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Alternative care pathways

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https://www.readbyqxmd.com/read/28808901/the-utility-of-routine-intensive-care-admission-for-patients-undergoing-intracranial-neurosurgical-procedures-a-systematic-review
#1
Cesar Cimonari de Almeida, M Dustin Boone, Yosef Laviv, Burkhard S Kasper, Clark C Chen, Ekkehard M Kasper
BACKGROUND: Patients who have undergone intracranial neurosurgical procedures have traditionally been admitted to an intensive care unit (ICU) for close postoperative neurological observation. The purpose of this study was to systematically review the evidence for routine ICU admission in patients undergoing intracranial neurosurgical procedures and to evaluate the safety of alternative postoperative pathways. METHODS: We were interested in identifying studies that examined selected patients who presented for elective, non-emergent intracranial surgery whose postoperative outcomes were compared as a function of ICU versus non-ICU admission...
August 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28794660/a-renal-colic-fast-track-pathway-to-improve-waiting-times-and-outcomes-for-patients-presenting-to-the-emergency-department
#2
Omar Al Kadhi, Kate Manley, Madhavi Natarajan, Valmiki Lutchmedial, Abbi Forsyth, Kate Tabrett, Jonathan Betteridge, William Finch, Heinrich Hollis
INTRODUCTION: Renal colic is commonly encountered in the emergency department (ED). We validated a fast track renal colic (FTRC) initiative to decrease patient waiting times and streamline patient flow. METHOD: The FTRC pathway was devised according to the National Institute for Health and Care Excellence clinical summary criteria for the management of patients with suspected renal colic. ED triage nurses use the pathway to identify patients with likely renal colic suitable for fast track to analgesia, investigation and management...
2017: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/28777197/elabela-improves-cardio-renal-outcome-in-fatal-experimental-septic-shock
#3
David Coquerel, Frédéric Chagnon, Xavier Sainsily, Lauralyne Dumont, Alexandre Murza, Jérôme Côté, Robert Dumaine, Philippe Sarret, Éric Marsault, Dany Salvail, Mannix Auger-Messier, Olivier Lesur
OBJECTIVES: Apelin-13 was recently proposed as an alternative to the recommended β-adrenergic drugs for supporting endotoxin-induced myocardial dysfunction. Since Apelin-13 signals through its receptor (Apelin peptide jejunum) to exert singular inotropic/vasotropic actions and to optimize body fluid balance, this candidate pathway might benefit septic shock management. Whether the newly discovered ELABELA (ELA), a second endogenous ligand of the Apelin peptide jejunum receptor highly expressed in the kidney, further improves cardio-renal impairment remains unknown...
August 2, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28764868/modeling-new-immunoregulatory-therapeutics-as-antimicrobial-alternatives-for-treating-clostridium-difficile-infection
#4
Andrew Leber, Raquel Hontecillas, Vida Abedi, Nuria Tubau-Juni, Victoria Zoccoli-Rodriguez, Caroline Stewart, Josep Bassaganya-Riera
The current treatment paradigm in Clostridium difficile infection is the administration of antibiotics contributing to the high rates of recurrent infections. Recent alternative strategies, such as fecal microbiome transplantation and anti-toxin antibodies, have shown similar efficacy in the treatment of C. difficile associated disease (CDAD). However, barriers exist for either treatment or other novel treatments to displace antibiotics as the standard of care. To aid in the comparison of these and future treatments in CDAD, we developed an in silico pipeline to predict clinical efficacy with nonclinical results...
May 2017: Artificial Intelligence in Medicine
https://www.readbyqxmd.com/read/28757175/-main-novelties-of-the-last-set-of-european-guidelines-for-the-management-of-heart-failure
#5
Richard Isnard, Nadjib Hammoudi, Lise Legrand, Françoise Pousset
Heart failure is the main chronic disease in cardiology. Its prognosis remains poor despite improvements in its management that allow patients to live increasingly longer with this disease, alternating periods of stability and episodes of decompensation. Treatment guidelines are regularly updated to integrate new results of recent trials that are likely to influence routine care. These guidelines are proposed with different classes of recommendations and difference levels of evidence. It is of paramount importance to summarize the guidelines to make them accessible to the vast majority of cardiologists and easier to read to promote their application...
