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integrated care pathways

Dimosthenis A Sarigiannis, Spyros P Karakitsios, Evangelos Handakas, Konstantina Simou, Ermioni Solomou, Alberto Gotti
The current study aims at a comprehensive risk characterization of bisphenol A (BPA) supported by an integrated exposure modelling framework that comprises far field and near field exposure modelling coupled to a dynamic lifetime PBTK model. Exposure analysis was done on European data of BPA food residues and human biomonitoring (HBM). The latter were further assimilated through an advanced exposure reconstruction modelling framework to estimate the corresponding external and internal systemic dose of BPA and its metabolites...
October 18, 2016: Food and Chemical Toxicology
Marianne Williams, Yvonne Barclay, Rosie Benneyworth, Steve Gore, Zoe Hamilton, Rudi Matull, Iain Phillips, Leah Seamark, Kate Staveley, Steve Thole, Emma Greig
BACKGROUND: Irritable bowel syndrome (IBS) costs the National Health Service almost £12 million per annum. Despite national guidelines advising primary care management, these have failed to stem secondary care referrals of patients with likely IBS for unnecessary and costly assessment and investigation without necessarily achieving resolution of their symptoms. METHODS: In 2011, an integrated team from primary and secondary care developed a business case using baseline data to create a Somerset-wide IBS pathway using Clinical Commissioning Group funding...
October 2016: Frontline Gastroenterology
Sarah A Weiss, Joseph Han, Farbod Darvishian, Jeremy Tchack, Sung Won Han, Karolina Malecek, Michelle Krogsgaard, Iman Osman, Judy Zhong
BACKGROUND: Age has been reported as an independent prognostic factor for melanoma-specific survival (MSS). We tested the hypothesis that age impacts the host anti-tumor immune response, accounting for age-specific survival outcomes in three unique melanoma patient cohorts. METHODS: We queried the U.S. population-based Surveillance, Epidemiology, and End Results Program (SEER), the prospective tertiary care hospital-based Interdisciplinary Melanoma Cooperative Group (IMCG) biorepository, and the Cancer Genome Atlas (TCGA) biospecimen database to test the association of patient age at time of melanoma diagnosis with clinicopathologic features and survival outcomes...
October 19, 2016: Journal of Translational Medicine
Ryan Hakimi, Ankur Garg
PURPOSE OF REVIEW: Hemorrhagic stroke comprises approximately 15% to 20% of all strokes. This article provides readers with an understanding of the indications and significance of various neuroimaging techniques available for patients presenting with hemorrhagic strokes of distinct causes. RECENT FINDINGS: The most common initial neuroimaging study is a noncontrast head CT, which allows for the identification of hemorrhage. Once an intracranial hemorrhage has been identified, the pattern of blood and the patient's medical history, neurologic examination, and laboratory studies lead the practitioner to pursue further neuroimaging studies to guide the medical, surgical, and interventional management...
October 2016: Continuum: Lifelong Learning in Neurology
Priyakshi Kalita-de Croft, Fares Al-Ejeh, Amy E McCart Reed, Jodi M Saunus, Sunil R Lakhani
Our understanding of the natural history of breast cancer has evolved alongside technologies to study its genomic, transcriptomic, proteomic, and metabolomics landscapes. These technologies have helped decipher multiple molecular pathways dysregulated in breast cancer. First-generation 'omics analyses considered each of these dimensions individually, but it is becoming increasingly clear that more holistic, integrative approaches are required to fully understand complex biological systems. The 'omics represent an exciting era of discovery in breast cancer research, although important issues need to be addressed to realize the clinical utility of these data through precision cancer care...
November 2016: Advances in Anatomic Pathology
Abdallah Ibrahim, Sidua Hor, Ozge S Bahar, Duah Dwomoh, Mary M McKay, Reuben K Esena, Irene A Agyeponge
BACKGROUND: The process to seek for care by patients who experience episodes of mental disorders may determine how and where they receive the needed treatment. This study aimed to understand the pathways that people with mental disorders traversed for psychiatric services, particularly where these individuals will first seek treatment and the factors that influence such pathways to mental health care. METHODS: A cross-sectional study conducted at Pantang psychiatric hospital in Accra, Ghana involving 107 patients of ages 18 and older and their family members...
2016: International Journal of Mental Health Systems
Alison Turner, Abeda Mulla, Andrew Booth, Shiona Aldridge, Sharon Stevens, Fraser Battye, Peter Spilsbury
BACKGROUND: NHS England's Five Year Forward View (NHS England, Five Year Forward View, 2014) formally introduced a strategy for new models of care driven by simultaneous pressures to contain costs, improve care and deliver services closer to home through integrated models. This synthesis focuses on a multispecialty community provider (MCP) model. This new model of care seeks to overcome the limitations in current models of care, often based around single condition-focused pathways, in contrast to patient-focused delivery (Royal College of General Practitioners, The 2022 GP: compendium of evidence, 2012) which offers greater continuity of care in recognition of complex needs and multimorbidity...
