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https://www.readbyqxmd.com/read/27899745/exploring-provider-reactions-to-decision-aid-distribution-and-shared-decision-making-lessons-from-two-specialties
#1
Clarissa Hsu, David T Liss, Dominick L Frosch, Emily O Westbrook, David Arterburn
BACKGROUND: A critical component of shared decision making (SDM) is the role played by health care providers in distributing decision aids (DAs) and initiating SDM conversations. Existing literature indicates that decisions about designing and implementing DAs must take provider perspectives into account. However, little is known about how differences in provider attitudes across specialties may impact DA implementation and how provider attitudes may shift after DA implementation. Group Health's Decision Aid Implementation project was carried out in six specialties using 12 video-based DAs for preference-sensitive conditions; this study focused on two of the six specialties...
January 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27785341/sex-and-gender-medicine-in-physician-clinical-training-results-of-a-large-single-center-survey
#2
Shivani Dhawan, May Bakir, Erika Jones, Sarah Kilpatrick, C Noel Bairey Merz
BACKGROUND: "Sex and Gender Medicine" is a novel medical discipline that takes into account the effects of sex and gender on the health of women and men. The Institute of Medicine in the USA declared in its 2001 and 2010 statements that being a woman or a man significantly impacts the course of diseases, and therefore, this fact must be considered in diagnosis and therapy. We evaluated the representation of Sex and Gender Medicine in clinical training at Cedars-Sinai Medical Center, a large, tertiary, non-profit, academic medical training center in the Western United States...
2016: Biology of Sex Differences
https://www.readbyqxmd.com/read/27769084/pulmonary-embolism-response-teams
#3
Alison S Witkin, Savanah Harshbarger, Christopher Kabrhel
Pulmonary embolism is a common and often life-threatening event. Treatment options include anticoagulation alone, catheter-directed therapies, and surgical thromboembolectomy. While guidelines exist, there is often controversy over which treatment is most appropriate, particularly for intermediate-risk patients. The traditional care model, in which the primary team is responsible for consulting the appropriate specialists, may be inadequate and inefficient for emergent situations, as ensuring coordination and communication between various consulting services can be a time consuming and confusing process...
November 2016: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27712724/the-future-of-cardiac-imaging-report-of-a-think-tank-convened-by-the-american-college-of-cardiology
#4
Pamela S Douglas, Manuel D Cerqueira, Daniel S Berman, Kavitha Chinnaiyan, Meryl S Cohen, Justin B Lundbye, Rajan A G Patel, Partho P Sengupta, Prem Soman, Neil J Weissman, Timothy C Wong
The American College of Cardiology's Executive Committee and Cardiovascular Imaging Section Leadership Council convened a discussion regarding the future of cardiac imaging among thought leaders in the field during a 2 day Think Tank. Participants were charged with thinking broadly about the future of imaging and developing a roadmap to address critical challenges. Key areas of discussion included: 1) how can cardiac imaging services thrive in our new world of value-based health care? 2) Who is the cardiac imager of the future and what is the role of the multimodality imager? 3) How can we nurture innovation and research in imaging? And 4) how can we maximize imaging information and optimize outcomes? This document describes the proceedings of this Think Tank...
October 2016: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27673575/knowledge-gaps-in-cardiovascular-care-of-older-adults-a-scientific-statement-from-the-american-heart-association-american-college-of-cardiology-and-american-geriatrics-society-executive-summary
#5
Michael W Rich, Deborah A Chyun, Adam H Skolnick, Karen P Alexander, Daniel E Forman, Dalane W Kitzman, Mathew S Maurer, James B McClurken, Barbara M Resnick, Win K Shen, David L Tirschwell
The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease (CVD) is the leading cause of death and major disability in adults aged 75 and older. Despite the effect of CVD on quality of life, morbidity, and mortality in older adults, individuals aged 75 and older have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older adults with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in nursing homes and assisted living facilities...
