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primary care practice

Pei-Ying Yeh, Hsiao-Ping Chen, Jing-Yi Wu
Simultaneous pancreas-kidney (SPK) transplantation is the primary surgical treatment for type I diabetes mellitus with end-stage renal disease. However, this transplant surgery has a high-risk of surgical complications, including duodenal anastomotic leakage, which may lead to pancreas transplantation failure if the leakage worsens. This case report describes a patient who suffered from duodenal anastomotic leakage after SPK transplantation. The digestive enzymes eroded the wound and skin around the wound, resulting in periwound moisture-associated dermatitis...
April 2018: Hu Li za Zhi the Journal of Nursing
Ripdaman Singh, Fergal O'Hagan
Purpose During return to work (RTW), communication between health care providers and employers largely takes place through standardize paper-based forms. Information technology (IT) platforms may provide advantages in enabling information exchange and decision-making through sharing of guidelines and resources. We investigated stakeholder perspectives on the prospect of IT use for RTW communication in Ontario, Canada. Methods Consistent with the exploratory nature of the questions, qualitative methods were used...
March 21, 2018: Journal of Occupational Rehabilitation
Alonzo T Folger, Emily A Eismann, Nicole B Stephenson, Robert A Shapiro, Maurizio Macaluso, Maggie E Brownrigg, Robert J Gillespie
OBJECTIVES: The study objective was to determine if maternal and paternal exposure to adverse childhood experiences (ACEs) have a significant association with negative offspring development at 24 months of age in a suburban pediatric primary care population. METHODS: A retrospective cohort study was conducted of 311 mother-child and 122 father-child dyads who attended a large pediatric primary care practice. Children were born from October 2012 to June 2014, and data were collected at the 2-, 4-, and 24-month well-child visits...
March 21, 2018: Pediatrics
Anne Marie C Neill
Objective Referral audit - are local recommendations required to translate guideline to practice? Study design In total, 50 consecutive, anonymised referral letters reviewed during the initial consultation in a specialist menopause clinic; the reasons for referral along with the patient's age and the source of referral were analysed. Results Several common reasons for referral were identified. Sexual dysfunction, including loss of libido and dyspareunia, resulted in 11 (22%) referrals. Ten (20%) women were troubled by persistent symptoms or side effects from HRT; 9 (18%) women were referred before hormone replacement therapy was discussed or commenced; 7 (14%) women seeking advice for their menopausal symptoms had a family or personal history of cancer; 5(10%) were migraineurs; 2(4%) women had premature ovarian insufficiency; 2(4%) were denied hormone replacement therapy because of concern about venous thromboembolism risk; and 4 (8%) had miscellaneous medical disorders...
January 1, 2018: Post Reproductive Health
Manoel Vieira de Miranda Neto, Talita Rewa, Valéria Marli Leonello, Maria Amélia de Campos Oliveira
OBJECTIVE: Reflect on the role of advanced practice nursing (APN) in the context of Brazilian primary health care. METHOD: analysis of the main scientific productions and of the discussion on the implementation of APN. RESULTS: there are favorable areas for the work of APN in primary health care, especially in the family health strategy. Professional master's degree and nurse residency programs constitute powerful training spaces. As a challenge, standardized definition of the roles of advanced practice nurses and of minimum training for work are necessary...
2018: Revista Brasileira de Enfermagem
Sandra Rejane Soares Ferreira, Lisiane Andréia Devinar Périco, Vilma Regina Freitas Gonçalves Dias
OBJECTIVE: to promote thinking on the work of nurses in Primary Health Care (PHC) and the necessary aspects for the (re)construction of this professional practice, reinforcing its role in the care of individuals, families and communities. METHOD: to apply the questions raised in the process of organizing a book, the literature and the PHS work experience of the authors. RESULTS: Conflicts, dilemmas and relevant aspects of the practice of nurses in PHC are presented, contributing to critical thinking about the context of work and the need to articulate the category in the construction of its workspace...
2018: Revista Brasileira de Enfermagem
Cynthia de Jesus Freire, Lucas Roberto da Silva Barbosa, João Gomes da Costa, Renata Guerda de Araújo Santos, Aldenir Feitosa Dos Santos
OBJECTIVE: To demonstrate the use of phytotherapy as a therapy adopted in the context of Primary Care to Childhood. METHOD: Observational and analytical field research, with quantitative-qualitative approach. A semi-structured survey was used on socio-demographic and ethnopharmacological variables, audio interview and daily observation. RESULTS: The production of knowledge about phytotherapy constitutes a family heritage, but incorporated data resulting from the daily experiences shared by the community...
