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https://www.readbyqxmd.com/read/28441218/research-on-the-pa-profession-the-medical-model-shifts
#1
Richard W Dehn, Christine M Everett, Roderick S Hooker
Physician assistant (PA)-focused research arose in response to the idea that an assistant to the busy physician could improve healthcare delivery. The process of answering questions about the profession has involved multiple approaches and various scholarly disciplines. In the course of this undertaking, what emerged were three stages of examination of PA behavior. The bibliographic span from this period contains about 2,400 studies that advance some notion of PA benefit to society. On the 50th anniversary of the PA profession, a question arises as to what research has shown...
May 2017: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/28435281/first-do-no-harm-institutional-betrayal-and-trust-in-health-care-organizations
#2
Carly Parnitzke Smith
PURPOSE: Patients' trust in health care is increasingly recognized as important to quality care, yet questions remain about what types of health care experiences erode trust. The current study assessed the prevalence and impact of institutional betrayal on patients' trust and engagement in health care. PARTICIPANTS AND METHODS: Participants who had sought health care in the US in October 2013 were recruited from an online marketplace, Amazon's Mechanical Turk. Participants (n = 707; 73% Caucasian; 56...
2017: Journal of Multidisciplinary Healthcare
https://www.readbyqxmd.com/read/28431202/pharmacological-interventions-for-acute-pancreatitis
#3
REVIEW
Elisabetta Moggia, Rahul Koti, Ajay P Belgaumkar, Federico Fazio, Stephen P Pereira, Brian R Davidson, Kurinchi Selvan Gurusamy
BACKGROUND: In people with acute pancreatitis, it is unclear what the role should be for medical treatment as an addition to supportive care such as fluid and electrolyte balance and organ support in people with organ failure. OBJECTIVES: To assess the effects of different pharmacological interventions in people with acute pancreatitis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2016, Issue 9), MEDLINE, Embase, Science Citation Index Expanded, and trial registers to October 2016 to identify randomised controlled trials (RCTs)...
April 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28401418/development-of-a-care-guidance-index-based-on-what-matters-to-patients
#4
John H Wasson, Laura Soloway, L Gordon Moore, Paul Labrec, Lynn Ho
INTRODUCTION: Targeting resources for a designated higher-risk subgroup is a strategy for chronic care management. However, risk-designation has several limitations: it is inaccurate, seldom helpful for care guidance, and potentially misallocates care away from many patients. METHODS: To address limitations of risk designation, we tested a "what matters index" (WMI) in 19,593 adult patients with chronic conditions. The WMI contains five binary measures: insufficient confidence to manage health problems, level of pain, emotional problems, polypharmacy, and adverse medication effects...
April 11, 2017: Quality of Life Research
https://www.readbyqxmd.com/read/28392702/hepatic-encephalopathy-what-the-multidisciplinary-team-can-do
#5
REVIEW
Andy Liu, Eric R Yoo, Osama Siddique, Ryan B Perumpail, George Cholankeril, Aijaz Ahmed
Hepatic encephalopathy (HE) is a complex disease requiring a multidisciplinary approach among specialists, primary care team, family, and caregivers. HE is currently a diagnosis of exclusion, requiring an extensive workup to exclude other possible etiologies, including mental status changes, metabolic, infectious, traumatic, and iatrogenic causes. The categorization of HE encompasses a continuum, varying from the clinically silent minimal HE (MHE), which is only detectable using psychometric tests, to overt HE, which is further divided into four grades of severity...
2017: Journal of Multidisciplinary Healthcare
https://www.readbyqxmd.com/read/28389482/what-are-the-risks-and-benefits-of-temporarily-discontinuing-medications-to-prevent-acute-kidney-injury-a-systematic-review-and-meta-analysis
#6
Penny Whiting, Andrew Morden, Laurie A Tomlinson, Fergus Caskey, Thomas Blakeman, Charles Tomson, Tracey Stone, Alison Richards, Jelena Savović, Jeremy Horwood
OBJECTIVES: To summarise evidence on temporary discontinuation of medications to prevent acute kidney injury (AKI). DESIGN: Systematic review and meta-analysis of randomised and non-randomised studies. PARTICIPANTS: Adults taking diuretics, ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), direct renin inhibitors, non-steroidal anti-inflammatories, metformin or sulfonylureas, experiencing intercurrent illnesses, radiological or surgical procedures...
April 7, 2017: BMJ Open
https://www.readbyqxmd.com/read/28377450/specialist-paediatric-palliative-care-services-what-are-the-benefits
#7
Sarah Mitchell, Andrew Morris, Karina Bennett, Laiba Sajid, Jeremy Dale
BACKGROUND: The number of children and young people (CYP) living with life-limiting and life-threatening conditions is rising. Paediatric palliative care is a relatively new aspect of healthcare, the delivery of which is variable, with a wide range of healthcare and voluntary sector providers involved. Policy recommendations are for Specialist Paediatric Palliative Care (SPPC) services to be supported by a physician with specialist training. AIM: To examine the research evidence regarding the distinct benefits of SPPC services, with 'Specialist Paediatric Palliative Care' defined as palliative care services supported by a specialist physician...
