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https://www.readbyqxmd.com/read/28346590/implementation-and-evaluation-of-a-large-scale-teleretinal-diabetic-retinopathy-screening-program-in-the-los-angeles-county-department-of-health-services
#1
Lauren P Daskivich, Carolina Vasquez, Carlos Martinez, Chi-Hong Tseng, Carol M Mangione
Importance: Diabetic retinopathy (DR) is the leading cause of blindness in adults of working age in the United States. In the Los Angeles County safety net, a nonvertically integrated system serving underinsured and uninsured patients, the prevalence of DR is approximately 50%, and owing to limited specialty care resources, the average wait times for screening for DR have been 8 months or more. Objective: To determine whether a primary care-based teleretinal DR screening (TDRS) program reduces wait times for screening and improves timeliness of needed care in the Los Angeles County safety net...
March 27, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28346246/analysis-of-a-patient-intervention-to-reduce-patients-who-leave-without-being-seen-in-an-ophthalmology-dedicated-emergency-room
#2
Alice C Lorch, Maureen Martinez, Matthew Gardiner
Patients who leave without being seen (LWBS) by a medical provider in emergency care settings are a concern because their urgent complaints remain unaddressed. This study aims to characterize the LWBS population in an ophthalmology-dedicated emergency room and to evaluate an intervention designed to decrease the number of these patients. A program of rounding and patient contact in the waiting room of our emergency room was initiated to this end. A patient database was used retrospectively to review 13,124 charts and collect clinical and demographic data on 71 LWBS patients...
March 24, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28344507/patients-experience-of-using-primary-care-services-in-the-context-of-indonesian-universal-health-coverage-reforms
#3
Fitriana Murriya Ekawati, Mora Claramita, Krishna Hort, John Furler, Sharon Licqurish, Jane Gunn
BACKGROUND: The World Health Organization (WHO) recommendation on universal coverage has been implemented in Indonesia as Jaminan Kesehatan Nasional (JKN). It was designed to provide people with equitable and high-quality health care by strengthening primary care as the gate-keeper to hospitals. However, during its first year of implementation, recruitment of JKN members was slow, and the referral rates from primary to secondary care remained high. Little is known about how the public views the introduction of JKN or the factors that influence their decision to enroll in JKN...
2017: Asia Pacific Family Medicine
https://www.readbyqxmd.com/read/28342891/cost-utility-of-group-acceptance-and-commitment-therapy-for-fibromyalgia-versus-recommended-drugs-an-economic-analysis-alongside-a-6-month-randomised-controlled-trial-conducted-in-spain-effigact-study
#4
Juan V Luciano, Francesco D'Amico, Albert Feliu-Soler, Lance M McCracken, Jaume Aguado, María T Peñarrubia-María, Martin Knapp, Antoni Serrano-Blanco, Javier García-Campayo
The aim of this study was to analyse the cost-utility of a group-based form of Acceptance and Commitment Therapy (GACT) in patients with fibromyalgia (FM) compared to patients receiving recommended pharmacological treatment (RPT) or on a waiting list (WL). The data were derived from a previously published study, an RCT that focused on clinical outcomes. Health economic outcomes included health-related quality of life and healthcare use at baseline and at 6-month follow-up using the EuroQol (EQ-5D-3L) and the Client Service Receipt Inventory (CSRI), respectively...
March 22, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28334728/does-emergency-presentation-of-cancer-represent-poor-performance-in-primary-care-insights-from-a-novel-analysis-of-linked-primary-and-secondary-care-data
#5
Peter Murchie, Sarah M Smith, Michael S Yule, Rosalind Adam, Melanie E Turner, Amanda J Lee, Shona Fielding
BACKGROUND: People diagnosed with cancer following emergency presentation have poorer short-term survival. To what extent this signifies a missed opportunity for earlier diagnosis in primary care remains unclear as little detailed data exist on the patient/general practitioner interaction beforehand. METHODS: Analysis of primary care and regional data for 1802 cancer patients from Northeast Scotland. Adjusted odds ratios (OR) and 95% confidence intervals (CIs) for patient and GP practice predictors of emergency presentation...
