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https://www.readbyqxmd.com/read/29452560/health-care-efficiencies-consolidation-and-alternative-models-vs-health-care-and-antitrust-regulation-irreconcilable-differences
#1
Michael W King
Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation...
November 2017: American Journal of Law & Medicine
https://www.readbyqxmd.com/read/29449827/sun-exposure-across-the-life-course-significantly-modulates-early-multiple-sclerosis-clinical-course
#2
Steve Simpson, Ingrid van der Mei, Robyn M Lucas, Anne-Louise Ponsonby, Simon Broadley, Leigh Blizzard, Bruce Taylor
Background: Low vitamin D and/or sun exposure have been associated with increased risk of multiple sclerosis (MS) onset. However, comparatively, few studies have prospectively examined associations between these factors and clinical course. Objectives: To evaluate the association of sun exposure parameters and vitamin D levels with conversion to MS and relapse risk in a prospectively monitored cohort of 145 participants followed after a first demyelinating event up to 5-year review (AusLong Study)...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29449725/iatrogenic-colorectal-kaposi-s-sarcoma-complicating-a-refractory-ulcerative-colitis-in-a-human-immunodeficiency-negative-virus-patient
#3
L Chtourou, L Ayedi, H Rejab, M Boudabous, L Mnif, A Grati, T Boudaouara, R Mzali, A Amouri, N Tahri
Kaposi sarcoma is an unusual tumor associated to a human herpes virus-8 infection involving the skin or internal organs. Iatrogenic Kaposi's sarcoma often occurs in patients receiving immunosuppressive therapy. So far, a few Kaposi's sarcoma cases have been reported in the literature associated with inflammatory bowel diseases. We report a 53-year-old male diagnosed with a severe refractory ulcerative colitis who was treated with corticosteroids and azathioprine. The patient underwent a colectomy after the failure of medical treatment...
December 2017: Pathologica
https://www.readbyqxmd.com/read/29449120/bilateral-phlegmasia-cerulea-dolens-after-warfarin-reversal-for-acute-rectal-bleeding-a-case-report
#4
Burr Fong, Daniel Novak, Michael Dalley, Gregory Alfred
BACKGROUND: Deep vein thrombosis (DVT) is a common disease that is diagnosed in approximately 1 in 1000 adults annually. Extensive DVT can lead to life- or limb-threatening diagnoses such as phlegmasia cerulea dolens (PCD), phlegmasia alba dolens, and venous gangrene. PCD, also known as massive iliofemoral venous thrombosis, is rare, and a severe complication of DVT. CASE REPORT: We report a case of a 94-year-old bedridden woman with past medical history of dementia, hypertension, pulmonary embolism, DVT, and atrial fibrillation...
February 12, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29448967/facial-nerve-stimulation-in-normal-pigs-and-healthy-human-volunteers-transitional-development-of-a-medical-device-for-the-emergency-treatment-of-ischemic-stroke
#5
Olivia Sanchez, Andrea García, Fernando Castro-Prado, Miriam Perez, Rafael Lara-Estrada, Martin Ramirez-Meza, Montserrat Godinez, Michael L Coco, Joaquín Azpiroz, Mark K Borsody, Emilio Sacristán
BACKGROUND: Magnetic stimulation of the facial nerve has been tested in preclinical studies as a new, non-invasive emergency treatment of ischemic stroke that acts by increasing cerebral blood flow (CBF). The objective of the studies reported herein was to identify minimal stimulation parameters that increase CBF in large animals and then test those stimulation parameters in healthy volunteers for safety, tolerability, and effectiveness at increasing CBF. This translational research is necessary preparation for clinical studies in ischemic stroke patients...
February 15, 2018: Journal of Translational Medicine
https://www.readbyqxmd.com/read/29444576/-fractures-of-the-fifth-metatarsal-base
#6
K Bušková, D Kuběnová, M Tuček
Fractures of the fifth metatarsal base are among the most common fractures of the foot. They are typically caused by indirect violence during sports activities. This region is also a site where stress fractures occur frequently. Diagnosis is based on the patients medical history, clinical examination and imaging methods. The fundamental imaging method is radiography of the foot in three views. MRI is used primarily for early diagnosis of stress fractures. CT examination is beneficial mainly in complex foot injuries, in order to rule out associated fractures...
