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https://www.readbyqxmd.com/read/29140185/thrombolysis-improving-door-to-needle-times-for-ischemic-stroke-treatment-a-narrative-review
#1
Noreen Kamal, Eric E Smith, Thomas Jeerakathil, Michael D Hill
Background The effectiveness of thrombolysis is highly time dependent. For this reason, short target times have been set to reduce time to treatment from hospital arrival, which is called door-to-needle time. Summary of review There has been considerable work done at single centers and across multiple hospitals to improve door-to-needle time. There have been reductions of 8 to 47 min when applying one or more improvement strategies at single centers, and there have been many multi-hospital initiatives. The delays to treatment have been attributed to both patient and hospital factors, and strategies to address these delays have been proven to reduce door-to-needle time...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29139565/leukocyte-adhesion-defect-i-rare-primary-immune-deficiency
#2
Nitesh Tewari, Vijay Prakash Mathur, Vikender Singh Yadav, Prabhat Chaudhari
Leukocyte adhesion defect I is a rare disorder (1:1,000,000) caused by diminished expression of CD-18 β2 integrins on leukocytes leading to abnormal adhesion, migration, and chemotaxis. Clinical manifestations include delayed separation of umbilical cord, omphalitis, recurrent severe infections, impaired wound healing, persistent oral ulcers, and severe periodontitis in primary and permanent dentition. A 5-year-old girl, second-born child to parents with consanguinity, presented with pain and mobility of lower teeth...
November 15, 2017: Special Care in Dentistry
https://www.readbyqxmd.com/read/29138293/icare-acs-improving-care-processes-for-patients-with-suspected-acute-coronary-syndrome-a-study-of-cross-system-implementation-of-a-national-clinical-pathway
#3
Martin P Than, John W Pickering, Jeremy M Dryden, Sally J Lord, S Andrew Aitken, Sally J Aldous, Kate E Allan, Michael W Ardagh, John W N Bonning, Rosie Callender, Laura R E Chapman, Jonathan P Christiansen, Andre P J Cromhout, Louise Cullen, Joanne M Deely, Gerard P Devlin, Katherine A Ferrier, Christopher M Florkowski, Christopher M A Frampton, Peter M George, Gregory J Hamilton, Allan S Jaffe, Andrew J Kerr, G Luke Larkin, Richard M Makower, Timothy J E Matthews, William A Parsonage, W Frank Peacock, Bradley F Peckler, Nicholaas C van Pelt, Louise Poynton, A Mark Richards, Anthony G Scott, Mark B Simmonds, David Smyth, Oliver P Thomas, Andrew C Y To, Stephen A Du Toit, Richard W Troughton, Kim M Yates
BACKGROUND : Efforts to safely reduce length of stay for emergency department patients with symptoms suggestive of acute coronary syndrome (ACS) have had mixed success. Few system-wide efforts affecting multiple hospital emergency departments have ever been evaluated. We evaluated the effectiveness of a nationwide implementation of clinical pathways for potential ACS in disparate hospitals. METHODS : This was a multicenter pragmatic stepped-wedge before-and-after trial in 7 New Zealand acute care hospitals with 31 332 patients investigated for suspected ACS with serial troponin measurements...
November 14, 2017: Circulation
https://www.readbyqxmd.com/read/29116316/characteristics-and-factors-associated-with-hospitalization-in-early-childhood-2004-pelotas-brazil-birth-cohort
#4
Vera Lucia Schmidt da Silva, Giovanny Vinícius Araújo de França, Iná S Santos, Fernando C Barros, Alícia Matijasevich
Hospitalization is a frequent event in early childhood. In Brazil, the National Household Sample Survey of 2008 showed a 9% hospitalization rate among children in the first four years of life. The study aimed to describe the characteristics of hospitalization in the first six years of life and analyze the early factors associated with hospitalization in a birth cohort in southern Brazil. A zero-inflated Poisson model was used to simultaneously examine the effects of co-variables for the occurrence of a given event and to count events...
