375,993 results match your criteria Journal of Primary Care & Community Health [Journal]


The Impact of Using Emotionally Arousing Stimuli on Muscle Response Testing Accuracy.

Complement Med Res 2019 Apr 18:1-9. Epub 2019 Apr 18.

School of Health Sciences, City University London, London, United Kingdom.

Introduction: Muscle response testing (MRT) is an assessment method used by 1 million practitioners worldwide, yet its usefulness remains uncertain. The aim of this study, one in a series assessing the accuracy of MRT, was to determine whether emotionally arousing stimuli influence its accuracy compared to neutral stimuli.

Methods: To assess diagnostic test accuracy 20 MRT practitioners were paired with 20 test patients (TPs). Read More

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https://www.karger.com/Article/FullText/497188
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http://dx.doi.org/10.1159/000497188DOI Listing
April 2019
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Narrow-band Imaging for Detection of Neoplasia at Colonoscopy: a Meta-analysis of Data From Individual Patients in Randomized Controlled Trials.

Gastroenterology 2019 Apr 15. Epub 2019 Apr 15.

Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford OX3 9DU, UK. Electronic address:

Background & Aims: Adenoma detection rate (ADR) is an important quality assurance measure for colonoscopy. Some studies suggest that narrow band imaging (NBI) may be more effective at detection of adenomas than white-light endoscopy (WLE) when bowel preparation is optimal. We conducted a meta-analysis of data from individual patients in randomized controlled trials that compared the efficacy of NBI to WLE in detection of adenomas. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00165085193570
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http://dx.doi.org/10.1053/j.gastro.2019.04.014DOI Listing
April 2019
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Video strategies improved health professional knowledge across different contexts: a helix counterbalanced randomised controlled study.

J Clin Epidemiol 2019 Apr 15. Epub 2019 Apr 15.

Building G, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University Peninsula Campus, McMahons Road, Frankston, 3199 Victoria, Australia. Electronic address:

Objective: This study aimed to apply a novel helix counterbalanced randomised controlled trial design to evaluate the effectiveness of video versus written knowledge translation strategies for improving health professional knowledge of evidence provided in scientific journal articles.

Study Design And Setting: A Helix counterbalanced randomised controlled trial was used to compare the impact of delivering research information via video or written modalities compared to a no-information control across three health contexts. Interventions were delivered and data collected via an online survey to nursing and allied health professionals across five hospitals within a public health service in Melbourne, Australia. Read More

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http://dx.doi.org/10.1016/j.jclinepi.2019.04.003DOI Listing

Incidence and factors associated with substance abuse and patient-related violence in the emergency department: A literature review.

Australas Emerg Care 2018 Nov 2;21(4):159-170. Epub 2018 Nov 2.

Austin Clinical School of Nursing, La Trobe University, Heidelberg, Victoria, Australia.

Background: The level of workplace violence in emergency departments worldwide has reached an alarming level. Substance abuse is thought to play a major part in the escalation of aggressive and violent behaviour and is suspected to be responsible for the majority of violent escalations in the emergency department. The aim of this scoping review was (1) to investigate the incidence of workplace violence in the emergency department, their association to substance abuse and (2) to identify factors associated with workplace violence such as perpetrator characteristics and environmental factors. Read More

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http://dx.doi.org/10.1016/j.auec.2018.10.004DOI Listing
November 2018

Enhancing the training of trauma resuscitation flash teams: A mixed methods study.

Australas Emerg Care 2018 Nov 29;21(4):143-149. Epub 2018 Oct 29.

Sydney Nursing School, University of Sydney, Sydney, NSW, Australia; Emergency Department, Illawarra Shoalhaven, Australia.

Aims: To determine whether simulated multidisciplinary team training influences teamwork practices and experiences when resuscitating critically injured patients and to generate evidence for training trauma resuscitation flash teams.

Background: Trauma teams perform in stressful situations. They are 'flash' teams, mobilised quickly and comprise of different specialties and disciplines. Read More

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http://dx.doi.org/10.1016/j.auec.2018.10.002DOI Listing
November 2018

Implementation of guidelines for sepsis management in emergency departments: A systematic review.

Australas Emerg Care 2018 Nov 8;21(4):111-120. Epub 2018 Nov 8.

Deakin University Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Australia; Northern Health, Nursing, Epping, Melbourne, Vic., Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership Box Hill, Australia.

