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https://www.readbyqxmd.com/read/29331253/evaluation-of-three-machine-learning-models-for-self-referral-decision-support-on-low-back-pain-in-primary-care
#1
Wendy Oude Nijeweme-d'Hollosy, Lex van Velsen, Mannes Poel, Catharina G M Groothuis-Oudshoorn, Remko Soer, Hermie Hermens
BACKGROUND: Most people experience low back pain (LBP) at least once in their life and for some patients this evolves into a chronic condition. One way to prevent acute LBP from transiting into chronic LBP, is to ensure that patients receive the right interventions at the right moment. We started research in the design of a clinical decision support system (CDSS) to support patients with LBP in their self-referral to primary care. For this, we explored the possibilities of using supervised machine learning...
February 2018: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29330245/impact-of-pharmacist-previsit-input-to-providers-on-chronic-opioid-prescribing-safety
#2
Nicholas Cox, Casey R Tak, Susan E Cochella, Eric Leishman, Karen Gunning
INTRODUCTION: Primary care providers (PCPs) account for half of opioid prescriptions, often feel chronic pain patients are challenging to manage, and there is wide variability in practice patterns. The purpose of this pilot study was to evaluate the impact of a previsit pharmacist review of high-risk patients treated with opioids for chronic pain on compliance to guideline recommendations at a family medicine residency clinic. METHODS: All adult patients with an appointment for chronic pain who were prescribed >50 morphine milligram equivalents (MMEs)/day had charts reviewed by a pharmacist before each appointment; recommendations were sent electronically to the provider before the appointment...
January 2018: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29330240/structured-management-of-chronic-nonmalignant-pain-with-opioids-in-a-rural-primary-care-office
#3
Kevin S McCann, Shawndra Barker, Raymond Cousins, Adam Franks, Clinton McDaniel, Stephen Petrany, Eric Riley
INTRODUCTION: The use of opioid medication for nonmalignant chronic pain (NMCP) increased dramatically during the last 20 years. There have been regulatory changes implemented to reduce the risk of harm to both patients and society. Much of the burden of monitoring these patients is falling on primary care physicians (PCPs), who do not have the time or resources to handle what is entailed in a best-practice approach to NMCP. METHODS: A retrospective study was conducted with all patients on opioid medication for NMCP who were enrolled onto an individual PCP's practice...
January 2018: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29330232/interventions-must-be-realistic-to-be-useful-and-completed-in-family-medicine
#4
EDITORIAL
Marjorie A Bowman, Dean A Seehusen, Anne Victoria Neale
Being realistic while helping our patients is this issue's theme. Given the volume of tasks required in family medicine, recommendations for improvements in direct care or care measurement cannot just be evidence-based but must also be realistic. On the list of realistic: ordering antipsychotics for symptoms of dementia in the elderly, despite recommendations to not do so; ordering antidepressants without fear that the patient could develop hypertension; mental health care providers in primary care offices; forced choice for opioid management; plus agenda setting for visit efficiency...
January 2018: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29330101/telephone-based-weight-loss-support-for-patients-with-knee-osteoarthritis-a-pragmatic-randomized-controlled-trial
#5
Kate M O'Brien, John Wiggers, Amanda Williams, Elizabeth Campbell, Rebecca K Hodder, Luke Wolfenden, Sze Lin Yoong, Emma K Robson, Robin Haskins, Steven J Kamper, Chris Rissel, Christopher M Williams
OBJECTIVE: To determine the effectiveness of telephone-based weight loss support in reducing the intensity of knee pain in patients with knee osteoarthritis, who are overweight or obese, compared to usual care. DESIGN: We conducted a parallel randomized controlled trial (RCT), embedded within a cohort multiple RCT of patients on a waiting list for outpatient orthopaedic consultation at a tertiary referral hospital in NSW, Australia. Patients with knee osteoarthritis, classified as overweight or obese (body mass index between ≥27kg/m2 and <40kg/m2) were randomly allocated to receive referral to an existing non-disease specific government funded 6-month telephone-based weight management and healthy lifestyle service or usual care...
