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Alternative care pathways

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https://www.readbyqxmd.com/read/29158247/predictive-values-of-referrals-for-transient-ischaemic-attack-from-first-contact-health-care-a-systematic-review
#1
Rebecca Kandiyali, Daniel S Lasserson, Penny Whiting, Alison Richards, Jonathan Mant
BACKGROUND: Over 150 000 cases of suspected transient ischaemic attack (TIA) are referred to outpatient clinics in England each year. The majority of referrals are made by GPs. AIM: This study aimed to identify how many patients referred to a TIA clinic actually have TIA (that is, calculate the positive predictive value [PPV] of first-contact healthcare referral) and to record the alternative diagnoses in patients without TIA, in order to determine the optimal service model for patients with suspected TIA...
November 20, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/29140483/integrative-whole-person-oncology-care-in-the-uk
#2
Catherine Zollman, Axel Walther, Helen E Seers, Rachel C Jolliffe, Marie J Polley
The term "whole-person cancer care"-an approach that addresses the needs of the person as well as treating the disease-is more widely understood in the United Kingdom than its synonym "integrative oncology." The National Health Service (NHS) provides free access to care for all, which makes it harder to prioritize NHS funding of whole-person medicine, where interventions may be multimodal and lacking in cost-effectiveness data. Despite this, around 30% of cancer patients are known to use some form of complementary or alternative medicine (CAM)...
November 1, 2017: Journal of the National Cancer Institute. Monographs
https://www.readbyqxmd.com/read/29105259/identifying-causal-mechanisms-in-health-care-interventions-using-classification-tree-analysis
#3
Ariel Linden, Paul R Yarnold
RATIONALE, AIMS, AND OBJECTIVES: Mediation analysis identifies causal pathways by testing the relationships between the treatment, the outcome, and an intermediate variable that mediates the relationship between the treatment and outcome. This paper introduces classification tree analysis (CTA), a machine-learning procedure, as an alternative to conventional methods for analysing mediation effects. METHOD: Using data from the JOBS II study, we compare CTA to structural equation models (SEMs) by assessing their consistency in revealing mediation effects on 2 outcomes; reemployment (a binary variable) and depressive symptoms (a continuous variable)...
November 3, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/29096631/prediction-of-uncomplicated-pregnancies-in-obese-women-a-prospective-multicentre-study
#4
Matias C Vieira, Sara L White, Nashita Patel, Paul T Seed, Annette L Briley, Jane Sandall, Paul Welsh, Naveed Sattar, Scott M Nelson, Debbie A Lawlor, Lucilla Poston, Dharmintra Pasupathy
BACKGROUND: All obese pregnant women are considered at equal high risk with respect to complications in pregnancy and birth, and are commonly managed through resource-intensive care pathways. However, the identification of maternal characteristics associated with normal pregnancy outcomes could assist in the management of these pregnancies. The present study aims to identify the factors associated with uncomplicated pregnancy and birth in obese women, and to assess their predictive performance...
November 3, 2017: BMC Medicine
https://www.readbyqxmd.com/read/29094806/performance-of-an-algorithm-based-approach-to-the-diagnosis-and-management-of-functional-gastrointestinal-disorders-a-pilot-trial
#5
E C Linedale, A Mikocka-Walus, A D Vincent, P R Gibson, J M Andrews
BACKGROUND: Recent advances in the development of diagnostic criteria and effective management options for functional gastrointestinal disorders (FGIDs) have not yet been integrated into clinical practice. There is a clear need for the development and validation of a simple clinical pathway for the diagnosis and management of FGIDs which can be used in primary care. METHODS: In this controlled pilot study, we designed and evaluated a non-specialist-dependent, algorithm-based approach for the diagnosis and management of FGIDs (ADAM-FGID)...
