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Care pathways

Mark J D Jordans, Nagendra P Luitel, Brandon A Kohrt, Sujit D Rathod, Emily C Garman, Mary De Silva, Ivan H Komproe, Vikram Patel, Crick Lund
BACKGROUND: In low-income countries, care for people with mental, neurological, and substance use (MNS) disorders is largely absent, especially in rural settings. To increase treatment coverage, integration of mental health services into community and primary healthcare settings is recommended. While this strategy is being rolled out globally, rigorous evaluation of outcomes at each stage of the service delivery pathway from detection to treatment initiation to individual outcomes of care has been missing...
February 2019: PLoS Medicine
Tao Wang, Li-Ni Zeng, Zhe Zhu, Yu-Hui Wang, Lu Ding, Wei-Bin Luo, Xiao-Min Zhang, Zhi-Wei He, Hong-Fu Wu
Brachial plexus avulsion often results in massive motor neuron death and severe functional deficits of target muscles. However, no satisfactory treatment is currently available. Hypoxia-inducible factor 1α is a critical molecule targeting several genes associated with ischemia-hypoxia damage and angiogenesis. In this study, a rat model of brachial plexus avulsion-reimplantation was established, in which C5-7 ventral nerve roots were avulsed and only the C6 root reimplanted. Different implants were immediately injected using a microsyringe into the avulsion-reimplantation site of the C6 root post-brachial plexus avulsion...
June 2019: Neural Regeneration Research
Lir-Wan Fan, Kathleen Carter, Abhay Bhatt, Yi Pang
We previously reported that intranasal insulin protects substantia nigra dopaminergic neurons against 6-hydroxydopamine neurotoxicity in rats. This study aimed to assess insulin pharmacokinetics in the rat brain following intranasal application. Recombinant human insulin (rh-Ins) or phosphate buffer solution was administered to both nostrils of rats. Animals were sacrificed at 15 minutes, 1, 2, and 6 hours to determine insulin levels in different brain regions by an ultrasensitive, human-specific enzyme-linked immunosorbent assay kit...
June 2019: Neural Regeneration Research
Alison Hiong, Karin A Thursky, Georgina Venn, Benjamin W Teh, Gabrielle M Haeusler, Megan Crane, Monica A Slavin, Leon J Worth
PURPOSE: Sepsis is a significant complication following cancer surgery. Although standardised care bundles improve sepsis outcomes in other populations, the benefits in cancer patients are unclear. The objectives of this study were to describe the epidemiology of sepsis in cancer patients post-surgery, and to evaluate the impact of a clinical sepsis pathway on management and clinical outcomes. METHODS: A standardised hospital-wide sepsis pathway was developed in 2013, and all cases of sepsis at the Peter MacCallum Cancer Centre in 2014 were retrospectively evaluated...
February 13, 2019: European Journal of Cancer Care
P Malaka De Silva, Ayush Kumar
Acinetobacter baumannii is a notorious pathogen in health care settings around the world, primarily due to high resistance to antibiotics. A. baumannii also shows an impressive capability to adapt to harsh conditions in clinical settings, which contributes to its persistence in such conditions. Following their traditional role, the T wo C omponent S ystems (TCSs) present in A. baumannii play a crucial role in sensing and adapting to the changing environmental conditions. This provides A. baumannii with a greater chance of survival even in unfavorable conditions...
2019: Frontiers in Microbiology
Rachel Cohen, Rachael Gooberman-Hill
OBJECTIVES: To conduct a systematic review of qualitative studies which explore health professionals' experiences of and perspectives on the enhanced recovery after surgery (ERAS) pathway. DESIGN: Systematic review of qualitative literature using a qualitative content analysis. Literature includes the experiences and views of a wide range of multidisciplinary team and allied health professional staff, to incorporate a diverse range of clinical and professional perspectives...
February 12, 2019: BMJ Open
Graham C Wong, Michelle Welsford, Craig Ainsworth, Wael Abuzeid, Christopher B Fordyce, Jennifer Greene, Thao Huynh, Laurie Lambert, Michel Le May, Sohrab Lutchmedial, Shamir R Mehta, Madhu Natarajan, Colleen M Norris, Christopher B Overgaard, Michele Perry Arnesen, Ata Quraishi, Jean François Tanguay, Mouheiddin Traboulsi, Sean van Diepen, Robert Welsh, David A Wood, Warren J Cantor
Rapid reperfusion of the infarct-related artery is the cornerstone of therapy for the management of acute ST-elevation myocardial infarction (STEMI). Canada's geography presents unique challenges for timely delivery of reperfusion therapy for STEMI patients. The Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology STEMI guideline was developed to provide advice regarding the optimal acute management of STEMI patients irrespective of where they are initially identified: in the field, at a non-percutaneous coronary intervention-capable centre or at a percutaneous coronary intervention-capable centre...
