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https://www.readbyqxmd.com/read/29155224/medical-encounter-mental-health-diagnoses-non-fatal-injury-and-polypharmacy-indicators-of-risk-for-accident-death-in-the-us-army-enlisted-soldiers-2004-2009
#1
Lisa Lewandowski-Romps, Heather M Schroeder, Patricia A Berglund, Lisa J Colpe, Kenneth Cox, Keith Hauret, Jeffrey D Hay, Bruce Jones, Roderick J A Little, Colter Mitchell, Michael Schoenbaum, Paul Schulz, Murray B Stein, Robert J Ursano, Steven G Heeringa
Accidents are a leading cause of deaths in U.S. active duty personnel. Understanding accident deaths during wartime could facilitate future operational planning and inform risk prevention efforts. This study expands prior research, identifying health risk factors associated with U.S. Army accident deaths during the Afghanistan and Iraq war. Military records for 2004-2009 enlisted, active duty, Regular Army soldiers were analyzed using logistic regression modeling to identify mental health, injury, and polypharmacy (multiple narcotic and/or psychotropic medications) predictors of accident deaths for current, previously, and never deployed groups...
November 16, 2017: Preventive Medicine
https://www.readbyqxmd.com/read/29144718/the-emerging-role-of-gammacore%C3%A2-in-the-management-of-cluster-headache-expert-panel-recommendations
#2
Stephen D Silberstein, Anne H Calhoun, Christina Treppendahl, David W Dodick, Alan M Rapoport, Avinash Mamidi, Peter Vargas, Thomas H Ebert, Stewart J Tepper
A panel of 9 experts, including neurologists, other headache specialists, and medical and pharmacy directors, from 4 health plans (1 integrated delivery network and 3 plans with commercial, Medicare, and Medicaid lines of business), convened to discuss cluster headache (CH). Topics covered included the current treatment landscape, treatment challenges, economic impact of disease, and gaps in care for patients with CH. One major challenge in the management of CH is that it is underrecognized and frequently misdiagnosed, leading to delays in and suboptimal treatment for patients who suffer from this painful and disabling condition...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29144250/case-not-closed-prescription-errors-12-years-after-computerized-physician-order-entry-implementation
#3
Gili Kadmon, Michal Pinchover, Avichai Weissbach, Shirley Kogan Hazan, Elhanan Nahum
OBJECTIVE: To assess the prolonged impact of computerized physician order entry (CPOE) on medication prescription errors in pediatric intensive care patients. STUDY DESIGN: This observational study was conducted at a pediatric intensive care unit in which a CPOE (Metavision, iMDsoft, Israel) with a limited clinical decision support system was implemented between 2004 and 2007. Since then, no changes were made to the systems. We analyzed 2500 electronic prescriptions (1250 prescriptions from 2015 and 1250 prescriptions from 2016)...
November 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29139096/the-modified-frailty-index-and-30-day-adverse-events-in-oncologic-neurosurgery
#4
Brett E Youngerman, Alfred I Neugut, Jingyan Yang, Dawn L Hershman, Jason D Wright, Jeffrey N Bruce
The modified frailty index (mFI) is emerging as a leading measure for preoperative risk assessment using routinely available medical record data. Our objective was to determine if mFI predicts morbidity and mortality in the diverse national cohort of patients undergoing neurosurgery for intracranial neoplasms. We identified patients in the National Surgical Quality Improvement Program who underwent oncologic neurosurgery procedures between 2008 and 2012. The mFI, ranging from 0 to 1, was calculated as the proportion of 11 possible risk factors present...
November 14, 2017: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/29136327/long-term-follow-up-after-implantation-of-a-telemetric-intraocular-pressure-sensor-in-patients-with-glaucoma-a-safety-report
#5
Antonis Koutsonas, Peter Walter, Gernot Roessler, Niklas Plange
IMPORTANCE: To investigate the long-term safety of a novel intraocular telemetric pressure sensor. BACKGROUND: Acquisition of accurate intraocular pressure (IOP) data is vital for sufficient medical care of glaucoma patients. Non-invasive self-tonometry with a telemetric IOP sensor can provide important information regarding the individual IOP profile. DESIGN: Retrospective analysis of long-term follow-up data assessed during outpatient visits in a university hospital...
