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https://www.readbyqxmd.com/read/28731946/treatment-minimization-in-older-patients-with-early-stage-breast-cancer
#1
Tara M Hansen, Richard C Zellars
The management of early-stage breast cancer in older patients is complex and requires a careful balance of the risk of cancer death with the competing risks of comorbidities and treatment-related toxicity in women with largely favorable disease. As the US population continues to age, oncologists will increasingly encounter this clinical challenge. Several strategies involving each core component of breast cancer therapy have been investigated to minimize treatment in these patients while still maintaining acceptable outcomes...
July 2017: Cancer Journal
https://www.readbyqxmd.com/read/28731848/usability-acceptability-and-impact-of-a-pediatric-teledermatology-mobile-health-application
#2
Alexander G Fiks, Linda Fleisher, Lindsay Berrigan, Emily Sykes, Stephanie L Mayne, Rachel Gruver, Katherine Halkyard, Olivia S Jew, Patrick FitzGerald, Flaura Winston, Patrick McMahon
OBJECTIVE: Pediatric dermatology appointment wait times often exceed several months. We evaluated the usability, acceptability, and clinical impact of a store-and-forward teledermatology mobile application (app) linking families with pediatric dermatologists. METHODS: Parents of children age 6 weeks to 17 years or individuals 18-21 years old were invited (by e-mail or referral) to participate in this single group, prospective study. Within the app, users photographed the skin condition, answered questions, and submitted their case for review...
July 21, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28729329/fluids-in-sepsis-and-septic-shock-fissh-protocol-for-a-pilot-randomised-controlled-trial
#3
Bram Rochwerg, Tina Millen, Peggy Austin, Michelle Zeller, Frédérick D'Aragon, Roman Jaeschke, Marie-Hélène Masse, Sangeeta Mehta, Francois Lamontagne, Maureen Meade, Gordon Guyatt, Deborah J Cook
INTRODUCTION: Observational evidence suggests physiological benefits and lower mortality with lower chloride solutions; however, 0.9% saline remains the most widely used fluid worldwide. Given uncertainty regarding the association of lower chloride on mortality, it is unlikely that practice will change without direct randomised clinical trial (RCT) evidence. This pilot RCT will investigate the feasibility of a large-scale trial directly comparing low chloride with high chloride fluids in patients with septic shock...
July 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28728965/survival-analysis-of-metal-crowns-versus-restorations-in-primary-mandibular-molars
#4
Gerardo Maupomé, Juan F Yepes, Madison Galloway, Qing Tang, George J Eckert, Timothy Downey, LaQuia Vinson
BACKGROUND: The effectiveness of stainless steel crowns (SSCs) versus direct restorations when placed in primary mandibular molars (teeth nos. L and S) is uncertain. The authors evaluated effectiveness by gauging longevity of treatment. METHODS: The authors obtained private dental insurance claims (2004-2016) from a national dental data warehouse. Paid insurance claims records (n = 1,323,489) included type of treating dentist, treatment placed, and patient age...
July 17, 2017: Journal of the American Dental Association
https://www.readbyqxmd.com/read/28727486/association-of-physician-orders-for-life-sustaining-treatment-form-use-with-end-of-life-care-quality-metrics-in-patients-with-cancer
#5
Sandra L Pedraza, Stacey Culp, Mark Knestrick, Evan Falkenstine, Alvin H Moss
PURPOSE: Many patients with advanced cancer receive aggressive treatment near the end of life. The Physician Orders for Life-Sustaining Treatment (POLST) form is an innovation that converts patient preferences into medical orders. We compared the end-of-life care of patients with advanced cancer who had completed POLST forms with that of patients who had advance directives (ADs). METHODS: We studied 2,159 West Virginians with ADs and/or POLST forms in the West Virginia e-Directive Registry who died as a result of cancer between January 2011 and February 2016...
July 20, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28725165/cost-effectiveness-of-pre-referral-antimalarial-treatment-in-severe-malaria-among-children-in-sub-saharan-africa
#6
Vivian Rakuomi, Faith Okalebo, Stanley Ndwigah, Levi Mbugua
BACKGROUND: In 2013, 78% of malaria deaths occurred in children aged 5 years and below, in sub-Saharan Africa. Treatment of severe malaria requires a health facility with inpatient care. However, in most sub-Sahara African countries, access to health facilities is a major problem. Pre-referral antimalarial treatments aim to delay the progress of severe malaria as patients seek to access health facilities. Rectal artesunate can be administered in the community as a pre-referral treatment in rural hard-to-reach areas...
2017: Cost Effectiveness and Resource Allocation: C/E
https://www.readbyqxmd.com/read/28725122/two-incisions-direct-anterior-approach-for-thr-surgical-technique-and-early-outcome
#7
Ritesh Rathi, Idriss Tourabaly, Alexis Nogier
PURPOSE: In recent times the direct anterior approach for total hip replacement has gained considerable interest among orthopaedic surgeons because of the relative muscle-sparing nature than other surgical approaches. However, critics believe that this approach is associated with steep learning curve and high complication rates, mainly attributed to a more limited exposure to the femur. In order to make femoral access easier and implantation of acetabulum in anatomic plane, we designed a "two incisions anterior approach technique" for total hip replacement...
