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Access to medication

Flavia Westphal, Suzete Maria Fustinoni, Vânia Lopes Pinto, Patrícia de Souza Melo, Anelise Riedel Abrahão
Objective: To identify the profile of women seen in a Fetal Medicine unit, diagnosed with fetal abnormality incompatible with neonatal survival in their current pregnancy, and to check the association of gestational age upon diagnosis with the option of pregnancy termination. Methods: This is a retrospective cohort study carried out in the Fetal Medicine Outpatients Clinic of a university hospital, in the city of São Paulo (SP), Brazil, using medical records of pregnant women with fetus presenting abnormalities incompatible with neonatal survival...
July 2016: Einstein
Umit Kervan, Sinan Sabit Kocabeyoglu, Dogan Emre Sert, Emre Aygün, Kemal Kavasoglu, Mehmet Karahan, Ertekin Utku Unal, Mustafa Pac
OBJECTIVES: The common femoral artery is the standard site for immediate vascular access when initiating adult venoarterial extracorporeal membrane oxygenation. However, this approach is fraught with problems such as femoral artery occlusion, distal limb ischemia, reperfusion injury resulting in compartment syndrome, retroperitoneal hemorrhage, thrombosis, embolization, and most importantly, pulmonary edema. Here, we show our preference of using the subclavian artery with a side graft as a different cannulation technique for outflow of extracorporeal membrane oxygenation, which can avoid complications associated with different access techniques...
October 14, 2016: Experimental and Clinical Transplantation
Kim Robyn Kennedy, Assoc Prof Kirsten Auret
BACKGROUND: Febrile neutropenia is a life-threatening complication of chemotherapy. The widely dispersed population of Australia creates challenges for rural patients in accessing healthcare services. Cancer treatment is particularly burdensome with patients being forced to relocate to the city for treatment, or to endure long and repeated journeys to the city. This study aimed to assess the safety of chemotherapy in a rural centre with a General Physician-led model, by analysing febrile neutropenia in Albany Hospital, a regional cancer centre in Western Australia...
October 18, 2016: Internal Medicine Journal
J E Dietrich, D L Yee, X M Santos, J L Bercaw-Pratt, J Kurkowski, H Soni, Y J Lee-Kim, M D Shah, D Mahoney, L V Srivaths
BACKGROUND: Bleeding disorders (BD) occur in up to 50% of adolescents with heavy menstrual bleeding (HMB). This presents unique challenges to healthcare providers given the complexity of treating the condition and such complexity can result in difficulty with patients understanding basic information about their condition, limit communication with medical providers, and patient compliance. SPECIFIC AIMS: To use an electronic approach to enhance patient compliance with medications used to treat their HMB...
October 14, 2016: Journal of Pediatric and Adolescent Gynecology
M Sánchez Mollá, I Candela García, F J Gómez-Romero, D Orozco Beltrán, M Ollero Baturone
OBJECTIVE: To determine the prevalence of patients with multiple chronic diseases in Primary Care using the multiple morbidity criteria and Clinical Risk Groups, and the agreement in identifying high-risk patients that require case management with both methods. MATERIAL AND METHOD: A cross-sectional study was conducted on 240 patients, selected by random sampling of 16 care quotas from two Primary Health Care centres of a health area. Informed consent was obtained to access their electronic medical records for the study, and a record was made of age, sex, health status of Clinical Risk Groups, severity, multiple morbidity criteria, and Charlson index by physicians during clinical practice...
October 14, 2016: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
David M Levine, Jeffrey A Linder, Bruce E Landon
Importance: Widespread deficits in the quality of US health care were described over a decade ago. Since then, local, regional, and national efforts have sought to improve quality and patient experience, but there is incomplete information about whether such efforts have been successful. Objective: To measure changes in outpatient quality and patient experience in the United States from 2002 to 2013. Design, Setting, and Participants: We analyzed temporal trends from 2002 to 2013 using quality measures constructed from the Medical Expenditure Panel Survey (MEPS), a nationally representative annual survey of the US population that collects data from individual respondents as well as respondents' clinicians, hospitals, pharmacies, and employers...
