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Healthcare systems

Hendramoorthy Maheswaran, Stavros Petrou, Danielle Cohen, Peter MacPherson, Felistas Kumwenda, David G Lalloo, Elizabeth L Corbett, Aileen Clarke
INTRODUCTION: Although HIV infection and its associated co-morbidities remain the commonest reason for hospitalisation in Africa, their impact on economic costs and health-related quality of life (HRQoL) are not well understood. This information is essential for decision-makers to make informed choices about how to best scale-up anti-retroviral treatment (ART) programmes. This study aimed to quantify the impact of HIV infection and ART on economic outcomes in a prospective cohort of hospitalised patients with high HIV prevalence...
2018: PloS One
Amy C Justice, Kirsha S Gordon, Melissa Skanderson, Eva Jennifer Edelman, Kathleen M Akgün, Cynthia L Gibert, Vincent Lo Re, David Rimland, Julie A Womack, Christina M Wyatt, Janet P Tate
BACKGROUND: HIV-positive individuals (HIV+) on antiretrovirals commonly take enough other medications to cross a threshold for polypharmacy but little is known about associated outcomes. We asked whether non-antiretroviral polypharmacy is associated with hospitalization and mortality and whether associations differ by HIV status. METHODS: Data on HIV+ and uninfected individuals in the US Veterans Affairs Healthcare System were analyzed. Eligible HIV+ were on antiretrovirals with suppressed HIV-1 RNA and uninfected individuals received at least one medication...
March 27, 2018: AIDS
Phillip Joy, Matthew Numer
Lesbian, gay, bisexual, trans, and queer people (LGBTQ) have unique concerns regarding their nutritional health while experiencing disparities within the Canadian healthcare system. Dietetic training programs often do not provide adequate knowledge or skills to students to be competent in meeting the needs of this population. Drawing from literature from other health programs, this paper outlines key strategies to the integration of LGBTQ curriculum into dietetic training programs. LGBTQ training can help students gain cultural competencies, knowledge and understanding of the LGBTQ communities, and the nutritional concerns within them...
March 15, 2018: Canadian Journal of Dietetic Practice and Research
K Kragelund Nielsen, L Groth Grunnet, H Terkildsen Maindal
In this review, we aim to summarize knowledge about gestational diabetes (GDM) after delivery; with special focus on the potential of preventing Type 2 diabetes in a family context. The review expands on the key messages from a symposium held in Copenhagen in May 2017 and highlights avenues for future research. A narrative review of the symposium presentations and related literature is given. GDM is associated with increased short- and long-term adverse outcomes including Type 2 diabetes for both mother and offspring...
March 15, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
Sylvie Perreault, Payman Shahabi, Robert Côté, Stéphanie Dumas, Étienne Rouleau-Mailloux, Yassamin Feroz Zada, Sylvie Provost, Ian Mongrain, Marc Dorais, Thao Huynh, Simon Kouz, Ariel Diaz, Mark Blostein, Simon de Denus, Jacques Turgeon, Jeffrey Ginsberg, Jacques Lelorier, Lyne Lalonde, Lambert Busque, Jeannine Kassis, Mario Talajic, Jean-Claude Tardif, Marie-Pierre Dubé
BACKGROUND: Over- and under-coagulation with warfarin is associated with hemorrhagic and thromboembolic events, respectively. Genetic and clinical factors affect warfarin response, and the causes of this variability remain unclear. We present descriptive statistics and test for predictors of poor anticoagulation control. METHODS: The Quebec Warfarin Cohort (QWC) comprises 1,059 new warfarin users, with prospective follow up using telephone questionnaires every 3 months for one year, and using healthcare administrative databases (RAMQ and Med-Echo) for 5-year prior to cohort entry and up to 10-years following active patient participation...
March 15, 2018: Clinical Cardiology
Sara Guerri, Daniele Mercatelli, Maria Pilar Aparisi Gómez, Alessandro Napoli, Giuseppe Battista, Giuseppe Guglielmi, Alberto Bazzocchi
Bone and muscle are two deeply interconnected organs and a strong relationship between them exists in their development and maintenance. The peak of both bone and muscle mass is achieved in early adulthood, followed by a progressive decline after the age of 40. The increase in life expectancy in developed countries resulted in an increase of degenerative diseases affecting the musculoskeletal system. Osteoporosis and sarcopenia represent a major cause of morbidity and mortality in the elderly population and are associated with a significant increase in healthcare costs...
