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https://www.readbyqxmd.com/read/28340022/nicotine-content-and-physical-properties-of-large-cigars-and-cigarillos-in-the-united-states
#1
Bartosz Koszowski, Meridith Hill Thanner, Wallace B Pickworth, Kenneth M Taylor, Lynn C Hull, Megan J Schroeder
Introduction: Cigars are combusted tobacco products consisting of filler, binder, and wrapper, which are derived from tobacco. Despite the abundance of literature on the composition of traditional combusted cigarettes, research is limited on the physical and chemical properties of cigars. Therefore, research on cigar properties may be useful to better understand their health impact. Methods: In this study, twenty large cigar and cigarillo products were characterized for physical properties (ie, weight, length, and diameter), filler nicotine content, and tobacco pH...
March 4, 2017: Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco
https://www.readbyqxmd.com/read/28334585/uptake-and-utilization-of-practice-guidelines-in-hospitals-in-the-united-states-the-case-of-routine-episiotomy
#2
Katy B Kozhimannil, Pinar Karaca-Mandic, Cori J Blauer-Peterson, Neel T Shah, Jonathan M Snowden
BACKGROUND: The gap between publishing and implementing guidelines differs based on practice setting, including hospital geography and teaching status. On March 31, 2006, a Practice Bulletin published by the American College of Obstetricians and Gynecologists (ACOG) recommended against the routine use of episiotomy and urged clinicians to make judicious decisions to restrict the use of the procedure. OBJECTIVE: This study investigated changes in trends of episiotomy use before and after the ACOG Practice Guideline was issued in 2006, focusing on differences by hospital geographic location (rural/urban) and teaching status...
January 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28331764/how-many-of-the-biopsy-decisions-taken-at-inexperienced-breast-radiology-units-were-correct
#3
Özlem Demircioğlu, Meral Uluer, Erkin Arıbal
OBJECTIVE: In this study, we aimed to determine the need for biopsy in patients referred from other clinics for the performance of biopsy with the suspicion of breast cancer. MATERIALS AND METHODS: 112 patients were included in the study. It was decided that their biopsies be performed following examinations in other clinics and they presented to the breast radiology unit of our hospital for a second opinion. The demographic characteristics, diagnostic studies completed in the other centers, properties of lesions, decision made as a result of examinations and BI-RADS (Breast Imaging Reporting and Data Systems) categorizations were recorded on the registration forms of the study patients...
January 2017: J Breast Health (2013)
https://www.readbyqxmd.com/read/28330409/guidelines-on-constructing-funnel-plots-for-quality-indicators-a-case-study-on-mortality-in-intensive-care-unit-patients
#4
Ilona Wm Verburg, Rebecca Holman, Niels Peek, Ameen Abu-Hanna, Nicolette F de Keizer
Funnel plots are graphical tools to assess and compare clinical performance of a group of care professionals or care institutions on a quality indicator against a benchmark. Incorrect construction of funnel plots may lead to erroneous assessment and incorrect decisions potentially with severe consequences. We provide workflow-based guidance for data analysts on constructing funnel plots for the evaluation of binary quality indicators, expressed as proportions, risk-adjusted rates or standardised rates. Our guidelines assume the following steps: (1) defining policy level input; (2) checking the quality of models used for case-mix correction; (3) examining whether the number of observations per hospital is sufficient; (4) testing for overdispersion of the values of the quality indicator; (5) testing whether the values of quality indicators are associated with institutional characteristics; and (6) specifying how the funnel plot should be constructed...
January 1, 2017: Statistical Methods in Medical Research
https://www.readbyqxmd.com/read/28328388/bedside-critical-care-staff-use-of-intensive-care-unit-telemedicine-comparisons-by-intensive-care-unit-complexity
#5
Jonathan T Thomas, Jane Moeckli, Michelle A Mengeling, Cassie Cunningham Goedken, Jacinda Bunch, Peter Cram, Heather Schacht Reisinger
BACKGROUND: Effects of Intensive Care Unit (ICU) telemedicine on patient and staff outcomes are mixed. Variation in utilization is potentially driving these differences. INTRODUCTION: ICU telemedicine utilization is understudied, with existing research focusing on telemedicine staff. We assess ICU telemedicine utilization from the perspective of the end user-ICU staff-to better understand how telemedicine use is conceptualized and practiced at the bedside. MATERIALS AND METHODS: We conducted a thematic content analysis of semistructured interviews with bedside ICU staff...