2018: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
https://www.readbyqxmd.com/read/29442478/a-clinical-audit-diagnostic-and-epidemiological-evaluation-of-the-adrenal-incidentaloma-ai
#7
Vincenzo Nuzzo, Tiziana Attardo, Giuseppe Augello, Davide Brancato, Salvatore Camerlingo, Clelia Canale, Federica Coretti, Alessandro Franco, Francesco Giacometti, Maurizio Gambacorta, Massimo Loreno, Ada Maffettone, Vincenzo Provenzano, Alfonso Zuccoli
Audit is a clinical instrument of government characterized by a whole process of evaluation inter pares to improve medical behaviors in the clinical practice. Different endocrinopathies are underestimated in the clinical and diagnostics practice but they can be a real problem in patients admitted in the departments of Internal Medicine. The Adrenal Incidentaloma (AI) is an accidental discovery with an incidence equal to 4% in radiologic studies but it's rarely considereted in the internal disorders. In the departments of Internal Medicine are hospitalized each year approximately 1...
February 13, 2018: Minerva Endocrinologica
https://www.readbyqxmd.com/read/29442297/a-single-center-cost-analysis-of-treating-primary-and-metastatic-brain-cancers-with-either-brain-laser-interstitial-thermal-therapy-litt-or-craniotomy
#8
Eric C Leuthardt, Jeff Voigt, Albert H Kim, Pete Sylvester
BACKGROUND: Brain laser interstitial thermal therapy (LITT) under magnetic resonance imaging (MRI) guidance has recently gained US clinical approval for the ablation of soft, neurological tissue. LITT is a minimally invasive alternative to craniotomy. OBJECTIVE: While safety and efficacy are the focus of most current LITT studies, it is unclear how acute care costs (inpatient care ± aftercare) of LITT compare to craniotomy in an academic medical center. Therefore, the purpose of this analysis is to examine these costs of using brain LITT under MRI guidance compared to craniotomy in complex anatomies...
March 2017: PharmacoEconomics Open
https://www.readbyqxmd.com/read/29441772/-current-status-of-forensic-identification-for-blunt-injuries-of-internal-carotid-arterial-system
#9
REVIEW
X M Wu, G Zhang, Q Wang, Z X Ni, M Liu, L B Yun, X F Yi
Internal carotid arterial system is the main source of blood supply in brain. In forensic identification practice, blunt injures of internal carotid arterial system usually cause complications such as thrombus, aneurysm and arteriovenous fistula, etc. The deaths following delayed cerebral infarction or intracranial haemorrhage are not rare. At present, literature of deaths caused by blunt injuries of internal carotid arterial system mainly consist of case reports in China. This paper reviews related literature and case reports at home and abroad, and summarizes forensic medical features and identification method of the deaths caused by such injuries...
December 2017: Fa Yi Xue za Zhi
https://www.readbyqxmd.com/read/29441591/beyond-the-binaries-reshaping-pain-communication-through-arts-workshops
#10
Jen Tarr, Flora Cornish, Elena Gonzalez-Polledo
Pain is difficult to communicate and translate into language, yet most social research on pain experience uses questionnaires and semi-structured interviews that rely on words. In addition to the mind/body dualism prevalent in pain medicine in these studies pain communication is characterised by further value-laden binaries such as real/unreal, visible/invisible, and psychological/physical. Starting from the position that research methods play a role in constituting their object, this article examines the potential of participatory arts workshops for developing different versions of pain communication...
February 13, 2018: Sociology of Health & Illness
https://www.readbyqxmd.com/read/29440123/portrait-patient-centered-outcomes-related-to-treatment-practices-in-peripheral-arterial-disease-investigating-trajectories-overview-of-design-and-rationale-of-an-international-prospective-peripheral-arterial-disease-study
#11
REVIEW
Kim G Smolderen, Kensey Gosch, Manesh Patel, W Schuyler Jones, Alan T Hirsch, John Beltrame, Rob Fitridge, Mehdi H Shishehbor, Johan Denollet, Patrick Vriens, Jan Heyligers, Nancy Stone MEd, Herbert Aronow, J Dawn Abbott, Clementine Labrosciano, Rudolf Tutein-Nolthenius, John A Spertus
BACKGROUND: Health status outcomes, including symptoms, functional status, and quality of life, are critically important outcomes from patients' perspectives. The PORTRAIT study (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) was designed to prospectively define health status outcomes and examine associations between patients' characteristics and care to these outcomes among those presenting with new-onset or worsened claudication...
