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https://www.readbyqxmd.com/read/27913561/hospitals-and-patients-working-in-unity-how-r-u-protocol-for-a-prospective-feasibility-study-of-telephone-peer-support-to-improve-older-patients-quality-of-life-after-emergency-department-discharge
#1
Judy A Lowthian, Alyse Lennox, Andrea Curtis, Jeremy Dale, Colette Browning, De Villiers Smit, Gillian Wilson, Debra O'Brien, Cate Rosewarne, Lee Boyd, Cath Garner, Peter Cameron
INTRODUCTION: Older people presenting to an emergency department (ED) have a higher likelihood of social isolation, loneliness and depression; which are all associated with negative health outcomes and increased health service use, including higher rates of ED attendance. The HOW R U? study aims to ascertain the feasibility and acceptability of a postdischarge telephone support programme for older ED patients following discharge. The intervention, which aims to improve quality of life, will be delivered by hospital-based volunteers...
December 2, 2016: BMJ Open
https://www.readbyqxmd.com/read/27911003/current-psychotropic-medication-prescribing-patterns-in-late-life-bipolar-disorder
#2
Soham Rej, Nathan Herrmann, Kenneth Shulman, Hadas D Fischer, Kinwah Fung, Andrea Gruneir
OBJECTIVE: Many patients with bipolar disorder are reaching old age, but whether they are receiving evidence-based psychotropic treatment remains unclear. Our objective was to describe current psychotropic prescribing patterns in a large Canadian late-life bipolar sample. METHODS: Population-based cross-sectional study of 1443 bipolar disorder patients aged ≥ 66, discharged from a psychiatric hospitalization in Ontario, Canada from 1 April 2006 to 31 March 2012...
December 2, 2016: International Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/27902988/smell-and-taste-to-improve-nutrition-in-very-preterm-infants-a-randomized-controlled-pilot-trial
#3
Friederike Beker, Gillian Opie, Elizabeth Noble, Yannan Jiang, Frank H Bloomfield
BACKGROUND: The perception of smell and taste, though present early in development, is not routinely considered in the care of preterm infants. Smell and taste are known to increase gut motility, insulin secretion, and the release of appetite, digestive and metabolic hormones. OBJECTIVE: We aimed to investigate the effect of regular smell and taste on the time from birth to full enteral feeds, and the feasibility of the study protocol in very preterm infants. METHODS: In a randomized controlled trial, infants <29 weeks' postmenstrual age (PA) were assigned to receive either the smell and taste of milk before each feed or to have no exposure to the smell and taste of milk (control)...
December 1, 2016: Neonatology
https://www.readbyqxmd.com/read/27902730/spectrum-of-cerebrovascular-disease-in-patients-with-multiple-myeloma-undergoing-chemotherapy-results-of-a-case-control-study
#4
Archana Hinduja, Kaustubh Limaye, Rahul Ravilla, Appalnaidu Sasapu, Xenofon Papanikolaou, Lai Wei, Michel Torbey, Sarah Waheed
OBJECTIVES: Patients with multiple myeloma (MM) are at increased risk of arterial thrombosis. Our aim was to determine the risk factors, mechanisms and outcome of strokes in these patients. METHODS: We conducted a retrospective matched case-control study from our database of MM patients enrolled in Total Therapy (TT) 2, TT3a and TT3b protocols who developed a vascular event (transient ischemic attack, ischemic stroke, or intracerebral hemorrhage) from October 1998 to January 2014...
2016: PloS One
https://www.readbyqxmd.com/read/27899130/antibiotic-prophylaxis-in-reduction-mammaplasty-study-protocol-for-a-randomized-controlled-trial
#5
Edgard Silva Garcia, Daniela Francescato Veiga, Joel Veiga-Filho, Isaías Vieira Cabral, Natália Lana Larcher Pinto, Neil Ferreira Novo, Miguel Sabino Neto, Lydia Masako Ferreira
BACKGROUND: The role of antibiotics in surgical procedures where the risk of surgical site infection (SSI) is low remains uncertain. There is, to date, no evidence to justify the routine use of antibiotics in postoperative reduction mammaplasty. The aim of this study is to evaluate the effect of postoperative antibiotic treatment on the occurrence of SSI after breast reduction surgery. METHODS: This is a double-blind randomized clinical trial with 124 breast hypertrophy patients allocated to two treatment groups: antibiotic (n = 62) and placebo (n = 62)...
