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Primary care management

Sarah N Bowe, C Alessandra Colaianni, Alisa Yamasaki, Brian M Cummings, Christopher J Hartnick
Importance: Health care organizations are complex and evolving systems. To date, longitudinal evaluation to ensure the sustainability of quality improvement (QI) initiatives has been missing from the otolaryngology literature. We sought to reassess perioperative management of laryngotracheal reconstruction, which requires adequate sedation. Objective: Using principles of continuous QI, the objectives of this study were to (1) describe step-by-step methods to sustain QI efforts and (2) revisit a series of process, outcome, and balance measures for sedation weaning management following implementation of a new electronic health record (EHR)...
February 14, 2019: JAMA Otolaryngology—Head & Neck Surgery
Alda F A Pires, Amos Peterson, Jerome N Baron, Ragan Adams, Beatriz Martínez-López, Dale Moore
The number of small-scale and backyard livestock and poultry owners in urban and peri-urban areas has increased greatly over the last 10 years in the U.S. However, these animal owners may live in areas without access to livestock and/or poultry veterinary care. The purpose of this study was to identify potential veterinary service needs of these animal owners in the western US, assess their use of management and husbandry practices with regards to disease prevention, and assess their attitudes about animal health and food safety...
2019: PloS One
Cheryl L Damberg, Marissa Silverman, Lane Burgette, Mary E Vaiana, M Susan Ridgely
OBJECTIVES: To understand physician organization (PO) responses to financial incentives for quality and total cost of care among POs that were exposed to a statewide multipayer value-based payment (VBP) program, and to identify challenges that POs face in advancing the goals of VBP. STUDY DESIGN: Semistructured qualitative interviews and survey. METHODS: We drew a stratified random sample of 40 multispecialty California POs (25% of the POs that were eligible for incentives)...
February 1, 2019: American Journal of Managed Care
Eun-Ho Lee, Sung-Cheol Yun, Ye-Ji Lim, Jun-Young Jo, Dae-Kee Choi, In-Cheol Choi
We assessed whether perioperative fluid management with balanced solutions and a limited volume of hydroxyethyl starch (renal-protective fluid management [RPF] strategy) could improve renal outcomes after cardiovascular surgery.For this retrospective observational study, we evaluated 2613 patients who underwent cardiovascular surgery from January 1, 2010 to December 31, 2013. The control group were given intravenous fluids with saline-based solutions and unlimited volumes of hydroxyethyl starch solutions and the RPF group were given intravenous fluids with RPF...
February 2019: Medicine (Baltimore)
Chang-Yeon Kim, Christopher D Collier, Raymond W Liu, Patrick J Getty
BACKGROUND: Chondrosarcoma is the second most frequent primary sarcoma of bone and frequently occurs in the pelvis. Surgical resection is the primary treatment with the two main operative modalities being limb-sparing resection and amputation. Contemporary management has trended toward limb-sparing procedures; however, whether this approach has an adverse effect on long-term survival is unclear. QUESTIONS/PURPOSES: (1) What are the 5- and 10-year survival rates after limb-sparing surgery and amputation? (2) What factors are associated with survival after contemporary surgical management of pelvic chondrosarcoma? METHODS: The 2004-2014 National Cancer Database, a nationwide registry that includes approximately 70% of all new cancers in the United States with requirement for 90% followup, was reviewed for patients diagnosed with pelvic chondrosarcoma who had undergone limb-sparing surgery or amputation...
March 2019: Clinical Orthopaedics and related Research
Lisa A Moon, Greg Clancy, John Welton, Ellen Harper
The use of nursing big data sets for value-based measurement is novel. Nursing value measurement depends on the availability of essential data attributes in the electronic health record related to nursing care delivered (what happened, when, and the result seen). Key in measuring value is a standardized structure and format of these attributes for enabling uniform consistent analysis, along with data sets that are sharable and comparable across individuals and groups, time, organization, and practice focus...
