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https://www.readbyqxmd.com/read/28550693/healthcare-for-the-aging-citizen-and-the-aging-citizen-for-healthcare-involving-patient-advisors-in%C3%A2-elder-friendly-care-improvement
#1
Jennifer Verma, Patricia O'Connor, Jerold Hodge, Howard Abrams, Jocelyn Bennett, Samir Sinha
With an aging population and a healthcare system that is overly reliant on providing expensive and sometimes problematic hospital-based care for older Canadians, driving improvements that promote elder-friendly care has never been more critical. The Acute Care for Elders (ACE) Strategy at Toronto's Mount Sinai Hospital is the focus of a pan-Canadian collaborative delivered by the Canadian Foundation for Healthcare Improvement in partnership with the Canadian Frailty Network. The intent is to spread the ACE Strategy's elder-friendly models of care and practices to 18 participating healthcare delivery organizations...
2017: Healthcare Quarterly
https://www.readbyqxmd.com/read/28550641/a-fascia-lata-free-flap-in-pelvic-exenteration-for-fournier-gangrene-due-to-advanced-rectal-cancer-a-case-report
#2
Hiroshi Sawayama, Nobutomo Miyanari, Hidetaka Sugihara, Shiro Iwagami, Takao Mizumoto, Tatsuo Kubota, Yoshio Haga, Hideo Baba
BACKGROUND: Fournier gangrene due to advanced rectal cancer is a rapidly progressive gangrene of the perineum and buttocks. Emergency surgical debridement of necrotic tissue is crucial, and secondary surgery to resect tumors is necessary for wound healing. However, pelvic exenteration damages the pelvic floor, increasing the likelihood of herniation of internal organs into the infectious wound. The management of pelvic exenteration for rectal cancer with Fournier gangrene has not yet been established...
December 2017: Surgical Case Reports
https://www.readbyqxmd.com/read/28550629/retrospective-analysis-of-outcomes-following-inferior-vena-cava-ivc-filter-placement-in-a-managed-care-population
#3
Damian Everhart, Jamieson Vaccaro, Karen Worley, Teresa L Rogstad, Mitchel Seleznick
The role of inferior vena cava filter (IVC) filters for prevention of pulmonary embolism (PE) is controversial. This study evaluated outcomes of IVC filter placement in a managed care population. This retrospective cohort study evaluated data for individuals with Humana healthcare coverage 2013-2014. The study population included 435 recipients of prophylactic IVC filters, 4376 recipients of therapeutic filters, and two control groups, each matched to filter recipients. Patients were followed for up to 2 years...
May 26, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28550483/-it-s-just-horrible-a-qualitative-study-of-patients-and-carers-experiences-of-bowel-dysfunction-in-multiple-sclerosis
#4
Lesley Dibley, Maureen Coggrave, Doreen McClurg, Sue Woodward, Christine Norton
Around 50% of people with multiple sclerosis (MS) experience neurogenic bowel dysfunction (constipation and/or faecal incontinence), reducing quality of life and increasing carer burden. No previous qualitative studies have explored the experiences of bowel problems in people with MS, or the views of their family carers. This study sought to understand 'what it is like' to live with bowel dysfunction and the impact this has on people with MS and carers. Using exploratory qualitative methods, 47 semi-structured interviews were conducted with participants recruited from specialist hospital clinics and community sources using purposive and chain-referral sampling...
May 26, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28550438/what-are-the-real-procedural-costs-of-bariatric-surgery-a-systematic-literature-review-of-published-cost-analyses
#5
REVIEW
Brett Doble, Sarah Wordsworth, Chris A Rogers, Richard Welbourn, James Byrne, Jane M Blazeby
This review aims to evaluate the current literature on the procedural costs of bariatric surgery for the treatment of severe obesity. Using a published framework for the conduct of micro-costing studies for surgical interventions, existing cost estimates from the literature are assessed for their accuracy, reliability and comprehensiveness based on their consideration of seven 'important' cost components. MEDLINE, PubMed, key journals and reference lists of included studies were searched up to January 2017...
