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Ambulatory Care

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https://www.readbyqxmd.com/read/28822828/targeted-lowering-of-central-blood-pressure-in-patients-with-hypertension-baseline-recruitment-rationale-and-design-of-a-randomized-controlled-trial-the-low-cbp-study
#1
James E Sharman, Tony Stanton, Christopher M Reid, Anthony Keech, Philip Roberts-Thomson, Simon Stewart, Robert Greenough, Michael Stowasser, Walter P Abhayaratna
BACKGROUND: High blood pressure (BP) is the most common modifiable cause of death from cardiovascular disease. Lowering BP with medication improves patient outcomes, but even in populations with normal upper arm (brachial) BP there remains considerable residual risk for cardiovascular disease and this may be due to persistently elevated central BP. There has never been a trial to determine the value of targeted central BP lowering among patients with hypertension, and this was the aim of this study...
August 16, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28822671/surgical-ultrasound-guided-carpal-tunnel-release
#2
T Apard, G Candelier
Ultrasound-guided surgery is a new trend stemming from the introduction of high-frequency linear probes and better quality screens. Surgical treatment of carpal tunnel syndrome is increasingly being performed under ultrasound guidance. Knowledge of musculoskeletal ultrasonography is obviously mandatory. Several types of cutting instruments (miniature knife, Gigli saw or hook) and surgical approaches (wrist or palm) have been described. Ultrasonography allows the wide-awake and local anesthesia with no tourniquet (WALANT) technique to be used in the context of ambulatory patient care...
August 16, 2017: Hand Surgery and Rehabilitation
https://www.readbyqxmd.com/read/28818227/impact-of-an-educational-program-on-the-quality-of-life-of%C3%A2-patients-with-lymphedema-a-preliminary-evaluation
#3
Sophie Blaise, Bernadette Satger, Gilles Pernod, Cécile Richaud, Béatrice Villemur, Patrick H Carpentier
OBJECTIVE: We report on the preliminary evaluation of a well-designed program, Living with Lymphedema. This longitudinal cohort study assessed patients' quality of life using questionnaires. Our main objective was to evaluate the satisfaction of the patients and their adherence to the program. This was done using a specific questionnaire of satisfaction as well as by noting patients' adherence to the program (number of patients attending all three consultations). The secondary objective was to assess the effect of the program on the patient's quality of life...
September 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28817750/the-surgeon-on-service-model-for-timely-economically-viable-inpatient-care-of-tracheostomy-patients-in-academic-pediatric-otolaryngology
#4
Jennifer M Lavin, James W Schroeder, Dana M Thompson
Importance: The traditional practice model for pediatric otolaryngologists at high-volume academic centers is to simultaneously balance outpatient care responsibilities with those of the inpatient service, emergency department, and ambulatory care clinics. This model leads to challenges with care coordination, timeliness of nonemergency operative care, and consistent participation in care and consultation at the attending surgeon level. The "surgeon on service" (SOS) model-where faculty members rotate to manage the inpatient service in lieu of outpatient responsibilities-has been described as one method to address this conundrum...
August 17, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/28817480/revised-national-estimates-of-emergency-department-visits-for-sepsis-in-the-united-states
#5
Henry E Wang, Allison R Jones, John P Donnelly
OBJECTIVES: The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. DESIGN: Analysis of data from the National Hospital Ambulatory Medical Care Survey. SETTING: U.S. emergency department visits, 2009-2011. PATIENTS: Adult (age, ≥ 18 yr) emergency department sepsis patients...
September 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28816891/computed-tomography-use-plateaus-among-children-with-emergency-visits-for-abdominal-pain
#6
Jahan Fahimi, Aaron E Kornblith, Hemal Kanzaria, Andrew Herring, Ralph C Wang
OBJECTIVES: Abdominal pain is a common pediatric complaint to emergency departments (EDs), and clinicians often rely on imaging for diagnosis. Studies have demonstrated an increase in computed tomography (CT) in this population. Following emphasis on radiation reduction by researchers and organizations, this study evaluates recent national trends in CT use among pediatric patients presenting to EDs with abdominal pain. METHODS: This is a cross-sectional analysis of ED patients 18 years or younger with chief complaint of abdominal pain in the National Hospital Ambulatory Medical Care Survey from 2008 to 2011...
