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Assisted outpatient treatment

Jung Ho Ko, Young-Joon Kim, Hyun Ho Jung
A 24-year-old man was admitted with sudden severe headache. Brain computed tomography (CT) revealed a subarachnoid hemorrhage in the basal cistern and both Sylvian cisterns and a left internal carotid artery angiogram showed a small aneurysm on the bifurcation of the left middle cerebral artery. We performed Y-configured stent-assisted coil embolization. On the fifth post-embolization day, the patient had chills, and his body temperature was over 38℃. Staphylococcus aureus was cultured from the venous blood sample...
January 1, 2018: Interventional Neuroradiology
Emanuele Rondonotti, Cristiano Spada, Samuel Adler, Andrea May, Edward J Despott, Anastasios Koulaouzidis, Simon Panter, Dirk Domagk, Ignacio Fernandez-Urien, Gabriel Rahmi, Maria Elena Riccioni, Jeanin E van Hooft, Cesare Hassan, Marco Pennazio
SMALL-BOWEL CAPSULE ENDOSCOPY (SBCE): 1: ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization.Strong recommendation, high quality evidence.However, the optimal timing for taking purgatives is yet to be established. 2: ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients.Strong recommendation, moderate quality evidence...
March 14, 2018: Endoscopy
Anna Karla de Oliveira Tito Borba, Ana Paula de Oliveira Marques, Vânia Pinheiro Ramos, Márcia Carrera Campos Leal, Ilma Kruze Grande de Arruda, Roberta Souza Pereira da Silva Ramos
This study aimed to investigate factors associated with the treatment adherence of 150 elderly diabetics assisted in gerontogeriatric outpatient service in northeastern Brazil. Full adherence to therapy was self-reported by 27.3% of the elderly. In the bivariate analysis, adherence was associated with self-perceived health, beliefs in the use of medication, understanding explanations about diabetes and professional responsible for treatment guidance. After analysis adjustment, only beliefs in medicine were significant when comparing non-adherence with full adherence (OR = 9...
March 2018: Ciência & Saúde Coletiva
Panos Sarigiovannis, Steve Cropper
BACKGROUND: Physiotherapy assistants account for approximately 20% of the physiotherapy workforce across a community health service in North Staffordshire. Although their job descriptions state that the post is primarily clinical, their role depends heavily on the qualified physiotherapists and how they utilize their clinical skills. METHODS: An audit of the physiotherapy assistants' tasks was carried out to reveal whether the physiotherapy assistants' time spent on clinical tasks complied with their job descriptions...
March 13, 2018: Musculoskeletal Care
Priyanka Bose, Andrew Wilson, Amit Mistri
INTRODUCTION Many patients who suffer a transient ischaemic attack (TIA) present to their general practitioner (GP). Early identification and treatment reduces the risk of subsequent stroke, disability and mortality. AIM To review the accuracy of TIA diagnosis in primary care, immediate management and interventions to assist GPs with the condition. METHODS This study included the search of Medline, Embase, Web of Science and Scopus databases (1995-2015). Relevant titles and abstracts were obtained using structured criteria (diagnosis, immediate management or intervention of TIAs in primary care), with full review and data extraction for eligible publications...
June 2017: Journal of Primary Health Care
Ayşe Büyükcam, Ateş Kara, Tuğba Bedir, Belgin Gülhan, Halil Özdemir, Murat Sütçü, Mine Düzgöl, Aslı Arslan, Tuna Tekin, Solmaz Çelebi, Musa Gürel Kukul, Gülsüm İclal Bayhan, Muhammet Köşker, Adem Karbuz, Melda Çelik, Zümrüt Kocabay Sütçü, Özge Metin, Sebahat Karakaşlılar, Abdullah Dağlı, Soner Sertan Kara, Eda Albayrak, Saliha Kanık, Hasan Tezer, Aslınur Parlakay, Ergin Çiftci, Ayper Somer, İlker Devrim, Zafer Kurugöl, Ener Çağrı Dinleyici, Pınar Atla
OBJECTIVES: Acute otitis media (AOM) is predominantly a disease of childhood and one of the common reasons for prescribing antibiotics. Ear pain is the main symptom of AOM, with the result that parents frequently seek immediate medical assistance for their children. Antibiotic therapy for AOM does not provide symptomatic relief in the first 24 hours, and analgesics are commonly recommended for relieving the pain associated with AOM. The aims of the present study were to assess pediatricians' attitudes toward AOM and ear pain management in Turkey...
