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https://www.readbyqxmd.com/read/28544274/antithrombotic-therapy-in-end-stage-renal-disease
#1
REVIEW
Svetha Chunduri, Jon E Folstad, Tushar J Vachharajani
The delicate balance of risk vs. benefit of using antiplatelet and antithrombotic agents in the general population is well established. The decision to use these agents in the end stage renal disease (ESRD) population remains complex and difficult. The concomitant association of a prothombotic state with high risk of bleeding in the ESRD population requires individualization and careful clinical judgment before implementing such therapy. There remains a paucity of clinical trials and lack of substantial evidence in literature for safe and effective use of antithrombotic drugs in patients with advanced chronic kidney disease...
May 23, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28544096/getting-safely-through-the-shift-a-qualitative-exploration-of-the-administrative-supervisor-role
#2
Susan H Weaver, Teri G Lindgren
AIM: The purpose of this qualitative study was to explore the administrative supervisors' perspective of their managerial practices and how these practices contribute to nurse and patient safety. BACKGROUND: The position of administrative supervisor, often referred to as house supervisor on the evening and night shifts, lacks empirical data supporting efficacy. METHOD: A focused ethnographic study was conducted with 30 administrative supervisors from acute care hospitals, using in-depth interviews and job descriptions...
May 25, 2017: Journal of Nursing Management
https://www.readbyqxmd.com/read/28543942/the-influence-of-authentic-leadership-on-safety-climate-in-nursing
#3
Hasan Fehmi Dirik, Seyda Seren Intepeler
AIM: This study analysed nurses' perceptions of authentic leadership and safety climate and examined the contribution of authentic leadership to the safety climate. BACKGROUND: It has been suggested and emphasised that authentic leadership should be used as a guidance to ensure quality care and the safety of patients and health-care personnel. METHODS: This predictive study was conducted with 350 nurses in three Turkish hospitals. The data were collected using the Authentic Leadership Questionnaire and the Safety Climate Survey and analysed using hierarchical regression analysis...
May 25, 2017: Journal of Nursing Management
https://www.readbyqxmd.com/read/28543692/the-impact-of-resident-involvement-in-breast-reconstruction-surgery-outcomes-by-modality-an-analysis-of-4-500-cases
#4
Kevin T Jubbal, Anthony Echo, Aldona J Spiegel, Shayan A Izaddoost
BACKGROUND: The goal of this study was to determine the impact of resident involvement on various methods of breast reconstruction via an American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) retrospective analysis. METHODS: We performed a retrospective analysis of the ACS NSQIP database to identify patients undergoing breast reconstruction by free flap, implant, latissimus dorsi (LD), and transverse rectus abdominis myocutaneous (TRAM) flap reconstruction modalities...
May 24, 2017: Microsurgery
https://www.readbyqxmd.com/read/28543642/bidirectional-superior-cavopulmonary-anastomosis-with-or-without-cardiopulmonary-bypass-a-randomized-study
#5
Sachin Talwar, Anish Gupta, Ashima Nehra, Neeti Makhija, Poonam Malhotra Kapoor, Vishnubhatla Sreenivas, Shiv Kumar Choudhary, Balram Airan
OBJECTIVES: This study aims to compare the bidirectional superior cavopulmonary anastomosis (BDG) with or without cardiopulmonary bypass (CPB). METHODS: 100 patients undergoing BDG were randomized into two groups: Off-CPB or on-CPB groups. All patients underwent near-infrared spectrophotometry (NIRS) and bispectral index (BIS) monitoring and pre- and postoperative serum 100 beta protein measurements (Sβ100) and neuro-cognitive evaluation. Postoperative intensive care unit (ICU) parameters were also studied...
