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https://www.readbyqxmd.com/read/29447402/intraoperative-endotracheal-cuff-pressure-study-how-education-and-availability-of-manometers-help-guide-safer-pressures
#1
Gregory J Stevens, Joel W Warfel, James K Aden, Scott D Blackwell
Introduction: Endotracheal intubation is a medical procedure that is often indicated in both the perioperative and critical care environments. Cuffed endotracheal tubes (ETT) allow for safer and more efficient delivery of positive pressure ventilation, as well as create a barrier to reduce the risk of micro-aspiration and anesthetic pollution in the operating room environment. Over-inflation of the endotracheal cuff can lead to serious and harmful sequelae. This study aimed to assess if departmental education paired with ready access to a manometer to assess cuff pressure would result in an improvement in the proportion of ETT cuff pressures in the goal range...
February 13, 2018: Military Medicine
https://www.readbyqxmd.com/read/29447091/obesity-in-pregnancy-a-comparison-of-four-national-guidelines
#2
Dana Vitner, Kristin Harris, Cynthia Maxwell, M D Farine
BACKGROUND: Obesity in pregnancy has become one of the most important challenges in obstetrical care given its prevalence and potential adverse impact on both mother and fetus. The primary objective of this descriptive review is to identify common themes and distinctions within the current recommendations for maternal obesity in the most updated version of four published national guidelines. METHODS: We reviewed the following guidelines for obesity in pregnancy: American College of Obstetricians and Gynecologists (ACOG) 2015, Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG) 2013, Royal College of Obstetrics and Gynecology (RCOG) 2010, and Society of Obstetrics and Gynecologists of Canada (SOGC) 2010...
February 15, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29444286/techniques-to-ensure-accurate-targeting-for-delivery-of-awake-laser-interstitial-thermotherapy
#3
Dimitri Laurent, Seth F Oliveria, Michael Shang, Frank Bova, Rachel Freedman, Maryam Rahman
BACKGROUND: Magnetic resonance imaging (MRI) guided laser interstitial thermal therapy (LITT) is an emerging neurosurgical treatment modality that is typically performed under general anesthesia. We describe a novel workflow developed at the University of Florida to deliver LITT in conscious patients without the use of general anesthesia. OBJECTIVE: To describe a novel workflow for LITT implementation in the awake patient with equivalent treatment results when compared to procedures performed under general anesthesia...
February 10, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29443648/readmission-patterns-after-gi-cancer-hospitalizations-the-medical-versus-surgical-patient
#4
Joanna-Grace M Manzano, Ming Yang, Hui Zhao, Linda S Elting, Marina C George, Ruili Luo, Maria E Suarez-Almazor
PURPOSE: Readmission within 30 days has been used as a metric for quality of care received at hospitals for certain diagnoses. In the era of accountability, value-based care, and increasing cancer costs, policymakers are looking into cancer readmissions as well. It is important to describe the readmission profile of patients with cancer in the most clinically relevant approach to inform policy and health care delivery that can positively impact patient outcomes. PATIENTS AND METHODS: We conducted a retrospective cohort study using linked Texas Cancer Registry and Medicare claims data...
February 13, 2018: Journal of Oncology Practice
https://www.readbyqxmd.com/read/29439305/strategic-application-of-radiotherapy-for-hepatocellular-carcinoma
#5
Seo Hee Choi, Jinsil Seong
With increasing clinical use, radiotherapy (RT) has been considered reliable and effective method for hepatocellular carcinoma (HCC) treatment, depending on extent of disease and patient characteristics. RT for HCC can improve therapeutic outcomes through excellent local control, downstaging, conversion from unresectable to resectable status, and treatments of unresectable HCCs with vessel invasion or multiple intrahepatic metastases. In addition, further development of modern RT technologies, including image-guided radiotherapy (IGRT), intensity-modulated radiotherapy (IMRT), and stereotactic body radiotherapy, has expanded the indication of RT...
