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Episode of care

Craig M Lilly, Omar Badawi, Xinggang Liu, Gill Christine S, Ilene Harris
OBJECTIVE: To determine whether patients transfused red blood cell (RBC) products according to guideline-specified pretransfusion hemoglobin (Hb) concentrations or for other reasons were more likely to survive their intensive care unit (ICU) stay. DESIGN: An observational study of 375 478 episodes of ICU care, over 5 years, was performed with ICU survival as the primary outcome. Outcomes were analyzed as a function of pretransfusion Hb concentration for groups with distinct transfusion indications while adjusting for potential confounders...
January 1, 2018: Journal of Intensive Care Medicine
Minjung Park, Jennifer Hunter, Soonman Kwon
High demand for traditional Korean medicine led to a policy change in 2010 allowing hospitals to provide Integrative medicine care that combines Western medicine and Korean medicine. This study evaluated the effects of Integrative medicine compared to Western medicine-only for managing acute stroke in South Korean hospitals. A retrospective matched case-control observational study was conducted for acute stroke patients admitted nationwide in 2012 and 2013. Propensity score matching was used to adjust for the likelihood of selecting Integrative medicine...
March 6, 2018: Health Policy
Eva Roos, Lowiek M Hubers, Robert J S Coelen, Marieke E Doorenspleet, Niek de Vries, Joanne Verheij, Ulrich Beuers, Thomas M van Gulik
BACKGROUND: Distinguishing perihilar cholangiocarcinoma (PHC) from benign forms of sclerosing cholangitis affecting the hilar bile ducts is challenging, since histological confirmation of PHC is difficult to obtain and accurate non-invasive diagnostic tests are not available. IgG4-associated cholangitis (IAC), an imitator of PHC, may present with clinical and radiographical signs of PHC. IAC can be accurately diagnosed with a novel qPCR test. The aim of this study was to investigate the incidence and long-term activity of IAC in patients resected for PHC in a single tertiary center over a period of 30 years...
March 16, 2018: American Journal of Gastroenterology
Stephane M Shepherd, Cynthia Willis-Esqueda, Yin Paradies, Diane Sivasubramaniam, Juanita Sherwood, Teresa Brockie
BACKGROUND: Disparities across a number of health indicators between the general population and particular racial and cultural minority groups including African Americans, Native Americans and Latino/a Americans have been well documented. Some evidence suggests that particular groups may receive poorer standards of care due to biased beliefs or attitudes held by health professionals. Less research has been conducted in specifically non-urban areas with smaller minority populations. METHODS: This study explored the self-reported health care experiences for 117 racial and cultural minority Americans residing in a Mid-Western jurisdiction...
March 16, 2018: International Journal for Equity in Health
Kouta Suzuki, Hidehito Niimura, Ryoko Yamazawa, Takahiro Nemoto, Masaaki Murakami, Masaru Mimura, Masafumi Mizuno
INTRODUCTION: In recent years, the early detection and treatment of the first episode of schizophrenia (FES) has attracted worldwide attention. In Japan, psychiatric care has changed to an open and accessible framework over the past decade. Therefore, the duration of untreated psychosis (DUP) is thought to have been shortened. The purposes of this study were to investigate whether recent DUP periods are shorter than they were 10 years ago and whether the DUP at present differs among psychiatric facilities...
March 7, 2018: Asian Journal of Psychiatry
Sunil Pradhan, Surjyaprakash S Choudhury
Introduction: Several extracranial symptoms, including somatic pain syndormes, are known to occur in migraine. Though neck pain has been occasionally described with migraine, its precise association and nature is not yet clear. Objective: To study the incidence and characteristics of neck pain in migraine with particular emphasis on its occurrence as a trigger or a part of the symptom complex of migraine, as well as its association with different phases of the migraine attack...
