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https://www.readbyqxmd.com/read/29687304/improved-outcomes-following-implementation-of-a-multidisciplinary-care-pathway-for-elderly-hip-fractures
#1
Raina Wallace, L D George Angus, Swapna Munnangi, Sally Shukry, Jody C DiGiacomo, Charles Ruotolo
BACKGROUND: Hip fractures in patients 65 years and older are associated with significant morbidity and mortality. With the steady increase in the elderly population, we implemented an evidence-based clinical practice guideline for the management of hip fractures to optimize patient care and surgical outcomes. AIMS: To evaluate the effects of a multidisciplinary hip fracture care pathway on patient outcomes in the care of elderly patients. METHODS: A retrospective analysis of the differences in outcomes prior to (January-October 2014) and after (November 2014-April 2016) implementation of a hip fracture care pathway at a regional Level I trauma center was performed...
April 23, 2018: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/29685177/severe-hypoglycaemia-in-diabetic-patients-in-pre-hospital-and-emergency-department-care-a-cross-sectional-survey
#2
César Esteves, Celestino Neves, João Jaime Sá, Davide Carvalho
OBJECTIVE: We aimed to characterize hypoglycaemia episodes and patients examined by a Pre-hospital Medical Emergency Unit (PH) and in the Emergency Department (ED) of our hospital. RESULTS: We identified 86 episodes of severe hypoglycaemia (PH: n 37; ED: n 49; both: n 12). Hypoglycaemia accounted for 4.7% of all emergency calls attended by the PH (n 793) and 0.11% of all ED episodes (n 54,366). Among episodes examined by the PH, 64.5% of involved patients had type 2 diabetes and 54...
April 23, 2018: BMC Research Notes
https://www.readbyqxmd.com/read/29680329/dual-diagnosis-of-mental-illness-and-substance-use-disorder-and-injury-in-adults-recently-released-from-prison-a-prospective-cohort-study
#3
Jesse T Young, Ed Heffernan, Rohan Borschmann, James R P Ogloff, Matthew J Spittal, Fiona G Kouyoumdjian, David B Preen, Amanda Butler, Lisa Brophy, Julia Crilly, Stuart A Kinner
BACKGROUND: People with mental illness and substance use disorder are over-represented in prisons. Injury-related mortality is elevated in people released from prison, and both mental illness and substance use disorder are risk factors for injury. Effective care coordination during the transition between criminal justice and community service providers improves health outcomes for people released from prison. However, the health outcomes and support needs of people with dual diagnosis (co-occurring mental illness and substance use disorder) released from prison are poorly understood...
April 17, 2018: Lancet. Public Health
https://www.readbyqxmd.com/read/29673137/herb-induced-liver-injuries-in-developing-nations-an-update
#4
REVIEW
Cecilia Nwadiuto Amadi, Orish Ebere Orisakwe
The last few decades have seen a rise in the use of herbal supplements, natural products, and traditional medicines. However, there are growing concerns related to the safety and toxicities of these medicines. These herbal medicines are associated with complications such as liver damage with a high incidence of mortalities and morbidities. Clinical manifestations range from asymptomatic cases with abnormal liver functions tests to sudden and severe liver failure necessitating liver transplantation. This work aimed to review the etiology, risk factors, diagnosis, clinical manifestations and selected clinical case reports of herbal hepatotoxicity in developing nations...
April 17, 2018: Toxics
https://www.readbyqxmd.com/read/29672398/evaluating-quality-metrics-and-cost-after-discharge-a-population-based-cohort-study-of-value-in-health-care-following-elective-major-vascular-surgery
#5
Charles de Mestral, Konrad Salata, Mohamad A Hussain, Ahmed Kayssi, Mohammed Al-Omran, Graham Roche-Nagle
BACKGROUND: Early readmission to hospital after surgery is an omnipresent quality metric across surgical fields. We sought to understand the relative importance of hospital readmission among all health services received after hospital discharge. OBJECTIVE: The aim of this study was to characterize 30-day postdischarge cost and risk of an emergency department (ED) visit, readmission, or death after hospitalization for elective major vascular surgery. METHODS: This is a population-based retrospective cohort study of patients who underwent elective major vascular surgery - carotid endarterectomy, EVAR, open AAA repair, bypass for lower extremity peripheral arterial disease - in Ontario, Canada, between 2004 and 2015...