April 2018: International Journal of Pediatric Otorhinolaryngology
Lynda Appleton, Helen Poole, Christine Wall
AIMS: To explore how cancer services may positively promote and support patients' well-being throughout treatment. Specifically to identify components of care that are important to patients and meet their needs BACKGROUND: Patients commonly experience stress and uncertainty during their cancer journey which can have a negative impact on their psychological health and quality of life. Comparatively, little is known about how patients may experience positive well-being during their treatment experience...
February 23, 2018: Journal of Advanced Nursing
Fanny L Loth, V Meraner, Bernhard Holzner, Susanne Singer, Irene Virgolini, Eva M Gamper
OBJECTIVE: In this retrospective investigation of patient pathways to psycho-oncological treatment (POT) we compared the number of POT referrals before and after implementation of electronic screening for POT needs and investigated psychosocial predictors for POT wish at a nuclear medicine department. METHODS: We extracted medical chart information about number of referrals and extent of follow-up contacts. During standard referral (November 2014-October 2015), POT needs were identified by clinical staff only...
February 20, 2018: Psycho-oncology
Sean Orzol, Rosalind Keith, Mynti Hossain, Michael Barna, G Greg Peterson, Timothy Day, Boyd Gilman, Laura Blue, Keith Kranker, Kate A Stewart, Sheila Hoag, Lorenzo Moreno
BACKGROUND: The Center for Medicare & Medicaid Innovation (CMMI) tests new models of paying for or delivering health care services and expands models that improve health outcomes while lowering medical spending. CMMI gave TransforMED, a national learning and dissemination contractor, a 3-year Health Care Innovation Award (HCIA) to integrate health information technology systems into physician practices. This paper estimates impacts of TransforMED's HCIA-funded program on patient outcomes and Medicare parts A and B spending...
April 2018: Medical Care
Charles D Burger, A Burak Ozbay, Howard M Lazarus, Ellen Riehle, Leslie B Montejano, Gregory Lenhart, R James White
BACKGROUND: Despite multiple treatment options, the prognosis of pulmonary arterial hypertension (PAH) remains poor. PAH patients experience a high economic burden due to comorbidities, hospitalizations, and medication costs. Although combination therapy has been shown to reduce hospitalizations, the relationship between treatment, health care utilization, and costs remains unclear. OBJECTIVE: To provide a characterization of health care utilization and costs in real-world settings by comparing periods before and after initiating PAH-specific treatment...
February 13, 2018: Journal of Managed Care & Specialty Pharmacy
Jonathan D Campbell, Melanie D Whittington, Chong H Kim, Gina R VanderVeen, Kelly G Knupp, Arnold Gammaitoni
OBJECTIVE: The objective of this study was to describe and quantify the impact of caring for a child with Dravet syndrome (DS) on caregivers. METHODS: We surveyed DS caregivers at a single institution with a large population of patient with DS. Survey domains included time spent/difficulty performing caregiving tasks (Oberst Caregiving Burden Scale, OCBS); caregiver health-related quality of life (EuroQoL 5D-5L, EQ-5D); and work/activity impairment (Work Productivity and Activity Impairment questionnaire, WPAI)...
February 1, 2018: Epilepsy & Behavior: E&B
Amanda Howard-Thompson, Muneeza Khan, Morgan Jones, Christa M George
In patients with type 2 diabetes mellitus, insulin may be used to augment therapy with oral glycemic medications or as insulin replacement therapy. The American Diabetes Association suggests the use of long-acting (basal) insulin to augment therapy with one or two oral agents or one oral agent plus a glucagon-like peptide 1 receptor agonist when the A1C level is 9% or more, especially if the patient has symptoms of hyperglycemia or catabolism. Insulin regimens should be adjusted every three or four days until targets of self-monitored blood glucose levels are reached...
January 1, 2018: American Family Physician
Elizabeth A Fradgley, Christine L Paul, Jamie Bryant, Alison Zucca, Christopher Oldmeadow
Efficient patient-centred quality improvement requires an understanding of the system-wide areas of dissatisfaction along with evidence to identify the programs which can be strategically targeted according to specific patient characteristics and preferences. This cross-sectional study reports the proportion of chronic disease outpatients selecting 23 patient-centred improvement initiatives. Using univariate tests and multivariable logistic regressions, this multi-site study also identifies initiatives differentially selected by outpatients according to clinical and demographic characteristics...
January 23, 2018: International Journal of Environmental Research and Public Health
Stephanie Posten, Jennifer Reed
Pediatric community acquired pneumonia (CAP) is frequently encountered by medical providers and is one of the most common reasons for hospital admission. CAP is known to cause significant morbidity and mortality, causing greater than 2 million deaths annually worldwide in children younger than five years old. The Infectious Disease Society of America (IDSA) released guidelines in 2011 with recommendations regarding appropriate diagnosis and management of community acquired pneumonia for children greater than 3 months age, with the goal of assisting providers in clinical decision making...
