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https://www.readbyqxmd.com/read/28431860/predictive-value-of-perfusion-defects-on-dual-energy-cta-in-the-absence-of-thromboembolic-clots
#1
Richard A P Takx, Thomas Henzler, U Joseph Schoepf, Thomas Germann, Stefan O Schoenberg, Aysel Shirinova, Ralf W Bauer, Claudia Frellesen, Long Jiang Zhang, John W Nance, Christian Fink, Paul Apfaltrer
BACKGROUND: To determine the predictive value of volumetrically measured lung perfusion defects (PDvol) and right ventricular dysfunction on dual-energy computed tomography angiography (DE-CTA) for predicting all cause mortality in patients suspected of pulmonary embolism (PE) but without evident thromboembolic clot on CTA. METHODS: 448 patients underwent DE-CTA on a 64-channel DSCT system between January 2007 and December 2012 for suspected PE, of which 115 were without detectable thromboembolic clot on CTA...
April 18, 2017: Journal of Cardiovascular Computed Tomography
https://www.readbyqxmd.com/read/28427405/ceiling-effect-in-emr-system-assimilation-a-multiple-case-study-in-primary-care-family-practices
#2
Marie-Claude Trudel, Josianne Marsan, Guy Paré, Louis Raymond, Ana Ortiz de Guinea, Éric Maillet, Thomas Micheneau
BACKGROUND: There has been indisputable growth in adoption of electronic medical record (EMR) systems in the recent years. However, physicians' progress in using these systems has stagnated when measured with maturity scales. While this so-called ceiling effect has been observed and its consequences described in previous studies, there is a paucity of research on the elements that could explain such an outcome. We first suggest that in the context of EMR systems we are in presence of a "tiered ceiling effect" and then we show why such phenomenon occurs...
April 20, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28423156/creation-of-an-internal-teledermatology-store-and-forward-system-in-an-existing-electronic-health-record-a-pilot-study-in-a-safety-net-public-health-and-hospital-system
#3
Zachary A Carter, Shauna Goldman, Kristen Anderson, Xiaxiao Li, Linda S Hynan, Benjamin F Chong, Arturo R Dominguez
Importance: External store-and-forward (SAF) teledermatology systems operate separately from the primary health record and have many limitations, including care fragmentation, inadequate communication among clinicians, and privacy and security concerns, among others. Development of internal SAF workflows within existing electronic health records (EHRs) should be the standard for large health care organizations for delivering high-quality dermatologic care, improving access, and capturing other telemedicine benchmark data...
April 19, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/28416242/human-papillomavirus-and-oral-squamous-cell-carcinoma-a-review-of-hpv-positive-oral-squamous-cell-carcinoma-and-possible-strategies-for-future
#4
REVIEW
Shan Jiang, Yong Dong
Oral squamous cell carcinoma (OSCC) is a common cancer worldwide. Besides tobacco use and alcohol consumption, human papillomavirus (HPV) infection has also been identified as a risk factor for OSCC recently. The OSCC incidence has increased in recent years, especially among younger women. The purpose of this article is to review clinical and epidemiological studies on the association between HPV infection and OSCCs, and the efficacy of HPV vaccine, so as to provide possible policy implications for preventing HPV-positive OSCC...
March 1, 2017: Current Problems in Cancer
https://www.readbyqxmd.com/read/28412946/big-data-and-data-repurposing-using-existing-data-to-answer-new-questions-in-vascular-dementia-research
#5
Fergus N Doubal, Myzoon Ali, G David Batty, Andreas Charidimou, Maria Eriksdotter, Martin Hofmann-Apitius, Yun-Hee Kim, Deborah A Levine, Gillian Mead, Hermann A M Mucke, Craig W Ritchie, Charlotte J Roberts, Tom C Russ, Robert Stewart, William Whiteley, Terence J Quinn
INTRODUCTION: Traditional approaches to clinical research have, as yet, failed to provide effective treatments for vascular dementia (VaD). Novel approaches to collation and synthesis of data may allow for time and cost efficient hypothesis generating and testing. These approaches may have particular utility in helping us understand and treat a complex condition such as VaD. METHODS: We present an overview of new uses for existing data to progress VaD research. The overview is the result of consultation with various stakeholders, focused literature review and learning from the group's experience of successful approaches to data repurposing...
