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E Nohuz, E Jouve, G Clement, B Jacquetin
OBJECTIVES: The use of pessary to put back up prolapsed organs to their normal position dates back prior to several millennia. This work aims to discuss its place in our clinical practice through an updated bibliographic review and emphasizes a hands-on approach to pessary fitting and management in terms of indication, pessary type selection, device' size, insertion, removal, follow-up visits and care. METHODS: A review of the literature, in the light of the latest publications and recommendations of French and international learned societies, as well as our own experience, were analyzed...
May 18, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
Raquel Catalao, Tigist Eshetu, Ruth Tsigebrhan, Girmay Medhin, Abebaw Fekadu, Charlotte Hanlon
BACKGROUND: In order to tackle the considerable treatment gap for epilepsy in many low- and middle-income countries (LMICs), a task sharing model is recommended whereby care is integrated into primary health services. However, there are limited data on implementation and impact of such services in LMICs. Our study aimed to explore the perspectives of service users and caregivers on the accessibility, experience and perceived impact of epilepsy treatment received in a task-shared model in a rural district of Ethiopia...
May 21, 2018: BMC Health Services Research
W Dale Dauphinee, John R Boulet, John J Norcini
Educational assessment for the health professions has seen a major attempt to introduce competency based frameworks. As high level policy developments, the changes were intended to improve outcomes by supporting learning and skills development. However, we argue that previous experiences with major innovations in assessment offer an important road map for developing and refining assessment innovations, including careful piloting and analyses of their measurement qualities and impacts. Based on the literature, numerous assessment workshops, personal interactions with potential users, and our 40 years of experience in implementing assessment change, we lament the lack of a coordinated approach to clarify and improve measurement qualities and functionality of competency based assessment (CBA)...
May 18, 2018: Advances in Health Sciences Education: Theory and Practice
Matthew W Johnson, Roland R Griffiths, Peter S Hendricks, Jack E Henningfield
This review assesses the abuse potential of medically-administered psilocybin, following the structure of the 8 factors of the US Controlled Substances Act (CSA). Research suggests the potential safety and efficacy of psilocybin in treating cancer-related psychiatric distress and substance use disorders, setting the occasion for this review. A more extensive assessment of abuse potential according to an 8 factor analysis would eventually be required to guide appropriate schedule placement. Psilocybin, like other 5-HT2A agonist classic psychedelics, has limited reinforcing effects, supporting marginal, transient non-human self-administration...
May 10, 2018: Neuropharmacology
Abbey Elsbernd, Maiken Hjerming, Camilla Visler, Lisa Lyngsie Hjalgrim, Carsten Utoft Niemann, Kirsten Boisen, Helle Pappot
BACKGROUND: Adolescents and young adults with cancer face significant challenges during the course of their medical treatment and recovery from illness. Many adolescents and young adults struggle with long-term complications in the physical, psychosocial, economic, and academic domains. Mobile health (mHealth) interventions provide an innovative platform for delivering supportive care, particularly through the utilization of apps on smartphones and tablets. To create a successful mHealth intervention for adolescents and young adults, youth input and feedback is essential...
May 10, 2018: JMIR Research Protocols
Markus Meyer, Klaus Donsa, Thomas Truskaller, Matthias Frohner, Birgit Pohn, Alexander Felfernig, Frank Sinner, Thomas Pieber
BACKGROUND: A fast and accurate data transmission from glucose meter to clinical decision support systems (CDSSs) is crucial for the management of type 2 diabetes mellitus since almost all therapeutic interventions are derived from glucose measurements. OBJECTIVES: Aim was to develop a prototype of an automated glucose measurement transmission protocol based on the Continua Design Guidelines and to embed the protocol into a CDSS used by healthcare professionals...
2018: Studies in Health Technology and Informatics
Jeremy Wildfire, Ryan Bailey, Rebecca Z Krouse, Spencer Childress, Britt Sikora, Nathan Bryant, Shane Rosanbalm, Emily Wilson, Jack G Modell
BACKGROUND: Frequent and thorough monitoring of patient safety is a requirement of clinical trials research. Safety data are traditionally reported in a tabular or listing format, which often translates into many pages of static displays. This poses the risk that clinically relevant signals will be obscured by the sheer volume of data reported. Interactive graphics enable the delivery of the vast scope of information found in traditional reports, but allow the user to interact with the charts in real time, focusing on signals of interest...
