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Poletto T, Fritsche Y, Fantinel VS, Muniz MFB, Harakava R, Stefenon VM. What's in my Pot? Six Colletotrichum Species Causing Anthracnose in Brazilian Pecan Orchards. Curr Microbiol 2024; 81:94. [PMID: 38340150 DOI: 10.1007/s00284-024-03622-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/19/2024] [Indexed: 02/12/2024]
Abstract
Pecan (Carya illinoinensis) is one important exotic forest crop cultivated in South America, specifically in Brazil, Uruguay, and Argentina. However, diseases such as anthracnose, favored by high humidity conditions and high summer temperatures, make its cultivation difficult, causing important loss to pecan farmers. This study used morphological and molecular approaches to identify the Colletotrichum species causing anthracnose in pecan plantations in Southern Brazil. The isolates obtained from pecan fruits with anthracnose symptoms were grouped through quantitative morphological characteristics into three distinct morphotypes. Molecular analysis of nuclear genes allowed the identification of six species of Colletotrichum causing anthracnose in pecan: C. nymphaeae, C. fioriniae, C. gloeosporioides, C. siamense, C. kahawae, and C. karsti. Three of these species are reported for the first time as causal agents of anthracnose in pecan. Therefore, these results provide an important basis for the adoption and/or development of anthracnose management strategies in pecan orchards cultivated in southern Brazil and neighboring countries.
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Affiliation(s)
- Tales Poletto
- Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
| | - Yohan Fritsche
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Fisch U, Kliem P, Grzonka P, Sutter R. Performance of large language models on advocating the management of meningitis: a comparative qualitative study. BMJ Health Care Inform 2024; 31:e100978. [PMID: 38307617 PMCID: PMC10840049 DOI: 10.1136/bmjhci-2023-100978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES We aimed to examine the adherence of large language models (LLMs) to bacterial meningitis guidelines using a hypothetical medical case, highlighting their utility and limitations in healthcare. METHODS A simulated clinical scenario of a patient with bacterial meningitis secondary to mastoiditis was presented in three independent sessions to seven publicly accessible LLMs (Bard, Bing, Claude-2, GTP-3.5, GTP-4, Llama, PaLM). Responses were evaluated for adherence to good clinical practice and two international meningitis guidelines. RESULTS A central nervous system infection was identified in 90% of LLM sessions. All recommended imaging, while 81% suggested lumbar puncture. Blood cultures and specific mastoiditis work-up were proposed in only 62% and 38% sessions, respectively. Only 38% of sessions provided the correct empirical antibiotic treatment, while antiviral treatment and dexamethasone were advised in 33% and 24%, respectively. Misleading statements were generated in 52%. No significant correlation was found between LLMs' text length and performance (r=0.29, p=0.20). Among all LLMs, GTP-4 demonstrated the best performance. DISCUSSION Latest LLMs provide valuable advice on differential diagnosis and diagnostic procedures but significantly vary in treatment-specific information for bacterial meningitis when introduced to a realistic clinical scenario. Misleading statements were common, with performance differences attributed to each LLM's unique algorithm rather than output length. CONCLUSIONS Users must be aware of such limitations and performance variability when considering LLMs as a support tool for medical decision-making. Further research is needed to refine these models' comprehension of complex medical scenarios and their ability to provide reliable information.
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Affiliation(s)
- Urs Fisch
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Paulina Kliem
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Pascale Grzonka
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University Basel, Basel, Switzerland
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Mehdipour A, Teshler L, Dal Bello-Haas V, Richardson J, Beauchamp M, Turnbull J, Chum M, Johnston W, O'Connell C, Luth W, Kuspinar A. Assessing the Measurement Properties of the Self-Administered Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R): A Rasch Analysis. Phys Ther 2023; 103:pzad109. [PMID: 37581600 DOI: 10.1093/ptj/pzad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/31/2023] [Accepted: 06/02/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE The self-administered version of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) is used to monitor function and disease progression in individuals with amyotrophic lateral sclerosis (ALS). However, the performance of the self-administered ALSFRS-R has not been assessed using Rasch Measurement Theory. Therefore, the purpose of this study was to examine the psychometric properties of the self-administered ALSFRS-R using Rasch analysis. METHODS Rasch analysis was performed on self-administered ALSFRS-R data from individuals with ALS across Canada. The following 6 aspects of Rasch analysis were examined using RUMM2030: fit via residuals and chi-square statistics, targeting via person-item threshold maps, dependency via item residual correlations, unidimensionality through principal components analysis of residuals, reliability via person separation index, and stability through differential item functioning analyses for sex, age, and language. RESULTS Analysis was performed on 122 participants (mean age: 52.9 years; 62.8% men). The overall scale demonstrated good fit, reliability, and stability; however, multidimensionality was found. To address this issue, items were divided into 3 subscales (bulbar, motor, and respiratory function), and Rasch analysis was performed for each subscale. The subscales demonstrated good fit, reliability, stability, and unidimensionality. However, there were still issues with item dependency for all subscale and targeting for bulbar and respiratory subscales. CONCLUSIONS The self-administered ALSFRS-R is reliable, internally valid, and stable across sex, age, and language subgroups; however, it is recommended that the ALSFRS-R be scored by subscale. Future studies can look at revising and/or adding items to tackle misfit, redundancy, and ceiling effects. IMPACT Self-administered measures are simple to administer and inexpensive. The self-administered ALSFRS-R was found to be psychometrically sound and can be used as a tool to monitor disease progression and function in ALS.
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Affiliation(s)
- Ava Mehdipour
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lizabeth Teshler
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Julie Richardson
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John Turnbull
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marvin Chum
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Wendy Johnston
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Colleen O'Connell
- Stan Cassidy Centre for Rehabilitation, Dalhousie Medicine New Brunswick, Fredericton, New Brunswick, Canada
| | - Westerly Luth
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Miranda JC, Raza SA, Kolawole B, Khan JK, Alvi A, Ali FS, Chukwudi EE, Ram N, Oluwatoyin A. Enhancing Diabetes Care in LMICs: Insights from a Multinational Consensus. Pak J Med Sci 2023; 39:1899-1906. [PMID: 37936776 PMCID: PMC10626083 DOI: 10.12669/pjms.39.7.8881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
The International Cardio-Metabolic Forum held a plenary session to establish a multinational consensus on the challenges faced in diabetes management within lower-middle-income countries (LMICs) and their potential solutions. Stakeholders, including patients, family/caretakers, healthcare professionals, and healthcare policymakers & organizations, participated in discussions. The audience of 280 doctors from 15 different countries (Pakistan, Qatar, Sri Lanka, Kenya, Myanmar, Georgia, Nigeria, Philippines, Uzbekistan, Iraq, Tanzania, Cambodia, Kazakhstan, South Sudan and Libya) was divided into 4 groups led by Group Leaders to represent each stakeholder group. Questionnaires addressing key challenges and solutions specific to each group were used to facilitate consensus development. Participants voted on relevant options based on their clinical experience. SLIDO software was used for polling, generating separate results for each group. The insights shared by healthcare professionals highlighted the importance of improving medication accessibility and cost-effectiveness for patients, emphasizing the need for adherence to treatment plans and lifestyle modifications. The significance of balanced nutrition with low glycemic index food for enhancing quality of life was recognized. Caregivers of diabetic patients with comorbidities face increasing demands for care, particularly in relation to age-related milestones. Healthcare professionals emphasized the challenges posed by cultural beliefs and health awareness, underscoring the importance of teamwork and early referral for managing comorbidities. Healthcare policymakers need to focus on disease education, awareness programs, screening guidelines, and advocacy for community and clinical screening. By addressing these challenges, a more comprehensive and effective approach to diabetes management can be achieved in LMICs, ultimately improving outcomes for individuals with diabetes.
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Affiliation(s)
- Jose Carlos Miranda
- Dr. Jose Carlos Miranda President, CEO Southeast Asian Medical Center, Philippines.
| | - S Abbas Raza
- Dr. S. Abbas Raza Shaukat Khanum Cancer Hospital & Research Center and National Hospital, Lahore, Pakistan.
| | - Babatope Kolawole
- Dr. Babatope Kolawole Obafemi Awolowo University and Teaching Hospital (OAUTH) Ile-Ife, Nigeria.
| | - Jahanzeb Kamal Khan
- Dr. Jahanzeb Kamal Khan College of Physicians & Surgeons of Pakistan, Karachi, Pakistan.
| | - Atiba Alvi
- Dr. Atiba Alvi Institute of Business Management, Karachi, Pakistan.
| | | | - Ejim Emmanuel Chukwudi
- Dr. Ejim Emmanuel Chukwudi University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria.
| | - Nanik Ram
- Dr. Nanik Ram The Aga Khan University Hospital, Karachi, Pakistan.
| | - Amira Oluwatoyin
- Dr. Amira Oluwatoyin Lagos University Teaching Hospital Idi-Araba, Nigeria.
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Townsend JS, Rohan EA, Sabatino SA, Puckett M. Use of Cancer Survivorship Care Guidelines by Primary Care Providers in the United States. J Am Board Fam Med 2023; 36:789-802. [PMID: 37775322 PMCID: PMC10658988 DOI: 10.3122/jabfm.2023.230036r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/21/2023] [Accepted: 05/01/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND National organizations have issued comprehensive cancer survivorship care guidelines to improve care of cancer survivors, many of whom receive care from primary care providers (PCPs). METHODS We analyzed Porter Novelli's 2019 fall DocStyles survey to assess use of cancer survivorship care guidelines, receipt of survivorship training, types of survivorship services provided, and confidence providing care among PCPs in the United States. We grouped PCPs by use of any guideline ("users") versus no guideline use ("nonusers"). We calculated descriptive statistics and conducted multivariable logistic regression analyses to examine guideline use, having received training on providing survivorship care services, and confidence in providing care. Within the panel, sampling quotas were set so that 1000 primary care physicians, 250 OB/GYNs, 250 pediatricians, and 250 nurse practitioners/physician assistants were recruited. RESULTS To reach selected quotas, 2696 health professionals were initially contacted to participate, resulting in a response rate of 64.9%. Sixty-two percent of PCPs reported using guidelines and 17% reported receiving survivorship care training. Use of any guidelines or receiving training was associated with reporting providing a range of survivorship services and confidence in providing care. After adjusting for demographic characteristics, guideline users were more likely than nonusers to report assessing genetic cancer risk (OR = 2.65 95% confidence interval (CI) (1.68, 4.17)), screening for cancer recurrence (OR = 2.32 95% CI (1.70, 3.18)) or a new cancer (OR = 1.63, 95% CI (1.20, 2.22)), and treating depression (OR = 1.64, 95% CI (1.20, 2.25)). Receipt of training was also positively associated with providing genetic risk assessment, surveillance for recurrence, as well as assessing late/long-term effects, and treating pain, fatigue, and sexual side effects. CONCLUSION Survivorship care guidelines and training support PCPs in providing a range of survivorship care services.
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Affiliation(s)
- Julie S Townsend
- From the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA (JST, EAR, SAS, MP).
| | - Elizabeth A Rohan
- From the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA (JST, EAR, SAS, MP)
| | - Susan A Sabatino
- From the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA (JST, EAR, SAS, MP)
| | - Mary Puckett
- From the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA (JST, EAR, SAS, MP)
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Woodall T, Russell A, Tak C, McLean W. Addressing Healthcare Utilization and Costs for Older Adults with Limited Mobility Through a Multidisciplinary Home-Based Primary Care Program. J Am Board Fam Med 2023; 36:550-556. [PMID: 37321655 DOI: 10.3122/jabfm.2022.220222r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/01/2022] [Accepted: 01/23/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Home-based primary care (HBPC) has shown promise in the management of multiple chronic conditions for patients who are homebound or who have limited mobility. The objective of this study was to implement and evaluate an HBPC program that integrates the services of clinical pharmacists and community aging services providers in a community-based setting. METHODS Mountain Area Health Education Center's (MAHEC) HBPC program brought together an interdisciplinary team including medical providers, pharmacists, and community aging services providers to conduct home visits with older adults (age 50+). A single-arm, prepost analysis was conducted to determine differences from the year before program enrollment to the year postenrollment. We examined the frequency of health care visits, high-cost health care utilization (emergency department [ED] utilization and hospitalizations), and health care costs. Descriptive statistics characterized the study population and outcomes. Fisher's Exact Tests were used to determine if there was a significant difference between years. RESULTS There were 130 home visits with 62 patients enrolled in the program. The Medicare Annual Wellness Visit (AWV) was completed for 32 (51.6%) patients. There were 13 (21.0%) and 12 (19.4%) individuals who had at least 1 ED visit and hospitalization, respectively, pre-enrollment as compared with 8 (12.9%) and 9 (14.5%) individuals postenrollment (p-value = 0.05, p-value = 0.06). During the postenrollment year, patient enrollees had an average per-member-per-month (PMPM) cost of $1567.96 as compared with $3053.21 in the year prior. CONCLUSIONS Pharmacist and community agency services-integrated HBPC was implemented in the community setting. There was a decrease in high-cost health care utilization and total health care expenditures for patients as compared with the previous year.
