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https://www.readbyqxmd.com/read/29161399/global-lessons-developing-military-trauma-care-and-lessons-for-civilian-practice
#1
T Woolley, J A Round, M Ingram
The wars in Iraq and Afghanistan have helped to shape the modern Defence Medical Services. Many lessons were learnt including the need for rapid haemorrhage control, senior decision-making and the evolution of deployed transfusion support. These changes were implemented simultaneously with a coherent, end-to-end medical plan from point of wounding through to rehabilitation. Implementation of the medical plan is harmonious with the NHS trauma pathway, and is key to ensuring effective delivery. Military anaesthetists have a long pre-deployment training pathway starting with a Certificate of Completion of Training (CCT) in anaesthesia and/or critical care, and with an emphasis on military skills related to their specific role...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29159004/linear-malignant-melanoma-in-situ-reports-and-review-of-cutaneous-malignancies-presenting-as-linear-skin-cancer
#2
Philip R Cohen
Melanomas usually present as oval lesions in which the borders may be irregular. Other morphological features of melanoma include clinical asymmetry, variable color, diameter greater than 6 mm and evolving lesions. Two males whose melanoma in situ presented as linear skin lesions are described and cutaneous malignancies that may appear linear in morphology are summarized in this report. A medical literature search engine, PubMed, was used to search the following terms: cancer, cutaneous, in situ, linear, malignant, malignant melanoma, melanoma in situ, neoplasm, and skin...
September 18, 2017: Curēus
https://www.readbyqxmd.com/read/29152104/a-developed-model-of-cancer-patients-participation-in-intravenous-chemotherapy-safety
#3
Zeng Na, Yan Qiaoyuan, Wang Binghan, Zhu Qin, Chen Yue, Peng Xin, Tan Cuilian, Yao Cheng
How to reduce intravenous chemotherapy-related adverse reactions of cancer patients is one focus of clinical work. Nowadays, patient for patient safety (PFPS) is an important component of hospital safety management and can contribute to a reduction in the rate of adverse events following intravenous chemotherapy of cancer patients. To guide and evaluate cancer patients participate in intravenous chemotherapy, we explored a scientific and practical model of cancer patients participation in intravenous chemotherapy safety...
October 20, 2017: Oncotarget
https://www.readbyqxmd.com/read/29149505/an-international-continence-society-ics-report-on-the-terminology-for-adult-neurogenic-lower-urinary-tract-dysfunction-anlutd
#4
Jerzy B Gajewski, Brigitte Schurch, Rizwan Hamid, Márcio Averbeck, Ryuji Sakakibara, Enrico F Agrò, Tamara Dickinson, Christopher K Payne, Marcus J Drake, Bernie T Haylen
INTRODUCTION: The terminology for adult neurogenic lower urinary tract dysfunction (ANLUTD) should be defined and organized in a clinically based consensus Report. METHODS: This Report has been created by a Working Group under the auspices and guidelines of the International Continence Society (ICS) Standardization Steering Committee (SSC) assisted at intervals by external referees. All relevant definitions for ANLUTD were updated on the basis of research over the last 14 years...
November 17, 2017: Neurourology and Urodynamics
https://www.readbyqxmd.com/read/29145353/cdc-grand-rounds-improving-medication-adherence-for-chronic-disease-management-innovations-and-opportunities
#5
Andrea B Neiman, Todd Ruppar, Michael Ho, Larry Garber, Paul J Weidle, Yuling Hong, Mary G George, Phoebe G Thorpe
Adherence to prescribed medications is associated with improved clinical outcomes for chronic disease management and reduced mortality from chronic conditions (1). Conversely, nonadherence is associated with higher rates of hospital admissions, suboptimal health outcomes, increased morbidity and mortality, and increased health care costs (2). In the United States, 3.8 billion prescriptions are written annually (3). Approximately one in five new prescriptions are never filled, and among those filled, approximately 50% are taken incorrectly, particularly with regard to timing, dosage, frequency, and duration (4)...