May 26, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28550422/prospective-evaluation-of-transanal-irrigation-for-fecal-incontinence-and-constipation
#6
T Juul, P Christensen
BACKGROUND: The aim of the present study was to evaluate the effect of transanal irrigation on bowel function and quality of life in a prospective cohort of Danish patients with fecal incontinence or constipation. METHODS: Patients with fecal incontinence or constipation of heterogeneous origin were treated by a specialist nurse at the Anal Physiology Clinic/Department of Surgery at Aarhus University Hospital, Aarhus, Denmark. If satisfactory results were not obtained after conservative bowel management, patients were instructed in the use the transanal irrigation procedure and were consecutively recruited for this observational cohort study in the period from March 2010 to September 2013...
May 26, 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/28550399/addition-of-second-line-steroid-sparing-immunosuppressants-like-mycophenolate-mofetil-improves-outcome-of-immunoglobulin-g4-related-disease-igg4-rd-a-series-from-a-tertiary-care-teaching-hospital-in-south-india
#7
Nikhil Gupta, John Mathew, Hindhumathi Mohan, Sudipta Dhar Chowdhury, Reuben Thomas Kurien, D J Christopher, Balamugesh Thangakunam, Mathew Alexander, Ajith Sivadasan, V Tamilarasi, Anna T Valson, Mahasampath Gowri, Jayakanthan Kabeerdoss, Debashish Danda
IgG4-related disease (IgG4-RD) is a systemic fibro-inflammatory disease. This disease may be associated with elevated serum and tissue IgG4 levels. Early treatment prevents fibrosis and organ damage. We retrospectively studied the clinicopathologic correlation and outcome of treatment in IgG4-RD. This single-center retrospective study was done using electronic records of patients subjected to assay of serum IgG4 levels in our laboratory by nephelometry. There were 473 patients with suspected IgG4-RD. Of them, 41 patients fulfilled comprehensive diagnostic criteria for IgG4-RD and 432 had diseases other than IgG4-RD...
May 26, 2017: Rheumatology International
https://www.readbyqxmd.com/read/28550383/-you-can-carry-the-torch-now-a-qualitative-analysis-of-parents-experiences-caring-for-a-child-with-trisomy-13-or-18
#8
Joshua D Arthur, Divya Gupta
Trisomy 13 and 18 (T 13/18) are rare chromosomal abnormalities associated with high morbidity and mortality. Improved survival rates and increased prevalence of aggressive medical intervention have resulted in families and physicians holding different perspectives regarding the appropriate management of children with T 13/18. Families were invited for open-ended interviews regarding their experiences with the medical care of a child with T 13/18 over the past 5 years. Seven of 33 invited families were surveyed; those who had spent more than 40 days in the hospital were most likely to accept the invitation (OR 8...
May 26, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/28550028/the-impact-of-a-hepatobiliary-multidisciplinary-team-assessment-in-patients-with-colorectal-cancer-liver-metastases-a-population-based-study
#9
Jennie Engstrand, Nikolaos Kartalis, Cecilia Strömberg, Mats Broberg, Anna Stillström, Tobias Lekberg, Eduard Jonas, Jacob Freedman, Henrik Nilsson
BACKGROUND: Assessing patients with colorectal cancer liver metastases (CRCLM) by a liver multidisciplinary team (MDT) results in higher resection rates and improved survival. The aim of this study was to evaluate the potentially improved resection rate in a defined cohort if all patients with CRCLM were evaluated by a liver MDT. PATIENTS AND METHODS: A retrospective analysis of patients diagnosed with colorectal cancer during 2008 in the greater Stockholm region was conducted...
May 26, 2017: Oncologist
https://www.readbyqxmd.com/read/28549957/three-stage-esophagectomy-combined-with-abdominal-aortic-aneurysm-repair-first-case-in-the-literature
#10
Chris Klonaris, Dimitrios Schizas, Georgios Karaolanis, Dimitrios Athanasiadis, Andreas Alexandrou, Theodore Liakakos
The purpose of this report is to describe the synchronous surgical treatment of an abdominal aortic aneurysm (AAA) with concomitant esophageal cancer (EC) with a three-stage esophagectomy, a real management challenge especially in establishing the therapeutic priorities and the ideal treatment approach. A 65-year old male was referred for treatment in our hospital with the diagnosis of AAA. He complained of general fatigue, weight loss and intermittent dysphagia. Contrast-enhanced CT and upper endoscopy showed the AAA and a large gastroesophageal junction (GEJ) tumor respectively...
