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well-being and planning

Dylan Tanzer, Karen Smith, Michael Tanzer
BACKGROUND: The implementation of care pathways in hip arthroplasty programs has been shown to result in a decreased length of stay (LOS), but often multiple elements of a care pathway are implemented at the same time. As a result, it is difficult to understand the impact each of the individual modifications has made to the patient's prepathway care. In particular, it is unknown what the role of patient expectations pertaining to anticipated LOS alone is on the LOS after primary THA. QUESTIONS/PURPOSES: (1) Does changing the patient's expectations regarding his or her anticipated LOS, without intentionally changing the rest of the care pathway, result in a change in the patient's LOS after primary THA? (2) Is the resultant LOS associated with the patient's age, gender, or day of the week the surgery was performed? METHODS: We retrospectively compared the LOS in 100 consecutive patients undergoing THA immediately after the implementation of a 4-day care pathway (4-day Group) with 100 consecutive patients, 3 months later, who were also in the same pathway but were told by their surgeon preoperatively and in the hospital to expect a LOS of 2 days (2-day Group)...
February 2018: Clinical Orthopaedics and related Research
Fern Jaspers-Fayer, Sarah Yao Lin, Laura Belschner, Janet Mah, Elaine Chan, Clare Bleakley, Rhonda Ellwyn, Annie Simpson, Katherine McKenney, S Evelyn Stewart
BACKGROUND: Sleep disturbances, including delayed sleep phase disorder (DSPD) and disorders of sleep initiation and maintenance (DIMS), have repeatedly been identified in adult obsessive-compulsive disorder (OCD). These disturbances have not been well-characterized objectively in pediatric OCD. METHODS: Thirty OCD-affected youth (8-18 yrs, 40% male) and 30 age and gender-matched healthy controls (HCs) completed the Sleep Disturbances Scale for Children (SDSC), and one week of continuous actigraphy with concurrent sleep diary documentation...
February 23, 2018: Journal of Anxiety Disorders
Minke S Nieuwboer, Marieke Perry, Rob van der Sande, Irma T H M Maassen, Marcel G M Olde Rikkert, Marjolein A van der Marck
Background: As the number of patients with complex healthcare needs grows, inter-professional collaboration between primary care professionals must be constantly optimized. General practitioners (GPs) and community nurses (CNs) are key professions in primary care; however, poor GP-CN communication is common, and research into the factors influencing its quality is limited. Objective: To explore patient-related GP-CN communication and facilitating and hindering factors, and to identify strategies to enhance this communication...
February 26, 2018: Family Practice
Paul T Cirino, Yusra Ahmed, Jeremy Miciak, W Pat Taylor, Elyssa H Gerst, Marcia A Barnes
OBJECTIVE: Executive function (EF) is a commonly used but difficult to operationalize construct. In this study, we considered EF and related components as they are commonly presented in the neuropsychological literature, as well as the literatures of developmental, educational, and cognitive psychology. These components have not previously been examined simultaneously, particularly with this level of comprehensiveness, and/or at this age range or with this sample size. We expected that the EF components would be separate but related, and that a bifactor model would best represent the data relative to alternative models...
February 2018: Neuropsychology
Rami A El Shafie, Angela Paul, Denise Bernhardt, Henrik Hauswald, Thomas Welzel, Tanja Sprave, Adriane Hommertgen, Johannes Krisam, Daniela Schmitt, Sebastian Klüter, Kai Schubert, Christina Klose, Meinhard Kieser, Jürgen Debus, Stefan Rieken
BACKGROUND: Neurosurgical resection is recommended for symptomatic brain metastases, in oligometastatic patients or for histology acquisition. Without adjuvant radiotherapy, roughly two-thirds of the patients relapse at the resection site within 24 mo, while the risk of new metastases in the untreated brain is around 50%. Adjuvant whole-brain radiotherapy (WBRT) can reduce the risk of both scenarios of recurrence significantly, although the associated neurocognitive toxicity is substantial, while stereotactic radiotherapy (SRT) improves local control at comparably low toxicity...
March 8, 2018: Neurosurgery
Suzanne Jolley, Elizabeth Kuipers, Catherine Stewart, Sophie Browning, Karen Bracegirdle, Nedah Basit, Kimberley Gin, Colette Hirsch, Richard Corrigall, Partha Banerjea, Grainne Turley, Daniel Stahl, Kristin R Laurens
OBJECTIVES: Health care guidelines recommend psychological interventions for childhood unusual experiences that are associated with distress or adverse functional impact (UEDs), based on adult, rather than child-specific, evidence. We report the first randomized controlled evaluation of the acceptability and potential clinical utility of cognitive behavioural therapy for childhood UEDs (CBT-UED). DESIGN: Pilot randomized controlled trial. METHODS: Participants aged 8-14 years were recruited from referrals to community services for children with emotional/behavioural problems and screened for self-reported UEDs...
