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Escalation of care

Sarah Carter Narendorf, Michelle R Munson, Micki Washburn, Nicole Fedoravicius, Richard Wagner, Sara K Flores
Young adults have low rates of outpatient service utilization and higher rates of emergency service use compared to older adults. This study explored pathways to crisis service use for uninsured young adults who accessed emergency psychiatric treatment. Participants were 55 young adults (ages 18-25) who were on an inpatient short-term stabilization unit and had qualifying diagnoses for outpatient services (bipolar, major depression, or schizophrenia). Semistructured qualitative interviews were conducted to understand decision-making and the events that led to service use...
October 24, 2016: American Journal of Orthopsychiatry
Daniel E Spratt, Payal D Soni, Patrick W McLaughlin, Gregory S Merrick, Richard G Stock, John C Blasko, Michael J Zelefsky
PURPOSE: To review outcomes for high-risk prostate cancer treated with combined modality radiation therapy (CMRT) utilizing external beam radiation therapy (EBRT) with a brachytherapy boost. METHODS AND MATERIALS: The available literature for high-risk prostate cancer treated with combined modality radiation therapy was reviewed and summarized. RESULTS: At this time, the literature suggests that the majority of high-risk cancers are curable with multimodal treatment...
October 19, 2016: Brachytherapy
Amita Trehan, Deepak Bansal, Neelam Varma, Ajay Vora
BACKGROUND: The outcome of malignancies in low- and middle-income countries (LMICs) is hampered owing to numerous factors. Current protocols are complex, demanding supportive care, often not optimally available. We de-escalated the UKALL 2003 protocol to improve the outcome of acute lymphoblastic leukemia (ALL) at our center. METHODS: In 2007-2009, children were treated as per the UKALL 2003 protocol (protocol 1). In 2010 and 2011, a modified version of the UKALL 2003 (protocol 2) was followed...
October 20, 2016: Pediatric Blood & Cancer
Rowan Forbes Shepherd, Tamara Kayali Browne, Linda Warwick
Ethical issues arise for genetic counselors when a client fails to disclose a genetic diagnosis of hereditary disease to family: they must consider the rights of the individual client to privacy and confidentiality as well as the rights of the family to know their genetic risk. Although considerable work has addressed issues of non-disclosure from the client's perspective, there is a lack of qualitative research into how genetic counselors address this issue in practice. In this study, a qualitative approach was taken to investigate whether genetic counselors in Australia use a relational approach to encourage the disclosure of genetic information from hereditary breast and ovarian cancer (HBOC) clients among family members; and if so, how they use it...
October 19, 2016: Journal of Genetic Counseling
Nophanan Chaikittisilpa, Abhijit V Lele, Vivian H Lyons, Bala G Nair, Shu-Fang Newman, Patricia A Blissitt, Monica S Vavilala
BACKGROUND: Current guidelines recommend routine clamping of external ventricular drains (EVD) for intrahospital transport (IHT). The aim of this project was to describe intracranial hemodynamic complications associated with routine EVD clamping for IHT in neurocritically ill cerebrovascular patients. METHODS: We conducted a retrospective review of cerebrovascular adult patients with indwelling EVD admitted to the neurocritical care unit (NICU) during the months of September to December 2015 at a tertiary care center...
October 18, 2016: Neurocritical Care
Chengxiang Tang, Judy Xu, Meng Zhang
BACKGROUND: Public health care dominated the services provision in China before 1980s. However, the number of private health care providers in China has been increasing since then. The growth of private hospitals escalated after a market-oriented reform was implemented in 2001. Through an experimental approach, this study aims to a better understanding of the dynamic change in preference of health care utilisation among the residents in urban China. METHODS: Based on a discrete choice experiment (DCE) from a random sample of respondents in urban China, the study evaluated preference over health care attributes affecting individuals' choice for the utilisation of hospital health care...
