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E Grossi, F Parisi, P Duca, V M Savasi
BACKGROUND: Pregnancy hormonal milieu represents a crucial determinant of fetal outcome. We aim to determine 17β-estradiol (E2 ) and progesterone (PGT) concentrations in spontaneous pregnancies during the first trimester. In addition, we aim to determine E2 concentrations as a function of gestational age (GA) and PGT. METHODS: Between November 2015 and March 2017, 104 healthy women of at least 18 years undergoing medical consultation for voluntary interruption of pregnancy were enrolled in an observational study at University Hospital ASST Fatebenefratelli Sacco, Milan, Italy...
October 15, 2018: Journal of Endocrinological Investigation
E Iu Iupatov, I M Ignat'ev, E E Fomina
The problem of chronic venous insufficiency in women during pregnancy is of current concern. A total of 115 pregnant women in the first, second and third trimesters of gestation were examined in a stage-wise manner. During the first stage we conducted a comprehensive clinical study with the obligatory consultation by the obstetrician-gynaecologist. At the second stage, all women were subjected to ultrasonographic examination of the venous system of both lower extremities and the small pelvis. Studying the diameters of the deep veins of the right and left lower limbs, as well as the paired veins of the small pelvis demonstrated no statistically significant differences, which made it possible to evaluate these parameters as a whole...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
M Libarle, Ph Simon, V Bogne, A Pintiaux, E Furet
Dysmenorrhea is one of the most common reasons for consultation in gynecology. The social and economic burdens are important. Dysmenorrhea may therefore be considered as a major public health issue. Its management is not yet optimal as dysmenorrhea still affects the quality of life of many patients. Primary dysmenorrhea, with no underlying organic cause, results from myometrial hyper contractility, arteriolar vasoconstriction, and tissue hypoxia. Secondary dysmenorrhea may involve the pathophysiological mechanisms of primary dysmenorrhea, but is mainly the expression of an underlying gynecological pathology...
2018: Revue Médicale de Bruxelles
Markus Ebke, Andreas Koch, Kim Dillen, Ingrid Becker, Raymond Voltz, Heidrun Golla
Background: The 12-months "surprise" question (12-SQ) for estimating prognosis and the need for integrating palliative care (PC) services has not yet been investigated for neurological patients. Objective: Test the value of the 12-SQ on a sample of neurorehabilitation patients. Methods: All patients newly registered in the Department of Neurorehabilitation, Dr. Becker Rhein-Sieg-Clinic (8/2016-03/2017) were asked to participate. The treating neurorehabilitation physicians (NP) and an external consulting PC physician (PCP) independently estimated patients' prognosis using the 12-SQ; while symptom burden was independently assessed using the standardized palliative outcome measurement HOPE-SP-CL, a set of additional neurological issues, and ECOG...
2018: Frontiers in Neurology
Mobolaji Famuyide, Caroline Compretta, Melanie Ellis
BACKGROUND: Neonatal nurse practitioners have become the frontline staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described. Research aim: To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is reflected in attitudes toward ethical dilemmas in the neonatal intensive care unit...
October 14, 2018: Nursing Ethics
Uche F Onyewuchi, Kathy Tomaszewski, Krishna K Upadhya, Priya S Gupta, Natalie Whaley, Anne E Burke, Maria E Trent
The objective of this quality improvement study was to assess the feasibility, acceptability, and impact of integrating long-acting reversible contraceptive (LARC) delivery services into an academic pediatric primary care practice. Adolescent medicine providers in Baltimore, Maryland, were trained in LARC placement with gynecology providers integrated to offer onsite LARC placement and procedural support. Referrals, appointments, and contraceptive method choice/receipt were tabulated. Of 212 individuals referred for LARC consultations, 104 attended appointments...
October 13, 2018: Clinical Pediatrics
T H Lam, K H Wong, K Kl Chan, M Cm Chan, D Vk Chao, A Ny Cheung, C Ym Fan, J Ho, E P Hui, K O Lam, C K Law, W L Law, H Hf Loong, R Kc Ngan, T Hf Tsang, M Cs Wong, R Mw Yeung, A Ch Ying, R Ching
Colorectal cancer is the commonest cancer in Hong Kong. The Cancer Expert Working Group on Cancer Prevention and Screening was established in 2002 under the Cancer Coordinating Committee to review local and international scientific evidence, assess and formulate local recommendations on cancer prevention and screening. At present, the Cancer Expert Working Group recommends that average-risk individuals aged 50 to 75 years and without significant family history consult their doctors to consider screening by: (1) annual or biennial faecal occult blood test, (2) sigmoidoscopy every 5 years, or (3) colonoscopy every 10 years...
