66,783 results match your criteria optimal care

All-sealed paper-based electrochemiluminescence platform for on-site determination of lead ions.

Biosens Bioelectron 2021 Jul 21;192:113524. Epub 2021 Jul 21.

School of Chemistry and Chemical Engineering, University of Jinan, Jinan, 250022, PR China. Electronic address:

Lab-on-paper (LOP) devices are urgently required for the rapid development of point-of-care diagnoses and environmental assays. Herein, an all-sealed paper-based electrochemiluminescence (ECL) platform was developed to achieve lead ions (Pb) sensitive analysis via incorporating convenient plastic package technology. Benefiting from transparent plastic encapsulation, the sealed devices effectively avoided the interference of O. Read More

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Interrater and intrarater reliability of the single arm military press (SAMP) test for upper limb function in patients with non-specific neck pain.

Musculoskelet Sci Pract 2021 Jul 20;55:102428. Epub 2021 Jul 20.

Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK. Electronic address:

Background: Performance measures that assess the upper limb disability (ULD) in patients with neck pain can provide useful information for making clinical decisions regarding the optimal management of those patients. The Single Arm Military Press (SAMP) test is a performance based ULD measure developed specifically for populations with neck pain. In this test, patients are asked to lift a 1 kg weight repetitively overhead for 30 s with repetitions counting as the score. Read More

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The serial connection of two extracorporeal membrane oxygenators for patient with refractory hypoxemia.

Heart Lung 2021 Jul 26;50(6):853-856. Epub 2021 Jul 26.

Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon 51472, Republic of Korea. Electronic address:

A 34-year-old man developed severe hypoxemia and hypercapnia due to acute respiratory distress during ventilator care after surgery with acute intracranial hemorrhage. Severe hypoxemia had not been corrected even with maximum extracorporeal membrane oxygenation (ECMO) flow and full ventilator settings. We applied a novel technique for the serial connection of two veno-venous ECMO circuits for optimal oxygen delivery and CO2 removal and could wean VV ECMO. Read More

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J Vasc Surg 2021 Jul 26. Epub 2021 Jul 26.

Division of Vascular Surgery, Complex Aortic Team, Royal Free NHS Foundation Trust, London, UK.

Objective: Varying opinions on optimal elective and emergent surgical management of infrarenal AAAs are expressed by the most recent Society for Vascular Surgery (SVS), European Society for Vascular Surgery (ESVS), versus NICE (National Institutes for Health and Care Excellence, UK) guidelines. The NICE guidelines propose that open surgical repair (OSR) serve as the default treatment for infrarenal AAA. The rationale for this approach relied on data from the early era of endovascular aneurysm repair (EVAR), and are in contrast to the more balanced approaches of the SVS and ESVS. Read More

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Hemodynamic impact of increasing time between fentanyl and propofol administration during anesthesia induction: a randomised, clinical trial.

Braz J Anesthesiol 2021 Jul 26. Epub 2021 Jul 26.

Hospital Central de la Defensa Gómez Ulla-IMIDEF, Critical Care and Pain Unit, Department of Anesthesia, Madrid, Spain.

Background And Objective: Anesthesia induction can produce severe propofol dose-dependent hypotension. Fentanyl coadministration reduces the catecholaminergic response to orotracheal intubation allowing propofol dose reduction. The aim of this study is to determine whether the hemodynamic response is improved by increasing the time between fentanyl and propofol administration and reducing the dose of the latter without increasing the time to achieve optimal hypnosis. Read More

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Saliva is inferior to nose and throat swabs for SARS-CoV-2 detection in children.

Acta Paediatr 2021 Jul 29. Epub 2021 Jul 29.

Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.

It is important to identify children and adolescents infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as they are often asymptomatic and may unintentionally spread the virus. However, information on the best sampling methods are limited. Most analyse nose and throat swabs with real-time polymerase chain reaction (RT-PCR), but these tests are uncomfortable and young children may not co-operate, increasing sub-optimal sample collection and false-negative results. Read More

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Target product profile for a dengue pre-vaccination screening test.

