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Karen Thomson, Sophie R Pestieau, Janish J Patel, Heather Gordish-Dressman, Ariana Mirzada, Zeev N Kain, Matthew E Oetgen
BACKGROUND: The Perioperative Surgical Home (PSH) is a patient-centered, team-based approach that aims to improve the value of perioperative care. We implemented a PSH for patients with adolescent idiopathic scoliosis who were undergoing posterior spinal fusion at Children's National Health System. We hypothesized that this PSH would improve patient surgical outcomes and reduce hospital length of stay (LOS). METHODS: A multidisciplinary group created evidence-based protocols for the preoperative, operative, postoperative, and postdischarge care of this patient population...
October 3, 2016: Anesthesia and Analgesia
Masha G Jones, Linda V DeCherrie, Yasmin S Meah, Cameron R Hernandez, Eric J Lee, David M Skovran, Theresa A Soriano, Katherine A Ornstein
Nurse practitioner (NP) comanagement involves an NP and physician sharing responsibility for the care of a patient. This study evaluates the impact of NP comanagement for clinically complex patients in a home-based primary care program on hospitalizations, 30-day hospital readmissions, and provider satisfaction. We compared preenrollment and postenrollment hospitalization and 30-day readmission rates of home-bound patients active in the Nurse Practitioner Co-Management Program within the Mount Sinai Visiting Doctors Program (MSVD) (n = 87) between January 1, 2012, and July 1, 2013...
September 13, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
Joshua S Shapiro, Michael S Humeniuk, Mustaqeem A Siddiqui, Neelima Bonthu, Darrell R Schroeder, Deanne T Kashiwagi
Little is known about which variables put patients with cancer at risk for 30-day hospital readmission. Comanagement of this often complex patient population by specialists and hospitalists has become increasingly common. This retrospective study examined inpatients with cancer comanaged by hospitalists, hematologists, and oncologists to determine the rate of readmission and factors associated with readmission. Patients in this cohort had a readmission rate of 23%. Patients who were discharged to a skilled nursing facility (odds ratio [OR] = 0...
August 25, 2016: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Brian P Chalmers, Cameron K Ledford, Joseph M Statz, Tad M Mabry, Arlen D Hanssen, Matthew P Abdel
INTRODUCTION: As patients who receive hematopoietic stem cell transplantation are at increased risk of avascular necrosis (AVN) and subsequent degenerative arthritis, THA may be considered in some of these patients, particularly as overall patient survival improves for patients undergoing stem-cell transplants. Patients receiving hematopoietic stem cell transplantation theoretically are at increased risk of experiencing complications, infection, and poorer implant survivorship owing to the high prevalence of comorbid conditions, immunosuppressive therapy regimens including corticosteroids, and often low circulating hematopoietic cell lines; however, there is a paucity of studies elucidating these risks...
August 19, 2016: Clinical Orthopaedics and related Research
Shveta S Motwani, Leal Herlitz, Divya Monga, Kenar D Jhaveri, Albert Q Lam
Paraproteins are monoclonal Igs that accumulate in blood as a result of abnormal excess production. These circulating proteins cause a diversity of kidney disorders that are increasingly being comanaged by nephrologists. In this review, we discuss paraprotein-related diseases that affect the glomerulus. We provide a broad overview of diseases characterized by nonorganized deposits, such as monoclonal Ig deposition disease (MIDD), proliferative GN with monoclonal Ig deposits (PGNMID), and C3 glomerulopathy, as well as those characterized by organized deposits, such as amyloidosis, immunotactoid glomerulopathy, fibrillary GN, and cryoglobulinemic GN, and rarer disorders, such as monoclonal crystalline glomerulopathies, paraprotein-related thrombotic microangiopathies, and membranous-like glomerulopathy with masked IgGκ deposits...
August 15, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Joseph Lunyera, Charles Jonassaint, Jude Jonassaint, Nirmish Shah
BACKGROUND: Sickle cell disease (SCD) is a complex chronic disease requiring multidisciplinary care that involves primary care physicians (PCPs) working with a hematologist or SCD specialists. However, PCPs often lack access to SCD specialists and are unaware of SCD guidelines or efficacious treatment. METHODS: We partnered with Community Care of North Carolina (CCNC) to identify assigned PCPs for SCD patients with Medicaid across North Carolina. CCNC network administrators distributed a web-based questionnaire for completion...
