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https://www.readbyqxmd.com/read/28441671/swimming-upstream-creating-a-culture-of-high-value-care
#1
Reshma Gupta, Christopher Moriates
As health system leaders strategize the best ways to encourage the transition toward value-based health care, the underlying culture-defined as a system of shared assumptions, values, beliefs, and norms existing within an environment-continues to shape clinician practice patterns. The current prevailing medical culture contributes to overtesting, overtreatment, and health care waste. Choosing Wisely lists, appropriateness criteria, and guidelines codify best practices, but academic medicine as a whole must recognize that faculty and trainees are all largely still operating within the same cultural climate...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28439421/factors-associated-with-cesarean-delivery-rates-a-single-institution-experience
#2
Spencer McClelland, Naomi Gorfinkle, Alan A Arslan, Maria Teresa Benedetto-Anzai, Teresa Cheon, Yuzuru Anzai
BACKGROUND: The aim of this study was to identify factors associated with variability in Cesarean delivery (CD) rates amongst providers at a single institution. METHODS: A retrospective cohort analysis was carried out on all births at NYU Langone Medical Center from 2005-2013. Data was collected for subjects and linked to diagnosis codes for singleton and twin deliveries. Descriptive characteristics were generated for all deliveries, and inferential analysis was performed including multiple covariates for singleton deliveries in the 2010-2013 cohort, including both univariate and multivariate regression analyses to identify factors associated with higher CD rates...
2017: Maternal Health, Neonatology and Perinatology
https://www.readbyqxmd.com/read/28438231/health-technology-assessment-in-evaluation-of-pharmaceuticals-in-the-czech-republic
#3
Lenka Vostalová, Jana Mazelová, Jiří Samek, Milan Vocelka
OBJECTIVES: In the Czech Republic, the health technology assessment (HTA) approaches have been implemented in evaluation of medicinal products since 2008. The aim of this study was to provide an overview of the implementation of HTA and different levels thereof in the evaluation process conducted by the State Institute for Drug Control (SUKL) and to describe the impact of HTA on the entrance of new medicinal entities into out-patient healthcare system including highly innovative and orphan drugs...
April 25, 2017: International Journal of Technology Assessment in Health Care
https://www.readbyqxmd.com/read/28438193/pathos-a-decision-support-system-for-reporting-high-throughput-sequencing-of-cancers-in-clinical-diagnostic-laboratories
#4
Kenneth D Doig, Andrew Fellowes, Anthony H Bell, Andrei Seleznev, David Ma, Jason Ellul, Jason Li, Maria A Doyle, Ella R Thompson, Amit Kumar, Luis Lara, Ravikiran Vedururu, Gareth Reid, Thomas Conway, Anthony T Papenfuss, Stephen B Fox
BACKGROUND: The increasing affordability of DNA sequencing has allowed it to be widely deployed in pathology laboratories. However, this has exposed many issues with the analysis and reporting of variants for clinical diagnostic use. Implementing a high-throughput sequencing (NGS) clinical reporting system requires a diverse combination of capabilities, statistical methods to identify variants, global variant databases, a validated bioinformatics pipeline, an auditable laboratory workflow, reproducible clinical assays and quality control monitoring throughout...
April 24, 2017: Genome Medicine
https://www.readbyqxmd.com/read/28437000/magnetically-guided-capsule-endoscopy
#5
REVIEW
Naveen Shamsudhin, Vladimir I Zverev, Henrik Keller, Salvador Pane, Peter W Egolf, Bradley J Nelson, Alexander M Tishin
Wireless capsule endoscopy (WCE) is a powerful tool for medical screening and diagnosis, where a small capsule is swallowed and moved by means of natural peristalsis and gravity through the human gastrointestinal (GI) tract. The camera-integrated capsule allows for visualization of the small intestine, a region which was previously inaccessible to classical flexible endoscopy. As a diagnostic tool, it allows to localize the sources of bleedings in the middle-part of the gastrointestinal tract and to identify diseases such as inflammatory bowel disease (Crohn's disease), Polyposis-Syndrome and tumors...
