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https://www.readbyqxmd.com/read/28444770/factors-associated-with-local-recurrence-in-operated-osteosarcomas-a-retrospective-evaluation-of-95-cases-from-a-tertiary-care-center-in-a-resource-challenged-environment
#1
Rishi R Poudel, Vivek Tiwari, Venkatesan S Kumar, Sameer Bakhshi, Shivanand Gamanagatti, Shah Alam Khan, Shishir Rastogi
BACKGROUND AND OBJECTIVES: Local control of disease is one of the main goals of osteosarcoma management. We conducted a retrospective evaluation of 95 operated cases of osteosarcoma over 7 years to know about the factors associated with local recurrence in resource-challenged environment of the developing world. METHODS: The factors which were evaluated and compared between local recurrence and non-local recurrence groups included demographic profile, site of tumor, whether biopsy done outside, type of surgery (limb salvage or amputation), presence of pathological fracture, vicinity of neurovascular bundle, tumor volume, histological subtype, chemotherapy induced necrosis, surgical margins, and delay in surgery...
April 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28441971/the-clinical-and-cost-effectiveness-of-stratified-care-for-patients-with-sciatica-the-scopic-randomised-controlled-trial-protocol-isrctn75449581
#2
Nadine E Foster, Kika Konstantinou, Martyn Lewis, Reuben Ogollah, Kate M Dunn, Danielle van der Windt, Ruth Beardmore, Majid Artus, Bernadette Bartlam, Jonathan C Hill, Sue Jowett, Jesse Kigozi, Christian Mallen, Benjamin Saunders, Elaine M Hay
BACKGROUND: Sciatica has a substantial impact on patients, and is associated with high healthcare and societal costs. Although there is variation in the clinical management of sciatica, the current model of care usually involves an initial period of 'wait and see' for most patients, with simple measures of advice and analgesia, followed by conservative and/or more invasive interventions if symptoms fail to resolve. A model of care is needed that does not over-treat those with a good prognosis yet identifies patients who do need more intensive treatment to help with symptoms, and return to everyday function including work...
April 26, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28437547/concordance-of-patient-and-physician-perceptions-of-care-in-an-orthopedic-clinic
#3
Kelly Zhang, Charles Day, Matthew L Iorio
It is essential to study whether physicians' perceptions align with their patients' views, as understanding patient perception leads to superior satisfaction and health outcomes. Previous studies have established differences in physician-patient perceptions, but no studies have been conducted in orthopedic clinics. The authors' primary goal was to evaluate differences in physician and patient perceptions of an orthopedic clinic visit. Their secondary objective was to determine the influence of visit length, demographics, and depression risk-level on patient satisfaction...
April 24, 2017: Orthopedics
https://www.readbyqxmd.com/read/28435492/applying-systems-engineering-reduces-radiology-transport-cycle-times-in-the-emergency-department
#4
Benjamin A White, Brian J Yun, Michael H Lev, Ali S Raja
INTRODUCTION: Emergency department (ED) crowding is widespread, and can result in care delays, medical errors, increased costs, and decreased patient satisfaction. Simultaneously, while capacity constraints on EDs are worsening, contributing factors such as patient volume and inpatient bed capacity are often outside the influence of ED administrators. Therefore, systems engineering approaches that improve throughput and reduce waste may hold the most readily available gains. Decreasing radiology turnaround times improves ED patient throughput and decreases patient waiting time...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28434390/how-preferences-for-continuity-and-access-differ-between-multimorbidity-and-healthy-patients-in-a-team-care-setting
#5
Katherine M Ehman, Mark Deyo-Svendsen, Zachary Merten, Anne Marie Kramlinger, Gregory M Garrison
INTRODUCTION: Team-based care has become an essential part of modern medical practice. Patient-centered medical homes often struggle to balance the dual competing goals of acute access and continuity of care. Multimorbidity patients may value continuity more than healthy patients, and thus may prefer to wait to see their primary care physician (PCP). METHODS: A total of 1700 randomly selected healthy adults and multimorbidity patients were asked to rate satisfaction with care and presented with 4 acute and 4 chronic scenarios to choose an access and continuity preference in an anonymous mailed survey...