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Affiliation(s)
- Tasha Woodall
- From the Department of Family Medicine, Department of Pharmacotherapy, Mountain Area Health Education Center, Biltmore Forest, NC (TW); Mission Health Partners, Department of Family Medicine, Mountain Area Health Education Center, Biltmore Forest, NC (AR); Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT (CT); Department of Family Medicine, Department of Geriatrics, Mountain Area Health Education Center, Biltmore Forest, NC (WM)
| | - Amy Russell
- From the Department of Family Medicine, Department of Pharmacotherapy, Mountain Area Health Education Center, Biltmore Forest, NC (TW); Mission Health Partners, Department of Family Medicine, Mountain Area Health Education Center, Biltmore Forest, NC (AR); Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT (CT); Department of Family Medicine, Department of Geriatrics, Mountain Area Health Education Center, Biltmore Forest, NC (WM)
| | - Casey Tak
- From the Department of Family Medicine, Department of Pharmacotherapy, Mountain Area Health Education Center, Biltmore Forest, NC (TW); Mission Health Partners, Department of Family Medicine, Mountain Area Health Education Center, Biltmore Forest, NC (AR); Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT (CT); Department of Family Medicine, Department of Geriatrics, Mountain Area Health Education Center, Biltmore Forest, NC (WM).
| | - William McLean
- From the Department of Family Medicine, Department of Pharmacotherapy, Mountain Area Health Education Center, Biltmore Forest, NC (TW); Mission Health Partners, Department of Family Medicine, Mountain Area Health Education Center, Biltmore Forest, NC (AR); Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT (CT); Department of Family Medicine, Department of Geriatrics, Mountain Area Health Education Center, Biltmore Forest, NC (WM)
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Casagrande SS, Lawrence JM. Blood glucose, blood pressure, and cholesterol testing among adults with diabetes before and during the COVID-19 pandemic, USA, 2019 vs 2021. BMJ Open Diabetes Res Care 2023; 11:e003420. [PMID: 37380358 PMCID: PMC10410960 DOI: 10.1136/bmjdrc-2023-003420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION Regular blood glucose/A1c, blood pressure (BP), and cholesterol (ABC) testing is important for diabetes management. It is unknown whether pandemic-related disruptions in medical care were negatively associated with ABC testing among US adults with diagnosed diabetes. RESEARCH DESIGN AND METHODS A cross-sectional analysis was conducted among adults ≥18 years with diagnosed diabetes who participated in the 2019 or 2021 National Health Interview Survey (n=3355 and n=3127, respectively). Adults with diabetes self-reported sociodemographic and diabetes-related characteristics, ABC testing in the past year, and delays or not getting medical care due to the pandemic (2021 only). Descriptive statistics were used to determine differences in ABC testing in 2019 vs 2021. Logistic regression models were used to assess the association between delays or not getting medical care due to the pandemic and ABC testing, adjusting for sociodemographic characteristics, diabetes duration, and diabetes medication use. RESULTS Overall, the prevalence of having a blood glucose/A1c or a BP test in the past year was high (>90%) but it was significantly lower in 2021 compared with 2019 (A1c: 94.2% vs 96.8%, p<0.001; BP: 96.8% vs 98.4%, p=0.002, respectively). Cholesterol testing remained stable (93.0% in 2021 vs 94.5% in 2019, p=0.053). In logistic regression analysis, after full adjustment, adults who reported delaying or not getting medical care when needed due to the pandemic were 50% less likely to get an ABC test in the past year compared with those who promptly received medical care (A1c: adjusted OR (aOR)=0.44, 95% CI 0.29-0.68; BP: aOR=0.48, 95% CI 0.27-0.85; cholesterol: aOR=0.48, 95% CI 0.31-0.75). CONCLUSIONS Disruptions in medical care during the pandemic were associated with a decrease in ABC testing. Future research is needed to assess whether blood glucose/A1c and BP testing returns to prepandemic levels and if reductions in these tests result in excess diabetes-related complications.
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Affiliation(s)
- Sarah S Casagrande
- Division of Public Health Research, DLH Holdings Corporation, Atlanta, Georgia, USA
| | - Jean M Lawrence
- Division of Diabetes, Endocrinology, and Metabolic Diseases, NIDDK, Bethesda, Maryland, USA
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Kim GS, Kim L, Shim MS, Baek S, Kim N, Park MK, Lee Y. [Psychometric Properties of the Korean Version of Self-Efficacy for HIV Disease Management Skills]. J Korean Acad Nurs 2023; 53:295-308. [PMID: 37435761 DOI: 10.4040/jkan.23016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE This study evaluated the validity and reliability of Shively and colleagues' self-efficacy for HIV disease management skills (HIV-SE) among Korean participants. METHODS The original HIV-SE questionnaire, comprising 34 items, was translated into Korean using a translation and back-translation process. To enhance clarity and eliminate redundancy, the author and expert committee engaged in multiple discussions and integrated two items with similar meanings into a single item. Further, four HIV nurse experts tested content validity. Survey data were collected from 227 individuals diagnosed with HIV from five Korean hospitals. Construct validity was verified through confirmatory factor analysis. Criterion validity was evaluated using Pearson's correlation coefficients with the new general self-efficacy scale. Internal consistency reliability and test-retest were examined for reliability. RESULTS The Korean version of HIV-SE (K-HIV-SE) comprises 33 items across six domains: "managing depression/mood," "managing medications," "managing symptoms," "communicating with a healthcare provider," "getting support/help," and "managing fatigue." The fitness of the modified model was acceptable (minimum value of the discrepancy function/degree of freedom = 2.49, root mean square error of approximation = .08, goodness-of-fit index = .76, adjusted goodness-of-fit index = .71, Tucker-Lewis index = .84, and comparative fit index = .86). The internal consistency reliability (Cronbach's α = .91) and test-retest reliability (intraclass correlation coefficient = .73) were good. The criterion validity of the K-HIV-SE was .59 (p < .001). CONCLUSION This study suggests that the K-HIV-SE is useful for efficiently assessing self-efficacy for HIV disease management.
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Affiliation(s)
- Gwang Suk Kim
- College of Nursing, Yonsei University, Seoul, Korea
- Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Layoung Kim
- College of Nursing, Yonsei University, Seoul, Korea
- Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
- S-L.E.A.P Global Nurse Scientist Program, College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea
| | - Mi-So Shim
- College of Nursing, Keimyung University, Daegu, Korea
| | | | - Namhee Kim
- Wonju College of Nursing, Yonsei University, Wonju, Korea
| | - Min Kyung Park
- College of Nursing, Yonsei University, Seoul, Korea
- National Police Hospital, Seoul, Korea
| | - Youngjin Lee
- S-L.E.A.P Global Nurse Scientist Program, College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea.
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Blaimschein ES. Research Report: Exploring Needs, Impediments and Perspectives for a Digital Mental Health Tool in Psychiatric Settings. Stud Health Technol Inform 2023; 301:89-95. [PMID: 37172159 DOI: 10.3233/shti230018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The COVID-19 pandemic brought forth rapid responses and changes in the acceptance of digital health interventions. Digital solutions appear increasingly promising, yet little is known about the peculiarities in the psychiatric context, contrary to other medical branches. The project MeHealth aimed at disclosing specific needs and reservations of patients and professionals in the psychiatric field. Apprehensions towards technology were found to be held on both sides. Cooperating with a psychiatric hospital in Austria, through a transdisciplinary research approach including focus groups and workshops, a framework for an integrated Digital Mental Health Tool was established. The findings leading to the framework show a strong need for patient-empowerment, enhancement of trust in technology and the need for multi-stakeholder cooperation. Digital tools should be designed to enhance the continuity of care and information exchange on behalf of the patient. Learnings were gained, which prove recommendable for future R&D projects on digitalization in the delicate field of psychiatry.
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Walle AD, Ferede TA, Shibabaw AA, Wubante SM, Guadie HA, Yehula CM, Demsash AW. Willingness of diabetes mellitus patients to use mHealth applications and its associated factors for self-care management in a low-income country: an input for digital health implementation. BMJ Health Care Inform 2023; 30:bmjhci-2023-100761. [PMID: 37236653 DOI: 10.1136/bmjhci-2023-100761] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Although mHealth applications are becoming more widely available and used, there is no evidence about why people are willing to use them. Therefore, this study aimed to assess the willingness of patients with diabetes to use mHealth applications and associated factors for self-care management in Ethiopia. METHODS An institutional cross-sectional study was conducted among 422 patients with diabetes. Data were collected using pretested interviewer-administered questionnaire. Epi Data V.4.6 for entering the data and STATA V.14 for analysing the data were used. A multivariable logistic regression analysis was carried out to identify factors associated with patient's willingness to use mobile health applications. RESULTS A total of 398 study participants were included in the study. About 284 (71.4%) 95% CI (66.8% to 75.9%)). Of participants were willing to use mobile health applications. Patients below 30 years of age (adjusted OR, AOR 2.21; 95% CI (1.22 to 4.10)), urban residents (AOR 2.12; 95% CI (1.12 to 3.98)), internet access (AOR 3.91; 95% CI (1.31 to 11.5)), favourable attitude (AOR 5.20; 95% CI (2.60 to 10.40)), perceived ease of use (AOR 2.57; 95% CI (1.34 to 4.85)) and perceived usefulness (AOR 4.67; 95% CI (1.95 to 5.77)) were significantly associated with patients' willingness to use mobile health applications. CONCLUSIONS Overall, diabetes patients' willingness to use mobile health applications was high. Patients' age, place of residence, internet access, attitude, perceived ease of use and perceived usefulness were significant factors concerning their willingness to use mobile health applications. Considering these factors could provide insight for developing and adopting diabetes management applications on mobile devices in Ethiopia.
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Affiliation(s)
- Agmasie Damtew Walle
- Department of Health Informatics, College of Health Science, Mattu University, Mettu, Ethiopia
| | - Tigist Andargie Ferede
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Adamu Ambachew Shibabaw
- Department of Health Informatics, College of Health Science, Mattu University, Mettu, Ethiopia
| | - Sisay Maru Wubante
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Habtamu Alganeh Guadie
- Department of Health System Management and Health Economics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Chalachew Msganaw Yehula
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Gardner-Buckshaw SL, Perzynski AT, Spieth R, Khaira P, Delos Reyes C, Novak L, Kropp D, Caron A, Boltri JM. Increasing Primary Care Utilization of Medication-Assisted Treatment (MAT) for Opioid Use Disorder. J Am Board Fam Med 2023; 36:251-266. [PMID: 36948541 DOI: 10.3122/jabfm.2022.220281r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/21/2022] [Accepted: 12/05/2022] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND With increasing prevalence of opioid use disorders (OUDs) there is an urgent need for OUD trained front line primary care providers (PCPs) who can help improve patient adherence to addiction treatment. Unfortunately, most physicians have had limited training for treating patients with addiction, leaving clinicians under prepared. To address this need, we created a Medication-Assisted Treatment (MAT) training program specifically designed for PCPs. INTERVENTION A 4-hour PCP focused buprenorphine office-based implementation training was designed to supplement the 8-hour SAMHSA DATA 2000 waiver training. The intent of the supplemental training is to increase PCP likelihood of implementing MAT through practical evidenced-based implementation, addressing barriers reported by waivered PCPs. METHODS We developed and validated a new pre- and postsurvey instrument that assesses changes in participants knowledge, skills, and attitudes. Data were entered into REDCap, and composite scales were created and analyzed to determine pre-post differences. RESULTS A total of 183 participants completed pre-post evaluations. Pre-post comparisons indicated substantial improvement in learner levels of confidence in implementing MAT care processes and in their interactions with MAT patients (df = 4, F = 203.518, P < .001). Participants described themselves as more comfortable identifying patients who would benefit from MAT (t = 15.04, P < .001), more competent in implementing MAT (t = 21.27, P < .001) and more willing (t = 15.56, P < .001) to implement MAT after training. CONCLUSION Evidence suggests that a new MAT training program that supplements the SAMHSA waiver training increases confidence and willingness to implement MAT among PCPs. Efforts to replicate this success to allow for further generalization and policy recommendations are warranted.
