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Primary care

Ines Weinhold, Sebastian Gurtner
In light of the rising regional inequalities in primary care provider supply, to ensure equitable access is a pressing issue in health policy. Most policy approaches fall short in considering the patient perspective when defining shortage areas. As a consequence, implementations of new service delivery models might fail to be responsive to patients' expectations. To explore regional differences in the relative importance of structure and process attributes as drivers of patient satisfaction with local primary care, we collected data from residents of three objectively well-supplied urban and six objectively worse-supplied rural areas in Germany and tested a multi-group structural equation model...
June 21, 2018: Social Science & Medicine
Jaedon P Avey, Lisa G Dirks, Denise A Dillard, Spero M Manson, Melissa Merrick, Julia J Smith, Guilford C Prickette, Sonda Tetpon, Donna Galbreath, Brianna Triplett, Renee F Robinson
BACKGROUND: Depression remains the second leading cause of disability worldwide. Symptoms of depression are expressed and experienced differently across cultural groups, impacting treatment decisions. Patient preferences predict service utilization, treatment selection and persistence, as well as health outcomes for medical and behavioral health conditions, including depression. We identified depression management preferences of Alaska Native and American Indian (AN/AI) people who receive care within a comprehensive, integrated, tribally owned and operated healthcare facility in Anchorage, Alaska...
June 7, 2018: Journal of Affective Disorders
France Légaré, Rhéda Adekpedjou, Dawn Stacey, Stéphane Turcotte, Jennifer Kryworuchko, Ian D Graham, Anne Lyddiatt, Mary C Politi, Richard Thomson, Glyn Elwyn, Norbert Donner-Banzhoff
BACKGROUND: Shared decision making (SDM) is a process by which a healthcare choice is made by the patient, significant others, or both with one or more healthcare professionals. However, it has not yet been widely adopted in practice. This is the second update of this Cochrane review. OBJECTIVES: To determine the effectiveness of interventions for increasing the use of SDM by healthcare professionals. We considered interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both...
July 19, 2018: Cochrane Database of Systematic Reviews
Aishwarya Vijay, Jessica E Becker, Joseph S Ross
Off-label prescribing of psychiatric drugs is common, despite lacking strong scientific evidence of efficacy and potentially increasing risk for adverse events. The goal of this study was to characterize prevalence of off-label prescriptions of psychiatric drugs and examine patient and clinician predictors of off-label use. This manuscript presents a retrospective, cross-sectional study using data from the 2012 and 2013 National Ambulatory Medical Care Surveys (NAMCS). The study examined all adult outpatient visits to psychiatric practices for chronic care management with a single listed visit diagnosis in which at least one psychiatric drug was prescribed...
2018: PloS One
Maria Salinas, Maite López-Garrigós, Emilio Flores, Javier Lugo, Carlos Leiva-Salinas
Background The clinical laboratory plays a crucial role in the diagnosis and monitoring of chronic kidney disease. The quantitative measurement of urine albumin in a spot sample, expressed as ratio per creatinine (ACR) is the most frequently used biomarker for such a purpose. Our aim was to evaluate the diagnostic performances of a strip for measuring ACR for differentiating patients who are candidates for subsequent albumin quantification, and to evaluate the economic effects of its implementation. Methods We systematically measured strip analysis when quantitative urinary albumin was requested...
July 19, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
Aileen Chang, Elizabeth Patberg, Victor Cueto, Hua Li, Bhavana Singh, Sonjia Kenya, Yisel Alonzo, Olveen Carrasquillo
OBJECTIVES: To determine whether a 1-year community health worker intervention improves access to care and service utilization among Latinos with diabetes. METHODS: We conducted a single-blind randomized trial of 300 adults with poorly controlled diabetes treated in 2 public hospital clinics in Miami, Florida. We began enrollment in 2010 and completed follow-up in 2015. We examined access and utilization using self-reported measures and data from electronic medical records...
July 19, 2018: American Journal of Public Health
Julia L Marcus, Kenneth Levine, Chris Grasso, Douglas S Krakower, Victoria Powell, Kyle T Bernstein, Stephen Boswell, Kenneth H Mayer
OBJECTIVES: To determine whether HIV preexposure prophylaxis (PrEP) use is associated with use of non-HIV-related health care. METHODS: We conducted a cross-sectional study of potential PrEP candidates at a Boston, Massachusetts, community health clinic during 2012 to 2016, comparing the proportion of PrEP users and non-PrEP users receiving primary care. RESULTS: Of 5857 PrEP candidates, 2047 (35%) were prescribed PrEP. After adjustment for demographics and number of visits, more PrEP users received influenza vaccination (prevalence ratio [PR] = 1...
