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https://www.readbyqxmd.com/read/29029061/effects-of-access-to-radiology-in-out-of-hours-primary-care-in-the-netherlands-a-prospective-observational-study
#1
Martijn Hendrik Rutten, Marleen Smits, Yvonne Anthonia Sebastiana Peters, Willem Jan Jozef Assendelft, Gert Pieter Westert, Paul Hendrikus Josephus Giesen
Background: In the Netherlands, out-of-hours primary care is provided in general-practitioner-cooperatives (GPCs). These are increasingly located on site with emergency departments (ED), forming Emergency-Care-Access-Points (ECAP). A more efficient and economical organization of out-of-hours primary emergency care could be realized by increased collaboration at an ECAP. In this study, we compared the effects of different models with respect to access to (hospital) radiology by the GPC...
September 28, 2017: Family Practice
https://www.readbyqxmd.com/read/29021378/outcomes-of-a-specialized-interdisciplinary-approach-for-patients-with-cancer-with-aberrant-opioid-related-behavior
#2
Joseph Arthur, Tonya Edwards, Suresh Reddy, Kristy Nguyen, David Hui, Sriram Yennu, Minjeong Park, Diane Liu, Eduardo Bruera
BACKGROUND: Data on the development and outcomes of effective interventions to address aberrant opioid-related behavior (AB) in patients with cancer are lacking. Our outpatient supportive care clinic developed and implemented a specialized interdisciplinary team approach to manage patients with AB. The purpose of this study was to report clinical outcomes of this novel intervention. MATERIALS AND METHODS: The medical records of 30 consecutive patients with evidence of AB who received the intervention and a random control group of 70 patients without evidence of AB between January 1, 2015, and August 31, 2016, were reviewed...
October 11, 2017: Oncologist
https://www.readbyqxmd.com/read/29020717/ulnar-nerve-injury-on-removal-of-a-contraceptive-implant
#3
Eva E O'Grady, Dominic M Power
The close proximity of contraceptive implant placement to the course of the ulnar nerve can result in injury. Several factors have been implicated in this complication including: low BMI, erroneous placement of the implant, implantation over the brachial groove, and migration of the implant from its original insertion. Clinicians should familiarise themselves with the vulnerable neurovascular structures in the area and refer promptly to a specialist if any neurological symptoms develop during placement or removal of these devices...
December 2016: Practitioner
https://www.readbyqxmd.com/read/29019329/implications-of-observer-variation-in-gleason-scoring-of-prostate-cancer-on-clinical-management-a-collaborative-audit
#4
A Harbias, E Salmo, A Crump
BACKGROUND: Prostate cancer is the most frequently diagnosed cancer in men. Histological tumour grade is a strong predictor of outcome and helps determine what treatment options are offered. There are numerous studies on Inter-observer agreement/variability on prostate cancer grading. In this study, we were looking to establish if disconcordance between pathologists when grading prostate cancer, could affect treatment options offered to men. METHODS: In Greater Manchester West Cancer Sector, all prostate cancer biopsies undergo a central review by three pathologists with a special interest in urological pathology prior to referral for treatment at specialist centres...
September 2017: Gulf Journal of Oncology
https://www.readbyqxmd.com/read/29016931/the-tri-institutional-pain-registry-analysis-of-outpatient-pain-management-at-a-specialized-cancer-center
#5
V T Malhotra, P Glare, K S Tan, J Wills, A Gulati, V Puttanniah, J Hung, K Cubert, C Inturrisi
Objectives: The Outpatient Pain Clinics at Memorial Sloan Kettering Cancer Center participated in developing a pain registry to gain insight on the referral and management of cancer pain as related to demographic information, cancer history, prescription records, and interventional pain procedures stored in the institutional database. Methods: Five cohorts (subsets of one another) were defined and compared to describe demographics and differences in management and outcomes by age, race, sex, and cancer type...
June 20, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29016829/differential-reporting-of-work-related-mental-ill-health-in-doctors
#6
A Y Zhou, M Carder, L Hussey, M Gittins, R Agius
Background: Evidence suggests that the medical profession is reluctant to report mental ill-health despite its high prevalence. Aims: To compare differential reporting patterns in the incidence of work-related mental ill-health (WRMIH) affecting doctors with selected comparison occupational groups, as determined by surveillance by general practitioners (GPs), specialist psychiatrists and occupational physicians (OPs). Methods: New cases of medically reported WRMIH were reported prospectively between 2006 and 2009 by GPs, psychiatrists and OPs as part of The Health and Occupation Research (THOR) network...
August 4, 2017: Occupational Medicine
https://www.readbyqxmd.com/read/28993307/improving-access-to-allied-health-professionals-through-the-champlain-base-%C3%A2-econsult-service-a-cross-sectional-study-in-canada
#7
Fanny McKellips, Erin Keely, Amir Afkham, Clare Liddy
BACKGROUND: Allied health services are an important part of providing effective team-based care. The Champlain BASE™ (Building Access to Specialists through eConsultation) eConsult service facilitates quick and secure communication between primary care providers (PCPs) and allied health professionals (AHPs). AIM: To assess the eConsult service's ability to improve access to advice from AHPs. DESIGN AND SETTING: A cross-sectional study was carried out on all cases submitted to AHPs through the eConsult service between April 2011 and May 2016...
