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Primary care management

Amy L Christison, Susma Vaidya, Lydia Tinajero-Deck, Sarah E Hampl
BACKGROUND: Growth in the prevalence of severe pediatric obesity and tertiary care pediatric weight management programs supports the application of chronic disease management models to the care of children with severe obesity. One such model, the medical neighborhood, aims to optimize care coordination between primary and tertiary care by applying principles of the Patient-Centered Medical Home to all providers. METHODS: An exploration of the literature was performed describing effective programs, approaches, and coordinated care models applied to pediatric weight management and other chronic conditions...
August 15, 2018: Childhood Obesity
M Margariti, M Hadjulis, M Lazaridou, G F Angelidis, V Fotopoulos, L Markaki, F Koulouri
Schizophrenia is one of the most disabling disorders globally, with a significant impact on the professional, social and personal functioning of those affected. Mortality rates are estimated to be 2-2.5 times greater than in the general population attributable to not only suicide but also physical illnesses, such as cardiovascular, metabolic and infectious diseases. Patients with schizophrenia have increased needs for health services which vary according to the stage of the illness and the way the disorder affects the patient...
April 2018: Psychiatrikē, Psychiatriki
Nathalie Moise, Louise Falzon, Megan Obi, Siqin Ye, Sapana Patel, Christopher Gonzalez, Kelsey Bryant, Ian M Kronish
INTRODUCTION: Nearly 50% of depressed primary care patients referred to mental health services do not initiate mental health treatment. The most promising interventions for increasing depression treatment initiation in primary care settings remain unclear. METHODS: We performed a systematic search of publicly available databases from inception through August 2017 to identify interventions designed to increase depression treatment initiation. Two authors independently selected, extracted data, and rated risk of bias from included studies...
August 14, 2018: Journal of General Internal Medicine
Annie Heffernan Rominger, Gerardo Antonio Aguilar Gomez, Patrick Elliott
BACKGROUND: Medical care in resource limited settings is challenging, particularly with limited access to diagnostic and imaging studies. The most portable and cost effective diagnostic imaging in these areas is ultrasound. Ultrasound is a very teachable skill with a short, single intensive training course and hands-on teaching; however, there are limited data on a longitudinal point-of-care ultrasound (POCUS) curriculum in resource limited settings. The goal of this intervention is to develop an effective longitudinal POCUS curriculum for local physicians working in rural clinics in the state of Chiapas, Mexico, and evaluate its effectiveness on patient care...
August 15, 2018: Critical Ultrasound Journal
Khalid Mehmood, Nabeea Junaid
OBJECTIVE: To estimate the prevalence of undiagnosed diabetes in patients visiting the primary care physicians for any reason in urban outpatient settings. METHODS: This national, multicentre, non-interventional disease registry was conducted from October 2011 to August 2013 across Sindh and Punjab provinces of Pakistan and comprised randomly selected health centres with qualified general practitioners. Patients aged 45 years or more and willing to have a random blood sugar screening test were selected...
August 2018: JPMA. the Journal of the Pakistan Medical Association
Bhumika Aggarwal, Aruni Mulgirigama, Norbert Berend
Exercise-induced bronchoconstriction (EIB) can occur in individuals with and without asthma, and is prevalent among athletes of all levels. In patients with asthma, symptoms of EIB significantly increase the proportion reporting feelings of fearfulness, frustration, isolation, depression and embarrassment compared with those without symptoms. EIB can also prevent patients with asthma from participating in exercise and negatively impact their quality of life. Diagnosis of EIB is based on symptoms and spirometry or bronchial provocation tests; owing to low awareness of EIB and lack of simple, standardised diagnostic methods, under-diagnosis and mis-diagnosis of EIB are common...
August 14, 2018: NPJ Primary Care Respiratory Medicine
Hannah Dills, Kruti Shah, Barbara Messinger-Rapport, Kevin Bradford, Quratulain Syed
OBJECTIVES: Perform a systematic review to evaluate the outcome of deprescription compared with standard care. The focus was on chronic medical and mental health conditions managed in primary care. DESIGN: The databases searched include PubMed, Medline, EMBASE, the Cochrane Library, Scopus, and Web of Science. Each study was assessed for bias with the Cochrane Collaboration tool. SETTINGS AND PARTICIPANTS: This review included outpatient, assisted living, nursing home, and acute care settings (if medications for chronic disease were deprescribed)...
