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Ben Kridis W, Nefzi I, Souissi B, Ben Mahfoudh K, Dammak M, Daoud J, Khanfir A. Intramedullary spinal cord metastasis from breast cancer: an ambiguous entity. BMJ Support Palliat Care 2024:spcare-2024-004910. [PMID: 38697779 DOI: 10.1136/spcare-2024-004910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
Intramedullary spinal cord metastasis (IMSC) from solid tumors is rare. In this report, we describe the case of a patient treated at our center for breast cancer with intramedullary spinal cord metastases without bone and brain metastases or meningitis. Management of the disease remains challenging even with recent advances in the treatment of metastatic breast cancer. Treatment options include surgery, radiotherapy and chemotherapy. The prognosis of these patients still very poor.
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Affiliation(s)
- Wala Ben Kridis
- Medical Oncology, Habib Bourguiba Hospital university of Sfax, Sfax, Tunisia
| | - Issaad Nefzi
- Medical Oncology, Habib Bourguiba Hospital university of Sfax, Sfax, Tunisia
| | | | | | | | - Jamel Daoud
- Radiotherapy, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Afef Khanfir
- Medical Oncology, Habib Bourguiba Hospital university of Sfax, Sfax, Tunisia
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Benoist G, Cahn-Sellem F. [Diagnosis and treatment of VRS]. LA REVUE DU PRATICIEN 2022; 72:13-18. [PMID: 36512002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acute bronchiolitis is a very common condition in infants. It has a major effect on consultations in cities and use of hospital emergency rooms. The analysis of clinical data makes it easily to confirm the diagnosis and to assess the severity at the time of the evaluation, which determines the rest of the treatment. In all cases, families should be provided with simple monitoring advice given the potentially rapid development of the signs, especially in the youngest infants and those with vulnerability criteria.
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Affiliation(s)
- Grégoire Benoist
- Service de pédiatrie générale et hôpital de jour allergologie, CHU Ambroise-Paré, AP-HP, Paris, France ; membre du groupe de travail de la Haute Autorité de santé sur la bronchiolite aiguë en 2019 ; bureau de la SFP
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Volmerg JS, Bienzeisler J, Klausen AD, Seeger I, Günther U, De Sordi D, Röhrig R. ILEG - A Case of Recording Patient Journeys. Stud Health Technol Inform 2022; 294:713-714. [PMID: 35612187 DOI: 10.3233/shti220566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In 2019 the Gemeindenotfallsanitäter was introduced in the area of Oldenburg, and scientific monitoring starting 2021 with Inanspruchnahme, Leistungen und Effekte des Gemeindenotfallsanitäters. Since then, it is possible to track patient journeys, starting from the emergency call to the subsequent treatment. This short communication provides an overview of the necessary data-acquisition and dataflow from all participating institutions and its possibilities.
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Affiliation(s)
- Julia S Volmerg
- Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Aachen, Germany
| | - Jonas Bienzeisler
- Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Aachen, Germany
| | - Andrea D Klausen
- Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Aachen, Germany
- Research Network Emergency and Intensive Care Medicine, Oldenburg, Germany
- Carl von Ossietzky University, Oldenburg, Germany
| | - Insa Seeger
- Research Network Emergency and Intensive Care Medicine, Oldenburg, Germany
- Carl von Ossietzky University, Oldenburg, Germany
| | - Ulf Günther
- Research Network Emergency and Intensive Care Medicine, Oldenburg, Germany
| | | | - Rainer Röhrig
- Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Aachen, Germany
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Sarriot E, Story WT. On Learning About Efforts to Strengthen (and Reduce Harm to) Systems for Health. Health Policy Plan 2022; 37:535-538. [PMID: 35137084 DOI: 10.1093/heapol/czac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 01/03/2022] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
We comment on two embedded case studies of systems effects of successive mid-size projects looking back over 7-10 years, published in Health Policy and Planning. The papers examine humanitarian projects in Sudan and Pakistan and development projects (integrated Community Case Management) in Ethiopia, Malawi, and Mozambique. In this commentary, we summarize the two papers and discuss the overarching substantive and methodological lessons learned. In both development and humanitarian/emergency practice, projects navigate a dynamic space between gap-filling, systems support, and systems strengthening. In this, their contribution to systems strengthening depends heavily on the eco-system of government, development partners, and donors. Systems strengthening presents great challenges in definition, implementation, and measurement. Nonetheless, project implementers can and should renew their commitment to strengthening systems for health. This comes with a fundamental requirement for learning and evaluation.
