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integrated care pathways

Chau T Nguyen
Burnout is increasingly recognized as an issue of major importance affecting physicians of all ages and disciplines and thereby patients, systems, and health care in general. At the 2017 American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting, the scope of burnout in medicine was addressed, along with systematic issues that remain. While changing the culture of medicine and health systems to address this is needed, what strategies can health care providers use in their everyday lives to lessen the impact of burnout? Integrative medicine with its focus on wholeness of patient care, including the emotional, mental, social, and spiritual domains of health, is uniquely positioned in arming physicians with sets of tools to help them navigate patients to better health and healing...
March 1, 2018: Otolaryngology—Head and Neck Surgery
Katherine S Chen, Scott M Glaser, Allison E Garda, John A Vargo, M Saiful Huq, Dwight E Heron, Sushil Beriwal
BACKGROUND: Clinical pathways outline criteria for dose homogeneity and critical organ dosimetry. Based upon an internal audit showing suboptimal compliance with dosimetric parameters in whole breast irradiation (WBI), we conducted a mandatory web-based teaching conference for the network. This study reports the impact of this initiative on subsequent treatment plans. METHODS: Radiation treatment plans were collected for the 10 most recent patients receiving WBI at 16 institutions within the UPMC Hillman Cancer Center network...
March 16, 2018: Radiation Oncology
Andrew McDowell, Neeraj Raizada, Sunil D Khaparde, Raghuram Rao, Sanjay Sarin, Aakshi Kalra, Virender Singh Salhotra, Sreenivas Achuthan Nair, Catharina Boehme, Claudia M Denkinger
BACKGROUND: Diagnosing tuberculosis (TB) in children presents considerable challenges. Upfront testing on Xpert® MTB/RIF ('Xpert')-a rapid molecular assay with high sensitivity and specificity-for pediatric presumptive TB patients, as recommended by India's Revised National Tuberculosis Control Program (RNTCP), can pave the way for early TB diagnosis. As part of an ongoing project implemented by Foundation for Innovative New Diagnostics (FIND) dedicated to providing upfront free-of-cost (FOC) Xpert testing to children seeking care in the public and private sectors, a qualitative assessment was designed to understand how national guidelines on TB diagnosis and Xpert technology have been integrated into the pediatric TB care practices of different health providers...
2018: PloS One
Sherine Ismail, Mohamed Osman, Rayf Abulezz, Hani Alhamdan, K H Mujtaba Quadri
Pharmacists possess pivotal competencies and expertise in developing clinical pathways (CPs). We present a tertiary care facility experience of pharmacists vis-a-vis interprofessional collaboration for designing and implementing CPs. We participated in the development of CPs as leading members of a collaborative team of healthcare professionals. We reviewed literature, aligning it with hospital formulary and institutional standards, and participated in weekly team meetings for six months. Several tools and services were adapted to guide prescribing and standardization of care through time-bound order sets...
March 16, 2018: Pharmacy (Basel, Switzerland)
Peng Wu, Jia-Li Liu, Shi-Mei Pei, Chang-Peng Wu, Kai Yang, Shu-Peng Wang, Song Wu
BACKGROUND: Renal cell carcinoma (RCC) account for over 80% of renal malignancies. The most common type of RCC can be classified into three subtypes including clear cell, papillary and chromophobe. ccRCC (the Clear Cell Renal Cell Carcinoma) is the most frequent form and shows variations in genetics and behavior. To improve accuracy and personalized care and increase the cure rate of cancer, molecular typing for individuals is necessary. METHODS: We adopted the genome, transcriptome and methylation HMK450 data of ccRCC in The Cancer Genome Atlas Network in this research...
March 13, 2018: BMC Cancer
Michèle Twomey, Ana Šijački, Gert Krummrey, Tyson Welzel, Aristomenis K Exadaktylos, Marko Ercegovac
Emergency center visits are mostly unscheduled, undifferentiated, and unpredictable. A standardized triage process is an opportunity to obtain real-time data that paints a picture of the variation in acuity found in emergency centers. This is particularly pertinent as the influx of people seeking asylum or in transit mostly present with emergency care needs or first seek help at an emergency center. Triage not only reduces the risk of missing or losing a patient that may be deteriorating in the waiting room but also enables a time-critical response in the emergency care service provision...
