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Intensif care

Merete L Hetland, Niels Steen Krogh, Kim Hørslev-Petersen, Berit Schiøttz-Christensen, Inge Juul Sørensen, Jensen Dorte Vendelbo
OBJECTIVES: Electronic platforms have been developed to help the clinician monitor disease activity in rheumatoid arthritis (RA) to support at treat-to-target strategy. We present an initiative to interactively improve disease control in patients with rheumatoid arthritis. METHODS: In patients who presented with one or more swollen joints AND moderate/high disease activity (i.e. either CDAI≥10.1 and/or DAS-28CRP>3.2, which is automatically calculated in the DANBIO registry), a red alert was shown, which activated a pop-up: "This patient has at least one swollen joint AND either CDAI≥ 10...
September 2016: Clinical and Experimental Rheumatology
David Hamilton, Vinidh Paleri
Morbidity and mortality associated with increasingly radical doses of chemoradiotherapy have led many to question the current standard of care in head and neck cancer. Recently, surgeons have developed minimally invasive, transoral techniques which have demonstrated excellent survival and favourable functional outcomes. Transoral robotic surgery (TORS) is the most recent, cutting edge in the evolution of transoral techniques; TORS allows surgeons unprecedented access to and visualisation of the upper aerodigestive tract...
October 11, 2016: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Paige C Fairchild, Aviva G Nathan, Michael Quinn, Elbert S Huang, Neda Laiteerapong
BACKGROUND: Diabetes and hypertension are chronic conditions for which over 90 % of patients require medication regimens that must be intensified over time. However, delays in intensification are common, and may be partially due to unrealistic patient expectations. OBJECTIVE: To explore whether patient expectations regarding their diabetes and hypertension are congruent with the natural history of these conditions. DESIGN: Qualitative analysis of semi-structured interviews...
October 11, 2016: Journal of General Internal Medicine
Marie-Noëlle Bélanger-Lévesque, Marc Dumas, Simon Blouin, Jean-Charles Pasquier
BACKGROUND: While spirituality is well described in end-of-life care literature, research on its place in the delivery room remains largely limited to mother-oriented qualitative studies focusing on life-threatening situations (e.g., high-risk pregnancies). Our aim was to compare mothers' and fathers' spirituality during childbirth. METHODS: A mixed methods questionnaire was developed from our childbirth-related spirituality categorization and distributed to all parents of newborns, 12-24 h postpartum, over 45 consecutive days...
September 30, 2016: BMC Pregnancy and Childbirth
Marije van der Lende, Fieke M E Cox, Gerhard H Visser, Josemir W Sander, Roland D Thijs
OBJECTIVE: Following a sudden death at a residential care unit, the Dutch Health and Care Inspectorate advised intensification of the use of video monitoring (VM) at the unit. We assessed whether VM resulted in increased identification of seizures that required clinical intervention. METHODS: The unit provides care for 340 individuals with refractory epilepsy and severe learning disabilities. Acoustic detection systems (ADSs) cover all individuals; 37 people also have a bed motion sensor (BMS) and 46 people with possible nocturnal seizures are now monitored by VM...
September 30, 2016: Epilepsia
Jan S Lewin, Leah M Baumgart, Martha P Barrow, Katherine A Hutcheson
Importance: Voice prosthesis (VP) device life is a limiting factor of tracheoesophageal (TE) voice restoration that drives patient satisfaction, health care costs, and overall burden. Historic data suggest that TE VPs have an average device life of generally 3 to 6 months, but these data are typically derived from small samples using only 1 or 2 devices. Objective: To reexamine current device life in a large, contemporary cancer hospital in the United States that uses a wide assortment of VPs...
September 29, 2016: JAMA Otolaryngology—Head & Neck Surgery
Beverley Balkau, Serge Halimi, Jean-Frédéric Blickle, Bruno Vergès, Antoine Avignon, Claude Attali, Isabelle Chartier, Elisabeth Amelineau
OBJECTIVES: To describe the management of glucose-lowering agents in people with type 2 diabetes initially on oral monotherapy, cared for by French general practitioners, and to identify reasons underlying treatment non-intensification. METHODS: People with type 2 diabetes on oral monotherapy were recruited by general practitioners and followed-up over 12 months. Patient characteristics, HbA1c, and glucose-lowering treatments were recorded electronically. Management objectives and reasons for treatment non-intensification were solicited from the general practitioners...