January 9, 2018: Osteoarthritis and Cartilage
https://www.readbyqxmd.com/read/29325583/an-integrated-delivery-of-care-approach-to-improve-patient-reported-physical-function-and-mental-wellbeing-after-orthopedic-trauma-study-protocol-for-a-randomized-controlled-trial
#6
Laura Zdziarski-Horodyski, MaryBeth Horodyski, Kalia K Sadasivan, Jennifer Hagen, Terrie Vasilopoulos, Matthew Patrick, Robert Guenther, Heather K Vincent
BACKGROUND: Orthopedic trauma injury impacts nearly 2.8 million people each year. Despite surgical improvements and excellent survivorship rates, many patients experience poor quality of life (QOL) outcomes years later. Psychological distress commonly occurs after injury. Distressed patients more frequently experience rehospitalizations, pain medication dependence, and low QOL. This study was developed to test whether an integrative care approach (IntCare; ten-step program of emotional support, education, customized resources, and medical care) was superior to usual care (UsCare)...
January 11, 2018: Trials
https://www.readbyqxmd.com/read/29324560/contrast-media-extravasations-in-patients-undergoing-computerized-tomography-scanning-a-systematic-review-and-meta-analysis-of-risk-factors-and-interventions
#7
Sandrine Ding, Nicole Richli Meystre, Cosmin Campeanu, Giuseppe Gullo
OBJECTIVE: To identify risk factors and interventions preventing or reducing contrast medium extravasation. INTRODUCTION: Computed tomography (CT) is a radiological examination essential for the diagnosis and monitoring of many diseases. It is often performed with the intravenous (IV) injection of contrast agents. Use of these products can result in a significant complication, extravasation, which is the accidental leakage of IV material into the surrounding tissue...
January 2018: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29322243/humanistic-burden-of-disease-for-patients-with-advanced-melanoma-in-canada
#8
Winson Y Cheung, Martha S Bayliss, Michelle K White, Angela Stroupe, Andrew Lovley, Bellinda L King-Kallimanis, Kathryn Lasch
BACKGROUND: Metastatic melanoma is a highly aggressive cancer, often striking in the prime of life. This study provides new information directly from advanced melanoma (stage III and IV) patients on how their disease impacts their health-related quality of life (HRQL). METHODS: Twenty-nine in-depth, qualitative interviews were conducted with adult patients with advanced melanoma in Canada. A semi-structured interview guide was used. Interviews were transcribed verbatim and key concepts were identified using a grounded theory analytic approach...
January 10, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29322167/use-of-high-risk-coronary-atherosclerotic-plaque-detection-for-risk-stratification-of-patients-with-stable-chest-pain-a-secondary-analysis-of-the-promise-randomized-clinical-trial
#9
Maros Ferencik, Thomas Mayrhofer, Daniel O Bittner, Hamed Emami, Stefan B Puchner, Michael T Lu, Nandini M Meyersohn, Alexander V Ivanov, Elizabeth C Adami, Manesh R Patel, Daniel B Mark, James E Udelson, Kerry L Lee, Pamela S Douglas, Udo Hoffmann
Importance: Coronary computed tomographic angiography (coronary CTA) can characterize coronary artery disease, including high-risk plaque. A noninvasive method of identifying high-risk plaque before major adverse cardiovascular events (MACE) could provide practice-changing optimizations in coronary artery disease care. Objective: To determine whether high-risk plaque detected by coronary CTA was associated with incident MACE independently of significant stenosis (SS) and cardiovascular risk factors...
January 10, 2018: JAMA Cardiology
https://www.readbyqxmd.com/read/29320998/the-perceptions-and-experiences-of-women-who-achieved-and-did-not-achieve-a-waterbirth
#10
Lucy Lewis, Yvonne L Hauck, Caroline Crichton, Courtney Barnes, Corrinne Poletti, Helen Overing, Louise Keyes, Brooke Thomson
BACKGROUND: There is a gap in knowledge and understanding relating to the experiences of women exposed to the opportunity of waterbirth. Our aim was to explore the perceptions and experiences of women who achieved or did not achieve their planned waterbirth. METHODS: An exploratory design using critical incident techniques was conducted between December 2015 and July 2016, in the birth centre of the tertiary public maternity hospital in Western Australia. Women were telephoned 6 weeks post birth...
