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Care management

K Holstein, A Batorova, M Carvalho, K Fijnvandraat, P Holme, K Kavakli, T Lambert, A Rocino, V Jiménez-Yuste, J Astermark
INTRODUCTION: Inhibitor development in people with haemophilia is a serious complication that may require intensive and costly interventions. The goal of inhibitor management should be permanent inhibitor eradication through immune tolerance induction (ITI), but well-designed studies are lacking and the management of patients is therefore defined by the experience and views of the clinician. OBJECTIVES: To explore the current clinical practice and outcome of ITI therapy in Europe and how this may have changed over the last decade, as well as to provide consensus recommendations to guide clinicians in their clinical practice...
October 15, 2016: Thrombosis Research
C Teljeur, P S Moran, S Walshe, S M Smith, F Cianci, L Murphy, P Harrington, M Ryan
AIMS: To systematically review the evidence on the costs and cost-effectiveness of self-management support interventions for people with diabetes. BACKGROUND: Self-management support is the provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, potentially leading to improvements in HbA1c levels in people with diabetes. METHODS: Randomized controlled trials, observational studies or economic modelling studies were eligible for inclusion in the review...
October 22, 2016: Diabetic Medicine: a Journal of the British Diabetic Association
Kara J Walters, Anna Meador, John A Galdo, Katharine Ciarrocca
Coagulation disorders account for a high incidence of death in the U.S. due to stroke, myocardial infarction, and venous thromboembolism. In the past few years, numerous agents have been brought to market for the treatment of thromboembolism or prevention of thromboembolism. Similar to warfarin, these agents can cause bleeding disorders, which may exacerbate dental care treatment plans. This literature review examines the newer agents for the treatment of thromboembolism disorders, common side effects and drug interactions, the specific medical conditions each agent treats, and the dental perspective on how to medically management patients prescribed these medications...
October 22, 2016: Special Care in Dentistry
T Kuchuloria, T Akhvlediani, N Akhvlediani
This root cause analysis concerns the conflict in the Eastern Ukraine and its impact on healthcare delivery in the context of treating internally displaced persons (IDPs). Inadequate treatment of tuberculosis (TB) was selected as a major topic for intervention planning in conflict areas in Ukraine. With respect to treating TB among IDPs, rapid diagnosis and adequate nutrition and shelter are important components of care and disease control. The DOT, supported by trained primary healthcare providers equipped with rapid MDR TB diagnostic capacities, need to provide appropriate shelter and nutrition to IDPs...
September 2016: Georgian Medical News
M Kajaia, M Butsashvili, L Gulbiani, Kh Khatiashvili, K Mindeli, N Osepaishvili, K Gordeladze, A Kobaek, G Kamkamidze
In 2014-2016, the Georgia Red Cross Society (GRCS) implemented a project to improve diabetes prevention, detection and care in rural Georgia, namely in the Gardabani district. The KAP survey was conducted to determine current levels of knowledge, attitudes and practices regarding diabetes among the general population in the Gardabani district. We compared current findings with baseline results from a 2014 survey to identify trends. A cross sectional study design with multi-stage random sampling was used to select participants...
September 2016: Georgian Medical News
M Kochlamazashvili, Kh Khatiashvili, M Butsashvili, O Chubinishvili, Sh Khetsuriani, G Kamkamidze
In Georgia, causative agents among infants with systemic infections are generally not identified and "neonatal sepsis" is usually diagnosed and treated without determining the etiology. The objective of this study was to estimate the role of viral pathogens (Herpesviridae and Enteroviruses) among neonates with generalized infections. A cross-sectional study was performed among neonates younger than <8 weeks admitted to a neonatal intensive care unit (NICU) at the two largest pediatric hospitals in Tbilisi, Georgia...
September 2016: Georgian Medical News
Marleen Kunneman, Victor M Montori, Ana Castaneda-Guarderas, Erik P Hess
Both the practice of medicine and the expectations of patients regarding their care are changing. A point of confluence is in the need for medicine to be more patient centered, and in the need for patients to be more involved in their care.(1,2) This confluence is particularly pertinent when more than one reasonable approach is available to manage the patient's situation, and when those approaches differ in ways that matter to patients.(3) In shared decision-making (SDM), clinicians and patients work together to understand the patient's situation and to determine how best to address it...
