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Alternative care pathways

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https://www.readbyqxmd.com/read/28647838/preoperative-education-for-hip-and-knee-replacement-never-stop-learning
#1
REVIEW
Paul K Edwards, Simon C Mears, C Lowry Barnes
PURPOSE OF REVIEW: Participation in alternative payment models has focused efforts to improve outcomes and patient satisfaction while also lowering cost for elective hip and knee replacement. The purpose of this review is to determine if preoperative education classes for elective hip and knee replacement achieve these goals. RECENT FINDINGS: Recent literature demonstrates that patients who attend education classes prior to surgery have decreased anxiety, better post-operative pain control, more realistic expectations of surgery, and a better understanding of their surgery...
June 24, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28635159/nutrition-in-renal-supportive-care-patient-driven-and-flexible
#2
REVIEW
Jessica Stevenson, Anthony Meade, Ann-Maree Randall, Karen Manley, Stephanie Notaras, Susan Heaney, Maria Chan, Alison Smyth, Elizabeth Josland, Frank Brennan, Mark A Brown
Renal Supportive Care is an alternative treatment pathway in advanced Chronic Kidney Disease (CKD) that is being increasingly adopted, particularly in the elderly. RSC utilises principles of palliative care and has been developed to enhance the care for dialysis patients with a high symptom burden and those being managed on a non-dialysis pathway. Nutrition management is often an under-recognised component of care, and can play an important role in improving patients' quality of life to reduce symptom burden, support physical function and independence and provide appropriate counselling to patients and their families to ensure the goals of RSC are met...
June 20, 2017: Nephrology
https://www.readbyqxmd.com/read/28619124/multiplex-tests-to-identify-gastrointestinal-bacteria-viruses-and-parasites-in-people-with-suspected-infectious-gastroenteritis-a-systematic-review-and-economic-analysis
#3
Karoline Freeman, Hema Mistry, Alexander Tsertsvadze, Pam Royle, Noel McCarthy, Sian Taylor-Phillips, Rohini Manuel, James Mason
BACKGROUND: Gastroenteritis is a common, transient disorder usually caused by infection and characterised by the acute onset of diarrhoea. Multiplex gastrointestinal pathogen panel (GPP) tests simultaneously identify common bacterial, viral and parasitic pathogens using molecular testing. By providing test results more rapidly than conventional testing methods, GPP tests might positively influence the treatment and management of patients presenting in hospital or in the community. OBJECTIVE: To systematically review the evidence for GPP tests [xTAG(®) (Luminex, Toronto, ON, Canada), FilmArray (BioFire Diagnostics, Salt Lake City, UT, USA) and Faecal Pathogens B (AusDiagnostics, Beaconsfield, NSW, Australia)] and to develop a de novo economic model to compare the cost-effectiveness of GPP tests with conventional testing in England and Wales...
April 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28608545/an-alternative-pathway-to-eusociality-exploring-the-molecular-and-functional-basis-of-fortress-defense
#4
Sarah P Lawson, Leah Sigle, Abigail Lind, Andrew W Legan, Jessica N Mezzanotte, Hans-Willi Honegger, Patrick Abbot
Some animals express a form of eusociality known as 'fortress defense', in which defense rather than brood care is the primary social act. Aphids are small plant-feeding insects, but like termites, some species express division of labor and castes of aggressive juvenile 'soldiers'. What is the functional basis of fortress defense eusociality in aphids? Previous work showed that the acquisition of venoms might be a key innovation in aphid social evolution. We show that the lethality of aphid soldiers derives in part from the induction of exaggerated immune responses in insects they attack...
