Articles: ninos.
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Randomized Controlled Trial Multicenter Study
Transcatheter Valve Replacement in Severe Tricuspid Regurgitation.
Severe tricuspid regurgitation is associated with disabling symptoms and an increased risk of death. Data regarding outcomes after percutaneous transcatheter tricuspid-valve replacement are needed. ⋯ For patients with severe tricuspid regurgitation, transcatheter tricuspid-valve replacement was superior to medical therapy alone for the primary composite outcome, driven primarily by improvements in symptoms and quality of life. (Funded by Edwards Lifesciences; TRISCEND II ClinicalTrials.gov number, NCT04482062.).
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Sense of coherence (SOC) refers to the psychosocial aspects and origins of health. Sense of coherence is related to physical and psychological health and quality of life. Military studies on SOC are commonly related to military deployment or operations, military training, and military fitness. Sense of coherence is assessed using a self-report scale. The total score of the scale indicates the level of SOC. Psychometric research studies over 2 past decades, however, suggest that the SOC scale is a multidimensional measure, and the latent factors should be considered as separate dimensions of SOC. Thus far, there are no previous factorial structure studies of the SOC scale in military contexts or in military populations. The dimensions of SOC have not been investigated in relation to mental health and subjective well-being of soldiers, military personnel, or military recruits/conscripts. ⋯ SOC among conscripts is a 2-dimensional model. The experience of recovery from past mental health problems is related to a stronger motivational dimension (meaningfulness towards life), which shows upon obligatory military service and training. Sense of coherence motivational aspect may be useful when training recruits. Demographic variables, such as economic situation, family structure, and parents' employment, should be considered when assessing past and/or present mental health problems and SOC.
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Hospitalists working outside the Veterans Affairs (VA) system frequently will serve Veterans receiving care for acute conditions and/or awaiting transfer to VA facilities. ⋯ Most studied health conditions among Veterans of post-9/11 conflicts have focused on areas of particular importance to the VA. However, significant gaps remain, particularly in understanding the correlation between specific exposures and clinical outcomes currently observed and to be anticipated in the future in this population.
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Massive transfusion protocols (MTPs) ensure the timely and life-saving delivery of blood products to patients who are rapidly exsanguinating. Although essential, MTPs are also highly resource-intensive. Effective MTP implementation must balance the resources of the hospital with the needs of the patient population that they serve, as well as avoid instances of unjustified activations. Toward this goal, we implemented a set of policy improvements to our institution's MTP aimed at ensuring appropriate clinical activation. ⋯ In summary, we developed an MTP tailored to the needs of our Veterans Affairs Medical Center, providing a reliable system for blood product administration to patients with real massive transfusion requirements while reducing unjustified MTP activations. We credit the reduction in MTP activations mainly to improved education and training of clinicians, which, in turn, changed their ordering behaviors. Fewer unjustified MTP activations decrease the potential for wastage of resources such as blood and blood components and preserves work hours of staff for patients with true transfusion needs. We believe our strategy may have a widespread and compounding effect on improving blood stewardship nationwide, given our trainees' propensity to work at medical centers across the country and educate future trainees of their own.