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https://www.readbyqxmd.com/read/28351066/bringing-rounds-back-to-the-patient-a-one-year-evaluation-of-the-chiefs-service-model-for-inpatient-teaching
#1
Nadia L Bennett, Judd D Flesch, Peter Cronholm, James B Reilly, Jack Ende
PURPOSE: The Chiefs' Service (CS), a structured approach to inpatient teaching rounds, focuses on resident education and patient-centered care without disrupting patient census sizes or admitting cycles. It has five key elements: morning huddles; bedside rounds; diagnostic "time-outs"; day-of-discharge rounds; and postdischarge follow-up rounds. The authors hypothesized the CS model would be well received by residents and considered more effective than more-traditional rounds. METHOD: The CS was implemented on Penn Presbyterian Medical Center's general medicine inpatient service using a quasi-experimental design...
April 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28351064/the-early-tech-development-course-experiential-commercialization-education-for-the-medical-academician
#2
Jonathan Servoss, Connie Chang, Jonathan Fay, Kevin Ward
PROBLEM: Research produced by medical academicians holds promise for developing into biomedical innovations in therapeutics, devices, diagnostics, and health care information technology; however, the road to biomedical innovation is fraught with risk, including the challenge of moving from basic research insight onto a viable commercialization path. Compounding this challenge is the growing demand on medical academicians to be more productive in their clinical, teaching, and research duties within a resource-constrained environment...
April 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28351062/using-national-health-care-databases-and-problem-based-practice-analysis-to-inform-integrated-curriculum-development
#3
Amy J Baker, Mark R Raymond, Steven A Haist, John R Boulet
One challenge when implementing case-based learning, and other approaches to contextualized learning, is determining which clinical problems to include. This article illustrates how health care utilization data, readily available from the National Center for Health Statistics (NCHS), can be incorporated into an educational needs assessment to identify medical problems physicians are likely to encounter in clinical practice. The NCHS survey data summarize patient demographics, diagnoses, and interventions for tens of thousands of patients seen in various settings, including emergency departments (EDs), clinics, and hospitals...
April 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28351052/diabetic-macular-edema
#4
Francesco Bandello, Maurizio Battaglia Parodi, Paolo Lanzetta, Anat Loewenstein, Pascale Massin, Francesca Menchini, Daniele Veritti
Diabetic macular edema (DME), defined as a retinal thickening involving or approaching the center of the macula, represents the most common cause of vision loss in patients affected by diabetes mellitus. In the last few years, many diagnostic tools have proven to be useful in the detection and the monitoring of the features characterizing DME. On the other hand, several therapeutic approaches can now be proposed on the basis of the DME-specific characteristics. The aim of the present chapter is to thoroughly delineate the clinical and morphofunctional characteristics of DME and its current treatment perspectives...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28351047/postsurgical-cystoid-macular-edema
#5
Dinah Zur, Anat Loewenstein
Cystoid macular edema (CME) is a primary cause of reduced vision following both cataract and successful vitreoretinal surgery. The incidence of clinical CME following modern cataract surgery is 0.1-2.35%. Preexisting conditions such as diabetes mellitus and uveitis as well as intraoperative complications can raise the risk of postsurgical CME. The etiology of CME is not completely understood. Prolapsed or incarcerated vitreous and postoperative inflammatory processes have been proposed as causative agents. Pseudophakic CME is characterized by poor postoperative visual acuity...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28351044/diagnosis-and-detection
#6
Giovanni Staurenghi, Marco Pellegrini, Alessandro Invernizzi, Chiara Preziosa
The aim of the chapter is to provide a practical but exhaustive guide in detecting macular edema and to describe its features according to the retinal condition that causes it. The most useful imaging techniques (biomicroscopy, retinography, optical coherence tomography, and fluorescein/indocyanine-green angiography will be analyzed in order to identify the best diagnostic algorithm in each pathology. There is a table at the end of the chapter which summarizes the important points of the chapter.
