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https://www.readbyqxmd.com/read/27926675/improvement-in-total-joint-replacement-quality-metrics-year-one-versus-year-three-of-the-bundled-payments-for-care-improvement-initiative
#1
John M Dundon, Joseph Bosco, James Slover, Stephen Yu, Yousuf Sayeed, Richard Iorio
BACKGROUND: In January 2013, a large, tertiary, urban academic medical center began participation in the Bundled Payments for Care Improvement (BPCI) initiative for total joint arthroplasty, a program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. Medicare Severity-Diagnosis Related Groups (MS-DRGs) 469 and 470 were included. We participated in BPCI Model 2, by which an episode of care includes the inpatient and all post-acute care costs through 90 days following discharge...
December 7, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27926663/the-impact-of-value-based-healthcare-for-inflammatory-bowel-diseases-on-healthcare-utilization-a-pilot-study
#2
Welmoed K van Deen, Arlen Spiro, A Burak Ozbay, Martha Skup, Adriana Centeno, Natalie E Duran, Precious N Lacey, Darius Jatulis, Eric Esrailian, Martijn G H van Oijen, Daniel W Hommes
BACKGROUND AND OBJECTIVES: Value-based healthcare (VBHC) is considered to be the solution that will improve quality and decrease costs in healthcare. Many hospitals are implementing programs on the basis of this strategy, but rigorous scientific reports are still lacking. In this pilot study, we present the first-year outcomes of a VBHC program for inflammatory bowel disease (IBD) management that focuses on highly coordinated care, task differentiation of providers, and continuous home monitoring...
December 6, 2016: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27926622/reducing-chronic-obstructive-pulmonary-disease-30-day-readmissions-a-nurse-led-evidence-based-quality-improvement-project
#3
Joan Agee
Chronic obstructive pulmonary disease (COPD) is a debilitating disease resulting in frequent hospitalizations and increased healthcare costs. As leaders of multidisciplinary teams, acute care nurse leaders are challenged to reduce readmissions and costs. In October 2014, the Centers for Medicare and Medicaid Services expanded readmission penalties for 30-day readmissions to include COPD, making this an important issue for nurse leaders. This article describes how a regional medical center was able to decrease COPD readmissions...
January 2017: Journal of Nursing Administration
https://www.readbyqxmd.com/read/27926450/changing-health-behavior-motivation-from-i-must-to-i-want
#4
S Knecht, P Kenning
In the past, medicine was dominated by acute diseases. Since treatments were unknown to patients they followed their medical doctors´ directives-at least for the duration of the disease. Behavior was thus largely motivated by avoiding expected costs associated with alternative behaviors (I-must). The health challenges prevailing today are chronic conditions resulting from the way we chose to live. Traditional directive communication has not been successful in eliciting and maintaining appropriate lifestyle changes...
2016: Progress in Brain Research
https://www.readbyqxmd.com/read/27926449/the-role-of-dopamine-in-the-pathophysiology-and-treatment-of-apathy
#5
T T-J Chong, M Husain
Disorders of diminished motivation, such as apathy, are common and prevalent across a wide range of medical conditions, including Parkinson's disease, Alzheimer's dementia, stroke, depression, and schizophrenia. Such disorders have a significant impact on morbidity and quality of life, yet their management lacks consensus and remains unsatisfactory. Here, we review laboratory and clinical evidence for the use of dopaminergic therapies in the treatment of apathy. Dopamine is a key neurotransmitter that regulates motivated decision making in humans and other species...
2016: Progress in Brain Research
https://www.readbyqxmd.com/read/27926378/automated-segmentation-of-white-matter-fiber-bundles-using-diffusion-tensor-imaging-data-and-a-new-density-based-clustering-algorithm
#6
Tahereh Kamali, Daniel Stashuk
OBJECTIVE: Robust and accurate segmentation of brain white matter (WM) fiber bundles assists in diagnosing and assessing progression or remission of neuropsychiatric diseases such as schizophrenia, autism and depression. Supervised segmentation methods are infeasible in most applications since generating gold standards is too costly. Hence, there is a growing interest in designing unsupervised methods. However, most conventional unsupervised methods require the number of clusters be known in advance which is not possible in most applications...