April 18, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29670383/the-economic-and-clinical-burden-of-early-versus-late-initiation-of-celecoxib-among-patients-with-osteoarthritis
#6
Ahmed Shelbaya, Caitlyn T Solem, Chris Walker, Yin Wan, Courtney Johnson, Joseph C Cappelleri
Objective: This study aimed to evaluate the characteristics associated with early versus late initiation of celecoxib treatment after osteoarthritis (OA) diagnosis and whether economic and safety outcomes differ between patients with early versus late initiation of celecoxib. Methods: Adults (≥18 years) with a confirmed OA diagnosis (International Classification of Diseases, 9th Edition, Clinical Modifications code: 715.XX), ≥12 months of continuous pre- and post-index enrollment, and ≥1 post-index claim for celecoxib were included from the MarketScan® Commercial Claims and Encounter Database (2009-2013)...
2018: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/29665522/task-shifting-midwifery-support-workers-as-the-second-health-worker-at-a-home-birth-in-the-uk-a-qualitative-study
#7
Beck Taylor, Catherine Henshall, Laura Goodwin, Sara Kenyon
OBJECTIVE: Traditionally two midwives attend home births in the UK. This paper explores the implementation of a new home birth care model where births to low risk women are attended by one midwife and one Midwifery Support Worker (MSW). DESIGN AND SETTING: The study setting was a dedicated home birth service provided by a large UK urban hospital. PARTICIPANTS: Seventy-three individuals over 3 years: 13 home birth midwives, 7 MSWs, 7 commissioners (plan and purchase healthcare), 9 managers, 23 community midwives, 14 hospital midwives...
March 13, 2018: Midwifery
https://www.readbyqxmd.com/read/29659856/integration-of-physical-abuse-clinical-decision-support-into-the-electronic-health-record-at-a-tertiary-care-children-s-hospital
#8
Srinivasan Suresh, Richard A Saladino, Janet Fromkin, Emily Heineman, Tom McGinn, Rudolph Richichi, Rachel P Berger
Objective: To evaluate the effect of a previously validated electronic health record-based child abuse trigger system on physician compliance with clinical guidelines for evaluation of physical abuse. Methods: A randomized controlled trial (RCT) with comparison to a preintervention group was performed. RCT-experimental subjects' providers received alerts with a direct link to a physical abuse-specific order set. RCT-control subjects' providers had no alerts, but could manually search for the order set...
April 12, 2018: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29658993/does-the-primary-care-behavioral-health-model-reduce-emergency-department-visits
#9
Neftali Serrano, Ronald Prince, Meghan Fondow, Kenneth Kushner
OBJECTIVE: To examine the impact of integrating behavioral health services using the primary care behavioral health (PCBH) model on emergency department (ED) utilization. DATA SOURCES: Utilization data from three Dane County, Wisconsin hospitals and four primary care clinics from 2003 to 2011. STUDY DESIGN: We used a retrospective, quasi-experimental, controlled, pre-post study design. Starting in 2007, two clinics began integrating behavioral health into their primary care practices with a third starting in 2010...
April 16, 2018: Health Services Research
https://www.readbyqxmd.com/read/29657369/factors-affecting-the-effective-management-of-acute-stroke-a-prospective-observational-study
#10
C V Nagendra, T S Srinath Kumar, Vikram Bohra, Viju Wilben, Vivek Karan, Vikram Huded
Background: Stroke, characterized by sudden loss of cerebral function, is among one of the leading cause of death and disability world over. The newer treatment modalities have changed the landscape of stroke treatment but are very much time bound. Aim: To characterize pre-hospital and in-hospital factors affecting acute stroke management thus defining lacunae in stroke management. Subjects and Methods: A prospective observational study, conducted at the emergency department of a tertiary care center in southern India from August 2015 to July 2016...
