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Managing uncertainty

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https://www.readbyqxmd.com/read/29790138/-the-relationship-between-fatigue-and-uncertainty-in-patients-with-liver-cirrhosis
#1
Wan-Ju Lin, Hui-Man Huang, Fan-Ko Sun
BACKGROUND: Cirrhosis is a chronic, progressive, and currently incurable disease. Cirrhotic patients often experience uncertainty due to poor control of symptoms and disease recurrence. Although fatigue is a common symptom in patients with liver cirrhosis, this symptom is often ignored by healthcare professionals due to the lack of efficacious treatment options. Improper management of fatigue may trigger greater uncertainty and affect adaptation success. PURPOSE: To explore the relationship between fatigue and uncertainty and the factors that respectively relate to these two concepts in liver cirrhosis patients...
June 2018: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/29789964/caring-for-women-with-multiple-sclerosis-across-the-lifespan
#2
REVIEW
Kelsey Rankin, Riley Bove
PURPOSE OF REVIEW: Caring for women with multiple sclerosis (MS), whose first symptoms typically begin during the childbearing years, requires a comprehensive approach to management across a range of reproductive exposures, and beyond through menopause. RECENT FINDINGS: This article summarizes what is known about the disease course in women with MS, how it differs from men, and the current state of knowledge regarding effects of reproductive exposures (menarche, childbearing, menopause) on MS-related inflammation and neurodegeneration...
May 23, 2018: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/29788982/tisu-extracorporeal-shockwave-lithotripsy-as-first-treatment-option-compared-with-direct-progression-to-ureteroscopic-treatment-for-ureteric-stones-study-protocol-for-a-randomised-controlled-trial
#3
Samuel McClinton, Sarah Cameron, Kathryn Starr, Ruth Thomas, Graeme MacLennan, Alison McDonald, Thomas Lam, James N'Dow, Mary Kilonzo, Robert Pickard, Ken Anson, Frank Keeley, Neil Burgess, Charles Terry Clark, Sara MacLennan, John Norrie
BACKGROUND: Urinary stone disease is very common with an estimated prevalence among the general population of 2-3%. Ureteric stones are associated with severe pain as they pass through the urinary tract and have significant impact on patients' quality of life due to the detrimental effect on their ability to work and need for hospitalisation. Most ureteric stones can be expected to pass spontaneously with supportive care. However, between one-fifth and one-third of cases require an intervention...
May 22, 2018: Trials
https://www.readbyqxmd.com/read/29785719/children-s-experiences-and-expectations-of-kidney-transplantation-a-qualitative-interview-study
#4
Rachael C Walker, Derisha Naicker, Tonya Kara, Suetonia C Palmer
RATIONALE AND OBJECTIVE: Kidney transplantation offers improved quality of life and life expectancy compared with dialysis for children. This study aims to understand the experiences and expectations of children during the kidney transplantation process to inform clinical care. STUDY DESIGN: Face-to-face, semi-structured interviews. SETTING AND PARTICIPANTS: We interviewed 13 children and adolescents aged between 7 and 17 years old in New Zealand who had received a kidney transplantation...
May 21, 2018: Nephrology
https://www.readbyqxmd.com/read/29784867/patient-beliefs-and-attitudes-to-taking-statins-systematic-review-of-qualitative-studies
#5
Angela Ju, Camilla S Hanson, Emily Banks, Rosemary Korda, Jonathan C Craig, Tim Usherwood, Peter MacDonald, Allison Tong
BACKGROUND: Statins are effective in preventing cardiovascular disease (CVD) events and are recommended for at-risk individuals but estimated adherence rates are low. AIM: To describe patients' perspectives, experiences, and attitudes towards taking statins. DESIGN AND SETTING: Systematic review of qualitative studies reporting perspectives of patients on statins. METHOD: PsycINFO, CINAHL, Embase, MEDLINE, and PhD dissertations from inception to 6 October 2016 were searched for qualitative studies on adult patients' perspectives on statins...
