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https://www.readbyqxmd.com/read/28551862/delivery-of-community-based-care-through-inter-professional-teams-in-brazil-s-unified-health-system-uhs-comparing-perceptions-across-community-health-agents-chas-nurses-and-physicians
#1
Rahbel Rahman, Rogério Meireles Pinto, Margareth Santos Zanchetta, Melanie M Wall
Given the shortage of medical providers and the need for medical decisions to be responsive to community needs, including lay health providers in health teams has been recommended as essential for the successful management of global health care systems. Brazil's Unified Health System (UHS) is a model for delivering community-based care through Family Health Strategy (FHS) interdisciplinary teams comprised of medical and lay health providers-Community Health Agents (CHAs), nurses, and physicians. This study aims to understand how medical and lay health providers' perceptions and attitudes could impact the delivery of community-based care...
May 27, 2017: Journal of Community Health
https://www.readbyqxmd.com/read/28551523/digitonin-does-not-flip-across-cholesterol-poor-membranes
#2
Helen Y Fan, Heiko Heerklotz
Digitonin is commonly used to permeabilize cell membranes and solubilize membrane components. It interacts specifically with cholesterol in the membrane which leads to the formation of pores. Thus far, the mechanism by which digitonin interacts with the membrane has only been described qualitatively. We investigated this interaction in model membranes that contain little or no cholesterol with a combination of isothermal titration calorimetry, dynamic light scattering, and zeta potential measurements. Digitonin partitions fully asymmetrically into large unilamellar vesicles of phosphocholine (PC) lipid at 20°C (remaining in the outer leaflet only), with a partition coefficient of 0...
May 17, 2017: Journal of Colloid and Interface Science
https://www.readbyqxmd.com/read/28551391/preoperative-vs-postoperative-radiation-therapy-in-localized-soft-tissue-sarcoma-nationwide-patterns-of-care-and-trends-in-utilization
#3
Stanislav Lazarev, Heather McGee, Erin Moshier, Meng Ru, Elizabeth G Demicco, Vishal Gupta
PURPOSE: The timing of perioperative radiation therapy (RT) in the treatment of soft tissue sarcoma (STS) varies among institutions. This study examines patterns of care, trends in utilization, and survival with preoperative versus postoperative RT for primary STS. METHODS AND MATERIALS: Using the National Cancer Data Base, we identified patients with stage I-III STS who underwent definitive surgery with either preoperative or postoperative RT between 2004 and 2012...
April 18, 2017: Practical Radiation Oncology
https://www.readbyqxmd.com/read/28551289/emergency-department-length-of-stay-and-outcome-after-ischemic-stroke
#4
Artin Minaeian, Anand Patel, Basad Essa, Richard P Goddeau, Majaz Moonis, Nils Henninger
BACKGROUND: Emergency department length of stay (ED-LOS) has been associated with worse outcomes after various medical conditions. However, there is a relative paucity of data for ischemic stroke patients. We sought to determine whether a longer ED-LOS is associated with a poor 90-day outcome after ischemic stroke. METHODS: This study is a retrospective analysis of a single-center cohort of consecutive ischemic stroke patients (n = 325). Multivariable linear and logistic regression models were constructed to determine factors independently associated with ED-LOS as well as a poor 90-day outcome (modified Rankin Scale [mRS] score >2), respectively...
May 24, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28551081/exposure-to-stress-across-the-life-course-and-its-association-with-anxiety-and-depressive-symptoms-results-from-the-australian-women-s-wellness-after-cancer-program-wwacp
#5
Charrlotte Seib, Alexandra McCarthy, Amanda McGuire, Janine Porter-Steele, Sarah Balaam, Robert S Ware, Debra Anderson
OBJECTIVES: Earlier life stressors can increase the risk of persistent anxiety and depressive symptoms in women after cancer, though our understanding of the underlying mechanisms is limited. In this study, we tested alternative life course models to determine which best described associations between exposure to stressors in childhood, adolescence, and adulthood, and self-reported health in women previously treated for breast, gynaecological, and blood cancer. STUDY DESIGN: Data were drawn from 351 Australian women within 2 years of completing active cancer treatment who were participating in the Women's Wellness After Cancer Program (WWACP) randomised controlled trial...
