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Continuity of Care Document

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https://www.readbyqxmd.com/read/28651351/applying-a-theory-driven-framework-to-guide-quality-improvement-efforts-in-nursing-homes-the-lock-model
#1
Whitney L Mills, Camilla B Pimentel, Jennifer A Palmer, A Lynn Snow, Nancy J Wewiorski, Rebecca S Allen, Christine W Hartmann
Purpose of the Study: Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes. Design and development: The framework is grounded in the foundational concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning...
June 23, 2017: Gerontologist
https://www.readbyqxmd.com/read/28644837/real-world-first-line-treatment-and-overall-survival-in-non-small-cell-lung-cancer-without-known-egfr-mutations-or-alk-rearrangements-in-us-community-oncology-setting
#2
Amy P Abernethy, Ashwini Arunachalam, Thomas Burke, Caroline McKay, Xiting Cao, Rachael Sorg, David P Carbone
PURPOSE: To establish a baseline for care and overall survival (OS) based upon contemporary first-line treatments prescribed in the era before the introduction of immune checkpoint inhibitors, for people with metastatic non-small cell lung cancer (NSCLC) without common actionable mutations. METHODS: Using a nationally representative electronic health record data from the Flatiron dataset which included 162 practices from different regions in US, we identified patients (≥18 years old) newly diagnosed with stage IV NSCLC initiating first-line anticancer therapy (November 2012- January 2015, with follow-up through July 2015)...
2017: PloS One
https://www.readbyqxmd.com/read/28644115/evaluation-of-the-effectiveness-and-cost-effectiveness-of-lightweight-fibreglass-heel-casts-in-the-management-of-ulcers-of-the-heel-in-diabetes-a-randomised-controlled-trial
#3
William Jeffcoate, Frances Game, Vivienne Turtle-Savage, Alison Musgrove, Patricia Price, Wei Tan, Lucy Bradshaw, Alan Montgomery, Deborah Fitzsimmons, Angela Farr, Thomas Winfield, Ceri Phillips
BACKGROUND: Ulcers of the foot in people with diabetes mellitus are slow to heal and result in considerable cost and patient suffering. The prognosis is worst for ulcers of the heel. OBJECTIVE: To assess both the clinical effectiveness and the cost-effectiveness of lightweight fibreglass casts in the management of heel ulcers. DESIGN: A pragmatic, multicentre, parallel, observer-blinded randomised controlled trial. A central randomisation centre used a computer-generated random number sequence to allocate participants to groups...
May 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28643749/treatment-of-high-risk-neuroblastoma-national-protocol-results-of-the-turkish-pediatric-oncology-group
#4
Serap Aksoylar, Ali Varan, Canan Vergin, Volkan Hazar, Ferhan Akici, Ayhan Dagdemir, Mustafa Buyukavci, Rejin Kebudi, Nilgun Kurucu, Betul Sevinir, Emel Unal, Sema Vural, Elif Guler, Hilmi Apak, Haldun Oniz, Ceyda Karadeniz, Cengiz Canpolat, Sema Anak, Inci Ilhan, Dilek Ince, Emre Cecen, Nur Olgun
BACKGROUND: The national protocol aimed to improve the outcome of the high risk neuroblastoma patients by high-dose chemotherapy and stem cell rescue with intensive multimodal therapy. MATERIALS AND METHODS: After the 6 induction chemotherapy cycles, patients without disease progression were nonrandomly (by physicians' and/or parent's choices) allocated into two treatment arms, which were designed to continue the conventional chemotherapy (CCT), or myeloablative therapy with autologous stem cell rescue (ASCR)...
