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https://www.readbyqxmd.com/read/28550348/medication-regimen-complexity-and-prevalence-of-potentially-inappropriate-medicines-in-older-patients-after-hospitalisation
#1
Wei Terk Chang, Stefan R Kowalski, Wassana Sorich, Christopher P Alderman
Background There is a relative paucity of information to characterise potential changes in medication regimen complexity and prevalence of prescribing of potentially inappropriate medications after hospitalisation, both in Australia and elsewhere. Objective To evaluate medication regimen complexity and the prevalence of potentially inappropriate medications before and after admission to hospital. Setting General medical units of a tertiary care hospital in Australia. Methods Retrospective cohort study of patients aged 65 years and above...
May 26, 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28550145/paediatric-innovation-in-pakistan-our-experience-and-a-call-to-action
#2
Walid Farooqi, Faysal Subhani, Asad Mian
Standardisation in paediatric medicine may have the unintended effect of stifling innovation. Thinking outside the box becomes even more important in low-income to middle-income countries like Pakistan, where a large paediatric population requires healthcare. In addition, there is always a lack of funds, making an innovative, low-cost and high impact solution all the more necessary. While regulation and formal research is an integral part of the process, the local synthesis of a solution must start with a creative idea...
May 26, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28549789/systematic-approaches-to-adverse-events-in-obstetrics-part-i-event-identification-and-classification
#3
Christian M Pettker
Despite our best intentions to improve health when a patient presents for care, adverse events are ubiquitous in medical practice today. Known complications related to the course of a patient's illness or condition or to the characteristics of the treatment have been an openly stated part of taking care of patients for centuries. However, it is only in the past decade that preventable adverse events, instances of harm related to error and deviations in accepted practice have become a primary part of these conversations...
May 23, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/28549460/learning-to-use-electronic-health-records-can-we-stay-patient-centered-a-pre-post-intervention-study-with-family-medicine-residents
#4
Cédric Lanier, Melissa Dominicé Dao, Patricia Hudelson, Bernard Cerutti, Noëlle Junod Perron
BACKGROUND: The Electronic Health Record (EHR) is now widely used in clinical encounters. Because its use can negatively impact the physician-patient relationship, several recommendations on the "patient-centered" use of the EHR have been published. However, the impact of training to improve EHR use during clinical encounters is not well known. The aim of this study was to assess the impact of training on residents' EHR-related communication skills and explore whether they varied according to the content of the consultation...
May 26, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28547268/primary-care-providers-experience-management-and-referral-patterns-regarding-pelvic-floor-disorders-a-national-survey
#5
Donna Mazloomdoost, Catrina C Crisp, Steven D Kleeman, Rachel N Pauls
INTRODUCTION AND HYPOTHESIS: Primary care physicians can impact womens' access to care. We assessed primary care providers' experience and management regarding pelvic floor disorders. METHODS: This Institutional Review Board approved study invited internal and family Medicine Program Directors to complete and distribute to faculty an online survey designed to query demographics, perceptions, management, and referral patterns regarding urinary incontinence (UI), overactive bladder (OAB), and pelvic organ prolapse (POP) in females...
May 25, 2017: International Urogynecology Journal
https://www.readbyqxmd.com/read/28546866/a-diagnostic-protocol-designed-for-determining-allergic-causes-in-patients-with-blood-eosinophilia
#6
Jean-François Magnaval, Guy Laurent, Noémie Gaudré, Judith Fillaux, Antoine Berry
BACKGROUND: Blood eosinophilia is a common laboratory abnormality, and its characterization frequently represents a quandary for primary care physicians. Consequently, in France, specialists and particularly hematologists, often must investigate patients who present with blood eosinophilia that often, but not always, occurs because of allergic causes. Both the Departments of Hematology and Parasitology at Toulouse University Hospitals established a collaboration to rule out allergic causes of eosinophilia, particularly helminthiases, prior to initiating more sophisticated investigations...
2017: Military Medical Research
https://www.readbyqxmd.com/read/28545400/the-role-of-a-behavioural-medicine-intervention-in-physiotherapy-for-the-effects-of-rehabilitation-outcomes-in-exercise-based-cardiac-rehabilitation-ecra-the-study-protocol-of-a-randomised-controlled-trial
#7
Sabina Borg, Birgitta Öberg, Lennart Nilsson, Anne Söderlund, Maria Bäck
BACKGROUND: To help patients with coronary artery disease (CAD) benefit from the positive health effects attained by exercise-based cardiac rehabilitation (CR), adherence to these programmes according to international guidelines is important. Strategies to increase adherence to exercise-based CR are mainly an unexplored area. The objective of this study is to investigate the effects of a behavioural medicine intervention in physiotherapy, containing goal-setting, self-monitoring and feedback, with the aim of improving rehabilitation outcomes for exercise-based CR, compared with usual care...
