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Christopher A Caulfield, John Stephens, Zarina Sharalaya, Jeffrey P Laux, Carlton Moore, Daniel E Jonas, Edmund A Liles
OBJECTIVES: To describe the characteristics and outcomes of patients discharged from the emergency department (ED) by hospitalist physicians. STUDY DESIGN: Retrospective cohort study at a tertiary academic medical center. METHODS: We used consultation Current Procedural Technology codes to identify patients discharged from the ED after referral for hospitalist admission from April 2011 to April 2014. We report patient demographics and primary diagnoses...
March 2018: American Journal of Managed Care
Michael E Reschen, Andrea Mazzella, Edward Sharples
Background and aims: Dysfunction of a kidney transplant often requires histological sampling by percutaneous ultrasound-guided core needle biopsy. Transplant biopsy is more specialized than native kidney biopsy, the indications and complications are less well defined and in England are performed mainly by nephrologists. The aims of the study were to evaluate the adequacy and complication rate in living and deceased donor recipients according to training status of the nephrologist, assess the accuracy of physicians in predicting rejection, the threshold creatinine rise for biopsy, and the change in drug management post-biopsy...
April 2018: Annals of Medicine and Surgery
Brian Shiner, Christine Leonard Westgate, Vanessa Simiola, Richard Thompson, Paula P Schnurr, Joan M Cook
Objective: Available studies on implementation of evidence-based psychotherapy (EBP) for patients attending Department of Veterans Affairs (VA) residential post-traumatic stress disorder (PTSD) programs rely on therapist self-report of EBP delivery. Patient-level data on receipt of EBP are needed both to corroborate therapist self-report and to understand patient factors that predict receipt of EBPs for PTSD. Materials and Methods: We identified 159 therapists from 38 VA residential PTSD programs who responded to a survey about EBP implementation during the 2015 fiscal year (FY15)...
March 14, 2018: Military Medicine
James E McNicholas
No abstract text is available yet for this article.
March 13, 2018: Military Medicine
Mark T Corkum, Wei Liu, David A Palma, Glenn S Bauman, Robert E Dinniwell, Andrew Warner, Mark V Mishra, Alexander V Louie
BACKGROUND: Cancer patients frequently search the Internet for treatment options, and hospital websites are seen as reliable sources of knowledge. Guidelines support the use of proton radiotherapy in specific disease sites or on clinical trials. This study aims to evaluate direct-to-consumer advertising content and claims made by proton therapy centre (PTC) websites worldwide. METHODS: Operational PTC websites in English were identified through the Particle Therapy Co-Operative Group website...
March 15, 2018: Radiation Oncology
Ana E López-Pérez, Kulmira Nurgali, Raquel Abalo
Beyond their well-known role in embryonic development of the central and peripheral nervous system, neurotrophins, particularly nerve growth factor and brain-derived neurotrophic factor, exert an essential role in pain production and sensitization. This has mainly been studied within the framework of somatic pain, and even antibodies (tanezumab and fasinumab) have recently been developed for their use in chronic somatic painful conditions, such as osteoarthritis or low back pain. However, data suggest that neurotrophins also exert an important role in the occurrence of visceral pain and visceral sensitization...
April 2018: Behavioural Pharmacology
Klaus Griesar, John Bessant, Sabine Bernschneider-Reif
The elephant is in the room-a metaphorical idiom for an obvious problem or risk that nobody wants to discuss. This abstract is not intended to be a summary, to reveal major findings, or unveil conclusions. On the contrary, it is aimed to provoke curiosity as to the question of corporate survival. Is there any recipe to be followed for companies to achieve this? The answer comes neither from the modest and traditional study rooms of philosophers nor the recent fact-based studies from the offices (and well-paid opinions) of business consultants...
March 15, 2018: Angewandte Chemie
L Vincze, M E Rollo, M J Hutchesson, R Callister, C E Collins
BACKGROUND: A tailored approach to nutrition and physical activity advice can support women following childbirth in managing barriers (i.e. time and childcare) to making healthy lifestyle changes. The aim of the present study was to evaluate the implementation, acceptability and preliminary efficacy of a personally tailored nutrition and exercise programme for postpartum women delivered via video-consultations by an accredited practising dietitian (APD) and accredited exercise physiologist (AEP)...
