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Continuity Care

T Saetrang, I T Bjørk, H Capjon, M Rasmussen
AIM: Duchenne muscular dystrophy (DMD) is an x-linked myopathy affecting one in 3,600 - 6,000 live male births. The aim of this study was to gain further insight into how parents experience caring for boys with DMD. METHODS: Using a qualitative design, parents in 12 families with boys with DMD, whereof two pairs of siblings, were interviewed in 2014 and 2015. Participants were parents of boys followed at Oslo University Hospital or other hospitals in the South-Eastern health region of Norway...
August 17, 2018: Acta Paediatrica
Nora W Wong
This article addresses whether physicians' close ties to their patients might play an unexamined role in their reluctance to initiate palliative care. In cases characterized by uncertainty, physicians' emotional investment in their patients and patients' families might unduly promote decisions to continue aggressive treatment rather than transition to comfort care. Continued evaluation and communication of patient status, including scheduled objective consultations, can align compassionate actions with patients' best interests...
August 1, 2018: AMA Journal of Ethics
Jose Garnacho-Montero, Irene Barrero-García, Maria de Gracia Gómez-Prieto, Ignacio Martín-Loeches
Despite advances in modern medicine, severe community-acquired pneumonia (CAP) continues to be a potentially deadly disease. Mortality rate reaches up to the 50% in patients requiring admission to the Intensive Care Unit (ICU) when developing septic shock. Areas covered: We aim to describe the optimal management of severe CAP including antibiotic therapy, future antimicrobial options, and non-antibiotic (so-called adjunctive) therapies. A literature search was performed to identify all clinical trials, observational studies, meta-analysis, and reviews about this topic from PubMed...
August 17, 2018: Expert Review of Anti-infective Therapy
Nirav S Kapadia, Andrea M Austin, Donald Q Carmichael, Qianfei Wang, Elisabeth D Erekson, Diane Feskanich, Francine Grodstein, Anna N A Tosteson, Julie P W Bynum
BACKGROUND: To better understand health habits in older nurses versus the general population, we sought to determine whether the demographics, health care utilization, and Medicare spending by the Nurses' Health Study (NHS) participants enrolled in Medicare and a matched sample of Medicare beneficiaries meaningfully differed. MATERIALS AND METHODS: Analytic cohorts included a random 20% sample of Medicare beneficiaries continuously enrolled in fee for service (FFS) Medicare that were propensity matched to the NHS participants continuously enrolled in FFS Medicare in a single year (2012)...
August 17, 2018: Journal of Women's Health
Roxana M Grasu, Juan P Cata, Anh Q Dang, Claudio E Tatsui, Laurence D Rhines, Katherine B Hagan, Shreyas Bhavsar, Sally R Raty, Radha Arunkumar, Yury Potylchansky, Ian Lipski, Benjamin A Arnold, Thomas M McHugh, Justin E Bird, Andrea Rodriguez-Restrepo, Mike Hernandez, Keyuri U Popat
OBJECTIVE Enhanced Recovery After Surgery (ERAS) programs follow a multimodal, multidisciplinary perioperative care approach that combines evidence-based perioperative strategies to accelerate the functional recovery process and improve surgical outcomes. Despite increasing evidence that supports the use of ERAS programs in gastrointestinal and pelvic surgery, data regarding the development of ERAS programs in spine surgery are scarce. To evaluate the impact of an Enhanced Recovery After Spine Surgery (ERSS) program in a US academic cancer center, the authors introduced such a program and hypothesized that ERSS would have a significant influence on meaningful clinical measures of postoperative recovery, such as pain management, postoperative length of stay (LOS), and complications...
August 17, 2018: Journal of Neurosurgery. Spine
Peter Wolf, Wolfgang Weger, Franz Legat, Clemens Painsi, Werner Saxinger, Robert Müllegger, Paul Sator, Gudrun Ratzinger, Sylvia Selhofer, Leo Richter, Wolfgang Salmhofer, Bernhard Lange-Asschenfeldt, Franz Trautinger, Alexander Mlynek, Robert Strohal, Matthias Augustin, Franz Quehenberger
BACKGROUND: Patients with psoriasis experience impairment in quality of life. Thus, high-quality dermatological care is of particular importance. PATIENTS AND METHODS: We performed a nationwide cross-sectional survey in Austria (BQSAustria Psoriasis 2014/2015) with a special focus on quality of life and satisfaction with treatment among psoriasis patients predominantly treated at tertiary care centers. RESULTS: Overall, 70.2 % of 1,184 patients reported impaired quality of life (DLQI 2-5: 29...
