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Influence of Information-Based Continuous Care on Disease Control and Treatment Compliance of Elderly Diabetic Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4023123. [PMID: 36285157 PMCID: PMC9588350 DOI: 10.1155/2022/4023123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/02/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Abstract
Background The incidence of diabetes is increasing year by year. For elderly diabetic patients, poor blood glucose control and worsening immune function greatly increase the risk of complications, which will seriously affect their quality of life. Purpose This paper primarily clarifies the influence of information-based continuous care on disease control and treatment compliance of elderly diabetic patients. Methods From December 2018 to December 2021, 106 elderly diabetic patients were selected, and their clinical data were retrospectively studied. Patients were grouped according to the type of care they received: an observation group (OG) comprising 56 cases receiving information-based continuous care and a control group (CG) including 50 cases treated with routine nursing. The two cohorts of patients were compared regarding disease control, treatment compliance, glucose and lipid metabolism (GLM), and self-management. Results After analysis, it was found that the disease control and treatment compliance were statistically higher in OG compared with CG. OG also showed significantly reduced fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG), total cholesterol (TC), and triglyceride (TG) after nursing that were all lower compared with CG. In terms of self-management, OG outperformed CG in diet, exercise, blood glucose monitoring, and adherence to medical regimens. Conclusions Information-based continuous care has beneficial effects on disease control and treatment compliance of elderly diabetic patients and can help control blood sugar and optimize patients' self-management level, with high clinical promotion value.
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Szabo G, Thursz M, Shah VH. Therapeutic advances in alcohol-associated hepatitis. J Hepatol 2022; 76:1279-1290. [PMID: 35589250 DOI: 10.1016/j.jhep.2022.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/03/2022] [Accepted: 03/24/2022] [Indexed: 02/07/2023]
Abstract
In recent years, there have been important advances in our understanding of alcohol-associated hepatitis (AH), which have occurred in parallel with a surge in clinical trial activity. Meanwhile, the broader medical field has seen a transformation in care paradigms based on emerging digital technologies. This review focuses on breakthroughs in our understanding of AH and how these breakthroughs are leading to new paradigms for biomarker discovery, clinical trial activity, and care models for patients. It portends a future in which multimodal data from genetic, radiomic, histologic, and environmental sources can be integrated and synthesised to generate personalised biomarkers and therapies for patients with AH.
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Affiliation(s)
- Gyongyi Szabo
- Carol M. Gatton Chairman of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mark Thursz
- Division of Digestive Diseases, Imperial College, London, UK.
| | - Vijay H Shah
- Mitchell T. Rabkin, M.D. Chair, Professor of Medicine, Harvard Medical School, Chief Academic Officer, Beth Israel Deaconess Medical Center and Beth Israel Lahey Health, Boston, MA, USA
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McKay JR, Gustafson DH, Ivey M, P-Romashko K, Curtis B, Thomas T, Oslin DA, Polsky D, Quanbeck A, Lynch KG. Efficacy and comparative effectiveness of telephone and smartphone remote continuing care interventions for alcohol use disorder: a randomized controlled trial. Addiction 2022; 117:1326-1337. [PMID: 34859519 PMCID: PMC10600977 DOI: 10.1111/add.15771] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 11/05/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Management of alcohol use disorder (AUD) could be enhanced by effective remote treatments. This study tested whether supplementing intensive outpatient programs (IOPs) with continuing care delivered via (1) telephone, (2) smartphone or (3) their combination improves outcomes relative to (4) IOP only. Continuing care conditions were also compared. DESIGN Randomized controlled trial of four groups with 3-, 6-, 9-, 12- and 18-month follow-ups. SETTING University research center in Philadelphia, PA, USA. PARTICIPANTS Participants (n = 262) met DSM-V criteria for AUD, were