2018: Revista Brasileira de Enfermagem
Marcela García Vera, Miriam Aparecida Barbosa Merighi, Claudete Aparecida Conz, Marcelo Henrique da Silva, Maria Cristina Pinto de Jesus, Luz Angélica Muñoz González
OBJECTIVE: to understand the meaning of nursing care in primary health care from the perspective of Chilean nurses. METHOD: this was a qualitative study based on the social phenomenology of Alfred Schutz. Data was collected between January and April 2013, through interviews with 13 primary health care nurses in Chile. RESULTS: the nurses perceived primary care as a gratifying experience, considering it an encounter of subjectivities. However, they felt burdened with multiple functions and by the hierarchical pressure to achieve targets...
2018: Revista Brasileira de Enfermagem
Peter G Bittar, Anna R Carlson, Ann Mabie-DeRuyter, Jeffrey R Marcus, Alexander C Allori
OBJECTIVE: Our objective is to describe the process of adapting a conceptual framework into a practical toolkit for one cleft team. DESIGN: This is a single-arm implementation study in a single institution. SETTING: Implementation took place at a mid-sized multidisciplinary clinic for patients with cleft lip and/or palate (CL/P) from urban/suburban and rural areas across North Carolina and neighboring states. PARTICIPANTS: Eligible participants were patients with CL/P from English-speaking families...
January 1, 2018: Cleft Palate-craniofacial Journal
Rebecca Simon, Sharon W Lahiri
OBJECTIVE: To identify provider recommendations and barriers in obesity management in a multicenter academic health system with extensive weight-loss management resources. METHODS: A 26-question online survey was sent to attending physicians, trainees, and advanced practice providers in primary care specialties (internal medicine, family medicine, women's health) and endocrinology. RESULTS: The survey response rate was 26% (111/430). Of respondents, 50% were internal medicine, 24% family medicine, 16% women's health, and 9% endocrinology...
March 21, 2018: Endocrine Practice
Matthew E Levy, Alan E Greenberg, Manya Magnus, Naji Younes, Amanda Castel
Statin coverage has been examined among HIV-infected patients using Adult Treatment Panel III (ATP III) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines, although not with newer National Lipid Association (NLA) guidelines. We investigated statin eligibility, prescribing practices, and therapeutic responses using these three guidelines. Sociodemographic, clinical, and laboratory data were collected between 2011 and 2016 for HIV-infected outpatients enrolled in the DC Cohort, a multi-center, prospective, observational study in Washington, DC...
February 2018: AIDS Patient Care and STDs
Rimen Lim
Sleep disturbance is a significant issue for patients in intensive care units (ICUs), which can affect their health and recovery from illness. Therefore, it is important to consider ways to address sleep disturbance in these settings. One strategy that has been suggested is the use of 'quiet time' interventions, which involve a defined period where there is a reduction in controllable light and sound, and where interruptions at the patient's bedside are minimised. AIM: To determine the effectiveness of quiet time interventions in improving patients' sleep quality in ICUs; to investigate other potential clinical benefits of quiet time interventions; and to consider the effect of incorporating open visitation when implementing quiet time interventions...
March 21, 2018: Nursing Standard
R Dumont, F Puleo, J Collignon, N Meurisse, M Chavez, L Seidel, P Gast, M Polus, C Loly, Ph Delvenne, P Meunier, R Hustinx, A Deroover, O Detry, E Louis, Ph Martinive, D Van Daele
BACKGROUND AND STUDY AIMS: The current standard of care for resectable pancreatic ductal adenocarcinoma (PDAC) is surgery-first followed by adjuvant chemotherapy. We review our single center experience in a PDAC cohort managed by the surgery-first strategy. We then compare our data to those of Belgian and international literature. PATIENTS METHODS: We reviewed a series of 83 consecutive resectable patients with PDAC, treated by the surgery-first approach in a Belgian Academic Hospital between 2007 and 2013...
