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Portable Medical Orders and End of Life Measures in Acute Myeloid Leukemia and Myelodysplastic Syndromes.

Blood Adv 2021 Sep 15. Epub 2021 Sep 15.

University of Rochester Medical Center, Rochester, New York, United States.

Patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) experience high rates of hospitalization, intensive care unit (ICU) admissions, and in-hospital deaths at end of life (EOL). Early goals-of-care (GOC) discussions might reduce intensity of care at EOL. Portable Medical Order (POLST) forms, known as Medical Orders for Life Sustaining Treatment (MOLST) forms in New York State, allow patients to translate GOC discussions into specific medical orders that communicate their wishes during a medical emergency. Read More

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September 2021

Establishing Benchmarks for Antimicrobial Use in Canadian Children's Hospitals: Results From 2 National Point Prevalence Surveys.

Pediatr Infect Dis J 2021 Oct;40(10):899-905

Division of Infectious Diseases, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.

Background: Point prevalence surveys (PPS) are potentially useful to measure antimicrobial use across institutions. The objectives of the study were to describe and compare antimicrobial use between pediatric hospitals in Canada.

Methods: Fifteen pediatric hospitals all with pediatric infectious diseases service participated in 2 single-day PPS in 2018/19. Read More

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October 2021

Sirolimus (Rapamycin) for Slow-Flow Malformations in Children: The Observational-Phase Randomized Clinical PERFORMUS Trial.

JAMA Dermatol 2021 Sep 15. Epub 2021 Sep 15.

University of Tours, Centre Hospitalier Régional Universitaire Tours, Department of Pediatric Radiology, Tours, France.

Importance: Sirolimus is increasingly being used to treat various vascular anomalies, although evidence of its efficacy is lacking.

Objective: To assess the efficacy and safety of sirolimus for children with slow-flow vascular malformations to better delineate the indications for treatment.

Design, Setting And Participants: This multicenter, open-label, observational-phase randomized clinical trial included 59 children aged 6 to 18 years with a slow-flow vascular malformation who were recruited between September 28, 2015, and March 22, 2018, in 11 French tertiary hospital centers. Read More

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September 2021

Do-not-resuscitate order in COVID-19 times: bioethics and professional ethics.

Rev Gaucha Enferm 2021 13;42(spe):e20200172. Epub 2021 Sep 13.

Universidade Federal do Rio de Janeiro (UFRJ), Escola de Enfermagem Anna Nery, Programa de Pós-Graduação Stricto Sensu. Rio de Janeiro, Rio de Janeiro, Brasil.

Objective: To reflect about the do-not-resuscitation order at COVID-19 in Brazil, under bioethical focus and medical and nursing professional ethics.

Method: Reflection study based on the principlist bioethics of Beauchamps and Childress and in professional ethics, problematizing actions, and decisions of non-resuscitation in the pandemic.

Results: It is important to consider the patient's clinic, appropriation of treatment goals for people with comorbidities, elderly people, with less chance of surviving to resuscitation, or less quality of life, with the palliative care team, to avoid dysthanasia, use of scarce resources and greater exposure of professionals to contamination. Read More

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September 2021

The patient-driven payment model: A missed opportunity for patient-centered cancer care.

J Am Geriatr Soc 2021 Sep 14. Epub 2021 Sep 14.

Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.

Hospitalized older patients with advanced cancer who were discharged to a skilled nursing facility (SNF) for rehabilitation are unlikely to receive future cancer treatment, have high 30-day readmission rates, and high mortality yet minimal hospice use. The Medicare SNF benefit was designed to be a bridge and provide short-term nursing and rehabilitation care for patients after a hospitalization. However, advanced cancer patients churn through the health system cycling between the hospital, post-acute care facilities, and home in the last months of life. Read More

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September 2021

Disseminated intravascular coagulation from disseminated histoplasmosis in uncontrolled HIV - Case report.

IDCases 2021 31;26:e01270. Epub 2021 Aug 31.

Department of Internal Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.

This case report describes an atypical presentation of a relatively common opportunistic infection, without documented exposure to areas known at the time to be endemic, resulting in catastrophic complications. The patient presented with a two month progressive history of vomiting, diarrhea, productive cough, and shortness of breath, on the background of poorly-controlled HIV. There was a low index of suspicion for infection with histoplasmosis, particularly given the large differential diagnosis and the lack of travel or endemic precedence. Read More

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Determining the Value-Efficiency of Respiratory Care.

