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Adewole S Adamson, Elizabeth A Suarez, April R Gorman
Importance: Prescription underuse is associated with poorer clinical outcomes. A significant proportion of underuse is owing to primary nonadherence, defined as the rate at which patients fail to fill and pick up new prescriptions. Although electronic prescribing increases coordination of care and decreases errors, its effect on primary nonadherence is less certain. Objectives: To analyze factors associated with primary nonadherence to dermatologic medications and study whether electronic prescribing affects rates of primary nonadherence...
October 26, 2016: JAMA Dermatology
Edward Goldson
The debate about disability, family and society is an old one. The needs of individuals with disabilities have not been a priority in most societies. However, this population is increasing with the advances in our medical technology and we can no longer ignore them. Overall care, from diagnosis to treatment and integration into society has been fragmented and disorganized. Thus, new thinking about individuals with disabilities has to take place. This article suggests the need for a paradigm shift has to how individuals with disabilities should be viewed and suggests a different model for the development of systems to meet the needs of this growing population...
October 2016: Ciência & Saúde Coletiva
Katharine Kripke, Jason Reed, Catherine Hankins, Gregory Smiley, Catey Laube, Emmanuel Njeuhmeli
BACKGROUND: The report of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for World AIDS Day 2014 highlighted a Fast-Track Strategy that sets ambitious treatment and prevention targets to reduce global HIV incidence to manageable levels by 2020 and end the AIDS epidemic by 2030. The 90-90-90 treatment targets for 2020 call for 90% of people living with HIV to know their HIV status, 90% of people who know their status to receive treatment, and 90% of people on HIV treatment to be virally suppressed...
2016: PloS One
Catherine Hankins, Mitchell Warren, Emmanuel Njeuhmeli
Over 11 million voluntary medical male circumcisions (VMMC) have been performed of the projected 20.3 million needed to reach 80% adult male circumcision prevalence in priority sub-Saharan African countries. Striking numbers of adolescent males, outside the 15-49-year-old age target, have been accessing VMMC services. What are the implications of overall progress in scale-up to date? Can mathematical modeling provide further insights on how to efficiently reach the male circumcision coverage levels needed to create and sustain further reductions in HIV incidence to make AIDS no longer a public health threat by 2030? Considering ease of implementation and cultural acceptability, decision makers may also value the estimates that mathematical models can generate of immediacy of impact, cost-effectiveness, and magnitude of impact resulting from different policy choices...
2016: PloS One
Carlo Signorelli, Veronica Ciorba, Federica Pezzetti, Anna Odone, Armando Gozzini, Antonello Zangrandi
Health authorities, medical directors and managers are called to face increasing and inter-related challenges regarding the ongoing financial crisis, aging of the population and the need to acquire innovative medical technologies. These challenges need to be tackled in order to ensure sustainability of the healthcare systems and appropriateness and quality of healthcare services. In Italy, the role of medical directors has progressively evolved over the years and now requires strengthened managerial skills and additional professional expertise and skills to plan, implement and evaluate the new systems of government...
July 2016: Igiene e Sanità Pubblica
Joanna P MacEwan, Felicia M Forma, Jason Shafrin, Ainslie Hatch, Darius N Lakdawalla, Jean-Pierre Lindenmayer
BACKGROUND: Poor medication adherence contributes to negative treatment response, symptom relapse, and hospitalizations in schizophrenia. Many health plans use claims-based measures like medication possession ratios or proportion of days covered (PDC) to measure patient adherence to antipsychotics. Classifying patients solely on the basis of a single average PDC measure, however, may mask clinically meaningful variations over time in how patients arrive at an average PDC level. OBJECTIVE: To model patterns of medication adherence evolving over time for patients with schizophrenia who initiated treatment with an oral atypical antipsychotic and, based on these patterns, to identify groups of patients with different adherence behaviors...
