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Comanagement

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https://www.readbyqxmd.com/read/28101033/maximizing-the-benefit-cost-ratio-of-anthracyclines-in-metastatic-breast-cancer-case-report-of-a-patient-with-a-complete-response-to-high-dose-doxorubicin
#1
Kevin Shee, Alan T Kono, Susan P D'Anna, Mark A Seltzer, Xiaoying Lu, Todd W Miller, Mary D Chamberlin
Despite the clinical efficacy of anthracycline agents such as doxorubicin, dose-limiting cardiac toxicities significantly limit their long-term use. Here, we present the case of a 33-year-old female patient with extensive metastatic ER+/PR+/HER2- mucinous adenocarcinoma of the breast, who was started on doxorubicin/cyclophosphamide therapy after progressing on paclitaxel and ovarian suppressor goserelin with aromatase inhibitor exemestane. The patient was comanaged by cardiology, who carefully monitored measures of cardiac function, including EKGs, serial echocardiograms, and profiling of lipids, troponin, and pro-BNP every 2 months...
September 2016: Case Reports in Oncology
https://www.readbyqxmd.com/read/28091432/depression-and-posttraumatic-stress-disorder-among-road-traffic-accident-victims-managed-in-a-tertiary-hospital-in-southern-nigeria
#2
J E Asuquo, B E Edet, I E Abang, E A Essien, O G Osakwe, E J Aigbomain, K C Chigbundu
BACKGROUND: Psychological responses to traumatic events vary widely across different cultures but studies in the developing countries are scant. The objective of this study is to determine prevalence of depression and posttraumatic stress disorder (PTSD) among patients involved in road traffic accident (RTA) compared with that of the general population using a matched control group. MATERIALS AND METHODS: The study design was case control and employed the convenient sampling technique...
February 2017: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/28056665/the-patient-perspective-on-the-effects-of-medical-record-accessibility-a-systematic-review
#3
Peter Vermeir, Sophie Degroote, Dominique Vandijck, Hanne Van Tiggelen, Renaat Peleman, Rik Verhaeghe, An Mariman, Dirk Vogelaers
BACKGROUND: Health care is shifting from a paternalistic to a participatory model, with increasing patient involvement. Medical record accessibility to patients may contribute significantly to patient comanagement. OBJECTIVES: To systematically review the literature on the patient perspective of effects of personal medical record accessibility on the individual patient, patient-physician relationship and quality of medical care. METHODS: Screening of PubMed, Web of Science, Cinahl, and Cochrane Library on the keywords 'medical record', 'patient record', 'communication', 'patient participation', 'doctor-patient relationship', 'physician-patient relationship' between 1 January 2002 and 31 January 2016; systematic review after assessment for methodological quality...
January 6, 2017: Acta Clinica Belgica
https://www.readbyqxmd.com/read/27988160/vascular-surgeon-hospitalist-comanagement-improves-in-hospital-mortality-at-the-expense-of-increased-in-hospital-cost
#4
Rami O Tadros, Melissa L Tardiff, Peter L Faries, Michael Stoner, Chien Yi M Png, David Kaplan, Ageliki G Vouyouka, Michael L Marin
OBJECTIVE: We have shown that vascular surgeon- hospitalist co management resulted in improved in-hospital mortality rates. We now aim to assess the impact of the hospitalist co management service (HCS) on healthcare cost. METHODS: A total of 1558 patients were divided into three cohorts and compared: 516 in 2012, 525 in 2013, and 517 in 2014. The HCS began in January 2013. Data were standardized for six vascular surgeons that were present 2012-2014. New attendings were excluded...
December 14, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27929247/initial-management-of-patients-with-hiv-infection
#5
Ronald H Goldschmidt, Carolyn Chu, Betty J Dong
Human immunodeficiency virus (HIV) infection has become a treatable chronic disease with near-normal life expectancy when patients receive antiretroviral therapy (ART). Family physicians and other primary care clinicians commonly provide long-term comprehensive care for persons with HIV infection. This article describes the scope of initial care, including obtaining a thorough history; physical examination for HIV-associated manifestations; attention to HIV-specific immunization schedules; routine and HIV-specific laboratory evaluation; and ensuring standard health care maintenance to prevent HIV- and non-HIV-related morbidity and mortality...