February 2019: Canadian Journal of Cardiology
I-Hao Cheng, Jacquie McBride, Miriam Decker, Therese Watson, Hannah Jakubenko, Alana Russo
It is important to address the health needs of asylum seekers within the early stages of their arrival in Australia, as this impacts all aspects of their resettlement. However, asylum seekers face a range of barriers to accessing timely and appropriate health care in the community. In 2012, the increasing number of asylum seekers in Australia placed additional demand on health and social services in high-settlement regions. Health providers experienced a substantial increase in Medicare ineligible clients and avoidable presentations to Emergency Departments, and the health needs of new asylum seeker arrivals were not being fully addressed...
February 14, 2019: Australian Journal of Primary Health
Brittney Mazzone, Shawn Farrokhi, Andrew DePratti, Julianne Stewart, Kimberly Rowe, Marilynn Wyatt
BACKGROUND: Severe ankle and foot injuries in the U.S. military can result in high-level functional limitation, lost duty days and medical discharge. OBJECTIVE: To assess the effectiveness of the Return to Run Clinical Pathway (RTR) in returning patients with lower extremity fractures who utilize the Intrepid Dynamic Exoskeletal Orthosis (IDEO) to high-level mobility. METHODS: Thirty service members with lower extremity fractures who utilized the IDEO unilaterally and completed the RTR at Naval Medical Center San Diego were included...
February 13, 2019: Journal of Orthopaedic and Sports Physical Therapy
Monica Cations, Natalie May, Maria Crotty, Lee-Fay Low, Lindy Clemson, Craig Whitehead, James McLoughlin, Kate Swaffer, Kate E Laver
Background and Objectives: Multidisciplinary rehabilitation is not incorporated into the usual care pathway for dementia despite increasing demand from key advocates. Clinician views regarding the relevance of rehabilitation in dementia care are not well known. This qualitative study explored the perspectives of health professionals regarding barriers to provision of multidisciplinary rehabilitation programs for people with dementia. Research Design and Methods: Sixteen health professionals from a variety of settings and professional backgrounds were purposively sampled using maximum variation sampling...
February 13, 2019: Gerontologist
Danielle Weiss, Sarah Ostrowski-Delahanty, Jason Van Allen, Paige Seegan, Meghan L Marsac
PURPOSE: Nurses are at the forefront of children's postinjury recovery; this unique role provides an opportunity for nurses to recognize and screen for symptoms that may interfere with children's quality of life (QOL). As such, aims of the present investigation were to explore selected variables (e.g., posttraumatic stress symptoms [PTSS], hope) that have the potential to impact QOL after pediatric injury, with a larger goal of contributing to recommendations for nursing practice to support children's full (physical and emotional) recovery during the peritrauma period following injury...
February 13, 2019: Journal for Specialists in Pediatric Nursing: JSPN
A D Irvine, P Mina-Osorio
BACKGROUND: Atopic dermatitis (AD) is a heterogeneous disease with a multifactorial aetiology and complex pathophysiology. This heterogeneity translates into different trajectories of disease progression with respect to severity, persistence, and risk of development of atopic comorbidities. Determining which possible disease trajectories or comorbidities any individual child might develop is challenging in clinical practice. Tools that help identify paediatric patients at higher risk of disease progression would greatly aid clinicians...
February 13, 2019: British Journal of Dermatology
Zebin Wang, Kaiming Sun, Yonghong Xiao, Bin Feng, Keith Mikule, XiaoYan Ma, Ningping Feng, Christopher P Vellano, Lorenzo Federico, Joseph R Marszalek, Gordon B Mills, Jeffrey Hanke, Sridhar Ramaswamy, Jing Wang
PARP inhibitors have been proven clinically efficacious in platinum-responsive ovarian cancer regardless of BRCA1/2 status and in breast cancers with germline BRCA1/2 mutation. However, resistance to PARP inhibitors may preexist or evolve during treatment in many cancer types and may be overcome by combining PARP inhibitors with other therapies, such as immune checkpoint inhibitors, which confer durable responses and are rapidly becoming the standard of care for multiple tumor types. This study investigated the therapeutic potential of combining niraparib, a highly selective PARP1/2 inhibitor, with anti-PD-1 immune checkpoint inhibitors in preclinical tumor models...
February 12, 2019: Scientific Reports
Stephen Barclay, Emily Moran, Sue Boase, Margaret Johnson, Roberta Lovick, Jonathan Graffy, Patrick L White, Brenda Deboys, Katy Harrison, Brooke Swash
INTRODUCTION: Primary care has a central role in palliative and end of life care: 45.6% of deaths in England and Wales occur under the care of primary care teams at home or in care homes. The Community Care Pathways at the End of Life (CAPE) study investigated primary care provided for patients in the final 6 months of life. This paper highlights the opportunities and challenges associated with primary palliative care research in the UK, describing the methodological, ethical, logistical and gatekeeping challenges encountered in the CAPE study and how these were addressed...
