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https://www.readbyqxmd.com/read/29457258/quality-of-prescribing-by-physicians-nurse-practitioners-and-physician-assistants-in-the-united-states
#1
Shiyin Jiao, Irene B Murimi, Randall S Stafford, Ramin Mojtabai, G Caleb Alexander
OBJECTIVE: Nurse practitioners (NPs) and physician assistants (PAs) have increasingly broad prescribing authority in the United States, yet little is known regarding how the quality of their prescribing practices compares to that of physicians. The objective of this study was to compare the quality of prescribing practices of physicians and non-physician providers. METHODS: A serial cross-sectional analysis of the 2006-2012 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) was performed...
February 19, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29455786/examination-of-the-appropriate-timing-of-reperfusion-therapy-for-recent-myocardial-infarction-a-japanese-single-center-retrospective-study
#2
Yukio Mizuguchi, Hiroki Shibutani, Sho Hashimoto, Takeshi Yamada, Norimasa Taniguchi, Shunsuke Nakajima, Tetsuya Hata, Akihiko Takahashi
BACKGROUND: The various guidelines clearly mention the treatment strategies for in patient of acute myocardial infarction (MI) presenting more than 24h from symptom onset (recent myocardial infarction, RMI). However, the appropriate timing of reperfusion for RMI is unclear. METHODS: We retrospectively evaluated 525 consecutive MI patients who underwent percutaneous coronary intervention (PCI) in our hospital between January 2008 and December 2012. RESULTS: Sixty RMI patients were more frequently associated with cardiac complications such as myocardial rupture (3...
January 2018: Indian Heart Journal
https://www.readbyqxmd.com/read/29455544/heart-failure-affects-liver-morphology-and-function-what-are-the-clinical-implications
#3
E Goncalvesova, M Kovacova
Liver dysfunction in heart failure is common and usually clinically significant, especially in patients with advanced or severe acute heart failure. Lesions are caused by an impaired hepatic circulation due to congestion and hypoperfusion. Congestive lesions are more common and typically manifested by painful hepatomegaly and increased direct bilirubin and alkaline phosphatase. The inferior vena cava and hepatic veins are usually dilated. Congestive lesions are characterized by dilatation of the central vein with fibrotic changes in the surrounding areas on histological examination...
2018: Bratislavské Lekárske Listy
https://www.readbyqxmd.com/read/29455441/a-proactive-transfer-policy-for-critical-patient-flow-management
#4
Jaime González, Juan-Carlos Ferrer, Alejandro Cataldo, Luis Rojas
Hospital emergency departments are often overcrowded, resulting in long wait times and a public perception of poor attention. Delays in transferring patients needing further treatment increases emergency department congestion, has negative impacts on their health and may increase their mortality rates. A model built around a Markov decision process is proposed to improve the efficiency of patient flows between the emergency department and other hospital units. With each day divided into time periods, the formulation estimates bed demand for the next period as the basis for determining a proactive rather than reactive transfer decision policy...
February 17, 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29455034/preoperative-risk-factors-for-unexpected-postoperative-intensive-care-unit-admission-a-retrospective-case-analysis
#5
Joshua B Knight, Evan E Lebovitz, Theresa A Gelzinis, Ibtesam A Hilmi
INTRODUCTION: The purpose of this retrospective case-control study was to investigate preoperative risk factors for unexpected postoperative intensive care unit (ICU) admissions in patients undergoing non-emergent surgical procedures in a tertiary medical centre. METHODS: A medical record review of adult patients undergoing elective non-cardiac and non-transplant major surgical procedures during the period of January 2011 through December 2015 in the operating rooms of a large university hospital was carried out...
February 15, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29454747/plasminogen-activator-inhibitor-1-reduces-tpa-dependent-fibrinolysis-and-intrahepatic-hemorrhage-in-experimental-acetaminophen-overdose
#6
Asmita Pant, Anna K Kopeć, Kevin S Baker, Holly Cline-Fedewa, Daniel A Lawrence, James P Luyendyk
Acetaminophen (APAP)-induced liver injury in mice is associated with activation of the coagulation cascade and deposition of fibrin in liver. Plasminogen activator inhibitor-1 (PAI-1) is an important physiological inhibitor of tissue-type plasminogen activator (tPA) and plays a critical role in fibrinolysis. PAI-1 expression is increased in both experimental APAP-induced liver injury and patients with acute liver failure. Prior studies have shown that PAI-1 prevents intrahepatic hemorrhage and mortality after APAP challenge, but the downstream mechanisms are not clear...