March 15, 2018: Journal of Human Nutrition and Dietetics: the Official Journal of the British Dietetic Association
Saeedullah Jan, Abid Hussain, Muhammad Ibrahim, Sarah Saeed
This study was planned to examine the hard and soft form of learning resources available on the internet accessed by the teaching faculty. This study was conducted at the Peshawar Medical College, Peshawar, Pakistan from January 2to April 2017. As the target population was not too large, no sampling technique was employed and census-based approach was adopted. For data collection, the pre-tested questionnaire was distributed among 115 faculty members of both basic and clinical sciences groups with a response rate of 66(57...
March 2018: JPMA. the Journal of the Pakistan Medical Association
Sophia M Schermerhorn, Paul J Auchincloss, Kyle Kraft, Kenneth J Nelson, Jeremy C Pamplin
Review the management of a patient with acute patella fracture supported by telemedical consultation. Clinical Context: Regionally Aligned Forces (RAF) supporting US Army Africa/Southern European Task Force (USARAF/ SETAF) in Africa Command area of responsibility. Care was provided by a Role I facility on the compound. Organic Expertise: Three 68W combat medics; one Special Operations Combat Medic (SOCM). Closest Medical Support: Organic battalion physician assistant (PA) located in the United States; USARAF PA located in a European country; French Role II located in nearby West African country; telemedical consults via e-mail, phone, or videoteleconsultation...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Lisa D DiMartino, Sarah A Birken, Laura C Hanson, Justin G Trogdon, Alecia S Clary, Morris Weinberger, Katherine Reeder-Hayes, Bryan J Weiner
BACKGROUND: The implementation science literature has contributed important insights regarding the influence of formal policies and practices on health care innovation implementation, whereas informal implementation policies and practices have garnered little attention. The broader literature suggests that informal implementation policies and practices could also influence innovation use. PURPOSE: We used the Organizational Theory of Innovation Implementation to further understand the role of formal and informal implementation policies and practices as determinants of implementation effectiveness...
March 12, 2018: Health Care Management Review
John W Wax, Amy W An, Nicole Kosier, Timothy E Quill
Voluntary stopping of eating and drinking (VSED) is a deliberate, self-initiated attempt to hasten death in the setting of suffering refractory to optimal palliative interventions or prolonged dying that a person finds intolerable. Individuals who consider VSED tend to be older, have a serious but not always imminently terminal illness, place a high value on independence, and have significant illness burden. VSED can theoretically be performed independent of clinician assistance and therefore avoids many of the ethical and legal concerns associated with physician-assisted dying or other palliative measures of last resort, However, VSED is an intense process fraught with new sources of somatic and emotional suffering for individuals and their caregivers, so VSED is best supervised by an experienced, well-informed clinician who can provide appropriate pre-intervention assessment, anticipatory guidance, medical treatment of symptoms, and emotional support...
March 2018: Journal of the American Geriatrics Society
David E Winchester, Kristopher Kline, Christopher Estel, Dhruv Mahtta, Sean Taasan, Franck W Peacock
Background: The impact of cardiac troponin (cTn) testing on the downstream use of cardiovascular services is not well understood. We conducted this large-scale single centre cohort study to investigate the patterns of testing that result from the use of cTn. Methods: We conducted this investigation using data collected between 1 January 2013 and 18 December 2015 from an academically affiliated tertiary care centre. Data from all hospitalised patients evaluated with cTn (Roche Elecsys cTn-T) assay were collected from our integrated data repository and divided into two cohorts: all cTn assays negative (<0...
2018: Open Heart
Carl Joakim Brandt, Jane Clemensen, Jesper Bo Nielsen, Jens Søndergaard
OBJECTIVES: Assisting patients in lifestyle change using collaborative e-health tools can be an efficient treatment for non-communicable diseases like diabetes, cardiovascular disease and chronic obstructive lung disease that are caused or aggravated by unhealthy living in the form of unhealthy diet, physical inactivity or tobacco smoking. In a prospective pilot study, we tested an online collaborative e-health tool in general practice. The aim of this study was to identify drivers of importance for long-term personal lifestyle changes from a patient perspective when using a collaborative e-health tool, including the support of peers and healthcare professionals...