April 4, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28372825/trauma-care-in-india-a-review-of-the-literature
#8
Hadley K H Wesson, Mimmie Kwong
BACKGROUND: We reviewed the published literature related to prehospital and hospital trauma care in India to identify how trauma care is defined in the literature and what factors limit the delivery of appropriate trauma care. In summarizing the evidence and recommendations regarding trauma care, this review identifies essential research and development goals to address the burden of injury in India. METHODS: A review of the literature was conducted between August 2014 and September 2014...
March 31, 2017: Surgery
https://www.readbyqxmd.com/read/28367382/goal-directed-health-care-redefining-health-and-health-care-in-the-era-of-value-based-care
#9
REVIEW
James Mold
Health care reform efforts have increasingly emphasized payment models that reward value (quality/cost). It seems appropriate, therefore, to examine what we value in health care, and that will require that we examine our definition of health. In spite of admonitions from the World Health Organization and others, our current health care system operates under the assumption that health represents the absence of health problems. While that perspective has led to incredible advances in medical science, it now may be adversely affecting value...
February 21, 2017: Curēus
https://www.readbyqxmd.com/read/28364218/-memorandum-of-the-german-society-for-rheumatology-on-the-quality-of-treatment-in-rheumatology-update-2016
#10
A Zink, J Braun, E Gromnica-Ihle, D Krause, H J Lakomek, W Mau, U Müller-Ladner, J Rautenstrauch, C Specker, M Schneider
On behalf of the Steering Committee of the German Society for Rheumatology, in 2016 the Interdisciplinary Commission on Healthcare Quality updated the 2008 memorandum on rheumatological healthcare in Germany. The update considers changes in therapeutic strategies, treatment targets as well as current structures in healthcare and the political framework. It concentrates on examination of the need for rheumatologists with a background in internal medicine and determines the gap between needs and supply. The internist rheumatologist is responsible for the care of patients with inflammatory rheumatic diseases and contributes to the care of patients with severe forms of other musculoskeletal diseases...
April 2017: Zeitschrift Für Rheumatologie
https://www.readbyqxmd.com/read/28350314/integrating-quality-improvement-and-continuing-professional-development-at-an-academic-medical-center-a-partnership-between-practice-plan-hospital-and-medical-school
#11
Barbara Gold, Dawn England, William Riley, Ginny Jacobs-Halsey, Corinne Webb, Bobbi Daniels
INTRODUCTION: While quality improvement (QI) initiatives can be a highly effective means for improving health care delivery in academic medical centers (AMCs), many health care professionals are not formally trained in basic QI methodology, engaging clinicians in QI activities can be challenging, and there is often a lack of integration and coordination among QI functions (eg, Departments of Quality and Safety, Continuing Professional Development). In our AMC, we undertook a collaborative approach to achieve better vertical and horizontal integration of our QI education efforts...
October 2016: Journal of Continuing Education in the Health Professions
https://www.readbyqxmd.com/read/28347441/assessment-of-a-personalized-and-distributed-patient-guidance-system
#12
Mor Peleg, Yuval Shahar, Silvana Quaglini, Tom Broens, Roxana Budasu, Nick Fung, Adi Fux, Gema García-Sáez, Ayelet Goldstein, Arturo González-Ferrer, Hermie Hermens, M Elena Hernando, Val Jones, Guy Klebanov, Denis Klimov, Daniel Knoppel, Nekane Larburu, Carlos Marcos, Iñaki Martínez-Sarriegui, Carlo Napolitano, Àngels Pallàs, Angel Palomares, Enea Parimbelli, Belén Pons, Mercedes Rigla, Lucia Sacchi, Erez Shalom, Pnina Soffer, Boris van Schooten
OBJECTIVES: The MobiGuide project aimed to establish a ubiquitous, user-friendly, patient-centered mobile decision-support system for patients and for their care providers, based on the continuous application of clinical guidelines and on semantically integrated electronic health records. Patients would be empowered by the system, which would enable them to lead their normal daily lives in their regular environment, while feeling safe, because their health state would be continuously monitored using mobile sensors and self-reporting of symptoms...
May 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28343877/what-are-nursing-facilities-doing-to-reduce-potentially-avoidable-hospitalizations
#13
Laura Coots Daras, Joyce M Wang, Melvin J Ingber, Catherine Ormond, Nathaniel W Breg, Galina Khatutsky, Zhanlian Feng
OBJECTIVES: Hospitalizations among nursing facility residents are frequent and often potentially avoidable. A number of initiatives and interventions have been developed to reduce excessive hospitalizations; however, little is known about the specific approaches nursing facilities use to address this issue. The objective of this study is to better understand which types of interventions nursing facilities have introduced to reduce potentially avoidable hospitalizations of long-stay nursing facility residents...