March 12, 2018: International Journal of Environmental Research and Public Health
Jennifer Naper, Luis Manetto, Diane Wiren
INTRODUCTION Local guidelines exist in Nelson to assist general practitioners (GPs) in supporting overweight and obese patients with weight loss and improvements in their overall health. This audit measures whether this role is fulfilled in a Very Low Cost Access practice in Nelson, in which 76% of enrolled patients reside in New Zealand social deprivation index quintiles 4 and 5. AIM This study measured whether Nelson Marlborough District Health Board Health Pathways and the Ministry of Health Clinical Guidelines are followed in identifying risk and initiating management, including treatment of additional risk factors, lifestyle modification and dietitian referral...
December 2017: Journal of Primary Health Care
Antonella Cotoia, Lucia Mirabella, Sabrina Altamura, Rachele Villani, Flavia Marchese, Giuseppe Ferrara, Karim Mariano, Tullo Livio, Gilda Cinnella
BACKGROUND: Sepsis caused by complicated intra-abdominal infection is associated with high mortality. Loss of endothelial barrier integrity, inflammation, and impaired cellular oxygen have been shown to be primary contributors to sepsis. To date, little is known regarding the pathway for the mobilization of endothelial progenitor cells (EPCs) from the bone marrow in sepsis whereas stromal-cell-derived factor 1a (SDF-1a) and hypoxia inducible factor 1 (HIF-1) seem to have a role in the EPC response to hypoxic microenvironments...
March 12, 2018: Trials
Sikhumbuzo A Mabunda, Leslie London, David Pienaar
BACKGROUND: A comprehensive primary healthcare (PHC) approach requires clear referral and continuity of care pathways. South Africa is a lower-middle income country (LMIC) that lacks data on the role of intermediate care (IC) services in the health system. This study described the model of service provision at one facility in Cape Town, including reason for admission, the mix of services and skills provided and needed, patient satisfaction, patient outcome and articulation with other services across the spectrum of care...
May 14, 2017: International Journal of Health Policy and Management
Heather Moquin, Cydnee Seneviratne, Lorraine Venturato
Background: Undergraduate nursing placement in aged care is forecast to grow in importance with the increasing aging population, and to help to reverse trends in student lack of interest in gerontology careers. However, there is a need to better understand undergraduate nursing students' experiences on placement with older adults, as well as key features of quality learning within residential aged care. The aim of this study was to explore how nursing students understand learning within residential aged care...
2018: BMC Nursing
M Fung-Kee-Fung, D E Maziak, J R Pantarotto, J Smylie, L Taylor, T Timlin, T Cacciotti, P J Villeneuve, C Dennie, C Bornais, S Madore, J Aquino, P Wheatley-Price, R S Ozer, D J Stewart
Background: The Ottawa Hospital (toh) defined delay to timely lung cancer care as a system design problem. Recognizing the patient need for an integrated journey and the need for dynamic alignment of providers, toh used a learning health system (lhs) vision to redesign regional diagnostic processes. A lhs is driven by feedback utilizing operational and clinical information to drive system optimization and innovation. An essential component of a lhs is a collaborative platform that provides connectivity across silos, organizations, and professions...
February 2018: Current Oncology
Mary Sawtell, Lorna Sweeney, Meg Wiggins, Cathryn Salisbury, Sandra Eldridge, Lauren Greenberg, Rachael Hunter, Inderjeet Kaur, Christine McCourt, Bethan Hatherall, Gail Findlay, Joanne Morris, Sandra Reading, Adrian Renton, Ruth Adekoya, Belinda Green, Belinda Harvey, Sarah Latham, Kanta Patel, Logan Vanlessen, Angela Harden
BACKGROUND: The provision of high-quality maternity services is a priority for reducing inequalities in health outcomes for mothers and infants. Best practice includes women having their initial antenatal appointment within the first trimester of pregnancy in order to provide screening and support for healthy lifestyles, well-being and self-care in pregnancy. Previous research has identified inequalities in access to antenatal care, yet there is little evidence on interventions to improve early initiation of antenatal care...
March 5, 2018: Trials
Monti Khatod
BACKGROUND: Total joint arthroplasty is a successful operation with increasing prevalence in the United States. Kaiser Permanente has been using multiple tools to optimize patient outcomes while keeping health-care expenditures in check. METHODS: We describe the patient, surgeon, and hospital perspective toward the delivery of sustainable arthroplasty care for a growing elderly population. Quality metrics for each stakeholder are presented. RESULTS: Kaiser Permanente optimizes value for the patient, surgeon, and hospital with the use of evidence-based integrated care pathways and a national joint arthroplasty registry...
