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https://www.readbyqxmd.com/read/29240850/hospitalist-and-internal-medicine-leaders-perspectives-of-early-discharge-challenges-at-academic-medical-centers
#1
Hemali Patel, Margaret C Fang, Michelle Mourad, Adrienne Green, Robert M Wachter, Ryan D Murphy, James D Harrison
Improving early discharges may improve patient flow and increase hospital capacity. We conducted a national survey of academic medical centers addressing the prevalence, importance, and effectiveness of early-discharge initiatives. We assembled a list of hospitalist and general internal medicine leaders at 115 US-based academic medical centers. We emailed each institutional representative a 30-item online survey regarding early-discharge initiatives. The survey included questions on discharge prioritization, the prevalence and effectiveness of early-discharge initiatives, and barriers to implementation...
December 6, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29239576/living-donor-kidney-transplantation
#2
Ilkka Helanterä, Eero Honkanen, Jutta Huhti, Helena Isoniemi, Hannu Jalanko, Marko Lempinen, Marja Miettinen, Arno Nordin, Risto Tertti, Satu Mäkelä
While the majority of kidney transplantations in Finland have been traditionally performed from deceased donors, the frequency of living donors should be increased. Kidney donation is a safe procedure for a carefully examined donor, and for the recipient living donation enables elective surgery and preemptive transplantation. Potential risks for the donor must be minimized, but according to current recommendations, mild hypertension or obesity are not absolute contraindications for donation. Guidelines for donor selection and examination have been updated to simplify the process for all parties...
2017: Duodecim; Lääketieteellinen Aikakauskirja
https://www.readbyqxmd.com/read/29237252/usefulness-of-valacyclovir-prophylaxis-for-cytomegalovirus-infection-after-anti-thymocyte-globulin-as-rejection-therapy
#3
Eun Jeong Ko, Ji Hyun Yu, Chul Woo Yang, Byung Ha Chung
Background/Aims: Anti-thymocyte globulin (ATG) treatment for acute T-cell mediated rejection (TCMR) can increase the risk of cytomegalovirus (CMV) infection. We aimed to evaluate the effect of valacyclovir prophylaxis against CMV infection after ATG administration as anti-rejection therapy. Methods: We retrospectively analyzed 55 kidney transplant recipients (KTRs) receiving ATG for steroid resistant TCMR. In all KTRs, we used intravenous ganciclovir during ATG injection...
December 15, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29236272/medical-malpractice-and-transoral-robotic-surgery-evaluation-and-some-preemptive-thoughts
#4
Daniel D Lydiatt, Ryan Sewell
Medical malpractice is costly and disruptive, and it is important to prevent. We conducted a study with the objective to look at medical malpractice in robotic surgery overall, to evaluate reasons for litigation, and to comment on possible strategies to avoid litigation with transoral robotic surgery. We used the Westlaw computerized database to identify all state and federal verdict summaries in medical malpractice cases. We found 17 cases alleging malpractice that involved the use of robotic surgery. In all, the plaintiffs in 6 cases (35%) contended that an open rather than a robotic approach should have been used, 5 (29%) alleged negligent credentialing, 4 (24%) alleged training deficiencies, 2 (12%) alleged manufacturing problems, and 1 (6%) charged that robotic surgery should have been performed instead of open surgery (1 case involved two of these allegations)...
December 2017: Ear, Nose, & Throat Journal
https://www.readbyqxmd.com/read/29226172/enteric-microbiome-markers-as-early-predictors-of-clinical-outcome-in-allogeneic-hematopoietic-stem-cell-transplant-results-of-a-prospective-study-in-adult-patients
#5
Nicasio Mancini, Raffaella Greco, Renée Pasciuta, Maria Chiara Barbanti, Giacomo Pini, Olivia Beatrice Morrow, Mara Morelli, Luca Vago, Nicola Clementi, Fabio Giglio, Maria Teresa Lupo Stanghellini, Alessandra Forcina, Laura Infurnari, Sarah Marktel, Andrea Assanelli, Matteo Carrabba, Massimo Bernardi, Consuelo Corti, Roberto Burioni, Jacopo Peccatori, Maria Pia Sormani, Giuseppe Banfi, Fabio Ciceri, Massimo Clementi
Background: Infections and graft-vs-host disease (GvHD) still represent major, not easily predictable complications in allogeneic hematopoietic stem cell transplant (allo-HSCT). Both conditions have been correlated to altered enteric microbiome profiles during the peritransplant period. The main objective of this study was to identify possible early microbiome-based markers useful in pretransplant risk stratification. Methods: Stool samples were collected from 96 consecutive patients at the beginning of the pretransplant conditioning regimen (T0) and at 10 (T1) and 30 (T2) days following transplant...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/29225326/noninvasive-coronary-plaque-imaging
#6
Teruo Noguchi, Kazuhiro Nakao, Yasuhide Asaumi, Yoshiaki Morita, Fumiyuki Otsuka, Yu Kataoka, Hayato Hosoda, Hiroyuki Miura, Tetsuya Fukuda, Satoshi Yasuda
Early identification of high-risk or vulnerable atherosclerotic plaques prone to rupture and performing preemptive therapy prior to catastrophic cardiovascular events are optimal goals of plaque imaging. Despite the advances in imaging modalities to identify vulnerable characteristics, the predictive value of the imaging techniques in the clinical setting is still developing. In this regard, reliable and high-sensitive imaging modalities identifying vulnerable plaque characters that may lead to future cardiovascular events will be useful...