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Affiliation(s)
- Eric Sarriot
- Formerly Save the Children, Department of Global Health, 899 North Capitol Street NE #900, Washington, DC 20002, USA
- Gavi, The Vaccine Alliance, Health Systems and Immunisation Strengthening Team, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva 1218, Switzerland
| | - William T Story
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Dr, Iowa City, IA 52242, USA
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Heinrich S, Schiller C, Grünzig M, Klatt T, Geyer J, Meyer G. [Dementia Care Nurse - Feasibility study of outreach assistance for people with dementia and their family carers]. Pflege 2021; 34:275-284. [PMID: 34546090 DOI: 10.1024/1012-5302/a000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Dementia Care Nurse - Feasibility study of outreach assistance for people with dementia and their family carers Abstract. Background: Case management for dementia is stipulated in the German national dementia strategy. The effectiveness of case management has been investigated many times, yet the results are heterogeneous. On the contrary, the implementation processes of case management concepts have to date rarely been described or evaluated in detail. Aim: The aim of the project was to analyze the implementation of an outreaching assistance for people with dementia and to explore the changes in care, acceptance, and also facilitators and barriers to the implementation. Methods: Between 08 / 2018 and 07 / 2019, outreaching assistance for people with dementia and their family carers was implemented. Quantitative and qualitative data were prospectively collected using semi-standardised interviews in the context of outreach assistance. Results: A total of 113 people with dementia were included in the study, and for the most part family carers could be involved. On average, eight contacts took place over a period of 74 days. The areas of need and support were diverse. The use of support services increased by 19 % after the end of the intervention. Conclusions: The implementation of continuous and processual support for people with dementia and their carers is possible, whereby the structure and procedure should be transparent. A comprehensive orientation and networking is beneficial. The effectiveness of the intervention remains to be investigated in a controlled study.
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Affiliation(s)
- Stephanie Heinrich
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
| | - Christine Schiller
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
| | - Manuela Grünzig
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
| | - Thomas Klatt
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
| | - Jennifer Geyer
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
| | - Gabriele Meyer
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
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Warren M, Knecht J, Verheijde J, Tompkins J. Association of AM-PAC "6-Clicks" Basic Mobility and Daily Activity Scores With Discharge Destination. Phys Ther 2021; 101:6124779. [PMID: 33517463 DOI: 10.1093/ptj/pzab043] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/25/2020] [Accepted: 11/29/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective was to use the Activity Measure for Post-Acute Care "6-Clicks" scores at initial physical therapist and/or occupational therapist evaluation to assess (1) predictive ability for community versus institutional discharge, and (2) association with discharge destination (home/self-care [HOME], home health [HHA], skilled nursing facility [SNF], and inpatient rehabilitation facility [IRF]). METHODS In this retrospective cohort study, initial "6-Clicks" Basic Mobility and/or Daily Activity t scores and discharge destination were obtained from electronic health records of 17,546 inpatient admissions receiving physical therapy/occupational therapy at an academic hospital between October 1, 2015 and August 31, 2018. For objective (1), postacute discharge destination was dichotomized to community (HOME and HHA) and institution (SNF and IRF). Receiver operator characteristic curves determined the most predictive Basic Mobility and Daily Activity scores for discharge destination. For objective (2), adjusted odds ratios (OR) from multinomial logistic regression assessed association between discharge destination (HOME, HHA, SNF, IRF) and cut-point scores for Basic Mobility (≤40.78 vs >40.78) and Daily Activity (≤40.22 vs >40.22), accounting for patient and clinical characteristics. RESULTS Area under the curve for Basic Mobility was 0.80 (95% CI = 0.80-0.81) and Daily Activity was 0.81 (95% CI = 0.80-0.82). The best cut-point for Basic Mobility was 40.78 (raw score = 16; sensitivity = 0.71 and specificity = 0.74) and for Daily Activity was 40.22 (raw score = 19; sensitivity = 0.68 and specificity = 0.79). Basic Mobility and Daily Activity were significantly associated with discharge destination, with those above the cut-point resulting in increased odds of discharge HOME. The Basic Mobility scores ≤40.78 had higher odds of discharge to HHA (OR = 1.7 [95% CI = 1.5-1.9]), SNF (OR = 7.8 [95% CI = 6.8-8.9]), and IRF (OR = 7.5 [95% CI = 6.3-9.1]), and the Daily Activity scores ≤40.22 had higher odds of discharge to HHA (OR = 1.8 [95% CI = 1.7-2.0]), SNF (OR = 8.9 [95% CI = 7.9-10.0]), and IRF (OR = 11.4 [95% CI = 9.7-13.5]). CONCLUSION 6-Clicks at physical therapist/occupational therapist initial evaluation demonstrated good prediction for discharge decisions. Higher scores were associated with discharge to HOME; lower scores reflected discharge to settings with increased support levels. IMPACT Initial Basic Mobility and Daily Activity scores are valuable clinical tools in the determination of discharge destination.
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Affiliation(s)
- Meghan Warren
- Patient Centered Outcomes Research Institute, Washington, DC, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, USA
| | - Jeff Knecht
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, USA
| | - Joseph Verheijde
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, USA
| | - James Tompkins
- Department of Rehabilitation Services, Bayhealth, Dover, Delaware, USA
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Thibault L, Boisgontier A, Charvin M, Grandazzi G, Moutel G. [Clinical management of intersex conditions in France]. Rev Prat 2020; 70:1069-1075. [PMID: 33739645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Clinical management of intersex conditions in france. Although a better understanding of the nuances of the spectrum linking the normal to the pathological seems to be acquired today, some situations such as intersexuality remain problematic and impose legitimate questions about intervention modalities by medical profession. It is characterized by variations in sexual development both in the genital organs and overall sexual characteristics. Since the 1950s, its clinical management has been based on heavy medical procedures in the first years of life and throughout childhood and adolescence. These procedures such as repeated surgical operations, hormonal treatments and vaginal dilations are often not agreed by the child. In the early 2000s, there was an emergence of associations promoting interests of intersex people and a dissemination of intersex testimonies. They aiming to alert the public opinion by showing consequences and limitations of early systematic sexual conformation. These procedures, practiced and defended today by some specialists, are a subject of debate. Therefore, we propose an analysis of ethical stakes of this situation, which is part of the current debate on patient care modalities. A reorganisation of care pathway based on a well-reasoned and supervised bio-psycho-social approach would therefore emerge. This approach avoids systematic interventionism and allows patients to make free choices.
