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https://www.readbyqxmd.com/read/29151092/conversion-factitious-disorder-and-malingering-a-distinct-pattern-or-a-continuum
#1
Silvio Galli, Laurent Tatu, Julien Bogousslavsky, Selma Aybek
This chapter is aimed at highlighting the recent findings concerning physiopathology, diagnosis, and management of conversion, factitious disorder, and malingering. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Practitioners are often confronted to medically unexplained symptoms; they represent almost 30% of neurologist's consultation...
2018: Frontiers of Neurology and Neuroscience
https://www.readbyqxmd.com/read/29151022/quality-of-care-for-people-with-multimorbidity-a-case-series
#2
Michaela L Schiøtz, Dorte Høst, Mikkel B Christensen, Helena Domínguez, Yasmin Hamid, Merete Almind, Kim L Sørensen, Thomas Saxild, Rikke Høgsbro Holm, Anne Frølich
BACKGROUND: Multimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people with multimorbidity in the publicly funded healthcare system in Denmark. METHODS: To investigate the quality of care for people with multimorbidity different groups of clinicians from the hospital, general practice and the municipality reviewed records from 23 persons with multimorbidity and discussed them in three focus groups...
November 18, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/29149912/trial-to-incentivise-adherence-for-diabetes-triad-study-protocol-for-a-randomised-controlled-trial
#3
Marcel Bilger, Mitesh Shah, Ngiap Chuan Tan, Kaye Louise Howard, Hui Yan Xu, Ecosse Luc Lamoureux, Eric Andrew Finkelstein
BACKGROUND: Many people with diabetes have suboptimal glycaemic control due to not being adherent to their treatment regimen. Behavioural economic theory suggests that the lack of adherence results from the disconnect between the timing of when costs and benefits accrue. One strategy to address this discontinuity is to offer patients a near-term benefit, such as a financial reward. Whereas there is evidence that rewards can improve treatment adherence and sometimes health outcomes, further research is needed to determine whether rewards are more effective when targeting processes or intermediary health outcomes...
November 17, 2017: Trials
https://www.readbyqxmd.com/read/29149317/decision-space-for-health-workforce-management-in-decentralized-settings-a-case-study-in-uganda
#4
Alvaro Alonso-Garbayo, Joanna Raven, Sally Theobald, Freddie Ssengooba, Milly Nattimba, Tim Martineau
The aim of this paper is to improve understanding about how district health managers perceive and use their decision space for human resource management (HRM) and how this compares with national policies and regulatory frameworks governing HRM. The study builds upon work undertaken by PERFORM Research Consortium in Uganda using action-research to strengthen human resources management in the health sector. To assess the decision space that managers have in six areas of HRM (e.g. policy, planning, remuneration and incentives, performance management, education and information) the study compares the roles allocated by Uganda's policy and regulatory frameworks with the actual room for decision-making that district health managers perceive that they have...
November 1, 2017: Health Policy and Planning
https://www.readbyqxmd.com/read/29149313/how-do-health-workers-experience-and-cope-with-shocks-learning-from-four-fragile-and-conflict-affected-health-systems-in-uganda-sierra-leone-zimbabwe-and-cambodia
#5
Sophie Witter, Haja Wurie, Pamela Chandiwana, Justine Namakula, Sovannarith So, Alvaro Alonso-Garbayo, Freddie Ssengooba, Joanna Raven
This article is grounded in a research programme which set out to understand how to rebuild health systems post-conflict. Four countries were studied-Uganda, Sierra Leone, Zimbabwe and Cambodia-which were at different distances from conflict and crisis, as well as having unique conflict stories. During the research process, the Ebola epidemic broke out in West Africa. Zimbabwe has continued to face a profound economic crisis. Within our research on health worker incentives, we captured insights from 128 life histories and in-depth interviews with a variety of staff that had remained in service...
November 1, 2017: Health Policy and Planning
https://www.readbyqxmd.com/read/29148387/incentives-for-bushmeat-consumption-and-importation-among-west-african-immigrants-minnesota-usa
#6
Emily Walz, David Wilson, Jacob C Stauffer, Danushka Wanduragala, William M Stauffer, Dominic A Travis, Jonathan D Alpern
The knowledge, attitudes, and practices surrounding bushmeat consumption and importation in the United States are not well described. Focus groups of West African persons living in Minnesota, USA, found that perceived risks are low and unlikely to deter consumers. Incentives for importation and consumption were multifactorial in this community.
December 2017: Emerging Infectious Diseases
https://www.readbyqxmd.com/read/29148354/case-managers-for-high-risk-high-cost-patients-as-agents-and-street-level-bureaucrats
#7
Jeffrey Swanson, William G Weissert
Case management programs often designate a nurse or social worker to take responsibility for guiding care when patients are expected to be expensive or risk a major decline. We hypothesized that though an intuitively appealing idea, careful program design and faithful implementation are essential if case management programs are to succeed. We employed two theory perspectives, principal-agent framework and street-level bureaucratic theory to describe the relationship between program designers (principals) and case managers (agents/street-level bureaucrats) to review 65 case management studies...