November 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27628103/significance-of-frailty-for-predicting-adverse-clinical-outcomes-in-different-patient-groups-with-specific-medical-conditions
#6
Martin Ritt, Karl-Günter Gaßmann, Cornel Christian Sieber
Frailty is a major health burden in an aging society. It constitutes a clinical state of reduced physiological reserves that is associated with a diminished ability to withstand internal and external stressors. Frail patients have an increased risk for adverse clinical outcomes, such as mortality, readmission to hospital, institutionalization and falls. Of further clinical interest, frailty might be at least in part reversible in some patients and subject to preventive strategies. In daily clinical practice older patients with a complex health status, who are mostly frail or at least at risk of developing frailty, are frequently cared for by geriatricians...
October 2016: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/27611706/critical-appraisal-of-appropriateness-in-nuclear-cardiology
#7
Claudio Marcassa
Radionuclide myocardial perfusion imaging (MPI) is a large component of the healthcare spending both in developed and developing countries. MPI is also responsible for a significant increase in the exposition of patients and health care operators to ionizing radiations for medical purposes. Thus, health-care systems and pertinent scientific societies were involved in developing criteria to contain the non-appropriate use by implementing Appropriate Use Criteria and Clinical Indications Guidelines. The present manuscript will review the concept and limitations of such an approach...
December 2016: Quarterly Journal of Nuclear Medicine and Molecular Imaging
https://www.readbyqxmd.com/read/27571334/-anmco-sic-consensus-document-the-heart-failure-network-organization-of-outpatient-care
#8
Nadia Aspromonte, Michele Massimo Gulizia, Andrea Di Lenarda, Andrea Mortara, Ilaria Battistoni, Renata De Maria, Michele Gabriele, Massimo Iacoviello, Alessandro Navazio, Daniela Pini, Giuseppe Di Tano, Marco Marini, Renato Pietro Ricci, Gianfranco Alunni, Donatella Radini, Marco Metra, Francesco Romeo
Changing demographics and an increasing burden of multiple chronic comorbidities in western countries dictate refocusing of heart failure (HF) services from acute in-hospital care to better support the long inter-critical out-of-hospital phases of HF. The needs of the HF population are not adequately addressed by current HF outpatient services, as documented by differences in age, gender, comorbidities and recommended therapies between patients discharged for hospitalized HF and those followed up at HF clinics...
July 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/27564559/use-of-anesthesia-for-imaging-studies-and-interventional-procedures-in-children
#9
Yolanda Y Huang, Lucy Li, Matthew Monteleone, Lynne Ferrari, Lisa J States, James J Riviello, Steven G Kernie, Ali A Mencin, Sumit Gupta, Lena S Sun
Ongoing investigation from the Pediatric Anesthesia NeuroDevelopment Assessment (PANDA) study hopes to examine the long-term effect on cognitive and language development of a single anesthetic exposure in children undergoing inguinal hernia repair. The fifth PANDA Symposium, held in April 2016, continued the mission of previous symposia to examine evidence from basic science and clinical studies on potential neurotoxic effects of anesthetics on developing brain. At the 2016 Symposium, a panel of specialists from nonsurgical pediatric disciplines including anesthesiology, radiology, neurology, gastroenterology, oncology, cardiology, and critical care reviewed use of anesthesia in their practices, including how concern over possible neurodevelopmental effects of early childhood anesthetic exposure has changed discussion with patients and families regarding risks and benefits of imaging studies and interventional procedures involving sedation or anesthesia...
August 25, 2016: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/27555314/the-virtual-obstetrical-intensive-care-unit-providing%C3%A2-critical-care-for-contemporary-obstetrics-in%C3%A2-nontraditional%C3%A2-locations
#10
Michael P Leovic, Hailey N Robbins, Michael R Foley, Roman S Starikov
Management of the critically ill pregnant patient presents a clinical dilemma in which there are sparse objective data to determine the optimal setting for provision of high-quality care to these patients. This clinical scenario will continue to present a challenge for providers as the chronic illness and comorbid conditions continue to become more commonly encountered in the obstetric population. Various care models exist across a broad spectrum of facilities that are characterized by differing levels of resources; however, no studies have identified which model provides the highest level of care and patient safety while maintaining a reasonable degree of cost-effectiveness...
