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https://www.readbyqxmd.com/read/28086826/offering-patients-therapy-options-in-unplanned-start-options-implementation-of-an-educational-program-is-feasible-and-effective
#1
Anna Machowska, Mark Dominik Alscher, Satyanarayana Reddy Vanga, Michael Koch, Michael Aarup, Abdul Rashid Qureshi, Bengt Lindholm, Peter Rutherford
BACKGROUND: Patients with unplanned dialysis start (UPS) have worse clinical outcomes than non-UPS patients, and receive peritoneal dialysis (PD) less frequently. In the OPTiONS study of UPS patients, an educational programme (UPS-EP) aiming at improving care of UPS patients by facilitating care pathways and enabling informed choice of dialysis modality was implemented. We here report on impact of UPS-EP on modality choice and clinical outcomes in UPS patients. METHODS: This non-interventional, prospective, multi-center, observational study included 270 UPS patients from 26 centers in 6 European countries (Austria, Germany, Denmark, France, United Kingdom and Sweden) who prior to inclusion presented acutely, or were being followed by nephrologists but required urgent dialysis commencement by an acutely placed CVC or PD catheter...
January 13, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28072761/immediate-chest-x-ray-for-patients-at-risk-of-lung-cancer-presenting-in-primary-care-randomised-controlled-feasibility-trial
#2
Richard D Neal, Allan Barham, Emily Bongard, Rhiannon Tudor Edwards, Jim Fitzgibbon, Gareth Griffiths, Willie Hamilton, Kerenza Hood, Annmarie Nelson, David Parker, Cath Porter, Hayley Prout, Kirsty Roberts, Trevor Rogers, Emma Thomas-Jones, Angela Tod, Seow Tien Yeo, Chris N Hurt
BACKGROUND: Achieving earlier stage diagnosis is one option for improving lung cancer outcomes in the United Kingdom. Patients with lung cancer typically present with symptoms to general practitioners several times before referral or investigation. METHODS: We undertook a mixed methods feasibility individually randomised controlled trial (the ELCID trial) to assess the feasibility and inform the design of a definitive, fully powered, UK-wide, Phase III trial of lowering the threshold for urgent investigation of suspected lung cancer...
January 10, 2017: British Journal of Cancer
https://www.readbyqxmd.com/read/28060178/assessment-of-splints-applied-for-pediatric-fractures-in-an-emergency-department-urgent-care-environment
#3
Joshua M Abzug, Brandon S Schwartz, Aaron J Johnson
BACKGROUND: Fractures are common in the pediatric population. The initial evaluation is rarely by an orthopaedic surgeon, but commonly an emergency room or urgent care center physician/extender. This typically involves splint application by a nonorthopaedist to immobilize the extremity and provide stabilization. Iatrogenic injuries from inappropriate splint placement are a potential public health and legal concern that can lead to complications. The primary purpose of this study was to prospectively evaluate the adequacy of all splints placed on patients who presented to a pediatric orthopaedic office; secondary outcomes included assessing prevalence and types of complications that were associated with inadequate splints...
January 5, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28052316/training-interventions-for-improving-telephone-consultation-skills-in-clinicians
#4
REVIEW
Alberto Vaona, Yannis Pappas, Rumant S Grewal, Mubasshir Ajaz, Azeem Majeed, Josip Car
BACKGROUND: Since 1879, the year of the first documented medical telephone consultation, the ability to consult by telephone has become an integral part of modern patient-centred healthcare systems. Nowadays, upwards of a quarter of all care consultations are conducted by telephone. Studies have quantified the impact of medical telephone consultation on clinicians' workload and detected the need for quality improvement. While doctors routinely receive training in communication and consultation skills, this does not necessarily include the specificities of telephone communication and consultation...
January 5, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28050179/psychopathology-of-the-general-population-referred-by-primary-care-physicians-for-urgent-assessment-in-psychiatric-hospitals
#5
Judith McLenan, Carlo Lazzari, Gail McMillan, Robert Mackie
Objective: The aim of this study was to evaluate the type, severity and progression of psychiatric pathologies in a sample of 372 outpatients (age range 18-65 years) referred by their primary general practitioners (GPs) to an Urgent Referral Team (URT) based in a psychiatric hospital in Aberdeen, Scotland. This team offers immediate appointments (1- to 7-day delays) for rapid assessments and early interventions to the outpatients referred by their primary family doctors. Method: One-sample t-test and z statistic were used for data analysis...