November 14, 2017: Clinical & Experimental Ophthalmology
https://www.readbyqxmd.com/read/29133291/watcher-initiative-associated-with-decrease-in-failure-to-rescue-events-in-pediatric-population
#6
Melanie McClain Smith, Maryanne Chumpia, Lindsey Wargo, Julie Nicol, Mark Bugnitz
BACKGROUND AND OBJECTIVES: Improved situation awareness may prevent unplanned ICU transfers. Transfers with serious safety issues may be classified as unrecognized situation awareness failure events (UNSAFE) and are associated with intubation, vasopressors, or >3 fluid boluses within 1 hour before or after ICU arrival. Our aim was to decrease the proportion of unplanned ICU transfers that met UNSAFE criteria by 50% in 1 year. METHODS: We adapted a previously described huddle-based intervention...
November 13, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/29130474/interventions-for-the-reduction-of-prescribed-opioid-use-in-chronic-non-cancer-pain
#7
REVIEW
Christopher Eccleston, Emma Fisher, Kyla H Thomas, Leslie Hearn, Sheena Derry, Cathy Stannard, Roger Knaggs, R Andrew Moore
BACKGROUND: This is the first update of the original Cochrane Review published in 2013. The conclusions of this review have not changed from the 2013 publication. People with chronic non-cancer pain who are prescribed and are taking opioids can have a history of long-term, high-dose opioid use without effective pain relief. In those without good pain relief, reduction of prescribed opioid dose may be the desired and shared goal of both patient and clinician. Simple, unsupervised reduction of opioid use is clinically challenging, and very difficult to achieve and maintain...
November 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29114896/a-shared-decision-making-tool-for-obstructive-sleep-apnea-without-tonsillar-hypertrophy-a-randomized-controlled-trial
#8
Mathieu Bergeron, Angela L Duggins, Aliza P Cohen, Karin Tiemeyer, Lisa Mullen, Joseph Crisalli, Angela McArthur, Stacey L Ishman
OBJECTIVES/HYPOTHESIS: Shared decision-making is a process whereby patients and clinicians jointly establish a treatment plan integrating clinical evidence and patient values and preferences. Although this approach has been successfully employed in numerous medical disciplines, often using shared decision-making tools, otolaryngologic research assessing its use is scant. Our primary objective was therefore to determine if the tools we developed reduced decisional conflict for children with obstructive sleep apnea without tonsillar hypertrophy...
November 8, 2017: Laryngoscope
https://www.readbyqxmd.com/read/29113972/localized-synchrotron-irradiation-of-mouse-skin-induces-persistent-systemic-genotoxic-and-immune-responses
#9
Jessica Ventura, Pavel N Lobachevsky, Jason S Palazzolo, Helen Forrester, Nicole M Haynes, Alesia Ivashkevich, Andrew W Stevenson, Christopher J Hall, Andreas Ntargaras, Vasilis Kotsaris, Gerasimos Ch Pollakis, Gianna Potsi, Konstantinos Skordylis, Georgia Terzoudi, Ioannis S Pateras, Vassilis G Gorgoulis, Alexandros G Georgakilas, Carl N Sprung, Olga A Martin
The importance of nontargeted (systemic) effects of ionizing radiation is attracting increasing attention. Exploiting synchrotron radiation generated by the Imaging and Medical Beamline at the Australian Synchrotron, we studied radiation-induced nontargeted effects in C57BL/6 mice. Mice were locally irradiated with a synchrotron X-ray broad beam and a multiplanar microbeam radiotherapy beam. To assess the influence of the beam configurations and variations in peak dose and irradiated area in the response of normal tissues outside the irradiated field at 1 and 4 days after irradiation, we monitored oxidatively induced clustered DNA lesions (OCDL), DNA double-strand breaks (DSB), apoptosis, and the local and systemic immune responses...
November 7, 2017: Cancer Research
https://www.readbyqxmd.com/read/29108735/emergency-department-patient-burden-from-an-electronic-dance-music-festival
#10
Neeraj Chhabra, Renee P Gimbar, Lisa M Walla, Trevonne M Thompson
BACKGROUND: Electronic dance music (EDM) festivals are increasingly common and psychoactive substance use is prevalent. Although prehospital care can obviate the transfer of many attendees to health care facilities (HCFs), little is known regarding the emergency department (ED) burden of patients presenting from EDM festivals. OBJECTIVES: This study describes the patient volume, length of stay (LOS), and presenting complaints of patients from a 3-day EDM festival in close proximity to an area ED...
