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Integrated Care

Sanaa Al Najjar, Tamer Al Shaer
BACKGROUND: To meet the emerging needs of the increasing numbers of patients with non-communicable diseases and to provide optimum care with optimum contact time and minimum waiting time, as stated in UNRWA guidelines, the mobile phone text messaging system was implemented in UNRWA centres to remind patients of upcoming appointments and to thereby improve the quality of care for vulnerable patients and regulate the work load in the clinics for non-communicable diseases. The aim of this study was to assess the causes for lack of adherence to the appointment system at UNRWA centres...
February 21, 2018: Lancet
Marwan Diab, Yasser Abu Jamei, Ashraf Kagee, Guido Veronese
BACKGROUND: In the context of violations of human rights and insecurity, the Gaza Community Mental Health Programme (GCMHP) provides mental health services and psychosocial interventions that match local cultural and social norms. The GCMHP uses a community mental health approach to promote the psychological wellbeing of the people living in the Gaza Strip and advocate on mental health issues. METHODS: The GCMHP provides preventive and therapeutic care to a broad public health spectrum of Gazan society...
February 21, 2018: Lancet
Majed Hababeh, Wafaa Zeidan, Mariam Abdel El-Kader, Anwar Al Thaher, Nimer Kassim, Elias Habash, Hasan Arab, Ali Khader, Akihiro Seita
BACKGROUND: UNRWA introduced family planning services in 1994 as an integral part of its expanded maternal and child health-care programme. The main objective of UNRWA's family planning programme is to promote the health of mothers, children, and their families. The aim of this follow-up study was to assess contraceptive practices in the target population 5 years after the 2010 follow-up study and to identify future programme needs. METHODS: This cross-sectional survey was a done by trained nurses from June 1 to Dec 31, 2015...
February 21, 2018: Lancet
Amir S Steinberg, Anish B Parikh, Sara Kim, Damaris Peralta-Hernandez, Talaat Aggour, Luis Isola
OBJECTIVES: Antibiotic stewardship is an integral aspect of hospital care, limiting the potential for resistance while working to minimize waste. A similar system is needed in oncology, given the rapid proliferation of new therapies and the challenges of navigating a complicated reimbursement environment. A "cancer therapy stewardship program" has never been described in the literature. Here, we detail our efforts to design and implement such a program and share lessons learned to inform future projects...
March 2018: American Journal of Managed Care
Marc J Weigensberg, Cheryl Vigen, Paola Sequeira, Donna Spruijt-Metz, Magaly Juarez, Daniella Florindez, Joseph Provisor, Anne Peters, Elizabeth A Pyatak
Background: The transition of young adults with type 1 diabetes (T1D) from pediatric to adult care is challenging and frequently accompanied by worsening of diabetes-related health. To date, there are no reports which prospectively assess the effects of theory-based psycho-behavioral interventions during the transition period neither on glycemic control nor on psychosocial factors that contribute to poor glycemic control. Therefore, the overall aim of this study was to develop and pilot test an integrative group intervention based on the underlying principles of self-determination theory (SDT), in young adults with T1D...
2018: Global Advances in Health and Medicine: Improving Healthcare Outcomes Worldwide
Miya Narushima, Jian Liu, Naomi Diestelkamp
The Active Ageing Framework has been adapted as a global strategy in ageing policies, practices and research over the last decade. Lifelong learning, however, has not been fully integrated into this discourse. Using survey data provided by 416 adults (aged 60 years and above) enrolled in non-formal general-interest courses in a public continuing education programme in Canada, this study examined the association between older adults' duration of participation in the courses and their level of psychological wellbeing, while taking their age, gender, self-rated health and vulnerability level into consideration...
April 2018: Ageing and Society
Elizabeth C Briere, Tracy Pondo, Mark Schmidt, Tami Skoff, Nong Shang, Alison Naleway, Stacey Martin, Michael L Jackson
PURPOSE: Despite high national vaccination coverage with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines among U.S. adolescents, rates of adolescent pertussis disease are increasing. We estimated the duration of protection after Tdap vaccination and the possible effects of the change from whole-cell to acellular childhood pertussis vaccines in the United States during the 1990s. METHODS: We conducted a retrospective cohort analysis among 11- to 18-year-olds enrolled in two integrated health-care delivery systems during 2005-2012...
