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Patient-centered outcomes

Michael I Prats, Bret P Nelson, Delia L Gold, Lauren D Branditz, Creagh T Boulger, David P Bahner
Protocols for the sanitation and maintenance of point-of-care ultrasound (US) equipment are lacking. This study introduces the CLEAR protocol (clean, locate, energize, augment supplies, and remove patient identifiers) as a tool to improve the readiness of US equipment, termed US equipment homeostasis. The state of US equipment homeostasis in the emergency department of a single academic center was investigated before and after implementing this protocol, with an improvement in outcomes. These findings demonstrate that the CLEAR protocol can improve US homeostasis...
August 19, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
D Heidenreich, S Kreil, M Jawhar, N Müller, F Nolte, K-P Becker, T Miethke, W-K Hofmann, Stefan A Klein
Multidrug-resistant organisms (MDRO) have been developing as an emerging problem in allogeneic hematopoietic cell transplantation (HCT). Since no data are available on the course of MDRO colonization after HCT, we investigated in this retrospective, single-center study, persistence and clearance of MDRO after HCT. From June 2010 to December 2015, 121 consecutive HCT patients were included. Patients received a MDRO screening before conditioning as well as surveillance cultures after HCT. In MDRO-colonized patients, surveillance specimens were taken until MDRO were no longer detectable...
August 18, 2018: Annals of Hematology
Bao Sun, Fazhong He, Lei Sun, Jiecan Zhou, Jiayi Shen, Jing Xu, Bin Wu, Rong Liu, Xingyu Wang, Heng Xu, Xiaoping Chen, Honghao Zhou, Zhaoqian Liu, Wei Zhang
PURPOSE: Glycated hemoglobin A1c (HbA1c ) and fasting plasma glucose (FPG) was identified to account for the risk of cardiovascular diseases in type 2 diabetic patients, but no study evaluated the risk based on both HbA1c and FPG levels. We described the risk of major adverse cardiovascular events (MACE) and hypoglycemic in type 2 diabetic patients according to both HbA1c and FPG levels. METHODS: With the usage of databases of Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE), 1815 patients from 61 centers in China was identified and grouped according to the criterion value of HbA1c and FPG: Good glycemic control (HbA1c  < 6...
August 18, 2018: Endocrine
Saeed El Zein, Jean El-Sheikh, Aline Zakhem, Dima Ibrahim, Ali Bazarbashi, Souha S Kanj
PURPOSE: Mucormycosis (MCM) is a rare fungal infection affecting people with impaired immunity. Data related to MCM from Lebanon are scarce. The aim of this study is to shed light on the epidemiology, incidence, and outcome of patients with MCM hospitalized at a tertiary care center in Lebanon. METHODS: We conducted a retrospective chart review between Jan 1, 2008 and Jan 10, 2018. All patients with proven or probable MCM were included. RESULTS: A total of 20 patients were included...
August 18, 2018: Infection
Amélie Bernier-Jean, William Beaubien-Souligny, Thierry Ducruet, Anatolie Duca, Martin Albert, Valéry Lavergne, Josée Bouchard
PURPOSE: Recent studies suggest that acute kidney injury (AKI) can affect distant organ function and increase non-renal complications. We determined whether AKI is associated with an increased risk of incident infections. MATERIAL AND METHODS: We conducted a one-year single-center retrospective cohort study, excluding patients readmitted to the ICU or for <24 h, on chronic dialysis, and kidney transplant recipients. The primary outcome was the development of incident infections analyzed by multivariate time-dependent Cox models...
August 8, 2018: Journal of Critical Care
Archana Roy, Alan Peaceman, Moeun Son, Joe Feinglass
BACKGROUND: Quality measures for maternal childbirth outcomes remain controversial, although there is a consensus that maternal morbidity has been increasing in recent years. To determine whether childbirth safety has declined in Illinois, the likelihood of maternal obstetric complications was modeled by using both an established measure of severe maternal morbidity and a more expansive complication coding algorithm. METHODS: In a retrospective cohort study of 792,122 deliveries at 127 Illinois hospitals from July 2010 to September 2015, International Classification of Diseases, Ninth Revision (ICD-9) codes were used to identify Centers for Disease Control and Prevention-defined severe maternal morbidity, as well as other maternal complications defined by a route of delivery-specific algorithm originally used to evaluate the quality of obstetrics residency programs...
August 15, 2018: Joint Commission Journal on Quality and Patient Safety
Takao Sato, Yoshifusa Aizawa, Koichi Fuse, Satoshi Fujita, Yoshio Ikeda, Hitoshi Kitazawa, Minoru Takahashi, Masaaki Okabe
BACKGROUND: Inappropriate doses of direct oral anticoagulants (DOACs) are often prescribed. This study evaluated the prevalence, outcomes, and predictors of the prescription of inappropriately low doses of 4 types of DOACs in patients with atrial fibrillation (AF). METHODS: We retrospectively analyzed prospectively collected data from a single-center registry with 2272 patients prescribed DOACs for AF (apixaban: 1014; edoxaban: 267; rivaroxaban: 498; dabigatran: 493)...