March 23, 2017: British Journal of Cancer
https://www.readbyqxmd.com/read/28330486/relationships-between-structure-process-and-outcome-to-assess-quality-of-integrated-chronic-disease-management-in-a-rural-south-african-setting-applying-a-structural-equation-model
#6
Soter Ameh, Francesc Xavier Gómez-Olivé, Kathleen Kahn, Stephen M Tollman, Kerstin Klipstein-Grobusch
BACKGROUND: South Africa faces a complex dual burden of chronic communicable and non-communicable diseases (NCDs). In response, the Integrated Chronic Disease Management (ICDM) model was initiated in primary health care (PHC) facilities in 2011 to leverage the HIV/ART programme to scale-up services for NCDs, achieve optimal patient health outcomes and improve the quality of medical care. However, little is known about the quality of care in the ICDM model. The objectives of this study were to: i) assess patients' and operational managers' satisfaction with the dimensions of ICDM services; and ii) evaluate the quality of care in the ICDM model using Avedis Donabedian's theory of relationships between structure (resources), process (clinical activities) and outcome (desired result of healthcare) constructs as a measure of quality of care...
March 23, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28327100/impact-of-a-continuing-medical-education-meeting-on-the-use-and-timing-of-urgent-cancer-referrals-among-general-practitioners-a-before-after-study
#7
Berit Skjødeberg Toftegaard, Flemming Bro, Alina Zalounina Falborg, Peter Vedsted
BACKGROUND: Detection of cancer in general practice is challenging because symptoms are diverse. Even so-called alarm symptoms have low positive predictive values of cancer. Nevertheless, appropriate referral is crucial. As 85% of cancer patients initiate their cancer diagnostic pathway in general practice, a Continuing Medical Education meeting (CME-M) in early cancer diagnosis was launched in Denmark in 2012. We aimed to investigate the effect of the CME-M on the primary care interval, patient contacts with general practice and use of urgent cancer referrals...
March 21, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28327082/out-of-hours-care-in-germany-high-utilization-by-adult-patients-with-minor-ailments
#8
R Leutgeb, P Engeser, S Berger, J Szecsenyi, G Laux
BACKGROUND: Family practitioners (FPs) who work in Out-Of-Hours Care (OOHC) - especially in rural areas - complain about high workload related to low urgency and potentially unnecessary patient presentations with minor ailments. The aim of this study was to describe Reasons for Encounter (RFEs) in primary OOHC taken into account the doctor's perspective in the context of high workload without knowing patients' motives for visiting an OOHC-centre. METHODS: Within this descriptive study, OOHC data from 2012 were evaluated from a German statutory health insurance company in the federal state of Baden-Wuerttemberg...
March 21, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28316856/giant-splenorenal-shunt-in-a-young-patient-with-autoimmune-hepatitis-primary-biliary-cholangitis-overlap-syndrome-and-portal-vein-thrombosis
#9
F Chegai, A U Cavallo, M Forcina, V Giuricin, F Castellani, L Greco, M Manuelli, T M Manzia, G Sergiacomi
We present a case of giant Splenorenal Shunt (SRS) associated with portal vein thrombosis in a 37-year-old woman with a twelve-year history of autoimmune hepatitis/primary biliary cholangitis overlap syndrome. At the moment of the CT examination laboratory tests showed creatinine 1.5 mg/dl, bilirubin 1.5 mg/dl, INR 3, and Na 145 mmol/l and the Model End-Stage Liver Disease score was 24. Extensive calcified thrombosis causing complete occlusion of the portal vein lumen and partially occluding the origin of the superior mesenteric vein was present and a small calcified thrombus in the Splenic Vein lumen was also evident...
