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proactive care

John R Hurst, Maria Dilleen, Kevin Morris, Siân Hills, Birol Emir, Rupert Jones
Purpose: Inappropriate use of an inhaled corticosteroid (ICS) for COPD has clinical and economic disadvantages. This retrospective analysis of The UK Health Improvement Network (THIN) database identified factors influencing treatment escalation (step-up) from a long-acting muscarinic antagonist (LAMA) to triple therapy (LAMA + long-acting β-agonist-ICS). Secondary objectives included time to step up from first LAMA prescription, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grouping (2011/2013, 2017), and Medical Research Council (MRC) grade prior to treatment escalation...
2018: International Journal of Chronic Obstructive Pulmonary Disease
Erin S Rogers, Steven S Fu, Paul Krebs, Siamak Noorbaloochi, Sean M Nugent, Amy Gravely, Scott E Sherman
INTRODUCTION: Veterans with a mental health diagnosis have high rates of tobacco use but encounter low rates of treatment from providers. This study tested whether a proactive tobacco treatment approach increases treatment engagement and abstinence rates in Department of Veterans Affairs mental health patients. STUDY DESIGN: RCT. SETTING/PARTICIPANTS: The study was performed from 2013 to 2017 and analyses were conducted in 2017. Investigators used the electronic medical record at four Veterans Administration facilities to identify patients documented as current smokers and who had a mental health clinic visit in the past 12 months...
March 15, 2018: American Journal of Preventive Medicine
Michelle A Farrar, Hooi Ling Teoh, Kate A Carey, Anita Cairns, Robin Forbes, Karen Herbert, Sandra Holland, Kristi J Jones, Manoj P Menezes, Margot Morrison, Kate Munro, Daniella Villano, Richard Webster, Ian R Woodcock, Eppie M Yiu, Hugo Sampaio, Monique M Ryan
BACKGROUND: Spinal muscular atrophy (SMA) is a devastating motor neuron disorder causing progressive muscle weakness and respiratory insufficiency. We present the initial Australian experiences implementing the expanded access programme (EAP) to enable preapproval access to nusinersen, the first disease-modifying therapy, for SMA type 1. METHODS: An Australian multicentre, open-label EAP for nusinersen enrolled patients with infantile-onset SMA type 1 from November 2016 to September 2017...
March 16, 2018: Journal of Neurology, Neurosurgery, and Psychiatry
Mosarrat J Qureshi, Manoj Kumar
BACKGROUND: Providing effective positive pressure ventilation is considered to be the single most important component of successful neonatal resuscitation. Ventilation is frequently initiated manually with bag and face mask (BMV) followed by endotracheal intubation if respiratory depression continues. These techniques may be difficult to perform successfully resulting in prolonged resuscitation or neonatal asphyxia. The laryngeal mask airway (LMA) may achieve initial ventilation and successful resuscitation faster than a bag-mask device or endotracheal intubation...
March 15, 2018: Cochrane Database of Systematic Reviews
Bente T Jensen, Susanne V Lauridsen, Jørgen B Jensen
PURPOSE OF REVIEW: Whether prehabilitation in radical cystectomy adds to the effort of reducing postoperative morbidity and impairments in the survivorship phase has until recently received limited attention. This narrative review aims to summarize the current evidence base on prehabilitaion interventions focusing on the efficacy of procedure-specific interventions and the influence on postoperative outcomes. RECENT FINDINGS: Given the oncological risk, there is a relative short window to intervene and proactively optimize the patient before radical cystectomy...
March 13, 2018: Current Opinion in Urology
Leena Nahata, Nicole M Caltabellotta, Nicholas D Yeager, Vicky Lehmann, Stacy L Whiteside, Sarah H O'Brien, Gwendolyn P Quinn, Cynthia A Gerhardt
Infertility is a common and distressing late effect of cancer treatment among male survivors. Investigators examined desire for parenthood, prioritization of fertility compared to other life goals, and reports of fertility-related discussions among a cohort of male adolescent and young adult survivors. Eighty percent desired a biological child, yet only 31% ranked having a child among their "top 3" life goals. Only 40% reported fertility-related discussions with their health care providers in survivorship...