December 9, 2017: Journal of Atherosclerosis and Thrombosis
https://www.readbyqxmd.com/read/29222916/transplanting-hcv-positive-livers-into-hcv-negative-patients-with-preemptive-antiviral-treatment-a-modeling-study
#7
Jagpreet Chhatwal, Sumeyye Samur, Emily D Bethea, Turgay Ayer, Fasiha Kanwal, Chin Hur, Mark S Roberts, Norah Terrault, Raymond T Chung
Under current guidelines hepatitis C virus (HCV)-positive livers are not transplanted into HCV-negative recipients because of adverse post-transplant outcomes associated with allograft HCV infection. However, HCV can now be cured post liver transplant (LT) using direct-acting antivirals (DAAs) with >90% success; therefore, HCV-negative patients on the liver transplant (LT) waiting list may benefit from accepting HCV-positive organs with preemptive treatment. Our objective was to evaluate if and in which HCV-negative patients the potential benefit of accepting an HCV-positive (i...
December 9, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/29215460/comparison-of-preemptive-therapy-and-antiviral-prophylaxis-for-prevention-of-cytomegalovirus-in-seropositive-liver-transplant-recipients
#8
Amy W Liu, Kamonwan Jutivorakool, Cynthia E Fisher, Robert M Rakita, Jorge D Reyes, Renuka B Bhattacharya, Keith R Jerome, Ajit P Limaye
BACKGROUND: Few studies have directly compared preemptive therapy (PET) and antiviral prophylaxis (AP) for prevention of cytomegalovirus disease in CMV seropositive (R+) orthotopic liver transplant (OLT) recipients. METHODS: We prospectively assessed CMV disease and clinical outcomes among 160 consecutive R+ OLT recipients who received PET (weekly plasma CMV PCR for 3 months, oral valganciclovir 900 mg twice daily for CMV viremia >250 IU/mL, until 2 consecutive negative weekly PCR results) and compared them to a historical cohort of 156 R+ recipients who received AP (valganciclovir 900 mg daily for 3 months)...
December 5, 2017: Transplantation
https://www.readbyqxmd.com/read/29211658/letermovir-prophylaxis-for-cytomegalovirus-in-hematopoietic-cell-transplantation
#9
Francisco M Marty, Per Ljungman, Roy F Chemaly, Johan Maertens, Sanjeet S Dadwal, Rafael F Duarte, Shariq Haider, Andrew J Ullmann, Yuta Katayama, Janice Brown, Kathleen M Mullane, Michael Boeckh, Emily A Blumberg, Hermann Einsele, David R Snydman, Yoshinobu Kanda, Mark J DiNubile, Valerie L Teal, Hong Wan, Yoshihiko Murata, Nicholas A Kartsonis, Randi Y Leavitt, Cyrus Badshah
Background Cytomegalovirus (CMV) infection remains a common complication after allogeneic hematopoietic-cell transplantation. Letermovir is an antiviral drug that inhibits the CMV-terminase complex. Methods In this phase 3, double-blind trial, we randomly assigned CMV-seropositive transplant recipients, 18 years of age or older, in a 2:1 ratio to receive letermovir or placebo, administered orally or intravenously, through week 14 after transplantation; randomization was stratified according to trial site and CMV disease risk...
December 6, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29210970/evaluating-the-implementation-of-a-preemptive-multimodal-analgesia-protocol-in-a-plastic-surgery-office
#10
Brandi Tinsbloom, Virginia C Muckler, William T Stoeckel, Robert L Whitehurst, Brett Morgan
Many patients undergoing plastic surgery experience significant pain postoperatively. The use of preemptive, multimodal analgesia techniques to reduce postoperative pain has been widely described in the literature. This quality improvement project evaluated the implementation of a preemptive, multimodal analgesia protocol in an office-based plastic surgery facility to decrease postoperative pain, decrease postoperative opioid consumption, decrease postanesthesia care time, and increase patient satisfaction...
