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https://www.readbyqxmd.com/read/28439218/pediatric-reference-intervals-for-biochemical-markers-gaps-and-challenges-recent-national-initiatives-and-future-perspectives
#1
Houman Tahmasebi, Victoria Higgins, Angela W S Fung, Dorothy Truong, Nicole M A White-Al Habeeb, Khosrow Adeli
Reference intervals provide valuable information to medical practitioners in their interpretation of quantitative laboratory test results, and are critical in the assessment of patient health and in clinical decision-making. The reference interval serves as a health-associated benchmark with which to compare an individual test result. While the concept of reference intervals and their utility appear straightforward, the process of establishing accurate and reliable reference intervals is considerably complex and involved...
March 2017: EJIFCC
https://www.readbyqxmd.com/read/28439135/assessment-of-direct-oral-anticoagulant-prescribing-and-monitoring-pre-and-post-implementation-of-a-pharmacy-protocol-at-a-community-teaching-hospital
#2
Christina Miele, Mary Taylor, Aditi Shah
Background: Direct oral anticoagulants (DOACs) have become popular alternatives to vitamin K antagonists for the treatment and prevention of thromboembolic diseases; however, there are limited data regarding the appropriate use of DOACs in clinical practice. To ensure safety and efficacy of these medications, it is important that decisions regarding their use in patients rely on the available evidence. Objective: The purpose of this study was to evaluate the appropriateness of DOAC prescribing in adult patients before and after the implementation of a pharmacist-driven DOAC protocol...
March 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/28437813/presenting-symptoms-of-pituitary-apoplexy
#3
Efstratios-Stylianos Pyrgelis, Ioannis Mavridis, Maria Meliou
The classical term "pituitary apoplexy" (PA) describes a clinical syndrome usually characterized by abrupt onset of headache accompanied by neurologic and/or endocrinologic deterioration due to sudden expansion of a mass within the sella turcica as a result of hemorrhage or infarction within a pituitary tumor and adjacent pituitary gland. PA is a medical emergency and a difficult diagnosis to establish. Thus this article reviews the presenting symptoms of PA patients to help clinicians recognize or at least suspect this critical condition early on...
April 24, 2017: Journal of Neurological Surgery. Part A, Central European Neurosurgery
https://www.readbyqxmd.com/read/28437208/considerations-for-quality-improvement-in-radiation-oncology-therapy-for-patients-with-uncomplicated-painful-bone-metastases
#4
Anne M Walling, Phillip J Beron, Tania Kaprealian, Patrick A Kupelian, Neil S Wenger, Susan A McCloskey, Christopher R King, Michael Steinberg
BACKGROUND: There is an increasing need for evidence-based efficiency in providing a growing amount of cancer care. One example of a quality gap is the use of multiple-fraction palliative radiation for patients with advanced cancer who have uncomplicated bone metastases; evidence suggests similar pain outcomes for treatment regimens with a lower burden of treatments. METHODS: During the first phase of quality improvement work, we used RAND/UCLA appropriateness methodology to understand how radiation oncologists at one academic medical center rate the appropriateness of different treatment regimens for painful uncomplicated bone metastases...
February 23, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28435905/transurethral-resection-of-the-prostate-bladder-explosion-and-hyponatremic-encephalopathy-a-rare-case-report-of-malpractice
#5
Giuseppe Vacchiano, Aldo Rocca, Rita Compagna, Anna Ginevra Immacolata Zamboli, Vera Cirillo, Lorenza Di Domenico, Veronica Di Nardo, Giuseppe Servillo, Bruno Amato
We present an original case report of a bladder explosion during a TURP intervention for benign prostatic hypertrophy, that was brought on by the absorption of about 5 liters of glycine 1.5% and then onset of a severe hyponatremia. The quick and inappropriate correction of this electrolyte imbalance led the onset of encephalopathy and the death of the patient. The authors discuss the pathogenesis of these uncommon diseases and, considering the most recent Italian Legislation, they highlight the importance to respect good clinical practice standards and guidelines to ensure the most appropriate treatments for the patient and remove any assumptions of medical liability...
