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Durable medical

Mark Xavier Cicero, Travis Whitfill, Frank Overly, Janette Baird, Barbara Walsh, Jorge Yarzebski, Antonio Riera, Kathleen Adelgais, Garth D Meckler, Carl Baum, David Christopher Cone, Marc Auerbach
OBJECTIVE: Paramedics and emergency medical technicians (EMTs) triage pediatric disaster victims infrequently. The objective of this study was to measure the effect of a multiple-patient, multiple-simulation curriculum on accuracy of pediatric disaster triage (PDT). METHODS: Paramedics, paramedic students, and EMTs from three sites were enrolled. Triage accuracy was measured three times (Time 0, Time 1 [two weeks later], and Time 2 [6 months later]) during a disaster simulation, in which high and low fidelity manikins and actors portrayed 10 victims...
October 17, 2016: Prehospital Emergency Care
Francesco Nappi, Cristiano Spadaccio, Jean Louis Sablayrolles
The recent literature on transcatheter aortic valve replacement (TAVR) is shedding new light on the perspective to extend this procedure to other lower risk-category of patients, leading in fact to a potential erosion of the current guidelines. Notwithstanding the warnings provided in the literature regarding the risk of severely impairing complications, unclear survival advantage and cost-inefficiency, many observational studies, especially performed in high-volume centers, support a general drive toward the recruitment of intermediate-low risk patients in the expectation of clinical advantages versus standard surgical replacement...
October 6, 2016: JACC. Cardiovascular Interventions
Bruce L Rollman, Bea Herbeck Belnap, Sati Mazumdar, Kaleab Z Abebe, Jordan F Karp, Eric J Lenze, Herbert C Schulberg
BACKGROUND: Collaborative care for depression is more effective in improving treatment outcomes than primary care physicians' (PCPs) usual care (UC). However, few trials of collaborative care have targeted anxiety. OBJECTIVE: To examine the impact and 12-month durability of a centralized, telephone-delivered, stepped collaborative care intervention (CC) for treating anxiety disorders across a network of primary care practices. DESIGN: Randomized controlled trial with blinded outcome assessments...
October 6, 2016: Journal of General Internal Medicine
Valentina Palmieri, Massimiliano Papi, Claudio Conti, Gabriele Ciasca, Giuseppe Maulucci, Marco De Spirito
The clinical challenge that research on antibacterial coatings faces nowadays is the need of reduction of resistant bacterial infections, major source of implant rejection and repeated surgery. In order to avoid microorganisms attachment and biofilm formation, coating materials on medical devices have been developed with shortcomings represented by short-term durability and induction of new mechanisms of bacterial resistance. Graphene-based films and hydrogel could represent the next generation protective coatings due to their excellent mechanical, chemical and thermal properties, high nanoparticle adsorption and antibacterial action...
October 6, 2016: Expert Review of Medical Devices
Julian Mackay-Wiggan, Ali Jabbari, Nhan Nguyen, Jane E Cerise, Charlotte Clark, Grace Ulerio, Megan Furniss, Roger Vaughan, Angela M Christiano, Raphael Clynes
BACKGROUND. Alopecia areata (AA) is a common autoimmune disease with a lifetime risk of 1.7%; there are no FDA-approved treatments for AA. We previously identified a dominant IFN-γ transcriptional signature in cytotoxic T lymphocytes (CTLs) in human and mouse AA skin and showed that treatment with JAK inhibitors induced durable hair regrowth in mice by targeting this pathway. Here, we investigated the use of the oral JAK1/2 inhibitor ruxolitinib in the treatment of patients with moderate-to-severe AA. METHODS...
September 22, 2016: JCI Insight
Luis A Berrios
More than one-third of the US adult population and 17% of the youth are now obese, and obesity is associated with more than $147 billion a year in health care costs. Critical care nurses should understand the physiological differences and practice guidelines for patients with a body mass index greater than 30. The ABCD approach encompasses key clinical concepts in the management of critically ill obese and morbidly obese patients, including management of airways and breathing, minimizing nurses' back and other injuries, increasing awareness of bias, circulation problems, risks of decubitus ulcers and other skin breakdown, differences in drug calculations and metabolism, limitations in diagnostic equipment and imaging, diet and nutritional recommendations, and concerns with durable medical equipment...