Respir Care 2021 Sep 14. Epub 2021 Sep 14.

Kauffman Consulting, LLC.

In order to determine, document, and communicate the value of respiratory therapists performing respiratory care procedures, the respiratory care profession needs to position itself to capture and report both time and value standards that can be applied in justifying respiratory care resources. To do this, we propose a new metric called value-efficiency, defined as the product of activity efficiency and activity value. Activity efficiency is conventionally defined as activity hours (product of activity volume and standard time) divided by worked hours. Read More

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September 2021

Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study.

BMC Health Serv Res 2021 Sep 14;21(1):964. Epub 2021 Sep 14.

Rovaniemi Health Center, Koskikatu 25, 96200, Rovaniemi, Finland.

Background: Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. Read More

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September 2021

In-Hospital Morbidity and Mortality with Delays to Femoral Shaft Fracture Fixation.

J Orthop Trauma 2021 Sep 14. Epub 2021 Sep 14.

Department of Orthopaedic Surgery, Washington University, St. Louis, MO Center for Administrative Data Research, Washington University, St. Louis, MO Department of Orthopaedic Surgery, UC-Davis, Sacramento, CA.

Objectives: The goals of this study were to investigate trends in the timing to femur fracture fixation in trauma centers in the United States, identify predictors for delayed treatment, and analyze the association of timing to fixation with in-hospital morbidity and mortality using data from the National Trauma Data Bank (NTDB).

Methods: Patients with femoral shaft fractures treated from 2007-2015 were identified from the NTDB, and grouped by timing of femur fixation: <24 hours, 24-48 hours, and >48 hours after hospital presentation. The primary outcome measure was in-hospital postoperative mortality rate. 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

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

Back to the Basics-Is Comfort Care the Same as Do Not Resuscitate? How Misinterpreting Code Status May Lead to Potential Patient Harm.

Am J Hosp Palliat Care 2021 Sep 14:10499091211046235. Epub 2021 Sep 14.

Internal Medicine Residency Program, Madigan Army Medical Center, Tacoma, WA, USA.

Several research studies have shown that code status documentation is misinterpreted or incorrectly defined by a significant number of medical professionals. This misinterpretation among the medical team (i.e. Read More

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September 2021

[Study of the factors contributing to poor quality of life in chronic heart failure with reduced ejection fraction].

Ann Cardiol Angeiol (Paris) 2021 Sep 10. Epub 2021 Sep 10.

Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040.

Background: The increasing prevalence and poor prognosis associated with chronic heart failure (CHF) have made the improvement of quality of life (QoL) one of the main goals in the treatment of CHF patients. Since little is known about the QoL in Tunisian patients with heart failure (HF), the current study was performed to assess QoL in a sample of Tunisian patients hospitalized with HF and to identify factors related to QoL.

Methods: In this prospective study, we evaluated patients with CHF attending the cardiology department of Habib Thameur University Hospital in a four-month period. Read More

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September 2021

Sensitive and semiquantitative detection of soil-transmitted helminth infection in stool using a recombinase polymerase amplification-based assay.

PLoS Negl Trop Dis 2021 Sep 13;15(9):e0009782. Epub 2021 Sep 13.

PATH, Seattle, Washington, United States of America.

Background: Soil-transmitted helminths (STHs) are parasitic nematodes that inhabit the human intestine. They affect more than 1.5 billion people worldwide, causing physical and cognitive impairment in children. Read More

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September 2021

Fecal Microbiota Transplantation and Medical Therapy for Clostridium difficile Infection: Meta-analysis of Randomized Controlled Trials.

J Clin Gastroenterol 2021 Sep 9. Epub 2021 Sep 9.

Departments of Medicine Gastroenterology and Hepatology Library Services, Cleveland Clinic Foundation Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH Department of Medicine, UPMC, Pittsburgh, PA Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL Department of Medicine, Asante Rogue Regional Medical Center, Medford, OR Baba Farid University of Health Sciences, Faridkot, Punjab, India.

Goals: The aim was to assess the effectiveness of fecal microbiota transplantation (FMT) against medical therapy (MT).

Background: FMT has shown good outcomes in the treatment of Clostridium difficile infection (CDI). We aimed to conduct a systematic review and meta-analysis to compare the effectiveness of FMT versus MT for CDI. Read More

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September 2021

Measuring treatment effect on psoriatic arthritis-related domains: insights from the SPIRIT-H2H study at weeks 24 and 52.