November 2016: Journal of Managed Care & Specialty Pharmacy
Jason Shafrin, Taylor T Schwartz, Darius N Lakdawalla, Felicia M Forma
BACKGROUND: Nonadherence to antipsychotic medication among patients with schizophrenia results in poor symptom management and increased health care and other costs. Despite its health impact, medication adherence remains difficult to accurately assess. New technologies offer the possibility of real-time patient monitoring data on adherence, which may in turn improve clinical decision making. However, the economic benefit of accurate patient drug adherence information (PDAI) has yet to be evaluated...
November 2016: Journal of Managed Care & Specialty Pharmacy
Janice L Pringle, Arnie Aldridge, Shannon M Kearney, Kim Grasso, John Radack, Susan Hogue, Chronis Manolis
BACKGROUND: Medication nonadherence is problematic throughout health care practice. Patient nonadherence is a result of several factors, such as financial issues, confusion about the medication, or concerns about possible side effects. Efforts to improve adherence have been implemented, but new strategies are needed to ensure that patients fill their medication prescriptions and adhere to their prescribed use. OBJECTIVE: To investigate whether providing patients with a free 30-day supply of medication at the point of care via a dispensing kiosk-a secure, computerized cabinet placed in the prescriber's office-that provides sample medication and educational materials had a measurable impact on adherence and health care cost...
November 2016: Journal of Managed Care & Specialty Pharmacy
Scott Monteith, Tasha Glenn
Automated decision-making by computer algorithms based on data from our behaviors is fundamental to the digital economy. Automated decisions impact everyone, occurring routinely in education, employment, health care, credit, and government services. Technologies that generate tracking data, including smartphones, credit cards, websites, social media, and sensors, offer unprecedented benefits. However, people are vulnerable to errors and biases in the underlying data and algorithms, especially those with mental illness...
December 2016: Current Psychiatry Reports
Brandon N Kyle, Irma Corral, Nadyah Janine John, P G Shelton
Returning to the original emphasis of higher education, universities have increasingly recognized the value and scholarship of teaching, and medical schools have been part of this educational scholarship movement. At the same time, the preferred learning styles of a new generation of medical students and advancements in technology have driven a need to incorporate technology into psychiatry undergraduate medical education (UGME). Educators need to understand how to find, access, and utilize such educational technology...
October 26, 2016: Psychiatric Quarterly
Roberto Nuño Solinís, Patricia Arratibel Ugarte, Ander Rojo, Yuri Sanchez Gonzalez
INTRODUCTION: The goal of chronic hepatitis C (CHC) treatment is to achieve a sustained virologic response (SVR). The new generation of direct-acting antivirals (DAAs) offers 90-100% SVR rates. However, access to these treatments is generally limited to patients with advanced liver disease. The aim of this review is to provide an overview of the clinical and economic benefits of achieving SVR and to better understand the full value of CHC treatment in all stages of liver disease. METHODS: A comprehensive literature review was performed using the PubMed, Embase, and Cochrane library databases to identify articles examining the clinical, economic, and quality of life benefits associated with SVR...
October 25, 2016: Infectious Diseases and Therapy
Angela Roberts Selzer, Matthew Murrell, Eugene Shostak
PURPOSE OF REVIEW: As the field of interventional pulmonology continues to expand and develop at a rapid pace, anesthesiologists are increasingly called upon to provide well tolerated anesthetic care during these procedures. These patients may not be candidates for surgical treatment and often have multiple comorbidities. It is important for anesthesiologists to familiarize themselves with these procedures and their associated risks and complications. RECENT FINDINGS: The scope of the interventional pulmonologist's practice is varied and includes both diagnostic and therapeutic procedures...
October 25, 2016: Current Opinion in Anaesthesiology
Valentina Iacopino, Daniele Mascia, Americo Cicchetti
BACKGROUND: In recent decades, the role of technology in health care organizations has become increasingly relevant because it enhances health care outcomes and the achievement of clinical goals. Extant research demonstrates that the effectiveness of a medical innovation depends largely on health care professionals' perceptions of its usefulness and impact on their activities and practices. We also know that interaction among social actors contributes to the shaping of their judgments and opinions regarding innovation...
