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https://www.readbyqxmd.com/read/27913657/cost-benefit-analysis-of-telehealth-in-pre-hospital-care
#1
James R Langabeer, Tiffany Champagne-Langabeer, Diaa Alqusairi, Junghyun Kim, Adria Jackson, David Persse, Michael Gonzalez
OBJECTIVE: There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. METHODS: Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention...
December 2, 2016: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/27913531/treatment-of-older-patients-with-acute-lymphoblastic-leukemia
#2
Nicola Gökbuget
The treatment of older patients with acute lymphoblastic leukemia (ALL) is an unmet medical need. With increasing age, ALL patients have a significantly lower clinical remission rate, higher early mortality, higher relapse rate, and poorer survival compared with younger patients. This is only partly explained by a higher incidence of poor prognostic factors in the older age group. Most importantly, intensive chemotherapy with or without stem cell transplantation (SCT) is less well tolerated in older patients...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27911667/barriers-and-benefits-in-telemedicine-arising-between-a-high-technology-hospital-service-provider-and-remote-public-healthcare-units-a-qualitative-study-in-brazil
#3
Carlos Henrique Amaral de Souza, Renata Albaladejo Morbeck, Milton Steinman, Cora Pereira Hors, Mario Maia Bracco, Elisa H Kozasa, Eliseth Ribeiro Leão
BACKGROUND: In Brazil, the Program for Institutional Development of the Unified Healthcare System (PROADI-SUS) has implemented a telemedicine service for urgent situations and emergencies. It is delivered by a high-technology (HT) hospital to 15 remote healthcare units (RUs) in 11 different Brazilian states. The aim of this study was to investigate possible barriers and benefits in telemedicine service among these units. MATERIALS AND METHODS: We performed a qualitative study on the perceptions of physicians involved in telemedicine service in their role as providers and consultants...
December 2, 2016: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/27910113/diagnostic-accuracy-of-faecal-biomarkers-in-detecting-colorectal-cancer-and-adenoma-in-symptomatic-patients
#4
M M Widlak, C L Thomas, M G Thomas, C Tomkins, S Smith, N O'Connell, S Wurie, L Burns, C Harmston, C Evans, C U Nwokolo, B Singh, R P Arasaradnam
BACKGROUND: The diagnosis of colorectal cancer (CRC) can be difficult as symptoms are variable with poor specificity. Thus, there is a quest for simple, non-invasive testing that can help streamline those with significant colonic pathology. AIM: To assess using faecal immunochemical test for haemoglobin (FIT) or faecal calprotectin (FCP) to detect CRC and adenoma in symptomatic patients referred from primary care. METHODS: A total of 799 referred for urgent lower gastrointestinal investigations were prospectively recruited...
December 1, 2016: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/27909934/current-achievements-and-future-perspectives-of-metronomic-chemotherapy
#5
REVIEW
Adriana Romiti, Rosa Falcone, Michela Roberto, Paolo Marchetti
In recent years, many anticancer drugs have been tested at metronomic dosages for a variety of tumours. Mechanisms of action attributed to metronomic chemotherapy (MCT) include antiangiogenesis, immunomodulation, direct inhibition of tumour growth, effect on tumour initiating cells and the modulation of clonal evolution. An active clinical research, aimed at testing MCT in several cancers, has been conducted over the past 15 years. However, because the majority of available results come from earlier phase II studies, mainly performed in the area of breast cancer (BC), it is clear that there are areas still to be investigated...
December 1, 2016: Investigational New Drugs
https://www.readbyqxmd.com/read/27909570/need-for-accessible-infertility-care-in-ghana-the-patients-voice
#6
Nana Yaw Osei
According to the Ghana Statistical Service (GSS) infertility and childlessness are the most important reason for divorce in Ghana. The traditional Ghanaian society is pro-natal and voluntary childlessness is very uncommon. Patient groups are almost non-existent in Sub-Saharan Africa, aggravating the situation of childless couples. Due to the lack of enough and affordable high quality infertility services, many women resort to traditional healing, witchcraft and spiritual mediation. Considering the severe sociocultural and economic consequences of childlessness, especially for women, there is an urgent need for accessible and affordable high quality infertility care in Ghana...