August 14, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28816774/practitioner-gender-and-quality-of-care-in-ambulatory-cardiology-practices-a-report-from-the-national-cardiovascular-data-practice-innovation-and-clinical-excellence-pinnacle-registry
#7
Dipti Gupta, Fengming Tang, Frederick A Masoudi, Philip G Jones, Paul S Chan, Stacie L Daugherty
BACKGROUND: Some studies suggest that female practitioners are more likely to provide guideline-concordant care than male practitioners; however, little is known about the role of practitioner gender in cardiology. OBJECTIVE: The aim of the study was to measure the association between practitioner gender and adherence to the cardiovascular performance measures in the American College of Cardiology's ambulatory Practice Innovation and Clinical Excellence Registry...
August 15, 2017: Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/28816756/characterizing-the-posttransfer-period-among-patients-with-pediatric-onset-ibd-the-impact-of-academic-versus-community-adult-care-on-emergent-health-resource-utilization
#8
Natasha Bollegala, Eric I Benchimol, Anne M Griffiths, Adrienne Kovacs, Allan H Steinhart, Xinbei Zhao, Geoffrey C Nguyen
BACKGROUND: Patients diagnosed with inflammatory bowel disease (IBD) during childhood require transfer to an adult gastroenterologist, in Ontario usually just before their 18th birthday. Pediatric onset IBD is a complex phenotype with demonstrated noncompliance risk that may require targeted measures to optimize health care outcomes in the adult care setting. PURPOSE: The purpose of this study was to determine the impact of posttransfer health care setting (academic versus community gastroenterologist) on emergent health resource utilization...
September 2017: Inflammatory Bowel Diseases
https://www.readbyqxmd.com/read/28816746/characterizing-the-posttransfer-period-among-patients-with-pediatric-onset-ibd-the-impact-of-academic-versus-community-adult-care-on-emergent-health-resource-utilization
#9
Natasha Bollegala, Eric I Benchimol, Anne M Griffiths, Adrienne Kovacs, Allan H Steinhart, Xinbei Zhao, Geoffrey C Nguyen
BACKGROUND: Patients diagnosed with inflammatory bowel disease (IBD) during childhood require transfer to an adult gastroenterologist, in Ontario usually just before their 18th birthday. Pediatric onset IBD is a complex phenotype with demonstrated noncompliance risk that may require targeted measures to optimize health care outcomes in the adult care setting. PURPOSE: The purpose of this study was to determine the impact of posttransfer health care setting (academic versus community gastroenterologist) on emergent health resource utilization...
August 14, 2017: Inflammatory Bowel Diseases
https://www.readbyqxmd.com/read/28816721/drop-in-cd4-counts-below-200-cells-%C3%A2%C2%B5l-after-reaching-or-starting-from-values-higher-than-350-cells-%C3%A2%C2%B5l-in-hiv-infected-patients-with-virological-suppression
#10
Nicola Gianotti, Giulia Marchetti, Andrea Antinori, Annalisa Saracino, Andrea Gori, Giuliano Rizzardini, Miriam Lichtner, Alessandra Bandera, Cristina Mussini, Enrico Girardi, Antonella d'Arminio Monforte, Alessandro Cozzi-Lepri
BACKGROUND: Aim of the study was to quantify the risk of a drop in CD4+ counts below 200 cells/µL after reaching values >350 cells/µL on antiretroviral therapy (or after starting antiretroviral therapy with CD4+ count >350 cells/µL) in the absence of virological failure. SETTING: Ambulatory care services, Italy. METHODS: Prospective cohort study of patients enrolled in the ICONA Foundation Study cohort who started ART with >350 CD4+/μL, or with ≤350 CD4+/µL and reached values >350 cells/µL after virological suppression (VS, defined by two consecutive viral loads ≤50 copies/mL)...
