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integrated medical treatment

Claudio Franceschi, Paolo Garagnani, Noémie Gensous, Maria Giulia Bacalini, Maria Conte, Stefano Salvioli
Down syndrome (DS) has been proposed by George Martin as a segmental progeroid syndrome since 1978. In fact, DS persons suffer from several age-associated disorders much earlier than euploid persons. Furthermore, a series of recent studies have found that DS persons display elevated levels of age biomarkers, thus supporting the notion that DS is a progeroid trait. Nowadays, due to the progressive advancements in social inclusion processes and medical assistance, DS persons live much longer than in the past; therefore, the early-onset health problems of these persons are becoming an urgent and largely unmet social and medical burden...
February 15, 2019: Aging Cell
Ruth Kleinpell, Curtis N Sessler, Clareen Wiencek, Marc Moss
OBJECTIVES: Over-utilization of tests, treatments, and procedures is common for hospitalized patients in ICU settings. American Board of Internal Medicine Foundation's Choosing Wisely campaign tasked professional societies to identify sources of overuse in specialty care practice. The purpose of this study was to assess how critical care clinicians were implementing the Critical Care Societies Collaborative Choosing Wisely recommendations in clinical practice. DESIGN: Descriptive survey methodology with use of Research Electronic Data Capture (https://projectredcap...
March 2019: Critical Care Medicine
Sung Eun Choi, Seth A Berkowitz, John S Yudkin, Huseyin Naci, Sanjay Basu
BACKGROUND: Personalizing medical treatment often requires practitioners to compare multiple treatment options, assess a patient's unique risk and benefit from each option, and elicit a patient's preferences around treatment. We integrated these 3 considerations into a decision-modeling framework for the selection of second-line glycemic therapy for type 2 diabetes. METHODS: Based on multicriteria decision analysis, we developed a unified treatment decision support tool accounting for 3 factors: patient preferences, disease outcomes, and medication efficacy and safety profiles...
February 15, 2019: Medical Decision Making: An International Journal of the Society for Medical Decision Making
Vanara F Passos, Mary A S Melo, Jennifer Park, Howard E Strassler
Dental erosion is a multifactorial condition associated with chemical, biological, and behavioral factors whereby a non-bacterial chemical process leads to an irreversible loss of dental structure. Consequences of this erosive process include painful sensitivity, susceptibility to further erosion, mechanical wear, changes in occlusion, exposure of dental pulp, and poor esthetics. Substantial evidence has revealed new insights to diagnosing early stages of dental erosion and enabling novel preventive approaches to control its progression...
February 2019: Compendium of Continuing Education in Dentistry
Clare Viglione, Dylaney Bouwman, Nadera Rahman, Yixin Fang, Jeannette M Beasley, Scott Sherman, Xavier Pi-Sunyer, Judith Wylie-Rosett, Craig Tenner, Melanie Jay
Background: Goals for Eating and Moving (GEM) is a technology-assisted health coaching intervention to improve weight management in primary care at the Veterans Health Administration (VHA) that we designed through prior rigorous formative studies. GEM is integrated within the patient-centered medical home and utilizes student health coach volunteers to counsel patients and encourage participation in VHA's intensive weight management program, MOVE!. The primary aim of this study was to determine the feasibility and acceptability of GEM when compared to Enhanced Usual Care (EUC)...
2019: BMC Obesity
Angela Iannitelli, Serena Parnanzone, Giulia Pizziconi, Giulia Riccobono, Francesca Pacitti
The discovery of psychoanalysis and of psychotropic medications represent two radical events in understanding and treatment of mental suffering. The growth of both disciplines together with the awareness of the impracticality of curing mental suffering only through pharmacological molecules-the collapse of the "Great Illusion"-and the experience of psychoanalysts using psychotropic medications along with depth psychotherapeutic treatment, have led to integrated therapies which are arguably more effective than either modality alone...