February 12, 2019: BMJ Supportive & Palliative Care
Christopher I Price, Lisa Shaw, Peter Dodd, Catherine Exley, Darren Flynn, Richard Francis, Saiful Islam, Mehdi Javanbakht, Rachel Lakey, Joanne Lally, Graham McClelland, Peter McMeekin, Helen Rodgers, Helen Snooks, Louise Sutcliffe, Pippa Tyrell, Luke Vale, Alan Watkins, Gary A Ford
BACKGROUND: Despite evidence from clinical trials that intravenous (IV) thrombolysis is a cost-effective treatment for selected acute ischaemic stroke patients, there remain large variations in the rate of IV thrombolysis delivery between stroke services. This study is evaluating whether an enhanced care pathway delivered by paramedics (the Paramedic Acute Stroke Treatment Assessment (PASTA)) could increase the number of patients who receive IV thrombolysis treatment. METHODS: Study design: Cluster randomised trial with economic analysis and parallel process evaluation...
February 12, 2019: Trials
Hongxiang Chai, Yu Xiang, Rong Chen, Zhiyu Shao, Li Gu, Li Li, Qiang He
Simultaneous nitrification and denitrification (SND) is an energy-saving wastewater treatment process, however, the nitrogen removal pathways are not clear. An enhanced SND sequencing batch biofilm reactor with a SND ratio above 97.3% was built to treat low carbon to nitrogen ratio wastewater. When traditional nitrification was inhibited, ammonia removal efficiency still reached 45% in 8 h while the NO3 - and NO2 - concentration was less than 3 mg/L and 0.01 mg/L during the complete process, respectively...
February 4, 2019: Bioresource Technology
Shubha Bhat, Toni Zahorian, Regine Robert, Francis A Farraye
In an effort to manage health care costs and avoid improper medication use, prior authorizations (PAs) have become a standard stipulation required by payers in the determination of medication coverage. For gastroenterologists managing patients, especially those with inflammatory bowel disease (IBD), the PA process is time-consuming and further complicated by 2 additional factors: step therapy requirements and failure of payers to recognize updated IBD treatment pathways. These factors often lead to PA denials and cause treatment delays, which in turn can lead to disease progression, ongoing patient suffering, and ultimately an increase in both direct and indirect total costs...
February 8, 2019: Inflammatory Bowel Diseases
Ruth E Farmer, Deborah Ford, Rohini Mathur, Nish Chaturvedi, Rick Kaplan, Liam Smeeth, Krishnan Bhaskaran
Background: Previous studies provide conflicting evidence on whether metformin is protective against cancer. When studying time-varying exposure to metformin, covariates such as body mass index (BMI) and glycated haemoglobin (HbA1c) may act as both confounders and causal pathway variables, and so cannot be handled adequately by standard regression methods. Marginal structural models (MSMs) with inverse probability of treatment weights (IPTW) can correctly adjust for such confounders. Using this approach, the main objective of this study was to estimate the effect of metformin on cancer risk compared with risk in patients with T2DM taking no medication...
February 6, 2019: International Journal of Epidemiology
Sara Rezai Amin, Carole Gruszczynski, Bruno P Guiard, Jacques Callebert, Jean-Marie Launay, Franck Louis, Catalina Betancur, Vincent Vialou, Sophie Gautron
Cre/loxP recombination is a widely used approach to study gene function in vivo, using mice models expressing the Cre recombinase under the control of specific promoters or through viral delivery of Cre-expressing constructs. A profuse literature on transgenic mouse lines points out the deleterious effects of Cre expression in various cell types and tissues, presumably by acting on illegitimate loxP-like sites present in the genome. However, most studies reporting the consequences of Cre-lox gene invalidation often omit adequate controls to exclude the potential toxic effects of Cre, compromising the interpretation of data...
February 12, 2019: Journal of Neurochemistry
Chadwick D Miller, Jason P Stopyra, Simon A Mahler, L Doug Case, Sujethra Vasu, Ronny A Bell, W Gregory Hundley
BACKGROUND: Patients from racial and ethnic minority groups presenting to the Emergency Department (ED) with chest pain experience lower odds of receiving stress testing compared with nonminorities. Studies have demonstrated that care pathways administered within the ED can reduce health disparities, but this has yet to be studied as a strategy to increase stress testing equity. METHODS: A secondary analysis from 3 randomized clinical trials involving ED patients with acute chest pain was performed to determine whether a care pathway, ACES (Accelerated Chest pain Evaluation with Stress imaging), reduces the racial disparity in index visit cardiac testing between African American (AA) and White patients...
March 2019: Critical Pathways in Cardiology
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