August 12, 2017: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/28816535/professional-continuous-flash-glucose-monitoring-with-ambulatory-glucose-profile-reporting-to-supplement-a1c-rationale-and-practical-implementation
#11
Irl B Hirsch, Carol A Verderese
OBJECTIVE: Recent consensus statements strongly advocate downloading and interpretation of continuous glucose data for diabetes management in patients with type 1 or type 2 diabetes. Supplementing periodic A1C testing with intermittent continuous glucose monitoring (CGM) using a standardized report form known as the ambulatory glucose profile (AGP) is an evolving standard of care. The rationale for this approach and its implementation with a recently approved novel monitoring technology are explored...
August 17, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28816338/prediction-of-emergency-department-hospital-admission-based-on-natural-language-processing-and-neural-networks
#12
Xingyu Zhang, Joyce Kim, Rachel E Patzer, Stephen R Pitts, Aaron Patzer, Justin D Schrager
OBJECTIVE: To describe and compare logistic regression and neural network modeling strategies to predict hospital admission or transfer following initial presentation to Emergency Department (ED) triage with and without the addition of natural language processing elements. METHODS: Using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a cross-sectional probability sample of United States EDs from 2012 and 2013 survey years, we developed several predictive models with the outcome being admission to the hospital or transfer vs...
August 16, 2017: Methods of Information in Medicine
https://www.readbyqxmd.com/read/28815459/a-roadmap-for-reducing-cardiac-device-infections-a-review-of-epidemiology-pathogenesis-and-actionable-risk-factors-to-guide-the-development-of-an-infection-prevention-program-for-the-electrophysiology-laboratory
#13
REVIEW
Westyn Branch-Elliman
PURPOSE OF REVIEW: Cardiovascular implantable electronic device (CIED) infections are highly morbid, common, and costly, and rates are increasing (Sohail et al. Arch Intern Med 171(20):1821-8 2011; Voigt et al. J Am Coll Cardiol 48(3):590-1 2006). Factors that contribute to the development of CIED infections include patient factors (comorbid conditions, self-care, microbiome), procedural details (repeat procedure, contamination during procedure, appropriate pre-procedural prep, and antimicrobial use), environmental and organizational factors (patient safety culture, facility barriers, such as lack of space to store essential supplies, quality of environmental cleaning), and microbial factors (type of organism, virulence of organism)...
August 16, 2017: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/28815375/disparities-in-emergency-department-wait-time-among-patients-with-mental-health-and-substance-related-disorders
#14
Samuel T Opoku, Bettye A Apenteng, Emmanuel A Akowuah, Soumitra Bhuyan
This study examined disparities in emergency department (ED) wait time for patients with mental health and substance-related disorders (PwMHSDs), using data from the 2009-2011 National Hospital Ambulatory Medical Care Survey (NHAMCS). Wait time was defined as the time between arrival at ED and being seen by an ED provider. Results from multivariable regression models show racial disparities, with non-Hispanic Black PwMHSDs experiencing longer ED wait time, compared to non-Hispanic White PwMHSDs. A temporal decline in ED wait time was also observed over the study period...
August 16, 2017: Journal of Behavioral Health Services & Research
https://www.readbyqxmd.com/read/28813753/pre-guideline-trends-associated-with-chest-radiograph-usage-for-pediatric-community-acquired-pneumonia-in-emergency-department-settings
#15
Eric W Jones, Benjamin Meyer, Aaron M Berg, Benson S Hsu
BACKGROUND: Health care spending in the U.S. totaled $3 trillion in 2014 and continues to increase rapidly. Minimizing waste through clinical guidelines is a promising strategy to reduce spending without compromising patient care. In 2011, clinical guidelines recommended against the use of chest X-ray (CXR) for diagnosis of community-acquired pneumonia (CAP) in pediatric ambulatory settings. However, use of CXR has not changed post-guideline. Thus, understanding the drivers of CXR utilization prior to guideline implementation could improve guideline adherence...
