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https://www.readbyqxmd.com/read/29352649/optimal-use-of-peri-operative-human-chorionic-gonadotrophin-concentrations-to-identify-persistent-ectopic-pregnancy-after-laparoscopic-salpingostomy-a-retrospective-cohort-study
#1
Abraham N Morse, Wenyue Si, Shuang Qin, Huiying Liang
The aim of this study was to improve clinical decision-making for the identification of persistent ectopic pregnancy after linear salpingostomy. The study identified 854 laparoscopic salpingostomies performed between 2011 and 2016; 794 had a human chorionic gonadotrophin (HCG) <10 mIU/ml documented in the electronic medical record within 1 month after surgery ('successes'). Sixty (7%) received either methotrexate or repeat surgery for persistent ectopic pregnancy ('failures'). Five hundred and seventeen, including 46 'failures', had two or more immediate post-operative HCG measurements available...
December 28, 2017: Reproductive Biomedicine Online
https://www.readbyqxmd.com/read/29351893/a-clinical-decision-support-engine-based-on-a-national-medication-repository-for-the-detection-of-potential-duplicate-medications-design-and-evaluation
#2
Cheng-Yi Yang, Yu-Sheng Lo, Ray-Jade Chen, Chien-Tsai Liu
BACKGROUND: A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients' integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients' medication records prescribed by different health care facilities across Taiwan...
January 19, 2018: JMIR Medical Informatics
https://www.readbyqxmd.com/read/29351876/vital-signs-analysis-algorithm-detects-inflammatory-response-in-premature-infants-with-late-onset-sepsis-and-necrotizing-enterocolitis
#3
Leena B Mithal, Ram Yogev, Hannah L Palac, Daniel Kaminsky, Ilan Gur, Karen K Mestan
BACKGROUND: Nonspecific clinical signs and suboptimal diagnostic tests limit accurate identification of late onset sepsis (LOS) and necrotizing enterocolitis (NEC) in premature infants, resulting in significant morbidity and antibiotic overuse. An infant's systemic inflammatory response may be identified earlier than clinical suspicion through analysis of multiple vital signs by a computerized algorithm (RALIS). AIM: To evaluate the revised RALIS algorithm for detection of LOS and NEC in preterm infants...
January 16, 2018: Early Human Development
https://www.readbyqxmd.com/read/29351748/a-comparative-study-of-three-conservative-treatments-in-patients-with-lumbar-spinal-stenosis-lumbar-spinal-stenosis-with-acupuncture-and-physical-therapy-study-lap-study
#4
Hiroyuki Oka, Ko Matsudaira, Yuichi Takano, Daichi Kasuya, Masaki Niiya, Juichi Tonosu, Masayoshi Fukushima, Yasushi Oshima, Tomoko Fujii, Sakae Tanaka, Hirohiko Inanami
BACKGROUND: Although the efficiency of conservative management for lumbar spinal stenosis (LSS) has been examined, different conservative management approaches have not been compared. We have performed the first comparative trial of three types of conservative management (medication with acetaminophen, exercise, and acupuncture) in Japanese patients with LSS. METHODS: Patients with L5 root radiculopathy associated with LSS who visited our hospital for surgical treatment were enrolled between December 2011 and January 2014...
January 19, 2018: BMC Complementary and Alternative Medicine
https://www.readbyqxmd.com/read/29351736/studying-medical-communication-with-video-vignettes-a-randomized-study-on-how-variations-in-video-vignette-introduction-format-and-camera-focus-influence-analogue-patients-engagement
#5
Leonie N C Visser, Nadine Bol, Marij A Hillen, Mathilde G E Verdam, Hanneke C J M de Haes, Julia C M van Weert, Ellen M A Smets
BACKGROUND: Video vignettes are used to test the effects of physicians' communication on patient outcomes. Methodological choices in video-vignette development may have far-stretching consequences for participants' engagement with the video, and thus the ecological validity of this design. To supplement the scant evidence in this field, this study tested how variations in video-vignette introduction format and camera focus influence participants' engagement with a video vignette showing a bad news consultation...