December 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27545700/the-emergency-medical-care-of-patients-with-acute-myocardial-infarction
#11
Martin Stockburger, Birga Maier, Georg Fröhlich, Wolfgang Rutsch, Steffen Behrens, Ralph Schoeller, Heinz Theres, Stefan Poloczek, Gerd Plock, Helmut Schühlen
BACKGROUND: Optimizing the emergency medical care chain might shorten the time to treatment of patients with ST-elevation myocardial infarction (STEMI). The initial care by a physician, and, in particular, correct ECG interpretation, are critically important factors. METHODS: From 1999 onward, data on the care of patients with myocardial infarction have been recorded and analyzed in the Berlin Myocardial Infarction Registry. In the First Medical Contact Study, data on initial emergency medical care were obtained on 1038 patients who had been initially treated by emergency physicians in 2012...
July 25, 2016: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/27513327/the-state-of-point-of-care-ultrasonography-use-and-training-in-neonatal-perinatal-medicine-and-pediatric-critical-care-medicine-fellowship-programs
#12
J Nguyen, R Amirnovin, R Ramanathan, S Noori
OBJECTIVE: The current state of point-of-care ultrasonography (POCUS) use and education in neonatal-perinatal medicine (NPM) and pediatric critical care medicine (PCCM) is unknown. Our aim was to quantify POCUS use, training and perceptions regarding education and barriers among the United States NPM and PCCM fellowship programs. STUDY DESIGN: A 14-question survey was emailed to the fellowship directors of all the United States NPM and PCCM fellowship programs. RESULTS: The response rate was 55% (52/95) and 59% (39/66) for NPM and PCCM programs, respectively...
November 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/27476983/assessment-and-utility-of-frailty-measures-in-critical-illness-cardiology-and-cardiac-surgery
#13
REVIEW
Naheed Rajabali, Darryl Rolfson, Sean M Bagshaw
Frailty is a clearly emerging theme in acute care medicine, with obvious prognostic and health resource implications. "Frailty" is a term used to describe a multidimensional syndrome of loss of homeostatic reserves that gives rise to a vulnerability to adverse outcomes after relatively minor stressor events. This is conceptually simple, yet there has been little consensus on the operational definition. The gold standard method to diagnose frailty remains a comprehensive geriatric assessment; however, a variety of validated physical performance measures, judgement-based tools, and multidimensional scales are being applied in critical care, cardiology, and cardiac surgery settings, including open cardiac surgery and transcatheter aortic value replacement...
September 2016: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27472989/point-of-care-ultrasound-a-wfumb-position-paper
#14
Christoph F Dietrich, Adrian Goudie, Liliana Chiorean, Xin Wu Cui, Odd Helge Gilja, Yi Dong, Jacques S Abramowicz, Sudhir Vinayak, Susan Campbell Westerway, Christian Pállson Nolsøe, Yi-Hong Chou, Michael Blaivas
Over the last decade, the use of portable ultrasound scanners has enhanced the concept of point of care ultrasound (PoC-US), namely, "ultrasound performed at the bedside and interpreted directly by the treating clinician." PoC-US is not a replacement for comprehensive ultrasound, but rather allows physicians immediate access to clinical imaging for rapid and direct solutions. PoC-US has already revolutionized everyday clinical practice, and it is believed that it will dramatically change how ultrasound is applied in daily practice...
July 26, 2016: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/27465298/epidemiology-of-adverse-events-and-medical-errors-in-the-care-of-cardiology-patients
#15
Yoshinori Ohta, Izumi Miki, Takeshi Kimura, Mitsuru Abe, Mio Sakuma, Kaoru Koike, Takeshi Morimoto
OBJECTIVES: There have been epidemiological studies of adverse events (AEs) among general patients but those of patients cared by cardiologist are not well scrutinized. We investigated the occurrence of AEs and medical errors (MEs) among adult patients with cardiology in Japan. METHODS: We conducted a cross-sectional study of adult outpatients at a Japanese teaching hospital from February through November 2006. We measured AE and ME incidents from patient report, which were verified by medical records, laboratory data, incident reports, and prescription queries...