October 2016: Critical Care Nurse
Chandler A Long, Lucas H Timmins, Panagiotis Koutakis, Traci T Goodchild, David J Lefer, Iraklis I Pipinos, George P Casale, Luke P Brewster
OBJECTIVE: Peripheral arterial disease (PAD) is a significant age-related medical condition with limited pharmacologic options. Severe PAD, termed critical limb ischemia, can lead to amputation. Skeletal muscle is the end organ most affected by PAD, leading to ischemic myopathy and debility of the patient. Currently, there are not any therapeutics to treat ischemic myopathy, and proposed biologic agents have not been optimized owing to a lack of preclinical models of PAD. Because a large animal model of ischemic myopathy may be useful in defining the optimal dosing and delivery regimens, the objective was to create and to characterize a swine model of ischemic myopathy that mimics patients with severe PAD...
September 29, 2016: Journal of Vascular Surgery
Jesús Romero-Maroto, Lidia Verdú-Verdú, Luis Gómez-Pérez, Carla Pérez-Tomás, Juan-José Pacheco-Bru, Ana López-López
BACKGROUND: Female urethral stricture is a rare condition. Different types of urethroplasty have been described. However, high quality studies are sparse. The most common technique used-the Blandy's technique-has resulted in our cases in a retrusive meatus and an inward urinary stream. OBJECTIVE: To show the efficacy and safety of an alternative vaginal wall flap urethroplasty. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional observational study was undertaken in a single University Hospital...
September 27, 2016: European Urology
Vasu Divi, Li Tao, Alice Whittemore, Ingrid Oakley-Girvan
BACKGROUND: Advanced head and neck cancer (HNC) is a complex group of diseases that requires the input and coordination of multiple providers. While there are general guidelines for treatment, there is also considerable variation in how patients are treated, and how long they survive after treatment. It is unclear how the treatment variations relate to treatment costs and survival. METHODS: We identified 3678 Medicare patients with advanced HNC treated in 12 US regions between 2004 and 2009 using the linked database containing Medicare and Surveillance Epidemiology and End Results (SEER) data...
October 2016: Oral Oncology
Jan S Lewin, Leah M Baumgart, Martha P Barrow, Katherine A Hutcheson
Importance: Voice prosthesis (VP) device life is a limiting factor of tracheoesophageal (TE) voice restoration that drives patient satisfaction, health care costs, and overall burden. Historic data suggest that TE VPs have an average device life of generally 3 to 6 months, but these data are typically derived from small samples using only 1 or 2 devices. Objective: To reexamine current device life in a large, contemporary cancer hospital in the United States that uses a wide assortment of VPs...
September 29, 2016: JAMA Otolaryngology—Head & Neck Surgery
Yang Si, Andrea Cossu, Nitin Nitin, Yue Ma, Cunyi Zhao, Bor-Sen Chiou, Trung Cao, Dong Wang, Gang Sun
Antimicrobial polymeric films that are both mechanically robust and function renewable would have broad technological implications for areas ranging from medical safety and bioengineering to foods industry; however, creating such materials has proven extremely challenging. Here, a novel strategy is reported to create high-strength N-halamine incorporated poly(vinyl alcohol-co-ethylene) films (HAF films) with renewable antimicrobial activity by combining melt radical graft polymerization and reactive extrusion technique...
September 28, 2016: Macromolecular Bioscience
Hasan A Zaidi, David J Cote, Joseph P Castlen, William T Burke, Yong-Hui Liu, Timothy R Smith, Edward R Laws
BACKGROUND: Primary lactotroph disinhibition, or stalk effect, occurs when mechanical compression of the pituitary stalk disrupts the tonic inhibition by dopamine released by the hypothalamus. The resolution of pituitary stalk effect-related hyperprolactinemia post-operatively has not been studied in a large cohort of patients. We performed a retrospective review to investigate the time course of recovery of lactotroph disinhibition after transsphenoidal surgery. METHODS: Medical records were retrospectively reviewed for all patients undergoing transsphenoidal surgery with the senior author from April 2008 to November 2014...
September 23, 2016: World Neurosurgery
Stephen Trevick, Minjee Kim, Andrew Naidech
The Neuro-ICU is a multidisciplinary location that presents peculiar challenges and opportunities for patients with life-threatening neurological disease. Communication skills are essential in supporting caregivers and other embedded providers (e.g., neurosurgeons, advanced practice providers, nurses, pharmacists), through leadership. Limitations to prognostication complicate how decisions are made on behalf of non-communicative patients. Cognitive dysfunction and durable reductions in health-related quality of life are difficult to predict, and the diagnosis of brain death may be challenging and confounded by medications and comorbidities...