October 21, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Magdalena M Sakowska, Megan V Thomas, Saxon Connor, Ross Roberts
BACKGROUND: In measuring quality of health-care delivery, digital infrastructure is essential. The aim at this tertiary centre was to create a hospital-wide workflow system that collected data prospectively as part of daily practice. METHODS: In moving towards an electronic health record, a hospital-wide integrated workflow system was introduced in 2013, which electronically managed the perioperative patient journey while simultaneously facilitating surgical audit...
October 21, 2016: ANZ Journal of Surgery
Sathyaseelan Subramaniam, Jacqueline Bober, Jennifer Chao, Shahriar Zehtabchi
BACKGROUND: Traditionally, emergency department (ED) physicians rely on their clinical examination to differentiate between cellulitis and abscess when evaluating skin and soft tissue infections (SSTI). Management of an abscess requires incision and drainage, whereas cellulitis generally requires a course of antibiotics. Misdiagnosis often results in unnecessary invasive procedures, sedations (for incision and drainage in pediatric patients), or a return ED visit for failed antibiotic therapy...
October 21, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
S J Lain, C L Roberts, D M Bond, J Smith, J M Morris
OBJECTIVE: This study is an economic evaluation of immediate birth compared with expectant management in women with preterm prelabour rupture of the membranes near term (PPROMT). DESIGN: A cost-effectiveness analysis alongside the PPROMT randomised controlled trial. SETTING: Obstetric departments in 65 hospitals across 11 countries. POPULATION: Women with a singleton pregnancy with ruptured membranes between 34(+0) and 36(+6) weeks gestation...
October 21, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
D Donegan, N Singh Ospina, R Rodriguez-Gutierrez, Z Al-Hilli, G B Thompson, B L Clarke, W F Young
BACKGROUND: In patients with multiple endocrine neoplasia type 1 (MEN-1), pancreaticoduodenal (PD) neuroendocrine tumors (NETs) are associated with early mortality, yet, the best treatment strategy, remains uncertain. AIM: To assess patient important outcomes (mortality and metastasis) of PD NETs and predictors of outcomes in patients with MEN-1. METHODS: Retrospective cohort of patients with MEN-1 who attended the Mayo Clinic, Rochester, MN from 1997-2014...
October 21, 2016: Clinical Endocrinology
Hong Shang, Subramaniam Sukumar, Cornelius von Morze, Robert A Bok, Irene Marco-Rius, Adam Kerr, Galen D Reed, Eugene Milshteyn, Michael A Ohliger, John Kurhanewicz, Peder E Z Larson, John M Pauly, Daniel B Vigneron
PURPOSE: Balanced steady-state free precession (bSSFP) sequences can provide superior signal-to-noise ratio efficiency for hyperpolarized (HP) carbon-13 ((13) C) magnetic resonance imaging by efficiently utilizing the nonrecoverable magnetization, but managing their spectral response is challenging in the context of metabolic imaging. A new spectrally selective bSSFP sequence was developed for fast imaging of multiple HP (13) C metabolites with high spatiotemporal resolution. THEORY AND METHODS: This novel approach for bSSFP spectral selectivity incorporates optimized short-duration spectrally selective radiofrequency pulses within a bSSFP pulse train and a carefully chosen repetition time to avoid banding artifacts...
October 21, 2016: Magnetic Resonance in Medicine: Official Journal of the Society of Magnetic Resonance in Medicine
Andrew S Hwang, Steven J Atlas, Johan Hong, Jeffrey M Ashburner, Adrian H Zai, Richard W Grant, Clemens S Hong
BACKGROUND: A better understanding of the attributes of patients who require more effort to manage may improve risk adjustment approaches and lead to more efficient resource allocation, improved patient care and health outcomes, and reduced burnout in primary care clinicians. OBJECTIVE: To identify and characterize high-effort patients from the physician's perspective. DESIGN: Cohort study. PARTICIPANTS: Ninety-nine primary care physicians in an academic primary care network...