April 2017: Journal of Cancer Research and Therapeutics
https://www.readbyqxmd.com/read/28637744/group-clinics-for-young-adults-with-diabetes-in-an-ethnically-diverse-socioeconomically-deprived-setting-together-study-protocol-for-a-realist-review-co-design-and-mixed-methods-participatory-evaluation-of-a-new-care-model
#5
Chrysanthi Papoutsi, Dougal Hargreaves, Grainne Colligan, Ann Hagell, Anita Patel, Desirée Campbell-Richards, Russell M Viner, Shanti Vijayaraghavan, Martin Marshall, Trisha Greenhalgh, Sarah Finer
INTRODUCTION: Young adults with diabetes often report dissatisfaction with care and have poor diabetes-related health outcomes. As diabetes prevalence continues to rise, group-based care could provide a sustainable alternative to traditional one-to-one consultations, by engaging young people through life stage-, context- and culturally-sensitive approaches. In this study, we will co-design and evaluate a group-based care model for young adults with diabetes and complex health and social needs in socioeconomically deprived areas...
June 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28622194/population-based-cancer-screening-measurement-of-coordination-and-continuity-of-care
#6
Llucia Benito, Jose Espinosa, Gemma Binefa, Carmen Vidal, María Teresa Lluch, Montse Puig, Maria Fernandez, Isabel Padrol, Montse García
BACKGROUND: European guidelines for the quality of screening programs for breast and colorectal cancer describe process, structure, and outcome indicators. However, none of them specifically evaluate coordination and continuity of care during the cancer screening process. OBJECTIVES: The aim of this study was to identify and adapt care quality indicators related to the coordination and continuity of the cancer screening process to assess nursing care in cancer screening programs...
June 15, 2017: Cancer Nursing
https://www.readbyqxmd.com/read/28617424/outcomes-following-indomethacin-prophylaxis-in-extremely-preterm-infants-in-an-all-referral-nicu
#7
T D Nelin, E Pena, T Giacomazzi, S Lee, J W Logan, M Moallem, R Bapat, E G Shepherd, L D Nelin
OBJECTIVE: We examined data from a contemporary cohort of extreme prematurity (EP) infants admitted to an all-referral Children's Hospital neonatal intensive care unit (NICU) to determine whether prophylactic indomethacin (PI) may continue to benefit these patients. STUDY DESIGN: An observational study utilizing the small baby ICU data registry that was queried for all EP infants admitted between 2005 and 2014 with documentation of PI use (671 total EP infants; 141 (21%) did not receive PI (control); 530 (79%) received PI (PI)...
June 15, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28612657/improving-care-for-advanced-copd-through-practice-change-experiences-of-participation-in-a-canadian-spread-collaborative
#8
Jennifer Y Verma, Claudia Amar, Shannon Sibbald, Graeme M Rocker
Chronic obstructive pulmonary disease (COPD) is a leading cause of death, morbidity, and health-care spending. The Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ has proved highly beneficial for patients and the health-care system. With direct investment of <$1-million CAD, a pan-Canadian quality improvement collaborative (QIC) supported the spread of INSPIRED to 19 teams in the 10 Canadian provinces contingent upon participation in evaluation. The collaborative evaluation followed a mixed-methods summative approach relying on collated quantitative data, team documents, and surveys sent to core members of the 19 teams...
January 1, 2017: Chronic Respiratory Disease
https://www.readbyqxmd.com/read/28610686/levels-of-physical-activity-and-sleep-patterns-among-older-people-with-dementia-living-in-long-term-care-facilities-a-24-h-snapshot
#9
Wendy Moyle, Cindy Jones, Jenny Murfield, Brian Draper, Elizabeth Beattie, David Shum, Lukman Thalib, Siobhan O'Dwyer, Cindy M Mervin
OBJECTIVES: To objectively measure over a 24-h period the daytime and nighttime levels of physical activity and sleep patterns of older people with dementia living in long-term care facilities. STUDY DESIGN: Nested within a larger research program, this cross-sectional study involved 415 residents, aged ≥60 years, with a documented diagnosis of dementia, from 28 long-term care facilities in south-east Queensland, Australia. MAIN OUTCOME MEASURES: Residents wore SenseWear(®) activity armbands continuously for 24h, with data recorded for: step count; total energy expenditure; metabolic equivalent of task (MET); and the amount of time spent physically active, lying down, awake, and asleep...
