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https://www.readbyqxmd.com/read/27900923/-the-infection-risk-scan-in-clinical-practice-improving-infection-prevention-and-antibiotic-use-through-transparency
#1
I Willemsen, J A J W Kluytmans
OBJECTIVE: The increase in Highly Resistant Micro-Organisms (HRMO) in hospitals and nursing homes requires an intensification of infection prevention measures. This paper describes a new, standardised approach to infection prevention and monitoring of antibiotic use. DESIGN: Cross-sectional, observational study. METHOD: The Infection RIsk Scan (IRIS) measures a number of objectifiable variables in the field of infection prevention, including the dissemination of HRMO, the use of antibiotics and indwelling medical devices, environmental contamination, hand hygiene and personal hygiene of healthcare workers, and various infection control preconditions...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27875542/educational-outreach-with-an-integrated-clinical-tool-for-nurse-led-non-communicable-chronic-disease-management-in-primary-care-in-south-africa-a-pragmatic-cluster-randomised-controlled-trial
#2
Lara R Fairall, Naomi Folb, Venessa Timmerman, Carl Lombard, Krisela Steyn, Max O Bachmann, Eric D Bateman, Crick Lund, Ruth Cornick, Gill Faris, Thomas Gaziano, Daniella Georgeu-Pepper, Merrick Zwarenstein, Naomi S Levitt
BACKGROUND: In many low-income countries, care for patients with non-communicable diseases (NCDs) and mental health conditions is provided by nurses. The benefits of nurse substitution and supplementation in NCD care in high-income settings are well recognised, but evidence from low- and middle-income countries is limited. Primary Care 101 (PC101) is a programme designed to support and expand nurses' role in NCD care, comprising educational outreach to nurses and a clinical management tool with enhanced prescribing provisions...
November 2016: PLoS Medicine
https://www.readbyqxmd.com/read/27858912/a-randomized-controlled-clinical-trial-on-the-impact-of-ccr5-blockade-with-maraviroc-in-early-infection-on-t-cell-dynamics
#3
Maile Y Karris, Anya Umlauf, Florin Vaida, Douglas Richman, Susan Little, Davey Smith
BACKGROUND: Initiation of antiretroviral therapy (ART) in early HIV infection demonstrates clinical benefits including enhanced CD4 T-lymphocyte recovery and minimization of the latent HIV reservoir. Whether ART intensification with CCR5 blockade provides additional benefits is unknown. TRIAL DESIGN: This randomized controlled trial evaluated the impact of maraviroc (MVC) intensification in persons starting ART in acute and early HIV (AEH, within 3 months of estimated date of infection)...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27854311/care-seeking-for-diarrhoea-in-southern-malawi-attitudes-practices-and-implications-for-diarrhoea-control
#4
Salule Masangwi, Neil Ferguson, Anthony Grimason, Tracy Morse, Lawrence Kazembe
This paper examined care-seeking behaviour and its associated risk factors when a family member had diarrhoea. Data was obtained from a survey conducted in Chikwawa, a district in Southern Malawi. Chikwawa is faced with a number of environmental and socioeconomic problems and currently diarrhoea morbidity in the district is estimated at 24.4%, statistically higher than the national average of 17%. Using hierarchically built data from a survey of 1403 households nested within 33 communities, a series of two level binary logistic regression models with Bayesian estimation were used to determine predictors of care-seeking behaviour...
November 15, 2016: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/27801415/-comparative-evaluation-of-the-intensity-of-reparative-processes-in-the-lower-extremity-soft-tissues-of-diabetic-patients-receiving-local-negative-pressure-wound-treatment-and-standard-wound-care
#5
G R Galstyan, A Yu Tokmakova, E L Zaitseva, L P Doronina, I A Voronkova, R V Molchkov
AIM: To study the intensity of soft tissue repair in patients with diabetic foot syndrome (DFS) during local negative pressure wound treatment versus standard wound care. SUBJECTS AND METHODS: The investigators estimated the clinical (wound sizes, local tissue oxygenation), histological (light microscopy), and immunohistochemical (CD31, CD68, MMP-9, and TIMP-1) markers for reparative processes in patients with DFS during vacuum therapy versus standard wound care...
2016: Terapevticheskiĭ Arkhiv
https://www.readbyqxmd.com/read/27792661/treatment-intensification-for-hypertension-in-us-ambulatory-medical-care
#6
Lin Mu, Kenneth J Mukamal
BACKGROUND: Hypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all-cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care. METHODS AND RESULTS: Using the nationally representative National Ambulatory Medical Care Survey (2005-2012) and National Hospital Ambulatory Medical Care Survey (2005-2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication...
October 22, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27785777/current-management-of-childhood-acute-myeloid-leukemia
#7
Jeffrey E Rubnitz
The outcome for children with acute myeloid leukemia (AML) has improved significantly over the past 30 years, with complete remission and overall survival rates exceeding 90 and 60%, respectively, in recent clinical trials. However, these improvements have not been achieved by the introduction of new agents. Instead, intensification of standard chemotherapy, more precise risk classification, improvements in supportive care, and the use of minimal residual disease to monitor response to therapy have all contributed to this success...
