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Continuity Care

Ottavia Spiga, Vittoria Cicaloni, Andrea Zatkova, Lia Millucci, Giulia Bernardini, Andrea Bernini, Barbara Marzocchi, Monica Bianchini, Andrea Zugarini, Alberto Rossi, Matteo Zazzeri, Alfonso Trezza, Bruno Frediani, Lakshminarayan Ranganath, Daniela Braconi, Annalisa Santucci
This paper describes our experience with the development and implementation of a database for the rare disease Alkaptonuria (AKU, OMIM: 203500). AKU is an autosomal recessive disorder caused by a gene mutation leading to the accumulation of homogentisic acid (HGA). Analogously to other rare conditions, currently there are no approved biomarkers to monitor AKU progression or severity. Although some biomarkers are under evaluation, an extensive biomarker analysis has not been undertaken in AKU yet. In order to fill this gap, we gained access to AKU-related data that we carefully processed, documented and stored in a database, which we named ApreciseKUre...
October 5, 2018: Computers in Biology and Medicine
Ulrica Lovén Wickman, Pia Yngman-Uhlin, Henrik Hjortswang, Marika Wenemark, Henrik Stjernman, Barbara Riegel, Gunilla Hollman Frisman
BACKGROUND: Patients with inflammatory bowel disease have lifelong needs to learn how to manage their symptoms and life situation. The range of actions that patients take in order to manage daily life and maintain health is referred to as self-care. Assessment of self-care in patients with inflammatory bowel disease could allow targeted support and education by health care professionals. There are no existing measures assessing self-care in patients with inflammatory bowel disease. OBJECTIVES: The aim was to develop and evaluate the self-care questionnaire for assessment of self-care among patients with inflammatory bowel disease...
September 12, 2018: International Journal of Nursing Studies
Anne F Peery, Seth D Crockett, Caitlin C Murphy, Jennifer L Lund, Evan S Dellon, J Lucas Williams, Elizabeth T Jensen, Nicholas J Shaheen, Alfred S Barritt, Sarah R Lieber, Bharati Kochar, Edward L Barnes, Y Claire Fan, Virginia Pate, Joseph Galanko, Todd H Baron, Robert S Sandler
BACKGROUND & AIMS: Estimates of disease burden can inform national health priorities for research, clinical care, and policy. We aimed to estimate health care use and spending among gastrointestinal (GI) (including luminal, liver, and pancreatic) diseases in the United States. METHODS: We estimated health care use and spending based on the most currently available administrative claims from commercial and Medicare Supplemental plans, data from the GI Quality Improvement Consortium Registry, and national databases...
October 10, 2018: Gastroenterology
M A Maher, T M Sayyed, S W El-Khadry
OBJECTIVE: To study the tocolytic action of nifedipine combined with sildenafil citrate (SC) and if the combination is superior to nifedipine alone in inhibiting threatened preterm labour (PTL). DESIGN: Prospective randomised study. SETTING: An Egyptian university hospital. POPULATION: Women with threatened PTL who received either nifedipine with SC or nifedipine alone. METHODS: Patients were randomly allocated to receive either (1) nifedipine 20 mg orally (stat dose), followed by 10 mg orally every 6-8 hours at the same time as vaginal administration of SC (25 mg at 8-hourly intervals) or (2) nifedipine alone...
October 13, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
Mark G Elliman, Oulaivanh Vongxay, Bandith Soumphonphakdy, Amy Gray
AIM: Hyponatraemia is a common and potentially deadly complication affecting hospitalised children world-wide. Hypotonic intravenous fluids can be a significant exacerbating factor. Exclusive use of isotonic fluids, coupled with rigorous blood monitoring, has proven effective in reducing hyponatraemia in developed settings. In developing countries, where hyponatraemia is often more common and severe, different factors may contribute to its incidence and detection. We aimed to determine the prevalence and disease associations of hyponatraemia and describe the intravenous maintenance fluid prescribing practices in a Lao paediatric intensive care unit...
October 13, 2018: Journal of Paediatrics and Child Health
Sayaka Maeda, Tatsuya Morita, Masayuki Ikenaga, Hirofumi Abo, Yoshiyuki Kizawa, Satoru Tsuneto
PURPOSES: Despite extensive debate on palliative sedation over the last few decades, no studies have explored longitudinal changes in physicians' opinion. Moreover, little is known about how physicians' opinions affect their practice. This study aimed to clarify (1) changes in palliative care specialists' opinions on palliative sedation and (2) the effects of these opinions on clinical practice. METHODS: In 2000 and 2016, nationwide questionnaire surveys involving Japanese palliative care specialists were performed: measurement was based on agreement with opinions on palliative sedation...
October 12, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Xue-Qing Yu, Meng-Hua Chen, Jie Dong, Hong Liu, Zhang-Suo Liu, Qiang Yao, James A Sloand, Mark Marshall
BACKGROUND: The aim of this study was to determine if there were centers in China with unusually high levels of risk-adjusted mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: We analyzed an inception cohort commencing CAPD between 1 January 2005 and 13 August 2015, followed until death, dropout defined as discontinuation of Baxter products, loss to follow-up, or 13 November 2015, whichever occurred first. We calculated standardized mortality ratios (SMRs) from Cox proportional hazards models, adjusting for age, gender, employment status, insurance status, primary renal disease, size of peritoneal dialysis (PD) program, and year of dialysis inception...
