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Non comfort medication

Gustavo Chavez, Ilana B Richman, Rajani Kaimal, Jason Bentley, Lee Ann Yasukawa, Russ B Altman, Vyjeyanthi S Periyakoil, Jonathan H Chen
IMPORTANCE: Critically ill patients often receive high-intensity life sustaining treatments (LST) in the intensive care unit (ICU), although they can be ineffective and eventually undesired. Determining the risk factors associated with reversals in LST goals can improve patient and provider appreciation for the natural history and epidemiology of critical care and inform decision making around the (continued) use of LSTs. METHODS: This is a single institution retrospective cohort study of patients receiving life sustaining treatment in an academic tertiary hospital from 2009 to 2013...
2018: PloS One
Maja Pedersen, Camilla Bring, Nina Brünés, Ove Andersen, Janne Petersen, Mary Jarden
The aim of this study was to explore homeless people's health perspectives and experiences of a 2-week medical respite care programme following acute hospitalisation. There is a high level of health inequality when comparing the health status of homeless people to the general population, including increased mortality and morbidity. Homelessness predisposes an increased risk of infectious disease, cancer and chronic illness, such as diabetes and cardiovascular disease. Moreover, homeless people have a higher frequency of acute hospitalisation than general population estimates...
February 28, 2018: Health & Social Care in the Community
Julia F-M Gilmartin-Thomas, John McNeil, Anne Powell, Daniel T Malone, Rory Wolfe, Ian C Larson, Claire L O'Reilly, Carl M Kirkpatrick, Eva Kipen, Tanya Petrovich, J Simon Bell
BACKGROUND: Clinical practice guidelines for dementia highlight the importance of providing patient-centered care. This can be achieved by improving health professionals' attitudes and knowledge toward people with dementia. OBJECTIVE: Quantitatively evaluate the impact of a virtual dementia experience on medical and pharmacy students' knowledge and attitudes toward people with dementia. METHODS: A non-randomized controlled study from September-October 2016...
2018: Journal of Alzheimer's Disease: JAD
Rachel Whitty, Sandra Porter, Kiran Battu, Pranjal Bhatt, Ellen Koo, Csilla Kalocsai, Peter Wu, Kendra Delicaet, Isaac I Bogoch, Robert Wu, James Downar
BACKGROUND: Many seriously ill and frail inpatients receive potentially inappropriate or harmful medications and do not receive medications for symptoms of advanced illness. We developed and piloted an interprofessional Medication Rationalization (MERA) approach to deprescribing inappropriate medications and prescribing appropriate comfort medications. METHODS: We conducted a single-centre pilot study of inpatients at risk of 6-month mortality from advanced age or morbidity...
February 16, 2018: CMAJ Open
Elliot M Ross, Theodore T Redman, Julian G Mapp, Derek J Brown, Kaori Tanaka, Craig W Cooley, Chetan U Kharod, David A Wampler
BACKGROUND: The "Stop the Bleed" campaign advocates for non-medical personnel to be trained in basic hemorrhage control. However, it is not clear what type of education or the duration of instruction needed to meet that requirement. The objective of this study was to determine the impact of a brief hemorrhage control educational curriculum on the willingness of laypersons to respond during a traumatic emergency. METHODS: This "Stop the Bleed" education initiative was conducted by the University of Texas Health San Antonio Office of the Medical Director (San Antonio, Texas USA) between September 2016 and March 2017...
February 19, 2018: Prehospital and Disaster Medicine
M Monica Gavris, Ioana Olteanu, Erzsebet Kantor, Radu Mateescu, Roxana Belicioiu
Purpose: To present the new IRIDEX MicroPulse P3 (MP3) technology in patients with refractory glaucoma and our preliminary results at 1 week and 1 month postoperatively. Methods: IRIDEX MP3 laser cyclophotocoagulation was performed in 7 eyes of 7 patients under retrobulbar anaesthesia with lidocaine 2% in the operating room. Each eye received two treatments of 80-90s over the superior and inferior hemisphere, avoiding the temporal- and nasal-most clock hours. 810nm IRIDEX MP3 was set to 31,3% duty cycle (0,5ms treatment pulse followed by 1,1 ms of rest)...