January 19, 2018: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/29351735/assessing-the-effect-of-a-partly-unobserved-exogenous-binary-time-dependent-covariate-on-survival-probabilities-using-generalised-pseudo-values
#6
Ulrike Pötschger, Harald Heinzl, Maria Grazia Valsecchi, Martina Mittlböck
BACKGROUND: Investigating the impact of a time-dependent intervention on the probability of long-term survival is statistically challenging. A typical example is stem-cell transplantation performed after successful donor identification from registered donors. Here, a suggested simple analysis based on the exogenous donor availability status according to registered donors would allow the estimation and comparison of survival probabilities. As donor search is usually ceased after a patient's event, donor availability status is incompletely observed, so that this simple comparison is not possible and the waiting time to donor identification needs to be addressed in the analysis to avoid bias...
January 19, 2018: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/29351371/implementation-of-standardized-clinical-processes-for-tpmt-testing-in-a-diverse-multidisciplinary-population-challenges-and-lessons-learned
#7
Kristin W Weitzel, D Max Smith, Amanda R Elsey, Benjamin Q Duong, Benjamin Burkley, Michael Clare-Salzler, Yan Gong, Tara A Higgins, Benjamin Kong, Taimour Langaee, Caitrin W McDonough, Benjamin J Staley, Teresa T Vo, Dyson T Wake, Larisa H Cavallari, Julie A Johnson
Although thiopurine S-methyltransferase (TPMT) genotyping to guide thiopurine dosing is common in the pediatric cancer population, limited data exist on TPMT testing implementation in diverse, multidisciplinary settings. We established TPMT testing (genotype and enzyme) with clinical decision support, provider/patient education, and pharmacist consultations in a tertiary medical center and collected data over 3 years. During this time, 834 patients underwent 873 TPMT tests (147 (17%) genotype, 726 (83%) enzyme)...
January 19, 2018: Clinical and Translational Science
https://www.readbyqxmd.com/read/29351053/patient-variability-seldom-assessed-in-cost-effectiveness-studies
#8
Tara A Lavelle, David M Kent, Christine M Lundquist, Teja Thorat, Joshua T Cohen, John B Wong, Natalia Olchanski, Peter J Neumann
BACKGROUND: Cost-effectiveness analysis (CEA) estimates can vary substantially across patient subgroups when patient characteristics influence preferences, outcome risks, treatment effectiveness, life expectancy, or associated costs. However, no systematic review has reported the frequency of subgroup analysis in CEA, what type of heterogeneity they address, and how often heterogeneity influences whether cost-effectiveness ratios exceed or fall below conventional thresholds. METHODS: We reviewed the CEA literature cataloged in the Tufts Medical Center CEA Registry, a repository describing cost-utility analyses published through 2016...
January 1, 2018: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/29351046/young-adults-experience-of-appearance-altering-orthognathic-surgery-a-longitudinal-interpretative-phenomenologic-analysis
#9
Morna J Liddle, Sarah R Baker, Keith G Smith, Andrew R Thompson
OBJECTIVE: To gain an experiential account of the processes of change associated specifically with orthognathic surgery. DESIGN: A qualitative design was used. Semistructured interviews were carried out with 7 participants approximately 1 week before and 6-8 weeks after surgery. The data were analyzed using interpretative phenomenologic analysis (IPA). SETTING: Participants were recruited from a NHS Dental Hospital. PARTICIPANTS: Patients aged 16 to 25 years scheduled to undergo orthognathic surgery on both the upper and lower jaws were purposively sought to participate...
February 2018: Cleft Palate-craniofacial Journal
https://www.readbyqxmd.com/read/29350780/an-evolutionary-concept-analysis-of-futility-in-healthcare
#10
Lauren Morata
AIM: To report a concept analysis of futility in healthcare. BACKGROUND: Each member of the healthcare team, the physician, the nurse, the patient, the family and all others involved perceive futility differently. The current evidence and knowledge in regard to futility in healthcare manifest a plethora of definitions, meanings and interpretations without consensus. DESIGN: Concept analysis. DATA SOURCES: Databases searched included Medline, Cumulative Index of Nursing and Allied Health Literature, Academic Search Premier, Cochrane Database of Systematic Reviews and PsycINFO...
