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By St. Lukes Medical Library Chesterfield
Joel Cho, Trevor P Jensen, Kreegan Rierson, Benji K Matthews, Anjali Bhagra, Ricardo Franco-Sadud, Loretta Grikis, Michael Mader, Ria Dancel, Brian P Lucas, Nilam J Soni
1. We recommend that ultrasound guidance should be used for paracentesis to reduce the risk of serious complications, the most common being bleeding. 2. We recommend that ultrasound guidance should be used to avoid attempting paracentesis in patients with an insufficient volume of intraperitoneal free fluid to drain. 3. We recommend that ultrasound guidance should be used with paracentesis to improve the success rates of the overall procedure. 4. We recommend that ultrasound should be used to assess the volume and location of intraperitoneal free fluid to guide clinical decision making of where paracentesis can be safely performed...
January 2, 2019: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Nilam J Soni, Daniel Schnobrich, Benji K Matthews, David M Tierny, Trevor P Jensen, Ria Dancel, Joel Cho, Renee K Dversdal, Gregory Mints, Anjali Bhagra, Kreegan Reierson, Linda M Kurian, Gigi Y Liu, Carolina Candotti, Brandon Boesch, Charles M LoPresti, Joshua Lenchus, Tanping Wong, Gordon Johnson, Anna M Maw, Ricardo Franco-Sadud, Brian P Lucas
Many hospitalists incorporate point-of-care ultrasound (POCUS) into their daily practice to answer specific diagnostic questions or to guide performance of invasive bedside procedures. However, standards for hospitalists in POCUS training and assessment are not yet established. Most internal medicine residency training programs, the major pipeline for incoming hospitalists, have only recently begun to incorporate POCUS in their curricula. The purpose of this document is to inform a broad audience on what POCUS is and how hospitalists are using it...
January 2, 2019: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Masoud Hosseini, Anthony Faiola, Josette Jones, Daniel J Vreeman, Huanmei Wu, Brian E Dixon
Background: Information reconciliation is a common yet complex and often time-consuming task performed by healthcare providers. While electronic health record systems can receive "outside information" about a patient in electronic documents, rarely does the computer automate reconciling information about a patient across all documents. Materials and Methods: Using a mixed methods design, we evaluated an information system designed to reconcile information across multiple electronic documents containing health records for a patient received from a health information exchange (HIE) network...
December 19, 2018: Journal of the American Medical Informatics Association: JAMIA
Karla Lancaster, Aseel Abuzour, Manmeet Khaira, Annalise Mathers, April Chan, Vivian Bui, Annie Lok, Lehana Thabane, Lisa Dolovich
BACKGROUND: Electronic health (eHealth) tools are becoming increasingly popular for helping patients' self-manage chronic conditions. Little research, however, has examined the effect of patients using eHealth tools to self-report their medication management and use. Similarly, there is little evidence showing how eHealth tools might prompt patients and health care providers to make appropriate changes to medication use. OBJECTIVE: The objective of this systematic review was to determine the impact of patients' use of eHealth tools on self-reporting adverse effects and symptoms that promote changes to medication use...
December 18, 2018: Journal of Medical Internet Research
Jason W Busse, Li Wang, Mostafa Kamaleldin, Samantha Craigie, John J Riva, Luis Montoya, Sohail M Mulla, Luciane C Lopes, Nicole Vogel, Eric Chen, Karin Kirmayr, Kyle De Oliveira, Lori Olivieri, Alka Kaushal, Luis E Chaparro, Inna Oyberman, Arnav Agarwal, Rachel Couban, Ludwig Tsoi, Tommy Lam, Per Olav Vandvik, Sandy Hsu, Malgorzata M Bala, Stefan Schandelmaier, Anne Scheidecker, Shanil Ebrahim, Vahid Ashoorion, Yasir Rehman, Patrick J Hong, Stephanie Ross, Bradley C Johnston, Regina Kunz, Xin Sun, Norman Buckley, Daniel I Sessler, Gordon H Guyatt
Importance: Harms and benefits of opioids for chronic noncancer pain remain unclear. Objective: To systematically review randomized clinical trials (RCTs) of opioids for chronic noncancer pain. Data Sources and Study Selection: The databases of CENTRAL, CINAHL, EMBASE, MEDLINE, AMED, and PsycINFO were searched from inception to April 2018 for RCTs of opioids for chronic noncancer pain vs any nonopioid control. Data Extraction and Synthesis: Paired reviewers independently extracted data...
