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expectant management

I-Shiang Tzeng, Su-Hsun Liu, Kuan-Fu Chen, Chin-Chieh Wu, Jih-Chang Chen
To reduce patient boarding time at the emergency department (ED) and to improve the overall quality of the emergent care system in Taiwan, the Minister of Health and Welfare of Taiwan (MOHW) piloted the Grading Responsible Hospitals for Acute Care (GRHAC) audit program in 2007-2009.The aim of the study was to evaluate the impact of the GRHAC audit program on the identification and management of acute myocardial infarction (AMI)-associated ED visits by describing and comparing the incidence of AMI-associated ED visits before (2003-2007), during (2007-2009), and after (2009-2012) the initial audit program implementation...
October 2016: Medicine (Baltimore)
Nancy J Carballo, Cathy A Alessi, Jennifer L Martin, Michael N Mitchell, Ron D Hays, Nananda Col, Emily S Patterson, Stella Jouldjian, Karen Josephson, Constance H Fung
PURPOSE: Obstructive sleep apnea is a prevalent sleep disorder among older adults. Oral appliances are increasingly prescribed as therapy for obstructive sleep apnea. Adherence to oral appliance therapy is highly variable. Based on value-expectancy theory and other social-psychological theories, adherence to oral appliance therapy may be influenced by patients' perceived effectiveness of the therapy, self-efficacy, and availability of social support. We examined these perceptions among older adults with obstructive sleep apnea who were prescribed oral appliance therapy...
October 14, 2016: Clinical Therapeutics
M Sánchez Mollá, I Candela García, F J Gómez-Romero, D Orozco Beltrán, M Ollero Baturone
OBJECTIVE: To determine the prevalence of patients with multiple chronic diseases in Primary Care using the multiple morbidity criteria and Clinical Risk Groups, and the agreement in identifying high-risk patients that require case management with both methods. MATERIAL AND METHOD: A cross-sectional study was conducted on 240 patients, selected by random sampling of 16 care quotas from two Primary Health Care centres of a health area. Informed consent was obtained to access their electronic medical records for the study, and a record was made of age, sex, health status of Clinical Risk Groups, severity, multiple morbidity criteria, and Charlson index by physicians during clinical practice...
October 14, 2016: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
Carlos M Mery, Keila N Lopez, Silvana Molossi, S Kristen Sexson-Tejtel, Rajesh Krishnamurthy, E Dean McKenzie, Charles D Fraser, Scott B Cantor
OBJECTIVES: The goal of this study was to use decision analysis to evaluate the impact of varying uncertainties on the outcomes of patients with anomalous aortic origin of a coronary artery. METHODS: Two separate decision analysis models were created: one for anomalous left coronary artery (ALCA) and one for anomalous right coronary artery (ARCA). Three strategies were compared: observation, exercise restriction, and surgery. Probabilities and health utilities were estimated on the basis of existing literature...
November 2016: Journal of Thoracic and Cardiovascular Surgery
Sarah Brudler, Karsten Arnbjerg-Nielsen, Michael Zwicky Hauschild, Martin Rygaard
Expected increases in pluvial flooding, due to climatic changes, require large investments in the retrofitting of cities to keep damage at an acceptable level. Many cities have investigated the possibility of implementing stormwater management (SWM) systems which are multi-functional and consist of different elements interacting to achieve desired safety levels. Typically, an economic assessment is carried out in the planning phase, while environmental sustainability is given little or no attention. In this paper, life cycle assessment is used to quantify environmental impacts of climate change adaptation strategies...
October 11, 2016: Water Research
Deepanshu Jain, Ejaz Mahmood, Shashideep Singhal
Benign intestine strictures secondary to postoperative narrowing or inflammatory bowel disease can be managed surgically or conservatively. Some patients may not be suitable surgical candidates and some patients may choose not to have repeat surgery. Biodegradable (BD) stents offer a prolonged dilatory effect before gradual degradation and obviates the need of a second procedure for stent removal. BD stents have high technical success rates (mean, 94.4%; median, 100%; range, 86% to 100%) but widely variable clinical success rates (range, 45% to 100%)...