October 17, 2016: JAMA Internal Medicine
Chen Zhan, Natalia Grundtvig, Bent Helmuth Klug
OBJECTIVES: Recent studies suggest that lung ultrasound is a good, radiation-free alternative to chest radiography in children with pneumonia. We investigated how bedside lung ultrasound performed by a pediatric resident compared with chest radiography in children with suspected pneumonia. METHODS: This was a prospective study comparing bedside lung ultrasound to chest radiography as the reference standard. Children aged 0 to 15 years with suspected pneumonia at a pediatric emergency department were included and underwent chest radiography and lung ultrasound...
October 4, 2016: Pediatric Emergency Care
Laura E Edsberg, Joyce M Black, Margaret Goldberg, Laurie McNichol, Lynn Moore, Mary Sieggreen
Our understanding of pressure injury etiology and development has grown in recent years through research, clinical expertise, and global interdisciplinary expert collaboration. Therefore, the National Pressure Ulcer Advisory Panel (NPUAP) has revised the definition and stages of pressure injury. The revision was undertaken to incorporate the current understanding of the etiology of pressure injuries, as well as to clarify the anatomical features present or absent in each stage of injury. An NPUAP-appointed Task Force reviewed the literature and created drafts of definitions, which were then reviewed by stakeholders and the public, including clinicians, educators, and researchers around the world...
October 4, 2016: Journal of Wound, Ostomy, and Continence Nursing
Jeniece Trast Ilkowitz, Steven Choi, Michael L Rinke, Kathy Vandervoot, Rubina A Heptulla
BACKGROUND: Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions. METHODS: A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families...
October 2016: Quality Management in Health Care
Joel Scholten, Ellen Danford, Azadeh Leland, Heather Malecki, Douglas Bidelspach, Brent Taylor, Nina Sayer
PURPOSE OF STUDY: Individualized interdisciplinary care is the hallmark for rehabilitation following traumatic brain injury (TBI). Veterans Health Administration (VHA) utilizes an electronic note template to document Interdisciplinary Rehabilitation and Community Reintegration (IRCR) care plans for Veterans with TBI requiring rehabilitation. All Veterans with a TBI diagnosis, receiving skilled therapy for TBI-related issues, and followed by a case manager must receive a care plan. The purpose of this study was to determine the level of compliance with the IRCR care plan requirements used to identify Veterans with TBI in need of the care plan and to evaluate the reasons for inconsistent compliance...
November 2016: Professional Case Management
Mohamed M Abuzaid, Aishah M Alnuaimi, Asma M Abdi, Elika A Mohajer, Ifrah A Mohamed, Rawan A Bilwani, Shaima B Alhammadi
BACKGROUND: Radiological examinations require prior preparation that patients should be informed about. Radiologists and radiologic technologists have limited time and resources to do so. Therefore, the internet is a valuable and accessible resource for patient education, but the information may not be reliable, especially that in Arabic language. This study aimed to develop online patient education resources about imaging procedures in Arabic. It also evaluated the understandability and actionability of the source materials...
September 2016: Journal of the Egyptian Public Health Association
Ana L Neves, Tiago Henriques-Coelho, Adelino Leite-Moreira, José C Areias
OBJECTIVE: The aim of this article is to evaluate the clinical utility of brain natriuretic peptide in pediatric patients, examining the diagnostic value, management, and prognostic relevance, by critical assessment of the literature. DATA SOURCES: In December 2015, a literature search was performed (PubMed access to MEDLINE citations; and included these Medical Subject Headings and text terms for the key words: "brain natriuretic peptide," "amino-terminal pro-brain natriuretic peptide," "children," "neonate/s," "newborn/s," "infant/s," and "echocardiography...
September 30, 2016: Pediatric Critical Care Medicine
Paul E Farmer, Joseph J Rhatigan
Shortages of trained health care workers plague low- and middle-income countries around the world. When resources are scarce, the ability to support medical education is severely constrained. While there are many important "building blocks" of health systems that need to be bolstered in low- and middle-income countries, the authors propose that U.S. academic medicine can make unique contributions in the realm of human resource development-specifically, increasing the supply of physicians who directly provide health care to the populations they serve and who often manage and lead these health systems...
