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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/29778087/midwifery-management-of-pregnant-women-who-are-obese
#2
Margi Reither, Elaine Germano, Michele DeGrazia
INTRODUCTION: Obesity is associated with increased risks for adverse health outcomes during and after pregnancy in both the woman with obesity and her infant. This study was designed to investigate midwifery management of pregnant women with obesity. METHODS: Certified midwives and certified nurse-midwives who were members of the American College of Nurse-Midwives were sent a survey. The survey instrument was divided into 4 sections: demographic characteristics; practice guidelines and protocols; the role of the 2015 Levels of Maternal Care guidelines for referral, including transfer to a higher level of care; and factors that influence management of pregnant women with obesity...
May 19, 2018: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/29778086/pelvic-floor-physical-therapy-and-women-s-health-promotion
#3
REVIEW
Samantha Lawson, Ashley Sacks
Pelvic floor dysfunction is defined as abnormal function of the pelvic floor and includes conditions that can have significant adverse impacts on a woman's quality of life, including urinary incontinence (stress, urge, and mixed), fecal incontinence, pelvic organ prolapse, sexual dysfunction, diastasis recti abdominis, pelvic girdle pain, and chronic pain syndromes. Women's health care providers can screen for, identify, and treat pelvic floor dysfunction. This article examines the case of a woman with multiple pelvic-floor-related problems and presents the evidence for the use of pelvic floor physical therapy (PFPT) for pregnancy-related pelvic floor dysfunction...
May 19, 2018: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/29777967/rates-and-correlates-of-disordered-eating-among-women-veterans-in-primary-care
#4
Laura J Buchholz, Paul R King, Laura O Wray
Rates of disordered eating may be higher among women veterans than civilians, and are associated with co-occurring mental health (MH) conditions, such as depression, post-traumatic stress disorder (PTSD), and alcohol misuse. Although evidence suggests that these conditions are common in primary care settings, limited research has examined symptoms of disordered eating among women veterans in primary care. This study used a cross-sectional design to examine rates and MH correlates of disordered eating among women veterans treated in a primary care setting...
May 16, 2018: Eating Behaviors
https://www.readbyqxmd.com/read/29777865/a-prospective-non-interventional-registry-study-of-patients-initiating-a-course-of-drug-therapy-for-overactive-bladder-perspective-rationale-design-and-methodology
#5
Eric S Rovner, Kevin V Carlson, Anna S Deal, Kavita V Nair, Eva E Oakkar, Julie Park, Eric Gemmen, Rita M Kristy, Katherine L Gooch, Carol R Schermer
INTRODUCTION: Pharmacotherapy of overactive bladder (OAB) typically involves treatment with an antimuscarinic or mirabegron, a β3-adrenoceptor agonist, but real-world evidence on their use, including treatment access, persistence, and switching, is limited. Here, we describe the design of a prospective, multicenter, non-interventional registry of patients beginning a new course of OAB pharmacological therapy in routine clinical practice. METHODS: Adults with an OAB diagnosis for at least 3 months who either initiated a new course of mirabegron or antimuscarinic, or who switched therapy were enrolled into PERSPECTIVE (A Prospective, Non-intErventional Registry Study of Patients Initiating a Course of Drug Therapy for OveractIVE Bladder)...
May 16, 2018: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/29777660/chronic-obstructive-pulmonary-disease-exacerbations-a-need-for-action
#6
Antonio Anzueto, Marc Miravitlles
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, with exacerbations contributing strongly to the overall severity and burden of disease at the individual level. Many patients with COPD are managed predominantly in the primary care setting; therefore, primary care physicians (PCPs) must have awareness and understanding of the causes, effects, and management of exacerbations in COPD. This review offers practical information regarding how exacerbations are defined in the treatment setting, pathogenic and environmental causes, options for exacerbation treatment and prevention, and suggestions for improving care in the clinic...
May 16, 2018: American Journal of Medicine
https://www.readbyqxmd.com/read/29777635/reducing-the-number-of-obstetrical-beds-by-challenging-traditions
#7
Camilla Dalby Salvig, Marie Højriis Storkholm, Jannie Dalby Salvig, Niels Uldbjerg
The aim of this commentary is to describe changes in women care at an obstetric department that made it possible to reduce the number of beds from 40 to 29. Patient pathways were reviewed and revised using lean methodology. The mean length of stay was reduced from 70 to 59 hours and the mean numbers of hospitalizations per woman from 1.26 to 1.20. At the organizational level, we introduced a Family Department, home management of newborns, home monitoring of the women with cardiotocography and blood samples, and intrapartum Group B Streptococcus-PCR...