March 12, 2018: British Journal of Clinical Psychology
Danielle Alice Banfield, Carly Adamson, Amy Tomsett, James Povey, Tony Fordham, Sarah Kathryn Richards
Background: The surgical post-take ward round is a complex multidisciplinary interaction in which new surgical patients are reviewed and management plans formulated. Its fast-paced nature can lead to poor communication and inaccurate or incomplete documentation with potential detriment to patient safety. Junior team members often do not fully understand the diagnosis and management plan. Aims: The aims of this project were to improve both communication and documentation on the surgical post-take ward round, influencing patient safety...
2018: BMJ open quality
Bronwyn Louise Pearse, Claire M Rickard, Samantha Keogh, Yoke Lin Fung
BACKGROUND: Bleeding management in cardiac surgery is challenging. Many guidelines exist to support bleeding management; however, literature demonstrates wide variation in practice. In 2012, a quality initiative was undertaken at The Prince Charles Hospital, Australia to improve bleeding management for cardiac surgery patients. The implementation of the quality initiative resulted in significant reductions in the incidence of blood transfusion, re-exploration for bleeding; superficial leg and chest wound infections; length of hospital stay, and cost...
March 8, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Nicholas Y Tan, Omar Z Yasin, Alan Sugrue, Abdallah El Sabbagh, Thomas A Foley, Samuel J Asirvatham
The left atrial appendage has been implicated as a major nidus for thrombus formation, particularly in atrial fibrillation. This discovery has prompted substantial interest in the development of left atrial appendage exclusion devices aimed at decreasing systemic thromboembolism risk. Its deceptively simple appearance belies the remarkable complexity that characterizes its anatomy and physiology. We highlight the key anatomic features and variations of the left atrial appendage as well as its relationships with surrounding structures...
April 2018: Interventional Cardiology Clinics
Matúš Kubák, Róbert Štefko, Miroslav Barták, Jaroslav Majerník, Tatiana Vagašová, Michaela Fedelešová
AIM: Cancer mortality distribution was investigated by detailed neoplasms groups, age, sex, marital status of deceased, and regions in the Slovak Republic, and examined how these determinants influence the odds of dying due to cancer. METHODS: A retrospective analysis of cancer mortality statistics registered in the Slovak Republic during the years 1996-2014. For this time period, data was available only on the underlying subgroups of cancer deaths, place of death, age, year, sex, and marital status...
December 2017: Central European Journal of Public Health
Muhammad Irfan Farooque
Training in Emergency medicine for nearly 5 years, I thought the finish line was getting near and becoming a consultant was just down the corner. I was enjoying work, getting better every day and well appreciated by peers. But little did I know that life had other plans. I ended up in an emergency department presenting with status epilepticus preceded by vague ongoing symptoms lasting for 2 months. I was intubated and transferred to Intensive care and did not receive a formal diagnosis which still remains a mystery...
March 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Alida Esmail, Frédérique Poncet, Annie Rochette, Claudine Auger, Christophe Billebaud, Élaine de Guise, Isabelle Ducharme, Eva Kehayia, Delphine Labbé, Noémi Dahan-Oliel, Isabelle Lessard, Olivier Vermeersch, Bonnie Swaine
INTRODUCTION: Clothing is an important aspect of nearly all human societies from performing social and cultural functions to indicating social status, a form of protection and a way for self-expression. It can help or hinder the ability to fulfil everyday activities and social roles and with the rising industry of wearable technologies, smart textiles are adding health-monitoring functions to clothing. The influence that clothing can have on the life of someone with a physical disability is significant, and further research is needed to understand it better...
March 8, 2018: BMJ Open
R Di Maio, S Fais, P Ligas, E Piegari, R Raga, R Cossu
As it is well-known, the characterization plan of an old landfill site is the first stage of the project for the treatment and reclamation of contaminated lands. It is a preliminary in-situ study, with collection of data related to pollution phenomena, and is aimed at defining the physical properties and the geometry of fill materials as well as the possible migration paths of pollutants to the surrounding environmental targets (subsoil and groundwater). To properly evaluate the extent and potential for subsoil contamination, waste volume and possible leachate emissions from the landfill have to be assessed...