December 18, 2018: JAMA: the Journal of the American Medical Association
Vinay Kini, P Michael Ho
Importance: Among adults with chronic illness, 30% to 50% of medications are not taken as prescribed. In the United States, it is estimated that medication nonadherence is associated with 125 000 deaths, 10% of hospitalizations, and $100 billion in health care services annually. Observations: PubMed was searched from January 1, 2000, to September 6, 2018, for English-language randomized clinical trials of interventions to improve medication adherence. Trials of patients younger than 18 years, trials that used self-report as the primary adherence outcome, and trials with follow-up periods less than 6 months were excluded; 49 trials were included...
December 18, 2018: JAMA: the Journal of the American Medical Association
Marco A Zenati, Deepak L Bhatt, Faisal G Bakaeen, Eileen M Stock, Kousick Biswas, J Michael Gaziano, Rosemary F Kelly, Elaine E Tseng, Jerene Bitondo, Jacquelyn A Quin, G Hossein Almassi, Miguel Haime, Brack Hattler, Ellen DeMatt, Alexandra Scrymgeour, Grant D Huang
BACKGROUND: The saphenous-vein graft is the most common conduit for coronary-artery bypass grafting (CABG). The influence of the vein-graft harvesting technique on long-term clinical outcomes has not been well characterized. METHODS: We randomly assigned patients undergoing CABG at 16 Veterans Affairs cardiac surgery centers to either open or endoscopic vein-graft harvesting. The primary outcome was a composite of major adverse cardiac events, including death from any cause, nonfatal myocardial infarction, and repeat revascularization...
November 11, 2018: New England Journal of Medicine
Sarah Birken, Alecia Clary, Amir Alishahi Tabriz, Kea Turner, Rosemary Meza, Alexandra Zizzi, Madeline Larson, Jennifer Walker, Martin Charns
BACKGROUND: Middle managers are in a unique position to promote the implementation of evidence-based practices (EBPs) in healthcare organizations, yet knowledge of middle managers' role in implementation and determinants (e.g., individual-, organizational-, and system-level factors) which influence their role remains fractured, spanning decades and disciplines. To synthesize understanding, we undertook a systematic review of studies of middle managers' role in healthcare EBP implementation and determinants of that role...
December 12, 2018: Implementation Science: IS
Candice Downey, Rebecca Randell, Julia Brown, David G Jayne
BACKGROUND: Vital signs monitoring is a universal tool for the detection of postoperative complications; however, unwell patients can be missed between traditional observation rounds. New remote monitoring technologies promise to convey the benefits of continuous monitoring to patients in general wards. OBJECTIVE: The aim of this pilot study was to evaluate whether continuous remote vital signs monitoring is a practical and acceptable way of monitoring surgical patients and to optimize the delivery of a definitive trial...
December 11, 2018: Journal of Medical Internet Research
Dean F Sittig, Adam Wright, Enrico Coiera, Farah Magrabi, Raj Ratwani, David W Bates, Hardeep Singh
We identify and describe nine key, short-term, challenges to help healthcare organizations, health information technology developers, researchers, policymakers, and funders focus their efforts on health information technology-related patient safety. Categorized according to the stage of the health information technology lifecycle where they appear, these challenges relate to (1) developing models, methods, and tools to enable risk assessment; (2) developing standard user interface design features and functions; (3) ensuring the safety of software in an interfaced, network-enabled clinical environment; (4) implementing a method for unambiguous patient identification (1-4 Design and Development stage); (5) developing and implementing decision support which improves safety; (6) identifying practices to safely manage information technology system transitions (5 and 6 Implementation and Use stage); (7) developing real-time methods to enable automated surveillance and monitoring of system performance and safety; (8) establishing the cultural and legal framework/safe harbor to allow sharing information about hazards and adverse events; and (9) developing models and methods for consumers/patients to improve health information technology safety (7-9 Monitoring, Evaluation, and Optimization stage)...
