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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/28806860/patient-caregiver-and-provider-perceptions-of-pain-and-pain-management-in-adolescents-and-young-adults-with-bleeding-disorders
#2
Angela Lambing, Cynthia D Nichols, James E Munn, Terry L Anderson, Bartholomew J Tortella, Michelle L Witkop
INTRODUCTION: Recurrent bleeding and associated pain are critical components in the management of bleeding disorders, yet scant data describe perceptions of pain in this patient population. OBJECTIVE: This study assessed perceptions of pain and pain management in adolescents and young adults (AYAs) with haemophilia or von Willebrand disease (VWD) to determine agreement/disagreement between patients, caregivers and health care providers. METHODS: Using an online questionnaire, AYA patients (N=89), their caregivers (N=77), and providers (N=54) reported on pain perception, pain treatment and pain control...
August 14, 2017: Haemophilia: the Official Journal of the World Federation of Hemophilia
https://www.readbyqxmd.com/read/28806744/sustainability-of-knowledge-implementation-in-a-low-and-middle-income-context-experiences-from-a-facilitation-project-in-vietnam-targeting-maternal-and-neonatal-health
#3
Leif Eriksson, Anna Bergström, Dinh Thi Phuong Hoa, Nguyen Thu Nga, Ann Catrine Eldh
BACKGROUND: In a previous trial in Vietnam, a facilitation strategy to secure evidence-based practice in primary care resulted in reduced neonatal mortality over a period of three years. While little is known as to what ensures sustainability in the implementation of community-based strategies, the aim of this study was to investigate factors promoting or hindering implementation, and sustainability of knowledge implementation strategies, by means of the former Neonatal Knowledge Into Practice (NeoKIP) trial...
2017: PloS One
https://www.readbyqxmd.com/read/28806628/complete-step-section-microscopic-study-of-a-swan-ganz-catheter-related-pulmonary-artery-rupture-a-frequently-lethal-complication-that-to-our-knowledge-has-not-had-a-comprehensive-microscopic-examination-case-report-and-literature-review
#4
Ya Xu, L Clarke Stout
BACKGROUND: Introduced in 1970, the Swan-Ganz catheter (SGC) soon became widely used because of its unique usefulness in managing intensive care patients. Unfortunately, SGC usage was complicated by pulmonary artery rupture (PAR) with a 50% mortality rate that led to a near banning of the SCG in the late 1980s. Increasing knowledge and decreasing incidence of SGC-related PARs (SGPARs) led to the current feeling that the present SGPAR incidence is now low enough to tolerate given the lives saved by SGC usage...
July 4, 2017: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
https://www.readbyqxmd.com/read/28806593/supporting-people-with-young-onset-dementia-and-their-families-an-evaluation-of-a-training-course-for-care-workers
#5
Raymond Smith, Ann Ooms, Nan Greenwood
This article reports the findings of an evaluation of a training course for care workers who care for people with dementia in the community. Twenty-four care workers participated in the training which took place in London and Surrey, United Kingdom. The training had a significant positive impact on participants' confidence in understanding the experiences and social care needs of people with young onset dementia (YOD) and their families. Participants also perceived that the training would help them improve their working practice by furthering their understanding of practical approaches to supporting and caring for people with dementia in general...
August 8, 2017: Nurse Education in Practice
https://www.readbyqxmd.com/read/28806586/the-new-frontier-of-strategic-alliances-in-health-care-new-partnerships-under-accountable-care-organizations
#6
Valerie A Lewis, Katherine I Tierney, Carrie H Colla, Stephen M Shortell
Accountable care organizations (ACOs) and similar reforms aim to improve coordination between health care providers; however, due to the fragmented nature of the US health care system, successful coordination will hinge in large part on the ability of health care organizations to successfully partner across organizational boundaries. Little is known about new partnerships formed under the ACO model. We use mixed methods data from the National Survey of ACOs, Medicare ACO performance data and interviews with executive leaders across 31 ACOs to examine the prevalence, characteristics, and capabilities of partnership ACOs and why and how ACO partnerships form...
May 2, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28806561/delirium-and-exposure-to-psychoactive-medications-in-critically-ill-adults-a-multi-centre-observational-study
#7
Lisa D Burry, David R Williamson, Sangeeta Mehta, Marc M Perreault, Ioanna Mantas, Ranjeeta Mallick, Dean A Fergusson, Orla Smith, Eddy Fan, Sebastien Dupuis, Margaret Herridge, Louise Rose
PURPOSE: Investigate the relationship between psychoactive drugs and delirium. MATERIALS AND METHODS: Prospective observational study of 520 critically ill adult patients admitted ≥24h to 6 intensive care units (ICUs). Data were collected on psychoactive drug exposure, use of sedation administration strategies, and incident delirium (Intensive Care Delirium Screening Checklist score≥4). RESULTS: Delirium was detected in 260 (50%) patients, median (IQR) duration 2 (1-5) days, and time to onset 3 (2-5) days...