Introduction: Timely, evidence-based emergency care for sepsis saves lives. The primary aim of this systematic review was to examine the effect of implementation of guidelines for the ED management of sepsis on time to antibiotic administration. Secondary aims were to examine changes in evidence-based sepsis care and patient outcomes. Read More

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http://dx.doi.org/10.1016/j.auec.2018.10.003DOI Listing
November 2018

Do consumers who identify as Muslim experience culturally safe care (CSC) in the Emergency Department (ED)? A scoping review.

Australas Emerg Care 2018 Aug 1;21(3):93-98. Epub 2018 Sep 1.

School of Nursing, Midwifery and Paramedicine, Faculty of Health, University of Sunshine Coast, Maroochydore DC 4558, Queensland, Australia.

Lack of awareness about cultural and religious values and beliefs of patients presenting to Emergency Departments (ED) can compromise patient care and safety. Muslim Australians represent the fastest growing religious demographic group, with over a 77% growth in the last decade. The changing face of the Australian population requires that Australian health care carefully consider the dominant Western cultural paradigm currently influencing health care delivery. Read More

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http://dx.doi.org/10.1016/j.auec.2018.08.001DOI Listing

Incidence, characteristics and outcomes of patients that return to Emergency Departments. An integrative review.

Australas Emerg Care 2019 Mar 6;22(1):47-68. Epub 2019 Jan 6.

Susan Wakil School of Nursing, Midwifery, University of Sydney, Australia; Illawarra Shoalhaven Local Health District, NSW, Australia.

Background: Unplanned return visits account for up to 5% of Emergency Department presentations in Australia and have been associated with adverse events and increased costs. A large number of studies examine the incidence, characteristics and outcomes of unplanned return visits but few studies examine the reasons for return from a patient perspective. The objective of this integrative review was to determine the incidence, characteristics, outcomes and reasons for unplanned return visits to Emergency Departments. Read More

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http://dx.doi.org/10.1016/j.auec.2018.12.003DOI Listing

What we know about management and organisation of primary dental care in Brazil.

PLoS One 2019 18;14(4):e0215429. Epub 2019 Apr 18.

Department of Community and Preventive Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

This cross-sectional study evaluated the management and organisation of primary dental care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care (PMAQ-AB) were used. Dentists from 18,114 Oral Health Teams (OHTs) answered a structured questionnaire in 2014. Read More

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215429PLOS

Individual, clinical and system factors associated with the place of death: A linked national database study.

PLoS One 2019 18;14(4):e0215566. Epub 2019 Apr 18.

Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.

Background: Many middle- and high-income countries face the challenge of meeting preferences for home deaths. A better understanding of associated factors could support the design and implementation of policies and practices to enable dying at home. This study aims to identify factors associated with the place of death in Singapore, a country with a strong sense of filial piety. Read More

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215566PLOS

Risk factors for postoperative delirium in patients undergoing microvascular decompression.

PLoS One 2019 18;14(4):e0215374. Epub 2019 Apr 18.

Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu Province, People's Republic of China.

This study is to identify the risk factors for postoperative delirium (PODE) in patients undergoing microvascular decompression (MVD) for the treatment of primary cranial nerve disorders. We retrospectively reviewed the data of 912 patients (354 men, 558 women) with primary cranial nerve disorders (trigeminal neuralgia, 602 patients; hemifacial spasm, 296 patients; glossopharyngeal neuralgia, 14 patients) who underwent MVD in the Neurosurgery Department of Lanzhou University Second Hospital between July 2007 and June 2018. Potential risk factors for PODE were identified using univariate and multivariate stepwise logistic regression analysis. Read More

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215374PLOS
April 2019
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Increased Testing and Health Care Costs for Pediatric Cannabis Exposures.

Pediatr Emerg Care 2019 Apr 12. Epub 2019 Apr 12.

University of Colorado Anschutz Medical Campus, Aurora, CO.

Objectives: This study aimed to evaluate the process of identifying marijuana exposure in a children's hospital emergency department and compare the cost of diagnostic testing and procedures.

Methods: A retrospective chart review was performed on patients 31 days to 20 years old with a positive marijuana toxicology screen result between November 2009 and December 2014. Primary outcomes included time to provider recognition of marijuana exposure, number of diagnostic tests and procedures performed, and length of hospital stay. Read More

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http://dx.doi.org/10.1097/PEC.0000000000001811DOI Listing

What Is the Association Between Hospital Volume and Complications After Revision Total Joint Arthroplasty: A Large-database Study.

Clin Orthop Relat Res 2019 May;477(5):1221-1231

B. F. Ricciardi, A. Y. Liu, B. Qiu, T. G. Myers, C. P. Thirukumaran, Department of Orthopedic Surgery, University of Rochester School of Medicine, Rochester, NY, USA B. F. Ricciardi, C. P. Thirukumaran, Center for Musculoskeletal Research, Department of Orthopedic Surgery, University of Rochester School of Medicine, Rochester, NY, USA.

