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Patient-centered medical home

Anuja Bandyopadhyay, A Ioana Cristea, Stephanie D Davis, Veda L Ackerman, James E Slaven, Hasnaa E Jalou, Deborah C Givan, Ameet Daftary
RATIONALE: There is a lack of evidence regarding factors associated with failure of tracheostomy decannulation. OBJECTIVES: We aimed to identify characteristics of pediatric patients who fail a tracheostomy decannulation challenge Methods: A retrospective review was performed on all patients who had a decannulation challenge at a tertiary care center from June 2006 to October 2013. Tracheostomy decannulation failure was defined as reinsertion of the tracheostomy tube within 6 months of the challenge...
October 21, 2016: Annals of the American Thoracic Society
Suhitha Veeravelli, Bijan Najafi, Ivan Marin, Fernando Blumenkron, Shannon Smith, Stephen A Klotz
Approximately 1.2 million people in the United States live with HIV infection. Medical advancements have increased the life expectancy and this cohort is aging. HIV-positive individuals have a high incidence of frailty (~20%) characterized by depression and sedentary behavior. Exercise would be healthy, but due to the frail status of many HIV-positive individuals, conventional exercise is too taxing. The aim of this study was to evaluate the effectiveness and acceptability of a novel game-based training program (exergame) in ameliorating some aspects of frailty in HIV-infected individuals...
October 6, 2016: Journal of Visualized Experiments: JoVE
Ramesh Kumar, Frederic W B Deleyiannis, Corbett Wilkinson, Brent R O'Neill
OBJECTIVE The authors' goals in this study were to describe a series of dog attacks on children that required neurosurgical consultation and to better understand the pattern of injuries inflicted, the circumstances that place children at risk for attack, and the dog breeds involved. In addition, the authors review the surgical and medical management of these patients. METHODS The authors performed a retrospective review of all children requiring neurosurgical consultation for dog bite at a regional Level 1 pediatric trauma center over a 15-year period...
October 21, 2016: Journal of Neurosurgery. Pediatrics
Toshiyuki Iwahata, Takeshi Shin, Yukihito Shimomura, Keisuke Suzuki, Tomohiro Kobayashi, Akane Miyata, Yoshitomo Kobori, Shigehiro Soh, Hiroshi Okada
OBJECTIVES: To present a single-center experience with testicular sperm extraction and intracytoplasmic sperm injection for fathering biological children in patients with ejaculatory dysfunction as a result of spinal cord injury. METHODS: Testicular sperm extraction was carried out in 52 male patients with ejaculatory dysfunction as a result of spinal cord injury. We investigated sperm retrieval rates and pregnancy rates from medical records. Data on age, testicular volume, hormonal status (luteinizing hormone, follicle stimulating hormone and testosterone), and time since spinal cord injury were obtained and analyzed to detect potential associations with the presence of spermatogenesis...
October 21, 2016: International Journal of Urology: Official Journal of the Japanese Urological Association
Steven Steinhubl
Despite having the basic tools necessary to appropriately identify and manage individuals with hypertension for over half a century it remains the single greatest contributing risk factor to morbidity and mortality worldwide today. Since diagnosis and effective treatment availability are not issues, this major failing in care can be attributed to inadequate systems of care: systems that have led to only <20% of hypertensive individuals globally having their blood pressure adequately controlled. Even in the US, where it is one of the most common reasons for a primary care visit, and with over $42...
September 2016: Journal of Hypertension
Daniel Ngui, Michael J H Qiu, Michael Mann
OBJECTIVE: In order to address the systematic and practice management issues associated with managing hypertension, we undertook a quality improvement project at a multi-physician clinic in Vancouver, British Columbia, Canada. We piloted an evidence-based electronic medical record (EMR) hypertension management dashboard based on the 2014 Canadian Hypertension Education Program (CHEP) guideline recommendations. Since June 1, 2015, our chronic disease coordinator utilized our EMR HTN Dashboard to generate patient recalls, create physician reminders and to enhance internal clinic referrals to provide 1:1 patient hypertension self-management education by physicians and our clinical pharmacist team...
September 2016: Journal of Hypertension
Ruixin Ma, Qiongying Wang, Ningyin Li, Yang Zhao, Xu Zhao, Heng Yu, Jing Yu
OBJECTIVE: Home blood pressure monitoring (HBPM) is more likely to reflect the patient's underlying blood pressure (BP), than measurements in the clinic. HBPM coupled with titration of medications under the guidance of doctors, is a viable intervention to control hypertension. The purpose of this study is to evaluate whether HBPM can increase the safety of the combination therapy of three or more different classes of antihypertensive drugs. DESIGN AND METHOD: We enrolled patients with severe (grade 3) hypertension, whose BP remain uncontrolled under combination treatment with standard doze of an angiotensin II receptor blocker and hydrochlorothiazide...