May 19, 2017: Maturitas
https://www.readbyqxmd.com/read/28551002/development-of-a-computer-interpretable-clinical-guideline-model-for-decision-support-in-the-differential-diagnosis-of-hyponatremia
#6
Arturo González-Ferrer, M Ángel Valcárcel, Martín Cuesta, Joan Cháfer, Isabelle Runkle
INTRODUCTION: Hyponatremia is the most common type of electrolyte imbalance, occurring when serum sodium is below threshold levels, typically 135mmol/L. Electrolyte balance has been identified as one of the most challenging subjects for medical students, but also as one of the most relevant areas to learn about according to physicians and researchers. We present a computer-interpretable guideline (CIG) model that will be used for medical training to learn how to improve the diagnosis of hyponatremia applying an expert consensus document (ECDs)...
July 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28550999/process-mining-routinely-collected-electronic-health-records-to-define-real-life-clinical-pathways-during-chemotherapy
#7
Karl Baker, Elaine Dunwoodie, Richard G Jones, Alex Newsham, Owen Johnson, Christopher P Price, Jane Wolstenholme, Jose Leal, Patrick McGinley, Chris Twelves, Geoff Hall
BACKGROUND: There is growing interest in the use of routinely collected electronic health records to enhance service delivery and facilitate clinical research. It should be possible to detect and measure patterns of care and use the data to monitor improvements but there are methodological and data quality challenges. Driven by the desire to model the impact of a patient self-test blood count monitoring service in patients on chemotherapy, we aimed to (i) establish reproducible methods of process-mining electronic health records, (ii) use the outputs derived to define and quantify patient pathways during chemotherapy, and (iii) to gather robust data which is structured to be able to inform a cost-effectiveness decision model of home monitoring of neutropenic status during chemotherapy...
July 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28550908/discordance-between-surgical-care-improvement-project-adherence-and-postoperative-outcomes-implications-for-new-joint-commission-standards
#8
Victor Chang, Robert H Blackwell, Talar Markossian, Ryan M Yau, Barbara A Blanco, Matthew A C Zapf, Gerard J Abood, Gopal N Gupta, Paul C Kuo, Anai N Kothari
BACKGROUND: Infectious (INF) and venous thromboembolism (VTE) complication rates are targeted by surgical care improvement project (SCIP) INF and SCIP VTE measures. We analyzed how adherence to SCIP INF and SCIP VTE affects targeted postoperative outcomes (wound complication [WC], deep vein thrombosis, and pulmonary embolism [PE]) using all-payer data. MATERIALS AND METHODS: A retrospective review (2007-2011) was conducted using Healthcare Cost and Utilization Project State Inpatient Database Florida and Medicare's Hospital Compare...
May 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28550744/evaluation-of-a-multi-site-program-designed-to-strengthen-relational-bonds-for-siblings-separated-by-foster-care
#9
Jeffrey Waid, Armeda Stevenson Wojciak
Sibling relationships in foster care settings have received increased attention in recent years. Despite growing evidence regarding the protective potential of sibling relationships for youth in care, some sibling groups continue to experience foster care related separation, and few programs exist to address the needs of these youth. This study describes and evaluates Camp To Belong, a multi-site program designed to provide short-term reunification to separated sibling groups through a week-long summer camp experience...
May 13, 2017: Evaluation and Program Planning
https://www.readbyqxmd.com/read/28550706/st-michael-s-improvement-program-a-collaborative-approach-to-sustainable-cost-savings
#10
Anne Trafford, Danielle Jane
In response to a challenging financial environment and increasing patient demand, St. Michael's Hospital needed to find long-term sustainable solutions to continue to provide high-quality patient care and invest in key priorities. By conducting Operational Reviews in focused areas, the hospital achieved $7.4 million of in-year savings in the first year, found standardizations, process efficiencies and direct cost savings that positioned itself for success in future funding models. Initiatives were grounded in evidence and relied heavily on the effective execution by the leadership, front-line staff and physicians...