October 2016: Artificial Intelligence in Medicine
https://www.readbyqxmd.com/read/27925145/the-oldest-old-in-the-emergency-department-impact-of-renal-function
#7
T Brünnler, M Drey, G Dirrigl, C Weingart, F Rockmann, C Sieber, U Hoffmann
OBJECTIVES: The ageing population implicates an increasing numbers of older adults attending Emergency Departments (ED). We assessed the effect of estimated glomerular filtration rate as a predictor of clinical outcomes in oldest-old patients ≥ 85 years attending the ED in an university teaching hospital. DESIGN: Within three years, 81831 patient contacts were made in our ED. 7799 (9.5%) were older than 85 years, in whom we analyzed the impact of renal function on various outcome parameters...
2016: Journal of Nutrition, Health & Aging
https://www.readbyqxmd.com/read/27924723/clinical-management-of-diabetes-mellitus-in-the-older-adult-patient
#8
Nana Yaw Adu-Sarkodie
BACKGROUND: In 2009, approximately 40 million people were 65 years or older. Majority of persons over the age of 65 have at least one chronic medical condition. In 2002-2003, the most frequently occurring conditions among older adults were hypertension (51%), arthritis (48%), heart disease (31%), cancer of any type (21%), and diabetes (16%). The cost of diabetes care, both direct and indirect, was $245 billion in 2012. Fifty-nine percent of the direct medical cost was for the population aged 65 and over...
December 6, 2016: Current Diabetes Reviews
https://www.readbyqxmd.com/read/27924429/cyp2c19-lof-and-gof-guided-antiplatelet-therapy-in-patients-with-acute-coronary-syndrome-a-cost-effectiveness-analysis
#9
Minghuan Jiang, Joyce H S You
PURPOSE: This study aimed to examine the cost-effectiveness of CYP2C19 loss-of-function and gain-of-function allele guided (LOF/GOF-guided) antiplatelet therapy in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). METHODS: A life-long decision-analytic model was designed to simulate outcomes of three strategies: universal clopidogrel (75 mg daily), universal alternative P2Y12 inhibitor (prasugrel 10 mg daily or ticagrelor 90 mg twice daily), and LOF/GOF-guided therapy (LOF/GOF allele carriers receiving alternative P2Y12 inhibitor, wild-type patients receiving clopidogrel)...
December 7, 2016: Cardiovascular Drugs and Therapy
https://www.readbyqxmd.com/read/27924215/influence-diagram-of-physiological-and-environmental-factors-affecting-heart-rate-variability-an-extended-literature-overview
#10
REVIEW
Julien Fatisson, Victor Oswald, François Lalonde
Heart rate variability (HRV) corresponds to the adaptation of the heart to any stimulus. In fact, among the pathologies affecting HRV the most, there are the cardiovascular diseases and depressive disorders, which are associated with high medical cost in Western societies. Consequently, HRV is now widely used as an index of health. In order to better understand how this adaptation takes place, it is necessary to examine which factors directly influence HRV, whether they have a physiological or environmental origin...
January 2016: Heart International
https://www.readbyqxmd.com/read/27924187/evaluating-outcomes-in-patients-with-overactive-bladder-within-an-integrated-healthcare-delivery-system-using-a-treatment-patterns-analyzer
#11
Daniel B Ng, Melissa McCart, Christopher Klein, Chelsey Campbell, Robert Schoenhaus, Todd Berner
BACKGROUND: Overactive bladder (OAB) is a relatively common disease that has been linked to a variety of comorbidities, reductions in quality of life, and increased healthcare costs. Antimuscarinic agents are the standard of care among pharmacologic treatments for OAB, but these drugs are linked to high levels of anticholinergic burden, especially in the elderly. OBJECTIVE: To demonstrate how efficient data analysis can be used to identify gaps in care as a result of improvement strategies for OAB within an integrated healthcare delivery system setting...
