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https://www.readbyqxmd.com/read/28724126/comparative-outcomes-after-percutaneous-coronary-intervention-among-black-and-white-patients-treated-at-us-veterans-affairs-hospitals
#1
Taisei Kobayashi, Thomas J Glorioso, Ehrin J Armstrong, Thomas M Maddox, Mary E Plomondon, Gary K Grunwald, Steven M Bradley, Thomas T Tsai, Stephen W Waldo, Sunil V Rao, Subhash Banerjee, Brahmajee K Nallamothu, Deepak L Bhatt, A Garvey Rene, Robert L Wilensky, Peter W Groeneveld, Jay Giri
Importance: Current comparative outcomes among black and white patients treated with percutaneous coronary intervention (PCI) in the Veterans Affairs (VA) health system are not known. Objective: To compare outcomes between black and white patients undergoing PCI in the VA health system. Design, Setting, and Participants: This study compared black and white patients who underwent PCI between October 1, 2007, and September 30, 2013, at 63 VA hospitals using data recorded in the VA Clinical Assessment, Reporting, and Tracking System for Cardiac Catheterization Laboratories (CART-CL) program...
July 19, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28720635/increased-public-accountability-for-hospital-nonprofit-status-potential-impacts-on-residency-positions
#2
Melanie C Raffoul, Robert L Phillips
BACKGROUND: The Institute of Medicine recently called for greater graduate medical education (GME) accountability for meeting the workforce needs of the nation. The Affordable Care Act expanded community health needs assessment (CHNA) requirements for nonprofit and tax-exempt hospitals to include community assessment, intervention, and evaluation every 3 years but did not specify details about workforce. Texas receives relatively little federal GME funding but has used Medicaid waivers to support GME expansion...
July 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28720039/the-revamp-trial-to-evaluate-hiv-resistance-testing-in-sub-saharan-africa-a-case-study-in-clinical-trial-design-in-resource-limited-settings-to-optimize-effectiveness-and-cost-effectiveness-estimates
#3
Mark J Siedner, Mwebesa B Bwana, Mahomed-Yunus S Moosa, Michelle Paul, Selvan Pillay, Suzanne McCluskey, Isaac Aturinda, Kevin Ard, Winnie Muyindike, Pravikrishnen Moodley, Jaysingh Brijkumar, Tamlyn Rautenberg, Gavin George, Brent Johnson, Rajesh T Gandhi, Henry Sunpath, Vincent C Marconi
BACKGROUND: In sub-Saharan Africa, rates of sustained HIV virologic suppression remain below international goals. HIV resistance testing, while common in resource-rich settings, has not gained traction due to concerns about cost and sustainability. OBJECTIVE: We designed a randomized clinical trial to determine the feasibility, effectiveness, and cost-effectiveness of routine HIV resistance testing in sub-Saharan Africa. APPROACH: We describe challenges common to intervention studies in resource-limited settings, and strategies used to address them, including: (1) optimizing generalizability and cost-effectiveness estimates to promote transition from study results to policy; (2) minimizing bias due to patient attrition; and (3) addressing ethical issues related to enrollment of pregnant women...
July 18, 2017: HIV Clinical Trials
https://www.readbyqxmd.com/read/28711332/predictors-of-operating-room-extubation-in-adult-cardiac-surgery
#4
Kathirvel Subramaniam, Diana S DeAndrade, Daniel R Mandell, Andrew D Althouse, Rajan Manmohan, Stephen A Esper, Jeffrey M Varga, Vinay Badhwar
OBJECTIVE: The primary objective of the study was to identify perioperative factors associated with successful immediate extubation in the operating room after adult cardiac surgery. The secondary objective was to derive a simplified predictive scoring system to guide clinicians in operating room extubation. METHODS: All 1518 patients in this retrospective cohort study underwent standardized fast-track cardiac anesthetic protocol during adult cardiac surgery. Perioperative variables between patients who had successful extubation in the operating room versus in the intensive care unit were retrospectively analyzed using both univariate and multivariable logistic regression analyses...
