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Patient-centered outcomes

Chrysi Stavropoulou, Reem N Atout, Meredith Brownlee, Robert J Schroth, Anastasia Kelekis-Cholakis
BACKGROUND: The purpose was to compare patient-centered outcomes, early wound healing and post-operative complications at palatal donor area of subepithelial connective tissue grafts (CTG) between cyanoacrylates tissue adhesives and Polytetrafluoroethylene (PTFE) sutures. METHODS: 36 patients who required harvesting of CTG were enrolled in this randomized clinical trial and assigned to one of two groups. In the "suture" group, wound closure was achieved with standardized continuous interlocking 6-0 PTFE sutures, while in the "cyanoacrylate" group, a high viscosity blend of n-butyl and 2-octyl cyanoacrylate was applied until hemostasis was achieved...
December 5, 2018: Journal of Periodontology
Emily L Fargo, Frank D'Amico, Aaron Pickering, Kathleen Fowler, Ronald Campbell, Megan Baumgartner
BACKGROUND:  Sepsis is a serious medical condition that can lead to organ dysfunction and death. Research shows that each hour delay in antibiotic administration increases mortality. The Surviving Sepsis Campaign Bundles created standards to assist in the timely treatment of patients with suspected sepsis to improve outcomes and reduce mortality. OBJECTIVE:  This article determines if the use of an electronic physician order-set decreases time to antibiotic ordering for patients with sepsis in the emergency department (ED)...
October 2018: Applied Clinical Informatics
Frank A Giordano, Grit Welzel, Victor Siefert, Lennart Jahnke, Thomas Ganslandt, Frederik Wenz, Anca-Ligia Grosu, Felix Heinemann, Nils H Nicolay
There is accumulating evidence from randomized trials suggesting that digital patient-centered care allows a more reliable detection of tumour-related symptoms and adverse events - with a direct impact on overall survival. Consequently, a variety of unsynchronized approaches were kicked off to (electronically) measure patient-reported outcomes (PROs). Despite increasing evidence that PRO data are highly relevant for patient care, the data generated in these initial projects lack standardized processing pathways in order to impact clinical routine; therefore, potential future routine PRO assessments require adequate analysis, storage and processing to allow a robust, reproducible and reliable incorporation into routine clinical decision-making...
December 5, 2018: Oncology
Gillian A M Tarr, Linda Chui, Bonita E Lee, Xiao-Li Pang, Samina Ali, Alberto Nettel-Aguirre, Otto G Vanderkooi, Byron M Berenger, James Dickinson, Phillip I Tarr, Steven Drews, Judy MacDonald, Kelly Kim, Stephen B Freedman
Background: The ability to identify bacterial pathogens that necessitate specific clinical management or public health action in children with acute gastroenteritis is crucial to patient care and public health. However, existing stool testing guidelines offer inconsistent recommendations, and their performance characteristics are unknown. We evaluated six leading gastroenteritis guidelines (e.g. those of the Centers for Disease Control and Prevention and Infectious Disease Society of America) that recommend when to test children's stool for bacterial enteropathogens...
December 4, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Amir A Sazgar, Yeganeh Teymoori, Amir K Sazgar
Background: In revision rhinoplasty, insufficient septal cartilage is a common finding. In these cases, harvesting of costal cartilage or conchal cartilage is needed which is time consuming and has morbidity. Use of the septal bone/cartilage composite graft or bony-cartilaginous unit as a graft in rhinoplasty is a new technique. Objectives: The aim of this research was to evaluate subjective and objective effects of using this graft in revision rhinoplasty. Methods: In this clinical trial study, we examined 40 patients lacking sufficient septal cartilage for grafting who referred to a tertiary center and a private setting from January 2016 to March 2017 for revision septorhinoplasty...
December 4, 2018: Aesthetic Surgery Journal
Marina Rechden Lobato Palmeiro, Mariana Bauer Bronstrup, Justin Durham, Angus Walls, Rosemary Sadami Arai Shinkai
The impact of oral rehabilitation on masticatory function and oral health-related quality of life (OHRQoL) may vary with the experience of the individual with tissue loss. Our hypothesis is that patient-centered outcomes vary among adults who have experienced large defects in the maxilla due to congenital or acquired conditions even after oral rehabilitation to restore aesthetics and function. This study compared OHRQoL, perceived masticatory ability, maximum bite force (MBF), and symptoms of pain and depression among subjects with acquired (edentulous maxilla) and congenital (cleft lip and palate) loss of oral tissues in the maxilla after dental treatment...
November 29, 2018: Brazilian Oral Research
Fabiani Palagi Machado, Alessandra Rosa Vicari, Fábio Spuldaro, João Batista Saldanha de Castro Filho, Roberto Ceratti Manfro
OBJECTIVE: To investigate the correlation between total lymphocyte and CD3+ T cell counts in peripheral blood in renal transplant patients treated with anti-thymocyte globulin, and discuss related outcomes. METHODS: A single-center, retrospective study involving 226 patients submitted to kidney transplant between 2008 and 2013, and treated with anti-thymocyte globulin for induction or treatment of cellular rejection. Doses were adjusted according to CD3+ T cell or total lymphocyte counts in peripheral blood...