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28350976/neuroendocrine-tumor-of-the-common-bile-duct-case-report
#7
C Raspanti, N Falco, V Silvestri, G Rotolo, S Bonventre, G Gulotta
Neuroendocrine tumors (NET) are a very heterogeneous group of neoplasms; in recent years we have seen an increase in their incidence (3.65 /100.000/year). They can be associated with hereditary endocrine syndromes (MEN, Von Hippel Lindau); they can occur at any age and the incidence is slightly higher in men than women. The aetiology of the neuroendocrine tumors is unclear; in most cases, inflammation of the bile ducts may be the underlying cause and for this reason, the initial patient's evaluation should be focused on the different aspects concerning the oncological one and the possible sequelae of the biliary obstructions that can evolve in biliary sepsis...
November 2016: Il Giornale di Chirurgia
https://www.readbyqxmd.com/read/28350935/screening-for-celiac-disease-evidence-report-and-systematic-review-for-the-us-preventive-services-task-force
#8
Roger Chou, Christina Bougatsos, Ian Blazina, Katherine Mackey, Sara Grusing, Shelley Selph
Importance: Silent or subclinical celiac disease may result in potentially avoidable adverse health consequences. Objective: To review the evidence on benefits and harms of screening for celiac disease in asymptomatic adults, adolescents, and children 3 years and older for the US Preventive Services Task Force. Data Sources: Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews, searched to June 14, 2016...
March 28, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28350903/advancing-diagnostics-to-address-antibacterial-resistance-the-diagnostics-and-devices-committee-of-the-antibacterial-resistance-leadership-group
#9
Ephraim L Tsalik, Elizabeth Petzold, Barry N Kreiswirth, Robert A Bonomo, Ritu Banerjee, Ebbing Lautenbach, Scott R Evans, Kimberly E Hanson, Jeffrey D Klausner, Robin Patel
Diagnostics are a cornerstone of the practice of infectious diseases. However, various limitations frequently lead to unmet clinical needs. In most other domains, diagnostics focus on narrowly defined questions, provide readily interpretable answers, and use true gold standards for development. In contrast, infectious diseases diagnostics must contend with scores of potential pathogens, dozens of clinical syndromes, emerging pathogens, rapid evolution of existing pathogens and their associated resistance mechanisms, and the absence of gold standards in many situations...
March 15, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28350902/the-role-of-stewardship-in-addressing-antibacterial-resistance-stewardship-and-infection-control-committee-of-the-antibacterial-resistance-leadership-group
#10
Deverick J Anderson, Timothy C Jenkins, Scott R Evans, Anthony D Harris, Robert A Weinstein, Pranita D Tamma, Jennifer H Han, Ritu Banerjee, Robin Patel, Theoklis Zaoutis, Ebbing Lautenbach
Antibacterial resistance is increasing globally and has been recognized as a major public health threat. Antibacterial stewardship is the coordinated effort to improve the appropriate use of antibiotics with the aim to decrease selective pressure for multidrug-resistant organisms in order to preserve the utility of antibacterial agents. This article describes the activities of the Antibacterial Resistance Leadership Group (ARLG) in the area of antibacterial stewardship. To date, the ARLG has focused intensely on development of rapid diagnostic tests, which (when coupled with educational and institutional initiatives) will enable the robust stewardship that is needed to address the current crisis of antibacterial resistance...
March 15, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28350899/fundamentals-and-catalytic-innovation-the-statistical-and-data-management-center-of-the-antibacterial-resistance-leadership-group
#11
Jacqueline Huvane, Lauren Komarow, Carol Hill, Thuy Tien T Tran, Carol Pereira, Susan L Rosenkranz, Matt Finnemeyer, Michelle Earley, Hongyu Jeanne Jiang, Rui Wang, Judith Lok, Scott R Evans
The Statistical and Data Management Center (SDMC) provides the Antibacterial Resistance Leadership Group (ARLG) with statistical and data management expertise to advance the ARLG research agenda. The SDMC is active at all stages of a study, including design; data collection and monitoring; data analyses and archival; and publication of study results. The SDMC enhances the scientific integrity of ARLG studies through the development and implementation of innovative and practical statistical methodologies and by educating research colleagues regarding the application of clinical trial fundamentals...
