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https://www.readbyqxmd.com/read/29241809/chemotherapy-use-end-of-life-care-and-costs-of-care-among-patients-diagnosed-with-stage-iv-pancreatic-cancer
#1
Yuhua Bao, Renee C Maciejewski, Melissa M Garrido, Manish A Shah, Paul K Maciejewski, Holly G Prigerson
CONTEXT: For patients with metastatic cancer and limited life-expectancy, potential benefits of chemotherapy must be balanced against harms to quality-of-life near death and increased out-of-pocket costs of care. OBJECTIVES: To evaluate the association between chemotherapy use by patients with Stage IV pancreatic cancer and health care use and Medicare and out-of-pocket costs in the last 30 days of life. METHODS: We conducted a retrospective, cohort study of 3,825 patients 66 years or older when diagnosed with Stage IV pancreatic cancer in 2006-2011, using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data...
December 11, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29237710/short-term-outcomes-and-factors-associated-with-adverse-events-among-adults-discharged-from-the-emergency-department-after-treatment-for-acute-heart-failure
#2
Dana R Sax, Dustin G Mark, Renee Y Hsia, Thida C Tan, Grace H Tabada, Alan S Go
BACKGROUND: Although 80% of patients with heart failure seen in the emergency department (ED) are admitted, less is known about short-term outcomes and demand for services among discharged patients. METHODS AND RESULTS: We examined adult members of a large integrated delivery system who visited an ED for acute heart failure and were discharged from January 1, 2013, through September 30, 2014. The primary outcome was a composite of repeat ED visit, hospital admission, or death within 7 days of discharge...
December 2017: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29224990/the-shift-to-same-day-outpatient-joint-arthroplasty-a-systematic-review
#3
REVIEW
Jeffrey D Hoffmann, Nicholas A Kusnezov, John C Dunn, Nicholas J Zarkadis, Gens P Goodman, Richard A Berger
BACKGROUND: Hip and knee arthroplasties length of stay continues to shorten after advances in perioperative and intraoperative management, as well as financial incentives. Some authors have demonstrated good results with outpatient arthroplasty, but safety and general feasibility of such procedures remain unclear. Our hypothesis is that outpatient arthroplasty would demonstrate higher readmission and complication rates than inpatient arthroplasty. METHODS: We performed a systematic review of all publications on outpatient arthroplasty between January 1, 2000 and June 1, 2016...
November 22, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29220082/benefits-of-multimodal-enhanced-recovery-pathway-in-patients-undergoing-kidney-transplantation
#4
Kevin A Espino, J Reinier F Narvaez, Michael C Ott, Liise K Kayler
BACKGROUND: Use of Enhanced recovery after surgery (ERAS) pathways to accelerate functional recovery and reduce length of stay (LOS) has rarely been investigated in kidney transplantation (KTX). MATERIALS AND METHODS: Consecutive adult isolated KTXs between 7/2015-7/2016 (ERAS, n=139) were compared with a historical cohort between 1/2014-7/2015 (HISTORIC, n=95). RESULTS: ERAS recipients were significantly more likely to receive kidneys that were non-local (56...
December 8, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/29202599/bereaved-parents-health-status-during-the-first-6-months-after-their-child-s-death
#5
Nancy Dias, Debra Brandon, Joan E Haase, Paula Tanabe
PURPOSE: To examine bereaved parents' physical, mental, and social health during the first 6 months after their child's (<12 years) death from a life-threatening illness. BACKGROUND AND SIGNIFICANCE: Bereaved parents have higher mortality and morbidity rates when compared to nonbereaved parents. Acute illnesses, hospitalizations, and medication changes are highest in the first 6 months. An understanding of bereaved parents' health risk indicators can help inform development of health promotion and disease prevention measures...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29175877/the-feasibility-of-an-interactive-voice-response-system-ivrs-for-monitoring-patient-safety-after-discharge-from-the-ed
#6
Lisa A Calder, A Adam Cwinn, Mathieu Gatien, Andrew Gee, Natasha Larocque, Samantha Calder-Sprackman, Ria De Gorter, Jennifer Zlepnig, Ian G Stiell, Alan J Forster
BACKGROUND: Return ED visits are frequent and may be due to adverse events: adverse outcomes related to healthcare received. An interactive voice response system (IVRS) is a technology that translates human telephone input into digital data. Use of IVRS has been explored in many healthcare settings but to a limited extent in the ED. We determined the feasibility of using an IVRS to assess for adverse events after ED discharge. METHODS: This before and after study assessed detection of adverse events among consecutive high-acuity patients discharged from a tertiary care ED pre-IVRS and post-IVRS over two 2-week periods...
