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https://www.readbyqxmd.com/read/29766138/risk-stratification-tools-in-emergency-general-surgery
#1
REVIEW
Joaquim Michael Havens, Alexandra B Columbus, Anupamaa J Seshadri, Carlos V R Brown, Gail T Tominaga, Nathan T Mowery, Marie Crandall
The use of risk stratification tools (RST) aids in clinical triage, decision making and quality assessment in a wide variety of medical fields. Although emergency general surgery (EGS) is characterized by a comorbid, physiologically acute patient population with disparately high rates of perioperative morbidity and mortality, few RST have been explicitly examined in this setting. We examined the available RST with the intent of identifying a tool that comprehensively reflects an EGS patients perioperative risk for death or complication...
2018: Trauma surgery & acute care open
https://www.readbyqxmd.com/read/29764629/an-open-randomized-controlled-study-comparing-an-online-text-based-scenario-and-a-serious-game-by-belgian-and-swiss-pharmacy-students
#2
Jérôme Berger, Noura Bawab, Jeremy De Mooij, Denise Sutter Widmer, Nicolas Szilas, Carine De Vriese, Olivier Bugnon
INTRODUCTION: To compare online learning tools, looped, branch serious game (SG) and linear text-based scenario (TBS), among a sample of Belgian and Swiss pharmacy students. METHODS: Open randomized controlled study. The lesson was based on the case of a benign cough in a healthy child. A randomized sample of 117 students: only the Swiss students had attended a previous lecture on coughs. Participation rate, pre- and post-experience Likert scales and students' clinical knowledge were measured...
March 2018: Currents in Pharmacy Teaching & Learning
https://www.readbyqxmd.com/read/29753877/developing-a-decision-support-system-for-patients-with-severe-infection-conditions-in-prehospital-care
#3
Niclas Johansson, Carl Spindler, John Valik, Veronica Vicente
OBJECTIVE: To develop and validate a prehospital decision support system (DSS) for the emergency medical services (EMS), enabling identification and steering of patients with critical infectious conditions - severe respiratory tract infections, severe CNS-infections and sepsis - to a specialized emergency department (ED) for infectious diseases. METHODS: The development process has involved four consecutive steps. The first step was gathering data from the electronic Patient Care Record on patients transported by the EMS, to identify retrospectively appropriate patient categories for steering...
May 10, 2018: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/29750130/light-sheet-microscopy-for-slide-free-non-destructive-pathology-of-large-clinical-specimens
#4
Adam K Glaser, Nicholas P Reder, Ye Chen, Erin F McCarty, Chengbo Yin, Linpeng Wei, Yu Wang, Lawrence D True, Jonathan T C Liu
For the 1.7 million patients per year in the U.S. who receive a new cancer diagnosis, treatment decisions are largely made after a histopathology exam. Unfortunately, the gold standard of slide-based microscopic pathology suffers from high inter-observer variability and limited prognostic value due to sampling limitations and the inability to visualize tissue structures and molecular targets in their native 3D context. Here, we show that an open-top light-sheet microscope optimized for non-destructive slide-free pathology of clinical specimens enables the rapid imaging of intact tissues at high resolution over large 2D and 3D fields of view, with the same level of detail as traditional pathology...
July 2017: Nature Biomedical Engineering
https://www.readbyqxmd.com/read/29738400/using-a-validated-middle-age-and-geriatric-risk-tool-to-identify-early-48hr-hospital-mortality-and-associated-cost-of-care
#5
Ariana Lott, Jack Haglin, Hesham Saleh, Jordan Hall, Kenneth A Egol, Sanjit R Konda
OBJECTIVES: 1) Demonstrate that a validated trauma triage score for middle-aged and geriatric patients could identify those at high risk for mortality within the first two days of hospitalization and 2) determine the cost of care for this cohort of patients DESIGN:: Prospective cohort study SETTING:: Single Level 1 Trauma Center PATIENTS:: Patients 55 years and older who were evaluated in the emergency department setting by Orthopaedics or who met American College of Surgeons Tier 1-3 criteria INTERVENTION:: Calculation of validated trauma triage score, Score for Trauma Triage in Geriatric and Middle Aged (STTGMA), using patient's demographic, injury severity, and functional statusMain Outcome Measurements: length of stay, inpatient mortality, time between presentation and time of death, and direct variable costs of hospitalization RESULTS:: A total of 1470 consecutive patients (mean age of 72...
