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https://www.readbyqxmd.com/read/27905076/improvement-of-time-in-therapeutic-range-with-warfarin-by-pharmaceutical-intervention
#1
Alvaro Víquez-Jaikel, Victoria Hall-Ramírez, Allan Ramos-Esquivel
Background Anticoagulation therapy with warfarin is highly effective for prevention and treatment of thromboembolic disorders. Nevertheless, its management is challenging especially in developing countries, where the medical access is difficult and patient education is poor. Objective To determine the effect of pharmaceutical intervention (PI) on the time in therapeutic range (TTR) of a group of anticoagulated patients from our referral center. Method A group of consecutive outpatients previously treated by usual medical care underwent PI...
November 30, 2016: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/27903252/shifting-tides-in-the-emigration-patterns-of-canadian-physicians-to-the-united-states-a-cross-sectional-secondary-data-analysis
#2
Thomas R Freeman, Stephen Petterson, Sean Finnegan, Andrew Bazemore
BACKGROUND: The relative ease of movement of physicians across the Canada/US border has led to what is sometimes referred to as a 'brain drain' and previous analysis estimated that the equivalent of two graduating classes from Canadian medical schools were leaving to practice in the US each year. Both countries fill gaps in physician supply with international medical graduates (IMGs) so the movement of Canadian trained physicians to the US has international ramifications. Medical school enrolments have been increased on both sides of the border, yet there continues to be concerns about adequacy of physician human resources...
December 1, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27901552/diagnosis-and-management-of-hyperthyroidism-in-pregnancy-a-review
#3
Jennifer Renae King, Ruben Lachica, Richard H Lee, Martin Montoro, Jorge Mestman
Importance: Hyperthyroidism has important implications for pregnancy, affecting both mother and fetus. Appropriate maternal and fetal management iscritical to avoiding adverse pregnancy outcomes and requires a multidisciplinary approach. Objective: To describe maternal diagnosis and management of hyperthyroidism, across all stages of pregnancy. In addition, to review clinical signs of fetal thyroid dysfunction due to maternal Graves disease and discuss management considerations...
November 2016: Obstetrical & Gynecological Survey
https://www.readbyqxmd.com/read/27899496/hormonal-contraception-and-risk-of-thromboembolism-in-women-with-diabetes
#4
Sarah H O'Brien, Terah Koch, Sara K Vesely, Eleanor Bimla Schwarz
OBJECTIVE: To investigate safety of hormonal contraception with regard to thromboembolic events in women with type 1 or 2 diabetes. RESEARCH DESIGN AND METHODS: We used data from 2002-2011 in Clinformatics Data Mart to identify women in the U.S., 14-44 years of age, with an ICD-9-CM code for diabetes and a prescription for a diabetic medication or device. We examined contraceptive claims and compared time to thromboembolism (venous thrombosis, stroke, or myocardial infarction) among women with diabetes dispensed hormonal contraception using a modification of Cox regression to control for age, smoking, obesity, hypertension, hyperlipidemia, diabetic complications, and history of cancer; we excluded data for 3 months after women gave birth...
November 29, 2016: Diabetes Care
https://www.readbyqxmd.com/read/27895901/prevention-of-hospital-acquired-pneumonia-in-non-ventilated-adult-patients-a-narrative-review
#5
REVIEW
Leonor Pássaro, Stephan Harbarth, Caroline Landelle
BACKGROUND: Pneumonia is one of the leading hospital-acquired infections worldwide and has an important impact. Although preventive measures for ventilator-associated pneumonia (VAP) are well known, less is known about appropriate measures for prevention of hospital-acquired pneumonia (HAP). AIM: The purpose of this narrative review is to provide an overview of the current standards for preventing HAP in non-ventilated adult patients. METHODS: A search of the literature up to May 2015 was conducted using Medline for guidelines published by national professional societies or professional medical associations...
