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https://www.readbyqxmd.com/read/28091333/an-ecological-approach-to-reducing-potentially-inappropriate-medication-use-canadian-deprescribing-network
#1
Cara Tannenbaum, Barbara Farrell, James Shaw, Steve Morgan, Johanna Trimble, Jane Currie, Justin Turner, Paula Rochon, James Silvius
Polypharmacy is growing in Canada, along with adverse drug events and drug-related costs. Part of the solution may be deprescribing, the planned and supervised process of dose reduction or stopping of medications that may be causing harm or are no longer providing benefit. Deprescribing can be a complex process, involving the intersection of patients, health care providers, and organizational and policy factors serving as enablers or barriers. This article describes the justification, theoretical foundation, and process for developing a Canadian Deprescribing Network (CaDeN), a network of individuals, organizations, and decision-makers committed to promoting the appropriate use of medications and non-pharmacological approaches to care, especially among older people in Canada...
January 16, 2017: Canadian Journal on Aging, la Revue Canadienne du Vieillissement
https://www.readbyqxmd.com/read/28088009/cardiac-output-and-systemic-vascular-resistance-clinical-assessment-compared-with-a-noninvasive-objective-measurement-in-children-with-shock
#2
Asma Razavi, Christopher J L Newth, Robinder G Khemani, Fernando Beltramo, Patrick A Ross
PURPOSE: To evaluate physician assessment of cardiac output and systemic vascular resistance in patients with shock compared with an ultrasonic cardiac output monitor (USCOM). To explore potential changes in therapy decisions if USCOM data were available using physician intervention answers. STUDY DESIGN: Double-blinded, prospective, observational study in a tertiary hospital pediatric intensive care unit. Forty children (<18years) admitted with shock, requiring ongoing volume resuscitation or inotropic support...
December 28, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/28087800/health-care-engagement-among-lgbt-older-adults-the-role-of-depression-diagnosis-and-symptomatology
#3
Chengshi Shiu, Hyun-Jun Kim, Karen Fredriksen-Goldsen
PURPOSE OF THE STUDY: Optimal engagement in health care plays a critical role in the success of disease prevention and treatment, particularly for older adults who are often in greater need of health care services. However, to date, there is still limited knowledge about the relationship between depression and health care engagement among lesbian, gay, bisexual, and transgender (LGBT) older adults. DESIGN AND METHODS: This study utilized data from Aging with Pride: National Health, Aging, Sexuality/Gender Study, from the 2014 survey with 2,450 LGBT adults 50 years old and older...
February 2017: Gerontologist
https://www.readbyqxmd.com/read/28086871/the-integrated-care-pathway-for-post-stroke-patients-icapps-a-shared-care-approach-between-stakeholders-in-areas-with-limited-access-to-specialist-stroke-care-services
#4
Aznida Firzah Abdul Aziz, Nor Azlin Mohd Nordin, Mohd Fairuz Ali, Noor Azah Abd Aziz, Saperi Sulong, Syed Mohamed Aljunid
BACKGROUND: Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking. METHODS: Expert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted...
January 13, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28078497/anti-inflammatory-effect-of-naravelia-zeylanica-dc-via-suppression-of-inflammatory-mediators-in-carrageenan-induced-abdominal-oedema-in-zebrafish-model
#5
Sanmuga Priya Ekambaram, Senthamil Selvan Perumal, Selvaranjani Pavadai
The traditional herbal medicines are receiving great importance in the health care sector, especially in Indian system of medicine, i.e, Ayurveda. The present study focused on the standardization of Naravelia zeylanica (L.) DC in terms of its active phytochemicals and to evaluate the anti-inflammatory activity of ethanol extract of N. zeylanica (ENZ). An analytical method was developed by high-performance liquid chromatography for simultaneous determination of β-sitosterol, lupeol and oleanolic acid in ENZ...