November 6, 2017: Cadernos de Saúde Pública
https://www.readbyqxmd.com/read/29110824/long-term-psychosocial-consequences-of-surgical-congenital-malformations
#5
Trond H Diseth, Ragnhild Emblem
Surgical congenital malformations often represent years of treatment, large number of hospital stays, treatment procedures, and long-term functional sequels affecting patients' psychosocial functioning. Both functional defects and psychosocial difficulties that occur commonly in childhood may pass through adolescence on to adulthood. This overview presents reports published over the past 3 decades to elucidate the long-term psychosocial consequences of surgical congenital malformations. Literature searches conducted on PubMed database revealed that less than 1% of all the records of surgical congenital malformations described long-term psychosocial consequences, but with diverse findings...
October 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29095965/frequent-undetected-mrsa-ward-based-transmission-linked-to-patient-sharing-between-hospitals
#6
Olga Tosas Auguet, Richard A Stabler, Jason Betley, Mark D Preston, Mandeep Dhaliwal, Michael Gaunt, Avgousta Ioannou, Nergish Desai, Tacim Karadag, Rahul Batra, Jonathan A Otter, Helene Marbach, Taane G Clark, Jonathan D Edgeworth
Background: Recent evidence suggests hospital transmission of methicillin-resistant Staphylococcus aureus (MRSA) is uncommon in UK centers that have implemented sustained infection control programmes. We investigated whether a healthcare-network analysis could shed light on transmission paths currently sustaining MRSA levels in UK hospitals. Methods: A cross-sectional observational study was performed in two NHS hospital groups and a general district hospital in South-East London...
October 31, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29072191/compulsory-admissions-in-southwest-greece-2010-2011-a-descriptive-report
#7
M Skokou, P Gouma, P Gourzis
Compulsory admissions represent a significant proportion of psychiatric hospitalizations. A wide variation seems to exist internationally regarding legal frameworks, administrative procedures, detention rates and clinical practice. The aim of the present study is to describe qualitative and quantitative features of compulsory admissions in a large administrative area in southwest Greece, in order to identify targets for future research and possible remediation. Involuntary assessments and admissions in the Department of Psychiatry of the University Hospital of Patras were retrospectively assessed, during a 12-month period, for demographic features and data regarding legal procedures...
July 2017: Psychiatrikē, Psychiatriki
https://www.readbyqxmd.com/read/29071165/federated-tensor-factorization-for-computational-phenotyping
#8
Yejin Kim, Jimeng Sun, Hwanjo Yu, Xiaoqian Jiang
Tensor factorization models offer an effective approach to convert massive electronic health records into meaningful clinical concepts (phenotypes) for data analysis. These models need a large amount of diverse samples to avoid population bias. An open challenge is how to derive phenotypes jointly across multiple hospitals, in which direct patient-level data sharing is not possible (e.g., due to institutional policies). In this paper, we developed a novel solution to enable federated tensor factorization for computational phenotyping without sharing patient-level data...
August 2017: KDD: Proceedings
https://www.readbyqxmd.com/read/29040245/code-team-training-demonstrating-adherence-to-aha-guidelines-during-pediatric-code-blue-activations
#9
Claire Stewart, Jamie Shoemaker, Rachel Keller-Smith, Katherine Edmunds, Andrew Davis, Ken Tegtmeyer
OBJECTIVE: Pediatric code blue activations are infrequent events with a high mortality rate despite the best effort of code teams. The best method for training these code teams is debatable; however, it is clear that training is needed to assure adherence to American Heart Association (AHA) Resuscitation Guidelines and to prevent the decay that invariably occurs after Pediatric Advanced Life Support training. The objectives of this project were to train a multidisciplinary, multidepartmental code team and to measure this team's adherence to AHA guidelines during code simulation...
