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https://www.readbyqxmd.com/read/29151248/adiponectin-and-vitamin-d-binding-protein-are-independently-associated-at-birth-in-both-mothers-and-neonates
#1
Spyridon N Karras, Stergios Α Polyzos, Danforth A Newton, Carol L Wagner, Bruce W Hollis, Jody van den Ouweland, Erdinc Dursun, Duygu Gezen-Ak, Kalliopi Kotsa, Cedric Annweiler, Declan P Naughton
CONTEXT: Adult body fat is associated with birth anthropometry, suggesting a role for metabolic regulators including vitamin D and the adipokines-adiponectin and irisin-which have been reported to interact but, as yet, data remain controversial. OBJECTIVE: To study (i) the relationship between vitamin D, its binding protein (VDBP) and the adipokines, adiponectin, and irisin in mothers and neonates at birth and (ii) their effects on neonate anthropometric outcomes...
November 18, 2017: Endocrine
https://www.readbyqxmd.com/read/29150885/recognizing-the-haystack-is-the-task-of-the-primary-care-physician
#2
N A Kukutsch, G Argenziano, W Bergman
In a reply to our letter Ferrandiz and colleagues wondered why dermoscopy experts did not already fully embrace teledermoscopy (TD) for suspicious pigmented skin lesions.(1) Our study showed that the structure of the health systems that were investigated differed, with countries where primary care physicians (PCP) hold a gate keeper function and others with direct access to a dermatologist. Significant differences in waiting time and travel distance were observed.(2) Since we believe that there is enough evidence that the addition of high quality dermoscopic pictures to a teleconsultation leads to higher accuracy of the diagnosis we did not investigate this question in our survey...
November 17, 2017: Journal of the European Academy of Dermatology and Venereology: JEADV
https://www.readbyqxmd.com/read/29150883/finding-the-needle-in-the-haystack-is-teledermoscopy-s-task
#3
Lara Ferrándiz, Almudena Fernández-Orland, David Moreno-Ramírez
We read with interest the recent letter in this journal by Kukutsch et al. as to the opinion of an international group of experts on dermoscopy about the practice of teledermoscopy (TDC) between primary care physicians (PCPs) and a remote dermatologist. This article is protected by copyright. All rights reserved.
November 17, 2017: Journal of the European Academy of Dermatology and Venereology: JEADV
https://www.readbyqxmd.com/read/29150794/shunt-surgery-in-idiopathic-normal-pressure-hydrocephalus-is-cost-effective-a-cost-utility-analysis
#4
Mats Tullberg, Josefine Persson, Jakob Petersen, Per Hellström, Carsten Wikkelsø, Åsa Lundgren-Nilsson
BACKGROUND: The objective was to evaluate the cost-effectiveness of shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). METHODS: Health-related quality of life was evaluated before and 6 months after surgery using the EQ-5D-3 L (EuroQOL group five-dimensions health survey) in 30 patients (median age, 71 years; range, 65-89 years) diagnosed with iNPH. The costs associated with shunt surgery were assessed by a detailed survey with interviews and extraction of register data concerning the cost of hospital care, primary care, residential care, home-care service and informal care...
November 17, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/29150473/patient-level-and-practice-level-factors-associated-with-consultation-duration-a-cross-sectional-analysis-of-over-one-million-consultations-in-english-primary-care
#5
Sarah Stevens, Clare Bankhead, Toqir Mukhtar, Rafael Perera-Salazar, Tim A Holt, Chris Salisbury, F D Richard Hobbs
OBJECTIVES: Consultation duration has previously been shown to be associated with patient, practitioner and practice characteristics. However, previous studies were conducted outside the UK, considered only small numbers of general practitioner (GP) consultations or focused primarily on practitioner-level characteristics. We aimed to determine the patient-level and practice-level factors associated with duration of GP and nurse consultations in UK primary care. DESIGN AND SETTING: Cross-sectional data were obtained from English general practices contributing to the Clinical Practice Research Datalink (CPRD) linked to data on patient deprivation and practice staffing, rurality and Quality and Outcomes Framework (QOF) achievement...
