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Reliability of Hospital-Level Mortality in Abdominal Aortic Aneurysm Repair.

J Vasc Surg 2021 Sep 15. Epub 2021 Sep 15.

Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI.

Objective: The relationship between volume and surgical outcome has been shown for a variety of surgical procedures. The effect in abdominal aortic aneurysm repair continues to be debated. Reliability adjustment has been used as a method to remove statistical noise from hospital level outcomes but its impact on aortic aneurysm repair is not well understood. Read More

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September 2021

The impact of COVD-19 on North American dermatology practices.

J Cosmet Dermatol 2021 Sep 18. Epub 2021 Sep 18.

Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.

COVID-19 continues to affect the delivery of healthcare services, as practices across North America gradually re-open with new safety measures and practice guidelines. Specifically in dermatology, clinical care is delivered in close physician-patient proximity through physical examination and the use of additional diagnostic and therapeutic procedures. We designed a 10-question survey to better understand how COVID-19 has impacted the delivery of care in North American dermatology practices. Read More

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September 2021

SEDAR/SECCE ECMO management consensus document.

Rev Esp Anestesiol Reanim (Engl Ed) 2021 Sep 14. Epub 2021 Sep 14.

Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain.

ECMO is an extracorporeal cardiorespiratory support system whose use has been increased in the last decade. Respiratory failure, postcardiotomy shock, and lung or heart primary graft failure may require the use of cardiorespiratory mechanical assistance. In this scenario perioperative medical and surgical management is crucial. Read More

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September 2021

Advances in Geriatric Hip Fractures: Pre-Operative Considerations and Tips to Optimize Outcome.

J Orthop Trauma 2021 Oct;35(Suppl 5):S32-S37

Department of Orthopaedics, Wake Forest School of Medicine, Winston-Salem, NC.

Summary: Geriatric hip fractures are complicated by increased morbidity and mortality, and their incidence continues to rise around the world. Frequent considerations in treating geriatric hip fractures include optimal time to surgery, need for preoperative cardiac clearance, risks of operating through anticoagulation, utilization of regional anesthesia, and collaborative care between treatment teams. This article aims to summarize these factors as well as to provide some tips and tricks that can be helpful in their surgical management. Read More

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October 2021

Centering Social Justice for Covid-19 Resources and Research.

Authors:
Virginia A Brown

Hastings Cent Rep 2021 Sep;51(5):51-53

In the September-October 2021 issue of the Hastings Center Report, neither the article by MaryKatherine Gaurke et al. nor the article by Alex Rajczi et al. offers a comprehensive analysis of a just allocation of scarce resources-one "rooted in a collective agreement about what constitutes health in/justice. Read More

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September 2021

How I Treat Chronic Phase Chronic Myelogenous Leukemia.

Authors:
Ellin Berman

Blood 2021 Sep 16. Epub 2021 Sep 16.

Memorial Sloan-Kettering Cancer Center, New York, New York, United States.

When imatinib, the first tyrosine kinase inhibitor (TKI) developed for use in chronic myelogenous leukemia (CML) was approved in 2001, the treatment of this disease was forever changed. Significant reductions in the molecular burden of disease were seen with the first generation TKI imatinib and with the addition of dasatinib (2006), nilotinib (2007), bosutinib (2012) and ponatinib (2013), deeper and more rapid reductions were noted. Physicians could begin to tailor TKI therapy to individual patients, and patients who did not respond to or could not tolerate first line therapy now had options. Read More

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September 2021

Pyridostigmine bromide, chlorpyrifos, and DEET combined Gulf War exposure insult depresses mitochondrial function in neuroblastoma cells.

J Biochem Mol Toxicol 2021 Sep 15:e22913. Epub 2021 Sep 15.

Laboratory of Molecular Biology, VA New Jersey Health Care System, Research & Development (Mailstop 15), East Orange, New Jersey, USA.

Gulf War Illness (GWI) is defined by the Centers for Disease Control and Prevention (CDC) as a multi-symptom illness having at least one symptom from two of three factors, which include: fatigue, mood-cognition problems, and musculoskeletal disorders. The cluster of long-term symptoms is unique to military personnel from coalition countries including United States, Australia, and the United Kingdom that served in Operation Desert Storm from 1990 to 1991. Reporting of these symptoms is much lower among soldiers deployed in other parts of the world like Bosnia during the same time period. Read More

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September 2021

Cardiovascular disease and COVID-19: a consensus paper from the ESC Working Group on Coronary Pathophysiology & Microcirculation, ESC Working Group on Thrombosis and the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Heart Rhythm Association (EHRA).

Cardiovasc Res 2021 Sep 16. Epub 2021 Sep 16.

Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.

