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https://www.readbyqxmd.com/read/28343161/fulminant-invasive-meningococcal-disease-due-to-serogroup-y-infection-a-highly-unusual-case-reflecting-worrying-increases-in-carriage-and-incidence
#1
Akash Maniam, Sriram Ravichandran
A young man presented to accident and emergency with a short history of diarrhoea and vomiting, with no medical history. He deteriorated rapidly during triage and never regained consciousness. He was pronounced dead after hours of attempted resuscitation. He was found to have organisms suggestive of diplococci on his blood film and subsequently had MenY found via PCR testing. This case illustrates a highly unusual presentation of invasive meningococcal disease caused by MenY which is quietly and dangerously increasing in incidence in the UK, particularly in young healthy patients...
March 25, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28343151/gastric-outlet-obstruction-an-unusual-case-of-primary-duodenal-tuberculosis
#2
Sanket Kalpande, Jayashri Sanjay Pandya, Ajeet Tiwari, Devbrata Adhikari
BACKGROUND: Tuberculosis is a major health problem worldwide. Gastrointestinal tuberculosis presenting as isolated involvement of the duodenum is a rare case. CASE PRESENTATION: A 13 year male, presented with features of gastric outlet obstruction. CT enterography scan showed circumferential mural thickening in first and second part of duodenal junction causing luminal narrowing. Upper GI endoscopy confirmed the narrowing of D1-D2 junction. Duodenal biopsy showed duodenitis with negative result for AFB stain, Helicobacter Pylori...
March 24, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28342777/teaching-and-assessing-professionalism-in-radiology-resident-education
#3
REVIEW
Aine Marie Kelly, Larry D Gruppen, Patricia B Mullan
Radiologists in teaching hospitals and in practices with residents rotating through are involved in the education of their residents. The Accreditation Council for Graduate Medical Education requires evidence that trainees are taught and demonstrate competency not only in medical knowledge and in patient care-the historic focus of radiology education-but also in the so-called non-interpretative core competencies, which include professionalism and interpersonal skills. In addition to accreditation agencies, the prominent assessment practices represented by the American Board of Radiology core and certifying examinations for trainees, as well as Maintenance of Certification for practitioners, are planning to feature more non-interpretative competency assessment, including professionalism to a greater extent...
March 22, 2017: Academic Radiology
https://www.readbyqxmd.com/read/28342694/nursing-led-home-visits-post-hospitalization-for-children-with-medical-complexity
#4
Sarah Wells, Margaret O'Neill, Jayne Rogers, Kevin Blaine, Amy Hoffman, Sarah McBride, Meghan M Tschudy, Igor Shumskiy, Sangeeta Mauskar, Jay G Berry
PURPOSE: Hospital discharge for children with medical complexity (CMC) can be challenging for families. Home visits could potentially benefit CMC and their families after leaving the hospital. We assessed the utility of post-discharge home visits to identify and address health problems for recently hospitalized CMC. DESIGN AND METHODS: A prospective study of 36 CMC admitted to a children's hospital from 4/15/2015 to 4/14/2016 identified with a possible high risk of hospital readmission and offered a post-discharge home visit within 72h of discharge...
March 23, 2017: Journal of Pediatric Nursing
https://www.readbyqxmd.com/read/28342626/understanding-the-health-care-utilization-of-children-who-require-medical-technology-a-descriptive-study-of-children-who-require-tracheostomies
#5
Regena Spratling
Children who require medical technology have complex chronic illnesses. This medical technology, including ventilators, oximeters, tracheostomy tubes, and feeding tubes, allows children and their families to live at home; however, the management of the children's care by informal caregivers is complex with the need for intensive, specialized care. The purpose of this study was to examine the sociodemographic and clinical characteristics that affect health care utilization in a population of children who require medical technology...
April 2017: Applied Nursing Research: ANR
https://www.readbyqxmd.com/read/28342622/an-analysis-of-the-relationship-between-burnout-socio-demographic-and-workplace-factors-and-job-satisfaction-among-emergency-department-health-professionals
#6
Menderes Tarcan, Neşet Hikmet, Benjamin Schooley, Mehmet Top, Gamze Yorgancıoglu Tarcan
INTRODUCTION: Burnout among emergency medical practitioners and personnel negatively affects career satisfaction and job performance and can lead to mental health issues, including anxiety, depression, and suicide. PURPOSE: This study investigated the relationship between the perceptions of burnout and job satisfaction of those working in two different hospital's emergency departments assessing the effect of burnout dimensions and additional factors (age, position, marital status, annual income, employment type, gender, patient encounters, and household economic well-being) on job satisfaction...