August 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148352/nursing-home-response-to-nursing-home-compare-the-provider-perspective
#8
Marcelo Coca Perraillon, Daniel J Brauner, R Tamara Konetzka
Nursing Home Compare (NHC) publishes composite quality ratings of nursing homes based on a five-star rating system, a system that has been subject to controversy about its validity. Using in-depth interviews, we assess the views of nursing home administrators and staff on NHC and unearth strategies used to improve ratings. Respondents revealed conflicting goals and strategies. Although nursing home managers monitor the ratings and expend effort to improve scores, competing goals of revenue maximization and avoidance of litigation often overshadow desire to score well on NHC...
August 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148344/moderating-effects-of-patient-characteristics-on-the-impact-of-financial-incentives
#9
Meredith B Rosenthal, Andrea B Troxel, Kevin G Volpp, Walter F Stewart, Thomas D Sequist, James B Jones, AnneMarie G Hirsch, Karen Hoffer, Jingsan Zhu, Wenli Wang, Amanda Hodlofski, Darra Finnerty, Jack J Huang, David A Asch
While financial incentives to providers or patients are increasingly common as a quality improvement strategy, their impact on patient subgroups and health care disparities is unclear. To examine these patterns, we analyzed data from a randomized clinical trial of financial incentives to lower low-density lipoprotein (LDL) cholesterol levels in patients at risk for cardiovascular disease. Patients with higher baseline LDL experienced greater cholesterol reductions in the shared incentive arm (0.23 mg/dL per unit change in baseline LDL, 95% CI [-0...
May 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148335/geographic-variation-in-medicaid-acceptance-across-michigan-primary-care-practices-in-the-era-of-the-affordable-care-act
#10
Renuka Tipirneni, Karin V Rhodes, Rodney A Hayward, Richard L Lichtenstein, HwaJung Choi, Emily K Arntson, Jessica M Landgraf, Matthew M Davis
Coverage and access have improved under the Affordable Care Act, yet it is unclear whether recent gains have reached those regions within states that were most in need of improved access to care. We examined geographic variation in Medicaid acceptance among Michigan primary care practices before and after Medicaid expansion in the state, using data from a simulated patient study of primary care practices. We used logistic regression analysis with time indicators to assess regional changes in Medicaid acceptance over time...
March 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148332/medicare-advantage-and-traditional-medicare-hospitalization-intensity-and-readmissions
#11
Rachel Mosher Henke, Zeynal Karaca, Teresa B Gibson, Eli Cutler, Marguerite L Barrett, Katharine Levit, Jayne Johann, Lauren Hersch Nicholas, Herbert S Wong
Medicare Advantage plans have incentives and tools to optimize patient care. Therefore, Medicare Advantage hospitalizations may have lower cost and higher quality than similar traditional Medicare hospitalizations. We applied a coarsened matching approach to 2013 Healthcare Cost and Utilization Project hospital discharge data from 22 states to compare hospital cost, length of stay, and readmissions for Traditional Medicare and Medicare Advantage. We found that Medicare Advantage hospitalizations were substantially less expensive and shorter for mental health stays but costlier and longer for injury and surgical stays...
March 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148329/the-implementation-of-performance-management-systems-in-u-s-physician-organizations
#12
Alexander F Pimperl, Hector P Rodriguez, Julie A Schmittdiel, Stephen M Shortell
Performance management systems (PMSYS) aid in improving the quality and efficiency of care, but little is known about factors that influence more robust PMSYS among physician organizations. Using a nationally representative survey of U.S. medical practices, we examined the extent to which organizational capabilities and external factors were associated with more developed PMSYS. Linear regression estimated the relative impact of these factors on PMSYS. On average, practices implemented a minority (32 points out of 100) of the PMSYS processes assessed...
March 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29147056/organizing-integrated-health-care-services-to-meet-older-people-s-needs
#13
Islene Araujo de Carvalho, JoAnne Epping-Jordan, Anne Margriet Pot, Edward Kelley, Nuria Toro, Jotheeswaran A Thiyagarajan, John R Beard
In most countries, a fundamental shift in the focus of clinical care for older people is needed. Instead of trying to manage numerous diseases and symptoms in a disjointed fashion, the emphasis should be on interventions that optimize older people's physical and mental capacities over their life course and that enable them to do the things they value. This, in turn, requires a change in the way services are organized: there should be more integration within the health system and between health and social services...
November 1, 2017: Bulletin of the World Health Organization
https://www.readbyqxmd.com/read/29147032/emptying-the-stores-lysosomal-diseases-and-therapeutic-strategies
#14
REVIEW
Frances M Platt
Lysosomal storage disorders (LSDs) - designated as 'orphan' diseases - are inborn errors of metabolism caused by defects in genes that encode proteins involved in various aspects of lysosomal homeostasis. For many years, LSDs were viewed as unattractive targets for the development of therapies owing to their low prevalence. However, the development and success of the first commercial biologic therapy for an LSD - enzyme replacement therapy for type 1 Gaucher disease - coupled with regulatory incentives rapidly catalysed commercial interest in therapeutically targeting LSDs...
