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Primary care management

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BACKGROUND: A body of empirical work demonstrates that wide fluctuations in a person's blood pressure across consecutive measures, known as blood pressure variability (BPV), hold prognostic value to predict stroke and transient ischemic attack. However, the magnitude of association between BPV and other neurological outcomes remains less clear. This systematic review aims to pool together data regarding BPV with respect to incident dementia, cognitive impairment, and cognitive function...
October 15, 2018: Systematic Reviews
Maryam Sina, Freya MacMillan, Tinashe Dune, Navodya Balasuriya, Nouran Khouri, Ngan Nguyen, Vasyngpong Jongvisal, Xiang Hui Lay, David Simmons
BACKGROUND: Poor diabetes management prior to conception, results in increased rates of fetal malformations and other adverse pregnancy outcomes. We describe the development of an integrated, pre-pregnancy management strategy to improve pregnancy outcomes among women of reproductive age with diabetes in a multi-ethnic district. METHODS: The strategy included (i) a narrative literature review of contraception and pre-pregnancy interventions for women with diabetes and development of a draft plan; (ii) a chart review of pregnancy outcomes (e...
October 15, 2018: BMC Pregnancy and Childbirth
Peter H Baenziger, Karen Moody
Children with central nervous system (CNS) malignancies often suffer from high symptom burden and risk of death. Pediatric palliative care is a medical specialty, provided by an interdisciplinary team, which focuses on enhancing quality of life and minimizing suffering for children with life-threatening or life-limiting disease, and their families. Primary palliative care skills, which include basic symptom management, facilitation of goals-of-care discussions, and transition to hospice, can and should be developed by all providers of neuro-oncology care...
October 13, 2018: Bioengineering
K Brizzi, C J Creutzfeldt
Neuropalliative care is a new and growing field within neurology that focuses on improving the quality of life of patients with serious neurologic illnesses. While specialty-level palliative care training is available to interested neurologists, all neurologists can strive to provide primary palliative care for their patients. In this review, we will describe the scope of neuropalliative care, define patient populations who may benefit from palliative care, and explore the communication and symptom management skills essential to palliative care delivery...
October 2018: Seminars in Neurology
Marisa Miraldo, Carol Propper, Rachael I Williams
In 2006, the Massachusetts healthcare reform was introduced to mandate health insurance, extend eligibility of publicly subsidised health insurance, improve quality and access to care and develop preventive health services. The objective of this study was to determine the impact of expanding publicly subsidised health insurance through the Massachusetts reform on access to primary care, disease management and behavioural risk factors. Using cross-sectional data from the Behavioural Risk Factor Surveillance System (BRFSS) from 2001 to 2010 and exploiting the selective introduction of the healthcare reform, we assessed its impact on primary care access, behavioural risk factors, such as obesity, and receipt of diabetes management tests...
September 20, 2018: Social Science & Medicine
Ranmini S Kularatne, Ronelle Niit, Jane Rowley, Tendesayi Kufa-Chakezha, Remco P H Peters, Melanie M Taylor, Leigh F Johnson, Eline L Korenromp
OBJECTIVES: To estimate trends in prevalence and incidence of syphilis, gonorrhea and chlamydia in adult men and women in South Africa. METHODS: The Spectrum-STI tool estimated trends in prevalence and incidence of active syphilis, gonorrhea and chlamydia, fitting South African prevalence data. Results were used, alongside programmatic surveillance data, to estimate trends in incident gonorrhea cases resistant to first-line treatment, and the reporting gap of symptomatic male gonorrhea and chlamydia cases treated but not reported as cases of urethritis syndrome...
2018: PloS One
Tamilyn Bakas, Debi Sampsel, Jahmeel Israel, Ameya Chamnikar, Angela Ellard, John Greer Clark, Megan Gresham Ulrich, Dieter Vanderelst
BACKGROUND AND PURPOSE: With the growth in the aging population, and shortage of primary care providers, telehealth programs are needed to optimize healthy independent living for older adults. The purpose of this study was to evaluate a nurse-led intervention program delivered through a telepresence robot to promote healthy lifestyles and address chronic illness management among older adults living independently in a retirement community. Telepresence robots provide two-way video-mediated communication with remote in-home navigation...