October 18, 2016: BMC Health Services Research
Folafoluwa O Odetola, Renee R Anspach, Yong Y Han, Sarah J Clark
PURPOSE: To investigate the decision making underlying transfer of children with respiratory failure from level II to level I pediatric intensive care unit care. METHODS: Interviews with 19 eligible level II pediatric intensive care unit physicians about a hypothetical scenario of a 2-year-old girl in respiratory failure: RESULTS: At baseline, indices critical to management were as follows: OI (53%), partial pressure of oxygen in arterial blood (Pao2)/Fio2 (32%), and inflation pressure (16%)...
October 4, 2016: Journal of Critical Care
Natalie K Bradford, Liam J Caffery, Anthony C Smith
INTRODUCTION: With the escalating costs of health care, issues with recruitment and retention of health practitioners in rural areas, and poor economies of scale, the question of delivering people to services or services to people is a dilemma for health authorities around the world. People living in rural areas have poorer health outcomes compared to their urban counterparts, and the problem of how to provide health care and deliver services in rural locations is an ongoing challenge...
October 2016: Rural and Remote Health
Jacob A Miller, Elizabeth E Bennett, Roy Xiao, Rupesh Kotecha, Samuel T Chao, Michael A Vogelbaum, Gene H Barnett, Lilyana Angelov, Erin S Murphy, Jennifer S Yu, Manmeet S Ahluwalia, John H Suh, Alireza M Mohammadi
BACKGROUND: The primary dose-limiting toxicity of stereotactic radiosurgery (SRS) is radiation necrosis (RN), which occurs after approximately 5% to 10% of treatments. This adverse event may worsen neurologic deficits, increase the frequency and cost of imaging, and necessitate prolonged treatment with steroids or antiangiogenic agents. Previous investigations have primarily identified lesion size and dosimetric constraints as risk factors for RN in small populations. We hypothesized that disease histology, receptor status, and mutational status are associated with RN...
September 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Charles L Francoeur, Stephan A Mayer
For patients who survive the initial bleeding event of a ruptured brain aneurysm, delayed cerebral ischemia (DCI) is one of the most important causes of mortality and poor neurological outcome. New insights in the last decade have led to an important paradigm shift in the understanding of DCI pathogenesis. Large-vessel cerebral vasospasm has been challenged as the sole causal mechanism; new hypotheses now focus on the early brain injury, microcirculatory dysfunction, impaired autoregulation, and spreading depolarization...
October 14, 2016: Critical Care: the Official Journal of the Critical Care Forum
Alison Vogel, Diana Lennon, Emma Best, Alison Leversha
Admissions for skin and soft-tissue infections have been increasing steadily in children and in the general population. Concerns have been raised recently about the increasing widespread use of topical fusidic acid and concurrent increase of fusidic acid-resistant Staphylococcus aureus. Fusidic acid resistance and methicillin resistant Staphylococcus aureus (MRSA) are both more prevalent in youngest age group (<5 year-olds) and particularly in the North island. In New Zealand, fusidic acid is recommended for treatment of minor impetigo and is the only fully-funded topical antibiotic...
October 14, 2016: New Zealand Medical Journal
Brandon Battis, Linda Clifford, Mostaqul Huq, Edrick Pejoro, Scott Mambourg
OBJECTIVES: Patients treated with oral chemotherapy appear to have less contact with the treating providers. As a result, safety, adherence, medication therapy monitoring, and timely follow-up may be compromised. The trend of treating cancer with oral chemotherapy agents is on the rise. However, standard clinical guidance is still lacking for prescribing, monitoring, patient education, and follow-up of patients on oral chemotherapy across the healthcare settings. The purpose of this project is to establish an oral chemotherapy monitoring clinic, to create drug and lab specific provider order sets for prescribing and lab monitoring, and ultimately to ensure safe and effective treatment of the veterans we serve...
October 12, 2016: Journal of Oncology Pharmacy Practice
Ismail Jatoi, John R Benson, Masakazu Toi
With the advent of sentinel lymph node biopsy, surgical methods for accurately staging the axilla in patients with early-stage breast cancer have become progressively less extensive, with formal axillary lymph node dissection confined to a dwindling group of patients. Although details of methods for sentinel lymph node biopsy have yet to be standardised, this technique is now widely practised and accepted as standard of care worldwide. In the past 5 years, attention has focused on minimisation of surgical morbidity by restricting further axillary surgery or considering radiotherapy in patients with a small tumour burden in their sentinel nodes...