September 2017: Journal of Orthopaedics
https://www.readbyqxmd.com/read/28724363/comparing-patient-and-healthcare-worker-experiences-during-a-dengue-outbreak-in-singapore-understanding-the-patient-journey-and-the-introduction-of-a-point-of-care-test-poct-toward-better-care-delivery
#8
Qinghui Tan, Zoe J-L Hildon, Shweta Singh, Jin Jing, Tun Linn Thein, Richard Coker, Hubertus J M Vrijhoef, Yee Sin Leo
BACKGROUND: In the aftermath of an upsurge in the number of dengue cases in 2013 and 2014, the SD BIOLINE Dengue Duo rapid diagnostic Point-of-Care Test (POCT) kit was introduced in Tan Tock Seng Hospital, Singapore in June 2013. It is known that the success of POCT usage is contingent on its implementation within the health system. We evaluated health services delivery and the Dengue Duo rapid diagnostic test kit application in Singapore from healthcare workers' perspectives and patient experiences of dengue at surge times...
July 19, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28724150/pregnancy-options-counseling-and-abortion-referrals-among-us-primary-care-physicians-results-from-a-national-survey
#9
Kelsey Holt, Elizabeth Janiak, Marie C McCormick, Ellice Lieberman, Christine Dehlendorf, Sandhya Kajeepeta, Jacquelyn M Caglia, Ana Langer
BACKGROUND AND OBJECTIVES: Primary care physicians (PCPs) can play a critical role in addressing unintended pregnancy through high-quality options counseling and referrals. METHODS: We surveyed a nationally representative sample of 3,000 PCPs in general, family, and internal medicine on practices and opinions related to options counseling for unintended pregnancy. We assessed predictors of physician practices using multivariable logistic regression weighted for sampling design and differential non-response...
July 2017: Family Medicine
https://www.readbyqxmd.com/read/28724147/community-and-interns-perspectives-on-community-participatory-medical-education-from-passive-to-active-participation
#10
Akiteru Takamura, Hidekazu Misaki, Yousuke Takemura
BACKGROUND AND OBJECTIVES: The use of community-based medical education as a method of learning primary care is now common worldwide. However, in many cases community participation remains passive. This study sought to explore the effects of introducing community members into medical education as active teachers. Medical education taught directly by community members might be a key to comprehensive community-based learning. METHODS: This study was conducted in Japan at two postgraduate programs in community hospitals...
July 2017: Family Medicine
https://www.readbyqxmd.com/read/28723302/why-use-group-visits-for-opioid-use-disorder-treatment-in-primary-care-a-patient-centered-qualitative-study
#11
Randi Sokol, Chiara Albanese, Deviney Chaponis, Jessica Early, George Maxted, Diana Morrill, Grace Poirier, Fran Puopolo, Zev Schuman-Olivier
BACKGROUND: Primary care providers are well positioned to respond to the opioid crisis by providing buprenorphine/naloxone (B/N) through shared medical appointments (SMA). While quantitative research has been previously conducted on SMAs with B/N, we conducted a qualitative assessment from the patients' point of view, considering whether and how group visits provide value for patients. METHODS: Twenty-five participants with opioid use disorder (OUD) who were enrolled in a weekly B/N group visit at a family medicine clinic participated in either of two one-hour-long focus groups, which were conducted as actual group visits...
July 19, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28723244/evaluation-of-the-national-health-service-nhs-direct-pilot-telehealth-program-cost-effectiveness-analysis
#12
Malcolm Clarke, Joanna Fursse, Nancy Connolly, Urvashi Sharma, Russell Jones
OBJECTIVE: To evaluate the cost-effectiveness of a pilot telehealth program applied to a wide population of patients with chronic obstructive pulmonary disease (COPD). DESIGN: Vital signs data were transmitted from the home of the patient on a daily basis using a patient monitoring system for review by community nurse to assist decisions on management. SETTING: Community services for patients diagnosed with COPD. PARTICIPANTS: Two Primary Care Trusts (PCTs) enrolled 321 patients diagnosed with COPD into the telehealth program...
July 18, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28722558/situating-mobile-health-a-qualitative-study-of-mhealth-expectations-in-the-rural-health-district-of-nouna-burkina-faso
#13
Vincent Duclos, Maurice Yé, Kagoné Moubassira, Hamidou Sanou, N Hélène Sawadogo, Gilles Bibeau, Ali Sié
BACKGROUND: The implementation of mobile health (mHealth) projects in low- and middle-income countries raises high and well-documented expectations among development agencies, policymakers and researchers. By contrast, the expectations of direct and indirect mHealth users are not often examined. In preparation for a proposed intervention in the Nouna Health District, in rural Burkina Faso, this study investigates the expected benefits, challenges and limitations associated with mHealth, approaching these expectations as a form of situated knowledge, inseparable from local conditions, practices and experiences...
