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https://www.readbyqxmd.com/read/28538648/less-is-more-antibiotic-duration-and-outcomes-in-fournier-s-gangrene
#1
Margaret Lauerman, Olga Kolesnik, Kinjal Sethuraman, Ronald Rabinowitz, Manjari Joshi, Emily Clark, Deborah Stein, Thomas Scalea, Sharon Henry
BACKGROUND: Antibiotic management of Fournier's gangrene (FG) is without evidence-based guidelines, and is based on expert opinion. The effect of duration of antibiotic therapy on outcomes in FG is unknown. METHODS: A retrospective review was performed of FG patients from 2012-2015 at a single institution. Patients were managed by our institutional practice of complete primary wound closure as possible, with antibiotic duration according to physician judgement. Patients were stratified into multiple durations of antibiotic administration...
May 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28538427/return-on-investment-of-advanced-practice-medical-degrees-nps-vs-pas
#2
Christopher K Craig, James H Holmes, Jeffery E Carter
As the United States faces a predicted physician shortage over the next 2 decades, physician assistants (PAs) and NPs are expected to fill the void. At the same time, because education is expensive, student loan and tuition increases have many potential applicants assessing differences in reimbursement and wondering about their return on investment (ROI). An analysis compared PA and NP salaries by incorporating national salary data, federal income tax, and student loans for a comparative analysis of each career pathway...
June 2017: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/28538332/examining-drivers-of-health-care-spending-evidence-on-self-referral-among-a-privately-insured-population
#3
Jean M Mitchell, James D Reschovsky, Roy J Film, Luisa Franzini
BACKGROUND: Despite the enactment of laws to restrict the practice of self-referral, exceptions in these prohibitions have enabled these arrangements to persist and proliferate. Most research documenting the effects of self-referral arrangements analyzed claims records from Medicare beneficiaries. Empirical evidence documenting the effects of self-referral on use of services and spending incurred by persons with private insurance is sparse. OBJECTIVES: We analyzed health insurance claims records from a large private insurer in Texas to evaluate the effects of physician self-referral arrangements involving physical therapy on the treatment of patients with frozen shoulder syndrome, elbow tendinopathy or tendinitis, and patellofemoral pain syndrome...
May 19, 2017: Medical Care
https://www.readbyqxmd.com/read/28538006/evaluation-and-management-of-patch-test-negative-patients-with-generalized-dermatitis
#4
Alison Spiker, Christen M Mowad
BACKGROUND: Patients with generalized dermatitis are common in dermatology practices. Allergic contact dermatitis is often suspected, and patients frequently undergo patch testing. When patch testing result is negative, further evaluation and management of these patients are challenging. OBJECTIVE: The purpose of this study was to survey members of the American Contact Dermatitis Society regarding the evaluation and management of patch test-negative patients with generalized dermatitis...
May 23, 2017: Dermatitis
https://www.readbyqxmd.com/read/28537981/development-of-education-and-research-in-anesthesia-and-intensive-care-medicine-at-the-university-teaching-hospital-in-lusaka-zambia-a-descriptive-observational-study
#5
Anna Janowicz, Tuma Kasole, Emily Measures, Meg Langley, Fastone M Goma, Feruza Ismailova, John A Kinnear, M Dylan Bould
BACKGROUND: Data from 2006 show that the practice of anesthesia at the University Teaching Hospital in Lusaka, Zambia was underdeveloped by international standards. Not only was there inadequate provision of resources related to environment, equipment, and drugs, but also a severe shortage of staff, with no local capability to train future physician anesthetic providers. There was also no research base on which to develop the specialty. This study aimed to evaluate patient care, education and research to determine whether conditions had changed a decade later...