November 30, 2016: Trials
https://www.readbyqxmd.com/read/27898439/limiting-sedation-for-patients-with-acute-respiratory-distress-syndrome-time-to-wake-up
#6
Faraaz Ali Shah, Timothy D Girard, Sachin Yende
PURPOSE OF REVIEW: Critically ill patients with acute respiratory distress syndrome (ARDS) may require sedation in their clinical care. The goals of sedation in ARDS patients are to improve patient comfort and tolerance of supportive and therapeutic measures without contributing to adverse outcomes. This review discusses the current evidence for sedation management in patients with ARDS. RECENT FINDINGS: Deep sedation strategies should be avoided in the care of patients with ARDS because deep sedation has been associated with increased time on mechanical ventilation, longer ICU and hospital length of stay, and higher mortality in critically ill patients...
November 24, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27896794/efficacy-and-safety-of-ultrasound-guided-placement-of-central-venous-port-systems-via-the-right-internal-jugular-vein-in-elderly-oncologic-patients-our-single-center-experience-and-protocol
#7
Alfonso Canfora, Claudio Mauriello, Antonio Ferronetti, Gianpaolo Marte, Vittorio Di Maio, Guido Ciorra, Maria Grazia Esposito, Maria Elena Giuliano, Giovanni Fregola, Luigi Barra, Salvatore Cuzzovaglia, Vincenzo Bottino, Pietro Maida
BACKGROUND: Ultrasound-guidance has become the routine method for internal jugular vein (IJV) catheterization reducing dramatically failure and complication rates for central venous port (CVP) placement. AIMS: The aim of this study was to determine the safety and efficacy of ultrasound-guided IJV CVP placement in elderly oncologic patients. METHODS: Between January 2013 and December 2015, 101 elderly oncological patients underwent right IJV CVP placement under ultrasound-guidance...
November 28, 2016: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/27894327/a-statistical-analysis-protocol-for-the-time-differentiated-target-temperature-management-after-out-of-hospital-cardiac-arrest-tth48-clinical-trial
#8
Hans Kirkegaard, Asger Roer Pedersen, Ville Pettilä, Jakob Hjort, Bodil Steen Rasmussen, Inge de Haas, Jørgen Feldbæk Nielsen, Susanne Ilkjær, Anne Kaltoft, Anni Nørgaard Jeppesen, Anders Morten Grejs, Christophe Henri Valdemar Duez, Alf Inge Larsen, Valdo Toome, Urmet Arus, Fabio Silvio Taccone, Christian Storm, Timo Laitio, Markus B Skrifvars, Eldar Søreide
BACKGROUND: The TTH48 trial aims to determine whether prolonged duration (48 hours) of targeted temperature management (TTM) at 33 (±1) °C results in better neurological outcomes compared to standard duration (24 hours) after six months in comatose out-of-hospital cardiac arrest (OHCA) patients. METHODS: TTH48 is an investigator-initiated, multicentre, assessor-blinded, randomised, controlled superiority trial of 24 and 48 hours of TTM at 33 (±1) ° C performed in 355 comatose OHCA patients aged 18 to 80 years who were admitted to ten intensive care units (ICUs) in six Northern European countries...
November 28, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27893567/determining-whether-a-dosage-specific-and-individualized-home-exercise-program-with-consults-reduces-fall-risk-and-falls-in-community-dwelling-older-adults-with-difficulty-walking-a-randomized-control-trial
#9
Estelle Gallo, Maria Stelmach, Fernanda Frigeri, Dong-Hyun Ahn
BACKGROUND AND PURPOSE: The development and implementation of effective interventions to prevent falls in older adults is a public health priority. The purpose of this study was to compare the efficacy of a new practice model, incorporating Shubert's evidence-based fall prevention recommendations, with the usual ambulatory physical therapy (PT) at Rusk Rehabilitation, to decrease fall risk among older adults living in the community. The hypotheses were (1) the proposed program would decrease participants' fall risk, (2) it would be more effective than our usual PT, and (3) the addition of 4 consults after discharge would improve compliance with a home exercise program...
