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Osama Mosa, Milan Skitek, Ales Jerin
CONTEXT AND OBJECTIVE: Acute kidney injury (AKI) is still a headache for clinicians and scientists as a possible reason for increased death among intensive care unit (ICU) patients after invasive cardiac surgery. Furthermore, the diagnostic process for AKI using conventional biomarkers is not sufficient to ensure early warning of this condition because of the morbid influence of non-renal factors that definitively delay the time for the prognosis. These imposed limitations have led to significant amounts of research targeted towards identifying novel biomarkers for AKI with a sustained degree of sensitivity and specificity...
October 13, 2016: São Paulo Medical Journal, Revista Paulista de Medicina
Kirsten Beck, Elaine Albert, Andrew Johnsen, Courtney Newhouse, John McGuire
Medical rounds in the Pediatric Intensive Care Unit (PICU) took about four hours each day to complete. The length of rounds was affecting the advancement of care of the patients, the engagement of sub-specialty providers who needed to be present on other rounds, and the engagement of the PICU faculty and staff due to overburdening waste created by the long duration of rounds. Specific interventions were identified aimed at reducing the duration of rounds each day, increasing engagement of the rounding team and satisfying the needs of the patients and families...
2016: BMJ Quality Improvement Reports
Jonas Schaffrath, Mario Schmitz-Buhl, Ali Kemal Gün, Euphrosyne Gouzoulis-Mayfrank
Medical and psychological care of refugees is among the most important current challenges in German health politics. Work with patients from this heterogeneous group who have often faced severe stress before, during and after their migration is currently based on a thin data foundation. Based on introductory information on current knowledge concerning psychiatric morbidity of refugees this article presents the psychiatric care of refugees at LVR Clinics Cologne - a psychiatric specialty hospital situated in North Rhine-Westphalia, Germany...
October 17, 2016: Psychotherapie, Psychosomatik, Medizinische Psychologie
Andréa Marques, Ana M Rodrigues, José Carlos Romeu, Afonso Ruano, Ana Paula Barbosa, Eugénia Simões, Fernanda Águas, Helena Canhão, José Delgado Alves, Raquel Lucas, Jaime Cunha Branco, Jorge Laíns, Mário Mascarenhas, Susete Simões, Viviana Tavares, Oscar Lourenço, José António Pereira da Silva
OBJECTIVE: To establish Portuguese recommendations regarding the indication to perform DXA and to initiate medication aimed at the prevention of fragility fractures. METHODS: A multidisciplinary panel, representing the full spectrum of medical specialties and patient associations devoted to osteoporosis, as well as national experts in this field and in health economics, was gathered to developed recommendations based on available evidence and expert consensus. Recently obtained data on the Portuguese epidemiologic, economic and quality-of-life aspects of fragility fractures were used to support decisions...
October 18, 2016: Acta Reumatológica Portuguesa
Tan Ying Peh, Grace Meijuan Yang, Lalit Kumar Radha Krishna, Alethea Chung Peng Yee
BACKGROUND: Doctors report inadequate training and lack confidence in providing palliative care. Although palliative care training improves self-assessed competence, it is not known whether the duration of a palliative medicine (PM) posting affects the extent of improvement in confidence. OBJECTIVE: The aim of this study was to determine whether the duration of a PM posting affects the extent of improvement in doctors' confidence in various aspects of palliative care...
October 17, 2016: Journal of Palliative Medicine
M Bhutta, R Mandavia, I Syed, A Qureshi, R Hettige, B Y W Wong, S Saeed, J Cartledge
OBJECTIVE: To ascertain determinants of an interest in a career in ENT surgery through a survey of medical students and junior doctors. METHODS: A survey was administered, comprising Likert scales, forced response and single option questions, and free text responses, at five different courses or events for those interested in a career in ENT. RESULTS: The survey had an 87 per cent response rate; respondents consisted of 43 applicants for national selection, 15 foundation doctors and 23 medical students...
