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https://www.readbyqxmd.com/read/28886977/an-optimization-model-for-collection-haul-transfer-treatment-and-disposal-of-infectious-medical-waste-application-to-a-greek-region
#1
Gerasimos Mantzaras, Evangelos A Voudrias
The objective of this work was to develop an optimization model to minimize the cost of a collection, haul, transfer, treatment and disposal system for infectious medical waste (IMW). The model calculates the optimum locations of the treatment facilities and transfer stations, their design capacities (t/d), the number and capacities of all waste collection, transport and transfer vehicles and their optimum transport path and the minimum IMW management system cost. Waste production nodes (hospitals, healthcare centers, peripheral health offices, private clinics and physicians in private practice) and their IMW production rates were specified and used as model inputs...
September 5, 2017: Waste Management
https://www.readbyqxmd.com/read/28872765/digital-therapy-in-diabetes
#2
REVIEW
Avivit Cahn, Amit Akirov, Itamar Raz
Diabetes care is largely dependent on patient self-management and empowerment, given that patients with diabetes must make numerous daily decisions of what to eat, when to exercise, and determine their insulin dose and timing if required. Additionally, patients and providers are generating vast amounts of data from many sources including electronic medical records, insulin pumps, sensors, glucometers, other wearables, as well as evolving genomic, proteomic, metabolomic and microbiomic data. Multiple digital tools and apps have been developed to assist patients to choose wisely, as well as enhance their compliance by employing motivational tools and incorporating incentives from social media and gaming techniques...
September 5, 2017: Journal of Diabetes
https://www.readbyqxmd.com/read/28870498/drug-adherence-in-hypertension
#3
REVIEW
M Burnier
Blood pressure control remains unsatisfactory in all countries of the world with at best 60% of treated hypertensive patients reaching recommended therapeutic goals. Several factors have been identified which may explain why the rate of blood pressure control remains low. Among them, one can cite medical inertia and a poor adherence to drug therapies. In the absence of new drugs to control blood pressure, drug adherence has become a major issue in the management of hypertensive patients. Numerous studies have demonstrated that the major problem is the lack of persistence followed by a poor day to day execution of the prescribed regimens...
September 1, 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/28866621/randomised-controlled-trial-to-assess-the-effect-of-a-just-in-time-training-on-procedural-performance-a-proof-of-concept-study-to-address-procedural-skill-decay
#4
Jeremy B Branzetti, Adeyinka A Adedipe, Matthew J Gittinger, Elizabeth D Rosenman, Sarah Brolliar, Anne K Chipman, James A Grand, Rosemarie Fernandez
BACKGROUND: A subset of high-risk procedures present significant safety threats due to their (1) infrequent occurrence, (2) execution under time constraints and (3) immediate necessity for patient survival. A Just-in-Time (JIT) intervention could provide real-time bedside guidance to improve high-risk procedural performance and address procedural deficits associated with skill decay. OBJECTIVE: To evaluate the impact of a novel JIT intervention on transvenous pacemaker (TVP) placement during a simulated patient event...
September 2, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28864080/developing-the-brain-early-illustrations-of-cerebral-cortex-and-its-gyri
#5
Harry Sutherland-Foggio
BACKGROUND: Throughout the Middle Ages, most representations of the brain amounted to highly schematized ventricles housed within abstract squiggles of neural tissue. The works by the pre-eminent Flemish anatomist Andreas Vesalius in his De Humani Corporis Fabrica (1543) added considerably more accuracy and detail-still, his drawings of cerebral hemispheres do not exhibit the gyral-sulcal pattern recognized today. Identifiable cortical landmarks would not be featured in print until Cerebri Anatome (1664) by the English physician Thomas Willis...
