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Clarke T, Leung E, Fleg A. A Case of Chronic Undiagnosed 2:1 Isolated Atrial Flutter in a Patient With an Autoimmune Disease. Cureus 2023; 15:e48240. [PMID: 38054141 PMCID: PMC10694480 DOI: 10.7759/cureus.48240] [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] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/07/2023] Open
Abstract
Atrial flutter (AFL) is typically associated with structural heart diseases or metabolic abnormalities. However, isolated symptomatic AFL, which occurs without abnormal heart anatomy, remains a rare occurrence and is underrepresented in the literature. This case report highlights the significance of recognizing and investigating symptoms suggestive of arrhythmias, especially in patients with autoimmune conditions.
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Affiliation(s)
- Tegan Clarke
- Surgery, University of New Mexico School of Medicine, Albuquerque, USA
| | - Eric Leung
- Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Anthony Fleg
- Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, USA
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2
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Alexander Muacevic, John R Adler. Prevention-Focused Care: The Potential Role of Chiropractors in Hong Kong’s Primary Healthcare Transformation. Cureus; 15:e36950. [PMID: 37009374 PMCID: PMC10064816 DOI: 10.7759/cureus.36950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
Hong Kong's healthcare system is moving toward preventive and primary care to address the complicated demands of the aging population. Chiropractic professionals are in an advantageous position to support a prevention-focused strategy by identifying musculoskeletal problems early, reducing risks, and promoting healthy lifestyles. This article examines how the involvement of chiropractors in public health programs could improve population health in Hong Kong and boost primary care. The inclusion of chiropractors in district health centers and other initiatives would offer safer and more cost-effective choices for treating functional problems and chronic pain. Chiropractors should be involved in policymakers' attempts to create a sustainable healthcare system that meets Hong Kong's long-term healthcare requirements.
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Han X, Pittman P, Ku L. The Effect of National Health Service Corps Clinician Staffing on Medical and Behavioral Health Care Costs in Community Health Centers. Med Care 2021; 59:S428-S433. [PMID: 34524239 PMCID: PMC8428858 DOI: 10.1097/mlr.0000000000001610] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Prior studies of community health centers (CHCs) have found that clinicians supported by the National Health Service Corps (NHSC) provide a comparable number of primary care visits per full-time clinician as non-NHSC clinicians and provide more behavioral health care visits per clinician than non-NHSC clinicians. This present study extends prior research by examining the contribution of NHSC and non-NHSC clinicians to medical and behavioral health costs per visit. METHODS Using 2013-2017 data from 1022 federally qualified health centers merged with the NHSC participant data, we constructed multivariate linear regression models with health center and year fixed effects to examine the marginal effect of each additional NHSC and non-NHSC staff full-time equivalent (FTE) on medical and behavioral health care costs per visit in CHCs. RESULTS On average, each additional NHSC behavioral health staff FTE was associated with a significant reduction of 3.55 dollars of behavioral health care costs per visit in CHCs and was associated with a larger reduction of 7.95 dollars in rural CHCs specifically. In contrast, each additional non-NHSC behavioral health staff FTE did not significantly affect changes in behavioral health care costs per visit. Each additional NHSC primary care staff FTE was not significantly associated with higher medical care costs per visit, while each additional non-NHSC clinician contributed to a slight increase of $0.66 in medical care costs per visit. CONCLUSIONS Combined with previous findings on productivity, the present findings suggest that the use of NHSC clinicians is an effective approach to improving the capacity of CHCs by increasing medical and behavioral health care visits without increasing costs of services in CHCs, including rural health centers.
