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Medical care avoidance

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https://www.readbyqxmd.com/read/29346472/a-revised-estimate-of-costs-associated-with-routine-preoperative-testing-in-medicare-cataract-patients-with-a-procedure-specific-indicator
#1
Catherine L Chen, Theodore H Clay, Stephen McLeod, Han-Ying Peggy Chang, Adrian W Gelb, R Adams Dudley
Importance: Routine preoperative medical testing is not recommended for patients undergoing low-risk surgery, but testing is common before surgery. A 30-day preoperative testing window is conventionally used for study purposes; however, the extent of routine testing that occurs prior to that point is unknown. Objective: To improve on existing cost estimates by identifying all routine preoperative testing that takes place after the decision is made to perform cataract surgery...
January 18, 2018: JAMA Ophthalmology
https://www.readbyqxmd.com/read/29346039/evaluation-of-a-french-regional-telemedicine-network-dedicated-to-neurological-emergencies-a-14-year-study
#2
Elisabeth Medeiros de Bustos, Eric Berthier, Didier Chavot, Benjamin Bouamra, Thierry Moulin
BACKGROUND: Equality in healthcare between urban and rural areas is problematic in France. Telemedicine networks are expected to improve equality in expertise assessment. We aimed to evaluate the use and impact of a regional rural French telemedicine network, dedicated to medical and surgical neurological emergencies, on interhospital patient transfers. METHODS: Eight community hospital emergency departments were remotely connected to the only university hospital in Franche-Comté, France...
January 18, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/29341525/-general-internal-medicine%C3%A2-2017-scientific-breakthroughs-in-ambulatory-care
#3
Alexandre Gouveia, Lionel De Alencastro, Yvonne Fierz, Lionel Koehli, Alexandre Béguelin, Olivier Pasche, Kevin Selby, Patrick Bodenmann
Bariatric surgery improves glycemic control in obese patients with diabetes type 2. Dual antiplatelet therapy can be maintained beyond 12 months after a myocardial infarction. Levothyroxine is not beneficial among patients ≥ 65 years that have subclinical hypothyroidism. Prophylactic anticoagulation in lower limb immobilisation should be reserved only for patients with a high risk of thromboembolism. A diagnosis of asthma should be initially confirmed by a spirometry if clinically suspected. A proton pump inhibitor is indicated for patients ≥ 65 years that are treated with aspirin...
January 17, 2018: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29339011/facilitators-and-barriers-to-healthy-pregnancy-spacing-among-medicaid-beneficiaries-findings-from-the-national-strong-start-initiative
#4
Caitlin Cross-Barnet, Brigette Courtot, Ian Hill, Sarah Benatar, Morgan Cheeks, Jenny Markell
BACKGROUND: Closely spaced, unintended pregnancies are common among Medicaid beneficiaries and create avoidable risks for women and infants, including preterm birth. The Strong Start for Mothers and Newborns Initiative, a program of the Center for Medicare and Medicaid Innovation, intended to prevent preterm birth through psychosocially based enhanced prenatal care in maternity care homes, group prenatal care, and birth centers. Comprehensive care offers the opportunity for education and family planning to promote healthy pregnancy spacing...
January 12, 2018: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/29338328/avoidance-meaning-and-grief-psychosocial-factors-influencing-engagement-in-hiv-care
#5
Georgia J Michlig, Ryan P Westergaard, Yukyan Lam, Azal Ahmadi, Gregory D Kirk, Andrew Genz, Jeanne Keruly, Heidi Hutton, Pamela J Surkan
Although the introduction of antiretroviral therapy has rendered HIV a chronic illness, inconsistent engagement in HIV care by key populations limits its public health impact. Poor engagement in care is especially prevalent among vulnerable populations with mental health and substance use disorders. Beyond structural and health system considerations, psychosocial factors may present challenges to sustained engagement. We conducted a qualitative study using in-depth interviews with 31 primarily African American, urban-based individuals, many with past or current drug use and mental disorders, living with HIV...
January 17, 2018: AIDS Care
https://www.readbyqxmd.com/read/29338316/retroareolar-masses-and-intraductal-abnormalities-detected-on-screening-ultrasound-can-biopsy-be-avoided
#6
Yang Guo, Madhavi Raghu, Melissa Durand, Regina Hooley
OBJECTIVE: To investigate the malignancy rate of retroareolar masses and intraductal abnormalities discovered in asymptomatic women during screening whole breast ultrasound (US-S) and determine if biopsy can be avoided. METHODS: This is a HIPAA compliant retrospective study. Our radiology electronic medical records were searched for the phrases "retroareolar mass" or "intraductal mass" combined with "screening whole breast ultrasound" performed between 10/1/2009 to 5/30/2015...