July 27, 2017: La Presse Médicale
https://www.readbyqxmd.com/read/28742031/patient-specific-left-ventricular-flow-simulations-from-transthoracic-echocardiography-robustness-evaluation-and-validation-against-ultrasound-doppler-and-magnetic-resonance-imaging
#6
David Larsson, Jeannette H Spuhler, Sven Petersson, Tim Nordenfur, Massimiliano Colarieti-Tosti, Johan Hoffman, Reidar Winter, Matilda Larsson
The combination of medical imaging with computational fluid dynamics (CFD) has enabled the study of 3D blood flow on a patient-specific level. However, with models based on gated high-resolution data, the study of transient flows, and any model implementation into routine cardiac care, is challenging. The present paper presents a novel pathway for patient-specific CFD modelling of the left ventricle (LV), using 4D transthoracic echocardiography (TTE) as input modality. To evaluate the clinical usability, two sub-studies were performed...
July 21, 2017: IEEE Transactions on Medical Imaging
https://www.readbyqxmd.com/read/28736393/traditional-healers-faith-healers-and-medical-practitioners-the-contribution-of-medical-pluralism-to-bottlenecks-along-the-cascade-of-care-for-hiv-aids-in-eastern-and-southern-africa
#7
Mosa Moshabela, Dominic Bukenya, Gabriel Darong, Joyce Wamoyi, Estelle McLean, Morten Skovdal, William Ddaaki, Kenneth Ondeng'e, Oliver Bonnington, Janet Seeley, Victoria Hosegood, Alison Wringe
OBJECTIVES: There are concerns that medical pluralism may delay patients' progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with HIV (PLHIV) in African settings remain unclear. We sought to establish the manifestation of medical pluralism among PLHIV, and explore mechanisms through which medical pluralism contributes bottlenecks along the HIV care cascade. METHODS: We conducted a multicountry exploratory qualitative study in seven health and demographic surveillance sites in six eastern and southern African countries: Uganda, Kenya, Tanzania, Malawi, Zimbabwe and South Africa...
July 2017: Sexually Transmitted Infections
https://www.readbyqxmd.com/read/28714723/the-implementation-and-testing-of-a-referral-management-system-to-address-barriers-to-treatment-seeking-among-primary-care-veterans-with-ptsd
#8
Kyle Possemato, Emily M Johnson, Laura O Wray, Brad Webster, Tracy Stecker
Primary care (PC) patients have low rates of engagement in evidence-based psychotherapy for PTSD due to a variety of patient- and system-level barriers. We conducted a hybrid effectiveness-implementation study of a referral management system, called coordinated and alternative pathway to engagement (CAPE), to address barriers to receiving evidence-based treatment for PTSD. CAPE included the delivery of 1 session of cognitive-behavioral therapy (CBT) within PC to identify and change treatment-seeking beliefs, phone contacts to assist veterans in attending appointments, and PC staff trainings on how to implement clinical practice guidelines for PTSD in PC...
July 17, 2017: Psychological Services
https://www.readbyqxmd.com/read/28708930/effects-of-high-intensity-aerobic-interval-training-on-cardiovascular-disease-risk-in-testicular-cancer-survivors-a-phase-2-randomized-controlled-trial
#9
Scott C Adams, Darren S DeLorey, Margie H Davenport, Michael K Stickland, Adrian S Fairey, Scott North, Alexander Szczotka, Kerry S Courneya
BACKGROUND: Testicular cancer survivors (TCS) have an increased risk of treatment-related cardiovascular disease (CVD), which may limit their overall survival. We evaluated the effects of high-intensity aerobic interval training (HIIT) on traditional and novel CVD risk factors and surrogate markers of mortality in a population-based sample of TCS. METHODS: This phase 2 trial (ClinicalTrials.gov identifier NCT02459132) randomly assigned 63 TCS to usual care (UC) or 12 weeks of supervised HIIT (ie, alternating periods of vigorous-intensity and light-intensity aerobic exercise)...
