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communicating risk to patients

Gladstone C McDowell, Joseph Winchell
OBJECTIVES: The majority of patients seeking medical care for chronic pain consult a primary care physician (PCP). Because systemic opioids are commonly prescribed to patients with chronic pain, PCPs are attempting to balance the competing priorities of providing adequate pain relief while reducing risks for opioid misuse and overdose. It is important for PCPs to be aware of pain management strategies other than systemic opioid dose escalation when patients with chronic pain fail to respond to conservative therapies and to initiate a multimodal treatment plan...
March 15, 2018: Postgraduate Medicine
Roseanne O Yeung, Jing-Heng Cai, Yuying Zhang, Andrea O Luk, Jun-Hao Pan, Junmei Yin, Risa Ozaki, Alice P S Kong, Ronald Ma, Wing-Yee So, Chiu Chi Tsang, K P Lau, Edwin Fisher, Williams Goggins, Brian Oldenburg, Julianna Chan
Background: In a randomized controlled trial of 628 Chinese patients with type 2 diabetes receiving multidisciplinary care in the Joint Asia Diabetes Evaluation (JADE) Progam, 372 were randomized to receive additional telephone-based peer support (Peer Empowerment And Remote communication Linked by information technology, PEARL) intervention. After 12 months, all-cause hospitalization was reduced by half in the PEARL group especially in those with high Depression Anxiety and Stress Scale (DASS) scores...
2018: Clinical Diabetes and Endocrinology
Rahat A Abdoellakhan, Nakisa Khorsand, Reinier M Van Hest, Nic Veeger, Ewoud Ter Avest, Paula F Ypma, Laura M Faber, Karina Meijer
INTRODUCTION: There is currently little evidence for the optimal dosing strategy of four-factor prothrombin complex concentrates (PCC) in vitamin K antagonist (VKA)-related bleeds. The generally accepted dosing strategy is the use of a variable dose calculated using patient-specific characteristics as per manufacturer's instruction. However, evidence exists that the use of a fixed low dose of 1000 international units of factor IX (IU fIX) might also suffice. Recent studies indicate that in terms of haemostatic effectiveness, the fixed dosing strategy might be even superior to the variable dosing strategy...
March 14, 2018: BMJ Open
Endrias Markos Woldesemayat, Andargachew Kassa, Taye Gari, Mesay Hailu Dangisso
BACKGROUND: Non-communicable chronic diseases (NCCDs) multi-morbidity is becoming one of the public health problems in Ethiopia. The objective of this study was to describe the prevalence of NCCDs and multi-morbidity among adult patients at Hawassa University Comprehensive Specialized Hospital (HUCSH). METHODS: Between January and February 2016, a cross-sectional study was carried out among patients aged ⩾ 18 years attending the outpatient department of the hospital...
March 14, 2018: BMC Public Health
Paul I Musey, John A Lee, Cassandra A Hall, Jeffrey A Kline
BACKGROUND: Approximately 80% of patients presenting to emergency departments (ED) with chest pain do not have any true cardiopulmonary emergency such as acute coronary syndrome (ACS). However, psychological contributors such as anxiety are thought to be present in up to 58%, but often remain undiagnosed leading to chronic chest pain and ED recidivism. METHODS: To evaluate ED provider beliefs and their usual practices regarding the approach and disposition of patients with low risk chest pain associated with anxiety, we constructed a 22-item survey using a modified Delphi technique...
March 14, 2018: BMC Emergency Medicine
Michael Kerin Morgan, Mathew Guilfoyle, Ramez Kirollos, Gillian Z Heller
BACKGROUND: Avoiding the risk of postoperative hemorrhage after brain arteriovenous malformation (AVM) resection involves aggressive blood pressure control. Remodeling of the feeding arterial system is critical in reducing this risk. OBJECTIVE: To investigate factors predicting time to return to normal on digital subtraction angiography (DSA) after AVM resection. METHODS: For AVM in which the largest feeding artery (FA) on DSA was in the anterior circulation, the preoperative and postoperative diameter of the FA were compared with the diameter of the internal carotid artery (IC) immediately proximal to the posterior communicating artery...