October 21, 2016: Journal of General Internal Medicine
Efe Levent Aras, Cody Bunger, Ebbe Stender Hansen, Rikke Søgaard
BACKGROUND AND PURPOSE: There is a lack of evidence on the broad health-care costs of treating spine trauma patients without neurological deficits conservatively. The aim of the present study was to estimate the primary and secondary health-care sector costs associated with conservative treatment of spine fractures as well as their determinants. METHODS: Patients were identified between 1999 and 2008 in the hospital's administrative system based on relevant diagnostic codes...
October 21, 2016: European Spine Journal
Douglas W Jones, Kirsten Dansey, Allen D Hamdan
Patients with end-stage renal disease (ESRD) who present with critical limb ischemia (CLI) have become an increasingly common and complex treatment problem for vascular surgeons. Dialysis patients have high short-term mortality rates regardless of whether revascularization is pursued. ESRD patients with CLI can be managed with: local wound care, endovascular or surgical revascularization, or amputation. Some patients may heal small foot wounds with local wound care alone, even if distal perfusion is marginal, as long as any infectious process has been controlled...
October 20, 2016: Vascular and Endovascular Surgery
Jason Mackey, Jane C Khoury, Kathleen Alwell, Charles J Moomaw, Brett M Kissela, Matthew L Flaherty, Opeolu Adeoye, Daniel Woo, Simona Ferioli, Felipe De Los Rios La Rosa, Sharyl Martini, Pooja Khatri, Joseph P Broderick, Mario Zuccarello, Dawn Kleindorfer
OBJECTIVE: To characterize temporal trends in subarachnoid hemorrhage (SAH) incidence and outcomes over 5 time periods in a large population-based stroke study in the United States. METHODS: All SAHs among residents of the Greater Cincinnati/Northern Kentucky region at least 20 years of age were identified and verified via study physician review in 5 distinct year-long study periods between 1988 and 2010. We abstracted demographics, care patterns, and outcomes, and we compared incidence and case-fatality rates across the study periods...
October 21, 2016: Neurology
Jennifer C Cook, Richard H Tran, J Herbert Patterson, Jo E Rodgers
PURPOSE: The pharmacology, clinical efficacy, and safety profiles of evolving therapies for the management of chronic heart failure (HF) and acute decompensated heart failure (ADHF) are described. SUMMARY: HF confers a significant financial burden despite the widespread use of traditional guideline-directed medical therapies such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and aldosterone receptor antagonists, and the rates of HF-related mortality and hospitalization have remained unacceptably high...
November 1, 2016: American Journal of Health-system Pharmacy: AJHP
Clement Chung
PURPOSE: Current strategies for managing neuroendocrine tumors (NETs) in adult patients are reviewed, with a focus on medication safety concerns. SUMMARY: NETs usually originate in the gastrointestinal or bronchopulmonary tract. Symptoms due to hormonal hypersecretion often occur in patients with foregut or midgut NETs or liver metastases. Surgical resection is recommended for most localized NETs, while systemic cytotoxic chemotherapy is typically used for high-grade and pancreatic tumors...
November 1, 2016: American Journal of Health-system Pharmacy: AJHP
Nicole M Orr, Rebecca S Boxer, Mary A Dolansky, Larry A Allen, Daniel E Forman
Skilled nursing facilities (SNF) have emerged as an integral component of care for older adults with heart failure (HF). Despite their prominent role, poor clinical outcomes for the medically complex patients with HF managed in SNFs are common. Barriers to providing quality care include poor transitional care during hospital-to-SNF and SNF-to-community discharges, lack of HF training among SNF staff, and a lack of a standardized care process among SNF facilities. While no evidence-based practice standards have been established, various measures and tools designed to improve HF management in SNFs are being investigated...
October 18, 2016: Journal of Cardiac Failure
David W Schopfer, Daniel E Forman
Cardiac rehabilitation (CR) is a comprehensive lifestyle program that can have particular benefit for older patients with heart failure (HF). Prevalence of HF is increasingly common among older adults. Mounting effects of cardiovascular risk factors in older age as well as the added effects of geriatric syndromes such as multimorbidity, frailty, and sedentariness contribute to the high incidence of HF as well as to management difficulty. Cardiac rehabilitation can play a decisive role in improving function, quality of life, symptoms, morbidity, and mortality, and also address the idiosyncratic complexities of care that often arise in old age...
October 18, 2016: Journal of Cardiac Failure
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