2017: Case Reports in Radiology
https://www.readbyqxmd.com/read/28298187/icanadapt-early-protocol-randomised-controlled-trial-rct-of-clinician-supervised-transdiagnostic-internet-delivered-cognitive-behaviour-therapy-icbt-for-depression-and-or-anxiety-in-early-stage-cancer-survivors-vs-treatment-as-usual
#10
M J Murphy, J M Newby, P Butow, L Kirsten, K Allison, S Loughnan, M A Price, J Shaw, H Shepherd, J Smith, G Andrews
BACKGROUND: This RCT with two parallel arms will evaluate the efficacy of an internet-delivered transdiagnostic cognitive behavioural therapy (iCBT) intervention for the treatment of clinical depression and/or anxiety in early stage cancer survivors. METHODS/DESIGN: Early stage cancer survivors will be recruited via the research arm of a not-for-profit clinical research unit and randomised to an intervention (iCBT) group or a 'treatment as usual' (TAU) control group...
March 15, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28289108/access-to-primary-care-appointments-following-2014-insurance-expansions
#11
Karin V Rhodes, Simon Basseyn, Ari B Friedman, Genevieve M Kenney, Douglas Wissoker, Daniel Polsky
PURPOSE: The Patient Protection and Affordable Care Act (ACA) expanded coverage to roughly 12 million individuals by mid-2014 and 20 million by 2016, raising concern about the capacity of the primary care system to absorb these individuals. We set out to determine how justified the concern was. METHODS: We used an audit design in which simulated patients called primary care practices seeking new-patient appointments in 10 diverse states (Arkansas, Georgia, Iowa, Illinois, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas) from November 2012 through March 2013 and from May 2014 through July 2014, before and after the major ACA insurance expansions...
March 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/28289016/gambling-problems-among-patients-in-primary-care-a-cross-sectional-study-of-general-practices
#12
Sean Cowlishaw, Lone Gale, Alison Gregory, Jim McCambridge, David Kessler
BACKGROUND: Primary care is an important context for addressing health-related behaviours, and may provide a setting for identification of gambling problems. AIM: To indicate the extent of gambling problems among patients attending general practices, and explore settings or patient groups that experience heightened vulnerability. DESIGN AND SETTING: Cross-sectional study of patients attending 11 general practices in Bristol, South West England...
March 13, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/28286331/stems-pilot-trial-a-pilot-cluster-randomised-controlled-trial-to-investigate-the-addition-of-patient-direct-access-to-physiotherapy-to-usual-gp-led-primary-care-for-adults-with-musculoskeletal-pain
#13
Annette Bishop, Reuben O Ogollah, Sue Jowett, Jesse Kigozi, Stephanie Tooth, Joanne Protheroe, Elaine M Hay, Chris Salisbury, Nadine E Foster
INTRODUCTION: Around 17% of general practitioner (GP) consultations are for musculoskeletal conditions, which will rise as the population ages. Patient direct access to physiotherapy provides one solution, yet adoption in the National Health Service (NHS) has been slow. SETTING: A pilot, pragmatic, non-inferiority, cluster randomised controlled trial (RCT) in general practice and physiotherapy services in the UK. OBJECTIVES: Investigate feasibility of a main RCT...
March 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/28285102/the-impact-of-an-emergency-department-ambulance-offload-nurse-role-a-retrospective-comparative-study
#14
Tanya Greaves, Marion Mitchell, Ping Zhang, Julia Crilly
OBJECTIVE: This study aimed to evaluate the impact of an Emergency Department Ambulance Offload Nurse (EDAOLN) role on patient and health services outcomes in one Queensland Emergency Department (ED). METHODS: A retrospective study of all ED presentations (n=21,454) made to a tertiary hospital ED in Queensland, Australia, during July 9, 2012 - November 2, 2012; 39days before (T1), during (T2) and after (T3) the introduction of the trial of an EDAOLN role. The primary outcome of interest was time to be seen by a clinician...