February 2018: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/29438554/microwave-diathermy-in-physiotherapy-introduction-and-evaluation-of-a-quality-control-procedure
#12
Constantinos Koutsojannis, Andreas Andrikopoulos, Adam Adamopoulos, Ioannis Seimenis
Microwave diathermies (MWDs) are electromagnetic (EM) radiation emitting systems that are used by physiotherapists for thermotherapy treatment. Although this form of therapy is widely available in most physiotherapy units worldwide, management of the equipment is not obligatory addressed either by clinical engineers or medical physicists. A novel quality control (QC) protocol for MWD equipment, examining mechanical, electrical and electronic condition, the power output and EM radiation distribution in the electrotherapy room, was used during a national QC survey...
February 9, 2018: Radiation Protection Dosimetry
https://www.readbyqxmd.com/read/29438156/anxiety-sensitivity-physical-and-cognitive-concerns-in-relation-to-smoking-oriented-cognition-an-examination-among-treatment-seeking-adults-who-smoke
#13
Kirsten J Langdon, Jafar Bakhshaie, Alicia Lopez, Niloofar Tavakoli, Lorra Garey, Amanda M Raines, Brooke Y Kauffman, Norman B Schmidt, Michael J Zvolensky
OBJECTIVES: Elevated levels of anxiety sensitivity (AS; fear of anxiety and internal sensations) is highly common among adults who smoke, and contributes to several maladaptive smoking beliefs and behaviors. AS is comprised of 3 empirically established factors, relating to fears of social concerns, fears of physical symptoms, and fears of cognitive dyscontrol. Relatively few studies have examined how these 3 subscales pertain to smoking processes. The aim of the present investigation was to examine, among treatment-seeking adults who smoke, the interactive effects of AS-physical and cognitive concerns in relation to: perceived barriers to smoking cessation; smoking-related negative reinforcement expectancies; and smoking-related avoidance and inflexibility...
February 12, 2018: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/29435293/a-case-of-peritoneal-malignant-mesothelioma-following-radiation-therapy-for-cervical-cancer
#14
Mitsutake Yano, Yuji Ikeda, Tomomi Kato, Mika Sakaki, Sho Sato, Akira Yabuno, Eito Kozawa, Masanori Yasuda
The present study presents a case of peritoneal malignant mesothelioma (PMM) following radiation therapy for cervical cancer. A 34-year-old Japanese woman, without asbestos exposure, was referred to the Department of Gynecologic Oncology, Saitama Medical University International Medical Center due to a cervical mass, and was diagnosed with cervical squamous cell carcinoma (SCC). The serum levels of tumor markers, including SCC antigen and cancer antigen 125 (CA125) were 229.0 ng/ml and 54.4 U/ml, respectively...
February 2018: Molecular and Clinical Oncology
https://www.readbyqxmd.com/read/29434084/comprehensive-assessment-of-risk-factors-of-cause-specific-infant-deaths-in-japan
#15
Yui Yamaoka, Naho Morisaki, Haruko Noguchi, Hideto Takahashi, Nanako Tamiya
BACKGROUND: Public attention is given to infants with socially high risks of child abuse and neglect, while clinical attention is provided to infants with a biologically high risk of diseases. However, few studies have systematically evaluated how biological or social factors cross over and affect cause-specific infant mortality. METHODS: We linked birth data with death data from the Japanese national vital statistics database for all infants born from 2003-2010...
February 10, 2018: Journal of Epidemiology
https://www.readbyqxmd.com/read/29432074/an-opioid-overdose-curriculum-for-medical-residents-impact-on-naloxone-prescribing-knowledge-and-attitudes
#16
Jessica Lee Taylor, Alison B Rapoport, Christopher F Rowley, Kenneth J Mukamal, Wendy Stead
BACKGROUND: Despite escalating opioid overdose death rates, addiction medicine is underrepresented in residency curricula. Providing naloxone to at-risk patients, relatives, and first responders reduces overdose deaths, but rates of naloxone prescribing remain low. The goal of this study is to examine the impact of a brief curricular intervention for internal medicine residents on naloxone prescribing rates, knowledge, and attitudes. METHODS: Internal medicine residents (n = 160) at an urban, tertiary care medical center received two one-hour didactic sessions addressing overdose prevention, including intranasal naloxone...