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Affiliation(s)
- Stacey L Gardner-Buckshaw
- From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB).
| | - Adam T Perzynski
- From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB)
| | - Russell Spieth
- From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB)
| | - Poojajeet Khaira
- From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB)
| | - Chris Delos Reyes
- From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB)
| | - Laura Novak
- From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB)
| | - Denise Kropp
- From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB)
| | - Aleece Caron
- From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB)
| | - John M Boltri
- From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB)
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Yoon J, Chen C, Chao S, Wong E, Rosland AM. Adherence to Diabetes Medications and Health Care Use During the COVID-19 Pandemic Among High-Risk Patients. J Am Board Fam Med 2023:jabfm. [PMID: 36868867 DOI: 10.3122/jabfm.2022.220319R1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic caused potentially disruptive shocks to chronic condition care. We examined how diabetes medication adherence, related hospitalizations, and primary care use changed in high-risk veterans prepandemic and postpandemic. METHODS We conducted longitudinal analyses on a cohort of high-risk diabetes patients in the Veterans Affairs (VA) health care system. Primary care visits by modality, medication adherence, and VA acute hospitalizations and emergency department (ED) visits were measured. We also estimated differences for subgroups of patients by race/ethnicity, age, and rural/urban location. RESULTS Patients were 95% male with mean age 68 years. Prepandemic patients received a mean per quarter of 1.5 in-person primary care visits and 1.3 virtual visits, 0.10 hospitalizations, and 0.22 ED visits, with mean adherence of 0.82. The early pandemic was associated with fewer in-person primary care visits, more virtual visits, fewer hospitalizations and ED visits per patient, and no change in adherence; there were no midpandemic versus prepandemic differences in hospitalizations or adherence. Black and nonelderly patients had lower adherence during the pandemic. CONCLUSION Adherence to diabetes medications and primary care use remained high for most patients even though virtual care replaced in-person care. Black and nonelderly patients may require additional intervention to address lower adherence.
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Mold JW, DeWalt DA, Duffy FD. Goal-Oriented Prevention: How to Fit a Square Peg into a Round Hole. J Am Board Fam Med 2023:jabfm. [PMID: 36868868 DOI: 10.3122/jabfm.2022.220283R1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 03/05/2023] Open
Abstract
Prevention does not fit well within our problem-oriented medical paradigm in which the focus is on curing or ameliorating existing diseases. It is easier and more satisfying to solve existing problems than it is to advise and motivate patients to implement measures to prevent future problems that may or may not occur. Clinician motivation is further diminished by the time required to help people make lifestyle changes, the low reimbursement rate, and the fact that the benefits, if any, are often not apparent for years. Typical patient panel sizes make it difficult to provide all of the recommended disease-oriented preventive services and to also address the social and lifestyle factors that can impact future health problems. One solution to this square peg-round hole mismatch is to focus on the goals, life extension and prevention of future disabilities.
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Phillips WR, Uygur JM, Egnew TR. A Comprehensive Clinical Model of Suffering. J Am Board Fam Med 2023:jabfm. [PMID: 36801843 DOI: 10.3122/jabfm.2022.220308R1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 02/23/2023] Open
Abstract
Suffering is often a part of the illness experience, and relieving it is a fundamental obligation of medicine. Distress, injury, disease, and loss generate suffering when they threaten meaning in the patient's personal narrative. Family physicians have exceptional opportunities and responsibilities to manage suffering through long-term continuity relationships, demonstrating empathy, and building trust over time and across problems. We propose a new Comprehensive Clinical Model of Suffering (CCMS) founded on the family medicine approach to whole-patient care. Comprehending that suffering can involve every aspect of a patient's life, the CCMS is constructed on 4 axes and 8 domains that form a "Review of Suffering" to help clinicians recognize and manage patient suffering. Applied to clinical care, the CCMS can guide observation and empathetic questioning. Applied to teaching, it can provide a framework for discussions of complex and challenging patients. Barriers to applying the CCMS in practice include clinician training, time with patients, and competing demands. However, by structuring the clinical assessment of suffering, the CCMS may increase the efficiency and effectiveness of clinical encounters and improve patient care and outcomes. The application of the CCMS to patient care, clinical training, and research will require further evaluation.
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15
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Niyibizi A, Cisse MS, Rovito PF, Puente M. Angiotensin-Converting Enzyme (ACE) Inhibitor-Induced Angioedema of the Small Bowel: A Diagnostic Dilemma. J Am Board Fam Med 2023; 36:160-3. [PMID: 36707241 DOI: 10.3122/jabfm.2022.220276R1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Angioedema of the tongue, oral mucosa, and pharynx is a highly visible and easily diagnoseable side effect of Angiotensin-converting enzyme inhibitors (ACEI). Angioedema of the small bowel is a rarer, and underrecognized, adverse event that may present as a diagnostic challenge due to its nonspecific symptoms and lack of visibility, and because of a general lack of awareness of it among physicians. Failure to consider ACEI-induced angioedema of the small bowel in differential diagnoses may result in unnecessary interventions and delay of treatment. METHODS We describe the case of a 61-year-old female who was diagnosed with ACEI-induced angioedema of the small intestine after several repeated evaluations. We undertook a literature search to help provide diagnostic, treatment, and management suggestions in patients with ACEI-induced angioedema of the small intestine. RESULTS AND CONCLUSION In the literature, we found that age, patient demographics, and careful medical reconciliation, paired with diagnostic clues in radiology, can assist in accurate diagnosis. More broadly, family and emergency medicine physicians, surgeons, radiologists, and internists should be aware of this rare side effect caused by this commonly prescribed medication to avert unnecessary medical treatments and procedures.
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16
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Cohen DJ, Wyte-Lake T, Bonsu P, Albert SL, Kwok L, Paul MM, Nguyen AM, Berry CA, Shelley DR. Organizational Factors Associated with Guideline Concordance of Chronic Disease Care and Management Practices. J Am Board Fam Med 2022; 35:1128-1142. [PMID: 36564193 DOI: 10.3122/jabfm.2022.210502r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/08/2022] [Accepted: 06/27/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Guidelines for managing and preventing chronic disease tend to be well-known. Yet, translation of this evidence into practice is inconsistent. We identify a combination of factors that are connected to guideline concordant delivery of evidence-informed chronic disease care in primary care. METHODS Cross-sectional observational study; purposively selected 22 practices to vary on size, ownership and geographic location, using National Quality Forum metrics to ensure practices had a ≥ 70% quality level for at least 2 of the following: aspirin use in high-risk individuals, blood pressure control, cholesterol and diabetes management. Interviewed 2 professionals (eg, medical director, practice manager) per practice (n = 44) to understand staffing and clinical operations. Analyzed data using an iterative and inductive approach. RESULTS Community Health Centers (CHCs) employed interdisciplinary clinical teams that included a variety of professionals as compared with hospital-health systems (HHS) and clinician-owned practices. Despite this difference, practice members consistently reported a number of functions that may be connected to clinical chronic care quality, including: having engaged leadership; a culture of teamwork; engaging in team-based care; using data to inform quality improvement; empaneling patients; and managing the care of patient panels, with a focus on continuity and comprehensiveness, as well as having a commitment to the community. CONCLUSIONS There are mutable organizational attributes connected-guideline concordant chronic disease care in primary care. Research and policy reform are needed to promote and study how to achieve widespread adoption of these functions and organizational attributes that may be central to achieving equity and improving chronic disease prevention.
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Affiliation(s)
- Deborah J Cohen
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Tamar Wyte-Lake
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Pamela Bonsu
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Stephanie L Albert
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Lorraine Kwok
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Margaret M Paul
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Ann M Nguyen
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Carolyn A Berry
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Donna R Shelley
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
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Kuzel AJ, Cuellar A, Nichols L. The EvidenceNOW Practice Support Initiative: The Heart of Virginia Healthcare. J Am Board Fam Med 2022; 35:979-89. [PMID: 36257695 DOI: 10.3122/jabfm.2022.05.210021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 10/01/2021] [Accepted: 04/25/2022] [Indexed: 03/21/2023] Open
Abstract
PURPOSE HHS' Million Hearts campaign focused the delivery system on ABCS clinical quality measures (appropriate Aspirin use, Blood pressure control, Cholesterol control, and Smoking cessation counseling). AHRQ's Evidence Now project funded 7 collaboratives to test different ways to improve performance and outcomes on ABCS within small primary care practices. The Heart of Virginia Health care (HVH) collaborative designed 1 of the approaches in Evidence Now. METHODS Two hundred sixty-four eligible practices were recruited to participate and randomized to 3 cohorts in a stepped wedge design, and 173, employing 16 different EHRs, remained for the duration of the initiative. The practice support curriculum was delivered by trained practice coaches to enhance overall practice function and improve performance on the ABCS metrics. The intervention consisted of a kickoff meeting, 3 months of intensive support, 9 months of ongoing support, and access to online learning materials and expert faculty. The mean practice contact time with coaches was 428 minutes, but the standard deviation was 426 minutes. RESULTS Overall, the short HVH intervention had a small but statistically significant positive average effects on appropriate use of aspirin and other antithrombotics, small negative effects on blood pressure control, except for those practices which did not attend the kickoff, and small negative effects on smoking cessation counseling. CONCLUSIONS The intervention phase was truncated due to difficulty in recruiting a sufficient number of practices. This undoubtedly contributed to the lack of substantial improvements in the ABCS. Other likely contributing factors were our inability to provide real time feedback on metrics and the frequency with which major practice disruptions occurred. Future efforts to improve primary care practice function should allow adequate time for both practice recruitment and external support.
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18
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Yang CF, Liao TWE, Chu YL, Chen LZ, Huang LY, Yang TF, Ho HC, Kao SM, Niu DM. Long-term outcomes of very early treated infantile-onset Pompe disease with short-term steroid premedication: experiences from a nationwide newborn screening programme. J Med Genet 2022; 60:430-439. [PMID: 36137614 DOI: 10.1136/jmg-2022-108675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/02/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Starting enzyme replacement therapy (ERT) before severe irreversible muscular damage occurs is important in infantile-onset Pompe disease (IOPD). This long-term follow-up study demonstrates our diagnostic and treatment strategies for IOPD and compares our clinical outcomes with those of other medical centres. METHODS In this long-term follow-up study, we analysed the outcomes of very early ERT with premedication hydrocortisone in patients with IOPD. Out of 1 228 539 infants screened between 1 January 2010 and 28 February 2021, 33 newborns had confirmed IOPD in Taipei Veterans General Hospital. Twenty-six were regularly treated and monitored at Taipei Veterans General Hospital. Echocardiographic parameters, biomarkers, IgG antibodies against alglucosidase alpha, pulmonary function variables and developmental status were all assessed regularly over an average follow-up duration of 6.18±3.14 years. We compared the long-term treatment outcomes of our patients with those of other research groups. RESULTS The average age at ERT initiation was 9.75±3.17 days for patients with classic IOPD. The average of the latest antialglucosidase alpha IgG titre was 669.23±1159.23. All enrolled patients had normal heart sizes, motor milestones, cognitive function and pulmonary function that were near-normal to normal. Compared with patients in other studies, our patients had better outcomes in all aspects. CONCLUSION Very early ERT using our rapid diagnostic and treatment strategy enabled our patients with IOPD to have better outcomes than patients in other medical centres.
