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https://www.readbyqxmd.com/read/28498197/overuse-of-health-care-services-in-the-management-of-cancer-a-systematic-review
#1
Shrujal S Baxi, Minal Kale, Salomeh Keyhani, Benjamin R Roman, Annie Yang, Antonio P Derosa, Deborah Korenstein
BACKGROUND: Overuse, the provision of health services for which harms outweigh the benefits, results in suboptimal patient care and may contribute to the rising costs of cancer care. We performed a systematic review of the evidence on overuse in oncology. METHODS: We searched Medline, EMBASE, the Cochrane Library, Web of Science, SCOPUS databases, and 2 grey literature sources, for articles published between December 1, 2011 and March 10, 2017. We included publications from December 2011 to evaluate the literature since the inception of the ABIM Foundation's Choosing Wisely initiative in 2012...
May 11, 2017: Medical Care
https://www.readbyqxmd.com/read/28489834/endoscopic-gastrostomy-critical-analysis-in-a-regional-referral-hospital
#2
Gabriel Marques Fávaro, Tiago Franco Filho, Diego Soares Coca, Marco Antonio Cunha, Ricardo Sato Uemura, Carlos Kyoshi Furuya Júnior, Dayse Aparício, Everson L A Artifon
INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a safe and effective endoscopic surgical procedure for enteral access and gastrointestinal decompression, and it is an excellent alternative to surgical gastrostomy. There are various clinical indications and these mainly include the need for prolonged enteral nutritional support due to complications from neurological, geriatric and oncological diseases and decompression of the gastrointestinal tract. Although safe and effective, a number of possible complications relating to the time (early or late complications) and severity (minor or major complications) may occur...
January 2017: Revista de Gastroenterología del Perú: órgano Oficial de la Sociedad de Gastroenterología del Perú
https://www.readbyqxmd.com/read/28488991/geriatric-hip-fracture-care-fixing-a-fragmented-system
#3
Mary E Anderson, Kelly Mcdevitt, Ethan Cumbler, Heather Bennett, Zachary Robison, Bryan Gomez, Jason W Stoneback
CONTEXT: Fragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28458958/the-intersection-of-oncology-prognosis-and-cancer-rehabilitation
#4
REVIEW
Sean Robinson Smith, Jasmine Yiqian Zheng
PURPOSE OF REVIEW: This review examines the delivery of rehabilitation care to cancer patients with relation to disease prognosis. This includes the evaluation when patients are referred for rehabilitation services and the effectiveness of rehabilitation interventions across the cancer continuum. RECENT FINDINGS: Although prognosticating life expectancy is difficult, referrals for rehabilitation interventions appear to be affected by physician attitudes towards patients with advanced disease, in part because of misconceptions about the nature of rehabilitation for oncology patients...
2017: Current Physical Medicine and Rehabilitation Reports
https://www.readbyqxmd.com/read/28450739/comparing-mortality-risk-of-patients-with-acute-hip-fractures-admitted-to-a-major-trauma-centre-on-a-weekday-or-weekend
#5
Rajpal Nandra, Jack Pullan, Jonathan Bishop, Khalid Baloch, Liam Grover, Keith Porter
Proximal femoral fractures are a major public health concern with estimated annual direct and social costs amounting to £2 billion and average 30-day mortality risk of 7.5%. In response to the recent debate over out-of-hours hospital provision we investigated the 'weekend effect' at a major trauma centre, caring for acute injuries. A single centre, multi-surgeon review of 2060 patients performed. The distribution of patient and treatment variables compared in patients admitted on a weekday or the weekend. Fewer patients met performance indicators during weekend admission, time to surgery (63 vs...
April 27, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28410002/comparing-behavioral-health-models-for-reducing-risky-drinking-among-older-male-veterans
#6
Nikki R Wooten, Abbas S Tavakoli, Marlene B Al-Barwani, Naomi A Thomas, Hrishikesh Chakraborty, Anna M Scheyett, Kelly M Kaminski, Alyssia C Woods, Sue E Levkoff
BACKGROUND: Screening older veterans in Veterans Affairs Medical Center (VAMC) primary care clinics for risky drinking facilitates early identification and referral to treatment. OBJECTIVE: This study compared two behavioral health models, integrated care (a standardized brief alcohol intervention co-located in primary care clinics) and enhanced referral care (referral to specialty mental health or substance abuse clinics), for reducing risky drinking among older male VAMC primary care patients...
