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Emergent care

Jeffrey Braithwaite, Peter D Hibbert, Adam Jaffe, Les White, Christopher T Cowell, Mark F Harris, William B Runciman, Andrew R Hallahan, Gavin Wheaton, Helena M Williams, Elisabeth Murphy, Charlotte J Molloy, Louise K Wiles, Shanthi Ramanathan, Gaston Arnolda, Hsuen P Ting, Tamara D Hooper, Natalie Szabo, John G Wakefield, Clifford F Hughes, Annette Schmiede, Chris Dalton, Sarah Dalton, Joanna Holt, Liam Donaldson, Ed Kelley, Richard Lilford, Peter Lachman, Stephen Muething
Importance: The quality of routine care for children is rarely assessed, and then usually in single settings or for single clinical conditions. Objective: To estimate the quality of health care for children in Australia in inpatient and ambulatory health care settings. Design, Setting, and Participants: Multistage stratified sample with medical record review to assess adherence with quality indicators extracted from clinical practice guidelines for 17 common, high-burden clinical conditions (noncommunicable [n = 5], mental health [n = 4], acute infection [n = 7], and injury [n = 1]), such as asthma, attention-deficit/hyperactivity disorder, tonsillitis, and head injury...
March 20, 2018: JAMA: the Journal of the American Medical Association
Chih-Yuan Wang, Yi-Chan Chen, Ti-Hsuan Chien, Hao-Yu Chang, Yu-Hsien Chen, Chih-Ying Chien, Ting-Shuo Huang
Here we conducted a retrospective analysis of hospital-based trauma registry database for evaluating the impacts of comorbidities on the prognosis for traumatized patients using Index of Coexistent Comorbidity Disease (ICED) scores. We analyzed the data of patients with blunt trauma who visited emergency department between January 1, 2011, and December 31, 2015 in Chang-Gung Memorial Hospital, Keelung branch, a single level I trauma center in the Northern Taiwan. All consecutive patients with blunt trauma who admitted to the intensive care unit or ordinary ward after initial managements in the emergency department were included...
2018: PloS One
Xing Chen, Wang Kang, Daoqian Zhu, Xichao Zhang, Na Lei, Youguang Zhang, Yan Zhou, Weisheng Zhao
Neuromorphic computing, which relies on a combination of a large number of neurons massively interconnected by an even larger number of synapses, has been actively studied for its characteristics such as energy efficiency, intelligence, and adaptability. To date, while the development of artificial synapses has shown great progress with the introduction of emerging nanoelectronic devices, e.g., memristive devices, the implementation of artificial neurons, however, depends mostly on semiconductor-based circuits via integrating many transistors, sacrificing energy efficiency and integration density...
March 20, 2018: Nanoscale
Harissou Adamou, Ibrahim Amadou Magagi, Oumarou Habou, Ousseini Adakal, Kabirou Ganiou, Magagi Amadou
Background: To describe the aetiological and prognostic aspects of acute mechanical intestinal obstruction (AMIO) in children at Zinder National Hospital (Niger). Materials and Methods: This was a cross-sectional study on a period to January 2013-June 2015. The database included all children under 15 years of age with a surgical diagnosis of mechanical intestinal obstruction. P < 0.05 was considered statistically significant for analysis. Results: AMIOs represent 21...
July 2017: African Journal of Paediatric Surgery: AJPS
Daniel K Ting, Eddy S Lang
Clinical question Should I use apneic oxygenation when intubating patients in the emergency department to increase peri-intubation oxygen saturation and first-pass success? Article chosen Oliveira JE, Silva L, Cabrera D, Barrionuevo P, et al. Effectiveness of apneic oxygenation during intubation: a systematic review and meta-analysis. Ann Emerg Med 2017;70(4):483-94. OBJECTIVE: The purpose of this study was to synthesize and appraise the apneic oxygenation literature for its effect on peri-intubation outcomes...
March 20, 2018: CJEM
Fauzia Knight, Renata Kokanović, Damien Ridge, Lisa Brophy, Nicholas Hill, Kate Johnston-Ataata, Helen Herrman
Supported decision-making (SDM) is a principle guiding mental health service provision, which aims to improve people's ability to make informed decisions about their care. Understanding diverse individual needs is vital to its success. Based on 29 narrative interviews with people diagnosed with mental illness in Australia, we examine how participants reflected on their own experiences of SDM. We find that participants' conceptualization of mental health expertise, their own experiences and sense of agency, and their varying needs for dependence and independence influenced their relationships with mental health practitioners...