June 13, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28710700/enhancing-state-medical-home-capacity-through-a-care-coordination-technical-assistance-model
#5
Susan Berry, Patti Barovechio, Emily Mabile, Tri Tran
Introduction A practice-based care coordination (CC) model was developed by Louisiana's Title V Children's Special Health Services (CSHS) program to meet the overwhelming needs of the New Orleans post-Katrina population. The pilot clinic demonstrated an improvement in medical home (MH) capacity over the course of 3 months. The purpose of the current study is to evaluate the replicability of the model and sustainability of MH improvement over at least 2 years, while identifying factors that may modify the effect of the intervention...
July 14, 2017: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/28706083/wealth-related-inequality-in-early-uptake-of-hiv-testing-among-pregnant-women-an-analysis-of-data-from-a-national-cross-sectional-survey-south-africa
#6
Nobubelo Kwanele Ngandu, Carine Van Malderen, Ameena Goga, Niko Speybroeck
OBJECTIVES: Wealth-related inequality across the South African antenatal HIV care cascade has not been considered in detail as a potential hindrance to eliminating mother-to-child HIV transmission (EMTCT). We aimed to measure wealth-related inequality in early (before enrolling into antenatal care) uptake of HIV testing and identify the contributing determinants. DESIGN: Cross-sectional survey. SETTINGS: South African primary public health facilities in 2012...
July 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/28703869/early-supported-discharge-services-for-people-with-acute-stroke
#7
REVIEW
Peter Langhorne, Satu Baylan
BACKGROUND: People with stroke conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed that offer people in hospital an early discharge with rehabilitation at home (early supported discharge: ESD). OBJECTIVES: To establish if, in comparison with conventional care, services that offer people in hospital with stroke a policy of early discharge with rehabilitation provided in the community (ESD) can: 1) accelerate return home, 2) provide equivalent or better patient and carer outcomes, 3) be acceptable satisfactory to patients and carers, and 4) have justifiable resource implications use...
July 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28689310/an-interactive-mobile-phone-website-platform-to-facilitate-real-time-management-of-medication-in-chronically-ill-patients
#8
Helena Anglada-Martínez, Maite Martin-Conde, Marina Rovira-Illamola, Jose Miguel Sotoca-Momblona, Ethel Sequeira, Valentin Aragunde, Carles Codina-Jané
Poor adherence to medication is a prevalent issue that affects 50-60% of chronically ill patients. We present Medplan, a platform for patients/caregivers and healthcare professionals (HCPs) that aims to enhance adherence, increase patient medication knowledge, and facilitate communication between patients and HCPs. The Medplan platform was designed and developed by a multidisciplinary team composed of primary care and hospital physicians, pharmacists, patients, and developers. We questioned 62 patients in order to know their opinion about the different functions the app would incorporate and other possible features that should be taken into consideration...
August 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28685043/comprehensive-review-of-the-evidence-regarding-the-effectiveness-of-community-based-primary-health-care-in-improving-maternal-neonatal-and-child-health-5-equity-effects-for-neonates-and-children
#9
Meike Schleiff, Richard Kumapley, Paul A Freeman, Sundeep Gupta, Bahie M Rassekh, Henry B Perry
BACKGROUND: The degree to which investments in health programs improve the health of the most disadvantaged segments of the population-where utilization of health services and health status is often the worst-is a growing concern throughout the world. Therefore, questions about the degree to which community-based primary health care (CBPHC) can or actually does improve utilization of health services and the health status of the most disadvantaged children in a population is an important one...
