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https://www.readbyqxmd.com/read/29049115/an-evidence-based-approach-to-the-prescription-opioid-epidemic-in-orthopedic-surgery
#1
Ellen M Soffin, Seth A Waldman, Roberta J Stack, Gregory A Liguori
Orthopedic surgery is associated with significant perioperative pain. Providing adequate analgesia is a critical component of patient care and opioids play a vital role in the acute postoperative setting. However, opioid prescribing for patients undergoing orthopedic procedures has recently been identified as a major contributor to the current opioid epidemic. As opioid usage and related morbidity and mortality continue to rise nationwide, opioid-prescribing practices are under increased scrutiny. Here, we update the evidence base and recommendations behind a set of interventions developed at the Hospital for Special Surgery to address the national epidemic at the local level...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29047381/a-critical-appraisal-of-guidelines-used-for-management-of-severe-acute-malnutrition-in-south-africa-s-referral-system
#2
Faith Nankasa Mambulu-Chikankheni, John Eyles, Ejemai Amaize Eboreime, Prudence Ditlopo
BACKGROUND: Focusing on healthcare referral processes for children with severe acute malnutrition (SAM) in South Africa, this paper discusses the comprehensiveness of documents (global and national) that guide the country's SAM healthcare. This research is relevant because South African studies on SAM mostly examine the implementation of WHO guidelines in hospitals, making their technical relevance to the country's lower level and referral healthcare system under-explored. METHODS: To add to both literature and methods for studying SAM healthcare, we critically appraised four child healthcare guidelines (global and national) and conducted complementary expert interviews (n = 5)...
October 18, 2017: Health Research Policy and Systems
https://www.readbyqxmd.com/read/29044819/repeated-sleep-quality-assessment-and-use-of-sleep-promoting-interventions-in-icu
#3
Ashika Menear, Rosalind Elliott, Leanne M Aitken, Sara Lal, Sharon McKinley
To describe sleep quality using repeated subjective assessment and the ongoing use of sleep-promoting interventions in intensive care. It is well known that the critically ill experience sleep disruption while receiving treatment in the intensive care unit. Both the measurement and promotion of sleep is challenging in the complex environment of intensive care unit. Repeated subjective assessment of patients' sleep in the intensive care unit and use of sleep-promoting interventions has not been widely reported...
October 16, 2017: Nursing in Critical Care
https://www.readbyqxmd.com/read/29044713/investigation-of-umbilical-venous-vessels-anatomy-and-diameters-as-a-guideline-for-catheter-placement-in-newborns
#4
F Eifinger, Z Fuchs, F Koerber, T Persigehl, M Scaal
INTRODUCTION: Umbilical cord catheters (UCC) are important for the primary care of critically ill newborns. To analyze anatomical variations of the umbilical vein (UV) and its further course, we performed abdominal spiral-CT examinations on stillborns. The aim of the study was to explore the high incidence of mal-positioned UCCs and to improve their positioning. MATERIALS AND METHODS: Eighteen stillborns were investigated (29.2 weeks ± 6.7 weeks (IQR)). CTs were performed using either air or contrast medium injection into the UV...
October 17, 2017: Clinical Anatomy
https://www.readbyqxmd.com/read/29039683/a-systematic-review-of-federal-drug-administration-docket-for-community-consultation-and-public-disclosure-in-exception-from-informed-consent-trials
#5
Adrianne N Haggins, Deneil Harney, Sara Scott, Robert Silbergleit
BACKGROUND: Exception from informed consent imposes community consultation and public disclosure requirements on clinical investigation in critically ill and injured patients. In 2011, the Food and Drug Administration instructed sponsors to submit publically disclosed information to the Food and Drug Administration Docket, but to date there has been no comprehensive analysis of available data. We summarized the community consultation and public disclosure practices of exception from informed consent trials published on the Food and Drug Administration Docket in order to better understand the breadth of common practices that exists among acute care clinical research...
