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Wagner W, Doyle TA, Francomano CA, Knight DRT, Halverson CME. Patient interest in the development of a center for Ehlers-Danlos syndrome/hypermobility spectrum disorder in the Chicagoland region. Orphanet J Rare Dis 2024; 19:122. [PMID: 38486236 PMCID: PMC10938836 DOI: 10.1186/s13023-024-03109-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/29/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The Ehlers-Danlos Syndromes (EDS) are a group of connective tissue disorders that are hereditary in nature and characterized by joint hypermobility and tissue fragility. The complex nature of this unique patient population requires multidisciplinary care, but appropriate centers for such care do not exist in large portions of the country. Need for more integrated services has been identified in Chicagoland, or Chicago and its suburbs. In order to explore and begin to address barriers to seeking appropriate care facing EDS patients in this region, we developed an online survey which we circulated through EDS social media groups for Chicagoland patients. RESULTS Three hundred and nine unique respondents participated. We found that there exists a strong medical need for and interest in the development of a center in the region, and participants reported that, if made available to them, they would make extensive and regular use of such a facility. CONCLUSIONS We conclude that the establishment of a collaborative medical center specializing in the diagnosis and treatment of EDS, Hypermobility Spectrum Disorder, and related disorders in the Chicagoland area would greatly benefit patients by providing comprehensive care, alleviate the burden on overworked healthcare providers, and contribute to the sustainability of medical facilities.
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Affiliation(s)
| | - Tom A Doyle
- Center for Bioethics, Indiana University School of Medicine, 410 W 10th St, HITS 3133, Indianapolis, IN, 46202, USA
| | - Clair A Francomano
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dacre R T Knight
- Department of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Colin M E Halverson
- Center for Bioethics, Indiana University School of Medicine, 410 W 10th St, HITS 3133, Indianapolis, IN, 46202, USA.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Anthropology, Indiana University, Indianapolis, IN, USA.
- Charles Warren Fairbanks Center for Medical Ethics, Indianapolis, IN, USA.
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Jones HE, Andringa K, Carroll S, Johnson E, Horton E, O'Grady K, Stanford D, Renz C, Thorp J. Comprehensive Treatment for Pregnant and Parenting Women with Substance Use Disorders and Their Children: The UNC Horizons Story. Matern Child Health J 2024; 28:409-425. [PMID: 38189846 DOI: 10.1007/s10995-023-03870-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVES To describe how the UNC Horizons program, a comprehensive women-centered program for pregnant and parenting women with substance use disorders, and its patient population have changed over time and summarize basic neonatal outcomes for infants born to women in treatment at Horizons. METHODS Yearly Annual Reports from fiscal years of 1994 to 2017 were abstracted. Patient characteristics and infant outcomes compared to normative North Carolina data were examined. RESULTS Highlights of findings include: The percentage of women for whom opioids were the primary substance of use increased from 0% in 1995-1996 to 62% in 2016-17, while cocaine decreased from 66 to 12%. Intravenous substance use history increased from 7% in 1994-1995 to 41% in 2016-2017. The number of women reporting a history of incarceration rose from 10-20% in the early years to 40%-50% beginning in 2007-2008. The proportion of women reporting a desire to hurt themselves rose from 20% in 2004-2005 to 40% in 2016-2017. Self-reported suicide attempt history remained consistent at 32% across years. While reporting of childhood physical abuse remained at 38% across years, reporting of sexual abuse and domestic violence trended upward. Horizons did not differ from North Carolina in the likelihood of patients giving birth prematurely [χ2(13) = 20.6,p = .082], or the likelihood of a patient giving birth to a low birthweight infant [χ2(13) = 14.7,p = .333]. CONCLUSIONS FOR PRACTICE Breaking the cycle of addiction for women and children must focus on helping women with substance use problems develop a sense of hope that their lives can improve, and a sense of feeling safe and nurtured.
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Affiliation(s)
- Hendrée E Jones
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 410 North Greensboro Street, Suite 220, Carrboro, NC, 27510, USA.
- Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD, 21224, USA.
| | - Kim Andringa
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 410 North Greensboro Street, Suite 220, Carrboro, NC, 27510, USA
| | - Senga Carroll
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 410 North Greensboro Street, Suite 220, Carrboro, NC, 27510, USA
| | - Elisabeth Johnson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 410 North Greensboro Street, Suite 220, Carrboro, NC, 27510, USA
| | - Evette Horton
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 410 North Greensboro Street, Suite 220, Carrboro, NC, 27510, USA
| | - Kevin O'Grady
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
| | - Deborah Stanford
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 410 North Greensboro Street, Suite 220, Carrboro, NC, 27510, USA
| | - Connie Renz
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 410 North Greensboro Street, Suite 220, Carrboro, NC, 27510, USA
| | - John Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 410 North Greensboro Street, Suite 220, Carrboro, NC, 27510, USA
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Sève P, Morlat P, Ranque B, Lavigne C, Bourgarit A, Rauzy O, Godeau B, Mouthon L. [Messages from the estates general on French internal medicine]. Rev Med Interne 2024; 45:69-78. [PMID: 38290857 DOI: 10.1016/j.revmed.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
Internal medicine is a medical specialty that is often poorly understood by the general public and sometimes misidentified. In an era of increasing subspecialization and high technicality, it is characterized by a comprehensive approach centered on clinical evaluation. Unlike what is observed in most developed countries, where systemic autoimmune diseases are managed by organ specialists based on their mode of presentation, French internists are at the forefront for diagnosing and managing these diseases. Their multidisciplinary training gives them legitimacy to justify this role. Internists also play a crucial role in the management of patients requiring unplanned hospitalizations downstream from emergency departments and in connection with primary care. Internists primarily practice in a hospital setting, with a specific position in the French healthcare system aligned with the training frameworks of all medical specialties. To better define internal medicine, its role in care activities, as well as in education and research, internists organized a General Assembly of internal medicine that took place on September 28, 2023, in Paris. Structured around think tanks focusing on care, education, and research activities, the general assembly aimed to improve visibility on internal medicine and internists. This article recounts the discussions that animated this meeting and highlights the main ideas that emerged. These general assemblies constitute a foundational step and will be followed by a Consultation Conference in order to better identify and promote internal medicine and internists, regardless of their types and places of practice.
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Affiliation(s)
- P Sève
- Service de médecine interne, centre de référence maladies auto-inflammatoires et des amyloses, hôpital universitaire Croix-Rousse, hospices civils de Lyon, Lyon, France; Research on Healthcare Performance (RESHAPE), Inserm U1290, université Claude-Bernard Lyon 1, Lyon, France.
| | - P Morlat
- Service de médecine interne et maladies infectieuses, CHU et université de Bordeaux, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France
| | - B Ranque
- Service de médecine interne, centre de référence des maladies héréditaires du globule rouge, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris-Centre, université Paris Cité, Paris, France
| | - C Lavigne
- Service de médecine interne-immunologie clinique, centre de référence des maladies auto-immunes et auto-inflammatoires rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe, CHU d'Angers, université d'Angers, Angers, France
| | - A Bourgarit
- Service de médecine interne polyvalente et immunologie clinique, hôpital Jean-Verdier, HUPSSD AP-HP, université Sorbonne Paris Nord, Bondy, France; Immunité, infection et cancer des cellules NK & T UMRS SU - Inserm U1135 - CNRS EMR 8255, faculté de médecine Sorbonne université, 91, boulevard de l'Hôpital, 75013 Paris, France; Conseil National Professionnel (CNP) de Médecine Interne, Paris, France
| | - O Rauzy
- Institut universitaire du cancer Toulouse Oncopole, Toulouse University Hospital, Toulouse, France
| | - B Godeau
- Service de médecine interne, centre de référence des cytopénies auto-immunes de l'adulte, CHU Henri-Mondor, AP-HP, UPEC, Créteil, France
| | - L Mouthon
- Service de médecine interne, centre de référence maladies auto-immunes et auto-inflammatoires systémiques rares d'Ile de France, de l'Est et de l'Ouest, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, université Paris Cité, Paris, France
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Mabuza LH, Moshabela M. What do medical students and their clinical preceptors understand by primary health care in South Africa? A qualitative study. BMC Med Educ 2023; 23:785. [PMID: 37864172 PMCID: PMC10589924 DOI: 10.1186/s12909-023-04751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/05/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND The definition of Primary Health Care (PHC) issued by the World Health Organisation in 1978 indicated that essential health care should be made accessible to individuals and their communities close to where they live and work. In 1992 Starfield articulated the four pillars of PHC: the patient's first contact with healthcare, comprehensive care, coordinated care and continuous care. Using this literature guidance, this study sought to explore what undergraduate medical students and their clinical preceptors understood by PHC in four South African medical schools. METHODS A qualitative study using the phenomenological design was conducted among undergraduate medical students and their clinical preceptors. The setting was four medical schools in South Africa (Sefako Makgatho Health Sciences University, Walter Sisulu University and the University of KwaZulu-Natal and the Witwatersrand University). A total of 27 in-depth interviews were conducted among the clinical preceptors and 16 focus group discussions among the students who were in their clinical years of training (MBChB 4-6). Interviews were digitally recorded and transcribed verbatim, followed by thematic data analysis using the MAXQDA 2020 (Analytics Pro) software. RESULTS Four themes were identified in which there were similarities between the students and their preceptors regarding their understanding of PHC: (1) PHC as the patient's first contact with the healthcare system; (2) comprehensive care; (3) coordination of care and (4) continuity of care. A further two themes were identified in which these two groups were not of similar understanding: (5) PHC as a level or an approach to healthcare and (6) the role of specialist clinical preceptors in PHC. CONCLUSIONS Medical students and their clinical preceptors displayed an understanding of PHC in line with four pillars articulated by Starfield and the WHO definition of PHC. However, there remains areas of divergence, on which the medical schools should follow the guidance provided by the WHO and Starfield for a holistic understanding of PHC.
