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https://www.readbyqxmd.com/read/29451516/-evidence-based-medicine-vs-personalized-medicine
#1
Lucio Capurso
Evidence-based medicine (EBM) and personalized medicine (PM) are driven by two diverse modes of reasoning about «evidence making». EBM has been criticized since his quality mark has been misappropriated by vested interests, the benefits statistically significant may be marginal in clinical practice, rigid rules and technology may produce care that is management driven rather than patient centered. On the contrary PM (or "precision medicine") refers to the tailoring of medical treatment to the specific characteristics of each patient involving the ability to classify individuals into subpopulations that are uniquely susceptible to a specific treatment, sparing expense and side effects and is derived from doubts on the results of subgroup analyses and on non responders in clinical trials typical of EBM...
January 2018: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/29451116/population-tailored-care-for-homeless-veterans-and-acute-care-use-cost-and-satisfaction-a-prospective-quasi-experimental-trial
#2
Thomas P O'Toole, Erin E Johnson, Matthew Borgia, Amy Noack, Jean Yoon, Elizabeth Gehlert, Jeanie Lo
INTRODUCTION: Although traditional patient-centered medical homes (PCMHs) are effective for patients with complex needs, it is unclear whether homeless-tailored PCMHs work better for homeless veterans. We examined the impact of enrollment in a Veterans Health Administration (VHA) homeless-tailored PCMH on health services use, cost, and satisfaction compared with enrollment in a traditional, nontailored PCMH. METHODS: We conducted a prospective, multicenter, quasi-experimental, single-blinded study at 2 VHA medical centers to assess health services use, cost, and satisfaction during 12 months among 2 groups of homeless veterans: 1) veterans receiving VHA homeless-tailored primary care (Homeless-Patient Aligned Care Team [H-PACT]) and 2) veterans receiving traditional primary care services (PACT)...
February 15, 2018: Preventing Chronic Disease
https://www.readbyqxmd.com/read/29449273/novel-patient-centered-approach-to-facilitate-same-day-discharge-in-patients-undergoing-elective-percutaneous-coronary-intervention
#3
Amit P Amin, Patricia Crimmins-Reda, Samantha Miller, Brandon Rahn, Mary Caruso, Andrew Pierce, Brandy Dennis, Marissa Pendegraft, Katrine Sorensen, Howard I Kurz, John M Lasala, Alan Zajarias, Richard G Bach, Hemant Kulkarni, Jasvindar Singh
BACKGROUND: Same-day discharge (SDD) after elective percutaneous coronary intervention is safe, less costly, and preferred by patients, but it is usually performed in low-risk patients, if at all. To increase the appropriate use of SDD in more complex patients, we implemented a "patient-centered" protocol based on risk of complications at Barnes-Jewish Hospital. METHODS AND RESULTS: Our objectives were as follows: (1) to evaluate time trends in SDD; (2) to compare (a) mortality, bleeding, and acute kidney injury, (b) patient satisfaction, and (c) hospital costs by SDD versus no SDD (NSDD); and (3) to compare SDD eligibility by our patient-centered approach versus Society for Cardiovascular Angiography and Interventions guidelines...
February 15, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29449200/mhealth-technology-and-nurse-health-coaching-to-improve-health-in-diabetes-protocol-for-a-randomized-controlled-trial
#4
Sheridan Miyamoto, Madan Dharmar, Sarina Fazio, Yajarayma Tang-Feldman, Heather M Young
BACKGROUND: Chronic diseases, including diabetes mellitus, are the leading cause of mortality and disability in the United States. Current solutions focus primarily on diagnosis and pharmacological treatment, yet there is increasing evidence that patient-centered models of care are more successful in improving and addressing chronic disease outcomes. OBJECTIVE: The objective of this clinical trial is to evaluate the impact of a mobile health (mHealth) enabled nurse health coaching intervention on self-efficacy among adults with type-2 diabetes mellitus...