November 2, 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/29094099/improving-access-to-cancer-treatments-the-role-of-biosimilars
#6
Rakesh Chopra, Gilberto Lopes
Biologics play a key role in cancer treatment and are principal components of many therapeutic regimens. However, they require complex manufacturing processes, resulting in high cost and occasional shortages in supply. The cost of biologics limits accessibility of cancer treatment for many patients. Effective and affordable cancer therapies are needed globally, more so in developing countries, where health care resources can be limited. Biosimilars, which have biologic activity comparable to their corresponding reference drugs and are often more cost effective, have the potential to enhance treatment accessibility for patients and provide alternatives for decision makers (ie, prescribers, regulators, payers, policymakers, and drug developers)...
October 2017: Journal of Global Oncology
https://www.readbyqxmd.com/read/29079709/hif2%C3%AE-targeted-rnai-therapeutic-inhibits-clear-cell-renal-cell-carcinoma
#7
So C Wong, Weijun Cheng, Holly Hamilton, Anthony L Nicholas, Darren H Wakefield, Aaron Almeida, Andrei V Blokhin, Jeffrey Carlson, Zane C Neal, Vladimir Subbotin, Guofeng Zhang, Julia Hegge, Stephanie Bertin, Vladimir S Trubetskoy, David B Rozema, David L Lewis, Steven B Kanner
Targeted therapy against VEGF and mTOR pathways has been established as the standard-of-care for metastatic clear cell renal cell carcinoma (ccRCC); however, these treatments frequently fail and most patients become refractory requiring subsequent alternative therapeutic options. Therefore, development of innovative and effective treatments is imperative. About 80-90% of ccRCC tumors express an inactive mutant form of the von Hippel-Lindau protein (pVHL), an E3 ubiquitin ligase that promotes target protein degradation...
October 27, 2017: Molecular Cancer Therapeutics
https://www.readbyqxmd.com/read/29073847/states-with-medically-needy-pathways-differences-in-long-term-and-temporary-medicaid-entry-for-low-income-medicare-beneficiaries
#8
Laura M Keohane, Amal Trivedi, Vincent Mor
Medically needy pathways may provide temporary catastrophic coverage for low-income Medicare beneficiaries who do not otherwise qualify for full Medicaid benefits. Between January 2009 and June 2010, states with medically needy pathways had a higher percentage of low-income beneficiaries join Medicaid than states without such programs (7.5% vs. 4.1%, p < .01). However, among new full Medicaid participants, living in a state with a medically needy pathway was associated with a 3.8 percentage point (adjusted 95% confidence interval [1...
October 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29060204/movement-related-brain-oscillations-vary-with-lesion-location-in-severely-paralyzed-chronic-stroke-patients
#9
Andreas M Ray, Eduardo Lopez-Larraz, Thiago C Figueiredo, Niels Birbaumer, Ander Ramos-Murguialday
In the past few years, innovative upper-limb rehabilitation methods have been proposed for chronic stroke patients. These methods aim at functional motor rehabilitation using Brain-machine interfaces to constitute an alternate pathway from the brain to the muscles. Even in patients with absence of residual finger movements, recovery could be achieved. The extent to which these interventions are affected by individual lesion topology is yet to be understood. In this study EEG was measured in 30 chronic stroke patients during movement attempts of the paretic arm...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29038180/appropriateness-of-cases-presenting-in-the-emergency-department-following-ambulance-service-secondary-telephone-triage-a-retrospective-cohort-study
#10
Kathryn Eastwood, Karen Smith, Amee Morgans, Johannes Stoelwinder
OBJECTIVE: To investigate the appropriateness of cases presenting to the emergency department (ED) following ambulance-based secondary telephone triage. DESIGN: A pragmatic retrospective cohort analysis of all the planned and unplanned ED presentations within 48 hours of a secondary telephone triage. SETTING: The secondary telephone triage service, called the Referral Service, and the hospitals were located in metropolitan Melbourne, Australia and operated 24 hours a day, servicing 4...