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Affiliation(s)
- Langalibalele Honey Mabuza
- School of Medicine, Clinical Integrated Programs, Sefako Makgatho Health Sciences University, 0012, Pretoria, South Africa.
| | - Mosa Moshabela
- Research and Innovation, University of KwaZulu-Natal, 4001, Durban, South Africa
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Ambushe SA, Awoke N, Demissie BW, Tekalign T. Holistic nursing care practice and associated factors among nurses in public hospitals of Wolaita zone, South Ethiopia. BMC Nurs 2023; 22:390. [PMID: 37853394 PMCID: PMC10583383 DOI: 10.1186/s12912-023-01517-0] [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: 05/27/2023] [Accepted: 09/17/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Holistic nursing care is an approach to patient care that takes into account the physical, social, spiritual, and psychological needs of the patient. Providing holistic care has been found to be an effective way to prevent diseases and death, as well as improve the quality of healthcare provided to patients. However, despite its perceived benefits, many nurses lack experience with holistic care and only focus on patients' physical needs, treating them as biological machines while ignoring their spiritual, mental, and social needs. Therefore, this study aimed to assess the practice of holistic nursing care and its associated factors among nurses. METHODS A hospital-based cross-sectional study was conducted among 422 sampled Nurses working in public hospitals in Wolaita Zone. Systematic random sampling was applied to select the study participants. A self-administered, pretested questionnaire was used to collect the data. The collected data were entered into Epi Data version 4.6 and analyzed using SPSS version 25. Binary and multivariable logistic regression analyses were used to identify factors associated with holistic nursing care practice. Statistical significance was declared at a p-value less than 0.05. The strength of the association was indicated by the AOR and 95% CI. RESULT The study found that the overall practice of holistic nursing care was 21%. Nurses with a diploma in nursing (AOR: 0.28; 95% CI: 0.11, 0.71), nurses working in a hospital with no continuous in-service learning (AOR: 0.39; 95% CI: 0.20, 0.76), nurses with a poor relationship with patients (AOR: 0.31; 95% CI: 0.16, 0.58), and nurses with poor knowledge of holistic nursing care practice (AOR: 0.41; 95% CI: 0.21, 0.7) were factors associated with a lower likelihood of practicing holistic nursing care. CONCLUSION This study found that the practice of holistic nursing care among nurses working in public hospitals in the Wolaita Zone was low. Level of education, the unit of work, continuous in-service learning, the nurse-patient relationship, and the knowledge of nurses were factors associated with holistic nursing care. The provision of in-service training and the creation of trusting, positive relationships were suggested to improve the practice of holistic nursing care.
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Affiliation(s)
- Selamawit Ataro Ambushe
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Nefsu Awoke
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Birhanu Wondimeneh Demissie
- School of Nursing and Midwifery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Tiwabwork Tekalign
- School of Nursing, College of Medicine and Health Science, Arbaminch University, Arbaminch, Ethiopia
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Ally M, Balandya E. Current challenges and new approaches to implementing optimal management of sickle cell disease in sub-Saharan Africa. Semin Hematol 2023; 60:192-199. [PMID: 37730472 PMCID: PMC10909340 DOI: 10.1053/j.seminhematol.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/01/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
Sickle cell disease (SCD) is the most common life-threatening monogenic disorder in the world. The disease is highly prevalent in malaria endemic areas with over 75% of patients residing in Sub-Saharan Africa (SSA). It is estimated that, without proper care, up to 90% of children with SCD will not celebrate their fifth birthday. Early identification and enrolment into comprehensive care has been shown to reduce the morbidity and mortality related with SCD complications. However, due to resource constraints, the SSA is yet to implement universal newborn screening programs for SCD. Furthermore, care for patients with SCD in the region is hampered by the shortage of qualified healthcare workers, lack of guidelines for the clinical management of SCD, limited infrastructure for inpatient and outpatient care, and limited access to blood and disease modifying drugs such as Hydroxyurea which contribute to poor clinical outcomes. Curative options such as bone marrow transplant and gene therapy are expensive and not available in many SSA countries. In addressing these challenges, various initiatives are ongoing in SSA which aim to enhance awareness on SCD, improve patient identification and retention to care, harmonize the standards of care for SCD, improve the skills of healthcare workers and conduct research on pertinent areas in SCD in the SSA context. Fortifying these measures is paramount to improving the outcomes of SCD in SSA.
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Affiliation(s)
- Mwashungi Ally
- Sickle Pan African Research Consortium, Tanzania site Sickle Cell Program Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania.
| | - Emmanuel Balandya
- Sickle Pan African Research Consortium, Tanzania site Sickle Cell Program Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
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Nasser A, Iddy H. Setting up a network of comprehensive care for patients with chronic myeloid leukemia: Lessons learned from Tanzania. Semin Hematol 2023; 60:204-208. [PMID: 37429792 DOI: 10.1053/j.seminhematol.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/13/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023]
Abstract
Over the last 2 decades, the introduction of targeted therapies and the advances in the detection of BCR::ABL1 oncogene have dramatically improved comprehensive care for patients with Chronic myeloid leukemia (CML). The once deadly malignancy has now transformed into a chronic disease with an overall patient survival approaching that of the age-matched general population. While excellent prognoses have been reported among CML patients in high-income countries, it is unfortunately not the same for those living in low and middle-income (LMIC) countries such as Tanzania. This disparity is largely contributed by barriers associated with the provision of comprehensive care including early diagnosis, access to treatment, and regular monitoring of the disease. In this review, we will share our experiences and lessons learned in setting up a network of comprehensive care for patients with CML in Tanzania.
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Affiliation(s)
- Ahlam Nasser
- Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Hamisa Iddy
- Department of Oncology, Ocean Road Cancer Institute, Tanzania
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Gupta M, Kankaria A, Sahoo SS, Bhatnagar S, Kakkar R, Grewal A, Pruthi G, Goyal LD. Comprehensive coordinated community based palliative care (C3PaC) model for cancer patients in North India: a mixed-method implementation research study protocol. BMC Palliat Care 2023; 22:61. [PMID: 37217912 DOI: 10.1186/s12904-023-01184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Cancer remains an escalating and challenging public health issue. The management, especially palliative care (PC), is disintegrated and out of reach of in need patients. The overall aim of the project is to develop a feasible and scalable Comprehensive Coordinated Community based PC model for Cancer Patients (C3PaC); congruent with socio-cultural, context and unmet needs in north India. METHODS A mixed method approach will be used for three-phased pre- and post-intervention study in one of the districts of North India, having a high incidence of cancer. During phase I, validated tools will be used for quantitative assessment of palliative needs among cancer patients and their caregivers. Barriers and challenges for provision of palliative care will be explored using in-depth interviews and focus group discussions among participants and health care workers. The findings of phase I along with inputs from national experts and literature review will provide inputs for the development of the C3PAC model in phase II. During phase III C3PAC model will be deployed over a period of 12 months and its impact assessed. Categorical and continuous variables will be depicted as frequency (percentages) and mean ± SD/median (IQR) respectively. Chi-square test/Fischer test, independent samples Student t-tests and Mann-Whitney U tests will be used for categorical, normally and non-normally distributed continuous variables, respectively. Qualitative data will be analyzed using thematic analysis using Atlas.ti 8 software. DISCUSSION The proposed model is designed to address the unmet palliative care needs, to empower community-based healthcare providers in comprehensive home-based PC and to improve the quality of life of cancer patients and caregivers. This model will provide pragmatic scalable solutions in comparable health systems particularly in low- and lower-middle Income countries. TRIAL REGISTRATION The study has been registered with the Clinical Trial Registry-India (CTRI/2023/04/051357).
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Affiliation(s)
- Mayank Gupta
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, India.
| | - Ankita Kankaria
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, India
| | - Soumya Swaroop Sahoo
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, India
| | | | - Rakesh Kakkar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, India
| | - Anju Grewal
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Gegal Pruthi
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Lajya Devi Goyal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bathinda, India
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Wang S, He L, Liu S, Zhang X. Comparing the impact of comprehensive care with conventional care in children with congenital heart disease: a systematic review and meta-analysis. Transl Pediatr 2023; 12:417-428. [PMID: 37035398 PMCID: PMC10080480 DOI: 10.21037/tp-23-96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/20/2023] [Indexed: 04/11/2023] Open
Abstract
Background This study compares the impact of comprehensive care and conventional care on interventional therapy in children with congenital heart disease and to provide a reference basis for clinical care. Methods Clinical randomized controlled trials (RCTs) examining care during interventional therapy in children with congenital heart disease were identified in the PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang databases using a combination of subject terms and free terms. The retrieval time was from the establishment of the database to November 27th, 2022. The control group was given conventional care and the experimental group was given comprehensive care on the basis of conventional care. The outcome indicators included one or more of postoperative complications (number of cases), puncture time (minutes), pain score (points), surgical operation time (minutes), X-ray exposure time (minutes) and length of hospital stay (days). Meta-analysis was performed using Stata 14.0 software. The publication bias test was conducted using Harbor's test. Results A total of 24 RCTs were eventually included, and a total of 2,028 study subjects were enrolled, including 1,025 in the test group and 1,003 in the control group. Meta-analysis showed that comprehensive care resulted in a lower risk of complications [risk ratio (RR) =0.27; 95% confidence interval (CI): 0.21 to 0.34]. Furthermore, subjects who received comprehensive care had lower puncture time [standardized mean difference (SMD) =-2.50; 95% CI: -3.23 to -1.77], lower operating time [SMD (95% CI): -2.50 (-3.31, -1.68)], lower X-ray exposition time [SMD (95% CI): -1.29 (-2.51, -0.07)], shorter length of hospital stay [SMD (95% CI): -1.57 (-2.04, -1.09)], and lower pain scores [SMD (95% CI): -2.43 (-3.20, -1.65)]. Conclusions Comprehensive care has higher clinical utility, which is worthy of clinical application and popularization.
