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Care pathways

Carolyn A Fahey, Prosper F Njau, William H Dow, Ntuli Kapologwe, Sandra I McCoy
OBJECTIVE: Food insecurity (FI) impedes antiretroviral therapy (ART) adherence. We previously demonstrated that short-term cash and food incentives increased ART possession and retention in HIV services in Tanzania. To elucidate potential pathways that led to these achievements, we examined whether incentives also improved FI. DESIGN: Three-arm randomized controlled trial. METHODS: From 2013 to 2015, 805 food-insecure adult ART initiates (≤90 days) at three clinics were randomized to receive cash or food transfers (∼$11/month for ≤6 months, conditional on visit attendance) or standard-of-care (SOC) services...
October 15, 2018: AIDS
Priyancaa Jeyabaladevan, Shivaani Yogalingam
The rise of doctors becoming entrepreneurs can be the solution to the challenges the National Health Service (NHS) currently faces. Doctors and medical students with entrepreneurial aspirations are creating innovative solutions to the problems patients experience. With increasing patient load and decreasing resources in hospitals, it is necessary that medical students are inspired to develop skills that will help to identify problems within organisations and have the knowledge and platforms to convert ideas into reality...
December 2018: Medical Education Online
Arthur Vrignaud, Simon Pelletier, Emmanuelle Dernis, Yvon Moui, Bénédicte Haettich
Osteoporosis is responsible for fragility fractures, thus causing significant morbidity and mortality. This study shows that care pathways, such as Le Mans General Hospital Fracture Liaison Service, are useful and efficient in improving the prevention of osteoporosis and of its consequences. INTRODUCTION: Osteoporosis is a major public health concern, causing significant morbidity and mortality. Care pathways, called Fracture Liaison Services, have demonstrated their utility in preventing osteoporosis-associated morbidity and mortality...
October 15, 2018: Archives of Osteoporosis
Erica Carolina, Toshiki Kato, Vuong Cat Khanh, Kana Moriguchi, Toshiharu Yamashita, Kosuke Takeuchi, Hiromi Hamada, Osamu Ohneda
Background: Endothelial progenitor cells (EPCs) can be used to treat ischemic disease in cell-based therapy owing to their neovascularization potential. Glucocorticoids (GCs) have been widely used as strong anti-inflammatory reagents. However, despite their beneficial effects, side effects, such as impairing wound healing are commonly reported with GC-based therapy, and the effects of GC therapy on the wound healing function of EPCs are unclear. Methods: In this study, we investigated how GC treatment affects the characteristics and wound healing function of EPCs...
2018: Frontiers in Medicine
Rafael Bayarri-Olmos, Nikolaj Kirketerp-Moller, Laura Pérez-Alós, Karsten Skjodt, Mikkel-Ole Skjoedt, Peter Garred
Collectin-11 (CL-11) is a pattern recognition molecule of the lectin pathway of complement with diverse functions spanning from host defense to embryonic development. CL-11 is found in the circulation in heterocomplexes with the homologous collectin-10 (CL-10). Abnormal CL-11 plasma levels are associated with the presence of disseminated intravascular coagulation, urinary schistosomiasis, and congenital disorders. Although there has been a marked development in the characterization of CL-11 there is still a scarcity of clinical tools for its analysis...
2018: Frontiers in Immunology
Sara Redaelli, Monica Ceccon, Marina Zappa, Geeta G Sharma, Cristina Mastini, Mario Mauri, Marion Nigoghossian, Luca Massimino, Nicoletta Cordani, Francesca Farina, Rocco Piazza, Carlo Gambacorti-Passerini, Luca Mologni
Targeted therapy changed the standard of care in ALK-dependent tumors. However, resistance remains a major challenge. Lorlatinib is a third generation ALK inhibitor that inhibits most ALK mutants resistant to current ALK inhibitors. In this study, we utilize lorlatinib-resistant anaplastic large cell lymphoma (ALCL), non-small cell lung cancer (NSCLC), and neuroblastoma cell lines in vitro and in vivo to investigate the acquisition of resistance and its underlying mechanisms. ALCL cells acquired compound ALK mutations G1202R/G1269A and C1156F/L1198F in vitro at high drug concentrations...
October 15, 2018: Cancer Research
Mariano E Menendez, Sarah M Lawler, David Ring, Andrew Jawa
BACKGROUND: As reimbursement becomes increasingly tied to quality and patient experience, there is growing interest in alleviation of postoperative pain combined with optimal opioid stewardship. We characterized predictors of severe inpatient pain after elective total shoulder arthroplasty and evaluated its association with opioid use, operative time, hospital length of stay, discharge disposition, and cost. METHODS: We identified 415 patients undergoing elective primary total shoulder arthroplasty between 2016 and 2017 from our registry...