August 5, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28806494/body-piercing-motivations-and-implications-for-health
#8
REVIEW
Cheri Van Hoover, Carol-Ann Rademayer, Cindy L Farley
Body piercing has evolved from a behavior once considered extreme to an accepted choice among the general population. Earlobe piercing is so common that it is now considered a normative behavior. The motivations for choosing body piercing have changed and are associated with piercing site and number of piercings chosen by the individual. Meanings ascribed to body piercing were traditionally related to enhanced sexual desirability and experience, but now range from the innocuous, such as a fashion statement, to the risk laden, such as nonsuicidal self-injury...
August 14, 2017: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/28806455/association-of-state-access-standards-with-accessibility-to-specialists-for-medicaid-managed-care-enrollees
#9
Chima D Ndumele, Michael S Cohen, Paul D Cleary
Importance: Medicaid recipients have consistently reported less timely access to specialists than patients with other types of coverage. By 2018, state Medicaid agencies will be required by the Center for Medicare and Medicaid Services (CMS) to enact time and distance standards for managed care organizations to ensure an adequate supply of specialist physicians for enrollees; however, there have been no published studies of whether these policies have significant effects on access to specialty care...
August 14, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28806364/racial-and-ethnic-variation-in-perceptions-of-va-mental-health-providers-are-associated-with-treatment-retention-among-veterans-with-ptsd
#10
Michele Spoont, David Nelson, Michelle van Ryn, Margarita Alegria
BACKGROUND: Veterans with posttraumatic stress disorder (PTSD) who seek mental health care in the Veterans Health Administration frequently discontinue treatment prematurely. Early discontinuation of mental health treatment is more common among Veterans with PTSD who are of minority race or ethnicity. OBJECTIVES: To determine whether retention in individual therapy or pharmacotherapy among Veterans with PTSD are associated with patients' ratings of their mental health providers, and if those associations differ depending on Veteran race or ethnicity...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28806303/does-a-combination-of-laparoscopic-approach-and-full-fast-track-multimodal-management-decrease-postoperative-morbidity-a-multicenter-randomized-controlled-trial
#11
Léon Maggiori, Eric Rullier, Jérémie H Lefevre, Jean-Marc Régimbeau, Stéphane Berdah, Mehdi Karoui, Jérome Loriau, Arnaud Alvès, Eric Vicaut, Yves Panis
OBJECTIVE: The aim of this study was to assess whether association of laparoscopic approach and full fast track multimodal (FFT) management can reduce postoperative morbidity after colorectal cancer surgery, as compared to laparoscopic approach with limited fast-track program (LFT). SUMMARY OF BACKGROUND DATA: Recent advances in colorectal cancer surgery are introduction of laparoscopy and FFT implementation. METHODS: Patients eligible for elective laparoscopic colorectal cancer surgery were randomized into 2 groups: FFT or LFT care (with only early oral intake and mobilization starting on Day 1)...
August 11, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28806293/-optimizing-your-post-surgical-scars-a-systematic-review-on-best-practices-in-preventative-scar-management-1
#12
Justin L Perez, Rod J Rohrich
BACKGROUND: Scar management is critical for every plastic surgeon's practice and, ultimately, the patient's satisfaction with his or her aesthetic result. Despite the critical nature of this component of routine post-operative care, there has yet to be a comprehensive analysis of the available literature over the last decade to assess the best algorithmic approach to scar care. To this end, a systematic review of best practices in preventative scar management was conducted to elucidate the highest level of evidence available on this subject to date...
August 3, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28806284/is-extracorporeal-cardiopulmonary-resuscitation-practical-in-severe-chest-trauma-a-systematic-review-in-single-center-of-developing-country
#13
Up Huh, Seunghwan Song, Sung Woon Chung, Sang-Pil Kim, Chung Won Lee, Hyo Young Ahn, Miju Bae, Seon Hee Kim
BACKGROUND: We report our experience with extracorporeal cardiopulmonary resuscitation (ECPR) in patients with rupture of heart and major vessels caused by severe chest trauma. METHODS: From April 2015 to May 2016, 10 patients with suspected injuries to the heart and major vessels following focused assessment with sonography in trauma or computed tomography were selected from patients admitted at a level I trauma centre presenting with cardiac tamponade and tension haemothorax due to severe chest trauma...