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Affiliation(s)
- Shijian Wang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Limei He
- Department of Pediatrics, Hainan Western Central Hospital, Danzhou, China
| | - Shengnan Liu
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Xiangyun Zhang
- Department of Cardiovascular Medicine for Children, Hainan Women and Children’s Medical Center, Haikou, China
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Christopher H, Burns A, Josephat E, Makani J, Schuh A, Nkya S. Using DNA testing for the precise, definite, and low-cost diagnosis of sickle cell disease and other Haemoglobinopathies: findings from Tanzania. BMC Genomics 2021; 22:902. [PMID: 34915846 PMCID: PMC8679995 DOI: 10.1186/s12864-021-08220-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Sickle cell disease (SCD) is an important cause of under-five mortality. Tanzania is the 5th country in the world with the highest births prevalence of SCD individuals. Significant advances in the neonatal diagnosis of SCD using rapid point-of-care testing have been made. However genetic confirmation is still required for positive cases, in uncertain cases, in multiply transfused patients, to resolve compound heterozygosity (Hb S/ β0 Thal or Hb S/ β+ thal) not uncommon in the coastal regions of East Africa and increasingly also for pre-marital counselling and potentially for future curative approaches such as gene therapy. The currently available DNA tests are prohibitively expensive. Here, we describe an easy-to-use, affordable and accurate β-globin sequencing approach that can be easily integrated within existing NBS for SCD and other haemoglobinopathies especially in Low- and Middle-income Countries. Aim To evaluate an affordable DNA technology for the diagnosis of Sickle cell disease and other haemoglobinopathies in a resource-limited setting. Methods Laboratory-based validation study was conducted by Muhimbili University of Health and Allied Sciences and the University of Oxford involving sequencing of the entire β -haemoglobin locus using the Oxford Nanopore MinION platform. A total number of 36 Dried blood spots and whole blood samples were subjected to conventional protein-based methods (isoelectric focusing, HPLC), and/or sequenced by the Sanger method as comparators. Results Sequencing results for SCD using the MinION were 100% concordant with those from the Sanger method. In addition, the long-read DNA sequencing method enabled the resolution of cases with unusual phenotypes which make up 1% of all children in Tanzania. The cost is £11/ sample for consumables, which is cheaper compared to other sequencing platforms. Conclusions This is the first report of a comprehensive single DNA assay as a definitive diagnostic test for SCD and other haemoglobinopathies. The test is fast, precise, accurate and affordable.
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Affiliation(s)
- Heavenlight Christopher
- Sickle cell programme, Department of haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Adam Burns
- Oxford Molecular Diagnostics Centre, University of Oxford, Oxford, UK
| | - Emmanuel Josephat
- Sickle cell programme, Department of haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julie Makani
- Sickle cell programme, Department of haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna Schuh
- Sickle cell programme, Department of haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Oxford Molecular Diagnostics Centre, University of Oxford, Oxford, UK
| | - Siana Nkya
- Sickle cell programme, Department of haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Biological Sciences, Dar es Salaam University College of Education (DUCE), Dar es Salaam, Tanzania
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Thanapongsatorn P, Chaikomon K, Lumlertgul N, Yimsangyad K, Leewongworasingh A, Kulvichit W, Sirivongrangson P, Peerapornratana S, Chaijamorn W, Avihingsanon Y, Srisawat N. Comprehensive versus standard care in post-severe acute kidney injury survivors, a randomized controlled trial. Crit Care 2021; 25:322. [PMID: 34465357 PMCID: PMC8406590 DOI: 10.1186/s13054-021-03747-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/25/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Currently, there is a lack of evidence to guide optimal care for acute kidney injury (AKI) survivors. Therefore, post-discharge care by a multidisciplinary care team (MDCT) may improve these outcomes. This study aimed to demonstrate the outcomes of implementing comprehensive care by a MDCT in severe AKI survivors. METHODS This study was a randomized controlled trial conducted between August 2018 to January 2021. Patients who survived severe AKI stage 2-3 were enrolled and randomized to be followed up with either comprehensive or standard care for 12 months. The comprehensive post-AKI care involved an MDCT (nephrologists, nurses, nutritionists, and pharmacists). The primary outcome was the feasibility outcomes; comprising of the rates of loss to follow up, 3-d dietary record, drug reconciliation, and drug alert rates at 12 months. Secondary outcomes included major adverse kidney events, estimated glomerular filtration rate (eGFR), and the amount of albuminuria at 12 months. RESULTS Ninety-eight AKI stage 3 survivors were enrolled and randomized into comprehensive care and standard care groups (49 patients in each group). Compared to the standard care group, the comprehensive care group had significantly better feasibility outcomes; 3-d dietary record, drug reconciliation, and drug alerts (p < 0.001). The mean eGFR at 12 months were comparable between the two groups (66.74 vs. 61.12 mL/min/1.73 m2, p = 0.54). The urine albumin: creatinine ratio (UACR) was significantly lower in the comprehensive care group (36.83 vs. 177.70 mg/g, p = 0.036), while the blood pressure control was also better in the comprehensive care group (87.9% vs. 57.5%, p = 0.006). There were no differences in the other renal outcomes between the two groups. CONCLUSIONS Comprehensive care by an MDCT is feasible and could be implemented for severe AKI survivors. MDCT involvement also yields better reduction of the UACR and better blood pressure control. Trial registration Clinicaltrial.gov: NCT04012008 (First registered July 9, 2019).
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Affiliation(s)
- Peerapat Thanapongsatorn
- Department of Medicine, Central Chest Institute of Thailand, Nonthaburi, Thailand
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Nuttha Lumlertgul
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Khanitha Yimsangyad
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Win Kulvichit
- Department of Medicine, Central Chest Institute of Thailand, Nonthaburi, Thailand
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Sadudee Peerapornratana
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Yingyos Avihingsanon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Nattachai Srisawat
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
- Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Academy of Science, Royal Society of Thailand, Bangkok, Thailand.
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.
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Chen YC, Chang CY, Cheng SN, Pan RY, Shih YL, Li TY, Wang SH. Evolution of congenital haemophilia care in Taiwan. J Formos Med Assoc 2021; 121:582-591. [PMID: 34362614 DOI: 10.1016/j.jfma.2021.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/04/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022] Open
Abstract
Haemophilia care in Taiwan has come a long way over the past 35 years, from the absence of specialised haemophilia treatment centres before 1984 to the establishment of treatment centers in the majority of medical centers, the listing of haemophilia as a catastrophic illness with full treatment reimbursement by the Taiwan National Health Insurance (NHI), and the implementation of full NHI coverage for prophylaxis therapy. This has led to outcome improvements such as reduced bleed-related morbidity and mortality, fewer viral infections, and enhanced overall multi-modality care. Most people with haemophilia (PWH) are now able to live normal, active lives. Early diagnosis has improved through increased awareness, physician education, and prenatal diagnosis; while comprehensive care, including state of the art rehabilitation and orthopaedic management for haemophilic arthropathy, eradication therapy for chronic hepatitis C, and better treatments for human immunodeficiency virus, allows PWH to enjoy a better quality of life and improved survival. Efforts are now being made to raise prophylaxis rates through full NHI reimbursement and the use of extended half-life recombinant factor products. Overall, Taiwan has made great strides in haemophilia care and we would like to share these experiences for the benefit of all healthcare providers involved in haemophilia care.
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Affiliation(s)
- Yeu-Chin Chen
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan.
| | - Chia-Yau Chang
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Hemophilia Center, Division of Pediatric Hematology/Oncology, Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shin-Nan Cheng
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan; Tungs' Taichung MetroHarbor Hospital, Department of Pediatrics, Taichung, Taiwan
| | - Ru-Yu Pan
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan; Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lueng Shih
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsung-Ying Li
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan; Department of Rehabilitation, Tri-Service General Hospital, National Defence Medical Center, Taipei, Taiwan
| | - Sheng-Hao Wang
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan; Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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13
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Zou J, Gu L. Effects of comprehensive care on complications, oxygenation indexes and guardian's psychological mood of children with neonatal respiratory distress syndrome. Am J Transl Res 2021; 13:5147-5155. [PMID: 34150103 PMCID: PMC8205692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To observe the effects of comprehensive care on complications, oxygenation indexes of children with neonatal respiratory distress syndrome (NRDS), as well as their guardian's psychological mood. METHODS Totally 205 cases of children with NRDS admitted to our hospital from February 2018 to December 2019 were recruited and divided into two groups according to different nursing interventions. Cases receiving comprehensive care were included in the research group (RG, n=108), and cases receiving routine care were included in the control group (CG, n=97). The curative effect, improvement of clinical symptoms, complications during nursing process, improvement of oxygenation indexes, degree of lung injury, improvement of physiological health were observed and compared, as well as the improvement of parents' psychological mood and their satisfaction with this nursing intervention. RESULTS After care, RG had significantly better improvement of clinical indexes than that in CG, with notably lower PaCO2 and higher PaO2 and SaO2. Besides, children in RG showed remarkably lower Murray score and APACHE-II score, and the patients of children in RG also had lower SAS and SDS scores. The overall response rate (ORR) of children in RG was evidently higher than that in CG, the incidence of total complications in RG was evidently lower than that in CG, and the nursing satisfaction of parents in RG was evidently higher than that in CG. CONCLUSION Comprehensive care is effective for children with NRDS, which can improve oxygenation indexes and lung injury, reduce the incidence of complications, and improve the psychological mood of parents.