July 10, 2017: Pediatric Neurology
https://www.readbyqxmd.com/read/28852834/-legal-considerations-of-telemedical-care
#6
REVIEW
Hendrik Schneider
Telemedical methods are on the rise in patient care. In addition to the actual changes for both sides in the physician-patient relationship, the use of information and communication technology also involves legal challenges. This article deals with the legal framework of telemedical care. Thereby the article discusses the prohibition of remote treatment (§ 7 Abs. 4 MBO-Ä) and the question to what extent the omission of a telemedical method of treatment can fulfill a medical breach of duty. A distinction must be drawn between the question as to whether telemedical monitoring shall be executed and the question how to use telemedical systems, in order to mitigate liability risks for the physicians...
August 29, 2017: Herzschrittmachertherapie & Elektrophysiologie
https://www.readbyqxmd.com/read/28852809/the-fate-of-radiology-report-recommendations-at-a-pediatric-medical-center
#7
Bonmyong Lee, Hansel J Otero, Matthew T Whitehead
BACKGROUND: The American College of Radiology (ACR) practice parameters for communication dictate that follow-up recommendations be suggested when appropriate. Radiologists assume that referring physicians read their reports and heed their advice. In reality, recommendations might not be carried out or even acknowledged. OBJECTIVE: We aimed to determine the proportion of imaging recommendations that are acknowledged and acted upon. MATERIALS AND METHODS: We conducted a retrospective review of all consecutive radiology reports containing "recommend" in the impression at a single academic children's hospital over a 1-month period...
August 29, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28844764/hospital-strategies-for-reducing-emergency-department-crowding-a-mixed-methods-study
#8
Anna Marie Chang, Deborah J Cohen, Amber Lin, James Augustine, Daniel A Handel, Eric Howell, Hyunjee Kim, Jesse M Pines, Jeremiah D Schuur, K John McConnell, Benjamin C Sun
STUDY OBJECTIVE: Emergency department (ED) crowding and patient boarding are associated with increased mortality and decreased patient satisfaction. This study uses a positive deviance methodology to identify strategies among high-performing, low-performing, and high-performance improving hospitals to reduce ED crowding. METHODS: In this mixed-methods comparative case study, we purposively selected and recruited hospitals that were within the top and bottom 5% of Centers for Medicare & Medicaid Services case-mix-adjusted ED length of stay and boarding times for admitted patients for 2012...
August 25, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28835267/workplace-violence-in-a-tertiary-care-israeli-hospital-a-systematic-analysis-of-the-types-of-violence-the-perpetrators-and-hospital-departments
#9
Sigal Shafran-Tikva, Revital Zelker, Zvi Stern, David Chinitz
BACKGROUND: Worldwide, there is a widespread and disturbing pattern of violence towards healthcare workers. However, violent occurrences in Israeli hospitals have often been unrecognized and underreported. Moreover, most studies have not sufficiently differentiated among the different types of violence. To examine the different types of violence experienced by nurses and physicians, the types of perpetrators and the specialty fields involved. METHODS: A quantitative questionnaire was used to assess the incidence of a "basket" of violent behaviors, divided into eight types of violent manifestations...
August 23, 2017: Israel Journal of Health Policy Research
https://www.readbyqxmd.com/read/28833415/two-kinds-of-physician-assisted-death
#10
Govert den Hartogh
I argue that the concept 'physician-assisted suicide' covers two procedures that should be distinguished: giving someone access to humane means to end his own life, and taking co-responsibility for the safe and effective execution of that plan. In the first section I explain the distinction, in the following sections I show why it is important. To begin with I argue that we should expect the laws that permit these two kinds of 'assistance' to be different in their justificatory structure. Laws that permit giving access only presuppose that the right to self-determination implies a right to suicide, but laws that permit doctors to take co-responsibility may have to appeal to a principle of mercy or beneficence...
August 23, 2017: Bioethics
https://www.readbyqxmd.com/read/28826983/impact-of-a-stay-in-the-intensive-care-unit-on-the-preparation-of-advance-directives-descriptive-exploratory-qualitative-study
#11
Pascal Andreu, Auguste Dargent, Audrey Large, Nicolas Meunier-Beillard, Sandrine Vinault, Uriel Leiva Rojas, Fiona Ecarnot, Sébastien Prin, Pierre-Emmanuel Charles, Isabelle Fournel, Jean-Philippe Rigaud, Jean-Pierre Quenot
BACKGROUND: Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of Advance Directives (AD) after a stay in the ICU. METHODS: Study performed from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home >3 months previously. Semi-directive interviews with patients focused on 5 main points surrounding AD...
