Internal and emergency medicine
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Review
Patient empowerment as a component of health system reforms: rights, benefits and vested interests.
Different strategies have been developed across countries to foster citizens' and patients' involvement, from health policies to patients' active participation in decisions regarding their health. The spectrum varies from systems where patients lead the reform of health care services, to others where a paternalistic approach still limits patients' autonomy in decision-making. This paper describes: (1) different interventions for involving patients; (2) experiences to promote consumer evidence-based advocacy; and (3) barriers to consumer involvement in health system reforms, including vested interests in patients' associations. Citizens' involvement in health systems can vary substantially, but is gaining increasing weight.
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To evaluate cardiac output (CO), both invasive and semi-invasive monitors are used in critical care medicine. The pulmonary artery catheter is an invasive tool to assess CO with the major criticism that the level of its invasiveness is not supported by an improvement in patients' outcomes. ⋯ Cardiac output can be monitored continuously by different devices that analyze the stroke volume and CO. The purpose of this review is to understand these new technologies and their applications and limitations.
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Comparative Study
Emergency department crowding and risk of preventable medical errors.
The objective of the study is to determine the association between emergency department (ED) crowding and preventable medical errors (PME). This was a retrospective cohort study of 533 ED patients enrolled in the National ED Safety Study (NEDSS) in four Massachusetts EDs. Individual patients' average exposure to ED crowding during their ED visit was compared with the occurrence of a PME (yes/no) for the three diagnostic categories in NEDSS: acute myocardial infarction, asthma exacerbation, and dislocation requiring procedural sedation. ⋯ We identified a direct association between high levels of ED crowding and risk of preventable medical errors. Further study is needed to determine the generalizability of these results. Should such research confirm our findings, we would suggest that mitigating ED crowding may reduce the occurrence of preventable medical errors.
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Over the last decade, the advent of molecular targeted therapy radically changed the treatment of several forms of cancer. However, these innovative anticancer drugs, namely monoclonal antibodies and small molecule tyrosine kinase inhibitors were found to adversely affect cardiovascular function. ⋯ Here we address emerging cardiovascular events associated with targeted anticancer drugs by offering a concise review on: (1) mechanistic basis subtending cardiotoxicity and (2) clinical advice for effective patient management (i.e., detection, treatment, monitoring and reporting of cardiovascular side effects). In this scenario, onco-vigilance (i.e., pharmacovigilance oriented to oncologic drugs) is emerging as a key to support cardio-oncologists in appropriateness [corrected].