May 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28537977/perioperative-use-of-focused-transthoracic-cardiac-ultrasound-a-survey-of-current-practice-and-opinion
#6
Frederick Conlin, Neil R Connelly, Michael P Eaton, Patrick J Broderick, Jennifer Friderici, Adam C Adler
BACKGROUND: The advent of portable ultrasound machines in recent years has led to greater availability of focused cardiac ultrasound (FoCUS) in the perioperative and critical care setting. To our knowledge, its use in the perioperative setting among anesthesiologists remains undefined. We sought to assess the use of FoCUS by members of the Society of Cardiovascular Anesthesiologists (SCA) in clinical practice, to identify variations in its application, to outline limits to its use, and to understand the level of training of physicians using this technology...
May 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28537804/evaluation-of-testing-of-acute-leukemia-samples-survey-result-from-the-college-of-american-pathologists
#7
Tracy I George, Joseph A Tworek, Nicole E Thomas, Lisa A Fatheree, Rhona J Souers, Raouf E Nakhleh, Daniel A Arber
CONTEXT: - The classification and prognosis determination in acute leukemia (AL) are complex and it is unclear what testing is being performed in practice. OBJECTIVE: - To survey physicians describing their current practice of test ordering in the diagnosis of AL. DESIGN: - In anticipation of a guideline by the College of American Pathologists (CAP) and the American Society for Hematology on laboratory testing needed for the initial workup of AL, a baseline survey was designed by an expert panel from CAP...
May 24, 2017: Archives of Pathology & Laboratory Medicine
https://www.readbyqxmd.com/read/28535552/stem-cell-therapy-for-chronic-pain-management-review-of-uses-advances-and-adverse-effects
#8
Krishnan Chakravarthy, Yian Chen, Cathy He, Paul J Christo
BACKGROUND: This review article outlines the recent advances, uses, and adverse effects of cell-based therapy for chronic pain management. Cell based therapies are gaining increasing ground as novel treatment modalities for a variety of pain pathologies that include, but are not limited to, neuropathic pain and degenerative disc disease. As these treatment modalities become more common practice, we have focused our review to provide pain practitioners and other practicing physicians an understanding of the technology and to summarize key clinical data and existing clinical trials that are being pursued by clinical investigators worldwide...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28535546/cost-utility-analysis-of-lumbar-interlaminar-epidural-injections-in-the-treatment-of-lumbar-disc-herniation-central-spinal-stenosis-and-axial-or-discogenic-low-back-pain
#9
Laxmaiah Manchikanti, Vidyasagar Pampati, Ramsin M Benyamin, Joshua A Hirsch
BACKGROUND: Cost utility or cost effective analysis continues to take center stage in the United States for defining and measuring the value of treatments in interventional pain management. Appropriate cost utility analysis has been performed for caudal epidural injections, percutaneous adhesiolysis, and spinal cord stimulation. However, the literature pertaining to lumbar interlaminar epidural injections is lacking, specifically in reference to cost utility analysis derived from randomized controlled trials (RCTs) with a pragmatic approach in a practical setting...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28535519/development-of-the-new-kibou%C3%A2-equipment-for-continuous-renal-replacement-therapy-from-scratch-to-the-final-configuration
#10
Mauro Neri, Anna Lorenzin, Alessandra Brendolan, Francesco Garzotto, Fiorenza Ferrari, Silvia De Rosa, Raffaele Bonato, Gianluca Villa, Simona Bazzano, Fiorella D''Ippoliti, Zaccaria Ricci, Gaetano La Manna, Claudio Ronco
A new technology has recently appeared in the area of extracorporeal therapies for critically ill patients with acute kidney injury. The International Renal Research Institute of Vicenza was involved from the beginning in the development of a new continuous renal replacement therapy (CRRT) equipment with peculiar characteristics. We report the overall experience from design of the new machine to its in vitro and in vivo testing. Kibou® (Asahi Kasei Kuraray Medical Co., Ltd., Tokyo, Japan) is a new multifunctional machine designed for delivering RRT...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535321/rural-family-medicine-outcomes-at-the-university-of-minnesota-medical-school-duluth
#11
Anna Fuglestad, Jacob Prunuske, Ronald Regal, Courtney Hunter, James Boulger, Amy Prunuske
BACKGROUND AND OBJECTIVES: The University of Minnesota Medical School Duluth (MSD) opened in 1972 with a mission to train physicians serving rural Minnesota, emphasizing family medicine and American Indian (AI) communities. Nationwide there are shortages in family medicine and AI physicians, and MSD is a leader in these outcomes. METHODS: This is a longitudinal, retrospective cohort analysis of 1972-2009 MSD graduates using descriptive statistics and multivariate regression to determine relationships between gender, race, age, and hometown and outcomes of family medicine specialty, rural practice, and rural family medicine practice...
