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High value care

Laura Miller, Gerardo J Pacheco, Jud C Janak, Rose C Grimm, Nicole A Dierschke, Janice Baker, Jean A Orman
Background: Military working dogs (MWDs) are a major asset in the theater of operations. Their unique abilities make them ideal for tasks such as tracking, patrol, and scent detection. MWDs deployed to a war zone are exposed to harsh environments and battlefield dangers that increase their risk of disease, injuries, and death. Although canines have been used extensively in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), no published studies have reported detailed causes of death among MWDs deployed to these conflicts...
March 14, 2018: Military Medicine
Laura J Olivieri, David Zurakowski, Karthik Ramakrishnan, Lillian Su, Fahad A Alfares, Matthew R Irwin, Jenna Heichel, Axel Krieger, Dilip S Nath
BACKGROUND: Postoperative care delivered in the pediatric cardiac intensive care unit (CICU) relies on providers' understanding of patients' congenital heart defects (CHDs) and procedure performed. Novel, bedside use of virtual, three-dimensional (3D) heart models creates access to patients' CHD to improve understanding. This study evaluates the impact of patient-specific virtual 3D heart models on CICU provider attitudes and care delivery. METHODS: Virtual 3D heart models were created from standard preoperative cardiac imaging of ten patients with CHD undergoing repair and displayed on a bedside tablet in the CICU...
March 2018: World Journal for Pediatric & Congenital Heart Surgery
Shigeki Kushimoto, Satoshi Gando, Hiroshi Ogura, Yutaka Umemura, Daizoh Saitoh, Toshihiko Mayumi, Seitaro Fujishima, Toshikazu Abe, Atsushi Shiraishi, Hiroto Ikeda, Joji Kotani, Yasuo Miki, Shin-Ichiro Shiraishi, Koichiro Suzuki, Yasushi Suzuki, Naoshi Takeyama, Kiyotsugu Takuma, Ryosuke Tsuruta, Yoshihiro Yamaguchi, Norio Yamashita, Naoki Aikawa
BACKGROUND: Although the quick Sequential Organ Failure Assessment (qSOFA) has been recommended for identifying patients at higher risk of hospital death, it has only a 60% sensitivity for in-hospital mortality. On the other hand, hypothermia associates with increased mortality and organ failure in patients with sepsis. This study aimed to assess the predictive validity of qSOFA for identifying patients with sepsis at higher risk of multiple organ dysfunction or death and the complementary effect of hypothermia...
January 1, 2018: Journal of Intensive Care Medicine
Ande Rostvall, Wen Zhang, Wiebke Dürig, Gunno Renman, Karin Wiberg, Lutz Ahrens, Pablo Gago-Ferrero
This study evaluated the performance of five different sorbents (granular activated carbon (GAC), GAC + Polonite® (GAC + P), Xylit, lignite and sand) for a set of 83 micropollutants (MPs) (pharmaceuticals, perfluoroalkyl substances (PFASs), personal care products, artificial sweeteners, parabens, pesticide, stimulants), together representing a wide range of physicochemical properties. Treatment with GAC and GAC + P provided the highest removal efficiencies, with average values above 97%. Removal rates were generally lower for Xylit (on average 74%) and lignite (on average 68%), although they proved to be highly efficient for a few individual MPs...
March 6, 2018: Water Research
Jeffrey Olivet, Morgan Haselden, Sarah Piscitelli, Rachael Kenney, Alexander Shulman, Deborah Medoff, Lisa Dixon
AIM: Recent research on first episode psychosis (FEP) has demonstrated the effectiveness of coordinated specialty care (CSC) models to support young adults and their families, yet few tools exist to promote engagement in care. This study aimed to develop a prototype computer-based role-playing game (RPG) designed for young people who have experienced FEP, and conduct a pilot study to determine feasibility and test whether the game improves consumers' attitudes toward treatment and recovery...
March 15, 2018: Early Intervention in Psychiatry
Christina Krudy, Kavita Shah Arora
The United States, along with other resource-rich countries, leads global health care by advancing medical care through randomized controlled trials (RCTs). While most medical research is conducted in these resource-rich areas, RCTs, including replications of previous trials, are additionally carried out in low- and middle-income countries. On the basis of positive findings from several RCTs conducted in high-income countries, the Antenatal Corticosteroids Trial (ACT) evaluated the effectiveness of antenatal corticosteroids in reducing neonatal mortality in low- and middle-income countries...
