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"Care continuum"

William E Cunningham, Robert E Weiss, Terry Nakazono, Mark A Malek, Steve J Shoptaw, Susan L Ettner, Nina T Harawa
Importance: Diagnosis of human immunodeficiency virus (HIV) infection, linkage and retention in care, and adherence to antiretroviral therapy are steps in the care continuum enabling consistent viral suppression for people living with HIV, extending longevity and preventing further transmission. While incarcerated, people living with HIV receive antiretroviral therapy and achieve viral suppression more consistently than after they are released. No interventions have shown sustained viral suppression after jail release...
March 12, 2018: JAMA Internal Medicine
Zsolt J Nagykaldi, Huibert Tange, Jan De Maeseneer
Electronic health records (EHRs) have been in place for decades; however, most existing systems were designed in the prevailing disease- and payment-focused care paradigm that often loses sight of the goals, needs, and values of patients and clinicians. The goal-directed health care model was proposed more than 20 years ago, but no design principles have been developed for corresponding electronic record systems. Newly designed EHRs are needed to facilitate health care that is anchored by patient life and health goals...
March 2018: Annals of Family Medicine
P Todd Korthuis, E Jennifer Edelman
No abstract text is available yet for this article.
March 12, 2018: Addiction Science & Clinical Practice
Emma Slaymaker, Estelle McLean, Alison Wringe, Clara Calvert, Milly Marston, Georges Reniers, Chodziwadziwa Whiteson Kabudula, Amelia Crampin, Alison Price, Denna Michael, Mark Urassa, Daniel Kwaro, Maquins Sewe, Jeffrey W Eaton, Rebecca Rhead, Jessica Nakiyingi-Miiro, Tom Lutalo, Dorean Nabukalu, Kobus Herbst, Victoria Hosegood, Basia Zaba
Timely progression of people living with HIV (PLHIV) from the point of infection through the pathway from diagnosis to treatment is important in ensuring effective care and treatment of HIV and preventing HIV-related deaths and onwards transmission of infection.  Reliable, population-based estimates of new infections are difficult to obtain for the generalised epidemics in sub-Saharan Africa.  Mortality data indicate disease burden and, if disaggregated along the continuum from diagnosis to treatment, can also reflect the coverage and quality of different HIV services...
November 6, 2017: Gates Open Res
Ronnye Rutledge, Lynn Madden, Onyema Ogbuagu, Jaimie P Meyer
Women involved in the criminal justice system (WICJ) are at high risk of acquiring HIV and would benefit from HIV pre-exposure prophylaxis (PrEP) but there are no studies in this population to inform PrEP implementation programs. We conducted a cross-sectional survey of HIV-uninfected, cis-gender women on probation, parole and/or recently released from prison/jail to assess PrEP awareness, eligibility, potential barriers to uptake, and the PrEP care continuum. The 125 WICJ surveyed reported high rates of HIV risk behaviors including recent transactional sex (22...
March 11, 2018: AIDS Care
R Modi, K R Amico, A Knudson, A O Westfall, J Keruly, H M Crane, E B Quinlivan, C Golin, J Willig, A Zinski, R Moore, S Napravnik, L Bryan, M S Saag, M J Mugavero
In the first year after HIV diagnosis, patients are simultaneously processing with their diagnosis, typically with an emotional component, while also developing a routine of regular medical care visits and antiretroviral therapy (ART) adherence. Maintaining "HIV adherence" and integrating it into one's daily life is required to sustain viral load suppression (VS) over time. The HIV care continuum or "treatment cascade," an epidemiological snapshot of the national epidemic in the United States (US), indicates that a minority of persons living with HIV (PLWH) have achieved VS...
March 8, 2018: Contemporary Clinical Trials
David Kershenobich, Aldo Torre-Delgadillo, Luz María Aguilar-Valenzuela
Chronic hepatitis C is often asymptomatic and may progress over the years to cirrhosis and hepatocellular carcinoma. Although the prevalence and incident cases are decreasing, the peak mortality of hepatitis C virus (HCV)-related complications is ahead of us in most countries. The economic impact of this burden is enormous. Scaling up the identification of new opportunities to facilitate the road toward HCV elimination includes increasing screening, awareness, and the number of prescribing physicians. Screening should occur within the context of linkage-to-care and patient retention across the care continuum...