October 2017: Acta Gastro-enterologica Belgica
Supriya Singh, Kamary Coriolano, Jacob Davidson, Megan Cashin, Timothy Carey, Debra Bartley
Trampolines are widely used by children, but trampoline injuries can be severe and may require hospital care or even surgery. This pilot study examined the effectiveness of an educational intervention on caregivers' perceptions of trampoline use and safety for their children. Primary caregivers were recruited from the orthopedic clinic at the Children's Hospital at our institution in 2015. Caregivers were asked to complete a survey at two time points, initially in clinic and one week post educational intervention...
June 2018: Preventive Medicine Reports
Christopher J Smith, Russell J Buzalko, Nathan Anderson, Joel Michalski, Jordan Warchol, Stephen Ducey, Chad E Branecki
Introduction: Miscommunication during inter-unit handoffs between emergency and internal medicine physicians may jeopardize patient safety. Our goal was to evaluate the impact of a structured communication strategy on the quality of admission handoffs. Methods: We conducted a mixed-methods, pre-test/post-test study at a 560-bed academic health center with 60,000 emergency department (ED) patient visits per year. Admission-handoff best practices were integrated into a modified SBAR format, resulting in the Situation, Background, Assessment, Responsibilities & Risk, Discussion & Disposition, Read-back & Record (SBAR-DR) model...
March 2018: Western Journal of Emergency Medicine
Brian L Chang, Mary P Mercer, Nichole Bosson, Karl A Sporer
Introduction: The development of cardiac arrest centers and regionalization of systems of care may improve survival of patients with out-of-hospital cardiac arrest (OHCA). This survey of the local EMS agencies (LEMSA) in California was intended to determine current practices regarding the treatment and routing of OHCA patients and the extent to which EMS systems have regionalized OHCA care across California. Methods: We surveyed all of the 33 LEMSA in California regarding the treatment and routing of OHCA patients according to the current recommendations for OHCA management...
March 2018: Western Journal of Emergency Medicine
Ashley C Rider, Chad S Kessler, Whitney W Schwarz, Gillian R Schmitz, Laura Oh, Michael D Smith, Eric A Gross, Hans House, Michael C Wadman, Bruce M Lo
Introduction: The goal of this study was to characterize current practices in the transition of care between the emergency department and primary care setting, with an emphasis on the use of the electronic medical record (EMR). Methods: Using literature review and modified Delphi technique, we created and tested a pilot survey to evaluate for face and content validity. The final survey was then administered face-to-face at eight different clinical sites across the country...
March 2018: Western Journal of Emergency Medicine
Paloma Ruiz-Rodríguez, Antonio Cano-Vindel, Roger Muñoz-Navarro, Cristina M Wood, Leonardo A Medrano, Luciana Sofía Moretti
Introduction: In the primary care (PC) setting in Spain, the prevalence of emotional disorders (EDs) such as anxiety, depression and somatoform disorder is high. In PC patients, these disorders are not always managed in accordance with the recommendations provided by clinical practice guidelines, resulting in major direct and indirect economic costs and suboptimal treatment outcomes. The aim is to analyze and compare the cost-effectiveness and cost-utility of group-based psychological therapy versus treatment as usual (TAU)...
2018: Frontiers in Psychology
Andrew C Berry, Nicholas A Berry, Travis S Myers, Joseph Reznicek, Bruce B Berry
Background: Many healthcare professionals consider obese individuals to be unmotivated and to lack the willpower to follow through with weight-loss plans. This attitude may result in less effort put into diagnosing, documenting, and treating obesity. Our aim was to assess documentation patterns of obesity and hypertension overall, by primary care specialty, and in relation to provider body mass index (BMI). Methods: Twenty-two physicians from one outpatient community practice were included: 10 internal medicine and 12 family practice practitioners...
2018: Ochsner Journal
Eboni G Price-Haywood, Wanda Robinson, Jewel Harden-Barrios, Jeffrey Burton, Todd Burstain
Background: Opioid prescription drug abuse is a major public health concern. Healthcare provider prescribing patterns, especially among non-pain management specialists, are a major factor. Practice guidelines recommend what to do for safe opioid prescribing but do not provide guidance on how to implement best practices. Methods: We describe the implementation of electronic medical record clinical decision support (EMR CDS) for opioid management of chronic noncancer pain in an integrated delivery system...
2018: Ochsner Journal
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