March 12, 2018: Neurosurgery
S Kinsinger
Barrett's esophagus is a chronic esophageal condition that is associated with an increased risk of esophageal adenocarcinoma. This chronic condition negatively impacts patients' quality of life and is associated with increased levels of psychological distress. In 'Perceptions of risk and therapy among patients with Barrett's esophagus: a patient survey study,' Stier et al. explored factors associated with esophageal cancer risk perception and management decisions among patients with Barrett's esophagus. The results indicate that patients greatly overestimate their cancer risk and are willing to accept low success rates and high risks of complications to undergo endoscopic therapy...
March 9, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
Alexandra Wollum, Rose Gabert, Claire R McNellan, Jessica M Daly, Priscilla Reddy, Paurvi Bhatt, Miranda Bryant, Danny V Colombara, Pamela Naidoo, Belinda Ngongo, Anam Nyembezi, Zaino Petersen, Bryan Phillips, Shelley Wilson, Emmanuela Gakidou, Herbert C Duber
BACKGROUND: The HealthRise initiative seeks to implement and evaluate innovative community-based strategies for diabetes, hypertension and hypercholesterolemia along the entire continuum of care (CoC)-from awareness and diagnosis, through treatment and control. In this study, we present baseline findings from HealthRise South Africa, identifying gaps in the CoC, as well as key barriers to care for non-communicable diseases (NCDs). METHODS: This mixed-methods needs assessment utilized national household data, health facility surveys, focus group discussions, and key informant interviews in Umgungundlovu and Pixley ka Seme districts...
2018: PloS One
I Indurawa, E Amis, N Hannon, K Khadjooi
Background Atrial fibrillation is a major risk factor for ischaemic stroke. We investigated whether active screening for atrial fibrillation in secondary care, followed by careful evaluation of risk factors and communication to general practitioners from stroke specialists, could increase appropriate anticoagulation prescription. Methods Between 1/9/14 and 28/2/15 all acute medical admissions were screened for atrial fibrillation at Cambridge University Hospital. Individualised letters were sent to the general practitioners of patients who it was felt would benefit from anticoagulation...
December 2017: Journal of the Royal College of Physicians of Edinburgh
Emily S Patterson
Objective To integrate and synthesize insights from recent studies of workarounds to the intended use of health information technology (HIT) by health care professionals. Background Systems are safest when the documentation of how work is done in policies and procedures closely matches what people actually do when they are working. Proactively identifying and managing workarounds to the intended use of technology, including deviations from expected workflows, can improve system safety. Method A narrative review of studies of workarounds with HIT was conducted to identify themes in the literature...
March 1, 2018: Human Factors
Jason R Falvey, Robert E Burke, Kyle J Ridgeway, Daniel J Malone, Jeri E Forster, Jennifer E Stevens-Lapsley
BACKGROUND AND PURPOSE: Recent evidence has suggested physical therapist involvement in care transitions after hospitalization is associated with reduced rates of hospital readmissions. However, little is known about how physical therapists participate in care transitions for older adults, the content of care communications, and the facilitators and barriers of implementing evidence-based care transition strategies into practice. Thus, the purpose of this article is to evaluate participation in care transition activities known to influence readmission risk among older adults, and understand perceptions of and barriers to participation in these activities...
March 12, 2018: Journal of Geriatric Physical Therapy
Shigeomi Yokoya, Akihiko Hino, Yukihiro Goto, Youichi Hashimoto, Hideki Oka
BACKGROUND: The headache preceding an intracranial aneurysm (AN) rupture is called a sentinel headache (SH), and it is characterized by a sudden, intense, and persistent headache. As subarachnoid hemorrhage (SAH) often develops within several weeks of SH, its rapid diagnosis and treatment can improve the prognosis. CASE DESCRIPTION: A 52-year-old woman with migraine in her medical history visited the outpatient clinic due to left orbital pain. There was no neurological deficit...
March 9, 2018: World Neurosurgery
Midas Meijs, Frank-Erik de Leeuw, Hieronymus D Boogaarts, Rashindra Manniesing, Frederick Jan Anton Meijer
BACKGROUND: In case of carotid artery occlusion, the risk and extent of ischemic cerebral damage is highly dependent on the pathways of collateral flow, including the anatomy of the circle of Willis. In this report, cases are presented to illustrate that 4D-CTA can be considered as a non-invasive alternative to DSA for the evaluation of circle of Willis collateral flow. CASE DESCRIPTION: Five patients with unilateral internal carotid artery (ICA) occlusion underwent 4D-CTA for the evaluation of intracranial hemodynamics...