March 2018: Neurology India
Kresimir Radic, Marko Curkovic, Dario Bagaric, Maja Vilibic, Andrea Tomic, Maja Zivkovic
Patients with schizophrenia, nowadays chronic, frequently disabling mental disorder, get initial treatment after detection of a psychotic episode, seemingly late, potentially preventable stage of illness. As our knowledge about the nature of schizophrenia and other diseases of the spectrum is growing, so are the early interventions becoming more possible, and it is important to conceptualize the clinical, legal and moral issues emerging with new preventive treatments. Every intervention, especially in pre-clinical population, demands a careful risk-benefit assessment and having basic bioethical principles - primacy of patient's welfare, beneficience/non-maleficience, autonomy and justice - in mind...
March 2018: Psychiatria Danubina
Alban Ramette, Ben D Spycher, Jingying Wang, Myrofora Goutaki, Caroline S Beardsmore, Claudia E Kuehni
We examined temporal dependencies between repeated assessments of respiratory infections and asthma in children in the Leicester Respiratory Cohort, Leicestershire, UK. Asthma (doctor diagnosis, health care visits, wheeze frequency) and respiratory infections (cold duration and frequency, cough with colds, ear infections) in the previous 12 months were assessed repeatedly at ages 1, 4, and 6 years for children born between April 1996 and April 1997. We determined associations between contemporaneous and lagged measures of asthma and respiratory infections using structural equation modelling...
March 13, 2018: American Journal of Epidemiology
Linda W Samia, Ann O'Sullivan, Kate Cole Fallon, AbouEl-Makarim Aboueissa, Kenneth W Hepburn
Background and Objectives: The Savvy Advanced psychoeducation program was designed for previously trained caregivers of persons living with dementia to refine their problem-solving and planning skills and enhance their sense of self-efficacy as dementia progressed for the care recipient. Implementation, feasibility, participant satisfaction, and perceived program benefits were also evaluated. Research Design and Methods: A total of 100 dementia family caregivers participated in the 12-month evaluation of Savvy Advanced...
March 12, 2018: Gerontologist
Gunta Laizane, Anda Kivite, Inese Stars, Marita Cikovska, Ilze Grope, Dace Gardovska
BACKGROUND: Rotavirus is the leading cause of severe diarrhea in young children and infants worldwide, representing a heavy public health burden. Limited information is available regarding the impact of rotavirus gastroenteritis on the quality of life of affected children and their families. The objectives of study were to estimate the impact of rotavirus infection on health-related quality of life (HRQL), to assess the social and emotional effects on the families of affected children...
March 15, 2018: BMC Pediatrics
Florian Lamping, Thomas Jack, Nicole Rübsamen, Michael Sasse, Philipp Beerbaum, Rafael T Mikolajczyk, Martin Boehne, André Karch
BACKGROUND: Since early antimicrobial therapy is mandatory in septic patients, immediate diagnosis and distinction from non-infectious SIRS is essential but hampered by the similarity of symptoms between both entities. We aimed to develop a diagnostic model for differentiation of sepsis and non-infectious SIRS in critically ill children based on routinely available parameters (baseline characteristics, clinical/laboratory parameters, technical/medical support). METHODS: This is a secondary analysis of a randomized controlled trial conducted at a German tertiary-care pediatric intensive care unit (PICU)...
March 15, 2018: BMC Pediatrics
Annette Haywood, Sarah Barnes, Hazel Marsh, Stuart G Parker
BACKGROUND: Older people with an acute illness, many of whom are also frail, form a significant proportion of the acute hospital inpatient population. Attention is focusing on ways of improving the physical environment to optimize health outcomes and staff efficiency. PURPOSE: This article explores the effects of the physical environment in three acute care settings: acute hospital site, in-patient rehabilitation hospital, and intermediate care provision (a nursing home with some beds dedicated to intermediate care) chosen to represent different steps on the acute care pathway for older people and gain the perspectives of patients, family carers, and staff...
January 1, 2018: HERD
Daniel Isacson, Karl Andreasson, Maziar Nikberg, Kenneth Smedh, Abbas Chabok
PURPOSE: Outpatient management without antibiotics has been shown to be safe for selected patients diagnosed with acute uncomplicated diverticulitis (AUD). The aim of this study was to evaluate the impact on admissions, complication rates and health-care costs of the policy of outpatient treatment without using antibiotics. METHODS: The medical records of all patients diagnosed with AUD in the year before (2011) and after (2014) the implementation of outpatient management without antibiotics in Västmanland County were reviewed...
