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https://www.readbyqxmd.com/read/28806373/patient-aligned-care-team-engagement-to-connect-veterans-experiencing-homelessness-with-appropriate-health-care
#1
Adi V Gundlapalli, Andrew Redd, Daniel Bolton, Megan E Vanneman, Marjorie E Carter, Erin Johnson, Matthew H Samore, Jamison D Fargo, Thomas P O'Toole
BACKGROUND: Veterans experiencing homelessness frequently use emergency and urgent care (ED). OBJECTIVE: To examine the effect of a Patient-aligned Care Team (PACT) model tailored to the unique needs of Veterans experiencing homelessness (H-PACT) on frequency and type of ED visits in Veterans Health Administration (VHA) medical facilities. RESEARCH DESIGN: During a 12-month period, ED visits for 3981 homeless Veterans enrolled in (1) H-PACT at 20 VHA medical centers (enrolled) were compared with those of (2) 24,363 homeless Veterans not enrolled in H-PACT at the same sites (nonenrolled), and (3) 23,542 homeless Veterans at 12 non-H-PACT sites (usual care) using a difference-in-differences approach...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28804393/ageism-among-physicians-nurses-and-social-workers-findings-from-a-qualitative-study
#2
Aya Ben-Harush, Sharon Shiovitz-Ezra, Israel Doron, Sara Alon, Arthur Leibovitz, Hava Golander, Yafa Haron, Liat Ayalon
This study investigated ageism among healthcare professionals in various therapeutic settings in Israel. Using a qualitative approach, the current study aimed to examine similarities and differences across healthcare disciplines. Three focus groups were conducted with physicians, nurses, and social workers. Data from each focus group were analyzed separately, and then commonalities and differences across the groups were evaluated. Three main themes relating to older adults emerged from the data. The first theme pertains to perceived difficulties that healthcare professionals experience in working with older adults and their family members; the second focuses on invisibility and discriminatory communication patterns; and the third theme relates to provision of inappropriate care to older adults...
March 2017: European Journal of Ageing
https://www.readbyqxmd.com/read/28801267/primum-non-nocere-the-effects-of-sodium-hypochlorite-on-dentin-as-used-in-endodontics
#3
Li-Sha Gu, Xue-Qing Huang, Brandon Griffin, Brian R Bergeron, David H Pashley, Li-Na Niu, Franklin R Tay
The medical literature is replete with the maxim 'primum non nocere', cautioning health care providers to avoid doing any harm to human subjects in their delivery of medical care. Sodium hypochlorite (NaOCl) is a well-established irrigant for root canal treatment because of its antimicrobial and organic tissue remnant dissolution capability. However, little is known about the deleterious effect of this strong oxidizing agent on the integrity of human mineralized dentin. Iatrogenically-induced loss of dentin integrity may precipitate post-treatment root fracture and has potential medico-legal complications...
August 8, 2017: Acta Biomaterialia
https://www.readbyqxmd.com/read/28799509/update-on-pharmacological-treatment-of-progressive-myoclonus-epilepsies
#4
Edoardo Ferlazzo, Dorothee Kasteleijn-Nolst Trenite, Gerrit-Jan de Haan, Felix Felix Nitschke, Saija Ahonen, Sara Gasparini, Berge A Minassian
BACKGROUND: Progressive myoclonus epilepsies (PMEs) are a group of rare inherited diseases featuring a combination of myoclonus, seizures and variable degree of cognitive impairment. Despite extensive investigations, a large number of PMEs remain undiagnosed. In this review, we focus on the current pharmacological approach to PMEs. METHODS: References were mainly identified through PubMed search until February 2017 and backtracking of references in pertinent studies...