March 15, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28350898/leading-antibacterial-laboratory-research-by-integrating-conventional-and-innovative-approaches-the-laboratory-center-of-the-antibacterial-resistance-leadership-group
#12
Claudia Manca, Carol Hill, Andrea M Hujer, Robin Patel, Scott R Evans, Robert A Bonomo, Barry N Kreiswirth
The Antibacterial Resistance Leadership Group (ARLG) Laboratory Center (LC) leads the evaluation, development, and implementation of laboratory-based research by providing scientific leadership and supporting standard/specialized laboratory services. The LC has developed a physical biorepository and a virtual biorepository. The physical biorepository contains bacterial isolates from ARLG-funded studies located in a centralized laboratory and they are available to ARLG investigators. The Web-based virtual biorepository strain catalogue includes well-characterized gram-positive and gram-negative bacterial strains published by ARLG investigators...
March 15, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28350870/bacterial-clonal-diagnostics-as-a-tool-for-evidence-based-empiric-antibiotic-selection
#13
Veronika Tchesnokova, Hovhannes Avagyan, Elena Rechkina, Diana Chan, Mariya Muradova, Helen Ghirmai Haile, Matthew Radey, Scott Weissman, Kim Riddell, Delia Scholes, James R Johnson, Evgeni V Sokurenko
Despite the known clonal distribution of antibiotic resistance in many bacteria, empiric (pre-culture) antibiotic selection still relies heavily on species-level cumulative antibiograms, resulting in overuse of broad-spectrum agents and excessive antibiotic/pathogen mismatch. Urinary tract infections (UTIs), which account for a large share of antibiotic use, are caused predominantly by Escherichia coli, a highly clonal pathogen. In an observational clinical cohort study of urgent care patients with suspected UTI, we assessed the potential for E...
2017: PloS One
https://www.readbyqxmd.com/read/28350833/a-fast-and-frugal-algorithm-to-strengthen-diagnosis-and-treatment-decisions-for-catheter-associated-bacteriuria
#14
Aanand D Naik, Felicia Skelton, Amber B Amspoker, Russell A Glasgow, Barbara W Trautner
OBJECTIVES: Guidelines for managing catheter-associated urinary tract infection (CAUTI) and asymptomatic bacteria (ASB) are poorly translated into routine care due in part to cognitive diagnostic errors. This study determines if the accuracy for CAUTI and ASB diagnosis and treatment improves after implementation of a fast and frugal algorithm compared with traditional education methods. MATERIALS AND METHODS: A pre and post-intervention with contemporaneous comparison site involving inpatient and long term care wards at two regional Veterans Affairs Systems in United States...
2017: PloS One
https://www.readbyqxmd.com/read/28350792/association-between-delirium-superimposed-on-dementia-and-mortality-in-hospitalized-older-adults-a-prospective-cohort-study
#15
Thiago J Avelino-Silva, Flavia Campora, Jose A E Curiati, Wilson Jacob-Filho
BACKGROUND: Hospitalized older adults with preexisting dementia have increased risk of having delirium, but little is known regarding the effect of delirium superimposed on dementia (DSD) on the outcomes of these patients. Our aim was to investigate the association between DSD and hospital mortality and 12-mo mortality in hospitalized older adults. METHODS AND FINDINGS: This was a prospective cohort study completed in the geriatric ward of a university hospital in São Paulo, Brazil...
