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https://www.readbyqxmd.com/read/28738685/assessing-the-effect-of-the-vha-pcmh-model-on-utilization-patterns-among-veterans-with-ptsd
#1
Ian Randall, Charles Maynard, Gary Chan, Beth Devine, Chris Johnson
OBJECTIVES: The Veterans Health Administration (VHA) implemented a patient-centered medical home (PCMH)-based Patient Aligned Care Teams (PACT) model in 2010. We examined its effects on the utilization of health services among US veterans with posttraumatic stress disorder (PTSD). STUDY DESIGN: We analyzed VHA clinical and administrative data to conduct an interrupted time series study. Encounter-level data were obtained for the period of April 1, 2005, through March 31, 2014...
May 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28736393/traditional-healers-faith-healers-and-medical-practitioners-the-contribution-of-medical-pluralism-to-bottlenecks-along-the-cascade-of-care-for-hiv-aids-in-eastern-and-southern-africa
#2
Mosa Moshabela, Dominic Bukenya, Gabriel Darong, Joyce Wamoyi, Estelle McLean, Morten Skovdal, William Ddaaki, Kenneth Ondeng'e, Oliver Bonnington, Janet Seeley, Victoria Hosegood, Alison Wringe
OBJECTIVES: There are concerns that medical pluralism may delay patients' progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with HIV (PLHIV) in African settings remain unclear. We sought to establish the manifestation of medical pluralism among PLHIV, and explore mechanisms through which medical pluralism contributes bottlenecks along the HIV care cascade. METHODS: We conducted a multicountry exploratory qualitative study in seven health and demographic surveillance sites in six eastern and southern African countries: Uganda, Kenya, Tanzania, Malawi, Zimbabwe and South Africa...
July 2017: Sexually Transmitted Infections
https://www.readbyqxmd.com/read/28736131/variation-in-organization-of-transient-ischemic-attack-care-in-the-netherlands-a-nationwide-survey-study
#3
Fenna Floortje Muller, Frank de Beer, Marieke Christine Visser
BACKGROUND: Previous research has shown the importance of urgent initiation of antiplatelet therapy after transient ischemic attack (TIA) to reduce the risk of stroke. Many hospitals in the Netherlands have therefore implemented rapid pathways for assessment of patients with TIA. Dutch stroke guidelines lack clear directives for organization of TIA assessment and thus allow for variation. The aim of this study was to investigate variation in organization of TIA assessment in Dutch hospitals...
July 20, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28729318/a-national-survey-of-russian-physicians-knowledge-of-diagnosis-and-management-of-food-induced-anaphylaxis
#4
Daniel Munblit, Marina Treneva, Ilya Korsunskiy, Alan Asmanov, Alexander Pampura, John O Warner
OBJECTIVES: Food allergy is an increasing burden worldwide and is a common problem within paediatric populations, affecting 5%-8% of children. Anaphylaxis caused by food proteins is a potentially life-threatening condition and all healthcare practitioners should be aware of its recognition and management. Russia is the largest country in Europe but it is still unknown whether physicians are prepared to diagnose and manage food-induced anaphylaxis effectively. We aimed to examine physicians' knowledge of diagnosis and management of food-induced anaphylaxis...
July 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28723709/delivering-prep-to-pregnant-and-breastfeeding-women-in-sub-saharan-africa-the-implementation-science-frontier
#5
Dvora L Joseph Davey, Linda-Gail Bekker, Pamina Gorbach, Thomas Coates, Landon Myer
: HIV acquisition during pregnancy and postpartum periods remains high despite increased access to and initiation of antiretroviral therapy in sub-Saharan Africa. Moreover, maternal seroconversion during pregnancy and breastfeeding remains a source of significant paediatric HIV infection in the region. In order to curb vertical HIV transmission, HIV acquisition during pregnancy and lactation must significantly decline. Biological and behavioural factors contribute to high HIV incidence, including hormonal changes that alter genital mucosal surfaces, and frequent condomless sex with HIV-infected partners or partners of unknown serostatus...
