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https://www.readbyqxmd.com/read/29223435/atrial-fibrillation-decision-support-tool-population-perspective
#1
Mark H Eckman, Alexandru Costea, Mehran Attari, Jitender Munjal, Ruth E Wise, Carol Knochelmann, Matthew L Flaherty, Pete Baker, Robert Ireton, Brett M Harnett, Anthony C Leonard, Dylan Steen, Adam Rose, John Kues
BACKGROUND: Appropriate thromboprophylaxis for patients with atrial fibrillation or atrial flutter (AF) remains a national challenge. The recent availability of direct oral anticoagulants (DOACs) with comparable efficacy and improved safety compared with warfarin alters the balance between risk factors for stroke and benefit of anticoagulation. Our objective was to examine the impact of DOACs as an alternative to warfarin on the net benefit of oral anticoagulant therapy (OAT) in a real-world population of AF patients...
December 2017: American Heart Journal
https://www.readbyqxmd.com/read/29222541/estimating-cost-effectiveness-of-a-multimodal-ovarian-cancer-screening-program-in-the-united-states-secondary-analysis-of-the-uk-collaborative-trial-of-ovarian-cancer-screening-ukctocs
#2
Haley A Moss, Andrew Berchuck, Megan L Neely, Evan R Myers, Laura J Havrilesky
Importance: The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) is the largest randomized clinical trial to evaluate screening's impact on ovarian cancer mortality, assigning women to multimodal screening (MMS) with serum cancer antigen 125 (CA-125) interpreted using a risk algorithm. If the MMS screening method is eventually shown to reduce mortality and be cost-effective, then it may be accepted by the medical community as a feasible screening tool. Objective: To estimate the cost-effectiveness of an MMS screening program in the United States...
December 7, 2017: JAMA Oncology
https://www.readbyqxmd.com/read/29221929/use-of-pharmacy-technicians-in-elements-of-medication-therapy-management-delivery-a-systematic-review
#3
REVIEW
Stephanie A Gernant, My-Oanh Nguyen, Sanna Siddiqui, Matthew Schneller
BACKGROUND: Documented barriers to Medication Therapy Management (MTM) delivery, such as limited time and inefficient workflow may be overcome by utilizing support staff for administrative services. However, it is unknown how pharmacy technicians have been historically utilized to assist pharmacists in MTM-delivery. OBJECTIVE: To characterize literature describing pharmacy technicians' participation in actions commonly undertaken in the provision of MTM services...
November 24, 2017: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/29217447/early-experience-with-fenestrated-endovascular-compared-to-open-repair-of-complex-abdominal-aortic-aneurysms-in-a-high-volume-open-aortic-center
#4
Sarah E Deery, Robert T Lancaster, Anna M Gubala, Thomas F X O'Donnell, Christopher J Kwolek, Mark F Conrad, Richard P Cambria, Virendra I Patel
OBJECTIVE: Early data suggest that FEVAR is feasible but may have higher morbidity and unclear durability compared to open surgical repair (OSR) of complex abdominal aortic aneurysms (CAAA). We compared the early experience following elective FEVAR to traditional OSR of CAAA in a high-volume open aortic center. METHODS: All patients undergoing FEVAR and OSR for elective CAAA from 1/2010-7/2015 were identified. Univariate, multivariable logistic, and Cox hazards modeling were used to compare perioperative and intermediate outcomes...
December 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29216780/using-cost-analyses-to-inform-health-professions-education-the-economic-cost-of-pre-clinical-failure
#5
Jonathan Foo, Dragan Ilic, George Rivers, Darrell J R Evans, Kieran Walsh, Terry P Haines, Sophie Paynter, Prue Morgan, Stephen Maloney
BACKGROUND: Student failure creates additional economic costs. Knowing the cost of failure helps to frame its economic burden relative to other educational issues, providing an evidence-base to guide priority setting and allocation of resources. The Ingredients Method is a cost-analysis approach which has been previously applied to health professions education research. In this study, the Ingredients Method is introduced, and applied to a case study, investigating the cost of pre-clinical student failure...