March 7, 2018: Waste Management
Juan Ruano, Francisco Gómez-García, Jesús Gay-Mimbrera, Macarena Aguilar-Luque, José Luis Fernández-Rueda, Jesús Fernández-Chaichio, Patricia Alcalde-Mellado, Pedro J Carmona-Fernandez, Juan Luis Sanz-Cabanillas, Isabel Viguera-Guerra, Francisco Franco-García, Manuel Cárdenas-Aranzana, José Luis Hernández Romero, Marcelino Gonzalez-Padilla, Beatriz Isla-Tejera, Antonio Velez Garcia-Nieto
BACKGROUND: Epidemiology and the reporting characteristics of systematic reviews (SRs) and meta-analyses (MAs) are well known. However, no study has analyzed the influence of protocol features on the probability that a study's results will be finally reported, thereby indirectly assessing the reporting bias of International Prospective Register of Systematic Reviews (PROSPERO) registration records. OBJECTIVE: The objective of this study is to explore which factors are associated with a higher probability that results derived from a non-Cochrane PROSPERO registration record for a systematic review will be finally reported as an original article in a scientific journal...
March 9, 2018: Systematic Reviews
Rabha Elmesmari, Anne Martin, John J Reilly, James Y Paton
BACKGROUND: Obesity has been hypothesized to be associated with reduced moderate-to-vigorous physical activity (MVPA) and increased sedentary time (ST). It is important to assess whether, and the extent to which, levels of MVPA and ST are suboptimal among children and adolescents with obesity. The primary objective of this study was to examine accelerometer-measured time spent in MVPA and ST of children and adolescents with obesity, compared with MVPA recommendations, and with non-obese peers...
March 9, 2018: BMC Pediatrics
Niels Martin, Jose L Pascual, Dennis Crowe, Christine Toevs, Maurizio F Cereda, Mark Mikkelsen, Lewis J Kaplan
The US has witnessed a vast increase in animals in therapeutic roles. These roles include Service as defined by the American Disabilities Act (ADA) as well as other animal types that are not covered under the ADA provisions. Such animal roles are designated as Therapy animals and Emotional Support animals (ESA). Understanding the legal and regulatory requirements that govern how each animal type accesses healthcare facilities is essential in planning for their presence. Since only Service animals are required to be given access to facilities, individual institutions must plan for how to accommodate their presence throughout different phases of care...
March 8, 2018: Journal of Trauma and Acute Care Surgery
Judy Keefe, Kathy Cern, Sharon Wiita, Amy Raubenolt, Elizabeth Atkins
Disaster preparedness has come to the forefront for hospitals since the 9/11 attacks in 2001. Many improvements have been made in emergency management and planning for catastrophic events. Both urban and community hospitals have the same responsibilities and commitments to their patients and communities. When the announcement was made that the 2016 Republican National Convention was going to be held in Cleveland, OH, Cleveland Clinic Akron General (CCAG) had to be confident in its abilities to handle any situation that might arise not just as a community hospital but also as a Level I trauma center...
March 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Daichi Morioka, Nirina Mandrano, Hiroki Fujimoto, Yasushi Koga, Nobuhiro Sato, Yasuyoshi Tosa, Fumio Ohkubo, Shinya Yoshimoto
The usefulness of three-dimensional (3D) stereophotogrammetry for treating cleft lip (CL) has been well documented. However, there are only a few reliable anthropometric analyses in infants with CL because at this age they cannot assume a resting facial position. Since 2014, we have used a handheld 3D imaging system in the operating room to obtain optimal images of infants with CL and palate under general anesthesia. Currently, 168 infants with a unilateral cleft, 50 infants with bilateral clefts, and 47 infants with an isolated cleft palate are being followed up in this way for a maximum of 30 months...
March 8, 2018: Journal of Craniofacial Surgery
Mark Gainey, Montserrat Carles, Michael Mix, Philipp T Meyer, Michael Bock, Anca-Ligia Grosu, Dimos Baltas
Recently, there has been an increase in the imaging modalities available for radiotherapy planning and radiotherapy prognostic outcome: dual energy computed tomography (CT; DECT), dynamic contrast enhanced CT, dynamic contrast enhanced magnetic resonance imaging (MRI), diffusion-weighted MRI, positron emission tomography-CT, dynamic contrast enhanced ultrasound, magnetic resonance spectroscopy and positron emission tomography-MR. These techniques enable more precise gross tumor volume definition than CT alone and moreover allow subvolumes within the gross tumor volume to be defined which may be given a boost dose or an individual voxelized dose prescription may be derived...
March 9, 2018: Future Oncology
Andrew C Faust, Emily Guy, Nidhu Baby, Anthony Ortegon
BACKGROUND: Methemoglobinemia is a well-recognized adverse drug reaction related to the use of certain local anesthetic agents. The mainstay of treatment for methemoglobinemia is i.v. methylene blue, along with provision of supplemental oxygen; however, methylene blue is listed as a category X teratogen. This poses an issue should methemoglobinemia develop during pregnancy. CASE REPORT: A 35-year-old, 20-week and 5-day gravid female was transferred from an outpatient oral surgeon's office for hypoxia...
March 5, 2018: Journal of Emergency Medicine
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