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https://www.readbyqxmd.com/read/28228138/current-management-practices-for-patients-presenting-with-low-back-pain-to-a-large-emergency-department-in-canada
#1
Matthew L Nunn, Jill A Hayden, Kirk Magee
BACKGROUND: Low back pain (LBP) is one of the leading causes of disability. Presentations to the emergency department (ED) are common and consume significant healthcare resources. However, treatment of patients with LBP is variable and highly physician dependent. Our study objective was to describe the demographic and clinical characteristics of patients presenting to the ED with LBP, the diagnostic strategies employed by ED physicians, and the subsequent management. METHODS: We conducted a retrospective study using clinical and electronic health data at the Queen Elizabeth II Health Science Center's Charles V...
February 23, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28220381/pharmacological-management-of-people-living-with-end-stage-chronic-obstructive-pulmonary-disease
#2
Victoria Dalgliesh, Hilary Pinnock
Supportive care and pharmacological treatment can improve the quality of life of people with end-stage chronic obstructive pulmonary disease (COPD) who cope on a daily basis with substantial physical, psychological, social and spiritual morbidity. Smoking cessation is the only intervention that reduces the rate of progression of COPD, but evidence-based drug treatments and non-pharmacological strategies can relieve symptoms and reduce the impact of exacerbations. People with severe COPD live with increasingly troublesome breathlessness and other symptoms such as fatigue, pain, sputum production and weight loss...
February 21, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28176457/predictors-of-acupuncture-use-among-children-and-adolescents-with-cancer
#3
Sagar K Chokshi, Elena J Ladas, Katherine Taromina, Douglas McDaniel, Diane Rooney, Zhezhen Jin, Wei-Chun Hsu, Kara M Kelly
BACKGROUND: Evidence for the application of acupuncture in pediatric oncology is limited. We investigated the acceptance of acupuncture and factors associated with its use among children and adolescents with cancer. METHODS: Ninety acupuncture-naïve children receiving cancer treatment at Columbia University Medical Center (CUMC) provided consent/assent for participation. Participants could choose to receive or refuse integrative services offered at CUMC. Symptoms were collected for a 6-month period with the Memorial Symptom Assessment Scale (MSAS)...
February 8, 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28164409/emergency-physician-knowledge-attitudes-and-behavior-regarding-acep-s-choosing-wisely-recommendations-a-survey-study
#4
Michelle P Lin, Thomas Nguyen, Marc A Probst, Lynne D Richardson, Jeremiah D Schuur
OBJECTIVE: In 2013, the American College of Emergency Physicians joined the Choosing Wisely campaign; however, its impact on emergency physician behavior is unknown. We assessed knowledge, attitudes and self-reported behaviors regarding the Choosing Wisely recommendations. METHODS: We performed a cross-sectional survey of emergency physicians at a national meeting. We approached 819 physicians; 765 (93.4%) completed the survey. RESULTS: As a result of the Choosing Wisely campaign, most respondents (64...
February 6, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28158985/implementing-the-keele-stratified-care-model-for-patients-with-low-back-pain-an-observational-impact-study
#5
Adrian Bamford, Andy Nation, Susie Durrell, Lazaros Andronis, Ellen Rule, Hugh McLeod
BACKGROUND: The Keele stratified care model for management of low back pain comprises use of the prognostic STarT Back Screening Tool to allocate patients into one of three risk-defined categories leading to associated risk-specific treatment pathways, such that high-risk patients receive enhanced treatment and more sessions than medium- and low-risk patients. The Keele model is associated with economic benefits and is being widely implemented. The objective was to assess the use of the stratified model following its introduction in an acute hospital physiotherapy department setting in Gloucestershire, England...