Clin Rheumatol 2021 Sep 13. Epub 2021 Sep 13.

Sorbonne Université, INSERM, Institut Pierre Louis D'Epidémiologie Et de Santé Publique, Paris, France.

Introduction: Improvements in both musculoskeletal and non-musculoskeletal manifestations are important treatment goals in psoriatic arthritis (PsA).

Objective: These post hoc analyses determined whether additional benefits related to various PsA domains are observed in patients simultaneously achieving 50% improvement in American College of Rheumatology criteria (ACR50) and 100% improvement in Psoriasis Area Severity Index (PASI100), the primary endpoint of the SPIRIT-H2H study.

Methods: Patients with active PsA and psoriasis in SPIRIT-H2H (N = 566) were categorised into two sets of four response groups irrespective of treatment allocation (approved dosages of ixekizumab or adalimumab): patients who simultaneously achieved ACR50 and PASI100 response, achieved ACR50 response only, achieved PASI100 response only, or did not achieve ACR50 or PASI100 response after 24 and 52 weeks of treatment. Read More

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September 2021

Argatroban for Anticoagulation in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019.

Crit Care Explor 2021 Sep 7;3(9):e0530. Epub 2021 Sep 7.

Trauma & Critical Care Service, Department of Surgery, Brooke Army Medical Center, San Antonio, TX.

A significant proportion of patients with coronavirus disease 2019 requiring venovenous extracorporeal membrane oxygenation at our institution demonstrated heparin resistance, which in combination with a heparin shortage resulted in the transition to argatroban with or without aspirin as an alternative anticoagulation strategy. The optimal anticoagulation strategy for coronavirus disease 2019 patients requiring venovenous extracorporeal membrane oxygenation is unknown, and therefore, we sought to evaluate the efficacy and safety of argatroban with or without aspirin as an alternative anticoagulation strategy in this patient population.

Design: Retrospective cohort. Read More

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September 2021

Treatment of Iron Deficiency Anemia in CKD and End-Stage Kidney Disease.

Kidney Int Rep 2021 Sep 5;6(9):2261-2269. Epub 2021 Jun 5.

Division of Nephrology, Department of Medicine and Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Iron deficiency is common in individuals with chronic kidney disease and plays a major role in the development of anemia. Oral and intravenous iron agents are both available to replete iron in patients with chronic kidney disease diagnosed with iron deficiency. The choice of which agent to use is most often dictated by goals of therapy, tolerability, convenience, and response to prior therapy. Read More

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September 2021

Perioperative challenges in management of diabetic patients undergoing non-cardiac surgery.

World J Diabetes 2021 Aug;12(8):1255-1266

Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, United States.

Prediabetes and diabetes are important disease processes which have several perioperative implications. About one third of the United States population is considered to have prediabetes. The prevalence in surgical patients is even higher. Read More

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Patient Markers of Successful Diabetes Management.

Diabetes Spectr 2021 Aug 12;34(3):275-282. Epub 2021 Mar 12.

Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.

Purpose: For individuals with diabetes, diabetes health status may not align with A1C targets. Patients may use nonclinical targets when assessing their diabetes management success. Identifying these targets is important in developing patient-centered management plans. Read More

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Impact of a Longitudinal Intervention to Improve Care Coordination between a Hospital and a Hospice: A Quality Improvement Project.

Indian J Palliat Care 2021 Apr-Jun;27(2):216-221. Epub 2021 Aug 12.

Department of Supportive Care, Clinical and Research Fellow, Palliative Medicine, Princess Margaret Cancer Centre, Toronto, Canada.

Objectives: When patients with advanced cancer transition from systemic cancer treatments at MNJ Institute of Oncology to palliative and end-of-life care at a separate stand-alone non-governmental organisation-run hospice facility, there is insufficient transfer of health information, including details of cancer diagnosis and staging, past treatments, imaging reports and goals for future care. Without this information, the hospice care team is not adequately prepared to receive and deliver high-quality palliative care for these patients. This project aims to improve the care coordination between the hospital and hospice. Read More

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'Working in a comfort formerly unknown': medical holism and the radical ambitions behind interwar Bermondsey's foot clinic.

Med Humanit 2021 Sep 11. Epub 2021 Sep 11.

