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https://www.readbyqxmd.com/read/29352754/providing-ethical-healthcare-in-resource-poor-environments
#1
Kenneth V Iserson
The ethics of providing health care in resource-poor environments is a complex topic. It implies two related questions: What can we do with the resources on hand? Of all the things we can do, which ones should we do? "Resource-poor" (i.e., resource-challenged, resource-constrained) environments are situations in which clinicians, organizations, or healthcare systems have the knowledge and skills, but not the means, to carry out highly effective and beneficial interventions. Determinants of a population's health often rely less on disease and injury management than on recognizing and meeting their basic needs...
January 19, 2018: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/29352578/a-physiotherapist-led-exercise-and-education-program-for-preventing-recurrence-of-low-back-pain-a-randomised-controlled-pilot-trial
#2
Matthew L Stevens, Chung-Wei C Lin, Mark J Hancock, Trish Wisby-Roth, Jane Latimer, Chris G Maher
BACKGROUND: Before beginning a large and complex trial it is considered good practice to run a pilot study to assess the feasibility and acceptability so that quality is maintained and resources are not wasted. OBJECTIVE: To assesses the feasibility and acceptability of procedures for TOPS: Trial Of Prevention Strategies for low back pain. DESIGN: Randomised controlled pilot trial. METHODS: This is a trial of an 8 week, physiotherapist-led group exercise and education program for preventing recurrence of low back pain (LBP) in those recently recovered from LBP...
September 1, 2017: Physiotherapy
https://www.readbyqxmd.com/read/29352548/prediction-of-psychosis-across-protocols-and-risk-cohorts-using-automated-language-analysis
#3
Cheryl M Corcoran, Facundo Carrillo, Diego Fernández-Slezak, Gillinder Bedi, Casimir Klim, Daniel C Javitt, Carrie E Bearden, Guillermo A Cecchi
Language and speech are the primary source of data for psychiatrists to diagnose and treat mental disorders. In psychosis, the very structure of language can be disturbed, including semantic coherence (e.g., derailment and tangentiality) and syntactic complexity (e.g., concreteness). Subtle disturbances in language are evident in schizophrenia even prior to first psychosis onset, during prodromal stages. Using computer-based natural language processing analyses, we previously showed that, among English-speaking clinical (e...
February 2018: World Psychiatry: Official Journal of the World Psychiatric Association (WPA)
https://www.readbyqxmd.com/read/29352526/ectrims-ean-guideline-on-the-pharmacological-treatment-of-people-with-multiple-sclerosis
#4
X Montalban, R Gold, A J Thompson, S Otero-Romero, M P Amato, D Chandraratna, M Clanet, G Comi, T Derfuss, F Fazekas, H P Hartung, E Havrdova, B Hemmer, L Kappos, R Liblau, C Lubetzki, E Marcus, D H Miller, T Olsson, S Pilling, K Selmaj, A Siva, P S Sorensen, M P Sormani, C Thalheim, H Wiendl, F Zipp
BACKGROUND AND PURPOSE: Multiple sclerosis (MS) is a complex disease of the central nervous system. As new drugs are becoming available, knowledge on diagnosis and treatment must continuously evolve. There is therefore a need for a reference tool compiling current data on benefit and safety, to aid professionals in treatment decisions and use of resources across Europe. The European Committee of Treatment and Research in Multiple Sclerosis (ECTRIMS) and the European Academy of Neurology (EAN) have joined forces to meet this need...
January 19, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29352419/a-systematic-review-of-interventions-to-follow-up-test-results-pending-at-discharge
#5
Patrick J Darragh, T Bodley, A Orchanian-Cheff, K G Shojania, J L Kwan, P Cram
BACKGROUND: Patients are frequently discharged from the hospital before all test results have been finalized. Thirty to 40% of tests pending at discharge (TPADs) return potentially actionable results that could necessitate change in the patients' management, often unbeknownst to their physicians. Delayed follow-up of TPADs can lead to patient harm. We sought to synthesize the existing literature on interventions intended to improve the management of TPADs, including interventions designed to enhance documentation of TPADs, increase physician awareness when TPAD results finalize post-discharge, decrease adverse events related to missed TPADs, and increase physician satisfaction with TPAD management...