Background: Studies of primary total joint arthroplasty (TJA) show a correlation between hospital volume and outcomes; however, the relationship of volume to outcomes in revision TJA is not well studied.

Questions/purposes: We therefore asked: (1) Are 90-day readmissions more likely at low-volume hospitals relative to high-volume hospitals after revision THA and TKA? (2) Are in-hospital and 90-day complications more likely at low-volume hospitals relative to high-volume hospitals after revision THA and TKA? (3) Are 30-day mortality rates higher at low-volume hospitals relative to high-volume hospitals after revision THA and TKA?

Methods: Using 29,948 inpatient stays undergoing revision TJA from 2008 to 2014 in the Statewide Planning and Research Cooperative System (SPARCS) database for New York State, we examined the relationship of hospital revision volume by quartile and outcomes. The top 5 percentile of hospitals was included as a separate cohort. Read More

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http://dx.doi.org/10.1097/CORR.0000000000000684DOI Listing

Pathways to Independent Primary Care Clinical Practice: How Tall Is the Shortest Giant?

Acad Med 2019 Apr 16. Epub 2019 Apr 16.

M.J. Dewan is interim president and SUNY Distinguished Service Professor, Upstate Medical University, Syracuse, New York. J.J. Norcini is president and CEO, Foundation for the Advancement of International Medical Education and Research, Philadelphia, Pennsylvania.

Patients can be treated by a physician, a nurse practitioner (NP), or a physician assistant (PA) despite marked differences in the education and training for these three professions. This natural experiment allows examination of a critical question: what is the minimum education and training required to practice primary care? In other words, how tall is the shortest giant? State licensing requirements, not educational bodies, legislate minimum training. The current minimum is 6 years, which includes 27. Read More

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http://dx.doi.org/10.1097/ACM.0000000000002764DOI Listing

A Feasibility Study to Attribute Patients to Primary Interns on Inpatient Ward Teams Using Electronic Health Record Data.

Acad Med 2019 Apr 16. Epub 2019 Apr 16.

D.J. Schumacher is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio. D.T.Y. Wu is assistant professor of biomedical informatics and pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. K. Meganathan is senior clinical data analyst, Center for Health Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio. L. Li is research associate, Center for Health Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio. B. Kinnear is assistant professor of pediatrics and internal medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio. D.R. Sall is assistant professor of internal medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio. E. Holmboe is senior vice president for milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. C. Carraccio is vice president of competency-based assessment, American Board of Pediatrics, Chapel Hill, North Carolina. C. van der Vleuten is professor of education, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences; and scientific director, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands. J. Busari is consultant pediatrician and associate professor of medical education, Maastricht University, Maastricht, The Netherlands. M. Kelleher is assistant professor of pediatrics and internal medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio. D. Schauer is associate professor of internal medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio. E. Warm is professor of medicine and internal medicine program director, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Purpose: To inform graduate medical education (GME) outcomes at the individual resident level, this study sought a method for attributing care for individual patients to individual interns based on "footprints" in the electronic health record (EHR).

Method: Primary interns caring for patients on an internal medicine inpatient service were recorded daily by five attending physicians of record at University of Cincinnati Medical Center in August 2017 and January 2018. These records were considered gold standard identification of primary interns. Read More

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http://dx.doi.org/10.1097/ACM.0000000000002748DOI Listing

What Can the Giant Do? Defining the Path to Unsupervised Primary Care Practice by Competence, Not Time.

Acad Med 2019 Apr 16. Epub 2019 Apr 16.

E. Warm is professor of medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID https://orcid.org/0000-0002-6088-2434. B. Kinnear is assistant professor of medicine and pediatrics, and associate program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID https://orcid.org/0000-0003-0052-4130.

In this issue of Academic Medicine, Dewan and Norcini examine the significant variability of time-in-training between patient care "giants"-the physicians, nurse practitioners, and physician assistants who practice primary care-and they call for further studies to determine optimal training duration and eventual scope of practice. They ask, what is the minimum education and training required to practice primary care, or "how tall is the shortest giant?"In this Invited Commentary, the authors reframe the question from identifying the minimum length of training required, to identifying desired patient care outcomes. Primary care is not a uniform entity. Read More

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http://dx.doi.org/10.1097/ACM.0000000000002753DOI Listing

Selection or education? Medical school ranking and medical students' speciality choice preferences in the United States.

Educ Prim Care 2019 Apr 18:1-10. Epub 2019 Apr 18.

a Department of Healthcare Policy and Research , Weill Cornell Medical College, Cornell University , New York , NY , USA.

