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https://www.readbyqxmd.com/read/28918412/prediction-of-early-unplanned-intensive-care-unit-readmission-in-a-uk-tertiary-care-hospital-a-cross-sectional-machine-learning-approach
#1
Thomas Desautels, Ritankar Das, Jacob Calvert, Monica Trivedi, Charlotte Summers, David J Wales, Ari Ercole
OBJECTIVES: Unplanned readmissions to the intensive care unit (ICU) are highly undesirable, increasing variance in care, making resource planning difficult and potentially increasing length of stay and mortality in some settings. Identifying patients who are likely to suffer unplanned ICU readmission could reduce the frequency of this adverse event. SETTING: A single academic, tertiary care hospital in the UK. PARTICIPANTS: A set of 3326 ICU episodes collected between October 2014 and August 2016...
September 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/28918198/are-we-missing-hypoglycaemia-elderly-patients-with-insulin-treated-diabetes-present-to-primary-care-frequently-with-non-specific-symptoms-associated-with-hypoglycaemia
#2
Suzy V Hope, Phil J Taylor, Beverley M Shields, Andrew T Hattersley, Willie Hamilton
INTRODUCTION: We assessed if patients with known hypoglycaemia present on other occasions with non-specific symptoms associated with (but not diagnosed as) hypoglycaemia, potentially representing missed hypoglycaemia. METHODS: 335 primary care records (5/2/12-4/2/13) from patients aged >65 (79 on insulin, 85 on sulphonylureas, 121 on metformin only, 50 without diabetes) were assessed for hypoglycaemia episodes and consultations with non-specific symptoms, "hypo clues"...
September 11, 2017: Primary Care Diabetes
https://www.readbyqxmd.com/read/28915106/making-sense-of-a-haemolysis-monitoring-and-reporting-system-a-nationwide-longitudinal-multimethod-study-of-68-australian-laboratory-participant-organisations
#3
Ling Li, Elia Vecellio, Stephanie Gay, Rebecca Lake, Mark Mackay, Leslie Burnett, Douglas Chesher, Stephen Braye, Tony Badrick, Johanna I Westbrook, Andrew Georgiou
BACKGROUND: The key incident monitoring and management systems (KIMMS) quality assurance program monitors incidents in the pre- and postanalytical phases of testing in medical laboratories. Haemolysed specimens have been found to be the most frequent preanalytical error and have major implications for patient care. The aims of this study were to assess the suitability of KIMMS for quality reporting of haemolysis and to devise a meaningful method for reporting and monitoring haemolysis...
September 15, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28914955/alcohol-related-mortality-in-patients-with-psoriasis-a-population-based-cohort-study
#4
Rosa Parisi, Roger T Webb, Matthew J Carr, Kieran J Moriarty, C Elise Kleyn, Christopher E M Griffiths, Darren M Ashcroft
Importance: People diagnosed with psoriasis have an increased risk of premature mortality, but the underlying reasons for this mortality gap are unclear. Objective: To investigate whether patients with psoriasis have an elevated risk of alcohol-related mortality. Design, Setting, and Participants: An incident cohort of patients with psoriasis aged 18 years and older was delineated for 1998 through 2014 using the Clinical Practice Research Datalink (CPRD) and linked to Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality records...
September 15, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/28914555/evaluation-of-the-quality-of-care-of-elderly-patients-with-chronic-and-breakthrough-pain-treated-with-opioids-sand-study
#5
Manuel Jesús Rodríguez, Rosalía de la Torre, Josefa Luisa Ortega, José Manuel Trinidad, Diego Benítez, Antonio Javier Jiménez, Almudena Sanz-Yagüe, Begoña Soler, Luis Miguel Torres
OBJECTIVE: The objective of this study was to evaluate the quality of care of elderly patients with treatment for chronic pain (CP) and breakthrough pain (BTP). METHODS: A cross-sectional observational study was conducted in 20 pain units, selecting patients aged 70 years or older with baseline controlled CP in treatment with opioids and a diagnosis of BTP. Patients were classified as first episode of BTP or patient in follow-up. The patients completed the SF-12 quality of life questionnaire, Brief Pain Inventory, Lattinen Index, and Edmonton Symptoms Assessment Scale...
