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Primary care office

Sindy Villacres, Corrie E Chumpitazi
Pain is a chief complaint in children seeking medical care, yet it may also be experienced in evaluation and treatment during office visits. Inadequate relief of children's procedural pain and distress not only affects the experience of the children and their parents, but also adversely affects procedural outcomes. Despite increasing awareness and research, management of procedural pain and anxiety in children is often inadequate. In addition, parent and patient satisfaction is often tied to pain management...
March 1, 2018: Pediatric Annals
Shiva Kalidindi, Thomas A Lacy
Emergencies do occur in pediatric primary care offices. The American Academy of Pediatrics Committee on Pediatric Emergency Medicine recommends that primary care offices perform a self-assessment of office readiness for emergencies. Primary care offices should develop an emergency response plan to recognize, stabilize, and transfer sick children. They should also ensure their offices have the essential equipment, supplies, and medications readily available in case of emergencies. Primary care offices can prepare and practice for office emergencies through "mock codes" and by maintaining certification in basic and advanced life support courses...
March 1, 2018: Pediatric Annals
Rohan Parikh, Samantha K Kurosky, Margarita Udall, Jane Chang, Joseph C Cappelleri, Jim P Doherty, James A Kaye
OBJECTIVE: The objective of this article is to describe real-world treatment patterns and outcomes in patients with platinum-refractory/resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer (PRROC) in the United States, United Kingdom, and Canada. METHODS/MATERIALS: Physicians retrospectively reviewed medical records of women aged 18 years or older who were diagnosed with PRROC between January 2010 and June 2014. Patient characteristics, initial PRROC therapy, and health care utilization were assessed; progression-free survival (PFS) and overall survival were estimated using Kaplan-Meier and Cox proportional hazards methods...
March 14, 2018: International Journal of Gynecological Cancer
Gretchen Hackett, Jodi Brady, Robert P Olympia
Students presenting with syncope and/or seizure occur occasionally in the school setting. Several studies have shown that seizures as well as respiratory distress are the most common medical emergencies that prompt school nurses and staff to contact emergency medical services (EMS) to transport students to the closest emergency department (Knight 1999, Olympia 2005). It is important to develop a differential diagnosis for syncope, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow-up at their primary health care provider's office, or directly to the closest emergency department via EMS)...
March 1, 2018: NASN School Nurse
Deepa P Rao, Steven McFaull, Wendy Thompson, Gayatri C Jayaraman
INTRODUCTION: With growing awareness about traumatic brain injuries (TBI), there is limited information about population level patterns of TBI care in Canada. METHODS: We examined data from the Canadian Community Health Survey (years 2004, 2009, and 2014) among all respondents ages 12 years and older. TBI management characteristics examined included access to care within 48 hours of injury, point of care, hospital admission, and follow-up. RESULTS: We observed that many Canadians sought care within 48 hours of their injury, with no changes over time...
March 2018: Health Promotion and Chronic Disease Prevention in Canada
Jeanne M Ferrante, Eric K Shaw, Jennifer E Bayly, Jenna Howard, M Nell Quest, Elizabeth C Clark, Connie Pascal
BACKGROUND: Many primary care practices participating in patient-centered medical home (PCMH) transformation initiatives are expanding the work roles of their medical assistants (MAs). Little is known about attitudes of MAs or barriers and facilitators to these role changes. METHODS: Secondary data analysis of qualitative cross-case comparison study of 15 New Jersey primary care practices participating in a PCMH project during 2012 to 2013. Observation field notes and in-depth and key informant interviews (with physicians, office managers, staff and care coordinators) were iteratively analyzed using grounded theory...
March 2018: Journal of the American Board of Family Medicine: JABFM
Marjorie A Bowman, Anne Victoria Neale, Dean A Seehusen
This issue includes several excellent observational studies prompted by physicians' clinical questions. Many people use lots of menthol cough drops-does the menthol overall lengthen the cough duration? When should we intensify treatment of older individuals with diabetes? Do occipital nerve blocks work for acute migraine headaches? Did you know that the plantar fascia can rupture? What happens to those patients with chest pain but low pretest probability for serious cardiac disease who are admitted to the hospital? Acupuncture can work well-for the patients-but how can we incorporate it into the usual pace of the family medicine office? Is it a win-lose situation when medical assistant roles are expanded? How many practice sites do physicians have and does that make a difference in the number or type of health personnel shortage areas? What would you guess on the presence of humor in the medical office-more or less than half of the visits; introduced by doctors or patients; primary care or specialty doctors?...