May 21, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28542194/using-g6pd-tests-to-enable-the-safe-treatment-of-plasmodium-vivax-infections-with-primaquine-on-the-thailand-myanmar-border-a-cost-effectiveness-analysis
#6
Angela Devine, Minnie Parmiter, Cindy S Chu, Germana Bancone, François Nosten, Ric N Price, Yoel Lubell, Shunmay Yeung
BACKGROUND: Primaquine is the only licensed antimalarial for the radical cure of Plasmodium vivax infections. Many countries, however, do not administer primaquine due to fear of hemolysis in those with glucose-6-phosphate dehydrogenase (G6PD) deficiency. In other settings, primaquine is given without G6PD testing, putting patients at risk of hemolysis. New rapid diagnostic tests (RDTs) offer the opportunity to screen for G6PD deficiency prior to treatment with primaquine. Here we assessed the cost-effectiveness of using G6PD RDTs on the Thailand-Myanmar border and provide the model as an online tool for use in other settings...
May 24, 2017: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/28542046/elective-venovenous-extracorporeal-membrane-oxygenation-for-resection-of-endotracheal-tumor-a-case-report
#7
W Jonathan Dunkman, Alina Nicoara, Jacob Schroder, Momen M Wahidi, Aimen El Manafi, Desiree Bonadonna, Coral X Giovacchini, Frederick W Lombard
We present a case in which we electively used venovenous extracorporeal membrane oxygenation (VV-ECMO) to facilitate safe resection of a nearly obstructing airway tumor near the carina in a 37-year-old male. The patient was brought to the operating room and underwent bifemoral cannulation for VV-ECMO under light sedation while maintaining spontaneous ventilation. After VV-ECMO was initiated, general anesthesia was induced, and the tumor was resected via rigid bronchoscopy. After resection, the patient was intubated, weaned from ECMO, decannulated, awoken, extubated, and taken to the postanesthesia care unit for recovery...
May 24, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28541862/nonoperative-management-of-the-damaged-spleen-a-community-surgeon-looks-back
#8
Mark L Walker
Blunt spleen injury is usually managed nonoperatively. An 8-year retrospective analysis by one community surgeon was done to provide an overview of the role of CT, angiography, and transfusion in the management algorithm. A total of 2750 patients were screened and 125 patients were identified with spleen injury. Of these 125 patients, 72 were managed without surgery. These were young (mean age 32 ± 16 years) patients with mean Injury Severity Score of 16 ± 8. Angiography was used in 14 patients. These patients received more blood (5 ± 6 vs 2 ± units of packed red blood cells) than their nonangiogram counterparts...
May 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28541100/patient-education-and-mind-diversion-in-supportive-care
#9
Salima Sadruddin, Rafat Jan, Adnan A Jabbar, Kashmira Nanji, Ambreen Tharani Name
Cancer is a growing health problem worldwide. Common treatments include surgery, chemotherapy and radiation therapy. Systemic anti-cancer medications often result in an array of physical and psychological side effects. Supportive care assists patients with cancer in managing multidimensional symptoms that result from treatment or the illness itself. This review discusses supportive care and examines patient counselling and mind-diversion activities, which are safe and cost-effective strategies. Improving cancer patients' health and wellbeing should be encouraged in oncology nursing practice and by teaching students the knowledge and skills needed to provide supportive care...
May 25, 2017: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/28538960/diagnostic-accuracy-of-computed-tomography-derived-fractional-flow-reserve-a-systematic-review
#10
Christopher M Cook, Ricardo Petraco, Matthew J Shun-Shin, Yousif Ahmad, Sukhjinder Nijjer, Rasha Al-Lamee, Yuetsu Kikuta, Yasutsugu Shiono, Jamil Mayet, Darrel P Francis, Sayan Sen, Justin E Davies
Importance: Computed tomography-derived fractional flow reserve (FFR-CT) is a novel, noninvasive test for myocardial ischemia. Clinicians using FFR-CT must be able to interpret individual FFR-CT results to determine subsequent patient care. Objective: To provide clinicians a means of interpreting individual FFR-CT results with respect to the range of invasive FFRs that this interpretation might likely represent. Evidence Review: We performed a systematic review in accordance with guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses...