February 12, 2019: Computers, Informatics, Nursing: CIN
Lindsay A Sceats, Arden M Morris, M Kate Bundorf, K T Park, Cindy Kin
BACKGROUND: Sex-based treatment disparities occur in many diseases. Women undergo fewer procedural interventions, and their care is less consistent with guideline-based therapy. There is limited research exploring sex-based differences in ulcerative colitis treatment. We hypothesized that women are less likely to be treated with strategies consistent with long-term disease remission, including surgery and maintenance medications. OBJECTIVE: The aim of this study was to determine if patient sex is associated with choice of treatment strategy for ulcerative colitis...
February 8, 2019: Diseases of the Colon and Rectum
Emer P O Connel, Vincent Healy, Fidelma Fitzpatrick, Caitriona A Higgins, John P Burke, Deborah A McNamara
BACKGROUND: Unplanned readmission after surgery negatively impacts surgical recovery. Few studies have sought to define predictors of readmission in a rectal cancer cohort alone. Readmission following rectal cancer surgery may be reduced by the identification and modification of factors associated with readmission. OBJECTIVES: This study seeks to characterize the predictors of 30-day readmission following proctectomy for rectal cancer. DESIGN: This study is a retrospective analysis of prospectively gathered cohort data...
February 8, 2019: Diseases of the Colon and Rectum
Kürşad Aydın, Ayşe Kartal, Esma Keleş Alp
Background/aim: The aim of this study was to evaluate the nutritional status of children with cerebral palsy and determine the particular characteristics of the disorder. Materials and methods: The nutritional status of the children was assessed by the Gomez classification using weight-for-age. The Gross Motor Function Classification System was used to determine the gross and fine motor functions. Results: The study was conducted with 197 children (58...
February 11, 2019: Turkish Journal of Medical Sciences
Nick Nash, Charles W Kimbrough, Michael Mackowski, Matthew V Benns, Jason W Smith, Brian G Harbrecht, Matthew Bozeman
The incidence of obesity has been increasing in the United States, and the medical care of obese patients after injury is complex. Obesity has been linked to increased morbidity after blunt trauma. Whether increased girth protects abdominal organs from penetrating injury or complicates management from obesity-associated medical comorbidities after penetrating injury has not been well defined. All patients admitted with penetrating injury between January 1, 2010, and December 31, 2013, at a university-affiliated Level I center trauma center were reviewed...
January 1, 2019: American Surgeon
Cody C Frear, Bronwyn Griffin, Leila Cuttle, Steven M McPhail, Roy Kimble
BACKGROUND: Although negative pressure wound therapy (NPWT) is widely used in the management of several wound types, its efficacy as a primary therapy for acute burns has not yet been adequately investigated, with research in the paediatric population particularly lacking. There is limited evidence, however, that NPWT might benefit children with burns, amongst whom scar formation, wound progression and pain continue to present major management challenges. The purpose of this trial is to determine whether NPWT in conjunction with standard therapy accelerates healing, reduces wound progression and decreases pain more effectively than standard treatment alone...
February 13, 2019: Trials
Tyrone Reden L Sy, Retna Siwi Padmawati, Emmanuel S Baja, Riris Andono Ahmad
BACKGROUND: The Philippines has a high burden of TB and HIV, yet the WHO estimates that only 13% of Filipino TB patients know their HIV status. This is partly attributable to the lack of trained HIV counselors and medical technologists (or laboratory technicians) at the primary healthcare level. In Africa where resources and manpower are also scarce, TB/HIV care is already delegated to community health workers. Evidence is scant however about the acceptability and feasibility of engaging community health workers to provide HIV counseling and testing (HCT) among TB patients in the Philippines...
February 13, 2019: BMC Public Health
Viswanathan Mohan, Mark E Cooper, David R Matthews, Kamlesh Khunti
There is currently a worldwide epidemic of type 2 diabetes (T2D) that is predicted to increase substantially in the next few years. With 80% of the global T2D population living in low to middle-income countries, there are issues with cost and of access to appropriate medicines. The objective of this symposium was to provide an overview of the efficacy and safety of glucose-lowering drugs, focussing in particular on sulfonylureas (SUs) in patients with T2D using data taken from both randomised controlled trials (RCTs) and real-world studies, the application of strategies to ensure optimal patient adherence and clinical outcomes, and the optimal use of SUs in terms of dose adjustment and agent choice to ensure the best clinical outcome...