August 2018: Journal der Deutschen Dermatologischen Gesellschaft, Journal of the German Society of Dermatology: JDDG
Jasmin S Hanke, Julia Riebandt, Miena Wahabzada, Fatma Nur, Angela Wahabzada, Günes Dogan, Christina Feldmann, Axel Haverich, Aron-Friedrich Popov, Daniel Zimpfer, Jan D Schmitto
Literature on driving capacities of ventricular assist device patients is rare and driving restrictions differ from center to center. Currently, no guidelines exist on whether and when left ventricular assist device (LVAD) patients are allowed to begin driving cars after device implantation. In this study, we assess the driving abilities of patients after LVAD implantation. Three hundred and ninety LVAD patients have been surveyed in a worldwide, multicenter study. The single survey followed a multi-method design, including online, phone, and face-to-face interviews...
July 2018: Artificial Organs
Masha G Savelieff, Lucia Pappalardo, Panagiotis Azmanis
Aspergillus fungal infections continue to be a significant cause of morbidity and mortality in birds that can, in part, be attributed to the lack of a diagnostic "gold standard" for Aspergillus infection, and which delays the diagnosis, treatment, and outcome of avian patients. At present, none of the available methods in veterinary care can detect aspergillosis early enough and with the accuracy, precision, and specificity required of an ideal diagnostic tool. Therefore, researching methods of Aspergillus detection is still an active area of inquiry, and novel techniques continue to emerge...
August 17, 2018: Veterinary Clinical Pathology
Judy Clegg, Rachael Black, Antoin Smith, Shelagh Brumfitt
PURPOSE: Intensive interaction is used to increase communication in people at a pre-verbal stage of communication development. The aim of the study was to evaluate a city-wide implementation of intensive interaction training to care staff by investigating how staff use intensive interaction with adults with profound and multiple learning disability, and their perceived impact of intensive interaction on these service users. METHOD: In phase 1, a survey investigated the outcomes of intensive interaction training on the work practices of staff supporting people with profound and multiple learning disability...
August 17, 2018: Disability and Rehabilitation
Meng Jin, Jinmin Peng, Huimin Zhang, Bo Lu, Yi Lii, Dong Wu, Jiaming Qian, Hong Yang
BACKGROUND: Acute triglyceride (TG) lowering therapy is crucial in the early treatment of hypertriglyceridemia (HTG)-induced pancreatitis. Data concerning continuous intravenous infusion of insulin and heparin therapy (IHT) as an equivalent option to plasma exchange (PE) in HTG-induced pancreatitis are limited. We performed this study to compare the IHT and PE abilities to lower TG levels in the acute phase of HTG-induced pancreatitis. METHODS: This was a retrospective observational study conducted in a tertiary teaching hospital...
August 17, 2018: Journal of Digestive Diseases
Nicola Disma, James D O'Leary, Andreas W Loepke, Ansgar M Brambrink, Karin Becke, Nicola G Clausen, Jurgen C De Graaff, Fang Liu, Tom G Hansen, Mary E McCann, Cynthia F Salorio, Sulpicio Soriano, Lena S Sun, Peter Szmuk, David O Warner, Laszlo Vutskits, Andrew J Davidson
All commonly used general anesthetics have been shown to cause neurotoxicity in animal models, including nonhuman primates. Opinion, however, remains divided over how cumulative evidence from preclinical and human studies in this field should be interpreted and its translation to current practices in pediatric anesthesia and surgery. A group of international experts in laboratory and clinical sciences recently convened in Genoa, Italy, to evaluate the current state of both laboratory and clinical research and discuss future directions for basic, translational, and clinical studies in this field...
August 16, 2018: Paediatric Anaesthesia
Benjamin M Helm, Mark D Ayers, Adam C Kean
Clinical genetics services continue to expand into diverse medical specialties. An ever-increasing number of non-genetics providers are independently ordering genetic tests, interpreting results, and at times, making diagnoses leading to patient care recommendations. Non-genetics healthcare providers can help increase patient access to these services, but a potential pitfall occurs when these providers either do not have adequate expertise with genetic variant interpretation or do not have access to multi-disciplinary teams including genetic counselors or clinical geneticists for advanced review...
August 16, 2018: Journal of Genetic Counseling
Pamela K Mason
The system for graduate medical education (GME) in the USA is vital to maintaining a well-trained physician population to meet the needs of the nation. The funding of this system over the last several decades has been complicated, and the government's role in funding GME is controversial. In this paper, the current mechanisms for funding residency and fellowship training are outlined as well as proposed changes to system. The current system has made funding electrophysiology training difficult, and the proposed changes have profound implications...
