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https://www.readbyqxmd.com/read/29907323/taking-the-measure-of-the-profession-physician-associations-in-the-measurement-age
#1
REVIEW
Baruch Levi, Amos Zehavi, David Chinitz
Systematic measurement of healthcare services enables evaluation of health professionals' quality of work. Whereas policy makers find measurement a useful mechanism for quality improvement, a public choice perspective implies that physicians would resent such an initiative, which undermines their professional autonomy. In this article, we compare two healthcare systems of economically developed countries - Israel and the UK. Both systems share common features such as universal coverage, strong state intervention, and enthusiasm for New Public Management...
June 8, 2018: Health Policy
https://www.readbyqxmd.com/read/29907211/comparison-of-dexmedetomidine-versus-propofol-on-hemodynamics-in-surgical-critically-ill-patients
#2
Ya-Fei Chang, Anne Chao, Po-Yuan Shih, Yen-Chun Hsu, Chen-Tse Lee, Yu-Wen Tien, Yu-Chang Yeh, Lee-Wei Chen
BACKGROUND: Sedation with dexmedetomidine and propofol may cause hypotension or bradycardia. This study aimed to compare the effects of dexmedetomidine and propofol on hemodynamics and clinical outcomes in surgical intensive care unit (ICU) patients after major abdominal surgery. MATERIALS AND METHODS: Enrolled patients were randomly allocated to the dexmedetomidine or propofol group. Cardiac index was measured using a continuous noninvasive cardiac output monitor on the basis of chest bioreactance...
August 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29907209/using-artificial-intelligence-to-predict-prolonged-mechanical-ventilation-and-tracheostomy-placement
#3
Joshua Parreco, Antonio Hidalgo, Jonathan J Parks, Robert Kozol, Rishi Rattan
BACKGROUND: Early identification of critically ill patients who will require prolonged mechanical ventilation (PMV) has proven to be difficult. The purpose of this study was to use machine learning to identify patients at risk for PMV and tracheostomy placement. MATERIALS AND METHODS: The Multiparameter Intelligent Monitoring in Intensive Care III database was queried for all intensive care unit (ICU) stays with mechanical ventilation. PMV was defined as ventilation >7 d...
August 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29905929/beyond-classic-risk-adjustment-socioeconomic-status-and-hospital-performance-in-urologic-oncology-surgery
#4
Anobel Y Odisho, Ruth Etzioni, John L Gore
BACKGROUND: Safety-net hospitals (SNHs) care for more patients of low socioeconomic status (SES) than non-SNHs and are disproportionately punished under SES-naive Medicare readmission risk-adjustment models. This study was designed to develop a risk-adjustment framework that incorporates SES and to assess the impact on readmission rates. METHODS: California Office of Statewide Health Planning and Development data from 2007 to 2011 were used to identify patients undergoing radical cystectomy (RC) for bladder cancer (n = 3771) or partial nephrectomy (PN; n = 5556) or radical nephrectomy (RN; n = 13,136) for kidney cancer...
June 15, 2018: Cancer
https://www.readbyqxmd.com/read/29903387/administrative-databases-in-sports-medicine-research
#5
REVIEW
David Wasserstein, Ujash Sheth
There has been a dramatic rise in the use of large-scale health administrative databases to investigate clinical outcomes within sports medicine over the past few years. Although these data sets identify large numbers of patients, allowing for the investigation of regional trends, health care utilization, and outcomes of surgical intervention, they were not designed with the intention of answering clinical questions. Recognizing the methodological limitations associated with these databases is prudent to avoid propagating spurious conclusions...
July 2018: Clinics in Sports Medicine
https://www.readbyqxmd.com/read/29896072/nurses-knowledge-regarding-pain-management-in-high-acuity-care-units-a-case-study-of-palestine
#6
Basma Salameh
Background: Most patients who have been hospitalized at some point in time must have experienced a measure of pain despite improvements in health-care systems. Globally, there is a dearth in information with regard to pain management. Pain management is an essential process for nurses because they spend most time of the day with the patients. Therefore, nurses' level of knowledge and positive attitudes toward pain management reflect this vital and significant role played by nurses in critical care units...