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Affiliation(s)
- Chia-Feng Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Wei Ernie Liao
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Ling Chu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Zhen Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling-Yi Huang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Internal Medicine, Division of Nephrology, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan
| | - Tsui-Feng Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui-Chen Ho
- Taipei Institute of Pathology, Neonatal Screening Center, Taipei, Taiwan
| | - Shu-Min Kao
- Chinese Foundation of Health, Neonatal Screening Center, Taipei, Taiwan
| | - Dau-Ming Niu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan .,Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
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Cohen DJ, Wyte-Lake T, Bonsu P, Albert SL, Kwok L, Paul MM, Nguyen AM, Berry CA, Shelley DR. Organizational Factors Associated with Guideline Concordance of Chronic Disease Care and Management Practices. J Am Board Fam Med 2022:jabfm.2022.AP.210502. [PMID: 36113991 PMCID: PMC10515112 DOI: 10.3122/jabfm.2022.ap.210502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/08/2022] [Accepted: 06/27/2022] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Guidelines for managing and preventing chronic disease tend to be well-known. Yet, translation of this evidence into practice is inconsistent. We identify a combination of factors that are connected to guideline concordant delivery of evidence-informed chronic disease care in primary care. METHODS Cross-sectional observational study; purposively selected 22 practices to vary on size, ownership and geographic location, using National Quality Forum metrics to ensure practices had a ≥ 70% quality level for at least 2 of the following: aspirin use in high-risk individuals, blood pressure control, cholesterol and diabetes management. Interviewed 2 professionals (eg, medical director, practice manager) per practice (n = 44) to understand staffing and clinical operations. Analyzed data using an iterative and inductive approach. RESULTS Community Health Centers (CHCs) employed interdisciplinary clinical teams that included a variety of professionals as compared with hospital-health systems (HHS) and clinician-owned practices. Despite this difference, practice members consistently reported a number of functions that may be connected to clinical chronic care quality, including: having engaged leadership; a culture of teamwork; engaging in team-based care; using data to inform quality improvement; empaneling patients; and managing the care of patient panels, with a focus on continuity and comprehensiveness, as well as having a commitment to the community. CONCLUSIONS There are mutable organizational attributes connected-guideline concordant chronic disease care in primary care. Research and policy reform are needed to promote and study how to achieve widespread adoption of these functions and organizational attributes that may be central to achieving equity and improving chronic disease prevention.
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Affiliation(s)
- Deborah J Cohen
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS).
| | - Tamar Wyte-Lake
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Pamela Bonsu
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Stephanie L Albert
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Lorraine Kwok
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Margaret M Paul
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Ann M Nguyen
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Carolyn A Berry
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Donna R Shelley
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
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20
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Sabutsch S, Frohner M, Kleinoscheg G, Klostermann A, Svec N, Rainer-Sablatnig S, Tanjga N. ELGA Outpatient Clinic Report and ELGA Telehealth Note: Two HL7-CDA®-Based Modular Electronic Documents. Stud Health Technol Inform 2022; 293:73-78. [PMID: 35592963 DOI: 10.3233/shti220350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND From 2022, the "Outpatient Clinic Report" and the "Telehealth Note" will complement the existing e-Reports in the Austrian Electronic Health Record system ELGA. OBJECTIVES The specification of two harmonized implementation guides with standardized structure for all types of outpatient clinics in hospitals on the one hand and for telemonitoring treatments on the other hand. METHODS With the participation of expert groups, the contents were harmonized, and a data model was created. Template specifications were modelled in ART-DECOR and approved in the course of an HL7 Austria ballot. RESULTS Two sets of freely selectable building blocks and machine-readable content were created. CONCLUSION The "Outpatient Clinic Report" and the "Telehealth Note" are currently being implemented. The use of these documents will be evaluated as well as if additional machine-readable content is needed.
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21
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Leung PB, Nahid M, Rusli M, Brahmbhatt D, Pelzman FN, Tung J, Sterling MR. Factors Associated with Never Having Had A Video Visit. J Am Board Fam Med 2022; 35:634-7. [PMID: 35641050 DOI: 10.3122/jabfm.2022.03.210483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/03/2022] [Accepted: 01/19/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Disparities in access to video-visit services have been described during the COVID-19 pandemic. Thus, we aimed to examine factors associated with not having a video-visit among a medically high-risk ambulatory population. METHODS In this cross-sectional study, our telephone-based survey was designed to understand the health-related challenges, social needs, and access to and attitudes toward video-visit. RESULTS In the multivariable analysis, having fewer symptoms unrelated to COVID, more barriers to medications, and less confidence with video-visit software were significantly associated with an increased prevalence of not having a video-visit. CONCLUSIONS Our findings suggest that additional efforts are needed to eliminate disparate video-visit use.
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22
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Lee SY, Kim K, Park YB, Yoo KH. Does the Use of Asthma-Controller Medication in Accordance with Guidelines Reduce the Incidence of Acute Exacerbations and Healthcare Costs? Tuberc Respir Dis (Seoul) 2022; 85:11-17. [PMID: 35000364 PMCID: PMC8743641 DOI: 10.4046/trd.2021.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background In asthma, consistent control of chronic airway inflammation is crucial, and the use of asthma-controller medication has been emphasized. Our purpose in this study is to compare the incidence of acute exacerbation and healthcare costs related to the use of asthma-controller medication. Methods By using data collected by the National Health Insurance Review and Assessment Service, we compared one-year clinical outcomes and medical costs from July 2014 to June 2015 (follow-up period) between two groups of patients with asthma who received different prescriptions for recommended asthma-controller medication (inhaled corticosteroids or leukotriene receptor antagonists) at least once from July 2013 to June 2014 (assessment period). Results There were 51,757 patients who satisfied our inclusion criteria. Among them, 13,702 patients (26.5%) were prescribed a recommended asthma-controller medication during the assessment period. In patients using a recommended asthma-controller medication, the frequency of acute exacerbations decreased in the follow-up period, from 2.7% to 1.1%. The total medical costs of the controller group decreased during the follow-up period compared to the assessment period, from $3,772,692 to $1,985,475. Only 50.9% of patients in the controller group used healthcare services in the follow-up period, and the use of asthma-controller medication decreased in the follow-up period. Conclusion Overall, patients using a recommended asthma-controller medication showed decreased acute exacerbation and reduced total healthcare cost by half.
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Affiliation(s)
- Suh-Young Lee
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Division of Allergy and Clinical Immunology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Molecular Microbiology and Immunology, Brown University, Providence, RI, USA
| | - Kyungjoo Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
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Tien YY, Shih MC, Tien CP, Huang HK, Tu YK. To Treat or Not to Treat? Effect of Urate-Lowering Therapy on Renal Function, Blood Pressure and Safety in Patients with Asymptomatic Hyperuricemia: A Systematic Review and Network Meta-Analysis. J Am Board Fam Med 2022; 35:140-51. [PMID: 35039419 DOI: 10.3122/jabfm.2022.01.210273] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Hyperuricemia is associated with increased cardiovascular risk. Because patients with asymptomatic hyperuricemia (AH) experience no immediate discomfort and there are possible side effects of urate-lowering drugs, treatment for AH is controversial. We aimed to perform a network meta-analysis (NMA) to investigate the effects of different urate-lowering therapies (ULTs) on serum uric acid level, renal function, blood pressure (BP), and safety in AH patients. METHODS This NMA focused on AH patients. The intervention group (patients receiving urate-lowering drugs) was compared with others using other types of drugs, placebo, or usual care. We undertook a NMA under the frequentist framework by R. RESULTS Thirteen eligible trials were identified. The interventions included allopurinol, febuxostat, and benzbromarone, which are not approved in the United States. Benzbromarone and allopurinol had the best efficacy on lowering serum uric acid level in short-term and long-term follow-up (mean difference [MD] = -3.05; 95% CI, -5.19 to -0.91 vs MD = -3.17; 95% CI, -5.19 to -1.15). Patients using allopurinol had significantly higher eGFR than using placebo in both short-term and long-term follow-up (MD = 3.07; 95% CI, 0.18 to 5.95 vs MD = 4.10; 95% CI, 2.66 to 5.54). No difference in BP was found between groups, except for febuxostat to diastolic BP after long-term treatment (MD = -1.47; 95% CI, -2.91 to -0.04). No statistically increased odds of safety events were found with the use of ULT. CONCLUSIONS Our result showed that in AH patients, allopurinol has a renoprotective effect. Febuxostat has a significant impact in lowering diastolic BP. ULT does not result in a higher risk of safety events.
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Amaran S, Kamaruzaman AZM, Mohd Esa NY, Sulaiman Z. Malaysia Healthcare Early Response in Combatting COVID-19 Pandemic in 2020. Korean J Fam Med 2021; 42:425-437. [PMID: 34871483 PMCID: PMC8648488 DOI: 10.4082/kjfm.20.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022] Open
Abstract
The year 2020 saw the emergence of a novel coronavirus—the severe acute respiratory syndrome coronavirus 2—which has led to an unprecedented pandemic that has shaken the entire world. The pandemic has been a new experience for Malaysia, especially during the implementation of large-scale public health and social measures called the Movement Control Order (MCO). This paper seeks to describe the experiences of the Malaysian healthcare system thus far in combatting the pandemic. The Malaysian healthcare system comprises two main arms: public health and medicine. The public health arm focuses on early disease detection, contact tracing, quarantines, the MCO, and risk stratification strategies in the community. The medical arm focuses on the clinical management of coronavirus disease 2019 (COVID-19) patients; it encompasses laboratory services, the devising of clinical setting adjustments, and hospital management for COVID-19 and non-COVID-19 patients. Malaysia experienced intense emotions at the beginning of the pandemic, with great uncertainty regarding the pandemic’s outcome, as the world saw a frighteningly high COVID-19 mortality. As of writing (May 30, 2020), Malaysia has passed the peak of its second wave of infections. The experience thus far has helped in preparing the country’s healthcare system to be vigilant and more prepared for future COVID-19 waves. To date, the pandemic has changed many aspects of Malaysia’s life, and people are still learning to adapt to new norms in their lives.
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Affiliation(s)
- Safiya Amaran
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Ahmad Zulfahmi Mohd Kamaruzaman
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Training Management Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | | | - Zaharah Sulaiman
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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25
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Kim SN, Lee HJ, Kim SY, Lee N. [Validity and Reliability of Korean Version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale]. J Korean Acad Nurs 2021; 51:617-629. [PMID: 34737253 DOI: 10.4040/jkan.21069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/06/2021] [Accepted: 09/13/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study was to examine the validity and reliability of the Korean version of the self-efficacy for managing chronic disease 6-item scale (SECD-6-K). METHODS The English version of the Self-Efficacy for Managing Chronic Disease 6-item Scale first underwent forward and backward translation procedures. The SECD-6-K was then used to collect data from 350 adults diagnosed with chronic diseases. Content, construct, convergent, discriminant, and criterion validity were all evaluated. Reliability was assessed using Cronbach's α. SPSS 25.0 and the data were analyzed using AMOS 26.0 software. RESULTS The SECD-6-K consists of six items in two domains: disease management and health behavior. The results for construct, convergent, and discriminant validity were good. Exploratory factor analysis produced eigen values between 2.27 and 3.28, with factors total explained cumulative variance of 91.1%. Confirmatory factor analysis supported goodness of fit and reliability for the modified SECD-6-K model. The criterion validity also showed significant correlation with both the Patient Health Questionnaire and 12-item Short-Form Health Survey version 2. Finally, reliability was found to be excellent. CONCLUSION This study identified the high reliability and validity of SECD-6-K. The SECD-6-K is an appropriate tool for determining Korean patients' self-efficacy in managing their chronic conditions. Therefore, this scale may be used in clinical settings as well as in educational and research settings.
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Affiliation(s)
- Sook-Nam Kim
- College of Nursing, Catholic University of Pusan, Busan, Korea
| | - Hyun-Ju Lee
- College of Nursing, Catholic University of Pusan, Busan, Korea.
| | - So-Young Kim
- College of Nursing, Catholic University of Pusan, Busan, Korea
| | - Nayoon Lee
- College of Nursing, Catholic University of Pusan, Busan, Korea
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26
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Rogers EA, Abi H, Linzer M, Eton DT. Treatment Burden in People with Hypertension is Correlated with Patient Experience with Self-Management. J Am Board Fam Med 2021; 34:1243-5. [PMID: 34772780 DOI: 10.3122/jabfm.2021.06.210191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION New hypertension guidelines in the United States may require more people to take multiple medications or implement lifestyle changes. Increased treatment burden may be an unintended consequence and lead to worse health outcomes. Our study examined whether treatment burden is associated with factors related to self-management in those with hypertension. METHODS We conducted a cross-sectional mailed survey of patients from 2 medical centers in Minnesota. Participants with 2 or more medical conditions completed the Patient Experience with Treatment and Self-management (PETS), a validated treatment burden questionnaire, as well as measures of confidence in self-management ability, health literacy, health care-related financial difficulties, and perception of provider interpersonal skills. We used partial correlation analyses, controlling for age, sex, race, and education, to test relationships among study variables. RESULTS Of 254 respondents who had a diagnosis of hypertension, 54% were female, 74% were non-Hispanic White, and the mean age was 67 years. People with hypertension who reported having lower confidence in self-management ability, lower health literacy, more financial difficulties, and health care providers with poorer interpersonal skills reported higher treatment burden scores (PETS scales correlation magnitude range 0.09 to 0.62, P < .05 on all but 4). The strongest associations were observed for medical information and physical/mental exhaustion with self-management (correlation magnitudes from 0.25 to 0.54, P < .01). DISCUSSION Hypertension treatment guideline stringent blood pressure criteria may lead to more interventions-medical or lifestyle-creating strains on populations already challenged by abstract disease self-management and at risk of experiencing disparities in cardiovascular health outcomes.
