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Alternative care pathways

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https://www.readbyqxmd.com/read/28520694/metabolic-inflammatory-complex-in-sepsis-septic-cachexia-as-a-novel-potential-therapeutic-target
#1
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
#2
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
#3
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
#4
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
#5
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...
May 5, 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
#6
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
#7
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
https://www.readbyqxmd.com/read/28448782/amcp-partnership-forum-driving-value-and-outcomes-in-oncology
#8
(no author information available yet)
Innovation in cancer treatment has provided a wealth of recently available therapeutic agents and a healthy drug pipeline that promises to change the way we approach this disease and the lives of those affected in the years to come. However, the majority of these new agents, many of which are targeted to specific genomic features of various tumors, may challenge the health care system's ability to afford cancer care. This innovation drives the need to focus on the value of the treatments provided to patients with cancer and on methods to optimize the efficiency of the dollars we spend, in addition to the clinical value itself...
May 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28445713/deregulation-of-%C3%AE-synuclein-in-parkinson-s-disease-insight-from-epigenetic-structure-and-transcriptional-regulation-of-snca
#9
REVIEW
Subhrangshu Guhathakurta, Eugene Bok, Baggio A Evangelista, Yoon-Seong Kim
Understanding regulation of α-synuclein has long been a central focus for Parkinson's disease (PD) researchers. Accumulation of this protein in the Lewy body or neurites, mutations in the coding region of the gene and strong association of α-synuclein encoding gene multiplication (duplication/triplication) with familial form of PD have indicated the importance of this molecule in pathogenesis of the disease. Several years of research identified many potential faulty pathways associated with accumulation of α-synuclein inside dopaminergic neurons and its transmission to neighboring ones...
April 23, 2017: Progress in Neurobiology
https://www.readbyqxmd.com/read/28444767/the-dual-orexin-receptor-antagonist-dora-22-lowers-histamine-levels-in-the-lateral-hypothalamus-and-prefrontal-cortex-without-lowering-hippocampal-acetylcholine
#10
Lihang Leon Yao, Andres Ramirez, Anthony J Roecker, Steven Fox, Jason Uslaner, Sean M Smith, Robert Hodgson, Paul J Coleman, John J Renger, Christopher J Winrow, Anthony L Gotter
Chronic insomnia is defined as a persistent difficulty with sleep initiation maintenance or non-restorative sleep. The therapeutic standard of care for this condition is treatment with gamma-aminobutyric acid (GABA)A receptor modulators, which promote sleep but are associated with a panoply of side effects, including cognitive and memory impairment. Dual orexin receptor antagonists (DORAs) have recently emerged as an alternative therapeutic approach that acts via a distinct and more selective wake-attenuating mechanism with the potential to be associated with milder side effects...
April 26, 2017: Journal of Neurochemistry
https://www.readbyqxmd.com/read/28438503/expanding-role-of-certified-electronic-health-records-technology-in-radiology-the-macra-mandate
#11
Gregory N Nicola, Andrew B Rosenkrantz, Joshua A Hirsch, Ezequiel Silva, Keith J Dreyer, Michael P Recht
Radiology has historically been at the forefront of innovation and the advancement of technology for the benefit of patient care. However, challenges to early implementation prevented most radiologists from adopting and integrating certified electronic health record technology (CEHRT) into their daily workflow despite the early and potential advantages it offered. This circumstance places radiology at a disadvantage in the two payment pathways of the Medicare Access and CHIP Reauthorization Act of 2015: the Merit-Based Incentive Payment System (MIPS) and advanced alternative payment models (APMs)...
April 19, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28438453/effect-of-bundled-payments-and-health-care-reform-as-alternative-payment-models-in-total-joint-arthroplasty-a-clinical-review
#12
REVIEW
Ahmed Siddiqi, Peter B White, Jaydev B Mistry, Chukwuweike U Gwam, James Nace, Michael A Mont, Ronald E Delanois
BACKGROUND: In an effort to control rising healthcare costs, healthcare reforms have developed initiatives to evaluate the efficacy of alternative payment models (APMs) for Medicare reimbursements. The Center for Medicare and Medicaid Services Innovation Center (CMMSIC) introduced the voluntary Bundled Payments for Care Improvement (BPCI) model experiment as a means to curtail Medicare cost by allotting a fixed payment for an episode of care. The purpose of this review is to (1) summarize the preliminary clinical results of the BPCI and (2) discuss how it has led to other healthcare reforms and alternative payment models...
March 20, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28398118/the-role-of-the-hydrogen-sulfide-pathway-in-male-and-female-urogenital-system-in-health-and-disease
#13
Roberta d'Emmanuele di Villa Bianca, Ferdinando Fusco, Vincenzo Mirone, Giuseppe Cirino, Raffaella Sorrentino
SIGNIFICANCE: The endogenous hydrogen sulfide (H2S) pathway produces an array of biological effects that vary depending on the bodily region. In addition, the H2S pathway's relevance often changes depending on a healthy or disease state. There is abundant evidence pointing to a key role for this pathway in male and female genito-urinary diseases, suggesting it as a possible target for new therapeutic approaches. Recent Advances: The tissue-specific localization of the H2S enzymes in the genito-urinary tract has allowed for a better understanding of its role in the body's pathophysiology...