April 14, 2017: American Journal of Drug and Alcohol Abuse
https://www.readbyqxmd.com/read/28408619/data-linkage-to-improve-geriatric-oncology-research-a-feasibility-study
#7
Jennifer L Lund, Anne-Marie Meyer, Allison M Deal, Bong-Jin Choi, YunKyung Chang, Grant R Williams, Mackenzi Pergolotti, Emily J Guerard, Hyman B Muss, Hanna K Sanoff
Older adults (aged 65 years and older) diagnosed with cancer account for most cancer-related morbidity and mortality in the United States but are often underrepresented on clinical trials. Recent attention from a variety of professional, research, regulatory, and patient advocacy groups has centered on data linkage and data sharing as a means to capture patient information and outcomes outside of clinical trials to accelerate progress in the fight against cancer. The development of a more robust observational research data infrastructure would help to address gaps in the evidence base regarding optimal approaches to treating cancer among the growing and complex population of older adults...
April 13, 2017: Oncologist
https://www.readbyqxmd.com/read/28400963/psychiatry-and-the-geriatric-syndromes-creating-constructive-interfaces
#8
EDITORIAL
Simon Thacker, Mike Skelton, Rowan Harwood
Integrating mental and physical healthcare is difficult to achieve because of professional and organisational barriers. Psychiatrists recognise the problems resulting from fragmentation of services and want continuity of care for patients, but commissioning and service structures perpetuate these problems. One way forward may be to follow the syndromic model employed by geriatricians as a means of avoiding over-emphasis on diagnosis above the pragmatics of implementing multi-component, coordinated care. Commissioners need to be made aware of the overlap and complementarity of skills possessed by old age psychiatry and geriatric medicine to create joint services for people vulnerable to dementia and delirium...
April 2017: BJPsych Bulletin
https://www.readbyqxmd.com/read/28388276/a-formative-evaluation-of-a-nurse-practitioner-led-interprofessional-geriatric-outpatient-clinic
#9
Kevin T Hansen, Cheryl McDonald, Sue O'Hara, Leslie Post, Susan Silcox, Iris A Gutmanis
The number of older adults with multiple complex comorbidities and frailty is expected to increase dramatically in the coming decades, which will necessitate a concomitant increase in the need for skilled clinicians who are able to manage complex geriatric needs. Many physicians, however, lack the required formal training, often leading to long wait-lists for specialist clinics. Yet, clinics led by non-physician professionals specialising in geriatric care could decrease these delays. This article describes the development and evaluation of a nurse practitioner-led interprofessional geriatric outpatient clinic (Inter-D Clinic)...
April 7, 2017: Journal of Interprofessional Care
https://www.readbyqxmd.com/read/28372591/cooperation-between-geriatricians-and-general-practitioners-for-improved-pharmacotherapy-in-home-dwelling-elderly-people-receiving-polypharmacy-the-coop-study-study-protocol-for-a-cluster-randomised-controlled-trial
#10
Rita Romskaug, Espen Molden, Jørund Straand, Hege Kersten, Eva Skovlund, Kaisu H Pitkala, Torgeir Bruun Wyller
BACKGROUND: Polypharmacy and inappropriate drug use is associated with negative health outcomes among older people. Various interventions for improving drug treatment have been evaluated, but the majority of studies are limited by the use of surrogate outcomes or suboptimal design. Thus, the potential for clinically significant improvements from different interventions is still unclear. The main objective of this study is therefore to evaluate the effect upon patient-relevant endpoints of a cooperation between geriatricians and general practitioners on complex drug regimens in home-dwelling elderly people...