July 14, 2017: Cancer
https://www.readbyqxmd.com/read/28705316/cell-specific-pathways-supporting-persistent-fibrosis-in-heart-failure
#10
Stephen D Farris, Creighton Don, Deri Helterline, Christopher Costa, Tabitha Plummer, Susanne Steffes, Claudius Mahr, Nahush A Mokadam, April Stempien-Otero
BACKGROUND: Only limited data exist describing the histologic and noncardiomyocyte function of human myocardium in end-stage heart failure (HF). OBJECTIVES: The authors sought to determine changes in noncardiomyocyte cellular activity in patients with end-stage HF after left ventricular assist device (LVAD)-induced remodeling to identify mechanisms impeding recovery. METHODS: Myocardium was obtained from subjects undergoing LVAD placement and/or heart transplantation...
July 18, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28692142/big-g-and-little-g-geriatrics-education-for-physicians
#11
Kathryn E Callahan, Nina Tumosa, Rosanne M Leipzig
In the July 2016 issue of this journal, Dr. Mary Tinetti proposed that geriatric medicine abandon attempts to increase the numbers of board-certified geriatricians and change focus to the development of a "small elite workforce." What would be gained and what sacrificed by accepting this challenge? We agree that the best clinical use of a scarce resource, specialty trained geriatricians, is to care for frail, complex, severely ill elderly adults and to help design and study novel interventions in research, education, and care models to improve the care of all older adults, but for this to happen, all other providers must attain specific competency in the care of older adults...
July 10, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28680953/the-cost-impact-of-lenalidomide-for-newly-diagnosed-multiple-myeloma-in-the-eu5
#12
Steve Schey, Luis Felipe Casado Montero, Chloe Stengel-Tosetti, Craig J Gibson, Sujith Dhanasiri
INTRODUCTION: Lenalidomide is an active agent that was approved for use in the EU in 2015 as a first-line therapy for previously untreated, non-transplant eligible multiple myeloma patients. Our objective was to assess the cost impact of lenalidomide when selected as a first-line treatment for transplant-ineligible patients in France, Germany, Italy, Spain, and the United Kingdom (EU5). METHODS: We developed a cost-impact model of the total costs associated with newly diagnosed multiple myeloma over 5 years in the EU5 based on treatment duration and time to progression (TTP) (taken from trial data)...
2017: Oncology and Therapy
https://www.readbyqxmd.com/read/28673646/an-investor-perspective-on-forming-and-funding-your-medical-device-start-up
#13
Juan-Pablo Mas, Brian Hsueh
Novel and transformative medical technologies of all forms have the potential to make a significant positive impact on the lives of patients and on the health care system, and one common pathway for guiding such innovations from concept through commercialization is via the formation of a company. For entrepreneurs looking to build a medical technology company, several common challenges await, including questions around how and where to raise funding. Here, we review key considerations for the formation of medical technology companies as viewed through the lens of an investor...
June 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28660631/yes-health-is-important-but-as-much-for-its-importance-via-social-life-the-direct-and-indirect-effects-of-health-on-subjective-well-being-in-chronically-ill-individuals
#14
Admassu N Lamu, Jan Abel Olsen
There is an increasing evidence that health-related quality of life, income, and social relationships are important to our subjective well-being (SWB). Little is known, however, about the specific indirect pathways that link health to SWB via social relationships and income. On the basis of a unique data set of 7 disease groups from 6 OECD-countries (N = 6,173), we investigate the direct and indirect effects of health on SWB by using structural equation modeling. Three alternative measures of health are used: For generic instruments (EQ-5D-5L; SF-6D), the total indirect effect was stronger (0...
June 29, 2017: Health Economics
https://www.readbyqxmd.com/read/28647838/preoperative-education-for-hip-and-knee-replacement-never-stop-learning
#15
REVIEW
Paul K Edwards, Simon C Mears, C Lowry Barnes
PURPOSE OF REVIEW: Participation in alternative payment models has focused efforts to improve outcomes and patient satisfaction while also lowering cost for elective hip and knee replacement. The purpose of this review is to determine if preoperative education classes for elective hip and knee replacement achieve these goals. RECENT FINDINGS: Recent literature demonstrates that patients who attend education classes prior to surgery have decreased anxiety, better post-operative pain control, more realistic expectations of surgery, and a better understanding of their surgery...