October 16, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29026365/incidental-finding-of-bronchopulmonary-sequestration-in-a-64-year-old-female
#10
Pichapong Tunsupon, Ayesha Arshad, Sumit Patel, M Jeffery Mador
BACKGROUND: Bronchopulmonary sequestration is a congenital abnormality of the primitive foregut. In adults, the typical age at presentation is 20-25 years. CASE REPORT: A 64-year-old female was referred for evaluation of an 8 × 6-cm right lower lobe cystic lesion. Her medical history was significant for recurrent right lower lobe pneumonia requiring multiple hospitalizations. Her physical examination was significant for crackles at the right lung base. Computed tomography (CT) of the chest with contrast showed cystic changes with thickened septation of the medial segment of the right lower lobe lacking distinct visceral pleura and with arterial supply from the anomalous branch of the thoracic aorta arising near the celiac trunk...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/28982047/rehospitalization-and-suicide-following-electroconvulsive-therapy-for-bipolar-depression-a-population-based-register-study
#11
Katarzyna Popiolek, Ole Brus, Tove Elvin, Mikael Landén, Johan Lundberg, Pia Nordanskog, Axel Nordenskjöld
BACKGROUND: Electroconvulsive therapy (ECT) is effective in bipolar depression, but relapse is common. The aim of the study was (i) to identify prognostic factors (ii) and to determine the impact of pharmacological approaches on the risk for rehospitalization or suicide. METHODS: This register study analyzed data from individuals treated with inpatient ECT for bipolar depression. Subjects were identified using the Swedish National Patient Register between 2011 and 2014 and the Swedish National Quality Register for ECT...
September 25, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/28968966/early-postoperative-radiotherapy-is-associated-with-improved-outcomes-over-late-postoperative-radiotherapy-in-the-management-of-completely-resected-r0-stage-iiia-n2-non-small-cell-lung-cancer
#12
Huan-Huan Wang, Lei Deng, Qing-Lian Wen, Chun-Ze Zhang, Nicholas G Zaorsky, Bai-Lin Zhang, Jie Chen, Xian-Liang Zeng, Yao-Li Cui, Yang-Yang Shi, Hai-Ling Hou, Wei Wang, Bo Jiang, Jun Wang, Qing-Song Pang, Lu-Jun Zhao, Zhi-Yong Yuan, Ping Wang, Mao-Bin Meng
AIMS: The aim of this study was to evaluate the ideal timing of PORT in the management of completely resected (R0) Stage IIIA-N2 NSCLC. PATIENTS AND METHODS: Between January 2008 and December 2015, patients with known histologies of pathologic Stage IIIA-N2 NSCLC who underwent R0 resection and received PORT concurrent with or prior to two sequential cycles of chemotherapy ("early PORT") or with PORT administered after two cycles of chemotherapy ("late PORT") at multiple hospitals...
September 8, 2017: Oncotarget
https://www.readbyqxmd.com/read/28966158/hybrid-transcatheter-left-ventricular-reconstruction-for-the-treatment-of-ischemic-cardiomyopathy
#13
Carlo Zivelonghi, Patrick Klein, Martin J Swaans, Pierfrancesco Agostoni
AIMS: Treatment of advanced ischemic cardiomyopathy is often challenging, with recurrent episodes of cardiac decompensation and consequent need for multiple hospitalizations. Mixed outcomes have been previously reported after conventional surgical left ventricle(LV) reconstruction. Aim of this report is to describe a novel hybrid transcatheter technique to reconstruct the remodeled LV. METHODS AND RESULTS: In this manuscript, we provide a detailed step-by-step description of a novel procedure, called Less Invasive Ventricular Enhancement(LIVE), which reconstructs the remodeled LV by plication of anteroseptal LV scar, thus reducing the enlarged volume, decreasing wall stress and increasing ejection fraction...
October 3, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28962566/-i-stayed-with-my-illness-a-grounded-theory-study-of-health-seeking-behaviour-and-treatment-pathways-of-patients-with-obstetric-fistula-in-kenya
#14
Anne M Khisa, Grace M Omoni, Isaac K Nyamongo, Rachel F Spitzer
BACKGROUND: Obstetric fistula classic symptoms of faecal and urinary incontinence cause women to live with social stigma, isolation, psychological trauma and lose their source of livelihoods. There is a paucity of studies on the health seeking behaviour trajectories of women with fistula illness although women live with the illness for decades before surgery. We set out to establish the complete picture of women's health seeking behaviour using qualitative research. We sought to answer the question: what patterns of health seeking do women with obstetric fistula display in their quest for healing? METHODS: We used grounded theory methodology to analyse data from narratives of women during inpatient stay after fistula surgery in 3 hospitals in Kenya...