PLoS Negl Trop Dis 2021 Jul 29;15(7):e0009557. Epub 2021 Jul 29.

International Diagnostics Centre, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.

With increasing geographic spread, frequency, and magnitude of outbreaks, dengue continues to pose a major public health threat worldwide. Dengvaxia, a dengue live-attenuated tetravalent vaccine, was licensed in 2015, but post hoc analyses of long-term data showed serostatus-dependent vaccine performance with an excess risk of hospitalized and severe dengue in seronegative vaccine recipients. The World Health Organization (WHO) recommended that only persons with evidence of past dengue infection should receive the vaccine. Read More

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"I'm Being Forced to Make Decisions I Have Never Had to Make Before": Oncologists' Experiences of Caring for Seriously Ill Persons With Poor Prognoses and the Dilemmas Created by COVID-19.

JCO Oncol Pract 2021 Jul 29:OP2100119. Epub 2021 Jul 29.

Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI.

Purpose: The COVID-19 pandemic has created a new set of problems for clinicians. This study examines the experiences of oncologists providing care to seriously ill persons near the end of life in the context of the COVID-19 pandemic.

Methods: Between January 2020 and August 2020, we conducted semistructured, in-depth individual interviews with 22 purposefully sampled oncologists from practices enrolled in the Michigan Oncology Quality Consortium. Read More

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The Impact of the ISCHEMIA Trial on Clinical Practice: an Interventionist's Perspective.

Cardiovasc Drugs Ther 2021 Jul 29. Epub 2021 Jul 29.

Leicester Biomedical Research Centre, University Hospitals of Leicester, University of Leicester, Leicester, UK.

The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial is the latest in a series of studies evaluating the role of coronary revascularization plus optimal medical therapy (invasive management) as compared to optimal medical therapy alone (conservative management) in the management of patients with stable ischemic heart disease. The "headline" results suggested invasive management did not reduce overall major adverse cardiac events in the intermediate term (~ 3.2 years), although it did sustainably reduce angina. Read More

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Determining County-Level Counterfactuals for Evaluation of Population Health Interventions : A Novel Application of -Means Cluster Analysis.

Public Health Rep 2021 Jul 29:333549211030507. Epub 2021 Jul 29.

12268 Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, East Lansing and Grand Rapids, MI, USA.

Objectives: Evaluating population health initiatives at the community level necessitates valid counterfactual communities, which includes having similar population composition, health care access, and health determinants. Estimating appropriate county counterfactuals is challenging in states with large intercounty variation. We describe an application of -means cluster analysis for determining county-level counterfactuals in an evaluation of an intervention, a county perinatal system of care for Medicaid-insured pregnant women. Read More

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Evaluation of Bivalirudin as the Primary Anticoagulant in Patients Receiving Extracorporeal Membrane Oxygenation for SARS-CoV-2-Associated Acute Respiratory Failure.

Ann Pharmacother 2021 Jul 29:10600280211036151. Epub 2021 Jul 29.

University of Kentucky, Lexington, KY, USA.

Background: Extracorporeal membrane oxygenation (ECMO) is a potential option for the management of severe acute respiratory failure secondary to COVID-19. Conflicting the use of this therapy is the known coagulopathy within COVID-19, leading to an incidence of venous thrombotic events of 25% to 49%. To date, limited guidance is available on optimal anticoagulation strategies in this population. Read More

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The impact of maternal post-partum depressive symptoms on child diet at 18 months.

Matern Child Nutr 2021 Jul 28:e13187. Epub 2021 Jul 28.

Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Burwood, Victoria, Australia.

Post-partum depression (PPD) is a serious mental health problem, which can impair maternal behaviours and adversely affect the cognitive, emotional and behavioural development of children. This study aims to explore the impact of maternal depressive symptoms at 3 months post-partum (baseline) on child diet at 18 months of age (follow-up). This study used longitudinal data from 263 first-time mothers from the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Extend. Read More

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Focal cardiac ultrasound learning with pocked ultrasound device: A bicentric prospective blinded randomized study.