April 4, 2017: Trials
https://www.readbyqxmd.com/read/28367005/a-multidisciplinary-approach-to-improve-the-quality-of-care-for-patients-with-fragility-fractures
#11
Laura C Lamb, Stephanie C Montgomery, Brian Wong Won, Siobhan Harder, Jeffrey Meter, James M Feeney
BACKGROUND: Fragility fractures have become a worldwide epidemic associated with significant morbidity and mortality. As the world population ages, the number of patients that experience these fractures is also expected to rise. A multidisciplinary team was assembled that was coordinated by the Acute Inpatient Medical Service and included orthopedic surgeons, geriatricians, anesthesiologists, cardiologists, nurses, trauma surgeons, emergency medicine physicians, physiatrists, and physical therapists...
June 2017: Journal of Orthopaedics
https://www.readbyqxmd.com/read/28340600/an-evaluation-of-the-comparative-effectiveness-of-geriatrician-led-comprehensive-geriatric-assessment-for-improving-patient-and-healthcare-system-outcomes-for-older-adults-a-protocol-for-a-systematic-review-and-network-meta-analysis
#12
Charlene Soobiah, Caitlin Daly, Erik Blondal, Joycelyne Ewusie, Joanne Ho, Meghan J Elliott, Rossini Yue, Jayna Holroyd-Leduc, Barbara Liu, Sharon Marr, Jenny Basran, Andrea C Tricco, Jemila Hamid, Sharon E Straus
BACKGROUND: Comprehensive geriatric assessment (CGA) is an integrated model of care involving a geriatrician and an interdisciplinary team and can prioritize and manage complex health needs of older adults with multimorbidity. CGAs differ across healthcare settings, ranging from shared care conducted in primary care settings to specialized inpatient units in acute care. Models of care involving geriatricians vary across healthcare settings, and it is unclear which CGA model is most effective...
March 24, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28330452/a-structure-process-and-outcome-evaluation-of-the-geriatric-emergency-department-intervention-model-of-care-a-study-protocol
#13
Elizabeth Marsden, Andrea Taylor, Marianne Wallis, Alison Craswell, Marc Broadbent, Adrian Barnett, Kim-Huong Nguyen, Julia Crilly, Colleen Johnston, Amanda Glenwright
BACKGROUND: Emergency departments are chaotic environments in which complex, frail older persons living in the community and residential aged care facilities are sometimes subjected to prolonged emergency department lengths of stay, excessive tests and iatrogenic complications. Given the ageing population, the importance of providing appropriate, quality health care in the emergency department for this cohort is paramount. One possible solution, a nurse-led, physician-championed, emergency department gerontological intervention team, which provides frontload assessment, early collateral communication and appropriate discharge planning, has been developed...
March 23, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28320331/a-multi-component-cognitive-behavioural-intervention-for-the-treatment-of-fear-of-falling-after-hip-fracture-fit-hip-protocol-of-a-randomised-controlled-trial
#14
Maaike N Scheffers-Barnhoorn, Jolanda C M van Haastregt, Jos M G A Schols, Gertrudis I J M Kempen, Romke van Balen, Jan H M Visschedijk, Wilbert B van den Hout, Eve M Dumas, Wilco P Achterberg, Monica van Eijk
BACKGROUND: Hip fracture is a common injury in the geriatric population. Despite surgical repair and subsequent rehabilitation programmes, functional recovery is often limited, particularly in individuals with multi-morbidity. This leads to high care dependency and subsequent use of healthcare services. Fear of falling has a negative influence on recovery after hip fracture, due to avoidance of activity and subsequent restriction in mobility. Although fear of falling is highly prevalent after hip fracture, no structured treatment programme is currently available...
March 20, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28302066/geriatric-support-in-the-emergency-department-a-national-survey-in-belgium
#15
Els Devriendt, Isabelle De Brauwer, Lies Vandersaenen, Pieter Heeren, Simon Conroy, Benoit Boland, Johan Flamaing, Marc Sabbe, Koen Milisen
BACKGROUND: Older people in the emergency department (ED) represent a growing population and increasing proportion of the workload in the ED. This study investigated the support for frail older people in the ED, by exploring the collaboration between the geriatric services (GS) and the EDs in Belgian hospitals. METHODS: An electronic cross-sectional survey in all Belgian hospitals with an ED (n = 100) about care aspects, collaboration, education and infrastructure for older patients in the ED was collected...