January 11, 2017: Inflammopharmacology
https://www.readbyqxmd.com/read/28076304/the-use-of-liquid-chromatography-tandem-mass-spectrometry-for-therapeutic-drug-monitoring-of-antibiotics-in-cancer-patients
#6
Nahed El-Najjar, Jonathan Jantsch, André Gessner
Cancer remains a leading cause of mortality and morbidity worldwide. In addition to organ failure, the most frequent reasons for admission of cancer patients to intensive care units (ICU) are: infections and sepsis. As critically ill, the complexity of the health situation of cancer patients renders the standard antimicrobial regimen more complex and even inadequate which results in increased mortality rates. This is due to pathophysiological changes in the volume of distribution, increased clearance, as well as to organ dysfunction...
January 11, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28074989/-antidepressants-agents-in-breast-cancer-patients-using-tamoxifen-review-of-basic-and-clinical-evidence
#7
María Elisa Irarrázaval O, Leonardo Gaete G
Tamoxifen (Tmf), is a standard of care for women with estrogen receptor positive (ER+) breast cancer. Endoxifen is a Tmf metabolite generated by cytochrome P450 2D6 (CYP2D6). Antidepressive agents (AD) are often prescribed to women with breast cancer not only for depression, but also for anxiety and hot flashes. Some AD are substrates or inhibitors of the Tmf metabolic pathway. Therefore there may be interactions when Tmf and AD are prescribed simultaneously. Oncologic protection afforded by Tmf may become less effective or null when AD are indicated, especially in poor metabolizing patients...
October 2016: Revista Médica de Chile
https://www.readbyqxmd.com/read/28074754/legal-and-ethical-imperatives-for-using-certified-sign-language-interpreters-in-health-care-settings-how-to-do-no-harm-when-it-s-all-greek-sign-language-to-you
#8
Angela M Nonaka
Communication obstacles in health care settings adversely impact patient-practitioner interactions by impeding service efficiency, reducing mutual trust and satisfaction, or even endangering health outcomes. When interlocutors are separated by language, interpreters are required. The efficacy of interpreting, however, is constrained not just by interpreters' competence but also by health care providers' facility working with interpreters. Deaf individuals whose preferred form of communication is a signed language often encounter communicative barriers in health care settings...
September 1, 2016: Care Management Journals: Journal of Case Management ; the Journal of Long Term Home Health Care
https://www.readbyqxmd.com/read/28073360/centralising-and-optimising-decentralised-stroke-care-systems-a-simulation-study-on-short-term-costs-and-effects
#9
Maarten M H Lahr, Durk-Jouke van der Zee, Gert-Jan Luijckx, Patrick C A J Vroomen, Erik Buskens
BACKGROUND: Centralisation of thrombolysis may offer substantial benefits. The aim of this study was to assess short term costs and effects of centralisation of thrombolysis and optimised care in a decentralised system. METHODS: Using simulation modelling, three scenarios to improve decentralised settings in the North of Netherlands were compared from the perspective of the policy maker and compared to current decentralised care: (1) improving stroke care at nine separate hospitals, (2) centralising and improving thrombolysis treatment to four, and (3) two hospitals...
January 10, 2017: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/28072822/point-of-care-versus-central-laboratory-measurements-of-hemoglobin-hematocrit-glucose-bicarbonate-and-electrolytes-a-prospective-observational-study-in-critically-ill-patients
#10
Jérôme Allardet-Servent, Melissa Lebsir, Christian Dubroca, Martine Fabrigoule, Sylvie Jordana, Thomas Signouret, Matthias Castanier, Guillemette Thomas, Rettinavelou Soundaravelou, Anne Lepidi, Laurence Delapierre, Guillaume Penaranda, Philippe Halfon, Jean-Marie Seghboyan
INTRODUCTION: Rapid detection of abnormal biological values using point-of-care (POC) testing allows clinicians to promptly initiate therapy; however, there are concerns regarding the reliability of POC measurements. We investigated the agreement between the latest generation blood gas analyzer and central laboratory measurements of electrolytes, bicarbonate, hemoglobin, hematocrit, and glucose. METHODS: 314 paired samples were collected prospectively from 51 critically ill patients...
