Journal of evaluation in clinical practice
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Colorectal cancer (CRC) screening is widely recommended and implemented. However, sometimes CRC screening is not implemented despite good evidence, and some types of CRC screening are implemented despite lack of evidence. The objective of this article is to expose and elucidate relevant ethical issues in the literature on CRC screening that are important for open and transparent deliberation on CRC screening. ⋯ A series of important ethical issues have been identified and need to be addressed in open and transparent deliberation on CRC screening.
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Observational Study
The "bundle" approach to reduce the surgical site infection rate.
In Italy, since 2008, the surveillance of surgical site infections (SSIs) has been conducted following ECDC recommendations, according to the protocol of the National System of Surveillance of Surgical Site Infections. In 2009, in Piedmont region, where the study was conducted, it was introduced a survey of a "bundle" for every patient under SSIs surveillance. The bundle includes 5 items: infection risk index calculation, preoperative shower, trichotomy, antibiotic prophylaxis, and body temperature control. The aim of this study is the evaluation of the incidence rate of the SSIs in relation to the implementation of the bundle from January 1st to December 31st, 2012. ⋯ The use of surgical bundle seems to reduce significantly the SSIs rate in the colon surgery.
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Randomized Controlled Trial Multicenter Study
Mailed outreach and facilitated test ordering to promote cholesterol screening in community health centers: A randomized trial.
Lipid screening is central to cardiovascular risk assessment. We sought to determine whether a simple mailed outreach message and facilitated test ordering increase cholesterol screening among federally qualified community health center patients with no recent cholesterol screening test performed. ⋯ This outreach intervention promoting cholesterol screening was ineffective. Interventions that attempt to minimize barriers to cholesterol screening on multiple fronts and that are more compelling to patients are needed.
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A small percentage of emergency department (ED) visitors account for a disproportionate portion of ED visits. Little is known about their relationships with their primary care providers (PCPs). This study compares frequent and infrequent ED visitors' primary care utilization and perceptions of primary care access, continuity, and connectedness and examines primary care utilization and perceptions as predictors of ED use. ⋯ Although making twice as many primary care visits, these participants were less likely to report that they could get what they need from their PCP (76.12% vs 92.53%, P < .001). Despite similar primary care access and continuity, frequent ED visitors are less likely to report that they get what they need from their PCPs. Further research should investigate their needs and how primary care can best provide high-value care to this complex population.
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Comparative Study Observational Study
Surgical glue in laparoscopic sleeve gastrectomy: An initial experience and cost-effectiveness analysis.
Laparoscopic sleeve gastrectomy (LSG) is one of the most common bariatric procedures. Gastric leaks and bleeding are the most frequent complications, associated with a high clinical and economic burden. The best method of staple line reinforcement in LSG is debated. Surgical glue is one of the options available. The aim of this study was to assess the safety, efficiency, and relative cost-effectiveness of surgical glue used to perform LSG in morbid obese adults as compared with standard stapling. ⋯ Surgical glue might be a safe and cost-effective intervention in laparoscopic sleeve gastrectomy.