The cardiovascular system is significantly affected in coronavirus disease-19 (COVID-19). Microvascular injury, endothelial dysfunction and thrombosis resulting from viral infection or indirectly related to the intense systemic inflammatory and immune responses are characteristic features of severe COVID-19. Pre-existing cardiovascular disease and viral load are linked to myocardial injury and worse outcomes. Read More

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September 2021

Palliative care needs, concerns, and affirmative strategies for the LGBTQ population.

Palliat Care Soc Pract 2021 9;15:26323524211039234. Epub 2021 Sep 9.

Icahn School of Medicine at Mount Sinai, One Levy Place, 1070, New York, NY 10029, USA.

The Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning population, also known as sexual and gender minorities, are an incredibly marginalized and vulnerable population that have been disproportionately affected by the provision, delivery, and optimal access to high-quality medical care including palliative, hospice, and end-of-life care. The long-standing and unique experiences shaped by positive and negative historical events have led to a better understanding of significant barriers and gaps in equitable healthcare for this population. The intersection of both internal and external stressors as well as minority identities in the context of discriminatory political and societal infrastructures have resulted in variable health outcomes that continues to be plagued by economic barriers, oppressive legislative policies, and undesirable societal practices. Read More

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September 2021

Clinical and Laboratory Findings of 12 Children with Invasive Meningococcal Disease in Pediatric Intensive Care Unit.

Crit Care Res Pract 2021 4;2021:9713918. Epub 2021 Sep 4.

Department of Pediatric Intensive Care, Kocaeli University Faculty of Medicine, Umuttepe, Izmit 41001, Turkey.

Introduction: Invasive meningococcal disease (IMD) is a serious infectious disease requiring stay in a pediatric intensive care unit (PICU) that continues to be associated with high morbidity and mortality rates. Prompt recognition, early antibiotic therapy, and aggressive supportive therapies can reduce mortality. We aimed to assess the clinical and laboratory characteristics of children with IMD. Read More

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September 2021

Maintaining care delivery for non-communicable diseases in the face of the COVID-19 pandemic in western Kenya.

Pan Afr Med J 2021 22;39:143. Epub 2021 Jun 22.

Department of Medicine, NYU Grossman School of Medicine, New York, USA.

The coronavirus disease 2019 (COVID-19) pandemic has disrupted health systems worldwide, gravely threatening continuity of care for non-communicable diseases (NCDs), particularly in low-resource settings. We describe our efforts to maintain the continuity of care for patients with NCDs in rural western Kenya during the COVID-19 pandemic, using a five-component approach: 1) Protect: protect staff and patients; 2) Preserve: ensure medication availability and clinical services; 3) Promote: conduct health education and screenings for NCDs and COVID-19; 4) Process: collect process indicators and implement iterative quality improvement; and 5) Plan: plan for the future and ensure financial risk protection in the face of a potentially overwhelming health and economic catastrophe. As the pandemic continues to evolve, we must continue to pursue new avenues for improvement and expansion. Read More

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Clinical debriefing during the COVID-19 pandemic: hurdles and opportunities for healthcare teams.

Adv Simul (Lond) 2021 Sep 15;6(1):32. Epub 2021 Sep 15.

Health Education and Improvement Wales, Cardiff, UK.

The COVID-19 pandemic and the subsequent pressures on healthcare staff and resources have exacerbated the need for clinical teams to reflect and learn from workplace experiences. Surges in critically ill patients, the impact of the disease on the workforce and long term adjustments in work and life have upturned our normality. Whilst this situation has generated a new 'connectedness' within healthcare workers, it also continues to test our resilience. Read More

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September 2021

Radiation Oncology's Place in Payment Reform: ASTRO Advocates for a Place at the Table.

JCO Oncol Pract 2021 Sep 15:OP2100294. Epub 2021 Sep 15.

American Society for Radiation Oncology, Arlington, VA.

In its current form, the Radiation Oncology Model (RO Model) prioritizes payment cuts over true value-based payment transformation. With significant modifications to the payment methodology, the reporting requirements, and recognition of the unique challenges faced by disadvantaged populations, the RO Model can protect patient access to care, preserve the physician-patient decision-making process, and ensure the delivery of high-quality, efficient radiation therapy treatment. The American Society for Radiation Oncology has spent several years advocating for a meaningful alternative payment model for radiation oncology and continues to push The Center for Medicare and Medicaid Innovation for changes to the RO Model that will recognize these key outcomes. Read More

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September 2021

Staphylococcus aureus infections in children.

Curr Opin Infect Dis 2021 Oct;34(5):510-518

Department of Pediatrics, Division of Pediatric Infectious Diseases.

Purpose Of Review: Staphylococcus aureus is the most common invasive bacterial pathogen infecting children in the U.S. and many parts of the world. Read More

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October 2021

The viral phoenix: enhanced infectivity and immunity evasion of SARS-CoV-2 variants.

Environ Chem Lett 2021 Sep 9:1-6. Epub 2021 Sep 9.