2016: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/27893129/us-emergency-department-visits-for-outpatient-adverse-drug-events-2013-2014
#6
Nadine Shehab, Maribeth C Lovegrove, Andrew I Geller, Kathleen O Rose, Nina J Weidle, Daniel S Budnitz
Importance: The Patient Protection and Affordable Care Act of 2010 brought attention to adverse drug events in national patient safety efforts. Updated, detailed, nationally representative data describing adverse drug events can help focus these efforts. Objective: To describe the characteristics of emergency department (ED) visits for adverse drug events in the United States in 2013-2014 and describe changes in ED visits for adverse drug events since 2005-2006...
November 22, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27891735/hyperammonemia-in-ornithine-transcarbamylase-deficient-recipients-following-living-donor-liver-transplantation-from-heterozygous-carrier-donors
#7
Tri Hening Rahayatri, Hajime Uchida, Kengo Sasaki, Takanobu Shigeta, Yoshihiro Hirata, Hiroyuki Kanazawa, Vidyadhar Mali, Akinari Fukuda, Seisuke Sakamoto, Mureo Kasahara
Ornithine transcarbamylase deficiency (OTCD) is a urea cycle disorder of X-linked inheritance, affecting the detoxification of excess nitrogen and leading to hyperammonemia (hyper-NH3 ). Living donor liver transplantation (LDLT) has been applied for the treatment of OTCD. This case series retrospectively reviewed two OTCD patients who experienced hyper-NH3 following LDLT. The first case was a 5-year-old girl who had onset of OTCD at 2 years of age. Ornithine transcarbamylase (OTC) enzyme activity was 62% for the donor and 15% for the recipient...
November 28, 2016: Pediatric Transplantation
https://www.readbyqxmd.com/read/27891372/experience-with-splenic-abscess-from-southern-india
#8
Mallikarjuna Shetty, Swaroopa Deme, Knkj Mohan, Krishna Prasad Adiraju, Nageswar Rao Modugu, Naval Chandra, Amvr Narendra, Sathyanarayana Raju Yadati
INTRODUCTION: Splenic abscess is a rare entity with potentially life threatening complications. Sparse recent published data are available documenting the aetiological profile and management of patients with splenic abscess from India. AIM: To study the clinical profile of splenic abscess. MATERIALS AND METHODS: We retrospectively collected data from case records of admitted patients with splenic abscesses, to Nizam's Institute of Medical Sciences and Hospital which is a multispecialty, tertiary care referral hospital over a period of 15 months (from March 2014 to May 2015) and parameters studied were age, sex, symptoms, signs, risk factors, investigations like Ultrasound, CT scan, blood & microbiological culture, treatment and outcome...
October 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27890051/medication-and-treatment-adherence-following-hospital-discharge
#9
Claudia Greißing, Peter Buchal, Hans-Joachim Kabitz, Marcus Schuchmann, Niko Zantl, Susanne Schiek, Thilo Bertsche
BACKGROUND: Patients' drug regimens often need to be changed when they pass from one care sector to another, but these changes sometimes pose a safety risk. To avoid such risks, a new inter-sector transition concept was developed incorporating discharge medication plans and counseling modules for the patients themselves and the doctors receiving them into their care. METHODS: A prospective interventional trial was carried out in two internal medicine wards of a general hospital...
November 4, 2016: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/27888549/microscope-assisted-hepatic-artery-reconstruction-in-adult-living-donor-liver-transplantation-a-review-of-325-consecutive-cases-in-a-single-center
#10
Chen-Fang Lee, Johnny Chuieng Yi Lu, Ahmed Zidan, Ching-Song Lee, Tsung-Han Wu, Kun-Ming Chan, Wei-Chen Lee
BACKGROUND: Despite the technical and medical improvements in the recent years, hepatic artery thrombosis (HAT) remains a devastating complication after living donor liver transplantation (LDLT). We described our surgical techniques and monitoring protocols for hepatic artery reconstruction. We reported one of the lowest incidence rates of HAT in the literature. METHODS: Between 2008 and 2015, a total of 325 LDLTs performed at our institute were retrospectively analyzed...