Limited research exists on the influence of top-ranked medical schools on students' speciality choice. We surveyed medical students (n = 468) at eight medical schools in the United States including two ranked in the top 10. Significance tests and logistic regressions were used to determine the relationship between school ranking and preferences for various speciality attributes. Read More

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http://dx.doi.org/10.1080/14739879.2019.1603083DOI Listing

The Efficacy of Vitamin C in the Prevention of Complex Regional Pain Syndrome After Distal Radius Fractures: A Synthesis.

J Pain Palliat Care Pharmacother 2019 Apr 18:1-4. Epub 2019 Apr 18.

The current recommendation is to use daily doses of vitamin C to prevent the occurrence of the complex regional pain syndrome (CRPS) following a distal radius fracture. The study is a synthesis of the four primary studies that examine this issue. These studies have been previously examined in the meta-analysis literature. Read More

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http://dx.doi.org/10.1080/15360288.2019.1598530DOI Listing

Effect of Text Messaging on Risk Factor Management in Patients With Coronary Heart Disease.

Circ Cardiovasc Qual Outcomes 2019 Apr;12(4):e005616

Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (E.S.S., Q.D., H.M.K.).

Background: Mobile health technologies are low cost, scalable interventions with the potential to promote patient engagement and behavior change. We aimed to test whether a culturally sensitive text messaging intervention supporting secondary prevention improves the control of risk factors in patients with coronary heart disease in China.

Methods And Results: In this multicenter, single-blinded randomized controlled trial, 822 patients (mean age, 56. Read More

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http://dx.doi.org/10.1161/CIRCOUTCOMES.119.005616DOI Listing

The influence of delay elimination communication on the prevalence of primary nocturnal enuresis-a survey from Mainland China.

Neurourol Urodyn 2019 Apr 18. Epub 2019 Apr 18.

Pediatric Urodynamic Centre, Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Aims: A pilot survey shows that primary nocturnal enuresis (PNE) prevalence has increased significantly during the past decade in Mainland China. Whether it is related to the delay of elimination communication (EC) is unclear. This study retrospectively investigated the influence of delayed EC on the PNE prevalence in children and adolescents in mainland China. Read More

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http://dx.doi.org/10.1002/nau.24002DOI Listing
April 2019
2.873 Impact Factor

Effectiveness of Low Glycemic Index Diet Consultations Through a Diet Glycemic Assessment App Tool on Maternal and Neonatal Insulin Resistance: A Randomized Controlled Trial.

JMIR Mhealth Uhealth 2019 Apr 18;7(4):e12081. Epub 2019 Apr 18.

Children's Hospital of Fudan University, Shanghai, China.

Background: Low glycemic index (LGI) diet has shown to be effective in reducing maternal and neonatal complications in high-risk pregnancies.

Objective: This trial aimed to examine the effectiveness of individualized LGI diet consultations based on the accurate diet glycemic load (GL) assessment tool on maternal and neonatal insulin resistance levels and diet behavior changes in overweight and obese pregnant women.

Methods: Overweight and obese pregnant women were recruited before 16 weeks of gestation and randomized to the LGI diet arm or the control arm. Read More

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http://dx.doi.org/10.2196/12081DOI Listing

Implementing Web-Based Interventions in HIV Primary Care Clinics: Pilot Implementation Evaluation of Positive Health Check.

JMIR Form Res 2019 Apr 18;3(2):e10688. Epub 2019 Apr 18.

Center for Communication Science, RTI International, Durham, NC, United States.

Background: Web-based interventions can help people living with HIV achieve better clinical outcomes and behaviors, but integrating them into clinical practice remains challenging. There is a gap in understanding the feasibility of implementing these interventions in HIV clinic settings from the clinicians' perspective.

Objective: The goal of the research was to determine whether Positive Health Check (PHC)-a Web-based, tailored video counseling tool focused on increasing patient adherence and retention in care and reducing HIV risk among HIV-positive patients-was acceptable, appropriate, and feasible for HIV primary care clinic staff to implement in clinic workflows. Read More

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http://dx.doi.org/10.2196/10688DOI Listing

Correlates and predictors of mental health care utilization for veterans with PTSD: A systematic review.

Psychol Trauma 2019 Apr 18. Epub 2019 Apr 18.

VA Center for Integrated Healthcare.