October 27, 2016: Paediatric Drugs
https://www.readbyqxmd.com/read/27762199/using-an-electronic-platform-interactively-to-improve-treatment-outcome-in-patients-with-rheumatoid-arthritis-new-developments-from-the-danbio-registry
#8
Merete L Hetland, Niels Steen Krogh, Kim Hørslev-Petersen, Berit Schiøttz-Christensen, Inge Juul Sørensen, Jensen Dorte Vendelbo
OBJECTIVES: Electronic platforms have been developed to help the clinician monitor disease activity in rheumatoid arthritis (RA) to support at treat-to-target strategy. We present an initiative to interactively improve disease control in patients with rheumatoid arthritis. METHODS: In patients who presented with one or more swollen joints AND moderate/high disease activity (i.e. either CDAI≥10.1 and/or DAS-28CRP>3.2, which is automatically calculated in the DANBIO registry), a red alert was shown, which activated a pop-up: "This patient has at least one swollen joint AND either CDAI≥ 10...
September 2016: Clinical and Experimental Rheumatology
https://www.readbyqxmd.com/read/27742406/role-of-transoral-robotic-surgery-in-current-head%C3%A2-%C3%A2-neck-practice
#9
David Hamilton, Vinidh Paleri
Morbidity and mortality associated with increasingly radical doses of chemoradiotherapy have led many to question the current standard of care in head and neck cancer. Recently, surgeons have developed minimally invasive, transoral techniques which have demonstrated excellent survival and favourable functional outcomes. Transoral robotic surgery (TORS) is the most recent, cutting edge in the evolution of transoral techniques; TORS allows surgeons unprecedented access to and visualisation of the upper aerodigestive tract...
October 11, 2016: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
https://www.readbyqxmd.com/read/27730483/patients-future-expectations-for-diabetes-and-hypertension-treatments-through-the-diet%C3%A2-i-think-this-is-going-to-go-away
#10
Paige C Fairchild, Aviva G Nathan, Michael Quinn, Elbert S Huang, Neda Laiteerapong
BACKGROUND: Diabetes and hypertension are chronic conditions for which over 90 % of patients require medication regimens that must be intensified over time. However, delays in intensification are common, and may be partially due to unrealistic patient expectations. OBJECTIVE: To explore whether patient expectations regarding their diabetes and hypertension are congruent with the natural history of these conditions. DESIGN: Qualitative analysis of semi-structured interviews...
October 11, 2016: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/27716107/-that-was-intense-spirituality-during-childbirth-a-mixed-method-comparative-study-of-mothers-and-fathers-experiences-in-a-public-hospital
#11
Marie-Noëlle Bélanger-Lévesque, Marc Dumas, Simon Blouin, Jean-Charles Pasquier
BACKGROUND: While spirituality is well described in end-of-life care literature, research on its place in the delivery room remains largely limited to mother-oriented qualitative studies focusing on life-threatening situations (e.g., high-risk pregnancies). Our aim was to compare mothers' and fathers' spirituality during childbirth. METHODS: A mixed methods questionnaire was developed from our childbirth-related spirituality categorization and distributed to all parents of newborns, 12-24 h postpartum, over 45 consecutive days...
September 30, 2016: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/27686651/value-of-video-monitoring-for-nocturnal-seizure-detection-in-a-residential-setting
#12
Marije van der Lende, Fieke M E Cox, Gerhard H Visser, Josemir W Sander, Roland D Thijs
OBJECTIVE: Following a sudden death at a residential care unit, the Dutch Health and Care Inspectorate advised intensification of the use of video monitoring (VM) at the unit. We assessed whether VM resulted in increased identification of seizures that required clinical intervention. METHODS: The unit provides care for 340 individuals with refractory epilepsy and severe learning disabilities. Acoustic detection systems (ADSs) cover all individuals; 37 people also have a bed motion sensor (BMS) and 46 people with possible nocturnal seizures are now monitored by VM...
November 2016: Epilepsia
https://www.readbyqxmd.com/read/27684464/device-life-of-the-tracheoesophageal-voice-prosthesis-revisited
#13
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
https://www.readbyqxmd.com/read/27646493/reasons-for-non-intensification-of-treatment-in-people-with-type-2-diabetes-receiving-oral-monotherapy-outcomes-from-the-prospective-diattitude-study
#14
Beverley Balkau, Serge Halimi, Jean-Frédéric Blickle, Bruno Vergès, Antoine Avignon, Claude Attali, Isabelle Chartier, Elisabeth Amelineau
OBJECTIVES: To describe the management of glucose-lowering agents in people with type 2 diabetes initially on oral monotherapy, cared for by French general practitioners, and to identify reasons underlying treatment non-intensification. METHODS: People with type 2 diabetes on oral monotherapy were recruited by general practitioners and followed-up over 12 months. Patient characteristics, HbA1c, and glucose-lowering treatments were recorded electronically. Management objectives and reasons for treatment non-intensification were solicited from the general practitioners...
