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https://www.readbyqxmd.com/read/28099229/twenty-four-hour-ambulatory-blood-pressure-monitoring-for-clinical-evaluation-of-hypertensive-patients-in-primary-care-which-groups-would-most-benefit
#1
Guilherme B Grezzana, Airton T Stein, Lucia C Pellanda
BACKGROUND: Arterial hypertension is an important risk factor for cardiovascular outcomes. Blood pressure (BP) control levels remain largely out of target among primary healthcare (PHC) patients. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) may contribute toward the identification of cardiovascular risk groups. OBJECTIVE: To assess concordance between conventional office BP measurements and 24-h ABPM of hypertension control in cardiovascular risk groups of PHC hypertensive patients...
January 17, 2017: Blood Pressure Monitoring
https://www.readbyqxmd.com/read/28095802/a-case-control-study-investigating-factors-associated-with-high-infant-death-in-saiha-district-of-mizoram-india-bordering-myanmar
#2
Alok K Deb, Shanta Dutta, Chhaihlo Hnichho, Mary Vanlalpeki, Hli Thapi Phosa, Khaila Rakhu, Samuel Lalfakawma Fanai, Manoj Chakrabarti, Samiran Panda
BACKGROUND: Infant mortality has dropped considerably in India over the last 5 years. A sharp contrast to this decline in national average of infant mortality is the rate recorded during 2014-2015 from the southernmost district of Saiha, Mizoram having a common international border with Myanmar. As this district specific rate (113 per 1000 live births) is 3 times higher compared to the national and state average, the present investigation was carried out to identify associated factors...
January 17, 2017: BMC Pediatrics
https://www.readbyqxmd.com/read/28087291/primary-care-perspectives-on-hepatitis-c-virus-screening-diagnosis-and-linking-patients-to-appropriate-care
#3
Edward Lebovics, Richard Torres, Lucinda K Porter
Enormous progress has been made in recent years toward effectively treating and curing patients with chronic hepatitis C (CHC). However, at least half of the possible 7 million individuals infected with hepatitis C virus (HCV) in the US remain undiagnosed. The formidable task of increasing the number of patients diagnosed, and subsequently linked to appropriate care has fallen to primary care clinicians, who are mandated by some US States to offer screening to individuals born between 1945 and 1965 (the Baby Boomer Generation)...
January 10, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28079901/the-clinical-utility-of-dna-based-screening-for-fetal-aneuploidy-by-primary-obstetrical-care-providers-in-the-general-pregnancy-population
#4
Glenn E Palomaki, Edward M Kloza, Barbara M O'Brien, Elizabeth E Eklund, Geralyn M Lambert-Messerlian
OBJECTIVE: To assess the clinical utility of cell-free DNA (cfDNA)-based screening for aneuploidies offered through primary obstetrical care providers to a general pregnancy population. METHODS: Patient educational materials were developed and validated and providers were trained. Serum was collected for reflexive testing of cfDNA failures. Providers and patients were surveyed concerning knowledge, decision making, and satisfaction. Pregnancy outcome was determined by active or passive ascertainment...
January 12, 2017: Genetics in Medicine: Official Journal of the American College of Medical Genetics
https://www.readbyqxmd.com/read/28065558/the-availability-of-community-health-center-services-and-access-to-medical-care
#5
James B Kirby, Ravi Sharma
BACKGROUND: Community Health Centers (CHCs) funded by Section 330 of the Public Health Service Act are an essential part of the health care safety net in the US. The Patient Protection and Affordable Care Act expanded the program significantly, but the extent to which the availability of CHCs improve access to care in general is not clear. In this paper, we examine the associations between the availability of CHC services in communities and two key measures of ambulatory care access - having a usual source of care and having any office-based medical visits over a one year period...
