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https://www.readbyqxmd.com/read/29443716/time-for-an-acute-focus-on-chronic-care-in-undergraduate-medical-education
#1
Connie R Shi, Vinod E Nambudiri
As the burdens of chronic disease rise in the United States, both undergraduate and graduate medical education must adapt to adequately equip future physicians with the skills to manage the increasingly complex health needs affecting the population. However, traditional models of undergraduate medical education (UME) have made focusing on chronic care education challenging. In this Invited Commentary, the authors advocate for strengthening UME based upon five approaches to engage trainees in learning about chronic care across both the preclinical and clinical phases of their education: (1) introducing chronic care in the preclinical years; (2) prioritizing chronic care education across all specialties; (3) maximizing the fourth year of medical school through a chronic care focus; (4) creating chronic disease-focused advanced clerkships; and (5) leveraging technology for education...
February 13, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/29443439/complexity-of-the-relationships-of-pain-posttraumatic-stress-and-depression-in-combat-injured-populations-an-integrative-review-to-inform-evidence-based-practice
#2
Nicholas A Giordano, Christine Bader, Therese S Richmond, Rosemary C Polomano
BACKGROUND: Understanding the complex interrelationships between combat injuries, physical health, and mental health symptoms is critical to addressing the healthcare needs of wounded military personnel and veterans. The relationship between injury characteristics, pain, posttraumatic stress disorder (PTSD), and depression among combat-injured military personnel is unique to modern conflicts and understudied in the nursing literature. AIM: This integrative review synthesizes clinical presentations and relationships of combat injury, PTSD, depression, and pain in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) United States military service members and veterans...
February 14, 2018: Worldviews on Evidence-based Nursing
https://www.readbyqxmd.com/read/29437537/impact-of-comprehensive-medication-management-on-hospital-readmission-rates
#3
Holly Budlong, Amanda Brummel, Adam Rhodes, Hannah Nici
In 2012, the Fairview Health System implemented a formal care transitions process that included referrals to outpatient services provided by medication therapy management (MTM) pharmacists, among other clinical services. This analysis evaluates the impact of the MTM-provided comprehensive medication management (CMM) service on readmission rates. Retrospective electronic medical record (EMR) data were used to identify hospital admissions between December 1, 2012, and July 31, 2015. Thirty- and 60-day readmission rates were calculated in both a CMM and comparator cohort...
February 13, 2018: Population Health Management
https://www.readbyqxmd.com/read/29437531/improving-population-health-among-uninsured-patients-with-diabetes
#4
Michele H Talley, Shea Polancich, Jason B Williamson, Jennifer S Frank, William Curry, John F Russell, Cynthia Selleck
Diabetes is a leading cause of morbidity and mortality; prevalence of diabetes is especially high in the southeastern United States among minority populations and those from lower socioeconomic sectors without access to health care services. The purpose of this project was to evaluate the clinical and financial outcomes of a nurse-led, interprofessional collaborative practice model that provides care coordination and transitional care for uninsured patients with diabetes. Data for this study were collected and evaluated from medical records of patients seen at the Providing Access to Health Care (PATH) Clinic between August 1, 2015, through May 30, 2017...
February 13, 2018: Population Health Management
https://www.readbyqxmd.com/read/29436700/-a-valid-quality-system-for-mental-health-care-from-accountability-and-control-in-institutionalised-settings-to-co-creation-in-small-areas-and-a-focus-on-community-vital-signs
#5
J van Os, P H Delespaul
In a given year, around 25% of the Dutch population may experience significant mental health problems, much more than the mental health service can attend to, given a maximum capacity of 6% of the population per year. Due to the lack of a public mental health system, there is fierce competition over who gets to receive care from mental health services and little control over how the level of needs can be matched with the appropriate intensity of care. As a result, resources are being wasted and both overtreatment and undertreatment are prevalent...