April 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28429883/older-adults-attitudes-toward-depression-screening-in-primary-care-settings-and-exploring-a-brief-educational-pamphlet
#6
Avani Shah, Forrest Scogin, Christina M Pierpaoli, Amit Shah
OBJECTIVES: This study aimed to assess older adults' (OAs') attitudes toward depression screening in primary care settings with a survey and explore the impact of an educational pamphlet on these attitudes. METHODS: Older adults above age 55 (N = 140) were randomly stratified by sex to an intervention or control group. The study included a baseline assessment, posttest, the Geriatric Depression Scale-Short Form, a two-page pamphlet on health and mood, and a 10-question quiz...
April 21, 2017: International Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/28427444/interventions-to-reduce-wait-times-for-primary-care-appointments-a-systematic-review
#7
Dominique Ansell, James A G Crispo, Benjamin Simard, Lise M Bjerre
BACKGROUND: Accessibility and availability are important characteristics of efficient and effective primary healthcare systems. Currently, timely access to a family physician is a concern in Canada. Adverse outcomes are associated with longer wait times for primary care appointments and often leave individuals to rely on urgent care. When wait times for appointments are too long patients may experience worse health outcomes and are often left to use emergency department resources. The primary objective of our study was to systematically review the literature to identify interventions designed to reduce wait times for primary care appointments...
April 20, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28424459/development-and-outcomes-of-a-primary-care-based-sleep-assessment-service-in-canterbury-new-zealand
#8
Michael J Epton, Paul T Kelly, Brett I Shand, Sallyanne V Powell, Judith N Jones, Graham R B McGeoch, Michael C Hlavac
Prior to 2007, increasing demand for sleep services, plus inability to adequately triage severity, led to long delays in sleep assessment and accessing continuous positive airway pressure. We established a community sleep assessment service carried out by trained general practices using a standardised tool and overnight oximetry. All cases were discussed at a multi-disciplinary meeting, with four outcomes: severe obstructive sleep apnoea treated with continuous positive airway pressure; investigation with more complex studies; sleep physician appointment; no or non-severe sleep disorder for general practitioner management...
April 19, 2017: NPJ Primary Care Respiratory Medicine
https://www.readbyqxmd.com/read/28422816/why-not-wait-eight-institutions-share-their-experiences-moving-united-states-medical-licensing-examination-step-1-after-core-clinical-clerkships
#9
Michelle Daniel, Amy Fleming, Colleen O'Conner Grochowski, Vicky Harnik, Sibel Klimstra, Gail Morrison, Arnyce Pock, Michael L Schwartz, Sally Santen
The majority of medical students complete the United States Medical Licensing Examination Step 1 after their foundational sciences; however, there are compelling reasons to examine this practice. This article provides the perspectives of eight MD-granting medical schools that have moved Step 1 after the core clerkships, describing their rationale, logistics of the change, outcomes, and lessons learned. The primary reasons these institutions cite for moving Step 1 after clerkships are to foster more enduring and integrated basic science learning connected to clinical care and to better prepare students for the increasingly clinical focus of Step 1...
April 18, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28419106/quality-improvement-intervention-to-increase-adherence-to-art-prescription-policy-at-hiv-treatment-clinics-in-lusaka-zambia-a-cluster-randomized-trial
#10
Elizabeth A McCarthy, Hamsa L Subramaniam, Margaret L Prust, Marta R Prescott, Felton Mpasela, Albert Mwango, Leah Namonje, Crispin Moyo, Benjamin Chibuye, Jan Willem van den Broek, Lindsey Hehman, Sarah Moberley
INTRODUCTION: In urban areas, crowded HIV treatment facilities with long patient wait times can deter patients from attending their clinical appointments and picking up their medications, ultimately disrupting patient care and compromising patient retention and adherence. METHODS: Formative research at eight facilities in Lusaka revealed that only 46% of stable HIV treatment patients were receiving a three-month refill supply of antiretroviral drugs, despite it being national policy for stable adult patients...