July 18, 2017: AIDS
https://www.readbyqxmd.com/read/28722561/the-quality-of-free-antenatal-and-delivery-services-in-northern-sierra-leone
#6
Manso M Koroma, Samuel S Kamara, Evelyn A Bangura, Mohamed A Kamara, Virgil Lokossou, Namoudou Keita
BACKGROUND: The number of maternal deaths in sub-Saharan Africa continues to be overwhelmingly high. In West Africa, Sierra Leone leads the list, with the highest maternal mortality ratio. In 2010, financial barriers were removed as an incentive for more women to use available antenatal, delivery and postnatal services. Few published studies have examined the quality of free antenatal services and access to emergency obstetric care in Sierra Leone. METHODS: A cross-sectional survey was conducted in 2014 in all 97 peripheral health facilities and three hospitals in Bombali District, Northern Region...
July 12, 2017: Health Research Policy and Systems
https://www.readbyqxmd.com/read/28717760/pilot-survey-of-breast-cancer-management-in-sub-saharan-africa
#7
Verna D N K Vanderpuye, Olufunmilayo I Olopade, Dezheng Huo
PURPOSE: To understand the current state of breast cancer management in sub-Saharan Africa. METHODS: We conducted an anonymous online survey of breast cancer management among African Organization for Research and Treatment in Cancer (AORTIC) members by using a 42-question structured questionnaire in both English and French in 2013. RESULTS: Twenty members from 19 facilities in 14 countries responded to the survey. Twelve members (60%) belonged to a multidisciplinary breast cancer team...
June 2017: Journal of Global Oncology
https://www.readbyqxmd.com/read/28714734/being-disconnected-from-life-meanings-of-existential-loneliness-as-narrated-by-frail-older-people
#8
Marina Sjöberg, Ingela Beck, Birgit H Rasmussen, Anna-Karin Edberg
OBJECTIVES: This study illuminated the meanings of existential loneliness (EL) as narrated by frail older people. METHOD: Data were collected through individual narrative interviews with 23 people 76-101 years old receiving long-term care and services. A phenomenological hermeneutical analysis was performed, including a naïve reading and two structural analyses as a basis for a comprehensive understanding of EL. RESULT: Four themes were identified related to meanings of EL: (1) being trapped in a frail and deteriorating body; (2) being met with indifference; (3) having nobody to share life with; and (4) lacking purpose and meaning...
July 17, 2017: Aging & Mental Health
https://www.readbyqxmd.com/read/28712122/clinical-features-and-treatment-response-of-cutaneous-leishmaniasis-in-north-west-ethiopia
#9
Helina Fikre, Rezika Mohammed, Saba Atinafu, Johan van Griensven, Ermias Diro
OBJECTIVE: Cutaneous leishmaniasis (CL) receives far less attention than visceral leishmaniasis. Nevertheless, CL is predominantly caused by a unique species in Ethiopia (L aethiopica), which is known to cause severe forms such as diffuse (DCL) and mucocutaneous leishmaniasis (MCL). We report on the number and type of CL cases diagnosed, the clinical features, the treatments and treatment outcomes in North-West Ethiopia. METHODS: This is a retrospective chart record analysis of CL patients treated at the Leishmania Research and Treatment Center (LRTC) of the University of Gondar, Ethiopia...
July 16, 2017: Tropical Medicine & International Health: TM & IH
https://www.readbyqxmd.com/read/28709391/gp-training-practices-in-england-a-description-of-their-unique-features-based-on-national-data
#10
Charlotte Weston, Sanjiv Ahluwalia, Paul Bassett, Justin Lock, Stevo Durbaba, Mark Ashworth
Postgraduate general practitioner (GP) training structures have been reorganised with the formation of Health Education England (HEE). We aimed to broaden the findings of previous studies and identify key features of GP training practices. In particular, we wanted to extend previous findings regarding QOF achievement and patient experience derived from the General Practice Patient Survey (GPPS), with recent data on the use of urgent cancer referral pathways ('Two Week Wait', or '2WW,' referrals) and secondary care utilisation by GP training Practices...