May 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28340935/individual-and-hospital-related-determinants-of-potentially-inappropriate-admissions-emerging-from-administrative-records
#14
Marco Fusco, Alessandra Buja, Paolo Piergentili, Maria Teresa Golfetto, Gianni Serafin, Silvia Gallo, Livio Dalla Barba, Vincenzo Baldo
INTRODUCTION: The appropriate use of health care is an important issue in developed countries. The purpose of this study was to ascertain the extent of potentially inappropriate hospital admissions and their individual, clinical and hospital-related determinants. METHODS: Medical records were analyzed for the year 2014 held by the Local Heath Unit n. 13 in the Veneto Region of north-east Italy (19,000 records). The outcomes calculated were: admissions for conditions amenable to day hospital care; brief medical admissions; outlier lengths of stay for elderly patients' medical admissions; and medical admissions to surgical wards...
November 2016: Health Policy
https://www.readbyqxmd.com/read/28335770/a-model-of-influences-on-the-clinical-learning-environment-the-case-for-change-at-one-u-s-medical-school
#15
Howard B Fleit, Richard J Iuli, Janet E Fischel, Wei-Hsin Lu, Latha Chandran
BACKGROUND: The learning environment within a school of medicine influences medical students' values and their professional development. Despite national requirements to monitor the learning environment, mistreatment of medical students persists. METHODS: We designed a program called WE SMILE: We can Eradicate Student Mistreatment In the Learning Environment with a vision to enhance trainee and faculty awareness and ultimately eliminate medical student mistreatment...
March 23, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/28331455/exploring-patient-caregiver-and-healthcare-provider-perceptions-of-caring-for-patients-with-heart-failure-what-are-the-implications
#16
Betty M Kennedy, Vijayendra Jaligam, Beverly K Conish, William D Johnson, Brian Melancon, Peter T Katzmarzyk
BACKGROUND: Heart failure (HF) is an incurable and frequently progressive disease. Symptoms of HF may impair the ability of patients to perform daily living activities. As HF progresses, patients typically increase their reliance on caregivers. The purpose of this study was to determine what roles patients and caregivers perceive and desire for themselves in managing HF and to compare and contrast these roles with those perceived by healthcare providers. METHODS: A purposive sample (60 patients, 22 caregivers, and 11 healthcare providers) was enrolled in the study...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/28330379/patient-self-defined-goals
#17
Sandra Ellen Schellinger, Eric Worden Anderson, Monica Schmitz Frazer, Cindy Lynn Cain
This research, a descriptive qualitative analysis of self-defined serious illness goals, expands the knowledge of what goals are important beyond the physical-making existing disease-specific guidelines more holistic. Integration of goals of care discussions and documentation is standard for quality palliative care but not consistently executed into general and specialty practice. Over 14 months, lay health-care workers (care guides) provided monthly supportive visits for 160 patients with advanced heart failure, cancer, and dementia expected to die in 2 to 3 years...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28323607/language-based-inequity-in-health-care-who-is-the-poor-historian
#18
Alexander R Green, Chijioke Nze
Patients with limited English proficiency (LEP) are among the most vulnerable populations. They experience high rates of medical errors with worse clinical outcomes than English-proficient patients and receive lower quality of care by other metrics. However, we have yet to take the issue of linguistic inequities seriously in the medical system and in medical education, tacitly accepting that substandard care is either unavoidable or not worth the cost to address. We argue that we have a moral imperative to provide high-quality care to patients with LEP and to teach our medical trainees that such care is both expected and feasible...
March 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28321297/knowledge-is-power-a-quality-improvement-project-to-increase-patient-understanding-of-their-hospital-stay
#19
Eleanor Nicholson Thomas, Lloyd Edwards, Paul McArdle
Patients frequently leave hospital uninformed about the details of their hospital stay with studies showing that only 59.9% of patients are able to accurately state their diagnosis and ongoing management after discharge. 1 2 This places patients at a higher risk of complications. Educating patients by providing them with accurate and understandable information enables them to take greater control, potentially reducing readmission rates, and unplanned visits to secondary services whilst providing safer care and improving patient satisfaction...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28315481/a-patient-advocate-to-facilitate-access-and-improve-communication-care-and-outcomes-in-adults-with-moderate-or-severe-asthma-rationale-design-and-methods-of-a-randomized-controlled-trial
#20
Andrea J Apter, Knashawn H Morales, Xiaoyan Han, Luzmercy Perez, Jingru Huang, Grace Ndicu, Anna Localio, Alyssa Nardi, Heather Klusaritz, Marisa Rogers, Alexis Phillips, Zuleyha Cidav, J Sanford Schwartz
Few interventions to improve asthma outcomes have targeted low-income minority adults. Even fewer have focused on the real-world practice where care is delivered. We adapted a patient navigator, here called a Patient Advocate (PA), a term preferred by patients, to facilitate and maintain access to chronic care for adults with moderate or severe asthma and prevalent co-morbidities recruited from clinics serving low-income urban neighborhoods. We describe the planning, design, methodology (informed by patient and provider focus groups), baseline results, and challenges of an ongoing randomized controlled trial of 312 adults of a PA intervention implemented in a variety of practices...
March 14, 2017: Contemporary Clinical Trials
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