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Chung MK, Kim SS, Cheon YH, Hong SJ, Choi HJ, Seo MR, Hwang J, Ahn JK, Lee SH, Min HK, Cha HS, Lee SS, Lee J, Moon KW, Lee CK, Kim HO, Suh YS, Shim SC, Kang SW, Kim J, Choi ST, Song JS, Lee J. Patient Perspectives and Preferences Regarding Gout and Gout Management: Impact on Adherence. J Korean Med Sci 2021; 36:e208. [PMID: 34402226 PMCID: PMC8369315 DOI: 10.3346/jkms.2021.36.e208] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/01/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Patient-centered management is becoming increasingly important in gout, but there are limited studies exploring patients' perspectives and preferences. We aimed to investigate patients' perspectives and preferences regarding gout and gout management, and their impacts on adherence to urate lowering therapy (ULT). METHODS A paper-based survey was performed in patients with gout seen at the rheumatology outpatient clinics of 16 tertiary hospitals. The survey included questions regarding demographics, comorbidities, gout attacks, current treatment and adherence, and patients' perspectives and preferences regarding gout and gout management. Multivariate regression analysis was performed to determine the factors associated with ULT adherence. RESULTS Of 809 surveyed patients with gout, 755 (94.5%) were using ULT. Among those using ULT, 89.1% had ≥ 80% adherence to ULT. Majority of the patients knew management strategies to some extent (94.8%), perceived gout as a life-long disease (91.2%), and were making efforts toward practicing at least one lifestyle modification (89.2%). Most patients (71.9%) obtained information about gout management during their clinic visits. Approximately half of the patients (53.6%) preferred managing their disease with both ULT and lifestyle modification, 28.4% preferred ULT only, and 17.4% preferred lifestyle modification only. Adherence was better in patients with older age (odds ratio [OR], 1.03), those with better knowledge of gout management strategies (OR, 3.56), and those who had preference for ULT (OR, 2.07). CONCLUSION Patients' perspectives and management preferences had high impacts on adherence to ULT in gout. Consideration of patients' perspectives and preferences is important for achieving the desired clinical outcome in gout.
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Affiliation(s)
- Min Kyung Chung
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sung Soo Kim
- Division of Rheumatology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Yun Hong Cheon
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Jae Hong
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyo Jin Choi
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Mi Ryoung Seo
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jiwon Hwang
- Division of Rheumatology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Joong Kyong Ahn
- Division of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Hoon Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Jennifer Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ki Won Moon
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Chang Keun Lee
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Ok Kim
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Young Sun Suh
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Seung Cheol Shim
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - Seong Wook Kang
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - Jinhyun Kim
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - Sang Tae Choi
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, Korea
| | - Jung Soo Song
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, Korea.
| | - Jisoo Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
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Vali L, Ataollahi F, Amiresmaili M, Nakhaee N. Identification of Remarkable Dimensions in Management and Evaluation of Non-Communicable Disease Programmes: A systematic review and meta-synthesis. Sultan Qaboos Univ Med J 2021; 21:365-372. [PMID: 34522400 PMCID: PMC8407908 DOI: 10.18295/squmj.4.2021.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/05/2020] [Accepted: 11/17/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES This study aimed to identify indicators of proper programme development in the field of non-communicable diseases through the systematic review of existing literature. METHODS In this systematic review, a search was conducted through PubMed, Scopus, EMBASE, Web of Science, Google Scholar, Cochrane Library, ProQuest and grey literature. The search was limited to literature published between January 2000 and January 2019. RESULTS A total of 36 articles were found relevant to the study objectives. Data were obtained through these articles based on the context, input, process and product (CIPP) model. Seven subsets for context, five subsets for input, four subsets for process and six subsets for the product were identified. CONCLUSION According to CIPP subsets, indicators such as programme definition, appropriate organisational culture, structure and evaluation must be considered to develop an appropriate programme to improve health services.
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Affiliation(s)
- Leila Vali
- Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Ataollahi
- Faculty of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammadreza Amiresmaili
- Department of Health Economics and Management, Kerman University of Medical Sciences, Kerman, Iran
| | - Nouzar Nakhaee
- Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Rosli MR, Neoh CF, Wu DB, Hassan NW, Mahmud M, Rahimi A, Karuppannan M. Evaluation of home medication review for patients with type 2 diabetes mellitus by community pharmacists: a randomised controlled trial. Pharm Pract (Granada) 2021; 19:2397. [PMID: 34621450 PMCID: PMC8455124 DOI: 10.18549/pharmpract.2021.3.2397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/05/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Successful diabetes treatment requires commitment and understanding of disease management by the patients. OBJECTIVE This trial aimed to evaluate the programme effectiveness of home medication review by community pharmacists (HMR-CP) in optimising diabetes care and reducing medication wastage. METHODS A randomised controlled trial was conducted on 166 patients with Type 2 Diabetes Mellitus (T2DM) who were randomly assigned to the intervention or control groups. The intervention group received HMR-CP at 0-month, 3-month, and 6-month. The primary outcome was haemoglobin A1c (HbA1c) while clinical outcomes, anthropometric data, and humanistic outcomes were the secondary outcomes. For the intervention group, drug-related problems (DRP) were classified according to the Pharmaceutical Care Network Europe Foundation (PCNE). Medication adherence was determined based on the Pill Counting Adherence Ratio (PCAR). The cost of medication wastage was calculated based on the total missed dose by the T2DM patients multiplied by the cost of medication. General linear model and generalised estimating equations were used to compare data across the different time-points within and between the groups, respectively. RESULTS No significant difference was observed in the demographic and anthropometric data at baseline between the two groups except for fasting blood glucose (FBG). There was a significant reduction in the HbA1c (-0.91%) and FBG (-1.62mmol/L) over the study period (p<0.05). A similar observation was noted in diastolic blood pressure (DBP) and total cholesterol (TC) but not in high-density lipoprotein (HDL), and anthropometric parameters. Both utility value and Michigan Diabetes Knowledge Test (MDKT) scores increased significantly over time. As for the intervention group, significant changes in PCAR (p<0.001) and the number of DRP (p<0.001) were noted. CONCLUSIONS HMR-CP significantly improved the glycaemic control, QoL, medication adherence, and knowledge of T2DM patients as well as reduced the number of DRP and cost of medication wastage. However, the impact of HMR-CP on certain clinical and anthropometric parameters remains inconclusive and further investigation is warranted.
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Affiliation(s)
- M Rozaini Rosli
- BPharm, MBA. PhD. Faculty of Pharmacy, University of Technology MARA (UiTM). Selangor (Malaysia).
| | - Chin F Neoh
- PhD. Senior Lecturer. Faculty of Pharmacy, University of Technology MARA (UiTM). Selangor (Malaysia).
| | - David B Wu
- PhD. Director. Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-Being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Sunway Town, Selangor (Malaysia).
| | - Nazariah W Hassan
- M.D. Family medicine specialist, Pasir Mas City Health Clinic. Kelantan (Malaysia).
| | - Mahani Mahmud
- M.D. Senior Medical Officer at Pasir Mas City Health Clinic, Hospital Street, Pasir Mas, Kelantan, Malaysia.
| | - Afifah Rahimi
- BPharm. Senior Pharmacist at Pasir Mas City Health Clinic, Hospital Street, Pasir Mas, Kelantan, Malaysia.
| | - Mahmathi Karuppannan
- PhD. Senior Lecturer, Faculty of Pharmacy, University of Technology MARA (UiTM). Selangor (Malaysia).
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Nguyen KH, Fields JD, Cemballi AG, Desai R, Gopalan A, Cruz T, Shah A, Akom A, Brown W 3rd, Sarkar U, Lyles CR. The Role of Community-Based Organizations in Improving Chronic Care for Safety-Net Populations. J Am Board Fam Med 2021; 34:698-708. [PMID: 34312263 DOI: 10.3122/jabfm.2021.04.200591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Social determinants of health (SDoH) influence health outcomes and contribute to disparities in chronic disease in vulnerable populations. To inform health system strategies to address SDoH, we conducted a multi-stakeholder qualitative study to capture the multi-level influences on health for those living in socio-economically deprived contexts. METHODS Varied qualitative inquiry methods - in-depth interviews, participant-led neighborhood tours, and clinic visit observations - involving a total of 23 participants (10 patients with chronic illnesses in San Francisco neighborhoods with high chronic disease rates, 10 community leaders serving the same neighborhoods, and 3 providers from San Francisco's public health care delivery system). Qualitative analyses were guided by the Chronic Care Model (CCM). RESULTS Several key themes emerged from this study. First, we enumerated a large array, neighborhood resources such as food pantries, parks/green spaces, and financial assistance services that interact with patients' self-management. Health service providers leveraged these resources to address patients' social needs but suggested a clear need for expanding this work. Second, analyses uncovered multiple essential mechanisms by which community-based organizations (CBOs) provided and navigated among many neighborhood health resources, including social support and culturally aligned knowledge. Finally, many examples of how structural issues such as institutional racism, transportation, and housing inequities are intertwined with health and social service delivery were elucidated. CONCLUSION The results contribute new evidence toward the community domain of the CCM. Health care systems must intentionally partner with CBOs to address SDoH and improve community resources for chronic care management, and directly address structural issues to make progress.
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Steiner B, Richter I, Elgert L, Haux R, Wolf KH. Mobile Health Applications for Rehabilitation of Musculoskeletal Diseases of the Shoulder: A Systematic Analysis. Stud Health Technol Inform 2021; 278:195-202. [PMID: 34042894 DOI: 10.3233/SHTI210069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Rehabilitation of musculoskeletal diseases (MSD) of the shoulder is a multifaceted long-term process, which is often not transparent to affected patients. Mobile health applications (apps) have the potential to support this complex process by improving patients' self-management skills. However, there seems to be a lack of apps providing a holistic approach to motivate and guide patients during the whole rehabilitation process. Therefore, a systematic analysis of apps on Google Play Store was conducted by two independent reviewers. A total of 3227 apps were identified, of which 64 met the eligibility criteria for the qualitative analysis. The majority of analyzed apps were developed generally for patients with MSD of the shoulder, rarely for specific diseases (individual needs of patients). The majority of apps focus on the provision of information, exercise training, and alternative medicine. Apps for diagnostics, inpatient treatment, and self-management, especially for multiple rehabilitation phases, are rare or even not existent. Game design elements are seldom used. If there are any, then simple to implement ones, e.g. messages and progress bars. The (psychological) effects of individual game design elements on patients seem to be neglected, when selecting and implementing game-components.
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Seo MR, Kim G, Moon KW, Sung YK, Yoo JJ, Yoon CH, Lee EB, Lee J, Kang EH, Kim H, Park EJ, Uhm WS, Lee MS, Lee SW, Choi BY, Hong SJ, Baek HJ. Quality Indicators for Evaluating the Health Care of Patients with Rheumatoid Arthritis: a Korean Expert Consensus. J Korean Med Sci 2021; 36:e109. [PMID: 33942576 PMCID: PMC8093604 DOI: 10.3346/jkms.2021.36.e109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/22/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is increasing interest in the quality of health care and considerable efforts are being made to improve it. Rheumatoid arthritis (RA) is a disease that can result in favorable outcomes when appropriate diagnosis and treatment are provided. However, several studies have shown that RA is often managed inappropriately. Therefore, the Korean College of Rheumatology aimed to develop quality indicators (QIs) to evaluate and improve the health care of patients with RA. METHODS Preliminary QIs were derived based on the existing guidelines and QIs for RA. The final QIs were determined through two separate consensus meetings of experts. The consensus was achieved through a panel of experts who voted using the modified Delphi method. RESULTS Fourteen final QIs were selected among 70 preliminary QIs. These included early referral to and regular follow-up with a rheumatologist, radiographs of the hands and feet, early initiation and maintenance of disease-modifying anti-rheumatic drug (DMARD) therapy, periodic assessment of disease activity, screening for drug safety and comorbidities, including viral hepatitis and tuberculosis before biologic DMARD therapy, periodic laboratory testing, supplementation with folic acid, assessment of the risk for cervical spine instability before general anesthesia, patient education, and specialized nurse. CONCLUSION These QIs can be used to assess and improve the quality of health care for patients with RA.
