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https://www.readbyqxmd.com/read/28938251/critical-illness-related-corticosteroid-insufficiency-circi-a-narrative-review-from-a-multispecialty-task-force-of-the-society-of-critical-care-medicine-sccm-and-the-european-society-of-intensive-care-medicine-esicm
#1
Djillali Annane, Stephen M Pastores, Wiebke Arlt, Robert A Balk, Albertus Beishuizen, Josef Briegel, Joseph Carcillo, Mirjam Christ-Crain, Mark S Cooper, Paul E Marik, Gianfranco Umberto Meduri, Keith M Olsen, Bram Rochwerg, Sophia C Rodgers, James A Russell, Greet Van den Berghe
OBJECTIVE: To provide a narrative review of the latest concepts and understanding of the pathophysiology of critical illness-related corticosteroid insufficiency (CIRCI). PARTICIPANTS: A multi-specialty task force of international experts in critical care medicine and endocrinology and members of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. DATA SOURCES: Medline, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews...
September 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28937529/effects-of-propofol-on-wound-closure-and-barrier-function-of-cultured-endothelial-cells-an-in-vitro-experimental-study
#2
Karina Zitta, Lars Hummitzsch, Ole Broch, Matthias Gruenewald, Henning Ohnesorge, Kerstin Parczany, Markus Steinfath, Martin Albrecht
BACKGROUND: Propofol is widely used in routine clinical practice for the induction and maintenance of anaesthesia. Although propofol is regarded as a well tolerated anaesthetic, its effect on intact or damaged endothelial cells has not yet been elucidated. OBJECTIVE: The aim of this study was to investigate the effects of different concentrations of propofol on cell damage, metabolic activity, barrier function and wound healing capacity of human endothelial cells...
September 20, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28936695/early-application-of-airway-pressure-release-ventilation-may-reduce-the-duration-of-mechanical-ventilation-in-acute-respiratory-distress-syndrome
#3
Yongfang Zhou, Xiaodong Jin, Yinxia Lv, Peng Wang, Yunqing Yang, Guopeng Liang, Bo Wang, Yan Kang
PURPOSE: Experimental animal models of acute respiratory distress syndrome (ARDS) have shown that the updated airway pressure release ventilation (APRV) methodologies may significantly improve oxygenation, maximize lung recruitment, and attenuate lung injury, without circulatory depression. This led us to hypothesize that early application of APRV in patients with ARDS would allow pulmonary function to recover faster and would reduce the duration of mechanical ventilation as compared with low tidal volume lung protective ventilation (LTV)...
September 22, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28936618/defining-and-measuring-diagnostic-uncertainty-in-medicine-a-systematic-review
#4
Viraj Bhise, Suja S Rajan, Dean F Sittig, Robert O Morgan, Pooja Chaudhary, Hardeep Singh
BACKGROUND: Physicians routinely encounter diagnostic uncertainty in practice. Despite its impact on health care utilization, costs and error, measurement of diagnostic uncertainty is poorly understood. We conducted a systematic review to describe how diagnostic uncertainty is defined and measured in medical practice. METHODS: We searched OVID Medline and PsycINFO databases from inception until May 2017 using a combination of keywords and Medical Subject Headings (MeSH)...
September 21, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28933789/trends-in-utilization-and-costs-of-brca-testing-among-women-aged-18-64-years-in-the-united-states-2003-2014
#5
Zhuo Chen, Katherine Kolor, Scott D Grosse, Juan L Rodriguez, Julie A Lynch, Ridgely Fisk Green, W David Dotson, M Scott Bowen, Muin J Khoury
PurposeWe examined 12-year trends in BRCA testing rates and costs in the context of clinical guidelines, national policies, and other factors.MethodsWe estimated trends in BRCA testing rates and costs from 2003 to 2014 for women aged 18-64 years using private claims data and publicly reported revenues from the primary BRCA testing provider.ResultsThe percentage of women with zero out-of-pocket payments for BRCA testing increased during 2013-2014, after 7 years of general decline, coinciding with a clarification of Affordable Care Act coverage of BRCA genetic testing...