May 21, 2018: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/29782533/shared-responsibility-for-managing-fatigue-hearing-the-pilots
#6
Jennifer L Zaslona, Karyn M O'Keeffe, T Leigh Signal, Philippa H Gander
In commercial aviation, fatigue is defined as a physiological state of reduced mental or physical performance capability resulting from sleep loss, extended wakefulness, circadian phase, and/or workload. The International Civil Aviation Organisation mandates that responsibility for fatigue risk management is shared between airline management, pilots, and support staff. However, to date, the majority of research relating to fatigue mitigations in long range operations has focused on the mitigations required or recommended by regulators and operators...
2018: PloS One
https://www.readbyqxmd.com/read/29781319/assessing-the-role-of-ranibizumab-in-improving-the-outcome-of-glaucoma-filtering-surgery-and-neovascular-glaucoma
#7
Andreas Katsanos, Kostantina Gorgoli, Dimitrios G Mikropoulos, Esther Arranz-Marquez, Georgios P Athanasopoulos, Miguel A Teus, Anastasios G P Konstas
Ranibizumab was the first anti-vascular endothelial growth factor (VEGF) agent approved for the treatment of neovascular age-related macular degeneration. The use of ranibizumab and other anti-VEGF medications in recent years has revolutionized the treatment of several sight-threatening retinal disorders. Emerging evidence has demonstrated that anti-VEGF treatment can offer advantages in the management of other ocular conditions where VEGFs play a key role: ocular scarring following glaucoma filtering surgery and neovascular glaucoma (NVG)...
May 19, 2018: Expert Opinion on Biological Therapy
https://www.readbyqxmd.com/read/29780445/a-comparison-of-simulated-and-field-derived-leaf-area-index-lai-and-canopy-height-values-from-four-forest-complexes-in-the-southeastern-usa
#8
John S Iiames, Ellen Cooter, Donna Schwede, Jimmy Williams
Vegetative leaf area is a critical input to models that simulate human and ecosystem exposure to atmospheric pollutants. Leaf area index (LAI) can be measured in the field or numerically simulated, but all contain some inherent uncertainty that is passed to the exposure assessments that use them. LAI estimates for minimally managed or natural forest stands can be particularly difficult to develop as a result of interspecies competition, age and spatial distribution. Satellite-based LAI estimates hold promise for retrospective analyses, but we must continue to rely on numerical models for alternative management analysis...
2018: Forests
https://www.readbyqxmd.com/read/29779008/intervention-planning-for-the-reduce-maintenance-intervention-a-digital-intervention-to-reduce-reulceration-risk-among-patients-with-a-history-of-diabetic-foot-ulcers
#9
Kate Greenwell, Katy Sivyer, Kavita Vedhara, Lucy Yardley, Frances Game, Trudie Chalder, Gayle Richards, Nikki Drake, Katie Gray, John Weinman, Katherine Bradbury
OBJECTIVES: To develop a comprehensive intervention plan for the REDUCE maintenance intervention to support people who have had diabetic foot ulcers (DFUs) to sustain behaviours that reduce reulceration risk. METHODS: Theory-based, evidence-based and person-based approaches to intervention development were used. In phase I of intervention planning, evidence was collated from a scoping review of the literature and qualitative interviews with patients who have had DFUs (n=20)...
May 18, 2018: BMJ Open
https://www.readbyqxmd.com/read/29777618/guideline-of-guidelines-bladder-pain-syndrome
#10
REVIEW
Sachin Malde, Stefano Palmisani, Adnan Al-Kaisy, Arun Sahai
Bladder pain syndrome (BPS) is a severely debilitating, chronic disorder of unknown aetiology that has a significant negative impact on quality of life. A community-based study of American women has reported a high prevalence of 2.7% - 6.5% [1]. Despite this, there is still a lack of consensus worldwide on how to define the condition, the nomenclature to use, and how to optimally treat patients. This is reflected in the considerable variation in management worldwide, and the divergent recommendations in national and international guidelines...