October 1, 2016: Systematic Reviews
Charlotte Şahin, Olaf Iseringhausen, Kira Hower, Constanze Liebe, Anja Rethmeier-Hanke, Bernd Wedmann
BACKGROUND: Regional planning of healthcare requires special consideration for the complex needs of elderly, multimorbid people living in a domestic environment. In the District of Lippe, a hospital (Klinikum Lippe) and network of ambulatory care physicians (Ärztenetz Lippe) developed and tested a geriatric care network based on case management for geriatric patients living in a domestic environment. MATERIAL AND METHODS: The establishment of the geriatric care network (e...
September 30, 2016: Zeitschrift Für Gerontologie und Geriatrie
V Kuznetsov, K Bissell
Setting: Many tuberculosis services are implementing new diagnostics to accelerate treatment initiation for multidrug-resistant tuberculosis. Successful implementation and uptake are likely to depend on many factors. Objective: To describe the perceptions of the Arkhangelsk health services staff in Northern Russia on the process of introducing the line-probe assay and to determine what facilitates the process of uptake into practice. Design: Process evaluation; semi-structured, in-depth interviews with key informants from civil and penitentiary health services; content analysis...
September 2016: Public Health Action
Nooshin Razani, Michael A Kohn, Nancy M Wells, Doug Thompson, Hanna Hamilton Flores, George W Rutherford
BACKGROUND: Contact with nature improves human health; stress reduction is a mediating pathway. Stay Healthy in Nature Everyday (SHINE) is a stress reduction and health promotion intervention for low-income families at an urban Federally Qualified Health Center. We plan to evaluate two service-delivery models for SHINE and present here the intervention design and evaluation protocol. METHODS: Behavioral change theory and environmental education literature informed the intervention...
September 29, 2016: Contemporary Clinical Trials
Ursula Koch, Somava Stout, Bruce E Landon, Russell S Phillips
Innovations in payment are encouraging clinical-community partnerships that address health determinants. However, little is known about how healthcare systems transform and partner to improve population health. We synthesized views of population health experts from nine organizations and illustrated the resulting model using examples from four health systems. The transformation requires a foundation of primary care, connectors and integrators that span the boundaries, sharing of goals among participants, aligned funding and incentives, and a supporting infrastructure, all leading to a virtuous cycle of collaboration...
September 28, 2016: Healthcare
Roger J Packer, Stephan Pfister, Eric Bouffet, Robert Avery, Pratiti Bandopadhayay, Miriam Bornhorst, Daniel C Bowers, David Ellison, Jason Fangusaro, Nicholas Foreman, Maryam Fouladi, Amar Gajjar, Daphne Haas-Kogan, Cynthia Hawkins, Cheng-Ying Ho, Eugene Hwang, Nada Jabado, Lindsay B Kilburn, Alvaro Lassaletta, Keith L Ligon, Maura Massimino, Schouten-van Meeteren, Sabine Mueller, Theo Nicolaides, Giorgio Perilongo, Uri Tabori, Gilbert Vezina, Katherine Warren, Olaf Witt, Yuan Zhu, David T Jones, Mark Kieran
For the past decade, it has been recognized that pediatric low-grade gliomas (LGGs) and glial-neuronal tumors carry distinct molecular alterations with resultant aberrant intracellular signaling in the Ras-mitogen-activated protein kinase pathway. The conclusions and recommendations of a consensus conference of how best to integrate the growing body of molecular genetic information into tumor classifications and, more importantly, for future treatment of pediatric LGGs are summarized here. There is uniform agreement that molecular characterization must be incorporated into classification and is increasingly critical for appropriate management...
September 28, 2016: Neuro-oncology
Lauren Schwartz, Anthony Holland, Elisabeth Dykens, Theresa Strong, Elizabeth Roof, Jessica Bohonowych
: This paper reports on the 'Prader-Willi Syndrome (PWS) Mental Health Research Strategy Workshop' that took place in March 2015. PWS is characterized by a complex phenotype affecting multiple systems with a high prevalence of maladaptive behaviours, and neuropsychiatric illness. Prader Willi syndrome results from the absence of paternally derived alleles located at the imprinted chromosomal locus, 15q11-13. The goal of the workshop was to highlight the state of the science of the mental health of people with this rare neurodevelopmental disorder...
September 29, 2016: Orphanet Journal of Rare Diseases
(no author information available yet)
In areas where weight management services are not established, an integrated approach is required to sustain results. This article in Primary Health Care suggests using a stepped care approach using a model such as SHINE (Self, Help, Independence, Nutrition and Exercise). This model can be used to provide a holistic and integrative care pathway for children and young people with severe obesity.