September 21, 2017: Genetics in Medicine: Official Journal of the American College of Medical Genetics
https://www.readbyqxmd.com/read/28933701/a-cross-sectional-descriptive-study-of-medication-use-among-persons-with-a-gastrointestinal-stoma
#6
Bianca Augusta Pereira de Paula, Geisa Cristina da Silva Alves, Álvaro PercÍnio, Mariana Linhares Pereira, Juliano Teixeira Moraes, Cristina Sanches
Research on the use of medications in people with intestinal stomas is lacking, creating gaps in knowledge of pharmacoepidemiology in these patients. A cross-sectional, descriptive study was conducted over a period of 4 months in Divinópolis, Brazil to describe the profile of medication use among people enrolled in the Health Support Service for People with Stoma - Level II (SSPS II) of a municipality in the state of Minas Gerais, Brazil. All patients from SSPS II with a colostomy or ileostomy were invited by phone to participate; those with incomplete registration data and/or who were <18 years old, hospitalized for any reason, or had their stoma reversed were excluded from participation...
September 2017: Ostomy/wound Management
https://www.readbyqxmd.com/read/28932160/family-medicine-practice-in-saudi-arabia-the-current-situation-and-proposed-strategic-directions-plan-2020
#7
Yahia M Al-Khaldi, Essam A Al-Ghamdi, Tariq I Al-Mogbil, Hesham I Al-Khashan
OBJECTIVES: The objectives of this study were to assess the current situation of the teaching and training of undergraduate and postgraduate programs in family medicine in KSA, assess the current practice of family medicine, and draw a roadmap to achieve Saudi vision 2020. MATERIALS AND METHODS: This study was conducted with the support and collaboration of the Primary Health Care Department of the Ministry of Health, Saudi Arabia, and World Health Organization (EMRO) in November 2015...
September 2017: Journal of Family & Community Medicine
https://www.readbyqxmd.com/read/28931438/global-collaborative-healthcare-assessing-the-resource-requirements-at-a-leading-academic-medical-center
#8
REVIEW
Nicole J Rosson, Heitham T Hassoun
INTRODUCTION: Academic Medical Centers ("AMCs") have served as a hub of the United States ("US") health system and represented the state-of-the art in American health care for well over a century. Currently, the global healthcare market is both massive and expanding and is being altered by the unprecedented impact of technological advances and globalization. This provides AMCs a platform to enter into trans-national collaborative partnerships with healthcare organizations around the world, thus providing a means to deliver on its promise globally while also expanding and diversifying its resources...
September 20, 2017: Globalization and Health
https://www.readbyqxmd.com/read/28931399/principles-practices-and-knowledge-of-clinicians-when-assessing-febrile-children-a-qualitative-study-in-kenya
#9
Anneka M Hooft, Kelsey Ripp, Bryson Ndenga, Francis Mutuku, David Vu, Kimberly Baltzell, Linnet N Masese, John Vulule, Dunstan Mukoko, A Desiree LaBeaud
BACKGROUND: Clinicians in low resource settings in malaria endemic regions face many challenges in diagnosing and treating febrile illnesses in children. Given the change in WHO guidelines in 2010 that recommend malaria testing prior to treatment, clinicians are now required to expand the differential when malaria testing is negative. Prior studies have indicated that resource availability, need for additional training in differentiating non-malarial illnesses, and lack of understanding within the community of when to seek care play a role in effective diagnosis and treatment...
September 20, 2017: Malaria Journal
https://www.readbyqxmd.com/read/28930763/a-new-community-health-center-academic-medicine-partnership-for-medicaid-cost-control-powered-by-the-mega-teaching-health-center
#10
Richard E Rieselbach, Ted Epperly, Aaron Friedman, David Keahey, Eleanor McConnell, Karen Nichols, Greg Nycz, Jeanette Roberts, Kenneth Schmader, Peter Shin, Derri Shtasel
Community health centers (CHCs), a principal source of primary care for over 24 million patients, provide high-quality affordable care for medically underserved and lower-income populations in urban and rural communities. The authors propose that CHCs can assume an important role in the quest for health care reform by serving substantially more Medicaid patients. Major expansion of CHCs, powered by mega teaching health centers (THCs) in partnership with regional academic medical centers (AMCs) or teaching hospitals, could increase Medicaid beneficiaries' access to cost-effective care...