January 19, 2018: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/29352006/machine-learning-in-cardiovascular-medicine-are-we-there-yet
#6
REVIEW
Khader Shameer, Kipp W Johnson, Benjamin S Glicksberg, Joel T Dudley, Partho P Sengupta
Artificial intelligence (AI) broadly refers to analytical algorithms that iteratively learn from data, allowing computers to find hidden insights without being explicitly programmed where to look. These include a family of operations encompassing several terms like machine learning, cognitive learning, deep learning and reinforcement learning-based methods that can be used to integrate and interpret complex biomedical and healthcare data in scenarios where traditional statistical methods may not be able to perform...
January 19, 2018: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29351790/development-of-a-framework-to-improve-the-process-of-recruitment-to-randomised-controlled-trials-rcts-the-sear-screened-eligible-approached-randomised-framework
#7
Caroline Wilson, Leila Rooshenas, Sangeetha Paramasivan, Daisy Elliott, Marcus Jepson, Sean Strong, Alison Birtle, David J Beard, Alison Halliday, Freddie C Hamdy, Rebecca Lewis, Chris Metcalfe, Chris A Rogers, Robert C Stein, Jane M Blazeby, Jenny L Donovan
BACKGROUND: Research has shown that recruitment to trials is a process that stretches from identifying potentially eligible patients, through eligibility assessment, to obtaining informed consent. The length and complexity of this pathway means that many patients do not have the opportunity to consider participation. This article presents the development of a simple framework to document, understand and improve the process of trial recruitment. METHODS: Eight RCTs integrated a QuinteT Recruitment Intervention (QRI) into the main trial, feasibility or pilot study...
January 19, 2018: Trials
https://www.readbyqxmd.com/read/29351705/percutaneous-endoscopic-rendezvous-procedure-for-the-management-of-bile-duct-injuries-after-cholecystectomy-short-and-long-term-outcomes
#8
Anne Marthe Schreuder, Klaske A C Booij, Philip R de Reuver, Otto M van Delden, Krijn P van Lienden, Marc G Besselink, Olivier R Busch, Dirk J Gouma, Erik A J Rauws, Thomas M van Gulik
BACKGROUND:  Bile duct injury (BDI) remains a daunting complication of laparoscopic cholecystectomy. In patients with complex BDI, a percutaneous-endoscopic rendezvous procedure may be required to establish bile duct continuity. The aim of this study was to assess short- and long-term outcomes of the rendezvous procedure. METHODS:  All consecutive patients with BDI referred to our tertiary referral center between 1995 and 2016 were analyzed. A rendezvous procedure was performed when endoscopic or radiologic intervention failed, and when deemed feasible by a dedicated multidisciplinary team including hepatopancreaticobiliary surgeons, gastrointestinal endoscopists, and interventional radiologists...
January 19, 2018: Endoscopy
https://www.readbyqxmd.com/read/29351650/are-evidence-based-community-engaged-energy-balance-interventions-enough-for-extremely-vulnerable-populations
#9
Nancy E Schoenberg, Yelena N Tarasenko, Claire Snell-Rood
Well-documented associations between lifestyle behaviors and disease outcomes necessitate evidence-based health promotion interventions. To enhance potential efficacy and effectiveness, interventionists increasingly respond to community priorities, employ comprehensive theoretical frameworks, invest heavily to ensure cultural fit, implement evidence-based programming, and deploy research gold standards. We describe a project that followed all of these recommended strategies, but did not achieve desired outcomes...
January 17, 2018: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/29351520/beyond-clinical-complexity-non-medical-barriers-to-nursing-home-care-for-rural-residents
#10
Carrie Henning-Smith, Katy B Kozhimannil, Michelle M Casey, Shailendra Prasad
We conducted a qualitative content analysis of barriers to nursing home admission for rural residents. Data came from semi-structured interviews with 23 rural hospital discharge planners across five states (Georgia, Idaho, Minnesota, Pennsylvania, and Wisconsin). From those, we identified four themes around non-medical barriers to rural nursing home placement with particular salience in rural areas: financial issues; transportation; nursing home availability and infrastructure; and timeliness. We also identified policy and programmatic interventions across four themes: loosen bureaucratic requirements; improve communication between facilities; increase rural long-term care capacity; and address underlying social determinants of health...
