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Escalation of care

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https://www.readbyqxmd.com/read/28528239/the-experiences-of-women-midwives-and-obstetricians-when-women-decline-recommended-maternity-care-a-feminist-thematic-analysis
#1
Bec Jenkinson, Sue Kruske, Sue Kildea
BACKGROUND: pregnant women, like all competent adults, have the right to refuse medical treatment, although concerns about maternal and fetal safety can make doing so problematic. Empirical research about refusal of recommended maternity care has mostly described the attitudes of clinicians, with women's perspectives notably absent. DESIGN: feminist thematic analysis of in-depth, semi-structured interviews with women's (n=9), midwives' (n=12) and obstetricians' (n=9) about their experiences of refusal of recommended maternity care...
May 11, 2017: Midwifery
https://www.readbyqxmd.com/read/28524382/an-observational-study-of-patient-care-outcomes-sensitive-to-handover-quality-in-the-post-anaesthetic-care-unit
#2
Nichole Lillibridge, Mari Botti, Beverley Wood, Bernice Redley
AIMS AND OBJECTIVES: To identify patient care outcome indicators sensitive to the quality of interprofessional handover between the anaesthetist and the Post-Anaesthetic Care Unit nurse. BACKGROUND: The relationship between interprofessional clinical handover when patients are transferred from the operating theatre to the Post-Anaesthetic Care Unit and patient outcomes of subsequent patient care delivery is not well understood. DESIGN: Naturalistic, exploratory descriptive design using observation...
May 19, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28511960/inadequate-target-volume-delineation-and-local-regional-recurrence-after-intensity-modulated-radiotherapy-for-human-papillomavirus-positive-oropharynx-cancer
#3
Allen M Chen, Robert Chin, Philip Beron, Taeko Yoshizaki, Argin G Mikaeilian, Minsong Cao
PURPOSE: To perform a spatial analysis of local-regional recurrences, in relation to quantitative dose distribution, among patients treated by intensity-modulated radiotherapy (IMRT) for human papillomavirus (HPV)-positive oropharyngeal cancer. METHODS AND MATERIALS: The records of 107 consecutive patients who presented for consideration of re-irradiation for local-regional recurrent disease occurring in a previously irradiated field were reviewed. The original IMRT plans were retrieved for those with HPV-positive disease originating from the oropharynx, and deformable image registration was used to fuse the magnetic resonance imaging (MRI) and positron emission tomography (PET) scans obtained at recurrence to the pre-treatment planning computed tomography (CT) dataset...
May 13, 2017: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
https://www.readbyqxmd.com/read/28506865/protocol-driven-neurological-prognostication-and-withdrawal-of-life-sustaining-therapy-after-cardiac-arrest-and-targeted-temperature-management
#4
Irina Dragancea, Matthew P Wise, Nawaf Al-Subaie, Julius Cranshaw, Hans Friberg, Guy Glover, Tommaso Pellis, Rebecca Rylance, Andrew Walden, Niklas Nielsen, Tobias Cronberg
BACKGROUND: Brain injury is reportedly the main cause of death for patients resuscitated after out-of-hospital cardiac arrest (OHCA). However, the majority may actually die following withdrawal of life-sustaining therapy (WLST) with a presumption of poor neurological recovery. We investigated how the protocol for neurological prognostication was used and how related treatment recommendations might have affected WLST decision-making and outcome after OHCA in the Targeted Temperature Management (TTM) trial...
May 12, 2017: Resuscitation
https://www.readbyqxmd.com/read/28506082/novel-use-of-active-leptospermum-honey-for-ringed-fixator-pin-site-care-in-diabetic-charcot-deformity-patients
#5
Alexander L Lazarides, Kamran S Hamid, Michael S Kerzner
INTRODUCTION: Open reduction with external fixation (OREF) utilizing fine wire ringed fixators for correction of Charcot deformity has gained popularity over the past decade. Pin site infections are a well-documented complication of external fixation as well as a driver of escalating health care costs. We aimed to demonstrate the safety and efficacy of a novel method of pin site care utilizing active Leptospermum honey-impregnated dressings (MediHoney) in diabetic patients undergoing deformity correction with OREF...
