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https://www.readbyqxmd.com/read/29099982/sources-of-distress-in-primary-care-opioid-management-and-the-role-of-a-controlled-substance-review-group-a-qualitative-study
#1
Elizabeth Hulen, Somnath Saha, Benjamin J Morasco, Claire Zeigler, Katherine Mackey, Samuel T Edwards
Objective: The objective of the study was to explore provider perspectives surrounding opioid prescribing in the context of the early implementation of a multidisciplinary group, called the Controlled Substance Review Group, that provided structured opioid case discussion and consultation to primary care providers. Setting: A Veterans Health Administration primary care clinic in Portland, Oregon. Participants: 12 members of primary care clinic staff representing multiple disciplines with recent participation in the Controlled Substance Review Group...
November 1, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29059005/a-hand-held-robotic-device-for-peripheral-intravenous-catheterization
#2
Zhuoqi Cheng, Brian L Davies, Darwin G Caldwell, Giacinto Barresi, Qinqi Xu, Leonardo S Mattos
Intravenous catheterization is frequently required for numerous medical treatments. However, this process is characterized by a high failure rate, especially when performed on difficult patients such as newborns and infants. Very young patients have small veins, and that increases the chances of accidentally puncturing the catheterization needle directly through them. In this article, we present the design, development and experimental evaluation of a novel hand-held robotic device for improving the process of peripheral intravenous catheterization by facilitating the needle insertion procedure...
October 1, 2017: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine
https://www.readbyqxmd.com/read/28950326/lung-transplantation-for-idiopathic-pulmonary-arterial-hypertension-on-intraoperative-and-postoperatively-prolonged-extracorporeal-membrane-oxygenation-provides-optimally-controlled-reperfusion-and-excellent-outcome
#3
Bernhard Moser, Peter Jaksch, Shahrokh Taghavi, Gabriella Muraközy, Georg Lang, Helmut Hager, Claus Krenn, Georg Roth, Peter Faybik, Andreas Bacher, Clemens Aigner, José R Matilla, Konrad Hoetzenecker, Philipp Hacker, Irene Lang, Walter Klepetko
OBJECTIVES: Lung transplantation for idiopathic pulmonary arterial hypertension has the highest reported postoperative mortality of all indications. Reasons lie in the complexity of treatment of these patients and the frequent occurrence of postoperative left ventricular failure. Transplantation on intraoperative extracorporeal membrane oxygenation support instead of cardiopulmonary bypass and even more the prolongation of extracorporeal membrane oxygenation into the postoperative period helps to overcome these problems...
July 27, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28913733/a-prospective-feasibility-trial-of-a-novel-intravascular-catheter-system-with-retractable-coiled-tip-guidewire-placed-in-difficult-intravascular-access-diva-patients-in-the-emergency-department
#4
Christopher Raio, Robert Elspermann, Natwalee Kittisarapong, Brendon Stankard, Tanya Bajaj, Veena Modayil, Mathew Nelson, Gerardo Chiricolo, Benjamin Wie, Alexandra Snock, Michael Mackay, Adam Ash
The primary study objective was to evaluate insertion success rates. Secondary objectives included patient satisfaction, procedure time, complication rates, completion of therapy and dwell time of the novel AccuCath(®) 2.25″ Blood Control (BC) Catheter System (FDA approved) placed in difficult-access patients. This was a single-arm feasibility trial evaluating the AccuCath(®) 2.25″ BC Catheter System in a convenience sample of DIVA patients defined as at least two failed initial attempts or a history of difficult access plus the inability to directly visualize or palpate a target vein...
September 14, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28874898/experiences-of-canadian-oncologists-with-difficult-patient-deaths-and-coping-strategies-used
#5
L Granek, L Barbera, O Nakash, M Cohen, M K Krzyzanowska
OBJECTIVES: We aimed to explore and identify what makes patient death more emotionally difficult for oncologists and how oncologists cope with patient death. METHODS: A convenience sample of 98 Canadian oncologists (50 men, 48 women) completed an online survey that included a demographics section and a section about patient death. RESULTS: More than 80% of oncologists reported that patient age, long-term management of a patient, and unexpected disease outcomes contributed to difficult patient loss...
August 2017: Current Oncology
https://www.readbyqxmd.com/read/28868968/can-regenerative-medicine-and-nanotechnology-combine-to-heal-wounds-the-search-for-the-ideal-wound-dressing
#6
Payam Zarrintaj, Abolfazl Salehi Moghaddam, Saeed Manouchehri, Zhaleh Atoufi, Anahita Amiri, Mohammad Amir Amirkhani, Mohammad Ali Nilforoushzadeh, Mohammad Reza Saeb, Michael R Hamblin, Masoud Mozafari
Skin is the outermost covering of the human body and at the same time the largest organ comprising 15% of body weight and 2 m(2) surface area. Skin plays a key role as a barrier against the outer environment depending on its thickness, color and structure, which differ from one site to another. The four major types of problematic wounds include ulcers (diabetic, venous, pressure) and burn wounds. Developing novel dressings helps us to improve the wound healing process in difficult patients. Recent advances in regenerative medicine and nanotechnology are revolutionizing the field of wound healing...