August 11, 2018: Journal of the American Medical Directors Association
Joanna Goldthorpe, Caroline Sanders, Lesley Gough, Jean Rogers, Colette Bridgman, Martin Tickle, Iain Pretty
BACKGROUND: A primary care oral surgery service was commissioned alongside an electronic referral management system in England, in response to rising demand for Oral Surgery services in secondary care. It is important to ensure that standards of quality and safety are similar to those in existing secondary care services, and that the new service is acceptable to stakeholders. The aim of this study is therefore to conduct an in depth case study to explore safety, quality, acceptability and implementation of the new service...
August 14, 2018: BMC Health Services Research
Marelle Heesterbeek, Eddy A Van der Zee, Marieke J G van Heuvelen
BACKGROUND: Dementia affects cognitive functioning, physical functioning, activities of daily living (ADLs), and quality of life (QOL). Pharmacological treatments to manage, cure or prevent dementia remain controversial. Therefore development of non-pharmacological approaches to prevent, or at least delay the onset and progression of dementia is urgently needed. Passive exercise is proposed to be such a non-pharmacological alternative. This study primarily aims to investigate the effects of three different forms of passive exercise on QOL and ADLs of institutionalized patients with dementia...
August 14, 2018: BMC Geriatrics
Rosy Tsopra, Jeremy C Wyatt, Paul Beirne, Kirsty Rodger, Matthew Callister, Dipansu Ghosh, Ian J Clifton, Paul Whitaker, Daniel Peckham
RATIONALE: One of the key functions of the discharge summary is to convey accurate diagnostic description of patients. Inaccurate or missing diagnoses may result in a false clinical picture, inappropriate management, poor quality of care, and a higher risk of re-admission. While several studies have investigated the presence or absence of diagnoses within discharge summaries, there are very few published studies assessing the accuracy of these diagnoses. The aim of this study was to measure the accuracy of diagnoses recorded in sample summaries, and to determine if it was correlated with the type of diagnoses (eg, "respiratory" diagnoses), the number of diagnoses, or the length of patient stay...
August 14, 2018: Journal of Evaluation in Clinical Practice
Henrik Svedsater, Helen A Doll, Jake Macey, Gail Miles, Lisa Bradshaw, Magdalena Vanya
INTRODUCTION: This study evaluated patients' experiences with fluticasone furoate/vilanterol (FF/VI) combination therapy in UK patients with asthma or chronic obstructive pulmonary disease (COPD). METHODS: Participants aged ≥ 18 years, with self-reported, physician-diagnosed asthma or COPD (≥ 1 year) who had been receiving FF/VI (≥ 3 months) were recruited from UK primary care. This two-phase, mixed-methods study consisted of a semi-structured, telephone-interview phase (qualitative) and a self-completed online/paper-survey phase (quantitative)...
August 13, 2018: Advances in Therapy
F F Girrbach, F Hilbig, M Michael, M Bernhard
BACKGROUND: A myriad of publications have contributed to an evidence-based approach to airway management in emergency services and admissions in recent years; however, it remains unclear which international registries on airway management in emergency medicine currently exist and how they are characterized concerning inclusion criteria, patient characteristics and definition of complications. METHODS: A systematic literature research was carried out in PubMed with respect to publications from 2007-2017...
August 13, 2018: Der Anaesthesist
Ana C Bradi, Lucian Sitwell, Clare Liddy, Amir Afkham, Erin Keely
Background: Access to neurology consultation is limited by high demand and urgency of the presentation. Champlain BASETM (Building Access to Specialists through eConsultation) (eConsult service) aims to increase access through direct communication between primary care providers (PCPs) and specialists. Rapid responses to PCP questions can guide management and sometimes relieve the need for a formal consultation. We reviewed which topics were frequently addressed, the types of questions asked, and the effect on primary care for the patient...
June 2018: Neurology. Clinical Practice
Caroline Bollars, Take Naseri, Robert Thomsen, Cherian Varghese, Kristine Sørensen, Nanne de Vries, Ree Meertens
Problem: Samoa has been struggling to address the burden of noncommunicable diseases at the health system, community and individual levels. Approach: The World Health Organization (WHO) package of essential noncommunicable disease interventions for primary health care in low-resource settings was adopted in seven villages throughout Samoa in 2015. The National Steering Committee Members designed and implemented a screening process, and local facilitators and health-care workers collected health and lifestyle data...