April 2017: Romanian Journal of Ophthalmology
Saki Fujita, Isaree Pitaktong, Graeme Vosit Steller, Victor Dadfar, Qinwen Huang, Sindhu Banerjee, Richard Guo, Hien Tan Nguyen, Robert Harry Allen, Seth Shay Martin
Background: Social support received by patients from family and community has been identified as a key factor for success in improving medication adherence in those patients. This pilot study aimed to investigate the usability and feasibility of PillPal, a smartphone application that uses video-chatting as a social motivation medium to encourage medication adherence in cardiovascular disease (CVD) patients. We additionally gathered feedback on the Physician Calendar, an accompanying web platform that allows clinicians to view patient adherence data generated from the app...
2018: MHealth
Brett Schrewe
One of the most exciting yet stressful times in a physician's life is transitioning from supervised training into independent practice. The majority of literature devoted to this topic has focused upon a perceived gap between clinical and non-clinical skills and interventions taken to address it. Building upon recent streams of scholarship in identity formation and adaptation to new contexts, this work uses a Heideggerian perspective to frame an autoethnographical exploration of the author's transition into independent paediatric practice...
February 13, 2018: Advances in Health Sciences Education: Theory and Practice
Ryszard Piotrowicz, Paweł Krzesiński, Paweł Balsam, Maciej Kempa, Renata Główczyńska, Marcin Grabowski, Łukasz Kołtowski, Ewa Lewicka, Michał Peller, Ewa Piotrowicz, Jakub Podolec, Adam Stańczyk, Justyna Zajdel, Grzegorz Opolski
For several years, we have observed the dynamic development of technologies that allow patients to access medical care from the comfort of their homes, without direct contact with the doctor. Innovative solutions based on telemedicine improve care coordination and communication among clinicians, patients, and their families, as well as increases patients' security and gives them greater independence, thus eliminating health care inequalities. The rapidly growth of telemedicine and the adoption of new technologies in clinical practice is also observed in Poland...
February 14, 2018: Kardiologia Polska
Philip Dawe, Andrew Kirkpatrick, Max Talbot, Andrew Beckett, Naisan Garraway, Heather Wong, Syed Morad Hameed
BACKGROUND: Damage-control and emergency surgical procedures in trauma have the potential to save lives. They may occasionally not be performed due to clinician inexperience or lack of comfort and knowledge. METHODS: Canadian Armed Forces (CAF) non-surgeon Medical Officers (MOs) participated in a live tissue training exercise. They received tele-mentoring assistance using a secure video-conferencing application on a smartphone/tablet platform. Feasibility of tele-mentored surgery was studied by measuring their effectiveness at completing a set series of tasks in this pilot study...
February 2, 2018: American Journal of Surgery
Tracy Flanagan, Amy Alabaster, Brigid McCaw, Nicole Stoller, Carey Watson, Kelly C Young-Wolff
INTRODUCTION: Adverse childhood experiences (ACEs) are common among pregnant women and contribute to increased risk for negative perinatal outcomes, yet few clinicians screen prenatal patients for ACEs. The purpose of this study was to evaluate the feasibility and acceptability of screening for ACEs in standard prenatal care. METHODS: We evaluated a 4-month pilot (March 2016-June 2016) to screen pregnant women (at ∼14-23 weeks of gestation) for ACEs and resiliency in two Kaiser Permanente Northern California medical centers (N = 480)...
January 19, 2018: Journal of Women's Health
Lynn K Herrmann, Nancy Udelson, Cheryl Kanetsky, Hongyan Liu, Kristin Cassidy, Elisabeth Welter, Martha Sajatovic
Objective Develop and test a stigma awareness and education curriculum targeted to non-medical staff of a local Alzheimer's Association chapter. Methods The curriculum, developed in collaboration with leadership and educational staff from the Cleveland Chapter of the Alzheimer's Association, included a definition, types, and domains of stigma; effects of stigma on individuals with dementia and their families; stigma evaluation studies; tips to address the topic of dementia-related stigma with individuals and families...
January 1, 2018: Dementia
Madhav G Deo
A buzzword in Indian press and amongst the policy makers is that India is short of the WHO recommended doctor to population ratio of 1:1000. The recommendations were formulated to facilitate programs to achieve some of the health related UN-Millennium Development Goals (MDGs). Infections and malnutrition, which can be comfortably handled by a basic MBBS doctor, were the dominant health issues at the time of the formulation of the MDGs. However, all countries worldwide are going through health epidemiological transition and health impact of the non-communicable disorders (NCDs) can be no more ignored even by the low income nations...