March 2018: Journal of the American Board of Family Medicine: JABFM
Sanjay Chauhan, Sayeed Unisa, Beena Joshi, Ragini Kulkarni, Amarjeet Singh, Thilakavathi Subramanian, Ramendra Narayan Chaudhuri, A C Baishya, Shalini Bharat, Anushree Patil, Achhelal Pasi, Dinesh Agarwal
Background: Infertility is a neglected service component in the public health-care system in India. Objectives: This study aims to assess the availability and practices on prevention and management services for infertility in the district health system. Methodology: A cross-sectional survey of selected health facilities and the staff from 12 district hospitals (DHs), 24 community health centers (CHCs), 48 primary health centers (PHCs), and 48 subcenters was conducted using qualitative and quantitative methods...
January 2018: Indian Journal of Community Medicine
Maxine D Fisher, Ancilla W Fernandes, Temitope O Olufade, Paul J Miller, Mark S Walker, Moon Fenton
PURPOSE: The goal of this study was to describe patient characteristics, health resource utilization (HRU), and costs associated with treating recurrent or refractory head and neck cancer (HNC) among patients with disease progression in the community oncology setting. METHODS: This retrospective observational study was conducted by using data from the Vector Oncology Data Warehouse. Patients had been diagnosed with locally advanced or metastatic (stage III-IVc) HNC between January 1, 2007, and October 1, 2015...
March 9, 2018: Clinical Therapeutics
Teresa To, Laura Y Feldman, Jingqin Zhu, Andrea S Gershon
During pregnancy, women with asthma may be at higher risk of exacerbation. The objective of this study was to determine whether women with asthma in Ontario, Canada have increased health services utilization (HSU) during pregnancy.Rates of asthma-specific, asthma-related and non-pregnancy-related HSU were calculated in a population-based cohort of pregnant women with asthma. Poisson regression with repeated measures was used to determine adjusted rate ratios and 95% confidence intervals of HSU during and one year after pregnancy, compared to the year before pregnancy...
March 8, 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Scott D Casey, Bryn E Mumma
BACKGROUND: Sex, race, and insurance status are associated with treatment and outcomes in several cardiovascular diseases. These disparities, however, have not been well-studied in out-of-hospital cardiac arrest (OHCA). OBJECTIVE: Our objective was to evaluate the association of patient sex, race, and insurance status with hospital treatments and outcomes following OHCA. METHODS: We studied adult patients in the 2011-2015 California Office of Statewide Health Planning and Development (OSHPD) Patient Discharge Database with a "present on admission" diagnosis of cardiac arrest (ICD-9-CM 427...
March 5, 2018: Resuscitation
Kelly R Ylitalo, M Renée Umstattd Meyer, Beth A Lanning, Christina During, Ryan Laschober, Jackson O Griggs
Adults with limited health literacy have difficulty managing chronic conditions, higher hospitalization rates, and more healthcare expenditures. Simple screening tools have been developed, but limited work has evaluated instruments among low-income populations. This study assessed health literacy among primary care patients of a federally qualified health center, and compared a single screening question about perceived difficulty completing medical forms.A cross-sectional survey was administered to English-speaking patients ≥40 years...
March 2018: Medicine (Baltimore)
William J Heerman, Wendy L Bennett, Jennifer L Kraschnewski, Elizabeth Nauman, Amanda E Staiano, Kenneth A Wallston
Background: Since 2014 the Patient Centered Outcomes Research Institute (PCORI) has funded 13 Clinical Data Research Networks (CDRNs) around the country to support large-scale comparative effectiveness research and pragmatic clinical trials. To provide guidance for future recruitment efforts among CDRNs this study described differential willingness to participate in weight-related research by body mass index (BMI) and sociodemographic characteristics. Methods: During 2014-2016 we surveyed participants from three CDRNs including the Mid-South CDRN, REACHnet, and the PaTH Network, representing 14 medical centers...
2018: BMC Obesity
Kimberley Jacobs, Molly Posa, Whitney Spellicy, Jaclyn Otero, Maria Kelly
BACKGROUND: Pediatric exposure to influenza-infected adult caregivers (AC) is a significant risk factor for developing influenza. Poor access to vaccines contributes to low adult vaccination rates. We offered adult vaccination at regularly scheduled pediatric office visits and examined barriers to improve future vaccination rates. METHODS: Via a retrospective chart review, we identified ACs who received an influenza vaccination at one of three pediatric clinics within an academic center from August 2015 to May 2016...
