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https://www.readbyqxmd.com/read/27932546/what-can-a-participatory-approach-to-evaluation-contribute-to-the-field-of-integrated-care
#1
Laura Eyre, Michael Farrelly, Martin Marshall
Better integration of care within the health sector and between health and social care is seen in many countries as an essential way of addressing the enduring problems of dwindling resources, changing demographics and unacceptable variation in quality of care. Current research evidence about the effectiveness of integration efforts supports neither the enthusiasm of those promoting and designing integrated care programmes nor the growing efforts of practitioners attempting to integrate care on the ground. In this paper we present a methodological approach, based on the principles of participatory research, that attempts to address this challenge...
December 8, 2016: BMJ Quality & Safety
https://www.readbyqxmd.com/read/27927661/differences-among-primary-care-patients-with-different-mechanical-patterns-of-low-back-pain-a-cross-sectional-investigation
#2
Lauren S Della Mora, Anthony V Perruccio, Elizabeth M Badley, Y Raja Rampersaud
OBJECTIVES: To characterise and compare a persistent low back pain (LBP) population based on 4 clinical pain patterns. DESIGN: Cross-sectional analysis of patient-reported data. SETTING: Patients from 220 primary care practitioners in 3 cities in Ontario, Canada. PARTICIPANTS: 1020 individuals seeking LBP care. INCLUSION CRITERIA: LBP symptoms lasting 1½-12 months, or unmanageable recurrent symptoms; ages 18+years...
December 7, 2016: BMJ Open
https://www.readbyqxmd.com/read/27919865/shared-decision-making-in-patients-with-low-risk-chest-pain-prospective-randomized-pragmatic-trial
#3
Erik P Hess, Judd E Hollander, Jason T Schaffer, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Nilay D Shah, Jonathan Inselman, Jeph Herrin, Ana Castaneda-Guarderas, Victor M Montori
OBJECTIVE:  To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. DESIGN:  Multicenter pragmatic parallel randomized controlled trial. SETTING:  Six emergency departments in the United States. PARTICIPANTS:  898 adults (aged >17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain...
December 5, 2016: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/27918408/full-practice-authority-for-nurse-practitioners
#4
Deborah Dillon, Faye Gary
Implementation of the Affordable Care Act (2010) enabled more than 30 million people to have new access to primary care services. On the basis of current utilization patterns, demand for primary care providers is expected to grow more rapidly than physician supply. This imbalance is expected to worsen, as the aging population requires more health care resources. In addition, more patients are requiring critical care services and physician numbers are not keeping with this growing need. Restrictions on resident physician practice hours have impacted inpatient care as well...
January 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/27912996/alternative-exercise-traditions-in-cancer-rehabilitation
#5
REVIEW
Kathryn J Ruddy, Daniela L Stan, Anjali Bhagra, Mary Jurisson, Andrea L Cheville
Alternative exercise traditions (AETs) such as Pilates, yoga, Tai Chi Chuan, Qigong, and various forms of dance offer the potential to improve diverse outcomes among cancer survivors by reducing adverse symptoms and mood disorders, and by enhancing function. Additionally AETs have emerged as a potential means to address deficits in current disease-focused care delivery models which are marked by prevalent under-treatment of symptoms and physical impairments. Relative to therapeutic exercise in allopathic models, many AETs are comparatively affordable and accessible...
February 2017: Physical Medicine and Rehabilitation Clinics of North America
https://www.readbyqxmd.com/read/27910294/medication-management-in-the-older-adult-a-narrative-exploration
#6
Johnanna Hernandez
BACKGROUND AND PURPOSE: The purpose of this study was to characterize the meaning nurse practitioners (NPs) ascribed to personal experiences providing care to older adults who take multiple medications to manage complex conditions. The study illuminated the NP experience in caring for the older adult while addressing the complexities of medication management through narrative stories in practice. METHODS: NPs self-identifying as caring for older adults were interviewed (N=15)...
December 2, 2016: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/27908336/appropriate-antibiotic-therapy
#7
REVIEW
Michael G Allison, Emily L Heil, Bryan D Hayes
Prescribing antibiotics is an essential component of initial therapy in sepsis. Early antibiotics are an important component of therapy, but speed of administration should not overshadow the patient-specific characteristics that determine the optimal breadth of antimicrobial therapy. Cultures should be drawn before antibiotic therapy if it does not significantly delay administration. Combination antibiotic therapy against gram-negative infections is not routinely required, and combination therapy involving vancomycin and piperacillin/tazobactam is associated with an increase in acute kidney injury...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27899006/french-women-s-representations-and-experiences-of-the-post-treatment-management-of-breast-cancer-and-their-perception-of-the-general-practitioner-s-role-in-follow-up-care-a-qualitative-study
#8
Catherine Laporte, Julie Vaure, Anne Bottet, Bénédicte Eschalier, Clémentine Raineau, Denis Pezet, Philippe Vorilhon
BACKGROUND: In France, the Cancer Plan II 2009-2013 was launched to improve post-cancer management and promote greater involvement of general practitioners (GPs) in follow-up care. OBJECTIVES: We investigated how women experienced the post-treatment management of breast cancer and perceived the role of the GP in follow-up care. DESIGN: We conducted a qualitative study based on semi-structured interviews with women with breast cancer in remission...
