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Primary care updates

Kate F Walker, Marion Kibuka, Jim G Thornton, Nia W Jones
BACKGROUND: Epidural analgesia in labour prolongs the second stage and increases instrumental delivery. It has been suggested that a more upright maternal position during all or part of the second stage may counteract these adverse effects. This is an update of a Cochrane Review published in 2017. OBJECTIVES: To assess the effects of different birthing positions (upright or recumbent) during the second stage of labour, on maternal and fetal outcomes for women with epidural analgesia...
November 9, 2018: Cochrane Database of Systematic Reviews
Mario Ganau, Vishal Prasad, Gianfranco K I Ligarotti, Nikolaos Ch Syrmos, Habib Ellamushi
OBJECTIVE: Gorham-Stout disease (GSD), commonly referred as vanishing bone or phantom bone disease, is a rare disorder characterized by spontaneous bone osteolysis due to proliferation of lymphangiomatous tissue. This disease can involve multiple bones and cause pathologic fractures. The exact cause of GSD is unknown and its severity is unpredictable; the disorder can potentially cause disfigurement or functional disability. According to CARE guidelines, we studied a 46 years old lady with a progressive defect of the skull...
November 10, 2018: Hellenic Journal of Nuclear Medicine
Julie Wm Egholm, Bolette Pedersen, Ann Merete Møller, Johanna Adami, Carsten B Juhl, Hanne Tønnesen
BACKGROUND: Risky consumption of alcohol is a global problem. More than 3.3 million deaths annually are associated with risky use of alcohol, and global alcohol consumption continues to increase. People who have high alcohol consumption often require planned and emergency surgical procedures.Risky drinking is associated with increased postoperative complications such as infections, cardiopulmonary complications, and bleeding episodes. Alcohol causes disorders of the liver, pancreas, and nervous system...
November 8, 2018: Cochrane Database of Systematic Reviews
Nicola McCleary, Amanda Andrews, Audrey Buelo, Mireille Captieux, Susan Morrow, Sharon Wiener-Ogilvie, Monica Fletcher, Liz Steed, Stephanie J C Taylor, Hilary Pinnock
Despite a robust evidence base for its effectiveness, implementation of supported self-management for asthma is suboptimal. Professional education is an implementation strategy with proven effectiveness, though the specific features linked with effectiveness are often unclear. We performed a systematic review of randomised controlled trials and controlled clinical trials (published from 1990 and updated to May 2017 using forward citation searching) to determine the effectiveness of professional education on asthma self-management support and identify features of effective initiatives...
November 6, 2018: NPJ Primary Care Respiratory Medicine
Rachelle Buchbinder, Renea V Johnston, Kobi J Rischin, Joanne Homik, C Allyson Jones, Kamran Golmohammadi, David F Kallmes
BACKGROUND: Percutaneous vertebroplasty remains widely used to treat osteoporotic vertebral fractures although our 2015 Cochrane review did not support its role in routine practice. OBJECTIVES: To update the available evidence of the benefits and harms of vertebroplasty for treatment of osteoporotic vertebral fractures. SEARCH METHODS: We updated the search of CENTRAL, MEDLINE and Embase and trial registries to 15 November 2017. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials (RCTs) of adults with painful osteoporotic vertebral fractures, comparing vertebroplasty with placebo (sham), usual care, or another intervention...
November 6, 2018: Cochrane Database of Systematic Reviews
Richard Williams, Richard Keers, Wouter T Gude, Mark Jeffries, Colin Davies, Benjamin Brown, Evangelos Kontopantelis, Anthony J Avery, Darren M Ashcroft, Niels Peek
BACKGROUND: Patient safety is vital to well-functioning health systems. A key component is safe prescribing, particularly in primary care where most medications are prescribed. Previous research demonstrated that the number of patients exposed to potentially hazardous prescribing can be reduced by interrogating the electronic health record (EHR) database of general practices and providing feedback to general practitioners in a pharmacist-led intervention. We aimed to develop and roll out an online dashboard application that delivers this audit and feedback intervention in a continuous fashion...