August 16, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Lyvonne N Tume, Frédéric V Valla
Ensuring optimal nutrition is vital in critically ill children and enteral feeding is the main route of delivery in intensive care. Feeding intolerance is the most commonly cited reason amongst pediatric intensive care unit healthcare professionals for stopping or withholding enteral nutrition, yet the definition for this remains inconsistent, nebulous, and entirely arbitrary. Not only does this pose problems clinically, but research in this field frequently uses feeding intolerance as an endpoint and the heterogeneity in this definition makes the comparison of studies difficult and meta-analysis impossible...
August 17, 2018: European Journal of Pediatrics
Daisuke Ito, Kazuyuki Inoue, Takashi Sumita, Keiko Hamaguchi, Kimie Kaneko, Morifumi Yanagisawa, Kouichi Inukai, Ikuo Inoue, Mitsuhiko Noda, Akira Shimada
Background: In our previous study, we investigated the efficacy of ipragliflozin, a sodium-glucose cotransporter (SGLT) 2 inhibitor on diabetic nephropathy in patients with type 2 diabetes and demonstrated that ipragliflozin significantly improved diabetic nephropathy in addition to reducing HbA1c and body weight. Herein, we conducted post-trial monitoring to determine whether these lowering effects on blood glucose and body weight or the beneficial effects on diabetic nephropathy were maintained long-term (104 weeks) after starting ipragliflozin treatment...
September 2018: Journal of Clinical Medicine Research
Lara Diem, Krassen Nedeltchev, Timo Kahles, Lutz Achtnichts, Oliver Findling
Background: Natalizumab significantly reduces the disease activity in patients with relapsing-remitting multiple sclerosis but due to the risk of progressive multifocal leukoencephalopathy it is often discontinued. Fingolimod is seen as an alternative, but there are no long-term analyses of the efficacy of fingolimod in this setting using the no evidence of disease activity (NEDA)-3 criteria. We provide an assessment of patients who discontinued natalizumab and switched to fingolimod or other treatments by evaluating the proportion of patients who fulfil NEDA-3 criteria after prolonged follow-up periods...
2018: Therapeutic Advances in Neurological Disorders
Travis Hay
The purpose of this study was to analyze the extent to which the 'thrifty gene hypothesis' remains embedded within regimes of Canadian health care. The thrifty gene hypothesis, formulated by the American geneticist and travelling scientist James V. Neel in 1962, proposed that Indigenous peoples were genetically predisposed to Type 2 diabetes due to the foodways of their ancestors. The hypothesis was functionally racist and based on what biological anthropologists now call 'the myth of forager food insecurity...
2018: Ethnicity & Disease
Haotong Wang, Alicia Rodriguez-Pla, Anthony Campagna
A 70-year-old man with history of stage IV renal cell carcinoma, chronic atrial fibrillation on warfarin, coronary artery disease status post-percutaneous coronary intervention resulting in an ischaemic cardiomyopathy with left ventricular ejection fraction of 40%-45%, presented with shortness of breath 10 days after starting pazopanib. Within the first week of starting pazopanib, the patient developed fatigue and progressive dyspnoea on exertion. His symptoms quickly worsened and he had compromised mental status...
August 16, 2018: BMJ Case Reports
Emilio Canovai, Laurens J Ceulemans, Guido Peers, Lutgart De Pourcq, Marleen Pijpops, Gert De Hertogh, Martin Hiele, Jacques Pirenne, Tim Vanuytsel
BACKGROUND & AIMS: Chronic intestinal failure is a complex medical condition which is associated with high costs. These patients require long-term home parenteral nutrition (HPN) and costs are compounded by frequent admissions for the underlying disease and HPN. However, it is unknown what the specific costs subdivisions are and how they evolve over time. The aim of the study was to evaluate the cost dynamics of HPN care in a cohort of stable, long-term intestinal failure patients...
August 2, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
D W Tscholl, L Handschin, P Neubauer, M Weiss, B Seifert, D R Spahn, C B Noethiger
BACKGROUND: Maintaining situation awareness of monitored patients can be challenging because care providers must continually read and integrate multiple waveforms and numerical vital sign values into a mental model of the patient's situation. We developed and evaluated a technology designed to improve perception of vital sign information by presenting patient status as an animated patient avatar. METHODS: After step-wise improvement of the avatar, anaesthesia professionals from two hospitals participated in a comparative study of conventional monitoring...
September 2018: British Journal of Anaesthesia
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