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https://www.readbyqxmd.com/read/28528537/intraoperative-mechanical-ventilation-state-of-the-art
#1
Lorenzo Ball, Federico Costantino, Giulia Orefice, Karthikka Chandrapatham, Paolo Pelosi
Mechanical ventilation is a cornerstone of the intraoperative management of the surgical patient and is still mandatory in several surgical procedures. In the last decades, research focused on preventing postoperative pulmonary complications (PPCs), both improving risk stratification through the use of predictive scores and protecting the lung adopting so-called protective ventilation strategies. The aim of this review is to give an up-to-date overview of the currently suggested intraoperative ventilation strategies, along with their pathophysiologic rationale, with a focus on challenging conditions, such as obesity, one-lung ventilation and cardiopulmonary bypass...
May 19, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28528365/the-value-of-evidence-in-the-decision-making-process-for-reimbursement-of-pharmacogenetic-dosing-of-warfarin
#2
Andrej Janzic, Igor Locatelli, Mitja Kos
BACKGROUND: After early clinical trials that evaluated pharmacogenetic (PG) algorithms, many healthcare payers were reluctant to cover this technology and, consequently, PG dosing of warfarin could not be translated into clinical practice. OBJECTIVE: The aim of this study was to estimate the value of upgrading evidence relating to PG dosing of warfarin from the healthcare payer perspective. METHODS: Randomized controlled trials (RCTs) that evaluated PG dosing of warfarin were identified through a systematic literature search, and their findings were combined by a cumulative meta-analysis...
May 20, 2017: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/28528171/accountable-care-organizations-and-the-use-of-cancer-screening
#3
Christian P Meyer, Anna Krasnova, Jesse D Sammon, Stuart R Lipsitz, Joel S Weissman, Maxine Sun, Quoc-Dien Trinh
Cancer preventive services, when used appropriately, result in improved health, better quality of life and decreased costs. For these reasons, cancer preventive services represent important priorities within the Affordable Care Act (ACA). Among the many provisions to improve access to preventive services the ACA introduced Accountable Care Organizations (ACOs) as trajectory to deliver coordinated, high-quality care. In order to evaluate this benchmark, we analyzed (in 2016/Boston) screening prevalence of breast cancer, a recommended screening test according to the United States Preventive Services Task Force (USPSTF), and prostate cancer, for which screening is no longer recommended by the USPSTF, among traditional Medicare beneficiaries and those enrolled in ACOs...
May 17, 2017: Preventive Medicine
https://www.readbyqxmd.com/read/28527931/predictors-of-surgical-site-infection-after-open-lower-extremity-revascularization
#4
Frank M Davis, Danielle C Sutzko, Scott F Grey, M Ashraf Mansour, Krishna M Jain, Timothy J Nypaver, Greg Gaborek, Peter K Henke
OBJECTIVE: Surgical site infection (SSI) after open lower extremity bypass (LEB) is a serious complication leading to an increased rate of graft failure, hospital readmission, and health care costs. This study sought to identify predictors of SSI after LEB for arterial occlusive disease and also potential modifiable factors to improve outcomes. METHODS: Data from a statewide cardiovascular consortium of 35 hospitals were used to obtain demographic, procedural, and hospital risk factors for patients undergoing elective or urgent open LEB between January 2012 and June 2015...
June 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28527794/farmers-preferences-for-automatic-lameness-detection-systems-in-dairy-cattle
#5
T Van De Gucht, W Saeys, A Van Nuffel, L Pluym, K Piccart, L Lauwers, J Vangeyte, S Van Weyenberg
As lameness is a major health problem in dairy herds, a lot of attention goes to the development of automated lameness-detection systems. Few systems have made it to the market, as most are currently still in development. To get these systems ready for practice, developers need to define which system characteristics are important for the farmers as end users. In this study, farmers' preferences for the different characteristics of proposed lameness-detection systems were investigated. In addition, the influence of sociodemographic and farm characteristics on farmers' preferences was assessed...
