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https://www.readbyqxmd.com/read/28637090/early-warning-systems-and-rapid-response-to-the-deteriorating-patient-in-hospital-a-realist-evaluation
#1
Jennifer Mcgaughey, Peter O'Halloran, Sam Porter, John Trinder, Bronagh Blackwood
AIM: To identify those contexts and mechanisms that enable or constrain the implementation of Rapid Response Systems on acute general hospital wards to recognise and respond to patient deterioration. BACKGROUND: Rapid Response Systems allow deteriorating patients to be recognised using Early Warning Systems, referred early via escalation protocols and managed at the bedside by competent staff. DESIGN: Realist Evaluation. METHODS: The research design was an embedded multiple case study approach of four wards in two hospitals in Northern Ireland which followed the principles of Realist Evaluation...
June 21, 2017: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/28635208/association-of-clinical-characteristics-of-patients-presenting-with-influenza-like-illness-or-severe-acute-respiratory-illness-with-development-of-acute-respiratory-distress-syndrome
#2
Muhammad Ijaz, Muhammad Jaffar Khan, Jawad Khan, Usama Usama
Clinical judgement and suspicion of influenza based on signs and symptoms of influenza-like illness and severe acute respiratory illness are critical for better patient outcome. Whether clinical characteristics of patients are associated with the development of acute respiratory distress syndrome and PCR positivity of samples was the aim of this study. We included all patients (n=37) presenting with influenza like illness (ILI) or severe acute respiratory illness (SARI) to a tertiary care hospital in northwest Pakistan during December 2015 until the end of January 2016...
May 18, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/28619959/defining-asthma-and-assessing-asthma-outcomes-using-electronic-health-record-data-a-systematic-scoping-review
#3
Mohammad A Al Sallakh, Eleftheria Vasileiou, Sarah E Rodgers, Ronan A Lyons, Aziz Sheikh, Gwyneth A Davies
There is currently no consensus on approaches to defining asthma or assessing asthma outcomes using electronic health record-derived data. We explored these approaches in the recent literature and examined the clarity of reporting.We systematically searched for asthma-related articles published between January 1, 2014 and December 31, 2015, extracted the algorithms used to identify asthma patients and assess severity, control and exacerbations, and examined how the validity of these outcomes was justified.From 113 eligible articles, we found significant heterogeneity in the algorithms used to define asthma (n=66 different algorithms), severity (n=18), control (n=9) and exacerbations (n=24)...
June 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28619065/open-issues-in-mucopolysaccharidosis-type-i-hurler
#4
REVIEW
Rossella Parini, Federica Deodato, Maja Di Rocco, Edoardo Lanino, Franco Locatelli, Chiara Messina, Attilio Rovelli, Maurizio Scarpa
Mucopolysaccharidosis I-Hurler (MPS I-H) is the most severe form of a metabolic genetic disease caused by mutations of IDUA gene encoding the lysosomal α-L-iduronidase enzyme. MPS I-H is a rare, life-threatening disease, evolving in multisystem morbidity including progressive neurological disease, upper airway obstruction, skeletal deformity and cardiomyopathy. Allogeneic hematopoietic stem cell transplantation (HSCT) is currently the gold standard for the treatment of MPS I-H in patients diagnosed and treated before 2-2...
June 15, 2017: Orphanet Journal of Rare Diseases
https://www.readbyqxmd.com/read/28618320/screening-for-potential-child-maltreatment-in-parents-of-a-newborn-baby-the-predictive-validity-of-an-instrument-for-early-identification-of-parents-at-risk-for-child-abuse-and-neglect-iparan
#5
Claudia E van der Put, Merian B R Bouwmeester-Landweer, Eleonore A Landsmeer-Beker, Jan M Wit, Friedo W Dekker, N Pieter J Kousemaker, Herman E M Baartman
For preventive purposes it is important to be able to identify families with a high risk of child maltreatment at an early stage. Therefore we developed an actuarial instrument for screening families with a newborn baby, the Instrument for identification of Parents At Risk for child Abuse and Neglect (IPARAN). The aim of this study was to assess the predictive validity of the IPARAN and to examine whether combining actuarial and clinical methods leads to an improvement of the predictive validity. We examined the predictive validity by calculating several performance indicators (i...