November 24, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29159148/endovascular-treatment-of-symptomatic-vasospasm-after-aneurysmal-subarachnoid-hemorrhage-a-three-year-experience
#7
Eun-Sung Park, Dae-Won Kim, Sung-Don Kang
Objective: The cause of severe clinical vasospasm after aneurysmal subarachnoid hemorrhage remains unknown, despite extensive research over the past 30 years. However, the intra-arterial administration of vasodilating agents and balloon angioplasty have been successfully used in severe refractory cerebral vasospasm. Materials and Methods: We retrospectively analyzed the data of 233 patients admitted to our institute with aneurysmal subarachnoid hemorrhage (SAH) over the past 3 years...
September 2017: Journal of Cerebrovascular and Endovascular Neurosurgery
https://www.readbyqxmd.com/read/29153752/hospice-care-for-patients-with-dementia-in-the-united-states-a-longitudinal-cohort-study
#8
Aline De Vleminck, R Sean Morrison, Diane E Meier, Melissa D Aldridge
BACKGROUND: Patients with dementia form an increasing proportion of those entering hospice care. Little is known about the types of hospices serving patients with dementia and the patterns of hospice use, including timing of hospice disenrollment between patients with and without dementia. OBJECTIVES: To characterize the hospices that serve patients with dementia, to compare patterns of hospice disenrollment for patients with dementia and without dementia, and to evaluate patient-level and hospice-level characteristics associated with hospice disenrollment...
November 16, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29136314/syncope-prognosis-based-on-emergency-department-diagnosis-a-prospective-cohort-study
#9
Cristian Toarta, Muhammad Mukarram, Kirtana Arcot, Soo-Min Kim, Sarah Gaudet, Marco L A Sivilotti, Brian H Rowe, Venkatesh Thiruganasambandamoorthy
OBJECTIVE: Relatively little is known about outcomes after disposition among syncope patients assigned various diagnostic categories during emergency department (ED) evaluation. We sought to measure the outcomes among these groups within 30 days of the initial ED visit. METHODS: We prospectively enrolled adult syncope patients at six EDs and excluded patients with pre-syncope, persistent mental status changes, intoxication, seizure, and major trauma. Patient characteristics, ED management, diagnostic impression (presumed vasovagal, orthostatic, cardiac, or other/unknown) at the end of the ED visit and physicians' confidence in assigning the etiology were collected...
November 14, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29127240/the-association-of-severe-hypoglycemia-with-incident-cardiovascular-events-and-mortality-in-adults-with-type-2-diabetes
#10
Alexandra K Lee, Bethany Warren, Clare J Lee, John W McEvoy, Kunihiro Matsushita, Elbert S Huang, A Richey Sharrett, Josef Coresh, Elizabeth Selvin
OBJECTIVE: There is suggestive evidence linking hypoglycemia with cardiovascular disease, but few data have been collected in a community-based setting. Information is lacking on individual cardiovascular outcomes and cause-specific mortality. RESEARCH DESIGN AND METHODS: We conducted a prospective cohort analysis of 1,209 participants with diagnosed diabetes from the Atherosclerosis Risk in Communities (ARIC) Study (analytic baseline, 1996-1998). Severe hypoglycemic episodes were identified using first position ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls through 2013...
