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J Niclot, A Stansal, O Saint-Lary, I Lazareth, P Priollet
INTRODUCTION: Abdominal aortic aneurysm (AAA) is a silent pathology with often fatal consequences in case of rupture. AAA screening, recommended in France and many other countries, has shown its effectiveness in reducing specific mortality. However, AAA screening rate remains insufficient. OBJECTIVE: To identify barriers to AAA screening in general practice. MATERIAL AND METHOD: Qualitative study carried out during 2016 among general practitioners based in Paris...
May 2018: Journal de Médecine Vasculaire
Eric R Coon, Paul C Young, Ricardo A Quinonez, Daniel J Morgan, Sanket S Dhruva, Alan R Schroeder
Importance: Medical overuse has historically focused on adult health care, but interest in how children are affected by medical overuse is increasing. This review examines important research articles published in 2016 that address pediatric overuse. Observations: A structured search of PubMed and a manual review of the tables of contents of 10 journals identified 169 articles related to pediatric overuse published in 2016, from which 8 were selected based on the quality of methods and potential harm to patients in terms of prevalence and magnitude...
May 1, 2018: JAMA Pediatrics
Carlos Martins, Maciek Godycki-Cwirko, Bruno Heleno, John Brodersen
BACKGROUND: According to the Wonca International Dictionary for General/Family Practice Quaternary Prevention is defined as: 'Action taken to identify patient at risk of overmedicalization, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.' The concept of quaternary prevention was initially proposed by Marc Jamoulle and the targets were mainly patients with illness but without a disease. OBJECTIVES: The purpose of this opinion article is to open the debate around a new possible definition and a new conceptual model of quaternary prevention based on the belief that quaternary prevention should be present in physicians' minds for every intervention they suggest to a patient...
December 2018: European Journal of General Practice
Lisa Rosenbaum
They called me Ms. Appropriate. When I was a cardiology fellow, health care costs were skyrocketing, and I considered devoting my career to curbing inappropriate use of medical resources. My first target, as a supervisor of cardiac stress tests, was referrals of patients for unnecessary testing —..
December 14, 2017: New England Journal of Medicine
Nathan D Shippee, Tetyana P Shippee, Patrick D Mobley, Karl M Fernstrom, Heather R Britt
BACKGROUND: Patients with serious chronic illness are at a greater risk of depersonalized, overmedicalized care as they move into later life. Existing intervention research on person-focused care for persons in this transitional period is limited. OBJECTIVE: To test the effects of LifeCourse, a team-based, whole-person intervention emphasizing listening to and knowing patients, on patient experience at 6 months. DESIGN: This is a quasi-experimental study with patients allocated to LifeCourse and comparison groups based on 2 geographic locations...
January 2018: American Journal of Hospice & Palliative Care
Maria Regina Torloni, Ana Pilar Betrán, José M Belizán
The Birth in Brazil study is the largest national hospital-based survey in Brazil regarding birth practices. Conducted in 2011-2012, it collected information from 266 public and private healthcare facilities and interviewed nearly 24,000 postpartum women. It is also the latest effort to map out how labor and delivery are managed in this county in the 21st century. The journal Reproductive Health has published a supplement including 10 articles presenting the results of a series of analyses using this valuable resource...
October 17, 2016: Reproductive Health
Henrik Vogt, Bjørn Hofmann, Linn Getz
The emerging concept of systems medicine (or 'P4 medicine'-predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards 'precision medicine'. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease...
June 2016: Medicine, Health Care, and Philosophy
T Hanslik, A Flahault
Overmedicalization refers to non-validated medical practices, with no clear benefits, potentially harmful and therefore unnecessarily costly. Awareness is growing with respect to this serious public health problem. Permanent expansion of diagnostic or therapeutic interventions, disease mongering, inadequate management of diagnostic uncertainty, conflict of interest or lack of commitment by physicians and patients in shared decision making. Overmedicalization is made possible by a lack of training of health professionals and users on medical decision process...
March 2016: La Revue de Médecine Interne
Nathan J Jamieson, Camilla S Hanson, Michelle A Josephson, Elisa J Gordon, Jonathan C Craig, Fabian Halleck, Klemens Budde, Allison Tong
BACKGROUND: Kidney transplantation offers better outcomes compared to dialysis, but requires patients to adhere to an ongoing and complex self-management regimen. Medication nonadherence remains a leading cause of transplant loss, and inadequate self-management undermines transplantation and other health outcomes. We aimed to describe kidney transplant recipients' motivations, challenges, and attitudes toward self-management. STUDY DESIGN: Systematic review and thematic synthesis of qualitative studies...