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Affiliation(s)
- Jing Zou
- Department of Neonatology, Changzhou Second People's Hospital Changzhou 213164, Jiangsu Province, China
| | - Liyan Gu
- Department of Neonatology, Changzhou Second People's Hospital Changzhou 213164, Jiangsu Province, China
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14
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Lu J, Xiao D, Sun J, Huang J. Effect of comprehensive nursing on the appearance and recovery effect of oral squamous cell carcinoma patients. Am J Transl Res 2021; 13:5519-5525. [PMID: 34150152 PMCID: PMC8205707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the effect of comprehensive nursing on the appearance and recovery of oral squamous cell carcinoma. METHODS 52 patients with oral squamous cell carcinoma admitted to our hospital from February 2019 to February 2020 were selected and divided into a control group (n = 26, conventional nursing care) and an observation group (n = 26, comprehensive nursing). The postoperative hospital stay and postoperative intravenous infusion time, quality of life score, postoperative complications, nursing satisfaction, shape recovery, SAS score, etc. were compared between the two groups. RESULTS (1) The observation group had a shorter postoperative hospital stay and postoperative intravenous infusion time compared to the control group. The observation group also showed higher scores of ADL, psychological function, physical function, and social function after nursing. Regarding the incidence of postoperative complications, the observation group was lower than the control group; the observation group had higher nursing satisfaction (92.31%) than the control group (61.54%) (All P < 0.05). (2) The satisfaction rate in terms of postoperative appearance recovery and overall recovery in the observation group were all significantly higher than the control group (P < 0.05). (3) The ASA score in observation group was significantly lower compared to the control group (inter-group effect: F = 76.210, P < 0.001), and the ASA score of both groups had a tendency to decrease with time (time effect: F = 36.580, P < 0.001); There is an interaction effect between grouping and time (interaction effect: F = 11.770, P < 0.001). (4) After nursing, the VAS score of the two groups of patients was lower than that before nursing, and the score of observation group patients was much lower (P < 0.05). CONCLUSION The application of comprehensive nursing in patients with oral squamous cell carcinoma is remarkable, which can promote the recovery of patients' disease and their appearance, decrease postoperative complications, and relieve the anxiety feelings of patients, with a higher satisfaction rate.
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Affiliation(s)
- Junli Lu
- Infection Control Department, Qingdao Chengyang District People’s HospitalQingdao, China
| | - Dailing Xiao
- Stomatology Department, Qingdao Chengyang District People’s HospitalQingdao, China
| | - Junjie Sun
- Stomatology Department, Qingdao Chengyang District People’s HospitalQingdao, China
| | - Junqian Huang
- Administration, Qingdao Chengyang District People’s HospitalQingdao, China
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Fan Y, Chu X, Jiang L, Du X. The clinical value of comprehensive nursing intervention in preventing ventilator-associated pneumonia. Am J Transl Res 2021; 13:3845-3850. [PMID: 34017575 PMCID: PMC8129291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aim of the present study was to evaluate the clinical value of comprehensive nursing intervention in preventing ventilator-associated pneumonia (VAP). METHODS Eligible 116 patients who received mechanical ventilation in our hospital from June 2018 to December 2019 were equally randomized into a control group and an observation group. The observation group adopted comprehensive nursing while conventional nursing was adopted in the control group accordingly. The mechanical ventilation time, hospitalization time, VAP incidence, psychological status, quality of life and nursing satisfaction were compared. RESULTS The mechanical ventilation and hospitalization time in the observation group was shorter compared to that in the control group (P < 0.05). For the VAP incidence, the observation group exhibited a significantly lower level than the control group (3.44% vs 13.79%) (P < 0.05). SAS and SDS scores before intervention were not different between the groups (P > 0.05); after intervention, the scores in both groups decreased, and the scores of the former group were significantly lower than those of the latter group (P < 0.05). The quality of life scores before intervention did not show any significant difference (P > 0.05); after intervention, a significant increase of quality of life in the observation group was observed compared to the control group (P < 0.05). The nursing satisfaction rate in the observation group was found to be higher when compared with that in the control group (94.87% vs 81.03%, P < 0.05). After intervention, the oxygenation index, the ratio of alveolar arterial oxygen partial pressure difference to arterial oxygen partial pressure (P(A-a)DO2/PaO2), and oxygen partial pressure in both groups of patients were improved compared with those before intervention. After intervention, a significant increase in the oxygen partial pressure and oxygenation index was identified in the observation group compared with the control group, while the P(A-a)DO2/PaO2 was found to be in a lower level (P < 0.05). CONCLUSION Comprehensive nursing intervention can shorten the mechanical ventilation and hospitalization time, prevent the occurrence of VAP, ease the negative emotions of patients, and improve their quality of life as well as nursing satisfaction.
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Affiliation(s)
- Yunxiu Fan
- Department of Gynaecology, Changyi People’s HospitalChangyi, Shandong, P. R. China
| | - Xiaoyan Chu
- Department of Joint Surgery, Changyi People’s HospitalChangyi, Shandong, P. R. China
| | - Lijuan Jiang
- Obstetrical Department, Changyi People’s HospitalChangyi, Shandong, P. R. China
| | - Xinxin Du
- ICU, Changyi People’s HospitalChangyi, Shandong, P. R. China
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Abstract
The number of cancer survivors is increasing globally. More than 15.5 million Americans in 2016 and 1.3 million Koreans in 2013 were living with cancer history. This growing population is expected to increase due to marked development of cancer treatment and early detection. Especially, breast cancer is the second most common cancer in Korean women with relatively favorable 5-year survival rate. Cancer survivors generally face various physical, psychological, and social problems including late-effect or long-term effect after cancer treatment and high risk for second primary cancer and comorbid chronic diseases such as cardiovascular disease and bone health. Breast cancer survivors also encounter wide range of health problems. To satisfy their complex needs, comprehensive supports are required. We categorized the strategy of comprehensive care for breast cancer survivors into (1) Surveillance for primary cancer, (2) Screening of second primary cancer, (3) Management of comorbid health condition, (4) Promoting healthy lifestyle behaviors, and (5) Preventive care. In the future, studies for providing best comprehensive care for breast cancer survivors are needed according to the individuals' demand.
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Affiliation(s)
- Su Min Jeong
- Seoul National University Hospital, Seoul, South Korea
| | - Sang Min Park
- Seoul National University Hospital, Seoul, South Korea.
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17
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Khosravi A, Ravari A, Mirzaei T, Gholamrezapour M. Effects of a Comprehensive Care Program on the Readmission Rate and Adherence to Treatment in Elderly Patients with Chronic Obstructive Pulmonary Disease. Tanaffos 2020; 19:401-412. [PMID: 33959179 PMCID: PMC8088150] [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] [Received: 09/15/2019] [Accepted: 06/27/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The low treatment adherence of patients with chronic obstructive pulmonary disease (COPD) leads to the exacerbation of their symptoms and readmission. Comprehensive care programs are among interventions that can improve the patients' adherence to treatment and prevent readmission. The present study aimed to evaluate the effects of a comprehensive care program on the adherence to treatment and readmission of COPD patients. MATERIALS AND METHODS This randomized clinical trial was performed in a hospital in Rafsanjan, Iran, in 2017. Sixty elderly patients with COPD were randomly enrolled in this study by pair-matching. The intervention group participated in a comprehensive care program, whereas the control group received routine care. The readmission rate and adherence to treatment were measured at one-, three-, and six-month intervals. To evaluate the patients' adherence to treatment, an adherence-to-treatment questionnaire for chronic diseases was used. Data were analyzed using Chi-square test, independent t-test, and repeated measures ANOVA at a significance level of 0.05. RESULTS A significant difference was observed between the two groups in terms of readmission at the end of the study (P=0.03). In the intervention group, the mean level of adherence to treatment and its subscales improved as compared to the control group, and there was a significant difference between the two groups. CONCLUSION Although most of the patients in this study were old, with a rather low educational level and socioeconomic status, the care program could improve their treatment adherence and reduce the readmission rate.
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Affiliation(s)
- Ali Khosravi
- School of Nursing and Midwifery, Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ali Ravari
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Tayebeh Mirzaei
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Smitha K, Pradeep AR, Anvitha D, Pattar I. Factors influencing the periodontal referral behaviour of the general dental practitioners to a periodontist: A cross-sectional survey. Indian J Dent Res 2020; 31:629-635. [PMID: 33107468 DOI: 10.4103/ijdr.ijdr_596_18] [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: 11/04/2022] Open
Abstract
Aim In India, dental care scenario is unique and unequally available to the general population with both government-run hospitals and private dental clinics catering to the oral healthcare needs of the patients. There is lack of studies to address how periodontal diseases are managed in general dental practice in India. This study aimed to understand the periodontal referral patterns of general dental practitioners (GDP) to a periodontist in Karnataka state, India. Materials and Methods This study employed a qualitative approach. Purposive samples of 400 referring dentists were interviewed using structured in-depth questionnaire. The questionnaire consists of a combination of selected response to the questions and close-ended questions, which was distributed to the GDPs of Karnataka state. Results This survey shows deficient delivery of definitive periodontal treatment. Only 2% of the GDP reported that 80%-100% of their patients received scaling. Location of the practice appeared to have a major role in periodontal referral. Farther the location of the practice from district headquarters, poor was the referral. Clinical skill of the specialist appeared to have a major influence on the selection of specialist followed by academic qualification. Conclusion This survey provides insight into the periodontal referral process by GDPs in India.