November 26, 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/27883306/lessons-from-a-transgender-patient-for-health-care-professionals
#11
Ryan K Sallans
It is not uncommon for transgender patients to avoid sharing information about their identity and medical history with health care professionals, due to past negative experiences within health care settings. Professionals who show sensitivity to the topic and express care about health record documentation can increase a transgender patient's trust. There are many opportunities to increase transgender health literacy, including consultation, conferences, webinars, books, and articles focused on transgender health care...
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27880650/deconstructing-chronic-low-back-pain-in-the-older-adult-step-by-step-evidence-and-expert-based-recommendations-for-evaluation-and-treatment-part-xi-dementia
#12
Rollin Wright, Monica Malec, Joseph W Shega, Eric Rodriguez, Joseph Kulas, Lisa Morrow, Juleen Rodakowski, Todd Semla, Debra K Weiner
: OBJECTIVE : To present the 11th in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of 12 important contributions to pain and disability in older adults with CLBP. This article focuses on dementia. METHODS:  A modified Delphi technique was used to develop an algorithm for an approach to treatment for older adults living with CLBP and dementia...
November 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27876690/-mommy-blogs-and-the-vaccination-exemption-narrative-results-from-a-machine-learning-approach-for-story-aggregation-on-parenting-social-media-sites
#13
Timothy R Tangherlini, Vwani Roychowdhury, Beth Glenn, Catherine M Crespi, Roja Bandari, Akshay Wadia, Misagh Falahi, Ehsan Ebrahimzadeh, Roshan Bastani
BACKGROUND: Social media offer an unprecedented opportunity to explore how people talk about health care at a very large scale. Numerous studies have shown the importance of websites with user forums for people seeking information related to health. Parents turn to some of these sites, colloquially referred to as "mommy blogs," to share concerns about children's health care, including vaccination. Although substantial work has considered the role of social media, particularly Twitter, in discussions of vaccination and other health care-related issues, there has been little work on describing the underlying structure of these discussions and the role of persuasive storytelling, particularly on sites with no limits on post length...
November 22, 2016: JMIR Public Health and Surveillance
https://www.readbyqxmd.com/read/27873571/the-determinants-of-defensive-medicine-practices-in-belgium
#14
Tom Vandersteegen, Wim Marneffe, Irina Cleemput, Dominique Vandijck, Lode Vereeck
In 2010 the Belgian government introduced a low cost administrative procedure for compensating medical injuries to overcome the major shortcomings of the existing tort system. This paper examines, for the first time, to what extent this reform had an impact on physician specialists' defensive practices and what are the relevant determinants affecting physicians' clinical decision making. Based on a survey of 508 physicians, we find evidence of a relatively modest increase in defensive practices among physicians in various specialties...
November 22, 2016: Health Economics, Policy, and Law
https://www.readbyqxmd.com/read/27872173/medical-morbidity-and-mortality-conferences-past-present-and-future
#15
REVIEW
J George
Morbidity and mortality conferences (MMCs) have three potential aims-to improve patient safety by reducing adverse events and preventable deaths, to improve overall quality of care as part of the hospital governance structure and as educational learning events. At present, medical MMCs vary widely in format and attendance from hospital to hospital. The evidence for MMCs actually reducing adverse events and preventing avoidable deaths is disappointing. There is better evidence for their educational role. The majority of medical deaths in hospitals are frail older people with poor life expectancy in whom inadequate care is more likely to be due to errors of omission rather than commission...