April 24, 2017: Medical Physics
https://www.readbyqxmd.com/read/28434961/cranioplasty-infection-and-resorption-are-associated-with-presence-of-a-ventriculoperitoneal-shunt-a-systematic-review-and-meta-analysis
#6
REVIEW
Christian M Mustroph, James G Malcolm, Rima S Rindler, Jason K Chu, Jonathan A Grossberg, Gustavo Pradilla, Faiz U Ahmad
BACKGROUND: Following decompressive craniectomy, hydrocephalus is a common complication often requiring placement of a ventriculoperitoneal shunt (VPS). Complications in the presence of a VPS have been reported but without clear association. METHODS: PRISMA guidelines were used to perform a literature search using PubMed to identify articles that published the complication rates associated with staged or simultaneous cranioplasty and VPS. From event rates, odds ratios [OR, 95% Confidence Interval (CI)] of complications were calculated...
April 18, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28432189/safety-and-efficiency-of-a-new-generic-package-labelling-a-before-and-after-study-in-a-simulated-setting
#7
Beate Hennie Garcia, Renate Elenjord, Camilla Bjornstad, Kjell Hermann Halvorsen, Sigurd Hortemo, Steinar Madsen
BACKGROUND: Medication errors are frequent and may cause harm to patients and increase healthcare expenses. AIM: To explore whether a new labelling influences time and errors when preparing medications in accordance with medication charts in an experimental setting. METHOD: We carried out an uncontrolled before and after study with 3 months inbetween experiments. Phase I used original labelling and phase II used new generic labelling. We set up an experimental medicine room, simulating a real-life setting...
April 21, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28431869/the-diagnostic-and-prognostic-value-of-the-optic-nerve-sheath-diameter-on-ct-for-diagnosis-spontaneous-subarachnoid-hemorrhage
#8
Murat Yesilaras, Turgay Yilmaz Kilic, Suveyda Yesilaras, Ozge Duman Atilla, Dilek Öncel, Mahmut Çamlar
INTRODUCTION: The aim of this study was to investigate the relationship between the optic nerve sheath diameter (ONSD) measured on non-contrast head computed tomography (CT) and the diagnosis and prognosis of spontaneous subarachnoid hemorrhage (SAH) on emergency department (ED) patients. METHOD: We used a matched control group of patients with the same age and gender who were diagnosed in the ED with spontaneous SAH and who admitted to the ED with headache. Four emergency medicine attending physicians made the ONSD measurements...
April 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28431426/anesthesiologists-and-disaster-medicine-a-needs-assessment-for-education-and-training-and-reported-willingness-to-respond
#9
Heather K Hayanga, Daniel J Barnett, Natasha R Shallow, Michael Roberts, Carol B Thompson, Itay Bentov, Gozde Demiralp, Bradford D Winters, Deborah A Schwengel
BACKGROUND: Anesthesiologists provide comprehensive health care across the emergency department, operating room, and intensive care unit. To date, anesthesiologists' perspectives regarding disaster medicine and public health preparedness have not been described. METHODS: Anesthesiologists' thoughts and attitudes were assessed via a Web-based survey at 3 major academic institutions. Frequencies, percentages, and odds ratios (ORs) were used to assess self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, employee development, professional obligation, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond (WTR)...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28430747/interprosthetic-and-peri-implant-fractures-principles-of-operative-fixation-and-future-directions
#10
Frank A Liporace, Richard S Yoon, Cory A Collinge
Advances in medicine and orthopaedic implant technology have dramatically increased the number of patients sustaining interprosthetic, inter-, or peri-implant fractures. For these complex clinical scenarios, there are currently no available treatment algorithms. In this review, we outline the principles, strategies, and techniques to obtain both successful reconstruction and maximum function. LEVEL OF EVIDENCE: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence...
