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https://www.readbyqxmd.com/read/28730845/evaluation-of-toxicity-after-acute-accidental-methotrexate-ingestions-in-children-under-6-years-old-a-16-year-multi-center-review
#1
Hannah Hays, Michael C Beuhler, Henry A Spiller, Julie Weber, James B Mowry, Mark L Ryan, Natalie E Spiller, Ashley Webb
CONTEXT: There is little data on the frequency of adverse events following acute methotrexate ingestions in pediatric patients. Likewise, recommendations for observation length, site and management strategies in this population are not well established. Therefore, most recommendations are modeled after management of chronic overdose in patients with underlying medical conditions. OBJECTIVE: The primary objective of this study is to determine the frequency of acute toxicity after acute methotrexate accidental unsupervised ingestions in patients less than six years...
July 21, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28730508/quality-improvement-initiatives-in-inflammatory-bowel-disease
#2
REVIEW
Sameer K Berry, Corey A Siegel, Gil Y Melmed
PURPOSE OF REVIEW: This article serves as an overview of several quality improvement initiatives in inflammatory bowel disease (IBD). RECENT FINDINGS: IBD is associated with significant variation in care, suggesting poor quality of care. There have been several efforts to improve the quality of care for patients with IBD. Quality improvement (QI) initiatives in IBD are intended to be patient-centric, improve outcomes for individuals and populations, and reduce costs-all consistent with "the triple aim" put forth by the Institute for Healthcare Improvement (IHI)...
August 2017: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/28726549/homeless-veterans-experiences-with-substance-use-recovery-and-treatment-through-photo-elicitation
#3
Samuel F Sestito, Keri L Rodriguez, Shaddy K Saba, James W Conley, Michael A Mitchell, Adam J Gordon
BACKGROUND: Homeless Veterans often have addictions and comorbidities that complicate utilization of longitudinal healthcare services, such as primary care. An understanding of experiences of Veterans enrolled in a Homeless Patient Aligned Care Team (H-PACT) may improve addiction treatment engagement in these settings. We aimed to describe H-PACT Veterans' experiences with substance use (SU), substance use recovery (SUR), and substance use treatment (SUT). METHODS: Homeless Veterans were recruited from a Veteran primary care medical home clinic between September 2014 and March 2015...
July 20, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28723789/measuring-the-impact-of-emergency-medical-services-ems-on-out-of-hospital-cardiac-arrest-survival-in-a-developing-country-a-key-metric-for-ems-systems-performance
#4
Mazen El Sayed, Reem Al Assad, Yasmin Abi Aad, Nour Gharios, Marwan M Refaat, Hani Tamim
Out-of-hospital cardiac arrest (OHCA) can be used to evaluate the overall performance of the emergency medical services' (EMS) system. This study assessed the impact of EMS on OHCA survival rates in a setting where the prehospital system is underdeveloped.A retrospective chart review was carried out over a 5-year period of all adult OHCA patients admitted to the emergency department (ED) of a tertiary care center in Lebanon.A total of 271 patients with OHCA (179 [66.1%] men, mean age of 69.9 [standard deviation = 15...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28720628/the-patient-centered-medical-home-pcmh-framing-typology-for-understanding-the-structure-function-and-outcomes-of-pcmhs
#5
Autumn M Kieber-Emmons, William L Miller
INTRODUCTION: Patient-centered medical homes (PCHMs) aspire to transform today's challenged primary care services. However, it is unclear which PCMH characteristics produce specific outcomes of interest for care delivery. This study tested a novel typology of PCMH practice transformation, the PCMH framing typology, and evaluated measurable outcomes by each type. METHODS: Using the Patient-Centered Primary Care Collaborative 2012 to 2013 Annual Review, this secondary analysis of the published PCMH literature extracted data from publications of 59 PCMHs...