January 2017: Open Medicine (Warsaw, Poland)
https://www.readbyqxmd.com/read/28431157/agreement-between-renal-prescribing-references-and-determination-of-prescribing-appropriateness-in-hospitalised-patients-with-chronic-kidney-disease
#6
Michelle O'Shaughnessy, Niamh Allen, John O'Regan, Edwina Payne-Danson, Lise Mentre, Dawn Davin, Peter Lavin, Tamasine Grimes
Background: Chronic kidney disease (CKD) is a risk factor for adverse drug events. The clinical significance of discordance between renal prescribing references is unknown. Aim: We determined the prevalence of potentially inappropriate prescribing (PIP) in CKD, measured agreement between two prescribing references, and assessed potential for harm consequent to PIP. Design: Single-centre observational study. Methods: A random sample of hospitalised patients with CKD were grouped according to baseline CKD stage (3, 4, or 5)...
April 18, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/28430956/achieving-high-reliability-in-histology-%C3%A2-an-improvement-series-to-reduce-errors
#7
Yael K Heher, Yigu Chen, Sergey Pyatibrat, Edward Yoon, Jeffrey D Goldsmith, Kenneth E Sands
Objectives: Despite sweeping medical advances in other fields, histology processes have by and large remained constant over the past 175 years. Patient label identification errors are a known liability in the laboratory and can be devastating, resulting in incorrect diagnoses and inappropriate treatment. The objective of this study was to identify vulnerable steps in the histology workflow and reduce the frequency of labeling errors (LEs). Methods: In this 36-month study period, a numerical step key (SK) was developed to capture LEs...
November 1, 2016: American Journal of Clinical Pathology
https://www.readbyqxmd.com/read/28429690/-our-experience-in-the-diagnosis-and-treatment-of-postural-orthostatic-tachycardia-syndrome-vasovagal-syncope-and-inappropriate-sinus-tachycardia-in-children
#8
Sezen Ugan Atik, Reyhan Dedeoğlu, Aida Koka, Funda Öztunç
OBJECTIVES: The aim of this study was to share our experience in the diagnosis and treatment of patients who presented at our clinic with syncope, pre-syncope, dizziness, and palpitations. STUDY DESIGN: Patients who were treated at pediatric cardiology clinic for complaints of syncope, dizziness, and palpitations between 2014 and 2016 were enrolled in the study. Detailed history of the patients, physical examination findings, laboratory and electrocardiogram results were recorded...
April 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/28429629/developing-indicators-of-appropriate-and-inappropriate-end-of-life-care-in-people-with-alzheimer-s-disease-cancer-or-chronic-obstructive-pulmonary-disease-for-population-level-administrative-databases-a-rand-ucla-appropriateness-study
#9
Robrecht De Schreye, Dirk Houttekier, Luc Deliens, Joachim Cohen
BACKGROUND: A substantial amount of aggressive life-prolonging treatments in the final stages of life has been reported for people with progressive life-shortening conditions. Monitoring appropriate and inappropriate end-of-life care is an important public health challenge and requires validated quality indicators. AIM: To develop indicators of appropriate and inappropriate end-of-life care for people with cancer, chronic obstructive pulmonary disease or Alzheimer's disease, measurable with population-level administrative data...
April 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28429542/study-of-the-wearable-cardioverter-defibrillator-in-advanced-heart-failure-patients-swift
#10
Alon Barsheshet, Valentina Kutyifa, Theodora Vamvouris, Arthur J Moss, Yitschak Biton, Leway Chen, Eugene Storozynsky, Chingping Wan, Steven J Szymkiewicz, Ilan Goldenberg
INTRODUCTION: The wearable cardioverter defibrillator (WCD) may allow stabilization until reassessment for an implantable cardioverter defibrillator (ICD) among high-risk HF patients. However, there are limited data on the WCD benefit in the acute decompensated HF setting. METHODS AND RESULTS: The Study of the Wearable Cardioverter Defibrillator in Advanced Heart-Failure Patients (SWIFT) was a prospective clinical trial carried out at two medical centers. Patients hospitalized with advanced HF symptoms and reduced left ventricular ejection function (LVEF) were enrolled and prescribed a WCD prior to discharge for a total of 3 months...