Objective: Treatment utilization among veterans with posttraumatic stress disorder (PTSD) is low. Understanding correlates and predictors of mental health care for veterans with PTSD is critical to facilitating treatment utilization. However, given the size of the literature base and disparate findings, it is difficult to interpret available research. Read More

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http://dx.doi.org/10.1037/tra0000461DOI Listing

Turk J Med Sci 2019 Apr 18;49(2):610-616. Epub 2019 Apr 18.

Background/aim: The aim of this study is to present the results of modified combined decongestive therapy (CDT) in patients with lower extremity lymphedema (LEL).

Materials And Methods: We retrospectively reviewed 95 patients aged 55.84 ± 15. Read More

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http://dx.doi.org/10.3906/sag-1809-25DOI Listing

SGLT2 inhibition to address the unmet needs in diabetic nephropathy.

Diabetes Metab Res Rev 2019 Apr 18:e3171. Epub 2019 Apr 18.

Department of Medical Sciences, University of Turin, Turin, Italy.

Current treatment of diabetic nephropathy is effective; however, substantial gaps in care still remain and new therapies are urgently needed to reduce the global burden of the complication. Desirable properties of an "ideal" new drug should include: primary prevention of microalbuminuria, additive/synergistic anti-proteinuric effect in combination therapy with renin angiotensin system blockers, reduction of chronic kidney disease progression to lower the risk of end-stage renal disease, and cardiovascular protection. Growing evidence suggests that sodium-glucose cotransporter 2 inhibitors (SGLT2i) may fulfill many of these criteria and represent novel tools to cover the unmet needs in diabetic nephropathy care. Read More

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https://onlinelibrary.wiley.com/doi/abs/10.1002/dmrr.3171
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http://dx.doi.org/10.1002/dmrr.3171DOI Listing
April 2019
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Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation.

Cochrane Database Syst Rev 2019 Apr 18;4:CD013308. Epub 2019 Apr 18.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, Oxfordshire, UK, OX2 6GG.

Background: Nicotine replacement therapy (NRT) aims to replace nicotine from cigarettes to ease the transition from cigarette smoking to abstinence. It works by reducing the intensity of craving and withdrawal symptoms. Although there is clear evidence that NRT used after smoking cessation is effective, it is unclear whether higher doses, longer durations of treatment, or using NRT before cessation add to its effectiveness. Read More

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http://dx.doi.org/10.1002/14651858.CD013308DOI Listing

Evaluation of appropriate use of bisphosphonates and denosumab in patients with cancer.

J Oncol Pharm Pract 2019 Apr 18:1078155219842277. Epub 2019 Apr 18.

1 Pharmacy Department, Indianapolis VA Medical Center, Indianapolis, USA.

Background: National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. Read More

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http://dx.doi.org/10.1177/1078155219842277DOI Listing

Later Life Care Planning and Concerns of Transgender Older Adults in Canada.

Int J Aging Hum Dev 2019 Apr 18:91415019843520. Epub 2019 Apr 18.

3 San Francisco State University, CA, USA.

While the particular health-care concerns of transgender people have been documented and transgender aging is an emerging area of scholarship, little is known about planning for later and end-of-life care among transgender older adults. As part of a larger project, focus groups and interviews were conducted with 24 transgender older adults (average age 70 years) living in five cities in Canada exploring their concerns and explicit plans for later life care. Three primary themes emerged: (a) "dealing with the day-to-day" reflecting economic precarity and transitioning in later life, (b) fractures and support within family and community, and (c) "there's a huge gap between principle and practice" reflecting mixed experiences and perceptions of health-care services. Read More

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http://dx.doi.org/10.1177/0091415019843520DOI Listing

Beyond checkboxes: A qualitative assessment of physicians' experiences providing care in a patient-centred medical home.

J Eval Clin Pract 2019 Apr 17. Epub 2019 Apr 17.

Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.

Rationale, Aims, And Objectives: The patient-centred medical home (PCMH) is an innovative approach to health care reform. Despite a well-established process for recognizing PCMH practices, fidelity to, and/or adaptation of, the PCMH model can limit health care and population health improvements. This study explored the connection between fidelity/adaptation to the PCMH model with implementation successes and challenges through the experiences of family and internal medicine PCMH physicians. Read More

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http://dx.doi.org/10.1111/jep.13136DOI Listing

The effect of risk communication on periodontal treatment outcomes: A randomized controlled trial.

J Periodontol 2019 Apr 17. Epub 2019 Apr 17.

Dental Institute, King's College London, London, United Kingdom of Great Britain and Northern Ireland.

Background: This study determines the effects of a routine assessment (Treatment as Usual, TAU) versus a risk communication intervention (Risk) versus a Goal-Setting, Planning and Self-Monitoring (GPS) intervention on periodontal disease patients' clinical and psychological outcomes.

