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Healthcare prioritisation

(no author information available yet)
A qualified nurse, district nurse and health visitor, Sue McBean prioritises health inequalities and primary healthcare in her work. She has a master's degree in health education and recently retired from full-time academic work.
September 14, 2016: Nursing Standard
Giridhara R Babu, Gvs Murthy, R Deepa, Yamuna, Prafulla, H Kiran Kumar, Maithili Karthik, Keerti Deshpande, Sara E Benjamin Neelon, D Prabhakaran, Anura Kurpad, Sanjay Kinra
BACKGROUND: India is experiencing an epidemic of obesity-hyperglycaemia, which coincides with child bearing age for women. The epidemic can be sustained and augmented through transgenerational transmission of adiposity and glucose intolerance in women. This presents an opportunity for exploring a clear strategy for the control of this epidemic in India. We conducted a study between November 2013 and May 2015 to inform the design of a large pregnancy cohort study. Based on the findings of this pilot, we developed the protocol for the proposed birth cohort of 5000 women, the recruitment for which will start in April 2016...
October 14, 2016: BMC Pregnancy and Childbirth
Amy Tanti, Benjamin Micallef, Anthony Serracino-Inglott, John-Joseph Borg
Regulatory authorities have a legal mandate to implement and maintain a Pharmacovigilance System designed to monitor the safety of authorised medicinal products and detect any change to their risk-benefit balance. Areas covered: This review maps the implementation of pharmacovigilance activities in Malta since accession in the EU in mid 2004 and discusses the challenges the Maltese Regulator encountered while setting up adequate and effective systems to fulfil its legal mandate. Areas reviewed are those around ADR reporting, promotion and safety communications including rapid alerts and recalls, direct healthcare professional communications, risk minimisation measures and safety circulars and quality systems...
October 12, 2016: Expert Opinion on Drug Safety
A E Macbeth, J Tomlinson, A G Messenger, K Moore-Millar, C Michaelides, A R Shipman, J M Kassim, J R Brockley, W Szczecinska, P Farrant, R Robinson, J Rodgers, J Chambers, S Upadhyaya, M Harries
BACKGROUND: Alopecia areata is a common hair loss disorder that results in patchy to complete hair loss. Many uncertainties exist around the most effective treatments for this condition. OBJECTIVES: To identify uncertainties in alopecia areata management and treatment that are important to both service users (people with hair loss, carers and relatives) and healthcare professionals. METHODS: An alopecia areata priority setting partnership was established between patients, their carers and relatives, and healthcare professionals to identify the most important uncertainties in alopecia areata...
October 1, 2016: British Journal of Dermatology
Y Louise Wan, Rachel Beverley-Stevenson, Daloni Carlisle, Sinead Clarke, Richard J Edmondson, Steve Glover, Julie Holland, Carol Hughes, Henry C Kitchener, Sarah Kitson, Tracie Miles, Richard Morley, Jo Morrison, Linsey Nelson, Melanie Powell, Laura Sadler, Anne Tomlinson, Katharine Tylko-Hill, Jo Whitcombe, Emma J Crosbie
BACKGROUND: Endometrial cancer (EC) is the most common gynaecological cancer in developed nations and its incidence is rising. As a direct consequence, more women are dying from EC despite advances in care and improved survivorship. There is a lack of research activity and funding, as well as public awareness about EC. We sought to engage patients, carers and healthcare professionals to identify the most important unanswered research questions in EC. METHODOLOGY: The priority setting methodology was developed by the James Lind Alliance and involved four key stages: gathering research questions; checking these against existing evidence; interim prioritisation; and a final consensus meeting during which the top ten unanswered research questions were agreed using modified nominal group methodology...
September 1, 2016: Gynecologic Oncology
Thomas Ward, Jason Gordon, Beverley Jones, Hayley Bennett, Samantha Webster, Anupama Kalsekar, Yong Yuan, Michael Brenner, Phil McEwan
BACKGROUND: Targeted intervention in patients with hepatitis C virus (HCV) closest to end-stage liver disease (ESLD) progression may offer an approach to treatment prioritisation whilst delivering benefits for patients and the healthcare system. In contrast to previous HCV economic analyses, this study aimed to estimate the health economic value of sustained virologic response (SVR) stratified by the patient's propensity to progress to ESLD. METHODS: An HCV natural history model was adapted to estimate the value of avoiding ESLD complications following SVR, assessed as cost offsets and quality-adjusted life year (QALY) gains, as a function of time to ESLD at treatment initiation...