May 1, 2017: Foot & Ankle Specialist
https://www.readbyqxmd.com/read/28501815/can-the-prehospital-national-early-warning-score-identify-patients-most-at-risk-from-subsequent-deterioration
#6
Joanna Shaw, Rachael T Fothergill, Sophie Clark, Fionna Moore
INTRODUCTION: The National Early Warning Score (NEWS) aids the early recognition of those at risk of becoming critically ill. NEWS has been recommended for use by ambulance services, but very little work has been undertaken to date to determine its suitability. This paper examines whether a prehospital NEWS derived from ambulance service clinical observations is associated with the hospital ED disposition. METHODS: Prehospital NEWS was retrospectively calculated from the ambulance service clinical records of 287 patients who were treated by the ambulance service and transported to hospital...
May 13, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28501751/the-state-of-everyday-quantitative-eeg-use-in-canada-a-national-technologist-survey
#7
Marcus C Ng, Kara Gillis
PURPOSE: This study sought to determine the state of quantitative EEG (QEEG) use in Canada, as QEEG may provide a partial solution to the issue of escalating EEG demand against insufficient health care resources. METHODS: A 10-item survey questionnaire was administered to participants at the annual meeting of the Canadian Association of Electroneurophysiology Technologists, which was held in parallel with the annual meeting of the Canadian Neurological Sciences Federation...
May 5, 2017: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/28501533/promising-modalities-to-identify-and-monitor-eosinophilic-esophagitis
#8
Girish Hiremath, Sandeep K Gupta
Eosinophilic esophagitis (EoE) is an allergen-mediated condition characterized by symptoms of esophageal dysfunction and histological evidence of intense eosinophilic inflammation involving the esophagus in absence of overlapping conditions such as gastroesophageal reflux disease. Since the initial description as a distinct entity about two decades ago, there has been a remarkable rise in the recognition of this clinico-pathologic entity. Current approach to diagnose and monitor EoE requires repeated esophagogastroduodenoscopies (EGDs), with associated sedation/anesthesia, to visualize mucosal abnormalities, and to obtain multiple biopsies for histologic assessment and to evaluate treatment response...
May 10, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28500923/history-injury-and-psychosocial-risk-factor-commonalities-among-cases-of-fatal-and-near-fatal-physical-child-abuse
#9
Mary Clyde Pierce, Kim Kaczor, Deborah Acker, Tina Webb, Allen Brenzel, Douglas J Lorenz, Audrey Young, Richard Thompson
Failure to recognize child maltreatment results in chronic exposure to high-risk environments where re-injury or death may occur. We analyzed a series (n=20) of fatal (n=10) and near-fatal (n=10) physical child abuse cases from the Commonwealth of Kentucky to identify commonalities and determine whether indicators of maltreatment were present prior to the child's fatal or near-fatal event. We conducted retrospective state record reviews involving children <4years of age classified as physical child abuse by the Cabinet for Health and Family Services during a 12 month period...
May 10, 2017: Child Abuse & Neglect
https://www.readbyqxmd.com/read/28500122/navigating-the-benefits-and-burdens-of-life-saving-treatment-in-severely-decompensated-cirrhosis-an-illustrative-multisourced-narrative
#10
Philip Berry, Kuldeep Cheent, Heather Lewis, Marcus Peck
Severely decompensated cirrhosis presents major challenges in terms of balancing the benefits and burdens of life-extending treatment. Using accounts and interviews with a patient, her mother, consultant hepatologists and a consultant intensivist, this article explores the decision making around a 43-year-old woman with alcoholic liver disease who died after 100 days in a hospital. Particular focus is given to decisions on escalation, recognition of futility, distress associated with therapy and how messages given during end-of-life discussions are processed...