June 27, 2016: Facts, Views & Vision in ObGyn
https://www.readbyqxmd.com/read/27907954/today-s-approach-to-treating-brain-swelling-in-the-neuro-intensive-care-unit
#7
Shreyansh Shah, W Taylor Kimberly
Brain swelling is an urgent clinical problem that frequently accompanies ischemic stroke, brain hemorrhage, and traumatic brain injury; it increases morbidity and mortality associated with them. It occurs due to failure of membrane transporters and leakage of the blood-brain barrier (BBB), resulting in combination of cytotoxic, ionic, and vasogenic edema. Currently, decompressive craniectomy and osmotherapy are the mainstays of management, but these therapies do not halt the underlying molecular cascade leading to brain swelling...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27906698/ige-and-eosinophils-as-therapeutic-targets-in-asthma
#8
Tanvi R Patel, Sanjiv Sur
PURPOSE OF REVIEW: Asthma is a chronic inflammatory disorder characterized by reversible airflow obstruction, which is being more widely recognized as a broad-spectrum disease that encompasses multiple patient characteristics and pathophysiologic mechanisms. Suboptimal asthma control leads to increasing burden of healthcare costs and loss of productivity to society. Biologic therapies targeted at IgE and eosinophils can be used in poorly controlled allergic and eosinophilic asthma, respectively...
November 30, 2016: Current Opinion in Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/27906029/trends-in-clinical-characteristics-and-outcomes-of-pre-art-care-at-a-large-hiv-clinic-in-nairobi-kenya-a-retrospective-cohort-study
#9
Jared O Mecha, Elizabeth N Kubo, Lucy W Nganga, Peter N Muiruri, Lilian N Njagi, Immaculate N Mutisya, Justine J Odionyi, Syokau C Ilovi, Mary Wambui, Christopher Githu, Richard Ngethe, Elizabeth M Obimbo, Zipporah W Ngumi
BACKGROUND: The success of antiretroviral therapy in resource-scarce settings is an illustration that complex healthcare interventions can be successfully delivered even in fragile health systems. Documenting the success factors in the scale-up of HIV care and treatment in resource constrained settings will enable health systems to prepare for changing population health needs. This study describes changing demographic and clinical characteristics of adult pre-ART cohorts, and identifies predictors of pre-ART attrition at a large urban HIV clinic in Nairobi, Kenya...
November 14, 2016: AIDS Research and Therapy
https://www.readbyqxmd.com/read/27905990/oral-dental-items-in-the-resident-assessment-instrument-minimum-data-set-2-0-lack-validity-results-of-a-retrospective-longitudinal-validation-study
#10
Matthias Hoben, Jeffrey W Poss, Peter G Norton, Carole A Estabrooks
BACKGROUND: Oral health in nursing home residents is poor. Robust, mandated assessment tools such as the Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2.0 are key to monitoring and improving quality of oral health care in nursing homes. However, psychometric properties of RAI-MDS 2.0 oral/dental items have been challenged and criterion validity of these items has never been assessed. METHODS: We used 73,829 RAI-MDS 2.0 records (13,118 residents), collected in a stratified random sample of 30 urban nursing homes in Western Canada (2007-2012)...