September 1, 2016: Clinical Drug Investigation
Fiona Barker, Emma Mackenzie, Lynette Elliott, Simon Jones, Simon de Lusignan
BACKGROUND: Acquired adult-onset hearing loss is a common long-term condition for which the most common intervention is hearing aid fitting. However, up to 40% of people fitted with a hearing aid either fail to use it or may not gain optimal benefit from it. This is an update of a review first published in The Cochrane Library in 2014. OBJECTIVES: To assess the long-term effectiveness of interventions to promote the use of hearing aids in adults with acquired hearing loss fitted with at least one hearing aid...
2016: Cochrane Database of Systematic Reviews
Sonia Maria Martins, William Salibe-Filho, Luís Paulo Tonioli, Luís Eduardo Pfingesten, Patrícia Dias Braz, Juliet McDonnell, Siân Williams, Débora do Carmo, Jaime Correia de Sousa, Hilary Pinnock, Rafael Stelmach
Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of hospitalisation and death in the city of Sao Bernardo do Campo. The municipality had difficulties in sustaining a pulmonology specialist team. Local policy has strengthened the knowledge of the primary care teams to improve the management of these diseases. Our aim is to pilot the implementation of an educational intervention based on collaborative care focused on reducing respiratory-related referrals. We implemented 'matrix support': a Brazilian collaborative educational intervention promoting specialist training and support for primary care physicians in three health territories with the highest number of referrals...
2016: NPJ Primary Care Respiratory Medicine
David Peiris, Lei Sun, Anushka Patel, Maoyi Tian, Beverley Essue, Stephen Jan, Puhong Zhang
BACKGROUND: Type 2 diabetes (T2DM) affects 113.9 million people in China, the largest number of any country in the world (JAMA 310:948-59, 2013). T2DM prevalence has risen dramatically from around 1 % in the 1980s to now over 10 % and is expected to continue rising. Despite the growing disease burden, few people with T2DM are achieving adequate management targets to prevent complications. Health system infrastructure in China is struggling to meet these gaps in care, and innovative, cost-effective and affordable solutions are needed...
2016: Implementation Science: IS
Carol Davy, Alan Cass, John Brady, Joanne DeVries, Barry Fewquandie, Suzzane Ingram, Ricky Mentha, Pamela Simon, Bernadette Rickards, Samantha Togni, Hueming Liu, David Peiris, Deborah Askew, Elaine Kite, Leda Sivak, Maree Hackett, Josée Lavoie, Alex Brown
OBJECTIVE: Given the high prevalence of chronic disease, it is of concern that access to and sustained engagement with primary healthcare services by Aboriginal and Torres Strait Islander Australians is often far lower than would be expected. This study sought to explore ways in which relationships can support sustained engagement with healthcare services. METHODS: Semi-structured interviews were conducted with 126 Aboriginal and Torres Strait Islander participants with and without chronic disease and 97 Aboriginal and Torres Strait Islander and non-Indigenous healthcare providers, healthcare service managers or administrative staff...
August 14, 2016: Australian and New Zealand Journal of Public Health
Jamie J D'Costa, James C Goldsmith, Jayne S Wilson, Richard T Bryan, Douglas G Ward
For over 80 years, cystoscopy has remained the gold-standard for detecting tumours of the urinary bladder. Since bladder tumours have a tendency to recur and progress, many patients are subjected to repeated cystoscopies during long-term surveillance, with the procedure being both unpleasant for the patient and expensive for healthcare providers. The identification and validation of bladder tumour specific molecular markers in urine could enable tumour detection and reduce reliance on cystoscopy, and numerous classes of biomarkers have been studied...
2016: Bladder Cancer
Jonathan C Hill, Sujin Kang, Elena Benedetto, Helen Myers, Steven Blackburn, Stephanie Smith, Kate M Dunn, Elaine Hay, Jonathan Rees, David Beard, Sion Glyn-Jones, Karen Barker, Benjamin Ellis, Ray Fitzpatrick, Andrew Price
OBJECTIVES: Current musculoskeletal outcome tools are fragmented across different healthcare settings and conditions. Our objectives were to develop and validate a single musculoskeletal outcome measure for use throughout the pathway and patients with different musculoskeletal conditions: the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ). SETTING: A consensus workshop with stakeholders from across the musculoskeletal community, workshops and individual interviews with a broad mix of musculoskeletal patients identified and prioritised outcomes for MSK-HQ inclusion...
2016: BMJ Open
Christiane Muth, Sebastian Harder, Lorenz Uhlmann, Justine Rochon, Birgit Fullerton, Corina Güthlin, Antje Erler, Martin Beyer, Marjan van den Akker, Rafael Perera, André Knottnerus, Jose M Valderas, Ferdinand M Gerlach, Walter E Haefeli
OBJECTIVE: To improve medication appropriateness and adherence in elderly patients with multimorbidity, we developed a complex intervention involving general practitioners (GPs) and their healthcare assistants (HCA). In accordance with the Medical Research Council guidance on developing and evaluating complex interventions, we prepared for the main study by testing the feasibility of the intervention and study design in a cluster randomised pilot study. SETTING: 20 general practices in Hesse, Germany...