February 14, 2018: Clinical and Molecular Hepatology
https://www.readbyqxmd.com/read/29436401/evaluation-of-a-hub-and-spoke-model-for-the-delivery-of-femtosecond-laser-assisted-cataract-surgery-within-the-context-of-a-large-randomised-controlled-trial
#6
Harry W Roberts, Vijay K Wagh, Isabella J M Mullens, Simone Borsci, Melody Z Ni, David P S O'Brart
AIMS: To test a hypothesis that cataract operating room (OR) productivity can be improved with a femtosecond laser (FL) using a hub-and-spoke model and whether any increase in productivity can offset additional costs relating to the FL. METHODS: 400 eyes of 400 patients were enrolled in a randomised-controlled trial comparing FL-assisted cataract surgery (FLACS) with conventional phacoemulsification surgery (CPS). 299 of 400 operations were performed on designated high-volume theatre lists (FLACS=134, CPS=165), where a hub-and-spoke FLACS model (1×FL, 2×ORs=2:1) was compared with independent CPS theatre lists...
February 7, 2018: British Journal of Ophthalmology
https://www.readbyqxmd.com/read/29432404/duration-to-establish-an-emergency-vascular-access-and-how-to-accelerate-it-a-simulation-based-study-performed-in-real-life-neonatal-resuscitation-rooms
#7
Eva M Schwindt, Florian Hoffmann, Philipp Deindl, Thomas J Waldhoer, Jens C Schwindt
OBJECTIVES: To compare the duration to establish an umbilical venous catheter and an intraosseous access in real hospital delivery rooms and as a secondary aim to assess delaying factors during establishment and to provide recommendations to accelerate vascular access in neonatal resuscitation. DESIGN: Retrospective analysis of audio-video recorded neonatal simulation training. SETTINGS: Simulation training events in exact replications of actual delivery/resuscitation rooms of 16 hospitals with different levels of care (Austria and Germany)...
February 9, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29432379/dexmedetomidine-as-a-part-of-general-anaesthesia-for-caesarean-delivery-in-patients-with-pre-eclampsia-efficacy-and-foetal-outcome-a-randomised-double-blinded-trial
#8
Ashraf M Eskandr, Ahmed A Metwally, Abd-Elrahman A Ahmed, Elham M Elfeky, Islam M Eldesoky, Manar A Obada, Osama A Abd-Elmegid
BACKGROUND: During general anaesthesia, endotracheal intubation of patients with pre-eclampsia causes stimulation of the sympathetic nervous system and catecholamine release, which may lead to maternal and neonatal complications. OBJECTIVE: To attenuate both the stress response and the haemodynamic response to tracheal intubation in patients with pre-eclampsia. DESIGN: A randomised, double-blind, controlled study. SETTING: Single University Hospital...
February 9, 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29431872/interventions-to-prevent-hypothermia-at-birth-in-preterm-and-or-low-birth-weight-infants
#9
REVIEW
Emma M McCall, Fiona Alderdice, Henry L Halliday, Sunita Vohra, Linda Johnston
BACKGROUND: Newborn admission temperature is a strong predictor of outcomes across all gestations. Hypothermia immediately after birth remains a worldwide issue and, if prolonged, is associated with harm. Keeping preterm infants warm is difficult even when recommended routine thermal care guidelines are followed in the delivery room. OBJECTIVES: To assess the efficacy and safety of interventions designed for prevention of hypothermia in preterm and/or low birth weight infants applied within 10 minutes after birth in the delivery room, compared with routine thermal care or any other single/combination of intervention(s) also designed for prevention of hypothermia in preterm and/or low birth weight infants applied within 10 minutes after birth in the delivery room...
February 12, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29427893/ghana-s-community-based-primary-health-care-why-women-and-children-are-disadvantaged-by-its-implementation
#10
Roger A Atinga, Irene Akua Agyepong, Reuben K Esena
Policy analysis on why women and children in low- and middle-income settings are still disadvantaged by access to appropriate care despite Primary Health Care (PHC) programmes implementation is limited. Drawing on the street-level bureaucracy theory, we explored how and why frontline providers (FLP) actions on their own and in interaction with health system factors shape Ghana's community-based PHC implementation to the disadvantage of women and children accessing and using health services. This was a qualitative study conducted in 4 communities drawn from rural and urban districts of the Upper West region...