October 1, 2017: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/29039621/supporting-emergency-medical-care-teams-with-an-integrated-status-display-providing-real-time-access-to-medical-best-practices-workflow-tracking-and-patient-data
#6
PoLiang Wu, Min-Young Nam, Jeonghwan Choi, Alex Kirlik, Lui Sha, Richard B Berlin
The work of a hospital's medical staff is safety critical and often occurs under severe time constraints. To provide timely and effective cognitive support to medical teams working in such contexts, guidelines in the form of best practice workflows for healthcare have been developed by medical organizations. However, the high cognitive load imposed in such stressful and rapidly changing environments poses significant challenges to the medical staff or team in adhering to these workflows. In collaboration with physicians and nurses from Carle Foundation Hospital, we first studied and modeled medical team's individual responsibilities and interactions in cardiac arrest resuscitation and decomposed their overall task into a set of distinct cognitive tasks that must be specifically supported to achieve successful human-centered system design...
October 17, 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/29038971/the-implementation-of-targeted-temperature-management-an-evidence-based-guideline-from-the-neurocritical-care-society
#7
Lori Kennedy Madden, Michelle Hill, Teresa L May, Theresa Human, Mary McKenna Guanci, Judith Jacobi, Melissa V Moreda, Neeraj Badjatia
BACKGROUND: Targeted temperature management (TTM) is often used in neurocritical care to minimize secondary neurologic injury and improve outcomes. TTM encompasses therapeutic hypothermia, controlled normothermia, and treatment of fever. TTM is best supported by evidence from neonatal hypoxic-ischemic encephalopathy and out-of-hospital cardiac arrest, although it has also been explored in ischemic stroke, traumatic brain injury, and intracranial hemorrhage patients. Critical care clinicians using TTM must select appropriate cooling techniques, provide a reasonable rate of cooling, manage shivering, and ensure adequate patient monitoring among other challenges...
October 16, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29038868/the-global-spine-care-initiative-a-review-of-reviews-and-recommendations-for-the-non-invasive-management-of-acute-osteoporotic-vertebral-compression-fracture-pain-in-low-and-middle-income-communities
#8
REVIEW
Arthur Ameis, Kristi Randhawa, Hainan Yu, Pierre Côté, Scott Haldeman, Roger Chou, Eric L Hurwitz, Margareta Nordin, Jessica J Wong, Heather M Shearer, Anne Taylor-Vaisey
PURPOSE: The purpose of this review was to develop recommendations for non-invasive management of pain due to osteoporotic vertebral compression fractures (OVCF) that could be applied in medically underserved areas and low- and middle-income countries. METHODS: We conducted a systematic review and best evidence synthesis of systematic reviews on the non-invasive management of OVCF. Eligible reviews were critically appraised using the Scottish Intercollegiate Guidelines Network criteria...
October 16, 2017: European Spine Journal
https://www.readbyqxmd.com/read/29035778/the-over-researched-community-an-ethics-analysis-of-stakeholder-views-at-two-south-african-hiv-prevention-research-sites
#9
Jennifer Koen, Douglas Wassenaar, Nicole Mamotte
Health research in resource-limited, multi-cultural contexts raises complex ethical concerns. The term 'over-researched community' (ORC) has been raised as an ethical concern and potential barrier to community participation in research. However, the term lacks conceptual clarity and is absent from established ethics guidelines and academic literature. In light of the concern being raised in relation to research in low- and middle-income countries (LMICs), a critical and empirical exploration of the meaning of ORC was undertaken...
October 7, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/29032979/a-treatment-algorithm-for-the-management-of-intraoral-burns-a-narrative-review
#10
REVIEW
Steve Kang, Kenneth Kufta, Thomas P Sollecito, Neeraj Panchal
Oral mucosa follows a distinctly different trajectory of wound healing than skin. Although there are contemporary guidelines regarding treatment of burns to the skin, there is no standard of care specific to intraoral burns. This narrative review proposes an evidence-based treatment algorithm for the management of intraoral burns. Data was collated through a comprehensive review of the literature and only included studies that have reported particular success with favorable short- and long-term prognoses. In order to critically appraise the strength of the treatment recommendations, the GRADE criteria was applied to each arm of the algorithm...
