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https://www.readbyqxmd.com/read/29150885/recognizing-the-haystack-is-the-task-of-the-primary-care-physician
#1
N A Kukutsch, G Argenziano, W Bergman
In a reply to our letter Ferrandiz and colleagues wondered why dermoscopy experts did not already fully embrace teledermoscopy (TD) for suspicious pigmented skin lesions.(1) Our study showed that the structure of the health systems that were investigated differed, with countries where primary care physicians (PCP) hold a gate keeper function and others with direct access to a dermatologist. Significant differences in waiting time and travel distance were observed.(2) Since we believe that there is enough evidence that the addition of high quality dermoscopic pictures to a teleconsultation leads to higher accuracy of the diagnosis we did not investigate this question in our survey...
November 17, 2017: Journal of the European Academy of Dermatology and Venereology: JEADV
https://www.readbyqxmd.com/read/29150468/prevalence-and-recognition-of-obesity-and-its-associated-comorbidities-cross-sectional-analysis-of-electronic-health-record-data-from-a-large-us-integrated-health-system
#2
Kevin M Pantalone, Todd M Hobbs, Kevin M Chagin, Sheldon X Kong, Brian J Wells, Michael W Kattan, Jonathan Bouchard, Brian Sakurada, Alex Milinovich, Wayne Weng, Janine Bauman, Anita D Misra-Hebert, Robert S Zimmerman, Bartolome Burguera
OBJECTIVE: To determine the prevalence of obesity and its related comorbidities among patients being actively managed at a US academic medical centre, and to examine the frequency of a formal diagnosis of obesity, via International Classification of Diseases, Ninth Revision (ICD-9) documentation among patients with body mass index (BMI) ≥30 kg/m(2). DESIGN: The electronic health record system at Cleveland Clinic was used to create a cross-sectional summary of actively managed patients meeting minimum primary care physician visit frequency requirements...
November 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/29150390/pulmonary-embolism-rule-out-criteria-perc-rule-in-european-patients-with-low-implicit-clinical-probability-percepic-a-multicentre-prospective-observational-study
#3
Andrea Penaloza, Caroline Soulié, Thomas Moumneh, Quentin Delmez, Alexandre Ghuysen, Dominique El Kouri, Christian Brice, Nicolas S Marjanovic, Jacques Bouget, Fares Moustafa, Albert Trinh-Duc, Catherine Le Gall, Lionel Imsaad, Jean-Marie Chrétien, Béatrice Gable, Philippe Girard, Olivier Sanchez, Jeannot Schmidt, Grégoire Le Gal, Guy Meyer, Nicolas Delvau, Pierre-Marie Roy
BACKGROUND: The ability of the pulmonary embolism rule-out criteria (PERC) to exclude pulmonary embolism without further testing remains debated outside the USA, especially in the population with suspected pulmonary embolism who have a high prevalence of the condition. Our main objective was to prospectively assess the predictive value of negative PERC to rule out pulmonary embolism among European patients with low implicit clinical probability. METHODS: We did a multicentre, prospective, observational study in 12 emergency departments in France and Belgium...
November 14, 2017: Lancet Haematology
https://www.readbyqxmd.com/read/29150180/family-centre-bereavement-practices-in-danish-intensive-care-units-a-cross-sectional-national-survey
#4
Ingrid Egerod, Gudrun Kaldan, Maureen Coombs, Marion Mitchell
BACKGROUND: Mortality in Danish intensive care units (ICUs) continues at 27%, resulting in a large number of bereaved family members being cared for in the ICU. OBJECTIVES: To investigate the provision of bereavement care and follow-up services for bereaved families in Danish ICUs. METHODOLOGY: Self-administered computerized cross-sectional nation-wide survey of Danish ICUs. RESULTS: Nurses at 46 of 48 (96%) ICUs in Denmark responded...