J Clin Ultrasound 2021 Jul 28. Epub 2021 Jul 28.

Montpellier University, EA 2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France.

Purpose: Point-of-care ultrasound using a pocket-ultrasound-device (PUD) is increasing in clinical medicine but the optimal way to teach focused cardiac ultrasound is not clear. We evaluated whether teaching using a PUD or a conventional-ultrasound-device (CUD) is different when the final exam was conducted on a PUD. The primary aim was to compare the weighted total quality scale (WTQS, out of 100) obtained by participants in the two groups (CUD and PUD) on a live volunteer 2-4 weeks after their initial training. Read More

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The prevalence of SARS-CoV-2 antibodies in triage-negative patients and staff of a fertility setting from lockdown release throughout 2020.

Hum Reprod Open 2021 27;2021(3):hoab028. Epub 2021 Jul 27.

Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania.

Study Question: What is the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in triage-negative patients undergoing ART and fertility care providers after lockdown release and throughout 2020?

Summary Answer: Out of the triage-negative patients whose blood samples were assessed for SARS-CoV-2 antibodies over 6 months, 5.2% yielded positive results with a significantly higher rate in health care workers (HCWs) and a significant month-by-month increase in those with evidence of antibodies.

What Is Known Already: Patients of reproductive age are more prone to asymptomatic or minimal forms of coronavirus disease 2019 (COVID-19) as compared to older age groups, and the identification of those with active infection and those already exposed (and probably immunized) is important for safety and cost-effective use of testing resources in the fertility setting. Read More

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3D CNN classification model for accurate diagnosis of coronavirus disease 2019 using computed tomography images.

J Med Imaging (Bellingham) 2021 Jan 23;8(Suppl 1):017502. Epub 2021 Jul 23.

OPPO Research Institute, Shenzhen, China.

The coronavirus disease (COVID-19) has been spreading rapidly around the world. As of August 25, 2020, 23.719 million people have been infected in many countries. Read More

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January 2021

Oral Health Status and Treatment Need in Geriatric Patients with Different Degrees of Cognitive Impairment and Dementia: A Cross-Sectional Study.

J Family Med Prim Care 2021 Jun 2;10(6):2171-2176. Epub 2021 Jul 2.

Private Practitioner and Consultant Oral Surgeon Thandalam, Chennai, Tamil Nadu, India.

Background: Health can be defined as more than an absence or lack of disease. It is generally related to personal, physical, social, along with spiritual wellness. However, the importance of good health is comparable with a progressive physical and cognitive limitations due to aging and hence, its clear definition is not possible. Read More

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Immune Signature Linked to COVID-19 Severity: A SARS-Score for Personalized Medicine.

Front Immunol 2021 12;12:701273. Epub 2021 Jul 12.

Centre de Recherche des Cordeliers, Sorbonne Universite, Inserm, Universite de Paris, Team Inflammation, Complement and Cancer, Paris, France.

SARS-CoV-2 infection leads to a highly variable clinical evolution, ranging from asymptomatic to severe disease with acute respiratory distress syndrome, requiring intensive care units (ICU) admission. The optimal management of hospitalized patients has become a worldwide concern and identification of immune biomarkers predictive of the clinical outcome for hospitalized patients remains a major challenge. Immunophenotyping and transcriptomic analysis of hospitalized COVID-19 patients at admission allow identifying the two categories of patients. Read More

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Shared Decision Making in Primary Care Based Depression Treatment: Communication and Decision-Making Preferences Among an Underserved Patient Population.

Front Psychiatry 2021 12;12:681165. Epub 2021 Jul 12.

College of Public Health, Temple University, Philadelphia, PA, United States.