November 3, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29102097/management-of-an-entrapped-patient-with-a-field-amputation
#11
John C Bunyasaranand, Erasmo Espino, Kelli A Rummings, Gregory M Christiansen
BACKGROUND: Emergency surgical amputations are rare and resource-intensive lifesaving interventions. Most emergency medical services (EMS) lack a formal protocol to manage these high-risk but low-occurrence events. There has been limited attention in the EMS community to address this issue. Without a literature-based approach, the EMS community has been offered little guidance on managing surgical field amputations. CASE REPORT: A 38-year-old man was terminally entrapped below the waist in an industrial auger...
October 25, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29102087/availability-cost-and-prescription-patterns-of-antihypertensive-medications-in-primary-health-care-in-china-a-nationwide-cross-sectional-survey
#12
Meng Su, Qiuli Zhang, Xueke Bai, Chaoqun Wu, Yetong Li, Elias Mossialos, George A Mensah, Frederick A Masoudi, Jiapeng Lu, Xi Li, Sebastian Salas-Vega, Anwen Zhang, Yuan Lu, Khurram Nasir, Harlan M Krumholz, Lixin Jiang
BACKGROUND: Around 200 million adults in China have hypertension, but few are treated or achieve adequate control of their blood pressure. Available and affordable medications are important for successfully controlling hypertension, but little is known about current patterns of access to, and use of, antihypertensive medications in Chinese primary health care. METHODS: We used data from a nationwide cross-sectional survey (the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project primary health care survey), which was undertaken between November, 2016 and May, 2017, to assess the availability, cost, and prescription patterns of 62 antihypertensive medications at primary health-care sites across 31 Chinese provinces...
October 25, 2017: Lancet
https://www.readbyqxmd.com/read/29102084/prevalence-awareness-treatment-and-control-of-hypertension-in-china-data-from-1%C3%A2-7-million-adults-in-a-population-based-screening-study-china-peace-million-persons-project
#13
Jiapeng Lu, Yuan Lu, Xiaochen Wang, Xinyue Li, George C Linderman, Chaoqun Wu, Xiuyuan Cheng, Lin Mu, Haibo Zhang, Jiamin Liu, Meng Su, Hongyu Zhao, Erica S Spatz, John A Spertus, Frederick A Masoudi, Harlan M Krumholz, Lixin Jiang
BACKGROUND: Hypertension is common in China and its prevalence is rising, yet it remains inadequately controlled. Few studies have the capacity to characterise the epidemiology and management of hypertension across many heterogeneous subgroups. We did a study of the prevalence, awareness, treatment, and control of hypertension in China and assessed their variations across many subpopulations. METHODS: We made use of data generated in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project from Sept 15, 2014, to June 20, 2017, a population-based screening project that enrolled around 1·7 million community-dwelling adults aged 35-75 years from all 31 provinces in mainland China...
October 25, 2017: Lancet
https://www.readbyqxmd.com/read/29089750/inappropriate-pharmacological-treatment-in-older-adults-affected-by-cardiovascular-disease-and-other-chronic-comorbidities-a-systematic-literature-review-to-identify-potentially-inappropriate-prescription-indicators
#14
Ersilia Lucenteforte, Niccolò Lombardi, Davide Liborio Vetrano, Domenico La Carpia, Zuzana Mitrova, Ursula Kirchmayer, Giovanni Corrao, Francesco Lapi, Alessandro Mugelli, Alfredo Vannacci
Avoiding medications in which the risks outweigh the benefits in the elderly patient is a challenge for physicians, and different criteria to identify inappropriate prescription (IP) exist to aid prescribers. Definition of IP indicators in the Italian geriatric population affected by cardiovascular disease and chronic comorbidities could be extremely useful for prescribers and could offer advantages from a public health perspective. The purpose of the present study was to identify IP indicators by means of a systematic literature review coupled with consensus criteria...
2017: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/29083971/patient-outcomes-health-care-resource-use-and-costs-associated-with-high-versus-low-hedis-asthma-medication-ratio
#15
Allan T Luskin, Evgeniya N Antonova, Michael S Broder, Eunice Chang, Karina Raimundo, Paul G Solari
BACKGROUND: The Healthcare Effectiveness Data and Information Set (HEDIS) quality measures for asthma include the asthma medication ratio (AMR) as a marker of quality of care for patients with asthma. Few data are available to describe the association between health care use and costs in patients with high versus low AMR. OBJECTIVE: To characterize health care use and costs associated with high versus low AMR in patients participating in commercial health plans...