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Affiliation(s)
- Mi Ryoung Seo
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Gunwoo Kim
- Division of Rheumatology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Ki Won Moon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yoon Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Jong Jin Yoo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Chong Hyeon Yoon
- Division of Rheumatology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun Bong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jisoo Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyungjin Kim
- Department of Medical Humanities, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Park
- Division of Rheumatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Wan Sik Uhm
- Uhm's Hanyang Rheumatism Clinic, Seoul, Korea
| | - Myeung Su Lee
- Division of Rheumatology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | | | - Byoong Yong Choi
- Department of Internal Medicine, Seoul Medical Center, Seoul Metropolitan Government, Seoul, Korea
| | - Seung Jae Hong
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
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Bouvier AM, Jooste V, Sanchez-Perez MJ, Bento MJ, Rocha Rodrigues J, Marcos-Gragera R, Carmona-Garcia MC, Luque-Fernandez MA, Minicozzi P, Bouvier V, Innos K, Sant M. Differences in the management and survival of metastatic colorectal cancer in Europe. A population-based study. Dig Liver Dis 2021; 53:639-645. [PMID: 33637435 DOI: 10.1016/j.dld.2021.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/08/2021] [Accepted: 01/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The management regarding metastatic colorectal cancer throughout Europe is not well known. AIMS To draw a European comparison of the management and prognosis of metastatic colorectal cancers. METHODS Factors associated with chemotherapy administration were identified through logistic regressions. Net survival was estimated and crude probabilities of death related to cancer and other causes using a flexible cumulative hazard model. RESULTS Among the 13 227 patients with colorectal cancer diagnosed between 2010 and 2013 in cancer registries from 10 European countries, 3140 were metastatic. 62% of metastatic patients received chemotherapy. Compared to Spain, the related adjusted odds ratios ranged from 0.7 to 4.0 (P<0.001) according to country. The 3-year net survival by country ranged between 16% and 37%. The survival gap between countries diminished from 21% to 10% when adjusting for chemotherapy, age and sex. Geographical differences in the crude probability of death related to cancer were large for patients <70 or ≥80 years at diagnosis. CONCLUSION Heterogeneity in the application of European guidelines partly explain these differences. General health between populations, accessibility to a reference centre, or provision of health care could also be involved. Further population-based studies are warranted to disentangle between these possible explanations.
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Affiliation(s)
- Anne-Marie Bouvier
- Digestive cancer registry of Burgundy, Dijon, France; Dijon University Hospital, Dijon, France; INSERM UMR 1231, Dijon, France; University of Burgundy, Dijon, France.
| | - Valérie Jooste
- Digestive cancer registry of Burgundy, Dijon, France; Dijon University Hospital, Dijon, France; INSERM UMR 1231, Dijon, France; University of Burgundy, Dijon, France
| | - Maria José Sanchez-Perez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain; Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Maria José Bento
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Porto, Portugal; Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal; Institute of Biomedical Sciences Abel Salazar, University of Porto, (ICBAS-UP), Porto, Portugal
| | - Jessica Rocha Rodrigues
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Porto, Portugal; Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain; Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain; Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Maria Carmen Carmona-Garcia
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Dr. Josep Trueta, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Miguel Angel Luque-Fernandez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain; Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Véronique Bouvier
- Digestive tumors registry of Calvados, Caen, France; U1086 INSERM UCN, ANTICIPE, Caen, France; Caen University Hospital, Caen, France
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Kjaer PH, Fisher L, Potter MB, Dedhia M, Parra J, Ejskjaer N, Skovlund S, Hessler D. Examining Variations in Action Plan Quality Among Adults With Type 2 Diabetes in Primary Care. J Am Board Fam Med 2021; 34:608-17. [PMID: 34088821 DOI: 10.3122/jabfm.2021.03.200285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Collaborative goal setting and action-planning are key elements of self-management support for people with type 2 diabetes mellitus (T2DM), however little is known regarding action plan quality or correlation of quality in primary T2DM care. METHODS T2DM patients from 12 primary care sites participated in either: Connection to Health (CTH; 6 practices), consisting of a health survey followed by collaborative action planning, or Enhanced Engagement CTH (EE-CTH; 6 practices), including additional training in relationship building promoting patient engagement. Action plan quality was rated using an adapted version of the Goal-Setting Evaluation Tool for Diabetes (GET-D) (dual coding of 20%, inter-rater reliability [IRR] >80%). Associations with patient characteristics were examined using generalized linear mixed models adjusting for clustering by clinic and intervention arm. RESULTS With a mean score ± standard deviation (SD) of 14.62 ± 3.87 on a 0 to 20 scale (n = 725), overall action plan quality was moderate-high. Higher health literacy (β = 1.184, 95% CI, 0.326-2.041; P = .007), and having no social risks (β = 0.416; 95% CI, 0.062-0.770; P = .021) were associated with higher action plan quality, whereas sex, age, language, education level, depression, stress, and health distress were unrelated to quality (P value not significant). Higher quality was associated with greater patient confidence in the plan (β = 0.050; 95% CI, 0.016-0.084, P = .004). CONCLUSIONS Although there was a considerable difference in action plan quality ratings, ratings did not systematically differ based on most patient demographic or mental health measures. Results suggest that action planning should be tailored to health literacy and social risks. Further research should examine associations between quality and longer-term clinical outcomes.
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Zogas A, Gillespie C, Kleinberg F, Reisman JI, Ndiwane N, Tran MH, Ourth HL, Morreale AP, Miller DR, McCullough MB. Clinical Pharmacist Integration Into Veterans' Primary Care: Team Members Perspectives. J Am Board Fam Med 2021; 34:320-7. [PMID: 33833000 DOI: 10.3122/jabfm.2021.02.200328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND With the restructuring of primary care into patient-centered medical homes (PCMH), researchers have described role transformations that accompany the formation of core primary care teamlets (eg, primary care provider, registered nurse care manager, licensed practical nurse, medical support assistant). However, few studies offer insight into how primary care teamlets, once established, integrate additional extended team members, and the factors that influence the quality of their integration. METHODS We examine the process of integrating Clinical Pharmacy Specialists (CPS) into primary care teams in the Veterans Health Administration (VHA). We conducted semi-structured interviews with CPS (n = 6) and clinical team members (n = 16) and performed a thematic analysis of interview transcripts. RESULTS We characterize 2 ways CPS are integrated into primary care teamlets: in consultative roles and collaborative roles. CPS may be limited to consultative roles by team members' misconceptions about their competencies (ie, if CPS are perceived to handle only medication-related issues like refills) and by primary care providers' opinions about distributing responsibilities for patient care. Over time, teams may correct misconceptions and integrate the CPS in a more collaborative role (ie, CPS helps manage disease states with comprehensive medication management). CONCLUSIONS CPS integrated into collaborative roles may have more opportunities to optimize their contributions to primary care, underscoring the importance of clarifying roles as part of adequately integrating advanced practitioners in interprofessional teams.
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Bensken WP, Dong W, Gullett H, Etz RS, Stange KC. Changing Reasons for Visiting Primary Care Over a 35-Year Period. J Am Board Fam Med 2021; 34:442-8. [PMID: 33833017 DOI: 10.3122/jabfm.2021.02.200145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To understand changes in reasons for visit to primary care in the face of an aging population, growing evidence for proactive preventive and chronic disease services, and the rise of the chronic care model. METHODS We examined the reason for visits to primary care physicians using the National Ambulatory Medical Care Survey (NAMCS) from 1980-2015. RESULTS Among all physicians, the percent of visits for prevention increased from 17% in 2001 to 20% in 2015. Among visits to primary care, most continued to be for acute problems - with the percent of visits for acute illness declining over the past 15 years, after remaining steady for two decades. Preventive care visits increased from 19% in 2001 to 26% in 2015. The percent of primary care visits for chronic conditions declined between 1980 and 2000, and then remained steady, accounting for 30% in 2001 and 31% in 2015. CONCLUSIONS Growing emphasis on chronic disease management is not reflected in the percent of primary care visits for chronic illness. This study highlights the potential utility of longitudinal data within a historical interpretive frame, while raising questions about the utility of using a main reason for visit to classify complex primary care visits.
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Koff PB, Min SJ, Freitag TJ, Diaz DLP, James SS, Voelkel NF, Linderman DJ, Diaz Del Valle F, Zakrajsek JK, Albert RK, Bull TM, Beck A, Stelzner TJ, Ritzwoller DP, Kveton CM, Carwin S, Ghosh M, Keith RL, Westfall JM, Vandivier RW. Impact of Proactive Integrated Care on Chronic Obstructive Pulmonary Disease. Chronic Obstr Pulm Dis 2021; 8. [PMID: 33238087 DOI: 10.15326/jcopdf.2020.0139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Up to 50% of chronic obstructive pulmonary disease (COPD) patients do not receive recommended care for COPD. To address this issue, we developed Proactive Integrated Care (Proactive iCare), a health care delivery model that couples integrated care with remote monitoring. Methods We conducted a prospective, quasi-randomized clinical trial in 511 patients with advanced COPD or a recent COPD exacerbation, to test whether Proactive iCare impacts patient-centered outcomes and health care utilization. Patients were allocated to Proactive iCare (n=352) or Usual Care ( =159) and were examined for changes in quality of life using the St George's Respiratory Questionnaire (SGRQ), symptoms, guideline-based care, and health care utilization. Findings Proactive iCare improved total SGRQ by 7-9 units (p < 0.0001), symptom SGRQ by 9 units (p<0.0001), activity SGRQ by 6-7 units (p<0.001) and impact SGRQ by 7-11 units (p<0.0001) at 3, 6 and 9 months compared with Usual Care. Proactive iCare increased the 6-minute walk distance by 40 m (p<0.001), reduced annual COPD-related urgent office visits by 76 visits per 100 participants (p<0.0001), identified unreported exacerbations, and decreased smoking (p=0.01). Proactive iCare also improved symptoms, the body mass index-airway obstruction-dyspnea-exercise tolerance (BODE) index and oxygen titration (p<0.05). Mortality in the Proactive iCare group (1.1%) was not significantly different than mortality in the Usual Care group (3.8%; p=0.08). Interpretation Linking integrated care with remote monitoring improves the lives of people with advanced COPD, findings that may have been made more relevant by the coronavirus 2019 (COVID-19) pandemic.
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Affiliation(s)
- Patricia B Koff
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Sung-Joon Min
- Division of Health Care Policy and Research, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States
| | - Tammie J Freitag
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Debora L P Diaz
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Shannon S James
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Norbert F Voelkel
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Derek J Linderman
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Fernando Diaz Del Valle
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Jonathan K Zakrajsek
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Richard K Albert
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Todd M Bull
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Arne Beck
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States
| | - Thomas J Stelzner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States
| | - Christine M Kveton
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States
| | - Stephanie Carwin
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States
| | - Moumita Ghosh
- National Jewish Health, Denver, Colorado, United States
| | - Robert L Keith
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.,Denver Veterans Administration Medical Center, Denver, Colorado, United States
| | - John M Westfall
- Department of Family Medicine, High Plains Research Network, University of Colorado Denver, Anschutz Medical Campus, United States
| | - R William Vandivier
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
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Valizadeh M, Hosseinpanah F, Ramezani Tehrani F, Abdi H, Mehran L, Hadaegh F, Amouzegar A, Sarvghadi F, Azizi F. Iranian Endocrine Society Guidelines for Screening, Diagnosis, and Management of Gestational Diabetes Mellitus. Int J Endocrinol Metab 2021; 19:e107906. [PMID: 33815518 PMCID: PMC8010429 DOI: 10.5812/ijem.107906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/12/2020] [Accepted: 11/14/2020] [Indexed: 11/17/2022] Open
Abstract
CONTEXT Gestational diabetes mellitus (GDM) is an important endocrine disorder in perinatology, associated with several maternal and neonatal complications. Development of national guidelines can inform clinicians, health policymakers, and researchers about the most recent evidence and practical issues of diagnosis and management of GDM. OBJECTIVES We aimed to develop clinical practice guidelines for the diagnosis and management of GDM in Iranian pregnant women. EVIDENCE ACQUISITION The Iranian Endocrine Society constituted a task force, consisting of obstetrician-gynecologists, endocrinologists, a clinical nutritionist, a clinical epidemiologist, and a librarian, to review the published literature and propose national guidelines for the diagnosis and management of GDM. The consensus was reached on all recommendations in several group meetings with a majority decision. The evidence and recommendations were graded according to the American College of Physicians' Guideline Grading System. RESULTS The proposed guidelines included recommendations for screening, diagnosis, and management of GDM in Iran. CONCLUSIONS By using an evidence-based approach, these national GDM guidelines can address important clinical issues in the diagnosis and management of Iranian women with GDM.