August 12, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28806283/expanding-the-scope-of-quality-measurement-in-surgery-to-include-non-operative-care-results-from-the-acs-nsqip-emergency-general-surgery-pilot
#14
Michael W Wandling, Clifford Y Ko, Paul E Bankey, Chris Cribari, H Gill Cryer, Jose J Diaz, Therese M Duane, S Morad Hameed, Matthew M Hutter, Michael H Metzler, Justin L Regner, Patrick M Reilly, H David Reines, Jason L Sperry, Kristan L Staudenmayer, Garth H Utter, Marie L Crandall, Karl Y Bilimoria, Avery B Nathens
BACKGROUND: Patients managed non-operatively have been excluded from risk-adjusted benchmarking programs, including the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). Consequently, optimal performance evaluation is not possible for specialties like emergency general surgery (EGS) where non-operative management is common. We developed a multi-institutional EGS clinical data registry within ACS NSQIP that includes patients managed non-operatively to evaluate variability in non-operative care across hospitals and identify gaps in performance assessment that occur when only operative cases are considered...
August 12, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28806234/delirium-in-the-critically-ill-child
#15
Sharon Norman, Asma A Taha, Helen N Turner
PURPOSE/OBJECTIVE: The purposes of this article are to describe the scientific literature on assessment, prevention, and management of delirium in critically ill children and to articulate the implications for clinical nurse specialists, in translating the evidence into practice. DESCRIPTION: A literature search was conducted in 4 databases-OvidMEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsychINFO, and Web of Science-using the terms "delirium," "child," and "critically ill" for the period of 2006 to 2016...
September 2017: Clinical Nurse Specialist CNS
https://www.readbyqxmd.com/read/28806221/admission-to-intensive-care-for-palliative-care-or-potential-organ-donation-demographics-circumstances-outcomes-and-resource-use
#16
Andrew Melville, Gali Kolt, David Anderson, Joanna Mitropoulos, David Pilcher
OBJECTIVES: To describe the characteristics, circumstances, change over time, resource use, and outcomes of patients admitted to ICUs in Australia and New Zealand for the purposes of "palliative care of a dying patient" or "potential organ donation," and compare with actively managed ICU patients. DESIGN: A retrospective study of data from the Australian and New Zealand Intensive Care Society Adult Patient Database and a nested cohort analysis of a single center...
August 11, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28806175/point-of-care-ultrasound-facilitated-detection-of-femoral-occlusive-septic-emboli-during-mitral-valve-surgery-a-case-report
#17
Melissa L Bellomy, Susan Eagle, Mias Pretorius, Ben R Barton, Yafen Liang
Acute lower extremity ischemia from septic emboli is a surgical emergency. Timely diagnosis and management are critical to improve patient outcome. However, traditional diagnostic modalities such as intraoperative angiogram are time-consuming, require special equipment and personnel, and introduce contrast exposure for critically ill patients. There are limited reports of utilization of point-of-care ultrasound to detect peripheral septic emboli. We present a case where femoral occlusive septic emboli were identified by point-of-care ultrasound after mitral valve replacement...
August 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28806160/delirium-in-hospitalized-patients-risks-and-benefits-of-antipsychotics
#18
REVIEW
Robyn Pauline Thom, Clare Kelleher Mock, Polina Teslyar
Consensus panel guidelines advocate for the judicious use of antipsychotic drugs to manage delirium in hospitalized patients when nonpharmacologic measures fail and the patient is in significant distress from symptoms, poses a safety risk to self or others, or is impeding essential aspects of his or her medical care. Here, we review the use of haloperidol, olanzapine, quetiapine, risperidone, and aripiprazole for this purpose.
August 2017: Cleveland Clinic Journal of Medicine
https://www.readbyqxmd.com/read/28806034/a-primer-for-the-primary-care-physician-management-of-overactive-bladder-syndrome
#19
Margaret E Free, Matthew A Barker
Overactive bladder syndrome affects millions of women in the U.S. and is defined by urinary urgency, urinary frequency, and small volume voids, with or without nocturia and incontinence. Overactive bladder is a diagnosis of exclusion, and several therapies exist for the management of this condition. This article outlines a systematic approach that the primary care physician can take when treating a patient with overactive bladder.
September 2016: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28805960/factors-associated-with-high-pain-intensity-during-wound-care-procedures-a-model
#20
Sue E Gardner, Linda I Abbott, Catherine A Fiala, Barbara A Rakel
The most common wound care procedures (WPCs) performed on open wounds are dressing changes and wound cleansing. Dressing changes cause moderate to severe pain in 74% of patients, nearly half (36%) of whom experience severe pain (rated as 8-10 on a 10-point numeric rating scale). The purpose of this paper is to propose a model of clinically accessible factors that can be tested in order to develop a clinical tool to identify which patients are likely to experience high intensity pain during nonoperative WCPs, such as dressing changes...
June 8, 2017: Wound Repair and Regeneration
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