October 17, 2016: Journal of Laryngology and Otology
Federico Gelpi, Daniele De Santis, Simone Marconcini, Francesco Briguglio, Marco Finotti
This clinical report illustrates a multidisciplinary approach for the rehabilitation of a young adult patient affected by a bilateral edentulous space and an anterior deep bite. The patient required orthodontics and surgical corticotomy and implantology (both performed with a piezo device). A multidisciplinary planning approach, including orthodontics, oral and periodontic surgery, and restorative dentistry, has an important role in the final outcome of treatment. In fact a dental class I occlusion has been established only on the right side...
December 2015: Int J Implant Dent
Laura A Thompson, Tracy A Romano
Increased pressure, associated with diving, can alter cell function through several mechanisms and has been shown to impact immune functions performed by peripheral blood mononuclear cells (PBMC) in humans. While marine mammals possess specific adaptations which protect them from dive related injury, it is unknown how their immune system is adapted to the challenges associated with diving. The purpose of this study was to measure PBMC activation (IL2R expression) and Concanavalin A induced lymphocyte proliferation (BrdU incorporation) in belugas following in vitro pressure exposures during baseline, Out of Water Examination (OWE) and capture/release conditions...
2016: Frontiers in Physiology
Patrick C Sanger, Vlad V Simianu, Cameron E Gaskill, Cheryl Al Armstrong, Andrea L Hartzler, Ross J Lordon, William B Lober, Heather L Evans
BACKGROUND: Postoperative surgical site infections (SSI) are common and costly. Most occur post-discharge, and may result in potentially preventable readmission and/or unnecessary urgent evaluation. Mobile health approaches incorporating patient-generated wound photos are being implemented in an attempt to optimize triage and management. We assessed how adding wound photos to existing data sources modifies provider decision-making. STUDY DESIGN: Web-based simulation survey using convenience sample of providers with expertise in surgical infections...
October 13, 2016: Journal of the American College of Surgeons
Lauren J Ralph, Diana Greene Foster, Katrina Kimport, David Turok, Sarah C M Roberts
OBJECTIVE: Evaluating decisional certainty is an important component of medical care, including preabortion care. However, minimal research has examined how to measure certainty with reliability and validity among women seeking abortion. We examine whether the Decisional Conflict Scale (DCS), a measure widely used in other health specialties and considered the gold standard for measuring this construct, and the Taft-Baker Scale (TBS), a measure developed by abortion counselors, are valid and reliable for use with women seeking abortion and predict the decision to continue the pregnancy...
October 10, 2016: Contraception
W Kelly Wu, Maame Yaa A B Yiadom, Sean P Collins, Wesley H Self, Ken Monahan
INTRODUCTION: A triage cardiology program, in which cardiologists provide consultation to the Emergency Department (ED), may safely reduce admissions. For patients with chest pain, the HEART Pathway may obviate the need for cardiology involvement, unless there is a difference between ED and cardiology assessments. Therefore, in a cohort concurrently evaluated by both specialties, we analyzed discordance between ED and cardiology HEART scores. METHODS: We performed a single-center, cross-sectional, retrospective study of adults presenting to the ED with chest pain who had a documented bedside evaluation by a triage cardiologist...
September 28, 2016: American Journal of Emergency Medicine
Daniel J Ozzello, Jason R Kolfenbach, Alan G Palestine
INTRODUCTION: Uveitis specialists and rheumatologists treat patients with anterior scleritis, but data from controlled trials to guide management are scarce, making differences in treatment paradigms possible. METHODS: 1044 uveitis specialists and rheumatologists were surveyed regarding therapy for a patient with anterior scleritis. Respondents were asked to select first- and second-choice therapies and then reselect therapies assuming that the costs of all options were equal and that insurance approval was ensured...
October 15, 2016: Ophthalmology and Therapy
Christian Wehner, Klara Janjić, Hermann Agis
Plasmin is a proteolytic enzyme that is crucial in fibrinolysis. In oral tissues, the plasminogen system plays an essential role in physiological and pathological processes, which in addition to fibrinolysis include degradation of extracellular matrix, inflammation, immune response, angiogenesis, tissue remodeling, cell migration, and wound healing. Oral tissues reveal a change in the plasminogen system during pathological processes such as periodontitis, peri-implantitis, or pulpitis, as well as in response to mechanical load...