August 15, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Lisa Howard, Randa Berdusco, Franco Momoli, J Pollock, Allan Liew, Steve Papp, Karl-Andre Lalonde, Wade Gofton, Sara Ruggiero, Peter Lapner
BACKGROUND: Proximal humerus fractures are the third most common fracture in the elderly population and are expected to increase due to the aging population. Surgical fixation with locking plate technology has increased over the last decade despite a lack of proven superiority in the literature. Three previous randomized controlled trials have not shown a difference in patient-centered outcomes when comparing non-operative treatment with open reduction and internal fixation. Low patient enrollment and other methodological concerns however limit the generalizability of these conclusions and as a result, management of these fractures remains a controversy...
August 18, 2018: BMC Musculoskeletal Disorders
Jong Mok Park, Seung Woo Yang, Ju Hyun Shin, Yong Gil Na, Ki Hak Song, Jae Sung Lim
PURPOSE: It remains unclear whether laparoscopic radiofrequency ablation (RFA) for primary treatment of small renal masses is similar to partial nephrectomy (PN) in terms of long-term oncological and renal function outcomes. We reviewed the long-term outcomes for patients with T1a renal masses treated with either laparoscopic RFA or PN. MATERIALS AND METHODS: This retrospective single-center study on 115 patients who were treated by laparoscopic RFA or PN for small (<4 cm) renal masses between January 2005 and October 2014 was performed at Chungnam National University Hospital...
August 18, 2018: Urology Journal
Bernardo Cacho-Díaz, Héctor Spínola-Maroño, Laura G Mendoza-Olivas, Myrna Candelaria
INTRODUCTION: Cerebrovascular disease (CVD) and cancer are among the most common causes of mortality worldwide, preceded only by ischemic heart disease (IHD). Thrombocytopenia was shown to be associated with poor outcomes in IHD and CVD in the general population. This study aimed to assess the relationship of thrombocytopenia with poor outcomes in cancer patients with CVD. MATERIALS AND METHODS: Data on patients with concomitant CVD and cancer who were initially treated at a cancer referral center between January 2010 and December 2017 were included...
August 18, 2018: Journal of Neuro-oncology
Phillip Weeks, Adam Sieg, Indranee Rajapreyar, Sriram Nathan, Marwan Jumean, Manish Patel, Rajko Radovancevic, Biswajit Kar, Igor Gregoric
Pump thrombosis remains a serious complication of implantable ventricular assist device therapy and is associated with increased risk of morbidity and mortality. Optimal management strategies remain controversial and are guided largely by limited literature and expert opinion. Medical management of pump thrombosis, including the use of direct thrombin inhibitors, has been associated with mixed results. The purpose of this study is to report the outcomes associated with bivalirudin therapy in LVAD patients with suspected pump thrombosis...
August 17, 2018: Journal of Thrombosis and Thrombolysis
Mustafa Koray Balcı, Ejder Ciğer, Seçil Arslanoğlu, Akif İşlek
OBJECTIVES: To present the outcomes of our case series of head and neck necrotizing fasciitis (HNNF) in which vacuum-assisted closure (VAC) is used in most of the cases in the treatment. METHODS: Case series in a tertiary referral center. RESULTS: Eleven patients were treated for HNNF between January 2008 and January 2017. Patients were two females and nine males, the mean age was 57.1. Oral cavity and tracheotomy/tracheostomy sites were the main aetiological foci of the infection...
August 17, 2018: European Archives of Oto-rhino-laryngology
Karl R Abi-Aad, Rami James N Aoun, Rudy J Rahme, Jennifer D Ward, Jason Kniss, Mary Jeanne Kwasny, Mithun G Sattur, Matthew E Welz, Bernard R Bendok
PURPOSE: Aneurysm recanalization constitutes a limitation in the endovascular treatment of intracranial aneurysms using conventional bare platinum coils. The development of platinum coils coupled with hydrogel polymers aimed at decreasing the rates of recurrence by way of enhanced coil packing density and biological healing within the aneurysm. While enhanced occlusion and durability has been shown for the first generation hydrogel coils, their use was limited by technical challenges...
