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Primary care management

Shirdhya Joypaul, Fiona S Kelly, Michelle A King
Objective: To measure the impact of the multidisciplinary Turning Pain Into Gain program in people experiencing chronic pain of any etiology. Methods: A mixed-methods observational study of 252 participants was used to explore the impact of Turning Pain Into Gain on medication use; quality of life and functioning, as measured by the Pain Self-Efficacy Questionnaire; and self-reported hospitalizations between 2015 and 2016. Results: Responses from 178 participants showed an increased alignment with Australian pain medication guidelines (e...
December 12, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Tomoaki Yatabe, Moritoki Egi, Masahiko Sakaguchi, Takashi Ito, Nobuhiro Inagaki, Hiromi Kato, Jun Kaminohara, Amane Konishi, Michiko Takahashi, Hiroomi Tatsumi, Masaru Tobe, Ikue Nakashima, Naoki Nakamoto, Takeshi Nishimura, Masakazu Nitta, Masaji Nishimura
BACKGROUND: There is lack of evidence regarding nutritional management among intensive care unit (ICU) patients in a population with relatively low body mass index. Therefore, we conducted an observational study to assess the nutritional management in Japanese ICUs. Also, we investigated the impact of nutritional management and rehabilitation on physical outcome. METHODS: The study population comprised 389 consecutive patients who received mechanical ventilation for at least 24 h and those admitted to the ICU for > 72 h in 13 hospitals...
December 12, 2018: Annals of Nutrition & Metabolism
Elen Ferraz Teston, Dandara Novakowski Spigolon, Edilaine Maran, Aliny de Lima Santos, Laura Misue Matsuda, Sonia Silva Marcon
OBJECTIVE: to grasp the perspective of nurses on health education in the process of caring for people with Diabetes Mellitus in Primary Care. METHOD: a descriptive study of a qualitative nature carried out with 13 nurses from the Family Health Strategy in Southern Brazil. The data were collected in November and December of 2017, through recorded interviews, which were submitted to content analysis, thematic modality. RESULTS: three categories emerged, which show from the perspective of nurses, the influence of structural and assistance characteristics in the development of educational actions; outcomes of these actions, and possibilities to increase their quality as central to the nursing action...
2018: Revista Brasileira de Enfermagem
Matheus Costa Brandão Matos, Layze Braz de Oliveira, Artur Acelino Francisco Luz Nunes Queiroz, Álvaro Francisco Lopes Sousa, Andreia Rodrigues Moura da Costa Valle, Denise de Andrade, Maria Eliete Batista Moura
OBJECTIVE: To evaluate the knowledge of Nursing professionals regarding waste management in primary healthcare services. METHOD: Descriptive study with a mixed approach, developed with 42 nursing professionals who worked in basic health units of a capital in the Brazilian Northeast Region. Quantitative variables were analyzed by the SPSS 20.0 program. Reports were processed by the IRaMuTeQ software, analyzed according to the descending hierarchical classification, and grounded on the Collective Subject Discourse...
2018: Revista Brasileira de Enfermagem
Regina Cavalcante Agonigi, Simone Mendes Carvalho, Mary Ann Menezes Freire, Lucas Fernandes Gonçalves
OBJECTIVE: To identify the factors interfering in the production of care in the daily work of health professionals from the Primary Health Care. METHOD: Qualitative research carried out with Family Health Strategy (FHS) teams, in the health units of Rocinha (Rocinha is a favela located in the South Zone of the city of Rio de Janeiro, Brazil). To analyze the data, the thematic network proposed by Attride-Stirling was used. RESULTS: The routine of Teams in the Production of Care was the denomination of the network formed by the following themes: scales of services of the teams; structural problems of Family Health Units; standardization of protocols; challenges for the production of care; and collections of micro and macro management...
2018: Revista Brasileira de Enfermagem
Johanne Martel-Pelletier, Emmanuel Maheu, Jean-Pierre Pelletier, Ludmila Alekseeva, Ouafa Mkinsi, Jaime Branco, Pierre Monod, Frédéric Planta, Jean-Yves Reginster, François Rannou
BACKGROUND AND AIMS: Although osteoarthritis (OA) is managed mainly in primary care, general practitioners (GPs) are not always trained in its diagnosis, which leads to diagnostic delays, unnecessary resource utilization, and suboptimal patient outcomes. METHODS: To address this situation, an International Rheumatologic Board (IRB) of 8 experts from 3 continents developed guidelines for the diagnosis of OA in primary care. The focus was three major topologies: hip, knee, and hand/finger OA...