November 23, 2016: Journal of Geriatric Physical Therapy
https://www.readbyqxmd.com/read/27891392/a-study-of-evaluation-and-management-of-rare-congenital-breast-diseases
#10
Rikki Singal, Sudhir Kumar Mehta, Jyoti Bala, Muzzafar Zaman, Amit Mittal, Guarav Gupta, Samer Rudra, Samita Singal
INTRODUCTION: Polymastia and polythelia may be asymptomatic or cause pain, restriction of arm movement, milk discharge, cosmetic problems or anxiety. Cosmesis is the main indication for surgical excision of accessory breasts in axilla. In addition it also confirms the diagnosis and allays the patient's fear of harbouring a malignancy. AIM: To evaluate the presentation of symptoms, investigations required for diagnosis and the management to improve the treatment protocols in patients with breast diseases...
October 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27888534/early-steroid-withdrawal-results-in-improved-patient-and-graft-survival-and-lower-risk-of-post-transplant-cardiovascular-risk-profiles-a-single-center-10-year-experience
#11
Reynold Lopez-Soler, Ryan Chan, Jessica Martinolich, Lisa Park, Ashar Ata, Nikolaos Chandolias, David Conti
Long term use of steroids results in predictable secondary effects that can lead to increased morbidity and mortality. In this study, we present 10 years' worth of data of early steroid withdrawal (ESW) immunosuppression consisting of Mycophenolate, Sirolimus, and Tacrolimus. From 2003 to 2013, 563 kidney transplant recipients were weaned off steroids prior to discharge. We compared outcomes with that of our 65 historical controls maintained on steroids. We analyzed graft and patient survival and determined the incidence of steroid-related comorbidities such as hypertension, hypercholesterolemia, diabetes, coronary artery disease, and weight gain...
November 26, 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/27885832/defining-pediatric-inpatient-cardiology-care-delivery-models-a-survey-of-pediatric-cardiology-programs-in-the-usa-and-canada
#12
Antonio R Mott, Steven R Neish, Melissa Challman, Timothy F Feltes
BACKGROUND: The treatment of children with cardiac disease is one of the most prevalent and costly pediatric inpatient conditions. The design of inpatient medical services for children admitted to and discharged from noncritical cardiology care units, however, is undefined. North American Pediatric Cardiology Programs were surveyed to define noncritical cardiac care unit models in current practice. METHOD: An online survey that explored institutional and functional domains for noncritical cardiac care unit was crafted...
November 25, 2016: Congenital Heart Disease
https://www.readbyqxmd.com/read/27885446/post-cardiotomy-rescue-extracorporeal-cardiopulmonary-resuscitation-in-neonates-with-single-ventricle-after-intractable-cardiac-arrest-attrition-after-hospital-discharge-and-predictors-of-outcome
#13
Anastasios C Polimenakos, Vincent Rizzo, Chawki F El-Zein, Michel N Ilbawi
Extracorporeal cardiopulmonary resuscitation (ECPR) in children with cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) has been reported with encouraging results. We reviewed outcomes of neonates with functional single ventricle (FSV) surviving post-cardiotomy ECPR after hospital discharge. Fifty-eight patients who required post-cardiotomy extracorporeal membrane oxygenation (ECMO) since the introduction of our ECPR protocol (January 2007-December 2011) were identified. Forty-one were neonates...
November 24, 2016: Pediatric Cardiology
https://www.readbyqxmd.com/read/27885414/clinical-implementation-of-an-emergency-department-coronary-computed-tomographic-angiography-protocol-for-triage-of-patients-with-suspected-acute-coronary-syndrome
#14
Brian B Ghoshhajra, Richard A P Takx, Pedro V Staziaki, Harshna Vadvala, Phillip Kim, Tomas G Neilan, Nandini M Meyersohn, Daniel Bittner, Sumbal A Janjua, Thomas Mayrhofer, Jeffrey L Greenwald, Quyhn A Truong, Suhny Abbara, David F M Brown, James L Januzzi, Sanjeev Francis, John T Nagurney, Udo Hoffmann
OBJECTIVES: To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience. METHODS: Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure...
November 24, 2016: European Radiology
https://www.readbyqxmd.com/read/27883921/how-well-is-microlitter-purified-from-wastewater-a-detailed-study-on-the-stepwise-removal-of-microlitter-in-a-tertiary-level-wastewater-treatment-plant
#15
Julia Talvitie, Anna Mikola, Outi Setälä, Mari Heinonen, Arto Koistinen
Wastewater treatment plants (WWTPs) can offer a solution to reduce the point source input of microlitter and microplastics into the environment. To evaluate the contributing processes for microlitter removal, the removal of microlitter from wastewater during different treatment steps of mechanical, chemical and biological treatment (activated sludge) and biologically active filter (BAF) in a large (population equivalent 800 000) advanced WWTP was examined. Most of the microlitter was removed already during the pre-treatment and activated sludge treatment further decreased the microlitter concentration...