Methods: In a three-arm randomized controlled trial (RCT; registration: ISRCTN59696243) adults (N = 97) judged to have moderate oral hygiene attended a primary dental care setting for a standard consultation. Intervention participants received an individualized calculation of their periodontal disease risk using only the Previser Risk Calculator (Risk group) or supplemented with a GPS-behavioral intervention (GPS group). Read More

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http://dx.doi.org/10.1002/JPER.18-0385DOI Listing

Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years.

Intensive Care Med 2019 Apr 17. Epub 2019 Apr 17.

Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Background: Prospective randomized controlled studies have demonstrated that addition of chlorhexidine (CHG) dressings reduces the rate of catheter (central venous and arterial)-associated bloodstream infections (CABSIs). However, studies confirming their impact in a real-world setting are lacking.

Methods: We conducted a real-world data study evaluating the impact of incrementally introducing chlorhexidine dressings (sponge or gel) in addition to an ongoing catheter bundle on the rates of CABSI, expressed as incidence density rates per 1000 catheter-days measured as part of a surveillance program. Read More

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http://dx.doi.org/10.1007/s00134-019-05617-xDOI Listing

Developmental delay: identification and management at primary care level.

Singapore Med J 2019 Mar;60(3):119-123

Department of Paediatrics, Child Developmental Service, KK Women's and Children's Hospital, Singapore.

Developmental delays are common in childhood, occurring in 10%-15% of preschool children. Global developmental delays are less common, occurring in 1%-3% of preschool children. Developmental delays are identified during routine checks by the primary care physician or when the parent or preschool raises concerns. Read More

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http://dx.doi.org/10.11622/smedj.2019025DOI Listing

Changes in plasma phospholipid fatty acid profiles over 13 years and correlates of change: European Prospective Investigation into Cancer and Nutrition-Norfolk Study.

Am J Clin Nutr 2019 Apr 17. Epub 2019 Apr 17.

MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.

Background: Little is known about changes in blood fatty acid compositions over time and the correlates of any changes in a general population.

Objective: The aim of this study was to estimate changes in 27 individual plasma phospholipid fatty acids and fatty acid groups over time, and to identify potential correlates of these changes.

Methods: Plasma phospholipid fatty acids were profiled at 3 time-points (1993-1997, 1998-2000, 2004-2011) among 722 participants in the European Prospective Investigation into Cancer and Nutrition-Norfolk Study, UK. Read More

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http://dx.doi.org/10.1093/ajcn/nqz030DOI Listing

A provider feedback intervention to increase uptake of colorectal cancer screening in a Swiss academic general practice.

BMJ Open Qual 2019 3;8(1):e000452. Epub 2019 Mar 3.

Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.

Colorectal cancer (CRC) cancer screening uptake is low in our diverse, outpatient teaching clinic. A state-level public screening programme was recently launched that provides faecal immunochemical tests or screening colonoscopy to all citizens aged 50-69 years via mailed invitations, with the possibility of earlier, opportunistic inclusion. Mailed outreach is expected to be rolled out over the next 5 years. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440588PMC

Contribution of adverse events to death of hospitalised patients.

BMJ Open Qual 2019 13;8(1):e000377. Epub 2019 Feb 13.

Department of Community Medicine, University of Tromsø, Tromsø, Norway.

Background: There is no standardised method to investigate death as a patient safety indicator and we need valid and reliable measurements to use adverse events contributing to death as a quality measure.

Objective: To investigate the contribution of severe adverse events to death in hospitalised patients and clarify methodological differences using the Global Trigger Tool method on all inpatient deaths compared with a sample of general hospitalised patients.

Method: Retrospective records reviewing using the Global Trigger Tool method. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2018-000377
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http://dx.doi.org/10.1136/bmjoq-2018-000377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440591PMC
February 2019
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Using lean thinking to improve hypertension in a community health centre: a quality improvement report.

BMJ Open Qual 2019 8;8(1):e000373. Epub 2019 Feb 8.

Lynn Community Health Center, Lynn, Massachusetts, USA.

Background: Achieving better care at lower cost in the US healthcare safety net will require federally qualified health centres (FQHC) to implement new models of team-based population healthcare. Lean thinking may offer a way to reduce the financial risk of practice transformation while increasing the likelihood of sustained improvement.

Objective: To demonstrate system-level improvement in hypertension control in a large FQHC through the situational use of lean thinking and statistical process control. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440610PMC
February 2019

Reducing inappropriate outpatient antibiotic prescribing: normative comparison using unblinded provider reports.

BMJ Open Qual 2019 13;8(1):e000351. Epub 2019 Feb 13.

