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Alternative care pathways

M N Kirshbaum, J Dent, J Stephenson, A E Topping, V Allinson, M McCoy, S Brayford
This study evaluated the acceptability of a supportive model of follow-up. One hundred and twelve women recovering from breast cancer were randomised to receive standard breast clinic aftercare (Control n = 56) or on demand by open access aftercare by breast care nurses (Intervention n = 56). Participants attended a support-based psycho-educational programme delivered in four half-day group sessions. Three quality of life questionnaires (EORTC QLQ-C30, QLQ-BR23, HADS) were administered at baseline and 6-monthly intervals for 2 years...
September 26, 2016: European Journal of Cancer Care
Christopher Crowley, Amy R Stuck, Tracy Martinez, Alan C Wittgrove, Feng Zeng, Jesse J Brennan, Theodore C Chan, James P Killeen, Edward M Castillo
BACKGROUND: Almost 70% of hospital admissions for Medicare beneficiaries originate in the emergency department (ED). Research suggests that some of these patients' needs may be better met through home-based care options after evaluation and treatment in the ED. OBJECTIVE: We sought to estimate Medicare cost savings resulting from using the Home Health benefit to provide treatment, when appropriate, as an alternative to inpatient admission from the ED. METHODS: This is a prospective study of patients admitted from the ED...
September 28, 2016: Journal of Emergency Medicine
Aurélie Duruflé, Claire Le-Meur, Marie-Pierre Reillon, Claire Lozach, Benoit Nicolas
Many mobile teams were created over the past decade in various medical specialties including physical medicine and rehabilitation (MPR). The Pôle Saint-Helier has created a mobile team of rehabilitation-reintegration (EM2R) in December 2012 with support from the Regional Health Agency of Brittany. It operates on the health territory No. 5 of Brittany near people experiencing neurological disability. Its main mission is to implement the necessary devices to facilitate the home return of people hospitalized after a neurological event or maintaining to home people with neurological disorders...
September 2016: Annals of Physical and Rehabilitation Medicine
Naftali Stern
As both the rate of hypertension and cancer rise with age, concomitant hypertension in patients receiving treatment for cancer is very common. Increase in blood pressure during cancer treatment requires careful clinical assessment. Distinction between discontinuation or malabsorption of antihypertensive treatment due to factors such as nausea/vomiting/diarrhea and anti-cancer drug specific effects must be first made. De-novo hypertension during cancer treatment is likely related to anticancer drugs per se. Classical chemotherapeutic agents such as cyclophosphamide, cisplatin and busulfan have been previously linked to rising blood pressure...
September 2016: Journal of Hypertension
Karina J Lewis, Leo Ross, Michel W Coppieters, Bill Vicenzino, Annina B Schmid
INTRODUCTION: Carpal tunnel syndrome (CTS) is a prevalent upper limb condition that results in significant individual and socioeconomic costs. Large patient numbers, long outpatient waiting times and traditional referral pathways in public health systems create delays in accessing treatment for this condition. Alternative care pathways aimed at streamlining access to treatment and reducing the need for surgical intervention warrant further investigation. METHODS: A randomised, single-blind controlled clinical trial will be conducted...
2016: BMJ Open
Bindu V Manyam, Rahul Tendulkar, Sheen Cherian, Frank Vicini, Shahed N Badiyan, Chirag Shah
PURPOSE/OBJECTIVE(S): After breast conserving surgery, adjuvant radiation therapy represents the standard of care for most patients. However, multiple options exist beyond standard fractionated whole breast irradiation including hypofractionated whole breast irradiation (HFRT), accelerated partial breast irradiation (APBI), and endocrine therapy (ET) alone, which can limit treatment duration, and potentially reduce morbidity and cost. Limited data are available on the percentage of patients eligible for these alternatives; therefore, a Surveillance Epidemiology and End Results (SEER) analysis was performed to assess candidacy for these alternative options in women with early stage breast cancer...
September 15, 2016: American Journal of Clinical Oncology
Phaik Yeong Cheah, Michael Parker, Arjen M Dondorp
Over 90% of deaths attributable to malaria are in African children under 5 years old. Yet, new treatments are often tested primarily in adult patients and extrapolations have proven to be sometimes invalid, especially in dosing regimens. For studies in severe malaria an additional complication is that the decline in severe malaria in adult patients precludes sufficiently powered trials in adults, before the intervention can be tested in the ultimate target group, paediatric severe malaria. In this paper we propose an alternative pathway to the development of drugs for use in paediatric severe malaria...
