162,578 results match your criteria Primary Health Care Research & Development[Journal]


Lung Cancer App (LuCApp) study protocol: a randomised controlled trial to evaluate a mobile supportive care app for patients with metastatic lung cancer.

BMJ Open 2019 Feb 15;9(2):e025483. Epub 2019 Feb 15.

Centre for Research in Health and Social Care Management (CERGAS), SDA Bocconi, Milano, Italy.

Introduction: Mobile health technologies may enhance patient empowerment and data integration along the whole care continuum. However, these interventions pose relatively new regulatory, organisational and technological challenges that limit appropriate evaluation. Lung Cancer App (LuCApp) is a mobile application developed by researchers and clinicians to promote real-time monitoring and management of patients' symptoms. Read More

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http://dx.doi.org/10.1136/bmjopen-2018-025483DOI Listing
February 2019

Therapist-guided and parent-guided internet-delivered behaviour therapy for paediatric Tourette's disorder: a pilot randomised controlled trial with long-term follow-up.

BMJ Open 2019 Feb 15;9(2):e024685. Epub 2019 Feb 15.

Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Objective: Behaviour therapy (BT) for Tourette's disorder (TD) and persistent (chronic) motor or vocal tic disorder (PTD) is rarely available. We evaluated the feasibility of adapting two existing BT protocols for TD/PTD (habit reversal training (HRT) and exposure and response prevention (ERP)) into a therapist-guided and parent-guided online self-help format.

Design: A pilot, single-blind, parallel group randomised controlled trial. Read More

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http://dx.doi.org/10.1136/bmjopen-2018-024685DOI Listing
February 2019

Using specialist screening practitioners (SSPs) to increase uptake of bowel scope (flexible sigmoidoscopy) screening: results of a feasibility single-stage phase II randomised trial.

BMJ Open 2019 Feb 15;9(2):e023801. Epub 2019 Feb 15.

Research Department of Behavioural Science and Health, University College London, London, UK.

Objective: To determine the feasibility of specialist screening practitioners (SSPs) offering patient navigation (PN) to facilitate uptake of bowel scope screening (BSS) among patients who do not confirm or attend their appointment.

Design: A single-stage phase II trial.

Setting: South Tyneside District Hospital, Tyne and Wear, England, UK. Read More

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http://dx.doi.org/10.1136/bmjopen-2018-023801DOI Listing
February 2019

PROFIT, a PROspective, randomised placebo controlled feasibility trial of Faecal mIcrobiota Transplantation in cirrhosis: study protocol for a single-blinded trial.

BMJ Open 2019 Feb 15;9(2):e023518. Epub 2019 Feb 15.

James Black Centre, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.

Introduction: Patients with advanced cirrhosis have enteric bacterial dysbiosis and translocation of bacteria and their products across the gut epithelial barrier. This culminates in systemic inflammation and endotoxaemia, inducing innate immune dysfunction which predisposes to infection, and development of complications such as bleeding, sepsis and hepatic encephalopathy. This feasibility study aims to assess the safety of administering faecal microbiota transplantion to patients with cirrhosis and explore the effect of the intervention on their prognosis by achieving restoration of a healthy gut microbiome. Read More

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http://dx.doi.org/10.1136/bmjopen-2018-023518DOI Listing
February 2019

Can differences in length of stay between Dutch university hospitals and other hospitals be explained by patient characteristics? A cross-sectional study.

BMJ Open 2019 Feb 15;9(2):e021851. Epub 2019 Feb 15.

Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.

Objectives: The indicator unexpectedly long length of stay (UL-LOS) is used to gain insight into quality and safety of care in hospitals. The calculation of UL-LOS takes patients' age, main diagnosis and main procedure into account. University hospitals have relatively more patients with a UL-LOS than other hospitals. Read More

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http://dx.doi.org/10.1136/bmjopen-2018-021851DOI Listing
February 2019

Conversion of other opioids to methadone: a retrospective comparison of two methods.

BMJ Support Palliat Care 2019 Feb 16. Epub 2019 Feb 16.

Department of Supportive and Palliative Care, Mater Health Services, Brisbane, Queensland, Australia

Context: A rapid method of methadone conversion known as the Perth Protocol is commonly used in Australian palliative care units. There has been no follow-up or validation of this method and no comparison between different methods of conversion.

Objectives: The primary objective of this study was to test the hypothesis that the achieved doses of methadone are independent of the conversion method (rapid vs slower). Read More

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http://dx.doi.org/10.1136/bmjspcare-2018-001645DOI Listing
February 2019

Risk assessment scales to predict risk of hospital treated repeat self-harm: A cost-effectiveness modelling analysis.

J Affect Disord 2019 Feb 11;249:208-215. Epub 2019 Feb 11.

Centre for Mental Health and Safety and Greater Manchester Patient Safety Translational Research Centre, United Kingdom; Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building Oxford Road, Manchester M13 9PL, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.