October 21, 2016: Population Health Metrics
https://www.readbyqxmd.com/read/27903834/saliva-diagnostics-current-views-and-directions
#11
Karolina Elżbieta Kaczor-Urbanowicz, Carmen Martin Carreras-Presas, Katri Aro, Michael Tu, Franklin Garcia-Godoy, David Tw Wong
In this review, we provide an update on the current and future applications of saliva for diagnostic purposes. There are many advantages of using saliva as a biofluid. Its collection is fast, easy, inexpensive, and non-invasive. In addition, saliva, as a "mirror of the body," can reflect the physiological and pathological state of the body. Therefore, it serves as a diagnostic and monitoring tool in many fields of science such as medicine, dentistry, and pharmacotherapy. Introduced in 2008, the term "Salivaomics" aimed to highlight the rapid development of knowledge about various "omics" constituents of saliva, including: proteome, transcriptome, micro-RNA, metabolome, and microbiome...
November 29, 2016: Experimental Biology and Medicine
https://www.readbyqxmd.com/read/27903774/-they-shouldn-t-be-coming-to-the-ed-should-they-a-descriptive-service-evaluation-of-why-patients-with-palliative-care-needs-present-to-the-emergency-department
#12
Emilie Green, Sarah Ward, Will Brierley, Ben Riley, Henna Sattar, Tim Harris
BACKGROUND: Patients with palliative care needs frequently attend the emergency department (ED). There is no international agreement on which patients are best cared for in the ED, compared to the primary care setting or direct admission to the hospital. This article presents the quantitative phase of a mixed-methods service evaluation, exploring the reasons why patients with palliative care needs present to the ED. METHODS: This is a single-center, observational study including all patients under the care of a specialist palliative care team who presented to the ED over a 10-week period...
November 30, 2016: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27903048/resistance-exercise-induced-rhabdomyolysis-need-for-immediate-intervention-and-proper-counselling
#13
Maysaa A Khalil, Basem R Saab
BACKGROUND: Rhabdomyolysis results from damage to skeletal muscle. Improper resistance training may result in rhabdomyolysis, which can cause acute kidney injury, serious metabolic abnormalities, compartmental syndrome and even death. Proper counselling for athletes may prevent this condition. OBJECTIVE: We present two patients with unilateral swelling after resistance exercise. The workup revealed rhabdomyolysis. We highlight the importance of counselling to prevent rhabdomyolysis secondary to resistance exercise...
December 2016: Australian Family Physician
https://www.readbyqxmd.com/read/27895697/trends-in-clinical-characteristics-and-outcomes-of-pre-art-care-at-a-large-hiv-clinic-in-nairobi-kenya-a-retrospective-cohort-study
#14
Jared O Mecha, Elizabeth N Kubo, Lucy W Nganga, Peter N Muiruri, Lilian N Njagi, Immaculate N Mutisya, Justine J Odionyi, Syokau C Ilovi, Mary Wambui, Christopher Githu, Richard Ngethe, Elizabeth M Obimbo, Zipporah W Ngumi
BACKGROUND: The success of antiretroviral therapy in resource-scarce settings is an illustration that complex healthcare interventions can be successfully delivered even in fragile health systems. Documenting the success factors in the scale-up of HIV care and treatment in resource constrained settings will enable health systems to prepare for changing population health needs. This study describes changing demographic and clinical characteristics of adult pre-ART cohorts, and identifies predictors of pre-ART attrition at a large urban HIV clinic in Nairobi, Kenya...
2016: AIDS Research and Therapy
https://www.readbyqxmd.com/read/27894709/external-validation-in-an-intermediate-unit-of-a-respiratory-decompensation-model-trained-in-an-intensive-care-unit
#15
Holly N Blackburn, Matthew T Clark, Travis J Moss, Jeffrey S Young, J Randall Moorman, Douglas E Lake, J Forrest Calland
BACKGROUND: Preventing urgent intubation and upgrade in level of care in patients with subclinical deterioration could be of great utility in hospitalized patients. Early detection should result in decreased mortality, duration of stay, and/or resource use. The goal of this study was to externally validate a previously developed, vital sign-based, intensive care unit, respiratory instability model on a separate population, intermediate care patients. METHODS: From May 2014 to May 2016, the model calculated relative risk of adverse events every 15 minutes (n = 373,271 observations) for 2,050 patients in a surgical intermediate care unit...