February 15, 2018: JMIR Research Protocols
https://www.readbyqxmd.com/read/29449147/relation-between-hba-1c-and-incident-cardiovascular-disease-over-a-period-of-6-years-in-the-hong-kong-population
#5
E Y F Wan, E Y T Yu, C S C Fung, W Y Chin, D Y T Fong, A K C Chan, C L K Lam
AIM: The current trend on diabetes management advocates replacing the paradigm from a uniform to an individualized patient-centered haemoglobin A 1c (HbA 1c ) target, but there is no consensus on the optimal HbA 1c level. The study aimed at examining the association between HbA 1c and the risk of cardiovascular diseases (CVD) for diabetic patients with different characteristics, in order to identify patient-centered treatment targets. METHODS: A retrospective cohort study was conducted on 115,782 Chinese adult primary care patients with type 2 diabetes mellitus (DM) but no known CVD history, who were prescribed antidiabetic medications in 2010-2011...
February 3, 2018: Diabetes & Metabolism
https://www.readbyqxmd.com/read/29447302/in-throwers-with-posterior-instability-rotator-cuff-tears-are-common-but-do-not-affect-surgical-outcomes
#6
Justin W Arner, Michael P McClincy, James P Bradley
In a previous study, compared with throwing athletes with superior labral anterior posterior (SLAP) tears, those with concomitant SLAP tears and rotator cuff tears (RCTs) had significantly poorer outcome scores and return to play. Posterior shoulder instability also occurs in throwing athletes, but no studies currently exist regarding outcomes of these patients with concomitant RCTs. The authors hypothesized that throwing athletes treated with arthroscopic capsulolabral repair for posterior shoulder instability with coexistent rotator cuff pathology would have poorer outcome scores and return to play...
January 2018: American Journal of Orthopedics
https://www.readbyqxmd.com/read/29445831/using-a-sequential-explanatory-mixed-method-to-evaluate-the-therapeutic-window-of-opportunity-for-initiating-osteoporosis-treatment-following-fragility-fractures
#7
S Roux, I Gaboury, N Gionet-Landry, M-P Garant, M-C Beaulieu, N Carrier, F Cabana, G Boire
Interventions targeting patients with recent fragility fracture and their physician were most successful at initiating osteoporosis treatment during the first 12 months. This window of opportunity had already closed after 1 year. The reasons for declining or accepting the intensive intervention were explored in patients still untreated at 12 months. INTRODUCTION: A fragility fracture (FF) event identifies patients most likely to benefit from osteoporosis treatment. Nonetheless, most FF patients go untreated...
February 14, 2018: Osteoporosis International
https://www.readbyqxmd.com/read/29445521/a-method-for-co-creation-of-an-evidence-based-patient-workbook-to-address-alcohol-use-when-quitting-smoking-in-primary-care-a-case-study
#8
Nadia Minian, Aliya Noormohamed, Laurie Zawertailo, Dolly Baliunas, Norman Giesbrecht, Bernard Le Foll, Jürgen Rehm, Andriy Samokhvalov, Peter L Selby
Plain English summary: The purpose of this paper is to describe a patient engagement event designed to create an educational workbook with smokers who drink alcohol at harmful levels. The goal was to create a workbook that combined scientific evidence with patients' values, preferences, and needs. Fourteen adult smokers who drink alcohol were invited to the Centre for Addiction and Mental Health (CAMH) to take part in a four-hour event to help design the workbook with the CAMH research team...
2018: Research Involvement and Engagement
https://www.readbyqxmd.com/read/29445267/a-patient-and-community-centered-approach-selecting-endpoints-for-a-randomized-trial-of-a-novel-advance-care-planning-tool
#9
John Fp Bridges, Norah L Crossnohere, Anne L Schuster, Judith A Miller, Carolyn Pastorini, Rebecca A Aslakson
Background: Despite a movement toward patient-centered outcomes, best practices on how to gather and refine patients' perspectives on research endpoints are limited. Advanced care planning (ACP) is inherently patient centered and would benefit from patient prioritization of endpoints for ACP-related tools and studies. Objective: This investigation sought to prioritize patient-centered endpoints for the content and evaluation of an ACP video being developed for patients undergoing major surgery...