Background: Risk scales are used widely for assessing individuals presenting to Emergency Departments (EDs) following self-harm. There is growing evidence that risk scales have limited clinical utility in identifying episodes at highest risk of repeat self-harm. However, their cost-effectiveness in terms of treatment allocation and subsequent repeat self-harm is unknown. Read More

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http://dx.doi.org/10.1016/j.jad.2019.02.036DOI Listing
February 2019

Procalcitonin-Guided Antibiotic Discontinuation and Mortality in Critically Ill Adults: A Systematic Review and Meta-Analysis.

Chest 2019 Feb 14. Epub 2019 Feb 14.

Critical Care Medicine Department, National Institutes of Health, Bethesda, MD 20892.

Background: Procalcitonin (PCT)-guided antibiotic discontinuation appears to decrease antibiotic use in critically ill patients, but its impact on survival remains less certain.

Methods: We searched PubMed, EMBASE, Scopus, Web of Science, and CENTRAL for RCTs of PCT-guided antibiotic discontinuation in critically ill adults reporting survival or antibiotic duration. Searches were conducted without language restrictions from inception to 07/23/2018. Read More

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http://dx.doi.org/10.1016/j.chest.2018.12.029DOI Listing
February 2019

General and abdominal adiposity and the risk of Parkinson's disease: A prospective cohort study.

Parkinsonism Relat Disord 2019 Feb 8. Epub 2019 Feb 8.

Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Germany. Electronic address:

Introduction: Due to demographic change, an increase in the frequency of Parkinson's disease (PD) patients is expected in the future and, thus, the identification of modifiable risk factors is urgently needed. We aimed to examine the associations of body mass index (BMI) and waist circumference (WC) with incident PD.

Methods: In 13 of the 23 centers of the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a total of 734 incident cases of PD were identified between 1992 and 2012 with a mean follow-up of 12 years. Read More

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http://dx.doi.org/10.1016/j.parkreldis.2019.01.019DOI Listing
February 2019

A call for better doctor-nurse collaboration: A qualitative study of the experiences of junior doctors and nurses in escalating care for deteriorating ward patients.

Aust Crit Care 2019 Feb 13. Epub 2019 Feb 13.

Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 2,10 Medical Drive, Singapore 117597.

Background: Despite the widespread implementation of medical emergency teams (METs) in hospitals to provide immediate interventions to deteriorating ward patients, little is known about how junior doctors and nurses escalate care for deteriorating ward patients in hospitals with established MET services.

Objectives: The objective of this research study was to explore the experiences of junior doctors and nurses in escalating care for clinically deteriorating patients in general wards.

Methods: Twenty-four individual interviews were conducted with 10 junior doctors and 14 registered nurses of a 1000-bed acute general hospital with the most established MET service in Singapore. Read More

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http://dx.doi.org/10.1016/j.aucc.2019.01.006DOI Listing
February 2019

A randomized, double-blind, placebo-controlled trial to assess the efficAcy and safety of Trimetazidine in patients with angina pectoris having been treated by percutaneous coronary intervention (ATPCI study): Rationale, design, and baseline characteristics.

Am Heart J 2019 Jan 15;210:98-107. Epub 2019 Jan 15.

Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France; INSERM U-970, Paris, France.

Background: About 30% of angina patients have persisting symptoms despite successful revascularization and antianginal therapy. Moreover, in stable patients, percutaneous coronary intervention (PCI) does not improve survival as compared with medical therapy alone. Trimetazidine, an antianginal agent devoid of hemodynamic effect, may help reducing symptoms and improving outcomes after PCI. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00028703193000
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http://dx.doi.org/10.1016/j.ahj.2018.12.015DOI Listing
January 2019
2 Reads

Improving child weight management uptake through enhanced National Child Measurement Programme parental feedback letters: A randomised controlled trial.

Prev Med 2019 Feb 13. Epub 2019 Feb 13.

PHE Behavioural Insights Team (PHE BI), Research, Translation & Innovation Division, 6th Floor, Wellington House, 133-155 Waterloo Road, London SE1 8UG, United Kingdom of Great Britain and Northern Ireland.

This single-blind, pragmatic, cluster randomised controlled trial aims to investigate uptake of children's weight management services in response to enhanced National Child Measurement Programme (NCMP) letters providing weight status feedback to parents in three English counties in 2015. Parents of 2642 overweight or very overweight (obese) children aged 10-11 years received an intervention or control letter informing them of their child's weight status. Intervention letters included (i) a visual tool to help weight status recognition, (ii) a social norms statement, and for very overweight children, (iii) a prepopulated booking form for weight management services. Read More

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http://dx.doi.org/10.1016/j.ypmed.2019.01.023DOI Listing
February 2019

Mediterranean diet adherence and risk of esophageal and gastric cancer subtypes in the Netherlands Cohort Study.

Gastric Cancer 2019 Feb 15. Epub 2019 Feb 15.

Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.