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Affiliation(s)
- Kanathur Smitha
- Department of Periodontology, Government Dental College and Research Institute, Bangalore, Karnataka, India
| | - A R Pradeep
- Department of Periodontology, Government Dental College and Research Institute; Oxford Dental College and Hospital, Bangalore, Karnataka, India
| | - Devaraj Anvitha
- Department of Periodontology, Farooqia Dental College, Mysore, Karnataka, India
| | - Ishwar Pattar
- Community Health Centre, Nippani, Belgaum (Dist), Karnataka, India
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Somé NH, Devlin RA, Mehta N, Zaric GS, Sarma S. Team-based primary care practice and physician's services: Evidence from Family Health Teams in Ontario, Canada. Soc Sci Med 2020; 264:113310. [PMID: 32877846 DOI: 10.1016/j.socscimed.2020.113310] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/24/2020] [Accepted: 08/15/2020] [Indexed: 01/17/2023]
Abstract
Team-based primary care offers a wide range of health services to patients by using interdisciplinary health care providers committed to delivering comprehensive, coordinated and high-quality care through team collaboration. Ontario's Family Health Team (FHT), the largest team-based practice model in Canada, was introduced to improve access to and effectiveness of primary health care services, and was available primarily for physicians paid under blended capitation models (Family Health Organizations and Family Health Networks). Using health administrative data on physicians practicing under blended capitation models in Ontario between 2006 and 2015, we study the impact of switching from non-FHT to FHTs on the production of capitated comprehensive care services, after-hours services, non-incentivized services, and services provided to non-enrolled patients by family physicians. We find that when in FHTs, physicians increase the production of total services and non-incentivized services by 26% and 5% per annum and reduce capitated comprehensive care services by 3.2% per annum. When in FHTs, physicians also see and enroll more patients relative to those practicing in non-FHTs. We find evidence of improved access to physician's services under team-based primary care, but switching to FHTs has no effect on the production of after-hours services and services provided to non-enrolled patients.
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Kant R, Yadav P, Kishore S, Kumar R, Kataria N. "Patient centered care in medical disinformation era" among patients attending tertiary care hospital: A cross sectional study. J Family Med Prim Care 2020; 9:2480-2486. [PMID: 32754524 PMCID: PMC7380827 DOI: 10.4103/jfmpc.jfmpc_362_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/28/2020] [Accepted: 04/08/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Patient-centered care refers to the provision of care for patients' comprehensive needs, perspectives, and preferences. In health security, communication between patient and physician is the main key through which we plan and implement to threats that can affect huge population. AIM The aim of this study was to assess the patient-centered care in medical disinformation era among patients attending tertiary care teaching hospital, Rishikesh. MATERIALS AND METHODS A descriptive cross-sectional study was planned by enrolling 240 patients attending tertiary care teaching hospital. Total consecutive sampling technique was chosen to recruit the patients for the study. TOOLS Tools used were case reporting form and components of primary care index (CPCI). RESULTS The results show statistically significant association between chronic history of illness of patient (P = 0.02), education of patient (P = 0.008), and habitat of patient (P = 0.05) with interpersonal communication between patient and physician, and the results also show statistically significant association between accumulated knowledge (P = 0.000), coordination of care (P = 0.001), continuity belief (P = 0.000), comprehensiveness of care (P = 0.001), and first contact (P = 0.001) with interpersonal communication between patient and physician. The lowest mean percentage of patient-centered care score was observed for accumulated knowledge (65.70%) and the highest mean percentage (85.15%) score of patient-centered care was observed for interpersonal communication. CONCLUSIONS This study concluded that patient-centered care improves interpersonal communication between patient and physician. Threats arising due to present medical disinformation era can be combat by patient-centered care.
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Affiliation(s)
- Ravi Kant
- Division of Diabetes and Metabolism, General Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Yadav
- Centre of Excellence in Nursing Education and Research, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Surekha Kishore
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajesh Kumar
- Centre of Excellence in Nursing Education and Research, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Neetu Kataria
- Centre of Excellence in Nursing Education and Research, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Rojnueangnit K, Khaosamlee P, Chunsuwan I, Vorravanpreecha N, Lertboonnum T, Rodjanadit R, Sriplienchan P. Quality of life and comprehensive health supervision for children with Down syndrome in Thailand. J Community Genet 2020; 11:351-358. [PMID: 32088880 DOI: 10.1007/s12687-020-00458-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/06/2019] [Accepted: 02/17/2020] [Indexed: 11/29/2022] Open
Abstract
Children with Down syndrome often require several specialty doctors and multidisciplinary teams for their associated anomalies. This may impact their quality of life and creates gaps in treatment monitoring. No studies have yet been conducted in Thailand to measure their quality of life and level of comprehensive health supervision. Therefore, we aimed to study the quality of life among children with Down syndrome and determine if they receive comprehensive health supervision for their condition. In this descriptive research, data were collected from a medical record review of children with Down syndrome during a 1-year period in our Pediatric Outpatient Clinic; 50 children and 39 caregivers participated. Mean total quality of life score of the children was 67.9/100 points. The children had the highest scores (73.6 ± 12.8) in emotional functioning and the lowest (57.2 ± 25.6) in cognitive functioning. It appears that the quality of life may be lower in Down syndrome patients than in Thai children without it. Regarding health supervision, all 50 were screened for thyroid function, and 48 received cardiac evaluations. However, only 17 (34%) received "complete basic assessment" of 5 screening combinations with developmental evaluations and growth monitoring. Furthermore, none received "comprehensive" evaluations for all recommended conditions. While these findings show a need for health supervision improvement for children with Down syndrome within our hospital, they may also be indicative for most care facilities throughout Thailand.
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Affiliation(s)
- Kitiwan Rojnueangnit
- Department of Pediatrics, Faculty of Medicine, Thammasat University, 99 Moo 18 Phahonyothin Road, Khlong Luang, Pathumthani, 12120, Thailand.
| | - Penrawee Khaosamlee
- Department of Pediatrics, Faculty of Medicine, Thammasat University, 99 Moo 18 Phahonyothin Road, Khlong Luang, Pathumthani, 12120, Thailand.,Department of Pediatrics, Amnatcharoen Hospital, Amnat Charoen, Thailand
| | - Issarapa Chunsuwan
- Department of Pediatrics, Faculty of Medicine, Thammasat University, 99 Moo 18 Phahonyothin Road, Khlong Luang, Pathumthani, 12120, Thailand
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Richardson EV, Fifolt M, Barstow EA, Silveira SL, Sikes EM, Motl RW. The priorities of neurologists for exercise promotion in comprehensive multiple sclerosis care. Mult Scler Relat Disord 2020; 38:101482. [PMID: 31707216 DOI: 10.1016/j.msard.2019.101482] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/04/2019] [Accepted: 10/27/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Fewer than 20% of persons with multiple sclerosis (MS) engage in sufficient amounts of exercise for experiencing health and wellness benefits. Neurologists have a powerful and influential relationship among patients, highlighting the potential for the patient-provider interaction to be a gateway for promoting exercise behavior. Neurologists, however, are under-supported and under-resourced for promoting exercise in comprehensive MS care. The purpose of this study was to determine the priorities of neurologists for exercise promotion among patients in comprehensive MS care and, where possible, provide suggestions for how each priority may be addressed in practice. METHODS Priority areas were identified through deductive content analysis of 20 semi-structured interviews with practicing neurologists. RESULTS Seven priority areas were identified regarding promotion of exercise among patients in comprehensive MS care. These included 1). How do I fit exercise promotion into a patient's appointment? 2). What resources should I give my patients about exercise? 3). What are the benefits of exercise for people with MS? 4). What training can I do to be better informed about exercise? 5). What are the prescriptions/guidelines for exercise among persons with MS? 6). What kind of services can I rely on to support me in promoting and supporting exercise behavior? 7). How do I negotiate reimbursement and insurance restrictions when I promote exercise? CONCLUSIONS This research sets an agenda regarding approaches for exercise promotion among patients with MS through interactions with neurologists in comprehensive care settings.
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Abdel-All M, Abimbola S, Praveen D, Joshi R. What do Accredited Social Health Activists need to provide comprehensive care that incorporates non-communicable diseases? Findings from a qualitative study in Andhra Pradesh, India. Hum Resour Health 2019; 17:73. [PMID: 31640722 PMCID: PMC6805300 DOI: 10.1186/s12960-019-0418-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/20/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND The Indian National Program for Cardiovascular Disease, Diabetes, Cancer and Stroke (NPCDCS) was introduced to provide non-communicable disease (NCD) care through primary healthcare teams including Accredited Social Health Activists (ASHAs). Since ASHAs are being deployed to provide NCD care on top of their regular work for the first time, there is a need to understand the current capacity and challenges faced by them. METHODS A desktop review of NPCDCS and ASHA policy documents was conducted. This was followed by group discussions with ASHAs, in-depth interviews with their supervisors and medical officers and group discussions with community members in Guntur, Andhra Pradesh, India. The multi-stakeholder data were analysed for themes related to needs, capacity, and challenges of ASHAs in providing NCD services. RESULTS This study identified three key themes-first, ASHAs are unrecognised as part of the formal NPCDCS service delivery team. Second, they are overburdened, since they deliver several NPCDCS activities without receiving training or remuneration. Third, they aspire to be formally recognised as employees of the health system. However, ASHAs are enthusiastic about the services they provide and remain an essential link between the health system and the community. CONCLUSION ASHAs play a key role in providing comprehensive and culturally appropriate care to communities; however, they are unrecognised and overburdened and aspire to be part of the health system. ASHAs have the potential to deliver a broad range of services, if supported by the health system appropriately. TRIAL REGISTRATION The study was registered with "Clinical Trials Registry - India" (identifier CTRI/2018/03/012425 ).
