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Chad M Hodge, Scott P Narus
Objective: Problem list data is a driving force for many beneficial clinical tools, yet these data remain underutilized. We performed a systematic literature review, pulling insights from previous research, aggregating insights into themes, and distilling themes into actionable advice. We sought to learn what changes we could make to existing applications, to the clinical workflow, and to clinicians' perceptions that would improve problem list utilization and increase the prevalence of problems data in the electronic medical record...
March 14, 2018: Journal of the American Medical Informatics Association: JAMIA
Charlotte E Teunissen, Markus Otto, Sebastiaan Engelborghs, Sanna-Kaisa Herukka, Sylvain Lehmann, Piotr Lewczuk, Alberto Lleó, Armand Perret-Liaudet, Hayrettin Tumani, Martin R Turner, Marcel M Verbeek, Jens Wiltfang, Henrik Zetterberg, Lucilla Parnetti, Kaj Blennow
Body fluid biomarkers have great potential for different clinical purposes, including diagnosis, prognosis, patient stratification and treatment effect monitoring. This is exemplified by current use of several excellent biomarkers, such as the Alzheimer's disease cerebrospinal fluid (CSF) biomarkers, anti-neuromyelitis optica antibodies and blood neurofilament light. We still, however, have a strong need for additional biomarkers and several gaps in their development and implementation should be filled. Examples of such gaps are i) limited knowledge of the causes of neurological diseases, and thus hypotheses about the best biomarkers to detect subclinical stages of these diseases; ii) the limited success translating discoveries obtained by e...
March 15, 2018: Alzheimer's Research & Therapy
Lisa Blom, Lucie Laflamme, Helle Mölsted Alvesson
BACKGROUND: Image-based teleconsultation between medical experts and healthcare staff at remote emergency centres can improve the diagnosis of conditions which are challenging to assess. One such condition is burns. Knowledge is scarce regarding how medical experts perceive the influence of such teleconsultation on their roles and relations to colleagues at point of care. METHODS: In this qualitative study, semi-structured interviews were conducted with 15 medical experts to explore their expectations of a newly developed App for burns diagnostics and care prior to its implementation...
2018: PloS One
Pamela Fergusson, Nicole Greenspan, Lukas Maitland, Rémy Huberdeau
Transgender people are an important group for whom access to healthcare is often problematic. Dietitians need to be aware of key issues in transgender health to provide culturally competent clinical nutritional care. This article serves as a primer, clarifying key terms and concepts, exploring the impact of stigma and discrimination on health and nutrition for people from transgender communities, and offering practical advice for nutritional and other related issues. Education for dietitians both pre- and postqualification is an important part of improving care and building skills and awareness of cultural humility...
March 15, 2018: Canadian Journal of Dietetic Practice and Research
Amy G Bryant, Jonas J Swartz
Crisis pregnancy centers are organizations that seek to intercept women with unintended pregnancies who might be considering abortion. Their mission is to prevent abortions by persuading women that adoption or parenting is a better option. They strive to give the impression that they are clinical centers, offering legitimate medical services and advice, yet they are exempt from regulatory, licensure, and credentialing oversight that apply to health care facilities. Because the religious ideology of these centers' owners and employees takes priority over the health and well-being of the women seeking care at these centers, women do not receive comprehensive, accurate, evidence-based clinical information about all available options...
March 1, 2018: AMA Journal of Ethics
Lakshmi N Yatham, Sidney H Kennedy, Sagar V Parikh, Ayal Schaffer, David J Bond, Benicio N Frey, Verinder Sharma, Benjamin I Goldstein, Soham Rej, Serge Beaulieu, Martin Alda, Glenda MacQueen, Roumen V Milev, Arun Ravindran, Claire O'Donovan, Diane McIntosh, Raymond W Lam, Gustavo Vazquez, Flavio Kapczinski, Roger S McIntyre, Jan Kozicky, Shigenobu Kanba, Beny Lafer, Trisha Suppes, Joseph R Calabrese, Eduard Vieta, Gin Malhi, Robert M Post, Michael Berk
The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments...
March 14, 2018: Bipolar Disorders
Marta Trapero-Bertran, Celia Muñoz, Kathryn Coyle, Doug Coyle, Adam Lester-George, Reiner Leidl, Bertalan Németh, Kei-Long Cheung, Subhash Pokhrel, Ángel Lopez-Nicolás
AIMS: To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). DESIGN: We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov-based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion...
