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https://www.readbyqxmd.com/read/28437795/effect-of-using-the-heart-score-in-patients-with-chest-pain-in-the-emergency-department-a-stepped-wedge-cluster-randomized-trial
#1
Judith M Poldervaart, Johannes B Reitsma, Barbra E Backus, Hendrik Koffijberg, Rolf F Veldkamp, Monique E Ten Haaf, Yolande Appelman, Herman F J Mannaerts, Jan-Melle van Dantzig, Madelon van den Heuvel, Mohamed El Farissi, Bernard J W M Rensing, Nicolette M S K J Ernst, Ineke M C Dekker, Frank R den Hartog, Thomas Oosterhof, Ghizelda R Lagerweij, Eugene M Buijs, Maarten W J van Hessen, Marcel A J Landman, Roland R J van Kimmenade, Luc Cozijnsen, Jeroen J J Bucx, Clara E E van Ofwegen-Hanekamp, Maarten-Jan Cramer, A Jacob Six, Pieter A Doevendans, Arno W Hoes
Background: The HEART (History, Electrocardiogram, Age, Risk factors, and initial Troponin) score is an easy-to-apply instrument to stratify patients with chest pain according to their short-term risk for major adverse cardiac events (MACEs), but its effect on daily practice is unknown. Objective: To measure the effect of use of the HEART score on patient outcomes and use of health care resources. Design: Stepped-wedge, cluster randomized trial...
April 25, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28437506/treatment-of-unstable-trochanteric-femur-fractures-proximal-femur-nail-versus-proximal-femur-locking-compression-plate
#2
Ashutosh Kumar Singh, Nidi Narsaria, Arun G R, Vivek Srivastava
Unstable trochanteric femur fractures are common fractures that are difficult to manage. We conducted a prospective study to compare functional outcomes and complications of 2 different implant designs, proximal femur nail (PFN) and proximal femur locking compression plate (PFLCP), used in internal fixation of unstable trochanteric femur fractures. On hospital admission, 48 patients with unstable trochanteric fractures were randomly assigned (using a sealed envelope method) to treatment with either PFN (24 patients) or PFLCP (24 patients)...
March 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28437459/management-and-outcomes-of-severe-dengue-patients-presenting-with-sepsis-in-a-tropical-country
#3
Prapit Teparrukkul, Viriya Hantrakun, Nicholas P J Day, T Eoin West, Direk Limmathurotsakul
BACKGROUND: Dengue is a common cause of infection in adults in tropical countries. Sepsis is a syndrome of systemic manifestations induced by infection of any organisms; including bacterial, fungal and viral agents. Here, we investigated the diagnosis, management and outcomes of dengue patients presenting with sepsis in a prospective study of community-acquired sepsis in Thailand. METHODS: From June to December 2015, 874 adult patients (age≥18 years) with suspected or documented community-acquired infection, with ≥3 diagnostic criteria for sepsis according to the Surviving Sepsis Campaign 2012, and within 24 hours of admission were evaluated...
2017: PloS One
https://www.readbyqxmd.com/read/28437320/development-of-a-claims-based-frailty-indicator-anchored-to-a-well-established-frailty-phenotype
#4
Jodi B Segal, Hsien-Yen Chang, Yu Du, Jeremy D Walston, Michelle C Carlson, Ravi Varadhan
BACKGROUND: Fried and colleagues described a frailty phenotype measured in the Cardiovascular Health Study (CHS). This phenotype is manifest when ≥3 of the following are present: low grip strength, low energy, slowed waking speed, low physical activity, or unintentional weight loss. We sought to approximate frailty phenotype using only administrative claims data to enable frailty to be assessed without physical performance measures. STUDY DESIGN: We used the CHS cohort data linked to participants Medicare claims...
April 21, 2017: Medical Care
https://www.readbyqxmd.com/read/28437317/dementia-comorbidity-and-physical-function-in-the-program-of-all-inclusive-care-for-the-elderly
#5
Jason R Falvey, Allison M Gustavson, Lisa Price, Lucine Papazian, Jennifer E Stevens-Lapsley
BACKGROUND: Participants in the Program of All-Inclusive Care for the Elderly (PACE) are a unique clinical population of medically complex and highly disabled older adults who qualify for nursing home level care but receive services in the community. A main goal of PACE programs is to prevent further declines in physical function that may necessitate costly institutionalization. This study evaluates how multimorbidity and dementia impact both self-selected gait speed and Timed Up and Go (TUG) in this population...
