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Alternative care pathways

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https://www.readbyqxmd.com/read/29339540/radio-resistant-cervical-cancers-are-sensitive-to-inhibition-of-glycolysis-and-redox-metabolism
#1
Ramachandran Rashmi, Xiaojing Huang, John M Floberg, Adnan Elhammali, Michael L McCormick, Gary J Patti, Douglas R Spitz, Julie K Schwarz
Highly glycolytic cervical cancers largely resist treatment by cisplatin and co-administered pelvic irradiation as the present standard of care. In this study, we investigated the effects of inhibiting glycolysis and thiol redox metabolism to evaluate them as alternate treatment strategies in these cancers. In a panel of multiple cervical cancer cell lines, we evaluated sensitivity to inhibition of glycolysis (2-DG) with or without simultaneous inhibition of glutathione and thioredoxin metabolism (BSO/AUR)...
January 16, 2018: Cancer Research
https://www.readbyqxmd.com/read/29322309/the-global-spine-care-initiative-a-summary-of-guidelines-on-invasive-interventions-for-the-management-of-persistent-and-disabling-spinal-pain-in-low-and-middle-income-communities
#2
REVIEW
Emre Acaroğlu, Margareta Nordin, Kristi Randhawa, Roger Chou, Pierre Côté, Tiro Mmopelwa, Scott Haldeman
PURPOSE: The purpose of this study was to synthesize recommendations on the use of common elective surgical and interventional procedures for individuals with persistent and disabling non-radicular/axial with or without myelopathy, radicular back pain, cervical myelopathy, symptomatic spinal stenosis, and fractures due to osteoporosis. This review was to inform a clinical care pathway on the patient presentations where surgical interventions could reasonably be considered. METHODS: We synthesized recommendations from six evidence-based clinical practice guidelines and one appropriate use criteria guidance for the surgical and interventional management of persistent and disabling spine pain...
January 10, 2018: European Spine Journal
https://www.readbyqxmd.com/read/29321074/patient-and-case-characteristics-associated-with-no-paramedic-treatment-for-low-acuity-cases-referred-for-emergency-ambulance-dispatch-following-a-secondary-telephone-triage-a-retrospective-cohort-study
#3
Kathryn Eastwood, Amee Morgans, Johannes Stoelwinder, Karen Smith
BACKGROUND: Predicting case types that are unlikely to be treated by paramedics can aid in managing demand for emergency ambulances by identifying cases suitable for alternative management pathways. The aim of this study was to identify the patient characteristics and triage outcomes associated with 'no paramedic treatment' for cases referred for emergency ambulance dispatch following secondary telephone triage. METHODS: A retrospective cohort analysis was conducted of cases referred for emergency ambulance dispatch following secondary telephone triage between September 2009 and June 2012...
January 10, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29310993/consensus-methodology-to-determine-minor-ailments-appropriate-to-be-directed-for-management-within-community-pharmacy
#4
Hamde Nazar, Zachariah Nazar, Andre Yeung, Mike Maguire, Alex Connelly, Sarah P Slight
BACKGROUND: National Health Service (NHS) 111, a medical helpline for urgent care used within the England and Scotland, receives significant numbers of patient calls yearly for a range of clinical conditions. Some are considered high acuity and mainly directed to urgent and emergency care. Low acuity conditions are also directed to these costly, overburdened services. Community pharmacy is a recognised setting for effective low acuity condition management and could offer an alternative...
January 4, 2018: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/29303422/use-training-and-opinions-about-effectiveness-of-transesophageal-echocardiography-in-adult-liver-transplantation-among-anesthesiologists-in-the-united-states
#5
Jeron Zerillo, Bryan Hill, Sang Kim, Samuel DeMaria, M Susan Mandell
STUDY OBJECTIVE: Describe transesophageal echocardiography (TEE) use, preparatory training and opinions about clinical importance, and future training pathways in a sample of liver transplant anesthesiologists. DESIGN: Online survey questionnaire. SETTING: Liver Transplant Centers in the United States. PARTICIPANTS: Director of Liver Transplant Anesthesia or designated alternate respondent. RESULTS: A total of 79 Directors or alternates from 111 (71%) centers were identified...
