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cost conscious

Andrea O Rossetti, Kaspar Schindler, Vincent Alvarez, Raoul Sutter, Jan Novy, Mauro Oddo, Loane Warpelin-Decrausaz, Stephan Rüegg
Continuous video-EEG is recommended for patients with altered consciousness; as compared to routine EEG (lasting <30 minutes), it improves seizure detection, but is time- and resource-consuming. Although North American centers increasingly implement continuous video-EEG, most other (including European) hospitals have insufficient resources. Only one study suggested that continuous video-EEG could improve outcome in adults, and a recent assessments challenge this view. This article reviews current evidence on the added value for continuous video-EEG in clinical terms and describes a design for a prospective study...
March 8, 2018: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Leena Paakkari, Shanti George
BACKGROUND: Schools are seen as crucial environments to influence and develop the health literacy of new generations, but without sufficient reflection on the ethical underpinnings of intentions and interventions around health literacy. In contrast, we argue here that ethics are fundamental to all education. The article adopts a 'One world' approach that generalizes broadly across the so-called Global North and Global South. It also generalizes across various age groups among school pupils, advocating age appropriate application of the arguments advanced...
March 6, 2018: BMC Public Health
Jackson G Turbeville, Hossein Alinia, Sara Moradi Tuchayi, Naeim Bahrami, Leah A Cardwell, Olabola Awosika, Irma Richardson, Karen E Huang, Steven R Feldman
The recalcitrance of rosacea to many treatment options may prompt patients to spend exorbitant amounts of money on unsubstantiated treatment regimens in an effort to achieve relief. The authors examine the relationship between disease severity and treatment cost across several demographic and socioeconomic strata. Familiarization of evidence-based clinical recommendations and consensus guidelines may equip physicians to educate patients about the most efficacious and cost-effective treatment options to assist patients in making cost-conscious decisions in the management of their rosacea...
April 2018: Dermatologic Clinics
Brandon James, Andrew D Chang, Ryan A McTaggart, Morgan Hemendinger, Brian Mac Grory, Shawna M Cutting, Tina M Burton, Michael E Reznik, Bradford Thompson, Linda Wendell, Ali Mahta, Matthew Siket, Tracy E Madsen, Kevin N Sheth, Amre Nouh, Karen L Furie, Mahesh V Jayaraman, Pooja Khatri, Shadi Yaghi
OBJECTIVES: Early neurological deterioration prompting urgent brain imaging occurs in nearly 15% of patients with ischaemic stroke receiving intravenous tissue plasminogen activator (tPA). We aim to determine risk factors associated with symptomatic intracranial haemorrhage (sICH) in patients with ischaemic stroke undergoing emergent brain imaging for early neurological deterioration after receiving tPA. METHODS: We abstracted data from our prospective stroke database and included all patients receiving tPA for ischaemic stroke between 1 March 2015 and 1 March 2017...
February 27, 2018: Journal of Neurology, Neurosurgery, and Psychiatry
Adam C Raikes, Sydney Y Schaefer, Breanna E Studenka
OBJECTIVES: Long-term monitoring of concussion recovery requires time- and cost-effective methods. Physiologic complexity may be useful in evaluating visual-motor integration following concussion. The purpose of this study was to quantify the extent to which prior number of concussions influenced visual-motor tracking force complexity. METHODS: Thirty-five individuals with a self-reported concussion history (age: 20.92 ± 1.98) and 15 without (age: 20.92 ± 2...
February 27, 2018: Brain Injury: [BI]
Atsushi Asai, Sakiko Masaki, Taketoshi Okita, Aya Enzo, Yasuhiro Kadooka
BACKGROUND: Destination therapy (DT) is the permanent implantation of a left ventricular assist device (LVAD) in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications...
February 27, 2018: BMC Medical Ethics
Amy L McIntosh, Christy M Christophersen
Motocross is a popular sport in which participants ride a two-wheeled, motorized vehicle on an uneven 2-km track with natural or human-made obstacles. Participants compete at high rates of speed, and children as young as age 4 years compete in age-appropriate groups. Motocross is recognized as a strenuous sport with a high accident rate. Most injuries are musculoskeletal in nature. The most commonly injured areas are the forearm, clavicle, femur, and tibia. Many injuries require surgical treatment. Some patients sustain head trauma with loss of consciousness...