October 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/29032471/copper-and-cerium-regulated-gene-expression-in-methylosinus-trichosporium-ob3b
#11
Wenyu Gu, Jeremy D Semrau
In aerobic methanotrophs, copper and cerium control the expression and activity of different forms of methane monooxygenase and methanol dehydrogenase, respectively. To exploit methanotrophy for the valorization of methane, it is crucial to determine if these metals exert more global control on gene expression in methanotrophs. Using RNA-Seq analysis we compared the transcriptome of Methylosinus trichosporium OB3b grown in the presence of varying amounts of copper and cerium. When copper was added in the absence of cerium, expression of genes encoding for both soluble and particulate methane monooxygenases varied as expected...
December 2017: Applied Microbiology and Biotechnology
https://www.readbyqxmd.com/read/29031387/metabolic-pathways-of-oleic-and-palmitic-acid-are-intensified-in-pcos-patients-with-normal-androgen-levels
#12
Szczuko Małgorzata, Zapałowska-Chwyć Marta, Drozd Arleta, Maciejewska Dominika, Starczewski Andrzej, Stachowska Ewa
CONTEXT: The aetiology and pathogenesis polycystic ovary syndrome (PCOS) remain uncertain and thus the relative studies are still crucial. OBJECTIVE: Our aim was to analyse the fatty acids profiles of the main phospholipids species in serum from women with PCOS classified into phenotypes, and to diagnose women more susceptible to the occurrence of inflammatory state. DESIGN: PCOS screening tests were performed in The Clinic of Gynecology and Urogynecology of Pomeranian Medical University in the 2014-2015 years...
November 2017: Prostaglandins, Leukotrienes, and Essential Fatty Acids
https://www.readbyqxmd.com/read/29021832/pharmacogenomics-in-the-treatment-of-mood-disorders-strategies-and-opportunities-for-personalized-psychiatry
#13
REVIEW
Azmeraw T Amare, Klaus Oliver Schubert, Bernhard T Baune
Personalized medicine (personalized psychiatry in a specific setting) is a new model towards individualized care, in which knowledge from genomics and other omic pillars (microbiome, epigenomes, proteome, and metabolome) will be combined with clinical data to guide efforts to new drug development and targeted prescription of the existing treatment options. In this review, we summarize pharmacogenomic studies in mood disorders that may lay the foundation towards personalized psychiatry. In addition, we have discussed the possible strategies to integrate data from omic pillars as a future path to personalized psychiatry...
September 2017: EPMA Journal
https://www.readbyqxmd.com/read/28987035/the-psychoneuroimmunological-role-of-omega-3-polyunsaturated-fatty-acids-in-major-depressive-disorder-and-bipolar-disorder
#14
Ian Hunter Rutkofsky, Anser Saeed Khan, Sindhu Sahito, Vikram Kumar
Context • Psychoneuroimmunology is the interdisciplinary study that links behavioral health with the neuroendocrinal system and investigates that link's bidirectional impact on the human immune system. Mechanistic studies have shown how omega-3 polyunsaturated fatty acids (PUFAs), like those found in fish oil, can modulate key pathways involved in inflammation, sympathetic activity, oxidative stress, transcription factors, and inflammatory cytokine production. Objective • The research team intended to investigate the effects that PUFAs have on the brain and the immune system, including the effects of proinflammatory cytokines and oxidative stress, and their therapeutic benefits in major depressive disorder (MDD) and bipolar disorder, either as an alternative monotherapy or a complementary adjunct treatment...
July 2017: Advances in Mind-body Medicine
https://www.readbyqxmd.com/read/28982688/deep-learning-based-multi-omics-integration-robustly-predicts-survival-in-liver-cancer
#15
Kumardeep Chaudhary, Olivier B Poirion, Liangqun Lu, Lana X Garmire
Identifying robust survival subgroups of hepatocellular carcinoma (HCC) will significantly improve patient care. Currently, endeavor of integrating multi-omics data to explicitly predict HCC survival from multiple patient cohorts is lacking. To fill in this gap, we present a deep learning (DL) based model on HCC that robustly differentiates survival subpopulations of patients in six cohorts. We build the DL based, survival-sensitive model on 360 HCC patients' data using RNA-seq, miRNA-seq and methylation data from TCGA, which predicts prognosis as good as an alternative model where genomics and clinical data are both considered...