October 12, 2018: Journal of Shoulder and Elbow Surgery
Jae H Choi, John Pile-Spellman
Reperfusion is the first line of care in a growing number of eligible acute ischemic stroke patients. Early reperfusion with thrombolytic drugs and endovascular mechanical devices is associated with improved outcome and lower mortality rates compared with natural history. Reperfusion is not without risk, however, and may result in reperfusion injury, which manifests in hemorrhagic transformation, brain edema, infarct progression, and neurologic worsening. In this article, the functional and structural changes and underlying molecular mechanisms of ischemia and reperfusion are reviewed...
November 2018: Neuroimaging Clinics of North America
Maryline Bovero, Cristiano Giacomo, Marc Ansari, Marie-José Roulin
PURPOSE: The development of advanced nursing practices (ANP) can meet challenges presented by evolving needs of health care. We aimed at describing the approach taken to implement ANP in a pediatric oncology-hematology unit. METHOD: The Participatory, Evidence-informed, Patient-centered Process for Advanced practice was considered as a conceptual framework for the development, implementation and evaluation of the nursing role. Successive steps were taken for identifying patients and family needs, defining the health care priorities, and establishing a new health care model...
October 2018: European Journal of Oncology Nursing: the Official Journal of European Oncology Nursing Society
Silvio Danese, Rupa Banerjee, Jr Fraser Cummings, Iris Dotan, Paulo G Kotze, Rupert W Leong, Kristine Paridaens, Laurent Peyrin-Biroulet, Glyn Scott, Gert Van Assche, Jan Wehkamp, Jesús K Yamamoto-Furusho
Symptomatic ulcerative colitis (UC) can be a chronic, disabling condition. Flares in disease activity are associated with many of the negative impacts of mild-to-moderate UC. Rapid resolution of flares can provide benefits to patients and healthcare systems. i Support Therapy-Access to Rapid Treatment (iSTART) introduces patient-centered care for mild-to-moderate UC. iSTART provides patients with the ability to self-assess symptomology and self-start a short course of second-line treatment when necessary. An international panel of experts produced consensus statements and recommendations...
October 16, 2018: Intestinal Research
G Cerrato, C L Bianchi, F Galli, C Pirola, S Morandi, V Capucci
The ingredients of Pharmaceuticals and Personal Care Products (PPCPs) persist in water and conventional treatment plants are not able to remove them efficiently. Sonochemical treatment is insufficient to mineralize organics such as ibuprofen into CO2 and H2 O. TiO2 degrades ibuprofen (IBP) under UV light; however, it does not reach a high grade of conversion. Here, we investigated the mineralization of ibuprofen to CO2 by TiO2 UV-C photocatalysis. We replaced nano-sized P25 (the standard catalyst) with a micro-sized commercial sample of TiO2 to preclude the use of nanoparticles which are dangerous for human health and because typical filtration systems are expensive and inefficient...
September 25, 2018: Journal of Hazardous Materials
Zsolt Horváth, Róbert Urbán
BACKGROUND: Excessive alcohol use may harm not only the individual drinker, but also the lives of their family members. The stress-strain-coping-support (SSCS) model emphasizes that the stress experienced by family members could lead to the development of various physical and psychological symptoms. OBJECTIVES: The aim of the current study is to examine the possible moderating and mediating role of coping on the relationship between stress and strain among family members seeking help due to a relative's alcohol misuse...
October 9, 2018: Addictive Behaviors
Joukje C Swinkels, Marjolein I Broese van Groenou, Alice de Boer, Theo G van Tilburg
Background and Objectives: The general view is that partner-caregiver burden increases over time but findings are inconsistent. Moreover, the pathways underlying caregiver burden may differ between men and women. This study examines to what degree and why partner-caregiver burden changes over time. It adopts Pearlin's Caregiver Stress Process Model, as it is expected that higher primary and secondary stressors will increase burden and larger amounts of resources will lower burden. Yet, the impact of stressors and resources may change over time...
October 12, 2018: Gerontologist
Santosh Gautam, Gosia Sylwestrzak, John Barron, Xiaoxue Chen, Michael Eleff, David Debono, Ann Nguyen, Michael Fisch
PURPOSE: Pathway regimens are value-driven, evidence-based therapies that aim at high-quality, affordable cancer care. There are few real-world data to support the value of such regimens, especially for patients with breast cancer. MATERIALS AND METHODS: Using nationally representative claims data from Anthem, together with clinical data from its Cancer Care Quality Program, we identified patients with breast cancer for whom chemotherapy was initiated between January 2015 and October 2016...