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Affiliation(s)
- Marwa Abdel-All
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
| | - Seye Abimbola
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - D Praveen
- The George Institute for Global Health, University of New South Wales, New Delhi, India
| | - Rohina Joshi
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, University of New South Wales, New Delhi, India
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Abstract
Chronic obstructive pulmonary disease (COPD) is a common chronic disease worldwide and incurs heavy utilization of healthcare resources. Many COPD patients have comorbidities and experience exacerbations in the course of the disease. Correct diagnosis and appropriate disease assessment are essential for clinical management. Comprehensive care for patients with different severity of disease aims to offer personalized treatment to suit individual needs. Patients with recent exacerbations also need extra care for the post-acute and rehabilitation phases. Comprehensive care consists of self-management and pulmonary rehabilitation and involves multiple healthcare providers working together closely to provide formal structured programmes for patients. The setting, professionals involved, content and the duration of programme vary a lot among different comprehensive care models. Some randomized controlled trials suggested there was improvement in quality of life, exercise capacity and reduced hospital admissions for participants in comprehensive care programmes compared with controls. However, other studies showed that such programmes might not confer benefits and might even bring harm. The reason for the differences in clinical effect of programmes might be due to differences in study design, components and subjects involved in the studies. Careful evaluation of each programme is thus mandatory. Further research is needed to evaluate the safety and effectiveness of comprehensive care management for COPD patients, both at the stable and post-acute exacerbation state.
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Affiliation(s)
- Fanny Wai San Ko
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Pang Chan
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - David Shu Cheong Hui
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Abstract
The World Federation of Hemophilia (WFH) states in its Guidelines for the Management of Hemophilia, Second Edition [1], that people with hemophilia are best managed in a comprehensive care setting. That team is typically comprised of a core group including a hematologist, nurse coordinator, physiotherapist, social worker, specialized lab technologist and data manager, and as needed, by other specialists. Hemophilia is an X-linked congenital bleeding disorder caused by a deficiency of coagulation factor VIII (FVIII) in hemophilia A or factor IX (FIX) in hemophilia B. There are a number of other disorders that are now typically treated in these comprehensive care centers including von Willebrand disease (VWD), rare factor deficiencies (I, II, V, V & VIII, VII, X, XI and XIII), and inherited platelet function disorders. Models of comprehensive care delivery for hemophilia and other inherited bleeding disorders were first defined in the 1960s and have been in constant evolution ever since. Comprehensive care for hemophilia and other inherited bleeding disorders was made possible by the discovery of cryoprecipitate for the treatment of hemophilia A in the mid-1960s and, in the decade that followed, the development of lyophilized clotting factor concentrates. It was quickly realized that treatment at home was far preferable to frequent visits to Emergency Departments or out-patient. Tragically, the same clotting factor concentrates that revolutionized treatment and dramatically improved quality of life exposed thousands of people with hemophilia to HIV-AIDS and hepatitis C in the late 1970s and 1980s [2]. The model of comprehensive care was forced to add specialists in infectious disease and hepatology. At the same time, the crisis accelerated the development of recombinant FVIII and IX clotting factors; these entered the clinic in 1993 and 1997 respectively. The proven safety of both recombinant and plasma-derived products spurred on the expansion of prophylactic care to more patients. Today, with the success of a comprehensive care model that keeps patients out of the hospital (and out of sight), and promises a normal lifespan, there is an emerging impression among many health system managers that the problem of hemophilia is "solved." In 2019, however, even the best care and treatment remains highly burdensome and not entirely efficacious. Emerging innovative therapies are promising yet dramatically different in their modes of action, dosing and administration. Much of what has been learned in terms of management of the disease over the last 50 years may no longer be relevant. Rather than one type of treatment for all, there may well be many different therapies. Comprehensive care centres will not become obsolete. It will remain critically important that specialized staff be able to foster long-term relationships with patients and their families. Indeed, they will need to expand their knowledge and expertise in order to be able to continue to deliver the standards of care so carefully developed since the 1960s.
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Alschuler KN, Stobbe GA, Hertz DP, Johnson KL, von Geldern G, Wundes A, Reynolds P, Unruh K, Scott JD. Impact of Multiple Sclerosis Project ECHO (Extension for Community Healthcare Outcomes) on Provider Confidence and Clinical Practice. Int J MS Care 2019; 21:143-150. [PMID: 31474806 DOI: 10.7224/1537-2073.2018-014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Project ECHO (Extension for Community Healthcare Outcomes) represents a novel approach to addressing disparities in multiple sclerosis (MS) care. A primary mechanism of the program is the use of case consultations to rapidly transfer knowledge from content experts to community providers who care for individuals with MS. Methods MS Project ECHO was pilot tested as a weekly 60-minute videoconference delivered to 24 clinicians across 13 practice sites over 41 weeks. Participants completed a variety of measures related to their experience in the program and answered qualitative questions via exit interview. We report on the responses to exit interview questions related to the case consultation component of MS Project ECHO. Results Participant responses regarding case consultations generated four themes: 1) improved confidence among participants in the existing treatment decision, 2) direct change in the care of the patient provided by the participant, 3) changed practice habits for all of the participant's patients with MS, and 4) increased perception that patients had confidence in the participant as an MS care provider. Conclusions Participant responses support MS Project ECHO as a program that may directly and indirectly affect the way providers deliver MS care in underserved areas. Further research is needed to examine the resulting effect on patient outcomes.
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Álvarez Cabo D, Alemany A, Martínez Sesmero JM, Moreno Guillén S. Healthcare and economic impact. Enferm Infecc Microbiol Clin 2019; 36 Suppl 1:19-25. [PMID: 30115403 DOI: 10.1016/s0213-005x(18)30242-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This chapter reviews the current model of HIV patient care and its economic impact. There are clinical and geographical differences in the care HIV patients receive and a need to develop new models of comprehen-sive HIV care has been identified. HIV infection in Spain is an important and expensive public health problem. The main costs are due to an-tiretroviral therapy, indirect costs and the cost of admission, consultation and diagnostic testing. A strong correlation between severity and cost has been identified. Patients diagnosed late have a poorer clinical course, increased mortality and require more medical and therapeutic resources. Early detection of the disease significantly improves the clinical outcomes of patients. The increased number of patients receiving treatment and their progressive ageing will increase costs of HIV healthcare in the coming years.
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Affiliation(s)
- Daniel Álvarez Cabo
- Dirección General, Fundación de la Clínica Universitaria, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
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Healey K, Zabad R, Young L, Lindner A, Lenz N, Stewart R, Charlton M. Multiple Sclerosis at Home Access (MAHA): An Initiative to Improve Care in the Community. Int J MS Care 2019; 21:101-112. [PMID: 31191175 DOI: 10.7224/1537-2073.2018-006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Caring for individuals with progressive, disabling forms of multiple sclerosis (MS) presents ongoing, complex challenges in health care delivery, especially access to care. Although mobility limitations represent a major hurdle to accessing comprehensive and coordinated care, fragmentation in current models of health care delivery magnify the problem. Importantly, individuals with disabling forms of MS are exceedingly likely to develop preventable secondary complications and to incur significant suffering and increased health care utilization and costs. Methods A house call program, Multiple Sclerosis at Home Access (MAHA), was implemented. The program was designed to provide comprehensive services and prevent common complications. Key aspects included monthly house calls, continuity among providers, and a multidisciplinary team led by a comprehensivist, a provider bridging subspecialty and primary care. A total of 21 adult patients (Expanded Disability Status Scale score ≥7.5) completed 1 full year of the program. Results During the 2-year preevaluation and postevaluation period, half of the hospital admissions were related to secondary and generally preventable complications. Aside from a single outlying individual important to the evaluation, in the year after program implementation, decreases were found in number of individuals hospitalized, hospitalizations/skilled facility admissions, and hospital days; the total number of overall emergency department (ED) visits decreased; and ED-only visits increased (ie, ED visits without hospital admission). Patient satisfaction reports and quality indicators were positive. Fifty percent of patients participated in supplementary televisits. Conclusions This program evaluation suggests that a house call-based practice is a viable solution for improving care delivery for patients with advanced MS and disability.
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Kondziela JM, Schulz J, Brunst B, Fuchs S, Gerlinger S, Neif B, Staab-Kupke H, Vasileiadis S, Brodisch P, Knake S, Kniess T, Schade B, Neubauer BA, Rosenow F, Schubert-Bast S, Strzelczyk A, Willems LM. [Acceptance, demand, reasons for consultation and outcome of counseling on epilepsy in Hesse and Lower Franconia]. Nervenarzt 2019; 90:832-839. [PMID: 30694366 DOI: 10.1007/s00115-019-0676-8] [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] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM The diagnosis of epilepsy is often accompanied by relevant restrictions for patients, which may result in disease-specific daily problems that need targeted and professional counseling. Specialized epilepsy counseling services (ECS) were introduced in some German states since 1996 to provide an additional and independent service for epilepsy-related problems. The objective of this prospective, multicenter cohort study at six ECS was to determine and analyze the acceptance, demand and frequent reasons for consultation in Hesse and Lower Franconia. RESULTS A total of 435 clients were enrolled during the 12-month observation period (June 2014-May 2015) of which 74.3% were adults (n = 323, mean age 40.3 ± 14.7 years, range 18-76 years, 51.7% female) and 25.7% children and adolescents (n = 112, mean age 9.4 ± 4.8 years, range 1-17 years, 52.7% female). The mean number of outpatient consultations per year was 2.5 (median 2.0, SD ± 2.8, range 1-20), whereby a general counseling on dealing with epilepsy (adults 55.7%, children and adolescents 51.8%), clarification and information about the disease (43.7% and 41.1%, respectively) and assistance in applying for support (39.0% and 46.4%, respectively) were the most frequent issues. The distance from the place of residence to the ECS was significantly shorter in Lower Franconia compared to Hesse (p < 0.002). Client satisfaction was high with a mean patient satisfaction questionnaire (ZUF-8) score of 29.0 (maximum score 32). Overall 96.4% of the clients rated the quality of counseling as good or very good and 96.6% would consider consulting the ECS again in case of new problems. In cases of threatened workplace, training position or situation at school, counseling helped to avoid negative consequences in 72.0% of cases. CONCLUSION The ECS are frequently used, appreciated and effective institutions for adults and children with epilepsy as well as for their caregivers. The ECS complements the existing comprehensive specialized outpatient and inpatient care for epilepsy in Germany; however, in view of their limited numbers and inhomogeneous allocation, the number and the availability of ECS should be expanded on the national level.
