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https://www.readbyqxmd.com/read/29149124/how-do-you-adapt-your-plans-for-a-nursing-career-when-the-unexpected-occurs
#1
Nadia Spawn
I graduated nursing school seven months pregnant in November 2015. My plans were to take the NCLEX immediately, give birth, take three months to adjust, and begin my nursing career in a glamorous emergency department position by the spring.
 Fast forward to January 2016. My family lost three members in a car accident and my daughter was born high-needs, requiring multiple hospitalizations. Although she and my family needed me, I was anxious about taking too much time off after nursing school, which could delay my career advancement...
December 1, 2017: Clinical Journal of Oncology Nursing
https://www.readbyqxmd.com/read/29148334/evidence-of-pent-up-demand-for-care-after-medicaid-expansion
#2
Angela R Fertig, Caroline S Carlin, Scott Ode, Sharon K Long
We compared new Medicaid enrollees with similar ongoing enrollees for evidence of pent-up demand using claims data following Minnesota's 2014 Medicaid expansion. We hypothesized that if new enrollees had pent-up demand, utilization would decline over time as testing and disease management plans are put in place. Consistent with pent-up demand among new enrollees, the probability of an office visit, a new patient office visit, and an emergency department visit declines over time for new enrollees relative to ongoing Medicaid enrollees...
March 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29147816/development-of-pseudoaneurysm-in-cesarean-section-scar-pregnancy-a-case-report-and-literature-review
#3
Shunki Kiyokawa, Tatsuyuki Chiyoda, Kazunori Ueno, Keiko Saotome, Seon-Hye Kim, Sakura Nakada
Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. It is becoming more common, but it can lead to uterine rupture and severe hemorrhage. Here, we report a case of a 37-year-old woman with CSP complicated with pseudoaneurysm. The pseudoaneurysm emerged following focal injection of methotrexate (MTX) and potassium chloride with systemic MTX treatment. Due to a risk of sudden bleeding, uterine artery embolization (UAE) was recommended, but the patient hoped to avoid this if possible. Because the serum human chorionic gonadotropin level and the gestational sac were still persistent, dilation and curettage were performed with interventional radiologists on standby...
November 16, 2017: Journal of Medical Ultrasonics
https://www.readbyqxmd.com/read/29146401/neratinib-after-trastuzumab-based-adjuvant-therapy-in-her2-positive-breast-cancer-extenet-5-year-analysis-of-a-randomised-double-blind-placebo-controlled-phase-3-trial
#4
Miguel Martin, Frankie A Holmes, Bent Ejlertsen, Suzette Delaloge, Beverly Moy, Hiroji Iwata, Gunter von Minckwitz, Stephen K L Chia, Janine Mansi, Carlos H Barrios, Michael Gnant, Zorica Tomašević, Neelima Denduluri, Robert Šeparović, Erhan Gokmen, Anna Bashford, Manuel Ruiz Borrego, Sung-Bae Kim, Erik Hugger Jakobsen, Audrone Ciceniene, Kenichi Inoue, Friedrich Overkamp, Joan B Heijns, Anne C Armstrong, John S Link, Anil Abraham Joy, Richard Bryce, Alvin Wong, Susan Moran, Bin Yao, Feng Xu, Alan Auerbach, Marc Buyse, Arlene Chan
BACKGROUND: ExteNET showed that 1 year of neratinib, an irreversible pan-HER tyrosine kinase inhibitor, significantly improves 2-year invasive disease-free survival after trastuzumab-based adjuvant therapy in women with HER2-positive breast cancer. We report updated efficacy outcomes from a protocol-defined 5-year follow-up sensitivity analysis and long-term toxicity findings. METHODS: In this ongoing randomised, double-blind, placebo-controlled, phase 3 trial, eligible women aged 18 years or older (≥20 years in Japan) with stage 1-3c (modified to stage 2-3c in February, 2010) operable breast cancer, who had completed neoadjuvant and adjuvant chemotherapy plus trastuzumab with no evidence of disease recurrence or metastatic disease at study entry...