February 13, 2019: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
M Novi, C Vanni, P D Parchi, M Di Paolo, N Piolanti, M Scaglione
PURPOSE: Over the years, the number of total hip replacements has been steadily increasing. Despite the improvement in surgical results, the number of claims for malpractice is higher. The primary endpoint of this work is to provide an analysis of litigation after hip replacement, to outline what are the instigating causes and costs. The secondary endpoint is to propose a possible preventive strategy for an improved care and a reduction in legal proceedings. MATERIALS AND METHODS: The data of this study were collected from medical and legal files and from professional liability insurance of our institution from January 2005 to December 2016...
February 13, 2019: Musculoskeletal Surgery
Greta B Raglan, Jay Schulkin, Elizabeth Micks
Depression in women is more common during perimenopause (the transition to menopause) than at other times in the life cycle. Symptoms of depression may be different in perimenopausal women compared to younger or older women, and are often dismissed as part of normal menopause. This is an expert narrative review. There are several evidence-based screening modalities which can be integrated into routine women's health visits, and can facilitate distinguishing between depression and normal perimenopausal symptoms...
February 13, 2019: Archives of Women's Mental Health
Deidra C Crews, Aminu K Bello, Gamal Saadi
Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. In many settings, rates of kidney disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management...
February 13, 2019: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Moara Ailane Thum, Julio Baldisserotto, Roger Keller Celeste
This article sought to evaluate e-SUS AB's impact on procedure and consultation notification in the Outpatient Information System of the Brazilian Unified National Health System (SIA/SUS) in Brazilian municipalities. This is an ecological study with longitudinal comparisons before, during and after the e-SUS AB implementation period (June 2013 to May 2015) and, during implementation, cross-sectional comparison between municipalities in completed, intermediary and initial implementation stages. Rates were described using means and standard deviations and analyzed through negative binomial regression...
February 11, 2019: Cadernos de Saúde Pública
Omar H Ahmed, Dylan F Roden, Yasmina C Ahmed, Binhuan Wang, Cherie-Ann O Nathan, David Myssiorek
OBJECTIVES: Standards of care for total laryngectomy (TL) patients in the postoperative period have not been established. Perioperative care remains highly variable and perhaps primarily anecdotally based. The aim of this study was to survey members of the American Head and Neck Society to capture management practices in the perioperative care of TL patients. METHODS: In this survey study, an electronic survey was distributed to the international attending physician body of the American Head and Neck Society...
February 13, 2019: Annals of Otology, Rhinology, and Laryngology
Hsien Seow, Lialoma Salam-White, Daryl Bainbridge
BACKGROUND: Access to community-based specialist palliative care teams has been shown to improve patients' quality of life; however, the impact on health system expenditures is unclear. This study aimed to determine whether exposure to these teams reduces health system costs compared with usual care. METHODS: We conducted a retrospective matched cohort study in Ontario, Canada, using linked administrative data. Decedents treated by 1 of 11 community-based specialist palliative care teams in 2009/10 and 2010/11 (the exposed group) were propensity score matched (comorbidity, extent of home care, etc...
January 2019: CMAJ Open
Nikki Scheiner, Sarah Cohen, Ruth Davis, Tim Gale, Amanda Agyare
Aims and methodThe Frequent Attenders Programme is a joint initiative between Hertfordshire Rapid Assessment, Interface and Discharge service and the Emergency Department of the West Hertfordshire NHS Trust, which aims to divert frequent attenders from the emergency department by addressing their unmet needs. This paper describes the range of interventions put in place from the time that the service was set up in 2014 until the introduction of the new national Commissioning for Quality and Innovation 2017-2019, which tasked National Health Service trusts to improve services for people with mental health needs who present to Accident and Emergency...
February 13, 2019: BJPsych Bulletin
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