November 16, 2016: Water Research
https://www.readbyqxmd.com/read/27882418/compliance-with-guidelines-of-enhanced-recovery-after-surgery-in-elderly-patients-undergoing-gastrectomy
#16
Oh Jeong, Young Kyu Park, Mi Ran Jung, Seong Yeob Ryu
BACKGROUND: Enhanced recovery after surgery (ERAS) aims at expediting postoperative recovery by implementing specific strategies in perioperative management. However, the tolerance to such fast-tracking protocols is under debate, especially in elderly patients. We aimed to investigate rate of compliance with the main ERAS guidelines in elderly gastrectomy patients. METHODS: Using data for 168 gastric cancer patients who underwent ERAS after gastrectomy as part of Clinical Trial NCT01653496, we calculated the rates of compliance with nine main ERAS guidelines and compared the compliance rates of elderly (≥70 years) and non-elderly (<70 years) patients...
November 23, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27881185/melatonin-and-melatonin-agonists-to-prevent-and-treat-delirium-in-critical-illness-a-systematic-review-protocol
#17
Jennifer Foster, Lisa D Burry, Lehana Thabane, Karen Choong, Kusum Menon, Mark Duffett, Alexandra Cheung, Melanie Guenette, Timothy Chimunda, Louise Rose
BACKGROUND: Delirium is a syndrome characterized by acute fluctuations and alterations in attention and arousal. Critically ill patients are at particularly high risk, and those that develop delirium are more likely to experience poor clinical outcomes such as prolonged duration of ICU and hospital length of stay, and increased mortality. Melatonin and melatonin agonists (MMA) have the potential to decrease the incidence and severity of delirium through their hypnotic and sedative-sparing effects, thus improving health-related outcomes...
November 24, 2016: Systematic Reviews
https://www.readbyqxmd.com/read/27880927/very-low-risk-st-segment-elevation-myocardial-infarction-it-exists-and-may-be-easily-identified
#18
Felipe Díez-Delhoyo, María Jesús Valero-Masa, Jesús Velásquez-Rodríguez, Carolina Devesa-Cordero, Iago Sousa-Casasnovas, Miriam Juárez, Rocío Angulo-Llanos, Francisco Fernández-Avilés, Manuel Martínez-Sellés
BACKGROUND: Early discharge protocols have been proposed for ST-segment elevation myocardial infarction (STEMI) low risk patients despite the existence of few but significant cardiovascular events during mid-term follow-up. We aimed to identify a subgroup of patients among those considered low-risk in which prognosis would be particularly good. METHODS: We analyzed 30-day outcomes and long-term follow-up among 1.111 STEMI patients treated with reperfusion therapy...
November 17, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27878902/a-retrospective-comparison-of-intrathecal-morphine-and-epidural-hydromorphone-for-analgesia-following-posterior-spinal-fusion-in-adolescents-with-idiopathic-scoliosis
#19
Rebecca A Hong, Kathleen M Gibbons, G Ying Li, Ashlee Holman, Terri Voepel-Lewis
BACKGROUND: Posterior spinal fusion to correct idiopathic scoliosis is associated with severe postoperative pain. Intrathecal morphine is commonly used for analgesia after adolescent posterior spinal fusion; however, anticipating and managing the increase in pain scores after resolution of analgesic effect of intrathecal morphine analgesia is challenging. In 2014, we developed a clinical protocol detailing both the administration of intrathecal morphine intraoperatively and the transition to routine, scheduled oral analgesics at 18 h postoperatively...
November 22, 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27876328/best-clinical-practice-controversies-in-transient-ischemic-attack-evaluation-and-disposition-in-the-emergency-department
#20
Brit Long, Alex Koyfman
BACKGROUND: Transient ischemic attack (TIA) affects over 200,000 patients annually in the United States, and it precedes approximately 14% to 23% of strokes. Patients are typically admitted for evaluation and management. OBJECTIVE: This review investigates the controversies of emergency department (ED) evaluation of TIA, including imaging, clinical risk scores, rapid diagnostic protocols, and disposition. DISCUSSION: TIA is a common condition, with over 200,000 patients affected annually, and is associated with risk of stroke...
November 19, 2016: Journal of Emergency Medicine
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