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https://www.readbyqxmd.com/read/27922990/robotically-assisted-thoracic-surgery-proposed-guidelines-for-privileging-and-credentialing
#1
Faiz Y Bhora, Adnan M Al-Ayoubi, Sadiq S Rehmani, Craig M Forleiter, Wissam N Raad, Scott G Belsley
OBJECTIVE: Increased use of robotically assisted thoracic surgery (RATS) necessitates effective credentialing guidelines to ensure safe outcomes. We provide a stepwise algorithm for granting privileges and credentials in RATS. This algorithm reflects graduated responsibility and complexity of the surgical procedures performed. Furthermore, it takes into account volume, outcomes, surgeon's competency, and appropriateness of robot usage. METHODS: We performed a literature review for available strategies to grant privileges and credentials for implementing robotic surgery...
December 5, 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27922912/the-current-overuse-and-misuse-of-meta-analyses-on-sublingual-immunotherapy-the-case-of-grass-pollen-allergy
#2
Erminia Ridolo, Cristoforo Incorvaia, Bruna Luciana Gritti, Giovanni Passalacqua
PURPOSE OF REVIEW: Meta-analysis provides the highest level of evidence-based efficacy of a medical treatment or intervention. Allergen immunotherapy in its two forms of subcutaneous immunotherapy and sublingual immunotherapy (SLIT) is an effective treatment of respiratory allergy as shown by meta-analyses, but in recent years there has been an overflow of meta-analyses on SLIT, with contrasting results that may generate confusion among physicians. RECENT FINDINGS: It can be observed that flaws are often present in meta-analyses including: incorrect selection of trials, inappropriate use of evaluation parameters for the analysis, and unsuitable analyses...
December 5, 2016: Current Opinion in Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/27922866/quality-and-safety-in-health-care-part-xix-variants-of-the-eras-program
#3
Jay A Harolds
The integrated recovery pathway is a variant of the enhanced recovery pathway after surgery program, which saw a further decrease in complications and mean length of stay after a change in culture was instituted with more accountability of the staff to following the pathway. This was accomplished using a team-based comprehensive unit-based safety program. It has also been found that another variant of the enhanced recovery pathway after surgery program had a further improvement of patient outcomes after instituting a "preventive surgical site infection bundle...
December 3, 2016: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/27922774/controlled-drugs-and-the-principle-of-double-effect-the-role-of-the-district-nurse
#4
Richard Griffith
The role of district nurses in the effective management of pain in palliative care has been strengthened by the Misuse of Drugs (Amendment No.2) (England, Wales and Scotland) Regulations 2012 that allow district nurses who are independent or supplementary prescribers to prescribe and administer controlled drugs. However, prescribing controlled drugs brings increased responsibility and accountability for the safe management of these medicines. In this article Richard Griffith considers the principle of double effect that seeks to ensure that patients in intractable pain receive the analgesia they require to manage that pain while district nurses avoid liability and prosecution under the law of murder...
December 2, 2016: British Journal of Community Nursing
https://www.readbyqxmd.com/read/27922462/fostering-evidence-based-quality-improvement-for-patient-centered-medical-homes-initiating-local-quality-councils-to-transform-primary-care
#5
Susan E Stockdale, Jessica Zuchowski, Lisa V Rubenstein, Negar Sapir, Elizabeth M Yano, Lisa Altman, Jacqueline J Fickel, Skye McDougall, Timothy Dresselhaus, Alison B Hamilton
BACKGROUND: Although the patient-centered medical home endorses quality improvement principles, methods for supporting ongoing, systematic primary care quality improvement have not been evaluated. We introduced primary care quality councils at six Veterans Health Administration sites as an organizational intervention with three key design elements: (a) fostering interdisciplinary quality improvement leadership, (b) establishing a structured quality improvement process, and (c) facilitating organizationally aligned frontline quality improvement innovation...
December 3, 2016: Health Care Management Review
https://www.readbyqxmd.com/read/27922454/a-clinician-s-guide-to-privacy-and-communication-in-the-icu
#6
Leslie Francis, Micah A Vorwaller, Hanan Aboumatar, Dominick L Frosch, John Halamka, Ronen Rozenblum, Eileen Rubin, Barbara Sarnoff Lee, Jeremy Sugarman, Kathleen Turner, Samuel M Brown
OBJECTIVE: To review the legal issues concerning family members' access to information when patients are in the ICU. DATA SOURCES: U.S. Code, U.S. Code of Federal Regulations, and state legislative codes. DATA EXTRACTION: Relevant legal statutes and regulations were identified and reviewed by the two attorney authors (L. F., M. A. V.). STUDY SELECTION: Not applicable. DATA SYNTHESIS: Review by all coauthors...