2019: Frontiers in Human Neuroscience
Jacob A Doll, W Schuyler Jones, Yuliya Lokhnygina, Sara Culpepper, Robin L Parks, Christy Calhoun, David H Au, Manesh R Patel
Background Guidelines recommend patient engagement in shared decision-making regarding coronary revascularization, but studies demonstrate poor patient understanding of risks, benefits, and alternatives. Effective strategies are needed to integrate informed patient preferences into clinical care, particularly for patients undergoing diagnostic coronary angiography. Methods and Results We developed a web-based decision aid to educate patients and survey their treatment preferences before angiography. We compared knowledge, attitudes, and preferences of 203 patients with and without use of the decision aid...
February 2019: Circulation. Cardiovascular Quality and Outcomes
Daniel H Low, Warren Phipps, Jackson Orem, Corey Casper, Rachel A Bender Ignacio
PURPOSE: Health system constraints limit access to HIV and cancer treatment programs in sub-Saharan Africa. Limited access and continuity of care affect morbidity and mortality of patients with cancer and HIV. We assessed barriers in the care cascade of comorbid HIV and cancer. PATIENTS AND METHODS: Structured interviews were conducted with 100 adult patients with HIV infection and new diagnoses of cancer at the Uganda Cancer Institute. Participants completed follow-up questionnaires after 1 year to assess ongoing engagement with and barriers to care...
February 2019: Journal of Global Oncology
Jennifer M Wray, Sandra Coulon, Nina Wong, Derek Szafranski, Daniel F Gros
Objective: To determine if a single behavioral health appointment in primary care would result in improvements in participants' perceptions of mental health treatment. Methods: Survey data from 32 patients seen in a Veterans Affairs medical center primary care clinic were collected (May 2017 to December 2017) before and after a brief appointment with a behavioral health provider. The primary outcome measure was change in pre- to post-session response to 6 items measuring perceptions of treatment taken from the Perceptions About Services Scale-Revised...
February 14, 2019: Primary Care Companion to CNS Disorders
A V Kuzmenko, V V Kuzmenko, T A Gyaurgiev
INTRODUCTION: Lower urinary tract infections (LUTI) are the most common urological diseases. Fosfomycin is one of the antibiotic agents with proven efficacy that are most frequently used to treat UTIs. Despite the high effectiveness of antibiotic therapy with this drug, in some patients, the LUTIs persist or recur. It is advisable to prevent the development of recurrent infections using herbal preparations. The study aimed to evaluate the effectiveness of integrated treatment of women with acute uncomplicated cystitis using the plant-based medication Phytolysin...
October 2018: Urologii︠a︡
Alexis Coulourides Kogan, Tony Rosen, Adria Navarro, Diana Homeier, Krithika Chennapan, Laura Mosqueda
BACKGROUND: Standardization in tools and documentation of child abuse and intimate partner violence have proven helpful in completely documenting injuries and suspected abuse among these populations. Similar tools do not yet exist for older adults and elder abuse. OBJECTIVE: To (1) use insights from experts to develop a tool to assist clinicians in appropriately and completely documenting physical findings in injured older adults for potential future forensic investigation of abuse or neglect and (2) to assess the feasibility of incorporating this tool into clinical practice...
February 13, 2019: Journal of General Internal Medicine
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
Jenessa S Price, Sadie E Larsen, Lawrence A Miller, Heather M Smith, Jennifer A Apps, Jo M Weis
Nutrition deficits are common in patients with chronic illnesses reliant upon nutrition support and can contribute to an increase in cognitive deficits that impact treatment adherence and challenge patients' abilities to cope and successfully implement appropriate psychological and psychosocial interventions. Adopting a multidisciplinary approach addresses biological, psychological, and social barriers that help patients, families, and caregivers develop and maintain proper nutrition behaviors that can enhance patients' quality of life and reduce frustration and misunderstandings with medical providers...
February 12, 2019: Nutrition in Clinical Practice
Sheila Chanani, Anagha Waingankar, Neena Shah More, Shanti Pantvaidya, Armida Fernandez, Anuja Jayaraman
This study reviews the performance of a community-based nutrition programme in preventing and treating wasting without complications among children under age three in urban informal settlements of India. Implemented by a non-profit organization, with national (Integrated Child Development Services [ICDS]) and city-level (Municipal Corporation of Greater Mumbai [MCGM]) government partners, the programme screened 7,759 children between May 2014 and April 2015. During this period, the programme admitted 705 moderately wasted and 189 severely wasted children into the treatment group and 6,820 not wasted children into the prevention group...