January 5, 2017: Healthcare
https://www.readbyqxmd.com/read/28062811/moving-upstream-health-extension-and-primary-care
#6
Lyle J Fagnan
Health extension programs represent an opportunity for practice-based research networks (PBRNs) and primary care practices to develop collaborations reaching beyond the clinic walls to address the upstream social determinants of health and engage in community-based research. The Health Extension Regional Officers (HEROs) program at the University of New Mexico described in this issue of the JABFM is an innovative model with a bidirectional approach to linking academic health centers to community-based practices and organizations...
January 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28060178/assessment-of-splints-applied-for-pediatric-fractures-in-an-emergency-department-urgent-care-environment
#7
Joshua M Abzug, Brandon S Schwartz, Aaron J Johnson
BACKGROUND: Fractures are common in the pediatric population. The initial evaluation is rarely by an orthopaedic surgeon, but commonly an emergency room or urgent care center physician/extender. This typically involves splint application by a nonorthopaedist to immobilize the extremity and provide stabilization. Iatrogenic injuries from inappropriate splint placement are a potential public health and legal concern that can lead to complications. The primary purpose of this study was to prospectively evaluate the adequacy of all splints placed on patients who presented to a pediatric orthopaedic office; secondary outcomes included assessing prevalence and types of complications that were associated with inadequate splints...
January 5, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28060177/influence-of-insurance-type-on-the-access-to-pediatric-care-for-children-with-distal-radius-torus-fractures
#8
Harrison Potak, Christopher A Iobst
BACKGROUND: Previous literature has demonstrated that pediatric orthopaedic patients with private insurance have less difficulty obtaining appointments than those with Medicaid. Not all injuries of an orthopaedic nature, however, require specialist care. This study evaluated the willingness of pediatricians to provide care for minor orthopaedic injuries and whether or not the patient's insurance status influenced the decision to provide care. METHODS: Ninety-nine pediatric primary care offices were randomly selected from 2 regions in Florida...
January 5, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28059432/primary-care-providers-prescribing-practices-of-opioid-controlled-substances
#9
Lisa B E Shields, Soraya Nasraty, Alisha D Bell, Anil N Vinayakan, Raghunath S Gudibanda, Steven T Hester, Joshua T Honaker
OBJECTIVE: Prescription opioid abuse poses a significant public health concern. House Bill 1 (HB1) was enacted in 2012 to address prescription drug abuse in Kentucky. The authors investigated the impact of HB1 on primary care providers' (PCPs) prescribing practices of Schedule II controlled substances. DESIGN: Retrospective evaluation of PCPs' prescribing practices in an adult outpatient setting. METHODS: A review of the prescribing practices for Schedule II controlled substances written by 149 PCPs...
November 2016: Journal of Opioid Management
https://www.readbyqxmd.com/read/28052877/blood-pressure-measurement-anno-2016
#10
REVIEW
Jan A Staessen, Yan Li, Azusa Hara, Kei Asayama, Eamon Dolan, Eoin O'Brien
The rational management of hypertension (HT) inevitably starts with accurate measurement of blood pressure (BP). The recently published Systolic Blood Pressure Intervention Trial implemented automated office BP measurement. However, event-driven studies have overwhelmingly indicated that out-of-the-office BP monitoring is a prerequisite for risk stratification and for identifying the need of initiating or adjusting antihypertensive drug treatment. 24-Hour ambulatory BP monitoring is the preferred method of BP measurement and addresses major issues not covered by conventional or automated office BP measurement or home BP monitoring, such as reliably diagnosing nocturnal HT (the time window of the day during which BP is most predictive of adverse cardiovascular outcome), hypotension, or masked HT, a condition that affects 15% of the general populations and carries a risk equal to that of HT on both office and out-of-the-office BP measurement...
January 4, 2017: American Journal of Hypertension
https://www.readbyqxmd.com/read/28051841/a-review-of-a-national-training-initiative-to-increase-provider-use-of-mat-to-address-the-opioid-epidemic
#11
REVIEW
Frances R Levin, Adam Bisaga, Maria A Sullivan, Arthur Robin Williams, Kathryn Cates-Wessel
BACKGROUND AND OBJECTIVES: The Providers' Clinical Support System for Medication Assisted Treatment (PCSS-MAT) initiative focuses on training and mentoring health professionals in the treatment of opioid use disorders (OUD) using pharmacological strategies. Led by the American Academy of Addiction Psychiatry (AAAP), PCSS-MAT is a consortium representing four of the five national professional organizations authorized by DATA 2,000-AAAP, American Osteopathic Academy of Addiction Medicine, American Psychiatric Association, and American Society of Addiction Medicine...