May 2018: International Journal of Health Sciences
https://www.readbyqxmd.com/read/29895113/-how-to-improve-the-prevention-and-treatment-of-ocular-chemical-burns-in-china-important-elements
#7
Y F Huang, L L Wang
Ocular chemical burns are common and serious ocular emergencies which require immediate and intensive evaluation and treatment. Loss of vision and disfigurement affect the victims, bringing great sufferings to themselves and their families. China is the biggest developing country in the world with a large number of such cases. The prevention of ocular chemical burns is emphasized in different aspects. After emergency treatment, proper care of chemical burns is started by control of inflammation with corticosteroids...
June 11, 2018: [Zhonghua Yan Ke za Zhi] Chinese Journal of Ophthalmology
https://www.readbyqxmd.com/read/29894253/on-foreign-soil-anaesthetists-at-the-surgical-multidisciplinary-team-meeting
#8
David Timbrell, Pradeep Prabhu
Decision making through multidisciplinary teams offers an opportunity to improve perioperative care for high-risk surgical patients. While multidisciplinary team decision making is commonplace in the NHS, involvement of perioperative physicians including anaesthetists and intensivists in this process is not well established. This article presents an exemplar of anaesthetic and intensivist involvement in a joint perioperative upper gastrointestinal cancer multidisciplinary team meeting at the Royal Surrey County Hospital in Guildford, UK...
June 2, 2018: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29893906/insurance-correlates-with-improved-access-to-care-and-outcome-among-glioblastoma-patients
#9
Desmond A Brown, Benjamin T Himes, Panagiotis Kerezoudis, Yirengah M Chilinda-Salter, Sanjeet S Grewal, Joshua A Spear, Mohamad Bydon, Terry C Burns, Ian F Parney
Background: The current standard of care for glioblastoma (GBM) constitutes maximal safe surgical resection, followed by fractionated radiation and temozolomide. This treatment regimen is logistically burdensome, and in a healthcare system in which access to care is variable, there may be patients with worsened outcomes due to inadequate access to optimal treatment. Methods: The National Cancer Database was queried for patients diagnosed with GBM in 2006-2014. Patients were grouped according to insurance status: private insurance, Medicare, Medicaid, or uninsured...
June 11, 2018: Neuro-oncology
https://www.readbyqxmd.com/read/29889958/surgery-at-sea-the-effect-of-simulated-high-sea-states-on-surgical-performance
#10
Eric Pierce, Renato Rapada, Penelope Anne Herder, Anthony J LaPorta, Tuan N Hoang, Mathew Pena, Jeff Blankenship, Jeff Kiser, Sarah Ashley Catlin
BACKGROUND: The US Navy initiated design concepts for a Medical Mission Module Support Container (M3SC), a mobile operating room capable of rapid installation aboard maneuverable ships within proximity of active combat units. The M3SC provides an alternative echelon of care in the current trauma system by decreasing the time between point of injury, arrival, and surgical intervention. The mobile ships used as M3SC platforms, however, are more susceptible to oceanic conditions that can induce detrimental physiologic motion sickness in medical personnel and patients aboard the vessels...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/29881956/the-safety-and-efficacy-of-nicotine-replacement-therapy-in-the-intensive-care-unit-a-randomised-controlled-pilot-study
#11
Ben de Jong, Anne Sophie Schuppers, Arriette Kruisdijk-Gerritsen, Maurits Erwin Leo Arbouw, Hubertus Laurentius Antonius van den Oever, Arthur R H van Zanten
BACKGROUND: Studies evaluating nicotine replacement therapy (NRT) to prevent nicotine withdrawal symptoms in ICU patients have yielded conflicting results. We performed a randomised controlled double-blind pilot study to assess the safety and efficacy of NRT in critically ill patients. Mechanically ventilated patients admitted to two medical-surgical intensive care units and smoking more than 10 cigarettes per day before ICU admission were enrolled in this study. Participants were randomised to transdermal NRT (14 or 21 mg per day) or placebo until ICU discharge or day 30...