Background: Mediterranean diet (MD) adherence has been associated with reduced risks of esophageal and gastric cancer (subtypes) in a limited number of studies. We prospectively investigated associations between MD adherence and risks of esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC), gastric cardia adenocarcinoma (GCA), and gastric non-cardia adenocarcinoma (GNCA) in a Dutch cohort.

Methods: Analyses were conducted using data from the 120852 participants of the Netherlands Cohort Study (NLCS), who were aged between 55 and 69 years at enrollment. Read More

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http://dx.doi.org/10.1007/s10120-019-00927-xDOI Listing
February 2019

Adverse Events from Emollient Use in Eczema: A Restricted Review of Published Data.

Dermatol Ther (Heidelb) 2019 Feb 15. Epub 2019 Feb 15.

Population Health Sciences, University of Bristol, Bristol, UK.

Atopic dermatitis/eczema is a chronic inflammatory skin condition, and emollients are the first-line treatment. Despite their widespread use, there is uncertainty about the frequency and type of adverse events associated with different emollients. We conducted a restricted review of published data on adverse events associated with emollient use in eczema. Read More

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http://dx.doi.org/10.1007/s13555-019-0284-3DOI Listing
February 2019

Validation of a health screening questionnaire for primary care using Rasch models.

J Patient Rep Outcomes 2019 Feb 15;3(1):12. Epub 2019 Feb 15.

Centre of Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark.

Background: Health inequality is on the rise due to various social and individual factors. While preventive health checks (PHC) aim to counteract health inequality, there is robust evidence against the use of PHC in general practice. It is unknown which factors can identify persons who will benefit from preventive interventions that are more beneficial than harmful. Read More

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http://dx.doi.org/10.1186/s41687-019-0104-7DOI Listing
February 2019

The impact of improved water, sanitation and hygiene on oral rotavirus vaccine immunogenicity in Zimbabwean infants: sub-study of a cluster-randomized trial.

Clin Infect Dis 2019 Feb 16. Epub 2019 Feb 16.

Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.

Background: Oral vaccines have lower efficacy in developing compared to developed countries. Poor water, sanitation and hygiene (WASH) may contribute to reduced oral vaccine immunogenicity.

Methods: We conducted a cluster-randomized 2x2 factorial trial in rural Zimbabwe (NCT01824940). Read More

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https://academic.oup.com/cid/advance-article/doi/10.1093/cid
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http://dx.doi.org/10.1093/cid/ciz140DOI Listing
February 2019
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A Telehealth-Enhanced Referral Process in Pediatric Primary Care: A Cluster Randomized Trial.

Pediatrics 2019 Feb 15. Epub 2019 Feb 15.

Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California.

: media-1vid110.1542/5984243450001PEDS-VA_2018-2738 OBJECTIVES: To improve the mental health (MH) referral process for children referred from primary care to community mental health clinics (CMHCs) by using a community-partnered approach.

Methods: Our partners were a multisite federally qualified health center and 2 CMHCs in Los Angeles County. Read More

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http://dx.doi.org/10.1542/peds.2018-2738DOI Listing
February 2019

Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: confirmation between eye screening and comprehensive eye examination diagnoses.

Br J Ophthalmol 2019 Feb 15. Epub 2019 Feb 15.

Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.

Aims: To evaluate agreement between ocular findings of a telemedicine eye screening (visit 1) with diagnoses of a comprehensive eye examination (visit 2).

Methods: A primary care practice (PCP)-based telemedicine screening programme incorporating fundus photography, intraocular pressure (IOP) and clinical information was conducted. Eligible individuals were African American, Hispanic/Latino or Asian over the age of 40; Caucasian individuals over age 65; and adults of any ethnicity over age 40 with a family history of glaucoma or diabetes. Read More

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http://dx.doi.org/10.1136/bjophthalmol-2018-313451DOI Listing
February 2019

Neuropsychiatric symptoms in Tanzanian HIV-infected children receiving long-term efavirenz treatment: a multicentre, cross-sectional, observational study.

Lancet HIV 2019 Feb 12. Epub 2019 Feb 12.

Department of Paediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

Background: Efavirenz is commonly prescribed for children with HIV infection, yet little is known about risks of neuropsychiatric side-effects. We aimed to compare competence (social involvement, activities, and school performance) and psychopathology (internalising and externalising problems), cognitive performance (intelligence and working memory), and adherence in Tanzanian children on an efavirenz-based versus a non-efavirenz-based regimen.

Methods: In this multicentre, cross-sectional, observational study, we included consecutive children (aged 6-12 years) with HIV infection, on combination antiretroviral therapy (cART) for at least 6 months, and with viral loads of less than 1000 copies per mL from HIV care clinics of three primary health facilities and three referral hospitals in Moshi, Kilimanjaro, Tanzania. Read More

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http://dx.doi.org/10.1016/S2352-3018(18)30329-1DOI Listing
February 2019

The prevalence and associated factors of skin tears in Belgian nursing homes: A cross-sectional observational study.