November 17, 2017: Nature Reviews. Drug Discovery
https://www.readbyqxmd.com/read/29146502/protracted-motivational-dopamine-related-deficits-following-adolescence-sugar-overconsumption
#15
Fabien Naneix, Florence Darlot, Véronique De Smedt-Peyrusse, Jean-Rémi Pape, Etienne Coutureau, Martine Cador
Adolescence represents a critical period characterized by major neurobiological changes. Chronic stimulation of the reward system during adolescence might constitute an important factor of vulnerability to pathological development. Increasing evidences suggest that adolescent overconsumption of sweet palatable foods impact reward-based processes. However, the neurobiological bases of these deficits remain poorly understood. Previous studies have demonstrated motivational deficits for palatable foods after sweet diet exposure during adolescence that might involve the dopamine (DA) system, a central actor in incentive processes...
November 13, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/29145996/-comparative-profile-of-the-use-of-filter-needles-in-quebec-and-france-in-healthcare-facility
#16
L Painchart, P Odou, J-F Bussières
OBJECTIVES: The manipulation of drugs from glass ampules can generate particles when the ampule is broken. Several authors recommend the use of filter needle to withdraw the drug content. The main objective is to establish an inventory of the use of filter needles and the perception of pharmacists in Quebec and in France. METHODS: This is a cross-sectional descriptive study. A questionnaire was sent to all health facilities in Quebec (n=30) and a selection of hospitals in France (n=100)...
November 13, 2017: Annales Pharmaceutiques Françaises
https://www.readbyqxmd.com/read/29145751/negative-symptoms-and-reward-disturbances-in-schizophrenia-before-and-after-antipsychotic-monotherapy
#17
Mette Ødegaard Nielsen, Egill Rostrup, Brian Villumsen Broberg, Sanne Wulff, Birte Glenthøj
BACKGROUND: Negative symptoms (NS) are a central part of the symptomatology of schizophrenia, which is highly correlated to the functional outcome. Disturbances of the brain reward system are suggested to be central in the pathogenesis of NS by decreasing motivation and hedonic experiences. In this study, we compared reward-related brain activity in patients improving and not improving in NS after treatment with amisulpride. METHODS: Thirty-nine antipsychotic-naive patients and 49 healthy controls completed functional magnetic resonance imaging with a modified monetary incentive delay task...
November 1, 2017: Clinical EEG and Neuroscience: Official Journal of the EEG and Clinical Neuroscience Society (ENCS)
https://www.readbyqxmd.com/read/29143703/dose-response-evaluation-of-the-standardized-ileal-digestible-tryptophan-lysine-ratio-to-maximize-growth-performance-of-growing-finishing-gilts-under-commercial-conditions
#18
M A D Gonçalves, M D Tokach, N M Bello, K J Touchette, R D Goodband, J M DeRouchey, J C Woodworth, S S Dritz
Environmental regulations as well as economic incentives have resulted in greater use of synthetic amino acids in swine diets. Tryptophan is typically the second limiting amino acid in corn-soybean meal-based diets. However, using corn-based co-products emphasizes the need to evaluate the pig's response to increasing Trp concentrations. Therefore, the objective of these studies was to evaluate the dose-response to increasing standardized ileal digestible (SID) Trp : Lys on growth performance of growing-finishing gilts housed under large-scale commercial conditions...
November 16, 2017: Animal: An International Journal of Animal Bioscience
https://www.readbyqxmd.com/read/29142964/impact-of-the-end-stage-renal-disease-prospective-payment-system-on-the-use-of-peritoneal-dialysis
#19
Qian Zhang, Mae Thamer, Onkar Kshirsagar, Yi Zhang
Introduction: The End Stage Renal Disease (ESRD) Prospective Payment System (PPS), implemented by the Centers for Medicare and Medicaid Services in January 2011, encouraged use of peritoneal dialysis (PD) through various financial incentives. Our goal was to determine whether PPS effectively increased PD use in incident dialysis patients. Methods: Our study used the United States Renal Data System (USRDS) to identify 430,927 adult patients who initiated dialysis between 2009 and 2012...
May 2017: KI Reports
https://www.readbyqxmd.com/read/29142296/the-dopamine-motive-system-implications-for-drug-and-food-addiction
#20
REVIEW
Nora D Volkow, Roy A Wise, Ruben Baler
Behaviours such as eating, copulating, defending oneself or taking addictive drugs begin with a motivation to initiate the behaviour. Both this motivational drive and the behaviours that follow are influenced by past and present experience with the reinforcing stimuli (such as drugs or energy-rich foods) that increase the likelihood and/or strength of the behavioural response (such as drug taking or overeating). At a cellular and circuit level, motivational drive is dependent on the concentration of extrasynaptic dopamine present in specific brain areas such as the striatum...
November 16, 2017: Nature Reviews. Neuroscience
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