September 4, 2017: Nanomedicine
https://www.readbyqxmd.com/read/28853970/primary-care-physicians-views-about-prescribing-methadone-to-treat-opioid-use-disorder
#7
James D Livingston, Erica Adams, Marlee Jordan, Zachary MacMillan, Ramm Hering
BACKGROUND: Methadone maintenance treatment is an effective way to reduce harms associated with opioid use disorder and, in several countries, is delivered in community-based primary care settings. Expanding methadone into primary care depends, in part, on physicians' willingness and readiness to integrate it into their practices. OBJECTIVES: This qualitative study explores factors that primary care physicians consider important when contemplating prescribing methadone to treat opioid use disorder...
August 30, 2017: Substance Use & Misuse
https://www.readbyqxmd.com/read/28836162/prevalence-of-morphometric-vertebral-fractures-in-difficult-patients-with-acromegaly-with-different-biochemical-outcomes-after-multimodal-treatment
#8
S Chiloiro, M Mormando, A Bianchi, A Giampietro, D Milardi, C Bima, G Grande, A M Formenti, G Mazziotti, A Pontecorvi, A Giustina, L De Marinis
INTRODUCTION: Skeletal fragility with high risk of vertebral fractures is an emerging complication of acromegaly in close relationship with duration of active disease. The aim of this cross-sectional study was to evaluate the prevalence and determinants of vertebral fractures in males and females with a history of long-standing active acromegaly undergoing treatment with Pegvisomant. SUBJECTS AND METHODS: Thirty-eight patients (25 females, 13 males) with acromegaly under Pegvisomant therapy were evaluated for vertebral fractures and bone mineral density at lumbar spine and femoral neck...
August 23, 2017: Endocrine
https://www.readbyqxmd.com/read/28817301/patients-views-of-a-behavioral-intervention-including-financial-incentives
#9
Judy A Shea, Aderinola Adejare, Kevin G Volpp, Andrea B Troxel, Darra Finnerty, Karen Hoffer, Thomas Isaac, Meredith Rosenthal, Thomas D Sequist, David A Asch
OBJECTIVES: Clinical trials are increasingly testing the effectiveness of paying patients' financial incentives for achieving desired clinical outcomes. Some researchers and providers are concerned that patient financial incentives will harm the doctor-patient relationship. How patients feel about these approaches, and these trials, is largely unknown. This study examined patients' perceptions of a compound behavioral and financial incentive intervention used in a large multicenter trial to lower low-density lipoprotein cholesterol (LDL-C), including their perceptions of benefits and challenges and the study's effect on patients' relationship with their primary care physicians (PCPs)...
June 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28800796/difficult-patients-in-the-emergency-department-personality-disorders-and-beyond
#10
REVIEW
Nidal Moukaddam, Araceli Flores, Anu Matorin, Nicholas Hayden, Veronica Theresa Tucci
Physician-patient encounters in clinical settings, especially in the emergency department, can be of varying degrees of difficulty. Medically complicated, challenging cases can be paradoxically rewarding, whereas psychologically driven difficulty is frustrating and counterproductive for patient care. This article presents 3 different complementary perspectives on difficult patients: clinical presentations, manifestations of personality traits and disorders in clinical settings, and how physician feelings may affect care...
September 2017: Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28779809/is-this-my-ankle-or-my-foot
#11
REVIEW
William Hodges Davis
Understanding of the complexities of the adult acquired pathologic flatfoot has undergone serious evolution in the past 30 years to an understanding of the subtleties of what causes the different presentations and drives successful treatment. As the treatment of ankle arthritis evolves from fusion to ankle replacement, the need for answers for the difficult patient with valgus degenerative ankle disease begs a look at what causes this form of flatfoot. This article poses the question, is there a subset of patients with "flatfoot" that has little to do with the foot and is all about the ankle?...
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28775221/in-situ-medical-simulation-for-pre-implementation-testing-of-clinical-service-in-a-regional-hospital-in-hong-kong
#12
P P Chen, N Tk Tsui, A Sw Fung, A Hf Chiu, W Cw Wong, H T Leong, P Sf Lee, J Yw Lau
The implementation of a new clinical service is associated with anxiety and challenges that may prevent smooth and safe execution of the service. Unexpected issues may not be apparent until the actual clinical service commences. We present a novel approach to test the new clinical setting before actual implementation of our endovascular aortic repair service. In-situ simulation at the new clinical location would enable identification of potential process and system issues prior to implementation of the service...
August 2017: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/28745190/giving-equal-care-to-the-difficult-patient
#13
Mandy Day-Calder
One of our dogs, Ben, is a timid little thing. On a lead he can bark and growl, and to the untrained eye he must appear aggressive at times.
July 26, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28736122/treatment-of-tibial-nonunion-with-posterolateral-bone-grafting
#14
Michael J Foster, Robert V O'Toole, Theodore T Manson
OBJECTIVES: Posterolateral bone grafting to treat nonunions of the distal two-thirds of the tibia avoids the often traumatized and more tenuous anterior soft-tissue envelope. Few modern reports of its effectiveness are available. We assessed whether posterolateral bone grafting leads to high union and low complication rates. METHODS: We conducted a retrospective review at a Level I trauma center. Our study group was 59 patients with distal two-thirds tibial fractures treated with posterolateral bone grafting...