November 29, 2018: Einstein
Kari Remes, Pekka Anttila, Raija Silvennoinen, Mervi Putkonen, Hanna Ollikainen, Venla Terävä, Marjatta Sinisalo, Kristiina Kananen, Frida Schain, Päivi Castren-Kortegangas, Tiina M Järvinen, Marta Pisini, Felix Wahl, Tricia Dixon, Amy Leval
Outcomes for patients with multiple myeloma (MM) have improved with the advent of novel therapies, however, real-world evidence of outcomes in clinical practice is scarce. We conducted a multi-center registry study to build a reliable picture of treatment and patient outcomes in Finland. The aim of this study was also to understand any methodological challenges in assessing treatment outcomes using disease registry data. METHODS: We carried out a retrospective, observational study using data from the national Finnish Hematology Registry (FHR) to provide real-world evidence of outcomes for all adult patients diagnosed with and treated for MM between 2009-2013 at one of the six regional hospitals, with at least six months of recorded follow-up...
2018: PloS One
Theodor Voiosu, Andrei Voiosu, Andreea Benguş, Bogdan Mateescu
BACKGROUND: Endoscopic retrograde cholangiopancreatography has evolved significantly in recent years. The increase in complexity and range of applications has not been adequately reflected in an improvement of training methods for ERCP, with many endoscopists failing to meet required performance standards during their training period and limited available data on their performance immediately after completing training. We aimed to analyze the performance of an independent operator from a developing country after the completion of formal training with regard to procedure and patient-related outcomes...
November 1, 2018: Romanian Journal of Internal Medicine, Revue Roumaine de Médecine Interne
Chengtao Wang, Zebin Chen, Jun Dong, Bixiu Wen, Yong Fang
OBJECTIVE: To investigate the relationship between the pretreatment body mass index (BMI) and the clinical outcomes in patients with localized stage I - III renal cell carcinoma (RCC) surgically treated. MATERIALS AND METHODS: From January 2000 to December 2012, 798 patients with stage I - III RCC were recruited from First Affiliated Hospital and Cancer Center of Sun Yat - Sen University. Patients were divided into two groups of BMI < 25 kg / m2 or BMI ≥ 25 kg / m2 according to the World Health Organization classifications for Asian populations...
November 2018: International Braz J Urol: Official Journal of the Brazilian Society of Urology
Alessia Castellino, Jose S Pulido, Patrick B Johnston, Kay M Ristow, N Nora Bennani, David J Inwards, William R Macon, Ivana N M Micallef, Rebecca L King, Diva R Salomao, Thomas E Witzig, Thomas M Habermann, Grzegorz S Nowakowski
Vitreoretinal lymphoma (VRL) management remains a challenge. We present 72 patients with VRL, diagnosed at Mayo Clinic between 1990-2018. Three nondiffuse large B-cell lymphoma (DLBCL) histology cases were excluded. Among 69 DLBCL, 33 patients had primary VRL (PVRL), 18 concurrent intraocular and central nervous system (CNS) or systemic disease and 18 secondary VRL. Patients received intraocular chemotherapy (intraocular injections of rituximab or metothrexate or steroids or in combination), radiotherapy, systemic or combined systemic plus intraocular treatment in 9, 10, 35, and 15 cases, respectively...
December 5, 2018: American Journal of Hematology
Harun Kundi, Jeffrey J Popma, Kamal R Khabbaz, Louis M Chu, Jordan B Strom, Linda R Valsdottir, Changyu Shen, Robert W Yeh
Importance: Hospital outcomes for transcatheter aortic valve replacement (TAVR) may be dependent on the quality of evaluation, personnel, and procedural and postprocedural care common to patients undergoing cardiac surgery. Objectives: We sought to assess whether those hospitals with better patient outcomes for surgical aortic valve replacement (SAVR) subsequently achieved better TAVR outcomes after launching TAVR programs. Design, Setting, and Participants: This national cohort included US patients 65 years and older...
December 5, 2018: JAMA Cardiology
Susanne Muehlschlegel
PURPOSE OF REVIEW: This article reviews the epidemiology, clinical presentation, diagnosis, and management of patients with aneurysmal subarachnoid hemorrhage (SAH). SAH is a type of hemorrhagic stroke and is a neurologic emergency with substantial morbidity and mortality. This article reviews the most common and potentially life-threatening neurologic and medical complications to promote their early recognition and prevent secondary brain injury. RECENT FINDINGS: Over the past 30 years, the incidence of SAH has remained stable; yet, likely because of improved care in specialized neurocritical care units, discharge mortality has considerably decreased...
December 2018: Continuum: Lifelong Learning in Neurology
Beau Kelly, James E Squires, Brian Feingold, David K Hooper, George V Mazariegos
PURPOSE OF REVIEW: Pediatric transplantation faces unique challenges in implementing dynamic quality improvement measures because of proportionally smaller volumes compared to adults, logistics of being integrated successfully within larger or complex hospital systems, lack of adult-affiliated transplant centers, varying focus in prioritization of relevant outcome metrics, and potential lack of sufficient resources. RECENT FINDINGS: To address these challenges, multiinstitutional collaborations have developed which have proven increasingly effective in driving awareness and quality improvement measures to supplement regulatory efforts in the pediatric population...