October 4, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Alicia Pike, Riana R Pryor, Stephanie M Mazerolle, Rebecca Stearns, Douglas J Casa
CONTEXT:  Availability of athletic trainer (AT) services in US secondary schools has recently been reported to be as high as 70%, but this only describes the public sector. The extent of AT coverage in private secondary school settings has yet to be investigated and may differ from the public secondary school setting for several reasons, including differences in funding sources. OBJECTIVE:  To determine the level of AT services in US private secondary schools and identify the reasons why some schools did not employ ATs...
October 17, 2016: Journal of Athletic Training
Ronelle E Welton, David J Williams, Danny Liew
BACKGROUND: This study provides the first contemporary epidemiological insight into venomous injuries based on demographics and geography in Australia in the timeframe 2000-2013. METHODS: Analysis of national hospitalisation and mortality data to examine the incidence of injury and death due to envenoming in Australia. Rates were calculated using the intercensal population for all Australian age groups. RESULTS: Over the study period, deaths were due to an anaphylactic event (0...
October 17, 2016: Internal Medicine Journal
David M Dror, Arpita Chakraborty, Atanu Majumdar, Pradeep Panda, Ruth Koren
BACKGROUND & OBJECTIVES: The evidence-base of the impact of community-based health insurance (CBHI) on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar s0 tates of India on insured households' self-medication and financial position. METHODS: Data originated from (i) household surveys, and (ii) the Management Information System of each CBHI. Study design was "staggered implementation" cluster randomized controlled trial with enrollment of one-third of the treatment group in each of the years 2011, 2012 and 2013...
June 2016: Indian Journal of Medical Research
Maria Campos, C Batista, N R Jesus, C M Silva, T P Silva
Cardiovascular patients frequently use herbal medicinal products, in order to contribute to the improvement of their chronic condition without medical intervention. However, they are likely to suffer from adverse effects from natural products and herb-drug interactions. This work aimed to alert cardiovascular patients and healthcare providers of the potential of occurrence of herb-drug interactions with cardiovascular therapy. Information obtained from the campaign "Aprender Saúde Entre as Plantas e os Medicamentos", carried out by the Observatory of Herb-Drug Interactions (www...
October 7, 2016: Cardiovascular & Hematological Agents in Medicinal Chemistry
Lotte Skøt, Tina Jeppesen, Angelina Isabella Mellentin, Ask Elklit
PURPOSE: This descriptive study sought to explore barriers faced by Deaf and hard-of-hearing (D/HH) individuals in Denmark when accessing medical and psychosocial services following large-scale disasters and individual traumatic experiences. METHODS: Semi-structured interviews were conducted with nine D/HH individuals who had experienced at least one disaster or other traumatic event. RESULTS: Difficulties were encountered during interactions with first response and healthcare services, which centered on: (1) lack of Deaf awareness among professionals, (2) problems accessing interpreter services, (3) professionals relying on hearing relatives to disseminate information, and (4) professionals who were unwilling to adjust their speech or try different forms of communication...
October 17, 2016: Disability and Rehabilitation
Ara Aiken, R Gomperts, J Trussell
OBJECTIVE: To examine the characteristics and experiences of women in Ireland and Northern Ireland seeking at-home medical termination of pregnancy (TOP) using online telemedicine. DESIGN: Population-based study. SETTING: Ireland and Northern Ireland. POPULATION: Between 1 January 2010 and 31 December 2015, 5650 women requested at-home medical TOP through online telemedicine initiative Women on Web. METHODS: We examined the demographics and circumstances of women requesting medical TOP and examined the experiences of the 1023 women who completed TOP between January 2010 and December 2012...
October 17, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Tamar Sapir, Erica Rusie, Laurence Greene, Jinoos Yazdany, Mark L Robbins, Eric M Ruderman, Jeffrey D Carter, Barry Patel, Kathleen Moreo
INTRODUCTION: In recent years researchers have reported deficits in the quality of care provided to patients with rheumatoid arthritis (RA), including low rates of performance on quality measures. We sought to determine the influence of a quality improvement (QI) continuing education program on rheumatologists' performance on national quality measures for RA, along with other measures aligned with National Quality Strategy priorities. Performance was assessed through baseline and post-education chart audits...
December 2015: Rheumatol Ther
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