largely male (71%) and African American (82%). INTERVENTIONS AND COMPARATOR Telephone monitoring and counseling (TMC; n = 59), addiction comprehensive health enhancement support system (ACHESS; n = 68) and TMC + ACHESS (n = 70) provided for 12 months. The control condition received IOP only (TAU; n = 65). MEASUREMENT The primary outcome was percentage of days heavy drinking (PDHD) in months 1-12. Secondary outcomes were any drinking, any drug use, drinking consequences and quality of life. FINDINGS Mean PDHD in months 1-12 was 10.29 in TAU, 5.41 in TMC, 6.80 in ACHESS and 5.99 in TMC + ACHESS. PDHD was lower in TMC [Cohen's d = 0.35, P = 0.018, 95% confidence interval (CI) = (-1.42, -0.20)], ACHESS [d = 0.31, P = 0.031, 95% CI = (-1.27, -0.06)] and TMC + ACHESS [d = 0.36, P = 0.009, 95% CI = (-1.40, -0.20)] than in TAU. Differences between TMC + ACHESS, TMC and ACHESS were small (d ≤ 0.06) and non-significant. Findings were inconclusive as to whether or not the treatment conditions differed on PDHD at 18 months. A significant effect was obtained on any drinking, which was higher in months 1-12 in TAU than in TMC [odds ratio (OR) = 3.02, standard error (SE) = 0.43, 95% CI = (1.30, 6.99), P = 0.01] and TMC + ACHESS [OR = 2.43, SE = 0.39, 95% CI = (1.12, 5.27), P = 0.025). No other significant effects were obtained on other secondary outcomes during or after treatment. CONCLUSIONS A telephone-delivered intervention and a smartphone-delivered intervention, alone and in combination, provided effective remote continuing care for alcohol use disorder. The combination of both interventions was not superior to either alone and effects did not persist post-treatment.
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Affiliation(s)
- James R. McKay
- Center for Studies of Addiction, Perelman School of Medicine. University of Pennsylvania, 3535 Market St., Suite 500, Philadelphia, PA 19104
- Crescenz VAMC, 3900 Woodland Ave, Philadelphia, PA 19104
| | - David H. Gustafson
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, 4109 Mechanical Engineering Building, 1513 University Ave., Madison, WI 53706
| | - Megan Ivey
- Center for Studies of Addiction, Perelman School of Medicine. University of Pennsylvania, 3535 Market St., Suite 500, Philadelphia, PA 19104
| | - Klaren P-Romashko
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, 4109 Mechanical Engineering Building, 1513 University Ave., Madison, WI 53706
| | - Brenda Curtis
- Technology and Translational Research Unit, National Institute on Drug Abuse National Institute of Health, Biomedical Research Center, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224
| | - Tyrone Thomas
- Center for Studies of Addiction, Perelman School of Medicine. University of Pennsylvania, 3535 Market St., Suite 500, Philadelphia, PA 19104
| | - David A. Oslin
- Center for Studies of Addiction, Perelman School of Medicine. University of Pennsylvania, 3535 Market St., Suite 500, Philadelphia, PA 19104
- Crescenz VAMC, 3900 Woodland Ave, Philadelphia, PA 19104
| | - Daniel Polsky
- Department of Health Policy and Management, Bloomberg School of Public Health Carey Business School, Johns Hopkins University, 624 N. Broadway, Room 661, Baltimore, MD
| | - Andrew Quanbeck
- Department of Family Medicine & Community Health, University of Wisconsin-Madison, 800 University Bay Drive, Madison, WI 53705
| | - Kevin G. Lynch
- Center for Studies of Addiction, Perelman School of Medicine. University of Pennsylvania, 3535 Market St., Suite 500, Philadelphia, PA 19104
- Crescenz VAMC, 3900 Woodland Ave, Philadelphia, PA 19104
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Harris RA, Mandell DS, Kampman KM, Bao Y, Campbell K, Cidav Z, Coviello DM, French R, Livesey C, Lowenstein M, Lynch KG, McKay JR, Oslin DW, Wolk CB, Bogner HR. Collaborative care in the treatment of opioid use disorder and mental health conditions in primary care: A clinical study protocol. Contemp Clin Trials 2021; 103:106325. [PMID: 33631356 PMCID: PMC8117118 DOI: 10.1016/j.cct.2021.106325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND People with opioid use disorder (OUD) often have a co-occurring psychiatric disorder, which elevates the risk of morbidity and mortality. Promising evidence supports the use of collaborative care for treating people with OUD in primary care. Whether collaborative care interventions that treat both OUD and psychiatric disorders will result in better outcomes is presently unknown. METHODS The Whole Health Study is a 3-arm randomized controlled trial designed to test collaborative care treatment for OUD and the psychiatric