July 19, 2018: American Journal of Public Health
Hilary K Seligman, Morgan Smith, Sophie Rosenmoss, Michelle Berger Marshall, Elaine Waxman
OBJECTIVES: To determine whether food bank provision of self-management support and diabetes-appropriate food improves glycemic control among clients with diabetes. METHODS: We screened 5329 adults for diabetes at food pantries (n = 27) affiliated with food banks in Oakland, California; Detroit, Michigan; and Houston, Texas, between October 2015 and September 2016. We individually randomized 568 participants with hemoglobin A1c (HbA1c) 7.5% or greater to waitlist control or 6-month intervention including food, diabetes education, health care referral, and glucose monitoring...
July 19, 2018: American Journal of Public Health
Philip C Robinson, Nicola Dalbeth
Febuxostat is a potent non-purine selective xanthine oxidase inhibitor approved by the FDA in 2009 for management of hyperuricemia in people with gout. Areas covered: The authors summarize the pre-clinical studies and pivotal randomized controlled trials of febuxostat when used as a treatment for hyperuricaemia in gout Expert opinion: Febuxostat has clinical efficacy in serum urate lowering, and long-term use leads to improved outcomes such as gout flare frequency and tophus burden. Recently published post-approval placebo-controlled trials have demonstrated urate-lowering efficacy and safety of febuxostat in patients with chronic kidney disease, and reduced frequency of gout flares in people with early onset of gout...
July 19, 2018: Expert Opinion on Pharmacotherapy
Jeffrey E Lancet, Geoffrey L Uy, Jorge E Cortes, Laura F Newell, Tara L Lin, Ellen K Ritchie, Robert K Stuart, Stephen A Strickland, Donna Hogge, Scott R Solomon, Richard M Stone, Dale L Bixby, Jonathan E Kolitz, Gary J Schiller, Matthew J Wieduwilt, Daniel H Ryan, Antje Hoering, Kamalika Banerjee, Michael Chiarella, Arthur C Louie, Bruno C Medeiros
Purpose CPX-351 is a dual-drug liposomal encapsulation of cytarabine and daunorubicin that delivers a synergistic 5:1 drug ratio into leukemia cells to a greater extent than normal bone marrow cells. Prior clinical studies demonstrated a sustained drug ratio and exposure in vivo and prolonged survival versus standard-of-care cytarabine plus daunorubicin chemotherapy (7+3 regimen) in older patients with newly diagnosed secondary acute myeloid leukemia (sAML). Patients and Methods In this open-label, randomized, phase III trial, 309 patients age 60 to 75 years with newly diagnosed high-risk/sAML received one to two induction cycles of CPX-351 or 7+3 followed by consolidation therapy with a similar regimen...
July 19, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Magali Pirson, Jean-Etienne Poirrier, Sophie Joubert, Julie Van den Bulcke, Pol Leclercq, Laura Avena, Burcin Bilge, Pauline Blanquet, Karine Calet, Baudouin Byl
INTRODUCTION: Intestinal Clostridium difficile Infection (CDI) treated in hospitals may concern patients whose reason for admission is CDI (primary diagnosis) or who have acquired CDI during their stay (secondary diagnosis). OBJECTIVES: The objective of this study is to evaluate the cost for social security and hospitals and the length of hospital stays related to CDIs as the main reason for admission. METHOD: This study was carried out in 2012 in 13 Belgian hospitals...
April 2018: Acta Gastro-enterologica Belgica
Helena J Teede, Marie L Misso, Michael F Costello, Anuja Dokras, Joop Laven, Lisa Moran, Terhi Piltonen, Robert J Norman
STUDY QUESTION: What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? SUMMARY ANSWER: International evidence-based guidelines including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of women with PCOS. WHAT IS KNOWN ALREADY: Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated...
July 19, 2018: Clinical Endocrinology
Adil R Dingankar, Dominic A Cave, Vijay Anand, V Ben Sivarajan, Susan Nahirniak, Cathy Sheppard, Jan Hanot, Gonzalo Garcia Guerra
OBJECTIVES: To determine the clinical benefit of using colloids versus crystalloids for volume resuscitation in children admitted after cardiac surgery. DESIGN: Retrospective pre-/postintervention cohort study. SETTING: Stollery Children's Hospital tertiary care pediatric cardiac ICU. PATIENTS: Children admitted to the pediatric cardiac ICU after cardiac surgery. INTERVENTIONS: Fluid resuscitation policy change in which crystalloids replaced albumin 5% as the primary fluid strategy for resuscitation after cardiac surgery...