October 4, 2016: Journal of Clinical Gastroenterology
D Kojo Hamilton, Christopher Kong, Jayme Hiratzka, Alec G Contag, Tamir Ailon, Breton Line, Alan Daniels, Justin S Smith, Peter Passias, Themistocles Protopsaltis, Daniel Sciubba, Douglas Burton, Christopher Shaffrey, Eric Klineberg, Gregory Mundis, Han-Jo Kim, Virginie Lafage, Renaud Lafage, Justin Scheer, Oheneba Boachie-Adjei, Shay Bess, Robert Hart
STUDY DESIGN: This is a multicenter retrospective review of prospectively collected cases. OBJECTIVE: Our objective was to evaluate the relationship between patient satisfaction, HRQoL scores, complications, and radiographic measures at 2 years post-operative follow-up. SUMMARY OF BACKGROUND DATA: For patients receiving operative management for adult spine deformity (ASD), the relationship between health-related quality of life (HRQoL) measures, radiographic parameters, post-operative complications, and self-reported satisfaction remains unclear...
September 29, 2016: Spine
Maxime Luu, Marc Bardou, Philippe Bonniaud, Françoise Goirand
Omalizumab is a subcutaneously administrated monoclonal anti-IgE antibody indicated in adults, adolescents and children 6 years of age and older with moderate to severe allergic asthma uncontrolled by conventional pharmacological treatments and sensitization to at least one perennial allergen. Area covered: This drug evaluation summarizes published data on pharmacokinetic and pharmacodynamic properties of omalizumab, on clinical efficacy and safety, including real-world evidence, and provides a medico-economic evaluation of the drug...
October 17, 2016: Expert Opinion on Drug Metabolism & Toxicology
Melanie S Fischer, Donald H Baucom, Brian R Baucom, Jonathan S Abramowitz, Jennifer S Kirby, Cynthia M Bulik
Impaired emotion regulation and maladaptive strategies to manage distress are central to psychopathology, including obsessive-compulsive disorder (OCD) and anorexia nervosa (AN). Emotion regulation can be fostered or thwarted by romantic partners, and the tendency to rely on interpersonally oriented emotion regulation may vary by disorder. This study examined coregulation as a form of interpersonal emotion regulation in OCD and AN. We hypothesized that OCD is associated with exaggerated and AN with diminished coregulation, and that OCD patients have greater overall levels of emotional arousal than AN patients...
October 17, 2016: Journal of Family Psychology: JFP
Yu Sun Bin, Christine L Roberts, Michael C Nicholl, Natasha Nassar, Jane B Ford
BACKGROUND: Recent population-wide changes in perinatal risk factors may affect rates of breech presentation at birth, and have implications for the provision of breech services and training in breech management. AIMS: To investigate whether changes in maternal and pregnancy characteristics explain the observed trend in breech presentation at term. MATERIALS AND METHODS: All singleton term (≥37 week) births in New South Wales during 2002-2012 were identified through birth and associated hospital records...
October 17, 2016: Australian & New Zealand Journal of Obstetrics & Gynaecology
Angela Vitrano, Giuseppina Calvaruso, Eliana Lai, Grazia Colletta, Alessandra Quota, Calogera Gerardi, Luciana Concetta Rigoli, Lorella Pitrolo, Liana Cuccia, Francesco Gagliardotto, Aldo Filosa, Vincenzo Caruso, Crocetta Argento, Saveria Campisi, Michele Rizzo, Luciano Prossomariti, Carmelo Fidone, Maria Fustaneo, Rosario Di Maggio, Aurelio Maggio
In the last few decades, the life expectancy of regularly transfused β-thalassaemia major (TM) patients has dramatically improved following the introduction of safe transfusion practices, iron chelation therapy, aggressive treatment of infections and improved management of cardiac complications. How such changes, especially those attributed to the introduction of iron chelation therapy, improved the survival of TM patients to approach those with β-thalassaemia intermedia (TI) remains unknown. Three hundred and seventy-nine patients with TM (n = 284, dead 40) and TI (n = 95, dead 13) were followed retrospectively since birth until 30 June 2015 or death...
October 17, 2016: British Journal of Haematology
Marie Christine Iliou, Jean Christophe Blanchard, Aurélia Lamar-Tanguy, Pascal Cristofini, François Ledru
Large subsets of patients admitted in cardiac rehabilitation centers are having a pacemaker, cardiac resynchronization (CRT) or implantable cardiac defibrillator (ICD). Cardiac rehabilitation for patients, mostly with heart failure, with implanted electronic devices as pacemakers or ICD is a unique opportunity not only to optimize the medical treatment, to increase their exercise capacity and improves their clinical condition but also to supervise the correct functioning of the device. CRT reduces clinical symptoms and increases slightly the exercise capacity...
October 14, 2016: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
John E Stone, Peter Messmer, Robert Sisneros, Klaus Schulten
Large scale molecular dynamics simulations produce terabytes of data that is impractical to transfer to remote facilities. It is therefore necessary to perform visualization tasks in-situ as the data are generated, or by running interactive remote visualization sessions and batch analyses co-located with direct access to high performance storage systems. A significant challenge for deploying visualization software within clouds, clusters, and supercomputers involves the operating system software required to initialize and manage graphics acceleration hardware...