May 2017: Family Medicine
https://www.readbyqxmd.com/read/28535315/early-career-outcomes-of-family-medicine-residency-graduates-exposed-to-innovative-flexible-longitudinal-tracks
#12
Richard A Young, Dan Casey, Diana Singer, Elaine Waller, Patricia A Carney
BACKGROUND AND OBJECTIVES: The Preparing the Personal Physician for Practice (P4) project used a case series design to study innovations in the content, length, structure, and location of residency training in 14 geographically diverse family medicine programs between 2007 and 2012. We aimed to explore how offering flexible longitudinal tracks (FLT) affected graduates' scope of practice, particularly in maternal child health (MCH), which included at least 17 months of focused training that increased each year over 4 years...
May 2017: Family Medicine
https://www.readbyqxmd.com/read/28535314/team-training-in-family-medicine-residency-programs-and-its-impact-on-team-based-practice-post-graduation
#13
Patricia A Carney, Elaine Waller, Eve Dexter, Miguel Marino, Kelly Morton, Larry Green, Colleen T Fogarty, Samuel Jones, M Patrice Eiff
OBJECTIVE: Our objective was to examine perceptions of adequacy in team-based care training during residency and whether this influences practice choice post- residency training. METHODS: We analyzed self-administered survey data from recent residency graduates collected as part of the Preparing Personal Physicians for Practice (P4) Project to characterize residents' perceptions of adequacy of training they received on team-based care. Multivariable logistic regression was used to assess the association between adequacy of team-based care training and joining practices that use team-based care after residency graduation, adjusting for differences in demographics...
May 2017: Family Medicine
https://www.readbyqxmd.com/read/28534681/referral-of-older-thyroid-cancer-patients-to-a-high-volume-surgeon-results-of-a-multidisciplinary-physician-survey
#14
Maria Papaleontiou, Paul G Gauger, Megan R Haymart
OBJECTIVE: Surgical outcomes of thyroid cancer patients are improved with high-volume surgeons. However, age disparities in referral to specialist surgical centers still exist. The factors that influence decision-making regarding referral of older thyroid cancer patients to high-volume surgeons remain unknown. METHODS: We surveyed members of the Endocrine Society, American College of Physicians and American Academy of Family Practice. RESULTS: Overall, 270 physicians completed the survey...
May 23, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28534429/prevalence-and-costs-of-defensive-medicine-a-national-survey-of-italian-physicians
#15
Massimiliano Panella, Carmela Rinaldi, Fabrizio Leigheb, Sanita Knesse, Chiara Donnarumma, Seval Kul, Kris Vanhaecht, Francesco Di Stanislao
Objective To identify the prevalence of the practice of defensive medicine among Italian hospital physicians, its costs and the reasons for practising defensive medicine and possible solutions to reduce the practice of defensive medicine. Methods Cross-sectional web survey. Main outcome measures Number of physicians reporting having engaged in any defensive medicine behaviour in the previous year. Results A total of 1313 physicians completed the survey. Ninety-five per cent believed that defensive medicine would increase in the near future...