May 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28428081/intraoperative-image-guidance-compared-with-free-hand-methods-in-adolescent-idiopathic-scoliosis-posterior-spinal-surgery-a-systematic-review-on-screw-related-complications-and-breach-rates
#11
Andrew Chan, Eric Parent, Karl Narvacan, Cindy San, Edmond Lou
BACKGROUND CONTEXT: Severe adolescent idiopathic scoliosis (AIS) is a 3D spinal deformity requiring surgery to stop curve progression. Posterior spinal instrumentation and fusion with pedicle screws is the standard surgery for AIS curve correction. Vascular and neurologic complications related to screw-malpositioning are concerns in surgeries for AIS. Breach rates are reported at 15.7%, implant-related complications at 1.1% and neurologic deficit at 0.8%. Free-hand screw insertion remains the prevailing method of screw placement while image guidance has been suggested to improve placement accuracy...
April 17, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28424823/-coma-in-the-emergency-room
#12
M Braun, C J Ploner, T Lindner, M Möckel, W U Schmidt
Coma of unknown origin (CUO) is a frequent unspecific emergency symptom associated with a high mortality. A fast diagnostic work-up is essential given the wide spectrum of underlying diagnoses that are made up of approximately 50% primary central nervous system (CNS) pathologies and approximately 50% extracerebral, almost exclusively internal medical causes. Despite the high mortality associated with this symptom, there are currently no generally accepted management guidelines for adult patients presenting with CUO...
April 19, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28424099/influence-of-opacification-in-the-frontal-recess-on-frontal-sinusitis
#13
K Hashimoto, K Tsuzuki, K Okazaki, M Sakagami
OBJECTIVES: This study aimed to radiologically evaluate the influence of inflammatory changes in frontal recess cells on frontal sinusitis. METHODS: A total of 93 patients (186 sides) who underwent primary sinonasal surgery at Hyogo College of Medicine were enrolled in 2015 and 2016. Opacification of agger nasi, fronto-ethmoidal, ethmoid bulla, suprabullar and frontal bulla cells was determined by pre-operative computed tomography and its influence on frontal sinusitis was investigated...
April 20, 2017: Journal of Laryngology and Otology
https://www.readbyqxmd.com/read/28421396/-11-c-methionine-pet-ct-findings-in-benign-brain-disease
#14
REVIEW
Reiko Nakajima, Ken Kimura, Koichiro Abe, Shuji Sakai
(11)C-methionine (MET) is one of the most commonly used positron emission tomography (PET) tracers for evaluation of malignant brain tumor, with MET-PET being a sensitive technique for visualization of primary and recurrent malignant brain tumors. However, previous reports have demonstrated MET uptake in lesions associated with benign brain diseases. These diseases usually show an increase in MET uptake similar to that of malignant tumors. This pitfall in MET-PET image interpretation is important not only for nuclear medicine professionals, but also for radiologists...
April 18, 2017: Japanese Journal of Radiology
https://www.readbyqxmd.com/read/28421376/using-the-stopbang-questionnaire-and-other-pre-test-probability-tools-to-predict-osa-in-younger-thinner-patients-referred-to-a-sleep-medicine-clinic
#15
Michael J McMahon, Karen L Sheikh, Teotimo F Andrada, Aaron B Holley
BACKGROUND: The STOPBANG questionnaire is used to predict the presence of obstructive sleep apnea (OSA). We sought to assess the performance of the STOPBANG questionnaire in younger, thinner patients referred to a sleep medicine clinic. METHODS: We applied the STOPBANG questionnaire to patients referred for level I polysomnography (PSG) at our sleep center. We calculated likelihood ratios and area under the receiver operator characteristic (AUROC) curve and performed sensitivity analyses...
April 19, 2017: Sleep & Breathing, Schlaf & Atmung
https://www.readbyqxmd.com/read/28420381/operations-research-in-global-health-a-scoping-review-with-a-focus-on-the-themes-of-health-equity-and-impact
#16
REVIEW
Beverly D Bradley, Tiffany Jung, Ananya Tandon-Verma, Bassem Khoury, Timothy C Y Chan, Yu-Ling Cheng
BACKGROUND: Operations research (OR) is a discipline that uses advanced analytical methods (e.g. simulation, optimisation, decision analysis) to better understand complex systems and aid in decision-making. Herein, we present a scoping review of the use of OR to analyse issues in global health, with an emphasis on health equity and research impact. A systematic search of five databases was designed to identify relevant published literature. A global overview of 1099 studies highlights the geographic distribution of OR and common OR methods used...