September 14, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28928190/interdisciplinary-model-of-care-radicals-for-early-detection-and-management-of-chronic-obstructive-pulmonary-disease-copd-in-australian-primary-care-study-protocol-for-a-cluster-randomised-controlled-trial
#11
Jenifer Liang, Michael J Abramson, Nicholas Zwar, Grant Russell, Anne E Holland, Billie Bonevski, Ajay Mahal, Benjamin van Hecke, Kirsten Phillips, Paula Eustace, Eldho Paul, Kate Petrie, Sally Wilson, Johnson George
INTRODUCTION: Up to half of all smokers develop clinically significant chronic obstructive pulmonary disease (COPD). Gaps exist in the implementation and uptake of evidence-based guidelines for managing COPD in primary care. We describe the methodology of a cluster randomised controlled trial (cRCT) evaluating the efficacy and cost-effectiveness of an interdisciplinary model of care aimed at reducing the burden of smoking and COPD in Australian primary care settings. METHODS AND ANALYSIS: A cRCT is being undertaken to evaluate an interdisciplinary model of care (RADICALS - Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers)...
September 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28924688/the-barrier-to-informed-choice-in-cancer-screening-statistical-illiteracy-in-physicians-and-patients
#12
Odette Wegwarth, Gerd Gigerenzer
An efficient health care requires both informed doctors and patients. Our current healthcare system falls short on both counts. Most doctors and patients do not understand the available medical evidence. To illustrate the extent of the problem in the setting of cancer screening: In a representative sample of some 5000 women in nine European countries, 92% overestimated the reduction of breast cancer mortality by mammography by a factor of 10-200, or did not know. For a similar sample of about 5000 men with respect to PSA screening, this number was 89%...
2018: Recent Results in Cancer Research
https://www.readbyqxmd.com/read/28924527/hepatitis-c-screening-the-downstream-dissemination-of-evolving-guidelines-in-a-resident-continuity-clinic
#13
Kamraan Madhani, Ali Aamar, David Chia
Background In 2012, the Centers for Disease Control and Prevention (CDC) published guidelines supporting one-time screening for hepatitis C (HCV) in all persons born between 1945 and 1965. It is estimated that 75% of adults infected with HCV fall within this cohort. Furthermore, it is projected that this preventative health intervention would lead to the diagnosis of 800,000 unknown cases and the prevention of 120,000 deaths. Objectives The primary objectives are to measure adherence to HCV screening in a continuity practice staffed by internal medicine residents and attending physicians and to measure the effect of educational interventions to enhance HCV screening...
July 7, 2017: Curēus
https://www.readbyqxmd.com/read/28923820/family-medicine-in-ethiopia-lessons-from-a-global-collaboration
#14
Ann Evensen, Dawit Wondimagegn, Daniel Zemenfes Ashebir, Katherine Rouleau, Cynthia Haq, Abbas Ghavam-Rassoul, Praseedha Janakiram, Elizabeth Kvach, Heidi Busse, James Conniff, Brian Cornelson
BACKGROUND: Building the capacity of local health systems to provide high-quality, self-sustaining medical education and health care is the central purpose for many global health partnerships (GHPs). Since 2001, our global partner consortium collaborated to establish Family Medicine in Ethiopia; the first Ethiopian family physicians graduated in February 2016. METHODS: The authors, representing the primary Ethiopian, Canadian, and American partners in the GHP, identified obstacles, accomplishments, opportunities, errors, and observations from the years preceding residency launch and the first 3 years of the residency...
September 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28923812/primary-care-and-public-health-perspectives-on-integration-at-the-local-level-a-multi-state-study
#15
Rebekah Pratt, Beth Gyllstrom, Kim Gearin, David Hahn, Lisa VanRaemdonck, Kevin Peterson, Laura-Mae Baldwin
OBJECTIVE: The Institute of Medicine argues that the integration of primary care (PC) and public health (PH) is of paramount importance. We undertook this qualitative study to better understand how these collaborations function. DATA SOURCES: Investigators from PC and PH practice-based research networks in Colorado, Minnesota, Washington, and Wisconsin identified 40 key informants from the PH and PC fields within their respective states. STUDY DESIGN: The key informants participated in standardized, semistructured interviews...