October 2017: Plastic Surgical Nursing
https://www.readbyqxmd.com/read/29210106/preemptive-second-kidney-transplantation-is-associated-with-better-graft-survival-compared-to-non-preemptive-second-transplantation-a-multicenter-french-2000-2014-cohort-study
#11
S Girerd, N Girerd, K Duarte, C Legendre, G Mourad, V Garrigue, E Morelon, F Buron, N Kamar, A Del Bello, M Ladrière, M Kessler, L Frimat
BACKGROUND: The impact of preemptive second kidney transplantation (2KT) on graft and patient survival is poorly established. METHODS: The association between preemptive 2KT (p2KT, N=93) and outcomes was estimated in a multicenter French cohort of 2KT (N=1314) recipients using propensity score methods. RESULTS: During follow-up, there were 274 returns to dialysis and 134 deaths. p2KT was associated with lower death-censored graft loss = 0...
December 5, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/29207952/economic-burden-of-preemptive-treatment-of-cmv-infection-after-allogeneic-stem-cell-transplantation-a-retrospective-study-of-208-consecutive-patients
#12
Christine Robin, François Hémery, Christel Dindorf, Julien Thillard, Ludovic Cabanne, Rabah Redjoul, Florence Beckerich, Christophe Rodriguez, Cécile Pautas, Andrea Toma, Sébastien Maury, Isabelle Durand-Zaleski, Catherine Cordonnier
BACKGROUND: Cytomegalovirus (CMV) infection and disease (CMV episodes) are global concerns after allogeneic hematopoietic stem cell transplantation (HSCT). They affect survival, both by direct and indirect effects. Due to safety issues of current anti-CMV antivirals, long-term CMV prophylaxis is poorly tolerated and the most common strategy to decrease the incidence of CMV disease is preemptive. New, less toxic, molecules are currently being assessed for CMV prophylaxis which should replace or considerably decrease the preemptive approach...
December 5, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/29204441/preemptive-analgesic-and-antioxidative-effect-of-curcumin-for-experimental-migraine
#13
Adriana E Bulboacă, Sorana D Bolboacă, Ioana C Stănescu, Carmen A Sfrângeu, Angelo C Bulboacă
Objective: Our study aimed to investigate the analgesic and antioxidative stress effects of Curcumin (CC) in experimental migraine induced by Nitroglycerin (NTG) on rats, compared with Indomethacin (ID) and Propranolol (PP) treatments. Material and Methods: Five groups of 10 rats treated i.p. were investigated: control group (healthy rats) injected with saline solution (0.9%), NTG-control group injected with NTG (1 mg/100 gbw, bw = body weight), and three groups with pretreatment applied 30 min previous to the formalin test (NTG + CC group: Curcumin (10 mg/100 gbw), NTG + PP group: Propranolol (100 μg/100 gbw), and NTG + ID group: Indomethacin (0...
2017: BioMed Research International
https://www.readbyqxmd.com/read/29194767/evolution-of-lung-and-kidney-allograft-function-in-patients-receiving-kidney-after-lung-transplantation
#14
Nina T Weber, Marco Bonani, Christian Benden, Andreas Schleich, Thomas Fehr, Thomas F Mueller, Macé M Schuurmans
Calcineurin inhibitor (CNI) toxicity leads to ESRD in almost half of long-term survivors after lung transplantation, some of them receiving kidney transplants. Little is known about the outcomes of kidney and lung allograft function following kidney after lung transplantation (KALTPL) in the modern era. We retrospectively analyzed a group of 13 consecutive patients who received a KALTPL with respect to their renal and pulmonary function and immunological evolution over 2 years. We documented a stable evolution of forced expiratory volume in one second (FEV1) after KALTPL in most patients as well as an excellent kidney graft during the 2-year follow-up period...
December 1, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/29193749/clinical-implementation-of-pharmacogenetic-testing-in-a-hospital-of-the-spanish-national-health-system-strategy-and-experience-over-3-years
#15
Alberto M Borobia, Irene Dapia, Hoi Y Tong, Pedro Arias, Mario Muñoz, Jair Tenorio, Rafael Hernández, Irene García García, Gema Gordo, Elena Ramírez, Jesús Frías, Pablo Lapunzina, Antonio J Carcas
In 2014, we established a pharmacogenetics unit with the intention of facilitating the integration of pharmacogenetic testing into clinical practice. This unit was centered around two main ideas: i) individualization of clinical recommendations, and ii) preemptive genotyping in risk populations. Our unit is based on the design and validation of a single nucleotide polymorphism (SNP) microarray, which has allowed testing of 180 SNPs associated with drug response (PharmArray), and clinical consultation regarding the results...