August 4, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28810207/intermediate-care-to-intensive-care-triage-a-quality-improvement-project-to-reduce-mortality
#12
David N Hager, Pranav Chandrashekar, Robert W Bradsher, Ali M Abdel-Halim, Souvik Chatterjee, Melinda Sawyer, Roy G Brower, Dale M Needham
PURPOSE: Medical patients whose care needs exceed what is feasible on a general ward, but who do not clearly require critical care, may be admitted to an intermediate care unit (IMCU). Some IMCU patients deteriorate and require medical intensive care unit (MICU) admission. In 2012, staff in the Johns Hopkins IMCU expressed concern that patient acuity and the threshold for MICU admission were too high. Further, shared triage decision-making between residents and supervising physicians did not consistently occur...
August 3, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28795973/the-academy-of-master-clinicians-recognition-of-clinical-excellence-within-an-academic-medical-center
#13
John H Glick, Victoria Mulhern, Kim M Olthoff, Jack Ende
PROBLEM: Academic health centers face increasing challenges in pursuing and maintaining clinical excellence in their tripartite mission. At Penn Medicine, an institution-wide strategic planning process was initiated in 2012. Among the recommendations that arose from that process was to enhance the recognition of Penn Medicine's most outstanding clinicians. The Academy of Master Clinicians (AoMC) was founded in 2013. APPROACH: The ad hoc committee charged with the development and implementation of the AoMC provided a mission statement, eligibility criteria, and a process for nomination and selection of AoMC members...
August 8, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28792506/can-magnetic-resonance-spectroscopy-differentiate-malignant-and-benign-causes-of-lymphadenopathy-an-in-vitro-approach
#14
Lionel Buré, Louis-Martin Boucher, Miriam Blumenkrantz, Stefan Schob, Pierre Lafaye de Micheaux, Caroline Reinhold, Benoit Gallix
Lymphadenopathy continues to be a common problem to radiologists and treating physicians because of the difficulty in confidently categorizing a node as being benign or malignant using standard diagnostic techniques. The goal of our research was to assess whether magnetic resonance (MR) spectroscopy contains the necessary information to allow differentiation of benign from malignant lymph nodes in an in-vitro approach using a modern pattern recognition method. Tissue samples from a tissue bank were analyzed on a nuclear magnetic resonance (NMR) spectrometer...
2017: PloS One
https://www.readbyqxmd.com/read/28766103/protocol-driven-decision-support-within-e-referral-systems-to-streamline-patient-consultation-triaging-and-referrals-from-primary-care-to-specialist-clinics
#15
Ehsan Maghsoud-Lou, Sean Christie, Samina Raza Abidi, Syed Sibte Raza Abidi
Patient referral is a protocol where the referring primary care physician refers the patient to a specialist for further treatment. The paper-based current referral process at times lead to communication and operational issues, resulting in either an unfulfilled referral request or an unnecessary referral request. Despite the availability of standardized referral protocols they are not readily applied because they are tedious and time-consuming, thus resulting in suboptimal referral requests. We present a semantic-web based Referral Knowledge Modeling and Execution Framework to computerize referral protocols, clinical guidelines and assessment tools in order to develop a computerized e-Referral system that offers protocol-based decision support to streamline and standardize the referral process...
September 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28752731/cardiac-imaging-in-patients-with-dyspnea
#16
Pierfranco Dellavesa, Federico Nardi
Acute dyspnea is a frequent cause of access to the Discharge Department (DEA); Differentiation between cardiogenic and respiratory causes does not always seem simple and certain, causing a delay in initiating targeted therapies and prolonging the Patient's stay in the emergency department. The basic elements for the diagnosis remain the history and the objective examination, supplemented by the execution of an electrocardiogram, a determination of blood parameters and the execution of a chest X-ray. The limits of radiological semeiotics, related to a low sensitivity to high specificity, promote other methods available to the physician of First Aid...