February 16, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28327433/sonographic-prediction-of-outcome-of-vacuum-deliveries-a-multicenter-prospective-cohort-study
#6
Birgitte H Kahrs, Sana Usman, Tullio Ghi, Aly Youssef, Erik A Torkildsen, Elsa Lindtjørn, Tilde B Østborg, Sigurlaug Benediktsdottir, Lis Brooks, Lotte Harmsen, Pål R Romundstad, Kjell Å Salvesen, Christoph C Lees, Torbjørn M Eggebø
BACKGROUND: Safe management of the second stage of labor is of great importance. Unnecessary interventions should be avoided and correct timing of interventions focused. Ultrasound assessment of fetal position and station has a potential to improve the precision in diagnosing and managing prolonged or arrested labors. The decision to perform vacuum delivery is traditionally based on subjective assessment by digital vaginal examination and clinical expertise and there is currently no method of objectively quantifying the likelihood of successful delivery...
March 18, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28320376/how-to-make-carer-involvement-in-mental-health-inpatient-units-happen-a-focus-group-study-with-patients-carers-and-clinicians
#7
Domenico Giacco, Aysegul Dirik, Justina Kaselionyte, Stefan Priebe
BACKGROUND: Carers are family members or friends who support people with a mental health problem without being paid. Carer involvement in mental health treatment has been consistently supported by research evidence and promoted by policies but its implementation rates are poor. Particularly when patients are treated in inpatient units, carers often report being left without information or being excluded from decisions about treatment. In this study we have explored, along with staff perspectives, views of patients and carers who had a recent experience of inpatient mental health care on how to improve the implementation of carer involvement in inpatient care...
March 21, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28318346/use-of-patient-controlled-psychiatric-hospital-admissions-mental-health-professionals-perspective
#8
Trine Ellegaard, Mimi Mehlsen, Kirsten Lomborg, Vibeke Bliksted
BACKGROUND: In a patient-controlled admission (PCA) programme, the decision about hospital admission is made solely by the patient, with no gatekeeper function allocated to the mental health professionals (MHPs). Current knowledge about how MHPs experience and evaluate PCA is sparse. AIMS: This Danish multi-centre study examined the MHP assessment of the PCA programme in daily clinical practice, and compared PCA evaluations made by MHPs and patients. METHODS: A questionnaire was developed and a survey conducted over the course of a year at all Danish mental health units included in the PCA programme...
March 20, 2017: Nordic Journal of Psychiatry
https://www.readbyqxmd.com/read/28302713/family-cord-blood-banking-for-sickle-cell-disease-a-twenty-year-experience-in-two-dedicated-public-cord-blood-banks
#9
Hanadi Rafii, Françoise Bernaudin, Helene Rouard, Valérie Vanneaux, Annalisa Ruggeri, Marina Cavazzana, Valerie Gauthereau, Aurélie Stanislas, Malika Benkerrou, Mariane De Montalembert, Christele Ferry, Robert Girot, Cecile Arnaud, Annie Kamdem, Joelle Gour, Claudine Touboul, Audrey Cras, Mathieu Kuentz, Claire Rieux, Fernanda Volt, Barbara Cappelli, Karina T Maio, Annalisa Paviglianiti, Chantal Kenzey, Jerome Larghero, Eliane Gluckman
Efforts to implement family cord blood banking have been developed in the past decades for siblings requiring stem cell transplantation for conditions such as sickle cell disease. However, public banks are faced with challenging decisions about the units to be stored, discarded, or used for other endeavors. We report here 20 years of experience in family cord blood banking for sickle cell disease in two dedicated public banks. Participants were pregnant women who had previous child diagnosed with homozygous sickle cell disease...