GKT School of Medical Education, King's College London, London, UK

In 1930, the Bermondsey Public Health Department made the rather unusual decision to establish the first municipal foot clinic in Britain. This pioneering and popular clinic was founded at a time when the aims of public health were being renegotiated. Historical discussion of the reconceptualisation of public health in the interwar period typically depicts a paradigm shift in which public health was no longer focused solely on sanitising the physical environment, but was characterised by an additional, separate aim: the development of hygienic behaviour within patients. Read More

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September 2021

Standardizing postoperative handoffs using the evidence-based IPASS framework through a multidisciplinary initiative improves handoff communication for neurosurgical patients in the neuro-intensive care unit.

J Clin Neurosci 2021 Oct 5;92:67-74. Epub 2021 Aug 5.

Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States.

Errors in communication are a major source of preventable medical errors. Neurosurgical patients frequently present to the neuro-intensive care unit (NICU) postoperatively, where handoffs occur to coordinate care within a large multidisciplinary team. A multidisciplinary working group at our institution started an initiative to improve postoperative neurosurgical handoffs using validated quality improvement methodology. Read More

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October 2021

Hypertonic Saline for Hyponatremia: Meeting Goals and Avoiding Harm.

Am J Kidney Dis 2021 Sep 8. Epub 2021 Sep 8.

Rochester General Hospital and University of Rochester School of Medicine and Dentistry, Rochester, New York. Electronic address:

Hypertonic saline has been used for the treatment of hyponatremia for nearly a century. There is now general consensus that hypertonic saline should be used in patients with hyponatremia associated with moderate or severe symptoms to prevent neurological complications. However, much less agreement exists among experts regarding other aspects of its use. Read More

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September 2021

A Model of Collaboration Can Expand the Opportunities in Adaptive Sports Equipment.

Am J Phys Med Rehabil 2021 Sep 9. Epub 2021 Sep 9.

University of Cincinnati, Department of Physical Medicine & Rehabilitation Cincinnati Children's Hospital and Medical Center Division of Physical Therapy Spaulding Rehabilitation Hospital, Department of Physical Medicine & Rehabilitation Kelley Adaptive Sports Research Institute.

Abstract: PM&R requires teamwork and innovation to help our patient's reach their goals and to optimize their quality of life, and one way is through participation in sports. 1,2,3,4 Unfortunately, people with disabilities participate in sports ~20% less than their peers, and reasons for this disparity include equipment cost and availability. 1,2,5,6 A unique way for PM&R clinicians to aid in overcoming these barriers is to collaborate with other fields to make adaptive equipment that meets our patients' needs. Read More

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September 2021

The impact of preoperative supine radiographs on surgical strategy in adult spinal deformity.

J Neurosurg Spine 2021 Sep 10:1-7. Epub 2021 Sep 10.

Objective: Preoperative planning for adult spinal deformity (ASD) surgery is essential to prepare the surgical team and consistently obtain postoperative alignment goals. Positional imaging may allow the surgeon to evaluate spinal flexibility and anticipate the need for more invasive techniques. The purpose of this study was to determine whether spine flexibility, defined by the change in alignment between supine and standing imaging, is associated with the need for an osteotomy in ASD surgery. Read More

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September 2021

Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality.

PLoS One 2021 10;16(9):e0256793. Epub 2021 Sep 10.

Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States of America.

Introduction: Addiction consult services (ACS) engage hospitalized patients with opioid use disorder (OUD) in care and help meet their goals for substance use treatment. Little is known about how ACS affect mortality for patients with OUD. The objective of this study was to design and validate a model that estimates the impact of ACS care on 12-month mortality among hospitalized patients with OUD. Read More

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September 2021

Impact of Augmented Intelligence on Utilization of Palliative Care Services in a Real-World Oncology Setting.

JCO Oncol Pract 2021 Sep 10:OP2100179. Epub 2021 Sep 10.

Rainier Hematology Oncology/Northwest Medical Specialties, Seattle, WA.

Purpose: For patients with advanced cancer, timely referral to palliative care (PC) services can ensure that end-of-life care aligns with their preferences and goals. Overestimation of life expectancy may result in underutilization of PC services, counterproductive treatment measures, and reduced quality of life for patients. We assessed the impact of a commercially available augmented intelligence (AI) tool to predict 30-day mortality risk on PC service utilization in a real-world setting. Read More

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September 2021