November 1, 2016: American Family Physician
https://www.readbyqxmd.com/read/27870675/comanagement-and-gainsharing-opportunities-for-independent-physicians
#6
Chris McBride, Peter L Althausen
Gainsharing and comanagament programs are both successful means of achieving physician buy-in for all cost containment programs in Orthopaedic Trauma. Under comanagement agreements, physicians are reimbursed for their time and intellectual efforts in program and algorithm creation. The cost is minimal for the hospital in return for the millions of dollars in savings they achieve. Gainsharing models can incentivize physicians to quickly adopt cost-effective implant choices, care plans, and program development...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27870673/financial-impact-of-dual-vendor-matrix-pricing-and-sole-source-contracting-on-implant-costs
#7
Peter L Althausen, Joan Lapham, Lisa Mead
Implant costs comprise the largest proportion of operating room supply costs for orthopedic trauma care. Over the years, hospitals have devised several methods of controlling these costs with the help of physicians. With increasing economic pressure, these negotiations have a tremendous ability to decrease the cost of trauma care. In the past, physicians have taken no responsibility for implant pricing which has made cost control difficult. The reasons have been multifactorial. However, industry surgeon consulting fees, research support, and surgeon comfort with certain implant systems have played a large role in slowing adoption of cost-control measures...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27870671/surgeon-attitudes-regarding-the-use-of-generic-implants-an-ota-survey-study
#8
Justin A Walker, Peter L Althausen
OBJECTIVES: To determine the role of generic orthopaedic trauma implants in the current orthopaedic trauma market, as perceived by OTA members, and investigate potential hurdles to the use of generic implants and other cost-containment measures. DESIGN: Survey study. SETTING: Not applicable. PARTICIPANTS: All active OTA members with valid e-mail addresses were invited to participate. INTERVENTION: Participants completed a brief online survey with questions regarding participation in cost-containment and incentive programs, industry relationships, generic implant use, and the role of surgeons in cost containment...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27847675/an-orthopedic-hospitalist-comanaged-hip-fracture-service-reduces-inpatient-length-of-stay
#9
Daniel N Bracey, Tunc C Kiymaz, David C Holst, Kamran S Hamid, Johannes F Plate, Erik C Summers, Cynthia L Emory, Riyaz H Jinnah
INTRODUCTION: Hip fractures are common in the elderly patients with an incidence of 320 000 fractures/year in the United States, representing a health-care cost of US$9 to 20 billion. Hip fracture incidence is projected to increase dramatically. Hospitals must modify clinical models to accommodate this growing burden. Comanagement strategies are reported in the literature, but few have addressed orthopedic-hospitalist models. An orthopedic-hospitalist comanagement (OHC) service was established at our hospital to manage hip fracture patients...
December 2016: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/27831826/hospitalist-vascular-surgery-comanagement-effects-on-complications-and-mortality
#10
Colin T Iberti, Alan Briones, Erin Gabriel, Andrew S Dunn
OBJECTIVES: Hospitalized vascular surgery patients have multiple severe comorbidities, poor functional status, and high perioperative cardiac risk. Thus they may be ideal patients for a collaborative care model. However, there is little evidence for a comanagement model on clinical outcomes. METHODS: The two-year pre-post study consisted of a comanagement model where a hospitalist actively participated in the medical care of American Society of Anesthesiologist Physical Status Classification scale 3 or 4 vascular surgery patients...
December 2016: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/27824404/contracting-strategies-for-arthroplasty-bundles-to-population-health
#11
David J Jacofsky, Paul Jawin, Geoff Walton, Lisa Fraser
Orthopedics, and especially total joint replacement (TJR), is growing in payer prominence due to large projected increases in volume. The unsustainability of the fee-for-service payment system has lead Centers for Medicare and Medicaid Services to employ new value and risk-based contracting strategies on a population health basis and on an episode of care basis, with programs such as the Bundled Payment for Care Improvement program and the Comprehensive Care for Joint Replacement program. These trends are forcing hospitals and physicians to align to improve quality and reduce costs through new structures such as Accountable Care Organizations, comanagement programs, and gainsharing...
January 2017: Journal of Knee Surgery
https://www.readbyqxmd.com/read/27757421/empty-forest-or-empty-rivers-a-century-of-commercial-hunting-in-amazonia
#12
André P Antunes, Rachel M Fewster, Eduardo M Venticinque, Carlos A Peres, Taal Levi, Fabio Rohe, Glenn H Shepard
The Amazon basin is the largest and most species-rich tropical forest and river system in the world, playing a pivotal role in global climate regulation and harboring hundreds of traditional and indigenous cultures. It is a matter of intense debate whether the ecosystem is threatened by hunting practices, whereby an "empty forest" loses critical ecological functions. Strikingly, no previous study has examined Amazonian ecosystem resilience through the perspective of the massive 20th century international trade in furs and skins...
October 2016: Science Advances
https://www.readbyqxmd.com/read/27749348/perioperative-surgical-home-in-pediatric-settings-preliminary-results
#13
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...
November 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27631706/using-nurse-practitioner-comanagement-to-reduce-hospitalizations-and-readmissions-within-a-home-based-primary-care-program
#14
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
https://www.readbyqxmd.com/read/27561695/risk-factors-for-readmission-in-patients-with-cancer-comanaged-by-hospitalists
#15
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
https://www.readbyqxmd.com/read/27542147/what-risks-are-associated-with-primary-tha-in-recipients-of-hematopoietic-stem-cell-transplantation
#16
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...
February 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27526706/paraprotein-related-kidney-disease-glomerular-diseases-associated-with-paraproteinemias
#17
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...
December 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27506442/attitudes-of-primary-care-physicians-toward-sickle-cell-disease-care-guidelines-and-comanaging-hydroxyurea-with-a-specialist
#18
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
https://www.readbyqxmd.com/read/27501701/orthogeriatric-co-management-improves-the-outcome-of-long-term-care-residents-with-fragility-fractures
#19
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
https://www.readbyqxmd.com/read/27490123/an-update-on-ocular-allergy
#20
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
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