2016: BMJ Open
Adeloye A Adeniji, Bob Mash
BACKGROUND: In public healthcare facilities, where the patient numbers and the available resources are often disproportionate, triage is used to prioritise when patients are seen. Patients may not understand the triage process and have strong views on how to improve their experience. AIM: This study explored the views of patients who had undergone triage in the emergency centre of a primary care facility. SETTING: Gugulethu Community Health Centre, Cape Town...
2016: African Journal of Primary Health Care & Family Medicine
Angela Natalie Barrett, Henna Vishal Advani, Lyn S Chitty, Lin Lin Su, Arijit Biswas, Wei Ching Tan, Melissa Hill, Mahesh Choolani
INTRODUCTION: Invasive prenatal diagnosis (IPD) has long been used to prenatally diagnose Down syndrome (DS), but is associated with a small risk of miscarriage. Meanwhile, noninvasive prenatal testing (NIPT) is a highly sensitive screening test using cell-free DNA in maternal blood for detection of DS that removes the risk of miscarriage, but confers a small risk of false-positive and false-negative results. Their implementations into clinical practice require an understanding of stakeholder preferences...
June 29, 2016: Singapore Medical Journal
(no author information available yet)
Multimorbidity and associated polypharmacy present a significant and increasing challenge to patients, carers and healthcare professionals.(1,2) While it is recognised that polypharmacy can be beneficial, there is considerable potential for harm, particularly through drug interactions, adverse drug events and non-adherence.(1) Such harms are amplified in people who are frail and who may require interventions to be tailored to their individual needs rather than strictly following guidance designed to manage single diseases...
June 2016: Drug and Therapeutics Bulletin
Phillip A Gribble, Chris M Bleakley, Brian M Caulfield, Carrie L Docherty, François Fourchet, Daniel Tik-Pui Fong, Jay Hertel, Claire E Hiller, Thomas W Kaminski, Patrick O McKeon, Kathryn M Refshauge, Evert A Verhagen, Bill T Vicenzino, Erik A Wikstrom, Eamonn Delahunt
Lateral ankle sprains (LASs) are the most prevalent musculoskeletal injury in physically active populations. They also have a high prevalence in the general population and pose a substantial healthcare burden. The recurrence rates of LASs are high, leading to a large percentage of patients with LAS developing chronic ankle instability. This chronicity is associated with decreased physical activity levels and quality of life and associates with increasing rates of post-traumatic ankle osteoarthritis, all of which generate financial costs that are larger than many have realised...
June 3, 2016: British Journal of Sports Medicine
Andrea Marcellusi, Raffaella Viti, Francesco Damele, Calogero Cammà, Gloria Taliani, Francesco Saverio Mennini
BACKGROUND AND OBJECTIVE: In Italy, the Italian Pharmaceutical Agency (AIFA) criteria used F3-F4 fibrosis stages as the threshold to prioritise the treatment with interferon (IFN)-free regimens, while in genotype 1 chronic hepatitis C (G1 CHC) patients with fibrosis of liver stage 2, an approach with pegylated interferon (PEG-IFN)-based triple therapy with simeprevir was suggested. The key clinical question is whether, in an era of financial constraints, the application of a universal IFN-free strategy in naïve G1 CHC patients is feasible within a short time horizon...
August 2016: Clinical Drug Investigation
Karin Piil, Mary Jarden
INTRODUCTION: Patient involvement in healthcare has expanded from the clinical practice setting to include collaboration during the research process. There has been a growing international interest in patient and public involvement in setting research priorities to reduce the risk of discrepancy between what patients with cancer and their relatives experience as important unanswered questions and those which are actually researched. This study aims to challenge the conventional research process by inviting patients with life-threatening cancer (primary malignant brain tumours or acute leukaemia), relatives and patient organisations to join forces with clinical specialists and researchers to identify, discuss and prioritise supportive care and rehabilitation issues in future research...
2016: BMJ Open
Virendra Kumar, Anindya Jayanta Mishra
Purpose This paper aims to explore the challenges and benefits arising from the involvement of Panchayati Raj Institutions (PRIs) in the provisioning of primary healthcare in a decentralised health system of India. Design/methodology/approach A qualitative study design was used in this study. Data were collected through semi-structured interviews from 89 respondents selected from nine primary health centres across the district. A thematic analytical framework approach was used to analyse the data. Findings The research results indicate that there are several challenges resulting from PRIs involvement, including prioritisation of service providers and users, coercive unethical work and lack of communication...
May 3, 2016: Leadership in Health Services
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