October 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Sarah Chuzi, Sarah Hale, Jason Arnold, Amy Zhou, Rebecca Harap, Kathleen L Grady, Jonathan D Rich, Clyde W Yancy, Adeboye Ogunseitan, Eytan Szmuilowicz, Jane E Wilcox
INTRODUCTION: In 2013 the Centers for Medicare and Medicaid Services (CMS) issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team prior to surgery. Subsequently, many VAD programs implemented a mandatory pre-implantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. METHODS: All patients undergoing DT VAD at Northwestern Memorial Hospital from October 30, 2013 (the CMS decision date) through March 1, 2018 were included...
October 10, 2018: Journal of Pain and Symptom Management
Kathryn E Miller, Ryan D Coleman, Leah Eisenberg, Joan Henriksen, John D Lantos, Elliott Mark Weiss
An infant with complex congenital heart disease suffers a prolonged cardiac arrest with minutes of anoxia. He is left with severe brain damage and profound neurologic impairment. He no longer responds to caregivers. Much of the time, he cries and grimaces as if in pain. He has required increasing sedation to control these symptoms. His parents live hours from the hospital and seldom visit. When their infant's situation is explained to them over the telephone, they request that doctors "do everything to keep him alive...
October 12, 2018: Pediatrics
D A Singleton, F Sánchez-Vizcaíno, E Arsevska, S Dawson, P H Jones, P J M Noble, G L Pinchbeck, N J Williams, A D Radford
Pharmaceutical agents (PAs) are commonly prescribed in companion animal practice in the United Kingdom. However, little is known about PA prescription on a population-level, particularly with respect to PAs authorised for human use alone prescribed via the veterinary cascade; this raises important questions regarding the efficacy and safety of PAs prescribed to companion animals. This study explored new approaches for describing PA prescription, diversity and co-prescription in dogs, cats and rabbits utilising electronic health records (EHRs) from a sentinel network of 457 companion animal-treating veterinary sites throughout the UK over a 2-year period (2014-2016)...
November 1, 2018: Preventive Veterinary Medicine
Christopher W Snyder, Jeremy D Kauffman, Etienne E Pracht, Paul D Danielson, David J Ciesla, Nicole M Chandler
BACKGROUND: Effective and sustainable pediatric trauma care requires systems of regionalization and interfacility transfer. Avoidable transfer, also known as secondary overtriage, occurs when a patient is transferred to a regional trauma center after initial evaluation at another facility that is capable of providing definitive care. The purpose of this study was to identify risk factors for avoidable transfer among pediatric trauma patients in southwest Florida. METHODS: All pediatric trauma patients two years and older transferred from outlying hospitals to the emergency department (ED) of a single state-designated pediatric trauma center between 2009 and 2017 were obtained from the institutional registry...
October 11, 2018: Journal of Trauma and Acute Care Surgery
Daniele Carrieri, Heidi C Howard, Caroline Benjamin, Angus J Clarke, Sandi Dheensa, Shane Doheny, Naomi Hawkins, Tanya F Halbersma-Konings, Leigh Jackson, Hülya Kayserili, Susan E Kelly, Anneke M Lucassen, Álvaro Mendes, Emmanuelle Rial-Sebbag, Vigdís Stefánsdóttir, Peter D Turnpenny, Carla G van El, Irene M van Langen, Martina C Cornel, Francesca Forzano
Technological advances have increased the availability of genomic data in research and the clinic. If, over time, interpretation of the significance of the data changes, or new information becomes available, the question arises as to whether recontacting the patient and/or family is indicated. The Public and Professional Policy Committee of the European Society of Human Genetics (ESHG), together with research groups from the UK and the Netherlands, developed recommendations on recontacting which, after public consultation, have been endorsed by ESHG Board...
October 11, 2018: European Journal of Human Genetics: EJHG
John H Y Moi, Uyen Phan, Adam de Gruchy, Danny Liew, Tanya I Yuen, John E Cunningham, Ian P Wicks
OBJECTIVES: To report on the design, implementation and evaluation of the safety and effectiveness of the Back pain Assessment Clinic (BAC) model. DESIGN: BAC is a new, community-based specialist service for assessing and managing neck and low back pain (LBP). The BAC pilot was supported by a Victorian Department of Health and Human Services grant and was evaluated using the Victorian Innovation Reform Impact Assessment Framework (VIRIAF). Data were obtained by auditing BAC activity (22 July 2014 to 30 June 2015) and conducting surveys and interviews of patients, stakeholders and referrers...