September 2016: International Health
Cameron C Trenor
We have entered an exciting era in the care of patients with vascular anomalies. These disorders require multidisciplinary care and coordination and dedicated centers have emerged to address this need. Vascular tumors have been treated with medical therapies for many years, while malformations have been historically treated with endovascular and operative procedures. The recent serendipitous discoveries of propranolol and sirolimus for vascular anomalies have revolutionized this field. In particular, sirolimus responses are challenging the dogma that vascular malformations are not biologically active...
September 2016: Seminars in Cutaneous Medicine and Surgery
Brett P Bielory, Steven P Shah, Terrence P O'Brien, Victor L Perez, Leonard Bielory
PURPOSE OF REVIEW: The present review provides an overview on the potential of different systemic and topical treatments in chronic forms of ocular allergy and dry eye disorder (DED). The impact on anterior surface of ocular inflammatory disorder encompasses an array of conditions, which are frequently underreported. This can contribute to underdiagnoses and ineffective management from healthcare providers such as an allergist and/or ophthalmologist who routinely provide care for these common disorders...
October 2016: Current Opinion in Allergy and Clinical Immunology
Anita Salamonsen, Mona A Kiil, Agnete Egilsdatter Kristoffersen, Trine Stub, Gro R Berntsen
BACKGROUND: The concept of "patient pathways" in cancer care is most commonly understood as clinical pathways, operationalized as standardized packages of health care based on guidelines for the condition in question. In this understanding, patient pathways do not address multimorbidity or patient experiences and preferences. This study explored patient pathways understood as the individual and cultural life course, which includes both life and health events. The overall aim was to contribute to supportive and targeted cancer care...
2016: Patient Preference and Adherence
Frederic Chagnon, David Coquerel, Dany Salvail, Eric Marsault, Robert Dumaine, Mannix Auger-Messier, Philippe Sarret, Olivier Lesur
OBJECTIVE: Dobutamine is the currently recommended β-adrenergic inotropic drug for supporting sepsis-induced myocardial dysfunction when cardiac output index remains low after preload correction. Better and safer therapies are nonetheless mandatory because responsiveness to dobutamine is limited with numerous side effects. Apelin-13 is a powerful inotropic candidate that could be considered as an alternative noncatecholaminergic support in the setting of inflammatory cardiovascular dysfunction...
August 26, 2016: Critical Care Medicine
Donna L Littlewood, Patricia Gooding, Simon D Kyle, Daniel Pratt, Sarah Peters
OBJECTIVE: Sleep problems are associated with increased risk of suicide, independent of depression. This analysis explores narrative accounts of the role of sleep in relation to suicidal thoughts and behaviours. DESIGN: Qualitative study, based on in-depth semistructured interviews which were analysed with an inductive, latent thematic analysis. PARTICIPANTS: A maximum variation sample of 18 people with experience of a major depressive episode, and suicidal thoughts and behaviours...
2016: BMJ Open
Caroline E Fryer, Julie A Luker, Michelle N McDonnell, Susan L Hillier
BACKGROUND: Stroke results from an acute lack of blood supply to the brain and becomes a chronic health condition for millions of survivors around the world. Self management can offer stroke survivors a pathway to promote their recovery. Self management programmes for people with stroke can include specific education about the stroke and likely effects but essentially, also focusses on skills training to encourage people to take an active part in their management. Such skills training can include problem-solving, goal-setting, decision-making, and coping skills...
2016: Cochrane Database of Systematic Reviews
Mahmoud A O Dawood, Shunsuke Koshio, Manabu Ishikawa, Mabrouk El-Sabagh, M Angeles Esteban, Amr I Zaineldin
A usual strategy in modern aquaculture to combat production bottlenecks associated with intensification is preventive health care through the use of consumer and environment-friendly alternatives including probiotics. The current study evaluates the influence of Lactobacillus rhamnosus (LR), a lyophilized probiotic bacterium, on health status and performance of red sea bream (Pagrus major). Probiotics were incorporated in the diets at four different concentrations: 0 (control diet, LR0), 10(2) (LR1), 10(4) (LR2) and 10(6) (LR3) cells g(-1) and diets were administered to the fish for a period of 8 weeks...