December 11, 2018: Health Informatics Journal
Chun Shing Kwok, Sunil V Rao, Ian C Gilchrist, Jessica Potts, Vinayak Nagaraja, Mark Gunning, James Nolan, Evangelos Kontopantelis, Olivier F Bertrand, Mamas A Mamas
The cost of inpatient percutaneous coronary interventions (PCI) procedure is related to length of stay (LOS). It is unknown, how LOS may be associated with readmission rates and costs of index PCI and readmissions in elective PCI. This study aims to evaluate rates, predictors, causes, and costs associated with 30-day unplanned readmissions according to lLOS in patients, who underwent elective PCI. We included patients in the Nationwide Readmission Database, who were admitted to hospital from 2010 to 2014, who underwent uncomplicated elective PCI...
January 1, 2019: American Journal of Cardiology
Gabrielle L Anderson, Jennifer L Osborn, Scott D Nei, Malcolm R Bell, Gregory W Barsness, Kristin C Mara, Narith N Ou
Potent platelet inhibition is one of the most important medical interventions to prevent ischemic complications during and after percutaneous coronary intervention (PCI). Practice has evolved with the introduction of potent oral P2Y12 inhibitors that provide quick, effective platelet inhibition, and the need for routine glycoprotein IIb/IIIa inhibitors (GPIs) has decreased. Additionally, a shorter duration of GPI infusion has been shown to be safe with adequate oral antiplatelet loading, but clinical outcome data are limited to eptifibatide...
January 1, 2019: American Journal of Cardiology
Nader Najafi, Russ Cucina, Bruce Pierre, Raman Khanna
Importance: Physicians frequently use cardiac monitoring, or telemetry, beyond the duration recommended by published practice standards, resulting in "alarm fatigue" and excess cost. Prior studies have demonstrated an association between multicomponent quality improvement interventions and safe reduction of telemetry duration. Objective: To determine if a single-component intervention, a targeted electronic health record (EHR) alert, could achieve similar gains to multicomponent interventions and safely reduce unnecessary monitoring...
December 10, 2018: JAMA Internal Medicine
Tetsuo Shoji, Masaaki Inaba, Masafumi Fukagawa, Ryoichi Ando, Masanori Emoto, Hisako Fujii, Akira Fujimori, Mitsuru Fukui, Hiroki Hase, Tetsuya Hashimoto, Hideki Hirakata, Hirokazu Honda, Tatsuo Hosoya, Yuji Ikari, Daijo Inaguma, Toru Inoue, Yoshitaka Isaka, Kunitoshi Iseki, Eiji Ishimura, Noritomo Itami, Chiharu Ito, Toshitaka Kakuta, Toru Kawai, Hideki Kawanishi, Shuzo Kobayashi, Junko Kumagai, Kiyoshi Maekawa, Ikuto Masakane, Jun Minakuchi, Koji Mitsuiki, Takashi Mizuguchi, Satoshi Morimoto, Toyoaki Murohara, Tatsuya Nakatani, Shigeo Negi, Shinichi Nishi, Mitsushige Nishikawa, Tetsuya Ogawa, Kazumichi Ohta, Takayasu Ohtake, Mikio Okamura, Senji Okuno, Takashi Shigematsu, Toshitsugu Sugimoto, Masashi Suzuki, Hideki Tahara, Yoshiaki Takemoto, Kenji Tanaka, Yoshihiro Tominaga, Yoshiharu Tsubakihara, Yoshihiro Tsujimoto, Kazuhiko Tsuruya, Shinichiro Ueda, Yuzo Watanabe, Kunihiro Yamagata, Tomoyuki Yamakawa, Shozo Yano, Keitaro Yokoyama, Noriaki Yorioka, Minoru Yoshiyama, Yoshiki Nishizawa
Importance: Patients with chronic kidney disease have impaired vitamin D activation and elevated cardiovascular risk. Observational studies in patients treated with hemodialysis showed that the use of active vitamin D sterols was associated with lower risk of all-cause mortality, regardless of parathyroid hormone levels. Objective: To determine whether vitamin D receptor activators reduce cardiovascular events and mortality in patients without secondary hyperparathyroidism undergoing hemodialysis...