July 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28720627/costs-of-transforming-established-primary-care-practices-to-patient-centered-medical-homes-pcmhs
#6
Neil S Fleming, Briget da Graca, Gerald O Ogola, Steven D Culler, Jessica Austin, Patrice McConnell, Russell McCorkle, Phil Aponte, Michael Massey, Cliff Fullerton
BACKGROUND: The patient-centered medical home (PCMH) shows promise for improving care and reducing costs. We sought to reduce the uncertainty regarding the time and cost of PCMH transformation by quantifying the direct costs of transforming 57 practices in a medical group to National Committee for Quality Assurance (NCQA)-recognized Level III PCMHs. METHODS: We conducted structured interviews with corporate leaders, and with physicians, practice administrators, and office managers from a representative sample of practices regarding time spent on PCMH transformation and NCQA application, and related purchases...
July 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28720620/in-this-issue-opiates-tobacco-social-determinants-of-health-social-accountability-for-non-profit-hospitals-more-on-pcmh-and-clinical-topics
#7
EDITORIAL
Marjorie A Bowman, Anne Victoria Neale, Dean A Seehusen
This issue contains several articles about the factors contributing to the complex and deadly interplay between social determinants of health, pain, mental illness, and addictive substances such as opioids and tobacco. One article clearly is a call to action: more than half of opioid prescriptions in the United States are given to patients with mental health problems. Two articles report work on the next steps for social determinants of health in health care settings. Social accountability based on community health needs assessments required of community hospitals should lead to the creation of more family medicine residency positions...
July 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28716041/potentially-inappropriate-home-medications-among-older-patients-with-cardiovascular-disease-admitted-to-a-cardiology-service-in-usa
#8
Marwan Sheikh-Taha, Hani Dimassi
BACKGROUND: The use of potentially inappropriate medications (PIMs) may pose more risks than benefits to patients and is a major factor contributing to the likelihood of serious adverse drug reactions and negative health outcomes among older patients. METHODS: A retrospective chart review was conducted in a tertiary care center in USA where home medications of the older patients were reviewed and analyzed upon hospital admission over three months, from March till May 2016...
July 17, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28716014/the-comprehensive-post-acute-stroke-services-compass-study-design-and-methods-for-a-cluster-randomized-pragmatic-trial
#9
Pamela W Duncan, Cheryl D Bushnell, Wayne D Rosamond, Sara B Jones Berkeley, Sabina B Gesell, Ralph B D'Agostino, Walter T Ambrosius, Blair Barton-Percival, Janet Prvu Bettger, Sylvia W Coleman, Doyle M Cummings, Janet K Freburger, Jacqueline Halladay, Anna M Johnson, Anna M Kucharska-Newton, Gladys Lundy-Lamm, Barbara J Lutz, Laurie H Mettam, Amy M Pastva, Mysha E Sissine, Betsy Vetter
BACKGROUND: Patients discharged home after stroke face significant challenges managing residual neurological deficits, secondary prevention, and pre-existing chronic conditions. Post-discharge care is often fragmented leading to increased healthcare costs, readmissions, and sub-optimal utilization of rehabilitation and community services. The COMprehensive Post-Acute Stroke Services (COMPASS) Study is an ongoing cluster-randomized pragmatic trial to assess the effectiveness of a comprehensive, evidence-based, post-acute care model on patient-centered outcomes...
July 17, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28715467/dealing-with-foreign-cultural-paradigms-a-systematic-review-on-intercultural-challenges-of-international-medical-graduates
#10
Kerstin Michalski, Nabeel Farhan, Edith Motschall, Werner Vach, Martin Boeker
OBJECTIVES: An increasing number of International Medical Graduates (IMG), who are defined to be physicians working in a country other than their country of origin and training, immigrate to Western countries. In order to ensure safe and high-quality patient care, they have to take medical and language tests. This systematic review aims to (1) collect all empiric research on intercultural communication of IMGs in medical settings, (2) identify and categorize all text passages mentioning intercultural issues in the included studies, and (3) describe the most commonly reported intercultural areas of communication of IMGs...