October 9, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/28993112/hospitalization-due-to-acute-exacerbation-of-chronic-pain-an-intervention-study-in-a-university-hospital
#8
Daniel W Wheeler, Sara Kinna, Andrew Bell, Peter J Featherstone, David J Sapsford, Sam P Bass
BACKGROUND AND AIMS: Hospitalization as a result of acute exacerbation of complex chronic pain is a largely hidden problem, as patients are often admitted to hospital under a variety of specialities, and there is frequently no overarching inpatient chronic pain service dedicated to their management. Our institution had established an inpatient acute pain service overseen by pain physicians and staffed by specialist nurses that was intended to focus on the management of perioperative pain...
October 6, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/28988545/a-controlled-trial-of-screening-brief-intervention-and-referral-for-treatment-sbirt-implementation-in-primary-care-in-the-united-arab-emirates
#9
Catriona Matheson, Christiane Pflanz-Sinclair, Amna Almarzouqi, Christine M Bond, Amanda J Lee, Anwar Batieha, H Al Ghaferi, A El Kashef
Aim This project evaluated the effectiveness of screening brief intervention and referral for treatment (SBIRT) in primary care in Abu Dhabi to manage patients with problematic substance use. This study aimed to determine whether: (i) training primary care physicians on the SBIRT model increased the identification of patients using substances at a harmful, hazardous or dependent level; (ii) training improved physicians' knowledge, attitudes and beliefs in self-efficacy in managing substance use. BACKGROUND: Substance use is increasing in the United Arab Emirates yet there has been no formal primary care intervention...
October 9, 2017: Primary Health Care Research & Development
https://www.readbyqxmd.com/read/28986071/severe-asthma-and-the-primary-care-provider-identifying-patients-and-coordinating-multidisciplinary-care
#10
Barbara P Yawn, Michael E Wechsler
Without proper care, patients with severe forms of asthma face substantial medical risks, marked reductions in quality of life, and other significant disease-related burdens. Therefore, it is essential that primary care clinicians and other healthcare providers are adept at identifying cases of severe asthma based on symptom control, exacerbation risks, and the need for relatively aggressive treatment regimens (eg, high-dose inhaled corticosteroids with long-acting controller medications, and/or frequent oral corticosteroid use)...
October 3, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28985688/diagnosis-and-management-of-pancreatic-exocrine-insufficiency-pei-in-primary-care-consensus-guidance-of-a-canadian-expert-panel
#11
P Durie, J-D Baillargeon, S Bouchard, F Donnellan, S Zepeda-Gomez, C Teshima
Pancreatic exocrine insufficiency (PEI) results in maldigestion due to inadequate activity of pancreatic enzymes in the small bowel. PEI can arise from a variety of medical conditions that reduce enzyme synthesis within the pancreatic parenchyma or from secondary factors that may occur despite optimal parenchymal function, such as pancreatic duct obstruction or reduced or poorly synchronized enzyme release. The most characteristic symptom of PEI is steatorrhea - voluminous, lipid-rich stools; other common signs and symptoms include unexplained weight loss and deficiencies of fat-soluble vitamins and other micronutrients...
October 6, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28984173/facilitators-and-barriers-to-referral-compliance-among-dental-patients-with-increased-risk-of-obstructive-sleep-apnea
#12
Banu Saglam-Aydinatay, Serdar Uysal, Tülin Taner
OBJECTIVE: Our aims were to determine the adherence rate to dentist referrals for sleep apnea evaluation and the barriers and facilitators to referral compliance. MATERIAL AND METHODS: A sample of 1099 patients was screened with the STOP-Bang questionnaire. Those with elevated risk were referred for a sleep evaluation. An interview was conducted over the phone to determine compliance to referral and the barriers and facilitators to compliance. RESULTS: Of the 1099 patients (mean age: 45...
October 6, 2017: Acta Odontologica Scandinavica
https://www.readbyqxmd.com/read/28982720/routes-to-diagnosis-of-heart-failure-observational-study-using-linked-data-in-england
#13
Alex Bottle, Dani Kim, Paul Aylin, Martin R Cowie, Azeem Majeed, Benedict Hayhoe
OBJECTIVE: Timely diagnosis and management of heart failure (HF) is critical, but identification of patients with suspected HF can be challenging, especially in primary care. We describe the journey of people with HF in primary care from presentation through to diagnosis and initial management. METHODS: We used the Clinical Practice Research Datalink (primary care consultations linked to hospital admissions data and national death registrations for patients registered with participating primary care practices in England) to describe investigation and referral pathways followed by patients from first presentation with relevant symptoms to HF diagnosis, particularly alignment with recommendations of the National Institute for Health and Care Excellence guideline for HF diagnosis...