November 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/29150471/biochemical-monitoring-after-initiation-of-aldosterone-antagonist-therapy-in-users-of-renin-angiotensin-system-blockers-a-uk-primary-care-cohort-study
#6
Sarah-Jo Sinnott, Kathryn E Mansfield, Morten Schmidt, Krishnan Bhaskaran, Liam Smeeth, Dorothea Nitsch, Laurie A Tomlinson
OBJECTIVE: To determine the frequency of biochemical monitoring after initiation of aldosterone antagonists(AA) in patients also using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB). SETTING: UK primary care. PARTICIPANTS: ACEI/ARB users who initiated AA between 2004 and 2014. OUTCOMES: We calculated the proportions with: (1) biochemical monitoring ≤2 weeks post initiation of AA, (2) adverse biochemical values ≤2 months (potassium ≥6 mmol/L, creatinine ≥220 µmol/L and ≥30% increase in creatinine from baseline) and (3) discontinuers of AA in those with an adverse biochemical value...
November 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/29150468/prevalence-and-recognition-of-obesity-and-its-associated-comorbidities-cross-sectional-analysis-of-electronic-health-record-data-from-a-large-us-integrated-health-system
#7
Kevin M Pantalone, Todd M Hobbs, Kevin M Chagin, Sheldon X Kong, Brian J Wells, Michael W Kattan, Jonathan Bouchard, Brian Sakurada, Alex Milinovich, Wayne Weng, Janine Bauman, Anita D Misra-Hebert, Robert S Zimmerman, Bartolome Burguera
OBJECTIVE: To determine the prevalence of obesity and its related comorbidities among patients being actively managed at a US academic medical centre, and to examine the frequency of a formal diagnosis of obesity, via International Classification of Diseases, Ninth Revision (ICD-9) documentation among patients with body mass index (BMI) ≥30 kg/m(2). DESIGN: The electronic health record system at Cleveland Clinic was used to create a cross-sectional summary of actively managed patients meeting minimum primary care physician visit frequency requirements...
November 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/29150233/management-of-first-depression-or-generalized-anxiety-disorder-episode-in-adults-in-primary-care-a-systematic-metareview
#8
Damien Driot, Michel Bismuth, Adrien Maurel, Julie Soulie-Albouy, Jordan Birebent, Stéphane Oustric, Julie Dupouy
CONTEXT: General Practitioners (GPs) are the leading antidepressants prescribers in Europe and in France. Difficulties in implementing existing recommendations in daily practice have been described. OBJECTIVE: The objective of this study was to elaborate two algorithms to guide GPs in the patient management for a first major depressive disorder (MDD) or generalized anxiety disorder (GAD) episode in primary care. DATA SOURCES: PubMed, Cochrane, and ISI Web of Science were explored using mainly the following keywords: depressive disorder, anxiety disorders, antidepressive agents or antidepressant...
November 14, 2017: La Presse Médicale
https://www.readbyqxmd.com/read/29150163/the-management-of-diagnosed-heart-failure-in-older-people-in-primary-care
#9
REVIEW
Nicholas R Jones, F D Richard Hobbs, Clare J Taylor
Heart failure (HF) is a common condition affecting predominantly older people. Symptoms include breathlessness and fatigue, and can significantly reduce quality of life. HF rarely occurs in isolation, with most patients having several co-existing diseases requiring multiple medications. There is a large evidence base for treatment of HF with reduced ejection fraction, or HFrEF; however, many of the trials did not include older people with multimorbidity so their findings should be applied to this group with some caution...
December 2017: Maturitas
https://www.readbyqxmd.com/read/29149875/prevalence-of-antibiotic-prescription-in-pediatric-outpatients-in-italy-the-role-of-local-health-districts-and-primary-care-physicians-in-determining-variation-a-multilevel-design-for-healthcare-decision-support
#10
Mirko Di Martino, Adele Lallo, Ursula Kirchmayer, Marina Davoli, Danilo Fusco
BACKGROUND: According to scientific literature, antibacterials are prescribed for common pediatric conditions that do not benefit from antibiotic therapy. The link between antibiotic use and bacterial resistance is well known. Antibiotic overprescribing generates high social costs and severe consequences for children. Our objectives were to analyze antibiotic prescription patterns in pediatric outpatients residing in the Lazio region (Italy), to identify physicians' characteristics associated with increased propensity for prescription, to identify the priority axes for action to improve the rational use of antibiotics...