May 25, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28545159/the-value-transformation-of-health-care-impact-on-neuromuscular-and-electrodiagnostic-medicine
#8
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/28544284/the-national-healthcare-system-claims-databases-in-france-sniiram-and-egb-powerful-tools-for-pharmacoepidemiology
#9
Julien Bezin, Mai Duong, Régis Lassalle, Cécile Droz, Antoine Pariente, Patrick Blin, Nicholas Moore
The French health care system is based on universal coverage by one of several health care insurance plans. The SNIIRAM database merges anonymous information of reimbursed claims from all these plans, linked to the national hospital-discharge summaries database system (PMSI) and the national death registry. It now covers 98.8% of the French population, over 66 million persons, from birth (or immigration) to death (or emigration), making it possibly the world's largest continuous homogeneous claims database...
May 24, 2017: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/28540039/successful-withdrawal-from-high-dose-benzodiazepine-in-a-young-patient-through-electronic-monitoring-of-polypharmacy-a-case-report-in-an-ambulatory-setting
#10
REVIEW
Hèctor R Loscertales, Valerie Wentzky, Kenneth Dürsteler, Johannes Strasser, Kurt E Hersberger, Isabelle Arnet
BACKGROUND: Dependence on high-dose benzodiazepines (BZDs) is well known and discontinuation attempts are generally unsuccessful. A well established protocol for high-dose BZD withdrawal management is lacking. We present the case of withdrawal from high-dose lorazepam (>20 mg daily) in an unemployed 35-year-old male outpatient through agonist substitution with long-acting clonazepam and electronic monitoring over 28 weeks. METHODS: All medicines were repacked into weekly 7 × 4 cavity multidose punch cards with an electronic monitoring system...
May 2017: Therapeutic Advances in Psychopharmacology
https://www.readbyqxmd.com/read/28539080/keeping-candles-lit-the-role-of-concierge-medicine-in-the-future-of-primary-care
#11
Rocco Palumbo
Universal coverage and financial sustainability are two competing aims in primary care. Patient empowerment and patient engagement have been suggested as essential ingredients of the recipe for innovative primary care models aimed at sustaining universal coverage. Concierge medicine is achieving a growing popularity among both scholars and practitioners as a direct primary care practice which allows to bridge the gap between patient empowerment and patient engagement. However, ethical and legal concerns hinder the diffusion of concierge models in the current primary care practices...
May 2017: Health Services Management Research
https://www.readbyqxmd.com/read/28538934/availability-of-herbal-medicines-and-medicinal-plants-in-the-primary-health-facilities-of-the-state-of-s%C3%A3-o-paulo-southeast-brazil-results-from-the-national-program-for-access-and-quality-improvement-in-primary-care
#12
Maria do Carmo Gullaci Guimarães Caccia-Bava, Bianca Waléria Bertoni, Ana Maria Soares Pereira, Edson Zangiacomi Martinez
This study aims to describe the availability of herbal medicines and medicinal plants in the primary care facilities in the state of São Paulo, Southeast Brazil, from the results of the first cycle of the National Program for Access and Quality Improvement in Primary Care (PMAQ). The PMAQ uses a national cross-sectional multicenter design, with data from 4,249 health facilities distributed among 645 municipalities of the state of São Paulo. Of these facilities, 467 (11%) had herbal medicines and/or medicinal plants...
May 2017: Ciência & Saúde Coletiva
https://www.readbyqxmd.com/read/28537057/physician-directed-diabetes-education-without-a-medication-change-and-associated-patient-outcomes
#13
Hun Sung Kim, Hyunah Kim, Hae Kyung Yang, Eun Young Lee, Yoo Jin Jeong, Tong Min Kim, So Jung Yang, Seo Yeon Baik, Seung Hwan Lee, Jae Hyoung Cho, In Young Choi, Hyeon Woo Yim, Bong Yun Cha
BACKGROUND: When patients with diabetes mellitus (DM) are first referred to a hospital from primary health care clinics, physicians have to decide whether to administer an oral hypoglycemic agent (OHA) immediately or postpone a medication change in favor of diabetes education regarding diet or exercise. The aim of this study was to determine the effect of diabetes education alone (without alterations in diabetes medication) on blood glucose levels. METHODS: The study was conducted between January 2009 and December 2013 and included patients with DM...
May 12, 2017: Diabetes & Metabolism Journal
https://www.readbyqxmd.com/read/28536932/thromboprophylaxis-in-extracorporeal-circuits-current-pharmacological-strategies-and-future-directions
#14
REVIEW
Gail M Annich, Oshri Zaulan, Megan Neufeld, Deborah Wagner, Melissa M Reynolds
The development of extracorporeal devices for organ support has been a part of medical history and progression since the late 1900s. These types of technology are primarily used and developed in the field of critical care medicine. Unfractionated heparin, discovered in 1916, has really been the only consistent form of thromboprophylaxis for attenuating or even preventing the blood-biomaterial reaction that occurs when such technologies are initiated. The advent of regional anticoagulation for procedures such as continuous renal replacement therapy and plasmapheresis have certainly removed the risks of systemic heparinization and heparin effect, but the challenges of the blood-biomaterial reaction and downstream effects remain...