April 17, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28408759/reliably-estimating-prevalences-of-atopic-children-an-epidemiological-study-in-an-extensive-and-representative-primary-care-database
#6
David H J Pols, Mark M J Nielen, Joke C Korevaar, Patrick J E Bindels, Arthur M Bohnen
Electronic health records stored in primary care databases might be a valuable source to study the epidemiology of atopic disorders and their impact on health-care systems and costs. However, the prevalence of atopic disorders in such databases varies considerably and needs to be addressed. For this study, all children aged 0-18 years listed in a representative primary care database in the period 2002-2014, with sufficient data quality, were selected. The effects of four different strategies on the prevalences of atopic disorders were examined: (1) the first strategy examined the diagnosis as recorded in the electronic health records, whereas the (2) second used additional requirements (i...
April 13, 2017: NPJ Primary Care Respiratory Medicine
https://www.readbyqxmd.com/read/28400992/implementation-of-a-software-application-for-presurgical-case-history-review-of-frozen-section-pathology-cases
#7
Andrew P Norgan, Mathew L Okeson, Justin E Juskewitch, Kabeer K Shah, William R Sukov
BACKGROUND: The frozen section pathology practice at Mayo Clinic in Rochester performs ~20,000 intraoperative consultations a year (~70-80/weekday). To prepare for intraoperative consultations, surgical pathology fellows and residents review the case history, previous pathology, and relevant imaging the day before surgery. Before the work described herein, review of pending surgical pathology cases was a paper-based process requiring handwritten transcription from the electronic health record, a laborious and potentially error prone process...
2017: Journal of Pathology Informatics
https://www.readbyqxmd.com/read/28399129/the-effects-of-implementing-a-point-of-care-electronic-template-to-prompt-routine-anxiety-and-depression-screening-in-patients-consulting-for-osteoarthritis-the-primary-care-osteoarthritis-trial-a-cluster-randomised-trial-in-primary-care
#8
Christian D Mallen, Barbara I Nicholl, Martyn Lewis, Bernadette Bartlam, Daniel Green, Sue Jowett, Jesse Kigozi, John Belcher, Kris Clarkson, Zoe Lingard, Christopher Pope, Carolyn A Chew-Graham, Peter Croft, Elaine M Hay, George Peat
BACKGROUND: This study aimed to evaluate whether prompting general practitioners (GPs) to routinely assess and manage anxiety and depression in patients consulting with osteoarthritis (OA) improves pain outcomes. METHODS AND FINDINGS: We conducted a cluster randomised controlled trial involving 45 English general practices. In intervention practices, patients aged ≥45 y consulting with OA received point-of-care anxiety and depression screening by the GP, prompted by an automated electronic template comprising five questions (a two-item Patient Health Questionnaire-2 for depression, a two-item Generalized Anxiety Disorder-2 questionnaire for anxiety, and a question about current pain intensity [0-10 numerical rating scale])...
April 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28398923/the-association-between-visiting-intensivists-and-icu-outcomes
#9
Tony Whitehouse, James Hodson, Philip Pemberton, Tonny Veenith, Catherine Snelson, Julian Bion, Gordon D Rubenfeld
OBJECTIVES: We hypothesized that intensivists unfamiliar with an ICU team and the context of that ICU would affect patient outcomes. We examined differences in mortality when ICU patients were admitted under intensivists routinely working in that ICU and compared with those admitted by intensivists familiar with an ICU elsewhere in the same hospital. DESIGN, SETTINGS, AND PATIENTS: A 5-year natural experimental crossover study involving patients admitted to four ICUs in a large U...
April 10, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28392728/external-quality-assessment-beyond-the-analytical-phase-an-australian-perspective
#10
REVIEW
Tony Badrick, Stephanie Gay, Euan J McCaughey, Andrew Georgiou
External Quality Assessment (EQA) is the verification, on a recurring basis, that laboratory results conform to expectations for the quality required for patient care. It is now widely recognised that both the pre- and post-laboratory phase of testing, termed the diagnostic phases, are a significant source of laboratory errors. These errors have a direct impact on both the effectiveness of the laboratory and patient safety. Despite this, Australian laboratories tend to be focussed on very narrow concepts of EQA, primarily surrounding test accuracy, with little in the way of EQA programs for the diagnostic phases...