November 21, 2016: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/27872118/cost-burden-of-type-2-diabetes-in-germany-results-from-the-population-based-kora-studies
#16
Susanne Ulrich, Rolf Holle, Margarethe Wacker, Renee Stark, Andrea Icks, Barbara Thorand, Annette Peters, Michael Laxy
OBJECTIVE: To examine the impact of type 2 diabetes on direct and indirect costs and to describe the effect of relevant diabetes-related factors, such as type of treatment or glycaemic control on direct costs. DESIGN: Bottom-up excess cost analysis from a societal perspective based on population-based survey data. PARTICIPANTS: 9160 observations from 6803 individuals aged 31-96 years (9.6% with type 2 diabetes) from the population-based KORA (Cooperative Health Research in the Region of Augsburg) studies in Southern Germany...
November 21, 2016: BMJ Open
https://www.readbyqxmd.com/read/27872024/floppy-glans-syndrome-pathogenesis-and-treatment
#17
REVIEW
Michael Bickell, Neil Manimala, Justin Parker, Brian Steixner, Lucas Wiegand, Rafael Carrion
INTRODUCTION: Floppy glans syndrome (FGS) is a potential complication of penile prosthesis placement in patients with erectile dysfunction. FGS affects a very small proportion of these patients, and it can manifest in a ventral, dorsal, or lateral droop of a hypermobile glans, which can cause affected patients to complain of painful, unsatisfying, or otherwise difficult attempts at sexual intercourse. Incorrect cylinder sizing can even result in extreme conditions such as flail penis or S-shaped deformity...
April 2016: Sexual Medicine Reviews
https://www.readbyqxmd.com/read/27870546/integrated-care-organizations-medicare-financing-for-care-at-home
#18
Karen Davis, Amber Willink, Cathy Schoen
OBJECTIVES: As the boomer population ages, there is a growing need for integrated care organizations (ICOs) that can integrate both medical care and long-term services and supports in the home. This paper presents a policy proposal to support the creation of ICOs, redesign care, and provide financing for home- and community-based services (HCBS), with the goal of enhancing financial protection for beneficiaries, coordinating care, and preventing costly hospital and nursing home use. METHODS: This study used the 2012 Medicare Current Beneficiary Survey (MCBS) Cost and Use File, inflated to 2016 figures, to describe the characteristics of Medicare beneficiaries and their healthcare utilization and spending...
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27869758/the-impact-of-rurality-and-disadvantage-on-the-diagnostic-interval-for-breast-cancer-in-a-large-population-based-study-of-3202-women-in-queensland-australia
#19
Philippa H Youl, Joanne F Aitken, Gavin Turrell, Suzanne K Chambers, Jeffrey Dunn, Christopher Pyke, Peter D Baade
Delays in diagnosing breast cancer (BC) can lead to poorer outcomes. We investigated factors related to the diagnostic interval in a population-based cohort of 3202 women diagnosed with BC in Queensland, Australia. Interviews ascertained method of detection and dates of medical/procedural appointments, and clinical information was obtained from medical records. Time intervals were calculated from self-recognition of symptoms (symptom-detected) or mammogram (screen-detected) to diagnosis (diagnostic interval (DI))...
November 19, 2016: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/27869630/a-prospective-evaluation-of-opioid-utilization-after-upper-extremity-surgical-procedures-identifying-consumption-patterns-and-determining-prescribing-guidelines
#20
REVIEW
Nayoung Kim, Jonas L Matzon, Jack Abboudi, Christopher Jones, William Kirkpatrick, Charles F Leinberry, Frederic E Liss, Kevin F Lutsky, Mark L Wang, Mitchell Maltenfort, Asif M Ilyas
BACKGROUND: Although adequate management of postoperative pain with oral analgesics is an important aspect of surgical procedures, inadvertent overprescribing can lead to excess availability of opioids in the community for potential diversion. The purpose of our study was to prospectively evaluate opioid consumption following outpatient upper-extremity surgical procedures to determine opioid utilization patterns and to develop prescribing guidelines. METHODS: All patients undergoing outpatient upper-extremity surgical procedures over a consecutive 6-month period had the following prospective data collected: patient demographic characteristics, surgical details, anesthesia type, and opioid prescription and consumption patterns...
October 19, 2016: Journal of Bone and Joint Surgery. American Volume
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