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Managed care

Maree Johnson, Tracy Levett-Jones, R Langdon, Gabrielle Weidemann, Elizabeth Manias, Bronwyn Everett
OBJECTIVES: We sought to evaluate the perceptions of nurses of an e-learning educational program to encourage the use of behavioural strategies-blocking, engaging, mediating, multitasking, and preventing-to reduce the negative effects of interruptions during medication administration. DESIGN: A qualitative design was used to evaluate the impact of this e-learning educational intervention on nurses' behaviour. SETTINGS: Two wards (palliative care and aged care) from two different hospitals within a large local health service within Sydney Australia, were included in the study...
June 30, 2018: Nurse Education Today
Corinna L Schultz, Melissa A Alderfer
BACKGROUND: Management of pediatric cancer entails frequent laboratory and radiology testing to monitor response to treatment, side effects, and possible relapse of disease. Little is known about how caregivers of children with cancer would like to receive results of these tests and whether on-line patient portals may meet those preferences. PROCEDURES: One-on-one semistructured interviews were conducted with 19 caregivers of children with cancer purposively sampled for breadth on demographic characteristics...
July 14, 2018: Pediatric Blood & Cancer
Anita Afzali, Seymour Katz
PURPOSE OF REVIEW: Early- and late-onset of inflammatory bowel disease (IBD) may perhaps be etiologically distinct and potentially attributed to genetics, environmental or microbial factors. We review disease factors and clinical characteristics, as well as unique management and treatment strategies to consider when caring for the "baby" or "baby boomer" with IBD. RECENT FINDINGS: Around 25% of cases of initial diagnosis of IBD is made before the age of 18 years old, and another 15-20% made after the age of 60...
July 13, 2018: Current Treatment Options in Gastroenterology
Douglas R Stewart, Bruce R Korf, Katherine L Nathanson, David A Stevenson, Kaleb Yohay
DISCLAIMER: This practice resource is designed primarily as an educational resource for medical geneticists and other clinicians to help them provide quality medical services. Adherence to this practice resource is completely voluntary and does not necessarily assure a successful medical outcome. This practice resource should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed to obtaining the same results...
July 2018: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Robert P Nolan, Ross Feldman, Martin Dawes, Janusz Kaczorowski, Hazel Lynn, Susan I Barr, Carolyn MacPhail, Scott Thomas, Jack Goodman, Gunther Eysenbach, Sam Liu, Rika Tanaka, Jelena Surikova
BACKGROUND: The efficacy of internet-based interventions to improve hypertension management is not established. We evaluated the therapeutic benefit of e-counseling by adapting best evidence guidelines for behavioral counseling. METHODS AND RESULTS: This multicenter double-blind randomized controlled trial included assessments at baseline, 4 months, and 12 months. Participants were 35 to 74 years of age and diagnosed with hypertension: systolic/diastolic blood pressure (BP) 130 to 180/85 to 110 mm Hg...
July 2018: Circulation. Cardiovascular Quality and Outcomes
Al B Benson, Alan P Venook, Mahmoud M Al-Hawary, Lynette Cederquist, Yi-Jen Chen, Kristen K Ciombor, Stacey Cohen, Harry S Cooper, Dustin Deming, Paul F Engstrom, Jean L Grem, Axel Grothey, Howard S Hochster, Sarah Hoffe, Steven Hunt, Ahmed Kamel, Natalie Kirilcuk, Smitha Krishnamurthi, Wells A Messersmith, Jeffrey Meyerhardt, Mary F Mulcahy, James D Murphy, Steven Nurkin, Leonard Saltz, Sunil Sharma, David Shibata, John M Skibber, Constantinos T Sofocleous, Elena M Stoffel, Eden Stotsky-Himelfarb, Christopher G Willett, Evan Wuthrick, Kristina M Gregory, Lisa Gurski, Deborah A Freedman-Cass
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Rectal Cancer address diagnosis, staging, surgical management, perioperative treatment, management of recurrent and metastatic disease, disease surveillance, and survivorship in patients with rectal cancer. This portion of the guidelines focuses on the management of localized disease, which involves careful patient selection for curative-intent treatment options that sequence multimodality therapy usually comprised of chemotherapy, radiation, and surgical resection...
July 2018: Journal of the National Comprehensive Cancer Network: JNCCN
Al B Benson, Alan P Venook, Mahmoud M Al-Hawary, Lynette Cederquist, Yi-Jen Chen, Kristen K Ciombor, Stacey Cohen, Harry S Cooper, Dustin Deming, Paul F Engstrom, Jean L Grem, Axel Grothey, Howard S Hochster, Sarah Hoffe, Steven Hunt, Ahmed Kamel, Natalie Kirilcuk, Smitha Krishnamurthi, Wells A Messersmith, Jeffrey Meyerhardt, Mary F Mulcahy, James D Murphy, Steven Nurkin, Leonard Saltz, Sunil Sharma, David Shibata, John M Skibber, Constantinos T Sofocleous, Elena M Stoffel, Eden Stotsky-Himelfarb, Christopher G Willett, Evan Wuthrick, Kristina M Gregory, Deborah A Freedman-Cass
The NCCN Guidelines for Anal Carcinoma provide recommendations for the management of patients with squamous cell carcinoma of the anal canal or perianal region. Primary treatment of anal cancer usually includes chemoradiation, although certain lesions can be treated with margin-negative local excision alone. Disease surveillance is recommended for all patients with anal carcinoma because additional curative-intent treatment is possible. A multidisciplinary approach including physicians from gastroenterology, medical oncology, surgical oncology, radiation oncology, and radiology is essential for optimal patient care...