March 12, 2018: BMJ Open
G Legendre, L Delbos, E Hudon, N Chabbert-Buffet, S Geoffron, M Sauvan, H Fernandez, P-E Bouet, P Descamps
OBJECTIVE: The objective of this work is to evaluate the place of new treatments in the management of endometriosis outside the context of infertility. METHODS: A review of the literature was conducted by consulting Medline data until July 2017. RESULTS: Dienogest is effective compared to placebo in short term (NP2) and long term (NP4) for the treatment of painful endometriosis. In comparison with GnRH agonists, dienogest is also effective in terms of decreased pain and improved quality of life in non-operated patients (NP2) as well as for recurrence of lesions and symptomatology postoperatively (NP2)...
March 9, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
Graham McGeoch, Kieran Holland, Melissa Kerdemelidis, Nikki Elliot, Brett Shand, Catherine Fink, Anne Dixon, Carolyn Gullery
INTRODUCTION Unmet needs are a key indicator of the success of a health system. Clinicians and funders in Christchurch, Canterbury, New Zealand were concerned that unmet health need was hidden. AIM The aim of this survey was to estimate the proportion of patients attending general practice who were unable to access clinically indicated referred services. METHODS The survey used a novel method to estimate unserviced health needs. General practitioners (GPs, n = 54) asked their patients (n = 2135) during a consultation about any health needs requiring a referred service...
December 2017: Journal of Primary Health Care
Katherine E Gallagher, Tusajigwe Erio, Kathy Baisley, Shelley Lees, Deborah Watson-Jones
BACKGROUND: The burden of cervical cancer and shortage of screening services in Tanzania confers an urgent need for human papillomavirus (HPV) vaccination. However, the sustainability and impact of another new vaccine campaign in an under-resourced health system requires consideration. We aimed to determine the impact of the government's school-based HPV vaccine campaign in Kilimanjaro region on the provision of routine primary health services and staff workload. METHODS: Data on daily numbers of consultations were collected from health facility register books in 63 dispensaries and health centres in North-West Tanzania for 20 weeks in 2014...
March 12, 2018: BMC Health Services Research
Sara C Atehortúa, Luz H Lugo, Mateo Ceballos, Esteban Orozco, Paula A Castro, Juan C Arango, Heidi E Mateus
OBJECTIVES: To determine the cost-effectiveness ratio of different courses of action for the diagnosis of Duchenne or Becker muscular dystrophy in Colombia. METHODS: The cost-effectiveness analysis was performed from the Colombian health system perspective. Decision trees were constructed, and different courses of action were compared considering the following tests: immunohistochemistry (IHC), Western blot (WB), multiplex polymerase chain reaction, multiplex ligation-dependent probe amplification (MLPA), and the complete sequencing of the dystrophin gene...
March 9, 2018: Value in Health Regional Issues
Courtney D Nordeck, Christopher Welsh, Robert P Schwartz, Shannon Gwin Mitchell, Art Cohen, Kevin E O'Grady, Jan Gryczynski
BACKGROUND: Substance use disorders (SUD) are associated with non-adherence to medical care and high utilization of hospital services. This study characterized patterns and correlates of rehospitalization among patients seen by a hospital-based SUD consultation-liaison (CL) team. METHODS: This study was a retrospective medical record review of patients in a large urban academic hospital who received SUD consultation and were diagnosed with opioid, cocaine, and/or alcohol use disorder (N = 267)...
March 2, 2018: Drug and Alcohol Dependence
Sanders Chang, Peter May, Nathan E Goldstein, Juan Wisnivesky, Doran Ricks, David Fuld, Melissa Aldridge, Kenneth Rosenzweig, R Sean Morrison, Kavita V Dharmarajan
CONTEXT: Palliative radiation therapy (PRT) is a highly effective treatment in alleviating symptoms from bone metastases; however, currently used standard fractionation schedules can lead to costly care, especially when patients are treated in an inpatient setting. The Palliative Radiation Oncology Consult (PROC) service was developed in 2013 to improve appropriateness, timeliness, and care value from PRT. OBJECTIVE: Our primary objective was to compare total costs among two cohorts of inpatients with bone metastases treated with PRT before, or after, PROC establishment...
March 8, 2018: Journal of Pain and Symptom Management
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