April 21, 2017: Journal of Geriatric Physical Therapy
https://www.readbyqxmd.com/read/28437232/epidemiological-physiological-and-molecular-characteristics-of-a-brazilian-collection-of-carbapenem-resistant-acinetobacter-baumannii-and-pseudomonas-aeruginosa
#6
Vanessa Cordeiro Dias, Juliana Alves Resende, André Netto Bastos, Lucas Quinet De Andrade Bastos, Victor Quinet De Andrade Bastos, Ricardo Villela Bastos, Cláudio Galuppo Diniz, Vânia Lúcia Da Silva
Nonfermenting Gram-negative bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii are widespread in the environment and are increasingly associated with nosocomial infections, often associated with multidrug-resistance phenotypes. This study aimed to evaluate epidemiological, physiological, and molecular characteristics of carbapenem resistance in P. aeruginosa and A. baumannii. In total, 63 nonreplicated strains (44 A. baumannii and 19 P. aeruginosa) were isolated from hospitalized patients. Antimicrobial resistance patterns, biocide tolerance, oxidative stress, hemolytic activity, and biofilm formation were assessed...
February 24, 2017: Microbial Drug Resistance: MDR: Mechanisms, Epidemiology, and Disease
https://www.readbyqxmd.com/read/28437209/conversations-about-goals-and-values-are-feasible-and-acceptable-in-long-term-acute-care-hospitals-a-pilot-study
#7
Daniela J Lamas, Robert L Owens, R Nicholas Nace, Anthony F Massaro, Nathan J Pertsch, Susan T Moore, Rachelle E Bernacki, Susan D Block
RATIONALE: The chronically critically ill have survived acute critical illness but require prolonged mechanical ventilation. These patients are frequently transferred from acute care to long-term acute care hospitals (LTACHs) for prolonged recovery, yet many suffer setbacks requiring readmission to acute care. The patient's relatively improved condition while at the LTACH might be an opportunity for communication regarding care goals; however, there have been no prior studies of the feasibility of such conversations in the LTACH...
February 24, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28437204/drainage-percutaneous-endoscopic-gastrostomy-for-malignant-bowel-obstruction-in-gastrointestinal-cancers-prognosis-and-implications-for-timing-of-palliative-intervention
#8
Kerry-Ann Pinard, Tabitha N Goring, Barbara C Egan, Douglas J Koo
BACKGROUND: Malignant bowel obstruction (MBO) is a frequent complication in patients with advanced solid tumors. Palliative relief may be achieved by the use of a drainage percutaneous endoscopic gastrostomy (dPEG) tube, although optimal timing of placement remains unknown. OBJECTIVES: To determine median survival after diagnosis of MBO and dPEG placement, factors associated with worse survival in MBO, factors associated with receipt of dPEG, and association of timing of dPEG placement on survival...
February 16, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28437201/the-impact-of-community-based-palliative-care-on-utilization-and-cost-of-acute-care-hospital-services-in-the-last-year-of-life
#9
David Youens, Rachael Moorin
BACKGROUND: Community-based palliative care may potentially benefit patients by offering their preferred care at the end of life and benefit systems by reducing hospital use. OBJECTIVE: To compare place of death and acute care hospital use in the last year of life between cancer decedents who did and did not access a community-based palliative care service (PCS). DESIGN: Retrospective observational cohort study using linked individual administrative records from cancer registry, hospital, emergency department (ED), mortality, and PCS databases...
February 16, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28436733/social-and-hospital-costs-of-patients-admitted-to-a-university-hospital-in-brazil-due-to-motorcycle-crashes
#10
Katia Campos Dos Anjos, Marcelo Rosa de Rezende, Rames Mattar Júnior
OBJECTIVE: The present study aimed to investigate the social and hospital costs of patients treated at a public hospital who were motorcycle crash victims. METHOD: This prospective study was on 68 motorcycle riders (drivers or passengers), who were followed up from hospital admission to six months after the crash. A questionnaire covering quantitative and qualitative questions was administered. RESULTS: Motorcycle crash victims were responsible for 12% of the institution's hospital admissions; 54...