May 12, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28499988/melanocortin-neurons-multiple-routes-to-regulation-of-metabolism
#11
REVIEW
Wen-Jie Shen, Ting Yao, Xingxing Kong, Kevin W Williams, Tiemin Liu
The burden of disability, premature death, escalating health care costs and lost economic productivity due to obesity and its associated complications including hypertension, stroke, cardiovascular disease and type 2 diabetes is staggering [1, 2]. A better understanding of metabolic homeostatic pathways will provide us with insights into the biological mechanisms of obesity and how to fundamentally address this epidemic [3-6]. In mammals, energy balance is maintained via a homeostatic system involving both peripheral and central melanocortin systems; changes in body weight reflect an unbalance of the energetic state [7-9]...
May 9, 2017: Biochimica et Biophysica Acta
https://www.readbyqxmd.com/read/28498877/high-end-of-life-health-care-costs-and-hospitalization-burden-in-inflammatory-bowel-disease-patients-a-population-based-study
#12
Sanjay K Murthy, Paul D James, Lilia Antonova, Mathieu Chalifoux, Peter Tanuseputro
BACKGROUND: End of life (EOL) care is associated with greater costs, particularly for acute care services. In patients with inflammatory bowel disease (IBD), EOL costs may be accentuated due to reliance on hospital-based services and expensive diagnostic tests and treatments. We aimed to compare EOL health care use and costs between IBD and non-IBD decedents. METHODS: We conducted a retrospective cohort study of all decedents of Ontario, Canada between 2010 and 2013 using linked health administrative data...
2017: PloS One
https://www.readbyqxmd.com/read/28498155/therapeutic-drug-monitoring-to-guide-infliximab-dose-adjustment-is-associated-with-better-endoscopic-outcomes-than-clinical-decision-making-alone-in-active-inflammatory-bowel-disease
#13
Orlaith B Kelly, Sarah Oʼ Donnell, Joanne M Stempak, A Hillary Steinhart, Mark S Silverberg
BACKGROUND: Adequate infliximab (IFX) levels are associated with favorable outcomes in inflammatory bowel disease. Using therapeutic drug monitoring (TDM) to guide dosing is cost effective and associated with clinical improvement, but effect on endoscopic outcomes remains unclear. METHODS: Primary responders to IFX who underwent dose escalation (2008-2014) were reviewed. Patients with active endoscopic disease were included. Two cohorts were examined: TDM-based decision to escalate (TDM) and clinical decision (non-TDM)...
May 11, 2017: Inflammatory Bowel Diseases
https://www.readbyqxmd.com/read/28495639/safety-and-tolerability-of-the-first-in-class-agent-cpi-613-in-combination-with-modified-folfirinox-in-patients-with-metastatic-pancreatic-cancer-a-single-centre-open-label-dose-escalation-phase-1-trial
#14
Angela Alistar, Bonny B Morris, Rodwige Desnoyer, Heidi D Klepin, Keyanoosh Hosseinzadeh, Clancy Clark, Amy Cameron, John Leyendecker, Ralph D'Agostino, Umit Topaloglu, Lakmal W Boteju, Asela R Boteju, Rob Shorr, Zuzana Zachar, Paul M Bingham, Tamjeed Ahmed, Sandrine Crane, Riddhishkumar Shah, John J Migliano, Timothy S Pardee, Lance Miller, Gregory Hawkins, Guangxu Jin, Wei Zhang, Boris Pasche
BACKGROUND: Pancreatic cancer statistics are dismal, with a 5-year survival of less than 10%, and more than 50% of patients presenting with metastatic disease. Metabolic reprogramming is an emerging hallmark of pancreatic adenocarcinoma. CPI-613 is a novel anticancer agent that selectively targets the altered form of mitochondrial energy metabolism in tumour cells, causing changes in mitochondrial enzyme activities and redox status that lead to apoptosis, necrosis, and autophagy of tumour cells...