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Affiliation(s)
- Léa Thibault
- Espace de réflexion éthique de Normandie, CHU de Caen, Normandie Université, Caen, France
| | - Audrey Boisgontier
- Centre de recherches et d'études sur les droits fondamentaux, Université Paris Nanterre, Nanterre, France
| | - Maud Charvin
- Espace de réflexion éthique de Normandie, CHU de Caen, Normandie Université, Caen, France
- ANTICIPE, Normandie Université, Unicaen, Inserm, Caen, France
| | - Guillaume Grandazzi
- Espace de réflexion éthique de Normandie, CHU de Caen, Normandie Université, Caen, France
- Centre de recherche Risques et vulnérabilités EA 3918, Caen, France
| | - Grégoire Moutel
- Espace de réflexion éthique de Normandie, CHU de Caen, Normandie Université, Caen, France
- ANTICIPE, Normandie Université, Unicaen, Inserm, Caen, France
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Habibi SAH, Romito L, Aloosh O, Rohani M, Moghadas F, Parvaresh M, Shahidi G, Moghaddasi M, Ziayi E, Emamikhah M. Parkinsonism management issues in a patient with exhausted subthalamic deep brain stimulation battery, stricken by severe acute respiratory syndrome coronavirus 2. Curr J Neurol 2020; 19:211-214. [PMID: 38011430 PMCID: PMC8236425 DOI: 10.18502/cjn.v19i4.5549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/27/2020] [Indexed: 11/24/2022]
Abstract
Background: Nowadays, many neurological conditions, including Parkinson's disease (PD), are treated with deep brain stimulation (DBS). Life-threatening consequences can occur from DBS hardware failure or sudden implantable pulse generator (IPG) battery depletion. This issue may potentially worsen in concomitance with medical or infectious conditions, requiring stronger emergency management. Methods: We present here a 58 year-old PD patient with DBS, whose IPG replacement surgery was complicated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and we report management of this patient along with recommendations for patients with similar situation. Results: As the newly-emerged coronavirus disease 2019 (COVID-19) is now announced to be pandemic, new protocols and specific measures for each individual group of patients with chronic diseases seem obligatory. Regarding our recent experience with a patient suffering from PD, on DBS treatment, who needed hospitalization, we felt useful to share our experience as a recommended protocol for similar patients in the time of current pandemic. Conclusion: Close monitoring of laboratory and clinical signs should be warranted in patients with PD awaiting IPG replacement in order to be prepared in these novel conditions that may precipitate an akinetic crisis/dystonic storm and to prevent life-threatening complications during the current pandemic.
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Affiliation(s)
- Seyed Amir Hassan Habibi
- Department of Neurology, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Luigi Romito
- Department of Clinical Neurosciences, Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Oldooz Aloosh
- Department of Internal Medicine, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Rohani
- Department of Neurology, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Moghadas
- Department of Neurology, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Parvaresh
- Department of Neurosurgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamali Shahidi
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Moghaddasi
- Department of Neurology, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Ziayi
- Department of Neurosurgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Emamikhah
- Department of Neurology, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Amsellem N, Pistilli B. [Prognostic assessment and treatment of early breast cancer]. Rev Prat 2020; 70:733-737. [PMID: 33739717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Prognostic assessment and treatment of early breast cancer. Breast cancer is the most common cancer occurring in France and worldwide. In 2017 it has been estimated that 59.000 women in France have been diagnosed with breast cancer. Breast cancer prognosis depends on multiple factors: tumor stage (TNM), histology, molecular sub-type and grade. The treatment of early breast cancer usually involves different strategies, such as surgery, chemotherapy, endocrine therapy, targeted therapies and radiotherapy, on the basis of the different sub-types.
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Affiliation(s)
- Noemi Amsellem
- Comité de pathologie mammaire, institut Gustave-Roussy, Villejuif, France
| | - Barbara Pistilli
- Comité de pathologie mammaire, institut Gustave-Roussy, Villejuif, France
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Lange L, Pimperl A, Schulte T, Groene O, Tanke M. [High-cost patients in Germany: General description of utilization and costs]. Z Evid Fortbild Qual Gesundhwes 2020; 153-154:76-83. [PMID: 32540309 DOI: 10.1016/j.zefq.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Studies from different countries have shown that a small number of insured persons (high-cost patients) are responsible for a large portion of health care spending. At the same time, it is assumed that some of these costs could be saved by a better management of this group of people. The aim of this article is to analyze the performance and cost profiles of high-cost patients, to put them in an international comparison, and to derive a better management approach. METHODS Retrospective observation study based on statutory health insurance data from two statutory health insurances for the year 2013. STUDY POPULATION top 5 %, as well as top 1 % of the most expensive insured persons. Identification of characteristics of high-cost patients and international comparison with the Netherlands, the USA, Canada, Spain, England and Japan. RESULTS 5 % of insured persons account for almost half of the total costs and the most expensive 1 % of 22 %. These high-cost patients in Germany are, on average, 20 years older than the general population. Almost every person of the high-cost population was prescribed at least one medication during the study period (99.2 %), and 85.8 % had at least one hospital stay. Hospital care accounts for the biggest part of total costs: 75 % together with drugs. The average per capita costs caused by one of the 5 % most expensive insured persons in the year under review are 20 times higher than that of the other 95 % of insured persons. High-cost patients are generally more multimorbid and have higher mortality rates. The most common diagnoses of these patients are hypertension, lipoprotein metabolism disorder and back pain. CONCLUSION Similar to other developed countries, Germany faces the challenge to develop and implement adequate intervention approaches addressing the special requirements of high-cost insured persons. This paper provides a first basis. The analogies of high-cost patients in Germany and other countries illustrate the need for transnational research and intervention approaches on this specific issue. More in-depth work is needed to investigate the potentials of Predictive Modelling and integrated care approaches to the management of this group of insured persons.