February 12, 2018: Substance Abuse
https://www.readbyqxmd.com/read/29431977/hemorrhoids-diagnosis-and-treatment-options
#17
Timothy Mott, Kelly Latimer, Chad Edwards
Many Americans between 45 and 65 years of age experience hemorrhoids. Hemorrhoidal size, thrombosis, and location (i.e., proximal or distal to the dentate line) determine the extent of pain or discomfort. The history and physical examination must assess for risk factors and clinical signs indicating more concerning disease processes. Internal hemorrhoids are traditionally graded from I to IV based on the extent of prolapse. Other factors such as degree of discomfort, bleeding, comorbidities, and patient preference should help determine the order in which treatments are pursued...
February 1, 2018: American Family Physician
https://www.readbyqxmd.com/read/29431126/repetitive-transcranial-magnetic-stimulation-for-depression-after-basal-ganglia-ischaemic-stroke-protocol-for-a-multicentre-randomised-double-blind-placebo-controlled-trial
#18
Ying Tang, Aimin Chen, Shuzhen Zhu, Li Yang, Jiyuan Zhou, Suyue Pan, Min Shao, Lianxu Zhao
INTRODUCTION: Studies suggest that repetitive transcranial magnetic stimulation (rTMS) is effective for the treatment of depression and promotes the repair of white matter. This study aims to assess the effectiveness of rTMS in treating depression after basal ganglia ischaemic stroke and to examine whether such effects are related to restoration of white matter integrity. METHODS AND ANALYSIS: Sixty-six participants will be recruited from Zhujiang Hospital, Nanfang Hospital and Sichuan Bayi Rehabilitation Hospital and randomised in a 1:1 ratio to receive active rTMS treatment or sham rTMS treatment in addition to routine supportive treatments...
February 3, 2018: BMJ Open
https://www.readbyqxmd.com/read/29429636/the-expand-study-efficacy-and-safety-of-rivaroxaban-in-japanese-patients-with-non-valvular-atrial-fibrillation
#19
Hiroaki Shimokawa, Takeshi Yamashita, Shinichiro Uchiyama, Takanari Kitazono, Wataru Shimizu, Takanori Ikeda, Masahiro Kamouchi, Koichi Kaikita, Koji Fukuda, Hideki Origasa, Ichiro Sakuma, Keijiro Saku, Yasuo Okumura, Yuichiro Nakamura, Hideo Morimoto, Naoki Matsumoto, Akihito Tsuchida, Junya Ako, Nobuyoshi Sugishita, Shogo Shimizu, Hirotsugu Atarashi, Hiroshi Inoue
AIMS: The EXPAND study examined the real-world efficacy and safety of rivaroxaban for the prevention of stroke and systemic embolism (SE) in Japanese patients with non-valvular atrial fibrillation (NVAF). METHODS AND RESULTS: This multicenter, prospective, non-interventional, observational, cohort study was conducted at 684 medical centers in Japan. A total of 7141 NVAF patients ≥20 years of age (mean, 71.6 ± 9.4 years) who were being or about to be treated with rivaroxaban (10 mg/day, 43...
February 3, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29428245/sick-leave-after-surgery-for-thumb-carpometacarpal-osteoarthritis-a-population-based-study
#20
Jennifer Moriatis Wolf, Isam Atroshi, Caddie Zhou, Jon Karlsson, Martin Englund
PURPOSE: Patients undergoing surgery for thumb carpometacarpal (CMC1) osteoarthritis often require sick leave owing to postoperative immobilization, pain, and decreased function. Our goal was to evaluate the amount of sick leave after surgery for 2 common CMC1 arthroplasty procedures. METHODS: Using registry data from the Skåne region of southern Sweden, cross-linked with employment data showing person-specific sick leave, 2 cohorts of CMC1 surgical patients, between ages 40 and 59 years, were examined...
February 7, 2018: Journal of Hand Surgery
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