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Care pathways

Aaron M Ogletree, Mark Brennan-Ing, Rosemary Blieszner, Stephen E Karpiak, Laura P Sands
Background and Objectives: Older adults with HIV face greater health burden than HIV-uninfected counterparts. Little is known about resources that might mediate the influence of physiological health burden on psychological well-being. Informed by the stress process model, we assessed the influence of multifaceted health burden indicators on depressive symptoms and evaluated the mediating effects of social support adequacy. Research Design and Methods: This cross-sectional study used structural equation modeling with data from 640 older men who participated in the Research on Older Adults with HIV study in the United States...
December 12, 2018: Gerontologist
Sabina Zapponi, Aline Ferreira, Paolo Galvagni, Camilla Roccatagliata, Simone Rodolfi, Miriana Spina, Chiara Foà, Leopoldo Sarli, Giovanna Artioli
BACKGROUND: The 38/2010 law has widened the supply of palliative care for patients with chronic and degenerative illness. Dementia is a chronic and debilitating illness and it requires specific, complex and constant assistance, involving the health professionals' community and family, and should also benefit from palliative care. But what do the caregivers of these patients think about it? AIM: To explore the point of view of caregivers accompanying dementia patients regarding palliative care and the accompaniment of the medical team...
December 7, 2018: Acta Bio-medica: Atenei Parmensis
Johanne Martel-Pelletier, Emmanuel Maheu, Jean-Pierre Pelletier, Ludmila Alekseeva, Ouafa Mkinsi, Jaime Branco, Pierre Monod, Frédéric Planta, Jean-Yves Reginster, François Rannou
BACKGROUND AND AIMS: Although osteoarthritis (OA) is managed mainly in primary care, general practitioners (GPs) are not always trained in its diagnosis, which leads to diagnostic delays, unnecessary resource utilization, and suboptimal patient outcomes. METHODS: To address this situation, an International Rheumatologic Board (IRB) of 8 experts from 3 continents developed guidelines for the diagnosis of OA in primary care. The focus was three major topologies: hip, knee, and hand/finger OA...
December 11, 2018: Aging Clinical and Experimental Research
Paula J Busse, Henriette Farkas, Aleena Banerji, William R Lumry, Hilary J Longhurst, Daniel J Sexton, Marc A Riedl
Hereditary angioedema (HAE) with C1 esterase inhibitor (C1-INH) deficiency (C1-INH-HAE) is a rare disease characterized by diminished levels or dysfunctional activity of C1-INH, leading to dysregulated plasma kallikrein activity within the kallikrein-kinin pathway. Symptoms manifest as painful, potentially life-threatening swelling of subcutaneous tissues throughout the body and/or submucosal edema in the upper airway or gastrointestinal tract. Attacks recur with unpredictable frequency, intensity, and duration, placing a heavy burden on patients' daily lives...
December 12, 2018: BioDrugs: Clinical Immunotherapeutics, Biopharmaceuticals and Gene Therapy
Jeanette M Bennett, Glenn Reeves, George E Billman, Joachim P Sturmberg
Siloed or singular system approach to disease management is common practice, developing out of traditional medical school education. Textbooks of medicine describe a huge number of discrete diseases, usually in a systematic fashion following headings like etiology, pathology, investigations, differential diagnoses, and management. This approach suggests that the body has a multitude of ways to respond to harmful incidences. However, physiology and systems biology provide evidence that there is a simple mechanism behind this phenotypical variability...
2018: Frontiers in Medicine
Kristoffer Halvorsrud, James Nazroo, Michaela Otis, Eva Brown Hajdukova, Kamaldeep Bhui
BACKGROUND: As part of a national programme to tackle ethnic inequalities, we conducted a systematic review and meta-analysis of research on ethnic inequalities in pathways to care for adults with psychosis living in England and/or Wales. METHODS: Nine databases were searched from inception to 03.07.17 for previous systematic reviews, including forward and backward citation tracking and a PROSPERO search to identify ongoing reviews. We then carried forward relevant primary studies from included reviews (with the latest meta-analyses reporting on research up to 2012), supplemented by a search on 18...