January 19, 2018: Journal of Aging & Social Policy
https://www.readbyqxmd.com/read/29351045/gender-views-and-relationships-in-families-of-children-with-craniofacial-differences
#11
Danielle N Shapiro, Jennifer Waljee, Steven Buchman, Kavitha Ranganathan, Seth Warshcausky
OBJECTIVE: Gender values and beliefs are known to influence family functioning. The aim of the current study was to describe the association between views about gender and family functioning within families with a child with a craniofacial difference (CFD). DESIGN: Participants included 74 dyads composed of children (8-18 years old) with CFD (n = 36 female), including cleft lip/palate, and a parent (n = 56 female). Children and caregivers both completed the activities subscale of the Occupations, Activities, and Traits-Attitudes Measure (C/OAT-AM)...
February 2018: Cleft Palate-craniofacial Journal
https://www.readbyqxmd.com/read/29350159/clinical-and-molecular-epidemiology-of-staphylococcal-toxic-shock-syndrome-in-the-united-kingdom
#12
Hema Sharma, Debra Smith, Claire E Turner, Laurence Game, Bruno Pichon, Russell Hope, Robert Hill, Angela Kearns, Shiranee Sriskandan
Staphylococcal toxic shock syndrome (TSS) was originally described in menstruating women and linked to TSS toxin 1 (TSST-1)-producing Staphylococcus aureus. Using UK national surveillance data, we ascertained clinical, molecular and superantigenic characteristics of TSS cases. Average annual TSS incidence was 0.07/100,000 population. Patients with nonmenstrual TSS were younger than those with menstrual TSS but had the same mortality rate. Children <16 years of age accounted for 39% of TSS cases, most caused by burns and skin and soft tissue infections...
February 2018: Emerging Infectious Diseases
https://www.readbyqxmd.com/read/29349881/speech-and-language-therapists-perspectives-of-therapeutic-alliance-construction-and-maintenance-in-aphasia-rehabilitation-post-stroke
#13
Michelle Lawton, Karen Sage, Gillian Haddock, Paul Conroy, Laura Serrant
BACKGROUND: Therapeutic alliance refers to the interactional and relational processes operating during therapeutic interventions. It has been shown to be a strong determinant of treatment efficacy in psychotherapy, and evidence is emerging from a range of healthcare and medical disciplines to suggest that the construct of therapeutic alliance may in fact be a variable component of treatment outcome, engagement and satisfaction. Although this construct appears to be highly relevant to aphasia rehabilitation, no research to date has attempted to explore this phenomenon and thus consider its potential utility as a mechanism for change...
January 18, 2018: International Journal of Language & Communication Disorders
https://www.readbyqxmd.com/read/29349385/novel-non-gadolinium-enhanced-magnetic-resonance-imaging-technique-of-pedal-artery-aneurysms
#14
J Devin B Watson, Beatrice Grasu, Rajiv Menon, Raymond Pensy, Robert S Crawford, Taehoon Shin
Non-gadolinium-enhanced magnetic resonance angiography (nMRA) is a noninvasive, contrast-free imaging modality used for visualizing pedal arterial anatomy. We report application of the nMRA technique for detailed arterial imaging in a patient with dorsalis pedis aneurysm. Compared with digital subtraction angiography, we demonstrate that nMRA provides sufficient arterial detail needed to develop a complex operative plan before vascular intervention without risk of contrast agent or ionizing radiation exposure...
June 2017: Journal of Vascular Surgery Cases and Innovative Techniques
https://www.readbyqxmd.com/read/29349286/exercise-self-efficacy-in-adults-with-congenital-heart-disease
#15
Annika Bay, Camilla Sandberg, Ulf Thilén, Karin Wadell, Bengt Johansson
Background: Physical activity improves health, exercise tolerance and quality of life in adults with congenital heart disease (CHD), and exercise training is in most patients a high-benefit low risk intervention. However, factors that influence the confidence to perform exercise training, i.e. exercise self-efficacy (ESE), in CHD patients are virtually unknown. We aimed to identify factors related to low ESE in adults with CHD, and potential strategies for being physically active. Methods: Seventy-nine adults with CHD; 38 with simple lesions (16 women) and 41 with complex lesions (17 women) with mean age 36...