February 2018: Quantitative Imaging in Medicine and Surgery
Mohan Giri, Mamata Giri, Rabin Jung Thapa, Bibhuti Upreti, Bijay Pariyar
Breast cancer is the second most common malignancy among Nepalese women. Breast cancer places a substantial burden on the Nepalese healthcare system, but information regarding the number of women living with breast cancer is not well recorded. In countries with lower levels of resources such as Nepal, breast cancers are commonly diagnosed at late stages and women may receive inadequate treatment, pain relief or palliative care. Socioeconomic disparities and insufficient financial resources hinder prevention of breast cancer in Nepal...
April 2018: Biomedical Reports
Jacqueline Murphy, Mark G Pritchard, Lok Yin Cheng, Roshni Janarthanan, José Leal
INTRODUCTION: Hip and knee replacement represents a significant burden to the UK healthcare system. 'Enhanced recovery' pathways have been introduced in the National Health Service (NHS) for patients undergoing hip and knee replacement, with the aim of improving outcomes and timely recovery after surgery. To support policymaking, there is a need to evaluate the cost-effectiveness of enhanced recovery pathways across jurisdictions. Our aim is to systematically summarise the published cost-effectiveness evidence on enhanced recovery in hip and knee replacement, both as a whole and for each of the various components of enhanced recovery pathways...
March 14, 2018: BMJ Open
Aimilia Exarchakou, Bernard Rachet, Aurélien Belot, Camille Maringe, Michel P Coleman
OBJECTIVE: To assess the effectiveness of the NHS Cancer Plan (2000) and subsequent national cancer policy initiatives in improving cancer survival and reducing socioeconomic inequalities in survival in England. DESIGN: Population based cohort study. SETTING: England. POPULATION: More than 3.5 million registered patients aged 15-99 with a diagnosis of one of the 24 most common primary, malignant, invasive neoplasms between 1996 and 2013...
March 14, 2018: BMJ: British Medical Journal
Christiana R Dallas, Curtis H Harris, Cham E Dallas
In the U.S., migration has been documented to affect the prevalence of infectious disease. As a mitigation entity, border security has been recorded by numerous scholarly works as being essential to the support of the health of the U.S. POPULATION: Consequently, the lack of current health care monitoring of the permeable U.S. border places the U.S. population at risk in the broad sectors of infectious disease and interpersonal violence. Visualizing border security in the context of public health mitigation has significant potential to protect migrant health as well as that of all populations on both sides of the border...
March 15, 2018: Disaster Medicine and Public Health Preparedness
Stephanie M Topp, Chanda Mwamba, Anjali Sharma, Njekwa Mukamba, Laura K Beres, Elvin Geng, Charles B Holmes, Izukanji Sikazwe
BACKGROUND: Failure to keep people living with HIV engaged in life-long care and treatment has serious implications for individual and population-level health. Nested within a four-province study of HIV care and treatment outcomes, we explored the dynamic role of social and service-related factors influencing retention in HIV care in Zambia. METHODS: From a stratified random sample of 31 facilities, eight clinics were selected, one urban and one rural from each province...
2018: PloS One
Rangarirai Matima, Katherine Murphy, Naomi S Levitt, Rhonda BeLue, Tolu Oni
BACKGROUND: Current South African health policy for chronic disease management proposes integration of chronic services for better outcomes for chronic conditions; that is based on the Integrated Chronic Disease Model (ICDM). However, scant data exist on how patients with chronic multimorbidities currently experience the (re)-organisation of health services and what their perceived needs are in order to enhance the management of their conditions. METHODS: A qualitative study was conducted in a community health centre treating both HIV and diabetes patients in Cape Town...
2018: PloS One
Bradley J Schaffer, Kelly Fulmer
The study examines and evaluates the effectiveness of a federal and county collaboration in Pennsylvania designed to help military veterans with child support arrearages in the criminal justice system. The study focused on the veteran participants (n=232) identified psychosocial problems, their range of justice involvement, strategies to mitigate, address barriers and legal dilemmas through the collaborative. The average age 40, majority male, Caucasian, divorced, enrolled in Veterans Administration (VA) healthcare, serving on supervised parole or probation, homeless episodes, and income <$500...