February 13, 2017: Traffic Injury Prevention
https://www.readbyqxmd.com/read/28436579/infection-related-mortality-in-hispanic-and-non-hispanic-children-with-cancer
#11
Rochelle R Smits-Seemann, Jacob Pettit, Hongyan Li, Anne C Kirchhoff, Mark N Fluchel
BACKGROUND: Hispanic children with cancer experience poorer survival than their White counterparts. Infection is a known cause of cancer-related mortality; however, little is known about the risk of infection-related death among Hispanic children with cancer. We examine the association of Hispanic ethnicity with infection-related mortality and life-threatening events among children with cancer. PROCEDURE: For a cohort of all pediatric cancer patients diagnosed from 1986 to 2012 and treated at a single tertiary care center, we obtained national death records to determine all-cause mortality and infection-related mortality, as well as intensive care unit (ICU) admissions as a surrogate for life-threatening events...
April 24, 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28436569/association-of-waist-circumference-with-outcomes-in-an-acute-general-surgical-unit
#12
Thomas Ryan, Preet Gosal, Alexa Seal, Joe McGirr, Nicholas Williams
BACKGROUND: Obesity prevalence is increasing in Australia, particularly in non-metropolitan areas. The effect of obesity on acute surgical outcomes is not known. We aimed to record waist circumference (WC) (surrogate for obesity) amongst acute surgical unit (ASU) patients in a New South Wales regional hospital, and compare outcome measures (length of stay (LOS), unplanned return to theatre, readmission rates, intensive care unit (ICU) admission and mortality). METHODS: Retrospective cohort study of 4 months of consecutive ASU admissions, excluding age <16, pregnancy, out-of-area transfer and incomplete data...
April 24, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28436194/impact-of-living-arrangements-on-clinical-outcomes-among-older-patients-with-dementia-or-cognitive-impairment-admitted-to-the-geriatric-evaluation-and-management-unit-in-taiwan
#13
Cheng-Hao Hung, Ting-Ching Tang, Chih-Jen Wang, Li-Kuo Liu, Li-Ning Peng, Liang-Kung Chen
AIM: To evaluate the impact of living arrangements on mortality and functional decline among older patients with dementia or cognitive impairment after discharge from a geriatric evaluation and management unit (GEMU) in Taiwan. METHODS: The present retrospective cohort study used data from the Veteran Affairs Comprehensive Geriatric Assessment from January 2015 to May 2016 for analysis. Data of patients aged 65 years and older with dementia or cognitive impairment at admission to the GEMU of Taipei Veterans General Hospital during the study period were retried for study...
April 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28436191/hospitalization-and-associated-factors-in-people-with-alzheimer-s-disease-residing-in-a-long-term-care-facility-in-southern-taiwan
#14
Chu-Sheng Lin, Shih-Yi Lin, Ming-Yueh Chou, Liang-Yu Chen, Kuei-Yu Wang, Liang-Kung Chen, Yu-Te Lin, Ching-Hui Loh
AIM: It has been reported that many people with dementia require hospitalizations. The objective of the present study was to determine predictive factors for hospitalizations in people with dementia. METHODS: A total of 70 individuals with dementia living in a veterans' home in southern Taiwan were consecutively enrolled. During prospective follow up, all hospitalization events were recorded. RESULTS: The mean age of residents with dementia was 86...
April 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28436125/the-quipp-app-a-safe-alternative-to-a-treat-all-strategy-for-threatened-preterm-labour
#15
Helena A Watson, Jenny Carter, Paul T Seed, Rachel M Tribe, Andrew H Shennan
OBJECTIVES: To evaluate the impact of a treat-all policy (advocated by NICE) compared to the QUIPP app (predictive model combining history of spontaneous preterm birth gestation and quantitative fetal fibronectin) for women in threatened preterm labour at <30 weeks gestation. METHODS: We conducted a subanalysis of prospectively collected data of pregnant women presenting with symptoms of preterm labour from the EQUIPP (REC Ref. 10/H0806/68) and PETRA (REC Ref...