June 2017: Journal of Global Health
https://www.readbyqxmd.com/read/28681427/delirium-after-fast-track-hip-and-knee-arthroplasty-a-cohort-study-of-6331-elderly-patients
#10
P B Petersen, C C Jørgensen, H Kehlet
BACKGROUND: Postoperative delirium (PD) is a well-known complication among elderly surgical patients and associated with increased morbidity, mortality and length of stay (LOS). In elective orthopedic surgery, including hip and knee arthroplasty (THA/TKA), most studies report incidences between 5% and 10%. The multimodal optimization of perioperative care (fast-track) aims to enhance recovery and reduce morbidity and LOS, but limited data are available on the effect on PD. Consequently, the study investigated signs of PD associated with LOS > 4 days...
August 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28676467/the-rules-of-engagement-perspectives-on-secure-messaging-from-experienced-ambulatory-patient-portal-users
#11
Cynthia J Sieck, Jennifer L Hefner, Jeanette Schnierle, Hannah Florian, Aradhna Agarwal, Kristen Rundell, Ann Scheck McAlearney
BACKGROUND: Patient portals have shown promise in engaging individuals in self-management of chronic conditions by allowing patients to input and track health information and exchange secure electronic messages with their providers. Past studies have identified patient barriers to portal use including usability issues, low health literacy, and concerns about loss of personal contact as well as provider concerns such as increased time spent responding to messages. However, to date, studies of both patient and provider perspectives on portal use have focused on the pre-implementation or initial implementation phases and do not consider how these issues may change as patients and providers gain greater experience with portals...
July 4, 2017: JMIR Medical Informatics
https://www.readbyqxmd.com/read/28659252/mobile-phone-short-messages-to-improve-exclusive-breastfeeding-and-reduce-adverse-infant-feeding-practices-protocol-for-a-randomized-controlled-trial-in-yangon-myanmar
#12
Myat Pan Hmone, Mu Li, Ashraful Alam, Michael J Dibley
BACKGROUND: Myanmar has a high burden of mortality for children aged younger than 5 years in which undernutrition plays a major role. Despite current efforts, the exclusive breastfeeding rate for children under 6 months is only 24%. To date there have been no interventions using mobile phones to improve breastfeeding and other feeding practices in Myanmar. OBJECTIVE: This study aims to implement a breastfeeding promotion intervention using mobile phone text messages in Yangon, Myanmar, and evaluate its impact on breastfeeding practices...
June 28, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28648219/primary-care-collaboration-to-improve-diagnosis-and-screening-for-colorectal-cancer
#13
Gordon D Schiff, Trudy Bearden, Lindsay Swain Hunt, Jennifer Azzara, Jay Larmon, Russell S Phillips, Sara Singer, Brandon Bennett, Jonathan R Sugarman, Asaf Bitton, Andrew Ellner
BACKGROUND: Colorectal cancer (CRC) is a leading cause of cancer death, reducible by screening and early diagnosis, yet many patients fail to receive recommended screening. As part of an academic improvement collaborative, 25 primary care practices worked to improve CRC screening and diagnosis. METHODS: The project featured triannual learning sessions, monthly conference calls, practice coach support, and monthly reporting. The project phases included literature review and interviews with national leaders/organizations, development of driver diagrams to identify key factors and change ideas, project launch and practice team planning, and a practice improvement phase...
July 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28645958/factors-predicting-self-reported-medication-low-adherence-in-a-large-sample-of-adults-in-the-us-general-population-a-cross-sectional-study
#14
Michael Feehan, Margaux A Morrison, Casey Tak, Donald E Morisky, Margaret M DeAngelis, Mark A Munger
OBJECTIVES: The study objective was to determine the level and correlates of self-reported medication low adherence in the US general population. SETTING: A 30 min cross-sectional online survey was conducted with a national sample of adults. PARTICIPANTS: 9202 adults (aged 18+) who had filled at least three or more prescriptions at a community pharmacy in the past 12 months. PRIMARY AND SECONDARY OUTCOME MEASURES: Self-reported medication adherence was measured with the 8-item Morisky Medication Adherence Scale...