March 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Giorgio Visentin
The article of Marc Jamoulle shows the importance of the contribution of general practitioners (GPs) in improving the quality and the efficiency of the health systems. Starting from the concept of quaternary prevention for reducing excessive costs in the preventive procedures, he suggests a change of paradigm in every daily activity of the GP in order to have a stronger ethical approach to the patient. This means spending more time in the consultation in order to better understand her/his real needs and share a common decision for minimizing the costs and solving the patient's problems in agreement with her/his believes and values...
August 2015: International Journal of Health Policy and Management
Hamilton Wagner
The article analyzes literature problems using as a parameter the quaternary prevention concept, introducing guidelines to have good shared decisions that avoid overdiagnosis and overtreatment and improve the quality of life. The author proposes a four-step approach: reliable evidence, awareness about populations profile, independent research analysis, and an understandable format by ordinary people.
August 2015: International Journal of Health Policy and Management
Marc Jamoulle
In response to the questioning of Health Policy and Management (HPAM) by colleagues on the role of rank and file family physicians in the same journal, the author, a family physician in Belgium, is trying to highlight the complexity and depth of the work of his colleagues and their contribution to the understanding of the organization and economy of healthcare. It addresses, in particular, the management of health elements throughout the ongoing relationship of the family doctor with his/her patients. It shows how the three dimensions of prevention, clearly included in the daily work, are complemented with the fourth dimension, quaternary prevention or prevention of medicine itself, whose understanding could help to control the economic and human costs of healthcare...
February 2015: International Journal of Health Policy and Management
Tiziana Leone
OBJECTIVE: To understand the interaction between health systems and individual factors in determining the probability of a cesarean delivery in India. METHODS: In a retrospective study, data from the 2007-2008 District Level Household and Facility Survey was used to determine the risk of cesarean delivery in six states (Punjab, Delhi, Maharashtra, Andhra Pradesh, Kerala, and Tamil Nadu). Multilevel modeling was used to account for district and community effects...
November 2014: International Journal of Gynaecology and Obstetrics
David Forbes, Alicia Lim, Madhur Ravikumara
PURPOSE OF REVIEW: Gastroesophageal reflux (GER) remains a common, challenging problem for clinicians, with differentiation of normal development from disease a particular issue. This review updates clinicians on advances in diagnosis of GER, relationship to other problems, and current practice in management. RECENT FINDINGS: Development and understanding of multichannel intraluminal impedance-pH monitoring has given insights into the relationship of GER to symptoms...
October 2013: Current Opinion in Pediatrics
George R Saade
No abstract text is available yet for this article.
August 2013: Obstetrics and Gynecology
Mervyn Singer
The greatest advances in critical care over the past two decades have been achieved through doing less to the patient. We have learnt through salutary experience that our burgeoning Master-of-the-Universe capabilities and the oh-so-obvious stratagems instilled in us from youth were often ineffective or even deleterious. This re-education process, however, is far from complete. We are now rightly agonizing over the need for better characterization of pathophysiology, earlier identification of disease processes and a more directed approach to therapeutic intervention...
2013: Critical Care: the Official Journal of the Critical Care Forum
Wendy Glauser
No abstract text is available yet for this article.
August 9, 2011: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Jerry M Spiegel, Shafik Dharamsi, Kishor M Wasan, Annalee Yassi, Burton Singer, Peter J Hotez, Christy Hanson, Donald A P Bundy
This PLoS Medicine Debate examines the different approaches that can be taken to tackle neglected tropical diseases (NTDs). Some commentators, like Jerry Spiegel and colleagues from the University of British Columbia, feel there has been too much focus on the biomedical mechanisms and drug development for NTDs, at the expense of attention to the social determinants of disease. Burton Singer argues that this represents another example of the inappropriate "overmedicalization" of contemporary tropical disease control...
May 2010: PLoS Medicine
Neil L Schechter
No abstract text is available yet for this article.
October 2008: Journal of Developmental and Behavioral Pediatrics: JDBP
Yongyuth Pongsupap, Wim Van Lerberghe
BACKGROUND: In Thailand, family practice was developed primarily through a small number of self-styled family practitioners, who were dedicated to this professional field without having benefited from formal training in the specific techniques of family practice. In the context of a predominantly hospital-based health care system, much depends on their personal motivation and commitment to this area of medicine. The purpose of this paper is to compare the responsiveness, degree of patient-centredness, adequacy of therapeutic decisions and the cost of care in 37 such self-styled family practices, i...
2006: Human Resources for Health
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