November 29, 2016: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/27898628/fracture-and-nonaccidental-injury-a-case-report-of-a-lateral-condylar-fracture-in-a-13-month-old
#9
Helen Levin, Gurinder Sangha, Timothy P Carey, Rodrick Lim
Pediatric nonaccidental injury (NAI) is an important entity that is commonly seen in a variety of medical settings. These children often present to the emergency department or primary care physicians as the first point of contact after an NAI. There is a major risk associated with nonrecognition of an NAI, including a 35% chance of subsequent injury and a 5% to 10% risk of mortality. Therefore, it is essential for physicians to be vigilant when assessing injuries compatible with NAI, especially in infants and young children who are not able to independently express themselves...
December 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27891402/clinical-analysis-of-ectopic-pregnancies-in-a-tertiary-care-centre-in-southern-india-a-six-year-retrospective-study
#10
S Tahmina, Mary Daniel, Preethy Solomon
INTRODUCTION: Ectopic Pregnancy (EP) is a life-threatening emergency commonly encountered by medical practitioners where diagnosis can often be missed. Any woman in the reproductive age group, presenting with lower abdominal pain or vaginal bleeding must raise the suspicion of an ectopic pregnancy to prevent mortality and morbidity. AIM: To review all cases of EP and determine the incidence of EP. To study the high risk factors and know the types of clinical presentation, methods of diagnosis, outcome and complications...
October 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27890530/provider-perspectives-on-adding-biomarker-screening-for-tobacco-smoke-exposure-to-lead-screening-at-well-child-visits
#11
Winta Ghidei, Gail Brottman, Eline Lenne, Tukhanh Quan, Anne Joseph
INTRODUCTION: Measurement of cotinine, a biomarker of tobacco smoke exposure, can accurately identify children at risk of health consequences from secondhand smoke. This study reports perspectives from pediatric health care providers on incorporating routine cotinine screening into well-child visits. METHODS: Key informant interviews (N = 28) were conducted with pediatric primary care providers: physicians, nurse practitioners, and registered nurses. RESULTS: Themes identified in the interviews included the following: (a) Cotinine screening would assess children's exposure to tobacco smoke more reliably than parental report; (b) Addressing positive cotinine screening results might require additional resources; (c) Wheezing and a history of emergency department visits increased the salience of cotinine screening; and (d) A better understanding of the significance of specific cotinine test values would improve utility...
November 24, 2016: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/27889288/quiet-dissent-the-attitudes-beliefs-and-behaviours-of-uk-osteopaths-who-reject-low-back-pain-guidance-a-qualitative-study
#12
Joanna Figg-Latham, Dévan Rajendran
INTRODUCTION: Clinical guidelines are derived from best research evidence and aim to: improve quality of non-specific low back pain (nsLBP) management and identify patients at risk of suffering chronic pain. However, guideline discordant attitudes and beliefs have been identified in healthcare students and practitioners, including osteopaths. DESIGN: A qualitative approach with elements of grounded theory was used to explore underlying attitudes and beliefs of practitioners/students working in a British osteopathic education institution...
October 18, 2016: Manual Therapy
https://www.readbyqxmd.com/read/27883873/doctors
#13
Gaya Sritharan, Amber C Mills, Michele R Levinson, Anthea L Gellie
Objectives The aims of the present study were to investigate doctors' attitudes regarding the discussion and writing of not for resuscitation (NFR) orders and to identify potential barriers to the completion of these orders.Methods A questionnaire-based convenience study was undertaken at a tertiary hospital. Likert scales and open-ended questions were directed to issues surrounding the discussion, timing, understanding and writing of NFR orders, including legal and personal considerations.Results Doctors thought the presence of an NFR order both should and does alter care delivered by nursing staff, particularly delivery of pain relief, nursing observations and contacting the medical emergency team...