Central Texas Veterans Health Care System, 1901 Veterans Memorial Drive, Temple, TX USA.

SARS-CoV-2 pandemic continues with emergence of new variants of concerns. These variants are fueling the third and fourth waves of pandemic across many nations. Here we describe the new emerging variants of SARS-CoV-2 and why they have enhanced infectivity and possess the ability to evade immunity. Read More

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September 2021

Diagnostic testing and vaccination for COVID-19 among First Nations, Metis and Inuit in Manitoba, Canada: protocol for a nations-based cohort study using linked administrative data.

BMJ Open 2021 09 14;11(9):e052936. Epub 2021 Sep 14.

Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada.

Introduction: Decades of research demonstrate that First Nations, Metis and Inuit (FN/M/I) populations have differential access to diagnostic and therapeutic healthcare. Emerging evidence shows that this continues to be the case during the SARS-CoV-2 pandemic. In an effort to rectify these differences in access to care, our team, which is co-led by FN/M/I partners, will generate and distribute evidence on COVID-19 diagnostic testing and vaccination in high-priority FN/M/I populations in Manitoba, with the goal of identifying system-level and individual-level factors that act as barriers to equitable care and thereby informing Indigenous-led public health responses. Read More

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September 2021

From Chronic Wounds to Scarring: The Growing Healthcare Burden of Under- and Over-healing Wounds.

Adv Wound Care (New Rochelle) 2021 Sep 15. Epub 2021 Sep 15.

Stanford University School of Medicine, 10624, Surgery, Plastic and Reconstructive Surgery, Stanford, California, United States.

Significance: Wound healing is the largest medical market without an existing small molecule/drug treatment. Both "under-healing" (chronic wounds) and "over-healing" (scarring) cause a substantial biomedical burden and lifelong consequences for patients. These problems cost tens of billions of dollars per year in the United States alone, a number expected to grow as the population ages and the prevalence of common comorbidities (e. Read More

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September 2021

The divided dose approach to perioperative buprenorphine -management in patients with opioid use disorder.

J Opioid Manag 2021 ;17(7):101-107

Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York.

There is limited evidence and no clear consensus suggesting best practices for perioperative buprenorphine management in patients with opioid use disorder. As such, we aimed to develop a standardized perioperative management approach with the goals of (1) optimizing perioperative analgesia, (2) minimizing relapse risk, (3) setting expectations for patients and clinicians, (4) achieving prescribing consistency and mitigating risk among clinicians not familiar with perioperative buprenorphine management, and (5) maintaining continuity throughout care transitions. An interprofessional expert focus group convened to develop a consensus algorithm based upon buprenorphine's unique pharmacologic features and published perioperative management recommendations. Read More

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September 2021

Trends in the Concentration and Distribution of Health Care Expenditures in the US, 2001-2018.

JAMA Netw Open 2021 Sep 1;4(9):e2125179. Epub 2021 Sep 1.

Recon Strategy, Cambridge, Massachusetts.

Importance: The concentration of health care expenditures has important implications for managing risk pools, drug benefit design, and care management.

Objective: To examine trends in the concentration of health care spending in different population groups and expenditure categories in the US between 2001 and 2018.

Design, Setting, And Participants: This study is a cross-sectional analysis of Medical Expenditure Panel Surveys (MEPS) collected between 2001 and 2018. Read More

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September 2021

Electronic cigarettes for smoking cessation.

Cochrane Database Syst Rev 2021 Sep 14;9:CD010216. Epub 2021 Sep 14.

Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Background: Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol formed by heating an e-liquid. Some people who smoke use ECs to stop or reduce smoking, but some organizations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit and if they are safe to use for this purpose. Read More

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September 2021

Caring for Patients With Dementia at End of Life.

Am J Hosp Palliat Care 2021 Sep 14:10499091211046247. Epub 2021 Sep 14.

Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.

Care of the dementia patient continues to be challenging. It is a terminal condition that many times goes undiagnosed leading to improper evidence-based interventions. Healthcare professionals (HCPs) should initiate goals of care conversations early with patients and their families in order to align treatment preferences. Read More

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September 2021

Occupational Health and Safety Measures in Healthcare Settings During COVID-19: Strategies for Protecting Staff, Patients and Visitors.

Disaster Med Public Health Prep 2021 Sep 14:1-27. Epub 2021 Sep 14.

Department of Medical Physics, Grand River Regional Cancer Centre, Kitchener, ON, Canada.

The COVID-19 (SARS-CoV-2) pandemic has profoundly impacted almost every aspect of healthcare systems worldwide, placing the health and safety of frontline healthcare workers at risk and still continues to remain an important public health challenge. Several hospitals have put in place strategies to manage space, staff, and supplies in order to continue to deliver optimum care to patients while at the same time protecting the health and safety of staff and patients. However, the emergence of the second and third waves of the virus with the influx of new cases continue to add an additional level of complexity to the already challenging situation of containing the spread and lowering the rate of transmission and thus pushing healthcare systems to the limit. Read More

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September 2021

Inadequate reporting of participants eligible for randomized controlled trials - A Systematic Review and Meta-Analysis.