August 9, 2017: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/28797879/using-a-non-invasive-secure-skin-closure-following-total-knee-arthroplasty-leads-to-fewer-wound-complications-and-no-patient-home-care-visits-compared-to-surgical-staples
#5
Alberto V Carli, Sara Spiro, Brian T Barlow, Steven B Haas
BACKGROUND: Superficial wound complications occur in up to 10% of total knee arthroplasty (TKA) procedures and have been associated with periprosthetic joint infection. The ideal material for TKA closure should offer: 1) fast intraoperative application, 2) minimal wound complications and 3) removable by patients without assistance. We evaluated a novel, non-invasive, removable skin closure system for TKA to determine its effect on wound complications. METHODS: We prospectively evaluated 221 consecutive TKA patients who received skin closure using a non-invasive zipper-like system ('Zip'; Zip 16 Surgical Skin Closure System; Zipline Medical)...
August 7, 2017: Knee
https://www.readbyqxmd.com/read/28797671/pregnancy-after-bariatric-surgery-the-effect-of-time-to-conception-on-pregnancy-outcomes
#6
Patricia O Yau, Manish Parikh, John K Saunders, Patricia Chui, Tara Zablocki, Akuezunkpa Ude Welcome
BACKGROUND: At our medical center, female patients who have undergone bariatric surgery are advised to defer pregnancy for 2 years after surgery to avoid the following complications and their potential consequences for the fetus: inadequate gestational weight gain, inadequate postsurgical weight loss, hyperemesis gravidarum, nutritional deficiencies, gestational diabetes, and gestational hypertension. OBJECTIVES: To examine the effect of time from surgery to conception on pregnancy course and outcomes in bariatric patients...
July 17, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/28796772/mortality-within-30-days-of-systemic-anticancer-therapy-at-a-tertiary-cancer-centre-assessing-the-safety-and-quality-of-clinical-care
#7
Michelle Wilson, Weng Mak, Melissa Firth, Sanjeev Deva, Michael Findlay
AIMS: Thirty-day mortality has been proposed to be a useful indicator of avoidable harm to patients from systemic anticancer therapies (SACT). As a quality assurance tool, we assessed the 30-day mortality rate at Auckland City Hospital and compared this with international standards. METHODS: Clinical characteristics and treatment details of medical oncology patients who died within 30 days of SACT from October 2014-September 2015 were collected and compared with data from a similar series performed from October 2008-September 2009...
August 11, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28795012/chronic-kidney-disease-and-sports-participation-by-children-and-adolescents
#8
REVIEW
Vimal Master Sankar Raj, Dilip R Patel, Lakshmi Ramachandran
Individuals suffering from chronic kidney disease (CKD) deal with major morbidity and mortality including poor exercise tolerance. A variety of factors including anemia, poor muscle mass, cardiovascular changes and limited physical activity contribute to exercise intolerance. Studies suggest that early initiation of aerobic and resistance training improves the muscle function, ability to tolerate exercise and quality of life in CKD patients. A thorough medical examination and exercise testing are recommended before initiating an exercise regimen in individuals with CKD...
July 2017: Translational pediatrics
https://www.readbyqxmd.com/read/28792509/regional-citrate-anticoagulation-for-continuous-renal-replacement-therapy-in-pediatric-patients-with-liver-failure
#9
Keila Rodriguez, Poyyapakkam R Srivaths, Leyat Tal, Mary N Watson, Alyssa A Riley, Ryan W Himes, Moreshwar S Desai, Michael C Braun, Ayse Akcan Arikan
Pediatric liver failure patients frequently develop multiple organ failure and require continuous renal replacement therapy (CRRT) as part of supportive therapy in the pediatric intensive care unit. While many centers employ no anticoagulation for fear of bleeding complications, balanced coagulation disturbance predisposes these patients to clotting as well as bleeding, making maintenance of longer circuit life to deliver adequate dialysis clearance challenging. Regional citrate anticoagulation (RCA) is an attractive option as it avoids systemic anticoagulation, but since citrate metabolism is impaired in liver failure, concerns about toxicity has limited its use...