May 3, 2018: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29735752/selection-of-priority-natural-products-for-evaluation-as-potential-precipitants-of-natural-product-drug-interactions-a-napdi-center-recommended-approach
#6
Emily J Johnson, Vanessa Gonzalez-Perez, Dan-Dan Tian, Yvonne S Lin, Jashvant D Unadkat, Allan E Rettie, Danny D Shen, Jeannine S McCune, Mary F Paine
Pharmacokinetic interactions between natural products (NPs) and conventional medications (prescription and non-prescription) are a longstanding but understudied problem in contemporary pharmacotherapy. Consequently, there are no established methods for selecting and prioritizing commercially available NPs to evaluate as precipitants of NP-drug interactions (NPDIs). As such, NPDI discovery remains largely a retrospective, bedside-to-bench process. This Recommended Approach, developed by the Center of Excellence for Natural Product Drug Interaction Research (NaPDI Center), describes a systematic method for selecting NPs to evaluate as precipitants of potential clinically significant pharmacokinetic NPDIs...
May 7, 2018: Drug Metabolism and Disposition: the Biological Fate of Chemicals
https://www.readbyqxmd.com/read/29734507/screening-in-toddlers-and-preschoolers-at-risk-for-autism-spectrum-disorder-evaluating-a-novel-mobile-health-screening-tool
#7
Stephen M Kanne, Laura Arnstein Carpenter, Zachary Warren
There are many available tools with varying levels of accuracy designed to screen for Autism Spectrum Disorder (ASD) in young children, both in the general population and specifically among those referred for developmental concerns. With burgeoning waitlists for comprehensive diagnostic ASD assessments, finding accurate methods and tools for advancing diagnostic triage becomes increasingly important. The current study compares the efficacy of four oft used paper and pencil measures, the Modified Checklist for Autism in Toddlers Revised with Follow-up, the Social Responsiveness Scale, Second Edition, and the Social Communication Questionnaire, and the Child Behavior Checklist to a novel mobile-health screening tool developed by Cognoa, Inc...
May 7, 2018: Autism Research: Official Journal of the International Society for Autism Research
https://www.readbyqxmd.com/read/29729486/effect-of-the-tooth-surface-water-on-the-accuracy-of-dose-reconstructions-in-the-x-band-in-vivo-epr-dosimetry
#8
Jierui Zou, Junwang Guo, Guofu Dong, Lei Ma, Jianbo Cong, Ye Liu, Ye Tian, Ke Wu
The X-band in vivo EPR tooth dosimetry is promising as a tool for the initial triage after a large-scale radiation accident. The dielectric losses caused by water on the tooth surface (WTS) are one of the major sources of inaccuracies in this method. The effect was studied by theoretical simulation calculations and experiments with water films of various thicknesses on teeth. The results demonstrate the possibility of sufficiently accurate measurements of the radiation-induced signal of the tooth enamel provided that the thickness of the water film on the tooth is below 60 µm...
April 24, 2018: Applied Radiation and Isotopes
https://www.readbyqxmd.com/read/29727248/quantitative-fetal-fibronectin-and-cervical-length-in-symptomatic-women-results-from-a-prospective-blinded-cohort-study
#9
Lisa D Levine, Katheryne L Downes, Julie A Romero, Hope Pappas, Michal A Elovitz
OBJECTIVES: Our objectives were to determine whether quantitative fetal fibronectin (fFN) and cervical length (CL) screening can be used alone or in combination as prognostic tests to identify symptomatic women at highest or lowest risk for spontaneous preterm birth (sPTB). METHODS: A prospective, blinded cohort study of women presenting with a singleton gestation to our triage unit between 22-33w6d with preterm labor symptoms was performed. Women with ruptured membranes, moderate/severe bleeding, and dilation > 2 cm were excluded...