April 21, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28428489/superior-rhythm-discrimination-with-the-smartshock-technology-algorithm%C3%A3-results-of-the-implantable-defibrillator-with-enhanced-features-and-settings-for-reduction-of-inaccurate-detection-defense-trial
#11
Yasushi Oginosawa, Ritsuko Kohno, Toshihiro Honda, Kan Kikuchi, Masatsugu Nozoe, Takayuki Uchida, Hitoshi Minamiguchi, Koichiro Sonoda, Masahiro Ogawa, Takeshi Ideguchi, Yoshihisa Kizaki, Toshihiro Nakamura, Kageyuki Oba, Satoshi Higa, Keiki Yoshida, Soichi Tsunoda, Yoshihisa Fujino, Haruhiko Abe
BACKGROUND: Shocks delivered by implanted anti-tachyarrhythmia devices, even when appropriate, lower the quality of life and survival. The new SmartShock Technology(®)(SST) discrimination algorithm was developed to prevent the delivery of inappropriate shock. This prospective, multicenter, observational study compared the rate of inaccurate detection of ventricular tachyarrhythmia using the SST vs. a conventional discrimination algorithm.Methods and Results:Recipients of implantable cardioverter defibrillators (ICD) or cardiac resynchronization therapy defibrillators (CRT-D) equipped with the SST algorithm were enrolled and followed up every 6 months...
April 20, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28423857/the-association-between-the-stopp-start-criteria-and-gastro-intestinal-track-bleedings-in-elderly-patients
#12
Anouk Veldhuis, Danielle Sent, Linette Bruin-Huisman, Erna Beers, Ameen Abu-Hanna
Potentially inappropriate prescribing is a common problem, especially in elderly care. To tackle this problem, Irish medical experts have developed a list of criteria when medication should be added or omitted based upon the patient's physical condition and medication use, known as the STOPP and START criteria. The STOPP and START criteria have been formulated to identify the prescribing of potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). One of the most common problems of inappropriate prescribing is gastro-intestinal track bleedings...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28422415/impact-of-hospitalization-in-an-acute-geriatric-unit-on-polypharmacy-and-potentially-inappropriate-prescriptions-a-retrospective-study
#13
Marta Gutiérrez-Valencia, Mikel Izquierdo, Vincenzo Malafarina, Javier Alonso-Renedo, Belén González-Glaría, Beatriz Larrayoz-Sola, María Pilar Monforte-Gasque, Pello Latasa-Zamalloa, Nicolás Martínez-Velilla
AIM: Polypharmacy is a highly prevalent geriatric syndrome, and hospitalizations can worsen it. The aim of the present study was to analyze the influence of hospitalization on polypharmacy and indicators of quality of prescribing, and their possible association with health outcomes. METHODS: A retrospective study of 200 patients discharged from an acute geriatric unit was carried out. Indicators of quality of prescription were registered at admission and discharge: polypharmacy defined as ≥5 medications, hyperpolypharmacy (≥10), potentially inappropriate prescribing by Beers and Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria, potentially prescribing omissions by Screening Tool to Alert doctors to the Right Treatment (START) criteria, drug interactions and anticholinergic burden measured with the Anticholinergic Risk Scale...
April 19, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28420365/social-determinants-of-antibiotic-misuse-a-qualitative-study-of-community-members-in-haryana-india
#14
Anna K Barker, Kelli Brown, Muneeb Ahsan, Sharmila Sengupta, Nasia Safdar
BACKGROUND: Antibiotic resistance is a global public health crisis. In India alone, multi-drug resistant organisms are responsible for over 58,000 infant deaths each year. A major driver of drug resistance is antibiotic misuse, which is a pervasive phenomenon worldwide. Due to a shortage of trained doctors, access to licensed allopathic doctors is limited in India's villages. Pharmacists and unlicensed medical providers are commonly the primary sources of healthcare. Patients themselves are also key participants in the decision to treat an illness with antibiotics...
April 19, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28418482/effect-of-oral-dexamethasone-without-immediate-antibiotics-vs-placebo-on-acute-sore-throat-in-adults-a-randomized-clinical-trial
#15
Gail Nicola Hayward, Alastair D Hay, Michael V Moore, Sena Jawad, Nicola Williams, Merryn Voysey, Johanna Cook, Julie Allen, Matthew Thompson, Paul Little, Rafael Perera, Jane Wolstenholme, Kim Harman, Carl Heneghan
Importance: Acute sore throat poses a significant burden on primary care and is a source of inappropriate antibiotic prescribing. Corticosteroids could be an alternative symptomatic treatment. Objective: To assess the clinical effectiveness of oral corticosteroids for acute sore throat in the absence of antibiotics. Design, Setting, and Participants: Double-blind, placebo-controlled randomized trial (April 2013-February 2015; 28-day follow-up completed April 2015) conducted in 42 family practices in South and West England, enrolled 576 adults recruited on the day of presentation to primary care with acute sore throat not requiring immediate antibiotic therapy...