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Zabihi H, Farshidmehr P, Hajebi R, Rahimpour E, Vezvaei P. Management of a Penetrating Thoracic Injury with Thoracoscopy; A Case Study. Adv J Emerg Med 2020; 4:e11. [PMID: 31938780 DOI: 10.22114/ajem.v0i0.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction: Various strategies could be considered dealing with penetrating thoracic injuries. Thoracoscopy is much less invasive than routine thoracotomy approach for managing such cases in which the sharp object remains in the body. The case presented in this article was managed with thoracoscopy for a penetrating dorsolateral thoracic injury. Case Presentation: A 35-year-old man with a penetrating dorsolateral thoracic injury referred to the emergency department. Despite an elevated pulse rate, the patient has proper blood pressure and O2 saturation. Considering the patient's stability and the results of imaging which did not show any massive vascular injury, the patient was taken to the operation room for thoracoscopy. At thoracoscopy, we saw 4 cm of the blade in the thoracic cavity between the third and fourth intercostal space. There was a mild laceration of lung tissue without any active bleeding. Considering the position of the blade and the absence of active bleeding and vascular injury at the trauma site, we successfully removed the blade by the thoracoscope without any complications. Conclusion: Our experience of removing a retained knife by thoracoscopy showed that it can be an appropriate alternative for patients with penetrating thoracic injury who are hemodynamically stable and have appropriate conditions for thoracoscopy.
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Abstract
Challenges in dementia care at home - The situation at home of a married couple Abstract. Background: People with dementia and their relatives are faced with major challenges due to complex dementia symptoms. Families need information and counselling in order to find adequate dementia care services tailored to their needs. AIM This case report's objective is to exemplify the domestic situation of a married couple who is faced with significant challenges within the family and the care system due to the husband's dementia and Parkinson's disease. METHODS The Dementia Care Nurse project included case monitoring; by means of different assessments relevant information was recorded and the family's situation described. RESULTS The family's problems and their need for support were multifaceted and entailed reimbursement of costs, application for care services as well as management of challenging behaviours and reduction of the caregiver's psychosocial burden. CONCLUSIONS The family, particularly the spouse caregiver, was effectively supported in meeting the challenges of dementia, e. g. by drawing on professional services and sorting out entitlement to benefits. From the perspective of the experience in the project, independent counselling structures such as a case management approach are indispenable in order to stabilise the domestic situation.
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Affiliation(s)
- Manuela Grünzig
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg
| | - Christine Schiller
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg
| | - Thomas Klatt
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg
| | - Gabriele Meyer
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg
| | - Stephanie Heinrich
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg
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Breitbart J, Hiller TS, Schöne E, Schelle M, Sauerbrey U, Sommer M, Blank W, Schulz S, Vollmar HC, Wensing M, Margraf J, Gensichen J. [Panic disorder and agoraphobia in general practice: Advantages and pitfalls of a practice team-supported exposure training from the general practitioner's perspective - a qualitative study]. Z Evid Fortbild Qual Gesundhwes 2019; 143:15-20. [PMID: 31176641 DOI: 10.1016/j.zefq.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION For the treatment of anxiety disorders behavior therapy-oriented methods are recommended for primary care as well. Within the trial "Jena-PARADISE" a primary care practice team-supported exposure training for patients with panic disorder with or without agoraphobia was developed and evaluated. The present paper gives an overview of general practitioners' subjective views on the practicability, feasibility and effectiveness of this new intervention for both patients and GP teams. METHODS Questions were operationalized based on Bellg's intervention fidelity framework. Fourteen GPs of the intervention group were sampled purposefully and interviewed in a semi-structured way. Generated data were analyzed following Mayring's content analysis approach. RESULTS The treatment program was positively assessed among the GPs and seen as a useful therapeutic option for inadequately treated patients. The therapy elements 'psycho-education' and 'interoceptive exposure exercises' were described as feasible, while situational exercises and relapse prevention got a less positive rating. The active participation of the nurse in the treatment program was seen as supportive. CONCLUSION From the GP perspective, the treatment program for patients with panic disorder and/or agoraphobia seems to be a viable therapeutic option in primary care.
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Affiliation(s)
- Jörg Breitbart
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | | | - Elisabeth Schöne
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Mercedes Schelle
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Ulf Sauerbrey
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Michael Sommer
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Wolfgang Blank
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Sven Schulz
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Horst Christian Vollmar
- Abteilung für Allgemeinmedizin, Fakultät für Medizin, Ruhr-Universität Bochum, Bochum, Deutschland; Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Michel Wensing
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Jürgen Margraf
- Forschungs- und Behandlungszentrum für psychische Gesundheit, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Jochen Gensichen
- Institut für Allgemeinmedizin, Klinikum der Universität München, München, Deutschland; Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland.