May 17, 2017: Journal of Dairy Science
https://www.readbyqxmd.com/read/28527755/perioperative-neurologic-complications-during-spinal-fusion-surgery-incidence-and-trends
#6
Parthasarathy Thirumala, James Zhou, Piruthiviraj Natarajan, Jeffrey Balzer, Edward Dixon, David Okonkwo, D K Hamilton
BACKGROUND CONTEXT: Perioperative neurologic complications after spine surgery may increase morbidity and healthcare costs related to the procedure. PURPOSE: We estimate the national incidence of perioperative neurologic complications following anterior cervical discectomy and fusion (ACDF), posterior cervical fusion, and thoracolumbar fusion procedures using the Nationwide Inpatient Sample (NIS) data from 1999 to 2011. Additionally, we identify risk factors for developing perioperative neurologic complications and the effects of these injuries on quantifiable patient outcomes...
May 17, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28527687/cost-effectiveness-analysis-of-typhoid-conjugate-vaccines-in-five-endemic-low-and-middle-income-settings
#7
Marina Antillón, Joke Bilcke, A David Paltiel, Virginia E Pitzer
BACKGROUND: Typhoid fever remains endemic in low- and middle-income countries. Programmatic use of existing vaccines is limited, but upcoming typhoid conjugate vaccines (TCVs) could warrant wider use. We evaluated the cost-effectiveness of five TCV delivery strategies in three urban areas (Delhi and Kolkata, India and Nairobi, Kenya) and two rural settings (Lwak, Kenya and Dong Thap, Vietnam) with varying incidence. METHODS AND FINDINGS: We evaluated routine infant vaccination with and without catch-up campaigns among older individuals...
May 17, 2017: Vaccine
https://www.readbyqxmd.com/read/28527657/clinical-outcomes-and-cost-effectiveness-of-brief-guided-parent-delivered-cognitive-behavioural-therapy-and-solution-focused-brief-therapy-for-treatment-of-childhood-anxiety-disorders-a-randomised-controlled-trial
#8
Cathy Creswell, Mara Violato, Hannah Fairbanks, Elizabeth White, Monika Parkinson, Gemma Abitabile, Alessandro Leidi, Peter J Cooper
BACKGROUND: Half of all lifetime anxiety disorders emerge before age 12 years; however, access to evidence-based psychological therapies for affected children is poor. We aimed to compare the clinical outcomes and cost-effectiveness of two brief psychological treatments for children with anxiety referred to routine child mental health settings. We hypothesised that brief guided parent-delivered cognitive behavioural therapy (CBT) would be associated with better clinical outcomes than solution-focused brief therapy and would be cost-effective...
May 17, 2017: Lancet Psychiatry
https://www.readbyqxmd.com/read/28527495/consumer-mobile-health-apps-current-state-barriers-and-future-directions
#9
REVIEW
Cheng-Kai Kao, David M Liebovitz
This paper discusses the current state, barriers, and future directions of consumer-facing applications (apps). There are currently more than 165,000 mobile health apps publicly available in major app stores, the vast majority of which are designed for patients. The top 2 categories are wellness management and disease management apps, whereas other categories include self-diagnosis, medication reminder, and electronic patient portal apps. Apps specific to physical medicine and rehabilitation also are reviewed...
May 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28527266/-risk-factors-associated-with-the-development-of-perinatal-asphyxia-in-neonates-at-the-hospital-universitario-del-valle-cali-colombia-2010-2011
#10
Javier Torres-Muñoz, Christian Rojas, Diana Mendoza-Urbano, Darly Marín-Cuero, Sandra Orobio, Carlos Echandía
INTRODUCTION: Perinatal asphyxia is one of the main causes of perinatal mortality and morbidity worldwide and it generates high costs for health systems; however, it has modifiable risk factors. OBJECTIVE: To identify the risk factors associated with the development of perinatal asphyxia in newborns at Hospital Universitario del Valle, Cali, Colombia. MATERIALS AND METHODS: Incident cases and concurrent controls were examined. Cases were defined as newborns with moderate to severe perinatal asphyxia who were older than or equal to 36 weeks of gestational age, needed advanced resuscitation and presented one of the following: early neurological disorders, multi-organ commitment or a sentinel event...