March 15, 2018: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
Maxime Mallet, Nicolas Weiss, Dominique Thabut, Marika Rudler
Hyperammonemia plays a key role in the pathophysiology of hepatic encephalopathy (HE) and most HE treatments are ammonia-lowering drugs. However, the usefulness of measuring ammonemia in routine practice remains controversial and not recommended systematically even when neurological symptoms are present. First, ammonemia measurement should be carefully performed in order to avoid a falsely elevated result. When performed, a normal ammonemia in a cirrhotic patient with neurological symptoms should lead to reconsider the diagnosis of HE...
March 15, 2018: Clinics and Research in Hepatology and Gastroenterology
Kimberly Joseph, Sameer Gupta, James Yon, Renee Partida, Lee Cartagena, John Kubasiak, Vanessa Buie, Jared Miller, Dorion Wiley, Kimberly Nagy, Frederic Starr, Andrew Dennis, Matthew Kaminsky, Faran Bokhari
BACKGROUND: Checklists have been advocated to improve quality outcomes/communication in the critical care setting, but results have been mixed. A new checklist process, "TRAUMA LIFE", was implemented in our Trauma Intensive Care Unit (TICU) to replace prior checklists. The purpose of this study was to evaluate the impact of the "TRAUMA LIFE" process implementation on quality metrics and on patient/family communication in the TICU. METHODS: "TRAUMA LIFE" was considered maturely implemented by 2016...
March 9, 2018: American Journal of Surgery
Minjung Park, Jennifer Hunter, Soonman Kwon
High demand for traditional Korean medicine led to a policy change in 2010 allowing hospitals to provide Integrative medicine care that combines Western medicine and Korean medicine. This study evaluated the effects of Integrative medicine compared to Western medicine-only for managing acute stroke in South Korean hospitals. A retrospective matched case-control observational study was conducted for acute stroke patients admitted nationwide in 2012 and 2013. Propensity score matching was used to adjust for the likelihood of selecting Integrative medicine...
March 6, 2018: Health Policy
Kunal Bailoor, Leslie H Kamil, Ed Goldman, Laura M Napiewocki, Denise Winiarski, Christian J Vercler, Andrew G Shuman
Advance care planning allows patients to articulate preferences for their medical treatment, lifestyle, and surrogate decision-makers in order to anticipate and mitigate their potential loss of decision-making capacity. Written advance directives are often emphasized in this regard. While these directives contain important information, there are several barriers to consider: veracity and accuracy of surrogate decision-makers in making choices consistent with the substituted judgement standard, state-to-state variability in regulations, literacy issues, lack of access to legal resources, lack of understanding of medical options, and cultural disparities...
March 17, 2018: Journal of Bioethical Inquiry
David Guwatudde, Pilvikki Absetz, Peter Delobelle, Claes-Göran Östenson, Josefien Olmen Van, Helle Molsted Alvesson, Roy William Mayega, Elizabeth Ekirapa Kiracho, Juliet Kiguli, Carl Johan Sundberg, David Sanders, Göran Tomson, Thandi Puoane, Stefan Peterson, Meena Daivadanam
INTRODUCTION: Type 2 diabetes (T2D) is increasingly contributing to the global burden of disease. Health systems in most parts of the world are struggling to diagnose and manage T2D, especially in low-income and middle-income countries, and among disadvantaged populations in high-income countries. The aim of this study is to determine the added benefit of community interventions onto health facility interventions, towards glycaemic control among persons with diabetes, and towards reduction in plasma glucose among persons with prediabetes...
March 17, 2018: BMJ Open
Karteek Kadimisetty, Jinzhao Song, Aoife M Doto, Young Hwang, Jing Peng, Michael G Mauk, Frederic D Bushman, Robert Gross, Joseph N Jarvis, Changchun Liu
Molecular diagnostics that involve nucleic acid amplification tests (NAATs) are crucial for prevention and treatment of infectious diseases. In this study, we developed a simple, inexpensive, disposable, fully 3D printed microfluidic reactor array that is capable of carrying out extraction, concentration and isothermal amplification of nucleic acids in variety of body fluids. The method allows rapid molecular diagnostic tests for infectious diseases at point of care. A simple leak-proof polymerization strategy was developed to integrate flow-through nucleic acid isolation membranes into microfluidic devices, yielding a multifunctional diagnostic platform...