December 11, 2018: Aging Clinical and Experimental Research
Shokei Matsumoto, Kyoungwon Jung, Alan Smith, Motoyasu Yamazaki, Mitsuhide Kitano, Raul Coimbra
Background: The National Trauma Data Bank (NTDB) has served as a global benchmark for trauma care quality and outcomes. Herein, we compared patient characteristics, trauma management, and outcomes between Japanese emergency and critical care centers and US level 1 trauma centers using the Japanese Trauma Data Bank (JTDB) and NTDB. Methods: A retrospective cohort matching (1:1) study was performed. Patients treated in 2013 with an Injury Severity Score ≥9 were included...
2018: Trauma surgery & acute care open
Joel Jun Kai Koh, Rui Xiang Cheng, Yicheng Yap, Victoria Haldane, Yao Guo Tan, Krichelle Wei Qi Teo, Aastha Srivastava, Pei Shi Ong, Pablo Perel, Helena Legido-Quigley
Background: Atherosclerotic cardiovascular disease (ASCVD) is a growing public health threat globally, and many individuals remain undiagnosed, untreated, and their condition remains uncontrolled. The key to effective ASCVD management is adherence to pharmacotherapy, and non-adherence has been associated with an increased risk of cardiovascular events and complications such as stroke, further impacting a patient's ability to be adherent. Our qualitative study aimed to explore factors influencing medication adherence in the primary and secondary prevention of ASCVD in Singapore...
2018: Patient Preference and Adherence
Kirsi M Kinnunen, Penny Rapaport, Lucy Webster, Julie Barber, Simon D Kyle, Brendan Hallam, Claudia Cooper, Rossana Horsley, James A Pickett, Anastasia Vikhanova, Colin A Espie, Gill Livingston
BACKGROUND: It has been estimated that between 25% and 40% of people living with dementia suffer from sleep disturbances, and there are currently no known effective treatments. Sleep disturbances may be the direct result of dementia or due to other comorbidities, such as pain and limited mobility. If carers' sleep is also disturbed, carers too can become tired and stressed, and this sometimes results in the breakdown of care in the home. OBJECTIVES: To design an evidence-based manualised non-pharmacological therapy for sleep disturbances and test it for feasibility and acceptability...
December 2018: Health Technology Assessment: HTA
Ashruta Patel, Gary Daniels
BACKGROUND: Factitious disorder causing hypoglycemia is a psychiatric condition in which patients deliberately use blood sugar lowering medications to cause severe symptoms for the purposes of hospitalization or other primary gains. CASE PRESENTATION: We report a case of factitious hypoglycemia in a 19-year-old foster care adolescent female who presented to the Emergency Department with recurrent hypoglycemic episodes, to the degree that the patient required large amounts of dextrose and further management by intensive care unit hospitalization...
December 11, 2018: BMC Emergency Medicine
Juan I Muñoz-Bonet, José L López-Prats, Eva M Flor-Macián, Teresa Cantavella, Laura Bonet, Amparo Domínguez, Juan Brines
INTRODUCTION: Medical care for ventilator-dependent children must avoid hospital confinement, which is detrimental to the patient, their family and Paediatric Intensive Care Unit. Our objective was to assess the role of telemedicine in facilitating early and permanent discharge of such patients to home care. METHODS: This was a prospective clinical study (2007-2017) in tracheotomised ventilator-dependent children. We used a Big Data Telemedicine home system (Medlinecare 2...
December 11, 2018: Journal of Telemedicine and Telecare
Leonard J Keller, Vincent J Alentado, Joseph E Tanenbaum, Bryan S Lee, Amy S Nowacki, Edward C Benzel, Thomas E Mroz, Michael P Steinmetz
BACKGROUND CONTEXT: A spinal epidural abscess (SEA) is a serious condition that may be managed with antibiotics alone or with decompressive surgery combined with antibiotics. PURPOSE: The objectives of this study were to assess the clinical outcomes of SEA after surgical management and to identify the patient-level factors that are associated with outcomes following surgical decompression and removal of SEA. STUDY DESIGN/SETTING: Retrospective chart review analysis...
December 8, 2018: Spine Journal: Official Journal of the North American Spine Society
Rachel Rosenblum, Ran Huo, Bethann Scarborough, Nathan Goldstein, Cardinale B Smith
PURPOSE: The Quality Oncology Practice Initiative (QOPI) is a quality measurement and improvement program designed to assess practice performance for various consensus-based and evidence-based measures. In this study, we evaluated differences in QOPI metrics met among patients with advanced solid cancer receiving routine oncologic care alone (routine care) compared with patients receiving integrated oncology and specialty-level palliative care (supportive care). METHODS: We conducted a retrospective chart review of 100 randomly selected patients treated between June 2013 and June 2015 from our supportive care group and matched these patients to 100 routine care group patients on the basis of tumor type and initial oncology visit date...