disorders that commonly accompany OUD. Approximately 1200 primary care patients aged ≥18 years with OUD and depression, anxiety, or PTSD will be randomized to one of three conditions: (1) Augmented Usual Care, which consists of a primary care physician (PCP) waivered to prescribe buprenorphine and an addiction psychiatrist to consult on medication-assisted treatment; (2) Collaborative Care, which consists of a waivered PCP, a mental health care manager trained in psychosocial treatments for OUD and psychiatric disorders, and an addiction psychiatrist who provides consultation for OUD and mental health; or (3) Collaborative Care Plus, which consists of all the elements of the Collaborative Care arm plus a Certified Recovery Specialist to help with treatment engagement and retention. Primary outcomes are six-month rates of opioid use and six-month rates of remission of co-occurring psychiatric disorders. DISCUSSION The Whole Health Study will investigate whether collaborative care models that address OUD and co-occurring depression, anxiety, or PTSD will result in better patient outcomes. The results will inform clinical care delivery during the current opioid crisis. CLINICAL TRIALS REGISTRATION www.clinicaltrials.gov registration: NCT04245423.
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Affiliation(s)
- Rebecca Arden Harris
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kyle M Kampman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, USA
| | - Kristen Campbell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Zuleyha Cidav
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Donna M Coviello
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rachel French
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Cecilia Livesey
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Margaret Lowenstein
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kevin G Lynch
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James R McKay
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - David W Oslin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - Courtney Benjamin Wolk
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hillary R Bogner
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
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Graser Y, Stutz S, Rösner S, Moggi F, Soravia LM. Telephone- and Text Message-Based Continuing Care After Residential Treatment for Alcohol Use Disorder: A Randomized Clinical Multicenter Study. Alcohol Clin Exp Res 2020; 45:224-233. [PMID: 33245589 DOI: 10.1111/acer.14499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is characterized by extremely high rates of postresidential treatment relapse, and as such, continuing care to prevent relapse has become an important element in AUD treatment. In this regard, research has yielded heterogeneous evidence on telephone-based (TEL) and text message-based (TEX) continuing care. We aimed to compare the effectiveness of TEL and TEX continuing care provided in different frequencies by psychotherapists for patients from residential treatments in mitigating the occurrence of posttreatment relapse in patients who completed a 12-week abstinence-oriented residential treatment program for AUD. METHODS A total of 240 patients from 2 residential treatment programs for AUD were included in the study. Patients were randomly assigned to high- (10 contacts) or low-frequency (3 contacts) TEL, TEX (10 contacts) continuing care, or control group (1 contact) from discharge to 6-month follow-up. The TEL was intended to be supportive and consisted of several cognitive behavioral therapy components, whereas the TEX was based on behavioral self-monitoring techniques and additional calls in case of relapse or as needed. Sociodemographic, clinical, and alcohol-specific variables at residential treatment discharge and at 5-month follow-up were assessed through interviews and questionnaires. RESULTS Compared with the control group, patients in the high-frequency TEL were significantly more likely to be abstinent at 6-month follow-up and, in case of relapse, showed a tendency toward a longer time to first drink. Moreover, the high-frequency TEL and TEX groups had significantly higher alcohol-related self-efficacy 6 months after residential treatment. CONCLUSION High-frequency proactive telephone contact by psychotherapists known to the patient may help patients to surmount the vulnerable phase after residential treatment and, in case of relapse, might help patients stay connected to health services, which in turn prevents chronification and facilitates recovery from AUD.