July 12, 2017: Health Research Policy and Systems
https://www.readbyqxmd.com/read/28721691/occupational-therapy-for-adults-with-problems-in-activities-of-daily-living-after-stroke
#14
REVIEW
Lynn A Legg, Sharon R Lewis, Oliver J Schofield-Robinson, Avril Drummond, Peter Langhorne
BACKGROUND: A stroke occurs when the blood supply to part of the brain is cut off. Activities of daily living (ADL) are daily home-based activities that people carry out to maintain health and well-being. ADLs include the ability to: eat and drink unassisted, move, go to the toilet, carry out personal hygiene tasks, dress unassisted, and groom. Stroke causes impairment-related functional limitations that may result in difficulties participating in ADLs independent of supervision, direction, or physical assistance...
July 19, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28721463/exstrophy-bladder-reconstruction-or-diversion-for-the-underprivileged
#15
REVIEW
Yogesh Kumar Sarin, Virender Sekhon
The surgical techniques for management of bladder exstrophy epispadias complex have evolved from staged reconstruction, complete primary repair to radical mobilization. Post-operative complications add to the multiplicity of surgical procedures at each step. The end results are variable with many achieving continence rates of 85-89% only after bladder augmentation and clean intermittent catheterization. The situation is further complicated in resource-poor settings, where illiteracy and poverty are the driving factors for choosing a single operative procedure for creation of low pressure reservoir aiming at upper tract preservation and good primary continence...
July 18, 2017: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/28720630/primary-care-physician-roles-in-health-centers-with-oral-health-care-units
#16
Hannah L Maxey, Connor W Norwood, Donald L Weaver
INTRODUCTION: Integrating oral health care and primary care is a priority for improving population health. Primary care physicians (PCP) are filling expanded roles within oral health care to secure strong overall health for their patients. METHODS: This comparative case study examines the roles of PCPs at 5 federally qualified health centers that have integrated oral health care and primary care. Administrative data were obtained directly from the Health Resources and Services Administration...
July 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28720629/a-group-visit-initiative-improves-advance-care-planning-documentation-among-older-adults-in-primary-care
#17
Hillary D Lum, Rebecca L Sudore, Daniel D Matlock, Elizabeth Juarez-Colunga, Jacqueline Jones, Molly Nowels, Robert S Schwartz, Jean S Kutner, Cari R Levy
INTRODUCTION: Group visits for advance care planning (ACP) may help patients document preferences for decision makers and future care. We assessed the impact of a primary care-based ACP group visit (ACP-GV) intervention on older adults' ACP documentation and why patients participated. METHODS: Older adults (>65 years) in primary care participated in a 2-session ACP-GV intervention that promotes group dynamics, peer-based learning, and goal setting. Charts were reviewed at baseline, 3 months, and 12 months for documentation of decision makers and ACP forms...
July 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28720628/the-patient-centered-medical-home-pcmh-framing-typology-for-understanding-the-structure-function-and-outcomes-of-pcmhs
#18
Autumn M Kieber-Emmons, William L Miller
INTRODUCTION: Patient-centered medical homes (PCHMs) aspire to transform today's challenged primary care services. However, it is unclear which PCMH characteristics produce specific outcomes of interest for care delivery. This study tested a novel typology of PCMH practice transformation, the PCMH framing typology, and evaluated measurable outcomes by each type. METHODS: Using the Patient-Centered Primary Care Collaborative 2012 to 2013 Annual Review, this secondary analysis of the published PCMH literature extracted data from publications of 59 PCMHs...
July 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28720627/costs-of-transforming-established-primary-care-practices-to-patient-centered-medical-homes-pcmhs
#19
Neil S Fleming, Briget da Graca, Gerald O Ogola, Steven D Culler, Jessica Austin, Patrice McConnell, Russell McCorkle, Phil Aponte, Michael Massey, Cliff Fullerton
BACKGROUND: The patient-centered medical home (PCMH) shows promise for improving care and reducing costs. We sought to reduce the uncertainty regarding the time and cost of PCMH transformation by quantifying the direct costs of transforming 57 practices in a medical group to National Committee for Quality Assurance (NCQA)-recognized Level III PCMHs. METHODS: We conducted structured interviews with corporate leaders, and with physicians, practice administrators, and office managers from a representative sample of practices regarding time spent on PCMH transformation and NCQA application, and related purchases...
July 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28720121/the-effectiveness-of-daily-sms-reminders-in-pharmaceutical-care-of-older-adults-on-improving-patients-adherence-to-antihypertensive-medication-sppa-study-protocol-for-a-randomized-controlled-trial
#20
Zuzana Haramiova, Michal Stasko, Martin Hulin, Tomas Tesar, Magdalena Kuzelova, Donald M Morisky
BACKGROUND: Despite a variety of efficient and cost-effective antihypertensive medication, hypertension remains a serious health and economic burden. High consumption of cardiovascular drugs in the Slovak Republic does result neither in better hypertension control nor in significant decrease in cardiovascular mortality. At the same time, Slovakia has alarmingly low patients' adherence to medication intake. Studies have shown the efficiency of short messaging service (SMS) reminders to improve patients' adherence and health outcomes at low costs...
July 18, 2017: Trials
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