September 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28923806/improving-the-health-of-patients-and-communities-evolving-practice-based-research-pbr-and-collaborations
#16
Kevin Fiscella
This issue illustrates how research from practice-based research networks has evolved to span a spectrum from improving patient-level care and practice quality to improving health within local and global communities. Articles address patient-level improvements (a biomarker for cardiovascular disease progression, late-onset anorexia nervosa, complementary health approaches used by patients, and patient preferences related to antibiotics for acute respiratory infections); practice-level improvements (selection of types of fecal immunochemical tests, practice facilitation, practice registry implementation, community-based outreach, and bidirectional texting); and community-level improvements (primary care-public health partnership, influenza surveillance, and establishing family medicine training abroad)...
September 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28923026/dementia-and-cognitive-disorder-identified-at-a-forensic-psychiatric-examination-a-study-from-sweden
#17
Anette Ekström, Marianne Kristiansson, Karin Sparring Björkstén
BACKGROUND: Few studies have addressed the relationship between dementia and crime. We conducted a study of persons who got a primary or secondary diagnosis of dementia or cognitive disorder in a forensic psychiatric examination. METHODS: In Sweden, annually about 500 forensic psychiatric examinations are carried out. All cases from 2008 to 2010 with the diagnoses dementia or cognitive disorder were selected from the database of the Swedish National Board of Forensic Medicine...
September 18, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28923007/patients-beliefs-regarding-informed-consent-for-low-risk-pragmatic-trials
#18
Rafael Dal-Ré, Antonio J Carcas, Xavier Carné, David Wendler
BACKGROUND: The requirement to obtain written informed consent may undermine the potential of pragmatic randomized clinical trials (pRCTs) to improve evidence-based care. This requirement could compromise trials statistical power or even force it to close them down prematurely. However, recent data from the U.S. and Spain suggest that a majority of the public endorses written consent for low-risk pRCTs. The present manuscript assesses whether this view is shared by patients. METHODS: This was a cross-sectional, probability-based survey, with a 2 × 2 factorial design, assessing support for written informed consent versus verbal consent or general notification for two low-risk pRCTs in hypertension, one comparing 2 drugs with similar risk/benefit profiles and the other comparing the same drug being taken in the morning or at night...
September 18, 2017: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/28922959/compliance-to-the-primary-health-care-treatment-guidelines-and-the-essential-medicines-list-in-the-management-of-sexually-transmitted-infections-in-correctional-centres-in-south-africa-findings-and-implications
#19
Tammy B Matsitse, Elvera Helberg, Johanna C Meyer, Brian Godman, Amos Massele, Natalie Schellack
BACKGROUND: The emergence of antimicrobial resistance (AMR) is a global concern and a growing health crisis. Additionally, evidence has shown that non-compliance to treatment guidelines, especially in the management of communicable diseases such as sexually transmitted infections (STIs), has the potential of further enhancing AMR rates. Data on the extent of these challenges in Primary Health Care (PHC) facilities in correctional centres in South Africa (SA) is limited. Hence this study was conducted to determine the level of compliance with the 2008 PHC Standard Treatment Guidelines and Essential Medicines List (PHC STGs/EML) in the management of STIs, and to identify potential factors contributing to the compliance and non-compliance to guide future strategies...
September 19, 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28918569/highlights-from-the-ninth-international-symposium-of-thrombosis-and-anticoagulation-ista-ix-october-15-2016-salvador-bahia-brazil
#20
REVIEW
Renato D Lopes, Patricia O Guimarães, Elaine Hylek, Gilson S Feitosa-Filho, Luiz Ritt, Nivaldo Filgueiras, Eduardo Darzé, Mario S Rocha, Luis P Magalhães, Antonio Carlos Sobral Sousa, Luis Claudio Correia, Lucas Hollanda Oliveira, David A Garcia
To discuss and share knowledge about advances in the care of patients with thrombotic disorders, the Ninth International Symposium of Thrombosis and Anticoagulation was held in Salvador, Bahia, Brazil, on October 15, 2016. This scientific program was developed by clinicians for clinicians and was promoted by two major clinical research institutes-the Brazilian Clinical Research Institute and the Duke Clinical Research Institute of the Duke University School of Medicine. Comprising academic presentations and open discussion, the symposium had as its primary goal to educate, motivate, and inspire internists, cardiologists, hematologists, and other physicians by convening national and international visionaries, thought-leaders, and dedicated clinician-scientists...
September 16, 2017: Journal of Thrombosis and Thrombolysis
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