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Michelsen T, Lins C, Gudenkauf S, Hein A, Lüpkes C. Privacy by Design for Integrated Case and Care Management: Receiver-Oriented Encryption in STROKE OWL. Stud Health Technol Inform 2019; 258:110-114. [PMID: 30942725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Research into new forms of care for complex chronic diseases requires substantial efforts in the collection, storage, and analysis of medical data. Additionally, providing practical support for those who coordinate the actual care management process within a diversified network of regional service providers is also necessary. For instance, for stroke units, rehabilitation partners, ambulatory actors, as well as health insurance funds. In this paper, we propose the concept of comprehensive and practical receiver-oriented encryption (ROE) as a guiding principle for such data-intensive, research-oriented case management systems, and illustrate our concept with the example of the IT infrastructure of the project STROKE OWL.
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Affiliation(s)
- Timo Michelsen
- OFFIS - Institute for Information Technology, Div. Health, Oldenburg, Germany
| | - Christian Lins
- OFFIS - Institute for Information Technology, Div. Health, Oldenburg, Germany
| | - Stefan Gudenkauf
- University of Applied Sciences and Arts Hannover, Hannover, Germany
| | - Andreas Hein
- Carl von Ossietzky University Oldenburg, Dep. Health Services Research, Oldenburg, Germany
| | - Christian Lüpkes
- OFFIS - Institute for Information Technology, Div. Health, Oldenburg, Germany
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Imhof M, Eberle-Sejari R, Hagl M, Brusch F, Dieffenbach R, Ganser HG, Grade D, Krstovic-Keusgen D, Münzer A, Naumann A, Tewes A, Witt A, Goldbeck L, Rosner R. [Experiences with an intercultural training for professionals from child-welfare services working with children and adolescents following child abuse and neglect]. Z Kinder Jugendpsychiatr Psychother 2018; 47:204-210. [PMID: 30375938 DOI: 10.1024/1422-4917/a000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Experiences with an intercultural training for professionals from child-welfare services working with children and adolescents following child abuse and neglect Abstract. Background: As part of a multicenter study evaluating measures to improve access to evidenced-based treatment for children and adolescents following child abuse and neglect, we introduced and evaluated migration-adapted services, including a one-day intercultural training. Key issues were the dissemination of information concerning migration and acculturation, trauma and mental health to immigrant families as well as the development of exercises on intercultural competence and culturally sensitive work. Method: Near the end of the research project we gathered experiences and opinions concerning the work with immigrant families using an online survey in a subgroup of case managers working in the project (professionals in child-welfare services). This article presents two case report illustrating the practical relevance of the training's content. Results: Overall, the training was rated positively. In the opinion of the case managers, especially language barriers and cultural diversity should be considered while working with immigrant families. The case reports show that the training sensitized and supported the case managers supported the case managers when dealing with differing illness concepts, differing illness concepts, culture-sensitive assessment, or work with language mediators. Conclusions: The case management work also demonstrated the limitations of the psychosocial care system; the further dissemination of intercultural knowledge is important.
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Affiliation(s)
- Michaela Imhof
- 1 Department Psychologie, Katholische Universität Eichstätt-Ingolstadt
| | | | - Maria Hagl
- 1 Department Psychologie, Katholische Universität Eichstätt-Ingolstadt
| | - Frauke Brusch
- 3 Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Psychiatrische Klinik Lüneburg
| | - Rainer Dieffenbach
- 4 Kinder- und Jugendpsychiatrie, Vestische Kinder- und Jugendklink Datteln, Universität Witten/Herdecke
| | - Helene Gertrud Ganser
- 2 Klinik für Kinder und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm
| | - David Grade
- 4 Kinder- und Jugendpsychiatrie, Vestische Kinder- und Jugendklink Datteln, Universität Witten/Herdecke
| | | | - Annika Münzer
- 2 Klinik für Kinder und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm
| | - Alexander Naumann
- 3 Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Psychiatrische Klinik Lüneburg
| | - Alexander Tewes
- 3 Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Psychiatrische Klinik Lüneburg
| | - Andreas Witt
- 2 Klinik für Kinder und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm
| | - Lutz Goldbeck
- 2 Klinik für Kinder und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm
| | - Rita Rosner
- 1 Department Psychologie, Katholische Universität Eichstätt-Ingolstadt
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Kim H, Park J, Kweon K, Ahn J. Short- and Long-term Effects of Case Management on Suicide Prevention among Individuals with Previous Suicide Attempts: a Survival Analysis. J Korean Med Sci 2018; 33:e203. [PMID: 30079004 PMCID: PMC6070468 DOI: 10.3346/jkms.2018.33.e203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/08/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study examined the long-term preventive effects of a case management service on suicide reattempts, and clarified the factors related to suicide reattempts. METHODS We reviewed the medical records of suicide attempters who visited the emergency department of Ulsan University Hospital from August 28, 2013 to July 31, 2017. A 4-week case management service was provided to consenting participants, either face-to-face or by telephone. Using survival analysis, we analyzed differences in the time to the next emergency department visit for a suicide attempt according to whether participants completed the case management service. We also assessed which characteristics of participants were associated with suicide reattempts. RESULTS We found no overall difference in time to suicide reattempt between case-managed participants and controls over the entire observation period (median period: 19 months). However, in the first 24 weeks after the initial suicide attempt, the case-managed group showed a longer time to reattempt than did the control group (log-rank test = 4.243; P = 0.039). A higher risk of reattempt was found among participants with the medical benefit type of health insurance compared to those with national health insurance (hazard ratio [HR], 5.134; P < 0.001) and among participants aged 20-39 compared to those aged ≥ 60 (HR, 3.502; P = 0.05). CONCLUSION Case management had only short-term benefits (within 24 weeks of initial suicide attempt). Risk factors for suicide reattempts were having a medical benefit health insurance and being aged 20-39 years.
