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https://www.readbyqxmd.com/read/100001003/emergency-management-of-sepsis-the-simple-stuff-saves-lives
#1
David Sweet, Julian Marsden, Kendall Ho, Christina Krause, James A Russell
Many emergency departments have implemented sepsis protocols since the 2001 publication of results from the early goal-directed therapy trial, which showed early targeted resuscitation lowers mortality. As part of an attempt to improve clinical and operational outcomes for emergency departments across British Columbia, we reviewed sepsis management literature and considered sepsis protocol implementation in the province’s emergency departments. During the literature review we found that many observational studies confirmed an association between implementation of emergency sepsis protocols and decreased mortality...
May 2012: BC medical journal: BCMJ
https://www.readbyqxmd.com/read/29793072/leveraging-semantic-labels-for-multi-level-abstraction-in-medical-process-mining-and-trace-comparison
#2
Giorgio Leonardi, Manuel Striani, Silvana Quaglini, Anna Cavallini, Stefania Montani
Many medical information systems record data about the executed process instances in the form of an event log. In this paper, we present a framework, able to convert actions in the event log into higher level concepts, at different levels of abstraction, on the basis of domain knowledge. Abstracted traces are then provided as an input to trace comparison and semantic process discovery. Our abstraction mechanism is able to manage non trivial situations, such as interleaved actions or delays between two actions that abstract to the same concept...
May 21, 2018: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/29792218/sudden-cardiac-arrest-under-spinal-anesthesia-in-a-mission-hospital-a-case-report-and-review-of-the-literature
#3
Bamidele Johnson Alegbeleye
BACKGROUND: Sudden cardiac arrest following spinal anesthesia is relatively uncommon and a matter of grave concern for any anesthesiologist as well as clinicians in general. There have been, however, several reports of such cases in the literature. Careful patient selection, appropriate dosing of the local anesthetic, volume loading, close monitoring, and prompt intervention at the first sign of cardiovascular instability should improve outcomes. The rarity of occurrence and clinical curiosity of this entity suggest reporting of this unusual and possibly avoidable clinical event...
May 24, 2018: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/29792074/lessons-learned-conducting-a-multi-center-trial-with-a-military-population-the-tinnitus-retraining-therapy-trial
#4
Roberta W Scherer, Leonora D Sensinger, Benigno Sierra-Irizarry, Craig Formby
Background The Tinnitus Retraining Therapy Trial (TRTT), a randomized, placebo-controlled, multi-center trial, evaluated the efficacy of tinnitus retraining therapy and its individual components, tinnitus-specific educational counseling and sound therapy versus the standard of care, in military practice to improve study participants' quality of life. The trial was conducted at six US military hospitals to take advantage of the greater prevalence of tinnitus in the military population. Methods During the trial, various challenges arose that were uniquely related to the military setting...
May 1, 2018: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/29791985/-management-of-acute-cholecystitis
#5
REVIEW
Seung Ok Lee, Sung Kyun Yim
Acute cholecystitis is a common serious complication of gallstones. The reported mortality of acute cholecystitis is approximately 3%, but the rate increases with age or comorbidity of the patient. If appropriate treatment is delayed, complications can develop as a consequence with a grave prognosis. The current standard of care in acute cholecystitis is an early laparoscopic cholecystectomy with the appropriate administration of fluid, electrolyte, and antibiotics. On the other hand, the severity of the disease and patient's operational risk must be considered...
May 25, 2018: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
https://www.readbyqxmd.com/read/29791945/global-health-epilepsy
#6
Amza Ali
Epilepsy is a frequently misunderstood and highly stigmatized condition. Major treatment gaps exist across the world, most so in areas of financial constraint. Classification permits the best approaches to treatment and to ascertaining prognosis. The International League Against Epilepsy's new classification system emphasizes clinical aspects and utilizes all available resources to determine whether it is a focal or generalized epilepsy. The most important tools are a careful history, clinical examination, electroencephalography, and appropriate neuroimaging...
April 2018: Seminars in Neurology
https://www.readbyqxmd.com/read/29791643/conversation-map-an-educational-strategy-in-the-care-of-elderly-people-with-diabetes-mellitus
#7
Silvana Linhares de Carvalho, Marília Araripe Ferreira, Juliana Mineu Pereira Medeiros, Anne Caroline Ferreira Queiroga, Tatiana Rebouças Moreira, Francisca Diana da Silva Negreiros
OBJECTIVE: To report the experience of using diabetes conversation maps as an educational strategy for diabetic elderly people. METHOD: Experience report, conducted from July to December 2016 in a specialized outpatient clinic for diabetics, in Fortaleza, Ceará, Brazil. A total of 72 users participated, between diabetics and those accompanying them. RESULTS: The participants talked about issues that were not addressed in personal consultations, and could see themselves through the stories of others, thus realizing they were not alone and that others also experienced the same difficulties as them...
