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https://www.readbyqxmd.com/read/28749586/patient-decisions-to-receive-secondary-pharmacogenomic-findings-and-development-of-a-multidisciplinary-practice-model-to-integrate-results-into-patient-care
#1
J Kevin Hicks, Amy Shealy, Allison Schreiber, Marissa Coleridge, Ryan Noss, Marvin Natowicz, Rocio Moran, Timothy Moss, Angelika Erwin, Charis Eng
Whole exome sequencing (WES) has the potential of identifying secondary findings that are predictive of poor pharmacotherapy outcomes. The purpose of this study was to investigate patients' wishes regarding the reporting of secondary pharmacogenomic findings. WES results (n = 106 patients) were retrospectively reviewed to determine the number of patients electing to receive secondary pharmacogenomic results. Phenotypes were assigned based on Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines...
July 27, 2017: Clinical and Translational Science
https://www.readbyqxmd.com/read/28749453/mindfulness-based-stress-reduction-therapy-improves-patient-and-caregiver-reported-outcomes-in-cirrhosis
#2
Jasmohan S Bajaj, Michael Ellwood, Timothy Ainger, Thomas Burroughs, Andrew Fagan, Edith A Gavis, Douglas M Heuman, Michael Fuchs, Binu John, James B Wade
OBJECTIVES: Patient-reported outcomes such as health-related quality of life (HRQOL) are impaired in cirrhosis due to under-treated mood and sleep disorders, which can adversely impact their caregivers. Mindfulness-based stress reduction (MBSR) can improve patient-reported outcomes (PRO) in non-cirrhotic patients but their impact in cirrhosis is unclear. To evaluate the effect of MBSR and supportive group therapy on mood, sleep and HRQOL in cirrhotic patients and their caregivers. METHODS: Cirrhotic outpatients with mild depression (Beck Depression Inventory (BDI)>14) on screening with an adult caregiver were enrolled...
July 27, 2017: Clinical and Translational Gastroenterology
https://www.readbyqxmd.com/read/28749054/the-precision-medicine-nation
#3
Maya Sabatello, Paul S Appelbaum
The United States' ambitious Precision Medicine Initiative proposes to accelerate exponentially the adoption of precision medicine, an approach to health care that tailors disease diagnosis, treatment, and prevention to individual variability in genes, environment, and lifestyle. It aims to achieve this by creating a cohort of volunteers for precision medicine research, accelerating biomedical research innovation, and adopting policies geared toward patients' empowerment. As strategies to implement the PMI are formulated, critical consideration of the initiative's ethical and sociopolitical dimensions is needed...
July 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28748402/methodology-for-the-identification-of-vulnerable-asylum-seekers
#4
Sindi Visentin, Guido Pelletti, Thomas Bajanowski, Santo Davide Ferrara
Asylum seekers often experience situations of vulnerability, being frequently exposed to a heightened risk of harm, and thus require special care, support and protection. The categories of "vulnerable persons", identified by International Legislation, and an individual's classification as a "vulnerable asylum seeker", have important implications in the reception procedures, in the decision-making phase and in the definition of therapeutic needs and rehabilitation. The Istanbul Protocol, the first international guideline approved by the United Nations and applied in different contexts, is not applicable for the assessment of the totality of the conditions (medical and otherwise), and therefore, the identification and assessment of conditions of vulnerability is largely delegated to questionnaires administered by non-medical personnel...
July 26, 2017: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/28748106/a-feasibility-study-of-a-theory-based-intervention-to-improve-appropriate-polypharmacy-for-older-people-in-primary-care
#5
Cathal A Cadogan, Cristín Ryan, Gerard J Gormley, Jill J Francis, Peter Passmore, Ngaire Kerse, Carmel M Hughes
BACKGROUND: A general practitioner (GP)-targeted intervention aimed at improving the prescribing of appropriate polypharmacy for older people was previously developed using a systematic, theory-based approach based on the UK Medical Research Council's complex intervention framework. The primary intervention component comprised a video demonstration of a GP prescribing appropriate polypharmacy during a consultation with an older patient. The video was delivered to GPs online and included feedback emphasising the positive outcomes of performing the behaviour...