September 29, 2017: BMC Women's Health
https://www.readbyqxmd.com/read/28961888/multiclonal-emergence-of-levofloxacin-resistant-group-b-streptococcus-taiwan
#15
Chi-Jung Wu, Jui-Fen Lai, I-Wen Huang, Li-Yun Hsieh, Hui-Ying Wang, Yih-Ru Shiau, Tsai-Ling Lauderdale
Objectives: This study investigated the trend in antimicrobial resistance among group B Streptococcus (GBS) from a national surveillance programme in Taiwan and delineated characteristics of and factors associated with levofloxacin-resistant isolates. Methods: Clinical isolates of all sample types and patient groups were collected from multiple hospitals biennially between 2002 and 2012. Susceptibilities to different antibiotics were determined by broth microdilution...
September 6, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/28952874/is-the-level-of-education-associated-with-transitions-between-care-settings-in-older-adults-near-the-end-of-life-a-nationwide-retrospective-cohort-study
#16
Susanne Kelfve, Jonas Wastesson, Stefan Fors, Kristina Johnell, Lucas Morin
BACKGROUND: End-of-life transitions between care settings can be burdensome for older adults and their relatives. AIM: To analyze the association between the level of education of older adults and their likelihood to experience care transitions during the final months before death. DESIGN: Nationwide, retrospective cohort study using register data. SETTING/PARTICIPANTS: Older adults (⩾65 years) who died in Sweden in 2013 ( n = 75,722)...
September 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28946105/risk-of-drug-resistance-in-repeat-gram-negative-infections-among-patients-with-multiple-hospitalizations
#17
Mansi Agarwal, Elaine L Larson
PURPOSE: Drug resistance in gram-negative bacterial hospital-acquired infections (GNB HAIs) has become ubiquitous in recent years. Patients who experience multiple hospitalizations are at high risk of developing repeat GNB HAIs. This study aims to evaluate the relationship between repeat GNB HAIs and antibiotic susceptibility patterns. METHODS: Using electronic medical records from three hospitals, 4053 patients were identified with at least one HAI caused by K...
September 18, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28903802/can-national-healthcare-associated-infections-hais-data-differentiate-hospitals-in-the-united-states
#18
Max Masnick, Daniel J Morgan, John D Sorkin, Mark D Macek, Jessica P Brown, Penny Rheingans, Anthony D Harris
OBJECTIVE To determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website (http://medicare.gov/hospitalcompare) can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals. DESIGN Secondary analysis of publicly available HAI data for calendar year 2013. METHODS We assessed the availability of HAI data for geographically proximate hospitals (ie, hospitals within the same referral region) and then analyzed these data to determine whether they are useful to differentiate hospitals...
October 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28900499/profiling-chemotherapy-associated-myelotoxicity-among-chinese-gastric-cancer-population-receiving-cytotoxic-conventional-regimens-epidemiological-features-timing-predictors-and-clinical-impacts
#19
Ci Zhu, Yan Wang, Xicheng Wang, Chunmei Bai, Dan Su, Bing Cao, Jianming Xu
Objectives: We aim to evaluate the epidemiological features, timing, predictors and clinical impacts of chemotherapy-associated myelotoxicity in Chinese gastric cancer population receiving six established cytotoxic conventional regimens (CF/XP, EC(O)F/EC(O)X, DC(O)F/DC(O)X, PC(O)F/PC(O)X, FOLFOX4, or mFOLFOX7/XELOX). Patients and methods: A 4-year multicenter, prospective, observational study was conducted in multiple hospitals/institutes spanning three major regions in China. A total of 1,285 patients with gastric cancer, treated with six selected regimens between 2010 and 2014 were included...
2017: Journal of Cancer
https://www.readbyqxmd.com/read/28894838/recurrent-respiratory-papillomatosis-rrp-time-for-a-reckoning
#20
Peter Kin Cho Goon, Lars-Uwe Scholtz, Holger Sudhoff
OBJECTIVES: Recurrent respiratory papillomatosis (RRP) is a rare disease, but one with severe morbidity and occasional mortality. The aetiological agent is human papillomavirus (HPV), and HPV types 6 and 11 account for over 90% of all cases. In the active phase of the disease, patients require multiple hospital admissions for surgical removal or ablation of these benign tumors, which are likely to obstruct the airways if left unchecked. Long-term sequelae include scarring of the vocal cords, change in voice timbre, or even muteness if a tracheostomy is required...
August 2017: Laryngoscope Investigative Otolaryngology
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