June 7, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29876747/backward-planning-a-craniomaxillofacial-trauma-curriculum-for-the-surgical-workforce-in-low-resource-settings
#12
David A Shaye, Travis Tollefson, Irfan Shah, Gopal Krishnan, Damir Matic, Marcelo Figari, Thiam Chye Lim, Sunil Aniruth, Warren Schubert
BACKGROUND: Trauma is a significant contributor to global disease, and low-income countries disproportionately shoulder this burden. Education and training are critical components in the effort to address the surgical workforce shortage. Educators can tailor training to a diverse background of health professionals in low-resource settings using competency-based curricula. We present a process for the development of a competency-based curriculum for low-resource settings in the context of craniomaxillofacial (CMF) trauma education...
June 6, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29875941/pattern-of-bacterial-and-fungal-pathogen-in-patients-with-high-risk-for-invasive-fungal-disease-in-an-indonesian-tertiary-care-hospital-an-observational-study
#13
Gurmeet Singh, Stephanie Gita Wulansari
Introduction: In critically ill patients, there is a defect in host defense mechanism resulting in increased susceptibility to bacterial and fungal infection. The pattern of organisms causing infections varies between different countries and hospitals; therefore it is important that every hospital generates antibiograms to guide healthcare professionals during treatment with optimal choice of antibiotics. Our study aimed to described the pattern of fungal and bacterial pathogen in patients with high risk for invasive fungal disease (IFD)...
2018: Pan African Medical Journal
https://www.readbyqxmd.com/read/29874192/procalcitonin-guided-antibiotic-therapy-an-expert-consensus
#14
Michele Bartoletti, Massimo Antonelli, Francesco Arturo Bruno Blasi, Ivo Casagranda, Arturo Chieregato, Roberto Fumagalli, Massimo Girardis, Filippo Pieralli, Mario Plebani, Gian Maria Rossolini, Massimo Sartelli, Bruno Viaggi, Pierluigi Viale, Claudio Viscoli, Federico Pea
BACKGROUND: Procalcitonin (PCT) is a useful biomarker of bacterial infection and its use is associated to reduced duration of antibiotic therapy in the setting of intensive care medicine. To address the need of practical guidance for the use of PCT in various clinical settings, a group of experts was invited to participate at a consensus process with the aims of defining the rationale for appropriate use of PCT and for improving the management of critically ill patients with sepsis. METHODS: A group of 14 experts from anesthesiology and critical care, infectious diseases, internal medicine, pulmonology, clinical microbiology, laboratory medicine, clinical pharmacology and methodology provided expert opinion through a modified Delphi process, after a comprehensive literature review...
June 6, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/29870136/guidelines-and-checklists-for-short-term-missions-in-global-pediatric-surgery-recommendations-from-the-american-academy-of-pediatrics-delivery-of-surgical-care-global-health-subcommittee-american-pediatric-surgical-association-global-pediatric-surgery-committee
#15
Marilyn Butler, Elizabeth Drum, Faye M Evans, Tamara Fitzgerald, Jason Fraser, Ai-Xuan Holterman, Howard Jen, Matthew Kynes, Jenny Kreiss, Craig D McClain, Mark Newton, Benedict Nwomeh, James O'Neill, Doruk Ozgediz, George Politis, Henry Rice, David Rothstein, Julie Sanchez, Mark Singleton, Francine S Yudkowitz
Pediatric surgeons, anesthesia providers, and nurses from North America and other high-income countries are increasingly engaged in resource-limited areas, with short-term missions as the most common form of involvement. However, consensus recommendations currently do not exist for short-term missions in pediatric general surgery and associated perioperative care. The American Academy of Pediatrics (AAP) Delivery of Surgical Care Subcommittee and American Pediatric Surgical Association (APSA) Global Pediatric Surgery Committee, with the American Pediatric Surgical Nurses Association, Inc...