May 23, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28549778/stepwise-introduction-of-the-best-care-always-central-line-associated-bloodstream-infection-prevention-bundle-in-a-network-of-south-african-hospitals
#11
Guy A Richards, Adrian J Brink, Angeliki P Messina, Charles Feldman, Karin Swart, Dena van den Bergh
BACKGROUND: Health care associated infection (HAI) remains a major international problem. AIM: The "Best Care Always!" (BCA) campaign, was launched in South Africa to reduce common preventable HAI, including catheter associated bloodstream infection (CLABSI). METHODS: The intervention occurred in 43 Netcare Private Hospitals increasing later to 49 with 958 ICU and 439 high care (HC) beds and 1207 ICU and 493 HC beds, respectively. .Phase 1: April 2010-March 2011: ICU Infection Prevention and Control (IPC) nurse driven change: Commitment from management and doctors and training of IPC nurses...
May 23, 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28549765/improving-patient-centered-transitional-care-after-complex-abdominal-surgery
#12
Alexandra W Acher, Stephanie A Campbell-Flohr, Maria Brenny-Fitzpatrick, Kristine M Leahy-Gross, Sara Fernandes-Taylor, Alexander V Fisher, Suresh Agarwal, Amy J Kind, Caprice C Greenberg, Pascale Carayon, Sharon M Weber
BACKGROUND: Poor-quality transitions of care from hospital to home contribute to high rates of readmission after complex abdominal surgery. The Coordinated Transitional Care (C-TraC) program improved readmission rates in medical patients, but evidence-based surgical transitional care protocols are lacking. This pilot study evaluated the feasibility and preliminary effectiveness of an adapted surgical C-TraC protocol. STUDY DESIGN: The intervention includes in-person enrollment of patients...
May 18, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28549708/chronic-obstructive-pulmonary-disease-in-post-acute-long-term-care-settings-seizing-opportunities-to-individualize-treatment-and-device-selection
#13
Meenakshi Patel, Karl Steinberg, Manuel Suarez-Barcelo, Dana Saffel, Rick Foley, Chad Worz
INTRODUCTION: The burden of chronic obstructive pulmonary disease (COPD) in post-acute/long-term care (PA/LTC) settings is high, and many patients do not receive guideline-recommended care. METHODS: An interprofessional expert panel of PA/LTC professionals convened to discuss the unmet medical needs in patients with COPD in PA/LTC settings, and to make recommendations for the assessment of COPD patients to individualize the selection of maintenance treatment. RESULTS: Unmet needs observed in patients with COPD are described in addition to new tools for assessing individual patient abilities and appropriate device selection for maintenance treatment...
June 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28549668/patient-perspectives-on-diabetes-care-across-the-institute-of-medicine-s-six-domains-of-quality
#14
I J Halperin, G Mukerji, M Maione, P Segal, M Wolfs, J Goguen, L Jeffs
OBJECTIVES: To gather patient perspectives on quality of care provided in diabetes clinics within the framework of the Institute of Medicine's 6 domains of quality. METHODS: A qualitative study including semi-structured interviews was conducted at 5 academic hospital sites. Transcripts were analyzed using a direct content approach for themes and subthemes with saturation of themes achieved. Purposive sampling was conducted at 5 diabetes clinics (n=47 interviews)...
May 23, 2017: Canadian Journal of Diabetes
https://www.readbyqxmd.com/read/28549662/simplified-diagnostic-management-of-suspected-pulmonary-embolism-the-years-study-a-prospective-multicentre-cohort-study
#15
Tom van der Hulle, Whitney Y Cheung, Stephanie Kooij, Ludo F M Beenen, Thomas van Bemmel, Josien van Es, Laura M Faber, Germa M Hazelaar, Christian Heringhaus, Herman Hofstee, Marcel M C Hovens, Karin A H Kaasjager, Rick C J van Klink, Marieke J H A Kruip, Rinske F Loeffen, Albert T A Mairuhu, Saskia Middeldorp, Mathilde Nijkeuter, Liselotte M van der Pol, Suzanne Schol-Gelok, Marije Ten Wolde, Frederikus A Klok, Menno V Huisman
BACKGROUND: Validated diagnostic algorithms in patients with suspected pulmonary embolism are often not used correctly or only benefit subgroups of patients, leading to overuse of computed tomography pulmonary angiography (CTPA). The YEARS clinical decision rule that incorporates differential D-dimer cutoff values at presentation, has been developed to be fast, to be compatible with clinical practice, and to reduce the number of CTPA investigations in all age groups. We aimed to prospectively evaluate this novel and simplified diagnostic algorithm for suspected acute pulmonary embolism...