January 10, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29319608/novel-approach-to-characterising-individuals-with-low-back-related-leg-pain-cluster-identification-with-latent-class-analysis-and-12-month-follow-up
#11
Siobhán Stynes, Kika Konstantinou, Reuben Ogollah, Elaine M Hay, Kate M Dunn
Traditionally, low back-related leg pain (LBLP) is diagnosed clinically as referred leg pain or sciatica (nerve root involvement). However, within the spectrum of LBLP, we hypothesised that there may be other unrecognised patient subgroups. This study aimed to identify clusters of patients with LBLP using latent class analysis and describe their clinical course. The study population was 609 LBLP primary care consulters. Variables from clinical assessment were included in the latent class analysis. Characteristics of the statistically identified clusters were compared, and their clinical course more than 1 year was described...
January 9, 2018: Pain
https://www.readbyqxmd.com/read/29319605/epidural-hematoma-following-interlaminar-epidural-injection-in-patient-taking-aspirin
#12
Rebecca A Sanders, Markus A Bendel, Susan M Moeschler, William D Mauck
OBJECTIVE: We present a case report of a patient who developed an epidural hematoma following an interlaminar epidural steroid injection with no risk factors aside from old age and aspirin use for secondary prevention. CASE REPORT: A 79-year-old man developed an epidural hematoma requiring surgical treatment following an uncomplicated interlaminar epidural steroid injection performed for neurogenic claudication. In the periprocedural period, he continued aspirin for secondary prophylaxis following a myocardial infarction...
January 9, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29319461/hypnosis-is-more-effective-than-clinical-interviews
#13
Francisco Xavier De Almeida-Marques, José Sánchez-Blanco, Francisco Javier Cano-García
To determine whether hypnosis is more effective than conventional interviewing to find traumatic life events in patients with fibromyalgia, we carried out a within-subject experimental design with complete intragroup counterbalancing. Thirty-two women under care in a public primary care center gave 2 identical interviews, with an interval of 3 months, in which the occurrence of traumatic life events was explored, once in a state of wakefulness and once in a state of hypnosis. The state of consciousness was evaluated using 3 measures: bispectral index, skin conductance level, and pain intensity...
January 2018: International Journal of Clinical and Experimental Hypnosis
https://www.readbyqxmd.com/read/29316883/active-ingredients-of-a-person-centred-intervention-for-people-on-hiv-treatment-analysis-of-mixed-methods-trial-data
#14
Keira Lowther, Richard Harding, Victoria Simms, Aabid Ahmed, Zipporah Ali, Nancy Gikaara, Lorraine Sherr, Hellen Kariuki, Irene J Higginson, Lucy Ellen Selman
BACKGROUND: A new model of care is required to meet the changing needs of people living with HIV (PLWH), particularly in low and middle-income countries, where prevalence is highest. We evaluated a palliative care intervention for PLWH in Mombasa, Kenya. Although we found no effect on pain (primary outcome), there was a positive effect on mental health (secondary outcome) in the intervention group. To inform replication and implementation, we have determined the active ingredients of the intervention and their mechanisms of action...
January 10, 2018: BMC Infectious Diseases
https://www.readbyqxmd.com/read/29314360/patient-reported-symptoms-and-stepwise-symptom-management-in-patients-on-epidermal-growth-factor-inhibitors-a-retrospective-descriptive-cohort-study
#15
J J Koldenhof, M H G Langenberg, P O Witteveen, S C C M Teunissen
Adverse events (AEs) of epidermal growth factor inhibitors (EGFRi) influence well-being with a risk to dose modifications (DMs). Hereby, clinical benefit of treatment might be affected. This retrospective cohort study was set up to gain insight into the suitability and added value of a patient-reported outcome measurement tool (PROM), together with a stepwise intervention management plan for EGFRi-related AEs in daily practice. The primary objective was to gain insight into total treatment duration and DMs, and the secondary objective to gain insight into patient-reported symptoms and well-being as well as healthcare professional-reported AEs...