October 10, 2018: BMJ Open
Marie-Christine J P Franken, Simone P C Koenraads, Carike E M Holtmaat, Marc P van der Schroeff
PURPOSE: The first purpose was to define the recovery rate in children who stutter in a clinical sample, adding self-report to validate recovery status. The second purpose was to explore whether children who were judged to be recovered showed subjective experiences that might be interpreted as coping behaviors used to control speech fluency. METHODS: In this longitudinal study, preschool-age children whose parents consulted a speech-language pathologist about stuttering were followed for 9 years...
September 24, 2018: Journal of Fluency Disorders
Stacy A Ogbeide, Ryan R Landoll, Matthew K Nielsen, Kathryn E Kanzler
INTRODUCTION: Much of behavioral health care takes place within primary care settings rather than in specialty mental health settings. Access to specialty mental health care can be difficult due to limited access to mental health providers and wait times to receive mental health care. The purpose of this study is to determine patient satisfaction with behavioral health consultation visits that take place within the context of the primary care behavioral health consultation model. Patient likelihood to seek out specialty mental health care services if behavioral health consultation services were not provided was also examined...
October 11, 2018: Families, Systems & Health: the Journal of Collaborative Family Healthcare
Christopher Morris, Richard E Scott, Maurice Mars
The use of smartphones and IM has the potential to transform the delivery of health services by providing an easy to use, cost-effective tool for remote doctor-to-doctor and patient-to-doctor consultation and diagnosis. Whilst the introduction of new technologies has improved access to healthcare, it has also created new challenges. The aim of this paper was to review the literature on the use of Instant Messaging (IM) and IM applications (apps) in dermatology. METHOD: PubMed, Scopus, and Science Direct were searched for multiple terms for 20 individual IM apps linked to the terms telehealth, telemedicine, ehealth, e-health, mhealth, or m-health...
2018: Studies in Health Technology and Informatics
Mette Kjer Kaltoft, Jesper Bo Nielsen, Jack Dowie
In the health capital model, the main function of health services is not to produce health, but to support the person in their self-production investments. In the health context there are three types of decision support tools, depending on the role of the provider (e.g. clinician) and person. Non-mediative tools are designed to help the clinician decide what is best for the patient. Intermediative Patient Decision Aids are designed to help the clinician and patient decide together, in an encounter, what is best for the patient...
2018: Studies in Health Technology and Informatics
Georg Griesinger, Christophe Blockeel, Gennady T Sukhikh, Ameet Patki, Bharati Dhorepatil, Dong-Zi Yang, Zi-Jiang Chen, Elke Kahler, Claire Pexman-Fieth, Herman Tournaye
STUDY QUESTION: Is oral dydrogesterone 30 mg daily non-inferior to 8% micronized vaginal progesterone (MVP) gel 90 mg daily for luteal phase support in IVF? SUMMARY ANSWER: Oral dydrogesterone demonstrated non-inferiority to MVP gel for the presence of fetal heartbeats at 12 weeks of gestation (non-inferiority margin 10%). WHAT IS KNOWN ALREADY: The standard of care for luteal phase support in IVF is the use of MVP; however, it is associated with vaginal irritation, discharge and poor patient compliance...
October 10, 2018: Human Reproduction
Sara Farag, Pamela Frazzini Padilla, Katherine A Smith, Rebecca Flyckt, Michael L Sprague, Stephen E Zimberg
STUDY QUESTION: Is there perfusion to the fallopian tubes in ex-vivo and in-vivo uteri at the time of total laparoscopic hysterectomy (TLH), as observed using laser angiography with indocyanine green (ICG)? SUMMARY ANSWER: The fallopian tubes may have perfusion from the utero-ovarian vasculature alone. WHAT IS KNOWN ALREADY: The fallopian tubes are perfused by the uterine and utero-ovarian vessels. Perfusion can be measured using laser angiography with ICG...
October 10, 2018: Human Reproduction
Steven C Eberhardt, Marta E Heilbrun
Value in medicine is defined as the ratio of quality and service and health care outcomes to the costs and inefficiencies of providing care. Creating patient-centered value in radiology reporting requires radiologists to provide accurate diagnostic interpretations in an accessible format with useful advice on further imaging, as well as report-embedded reference materials desired by the referring provider. The value- and service-centered radiologist provides urgent communications when appropriate and is readily available for report consultations...
October 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
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