November 13, 2017: Lancet Oncology
https://www.readbyqxmd.com/read/29145966/outcome-evaluation-of-staged-treatment-for-bicondylar-tibial-plateau-fractures
#5
Vincenzo Giordano, Ney Pecegueiro do Amaral, Hilton A Koch, Rodrigo Pires E Albuquerque, Felipe Serrão de Souza, José Félix Dos Santos Neto
BACKGROUND: The universal accepted strategy for treating high-energy tibial plateau fractures remains a topic of ongoing debate. The challenge for the practicing orthopaedic trauma surgeon is to provide anatomical articular fracture reduction, with successfully managing the complex soft-tissue injury that is commonly present at patient admission. The primary aim of the actual study was to evaluate the results of a staged protocol for the treatment of high-energy bicondylar tibial plateau fractures...
October 2017: Injury
https://www.readbyqxmd.com/read/29145878/improving-readiness-for-recruitment-through-simulated-trial-activation-the-adjuvant-steroids-in-adults-with-pandemic-influenza-asap-trial
#6
Wei Shen Lim, Garry Meakin, Clare Brittain, Thomas Bewick, Lelia Duley
BACKGROUND: Research in public health emergencies requires trials to be set up in readiness for activation at short notice and in anticipation of limited timelines for patient recruitment. We conducted a simulated activation of a hibernating pandemic influenza clinical trial in order to test trial processes and to determine the value of such simulation in maintaining trial readiness. METHODS: The simulation involved the Nottingham Clinical Trials Unit, one participating hospital, one manufacturing unit and the Investigational Medicinal Product (IMP) supplier...
November 16, 2017: Trials
https://www.readbyqxmd.com/read/29145804/a-descriptive-study-of-the-health-information-needs-of-kenyan-women-in-the-first-6%C3%A2-weeks-postpartum
#7
Everlyne Rotich, Liz Wolvaardt
BACKGROUND: A large number of maternal and neonatal deaths occur during birth and 48 h after birth. The benefits of postnatal care to the mother and newborn cannot be overemphasized as this is another opportunity where complications that might arise from pregnancy and childbirth can be treated, as well as the time to provide important information on maternal and newborn care after delivery. This study aimed to determine the information needs of mother-baby pairs in the first 6 weeks after birth...
November 16, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29145584/critical-lessons-from-high-value-oncology-practices
#8
Douglas W Blayney, Melora K Simon, Beatrice Podtschaske, Scott Ramsey, Margaret Shyu, Craig Lindquist, Arnold Milstein
Importance: Cancer care is expensive. Cancer care provided by practice organizations varies in total spending incurred by patients and payers during treatment episodes and in quality of care, and this unnecessary variation contributes to the high cost. Objective: To use the variation in total spending and quality of care to assess oncology practice attributes distinguishing "high value" that may be tested and adopted by others to produce similar results. Design, Setting, and Participants: "Positive deviance" was used in this exploratory mixed-methods (quantitative and qualitative) analysis of interview results...
November 16, 2017: JAMA Oncology
https://www.readbyqxmd.com/read/29145409/predictors-of-suicide-ideation-among-older-adults-with-bipolar-disorder
#9
Norm O'Rourke, Marnin J Heisel, Sarah L Canham, Andrew Sixsmith
OBJECTIVES: Bipolar disorder (BD) carries the greatest risk of death by suicide of all psychiatric conditions as 25%-50% of those with BD will make one or more suicide attempt, and about 15% will intentionally end their lives. Among young adults with BD, substance misuse, medication non-adherence, age at onset, and comorbid psychiatric conditions each predict self-harm. It is currently unclear if these same factors or others predict suicide ideation among older adults with BD. METHODS: We recruited a global sample of 220 older adults with BD over 19 days using socio-demographically targeted, social media advertising and online data collection (Mean = 58...
2017: PloS One
https://www.readbyqxmd.com/read/29144977/birthplace-in-australia-processes-and-interactions-during-the-intrapartum-transfer-of-women-from-planned-homebirth-to-hospital
#10
Deborah Fox, Athena Sheehan, Caroline Homer
OBJECTIVE: the aim of the study was to explore the views and experiences of women, midwives and obstetricians on the intrapartum transfer of women from planned homebirth to hospital in Australia. DESIGN: a Constructivist Grounded Theory approach was taken, to conceptualise the social interactions and processes grounded in the data. SETTING: urban and regional areas in four states of south-eastern Australia. PARTICIPANTS: semi-structured qualitative interviews were conducted with 36 women, midwives and obstetricians who had experienced an intrapartum homebirth transfer within three years prior to the interview...
