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https://www.readbyqxmd.com/read/28646876/not-all-waits-are-equal-an-exploratory-investigation-of-emergency-care-patient-pathways
#1
Dawn Swancutt, Sian Joel-Edgar, Michael Allen, Daniel Thomas, Heather Brant, Jonathan Benger, Richard Byng, Jonathan Pinkney
BACKGROUND: Increasing pressure in the United Kingdom (UK) urgent care system has led to Emergency Departments (EDs) failing to meet the national requirement that 95% of patients are admitted, discharged or transferred within 4-h of arrival. Despite the target being the same for all acute hospitals, individual Trusts organise their services in different ways. The impact of this variation on patient journey time and waiting is unknown. Our study aimed to apply the Lean technique of Value Stream Mapping (VSM) to investigate care processes and delays in patient journeys at four contrasting hospitals...
June 24, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28646775/consequences-of-intensive-forest-harvesting-on-the-recovery-of-swedish-lakes-from-acidification-and-on-critical-load-exceedances
#2
Filip Moldan, Johanna Stadmark, Jens Fölster, Sara Jutterström, Martyn N Futter, Bernard J Cosby, Richard F Wright
Across much of the northern hemisphere, lakes are at risk of re-acidification due to incomplete recovery from historical acidification and pressures associated with more intensive forest biomass harvesting. Critical load (CL) calculations aimed at estimating the amount of pollutants an ecosystem can receive without suffering adverse consequences are dependent on these factors. Here, we present a modelling study of the potential effects of intensified forest harvesting on re-acidification of a set of 3239 Swedish lakes based on scenarios with varying intensities of forest biomass harvest and acid deposition...
June 21, 2017: Science of the Total Environment
https://www.readbyqxmd.com/read/28645890/tailored-communication-within-mobile-apps-for-diabetes-self-management-a-systematic-review
#3
Heidi Holmen, Astrid Klopstad Wahl, Milada Cvancarova Småstuen, Lis Ribu
BACKGROUND: The prevalence of diabetes is increasing and with the requirements for self-management and risk of late complications, it remains a challenge for the individual and society. Patients can benefit from support from health care personnel in their self-management, and the traditional communication between patients and health care personnel is changing. Smartphones and apps offer a unique platform for communication, but apps with integrated health care personnel communication based on patient data are yet to be investigated to provide evidence of possible effects...
June 23, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28644115/evaluation-of-the-effectiveness-and-cost-effectiveness-of-lightweight-fibreglass-heel-casts-in-the-management-of-ulcers-of-the-heel-in-diabetes-a-randomised-controlled-trial
#4
William Jeffcoate, Frances Game, Vivienne Turtle-Savage, Alison Musgrove, Patricia Price, Wei Tan, Lucy Bradshaw, Alan Montgomery, Deborah Fitzsimmons, Angela Farr, Thomas Winfield, Ceri Phillips
BACKGROUND: Ulcers of the foot in people with diabetes mellitus are slow to heal and result in considerable cost and patient suffering. The prognosis is worst for ulcers of the heel. OBJECTIVE: To assess both the clinical effectiveness and the cost-effectiveness of lightweight fibreglass casts in the management of heel ulcers. DESIGN: A pragmatic, multicentre, parallel, observer-blinded randomised controlled trial. A central randomisation centre used a computer-generated random number sequence to allocate participants to groups...
May 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28644074/reinforcing-marginality-maternal-health-interventions-in-rural-nicaragua
#5
Birgit Kvernflaten
To achieve Millennium Development Goal 5 on maternal health, many countries have focused on marginalized women who lack access to care. Promoting facility-based deliveries to ensure skilled birth attendance and emergency obstetric care has become a main measure for preventing maternal deaths, so women who opt for home births are often considered 'marginal' and in need of targeted intervention. Drawing upon ethnographic data from Nicaragua, this paper critically examines the concept of marginality in the context of official efforts to increase institutional delivery amongst the rural poor, and discusses lack of access to health services among women living in peripheral areas as a process of marginalization...