June 12, 2017: Child Abuse & Neglect
https://www.readbyqxmd.com/read/28612890/technology-in-rehabilitation-comparing-personalised-and-global-classification-methodologies-in-evaluating-the-squat-exercise-with-wearable-imus
#6
Martin A O'Reilly, Darragh Whelan, Tomás E Ward, Eamonn Delahunt, Brian Caulfield
BACKGROUND: The barbell squat is a popularly used lower limb rehabilitation exercise. It is also an integral exercise in injury risk screening protocols. To date athlete/patient technique has been assessed using expensive laboratory equipment or subjective clinical judgement; both of which are not without shortcomings. Inertial measurement units (IMUs) may offer a low cost solution for the objective evaluation of athlete/patient technique. However, it is not yet known if global classification techniques are effective in identifying naturally occurring, minor deviations in barbell squat technique...
June 14, 2017: Methods of Information in Medicine
https://www.readbyqxmd.com/read/28590153/is-it-acceptable-to-video-record-palliative-care-consultations-for-research-and-training-purposes-a-qualitative-interview-study-exploring-the-views-of-hospice-patients-carers-and-clinical-staff
#7
Marco Pino, Ruth Parry, Luke Feathers, Christina Faull
BACKGROUND: Research using video recordings can advance understanding of healthcare communication and improve care, but making and using video recordings carries risks. AIM: To explore views of hospice patients, carers and clinical staff about whether videoing patient-doctor consultations is acceptable for research and training purposes. DESIGN: We used semi-structured group and individual interviews to gather hospice patients, carers and clinical staff views...
February 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28580748/opioid-addiction-and-misuse-in-adult-and-adolescent-patients-with-cancer
#8
Ross Pinkerton, Janet R Hardy
In the context of a therapeutic opioid epidemic, particularly in the USA, where increasingly stringent screening for 'at risk' individuals and close monitoring of opioid prescription and use is strongly recommended, the issue of misuse within the cancer population must be addressed. Most patients with advanced cancer will have pain requiring opioid therapy at some stage during their disease course. In the majority, this will provide good pain relief with no short- or longer-term adverse sequelae. A subset will present with substance misuse issues that will influence management and prescribing practice...
June 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28579379/incorporating-patients-views-in-guideline-development-a-systematic-review-of-guidance-documents
#9
Anna Selva, Andrea Juliana Sanabria, Sandra Pequeño, Yuan Zhang, Ivan Solà, Héctor Pardo-Hernandez, Clara Selva, Holger Schünemann, Pablo Alonso-Coello
OBJECTIVE: To assess how guidance documents for developing clinical guidelines (CG) address the incorporation of patients' views in CG. STUDY DESIGN AND SETTING: Systematic review to identify the methodology provided in guidance documents for incorporating: a) patients or representatives and b) patients' views in the CG development process. The search was performed in 2017 in five databases. Two authors selected the studies and data extraction was double-checked...
June 1, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/28565738/-comparative-study-between-two-bleeding-grading-systems-of-primary-immune-thrombocytopenia
#10
S Xiao, Q Liu, M Hou
Objective: To evaluate prospectively the clinical significance of immune thrombocytopenia (ITP) bleeding scale (version 2016 of ITP bleeding scale) recommended in consensus of Chinese experts on diagnosis and treatment of adult primary immune thrombocytopenia (version 2016) by Chinese Medical Association. Methods: A total of 88 patients were assessed by ITP bleeding scale (version 2016) and ITP specific bleeding assessment tool (ITP-BAT) to analyze the association between bleeding score of ITP bleeding scale (version 2016) and platelet counts, gender, disease stage, also to evaluate interinstrument consistency between two bleeding grading systems...
