yahya Shehabi, Andrew B Forbes, Yaseen Arabi, Frances Bass, Rinaldo Bellomo, Suhaini Kadiman, Belinda D Howe, Colin McArthur, Michael C Reade, Ian Seppelt, Jukka Takala, Steve Webb, Matthew P Wise
BACKGROUND: Sedation strategy in critically ill patients who are mechanically ventilated is influenced by patient-related factors, choice of sedative agent and the intensity or depth of sedation prescribed. The impact of sedation strategy on outcome, in particular when delivered early after initiation of mechanical ventilation, is uncertain. OBJECTIVES: To present the protocol and analysis plan of a large randomised clinical trial investigating the effect of a sedation strategy, in critically ill patients who are mechanically ventilated, based on a protocol targeting light sedation using dexmedetomidine as the primary sedative, termed "early goal-directed sedation", compared with usual practice...
December 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/29197900/teaching-quality-improvement-to-medical-students-over-a-decade-of-experience
#11
Michelle Wise, Bridget Kool, Lynn Sadler, Roshini Peiris-John, Gillian Robb, Susan Wells
AIM: To describe how we incorporate experiential quality improvement (QI) learning at the University of Auckland by integrating a clinical audit project into the Year 6 obstetrics and gynaecology clinical attachment. METHODS: Students gain insight into the relevance of QI while engaged in day-to-day clinical work. Students work with a clinical supervisor to identify an area for potential improvement, set a standard of care, measure current practice, investigate reasons for deviation from the standard and make real-world suggestions to close the gap between best evidence and observed practice...
December 1, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/29189825/-appropriateness-and-surroundings-doing-more-does-not-mean-doing-better-choosing-wisely-an-unfulfilled-commitment
#12
Fulvio Camerini, Enrico Fabris, Gianfranco Sinagra
The attention of the medical community to the appropriateness of diagnostic and therapeutic procedures has increased in recent years, recognizing the need for a careful use of resources and for avoiding unnecessary and sometimes harmful medical tests, procedures and therapies. Not only healthcare providers, but also public, patients and politicians, should know the consequences of inappropriate decisions and behaviors. Indeed, inappropriateness has clinical (risks), economic (waste of resources), but also ethical implications (i...
December 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/29184456/validating-the-patient-experience-with-treatment-and-self-management-pets-a-patient-reported-measure-of-treatment-burden-in-people-with-diabetes
#13
Elizabeth A Rogers, Kathleen J Yost, Jordan K Rosedahl, Mark Linzer, Deborah H Boehm, Azra Thakur, Sara Poplau, Roger T Anderson, David T Eton
Aims: To validate a comprehensive general measure of treatment burden, the Patient Experience with Treatment and Self-Management (PETS), in people with diabetes. Methods: We conducted a secondary analysis of a cross-sectional survey study with 120 people diagnosed with type 1 or type 2 diabetes and at least one additional chronic illness. Surveys included established patient-reported outcome measures and a 48-item version of the PETS, a new measure comprised of multi-item scales assessing the burden of chronic illness treatment and self-care as it relates to nine domains: medical information, medications, medical appointments, monitoring health, interpersonal challenges, health care expenses, difficulty with health care services, role activity limitations, and physical/mental exhaustion from self-management...
2017: Patient related Outcome Measures
https://www.readbyqxmd.com/read/29182211/assessment-of-hypovolaemia-in-the-critically-ill
#14
Jan Van der Mullen, Robert Wise, Griet Vermeulen, Pieter-Jan Moonen, Manu L N G Malbrain
Assessment of the intravascular volume status of patients is one of the most challenging tasks for the intensive care clinician. It is also one of the most important skills in intensive care management as both hypervolaemia and hypovolaemia lead to increased morbidity and mortality. The assessment of hypovolaemic patients is aided by several clinical signs, laboratory investigations, and a multitude of haemodynamic monitoring systems. This review aims to outline the definitions, pathophysiology, and various assessment techniques (both old and new) employed by intensivists on the critically ill patient...