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Affiliation(s)
- Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hengameh Abdi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Sarvghadi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Stephens KA, Ike B, Baldwin LM, Packer C, Parchman M. Challenges and Approaches to Population Management of Long-Term Opioid Therapy Patients. J Am Board Fam Med 2021; 34:89-98. [PMID: 33452086 DOI: 10.3122/jabfm.2021.01.190100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Primary care is challenged with safely prescribing opioids for patients with chronic noncancer pain (CNCP), specifically to address risks for overdose, opioid use disorder, and death. We identify sociotechnical challenges, approaches, and recommendations in primary care to effectively track and monitor patients on long-term opioid therapy, a key component for supporting adoption of opioid prescribing guidelines. METHODS We examined qualitative data (field notes and postintervention interview and focus group transcripts) from 6 rural and rural-serving primary care organizations with 20 clinic locations enrolled in a study evaluating a practice redesign program to improve opioid medication management for CNCP patients. Two independent researchers used content analysis to categorize data into key themes to develop an understanding of sociotechnical factors critical to creating and implementing an approach to tracking and monitoring of patients on long-term opioid therapy in primary care practices. RESULTS Four factors were critical to developing a tracking and monitoring system. For each we describe common challenges and approaches used by the clinics to overcome then. The first factor, buy-in and participation, was essential for accomplishing the other 3. The other factors occurred sequentially: 1) cohort identification-finding the right patients, 2) data collection and extraction-tracking the right data, and 3) data use-monitoring patients and adjusting care processes. CONCLUSIONS We identified common challenges and approaches to tracking and monitoring patients using long-term opioid therapy for CNCP in primary care. Based on these findings we provide recommendations to build capacity for tracking and monitoring for organizations that are engaged in improving safe opioid-prescribing practices for CNCP in primary care.
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McDonnell MM, Elder NC, Stock R, Wolf M, Steeves-Reece A, Graham T. Project ECHO Integrated Within the Oregon Rural Practice-based Research Network (ORPRN). J Am Board Fam Med 2020; 33:789-95. [PMID: 32989075 DOI: 10.3122/jabfm.2020.05.200051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 11/08/2022] Open
Abstract
Two key advancements in improving the quality of primary care have been practice-based research networks (PBRNs) and Project Extension for Community Health care Outcomes (ECHO). PBRNs advance quality through research and transformation projects, often using practice facilitation. Project ECHO uses case-based telementoring to support community clinicians to deliver best-practice care. Although some PBRNs sponsor ECHO programs, the Oregon Rural Practice-based Research Network (ORPRN) has created a statewide network for ECHO programs (Oregon ECHO Network [OEN]). We facilitated a unique funding stream for the OEN by partnering with payers and health systems. The purpose of this article is to share our experience of how OEN programs and ORPRN research and transformation projects enhance practice recruitment and retention and improve financial stability. We describe the synergy between ORPRN projects and ECHO programs using 3 examples: tobacco cessation, chronic pain and opioid prescribing, and diabetes management. We highlight challenges and opportunities in these examples, beginning with their development, their implementation, and their ultimate alignment, despite varied funding streams and timelines. We believe that incorporating the OEN within ORPRN has been a success for both PBRN research and Project ECHO programs, allowing us to better support primary care practices across the state.
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Konstantakopoulou O, Galanis P, Kaitelidou D, Karagkouni I, Korompoki E, Ntaios G, Vemmos K, Papastefanatos S, Papastefanatos G, Tsampalas E, Alexopoulou H, Kalliontzakis I, Kouridaki A, Tountopoulou A, Kouzi I, Milionis H, Evaggelou C, Karagkiozi E, Hatzitolios AI, Savopoulos C, Myrou A, Mavraganis G, Vemmou A, Siskou O. Developing Patients' Experiences Database After Hospital Discharge: Another Step in Improving Stroke Care. Stud Health Technol Inform 2020; 272:441-444. [PMID: 32604697 DOI: 10.3233/shti200590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to assess stroke patients' experiences in regards to hospital stay and during discharge. A cross-sectional study with retrospective data collection was conducted including patients (n=135) with first-ever acute stroke, who were admitted in seven Public Hospitals in Greece ("Stroke Units Necessity for Patients, SUN4P" registry). The translated version of the NHS-Stroke Questionnaire in the Greek was used. 48.2% of patients rated their overall experience from the care they received as very good/excellent. 66% of patients reported that they participated in decision making about their care and 21.5% reported not having received help from the hospital's social services regarding any benefits/aids, thus lowering their overall patient experience score (p=0.017). Decision and policymakers must consider factors affecting stroke patients 'experiences during their hospitalization. The development of a national stroke patients' experiences database can help prioritize relevant actions and draw up a commonly accepted management and services redesign framework for patients.
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Affiliation(s)
- Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | - Iliana Karagkouni
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens Greece.,Hellenic Stroke Organization, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa Greece.,Hellenic Stroke Organization, Greece
| | | | - Stefanos Papastefanatos
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | | | | | - Helen Alexopoulou
- Department of Neurology, Panarkadikon General Hospital, Tripoli, Greece
| | | | | | - Argyro Tountopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Kouzi
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Chara Evaggelou
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Efstathia Karagkiozi
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa Greece
| | - Apostolos I Hatzitolios
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Athina Myrou
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens Greece
| | - Anastasia Vemmou
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens Greece
| | - Olga Siskou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
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Kim SI, Lechien JR, Ayad T, Jia H, Khoddami SM, Enver N, Raghunandhan SK, Hamdan AL, Eun YG. Management of Laryngopharyngeal Reflux in Asia. Clin Exp Otorhinolaryngol 2020; 13:299-307. [PMID: 32392640 PMCID: PMC7435427 DOI: 10.21053/ceo.2019.01669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/14/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This study was conducted to investigate the current practices of Asian otolaryngologists for laryngopharyngeal reflux (LPR). METHODS An online survey about LPR was sent to 2,000 members of Asian otolaryngological societies, and a subgroup analysis was performed between Western and Eastern Asian otolaryngologists. The survey was conducted by the Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies. RESULTS Among approximately 1,600 Asian otolaryngologists, 146 completed the survey (62 from Western Asian countries, 84 from Eastern Asian countries). A substantial majority (73.3%) of the otolaryngologists considered LPR and gastroesophageal reflux disease to be different diseases. The symptoms thought to be closely related to LPR were coughing after lying down, throat clearing, and globus sensation. The findings thought to be closely related to LPR were posterior commissure granulations and hypertrophy, arytenoids, and laryngeal erythema. The respondents indicated that they mostly diagnosed LPR (70%) after an empirical therapeutic trial of proton pump inhibitors (PPIs). Although multichannel intraluminal impedance-pH (MII-pH) monitoring is a useful tool for diagnosing nonacid or mixed LPR, 78% of Asian otolaryngologists never or very rarely used MII-pH. Eastern Asian otolaryngologists more frequently used once-daily PPIs (64.3% vs. 45.2%, P=0.021), whereas Western Asian otolaryngologists preferred to use twice-daily PPIs (58.1% vs. 39.3%, P=0.025). The poor dietary habits of patients were considered to be the main reason for therapeutic failure by Asian otolaryngologists (53.8%). Only 48.6% of Asian otolaryngologists considered themselves to be adequately knowledgeable and skilled regarding LPR. CONCLUSION Significant differences exist between Western and Eastern Asian otolaryngologists in the diagnosis and treatment of LPR. Future consensus statements are needed to establish diagnostic criteria and therapeutic regimens.
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Affiliation(s)
- Su Il Kim
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Tareck Ayad
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Huan Jia
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Seyyedeh Maryam Khoddami
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Larynx Function Laboratory, Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Necati Enver
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otolaryngology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Sampath Kumar Raghunandhan
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otology, Neurotology and Skullbase Surgery, Madras ENT Research Foundation, Chennai, India
| | - Abdul Latif Hamdan
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Young-Gyu Eun
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
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Nunes AB, Oliveira AP, Jamanca A, Brito DV, Silva NM, Duarte S, Coelho A. [Asthma Management and Control in Portuguese Speaking Countries]. ACTA MEDICA PORT 2020; 33:269-274. [PMID: 32238241 DOI: 10.20344/amp.11927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Asthma affects more than 339 million people worldwide. In the Community of Portuguese Speaking Countries, in 2016, its prevalence ranged from 9.5% (Portugal) to 3.91% (Brazil). Chronic disease management programs aim to improve the health status of patients with chronic disease and reduce associated costs. The objective of this study is to identify models of asthma asthma 'management and control' that are that are implemented in the Community of Portuguese Speaking Countries (CPLP), and analyse them through the integrated disease management model. MATERIAL AND METHODS A rapid review of the PubMed indexed scientific literature and grey literature on 'management and control of asthma' in the countries of the Community of Portuguese-Speaking Countries was carried out. RESULTS Portugal, Brazil and Mozambique presented publications on 'management and control of asthma', at different stages of implementation. Clinical management and organization and service delivery are the dimensions of integrated disease management most addressed in publications. DISCUSSION The implementation of asthma management and control programs is influenced by health systems, care delivery structures, and the surrounding political and social environment. The dimensions of funding and information systems are the most difficult to implement given the degree of economic, social and technological development of most countries under study. CONCLUSION Only Portugal, Brazil and Mozambique adopted asthma integrated disease management as the main form of asthma management and control. The programs developed by these countries can constitute a model for asthma integrated disease management in the other countries under study.
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Affiliation(s)
- Ana Beatriz Nunes
- Unidade de Saúde Pública. Agrupamento de Centros de Saúde do Alentejo Central. Évora. Portugal
| | - Ana Pinto Oliveira
- Unidade de Saúde Pública. Agrupamento de Centros de Saúde do Arco Ribeirinho. Barreiro. Portugal
| | - Aua Jamanca
- Serviço de Ginecologia. Hospital Nacional Simão Mendes. Bissau. Guiné-Bissau. Guinea-Bissau
| | - Duarte Vital Brito
- Unidade de Saúde Pública. Agrupamento de Centros de Saúde de Lisboa Central. Lisboa. Global Health and Tropical Medicine. Instituto de Higiene e Medicina Tropical. Universidade Nova de Lisboa. Lisboa. Portugal
| | - Nádia Mendes Silva
- Serviço de Pediatria. Hospital Nacional Simão Mendes. Bissau. Guinea-Bissau
| | - Sara Duarte
- Global Health and Tropical Medicine. Instituto de Higiene e Medicina Tropical. Universidade Nova de Lisboa. Lisboa. Unidade de Saúde Pública. Unidade Local de Saúde do Alto Minho. Viana do Castelo. Portugal
| | - Anabela Coelho
- Departamento da Qualidade na Saúde. Direção-Geral da Saúde. Lisboa. Portugal
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Ledford CJW, Fisher CL, Cafferty LA, Jackson JT, Seehusen DA, Crawford PF. Turning Points as Opportunities to Partner with Patients Living with type 2 Diabetes or Prediabetes. J Am Board Fam Med 2020; 33:211-9. [PMID: 32179604 DOI: 10.3122/jabfm.2020.02.190136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/01/2019] [Accepted: 10/07/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Understanding patients' perspectives about their diabetes and what causes those perspectives to shift is critical to building a treatment strategy with the patient and facilitating patient self-management behavior. Key "turning points" can provide crucial opportunities to enact a change in perspective. The goal of this study is to identify "turning points" that have significance to diabetes-related health. METHODS Research coordinators interviewed 33 patients aged 25 to 65 diagnosed with type 2 diabetes mellitus or prediabetes at medical centers in Augusta, Georgia, and Las Vegas, Nevada. Retrospective interview technique and turning point analysis was employed to plot health or diabetes management changes from diagnosis up to the present day. The constant comparative method was used to conduct a thematic analysis. Axial coding identified properties characterizing each turning point. RESULTS Patients reported 5 interrelated turning points occurring at various times after diagnosis: 1) gaining knowledge, either through patients own research and/or a health care class; 2) making lifestyle changes, including exercising and healthier eating; 3) encountering a life-changing event/transition, including events that derailed healthy behavior, motivated health behavior, and removed barriers to enacting healthy behavior; 4) receiving social support, either through holding patients accountable or encouraging them to enact healthy behavior; and 5) interacting with clinicians, such as medication changes or behavior changes critical to disease management. DISCUSSION These turning points provide specific moments throughout diabetes care in which family physicians can effectively partner with patients. By prompting, facilitating, or attending to these turning points, family physicians can partner with patients throughout diabetes care.