2018: Tijdschrift Voor Psychiatrie
https://www.readbyqxmd.com/read/29434419/physical-activity-of-icu-survivors-during-acute-admission-agreement-of-the-activpal-with-observation
#6
Claire E Baldwin, Kylie N Johnston, Alex V Rowlands, Marie T Williams
Purpose: We estimated the agreement of a thigh-worn accelerometer, the activPAL, used to measure activity and sedentary parameters, with observed mobility assessments of intensive care unit (ICU) survivors. Method: We prospectively compared activPAL measurements with direct observation during assessments at discharge from the ICU or acute hospital in eight participants with a median age of 56 (1st-3rd quartile 48-65) years and an Acute Physiology and Chronic Health Evaluation II score of 23 (1st-3rd quartile 17-24)...
2018: Physiotherapy Canada. Physiothérapie Canada
https://www.readbyqxmd.com/read/29434012/reducing-sedentary-time-for-obese-older-adults-protocol-for-a-randomized-controlled-trial
#7
Dori E Rosenberg, Amy K Lee, Melissa Anderson, Anne Renz, Theresa E Matson, Jacqueline Kerr, David Arterburn, Jennifer B McClure
BACKGROUND: Older adults have high rates of obesity and are prone to chronic health conditions. These conditions are in part due to high rates of sedentary time (ST). As such, reducing ST could be an innovative strategy for improving health outcomes among obese older adults. To test this theory, we developed a novel, technology-enhanced intervention to reduce sitting time (I-STAND) and pilot tested it to assess the feasibility, acceptability, and preliminary effects of the intervention on ST and biometric outcomes...
February 12, 2018: JMIR Research Protocols
https://www.readbyqxmd.com/read/29433699/the-health-care-experiences-of-lesbian-women-becoming-mothers
#8
REVIEW
Isabel Gregg
As modern family composition shifts-for many, away from a heteronormative nuclear family-so, too, must the health care that families receive. Lesbian women and their families face particular difficulties with maternity care in the United States and internationally, because many care providers lack an understanding of this population's specific health care needs. In this article, I examine the challenges faced by lesbian women during the transition period to new motherhood and recommend improvements that can be made by individual providers and the health care system as a whole to better provide culturally competent health care for this population...
February 2018: Nursing for Women's Health
https://www.readbyqxmd.com/read/29432396/gathering-tips-from-carers-to-support-people-with-dementia-an-adaptation-of-the-top-5-program-for-community-use
#9
Kerrie Westaway, Oliver Frank, Russell Shute, Anna Moffat, Vanessa LeBlanc, Debra Rowett, Natalie Blacker, Elizabeth Roughead
AIM: Behavioral and psychological symptoms of dementia are often managed inappropriately with antipsychotic medicines. The TOP 5 program, which involves recording up to five relevant and meaningful tips that assist in personalizing care for the person with dementia, has been tested in the hospital setting and transitions of care in Australia, and has been found to be useful. Our study aimed to adapt the TOP 5 program as a strategy to support people with dementia in a primary care setting and to test the acceptability of our adapted TOP 5 program materials...
February 9, 2018: International Journal of Evidence-based Healthcare
https://www.readbyqxmd.com/read/29432247/transition-from-pediatric-to-adult-neurologic-care
#10
Ann H Tilton, Claudio Melo de Gusmao
PURPOSE OF REVIEW: With advances in medical care, the number of youths surviving with medically complex conditions has been steadily increasing. Inadequate transition planning and execution can lead to gaps in care, unexpected emergency department visits, and an increase in health care costs and patient/caregiver anxiety. Many barriers that prevent adequate transition have been identified, including insufficient time or staff to provide transition services, inadequate reimbursement, resistance from patients and caregivers, and a dearth of accepting adult providers...
February 2018: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/29432230/youth-friendly-services-and-differentiated-models-of-care-are-needed-to-improve-outcomes-for-young-people-living-with-hiv
#11
Lindsey K Reif, Margaret L McNairy, Matthew R Lamb, Ruby Fayorsey, Batya Elul
PURPOSE OF REVIEW: Outcomes among young people living with HIV (YPLWH) remain disturbingly poor. We summarize recent research on youth-friendly services (YFS) and adolescent-specific differentiated care models, which may improve outcomes across the HIV care continuum for this vulnerable population. We further emphasize unique complexities that characterize the transition from childhood through adolescence to adulthood which must be considered when caring for YPLWH. RECENT FINDINGS: Studies suggest that YFS may improve outcomes in some but not all steps of the HIV care continuum...