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Affiliation(s)
- Hyeonjae Kim
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jangho Park
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kukju Kweon
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Joonho Ahn
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Seshan V, Alkhasawneh E, Al Kindi S, Al Simadi FAM, Arulappan J. Can Gestational Anemia be Alleviated with Increased Awareness of its Causes and Management Strategies? Implications for Health Care Services. Oman Med J 2018; 33:322-330. [PMID: 30038732 DOI: 10.5001/omj.2018.59] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives We conducted this study to assess the risk factors of gestational anemia and evaluate the effectiveness of a culturally-tailored nutrition educational intervention on hemoglobin (Hb) status among pregnant Omani women. Newborn birthweight was used as a birth outcome. Methods The study was conducted in two phases. The first phase investigated the risk factors associated with gestational anemia in 206 Omani women who were 3 20 years old and had at least completed 12 weeks of gestation. A suitable sample was recruited at a tertiary teaching hospital in Muscat, Oman. Hb status was recorded, and backward linear regression was used to analyze the demographic and obstetric variables associated with Hb levels. In the second phase, a specially designed culturally-tailored nutrition educational intervention was delivered to women in the study group by trained research assistants whereas women in the control group received routine care only. The Hb levels of the pregnant women and birth weight of newborns after the intervention were evaluated in the second phase of the study. Results The prevalence of gestational anemia among 206 pregnant Omani women was 41.7%. A significant negative relationship was found between Hb and parity whereas a positive relationship was found between Hb and gestational age. The Hb level increased as the gestational age advanced (β = 0.31, p < 0.050) and decreased as the parity increased (β = -0.22, p < 0.050). The pre-post mean difference of Hb levels in the study group was 11.0 g/dL and in the control group was 10.7 g/dL. The difference between the pre- and post-test Hb levels for the study group was significant (t = 3.58, p = 0.001), indicating that the culturally-tailored nutrition education intervention was effective in improving the Hb level in pregnant Omani women. No significant difference was found between the study and control group with respect to birth outcomes. Conclusion The prevalence of gestational anemia is high in pregnant Omani women. The use of a specially designed culturally-tailored nutrition education intervention for pregnant women supplemented with follow-up reminders can reduce the occurrence of gestational anemia. Such programs are ultimately necessary in light of the high prevalence of gestational anemia in developing countries.
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Affiliation(s)
- Vidya Seshan
- Maternal and Child Health Nursing, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Esra Alkhasawneh
- Maternal and Child Health Nursing, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Salam Al Kindi
- Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Judie Arulappan
- Maternal and Child Health Nursing, College of Nursing, Sultan Qaboos University, Muscat, Oman
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Abstract
BACKGROUND Case management has been adopted in Korea and been recognized as a promising care-coordination method that lowers costs and improves quality of care. However, the effectiveness of case management among individuals with chronic illnesses who reside in the community has yet to be established. AIM This systematic review identifies and synthesizes recent evidence of case management's effectiveness in managing chronic illnesses among adults in Korea. METHODS The methodology of this systematic review was guided by the Cochrane processes and PRISMA statements. A search of multiple bibliographic databases to identify studies of case management in the populations of Koreans adult with chronic illnesses was conducted. Studies that met the inclusion criteria were published in English or Korean. Nine empirical peer-reviewed studies published between 2008 and 2016 were selected for review. RESULTS The retrieved studies show that case management programmes in Korea for adults with chronic illness in the community were led by nurses. There was strong evidence that nurse-led case management was effective in improving psychobehavioural and objective clinical outcomes; however, results for health services utilization outcomes were mixed. CONCLUSION In future, research with rigorous study designs and large sample size in multiple settings are needed to further assess the effectiveness of case management in Korea. IMPLICATIONS FOR NURSING AND HEALTH POLICY Nurse-led case management would be of support in the care of chronic illnesses not only in Korea but also in Asian countries which share standard practice of case management with Korea. Nursing leaders should allocate resources to sponsor educational resources and practical strategies for evidence-based case management.