June 13, 2017: Evolution; International Journal of Organic Evolution
https://www.readbyqxmd.com/read/28605006/treating-periodontal-disease-for-preventing-adverse-birth-outcomes-in-pregnant-women
#5
REVIEW
Zipporah Iheozor-Ejiofor, Philippa Middleton, Marco Esposito, Anne-Marie Glenny
BACKGROUND: Periodontal disease has been linked with a number of conditions, such as cardiovascular disease, stroke, diabetes and adverse pregnancy outcomes, all likely through systemic inflammatory pathways. It is common in women of reproductive age and gum conditions tend to worsen during pregnancy. Some evidence from observational studies suggests that periodontal intervention may reduce adverse pregnancy outcomes. There is need for a comprehensive Cochrane review of randomised trials to assess the effect of periodontal treatment on perinatal and maternal health...
June 12, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28601828/colorectal-cancer-with-synchronous-liver-limited-metastases-the-protocol-of-an-inception-cohort-study-cosmic
#6
Ajith K Siriwardena, Anthony K C Chan, Agnieszka M Ignatowicz, James M Mason
INTRODUCTION: Colorectal cancer is the fourth most common cancer in the UK and an important cause of cancer-related death. In 20% of patients, there is metastasis to the liver or beyond at the time of diagnosis. The management of synchronous disease is complex. Conventional surgery removes the colorectal primary first, followed by chemotherapy, with resection of liver metastases as a final step. Advances in the availability and safety of liver surgery, anaesthesia and critical care have made two alternative options feasible...
June 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28581516/pancreatic-cancer-heterogeneity-and-response-to-mek-inhibition
#7
K Pedersen, F Bilal, C Bernadó Morales, M T Salcedo, T Macarulla, D Massó-Vallés, V Mohan, A Vivancos, M-J Carreras, X Serres, M Abu-Suboh, J Balsells, E Allende, I Sagi, L Soucek, J Tabernero, J Arribas
Our increasing knowledge of the mechanisms behind the progression of pancreatic cancer (PC) has not yet translated into effective treatments. Many promising drugs have failed in the clinic, highlighting the need for better preclinical models to assess drug efficacy and characterize mechanisms of resistance. Using different experimental models, including patient-derived xenografts (PDXs), we gauged the efficacy of therapies aimed at two hallmark lesions of PCs: activation of signaling pathways by oncogenic KRAS and inactivation of tumor-suppressor genes...
June 5, 2017: Oncogene
https://www.readbyqxmd.com/read/28579741/time-based-switching-control-of-genetic-regulatory-networks-toward-sequential-drug-intake-for-cancer-therapy
#8
Wasiu Opeyemi Oduola, Xiangfang Li, Chang Duan, Lijun Qian, Fen Wu, Edward R Dougherty
As cancer growth and development typically involves multiple genes and pathways, combination therapy has been touted as the standard of care in the treatment of cancer. However, drug toxicity becomes a major concern whenever a patient takes 2 or more drugs simultaneously at the maximum tolerable dosage. A potential solution would be administering the drugs in a sequential or alternating manner rather than concurrently. This study therefore examines the feasibility of such an approach from a switched system control perspective...
2017: Cancer Informatics
https://www.readbyqxmd.com/read/28571563/the-design-and-development-of-a-complex-multifactorial-falls-assessment-intervention-for-falls-prevention-the-prevention-of-falls-injury-trial-prefit
#9
Julie Bruce, Shvaita Ralhan, Ray Sheridan, Katharine Westacott, Emma Withers, Susanne Finnegan, John Davison, Finbarr C Martin, Sarah E Lamb
BACKGROUND: This paper describes the design and development of a complex multifactorial falls prevention (MFFP) intervention for implementation and testing within the framework of a large UK-based falls prevention randomised controlled trial (RCT). METHODS: A complex intervention was developed for inclusion within the Prevention of Falls Injury Trial (PreFIT), a multicentre pragmatic RCT. PreFIT aims to compare the clinical and cost-effectiveness of three alternative primary care falls prevention interventions (advice, exercise and MFFP), on outcomes of fractures and falls...