October 2016: Fish & Shellfish Immunology
Jesse M Pines, Frank McStay, Meaghan George, Jennifer L Wiler, Mark McClellan
Current alternative payment models (APMs) that move away from traditional fee-for-service payment often have explicit goals to reduce utilization in episodic settings, such as emergency departments (ED). We apply the new HHS payment reform taxonomy to illustrate a pathway to success for EDs in APMs. Despite the unique challenges faced by EDs, a variety of category 2 and 3 APMs may be applicable to EDs in the short- and long term to improve efficiency and value. Full and partially capitated models create incentives for longitudinal and episodic ED providers and payers to unite to create interventions to reduce costs...
August 2016: American Journal of Managed Care
F Jentzsch, O Olsson, J Westphal, M Reich, C Leder, K Kümmerer
To prevent water shortages in the future and to reduce domestic water consumption, decentralized grey water (GW) reuse has become increasingly important. This water has, however, to be free of pollutants. Conventional treatment of GW does not fully eliminate micropollutants such as the UV filter substance ethylhexyl methoxycinnamate (EHMC). EHMC, which is commonly used in sunscreens and personal care products, is an endocrine disruptor and shows potential to bioaccumulation, which is also reflected in its low water solubility...
August 13, 2016: Science of the Total Environment
Luis Antonio Pérez-García, Iván Martínez-Duncker, Héctor M Mora Montes
Protein glycosylation is a widely distributed posttranslational modification, though not exclusive to eukaryotic cells. The addition of glycans to proteins plays crucial roles in protein folding and secretion, cell-cell interaction, functional specificity and structural properties of both secreted and membrane-bound proteins. In this review, we emphasize the N-linked glycosylation pathway found in eukaryotic cells, the contribution of processing α-glycosidases, and the use of such enzymes as potential drug targets to control some medically relevant viral infections...
August 13, 2016: Current Protein & Peptide Science
Nadia Belmatoug, Maja Di Rocco, Cristina Fraga, Pilar Giraldo, Derralynn Hughes, Elena Lukina, Pierre Maison-Blanche, Martin Merkel, Claus Niederau, Ursula Plӧckinger, Johan Richter, Thomas M Stulnig, Stephan Vom Dahl, Timothy M Cox
PURPOSE: In Gaucher disease, diminished activity of the lysosomal enzyme, acid β-glucosidase, leads to accumulation of glucosylceramides and related substrates, primarily in the spleen, liver, and bone marrow. Eliglustat is an oral substrate reduction therapy approved in the European Union and the United States as a first-line treatment for adults with type 1 Gaucher disease who have compatible CYP2D6 metabolism phenotypes. A European Advisory Council of experts in Gaucher disease describes the characteristics of eliglustat that are distinct from enzyme augmentation therapy (the standard of care) and miglustat (the other approved substrate reduction therapy) and recommends investigations and monitoring for patients on eliglustat therapy within the context of current recommendations for Gaucher disease management...
August 10, 2016: European Journal of Internal Medicine
Dominique Stoppa-Lyonnet
BRCA1 and BRCA2 are tumour-suppressor genes encoding proteins that are essential for the repair of DNA double-strand breaks by homologous recombination (HR). Cells that lack either BRCA1 or BRCA2 repair these lesions by alternative, more error-prone mechanisms. Individuals carrying germline pathogenic mutations in BRCA1 or BRCA2 are at highly elevated risk of developing breast and/or ovarian cancer. Genetic testing for germline pathogenic mutations in BRCA1 and BRCA2 has proved to be a valuable tool for determining eligibility for cancer screening and prevention programmes...
September 2016: European Journal of Human Genetics: EJHG
Cécile Couchoud, Brenda Hemmelgarn, Peter Kotanko, Michael J Germain, Olivier Moranne, Sara N Davison
In using a patient-centered approach, neither a clinician nor a prognostic score can predict with absolute certainty how well a patient will do or how long he will live; however, validated prognostic scores may improve accuracy of prognostic estimates, thereby enhancing the ability of the clinicians to appreciate the individual burden of disease and the prognosis of their patients and inform them accordingly. They may also facilitate nephrologist's recommendation of dialysis services to those who may benefit and proposal of alternative care pathways that might better respect patients' values and goals to those who are unlikely to benefit...
August 10, 2016: Clinical Journal of the American Society of Nephrology: CJASN
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