February 9, 2018: Current Opinion in HIV and AIDS
https://www.readbyqxmd.com/read/29432041/qualitative-evaluation-of-the-coach-training-within-a-community-paramedicine-care-transitions-intervention
#12
Hunter Singh Lau, Matthew M Hollander, Jeremy T Cushman, Eva H DuGoff, Courtney M C Jones, Amy J H Kind, Michael T Lohmeier, Eric A Coleman, Manish N Shah
OBJECTIVE: The Care Transitions Intervention (CTI) has potential to improve the emergency department (ED)-to-home transition for older adults. Community paramedics may function as the CTI coaches; however, this requires the appropriate knowledge, skills, and attitudes, which they do not receive in traditional emergency medical services (EMS) education. This study aimed to define community paramedics' perceptions regarding their training needs to serve as CTI coaches supporting the ED-to-home transition...
February 12, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29430773/work-satisfaction-and-future-career-intentions-of-experienced-nurses-transitioning-to-primary-health-care-employment
#13
Christine Ashley, Kath Peters, Angela Brown, Elizabeth Halcomb
AIM: To explore registered nurses' reflections on transitioning from acute to primary health care employment, and future career intentions. BACKGROUND: Reforms in primary health care have resulted in increasing demands for a skilled primary health care nursing workforce. To meet shortfalls, acute care nurses are being recruited to primary health care employment, yet little is known about levels of satisfaction and future career intentions. METHOD: A sequential mixed methods study consisting of a survey and semi-structured interviews with nurses who transition to primary health care...
February 12, 2018: Journal of Nursing Management
https://www.readbyqxmd.com/read/29430762/assessment-of-cost-effective-changes-to-the-current-and-potential-provision-of-smoking-cessation-services-an-analysis-based-on-the-equiptmod
#14
Charlotte Anraad, Kei-Long Cheung, Mickaël Hiligsmann, Kathryn Coyle, Doug Coyle, Lesley Owen, Robert West, Hein de Vries, Silvia M Evers, Subhash Pokhrel
BACKGROUND AND AIMS: Increasing the reach of smoking cessation services and/or including new but effective medications to the current provision may provide significant health and economic benefits; the scale of such benefits is currently unknown. The aim of this study was to estimate the cost-effectiveness from a health-care perspective of viable national level changes in smoking cessation provision in the Netherlands and England. METHODS: A Markov-based state transition model [European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD)] was used to estimate costs and benefits [expressed in quality-adjusted life years (QALY)] of changing the current provision of smoking cessation programmes in the Netherlands and England...
February 11, 2018: Addiction
https://www.readbyqxmd.com/read/29429871/case-study-comparison-of-functional-vs-organic-stability-approaches-for-assessing-threat-potential-at-closed-landfills-in-the-usa
#15
Sean T O'Donnell, Michael D Caldwell, Morton A Barlaz, Jeremy W F Morris
Municipal solid waste (MSW) landfills in the USA are regulated under Subtitle D of the Resource Conservation and Recovery Act (RCRA), which includes the requirement to protect human health and the environment (HHE) during the post-closure care (PCC) period. Several approaches have been published for assessment of potential threats to HHE. These approaches can be broadly divided into organic stabilization, which establishes an inert waste mass as the ultimate objective, and functional stability, which considers long-term emissions in the context of minimizing threats to HHE in the absence of active controls...