January 1, 2018: Therapeutic Innovation & Regulatory Science
Melissa DeJonckheere, Claire H Robinson, Lindsey Evans, Julie Lowery, Bradley Youles, Adam Tremblay, Caitlin Kelley, Jeremy B Sussman
BACKGROUND: Recent clinical practice guidelines from major national organizations, including a joint United States Department of Veterans Affairs (VA) and Department of Defense (DoD) committee, have substantially changed recommendations for the use of the cholesterol-lowering statin medications after years of relative stability. Because statin medications are among the most commonly prescribed treatments in the United States, any change in their use may have significant implications for patients and providers alike...
April 24, 2018: JMIR Human Factors
M Eugenia Socias, Keith Ahamad, Bernard Le Foll, Ron Lim, Julie Bruneau, Benedikt Fischer, T Cameron Wild, Evan Wood, Didier Jutras-Aswad
BACKGROUND: Rates of non-medical use of opioids, and opioid use disorders (OUD) have been rising throughout North America. Methadone and buprenorphine/naloxone are the recommended first-line treatment options for OUD in Canada. Most studies to date have been conducted among heroin users, in controlled settings, and using similar strict dosing schedules (i.e., daily witnessed ingestion) despite buprenorphine/naloxone's superior safety profile, which allows a more flexible take-home dosing schedule...
April 5, 2018: Contemporary Clinical Trials
Colleen A McHorney, Concetta Crivera, François Laliberté, Guillaume Germain, Willy Wynant, Patrick Lefebvre
BACKGROUND: Medication non-adherence can result in poor health outcomes. Understanding differences in adherence rates to non-vitamin K oral anticoagulants (NOACs) could guide treatment decisions and improve clinical outcomes among patients with non-valvular atrial fibrillation (NVAF). OBJECTIVE: To compare adherence to rivaroxaban and apixaban among the overall NVAF population and subgroups of prior oral anticoagulant (OAC) users (e.g., multiple comorbidities, non-adherence risk factors)...
2018: PloS One
Sabine Jeromin, Manuel Vossel, Christian Rauchholz, Sylvain Billet, Christian-Andreas Mueller, Stéphane Lavallée, Klaus Radermacher, Mathias de la Fuente
Accurate planning transfer is a prerequisite for successful operative care. For different applications, diverse computer-assisted systems have been developed and clinically evaluated. This paper presents the implementation and evaluation of a new modular concept. The approach is based on passive application specific kinematics that are semi-automatically adjusted using a universal hand-held computer controlled Smart Screw Driver. The system was realized for pedicle screw instrumentation and evaluated according to IEC 60601-1-6 (usability engineering)...
March 30, 2018: International Journal of Medical Robotics + Computer Assisted Surgery: MRCAS
Susan Shapiro Braithwaite, Lisa P Clark, Thaer Idrees, Faisal Qureshi, Oluwakemi T Soetan
PURPOSE OF REVIEW: This review examines algorithm design features that may reduce risk for hypoglycemia while preserving glycemic control during intravenous insulin infusion. We focus principally upon algorithms in which the assignment of the insulin infusion rate (IR) depends upon maintenance rate of insulin infusion (MR) or a multiplier. RECENT FINDINGS: Design features that may mitigate risk for hypoglycemia include use of a mid-protocol bolus feature and establishment of a low BG threshold for temporary interruption of infusion...
March 26, 2018: Current Diabetes Reports
Maarit J Korhonen, Jenni Ilomäki, Janet K Sluggett, M Alan Brookhart, Renuka Visvanathan, Tina Cooper, Leonie Robson, J Simon Bell
BACKGROUND: Compared to randomized controlled trials, nonexperimental studies often report larger survival benefits but higher rates of adverse events for statin use vs nonuse. OBJECTIVE: We compared characteristics of statin users and nonusers living in aged care services and evaluated the relationships between statin use and all-cause mortality, all-cause and fall-related hospitalizations, and number of falls during a 12-month follow-up. METHODS: A prospective cohort study of 383 residents aged ≥65 years was conducted in six Australian aged care services...