September 15, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28913755/management-and-clinical-outcome-of-stable-coronary-artery-disease-in-austria-results-from-5%C3%A2-years-of-the-clarify-registry
#6
Irene M Lang, Roza Badr-Eslam, Nicola Greenlaw, Robin Young, Philippe Gabriel Steg
BACKGROUND: The population of patients with established coronary artery disease (CAD) is growing because of an improvement in outcomes and survival from acute disease episodes. Nevertheless, these patients remain at high risk of cardiovascular events. Thus, CAD management is important in prevention of disease progression. The objective of this analysis was to describe disease management and clinical outcome of Austrian outpatients with stable CAD over 5 years by using data from the international CLARIFY registry...
September 14, 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28913487/perioperative-surgical-home-meeting-tomorrow-s-challenges
#7
REVIEW
Teodora O Nicolescu
New healthcare models pose a variety of changes for anesthesiologists, ranging from the need to improve quality and to cost containment: as such, the concept of Perioperative Surgical Home (PSH) has been developed. Modelled after the UK's Enhanced Recovery After Surgery (ERAS), PSH takes a step further by coordinating care starting from the time a surgical decision is made for the patient to as many as 30 days postoperatively, taking a logical evidenced-based approach to judicious preoperative testing. Perioperative surgical home also relies heavily on engineering imported strategies such as the use of Lean Six Sigma methodologies, and involves active participation of all stakeholders...
October 2016: Rom J Anaesth Intensive Care
https://www.readbyqxmd.com/read/28912948/outbreak-of-fusarium-oxysporum-infections-in-children-with-cancer-an-experience-with-7-episodes-of-catheter-related-fungemia
#8
Fabianne Carlesse, Anna-Paula C Amaral, Sarah S Gonçalves, Hemilio Xafranski, Maria-Lucia M Lee, Victor Zecchin, Antonio S Petrilli, Abdullah M Al-Hatmi, Ferry Hagen, Jacques F Meis, Arnaldo L Colombo
BACKGROUND: Fusarium species are widely spread in nature as plant pathogens but are also able to cause opportunistic fungal infections in humans. We report a cluster of Fusarium oxysporum bloodstream infections in a single pediatric cancer center. METHODS: All clinical and epidemiological data related to an outbreak involving seven cases of fungemia by Fusarium oxysporum during October 2013 and February 2014 were analysed. All cultured isolates (n = 14) were identified to species level by sequencing of the TEF1 and RPB2 genes...
2017: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/28912916/acute-liver-failure-in-a-patient-travelling-from-asia-the-other-face-of-the-coin-of-infectious-disease
#9
Balen Abdulrahman, Mohamed H Ahmed, John Ramage
We present a case of a 63-year-old male who had travelled from South India to United Kingdom (UK) visiting relatives. He had developed episodes of diarrhea, vomiting and fevers while travelling and on assessment in hospital, mild abdominal distension was noted with rapid deterioration to hypovolemic shock. Initial blood test showed a low platelet count with deranged liver function tests (LFTs). It was noted that during admission to intensive care unit (ICU), blood continued to ooze from a previous surgical laparoscopy wound, central and arterial line access sites...
August 2017: Gastroenterology Research
https://www.readbyqxmd.com/read/28911335/mammary-phyllodes-tumor-with-six-episodes-of-a-relapse-a-case-report
#10
Nozomi Iimori, Shinichiro Kashiwagi, Tetsuro Ishikawa, Hidemi Kawajiri, Tsutomu Takashima, Masahiko Ohsawa, Kosei Hirakawa, Masaichi Ohira
BACKGROUND: Phyllodes tumor is a rare breast mass. Most phyllodes tumors are benign, but occasionally some show malignancy. Even if the tumors are benign, they can easily show recurrence. CASE PRESENTATION: We report a case of a 48-year-old Asian woman, who had previously undergone a tumorectomy of her left breast 12 years before, with a pathological diagnosis of fibroadenoma. Five years after the initial tumorectomy, the patient presented with an abnormally enlarged left breast...
September 15, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28906137/treatment-of-achromobacter-ventilator-associated-pneumonia-in-critically-ill-trauma-patients
#11
G Christopher Wood, Brittany L Jonap, George O Maish, Louis J Magnotti, Joseph M Swanson, Bradley A Boucher, Martin A Croce, Timothy C Fabian
BACKGROUND: Achromobacter sp are nonfermenting Gram-negative bacilli (NFGNB) that rarely cause severe infections, including ventilator-associated pneumonia (VAP). Data on the treatment of Achromobacter pneumonia are very limited, and the organism has been associated with a high mortality rate. Thus, more data are needed on treating this organism. OBJECTIVE: To evaluate the treatment of Achromobacter VAP in critically ill trauma patients. METHODS: This retrospective, observational study evaluated critically ill trauma patients who developed Achromobacter VAP...