January 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29299519/expeditious-emergency-room-referral-pathway-improves-patient-access-to-otolaryngology-care
#6
Jeffrey Johnson, Zi Yang Jiang, Daniel Martinez, David Smith, Elizabeth Curtis, David Robinson, Ibrahim Alava
Objectives: Historically at a multi-hospital residency program, there was an unexpected number of non-urgent consults from the county hospital emergency room (ER) that caused residents to make more trips between hospitals and come closer to violating duty hours. Moreover, there was also a poor follow-up rate for these patients. An alternate pathway to redirect such consults to the Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) clinic, staffed by an attending physician, was devised...
December 2017: Laryngoscope Investigative Otolaryngology
https://www.readbyqxmd.com/read/29277953/emergent-leadership-among-tenants-with-psychiatric-disabilities-living-in-supported-housing
#7
Myra Piat, Judith Sabetti, Deborah Padgett
The overall aim of this study was to explore the experiences of people with psychiatric disabilities living as tenants in independent, supported apartments for the first time. Supported housing provides an alternative to structured, custodial housing models, such as foster homes, or board-and-care homes, for clients in public mental health systems. This article reports findings on how leadership emerged among tenants after making the transition from custodial to supported housing. Semi-structured interviews were conducted with tenants (n = 24) and included questions on their housing history, current living situation, relationships with staff, participation, and understanding or experience of leadership...
December 25, 2017: International Journal of Mental Health Nursing
https://www.readbyqxmd.com/read/29260012/time-courses-of-plasma-il-6-and-hmgb-1-reflect-initial-severity-of-clinical-presentation-but-do-not-predict-poor-neurologic-outcome-following-subarachnoid-hemorrhage
#8
Heikki Kiiski, Jaakko Långsjö, Jyrki Tenhunen, Marika Ala-Peijari, Heini Huhtala, Mari Hämäläinen, Eeva Moilanen, Juha Öhman, Jukka Peltola
Objective: Patients with aneurysmal subarachnoid hemorrhage (aSAH) experience high mortality and morbidity. Neuroinflammation causes brain damage expansion after aSAH. Due to the complexity of the inflammatory response multiple biomarkers are needed to evaluate its' progression. We studied inflammatory process after aSAH by measuring two inflammatory biomarkers, interleukin-6 (IL-6) and high-mobility group box 1 (HMGB1) at simultaneous time-points after aSAH. Methods: In this prospective population-based study, IL-6 and HMGB1 were measured in aSAH patients (n = 47) for up to five days...
March 2017: ENeurologicalSci
https://www.readbyqxmd.com/read/29237034/long-term-care-provision-and-the-well-being-of-spousal-caregivers-an-analysis-of-138-european-regions
#9
Melanie Wagner, Martina Brandt
Objectives: The individual burden of caring for one's relatives not only depends on care characteristics but is also related to contextual factors. The objective of this study is to determine whether regional formal long-term care provision is linked to the well-being of spousal caregivers introducing the concept of "control" as central pathway to explain this link. Method: We applied multilevel analysis using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) from over 29,000 Europeans and 1,800 spousal caregivers located in 138 regions in 11 countries to analyze the effects of regional contexts on caregiver well-being...
December 11, 2017: Journals of Gerontology. Series B, Psychological Sciences and Social Sciences
https://www.readbyqxmd.com/read/29220703/referral-to-specialist-physiotherapists-in-the-management-of-whiplash-associated-disorders-perspectives-of-healthcare-practitioners
#10
Aila Nica Bandong, Andrew Leaver, Martin Mackey, Michele Sterling, Joan Kelly, Carrie Ritchie, Trudy Rebbeck
BACKGROUND: Guidelines for whiplash associated disorders (WAD) recommend early referral to specialists (e.g. specialist physiotherapists) of people who are not recovering. This recommendation is a key component of a proposed clinical pathway of care for WAD. OBJECTIVE: To explore healthcare practitioners' opinions about referral to specialist physiotherapists of people with WAD at high risk of non-recovery. DESIGN: Qualitative descriptive study...