March 8, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28273280/comparison-of-posttransplant-dermatologic-diseases-by-race
#15
Christina Lee Chung, Kumar S Nadhan, Christine M Shaver, Lauren M Ogrich, Mark Abdelmalek, Carrie Ann Cusack, Gregory E Malat, Ellen N Pritchett, Alden Doyle
Importance: The risk for skin cancer has been well characterized in white organ transplant recipients (OTRs); however, most patients on the waiting list for organ transplant in the United States are nonwhite. Little is known about cutaneous disease and skin cancer risk in this OTR population. Objective: To compare the incidence of cutaneous disease between white and nonwhite OTRs. Design, Setting, and Participants: This retrospective review of medical records included 412 OTRs treated from November 1, 2011, through April 22, 2016, at an academic referral center...
March 8, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/28264951/los-angeles-safety-net-program-econsult-system-was-rapidly-adopted-and-decreased-wait-times-to-see-specialists
#16
Michael L Barnett, Hal F Yee, Ateev Mehrotra, Paul Giboney
Lack of timely access to specialty care is a significant problem among disadvantaged populations, such as those served by the Los Angeles County Department of Health Services. In 2012 the department implemented an electronic system for the provision of specialty care called the eConsult system, in which all requests from primary care providers for specialty assistance were reviewed by specialists. In many cases, the specialist can address the primary care provider's question via an electronic dialogue, thereby eliminating the need for the patient to see a specialist in person...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28262913/pharmacological-interventions-for-recurrent-abdominal-pain-in-childhood
#17
REVIEW
Alice E Martin, Tamsin V Newlove-Delgado, Rebecca A Abbott, Alison Bethel, Joanna Thompson-Coon, Rebecca Whear, Stuart Logan
BACKGROUND: Between 4% and 25% of school-aged children at some stage complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with their daily lives. When no clear organic cause is found, the children are managed with reassurance and simple measures; a large range of pharmacological interventions have been recommended for use in these children. OBJECTIVES: To determine the effectiveness of pharmacological interventions for RAP in children of school age...
March 6, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28260473/perioperative-venoarterial-extracorporeal-membrane-oxygenation-support-during-heart-transplant
#18
Ender Gedik, Funda Atar, Aycan Ozdemirkan, Aynur Camkiran Firat, Pinar Zeyneloglu, Atilla Sezgin, Arash Pirat
OBJECTIVES: Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. This technique may be used after heart transplant for conditions refractory to medical treatment like primary graft failure. Previously, we reported our experience with patients who received extracorporeal support as a bridge to emergency heart transplant. In this study, we present our perioperative experience with heart transplants in which extracorporeal support was used...
February 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28258074/cost-effectiveness-of-watchful-waiting-in-acute-otitis-media
#19
Di Sun, T J McCarthy, Danica B Liberman
BACKGROUND: American Academy of Pediatrics guidelines for acute otitis media (AOM) allow for children meeting certain criteria to undergo watchful waiting (WW). The cost-effectiveness of this policy has not been evaluated in the United States. METHODS: A retrospective review of a random selection of 250 patients ≤18 years old with AOM in the emergency department of a tertiary care children's hospital was used to characterize current practice of AOM management...
March 3, 2017: Pediatrics
https://www.readbyqxmd.com/read/28257562/planned-early-birth-versus-expectant-management-for-women-with-preterm-prelabour-rupture-of-membranes-prior-to-37-weeks-gestation-for-improving-pregnancy-outcome
#20
REVIEW
Diana M Bond, Philippa Middleton, Kate M Levett, David P van der Ham, Caroline A Crowther, Sarah L Buchanan, Jonathan Morris
BACKGROUND: Current management of preterm prelabour rupture of the membranes (PPROM) involves either initiating birth soon after PPROM or, alternatively, adopting a 'wait and see' approach (expectant management). It is unclear which strategy is most beneficial for mothers and their babies. This is an update of a Cochrane review published in 2010 (Buchanan 2010). OBJECTIVES: To assess the effect of planned early birth versus expectant management for women with preterm prelabour rupture of the membranes between 24 and 37 weeks' gestation for fetal, infant and maternal well being...
March 3, 2017: Cochrane Database of Systematic Reviews
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