January 17, 2018: British Journal of Radiology
https://www.readbyqxmd.com/read/29337743/impact-of-a-novel-multiparameter-decision-support-system-on-intraoperative-processes-of-care-and-postoperative-outcomes
#7
Sachin Kheterpal, Amy Shanks, Kevin K Tremper
BACKGROUND: The authors hypothesized that a multiparameter intraoperative decision support system with real-time visualizations may improve processes of care and outcomes. METHODS: Electronic health record data were retrospectively compared over a 6-yr period across three groups: experimental cases, in which the decision support system was used for 75% or more of the case at sole discretion of the providers; parallel controls (system used 74% or less); and historical controls before system implementation...
February 2018: Anesthesiology
https://www.readbyqxmd.com/read/29337604/the-current-status-of-outcomes-based-contracting-for-manufacturers-and-payers-an-amcp-membership-survey
#8
Amy Duhig, Soumi Saha, Stacie Smith, Stew Kaufman, Janet Hughes
BACKGROUND: As the United States health care system shifts from traditional volume-based payments to value-based payments, outcomes-based contracts (OBCs) are gaining popularity among payers and manufacturers as a mechanism for the shift toward value. Under this model, stakeholders hope to align drug payment and value to real-world performance metrics (e.g., biomarkers and health care resource utilization). OBJECTIVE: To understand the experiences, perceptions, and needs of payers and manufacturers related to OBCs...
December 22, 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29335014/cost-effectiveness-study-of-early-versus-late-parenteral-nutrition-in-critically-ill-children-pepanic-preplanned-secondary-analysis-of-a-multicentre-randomised-controlled-trial
#9
Esther van Puffelen, Suzanne Polinder, Ilse Vanhorebeek, Pieter Jozef Wouters, Niek Bossche, Guido Peers, Sören Verstraete, Koen Felix Maria Joosten, Greet Van den Berghe, Sascha Cornelis Antonius Theodorus Verbruggen, Dieter Mesotten
BACKGROUND: The multicentre randomised controlled PEPaNIC trial showed that withholding parenteral nutrition (PN) during the first week of critical illness in children was clinically superior to providing early PN. This study describes the cost-effectiveness of this new nutritional strategy. METHODS: Direct medical costs were calculated with use of a micro-costing approach. We compared the costs of late versus early initiation of PN (n = 673 versus n = 670 patients) in the Belgian and Dutch study populations from a hospital perspective, using Student's t test with bootstrapping...
January 15, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29333825/6-minutes
#10
Pablo R Justich Zabala
At present, there is a trend towards reducing the duration of office visits. In some regions of Spain, it has been set at 6 minutes per patient. This impacts on several levels: literally, many times it is impossible to complete the medical act; at an emotional level, because there is little possibility to establish an adequate doctor-patient relationship; and symbolically, for considering that the main aspects of humane health care are expendable. This takes place in a society that tends to see health care as a merchandise subject to market rules that gives priority to the immediate over the important...
February 1, 2018: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/29329338/pharmacoepidemiological-assessment-of-adherence-and-influencing-co-factors-among-primary-open-angle-glaucoma-patients-an-observational-cohort-study
#11
Stefanie Frech, Daniel Kreft, Rudolf F Guthoff, Gabriele Doblhammer
The goal of this study was to assess the adherence of primary open-angle glaucoma (POAG) patients to medication, and to determine co-factors influencing adherence, using a representative sample of members of the largest German public health insurer. The observational cohort study was based on a longitudinal data set from 2010-2013 and included 250,000 insured persons aged 50 and older with 10,120 diagnosed POAG patients. Uni- and multivariate analysis was performed to investigate several aspects of glaucoma, such as prevalence, adherence, and co-factors influencing adherence...
2018: PloS One
https://www.readbyqxmd.com/read/29328354/end-of-life-conversations-as-a-legacy
#12
Jeanne M Sorrell
Advance directives such as living wills and health care powers of attorney are important documents that offer patients ways to avoid unwanted care when they are unable to express their wishes. Although health care professionals have increased focus on advance care planning in recent years, approximately two thirds of American adults do not have advance medical directives. In addition, 90% of individuals believe that talking to loved ones about end-of-life wishes is important, but only 27% have done so. It is important for nurses to understand the complex factors that influence how individuals make health care decisions and identify ways to encourage conversations with family, friends, and health care providers to help clarify patients' wishes for endof-life care...
January 1, 2018: Journal of Psychosocial Nursing and Mental Health Services
https://www.readbyqxmd.com/read/29327445/don-t-just-do-something-stand-there-the-value-and-art-of-deliberate-clinical-inertia
#13
Gerben Keijzers, Louise Cullen, Diana Egerton-Warburton, Daniel M Fatovich
It can be difficult to avoid unnecessary investigations and treatments, which are a form of low-value care. Yet every intervention in medicine has potential harms, which may outweigh the potential benefits. Deliberate clinical inertia is the art of doing nothing as a positive response. This paper provides suggestions on how to incorporate deliberate clinical inertia into our daily clinical practice, and gives an overview of current initiatives such as 'Choosing Wisely' and the 'Right Care Alliance'. The decision to 'do nothing' can be complex due to competing factors, and barriers to implementation are highlighted...