December 2016: American Journal on Addictions
https://www.readbyqxmd.com/read/28045591/clinical-practice-guideline-update
#12
Seth R Schwartz, Anthony E Magit, Richard M Rosenfeld, Bopanna B Ballachanda, Jesse M Hackell, Helene J Krouse, Claire M Lawlor, Kenneth Lin, Kourosh Parham, David R Stutz, Sandy Walsh, Erika A Woodson, Ken Yanagisawa, Eugene R Cunningham
Objective This update of the 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation cerumen impaction clinical practice guideline provides evidence-based recommendations on managing cerumen impaction. Cerumen impaction is defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. Changes from the prior guideline include a consumer added to the development group; new evidence (3 guidelines, 5 systematic reviews, and 6 randomized controlled trials); enhanced information on patient education and counseling; a new algorithm to clarify action statement relationships; expanded action statement profiles to explicitly state quality improvement opportunities, confidence in the evidence, intentional vagueness, and differences of opinion; an enhanced external review process to include public comment and journal peer review; and 3 new key action statements on managing cerumen impaction that focus on primary prevention, contraindicated intervention, and referral and coordination of care...
January 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28038764/is-all-cause-readmission-an-appropriate-performance-measure-for-pediatric-surgeons-a-case-study-in-pyloromyotomy
#13
Isobel H Marks, David C Chang, Peter T Masiakos, Cassandra M Kelleher
INTRODUCTION: All cause readmissions are used as a surrogate metric for quality of care for both hospitals and physicians, and are considered in pay for performance initiatives. However, the integrity of using all cause readmissions as a benchmark for surgical outcomes has received little attention. Pyloromyotomy for hypertrophic pyloric stenosis is considered a safe pediatric surgical procedure with few complications or readmissions. The incidence of in hospital complications has been reported, however the rate of readmissions and specifically the proportion of readmissions related to surgical complications have not been previously reported...
December 20, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28028918/mailed-outreach-and-facilitated-test-ordering-to-promote-cholesterol-screening-in-community-health-centers-a-randomized-trial
#14
Stephen D Persell, Tiffany Brown, Ji Young Lee, Eric Henley, Timothy Long, Thomas Sanchez, Regina Knight
RATIONALE, AIMS, AND OBJECTIVES: Lipid screening is central to cardiovascular risk assessment. We sought to determine whether a simple mailed outreach message and facilitated test ordering increase cholesterol screening among federally qualified community health center patients with no recent cholesterol screening test performed. METHODS: Using a patient-randomized controlled trial, we examined the effects of delivering a simple mailed outreach intervention promoting cholesterol testing and facilitated test ordering (without requiring an office visit)...
December 27, 2016: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28028324/patient-satisfaction-by-design
#15
REVIEW
Karen Jacobs
The concept of the patient experience as it relates to patient satisfaction is a complex dynamic. It is a dynamic that is becoming increasingly more important as patients are faced with multiple choices for their hearing and balance care. As reimbursement and performance policies have become more normative within health care, patient satisfaction has become a metric to measure quality. Patient satisfaction is no longer contained to just the interaction with the audiologist. It extends to the entire experience-the staff, the service, the product, and other factors...