October 15, 2018: Journal of Nursing Scholarship
Andrew D Williams, Marie-Louise Bird, Sibella Gk Hardcastle, Mark Kirschbaum, Kathryn J Ogden, Julia Ae Walters
BACKGROUND: Current treatment modalities for cancer have been successful in achieving improved survivorship; however, they come with a number of long-term adverse effects. Accidental falls are a common and clinically significant adverse event in people living with and beyond cancer and rates are higher than in the rest of the population. OBJECTIVES: To assess the effects of prescribed or provided exercise for reducing accidental falls, and falls risk factors of strength, flexibility and balance, in people living with and beyond cancer...
October 15, 2018: Cochrane Database of Systematic Reviews
Supa Pengpid, Karl Peltzer
Background: Quality of life is a key measure in estimating the burden of disease, especially of chronic diseases. This study investigated the impact of a variety of chronic diseases on quality of life (QoL) in primary health care patients in three Southeast Asian countries (Cambodia, Myanmar, and Vietnam). Methods: This cross-sectional survey was conducted on 4803 adult chronic disease patients (mean age 49.3 yr; SD=16.5) recruited systematically from primary health care centers in rural and urban areas in Cambodia, Myanmar and Vietnam in 2015...
September 2018: Iranian Journal of Public Health
Takayuki Nakai, Akira Matsuo, Yoshifumi Takata, Yasuhiro Usui, Koichi Kitamura, Daichi Chikazu
OBJECTIVE: Obstructive sleep apnea (OSA) is a significant social and health issue. An integrated multidisciplinary approach to OSA management may be the most effective owing to its multifactorial etiology. In this study, we evaluated the frequency and efficacy of various treatment modalities for OSA administered via an integrated care delivery model, and assessed the role of dental sleep medicine as part of a multidisciplinary team. MATERIALS AND METHODS: We retrospectively evaluated 1115 patients with OSA treated at the Tokyo Medical University Hospital's Outpatient Clinic for OSA by a multidisciplinary team under one roof...
November 2018: Acta Odontologica Scandinavica
Pilar Arrizabalaga, Mónica Gómez, Ignacio Menacho, Lidia Pallisa, Vanesa Jorge, Esteban Poch
The coordination between nephrology and primary care is well documented in the management of chronic kidney disease (CKD), but the real impact is uncertain. OBJECTIVE: To evaluate the efficiency of an outpatient nephrology program (ONP) implanted progressively over the course of 10 years regarding the demand for CKD care in the Integral Health Area of Barcelona Esquerra, accounting for 524,395 inhabitants, which is more than a third of the population of Barcelona. MATERIAL AND METHODS: The number and age of the new referrals to nephrology between 2004 and 2014 were identified and a referral index (RI) was established between the number of new referrals and the estimated prevalence of CKD in the population treated, based on the implementation of the ONP...
October 11, 2018: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Malaka Ameratunga, Dorothea Miller, Wayne Ng, Mori Wada, Augusto Gonzalvo, Lawrence Cher, Hui K Gan
Multi-disciplinary team meetings (MDTs) are considered essential to quality cancer care. For some malignancies, MDTs have been associated with improved outcomes, but data regarding the neuro-oncology MDT is limited. We prospectively described the MDT at our institution and evaluated its impact on clinical management. Cases were discussed amongst the treating team and a pre-MDT plan and reason for discussion (RFD) was documented before the MDT. Patient specific clinical data was captured prospectively, with further pathological and radiological information captured during the MDT...
October 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Sascha Köpke, Alessandra Solari, Anne Rahn, Fary Khan, Christoph Heesen, Andrea Giordano
BACKGROUND: People with multiple sclerosis (MS) are confronted with a number of important uncertainties concerning many aspects of the disease. These include diagnosis, prognosis, disease course, disease-modifying therapies, symptomatic therapies, and non-pharmacological interventions, among others. While people with MS demand adequate information to be able to actively participate in medical decision making and to self manage their disease, it has been shown that patients' disease-related knowledge is poor, therefore guidelines recommend clear and concise high-quality information at all stages of the disease...
October 14, 2018: Cochrane Database of Systematic Reviews
Tonya M Palermo, William T Zempsky, Carlton D Dampier, Chitra Lalloo, Amos S Hundert, Lexa K Murphy, Nitya Bakshi, Jennifer N Stinson
Many adolescents with sickle cell disease (SCD) experience recurrent and chronic pain, which has a negative impact on their health-related quality of life (HRQL). Cognitive-behavioral therapy (CBT) interventions can lead to improvement in pain and HRQL, yet due to barriers to care, most youth with SCD will not receive these interventions. To address this need for innovative programs targeting youth with SCD pain, we developed iCanCope, a tailored smartphone and web-based program that delivers a pain self-management intervention to youth with SCD...