2018: Revista Brasileira de Enfermagem
https://www.readbyqxmd.com/read/29791362/real-time-super-resolved-3d-in-turbid-water-using-a-fast-range-gated-cmos-camera
#8
Petter Risholm, Jostein Thorstensen, Jens T Thielemann, Kristin Kaspersen, Jon Tschudi, Chris Yates, Chris Softley, Igor Abrosimov, Jonathan Alexander, Karl Henrik Haugholt
We present a range-gated camera system designed for real-time (10 Hz) 3D estimation underwater. The system uses a fast-shutter CMOS sensor (1280×1024) customized to facilitate gating with 1.67 ns (18.8 cm in water) delay steps relative to the triggering of a solid-state actively Q-switched 532 nm laser. A depth estimation algorithm has been carefully designed to handle the effects of light scattering in water, i.e., forward and backward scattering. The raw range-gated signal is carefully filtered to reduce noise while preserving the signal even in the presence of unwanted backscatter...
May 10, 2018: Applied Optics
https://www.readbyqxmd.com/read/29791255/the-calorie-labeling-saga-federal-preemption-and-delayed-implementation-of-public-health-law
#9
Jason P Block
Passing the 2010 Affordable Care Act (ACA) was a landmark event in health care policy. The ACA’s scope also went beyond health care. Included among myriad health insurance reforms and coverage expansions was Section 4205, a federal requirement for food-establishment chains with 20 or more locations..
May 23, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29791184/expert-exchange-workgroup-on-children-aged-5-and-younger-with-severe-obesity-a-narrative-review-of-medical-and-genetic-risk-factors
#10
Nazrat Mirza, Thao-Ly Phan, June Tester, Angela Fals, Cristina Fernandez, George Datto, Elizabeth Estrada, Ihuoma Eneli
Severe obesity defined as an age- and gender-specific body mass index ≥120% of the 95th percentile in children younger than 5 years is well recognized as a significant challenge for prevention and treatment. This article provides an overview of the prevalence, classification of obesity severity, patterns of weight gain trajectory, medical and genetic risk factors, and comorbid disorders among young children with an emphasis on severe obesity. Studies suggest rapid weight gain trajectory in infancy, maternal smoking, maternal gestational diabetes, and genetic conditions are associated with an increased risk for severe obesity in early childhood...
May 23, 2018: Childhood Obesity
https://www.readbyqxmd.com/read/29791084/the-hospital-readmissions-reduction-program-learning-from-failure-of-a-healthcare-policy
#11
REVIEW
Ankur Gupta, Gregg C Fonarow
Heart failure is the leading cause of readmissions in patients aged ≥65 years with high associated societal and economic costs. The utilization metric of 30-day risk standardized readmission rates (RSRRs) has therefore become a target to reduce healthcare costs. In this review, we discuss in detail the implementation, effectiveness, and unintended consequences of the Hospital Readmissions Reduction Program (HRRP)-the major healthcare policy approach in the U.S. to reduce readmissions by financially penalizing hospitals with higher than average 30-day RSRRs...
May 23, 2018: European Journal of Heart Failure
https://www.readbyqxmd.com/read/29790991/understanding-delays-in-acute-stroke-care-a-systematic-review-of-reviews
#12
Yacine Lachkhem, Stéphane Rican, Étienne Minvielle
Background: Stroke is the leading cause of adult long-term disability in Western countries. Intravenous thrombolytic therapy with recombinant tissue plasminogen activator is safe and effective within the first 4.5 h after the onset of stroke. Various factors delaying acute stroke care have been identified in the literature. This review aimed to provide an overview of factors delaying acute stroke care and attempted to show how they interact in a synthetic framework. Methods: We conducted a systematic review of literature reviews published in Medline and DORIS until 2016 on factors influencing acute stroke pathway timeframe...
June 1, 2018: European Journal of Public Health
https://www.readbyqxmd.com/read/29790870/genetic-disorders-and-mortality-in-infancy-and-early-childhood-delayed-diagnoses-and-missed-opportunities
#13
Monica H Wojcik, Talia S Schwartz, Inbar Yamin, Heather L Edward, Casie A Genetti, Meghan C Towne, Pankaj B Agrawal
PurposeInfants admitted to a level IV neonatal intensive care unit (NICU) who do not survive early childhood are a population that is probably enriched for rare genetic disease; we therefore characterized their genetic diagnostic evaluation.MethodsThis is a retrospective analysis of infants admitted to our NICU between 1 January 2011 and 31 December 2015 who were deceased at the time of records review, with age at death less than 5 years.ResultsA total of 2,670 infants were admitted; 170 later died. One hundred six of 170 (62%) had an evaluation for a genetic or metabolic disorder...
April 12, 2018: Genetics in Medicine: Official Journal of the American College of Medical Genetics
https://www.readbyqxmd.com/read/29790864/implementing-comprehensive-primary-care-referral-tracking-in-a-patient-centered-medical-home
#14
Jenny Spahr, Jennifer Coddington, Nancy Edwards, Sara McComb
The Patient-Centered Medical Home care model emphasizes efficient, coordinated care distributed among interdisciplinary team members. One key function to care coordination is referral/test tracking. This study evaluated the referral practices in a nurse-managed Patient-Centered Medical Home primary care clinic. The major findings corroborate the need for a well-organized referral-tracking system that is centralized and contains safety nets to reduce the number of delayed or missed referrals.