November 2016: Current Neurology and Neuroscience Reports
Hasan A Zaidi, David J Cote, William T Burke, Joseph P Castlen, Wenya Linda Bi, Edward R Laws, Ian F Dunn
INTRODUCTION: Pituitary tumor apoplexy can result from either hemorrhagic or infarctive expansion of pituitary adenomas, and related mass effect can result in compression of critical neurovascular structures. The time course of recovery of visual field deficits, headaches, ophthalmoparesis, and pituitary dysfunction after endoscopic transsphenoidal surgery has not been well established. METHODS: Medical records were retrospectively reviewed for all patients who underwent endoscopic transsphenoidal surgery for pituitary tumor apoplexy from April 2008 to November 2014...
September 20, 2016: World Neurosurgery
Vivian Ho, Timothy K Allen, Urie Kim, William P Keenan, Meei-Hsiang Ku-Goto, Mark Sanderson
OBJECTIVES: We analyzed changes in healthcare spending associated with the implementation of Cigna's Collaborative Accountable Care (CAC) initiative in a large multi-clinic physician practice. STUDY DESIGN: We compared claims from 2009, prior to the CAC initiative, against claims for 2010 to 2011, contrasting the patients covered by Cigna's CAC initiative with patients in other practices in the same geographic area covered by Cigna's medical plan. METHODS: We used a propensity weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the CAC...
2016: American Journal of Managed Care
Lauren M Kropp, Jennifer F De Los Santos, Svetlana B McKee, Robert M Conry
Durable local control of irradiated cancer and distant abscopal effects are presumably immune mediated. To evaluate the role of radiotherapy (RT) for limited progression after anti-CTLA4 checkpoint inhibition, medical records of all patients with surgically incurable stage III or IV melanoma from a single institution who received ipilimumab as first-line immunotherapy and subsequent RT were reviewed. Sixteen patients who received RT to all sites of limited melanoma progression were analyzed. Eight patients with an incomplete initial response to ipilimumab received RT to new or progressive disease, whereas the remaining 8 patients with a complete initial response to ipilimumab received RT to sites of subsequent recurrence...
November 2016: Journal of Immunotherapy
Kimeya F Ghaderi, Scott T Schmidt, Brian C Drolet
OBJECTIVE: Despite increased emphasis on systems-based practice through the Accreditation Council for Graduate Medical Education core competencies, few studies have examined what surgical residents know about coding and billing. We sought to create and measure the effectiveness of a multifaceted approach to improving resident knowledge and performance of documenting and coding outpatient encounters. DESIGN: We identified knowledge gaps and barriers to documentation and coding in the outpatient setting...
September 16, 2016: Journal of Surgical Education
Jonathan Elmer, Jon C Rittenberger, Patrick J Coppler, Francis X Guyette, Ankur A Doshi, Clifton W Callaway
INTRODUCTION: The Institute of Medicine and American Heart Association have called for tiered accreditation standards and regionalization of post-cardiac arrest care, but there is little data to support that regionalization has a durable effect on patient outcomes. We tested the effect of treatment at a high-volume center on long-term outcome after sudden cardiac arrest (SCA). METHODS: We included patients hospitalized at one of 7 medical centers in Southwestern Pennsylvania after SCA from 2005 to 2013...
September 17, 2016: Resuscitation
Brittany A Potz, Thomas J Miner
Gastric outlet obstruction (GOO) is a common problem associated with advanced malignancies of the upper gastrointestinal tract. Palliative treatment of patients' symptoms who present with GOO is an important aspect of their care. Surgical palliation of malignancy is defined as a procedure performed with the intention of relieving symptoms caused by an advanced malignancy or improving quality of life. Palliative treatment for GOO includes operative (open and laparoscopic gastrojejunostomy) and non-operative (endoscopic stenting) options...
August 27, 2016: World Journal of Gastrointestinal Surgery
Yosuke Seki, Kazunori Kasama, Hidenori Haruta, Atsushi Watanabe, Renzo Yokoyama, Jose Paolo Cabreira Porciuncula, Akiko Umezawa, Yoshimochi Kurokawa
BACKGROUND: Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) has been designated as a novel bariatric surgery procedure. This combination of sleeve gastrectomy and proximal intestinal bypass theoretically offers an effective and prolonged anti-diabetes effect. This is a follow-up of our institution's previous report on the short-term effects of LSG-DJB on type 2 diabetes mellitus (T2DM), which a 68.7 % remission (HbA1c <6 % without diabetes medication) rate 1 year after surgery...
September 19, 2016: Obesity Surgery
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