October 2017: Injury
https://www.readbyqxmd.com/read/28734722/guidelines-for-the-understanding-and-management-of-pain-in-chronic-pancreatitis
#15
REVIEW
Asbjørn M Drewes, Stefan A W Bouwense, Claudia M Campbell, Güralp O Ceyhan, Myriam Delhaye, Ihsan Ekin Demir, Pramod K Garg, Harry van Goor, Christopher Halloran, Shuiji Isaji, John P Neoptolemos, Søren S Olesen, Tonya Palermo, Pankaj Jay Pasricha, Andrea Sheel, Tooru Shimosegawa, Eva Szigethy, David C Whitcomb, Dhiraj Yadav
Abdominal pain is the foremost complication of chronic pancreatitis (CP). Pain can be related to recurrent or chronic inflammation, local complications or neurogenic mechanisms with corresponding changes in the nervous systems. Both pain intensity and the frequency of pain attacks have been shown to reduce quality of life in patients with CP. Assessment of pain follows the guidelines for other types of chronic pain, where the multidimensional nature of symptom presentation is taken into consideration. Quantitative sensory testing may be used to characterize pain, but is currently used in a research setting in advanced laboratories...
July 13, 2017: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/28699946/using-standardized-patients-to-assess-hospitalist-communication-skills
#16
Dennis Chang, Micah Mann, Terry Sommer, Robert Fallar, Alan Weinberg, Erica Friedman
Standardized patients (SPs) have been used to assess communication skills in undergraduate medical education, but no published studies describe the use of SPs in assessing practicing physicians on their communication skills. In this study, done with 23 hospitalists at a large urban academic hospital, 3 SP scenarios, daily rounding, discharge, and interacting with a difficult patient, were created. After each encounter, each hospitalist reviewed their videotape and received feedback from their SP based on a checklist that had 3 core domains: Listen, Courtesy and Respect, and Explain...
July 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28689863/long-term-results-of-open-complex-abdominal-wall-hernia-repair-with-self-gripping-mesh-a-retrospective-cohort-study
#17
Leonard F Kroese, Lien H A van Eeghem, Joost Verhelst, Johannes Jeekel, Gert-Jan Kleinrensink, Johan F Lange
BACKGROUND: In case of complex ventral hernias, Rives-Stoppa and component separation technique are considered as favourable treatment techniques. However, mesh-related complications like recurrence, infection and chronic pain are still a common problem after mesh repair. Previous studies have reported promising results of the use of a self-gripping mesh (ProGrip™) in incisional hernia repair. This study aimed to evaluate the long term results of this mesh for complex ventral hernia treatment...
July 6, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28622670/adaptive-clutter-demodulation-for-non-contrast-ultrasound-perfusion-imaging
#18
Jaime Tierney, Crystal Coolbaugh, Theodore Towse, Brett Byram
Conventional Doppler ultrasound is useful for visualizing fast blood flow in large resolvable vessels. However, frame rate and tissue clutter caused by movement of the patient or sonographer make visualizing slow flow with ultrasound difficult. Patient and sonographer motion causes spectral broadening of the clutter signal, which limits ultrasound's sensitivity to velocities greater than 5-10 mm/s for typical clinical imaging frequencies. To address this, we propose a clutter filtering technique that may increase the sensitivity of Doppler measurements to at least as low as 0...
September 2017: IEEE Transactions on Medical Imaging
https://www.readbyqxmd.com/read/28597797/percutaneous-intervention-for-central-shunts-new-routes-new-strategies
#19
Bjorn Cools, Stephen C Brown, Derize E Boshoff, Benedicte Eyskens, Ruth Heying, Filip Rega, Bart Meyns, Marc Gewillig
Introduction In traditional locations, the standard Blalock-Taussig shunt presents numerous technical difficulties for percutaneous intervention. We changed our strategy to a central type shunt (Laks-type) with end-to-side pulmonary and side-to-side aortic anastomosis. The aim of this study was to determine whether this modified strategy would allow easier percutaneous manipulation in patients with small pulmonary arteries. Methods All children with a stretchable central vascular graft who required any form of percutaneous intervention were prospectively enrolled in the study...
April 2017: Acta Cardiologica
https://www.readbyqxmd.com/read/28577776/does-prior-cartilage-restoration-impact-outcomes-following-knee-arthroplasty
#20
Rachel M Frank, Craig J Della Valle, Darren R Plummer, Peter N Chalmers, Brian J Cole
This study compared patients who failed a cartilage restoration procedure and underwent ipsilateral knee arthroplasty with matched control subjects undergoing knee arthroplasty without prior cartilage restoration. Although patients with a failed cartilage procedure derived benefit from knee arthroplasty, their magnitude of improvement and final outcomes scores were lower than the matched control subjects. In this cohort, the cartilage patients also experienced little to no benefit from cartilage restoration, suggesting that unmeasured shared patient characteristics may play a role...
July 2017: Orthopedic Clinics of North America
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