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Affiliation(s)
- Xinxin Han
- School of Medicine, Tsinghua University, Beijing, China
| | | | - Leighton Ku
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
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4
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Smith KA, Vennik J, Morrison L, Hughes S, Steele M, Tiwari R, Bostock J, Howick J, Mallen C, Little P, Ratnapalan M, Lyness E, Misurya P, Leydon GM, Dambha-Miller H, Everitt HA, Bishop FL. Harnessing Placebo Effects in Primary Care: Using the Person-Based Approach to Develop an Online Intervention to Enhance Practitioners' Communication of Clinical Empathy and Realistic Optimism During Consultations. Front Pain Res (Lausanne) 2021; 2:721222. [PMID: 35295512 PMCID: PMC8915751 DOI: 10.3389/fpain.2021.721222] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/26/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Empathic communication and positive messages are important components of "placebo" effects and can improve patient outcomes, including pain. Communicating empathy and optimism to patients within consultations may also enhance the effects of verum, i.e., non-placebo, treatments. This is particularly relevant for osteoarthritis, which is common, costly and difficult to manage. Digital interventions can be effective tools for changing practitioner behavior. This paper describes the systematic planning, development and optimization of an online intervention-"Empathico"-to help primary healthcare practitioners enhance their communication of clinical empathy and realistic optimism during consultations. Methods: The Person-Based Approach to intervention development was used. This entailed integrating insights from placebo and behavior change theory and evidence, and conducting primary and secondary qualitative research. Systematic literature reviews identified barriers, facilitators, and promising methods for enhancing clinical empathy and realistic optimism. Qualitative studies explored practitioners' and patients' perspectives, initially on the communication of clinical empathy and realistic optimism and subsequently on different iterations of the Empathico intervention. Insights from the literature reviews, qualitative studies and public contributor input were integrated into a logic model, behavioral analysis and principles that guided intervention development and optimization. Results: The Empathico intervention comprises 7 sections: Introduction, Empathy, Optimism, Application of Empathico for Osteoarthritis, Reflection on my Consultations, Setting Goals and Further Resources. Iterative refinement of Empathico, using feedback from patients and practitioners, resulted in highly positive feedback and helped to (1) contextualize evidence-based recommendations from placebo studies within the complexities of primary healthcare consultations and (2) ensure the intervention addressed practitioners' and patients' concerns and priorities. Conclusions: We have developed an evidence-based, theoretically-grounded intervention that should enable practitioners to better harness placebo effects of communication in consultations. The extensive use of qualitative research throughout the development and optimization process ensured that Empathico is highly acceptable and meaningful to practitioners. This means that practitioners are more likely to engage with Empathico and make changes to enhance their communication of clinical empathy and realistic optimism in clinical practice. Empathico is now ready to be evaluated in a large-scale randomized trial to explore its impact on patient outcomes.
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Affiliation(s)
- Kirsten A. Smith
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Jane Vennik
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Leanne Morrison
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Stephanie Hughes
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Mary Steele
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Riya Tiwari
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Jennifer Bostock
- Policy Innovation & Evaluation Research Unit, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | - Christian Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, United Kingdom
| | - Paul Little
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Mohana Ratnapalan
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Emily Lyness
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Pranati Misurya
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Geraldine M. Leydon
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Hajira Dambha-Miller
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Hazel A. Everitt
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Felicity L. Bishop
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
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Willcox MJ, Dahl B. Exercise-Induced Inguinal Hydrocele: An Unconventional Presentation of a Common Problem. Cureus 2021; 13:e13596. [PMID: 33815996 PMCID: PMC8007168 DOI: 10.7759/cureus.13596] [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] [Indexed: 11/23/2022] Open
Abstract
Inguinal hernias are very common. Well-established diagnostic criteria including examination and imaging are available. Ultrasound, herniography, CT, and MR imaging can provide additional diagnostic information when examination alone is not deemed sufficient. However, decision making should not be overly dependent on imaging but must factor in all relevant information. Described here is a case that would have been a missed diagnosis and an example of unconventional documentation that facilitated the patient getting their care.