October 5, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28980273/specialized-pain-clinics-in-primary-care-common-diagnoses-referral-patterns-and-clinical-outcomes-novel-pain-management-model
#14
Yacov Fogelman, Eli Carmeli, Amir Minerbi, Baruch Harash, Simon Vulfsons
An estimated 19% of the adult population in western countries lives with chronic pain. Pain management lies mainly within the primary care and community setting. We evaluated the outcome of a new model of secondary care clinics, conducted by primary care physicians with specialized training in pain medicine. Data on referral patterns, prevalence of pain diagnosis, and medication consumption were recorded at five secondary pain management clinics in the community setting. In total, 997 patients with pain attended 2,652 visits (average 2...
October 5, 2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28979782/elderly-patients-with-chronic-kidney-disease-do-they-really-need-referral-to-the-nephrology-clinic
#15
Mark McClure, Thomas Jorna, Laura Wilkinson, Joanne Taylor
INTRODUCTION: Chronic kidney disease (CKD) is becoming increasingly common, especially in the elderly. In the UK, there has been a marked increase in the awareness and detection of CKD over the last decade. This is largely attributable to the introduction of automated estimated glomerular filtration rate (eGFR) reporting and renal indicators in the primary care Quality and Outcomes Framework (QOF) initiative, both of which were introduced in 2006. These two initiatives have had a significant impact on referral patterns to renal services...
October 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28979165/validation-of-autism-spectrum-disorder-diagnoses-recorded-in-the-clinical-practice-research-datalink-1990-2014
#16
Katrina Wilcox Hagberg, Susan S Jick
BACKGROUND: Prior studies have reported that the validity of autism spectrum disorder (ASD) diagnoses recorded in the Clinical Practice Research Datalink (CPRD) was high; however, diagnostic criteria and screening practices have changed since the last study was published in 2004. OBJECTIVES: 1) To calculate the positive predictive value (PPV) of ASD diagnoses recorded in the CPRD compared to original medical records and 2) to describe characteristics of cases and use of clinical codes that support the ASD diagnosis as recorded in the electronic data by general practitioners over time...
2017: Clinical Epidemiology
https://www.readbyqxmd.com/read/28975887/quality-assurance-of-the-western-denmark-heart-registry-a-population-based-healthcare-register
#17
Linda Aagaard Rasmussen, Hans Erik Bøtker, Lisette Okkels Jensen, Jan Ravkilde, Lars Riber, Per Hostrup Nielsen, Jan Jesper Andreasen, Carl-Johan Jakobsen
INTRODUCTION: During the past decade, the mandatory population-based healthcare database, the Western Denmark Heart Registry (WDHR), has provided the data for several research projects. As in most clinical registries, the data quality has not been validated thoroughly. This study was undertaken to evaluate the quality of registrations in the WDHR. METHODS: The audit supervised procedures from involved departments that were performed in 2013. An experienced research nurse completed data collection, and an experienced consultant evaluated the agreement between the WDHR and patient records...
October 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/28974585/routine-screening-in-the-general-hospital-what-happens-after-discharge-to-those-identified-as-at-risk-of-dementia
#18
Ana Phelps, Bethany Kingston, Rose M Wharton, Sarah T Pendlebury
Cognitive screening is recommended for older patients with unplanned hospital admission. We determined rates of reassessment/specialist memory referral after routine inclusion of at risk of dementia status in discharge documentation to primary care. Questionnaires were sent to relevant GP practices on consecutive patients aged ≥75 years identified as at risk and discharged 6 months earlier. Among 53 patients (mean age ±SD = 87.3±6.0 years, mean±SD Abbreviated Mental Test Score = 4.4±2.7), 49 (92%) patients had been reviewed since discharge, and 12/43 (28%) without previously known cognitive problem had had a cognitive reassessment...
October 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28974584/regular-and-frequent-feedback-of-specific-clinical-criteria-delivers-a-sustained-improvement-in-the-management-of-diabetic-ketoacidosis%C3%A2
#19
Punith Kempegowda, Ben Coombs, Peter Nightingale, Joht Singh Chandan, Jaffar Al-Sheikhli, Bhavana Shyamanur, Kasun Theivendran, Anitha Vijayan Melapatte, Umesh Salanke, Mohammed Akber, Sandip Ghosh, Parth Narendran
Efficient management of diabetic ketoacidosis (DKA) improves outcomes and reduces length of stay. While clinical audit improves the management of DKA, significant and sustained improvement is often difficult to achieve. We aimed to improve the management of DKA in our trust through the implementation of quality improvement methodology. Five specific targets (primary drivers: fluid prescription, fixed rate intravenous insulin infusion, glucose measurement, ketone measurement and specialist referral) were selected following a baseline audit...
October 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28973173/multidisciplinary-collaboration-in-primary-care-a-systematic-review
#20
Cecilia Saint-Pierre, Valeria Herskovic, Marcos Sepúlveda
Background: Several studies have discussed the benefits of multidisciplinary collaboration in primary care. However, what remains unclear is how collaboration is undertaken in a multidisciplinary manner in concrete terms. Objective: To identify how multidisciplinary teams in primary care collaborate, in regards to the professionals involved in the teams and the collaborative activities that take place, and determine whether these characteristics and practices are present across disciplines and whether collaboration affects clinical outcomes...
September 16, 2017: Family Practice
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