J Clin Epidemiol 2021 Sep 10. Epub 2021 Sep 10.

Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Objective: to characterize randomized controlled trials (RCTs) that did not report the overall number of participants assessed for eligibility and to identify factors associated with higher enrollment rates.

Study Design And Setting: Systematic review and meta-analysis of RCTs in several pre-defined fields in internal medicine. We randomly extracted 360 articles that were published in 2017. Read More

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September 2021

The economic impact of a clinical pharmacist's involvement in the hospital medicines policy in a rural area.

Int J Clin Pract 2021 Sep 13:e14859. Epub 2021 Sep 13.

Pharmacy Department, General Hospital Šibenik, Šibenik, Croatia.

Aim: The evidence of the value of pharmaceutical care continues to grow, however, data on its effect in rural areas are still scarce. The aim of this article is to evaluate the economic impact of a clinical pharmacist's involvement in the hospital medicines policy design in a rural area, through the drug and therapeutics committee (DTC) and public procurement for medicines.

Methods: An economic evaluation was conducted in the General Hospital Bjelovar which covers the Bjelovarsko-Bilogorska County in Croatia. Read More

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September 2021

Convexity in stoma care: developing a new ASCN UK guideline on the appropriate use of convex products.

Br J Nurs 2021 Sep;30(16):S12-S20

Education Officer, Association of Stoma Care Nurses UK and Head of Gastrointestinal Nurse Education, St Mark's Hospital, London.

One of the biggest challenges for specialist stoma care nurses (SCNs) caring for anyone living with a stoma is that of being confronted with a problematic stoma. This can be described as an ostomy that continues to cause leakage issues for the patient which, if persistent can quickly impact negatively on their quality of life. A convex stoma appliance, also termed convexity, is a possible solution to a problematic stoma. Read More

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September 2021

Legal Profession and Corruption in Health Care: Some Reflective Realities in South Africa.

Front Public Health 2021 25;9:688049. Epub 2021 Aug 25.

School of Public Leadership, Stellenbosch University, Stellenbosch, South Africa.

The article is an empirical attempt to research, analyse, and dissect the corrupt involvement of legal practitioners in illegal and fraudulent acts, and mainly their involvement in litigation associated with issues of medical negligence. This is done primarily but not exclusively through the utilisation of several qualitative research methods, including the content analysis of primary literary sources such as official state documents, existing legislation and court proceedings and personal interviews with senior public servants, as well as secondary sources. Beginning with a short exploration of South Africa's public legal terrain and the fears of sections of the statutory leadership of the legal profession, the article continues with the identification of key findings in several the country's provinces, the modus operandi of the corrupt individuals and groups, as well as the monetary, financial and social repercussions of such actions. Read More

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EUS in Pediatrics: A Multicenter Experience and Review.

Front Pediatr 2021 25;9:709461. Epub 2021 Aug 25.

Cedars-Sinai Medical Center, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States.

Endoscopic ultrasound (EUS) is a well-established tool used in the evaluation and treatment of a wide range of pathologies in adult medicine. EUS in pediatrics has been shown to be safe and technically effective, and its use continues to evolve. This article aims to describe the EUS experience at our tertiary-care centers with regard to safety, technical success, and its impact in clinical management. Read More

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Indications and Safety of High Flow Nasal Cannula in Pediatric Intensive Care Unit: Retrospective Single Center Experience in Saudi Arabia.

Pediatric Health Med Ther 2021 31;12:431-437. Epub 2021 Aug 31.

Department of Pediatrics, Abha Maternity and Children Hospital, Abha, Saudi Arabia.

Background: High flow nasal cannula (HFNC) is a new device for respiratory support. Its use continues to increase in pediatrics as its system is easily set up and well tolerated by patients. We aimed in this study to explore indications and safety of HFNC use and predictors of HFNC failure. Read More

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Patients, procedures, and PPE: Safe office-based anesthesia recommendations in the COVID-19 era.

Best Pract Res Clin Anaesthesiol 2021 Oct 20;35(3):415-424. Epub 2020 Nov 20.

Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, USA; Institute for Safety in Office-Based Surgery, Boston, MA, USA.

The growth of office-based surgery (OBS) has been due to ease of scheduling and convenience for patients; office-based anesthesia safety continues to be well supported in the literature. In 2020, the Coronavirus Disease 19 (COVID-19) has resulted in dramatic shifts in healthcare, especially in the office-based setting. The goal of closing the economy was to flatten the curve, impacting office-based and ambulatory practices. Read More

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October 2021