May 19, 2018: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/29777543/acquired-digital-fibrokeratoma-review-of-its-clinical-and-dermoscopic-features-and-differential-diagnosis
#8
REVIEW
Shawn Shih, Amor Khachemoune
Acquired digital fibrokeratoma (ADFK) is a rare, benign, fibrous tumor that most often occurs on fingers. It may resemble a rudimentary supernumerary digit and is often misdiagnosed as another common benign condition, such as common wart. It is typically asymptomatic and occurs as a solitary nodule less than 1 cm in diameter. Oftentimes ADFK shares clinical and/or histologic resemblance with other benign and malignant cutaneous conditions so it is crucial that careful examination is undertaken. In this article, we will discuss the clinical presentation, epidemiology, etiology, dermoscopic and histologic findings, management, and differential diagnoses for ADFK, with the hope that this review will facilitate timely diagnosis and management for this distinct condition...
May 19, 2018: International Journal of Dermatology
https://www.readbyqxmd.com/read/29777519/combination-glucose-lowering-therapy-plans-in-t2dm-case-based-considerations
#9
REVIEW
Lawrence Blonde, Susana Dipp, Daniel Cadena
Type 2 diabetes mellitus (T2DM) is a complex disease, and while lifestyle interventions remain the cornerstone of therapy, most patients will also require pharmacotherapy. Current diabetes treatment guidelines and algorithms recommend an individualized approach to setting glycemic goals and selecting treatment. Although a single antihyperglycemic agent may be appropriate as the initial T2DM pharmacotherapy, the progressive nature of the disease due to declining pancreatic β-cell function will result in the vast majority of T2DM patients eventually requiring two or more antihyperglycemic agents...
May 18, 2018: Advances in Therapy
https://www.readbyqxmd.com/read/29777463/considerations-that-will-determine-if-competency-based-assessment-is-a-sustainable-innovation
#10
W Dale Dauphinee, John R Boulet, John J Norcini
Educational assessment for the health professions has seen a major attempt to introduce competency based frameworks. As high level policy developments, the changes were intended to improve outcomes by supporting learning and skills development. However, we argue that previous experiences with major innovations in assessment offer an important road map for developing and refining assessment innovations, including careful piloting and analyses of their measurement qualities and impacts. Based on the literature, numerous assessment workshops, personal interactions with potential users, and our 40 years of experience in implementing assessment change, we lament the lack of a coordinated approach to clarify and improve measurement qualities and functionality of competency based assessment (CBA)...
May 18, 2018: Advances in Health Sciences Education: Theory and Practice
https://www.readbyqxmd.com/read/29777456/distal-bowel-re-feeding-in-patients-with-proximal-jejunostomy
#11
Anand Nagar, Siddharth Mehrotra, Amitabh Yadav, Vivek Mangla, Shailendra Lalwani, Naimish Mehta, Samiran Nundy
BACKGROUND: Patients who have a proximal jejunostomy are difficult to manage because of their high stoma output which results in fluid and electrolyte imbalance with repeated hospital admissions and the necessity for expensive parenteral nutrition (PN). There are few reports on the use of re-feeding of the proximal effluents in this situation. METHODS: We here relate our experience with this manoeuvre in 35 patients between Jan 2010 and Feb 2016 who had stomas less than 120 cm away from the duodenojejunal flexure...
May 18, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29777373/safety-and-feasibility-of-pulmonary-artery-pressure-guided-heart-failure-therapy-rationale-and-design-of-the-prospective-cardiomems-monitoring-study-for-heart-failure-mems-hf
#12
Christiane E Angermann, Birgit Assmus, Stefan D Anker, Johannes Brachmann, Georg Ertl, Friedrich Köhler, Stephan Rosenkranz, Carsten Tschöpe, Philip B Adamson, Michael Böhm
BACKGROUND: Wireless monitoring of pulmonary artery (PA) pressures with the CardioMEMS HF™ system is indicated in patients with New York Heart Association (NYHA) class III heart failure (HF). Randomized and observational trials have shown a reduction in HF-related hospitalizations and improved quality of life in patients using this device in the United States. OBJECTIVE: MEMS-HF is a prospective, non-randomized, open-label, multicenter study to characterize safety and feasibility of using remote PA pressure monitoring in a real-world setting in Germany, The Netherlands and Ireland...
May 19, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29777372/cardiac-surgery-2017-reviewed
#13
REVIEW
Torsten Doenst, Hristo Kirov, Alexandros Moschovas, David Gonzalez-Lopez, Rauf Safarov, Mahmoud Diab, Steffen Bargenda, Gloria Faerber
For the year 2017, more than 21,000 published references can be found in PubMed when entering the search term "cardiac surgery". This review focusses on conventional cardiac surgery, considering the new interventional techniques only if they were directly compared to classic techniques but also entails aspects of perioperative intensive care management. The publications last year provided a plethora of new and interesting information that helped to quantify classic surgical treatment effects and provided new guidelines for the management of structural heart disease, which made comparisons to interventional techniques easier...