June 23, 2017: Anthropology & Medicine
https://www.readbyqxmd.com/read/28640019/mini-fluid-challenge-of-100-ml-of-crystalloid-predicts-fluid-responsiveness-in-the-operating-room
#6
Matthieu Biais, Hugues de Courson, Romain Lanchon, Bruno Pereira, Guillaume Bardonneau, Marion Griton, Musa Sesay, Karine Nouette-Gaulain
BACKGROUND: Mini-fluid challenge of 100 ml colloids is thought to predict the effects of larger amounts of fluid (500 ml) in intensive care units. This study sought to determine whether a low quantity of crystalloid (50 and 100 ml) could predict the effects of 250 ml crystalloid in mechanically ventilated patients in the operating room. METHODS: A total of 44 mechanically ventilated patients undergoing neurosurgery were included. Volume expansion (250 ml saline 0...
June 21, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28639707/dressings-and-topical-agents-for-treating-pressure-ulcers
#7
REVIEW
Maggie J Westby, Jo C Dumville, Marta O Soares, Nikki Stubbs, Gill Norman
BACKGROUND: Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and promote healing, and there are many options to choose from including alginate, hydrocolloid and protease-modulating dressings. Topical agents have also been used as alternatives to dressings in order to promote healing.A clear and current overview of all the evidence is required to facilitate decision-making regarding the use of dressings or topical agents for the treatment of pressure ulcers...
June 22, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28631809/anabolic-steroids-for-treating-pressure-ulcers
#8
REVIEW
Cho Naing, Maxine A Whittaker
BACKGROUND: Pressure ulcers, also known as bed sores, pressure sores or decubitus ulcers develop as a result of a localised injury to the skin or underlying tissue, or both. The ulcers usually arise over a bony prominence, and are recognised as a common medical problem affecting people confined to a bed or wheelchair for long periods of time. Anabolic steroids are used as off-label drugs (drugs which are used without regulatory approval) and have been used as adjuvants to usual treatment with dressings, debridement, nutritional supplements, systemic antibiotics and antiseptics, which are considered to be supportive in healing of pressure ulcers...
June 20, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28629455/an-investigation-of-the-relationship-between-autonomy-childbirth-practices-and-obstetric-fistula-among-women-in-rural-lilongwe-district-malawi
#9
Julika Ayla Kaplan, Jonathan Kandodo, Joseph Sclafani, Susan Raine, Jennifer Blumenthal-Barby, Alison Norris, Abigail Norris-Turner, Elly Chemey, John Michael Beckham, Zara Khan, Reginald Chunda
BACKGROUND: Obstetric fistula is a childbirth injury caused by prolonged obstructed labor that results in destruction of the tissue wall between the vagina and bladder. Although obstetric fistula is directly caused by prolonged obstructed labor, many other factors indirectly increase fistula risk. Some research suggests that many women in rural Malawi have limited autonomy and decision-making power in their households. We hypothesize that women's limited autonomy may play a role in reinforcing childbirth practices that increase the risk of obstetric fistula in this setting by hindering access to emergency care and further prolonging obstructed labor...
June 19, 2017: BMC International Health and Human Rights
https://www.readbyqxmd.com/read/28626152/development-of-risk-assessment-scales-for-needed-support-long-term-care-certification-a-longitudinal-study-using-the-kihon-checklist-and-medical-assessment-data
#10
Taishi Tsuji, Daisuke Takagi, Naoki Kondo, Katsunori Kondo
Objectives This study aimed to develop risk assessment scales for predicting the incidence of Needed Support/Long-Term Care certification, by aggregating data from the Kihon Checklist, medical assessments, and long-term care insurance certification during a follow-up period (a maximum of 4 years and 2 months) conducted in a municipality.Methods This retrospective cohort study included 72,127 older adults aged 65 years or older living in K City (an ordinance-designated city) who responded to the Kihon Checklist in 2011...