November 17, 2017: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/29132361/the-impacts-of-implementation-of-national-essential-medicines-policies-on-primary-healthcare-institutions-a-cross-sectional-study-in-china
#6
Zhigang Guo, Xiaodong Guan, Luwen Shi
BACKGROUND: In 2009, China implemented the National Essential Medicines Policies (NEMPs) as part of a new round of medical system reforms. This study aims to evaluate the impacts of the NEMPs on primary healthcare institutions and discuss the roles of the policies in the new healthcare reforms of China. METHODS: The study selected a total of six representative provinces of China, generating a sample of 261 primary healthcare institutions from August to December in 2010...
November 13, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/29126410/more-than-visual-literacy-art-and-the-enhancement-of-tolerance-for-ambiguity-and-empathy
#7
Miriam Ethel Bentwich, Peter Gilbey
BACKGROUND: Comfort with ambiguity, mostly associated with the acceptance of multiple meanings, is a core characteristic of successful clinicians. Yet past studies indicate that medical students and junior physicians feel uncomfortable with ambiguity. Visual Thinking Strategies (VTS) is a pedagogic approach involving discussions of art works and deciphering the different possible meanings entailed in them. However, the contribution of art to the possible enhancement of the tolerance for ambiguity among medical students has not yet been adequately investigated...
November 10, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/29122794/consensus-validation-of-the-posamino-potentially-serious-alcohol-medication-interactions-in-older-adults-criteria
#8
Alice E Holton, Paul J Gallagher, Cristín Ryan, Tom Fahey, Gráinne Cousins
OBJECTIVES: Older adults are particularly vulnerable to adverse effects from concurrent alcohol and medication use. However, there is limited evidence regarding the prevalence of these adverse outcomes among older adults, and there is a lack of consensus regarding what constitutes an alcohol-interactive medicine. The objective of this study was to develop an explicit list of potentially serious alcohol-medication interactions for use in older adults. DESIGN: Following a systematic review, review of drug compendia and clinical guidance documents, a two-round Delphi consensus method was conducted...
November 8, 2017: BMJ Open
https://www.readbyqxmd.com/read/29122111/temperature-sensitive-medications-in-interfacility-transport-the-ice-pack-myth
#9
Jason Clancy, Cassandra Karish, Meghan Roddy, Judith J Sicilia, Michael T Bigham
INTRODUCTION: Critical Care Transport teams use various strategies to maintain temperature sensitive drugs and equipment at optimal temperature. The purpose of this study was to examine the effectiveness of current passive refrigeration of temperature sensitive transport medications/equipment. METHODS: Initially, we performed a retrospective review of transport durations. Subsequently, an experimental paradigm was created using a temperature probe inside of the transport cooler packs utilizing various configurations and initial starting temperatures with high and low "in range" temperature margins of 8°C (max) and 2°C (min)...
November 2017: Air Medical Journal
https://www.readbyqxmd.com/read/29121923/decentralised-training-for-medical-students-a-scoping-review
#10
Marietjie de Villiers, Susan van Schalkwyk, Julia Blitz, Ian Couper, Kalavani Moodley, Zohray Talib, Taryn Young
BACKGROUND: Increasingly, medical students are trained at sites away from the tertiary academic health centre. A growing body of literature identifies the benefits of decentralised clinical training for students, the health services and the community. A scoping review was done to identify approaches to decentralised training, how these have been implemented and what the outcomes of these approaches have been in an effort to provide a knowledge base towards developing a model for decentralised training for undergraduate medical students in lower and middle-income countries (LMICs)...
November 9, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/29121350/individualized-fsh-dosing-based-on-ovarian-reserve-testing-in-women-starting-ivf-icsi-a-multicentre-trial-and-cost-effectiveness-analysis
#11
Theodora C van Tilborg, Simone C Oudshoorn, Marinus J C Eijkemans, Monique H Mochtar, Ron J T van Golde, Annemieke Hoek, Walter K H Kuchenbecker, Kathrin Fleischer, Jan Peter de Bruin, Henk Groen, Madelon van Wely, Cornelis B Lambalk, Joop S E Laven, Ben Willem J Mol, Frank J M Broekmans, Helen L Torrance
STUDY QUESTION: Is there a difference in live birth rate and/or cost-effectiveness between antral follicle count (AFC)-based individualized FSH dosing or standard FSH dosing in women starting IVF or ICSI treatment? SUMMARY ANSWER: In women initiating IVF/ICSI, AFC-based individualized FSH dosing does not improve live birth rates or reduce costs as compared to a standard FSH dose. WHAT IS KNOWN ALREADY: In IVF or ICSI, ovarian reserve testing is often used to adjust the FSH dose in order to normalize ovarian response and optimize live birth rates...