May 14, 2017: Zhonghua Xue Ye Xue za Zhi, Zhonghua Xueyexue Zazhi
https://www.readbyqxmd.com/read/28560817/outcomes-of-pulmonary-arterial-hypertension-therapy-in-australia-is-monotherapy-adequate
#11
Avalon Moonen, Roger Garsia, Peter Youssef, Paul Torzillo, Tamera Corte, Christiane Boehm, Rachael Cordina, David Celermajer, Edmund Lau
BACKGROUND: In Australia, government-subsidised treatment of pulmonary arterial hypertension (PAH) is limited to monotherapy. Recent international guidelines advocate that initial combination therapy be considered for all symptomatic PAH patients. We sought to characterise "real-life" outcomes in PAH patients initiated on monotherapy. METHODS: We performed a retrospective analysis of 100 consecutive PAH patients at a single centre, who were commenced on monotherapy for PAH between 2004 and 2015...
May 31, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28554934/validity-of-the-italian-algorithm-for-the-attribution-of-neuropsychiatric-events-in-systemic-lupus-erythematosus-a-retrospective-multicentre-international-diagnostic-cohort-study
#12
Alessandra Bortoluzzi, Antonis Fanouriakis, Simone Appenzeller, Lilian Costallat, Carlo Alberto Scirè, Elana Murphy, George Bertsias, John Hanly, Marcello Govoni
OBJECTIVE: To validate the Italian algorithm of attribution of neuropsychiatric (NP) events to systemic lupus erythematosus (SLE) in an external international cohort of patients with SLE. METHODS: A retrospective cohort diagnostic accuracy design was followed. SLE patients attending three tertiary care lupus clinics, with one or more NP events, were included. The attribution algorithm, applied to the NP manifestations, considers four weighted items for each NP event: (1) time of onset of the event; (2) type of NP event (major vs minor), (3) concurrent non-SLE factors; (4) favouring factors...
May 29, 2017: BMJ Open
https://www.readbyqxmd.com/read/28551835/measurement-of-quality-of-life-and-attitudes-towards-illness-in-children-and-young-people-with-chronic-kidney-disease
#13
Jennifer Heath, Paul Norman, Martin Christian, Alan Watson
PURPOSE: Chronic kidney disease (CKD) can place restrictions upon biopsychosocial development in children; consequently, assessment of self-reported quality of life (QoL) is important in patient evaluations. This research aimed to evaluate a generic and renal-specific self-report QoL scale, assess children's attitudes towards living with CKD and propose an appropriate tool for future individual clinical use or departmental audit. METHODS: Seventy-one children (41 male, 30 female; mean age = 13...
May 27, 2017: Quality of Life Research
https://www.readbyqxmd.com/read/28545545/a-focused-ethnography-of-a-child-and-adolescent-mental-health-service-factors-relevant-to-the-implementation-of-a-depression-trial
#14
C E W Kitchen, S Lewis, P A Tiffin, P R Welsh, L Howey, D Ekers
BACKGROUND: Prior to commencing a randomised controlled trial, we conducted a focused ethnography to ensure that the trial was well suited to the proposed setting. METHODS: A six-month observation of a Child and Adolescent Mental Health Service site in the North-East of England was undertaken to observe the site procedures, staff culture and patient care pathways. During this period, documentary data were collected and interviews were conducted with key informants to provide insight into staff perceptions of the proposed trial...
May 25, 2017: Trials
https://www.readbyqxmd.com/read/28541400/identifying-frailty-in-the-emergency-department-feasibility-study
#15
Amy Elliott, Kay Phelps, Emma Regen, Simon Paul Conroy
Introduction: identifying the most at risk older people in Emergency Departments (EDs) may help guide clinical practice, and service improvement in emergency care, but little is known about how to implement such tools in practice. Methods: consensus building was used to determine the desirable characteristics of a risk stratification process, including focus groups and literature reviewing. Candidate tools were tested using clinical vignettes in semi-structured interviews with a range of clinicians working in one large ED, assessing speed of use, ease of use and agreement with clinical judgement...
