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Primary care

Karine Danno, Gérard Duru, Jean Marie Vetel
BACKGROUND:  The increasing use of psychotropic drugs to treat anxiety and depressive disorders (ADDs) is concerning. According to the study, 'Etude Pharmacoépidémiologique de l'Impact de Santé Publique des modes de prise en charge pour 3 groupes de pathologies' (EPI3)-LASER, adult ADD patients who consult a general practitioner prescribing homeopathic medicines (GP-Ho) report less psychotropic drug use and are marginally more likely to experience clinical improvement than those receiving conventional care...
March 20, 2018: Homeopathy: the Journal of the Faculty of Homeopathy
Nora B Henrikson, Caitlin C Morrison, Paula R Blasi, Matt Nguyen, Kendall C Shibuya, Carrie D Patnode
Importance: Exposure to UV radiation, especially in childhood, increases skin cancer risk. Objective: To systematically review the evidence on the benefits and harms of behavioral counseling for skin cancer prevention to inform the US Preventive Services Task Force (USPSTF). Data Sources: Cochrane Central Register of Controlled Trials, MEDLINE, and PubMed were searched for studies published from January 2009 to March 31, 2016, for skin cancer prevention and from August 2005 to March 31, 2016, for skin self-examination...
March 20, 2018: JAMA: the Journal of the American Medical Association
Neha Bairoliya, Günther Fink
BACKGROUND: While the high prevalence of preterm births and its impact on infant mortality in the US have been widely acknowledged, recent data suggest that even full-term births in the US face substantially higher mortality risks compared to European countries with low infant mortality rates. In this paper, we use the most recent birth records in the US to more closely analyze the primary causes underlying mortality rates among full-term births. METHODS AND FINDINGS: Linked birth and death records for the period 2010-2012 were used to identify the state- and cause-specific burden of infant mortality among full-term infants (born at 37-42 weeks of gestation)...
March 2018: PLoS Medicine
Florian Junne, Martina Michaelis, Eva Rothermund, Felicitas Stuber, Harald Gündel, Stephan Zipfel, Monika A Rieger
Objectives : This study analyses the perceived relevance of stress-dimensions in work-settings from the differential views of Human Resource Managers (HRM), Occupational Physicians (OP), Primary Care Physicians (PCP) and Psychotherapists (PT) in Germany. Methods : Cross-sectional study design, using a self-report questionnaire. Descriptive measures and explorative bivariate methods were applied for group-comparisons. Results are presented as rankings of perceived importance and as polarity profiles of contrasting views...
March 20, 2018: International Journal of Environmental Research and Public Health
Erica Dimitropoulos, Stephanie Bertucci, Kara Wong
BACKGROUND: Research has demonstrated that the combination of pharmacotherapy and psychological interventions in alcohol use disorder (AUD) treatment is superior to either alone. Despite this, medications remain highly underutilized in many outpatient treatment facilities. Pharmacists can serve as an excellent resource to aid in improving access to medications. METHODS: This study was a prospective, longitudinal evaluation of a pharmacist's role in a substance use disorder (SUD) clinic, specifically an intensive outpatient program (IOP)...
March 20, 2018: Substance Abuse
Kathryn M Nowotny, Jessica Frankeberger, Victoria E Rodriguez, Avelardo Valdez, Alice Cepeda
Herpes simplex virus type 2 (HSV-2) is among the most prevalent sexually transmitted infections in the United States. Despite this, there has been limited research on the correlates to HSV-2 among disadvantaged and marginalized women, particularly among Latinas. Data for the present analysis include 125 young adult Mexican-American women enrolled in a longitudinal study in a disadvantaged urban community in San Antonio, Texas. The current rate of tested HSV-2 infection is 56.8%. Our findings suggest strong comorbidity of genital herpes with injecting heroin use, Hepatitis C, sexual violence, incarceration, and mental illness...