September 28, 2016: Nursing Standard
Antonella Piazza, Paola Rucci, Massimo Clo, Dino Gibertoni, Lucia Camellini, Marinella Di Stani, Maria Pia Fantini, Mila Ferri, Angelo Fioritti
PURPOSE: To estimate the treated prevalence of eating disorders (ED) in Emilia-Romagna, Italy, and to compare health services utilization among age groups and geographical areas. METHODS: The study cohort consists of patients aged 12-64 years with a primary or secondary ED diagnosis, treated in regional healthcare facilities in 2012. Patients were followed up for 1 year from the first contact. Data were extracted from regional administrative databases. RESULTS: The study cohort included 1550 cases, 36...
September 29, 2016: Eating and Weight Disorders: EWD
Christopher L Grote, Alissa M Butts, Doug Bodin
OBJECTIVE: This invited paper is intended to give an overview regarding the education and training pathways for the practice of neuropsychology in the United States. It is also meant to describe the types of activities engaged in by neuropsychologists, a description of their work settings and the amounts/ways in which they are compensated for their work. METHOD: The authors reviewed the literature and relied on their professional and organizational experiences to collect the necessary data...
November 2016: Clinical Neuropsychologist
Achim Aigner, Roland Buesen, Tim Gant, Nigel Gooderham, Helmut Greim, Jörg Hackermüller, Bruno Hubesch, Madeleine Laffont, Emma Marczylo, Gunter Meister, Jay S Petrick, Reza J Rasoulpour, Ursula G Sauer, Kerstin Schmidt, Hervé Seitz, Frank Slack, Tokuo Sukata, Saskia M van der Vies, Jan Verhaert, Kenneth W Witwer, Alan Poole
The European Centre for the Ecotoxicology and Toxicology of Chemicals (ECETOC) organised a workshop to discuss the state-of-the-art research on noncoding RNAs (ncRNAs) as biomarkers in regulatory toxicology and as analytical and therapeutic agents. There was agreement that ncRNA expression profiling data requires careful evaluation to determine the utility of specific ncRNAs as biomarkers. To advance the use of ncRNA in regulatory toxicology, the following research priorities were identified: (1) Conduct comprehensive literature reviews to identify possibly suitable ncRNAs and areas of toxicology where ncRNA expression profiling could address prevailing scientific deficiencies...
September 20, 2016: Regulatory Toxicology and Pharmacology: RTP
Dominique Tremblay, Jean Latreille, Karine Bilodeau, Arnaud Samson, Linda Roy, Marie-France L'Italien, Christine Mimeault
This article discusses the case of a 47-year-old woman who underwent primary therapy with curative intent for breast cancer. The case illustrates a number of failure events in transferring information and responsibility from oncology to primary care teams. The article emphasizes the importance of shared leadership, as multiple team members, dispersed in time and space, pursue their own objectives while achieving the common goal of coordinating care for survivors of cancer transitioning across settings. Shared leadership is defined as a team property comprising shared responsibility and mutual influence between the patient and the patient's family, primary care providers, and oncology teams, whereby they lead each other toward quality and safety of care...
September 20, 2016: Journal of Oncology Practice
Frank Y Lin, Katie Bergstrom, Richard Person, Abhishek Bavle, Leomar Y Ballester, Sarah Scollon, Robin Raesz-Martinez, Andrew Jea, Sherri Birchansky, David A Wheeler, Stacey L Berg, Murali M Chintagumpala, Adekunle M Adesina, Christine Eng, Angshumoy Roy, Sharon E Plon, D Williams Parsons
The integration of genome-scale studies such as whole-exome sequencing (WES) into the clinical care of children with cancer has the potential to provide insight into the genetic basis of an individual's cancer with implications for clinical management. This report describes the results of clinical tumor and germline WES for a patient with a rare tumor diagnosis, rosette-forming glioneuronal tumor of the fourth ventricle (RGNT). Three pathogenic gene alterations with implications for clinical care were identified: somatic activating hotspot mutations in FGFR1 (p...
September 2016: Cold Spring Harbor Molecular Case Studies
Anne Marie Lyngsø, Nina Skavlan Godtfredsen, Anne Frølich
INTRODUCTION: Despite many initiatives to improve coordination of patient pathways and intersectoral cooperation, Danish health care is still fragmented, lacking intra- and interorganisational integration. This study explores barriers to and facilitators of interorganisational integration as perceived by healthcare professionals caring for patients with chronic obstructive pulmonary disease within the Danish healthcare system. METHODS: Seven focus groups were conducted in January through July 2014 with 21 informants from general practice, local healthcare centres and a pulmonary department at a university hospital in the Capital Region of Denmark...
2016: International Journal of Integrated Care
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