November 14, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29150146/annual-trends-in-follow-up-visits-for-pediatric-concussion-in-emergency-departments-and-physicians-offices
#5
Liraz Fridman, Michal Scolnik, Alison Macpherson, Linda Rothman, Astrid Guttmann, Anne M Grool, Daniel Rodriguez Duque, Roger L Zemek
OBJECTIVE: To assess whether children and youth with concussion receive follow-up visits in accordance with the recommended guidelines. STUDY DESIGN: We conducted a retrospective, population-based study using linked health administrative data from all concussion-related visits to emergency department and physician offices by children aged 5 through 18 years (range, 5.00-18.99) in Ontario between 2003 and 2013. We analyzed the percentage of children and youth seen for follow-up...
November 14, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29149903/improving-access-to-school-health-services-as-perceived-by-school-professionals
#6
Janine Bezem, Debbie Heinen, Ria Reis, Simone E Buitendijk, Mattijs E Numans, Paul L Kocken
BACKGROUND: The organisation of health assessments by preventive health services focusing on children's health and educational performance needs to be improved due to evolving health priorities such as mental health problems, reduced budgets and shortages of physicians and nurses. We studied the impact on the school professionals' perception of access to school health services (SHS) when a triage approach was used for population-based health assessments in primary schools. The triage approach involves pre-assessments by SHS assistants, with only those children in need of follow-up being assessed by a physician or nurse...
November 17, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/29149877/key-bottlenecks-to-the-provision-of-safe-obstetric-anaesthesia-in-low-income-countries-a-cross-sectional-survey-of-64-hospitals-in-uganda
#7
Isabella Epiu, Agnes Wabule, Andrew Kambugu, Harriet Mayanja-Kizza, Jossy Verel Bahe Tindimwebwa, Gerald Dubowitz
BACKGROUND: Despite recent advances in surgery and anaesthesia which significantly improve safety, many health facilities in low-and middle-income countries (LMICs) remain chronically under-resourced with inability to cope effectively with serious obstetric complications (Knight et al., PLoS One 8:e63846, 2013). As a result many of these countries still have unacceptably high maternal and neonatal mortality rates. Recent data at the national referral hospitals in East Africa reported that none of the national referral hospitals met the World Federation of Societies of Anesthesiologists (WFSA) international standards required to provide safe obstetric anaesthesia (Epiu I: Challenges of Anesthesia in Low-and Middle-Income Countries...
November 17, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29149875/prevalence-of-antibiotic-prescription-in-pediatric-outpatients-in-italy-the-role-of-local-health-districts-and-primary-care-physicians-in-determining-variation-a-multilevel-design-for-healthcare-decision-support
#8
Mirko Di Martino, Adele Lallo, Ursula Kirchmayer, Marina Davoli, Danilo Fusco
BACKGROUND: According to scientific literature, antibacterials are prescribed for common pediatric conditions that do not benefit from antibiotic therapy. The link between antibiotic use and bacterial resistance is well known. Antibiotic overprescribing generates high social costs and severe consequences for children. Our objectives were to analyze antibiotic prescription patterns in pediatric outpatients residing in the Lazio region (Italy), to identify physicians' characteristics associated with increased propensity for prescription, to identify the priority axes for action to improve the rational use of antibiotics...
November 17, 2017: BMC Public Health
https://www.readbyqxmd.com/read/29149791/the-dementia-care-coordination-program-engaging-health-systems-in-caregiver-supports
#9
Pamela Nadash, Nina M Silverstein, Frank Porell
This paper reports on a process evaluation using mixed methods to assess a Dementia Care Coordination Program, which is distinctive in using the medical system, rather than direct outreach, to identify and refer families to supports provided by an Alzheimer's Association chapter via dedicated care consultants. One care consultant received referrals from individual physicians, while the other, employed by a health plan, received referrals from health plan case managers. Through key informant interviews, focus groups, and physician and caregiver surveys, we identified key issues, finding high rates of stakeholder satisfaction, but some practical issues around information sharing and data tracking...