May 2016: IEEE International Symposium on Parallel & Distributed Processing, Workshops and Phd Forum: [proceedings]
Qingqi Yue, Ao Yuan, Xuan Che, Minh Huynh, Chunxiao Zhou
The Office of Disability Adjudication and Review (ODAR) is responsible for holding hearings, issuing decisions, and reviewing appeals as part of the Social Security Administration's disability determining process. In order to control and process cases, the ODAR has established a Case Processing and Management System (CPMS) to record management information since December 2003. The CPMS provides a detailed case status history for each case. Due to the large number of appeal requests and limited resources, the number of pending claims at ODAR was over one million cases by March 31, 2015...
August 2016: KDD: Proceedings
Dearbhaile C Collins, Kyra Velázquez-Kennedy, Sandra Deady, Adrian P Brady, Paul Sweeney, Derek G Power
Urachal carcinoma is an uncommon cancer whose rarity has precluded its study and evidence-based management strategies are lacking. This study assessed all urachal carcinomas in Ireland and clinical parameters in order to improve understanding. Urachal carcinomas diagnosed from 1994 to 2011 were identified from the National Cancer Registry in Ireland. Data obtained included patient age, gender, diagnostic year, pathology, tumor stage, patient treatment strategies and survival. Twenty-six urachal carcinomas were identified, the majority being adenocarcinoma...
September 5, 2016: Rare Tumors
Anne M Boonstra, Roy E Stewart, Albère J A Köke, René F A Oosterwijk, Jeannette L Swaan, Karlein M G Schreurs, Henrica R Schiphorst Preuper
Objectives: The 0-10 Numeric Rating Scale (NRS) is often used in pain management. The aims of our study were to determine the cut-off points for mild, moderate, and severe pain in terms of pain-related interference with functioning in patients with chronic musculoskeletal pain, to measure the variability of the optimal cut-off points, and to determine the influence of patients' catastrophizing and their sex on these cut-off points. Methods: 2854 patients were included. Pain was assessed by the NRS, functioning by the Pain Disability Index (PDI) and catastrophizing by the Pain Catastrophizing Scale (PCS)...
2016: Frontiers in Psychology
Nathan Young, Marianne Corriveau, Vivian M Nguyen, Steven J Cooke, Scott G Hinch
This article examines how potential users of scientific and local/traditional/experiential knowledge evaluate new claims to knowing, using 67 interviews with government employees and non-governmental stakeholders involved in co-managing salmon fisheries in Canada's Fraser River. Research has consistently shown that there are major obstacles to moving new knowledge into policy, management, and public domains. New concepts such as Knowledge Exchange (KE) and Knowledge Mobilization (KMb) are being used to investigate these obstacles, but the processes by which potential users evaluate (sometimes competing) knowledge claims remain poorly understood...
October 10, 2016: Journal of Environmental Management
L Guillod, S Habersaat, M Suter, T Jeanneret, C Bertoni, P Stéphan, S Urben
BACKGROUND: Adolescence is a stressful period where important biological, psychological and social changes occur. Adolescents are particularly vulnerable during this developmental period and can use various strategies to deal with daily stress, such as substance use or externalizing behaviors. In previous studies, stress in adolescents with externalizing behaviors was often linked to ineffective cognitive coping strategies (i.e., constructive thinking) and overlooking the biological aspects involved in stress management such as neuroendocrine regulation...
October 10, 2016: L'Encéphale
(no author information available yet)
Janet Morrison writing in Nursing Older People says that care home managers should challenge the belief that expectations in later life are low and instead engage older people in creative programmes. The author, CEO at the Baring Foundation, says that story-telling, comedy, and art can enhance self-esteem, confidence and mental wellbeing for older people in the community and in care homes.
September 14, 2016: Nursing Standard
Savita Katbamna, Lisa Manning, Amit Mistri, Mark Johnson, Thompson Robinson
OBJECTIVES: This paper presents the findings of a qualitative study exploring White and British Indian informal stroke carers' experiences of caring, factors contributing to their stress, and strategies used to overcome stress. DESIGN: A qualitative approach involving in-depth interviews was used to explore informal carers' experiences of caring for stroke survivors and the stress of caring at one and three to six months from the onset of stroke. Interviewers bilingual in English and Gujarati or Punjabi conducted interviews with carers...
October 15, 2016: Ethnicity & Health
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