August 9, 2016: Journal of Primary Care & Community Health
M Gosch, Y Hoffmann-Weltin, T Roth, M Blauth, J A Nicholas, C Kammerlander
BACKGROUND: Fragility fractures are a major health care problem worldwide. Both hip and non-hip fractures are associated with excess mortality in the years following the fracture. Residents of long-term nursing homes represent a special high-risk group for poor outcomes. Orthogeriatric co-management models of care have shown in multiple studies to have medical as well as economic advantages, but their impact on this high-risk group has not been well studied. OBJECTIVE: We studied the outcome of long-term care residents with hip and non-hip fractures admitted to a geriatric fracture center...
October 2016: Archives of Orthopaedic and Trauma Surgery
Marcus Shaker, Erin Salcone
PURPOSE OF REVIEW: The update reviews prevalence, classification, cause, and treatment options for allergic eye disease. RECENT FINDINGS: The incidence of allergic eye disease is underreported but may affect almost all patients with allergic rhinitis. Increased rates of oculonasal symptoms have been reported in the United States resulting in significant economic expenditures. The spectrum of allergic conjunctivitis and its differential considerations include seasonal and perennial conjunctivitis, vernal and atopic keratoconjunctivitis, and giant papillary conjunctivitis...
October 2016: Current Opinion in Allergy and Clinical Immunology
Mary S Mouw, Eleanor A Wertman, Clare Barrington, Jo Anne L Earp
PURPOSE: Most adolescent and young adult (AYA)-aged childhood cancer survivors develop physical and/or psychosocial sequelae; however, many do not receive long-term follow-up (LTF) critical for screening, prevention, and treatment of late effects. To develop a health services research agenda to optimize care models, we conducted qualitative research with LTF providers examining existing models, and successes and challenges in maintaining survivors' connections to care across their transition to adulthood...
August 3, 2016: Journal of Adolescent and Young Adult Oncology
Murali M Chakinala, Maribeth Duncan, Joel Wirth
Pulmonary hypertension remains a challenging condition to diagnose and manage. Decentralized care for pulmonary arterial hypertension (PAH) has led to shortcomings in the diagnosis and management of PAH. The Pulmonary Hypertension Association-sponsored Pulmonary Hypertension Care Center program is designed to recognize specialty centers capable of providing multidisciplinary and comprehensive care of PAH. Ideally, Pulmonary Hypertension Care Centers will comanage PAH patients with community-based practitioners and address the growing needs of this emerging population of long-term PAH patients...
August 2016: Cardiology Clinics
Christian Kammerlander, Hitendra K Doshi, Wolfgang Böcker, Markus Gosch
No abstract text is available yet for this article.
2016: BioMed Research International
Brook A Calton, Amy Alvarez-Perez, Diane G Portman, Kavitha J Ramchandran, Jessica Sugalski, Michael W Rabow
BACKGROUND: ASCO and IOM recommend palliative care (PC) across health care settings for patients with serious illnesses, including cancer. This study provides an overview of the current availability, structure, and basic quality of PC services within NCCN Member Institutions. METHODS: A PC survey was developed by NCCN staff and a working group of PC experts from 11 NCCN Member Institutions under the auspices of the NCCN Best Practices Committee. The survey was piloted and refined by 3 working group members and sent electronically to all 26 NCCN Member Institutions...
July 2016: Journal of the National Comprehensive Cancer Network: JNCCN
Lee A Jennings, Zaldy Tan, Neil S Wenger, Erin A Cook, Weijuan Han, Heather E McCreath, Katherine S Serrano, Carol P Roth, David B Reuben
Multiple studies have shown that quality of care for dementia in primary care is poor, with physician adherence to dementia quality indicators (QIs) ranging from 18% to 42%. In response, the University of California at Los Angeles (UCLA) Health System created the UCLA Alzheimer's and Dementia Care (ADC) Program, a quality improvement program that uses a comanagement model with nurse practitioner dementia care managers (DCM) working with primary care physicians and community-based organizations to provide comprehensive dementia care...
August 2016: Journal of the American Geriatrics Society
Molly A Martin, Eleanor C Floyd, Sara K Nixon, Sandra Villalpando, Madeleine Shalowitz, Elizabeth Lynch
This article describes formative work conducted to inform design of an intervention targeting asthma control in overweight/obese children. Using a PRECEDE-PROCEED framework and a community-based participatory research approach, investigators conducted key informant interviews and focus groups in a low-income urban community. Key informants (N = 18) represented schools and community agencies. Focus groups were conducted with caregivers (4 groups, N = 31) and children (3 groups, N = 30). Focus group participants were low-income and African American, Puerto Rican, or Mexican...
