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Peter M Hawkey, Roderic E Warren, David M Livermore, Cliodna A M McNulty, David A Enoch, Jonathan A Otter, A Peter R Wilson
The Working Party makes more than 100 tabulated recommendations in antimicrobial prescribing for the treatment of infections caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) and suggest further research, and algorithms for hospital and community antimicrobial usage in urinary infection. The international definition of MDR is complex, unsatisfactory and hinders the setting and monitoring of improvement programmes. We give a new definition of multiresistance. The background information on the mechanisms, global spread and UK prevalence of antibiotic prescribing and resistance has been systematically reviewed...
March 1, 2018: Journal of Antimicrobial Chemotherapy
T Platteau, J van Lankveld, L Apers, K Fransen, J Rockstroh, E Florence
OBJECTIVES: With persisting high numbers of new HIV diagnoses in Europe, HIV testing remains an important aspect of HIV prevention. The traditional centralized and medicalized HIV testing approach has been complemented with newly developed and evaluated non-traditional approaches. Two important factors guided this process: technological innovation and empowerment of the patient. METHODS: We present a matrix to develop an HIV testing approach, and elaborate on three commonly used ones: community based testing, self-testing, and self-sampling...
February 2018: HIV Medicine
Jessica S Yu, Eva Szigethy, Meredith Wallace, Francis Solano, Megan Oser
BACKGROUND: Implementation of digital behavioral health programs in primary care (PC) can improve access to care for patients in need. INTRODUCTION: This study provides preliminary data on user engagement and anxiety symptom change among patients referred by their PC provider to a guided, mobile cognitive behavioral program, Lantern. MATERIALS AND METHODS: Adults aged 20-65 years with at least mild anxiety (GAD-7 ≥ 5) during routine clinical screening in two PC practices were offered Lantern...
February 26, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
A Santiago Pérez, J A Peña Pedrosa, A I Alguacil Pau, A Pérez Morales, P Molina Muñoz, M T Benítez Giménez
INTRODUCTION: Pharmaceutical care to outpatients is currently one of the main occupations of hospital pharmacy services (PEX). There are several questionnaires to measure the satisfaction of the PEX of a pharmacy service, and the results of these questionnaires can generate improvement actions that result in satisfaction. OBJECTIVES: To verify if a satisfaction questionnaire for outpatients is valid for the generation of improvements in the care provided, and if after its implementation, the same questionnaire is able to detect changes in satisfaction...
February 17, 2018: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
Shruti Sevak, Ashley Woodfin, Zachary Hothem, Rose Callahan, James Robbins, Kathryn Ziegler
OBJECTIVE: Our aim was to develop an ultrasound-guided training curriculum for continuous infusion catheter placement in the paravertebral space and to create a gelatin thoracic spine-rib model for use in this training. We sought to create a model that was inexpensive and reusable such that multiple participants could use one model during training. DESIGN: The model was prepared by embedding a firm foam thoracic spine replica with bilateral attached ribs into an opaque gelatin mixture...
February 9, 2018: Journal of Surgical Education
Amanda Nikolic, Nilmini Wickramasinghe, Damian Claydon-Platt, Vikram Balakrishnan, Philip Smart
BACKGROUND: The use of communication apps on mobile phones offers an efficient, unobtrusive, and portable mode of communication for medical staff. The potential enhancements in patient care and education appear significant, with clinical details able to be shared quickly within multidisciplinary teams, supporting rapid integration of disparate information, and more efficient patient care. However, sharing patient data in this way also raises legal and ethical issues. No data is currently available demonstrating how widespread the use of these apps are, doctor's attitudes towards them, or what guides clinician choice of app...
February 9, 2018: JMIR Medical Informatics
Akshay Vankipuram, Stephen Traub, Vimla L Patel
The analysis of clinical workflow offers many challenges, especially in settings characterized by rapid dynamic change. Typically, some combination of approaches drawn from ethnography and grounded theory-based qualitative methods are used to develop relevant metrics. Medical institutions have recently attempted to introduce technological interventions to develop quantifiable quality metrics to supplement existing purely qualitative analyses. These interventions range from automated location tracking to repositories of clinical data (e...