May 4, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29724040/evaluation-of-a-digital-consultation-and-self-care-advice-tool-in-primary-care-a-multi-methods-study
#10
Julie Cowie, Eileen Calveley, Gillian Bowers, John Bowers
Digital services are often regarded as a solution to the growing demands on primary care services. Provision of a tool offering advice to support self-management as well as the ability to digitally consult with a General Practitioner (GP) has the potential to alleviate some of the pressure on primary care. This paper reports on a Phase II, 6-month evaluation of eConsult, a web-based triage and consultation system that was piloted across 11 GP practices across Scotland. Through a multi-method approach the evaluation explored eConsult use across practices, exposing both barriers and facilitators to its adoption...
May 2, 2018: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29719875/using-an-original-triage-and-on-call-management-tool-aids-identification-and-assessment-of-the-acutely-unwell-surgical-patient
#11
Stacie Hodge, Sebastian Helliar, Hamish Ian Macdonald, Paul Mackey
Until now, there have been no published surgical triage tools. We have developed the first such tool with a tiered escalation policy, aiming to improve identification and management of critically unwell patients. The existing sheet which is used to track new referrals and admissions to the surgical assessment unit was reviewed. The sheet was updated and a traffic light triage tool generated using National Early Warning Scores (NEWS), sepsis criteria and user discretion. A tiered escalation policy to guide urgency of assessment was introduced and education sessions for all staff undertaken, to ensure understanding and compliance...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29715251/time-spent-in-the-emergency-department-and-outcomes-in-patients-with-severe-sepsis-and-septic-shock
#12
RaeAnn Hirschy, Ethan Sterk, Rachel Dobersztyn, Megan A Rech
A majority of patients with severe sepsis and septic shock are first evaluated in the emergency department (ED). Methods such as screening tools have proven advantageous in earlier identification, allowing for timely initiation of treatment. Delay in symptom presentation and ED overcrowding contribute to deferment of sepsis bundle components and admission. To examine the impact of time from ED arrival to inpatient admission on mortality and length of stay (LOS) in patients with severe sepsis or septic shock...
April 2018: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/29707245/addressing-the-third-delay-implementing-a-novel-obstetric-triage-system-in-ghana
#13
David M Goodman, Emmanuel K Srofenyoh, Rohit Ramaswamy, Fiona Bryce, Liz Floyd, Adeyemi Olufolabi, Cecilia Tetteh, Medge D Owen
Institutional delivery has been proposed as a method for reducing maternal morbidity and mortality, but little is known about how referral hospitals in low-resource settings can best manage the expected influx of patients. In this study, we assess the impact of an obstetric triage improvement programme on reducing hospital-based delay in a referral hospital in Accra, Ghana. An Active Implementation Framework is used to describe a 5-year intervention to introduce and monitor obstetric triage capabilities. Baseline data, collected from September to November 2012, revealed significant delays in patient assessment on arrival...
2018: BMJ Global Health
https://www.readbyqxmd.com/read/29696452/computer-aided-analysis-of-64-and-320-slice-coronary-computed-tomography-angiography-a-comparison-with-expert-human-interpretation
#14
Moshrik Abd Alamir, Pamela Noack, Kristine H Jang, Jhanna A Moore, Roman Goldberg, Michael Poon
Routine use of CCTA to triage Emergency Department (ED) chest pain can reduce ED length of stay while providing accurate diagnoses. We evaluated the effectiveness of using Computer Aided Diagnosis in the triage of low to intermediate risk emergency chest pain patients with Coronary Computed Tomographic Angiography (CCTA). Using 64 and 320 slice CT scanners, we compared the diagnostic capability of computer aided diagnosis to human readers in 923 ED patients with chest pain. We calculated sensitivity, specificity, Positive Predictive Value and Negative Predictive Value for cases performed on each scanner...
April 25, 2018: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/29691799/the-discriminative-power-of-stop-bang-as-a-screening-tool-for-suspected-obstructive-sleep-apnea-in-clinically-referred-patients-considering-gender-differences
#15
Jin Mou, Bethann M Pflugeisen, Brian A Crick, Paul J Amoroso, Kirk T Harmon, Stephen F Tarnoczy, S Shirley Ho, Kimberly A Mebust
PURPOSE: Obstructive sleep apnea (OSA) is the most commonly seen clinical sleep disorder. STOP-Bang, a widely used screening tool, yields a composite score based on eight dichotomized items including male gender. This study was designed to validate STOP-Bang among clinically referred patients and tested alternative scoring designs on tool performance, with a focus on gender differences in OSA. METHOD: STOP-Bang was administered to 403 female and 532 male subjects, followed by comprehensive sleep evaluation that included measurement of apnea-hypopnea indexes...