September 16, 2016: Annales D'endocrinologie
Yolanda V Martínez, Stephen M Campbell, Mark Hann, Peter Bower
OBJECTIVE: To evaluate the relative importance of selfmanagement (SM) and quality of care (QoC) inpredicting glycaemic control in patients with type 2 diabetes. MATERIALS AND METHODS: A longitudinal cohort study was conducted in 204 adults diagnosed with type 2 diabetes. Self-management and quality of care were measured at baseline. HbA1c was measured at baseline and at six-month follow-up. RESULTS: None of the measures of self-management were significantly associated with HbA1c...
August 2016: Salud Pública de México
Nella Bieszk, Shannon L Reynolds, Wenhui Wei, Cralen Davis, Pravin Kamble, Claudia Uribe
BACKGROUND: Clinical inertia, which has been defined as the recognition of a problem with a patient's management but failing to act, is a concern in type 2 diabetes (T2D) because it places the patient at risk of diabetes-related complications. Despite managed care organizations making significant investment in this area, little is known about the impact of educational programs aimed at aligning patients and their physicians with diabetes guidelines and thus overcoming clinical inertia...
September 2016: Journal of Managed Care & Specialty Pharmacy
Dionne E Smid, Martijn A Spruit, Sarah Houben-Wilke, Jean W M Muris, Gernot G U Rohde, Emiel F M Wouters, Frits M E Franssen
INTRODUCTION: Care for patients with chronic obstructive pulmonary disease (COPD) can be provided in primary, secondary or tertiary care. Whether and to what extent patients with COPD treated in various healthcare settings differ in disease burden and healthcare utilization remains unknown. Therefore, daily symptoms, functional mobility, mood status, health status and healthcare utilization were compared between COPD patients in various care settings, to explore possibilities for healthcare-optimization...
September 2016: Respiratory Medicine
Nella Bieszk, Shannon L Reynolds, Wenhui Wei, Cralen Davis, Pravin Kamble, Claudia Uribe
BACKGROUND: Clinical inertia, which has been defined as the recognition of a problem with a patient's management but failing to act, is a concern in type 2 diabetes (T2D) because it places the patient at risk of diabetes-related complications. Despite managed care organizations making significant investment in this area, little is known about the impact of educational programs aimed at aligning patients and their physicians with diabetes guidelines and thus overcoming clinical inertia...
September 2016: Journal of Managed Care & Specialty Pharmacy
Ian Clark, Amanda Thompson
This paper examines the labour process of Healthcare Assistants (HCAs) at a National Health Service (NHS) hospital trust (TUH) in the context of the NHS modernisation agenda. It determines whether application of the modernisation agenda is formalised at TUH and considers how HCAs are affected. The paper is based upon 60 interviews with HCAs, structured questionnaires completed by all interview respondents, observation of HCAs and interviews with non-clinical managers. The findings show that elements of the modernisation agenda are informally implemented at TUH to the detriment of HCAs...
November 2015: New Technol Work Employ
Astrid Lavens, Kris Doggen, Chantal Mathieu, Frank Nobels, Evy Vandemeulebroucke, Michel Vandenbroucke, Ann Verhaegen, Viviane Van Casteren
BACKGROUND: Assessment of quality of care using classical threshold measures (TM) is open to debate. Measures that take into account the clinician's actions and the longitudinal nature of chronic care are more reliable, although their major limitation is that they require more sophisticated electronic health records. We created a clinical action measure (CAM) for the control of LDL and non-HDL cholesterol from low-complexity data, and investigated how quality of care in individual diabetes centres based on the CAM is related to that based on the classical TM...
2016: BMC Health Services Research
Adriana De Palma, Michael Kuhlmann, Stuart P M Roberts, Simon G Potts, Luca Börger, Lawrence N Hudson, Igor Lysenko, Tim Newbold, Andy Purvis
Bees are a functionally important and economically valuable group, but are threatened by land-use conversion and intensification. Such pressures are not expected to affect all species identically; rather, they are likely to be mediated by the species' ecological traits.Understanding which types of species are most vulnerable under which land uses is an important step towards effective conservation planning.We collated occurrence and abundance data for 257 bee species at 1584 European sites from surveys reported in 30 published papers (70 056 records) and combined them with species-level ecological trait data...