March 2, 2018: Pediatric Infectious Disease Journal
Cynthia M Rand, Hollyce Tyrrell, Rachel Wallace-Brodeur, Nicolas P N Goldstein, Paul M Darden, Sharon G Humiston, Christina S Albertin, William Stratbucker, Stanley J Schaffer, Wendy Davis, Peter G Szilagyi
OBJECTIVE: Human papillomavirus (HPV) vaccination rates remain low, in part because of missed opportunities (MOs) for vaccination. We used a learning collaborative quality improvement (QI) model to assess the effect of a multicomponent intervention on reducing MOs. METHODS: Study design: pre-post using a QI intervention in 33 community practices and 14 pediatric continuity clinics over 9 months to reduce MOs for HPV vaccination at all visit types. MEASURES: outcome measures comprised baseline and postproject measures of 1) MOs (primary outcome), and 2) HPV vaccine initiation and completion...
March 2018: Academic Pediatrics
Madhukar S Patel, Zhi Ven Fong, Brandon M Wojcik, Abraham Noorbakhsh, Samuel E Wilson, David C Chang
OBJECTIVE: Readmission after abdominal aortic aneurysm (AAA) repair to a different (non-index) hospital has been shown to be associated with high mortality rates. Factors influencing this association remain unknown. The objective of this study was to determine the impact of hospital teaching status on non-index hospital readmission and mortality. METHODS: An observational analysis of the longitudinally linked California Office of Statewide Health Planning and Development (OSHPD) database was conducted from 1995-2009...
March 1, 2018: Annals of Vascular Surgery
Susanne V Fleig, Bettina Weger, Hermann Haller, Florian P Limbourg
INTRODUCTION: We conducted a prospective, non-interventional, multicenter study to examine the effect of a fixed-dose combination of perindopril/amlodipine in patients with arterial hypertension. METHODS: Patients who were previously untreated or required a change in medication were treated with a fixed combination of perindopril/amlodipine (3.5/2.5 or 7.0/5.0 mg) for 12 weeks. Changes in office, home and ambulatory blood pressure (BP) were recorded. Adherence was assessed by the Hill-Bone medication adherence scale...
March 1, 2018: Advances in Therapy
Megumi J Okumura, Heather A Knauer, Kris E Calvin, John I Takayama
Background and Objectives Pediatricians face numerous challenges in providing care for children with special health care needs (CSHCN). Few studies have described health care resources available to support pediatricians to care for CSHCN. This study investigated available resources to care for CSHCN and factors associated with having a greater proportion of CSHCN in practice. Methods We conducted a statewide survey of active members of the American Academy of Pediatrics in California to study pediatric subspecialty care access, community and office resources and practice barriers...
March 1, 2018: Maternal and Child Health Journal
Thomas J M Kootstra, Suzanne C Wilkens, Mariano E Menendez, David Ring
BACKGROUND: In prior work we demonstrated that patient-rated physician empathy was the strongest driver of patient satisfaction after a visit to an orthopaedic hand surgeon. Data from the primary care setting suggest a positive association between physician empathy and clinical outcomes, including symptoms of the common cold. It is possible that an empathic encounter could make immediate and measureable changes in a patient's mindset, symptoms, and functional limitations. QUESTIONS/PURPOSES: (1) Comparing patients who rated their physicians as perfectly empathic with those who did not, is there a difference in pre- to postvisit change in Patient Reported Outcome Measurement Information System (PROMIS) Upper Extremity Function scores? (2) Do patients who gave their physicians perfectly empathic ratings have a greater decrease in pre- to postvisit change in Pain Intensity, PROMIS Pain Interference, and PROMIS Depression scores? METHODS: Between September 2015 and February 2016, based on the clinic patient flow, 134 new patients were asked to participate in this study...
February 23, 2018: Clinical Orthopaedics and related Research
Concepció Teixidó, Olga Díez, Josep R Marsal, Maria Giner-Soriano, Helena Pera, Mireia Martinez, Gisela Galindo-Ortego, Joan A Schoenenberger, Jordi Real, Ines Cruz, Rosa Morros
BACKGROUND/OBJECTIVES: Molluscum contagiosum is the most common skin infection in children. One topical treatment used for Molluscum contagiosum is potassium hydroxide. The objective of this study was to compare the efficacy of potassium hydroxide topical treatment at different concentrations with that of placebo in terms of complete clearing of Molluscum contagiosum lesions and to assess the safety and tolerance of potassium hydroxide topical treatment. METHODS: This was a double-blind randomized clinical trial of three treatments (potassium hydroxide 10%, potassium hydroxide 15%, placebo) applied once daily up to complete clearing of lesions (maximum duration 60 days) in 53 children aged 2-6 years in primary health care pediatric offices in Catalonia, Spain...
February 26, 2018: Pediatric Dermatology
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