2017: PloS One
https://www.readbyqxmd.com/read/28791786/emergency-department-provider-perspectives-on-benzodiazepine-opioid-co-prescribing-a-qualitative-study
#10
Howard S Kim, Danielle M McCarthy, Jason A Hoppe, D Mark Courtney, Bruce L Lambert
OBJECTIVE: Benzodiazepines and opioids are prescribed simultaneously (i.e. "co-prescribed") in many clinical settings, despite guidelines advising against this practice and mounting evidence that concomitant use of both medications increases overdose risk. This study sought to characterize the contexts in which benzodiazepine-opioid co-prescribing occurs and providers' reasons for co-prescribing. METHODS: We conducted focus groups with ED providers (resident and attending physicians, advanced practice providers, and pharmacists) from three hospitals using semi-structured interviews to elicit perspectives on benzodiazepine-opioid co-prescribing...
August 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28790453/perianal-fistulizing-crohn-s-disease-pathogenesis-diagnosis-and-therapy
#11
REVIEW
Julián Panés, Jordi Rimola
Perianal fistulizing Crohn's disease has a major negative effect on patient quality of life and is a predictor of poor long-term outcomes. Factors involved in the pathogenesis of perianal fistulizing Crohn's disease include an increased production of transforming growth factor β, TNF and IL-13 in the inflammatory infiltrate that induce epithelial-to-mesenchymal transition and upregulation of matrix metalloproteinases, leading to tissue remodelling and fistula formation. Care of patients with perianal Crohn's disease requires a multidisciplinary approach...
August 9, 2017: Nature Reviews. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28790039/answering-medical-questions-at-the-point-of-care-a-cross-sectional-study-comparing-rapid-decisions-based-on-pubmed-and-epistemonikos-searches-with-evidence-based-recommendations-developed-with-the-grade-approach
#12
Ariel Izcovich, Juan Martín Criniti, Federico Popoff, Martín Alberto Ragusa, Cristel Gigler, Carlos Gonzalez Malla, Manuela Clavijo, Matias Manzotti, Martín Diaz, Hugo Norberto Catalano, Ignacio Neumann, Gordon Guyatt
INTRODUCTION: Using the best current evidence to inform clinical decisions remains a challenge for clinicians. Given the scarcity of trustworthy clinical practice guidelines providing recommendations to answer clinicians' daily questions, clinical decision support systems (ie, assistance in question identification and answering) emerge as an attractive alternative. The trustworthiness of the recommendations achieved by such systems is unknown. OBJECTIVE: To evaluate the trustworthiness of a question identification and answering system that delivers timely recommendations...
August 7, 2017: BMJ Open
https://www.readbyqxmd.com/read/28789637/perceptions-practices-and-health-seeking-behaviour-constrain-je-aes-interventions-in-high-endemic-district-of-north-india
#13
Sanjay Chaturvedi, Neha Sharma, Manish Kakkar
BACKGROUND: Acute Encephalitis Syndrome (AES) and Japanese Encephalitis (JE) stay as poorly understood phenomena in India. Multiple linkages to determinants such as poverty, socio-economic status, gender, environment, and population distribution, make it a greater developmental issue than just a zoonotic disease. METHODS: A qualitative study was conducted to map knowledge, perceptions and practices of community and health systems level stakeholders. Seventeen interviews with utilizers of AES care, care givers from human and veterinary sectors, Non-governmental Organizations (NGOs), and pig owners and 4 Focused Group Discussions (FGDs) with farmers, community leaders, and students were conducted in an endemic north Indian district-Kushinagar...
August 8, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28782539/leveraging-the-medical-context-to-increase-upper-extremity-reconstruction-among-patients-with-tetraplegia-a-qualitative-analysis
#14
Chelsea A Harris, John-Michael Muller, Melissa J Shauver, Kevin C Chung
OBJECTIVES: (1) To characterize patients' medical experiences from initial injury until they become candidates for Upper Extremity Reconstruction (UER). (2) To identify points in this medical context that may be most amenable to interventions designed to increase UER utilization. DESIGN: A qualitative cross-sectional study using grounded theory methodology and constant comparative analysis of data collected through semi-structured individual interviews. SETTING: Community PARTICIPANTS: A sample of individuals with C4-C8 cervical spinal injuries (N=19) who sustained injuries at least one year prior to interview...