March 10, 2018: Biosensors & Bioelectronics
Amer M Johri, Joshua Durbin, Joseph Newbigging, Robert Tanzola, Ryan Chow, Sabe De, James Tam
The development of small, user friendly, handheld ultrasound devices has stimulated the growth of cardiac point-of-care ultrasound (POCUS) for the purpose of rapid, bedside cardiac assessment. Medical schools have begun integrating cardiac POCUS into their curricula. In this review the authors summarize the variable approaches taken by several medical training programs with respect to duration of POCUS training, prerequisite knowledge, and methods of delivering these skills (including e-learning, hands-on training, and simulation)...
March 14, 2018: Journal of the American Society of Echocardiography
J Hansen, L Zhang, A Eaton, R Baxter, C A Robertson, M D Decker, D P Greenberg, E Bassily, N P Klein
BACKGROUND: Menactra® vaccine (MenACWY-D) was licensed in the United States in 2005 for persons 11-55 years of age, in 2007 for children 2-10 years of age, and in 2011 for infants/toddlers 9-23 months of age. We conducted two studies at Kaiser Permanente Northern California (KPNC), an integrated health care organization, to assess the safety of MenACWY-D in 2-10-year-olds and 9-23-month-olds receiving the vaccine during routine clinical care. METHODS: We conducted observational, retrospective studies of MenACWY-D in 2-10-year-olds (October 2007-October 2010) and in 9-23-month-olds (June 2011-June 2014)...
March 14, 2018: Vaccine
Gabriele Gäbler, Michaela Coenen, Deborah Lycett, Tanja Stamm
BACKGROUND: High quality, continuity and safe interdisciplinary healthcare is essential. Nutrition and dietetics plays an important part within the interdisciplinary team in many health conditions. In order to work more effectively as an interdisciplinary team, a common terminology is needed. This study investigates which categories of the ICF-Dietetics are used in clinical dietetic care records in Austria and which are most relevant to shared language in different medical areas. METHOD: A national multicenter retrospective study was conducted to collect clinical dietetic care documentation reports...
March 3, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Shahin Sayed, William Cherniak, Mark Lawler, Soo Yong Tan, Wafaa El Sadr, Nicholas Wolf, Shannon Silkensen, Nathan Brand, Lai Meng Looi, Sanjay A Pai, Michael L Wilson, Danny Milner, John Flanigan, Kenneth A Fleming
Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs)...
March 14, 2018: Lancet
Rosechelle M Ruggiero
The entity of chronic critical illness (CCI) has shown a rise in the past decades for popularity and prevalence. CCI is loosely defined as the group of patients who require the intensive care setting for weeks to months; its hallmark is prolonged mechanical ventilation. The outcomes of chronically critically ill patients have been dismal and have not improved over time; 1-year survival hovers at approximately 50%. Given the high mortality, prognostic variables are important when making medical decisions. CCI encompasses a syndrome that includes altered pathophysiology across a variety of organ systems...
March 2018: American Journal of the Medical Sciences
Suad Sivić, Larisa Gavran, Salih Tandir, Elvir Peštalić
Aim To determine most common factors making patients with high blood pressure seek professionally unacceptable treatment of hypertension at the Emergency Department. Methods The survey was conducted at the Emergency Department of the Primary Health Care in Gradačac on randomly selected 207 patients who requested medical help because of high blood pressure. For all patients arterial blood pressure and body mass index (BMI) were measured. A survey about knowledge and attitudes regarding habits that affect high blood pressure as well as the socio-economic conditions was made...
February 1, 2018: Medicinski Glasnik
Anita D Misra-Hebert, Kevin M Pantalone, Xinge Ji, Alex Milinovich, Tanujit Dey, Kevin M Chagin, Janine M Bauman, Michael W Kattan, Robert S Zimmerman
OBJECTIVE: To identify severe hypoglycemia events, defined as emergency department visits or hospitalizations for hypoglycemia, in patients with type 2 diabetes receiving care in a large health system and to identify patient characteristics associated with severe hypoglycemia events. RESEARCH DESIGN AND METHODS: This was a retrospective cohort study from January 2006 to December 2015 using the electronic medical record in the Cleveland Clinic Health System (CCHS)...
March 16, 2018: Diabetes Care
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