March 2018: IJC Heart & Vasculature
https://www.readbyqxmd.com/read/29349268/socioeconomic-status-indicators-and-common-mental-disorders-evidence-from-a-study-of-prenatal-depression-in-pakistan
#16
Joanna Maselko, Lisa Bates, Sonia Bhalotra, John A Gallis, Karen O'Donnell, Siham Sikander, Elizabeth L Turner
There is growing interest in the relationship between socioeconomic status (SES), poverty, and mental health in low and middle-income countries (LMIC). However, it is not clear whether a gradient approach focused on a wider SES distribution or a binary poverty approach is more salient for mental health in LMIC. Yet this distinction has implications for interventions aimed at improving population health. We contribute to the literature by examining how multiple indicators of socioeconomic status, including gradient SES and binary poverty indicators, contribute to prenatal depression symptoms in a LMIC context...
April 2018: SSM—Population Health
https://www.readbyqxmd.com/read/29349238/engagement-with-health-care-providers-as-a-mediator-between-social-capital-and-quality-of-life-among-a-sample-of-people-living-with-hiv-in-the-united-states-path-analysis
#17
SoSon Jong, Adam Carrico, Bruce Cooper, Lisa Thompson, Carmen Portillo
Background: Social capital is "features of social organizations-networks, norms, and as trust that facilitate coordination and cooperation for mutual benefit". People with high social capital have lower mortality and better health outcomes. Although utilization of social networks has grown, social capital continues to be a complex concept in relation to health promotion. This study examined 1) associations between social capital and quality of life (QoL), 2) factors of social capital leading to higher QoL among people living with HIV (PLWH), 3) role of health care providers (HCP) as a mediator between social capital and QoL...
December 2017: SSM—Population Health
https://www.readbyqxmd.com/read/29348607/evaluation-of-mitochondrial-bioenergetics-dynamics-endoplasmic-reticulum-mitochondria-crosstalk-and-reactive-oxygen-species-in-fibroblasts-from-patients-with-complex-i-deficiency
#18
Guilhian Leipnitz, Al-Walid Mohsen, Anuradha Karunanidhi, Bianca Seminotti, Vera Y Roginskaya, Desiree M Markantone, Mateus Grings, Stephanie J Mihalik, Peter Wipf, Bennett Van Houten, Jerry Vockley
Mitochondrial complex I (CI) deficiency is the most frequent cause of oxidative phosphorylation (OXPHOS) disorders in humans. In order to benchmark the effects of CI deficiency on mitochondrial bioenergetics and dynamics, respiratory chain (RC) and endoplasmic reticulum (ER)-mitochondria communication, and superoxide production, fibroblasts from patients with mutations in the ND6, NDUFV1 or ACAD9 genes were analyzed. Fatty acid metabolism, basal and maximal respiration, mitochondrial membrane potential, and ATP levels were decreased...
January 18, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29348284/laryngeal-tuberculosis-a-rare-cause-of-critical-airway-obstruction
#19
Abigail Elizabeth Cole, Daniel Heaton, Ahmed Chekairi
Laryngeal tuberculosis (TB) is a rare condition, occurring in less than 1% of patients infected with pulmonary TB. We present a case of a 57-year-old male patient, who presented in extremis with audible stridor, increased work of breathing and cyanosis. In addition, the patient had a complex medical history, including a recent diagnosis of congenital malformation of the epiglottis. Emergency intervention was required to secure the airway, and after initial attempts at intubation were unsuccessful, an emergency tracheostomy was performed...
January 17, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29348280/marked-cachexia-in-probable-invasive-pulmonary-aspergillosis-with-bronchopleural-fistula
#20
Christiana Page, Laura Blazy, Melanie Jenkins, Rosalba Spiritoso
A 49-year-old man with a medical history of diabetes and heavy smoking was admitted to intensive care with severe bilateral pneumonia associated with marked cachexia. He developed a complex right-sided bronchopleural fistula and was transferred to our tertiary centre for consideration of surgical intervention.Despite escalation of antibiotic therapy, he did not improve and further investigations led to a diagnosis of invasive pulmonary aspergillosis. Definitive treatment plans required a right pneumonectomy; however, given the severity of cachexia, he remained unable to undergo such a large operation...
January 17, 2018: BMJ Case Reports
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