October 5, 2016: Archives of Oral Biology
Sarkis Kiramijyan, Romain Didier, Edward Koifman, Smita I Negi
BACKGROUND: It has become challenging for cardiovascular fellows-in-training (FIT) to determine which national cardiovascular conference (NCC) to attend given the broad range of meetings and the breadth of information offered. The aim of this study was to report our own experiences of the utility and individual strengths of the NCCs and to further understand the interventional cardiology (IC) FITs' viewpoint regarding the benefits of the individual NCCs. METHODS: A survey was formulated with questions and scenarios regarding topics deemed to be of highest importance for an IC-FIT...
October 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Kendall R Beck, Nicole Kim, Mandana Khalili
BACKGROUND: Vulnerable populations are disproportionately affected by hepatitis C virus (HCV) infection and experience high rates of health disparity. There are no data on real-world experience with highly efficacious direct-acting anti-HCV treatment in this population. AIMS: We aimed to evaluate the real-world experience with sofosbuvir-based regimens among a vulnerable HCV-infected population. METHODS: HCV treatment response was assessed among 204 patients who completed 12-24 weeks of sofosbuvir-based regimens (in combination with pegylated interferon and ribavirin, simeprevir, ledipasvir, or daclatasvir) at the San Francisco safety-net healthcare system liver specialty clinic between January 2014 and December 2015...
October 14, 2016: Digestive Diseases and Sciences
Alvin Rajkomar, Joanne Wing Lan Yim, Kevin Grumbach, Ami Parekh
BACKGROUND: Characterizing patient complexity using granular electronic health record (EHR) data regularly available to health systems is necessary to optimize primary care processes at scale. OBJECTIVE: To characterize the utilization patterns of primary care patients and create weighted panel sizes for providers based on work required to care for patients with different patterns. METHODS: We used EHR data over a 2-year period from patients empaneled to primary care clinicians in a single academic health system, including their in-person encounter history and virtual encounters such as telephonic visits, electronic messaging, and care coordination with specialists...
October 14, 2016: JMIR Medical Informatics
Sarah E Velasquez, Enrique Chaves-Carballo, Eve-Lynn Nelson
BACKGROUND: Approximately 2.7 million individuals in the United States are affected by epilepsy. It is the fourth most common neurological disorder and affects people of all ages, races, and economic backgrounds. In many rural states, the few pediatric neurologists commonly practice in the metropolitan areas. The inadequate resources present challenges for families residing in rural areas or with limited transportation resources. One remedy for this situation is to deliver pediatric neurology services to rural areas through videoconferencing...
August 10, 2016: Pediatric Neurology
Neal A deJong, Elisabeth P Dellon, Emily B Vander Schaaf, Alan D Stiles, Rachael A Carr, Michael J Steiner
OBJECTIVES: To assess whether the perception of enhanced access by parents in their child's primary care and main specialty practices is associated with preference for contacting either practice when problems arise with a child's chronic condition. STUDY DESIGN: In this cross-sectional survey study of parents whose children use both primary and specialty practices, we assessed perceptions of 3 components of enhanced access: (1) appointment availability when needed, (2) electronic communication with practices, and (3) other staff that help manage a child's health care needs...
October 11, 2016: Journal of Pediatrics
Jennifer Pearson, Ruth Westra
BACKGROUND AND OBJECTIVES: The Department of Family Medicine and Community Health Duluth has offered the Obstetrical Longitudinal Course (OBLC) as an elective for first-year medical students since 1999. The objective of the OBLC Impact Survey was to assess the effectiveness of the course over the past 15 years. METHODS: A Qualtrics survey was emailed to participants enrolled in the course from 1999-2014. Data was compiled for the respondent group as a whole as well as four cohorts based on current level of training/practice...
October 2016: Family Medicine
Fidelindo A Lim, Cheryl A Nadeau
The current emphasis to make nurses full partners in health care dialogue, education, research, practice, and policy-making has made nursing education more challenging and exciting. Competing themes in an already saturated curriculum allow little room for adding more content to formal teaching-learning activities. Well-organized student-led interest groups are an excellent avenue for conducting focused extracurricular offerings that allow students to exercise their leadership and organizational skills, advocate for academic excellence, and add specialty topics missing in the generalist curriculum...
July 2016: Nursing Education Perspectives
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