May 19, 2017: Antioxidants & Redox Signaling
https://www.readbyqxmd.com/read/28389865/what-is-the-long-term-economic-societal-effect-of-periprosthetic-infections-after-tha-a-markov-analysis
#14
Thomas J Parisi, Joseph F Konopka, Hany S Bedair
BACKGROUND: Current estimates for the direct costs of a single episode of care for periprosthetic joint infection (PJI) after THA are approximately USD 100,000. These estimates do not account for the costs of failed treatments and do not include indirect costs such as lost wages. QUESTIONS/PURPOSES: The goal of this study was to estimate the long-term economic effect to society (direct and indirect costs) of a PJI after THA treated with contemporary standards of care in a hypothetical patient of working age (three scenarios, age 55, 60, and 65 years)...
April 7, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28365040/future-considerations-for-clinical-dermatology-in-the-setting-of-21st-century-american-policy-reform-the-medicare-access-and-children-s-health-insurance-program-reauthorization-act-and-alternative-payment-models-in-dermatology
#15
John S Barbieri, Jeffrey J Miller, Harrison P Nguyen, Howard P Forman, Jean L Bolognia, Marta J VanBeek
With the introduction of the Medicare Access and Children's Health Insurance Program Reauthorization Act, clinicians who are not eligible for an exemption must choose to participate in 1 of 2 new reimbursement models: the Merit-based Incentive Payment System or Alternative Payment Models (APMs). Although most dermatologists are expected to default into the Merit-based Incentive Payment System, some may have an interest in exploring APMs, which have associated financial incentives. However, for dermatologists interested in the APM pathway, there are currently no options other than joining a qualifying Accountable Care Organization, which make up only a small subset of Accountable Care Organizations overall...
March 30, 2017: Journal of the American Academy of Dermatology
https://www.readbyqxmd.com/read/28351834/cutaneous-manifestations-of-tuberous-sclerosis-complex-and-the-paediatrician-s-role
#16
REVIEW
Michael A Cardis, Cynthia Marie Carver DeKlotz
Tuberous sclerosis complex (TSC) is a multisystem genetic disorder stemming from unregulated activation of the mammalian target of rapamycin (mTOR) pathway, resulting in the growth of hamartomas in multiple organs. TSC-related skin lesions often develop early in life and can be disfiguring, emotionally distressful and even painful at times. Recognition of TSC-associated skin features by paediatricians can be a catalyst for facilitating early implementation of treatment strategies and establishing appropriate follow-up care...
March 28, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28338918/integrated-mirna-and-mrna-expression-profiling-reveals-the-response-regulators-of-a-susceptible-tomato-cultivar-to-early-blight-disease
#17
Deepti Sarkar, Ranjan Kumar Maji, Sayani Dey, Arijita Sarkar, Zhumur Ghosh, Pallob Kundu
Early blight, caused by the fungus Alternaria solani, is a devastating foliar disease of tomatoes, causes massive yield loss each year worldwide. Molecular basis of the compatible host-pathogen interaction was elusive. We adopted next generation sequencing approach to decipher miRNAs and mRNAs that are differentially expressed during Alternaria-stress in tomato. Some of the interesting findings were also validated by alternative techniques. Our analysis revealed 181 known-miRNAs, belonging to 121 miRNA families, of which 67 miRNAs showed at least 2-fold change in expression level with the majority being downregulated...
March 3, 2017: DNA Research: An International Journal for Rapid Publication of Reports on Genes and Genomes
https://www.readbyqxmd.com/read/28334681/fluorescent-proteins-such-as-egfp-lead-to-catalytic-oxidative-stress-in-cells
#18
Douglas Ganini, Fabian Leinisch, Ashutosh Kumar, JinJie Jiang, Erik J Tokar, Christine C Malone, Robert M Petrovich, Ronald P Mason
Fluorescent proteins are an important tool that has become omnipresent in life sciences research. They are frequently used for localization of proteins and monitoring of cells [1,2]. Green fluorescent protein (GFP) was the first and has been the most used fluorescent protein. Enhanced GFP (eGFP) was optimized from wild-type GFP for increased fluorescence yield and improved expression in mammalian systems [3]. Many GFP-like fluorescent proteins have been discovered, optimized or created, such as the red fluorescent protein TagRFP [4]...
March 10, 2017: Redox Biology
https://www.readbyqxmd.com/read/28333693/pediatric-intestinal-failure-associated-liver-disease
#19
Cathleen M Courtney, Brad W Warner
PURPOSE OF REVIEW: The goal of this review is to provide updates on the definition, pathophysiology, treatment, and prevention of intestinal failure-associated liver disease (IFALD) that are relevant to care of pediatric patients. RECENT FINDINGS: Current literature emphasizes the multifactorial nature of IFALD. The pathogenesis is still largely unknown; however, molecular pathways have been identified. Key to these pathways are proinflammatory cytokines involved in hepatic inflammation and bile acids synthesis such as Toll-like receptor 4 and farnesoid X receptor, respectively...
June 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28328372/psychiatric-genomics-and-mental-health-treatment-setting-the-ethical-agenda
#20
Camillia Kong, Michael Dunn, Michael Parker
Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making...
April 2017: American Journal of Bioethics: AJOB
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