February 5, 2018: Social Science & Medicine
https://www.readbyqxmd.com/read/29425333/taking-an-hpv-vaccine-research-tested-intervention-to-scale-in-a-clinical-setting
#11
Suellen Hopfer, Anne E Ray, Michael L Hecht, Michelle Miller-Day, Rhonda Belue, Gregory Zimet, W Douglas Evans, Francis X McKee
Research tested interventions are seldom ready for wide spread use. Successful intervention adaptation to clinical settings demands an iterative process with target audience feedback. We describe the adaptation process of implementing an NCI research tested HPV vaccine intervention, Women's Stories, to a community clinic context (Planned Parenthood). Five phases are described for the adaptation of content and the development of a health kiosk intervention delivery system: (a) informant interviews with the target audience of young adult, predominantly African-American women, (b) translating HPV vaccine decision narratives into prevention messages, (c) health kiosk interface design, (d) conducting a usability study of the health kiosk intervention product, and (e) conducting a waiting room observational study...
February 7, 2018: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/29422335/comparison-of-three-continuous-positive-airway-pressure-cpap-interfaces-in-healthy-beagle-dogs-during-medetomidine-propofol-constant-rate-infusions
#12
Carolina Meira, Fabiola B Joerger, Annette P N Kutter, Andreas Waldmann, Simone K Ringer, Stephan H Böehm, Samuel Iff, Martina Mosing
OBJECTIVE: To compare the efficacy of three continuous positive airway pressure (CPAP) interfaces in dogs on gas exchange, lung volumes, amount of leak during CPAP and rebreathing in case of equipment failure or disconnection. STUDY DESIGN: Randomized, prospective, crossover, experimental trial. ANIMALS: Ten purpose-bred Beagle dogs. METHODS: Dogs were in dorsal recumbency during medetomidine-propofol constant rate infusions, breathing room air...
December 5, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/29421219/development-of-stabilizing-formulations-of-a-trivalent-inactivated-poliovirus-vaccine-in-a-dried-state-for-delivery-in-the-nanopatchtm-microprojection-array
#13
Ying Wan, John M Hickey, Christopher Bird, Katey Witham, Paul Fahey, Angus Forster, Sangeeta B Joshi, David B Volkin
The worldwide switch to inactivated polio vaccines (IPV) is a key component of the overall strategy to achieve and maintain global polio eradication. To this end, new IPV vaccine delivery systems may enhance patient convenience and compliance. In this work, we examine NanopatchTM (a solid, polymer micro-projection array) which offers potential advantages over standard needle/syringe administration including intradermal delivery and reduced antigen doses. Using trivalent IPV (tIPV) and a purpose-built evaporative dry-down system, candidate tIPV formulations were developed to stabilize tIPV during the drying process and upon storage...
February 5, 2018: Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/29420404/association-between-labor-and-delivery-unit-census-and-delays-in-patient-management-findings-from-a-computer-simulation-module
#14
Rose L Molina, Matthew Gombolay, Jennifer Jonas, Anna M Modest, Julie Shah, Toni H Golen, Neel T Shah
OBJECTIVE: To demonstrate the association between increases in labor and delivery unit census and delays in patient care decisions using a computer simulation module. METHODS: This was an observational cohort study of labor and delivery unit nurse managers. We developed a computer module that simulates the physical layout and clinical activity of the labor and delivery unit at our tertiary care academic medical center, in which players act as clinical managers in dynamically allocating nursing staff and beds as patients arrive, progress in labor, and undergo procedures...
February 5, 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29417615/the-effect-of-handover-location-on-trauma-theatre-start-time-an-estimated-cost-saving-of-%C3%A2-131%C3%A2-000-per-year
#15
Sam Nahas, Adam Ali, Kiran Majid, Roshan Joseph, Chris Huber, Victor Babu
BACKGROUND: The National Health Service was estimated to be in £2.45 billion deficit in 2015 to 2016. Trauma theatre utilization and efficiency has never been so important as it is estimated to cost £15/minute. METHODS: Structured questionnaires were given to 23 members of staff at our Trust who are actively involved in the organization or delivery of orthopaedic trauma lists at least once per week. This was used to identify key factors that may improve theatre efficiency...