November 28, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29182210/the-role-of-point-of-care-ultrasound-in-intra-abdominal-hypertension-management
#15
Bruno M Pereira, Renato G Pereira, Robert Wise, Gavin Sugrue, Tanya L Zachrison, Alcir E Dorigatti, Rossano K Fiorelli, Manu L N G Malbrain
BACKGROUND: Intra-abdominal hypertension is a common complication in critically ill patients. Recently the Abdominal Compartment Society (WSACS) developed a medical management algorithm with a stepwise approach according to the evolution of the intra-abdominal pressure and aiming to keep IAP ≤ 15 mm Hg. With the increased use of ultrasound as a bedside modality in both emergency and critical care patients, we hypothesized that ultrasound could be used as an adjuvant point-of-care tool during IAH management...
November 28, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29165775/re-operative-abdominal-predictive-score-a-prognostic-model-combining-acute-re-intervention-predictive-index-and-intra-abdominal-pressure
#16
Caridad de Dios Soler-Morejón, Tomás Ariel Lombardo-Vaillant, Teddy Osmín Tamargo-Barbeito, Robert Wise, Manu L N G Malbrain
BACKGROUND: The decision to re-operate after abdominal surgery is still difficult, especially in the setting of intra-abdominal sepsis. Mathematical models provide a good aid to both diagnosis and decision-making. METHODS: A prospective observational study was conducted with 300 patients consecutively admitted to the intensive care unit of an academic institution affiliated to Calixto García Medical Faculty following abdominal surgery from January 2008 to January 2010...
November 22, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29159367/promoting-high-value-practice-by-reducing-unnecessary-transfusions-with-a-patient-blood-management-program
#17
Divyajot Sadana, Ariella Pratzer, Lauren J Scher, Harry S Saag, Nicole Adler, Frank M Volpicelli, Moises Auron, Steven M Frank
Although blood transfusion is a lifesaving therapy for some patients, transfusion has been named 1 of the top 5 overused procedures in US hospitals. As unnecessary transfusions only increase risk and cost without providing benefit, improving transfusion practice is an effective way of promoting high-value care. Most high-quality clinical trials supporting a restrictive transfusion strategy have been published in the past 5 to 10 years, so the value of a successful patient blood management program has only recently been recognized...
November 20, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29157559/-deciding-wisely-together-an-initiative-of-the-association-of-the-scientific-medical-societies-in-germany-mission-methodology-and-application
#18
Monika Nothacker, Rolf Kreienberg, Ina Kopp
The question of how to improve healthcare quality and the need for patient empowerment and shared decision-making has been subject of political and scientific debate for years. In addition to various quality initiatives, "top lists" summarizing selected recommendations to increase awareness of overuse, spread by means of public campaigns, has become popular on the international level-known as the "Choosing Wisely" initiative. However, the trustworthiness of "top lists", their impact on patient-relevant outcomes, their role in and integration into the context of the various pre-existing approaches to improve healthcare quality and the effects of neglecting under- and misuse are not clear...
November 17, 2017: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/29153354/the-choosing-wisely-initiative-a-critical-analysis-with-a-special-focus-on-primary-care
#19
Karl Horvath, Andrea Siebenhofer
The Choosing Wisely initiative (CWI), a campaign led by the American Board of Internal Medicine (ABIM) Foundation, promotes doctor-patient communication and reducing waste in healthcare. At present, many of the top 5 lists from the Choosing Wisely Initiative appear to be primarily eminence-based and influenced by self-interest. The implementation of recommendations from these lists may mean taking a step backwards to the time before evidence-based medicine. On the other hand, despite all the challenges that the Choosing Wisely initiatives are currently facing, it is difficult to deny that they also hold great potential in terms of making healthcare systems more efficient and beneficial to patients...
November 15, 2017: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/29151269/how-to-practice-person-centred-care-a-conceptual-framework
#20
REVIEW
Maria J Santana, Kimberly Manalili, Rachel J Jolley, Sandra Zelinsky, Hude Quan, Mingshan Lu
BACKGROUND: Globally, health-care systems and organizations are looking to improve health system performance through the implementation of a person-centred care (PCC) model. While numerous conceptual frameworks for PCC exist, a gap remains in practical guidance on PCC implementation. METHODS: Based on a narrative review of the PCC literature, a generic conceptual framework was developed in collaboration with a patient partner, which synthesizes evidence, recommendations and best practice from existing frameworks and implementation case studies...
November 19, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
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