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Affiliation(s)
- J Y Joo
- College of Nursing, Gachon University, Incheon, Korea
| | - M F Liu
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Dawson S, Lawn S, Simpson A, Muir-Cochrane E. Care planning for consumers on community treatment orders: an integrative literature review. BMC Psychiatry 2016; 16:394. [PMID: 27832769 PMCID: PMC5105250 DOI: 10.1186/s12888-016-1107-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 11/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Case management is the established model for care provision in mental health and is delivered within current care philosophies of person-centred and recovery-oriented care. The fact that people with a mental illness may be forced to receive care and treatment in the community poses challenges for clinicians aiming to engage in approaches that promote shared decision-making and self-determination. This review sought to gain an in-depth understanding of stakeholders' perspectives and experiences of care planning for consumers' on CTOs. METHODS An integrative review method allowed for inclusion of a broad range of studies from diverse empirical sources. Systematic searches were conducted across six databases. Following appraisal, findings from included papers were coded into groups and presented against a framework of case management. RESULTS Forty-eight papers were included in the review. Empirical studies came from seven countries, with the majority reporting on qualitative methods. Many similarities were reported across studies. Positive gains from CTOs were usually associated with the nature of support received, highlighting the importance of the therapeutic relationship in care planning. Key gaps in care planning included a lack of connection between CTO, treatment and consumer goals and lack of implementation of focussed interventions. CONCLUSIONS Current case management processes could be better utilised for consumers on CTOs, with exploration of how this could be achieved warranted. Workers need to be sensitive to the 'control and care' dynamic in the care planning relationship, with person-centred approaches requiring core and advanced practitioner and communication skills, including empathy and trust.
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Affiliation(s)
- Suzanne Dawson
- School of Nursing & Midwifery, Flinders University, GPO Box 2100, Adelaide, 5001, Australia.
| | - Sharon Lawn
- School of Medicine, Flinders University, Adelaide, Australia
| | - Alan Simpson
- School of Health Sciences, Nursing, City University London, London, UK
| | - Eimear Muir-Cochrane
- School of Nursing & Midwifery, Flinders University, GPO Box 2100, Adelaide, 5001, Australia
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Liptzin DR, Gleason MC, Cicutto LC, Cleveland CL, Shocks DJ, White MK, Faino AV, Szefler SJ. Developing, Implementing, and Evaluating a School-Centered Asthma Program: Step-Up Asthma Program. J Allergy Clin Immunol Pract 2016; 4:972-979.e1. [PMID: 27283054 DOI: 10.1016/j.jaip.2016.04.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 04/19/2016] [Accepted: 04/26/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Asthma is a significant health problem among children: 9.3% of children in the United States suffer from asthma. Children with persistent asthma in inner cities have increased health care utilization, worse health care outcomes, increased school absences, and worse academic performance. OBJECTIVE We sought to create and evaluate a school-centered asthma program to reduce asthma morbidity and create asthma-friendly schools. METHODS We developed, implemented, and evaluated the Step-Up Asthma Program, a multidisciplinary school-centered asthma program. The program was designed as an outreach program with asthma counselors as a bridge between subspecialty asthma care, primary care providers, school nurses, and children with asthma. The core components of the program involve identifying children with asthma, providing evidence-based asthma education, and case management. Students' asthma knowledge, inhaler technique, and number of asthma exacerbations were evaluated over a 2-year period (2010-2012) as a pre-post study. RESULTS A total of 252 students enrolled in the Step-Up Asthma Program over a 2-year period. Significant improvements were noted in number of asthma action plans, rescue medications at school, and asthma controllers. Program participants had significant improvements in asthma knowledge scores (P < .001) and inhaler technique (P < .0001). There were significant reductions in asthma exacerbations defined as oral steroid courses, urgent care visits, and missed school days (P < .05) that persisted over time. CONCLUSIONS A guideline-based school-centered asthma program can significantly reduce asthma morbidity. The asthma counselor is the cornerstone of the program, providing asthma education and care coordination. The Step-Up Asthma Program is in its 10th year, and we believe the key elements of this program can be implemented in other school systems.
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Affiliation(s)
- Deborah R Liptzin
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; The Breathing Institute, Children's Hospital Colorado, Aurora, Colo
| | - Melanie C Gleason
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; The Breathing Institute, Children's Hospital Colorado, Aurora, Colo
| | - Lisa C Cicutto
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; Department of Medicine, National Jewish Health, Denver, Colo
| | | | | | - Martha K White
- The Breathing Institute, Children's Hospital Colorado, Aurora, Colo; Denver Public Schools, Denver, Colo
| | - Anna V Faino
- Department of Medicine, National Jewish Health, Denver, Colo
| | - Stanley J Szefler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; The Breathing Institute, Children's Hospital Colorado, Aurora, Colo.
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Park S, Choi KH, Oh Y, Lee HK, Kweon YS, Lee CT, Lee KU. Clinical Characteristics of the Suicide Attempters Who Refused to Participate in a Suicide Prevention Case Management Program. J Korean Med Sci 2015; 30:1490-5. [PMID: 26425048 PMCID: PMC4575940 DOI: 10.3346/jkms.2015.30.10.1490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 07/07/2015] [Indexed: 11/21/2022] Open
Abstract
Case management interventions for suicide attempters aimed at helping adjust their social life to prevent reattempts have high nonparticipation and dropout rates. We analyzed the clinical characteristics of the group who refused to participate in the suicide prevention program in Korea. A total of 489 patients with a suicide attempt who visited Uijeongbu St. Mary's Hospital, the Catholic University of Korea, from December 2009 to December 2013 were analyzed. All patients were divided into the participation group (n = 262) and the refusal group (n = 227) according to their participation in the case management program. Demographic and clinical characteristics of each group were examined. Results showed that the refusal group had low risks for suicide in terms of risk factors related with psychopathologies and presenting suicide behavior. That is, the refusal group had less patients with co-morbid medical illnesses and more patients with mild severity of depression compared to the participation group. However, the refusal group had more interpersonal conflict, more isolation of social integrity, and more impaired insight about suicide attempt. The results suggest that nonparticipation in the case management program may depend upon the patient's impaired insight about the riskiness of suicide and lack of social support.