October 2016: Iranian Journal of Psychiatry
https://www.readbyqxmd.com/read/28045952/predictive-factors-of-one-year-mortality-in-a-cohort-of-patients-undergoing-urgent-start-hemodialysis
#6
Luciene P Magalhães, Luciene M Dos Reis, Fabiana G Graciolli, Benedito J Pereira, Rodrigo B de Oliveira, Altay A L de Souza, Rosa M Moyses, Rosilene M Elias, Vanda Jorgetti
BACKGROUND: Chronic kidney disease (CKD) affects 10-15% of adult population worldwide. Incident patients on hemodialysis, mainly those on urgent-start dialysis at the emergency room, have a high mortality risk, which may reflect the absence of nephrology care. A lack of data exists regarding the influence of baseline factors on the mortality of these patients. The aim of this study was to evaluate the clinical and laboratory characteristics of this population and identify risk factors that contribute to their mortality...
2017: PloS One
https://www.readbyqxmd.com/read/28030492/stapled-versus-handsewn-a-prospective-emergency-surgery-study-shapes-an-american-association-for-the-surgery-of-trauma-multi-institutional-study
#7
Brandon R Bruns, David S Morris, Martin Zielinski, Nathan T Mowery, Preston R Miller, Kristen Arnold, Herb A Phelan, Jason Murry, David Turay, John Fam, John S Oh, Oliver L Gunter, Toby Enniss, Joseph D Love, David Skarupa, Matthew Benns, Alisan Fathalizadeh, Pak Shan Leung, Matthew M Carrick, Brent Jewett, Joseph Sakran, Lindsay O'Meara, Anthony V Herrera, Hegang Chen, Thomas M Scalea, Jose J Diaz
BACKGROUND: Data from the trauma patient population suggests handsewn anastomoses (HS) are superior to stapled (ST). A recent retrospective study in emergency general surgery (EGS) patients had similar findings. The aim of the current study is to evaluate HS and ST anastomoses in EGS patients undergoing urgent/emergent operations. METHODS: The study was sponsored by the AAST Multi-Institutional Studies Committee. Patients undergoing urgent/emergent bowel resection for EGS pathology were prospectively enrolled from 7/22/2013-12/31/2015...
December 23, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28030459/implementation-and-sequencing-of-practice-transformation-in-urban-practices-with-underserved-patients
#8
Denise D Quigley, Zachary S Predmore, Alex Y Chen, Ron D Hays
BACKGROUND: Patient-centered medical home (PCMH) has gained momentum as a model for primary-care health services reform. METHODS: We conducted interviews at 14 primary care practices undergoing PCMH transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. RESULTS: We found clinics pursued a common sequence of changes in PCMH transformation: Clinics began with National Committee for Quality Assurance (NCQA) level 3 recognition, adding care coordination staff, reorganizing data flow among teams, and integrating with a centralized quality improvement and accountability infrastructure...
January 2017: Quality Management in Health Care
https://www.readbyqxmd.com/read/28025734/reaching-key-populations-prep-uptake-in-an-urban-health-care-system-in-the-bronx-new-york
#9
Cedric H Bien, Viraj V Patel, Oni J Blackstock, Uriel R Felsen
Pre-exposure prophylaxis (PrEP) has been established as an effective HIV prevention tool, but real world studies are limited. To inform dissemination efforts, we sought to describe individuals prescribed PrEP in the largest health care system in the Bronx, New York, an urban region with a high burden of HIV. We used a clinical database and chart review to identify individuals prescribed PrEP between 2011 and 2015 (n = 108). A majority were Black and Hispanic, half were men who have sex with men, and nearly a third were cisgender women who have sex with men...
December 26, 2016: AIDS and Behavior
https://www.readbyqxmd.com/read/28011411/call-to-action-a-new-path-for-improving-diabetes-care-for-indigenous-peoples-a-global-review
#10
REVIEW
Stewart B Harris, Jordan W Tompkins, Braden TeHiwi
Diabetes has reached epidemic proportions in Indigenous populations around the globe, and there is an urgent need to improve the health and health equity of Indigenous peoples with diabetes through timely and appropriate diabetes prevention and management strategies. This review describes the evolution of the diabetes epidemic in Indigenous populations and associated risk factors, highlighting gestational diabetes and intergenerational risk, lifestyle risk factors and social determinants as having particular importance and impact on Indigenous peoples...