2018: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/28747895/combining-standard-conventional-measures-and-ecological-momentary-assessment-of-depression-anxiety-and-coping-using-smartphone-application-in-minor-stroke-population-a-longitudinal-study-protocol
#6
Camille Vansimaeys, Mathieu Zuber, Benjamin Pitrat, Claire Join-Lambert, Ruben Tamazyan, Wassim Farhat, Catherine Bungener
Context: Stroke has several consequences on survivors' daily life even for those who experience short-lasting neurological symptoms with no functional disability. Depression and anxiety are common psychological disorders occurring after a stroke. They affect long-term outcomes and quality of life but they are difficult to diagnose because of the neurobiological consequences of brain lesions. Current research priority is given to the improvement of the detection and prevention of those post-stroke psychological disorders...
2017: Frontiers in Psychology
https://www.readbyqxmd.com/read/28747588/surgical-site-infection-after-malignant-brain-tumor-resection-a-multicenter-study-for-induction-of-a-basic-care-bundle
#7
Takeo Uzuka, Hideaki Takahashi, Yoko Nakasu, Takeshi Okuda, Koichi Mitsuya, Nakamasa Hayashi, Takayuki Hirose, Hanako Kurai
Patients with malignant brain tumors are possibly at increased risk for surgical site infections (SSIs) considering the various medical situations associated with the disease. However, the actual rate of SSI after malignant brain tumor resection has not been well established, despite the potential impact of SSI on patient outcome. To investigate the incidence of SSI following malignant brain tumor surgery, we performed a retrospective study in 3 neurosurgical units. Subsequently, aiming at the reduction of incidence of SSI, we performed a prospective study using a care bundle technique in the same units...
July 26, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28747416/discitis-and-clostridium-perfringens-bacteraemia
#8
Chen Han Yong, Miranda Lam
The authors present a case involving an 80-year-old man with infectious T10/T11 discitis on the background of a recent Clostridium perfringens bacteraemia. This case report describes a case of probable C. perfringens discitis as further investigations failed to identify any causative agents. He was treated with intravenous piperacillin/tazobactam to good effect, achieving favourable clinical outcome. Diagnosis of discitis/osteomyelitis can often be delayed and mismanaged due to its non-specific presentations...
July 26, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28747349/outcomes-associated-with-a-pediatric-clinical-diabetes-network-in-ontario-a-population-based-time-trend-analysis
#9
Meranda Nakhla, Elham Rahme, Marc Simard, Astrid Guttmann
BACKGROUND: The Network of Ontario Pediatric Diabetes Programs was implemented in 2001. The objective of this study was to determine whether implementation of the network was associated with a decrease in the risk of acute diabetes-related complications and a reduction in the socioeconomic and geographic disparities in these outcomes. METHODS: We conducted a population-based time trend analysis of children (< 18 yr) with diabetes using health administrative databases in Ontario from 1996 to 2011...
July 24, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28747298/estimating-one-year-risk-of-incident-chronic-kidney-disease-retrospective-development-and-validation-study-using-electronic-medical-record-data-from-the-state-of-maine
#10
Shiying Hao, Tianyun Fu, Qian Wu, Bo Jin, Chunqing Zhu, Zhongkai Hu, Yanting Guo, Yan Zhang, Yunxian Yu, Terry Fouts, Phillip Ng, Devore S Culver, Shaun T Alfreds, Frank Stearns, Karl G Sylvester, Eric Widen, Doff B McElhinney, Xuefeng B Ling
BACKGROUND: Chronic kidney disease (CKD) is a major public health concern in the United States with high prevalence, growing incidence, and serious adverse outcomes. OBJECTIVE: We aimed to develop and validate a model to identify patients at risk of receiving a new diagnosis of CKD (incident CKD) during the next 1 year in a general population. METHODS: The study population consisted of patients who had visited any care facility in the Maine Health Information Exchange network any time between January 1, 2013, and December 31, 2015, and had no history of CKD diagnosis...