February 28, 2018: Journal of Arthroplasty
Moshood O Omotayo, Katherine L Dickin, David L Pelletier, Stephanie L Martin, Jacqueline K Kung'u, Rebecca J Stoltzfus
Calcium (Ca) supplementation to prevent preeclampsia can save maternal and newborn lives, but there are no program models for integration into existing antenatal care platforms. We used a program impact pathway model to guide the design of integrated Ca and iron-folate (IFA) supplementation in Kenya. We provided healthcare providers with job aids (posters and counseling cards), trained them on counseling techniques and supplementation guidelines, and developed behavior change materials for pregnant women (pill-taking calendars)...
February 2018: Maternal & Child Nutrition
Silvia Forni, Giulio Toccafondi, Bruno Viaggi, Maddalena Grazzini, Sara D'Arienzo, Fabrizio Gemmi, Andrea Vannucci, Giorgio Tulli
Antimicrobial resistance is a global threat caused by the rapid spread of multiresistant microorganisms. Antimicrobial stewardship (AS) is a coordinated intervention designed to improve the appropriate use of antimicrobials by promoting the selection of the optimal drug regimen, dose, duration of therapy and route of administration. AS programs have proved effective in reducing antimicrobial resistance, inappropriate antimicrobial use and in improving patient outcomes. Recently developed rapid diagnostic technologies in microbiology (RDTM) allows a faster and etiological diagnosis of infection and a reduction in the use of unnecessary empirical therapies...
February 2018: Recenti Progressi in Medicina
Gülay Ateş, Anne Frederieke Ebenau, Csilla Busa, Ágnes Csikos, Jeroen Hasselaar, Birgit Jaspers, Johan Menten, Sheila Payne, Karen Van Beek, Sandra Varey, Marieke Groot, Lukas Radbruch
BACKGROUND: Family carers manage a wide range of responsibilities in the lives and care of patients receiving palliative care. They fulfil multiple roles and perform activities within different settings. This has immediate consequences on family carers' every-day lives. According to literature, family carers in palliative care are both part of the formal and informal care network, but also persons in need of support. This article aims to investigate 1) burdens and rewards associated with family caregiving and 2) what family carers find helpful in their contact with professionals from integrated palliative care initiatives (IPC-i) and other services...
March 1, 2018: BMC Palliative Care
Irma H J Everink, Jolanda C M van Haastregt, Silvia M A A Evers, Gertrudis I J M Kempen, Jos M G A Schols
BACKGROUND: Integrated care pathways which cover multiple care settings are increasingly used as a tool to structure care, enhance coordination and improve transitions between care settings. However, little is known about their economic impact. The objective of this study is to determine the cost-effectiveness and cost-utility of an integrated care pathway designed for patients with complex health problems transferring from the hospital, a geriatric rehabilitation facility and primary care...
2018: PloS One
Eva Louie, Vicki Giannopoulos, Andrew Baillie, Gabriela Uribe, Simon Byrne, Mark Deady, Maree Teesson, Amanda Baker, Paul S Haber, Kirsten C Morley
Comorbid mental health and substance use problems are highly prevalent in substance use treatment settings and generally lead to poorer treatment outcomes. Pathways to Comorbidity Care (PCC) is a multi-modal training program developed to encourage an integrated service approach to improve clinicians' capacity to identify and manage comorbid substance use and mental health outcomes within public drug and alcohol treatment settings. In this paper we describe the concepts underlying the PCC Package and the use of Implementation Science to assess and overcome potential barriers, including clinicians' preferences, knowledge about best practice and professional culture...
February 28, 2018: Journal of Dual Diagnosis
Parashar Pravin Ramanuj, Rachel Talley, Joshua Breslau, Scarlett Sijia Wang, Harold Alan Pincus
People with co-occurring behavioral and physical conditions receive poorer care through traditional health care services. One solution has been to integrate behavioral and physical care services. This study assesses efforts to integrate behavioral health and primary care services in New York. Semi-structured interviews were conducted with 52 professionals in either group or individual settings. We aimed to identify factors which facilitate or hinder integration for people with serious mental illness and how these factors inter-relate...
February 27, 2018: Community Mental Health Journal
Anthony J Lisi, Stacie A Salsbury, Cheryl Hawk, Robert D Vining, Robert B Wallace, Richard Branson, Cynthia R Long, A Lucille Burgo-Black, Christine M Goertz
OBJECTIVE: The purpose of this study was to develop an integrated care pathway for doctors of chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities. METHODS: The research method used was a consensus process. A multidisciplinary investigative team reviewed clinical guidelines and Veterans Affairs pain and mental health initiatives to develop seed statements and care algorithms to guide chiropractic management and collaborative care of veterans with low back pain...
February 2018: Journal of Manipulative and Physiological Therapeutics
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