March 2, 2018: Journal of Clinical Lipidology
Satish R Raj, Lauren E Stiles
Postural Tachycardia Syndrome (POTS) is a multi-system disorder that can be associated with significant functional disability. Likely due to the multi-system nature of the disorder, it can be difficult for physicians caring for these patients with POTS to know enough about the management of problems that fall within so many different specialties. This special issue was written for these clinicians and their patients. We have brought together experts on POTS with different backgrounds to share their approach to many of the medical issues that confront patients with POTS...
March 15, 2018: Autonomic Neuroscience: Basic & Clinical
Peter M Hawkey, Roderic E Warren, David M Livermore, Cliodna A M McNulty, David A Enoch, Jonathan A Otter, A Peter R Wilson
The Working Party makes more than 100 tabulated recommendations in antimicrobial prescribing for the treatment of infections caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) and suggest further research, and algorithms for hospital and community antimicrobial usage in urinary infection. The international definition of MDR is complex, unsatisfactory and hinders the setting and monitoring of improvement programmes. We give a new definition of multiresistance. The background information on the mechanisms, global spread and UK prevalence of antibiotic prescribing and resistance has been systematically reviewed...
March 1, 2018: Journal of Antimicrobial Chemotherapy
T Platteau, J van Lankveld, L Apers, K Fransen, J Rockstroh, E Florence
OBJECTIVES: With persisting high numbers of new HIV diagnoses in Europe, HIV testing remains an important aspect of HIV prevention. The traditional centralized and medicalized HIV testing approach has been complemented with newly developed and evaluated non-traditional approaches. Two important factors guided this process: technological innovation and empowerment of the patient. METHODS: We present a matrix to develop an HIV testing approach, and elaborate on three commonly used ones: community based testing, self-testing, and self-sampling...
February 2018: HIV Medicine
Jessica S Yu, Eva Szigethy, Meredith Wallace, Francis Solano, Megan Oser
BACKGROUND: Implementation of digital behavioral health programs in primary care (PC) can improve access to care for patients in need. INTRODUCTION: This study provides preliminary data on user engagement and anxiety symptom change among patients referred by their PC provider to a guided, mobile cognitive behavioral program, Lantern. MATERIALS AND METHODS: Adults aged 20-65 years with at least mild anxiety (GAD-7 ≥ 5) during routine clinical screening in two PC practices were offered Lantern...
February 26, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
A Santiago Pérez, J A Peña Pedrosa, A I Alguacil Pau, A Pérez Morales, P Molina Muñoz, M T Benítez Giménez
INTRODUCTION: Pharmaceutical care to outpatients is currently one of the main occupations of hospital pharmacy services (PEX). There are several questionnaires to measure the satisfaction of the PEX of a pharmacy service, and the results of these questionnaires can generate improvement actions that result in satisfaction. OBJECTIVES: To verify if a satisfaction questionnaire for outpatients is valid for the generation of improvements in the care provided, and if after its implementation, the same questionnaire is able to detect changes in satisfaction...
January 2018: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
Shruti Sevak, Ashley Woodfin, Zachary Hothem, Rose Callahan, James Robbins, Kathryn Ziegler
OBJECTIVE: Our aim was to develop an ultrasound-guided training curriculum for continuous infusion catheter placement in the paravertebral space and to create a gelatin thoracic spine-rib model for use in this training. We sought to create a model that was inexpensive and reusable such that multiple participants could use one model during training. DESIGN: The model was prepared by embedding a firm foam thoracic spine replica with bilateral attached ribs into an opaque gelatin mixture...
February 9, 2018: Journal of Surgical Education
Amanda Nikolic, Nilmini Wickramasinghe, Damian Claydon-Platt, Vikram Balakrishnan, Philip Smart
BACKGROUND: The use of communication apps on mobile phones offers an efficient, unobtrusive, and portable mode of communication for medical staff. The potential enhancements in patient care and education appear significant, with clinical details able to be shared quickly within multidisciplinary teams, supporting rapid integration of disparate information, and more efficient patient care. However, sharing patient data in this way also raises legal and ethical issues. No data is currently available demonstrating how widespread the use of these apps are, doctor's attitudes towards them, or what guides clinician choice of app...
February 9, 2018: JMIR Medical Informatics
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