June 1, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28561663/beyond-alkylating-agents-for-gliomas-quo-vadimus
#10
Vinay K Puduvalli, Rekha Chaudhary, Samuel G McClugage, James Markert
Recent advances in therapies have yielded notable success in terms of improved survival in several cancers. However, such treatments have failed to improve outcome in patients with gliomas for whom surgery followed by radiation therapy and chemotherapy with alkylating agents remain the standard of care. Genetic and epigenetic studies have helped identify several alterations specific to gliomas. Attempts to target these altered pathways have been unsuccessful due to various factors, including tumor heterogeneity, adaptive resistance of tumor cells, and limitations of access across the blood-brain barrier...
2017: American Society of Clinical Oncology Educational Book
https://www.readbyqxmd.com/read/28560763/implementation-and-evaluation-of-a-peer-review-process-for-advanced-practice-nurses-in-a-university-hospital-setting
#11
Shelly K Bergum, Talitha Canaan, Christi Delemos, Elizabeth Funke Gall, Bonnie McCracken, Dave Rowen, Steve Salvemini, Kimberly Wiens
BACKGROUND AND PURPOSE: Over the past decade, implementation of the peer review process for the development of the advanced practice nurse (APN) has been emphasized. However, little exists in the literature regarding APN peer review. The peer review process is intended to help demonstrate competency of care, enhance quality improvement measures, and foster the professional growth of the APN. METHODS: APNs serving on a professional governance council within a university teaching hospital developed a model of peer review for APNs...
May 30, 2017: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/28545159/the-value-transformation-of-health-care-impact-on-neuromuscular-and-electrodiagnostic-medicine
#12
Pushpa Narayanaswami, Millie Suk, Lyell K Jones
INTRODUCTION: Beginning in 2017, most physicians who participate in Medicare are subject to the Medicare Access and CHIP Reauthorization Act (MACRA), the milestone legislation that signals the US health care system's transition from volume-based to value-based care. METHODS: Review of emerging trends in development of value-based healthcare systems in the US. RESULTS: MACRA and the resulting Quality Payment Program (QPP) create two participation pathways, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (AAPM) pathway...
May 25, 2017: Muscle & Nerve
https://www.readbyqxmd.com/read/28539111/written-versus-verbal-consent-a-qualitative-study-of-stakeholder-views-of-consent-procedures-used-at-the-time-of-recruitment-into-a-peripartum-trial-conducted-in-an-emergency-setting
#13
J Lawton, N Hallowell, C Snowdon, J E Norman, K Carruthers, F C Denison
BACKGROUND: Obtaining prospective written consent from women to participate in trials when they are experiencing an obstetric emergency is challenging. Alternative consent pathways, such as gaining verbal consent at enrolment followed, later, by obtaining written consent, have been advocated by some clinicians and bioethicists but have received little empirical attention. We explored women's and staff views about the consent procedures used during the internal pilot of a trial (GOT-IT), where the protocol permitted staff to gain verbal consent at recruitment...
May 24, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28520694/metabolic-inflammatory-complex-in-sepsis-septic-cachexia-as-a-novel-potential-therapeutic-target
#14
Masao Kaneki
Despite several decades of focused investigation, sepsis remains a major cause of mortality in critically ill patients. Advancements in intensive care have enabled more patients to survive the acute phase of sepsis than previously, but a growing number of them progress to chronic critical illness. The failure of previous randomized clinical trials of anti-inflammatory agents to show any pro-survival benefit in septic patients underscores current thought that simple anti-inflammatory strategies are ineffective because the inhibitory effect of anti-inflammatory agents undermines the immune response to pathogens...
May 17, 2017: Shock
https://www.readbyqxmd.com/read/28506567/the-impact-of-walk-in-centres-and-gp-co-operatives-on-emergency-department-presentations-a-systematic-review-of-the-literature
#15
REVIEW
Jessica Crawford, Simon Cooper, Robyn Cant, Ruth DeSouza
BACKGROUND: Internationally, non-urgent presentations are increasing the pressure on Emergency Department (ED) staff and resources. This systematic review aims to identify the impact of alternative emergency care pathways on ED presentations - specifically GP cooperatives and walk-in clinics. METHODS: Based on a structured PICO enquiry with either walk-in clinic or GP cooperative as the intervention, a search was made for peer-reviewed publications in English, between 2000 and 2014...
