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https://www.readbyqxmd.com/read/29347991/the-benefits-and-tolerance-of-exercise-in-myasthenia-gravis-mgex-study-protocol-for-a-randomised-controlled-trial
#1
Simone Birnbaum, Jean-Yves Hogrel, Raphael Porcher, Pierre Portero, Bernard Clair, Bruno Eymard, Sophie Demeret, Guillaume Bassez, Marcela Gargiulo, Estelle Louët, Sonia Berrih-Aknin, Asmaa Jobic, Philippe Aegerter, Philippe Thoumie, Tarek Sharshar
BACKGROUND: Research exploring the effects of physical exercise in auto-immune myasthenia gravis (MG) is scarce. The few existing studies present methodological shortcomings limiting the conclusions and generalisability of results. It is hypothesised that exercise could have positive physical, psychological as well as immunomodulatory effects and may be a beneficial addition to current pharmacological management of this chronic disease. The aim of this study is to evaluate the benefits on perceived quality of life (QOL) and physical fitness of a home-based physical exercise program compared to usual care, for patients with stabilised, generalised auto-immune MG...
January 18, 2018: Trials
https://www.readbyqxmd.com/read/29340166/withdrawal-of-antihypertensive-therapy-in-people-with-dementia-feasibility-study
#2
Veronika van der Wardt, Jennifer K Burton, Simon Conroy, Tomas Welsh, Pip Logan, Jaspal Taggar, Lukasz Tanajewski, John Gladman
Background: This study explored the feasibility of a randomised controlled withdrawal trial of antihypertensive medication in normotensive people with dementia. Feasibility aspects included response, recruitment, exclusion and drop-out rates, suitability of outcome measures, acceptability of study procedures and an indicative economic evaluation for a randomised controlled trial. Methods: A cohort study attempting the withdrawal of antihypertensive drugs where appropriate and a feasibility study of home-based blood pressure monitoring, in people with dementia treated for hypertension, was undertaken...
2018: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/29339012/patient-rated-access-to-needed-care-patient-centered-medical-home-principles-intertwined
#3
Julian Brunner, Emmeline Chuang, Donna L Washington, Danielle E Rose, Catherine Chanfreau-Coffinier, Jill E Darling, Ismelda A Canelo, Elizabeth M Yano
BACKGROUND: Primary care teams can facilitate access to care by helping patients to determine whether and when care is needed, and coordinating care across multiple clinicians and settings. Appointment availability metrics may or may not capture these contributions, but patients' own ratings of their access to care provide an important alternative view of access that may be more closely related to these key functions of care teams. PROCEDURES: We used a 2015 telephone survey of 1,395 women veterans to examine associations between key care team functions and patient-rated access to needed care...
January 12, 2018: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/29336905/getting-a-good-night-sleep-the-importance-of-recognizing-and-treating-nocturnal-hypokinesia-in-parkinson-s-disease
#4
REVIEW
Roongroj Bhidayasiri, Claudia Trenkwalder
When Parkinson's disease (PD) patients are asked about the quality of their sleep, their answers are dominated by difficulties associated with impaired mobility in bed, medically referred to as nocturnal hypokinesia. Nocturnal hypokinesia is symptomatic from the mid-stage of the disease, affecting up to 70% of PD patients, and contributes to poor sleep quality, and increased carer burden. Here we explore four areas of nocturnal hypokinesia that are relevant to clinical practice, namely: manifestations and definition; clinical assessment and objective monitoring; etiologies and contributing factors; and evidence-based therapeutic approaches...
January 5, 2018: Parkinsonism & related Disorders
https://www.readbyqxmd.com/read/29330643/antihypertensive-medication-and-dementia-risk-in-older-adult-african-americans-with-hypertension-a-prospective-cohort-study
#5
Michael D Murray, Hugh C Hendrie, Kathleen A Lane, Mengjie Zheng, Roberta Ambuehl, Shanshan Li, Frederick W Unverzagt, Christopher M Callahan, Sujuan Gao
BACKGROUND: African Americans are especially at risk of hypertension and dementia. Antihypertensive medications reduce the risk of cardiovascular events, but may also reduce the risk of dementia. OBJECTIVE: To assess the longitudinal effects of antihypertensive medications and blood pressure on the onset of incident dementia in a cohort of African Americans. DESIGN: Prospective cohort. PARTICIPANTS: 1236 community-dwelling patients from an inner-city public health care system, aged 65 years and older, with a history of hypertension but no history of dementia, and who had at least three primary care visits and a prescription filled for any medication...