March 15, 2018: Scandinavian Journal of Gastroenterology
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
Rikke Pilmann Laursen, Anni Larnkjaer, Christian Ritz, Iva Hojsak, Kim Michaelsen, Christian Mølgaard
AIM: We examined the frequency and potential risk factors for respiratory infections, diarrhoea and absences in infants during their first months in day care. METHODS: This prospective cohort study comprised 269 Danish infants aged 8-14 months and was part of a study that examined how probiotics affected absences from day care due to respiratory and gastrointestinal infections. The risk factors examined were the household, child characteristics and type of day care facility...
March 14, 2018: Acta Paediatrica
Jing Li Huang, Theo A Woehrle, Pat Conway, Catherine A McCarty, Madeline M Eyer, Steven D Eyer
PURPOSE: In 2007, Essentia Health St. Mary's Medical Center (SMMC), a Level II trauma center in northeastern Minnesota, implemented a protocol for patients who presented with blunt head trauma and were receiving warfarin for anticoagulation. The purpose of this study was to determine the incidence and risk factors of early delayed, warfarin-associated intracranial hemorrhage (ICH). METHODS: Adult patients with signs and symptoms of head injury on warfarin who were admitted by protocol to SMMC between March 2007 and June 2015 were included...
March 14, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Sturla Gjesdal, Tor Helge Holmaas, Karin Monstad, Øystein Hetlevik
OBJECTIVES: To identify new cases of musculoskeletal (MSK) disorders among employed people presenting in Norwegian primary care in 2012, frequency of sickness certification and length of sick leave. To identify patient-, diagnosis- and GP-related predictors of sickness certification, prolonged sick leave and return to work (RTW). METHODS: An observational multiregister-based cohort study covering all employed persons in Norway(1 176 681 women and 1 330 082 men) based on claims data from all regular GPs merged with individual sociodemographic data from public registers was performed...
March 14, 2018: BMJ Open
Rachael M Hunter, Naomi J Fulop, Ruth J Boaden, Christopher McKevitt, Catherine Perry, Angus I G Ramsay, Anthony G Rudd, Simon J Turner, Pippa J Tyrrell, Charles D A Wolfe, Stephen Morris
BACKGROUND: The economic implications of major system change are an important component of the decision to implement health service reconfigurations. Little is known about how best to report the results of economic evaluations of major system change to inform decision-makers. Reconfiguration of acute stroke care in two metropolitan areas in England, namely London and Greater Manchester (GM), was used to analyse the economic implications of two different implementation strategies for major system change...
March 14, 2018: Health Research Policy and Systems
Farouq Muhammad Dayyab, Garba Iliyasu, Aliyu Aminu, Zaiyad Garba Habib, Abdulwasiu Bolaji Tiamiyu, Sirajo Haliru Tambuwal, Muhammad Musa Borodo, Abdulrazaq Garba Habib
Background: Hospital-acquired infections (HAIs) are an important cause of morbidity and mortality. This study examined the epidemiology, clinical outcomes and microbiological profile of HAIs. Methods: This prospective study was carried out on patients identified to have developed HAIs while admitted to the medical wards, surgical wards, dialysis unit and intensive care unit (ICU) of the hospital. Patients were recruited consecutively until the target study population was reached...
March 12, 2018: Transactions of the Royal Society of Tropical Medicine and Hygiene
Hein Heidbuchel, Nikolaos Dagres, Matthias Antz, Karl-Heinz Kuck, Patrice Lazure, Suzanne Murray, Céline Carrera, Gerhard Hindricks, Alec Vahanian
Aims: Guideline-adherent treatment is associated with improved prognosis in atrial fibrillation (AF) patients but is insufficiently implemented in clinical practice. The European Society of Cardiology (ESC) performed a multinational educational needs assessment study among cardiologists, general practitioners/family physicians (GPs/FPs), and neurologists in order to evaluate knowledge and skills of physicians and system factors related to AF care delivery. Methods and results: A total of 561 physicians (294 cardiologists, 131 neurologists, and 136 GPs/FPs) from six European countries participated...
March 12, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
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