March 1, 2018: AMA Journal of Ethics
Michael A Mazzeffi, John M See, Brittney Williams, Justin Richards, Darin Zimmerman, Samuel Galvagno, Magali Fontaine, Kenichi Tanaka
BACKGROUND: Red blood cell (RBC) transfusion can be life-saving; however, the risks of RBC transfusion have been increasingly recognized, and current guidelines recommend restrictive transfusion in most patients. We hypothesized that RBC transfusions are decreasing in surgical patients. STUDY DESIGN AND METHODS: A retrospective review of the National Surgical Quality Improvement Program database was performed from 2011 to 2015. Index cases in five surgical specialties were studied: neurosurgery, thoracic surgery, gynecologic surgery, orthopedic surgery, and vascular surgery...
March 14, 2018: Transfusion
Mahmood Yousefi, Mehdi Yaseri, Ramin Nabizadeh, Elham Hooshmand, Mohsen Jalilzadeh, Amir Hossein Mahvi, Ali Akbar Mohammadi
Hypertension is becoming a global epidemic for both rural and urban populations; it is a major public health challenge in Iran. Fluoride can be a risk factor for hypertension. Cross-sectional analysis was conducted in two study areas to assess the relation of fluoride with blood pressure prevalence, BMI, waist circumference, and waist-to-hip ratio (WHR) among different age groups in both sexes. The mean value of fluoride concentration in the drinking water from the four study villages varied from 0.68 to 10...
March 14, 2018: Biological Trace Element Research
Charles M Nichols, Jody C May, Stacy D Sherrod, John A McLean
The field of ion mobility-based omics studies requires high-quality collision cross section (CCS) libraries to effectively utilize CCS as a molecular descriptor. Absolute CCS values with the highest precision are obtained on drift tube instruments by measuring the drift time of ions at multiple drift voltages, commonly referred to as a 'stepped field' experiment. However, generating large scale absolute CCS libraries from drift tube instruments is time consuming due to the current lack of high-throughput methods...
March 15, 2018: Analyst
Roseanne O Yeung, Jing-Heng Cai, Yuying Zhang, Andrea O Luk, Jun-Hao Pan, Junmei Yin, Risa Ozaki, Alice P S Kong, Ronald Ma, Wing-Yee So, Chiu Chi Tsang, K P Lau, Edwin Fisher, Williams Goggins, Brian Oldenburg, Julianna Chan
Background: In a randomized controlled trial of 628 Chinese patients with type 2 diabetes receiving multidisciplinary care in the Joint Asia Diabetes Evaluation (JADE) Progam, 372 were randomized to receive additional telephone-based peer support (Peer Empowerment And Remote communication Linked by information technology, PEARL) intervention. After 12 months, all-cause hospitalization was reduced by half in the PEARL group especially in those with high Depression Anxiety and Stress Scale (DASS) scores...
2018: Clinical Diabetes and Endocrinology
(no author information available yet)
Background: Type 1 diabetes is a condition in which the pancreas produces little or no insulin. People with type 1 diabetes must manage their blood glucose levels by monitoring the amount of glucose in their blood and administering appropriate amounts of insulin via injection or an insulin pump. Continuous glucose monitoring may be beneficial compared to self-monitoring of blood glucose using a blood glucose meter. It provides insight into a person's blood glucose levels on a continuous basis, and can identify whether blood glucose levels are trending up or down...
2018: Ontario Health Technology Assessment Series
Anders Anell, Margareta Dackehag, Jens Dietrichson
BACKGROUND: Providing equal access to health care is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where private providers are free to establish themselves in any part of the country. To improve equity in access to care, 15 out 21 county councils in Sweden have implemented risk-adjusted capitation based on the Care Need Index, which increases capitation to primary care centers with a large share of patients with unfavorable socioeconomic and demographic characteristics...
March 14, 2018: BMC Health Services Research
Bonnie L Westra, Steven G Johnson, Samira Ali, Karen M Bavuso, Christopher A Cruz, Sarah Collins, Meg Furukawa, Mary L Hook, Anne LaFlamme, Kay Lytle, Lisiane Pruinelli, Tari Rajchel, Theresa Tess Settergren, Kathryn F Westman, Luann Whittenburg
BACKGROUND:  Secondary use of electronic health record (EHR) data can reduce costs of research and quality reporting. However, EHR data must be consistent within and across organizations. Flowsheet data provide a rich source of interprofessional data and represents a high volume of documentation; however, content is not standardized. Health care organizations design and implement customized content for different care areas creating duplicative data that is noncomparable. In a prior study, 10 information models (IMs) were derived from an EHR that included 2...