March 1, 2018: Qualitative Health Research
Arinze Nkemdirim Okere
With the current legalization of medical marijuana and the possibility of recreational use being permitted in some states, the health care benefits associated with the use of marijuana is questionable. States that are on the path of legalizing marijuana, should recognize that as there are perceived positive benefits, there are also many evidence-based negative health consequences which may result in negative economic and societal consequences. As more data on health outcomes regarding the use of marijuana continue to emerge, policies directed toward legalizing marijuana, whether medical or recreational, should consider protecting the society from both harm and societal cost...
March 1, 2018: Annals of Pharmacotherapy
Tonderai Mabuto, Salome Charalambous, Caitlin Kennedy, Christopher J Hoffmann
Understanding the role of contextual factors beyond individual behavioural determinants is critical to identify strategies to achieve engagement in HIV clinical care. We sought to examine how subjective and objective evaluations of clinic-level costs and value placed on allopathic care influenced HIV care engagement. We used repeat in-depth interviews over 6 months among newly HIV diagnosed adults in South Africa. Data were analysed using thematic analyses and framework matrices to explore individual trajectories over time...
March 19, 2018: AIDS and Behavior
David Warr
For patients with cancer, the threat of chemotherapy-induced nausea and vomiting (CINV) can greatly influence treatment decisions and overall quality of life. Clinicians now have numerous effective antiemetic therapies to offer to patients, but selecting the optimal strategy can be complicated. Integration of current CINV guidelines, emerging data from recent clinical trials, and patient-specific risk factors can greatly improve antiemetic prophylaxis. Two challenging clinical scenarios are presented and discussed to provide insight on how to best approach these types of treatment decisions and apply recent advances in CINV prevention and management to patient care...
March 19, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Lee Schwartzberg
Recent years have witnessed significant improvements in the prevention and management of chemotherapy-induced nausea and vomiting (CINV), allowing patients to complete their prescribed chemotherapy regimens without compromising quality of life. This reduction in the incidence of CINV can be primarily attributed to the emergence of effective, well-tolerated antiemetic therapies, including serotonin (5-hydroxytryptamine or 5-HT3) receptor antagonists, neurokinin-1 (NK-1) receptor antagonists, and the atypical antipsychotic olanzapine...
March 19, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Mark Clemons
Numerous groups have published guidelines for the prevention and management of chemotherapy-induced nausea and vomiting (CINV). The current management of CINV, however, remains suboptimal, due in part to poor adherence to existing antiemetic guidelines. Challenges in clinical trial design have also slowed progress and complicated the selection of optimal antiemetic therapy. In addition, patient-specific characteristics and factors are not included in current CINV guidelines and are an important contributor to an individual's risk for nausea and vomiting...
March 19, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
I Marzi, T Lustenberger, P Störmann, K Mörs, N Wagner, S Wutzler
BACKGROUND: Every year up to 35,000 people in Germany are severely injured in accidents in traffic, during work or leisure activities. The 24-h availability of the trauma room as well as surgical and intensive care unit capacities are essential to provide optimal acute care. This study analyzed the frequency of utilization of the resource trauma room in a level I trauma center in the past. METHODS: Data of a level I trauma center from 2005 to 2016 including trauma room alerts deployed by the rescue coordination center and the number of patients found to be severely injured (ISS ≥ 16) during trauma room diagnostics were analyzed retrospectively...
March 19, 2018: Der Unfallchirurg
Tejas K Patel, Parvati B Patel
PURPOSE: The aim of this study was to estimate the prevalence of mortality among patients due to adverse drug reactions that lead to hospitalisation (fatal ADRAd ), to explore the heterogeneity in its estimation through subgroup analysis of study characteristics, and to identify system-organ classes involved and causative drugs for fatal ADRAd . METHODS: We identified prospective ADRAd -related studies via screening of the PubMed and Google Scholar databases with appropriate key terms...