Center for Healthcare Innovation, Ochsner Health System, New Orleans, Louisiana, USA.

Importance: Antibiotic resistance is a global health issue. Up to 50% of antibiotics are inappropriately prescribed, the majority of which are for acute respiratory tract infections (ARTI).

Objective: To evaluate the impact of unblinded normative comparison on rates of inappropriate antibiotic prescribing for ARTI. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440589PMC
February 2019

Optimising laboratory monitoring of chronic conditions in primary care: a quality improvement framework.

BMJ Open Qual 2019 29;8(1):e000349. Epub 2019 Mar 29.

Northern Devon Healthcare NHS Trust, Barnstaple, UK.

Monitoring of chronic conditions accounts for a significant proportion of blood testing in UK primary care; not all of this is based on evidence or guidelines. National benchmarking shows significant variation in testing rates for common blood tests. This project set out to standardise the blood tests used for monitoring of chronic conditions in primary care across North Devon, and to measure and reduce the harms of unwarranted testing. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440689PMC

Prevalence and causes of childhood blindness in Huidong County, South China, primary ascertained by the key informants.

BMJ Open Ophthalmol 2019 27;4(1):e000240. Epub 2019 Feb 27.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou City, China.

Purpose: The aim of this study is to ascertain the prevalence and causes of childhood blindness and severe visual impairment (BL/SVI) in Huidong, South China.

Methods: This cross-sectional study was conducted in early 2017 in areas of 139 816 children at the age of 0-15 as the study subjects. We used the trained key informants (KIs) to do preliminary visual test in the communities and refer those children suspected with blindness or unable to count fingers with both eyes at 5 m to hospital for further examination by paediatric ophthalmologist for causes. Read More

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http://dx.doi.org/10.1136/bmjophth-2018-000240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440593PMC
February 2019

Patient and clinician engagement with health information in the primary care waiting room: A mixed methods case study.

J Public Health Res 2019 Mar 11;8(1):1476. Epub 2019 Mar 11.

University of Melbourne, Australia.

Primary care waiting rooms can be sites of health promotion and health literacy development through the provision of readily accessible health information. To date, few studies have considered patient engagement with televised health messages in the waiting room, nor have studies investigated whether patients ask their clinicians about this information. The aim of this study was therefore to examine patient (or accompanying person) and clinician engagement with waiting room health information, including televised health messages. Read More

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http://dx.doi.org/10.4081/jphr.2019.1476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444378PMC

Immunisation financing and programme performance in the Middle East and North Africa, 2010 to 2017.

BMJ Glob Health 2019 30;4(2):e001248. Epub 2019 Mar 30.

United Nations Children's Fund, Regional Office for the Middle East and North Africa, Amman, Jordan.

Immunisation is a cornerstone to primary health care and is an exceptionally good value. The 14 low-income and middle-income countries in the Middle East and North Africa region make up 88% of the region's population and 92% of its births. Many of these countries have maintained high immunisation coverage even during periods of low or negative economic growth. Read More

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http://gh.bmj.com/lookup/doi/10.1136/bmjgh-2018-001248
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http://dx.doi.org/10.1136/bmjgh-2018-001248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441300PMC
March 2019
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How and why front-line health workers (did not) use a multifaceted mHealth intervention to support maternal and neonatal healthcare decision-making in Ghana.

BMJ Glob Health 2019 8;4(2):e001153. Epub 2019 Mar 8.

Ghana Health Service, Research and Development Division, Dodowa Research Centre, Accra, Ghana.

Introduction: Despite increasing use of mHealth interventions, there remains limited documentation of 'how and why' they are used and therefore the explanatory mechanisms behind observed effects on beneficiary health outcomes. We explored 'how and why' an mHealth intervention to support clinical decision-making by front-line providers of maternal and neonatal healthcare services in a low-resource setting was used. The intervention consisted of phone calls (voice calls), text messaging (short messaging service (SMS)), internet access (data) and access to emergency obstetric and neonatal protocols via an Unstructured Supplementary Service Data (USSD). Read More

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http://dx.doi.org/10.1136/bmjgh-2018-001153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441261PMC

A novel behavioural INTErvention to REduce Sitting Time in older adults undergoing orthopaedic surgery (INTEREST): protocol for a randomised controlled feasibility study.

Pilot Feasibility Stud 2019 6;5:54. Epub 2019 Apr 6.

1School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT UK.

Background: Osteoarthritis is a highly prevalent condition in older adults, that causes many sufferers to require a hip or knee replacement in order to improve their quality of life and reduce pain. Individuals waiting for hip or knee replacements are often highly sedentary; thus, it is pertinent to assess whether reducing their sedentariness prior to surgery may aid in improving post-operative outcomes.