December 2, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27921348/the-early-memories-of-warmth-and-safeness-scale-for-adolescents-cross-sample-validation-of-the-complete-and-brief-versions
#7
Paula Vagos, Diana Ribeiro da Silva, Nélio Brazão, Daniel Rijo, Paul Gilbert
: This work presents psychometric analyses on the Early Memories of Warmth and Safeness Scale, which intends to evaluate the subjective perception of ones' early rearing experiences. Factor structure, measurement invariance, latent mean comparisons and validity in relation to external variables (i.e., forms of self-criticism/self-assurance, experiential avoidance and depressive, anxious and stress symptoms) were investigated. A sample of 1464 adolescents (52.3% male adolescents, mean age = 16...
December 6, 2016: Clinical Psychology & Psychotherapy
https://www.readbyqxmd.com/read/27920591/left-atrial-myxomectomy-with-intraoperative-severe-mitral-regurgitation-and-complicated-postoperative-course-case-report
#8
Nareg Minaskeian, Patrick P Hu
Primary cardiac tumors are a rare occurrence with myxomas accounting for about half of the benign tumors. Once diagnosed, surgical resection is the standard of care. Our case describes a female in her 50s who underwent a myxoma resection under cardiopulmonary bypass via biatrial approach. Intraoperatively, the thin septal crux between the wall of the aorta and mitral valve was damaged during resection, requiring stem cell tissue matrix for repair. The patient also developed severe mitral regurgitation suggesting infarct to the left coronary system during resection, subsequently receiving a mechanical mitral valve and a saphenous vein bypass graft...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27920355/initiation-of-addiction-treatment-and-access-to-services-young-adults-accounts-of-their-help-seeking-experiences
#9
Vincent Wagner, Karine Bertrand, Jorge Flores-Aranda, Didier Acier, Natacha Brunelle, Michel Landry, Serge Brochu
Substance addiction in young adults is particularly problematic. Yet, much remain at stake in understanding the specifics of this population's access to services. The objective of this study is to explore young adults' initiation of substance misuse treatment. Our study sample was composed of 35 individuals aged 18 to 30 with problematic psychoactive substance use who have been identified in criminal courts, hospital emergency departments, and Health and Social Services Centers in Québec (Canada). A thematic analysis was performed on the 62 semi-structured interviews conducted with participants...
December 4, 2016: Qualitative Health Research
https://www.readbyqxmd.com/read/27920314/medicaid-meets-its-equal-access-requirement-for-dental-care-but-oral-health-disparities-remain
#10
Jaffer A Shariff, Burton L Edelstein
Most US children today have public or private dental health insurance, yet oral health among publicly insured children remains a policy concern. We analyzed data for 2011-12 from the National Survey of Children's Health to compare oral health status and the use of dental care among publicly and privately insured children. After we adjusted for demographic and parent characteristics, we found no differences between the two groups in parent-reported use of dental care or unmet need for dental care. However, compared to parents of privately insured children, parents of publicly insured children were less likely to report that the condition of their child's teeth was excellent or very good and more likely to report that the child had had a dental problem in the past twelve months...
December 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27920082/doctors-perspectives-on-psa-testing-illuminate-established-differences-in-prostate-cancer-screening-rates-between-australia-and-the-uk-a-qualitative-study
#11
Kristen Pickles, Stacy M Carter, Lucie Rychetnik, Vikki A Entwistle
OBJECTIVES: To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different. DESIGN: A grounded theory study. SETTING: Primary care practices in Australia and the UK. PARTICIPANTS: 69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations...
December 5, 2016: BMJ Open
https://www.readbyqxmd.com/read/27919447/case-mix-adjusted-cost-of-colectomy-at-low-middle-and-high-volume-academic-centers
#12
Alex L Chang, Young Kim, Audrey E Ertel, Richard S Hoehn, Koffi Wima, Daniel E Abbott, Shimul A Shah
BACKGROUND: Efforts to regionalize surgery based on thresholds in procedure volume may have consequences on the cost of health care delivery. This study aims to delineate the relationship between hospital volume, case mix, and variability in the cost of operative intervention using colectomy as the model. METHODS: All patients undergoing colectomy (n = 90,583) at 183 academic hospitals from 2009-2012 in The University HealthSystems Consortium Database were studied...
December 2, 2016: Surgery
https://www.readbyqxmd.com/read/27919398/what-is-needed-to-implement-a-web-based-audit-and-feedback-intervention-with-outreach-visits-to-improve-care-quality-a-concept-mapping-study-among-cardiac-rehabilitation-teams
#13
Mariëtte M van Engen-Verheul, Niels Peek, Joke A Haafkens, Erik Joukes, Tom Vromen, Monique W M Jaspers, Nicolette F de Keizer
INTRODUCTION: Evidence on successful quality improvement (QI) in health care requires quantitative information from randomized clinical trials (RCTs) on the effectiveness of QI interventions, but also qualitative information from professionals to understand factors influencing QI implementation. OBJECTIVE: Using a structured qualitative approach, concept mapping, this study determines factors identified by cardiac rehabilitation (CR) teams on what is needed to successfully implement a web-based audit and feedback (A&F) intervention with outreach visits to improve the quality of CR care...