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Affiliation(s)
| | - Brian Dahl
- Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA
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Nikolaeva IV, Zhernakova NI, Osmanov EA, Lebedev TJ, Manjakov RR. [The experience of reforming primary health care in conditions of increasing of population average age]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2020; 28:1374-1379. [PMID: 33338355 DOI: 10.32687/0869-866x-2020-28-6-1374-1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/03/2020] [Indexed: 11/06/2022]
Abstract
The article presents the experience of reforming primary health care in Belgorod Oblast in 2016-2019. In the process of reforming, the original organizational model of new interaction pattern "family doctor - patient - family members", was developed and implemented. The measures were taken to strengthen material-technical base and manpower potential of primary medical care. The general practitioners offices were positioned within "step accessibility" for patients. The continuous training of family doctors was organized at the workplace. The unified regional medical information system was developed and implemented enabling corporate conference communications, remote consultations, public feedback and remote arrangement of visits of patients to physician. The differentiated approach to remuneration of medical personnel was implemented using key performance indices that permitted to increase salaries and work quality. As a result of the reforms, the percentage of patients under supervision of family doctors increased up to 13%, the number of medical emergency calls decreased up to 3.3% and the number of calls because of illness decreased up to 17%. The mortality of population older than able-bodied age began to decrease and life expectancy reached relevant 74 years in 2019.
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Affiliation(s)
- I V Nikolaeva
- The Department of Health Care and Social Care of Population of the Belgorod Oblast, 308005, Belgorod, Russia
| | - N I Zhernakova
- The Federal State Autonomous Educational Institution of Higher Education "The Belgorod State National Research University", 308015, Belgorod, Russia,
| | - E A Osmanov
- The Federal State Budget Educational Institution of Higher Education "The G. R. Derjavin Tambov State University" 392000, Tambov, Russia
| | - T Ju Lebedev
- The Federal State Autonomous Educational Institution of Higher Education "The Belgorod State National Research University", 308015, Belgorod, Russia
| | - R R Manjakov
- The Federal State Budget Educational Institution of Higher Education "The G. R. Derjavin Tambov State University" 392000, Tambov, Russia
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Abstract
The recent Lebanese port explosion came as a continuation of a series of socioeconomic disasters the country has been facing during the past year. In addition, the massive impact of the coronavirus disease-19 (COVID-19) pandemic further hastened the collapse of the Lebanese healthcare system. In light of all those events, the Lebanese healthcare sector has faced major blows that will be difficult to recuperate from. In the aftermath of the Beirut port explosion, Lebanon received immense financial and medical support from the international community in a timely fashion, which secured first level care to victims of the explosion. Nevertheless, this forced Lebanon, which was considered a prominent tertiary medical hub in the Middle East, to slowly regress into an exclusive primary care provider. As such, it is crucial for local and regional stakeholders to build strong collaborations, and shape a unified vision of Lebanon's future healthcare system.
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Affiliation(s)
- Loulwa Farha
- Faculty of Medicine, American University of Beirut, Beirut, LBN
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Devarajan S, Sales JM, Hunt M, Comeau DL. PrEP and sexual well-being: a qualitative study on PrEP, sexuality of MSM, and patient-provider relationships. AIDS Care 2019; 32:386-393. [PMID: 31760759 DOI: 10.1080/09540121.2019.1695734] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Most new diagnoses of HIV in the United States are among men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is a medication that mitigates risk of HIV acquisition and requires regular STI testing and prescription refills with PrEP providers. Because PrEP care monitors sexual behavior, there is a need to understand how PrEP providers approach sexual health care for MSM patients. In this study, semi-structured qualitative interviews were conducted with 20 MSM in Atlanta, Georgia with current or past prescriptions for PrEP. Data were analyzed with thematic analysis using four major steps: (1) code and codebook development, (2) assigning codes to segments of interviews, (3) code-based and comparative analysis methods, and (4) developing thematic findings. Findings from interviews about changes in sexuality while using PrEP include decreased anxiety surrounding sex, increased feelings of control over personal health, and experiencing less stigma towards sexual partners with HIV. Participants indicated needs for tailored health advice based on individual sexual preferences, sexual health care free from stereotypical assumptions, and improved access to PrEP providers identifying as gay men or who practice in LGBT-friendly settings. Study findings support a call for a gain-frame approach to sexual health in PrEP care for MSM.
