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https://www.readbyqxmd.com/read/28716797/a-pragmatic-phase-iii-multisite-double-blind-placebo-controlled-parallel-arm-dose-increment-randomised-trial-of-regular-low-dose-extended-release-morphine-for-chronic-breathlessness-breathlessness-exertion-and-morphine-sulfate-beams-study-protocol
#1
David Currow, Gareth John Watts, Miriam Johnson, Christine F McDonald, John O Miners, Andrew A Somogyi, Linda Denehy, Nicola McCaffrey, Danny J Eckert, Philip McCloud, Sandra Louw, Lawrence Lam, Aine Greene, Belinda Fazekas, Katherine C Clark, Kwun Fong, Meera R Agar, Rohit Joshi, Sharon Kilbreath, Diana Ferreira, Magnus Ekström
INTRODUCTION: Chronic breathlessness is highly prevalent and distressing to patients and families. No medication is registered for its symptomatic reduction. The strongest evidence is for regular, low-dose, extended- release (ER) oral morphine. A recent large phase III study suggests the subgroup most likely to benefit have chronic obstructive pulmonary disease (COPD) and modified Medical Research Council breathlessness scores of 3 or 4. This protocol is for an adequately powered, parallel-arm, placebo-controlled, multisite, factorial, block-randomised study evaluating regular ER morphine for chronic breathlessness in people with COPD...
July 17, 2017: BMJ Open
https://www.readbyqxmd.com/read/28715535/improving-adherence-to-long-term-opioid-therapy-guidelines-to-reduce-opioid-misuse-in-primary-care-a-cluster-randomized-clinical-trial
#2
Jane M Liebschutz, Ziming Xuan, Christopher W Shanahan, Marc LaRochelle, Julia Keosaian, Donna Beers, George Guara, Kristen O'Connor, Daniel P Alford, Victoria Parker, Roger D Weiss, Jeffrey H Samet, Julie Crosson, Phoebe A Cushman, Karen E Lasser
Importance: Prescription opioid misuse is a national crisis. Few interventions have improved adherence to opioid-prescribing guidelines. Objective: To determine whether a multicomponent intervention, Transforming Opioid Prescribing in Primary Care (TOPCARE; http://mytopcare.org/), improves guideline adherence while decreasing opioid misuse risk. Design, Setting, and Participants: Cluster-randomized clinical trial among 53 primary care clinicians (PCCs) and their 985 patients receiving long-term opioid therapy for pain...
July 17, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28711121/history-principles-and-policies-of-observation-medicine
#3
REVIEW
Michael A Ross, Michael Granovsky
The history of observation medicine has paralleled the rise of emergency medicine over the past 50 years to meet the needs of patients, emergency departments, hospitals, and the US health care system. Just as emergency departments are the safety net of the health system, observation units are the safety net of emergency departments. The growth of observation medicine has been driven by innovations in health care, an ongoing shift of patients from inpatient to outpatient settings, and changes in health policy...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28710698/health-social-and-economic-outcomes-experienced-by-families-as-a-result-of-receiving-assistance-from-a-community-based-diaper-bank
#4
Kelley E C Massengale, Jennifer Toller Erausquin, Michelle Old
Objectives This paper aims to describe low-income recipients of a community-based diaper bank and the multiple daily challenges they face. Our paper seeks to document the health, social, and financial outcomes recipients experienced after receiving assistance. Methods We surveyed families (n = 150) about their experiences receiving diapers from a diaper bank in the southeastern United States. Additionally, we conducted short, focused interviews with families (n = 15) about outcomes after receiving diapers...
July 14, 2017: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/28710596/patterns-of-and-reasons-for-electronic-cigarette-use-in-primary-care-patients
#5
Sara Kalkhoran, Nicholas Alvarado, Maya Vijayaraghavan, Paula J Lum, Patrick Yuan, Jason M Satterfield
BACKGROUND: Electronic cigarette (e-cigarette) use is rising in both the general and clinical populations. Little is known about e-cigarette use in primary care, where physicians report discussing e-cigarette use with patients. OBJECTIVE: Identify how and why smokers in primary care use e-cigarettes. DESIGN: Cross-sectional secondary data analysis from a randomized controlled trial of a tablet intervention to deliver the 5As for smoking cessation in primary care...