December 12, 2018: BMC Medicine
Shizuka Kaneko, Youhei Ueda, Yumiko Tahara
BACKGROUND: Enhanced Recovery After Surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing profound stress responses following surgery [Wilmore and Kehlet: BMJ 2001; 322(7284): 473-6]. Glucagon-like peptide-1 receptor agonists (GLP-1RAgs), such as liraglutide, have recently been widely used as antidiabetic agents in patients with type 2 diabetes (T2D) because they maintain blood glucose at an ideal level throughout the day, including during postprandial periods, thereby improving hypoglycemia and body weight more than insulin therapies...
December 11, 2018: European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes
Yusmiati Liau, Ignatius Chua, Martin A Kennedy, Simran Maggo
Angioedema is a rare adverse effect of the commonly used angiotensin converting enzyme inhibitors (ACEi) and is reported to occur with a prevalence of 0.1 - 0.7%. Although most ACEi-induced angioedema (ACEi-A) cases are mild, severe cases requiring intensive care and even resulting in death have been reported in the literature. The mechanisms underlying ACEi-A are not yet fully understood, but bradykinin and/or substance P accumulation resulting from inhibition of ACE, is believed to play a crucial role. ACEi-A occurs at variable frequencies across different racial groups, suggesting a genetic association to the development of ACEi-A...
December 8, 2018: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
Rodney W Petersen
Birth by vaginal delivery is an evolutionary process refined over millennia to create a sustainable and safe method of human reproduction. A key argument against requiring consent for vaginal birth acknowledges that from an evolutionary point of view, vaginal delivery has successfully accompanied human development and remains the natural and default form of human birth. Concern has been raised by the Montgomery court case in the United Kingdom; however, the ruling does not mean consent is required for normal birth...
December 2018: Australian & New Zealand Journal of Obstetrics & Gynaecology
Ana Maria Roşca, Raluca Ţuţuianu, Irina Domnica Titorencu
In modern society, the healing of chronic wounds is still a major cause of discomfort for the patients and a financial burden for the care system. Current approaches use either organic tissue-engineered skin substitutes or stem cells based therapy. It has been shown that mesenchymal stem cells (MSCs) are able to improve the wound healing process by secreting factors with anti-inflammatory, anti-fibrotic and pro-angiogenic activities either as soluble molecules (growth factors, cytokines) or encapsulated within membrane vesicles (microparticles, exosomes)...
2018: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
Michael McCaul, Mike Clarke, Stevan R Bruijns, Peter W Hodkinson, Ben de Waal, Jennifer Pigoga, Lee A Wallis, Taryn Young
Introduction: An adaptive guideline development method, as opposed to a de novo guideline development, is dependent on access to existing high-quality up-to-date clinical practice guidelines (CPGs). We described the characteristics and quality of CPGs relevant to prehospital care worldwide, in order to strengthen guideline development in low-resource settings for emergency care. Methods: We conducted a descriptive study of a database of international CPGs relevant to emergency care produced by the African Federation for Emergency Medicine (AFEM) CPG project in 2016...
December 2018: African Journal of Emergency Medicine Revue Africaine de la Médecine D'urgence
Yibin Zhu, Jianjian Xiang, Wei Liu, Qian Cao, Wei Zhou
Background and Aims: Laparoscopic approach is recommended as the first-choice option for simple ileocecal resections. However, there are no randomized trials that have focused on patients with Crohn's disease (CD) treated by laparoscopy and enhanced recovery pathway. The aim of the present study is to prospectively evaluate the feasibility, safety, and short-term outcomes of laparoscopy with enhanced recovery pathway for CD patients undergoing ileocecal resection. Methods: A consecutive cohort of 32 CD patients who underwent laparoscopic ileocecal resection between December 2015 and December 2016 was randomized to enhanced recovery after surgery (ERAS) group or standard care group...
2018: Gastroenterology Research and Practice
Duncan Ayers, Charles Scerri
Dementia is a complex clinical syndrome characterised by progressive decline in cognitive function. It usually presents itself as impairment in memory, loss of judgement, abstract thinking and other disturbances that are severe enough to interfere with activities of daily living. It has long been considered as one of the major challenges at present posing an ever-increasing demand on global health and social care systems. Of all the different forms of dementia, Alzheimer's disease (AD) is the most common. The term non-coding RNA (ncRNA) refers to RNA sequences which do not have the ability to be translated into proteins and therefore mainly fall within the realm of the recently acknowledged 'dark matter' of the genome...