March 20, 2018: Behavioral Medicine
Steven K M Lau, Bhavani S Gannavarapu, Kristen Carter, Ang Gao, Chul Ahn, Jeffrey J Meyer, David J Sher, Aminah Jatoi, Rodney Infante, Puneeth Iyengar
PURPOSE: Socioeconomic status (SES) influences health care outcomes, but the influence of primary payer on cancer-associated wasting is unknown. We hypothesized that primary payer as an indicator of SES would influence pretreatment cancer-associated weight loss and treatment outcomes. MATERIALS AND METHODS: Retrospective review of medical records identified 1,366 patients with non-small-cell lung cancer (NSCLC) consecutively treated at a tertiary care health system between January 1, 2006 and December 31, 2013...
March 20, 2018: Journal of Oncology Practice
Kelly M Goedert, Peii Chen, Anne L Foundas, A M Barrett
Spatial neglect commonly follows right hemisphere stroke. It is defined as impaired contralesional stimulus detection, response, or action, causing functional disability. While prism adaptation treatment is highly promising to promote functional recovery of spatial neglect, not all individuals respond. Consistent with a primary effect of prism adaptation on spatial movements, we previously demonstrated that functional improvement after prism adaptation treatment is linked to frontal lobe lesions. However, that study was a treatment-only study with no randomised control group...
March 20, 2018: Neuropsychological Rehabilitation
Piotr Czempik, Daniel Cieśla, Piotr Knapik, Łukasz Krzych
BACKGROUND: Acute kidney injury (AKI) in critically ill patients has a deleterious impact on the prognosis, especially when renal replacement therapy (RRT) is required. This issue has not yet been investigated in the intensive care setting in Poland. OBJECTIVES: The aim of the study was to evaluate the short-term outcomes of AKI-RRT subjects, based on a large registry population. MATERIAL AND METHODS: This observational multicenter study covered 100 demographic and clinical variables from the Silesian Registry of ICUs regarding 15,030 adult patients hospitalized between October 2011 and December 2014...
March 16, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
(no author information available yet)
No abstract text is available yet for this article.
April 19, 2018: Nurse Practitioner
Brittany Wheatley
Skin cancer is treatable and curable. Primary care providers should perform skin assessments for detection of skin cancer, however, due to conflicting guidelines and time constraints, many providers do not conduct adequate skin inspections. This quality improvement project aimed to improve skin inspection, documentation, and skin cancer detection through increased patient gowning.
April 19, 2018: Nurse Practitioner
Sara J Edmund, Kate G Sheppard
No abstract text is available yet for this article.
April 19, 2018: Nurse Practitioner
Tudor Borza, Mary K Oerline, Ted A Skolarus, Edward C Norton, Justin B Dimick, Bruce L Jacobs, Lindsey A Herrel, Chad Ellimoottil, John M Hollingsworth, Andrew M Ryan, David C Miller, Vahakn B Shahinian, Brent K Hollenbeck
OBJECTIVE: To evaluate the effect of Medicare Shared Savings Program accountable care organizations (ACOs) on hospital readmission after common surgical procedures. SUMMARY BACKGROUND DATA: Hospital readmissions following surgery lead to worse patient outcomes and wasteful spending. ACOs, and their associated hospitals, have strong incentives to reduce readmissions from 2 distinct Centers for Medicare and Medicaid Services policies. METHODS: We performed a retrospective cohort study using a 20% national Medicare sample to identify beneficiaries undergoing 1 of 7 common surgical procedures-abdominal aortic aneurysm repair, colectomy, cystectomy, prostatectomy, lung resection, total knee arthroplasty, and total hip arthroplasty-between 2010 and 2014...
March 19, 2018: Annals of Surgery
Samrat Yeramaneni, Jeffrey L Gum, Leah Y Carreon, Eric O Klineberg, Justin S Smith, Amit Jain, Richard A Hostin
BACKGROUND: Readmissions following adult spinal deformity surgical procedures frequently occur, placing a substantial burden on patients and providers. Existing literature on readmission costs, including reason-specific readmission costs, is limited. The purposes of this study were to determine the most expensive reasons for readmission, to assess the impact of reasons and timing on readmission costs, and to estimate the drivers of total costs associated with adult spinal deformity surgical procedures...