July 26, 2017: JMIR Medical Informatics
https://www.readbyqxmd.com/read/28747248/pathways-between-childhood-adolescent-adversity-adolescent-socioeconomic-status-and-long-term-cardiovascular-disease-risk-in-young-adulthood
#11
Jenalee R Doom, Susan M Mason, Shakira F Suglia, Cari Jo Clark
OBJECTIVE: The current study investigated mediators between childhood/adolescent adversities (e.g., dating violence, maltreatment, homelessness, and parental death), low socioeconomic status (SES) during adolescence, and cardiovascular disease (CVD) risk in young adulthood. The purpose of these analyses was to understand whether SES during adolescence and childhood/adolescent adversities affect CVD risk through similar pathways, including maternal relationship quality, health behaviors, financial stress, medical/dental care, educational attainment, sleep problems, and depressive symptoms...
July 12, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28747193/impact-of-improved-recording-of-work-relatedness-in-primary-care-visits-at-occupational-health-services-on-sickness-absences-study-protocol-for-a-randomised-controlled-trial
#12
Salla Atkins, Ulla Ojajärvi, Nina Talola, Mervi Viljamaa, Jaakko Nevalainen, Jukka Uitti
BACKGROUND: Employment protects and fosters health. Occupational health services, particularly in Finland, have a central role in protecting employee health and preventing work ability problems. However, primary care within occupational health services is currently underused in informing preventive activities. This study was designed to assess whether the recording of work ability problems and improvement of follow-up of work-related primary care visits can reduce sickness absences and work disability pensions after 1 year...
July 26, 2017: Trials
https://www.readbyqxmd.com/read/28747191/implementation-findings-from-a-hybrid-iii-implementation-effectiveness-trial-of-the-diabetes-prevention-program-dpp-in-the-veterans-health-administration-vha
#13
Laura J Damschroder, Caitlin M Reardon, Mona AuYoung, Tannaz Moin, Santanu K Datta, Jordan B Sparks, Matthew L Maciejewski, Nanette I Steinle, Jane E Weinreb, Maria Hughes, Lillian F Pinault, Xinran M Xiang, Charles Billington, Caroline R Richardson
BACKGROUND: The Diabetes Prevention Program (DPP) is an effective lifestyle intervention to reduce incidence of type 2 diabetes. However, there are gaps in knowledge about how to implement DPP. The aim of this study was to evaluate implementation of DPP via assessment of a clinical demonstration in the Veterans Health Administration (VHA). METHODS: A 12-month pragmatic clinical trial compared weight outcomes between the Veterans Affairs Diabetes Prevention Program (VA-DPP) and the usual care MOVE!® weight management program (MOVE!)...
July 26, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28747024/clinical-profile-and-outcomes-in-octogenarians-with-atrial-fibrillation-a-community-based-study-in-a-specific-european-health-care-area
#14
Moisés Rodríguez-Mañero, Estrella López-Pardo, Alberto Cordero, Omar Kredieh, María Pereira-Vazquez, Jose-Luis Martínez-Sande, Alvaro Martínez-Gomez, Carlos Peña-Gil, José Novo-Platas, Javier García-Seara, Pilar Mazón, Ricardo Laje, Isabel Moscoso, Alfonso Varela-Román, Jose María García-Acuña, José Ramón González-Juanatey
BACKGROUND: Age increases risk of stroke and bleeding. Clinical trial data have had relatively low proportions of elderly subjects. We sought to study a Spanish population of octogenarians with atrial fibrillation (AF) by combining different sources of electronic clinical records from an area where all medical centres utilized electronic health record systems. METHODS: Data was derived from the Galician Healthcare Service information system. RESULTS: From 383,000 subjects, AF was coded in 7990 (2...
September 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28746708/effectiveness-and-safety-of-dementia-care-management-in-primary-care-a-randomized-clinical-trial
#15
Jochen René Thyrian, Johannes Hertel, Diana Wucherer, Tilly Eichler, Bernhard Michalowsky, Adina Dreier-Wolfgramm, Ina Zwingmann, Ingo Kilimann, Stefan Teipel, Wolfgang Hoffmann
Importance: Dementia care management (DCM) can increase the quality of care for people with dementia. Methodologically rigorous clinical trials on DCM are lacking. Objective: To test the effectiveness and safety of DCM in the treatment and care of people with dementia living at home and caregiver burden (when available). Design, Setting, and Participants: This pragmatic, general practitioner-based, cluster-randomized intervention trial compared the intervention with care as usual at baseline and at 12-month follow-up...