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Affiliation(s)
- Jacqueline M Kondziela
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Juliane Schulz
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Bernhard Brunst
- Epilepsieberatung Diakonisches Werk Hochtaunus, Frankfurt am Main, Deutschland
| | - Simone Fuchs
- Epilepsieberatung Unterfranken, Stiftung Juliusspital, Würzburg, Deutschland
| | - Stefan Gerlinger
- Abteilung für Kinderneurologie und Sozialpädiatrie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Birgit Neif
- Klinik für Neurologie, Hephata-Klinik, Schwalmstadt-Treysa, Deutschland
| | - Henrike Staab-Kupke
- Epilepsieberatung Unterfranken, Stiftung Juliusspital, Würzburg, Deutschland
| | - Silke Vasileiadis
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Peter Brodisch
- Epilepsieberatung, Innere Mission München, Diakonie in München und Oberbayern e. V., München, Deutschland
| | - Susanne Knake
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Tobias Kniess
- Klinik für Neurologie, Campus Rhön Klinikum AG, Bad Neustadt a.d. Saale, Deutschland
| | - Bernd Schade
- Klinik für Neurologie, Hephata-Klinik, Schwalmstadt-Treysa, Deutschland
| | - Bernd A Neubauer
- Abteilung für Kinderneurologie und Sozialpädiatrie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Felix Rosenow
- Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und Neurochirurgie, Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland
| | - Susanne Schubert-Bast
- Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und Neurochirurgie, Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland.,Schwerpunkt Neurologie, Neurometabolik, und Prävention der Klinik für Kinder- und Jugendmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Adam Strzelczyk
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland. .,Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und Neurochirurgie, Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland.
| | - Laurent M Willems
- Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und Neurochirurgie, Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland
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Coulaud PJ, Mujimbere G, Nitunga A, Kayonde C, Trenado E, Spire B, Bernier A. An Assessment of Health Interventions Required to Prevent the Transmission of HIV Infection Among Men Having Sex with Men in Bujumbura, Burundi. J Community Health 2018; 41:1033-43. [PMID: 27020779 DOI: 10.1007/s10900-016-0187-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Data regarding HIV among men having sex with men (MSM) in Burundi are scarce. In a context where same-sex practices are illegal, national recommendations including MSM have been issued in 2012. However, no study has been conducted to evaluate MSM's health needs, which would be useful to adapt recommendations and implement evidence-based interventions. This study aimed at identifying health needs expressed by MSM. A cross-sectional study was conducted in Bujumbura in 2014, in collaboration with the National Association for HIV positive people and AIDS patients. Fifty-one MSM, recruited during HIV prevention activities, self-completed a questionnaire. A descriptive analysis was conducted. Participants had a median age of 23 years, over 60 % declared being a member of an LGBT organisation and 76 % lived their homosexuality secretly or discretely. Over the last month, 67 % declared having had sex with a man and 32 % with a woman. In the previous 6 months, 40 % declared having systematically used a condom during sexual intercourse. In terms of health needs, 22 % did not use the services offered by HIV providers. Participants expressed needs in terms of prevention (access to rapid HIV tests, in a confidential setting, with counselling) and care (listening centre, free treatment, confidentiality). Medical expertise and being a good listener were the predominant healthcare staff qualities desired by participants. Results suggest that Burundian MSM represent an at-risk population, with low access to HIV services, in need of a comprehensive approach for HIV prevention, with community-based activities (HIV testing, counselling, prevention tools), psychological and social support.
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Affiliation(s)
- Pierre-Julien Coulaud
- INSERM, UMR_S 912, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), 13385, Marseille, France. .,UMR_S 912, IRD, Aix Marseille Université, 13385, Marseille, France.
| | - Gabriel Mujimbere
- Association Nationale de Soutien aux Séropositifs et malades du Sida, Centre Tuhiro, Quartier Kigobe Nord, 88 Avenue des Etats-Unis, 4152, Bujumbura, Burundi
| | - Arsène Nitunga
- Association Nationale de Soutien aux Séropositifs et malades du Sida, Centre Tuhiro, Quartier Kigobe Nord, 88 Avenue des Etats-Unis, 4152, Bujumbura, Burundi
| | - Candide Kayonde
- Association Nationale de Soutien aux Séropositifs et malades du Sida, Centre Tuhiro, Quartier Kigobe Nord, 88 Avenue des Etats-Unis, 4152, Bujumbura, Burundi
| | - Emmanuel Trenado
- Coalition Internationale Sida, Tour Essor, 14 rue Scandicci, 93500, Pantin, France
| | - Bruno Spire
- INSERM, UMR_S 912, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), 13385, Marseille, France.,UMR_S 912, IRD, Aix Marseille Université, 13385, Marseille, France
| | - Adeline Bernier
- Coalition Internationale Sida, Tour Essor, 14 rue Scandicci, 93500, Pantin, France
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Claveria Guiu I, Caro Mendivelso J, Ouaarab Essadek H, González Mestre MA, Albajar-Viñas P, Gómez I Prat J. The Catalonian Expert Patient Programme for Chagas Disease: An Approach to Comprehensive Care Involving Affected Individuals. J Immigr Minor Health 2017; 19:80-90. [PMID: 26895150 DOI: 10.1007/s10903-016-0345-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The Catalonian Expert Patient Programme on Chagas disease is a initiative, which is part of the Chronic Disease Programme. It aims to boost responsibility of patients for their own health and to promote self-care. The programme is based on nine sessions conducted by an expert patient. Evaluation was focusing in: habits and lifestyle/self-care, knowledge of disease, perception of health, self-esteem, participant satisfaction, and compliance with medical follow-up visits. Eighteen participants initiated the programme and 15 completed it. The participants were Bolivians. The 66.7 % of them had been diagnosed with chagas disease in Spain. The 100 % mentioned that they would participate in this activity again and would recommend it to family and friends. The knowledge about disease improve after sessions. The method used in the programme could serve as a key strategy in the field of comprehensive care for individuals with this disease.
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Awoonor-Williams JK, Baffoe P, Ayivor PK, Fofie C, Desai S, Chavkin W. Prevalence of conscientious objection to legal abortion among clinicians in northern Ghana. Int J Gynaecol Obstet 2017; 140:31-36. [PMID: 28940197 DOI: 10.1002/ijgo.12328] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 03/22/2017] [Revised: 07/30/2017] [Accepted: 09/20/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the prevalence of conscientious objection (CO), motivations, knowledge of Ghana's abortion law, attitudes, and behaviors toward abortion provision among medical providers in northern Ghana, and measures to regulate CO. METHODS Between June and November 2015, the present cross-sectional survey-based descriptive study measured prevalence, knowledge, and attitudes about CO among 213 eligible health practitioners who were trained in abortion provision and working in hospital facilities in northern Ghana. Results were stratified by facility ownership and provider type. RESULTS Approximately half (94/213, 44.1%) of trained providers reported that they were currently providing abortions. The overall prevalence of self-identified and hypothetical objection was 37.9% and 33.8%, respectively. Among 87 physicians, 37 (42.5%) and 39 (44.8%) were categorized as self-identified and hypothetical objectors, respectively. Among 126 midwives, nurses, and physician assistants, 43 (34.7%) and 33 (26.2%) were coded as self-identified and hypothetical objectors, respectively. A high proportion of providers reported familiarity with Ghana's abortion law and supported regulation of CO. CONCLUSION CO based on moral and religious grounds is prevalent in northern Ghana. Providers indicated an acceptance of policies and guidelines that would regulate its application to reduce the burden that CO poses for women seeking abortion services.
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Affiliation(s)
| | | | | | - Chris Fofie
- Global Doctors for Choice Ghana, Accra, Ghana
| | - Sheila Desai
- City University of New York, School of Public Health, New York, NY, USA
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Zia A, Rajpurkar M. Challenges of diagnosing and managing the adolescent with heavy menstrual bleeding. Thromb Res 2016; 143:91-100. [PMID: 27208978 DOI: 10.1016/j.thromres.2016.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/26/2016] [Accepted: 05/01/2016] [Indexed: 11/20/2022]
Abstract
Unpredictable, prolonged or heavy menstrual bleeding (HMB) may be expected for many adolescents soon after menarche. A decade of clinical experience and research has now established firmly that bleeding disorders (BD) are common in adolescents with HMB. Despite these advances, many questions remain, and several aspects of the diagnosis and management of BDs in adolescents are not supported by rigorous clinical trials. In this overview, four major areas will be discussed. First, we will discuss the frequency of BDs in young women with HMB. Up to 20% of older females with HMB are thought to have an underlying BD. Estimates from retrospective studies in adolescents suggest a prevalence that varies anywhere from 10 to 62%. Prospective studies with uniform hemostatic evaluation are needed to answer this question definitively. Second, we will review existing tools that help screen and diagnose adolescents with HMB with an underlying BD. Although identification of an underlying BD in older women with HMB is relatively straight forward, uncertainties remain for adolescents. Heavy menstrual bleeding in this age group may have different pathophysiological underpinnings than those in older women and may often be disregarded as anovulatory. There is an urgent need to develop novel tools, and evaluate existing diagnostic strategies in adolescents. Third, we will discuss the optimal medical management of HMB in young adolescents. As direct evidence is largely lacking, these areas are also subject to extrapolation from older women. Lastly, an important area- prediction, and management of future bleeding in those adolescents who are diagnosed with a mild BD-will be discussed. Throughout, areas of controversy and opportunities for further research are highlighted.