2018: Patient Preference and Adherence
https://www.readbyqxmd.com/read/29444602/evaluating-integrative-cancer-clinics-with-the-claim-assessment-profile-an-example-with-the-inspirehealth-clinic
#10
Lara Hilton, Pamela Elfenbaum, Shamini Jain, Meredith Sprengel, Wayne B Jonas
BACKGROUND: The evaluation of freestanding integrative cancer clinical programs is challenging and is rarely done. We have developed an approach called the Claim Assessment Profile (CAP) to identify whether evaluation of a practice is justified, feasible, and likely to provide useful information. OBJECTIVES: A CAP was performed in order to (1) clarify the healing claims at InspireHealth, an integrative oncology treatment program, by defining the most important impacts on its clients; (2) gather information about current research capacity at the clinic; and (3) create a program theory and path model for use in prospective research...
March 2018: Integrative Cancer Therapies
https://www.readbyqxmd.com/read/29444339/nursing-intensive-care-satisfaction-scale-nicss-development-and-validation-of-a-patient-centered-instrument
#11
M Romero-García, L de la Cueva-Ariza, Ll Benito-Aracil, T M Lluch-Canut, J Trujols-Albet, M A Martínez-Momblan, M E Juvé-Udina, P Delgado-Hito
AIM: To develop and validate the Nursing Intensive-Care-Satisfaction-Scale to measures satisfaction with nursing care from the critical care patient's perspective. BACKGROUND: Instruments that measure satisfaction with nursing cares have been designed and validated without taking the patient's perspective into consideration. Despite the benefits and advances in measuring satisfaction with nursing care, none instrument is specifically designed to assess satisfaction in intensive care units...
February 14, 2018: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/29441815/the-secret-drama-at-the-patient-s-bedside-refusal-of-treatment-because-of-the-practitioner-s-ethnic-identity-the-medical-staff-s-point-of-view
#12
Ariela Popper-Giveon, Yael Keshet
Patients' refusal of treatment based on the practitioner's ethnic identity reveals a clash of values: neutrality in medicine versus patient-centered care. Taking the Israeli-Palestinian conflict into account, this article aims at examining Israeli health care professionals' points of view concerning patients' refusal of treatment because of a practitioner's ethnic identity. Fifty in-depth interviews were conducted with 10 managers and 40 health care professionals, Jewish and Arab, employed at 11 public hospitals...
February 1, 2018: Qualitative Health Research
https://www.readbyqxmd.com/read/29441105/quality-improvement-in-pediatric-care
#13
REVIEW
Moon Sung Park
We often overlook the importance of several safety issues such as identification of patients, timeout procedure, hand hygiene, handoff communication, and many others. This ignorance, along with many other issues, leads to medical error being ranked as a third leading cause of death in the U.S. Consequently, quality improvement (QI) has become one of the major subjects in healthcare despite a relatively short history. Improving quality is about making healthcare safe, effective, patient-centered, timely, efficient, and equitable...
January 2018: Korean Journal of Pediatrics
https://www.readbyqxmd.com/read/29440123/portrait-patient-centered-outcomes-related-to-treatment-practices-in-peripheral-arterial-disease-investigating-trajectories-overview-of-design-and-rationale-of-an-international-prospective-peripheral-arterial-disease-study
#14
REVIEW
Kim G Smolderen, Kensey Gosch, Manesh Patel, W Schuyler Jones, Alan T Hirsch, John Beltrame, Rob Fitridge, Mehdi H Shishehbor, Johan Denollet, Patrick Vriens, Jan Heyligers, Nancy Stone MEd, Herbert Aronow, J Dawn Abbott, Clementine Labrosciano, Rudolf Tutein-Nolthenius, John A Spertus
BACKGROUND: Health status outcomes, including symptoms, functional status, and quality of life, are critically important outcomes from patients' perspectives. The PORTRAIT study (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) was designed to prospectively define health status outcomes and examine associations between patients' characteristics and care to these outcomes among those presenting with new-onset or worsened claudication...
February 2018: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/29439691/what-matters-most-protocol-for-a-randomized-controlled-trial-of-breast-cancer-surgery-encounter-decision-aids-across-socioeconomic-strata
#15
Marie-Anne Durand, Renata West Yen, A James O'Malley, Mary C Politi, Shubhada Dhage, Kari Rosenkranz, Katie Weichman, Julie Margenthaler, Anna N A Tosteson, Eloise Crayton, Sherrill Jackson, Ann Bradley, Robert J Volk, Karen Sepucha, Elissa Ozanne, Sanja Percac-Lima, Julia Song, Jocelyn Acosta, Nageen Mir, Glyn Elwyn
BACKGROUND: Breast cancer is the most commonly diagnosed malignancy in women. Mastectomy and breast-conserving surgery (BCS) have equivalent survival for early stage breast cancer. However, each surgery has different benefits and harms that women may value differently. Women of lower socioeconomic status (SES) diagnosed with early stage breast cancer are more likely to experience poorer doctor-patient communication, lower satisfaction with surgery and decision-making, and higher decision regret compared to women of higher SES...