July 2018: Journal of Nursing Care Quality
https://www.readbyqxmd.com/read/29790849/-n-methyl-d-aspartate-receptor-antibody-encephalitis-the-janus-faced-disorder
#15
Ildiko Sipos
The recognition of the antibody-mediated encephalitis as a separate entity among the immune disorders of the central nervous system was one of the greatest breakthroughs of the last two decades in neurology. Unlike viral or tumor-related encephalitis, the antibody-mediated form has a good response to immunotherapy, which gives a special clinical importance to the discovery. Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is one of the first fully characterized antibody-mediated encephalitises. This article attempts to summarize the clinical features of this complex neuropsychiatric disorder with the aim to help its early recognition and to report the clinical course and the outcome of our six seropositive anti-NMDAR cases...
March 2018: Neuropsychopharmacologia Hungarica
https://www.readbyqxmd.com/read/29790786/the-impact-of-disruption-of-the-care-delivery-system-by-commercial-laboratory-testing-in-a-children-s-health-care-system
#16
Beverly B Rogers, James L Adams, Alexis B Carter, Francine Uwindatwa, Cynthia B Brawley, Charles G Cochran, Leah N Bryan, Elizabeth P Weinzierl, Sampath Prahalad
CONTEXT: - Disruption of outpatient laboratory services by routing the samples to commercial reference laboratories may seem like a cost-saving measure by the payers, but results in hidden costs in quality and resources to support this paradigm. OBJECTIVE: - To identify differences when outpatient tests are performed at a Children's Hospital lab compared to a commercial reference lab, and the financial costs to support the reference laboratory testing. DESIGN: - Outpatient testing was sent to 3 different laboratories, specified by the payer...
May 23, 2018: Archives of Pathology & Laboratory Medicine
https://www.readbyqxmd.com/read/29790446/ninety-to-nothing-a-pdsa-quality-improvement-project
#17
Gayle Linda Prybutok
Purpose The purpose of this paper is to present a case study of a successful quality improvement project in an acute care hospital focused on reducing the time of the total patient visit in the emergency department. Design/methodology/approach A multidisciplinary quality improvement team, using the PDSA (Plan, Do, Study, Act) Cycle, analyzed the emergency department care delivery process and sequentially made process improvements that contributed to project success. Findings The average turnaround time goal of 90 minutes or less per visit was achieved in four months, and the organization enjoyed significant collateral benefits both internal to the organization and for its customers...
May 14, 2018: International Journal of Health Care Quality Assurance
https://www.readbyqxmd.com/read/29790443/improvement-of-laboratory-turnaround-time-using-lean-methodology
#18
Shradha Gupta, Sahil Kapil, Monica Sharma
Purpose The purpose of this paper is to discuss the implementation of lean methodology to reduce the turnaround time (TAT) of a clinical laboratory in a super speciality hospital. Delays in report delivery lead to delayed diagnosis increased waiting time and decreased customer satisfaction. The reduction in TAT will lead to increased patient satisfaction, quality of care, employee satisfaction and ultimately the hospital's revenue. Design/methodology/approach The generic causes resulting in increasing TAT of clinical laboratories were identified using lean tools and techniques such as value stream mapping (VSM), Gemba, Pareto Analysis and Root Cause Analysis...
May 14, 2018: International Journal of Health Care Quality Assurance
https://www.readbyqxmd.com/read/29789857/ongoing-development-and-evaluation-of-a-method-of-telemedicine-burn-care-management-with-a-smartphone
#19
David Boccara, Farid Bekara, Sabri Soussi, Matthieu Legrand, Marc Chaouat, Maurice Mimoun, Kevin Serror
In cases involving small burns in patients without a comorbidity or associated pathology, a referral from a surgeon is necessary and sometimes it cannot be ascertained when the patient is not brought in by a specialized team. The purpose of this retrospective study was to evaluate the quality of our method for performing telemedicine. This retrospective study included the 323 patients who were initially treated using the telemedicine system implemented between 2011 and 2016. This procedure only involved patients burned over a small portion of their body's surface area (ie, ≤15%) who were between 15 and 75 years of age and who did not have a major comorbidity...
December 4, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/29789465/efficacy-safety-and-usability-of-remifentanil-as-premedication-for-insure-in-preterm-neonates
#20
Hadiyah Y Audil, Sara Tse, Chad Pezzano, Amy Mitchell-van Steele, Joaquim M B Pinheiro
Background : We previously reported a 67% extubation failure with INSURE (Intubation, Surfactant, Extubation) using morphine as analgosedative premedication. Remifentanil, a rapid- and short-acting narcotic, might be ideal for INSURE, but efficacy and safety data for this indication are limited. Objectives : To assess whether remifentanil premedication increases extubation success rates compared with morphine, and to evaluate remifentanil's safety and usability in a teaching hospital context. Methods : Retrospective review of remifentanil orders for premedication, at a large teaching hospital neonatal intensive care unit (NICU)...
May 22, 2018: Children
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