May 12, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28482849/quality-of-life-of-depressed-and-suicidal-patients-seeking-services-from-traditional-and-faith-healers-in-rural-kenya
#16
Christine W Musyimi, Victoria N Mutiso, Sameera S Nayak, David M Ndetei, David C Henderson, Joske Bunders
BACKGROUND: In rural Kenya, traditional and faith healers provide an alternative pathway to health care, including mental health care. However, not much is known about the characteristics of the populations they serve. The purpose of this study was to determine the relationship between depression, suicidal ideation, and socio-demographic variables with Quality of Life (QoL) indicators in a sample seeking mental health services from traditional and faith healers in rural Kenya. Understanding QoL in this sample can help develop mental health policy and training to improve the well-being of this population...
May 8, 2017: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/28482674/management-of-hepatocellular-in-the-united-states
#17
Ali A Mokdad, Caitlin A Hester, Amit G Singal, Adam C Yopp
Hepatocellular carcinoma (HCC) is a major cause of cancer burden globally. In the United States, the incidence of HCC is forecast to continue to rise for the next 15 years. Patients with HCC vary markedly owing to heterogeneous tumor characteristics and concomitant liver dysfunction. In the United States and Europe, HCC is staged and managed according to the Barcelona Clinic Liver Cancer (BCLC) system. For very early and early stage HCC, or BCLC 0/A, liver transplant is the optimal treatment option. Liver resection and radiofrequency or microwave ablation are alternative treatment options...
April 2017: Chinese Clinical Oncology
https://www.readbyqxmd.com/read/28477347/p4-medicine-approach-to-obstructive-sleep-apnoea
#18
REVIEW
Diane C Lim, Kate Sutherland, Peter A Cistulli, Allan I Pack
P4 medicine is an evolving approach to personalized medicine. The four Ps offer a means to: Predict who will develop disease and co-morbidities; Prevent rather than react to disease; Personalize diagnosis and treatment; have patients Participate in their own care. P4 medicine is very applicable to obstructive sleep apnoea (OSA) because each OSA patient has a different pathway to disease and its consequences. OSA has both structural and physiological mechanisms with different clinical subgroups, different molecular profiles and different consequences...
July 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/28477230/a-matched-case-control-comparison-of-hospital-costs-and-outcomes-for-knee-replacement-patients-admitted-postoperatively-to-acute-care-versus-rehabilitation
#19
Brian K Tse, Tessa L Walters, Steven K Howard, T Edward Kim, Stavros G Memtsoudis, Eric C Sun, Alex Kou, Lorrie Graham, Robert King, Edward R Mariano
For select total knee arthroplasty (TKA) patients, we have established an alternative pathway to bypass the acute care surgical ward and directly admit patients from the post-anesthesia care unit to on-campus rehabilitation. We retrospectively examined whether this 'fast track' pathway decreased costs and improved patient outcomes. After reviewing records of consecutive primary unilateral TKA patients over a 15-month period, each patient admitted to rehabilitation was matched with a control admitted to the acute care ward...
May 5, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28449052/implementation-of-a-postoperative-outpatient-care-pathway-for-delayed-hyponatremia-following-transsphenoidal-surgery
#20
Michael A Bohl, Shahjehan Ahmad, William L White, Andrew S Little
BACKGROUND: After transsphenoidal surgery, delayed hyponatremia (DH) is the leading cause of 30-d unplanned hospital readmissions. OBJECTIVE: To determine the impact of a DH care pathway on 30-d readmissions after transsphenoidal surgery. METHODS: Data from before and after DH care pathway implementation were retrospectively reviewed. Patient demographics and clinical characteristics were compared. Readmission causes, clinical pathway failures, sodium trends, and symptoms were evaluated...
April 25, 2017: Neurosurgery
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