October 12, 2018: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
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
Nicole Brys, Julie A Keating, Mary Jo Knobloch, Nasia Safdar
BACKGROUND: We describe stakeholder engagement from a Patient-Centered Outcomes Research Institute-funded project to identify patients' research priorities for health care-associated infections (HAI). We summarize insights from these activities to highlight feasibility and benefits of stakeholder engagement in health care epidemiology research.Patients and caregivers who had an HAI experience were involved in a patient and caregiver stakeholder group. We engaged clinicians, infection prevention experts, state public health professionals, and quality improvement experts in an institutional stakeholder (IS) group in an academic tertiary care medical center...
October 9, 2018: American Journal of Infection Control
Valerie Nolt, Jeff Cain, Daniel Wermeling
BACKGROUND AND PURPOSE: Teaching students therapeutic knowledge is not the same as teaching them how to reason through clinical problems. It was determined a new approach was necessary to close the gap between classroom learning and clinical application. EDUCATIONAL ACTIVITY AND SETTING: A stand-alone clinical reasoning course was developed to enhance students' ability to think about and solve clinical problems. This course involved a variety of active-learning strategies based upon literature regarding clinical reasoning...
August 2018: Currents in Pharmacy Teaching & Learning
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
Jane Candlish, M Dawn Teare, Munyaradzi Dimairo, Laura Flight, Laura Mandefield, Stephen J Walters
BACKGROUND: In individually randomised trials we might expect interventions delivered in groups or by care providers to result in clustering of outcomes for participants treated in the same group or by the same care provider. In partially nested randomised controlled trials (pnRCTs) this clustering only occurs in one trial arm, commonly the intervention arm. It is important to measure and account for between-cluster variability in trial design and analysis. We compare analysis approaches for pnRCTs with continuous outcomes, investigating the impact on statistical inference of cluster sizes, coding of the non-clustered arm, intracluster correlation coefficient (ICCs), and differential variance between intervention and control arm, and provide recommendations for analysis...
October 11, 2018: BMC Medical Research Methodology
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
Elias Iosifidis, Savvas Papachristou, Emmanuel Roilides
The main indications for antifungal drug administration in pediatrics are reviewed as well as an update of the data of antifungal agents and antifungal policies performed. Specifically, antifungal therapy in three main areas is updated as follows: a) Prophylaxis of premature neonates against invasive candidiasis; b) management of candidemia and meningoencephalitis in neonates; and c) prophylaxis, empiric therapy, and targeted antifungal therapy in children with primary or secondary immunodeficiencies. Fluconazole remains the most frequent antifungal prophylactic agent given to high-risk neonates and children...
October 11, 2018: Journal of Fungi (Basel, Switzerland)
Doris M Rubio, Colleen A Mayowski, Marie K Norman
The biomedical workforce continues to lack diversity, despite growing evidence demonstrating the advantages of diverse teams in workplaces for creativity and innovation. At the University of Pittsburgh Institute for Clinical Research Education, we have taken a multi-pronged, collaborative approach to enhance the diversity of our trainees and scholars. We started by implementing a program for postdoctoral fellows and junior faculty, the Career Education and Enhancement for Health Care Research Diversity (CEED) program...
October 11, 2018: International Journal of Environmental Research and Public Health
Woo Yong Lee, Ki Deok Park, Yongbum Park
RATIONALE: Radiating leg pain usually originates from the lumbar spine and occasionally from peripheral lesions. Here we report a case involving a patient with radiating pain in the right leg who exhibited 2 suspicious lesions, including 1 spinal lesion and 1 extraspinal cystic mass lesion, on magnetic resonance imaging. Polydeoxyribonucleotide sodium (PDRN) was recently noted as such a substitute. PDRN has anti-inflammatory effects, as it lowers the expression of inflammatory cytokines including interleukin-6 and tumor necrosis factor-alpha...
October 2018: Medicine (Baltimore)
Mariana Del Grossi Moura, Luciane Cruz Lopes, Marcus Tolentino Silva, Sílvio Barberato-Filho, Rogério Heládio Lopes Motta, Cristiane de Cássia Bergamaschi
BACKGROUND: Rheumatoid arthritis affects 1% of the world's population and its current treatment options are costly. There are not enough studies that evaluated the efficacy and safety of anti-inflammatory drugs medications used to reduce rheumatoid arthritis's symptoms. This study will evaluate the effectiveness and the safety of steroid and nonsteroidal anti-inflammatory drugs for the treatment of patients with rheumatoid arthritis. METHODS: Randomized clinical trials eligible for our systematic review will enroll adults with rheumatoid arthritis treated with anti-inflammatory drugs compared with a control group (placebo or active control) at any dose, duration, and route of administration and double blind studies...
October 2018: Medicine (Baltimore)
Jialing Shi, Liying Wei, Rongzhi Huang, Liang Liao
BACKGROUND AND AIM: The increased mortality rate and other poor prognosis make malnutrition a serious issue for adult critically ill patients in intensive care unit care. This study was to compare outcomes between combined parenteral and enteral nutrition and enteral nutrition alone for adult critically ill patients. MATERIALS AND METHODS: The PubMed (June 30, 2018), EMBASE (June 30, 2018), and Cochrane library databases (June 30, 2018) were searched systematically...
October 2018: Medicine (Baltimore)
Atul Jaidka, Hailey Hobbs, Seth Koenig, Scott J Millington, Robert T Arntfield
Transesophageal echocardiography (TEE) is a safe and minimally invasive tool that can routinely provide high quality anatomic and hemodynamic information in the severely ill. Despite its potential for front-line acute care clinicians, TEE use has typically been reserved for diagnostic experts in the cardiac-surgical milieu. With the continued evolution of point-of-care ultrasound into increasingly sophisticated domains, TEE has gained steady uptake in many "non-traditional" environments for both advanced echocardiographic assessment as well as to answer more goal directed, fundamental questions...
October 9, 2018: Chest
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