2018: Revista de Investigación Clínica; Organo del Hospital de Enfermedades de la Nutrición
Preeti Pathela, Kelly Jamison, Sarah L Braunstein, Julia A Schillinger, Olga Tymejczyk, Denis Nash
BACKGROUND: Linkage/re-linkage to HIV care for virally unsuppressed persons with new sexually transmitted infections is critical for ending the HIV epidemic. We quantified HIV care continuum gaps, and viral suppression, among HIV-positive patients attending New York City (NYC) sexual health clinics (SHC). METHODS: 1,649 HIV-positive patients and a 10% sample of 11,954 patients with unknown HIV status on clinic visit date (DOV) were matched against the NYC HIV registry...
March 2, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
P Maxwell Courtney, Michael E West, William J Hozack
BACKGROUND: With recent healthcare reform efforts focusing on rewarding value instead of volume, it has become important for orthopedic surgeons to partner and align with their hospitals. We report our experience in aligning clinical and financial incentives with 6 health systems in our geographic area. METHODS: By managing the entire episode-of-care continuum for total hip and total knee arthroplasty patients, our standardized, evidence-based protocols have improved the quality of care for our joint arthroplasty patients...
January 31, 2018: Journal of Arthroplasty
Yesenia Merino, Leslie Adams, William J Hall
This Open Forum explores the role of implicit bias along the mental health care continuum, which may contribute to mental health disparities among vulnerable populations. Emerging research shows that implicit bias is prevalent among service providers. These negative or stigmatizing attitudes toward population groups are held at a subconscious level and are automatically activated during practitioner-client encounters. The authors provide examples of how implicit bias may impede access to care, clinical screening and diagnosis, treatment processes, and crisis response...
March 1, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
Monique Hennink, Bonnie Kaiser, Vincent Marconi
Retaining HIV patients in clinical care is a critical component of the HIV care continuum, impacting not only patients' virologic suppression but their overall health and wellbeing. Understanding reasons for patient drop out is therefore important to improve HIV outcomes and reduce transmission. This study used qualitative in-depth interviews with patients who dropped out of HIV care (n=16) from the Atlanta Veterans Affairs Medical Center, to explore their reasons for drop out and how they negotiate barriers to return to care...
February 28, 2018: AIDS Research and Human Retroviruses
Silvia D Vaca, Benjamin J Kuo, Joao Ricardo Nickenig Vissoci, Catherine A Staton, Linda W Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Henry E Rice, Gerald A Grant, Michael M Haglund
BACKGROUND: Significant care continuum delays between acute traumatic brain injury (TBI) and definitive surgery are associated with poor outcomes. Use of the "3 delays" model to evaluate TBI outcomes in low- and middle-income countries has not been performed. OBJECTIVE: To describe the care continuum, using the 3 delays framework, and its association with TBI patient outcomes in Kampala, Uganda. METHODS: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June to 30 November 2016...
February 26, 2018: Neurosurgery
Suan Ee Ong, Shilpa Tyagi, Jane Mingjie Lim, Kee Seng Chia, Helena Legido-Quigley
In response to a growing chronic disease burden and ageing population, Singapore implemented Regional Health Systems (RHS) in 2008. In January 2017, the MOH announced that the six RHS clusters would be reorganised into three in 2018. This qualitative study sought to identify the health system challenges, opportunities, and ways forward for the implementation of the RHS. We conducted semi-structured interviews with 35 key informants from RHS clusters, government, academia, and private and voluntary sectors. Integration, innovation, and people-centeredness were identified as the key principles of the RHS...