December 2018: Journal of Oncology Practice
Katharina Welsch, Helmut Breuninger, Gisela Metzler, Franziska Sickinger, Franziska Carola Eberle, Hans-Martin Häfner, Saskia Maria Schnabl
BACKGROUND: Cutaneous sarcomas are rare and characterized by pathogenetic heterogeneity. Knowledge about local infiltration patterns and recurrence rates may be useful in improving patient care and outcomes. The objective of the present study was to compare these two characteristics in sarcomas that had been treated using the identical surgical procedure. PATIENTS AND METHODS: Between 2006-2010, 84 patients with various types of sarcoma underwent surgery followed by three-dimensional histology...
December 2018: Journal der Deutschen Dermatologischen Gesellschaft, Journal of the German Society of Dermatology: JDDG
Zena Eh Moore, Joan Webster
BACKGROUND: Pressure ulcers, localised injuries to the skin or underlying tissue, or both, occur when people cannot reposition themselves to relieve pressure on bony prominences. These wounds are difficult to heal, painful, expensive to manage and have a negative impact on quality of life. Prevention strategies include nutritional support and pressure redistribution. Dressing and topical agents aimed at prevention are also widely used, however, it remains unclear which, if any, are most effective...
December 6, 2018: Cochrane Database of Systematic Reviews
Pauline Joyce, Zena Eh Moore, Janice Christie
BACKGROUND: Pressure ulcers, which are a localised injury to the skin, or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful, expensive to manage and have a negative impact on quality of life. While individual patient safety and quality care stem largely from direct healthcare practitioner-patient interactions, each practitioner-patient wound-care contact may be constrained or enhanced by healthcare organisation of services...
December 9, 2018: Cochrane Database of Systematic Reviews
Janani Pinidiyapathirage, Scott Kitchener, Sarah McNamee, Sacha Wynter, Jack Langford, Ashley Doyle, Andrew McMahon
OBJECTIVE: Agricultural industries are among the most dangerous in Australia posing significant public health risks. This study analyses the nature and management of agriculture-related injuries presenting to EDs in selected hospitals in Southern Queensland. METHODS: Data on agricultural injury presentations over a 6 month period was collected at four rural hospitals by a dedicated onsite hospital data coordinator. Additionally, in two of the participating hospitals all injury presentations over the same 6 month period were recorded...
December 11, 2018: Emergency Medicine Australasia: EMA
Simon Dunne, Laura Coffey, Linda Sharp, Deirdre Desmond, Rachael Gooberman-Hill, Eleanor O'Sullivan, Aileen Timmons, Ivan Keogh, Conrad Timon, Pamela Gallagher
BACKGROUND: Self-management may help cancer survivors to better deal with challenges to their physical, functional, social and psychological well-being presented by cancer and its treatment. Nonetheless, little is known about how people integrate cancer self-management practices into their daily lives. The aim of this study was to describe and characterise the processes through which head and neck cancer (HNC) survivors attempt to integrate self-management into their daily lives following primary treatment...
December 8, 2018: Journal of Cancer Survivorship: Research and Practice
Graham R McClure, Emilie P Belley-Cote, John Harlock, Andre Lamy, Michael Stacey, P J Devereaux, Richard P Whitlock
PURPOSE: Postoperative infection, particularly in cardiac surgery, results in significant morbidity, mortality, and healthcare cost. Identification of novel predictors of postoperative infection can target high-risk populations for prophylactic intervention. METHODS: Steroids in cardiac surgery (SIRS) was a multi-centre randomized-controlled trial assessing intraoperative administration of methylprednisone during cardiac surgery, which enrolled 7,507 patients across 80 centres in 18 countries...
December 10, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Kerstin Maehder, Bernd Löwe, Martin Härter, Daniela Heddaeus, Martin Scherer, Angelika Weigel
Background: Stepped care models comprise a graded treatment intensity and a systematic monitoring. For an effective implementation, stepped care models have to account for the high rates of mental and somatic comorbidity in primary care. Objectives: The aim of the systematic review was to take stock of whether present stepped care models take comorbidities into consideration. A further aim was to give an overview on treatment components and involved health care professionals...
December 7, 2018: Family Practice
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