December 2015: Journal of Applied Ecology
Mahmoud A O Dawood, Shunsuke Koshio, Manabu Ishikawa, Mabrouk El-Sabagh, M Angeles Esteban, Amr I Zaineldin
A usual strategy in modern aquaculture to combat production bottlenecks associated with intensification is preventive health care through the use of consumer and environment-friendly alternatives including probiotics. The current study evaluates the influence of Lactobacillus rhamnosus (LR), a lyophilized probiotic bacterium, on health status and performance of red sea bream (Pagrus major). Probiotics were incorporated in the diets at four different concentrations: 0 (control diet, LR0), 10(2) (LR1), 10(4) (LR2) and 10(6) (LR3) cells g(-1) and diets were administered to the fish for a period of 8 weeks...
October 2016: Fish & Shellfish Immunology
Rebecca C Rossom, Leif I Solberg, Emily D Parker, A Lauren Crain, Robin Whitebird, Michael Maciosek, Beth Molitor, Michael Trangle, Jürgen Unützer
BACKGROUND: Little is known about the reach and impact of collaborative care for depression outside of clinical trials. OBJECTIVE: The objective of this study was to examine the effect of a collaborative care intervention for depression on the rates of depression diagnosis, use of specific depression codes, and treatment intensification. RESEARCH DESIGN: Evaluation of a staggered, multiple baseline implementation initiative. SUBJECTS: Patients receiving depression care in primary care clinics throughout Minnesota from February 2008 through March 2011...
November 2016: Medical Care
Bruno Linetzky, Brad Curtis, Gustavo Frechtel, Renan Montenegro, Miguel Escalante Pulido, Oded Stempa, Janaina Martins de Lana, Juan José Gagliardino
BACKGROUND: Poor glycemic control in patients with type 2 diabetes is commonly recorded worldwide; Latin America (LA) is not an exception. Barriers to intensifying insulin therapy and which barriers are most likely to negatively impact outcomes are not completely known. The objective was to identify barriers to insulin progression in individuals with type 2 diabetes mellitus (T2DM) in LA countries (Mexico, Brazil, and Argentina). METHODS: MOSAIc is a multinational, non-interventional, prospective, observational study aiming to identify the patient-, physician-, and healthcare-based factors affecting insulin intensification...
2016: Diabetology & Metabolic Syndrome
Sudesna Chatterjee, Kamlesh Khunti, Melanie J Davies
The global epidemic of type 2 diabetes (T2DM) continues largely unabated due to an increasingly sedentary lifestyle and obesogenic environment. A cost-effective patient-centred approach, incorporating glucose-lowering therapy and modification of cardiovascular risk factors, could help prevent the inevitable development and progression of macrovascular and microvascular complications. Glycaemic optimization requires patient structured education, self-management and empowerment, and psychological support along with early and proactive use of glucose lowering therapies, which should be delivered in a system of care as shown by the Chronic Care Model...
June 2016: Best Practice & Research. Clinical Endocrinology & Metabolism
Pablo Bartolucci, Anoosha Habibi, Mehdi Khellaf, Françoise Roudot-Thoraval, Giovanna Melica, Anne-Sophie Lascaux, Stéphane Moutereau, Sylvain Loric, Orianne Wagner-Ballon, Jugurtha Berkenou, Aline Santin, Marc Michel, Bertrand Renaud, Yves Lévy, Frédéric Galactéros, Bertrand Godeau
BACKGROUND: Vaso-occlusive crisis (VOC), hallmark of sickle-cell disease (SCD), is the first cause of patients' Emergency-Room admissions and hospitalizations. Acute chest syndrome (ACS), a life-threatening complication, can occur during VOC, be fatal and prolong hospitalization. No predictive factor identifies VOC patients who will develop secondary ACS. METHODS: This prospective, monocenter, observational study on SS/S-β0thalassemia SCD adults aimed to identify parameters predicting ACS at Emergency-Department arrival...
August 2016: EBioMedicine
R W Coch, J B Green
AIMS: The increased risk of cardiovascular disease in patients with type 2 diabetes has been known for many years. However, until recently the cardiovascular (CV) impact of glucose lowering strategies has been inadequately understood. Major clinical trials have now investigated the impact of intensification of glycemic control upon CV outcomes, as well as the CV effects of glucose management with newer antihyperglycemic agents. DATA SYNTHESIS: Key findings from recently completed CV outcomes trials of dipeptidyl peptidase-4 (DPP4) inhibitors, GLP-1 receptor agonists, and sodium-glucose cotransporter 2 (SGLT2) inhibitors completed thus far are reviewed and summarized...
September 2016: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD
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