April 1, 2017: Biomédica: Revista del Instituto Nacional de Salud
https://www.readbyqxmd.com/read/28527158/asymptomatic-cryptococcal-antigenemia-in-people-living-with-hiv-plhiv-with-severe-immunosuppression-is-routine-crag-screening-indicated-in-india
#11
S Anuradha, Abhaya Narayana H, Richa Dewan, Ravinder Kaur, K Rajeshwari
BACKGROUND: Cryptococcal meningitis (CM) is a common, life-threatening opportunistic infection (OI) among people living with HIV (PLHIV) in India. Serum Cryptococcal antigen (CrAg) positivity is predictive of future occurrence of CM and pre-emptive treatment reduces its mortality. Routine CrAg screening among PLHIV is not adopted by India's national programme. This study evaluated the prevalence of CrAg and assessed CrAg positivity in predicting all-cause mortality among PLHIV. METHODS: This prospective study was conducted in a tertiary care, public health facility in New Delhi, India...
April 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/28526721/health-care-resource-utilization-and-associated-costs-among-metastatic-cutaneous-melanoma-patients-treated-with-ipilimumab-intuition-study
#12
Grant A McArthur, Peter Mohr, Paolo Antonio Ascierto, Ana Arance, Ana Banos Hernaez, Peter Kaskel, Michael Weichenthal, Reshma Shinde, Kendall Stevinson
BACKGROUND: There are limited real-world data on health care resource utilization (HCRU) among advanced melanoma patients. The objective of this study was to describe HCRU and health care costs associated with the management of advanced melanoma patients receiving ipilimumab. METHODS: This retrospective multinational, observational study included advanced melanoma patients from Australia, Germany, Italy, and Spain who had received at least 1 dose of ipilimumab. Data extracted from medical charts included inpatient admissions, outpatient visits, surgical procedures, laboratory investigations, radiation therapy, imaging studies, and concomitant medications...
May 19, 2017: Oncologist
https://www.readbyqxmd.com/read/28526311/dramatic-effects-of-a-new-antimicrobial-stewardship-program-in-a-rural-community-hospital
#13
Claudia R Libertin, Stephanie H Watson, William L Tillett, Joy H Peterson
BACKGROUND: New Joint Commission antimicrobial stewardship requirements took effect on January 1, 2017, promoted as a central strategy for coping with the emerging problems of antimicrobial resistance and Clostridium difficile infection. Our objective was to measure the effects of a new antimicrobial stewardship program (ASP) in a rural community hospital with no prior ASP, in the context of having a new infectious disease specialist on staff. METHODS: An ASP team was formed to implement a prospective audit with health care provider feedback and targeting 12 antimicrobial agents in a rural hospital in Georgia...
May 16, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28526229/cost-benefit-analysis-of-robotic-surgery-in-gynaecological-oncology
#14
REVIEW
Christos Iavazzo, Ioannis D Gkegkes
Robotic approach is a rather new technique that can be used to optimise the management of patients with gynaecological cancer. However, concerns have been raised regarding the cost of such an approach compared to laparoscopic or open techniques. The aim of our chapter is to review the data of papers published so far that analyse the cost of robotic gynaecological oncology. A systematic review of the current literature was performed trying to assess the cost of the robotic technique including parameters that affect it and ways to minimise it in favour of the patients and health care systems...