2017: PloS One
https://www.readbyqxmd.com/read/28714534/adjustable-thermoplastic-oral-appliance-versus-positive-airway-pressure-for-obstructive-sleep-apnea
#11
Wish Banhiran, Paraya Assanasen, Cherdchai Nopmaneejumrudlers, Nongyoaw Nujchanart, Wimontip Srechareon, Cheerasook Chongkolwatana, Choakchai Metheetrairut
OBJECTIVES/HYPOTHESIS: To compare outcomes of continuous positive airway pressure (CPAP) and the adjustable thermoplastic mandibular advancement splint (AT-MAS) for obstructive sleep apnea treatment. STUDY DESIGN: Randomized crossover, noninferiority, tertiary center setting. METHODS: Fifty patients with a mean age of 49.5 ± 10.6 years were enrolled. Inclusion criteria were age ≥18 years, apnea-hypopnea index (AHI) ≥5 events/hour, and oxygen saturation ≥70%...
July 17, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28713659/a-descriptive-report-of-early-mobilization-for-critically-ill-ventilated-patients-with-cancer
#12
Amanda Weeks, Claudine Campbell, Prabalini Rajendram, Weiji Shi, Louis Voigt
BACKGROUND: Early mobilization protocols have been successfully implemented to improve function in critically ill patients; however, no study has focused on the oncology population. OBJECTIVES: To investigate the feasibility of early mobilization and describe the rehabilitation interventions and discharge outcomes in a cohort of critically ill patients with cancer. DESIGN: Retrospective review. METHODS: A retrospective analysis of patients with cancer who participated in occupational and physical therapy while on mechanical ventilation utilizing an institutional early mobilization protocol from June 2010 - July 2011, was completed...
July 2017: Rehabilitation Oncology
https://www.readbyqxmd.com/read/28711194/factors-associated-with-epinephrine-administration-for-anaphylaxis-in-children-before-arrival-to-the-emergency-department
#13
Melissa Robinson, Matthew Greenhawt, David R Stukus
BACKGROUND: Epinephrine is the first-line treatment for anaphylaxis but may be underused by patients and medical personnel. OBJECTIVE: To evaluate factors associated with anaphylaxis management before arrival at the emergency department (ED) or urgent care center (UCC). METHODS: We performed a retrospective review of electronic medical records for all patients aged 0 to 25 years presenting with anaphylaxis to the ED or UCC at a pediatric academic referral center during 2009 to 2013...
June 30, 2017: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/28708933/colorectal-cancer-screening-at-us-community-health-centers-examination-of-sociodemographic-disparities-and-association-with-patient-provider-communication
#14
Sue C Lin, Duane McKinley, Alek Sripipatana, Laura Makaroff
BACKGROUND: Colorectal cancer (CRC) screening rates are low among underserved populations. High-quality patient-physician communication potentially influences patients' willingness to undergo CRC screening. Community health centers (HCs) provide comprehensive primary health care to underserved populations. This study's objectives were to ascertain national CRC screening rates and to explore the relations between sociodemographic characteristics and patient-provider communication on the receipt of CRC screening among HC patients...
July 14, 2017: Cancer
https://www.readbyqxmd.com/read/28701576/estimated-impact-of-emergency-medical-service-triage-of-stroke-patients-on-comprehensive-stroke-centers-an-urban-population-based-study
#15
Brian S Katz, Opeolu Adeoye, Heidi Sucharew, Joseph P Broderick, Jason McMullan, Pooja Khatri, Michael Widener, Kathleen S Alwell, Charles J Moomaw, Brett M Kissela, Matthew L Flaherty, Daniel Woo, Simona Ferioli, Jason Mackey, Sharyl Martini, Felipe De Los Rios la Rosa, Dawn O Kleindorfer
BACKGROUND AND PURPOSE: The American Stroke Association recommends that Emergency Medical Service bypass acute stroke-ready hospital (ASRH)/primary stroke center (PSC) for comprehensive stroke centers (CSCs) when transporting appropriate stroke patients, if the additional travel time is ≤15 minutes. However, data on additional transport time and the effect on hospital census remain unknown. METHODS: Stroke patients ≥20 years old who were transported from home to an ASRH/PSC or CSC via Emergency Medical Service in 2010 were identified in the Greater Cincinnati area population of 1...