December 5, 2016: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/27999483/level-of-competencies-of-family-physicians-in-kosovo-from-different-perspectives
#11
Gazmend Bojaj, Fitim Skeraj, Katarzyna Czabanowska, Genc Burazeri
AIM: The aim of this analysis was to compare the level of self-perceived competencies of primary health care physicians in Kosovo with patients' viewpoint, as well as the necessary (required) level of such competencies from decision-makers' standpoint. METHODS: Three cross-sectional studies were carried out in Kosovo in 2013 including: i) a representative sample of 1340 primary health care users aged ≥18 years (49% men; overall mean age: 50.5±17.9 years; response rate: 89%); ii) a representative sample of 597 primary health care physicians (49% men; overall mean age: 46...
October 2016: Materia Socio-medica
https://www.readbyqxmd.com/read/27993546/post-resuscitation-management-of-cardiac-arrest-patients-in-the-critical-care-environment-a-retrospective-audit-of-compliance-with-evidence-based-guidelines
#12
REVIEW
A Milonas, A Hutchinson, D Charlesworth, A Doric, J Green, J Considine
BACKGROUND: There is a clear relationship between evidence-based post resuscitation care and survival and functional status at hospital discharge. The Australian Resuscitation Council (ARC) recommends protocol driven care to enhance chance of survival following cardiac arrest. Healthcare providers have an obligation to ensure protocol driven post resuscitation care is timely and evidence based. OBJECTIVES: The aim of this study was to examine adherence to best practice guidelines for post resuscitation care in the first 24h from Return of Spontaneous Circulation for patients admitted to the intensive care unit from the emergency department having suffered out of hospital or emergency department cardiac arrest and survived initial resuscitation...
December 16, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/27988143/the-healthy-activity-program-hap-a-lay-counsellor-delivered-brief-psychological-treatment-for-severe-depression-in-primary-care-in-india-a-randomised-controlled-trial
#13
Vikram Patel, Benedict Weobong, Helen A Weiss, Arpita Anand, Bhargav Bhat, Basavraj Katti, Sona Dimidjian, Ricardo Araya, Steve D Hollon, Michael King, Lakshmi Vijayakumar, A-La Park, David McDaid, Terry Wilson, Richard Velleman, Betty R Kirkwood, Christopher G Fairburn
BACKGROUND: Although structured psychological treatments are recommended as first-line interventions for depression, only a small fraction of people globally receive these treatments because of poor access in routine primary care. We assessed the effectiveness and cost-effectiveness of a brief psychological treatment (Healthy Activity Program [HAP]) for delivery by lay counsellors to patients with moderately severe to severe depression in primary health-care settings. METHODS: In this randomised controlled trial, we recruited participants aged 18-65 years scoring more than 14 on the Patient Health Questionnaire 9 (PHQ-9) indicating moderately severe to severe depression from ten primary health centres in Goa, India...
December 14, 2016: Lancet
https://www.readbyqxmd.com/read/27979041/acute-cardioversion-vs-a-wait-and-see-approach-for-recent-onset-symptomatic-atrial-fibrillation-in-the-emergency-department-rationale-and-design-of-the-randomized-acwas-trial
#14
Elton Dudink, Brigitte Essers, Wouter Holvoet, Bob Weijs, Justin Luermans, Hemanth Ramanna, Anho Liem, Jurren van Opstal, Lukas Dekker, Vincent van Dijk, Timo Lenderink, Otto Kamp, Lennert Kulker, Michiel Rienstra, Bas Kietselaer, Marco Alings, Jos Widdershoven, Joan Meeder, Martin Prins, Isabelle van Gelder, Harry Crijns
BACKGROUND: Current standard of care for patients with recent-onset atrial fibrillation (AF) in the emergency department aims at urgent restoration of sinus rhythm, although paroxysmal AF is a condition that resolves spontaneously within 24 hours in more than 70% of the cases. A wait-and-see approach with rate-control medication only and when needed cardioversion within 48 hours of onset of symptoms is hypothesized to be noninferior, safe, and cost-effective as compared with current standard of care and to lead to a higher quality of life...