February 1, 2018: Journal of Biomedical Informatics
Mohammed Saqr, Uno Fors, Matti Tedre
BACKGROUND: Collaborative learning facilitates reflection, diversifies understanding and stimulates skills of critical and higher-order thinking. Although the benefits of collaborative learning have long been recognized, it is still rarely studied by social network analysis (SNA) in medical education, and the relationship of parameters that can be obtained via SNA with students' performance remains largely unknown. The aim of this work was to assess the potential of SNA for studying online collaborative clinical case discussions in a medical course and to find out which activities correlate with better performance and help predict final grade or explain variance in performance...
February 6, 2018: BMC Medical Education
J G D Cannon, D C Tran, S Li, S Chang
Smoothened inhibitors (SIs) are a new, targeted therapy for the treatment of advanced basal cell carcinoma (BCC), but their usage is significantly limited by the most common side effect, muscle spasms. Muscle spasms affect up to 80% of users, and are the most common reason for drug discontinuation despite tumor response. Currently, no placebo-controlled trials exist to guide the management of vismodegib-related muscle spasms. The medical literature suggests that the naturally occurring substance, levocarnitine (LC), can improve contractile function of muscle and reduce markers of exercise-induced stress...
February 6, 2018: Journal of the European Academy of Dermatology and Venereology: JEADV
Randy Klaassen, Kim C M Bul, Rieks Op den Akker, Gert Jan van der Burg, Pamela M Kato, Pierpaolo Di Bitonto
Self monitoring, personal goal-setting and coaching, education and social support are strategies to help patients with chronic conditions in their daily care. Various tools have been developed, e.g., mobile digital coaching systems connected with wearable sensors, serious games and patient web portals to personal health records, that aim to support patients with chronic conditions and their caregivers in realizing the ideal of self-management. We describe a platform that integrates these tools to support young patients in diabetes self-management through educational game playing, monitoring and motivational feedback...
January 30, 2018: Sensors
Kelly Reumkens, A J G van Oudheusden, J J G Gietel-Habets, M H E Tummers, C E M de Die-Smulders, L A D M van Osch
For couples at high risk of transmitting a cancer predisposition to offspring, reproductive decision-making can be challenging. As the choice between available reproductive options is preference-sensitive, the use of a decision aid can support these couples in their decisional process. The present study aims to investigate preferences and needs of involved stakeholders regarding the development and implementation of a patient decision aid. Semi-structured interviews assessing the needs and preferences regarding the content and functionalities of a decision support program were conducted among seven couples at risk for hereditary cancer and among eight clinical geneticists involved in oncogenetic counseling...
January 25, 2018: Journal of Genetic Counseling
Kirsten Bobrow, Andrew Farmer, Nomazizi Cishe, Ntobeko Nwagi, Mosedi Namane, Thomas P Brennan, David Springer, Lionel Tarassenko, Naomi Levitt
BACKGROUND: Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. We aimed to describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We further aimed to describe the developed intervention in line with reporting guidelines for a structured and systematic description...
January 23, 2018: BMC Health Services Research
Jessica L Moreau, Kristina M Cordasco, Alexander S Young, Sabine M Oishi, Danielle E Rose, Ismelda Canelo, Elizabeth M Yano, Sally G Haskell, Alison B Hamilton
BACKGROUND: Women veterans are a growing segment of Department of Veterans Affairs (VA) users with distinct mental health needs and well-documented barriers to care. Telemental health holds much promise for reducing barriers to mental health care. We assessed VA stakeholders' perceptions of telemental health's appropriateness and potential to address the mental health needs of women veteran VA users. METHODS: We conducted semistructured qualitative interviews with 40 key leadership and clinical stakeholders at VA medical centers and associated outpatient clinics...
January 12, 2018: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
Alvaro Sobrinho, Leandro Dias da Silva, Angelo Perkusich, Maria Eliete Pinheiro, Paulo Cunha
BACKGROUND: The chronic kidney disease (CKD) is a worldwide critical problem, especially in developing countries. CKD patients usually begin their treatment in advanced stages, which requires dialysis and kidney transplantation, and consequently, affects mortality rates. This issue is faced by a mobile health (mHealth) application (app) that aims to assist the early diagnosis and self-monitoring of the disease progression. METHODS: A user-centered design (UCD) approach involving health professionals (nurse and nephrologists) and target users guided the development process of the app between 2012 and 2016...