January 2018: Applied Clinical Informatics
Maria Lucia Specchia, Giuseppe La Torre, Giovanna Elisa Calabrò, Paolo Villari, Roberto Grilli, Antonio Federici, Walter Ricciardi, Chiara de Waure
Background: The current economic context calls for rationalizing health resources that can be pursued through disinvestment from low value health technologies to invest in the best performing ones, ensuring high healthcare quality. Oncology is a field where, because of high costs of health technologies and rapid innovation, disinvestment is crucial. Methods: On this basis, the research team investigated through a survey, based on a questionnaire, opinions and views of representatives of European countries about disinvestment, in terms of fields of application, potential advocates and barriers, specifically focusing on cancer care...
March 12, 2018: European Journal of Public Health
Tyler Sheetz, Cheryl T Lee
PURPOSE OF REVIEW: As the population ages, urologic oncologists are caring for older and more vulnerable patients that must withstand complex surgical treatments. Our healthcare environment emphasizes surgical quality, reductions in length of hospital stay, reduced readmission rates, and high patient satisfaction. So those who manage urologic malignancies must be able to optimize their patients. Understanding the concept of frailty, how to diagnose it in a timely and reliable manner, appreciate its perioperative impact, and consider interventions to reduce its effects may improve surgical outcomes...
March 13, 2018: Current Opinion in Urology
Lisa B VanWagner, Fasiha Kanwal
With the passage of the Affordable Care Act (ACA) followed by the physician payment reform, there is an urgent need to better understand the complex relationships between structure (including incentives), processes, and outcomes of health care and, based on this understanding, identify interventions that can ensure delivery of high value care to patients with liver disease. As hepatologists, how do we systematically address these issues and ensure that we provide high-value care to our patients? These factors combine in the burgeoning field of health services research...
March 14, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
William R Phillips, Toby Keys
BACKGROUND AND OBJECTIVES: Primary care (PC) requires interprofessional teamwork and training. Although clinical training in PC settings is well developed in some professions, classroom teaching on the principles and practice of PC provides additional opportunities for interprofessional education. METHODS: We offered an elective one-credit classroom course on PC over 3 years, 2013 through 2015, enrolling students from dentistry, medicine, nursing, pharmacy, physician assistant, public health, social work, and other fields...
March 2018: Family Medicine
Pedapati Radhakrishna, Kolar Vishwanath Vinod, Akkilagunta Sujiv, Rathinam Palamalai Swaminathan
Background: Glycosylated hemoglobin (HbA1c) has not been evaluated extensively for diabetes and prediabetes diagnosis and short-term variability of fasting plasma glucose (FPG), 2-h PG post-75 g glucose load (2 hPG) and HbA1c has not been studied among Indians. Objectives: The study aimed to compare the sensitivity of HbA1c, FPG and 2 hPG for diabetes and prediabetes diagnosis as per the American Diabetes Association criteria, assess short-term variability of three tests and determine optimal HbA1c cutoffs for diabetes and prediabetes diagnosis among high-risk south Indians...
January 2018: Indian Journal of Endocrinology and Metabolism
Carsten Nieder, Thomas A Kämpe
Introduction Our department's standard work-flow includes assessment of all the patients with the Edmonton Symptom Assessment System (ESAS), a one-sheet questionnaire addressing 11 major symptoms and wellbeing on a numeric scale of zero-10, before the palliative radiotherapy (PRT). Based on previous research, we hypothesized that the patients with minimal or moderate total symptom burden might have better overall survival after the PRT than those with at least one higher symptom score. Methods We performed a retrospective analysis of 94 patients and calculated actuarial survival from the first day of the PRT (Kaplan-Meier method)...
January 6, 2018: Curēus
Katharina Feil, Regina Feuerecker, Nicolina Goldschagg, Ralf Strobl, Thomas Brandt, Albrecht von Müller, Eva Grill, Michael Strupp
Background: Making the correct diagnosis of patients presenting with vertigo and dizziness in clinical practice is often challenging. Objective: In this study we examined the performance of the iPad based program me d x in the prediction of different clinical vertigo and dizziness diagnoses and as a diagnostic tool to distinguish between them. Patients and methods: The data collection was done in the outpatient clinic of the German Center of Vertigo and Balance Disorders...
2018: Frontiers in Neurology
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