September 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28900245/the-role-of-metronomic-capecitabine-for-treatment-of-recurrent-hepatocellular-carcinoma-after-liver-transplantation
#12
Matteo Ravaioli, Alessandro Cucchetti, Antonio Daniele Pinna, Vanessa De Pace, Flavia Neri, Maria Aurelia Barbera, Lorenzo Maroni, Giorgio Frega, Andrea Palloni, Stefania De Lorenzo, Maria Cristina Ripoli, Maria Abbondanza Pantaleo, Matteo Cescon, Massimo Del Gaudio, Giovanni Brandi
The management of recurrent hepatocellular carcinoma untreatable with surgical options is based on systemic therapy with sorafenib. Due to the high rates of adverse events connected to the therapy with sorafenib, metronomic capecitabine seems a promising strategy for these patients. We analyzed the data of 38 patients with hepatocellular carcinoma recurrent after liver transplantation performed at our center. We compared the outcome of 17 patients receiving metronomic capecitabine versus 20 patients experiencing best supportive care and versus the data of the literature about treatment with sorafenib...
September 12, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28899844/a-new-lipid-formulation-of-low-dose-ibuprofen-shows-non-inferiority-to-high-dose-standard-ibuprofen-the-flare-study-flaring-arthralgia-relief-evaluation-in-episodic-flaring-knee-pain-a-randomised-double-blind-study
#13
Sita Ma Bierma-Zeinstra, John Brew, Karen Stoner, Rosamund Wilson, Anthony Kilbourn, Philip G Conaghan
OBJECTIVE: To investigate short-term efficacy and safety of a novel lipid ibuprofen formulation 1200mg/day compared with standard ibuprofen 1200mg/day and 2400mg/day in episodic knee arthralgia/flaring pain. DESIGN: Multicentre, randomised, double-blind, 3-arm, non-inferiority trial conducted at 27 primary care centres. Adults with ≥1 knee flare episode within 12 months were recruited within 24 hours of new flare with pain severity ≥5 on a 0-10 numerical rating scale (NRS)...
September 9, 2017: Osteoarthritis and Cartilage
https://www.readbyqxmd.com/read/28899610/nosocomial-acquired-and-community-onset-clostridium-difficile-infection-at-an-academic-hospital-in-italy-epidemiology-recurrences-and-toxin-genes-distribution
#14
Valeria Visconti, Grazia Brunetti, Maria Rosaria Cuomo, Alessandra Giordano, Giammarco Raponi
Toxinogenic Clostridium difficile infection (CDI) is a leading cause of infectious diarrhea. In this retrospective cohort study the molecular epidemiology of hospital-acquired and community-associated CDI was investigated in patients admitted to a tertiary care hospital. CD in stools samples was revealed by a two steps diagnostic algorithm, firstly screening for positivity to GDH antigen and thereafter RT-PCR analysis. Increased CDI incidence was observed ranging from 1.70episodes/10000patient-days in the 1st year, to 2...
September 9, 2017: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
https://www.readbyqxmd.com/read/28898807/social-functioning-in-individuals-with-first-episode-psychosis-one-year-follow-up-study
#15
Vijaya Raghavan, Mangala Ramamurthy, Thara Rangaswamy
BACKGROUND: Improvement in social functioning is important for recovery in first episode psychosis (FEP). METHODOLOGY: 51 individuals diagnosed with first episode psychosis were assessed for social functioning at baseline and one year follow-up. RESULTS: Significant improvement was seen in certain domains of social functioning measured by LSP scale such as communication and non-turbulence while no significant changes were observed in self-care and social contact...