April 18, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28416830/-analysis-on-the-causes-of-unscheduled-suspensions-of-knee-and-hip-arthroplasty
#16
Y Li, Z J Li, K Zhang, H Tian, Y Q Liu, H Cai, F Li, M W Zhao
OBJECTIVE: To analyze and summarize the causes of unscheduled suspension of knee and hip arthroplasty and to provide the method for optimizing the patient's preoperative management and improving the efficiency of medical resources as well as the patient's satisfaction. METHODS: The data for this report was retrospectively collected from September 2013 to August 2014 in our hospital, from cases of knee and hip arthroplasty that were suspended before the scheduled operation time...
April 18, 2017: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
https://www.readbyqxmd.com/read/28416509/none-of-the-above-thrombotic-microangiopathy-beyond-ttp-and-hus
#17
Camila Masias, Sumithira Vasu, Spero R Cataland
Acquired thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are appropriately at the top of a clinician's differential when a patient presents with a clinical picture consistent with an acute thrombotic microangiopathy (TMA). However, there are several additional diagnoses that should be considered in patients presenting with an acute TMA, especially in patients with non-deficient ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity (>10%)...
April 17, 2017: Blood
https://www.readbyqxmd.com/read/28416178/the-effect-of-time-to-surgery-on-functional-ability-at-six-weeks-in-a-hip-fracture-population-in-mid-west-ireland
#18
Audrey Butler, Sinead Hahessy, Finbarr Condon
Patients with a hip fracture may be appropriately delayed for surgery as they require optimisation or clinical interventions to treat acute medical illnesses (Moja et al., 2012). Other patients are inappropriately delayed due to hospital factors (Brener, 2013; Lee & Elfar, 2014). Timely efficient admission and surgery is well documented as the best course of management for these patients. The aim of this prospective cohort longitudinal follow-up study was to establish if a relationship existed between duration of time spent in the Emergency Department (ED), time to surgery and functional ability in patients with hip fractures and to examine the effect prolonged waits may have on ability to return home...
March 9, 2017: International Journal of Orthopaedic and Trauma Nursing
https://www.readbyqxmd.com/read/28414853/-excessive-osteoporosis-screening-in-women-under-65-years-a-cross-sectional-study
#19
María de Las Nieves Ganiele, Sergio Adrián Terrasa, Karin Silvana Kopitowski
Overuse of osteoporosis screening in women at low risk of fracture may lead to overdiagnosis, inappropriate treatment and medicalization. The objective of this work was to estimate the proportion of women aged 45 to 64 enrolled in a private health insurance plan in Buenos Aires undergoing hip dual-energy x-ray absorptiometry (DXA) in 2011 without meeting osteoporosis screening criteria. In this cross-sectional study, 4310 women of this age range that had undergone a hip DXA were identified. A randomly selected sub-group of 401 women was then assessed for the presence of risk factors for osteoporosis and complete data were retrieved for 178 women...
July 2016: Salud Colectiva
https://www.readbyqxmd.com/read/28414065/effects-of-depression-screening-on-diagnosing-and-treating-mood-disorders-among-older-adults-in-office-based-primary-care-outpatient-settings-an-instrumental-variable-analysis
#20
Taeho Greg Rhee, Benjamin D Capistrant, Jon C Schommer, Ronald S Hadsall, Donald L Uden
Existing literature shows mixed findings regarding the efficacy and effectiveness of depression screening, and relatively little is known about the effectiveness of depression screening among older adults in primary care visits in the U.S. This study examines the effects of depression screening on the three following outcomes: mood disorder diagnoses, overall antidepressant prescriptions, and potentially inappropriate antidepressant prescriptions among older adults ages 65 or older in office-based outpatient primary care settings...
April 14, 2017: Preventive Medicine
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