March 19, 2018: European Journal of Clinical Pharmacology
Andrea Ciavattini, Giovanni Delli Carpini, Lorenzo Moriconi, Nicolò Clemente, Nina Montik, Rosa De Vincenzo, Anna Del Fabro, Monica Buttignol, Caterina Ricci, Francesca Moro, Francesco Sopracordevole
OBJECTIVES: To evaluate cervical regeneration at 6 months following excisional treatment for high-grade cervical intraepithelial neoplasia (CIN), and to investigate the effect of cone dimensions, age of patients and technique of excision on the efficacy of the regeneration process. DESIGN: Prospective observational multicentric study. SETTING: Three tertiary care and research centres. PARTICIPANTS: Among the 197 eligible women of childbearing age, older than 25 years of age, undergoing for the first time a loop electrosurgical excision procedure or carbon dioxide laser cervical excision for a high-grade CIN at the colposcopy-directed cervical punch biopsy, and with a final diagnosis of high-grade CIN, 165 completed the 6-month follow-up and were included in the analysis...
March 19, 2018: BMJ Open
Charlotte N L Chambers, Christopher M A Frampton, Martin McKee, Murray Barclay
OBJECTIVES: To estimate prevalence of and factors contributing to bullying among senior doctors and dentists in New Zealand's public health system, to ascertain rates of reporting bullying behaviour, perceived barriers to reporting and the effects of bullying professionally and personally. DESIGN: Cross-sectional, mixed methods study. SETTING: New Zealand. PARTICIPANTS: Members of the Association of Salaried Medical Specialists (40...
March 19, 2018: BMJ Open
Mark Olfson, Melanie Wall, Shuai Wang, Stephen Crystal, Jeffrey A Bridge, Shang-Min Liu, Carlos Blanco
OBJECTIVES: Among adolescents and young adults with nonfatal self-harm, our objective is to identify risk factors for repeated nonfatal self-harm and suicide death over the following year. METHODS: A national cohort of patients in the Medicaid program, aged 12 to 24 years ( n = 32 395), was followed for up to 1 year after self-harm. Cause of death information was obtained from the National Death Index. Repeat self-harm per 1000 person-years and suicide deaths per 100 000 person-years were determined...
March 19, 2018: Pediatrics
Bahare Salehi, Hossein Goudarzi, Bahram Nikmanesh, Hamidreza Houri, Mostafa Alavi-Moghaddam, Zohreh Ghalavand
RATIONALE: Acinetobacter baumannii is one of the antibiotic-resistant superbugs that threatens hospitalized patients. Emergence and spread of the multidrug-resistant (MDR) and extensively drug-resistant (XDR) clones cause erratic outbreaks following environmental contamination of hospital settings. OBJECTIVE: The present study intended to characterize the antimicrobial resistant profiles and the genotypes of clinical and environmental isolates of A. baumannii as a result of dissemination of resistant strains...
March 16, 2018: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Geoffrey A Anderson, Peter Kayima, Lenka Ilcisin, Noralis Portal Benitez, Katherine H Albutt, Susan M Briggs, Deepika Nehra
OBJECTIVE: The goal of this project was to create a multitiered trauma training curriculum that was designed specifically for the low-resource setting. DESIGN: We developed 2 courses designed to teach principles and skills necessary for trauma care. The first course, "Emergency Ward Management of Trauma (EWMT)," is designed to teach interns the initial assessment and stabilization of trauma patients in the emergency ward. The second course for mid-level surgical residents, "Surgical Techniques and Repairs in Trauma for the Low-resource Environment" (STaRTLE), is a cadaver-based operative trauma course designed to teach surgical exposures and techniques...
March 16, 2018: Journal of Surgical Education
Brian Wolf, Rory Sadoff, Victor Nannini
Toxic epidermal necrolysis (TEN) is a rare and severe mucocutaneous disorder characterized by mucosal and epidermal necrosis and sloughing. This potentially life-threatening condition, together with the less severe Stevens-Johnson syndrome, is commonly caused by an immunologic reaction to medications and can lead to many long-term complications. The disorder initially presents with fever, malaise, and painful mucosal ulcerations (most commonly oral) but progresses to widespread cutaneous lesions. A 14-year-old male patient was prescribed minocycline for treatment of his acne by his primary care doctor...
February 23, 2018: Journal of Oral and Maxillofacial Surgery
Richard Sola, Valerie A Waddell, Shawn D St Peter, Pablo Aguayo, David Juang
INTRODUCTION: Non-accidental trauma (NAT) has significant societal and health care implications. Standardized care has been shown to improve outcomes. The purpose of our study was to survey trauma centers and elucidate the continued variable management of NAT. METHODS: After institutional review board approval, an email survey was sent to Level 1 and 2 ACS verified trauma centers along with general and pediatric surgery training programs. Trauma hospital characteristics and NAT management were analyzed...
March 10, 2018: Injury
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