March 1, 2018: Journal of the American Academy of Orthopaedic Surgeons
Iacopo Cappellini, Fabio Picciafuochi, Daniele Ostento, Ginevra Danti, Angelo Raffaele De Gaudio, Chiara Adembri
BACKGROUND: The extensive use of neuromuscular blocking agents (NMBAs) during surgical procedures still leads to potential residual paralyzing effects in the postoperative period. Indeed, neuromuscular monitoring in an intra-operative setting is strongly advocated. Acetylcholinesterase inhibitors can reverse muscle block, but their short half-life may lead to residual curarization in the ward, especially when intermediate or long-acting NMBAs have been administered. Sugammadex is the first selective reversal drug for steroidal NMBAs; it has been shown to give full and rapid recovery of muscle strength, thus minimizing the occurrence of residual curarization...
February 21, 2018: Trials
Rajesh M Shetty, Antonio Bellini, Dhuleep S Wijayatilake, Mark A Hamilton, Rajesh Jain, Sunil Karanth, ArunKumar Namachivayam
BACKGROUND: Patients admitted to intensive care and on mechanical ventilation, are administered sedative and analgesic drugs to improve both their comfort and interaction with the ventilator. Optimizing sedation practice may reduce mortality, improve patient comfort and reduce cost. Current practice is to use scales or scores to assess depth of sedation based on clinical criteria such as consciousness, understanding and response to commands. However these are perceived as subjective assessment tools...
February 21, 2018: Cochrane Database of Systematic Reviews
Camilla S Hanson, Johanna Newsom, Davinder Singh-Grewal, Nicholas Henschke, Margaret Patterson, Allison Tong
BACKGROUND: Congenital lymphoedema is a lifelong condition that has detrimental physical and psychosocial outcomes for young patients and burdensome treatment responsibilities that may hamper patients' motivation for self-management. There is limited research from the perspective of young people with primary lymphoedema. We aimed to describe the experiences and views of children and adolescents with lymphoedema to inform patient-centred practice. METHODS: Twenty patients (aged 8-21 years) with primary lymphoedema were purposively sampled from two paediatric clinics in Sydney, Australia, to participate in a semistructured interview...
February 17, 2018: Archives of Disease in Childhood
Kavelin Rumalla, Vijay Letchuman, Kyle A Smith, Paul M Arnold
BACKGROUND: Hydrocephalus is a life-threatening sequela of traumatic brain injury (TBI) with poorly defined epidemiology in children. Here, we report the national incidence, risk factors, and outcomes associated with post-traumatic hydrocephalus (PTH). METHODS: The Kids Inpatient Database (2003, 2006, 2009, 2012) was queried using the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes to identify all patients (age 0 to 20) with TBI (850...
December 11, 2017: Pediatric Neurology
Vlasta Bari, Marco Ranucci, Beatrice De Maria, Beatrice Cairo, Valeria Pistuddi, Alberto Porta
BACKGROUND: Postoperative atrial fibrillation (AF) might be favored by cardiovascular control impairment. We hypothesize that cardiovascular regulation indexes derived from directional model-based analysis of the spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP) can identify subjects at risk to develop AF after coronary artery bypass graft (CABG) surgery. METHODS: Beat-to-beat HP and SAP series were derived from electrocardiogram (ECG) and invasive arterial pressure recorded for 5 min just before CABG surgery in conscious condition...
February 2, 2018: International Journal of Cardiology
Zuliang Feng, Michael P Feng, David P Feng, Mark J Rice, Carmen C Solórzano
In recent years, the use of robotic-assisted adrenalectomy (RA) has increased; however, many surgeons question its reported higher cost. In this study, we review our experience and strategies to reduce the cost of RA comparing it to Laparoscopic adrenalectomy (LA). Since May of 2010, 122 consecutive patients underwent minimally invasive adrenalectomy (58 RAs and 64 LA) by a high-volume adrenal surgeon at our institution. A cost analysis was performed for RA versus LA. Cost calculations included anesthesia professional fee, procedure time and consumables fees...
January 31, 2018: Journal of Robotic Surgery
Ianthe Boden, Elizabeth H Skinner, Laura Browning, Julie Reeve, Lesley Anderson, Cat Hill, Iain K Robertson, David Story, Linda Denehy
OBJECTIVE: To assess the efficacy of a single preoperative physiotherapy session to reduce postoperative pulmonary complications (PPCs) after upper abdominal surgery. DESIGN: Prospective, pragmatic, multicentre, patient and assessor blinded, parallel group, randomised placebo controlled superiority trial. SETTING: Multidisciplinary preadmission clinics at three tertiary public hospitals in Australia and New Zealand. PARTICIPANTS: 441 adults aged 18 years or older who were within six weeks of elective major open upper abdominal surgery were randomly assigned through concealed allocation to receive either an information booklet (n=219; control) or preoperative physiotherapy (n=222; intervention) and followed for 12 months...