November 22, 2017: Musculoskeletal Science & Practice
https://www.readbyqxmd.com/read/29199023/the-current-status-and-future-role-of-the-phosphoinositide-3-kinase-akt-signaling-pathway-in-urothelial-cancer-an-old-pathway-in-the-new-immunotherapy-era
#11
REVIEW
Sandy T Liu, Gavin Hui, Colleen Mathis, Karim Chamie, Allan J Pantuck, Alexandra Drakaki
The phosphoinositide 3 kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway is a well studied signaling pathway that regulates diverse cellular functions including proliferation, metabolism, and transcription. Aberrant activation of this pathway has been implicated in multiple cancers. Genomic studies have shown that activating mutations in oncogenes as well as inactivating mutations in tumor suppressor genes are present across a variety of malignancies, including urothelial carcinoma...
November 3, 2017: Clinical Genitourinary Cancer
https://www.readbyqxmd.com/read/29194465/rehabilitation-in-dementia-care
#12
Monica Cations, Kate E Laver, Maria Crotty, Ian D Cameron
Multidisciplinary rehabilitation is increasingly accepted as valuable in the management of chronic disease. Whereas traditional rehabilitation models focussed on recovery, maintaining independence and delaying functional decline are now considered worthwhile aims even where full recovery is not feasible. Despite this, rehabilitation is notably absent from dementia care literature and practice. People with dementia report frustration with the lack of availability of structured post-diagnosis pathways like those offered for other conditions...
November 29, 2017: Age and Ageing
https://www.readbyqxmd.com/read/29187189/operational-integration-in-primary-health-care-patient-encounters-and-workflows
#13
Dimitra Sifaki-Pistolla, Vasiliki-Eirini Chatzea, Adelais Markaki, Kyriakos Kritikos, Elena Petelos, Christos Lionis
BACKGROUND: Despite several countrywide attempts to strengthen and standardise the primary healthcare (PHC) system, Greece is still lacking a sustainable, policy-based model of integrated services. The aim of our study was to identify operational integration levels through existing patient care pathways and to recommend an alternative PHC model for optimum integration. METHODS: The study was part of a large state-funded project, which included 22 randomly selected PHC units located across two health regions of Greece...
November 29, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/29184057/the-effects-of-pi3k-mediated-signalling-on-glioblastoma-cell-behaviour
#14
Julia Langhans, Lukas Schneele, Nancy Trenkler, Hélène von Bandemer, Lisa Nonnenmacher, Georg Karpel-Massler, Markus D Siegelin, Shaoxia Zhou, Marc-Eric Halatsch, Klaus-Michael Debatin, Mike-Andrew Westhoff
The PI3K/Akt/mTOR signalling network is activated in almost 90% of all glioblastoma, the most common primary brain tumour, which is almost invariably lethal within 15 months of diagnosis. Despite intensive research, modulation of this signalling cascade has so far yielded little therapeutic benefit, suggesting that the role of the PI3K network as a pro-survival factor in glioblastoma and therefore a potential target in combination therapy should be re-evaluated. Therefore, we used two distinct pharmacological inhibitors that block signalling at different points of the cascade, namely, GDC-0941 (Pictilisib), a direct inhibitor of the near apical PI3K, and Rapamycin which blocks the side arm of the network that is regulated by mTOR complex 1...
November 29, 2017: Oncogenesis
https://www.readbyqxmd.com/read/29171172/cost-effectiveness-of-routine-viral-load-monitoring-in-low-and-middle-income-countries-a-systematic-review
#15
REVIEW
Ruanne V Barnabas, Paul Revill, Nicholas Tan, Andrew Phillips
INTRODUCTION: Routine viral load monitoring for HIV-1 management of persons on antiretroviral therapy (ART) has been recommended by the World Health Organization (WHO) to identify treatment failure. However, viral load testing represents a substantial cost in resource constrained health care systems. The central challenge is whether and how viral load monitoring may be delivered such that it maximizes health gains across the population for the costs incurred. We hypothesized that key features of program design and delivery costs drive the cost-effectiveness of viral load monitoring within programs...
November 2017: Journal of the International AIDS Society
https://www.readbyqxmd.com/read/29158247/predictive-values-of-referrals-for-transient-ischaemic-attack-from-first-contact-health-care-a-systematic-review
#16
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...
December 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
#17
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
#18
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
#19
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
#20
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)...
January 2018: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
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