February 19, 2018: Health Policy
Hilary J Aralis, Steve Shoptaw, Ron Brookmeyer, Amy Ragsdale, Robert Bolan, Pamina M Gorbach
For individuals living with human immunodeficiency virus (HIV), viral suppression positively affects quality and length of life and reduces risks for HIV transmission. Men of color who have sex with men (MoCSM) who have been diagnosed with HIV have disproportionately low rates of viral suppression, with concomitant increases in incidence. We identified specific social, structural, and psychiatric factors associated with viral suppression among a sample of 155 HIV-positive MoCSM. Cigarette smoking and biological markers of recent drug use were significantly associated with detectable viral load...
February 24, 2018: AIDS and Behavior
Brian W Pence, Jon C Mills, Angela M Bengtson, Bradley N Gaynes, Tiffany L Breger, Robert L Cook, Richard D Moore, David J Grelotti, Conall O'Cleirigh, Michael J Mugavero
Importance: Depression commonly affects adults with HIV and complicates the management of HIV. Depression among individuals with HIV tends to be chronic and cyclical, but the association of this chronicity with HIV outcomes (and the related potential for screening and intervention to shorten depressive episodes) has received little attention. Objective: To examine the association between increased chronicity of depression and multiple HIV care continuum indicators (HIV appointment attendance, treatment failure, and mortality)...
February 21, 2018: JAMA Psychiatry
Karolina Lisy, Micah D J Peters, Penelope Schofield, Michael Jefford
OBJECTIVES: To explore the cancer care experiences and unmet needs of people who identify as a sexual or gender minority. METHODS: A qualitative systematic review and meta-synthesis was undertaken based on a registered protocol. Following literature searching and study selection, study quality was examined using the Critical Appraisal Skill Programme Checklist. Qualitative data were extracted verbatim from included studies and synthesised using thematic analysis...
February 20, 2018: Psycho-oncology
(no author information available yet)
Patient-reported outcomes (PROs), which provide a direct measure of a patient's health status or treatment preferences, represent a key component of the shift toward patient-centered health care. PROs can measure the state of a patient's disease-specific and overall health throughout the care continuum, enabling them to have a variety of uses for key health care stakeholders. Currently, PROs are used in drug development, aligning patient and clinician goals in care, quality-of-care measures, and coverage and reimbursement decisions...
February 20, 2018: Journal of Managed Care & Specialty Pharmacy
M A Mannan, M A Hossain, J Nasim, Y Sabina, F Navila, D Subir
Since its inception, the neonatal mechanical ventilator has been considered an essential tool for managing preterm neonates with Respiratory Distress Syndrome (RDS) and is still regarded as an integral component in the neonatal respiratory care continuum. Mechanical ventilation of newborn has been practiced for several years with several advances made in the way. This clinical intervention study was done to analyze immediate outcome of preterm neonates with RDS required mechanical ventilation and conducted on preterm neonates with RDS required mechanical ventilation from July 2014 to June 2015...
January 2018: Mymensingh Medical Journal: MMJ
Lianne Jeffs, Åsa Muntlin Athlin, Jack Needleman, Debra Jackson, Alison Kitson
Considerable transformation is occurring in healthcare globally with organizations focusing on achieving the quadruple aim of improving the experience of care, the health of populations, and the experience of providing care while reducing per capita costs of health care. In response, health care organizations are employing performance measurement and quality improvement methods to achieve the quadruple aim. Despite the plethora of measures available to health managers, there is no standardized data set and virtually no indicators reflecting how patients actually experience the delivery of fundamental care, such as nutrition, hydration, mobility, respect, education, and psychosocial support...
February 15, 2018: Journal of Clinical Nursing
Daniel M Walker, Terri Menser, Po-Yin Yen, Ann Scheck McAlearney
BACKGROUND:  Patient portals specifically designed for the inpatient setting have significant potential to improve patient care. However, little is known about how the users of this technology, the patients, may interact with the inpatient portals. As a result, hospitals have limited ability to design approaches that support patient use of the portal. OBJECTIVES:  This study aims to evaluate the user experience associated with an inpatient portal. METHODS:  We used a Think-Aloud protocol to study user interactions with a commercially available inpatient portal-MyChart Bedside (MCB)...
January 2018: Applied Clinical Informatics
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