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https://www.readbyqxmd.com/read/29324253/a-qualitative-study-comparing-physician-reported-barriers-to-treating-addiction-using-buprenorphine-and-extended-release-naltrexone-in-u-s-office-based-practices
#1
Barbara Andraka-Christou, Matthew J Capone
AIM: Our aim was to compare physician-reported barriers to sublingual buprenorphine (BUP) and extended-release naltrexone (XR-NLT) prescribing in U.S. office-based practices, and to identify potential policies for minimizing these barriers. Only one previous qualitative study has examined physician-reported barriers to prescribing XR-NLT and no qualitative study has compared physician-reported barriers between the two medications. METHODS: Researchers conducted individual semi-structured and in-depth interviews with 20 licensed physicians in four U...
January 8, 2018: International Journal on Drug Policy
https://www.readbyqxmd.com/read/29282434/the-inspired-sinewave-technique-a-comparison-study-with-body-plethysmography-in-healthy-volunteers
#2
Phi Anh Phan, Cathy Zhang, Daniel Geer, Federico Formenti, Clive E W Hahn, Andrew D Farmery
The inspired sinewave technique is a noninvasive method to measure airway dead space, functional residual capacity, pulmonary blood flow, and lung inhomogeneity simultaneously. The purpose of this paper was to assess the repeatability and accuracy of the current device prototype in measuring functional residual capacity, and also participant comfort when using such a device. To assess within-session repeatability, six sinewave measurements were taken over two-hour period in 17 healthy volunteers. To assess day-to-day repeatability, measurements were taken over 16 days in 3 volunteers...
2017: IEEE Journal of Translational Engineering in Health and Medicine
https://www.readbyqxmd.com/read/29243015/relational-autonomy-in-the-care-of-the-vulnerable-health-care-professionals-reasoning-in-moral-case-deliberation-mcd
#3
Kaja Heidenreich, Anders Bremer, Lars Johan Materstvedt, Ulf Tidefelt, Mia Svantesson
In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals' moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis...
December 14, 2017: Medicine, Health Care, and Philosophy
https://www.readbyqxmd.com/read/29184819/psychosocial-aspects-of-diabetes-management-dilemma-of-diabetes-distress
#4
REVIEW
Ruqiya Shama Tareen, Kinza Tareen
Diabetes mellitus (DM) is a debilitating chronic illness with complex pathophysiological, psychological, and quality of life (QoL) implications creating a constant state of turbulence. Some of these interconnections are apparent to healthcare providers and are easily addressed in a routine diabetic clinical care. However, a large number of these hidden factors that interplay with each other and impact on the physical outcomes of DM goes unnoticed by health care providers. This is a frustrating and lonely predicament for DM patients making it very difficult for them to manage their illness well...
October 2017: Translational pediatrics
https://www.readbyqxmd.com/read/29174551/surgical-management-of-severe-osteoradionecrosis-of-the-mandibular-bone-by-using-double-free-flap-reconstruction
#5
Niklas Rommel, Marco Rainer Kesting, Nils Hagen Rohleder, Klaus-Dietrich Wolff, Jochen Weitz
PURPOSE: Osteoradionecrosis (ORN) of the jaws represents one of the most severe complications after primary or adjuvant radiation therapy (RT) of large head and neck tumors. In advanced ORN cases, surgical management is generally considered the therapy of choice. However, in several severe ORN patients with extensive bone and soft tissue defects, functional and aesthetic reconstruction represents a huge challenge for any surgeon, with an increased risk of post-operative wound healing disorders...
November 2, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/29168549/first-polish-analysis-of-the-treatment-of-advanced-heart-failure-in-children-with-the-use-of-berlinheart-excor-mechanical-circulatory-support
#6
Szymon Pawlak, Roman Przybylski, Janusz Skalski, Joanna Śliwka, Andrzej Kansy, Adam Grzybowski, Arkadiusz Wierzyk, Jacek Białkowski, Bohdan Maruszewski, Marian Zembala
BACKGROUND: The treatment of advanced heart failure in children and infants poses a serious management problem. Heart failure in that patient group is usually of congenital etiology. The treatment schedules for pediatric patients are in most cases adapted from the guidelines for treatment of adults. Up to 2009, the treatment of that extremely difficult group of patients was limited to pharmacological therapy and occasional heart transplantations. Constantly increasing problems with recruiting donors, especially for the pediatric group, contribute to the fact that mechanical support with the use of ventricular assist devices is for many children the only chance to survive the period of waiting for a heart donor...
November 23, 2017: Kardiologia Polska
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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 m2 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...
October 2017: Nanomedicine
https://www.readbyqxmd.com/read/28853970/primary-care-physicians-views-about-prescribing-methadone-to-treat-opioid-use-disorder
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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