September 2016: American Health & Drug Benefits
https://www.readbyqxmd.com/read/27924105/innovating-affordable-neonatal-care-equipment-for-use-at-scale
#12
REVIEW
V Sashi Kumar, V K Paul, K Sathasivam
The care of small and sick neonates requires biomedical technologies, such as devices that can keep babies warm (radiant warmers and incubators), resuscitate (self-inflating bags), track growth (weighing scales), treat jaundice (phototherapy units) and provide oxygen or respiratory support (hoods, continuous positive airway pressure (CPAP) devices and ventilators). Until the 1990s, most of these products were procured through import at a high cost and with little maintenance support. Emerging demand and an informal collaboration of neonatologists, engineers and entrepreneurs has led to the production of good quality equipment of several high-volume categories at affordable cost in India...
December 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/27923864/outcomes-of-the-smoker-s-health-project-a-pragmatic-comparative-effectiveness-trial-of-tobacco-dependence-interventions-based-on-self-determination-theory
#13
Geoffrey C Williams, Christopher P Niemiec, Heather Patrick, Richard M Ryan, Edward L Deci
A pragmatic comparative effectiveness trial examined whether extending the duration of a cost-effective, intensive tobacco-dependence intervention designed to support autonomy will facilitate long-term tobacco abstinence. Participants were randomly assigned to one of three tobacco-dependence interventions based on self-determination theory, namely, Intensive Treatment (IT; six contacts over 6 months), Extended Need Support (ENS; eight contacts over 12 months) and Harm Reduction (HR; eight contacts over 12 months with medication use if willing to reduce cigarette use by half)...
December 2016: Health Education Research
https://www.readbyqxmd.com/read/27923764/applications-of-deep-eutectic-solvents-in-biotechnology-and-bioengineering-promises-and-challenges
#14
REVIEW
Yves Paul Mbous, Maan Hayyan, Adeeb Hayyan, Won Fen Wong, Mohd Ali Hashim, Chung Yeng Looi
Deep eutectic solvents (DESs) have been touted recently as potential alternatives to ionic liquids (ILs). Although they possess core characteristics that are similar to those of ILs (e.g., low volatility, non-flammability, low melting points, low vapor pressure, dipolar nature, chemical and thermal stability, high solubility, and tuneability), DESs are superior in terms of the availability of raw materials, the ease of storage and synthesis, and the low cost of their starting materials. As such, they have become the subject of intensive research in various sectors, notably the chemical, electrochemical, and biological sectors...
December 3, 2016: Biotechnology Advances
https://www.readbyqxmd.com/read/27923701/prognostic-significance-of-repeat-biopsy-in-lupus-nephritis-histopathologic-worsening-and-a-short-time-between-biopsies-is-associated-with-significantly-increased-risk-for-end-stage-renal-disease-and-death
#15
Cristina Arriens, Sixia Chen, David R Karp, Ramesh Saxena, Kamalanathan Sambandam, Eliza Chakravarty, Judith A James, Joan T Merrill
BACKGROUND/PURPOSE: Approximately half of patients with systemic lupus erythematosus (SLE) develop lupus nephritis (LN), a major cause of morbidity and early mortality in that disease. Prolonged renal inflammation is associated with irreversible kidney damage which confers a 30% risk of end stage renal disease (ESRD), making early, aggressive treatment mandatory. Failure to achieve therapeutic response or recurrence of renal flare often prompts repeat biopsy. However, the role of repeat biopsy in determining long-term renal prognosis remains controversial...