December 7, 2017: Medical Teacher
https://www.readbyqxmd.com/read/29216014/incorporating-patients-preference-diagnosis-in-implantable-cardioverter-defibrillator-decision-making-a-review-of-recent-literature
#6
Krystina B Lewis, Sandra L Carroll, David Birnie, Dawn Stacey, Daniel D Matlock
PURPOSE OF REVIEW: Strong recommendations exist for implantable cardioverter defibrillators (ICD) in appropriately selected patients. Yet, patient preferences are not often incorporated when decisions about ICD therapy are made. Literature published since 2016 was reviewed aiming to discuss current advances and ongoing challenges with ICD decision-making in adults, discuss shared decision-making (SDM) as a strategy to incorporate preference diagnoses, summarize current evidence on effective interventions to facilitate SDM, and identify opportunities for research and practice...
January 2018: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/29215509/interval-female-sterilization
#7
Gretchen S Stuart, Shanthi S Ramesh
Female sterilization is relied on by nearly one in three women aged 35-44 years in the United States. Sterilization procedures are among the most common procedures that obstetrician-gynecologists perform. The most frequent sterilization procedures include postpartum tubal ligation, laparoscopic tubal disruption or salpingectomy, and hysteroscopic tubal occlusion. The informed consent process for sterilization is crucial and requires shared decision-making between the patient and the health care provider. Counseling should include the specific risks and benefits of the specific surgical approaches...
December 4, 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29215463/variation-in-practice-patterns-for-listing-patients-for-renal-transplantation-in-the-united-kingdom-a-national-survey
#8
Rishi Pruthi, Sarah Tonkin-Crine, Melania Calestani, Geraldine Leydon, Caroline Eyles, Gabriel C Oniscu, Charles Tomson, Andrew Bradley, John L Forsythe, Clare Bradley, John Cairns, Christopher Dudley, Christopher Watson, Heather Draper, Rachel Johnson, Wendy Metcalfe, Damian Fogarty, Rommel Ravanan, Paul J Roderick
INTRODUCTION: Despite the availability of guidelines for the evaluation of candidates for renal transplantation, variation in access to transplantation exists. This national survey investigates whether centre variation exists in the assessment of patients for renal transplantation in the UK. METHODS: An online survey, informed by qualitative interviews, was distributed to all UK renal centres. This survey examined centre approaches to chronic kidney disease service provision, transplant recipient assessment, education provision and wait-listing decision making processes...
December 5, 2017: Transplantation
https://www.readbyqxmd.com/read/29214960/first-come-first-served-in-the-intensive-care-unit-always
#9
Leonard M Fleck, Timothy F Murphy
Because the demand for intensive care unit (ICU) beds exceeds the supply in general, and because of the formidable costs of that level of care, clinicians face ethical issues when rationing this kind of care not only at the point of admission to the ICU, but also after the fact. Under what conditions-if any-may patients be denied admission to the ICU or removed after admission? One professional medical group has defended a rule of "first come, first served" in ICU admissions, and this approach has numerous moral considerations in its favor...
January 2018: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
https://www.readbyqxmd.com/read/29212522/a-systematic-review-of-neonatal-treatment-intensity-scores-and-their-potential-application-in-low-resource-setting-hospitals-for-predicting-mortality-morbidity-and-estimating-resource-use
#10
Jalemba Aluvaala, Gary S Collins, Michuki Maina, James A Berkley, Mike English
BACKGROUND: Treatment intensity scores can predict mortality and estimate resource use. They may therefore be of interest for essential neonatal care in low resource settings where neonatal mortality remains high. We sought to systematically review neonatal treatment intensity scores to (1) assess the level of evidence on predictive performance in predicting clinical outcomes and estimating resource utilisation and (2) assess the applicability of the identified models to decision making for neonatal care in low resource settings...