April 23, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28526163/new-hypnotic-drug-development-and-pharmacologic-considerations-for-clinical-anesthesia
#15
REVIEW
Mariah Kincaid Tanious, Sascha S Beutler, Alan D Kaye, Richard D Urman
Since the public demonstration of ether as a novel, viable anesthetic for surgery in 1846, the field of anesthesia has continually sought the ideal anesthetic-rapid onset, potent sedation-hypnosis with a high therapeutic ratio of toxic dose to minimally effective dose, predictable clearance to inactive metabolites, and minimal side effects. This article aims to review current progress of novel induction agent development and provide an update on the most promising drugs poised to enter clinical practice. In addition, the authors describe trends in novel agent development, implications for health care costs, and implications for perioperative care...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28526152/pharmacologic-properties-of-novel-local-anesthetic-agents-in-anesthesia-practice
#16
REVIEW
Chih H King, Sascha S Beutler, Alan D Kaye, Richard D Urman
Therapeutic duration of traditional local anesthetics when used in peripheral nerve blocks is normally limited. This article describes novel approaches to extend the duration of peripheral nerve blocks currently available or in development. Three newer approaches on extending the duration of peripheral nerve blocks include site-1 sodium channel blockers, novel local anesthetics delivery systems, and novel adjuvants of local anesthetics. Compared with plain amide-based and ester-based local anesthetics, alternative approaches show significant promise in decreasing postoperative pain, rescue opioid requirement, hospital length-of-stay, and overall health care cost, without compromising the established safety profile of traditional local anesthetics...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28526095/improving-hospital-based-end-of-life-care-processes-and-outcomes-a-systematic-review-of-research-output-quality-and-effectiveness
#17
Amy Waller, Natalie Dodd, Martin H N Tattersall, Balakrishnan Nair, Rob Sanson-Fisher
BACKGROUND: As in other areas of health delivery, there is a need to ensure that end-of-life care is guided by patient centred research. A systematic review was undertaken to examine the quantity and quality of data-based research aimed at improving the (a) processes and (b) outcomes associated with delivering end-of-life care in hospital settings. METHODS: Medline, EMBASE and Cochrane databases were searched between 1995 and 2015 for data-based papers. Eligible papers were classified as descriptive, measurement or intervention studies...
May 19, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28526062/polypharmacy-in-multimorbid-older-adults-protocol-for-a-systematic-review
#18
Caroline Sirois, Marie-Laure Laroche, Line Guénette, Edeltraut Kröger, Dan Cooper, Valérie Émond
BACKGROUND: Polypharmacy, the concurrent use of multiple medications, consistently evokes a negative connotation, notably because it is associated with a plethora of adverse events. Nonetheless, the number of individuals exposed to polypharmacy is increasing steeply, especially for older people with multiple diseases. There is a need to carefully study the phenomenon at the population scale to full assess the associated health outcomes. Yet, this reveals a complex task because there exists no consensus indicator of polypharmacy...
May 19, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28526046/balloon-versus-stenting-in-severe-ischaemia-of-the-leg-3-basil-3-study-protocol-for-a-randomised-controlled-trial
#19
Benjamin D Hunt, Matthew A Popplewell, Huw Davies, Lewis Meecham, Hugh Jarrett, Gareth Bate, Margaret Grant, Smitaa Patel, Catherine Hewitt, Lazaros Andronis, Jonathan J Deeks, Andrew Bradbury
BACKGROUND: Severe limb ischaemia (SLI) is defined as the presence of rest pain and/or tissue loss secondary to lower extremity atherosclerotic peripheral arterial disease. The superficial femoral and popliteal arteries are the most commonly diseased vessels in such patients and are being increasingly treated using endovascular revascularisation techniques. However, it is currently unknown whether drug-eluting stents and drug-coated balloons confer additional clinical benefits over more established techniques using plain balloons and bare metal stents, or whether they represent a cost-effective use of NHS resources...
May 19, 2017: Trials
https://www.readbyqxmd.com/read/28526022/a-descriptive-cross-sectional-study-of-medical-student-preferences-for-vodcast-design-format-and-pedagogical-approach
#20
Robin K Pettit, Marjorie Kinney, Lise McCoy
BACKGROUND: Vodcasts (video podcasts) are becoming increasingly popular in medical education. At A.T. Still University School of Osteopathic Medicine in Arizona (ATSU SOMA), vodcasts are an essential component of our blended learning environment, where year 2-4 students train in a contextual setting at community health centers across the U.S. Vodcasts are used far less frequently in our year 1 residential learning environment at the main campus in Arizona, but we are considering moving to significantly more interactive educational experiences with on-demand videos followed by in-class activities...
May 19, 2017: BMC Medical Education
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