July 2018: Journal of the National Comprehensive Cancer Network: JNCCN
Lizzy Mm Boots, Marjolein E de Vugt, Gertrudis Ijm Kempen, Frans Rj Verhey
BACKGROUND: The benefits of electronic health support for dementia caregivers are increasingly recognized. Reaching caregivers of people with early-stage dementia could prevent high levels of burden and psychological problems in the later stages. OBJECTIVE: The current study evaluates the effectiveness of the blended care self-management program, Partner in Balance, compared to a control group. METHODS: A single-blind randomized controlled trial with 81 family caregivers of community-dwelling people with mild dementia was conducted...
July 13, 2018: Journal of Medical Internet Research
Allison E Fay, Stefanie P Ferreri, Greene Shepherd, Kristin Lundeen, Gretchen L Tong, Trista Pfeiffenberger
OBJECTIVES: To determine the awareness, collaboration, and perceived values and barriers of enhanced pharmacy services from care managers and primary care practice responders. METHODS: An electronic questionnaire was sent to 1648 primary care practices and 600 care managers that work in 76 North Carolina counties containing an enhanced-service community pharmacy. Questionnaires were distributed in January 2017 and responses collected for 7 weeks. The questionnaire collected data on the awareness and perceived value of enhanced pharmacy services, preferred method and level of communication for referral, and barriers to using enhanced services...
July 2018: Journal of the American Pharmacists Association: JAPhA
Cody L Clifton, Ashley R Branham, Harskin Hj Hayes, Joseph S Moose, Laura A Rhodes, Macary Weck Marciniak
OBJECTIVES: To determine the financial impact of attributed patients enrolled in a medication adherence program at Community Pharmacy Enhanced Services Network (CPESN) pharmacies. SETTING: Five independently owned Moose Pharmacy locations in rural North Carolina, which are CPESN pharmacies. PRACTICE DESCRIPTION: Moose Pharmacy has a longstanding history of innovative change. Each Moose Pharmacy location provides enhanced pharmacy services, including adherence packaging, medication synchronization programs, immunizations, home visits, home delivery, comprehensive medication review, disease state management programs, point-of-care testing, and compounding...
July 2018: Journal of the American Pharmacists Association: JAPhA
Bernadette Aliprandi-Costa, Lucy Morgan, Lan-Chi Snell, Mario D Souza, Leonard Kritharides, John French, David Brieger, Isuru Ranasinghe
BACKGROUND: Increased access to reperfusion for ST elevation myocardial infarction (STEMI) has contributed to reduced mortality internationally. We describe temporal trends in pre-hospital care, in-hospital management and outcomes of the STEMI population in Australia. METHODS: Temporal trends with multiple regression analysis on the management and outcomes of STEMI patients enrolled across 46 Australian hospitals in the Australian cohort of the Global Registry of Acute Coronary Events (GRACE) and the Cooperative National Registry of Acute Coronary Care Guideline Adherence and Clinical Events (CONCORDANCE) between February 1999 and August 2016...
June 11, 2018: Heart, Lung & Circulation
David M Williams, Natasha Shrikrishnapalasuriyar, Waheeba Syed, Win L Yin, Richard Chudleigh, Stephen C Bain, David E Price, Jeffrey W Stephens
AIMS: Xultophy is the first fixed co-formulation pen containing insulin degludec and the glucagon-like peptide-1 (GLP-1) analogue liraglutide, authorized for type 2 diabetes patients since 2014. The aim was to review the clinical effectiveness of Xultophy across two hospitals in Wales. METHODS: Retrospective review of patients commenced on Xultophy between April 2016 and January 2018 was taken. Data related to glycemic control, weight and medication use were collected...
June 30, 2018: Diabetes & Metabolic Syndrome
V Lerma, M Macías, R Toro, A Moscoso, Y Alonso, O Hernández, F J de Abajo
OBJECTIVE: To describe how nursing care is delivered to patients with epidermal necrolysis in burn units/specialized units in Spain and a selection of countries. METHOD: Descriptive cross-sectional study. Data were collected through a structured questionnaire which was sent to nurse managers in all burn units in Spain and a selection of countries. Descriptive statistics was used to summarize the results. RESULTS: All BU/SUs in Spain (n=12) and seven BU/SUs from a selection of countries completed the questionnaire...