March 16, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28292646/follow-up-of-elderly-patients-with-urogenital-cancers-evaluation-of-geriatric-care-needs-and-related-actions
#16
Silvio Monfardini, Sara Morlino, Riccardo Valdagni, Mario Catanzaro, Ardit Tafa, Barbara Bortolato, Giovanni Petralia, Elisa Bonetto, Elisa Villa, Stefano Picozzi, Maria Cristina Locatelli, Giuseppe Galetti, Andrea Millul, Yasmin Albanese, Elisa Bianchi, Claudia Panzarino, Francesca Gerardi, Ettore Beghi
OBJECTIVES: To investigate a comprehensive geriatric assessment (CGA) with subsequent investigation of healthcare patterns in older patients with urological cancers undergoing initial surgery or radiotherapy, to verify the usefulness of the incorporation of geriatric principles in future care plans. MATERIAL AND METHODS: This is a prospective cohort study. From November 2011 to March 2015, CGA was offered to all patients aged 70+ years treated with radiotherapy or surgery at seven tertiary centers...
March 11, 2017: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/28285980/activities-function-and-health-related-quality-of-life-hrqol-of-older-adults-with-cancer
#17
Mackenzi Pergolotti, Allison M Deal, Grant R Williams, Ashley L Bryant, Jeannette T Bensen, Hyman B Muss, Bryce B Reeve
OBJECTIVE: This study aims to (1) describe the activities, function, and health-related quality of life (HRQOL) of a large sample of older adults (age ≥65) with cancer, (2) identify the associations with demographics, cancer type, comorbid conditions, and ability to participate in activities and functional status. MATERIALS AND METHODS: The Health Registry/Cancer Survivorship Cohort is an institutional database designed to aid cancer survivorship research. The registry includes three measures of patient-reported HRQOL: FACT-G and PROMIS® Global measures for physical and mental health...
March 9, 2017: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/28276179/effect-of-caregiving-relationship-and-formal-long-term-care-service-use-on-caregiver-well-being
#18
Kirsten Eom, Michael J Penkunas, Angelique W M Chan
AIM: Despite efforts to revise the traditional long-term care (LTC) model, informal caregivers continue to provide a substantial amount of support to older adults as front-line care providers. The present study aimed to understand the effect of informal caregiving on caregivers' well-being in Singapore with respect to different types of patient-caregiver relationships. Second, this study examined the association between formal LTC service use and caregivers' well-being. METHODS: Two waves of data for 781 dyads of patients with LTC needs and their caregivers from a longitudinal study were analyzed...
March 9, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28270122/implementation-of-integrated-geriatric-care-at-a-german-hospital-a-case-study-to-understand-when-and-why-beneficial-outcomes-can-be-achieved
#19
Loraine Busetto, Jörn Kiselev, Katrien Ger Luijkx, Elisabeth Steinhagen-Thiessen, Hubertus Johannes Maria Vrijhoef
BACKGROUND: Many health systems have implemented integrated care as an alternative approach to health care delivery that is more appropriate for patients with complex, long-term needs. The objective of this article was to analyse the implementation of integrated care at a German geriatric hospital and explore whether the use of a "context-mechanisms-outcomes"-based model provides insights into when and why beneficial outcomes can be achieved. METHODS: We conducted 15 semi-structured interviews with health professionals employed at the hospital...
March 7, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28253468/variation-in-outpatient-consultant-physician-fees-in-australia-by-specialty-and-state-and-territory
#20
Gary L Freed, Amy R Allen
OBJECTIVES: To determine the mean, median and 10th and 90th percentile levels of fees and out-of-pocket costs to the patient for an initial consultation with a consultant physician; to determine any differences in fees and bulk-billing rates between specialties and between states and territories. DESIGN, PARTICIPANTS AND SETTING: Analysis of 2015 Medicare claims data for an initial outpatient appointment with a consultant physician (Item 110) in 11 medical specialties representative of common adult non-surgical medical care (cardiology, endocrinology, gastroenterology, geriatric medicine, haematology, immunology/allergy, medical oncology, nephrology, neurology, respiratory medicine and rheumatology)...
March 6, 2017: Medical Journal of Australia
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