December 7, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/29208415/guideline-on-terminology-and-definitions-of-updating-clinical-guidelines-the-updating-glossary
#11
L Martínez García, H Pardo-Hernández, A J Sanabria, P Alonso-Coello, K Penman, E McFarlane
OBJECTIVE: The Guidelines International Network (G-I-N) Updating Guidelines Working Group launched an initiative to develop a glossary (the Updating Glossary) with domains, terms, definitions, and synonyms related to updating of clinical guidelines (CGs). STUDY DESIGN AND SETTING: The Steering Committee developed an initial list of domains, terms, definitions, and synonyms through brainstorming and discussion. The Panel Members participated in three rounds of feedback to discuss, refine, and clarify the proposed terms, definitions, and synonyms...
December 2, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/29202988/mobile-phone-generated-vibrations-used-to-detect-diabetic-peripheral-neuropathy
#12
Jonathan David May, Matthew William John Morris
BACKGROUND: In the current United Kingdom population the incidence of diabetic peripheral neuropathy is increasing. The presence of diabetic neuropathy affects decision making and treatment options. This study seeks to evaluate if the vibrations generated from a mobile phone can be used to screen patients for diabetic peripheral neuropathy. METHODS: This study comprised of 61 patients; a control group of 21 patients; a lower limb injury group of 19 patients; a diabetic peripheral neuropathy group of 21 patients...
December 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/29198260/management-of-late-presentation-congenital-heart-disease
#13
Parvathi U Iyer, Guillermo E Moreno, Luiz Fernando Caneo, Tahira Faiz, Lara S Shekerdemian, Krishna S Iyer
In many parts of the world, mostly low- and middle-income countries, timely diagnosis and repair of congenital heart diseases (CHDs) is not feasible for a variety of reasons. In these regions, economic growth has enabled the development of cardiac units that manage patients with CHD presenting later than would be ideal, often after the window for early stabilisation - transposition of the great arteries, coarctation of the aorta - or for lower-risk surgery in infancy - left-to-right shunts or cyanotic conditions...
December 2017: Cardiology in the Young
https://www.readbyqxmd.com/read/29197207/correlates-of-involuntary-admission-findings-from-an-italian-inpatient-psychiatric-unit
#14
Pierfrancesco Maria Balducci, Francesco Bernardini, Luca Pauselli, Alfonso Tortorella, Michael T Compton
BACKGROUND: Involuntary admission is challenging in terms of providing the most effective but least restrictive care in accordance with the country's regulations. A better understanding of correlates of voluntary versus involuntary admission legal status is crucial to improve clinical decision-making and effectiveness of the overall mental health care system. SUBJECTS AND METHODS: We collected chart-review data pertaining to 848 patients, discharged between June 2011 and June 2014, from an Italian inpatient psychiatric unit...
December 2017: Psychiatria Danubina
https://www.readbyqxmd.com/read/29194711/institutional-decision-to-adopt-y90-as-primary-treatment-for-hcc-informed-by-a-1-000-patient-15-year-experience
#15
Riad Salem, Ahmed Gabr, Ahsun Riaz, Ronald Mora, Rehan Ali, Michael Abecassis, Ryan Hickey, Laura Kulik, Daniel Ganger, Steven Flamm, Rohi Atassi, Bassel Atassi, Kent Sato, Al B Benson, Mary F Mulcahy, Nadine Abouchaleh, Ali Al Asadi, Kush Desai, Bartley Thornburg, Michael Vouche, Ali Habib, Juan Caicedo, Frank H Miller, Vahid Yaghmai, Joseph R Kallini, Samdeep Mouli, Robert J Lewandowski
Y90 transarterial radioembolization (TARE) is a transarterial locoregional therapy (LRT) for hepatocellular carcinoma (HCC). In this study, we present overall survival outcomes (OS) in a 1000-patient cohort acquired over a 15-year period. Between December 1, 2003 and March 31, 2017, 1000 patients with HCC were treated with TARE as part of a prospective cohort study. A comprehensive review of toxicity and survival outcomes was performed. Outcomes were stratified by baseline Child-Pugh (CP) class, United Network for Organ Sharing (UNOS) and Barcelona Clinic Liver Cancer (BCLC) staging systems...