March 14, 2018: Pediatric Blood & Cancer
Nancy Byatt, Lucille Cox, Tiffany A Moore Simas, Nisha Kini, Kathleen Biebel, Padma Sankaran, Holly A Swartz, Linda Weinreb
To elucidate (1) the challenges associated with under-recognition of bipolar disorder in obstetric settings, (2) barriers pregnant and postpartum women with bipolar disorder face when trying to access psychiatric care, and (3) how obstetric settings can identify such women and connect them with mental health services. Structured, in-depth interviews were conducted with 25 pregnant and postpartum women recruited from obstetric practices who scored ≥ 10 on the Edinburgh Postnatal Depression Scale and met DSM-IV criteria for bipolar disorder I, II, or not otherwise specified using the Mini International Neuropsychiatric Interview...
March 13, 2018: Archives of Women's Mental Health
Doug Oliver, Lisa Dolovich, Larkin Lamarche, Jessica Gaber, Ernie Avilla, Mehreen Bhamani, David Price
Primary care providers are critical in providing and optimizing health care to an aging population. This paper describes the volunteer component of a program (Health TAPESTRY) which aims to encourage the delivery of effective primary health care in novel and proactive ways. As part of the program, volunteers visited older adults in their homes and entered information regarding health risks, needs, and goals into an electronic application on a tablet computer. A total of 657 home visits were conducted by 98 volunteers, with 22...
2018: Frontiers in Medicine
Jeanne M Ferrante, Eric K Shaw, Jennifer E Bayly, Jenna Howard, M Nell Quest, Elizabeth C Clark, Connie Pascal
BACKGROUND: Many primary care practices participating in patient-centered medical home (PCMH) transformation initiatives are expanding the work roles of their medical assistants (MAs). Little is known about attitudes of MAs or barriers and facilitators to these role changes. METHODS: Secondary data analysis of qualitative cross-case comparison study of 15 New Jersey primary care practices participating in a PCMH project during 2012 to 2013. Observation field notes and in-depth and key informant interviews (with physicians, office managers, staff and care coordinators) were iteratively analyzed using grounded theory...
March 2018: Journal of the American Board of Family Medicine: JABFM
Emily S Patterson
Objective To integrate and synthesize insights from recent studies of workarounds to the intended use of health information technology (HIT) by health care professionals. Background Systems are safest when the documentation of how work is done in policies and procedures closely matches what people actually do when they are working. Proactively identifying and managing workarounds to the intended use of technology, including deviations from expected workflows, can improve system safety. Method A narrative review of studies of workarounds with HIT was conducted to identify themes in the literature...
March 1, 2018: Human Factors
Jouha Min, Maria Nothing, Ben Coble, Hui Zheng, Jongmin Park, Hyungsoon Im, Georg F Weber, Cesar M Castro, Filip K Swirski, Ralph Weissleder, Hakho Lee
Sepsis is an often fatal condition that arises when the immune response to an infection causes widespread systemic organ injury. A critical unmet need in combating sepsis is the lack of accurate early biomarkers that produce actionable results in busy clinical settings. Here, we report the development of a point-of-care platform for rapid sepsis detection. Termed IBS (integrated biosensor for sepsis), our approach leverages i) the newly-found pathophysiological role of cytokine interleukin-3 (IL-3) in early sepsis, and ii) a hybrid magneto-electrochemical sensor for IL-3 detection...
March 13, 2018: ACS Nano
Marta Trapero-Bertran, Celia Muñoz, Kathryn Coyle, Doug Coyle, Adam Lester-George, Reiner Leidl, Bertalan Németh, Kei-Long Cheung, Subhash Pokhrel, Ángel Lopez-Nicolás
AIMS: To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). DESIGN: We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov-based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion...
March 13, 2018: Addiction
Ross Arena, Amy McNeil, Steven Street, Samantha Bond, Deepika R Laddu, Carl J Lavie, Andrew P Hills
Noncommunicable and chronic disease are interchangeable terms. According to the World Health Organization, "they are of long duration and generally slow progression. The 4 main types of chronic diseases are cardiovascular diseases (ie, heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes." We have known about the benefits of physical activity (PA) for thousands of years. Perhaps our approach, from public health messaging to the individual clinical encounter, as to how PA and exercise are discussed and prescribed can be improved upon, with the ultimate goal of increasing the likelihood that an individual moves more; ultimately moving more should be the goal...