July 17, 2018: Pediatric Critical Care Medicine
Nomathemba Chandiwana, Shobna Sawry, Matthew Chersich, Elizabeth Kachingwe, Bulelani Makhathini, Lee Fairlie
Outcomes of HIV-infected children have improved dramatically over the past decade, but are undermined by patient loss to follow-up (LTFU). We assessed patterns of LTFU among HIV-infected children receiving antiretroviral treatment (ART) at a large inner-city HIV clinic in Johannesburg, South Africa between 2005 and 2014.Demographic and clinical data were extracted from clinic records of children under 12 years. Differences between characteristics of children retained in care and LTFU were assessed using Wilcoxon rank sum tests or Pearson χ tests...
July 2018: Medicine (Baltimore)
Megan E Collins, Steven Rum, Jane Wheeler, Karen Antman, Henry Brem, Joseph Carrese, Michelle Glennon, Jeffrey Kahn, E Magnus Ohman, Reshma Jagsi, Sara Konrath, Stacey Tovino, Scott Wright, Jeremy Sugarman
Grateful patients provide substantial philanthropic funding for health care institutions, resulting in important societal benefits. Although grateful patient fundraising (GPFR) is widespread, it raises an array of ethical issues for patients, physicians, development professionals, and institutions. These issues have not been described comprehensively, and there is insufficient guidance to inform the ethical practice of GPFR. Consequently, the authors convened a summit, The Ethics of Grateful Patient Fundraising, with the goal of identifying primary ethical issues in GPFR and offering recommendations regarding how to manage them...
July 17, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Larrie Greenberg
The challenging and changing face of medicine over the last 45 years of the author's career has dictated where faculty members' primary interaction with patients occurs, how they teach trainees, and how they measure educational outcomes. The transfer of patient care from the inpatient to the ambulatory setting in the late 20 century was instrumental in creating a "new' model for faculty; that is, the clinician educator (CE). This individual has been defined as a faculty member whose primary responsibility as part of the academic mission is patient care and whose focus is on the theoretical constructs that inform excellent teaching and effective learning, applying these to create and inform educational scholarship...
July 17, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Kathleen Bornhoeft
Background and Problem Statement: Obesity is a prevalent chronic disease associated with decreased life expectancy, increased morbidity and mortality, and escalating health care costs. PURPOSE: To explore perceptions, attitudes, and behaviors toward obesity management by providers in primary care. METHOD: Data were collected through a descriptive qualitative design using semi-structured face-to-face interviews at primary care practices. RESULTS: Common barriers to obesity management were identified and three major themes emerged; provider centered obstacles, perceived organizational obstacles, and provider perception of patient obstacles...
July 2018: Journal of Community Health Nursing
Bryan G Beutel, Bryan J Marascalchi, Eitan Melamed
BACKGROUND: Spasticity resulting from traumatic brain injury (TBI) or stroke can lead to debilitating sequelae, including deformities from joint subluxation and spasticity, causing a loss of functional independence. Despite the effectiveness of surgery to address these issues, it is unclear how often these procedures are performed. The objective of the study was to determine the rate of, and trends associated with, reconstructive upper extremity surgery in patients following TBI or stroke...
July 1, 2018: Hand: Official Journal of the American Association for Hand Surgery
Jamile A Ashmore, Kirk W Ditterich, Claire C Conley, Melissa R Wright, Peggy S Howland, Kelly L Huggins, Jena Cooreman, Priscilla S Andrews, Donald R Nicholas, Lind Roberts, Larissa Hewitt, Joan N Scales, Jenny K Delap, Christine A Gray, Lynelle A Tyler, Charlotte Collins, Catherine M Whiting, Brittany M Brothers, Marlena M Ryba, Barbara L Andersen
The gap between treatment development and efficacy testing to scaled up implementations of evidence-based treatment (EBT) is an estimated 20 years, and hybrid research designs aim to reduce the gap. One was used for a multisite study in cancer control, testing coprimary aims: (a) determine the feasibility and utility of a flexible EBT implementation strategy and (b) determine the clinical effectiveness of an EBT as implemented by newly trained providers. Therapists from 15 diverse sites implemented the biobehavioral intervention (BBI) for cancer patients ( N = 158) as part of standard care...
July 19, 2018: American Psychologist
André Hajek, Christian Brettschneider, Hendrik van den Bussche, Dagmar Lühmann, Anke Oey, Birgitt Wiese, Siegfried Weyerer, Jochen Werle, Angela Fuchs, Michael Pentzek, Janine Stein, Tobias Luck, Horst Bickel, Edelgard Mösch, Kathrin Heser, Michael Wagner, Martin Scherer, Wolfgang Maier, Steffi G Riedel-Heller, Hans-Helmut König
OBJECTIVE: The purpose of this study was to examine the impact of falls on depressive symptoms among the oldest old in Germany longitudinally. METHODS: Data were used from 2 waves of the multicenter prospective cohort "Study on needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe). This study covers primary care patients ≥85 years (at baseline: n = 547, average age of 88...
July 19, 2018: International Journal of Geriatric Psychiatry
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