December 2016: Annales D'endocrinologie
https://www.readbyqxmd.com/read/27599072/the-individual-contribution-and-relative-importance-of-self-management-and-quality-of-care-on-glycaemic-control-in-type-2-diabetes
#15
Yolanda V Martínez, Stephen M Campbell, Mark Hann, Peter Bower
OBJECTIVE: To evaluate the relative importance of selfmanagement (SM) and quality of care (QoC) inpredicting glycaemic control in patients with type 2 diabetes. MATERIALS AND METHODS: A longitudinal cohort study was conducted in 204 adults diagnosed with type 2 diabetes. Self-management and quality of care were measured at baseline. HbA1c was measured at baseline and at six-month follow-up. RESULTS: None of the measures of self-management were significantly associated with HbA1c...
August 2016: Salud Pública de México
https://www.readbyqxmd.com/read/27579824/-act-on-threes-paradigm-for-treatment-intensification-of-type-2-diabetes-in-managed-care-results-of-a-randomized-controlled-study-with-an-educational-intervention-targeting-improved-glycemic-control
#16
Nella Bieszk, Shannon L Reynolds, Wenhui Wei, Cralen Davis, Pravin Kamble, Claudia Uribe
BACKGROUND: Clinical inertia, which has been defined as the recognition of a problem with a patient's management but failing to act, is a concern in type 2 diabetes (T2D) because it places the patient at risk of diabetes-related complications. Despite managed care organizations making significant investment in this area, little is known about the impact of educational programs aimed at aligning patients and their physicians with diabetes guidelines and thus overcoming clinical inertia...
September 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27578474/burden-of-copd-in-patients-treated-in-different-care-settings-in-the-netherlands
#17
Dionne E Smid, Martijn A Spruit, Sarah Houben-Wilke, Jean W M Muris, Gernot G U Rohde, Emiel F M Wouters, Frits M E Franssen
INTRODUCTION: Care for patients with chronic obstructive pulmonary disease (COPD) can be provided in primary, secondary or tertiary care. Whether and to what extent patients with COPD treated in various healthcare settings differ in disease burden and healthcare utilization remains unknown. Therefore, daily symptoms, functional mobility, mood status, health status and healthcare utilization were compared between COPD patients in various care settings, to explore possibilities for healthcare-optimization...
September 2016: Respiratory Medicine
https://www.readbyqxmd.com/read/27574744/-act-on-threes-paradigm-for-treatment-intensification-of-type-2-diabetes-in-managed-care-results-of-a-randomized-controlled-study-with-an-educational-intervention-targeting-improved-glycemic-control
#18
Nella Bieszk, Shannon L Reynolds, Wenhui Wei, Cralen Davis, Pravin Kamble, Claudia Uribe
BACKGROUND: Clinical inertia, which has been defined as the recognition of a problem with a patient's management but failing to act, is a concern in type 2 diabetes (T2D) because it places the patient at risk of diabetes-related complications. Despite managed care organizations making significant investment in this area, little is known about the impact of educational programs aimed at aligning patients and their physicians with diabetes guidelines and thus overcoming clinical inertia...
September 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27570359/healthcare-assistants-distributional-losses-as-a-consequence-of-nhs-modernisation
#19
Ian Clark, Amanda Thompson
This paper examines the labour process of Healthcare Assistants (HCAs) at a National Health Service (NHS) hospital trust (TUH) in the context of the NHS modernisation agenda. It determines whether application of the modernisation agenda is formalised at TUH and considers how HCAs are affected. The paper is based upon 60 interviews with HCAs, structured questionnaires completed by all interview respondents, observation of HCAs and interviews with non-clinical managers. The findings show that elements of the modernisation agenda are informally implemented at TUH to the detriment of HCAs...
November 2015: New Technology, Work and Employment
https://www.readbyqxmd.com/read/27553193/clinical-action-measures-improve-the-reliability-of-feedback-on-quality-of-care-in-diabetes-centres-a-retrospective-cohort-study
#20
Astrid Lavens, Kris Doggen, Chantal Mathieu, Frank Nobels, Evy Vandemeulebroucke, Michel Vandenbroucke, Ann Verhaegen, Viviane Van Casteren
BACKGROUND: Assessment of quality of care using classical threshold measures (TM) is open to debate. Measures that take into account the clinician's actions and the longitudinal nature of chronic care are more reliable, although their major limitation is that they require more sophisticated electronic health records. We created a clinical action measure (CAM) for the control of LDL and non-HDL cholesterol from low-complexity data, and investigated how quality of care in individual diabetes centres based on the CAM is related to that based on the classical TM...
2016: BMC Health Services Research
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