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Affiliation(s)
| | - Jessica M Sales
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Machel Hunt
- Hope Clinic of the Emory Vaccine Center, Emory School of Medicine, Decatur, GA, USA
| | - Dawn L Comeau
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Meyer C, Ulbricht S, Baumeister SE, Schumann A, Rüge J, Bischof G, Rumpf HJ, John U. Proactive interventions for smoking cessation in general medical practice: a quasi-randomized controlled trial to examine the efficacy of computer-tailored letters and physician-delivered brief advice. Addiction 2008; 103:294-304. [PMID: 17995993 PMCID: PMC2253708 DOI: 10.1111/j.1360-0443.2007.02031.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To test the efficacy of (i) computer-generated tailored letters and (ii) practitioner-delivered brief advice for smoking cessation against an assessment-only condition; and to compare both interventions directly. DESIGN Quasi-randomized controlled trial. SETTING A total of 34 randomly selected general practices from a German region (participation rate 87%). PARTICIPANTS A total of 1499 consecutive patients aged 18-70 years with daily cigarette smoking (participation rate 80%). INTERVENTIONS The tailored letters intervention group received up to three individualized personal letters. Brief advice was delivered during routine consultation by the practitioner after an onsite training session. Both interventions were based on the Transtheoretical Model of behaviour change. MEASUREMENTS Self-reported point prevalence and prolonged abstinence at 6-, 12-, 18- and 24-month follow-ups. FINDINGS Among participants completing the last follow-up, 6-month prolonged abstinence was 18.3% in the tailored letters intervention group, 14.8% in the brief advice intervention group and 10.5% in the assessment-only control group. Assuming those lost to follow-up to be smokers, the rates were 10.2%, 9.7% and 6.7%, respectively. Analyses including all follow-ups confirmed statistically significant effects of both interventions compared to assessment only. Using complete case analysis, the tailored letters intervention was significantly more effective than brief advice for 24-hour [odds ratio (OR) = 1.4; P = 0.047] but not for 7-day point prevalence abstinence (OR = 1.4; P = 0.068) for prolonged abstinence, or for alternative assumptions about participants lost to follow-up. CONCLUSIONS The study demonstrated long-term efficacy of low-cost interventions for smoking cessation in general practice. The interventions are suitable to reach entire populations of general practices and smoking patients. Computer-generated letters are a promising option to overcome barriers to provide smoking cessation counselling routinely.
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Affiliation(s)
- Christian Meyer
- Department of Epidemiology and Social Medicine, University of Greifswald, Greifswald, Germany.
| | - Sabina Ulbricht
- University of Greifswald, Department of Epidemiology and Social MedicineGreifswald, Germany
| | - Sebastian E Baumeister
- University of Greifswald, Department of Epidemiology and Social MedicineGreifswald, Germany
| | - Anja Schumann
- Bremen Institute for Prevention Research and Social MedicineBremen, Germany
| | - Jeannette Rüge
- University of Greifswald, Department of Epidemiology and Social MedicineGreifswald, Germany
| | - Gallus Bischof
- University of Lübeck, Department of Psychiatry and Psychotherapy, Research Group S:TEP (Substance Abuse: Treatment, Epidemiology and Prevention)Lübeck, Germany
| | - Hans-Jürgen Rumpf
- University of Lübeck, Department of Psychiatry and Psychotherapy, Research Group S:TEP (Substance Abuse: Treatment, Epidemiology and Prevention)Lübeck, Germany
| | - Ulrich John
- University of Greifswald, Department of Epidemiology and Social MedicineGreifswald, Germany
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