March 16, 2017: Haematologica
https://www.readbyqxmd.com/read/28301702/space-for-the-prisoner-s-point-of-view
#10
Laura Haupt
The lead article in this issue discusses a potentially free metaphorical space-that of decision-making-within the confines, tangible and intangible, of life in jail or prison. By interviewing prisoner-participants from six clinical studies, Paul Christopher and colleagues sought to find out how these men and women would answer open-ended questions about their decision to enroll in the research. What the interviewers heard was that none saw themselves as having been inappropriately pressured to do so. In fact, a significant percentage of the prisoners described being dissuaded from participating in the studies...
March 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28300480/impossible-decision-an-investigation-of-risk-trade-offs-in-the-intensive-care-unit
#11
Tom W Reader, Geetha Reddy, Stephen J Brett
In the intensive care unit (ICU), clinicians must often make risk trade-offs on patient care. For example, on deciding whether to discharge a patient before they have fully recovered in order to create a bed for another, sicker, patient. When misjudged, these decisions can negatively influence patient outcomes: yet it can be difficult, if not impossible, for clinicians to evaluate with certainty the safest course of action. Using a vignette-based interview methodology, a naturalistic decision-making approach was utilised to study this phenomena...
March 16, 2017: Ergonomics
https://www.readbyqxmd.com/read/28295894/cost-effectiveness-analysis-appraisal-and-application-an-emergency-medicine-perspective
#12
Michael D April, Brian P Murray
Cost-effectiveness is an important goal for emergency care delivery. The many diagnostic, treatment, and disposition decisions made in the emergency department (ED) have a significant impact upon healthcare resource utilization. Cost-effectiveness analysis (CEA) is an analytic tool to optimize these resource allocation decisions through the systematic comparison of costs and effects of alternative healthcare decisions. Yet few emergency medicine leaders and policy-makers have any formal training in CEA methodology...
March 10, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28294320/nursing-clinical-practice-changes-to-improve-self-management-in-chronic-obstructive-pulmonary-disease
#13
J M Padilha, P A F Sousa, F M S Pereira
AIM: To propose nursing clinical practice changes to improve the development of patient self-management. BACKGROUND: Chronic obstructive pulmonary disease is one of the main causes of chronic morbidity, loss of quality of life and high mortality rates. INTRODUCTION: Control of the disease's progression, the preservation of autonomy in self-care and maintenance of quality of life are extremely challenging for patients to execute in their daily living...
March 13, 2017: International Nursing Review
https://www.readbyqxmd.com/read/28292502/opioid-overdose-education-and-naloxone-distribution-development-of-the-veterans-health-administration-s-national-program
#14
Elizabeth M Oliva, Melissa L D Christopher, Daina Wells, Mark Bounthavong, Michael Harvey, Julianne Himstreet, Thomas Emmendorfer, Michael Valentino, Mariano Franchi, Francine Goodman, Jodie A Trafton
OBJECTIVES: To prevent opioid-related mortality, the Veterans Health Administration (VHA) developed a national Opioid Overdose Education and Naloxone Distribution (OEND) program. SETTING: VHA's OEND program sought national implementation of OEND across all medical facilities (n = 142). PRACTICE DESCRIPTION: This paper describes VHA's efforts to facilitate nationwide health care system-based OEND implementation, including the critical roles of VHA's national pharmacy services and academic detailing services...
March 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28292204/a-national-survey-of-the-management-of-patients-with-incidental-meningioma-in-the-united-kingdom
#15
Mujtaba H Mohammad, Emmanuel Chavredakis, Rasheed Zakaria, Andrew Brodbelt, Michael D Jenkinson
BACKGROUND: Incidental meningiomas are increasingly being diagnosed due to widespread use of brain imaging. Treatment options include surveillance, surgery and stereotactic radiosurgery, but the natural history of these tumours is not fully understood and there are no accepted management guidelines to aid clinical decision-making. The aim of this study was to assess current practice in the United Kingdom and identify areas of variation for further study. METHODS: A questionnaire was distributed to all members of the Society of British Neurosurgeons (SBNS)...