June 24, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28635159/nutrition-in-renal-supportive-care-patient-driven-and-flexible
#16
REVIEW
Jessica Stevenson, Anthony Meade, Ann-Maree Randall, Karen Manley, Stephanie Notaras, Susan Heaney, Maria Chan, Alison Smyth, Elizabeth Josland, Frank Brennan, Mark A Brown
Renal Supportive Care is an alternative treatment pathway in advanced Chronic Kidney Disease (CKD) that is being increasingly adopted, particularly in the elderly. RSC utilises principles of palliative care and has been developed to enhance the care for dialysis patients with a high symptom burden and those being managed on a non-dialysis pathway. Nutrition management is often an under-recognised component of care, and can play an important role in improving patients' quality of life to reduce symptom burden, support physical function and independence and provide appropriate counselling to patients and their families to ensure the goals of RSC are met...
June 20, 2017: Nephrology
https://www.readbyqxmd.com/read/28619124/multiplex-tests-to-identify-gastrointestinal-bacteria-viruses-and-parasites-in-people-with-suspected-infectious-gastroenteritis-a-systematic-review-and-economic-analysis
#17
Karoline Freeman, Hema Mistry, Alexander Tsertsvadze, Pam Royle, Noel McCarthy, Sian Taylor-Phillips, Rohini Manuel, James Mason
BACKGROUND: Gastroenteritis is a common, transient disorder usually caused by infection and characterised by the acute onset of diarrhoea. Multiplex gastrointestinal pathogen panel (GPP) tests simultaneously identify common bacterial, viral and parasitic pathogens using molecular testing. By providing test results more rapidly than conventional testing methods, GPP tests might positively influence the treatment and management of patients presenting in hospital or in the community. OBJECTIVE: To systematically review the evidence for GPP tests [xTAG(®) (Luminex, Toronto, ON, Canada), FilmArray (BioFire Diagnostics, Salt Lake City, UT, USA) and Faecal Pathogens B (AusDiagnostics, Beaconsfield, NSW, Australia)] and to develop a de novo economic model to compare the cost-effectiveness of GPP tests with conventional testing in England and Wales...
April 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28608545/an-alternative-pathway-to-eusociality-exploring-the-molecular-and-functional-basis-of-fortress-defense
#18
Sarah P Lawson, Leah T Sigle, Abigail L Lind, Andrew W Legan, Jessica N Mezzanotte, Hans-Willi Honegger, Patrick Abbot
Some animals express a form of eusociality known as "fortress defense," in which defense rather than brood care is the primary social act. Aphids are small plant-feeding insects, but like termites, some species express division of labor and castes of aggressive juvenile "soldiers." What is the functional basis of fortress defense eusociality in aphids? Previous work showed that the acquisition of venoms might be a key innovation in aphid social evolution. We show that the lethality of aphid soldiers derives in part from the induction of exaggerated immune responses in insects they attack...
August 2017: Evolution; International Journal of Organic Evolution
https://www.readbyqxmd.com/read/28605006/treating-periodontal-disease-for-preventing-adverse-birth-outcomes-in-pregnant-women
#19
REVIEW
Zipporah Iheozor-Ejiofor, Philippa Middleton, Marco Esposito, Anne-Marie Glenny
BACKGROUND: Periodontal disease has been linked with a number of conditions, such as cardiovascular disease, stroke, diabetes and adverse pregnancy outcomes, all likely through systemic inflammatory pathways. It is common in women of reproductive age and gum conditions tend to worsen during pregnancy. Some evidence from observational studies suggests that periodontal intervention may reduce adverse pregnancy outcomes. There is need for a comprehensive Cochrane review of randomised trials to assess the effect of periodontal treatment on perinatal and maternal health...
June 12, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28601828/colorectal-cancer-with-synchronous-liver-limited-metastases-the-protocol-of-an-inception-cohort-study-cosmic
#20
Ajith K Siriwardena, Anthony K C Chan, Agnieszka M Ignatowicz, James M Mason
INTRODUCTION: Colorectal cancer is the fourth most common cancer in the UK and an important cause of cancer-related death. In 20% of patients, there is metastasis to the liver or beyond at the time of diagnosis. The management of synchronous disease is complex. Conventional surgery removes the colorectal primary first, followed by chemotherapy, with resection of liver metastases as a final step. Advances in the availability and safety of liver surgery, anaesthesia and critical care have made two alternative options feasible...
June 9, 2017: BMJ Open
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