October 5, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/28978238/ototoxicity-monitoring-through-the-eyes-of-the-treating-physician-perspectives-from-pulmonology-and-medical-oncology
#16
Angela C Garinis, Alexandra Cornell, Gopal Allada, Kevin P Fennelly, Ronald J Maggiore, Dawn Konrad-Martin
OBJECTIVES: Integrating audiological management into the care pathways of clinical specialties that prescribe ototoxic medications for essential, often life-preserving medical care that is critical for early hearing loss identification and remediation. Research shows that successful implementation of a new health service or intervention requires alignment of goals among provider groups, institutional leadership and patients. Thoughtful consideration of the physician's viewpoints about ototoxicity and its implications for treatment planning is, therefore, important for the implementation and enduring success of an ototoxicity monitoring programme (OMP)...
October 5, 2017: International Journal of Audiology
https://www.readbyqxmd.com/read/28967362/pain-management-in-rheumatology-research-training-and-practice
#17
REVIEW
David G Borenstein, Afton L Hassett, David Pisetsky
The Pain Management Task Force of the American College of Rheumatology published a report in 2010 highlighting pain management as a fundamental aspect of clinical practice, training and research. In the interim, the consideration of pain as a focus of attention of rheumatologists and rheumatology health professionals has become even more challenging than in 2010 because of the epidemic of opiate addiction and overdose death. The characterisation of categories of pain by mechanism (e.g., inflammation, joint degeneration, abnormalities of central pain processing) can help guide treatment...
September 2017: Clinical and Experimental Rheumatology
https://www.readbyqxmd.com/read/28965888/expanding-the-role-of-radiographers-in-reporting-suspected-lung-cancer-a-cost-effectiveness-analysis-using-a-decision-tree-model
#18
M K Bajre, M Pennington, N Woznitza, C Beardmore, M Radhakrishnan, R Harris, P McCrone
INTRODUCTION: To assess whether an enhanced role for radiographers in reporting lung cancer chest radiographs is cost-effective. METHODS: Costs and outcomes of chest radiograph reporting by reporting radiographer or by a radiologist were compared using a decision tree model. The model followed patients from an initial chest radiographs for suspected lung cancer to the provision of cancer care in positive cases. Sensitivity and specificity of reporting for radiographers and radiologists were derived from a recent trial...
November 2017: Radiography
https://www.readbyqxmd.com/read/28963077/payment-and-care-for-hematopoietic-cell-transplantation-patients-toward-a-specialized-medical-home-for-complex-care-patients
#19
James L Gajewski, Mark B McClellan, Navneet S Majhail, Parameswaran N Hari, Christopher N Bredeson, Richard T Maziarz, Charles F LeMaistre, Michael C Lill, Stephanie H Farnia, Krishna V Komanduri, Michael J Boo
Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time...
September 28, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28962566/-i-stayed-with-my-illness-a-grounded-theory-study-of-health-seeking-behaviour-and-treatment-pathways-of-patients-with-obstetric-fistula-in-kenya
#20
Anne M Khisa, Grace M Omoni, Isaac K Nyamongo, Rachel F Spitzer
BACKGROUND: Obstetric fistula classic symptoms of faecal and urinary incontinence cause women to live with social stigma, isolation, psychological trauma and lose their source of livelihoods. There is a paucity of studies on the health seeking behaviour trajectories of women with fistula illness although women live with the illness for decades before surgery. We set out to establish the complete picture of women's health seeking behaviour using qualitative research. We sought to answer the question: what patterns of health seeking do women with obstetric fistula display in their quest for healing? METHODS: We used grounded theory methodology to analyse data from narratives of women during inpatient stay after fistula surgery in 3 hospitals in Kenya...
September 29, 2017: BMC Women's Health
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