March 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28350785/the-picture-study-diagnostic-accuracy-of-multiparametric-mri-in-men-requiring-a-repeat-prostate-biopsy
#16
Lucy A M Simmons, Abi Kanthabalan, Manit Arya, Tim Briggs, Dean Barratt, Susan C Charman, Alex Freeman, James Gelister, David Hawkes, Yipeng Hu, Charles Jameson, Neil McCartan, Caroline M Moore, Shonit Punwani, Navin Ramachandran, Jan van der Meulen, Mark Emberton, Hashim U Ahmed
BACKGROUND: Transrectal prostate biopsy has limited diagnostic accuracy. Prostate Imaging Compared to Transperineal Ultrasound-guided biopsy for significant prostate cancer Risk Evaluation (PICTURE) was a paired-cohort confirmatory study designed to assess diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) in men requiring a repeat biopsy. METHODS: All underwent 3 T mpMRI and transperineal template prostate mapping biopsies (TTPM biopsies)...
March 28, 2017: British Journal of Cancer
https://www.readbyqxmd.com/read/28350752/the-yield-of-endoscopic-investigation-for-unintentional-weight-loss
#17
Naim Abu-Freha, Yotam Lior, Shira Shoher, Victor Novack, Alexander Fich, Alexander Rosenthal, Ohad Etzion
AIM: The aim of this study was to assess the yield of endoscopic evaluation in isolated unintentional weight loss (UWL) patients compared with patients with weight loss and additional symptoms or signs. PATIENTS AND METHODS: A retrospective review of all patients who underwent an endoscopic evaluation for the investigation of UWL at Soroka University Medical Center between 2006 and 2012. Data on clinical indication, endoscopic, and laboratory finding were retrieved...
May 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28350700/effects-of-medical-diagnostic-low-dose-x-rays-on-human-lymphocytes-mitochondrial-membrane-potential-apoptosis-and-cell-cycle
#18
Montree Tungjai, Nutnicha Phathakanon, Kanokporn Noy Rithidech
Low-dose radiation is widely used across the world for the diagnosis of many diseases by means of a variety of imaging technologies. However, the harmful effects of exposure to low-dose radiation during medical examination remain controversial. The authors studied the effects of medical diagnostic low-dose x rays (i.e., 0.03, 0.05, or 0.1 mGy) after an in vitro exposure of human lymphocytes. Cells with no irradiation served as the non-irradiated control group. Three biological indicators were used to determine the effects of medical diagnostic low-dose x rays at 4, 8, 24, 48, and 72 h post-irradiation...
May 2017: Health Physics
https://www.readbyqxmd.com/read/28350622/keratitis-due-to-achromobacter-xylosoxidans-in-a-contact-lens-user
#19
Cristina Almenara Michelena, María Ángeles Del Buey, Francisco Javier Ascaso, Jose Ángel Cristóbal
OBJECTIVES: Ocular infections due to Achromobacter xylosoxidans are extremely uncommon; their diagnosis is a challenge and the optimal treatment remains controversial. We present a case of A. xylosoxidans in a contact lens user and a review of the literature to facilitate diagnostic suspicion and empirical therapeutic management. METHODS: Review of the literature in PubMed and MEDLINE. We also document a case diagnosed in our department in January 2016. SETTING: Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain...
March 27, 2017: Eye & Contact Lens
https://www.readbyqxmd.com/read/28350570/low-density-lipoprotein-receptor-related-protein-4-positive-myasthenia-gravis-in-a-double-seronegative-electromyography-negative-patient
#20
Joshua M Kruger, Dimitrios Karussis, Paraskevi Zisimopoulou, Panayiota Petrou
We describe a patient with ocular myasthenia gravis, where single-fiber electromyography and testing for acetylcholine receptor and muscle-specific kinase antibodies were negative. However, antibodies to low-density lipoprotein receptor-related protein 4 (LRP4) were positive, and this prompted appropriate management. We recommend that testing for LRP4 antibodies be considered when the clinical suspicion for myasthenia gravis is high despite negative conventional diagnostic tests.
March 27, 2017: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
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