October 18, 2018: Journal of Innovation in Health Informatics
Traci J Speed, Vinay Parekh, William Coe, Denis Antoine
Chronic pain (CP) and opioid use disorder (OUD) remain challenging complex public health concerns. This is an updated review on the relationship between CP and OUD and the use of stepped care models for assessment and management of this vulnerable population. A literature search was conducted from 2008 to the present in PubMed, Embase, and PsycInfo using the terms pain or chronic pain and opioid-related disorders, opiate, methadone, buprenorphine, naltrexone, opioid abuse, opioid misuse, opioid dependen*, heroin addict, heroin abuse, heroin misuse, heroin dependen*, or analgesic opioids, and stepped care, integrated services, multidisciplinary treatment, or reinforcement-based treatment...
November 6, 2018: International Review of Psychiatry
Ahmet Butun, Mark Linden, Fiona Lynn, Jennifer McGaughey
BACKGROUND: The number of EDs visit is on the increase, and the pressure on EDs is of significant concern worldwide. The usage of EDs by parents of children with minor illness is an important and still unresolved problem causing a burden to healthcare services. The aim of this study was to review the literature to summarise parental reasons for visiting ED for children with minor illness. METHOD: Seven electronic databases (Medline, Embase, PsycINFO, CINAHL, PubMed, Web of Science and Scopus) were comprehensively searched during a 2-week period in August 2016 and updated between 11 and 20 June 2018...
November 2, 2018: Emergency Medicine Journal: EMJ
Jason M Woods, Halden F Scott, Pavan P Zaveri
Clinical care of pediatric sepsis depends on early recognition and basic initial steps and thus focused educational materials for providers in these early phases of care are needed. The authors sought to identify educational goals and establish a framework for those materials. The authors conducted a Delphi process to create consensus educational goals for the recognition and treatment of pediatric sepsis, focused on the needs of emergency and acute care providers. Experts in pediatric sepsis quality improvement and education were recruited...
October 2018: AEM education and training
Aneeza Z Agha, Rachel M Werner, Shimrit Keddem, Tiffany L Huseman, Judith A Long, Judy A Shea
BACKGROUND: While patient engagement can be beneficial for patient care, there are barriers to engaging patients. These barriers exist for health care organizations, for health care personnel, and for the patients themselves. Solutions to barriers are not well documented. OBJECTIVES: Our objective was to explore barriers to patient engagement efforts and their corresponding solutions. RESEARCH DESIGN: Qualitative interviews and site visits from a national sample of primary care facilities within the Veterans Health Administration were analyzed to understand patient engagement barriers and solutions...
October 31, 2018: Medical Care
Harshal Deshmukh, Emma Barker, Thineshkrishna Ambarasan, Daniel Levin, Samira Bell, Miles D Witham, Jacob George
BACKGROUND AND OBJECTIVE: Results of interventional trials in renovascular hypertension have been disappointing and medical therapy is the current recommended gold standard. However, the comparative long-term benefits of different antihypertensive drug classes in atherosclerotic renal artery stenosis are not known. We aim to assess the effect of different antihypertensive drug classes on outcomes in renovascular hypertension DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Using Tayside Health Informatics Centre database, anonymised data over a 6-year period was analysed...
October 29, 2018: Cardiovascular Therapeutics
Jerrold H Levy, Matthew D Neal, Jay H Herman
Platelet transfusions carry greater risks of infection, sepsis, and death than any other blood product, owing primarily to bacterial contamination. Many patients may be at particular risk, including critically ill patients in the intensive care unit. This narrative review provides an overview of the problem and an update on strategies for the prevention, detection, and reduction/inactivation of bacterial contaminants in platelets. Bacterial contamination and septic transfusion reactions are major sources of morbidity and mortality...
October 27, 2018: Critical Care: the Official Journal of the Critical Care Forum
Ruth Cornick, Sandy Picken, Camilla Wattrus, Ajibola Awotiwon, Emma Carkeek, Juliet Hannington, Pearl Spiller, Eric Bateman, Tanya Doherty, Merrick Zwarenstein, Lara Fairall
For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complicated by clinical guidance that is out of date, inconsistent and informed by evidence from high-income countries that ignores LMIC resource constraints and burden of disease. The Knowledge Translation Unit (KTU) of the University of Cape Town Lung Institute has developed, implemented and evaluated a health systems intervention in South Africa, and localised it to Botswana, Nigeria, Ethiopia and Brazil, that simplifies and standardises the care delivered by primary health workers while strengthening the system in which they work...