April 24, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28436106/therapeutic-plasma-exchange-as-part-of-multimodal-treatment-of-acquired-hemophilia-in-a-patient-with-concurrent-acute-intracerebral-bleed-and-pulmonary-embolism
#16
Geoffrey D Wool, David Chapel, Angela Treml, Jonathan L Miller
BACKGROUND: Autoantibodies against Factor VIII (FVIII) define the rare but life-threatening bleeding disorder acquired hemophilia A (AHA). Correction of FVIII deficiency and eradication of the factor inhibitor are the ultimate therapeutic goals in this disorder. Bypassing agents such as recombinant factor VIIa (rFVIIa) or FVIII inhibitor bypassing agent are often used to control coagulopathy before the inhibitor is eradicated. Bypassing agents carry a risk of thrombosis, however. CASE REPORT: We report a patient with newly diagnosed AHA and thalamic bleed who additionally had active atrial fibrillation and developed a segmental pulmonary embolism, limiting tolerable rFVIIa dosage...
April 24, 2017: Transfusion
https://www.readbyqxmd.com/read/28436086/male-clinical-norms-and-sex-differences-on-the-eating-disorder-inventory-edi-and-eating-disorder-examination-questionnaire-ede-q
#17
Kathryn E Smith, Tyler B Mason, Stuart B Murray, Scott Griffiths, Rachel C Leonard, Chad T Wetterneck, Brad E R Smith, Nicholas R Farrell, Bradley C Riemann, Jason M Lavender
OBJECTIVE: Evidence indicates that males account for a significant minority of patients with eating disorders (EDs). However, prior research has been limited by inclusion of small and predominantly non-clinical samples of males. This study aimed to (1) provide male clinical norms for widely used ED measures (Eating Disorder Examination Questionnaire [EDE-Q] and Eating Disorder Inventory-3 [EDI-3]) and (2) examine sex differences in overall ED psychopathology. METHOD: Participants were 386 male and 1,487 female patients with an ED diagnosis aged 16 years and older who completed the EDE-Q and EDI-3 upon admission to a residential or partial hospital ED treatment program...
April 24, 2017: International Journal of Eating Disorders
https://www.readbyqxmd.com/read/28435898/high-sensitivity-c-reactive-protein-albumin-ratio-as-a-predictor-of-in-hospital-mortality-in-older-adults-admitted-to-the-emergency-department
#18
Jaehun Oh, Soo Hyun Kim, Kyu Nam Park, Sang Hoon Oh, Young Min Kim, Han Joon Kim, Chun Song Youn
OBJECTIVE: The objective of this study was to test the hypothesis that an elevated high-sensitivity C-reactive protein (hs-CRP)/albumin ratio at admission increases the risk of mortality in older patients admitted to the hospital via the emergency department (ED). METHODS: We performed a retrospective analysis of patients admitted to the ED with any medical problem between May 2013 and October 2013 who were older than 65 years. The hs-CRP and albumin levels were measured at the time of admission to the ED...
March 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/28435897/association-between-lactate-clearance-during-post-resuscitation-care-and-neurologic-outcome-in-cardiac-arrest-survivors-treated-with-targeted-temperature-management
#19
Jung Chang Kim, Byung Kook Lee, Dong Hun Lee, Yong Hun Jung, Yong Soo Cho, Sung Min Lee, Seung Joon Lee, Chi Ho Park, Kyung Woon Jeung
OBJECTIVE: We investigated the association between lactate clearance or serum lactate levels and neurologic outcomes or in-hospital mortality in cardiac arrest survivors who were treated with targeted temperature management (TTM). METHODS: A retrospective analysis of data from cardiac arrest survivors treated with TTM between 2012 and 2015 was conducted. Serum lactate levels were measured on admission and at 12, 24, and 48 hours following admission. Lactate clearance at 12, 24, and 48 hours was also calculated...
March 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/28435896/association-between-persistent-tachycardia-and-tachypnea-and-in-hospital-mortality-among-non-hypotensive-emergency-department-patients-admitted-to-the-hospital
#20
Michael A Puskarich, Utsav Nandi, Ben G Long, Alan E Jones
OBJECTIVE: Vital sign trends are used in clinical practice to assess treatment response and aid in disposition, yet quantitative data to support this practice are lacking. This study aimed to determine the prognostic value of vital sign normalization. METHODS: Secondary analysis of a prospective cohort of adult emergency department (ED) patients admitted a single urban tertiary care hospital. A random sample of 182 days was chosen, and a manual review of all admissions was undertaken...
March 2017: Clinical and Experimental Emergency Medicine
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