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Affiliation(s)
- Yolanda Graser
- From the, Research, (YG, LMS), Suedhang Clinic, Kirchlindach, Switzerland
| | - Sonja Stutz
- Research and Development, (SS, SR), Forel Clinic, Ellikon, Switzerland
| | - Susanne Rösner
- Research and Development, (SS, SR), Forel Clinic, Ellikon, Switzerland
| | - Franz Moggi
- Translational Research Center, (FM, LMS), University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Leila M Soravia
- From the, Research, (YG, LMS), Suedhang Clinic, Kirchlindach, Switzerland.,Translational Research Center, (FM, LMS), University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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The Digital Health Landscape in Addiction and Substance Use Research: Will Digital Health Exacerbate or Mitigate Health Inequities in Vulnerable Populations? CURRENT ADDICTION REPORTS 2020. [DOI: 10.1007/s40429-020-00325-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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He X, Cai L, Huang S, Ma X, Zhou X. The design of electronic medical records for patients of continuous care. J Infect Public Health 2019; 14:117-122. [PMID: 31431422 DOI: 10.1016/j.jiph.2019.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 01/24/2023] Open
Abstract
In order to meet the ever-increasing needs of health care, as well as helping patients who need continuous care after being discharged from the hospital and making modern medical technology better serve humans, the design of electronic medical records for continuous care patients, especially those with malignant tumors, is investigated. In the research process, the idea of Browser/Server (B/S) framework is adopted, and the corresponding electronic medical record system is designed based on the targets and the overall structure of the system; afterward, the black-box testing and white-box testing are carried out to test the functions, reliability, and stability of the designed electronic medical record system; in addition, combined with other research results, the feasibility of the design is proved. It can be seen that the electronic medical record system designed for patients who need continuous care in the study is absolutely feasible, which can be further researched and improved with the development of electronic medical records; therefore, it would make greater contributions to both patients and hospitals in the future.
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Affiliation(s)
- Xiaolan He
- Deparment of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou City, 510630, Guangdong Province, China.
| | - Lei Cai
- Deparment of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou City, 510630, Guangdong Province, China
| | - Shiju Huang
- Deparment of Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe road, Tianhe District, Guangzhou City, 510630, Guangdong Province, China
| | - Xiaoju Ma
- Deparment of Cardiovascular Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe road, Tianhe District, Guangzhou City, 510630, Guangdong Province, China
| | - Xueling Zhou
- Deparment of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou City, 510630, Guangdong Province, China
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Peterson C, Liu Y, Xu L, Nataraj N, Zhang K, Mikosz CA. U.S. National 90-Day Readmissions After Opioid Overdose Discharge. Am J Prev Med 2019; 56:875-881. [PMID: 31003811 PMCID: PMC6527476 DOI: 10.1016/j.amepre.2018.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 01/04/2023]
Abstract
INTRODUCTION U.S. hospital discharges for opioid overdose increased substantially during the past two decades. This brief report describes 90-day readmissions among patients discharged from inpatient stays for opioid overdose. METHODS In 2018, survey-weighted analysis of hospital stays in the 2016 Healthcare Cost and Utilization Project National Readmissions Database yielded the national estimated proportion of patients with opioid overdose stays that had all-cause readmissions within ≤90 days. A multivariable logistic regression model assessed index stay factors associated with readmission by type (opioid overdose or not). Number of readmissions per patient was assessed. RESULTS More than 24% (n=14,351/58,850) of patients with non-fatal index stays for opioid overdose had at least one all-cause readmission ≤90 days of index stay discharge and 3% (n=1,658/58,850) of patients had at least one opioid overdose readmission. Less than 0.2% (n=104/58,850) of patients had more than one readmission for opioid overdose. Patient demographic characteristics (e.g., male, older age), comorbidities diagnosed during the index stay (e.g., drug use disorder, chronic pulmonary disease, psychoses), and other index stay factors (Medicare or Medicaid primary payer, discharge against medical advice) were significantly associated with both opioid overdose and non-opioid overdose readmissions. Nearly 30% of index stays for opioid overdose included heroin, which was significantly associated with opioid overdose readmissions. CONCLUSIONS A quarter of opioid overdose patients have ≤90 days all-cause readmissions, although opioid overdose readmission is uncommon. Effective strategies to reduce readmissions will address substance use disorder as well as comorbid physical and mental health conditions.
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Affiliation(s)
- Cora Peterson
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Yang Liu
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Likang Xu
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nisha Nataraj
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kun Zhang
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina A Mikosz
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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