March 13, 2018: Addiction
Marta Trapero-Bertran, Reiner Leidl, Celia Muñoz, Puttarin Kulchaitanaroaj, Kathryn Coyle, Maximilian Präger, Judit Józwiak-Hagymásy, Kei Long Cheung, Mickael Hiligsmann, Subhash Pokhrel
BACKGROUND AND AIMS: Modelling return on investment (ROI) from smoking cessation interventions requires estimates of their costs and benefits. This paper describes a standardized method developed to source both economic costs of tobacco smoking and costs of implementing cessation interventions for a Europe-wide ROI model [European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD)]. DESIGN: Focused search of administrative and published data...
March 13, 2018: Addiction
Om P Kurmi, Kourtney J Davis, Kin Bong Hubert Lam, Yu Guo, Julien Vaucher, Derrick Bennett, Jenny Wang, Zheng Bian, Huaidong Du, Liming Li, Robert Clarke, Zhengming Chen
Introduction: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with COPD deaths in China accounting for one-third of all such deaths. However, there is limited available evidence on the management of COPD in China. Methods: A random sample of 25 011 participants in the China Kadoorie Biobank, aged 38-87 years, from 10 regions in China was surveyed in 2013-2014. Data were collected using interviewer-administered questionnaires on the diagnosis ('doctor-diagnosed' or 'symptoms-based') and management of COPD (including use of medication and other healthcare resources), awareness of diagnosis and severity of symptoms in COPD cases...
2018: BMJ Open Respiratory Research
Ayushi Jayesh Shah, Vijaykumar Singh, Subita P Patil, Mithila R Gadkari, Varun Ramchandani, Karan Janak Doshi
Background: Compliance to antihypertensive therapy reduces the risk of complications. It is important to understand the factors affecting compliance in patients so that the goal of successful treatment is not jeopardized. Objectives: To determine the proportion of participants' compliant to treatment and various factors associated with compliance of antihypertensive treatment. Settings and Design: A cross-sectional study of 330 hypertensive patients on treatment attending the outpatient department of a tertiary care hospital in Mumbai...
January 2018: Indian Journal of Community Medicine
Harsh Dilipkumar Shah, Bonny Shah, Paresh V Dave, Janak B Katariya, Khyati P Vats
Context: Facility Based Newborn Care (FBNC) is a key strategy to improve child survival, especially in newborn care where neonatal mortality rate (NMR) is stagnant in declining. Gujarat has achieved considerable amount of reduction in child deaths, but neonatal health requires attention. The study was aimed to assess the admission pattern of Special Newborn Care Units (SNCUs) which supports decision-making. Settings and Design: A cross-sectional descriptive analysis was done from secondary data of the SNCU reports on the aspects of admission patterns, morbidity, and mortality pattern...
January 2018: Indian Journal of Community Medicine
Cynthia Cheng, Fatima Mithoowani, Thomas Ungar, Monica Lee
Background: Interaction between alcohol and certain medications can lead to adverse consequences. Individuals with mental health disorders are particularly vulnerable because of their psychotropic medications, which are typically taken over extended periods and which are known to have pharmacokinetic and pharmacodynamic interactions with alcohol. It is unknown what education these patients receive from their health care providers and how such interactions are managed. Objectives: To determine whether individuals with mental health disorders are aware of alcohol-drug interactions and if so, how they use such information...
January 2018: Canadian Journal of Hospital Pharmacy
Clare Liddy, Isabella Moroz, Amir Afkham, Erin Keely
PURPOSE: Excessive wait times for specialist appointments pose a serious barrier to patient care. To improve access to specialist care and reduce wait times, we launched the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service in April 2011. The objective of this study is to report on the impact of our multiple specialty eConsult service during the first 5 years of use after implementation, with a focus on growth and sustainability. METHODS: We conducted a cross-sectional study of all eConsult cases submitted between April 1, 2011 and April 30, 2016, and measured impact with system utilization data and mandatory close-out surveys completed at the end of each eConsult...
March 2018: Annals of Family Medicine
Sjoerd Broekman, Elisabeth Van Gils-Van Rooij, Berthold Meijboom, Dingenus De Bakker, Christoffel Yzermans
INTRODUCTION In the Netherlands, general practitioners (GPs) and emergency departments (EDs) collaborate increasingly in urgent care collaborations (UCCs) in which the two services share one combined entrance and joint triage. AIM The objective of this study is to determine if UCCs are cost-effective compared to the usual care setting where out-of-hours GP services and EDs work separately. METHODS This observational study compared UCCs with the usual care setting on costs by performing linear regression analyses...