April 24, 2018: Sleep & Breathing, Schlaf & Atmung
https://www.readbyqxmd.com/read/29678481/clinical-decision-support-tools-improving-cancer-care
#16
REVIEW
Robert C Stillman
OBJECTIVES: To describe the clinical decision support tools and advancements in health information technology currently utilized at a National Cancer Institute designated cancer center to aid in achieving the Institute for Healthcare Improvement Triple Aim project. DATA SOURCES: Published literature, Web sites. CONCLUSION: Advances in health information technology facilitate increasing quality and satisfaction with care, improving the health of populations, and reducing the cost of care...
April 17, 2018: Seminars in Oncology Nursing
https://www.readbyqxmd.com/read/29660578/implementing-the-risk-of-endometrial-malignancy-algorithm-rem-adding-obesity-as-a-predictive-factor-results-of-rem-b-in-a-single-center-survey
#17
Francesco Plotti, Stella Capriglione, Giuseppe Scaletta, Daniela Luvero, Salvatore Lopez, Francesca Fiori Nastro, Corrado Terranova, Carlo De Cicco Nardone, Roberto Montera, Roberto Angioli
OBJECTIVE: In 2013, our group assessed a risk stratification tool of endometrial cancer (EC), called REM (Risk of Endometrial Malignancy). A well known risk factor for EC is body mass index (BMI). In fact, (BMI > 30 and <35 kg/m2) and severe obesity (BMI > 35 kg/m2) were associated with a 2.6-fold and a 4.7-fold increase in EC risk, respectively. Therefore, in the present study we aim to improve the performance of REM, including BMI and developing a new scoring system, called REM-B (Risk of Endometrial Malignancy score associated to BMI), to classify patients into high risk or low risk groups for EC...
April 7, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/29656835/trauma-quality-improvement-reducing-triage-errors-by-automating-the-level-assignment-process
#18
David P Stonko, Dillon C O Neill, Bradley M Dennis, Melissa Smith, Jeffrey Gray, Oscar D Guillamondegui
BACKGROUND: Trauma patients are triaged by the severity of their injury or need for intervention while en route to the trauma center according to trauma activation protocols that are institution specific. Significant research has been aimed at improving these protocols in order to optimize patient outcomes while striving for efficiency in care. However, it is known that patients are often undertriaged or overtriaged because protocol adherence remains imperfect. The goal of this quality improvement (QI) project was to improve this adherence, and thereby reduce the triage error...
April 12, 2018: Journal of Surgical Education
https://www.readbyqxmd.com/read/29642920/reverse-shock-index-multiplied-by-glasgow-coma-scale-score-rsig-is-a-simple-measure-with-high-discriminant-ability-for-mortality-risk-in-trauma-patients-an-analysis-of-the-japan-trauma-data-bank
#19
Akio Kimura, Noriko Tanaka
BACKGROUND: The shock index (SI), defined as heart rate (HR) divided by systolic blood pressure (SBP), is reported to be a more sensitive marker of shock than traditional vital signs alone. In previous literature, use of the reverse shock index (rSI), taken as SBP divided by HR, is recommended instead of SI for hospital triage. Among traumatized patients aged > 55 years, SI multiplied by age (SIA) might provide better prediction of early post-injury mortality. Separately, the Glasgow Coma Scale (GCS) score has been shown to be a very strong predictor...
April 11, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29627769/development-and-validation-of-an-admission-prediction-tool-for-emergency-departments-in-the-netherlands
#20
Nicole Kraaijvanger, Douwe Rijpsma, Lian Roovers, Henk van Leeuwen, Karin Kaasjager, Lillian van den Brand, Laura Horstink, Michael Edwards
OBJECTIVE: Early prediction of admission has the potential to reduce length of stay in the ED. The aim of this study is to create a computerised tool to predict admission probability. METHODS: The prediction rule was derived from data on all patients who visited the ED of the Rijnstate Hospital over two random weeks. Performing a multivariate logistic regression analysis factors associated with hospitalisation were explored. Using these data, a model was developed to predict admission probability...
April 7, 2018: Emergency Medicine Journal: EMJ
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