September 2016: Journal of Hypertension
Robert P Olympia, Robert Wilkinson, Jennifer Dunnick, Brendan J Dougherty, Debra Zauner
OBJECTIVE: The aims of this study were to describe pediatric emergency department (ED) referrals from urgent care centers and to determine the percentage of referrals considered essential and serious. METHODS: A prospective study was conducted between April 2013 and April 2015 on patients younger than 21 years referred directly to an ED in central Pennsylvania from surrounding urgent care centers. Referrals were considered essential or serious based on investigations/procedures performed or medications/consultations received in the ED...
October 8, 2016: Pediatric Emergency Care
Richard G Malish
The Army transitioned to a Patient-Centered Medical Home concept for primary care beginning in 2011. In spite of organizational commitment to the paradigm, the transition has not been without pitfalls. This performance improvement project operated under the hypothesis that focusing on the market-based incentives of a capitated system would result in a quantum leap toward the Patient-Centered Medical Home ideal. Utilizing a simple teaching device to repetitively highlight clinic and provider behaviors incentivized in a value-based payment system, a single clinic achieved significant improvements in enrollment, patient satisfaction, and measures associated with prevention while assuming an identity as a "virtual clinic"...
October 2016: Military Medicine
Ester Risco, Adelaida Zabalegui, Susana Miguel, Marta Farré, Carme Alvira, Esther Cabrera
OBJECTIVE: To describe the implementation of the Balance of Care model in decision-making regarding the best care for patients with dementia in Spain. METHODS: The Balance of Care model was used, which consists of (1) describing the profile of the typical cases of people with dementia and their caregivers, (2) identifying the most suitable care setting for each of the cases (home-care or long-term care institution), (3) designing specific care plans for each case, and (4) evaluating the cost of the proposed care plans...
October 14, 2016: Gaceta Sanitaria
Derenda Lovelace, Diane Hancock, Sabrina S Hughes, Phyllis R Wyche, Claire Jenkins, Cindy Logan
BACKGROUND: In 2011, the Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) in Richmond, VA, had a cumulative readmission rate and emergency department (ED) revisits for discharged Veterans of 1 in 5. In 2012, a transitional care program (TCP) was implemented to improve care coordination and outcomes among Veterans, with an emphasis on geriatric patients with chronic disease. This TCP was created with an interdisciplinary approach using intensive case management interventions, with a goal of reducing Veteran ED and hospital revisits by 30%...
November 2016: Professional Case Management
Stefan Stefanovic, Markus Wallwiener, Uros Karic, Christoph Domschke, Luka Katic, Florin-Andrei Taran, Aleksandra Pesic, Andreas Hartkopf, Peyman Hadji, Martin Teufel, Florian Schuetz, Christof Sohn, Peter Fasching, Andreas Schneeweiss, Sara Brucker
PURPOSE: The capture of adequate treatment outcomes and quality of life (QOL) of advanced breast cancer patients in clinical routine represents a great challenge. Patient-reported outcomes (PROs) are data elements directly reported by patients about experiences with care, including symptoms, functional status, or quality of life. There is growing interest in the medical community for the evaluation and implementation of PROs of adverse events (PRO-AEs). Recent interest in PROs in health care has evolved in the context of patient centeredness...
October 17, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
G Iakimova, S Dimitrova, T Burté
OBJECTIVES: Computer-delivered Cognitive Behavioral Therapies (C-CBT) are emerging as therapeutic techniques which contribute to overcome the barriers of health care access in adult populations with depression. The C-CBTs provide CBT techniques in a highly structured format comprising a number of educational lessons, homework, multimedia illustrations and supplementary materials via interactive computer interfaces. Programs are often administrated with a minimal or regular support provided by a clinician or a technician via email, telephone, online forums, or during face-to-face consultations...
October 10, 2016: L'Encéphale
Mark E Kunik, A Lynn Snow, Nancy Wilson, Amber B Amspoker, Shubhada Sansgiry, Robert O Morgan, Jun Ying, Gayle Hersch, Melinda A Stanley
OBJECTIVES: To compare the efficacy of Preventing Aggression in Veterans with Dementia (PAVeD) with that of usual care in decreasing incidence of aggression (primary outcome) and pain and improving depression, pleasant events, caregiver burden, and patient-caregiver relationship quality (secondary outcomes). DESIGN: Randomized controlled trial with assessments at baseline and 3, 6, 9, and 12 months SETTING: Houston, TX. PARTICIPANTS: A total of 203 community-dwelling veterans with pain and dementia and their caregivers...