November 10, 2017: Diabetes Care
https://www.readbyqxmd.com/read/29120839/mental-health-follow-up-after-deliberate-self-harm-and-risk-for-repeat-self-harm-and-death
#11
Jon Hunter, Robert Maunder, Paul Kurdyak, Andrew S Wilton, Andrea Gruneir, Simone Vigod
Morbidity and mortality after deliberate self-harm (DSH) are high, so mental health care shortly after DSH is recommended. Using population-level health data we determined the association between a mental health visit and risk for repeat DSH with or without intensive care unit (ICU) admission or all-cause death. Over two years, 23,140 individuals had emergency department treatment for DSH. Within 30 days, 10.7% had a family physician mental health visit, 17.1% visited a psychiatrist, 3.6% visited both and 68...
September 13, 2017: Psychiatry Research
https://www.readbyqxmd.com/read/29110718/cardiac-patients-perceptions-of-neighboring-patients-risk-influence-on-psychological-stress-in-the-ed-and-subsequent-posttraumatic-stress
#12
Beatrice Konrad, David Hiti, Bernard P Chang, Jessica Retuerto, Jacob Julian, Donald Edmondson
BACKGROUND: As many as 12% of acute coronary syndrome (ACS) patients screen positive for post-traumatic stress disorder (PTSD) symptoms due to their cardiac event, and emergency department (ED) factors such as overcrowding have been associated with risk for PTSD. We tested the association of patients' perceptions of their proximity to a critically ill patient during ED evaluation for ACS with development of posttraumatic stress symptoms (PSS) in the month after hospital discharge. METHODS: Participants were enrolled in the REactions to Acute Care and Hospitalization (REACH) study during evaluation for ACS in an urban ED...
November 6, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29073949/stable-high-sensitivity-cardiac-troponin%C3%A2-t%C3%A2-levels-and-outcomes-in%C3%A2-patients-with%C3%A2-chest-pain
#13
Andreas Roos, Nadia Bandstein, Magnus Lundbäck, Ola Hammarsten, Rickard Ljung, Martin J Holzmann
BACKGROUND: There is a paucity of data on the association between high-sensitivity cardiac troponin (hs-cTn) levels and outcomes in patients with chest pain but no myocardial infarction (MI), or any other condition that may lead to acutely elevated troponin levels. OBJECTIVES: The authors hypothesized that any detectable high-sensitivity cardiac troponin T (hs-cTnT) level is associated with adverse outcomes. METHODS: All patients (N = 22,589) >25 years of age with chest pain and hs-cTnT analyzed concurrently in the emergency department of Karolinska University Hospital, Stockholm, Sweden from 2011 to 2014 were eligible for inclusion...
October 31, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29059689/in-state-and-interstate-associations-between-gun-shows-and-firearm-deaths-and-injuries-a-quasi-experimental-study
#14
Ellicott C Matthay, Jessica Galin, Kara E Rudolph, Kriszta Farkas, Garen J Wintemute, Jennifer Ahern
Background: Gun shows are an important source of firearms, but no adequately powered studies have examined whether they are associated with increases in firearm injuries. Objective: To determine whether gun shows are associated with short-term increases in local firearm injuries and whether this association differs by the state in which the gun show is held. Design: Quasi-experimental. Setting: California. Participants: Persons in California within driving distance of gun shows...
October 24, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29042362/comparative-safety-of-direct-oral-anticoagulants-and-warfarin-in-venous-thromboembolism-multicentre-population-based-observational-study
#15
MULTICENTER STUDY
Min Jun, Lisa M Lix, Madeleine Durand, Matt Dahl, J Michael Paterson, Colin R Dormuth, Pierre Ernst, Shenzhen Yao, Christel Renoux, Hala Tamim, Cynthia Wu, Salaheddin M Mahmud, Brenda R Hemmelgarn
Objective To determine the safety of direct oral anticoagulant (DOAC) use compared with warfarin use for the treatment of venous thromboembolism.Design Retrospective matched cohort study conducted between 1 January 2009 and 31 March 2016.Setting Community based, using healthcare data from six jurisdictions in Canada and the United States.Participants 59 525 adults (12 489 DOAC users; 47 036 warfarin users) with a new diagnosis of venous thromboembolism and a prescription for a DOAC or warfarin within 30 days of diagnosis...