November 2016: Seminars in Hearing
https://www.readbyqxmd.com/read/28028191/clinic-versus-daytime-ambulatory-blood-pressure-difference-in-hypertensive-patients-the-impact-of-age-and-clinic-blood-pressure
#16
José R Banegas, Luis M Ruilope, Alejandro de la Sierra, Ernest Vinyoles, Manuel Gorostidi, Juan J de la Cruz, Julián Segura, Anna Oliveras, Nieves Martell, Juan García-Puig, Bryan Williams
Clinic blood pressure (BP) is usually higher than daytime ambulatory BP in hypertensive patients, but some recent studies have challenged this view, suggesting that this relationship is strongly influenced by age. We used the Spanish ambulatory BP monitoring cohort to examine differences between clinic and daytime BP by age among 104 639 adult hypertensive patients (office systolic/diastolic BP ≥140/90 mm Hg or treated) in usual primary-care practice, across the wide age spectrum. To assess the impact of age, cardiovascular variables, and clinic BP on the clinic-daytime BP differences, we built multivariable regression models of the average BP differences, white-coat hypertension (high clinic BP and normal daytime BP), and masked hypertension (normal clinic BP and high daytime BP)...
December 27, 2016: Hypertension
https://www.readbyqxmd.com/read/28012800/separation-anxiety-disorder-in-school-age-children-what-health-care-providers-should-know
#17
Jerrica Vaughan, Jennifer A Coddington, Azza H Ahmed, MaryLou Ertel
Separation anxiety disorder (SAD) is the most common childhood anxiety disorder, and it has many consequences, particularly for school-age children. These consequences include excessive worry, sleep problems, distress in social and academic settings, and a variety of physical symptoms that, left untreated, can cause social and academic decline. Pediatric providers routinely see children in the primary care office and have the unique opportunity to diagnose, treat, and manage children with SAD. Despite this, SAD continues to be underdiagnosed and undertreated because of a gap in the literature regarding evidence-based practice guidelines for pediatric providers...
December 21, 2016: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/28011159/the-impact-of-state-tort-reforms-on-imaging-utilization
#18
Suhui Li, Avi Dors, Darwyyn Deyo, Danny R Hughes
PURPOSE: Defensive medicine, broadly defined as medical practices that protect physicians from malpractice lawsuits without providing benefits to patients, can lead to wasteful use of health care resources and higher cost. Although physicians cite malpractice liability as an important factor driving their decisions to order imaging tests, little research has been done to examine the systematic impact of liability pressure on overall imaging. The authors examined the extent to which radiography use is influenced by malpractice liability pressure among office-based physicians...
December 20, 2016: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28002663/psychiatric-disease-preceding-intracranial-tumor-diagnosis-investigating-the-association
#19
Kathryn R Tringale, Bayard R Wilson, Brian Hirshman, Tianzan Zhou, David Folsom, Marc A Norman, Igor Grant, Clark C Chen, Bob S Carter
Objective: Here, we examine rates of intracranial tumor diagnoses in patients with and without comorbid psychiatric diagnoses to better understand how psychiatric disease may alter risk profiles for brain tumor diagnosis. Methods: We used a longitudinal version of the California Office of Statewide Health Planning and Development (OSHPD) database, which includes all inpatient admissions in California from 1995 to 2010. We examined patients with confirmed hospital admissions from 1997 to 2004...
December 15, 2016: Primary Care Companion to CNS Disorders
https://www.readbyqxmd.com/read/27998659/radiographic-imaging-in-the-postanesthesia-care-unit-is-unnecessary-after-partial-knee-arthroplasty
#20
Andrew S Longenecker, Gregory S Kazarian, Giovanni P Boyer, Jess H Lonner
BACKGROUND: Obtaining routine radiographs in the postanesthesia care unit (PACU) after primary uncomplicated partial knee arthroplasty (PKA) is a common practice with unclear utility. The objective of this study is to determine the rate at which immediate postoperative radiographs identify an actionable problem after primary uncomplicated PKA and to determine the potential cost savings associated with foregoing the routine acquisition of these radiographs. METHODS: This was a retrospective review that assessed a consecutive series of 1366 primary uncomplicated PKAs (including 873 unicondylar knee arthroplasties, 313 patellofemoral arthroplasties, and 180 bicompartmental knee arthroplasties) performed between January 2008 and March 2016...
November 27, 2016: Journal of Arthroplasty
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