J Tissue Viability 2019 Feb 7. Epub 2019 Feb 7.

Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland; School of Health Sciences, Örebro University, Sweden. Electronic address:

Background: Although skin tears are among the most prevalent acute wounds in nursing homes, their recognition as a unique condition remains in its infancy. Elderly patients are at risk of developing skin tears due to increased skin fragility and other contributing risk factors. In order to provide (cost-) effective prevention, patients at risk should be identified in a timely manner. Read More

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http://dx.doi.org/10.1016/j.jtv.2019.01.003DOI Listing
February 2019

Hormonal medication in medically assisted reproduction: a systematic review of assessments from patients.

Reprod Biomed Online 2019 Jan 19. Epub 2019 Jan 19.

Centre for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Centre, University of Amsterdam Amsterdam, the Netherlands; University of Leuven, Department of Development and Regeneration, Leuven, Belgium; University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium; Research Foundation Flanders, Belgium. Electronic address:

Several hormonal fertility medications have comparable effectiveness. A literature review was conducted into patients' assessments regarding seven medication characteristics including 'side effects' and 'ease of use'. Medline, CINAHL and PsycINFO were searched for female fertility patients' written assessments of a hormonal medication. Read More

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http://dx.doi.org/10.1016/j.rbmo.2018.12.047DOI Listing
January 2019

Insulin resistance and insulin hypersecretion in the metabolic syndrome and type 2 diabetes: Time for a conceptual framework shift.

Diab Vasc Dis Res 2019 Feb 15:1479164119827611. Epub 2019 Feb 15.

3 CRCHUM and Montreal Diabetes Research Center, University of Montreal, Montreal, QC, Canada.

While few dispute the existence of the metabolic syndrome as a clustering of factors indicative of poor metabolic health, its utility above that of its individual components in the clinical care of individual patients is questioned. This is likely a consequence of the failure of clinicians and scientists to agree on a unifying mechanism to explain the metabolic syndrome. Insulin resistance has most commonly been proposed for this role and is generally considered to be a root causative factor for not only metabolic syndrome but also for its associated conditions of non-alcoholic fatty liver disease (NAFLD), polycystic ovary syndrome (PCOS), obesity-related type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). Read More

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http://dx.doi.org/10.1177/1479164119827611DOI Listing
February 2019

A decision-aid tool for ICU admission triage is associated with a reduction in potentially inappropriate intensive care unit admissions.

J Crit Care 2019 Feb 4;51:77-83. Epub 2019 Feb 4.

Medical Sciences PhD program, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil; Teaching and Research on Palliative Care Program, Hospital Sirio-Libanes, Sao Paulo, Brazil.

Purpose: Intensive care unit (ICU) admission triage occurs frequently and often involves highly subjective decisions that may lead to potentially inappropriate ICU admissions. In this study, we evaluated the effect of implementing a decision-aid tool for ICU triage on ICU admission decisions.

Methods: This was a prospective, before-after study. Read More

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http://dx.doi.org/10.1016/j.jcrc.2019.02.002DOI Listing
February 2019

Quality of life and psychological dysfunction in traumatized and nontraumatized patients with psychogenic nonepileptic seizures (PNES).

Epilepsy Behav 2019 Feb 12;92:341-344. Epub 2019 Feb 12.

CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands; Centre for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.

Objectives: Psychogenic nonepileptic seizures (PNES) have the appearance of epileptic seizures, yet show no epileptiform discharges in the brain. The quality of life (QOL) in patients with PNES is reportedly low and trauma eems to be a relevant risk factor. The objective of this study was to examine the difference between measures of (epilepsy-specific) QOL (Quality of Life in Epilepsy Inventory; QOLIE-31p) and psychological dysfunction (trauma symptom inventory; TSI) between patients with diagnosed PNES with self-reported trauma and those without self-reported trauma. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S15255050183095
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http://dx.doi.org/10.1016/j.yebeh.2019.01.024DOI Listing
February 2019
4 Reads

Rho-inhibition and neuroprotective effect on rotenone-treated dopaminergic neurons in vitro.

Neurotoxicology 2019 Feb 12. Epub 2019 Feb 12.

Department of Translational Research and of New Surgical and Medical Technologies, via Roma 55, University of Pisa, 56126 Pisa, Italy. Electronic address:

Mesencephalic cell cultures are a good model to study the vulnerability of dopaminergic neurons and reproduce, in vitro, experimental models of Parkinson's disease. Rotenone associated as an environmental neurotoxin related to PD, is able to provoke dopaminergic neuron degeneration by inhibiting complex I of the mitochondrial respiratory chain and by inducing accumulation of α-synuclein. Recently, rotenone has been described to activate RhoA, a GTPase protein. Read More

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http://dx.doi.org/10.1016/j.neuro.2019.02.006DOI Listing
February 2019

Predicting outcomes of chronic kidney disease from EMR data based on Random Forest Regression.