November 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29082725/upcoming-strategies-in-obstetrics-how-the-technology-of-clinical-audit-may-reduce-cesarean-birth
#16
Sara Paracchini, Bianca Masturzo, Domenico Tangolo, Enrica Roletti, Annalisa Piazzese, Rossella Attini, Alessandro Rolfo, Tullia Todros
BACKGROUND: The rate of cesarean delivery is currently increasing all over Europe. In Italy it reaches 38% of all child births. Therefore, it is important to identify the clinical and organizational variables that determine the appropriateness of elective cesarean delivery. With this aim we chose the technology of clinical audit, a process that promotes improvement in clinical practice through systematic review of clinical care in relation with explicit standards derived from scientific literature...
December 2017: Minerva Ginecologica
https://www.readbyqxmd.com/read/29073928/safety-of-tubal-ligation-by-minilaparotomy-provided-by-clinical-officers-versus-assistant-medical-officers-study-protocol-for-a-noninferiority-randomized-controlled-trial-in-tanzanian-women
#17
Mark A Barone, Zuhura Mbuguni, Japhet Ominde Achola, Carmela Cordero, Joseph Kanama, Projestine S Muganyizi, Jamilla Mwanga, Caitlin Shannon, Leopold Tibyehabwa
BACKGROUND: Female sterilization by tubal ligation is a safe, extremely effective, and permanent way to limit childbearing. It is the most popular modern contraceptive method worldwide. The simplest way to provide tubal ligation is by a procedure called minilaparotomy, generally performed with the client under local anesthesia with systemic sedation and analgesia. In Tanzania, unmet need for family planning is high and has declined little in the past decade. Access to tubal ligation is limited throughout the country, in large part because of a lack of trained providers...
October 26, 2017: Trials
https://www.readbyqxmd.com/read/29072544/a-narrative-review-of-the-safety-concerns-of-deprescribing-in-older-adults-and-strategies-to-mitigate-potential-harms
#18
Emily Reeve, Frank Moriarty, Rayan Nahas, Justin P Turner, Lisa Kouladjian O'Donnell, Sarah N Hilmer
As with prescribing or continuing medications, deprescribing brings with it the potential for harm as well as benefit. Uncertainty and avoidance of harm has been reported as a barrier to deprescribing in practice and may contribute to continuation of inappropriate medications. Areas covered: This narrative review covers four main safety concerns/potential harms of deprescribing in older adults: adverse drug withdrawal events, return of medical condition(s), reversal of drug-drug interactions and damage to the doctor-patient relationship...
October 26, 2017: Expert Opinion on Drug Safety
https://www.readbyqxmd.com/read/29065049/bioinformatics-associated-with-conjoined-twin-separation
#19
Sarah Jane Commander, Samantha J Jacques, Mark S Lloyd, Audra Rushing, Helena Karlberg, Edward P Buchanan
The separation of conjoined twins is a rare event in the medical field and presents many unique challenges to overcome. With the complexities of today's interconnected healthcare technology and electronic medical record, there are many intricate details that need significant attention to guarantee proper care and accurate record keeping for conjoined twins. Items that require attention are how to digitally represent the twins-as 1 patient or 2, how to incorporate the physiological monitors into the medical record, and how to ensure the proper amount of infrastructure, equipment, and space...
October 23, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29061154/a-multi-centre-randomised-trial-to-compare-the-effectiveness-of-geriatrician-led-admission-avoidance-hospital-at-home-versus-inpatient-admission
#20
Sasha Shepperd, Andrea Cradduck-Bamford, Chris Butler, Graham Ellis, Mary Godfrey, Alastair Gray, Anthony Hemsley, Pradeep Khanna, Peter Langhorne, Patricia McCaffrey, Lubena Mirza, Maj Pushpangadan, Scott Ramsay, Rebekah Schiff, David Stott, John Young, Ly-Mee Yu
BACKGROUND: There is concern that existing models of acute hospital care will become unworkable as the health service admits an increasing number of frail older people with complex health needs, and that there is inadequate evidence to guide the planning of acute hospital level services. We aim to evaluate whether geriatrician-led admission avoidance to hospital at home is an effective alternative to hospital admission. METHODS/DESIGN: We are conducting a multi-site randomised open trial of geriatrician-led admission avoidance hospital at home, compared with admission to hospital...
October 23, 2017: Trials
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