February 13, 2018: BMC Public Health
https://www.readbyqxmd.com/read/29439581/association-between-dementia-severity-and-recommended-lifestyle-changes-a-retrospective-cohort-study
#16
Timothy Thoits, Alison Dutkiewicz, Sarah Raguckas, Michael Lawrence, Jessica Parker, Jacob Keeley, Nicholas Andersen, Martha VanDyken, Maegan Hatfield-Eldred
OBJECTIVE: Early diagnosis of dementia leads to early treatment which is beneficial to patients and the community. We reviewed initial evaluations from the Spectrum Health Medical Group Neurocognitive Clinic (SHMGNC) to evaluate dementia stage at the time of diagnosis. METHODS: We retrospectively reviewed 110 randomly chosen initial evaluations from September 2008 to December 2015 at the SHMGNC. Patients underwent a neurological examination, Montreal Cognitive Assessment, and a battery of neuropsychological testing...
January 1, 2018: American Journal of Alzheimer's Disease and Other Dementias
https://www.readbyqxmd.com/read/29439543/patient-centered-care-in-breast-cancer-genetic-clinics
#17
Anne Brédart, Amélie Anota, Julia Dick, Violetta Kuboth, Olivier Lareyre, Antoine De Pauw, Alejandra Cano, Dominique Stoppa-Lyonnet, Rita Schmutzler, Sylvie Dolbeault, Jean-Luc Kop
With advances in breast cancer (BC) gene panel testing, risk counseling has become increasingly complex, potentially leading to unmet psychosocial needs. We assessed psychosocial needs and correlates in women initiating testing for high genetic BC risk in clinics in France and Germany, and compared these results with data from a literature review. Among the 442 counselees consecutively approached, 212 (83%) in France and 180 (97%) in Germany, mostly BC patients (81% and 92%, respectively), returned the 'Psychosocial Assessment in Hereditary Cancer' questionnaire...
February 12, 2018: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29439104/costs-at-the-end-of-life-perspectives-for-north-carolina
#18
Natalie C Ernecoff, Sally C Stearns
Many elders require supportive services, with many costs covered by Medicaid. Once terminal illness sets in, palliative care and hospice may help control cost while ensuring quality. This commentary reviews trends in cost at the end of life and describes selected strategies to improve patient-centered care in North Carolina.
January 2018: North Carolina Medical Journal
https://www.readbyqxmd.com/read/29438606/experience-and-context-shape-patient-and-clinician-goals-for-treatment-of-rheumatoid-arthritis-a-qualitative-study
#19
Jennifer L Barton, Elizabeth Hulen, Allison Schue, Edward H Yelin, Sarah S Ono, Anais Tuepker, Christopher J Koenig
OBJECTIVE: Patient and clinician goal alignment, central to effective patient-centered care, has been linked to improved patient experience and outcomes, but has not been explored in rheumatoid arthritis (RA). This study aimed to explore goal conceptualization among RA patients and clinicians. METHODS: Seven focus groups and one semi-structured interview were conducted with RA patients and clinicians recruited from four rheumatology clinics. An interview guide was developed to explore goal concordance related to RA treatment...
February 13, 2018: Arthritis Care & Research
https://www.readbyqxmd.com/read/29438295/patient-centered-communication
#20
Cynthia A Naughton
As the population ages, morbidity and mortality associated with chronic disease will increase. Some patient-centered improvements have been made in health care services, but optimal health has not been fully realized. Only when pharmacists have a holistic understanding of an individual patient, including their experience of illness and medication, can they effectively assess appropriateness, safety, efficacy, and adherence to medications and develop realistic treatment plans. When patients are involved in their care, they are better able to manage complex chronic conditions by understanding and adhering to their plan of care...
February 13, 2018: Pharmacy (Basel, Switzerland)
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