November 7, 2017: Human Reproduction
https://www.readbyqxmd.com/read/29117748/ward-round-simulation-in-final-year-medical-students-does-it-promote-students-learning
#12
Claudia Behrens, Diana H J M Dolmans, Jimmie Leppink, Gerard J Gormley, Erik W Driessen
INTRODUCTION: Ward round skills are essential for doctors in hospital settings. Literature shows medical students' deficiencies in these skills. Simulation has been used to train these skills. However, exposing learners to simulation at an early stage may be associated with a high cognitive load and limited learning. This study aims to determine how students experience this load and its interplay with performance and which factors promote and impair learning. METHODS: Fifty-six final year medical students participated in a simulated ward round training exercise...
November 9, 2017: Medical Teacher
https://www.readbyqxmd.com/read/29117055/improving-patient-experience-through-nursing-satisfaction
#13
Amanda McNicholas, Abby McCall, Alanna Werner, Ronda Wounderly, Erin Marinchak, Pamela Jones
Patient experience is a vital component of quality health care. In our institution we sought to improve both nursing satisfaction and collaboration, in conjunction with improving patient experience, predicting the two are directly proportional. We hypothesized that a more satisfied nursing team would result in an overall improvement in patient experience. To explore this hypothesis, we implemented multiple process changes to create an advanced practitioner-directed floor (APDF) on our 28-bed trauma, medical-surgical unit...
November 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/29114060/ethics-rounds-death-after-pediatric-dental-anesthesia-an-avoidable-tragedy
#14
Helen Lee, Peter Milgrom, Colleen E Huebner, Philip Weinstein, Wylie Burke, Erika Blacksher, John D Lantos
Early childhood caries (ECC) is the single most common chronic childhood disease. In the treatment of ECC, children are often given moderate sedation or general anesthesia. An estimated 100 000 to 250 000 pediatric dental sedations are performed annually in the United States. The most common medications are benzodiazepines, opioids, local anesthetics, and nitrous oxide. All are associated with serious adverse events, including hypoxemia, respiratory depression, airway obstruction, and death. There is no mandated reporting of adverse events or deaths, so we don't know how often these occur...
November 7, 2017: Pediatrics
https://www.readbyqxmd.com/read/29110186/patient-safety-ward-round-checklist-via-an-electronic-app-implications-for-harm-prevention
#15
C Keller, S Arsenault, M Lamothe, S R Bostan, R O'Donnell, J Harbison, C P Doherty
INTRODUCTION: Patient safety is a value at the core of modern healthcare. Though awareness in the medical community is growing, implementing systematic approaches similar to those used in other high reliability industries is proving difficult. The aim of this research was twofold, to establish a baseline for patient safety practices on routine ward rounds and to test the feasibility of implementing an electronic patient safety checklist application. METHODS: Two research teams were formed; one auditing a medical team to establish a procedural baseline of "usual care" practice and an intervention team concurrently was enforcing the implementation of the checklist...
