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https://www.readbyqxmd.com/read/28388818/enhancing-quality-of-provider-practices-for-older-adults-in-the-emergency-department-equipped
#1
Melissa Stevens, Susan N Hastings, Alayne D Markland, Ula Hwang, William Hung, Ann E Vandenberg, William Bryan, Dewayne Cross, James Powers, Gerald McGwin, Noor Fattouh, William Ho, Carolyn Clevenger, Camille P Vaughan
EQUiPPED is a multicomponent quality improvement initiative combining education, electronic clinical decision support, and individual provider feedback to influence prescribing and improve medication safety for older adults. The objective here was to evaluate the effectiveness and sustainability of EQUiPPED to reduce the use of potentially inappropriate medications (PIMs), as defined by the American Geriatrics Society 2012 Beers Criteria, prescribed to older Veterans at the time of emergency department (ED) discharge...
April 7, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28360508/new-applications-of-schr%C3%A3-dinger-type-inequalities-to-the-existence-and-uniqueness-of-schr%C3%A3-dingerean-equilibrium
#2
Jianjie Wang, Hugo Roncalver
As new applications of Schrödinger type inequalities appearing in Jiang (J. Inequal. Appl. 2016:247, 2016), we first investigate the existence and uniqueness of a Schrödingerean equilibrium. Next we propose a tritrophic Hastings-Powell model with two different Schrödingerean time delays. Finally, the stability and direction of the Schrödingerean Hopf bifurcation are also investigated by using the center manifold theorem and normal form theorem.
2017: Journal of Inequalities and Applications
https://www.readbyqxmd.com/read/28301707/authenticity-best-interest-and-clinical-nudging
#3
Søren Holm
In this issue of the Hastings Center Report, Moti Gorin, Steven Joffe, Neal Dickert, and Scott Halpern offer a comprehensive defense of the use of nudging techniques in the clinical context, with the aim of promoting the best interests of patients. Their argument is built on three important claims: Nudging is ubiquitous and inescapable in clinical choice situations, and there is no neutral way of informing patients about their treatment choices; many patients do not have authentic (preexisting) preferences concerning their treatment choices, and those that do can easily resist nudging; and, finally, since many people lack authentic preferences and those that do can still act on their preferences, nudging in the patients' best interest is justified...
March 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28301706/facts-values-and-journalism
#4
Susan Gilbert
At a time of fake news, hacks, leaks, and unverified reports, many people are unsure whom to believe. How can we communicate in ways that make individuals question their assumptions and learn? My colleagues at The Hastings Center and many journalists and scientists are grappling with this question and have, independently, reached the same first step: recognize that facts can't be fully understood without probing their connection to values. "Explaining the basics is important, of course, but we also need to diversify our approach to the coverage of science-particularly as it intersects with the matrix of cultural, religious, social, and political values of our readers," said an article in Undark, an online magazine of science journalism...
March 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28301699/coercion-and-access-to-health-care
#5
Keramet Reiter
In this issue of the Hastings Center Report, Paul Christopher and colleagues describe a study of why prisoners choose to enroll in clinical research. The article represents an important methodological and policy contribution to the literature on prisoner participation in research and medical experimentation. Given the methodological and ethical debates to which this research seeks to make an empirical contribution, the careful manner in which the study was conducted and the transparency with which the authors describe the research is especially noteworthy...