August 3, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28782502/society-for-maternal-fetal-medicine-smfm-consult-series-43-hepatitis-c-in-pregnancy-screening-treatment-and-management
#15
Brenna L Hughes, Charlotte M Page, Jeffrey A Kuller
In the United States, 1-2.5% of pregnant women are infected with hepatitis C virus (HCV), which carries an approximately 5% risk of transmission from mother to infant. HCV can be transmitted to the infant in utero or during the peripartum period, and infection during pregnancy is associated with increased risk of adverse fetal outcomes, including fetal growth restriction and low birth weight. The purpose of this document is to discuss the current evidence regarding HCV in pregnancy and to provide recommendations on screening, treatment, and management of this disease during pregnancy...
August 3, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28780893/abnormal-uterine-bleeding-in-perimenopause
#16
S R Goldstein, M A Lumsden
Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office or primary-care setting. The wider availability of diagnostic tools has allowed prompt diagnosis and treatment of an increasing number of menstrual disorders in an office setting. This White Paper reviews the advantages and disadvantages of transvaginal ultrasound, blind endometrial sampling and diagnostic hysteroscopy. Once a proper diagnosis has been established, appropriate therapy may be embarked upon...
August 7, 2017: Climacteric: the Journal of the International Menopause Society
https://www.readbyqxmd.com/read/28780659/preconception-counseling-for-women-with-cardiac-disease
#17
REVIEW
Mark A Clapp, Sarah N Bernstein
All providers who care for reproductive-aged women with cardiac disease should assess these patients' desires and plans for pregnancy at every encounter. For those considering pregnancy, preconception counseling, often performed by a maternal-fetal medicine specialist, can help patients understand the potential implications of pregnancy on their health and estimate the risks of an adverse cardiac event prior to conceiving. There are cardiac conditions, such as pulmonary hypertension and aortic stenosis, in which pregnancy may be contraindicated given the high morbidity and mortality; there are tools available to help quantify a patient's risk...
September 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28777450/self-management-interventions-including-action-plans-for-exacerbations-versus-usual-care-in-patients-with-chronic-obstructive-pulmonary-disease
#18
REVIEW
Anke Lenferink, Marjolein Brusse-Keizer, Paul Dlpm van der Valk, Peter A Frith, Marlies Zwerink, Evelyn M Monninkhof, Job van der Palen, Tanja W Effing
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self-management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self-management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care...
August 4, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28776873/the-systematic-tool-to-reduce-inappropriate-prescribing-strip-combining-implicit-and-explicit-prescribing-tools-to-improve-appropriate-prescribing
#19
A Clara Drenth-van Maanen, Anne J Leendertse, Paul A F Jansen, Wilma Knol, Carolina J P W Keijsers, Michiel C Meulendijk, Rob J van Marum
Inappropriate prescribing is a major health care issue, especially regarding older patients on polypharmacy. Multiple implicit and explicit prescribing tools have been developed to improve prescribing, but these have hardly ever been used in combination. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) combines implicit prescribing tools with the explicit Screening Tool to Alert physicians to the Right Treatment and Screening Tool of Older People's potentially inappropriate Prescriptions criteria and has shared decision-making with the patient as a critical step...
August 4, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28769592/drug-induced-dyspnea-versus-cystic-fibrosis-exacerbation-a-diagnostic-dilemma
#20
Saqib Walayat, Nooreen Hussain, Jaymon Patel, Faiz Hussain, Preeti Patel, Sonu Dhillon, Bhagat Aulakh, Subramanyam Chittivelu
Cystic fibrosis (CF) is a disease caused by a mutation in the cystic fibrosis transmembrane conductance regulator protein in the epithelial membrane, and affects at least 30,000 people in the USA. There are between 900 and 1000 new cases diagnosed every year. Traditionally, CF has been treated symptomatically with pancreatic enzymes, bronchodilators, hypertonic saline, and pulmozyme. In July 2015, the US Food and Drug Administration approved Orkambi (lumacaftor/ivacaftor), a combination drug that works on reversing the effects of the defective cystic fibrosis transmembrane conductance regulator protein...
2017: International Medical Case Reports Journal
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