January 1, 2017: Dementia
https://www.readbyqxmd.com/read/29149314/how-the-introduction-of-a-human-resources-information-system-helped-the-democratic-republic-of-congo-to-mobilise-domestic-resources-for-an-improved-health-workforce
#10
Jean-Robert Likofata Esanga, Claire Viadro, Leah McManus, Jennifer Wesson, Nicaise Matoko, Epiphane Ngumbu, Kate E Gilroy, Daren Trudeau
The Democratic Republic of Congo has flagged health workforce management and compensation as issues requiring attention, including the problem of ghost workers (individuals on payroll who do not exist and/or show up at work). Recognising the need for reliable health workforce information, the government has worked to implement iHRIS, an open source human resources information system that facilitates health workforce management. In Kasaï Central and Kasaï Provinces, health workers brought relevant documentation to data collection points, where trained teams interviewed them and entered contact information, identification, photo, current job, and employment and education history into iHRIS on laptops...
November 1, 2017: Health Policy and Planning
https://www.readbyqxmd.com/read/29149312/who-are-more-responsive-mixed-methods-comparison-of-public-and-private-sector-physicians-in-rural-bangladesh
#11
Taufique Joarder, Asha George, Malabika Sarker, Saifuddin Ahmed, David H Peters
Responsiveness of physicians (ROPs) reflects the social actions by physicians to meet the legitimate expectations of health care users. Responsiveness is important since it improves understanding and care seeking by users, as well as fostering trust in health systems rather than replicating discrimination and entrenching inequality. Given widespread public and private sector health care provision in Bangladesh, we undertook a mixed-methods study comparing responsiveness of public and private physicians in rural Bangladesh...
November 1, 2017: Health Policy and Planning
https://www.readbyqxmd.com/read/29148968/collecting-practice-level-data-in-a-changing-physician-office-based-ambulatory-care-environment-a-pilot-study-examining-the-physician-induction-interview-component-of-the-national-ambulatory-medical-care-survey
#12
Meghan C Halley, Katharine A Rendle, Brian Gugerty, Denys T Lau, Harold S Luft
Objective This report examines ways to improve National Ambulatory Medical Care Survey (NAMCS) data on practice and physician characteristics in multispecialty group practices. Methods From February to April 2013, the National Center for Health Statistics (NCHS) conducted a pilot study to observe the collection of the NAMCS physician interview information component in a large multispecialty group practice. Nine physicians were randomly sampled using standard NAMCS recruitment procedures; eight were eligible and agreed to participate...
November 2017: Vital and Health Statistics. Series 2, Data Evaluation and Methods Research
https://www.readbyqxmd.com/read/29148907/impact-of-patients-expressed-wishes-on-their-surrogate-decision-makers-preferred-decision-making-roles-in-japan
#13
Shuji Tsuda, Mieko Nakamura, Shigeru Aoki, Hiroshi Ono, Mitsuru Takagi, Hiroki Ohashi, Junichiro Miyachi, Yoshinori Matsui, Toshiyuki Ojima
BACKGROUND: Home medical care (HMC) patients and their families are expected to prepare for end-of-life decision making. OBJECTIVE: We investigated the decision readiness of HMC patients and their family surrogates. DESIGN: Cross-sectional survey. SETTING/SUBJECTS: We collected data from dyads, consisting of a HMC patient aged 65 years or older and a family member of the patient, recruited at four Japanese primary care clinics from January 2016 to November 2016...
November 17, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29148546/-chronic-kidney-disease-the-relevant-information-for-an-occupational-physician
#14
REVIEW
Marcin Renke, Jacek Parszuto, Marcin Rybacki, Wojciech Wołyniec, Przemysław Rutkowski, Bolesław Rutkowski, Jolanta Walusiak-Skorupa, Alicja Dębska-Ślizień
For a number of years chronic kidney disease (CKD) has been listed in the group of lifestyle diseases, such as obesity, diabetes, cardiovascular disease and hypertension. It is estimated that in Poland more than 4 million people may suffer from various stages of CKD. Chronic kidney disease may also be a consequence of all the other civilization diseases. At the same time it is worth noting that nephrological problems are increasingly being taken into account in modern medical certification. The aim of this work is, among other things, to improve safe access to the labor for patients with kidney diseases...