August 2017: Maturitas
https://www.readbyqxmd.com/read/28609308/evaluation-of-a-clinical-protocol-to-assess-and-diagnose-neuropathic-pain-during-acute-hospital-admission-results-from-traumatic-spinal-cord-injury
#10
Lise M A Bélanger, Hamed S Umedaly, Vanessa K Noonan, So Eyun Park, Jennifer Prince, Nancy P Thorogood, Tian Shen, Andrea F Townson, John T Street, Marcel F Dvorak, Michael Negraeff
OBJECTIVES: A clinical protocol was developed for clinicians to routinely assess and initiate treatment for patients with neuropathic pain (NP) in an acute care setting. The objectives of this study were to: (1) determine the incidence and onset of NP in patients with traumatic SCI during acute care and (2) describe how the implementation of a clinical protocol impacts the assessment and diagnosis of NP. METHODS: The study was a cohort analysis with a pre-post-test utilizing a historical control...
June 12, 2017: Clinical Journal of Pain
https://www.readbyqxmd.com/read/28599052/tccc-updates-two-decades-of-saving-lives-on-the-battlefield-tactical-combat-casualty-care-turns-20
#11
Frank K Butler
BACKGROUND: Twenty years ago, the original Tactical Combat Casualty Care (TCCC) article was published in this journal. Since TCCC is essentially a set of bestpractice prehospital trauma care guidelines customized for use on the battlefield, the presence of a journal with a specific focus on military medicine was a profound benefit to the initial presentation of TCCC to the US Military. METHODS: In the two ensuing decades, which included the longest continuous period of armed conflict in our nation's history, TCCC steadily evolved as the prehospital trauma care evidence base was augmented and as feedback from user medics, corpsmen, and pararescuemen was obtained...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28598746/core-principles-of-assessment-in-competency-based-medical-education
#12
Jocelyn Lockyer, Carol Carraccio, Ming-Ka Chan, Danielle Hart, Sydney Smee, Claire Touchie, Eric S Holmboe, Jason R Frank
The meaningful assessment of competence is critical for the implementation of effective competency-based medical education (CBME). Timely ongoing assessments are needed along with comprehensive periodic reviews to ensure that trainees continue to progress. New approaches are needed to optimize the use of multiple assessors and assessments; to synthesize the data collected from multiple assessors and multiple types of assessments; to develop faculty competence in assessment; and to ensure that relationships between the givers and receivers of feedback are appropriate...
June 2017: Medical Teacher
https://www.readbyqxmd.com/read/28598250/telehealth-centers-a-proposal-of-a-theoretical-model-for-evaluation
#13
Luana Gabriele Nilson, Luise Lüdke Dolny, Sônia Natal, Josimari Telino de Lacerda, Maria Cristina Marino Calvo
BACKGROUND: Telehealth is a form of assistance support and continuing education for professionals who work in Primary Healthcare. INTRODUCTION: The implementation of the Brazilian Telehealth Program has extended the need for evaluation of its results to improve its use and benefits. Thus, it is necessary to systematize the theory, principals, and guidelines that guide the program organization, its activities, and resources. The objective of this study is to propose a theoretical model of functioning and organization for telehealth centers of the Brazilian Telehealth Program...
June 9, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28597739/one-year-and-longer-dual-antiplatelet-therapy-after-an-acute-coronary-syndrome-a-belgian-position-paper
#14
Peter R Sinnaeve, Walter Desmet, Olivier Descamps, Sofie Gevaert, Guy De Backer, Philippe Kolh, Mathias Vrolix, Philippe Van De Borne, Antoine De Meester, Marc J Claeys, Christophe Beauloye
Acute coronary syndrome patients receive DAPT up to one year after their initial event. Exceptions to the guideline-recommended one-year rule, however, are not uncommon. The reasoning behind shorter treatments, such as unacceptable bleeding risk or urgent surgery, should be well documented in the patient's charts and discharge letter. Based on recent evidence, patients at high risk for repetitive events should continue on low-dose ticagrelor without a significant interruption at one year and indefinitely in the absence of excess bleeding risk...