February 3, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28156494/embedding-palliative-care-pc-in-a-community-based-cancer-center-benefits-and-barriers
#6
John Weems, Robert D Siegel, Teresa N Bowen, Leigh Stinnett, Jennifer Ashley
: 153 Background: The importance of involving PC early in the disease process of oncology patients is well documented. Decreased symptom burden, increased quality of life, and extended survival are proven outcomes; however, the provision of PC has largely been limited to the acute care setting in most institutions. Bon Secours St. Francis Health System, a community based healthcare system in Greenville, South Carolina, opened a comprehensive cancer center in late 2014. Our established inpatient PC team began seeing outpatients at the cancer center shortly after its opening...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156458/differences-in-the-symptom-distress-between-young-adult-and-adult-patients-with-advanced-cancer-admitted-to-acute-palliative-care-unit
#7
Yu Jung Kim, Ji Soo Park, Hye Jin Choi
: 99 Background: Understanding about young adults with advanced cancer in palliative care was still insufficient. The purpose of this study was to identify the differences in symptom distress between young (20-39 years) and older (≥ 40 years) adults with advanced cancer who were admitted to acute palliative care unit. METHODS: We retrospectively analyzed 502 consecutive patients admitted to acute palliative care unit between April 2015 and March 2016 in two tertiary cancer centers...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156446/acute-pain-management-in-radiation-oncology-quality-of-care-and-the-impact-of-an-integrated-palliative-oncology-service
#8
Tracy A Balboni, Steve E Braunstein, Shannon E Fogh, Wendy Anderson, Steve Pantilat, Allison Taylor, Alexander Spektor, Monica Shalini Krishnan, Daphne A Haas-Kogan, Lauren Michelle Hertan
: 195 Background: Radiotherapy (RT) effectively palliates bone metastases, but relief may take weeks, frequently necessitating acute pain management (APM). NCCN Guidelines for Adult Cancer Pain (V2.2015) recommend initiation/titration of analgesics for patients with pain scale value (PSV) ≥ 4. We sought to evaluate how often symptomatic patients have analgesic regimens assessed and intervened upon at radiation oncology (RO) consult for bone metastases, and the impact of a dedicated palliative RO service on APM...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28155043/can-appealing-to-patient-altruism-reduce-overuse-of-health-care-services-an-experimental-survey
#9
Kevin R Riggs, Peter A Ubel, Brendan Saloner
BACKGROUND: A challenge to reducing overuse of health services is communicating recommendations against unnecessary health services to patients. The predominant approach has been to highlight the limited benefit and potential harm of such services for that patient, but the prudent use of health resources can also benefit others. Whether appealing to patient altruism can reduce overuse is unknown. OBJECTIVE: To determine whether altruistic appeals reduce hypothetical requests for overused services and affect physician ratings...
February 2, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28151526/-pre-hospital-management-of-patients-with-chest-pain-and-or-dyspnoea-of-cardiac-origin
#10
Farzin Beygui, Maaret Castren, Natale Daniele Brunetti, Fernando Rosell-Ortiz, Michael Christ, Uwe Zeymer, Kurt Huber, Fredrik Folke, Leif Svensson, Hector Bueno, Arnoud Van't Hof, Nikolaos Nikolaou, Lutz Nibbe, Sandrine Charpentier, Eva Swahn, Marco Tubaro, Patrick Goldstein
Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up...
2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/28137901/complications-of-dysgerminoma-meeting-the-health-needs-of-patients-in-conflict-zones
#11
Lili Hayari, Erez Shir On, Andrei Fedorenko, Szvalb Sergio, Jamal Zidan, Evgeny Solomonov
A symptom of prolonged conflict is the destruction of infrastructure and healthcare systems. While the need for acute trauma services is obvious in conflict zones, patients with chronic diseases also require care. This report describes the clinical course of a young teenage girl with a large mid pelvic tumour originating from the left ovary and reaching the umbilicus. She presented with acute abdominal pain and underwent surgery in a healthcare facility within a conflict zone. She was then transferred to a neighbouring country for continuing care...
January 30, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28096024/improving-satisfaction-among-established-patients-in-a-midwestern-pain-clinic
#12
Kathy A Baule, Linda D Scott, Kelly D Rosenberger, W Stephen Minore
BACKGROUND: A problem in many health care practices is deciding the appropriate appointment length for new and established patients. Patients become frustrated when there is inadequate time to have their needs met, yet when a patient's clinic time is spontaneously lengthened, the provider gets behind in schedule, causing delays and greater frustration for others. AIM: The aims of this evidence based project were to determine whether implementation of a flexible appointment system would improve the current scheduling process in a pain clinic by allowing complex patients the opportunity to schedule a longer clinic appointment and would improve patient satisfaction...
February 2017: Applied Nursing Research: ANR
https://www.readbyqxmd.com/read/28076734/effect-of-a-mass-media-campaign-on-ambulance-use-for-chest-pain
#13
Ziad Nehme, Peter A Cameron, Muhammad Akram, Harry Patsamanis, Janet E Bray, Ian T Meredith, Karen Smith
OBJECTIVES: To evaluate the impact of comprehensive public awareness campaigns by the National Heart Foundation of Australia on emergency medical service (EMS) use by people with chest pain. DESIGN, SETTING AND PARTICIPANTS: A retrospective analysis of 253428 emergency ambulance attendances for non-traumatic chest pain in Melbourne, January 2008 - December 2013. Time series analyses, adjusted for underlying trend and seasonal effects, assessed the impact of mass media campaigns on EMS use...
January 16, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28066970/implementation-of-a-pharmacist-led-patient-controlled-analgesia-dosing-service
#14
Alen L Dezia, Tim D Baccus, Allycia M Natavio, Sean M Conroy, Levi M Hall
PURPOSE: The development and implementation of a pharmacist-led patient controlled analgesia (PCA) dosing service in a large academic institution is described. SUMMARY: To improve pain management at our institution and expand pharmacy clinical services, a pharmacist-led PCA dosing service was developed and implemented. The service is modeled after established antimicrobial and anticoagulation dosing services at our institution. A core group of pharmacists (service leaders) and a pain physician champion developed a policy and guideline and designed electronic medical record (EMR) tools to support the service...