March 9, 2018: World Neurosurgery
Katharine Wallis, Rebecca Tuckey
INTRODUCTION High-risk prescribing in general practice is common and places patients at increased risk of adverse events. AIM The Safer Prescribing and Care for the Elderly (SPACE) intervention, comprising audit and feedback plus practice mail-out to patients with high-risk prescribing, was designed to promote medicines review and support safer prescribing. This study aims to test the SPACE intervention feasibility in general practice. METHODS This feasibility study involved an Auckland Primary Health Organisation (PHO), a clinical advisory pharmacist, two purposively sampled urban general practices, and seven GPs...
June 2017: Journal of Primary Health Care
Bo Abrahamsen
Clinicians are trained in interpreting risk in our daily practice. While we understand the concept of absolute benefit and absolute harm rates, communicating such figures in a clear and intuitive way to patients is no easy task. And we do not of course work in a vacuum. Patient decisions are influenced by other healthcare providers and in some circumstances those providers will be the actual prescribers and the gatekeepers for testing and treatment.
March 12, 2018: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
Mohammad Sahebkar, Hamid Miri Heidarian, Pardis Noormohammadpour, Rahim Akrami, Nasrin Mansournia, Bahareh Tavana, Mohammad Ali Mansournia, Emmanuel Stamatakis
OBJECTIVE: To assess the prevalence and correlates of low physical activity among Iranian population aged 15-64 years. METHODS: We used the data collected in National Surveillance of Risk Factors of Non-Communicable Diseases in Iran, 2011. Physical activity was categorized in 3 levels of low, moderate, and high based on a Persian version of Global Physical Activity Questionnaire. The multistage cluster sampling design was accounted for using complex survey analysis method...
March 12, 2018: Scandinavian Journal of Medicine & Science in Sports
Michael E Snavely, Michael J Maze, Charles Muiruri, Lilian Ngowi, Flora Mboya, Julia Beamesderfer, Glory F Makupa, Anthon G Mwingwa, Bingileki F Lwezaula, Blandina T Mmbaga, Venance P Maro, John A Crump, Jan Ostermann, Matthew P Rubach
Introduction: Communicable diseases are the leading causes of death in Tanzania despite the existence of effective treatment tools. We aimed to assess the sociocultural and health system factors associated with mortality from febrile illness in northern Tanzania. Methods: We interviewed febrile inpatients to determine prevalence of barriers in seeking or receiving care and grouped these barriers using the Three Delays model (delays at home, in transport and at healthcare facilities)...
2018: BMJ Global Health
Louise S van Galen, Daisy Vedder, Tom Boeije, Wilma Jansen, Nieke E Mullaart-Jansen, Donald L van der Peet, Ralph K L So, Prabath W B Nanayakkara
BACKGROUND: Although unscheduled readmissions are increasingly being used as a quality indicator, only few readmission studies have focused on surgical patient populations. METHODS: An observational study "CURIOS@" was performed at three centers in the Netherlands. Readmitted patients and treating doctors were surveyed to assess the discharge process during index admission and their opinion on predictability and preventability of the readmission. Risk factors associated with predictability and preventability as judged by patients and their doctor were identified...
March 8, 2018: Journal of Surgical Research
Pius Kim, Suk Jung Jang
OBJECTIVE: Surgical clipping of the cerebral aenurysm is considered as a standard therapy with endovascular coil embolization. The surgical clipping is known to be superior to the endovascular coil embolization in terms of recurrent rate. However, a recurrent aneurysm which is initially treated by surgical clipping is difficult to handle. The purpose of this study was to research the management of the recurrent cerebral aneurysm after a surgical clipping and how to overcome them. METHODS: From January 1996 to December 2015, medical records and radiologic findings of 14 patients with recurrent aneurysm after surgical clipping were reviewed retrospectively...
March 2018: Journal of Korean Neurosurgical Society
Carole P Kaufmann, Dominik Stämpfli, Nadine Mory, Kurt E Hersberger, Markus L Lampert
INTRODUCTION: Identifying patients with a high risk for drug-related problems (DRPs) might optimise the allocation of targeted pharmaceutical care during the hospital stay and on discharge. OBJECTIVE: To develop a self-assessment screening tool to identify patients at risk for DRPs and validate the tool regarding feasibility, acceptability and the reliability of the patients' answers. DESIGN: Prospective validation study. SETTING: Two mid-sized hospitals (300-400 beds)...
March 9, 2018: BMJ Open
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