Math Biosci 2019 Feb 12. Epub 2019 Feb 12.

Bioinformatics and Mathematical Biosciences Lab, Department of Mathematics and Statistics, South Dakota State University, Brookings, SD, 57006, USA. Electronic address:

Chronic kidney disease (CKD) is prevalent across the world, and kidney function is well defined by an estimated glomerular filtration rate (eGFR). The progression of kidney disease can be predicted if the future eGFR can be accurately estimated using predictive analytics. In this study, we developed and validated a prediction model of eGFR by data extracted from a regional health system. Read More

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http://dx.doi.org/10.1016/j.mbs.2019.02.001DOI Listing
February 2019

Patterns and clinical consequences of discontinuing HIV preexposure prophylaxis during primary care.

J Int AIDS Soc 2019 Feb;22(2):e25250

Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Introduction: Discontinuations of HIV preexposure prophylaxis (PrEP) by at-risk individuals could decrease the effectiveness of PrEP. Our objective was to characterize patterns of, reasons for, and clinical outcomes associated with PrEP discontinuations in primary care.

Methods: We conducted medical chart reviews for patients prescribed PrEP during 2011 to 2014 at a Boston community health centre specializing in healthcare for sexual and gender minorities. Read More

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http://doi.wiley.com/10.1002/jia2.25250
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http://dx.doi.org/10.1002/jia2.25250DOI Listing
February 2019
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Team planning discussion and clinical performance: a prospective, randomised, controlled simulation trial.

Anaesthesia 2019 Feb 15. Epub 2019 Feb 15.

Health Services and Performance Research laboratory (EA 7425), Claude Bernard Lyon 1 University, Lyon, France.

Planning held before emergency management of a critical situation might be an invaluable asset for optimising team preparation. The purpose of this study was to investigate whether a brief planning discussion improved team performance in a simulated critical care situation. Forty-four pairs of trainees in anaesthesia and intensive care were randomly allocated to either an intervention or control group before participating in a standardised simulated scenario. Read More

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http://dx.doi.org/10.1111/anae.14602DOI Listing
February 2019

A systematic review for variables to be collected in a transplant database for improving risk prediction.

Transplantation 2019 Feb 6. Epub 2019 Feb 6.

Evidence-Based Practice Research Program, Mayo Clinic, MN, USA.

Background: This systematic review was commissioned to identify new variables associated with transplant outcomes that are not currently collected by the Organ Procurement and Transplantation Network (OPTN).

Methods: We identified 81 unique studies including 1,193,410 patients with median follow-up of 36 months posttransplant, reporting 108 unique risk factors.

Results: Most risk factors (104) were recipient-related; few (4) were donor-related. Read More

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http://dx.doi.org/10.1097/TP.0000000000002652DOI Listing
February 2019

Perioperative Epidural Use and Risk of Delirium in Surgical Patients: A Secondary Analysis of the PODCAST Trial.

Anesth Analg 2019 Feb 12. Epub 2019 Feb 12.

From the Department of Anesthesiology.

Background: Postoperative delirium is an important public health concern without effective prevention strategies. This study tested the hypothesis that perioperative epidural use would be associated with decreased risk of delirium through postoperative day 3.

Methods: This was a secondary, observational, nonrandomized analysis of data from The Prevention of Delirium and Complications Associated With Surgical Treatments Trial (PODCAST; NCT01690988). Read More

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http://dx.doi.org/10.1213/ANE.0000000000004038DOI Listing
February 2019
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Insights From Organized Crime for Disorganized Health Care.

Authors:
John H Wasson

J Ambul Care Manage 2019 Feb 13. Epub 2019 Feb 13.

Medicine and Community and Family Medicine, Dartmouth-Geisel School of Medicine, Lebanon, New Hampshire.

During college and medical school, the author's summer employment acquainted him with members of organized crime families. After a full career as a primary care clinician and geriatrician with research on improving health care delivery, the author opines that several insights from organized crime should be of interest to health care professionals: (1) don't damage the host; (2) protect the brand; and (3) lead necessary adaption. From these insights, the author presents symptoms of failure evidenced by the US health care system, followed by several adaptations that would reduce the system's costs, improve its image, and address future challenges. Read More

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http://dx.doi.org/10.1097/JAC.0000000000000273DOI Listing
February 2019

Evaluating a Community-Placed and Clinically Integrated Community Health Worker Program: A Realist Approach.

J Ambul Care Manage 2019 Feb 13. Epub 2019 Feb 13.

Division of Primary Care Internal Medicine (Drs Njeru, Quirindongo-Cedeño, and Wieland), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (Drs Ridgeway and Asiedu), Division of Health Care Policy and Research (Dr Radecki Breitkopf), and Department of Internal Medicine (Dr Gunderson and Ms Nelson and Mr O'Brien), Mayo Clinic, Rochester, Minnesota; and Intercultural Mutual Assistance Association (Ms Nelson and Mr Buzard), Rochester, Minnesota.