March 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28157371/search-for-b-%C3%A2-k-%C3%AF-%C3%AF-at-the-babar-experiment
#6
J P Lees, V Poireau, V Tisserand, E Grauges, A Palano, G Eigen, D N Brown, Yu G Kolomensky, H Koch, T Schroeder, C Hearty, T S Mattison, J A McKenna, R Y So, V E Blinov, A R Buzykaev, V P Druzhinin, V B Golubev, E A Kravchenko, A P Onuchin, S I Serednyakov, Yu I Skovpen, E P Solodov, K Yu Todyshev, A J Lankford, J W Gary, O Long, A M Eisner, W S Lockman, W Panduro Vazquez, D S Chao, C H Cheng, B Echenard, K T Flood, D G Hitlin, J Kim, T S Miyashita, P Ongmongkolkul, F C Porter, M Röhrken, Z Huard, B T Meadows, B G Pushpawela, M D Sokoloff, L Sun, J G Smith, S R Wagner, D Bernard, M Verderi, D Bettoni, C Bozzi, R Calabrese, G Cibinetto, E Fioravanti, I Garzia, E Luppi, V Santoro, A Calcaterra, R de Sangro, G Finocchiaro, S Martellotti, P Patteri, I M Peruzzi, M Piccolo, A Zallo, S Passaggio, C Patrignani, B Bhuyan, U Mallik, C Chen, J Cochran, S Prell, H Ahmed, A V Gritsan, N Arnaud, M Davier, F Le Diberder, A M Lutz, G Wormser, D J Lange, D M Wright, J P Coleman, E Gabathuler, D E Hutchcroft, D J Payne, C Touramanis, A J Bevan, F Di Lodovico, R Sacco, G Cowan, Sw Banerjee, D N Brown, C L Davis, A G Denig, M Fritsch, W Gradl, K Griessinger, A Hafner, K R Schubert, R J Barlow, G D Lafferty, R Cenci, A Jawahery, D A Roberts, R Cowan, R Cheaib, S H Robertson, B Dey, N Neri, F Palombo, L Cremaldi, R Godang, D J Summers, P Taras, G De Nardo, C Sciacca, G Raven, C P Jessop, J M LoSecco, K Honscheid, R Kass, A Gaz, M Margoni, M Posocco, M Rotondo, G Simi, F Simonetto, R Stroili, S Akar, E Ben-Haim, M Bomben, G R Bonneaud, G Calderini, J Chauveau, G Marchiori, J Ocariz, M Biasini, E Manoni, A Rossi, G Batignani, S Bettarini, M Carpinelli, G Casarosa, M Chrzaszcz, F Forti, M A Giorgi, A Lusiani, B Oberhof, E Paoloni, M Rama, G Rizzo, J J Walsh, A J S Smith, F Anulli, R Faccini, F Ferrarotto, F Ferroni, A Pilloni, G Piredda, C Bünger, S Dittrich, O Grünberg, M Heß, T Leddig, C Voß, R Waldi, T Adye, F F Wilson, S Emery, G Vasseur, D Aston, C Cartaro, M R Convery, J Dorfan, W Dunwoodie, M Ebert, R C Field, B G Fulsom, M T Graham, C Hast, W R Innes, P Kim, D W G S Leith, S Luitz, V Luth, D B MacFarlane, D R Muller, H Neal, B N Ratcliff, A Roodman, M K Sullivan, J Va'vra, W J Wisniewski, M V Purohit, J R Wilson, A Randle-Conde, S J Sekula, M Bellis, P R Burchat, E M T Puccio, M S Alam, J A Ernst, R Gorodeisky, N Guttman, D R Peimer, A Soffer, S M Spanier, J L Ritchie, R F Schwitters, J M Izen, X C Lou, F Bianchi, F De Mori, A Filippi, D Gamba, L Lanceri, L Vitale, F Martinez-Vidal, A Oyanguren, J Albert, A Beaulieu, F U Bernlochner, G J King, R Kowalewski, T Lueck, I M Nugent, J M Roney, N Tasneem, T J Gershon, P F Harrison, T E Latham, R Prepost, S L Wu
We search for the rare flavor-changing neutral current process B^{+}→K^{+}τ^{+}τ^{-} using data from the BABAR experiment. The data sample, collected at the center-of-mass energy of the ϒ(4S) resonance, corresponds to a total integrated luminosity of 424  fb^{-1} and to 471×10^{6}  BB[over ¯] pairs. We reconstruct one B meson, produced in the ϒ(4S)→B^{+}B^{-} decay, in one of many hadronic decay modes and search for activity compatible with a B^{+}→K^{+}τ^{+}τ^{-} decay in the rest of the event...
January 20, 2017: Physical Review Letters
https://www.readbyqxmd.com/read/28114655/disaggregation-of-cause-specific-cardiovascular-disease-mortality-among-hispanic-subgroups
#7
Fatima Rodriguez, Katherine G Hastings, Derek B Boothroyd, Sandra Echeverria, Lenny Lopez, Mark Cullen, Robert A Harrington, Latha P Palaniappan
Importance: Hispanics are the largest minority group in the United States and face a disproportionate burden of risk factors for cardiovascular disease (CVD) and low socioeconomic position. However, Hispanics paradoxically experience lower all-cause mortality rates compared with their non-Hispanic white (NHW) counterparts. This phenomenon has been largely observed in Mexicans, and whether this holds true for other Hispanic subgroups or whether these favorable trends persist over time remains unknown...