March 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29652816/the-emergency-medical-system-in-greece-opening-aeolus-bag-of-winds
#11
Ourania S Kotsiou, David S Srivastava, Panagiotis Kotsios, Aristomenis K Exadaktylos, Konstantinos I Gourgoulianis
An Emergency Medical Service (EMS) system must encompass a spectrum of care, with dedicated pre-hospital and in-hospital medical facilities. It has to be organised in such a way as to include all necessary services—such as triage accurate initial assessment, prompt resuscitation, efficient management of emergency cases, and transport to definitive care. The global economic downturn has had a direct effect on the health sector and poses additional threats to the healthcare system. Greece is one of the hardest-hit countries...
April 13, 2018: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29651626/current-topics-in-the-management-of-acute-traumatic-spinal-cord-injury
#12
Christopher D Shank, Beverly C Walters, Mark N Hadley
Acute traumatic spinal cord injury (SCI) affects more than 250,000 people in the USA, with approximately 17,000 new cases each year. It continues to be one of the most significant causes of trauma-related morbidity and mortality. Despite the introduction of primary injury prevention education and vehicle safety devices, such as airbags and passive restraint systems, traumatic SCI continues to have a substantial impact on the healthcare system. Over the last three decades, there have been considerable advancements in the management of patients with traumatic SCI...
April 12, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29644992/the-lived-experience-of-parents-whose-children-discharged-to-home-after-cardiac-surgery-for-congenital-heart-disease
#13
Silvio Simeone, Nicol Platone, Marco Perrone, Valentina Marras, Gianluca Pucciarelli, Martina Benedetti, Grazia Dell'Angelo, Teresa Rea, Assunta Guillari, Paola Da Valle, Gianpaolo Gargiulo, Stefano Botti, Giovanna Artioli, Giuseppe Comentale, Salvatore Ferrigno, Gaetano Palma, Stefania Baratta
BACKGROUND: Congenital Heart Diseases (CHDs) afflicting children are estimated in 8 per 1000 live births. Recent advances in surgery and medical treatments allowed an improvement in survival rates leading to changes in diseases management as chronic conditions. Parents involvement during clinical pathways is considered an essential component of care, but frequently they experience stress and anxiety conditions during the care path. These feelings are typical of the pre and peri-operative period, however they don't disappear easily and sometimes they can increase after hospital discharge, affecting the family environment and its behaviors...
April 4, 2018: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/29644869/pearls-and-pitfalls-in-imaging-of-blunt-traumatic-thoracic-aortic-injury-a-pictorial-review
#14
Neeral R Patel, Elizabeth Dick, Nicola Batrick, Michael Jenkins, Elika Kashef
Blunt thoracic aortic injury (TAI) occurs most frequently as a sequelae of high impact deceleration such as high velocity road traffic accidents and falls from height. The burden of mortality and morbidity is high, however advances in pre-hospital care, diagnostic imaging and endovascular therapies have improved outcomes in this group of patients. Emergent treatment depends on accurate, early diagnosis by the radiologist. It is therefore of paramount importance that radiologists are familiar with both the direct (intimal flap, pseudoaneurysm, aortic contour irregularity and contrast extravasation) and indirect (periaortic haematoma) imaging findings of TAI...
April 12, 2018: British Journal of Radiology
https://www.readbyqxmd.com/read/29628333/multidisciplinary-difficult-airway-course-an-essential-educational-component-of-a-hospital-wide-difficult-airway-response-program
#15
W Robert Leeper, Elliott R Haut, Vinciya Pandian, Sajan Nakka, Jeffrey Dodd-O, Nasir Bhatti, Elizabeth A Hunt, Mustapha Saheed, Nicholas Dalesio, Adam Schiavi, Christina Miller, Thomas D Kirsch, Lauren Berkow
OBJECTIVE: A hospital-wide difficult airway response team was developed in 2008 at The Johns Hopkins Hospital with three central pillars: operations, safety monitoring, and education. The objective of this study was to assess the outcomes of the educational pillar of the difficult airway response team program, known as the multidisciplinary difficult airway course (MDAC). DESIGN: The comprehensive, full-day MDAC involves trainees and staff from all provider groups who participate in airway management...