January 12, 2018: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/29330243/task-delegation-and-burnout-trade-offs-among-primary-care-providers-and-nurses-in-veterans-affairs-patient-aligned-care-teams-va-pacts
#6
Samuel T Edwards, Christian D Helfrich, David Grembowski, Elizabeth Hulen, Walter L Clinton, Gordon B Wood, Linda Kim, Danielle E Rose, Greg Stewart
PURPOSE: Appropriate delegation of clinical tasks from primary care providers (PCPs) to other team members may reduce employee burnout in primary care. However, (1) the extent to which delegation occurs within multidisciplinary teams, (2) factors associated with greater delegation, and (3) whether delegation is associated with burnout are all unknown. METHODS: We performed a national cross-sectional survey of Veterans Affairs (VA) PCP-nurse dyads in Department of VA primary care clinics, 4 years into the VA's patient-centered medical home initiative...
January 2018: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29330238/changing-patterns-of-mental-health-care-use-the-role-of-integrated-mental-health-services-in-veteran-affairs-primary-care
#7
Lucinda B Leung, Jean Yoon, Lisa V Rubenstein, Edward P Post, Maureen E Metzger, Kenneth B Wells, Catherine A Sugar, José J Escarce
OBJECTIVE: Aiming to foster timely, high-quality mental health care for Veterans, VA's Primary Care-Mental Health Integration (PC-MHI) embeds mental health specialists in primary care and promotes care management for depression. PC-MHI and patient-centered medical home providers work together to provide the bulk of mental health care for primary care patients with low-to-moderate-complexity mental health conditions. This study examines whether increasing primary care clinic engagement in PC-MHI services is associated with changes in patient health care utilization and costs...
January 2018: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29330235/primary-care-physician-perspectives-about-antipsychotics-and-other-medications-for-symptoms-of-dementia
#8
J William Kerns, Jonathan D Winter, Katherine M Winter, Terry Boyd, Rebecca S Etz
BACKGROUND: Guidelines, policies, and warnings have been applied to reduce the use of medications for behavioral and psychological symptoms of dementia (BPSD). Because of rare dangerous side effects, antipsychotics have been singled out in these efforts. However, antipsychotics are still prescribed "off label" to hundreds of thousands of seniors residing in nursing homes and communities. Our objective was to evaluate how and why primary-care physicians (PCPs) employ nonpharmacologic strategies and drugs for BPSD...
January 2018: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29326333/comet-a-multicomponent-home-based-disease-management-programme-versus-routine-care-in-severe-copd
#9
Romain Kessler, Pere Casan-Clara, Dieter Koehler, Silvia Tognella, Jose Luis Viejo, Roberto W Dal Negro, Salvador Díaz-Lobato, Karina Reissig, José Miguel Rodríguez González-Moro, Gilles Devouassoux, Jean-Michel Chavaillon, Pierre Botrus, Jean-Michel Arnal, Julio Ancochea, Anne Bergeron-Lafaurie, Carlos De Abajo, Winfried J Randerath, Andreas Bastian, Christian G Cornelissen, Georg Nilius, Joëlle B Texereau, Jean Bourbeau
The COPD Patient Management European Trial (COMET) investigated the efficacy and safety of a home-based COPD disease management intervention for severe COPD patients.The study was an international open-design clinical trial in COPD patients (forced expiratory volume in 1 s <50% of predicted value) randomised 1:1 to the disease management intervention or to the usual management practices at the study centre. The disease management intervention included a self-management programme, home telemonitoring, care coordination and medical management...