2018: BMJ Global Health
Anne Granstrøm Ekeland, Anne Helen Hansen, Trine Strand Bergmo
BACKGROUND: Earlier work has described videoconferencing technologies, peripheral equipment, organizational models, human relations, purposes, goals and roles as versatile, multifaceted, and those used differently in different clinical practices. Knowledge about benefits and challenges connected to specific characteristics of services are lacking. A 2005 systematic review of published definitions of electronic health (eHealth) identified 51 unique definitions. In addition, the "10 E's of eHealth" was developed...
October 25, 2018: Journal of Medical Internet Research
Michael Lepore, Kezia Scales, Ruth A Anderson, Kristie Porter, Trini Thach, Eleanor McConnell, Kirsten Corazzini
AIM: Federal regulations require nursing homes in the United States to support residents in directing their own care rather than having their care plans developed for them without their engagement, but knowledge of person-directed approaches to care planning in nursing homes is limited. The purpose of this study was to advance understanding of person-directed care planning (PDCP). METHODS: A multidisciplinary research team conducted a scoping review on individual and family involvement in care planning, including literature from a variety of care contexts...
October 25, 2018: International Journal of Older People Nursing
Mark H Ebell, Isabella Locatelli, Yolanda Mueller, Nicolas Senn, Kathryn Morgan
BACKGROUND: Test and treatment thresholds have not yet been described for decision-making regarding the likelihood of pneumonia in patients with acute cough. AIM: To determine decision thresholds in the management of patients with acute cough. DESIGN AND SETTING: Set among primary care physicians attending meetings in the US and Switzerland, using data from a prospective cohort of primary care patients. METHOD: Clinical vignettes were used to study the clinical decisions of physicians regarding eight patients with cough that varied by six signs and symptoms...
November 2018: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Isabelle Jeanne, Lynda E Chambers, Adna Kazazic, Tanya L Russell, Albino Bobogare, Hugo Bugoro, Francis Otto, George Fafale, Amanda Amjadali
BACKGROUND: Malaria remains a challenge in Solomon Islands, despite government efforts to implement a coordinated control programme. This programme resulted in a dramatic decrease in the number of cases and mortality however, malaria incidence remains high in the three most populated provinces. Anopheles farauti is the primary malaria vector and a better understanding of the spatial patterns parasite transmission is required in order to implement effective control measures. Previous entomological studies provide information on the ecological preferences of An...
October 22, 2018: Malaria Journal
Sarah J O'Brien, Roy A Sanderson, Stephen P Rushton
PURPOSE OF REVIEW: The purpose of the review is to provide an update on control measures for norovirus (NoV), which is the most commonly implicated pathogen in acute gastroenteritis and outbreaks, causing major disruption in nurseries, schools, hospitals and care homes. RECENT FINDINGS: Important developments include the discovery that virus particles, previously considered to be the infectious unit, also occur in clusters, which appear to be more virulent than individual virus particles; a working culture system using human stem-cell derived enteroids; promising results from early phase clinical trials of candidate NoV vaccines, which appear to be safe and immunogenic; chronic NoV affects patients with primary and secondary immune deficiencies...
October 20, 2018: Current Opinion in Gastroenterology
Samantha J McEwan, Hannah Maple, Paul J Gibbs
INTRODUCTION: Definitive access in patients requiring renal replacement therapy is an ever-increasing challenge. For those where autogenous venous access is no longer a viable option, arteriovenous grafts can be considered. This article describes long-term follow-up, complications and patency rates of the mid-thigh 'adductor loop' arteriovenous graft. METHODS: 50 mid-thigh loop arteriovenous grafts have been inserted into 48 patients in our unit over the past 11 years...
October 22, 2018: Journal of Vascular Access
Nadia Nathan, Laura Berdah, Keren Borensztajn, Annick Clement
Children interstitial lung disease (chILD) is a heterogeneous group of rare respiratory disorders characterized by inflammatory and fibrotic changes of the lung parenchyma. They include ILD related to exposure/environment insults, ILD related to systemic diseases processes, ILD related to primary lung parenchyma dysfunctions and ILD specific to infancy. Areas covered: This review provides an update on chILD pathophysiology and diagnosis approaches in immunocompetent children. It includes current information on genetic causes...
October 22, 2018: Expert Review of Respiratory Medicine
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