2017: PloS One
https://www.readbyqxmd.com/read/28066676/image-guided-localization-of-small-lung-nodules-in-video-assisted-thoracic-surgery
#11
REVIEW
Ze-Rui Zhao, Rainbow W H Lau, Peter S Y Yu, Randolph H L Wong, Calvin S H Ng
The advancement of imaging technology has recently facilitated single port minimally-invasive thoracic surgery techniques. Cone-beam computed tomography (CBCT) shows promising results in visualizing the target lesion and its surrounding critical anatomy, with an error of less than 2 mm. The integration of CBCT with the operating room (OR) to form the hybrid OR, provides unparalleled real-time imaging of the patient, which can be used with electromagnetic navigation bronchoscopy to confirm successful navigation and increase procedural accuracy particularly for small peripheral pulmonary targets...
October 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28065613/anca-negative-churg-strauss-syndrome-presenting-as-acute-multiple-cerebral-infarcts-a-case-report
#12
Klearchos Psychogios, Ilias Evmorfiadis, Spyros Dragomanovits, Athanasios Stavridis, Konstantinos Takis, Loukas Kaklamanis, Stathis Pantelis
Eosinophilic granulomatosis with polyangiitis (EGPA, previously named Churg-Strauss syndrome) is a form of necrotizing vasculitis occurring in patients with asthma and eosinophilia. Ischemic stroke is a relatively rare complication of the disease. We report a case of a 63-year-old woman with multiple embolic infarcts, hypereosinophilia (for >7 years), and skin rash. Elevated cardiac enzymes and cardiac magnetic resonance imaging were consistent with endomyocarditis. The simultaneous presence of history of asthma, sinusitis, hypereosinophilia, and vasculitis led to the diagnosis of EGPA...
January 5, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28064354/can-systematic-reviews-contribute-to-regulatory-decisions
#13
REVIEW
Corrado Barbui, Antonio Addis, Laura Amato, Giuseppe Traversa, Silvio Garattini
INTRODUCTION: The new call on independent research on drugs issued in October 2016 by the Italian Medicines Agency (AIFA) explicitly reported that proposals based on systematic reviews were not admissible, and no justification or explanation for this choice was given. Prompted by this policy decision, here, we briefly discuss the potential usefulness of systematic reviews in responding to regulatory needs. First, systematic reviews, by collecting, analysing and critically appraising all relevant studies on a specific topic, may be used by different stakeholders as a basis for making clinical and policy recommendations, including regulatory recommendations...
January 7, 2017: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28063849/recruitment-promotion-and-retention-of-women-in-academic-medicine-how-institutions-are-addressing-gender-disparities
#14
Phyllis L Carr, Christine Gunn, Anita Raj, Samantha Kaplan, Karen M Freund
OBJECTIVE: Greater numbers of women in medicine have not resulted in more women achieving senior positions. Programs supporting the recruitment, promotion, and retention of women in academic medicine could help to achieve greater advancement of more women to leadership positions. Qualitative research was conducted to understand such programs at 23 institutions and, using the social ecological model, examine how they operate at the individual, interpersonal, institutional, academic community, and policy levels...
January 4, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/28063264/preimplantation-3d-ultrasound-current-uses-and-challenges
#15
Sushila Arya, Sanja Kupesic Plavsic
The preimplantation ultrasound (US) refers to targeted imaging of the uterus and adnexa prior to assisted reproductive techniques (ART) to optimize the infertility treatment outcomes. After a thorough evidence based literature review, we propose the use of transvaginal three-dimensional (3D) US during the early follicular phase. A systematic approach for 3D US examination consists of a detailed examination of the uterine shape, size and contour, evaluation of the endometrial thickness, volume, pattern and vascularity, and assessment of the junctional zone regularity, echogenicity and thickness...