2017: [Nihon Kōshū Eisei Zasshi] Japanese Journal of Public Health
https://www.readbyqxmd.com/read/28625260/-predictive-value-of-four-different-scoring-systems-for-septic-patient-s-outcome-a-retrospective-analysis-with-311-patients
#11
Shengbiao Wang, Tao Li, Yunfeng Li, Jianwen Zhang, Xingui Dai
OBJECTIVE: To study the predicting value of four different scoring systems such as the acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, quick SOFA (qSOFA) score and systemic inflammatory response syndrome (SIRS) score for the prognosis of septic patients. METHODS: A retrospective analysis were conducted. Septic patients in intensive care unit (ICU) of the First People's Hospital of Chenzhou form July 1st, 2012 to June 30th, 2016 were enrolled...
February 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28625254/-a-multicenter-confirmatory-study-about-precision-and-practicability-of-sepsis-3
#12
Xiaotong Hu, Mingjie Wu, Qiang Fang
OBJECTIVE: To clinically validate the precision of diagnostic Sepsis-3 criteria, and to guide and generalize its clinical application. METHODS: A multicenter retrospective observational study was conducted. The patients admitted to intensive care unit (ICU) of 6 tertiary hospitals in Zhejiang Province from January to June 2015 were enrolled, and the patients satisfying the diagnostic criteria of Sepsis-2 and Sepsis-3 were screened. Population characteristics between the patients satisfying two editions were compared, and the diagnosis accuracy rate in different degree hospitals were investigated...
February 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28619766/diagnostic-performance-of-an-automatic-blood-pressure-measurement-device-microlife-watchbp-home-a-for-atrial-fibrillation-screening-in-a-real-world-primary-care-setting
#13
Pak-Hei Chan, Chun-Ka Wong, Louise Pun, Yu-Fai Wong, Michelle Man-Ying Wong, Daniel Wai-Sing Chu, Chung-Wah Siu
OBJECTIVE: To evaluate the diagnostic performance of a UK National Institute for Health and Care Excellence-recommended automatic oscillometric blood pressure (BP) measurement device incorporated with an atrial fibrillation (AF) detection algorithm (Microlife WatchBP Home A) for real-world AF screening in a primary healthcare setting. SETTING: Primary healthcare setting in Hong Kong. INTERVENTIONS: This was a prospective AF screening study carried out between 1 September 2014 and 14 January 2015...
June 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/28619268/ankle-hindfoot-after-calcaneal-fractures-a-biomechanical-study
#14
Xu Can, Li Mingqing, Wang Chenggong, Li Kanghua, Liu Hua
INTRODUCTION: Both the overall shape of the calcaneus and anatomical reduction of joint congruity are important prognostic factors. However, there is a significant lack of biomechanical data supporting the clinical importance of calcaneus height, length and heel width. The objective of this study was to determine the effects of abnormal calcaneus morphology on ankle-hindfoot biomechanics. HYPOTHESIS: The normal biomechanics of the ankle-hindfoot would be severely disrupted by the abnormal calcaneus morphology...
June 12, 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/28616361/hyperbaric-oxygen-therapy-side-effects-defined-and-quantified
#15
REVIEW
Marvin Heyboer, Deepali Sharma, William Santiago, Norman McCulloch
Significance: Hyperbaric oxygen therapy (HBOT) is an important advanced therapy in the treatment of problem wounds, including diabetic foot ulcers and late effect radiation injury. HBOT remains among the safest therapies used today. Nonetheless, there are side effects associated with HBOT. It is important for providers to be able to identify, understand, and quantify these side effects for prevention, management, and informed consent. Recent Advances: The past two decades have seen significant advancements in our understanding of the underlying mechanisms of HBOT...