November 28, 2017: Clinical and Translational Science
https://www.readbyqxmd.com/read/29192626/neutrophil-lymphocyte-ratio-predicts-postoperative-pain-after-orthognathic-surgery
#16
H C Turgut, M Alkan, M S Ataç, S K Altundağ, S Bozkaya, B Şimşek, B Işik, M Arslan
BACKGROUND AND AIM: Postoperative pain is well known and usually disturbing complication of surgery. Inflammation plays an important role in the development and progression of postoperative pain. We aimed to investigate possible relationship between preoperatively measured neutrophil-lymphocyte ratio (NLR) - as an inflammation marker - and postoperative analgesic demand in patients underwent orthognathic surgery. MATERIALS AND METHODS: We retrospectively investigated medical and anesthesia records of 177 patients underwent orthognathic surgery...
October 2017: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/29189311/role-of-preemptive-gabapentin-on-postoperative-analgesia-after-infraumbilical-surgeries-under-subarachnoid-block-a-randomized-placebo-controlled-double-blind-study
#17
Gaurav S Tomar, Farhat Singh, Grace Cherian
BACKGROUND: Preemptive use of gabapentin might accelerate recovery by reducing acute post-inguinal herniorrhaphy pain and opioid requirement being an analgesic. STUDY QUESTION: Assessing efficacy of three different doses of oral gabapentin premedication for postoperative pain management after inguinal herniorrhaphy under spinal anesthesia. STUDY DESIGN: This prospective, randomized, placebo controlled study was performed on 120 male patients (ASA I/II) undergoing inguinal herniorrhaphy under subarachnoid block...
November 14, 2017: American Journal of Therapeutics
https://www.readbyqxmd.com/read/29187986/spatially-varying-density-dependence-drives-a-shifting-mosaic-of-survival-in-a-recovering-apex-predator-canis-lupus
#18
Shawn T O'Neil, Joseph K Bump, Dean E Beyer
Understanding landscape patterns in mortality risk is crucial for promoting recovery of threatened and endangered species. Humans affect mortality risk in large carnivores such as wolves (Canis lupus), but spatiotemporally varying density dependence can significantly influence the landscape of survival. This potentially occurs when density varies spatially and risk is unevenly distributed. We quantified spatiotemporal sources of variation in survival rates of gray wolves (C. lupus) during a 21-year period of population recovery in the Upper Peninsula of Michigan, USA...
November 2017: Ecology and Evolution
https://www.readbyqxmd.com/read/29181331/effect-of-intravenous-acetaminophen-on-postoperative-pain-in-vitrectomy-a-randomized-double-blind-clinical-trial
#19
Seyed Hossein Sadrolsadat, Fardin Yousefshahi, Abbas Ostadalipour, Fatemeh Zahra Mohammadi, Jalil Makarem
Background: Nowadays, pain, nausea, and vomiting are regarded as important complications of anesthesia and surgery. The current study aimed at assessing the effect of preemptive intravenous acetaminophen on control of pain, nausea, vomiting, shivering, and drowsiness following the general anesthesia for retina and/or vitrectomy surgeries. Methods: In a randomized, double-blind, clinical trial, 83 candidates for retina or vitrectomy eye surgery under general anesthesia were distributed into 3 groups: A) 41 patients in the control group who received 100 mL of normal saline just before the surgery and 100 mL of normal saline 20 minutes before the end of surgery; B) 21 patients in the preemptive group who received acetaminophen 15 mg/kg in 100 mL normal saline just before the surgery and 100 mL normal saline 20 minutes before the end of surgery; C) 21 patients in the preventive group who received 100 mL normal saline just before the surgery and acetaminophen 15 mg/kg in 100 mL normal saline 20 minutes before the end of surgery...
June 2017: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/29179894/-preventative-and-therapeutic-relapse-strategies-after-allogeneic-hematopoietic-stem-cell-transplantation-guidelines-from-the-francophone-society-of-bone-marrow-transplantation-and-cellular-therapy-sfgm-tc
#20
Nabil Yafour, Florence Beckerich, Claude Eric Bulabois, Patrice Chevallier, Étienne Daguindau, Cécile Dumesnil, Thierry Guillaume, Anne Huynh, Stavroula Masouridi Levrat, Anne-Lise Menard, Mauricette Michallet, Cécile Pautas, Xavier Poiré, Aurelie Ravinet, Ibrahim Yakoub-Agha, Ali Bazarbachi
Disease relapse remains the first cause of mortality of hematological malignancies after allogeneic hematopoietic stem cell transplantation (allo-HCT). The risk of recurrence is elevated in patients with high-risk cytogenetic or molecular abnormalities, as well as when allo-HCT is performed in patients with refractory disease or with persistent molecular or radiological (PET-CT scan) residual disease. Within the frame of the 7th annual workshops of the francophone society for bone marrow transplantation and cellular therapy, the working group reviewed the literature in order to elaborate unified guidelines for the prevention and treatment of relapse after allo-HCT...
December 2017: Bulletin du Cancer
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