July 10, 2018: Burns: Journal of the International Society for Burn Injuries
Teresa Macarulla, Alfredo Carrato, Rafael Díaz, Adelaida García, Berta Laquente, Javier Sastre, Rafael Álvarez, Andres Muñoz, Manuel Hidalgo
Data regarding management of frail patients with pancreatic ductal adenocarcinoma practice is currently very scarce. Randomized clinical trials usually exclude these subgroup of patients and the majority of the publications only consider chronological age and ECOG performance status for their classification. Therefore, the current available data do not reflect daily clinical practice. Only data from a phase two study (FRAGANCE study), designed to select a tolerable dose-schedule of nab-placitaxel + gemcitabine (Phase oneNCT02382263) and to evaluate the efficacy of the selected regimen (Phase two) in patients with ECOG-2 and previously untreated advanced PDAC, are currently available...
July 10, 2018: Journal of Geriatric Oncology
Bianca J Levkovich, Gordon Bingham, Daryl Jones, Carl M Kirkpatrick, D J Jamie Cooper, Michael J Dooley
BACKGROUND: In hospitals, rapid response systems (RRSs) identify patients who deteriorate and provide critical care at their bedsides to stabilise and escalate care. Medications, including oral and parenteral pharmaceutical preparations, are the most common intervention for hospitalised patients and the most common cause of harm. This connection between clinical deterioration and medication safety is poorly understood. OBJECTIVES: To inform improvements in prevention and management of clinical deterioration, this review aimed to examine how medications contributed to clinical deterioration and how medications were used in RRSs...
July 10, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Lars Bossen, Alessio Gerussi, Vasiliki Lygoura, George F Mells, Marco Carbone, Pietro Invernizzi
Autoimmune liver diseases (AILDs) are complex conditions, which arise from the interaction between a genetic susceptibility and unknown environmental triggers. They represent a relevant cause of liver failure and liver transplantation worldwide. As a testimony of our progress in understanding the biology of AILDs and the disease progression is the overall median survival which has increased over the last decade. However, there are still major challenges such as the lack of therapies and surveillance strategies in primary sclerosing cholangitis (PSC), the management and treatment of non-responders to first-line therapies in primary biliary cholangitis (PBC) and the need for tailoring immunosuppressive drugs in autoimmune hepatitis (AIH)...
July 10, 2018: Autoimmunity Reviews
Romain Paule, Nathalie Morel, Véronique Le Guern, Micaela Fredi, Laetitia Coutte, Meriem Belhocine, Luc Mouthon, Claire le Jeunne, Anthony Chauvin, Jean-Charles Piette, Nathalie Costedoat-Chalumeau
OBJECTIVES: To assess the limitations of the SLICC (Systemic Lupus International Collaborating Clinics) classification criteria for systemic lupus erythematosus (SLE), in patients with primary antiphospholipid syndrome (PAPS). METHODS: Retrospective study of a cohort of APS patients (Sydney criteria). We successively excluded patients with (1) at least one "SLE-specific" manifestation (biopsy-proven SLE nephropathy, arthritis, cutaneous, or neurologic SLE manifestations, pericarditis, autoimmune haemolytic anaemia, oral and nasal ulcers, non-scarring alopecia, anti-dsDNA, and anti-Sm antibodies), (2) any other autoimmune connective tissue disease, and/or (3) antinuclear antibodies >1/320...
July 10, 2018: Autoimmunity Reviews
Briana M Cappiello, Heather M Hill, Teri T Bolton
Many comparative studies have focused on the emergence of solitary and social play in early development, however, few consider observer and parallel forms of play. In this study, we analyzed approximately 21 hours of video recordings and revealed a significant difference between the frequency of solitary, observer, parallel, and social object play states, in calf, juvenile, subadult, and adult bottlenose dolphins (Tursiops truncatus). While juveniles engaged in solitary play significantly more than other age groups, both juveniles and calves engaged in observer and social play significantly more than adults and subadults...
July 10, 2018: Behavioural Processes
Apoorve Nayyar, Kristalyn K Gallagher, Kandace P McGuire
Breast-conserving surgery (BCS) followed by radiation therapy is the current standard of care for early stage breast cancer. Successful BCS necessitates complete tumor resection with clear margins at the pathologic assessment of the specimen ("no ink on tumor"). The presence of positive margins warrants additional surgery to obtain negative final margins, which has significant physical, psychological, and financial implications for the patient. The challenge lies in developing accurate real-time intraoperative margin assessment techniques to minimize the presence of "ink on tumor" and the subsequent need for additional surgery...
August 2018: Surgical Clinics of North America
Andrija S Grustam, Johan L Severens, Daniele De Massari, Nasuh Buyukkaramikli, Ron Koymans, Hubertus J M Vrijhoef
OBJECTIVES: To assess the cost effectiveness of home telemonitoring (HTM) and nurse telephone support (NTS) compared with usual care (UC) in the management of patients with chronic heart failure, from a third-party payer's perspective. METHODS: We developed a Markov model with a 20-year time horizon to analyze the cost effectiveness using the original study (Trans-European Network-Home-Care Management System) and various data sources. A probabilistic sensitivity analysis was performed to assess the decision uncertainty in our model...
July 2018: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
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