May 8, 2017: Lancet Oncology
https://www.readbyqxmd.com/read/28491235/a-systematic-review-of-physical-activity-policy-recommendations-and-interventions-for-people-with-mental-health-problems-in-sub-saharan-african-countries
#15
Davy Vancampfort, Brendon Stubbs, Marc De Hert, Christy du Plessis, Caleb Ademola Omuwa Gbiri, Jepkemoi Kibet, Nancy Wanyonyi, James Mugisha
INTRODUCTION: There is a need for interventions to address the escalating mental health burden in Sub-Saharan Africa (SSA). Implementation of physical activity (PA) within the rehabilitation of people with mental health problems (PMHP) could reduce the burden and facilitate recovery. The objective of the current review was to explore (1) the role of PA within mental health policies of SSA countries, and (2) the current research evidence for PA to improve mental health in SSA. METHODS: We screened the Mental Health Atlas and MiNDbank for mental health policies in SSA countries and searched PubMed for relevant studies on PA in PMHP in SSA...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28491135/highlights-from-the-15th-st-gallen-international-breast-cancer-conference-15-18-march-2017-vienna-tailored-treatments-for-patients-with-early-breast-cancer
#16
Consuelo Morigi
The 15th St Gallen International Breast Cancer Conference was held in Vienna for the second time, from 15th-18th March 2017. 4000 people from 105 countries all over the world were invited to take part in the event. The real highlight of the conference was the last day with the International Consensus Session which was chaired by around 50 experts on breast cancer worldwide. With reference to data from scientific research, the consensus panel tried to offer guidelines for the management of breast cancer with the aim of providing patients with optimal treatment...
2017: Ecancermedicalscience
https://www.readbyqxmd.com/read/28480828/hierarchical-models-for-sharing-information-across-populations-in-phase-i-dose-escalation-studies
#17
Kristen M Cunanan, Joseph S Koopmeiners
The primary goal of a phase I clinical trial in oncology is to evaluate the safety of a novel treatment and identify the maximum tolerated dose, defined as the maximum dose with a toxicity rate below some pre-specified threshold. Researchers are often interested in evaluating the performance of a novel treatment in multiple patient populations, which may require multiple phase I trials if the treatment is to be used with background standard-of-care that varies by population. An alternate approach is to run parallel trials but combine the data through a hierarchical model that allows for a different maximum tolerated dose in each population but shares information across populations to achieve a more accurate estimate of the maximum tolerated dose...
January 1, 2017: Statistical Methods in Medical Research
https://www.readbyqxmd.com/read/28480067/radiation-therapy-for-hepatobiliary-malignancies
#18
REVIEW
Jonathan W Lischalk, Michael C Repka, Keith Unger
Hepatobiliary malignancies represent a heterogeneous group of diseases, which often arise in a background of underlying hepatic dysfunction complicating their local management. Surgical resection continues to be the standard of care for hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC); unfortunately the majority of patients are inoperable at presentation. The aggressiveness of these lesions makes locoregional control of particular importance. Historical experience with less sophisticated radiotherapy resulted in underwhelming efficacy and oftentimes prohibitive liver toxicity...
April 2017: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/28469900/a-unified-electronic-tool-for-cpr-and-emergency-treatment-escalation-plans-improves-communication-and-early-collaborative-decision-making-for-acute-hospital-admissions
#19
Mae Johnson, Martin Whyte, Robert Loveridge, Richard Yorke, Shairana Naleem
The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report 'Time to Intervene' (2012) stated that in a substantial number of cases, resuscitation is attempted when it was thought a 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision should have been in place. Early decisions about CPR status and advance planning about limits of care now form part of national recommendations by the UK Resuscitation Council (2016). Treatment escalation plans (TEP) document what level of treatment intervention would be appropriate if a patient were to become acutely unwell and were not previously formally in place at King's College Hospital...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28467228/dental-health-dispositions-of-pregnant-women-a-survey-from-a-hospital-clinic-in-istanbul
#20
Ayse Filiz Gokmen Karasu, Nukhet Kutuk, Serdar Aydin, Ilknur Adanir, Seda Ates, Neslihan Bademler
Dental hygienic habits should be maintained in pregnancy despite challenges. We aimed to study the dental attitudes and habits of pregnant women. The patients attending our hospital clinic were invited to fill out a structured questionnaire categorised into three major domains: (1) general oral hygiene status, (2) dental habits, and (3) dental attandence both during pregnancy and prior to pregnancy. Four hundred and seventy four women agreed to participate. Mean age of participants was 28 (18-43). While 184 (38%) women reported brushing twice a day, only 98 (20%) women claimed using floss and or mouth rinse...
May 3, 2017: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
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