September 6, 2017: Asian Journal of Psychiatry
https://www.readbyqxmd.com/read/28898283/sustained-effectiveness-and-cost-effectiveness-of-the-healthy-activity-programme-a-brief-psychological-treatment-for-depression-delivered-by-lay-counsellors-in-primary-care-12-month-follow-up-of-a-randomised-controlled-trial
#16
Benedict Weobong, Helen A Weiss, David McDaid, Daisy R Singla, Steven D Hollon, Abhijit Nadkarni, A-La Park, Bhargav Bhat, Basavraj Katti, Arpita Anand, Sona Dimidjian, Ricardo Araya, Michael King, Lakshmi Vijayakumar, G Terence Wilson, Richard Velleman, Betty R Kirkwood, Christopher G Fairburn, Vikram Patel
BACKGROUND: The Healthy Activity Programme (HAP), a brief behavioural intervention delivered by lay counsellors, enhanced remission over 3 months among primary care attendees with depression in peri-urban and rural settings in India. We evaluated the sustainability of the effects after treatment termination, the cost-effectiveness of HAP over 12 months, and the effects of the hypothesized mediator of activation on clinical outcomes. METHODS AND FINDINGS: Primary care attendees aged 18-65 years screened with moderately severe to severe depression on the Patient Health Questionnaire 9 (PHQ-9) were randomised to either HAP plus enhanced usual care (EUC) (n = 247) or EUC alone (n = 248), of whom 95% completed assessments at 3 months, and 91% at 12 months...
September 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28895277/evaluation-of-a-fever-management-algorithm-in-a-pediatric-cancer-center-in-a-low-resource-setting
#17
Sheena Mukkada, Cristel Kate Smith, Delta Aguilar, April Sykes, Li Tang, Mae Dolendo, Miguela A Caniza
BACKGROUND: In low- and middle-income countries (LMICs), inconsistent or delayed management of fever contributes to poor outcomes among pediatric patients with cancer. We hypothesized that standardizing practice with a clinical algorithm adapted to local resources would improve outcomes. Therefore, we developed a resource-specific algorithm for fever management in Davao City, Philippines. The primary objective of this study was to evaluate adherence to the algorithm. PROCEDURE: This was a prospective cohort study of algorithm adherence to assess the types of deviation, reasons for deviation, and pathogens isolated...
September 12, 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28893756/the-incidence-and-healthcare-costs-of-persistent-postoperative-pain-following-lumbar-spine-surgery-in-the-uk-a-cohort-study-using-the-clinical-practice-research-datalink-cprd-and-hospital-episode-statistics-hes
#18
Sharada Weir, Mihail Samnaliev, Tzu-Chun Kuo, Caitriona Ni Choitir, Travis S Tierney, David Cumming, Julie Bruce, Andrea Manca, Rod S Taylor, Sam Eldabe
OBJECTIVE: To characterise incidence and healthcare costs associated with persistent postoperative pain (PPP) following lumbar surgery. DESIGN: Retrospective, population-based cohort study. SETTING: Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases. PARTICIPANTS: Population-based cohort of 10 216 adults who underwent lumbar surgery in England from 1997/1998 through 2011/2012 and had at least 1 year of presurgery data and 2 years of postoperative follow-up data in the linked CPRD-HES...
September 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28893219/a-case-of-a-four-year-old-child-adopted-at-eight-months-with-unusual-mood-patterns-and-significant-polypharmacy
#19
Magdalena Romanowicz, Alastair J McKean, Jennifer Vande Voort
BACKGROUND: Long-term effects of neglect in early life are still widely unknown. Diversity of outcomes can be explained by differences in genetic risk, epigenetics, prenatal factors, exposure to stress and/or substances, and parent-child interactions. Very common sub-threshold presentations of children with history of early trauma are challenging not only to diagnose but also in treatment. CASE PRESENTATION: A Caucasian 4-year-old, adopted at 8 months, male patient with early history of neglect presented to pediatrician with symptoms of behavioral dyscontrol, emotional dysregulation, anxiety, hyperactivity and inattention, obsessions with food, and attachment issues...
September 11, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28892731/a-new-integrated-care-pathway-for-ambulance-attended-severe-hypoglycaemia-in-the-east-of-england-the-eastern-academic-health-science-network-eahsn-model
#20
Michael Sampson, Marcus Bailey, John Clark, Mark L Evans, Rebekah Fong, Helen Hall, Clare Hambling, Martin Hadley-Brown, Nick Morrish, Helen Murphy, Gerry A Rayman, Karunakaran Vithian, Peter Winocour, Amanda Harries
AIMS: We developed a new clinical integrated pathway linking a regional Ambulance Trust with a severe hypoglycaemia (SH) prevention team. We present clinical data from the first 2000 emergency calls taken through this new clinical pathway in the East of England. METHODS: SH patients attended by Ambulance crew receive written information on SH avoidance, and are contacted for further education through a new regional SH prevention team. All patients are contacted unless they actively decline...
September 1, 2017: Diabetes Research and Clinical Practice
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