March 21, 2018: Journal of Bone and Joint Surgery. American Volume
Jason A Brant, Steven J Eliades, Hannah Kaufman, Jinbo Chen, Michael J Ruckenstein
OBJECTIVE: To evaluate high-performing cochlear implant patients' performance on AzBio sentence testing. METHODS: Retrospective review of prospectively collected database at a tertiary care hospital. Unilateral cochlear implant patients with AzBio testing were included. The primary outcome of interest was AzBio performance scores in quiet and at +10 and +5 decibels signal to noise (dB S/N). RESULTS: One hundred eighty five subjects met inclusion criteria with scores for AzBio in quiet, 114 at +10 dB S/N, and 66 at +5 dB S/N...
March 19, 2018: Otology & Neurotology
Jeffrey M Ryckman, Chi Lin, Charles B Simone, Vivek Verma
OBJECTIVE: The standard of care for clinical IA cervical cancer is surgery, but nonoperative cases may receive definitive radiation therapy (RT). Herein, we investigated national practice patterns associated with the administration of definitive RT as compared with hysterectomy-based surgery (HYS) as well as delivery of adjuvant RT after HYS. METHODS/MATERIALS: The National Cancer Data Base (NCDB) was queried for clinical IA primary cervical cancer cases (2004-2013) receiving definitive RT or HYS with or without adjuvant RT...
March 20, 2018: International Journal of Gynecological Cancer
Bobbi Jo H Yarborough, Felicia W Chi, Carla A Green, Agatha Hinman, Jennifer Mertens, Arne Beck, Michael Horberg, Constance Weisner, Cynthia I Campbell
OBJECTIVES: Understand patient and system characteristics associated with performance on the Healthcare Effectiveness Data and Information Set (HEDIS) Alcohol and Other Drug (AOD) Initiation and Engagement of Treatment (IET) measures. METHODS: This mixed-methods study linked patient and health system data from four Kaiser Permanente regions to HEDIS performance measure data for 44,320 commercially or Medicare-insured adults with HEDIS-eligible AOD diagnoses in 2012...
March 19, 2018: Journal of Addiction Medicine
Andrea Acevedo
: Initiation and engagement (IET), a process quality indicator for the treatment for substance use disorders (SUDs), has been associated with better treatment outcomes and has been part of the Healthcare Effectiveness Data and Information Set for over a decade. However, nationally, IET rates tend to be low and not improving. Integration may be a promising way to improve IET and quality of care, as suggested by the findings. To guarantee that integration is a truly effective mechanism for improving patient engagement and quality would likely require providing clinicians and other primary care providers with additional support and training on SUDs and treatment, and ensure that everyone, regardless of demographic characteristics, can equally benefit from these system level changes...
March 19, 2018: Journal of Addiction Medicine
Sanjay V Desai, David A Asch, Lisa M Bellini, Krisda H Chaiyachati, Manqing Liu, Alice L Sternberg, James Tonascia, Alyssa M Yeager, Jeremy M Asch, Joel T Katz, Mathias Basner, David W Bates, Karl Y Bilimoria, David F Dinges, Orit Even-Shoshan, David M Shade, Jeffrey H Silber, Dylan S Small, Kevin G Volpp, Judy A Shea
Background Concern persists that inflexible duty-hour rules in medical residency programs may adversely affect the training of physicians. Methods We randomly assigned 63 internal medicine residency programs in the United States to be governed by standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or by more flexible policies that did not specify limits on shift length or mandatory time off between shifts. Measures of educational experience included observations of the activities of interns (first-year residents), surveys of trainees (both interns and residents) and faculty, and intern examination scores...
March 20, 2018: New England Journal of Medicine
Miran Brvar, Ming Yin Chan, Andrew H Dawson, Richard R Ribchester, Michael Eddleston
INTRODUCTION: Treatment of acute organophosphorus or carbamate insecticide self-poisoning is often ineffective, with tens of thousands of deaths occurring every year. Researchers have recommended the addition of magnesium sulfate or calcium channel blocking drugs to standard care to reduce acetylcholine release at cholinergic synapses. OBJECTIVE: We aimed to review systematically the evidence from preclinical studies in animals exposed to organophosphorus or carbamate insecticides concerning the efficacy of magnesium sulfate and calcium channel blocking drugs as therapy compared with placebo in reducing mortality or clinical features of poisoning...
March 20, 2018: Clinical Toxicology
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