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Vitale RJ, Pillai PB, Krishnan G, Jothydev S, Kesavadev J. The two levels of care for diabetes in a developing country: Mechanisms for improved intermediate health outcomes. Diabetes Metab Syndr 2016; 10:S90-S94. [PMID: 26703219 DOI: 10.1016/j.dsx.2015.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/27/2015] [Indexed: 01/30/2023]
Abstract
India has over 70 million citizens with diabetes, the second-most of any country worldwide. Disparities in learning skills, resources, education, and physician practices make it difficult to practically implement the diabetes management guidelines recommended by international scientific organizations. In its guidelines, the International Diabetes Federation advocates for three different levels of care based on availability of resources. This study investigates the differences in intermediate health outcomes between two diabetes care programs: one a comprehensive diabetes centre, the other a limited care setting. The comprehensive centre offers telemedicine and periodic diabetes education, empowering patients and providing 24-hour advice on lifestyle modifications, diet, and exercise. All patients of this centre practice self-monitoring of blood glucose. The subjects in the limited care setting receive minimal investigations and periodic physical follow-ups, and few patients have access to home glucose monitoring. The results showed that HbA1c (7.62 vs. 8.58, p=0.003), cholesterol (134.4 vs. 173.4, p<0.001), and diastolic blood pressure (72.9 vs. 77.0, p=0.016) were significantly lower in patients receiving comprehensive care, while the reductions in systolic blood pressure (134.6 vs. 138.7, p=0.202) did not achieve statistical significance. These reductions, which remained significant after correcting for confounding factors, could be attributed to more aggressive treatment regimens in the comprehensive care centre, as well as the real-time, frequent communication with medical professionals in the telemedicine program.
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Affiliation(s)
- Rebecca J Vitale
- Departments of Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Pradeep B Pillai
- Department of Diabetes, Jothydev's Diabetes Research Centre, Trivandrum, Kerala, India
| | - Gopika Krishnan
- Department of Diabetes, Jothydev's Diabetes Research Centre, Trivandrum, Kerala, India
| | - Sunitha Jothydev
- Department of Diabetes, Jothydev's Diabetes Research Centre, Trivandrum, Kerala, India
| | - Jothydev Kesavadev
- Department of Diabetes, Jothydev's Diabetes Research Centre, Trivandrum, Kerala, India.
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Ghosh K, Ghosh K. Management of Haemophilia in Developing Countries: Challenges and Options. Indian J Hematol Blood Transfus 2015; 32:347-55. [PMID: 27429529 DOI: 10.1007/s12288-015-0562-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/04/2015] [Indexed: 12/13/2022] Open
Abstract
There are significant challenges in managing haemophilia patients in developing countries. These challenges are (i) Lack of proper health care infrastructure and human resources suitable for haemophilia care (ii) Competing health care priorities of the government. (iii) Lack of penetrance of medical insurance in the population. (iv) Lesser visibility of the haemophilia patients in health care system (v) Low awareness across the medical profession, population and the policy makers about the condition (vi) Non availability of factor concentrates (vii) Inadequate utilization of knowledge for reducing factor concentrate use. (viii) Inadequate pain relief (ix) Challenges due to inhibitor developing (x) Viral hepatitis & (xi) Lack of research publications relevant to the country are some of the challenges faced by PWH for their management in developing country. The solutions are not easy but development of a strong patient organization with linkages with World Federation of Haemophilia is an important initial step. Following that internal and international twinning, use of internal sources, strong advocacy programme targeting government, doctors, opinion makers will solve many of the challenges in the time to come.
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Affiliation(s)
- Kanjaksha Ghosh
- National Institute of Immunohaematology, 13 Th Fl KEM Hospital, Parel Mumbai, 400012 India ; Haemophilia Federation of India, New Delhi, India
| | - Kinjalka Ghosh
- National Institute of Immunohaematology, 13 Th Fl KEM Hospital, Parel Mumbai, 400012 India ; Department of Biochemistry, Seth GS Medical College and KEM Hospital, Parel Mumbai, 400012 India
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Betschel S, Badiou J, Binkley K, Hébert J, Kanani A, Keith P, Lacuesta G, Yang B, Aygören-Pürsün E, Bernstein J, Bork K, Caballero T, Cicardi M, Craig T, Farkas H, Longhurst H, Zuraw B, Boysen H, Borici-Mazi R, Bowen T, Dallas K, Dean J, Lang-Robertson K, Laramée B, Leith E, Mace S, McCusker C, Moote B, Poon MC, Ritchie B, Stark D, Sussman G, Waserman S. Canadian hereditary angioedema guideline. Allergy Asthma Clin Immunol 2014; 10:50. [PMID: 25352908 PMCID: PMC4210625 DOI: 10.1186/1710-1492-10-50] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 09/10/2014] [Indexed: 11/26/2022]
Abstract
Hereditary angioedema (HAE) is a disease which is associated with random and often unpredictable attacks of painful swelling typically affecting the extremities, bowel mucosa, genitals, face and upper airway. Attacks are associated with significant functional impairment, decreased Health Related Quality of Life, and mortality in the case of laryngeal attacks. Caring for patients with HAE can be challenging due to the complexity of this disease. The care of patients with HAE in Canada is neither optimal nor uniform across the country. It lags behind other countries where there are more organized models for HAE management, and where additional therapeutic options are licensed and available for use. The objective of this guideline is to provide graded recommendations for the management of patients in Canada with HAE. This includes the treatment of attacks, short-term prophylaxis, long-term prophylaxis, and recommendations for self-administration, individualized therapy, quality of life, and comprehensive care. It is anticipated that by providing this guideline to caregivers, policy makers, patients and their advocates, that there will be an improved understanding of the current recommendations regarding management of HAE and the factors that need to be considered when choosing therapies and treatment plans for individual patients. The primary target users of this guideline are healthcare providers who are managing patients with HAE. Other healthcare providers who may use this guideline are emergency physicians, gastroenterologists, dentists and otolaryngologists, who will encounter patients with HAE and need to be aware of this condition. Hospital administrators, insurers and policy makers may also find this guideline helpful.
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Affiliation(s)
| | | | | | - Jacques Hébert
- />Department of Medicine, Laval University, Quebec City, Quebec Canada
| | - Amin Kanani
- />Department of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - Paul Keith
- />Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Gina Lacuesta
- />Department of Medicine, Dalhousie University, Halifax, Nova Scotia Canada
| | - Bill Yang
- />University of Ottawa Medical School, Ottawa, Ontario Canada
| | | | - Jonathan Bernstein
- />Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio USA
| | - Konrad Bork
- />Department of Dermatology, University Hospital of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | | | - Marco Cicardi
- />Department of Internal Medicine, UniversitadegliStudi di Milano, Ospedale L. Sacco, Milan, Italy
| | - Timothy Craig
- />Departments of Medicine and Pediatrics, Penn State University, Hershey, Pennsylvania USA
| | - Henriette Farkas
- />3rd Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Hilary Longhurst
- />Department of Immunology, Barts and the London NHS Trust, London, England, UK
| | - Bruce Zuraw
- />University of California, San Diego, San Diego, California USA
| | | | | | - Tom Bowen
- />Departments of Medicine and Paediatrics, University of Calgary, Calgary, Alberta Canada
| | - Karen Dallas
- />Saskatoon Health Region, Saskatoon, Saskatchewan Canada
| | - John Dean
- />BC Children’s Hospital, Vancouver, British Columbia Canada
| | | | - Benoît Laramée
- />Centre hospitalier de l’université de Montréal, Montréal, Quebec Canada
| | - Eric Leith
- />Department of Medicine, University of Toronto, Oakville, Ontario Canada
| | - Sean Mace
- />University of Toronto, Toronto, Ontario Canada
| | - Christine McCusker
- />Department of Immunology, McGill University Health Centre, Montreal, Quebec Canada
| | - Bill Moote
- />Department of Medicine, Western University, London, Ontario Canada
| | - Man-Chiu Poon
- />Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Calgary, Alberta Canada
| | - Bruce Ritchie
- />Departments of Medicine and Medical Oncology, University of Alberta, Edmonton, Alberta Canada
| | - Donald Stark
- />Department of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | | | - Susan Waserman
- />Department of Medicine, McMaster University, Hamilton, Ontario Canada
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Nyland J, Jakob R. Multi-factorial sustainability approach is necessary to preserve knee function following osteoarthritis diagnosis. World J Orthop 2013; 4:175-7. [PMID: 24147252 PMCID: PMC3801236 DOI: 10.5312/wjo.v4.i4.175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/23/2013] [Accepted: 08/08/2013] [Indexed: 02/06/2023] Open
Abstract
Knee function preservation following a diagnosis of osteoarthritis may benefit from healthy patient lifestyles, exercise or activity habits, and daily living routines. Underlying societal issues and social roles may contribute further to both ecological and knee function preservation concerns. Based on sustainability theory and social ecology concepts we propose that factors such as health history, genetic predisposition, socio-environmental factors and local-regional-global physiological system viability contribute to knee function preservation. Addressing only some of these factors or any one factor in isolation can lead the treating physician, surgeon and rehabilitation clinician to less than optimal treatment effectiveness. An example is presented of a 57-year-old man with medial tibiofemoral osteoarthritis. In the intervention decision-making process several factors are important. Patients who would benefit from early knee arthroplasty tend to place osteoarthritic knee pain elimination at the top of their list of treatment expectations. They also have minimal or no desire to continue impact sport, recreational or vocational activities. In contrast, patients who are good candidates for a knee function preservation treatment approach tend to have greater expectations to be able to continue impact sport, recreational or vocational activities, are willing and better able to implement significant behavioral changes and develop the support systems needed for their maintenance, are willing to tolerate and live with minor-to-moderate intermittent knee pain, and learn to become more pain tolerant.
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