July 14, 2017: Education for Primary Care
https://www.readbyqxmd.com/read/28695351/robustness-and-effectiveness-of-the-triage-system-in-the-pediatric-context
#11
Marcello Montefiori, Enrico di Bella, Lucia Leporatti, Paolo Petralia
BACKGROUND: The increasing use of emergency departments (EDs) potentially compromises their effectiveness and quality. The evaluation of the performance of the triage code system in a pediatric context is important because waiting time affects the quality of care for acutely ill patients. OBJECTIVE: In this study, we aimed to assess the effectiveness and robustness of the triage code system in a pediatric context and identify the determinants of waiting times for urgent and non-urgent patients...
July 10, 2017: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/28694308/association-of-delay-of-urgent-or-emergency-surgery-with-mortality-and-use-of-health-care-resources-a-propensity-score-matched-observational-cohort-study
#12
Daniel I McIsaac, Karim Abdulla, Homer Yang, Sudhir Sundaresan, Paula Doering, Sandeep Green Vaswani, Kednapa Thavorn, Alan J Forster
BACKGROUND: Delay of surgery for hip fracture is associated with increased risk of morbidity and mortality, but the effects of surgical delays on mortality and resource use in the context of other emergency surgeries is poorly described. Our objective was to measure the independent association between delay of emergency surgery and in-hospital mortality, length of stay and costs. METHODS: We identified all adult patients who underwent emergency noncardiac surgery between January 2012 and October 2014 at a single tertiary care centre...
July 10, 2017: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/28691331/scaling-up-proven-innovative-cervical-cancer-screening-strategies-challenges-and-opportunities-in-implementation-at-the-population-level-in-low-and-lower-middle-income-countries
#13
Francesca Holme, Sharon Kapambwe, Ashrafun Nessa, Partha Basu, Raul Murillo, Jose Jeronimo
The problem of cervical cancer in low- and lower-middle-income countries (LLMICs) is both urgent and important, and calls for governments to move beyond pilot testing to population-based screening approaches as quickly as possible. Experiences from Zambia, Bangladesh, Guatemala, Honduras, and Nicaragua, where scale-up of evidence-based screening strategies is taking place, may help other countries plan for large-scale implementation. These countries selected screening modalities recommended by the WHO that are within budgetary constraints, improve access for women, and reduce health system bottlenecks...
July 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/28684438/five-year-follow-up-after-transcatheter-aortic-valve-implantation-for-symptomatic-aortic-stenosis
#14
Ralf Zahn, Nicolas Werner, Ulrich Gerckens, Axel Linke, Horst Sievert, Philipp Kahlert, Rainer Hambrecht, Stefan Sack, Mohamed Abdel-Wahab, Ellen Hoffmann, Uwe Zeymer, Steffen Schneider
OBJECTIVES: Transcatheter aortic valve implantation (TAVI) has been implemented into the care of elderly patients suffering from severe symptomatic aortic stenosis. However, data on long-term follow-up are sparse and predictors of long-term mortality need to be evaluated to better select patients. Therefore, we aimed to analyse predictors of 5-year mortality after TAVI. METHODS: We analysed data from the German Transcatheter Aortic Valve Interventions-Registry. Each of the 27 participating hospitals agreed to include all consecutive TAVI patients at their institution...
July 6, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28670119/improved-lfias-for-highly-sensitive-detection-of-bnp-at-point-of-care
#15
Yan Gong, Jie Hu, Jane Ru Choi, Minli You, Yamin Zheng, Bo Xu, Ting Wen, Feng Xu
Heart failure (HF) has become a major cause of morbidity and mortality with a significant global economic burden. Although well-established clinical tests could provide early diagnosis, access to these tests is limited in developing countries, where a relatively higher incidence of HF is present. This has prompted an urgent need for developing a cost-effective, rapid and robust diagnostic tool for point-of-care (POC) detection of HF. Lateral flow immunoassay (LFIA) has found widespread applications in POC diagnostics...