January 2017: American Heart Journal
https://www.readbyqxmd.com/read/27974919/brief-report-serial-capillary-lactate-measurement-predict-the-evolution-of-early-sepsis
#15
REVIEW
A Purcarea, A Bourgarit, A Sovaila, C Ghiura, P Diemunsch, E Andres
OBJECTIVE: In intensive care settings, blood lactate level measurement proved to be an excellent predictor of outcomes. In patients requiring less urgent treatment, the arterial blood lactate is less sensitive and its usefulness remains to be proven. Capillary blood lactate dosing, an emergent point-of-care technique readily available should be more sensitive to changes in these settings. METHOD: prospective, observational, monocentric study conducted in a polyvalent internal medicine ward in a French University Hospital...
January 2016: Journal of Medicine and Life
https://www.readbyqxmd.com/read/27969013/nurses-perceptions-of-their-knowledge-and-barriers-to-ambulating-hospitalized-patients-in-acute-settings
#16
Alsacia L Sepulveda-Pacsi, Mary Soderman, Louise Kertesz
PURPOSE: The purpose of this study was to understand nurses' knowledge and perceptions of the importance of patient ambulation in acute care hospital settings. The data obtained from this survey will be used to create improvement initiatives that address patient ambulation. METHOD: An exploratory, cross-sectional study using a self-administered survey was conducted in two different hospital sites, and was completed by 192 nurses. A modified version of the validated and reliable tool entitled "Missed Nursing Care Survey" was used...
November 2016: Applied Nursing Research: ANR
https://www.readbyqxmd.com/read/27938401/testing-modes-of-computerized-sepsis-alert-notification-delivery-systems
#17
Mikhail A Dziadzko, Andrew M Harrison, Ing C Tiong, Brian W Pickering, Pablo Moreno Franco, Vitaly Herasevich
BACKGROUND: The number of electronic health record (EHR)-based notifications continues to rise. One common method to deliver urgent and emergent notifications (alerts) is paging. Despite of wide presence of smartphones, the use of these devices for secure alerting remains a relatively new phenomenon. METHODS: We compared three methods of alert delivery (pagers, EHR-based notifications, and smartphones) to determine the best method of urgent alerting in the intensive care unit (ICU) setting...
December 9, 2016: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/27931480/guidelines-for-the-management-of-traumatic-dental-injuries-3-injuries-in-the-primary-dentition
#18
Barbro Malmgren, Jens O Andreasen, Marie Therese Flores, Agneta Robertson, Anthony J DiAngelis, Lars Andersson, Giacomo Cavalleri, Nestor Cohenca, Peter Day, Morris Lamar Hicks, Olle Malmgren, Alex J Moule, Juan Onetto, Mitsuhiro Tsukiboshi
Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group...
October 2016: Pediatric Dentistry
https://www.readbyqxmd.com/read/27931478/guidelines-for-the-management-of-traumatic-dental-injuries-1-fractures-and-luxations-of-permanent-teeth
#19
Anthony J DiAngelis, Jens O Andreasen, Kurt A Ebeleseder, David J Kenny, Martin Trope, Asgeir Sigurdsson, Lars Andersson, Cecilia Bourguignon, Marie Therese Flores, Morris Lamar Hicks, Antonio R Lenzi, Barbro Malmgren, Alex J Moule, Yango Pohl, Mitsuhiro Tsukiboshi
Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions...
October 2016: Pediatric Dentistry
https://www.readbyqxmd.com/read/27925849/development-and-prospective-federal-state-wide-evaluation-of-a-device-for-height-based-dose-recommendations-in-prehospital-pediatric-emergencies-a-simple-tool-to-prevent-most-severe-drug-errors
#20
Jost Kaufmann, Bernhard Roth, Thomas Engelhardt, Alex Lechleuthner, Michael Laschat, Christoph Hadamitzky, Frank Wappler, Martin Hellmich
OBJECTIVE: Drug dosing errors pose a particular threat to children in prehospital emergency care. With the Pediatric emergency ruler (PaedER), we developed a simple height-based dose recommendation system and evaluated its effectiveness in a pre-post interventional trial as the Ethics Committee disapproved randomization due to the expected positive effect of the PaedER on outcome. METHODS: Pre-interventional data were retrospectively retrieved from the electronic records and medical protocols of the Cologne Emergency Medical Service over a two-year period prior to the introduction of the PaedER...
December 7, 2016: Prehospital Emergency Care
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