November 25, 2016: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/27879534/physician-provided-prehospital-critical-care-effect-on-patient-physiology-dynamics-and-on-scene-time
#14
Bjørn O Reid, Marius Rehn, Oddvar Uleberg, Andreas J Krüger
INTRODUCTION: Improved physiologic status can be seen as a surrogate measure of improved outcome and a field-friendly prognostic model such as the Mainz Emergency Evaluation Score (MEES) could quantify the effect on physiological response. We aim to examine the dynamic physiological profile as measured by this score on patients managed by physician-manned helicopter emergency medical services and how this profile was related to on-scene time expenditure and critical care interventions...
November 22, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/27877025/medication-knowledge-of-patients-hospitalized-for-heart-failure-at-admission-and-after-discharge
#15
Florian Custodis, Franziska Rohlehr, Angelika Wachter, Michael Böhm, Martin Schulz, Ulrich Laufs
BACKGROUND: A substantial aspect of health literacy is the knowledge of prescribed medication. In chronic heart failure, incomplete intake of prescribed drugs (medication non-adherence) is inversely associated with clinical prognosis. Therefore, we assessed medication knowledge in a cohort of patients with decompensated heart failure at hospital admission and after discharge in a prospective, cross-sectional study. METHODS: One hundred and eleven patients presenting at the emergency department with acute decompensated heart failure were included (mean age 78...
2016: Patient Preference and Adherence
https://www.readbyqxmd.com/read/27876101/caring-for-people-with-dementia-in-hospital-findings-from-a-survey-to-identify-barriers-and-facilitators-to-implementing-best-practice-dementia-care
#16
Joanne Tropea, Dina LoGiudice, Danny Liew, Carol Roberts, Caroline Brand
BACKGROUND: Best practice dementia care is not always provided in the hospital setting. Knowledge, attitudes and motivation, practitioner behavior, and external factors can influence uptake of best practice and quality care. The aim of this study was to determine hospital staff perceived barriers and enablers to implementing best practice dementia care. METHODS: A 17-item survey was administered at two Australian hospitals between July and September 2014. Multidisciplinary staff working in the emergency departments and general medical wards were invited to participate in the survey...
November 23, 2016: International Psychogeriatrics
https://www.readbyqxmd.com/read/27860251/incorporating-antiracism-coursework-into-a-cultural-competency-curriculum
#17
Wendy M Gordon, Safiya A U McCarter, Susan J Myers
Creating a socially conscious educational environment is an imperative if health care practitioners are to have a significant impact on health inequities. The effects of practitioner bias, prejudice, and discrimination on health and health outcomes have been well documented in the literature. Individuals being trained to provide health care will be entering into an increasingly diverse world and must be equipped with the appropriate knowledge and skills in order to meet the needs of those seeking their care...
November 2016: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/27852879/examining-the-sources-of-occupational-stress-in-an-emergency-department
#18
S Basu, C Yap, S Mason
BACKGROUND: Previous work has established that health care staff, in particular emergency department (ED) personnel, experience significant occupational stress but the underlying stressors have not been well quantified. Such data inform interventions that can reduce cases of occupational mental illness, burnout, staff turnover and early retirement associated with cumulative stress. AIMS: To develop, implement and evaluate a questionnaire examining the origins of occupational stress in the ED...
November 16, 2016: Occupational Medicine
https://www.readbyqxmd.com/read/27852722/patient-motives-behind-low-acuity-visits-to-the-emergency-department-in-germany-a-qualitative-study-comparing-urban-and-rural-sites
#19
Martina Schmiedhofer, Martin Möckel, Anna Slagman, Johann Frick, Stephan Ruhla, Julia Searle
OBJECTIVES: The increasing number of low-acuity visits to emergency departments (ED) is an important issue in Germany, despite the fact that all costs of inpatient and outpatient treatment are covered by mandatory health insurance. We aimed to explore the motives of patients categorised with low-acuity conditions for visiting an ED. METHODS: We conducted a qualitative study in two urban and one rural ED. We recruited a purposive sample of adults, who were assigned to the lowest two categories in the Manchester triage system...
November 16, 2016: BMJ Open
https://www.readbyqxmd.com/read/27848908/-systematic-detection-of-physical-child-abuse-at-emergency-rooms
#20
J S Sittig, C S P M Uiterwaal, K G M Moons, I M B Russel, R A J Nievelstein, E E S Nieuwenhuis, E M van de Putte
OBJECTIVE: The aim of our diagnostic accuracy study Child Abuse Inventory at Emergency Rooms (CHAIN-ER) was to establish whether a widely used checklist accurately detects or excludes physical abuse among children presenting to ERs with physical injury. DESIGN: A large multicentre study with a 6-month follow-up in 4 ERs in The Netherlands. METHOD: Participants were 4290 children aged 0-7 years, attending the ER because of physical injury. All children were systematically tested with an easy-to-use child abuse checklist (index test)...
2016: Nederlands Tijdschrift Voor Geneeskunde
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