January 19, 2018: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/29350672/rebounds-after-discharge-from-the-emergency-department-for-community-acquired-pneumonia-focus-on-the-usefulness-of-severity-scoring-systems
#11
Rodolfo Ferrari, Pierluigi Viale, Paolo Muratori, Fabrizio Giostra, Daniela Agostinelli, Roberto Lazzari, Riccardo Voza, Mario Cavazza
BACKGROUND: Community-acquired pneumonia (CAP) is common cause of hospital admission and leading cause of morbidity and mortality. Severity scoring systems are used to predict risk profile, outcome and mortality, and to help decisions about management strategies. Aim of the work and Methods: To critically analyze pneumonia "rebound" cases, once discharged from the emergency department (ED) and afterwards admitted. We conducted an observational clinical study in the acute setting of a university teaching hospital, prospectively analyzing, in a 1 year period, demographic, medical, clinical and laboratory data, and the outcome...
January 16, 2018: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/29350514/hospitalized-patients-and-family-members-preferences-for-real-time-transparent-access-to-their-hospital-records
#12
Michael J Waxman, Kurt Lozier, Lana Vasiljevic, Kira Novakofski, James Desemone, John O'Kane, Elizabeth M Dufort, David Wood, Ashar Ata, Louis Filhour, Richard J Blinkhorn
OBJECTIVES: To better understand patient satisfaction and perceived engagement with traditional hospital-based communication and to elicit patient preferences for health information technologies that would lead to improved satisfaction and engagement. STUDY DESIGN: We performed a mixed-methods study involving qualitative interviews followed by a survey of hospitalized patients and their family members at a single large academic medical center. METHODS: We conducted semi-structured interviews with 41 patients and surveyed 267 patients or family members to elicit their perspectives on satisfaction with traditional hospital communication methods, information needed to more fully engage in the patients' medical care, and potential solutions for improved hospital-based communication...
January 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29350363/is-nighttime-laparoscopic-general-surgery-under-general-anesthesia-safe
#13
Ahmet Kemalettin Koltka, Mehmet İlhan, Achmet Ali, Ali Fuat Kaan Gök, Nükhet Sivrikoz, Teoman Hakan Yanar, Mustafa Kayıhan Günay, Cemalettin Ertekin
BACKGROUND: Fatigue and sleep deprivation can affect rational decision-making and motor skills, which can decrease medical performance and quality of patient care. The aim of the present study was to investigate the association between times of the day when laparoscopic general surgery under general anesthesia was performed and their adverse outcomes. METHODS: All laparoscopic cholecystectomies and appendectomies performed at the emergency surgery department of a tertiary university hospital from 01...
January 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/29349833/a-systematic-assessment-of-key-design-and-performance-characteristics-of-drug-exposure-registries-requested-by-the-u-s-food-and-drug-administration
#14
Yanling Zhao, Ellen Pinnow, Jacqueline M Major
PURPOSE: The purpose of the study is to evaluate contributions to postmarket safety assessments and identify potential factors for enhancing implementation and utilization of registries in regulatory decision-making. METHODS: Registry documents (e.g., protocols, reports) submitted to the FDA were identified up to January 2016 through an extensive, systematic review of internal records and resources. We characterized nonpregnancy drug exposure registries based on prespecified design elements, performance, and regulatory impact...
January 19, 2018: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/29349791/predicting-patterns-of-change-and-stability-in-student-performance-across-a-medical-degree
#15
Barbara Griffin, Piers Bayl-Smith, Wendy Hu
CONTEXT: Evidence of predictive validity is essential for making robust selection decisions in high-stakes contexts such as medical student selection. Currently available evidence is limited to the prediction of academic performance at single points in time with little understanding of the factors that might undermine the predictive validity of tests of academic and non-academic qualities considered important for success. This study addressed these issues by predicting students' changing performance across a medical degree and assessing whether factors outside an institution's control (such as the uptake of commercial coaching) impact validity...