December 3, 2016: Clinical Immunology: the Official Journal of the Clinical Immunology Society
https://www.readbyqxmd.com/read/27923612/protocol-of-the-ktft-talk-study-to-reduce-racial-disparities-in-kidney-transplant-evaluation-and-living-donor-kidney-transplantation
#16
Kellee Bornemann, Emilee Croswell, Menna Abaye, Cindy L Bryce, Chung-Chou H Chang, Deborah S Good, Cathleen A Freehling Heiles, Mary Amanda Dew, L Ebony Boulware, Amit D Tevar, Larissa Myaskovsky
Living donor kidney transplantation (LDKT) is the optimal treatment for end-stage kidney disease (ESKD). The evaluation process for a kidney transplant is complex, time consuming, and burdensome to the ESKD patient. Also, race disparities exist in rates of transplant evaluation completion, transplantation, and LDKT. In December 2012 our transplant center implemented a streamlined, one-day evaluation process, dubbed Kidney Transplant Fast Track (KTFT). This paper describes the protocol of a two-part study to evaluate the effectiveness of KTFT at increasing transplant rates (compared to historical controls) and the TALK intervention (Talking About Live Kidney Donation) at increasing LDKT during KTFT...
December 3, 2016: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/27923549/assessing-the-value-of-mepolizumab-for-severe-eosinophilic-asthma-a-cost-effectiveness-analysis
#17
Melanie D Whittington, R Brett McQueen, Daniel A Ollendorf, Jeffrey A Tice, Richard H Chapman, Steven D Pearson, Jonathan D Campbell
BACKGROUND: Adding mepolizumab to standard treatment with inhaled corticosteroids and controller medications could decrease asthma exacerbations and use of long-term oral steroids in patients with severe disease and increased eosinophils; however, mepolizumab is costly and its cost effectiveness is unknown. OBJECTIVE: To estimate the cost effectiveness of mepolizumab. METHODS: A Markov model was used to determine the incremental cost per quality-adjusted life year (QALY) gained for mepolizumab plus standard of care (SoC) and for SoC alone...
December 3, 2016: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/27923381/economic-evaluation-of-artesunate-and-three-quinine-regimens-in-the-treatment-of-severe-malaria-in-children-at-the-ebolowa-regional-hospital-cameroon-a-cost-analysis
#18
Daniel Ethe Maka, Andreas Chiabi, Bolaji Obadeyi, Evelyn Mah, Séraphin Nguefack, Pamela Nana, Wilfred Mbacham, Elie Mbonda
BACKGROUND: Severe malaria is a leading cause of morbidity and mortality in under-fives in sub-Saharan Africa. Recently quinine has been replaced by artesunate as the first-line drug in the treatment of severe malaria in Cameroon. Artesunate has been shown to be cost-effective in African children, but whether these findings are transferable to Cameroonian children remains to be explored. OBJECTIVES: To conduct a cost-analysis of four different regimens used in the treatment from the perspective of the healthcare payer...
December 7, 2016: Malaria Journal
https://www.readbyqxmd.com/read/27922797/potential-obstacles-in-the-acquisition-of-oral-anticancer-medications
#19
Jennifer L Niccolai, Danielle L Roman, Justin M Julius, Rachelle W Nadour
PURPOSE: To determine the amount of time elapsed between prescriber order and patient receiving oral anticancer medication. PATIENTS AND METHODS: Adult patients with a diagnosis of cancer were prospectively identified in three outpatient oncology clinics when oral anticancer agents were prescribed during a 4-month observation period. For each patient, time to obtain medication was analyzed by the following time points: date of prescription, date of submission to insurance, date prior authorization was obtained, date financial assistance was received, date prescription was processed by pharmacy, and date patient received medication...
December 6, 2016: Journal of Oncology Practice
https://www.readbyqxmd.com/read/27922758/the-feasibility-of-implementing-a-communication-skills-training-course-in-pediatric-hematology-oncology-fellowship
#20
Lauren Weintraub, Lisa Figueiredo, Michael Roth, Adam Levy
Communication skills are a competency highlighted by the Accreditation Council on Graduate Medical Education; yet, little is known about the frequency with which trainees receive formal training or what programs are willing to invest. We sought to answer this question and designed a program to address identified barriers. We surveyed pediatric fellowship program directors from all disciplines and, separately, pediatric hematology/oncology fellowship program directors to determine current use of formal communication skills training...
December 6, 2016: Pediatric Hematology and Oncology
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