June 1, 2017: Advances in Wound Care
https://www.readbyqxmd.com/read/28608962/image-based-computational-fluid-dynamics-in-the-lung-virtual-reality-or-new-clinical-practice
#16
REVIEW
Kelly S Burrowes, Jan De Backer, Haribalan Kumar
The development and implementation of personalized medicine is paramount to improving the efficiency and efficacy of patient care. In the respiratory system, function is largely dictated by the choreographed movement of air and blood to the gas exchange surface. The passage of air begins in the upper airways, either via the mouth or nose, and terminates at the alveolar interface, while blood flows from the heart to the alveoli and back again. Computational fluid dynamics (CFD) is a well-established tool for predicting fluid flows and pressure distributions within complex systems...
June 13, 2017: Wiley Interdisciplinary Reviews. Systems Biology and Medicine
https://www.readbyqxmd.com/read/28604339/obesity-markers-associated-to-albuminuria-in-a-primary-care-center-in-lima-per%C3%A3%C2%BA
#17
Alberto E Quintanilla, Álvaro Taype-Rondan, María Lazo-Porras, Percy Herrera-Añazco
OBJECTIVE: To evaluate the association between three obesity markers, body mass index (BMI), abdominal circumference (AC), waist to height ratio (WHtR), and albuminuria in adults seen in a primary health care center specialized in chronic diseases in Lima, Perú. METHODS: A cross-sectional, descriptive, retrospective study in adults who attended a primary health care center specialized in chronic diseases in 2011. Patients were divided into four categories: healthy subjects and patients with high blood pressure, with type 2 diabetes mellitus (T2DM), and with both diseases (HBP+T2DM)...
June 2017: Endocrinología, diabetes y nutrición
https://www.readbyqxmd.com/read/28599216/fuzzy-risk-stratification-and-risk-assessment-model-for-clinical-monitoring-in-the-icu
#18
Albion Dervishi
BACKGROUND: The decisions that clinicians make in intensive care units (ICUs) based on monitored parameters reflecting physiological deterioration are of major medical and biomedical engineering interest. These parameters have been investigated and assessed for their usefulness in risk assessment. METHODS: Totally, 127 ICU adult patients were studied. They were selected from a MIMIC II Waveform Database Matched Subset and had continuous monitoring of heart rate, invasive blood pressure, and oxygen saturation...
June 2, 2017: Computers in Biology and Medicine
https://www.readbyqxmd.com/read/28598920/aerosolized-vasodilators-for-the-treatment-of-pulmonary-hypertension-in-cardiac-surgical-patients-a-systematic-review-and-meta-analysis
#19
Mahsa Elmi-Sarabi, Alain Deschamps, Stéphane Delisle, Hosham Ased, François Haddad, Yoan Lamarche, Louis P Perrault, Jean Lambert, Alexis F Turgeon, André Y Denault
BACKGROUND: In cardiac surgery, pulmonary hypertension is an important prognostic factor for which several treatments have been suggested over time. In this systematic review and meta-analysis, we compared the efficacy of inhaled aerosolized vasodilators to intravenously administered agents and to placebo in the treatment of pulmonary hypertension during cardiac surgery. We searched MEDLINE, CENTRAL, EMBASE, Web of Science, and clinicaltrials.gov databases from inception to October 2015...
June 7, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28598049/diabetes-drug-prescription-pattern-and-awareness-among-health-care-providers-in-sub-himalayan-region-of-india-a-population-based-study
#20
Jatinder Mokta, Kiran Mokta, Asha Ranjan, Ivan Joshi, Mahak Garg
BACKGROUND: To determine the pattern of diabetic drug prescription and awareness about diabetes among primary health providers in the rural areas of Himachal Pradesh situated in the western Himalayas at an elevation range from 350 meters (1,148ft) to 6900 meters (22,966ft) above sea level. METHODS AND MATERIAL: Study was conducted in 20 rural areas of Himachal Pradesh, located 50 to 400 Km from state capital, at 2200 to 10,000 feet altitude. Non-pregnant diabetic adults were surveyed through 31 diabetic camps...
May 2017: Journal of the Association of Physicians of India
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