December 1, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/29193899/role-of-cochrane-reviews-in-informing-us-private-payers-policies
#16
Ambrish Singh, Salman Hussain, Abul Kalam Najmi
AIM: To assess the use of Cochrane Reviews to inform the medical policy documents of major US private payers. METHODS: The publically available drug policy documents of the five major US private payers (covering about 50% market) namely: Anthem, Aetna, Cigna, Humana and United Healthcare (UHC) were assessed in February 2017 and reviewed to find whether they had used Cochrane Reviews. We extracted information such as use of Cochrane Reviews, number of Cochrane Reviews used, context of use and impact of Cochrane Reviews on policy, and Cochrane Review Group (CRG) and Cochrane Center linked to the Cochrane Review...
November 2017: Journal of Evidence-based Medicine
https://www.readbyqxmd.com/read/29190384/general-practitioner-and-nurse-prescriber-experiences-of-prescribing-antibiotics-for-respiratory-tract-infections-in-uk-primary-care-out-of-hours-services-the-unite-study
#17
S J Williams, A V Halls, S Tonkin-Crine, M V Moore, S E Latter, P Little, C Eyles, K Postle, G M Leydon
Background: Interventions are needed to reduce unnecessary antibiotic prescribing for respiratory tract infections (RTIs). Although community antibiotic prescribing appears to be decreasing in the UK, figures for out-of-hours (OOH) prescribing have substantially increased. Understanding the factors influencing prescribing in OOH and any perceived differences between general practitioner (GP) and nurse prescriber (NP) prescribing habits may enable the development of tailored interventions promoting optimal prescribing in this setting...
November 27, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29190157/factors-influencing-secondary-care-pharmacist-and-nurse-independent-prescribers-clinical-reasoning-an-interprofessional-analysis
#18
Aseel S Abuzour, Penny J Lewis, Mary P Tully
In the United Kingdom, pharmacist and nurse independent prescribers are responsible for both the clinical assessment of and prescribing for patients. Prescribing is a complex skill that entails the application of knowledge, skills, and clinical reasoning to arrive at a clinically appropriate decision. Decision-making is influenced and informed by many factors. This study, the first of its kind, explores what factors influence pharmacist and nurse independent prescribers during the process of clinical reasoning...
November 30, 2017: Journal of Interprofessional Care
https://www.readbyqxmd.com/read/29190037/routine-antibiotic-prophylaxis-after-normal-vaginal-birth-for-reducing-maternal-infectious-morbidity
#19
REVIEW
Mercedes Bonet, Erika Ota, Chioma E Chibueze, Olufemi T Oladapo
BACKGROUND: Infectious morbidities contribute to considerable maternal and perinatal morbidity and mortality, including women at no apparent increased risk of infection. To reduce the incidence of infections, antibiotics are often administered to women after uncomplicated childbirth, particularly in settings where women are at higher risk of puerperal infectious morbidities. OBJECTIVES: To assess whether routine administration of prophylactic antibiotics to women after normal (uncomplicated) vaginal birth, compared with placebo or no antibiotic prophylaxis, reduces postpartum maternal infectious morbidities and improves outcomes...
November 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29189590/management-of-pediatric-isolated-skull-fractures-a-decision-tree-and-cost-analysis-on-emergency-department-disposition-strategies
#20
Daniel C Williams, W Scott Russell, Annie L Andrews, Kit N Simpson, William T Basco, Ronald J Teufel
OBJECTIVE: Pediatric isolated skull fractures (ISFs) are common injuries that represent challenging disposition decisions for clinicians. The purpose of this study is to use a decision analysis to compare the clinical and cost-effectiveness of 3 emergency department (ED)-based disposition scenarios for a pediatric patient presenting with ISF. METHODS: We conducted a cost-effectiveness analysis comparing ED disposition scenarios that included current practice, increased at-home surveillance, and observation unit utilization...
November 20, 2017: Pediatric Emergency Care
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