August 17, 2018: Neuroradiology
Rupesh Agrawal, Dinesh Visva Gunasekeran, Dhananjay Raje, Aniruddha Agarwal, Quan Dong Nguyen, Onn Min Kon, Carlos Pavesio, Vishali Gupta
Purpose: The aim of this study was to examine regional variation management practices and outcomes for tubercular uveitis (TBU). Methods: In this retrospective multinational cohort study, patients from 25 international eye care centers diagnosed with TBU with a minimum follow-up of 1 year were included. The geographic variation in treatment outcomes on survival analysis in patients with TBU were analyzed. Treatment failure is defined as a persistence or recurrence of inflammation within 6 months of completing antitubercular therapy, the inability to taper oral corticosteroids to less than 10 mg/d or topical corticosteroid drops to less than 2 drops daily, and/or recalcitrant inflammation necessitating corticosteroid-sparing immunosuppressive therapy...
August 1, 2018: Investigative Ophthalmology & Visual Science
Valérie Malan, Laurence Bussières, Norbert Winer, Jean-Philippe Jais, Amandine Baptiste, Marc Le Lorc'h, Caroline Elie, Neil O'Gorman, Nicolas Fries, Véronique Houfflin-Debarge, Loic Sentilhes, Michel Vekemans, Yves Ville, Laurent J Salomon
Importance: Cell-free DNA (cfDNA) tests are increasingly being offered to women in the first trimester of pregnancies at a high risk of trisomy 21 to decrease the number of required invasive fetal karyotyping procedures and their associated miscarriages. The effect of this strategy has not been evaluated. Objective: To compare the rates of miscarriage following invasive procedures only in the case of positive cfDNA test results vs immediate invasive testing procedures (amniocentesis or chorionic villus sampling) in women with pregnancies at high risk of trisomy 21 as identified by first-trimester combined screening...
August 14, 2018: JAMA: the Journal of the American Medical Association
Ping Tan, Nan Xie, Jianzhong Ai, Hang Xu, Huan Xu, Liangren Liu, Lu Yang, Qiang Wei
To assess the prognostic impact of pretreatment albumin-to-alkaline phosphatase ratio (AAPR) in patients with upper tract urothelial carcinoma (UTUC), the data of 692 patients, operated between 2003 and 2016 in our center, were retrospectively assessed. The threshold of AAPR was defined as 0.58 by using the receiver-operating curve analysis. Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were evaluated using the Kaplan-Meier method. And the univariate and multivariate Cox's regression models were performed to identify independent prognostic predictors...
August 17, 2018: Scientific Reports
Amanda Parkes, Carla L Warneke, Katherine Clifton, Aydah Al-Awadhi, Oluchi Oke, Roberto Carmagnani Pestana, Omar Alhalabi, Jennifer K Litton, Gabriel N Hortobagyi
BACKGROUND: Patients with metastatic breast cancer with bone-only metastases (BOM) are a unique patient population without consensus regarding high-risk characteristics, which we sought to establish. METHODS: We identified 1,445 patients with BOM followed for at least 6 months at MD Anderson Cancer Center from January 1, 1997, to December 31, 2015. RESULTS: Seventy-one percent ( n = 936) of the 1,325 patients with BOM with available pain characterization were symptomatic at time of BOM diagnosis...
August 17, 2018: Oncologist
Julia Jacobs, Joyce Y Wu, Piero Perucca, Rina Zelmann, Malenka Mader, Francois Dubeau, Gary W Mathern, Andreas Schulze-Bonhage, Jean Gotman
OBJECTIVE: To evaluate the use of interictal high-frequency oscillations (HFOs) in epilepsy surgery for prediction of postsurgical seizure outcome in a prospective multicenter trial. METHODS: We hypothesized that a seizure-free outcome could be expected in patients in whom the surgical planning included the majority of HFO-generating brain tissue while a poor seizure outcome could be expected in patients in whom only a few such areas were planned to be resected...
August 17, 2018: Neurology
Elizabeth S Barnert, Ryan J Coller, Bergen B Nelson, Lindsey R Thompson, Thomas S Klitzner, Moira Szilagyi, Abigail M Breck, Paul J Chung
BACKGROUND AND OBJECTIVES: Defining and measuring health for children with medical complexity (CMC) is poorly understood. We engaged a diverse national sample of stakeholder experts to generate and then synthesize a comprehensive list of health outcomes for CMC. METHODS: With national snowball sampling of CMC caregiver, advocate, provider, researcher, and policy or health systems experts, we identified 182 invitees for group concept mapping (GCM), a rigorous mixed-methods approach...
August 17, 2018: Pediatrics
Andrew Kerr, Mark Smith, Lynn Reid, Lynne Baillie
BACKGROUND: Using technology in stroke rehabilitation is attractive. Devices such as robots or smartphones can help deliver evidence-based levels of practice intensity and automated feedback without additional labor costs. Currently, however, few technologies have been adopted into everyday rehabilitation. OBJECTIVE: This project aimed to identify stakeholder (therapists, patients, and caregivers) priorities for stroke rehabilitation technologies and to generate user-centered solutions for enhancing everyday adoption...
August 17, 2018: JMIR Rehabilitation and Assistive Technologies
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