April 2018: Current Problems in Cardiology
Caroline Christie, Simon Wynn-Thomas, Bianca McKinnon
INTRODUCTION In New Zealand, 41% of general practitioners (GPs) intend to retire by 2025. Increasing workforce shortages and other stressors are putting doctors at risk of burnout, which in turn can put patients at risk of harm. Offering a range of resources can signal an organisation's commitment to physician wellness while improving patient safety and organisational stability. AIM To replace the current reactive approach to impaired doctors with a proactive system of monitoring performance with the goal of identifying problems early...
September 2017: Journal of Primary Health Care
Arnaud Setondji Amoussouhoui, Ghislain Emmanuel Sopoh, Anita Carolle Wadagni, Roch Christian Johnson, Paulin Aoulou, Inès Elvire Agbo, Jean-Gabin Houezo, Micah Boyer, Mark Nichter
BACKGROUND: Mycobacterium ulcerans infection, commonly known as Buruli ulcer (BU), is a debilitating neglected tropical disease. Its management remains complex and has three main components: antibiotic treatment combining rifampicin and streptomycin for 56 days, wound dressings and skin grafts for large ulcerations, and physical therapy to prevent functional limitations after care. In Benin, BU patient care is being integrated into the government health system. In this paper, we report on an innovative pilot program designed to introduce BU decentralization in Ouinhi district, one of Benin's most endemic districts previously served by centralized hospital-based care...
March 12, 2018: PLoS Neglected Tropical Diseases
Hana Alharthi
Despite a newfound wealth of data and information, the healthcare sector is lacking in actionable knowledge. This is largely because healthcare data, though plentiful, tends to be inherently complex and fragmented. Health data analytics, with an emphasis on predictive analytics, is emerging as a transformative tool that can enable more proactive and preventative treatment options. This review considers the ways in which predictive analytics has been applied in the for-profit business sector to generate well-timed and accurate predictions of key outcomes, with a focus on key features that may be applicable to healthcare-specific applications...
March 8, 2018: Journal of Infection and Public Health
Daniel Serrani, Gabriela Galfetti, Cinthia Rodríguez
OBJECTIVE: to investigate factors in?uencing length of stay and predictors for the risk of readmission at an acute psychiatric inpatient unit. METHOD: retrospective cross-sectional clinical fle audit ranging four years back, a random selection of 378 patients was reviewed, including 178 cases and 200 controls. A case control study was employed in the study of length of stay, and for predictors of risk of readmission a retrospective cohort study was used. RESULTS: the 7 variables that were associated with length of stay were: 1- instruction level, 2- place of origin, 3- use of restraints, 4- gender, 5- marital status, 6- drug class, and 7- number of visits...
July 2017: Vertex: Revista Argentina de Psiquiatriá
Niels Martin, Jose L Pascual, Dennis Crowe, Christine Toevs, Maurizio F Cereda, Mark Mikkelsen, Lewis J Kaplan
The US has witnessed a vast increase in animals in therapeutic roles. These roles include Service as defined by the American Disabilities Act (ADA) as well as other animal types that are not covered under the ADA provisions. Such animal roles are designated as Therapy animals and Emotional Support animals (ESA). Understanding the legal and regulatory requirements that govern how each animal type accesses healthcare facilities is essential in planning for their presence. Since only Service animals are required to be given access to facilities, individual institutions must plan for how to accommodate their presence throughout different phases of care...
March 8, 2018: Journal of Trauma and Acute Care Surgery
Aaron Pinkhasov, Deepan Singh, Sridivya Chavali, Lori Legrand, Rose Calixte
Constant observation (CO) is a common economic burden on general hospitals. A quality improvement (QI) project focusing on behavioral health (BH) management of this population was piloted using a novel BH protocol for the proactive assessment and management of all patients requiring CO. The impact on CO-cost and length of stay (LOS) was assessed. Data on demographics, diagnoses, psychopharmacologic treatment, complications and clinical setting were collected and analyzed for all CO-patients over a 6-month period...
March 8, 2018: Community Mental Health Journal
Timothy P Hogan, Tana M Luger, Julie E Volkman, Mary Rocheleau, Nora Mueller, Anna M Barker, Kim M Nazi, Thomas K Houston, Barbara G Bokhour
BACKGROUND: As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages...
March 8, 2018: Journal of Medical Internet Research
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