June 6, 2016: Health Promotion Practice
Jonathan Bergman, Aaron A Laviana
Palliative care involves aggressively addressing and treating psychosocial, spiritual, religious, and family concerns, as well as considering the overall psychosocial structures supporting a patient. The concept of integrated palliative care removes the either/or decision a patient needs to make: they need not decide if they want either aggressive chemotherapy from their oncologist or symptom-guided palliative care but rather they can be comanaged by several clinicians, including a palliative care clinician, to maximize the benefit to them...
2016: Journal of Multidisciplinary Healthcare
Jonathan M Fenkel, Dina L Halegoua-DeMarzio
Liver transplant (LT) recipients are living longer than ever today and many will experience some form of allograft dysfunction. The common causes of allograft dysfunction vary significantly depending on the timing since LT. Most allograft abnormalities are manageable with minimally invasive procedures, medications, and lifestyle modification. The most common differential diagnoses by time period after LT, and diagnostic and management considerations, are highlighted. Collaboration and comanagement of LT recipients between primary care and the transplant hepatologist is essential for optimizing recipient and allograft outcomes...
May 2016: Medical Clinics of North America
Laura M Sterni, Joseph M Collaco, Christopher D Baker, John L Carroll, Girish D Sharma, Jan L Brozek, Jonathan D Finder, Veda L Ackerman, Raanan Arens, Deborah S Boroughs, Jodi Carter, Karen L Daigle, Joan Dougherty, David Gozal, Katharine Kevill, Richard M Kravitz, Tony Kriseman, Ian MacLusky, Katherine Rivera-Spoljaric, Alvaro J Tori, Thomas Ferkol, Ann C Halbower
BACKGROUND: Children with chronic invasive ventilator dependence living at home are a diverse group of children with special health care needs. Medical oversight, equipment management, and community resources vary widely. There are no clinical practice guidelines available to health care professionals for the safe hospital discharge and home management of these complex children. PURPOSE: To develop evidence-based clinical practice guidelines for the hospital discharge and home/community management of children requiring chronic invasive ventilation...
April 15, 2016: American Journal of Respiratory and Critical Care Medicine
Olof Wolf, Henrik Åberg, Ulrika Tornberg, Kenneth B Jonsson
INTRODUCTION: Comorbidities and polypharmacy complicate the treatment of geriatric patients with acute orthopedic injuries. A correct medication history and an updated medication list are a prerequisite for safe treatment of these debilitated patients. Published evidence suggests favorable outcomes with comanaged care. The aim of this study was to assess the accuracy of the inpatient medication lists generated at admission and investigate the efficacy of a dedicated ward-based pharmacist to find and correct mistakes in these lists...
March 2016: Geriatric Orthopaedic Surgery & Rehabilitation
Joanna G Katzman, Kevin Galloway, Cynthia Olivas, Kimberly McCoy-Stafford, Daniel Duhigg, George Comerci, Summers Kalishman, Chester C Buckenmaier, Laura McGhee, Kristin Joltes, Andrea Bradford, Brian Shelley, Jessica Hernandez, Sanjeev Arora
Project ECHO (Extension for Community Healthcare Outcomes) is an evidence-based model that provides high-quality medical education for common and complex diseases through telementoring and comanagement of patients with primary care clinicians. In a one to many knowledge network, the ECHO model helps to bridge the gap between primary care clinicians and specialists by enhancing the knowledge, skills, confidence, and practice of primary care clinicians in their local communities. As a result, patients in rural and urban underserved areas are able to receive best practice care without long waits or having to travel long distances...
March 2016: Military Medicine
Ton Satink, Staffan Josephsson, Jana Zajec, Edith H C Cup, Bert J M de Swart, Maria W G Nijhuis-van der Sanden
PURPOSE: To manage social roles is a challenging part of self-management post-stroke. This study explored how stroke survivors act as role managers with their spouses in the context of everyday activities. METHOD: Two stroke survivors with a first time stroke living at home with a spouse were included. Data were generated through participant observations at their own environment at 3, 6, 9, 15 and 21 months post-discharge. The narrative analysis focused on the actions of participants...
December 2016: Disability and Rehabilitation
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