July 26, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27454172/false-alarm-reduction-in-critical-care
#16
Gari D Clifford, Ikaro Silva, Benjamin Moody, Qiao Li, Danesh Kella, Abdullah Chahin, Tristan Kooistra, Diane Perry, Roger G Mark
High false alarm rates in the ICU decrease quality of care by slowing staff response times while increasing patient delirium through noise pollution. The 2015 PhysioNet/Computing in Cardiology Challenge provides a set of 1250 multi-parameter ICU data segments associated with critical arrhythmia alarms, and challenges the general research community to address the issue of false alarm suppression using all available signals. Each data segment was 5 minutes long (for real time analysis), ending at the time of the alarm...
August 2016: Physiological Measurement
https://www.readbyqxmd.com/read/27454007/assessing-ecg-signal-quality-indices-to-discriminate-ecgs-with-artefacts-from-pathologically-different-arrhythmic-ecgs
#17
C Daluwatte, L Johannesen, L Galeotti, J Vicente, D G Strauss, C G Scully
False and non-actionable alarms in critical care can be reduced by developing algorithms which assess the trueness of an arrhythmia alarm from a bedside monitor. Computational approaches that automatically identify artefacts in ECG signals are an important branch of physiological signal processing which tries to address this issue. Signal quality indices (SQIs) derived considering differences between artefacts which occur in ECG signals and normal QRS morphology have the potential to discriminate pathologically different arrhythmic ECG segments as artefacts...
August 2016: Physiological Measurement
https://www.readbyqxmd.com/read/27444872/risk-factors-of-acute-kidney-injury-requiring-renal-replacement-therapy-based-on-regional-registry-data
#18
Piotr Czempik, Daniel Cieśla, Piotr Knapik, Łukasz J Krzych
BACKGROUND: Acute kidney injury (AKI) is a common problem in critically ill patients treated in the intensive care unit (ICU) and is associated with high mortality, particularly when renal replacement therapy (RRT) is required. Our aim was to investigate the risk factors for AKI requiring RRT (AKI-RRT). METHODS: In our retrospective, multi-centre, observational study, we analysed 14,672 consecutive AKI-RRT patients hospitalized in ICUs in the Silesian Region (Poland) between October 2011 and December 2014...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/27379245/genetic-evaluation-and-use-of-chromosome-microarray-in-patients-with-isolated-heart-defects-benefits-and-challenges-of-a-new-model-in-cardiovascular-care
#19
REVIEW
Benjamin M Helm, Samantha L Freeze
Congenital heart defects (CHDs) are common birth defects and result in significant morbidity and global economic impact. Genetic factors play a role in most CHDs; however, identification of these factors has been historically slow due to technological limitations and incomplete understanding of the impact of human genomic variation on normal and abnormal cardiovascular development. The advent of chromosome microarray (CMA) brought tremendous gains in identifying chromosome abnormalities in a variety of human disorders and is now considered part of a standard evaluation for individuals with multiple congenital anomalies and/or neurodevelopmental disorders...
2016: Frontiers in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27364053/the-genesis-maturation-and-future-of%C3%A2-critical-care-cardiology
#20
REVIEW
Jason N Katz, Michael Minder, Benjamin Olenchock, Susanna Price, Michael Goldfarb, Jeffrey B Washam, Christopher F Barnett, L Kristin Newby, Sean van Diepen
The cardiac intensive care unit (CICU) has changed considerably over time and now serves a unique patient population with a high burden of cardiovascular and noncardiovascular critical illness. Patient complexity and technological evolutions in the CICU have catalyzed the development of critical care cardiology, a fledgling discipline that combines specialization in cardiovascular diseases with knowledge and experience in critical care medicine. Numerous uncertainties and challenges threaten to stymie the growth of this field...
July 5, 2016: Journal of the American College of Cardiology
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