Methods/design: The study will be a randomised controlled feasibility trial design, with 2:1 randomisation into an intervention and usual care group respectively. Read More

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http://dx.doi.org/10.1186/s40814-019-0437-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451782PMC

Correlation between ultrasonic and radiographic imaging of developmental dysplasia of the hip.

J Child Orthop 2019 Apr;13(2):155-160

Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands.

Purpose: The correlation between the degree of developmental hip dysplasia (DDH) measured on ultrasound images compared with that measured on radiographs is not clear. Most studies have compared ultrasonography (US) and radiographic images made at different times of follow-up. In this study the correlation between US images and radiographs of the hip made on the same day was evaluated. Read More

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http://dx.doi.org/10.1302/1863-2548.13.180165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442507PMC

Feeling safe or unsafe in psychiatric inpatient care, a hospital-based qualitative interview study with inpatients in Sweden.

Int J Ment Health Syst 2019 8;13:23. Epub 2019 Apr 8.

1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

Background: A major challenge in psychiatric inpatient care is to create an environment that promotes patient recovery, patient safety and good working environment for staff. Since guidelines and programs addressing this issue stress the importance of primary prevention in creating safe environments, more insight is needed regarding patient perceptions of feeling safe. The aim of this study is to enhance our understanding of feelings of being safe or unsafe in psychiatric inpatient care. Read More

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http://dx.doi.org/10.1186/s13033-019-0282-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6452515PMC

Visual Function Questionnaire as an outcome measure for homonymous hemianopia: subscales and supplementary questions, analysis from the VISION trial.

Eye (Lond) 2019 Apr 17. Epub 2019 Apr 17.

Division of Health and Social Care, King's College, London, WC2B 5RL, UK.

Background: We conduct supplementary analyses of the NEI VFQ-25 data to evaluate where changes occurred within subscales of the NEI VFQ-25 leading to change in the composite scores between the three treatment arms, and evaluate the NEI VFQ-25 with and without the Neuro 10 supplement.

Methods: A prospective, multicentre, parallel, single-blind, three-arm RCT of fourteen UK acute stroke units was conducted. Stroke survivors with homonymous hemianopia were recruited. Read More

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http://dx.doi.org/10.1038/s41433-019-0441-zDOI Listing

Preventive Effect of Oral Self-Care on Pneumonia Death among the Elderly with Tooth Loss: The Ohsaki Cohort 2006 Study.

Tohoku J Exp Med 2019 04;247(4):251-257

Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine.

Tooth loss is a risk factor for pneumonia mortality, but it is unclear whether oral care negates excess mortality due to pneumonia among community-dwelling elderly with tooth loss. The purpose of this study was to examine the influence of oral care on the association between the number of remaining teeth and the risk of pneumonia death. We analyzed for 18,098 individuals (aged ≥ 65 years) participating in a prospective cohort study. Read More

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http://dx.doi.org/10.1620/tjem.247.251DOI Listing

Protease-independent action of tissue plasminogen activator in brain plasticity and neurological recovery after ischemic stroke.

Proc Natl Acad Sci U S A 2019 Apr 17. Epub 2019 Apr 17.

Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh, Pittsburgh, PA 15213;

Emerging evidence suggests that tissue plasminogen activator (tPA), currently the only FDA-approved medication for ischemic stroke, exerts important biological actions on the CNS besides its well-known thrombolytic effect. In this study, we investigated the role of tPA on primary neurons in culture and on brain recovery and plasticity after ischemic stroke in mice. Treatment with recombinant tPA stimulated axonal growth in culture, an effect independent of its protease activity and achieved through epidermal growth factor receptor (EGFR) signaling. Read More

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http://dx.doi.org/10.1073/pnas.1821979116DOI Listing

Filamentous bacteriophages are associated with chronic lung infections and antibiotic resistance in cystic fibrosis.

Sci Transl Med 2019 Apr;11(488)

Center for Excellence in Pulmonary Biology, Department of Pediatrics, Stanford University, Stanford, CA 94305, USA.

Filamentous bacteriophage (Pf phage) contribute to the virulence of infections in animal models, but their relevance to human disease is unclear. We sought to interrogate the prevalence and clinical relevance of Pf phage in patients with cystic fibrosis (CF) using sputum samples from two well-characterized patient cohorts. Bacterial genomic analysis in a Danish longitudinal cohort of 34 patients with CF revealed that 26. Read More

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http://dx.doi.org/10.1126/scitranslmed.aau9748DOI Listing