May 23, 2017: Lancet
https://www.readbyqxmd.com/read/28549596/emerging-roles-of-the-cxcl12-cxcr4-axis-in-pancreatic-cancer-progression-and-therapy
#16
REVIEW
Richard L Sleightholm, Beth K Neilsen, Jing Li, Maria M Steele, Rakesh K Singh, Michael A Hollingsworth, David Oupicky
Chemokine networks regulate a variety of cellular, physiological, and immune processes. These normal functions can become appropriated by cancer cells to facilitate a more hospitable niche for aberrant cells by enhancing growth, proliferation, and metastasis. This is especially true in pancreatic cancer, where chemokine signaling is a vital component in the development of the supportive tumor microenvironment and the signaling between the cancer cells and surrounding stromal cells. Although expression patterns vary among cancer types, the chemokine receptor CXCR4 has been implicated in nearly every major malignancy and plays a prominent role in pancreatic cancer development and progression...
May 23, 2017: Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28549574/screening-for-psychologic-distress-in-taiwanese-cancer-inpatients-using-the-national-comprehensive-cancer-network-distress-thermometer-the-effects-of-patients-sex-and-chemotherapy-experience
#17
Yu-Jie Chiou, Chun-Yi Lee, Shau-Hsuan Li, Mian-Yoon Chong, Yu Lee, Liang-Jen Wang
BACKGROUND: Patients with cancer often experience distress, and early detection and management of psychologic distress are vital for improving patients' outcomes. OBJECTIVE: This study investigates the validity and determines the optimal cutoff score-for clinically significant distress-for the Taiwanese Distress Thermometer (DT). METHODS: This study consisted of 768 inpatients diagnosed with cancer in a general hospital in southern Taiwan...
April 6, 2017: Psychosomatics
https://www.readbyqxmd.com/read/28549520/-taking-over-somebody-s-life-experiences-of-surrogate-decision-makers-in-the-surgical-intensive-care-unit
#18
Elizabeth J Lilley, Megan A Morris, Nicholas Sadovnikoff, Jamahal M Luxford, Navin R Changoor, Anna Bystricky, Angela M Bader, Zara Cooper
BACKGROUND: Impaired capacity of patients necessitates the use of surrogates to make decisions on behalf of patients. Little is known about surrogate decision-making in the surgical intensive care unit, where the decline to critical illness is often unexpected. We sought to explore surrogate experiences with decision-making in the surgical intensive care unit. METHODS: This qualitative study was performed at 2 surgical intensive care units at a single, tertiary, academic hospital Surrogate decision-makers who had made a major medical decision for a patient in the surgical intensive care unit were identified and enrolled prospectively...
May 23, 2017: Surgery
https://www.readbyqxmd.com/read/28549466/radiographic-sarcopenia-predicts-postoperative-infectious-complications-in-patients-undergoing-pancreaticoduodenectomy
#19
Kosei Takagi, Ryuichi Yoshida, Takahito Yagi, Yuzo Umeda, Daisuke Nobuoka, Takashi Kuise, Toshiyoshi Fujiwara
BACKGROUND: Recently, skeletal muscle depletion (sarcopenia) has been reported to influence postoperative outcomes after certain procedures. This study investigated the impact of sarcopenia on postoperative outcomes following pancreaticoduodenectomy (PD). METHODS: We performed a retrospective study of consecutive patients (n = 219) who underwent PD at our institution between January 2007 and May 2013. Sarcopenia was evaluated using preoperative computed tomography...
May 26, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28549459/-a-steep-learning-curve-junior-doctor-perspectives-on-the-transition-from-medical-student-to-the-health-care-workplace
#20
Nancy Sturman, Zachary Tan, Jane Turner
BACKGROUND: The transition from medical student to hospital-based first year junior doctor (termed "intern" in Australia) is known to be challenging, and recent changes in clinical learning environments may reduce graduate preparedness for the intern workplace. Although manageable challenges and transitions are a stimulus to learning, levels of burnout in junior medical colleagues are concerning. In order to prepare and support medical graduates, educators need to understand contemporary junior doctor perspectives on this transition...
May 26, 2017: BMC Medical Education
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