Although depression is a significant public health issue, many individuals experiencing depressive symptoms are not effectively linked to treatment by their primary care provider, with underserved populations have disproportionately lower rates of engagement in depression care. Shared decision making (SDM) is an evidence-based health communication framework that can improve collaboration and optimize treatment for patients, but there is much unknown about how to translate SDM into primary care depression treatment among underserved communities. This study seeks to explore patients' experiences of SDM, and articulate communication and decision-making preferences among an underserved patient population receiving depression treatment in an urban, safety net primary care clinic. Read More

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Psychometric Properties of the Chinese Version of the Clinically Useful Depression Outcome Scale for Patients with Major Depressive Disorder.

Neuropsychiatr Dis Treat 2021 21;17:2387-2395. Epub 2021 Jul 21.

Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China.

Objective: This study aimed to evaluate the psychometric properties of the Chinese version of the Clinically Useful Depression Outcome Scale (CUDOS).

Methods: One hundred ninety patients with major depressive disorder (MDD) according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria were recruited to the study. The English version of the CUDOS was translated into Chinese using a forward and backward translation method, which was according to the guidelines of adaptation and validation of instruments in cross-cultural health care research. Read More

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Is It Better to Operate Congenital Lung Malformations when Patients are Still Asymptomatic?

J Indian Assoc Pediatr Surg 2021 May-Jun;26(3):170-176. Epub 2021 May 17.

Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Italy.

Context: Congenital lung malformation (CLM) is a rare developmental anomaly of the lower respiratory tract. The purposes are to define if the presence of respiratory symptoms, in CLM may affect surgical outcomes and to define optimal timing for surgery in asymptomatic patients.

Settings And Design: Retrospective review of patients with CLM from 2004 to 2018. Read More

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Unusual case of malignant pleural mesothelioma.

BMJ Case Rep 2021 Jul 28;14(7). Epub 2021 Jul 28.

Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK.

We present the case of a 65-year-old woman who presented with progressive dysphagia and was diagnosed with achalasia. She subsequently developed bilateral chylous pleural effusions, with no cause identified despite extensive investigations (including computed tomography (CT) scans, gastroscopy and medical thoracoscopy (MT)) and review at a dedicated pleural multidisciplinary team meeting.Despite optimal supportive management she deteriorated and was admitted to the intensive care unit, where she passed away due to sepsis and respiratory failure 10 months after initial presentation. Read More

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The role of sacubitril/valsartan in the treatment of chronic heart failure with reduced ejection fraction in hypertensive patients with comorbidities: From clinical trials to real-world settings.

Biomed Pharmacother 2020 Oct 21;130:110596. Epub 2020 Aug 21.

Nuclear Medicine Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy. Electronic address:

Background: Sacubitril/valsartan, the first agent to be approved in a new class of drugs called angiotensin receptor neprilysin inhibitors (ARNIs), has been shown to reduce cardiovascular mortality and morbidity compared to enalapril in outpatient subjects with chronic heart failure (HF) and reduced left ventricular ejection fraction (HFrEF). However, there is little real-world evidence about the efficacy of ARNIs in elderly hypertensive patients with HFrEF and comorbidities.

Methods: In this prospective open-label study, 108 subjects, 54 of them (mean age 78. Read More

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October 2020

Pediatric Health Information Technology-What We Need for Optimal Care of Children.

Sandy L Chung

Appl Clin Inform 2021 May 28;12(3):708-709. Epub 2021 Jul 28.

Pediatric Health Network, Children's National Hospital, Washington, District of Columbia., United States.

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European Guideline on Craniofacial Microsomia: A Version for Patients and Families.

J Craniofac Surg 2021 Jul 27. Epub 2021 Jul 27.

Department of Plastic and Reconstructive Surgery and Department of Oral and Maxillofacial Surgery, Dutch Craniofacial Center, Erasmus Medical Center, Rotterdam, The Netherlands.