July 27, 2017: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/28718756/stereotypes-influence-destination-memory-in-normal-aging
#17
Mohamad El Haj
Background/Study Context: A substantial body of literature suggests that stereotypes can play a determining role in making judgments about the source of information. This study investigated this issue for destination memory or remembering to whom information has been previously told. METHODS: Younger adults and older adults told six medical and six mechanical facts to a picture depicting a physician, and also told six different medical and six different mechanical facts to a picture depicting a mechanic...
July 2017: Experimental Aging Research
https://www.readbyqxmd.com/read/28690863/fertility-preservation-training-for-obstetrics-and-gynecology-fellows-a-highly-desired-but-non-standardized-experience
#18
Elizabeth J N Miller, Lisa M Cookingham, Teresa K Woodruff, Ginny L Ryan, Karen M Summers, Laxmi A Kondapalli, Divya K Shah
BACKGROUND: Despite a large body of data suggesting that delivery of fertility care to cancer patients is inconsistent and frequently insufficient, there is a paucity of literature examining training in fertility preservation for those physicians expected to discuss options or execute therapy. The study objective was to compare fertility preservation training between Reproductive Endocrinology & Infertility (REI) and Gynecologic Oncology (GYN ONC) fellows and assess the need for additional education in this field...
2017: Fertility Research and Practice
https://www.readbyqxmd.com/read/28681961/technical-tips-during-implantation-of-selective-upper-airway-stimulation
#19
Clemens Heiser, Erica Thaler, Ryan J Soose, B Tucker Woodson, Maurits Boon
OBJECTIVE: Selective upper airway stimulation is now well-established in the United States and in several European countries, with more than 1,000 patients implanted since U.S. Food and Drug Administration approval in April 2014. The authors herein, all head and neck surgeons, account for approximately one of every five implants completed to date. Several of the authors also provide comprehensive longitudinal care of their patients as dual-specialty sleep medicine physicians. STUDY DESIGN: Multi-center, retrospective clinical analysis...
July 6, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28681381/epilepsy-transition-from-pediatric-to-adult-care-recommendations-of-the-ontario-epilepsy-implementation-task-force
#20
REVIEW
Danielle M Andrade, Anne S Bassett, Eduard Bercovici, Felippe Borlot, Esther Bui, Peter Camfield, Guida Quaglia Clozza, Eyal Cohen, Timothy Gofine, Lisa Graves, Jon Greenaway, Beverly Guttman, Maya Guttman-Slater, Ayman Hassan, Megan Henze, Miriam Kaufman, Bernard Lawless, Hannah Lee, Lezlee Lindzon, Lysa Boissé Lomax, Mary Pat McAndrews, Dolly Menna-Dack, Berge A Minassian, Janice Mulligan, Rima Nabbout, Tracy Nejm, Mary Secco, Laurene Sellers, Michelle Shapiro, Marie Slegr, Rosie Smith, Peter Szatmari, Leeping Tao, Anastasia Vogt, Sharon Whiting, O Carter Snead
The transition from a pediatric to adult health care system is challenging for many youths with epilepsy and their families. Recently, the Ministry of Health and Long-Term Care of the Province of Ontario, Canada, created a transition working group (TWG) to develop recommendations for the transition process for patients with epilepsy in the Province of Ontario. Herein we present an executive summary of this work. The TWG was composed of a multidisciplinary group of pediatric and adult epileptologists, psychiatrists, and family doctors from academia and from the community; neurologists from the community; nurses and social workers from pediatric and adult epilepsy programs; adolescent medicine physician specialists; a team of physicians, nurses, and social workers dedicated to patients with complex care needs; a lawyer; an occupational therapist; representatives from community epilepsy agencies; patients with epilepsy; parents of patients with epilepsy and severe intellectual disability; and project managers...
September 2017: Epilepsia
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