Community health worker (CHW) programs can act as bridges between patients and health care teams, but the complexity and variability of program components and outcomes make them difficult to evaluate. This evaluation used a realist approach to identify underlying mechanisms and contextual factors associated with successful implementation of a community-placed CHW program affiliated with a primary care practice in the Midwest United States. The analysis identified mechanisms by which stakeholders built trust, self-efficacy, and empowerment to improve patient-centered outcomes and experiences. Read More

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http://dx.doi.org/10.1097/JAC.0000000000000268DOI Listing
February 2019

Using Electronic Clinical Decision Support in Patient-Centered Medical Homes to Improve Management of Diabetes in Primary Care: The DECIDE Study.

J Ambul Care Manage 2019 Feb 13. Epub 2019 Feb 13.

Delaware Valley Outcomes Research, Newark, Delaware (Dr Gill and Ms Turk); independent consultant (Dr Kucharski); Sanofi US, Inc, Bridgewater, New Jersey (Dr Pan); and Regeneron Pharmaceuticals Inc, Tarrytown, New York (Dr Wei).

This prospective, randomized, real-world study aimed to examine the impact of electronic health record-based clinical decision support (CDS) tools on the management of diabetes in small- to medium-sized primary care practices participating in Delaware's patient-centered medical home project. Overall, use of CDS systems was associated with greater reductions from baseline in hemoglobin A1c and low-density lipoprotein cholesterol, and more patients achieving treatment goals. Physicians and staff reported that the CDS toolkit empowered them to be more involved in clinical decision-making, thereby helping to improve diabetes care. Read More

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http://dx.doi.org/10.1097/JAC.0000000000000267DOI Listing
February 2019

Efficacy of Community-Based Exercise Therapy Among African American Patients With Peripheral Artery Disease: A Randomized Clinical Trial.

JAMA Netw Open 2019 Feb 1;2(2):e187959. Epub 2019 Feb 1.

Office of Research, School of Medicine, University of Kansas Medical Center, Wichita.

Importance: African American individuals are 2 times more likely than non-Hispanic white individuals to have peripheral artery disease (PAD). Structured community-based exercise therapy improves walking distance among patients with PAD, but these patients require motivation to adhere to therapy.

Objective: To assess whether motivational interviewing (MI) is more efficacious than Patient-Centered Assessment and Counseling for Exercise (PACE) or control to improve walking distance in African American patients with PAD. Read More

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http://dx.doi.org/10.1001/jamanetworkopen.2018.7959DOI Listing
February 2019

Analysis of Benefit of Intensive Care Unit Transfer for Deteriorating Ward Patients: A Patient-Centered Approach to Clinical Evaluation.

JAMA Netw Open 2019 Feb 1;2(2):e187704. Epub 2019 Feb 1.

Division of Medicine, University College London, London, United Kingdom.

Importance: It is unknown which deteriorating ward patients benefit from intensive care unit (ICU) transfer.

Objectives: To use an instrumental variable (IV) method that assesses heterogeneity and to evaluate estimates of person-centered treatment effects of ICU transfer and 28-day hospital mortality by age and illness severity.

Design, Setting, And Participants: An analysis of a prospective cohort study from November 1, 2010, to December 31, 2011. Read More

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http://dx.doi.org/10.1001/jamanetworkopen.2018.7704DOI Listing
February 2019

A Framework for Analyzing and Measuring Usage and Engagement Data (AMUsED) in Digital Interventions: Viewpoint.

J Med Internet Res 2019 Feb 15;21(2):e10966. Epub 2019 Feb 15.

Center for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom.

Trials of digital interventions can yield extensive, in-depth usage data, yet usage analyses tend to focus on broad descriptive summaries of how an intervention has been used by the whole sample. This paper proposes a novel framework to guide systematic, fine-grained usage analyses that better enables understanding of how an intervention works, when, and for whom. The framework comprises three stages to assist in the following: (1) familiarization with the intervention and its relationship to the captured data, (2) identification of meaningful measures of usage and specifying research questions to guide systematic analyses of usage data, and (3) preparation of datasheets and consideration of available analytical methods with which to examine the data. Read More

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http://www.jmir.org/2019/2/e10966/
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http://dx.doi.org/10.2196/10966DOI Listing
February 2019
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The Current State of Mobile Phone Apps for Monitoring Heart Rate, Heart Rate Variability, and Atrial Fibrillation: Narrative Review.

JMIR Mhealth Uhealth 2019 Feb 15;7(2):e11606. Epub 2019 Feb 15.

Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong).

Background: Mobile phone apps capable of monitoring arrhythmias and heart rate (HR) are increasingly used for screening, diagnosis, and monitoring of HR and rhythm disorders such as atrial fibrillation (AF). These apps involve either the use of (1) photoplethysmographic recording or (2) a handheld external electrocardiographic recording device attached to the mobile phone or wristband.