February 8, 2018: Waste Management
https://www.readbyqxmd.com/read/29426318/hospital-discharge-documentation-of-a-designated-clinician-for-follow-up-care-and-30-day-outcomes-in-hip-fracture-and-stroke-patients-discharged-to-sub-acute-care
#16
Andrea L Gilmore-Bykovskyi, Korey A Kennelty, Eva DuGoff, Amy J H Kind
BACKGROUND: Transitions to sub-acute care are regularly complicated by inadequate discharge communication, which is exacerbated by a lack of clarity regarding accountability for important follow-up care. Patients discharged to sub-acute care often have complex medical conditions and are at heightened risk for poor post-hospital outcomes, yet many do not see a provider until 30 days post discharge due to current standards in Medicare regulations. Lack of designation of a responsible clinician or clinic for follow-up care may adversely impact patient outcomes, but the magnitude of this potential impact has not been previously studied...
February 9, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29425869/fluorescence-studies-on-the-aggregation-behaviors-of-collagen-modified-with-nhs-activated-poly-%C3%AE-glutamic-acid
#17
Min Zhang, Junhui Yang, Qili Yang, Liulian Huang, Hui Wu, Lihui Chen, Cuicui Ding
The poly(γ-glutamic acid)-NHS (γ-PGA-NHS) esters were used to endow collagen with both of excellent water-solubility and thermal stability via cross-linking reaction between γ-PGA-NHS and collagen. In the present work, the effect of γ-PGA-NHS on the aggregation of collagen molecules was studied by fluorescence techniques. The fluorescence emission spectra of pyrene in collagen solutions and the intrinsic fluorescence emission spectra of collagen suggested different effects of γ-PGA-NHS on collagen molecules: inhibiting aggregation below critical aggregation concentration (CAC) and promoting aggregation above CAC...
February 6, 2018: International Journal of Biological Macromolecules
https://www.readbyqxmd.com/read/29425802/health-changes-in-low-income-men-transitioning-from-a-state-funded-prostate-cancer-program-to-comprehensive-insurance
#18
Jamal A Nabhani, Ruby Kuang, Hui Liu, Lorna Kwan, Mark S Litwin
PURPOSE: To evaluate the effect of transitioning from a prostate cancer-specific treatment program to comprehensive insurance under the Affordable Care Act (ACA) on the physical, mental, and prostate cancer-related health of poor, previously uninsured men. MATERIALS AND METHODS: We assessed general and prostate cancer-specific health-related quality of life (QOL) using the RAND 12-item short form health survey and UCLA Prostate Cancer Index at 3 time points in 24 men transitioning to comprehensive insurance (insured group) relative to 39 men remaining in the prostate cancer program (control group)...
February 6, 2018: Journal of Urology
https://www.readbyqxmd.com/read/29423967/suvorexant-is-associated-with-a-low-incidence-of-delirium-in-critically-ill-patients-a-retrospective-cohort-study
#19
Tomoyuki Masuyama, Masamitsu Sanui, Naoto Yoshida, Yusuke Iizuka, Kunio Ogi, Satoko Yagihashi, Kanae Nagatomo, Yusuke Sasabuchi, Alan K Lefor
BACKGROUND: Benzodiazepine use is a risk factor for the development of delirium in adult intensive care unit (ICU) patients. Suvorexant is an alternative to benzodiazepines to induce sleep, but the incidence of delirium in critically ill patients is unknown. We undertook this retrospective study to investigate the incidence of delirium in patients who receive suvorexant in the ICU. METHODS: This retrospective cohort study was conducted in a closed 12-bed ICU at a tertiary teaching hospital...
February 8, 2018: Psychogeriatrics: the Official Journal of the Japanese Psychogeriatric Society
https://www.readbyqxmd.com/read/29422170/-mobile-technology-to-improve-heart-failure-outcomes-a-proof-of-concept-paper
#20
Ponrathi Athilingam, Bradlee A Jenkins, Heather Zumpano, Miguel A Labrador
BACKGROUND: Heart failure (HF) causes significant symptom burden and human suffering with considerable economic burden due to hospital readmissions. Targeted interventions to encourage and support self-management behavior is warranted. AIM: To test the proof of concept of a mobile application (HeartMapp) in improving self-care management of patients with heart failure. METHOD: An exploratory inquiry used a field study strategy with purposeful sampling and constant comparative analysis to test the proof of concept of HeartMapp using The Business Model Canvas framework...
February 2018: Applied Nursing Research: ANR
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