January 2019: Maternal & Child Nutrition
Robert Myers
People with severe persistent mental illness pose a significant challenge to managed care organizations and society in general. The financial costs are staggering as is the community impact including homelessness and incarceration. This population also has a high incident of chronic comorbid disorders that not only drives up healthcare costs but also significantly shortens longevity. Traditional case management approaches are not always able to provide the intense and direct interventions required to adequately address the psychiatric, medical and social needs of this unique population...
November 6, 2018: Mental Illness
Mohamed S Al-Moamary, Sami A Alhaider, Abdullah A Alangari, Mohammed O Al Ghobain, Mohammed O Zeitouni, Majdy M Idrees, Abdullah F Alanazi, Adel S Al-Harbi, Abdullah A Yousef, Hassan S Alorainy, Mohamed S Al-Hajjaj
This is the fourth version of the updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of the SINA is to have guidelines that are up to date, simple to understand, and easy to use by healthcare workers dealing with asthma patients. To facilitate achieving the goals of asthma management, the SINA panel approach is mainly based on the assessment of symptom control and risk for both adults and children...
January 2019: Annals of Thoracic Medicine
Victoria W Reynolds, Melissa E Chinn, Jacob A Jolly, Tara N Kelley, Megan E Peter, Leena Choi, Samuel Nwosu, Barbara Carranza Leon, Autumn D Zuckerman
BACKGROUND: Access to proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors that lower low-density lipoprotein cholesterol in patients at high risk of atherosclerotic cardiovascular disease events has proven challenging. Methods to overcome access barriers are needed to fully realize the benefits of these novel agents. OBJECTIVE: This study evaluated medication access rates in patients prescribed a PCSK9 inhibitor at a health care system with integrated specialty pharmacy services...
January 14, 2019: Journal of Clinical Lipidology
Akihiro Nomura, Hiroki Tateno, Katsunori Masaki, Tomoyasu Muto, Shin Suzuki, Kohta Satake, Eisuke Hida, Koichi Fukunaga
BACKGROUND: Smoking cessation treatment programs have been widely available for patients with nicotine dependence. Despite intensive programs, the continuous abstinence rate (CAR) from weeks 9-12 is still about 50%. Recently, a smartphone app emerged as a novel tool for therapeutic interventions, including nicotine dependence. In this study, we developed "CureApp Smoking Cessation" (CASC), which consists of a smartphone app for patients and a Web-based patient management software for doctors with a mobile carbon monoxide (CO) checking device to improve the efficacy of the smoking cessation treatment...
February 11, 2019: JMIR Research Protocols
Janet V Diaz, Elisabeth D Riviello, Alfred Papali, Neill K J Adhikari, Juliana C Ferreira
Caring for critically ill patients is challenging in resource-limited settings, where the burden of disease and mortality from potentially treatable illnesses is higher than in resource-rich areas. Barriers to delivering quality critical care in these settings include lack of epidemiologic data and context-specific evidence for medical decision-making, deficiencies in health systems organization and resources, and institutional obstacles to implementation of life-saving interventions. Potential solutions include the development of common definitions for intensive care unit (ICU), intensivist, and intensive care to create a universal ICU organization framework; development of educational programs for capacity building of health care professionals working in resource-limited settings; global prioritization of epidemiologic and clinical research in resource-limited settings to conduct timely and ethical studies in response to emerging threats; adaptation of international guidelines to promote implementation of evidence-based care; and strengthening of health systems that integrates these interventions...
January 22, 2019: Annals of Global Health
Mei Chen, Michel Decary
Many health care providers have opened their EHR systems to patients in order to increase information sharing and patient participation. Accessing to EHR has offered the promises of improving patient understanding, engagement, and outcomes. Although patients generally appreciate the access to their health records, currently, most EHR systems are used as data storage and communication tools and their potential for promoting productive patient engagement have not fully developed. There is a need to develop and incorporate effective health literacy tools into EHR patient portals, helping patients interpret their health data, understand their medical conditions and treatment plans, make informed decisions, and take proper actions...
2019: Studies in Health Technology and Informatics
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