March 14, 2018: Journal of Evidence-informed Social Work
Kelly McGuire, Matthew Siegel
Children with Autism Spectrum Disorder (ASD) are admitted to inpatient psychiatric units at markedly high rates. As health insurance companies and government healthcare systems and regulators seek more evidence for healthcare outcomes, it is important to learn more about the effectiveness of psychiatric inpatient admissions for children with ASD to best inform decisions on provision and access to this level of care. Evidence for models of inpatient treatment for youth with ASD is presented, and key characteristics and consensus recommendations for care are discussed...
March 14, 2018: International Review of Psychiatry
Maria McInerney, Vikki Ho, Anita Koushik, Isabelle Massarelli, Isabelle Rondeau, Gavin R McCormack, Ilona Csizmadi
INTRODUCTION: Poor diet quality has been shown to increase the risk of common chronic diseases that can negatively impact quality of life and burden the healthcare system. Canada's Food Guide evidence-based recommendations provide dietary guidance aimed at increasing diet quality. Compliance with Canada's Food Guide can be assessed with the Canadian Healthy Eating Index (C-HEI), a diet quality score. The recently designed Canadian Diet History Questionnaire II (C-DHQ II), a comprehensive food frequency questionnaire could be used to estimate the C-HEI in Canadian populations with the addition of food group equivalents (representing Canada's Food Guide servings) to the C-DHQ II nutrient database...
March 2018: Health Promotion and Chronic Disease Prevention in Canada
Wei Gong, Aobo Li, Hui Ai, Han Shi, Xiao Wang, Shaoping Nie
Background Early discharge after successful primary angioplasty is common, but the evidence supporting the practice is still lacking. We therefore performed a meta-analysis assessing the safety of early discharge after primary angioplasty in low-risk patients with ST-segment elevation myocardial infarction (STEMI). Methods Randomised controlled trials were identified and extracted from PubMed, Embase, Cochrane Library databases and reference lists of relevant papers. Heterogeneity was analysed using the I2 test...
January 1, 2018: European Journal of Preventive Cardiology
Dana Siegal, Lindsay M Stratchko, Courtney DeRoo
Just as radiologic studies allow us to see past the surface to the vulnerable and broken parts of the human body, medical malpractice claims help us see past the surface of medical errors to the deeper vulnerabilities and potentially broken aspects of our healthcare delivery system. And just as the insights we gain through radiologic studies provide focus for a treatment plan for healing, so too can the analysis of malpractice claims provide insights to improve the delivery of safe patient care. We review 1325 coded claims where Radiology was the primary service provider to better understand the problems leading to patient harm, and the opportunities most likely to improve diagnostic care in the future...
September 26, 2017: Diagnosis
Lauren Penwell-Waines, Wendy Ward, Heather Kirkpatrick, Patrick Smith, Marwan Abouljoud
Recognizing the impact of healthcare professional (HCP) burnout has led to vigorous interest from organizations and individuals regarding how to most effectively promote HCP well-being. The present paper reviews the literature on HCP well-being and describes factors that impact well-being at various levels (i.e., system, institution, program, interpersonal, and individual). We propose that change must occur at all levels to have the greatest impact. Further, we highlight opportunities to advance research on HCP well-being (e...
March 13, 2018: Journal of Clinical Psychology in Medical Settings
Matthew P Smeltzer, Fedoria E Rugless, Bianca M Jackson, Courtney L Berryman, Nicholas R Faris, Meredith A Ray, Meghan Meadows, Anita A Patel, Kristina S Roark, Satish K Kedia, Margaret M DeBon, Fayre J Crossley, Georgia Oliver, Laura M McHugh, Willeen Hastings, Orion Osborne, Jackie Osborne, Toni Ill, Mark Ill, Wynett Jones, Hyo K Lee, Raymond S Signore, Roy C Fox, Jingshan Li, Edward T Robbins, Kenneth D Ward, Lisa M Klesges, Raymond U Osarogiagbon
Background: Responsible for 25% of all US cancer deaths, lung cancer presents complex care-delivery challenges. Adoption of the highly recommended multidisciplinary care model suffers from a dearth of good quality evidence. Leading up to a prospective comparative-effectiveness study of multidisciplinary vs. serial care, we studied the implementation of a rigorously benchmarked multidisciplinary lung cancer clinic. Methods: We used a mixed-methods approach to conduct a patient-centered, combined implementation and effectiveness study of a multidisciplinary model of lung cancer care...
February 2018: Translational Lung Cancer Research
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