2017: International Journal of Nanomedicine
https://www.readbyqxmd.com/read/28668199/chronic-respiratory-failure-utilization-of-a-pediatric-specialty-integrated-care-program
#16
Robert J Graham, Michael L McManus, Angie Mae Rodday, Ruth Ann Weidner, Susan K Parsons
OBJECTIVE: Describe utilization and satisfaction in a specialty integrated care program for children with severe, chronic respiratory insufficiency (CRI). SUBJECTS: Enrollees of the Critical Care, Anesthesia, Perioperative Extension (CAPE) and Home Ventilation Program. METHODS: Children with CRI received home visits, care coordination, and "on-demand" 24/7 access to physicians. Program activity and outcomes were recorded for 3 years using an adapted Care Coordination Measurement Tool© version...
March 2017: Healthcare
https://www.readbyqxmd.com/read/28666445/challenges-for-gatekeeping-a-qualitative-systems-analysis-of-a-pilot-in-rural-china
#17
Jin Xu, Anne Mills
BACKGROUND: Gatekeeping involves a generalist doctor who controls patients' access to specialist care, and has been discussed as an important policy option to rebalance the primary care and hospital sectors in low- and middle-income countries, despite thin evidence. A gatekeeping pilot in a Chinese rural setting launched in 2013 has offered an opportunity to study the functioning of gatekeeping under such conditions. METHODS: In this qualitative study within a mixed-method evaluation of the gatekeeping pilot, we developed an innovative systems analysis method, combining the World Health Organisation categorisation of health system building blocks, the "Framework" approach of policy analysis and causal loop analysis...
July 1, 2017: International Journal for Equity in Health
https://www.readbyqxmd.com/read/28647725/percutaneous-coronary-intervention-patients-and-cardiologists-experiences-of-the-informed-consent-process-in-northern-england-a-qualitative-study
#18
Joy Probyn, Joanne Greenhalgh, Janet Holt, Dwayne Conway, Felicity Astin
OBJECTIVE: Informed consent is central to ethical medical practice, but little is known about how the process takes place in clinical practice. Percutaneous coronary intervention (PCI) is a common revascularisation procedure. Studies report that patients overestimate benefits, forget the risks and are unaware of alternative treatments. The aim of this study was to describe PCI patients' and cardiologists' experiences of the informed consent process in acute care settings. DESIGN/SETTING/PARTICIPANTS: A qualitative study with a maximum variation sample of elective and acute PCI patients and cardiologists taking their consent, recruited from a district general hospital and tertiary centre...
June 24, 2017: BMJ Open
https://www.readbyqxmd.com/read/28646952/drug-resistant-tuberculosis-primary-transmission-and-management
#19
Alexander C Outhred, Philip N Britton, Ben J Marais
The DOTS strategy assisted global tuberculosis (TB) control, but was unable to prevent the emergence and spread of drug-resistant strains. Genomic evidence confirms the transmission of drug-resistant Mycobacterium tuberculosis strains in many different settings, indicative of epidemic spread. These findings emphasise the need for enhanced infection control measures in health care and congregate settings. Young children in TB endemic areas are particularly vulnerable. Although advances in TB drug and vaccine development are urgently needed, improved access to currently available preventive therapy and treatment for drug resistant TB could reduce the disease burden and adverse outcomes experienced by children...
June 2017: Journal of Infection
https://www.readbyqxmd.com/read/28646907/dimensions-of-social-capital-of-families-with-thalassemia-in-an-indigenous-population-in-tamil-nadu-india-a-qualitative-study
#20
Bharathi Palanisamy, Kalpana Kosalram, Vijayaprasad Gopichandran
BACKGROUND: Studies have shown that social capital is positively associated with health, and the association is context-based. Indigenous populations with poor access to health care largely depend on social capital for their health care needs. This study was conducted to explore the dimensions and types of social capital and its utilization by families with thalassemia for their health and well-being in an indigenous population in Tamil Nadu, India. METHODS: The participants in the study were parents who had children with thalassemia, belonged to an indigenous community in Tamil Nadu, were poor and marginalized, and had poor access to health care...
June 24, 2017: International Journal for Equity in Health
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