April 5, 2018: Journal of Surgical Education
https://www.readbyqxmd.com/read/29628149/distribution-of-rotavirus-genotypes-associated-with-acute-diarrhoea-in-zimbabwean-children-less-than-five-years-old-before-and-after-rotavirus-vaccine-introduction
#16
Arnold Mukaratirwa, Chipo Berejena, Pasipanodya Nziramasanga, Ismail Ticklay, Archebald Gonah, Kusum Nathoo, Portia Manangazira, Douglas Mangwanya, Joan Marembo, Jason M Mwenda, Goitom Weldegebriel, Mapaseka Seheri, Jacqueline E Tate, Catherine Yen, Umesh Parashar, Hilda Mujuru
BACKGROUND: Sentinel surveillance for diarrhoea is important to monitor changes in rotavirus epidemiological trends and circulating genotypes among children under 5 years before and after vaccine introduction. The Zimbabwe Ministry of Health and Child Care introduced rotavirus vaccine in national immunization program in May 2014. METHODS: Active hospital-based surveillance for diarrhoea was conducted at 3 sentinel sites from 2008 to 2016. Children aged less than 5 years, who presented with acute gastroenteritis as a primary illness and who were admitted to a hospital ward or treated at the emergency unit, were enrolled and had a stool specimen collected and tested for rotavirus by enzyme immunoassay (EIA)...
April 5, 2018: Vaccine
https://www.readbyqxmd.com/read/29622974/pre-hospital-and-hospital-delay-in-patients-with-non-st-elevation-acute-coronary-syndromes-in-tertiary-care
#17
G S Youssef, H H Kassem, O A Ameen, H S Al Taaban, H H Rizk
Background: Early presentation is desirable in all cases of acute prolonged chest pain. Causes of delayed presentation vary widely across geographic regions because of different patients' profile and different healthcare capabilities. Objectives: To detect causes of delay of Non-ST elevation acute coronary syndrome (NSTE-ACS) patients in our country. Methods: Patients admitted with NSTE-ACS were included. We recorded the time delay between the onsets of acute severe symptoms till their arrival to the hospital (Pre-hospital delay)...
September 2017: The Egyptian heart journal: (EHJ): official bulletin of the Egyptian Society of Cardiology
https://www.readbyqxmd.com/read/29622393/heart-failure-education-in-the-emergency-department-markedly-reduces-readmissions-in-un-and-under-insured-patients
#18
Vishwaratn Asthana, Miel Sundararajan, Ruth Linda Ackah, Vivek Karun, Arunima Misra, Allison Pritchett, Pallavi Bugga, Angela Siler-Fisher, William Frank Peacock
BACKGROUND: Heart failure (HF) readmissions are a longstanding national healthcare issue for both hospitals and patients. Our purpose was to evaluate the efficacy of a structured, educational intervention targeted towards un- and under-insured emergency department (ED) HF patients. METHODS: HF patients presenting to the ED for care were enrolled between July and December 2015 as part of an open label, interventional study, using a parallel observational control group...
March 21, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29620961/building-a-medicaid-ambulatory-complex-care-program-within-an-urban-medical-home
#19
Laura D Sander, Michael Albert, Nkem Okeke, Steven Kravet, Katherine Rediger, Sarah Johnson Conway, Maura J McGuire
Five percent of Medicaid patients account for 50% of total costs. Preventable costs are often incurred by patients with complex medical, behavioral, and social needs who disproportionately utilize acute care services. Evidence for design, implementation, and evaluation of complex care programs in the urban Medicaid population is lacking. The article provides a description of a complex care program (CCP), challenges, and early outcomes based on a pre-post evaluation. The CCP was located within an existing urban medical home...
April 5, 2018: Population Health Management
https://www.readbyqxmd.com/read/29617390/myeloma-patient-accounts-of-their-pathways-to-diagnosis
#20
Debra A Howell, Ruth I Hart, Alexandra G Smith, Una Macleod, Russell Patmore, Gordon Cook, Eve Roman
BACKGROUND: Pathways to myeloma diagnosis can be prolonged, and are often preceded by multiple GP consultations and emergency presentation. This is the first qualitative study to examine events leading to diagnosis by asking patients about their experiences during this time. METHODS: Set within a UK population-based cohort, semi-structured interviews were conducted with 20 myeloma patients with varying characteristics and pathways, 12 of whom invited their relatives to take part...
2018: PloS One
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