January 12, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29327351/negotiating-inter-professional-interaction-playing-the-general-practitioner-pharmacist-game
#14
Fay Bradley, Darren M Ashcroft, Nick Crossley
Despite a mutual interest in optimising the benefits of medication for patients, the general practitioner (GP) and community pharmacist (CP) often work in isolation from one another, both physically and figuratively. Sources of tension include pharmacy's 'shopkeeper' image, traditional medical hierarchies and potential encroachment on professional boundaries. This article examines GP and CP perceptions of their interactions and negotiations and, drawing on the works of Stein and Goffman, identifies a set of 'unwritten' rules, termed the 'GP-pharmacist game', which involves the concept of 'face-work'...
January 12, 2018: Sociology of Health & Illness
https://www.readbyqxmd.com/read/29325531/costs-of-potentially-inappropriate-medication-use-in-residential-aged-care-facilities
#15
S L Harrison, L Kouladjian O'Donnell, R Milte, S M Dyer, E S Gnanamanickam, C Bradley, E Liu, S N Hilmer, M Crotty
BACKGROUND: The potential harms of some medications may outweigh their potential benefits (inappropriate medication use). Despite recommendations to avoid the use of potentially inappropriate medications (PIMs) in older adults, the prevalence of PIM use is high in different settings including residential aged care. However, it remains unclear what the costs of these medications are in this setting. The main objective of this study was to determine the costs of PIMs in older adults living in residential care...
January 11, 2018: BMC Geriatrics
https://www.readbyqxmd.com/read/29324427/lemons-in-the-arizona-sunshine-the-effects-of-furocoumarins-leading-to-phytophotodermatitis-and-burn-like-injuries
#16
Marc R Matthews, Joel C VanderVelde, Daniel M Caruso, Kevin N Foster
INTRODUCTION: Phytophototoxic dermatitis is a strong phototoxic reaction to ultraviolet A (UV-A) radiation exposure after cutaneous contact with citrus fruit containing furocoumarins, leading to skin injury. At the Arizona Burn Center (Phoenix, AZ), the majority of these injuries are managed in the outpatient setting. CASE REPORT: The authors present a pediatric admission for burn-like injuries following prolonged cutaneous exposure to lemons while playing in the Arizona sunshine...
December 2017: Wounds: a Compendium of Clinical Research and Practice
https://www.readbyqxmd.com/read/29322713/communication-adaptations-for-a-diverse-international-patient-population
#17
Aditya Ghosh, Shashank Joshi, Amit K Ghosh
We live in an age of hyper connectivity, people from around the world are looking outside their own national borders to receive medical care. As more people are learning about the quality that the elite Indian hospitals provide at a competitive, and often more affordable, price compared to other institutions around the world, they are becoming increasingly interested in receiving their medical care in Indian hospitals. It is for this exact reason that it is very important to learn the importance of communicating effectively with people from a diverse background...
November 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/29320600/providing-physicians-with-feedback-on-medication-adherence-for-people-with-chronic-diseases-taking-long-term-medication
#18
REVIEW
Vincent Zaugg, Virginie Korb-Savoldelli, Pierre Durieux, Brigitte Sabatier
BACKGROUND: Poor medication adherence decreases treatment efficacy and worsens clinical outcomes, but average rates of adherence to long-term pharmacological treatments for chronic illnesses are only about 50%. Interventions for improving medication adherence largely focus on patients rather than on physicians; however, the strategies shown to be effective are complex and difficult to implement in clinical practice. There is a need for new care models addressing the problem of medication adherence, integrating this problem into the patient care process...
January 10, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29319359/secondary-and-tertiary-preventions-of-thyroid-disease
#19
Fereidoun Azizi, Ladan Mehran, Farhad Hosseinpanah, Hossein Delshad, Atieh Amouzegar
INTRODUCTION: Secondary and tertiary preventions are concerned with the recognition of the disease process in a very early stage and delay in progression to complete disease and minimization of complications and the impact of illness. METHODS: All articles related to secondary and tertiary prevention of thyroid diseases were reviewed. Using related key words, articles published between 2001 and 2015 were evaluated, categorized, and analyzed. RESULTS: In secondary prevention, congenital hypothyroidism and subclinical hypo and hyperthyroidism are equally important...
January 10, 2018: Endocrine Research
https://www.readbyqxmd.com/read/29318413/evaluation-of-postoperative-fever-after-surgical-correction-of-neuromuscular-scoliosis-implication-on-management
#20
Mohamed Abdelhamid Ali Yousef, Scott Rosenfeld
BACKGROUND: Scoliosis is a common deformity in patients with neuromuscular disorders which usually necessitates surgical correction. Patients with neuromuscular scoliosis are characterized by increased incidence of associated medical co-morbidities and higher postoperative complication rate; therefore, these patients are often managed with a wide multidisciplinary care team. Postoperative fever is a frequent complication after surgery which is often routinely investigated using different workup tests to rule out infection...
January 9, 2018: European Spine Journal
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