Objective: This review seeks to explore the current state of mobile phone apps in cardiac rhythmology while highlighting shortcomings for further research. Read More

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http://dx.doi.org/10.2196/11606DOI Listing
February 2019

Discussing Weight Management With Type 2 Diabetes Patients in Primary Care Using the Small Talk Big Difference Intervention: Protocol for a Randomized Controlled Trial.

JMIR Res Protoc 2019 Feb 15;8(2):e12162. Epub 2019 Feb 15.

Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.

Background: Guidelines for the management of type 2 diabetes universally recommend that adults with type 2 diabetes and obesity be offered individualized interventions to encourage weight loss. Yet despite the existing recommendations, provision of weight management services is currently patchy around the United Kingdom and where services are available, high attrition rates are often reported. In addition, individuals often fail to take up services, that is, after discussion with a general practitioner or practice nurse, individuals are referred to the service but do not attend for an appointment. Read More

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http://dx.doi.org/10.2196/12162DOI Listing
February 2019

The mortality rate and causes of death among juvenile idiopathic arthritis patients in Finland.

Clin Exp Rheumatol 2019 Feb 11. Epub 2019 Feb 11.

Department of Children and Adolescents, Oulu University Hospital; Medical Research Centre, University of Oulu and Oulu University Hospital; and PEDEGO Research Unit, University of Oulu, Finland.

Objectives: To explore mortality rates and causes of death in juvenile idiopathic arthritis (JIA) patients in Finland compared with the general population.

Methods: All incident patients with JIA (age <16 years at the index day) during 2000-2014 were collected from the nationwide register maintained by the Social Insurance Institution of Finland and The National Population Registry identified three age-, sex- and residence-matched controls for each case. They were followed up together until 31st Dec 2015. Read More

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February 2019

High- versus low-intensity interventions for perinatal depression delivered by non-specialist primary maternal care providers in Nigeria: cluster randomised controlled trial (the EXPONATE trial).

Br J Psychiatry 2019 Feb 15:1-8. Epub 2019 Feb 15.

Associate Professor,Division of Social and Transcultural Psychiatry,McGill University; andResearch Director,Department of Psychiatry,Jewish General Hospital,Canada.

Background: Contextually appropriate interventions delivered by primary maternal care providers (PMCPs) might be effective in reducing the treatment gap for perinatal depression.AimTo compare high-intensity treatment (HIT) with low-intensity treatment (LIT) for perinatal depression.

Method: Cluster randomised clinical trial, conducted in Ibadan, Nigeria between 18 June 2013 and 11 December 2015 in 29 maternal care clinics allocated by computed-generated random sequence (15 HIT; 14 LIT). Read More

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http://dx.doi.org/10.1192/bjp.2019.4DOI Listing
February 2019

Long-term prevalence and predictors of prolonged grief disorder amongst bereaved cancer caregivers: A cohort study.

Palliat Support Care 2019 Feb 15:1-8. Epub 2019 Feb 15.

Centre for Palliative Care, St Vincent's Hospital Melbourne,Australia.

ContextThe short-term impact of prolonged grief disorder (PGD) following bereavement is well documented. The longer term sequelae of PGD however are poorly understood, possibly unrecognized, and may be incorrectly attributed to other mental health disorders and hence undertreated.

Objectives: The aims of this study were to prospectively evaluate the prevalence of PGD three years post bereavement and to examine the predictors of long-term PGD in a population-based cohort of bereaved cancer caregivers. Read More

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http://dx.doi.org/10.1017/S1478951518001013DOI Listing
February 2019

Barriers and facilitators to adoption, implementation and sustainment of obesity prevention interventions in schoolchildren- a DEDIPAC case study.

BMC Public Health 2019 Feb 15;19(1):198. Epub 2019 Feb 15.

School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.

Background: The aim of the study was to explore the implementation of school based diet and physical activity interventions with respect to the barriers and facilitators to adoption, implementation and sustainability; supportive actions required for implementation and recommendations to overcome identified barriers. Two interventions rolled out nationally in Ireland were chosen; Food Dudes, a programme to encourage primary school children to consume more fruit and vegetables and Green Schools Travel (GST), an active travel to school programme in primary and secondary schools. Trained school coordinators (teachers) cascade the programmes to other teaching staff. Read More

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http://dx.doi.org/10.1186/s12889-018-6368-7DOI Listing
February 2019

Personalizing Second-Line Type 2 Diabetes Treatment Selection: Combining Network Meta-analysis, Individualized Risk, and Patient Preferences for Unified Decision Support.

Med Decis Making 2019 Feb 15:272989X19829735. Epub 2019 Feb 15.

Center for Primary Care and Outcomes Research and Center for Population Health Sciences, Departments of Medicine and of Health Research and Policy, Stanford University, Stanford, CA, USA.