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Affiliation(s)
- Soyoung Park
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychology, Sogang University, Seoul, Korea
| | - Kyoung Ho Choi
- Department of Emergency Medicine Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngmin Oh
- Department of Emergency Medicine Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae-Kook Lee
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Sil Kweon
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chung Tai Lee
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung-Uk Lee
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
Over the past decade, Medicare has tested care coordination programs in an effort to achieve the triple aim of improving the patient experience, improving population health, and lowering costs. Although savings from this promising concept have not materialized, private payers are starting to offer blended payments to primary care. From these demonstrations, we propose 5 lessons for practices implementing care coordination: (1) minimize expenses by sharing resources and avoiding cost ineffective interventions; (2) concentrate on high utilizers; (3) foster relationships with both providers and patients; (4) track patients across the medical neighborhood in real time; and (5) extend rather than a duplicate the efforts of primary care practices.
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Pakdaman A, Yarahmadi Z, Kharazifard MJ. Self-Reported Knowledge and Attitude of Dentists towards Prescription of Fluoride. J Dent (Tehran) 2015; 12:550-6. [PMID: 27123013 PMCID: PMC4847159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study aimed to assess the self-reported knowledge and attitude of dentists towards fluoride prescription. MATERIALS AND METHODS A questionnaire survey was conducted at the national annual dental congress in 2010 in Tehran-Iran. Dentists' level of knowledge about the preventive effects of systemic and topical administration of fluoride was assessed as well as their attitudes towards its application. Self-reported practice for two paper patients (a child and an adult with high risk of dental caries) was assessed. Data were analyzed using SPSS, chi-square test and logistic regression. RESULTS A total of 347 dentists including 232 (73.4%) males and 84 (26.6%) females responded; 84.7% agreed/strongly agreed with addition of fluoride to water and 66% agreed with prescription of fluoride tablets/drops in fluoride-deficient areas. Fluoridated toothpastes were considered useful by 85.3%; this rate was 78.7% for fluoride rinse and 87.6% for fluoride varnish, foam or gel. The majority of dentists (67.4%) reported no access to clear guidelines on fluoride application; 83% considered fluoride to be effective for caries prevention in children less than 12 years and 39.2% believed it was useful for adults and adolescents; 50% of the respondents correctly managed the high-risk child and adult with respect to appropriate selection of fluoride product. Younger dentists (OR=0.94; 95% CI 0.8-0.9; P=0.043) and new graduates (OR=0.94; 95% CI 0.89-0.99; P=0.034) were more likely to correctly manage the high-risk child. CONCLUSION Dentists had good knowledge and positive attitudes towards fluoride application. New graduates were more likely to correctly manage the young high-risk patient.
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Affiliation(s)
- Afsaneh Pakdaman
- Assistant Professor, Research Center for Caries Prevention, Dental Research Center Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran,Assistant Professor, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author: A Pakdaman, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran,
| | - Zahra Yarahmadi
- Dentist, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Kharazifard
- Postgraduate Student of Epidemiology, Dental Research Center Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
BACKGROUND Care management in primary care can be effective in helping patients with chronic disease improve their health; however, primary care practices are often challenged to identify revenue to pay for it. This study explored the impact of direct reimbursement on the provision of care management in a primary care physician organization. METHODS Using data on expenses and health plan reimbursement during the initial 16 months of care management implementation at 5 practices, we calculated the percentage of related costs that were covered by payments. Qualitative data from interviews with practice members were used to identify their perceived barriers to care management reimbursement and the impact of current reimbursement strategies on service delivery. RESULTS Direct reimbursement for care management covered only 21% of the costs. Reimbursement varied by care manager background, patient diagnoses, insurer, and indication for the visit. Barriers to gaining reimbursement included patient resistance to copay, clinician hesitation to bill for care management visits (for fear the patient may receive a bill), differential reimbursement policies of insurers, and general lack of reimbursement for care management in many cases. Although practice-level quality improvement incentives were an alternative means of supporting care management, because these incentives were not directly tied to the service of care management, they were used for other activities ultimately supporting patient care. CONCLUSIONS This study highlights the need for sufficient reimbursement to initiate and maintain care management for patients in primary care as proposed for service reforms under the Affordable Care Act.
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Hatten JL. Traumatic brain injury community case management: issues, impact and Hispanic orientation. NeuroRehabilitation 1998; 10:51-9. [PMID: 24525816 DOI: 10.3233/nre-1998-10106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Community Case Management (or Case Management Services) is defined and distinguished from insurance, hospital, non-profit and independent case management. The areas of focus of Community Case Management - disseminating information, personal adjustment counseling and acting as a personal resource - are defined and explained. A Community Case Management services program is summarized and the results of community case management are documented. Case Management with the Hispanic population is discussed. Two case studies are presented, one for a young Hispanic man and the other for a young Anglo man. Suggestions for working with a Hispanic case load are discussed.
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Affiliation(s)
- J L Hatten
- Traumatic Brain Injury Project, 950 S. Bascom Ave., Suite 2011, San Jose, CA 95128, USA
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