December 2018: Non-Coding RNA Research
Roop Gursahani, Raj K Mani, Sri Nagesh Simha
The recent supreme court of India judgment on autonomy makes it necessary for all practicing neurologists to appraise themselves of the changing legal framework for End-of-Life decision-making in India. A pathway has been prescribed for advance care planning and medical futility decision-making. This is an evolving landscape and in a diverse country may vary substantially by geography. Living wills and advance medical directives can be prepared by our patients, and we will be required to honor these instruments...
October 2018: Annals of Indian Academy of Neurology
Jimmy Rodriguez Murillo, Magdalena Kuras, Melinda Rezeli, Tasso Milliotis, Lazaro Betancourt, Gyorgy Marko-Varga
To acquire a deeper understanding of malignant melanoma (MM), it is essential to study the proteome of patient tissues. In particular, phosphoproteomics of MM has become of significant importance because of the central role that phosphorylation plays in the development of MM. Investigating clinical samples, however, is an extremely challenging task as there is usually only very limited quantities of material available to perform targeted enrichment approaches. Here, an automated phosphopeptide enrichment protocol using the AssayMap Bravo platform was applied to MM tissues and assessed for performance...
2018: PloS One
Jeremy R Beitler
PURPOSE OF REVIEW: The most effective strategies for treating the patient with acute respiratory distress syndrome center on minimizing ventilation-induced lung injury (VILI). Yet, current standard-of-care does little to modify mechanical ventilation to patient-specific risk. This review focuses on evaluation of bedside respiratory mechanics, which when interpreted in patient-specific context, affords opportunity to individualize lung-protective ventilation in patients with acute respiratory distress syndrome...
December 5, 2018: Current Opinion in Critical Care
Ellen M Soffin, Melinda M Gibbons, Elizabeth C Wick, Stephen L Kates, Maxime Cannesson, Michael J Scott, Michael C Grant, Samantha S Ko, Christopher L Wu
Enhanced recovery after surgery (ERAS) protocols represent patient-centered, evidence-based, multidisciplinary care of the surgical patient. Although these patterns have been validated in numerous surgical specialities, ERAS has not been widely described for patients undergoing hip fracture (HFx) repair. As part of the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery, we have conducted a full evidence review of interventions that form the basis of the anesthesia components of the ERAS HFx pathway...
December 7, 2018: Anesthesia and Analgesia
Frieda-Elsje Dreyer, Ganiy Opeyemi Abdulrahman, Gareth Waring, Kim Hinshaw
Placental steroid sulphatase deficiency (SSD) is an X-linked inborn error of metabolism. Congenital X-linked ichthyosis (XLI) is a genetic disorder of keratinisation caused by steroid sulphatase (STS) deficiency, which results in a scaling skin condition in male infants shortly after birth. It may be associated with failed induction of labor and prolonged labor leading to cesarean delivery due to 'cervical dystocia'. We present two cases of congenital ichthyosis. Thorough counselling of women with a previously affected pregnancy during the antenatal period should include discussion about mode of delivery and a critical review of the complexities of prenatal diagnosis in this condition...
November 2018: Annals of Saudi Medicine
Ashleigh C N Gibb, Megan A Crosby, Caraline McDiarmid, Denisa Urban, Jennifer Y K Lam, Paul W Wales, Megan Brockel, Mehul Raval, Martin Offringa, Erik D Skarsgard, Tomas Wester, Kenneth Wong, David de Beer, Gregg Nelson, Mary E Brindle
INTRODUCTION: Enhanced Recovery After Surgery (ERAS) guidelines integrate evidence-based practices into multimodal care pathways designed to optimise patient recovery following surgery. The objective of this project is to create an ERAS protocol for neonatal abdominal surgery. The protocol will identify and attempt to bridge the gaps between current practices and best evidence. Our study is the first paediatric ERAS protocol endorsed by the International ERAS Society. METHODS: A research team consisting of international clinical and family stakeholders as well as methodological experts have iteratively defined the scope of the protocol in addition to individual topic areas...
December 9, 2018: BMJ Open
Matthew Horrocks, Maria Michail, Aimee Aubeeluck, Nicola Wright, Richard Morriss
BACKGROUND: Suicide is a global public health concern, but it is preventable. Increased contact with primary care before the suicide or attempted suicide raises opportunities for intervention and prevention. However, suicide assessment and management are areas that many general practitioners (GPs) find particularly challenging. Previous research has indicated significant variability in how GPs understand, operationalize, and assess suicide risk, which subsequently has an impact on clinical decision making...
December 7, 2018: JMIR Research Protocols
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