April 18, 2017: Health Research Policy and Systems
https://www.readbyqxmd.com/read/28415406/pcl-foamed-scaffolds-loaded-with-5-fluorouracil-anti-cancer-drug-prepared-by-an-eco-friendly-route
#17
Aurelio Salerno, Concepción Domingo, Javier Saurina
This study describes a new preparation method, which combines freeze drying and supercritical CO2 foaming approaches, for the preparation of drug delivery scaffolds of polycaprolactone loaded with 5-fluorouracil, an anti-cancer drug, with low solubility in scCO2. It is a principal objective of this work to design a scCO2 strategy to reduce 5-Fu solubility limitations in its homogeneous distribution into a PCL scaffold through the design of an innovative processing method. The design of this process is considered valuable for the development of clean technology in pharmacy and medicine, since most of the active agents have a null solubility in scCO2·Supercritical CO2 is used as a blowing agent to induce polymer foaming by means of the low temperature pressure quench process...
June 1, 2017: Materials Science & Engineering. C, Materials for Biological Applications
https://www.readbyqxmd.com/read/28412072/do-slow-and-steady-residents-win-the-race-modeling-the-effects-of-peak-and-overall-resident-productivity-in-the-emergency-department
#18
Joshua W Joseph, Victor Novack, Matthew L Wong, Larry A Nathanson, Leon D Sanchez
BACKGROUND: Emergency medicine residents need to be staffed in a way that balances operational needs with their educational experience. Key to developing an optimal schedule is knowing a resident's expected productivity, a poorly understood metric. OBJECTIVE: We sought to measure how a resident's busiest (peak) workload affects their overall productivity for the shift. METHODS: We conducted a retrospective, observational study of resident productivity at an urban, tertiary care center with a 3-year Accreditation Council for Graduate Medical Education-approved emergency medicine training program, with 55,000 visits annually...
April 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28411354/preventing-the-complications-associated-with-the-use-of-dermal-fillers-in-facial-aesthetic-procedures-an-expert-group-consensus-report
#19
REVIEW
Fernando Urdiales-Gálvez, Nuria Escoda Delgado, Vitor Figueiredo, José V Lajo-Plaza, Mar Mira, Francisco Ortíz-Martí, Rosa Del Rio-Reyes, Nazaret Romero-Álvarez, Sofía Ruiz Del Cueto, María A Segurado, Cristina Villanueva Rebenaque
BACKGROUND: The use of dermal fillers in minimally invasive facial aesthetic procedures has become increasingly popular of late, yet as the indications and the number of procedures performed increase, the number of complications is also likely to increase. Paying special attention to specific patient characteristics and to the technique used can do much to avoid these complications. Indeed, a well-trained physician can also minimize the impact of such problems when they do occur. METHODS: A multidisciplinary group of experts in aesthetic treatments reviewed the main factors associated with the complications that arise when using dermal fillers...
April 14, 2017: Aesthetic Plastic Surgery
https://www.readbyqxmd.com/read/28410720/secondary-intraocular-lens-implantation-complication-rates-visual-acuity-and-refractive-outcomes
#20
Greg Brunin, Ahmar Sajjad, Eric J Kim, Ildamaris Montes de Oca, Mitchell P Weikert, Li Wang, Douglas D Koch, Zaina Al-Mohtaseb
PURPOSE: To compare complication rates, visual acuity, and refractive outcomes of secondary intraocular lens (IOLs) implantation. SETTING: Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. DESIGN: Retrospective case series. METHODS: All secondary IOLs placed by the anterior segment service were reviewed. Preoperative data, operative reports, and data from each subsequent postoperative visit were evaluated...
March 2017: Journal of Cataract and Refractive Surgery
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