September 2017: Journal of Primary Health Care
Andrew N Claxton, Paul M Dark
Sepsis is a medical emergency, which requires the initiation of broad-spectrum antimicrobial agents as early as possible. In the absence of positive microbiological cultures providing targeted antimicrobial advice, broad-spectrum antibiotics are commonly continued until there is clinical evidence of infection resolution. With an absence of robust evidence to inform when it is safe to stop antimicrobial agents in sepsis, the duration of antimicrobial courses may be longer than is required. Prolonged courses of potent broad-spectrum antimicrobials increase the risk of adverse drug events and contribute to the growing emergence of multidrug resistant pathogens, which is a global public health emergency...
March 2, 2018: British Journal of Hospital Medicine
Małgorzata Konieczyńska, Ewa Sobieraj, Agata Hanna Bryk, Maciej Dębski, Maciej Polak, Piotr Podolec, Barbara Małecka, Andrzej Pająk, Lien Desteghe, Hein Heidbuchel, Anetta Undas
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used for stroke prevention in patients with atrial fibrillation (AF) worldwide. Few articles have compared current understanding of AF patients about the disease and anticoagulant therapy in relation to the medications used. AIM: The aim of this study was to compare the knowledge of AF and anticoagulation between AF patients treated with NOACs and those on vitamin K antagonists (VKA)...
March 12, 2018: Kardiologia Polska
Kashif Aziz, Hafiz M Aeymon, Saba Batool
Sale of medicines is not rigorously controlled in Pakistan. Therefore, medical students start prescribing drugs and advising diagnostic tests before they graduate. This cross-sectional study investigated the frequency of independent medical prescription by 180 stratified, randomly selected final year medical students from 3 public medical colleges in Punjab, Pakistan. Data were obtained by self-administered questionnaire. One hundred and twelve students had prescribed medicines independently without any supervision; 38 had performed a physical examination before prescribing; and 74 had advised and 49 interpreted diagnostic tests independently...
March 5, 2018: Eastern Mediterranean Health Journal, la Revue de Santé de la Méditerranée Orientale
Tarang Sharma, Moni Choudhury, Juan Carlos Rejón-Parrilla, Pall Jonsson, Sarah Garner
BACKGROUND: The National Institute for Health and Care Excellence (NICE) was established in 1999 and provides national guidance and advice to improve health and social care. Several steps in the research cycle have been identified that can support the reduction of waste that occurs in biomedical research. The first step in the process is ensuring appropriate research priority setting occurs so only the questions that are needed to fill existing gaps in the evidence are funded. This paper summarises the research priority setting processes at NICE...
March 8, 2018: BMJ Open
Rebecca Susan Dewey, Deborah A Hall, Hannah Guest, Garreth Prendergast, Christopher J Plack, Susan T Francis
BACKGROUND: Rodent studies indicate that noise exposure can cause permanent damage to synapses between inner hair cells and high-threshold auditory nerve fibers, without permanently altering threshold sensitivity. These demonstrations of what is commonly known as hidden hearing loss have been confirmed in several rodent species, but the implications for human hearing are unclear. OBJECTIVE: Our Medical Research Council-funded program aims to address this unanswered question, by investigating functional consequences of the damage to the human peripheral and central auditory nervous system that results from cumulative lifetime noise exposure...
March 9, 2018: JMIR Research Protocols
Peter Okokhere, Andres Colubri, Chukwuemeka Azubike, Christopher Iruolagbe, Omoregie Osazuwa, Shervin Tabrizi, Elizabeth Chin, Sara Asad, Ehi Ediale, Mojeed Rafiu, Donatus Adomeh, Ikponmwosa Odia, Rebecca Atafo, Chris Aire, Sylvanus Okogbenin, Meike Pahlman, Beate Becker-Ziaja, Danny Asogun, Terrence Fradet, Ben Fry, Stephen F Schaffner, Christian Happi, George Akpede, Stephan Günther, Pardis C Sabeti
BACKGROUND: Lassa fever is a viral haemorrhagic disease endemic to west Africa. No large-scale studies exist from Nigeria, where the Lassa virus (LASV) is most diverse. LASV diversity, coupled with host genetic and environmental factors, might cause differences in disease pathophysiology. Small-scale studies in Nigeria suggest that acute kidney injury is an important clinical feature and might be a determinant of survival. We aimed to establish the demographic, clinical, and laboratory factors associated with mortality in Nigerian patients with Lassa fever, and hypothesised that LASV was the direct cause of intrinsic renal damage for a subset of the patients with Lassa fever...
March 6, 2018: Lancet Infectious Diseases
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