November 6, 2017: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/29107679/efficacy-and-safety-of-selective-internal-radiotherapy-with-yttrium-90-resin-microspheres-compared-with-sorafenib-in-locally-advanced-and-inoperable-hepatocellular-carcinoma-sarah-an-open-label-randomised-controlled-phase-3-trial
#16
Valérie Vilgrain, Helena Pereira, Eric Assenat, Boris Guiu, Alina Diana Ilonca, Georges-Philippe Pageaux, Annie Sibert, Mohamed Bouattour, Rachida Lebtahi, Wassim Allaham, Hélène Barraud, Valérie Laurent, Elodie Mathias, Jean-Pierre Bronowicki, Jean-Pierre Tasu, Rémy Perdrisot, Christine Silvain, René Gerolami, Olivier Mundler, Jean-Francois Seitz, Vincent Vidal, Christophe Aubé, Frédéric Oberti, Olivier Couturier, Isabelle Brenot-Rossi, Jean-Luc Raoul, Anthony Sarran, Charlotte Costentin, Emmanuel Itti, Alain Luciani, René Adam, Maïté Lewin, Didier Samuel, Maxime Ronot, Aurelia Dinut, Laurent Castera, Gilles Chatellier
BACKGROUND: Sorafenib is the recommended treatment for patients with advanced hepatocellular carcinoma. We aimed to compare the efficacy and safety of sorafenib to that of selective internal radiotherapy (SIRT) with yttrium-90 ((90)Y) resin microspheres in patients with hepatocellular carcinoma. METHODS: SARAH was a multicentre, open-label, randomised, controlled, investigator-initiated, phase 3 trial done at 25 centres specialising in liver diseases in France. Patients were eligible if they were aged at least 18 years with a life expectancy greater than 3 months, had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, Child-Pugh liver function class A or B score of 7 or lower, and locally advanced hepatocellular carcinoma (Barcelona Clinic Liver Cancer [BCLC] stage C), or new hepatocellular carcinoma not eligible for surgical resection, liver transplantation, or thermal ablation after a previously cured hepatocellular carcinoma (cured by surgery or thermoablative therapy), or hepatocellular carcinoma with two unsuccessful rounds of transarterial chemoembolisation...
October 26, 2017: Lancet Oncology
https://www.readbyqxmd.com/read/29103335/nummular-headache-an-update-and-future-prospects
#17
María Luz Cuadrado, Pedro López-Ruiz, Ángel L Guerrero
Nummular headache (NH) is characterized by continuous or intermittent head pain, which remains confined to a round or oval shaped area of the scalp, generally 1 to 6 cm in diameter. Usually mild or moderate in intensity, some patients suffer severe acute exacerbations or continuous disabling pain. Areas covered: This article reviews epidemiological and clinical features of NH, the most recently proposed pathophysiological mechanisms, and state-of-the-art management according to the literature. Expert commentary: Information regarding true incidence and prevalence is lacking, but NH is a fairly common disorder in patients attending a headache clinic...
November 9, 2017: Expert Review of Neurotherapeutics
https://www.readbyqxmd.com/read/29094620/tele-attending-can-emulate-and-even-improve-bedside-teaching-and-learning
#18
Robert J Adams
Telemedicine can be used for education as well as clinical care. Wearable platforms now allow a remote student to "tele-present" cases to "Tele-Attending" elsewhere in real time. Most of the features that medical students rate as important can be accommodated in this paradigm. Augmenting the bedside case presentation with teaching material from on-line sources may even improve bedside rounds. Tele-attending should be explored in particular to meet needs of students at Regional Medical Centers.
November 2, 2017: Medical Teacher
https://www.readbyqxmd.com/read/29091976/what-s-the-purpose-of-rounds-a-qualitative-study-examining-the-perceptions-of-faculty-and-students
#19
Oliver Hulland, Jeanne Farnan, Raphael Rabinowitz, Lisa Kearns, Michele Long, Bradley Monash, Priti Bhansali, H Barrett Fromme
BACKGROUND: Rounds are a critical activity on any inpatient service, but there is little literature describing the purpose of rounds from the perspective of faculty and trainees in teaching hospitals. OBJECTIVE: To evaluate and compare the perceptions of pediatric and internal medicine attendings and medical students regarding the purpose of inpatient attending rounds. METHODS: The authors conducted 10 semistructured focus groups with attendings and medical students in the spring of 2014 at 4 teaching hospitals...
November 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29090251/prognosis-following-dental-implant-treatment-under-general-anesthesia-in-patients-with-special-needs
#20
Il-Hyung Kim, Tae Seong Kuk, Sang Yoon Park, Yong-Suk Choi, Hyun Jeong Kim, Kwang-Suk Seo
BACKGROUND: This study retrospectively investigated outcomes following dental implantation in patients with special needs who required general anesthesia to enable treatment. METHODS: Patients underwent implant treatment under general anesthesia at the Clinic for the Disabled in Seoul National University Dental Hospital between January 2004 and June 2017. The study analyzed medical records and radiographs. Implant survival rates were calculated by applying criteria for success or failure...
September 2017: J Dent Anesth Pain Med
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