October 11, 2018: Contemporary Clinical Trials
Allan K Grill, Scott Brimble
OBJECTIVE: To help primary care providers, both family physicians and nurse practitioners, identify, detect, and manage patients with and at risk of chronic kidney disease (CKD), as well as outline criteria for appropriate referral to nephrology. SOURCES OF INFORMATION: Published guidelines on the topic of CKD and its comorbidities were reviewed. A MEDLINE search was conducted using the MeSH terms chronic renal insufficiency, family practice, and primary health care ...
October 2018: Canadian Family Physician Médecin de Famille Canadien
Silvia Librada Flores, Emilio Herrera Molina, Fátima Díaz Díez, María José Redondo Moralo, Cristina Castillo Rodríguez, Kathleen McLoughlin, Julian Abel, Tamen Jadad Garcia, Miguel Ángel Lucas Díaz, Inmaculada Trabado Lara, María Dolores Guerra-Martín, María Nabal
BACKGROUND: End-of-life needs can be only partly met by formalized health and palliative care resources. This creates the opportunity for the social support network of family and community to play a crucial role in this stage of life. Compassionate communities can be the missing piece to a complete care model at the end of life. OBJECTIVE: The main objective of this study is to evaluate the REDCUIDA (Redes de Cuidados or Network of Care) intervention for the development and management of networks of care around people with advanced disease or at the end of life...
October 12, 2018: JMIR Research Protocols
Carlos Ortiz-Bautista, Laura Morán-Fernández, Marta Díaz-García, Miguel Ángel Delgado-Nicolás, Inés Ponz-de Antonio, Adriana Rodríguez-Chaverri, Mª Dolores García-Cosio, Javier de Juan-Bagudá, David Lora-Pablos, Violeta Sánchez-Sánchez, Pilar Escribano-Subías, Héctor Bueno, Fernando Arribas-Ynsaurriaga, Juan F Delgado-Jiménez
BACKGROUND AND OBJECTIVE: Several trials have evaluated the effect of disease management programs in heart failure (HF) with diverse results. The aim of this study was to develop a simple nurse-led clinic intervention program for patients with HF and assess whether this intervention positively affects the prognosis of patients, their care costs and perceived quality of life (QoL). METHODS: Between 2011 and 2013, 127 patients with reduced ejection fraction were prospectively randomly allocated (1:2) to standard care or intervention program...
October 9, 2018: Medicina Clínica
Brandon Barnds, William Tucker, Brandon Morris, Armin Tarakemeh, John Paul Schroeppel, Scott Mullen, Bryan G Vopat
BACKGROUND: Controversy exists regarding optimal primary management of Lisfranc injuries. Whether open reduction internal fixation (ORIF) or primary arthrodesis is superior remains unknown. METHODS: A national insurance database of approximately 23.5 million orthopedic patients was retrospectively queried for subjects who were diagnosed with a Lisfranc injury from 2007 to 2016 based on international classification of diseases (ICD) codes (PearlDiver, Colorado Springs, CO)...
October 3, 2018: Injury
Nathalie Moise, Ravi N Shah, Susan Essock, Amy Jones, Jay Carruthers, Margaret A Handley, Lauren Peccoralo, Lloyd Sederer
BACKGROUND: In a large statewide initiative, New York State implemented collaborative care (CC) from 2012 to 2014 in 32 primary care settings where residents were trained and supported its sustainability through payment reforms implemented in 2015. Twenty-six clinics entered the sustainability phase and six opted out, providing an opportunity to examine factors predicting continued CC participation and fidelity. METHODS: We used descriptive statistics to assess implementation metrics in sustaining vs...
October 12, 2018: Implementation Science: IS
Irene Svenningsson, Camilla Udo, Jeanette Westman, Shabnam Nejati, Dominique Hange, Cecilia Björkelund, Eva-Lisa Petersson
OBJECTIVE: The aim of this study was to explore nurses' experiences and perceptions of working as care managers at primary care centers. DESIGN: Qualitative, focus group study. Systematic text condensation was used to analyze the data. SETTING: Primary health care in the region of Västra Götaland and region of Dalarna in Sweden. SUBJECTS: Eight nurses were trained during three days including treatment of depression and how to work as care managers...
October 12, 2018: Scandinavian Journal of Primary Health Care
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