January 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/29322475/the-scope-of-drug-related-problems-in-the-home-care-setting
#10
REVIEW
Carla Meyer-Massetti, Christoph R Meier, B Joseph Guglielmo
Introduction While drug-related problems (DRPs) in the inpatient setting are well known, the scope of these problems in home care has not been critically evaluated. Aim of the Review Our primary objective was to evaluate the incidence and demographics of DRPs in home care. Our specific aims were to characterize the rate of potentially inappropriate medications (PIMs), medication errors (MEs) and adverse drug events (ADEs) and to identify risk factors which contribute to DRPs in the home care setting. Methods Pubmed, Embase and CiNAHL databases were systematically searched from January 2000 to December 2016 for all publications which quantitatively characterized DRPs in the home care setting...
January 11, 2018: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/29317154/mobile-integrated-health-to-reduce-post-discharge-acute-care-visits-a-pilot-study
#11
Jennica Siddle, Peter S Pang, Christopher Weaver, Elizabeth Weinstein, Daniel O'Donnell, Thomas P Arkins, Charles Miramonti
BACKGROUND: Mobile Integrated Health (MIH) leverages specially trained paramedics outside of emergency response to bridge gaps in local health care delivery. STUDY OBJECTIVE: To evaluate the efficacy of a MIH led transitional care strategy to reduce acute care utilization. METHODS: This was a retrospective cohort analysis of a quality improvement pilot of patient patients from an urban, single county EMS, MIH transitional care initiative. We utilized a paramedic/social worker (or social care coordinator) dyad to provide in home assessments, medication review, care coordination, and improve access to care...
December 29, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29311178/using-state-administrative-data-to-identify-social-complexity-risk-factors-for-children
#12
Kimberly C Arthur, Barbara A Lucenko, Irina V Sharkova, Jingping Xing, Rita Mangione-Smith
PURPOSE: Screening for social determinants of health is challenging but critically important for optimizing child health outcomes. We aimed to test the feasibility of using an integrated state agency administrative database to identify social complexity risk factors and examined their relationship to emergency department (ED) use. METHODS: We conducted a retrospective cohort study among children younger than 18 years with Washington State Medicaid insurance coverage (N = 505,367)...
January 2018: Annals of Family Medicine
https://www.readbyqxmd.com/read/29310605/a-randomized-controlled-trial-of-a-skills-training-for-oncologists-and-a-communication-aid-for-patients-to-stimulate-shared-decision-making-about-palliative-systemic-treatment-choice-study-protocol
#13
I Henselmans, E M A Smets, J C J M de Haes, M G W Dijkgraaf, F Y de Vos, H W M van Laarhoven
BACKGROUND: Systemic treatment for advanced cancer offers uncertain and sometimes little benefit while the burden can be high. Hence, treatment decisions require Shared Decision Making (SDM). The CHOICE trial examines the separate and combined effect of oncologist training and a patient communication aid on SDM in consultations about palliative systemic treatment. METHODS: A RCT design with four parallel arms will be adopted. Patients with metastatic or irresectable cancer with a median life expectancy <12 months who meet with a medical oncologist to discuss the start or continuation of palliative systemic treatment are eligible...
January 8, 2018: BMC Cancer
https://www.readbyqxmd.com/read/29304742/key-attributes-of-patient-centered-medical-homes-associated-with-patient-activation-of-diabetes-patients
#14
Lori A Bilello, Allyson Hall, Jeffrey Harman, Christopher Scuderi, Nipa Shah, Jon C Mills, Shenae Samuels
BACKGROUND: Approximately 24 million Americans are living with diabetes. Patient activation among individuals with diabetes is critical to successful diabetes management. The Patient Centered Medical Home (PCMH) model holds promise for increasing patient activation in managing their health. However, what is not well understood is the extent to which individual components of the PCMH model, such as the quality of physician-patient interactions and organizational features of care, contribute to patient activation...
January 5, 2018: BMC Family Practice
https://www.readbyqxmd.com/read/29299003/impact-of-pharmacists-in-a-community-based-home-care-service-a-pilot-program
#15
Ashley N Walus, Donna M M Woloschuk
Background: Historically, pharmacists have not been included on home care teams, despite the fact that home care patients frequently experience medication errors. Literature describing Canadian models of pharmacy practice in home care settings is limited. The optimal service delivery model and distribution of clinical activities for home care pharmacists remain unclear. Objectives: The primary objective was to describe the impact of a pharmacist based at a community home care office and providing home visits, group education, and telephone consultations...