October 17, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/29026893/descending-necrotizing-mediastinitis-after-a-trigger-point-injection
#16
Jae Young Choe, Jong Kun Kim, Dong Eun Lee, Kang Suk Seo, Jung Bae Park, Mi Jin Lee, Hyun Wook Ryoo, Jae Yun Ahn, Sungbae Moon
Descending necrotizing mediastinitis (DNM) is a rare form of mediastinal infection. Most cases are associated with esophageal rupture. DNM after a trigger point injection in the upper trapezius has not been described previously. We present a case of DNM after a trigger point injection in the upper trapezius. A 70-year-old man visited the emergency department with chest discomfort and fever after a trigger point injection in the left upper trapezius. Chest computed tomography showed evidence of DNM, and antibiotic therapy was immediately administered intravenously...
September 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29023163/asthma-exacerbations-and-socio-economic-status-in-french-adults-with-persistent-asthma-a-prospective-cohort-study
#17
Katia Mazalovic, Flore Jacoud, Alexandra L Dima, Eric Van Ganse, Maeva Nolin, Didier C, Claire Zaba, The Astro-Lab Group
INTRODUCTION: Adults disadvantaged by poor socio-economic status (SES) are more severely affected by asthma compared to those with better SES. We aimed to determine whether the frequency of asthma exacerbations (AEx), as well as aspects related to AEx management, differed based on SES in patients treated with daily treatments. METHODS: This study, part of the prospective observational cohort ASTRO-LAB, included French adult patients with persistent asthma. Patients were considered as low SES if they benefited from publicly funded special health insurance and/or were perceived as low SES by their general practitioner...
October 12, 2017: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/29022427/confirming-the-timing-of-phase-based-costing-in-oncology-studies-a-case-example-in-advanced-melanoma
#18
Michael Atkins, Anna D Coutinho, Sasikiran Nunna, Komal Gupte-Singh, Michael Eaddy
AIMS: The utilization of healthcare services and costs among patients with cancer is often estimated by the phase of care: initial, interim, or terminal. Although their durations are often set arbitrarily, we sought to establish data-driven phases of care using joinpoint regression in an advanced melanoma population as a case example. METHODS: A retrospective claims database study was conducted to assess the costs of advanced melanoma from distant metastasis diagnosis to death during January 2010-September 2014...
October 30, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28988740/health-care-usage-and-suicide-risk-screening-within-1%C3%A2-year-of-suicide-death
#19
Amy R Stuck, Michael P Wilson, Christen E Chalmers, Jonathan Lucas, Andrew Sarkin, Kyle Choi, Kimberly Center
BACKGROUND: Research indicates patients often seek medical care within 1 year of suicide. Health care encounters are a crucial opportunity for health professionals to identify patients at highest risk and provide preventative services. OBJECTIVE: Study aims were to determine the characteristics of persons seeking health care within 12 months of suicide death and evaluate suicide risk screening (SRS) frequency in the emergency department (ED) vs. clinic settings...
October 5, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28985364/concomitant-pulmonologist-and-primary-care-for-chronic-obstructive-pulmonary-disease-a-population-study
#20
Andrea S Gershon, Erin M Macdonald, Jin Luo, Peter C Austin, Samir Gupta, Khalil Sivjee, Ross Upshur, Shawn D Aaron
Background: Pulmonologists provide quality care, however, their number is not adequate to take care of all the chronic obstructive pulmonary disease (COPD) needs of the population and their services come with a cost. Their optimal role should be defined, ideally based on evidence, to ensure that their abilities are applied most efficiently where needed. Objective: To determine if concomitant pulmonologist and primary care physician care after COPD hospital or emergency department discharge was associated with better health outcomes than primary care services alone...
November 16, 2017: Family Practice
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