March 1, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28096208/improving-door-to-needle-times-for-acute-ischemic-stroke-effect-of-rapid-patient-registration-moving-directly-to-computed-tomography-and-giving-alteplase-at-the-computed-tomography-scanner
#8
Noreen Kamal, Jessalyn K Holodinsky, Caroline Stephenson, Devika Kashayp, Andrew M Demchuk, Michael D Hill, Renee L Vilneff, Erin Bugbee, Charlotte Zerna, Nancy Newcommon, Eddy Lang, Darren Knox, Eric E Smith
BACKGROUND: The effectiveness of specific systems changes to reduce DTN (door-to-needle) time has not been fully evaluated. We analyzed the impact of 4 specific DTN time reduction strategies implemented prospectively in a staggered fashion. METHODS AND RESULTS: The HASTE (Hurry Acute Stroke Treatment and Evaluation) project was implemented in 3 phases at a single academic medical center. In HASTE I (June 6, 2012 to June 5, 2013), baseline performance was analyzed...
January 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28074585/a-good-death
#9
Tia Powell, Adira Hulkower
A good death is hard to find. Family members tell us that loved ones die in the wrong place-the hospital-and do not receive high-quality care at the end of life. This issue of the Hastings Center Report offers two articles from authors who strive to provide good end-of-life care and to prevent needless suffering. We agree with their goals, but we have substantial reservations about the approaches they recommend. Respect for the decisions of patients and their surrogates is a relatively new and still vulnerable aspect of medical care...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28074578/managing-conflicts-between-physicians-and-surrogates
#10
Carol Bayley
Two articles in this issue of the Hastings Center Report explore two sides of the same problematic coin. In "The Limits of Surrogates' Moral Authority and Physician Professionalism," Jeffrey Berger discusses the moral problem of a surrogate refusing a treatment, palliative sedation, on behalf of a patient whose suffering is refractory to intensive palliative efforts provided by a multidisciplinary team. In "After the DNR: Surrogates Who Persist in Requesting Cardiopulmonary Resuscitation," Ellen Robinson and her colleagues analyze data from a study of cases in which physicians wished not to perform cardiopulmonary resuscitation on patients whom they thought it would harm...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28074576/decisions-and-authority
#11
Gregory E Kaebnick
This issue of the Hastings Center Report (January-February 2017) features three articles exploring aspects of decision-making for others. In the first two, the focus is on the limits of surrogate decision-makers' authority when the surrogates' judgments about a patient's treatment conflict with the physicians'. If a physician decides that a patient will not benefit from CPR, for example, but the patient's surrogate insists on it, is the physician obliged to proceed with the procedure? Or can the physician, pointing to a duty to provide good care to the patient and not to cause the patient to suffer, get a do-not-resuscitate order for the patient-even in the face of the surrogate's objections? These are the questions that animate the first article, in which a group of authors report on a policy implemented at Massachusetts General Hospital to help doctors who face this dilemma...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/27875644/skepticism-in-the-genomic-era
#12
Rachel L Zacharias
I joined The Hastings Center this past summer, after graduating from Duke University, where I researched advancements in neuroscience and genomics and their import for law, ethics, and policy. This research required, to an extent, faith in the idea that researchers can identify pathways by which genes combine with epigenetic and environmental factors to affect neuronal activity and influence behaviors. Throughout my first months here, I have puzzled over broad critiques of "genomic hype" in recent literature, which clash with the optimistic rhetoric found in the Human Genome Project and the Precision Medicine Initiative...
November 2016: Hastings Center Report
https://www.readbyqxmd.com/read/27875641/saving-science-by-doing-less-of-it
#13
Gregory E Kaebnick
In the current issue of The New Atlantis, Daniel Sarewitz, professor of science and society at Arizona State University, argues that science is broken because it is managed and judged by scientists themselves, operating under Vannevar Bush's famous 1945 declaration that scientific progress depends on the "free play of free intellects … dictated by their curiosity." With that scientific agenda, society ends up with a lot of unnecessary, uncoordinated, and unproductive research. To save science, holds Sarewitz, we need to put it in the hands of people who are looking for practical solutions to specific problems...
November 2016: Hastings Center Report
https://www.readbyqxmd.com/read/27868105/feasibility-of-automated-3-dimensional-magnetic-resonance-imaging-pancreas-segmentation
#14
Shuiping Gou, Percy Lee, Peng Hu, Jean-Claude Rwigema, Ke Sheng
PURPOSE: With the advent of MR guided radiotherapy, internal organ motion can be imaged simultaneously during treatment. In this study, we evaluate the feasibility of pancreas MRI segmentation using state-of-the-art segmentation methods. METHODS AND MATERIAL: T2 weighted HASTE and T1 weighted VIBE images were acquired on 3 patients and 2 healthy volunteers for a total of 12 imaging volumes. A novel dictionary learning (DL) method was used to segment the pancreas and compared to t mean-shift merging (MSM), distance regularized level set (DRLS), graph cuts (GC) and the segmentation results were compared to manual contours using Dice's index (DI), Hausdorff distance and shift of the-center-of-the-organ (SHIFT)...