February 15, 2018: American Journal of Pathology
https://www.readbyqxmd.com/read/29453941/increased-morbidity-and-mortality-associated-with-falls-among-patients-with-cirrhosis
#7
Ghideon Ezaz, Susan L Murphy, Jessica Mellinger, Elliot B Tapper
BACKGROUND: Injuries are more morbid and complicated to manage in patients with cirrhosis. However, data are limited regarding the relative risk of injury and severity of injury from falls in patients with cirrhosis compared to those without cirrhosis. METHODS: We examined the nationally representative National Emergency Department Sample, an all-payer database including all patients presenting with falls 2009-2012. We determined the relative risks for and clinical associations with severe injuries...
February 14, 2018: American Journal of Medicine
https://www.readbyqxmd.com/read/29453737/two-stage-hepatectomy-aiming-for-the-development-of-intrahepatic-venous-collaterals-for-multiple-colorectal-liver-metastases
#8
Harufumi Maki, Shouichi Satou, Kentaro Nakajima, Atsuki Nagao, Kazuteru Watanabe, Hitoshi Satodate, Satoshi Nara, Kaoru Furushima, Yasushi Harihara
BACKGROUND: Aggressive hepatectomy with venous resection has a higher risk of postoperative liver failure (POLF) than hepatectomy without venous reconstruction; however, venous reconstruction is technically demanding. We performed a novel two-stage hepatectomy (TSH) without venous reconstruction in a patient with bilobar multiple colorectal liver metastases located near the caval confluence, waiting for the development of intrahepatic venous collaterals between procedures. CASE PRESENTATION: A 60-year-old man was referred to our hospital with sigmoid colon cancer accompanied by intraabdominal abscess and two synchronous liver metastases...
February 16, 2018: Surgical Case Reports
https://www.readbyqxmd.com/read/29452438/algorithmic-approach-for-intraoperative-salvage-of-venous-congestion-in-diep-flaps
#9
Erica L Bartlett, Dmitry Zavlin, Zachery K Menn, Aldona J Spiegel
BACKGROUND: Flap congestion is a frequently described intraoperative complication during autologous breast reconstruction with abdominal perforator flaps, which, if not addressed, can lead to detrimental results such as flap failure. Here, we describe our institution's algorithm of intraoperative salvage of congested flaps and present their outcomes. METHODS: All patient charts from 2002 to 2016 of a single plastic surgeon were reviewed for patients who underwent deep inferior epigastric perforator flap breast reconstruction resulting in 602 patients and 831 flaps...
February 16, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29451640/glucose-level-evaluation-in-monopedicled-rectus-abdominis-myocutaneous-flap-after-venous-occlusion-experimental-study-in-rats
#10
Gustavo Levacov Berlim, Antônio Carlos Pinto Oliveira, Ciro Paz Portinho, Emerson Morello, Carolina Barbi Linhares, Marcus Vinicius Martins Collares
OBJECTIVE: to validate an experimental model for the measurement of glycemic levels in surgical flaps with the use of common glucometers, and to analyze the diagnostic criteria for hypoperfusion of such flaps. METHODS: we performed vertical myocutaneous rectus abdominis flaps with upper pedicles bilaterally in 20 male Wistar rats, divided into two groups: with and without venous occlusion of the pedicle. We measured glucose levels in the flaps and in the systemic circulation with standard glucometers...