February 15, 2017: Biochemia Medica: časopis Hrvatskoga Društva Medicinskih Biokemičara
https://www.readbyqxmd.com/read/28391419/do-consultants-follow-up-on-tests-they-recommend-insights-from-an-academic-inpatient-gastrointestinal-consult-service
#11
Benjamin E Cassell, Ted Walker, Saad Alghamdi, Jason Bill, Pierre Blais, Harold Boutté, Jeffrey W Brown, Gregory S Sayuk, C Prakash Gyawali
BACKGROUND: Inpatient care is a fundamental part of gastroenterology training and involves the recommendation, performance, and interpretation of diagnostic tests. However, test results are not always communicated to patients or treating providers. We determined the process of communication of test results and recommendations in our inpatient gastroenterology (GI) consult service. METHODS: Test recommendations on 304 consecutive new GI consults (age 60.2 ± 1...
April 8, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28391236/study-on-the-utility-of-a-statewide-counselling-programme-for-improving-mortality-outcomes-of-patients-with-staphylococcus-aureus-bacteraemia-in-thuringia-support-a-study-protocol-of-a-cluster-randomised-crossover-trial
#12
S Weis, S Hagel, R P H Schmitz, A Scherag, F M Brunkhorst, C Forstner, B Löffler, M W Pletz
INTRODUCTION: Staphylococcus aureus bacteraemia (SAB) is a frequent infection with high mortality rates. It requires specific diagnostic and therapeutic management such as prolonged intravenous administration of antibiotics and aggressive search for and control of infectious sources. Underestimation of disease severity frequently results in delayed or inappropriate management of patients with SAB leading to increased mortality rates. According to observational studies, patient counselling by infectious disease consultants (IDC) improves survival and reduces the length of hospital stay as well as complication rates...
April 8, 2017: BMJ Open
https://www.readbyqxmd.com/read/28389399/integrating-musculoskeletal-education-and-patient-care-at-medical-student-run-free-clinics
#13
Thomas McQuillan, Nate Wilcox-Fogel, Emily Kraus, Amy Ladd, Michael Fredericson
BACKGROUND: Student-run free clinics (SRFCs) have emerged as an important educational component of United States (US) medical schools. Despite the prevalence of musculoskeletal (MSK) problems presenting to SRFCs, students and clinics are often unprepared to diagnose and treat common MSK complaints. OBJECTIVE: We sought to determine the scope of diagnosis and treatment at a medical student-run free clinic specializing in musculoskeletal care utilizing physical medicine and rehabilitation (PM&R) residents...
April 4, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28387062/association-of-coloproctology-of-great-britain-and-ireland-consensus-exercise-on-surgical-management-of-fistulating-perianal-crohn-s-disease
#14
M J Lee, N Heywood, P M Sagar, S R Brown, N S Fearnhead
BACKGROUND: Management of fistulating perianal Crohn's disease (fpCD) is a significant challenge for a colorectal surgeon. A recent survey of surgical practice in this condition showed variation in management approaches. As a result we set out to devise recommendations for practice for UK colorectal surgeons. METHODS: Results from a national survey were used to devise a set of potential consensus statements. Consultant colorectal surgeons were invited to participate in the exercise via the previous survey and the mailing list of the professional society...
April 7, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28381721/regulatory-science-in-practice-pharmaceuticals-and-medical-devices-agency
#15
Taisuke Hojo
 Review, safety, and relief services of the Pharmaceuticals and Medical Devices Agency are primarily focused on scientifically evaluating pharmaceuticals, medical devices, and cellular and tissue-based products referring to their quality, efficacy, and safety, which requires a variety of scientific knowledge and methods. Pharmaceutical regulation should be established based on the most advanced scientific expertise at all times. In order to evaluate products that use cutting-edge technology such as induced pluripotent stem cells and information and communication technology adequately, since fiscal year 2012 the Science Committee has been established as a platform to exchange opinions among members from top-ranking domestic and international academia and to enhance personnel exchanges through the Initiative to Facilitate Development of Innovative Drugs...