July 2016: Advances in Radiation Oncology
https://www.readbyqxmd.com/read/27852639/improving-geriatric-prescribing-in-the-ed-a-qualitative-study-of-facilitators-and-barriers-to-clinical-decision-support-tool-use
#15
Ann E Vandenberg, Camille P Vaughan, Melissa Stevens, Susan N Hastings, James Powers, Alayne Markland, Ula Hwang, William Hung, Katharina V Echt
Quality problem or issue: Clinical decision support (CDS) may improve prescribing for older adults in the Emergency Department (ED) if adopted by providers. Initial assessment: Existing prescribing order entry processes were mapped at an initial Veterans Administration Medical Center site, demonstrating cognitive burden, effort and safety concerns. Choice of solution: Geriatric order sets incorporating 2012 Beers guidelines and including geriatric prescribing advice and prepopulated order options were developed...
February 1, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/27729957/fetal-central-nervous-system-anomalies-detected-by-magnetic-resonance-imaging-a-two-year-experience
#16
Sepideh Sefidbakht, Sakineh Dehghani, Maryam Safari, Homeira Vafaei, Maryam Kasraeian
BACKGROUND: Magnetic resonance imaging (MRI) is gradually becoming more common for thorough visualization of the fetus than ultrasound (US), especially for neurological anomalies, which are the most common indications for fetal MRI and are a matter of concern for both families and society. OBJECTIVES: We investigated fetal MRIs carried out in our center for frequency of central nervous system anomalies. This is the first such report in southern Iran. MATERIALS AND METHODS: One hundred and seven (107) pregnant women with suspicious fetal anomalies in prenatal ultrasound entered a cross-sectional retrospective study from 2011 to 2013...
August 2016: Iranian Journal of Pediatrics
https://www.readbyqxmd.com/read/27660905/sources-of-circuit-thrombosis-in-pediatric-extracorporeal-membrane-oxygenation
#17
Susan M Hastings, David N Ku, Scott Wagoner, Kevin O Maher, Shriprasad Deshpande
Extracorporeal membrane oxygenation (ECMO) for cardiopulmonary support of critically ill patients is used frequently in the pediatric population. ECMO is burdened by complications, including thrombosis and hemorrhage. Here we demonstrate the focused location of clots, their histologic composition, and the relationship of in situ thrombus to local hemodynamics in ECMO circuits. Pediatric ECMO circuits from Children's Healthcare of Atlanta, Emory University (Atlanta, GA) were obtained after removal from extracorporeal support over a 2...
January 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/27649914/nurses-at-the-table
#18
Connie M Ulrich
Few bioethicists are educated with a view into nursing. Thus, much of the conceptual and empirical research on ethical issues in nursing practice has been conducted by nurse ethicists themselves and, to a lesser degree, by individuals with a strong interest in nursing ethics. Although this work has internally shaped nursing practice, education, and policy, the broader field of bioethics has seldom examined and acknowledged the everyday ethical concerns of practicing nurses and their important contributions to bioethics discourse...
September 2016: Hastings Center Report
https://www.readbyqxmd.com/read/27649829/telos-versus-praxis-in-bioethics
#19
Tod S Chambers
The authors of "A Conceptual Model for the Translation of Bioethics Research and Scholarship" argue that bioethics must respond to institutional pressures by demonstrating that it is having an impact in the world. Any impact, the authors observe, must be "informed" by the goals of the discipline of bioethics. The concept of bioethics as a discipline is central to their argument. They begin by citing an essay that Daniel Callahan wrote in the first issue of Hastings Center Studies. Callahan argued in this 1973 piece that bioethics had yet to attain the status of a discipline, and he lauded the freedom of being able to define a new discipline...
September 2016: Hastings Center Report
https://www.readbyqxmd.com/read/27649818/where-shall-we-go
#20
Gregory E Kaebnick
This issue of the Hastings Center Report coincides with the annual conference of the American Society for Bioethics and Humanities, whose theme this year is "Where do we stand?" The issue addresses that theme with the article by Debra Mathews and colleagues and the set of brief response essays that follow it. Mathews et al., drawing on work carried out by the Association of Bioethics Program Directors, pose questions about how to understand and evaluate the worth of bioethics research. Those questions require them to think very broadly about what bioethics is, in the first place, and how it is related to medicine, health policy, science, and society generally...
September 2016: Hastings Center Report
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