2017: Healthcare Quarterly
https://www.readbyqxmd.com/read/28550703/improving-patient-engagement-and-satisfaction-lessons-from-a-patient-driven-care-initiative-in-a-community-based-hospital
#11
Lisa Shiozaki, Kirsten Burgomaster, Manon Lemonde
Lack of collaboration and alignment between members of the healthcare team interfere with the patient-centred care approach. The Patient-Driven Care Project was initiated in 2012. This model sought to advance a system of care that is patient-driven, family-centred and provider-guided to improve the value to patients and give them more control on their health journey. The evaluation revealed that the efforts should focus on sustainability and continuation of support and encouragement of hospital colleagues to ensure each patient and family experience is based on caring communication at every interaction with them...
2017: Healthcare Quarterly
https://www.readbyqxmd.com/read/28550693/healthcare-for-the-aging-citizen-and-the-aging-citizen-for-healthcare-involving-patient-advisors-in%C3%A2-elder-friendly-care-improvement
#12
Jennifer Verma, Patricia O'Connor, Jerold Hodge, Howard Abrams, Jocelyn Bennett, Samir Sinha
With an aging population and a healthcare system that is overly reliant on providing expensive and sometimes problematic hospital-based care for older Canadians, driving improvements that promote elder-friendly care has never been more critical. The Acute Care for Elders (ACE) Strategy at Toronto's Mount Sinai Hospital is the focus of a pan-Canadian collaborative delivered by the Canadian Foundation for Healthcare Improvement in partnership with the Canadian Frailty Network. The intent is to spread the ACE Strategy's elder-friendly models of care and practices to 18 participating healthcare delivery organizations...
2017: Healthcare Quarterly
https://www.readbyqxmd.com/read/28550610/association-between-patient-centered-medical-home-capabilities-and-outcomes-for-medicare-beneficiaries-seeking-care-from-federally-qualified-health-centers
#13
Justin W Timbie, Peter S Hussey, Claude M Setodji, Amii Kress, Rosalie Malsberger, Tara A Lavelle, Mark W Friedberg, Suzanne G Wensky, Katherine D Giuriceo, Katherine L Kahn
BACKGROUND: Patient-centered medical home (PCMH) models of primary care have the potential to expand access, improve population health, and lower costs. Federally qualified health centers (FQHCs) were early adopters of PCMH models. OBJECTIVE: We measured PCMH capabilities in a diverse nationwide sample of FQHCs and assessed the relationship between PCMH capabilities and Medicare beneficiary outcomes. DESIGN: Cross-sectional, propensity score-weighted, multivariable regression analysis...
May 26, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28550592/certolizumab-pegol-for-treating-rheumatoid-arthritis-following-inadequate-response-to-a-tnf-%C3%AE-inhibitor-an-evidence-review-group-perspective-of-a-nice-single-technology-appraisal
#14
REVIEW
Iñigo Bermejo, Matt Stevenson, Rachel Archer, John W Stevens, Edward Goka, Mark Clowes, David L Scott, Adam Young
As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the manufacturer (UCB Pharma) of certolizumab pegol (CZP; Cimzia(®)) to submit evidence of its clinical and cost effectiveness for the treatment of rheumatoid arthritis (RA) following inadequate response to a tumour necrosis factor-α inhibitor (TNFi). The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG)...
May 26, 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/28550518/racial-ethnic-differences-in-perception-of-need-for-mental-health-treatment-in-a-us-national-sample
#15
Joshua Breslau, Matthew Cefalu, Eunice C Wong, M Audrey Burnam, Gerald P Hunter, Karen R Florez, Rebecca L Collins
PURPOSE: To resolve contradictory evidence regarding racial/ethnic differences in perceived need for mental health treatment in the USA using a large and diverse epidemiologic sample. METHODS: Samples from 6 years of a repeated cross-sectional survey of the US civilian non-institutionalized population were combined (N = 232,723). Perceived need was compared across three non-Hispanic groups (whites, blacks and Asian-Americans) and two Hispanic groups (English interviewees and Spanish interviewees)...