October 9, 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/29025426/the-complete-european-guidelines-on-phenylketonuria-diagnosis-and-treatment
#11
REVIEW
A M J van Wegberg, A MacDonald, K Ahring, A Bélanger-Quintana, N Blau, A M Bosch, A Burlina, J Campistol, F Feillet, M Giżewska, S C Huijbregts, S Kearney, V Leuzzi, F Maillot, A C Muntau, M van Rijn, F Trefz, J H Walter, F J van Spronsen
Phenylketonuria (PKU) is an autosomal recessive inborn error of phenylalanine metabolism caused by deficiency in the enzyme phenylalanine hydroxylase that converts phenylalanine into tyrosine. If left untreated, PKU results in increased phenylalanine concentrations in blood and brain, which cause severe intellectual disability, epilepsy and behavioural problems. PKU management differs widely across Europe and therefore these guidelines have been developed aiming to optimize and standardize PKU care. Professionals from 10 different European countries developed the guidelines according to the AGREE (Appraisal of Guidelines for Research and Evaluation) method...
October 12, 2017: Orphanet Journal of Rare Diseases
https://www.readbyqxmd.com/read/29025397/a-qualitative-study-of-patient-education-needs-for-hip-and-knee-replacement
#12
Deborah Kennedy, Amy Wainwright, Lucy Pereira, Susan Robarts, Patricia Dickson, Jennifer Christian, Fiona Webster
BACKGROUND: Quality health information is key to patient engagement, self-management and an enhanced healthcare experience. There is strong evidence to support involving patients and their families in the development and evaluation of health-related educational material. These factors were the impetus for our high volume joint replacement centre to undertake a qualitative study to elicit patient experiences to inform the development of effective strategies and education along the care continuum for hip and knee replacement...
October 12, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/29025086/a-critical-appraisal-of-guidelines-for-electronic-communication-between-patients-and-clinicians-the-need-to-modernize-current-recommendations
#13
Joy L Lee, Marianne S Matthias, Nir Menachemi, Richard M Frankel, Michael Weiner
Background: Patient-provider electronic communication has proliferated in recent years, yet there is a dearth of published research either leading to, or including, recommendations that improve clinical care and prevent unintended negative consequences. We critically appraise published guidelines and suggest an agenda for future work in this area. Objective: To understand how existing guidelines align with current practice, evidence, and technology. Methods: We performed a narrative review of provider-targeted guidelines for electronic communication between patients and providers, searching Ovid MEDLINE, Embase, and PubMed databases using relevant terms...
August 25, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29023584/intravenous-fluid-prescribing-errors-in-children-mixed-methods-analysis-of-critical-incidents
#14
Richard L Conn, Steven McVea, Angela Carrington, Tim Dornan
INTRODUCTION: Recent National Institute for Health and Care Excellence (NICE) guidelines aim to improve intravenous (IV) fluid prescribing for children, but existing evidence about how and why fluid prescribing errors occur is limited. Studying this can lead to more effective implementation, through education and systems design. AIMS: Identify types of IV fluid prescribing errors reported in practiceAnalyse factors that contribute to errorsProvide guidance to educators and those responsible for designing systems...
2017: PloS One
https://www.readbyqxmd.com/read/29023252/partner-notification-for-youth-living-with-hiv-in-14-cities-in-the-united-states
#15
Jacob J van den Berg, Marjan Javanbakht, Pamina M Gorbach, Bret J Rudy, Andrew O Westfall, Craig M Wilson, Michelle A Lally
BACKGROUND: Identifying factors associated with partner notification among youth living with HIV is critical for effective HIV prevention and treatment strategies. METHODS: A total of 924 male and female behaviorally-infected youth ages 13-24 across 14 U.S. cities completed an audio-computer assisted self-interview including questions about demographics and experiences with patient- and provider-referral partner notification. RESULTS: The majority of participants self-identified as male (82...