January 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/27919389/older-patients-use-of-technology-for-a-post-discharge-nutritional-intervention-a-mixed-methods-feasibility-study
#14
T Lindhardt, M H Nielsen
BACKGROUND: Malnutrition is frequent in older people and a precursor for morbidity and hospitalisation; furthermore low intake and weight loss during and after hospitalisation is well-described. Such patients are often excluded from technology projects on account of lack of skills. This is a barrier for their access to many current and future health care offers. OBJECTIVES: To test the acceptability, feasibility and preliminary efficacy of technology-supported energy- and protein-enforced homedelivered meals for older patients discharged from hospital...
January 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/27918409/a-system-approach-to-advanced-practice-clinician-standardization-and-high-reliability
#15
Susan Okuno-Jones, Alice Siehoff, Jennifer Law, Patricia Juarez
Advanced practice clinicians (APCs) are an integral part of the health care team. Opportunities exist within Advocate Health Care to standardize and optimize APC practice across the system. To enhance the role and talents of APCs, an approach to role definition and optimization of practice and a structured approach to orientation and evaluation are shared. Although in the early stages of development, definition and standardization of accountabilities in a framework to support system changes are transforming the practice of APCs...
January 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/27918403/new-hampshire-nurse-practitioners-take-the-lead-in-forming-an-accountable-care-organization
#16
Wendy L Wright
In 2012, New Hampshire nurse practitioners (NPs), along with Anthem Blue Cross/Blue Shield, formed the first Patient Centered Shared Savings Program in the nation, composed of patients managed by nurse practitioners employed within NP-owned and operated clinics. In this accountable care organization (ACO), NP-attributed patients were grouped into one risk pool. Data from the ACO and the NP risk pool, now in its third year, have produced compelling statistics. Nurse practitioners participating in this program have met or exceeded the minimum scores for 29 quality metrics along with a demonstrated cost-savings in the first 2 years of the program...
January 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/27918203/intergenerational-support-and-life-satisfaction-of-young-old-and-oldest-old-adults-in-china
#17
Jia Chen, Lucy P Jordan
OBJECTIVES: This study investigated variation across different old-age groups in the association between intergenerational support and elderly life satisfaction in China, taking into account both exchange patterns and different types of support. METHOD: Using the first two waves (2010 and 2012) of China Family Panel Studies, we applied the fixed-effect approach to examine the moderating effect of age separately for exchange patterns and different types of intergenerational support...
December 5, 2016: Aging & Mental Health
https://www.readbyqxmd.com/read/27918173/the-development-validation-and-feasibility-of-the-experienced-coercion-scale
#18
Olav Nyttingnes, Jorun Rugkåsa, Aina Holmén, Torleif Ruud
Existing scales for experienced coercion have limitations. We developed and validated a short self-report form for experienced coercion for use across care settings, care phases, and care measures. In Stage 1, we developed an item pool, based on the literature, patient accounts, interviews, and expert feedback. Stages 2 and 3 consisted of 2 cross-sectional studies, with patients from acute and nonacute inpatient wards, outpatient care, and supported housing. In Stage 2, patients (N = 212) responded to the Coercion Ladder and the experienced coercion items from Stage 1...
December 5, 2016: Psychological Assessment
https://www.readbyqxmd.com/read/27917735/top-1-of-inpatients-administered-antimicrobial-agents-comprising-50-of-expenditures-a-descriptive-study-and-opportunities-for-stewardship-intervention
#19
Jennifer Dela-Pena, Luiza Kerstenetzky, Lucas Schulz, Ron Kendall, Alexander Lepak, Barry Fox
OBJECTIVE To characterize the top 1% of inpatients who contributed to the 6-month antimicrobial budget in a tertiary, academic medical center and identify cost-effective intervention opportunities targeting high-cost antimicrobial utilization. DESIGN Retrospective cohort study. PATIENTS Top 1% of the antimicrobial budget from July 1 through December 31, 2014. METHODS Patients were identified through a pharmacy billing database. Baseline characteristics were collected through a retrospective medical chart review...
December 5, 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27917637/-cardiovascular-risk-in-rheumatic-diseases
#20
Sabína Oreská, Michal Tomčík
Cardiovascular diseases, as a result of atherosclerosis, are the leading cause of mortality in the world. Atherosclerosis used to be considered as a degenerative impairment of the artery wall. Nevertheless, it is presently rather regarded as an autoimmune process with the involvement of both innate and adaptive immunity. Recently, it was demonstrated that the cardiovascular risk is increased in autoimmune diseases.In the pathogenesis of atherosclerosis in chronic inflammatory diseases both traditional and non-traditional risk factors are important...
2016: Casopís Lékar̆ů C̆eských
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