December 11, 2018: JAMA: the Journal of the American Medical Association
Lesley Price, Jennifer MacDonald, Lucyna Gozdzielewska, Tracey Howe, Paul Flowers, Lesley Shepherd, Yvonne Watt, Jacqui Reilly
OBJECTIVE: To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC). METHODS: PRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed. RESULTS: Overall, 19 systematic reviews (n=20 articles) were included...
December 2018: Infection Control and Hospital Epidemiology
Allison M Cole, Kari A Stephens, Imara West, Gina A Keppel, Ken Thummel, Laura-Mae Baldwin
We use prescription of statin medications and prescription of warfarin to explore the capacity of electronic health record data to (1) describe cohorts of patients prescribed these medications and (2) identify cohorts of patients with evidence of adverse events related to prescription of these medications. This study was conducted in the WWAMI region Practice and Research Network (WPRN)., a network of primary care practices across Washington, Wyoming, Alaska, Montana and Idaho DataQUEST, an electronic data-sharing infrastructure...
December 10, 2018: Health Informatics Journal
Kaitlin H Wade, Scott T Chiesa, Alun D Hughes, Nish Chaturvedi, Marietta Charakida, Alicja Rapala, Vivek Muthurangu, Tauseef Khan, Nicholas Finer, Naveed Sattar, Laura D Howe, Abigail Fraser, Debbie A Lawlor, George Davey Smith, John E Deanfield, Nicholas J Timpson
Background: Body mass index (BMI) has been suggested to be causally related to cardiovascular health in mid-to-late life, but this has not been explored systematically at younger ages - nor with detailed cardiovascular phenotyping. Recall-by-Genotype (RbG) is an approach that enables the collection of precise phenotypic measures in smaller studies, whilst maintaining statistical power and ability for causal inference. Methods: In this study, we used a combination of conventional multivariable regression analysis, Mendelian randomization (MR) and sub-sample RbG methodologies to estimate the causal effect of BMI on gross-level and detailed cardiovascular health in healthy participants from the Avon Longitudinal Study of Parents and Children at age 17 (N=1420-3108 for different outcomes) and an independent sample from the same cohort (for RbG) study at age 21 (N=386-418)...
November 13, 2018: Circulation
Sicheng Zhou, Hong Kang, Bin Yao, Yang Gong
BACKGROUND: Medication events in clinical settings are significant threats to patient safety. Analyzing and learning from the medication event reports is an important way to prevent the recurrence of these events. Currently, the analysis of medication event reports is ineffective and requires heavy workloads for clinicians. An automated pipeline is proposed to help clinicians deal with the accumulated reports, extract valuable information and generate feedback from the reports. Thus, the strategy of medication event prevention can be further developed based on the lessons learned...
December 7, 2018: BMC Medical Informatics and Decision Making
W J Fawcett, M Thomas
It is widely recognised that prolonged fasting for elective surgery in both children and adults serves no purpose, adversely affects patient well-being and can be detrimental. Although advised fasting times for solids remain unchanged, there is good evidence to support a 1-h fast for children, with no increase in risk of pulmonary aspiration. In adults, a major focus has been the introduction of carbohydrate loading before anaesthesia, so that patients arrive for surgery not only hydrated but also in a more normal metabolic state...
November 30, 2018: Anaesthesia
Sandeep R Das, Brendan M Everett, Kim K Birtcher, Jenifer M Brown, William T Cefalu, James L Januzzi, Rita Rastogi Kalyani, Mikhail Kosiborod, Melissa L Magwire, Pamela B Morris, Laurence S Sperling
No abstract text is available yet for this article.
December 18, 2018: Journal of the American College of Cardiology
2018-12-13 12:38:48
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