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Kebir O, Laqueille X. [How to manage adult attention deficit hyperactivity disorder in patients with substance use disorders?]. Rev Prat 2020; 70:293-300. [PMID: 32877064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
How to manage adult attention deficit hyperactivity disorder in patients with substance use disorders? Adult attention deficit hyperactivity disorder (ADHD) frequently occurs with anxiety disorders, mood disorders and above all addictive comorbidities. Its evaluation must be systematic during an addictology consultation. ADHD is a neurodevelopmental disorder characterized by a complex clinical picture combining cognitive, affective and behavioral dimensions that frequently underlies addictive disorder. Substance misuse frequently begins as an over-the-counter medication. The multidimensional diagnostic approach makes it possible to detect these complex interactions. The motivational therapeutic approach involving the comorbidity issue is crucial to support the patient in his change towards a control of his addictions.
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Affiliation(s)
- Oussama Kebir
- Service d'addictologie Moreau de Tours, GHU psychiatrie et neurosciences de Paris, Paris, France
| | - Xavier Laqueille
- Service d'addictologie Moreau de Tours, GHU psychiatrie et neurosciences de Paris, Paris, France
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Chen J, Cai W, Li L. Profile of renal artery embolization (RAE) for renal trauma: A comparison of data from two major trauma center. Int Braz J Urol 2020; 46:194-202. [PMID: 32022507 PMCID: PMC7025829 DOI: 10.1590/s1677-5538.ibju.2019.0506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/06/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate usage of renal artery embolization (RAE) for renal injuries and discuss the indications for this treatment. MATERIALS AND METHODS A retrospective study was performed evaluating the electronic medical records of all patients with renal trauma admitted to two major comprehensive hospitals in Shantou city from January 2006 to December 2015. RESULTS There were 264 and 304 renal traumatic patients admitted to hospital A and B, respectively. LGRT was the reason for presentation in the majority of patients (522, 91.9%). A total of 534 (94.0%) patients were treated conservatively. RAE was performed in 9 patients from 2012 to 2015 at hospital A, including in 6 patients (6/9, 66.7%) with LGRT, and 3 patients (3/9, 33.3%) with HGRT. No patient underwent interventional therapy (RAE) at hospital B during the same period. No significant differences in the operative rate of hospital A were observed between the two time periods (2006-2011 and 2012-2015). The operative rate for LGRT between the two hospitals from 2006 to 2011 and 2012 to 2015 was not significantly different. Hospital A showed a significant decrease in the rate of conservative treatment for patients with LGRT. In the univariate and multivariate analyses, the AAST renal grade both were significantly associated with undergoing RAE. CONCLUSIONS LGRT was present in the majority of patients, and most cases of renal trauma could be treated with conservative treatment. RAE was well utilized for the treatment of renal trauma. However, some patients with LGRT were treated with unnecessary interventional therapy.
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Affiliation(s)
- Jie Chen
- Injury Prevention Research CenterShantou UniversityMedical CollegeShantouGuangdongChinaInjury Prevention Research Center, Shantou University Medical College, Shantou, Guangdong, P.R. China;
- Second Affiliated HospitalShantou UniversityMedical CollegeShantouGuangdongChina Department of Urology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P.R. China;
| | - Weicong Cai
- Injury Prevention Research CenterShantou UniversityMedical CollegeShantouGuangdongChinaInjury Prevention Research Center, Shantou University Medical College, Shantou, Guangdong, P.R. China;
- Department of Non-communicable Disease Control and PreventionShenzhen Center for Chronic Disease ControlShenzhenGuangdongChinaDepartment of Non-communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, P.R. China
| | - Liping Li
- Injury Prevention Research CenterShantou UniversityMedical CollegeShantouGuangdongChinaInjury Prevention Research Center, Shantou University Medical College, Shantou, Guangdong, P.R. China;
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Fink RM, Mooney EV, Saseen JJ, Billups SJ. A comparison of clinical pharmacist management of type 2 diabetes versus usual care in a federally qualified health center. Pharm Pract (Granada) 2020; 17:1618. [PMID: 31897259 PMCID: PMC6935544 DOI: 10.18549/pharmpract.2019.4.1618] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/20/2019] [Indexed: 01/04/2023] Open
Abstract
Background: Clinical pharmacists have demonstrated their ability to improve patient outcomes over usual care for patients with type 2 diabetes and glycemic levels above goal, though reasons for this are not well defined. Numerous medications exist for the management of patients with type 2 diabetes and different patterns of medication use by clinical pharmacists may explain these benefits. Objective: The objective of this study was to compare pharmacotherapy approaches to managing patients with uncontrolled type 2 diabetes receiving basal insulin by a clinical pharmacist versus usual care by a physician or advanced practice provider in a federally qualified health center. Methods: A retrospective cohort study of patients 18 to 85 years old with type 2 diabetes, A1C ≥9%, receiving basal insulin was conducted. Patients were grouped into two cohorts (1) those who received clinical pharmacist care and (2) those who received usual care from a physician or advanced practice provider. The primary outcome evaluated the proportion of patients treated with the addition of a non-basal insulin medication. Type of medication changes or additions as well as change in A1C and change in weight were also analyzed. Outcomes were evaluated at six months post-index A1C. Results: A total of 202 patients were identified (n=129 in the usual care group and n=73 in the clinical pharmacist group). A non-basal insulin medication was added in 29% of patients receiving usual care versus 41% of patients receiving clinical pharmacist care (adjusted p=0.040). Usual care providers more frequently added metformin, sulfonylureas and thiazolidinediones, while clinical pharmacists more frequently added prandial insulin, DPP-4 inhibitors, GLP-1 agonists, and SGLT-2 inhibitors. A1C decreased 1.6% in the clinical pharmacist group versus 0.9% in the usual care group (adjusted p=0.055). No significant change in weight was observed between the clinical pharmacist and usual care group (0.2 kg versus -1.0 kg, respectively; adjusted p=0.175). Conclusions: Pharmacotherapy approaches to managing patients with uncontrolled type 2 diabetes varied between clinical pharmacists and other clinician providers. For patients already on basal insulin, clinical pharmacists were more likely to intensify therapy with the addition of non-basal insulin, including more frequent initiation of prandial insulin and by adding newer antihyperglycemic agents.
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Affiliation(s)
- Rhianna M Fink
- PharmD, BCACP, BC-ADM. Assistant Professor. Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado. Aurora, CO (United States).
| | - Emanuela V Mooney
- PharmD, BCACP. Clinical Pharmacy Specialist. University of Colorado Health Medical Group. Colorado Springs, CO (United States).
| | - Joseph J Saseen
- PharmD, BCPS, BCACP. Professor and Vice Chair. Department of Clinical Pharmacy and Department of Family Medicine, University of Colorado Anschutz Medical Campus. Aurora, CO (United States).
| | - Sarah J Billups
- PharmD, BCPS. Assistant Professor. Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado. Aurora, CO (United States).
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Johansen ME, Yun J, Griggs JM, Jackson EA, Richardson CR. Anti-Hypertensive Medication Combinations in the United States. J Am Board Fam Med 2020; 33:143-6. [PMID: 31907256 DOI: 10.3122/jabfm.2020.01.190134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Examining the anti-hypertensive regimens of individuals with different comorbidities may offer insights into how we can improve hypertension management. METHODS The Medical Expenditure Panel Survey (2013-2015) was used to describe the most common single-, two-, three-, and four-drug hypertension regimens among hypertensive adults in four different comorbidity groups: 1. Hypertension only; 2. Hypertension and diabetes; 3. Hypertension and cardiovascular disease (coronary heart disease or stroke history); and 4. Hypertension, diabetes, and cardiovascular disease. RESULTS 15,901 adults with hypertension taking anti-hypertensive medications were included in the study. 58.6% (95% CI: 57.3-59.8) took multiple anti-hypertensive medications, but the proportion of adults taking multiple anti-hypertensives varied by comorbidity group. Regimens including an ACE-inhibitor/ARB were the most prevalent regimens among individuals taking ≥2 anti-hypertensive medications. The most common two-drug regimen for both the hypertension-only and hypertension-diabetes groups was an ACE-inhibitor/ARB with thiazide. The most prevalent regimen for the two cardiovascular disease groups was an ACE-inhibitor/ARB with beta-blocker. CONCLUSIONS Most individuals with hypertension use between 2-5 medications and the medications comprising these regimens vary by comorbidity. The ACCOMPLISH trial suggested that certain combinations may lead to superior cardiovascular outcomes. Research comparing the efficacy of different hypertension medication combinations among individuals with different comorbidities could lead to better patient hypertensionrelated outcomes.
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Kim B, Kim O. [The Disease Management Experience of Patients with Asthma: Grounded Theory Approach]. J Korean Acad Nurs 2020; 50:714-726. [PMID: 33142302 DOI: 10.4040/jkan.20139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study was to develop a situation-specific theory to explain the disease management experience of patients with asthma. METHODS Twenty participants with asthma were selected using the theoretical sampling method. The data were acquired through in-depth interviews conducted from June to October 2018 and analyzed using the grounded theory approach of Strauss and Corbin. RESULTS In total, 69 concepts, 30 subcategories, and 13 categories were generated to explain the disease management experience of patients with asthma. The core category of the disease management experience of patients with asthma was 'management of the disease to prevent aggravation of symptoms over the lifetime'. The disease management process of asthma patients included three steps: the 'cognition phase', the 'adjustment phase', and the 'maintenance phase'. However, some patients remained in the 'stagnation phase' of disease management, which represents the result of the continual pursuit of risky health behavior. There were three types of disease management experiences among patients with asthma: 'self-managing', 'partially self-managing', and 'avoidant'. CONCLUSION This study shows that patients with asthma must lead their disease management process to prevent exacerbation of their symptoms. It is imperative to develop nursing strategies and establish policies for effective disease management of patients with asthma based on their individual disease management processes and types.
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Affiliation(s)
- Bohye Kim
- College of Nursing, Ewha Womans University, Seoul, Korea.
| | - Oksoo Kim
- College of Nursing, Ewha Womans University, Seoul, Korea
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An TJ, Kim JW, Choi EY, Jang SH, Lee HY, Kang HS, Koo HK, Lee JM, Kim SK, Shin JW, Park SY, Rhee CK, Moon JY, Kim YH, Lee H, Kim YH, Kim JH, Lee SH, Kim DK, Yoo KH, Kim DG, Jung KS, Kim HJ, Yoon HK. Clinical Characteristics of Chronic Cough in Korea. Tuberc Respir Dis (Seoul) 2020; 83:31-41. [PMID: 31905430 PMCID: PMC6953492 DOI: 10.4046/trd.2019.0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chronic cough is defined as a cough lasting more than 8 weeks and socio-economic burden of chronic cough is enormous. The characteristics of chronic cough in Korea are not well understood. The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) published guidelines on cough management in 2014. The current study evaluated the clinical characteristics of chronic cough in Korea and the efficacy of the KATRD guidelines. METHODS This was a multi-center, retrospective observational study conducted in Korea. The participants were over 18 years of age. They had coughs lasting more than 8 weeks. Subjects with current pulmonary diseases, smokers, ex-smokers with more than 10 pack-years or who quit within the past 1 year, pregnant women, and users of cough-inducing medications were excluded. Evaluation and management of cough followed the KATRD cough-management guidelines. RESULTS Participants with chronic cough in Korea showed age in the late forties and cough duration of more than 1 year. Upper airway cough syndrome was the most common cause of cough, followed by cough-variant asthma (CVA). Gastro-esophageal reflux diseases and eosinophilic bronchitis were less frequently observed. Following the KATRD cough-management guidelines, 91.2% of the subjects improved after 4 weeks of treatment. Responders were younger, had a longer duration of cough, and an initial impression of CVA. In univariate and multivariate analyses, an initial impression of CVA was the only factor related to better treatment response. CONCLUSION The causes of chronic cough in Korea differed from those reported in other countries. The current Korean guidelines proved efficient for treating Korean patients with chronic cough.
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Affiliation(s)
- Tai Joon An
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Woo Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Eun Young Choi
- Division of Pulmonary and Allergy, Department of Internal Medicine, Regional Respiratory Center, Yeungnam University Hospital, Daegu, Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hwa Young Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Seon Kang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Hyeon Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jong Min Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Kyung Kim
- Division of Pulmonology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jong Wook Shin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - So Young Park
- Division of Pulmonary and Critical Care Medicine, Chungnam University Medical Center, Daejeon, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Yong Moon
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Yee Hyung Kim
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yong Hyun Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Je Hyeong Kim
- Division of Pulmonary, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Dong Gyu Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Ki Suck Jung
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hui Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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