April 27, 2016: American Journal of Geriatric Psychiatry
Maxine de la Cruz, Akhila Reddy, Vishidha Balankari, Margeaux Epner, Susan Frisbee-Hume, Jimin Wu, Diane Liu, Sriram Yennurajalingam, Hilda Cantu, Janet Williams, Eduardo Bruera
BACKGROUND: Improper use, storage, and disposal of prescribed opioids can lead to diversion or accidental poisoning. Our previous study showed a large proportion of cancer patients have unsafe opioid practices. Our objective was to determine whether an improvement occurred in the patterns of use, storage, and disposal of opioids among cancer outpatients after the implementation of a patient educational program. PATIENTS AND METHODS: Our palliative care (PC) clinic provides every patient with educational material (EM) on safe opioid use, storage, and disposal every time they receive an opioid prescription...
October 14, 2016: Oncologist
Gerald Kayingo, Owais Gilani, Vasco Deon Kidd, Mary L Warner
BACKGROUND AND OBJECTIVES: The transformation of primary care (PC) training sites into patient-centered medical homes (PCMH) has implications for the education of health professionals. This study investigates the extent to which physician assistant (PA) students report learning about the PCMH model and how clinical exposure to PCMH might impact their interest in a primary care career. METHODS: An electronic survey was distributed to second-year PA students who had recently completed their PC rotation from 12 PA programs...
October 2016: Family Medicine
Jason M Davies, Michael T Lawton
OBJECTIVE Treatment of cerebrovascular malformations has grown in complexity with the development of multimodal approaches, including microsurgery, endovascular treatments, and radiosurgery. In spite of this changing standard of care, the provision of care continues across a variety of settings. The authors sought to determine the risk of adverse outcome after treatment of patients with vascular malformations in the US. Patient, surgeon, and hospital characteristics, including volume, were tested as potential outcome predictors...
October 14, 2016: Journal of Neurosurgery
Michał Starosta, Justyna Redlicka, Michał Brzeziański, Marta Niwald, Elżbieta Miller
Diseases of the central nervous system are the most common cause of mobility and cognitive impairment. Stroke is the leading cause of hospitalization in the Neurological Rehabilitation Departments. Age increases the risk of stroke, therefore monitoring basic medical parameters, including blood pressure especially under age of 65, is a very important part of preventive healthcare. According to data from the National Association of Stroke, in 10% of patients after brain stroke, recovery of motor functions and mental state is almost complete, in 25% impairment is minimal, in 40% the functional and cognitive disability is moderated or significant therefore requires rehabilitation, in 10% in view of impossibility of active rehabilitation patients requires comprehensive nursing care service at home or in special long term care centers...
July 29, 2016: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
Erik Skobel, Christian Knackstedt, Alvaro Martinez-Romero, Dario Salvi, Cecilia Vera-Munoz, Andreas Napp, Jean Luprano, Ramon Bover, Sigrid Glöggler, Birna Bjarnason-Wehrens, Nikolaus Marx, Alan Rigby, John Cleland
Low adherence to cardiac rehabilitation (CR) might be improved by remote monitoring systems that can be used to motivate and supervise patients and tailor CR safely and effectively to their needs. The main objective of this study was to evaluate the feasibility of a smartphone-guided training system (GEX) and whether it could improve exercise capacity compared to CR delivered by conventional methods for patients with coronary artery disease (CAD). A prospective, randomized, international, multi-center study comparing CR delivered by conventional means (CG) or by remote monitoring (IG) using a new training steering/feedback tool (GEx System)...
October 11, 2016: Heart and Vessels
Katelyn M Steele, Janelle F Ruisinger, Jessica Bates, Emily S Prohaska, Brittany L Melton, Stephanie Hipp
OBJECTIVE: To evaluate the effects of pharmacist-conducted, home-based comprehensive medication reviews (CMRs) on drug therapy problems (DTPs) in geriatric patients. DESIGN: Pre-/postintervention study. SETTING: Grocery store chain affiliated with three independent living facilities. PARTICIPANTS: Twenty-five older adults using pharmacy delivery services for at least three chronic medications. INTERVENTION: A pharmacist conducted a home-based CMR for each participant...
2016: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
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