May 26, 2017: Social Psychiatry and Psychiatric Epidemiology
https://www.readbyqxmd.com/read/28550494/cost-effectiveness-of-combined-serum-anti-helicobacter-pylori-igg-antibody-and-serum-pepsinogen-concentrations-for-screening-for-gastric-cancer-risk-in-japan
#16
Shota Saito, Motoi Azumi, Yusuke Muneoka, Katsuhiko Nishino, Takashi Ishikawa, Yuichi Sato, Shuji Terai, Kouhei Akazawa
BACKGROUND: A combination of assays for the presence of serum anti-Helicobacter pylori IgG antibody (HPA) and serum pepsinogen (PG) concentrations can be used to screen for gastric cancer risk. In Japan, this "ABC method" is considered an effective means of stratifying gastric cancer risk. This study aimed to ascertain its cost-effectiveness for assessing gastric cancer risk. METHODS: A Markov model was constructed to compare the cost-effectiveness of two strategies for gastric cancer-risk screening over a 30-year period: the ABC method, which uses a combination of assessing the presence of HPA and measuring serum PG concentrations and scheduling endoscopies accordingly, and annual endoscopic screening...
May 26, 2017: European Journal of Health Economics: HEPAC: Health Economics in Prevention and Care
https://www.readbyqxmd.com/read/28550462/a-case-control-study-of-the-risk-factors-for-obstetric-fistula-in-tigray-ethiopia
#17
L Lewis Wall, Shewaye Belay, Tesfahun Haregot, Jonathan Dukes, Eyoel Berhan, Melaku Abreha
INTRODUCTION AND HYPOTHESIS: We tested the null hypothesis that there were no differences between patients with obstetric fistula and parous controls without fistula. METHODS: A unmatched case-control study was carried out comparing 75 women with a history of obstetric fistula with 150 parous controls with no history of fistula. Height and weight were measured for each participant, along with basic socio-demographic and obstetric information. Descriptive statistics were calculated and differences between the groups were analyzed using Student's t test, Mann-Whitney U test where appropriate, and Chi-squared or Fisher's exact test, along with backward stepwise logistic regression analyses to detect predictors of obstetric fistula...
May 26, 2017: International Urogynecology Journal
https://www.readbyqxmd.com/read/28550403/healthcare-utilization-and-costs-in-ards-survivors-a-1-year-longitudinal-national-us-multicenter-study
#18
A Parker Ruhl, Minxuan Huang, Elizabeth Colantuoni, Taruja Karmarkar, Victor D Dinglas, Ramona O Hopkins, Dale M Needham
PURPOSE: To evaluate (1) post-discharge healthcare utilization and estimated costs in ARDS survivors, and (2) the association between patient and intensive care-related variables, and 6-month patient status, with subsequent hospitalization and costs. METHODS: Longitudinal cohort study enrolling from four ARDSNet trials in 44 US hospitals. Healthcare utilization was collected via structured interviews at 6 and 12 months post-ARDS, and hospital costs estimated via the Medical Expenditure Panel Survey...
May 26, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28550378/longitudinal-modeling-of-depressive-trajectories-among-hiv-infected-men-using-cocaine
#19
Shibani Mukerji, Roxanna Haghighat, Vikas Misra, David R Lorenz, Alex Holman, Anupriya Dutta, Dana Gabuzda
Cocaine use is prevalent among HIV-infected individuals. While cross-sectional studies suggest that cocaine users may be at increased risk for depression, long-term effects of cocaine on depressive symptoms remain unclear. This is a longitudinal study of 341 HIV-infected and uninfected men (135 cocaine users and 206 controls) ages 30-60 enrolled in the Multicenter AIDS Cohort Study during 1996-2009. The median baseline age was 41; 73% were African-American. In mixed-effects models over a median of 4.8 years of observation, cocaine use was associated with higher depressive symptoms independent of age, education level, and smoking (n = 288; p = 0...
May 26, 2017: AIDS and Behavior
https://www.readbyqxmd.com/read/28550087/transcriptional-networks-in-rodent-models-support-a-role-for-gut-brain-communication-in-neurogenic-hypertension-a-review-of-the-evidence
#20
Jasenka Zubcevic, Ashley Baker, Christopher J Martyniuk
Hypertension (HTN) is the most prevalent condition observed in primary health care. Hypertension shows complex etiology, and neuroinflammation, overactive sympathetic drive, and the microbiome are associated with the disease. To obtain mechanistic perspective into neurogenic HTN, we first constructed a framework for transcriptional regulators of the disease using the Comparative Toxicogenomics Database. This approach yielded a core group of 178 transcripts that are prevalent in HTN, including leptin and neuropeptide Y...
May 26, 2017: Physiological Genomics
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