2018: Revista do Colégio Brasileiro de Cirurgiões
https://www.readbyqxmd.com/read/29451295/evaluation-of-hif-1%C3%AE-and-inos-in-ischemia-reperfusion-gastric-model-bioimpedance-histological-and-immunohistochemical-analyses
#11
Eduardo Peña-Mercado, Mario Garcia-Lorenzana, Elena Arechaga-Ocampo, Claudia H González-De la Rosa, Nohra E Beltran
Gastrointestinal ischemia/reperfusion (I/R) generates pathological alterations that could lead to death. Early ischemic damage markers could be used to guide therapy and improve outcomes. AIM: To relate hypoxia-inducible factor 1α (HIF-1α) activation and inducible nitric oxide synthase (iNOS) expression to gastric impedance changes due to I/R damage. METHODS: Experimental animals were randomly distributed into 3 groups: control, ischemia (30 min) and I/R (60 min)...
February 16, 2018: Histology and Histopathology
https://www.readbyqxmd.com/read/29450742/focused-cardiac-ultrasound-as-a-predictor-of-readmission-in-acute-decompensated-heart-failure
#12
Luke J Laffin, Amit V Patel, Narayan Saha, Julian Barbat, James K Hall, Matthew Cain, Kishan Parikh, Jay Shah, Kirk T Spencer
Acute decompensated heart failure (ADHF) is a common reason for admission to the hospital, and readmission is frequent. Multiple factors contribute to rehospitalizations, but inadequate assessment of volume status leading to persistent congestion is an important factor. We sought to determine if focused cardiac ultrasound (FCU) of the inferior vena cava (IVC), as a surrogate of volume status, would predict readmission of ADHF patients after index hospitalization. Patients admitted with a primary diagnosis of ADHF were prospectively enrolled...
February 15, 2018: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/29450383/eyesight-quality-and-computer-vision-syndrome
#13
Camelia Margareta Bogdănici, Diana Elena Săndulache, Corina Andreea Nechita
The aim of the study was to analyze the effects that gadgets have on eyesight quality. A prospective observational study was conducted from January to July 2016, on 60 people who were divided into two groups: Group 1 - 30 middle school pupils with a mean age of 11.9 ± 1.86 and Group 2 - 30 patients evaluated in the Ophthalmology Clinic, "Sf. Spiridon" Hospital, Iași, with a mean age of 21.36 ± 7.16 years. The clinical parameters observed were the following: visual acuity (VA), objective refraction, binocular vision (BV), fusional amplitude (FA), Schirmer's test...
April 2017: Romanian Journal of Ophthalmology
https://www.readbyqxmd.com/read/29449520/-a-case-of-hypertrophic-pachymeningitis-with-symptomatic-venous-congestion-due-to-sinus-stenosis
#14
Sho Umegaki, Shin-Ichiro Osawa, Kensuke Kimura, Toshimi Okushima, Nobuhisa Yajima, Tsuyoshi Kawamura, Teiji Tominaga
We report a patient with hypertrophic pachymeningitis and symptomatic stenosis of the superior sagittal sinus. A 71-year-old man presented with right hemiparesis, sensory-dominant aphasia, and right hemispatial neglect that had been worsening over 2 weeks. Computed tomography showed isodense crescent-shaped lesions deforming the surface of the left cerebral hemisphere, mimicking a subdural hematoma with atypical perifocal edema in the left parietal lobe. Magnetic resonance imaging showed diffuse thickening of the dura mater with contrast enhancement of his left cerebral hemisphere...
February 2018: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/29449412/hemodynamic-characteristics-in-significant-symptomatic-and-asymptomatic-primary-mitral-valve-regurgitation-at-rest-and-during-exercise
#15
Rine Bakkestrøm, Ann Banke, Nicolaj L Christensen, Redi Pecini, Akhmadjon Irmukhamedov, Mads Andersen, Barry A Borlaug, Jacob E Møller
BACKGROUND: In severe asymptomatic primary mitral valve regurgitation without risk factors, surgery strategy is controversial. We sought to clarify whether being symptomatic corresponds to the hemodynamic burden and reduced exercise capacity. A better understanding of this may contribute to optimize timing of surgery. METHODS AND RESULTS: Subjects with asymptomatic (New York Heart Association functional class I, n=29) or symptomatic (New York Heart Association functional class II and III, n=28) significant primary mitral valve regurgitation (effective regurgitant orifice, ≥0...