June 23, 2017: BMJ Open
https://www.readbyqxmd.com/read/28645890/tailored-communication-within-mobile-apps-for-diabetes-self-management-a-systematic-review
#15
Heidi Holmen, Astrid Klopstad Wahl, Milada Cvancarova Småstuen, Lis Ribu
BACKGROUND: The prevalence of diabetes is increasing and with the requirements for self-management and risk of late complications, it remains a challenge for the individual and society. Patients can benefit from support from health care personnel in their self-management, and the traditional communication between patients and health care personnel is changing. Smartphones and apps offer a unique platform for communication, but apps with integrated health care personnel communication based on patient data are yet to be investigated to provide evidence of possible effects...
June 23, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28645227/diabetic-and-obese-patient-clinical-outcomes-improve-during-a-care-management-implementation-in-primary-care
#16
Jodi Summers Holtrop, Zhehui Luo, Gretchen Piatt, Lee A Green, Qiaoling Chen, John Piette
BACKGROUND: To address the increasing burden of chronic disease, many primary care practices are turning to care management and the hiring of care managers to help patients coordinate their care and self-manage their conditions. Care management is often, but not always, proving effective at improving patient outcomes, but more evidence is needed. METHODS: In this pair-matched cluster randomized trial, 5 practices implemented care management and were compared with 5 comparison practices within the same practice organization...
June 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28632012/medical-school-outcomes-primary-care-specialty-choice-and-practice-in-medically-underserved-areas-by-physician-alumni-of-medprep-a-postbaccalaureate-premedical-program-for-underrepresented-and-disadvantaged-students
#17
Anneke M Metz
PROBLEM: Minorities continue to be underrepresented as physicians in medicine, and the United States currently has a number of medically underserved communities. MEDPREP, a postbaccalaureate medical school preparatory program for socioeconomically disadvantaged or underrepresented in medicine students, has a stated mission to increase the numbers of physicians from minority or disadvantaged backgrounds and physicians working with underserved populations. This study aims to determine how MEDPREP enhances U...
July 2017: Teaching and Learning in Medicine
https://www.readbyqxmd.com/read/28617023/integrated-behavioral-health-practice-facilitation-in-patient-centered-medical-homes-a-promising-application
#18
Sarah S Roderick, Nelly Burdette, Debra Hurwitz, Pano Yeracaris
INTRODUCTION: The purpose of this study was to assess the degree of behavioral health (BH) integration change in patient-centered medical homes (PCMHs) when using a practice facilitator (PF) specially trained in implementing integrated care and how a quasi-experimental design assists in this process. METHOD: Twelve PCMHs, 8 Federally Qualified Health Centers and 4 private practices, with varying degrees of BH services participated in this study. The degree of BH integration was assessed with a quasi-experimental design using the Maine Health Access Foundation's Site Self Assessment (MeHAF SSA) at baseline and after implementing site-specific BH services...
June 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/28617021/development-and-implementation-of-a-psychotherapy-tracking-database-in-primary-care
#19
Julia R Craner, Craig N Sawchuk, John D Mack, Michelle A LeRoy
INTRODUCTION: Although there is a rapid increase in the integration of behavioral health services in primary care, few studies have evaluated the effectiveness of these services in real-world clinical settings, in part due to the difficulty of translating traditional mental health research designs to this setting. Accordingly, innovative approaches are needed to fit the unique challenges of conducting research in primary care. The development and implementation of one such approach is described in this article...
June 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/28613458/tracking-rural-hospital-closures
#20
Samantha Scotti
(1) Over 50 percent of primary care health professional shortage areas (HPSAs) were in rural areas in November 2016, according to the Health Resources and Services Administration. (2) Rural areas face a higher uninsured rate than metropolitan areas. (3) Rural hospitals tend to have low patient volume, a high portion of patients on Medicare and Medicaid, and a high number of uninsured patients.
June 2017: NCSL Legisbrief
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