May 19, 2018: BJU International
https://www.readbyqxmd.com/read/29774392/cost-effectiveness-of-ventricular-assist-device-destination-therapy-for-advanced-heart-failure-in-duchenne-muscular-dystrophy
#11
Defne A Magnetta, JaHyun Kang, Peter D Wearden, Kenneth J Smith, Brian Feingold
Destination ventricular assist device therapy (DT-VAD) is well accepted in select adults with medically refractory heart failure (HF) who are not transplant candidates; however, its use in younger patients with progressive diseases is unclear. We sought to evaluate the cost-effectiveness of DT-VAD in Duchenne muscular dystrophy (DMD) patients with advanced HF. We created a Markov-state transition model (5-year horizon) to compare survival, costs, and quality of life (QOL) between medical management and DT-VAD in DMD with advanced HF...
May 17, 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/29773899/management-of-acute-hcv-infection-in-the-era-of-direct-acting-antiviral-therapy
#12
REVIEW
Marianne Martinello, Behzad Hajarizadeh, Jason Grebely, Gregory J Dore, Gail V Matthews
The management of acute HCV infection has not been standardized following the availability of direct-acting antiviral agents (DAAs) for chronic HCV infection, and substantial uncertainty exists regarding the optimal treatment regimen and duration. Despite the lack of direct evidence, the 2016 American Association for the Study of Liver Diseases (AASLD)-Infectious Diseases Society of America (IDSA) guidelines supported "the same regimens for acute HCV as recommended for chronic HCV infection … owing to high efficacy and safety", whereas the 2016 European Association for the Study of the Liver (EASL) guidelines recommended sofosbuvir-ledipasvir, sofosbuvir-velpatasvir or sofosbuvir plus daclatasvir for 8 weeks in acute HCV infection, with a longer duration of 12 weeks recommended for those infected with HIV and/or baseline HCV RNA levels >1,000,000 IU/ml...
May 17, 2018: Nature Reviews. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29772017/patient-reported-healthcare-expectations-in-inflammatory-bowel-diseases
#13
Valérie Pittet, Carla Vaucher, Florian Froehlich, Michel H Maillard, Pierre Michetti
BACKGROUND: Patient-reported experience is an important component of a holistic approach to quality of care. Patients' expectations of treatments and global disease management may indicate their illness representations and their satisfaction and hopes regarding quality of care. OBJECTIVE: To study expectations of patients with inflammatory bowel disease. METHODS: Two focus groups were conducted with 14 patients to explore their expectations about treatments and disease management...
2018: PloS One
https://www.readbyqxmd.com/read/29771225/the-resident-physician-as-leader-within-the-healthcare-team
#14
Lyn Kathryn Sonnenberg, Lesley Pritchard-Wiart, Jamiu Busari
Purpose The purpose of this study was to explore inter-professional clinicians' perspectives on resident leadership in the context of inter-professional teams and to identify a definition for leadership in the clinical context. In 2015, CanMEDS changed the title of one of the core competencies from manager to leader. The shift in language was perceived by some as returning to traditional hierarchical and physician-dominant structures. The resulting uncertainty has resulted in a call to action to not only determine what physician leadership is but to also determine how to teach and assess it...
May 8, 2018: Leadership in Health Services
https://www.readbyqxmd.com/read/29770887/the-importance-of-early-recognition-in-management-of-ercp-related-perforations
#15
Jason G Bill, Zachary Smith, Joseph Brancheck, Jeffrey Elsner, Paul Hobbs, Gabriel D Lang, Dayna S Early, Koushik Das, Thomas Hollander, Maria B Majella Doyle, Ryan C Fields, William G Hawkins, Steven M Strasberg, Chet Hammill, William C Chapman, Steven Edmundowicz, Daniel K Mullady, Vladimir M Kushnir
BACKGROUND: Iatrogenic perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare events, carrying with it a mortality of up to 8%. Given the rarity of this adverse event, there remains limited data and continued uncertainties when choosing therapeutic strategies. Our aims were to evaluate the management of ERCP-related perforations and compare outcomes based on timing of recognition. METHODS: The endoscopic databases of two tertiary care centers were interrogated to identify consecutive adult patients who sustained ERCP-related perforation over a 10-year period from 2006 to 2016...