November 25, 2016: Surgery
https://www.readbyqxmd.com/read/27894308/capacity-evaluation-for-general-practitioners-in-pudong-new-area-of-shanghai-an-empirical-study
#16
Ming Li, Zhiqun Shu, Xuan Huang, Zhaohui Du, Jun Wu, Qingshi Xia, Kun Liu, Jiquan Lou, Limei Jing
BACKGROUND: Building highly qualified General Practitioners (GPs) is key to the development of primary health care. It's therefore urgent to ensure the GPs' quality service under the background of the new round of health care system reforms in China. A new model of GP qualification examination was originally implemented in Pudong New Area of Shanghai, China, which aimed to empirically evaluate the GPs' capability in terms of clinical performance and social recognition. In the current study, an analysis was made of the first two years (2014-2015) of such theoretical and practical examinations on the GPs there with a view to getting a deep insight into the GP community so as to identify the barriers to such a form of GP qualification examination...
November 28, 2016: International Journal for Equity in Health
https://www.readbyqxmd.com/read/27893516/caregiver-expectations-and-satisfaction-of-urgent-care-in-a-pediatric-emergency-department
#17
Greg P Marconi, Phung K Pham, Alan L Nager
Health care delivery expectations that may affect patient and caregiver satisfaction are not clearly understood. This study examined caregiver expectations and satisfaction with urgent care in a pediatric emergency department. Of 201 caregivers surveyed, we found that caregivers have specific expectations regarding clinical care of their child in terms of radiographic imaging, blood testing, antibiotics, pain management, and subspecialty consultation. Caregivers were generally less dissatisfied with the actual care provided than the urgent care physicians expected...
November 23, 2016: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27893511/continuous-infusion-antiepileptic-medications-for-refractory-status-epilepticus-a-review-for-nurses
#18
Adam L Wiss, Michael Samarin, Jacob Marler, G Morgan Jones
Status epilepticus requires treatment with emergent initial therapy with a benzodiazepine and urgent control therapy with an additional antiepileptic drug (AED) to terminate clinical and/or electrographic seizure activity. However, nearly one-third of patients will prove refractory to the aforementioned therapies and are prone to a higher degree of neuronal injury, resistance to pharmacotherapy, and death. Current guidelines for refractory status epilepticus (RSE) recommend initiating a continuous intravenous (CIV) anesthetic over bolus dosing with a different AED...
January 2017: Critical Care Nursing Quarterly
https://www.readbyqxmd.com/read/27891229/nicotine-replacement-therapy-for-agitation-and-delirium-management-in-the-intensive-care-unit-a-systematic-review-of-the-literature
#19
Melanie Kowalski, Andrew A Udy, Hayden J McRobbie, Michael J Dooley
BACKGROUND: Active smokers are prevalent within the intensive care setting and place a significant burden on healthcare systems. Nicotine withdrawal due to forced abstinence on admission may contribute to increased agitation and delirium in this patient group. The aim of this systematic review was to determine whether management of nicotine withdrawal, with nicotine replacement therapy (NRT), reduces agitation and delirium in critically ill patients admitted to the intensive care unit (ICU)...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/27889470/delayed-administration-of-dopaminergic-drugs-is-not-associated-with-prolonged-length-of-stay-of-hospitalized-patients-with-parkinson-s-disease
#20
Rob Skelly, Lisa Brown, Andrew Fogarty
BACKGROUND: Punctual delivery of dopaminergic medication to Parkinson's disease (PD) patients may be important in optimizing disease control. We tested the hypothesis that prompt delivery of l-dopa medications to emergency hospital inpatients was associated with a decreased length of stay in hospital. METHODS: The study population consisted of all urgent hospitalizations for patients with a diagnosis of PD to the Royal Derby Hospital over a two-year period. Data were extracted on timing of delivery of drugs, number of co-morbidities and length of stay...
November 14, 2016: Parkinsonism & related Disorders
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