October 2016: Lancet Oncology
Pilar Anton-Martin, Vinai Modem, Donna Taylor, Donald Potter, Cindy Darnell-Bowens
INTRODUCTION: The purpose of this study is to describe the sedative and analgesic requirements identifying factors associated with medication escalation in neonates and children supported on ECMO. METHOD: Observational retrospective cohort study in a tertiary pediatric intensive care unit from June 2009 to June 2013. RESULTS: One hundred and sixty patients were included in the study. Fentanyl and midazolam were the first line agents used while on ECMO...
October 10, 2016: Perfusion
Adele Callaghan, Leigh Kinsman, Simon Cooper, Natalie Radomski
OBJECTIVES: Junior doctors are frequently the first doctor to be called by a nurse to review patients whose clinical status has declined in hospital wards, yet little is known about how well prepared they are to deal with this situation. This paper aims to identify the factors that influence junior doctors' early recognition and management of patient deterioration in an acute ward settings. METHOD: Integrative review methodology was used to allow for the inclusion of broad research designs, summarising current knowledge from existing research and identify gaps in the literature...
October 7, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Alyson Myers, Madhukar H Trivedi
Suicide is the tenth leading cause of death for Americans of all ages. Presence of a chronic medical illness (e.g. Diabetes mellitus) increases the risk of suicide. The goal of this review is to examine the relationship between diabetes and depression, as well as diabetes and suicide. Earlier this year, the U.S. Preventive Task Force (USPTF) escalated their recommendation for depression to include not only routine screening for depression but additional focus on active follow up that requires measurement based care...
October 5, 2016: Current Diabetes Reviews
Nicholas Waldron, Claire E Johnson, Peter Saul, Heidi Waldron, Jeffrey C Chong, Anne-Marie Hill, Barbara Hayes
BACKGROUND: Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. METHODS: Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature...
October 6, 2016: BMC Health Services Research
Carmen Peral, Francisco Sánchez-Ballester, José M García-Mediero, Jaime Ramos, Javier Rejas
OBJECTIVE: To carry out cost-effectiveness analysis from the Spanish National Health System perspective, of treating overactive bladder (OAB), in newly diagnosed patients with two flexible doses of fesoterodine in routine clinical practice. PATIENTS AND METHODS: Economic evaluation of flexible-dose fesoterodine in newly diagnosed patients, including two treatment groups: standard escalating from 4 to 8 mg or fast escalating to 8 mg. Costs were estimated from health care resources utilization related to OAB, and were expressed in 2015 Euros...
2016: ClinicoEconomics and Outcomes Research: CEOR
Gaël Piton, Claire Chaignat, Mikhael Giabicani, Jean-Paul Cervoni, Fabienne Tamion, Emmanuel Weiss, Catherine Paugam-Burtz, Gilles Capellier, Vincent Di Martino
BACKGROUND: The prognosis of cirrhotic patients admitted to the ICU is considered to be poor but has been mainly reported in liver ICU. We aimed to describe the prognosis of cirrhotic patients admitted to a general ICU, to assess the predictors of mortality in this population, and, finally, to identify a subgroup of patients in whom intensive care escalation might be discussed. RESULTS: We performed a retrospective monocentric study of all cirrhotic patients consecutively admitted between 2002 and 2014 in a general ICU in a regional university hospital...
December 2016: Annals of Intensive Care
Aaron L Leppin, Cara Fernandez, Jon C Tilburt
CONTEXT: Treatment of pain in cancer is a clinical priority. Many cancer patients seek and use complementary and alternative medicine (CAM) therapies. OBJECTIVES: To describe the role CAM plays in oncology clinicians' approaches to pain management and its alignment with patient preference and self-care. METHODS: We used quantitative criteria to identify patients with high, self-reported pain and reduced quality of life. For these patients, we merged quantitative and qualitative data from encounter audio recordings, patient surveys, and the medical record...
September 29, 2016: Journal of Pain and Symptom Management
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