May 24, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28538609/critical-care-interventions-for-asthmatic-patients-admitted-from-the-emergency-department-to-the-pediatric-intensive-care-unit
#11
Kristen Michelle Cundiff, James M Gerard, Robert G Flood
OBJECTIVES: The aim of this study was to assess the frequency and predictors of critical interventions in asthmatic patients admitted to the pediatric intensive care unit (PICU) at a tertiary-care pediatric hospital. METHODS: We conducted a retrospective chart review of patients admitted from our emergency department (ED) to the PICU for treatment of status asthmaticus between January 1, 2008, and March 31, 2013. Patients with concomitant medical conditions and those who received a critical intervention, other than continuously aerosolized albuterol, in the ED before admission were excluded...
May 23, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28538591/intrathecal-morphine-and-oral-analgesics-provide-safe-and-effective-pain-control-after-posterior-spinal-fusion-for-adolescent-idiopathic-scoliosis
#12
Ying Li, Rebecca A Hong, Christopher B Robbins, Kathleen M Gibbons, Ashlee E Holman, Michelle S Caird, Frances A Farley, Matthew D Abbott, Michelle C Burke
STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To demonstrate that intrathecal morphine (ITM) and oral analgesics provide effective pain control after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS), and this protocol has a low complication rate so patients can be admitted to a general care floor. SUMMARY OF BACKGROUND DATA: Previous studies have shown that ITM combined with intravenous patient-controlled analgesia or epidural infusion (EPI) provides effective pain control after PSF for AIS...
May 23, 2017: Spine
https://www.readbyqxmd.com/read/28538056/engaging-all-employees-in-efforts-to-achieve-high-reliability
#13
Anne Marie Benedicto
DRAMATIC AND NUMEROUS advances in science, technology, and medicine provide new opportunities to keep people healthy as well as to diagnose, treat, and cure disease. Unfortunately, increasing complexity increases opportunities for mistakes and errors, particularly in healthcare organizations as they struggle to prevent patient harm (). Safety problems persist and harm to patients continues despite widespread attention to the need for improvement ().An engaged and empowered workforce is critical to improving the patient experience, improving health outcomes, and correcting unsafe conditions ()...
July 2017: Frontiers of Health Services Management
https://www.readbyqxmd.com/read/28538054/achieving-high-reliability-with-people-processes-and-technology
#14
Candice L Saunders, John A Brennan
High reliability as a corporate value in healthcare can be achieved by meeting the "Quadruple Aim" of improving population health, reducing per capita costs, enhancing the patient experience, and improving provider wellness. This drive starts with the board of trustees, CEO, and other senior leaders who ingrain high reliability throughout the organization. At WellStar Health System, the board developed an ambitious goal to become a top-decile health system in safety and quality metrics. To achieve this goal, WellStar has embarked on a journey toward high reliability and has committed to Lean management practices consistent with the Institute for Healthcare Improvement's definition of a high-reliability organization (HRO): one that is committed to the prevention of failure, early identification and mitigation of failure, and redesign of processes based on identifiable failures...
July 2017: Frontiers of Health Services Management
https://www.readbyqxmd.com/read/28537646/three-port-laparoscopic-adjustable-gastric-banding-lagb-surgical-technique-and-three-years-follow-up
#15
Vincenzo Consalvo, Vincenzo Salsano, Gerardo Sarno
BACKGROUND: Adjustable Gastric Banding (AGB) is an effective and reversible bariatric procedure, which is usually performed using a mini-invasive laparoscopic approach. The majority of surgeons use a five-trocar technique, while AGB can be safely carried out with only three trocars. The aim of our study was to compare the outcomes of three-trocar laparoscopic adjustable gastric banding (LAGB) to the results obtained with the conventional technique. MATERIALS AND METHODS: A retrospective analysis of our database was carried out to assess the number of LAGB performed with the conventional five-port technique and the number of LAGB performed with the three-port approach...