July 12, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28700461/student-hotspotting-teaching-the-interprofessional-care-of-complex-patients
#16
Pablo Bedoya, Katherine Neuhausen, Alan Dow, E Marshall Brooks, Dawn Mautner, Rebecca S Etz
PROBLEM: Individuals with complex health and social needs drive much of the total cost of care. Addressing these individuals' needs and decreasing costs requires interprofessional teams, called "hotspotters," who engage with communities with high utilization. Training health professions students to succeed in the hotspotting approach may benefit trainees, academic health centers (AHCs), and communities. APPROACH: The Camden Coalition of Healthcare Providers and the Association of American Medical Colleges launched the Interprofessional Student Hotspotting Learning Collaborative in 2014...
July 11, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28696250/american-heart-association-s-call-to-action-for-payment-and-delivery-system-reform
#17
REVIEW
Vincent J Bufalino, Scott A Berkowitz, Timothy J Gardner, Ileana L Piña, Madeleine Konig
The healthcare system is undergoing a transition from paying for volume to paying for value. Clinicians, as well as public and private payers, are beginning to implement alternative delivery and payment models, such as the patient-centered medical home, accountable care organizations, and bundled payment arrangements. Implementation of these new models will necessitate delivery system transformation and will actively involve all fields of medical care, in particular medicine and surgery. This call to action, on behalf of the American Heart Association's Expert Panel on Payment and Delivery System Reform, serves to offer support and direction for further involvement by the American Heart Association...
July 10, 2017: Circulation
https://www.readbyqxmd.com/read/28695425/community-health-workers-bring-cost-savings-to-patient-centered-medical-homes
#18
Maurice L Moffett, Arthur Kaufman, Andrew Bazemore
The Patient-Centered Medical Home (PCMH) model demonstrated that processes of care can be improved while unnecessary care, such as preventable emergency department utilization, can be reduced through better care coordination. A complementary model, the Integrated Primary Care and Community Support (I-PaCS) model, which integrates community health workers (CHWs) into primary care settings, functions beyond improved coordination of primary medical care to include management of the social determinants of health...
July 10, 2017: Journal of Community Health
https://www.readbyqxmd.com/read/28692616/development-of-a-falls-registry-a-pilot-study
#19
Gina M Berg, Tara Carlson, Joanne Fairchild, Courtney Edwards, Ryan Sorell
Each year approximately 1 in 4 healthy older adults aged 65+ years and 1 in 2 aged 80+ years living in the community will fall. Fall-related injuries are the leading cause of death and disability and cost the United States approximately $31 billion annually. Currently, no repository of scene data exists that informs prevention programs regarding circumstances that contribute to older adult falls. This was a multicenter (4 sites: Kansas, Maryland, Oregon, and Texas) pilot study consisting of interviews of older (55+ years) patients who had been admitted to a trauma center with fall-related injuries...
July 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28679818/cms-strategies-to-reduce-antipsychotic-drug-use-in-nursing-home-patients-with-dementia-show-some-progress
#20
Judith A Lucas, John R Bowblis
The Centers for Medicare and Medicaid Services initiated three strategies (in March and July 2012 and in May 2013) to reduce the use of unnecessary antipsychotic medications in nursing homes, especially their widespread use to control behavioral symptoms of dementia. We examined 86,163 state recertification surveys conducted at 15,055 facilities in the period January 1, 2009-March 31, 2015. We found that these strategies were associated with increases in citations for only one of two targeted deficiencies (unnecessary drug use) and only after the third strategy (revisions to the federal guidelines for the citations) was implemented...
July 1, 2017: Health Affairs
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