April 2017: Applied Nursing Research: ANR
https://www.readbyqxmd.com/read/28342442/comparison-of-qsofa-and-sirs-for-predicting-adverse-outcomes-of-patients-with-suspicion-of-sepsis-outside-the-intensive-care-unit
#7
Eli J Finkelsztein, Daniel S Jones, Kevin C Ma, Maria A Pabón, Tatiana Delgado, Kiichi Nakahira, John E Arbo, David A Berlin, Edward J Schenck, Augustine M K Choi, Ilias I Siempos
BACKGROUND: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Task Force recently introduced a new clinical score termed quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) for identification of patients at risk of sepsis outside the intensive care unit (ICU). We attempted to compare the discriminatory capacity of the qSOFA versus the Systemic Inflammatory Response Syndrome (SIRS) score for predicting mortality, ICU-free days, and organ dysfunction-free days in patients with suspicion of infection outside the ICU...
March 26, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28342441/building-a-community-of-practice-in-rural-medical-education-growing-our-own-together
#8
Randall L Longenecker, David Schmitz
CONTEXT: This article chronicles the rise, decline, and recent resurgence of rural training track residency programs (RTTs) in the USA over the past 30 years and the emergence of a healthy community of practice in rural medical education. This has occurred during a time in the USA when federal and state funding of graduate medical education has been relatively stagnant and the rules around finance and accreditation of rural programs have been challenging. ISSUE: Many of the early family residency programs developed in the 1970s included a curricular focus on rural practice...
January 2017: Rural and Remote Health
https://www.readbyqxmd.com/read/28342384/utility-and-diagnostic-accuracy-of-bedside-lung-ultrasonography-during-medical-emergency-team-met-activations-for-respiratory-deterioration
#9
Soumitra Sen, Ghazwan Acash, Akmal Sarwar, Yuxiu Lei, James M Dargin
PURPOSE: We investigated the feasibility and diagnostic accuracy of lung ultrasonography during medical emergency team (MET) activations for respiratory deterioration. MATERIAL AND METHODS: We performed a prospective study of inpatients requiring MET evaluation for respiratory decompensation. A blinded investigator recorded videos of lung and lower extremity ultrasonography. The videos were reviewed by blinded investigators to determine a ultrasonography diagnosis...
March 16, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28340246/considerations-on-glycaemic-control-in-older-and-or-frail-individuals-with-diabetes-and-advanced-kidney-disease
#10
Nicolae Mircea Panduru, Ionut Nistor, Per-Henrik Groop, Wim Van Biesen, Ken Farrington, Adrian Covic
The increasing prevalence of chronic kidney disease (CKD) and diabetes over the last decade has resulted in increasing numbers of frail older patients with a combination of these conditions. Current treatment guidelines may not necessarily be relevant for such patients, who are mostly excluded from the trials upon which these recommendations are based. There is a paucity of data upon which to base the management of older patients with CKD. Nearly all current guidelines recommend less-tight glycaemic control for the older population, citing the lack of proven medium-term benefits and concerns about the high short-term risk of hypoglycaemia...
March 13, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28340128/crossing-the-health-it-chasm-considerations-and-policy-recommendations-to-overcome-current-challenges-and-enable-value-based-care
#11
Julia Adler-Milstein, Peter J Embi, Blackford Middleton, Indra Neil Sarkar, Jeff Smith
While great progress has been made in digitizing the US health care system, today's health information technology (IT) infrastructure remains largely a collection of systems that are not designed to support a transition to value-based care. In addition, the pursuit of value-based care, in which we deliver better care with better outcomes at lower cost, places new demands on the health care system that our IT infrastructure needs to be able to support. Provider organizations pursuing new models of health care delivery and payment are finding that their electronic systems lack the capabilities needed to succeed...
March 15, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28340053/does-the-regulatory-environment-for-e-cigarettes-influence-the-effectiveness-of-e-cigarettes-for-smoking-cessation-longitudinal-findings-from-the-itc-four-country-survey
#12
Hua-Hie Yong, Sara C Hitchman, K Michael Cummings, Ron Borland, Shannon M L Gravely, Ann McNeill, Geoffrey T Fong
Introduction: To date, no studies have explored how different regulatory environments may influence the effectiveness of ECs as a smoking cessation aid. Objective: This study compares the real-world effectiveness of adult smokers using ECs for quitting compared with quitting unassisted or quitting with NRT and/or prescription medications in two countries with restrictive policies towards ECs (i.e., Canada and Australia) versus two countries with less restrictive policies (i...
March 4, 2017: Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco
https://www.readbyqxmd.com/read/28340041/bleeding-complications-in-patients-undergoing-intrathecal-drug-delivery-system-implantation
#13
Nafisseh S Warner, Markus A Bendel, Matthew A Warner, Jacob J Strand, Halena M Gazelka, Bryan C Hoelzer, William D Mauck, Tim J Lamer, Daryl J Kor, Susan M Moeschler
Introduction.:  Intrathecal drug delivery systems (IDDSs) have dramatically improved analgesia and the functional status of cancer patients and those with chronic pain states. However, given the close proximity to the neuraxis and frequent concomitant use of antiplatelet or anticoagulant medications, this intervention is not without risk. The goal of this investigation was to determine the incidence of bleeding complications following IDDS placement. Methods.:  This is a retrospective review from 2005 through 2014 of adult patients undergoing IDDS implantation or revision at a tertiary care center...