May 17, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29777334/patient-engagement-in-community-health-center-leadership-how-does-it-happen
#14
Anjana E Sharma, Beatrice Huang, Margae Knox, Rachel Willard-Grace, Michael B Potter
Patient engagement in primary care leadership is an important means to involve community voices at community health centers. Federally qualified health centers (FQHCs) are mandated to have patient representation within their governing boards, while practices seeking patient-centered medical home certification receive credit for implementing patient advisory councils (PACs). Our objective was to compare and contrast how community health centers engage patients in clinic management, decision-making and planning within governing boards versus PACs...
May 18, 2018: Journal of Community Health
https://www.readbyqxmd.com/read/29777245/growth-assessment-and-monitoring-during-childhood
#15
Fabian Yap, Yung Seng Lee, Marion Margaret Hy Aw
Growth is an indicator of the health and nutritional status of infants and children. Health organisations and professionals worldwide advocate monitoring the growth of children with the primary aim of identifying and preventing malnutrition and/or obesity. Growth monitoring should be part of every health care consultation for children. However, physicians during health care consultations are often so busy addressing acute health issues, that they miss the opportunity to monitor the child's growth and provide anticipatory guidance...
April 2018: Annals of the Academy of Medicine, Singapore
https://www.readbyqxmd.com/read/29776973/challenges-in-end-of-life-dementia-care
#16
REVIEW
Anne A Fetherston, Grace Rowley, Charlotte L Allan
Dementia is a chronic, progressive disease that is now much more widely recognised and treated. Patients with dementia may require palliative care when they reach the end stage of their illness, or they may have mild-moderate cognitive symptoms comorbid with a life-limiting illness. The variety of presentations necessitates a highly individual approach to care planning, and patients should be encouraged to set their own goals and contribute to advanced care planning where possible. Assessment and management of distressing symptoms at the end of life can be greatly helped by a detailed knowledge of the individuals' prior wishes, interdisciplinary communication and recognition of changes in presentation that may result from new symptoms, for example, onset of pain, nutritional deficits and infection...
May 18, 2018: Evidence-based Mental Health
https://www.readbyqxmd.com/read/29776939/outcomes-of-transanal-endorectal-pull-through-for-rectal-atresia
#17
Mutaz Gieballa, Nawaf AlKharashi, Mohammed Al-Namshan, Saud AlJadaan
Rectal atresia is a rare anorectal malformation, and it has been reported to represent 1%-2% of all anorectal malformations. We report three newborns who were admitted to the neonatal intensive care unit for abdominal distention, bilious vomiting and failure to pass meconium. The external anus and genitalia were normal and well formed. Digital rectal examination showed a blind-ending anal canal. All three infants were initially managed with diverting colostomy and then transanal resection of the rectal atresia with primary anastomosis, followed by colostomy closure...
May 18, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29776903/prolonged-survival-with-maintenance-pemetrexed-for-a-multiple-primary-malignancy
#18
Md Shuayb, Md Salim Reza
Despite the fact that multiple primary malignancies (MPMs) are not new and have been diagnosed for about a hundred-year time, literatures on lung and colon primaries are scarce. We report a case of a 62-year-old Asian Bangladeshi man with stage IV lung adenocarcinoma who developed a metachronous stage II colon adenocarcinoma approximately 3 years later. A chemotherapy protocol of six cycles of pemetrexed/cisplatin followed by maintenance pemetrexed was used, and surgery was done for the colon primary. With more than 5 years of periodic follow-up, his disease remains stable without any local or metastatic recurrence...
May 18, 2018: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/29776901/a-moderated-e-forum-for-adults-with-cardiovascular-disease-usability-study
#19
Rika Tanaka, Anita Banerjee, Jelena Surikova, Jacqueline Tracey, Ada Payne, Heather Ross, Robert Nolan
BACKGROUND: Self-care behaviors are commonly prescribed to manage both cardiovascular disease and hypertension to reduce modifiable risk factors and improve quality of life. Nevertheless, long-term adherence to self-care recommendations for cardiac patients has been problematic. In cardiac patients, moderated online forums have been found to be particularly useful in supporting maintenance of heart-healthy diet and fewer hospital visits. As such, we developed the e-Forum, a Web-based moderated forum designed to promote continued user engagement and long-term self-care adherence...
May 18, 2018: JMIR Human Factors
https://www.readbyqxmd.com/read/29776801/determinants-of-a-good-perinatal-outcome-in-588-pregnancies-in-women-with-type-1-diabetes
#20
J Lepercq, C Le Ray, C Godefroy, L Pelage, D Dubois-Laforgue, J Timsit
AIM: This study assessed pregnancy outcomes in women with type 1 diabetes (T1D) over the last 15 years and identified modifiable factors associated with good perinatal outcomes. METHODS: Pregnancy outcomes were prospectively assessed in this cohort study of 588 singleton pregnancies (441 women) managed by standardized care from 2000 to 2014. A good perinatal outcome was defined as the uncomplicated delivery of a normally formed, non-macrosomic, full-term infant with no neonatal morbidity...
May 8, 2018: Diabetes & Metabolism
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