November 17, 2017: BMC Public Health
https://www.readbyqxmd.com/read/29149754/the-effect-of-comorbid-depression-on-the-use-of-unscheduled-hospital-care-by-people-with-a-long-term-condition-a-retrospective-observational-study
#11
Tom Ricketts, Emily Wood, John Soady, David Saxon, Joe Hulin, Sally Ohlsen, Caroline Mitchell
BACKGROUND: The prevalence of long-term conditions (LTCs) and multiple-morbidity is increasing. Depression prevalence increases with the number of LTCs. Self-management of LTCs improves outcomes, but depression impacts on self-management. Unscheduled hospital care may be a proxy for failure of planned care to support successful self-management. METHODS: Retrospective observational study based on routine NHS datasets covering 19 LTCs. Prevalence of LTCs and depression was identified in all primary care registered adults in one English city (n = 469,368)...
November 7, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/29149669/effective-clinical-classification-of-chronic-epilepsy-into-focal-and-generalized-a-cross-sectional-study
#12
Shambhu Kumar, Mamta Bhushan Singh, Garima Shukla, Sreenivas Vishnubhatla, M V Padma Srivastava, Vinay Goyal, Kameshwar Prasad, Victor Patterson
PURPOSE: Investigations such as EEG and brain imaging are often difficult to obtain in primary care settings of resource-limited regions impacting millions of epilepsy patients. We wanted to test the hypothesis that classification of chronic epilepsy into focal and generalized based on clinical history and examination alone would be comparable to making such a classification with additional inputs from EEG and brain imaging. METHODS: Two investigators independently classified consecutive chronic epilepsy patients into focal, generalized and unclassified epilepsy...
November 9, 2017: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/29148968/collecting-practice-level-data-in-a-changing-physician-office-based-ambulatory-care-environment-a-pilot-study-examining-the-physician-induction-interview-component-of-the-national-ambulatory-medical-care-survey
#13
Meghan C Halley, Katharine A Rendle, Brian Gugerty, Denys T Lau, Harold S Luft
Objective This report examines ways to improve National Ambulatory Medical Care Survey (NAMCS) data on practice and physician characteristics in multispecialty group practices. Methods From February to April 2013, the National Center for Health Statistics (NCHS) conducted a pilot study to observe the collection of the NAMCS physician interview information component in a large multispecialty group practice. Nine physicians were randomly sampled using standard NAMCS recruitment procedures; eight were eligible and agreed to participate...
November 2017: Vital and Health Statistics. Series 2, Data Evaluation and Methods Research
https://www.readbyqxmd.com/read/29148907/impact-of-patients-expressed-wishes-on-their-surrogate-decision-makers-preferred-decision-making-roles-in-japan
#14
Shuji Tsuda, Mieko Nakamura, Shigeru Aoki, Hiroshi Ono, Mitsuru Takagi, Hiroki Ohashi, Junichiro Miyachi, Yoshinori Matsui, Toshiyuki Ojima
BACKGROUND: Home medical care (HMC) patients and their families are expected to prepare for end-of-life decision making. OBJECTIVE: We investigated the decision readiness of HMC patients and their family surrogates. DESIGN: Cross-sectional survey. SETTING/SUBJECTS: We collected data from dyads, consisting of a HMC patient aged 65 years or older and a family member of the patient, recruited at four Japanese primary care clinics from January 2016 to November 2016...
November 17, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29148849/towards-an-overarching-model-for-electronic-medical-record-systems-including-problem-oriented-goal-oriented-and-other-approaches
#15
Huibert Tange, Zsolt Nagykaldi, Jan De Maeseneer
There is no consensus among health professionals on how to structure medical records to serve clinical decision-making. Three approaches co-exist (source-oriented, problem-oriented, goal-oriented), each suiting a different subset of patients. In primary care, the problem-oriented approach is dominant, but for patients with multiple conditions (multimorbidity) the goal-oriented approach seems more appropriate. There is a need to combine different approaches in one medical-record system. In this article, we explain some misconceptions about 'problems' and 'goals' that hinder the way to consensus...