November 2, 2017: Midwifery
https://www.readbyqxmd.com/read/29144719/real-world-health-plan-claims-analysis-of-differences-in-healthcare-utilization-and-total-cost-in-patients-suffering-from-cluster-headaches-and-those-without-headache-related-conditions
#11
Michael Polson, Todd C Lord, Themmi M Evangelatos, Maria Lopes, Briana L Santaniello
BACKGROUND: According to the World Health Organization, headache disorders are underappreciated by many health systems. These disorders have a substantial impact on quality of life, yet the true correlation between headache conditions and increased total healthcare utilization is not well understood. This study further explores the impact of headache conditions on healthcare utilization. OBJECTIVES: To assess differences in healthcare utilization and total cost in patients suffering from cluster headaches (CH) compared with patients without headache-related conditions...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29144718/the-emerging-role-of-gammacore%C3%A2-in-the-management-of-cluster-headache-expert-panel-recommendations
#12
Stephen D Silberstein, Anne H Calhoun, Christina Treppendahl, David W Dodick, Alan M Rapoport, Avinash Mamidi, Peter Vargas, Thomas H Ebert, Stewart J Tepper
A panel of 9 experts, including neurologists, other headache specialists, and medical and pharmacy directors, from 4 health plans (1 integrated delivery network and 3 plans with commercial, Medicare, and Medicaid lines of business), convened to discuss cluster headache (CH). Topics covered included the current treatment landscape, treatment challenges, economic impact of disease, and gaps in care for patients with CH. One major challenge in the management of CH is that it is underrecognized and frequently misdiagnosed, leading to delays in and suboptimal treatment for patients who suffer from this painful and disabling condition...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29143777/margination-of-fluorescent-polylactic-acid-polyaspartamide-based-nanoparticles-in-microcapillaries-in-vitro-the-effect-of-hematocrit-and-pressure
#13
Emanuela Fabiola Craparo, Rosa D'Apolito, Gaetano Giammona, Gennara Cavallaro, Giovanna Tomaiuolo
The last decade has seen the emergence of vascular-targeted drug delivery systems as a promising approach for the treatment of many diseases, such as cardiovascular diseases and cancer. In this field, one of the major challenges is carrier margination propensity (i.e., particle migration from blood flow to vessel walls); indeed, binding of these particles to targeted cells and tissues is only possible if there is direct carrier-wall interaction. Here, a microfluidic system mimicking the hydrodynamic conditions of human microcirculation in vitro is used to investigate the effect of red blood cells (RBCs) on a carrier margination in relation to RBC concentration (hematocrit) and pressure drop...
October 28, 2017: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
https://www.readbyqxmd.com/read/29141718/dengue-fever-surveillance-in-india-using-text-mining-in-public-media
#14
Andrea Villanes, Emily Griffiths, Michael Rappa, Christopher G Healey
Despite the improvement in health conditions across the world, communicable diseases remain among the leading mortality causes in many countries. Combating communicable diseases depends on surveillance, preventive measures, outbreak investigation, and the establishment of control mechanisms. Delays in obtaining country-level data of confirmed communicable disease cases, such as dengue fever, are prompting new efforts for short- to medium-term data. News articles highlight dengue infections, and they can reveal how public health messages, expert findings, and uncertainties are communicated to the public...
October 23, 2017: American Journal of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/29140945/a-retrospective-cohort-study-of-the-incidence-health-care-resource-utilization-and-costs-of-international-classification-of-diseases-clinical-modification-9th-revision-diagnosed-influenza-and-related-complications-in-us-children
#15
Philip O Buck, David M Smith, Rahul Shenolikar, Debra E Irwin
BACKGROUND: There is a paucity of data on the clinical and economic impact of seasonal influenza in children. This study estimated the incidence of diagnosed influenza and related complications and associated health care resource utilization and costs in US children. METHODS: Children ≥6 months and <18 years old diagnosed with influenza using International Classification of Diseases, Clinical Modification, 9th revision codes and enrolled in a health plan during at least one influenza season between 2010 and 2014 were matched to similar patients without diagnosed influenza (GSK study identifier: HO-15-15728)...