January 24, 2018: BMJ: British Medical Journal
Purujit J Thacker, Mansha Sethi, Jonathan Sternlieb, Doron Schneider, Mary Naglak, Rajeshkumar R Patel
OBJECTIVES: The aims of the study were the following: (1) to determine how often computed tomography (CT) scans of the head are obtained on rapid responses called for altered mental status (AMS), (2) to determine whether CT imaging of the head is required during all rapid responses called for AMS, (3) to determine which patients would benefit from CT scans of the head in this setting, (4) to note whether an adequate neurologic exam was documented, (5) to determine the cost of CT scans that did not change management, and (6) to examine the role of medications leading to AMS...
January 17, 2018: Journal of Patient Safety
Amishi Bajaj, Grant Harmon, John Weaver, Brendan Martin, Michael Mysz, Murat Surucu, John C Roeske, Andre A Konski, William Small, Matthew M Harkenrider
PURPOSE: While some institutions deliver multiple fractions per implant for MRI-based planning, it is common for only one fraction to be delivered per implant with CT-based cervical brachytherapy. The purpose of this study was to compare physician costs, hospital costs, and overall costs for cervical cancer patients treated with either CT-based or MRI-based high-dose-rate (HDR) cervical brachytherapy to determine if MRI-based brachytherapy as described can be financially feasible. METHODS AND MATERIALS: We identified 40 consecutive patients treated with curative intent cervical brachytherapy...
January 10, 2018: Brachytherapy
Doris Lin, Chirayu Shah, Steffanie Campbell, Jeffrey T Bates, Erica Lescinskas
OBJECTIVE: The goal of this study was to improve resident confidence in inpatient care and knowledge in hospital medicine topics with a newly developed rotation and curriculum called the Resident Inpatient Training Experience. METHODS: This study was a prospective observational study completed by postgraduate year-2 (PGY-2) internal medicine residents in two affiliated hospitals. Forty-six PGY-2 residents each rotated on the Resident Inpatient Training Experience service for 1 month and completed a pre- and postrotation confidential online survey...
January 2018: Southern Medical Journal
Massimo Di Maio
In recent years, the oncologic community has been widely debating the high costs of new anti-cancer drugs, that put at risk the sustainability of the health care system. In a study published in BMJ in October 2017, Davis and colleagues analyzed clinical trials conducted with anti-cancer drugs approved by the European Medicines Agency between 2009 and 2013. The authors emphasized that most anti-cancer drugs have been approved without any evidence of an improvement in overall survival and/or in quality of life...
December 2017: Recenti Progressi in Medicina
Androu Abdalmalak, Daniel Milej, Loretta Norton, Derek B Debicki, Teneille Gofton, Mamadou Diop, Adrian M Owen, Keith St Lawrence
There is a growing interest in the possibility of using functional neuroimaging techniques to aid in detecting covert awareness in patients who are thought to be suffering from a disorder of consciousness. Immerging optical techniques such as time-resolved functional near-infrared spectroscopy (TR-fNIRS) are ideal for such applications due to their low-cost, portability, and enhanced sensitivity to brain activity. The aim of this case study was to investigate for the first time the ability of TR-fNIRS to detect command driven motor imagery (MI) activity in a functionally locked-in patient suffering from Guillain-Barré syndrome...
October 2017: Neurophotonics
Kazuhiro Nakamura
Thermoregulatory behavior in homeothermic animals is an instinctive behavior to reduce the cost of their homeothermy, such as warm-seeking behavior to reduce metabolic energy for heat production in cold environments. A recent study identified the central neural pathway that transmits cutaneous thermosensory information on environmental temperature to drive thermoregulatory behavior. This study proposed that the brain mechanism that drives thermoregulatory behavior does not require conscious"feeling"(i.e., perception)of skin temperature mediated by the spinothalamocortical pathway, whereas thermosensory information that ascends through the spinal cord and the lateral parabrachial nucleus of the pons generates thermal comfort and discomfort that drive thermoregulatory behavior...
2018: Clinical Calcium
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