May 25, 2017: Age and Ageing
https://www.readbyqxmd.com/read/28540073/viscoelastic-testing-inside-and-beyond-the-operating-room
#16
REVIEW
Liang Shen, Sheida Tabaie, Natalia Ivascu
Hemorrhage is a major contributor to morbidity and mortality during the perioperative period. Current methods of diagnosing coagulopathy have various limitations including long laboratory runtimes, lack of information on specific abnormalities of the coagulation cascade, lack of in vivo applicability, and lack of ability to guide the transfusion of blood products. Viscoelastic testing offers a promising solution to many of these problems. The two most-studied systems, thromboelastography (TEG) and rotational thromboelastometry (ROTEM), offer similar graphical and numerical representations of the initiation, formation, and lysis of clot...
April 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28535332/interventions-for-treating-anxiety-after-stroke
#17
REVIEW
Peter Knapp, C Alexia Campbell Burton, John Holmes, Jenni Murray, David Gillespie, C Elizabeth Lightbody, Caroline L Watkins, Ho-Yan Y Chun, Sharon R Lewis
BACKGROUND: Approximately 20% of stroke patients experience clinically significant levels of anxiety at some point after stroke. Physicians can treat these patients with antidepressants or other anxiety-reducing drugs, or both, or they can provide psychological therapy. This review looks at available evidence for these interventions. This is an update of the review first published in October 2011. OBJECTIVES: The primary objective was to assess the effectiveness of pharmaceutical, psychological, complementary, or alternative therapeutic interventions in treating stroke patients with anxiety disorders or symptoms...
May 23, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28532611/hijacked-evidence-based-medicine-stay-the-course-and-throw-the-pirates-overboard
#18
John P A Ioannidis
The article discusses a number of criticisms that have been raised against evidence-based medicine, such as focusing on benefits and ignoring adverse events; being interested in averages and ignoring the wide variability in individual risks and responsiveness; ignoring clinician-patient interaction and clinical judgement; leading to some sort of reductionism; and falling prey to corruption from conflicts of interest. I argue that none of these deficiencies are necessarily inherent to evidence-based medicine...
April 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/28532470/health-care-professionals-attitudes-towards-evidence-based-medicine-in-the-workers-compensation-setting-a-cohort-study
#19
Nieke A Elbers, Robin Chase, Ashley Craig, Lyn Guy, Ian A Harris, James W Middleton, Michael K Nicholas, Trudy Rebbeck, John Walsh, Simon Willcock, Keri Lockwood, Ian D Cameron
BACKGROUND: Problems may arise during the approval process of treatment after a compensable work injury, which include excess paperwork, delays in approving services, disputes, and allegations of over-servicing. This is perceived as undesirable for injured people, health care professionals and claims managers, and costly to the health care system, compensation system, workplaces and society. Introducing an Evidence Based Medicine (EBM) decision tool in the workers' compensation system could provide a partial solution, by reducing uncertainty about effective treatment...
May 22, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28521082/training-doctors-briefly-and-in-situ-to-involve-their-patients-in-making-medical-decisions-preliminary-testing-of-a-newly-developed-module
#20
Jürgen Kasper, Katrin Liethmann, Christoph Heesen, Daniel R Reissmann, Friedemann Geiger
OBJECTIVE: To carry out preliminary evaluation of a training module for doctors to enhance their ability to involve their patients in medical decision making. The training refers to the shared decision-making (SDM) communication concept. METHODS: The training module includes a comprehensive manual, a corresponding video tutorial with communication examples and a 15-minute face-to-face feedback session based on an SDM analysis of a consultation recording provided by the trainee...
May 18, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
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