October 25, 2016: Health Care Management Review
Aliza B Solomon, Rachel Reed, Keith Benkov, Joseph Kingsbery, Sarah S Lusman, Lisa B Malter, Jeremiah Levine, Simon Rabinowitz, Martin Wolff, Sondra Zabar, Elizabeth Weinshel
BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) has described six core competencies with which trainees should demonstrate proficiency. Using the Objective Structured Clinical Exam (OSCE), we aimed to assess four of these competencies among Pediatric GI fellows (PG). METHODS: Eight first-year PG's from six medical centers in the New York area participated in a four-station OSCE with trained standardized patient (SP) actors. The cases included an "ED Consult" for lower GI bleeding; "Breaking Bad News" focusing on CF nutritional complications; "Second Opinion" for abdominal pain; "Transition of Care" for inflammatory bowel disease...
October 25, 2016: Journal of Pediatric Gastroenterology and Nutrition
Esther Helmich, Huei-Ming Yeh, Adina Kalet, Mohamed Al-Eraky
Becoming a doctor is fundamentally about developing a new, professional identity as a physician, which in and of itself may evoke many emotions. Additionally, medical trainees are increasingly moving from one cultural context to another and are challenged with navigating the resulting shifts in their professional identify. In this Article, the authors aim to address medical professional identity formation from a polyvocal, multidisciplinary, cross-cultural perspective. They delineate the cultural approaches to medical professionalism, reflect on professional identity formation in different cultures and on different theories of identity development, and advocate for a context-specific approach to professional identity formation...
October 25, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Alan Bleakley
Inequalities in society are reflected in patterns of disease and access to health care, where the disadvantaged suffer most. Traditionally, doctors have kept politics out of their work, even though politics often shape medicine. What political responsibilities, then, should doctors have as they facilitate the learning of medical students? The article in this issue by Kumagai, Jackson, and Razack goes straight to the heart of this question. These authors ask whether educators should be wary of "cutting close to the bone" in discussing issues that may restimulate trauma in some medical students...
October 25, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Jamie Ross, Fiona Stevenson, Rosa Lau, Elizabeth Murray
BACKGROUND: There is a significant potential for e-health to deliver cost-effective, quality health care, and spending on e-health systems by governments and healthcare systems is increasing worldwide. However, there remains a tension between the use of e-health in this way and implementation. Furthermore, the large body of reviews in the e-health implementation field, often based on one particular technology, setting or health condition make it difficult to access a comprehensive and comprehensible summary of available evidence to help plan and undertake implementation...
October 26, 2016: Implementation Science: IS
Antonio González-López, Pedro Antonio Campos-Morcillo, José Domingo Lago-Martín
PURPOSE: Line-pair resolution phantoms are used to determine the spatial resolution of medical imaging systems. In some cases, these phantoms are used to determine the maximum number of line-pairs per mm that the system can resolve. In other cases, a numerical determination of the modulation transfer function (MTF) is carried out by means of the analysis of the variance of ROIs on the image. In this note, a new procedure is implemented to calculate the presampled MTF of an imaging system...
October 2016: Medical Physics
Sandip P Tarpada, Wayne D Hsueh, Marc J Gibber
OBJECTIVES/HYPOTHESIS: E-learning, in its most rudimentary form, is the use of Internet-based resources for teaching and learning purposes. In surgical specialties, this definition encompasses the use of virtual patient cases, digital modeling, and online tutorials, as well as standardized video and imaging. As new technological frontiers rapidly emerge within otolaryngology, e-learning may be an effective alternative to traditional teaching. Here we present a systematic review of the literature assessing the efficacy of e-learning for otolaryngology education and a discussion of the relevance of these programs for both medical students and residents within the field...
October 26, 2016: Laryngoscope
Rafael Dal-Ré
-The International Committee of Medical Journal Editors (ICMJE) has published a draft proposal on de-identified individual clinical trial participant data (IPD) sharing, stating that sharing trial data requires planning to ensure appropriate research ethics committee approval and participants' informed consent. This is why its implementation will be deferred for one year after the publication of the final version of the policy. -When conducting research with anonymous data it is not feasible to obtain the informed consent from research participants...
October 26, 2016: European Journal of Clinical Investigation
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