May 16, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29767345/metastatic-breast-cancer-collateral-damage-project-mbccd-scale-development-and-preliminary-results-of-the-survey-of-health-impact-needs-and-experiences-shine
#16
Timothy J Williamson, Susan M Love, Jessica N Clague DeHart, Alexandra Jorge-Miller, Leah Eshraghi, Heather Cooper Ortner, Annette L Stanton
PURPOSE: Until recently, people with metastatic breast cancer (MBC) had a very poor prognosis. New treatment approaches have prolonged the time that people with MBC live, but their quality of life has received less attention. Consequently, the needs and concerns across financial, vocational, psychological, social, and physical domains in MBC patients are poorly understood-particularly regarding the collateral damage or longer-term, life-altering impacts of MBC and its treatments. This study's aims were to characterize MBC-related collateral damage, identify groups most likely to experience collateral damage, and examine its associations with psychological health, illness management, and health behaviors...
May 16, 2018: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/29767311/developing-a-non-point-source-p-loss-indicator-in-r-and-its-parameter-uncertainty-assessment-using-glue-a-case-study-in-northern-china
#17
Jingjun Su, Xinzhong Du, Xuyong Li
Uncertainty analysis is an important prerequisite for model application. However, the existing phosphorus (P) loss indexes or indicators were rarely evaluated. This study applied generalized likelihood uncertainty estimation (GLUE) method to assess the uncertainty of parameters and modeling outputs of a non-point source (NPS) P indicator constructed in R language. And the influences of subjective choices of likelihood formulation and acceptability threshold of GLUE on model outputs were also detected. The results indicated the following...
May 16, 2018: Environmental Science and Pollution Research International
https://www.readbyqxmd.com/read/29766981/-improvement-of-the-management-of-outpatient-consultations-by-a-direct-automatic-citation-of-interconsultations
#18
Manuel Villegas García, Julián Alcaraz Martínez, Herminia Pascual Saura, Juan José Gonzálvez Ortega, Antonia Ballesta Cabrero, José Manuel Moreno Rodríguez, Ángel Baeza Alcaraz
OBJECTIVE: The delay caused to provide an appointment and the uncertainty of the expected waiting time, are cause for discontent in the patients. The object of this work was to improve the accessibility to the consultation of specialized attention in our health area, decreasing the average waiting time and reduce the number of claims for this reason. METHODS: To measure the quality of the service provided, 5 criteria were developed and evaluated, by means of a cross section, in December 2015 for all patients pending appointment in the Area...
May 16, 2018: Revista Española de Salud Pública
https://www.readbyqxmd.com/read/29764879/quest-for-certainty-regarding-early-discharge-in-paediatric-low-risk-febrile-neutropenia-a-multicentre-qualitative-focus-group-discussion-study-involving-patients-parents-and-healthcare-professionals-in-the-uk
#19
Jessica E Morgan, Bob Phillips, Lesley A Stewart, Karl Atkin
OBJECTIVES: A systematic review of paediatric low-risk febrile neutropenia found that outpatient care is safe, with low rates of treatment failure. However, this review, and a subsequent meta-ethnography, suggested that early discharge of these patients may not be acceptable to key stakeholders. This study aimed to explore experiences and perceptions of patients, parents and healthcare professionals involved in paediatric febrile neutropenia care in the UK. SETTING: Three different centres within the UK, purposively selected from a national survey on the basis of differences in their service structure and febrile neutropenia management...
May 14, 2018: BMJ Open
https://www.readbyqxmd.com/read/29764174/healthy-end-of-life-project-help-a-progress-report-on-implementing-community-guidance-on-public-health-palliative-care-initiatives-in-australia
#20
Andrea Grindrod, Bruce Rumbold
BACKGROUND: Contemporary end of life care policies propose increasing community capacity by developing sustainable skills, policies, structures, and resources to support members of a community in caring for each other at the end of life. Public health approaches to palliative care provide strategies to bring this about. Practical implementation can however be ineffective, principally due to failures to grasp the systemic nature of public health interventions, or to ensure that programs are managed and owned by community members, not the professionals who may have introduced them...
April 2018: Annals of Palliative Medicine
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