May 23, 2017: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/28536899/effect-of-educating-the-primary-care-physician-about-headache-to-help-reduce-trivial-referrals-and-improve-the-number-and-quality-of-substantial-referrals-that-truly-need-subspecialty-headache-medicine-care
#15
REVIEW
Robert Cowan, Meredith Barad
Technology is likely to play an increasingly important role in the delivery of healthcare as the disparity between provider availability/expertise and patient numbers/needs increases. This article is intended to lend insight into the ways in which technology can facilitate the evaluation of patients with headache disorders and improve the ongoing monitoring of disease progression and response to therapy, following proper diagnosis. While it is not possible to prognosticate the impact of technologies not yet available, the article addresses potential novel usage of currently existing technology to standardize intake, expedite evaluations, ensure adequate history and documentation, and monitoring of patient care...
July 2017: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/28535316/residents-confidence-providing-primary-care-with-behavioral-health-integration
#16
Patrick Hemming, Amber Hewitt, Joseph J Gallo, Rodger Kessler, R B Levine
BACKGROUND AND OBJECTIVES: Behavioral health integration (BHI) entails integrated behavioral health clinicians (IBHCs) providing care-generally for mental health and substance abuse disorders and behavioral comorbidity- within the operational functioning of primary care. Because limited data exist regarding BHI in residency, we studied its impact on resident education by examining whether increased behavioral health (BH) co-management improved residents' perceived ability to treat BH conditions...
May 2017: Family Medicine
https://www.readbyqxmd.com/read/28535315/early-career-outcomes-of-family-medicine-residency-graduates-exposed-to-innovative-flexible-longitudinal-tracks
#17
Richard A Young, Dan Casey, Diana Singer, Elaine Waller, Patricia A Carney
BACKGROUND AND OBJECTIVES: The Preparing the Personal Physician for Practice (P4) project used a case series design to study innovations in the content, length, structure, and location of residency training in 14 geographically diverse family medicine programs between 2007 and 2012. We aimed to explore how offering flexible longitudinal tracks (FLT) affected graduates' scope of practice, particularly in maternal child health (MCH), which included at least 17 months of focused training that increased each year over 4 years...
May 2017: Family Medicine
https://www.readbyqxmd.com/read/28533200/beliefs-about-prescribed-medication-among-older-patients-with-polypharmacy-a-mixed-methods-study-in-primary-care
#18
Barbara Clyne, Janine A Cooper, Fiona Boland, Carmel M Hughes, Tom Fahey, Susan M Smith
BACKGROUND: Polypharmacy (≥5 medications) is common in older patients and is associated with adverse outcomes. Patients' beliefs about medication can influence their expectations for medication, adherence, and willingness to deprescribe. Few studies have examined beliefs about prescribed medication among older patients with polypharmacy in primary care. AIM: To explore medication-related beliefs in older patients with polypharmacy and factors that might influence beliefs...
May 22, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/28532856/implementation-of-a-referral-to-discharge-glycemic-control-initiative-for-reduction-of-surgical-site-infections-in-gynecologic-oncology-patients
#19
Laura Hopkins, Jennifer Brown-Broderick, James Hearn, Janine Malcolm, James Chan, Wendy Hicks-Boucher, Filomena De Sousa, Mark C Walker, Sylvain Gagné
OBJECTIVE(S): To evaluate the frequency of surgical site infections before and after implementation of a comprehensive, multidisciplinary perioperative glycemic control initiative. STUDY METHODS: As part of a CUSP (Comprehensive Unit-based Safety Program) initiative, between January 5 and December 18, 2015, we implemented comprehensive, multidisciplinary glycemic control initiative to reduce SSI rates in patients undergoing major pelvic surgery for a gynecologic malignancy ('Group II')...
May 20, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28532628/milestones-barriers-and-beacons-shared-decision-making-in-canada-inches-ahead
#20
France Légaré, Dawn Stacey, Pierre-Gerlier Forest, Marie-France Coutu, Patrick Archambault, Laura Boland, Holly O Witteman, Annie LeBlanc, Krystina B Lewis, Anik M C Giguere
Canada's approach to shared decision making (SDM) remains as disparate as its healthcare system; a conglomerate of 14 public plans - ten provincial, three territorial and one federal. The healthcare research funding environment has been largely positive for SDM because there was funding for knowledge translation research which also encompassed SDM. The funding climate currently places new emphasis on patient involvement in research and on patient empowerment in healthcare. SDM fields have expanded from primary care to elder care, paediatrics, emergency and critical care medicine, cardiology, nutrition, occupational therapy and workplace rehabilitation...
May 19, 2017: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
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