July 14, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28700781/efficacy-and-safety-of-spironolactone-in-acute-heart-failure-the-athena-hf-randomized-clinical-trial
#6
Javed Butler, Kevin J Anstrom, G Michael Felker, Michael M Givertz, Andreas P Kalogeropoulos, Marvin A Konstam, Douglas L Mann, Kenneth B Margulies, Steven E McNulty, Robert J Mentz, Margaret M Redfield, W H Wilson Tang, David J Whellan, Monica Shah, Patrice Desvigne-Nickens, Adrian F Hernandez, Eugene Braunwald
Importance: Persistent congestion is associated with worse outcomes in acute heart failure (AHF). Mineralocorticoid receptor antagonists administered at high doses may relieve congestion, overcome diuretic resistance, and mitigate the effects of adverse neurohormonal activation in AHF. Objective: To assess the effect of high-dose spironolactone and usual care on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels compared with usual care alone. Design, Setting, and Participants: This double-blind and placebo (or low-dose)-controlled randomized clinical trial was conducted in 22 US acute care hospitals among patients with AHF who were previously receiving no or low-dose (12...
July 12, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28700194/california-public-hospitals-improved-quality-of-care-under-medicaid-waiver-program
#7
Nederah Pourat
California has 12 county-owned and operated hospital systems and 5 University of California hospitals designated as public hospitals. These organizations deliver the majority of inpatient care and a significant amount of outpatient care to Medicaid patients in the state. In 2010, California was the first state in the nation to implement a five-year Delivery System Reform Incentive Payment (DSRIP) program under the Section §1115 Medicaid "Bridge to Reform" waiver to improve the capacity of these hospitals to deliver high quality and more efficient care...
June 2017: Policy Brief
https://www.readbyqxmd.com/read/28699083/a-therapy-system-for-post-traumatic-stress-disorder-using-a-virtual-agent-and-virtual-storytelling-to-reconstruct-traumatic-memories
#8
Myrthe L Tielman, Mark A Neerincx, Rafael Bidarra, Ben Kybartas, Willem-Paul Brinkman
Although post-traumatic stress disorder (PTSD) is well treatable, many people do not get the desired treatment due to barriers to care (such as stigma and cost). This paper presents a system that bridges this gap by enabling patients to follow therapy at home. A therapist is only involved remotely, to monitor progress and serve as a safety net. With this system, patients can recollect their memories in a digital diary and recreate them in a 3D WorldBuilder. Throughout the therapy, a virtual agent is present to inform and guide patients through the sessions, employing an ontology-based question module for recollecting traumatic memories to further elicit a detailed memory recollection...
August 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28698258/comparison-of-fatal-or-irreversible-events-with-extended-duration-betrixaban-versus-standard-dose-enoxaparin-in-acutely-ill-medical-patients-an-apex-trial-substudy
#9
C Michael Gibson, Serge Korjian, Gerald Chi, Yazan Daaboul, Purva Jain, Douglas Arbetter, Samuel Z Goldhaber, Russel Hull, Adrian F Hernandez, Renato D Lopes, Alex Gold, Alexander T Cohen, Robert A Harrington
BACKGROUND: Extended-duration betrixaban showed a significant reduction in venous thromboembolism in the APEX trial (Acute Medically Ill VTE Prevention With Extended Duration Betrixaban Study). Given the variable clinical impact of different efficacy and safety events, one approach to assess net clinical outcomes is to include only those events that are either fatal or cause irreversible harm. METHODS AND RESULTS: This was a post hoc analysis of the APEX trial-a multicenter, double-blind, randomized controlled trial comparing extended-duration betrixaban versus standard-of-care enoxaparin...