January 4, 2018: European Journal of Cancer Care
https://www.readbyqxmd.com/read/29313316/presentation-of-knee-osteoarthritis-in-the-emergency-department-a-problem-worth-mentioning
#16
Chukwuweike U Gwam, Jennifer I Etcheson, Nicole E George, Jaydev B Mistry, Nequesha Mohamed, Aamir Patel, Peace N Gwam, Nicolas S Piuzzi, Ronald E Delanois
INTRODUCTION: Osteoarthritis (OA) of the knee is a progressive debilitating disease affecting more than 27 million Americans. Treatment is often aimed at reducing pain and slowing disease progression. However, patients with significant barriers to healthcare may elect to visit the emergency department (ED) due to OA-related knee pain. The purpose of this study is to provide a detailed analysis of 1) patient demographics; 2) payor type; 3) charges; and 4) discharge status of patients presenting to the emergency department with a primary diagnosis of knee OA...
December 22, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/29307748/number-and-type-of-post-traumatic-stress-disorder-ptsd-symptom-domains-are-associated-with-patient-reported-outcomes-in-patients-with-chronic-pain
#17
Dale J Langford, Brian R Theodore, Danica Balsiger, Christine Tran, Ardith Z Doorenbos, David J Tauben, Mark D Sullivan
Post-Traumatic Stress Disorder (PTSD) commonly accompanies complex chronic pain, yet PTSD is often overlooked in chronic pain management. Using the 4-item Primary Care (PC)-PTSD screening tool, we evaluated the relationship between the number and type of PC-PTSD symptoms endorsed and a set of patient-reported outcomes, including: pain intensity and interference; function; mood; quality of life; and substance abuse risk in a consecutive sample of patients with chronic pain (n=4,402). Patients completed PainTracker™, a web-based patient-reported outcome tool that provides a multidimensional evaluation of chronic pain, as part of their intake evaluation at a specialty pain clinic in a community setting...
January 4, 2018: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/29307505/practical-considerations-in-medical-cannabis-administration-and-dosing
#18
REVIEW
Caroline A MacCallum, Ethan B Russo
Cannabis has been employed medicinally throughout history, but its recent legal prohibition, biochemical complexity and variability, quality control issues, previous dearth of appropriately powered randomised controlled trials, and lack of pertinent education have conspired to leave clinicians in the dark as to how to advise patients pursuing such treatment. With the advent of pharmaceutical cannabis-based medicines (Sativex/nabiximols and Epidiolex), and liberalisation of access in certain nations, this ignorance of cannabis pharmacology and therapeutics has become untenable...
January 4, 2018: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/29307457/integration-of-doctors-of-chiropractic-into-private-sector-health-care-facilities-in-the-united-states-a-descriptive-survey
#19
Stacie A Salsbury, Christine M Goertz, Elissa J Twist, Anthony J Lisi
OBJECTIVE: The purpose of this study was to describe the demographic, facility, and practice characteristics of doctors of chiropractic (DCs) working in private sector health care settings in the United States. METHODS: We conducted an online, cross-sectional survey using a purposive sample of DCs (n = 50) working in integrated health care facilities. The 36-item survey collected demographic, facility, chiropractic, and interdisciplinary practice characteristics, which were analyzed with descriptive statistics...
January 4, 2018: Journal of Manipulative and Physiological Therapeutics
https://www.readbyqxmd.com/read/29306768/desire-to-institutionalize-in-alzheimer-s-caregivers-an-empirical-analysis-on-italian-data
#20
Luisa Colucci, Ivana Molino, Francesco Amenta, Giuseppe Lucio Gaeta
OBJECTIVE: Families choice to institutionalize an Alzheimer's disease (AD)-affected relative is hard and possibly painful. Recent literature contributions have investigated the causes of the emergence of desire to institutionalize (DI) who is affected by AD. This paper contributes to the topic by providing an Italy-based empirical analysis of factors correlated with DI in primary informal caregivers of patients affected by AD. METHODS: Data were drawn from an original survey carried out over 2009...
December 30, 2017: Archives of Gerontology and Geriatrics
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