2017: PloS One
https://www.readbyqxmd.com/read/28406042/attributes-of-nuclear-imaging-centers-impacting-physician-referrals-for-single-photon-emission-computed-tomography-myocardial-perfusion-imaging-tests
#11
Junlong Li, Christy R Houle, James R Spalding, Hongbo Yang, Cheryl Q Xiang, Therese M Kitt, Rita M Kristy, Eric Q Wu
AIM: To evaluate nuclear imaging center attributes that cardiologists and primary care physicians (PCPs) consider when referring patients for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) tests, and how these attributes impact physician referral decisions in the United States. METHODS: A targeted literature review and seven one-to-one interviews with physicians and imaging center directors were conducted to identify attributes that could impact physicians' referral decisions...
April 13, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28403839/transfer-between-hospitals-as-a-predictor-of-delay-in-diagnosis-and-treatment-of-patients-with-non-small-cell-lung-cancer-a-register-based-cohort-study
#12
Maria Iachina, Erik Jakobsen, Anne Kudsk Fallesen, Anders Green
BACKGROUND: Lung cancer is the second most frequent cancer diagnosis in Denmark. Although improved during the last decade, the prognosis of lung cancer is still poor with an overall 5-year survival rate of approximately 12%. Delay in diagnosis and treatment of lung cancer has been suggested as a potential cause of the poor prognosis and as consequence, fast track cancer care pathways were implemented describing maximum acceptable time thresholds from referral to treatment. In Denmark, patients with lung cancer are often transferred between hospitals with diagnostic facilities to hospitals with treatment facilities during the care pathway...
April 12, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28402208/a-dynamic-approach-for-outpatient-scheduling
#13
James Creps, Vahid Lotfi
AIMS: Patient no-show is a recurrent problem in medical centers and, in conjunction with cancellation of appointments, often results in loss of productivity and excessive patient time to appointment. The purpose of this study was to develop a dynamic procedure for scheduling patients within an outpatient clinic where patients are expected to have multiple appointments, such as physical therapy, occupational therapy, primary care, and dentistry. METHODS: This retrospective study involved the year 2014 de-identified patient records from an outpatient clinic affiliated with a large university hospital...
April 12, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28396368/individual-utilisation-thresholds-and-exploring-how-gps-knowledge-of-their-patients-affects-diagnosis-a-qualitative-study-in-primary-care
#14
Matthias Michiels-Corsten, Stefan Bösner, Norbert Donner-Banzhoff
BACKGROUND: One of the tenets of general practice is that continuity of care has a beneficial effect on patient care. However, little is known about how continuity can have an impact on the diagnostic reasoning of GPs.Aim To explore GPs' diagnostic strategies by examining GPs' reflections on their patients' individual thresholds for seeking medical attention, how they arrive at their estimations, and which conclusions they draw.Design and setting Qualitative study with 12 GPs in urban and rural practices in Germany...
April 10, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/28389739/does-socioeconomic-status-affect-lengthy-wait-time-in-canada-evidence-from-canadian-community-health-surveys
#15
Mohammad Hajizadeh
Reasonable access to health services without financial or other barriers is a primary objective of the Canadian health system. Notwithstanding such concern about accessibility of services, long waiting times for health services have been a prominent health policy issue in recent years. Using pooled data from four nationally representative Canadian Community Health Surveys (CCHSs, 2000/01, 2003, 2005 and 2010; n = 266,962) we examine socioeconomic inequality in lengthy wait time (LWT) to health care among adults (aged 18-65) in Canada...