Background: Personalizing medical treatment often requires practitioners to compare multiple treatment options, assess a patient's unique risk and benefit from each option, and elicit a patient's preferences around treatment. We integrated these 3 considerations into a decision-modeling framework for the selection of second-line glycemic therapy for type 2 diabetes.

Methods: Based on multicriteria decision analysis, we developed a unified treatment decision support tool accounting for 3 factors: patient preferences, disease outcomes, and medication efficacy and safety profiles. Read More

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http://dx.doi.org/10.1177/0272989X19829735DOI Listing
February 2019

Differential Diagnosis Decision Support Systems in Primary and Out-of-Hours Care: A Qualitative Analysis of the Needs of Key Stakeholders in Scotland.

J Prim Care Community Health 2019 Jan-Dec;10:2150132719829315

1 University of Glasgow, Glasgow, UK.

Background: Differential Diagnosis Decision Support Systems (DDDSS) and other forms of clinical decision support systems may have a role in supporting clinicians and the public in making decisions about differential diagnosis and accessing health care services. The aim of this qualitative, focus group study was to explore the needs of out-of-hours and primary care clinicians, and members of the public in relation to DDDSS.

Methods: Twenty-nine participants (comprising 13 advanced nurse practitioners [ANPs], 7 general practitioners [GPs], 2 allied health professional advanced practitioners [AAPs], and 7 members of the public) took part in 1 of 6 focus groups. Read More

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http://dx.doi.org/10.1177/2150132719829315DOI Listing
February 2019

The clinical implication of CD45RA naïve T cells and CD45RO memory T cells in advanced pancreatic cancer: a proxy for tumor biology and outcome prediction.

Cancer Med 2019 Feb 14. Epub 2019 Feb 14.

State Key Laboratory for Oncogenes and Related Genes, Department of Oncology, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Naïve and memory T cells play a pivotal role in solid tumor pathogenesis but their role in pancreatic cancer progression remains elusive. Thus, we aimed to investigate their clinical potential in advanced pancreatic cancer (APC). Flow cytometry was performed to evaluate the level of baseline peripheral naïve and memory T cells from 137 APC patients before receiving first-line chemotherapy. Read More

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http://dx.doi.org/10.1002/cam4.1988DOI Listing
February 2019

Quality of life and its association with irritable bowel syndrome and fatigue ten years after giardiasis.

Neurogastroenterol Motil 2019 Feb 14:e13559. Epub 2019 Feb 14.

Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.

Background: Gastroenteritis has been associated with complications such as irritable bowel syndrome (IBS) and chronic fatigue (CF). Little is known about the implications for quality of life (QoL) in this setting. The aims of this study were to evaluate the association between exposure to Giardia infection and QoL ten years after the infection, and how this related to IBS and CF. Read More

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http://dx.doi.org/10.1111/nmo.13559DOI Listing
February 2019

Coordinating objects of care: Exploring the role of case managers as brokers in cancer patient pathways.

Eur J Cancer Care (Engl) 2019 Feb 14:e13017. Epub 2019 Feb 14.

Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Aarhus C, Denmark.

Objective: Healthcare systems increasingly make use of case managers to handle organisational complexity. In Danish cancer patient pathways, case managers handle the complexities of cancer diagnostics and treatment while adhering to pathway guidelines. This article explores how case managers handle their various responsibilities and focuses on the micro-politics of case management. Read More

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http://dx.doi.org/10.1111/ecc.13017DOI Listing
February 2019

Epidemiological and clinical characteristics and the approach to infant chickenpox in primary care.

Eur J Pediatr 2019 Feb 14. Epub 2019 Feb 14.

Primary health care Miralbueno, Servicio Aragonés de Salud, Zaragoza, Spain.

Chickenpox is not common in the first year of life (infant varicella) and there is a lack of data on its presentation, especially in primary care. A year-long observational study (July 2015-2016) carried out by a research network of primary care pediatricians throughout Spain.Two hundred and sixty-four pediatricians gathered data from 358 cases of clinically diagnosed chickenpox in infants. Read More

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http://dx.doi.org/10.1007/s00431-019-03332-9DOI Listing
February 2019

Knowledge, attitudes and use of anabolic-androgenic steroids among male gym users: A community based survey in Riyadh, Saudi Arabia.

Saudi Pharm J 2019 Feb 22;27(2):254-263. Epub 2018 Nov 22.

King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, College of Public Health and Health Informatics, Riyadh, Saudi Arabia.

Recreational use of anabolic-androgenic steroids (AAS) is a growing worldwide public health concern. However, studies assessing the level of awareness and knowledge of its effects on health are fairly limited, especially in developing countries, including Saudi Arabia. This community-based cross-sectional study was conducted to assess knowledge, attitudes and practices among male gym members toward AAS in Riyadh (Saudi Arabia) from March to October 2016. Read More

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http://dx.doi.org/10.1016/j.jsps.2018.11.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362160PMC
February 2019