March 15, 2017: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/28289851/withdrawal-of-artificial-nutrition-and-hydration-in-neonatal-intensive-care-parents-and-healthcare-practitioners-views
#16
Véronique Fournier, Elisabeth Belghiti, Laurence Brunet, Marta Spranzi
Withdrawing Artificial Nutrition and Hydration (WANH) in the neonatal intensive care units (NICUs) has long been controversial. In France, the practice has become a legal option since 2005. But even though, the question remains as to what the stakeholders' experience is, and whether they consider it ethically appropriate. In order to contribute to the debate, we initiated a study in 2009 to evaluate parental and health care professionals (HCP) perspectives, after they experienced WAHN for a newborn. The study included 25 cases from 5 different clinical neonatology departments...
March 13, 2017: Medicine, Health Care, and Philosophy
https://www.readbyqxmd.com/read/28288007/clinical-utility-of-the-heart-score-in-patients-admitted-with-chest-pain-to-an-inner-city-hospital-in-the-usa
#17
Soumya Patnaik, Mahek Shah, Yaser Alhamshari, Pradhum Ram, Ritika Puri, Marvin Lu, Percy Balderia, John B Imms, Obiora Maludum, Vincent M Figueredo
BACKGROUND: Chest pain is one of the most common presentations to a hospital, and appropriate triaging of these patients can be challenging. The HEART score has been used for such purposes in some countries and only a few validation studies from the USA are available. We aim to determine the utility of the HEART score in patients presenting with chest pain to an inner-city hospital in the USA. PATIENTS AND METHODS: We retrospectively screened 417 consecutive patients admitted with chest pain to the observation/telemetry units at Einstein Medical Center Philadelphia...
March 10, 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/28285482/clinical-image-visual-estimation-of-blood-loss
#18
Benjamin Donham, Robby Frondozo, Michael Petro, Andrew Reynolds, Jonathan Swisher, Ryan M Knight
Military prehospital providers frequently have to make important clinical decisions with only limited objective information and vital signs. Because of this, accurate estimation of blood loss, at the point of injury, can augment any available objective information. Prior studies have shown that individuals significantly overestimate the amount of blood loss when the amount of hemorrhage is small, and they tend to underestimate the amount of blood loss with larger amounts of hemorrhage. Furthermore, the type of surface on which the blood is deposited can impact the visual estimation of the amount of hemorrhage...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28282227/an-integrated-framework-for-effective-and-efficient-communication-with-families-in-the-adult-intensive-care-unit
#19
Jennifer B Seaman, Robert M Arnold, Leslie P Scheunemann, Douglas B White
The increased focus on patient and family-centered care in adult intensive care units (ICUs) has generated multiple platforms for clinician-family communication beyond traditional interdisciplinary family meetings (family meetings)-including family-centered rounds, bedside or telephone updates, and electronic family portals. Some clinicians and administrators are now using these platforms instead of conducting family meetings. For example, some institutions are moving toward using family-centered rounds as the main platform for clinician-family communication, and some physicians rely on brief daily updates to the family at the bedside or by phone, in lieu of family meetings...
March 10, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28281954/an-assessment-of-direct-restorative-material-use-in-posterior-teeth-by-american-and-canadian-pediatric-dentists-i-material-choice
#20
Rae E Varughese, Paul Andrews, Michael J Sigal, Amir Azarpazhooh
PURPOSE: The purpose of this study was to assess the preferences of pediatric dentists in Canada and the United States about clinical decision-making related to the placement of direct restorative materials. METHODS: A cross-sectional web-based survey was used to collect the preference of all active pediatric members of the Royal College of Dentists of Canada and the American Academy of Pediatric Dentistry on the use of direct restorative materials in posterior teeth in healthy, developmentally delayed (DD), and medically compromised (MC) children...
November 15, 2016: Pediatric Dentistry
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