March 3, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28340029/the-proportion-of-errors-in-medical-prescriptions-and-their-executions-among-hospitalized-children-before-and-during-accreditation
#14
Tal Margalit Mekory, Hilla Bahat, Benjamin Bar-Oz, Orna Tal, Matitiahu Berkovitch, Eran Kozer
Objective: To evaluate the rate of medication related errors in the pediatric ward and pediatric emergency department (PED), before and after implementing intervention strategies according to the Joint Commission International (JCI) accreditation program. Design: A retrospective cross-sectional study that included chart review. Setting: A university affiliated pediatric ward and PED. Participants: Children 0-18 years old admitted on February 2013 (before the JCI program) and February 2014 (during implementation of the JCI program)...
March 10, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28339989/pain-management-strategies-and-health-care-use-in-community-dwelling-individuals-living-with-chronic-pain
#15
Elizabeth G Mann, Ana Johnson, Ian Gilron, Elizabeth G VanDenKerkhof
Objective. : To describe factors associated with high clinic and emergency room (ER) use among individuals with chronic pain. Design. : This study is part of a larger cross-sectional survey on the epidemiology of chronic pain in Canada. The current analysis was guided by the Andersen-Newman Service Utilization Model. Methods. : Respondents (N = 702) were grouped into high (top 10%) and low (bottom 90%) users based on the number of visits made to clinics and ERs over the past year...
March 3, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28339988/utilization-of-health-care-services-and-ambulatory-resources-associated-with-chronic-noncancer-pain
#16
Cynthia Kay, Erica Wozniak, Joanne Bernstein
Objective.:  Examine traditional and uncompensated health care utilization associated with chronic noncancer pain. Design.:  Retrospective chart review. Setting.:  Tertiary academic medical center. Subjects.:  Internal medicine patients on long-term opioids for chronic noncancer pain with or without a pain agreement between April 1, 2014, and April 1, 2015 (N = 834). Patients without pain served as controls (N = 782)...
March 2, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28339769/incidence-and-potential-risk-factors-for-hospital-acquired-pneumonia-in-an-emergency-department-of-surgery
#17
Marie Stenlund, Rune Sjödahl, R N Pia Yngman-Uhlin
Objective: Hospital-acquired pneumonia (HAP) is associated with high mortality and is the second most common nosocomial infection. The aim of this study was to calculate the incidence and to identify potential risk factors for HAP in an emergency ward for surgical patients admitted because of acute abdomen or trauma. Design: A structured review of medical records was conducted. Patients diagnosed with pneumonia >48 h after admittance, were compared with a randomly chosen age-matched reference group...
February 23, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28339697/are-informed-policies-in-place-to-promote-safe-and-usable-ehrs-a-cross-industry-comparison
#18
Erica L Savage, Rollin J Fairbanks, Raj M Ratwani
Objective: Despite federal policies put in place by the Office of the National Coordinator (ONC) to promote safe and usable electronic health record (EHR) products, the usability of EHRs continues to frustrate providers and have patient safety implications. This study sought to compare government policies on usability and safety, and methods of examining compliance to those policies, across 3 federal agencies: the ONC and EHRs, the Federal Aviation Administration (FAA) and avionics, and the Food and Drug Administration (FDA) and medical devices...
February 19, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28339320/basic-life-support-access-to-injectable-epinephrine-across-the-united-states
#19
Ian D Brasted, Michael W Dailey
BACKGROUND:  Aggressive epinephrine administration has growing support in the treatment of anaphylaxis, a life-threatening allergic reaction. Emergency Medical Services (EMS) providers are frequently in a position to provide the first care to someone experiencing an anaphylactic reaction. Intramuscular injection of epinephrine is the definitive pharmacologic treatment for many associated symptoms. While easy to use, epinephrine autoinjectors (EAI) are prohibitively expensive, having increased in price ten-fold in ten years...
March 24, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28338808/the-relationship-between-cognitive-impairment-mortality-and-discharge-characteristics-in-a-large-cohort-of-older-adults-with-unscheduled-admissions-to-an-acute-hospital-a-retrospective-observational-study
#20
Carole Fogg, Paul Meredith, Jackie Bridges, Gill P Gould, Peter Griffiths
Background: older people with dementia admitted to hospital for acute illness have higher mortality and longer hospital stays compared to those without dementia. Cognitive impairment (CI) is common in older people, and they may also be at increased risk of poor outcomes. Methods: retrospective observational study of unscheduled admissions aged ≥75 years. Admission characteristics, mortality rates and discharge outcomes were compared between three groups: (i) known dementia diagnosis (DD), (ii) CI but no diagnosis of dementia and (iii) no CI...
February 25, 2017: Age and Ageing
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