November 2017: Canadian Journal of Hospital Pharmacy
https://www.readbyqxmd.com/read/29298664/the-prevention-of-delirium-in-elderly-with-obstructive-sleep-apnea-podesa-study-protocol-for-a-multi-centre-prospective-randomized-controlled-trial
#16
Jean Wong, David Lam, Stephen Choi, Mandeep Singh, Naveed Siddiqui, Sanjeev Sockalingam, Frances Chung
BACKGROUND: Delirium is a common problem that occurs in 5-50% of elderly individuals following surgery. Patients who develop delirium after surgery are at increased risk for serious complications. Recent studies suggest that patients with obstructive sleep apnea (OSA), a sleep disorder characterized by repeated episodes of complete or partial blockage of the upper airway - are at greater risk to develop delirium. OSA is more common in elderly individuals but is often undiagnosed. Identification and treatment of unrecognized OSA may reduce the incidence of postoperative delirium...
January 3, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29296050/the-hospice-information-system-and-its-association-with-the-congruence-between-the-preferred-and-actual-place-of-death
#17
Huang-Ren Lin, Jen-Hung Wang, Jyh-Gang Hsieh, Ying-Wei Wang, Sheng-Lun Kao
Objective: A Hospice Information System (HIS) developed in eastern Taiwan in 2012 aimed to improve the quality of hospice care through an integrated system that provided telemetry-based vital sign records, online 24/7 consultations, online video interviews, and online health educations. The purpose of this study was to explore the congruence between the preferred and actual place of death (POD) among patients who received HIS services. Materials and Methods: A retrospective study was performed from January 2012 to August 2016...
October 2017: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
https://www.readbyqxmd.com/read/29295829/medication-therapy-management-after-hospitalization-in-ckd-a-randomized-clinical-trial
#18
Katherine R Tuttle, Radica Z Alicic, Robert A Short, Joshua J Neumiller, Brian J Gates, Kenn B Daratha, Celestina Barbosa-Leiker, Sterling M McPherson, Naomi S Chaytor, Brad P Dieter, Stephen M Setter, Cynthia F Corbett
BACKGROUND AND OBJECTIVES: CKD is characterized by remarkably high hospitalization and readmission rates. Our study aim was to test a medication therapy management intervention to reduce subsequent acute care utilization. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The CKD Medication Intervention Trial was a single-blind (investigators), randomized clinical trial conducted at Providence Health Care in Spokane, Washington. Patients with CKD stages 3-5 not treated by dialysis who were hospitalized for acute illness were recruited...
January 2, 2018: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29287880/revisits-after-pediatric-tracheotomy-airway-concerns-result-in-returns
#19
Sophie Shay, Nina L Shapiro, Neil Bhattacharyya
OBJECTIVES: Children undergoing tracheotomy represent a medically vulnerable patient population, and understanding the reasons for revisiting the hospital setting following tracheotomy is critical for improving the quality of care for these patients. This study aims to investigate the incidence and characteristics of revisits following pediatric tracheotomy. METHODS: Cross-sectional, population-based study using state databases. The State Inpatient Databases and State Emergency Department Databases for California, Florida, Iowa and New York 2010-11 were linked and examined for cases of pediatric tracheotomy (patients < 18...
January 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29284521/exercise-intervention-for-unilateral-amputees-with-low-back-pain-study-protocol-for-a-randomised-controlled-trial
#20
Joseph G Wasser, Daniel C Herman, MaryBeth Horodyski, Jason L Zaremski, Brady Tripp, Phillip Page, Kevin R Vincent, Heather K Vincent
BACKGROUND: Atraumatic lower limb amputation is a life-changing event for approximately 185,000 persons in the United States each year. A unilateral amputation is associated with rapid changes to the musculoskeletal system including leg and back muscle atrophy, strength loss, gait asymmetries, differential mechanical joint loading and leg length discrepancies. Even with high-quality medical care and prostheses, amputees still develop secondary musculoskeletal conditions such as chronic low back pain (LBP)...
December 29, 2017: Trials
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