February 2018: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29448998/cardiac-amyloidosis-from-clinical-suspicion-to-morphological-diagnosis
#16
REVIEW
Pavla Flodrova, Patrik Flodr, Tomas Pika, Jiri Vymetal, Dusan Holub, Petr Dzubak, Marian Hajduch, Vlastimil Scudla
Amyloidosis is a heterogeneous group of diseases characterised by extracellular accumulation of amyloid in various tissues and organs of the body, leading to alteration and destruction of tissues. Heart involvement is the most important prognostic factor in patients with systemic amyloidosis and the diagnosis and typing of amyloid must be made properly. The clinical picture shows congestive heart failure with predominant right-sided heart failure symptoms in fully developed disease, various types of arrhythmias and characteristic electrocardiography and echocardiography findings...
February 12, 2018: Pathology
https://www.readbyqxmd.com/read/29448781/anion-photoelectron-spectroscopy-of-deprotonated-indole-and-indoline
#17
Daniel J Nelson, Allan M Oliveira, W Carl Lineberger
Anion photoelectron spectra of deprotonated indole have been obtained utilizing several photon energies. The slow electron velocity-map imaging spectrum of indolide allows for the determination of the electron affinity (EA) of indolyl, 2.4315 ± 0.0017 eV. The equilibrium geometry of indolide was shown to minimally distort upon photodetachment with only ring distortion vibrational modes of A' symmetry becoming significantly excited. Photoelectron spectra of indolide accessing the electronic ground state of indolyl displayed a photon energy dependence due to electron autodetachment...
February 14, 2018: Journal of Chemical Physics
https://www.readbyqxmd.com/read/29447854/risk-factors-associated-complications-for-postoperative-urinary-retention-after-lumbar-surgery-for-lumbar-spinal-stenosis
#18
Joshua L Golubovsky, Haariss Ilyas, Jinxiao Chen, Joseph E Tanenbaum, Thomas E Mroz, Michael P Steinmetz
BACKGROUND CONTEXT: Postoperative Urinary Retention (POUR) is a very common post-operative complication of all surgeries (5 - 70%) that may lead to complications such as urinary tract infection (UTI), bladder over-distention, autonomic dysregulation, and increased postoperative length of stay (LOS). Within the field of spine surgery, the reported incidence of POUR is highly variable (5.6 - 38%). Lack of clear stratification of surgical level, spinal pathology, and inadequate sample size is a major limitation of available studies concerning POUR following spine surgery that may lead to inconsistency in the incidence of POUR and the ability to model its occurrence and consequences...
February 12, 2018: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/29447344/the-balance-between-short-term-and-long-term-outcomes-of-bilateral-internal-thoracic-artery-skeletonization-in-coronary-artery-bypass-surgery-a-propensity-matched-cohort-study
#19
Janet M C Ngu, Ming Hao Guo, David Glineur, Diem Tran, Fraser D Rubens
OBJECTIVES: There is growing interest in the use of bilateral internal thoracic arteries (BITAs) for myocardial revascularization. This study sought to compare the balance between early benefits and long-term outcomes of skeletonized or non-skeletonized conduits and to determine whether differences in outcomes are affected by other patient risk factors. METHODS: BITAs were used in 1504 cases with either SK or NSK conduits. Propensity matching was completed using 22 covariates identifying 441 pairs of patients...
February 13, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29446730/salvaging-the-ischemic-heart-gi-coupled-receptors-in-mast-cells-activate-a-pkc%C3%AF-aldh2-pathway-providing-anti-ras-cardioprotection
#20
Alice Marino, Roberto Levi
BACKGROUND: Excessive norepinephrine (NE) release in the ischemic heart elicits severe and often lethal arrhythmias. Resident cardiac mast cells synthesize and store active renin, which is released upon degranulation, causing the activation of a local cardiac renin-angiotensin system (RAS) responsible for NE release and consequent arrhythmias. Toxic aldehydes, known to be formed by lipid peroxidation in ischemia/reperfusion (I/R), have been shown to degranulate mast cells and activate a local RAS...
February 13, 2018: Current Medicinal Chemistry
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