December 3, 2018: Current Opinion in Organ Transplantation
Jae Keun Park, Jong Kyun Lee, Ju Il Yang, Keol Lee, Joo Kyung Park, Kwang Hyuck Lee, Kyu Taek Lee
OBJECTIVES: The American Society for Gastrointestinal Endoscopy (ASGE) guidelines offered the risk-stratified approach in suspected choledocholithiasis. Previous studies have raised concern about the insufficient accuracy of the guideline, especially in high probability group. The purposes of this study were to authenticate the stratification and clinical predictors of the guidelines for suspected choledocholithiasis with no visible choledocholithiasis on computed tomography (CT) and to make clear the clinical strategy of endoscopic ultrasonography (EUS)...
December 5, 2018: Scandinavian Journal of Gastroenterology
Ali Fuat Kaan Gök, Yiğit Soydaş, Adem Bayraktar, Selman Emirikçi, Mehmet İlhan, Ahmet Kemalettin Koltka, Mustafa Kayıhan Günay
BACKGROUND: The aim of this study was to compare the obstetric and surgical outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA) performed for pregnant women at a single center. It was the hypothesis of this study that there would be no significant difference in the results. METHODS: The medical records of 57 consecutive pregnant women who underwent an appendectomy between January 2009 and September 2018 were reviewed retrospectively. The patients were divided into 2 groups: OA and LA...
November 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Heather Taffet Gold, Raj J Karia, Alissa Link, Rachel Lebwohl, Joseph D Zuckerman, Thomas J Errico, James D Slover, Aaron J Buckland, Devin M Mann, Michael N Cantor
We integrated and optimized patient-reported outcome measures into the electronic health record to provide quantitative, objective data regarding patients' health status, which is important for patient care, payer contracts, and research. With a multidisciplinary team from information technology, clinical informatics, population health, and physician champions, we used formal human-computer interaction techniques and user-centered design to integrate several technology platforms and computerized adaptive testing for the National Institutes of Health Patient-Reported Outcomes Measurement Information System...
December 5, 2018: Health Informatics Journal
I Karamouzis, M Caputo, C Mele, A Nuzzo, M Zavattaro, P Car, G Panzarasa, F Prodam, P Marzullo, Gianluca Aimaretti
OBJECTIVE: To evaluate early results of transsphenoidal surgery for pituitary adenomas. DESIGN: Retrospective evaluation of 90 consecutive patients undergoing endoscopic pituitary adenoma surgery (2007-2016) at "Maggiore della Carità" Hospital in Novara, Italy. Age at diagnosis, sex, symptoms at presentation, hormonal and radiological data, complications of surgery, and short-term follow-up information were collected. RESULTS: The majority of patients were male (M/F: 1...
December 4, 2018: Hormones: International Journal of Endocrinology and Metabolism
Thomas M Atkinson, Bryce B Reeve, Amylou C Dueck, Antonia V Bennett, Tito R Mendoza, Lauren J Rogak, Ethan Basch, Yuelin Li
BACKGROUND: Traditional concordance metrics have shortcomings based on dataset characteristics (e.g., multiple attributes rated, missing data); therefore it is necessary to explore supplemental approaches to quantifying agreement between independent assessments. The purpose of this methodological paper is to apply an Item Response Theory (IRT) -based framework to an existing dataset that included unidimensional clinician and multiple attribute patient ratings of symptomatic adverse events (AEs), and explore the utility of this method in patient-reported outcome (PRO) and health-related quality of life (HRQOL) research...
December 4, 2018: Journal of patient-reported outcomes
Massimo Breccia, Daniela Bartoletti, Massimiliano Bonifacio, Giuseppe A Palumbo, Nicola Polverelli, Elisabetta Abruzzese, Micaela Bergamaschi, Alessia Tieghi, Mario Tiribelli, Alessandra Iurlo, Francesco Cavazzini, Nicola Sgherza, Gianni Binotto, Alessandro Isidori, Mariella D'Adda, Monica Crugnola, Costanza Bosi, Florian Heidel, Matteo Molica, Luigi Scaffidi, Daniele Cattaneo, Roberto Latagliata, Giuseppe Auteri, Roberto M Lemoli, Renato Fanin, Domenico Russo, Franco Aversa, Antonio Cuneo, Gianpietro Semenzato, Lucia Catani, Michele Cavo, Nicola Vianelli, Robin Foà, Francesca Palandri
Comorbidities defined by the Charlson comorbidity index (CCI) and body mass index (BMI) are significantly associated with outcome in patients who receive continuous treatment with tyrosine kinase inhibitors. We evaluated the impact of CCI and BMI on responses, drug-related toxicities, and outcome in a cohort of 402 patients with myelofibrosis (MF) treated with ruxolitinib in 23 European Hematology Centers. Comorbidities were evaluable in all 402 patients. A higher (≥ 3) CCI did not correlate with a lower spleen reduction at any time (p = 0...
December 4, 2018: Annals of Hematology
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