February 2017: Acta Cardiologica
https://www.readbyqxmd.com/read/28594475/what-is-safety-miracles-benefit-risk-assessments-and-the-right-to-try
#15
Lisa M DeTora
Public discourse is full of quick solutions to health care problems like cancer and rare diseases. Among these is Right to Try legislation for experimental therapies. Right to Try legislation is based on the premise that all experimental agents in clinical trials are safe and guaranteed to produce miracles. Unfortunately, this notion is at odds with expert understanding, which indicates that the benefits and risks of drug products can only be understood together and evaluated incrementally and over time. The current manuscript examines why benefit to risk considerations, a lynchpin of the ethical conduct of clinical research since the Nuremberg Code, might be easily elided from public discourse...
June 8, 2017: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/28592064/-clinical-analysis-on-monitoring-and-comprehensive-treatment-after-carotid-endarterectomy
#16
X Y Wang, Z H Sun, L Liu, C Wu, Z Ji
Objective: To discuss the therapeutic effect of management of carotid endarterectomy in care unit. Methods: A total of 315 patients with carotid atherosclerotic stenosis were enrolled. All of the patients were taken into care unit under tracheal intubation anesthesia after carotid endarterectomy. Then the patients were managed with a breathing machine, continuous sedation, strict monitoring of hemodynamics and pupil change, strict control of heart rate and blood pressure, atomization inhalation therapy, treatment of anticoagulation and antiplatelet therapy and classification management of airway...
May 30, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28581881/prevalence-and-clinical-intentions-of-antithrombotic-therapy-on-discharge-to-hospice-care
#17
Christina A Kowalewska, Brie N Noble, Erik K Fromme, Mary Lynn McPherson, Kristi N Grace, Jon P Furuno
BACKGROUND: There are no guidelines for antithrombotic therapy on admission to hospice care. Antithrombotic therapy may offer some benefit in these patients, but is also associated with well-described risks. OBJECTIVE: We quantified the frequency and characteristics of patients prescribed antithrombotic therapy on discharge from acute care to hospice care. DESIGN: Retrospective cohort study. Settings/Subjects: Adult (age> = 21 years) patients discharged from acute care to hospice care between January 1, 2010 and June 30, 2014...
June 5, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28574980/diagnostics-for-neonatal-sepsis-current-approaches-and-future-directions
#18
REVIEW
Pui-YingIroh Tam, Catherine M Bendel
Progress has been made in the reduction of morbidity and mortality from neonatal sepsis. However, diagnosis continues to rely primarily on conventional microbiologic techniques, which can be inaccurate. The objective of this review is to provide the clinician with an overview of the current information available on diagnosing this condition. We review currently available diagnostic approaches for documenting neonatal sepsis, and also describe novel approaches for diagnosing infection in neonates that are under development and investigation...
June 2, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28574810/what-happens-to-high-cost-patients-an-analysis-of-the-trajectories-of-billed-charges-over-time
#19
Brady P Horn, Cameron S Crandall, Douglas S Binder, David P Sklar
A growing literature documents the substantial burden that a small proportion of high-cost, medically complex patients impose on health care systems. However, it is not clear whether high-cost patients remain costly over time. This study looks at the monthly distribution of billed charges for a cohort of high-cost, medically complex patients enrolled in an intensive care management program in a university health care system, and finds that the billing trajectory is heterogeneous and highly nonlinear, characterized by a substantial spike in billed charges prior to identification, followed by a considerable drop prior to enrollment and a sustained drop thereafter...
June 2, 2017: Population Health Management
https://www.readbyqxmd.com/read/28569202/a-health-partnership-to-reduce-neonatal-mortality-in-four-hospitals-in-rwanda
#20
Placide Ntigurirwa, Kathy Mellor, Daniel Langer, Mari Evans, Emily Robertson, Lisine Tuyisenge, Alan Groves, Tom Lissauer
BACKGROUND: A health partnership to improve hospital based neonatal care in Rwanda to reduce neonatal mortality was requested by the Rwandan Ministry of Health. Although many health system improvements have been made, there is a severe shortage of health professionals with neonatal training. METHODS: Following a needs assessment, a health partnership grant for 2 years was obtained. A team of volunteer neonatologists and paediatricians, neonatal nurses, lactation consultants and technicians with experience in Rwanda or low-income countries was assembled...
June 1, 2017: Globalization and Health
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