2017: Yakugaku Zasshi: Journal of the Pharmaceutical Society of Japan
https://www.readbyqxmd.com/read/28379326/an-automated-pharmacist-driven-initiative-improves-quality-of-care-for-staphylococcus-aureus-bacteremia
#16
Eric Wenzler, Fei Wang, Debra A Goff, Beth Prier, John Mellett, Julie E Mangino, Karri A Bauer
Background: Infectious diseases (ID) consultation and antimicrobial stewardship intervention have been shown to improve the management of Staphylococcus aureus bacteremia (SAB). As the workload of antimicrobial stewardship programs (ASPs) continues to increase, ASPs must find a way to maximize the efficiency of the program while optimizing patient outcomes. The objective of this study was to evaluate the impact of incorporating health informatics into the management of SAB via a pharmacist-driven initiative...
April 4, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28373173/prognosis-of-undiagnosed-chest-pain-linked-electronic-health-record-cohort-study
#17
MULTICENTER STUDY
Kelvin P Jordan, Adam Timmis, Peter Croft, Danielle A van der Windt, Spiros Denaxas, Arturo González-Izquierdo, Richard A Hayward, Pablo Perel, Harry Hemingway
Objective To ascertain long term cardiovascular outcomes in patients whose chest pain remained undiagnosed six months after first presentation.Design Cohort study.Setting UK electronic health record database (CALIBER) linking primary care, secondary care, coronary registry, and death registry information.Participants 172 180 adults aged ≥18 from 223 general practices presenting with a first episode of recorded chest pain, classified from medical records as diagnosed (non-coronary condition or angina) or undiagnosed (cause unattributed) at first consultation between 2002 and 2009 and with no previous record of cardiovascular disease...
April 3, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28370604/guideline-based-clinical-decision-support-in-acne-patients-receiving-isotretinoin-improving-adherence-and-cost-effectiveness
#18
R J Borgonjen, J A de Lange, P C M van de Kerkhof
Clinical practice guidelines have proven to be a tool for condensing the overwhelming quantity of (new) medical knowledge. However, there are barriers to implementation and adherence.(1,2) Often guidelines are still bulky texts that do not support in finding patient-specific recommendations.(2,3) Aforementioned barriers stimulated the development of clinical decision support (CDS) systems, which could ultimately be incorporated into electronic health records. CDS modifies clinician behavior through recommendations of specific actions...
March 29, 2017: Journal of the European Academy of Dermatology and Venereology: JEADV
https://www.readbyqxmd.com/read/28370246/electronic-health-records-and-the-disappearing-patient
#19
Linda M Hunt, Hannah S Bell, Allison M Baker, Heather A Howard
With rapid consolidation of American medicine into large-scale corporations, corporate strategies are coming to the forefront in health care delivery, requiring a dramatic increase in the amount and detail of documentation, implemented through use of electronic health records (EHRs). EHRs are structured to prioritize the interests of a myriad of political and corporate stakeholders, resulting in a complex, multi-layered, and cumbersome health records system, largely not directly relevant to clinical care. Drawing on observations conducted in outpatient specialty clinics, we consider how EHRs prioritize institutional needs manifested as a long list of requisites that must be documented with each consultation...
March 31, 2017: Medical Anthropology Quarterly
https://www.readbyqxmd.com/read/28359387/how-to-improve-opportunistic-screening-by-using-emrs-and-other-data-the-prevalence-of-undetected-diabetes-mellitus-in-target-population-in-croatia
#20
M Vrca Botica, L Carkaxhiu, J Kern, I Pavlić Renar, I Botica, I Zelić, D Iliev, A Vrca
OBJECTIVES: Opportunistic screening for type 2 diabetes (T2D) has not been adopted as part of routine practice. The aim of the study was to investigate the yield of opportunistic target screening for T2D in Croatia and to evaluate the process of screening by using data from electronic medical record. STUDY DESIGN: We conducted opportunistic screening in 23 general practitioners (GPs) in a population of 13,344 patients aged 45-70 years. METHODS: First, after excluding patients with T2D, patients with risk factors for T2D were derived from the electronic medical record and GP's assessment during the preconsultation phase...
April 2017: Public Health
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