January 12, 2018: BMC Medical Informatics and Decision Making
Laney K Jones, Alanna Kulchak Rahm, Michael R Gionfriddo, Janet L Williams, Audrey L Fan, Rebecca A Pulk, Eric A Wright, Marc S Williams
Increasingly, for a variety of indications, patients have their genomes sequenced and actionable results returned. A subset of returned results is pharmacogenomic (PGx) variants involved in the metabolism or action of medications. Although the impact of these variants on health is well-documented, little research exists on how to communicate these findings to patients and clinicians. We conducted semistructured interviews with end users to understand how best to communicate PGx results. Overall, patients and clinicians had similar opinions regarding report content, delivery, and application...
January 8, 2018: Clinical and Translational Science
Stacy W Gray, Jeffrey Gagan, Ethan Cerami, Angel M Cronin, Hajime Uno, Nelly Oliver, Carol Lowenstein, Ruth Lederman, Anna Revette, Aaron Suarez, Charlotte Lee, Jordan Bryan, Lynette Sholl, Eliezer M Van Allen
Objective: Misinterpretation of complex genomic data presents a major challenge in the implementation of precision oncology. We sought to determine whether interactive genomic reports with embedded clinician education and optimized data visualization improved genomic data interpretation. Materials and Methods: We conducted a randomized, vignette-based survey study to determine whether exposure to interactive reports for a somatic gene panel, as compared to static reports, improves physicians' genomic comprehension and report-related satisfaction (overall scores calculated across 3 vignettes, range 0-18 and 1-4, respectively, higher score corresponding with improved endpoints)...
January 5, 2018: Journal of the American Medical Informatics Association: JAMIA
Sarah Gimbel, Moses Mwanza, Marie Paul Nisingizwe, Cathy Michel, Lisa Hirschhorn
BACKGROUND: High-quality data are critical to inform, monitor and manage health programs. Over the seven-year African Health Initiative of the Doris Duke Charitable Foundation, three of the five Population Health Implementation and Training (PHIT) partnership projects in Mozambique, Rwanda, and Zambia introduced strategies to improve the quality and evaluation of routinely-collected data at the primary health care level, and stimulate its use in evidence-based decision-making. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, this paper: 1) describes and categorizes data quality assessment and improvement activities of the projects, and 2) identifies core intervention components and implementation strategy adaptations introduced to improve data quality in each setting...
December 21, 2017: BMC Health Services Research
Weeberb J Requia, Christopher D Higgins, Matthew D Adams, Moataz Mohamed, Petros Koutrakis
Little work has accounted for congestion, using data that reflects driving patterns, traffic volume, and speed, to examine the association between traffic emissions and human health. In this study, we performed a health risk assessment of PM2.5 emissions during congestion periods in the Greater Toronto and Hamilton Area (GTHA), Canada. Specifically, we used a micro-level approach that combines the Stochastic User Equilibrium Traffic Assignment Algorithm with a MOVES emission model to estimate emissions considering congestion conditions...
February 2018: Environment International
Angelina Dois, Paulina Bravo, Gabriela Soto
BACKGROUND: The Family and Community Health Model is based on three essential principles: user-centered care, comprehensive care and continuity of care. AIM: To describe the attributes and characteristics of the guiding principles of the Family and Community Health Model (FHM) from the perspective of primary care experts. MATERIAL AND METHODS: This was a qualitative study. An electronic Delphi was conducted with 29 national experts on primary care...
July 2017: Revista Médica de Chile
Ralf Itzwerth, Aye Moa, C Raina MacIntyre
We analysed Australian plans issued by the public sector and current at the time of the last human pandemic in 2009. They came from various levels of governance, and offered guidance in key domains. Using 13 established criteria, we rated 10 plans (national, state, and territorial) for their usefulness to guide health and medical intervention, business continuity, and crisis communication, plus consideration of at-risk populations. The intended end-user of most plans was not clear, whether hospital manager, health worker, or policy maker...
February 2018: Journal of Public Health Policy
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