October 15, 2018: Journal of Oncology Practice
Maud Hanappe, Lowell T Nicholson, Shekinah N C Elmore, Alexandra E Fehr, Jean Bosco Bigirimana, Ryan C Borg, John Butonzi, Cyprien Shyirambere, Egide Mpanumusingo, Marie O Benewe, Dan M Kanyike, Scott Triedman, Lawrence N Shulman, Christian Rusangwa, Paul H Park
PURPOSE: Low- and middle-income countries disproportionately comprise 65% of cancer deaths. Cancer care delivery in resource-limited settings, especially low-income countries in sub-Saharan Africa, is exceedingly complex, requiring multiple modalities of diagnosis and treatment. Given the vast human, technical, and financial resources required, access to radiotherapy remains limited in sub-Saharan Africa. Through 2017, Rwanda has not had in-country radiotherapy services. The aim of this study was to describe the implementation and early outcomes of the radiotherapy referral program at the Butaro Cancer Centre of Excellence and to identify both successful pathways and barriers to care...
October 2018: Journal of Global Oncology
A Pastijn, S Vasseur, F Deneft, M Caillet, F Janssens, S Rozenberg
The ageing of the population, having access to good quality of care, will result in an increase in the prevalence of pelvic floor diseases. Those persons, often in good general health, may experience difficulties in accepting functional pathologies, associated with loss in quality of life. One out of 2 women will have a pelvic floor problem and 1 out of 9 will have a surgical perineal procedure before the age of 80 years. The unitary character of the pelvic floor, a complex functional anatomic region, is often forgotten, essentially because the patients complain about one main pathology like urinary incontinence, genital prolapse, constipation and sexual disorders or chronic pain and will consult one specific specialist...
2018: Revue Médicale de Bruxelles
Suzanne A Maher, Richard Kyle, Bernard F Morrey, Michael J Yaszemski
Despite the wealth of innovation in the orthopaedic sciences, few technologies translate to clinical use. By way of a 2-day symposium titled "AAOS/ORS Translating Orthopaedic Technologies into Clinical Practice: Pathways from Novel Idea to Improvements in Standard of Care Research Symposium," key components of successful commercialization strategies were identified as a passionate entrepreneur working on a concept aimed at improving patient outcomes and decreasing the cost and burden of disease; a de-risking strategy that has due recognition of the regulatory approval process and associated costs while maximizing the use of institutional, state, and federal resources; and a well thought-out and prepared legal plan and high quality, protected intellectual property...
October 12, 2018: Journal of the American Academy of Orthopaedic Surgeons
Tarandeep Oberai, Maggie Killington, Kate Laver, Maria Crotty, Ruurd Jaarsma
ABSTRACTBackground:Delirium is a complex clinical syndrome characterized by disturbed consciousness, cognitive function, or perception and associated with serious adverse outcomes such as death, dementia, and the need for long-term care. However, recognition and management of delirium is poorly prioritized even though it is the most frequent complication among patients undergoing surgery following hip fracture. The aim of this study was to understand clinicians' from orthopedic speciality perceptions in relation to recognition, diagnosis, and management of delirium...
October 15, 2018: International Psychogeriatrics
Katherine J Baxter, Heather L Short, Curtis D Travers, Kurt F Heiss, Mehul V Raval
PURPOSE: The purpose of this study was to implement a novel surgeon-reported categorization (SRC) for pediatric appendicitis severity and determine if SRC was associated with outcomes. METHODS: We conducted a retrospective review of appendectomies by 15 surgeons within a single center from January to December 2016. The SRC was defined as: simple (category 1), gangrenous or adherent (category 2A), perforation with localized abscess (category 2B), and perforation with gross contamination (category 2C)...
October 13, 2018: Pediatric Surgery International
Pahriya Ashrap, Deborah J Watkins, Antonia M Calafat, Xiaoyun Ye, Zaira Rosario, Phil Brown, Carmen M Vélez-Vega, Akram Alshawabkeh, José F Cordero, John D Meeker
BACKGROUND: Understanding important sources and pathways of exposure to common chemicals known or suspected to impact human health is critical to eliminate or reduce the exposure. This is particularly important in areas such as Puerto Rico, where residents have higher exposures to numerous chemicals, as well as higher rates of many adverse health outcomes, compared to the mainland US. OBJECTIVE: The aim of this study was to assess distributions, time trends, and predictors of urinary triclocarban, phenol, and paraben biomarkers measured at multiple times during pregnancy among women living in Northern Puerto Rico...
October 10, 2018: Environment International
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