December 2017: European Journal of General Practice
https://www.readbyqxmd.com/read/29148335/geographic-variation-in-medicaid-acceptance-across-michigan-primary-care-practices-in-the-era-of-the-affordable-care-act
#16
Renuka Tipirneni, Karin V Rhodes, Rodney A Hayward, Richard L Lichtenstein, HwaJung Choi, Emily K Arntson, Jessica M Landgraf, Matthew M Davis
Coverage and access have improved under the Affordable Care Act, yet it is unclear whether recent gains have reached those regions within states that were most in need of improved access to care. We examined geographic variation in Medicaid acceptance among Michigan primary care practices before and after Medicaid expansion in the state, using data from a simulated patient study of primary care practices. We used logistic regression analysis with time indicators to assess regional changes in Medicaid acceptance over time...
March 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148334/evidence-of-pent-up-demand-for-care-after-medicaid-expansion
#17
Angela R Fertig, Caroline S Carlin, Scott Ode, Sharon K Long
We compared new Medicaid enrollees with similar ongoing enrollees for evidence of pent-up demand using claims data following Minnesota's 2014 Medicaid expansion. We hypothesized that if new enrollees had pent-up demand, utilization would decline over time as testing and disease management plans are put in place. Consistent with pent-up demand among new enrollees, the probability of an office visit, a new patient office visit, and an emergency department visit declines over time for new enrollees relative to ongoing Medicaid enrollees...
March 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148333/geographic-variations-in-physician-relationships-over-time-implications-for-care-coordination
#18
Eva H DuGoff, Juhee Cho, Yajuan Si, Craig Evan Pollack
Care coordination may be more challenging when the specific physicians with whom primary care physicians (PCPs) are expected to coordinate care change over time. Using Medicare data on physician patient-sharing relationships and the Dartmouth Atlas, we explored the extent to which PCPs tend to share patients with other physicians over time. We found that 70.7% of ties between PCPs and other physicians that were present in 2012 persisted in 2013, and additional shared patients in 2012 increased the odds of being connected in 2013...
March 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148198/ear-nose-and-throat-surgery-all-you-need-to-know-about-the-surgical-approach-to-the-management-of-middle-ear-effusions-in-australian-indigenous-and-non-indigenous-children
#19
REVIEW
Kelvin Kong, Francis J Lannigan, Peter S Morris, Amanda J Leach, Stephen J O'Leary
Otitis media (OM) is a common condition in Australia. It represents a spectrum of diseases from otitis media with effusion (OME) to chronic suppurative otitis media. For all the OM diagnoses, Australian Indigenous children have higher rates of early onset, severe and persistent disease. OME is the most common form of OM and often occurs after an upper respiratory tract infection. It can be difficult to diagnose (and often goes unrecognised). Hearing loss is the most important complication. The middle-ear effusion impedes the movement of the tympanic membrane and causes a conductive hearing loss of around 25 dB...
November 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/29148088/effectiveness-of-an-intensive-intervention-to-improve-lifestyles-in-subjects-with-intermediate-cardiovascular-risk-date-study-study-protocol-for-a-randomized-controlled-trial
#20
Natalia Sanchez-Aguadero, Sara Mora-Simon, Jose I Recio-Rodriguez, Rosario Alonso-Dominguez, Jesus Gonzalez-Sanchez, Cristina Martin-Martin, Manuel A Gomez-Marcos, Emiliano Rodriguez-Sanchez
AIM: To evaluate the effectiveness of an intensive intervention led by primary care nurses for lifestyle modification among subjects with intermediate cardiovascular risk. BACKGROUND: Cardiovascular diseases may be prevented by adopting healthy lifestyles. Interventions focused on populations at risk are more efficient than those aimed at the general population. More than 50 per cent of cardiovascular events occur in subjects with intermediate cardiovascular risk, but only a few studies have targeted this population...
November 17, 2017: Journal of Advanced Nursing
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