October 2017: Journal of the Association of Physicians of India
Uchenna R Ofoma, Yue Dong, Ognjen Gajic, Brian W Pickering
BACKGROUND: Quantitative studies have demonstrated several factors predictive of readmissions to intensive care. Clinical decision tools, derived from these factors have failed to reduce readmission rates. The purpose of this study was to qualitatively explore the experiences and perceptions of physicians and nurses to gain more insight into intensive care readmissions. METHODS: Semi-structured interviews of intensive care unit (ICU) and general medicine care providers explored work routines, understanding and perceptions of the discharge process, and readmissions to intensive care...
January 5, 2018: BMC Health Services Research
Gabriela E Lazalde, Melissa B Gilkey, Melanie L Kornides, Annie-Laurie McRee
INTRODUCTION: Offering HPV vaccine in settings beyond the traditional medical home holds promise for increasing the currently low levels of coverage. As adolescents frequently visit dentists, dental practices may be one such alternative vaccination setting. This study assessed parent attitudes about the roles dental providers could play in HPV prevention, including vaccine provision. METHODS: In September 2016, we conducted an online survey using a national sample (n = 1209) of U...
December 23, 2017: Vaccine
Kathryn A Collison, Pinal Patel, Andrew F Preece, Richard H Stanford, Raj K Sharma, Gregory Feldman
This randomised, open-label, cross-over, placebo-containing inhaler study assessed patient preference indicators for ELLIPTA and HandiHaler dry powder inhalers in patients with COPD (NCT02786927; GSK identifier: 204983). The primary objective of this study was to assess patient preference between ELLIPTA and HandiHaler based on the number of steps needed to use the inhaler. Eligible patients ≥40 years of age with COPD were randomised 1:1 to receive their current COPD medication plus a placebo-containing ELLIPTA or HandiHaler inhaler once daily for 7 ± 2 days (treatment period 1); this was followed by a 7 ± 2-day placebo treatment with the alternative inhaler...
February 2018: COPD
Hana Hamdi, Oumar Ba, Serigne Niang, Christian Ntizimira, Mouhadou Mbengue, Aminata Sophie Coulbary, Rokhaya Niang, Matthew Parsons, Joseph J Amon, Diederik Lohman
CONTEXT: With prevalence of noncommunicable diseases and life expectancy rising in Senegal, the need for palliative care is likely growing. No national palliative care needs assessments have been carried out. OBJECTIVES: To assess the capacity and need for palliative care in Senegal. METHODS: A multicomponent assessment of availability and demand for palliative care was conducted in two tertiary and two regional hospitals in Senegal in 2015 with approval from Senegal's National Ethics Committee for Health Research...
December 7, 2017: Journal of Pain and Symptom Management
Frederike J C Haverkamp, Gordon G Giesbrecht, Edward C T H Tan
BACKGROUND: Accidental hypothermia concerns a body core temperature of less than 35°C without a primary defect in the thermoregulatory system. It is a serious threat to prehospital patients and especially injured patients, since it can induce a vicious cycle of the synergistic effects of hypothermia, acidosis and coagulopathy; referred to as the trauma triad of death. To prevent or manage deterioration of a cold patient, treatment of hypothermia should ideally begin prehospital. Little effort has been made to integrate existent literature about prehospital temperature management...
November 4, 2017: Injury
Congli Wei, Chunyuan Ma
Catheter related infection is the most common complication of central venous catheter, which pathogen mainly originate from the pipe joint and the skin around puncture site. How to prevent catheter infection is an important issue in clinical nursing. The utility model disclosed a "disposable nursing applicator-pocket of indwelling central venous catheter", which is mainly used for the fixation and the protection. The main structure consists of two parts, one is medical applicator to protect the skin around puncture site, and the other is gauze pocket to protect the catheter external connector...
November 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Marina Gaínza-Lein, Robert Benjamin, Coral Stredny, Marlee McGurl, Kush Kapur, Tobias Loddenkemper
PURPOSE: The aim of this study was to analyze pre-hospital seizure rescue medication (RM) use in a pediatric epilepsy population, caregiver knowledge and comfort, and prescription patterns. METHOD: Cross-sectional observational study based on surveys to families of pediatric patients with epilepsy and based on medical chart review. RESULTS: One hundred (88%) out of 114 families answered the questionnaire. Fifty-five patients were females (55%), with a median (IQR) age of 11 (6-14) years...
October 13, 2017: Seizure: the Journal of the British Epilepsy Association
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