July 26, 2017: JAMA Psychiatry
https://www.readbyqxmd.com/read/28746388/the-role-of-personality-in-health-care-use-results-of-a-population-based-longitudinal-study-in-germany
#16
André Hajek, Jens-Oliver Bock, Hans-Helmut König
OBJECTIVE: To determine the role of personality in health care use longitudinally. METHODS: Data were derived from the German Socio-Economic Panel (GSOEP), a nationally representative, longitudinal cohort study of German households starting in 1984. Concentrating on the role of personality, we used data from the years 2005, 2009 and 2013. Personality was measured by using the GSOEP Big Five Inventory (BFI-S). Number of physician visits in the last 3 months and hospital stays in the last year were used as measures of health care use...
2017: PloS One
https://www.readbyqxmd.com/read/28746237/abdominoplasty-with-lymphatic-microsurgery-for-patients-with-secondary-lower-extremity-lymphedema
#17
Shinsuke Akita, Yoshihisa Yamaji, Hideki Tokumoto, Naoki Adachi, Yoshitaro Sasahara, Yoshitaka Kubota, Motone Kuriyama, Nobuyuki Mitsukawa
BACKGROUND: Patients with secondary lower extremity lymphedema (LEL) often develop suprapubic lymphedema. We developed a novel surgical method of shaping the lower abdomen and debulking suprapubic lymphedema with simultaneous reconstruction of lymphatic flow in case of LEL. METHODS: A skin incision in a fleur-de-lis pattern was performed for horizontal and vertical abdominal skin and fat resection. A caudal-based isosceles triangular flap was created on the central suprapubic region to reduce wound tension at the intersection of the horizontal and vertical incisions...
July 12, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28746074/understanding-the-multidimensional-effects-of-resident-duty-hours-restrictions-a-thematic-analysis-of-published-viewpoints-in-surgery
#18
Katharine S Devitt, Michael J Kim, Lesley Gotlib Conn, Frances C Wright, Carol-Anne Moulton, Itay Keshet, Najma Ahmed
PURPOSE: Individuals representing various surgical disciplines have expressed concerns with the impact of resident duty hours (RDH) restrictions on resident education and patient outcomes. This thematic review of published viewpoints aimed to describe the effects of these restrictions in surgery. METHOD: The authors conducted a qualitative systematic review of non-research-based literature published between 2003 and 2015. Articles were included if they focused on the RDH restrictions in surgery and resident wellness, health promotion, resident safety, resident education and/or training, patient safety, medical errors, and/or heterogeneity regarding training or disciplines...
July 25, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28746017/tumor-evolution-heterogeneity-and-therapy-for-our-patients-with-advanced-cancer-how-far-have-we-come
#19
Wafik S El-Deiry, Barry Taylor, Joel W Neal
The clinical and molecular heterogeneity of various cancer types is well documented. In the era of precision oncology whereby molecular profiling of tumors is incorporated into clinical care, both intra- and intertumoral molecular and genetic heterogeneity have been described. Together, they impact patient treatment and outcomes. Host genetics and the tumor microenvironment impact on tumor evolution and heterogeneity through variations in immune cell infiltration, stromal variations, and selection pressures from hypoxia or nutrient stress, among others...
2017: American Society of Clinical Oncology Educational Book
https://www.readbyqxmd.com/read/28745934/spinal-cord-injury-clinical-registries-improving-care-across-the-sci-care-continuum-by-identifying-knowledge-gaps
#20
Marcel F Dvorak, Christiana L Cheng, Nader Fallah, Argelio Santos, Derek Atkins, Suzanne Humphreys, Carly S Rivers, Barry A B White, Chester Ho, Henry Ahn, Brian K Kwon, Sean Christie, Vanessa K Noonan
Timely access and ongoing delivery of care and therapeutic interventions is needed to maximize recovery and function after traumatic spinal cord injury (tSCI). To ensure these decisions are evidence-based, access to consistent, reliable, and valid sources of clinical data is required. The Access to Care and Timing Model used data from the Rick Hansen SCI Registry (RHSCIR) to generate a simulation of healthcare delivery for persons after tSCI and to test scenarios aimed at improving outcomes and reducing the economic burden of SCI...
July 26, 2017: Journal of Neurotrauma
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