December 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/29140829/guiding-regulatory-t-cells-to-the-allograft
#16
Caroline Lamarche, Megan K Levings
PURPOSE OF REVIEW: The application of regulatory T cell (Treg) therapy in organ transplantation is actively being pursued using unmodified, typically polyclonal cells. As the results of these ongoing clinical trials emerge, it is time to plan the next wave of clinical trials of Tregs. Here we will review a key strategy to improve Treg effectiveness and reduce side effects, namely increasing Treg specificity - both in terms of antigen recognition and localization to the allograft. RECENT FINDINGS: Study of chemokine signatures accompanying acute rejection has revealed several chemokines that could be targeted to increase Treg homing...
November 14, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/29140508/interactions-with-the-healthcare-system-influence-advance-care-planning-activities-results-from-a-representative-survey-in-11-developed-countries
#17
Alex Sable-Smith, Kelly R Arnett, Molly A Nowels, Kathryn Colborn, Hillary D Lum, David Nowels
Aim: To identify factors associated with completion of Advance Care Planning (ACP) by patients seen in primary care in developed countries. We hypothesized that the quality of primary care is associated. Method: We analysed respondent reported individual and healthcare utilization factors associated with the completion of ACP activities from the 2014 Commonwealth Fund International Health Policy Survey of Older Adults in 11 Countries. The primary outcome is the combined number of ACP activities completed...
November 13, 2017: Family Practice
https://www.readbyqxmd.com/read/29139096/the-modified-frailty-index-and-30-day-adverse-events-in-oncologic-neurosurgery
#18
Brett E Youngerman, Alfred I Neugut, Jingyan Yang, Dawn L Hershman, Jason D Wright, Jeffrey N Bruce
The modified frailty index (mFI) is emerging as a leading measure for preoperative risk assessment using routinely available medical record data. Our objective was to determine if mFI predicts morbidity and mortality in the diverse national cohort of patients undergoing neurosurgery for intracranial neoplasms. We identified patients in the National Surgical Quality Improvement Program who underwent oncologic neurosurgery procedures between 2008 and 2012. The mFI, ranging from 0 to 1, was calculated as the proportion of 11 possible risk factors present...
November 14, 2017: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/29138016/the-challenges-of-detecting-and-responding-to-a-lassa-fever-outbreak-in-an-ebola-affected-setting
#19
E L Hamblion, P Raftery, A Wendland, E Dweh, G S Williams, R N C George, L Soro, V Katawera, P Clement, A N Gasasira, E Musa, T K Nagbe
OBJECTIVES: Lassa fever(LF), a priority emerging pathogen likely to cause major epidemics, is endemic in much of West Africa and difficult to distinguish from other viral haemorrhagic fevers including Ebola virus disease(EVD). Definitive diagnosis requires laboratory confirmation not widely available in affected settings. We report the public health action to contain a LF outbreak and challenges encountered in an EVD-affected setting. METHODS: In February 2016 a rapid response team was deployed in Liberia in response to a cluster of LF cases...
November 11, 2017: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/29135276/effects-of-the-new-york-state-concussion-management-and-awareness-act-lystedt-law-on-concussion-related-emergency-health-care-utilization-among-adolescents-2005-2015
#20
David R Baker, Erin R Kulick, Amelia K Boehme, James M Noble
BACKGROUND: All states have enacted legislation addressing the management of sports-related concussions (SRCs) in adolescent athletes. The effect of these laws on health care utilization is uncertain. Hypothesis/Purpose: The purpose was to evaluate the effects of New York's 2011 Concussion Management and Awareness Act ("Lystedt Law") on emergency department (ED) concussion health care visits (EDCHVs) and brain imaging utilization. It was hypothesized that New York concussion legislation would have a significant temporal effect on EDCHVs...
November 1, 2017: American Journal of Sports Medicine
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