May 24, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28537570/safe-and-uncomplicated-inguinal-hernia-surgery-in-the-elderly-message-from-anesthesiologists-to-general-surgeons
#16
Tomasz Chlebny, Piotr Zelga, Mateusz Pryt, Marta Zelga, Adam Dziki
Introduction Elderly patients are often discouraged from surgery due to the risk of complications that increases with age. Aim We wanted to assess mortality, morbidity, and complications in patients older than 75 years who underwent elective or emergency inguinal hernia repair in a single center. Methods All patients older than 75 years who were operated on because of inguinal hernia in the Department of General and Colorectal Surgery, Medical University of Lodz between 2003 and 2015 were analyzed. Detailed information was collected with regard to patient demographics, mode of admission, comorbidities, type of intervention, applied anesthesia, and 30-day outcomes...
April 30, 2017: Polski Przeglad Chirurgiczny
https://www.readbyqxmd.com/read/28537446/clinical-outcomes-of-hypogastric-artery-occlusion-for-endovascular-aortic-aneurysm-repair
#17
Wuttichai Saengprakai, Joost A van Herwaarden, George S Georgiadis, Worawong Slisatkorn, Frans L Moll
PURPOSE: To determine the midterm outcomes of internal iliac artery (IIA) coverage by a stent-graft in endovascular aortic aneurysm repair (EVAR) under specific anatomic and technical circumstances. MATERIAL AND METHODS: From January 2003 until January 2014, 57 patients with aortoiliac aneurysms, including 20 with 24 IIA aneurysms (IIAAs), underwent EVAR with IIA coverage. IIAA diameter change or IIA thrombosis, buttock claudication, type II endoleak, and secondary interventions related to the IIA were studied...
May 24, 2017: Minimally Invasive Therapy & Allied Technologies: MITAT
https://www.readbyqxmd.com/read/28537172/medicines-optimisation
#18
Bing Raz
What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The article discussed medicines optimisation, which was defined as a patient-centred approach to safe and effective medicines use to ensure patients achieve the best possible outcomes. It emphasised that involving patients in decisions about their care will assist in ensuring they get the most from their medicines.
May 24, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28536929/inferior-pedicle-reduction-mammoplasty-with-or-without-tourniquet-a-comparative-study
#19
Canser Yilmaz Demir, Yılmaz Sultanoglu, Omer Faruk Kocak, Muhammet Eren Ersoz
OBJECTIVE: To compare the perioperative findings of inferior pedicle reduction mammoplasty (IPRM) performed with or without a tourniquet. METHODS: This study was carried out in the plastic and reconstructive surgery department at a tertiary care center on a total of 42 consecutive women scheduled for IPRM. Patients in Group I (n = 21) underwent surgery using a tourniquet, whereas patients in Group II (n = 21) were operated on without a tourniquet. Levels of hemoglobin (Hb), hematocrit (Hct), Hct/Hb ratio, and platelet counts were noted preoperatively and on postoperative 24th and 48th h...
May 23, 2017: Aesthetic Plastic Surgery
https://www.readbyqxmd.com/read/28535732/duplex-ultrasound-surveillance-after-uncomplicated-endovascular-abdominal-aortic-aneurysm-repair
#20
Jacob S Schaeffer, Irina Shakhnovich, Kyle N Sieck, Kara J Kallies, Clark A Davis, Thomas H Cogbill
OBJECTIVES: Health-care costs and risks of radiation and intravenous contrast exposure challenge computed tomography angiography (CTA) as the standard surveillance method after endovascular abdominal aortic aneurysm repair (EVAR). We reviewed our experience using Duplex ultrasound scan (DUS) as an initial and subsequent surveillance technique after uncomplicated EVAR. METHODS: The medical records of patients who underwent EVAR from 2004 to 2014 with at least 1 postoperative imaging study were retrospectively reviewed...
January 1, 2017: Vascular and Endovascular Surgery
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