October 4, 2017: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/29022369/psychosocially-supportive-design-the-case-for-greater-attention-to-social-space-within-the-pediatric-hospital
#16
Rebecca McLaughlan
OBJECTIVE: Models of patient and family-centered care advocate catering to psychosocial needs when designing healthcare facilities yet there is little evidence available to determine how the built environment can cater to psychosocial needs. This article highlights the obstacles to overcoming this knowledge deficit in the pursuit of evidence-based guidelines to inform social provisions within the pediatric hospital setting. It will propose a working definition for psychosocial space and identify new research directions to enhance understandings of the relationship between social space and well-being...
January 1, 2017: HERD
https://www.readbyqxmd.com/read/29021727/analgesia-sedation-and-arousal-status-in-burn-patients-the-gap-between-recommendations-and-current-practices
#17
A Lavrentieva, N Depetris, I Rodini
Assessment and treatment of pain, agitation and delirium are integral parts of the management of critically ill patients. The purpose of this review is to describe how pain, delirium and agitation are managed in general intensive care units and in burn units, and to address whether management of these issues is compatible with internationally accepted recommendations. A substantial gap exists between the conception of the guidelines, clinical practice and physicians' statements regarding pain, sedation and delirium management...
June 30, 2017: Annals of Burns and Fire Disasters
https://www.readbyqxmd.com/read/29019796/monitoring-modalities-and-assessment-of-fluid-status-a-practice-management-guideline-from-the-eastern-association-for-the-surgery-of-trauma-east
#18
David S Plurad, William Chiu, Ali S Raja, Samuel M Galvagno, Uzer Khan, Dennis Y Kim, Samuel A Tisherman, Jeremy Ward, Mark E Hamill, Vicki Bennett, Brian Williams, Bryce Robinson
BACKGROUND: Fluid administration in critically ill surgical patients must be closely monitored to avoid complications. Resuscitation guided by invasive methods are not consistently associated with improved outcomes. As such, there has been increased use of Focused Ultrasound and Arterial Pulse Waveform Analysis (APWA) to monitor and aid resuscitation. An assessment of these methods using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework is presented...
October 11, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29017475/reliability-validity-and-responsiveness-of-the-german-self-reported-foot-and-ankle-score-sefas-in-patients-with-foot-or-ankle-surgery
#19
Dariusch Arbab, Katharina Kuhlmann, Christoph Schnurr, Bertil Bouillon, Christian Lüring, Dietmar König
BACKGROUND: Patient-reported outcome measures are a critical tool in evaluating the efficacy of orthopedic procedures and are increasingly used in clinical trials to assess outcomes of health care. The intention of this study was to develop and culturally adapt a German version of the Self-reported Foot and Ankle Score (SEFAS) and to evaluate reliability, validity and responsiveness. METHODS: According to Cross Cultural Adaptation of Self-Reported Measure guidelines forward and backward translation has been performed...
October 10, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/29016462/the-medical-futility-experience-of-nurses-in-caring-for-critically-ill-patients
#20
Ming-Yi Hsu, Shu-Fen Su, Lien-Ying Chiang, Sou-Jen Shih, Yu-Chen Chen
BACKGROUND: Medical futility is a key bioethical concern. In Taiwan, policymakers tend to provide care standards and evaluation guidelines for critically ill and terminal patients whose treatment is medically futile. However, the current status of medical futility for critically ill patients is inadequate, and no consensus currently exists on the definition of medical futility. PURPOSE: The aim of this study was to understand the medical futility experiences of intensive care nurses...
October 10, 2017: Journal of Nursing Research: JNR
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