December 2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
Ankit Shah, Margaret Duncan, Nipun Atreja, Kei Sing Tai, Mugdha Gore
OBJECTIVE: Opioid use disorder (OUD) can be managed with medication assisted therapy (MAT) (methadone [MET], buprenorphine [BUP], or extended-release naltrexone [XR-NTX]) or counseling alone (non-pharmacological therapy [NPT]). The objective of this study was to evaluate healthcare resource utilization and costs associated with XR-NTX compared with alternative treatments for opioid dependence. METHODS: Adults with a diagnosis of opioid dependence who initiated treatment with XR-NTX, BUP, MET, or NPT between January 1, 2011 and December 31, 2014 were identified in the Truven Health MarketScan Commercial administrative claims database...
February 1, 2018: Journal of Medical Economics
Kate Wolitzky-Taylor, Jennifer Krull, Richard Rawson, Peter Roy-Byrne, Richard Ries, Michelle G Craske
OBJECTIVE: Anxiety and substance use disorders are highly comorbid and mutually maintain each other. Treatments for anxiety disorders that are well integrated into substance use disorder treatment have the potential to improve both anxiety and substance use outcomes. METHOD: Ninety-seven individuals seeking treatment at a community-based, evidence-based intensive outpatient program for substance use disorders who also had anxiety disorders were randomized to either (a) usual care (UC) at the intensive outpatient program; or (b) UC + coordinated anxiety learning and management for addiction recovery centers (CALM ARC), a 7-session, group-based, computer-assisted but therapist-directed treatment for anxiety disorders adapted for individuals with anxiety disorder and substance use disorder comorbidity...
January 2018: Journal of Consulting and Clinical Psychology
Haruka Minami, Hannah R Brinkman, Shadi Nahvi, Julia H Arnsten, Monica Rivera-Mindt, David W Wetter, Erika Litvin Bloom, Lawrence H Price, Carlos Vieira, Remington Donnelly, Lauren M McClain, Katherine A Kennedy, Erica D'Aquila, M Fine, Danielle E McCarthy, J Graham Thomas, Jacki Hecht, Richard A Brown
BACKGROUND: Although individuals with psychiatric disorders are disproportionately affected by cigarette smoking, few outpatient mental health treatment facilities offer smoking cessation services. In this paper, we describe the development of a smartphone-assisted mindfulness smoking cessation intervention with contingency management (SMI-CM), as well as the design and methods of an ongoing pilot randomized controlled trial (RCT) targeting smokers receiving outpatient psychiatric treatment...
December 27, 2017: Contemporary Clinical Trials
Tess Worboys, Melinda Brassington, Elizabeth C Ward, Petrea L Cornwell
Introduction Telehealth offers a solution to assist delivery of occupational therapy (OT) services for hand therapy in rural and remote locations. However, there is currently no evidence to validate this service model. The aim of this study was to examine the validity of clinical decisions made during hand therapy sessions conducted via telehealth compared to a traditional clinical model (TCM) assessment, and explore patient and clinician satisfaction. Methods Eighteen patients referred for hand therapy to a rural/remote hospital-based outpatient service were assessed simultaneously via telehealth and a TCM assessment...
January 1, 2017: Journal of Telemedicine and Telecare
Ut T Bui, Helen Edwards, Kathleen Finlayson
Leg ulcers are hard to heal. Infection causes delayed healing, negatively impacting patients' quality of life, the healthcare system, and society. Early recognition of patients at high risk of infection is essential to prevent complications and reduce negative impacts. However, at present, factors associated with infection in this population are not yet clearly understood. The study aimed to identify factors that were significantly associated with infection in chronic leg ulcers. A sample of 561 patients with chronic leg ulcers, who were previously recruited at outpatient clinics and community settings within Australia between 2008 and 2015, were selected for the current analysis...
December 17, 2017: International Wound Journal
Hilary Mosher, Shoshana J Herzig, Itai Danovitch, Christina Boutsicaris, Sameer Hassamal, Karl Wittnebel, Azadeh Dashti, Teryl Nuckols
Individuals who are on long-term opioid therapy (LTOT) for chronic noncancer pain are frequently admitted to the hospital with acute pain, exacerbations of chronic pain, or comorbidities. Consequently, hospitalists find themselves faced with complex treatment decisions in the context of uncertainty about the effectiveness of LTOT as well as concerns about risks of overdose, opioid use disorders, and adverse events. Our multidisciplinary team sought to synthesize guideline recommendations and primary literature relevant to assessing medical inpatients on LTOT, with the objective of assisting practitioners in balancing effective pain treatment and opioid risk reduction...
December 6, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
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