November 8, 2017: Medycyna Pracy
https://www.readbyqxmd.com/read/29148355/vertical-integration-of-hospitals-and-physicians-economic-theory-and-empirical-evidence-on-spending-and-quality
#15
Brady Post, Tom Buchmueller, Andrew M Ryan
Hospital-physician vertical integration is on the rise. While increased efficiencies may be possible, emerging research raises concerns about anticompetitive behavior, spending increases, and uncertain effects on quality. In this review, we bring together several of the key theories of vertical integration that exist in the neoclassical and institutional economics literatures and apply these theories to the hospital-physician relationship. We also conduct a literature review of the effects of vertical integration on prices, spending, and quality in the growing body of evidence ( n = 15) to evaluate which of these frameworks have the strongest empirical support...
August 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148349/hospital-supply-expenses-an-important-ingredient-in-health-services-research
#16
Yousef Abdulsalam, Eugene Schneller
The purpose of this article is to shed light on hospital supply expenses, which form the second largest expense category after payroll and hold more promise for improving cost-efficiency compared to payroll. However, limited research has rigorously scrutinized this cost category, and it is rarely given specific consideration across cost-focused studies in health services publications. After reviewing previously cited estimates, we examine and independently validate supply expense data (collected by the American Hospital Association) for over 3,500 U...
July 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148344/moderating-effects-of-patient-characteristics-on-the-impact-of-financial-incentives
#17
Meredith B Rosenthal, Andrea B Troxel, Kevin G Volpp, Walter F Stewart, Thomas D Sequist, James B Jones, AnneMarie G Hirsch, Karen Hoffer, Jingsan Zhu, Wenli Wang, Amanda Hodlofski, Darra Finnerty, Jack J Huang, David A Asch
While financial incentives to providers or patients are increasingly common as a quality improvement strategy, their impact on patient subgroups and health care disparities is unclear. To examine these patterns, we analyzed data from a randomized clinical trial of financial incentives to lower low-density lipoprotein (LDL) cholesterol levels in patients at risk for cardiovascular disease. Patients with higher baseline LDL experienced greater cholesterol reductions in the shared incentive arm (0.23 mg/dL per unit change in baseline LDL, 95% CI [-0...
May 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148333/geographic-variations-in-physician-relationships-over-time-implications-for-care-coordination
#18
Eva H DuGoff, Juhee Cho, Yajuan Si, Craig Evan Pollack
Care coordination may be more challenging when the specific physicians with whom primary care physicians (PCPs) are expected to coordinate care change over time. Using Medicare data on physician patient-sharing relationships and the Dartmouth Atlas, we explored the extent to which PCPs tend to share patients with other physicians over time. We found that 70.7% of ties between PCPs and other physicians that were present in 2012 persisted in 2013, and additional shared patients in 2012 increased the odds of being connected in 2013...
March 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148329/the-implementation-of-performance-management-systems-in-u-s-physician-organizations
#19
Alexander F Pimperl, Hector P Rodriguez, Julie A Schmittdiel, Stephen M Shortell
Performance management systems (PMSYS) aid in improving the quality and efficiency of care, but little is known about factors that influence more robust PMSYS among physician organizations. Using a nationally representative survey of U.S. medical practices, we examined the extent to which organizational capabilities and external factors were associated with more developed PMSYS. Linear regression estimated the relative impact of these factors on PMSYS. On average, practices implemented a minority (32 points out of 100) of the PMSYS processes assessed...
March 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148326/understanding-professional-jurisdiction-changes-in-the-field-of-anesthesiology
#20
Scott Feyereisen, Joseph P Broschak, Beth Goodrick
We further our understanding of jurisdictional disputes between established professional groups through a 10-year longitudinal analysis of the differential adoption by U.S. states of policies expanding Certified Registered Nurse Anesthetists' (CRNAs) autonomy. In the United States, CRNAs are trained to deliver anesthetics to patients in the same way as physician anesthesiologists but have more restrictions in practice. Following a 2001 federal decision regarding Medicare reimbursement, states were permitted but not required to allow CRNAs to practice without physician supervision, potentially reducing health care costs...
January 1, 2017: Medical Care Research and Review: MCRR
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