August 1, 2018: Bulletin of the World Health Organization
Robin Urquhart, Jyoti Kotecha, Cynthia Kendell, Mary Martin, Han Han, Beverley Lawson, Cheryl Tschupruk, Emily Gard Marshall, Carol Bennett, Fred Burge
BACKGROUND: Strategies have been developed for use in primary care to identify patients at risk of declining health and dying, yet little is known about the perceptions of doing so or the broader implications and impacts. AIM: To explore the acceptability and implications of using a primary care-based electronic medical record algorithm to help providers identify patients in their practice at risk of declining health and dying. DESIGN AND SETTING: Qualitative descriptive study in Ontario and Nova Scotia, Canada...
August 13, 2018: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Charlotte Albury, Elizabeth Stokoe, Sue Ziebland, Helena Webb, Paul Aveyard
BACKGROUND: Guidelines encourage GPs to make brief opportunistic interventions to support weight loss. However, GPs fear that starting these discussions will lead to lengthy consultations. Recognising that patients are committed to take action could allow GPs to shorten brief interventions. AIM: To examine which patient responses indicated commitment to action, and the time saved if these had been recognised and the consultation closed sooner. DESIGN AND SETTING: A mixed-method cohort study of UK primary care patients participating in a trial of opportunistic weight management interventions...
August 13, 2018: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Nishma Patel, Rebecca J Beeken, Baptiste Leurent, Rumana Z Omar, Irwin Nazareth, Stephen Morris
OBJECTIVE: Ten Top Tips (10TT) is a primary care-led behavioural intervention which aims to help adults reduce and manage their weight by following 10 weight loss tips. The intervention promotes habit formation to encourage long-term behavioural changes. The aim of this study was to estimate the cost-effectiveness of 10TT in general practice from the perspective of the UK National Health Service. DESIGN: An economic evaluation was conducted alongside an individually randomised controlled trial...
August 13, 2018: BMJ Open
Musa AlHarbi, Nahla Ali Mobark, Latifa AlMubarak, Rasha Aljelaify, Mariam AlSaeed, Amal Almutairi, Fatmah Alqubaishi, M Emarat Hussain, Ali Abdullah O Balbaid, Amal Said Marie, Lamia AlSubaie, Saeed AlShieban, Nada alTassan, Shakti H Ramkissoon, Malak Abedalthagafi
Primary brain tumors are a leading cause of cancer-related morbidity and mortality in children. Glioblastoma (GBM) is a high-grade astrocytoma that occurs in both children and adults and is associated with a poor prognosis. Despite extensive study in recent years, the clinical management of these tumors has remained largely unchanged, consisting of surgical resection, conventional chemotherapy, and radiotherapy. Although the etiology and genomic drivers in GBM are diverse, constitutional mismatch repair-deficiency (CMMRD) syndrome is a rare, recessively inherited disease with a predisposition to gliomagenesis...
August 13, 2018: Oncologist
Danielle R Fixen, Sunny A Linnebur, Bennett L Parnes, Maria V Vejar, Joseph P Vande Griend
PURPOSE: The implementation and delivery of a pharmacist-led chronic care management (CCM) service in a geriatric primary care clinic are described. METHODS: A CCM service was provided March 1 through December 31, 2016, at the University of Colorado Hospital Seniors Clinic ("Seniors Clinic"). The electronic health record (EHR) team for the University of Colorado Health system developed a patient registry through EPIC Healthy Planet (Epic Systems Corp., Verona, WI) to identify patients at the Seniors Clinic eligible for CCM services...
August 13, 2018: American Journal of Health-system Pharmacy: AJHP
Nancy Cantey Banasiak
BACKGROUND: Asthma is one of the major chronic diseases in the pediatric population, affecting 9.5% of children. The National Heart, Lung, and Blood Institute recommends the use of the Asthma Control Test (ACT) for periodic assessment of asthma control. The purpose of this evidence-based project was to implement the Asthma Control Test screening tool into the primary care practice to improve management of patients with asthma by more accurately addressing asthma control. METHODS: The project was a pre- and post-implementation study comparing two different groups of patients with asthma seen at the clinic over 5-week periods...
August 10, 2018: Journal of Pediatric Health Care
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