January 1, 2017: Journal of Health Services Research & Policy
https://www.readbyqxmd.com/read/28534381/evaluation-of-complementary-and-alternative-medicine-trials-registered-in-clinicaltrials-gov-database
#16
Omer Dizdar, Emre Bilgin, Serkan Akin, Saadettin Kilickap, Mutlu Hayran
PURPOSE: Complementary and alternative medicine (CAM) products are increasingly used because they are perceived as natural, relatively low-cost and probably effective therapies for various diseases including cancer. We aimed to determine the quantity and major characteristics of recent herbal/alternative medicine trials registered in clinicaltrials. gov in patients with cancer. METHODS: "Cancer AND (herbal OR complementary OR alternative)" key words were used to query clinicaltrials...
March 2017: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
https://www.readbyqxmd.com/read/28533998/ipilimumab-as-a-cause-of-severe-pan-colitis-and-colonic-perforation
#17
Raj Shah, Danielle Witt, Talal Asif, Fahad F Mir
Ipilimumab is a human monoclonal antibody that functions as a cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitor that is used to treat malignant melanoma. Due to ipilimumab's removal of immune regulation, specifically through the inactivation of CTLA-4, it is commonly associated with inflammatory and autoimmune events. Gastrointestinal (GI) related immune-related adverse events such as diarrhea occur in 29% of patients with 7.6% of patients specifically suffering from colitis. We describe a case of colonic perforation with ipilimumab use...
April 20, 2017: Curēus
https://www.readbyqxmd.com/read/28533151/low-rates-of-androgen-deprivation-therapy-use-with-salvage-radiation-therapy-in-patients-with-prostate-cancer-after-radical-prostatectomy
#18
David D Yang, Vinayak Muralidhar, Brandon A Mahal, Michelle D Nezolosky, Shelby A Labe, Marie E Vastola, Ninjin Boldbaatar, Martin T King, Neil E Martin, Peter F Orio, Tni K Choueiri, Quoc-Dien Trinh, Robert B Den, Daniel E Spratt, Karen E Hoffman, Felix Y Feng, Paul L Nguyen
OBJECTIVE: The RTOG 9601 and GETUG-AFU 16 randomized controlled trials demonstrated that the addition of androgen deprivation therapy (ADT) to salvage radiation therapy (SRT) improves progression-free and, for RTOG 9601, overall survival. We examined national trends in the use of ADT with SRT. MATERIALS AND METHODS: Of the 484,009 patients in the National Cancer Database from 2004 to 2012 with localized or locally advanced prostate cancer treated with radical prostatectomy (RP), 4,200 men received SRT (≥6mo after surgery)...
May 19, 2017: Urologic Oncology
https://www.readbyqxmd.com/read/28532815/attitudes-and-practices-of-irish-hospital-based-physicians-towards-hand-hygiene-and-handrubbing-using-alcohol-based-hand-rubs-a-comparison-between-2007-and-2015
#19
Liz M Kingston, Barbara L Slevin, Nuala H O'Connell, Colum P Dunne
BACKGROUND: Hand hygiene is the cornerstone of infection prevention and control practices and reduces healthcare-associated infections significantly. Yet, international evidence suggests that medical doctors demonstrate poor compliance. AIM: To explore and compare practices and attitudes towards hand hygiene, in particular handrubbing using alcohol-based hand rubs (ABHR), among hospital-based physicians in Ireland between 2007 and 2015. METHODS: In 2007, a random sample of doctors in a large teaching hospital was invited to complete a postal survey using a validated questionnaire...
May 19, 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28532631/competency-based-medical-education-and-assessment-of-training-review-of-selected-national-obstetrics-and-gynaecology-curricula
#20
Milena Garofalo, Rajesh Aggarwal
There are global variations in obstetrics and gynaecology (OBGYN) training curricula, both in length and in their structure and content. The ultimate goal for all residency programs is to ensure a skilled, competent physician, capable of independent practice by the end of his or her training. An online search was used for nationally recognized OBGYN training curricula. The curricula of Australia, Canada, the Netherlands, the United Kingdom, and the United States were individually reviewed and evaluated for their use of competency-based medical education and methods of assessment, including simulation...
May 19, 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
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