January 9, 2017: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/28039801/persuasive-technology-in-teaching-acute-pain-assessment-in-nursing-results-in-learning-based-on-pre-and-post-testing
#15
Ana Graziela Alvarez, Grace T Marcon Dal Sasso, M Sriram Iyengar
BACKGROUND: Thousands of patients seek health services every day with complaints of pain. However, adequate pain assessment is still flawed, a fact that is partly related to gaps in professional learning on this topic. Innovative strategies such as the use of a virtual learning object mediated by persuasive technology in the learning of undergraduate nursing students can help to fill these gaps and to provide different ways of learning to learn. OBJECTIVE: To evaluate the results in learning among undergraduate nursing students about assessment of acute pain in adults and newborns, before and after an online educational intervention...
December 22, 2016: Nurse Education Today
https://www.readbyqxmd.com/read/28032571/readmissions-after-general-surgery-a-prospective-multicenter-audit
#16
Matthew J Lee, Sarah L Daniels, Jonathan R L Wild, Timothy R Wilson
BACKGROUND: Readmission rates after surgical procedures are viewed as a marker of quality of care and as a driver to improve outcomes in the United Kingdom, they are not remunerated. However, readmissions are not wholly avoidable. The aim of this study was to develop a regional overview of readmissions to determine the proportion that might be avoidable and to examine predictors of readmissions at a unit level. METHODS: We undertook a prospective multicenter audit of readmissions following National Health Service funded general surgical procedures in five National Health Service hospitals and three independent sector providers over a 2-wk period...
September 19, 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/28008258/incidence-risk-factors-and-phenomenological-characteristics-of-postoperative-delirium-in-patients-receiving-intravenous-patient-controlled-analgesia-a-prospective-cohort-study
#17
Yao Tsung Lin, Kuo Mao Lan, Li-Kai Wang, Chin-Chen Chu, Su-Zhen Wu, Chia-Yu Chang, Jen-Yin Chen
BACKGROUND: Intravenous patient-controlled analgesia (IVPCA) is a common method of relieving pain which is a risk factor of postoperative delirium (POD). However, research concerning POD in IVPCA patients is limited. OBJECTIVE: We aimed to determine the incidence, risk factors, and phenomenological characteristics of POD in patients receiving IVPCA. METHODS: A prospective, cohort study was conducted in post-general anesthesia IVPCA patients aged ≥60 years...
2016: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/28001292/predictors-for-unplanned-hospitalization-of-new-home-care-clients
#18
Jukka K Rönneikkö, Matti Mäkelä, Esa R Jämsen, Heini Huhtala, Harriet Finne-Soveri, Anja Noro, Jaakko N Valvanne
OBJECTIVES: To identify factors predicting unplanned hospitalization of new home care clients using the Resident Assessment Instrument for Home Care (RAI-HC). DESIGN: A register-based study based on RAI-HC assessments and nationwide hospital discharge records. SETTING: Municipal home care services in Finland. PARTICIPANTS: New Finnish home care clients aged 63 and older (N = 15,700). MEASUREMENTS: Information from home care clients' first RAI-HC assessment was connected to information regarding their first hospitalization over 1 year of follow-up...
December 21, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27982422/update-review-of-the-acute-porphyrias
#19
REVIEW
Penelope E Stein, Michael N Badminton, David C Rees
Acute porphyrias are rare inherited disorders due to deficiencies of haem synthesis enzymes. To date, all UK cases have been one of the three autosomal dominant forms, although penetrance is low and most gene carriers remain asymptomatic. Clinical presentation is typically with acute neurovisceral attacks characterised by severe abdominal pain, vomiting, tachycardia and hypertension. Severe attacks may be complicated by hyponatraemia, peripheral neuropathy sometimes causing paralysis, seizures and psychiatric features...
December 16, 2016: British Journal of Haematology
https://www.readbyqxmd.com/read/27965310/rare-cause-of-back-pain-staphylococcus-aureus-vertebral-osteomyelitis-complicated-by-recurrent-epidural-abscess-and-severe-sepsis
#20
Louise Dunphy, Shabnam Iyer, Christopher Brown
An epidural abscess represents a rare acute medical emergency, with a reported incidence of 2.5/10 000 hospital admissions annually. The clinical features include fever, spinal pain, radiating nerve root pain and leg weakness. When sepsis is present, prompt recognition is required to initiate appropriate antimicrobial therapy and surgical decompression. We present the case of a man aged 68 years presenting to the emergency department with a 3-day history of fever, low back, right hip and leg pain. He was hypoxic, tachycardic and hypotensive...
December 13, 2016: BMJ Case Reports
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