July 11, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28689056/patient-navigation-for-lung-cancer-screening-in-an-urban-safety-net-system-protocol-for-a-pragmatic-randomized-clinical-trial
#10
David E Gerber, Heidi A Hamann, Noel O Santini, Suhny Abbara, Hsienchang Chiu, Molly McGuire, Lisa Quirk, Hong Zhu, Simon J Craddock Lee
The National Lung Screening Trial demonstrated improved lung cancer mortality with annual low-dose computed tomography (CT) screening, leading to lung cancer screening endorsement by the United States Preventive Services Task Force and coverage by the Centers for Medicare and Medicaid. Adherence to annual CT screens in that trial was 95%, which may not be representative of real-world, particularly medically underserved populations. This pragmatic trial will determine the effect of patient-focused, telephone-based patient navigation on adherence to CT-based lung cancer screening in an urban safety-net population...
July 5, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28684357/promotora-assisted-depression-and-self-care-management-among-predominantly-latinos-with-concurrent-chronic-illness-safety-net-care-system-clinical-trial-results
#11
Kathleen Ell, María P Aranda, Shinyi Wu, Hyunsung Oh, Pey-Jiuan Lee, Jeffrey Guterman
The study evaluated depression and self-care management among patients with diabetes and/or heart disease in a 12-month randomized trial conducted in Los Angeles County Department of Health Services (LAC-DHS) community clinics. We compared LAC-DHS clinic usual care (UC) versus A-Helping-Hand (AHH) intervention in which bilingual promotoras, hired and supervised by the research project, provided 6 weekly psychoeducational sessions followed by boosters. Of 1957 screened, 348 depressed patients (PHQ-9 score≥10) were enrolled, randomized to AHH (n=178) or UC (n=170) after baseline interview assessing mental health, treatment receipt, co-morbid illness, self-care management, and environmental stressors...
July 3, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28682456/how-hospital-clinicians-select-patients-for-skilled-nursing-facilities
#12
Robert E Burke, Emily Lawrence, Amy Ladebue, Roman Ayele, Brandi Lippmann, Ethan Cumbler, Rebecca Allyn, Jacqueline Jones
OBJECTIVE: To understand how hospital-based clinicians evaluate older adults in the hospital and decide who will be transferred to a skilled nursing facility (SNF) for postacute care. DESIGN: Semistructured interviews paired with a qualitative analytical approach informed by Social Constructivist theory. SETTING: Inpatient care units in three hospitals. Purposive sampling was used to maximize variability in hospitals, units within hospitals, and staff on those units...
July 6, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28678891/patient-portal-readiness-among-postpartum-patients-in-a-safety-net-setting
#13
Daryl Wieland, Anne Gibeau, Caitlin Dewey, Melanie Roshto, Hilary Frankel
BACKGROUND: Maternity patients interact with the healthcare system over an approximately ten-month interval, requiring multiple visits, acquiring pregnancy-specific education, and sharing health information among providers. Many features of a web-based patient portal could help pregnant women manage their interactions with the healthcare system; however, it is unclear whether pregnant women in safety-net settings have the resources, skills or interest required for portal adoption. OBJECTIVES: In this study of postpartum patients in a safety net hospital, we aimed to: (1) determine if patients have the technical resources and skills to access a portal, (2) gain insight into their interest in health information, and (3) identify the perceived utility of portal features and potential barriers to adoption...
July 5, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28673530/comparison-of-the-substance-use-brief-screen-subs-to-the-audit-c-and-assist-for-detecting-unhealthy-alcohol-and-drug-use-in-a-population-of-hospitalized-smokers
#14
Benjamin H Han, Scott E Sherman, Alissa R Link, Binhuan Wang, Jennifer McNeely
Hospitalized patients have high rates of unhealthy substance use, which has important impacts on health both during and after hospitalization, but is infrequently identified in the absence of screening. The Substance Use Brief Screen (SUBS) was developed as a brief, self-administered instrument to identify use of tobacco, alcohol, illicit drugs, and non-medical use of prescription drugs, and was previously validated in primary care patients. This study assessed the diagnostic accuracy of the SUBS in comparison to longer screening instruments to identify unhealthy and high-risk alcohol and drug use in hospitalized current smokers...