January 19, 2018: Medical Education
https://www.readbyqxmd.com/read/29349711/impact-of-an-embedded-genetic-counselor-on-breast-cancer-treatment
#16
Holly J Pederson, Najaah Hussain, Ryan Noss, Courtney Yanda, Colin O'Rourke, Charis Eng, Stephen R Grobmyer
BACKGROUND: We predicted that embedding a genetic counselor within our breast practice would improve identification of high-risk individuals, timeliness of care, and appropriateness of surgical decision making. The aim of this study is to compare cancer care between 2012 and 2014, prior to embedding a genetic counselor in the breast center and following the intervention, respectively. METHODS: A retrospective review of patients diagnosed with breast cancer in 2012 (n = 471) and 2014 (n = 440) was performed to assess patterns of medical genetics referral, compliance with referral, genetic testing findings, and impact on treatment...
January 18, 2018: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/29349622/transfusion-practice-patterns-in-patients-with-anemia-receiving-myelosuppressive-chemotherapy-for-nonmyeloid-cancer-results-from-a-prospective-observational-study
#17
James Granfortuna, Kaye Shoffner, Stephen E DePasquale, Sejal Badre, Chet Bohac, Cisio De Oliveira Brandao
PURPOSE: The decision to prescribe packed red blood cell (PRBC) transfusions in patients with chemotherapy-induced anemia (CIA) includes assessment of clinical features such as the patient's cancer type and treatment regimen, severity of anemia symptoms, and presence of comorbidities. We examined contemporary transfusion practices in patients with nonmyeloid cancer and CIA. METHODS: Key inclusion criteria were age ≥ 18 years with nonmyeloid cancer, receiving first/second-line myelosuppressive chemotherapy, baseline hemoglobin (Hb) ≤ 10...
January 19, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29349590/law-as-clinical-evidence-a-new-constitutivemodel-of-medical-education-and-decision-making
#18
Malcolm Parker, Lindy Willmott, Ben White, Gail Williams, Colleen Cartwright
Over several decades, ethics and law have been applied to medical education and practice in a way that reflects the continuation during the twentieth century of the strong distinction between facts and values. We explain the development of applied ethics and applied medical law and report selected results that reflect this applied model from an empirical project examining doctors' decisions on withdrawing/withholding treatment from patients who lack decision-making capacity. The model is critiqued, and an alternative "constitutive" model is supported on the basis that medicine, medical law, and medical ethics exemplify the inevitable entanglement of facts and values...
January 18, 2018: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/29349524/-qualification-and-classification-of-medical-apps-what-should-be-noted-and-what-is-bfarm-s-contribution
#19
REVIEW
Nicole Rämsch-Günther, Sylvia Stern, Wolfgang Lauer
Smartphones and tablets with their nearly unlimited number of different applications have become an integral part of everyday life. Thus, mobile devices and applications have also found their way into the healthcare sector.For developers, manufacturers, or users as well, it is often difficult to decide whether a mobile health application is a medical device.In this context, it is extremely important for manufacturers to decide at an early stage of the development whether the product is to be introduced into the market as a medical device and is therefore subject to the legislation on medical devices...
January 18, 2018: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
https://www.readbyqxmd.com/read/29348275/microangiopathies-in-pregnancy
#20
Jailan Elayoubi, Kavitha Donthireddy, Divyesh Reddy Nemakayala
Thrombotic thrombocytopenic purpura (TTP) is a potentially reversible, life-threatening medical emergency. We present a case of a 21-year-old female with evidence of haemolytic anaemia based on the presence of positive markers of haemolysis. Negative Coomb's test, thrombocytopenia and placental infarcts raised suspicion for a thrombotic microangiopathy. She was diagnosed with TTP and managed with emergency plasma exchange. Her recovery was immediate.A presumptive diagnosis of TTP should be based on the presence of microangiopathic haemolytic anaemia with thrombocytopenia and plasma exchange should be initiated while complete work up is pending...
January 17, 2018: BMJ Case Reports
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