May 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29868971/perioperative-myocardial-injury-and-the-contribution-of-hypotension
#16
REVIEW
Daniel I Sessler, Ashish K Khanna
Mortality in the month following surgery is about 1000 times greater than anesthesia-related intraoperative mortality, and myocardial injury appears to be the leading cause. There is currently no known safe prophylaxis for postoperative myocardial injury, but there are strong associations among hypotension and myocardial injury, renal injury, and death. During surgery, the harm threshold is a mean arterial pressure of about 65 mmHg. In critical care units, the threshold appears to be considerably greater, perhaps 90 mmHg...
June 4, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29864793/prescribed-hypocaloric-nutrition-support-for-critically-ill-adults
#17
REVIEW
Mario I Perman, Agustín Ciapponi, Juan Va Franco, Cecilia Loudet, Adriana Crivelli, Virginia Garrote, Gastón Perman
BACKGROUND: There are controversies about the amount of calories and the type of nutritional support that should be given to critically-ill people. Several authors advocate the potential benefits of hypocaloric nutrition support, but the evidence is inconclusive. OBJECTIVES: To assess the effects of prescribed hypocaloric nutrition support in comparison with standard nutrition support for critically-ill adults SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, Embase and LILACS (from inception to 20 June 2017) with a specific strategy for each database...
June 4, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29864630/guidelines-risk-assessment-recommendations-for-venous-thromboembolism-prophylaxis-a-comparison-and-implementability-appraisal
#18
M J Moesker, N L Damen, E E Volmeijer, D Dreesens, E M de Loos, R Vink, M Coppens, M J Kruip, K Meijer, M Langelaan, M C de Bruijne, C Wagner
INTRODUCTION: Venous thromboembolism (VTE) prophylaxis guidelines for non-surgical patients recommend VTE- and bleeding risk assessment to guide prophylactic strategies. These recommendations differ between guidelines and implementation is suboptimal. Assessing a guideline's implementability characteristics helps predicting the ease of implementation and reveals barriers. OBJECTIVES: We aimed to compare guidelines' risk assessment recommendations and critically appraise the implementability characteristics...
May 26, 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29863638/characteristics-risk-factors-and-outcomes-of-extracorporeal-membrane-oxygenation-use-in-pediatric-cardiac-icus-a-report-from-the-pediatric-cardiac-critical-care-consortium-registry
#19
Marissa A Brunetti, J William Gaynor, Lauren B Retzloff, Jessica L Lehrich, Mousumi Banerjee, Venugopal Amula, David Bailly, Darren Klugman, Josh Koch, Javier Lasa, Sara K Pasquali, Michael Gaies
OBJECTIVES: Cardiopulmonary failure in children with cardiac disease differs from the general pediatric critical care population, yet the epidemiology of extracorporeal membrane oxygenation support in cardiac ICUs has not been described. We aimed to characterize extracorporeal membrane oxygenation utilization and outcomes across surgical and medical patients in pediatric cardiac ICUs. DESIGN: Retrospective analysis of the Pediatric Cardiac Critical Care Consortium registry to describe extracorporeal membrane oxygenation frequency and outcomes...
June 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29859130/thromboelastometry-guided-hemostatic-therapy-for-hemorrhagic-shock-in-the-postoperative-period-of-vascular-surgery-a-case-report
#20
Tomaz Crochemore, Felicio A Savioli
BACKGROUND: Hemorrhagic shock is a medical emergency that often complicates vascular surgery and can lead to death. Hemorrhagic shock is characterized by hypoperfusion and hemodynamic abnormalities leading to the collapse of homeostasis due to massive blood loss. Early diagnosis is critical for a favorable outcome. Thromboelastometry has been considered an effective tool for bleeding management in critically ill patients. Thromboelastometry can guide transfusion therapy quickly, reducing the need for blood products...
June 2, 2018: Journal of Medical Case Reports
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