August 2017: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/28673300/volunteer-navigation-partnerships-piloting-a-compassionate-community-approach-to-early-palliative-care
#15
Barbara Pesut, Wendy Duggleby, Grace Warner, Konrad Fassbender, Elisabeth Antifeau, Brenda Hooper, Madeleine Greig, Kelli Sullivan
BACKGROUND: A compassionate community approach to palliative care provides important rationale for building community-based hospice volunteer capacity. In this project, we piloted one such capacity-building model in which volunteers and a nurse partnered to provide navigation support beginning in the early palliative phase for adults living in community. The goal was to improve quality of life by developing independence, engagement, and community connections. METHODS: Volunteers received navigation training through a three-day workshop and then conducted in-home visits with clients living with advanced chronic illness over one year...
July 3, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28668911/recognizing-the-ordinary-as-extraordinary-insight-into-the-way-we-work-to-improve-patient-safety-outcomes
#16
Elizabeth A Henneman
The Institute of Medicine (now National Academy of Medicine) reports "To Err is Human" and "Crossing the Chasm" made explicit 3 previously unappreciated realities: (1) Medical errors are common and result in serious, preventable adverse events; (2) The majority of medical errors are the result of system versus human failures; and (3) It would be impossible for any system to prevent all errors. With these realities, the role of the nurse in the "near miss" process and as the final safety net for the patient is of paramount importance...
July 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28666693/effect-of-severity-of-illness-on-cesarean-delivery-rates-in-washington-state
#17
Jane Hitti, Suzan Walker, Thomas J Benedetti
BACKGROUND: Hospitals and providers are increasingly held accountable for their cesarean delivery rates. In the perinatal quality improvement arena, there is vigorous debate about whether all hospitals can be held to the same benchmark for an acceptable cesarean rate regardless of patient acuity. However, the causes of variation in hospital cesarean delivery rates are not well understood. OBJECTIVE: We sought to evaluate the association and temporal trends between severity of illness at admission and the primary term singleton vertex cesarean delivery rate among hospitals in Washington State...
June 27, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28661246/after-the-affordable-care-act-health-reform-and-the-safety-net
#18
Peter Shin, Marsha Regenstein
Two major safety net providers - community health centers and public hospitals - continue to play a key role in the health care system even in the wake of coverage reform. This article examines the gains and threats they face under the Affordable Care Act.
December 2016: Journal of Law, Medicine & Ethics: a Journal of the American Society of Law, Medicine & Ethics
https://www.readbyqxmd.com/read/28654581/improved-rates-of-immediate-breast-reconstruction-at-safety-net-hospitals
#19
Tiffany N S Ballard, Lin Zhong, Adeyiza O Momoh, Kevin C Chung, Jennifer F Waljee
BACKGROUND: Substantial federal resources have been directed toward ensuring the delivery of high-quality care at safety net hospitals. Although disparities in receipt of breast reconstruction persist at the patient level, the extent to which hospital factors contribute to these differences remains unclear. The rates of immediate breast reconstruction across safety net and non-safety net hospitals were investigated. METHODS: Women 21 years and older with breast cancer or increased risk of breast cancer undergoing immediate post-mastectomy reconstruction were identified in the Nationwide Inpatient Sample database...
July 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28650248/health-services-utilization-among-fee-for-service-medicare-and-medicaid-patients-under-age-65-with-behavioral-health-illness-at-an-urban-safety-net-hospital
#20
Ramon S Cancino, Brian W Jack, John Jarvis, Alice Kate Cummings, Ellie Cooper, Pierre-Yves Cremieux, James F Burgess
BACKGROUND: In 2011, fee-for-service patients with both Medicare and Medicaid (dual eligible) sustained $319.5 billion in health care costs. OBJECTIVE: To describe the emergency department (ED) use and hospital admissions of adult dual eligible patients aged under 65 years who used an urban safety net hospital. METHODS: This was a retrospective database analysis of patients aged between 18 and 65 years with Medicare and Medicaid, who used an urban safety net academic health center between January 1, 2011, and December 31, 2011...
July 2017: Journal of Managed Care & Specialty Pharmacy
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