Abstract: A European guideline on craniofacial microsomia was developed within the European Reference Network for rare and/or complex craniofacial anomalies and ear, nose, and throat disorders and published in 2020. The guideline provides an overview of optimal care provisions for patients with craniofacial microsomia and recommendations for the improvement of care. This document seeks to provide a tailored overview of this guideline for patients and their families. Read More

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Time to achieve delivery of nutrition targets is associated with clinical outcomes in critically ill children.

Am J Clin Nutr 2021 Jul 28. Epub 2021 Jul 28.

Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.

Background: Optimal nutrition in critically ill children involves a complex interplay between the doses, route, and timing of macronutrient delivery.

Objectives: We aimed to examine the association between the time to achieve delivery of 60% of the prescribed energy and protein targets and clinical outcomes in mechanically ventilated children.

Methods: We conducted a prospective, observational cohort study of mechanically ventilated children admitted to pediatric intensive care units (PICUs) worldwide. Read More

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Associations between early postoperative pain outcome measures and late functional outcomes in patients after knee arthroplasty.

PLoS One 2021 28;16(7):e0253147. Epub 2021 Jul 28.

Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Introduction/aim: Early rehabilitation, return to daily life activities and function are the ultimate goals of perioperative care. It is unclear which pain-related patient-reported outcome measures (PROM) mirror treatment effects or are related with early and late functional outcomes.

Methods: We examined associations between two approaches of pain management (scheduled vs 'on demand') and PROMs on post-operative days one and five (POD1, 5) with function on POD5 and 3 months after surgery in patients undergoing Total Knee Arthroplasty (TKA) in a single centre. Read More

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Predicting the environmental suitability for onchocerciasis in Africa as an aid to elimination planning.

PLoS Negl Trop Dis 2021 Jul 28;15(7):e0008824. Epub 2021 Jul 28.

Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Ghana.

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. Read More

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Hospital-free Days: A Pragmatic and Patient-centered Outcome for Trials Among Critically and Seriously Ill Patients.

Am J Respir Crit Care Med 2021 Jul 28. Epub 2021 Jul 28.

University of Pennsylvania Perelman School of Medicine, 14640, Philadelphia, Pennsylvania, United States.

Hospital-free days (HFDs), alternatively known as "days alive and outside the hospital," is increasingly used as a primary or secondary outcome in randomized trials among critically and seriously ill patients. This novel outcome measure addresses an existing gap in the availability of patient-centered, reliably obtained outcome measures among patients with acute respiratory failure, advanced lung diseases, lung transplantation, and other serious and critical illnesses. Traditional outcomes such as mortality, organ-failure-free days, and longitudinal patient-reported measures have distinct drawbacks that limit their suitability as endpoints in trials of patients with serious illness, particularly those trials with pragmatic designs. Read More

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A Reinforcement Learning-Based Framework for Crowdsourcing in Massive Health Care Internet of Things.

Big Data 2021 Jul 28. Epub 2021 Jul 28.

Department of Electrical Engineering, Yeungnam University, Gyeongsan, Republic of Korea.

Rapid advancements in the internet of things (IoT) are driving massive transformations of health care, which is one of the largest and critical global industries. Recent pandemics, such as coronavirus 2019 (COVID-19), include increasing demands for ubiquitous, preventive, and personalized health care to be provided to the public at reduced risks and costs with rapid care. Mobile crowdsourcing could potentially meet the future massive health care IoT (mH-IoT) demands by enabling anytime, anywhere sense and analyses of health-related data to tackle such a pandemic situation. Read More

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The role of the Swiss list of occupational diseases in the protection of workers' health.

Swiss Med Wkly 2021 Jul 28;151:w20538. Epub 2021 Jul 28.

Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland.

Occupational disease lists (ODLs) are essential legal mechanisms for recognising pathologies related to exposure to occupational hazards. In 2017, Switzerland revised its ODL and solicited stakeholders to review the ODL proposal. This revision represented an important and rare event, and was an opportunity to assess the legal status and role of Swiss ODL. Read More

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