April 7, 2017: European Journal of Health Economics: HEPAC: Health Economics in Prevention and Care
https://www.readbyqxmd.com/read/28385299/kick-the-bucket-one-hospital-system-s-journey-to-reduce-clostridium-difficile
#16
Molly Bridget Delaney
PROBLEM: Albert Einstein defines insanity as doing the same thing over again but expecting different results. Although the United States claims to reduce antibiotic abuse, practice strict isolation, and clean meticulously, the burden of Clostridium difficile outpaces goals. Unless innovative approaches are tried, we risk culling elderly, immunosuppressed, and otherwise debilitated populations. Emergency departments are a primary access point for patients who are unable to wait for primary care...
April 3, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28381224/informing-primary-care-reform-in-greece-patient-expectations-and-experiences-the-qualicopc-study
#17
Christos Lionis, Sophia Papadakis, Chrysanthi Tatsi, Antonis Bertsias, George Duijker, Prodromos-Bodosakis Mekouris, Wienke Boerma, Willemijn Schäfer
BACKGROUND: Primary health care is the cornerstone of a high quality health care system. Greece has been actively attempting to reform health care services in order to improve heath outcomes and reduce health care spending. Patient-centered approaches to health care delivery have been increasingly acknowledged for their value informing quality improvement activities. This paper reports the quality of primary health care services in Greece as perceived by patients and aspects of health care delivery that are valued by patients...
April 5, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28378961/primary-care-appointment-availability-and-the-aca-insurance-expansions
#18
Molly Candon, Daniel Polsky, Brendan Saloner, Douglas Wissoker, Katherine Hempstead, Genevieve M Kenney, Karin Rhodes
In the current debate in Congress over the Affordable Care Act (ACA), the issue of provider access is a major concern. Fortunately, our 10-state audit study published in JAMA Internal Medicine finds that primary care appointment availability for new patients with Medicaid increased 5.4 percentage points between 2012 and 2016 and remained stable for patients with private coverage. Over the same period, both Medicaid patients and the privately insured experienced a one-day increase in median wait times. Higher appointment availability for Medicaid patients is a surprising result given the increase in demand for care from millions of new Medicaid enrollees...
March 2017: LDI Issue Brief
https://www.readbyqxmd.com/read/28372709/tachyarrhythmias-and-bradyarrhythmias-differential-diagnosis-and-initial-management-in%C3%A2-the-primary-care-office
#19
REVIEW
Timothy Joseph Byrnes, Otto Costantini
Tachyarrhythmias and bradyarrhythmias are often seen in the outpatient setting. Patients can present minimally symptomatic or in extremis. Accurate diagnosis of the rhythm, plus a detailed clinical history, are critical for best management and optimal outcome. A 12-lead electrocardiogram is the cornerstone for diagnosis. Practitioners must identify patients who need immediate transport to an emergency department versus those who can safely wait for an outpatient specialty referral. This article reviews how to accurately diagnose and differentiate the most common tachyarrhythmias and bradyarrhythmias, the associated symptoms, and important concepts for the initial steps in the office management of such arrhythmias...
May 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28371816/evaluation-of-an-integrated-multidisciplinary-program-to-address-unsafe-use-of-opioids-prescribed-for-pain
#20
William C Becker, Sara N Edmond, Dana J Cervone, Ajay Manhapra, John J Sellinger, Brent A Moore, Ellen L Edens
Objectives. : Unsafe use of opioids prescribed for pain is a common challenge in primary care. We aimed to describe a novel clinical program designed to address this issue-the Opioid Reassessment Clinic-and evaluate preliminary efficacy. Methods. : The Opioid Reassessment Clinic is a multidisciplinary care team staffed by an internist, addiction psychiatrist, advanced practice nurse, and health psychologist designed to perform enhanced assessment and longitudinal treatment of patients with unsafe use of opioids prescribed for pain...
March 23, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
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