May 2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28813473/the-availability-of-pharmacies-in-the-united-states-2007-2015
#16
Dima Mazen Qato, Shannon Zenk, Jocelyn Wilder, Rachel Harrington, Darrell Gaskin, G Caleb Alexander
IMPORTANCE: Despite their increasingly important role in health care delivery, little is known about the availability, and characteristics, of community pharmacies in the United States. OBJECTIVES: (1) To examine trends in the availability of community pharmacies and pharmacy characteristics (24-hour, drive-up, home delivery, e-prescribing, and multilingual staffing) associated with access to prescription medications in the U.S. between 2007 and 2015; and (2) to determine whether and how these patterns varied by pharmacy type (retail chains, independents, mass retailers, food stores, government and clinic-based) and across counties...
2017: PloS One
https://www.readbyqxmd.com/read/28810869/-evolution-and-financial-cost-of-socioeconomic-inequalities-in-ambulatory-care-sensitive-conditions-an-ecological-study-for-portugal-2000-2014
#17
Klára Dimitrovová, Cláudia Costa, Paula Santana, Julian Perelman
BACKGROUND: Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are specific conditions for which hospitalization is thought to be avoidable through patient education, health promotion initiatives, early diagnosis and by appropriate chronic disease management, and have been shown to be greatly influenced by socioeconomic (SE) characteristics. We examined the SE inequalities in hospitalization rates for ACSC in Portugal, their evolution over time (2000-2014), and their associated financial burden...
August 16, 2017: International Journal for Equity in Health
https://www.readbyqxmd.com/read/28808952/effect-of-reducing-cost-sharing-for-outpatient-care-on-children-s-inpatient-services-in-japan
#18
Hirotaka Kato, Rei Goto
BACKGROUND: Assessing the impact of cost sharing on healthcare utilization is a critical issue in health economics and health policy. It may affect the utilization of different services, but is yet to be well understood. OBJECTIVE: This paper investigates the effects of reducing cost sharing for outpatient services on hospital admissions by exploring a subsidy policy for children's outpatient services in Japan. METHODS: Data were extracted from the Japanese Diagnosis Procedure Combination database for 2012 and 2013...
August 15, 2017: Health Economics Review
https://www.readbyqxmd.com/read/28808946/perioperative-care-of-elderly-surgical-outpatients
#19
REVIEW
Xuezhao Cao, Paul F White, Hong Ma
The ambulatory setting offers potential advantages for elderly patients undergoing elective surgery due to the advancement in both surgical and anesthetic techniques resulting in quicker recovery times, fewer complications, higher patient satisfaction, and reduced costs of care. This review article aims to provide a practical guide to anesthetic management of elderly outpatients. Important considerations in the preoperative evaluation of elderly outpatients with co-existing diseases, as well as the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and recommendations regarding the management of common postoperative complications (e...
August 14, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28806935/association-between-charlson-comorbidity-index-score-and-outcome-in-patients-with-stage-iiib-iv-non-small-cell-lung-cancer
#20
Lei Zhao, Lai-Han Leung, Jing Wang, Huihui Li, Juanjuan Che, Lian Liu, Xiaojun Yao, Bangwei Cao
BACKGROUND: This retrospective study investigated the association between the Charlson comorbidity index (CCI) score and the survival of patients with stage IIIB-IV (advanced, non-resectable) non-small cell lung cancer (NSCLC) who also did not have gene mutations in epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK). METHODS: The records of 165 patients (28-80 y, median 61 y) who met the above criteria and were admitted to Beijing Friendship Hospital Capital Medical University from 1 May 2010 to 1 October 2014were reviewed...
August 15, 2017: BMC Pulmonary Medicine
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