February 8, 2018: International Journal of Health Planning and Management
https://www.readbyqxmd.com/read/29408559/in-vivo-therapeutic-applications-of-cell-spheroids
#16
REVIEW
Chin Siang Ong, Xun Zhou, Jingnan Han, Chen Yu Huang, Andrew Nashed, Shipra Khatri, Gunnar Mattson, Takuma Fukunishi, Huaitao Zhang, Narutoshi Hibino
Spheroids are increasingly being employed to answer a wide range of clinical and biomedical inquiries ranging from pharmacology to disease pathophysiology, with the ultimate goal of using spheroids for tissue engineering and regeneration. When compared to traditional two-dimensional cell culture, spheroids have the advantage of better replicating the 3D extracellular microenvironment and its associated growth factors and signaling cascades. As knowledge about the preparation and maintenance of spheroids has improved, there has been a plethora of translational experiments investigating in vivo implantation of spheroids into various animal models studying tissue regeneration...
February 3, 2018: Biotechnology Advances
https://www.readbyqxmd.com/read/29406382/review-of-routes-to-administer-medication-during-prolonged-neonatal-resuscitation
#17
Michael Wagner, Monika Olischar, Megan O'Reilly, Katharina Goeral, Angelika Berger, Po-Yin Cheung, Georg M Schmölzer
OBJECTIVE: During neonatal cardiopulmonary resuscitation, early establishment of vascular access is crucial. We aimed to review current evidence regarding different routes for the administration of medications during neonatal resuscitation. DATA SOURCES: We reviewed PubMed, EMBASE, and Google Scholar using MeSH terms "catheterization," "umbilical cord," "delivery room," "catecholamine," "resuscitation," "simulation," "newborn," "infant," "intraosseous," "umbilical vein catheter," "access," "intubation," and "endotracheal...
February 5, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29406381/optimal-insertion-depth-for-endotracheal-tubes-in-extremely-low-birth-weight-infants
#18
Cheung Leung
OBJECTIVE: To determine the optimal endotracheal tube insertion depth in extremely low-birth-weight infants based on the association between endotracheal tube depth and gestational age, body weight, body length, and head and chest circumferences at birth. DESIGN: Retrospective chart review. SETTING: Neonatal ICU at a medical center. PATIENTS: Fifty-two hospitalized extremely low-birth-weight infants in our neonatal ICU...
February 5, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29402306/sustainable-reduction-of-antibiotic-induced-antimicrobial-resistance-arena-in-german-ambulatory-care-study-protocol-of-a-cluster-randomised-trial
#19
Martina Kamradt, Petra Kaufmann-Kolle, Edith Andres, Tonia Brand, Anja Klingenberg, Katharina Glassen, Regina Poß-Doering, Lorenz Uhlmann, Katharina Hees, Dorothea Weber, Andreas Gutscher, Veit Wambach, Joachim Szecsenyi, Michel Wensing
BACKGROUND: Despite many initiatives to enhance the rational use of antibiotics, there remains substantial room for improvement. The overall aim of this study is to optimise the appropriate use of antibiotics in German ambulatory care in patients with acute non-complicated infections (respiratory tract infections, such as bronchitis, sinusitis, tonsillitis and otitis media), community-acquired pneumonia and non-complicated cystitis, in order to counter the advancing antimicrobial resistance development...
February 5, 2018: Implementation Science: IS
https://www.readbyqxmd.com/read/29402260/equity-and-efficiency-of-medical-service-systems-at-the-provincial-level-of-china-s-mainland-a-comparative-study-from-2009-to-2014
#20
Jingmei Ding, Xuejun Hu, Xianzhi Zhang, Lei Shang, Min Yu, Huoliang Chen
BACKGROUND: The astonishing economic achievements of China in the past few decades have remarkably increased not only the quantity and quality of medical services but also the inequalities in health resources allocation across regions and inefficiency of the medical service delivery. METHODS: A descriptive analysis was used to compare the inequities in inputs and outputs of the provincial medical service systems, a non-radial super-efficiency data envelopment analysis model was then used to estimate the efficiency, and a regression analysis of the panel data was used to explore the determinants...
February 5, 2018: BMC Public Health
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