January 7, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28061896/improving-patient-flow-of-people-with-rheumatoid-arthritis-has-the-potential-to-simultaneously-improve-health-outcomes-and-reduce-direct-costs
#16
R Puchner, R Hochreiter, H Pieringer, A Vavrovsky
BACKGROUND: In our current economic climate of scarce resources there is a lot of debate around the best - and most efficient - way of delivering care, which points patients towards the right physician at the earliest opportunity. The aim of the study was to assess whether an improvement in the interdisciplinary management of rheumatoid arthritis (RA) has the potential to simultaneously improve health outcomes and reduce costs. METHODS: In a first step, we modelled the ways which lead patients with RA to the correct diagnosis, and the relevant specialist, respectively...
January 7, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28060415/gender-differences-in-affects-and-craving-in-alcohol-dependence-a-study-during-alcohol-detoxification
#17
Géraldine Petit, Olivier Luminet, Mariana Cordovil de Sousa Uva, Pauline Monhonval, Sophie Leclercq, Quentin Spilliaert, François Zammit, Pierre Maurage, Philippe de Timary
BACKGROUND: Alcohol craving is a major cause of relapse in alcohol-dependent (AD) patients. It is closely related to the high depression and anxiety symptoms that are frequently observed at the early stages of abstinence, and these comorbid symptoms might thus constitute a relapse factor when they persist after detoxification. As these negative affects are known to evolve during the detoxification process, the aim of this study was to investigate the course of the relation between affects and craving during detoxification, with a particular attention given to gender in light of the known differences in affects between AD men and women...
January 6, 2017: Alcoholism, Clinical and Experimental Research
https://www.readbyqxmd.com/read/28060083/effects-of-lifestyle-intervention-on-physiological-outcomes-in-chinese-adults-with-or-at-high-risk-of-metabolic-syndrome
#18
Sally Wai Sze Lo, Sek Ying Chair, Iris Fung Kam Lee
BACKGROUND: Metabolic syndrome (MS) increases the risk of cardiovascular events and the development of diabetes. This article reports the effects of lifestyle intervention on the physiological outcomes of people with or at high risk of MS in the community setting of Hong Kong. METHODS: Chinese adults with 2 or more MS components were recruited from 13 community centers, which were cluster-randomized to the intervention or control group. The intervention group received a low-intensity lifestyle intervention program for people with MS consisting of group sessions, individual counseling, and telephone follow-ups over 3 months...
January 5, 2017: Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/28059955/diagnosis-of-opportunistic-infections-hiv-co-infections-tuberculosis
#19
Lesley Scott, Pedro da Silva, Catharina C Boehme, Wendy Stevens, Chris Gilpin
PURPOSE OF REVIEW: Tuberculosis (TB) incidence has declined ∼1.5% annually since 2000, but continued to affect 10.4 million individuals in 2015, with 1/3 remaining undiagnosed or underreported. The diagnosis of TB among those co-infected with HIV is challenging as TB remains the leading cause of death in such individuals. Accurate and rapid diagnosis of active TB will avert mortality in both adults and children, reduce transmission, and assist in timeous decisions for antiretroviral therapy initiation...
January 5, 2017: Current Opinion in HIV and AIDS
https://www.readbyqxmd.com/read/28058085/microfluidic-cytometers-with-integrated-on-chip-optical-systems-for-red-blood-cell-and-platelet-counting
#20
Yingying Zhao, Qin Li, Xiaoming Hu, Yuhwa Lo
A microfluidic cytometer with integrated on-chip optical systems was designed for red blood cell (RBC) and platelet (PLT) counting. The design, fabrication, and characterization of the microfluidic cytometer with on-chip optical signal detection were described. With process using only a single mask, the device that integrates optical fibers and on-chip microlens with microfluidic channels on a polydimethylsiloxane layer by standard soft photolithography. This compact structure increased the sensitivity of the device and eliminated time-consuming free-space optical alignments...
November 2016: Biomicrofluidics
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