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نتیجه جستجو - Primary care

تعداد مقالات یافته شده: 26
ردیف عنوان نوع
1 Management of Pediatric Atopic Dermatitis by Primary Care Providers: A Systematic Review
مدیریت درماتیت آتوپیک اطفال توسط ارائه دهندگان مراقبت های اولیه: مرور سیستماتیک-2021
BACKGROUND: Primary care providers (PCPs), including pediatricians and general practitioners, are often the first to see children with eczema/atopic dermatitis (AD). Little is known about management of pediatric AD by PCPs and adherence to national guidelines. OBJECTIVE: To review existing literature examining management components of pediatric AD (topical corticosteroids [TCS], topical calcineurin inhibitors [TCIs], antihistamines, bathing, emollients, and diet) by PCPs. DATA SOURCES: PubMed/Medline and Embase. STUDY ELIGIBILITY CRITERIA: English-language articles dated 2015 to 2020 reporting outcomes addressing management of pediatric AD by PCPs. STUDY APPRAISAL AND SYNTHESIS METHODS: Two authors independently screened titles/abstracts, reviewed full-text articles, extracted relevant data, and evaluated study quality. Disagreements were resolved by a third author. RESULTS: Twenty articles were included. Surveys and national database analyses were the most common methodologies (n = 7 each). PCPs commonly prescribed TCS but had a preference for low-potency agents, overprescribed nonsedating antihistamines, and avoided TCIs. PCPs commonly recommended emollients, although this was not universal. Data characterizing nonmedication management were limited. LIMITATIONS: Most studies did not examine individual patient encounters, but rather relied on providers reporting their general behaviors. Provider behavior may vary based on country of practice. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Knowledge and management gaps exist among PCPs in treating pediatric AD in key areas including knowledge of TCS safety profiles and prescribing of TCIs. The current literature is largely limited to small studies that evaluate prescribing behaviors with limited data characterizing nonmedication management, highlighting the need for future research in this area.
KEYWORDS: atopic dermatitis | eczema | health care delivery | primary care provider | pediatric
مقاله انگلیسی
2 Knowledge, attitudes and practices regarding prediabetes among general practitioners in Reunion Island
دانش، نگرش و عملکرد در مورد پیش دیابت در میان پزشکان عمومی در جزیره Reunion-2021
Background: General practitioners (GPs) are among the first health care providers to be involved in prediabetes care, and their actions can prevent patients’ transition from prediabetes to diabetes. However, data on knowledge and management of prediabetes in primary care remain scarce. Aim: To describe the knowledge, attitudes and practices of GPs towards prediabetes. Design and setting: This descriptive cross-sectional study included all private GPs working in Reunion Island.
Method: GPs were sent an electronic questionnaire that specifically sought to establish whether GPs knew the definition of prediabetes and whether their practices were in line with French guidelines for prediabetes screening and management.
Results: A total of 121 GPs completed the questionnaire. Of these, 95.0% knew the definition of impaired fasting glucose, but only 66.1% knew that of impaired glucose tolerance. Many GPs reported practices that are not recommended in guidelines. Thus, 59% of respondents declared that they monitored prediabetes with HbA1c and 10% said that they prescribed oral anti-diabetic drugs as prediabetes treatment. The risks factors associated with prediabetes were generally well known. Although 59.5% of respondents reported not having enough time to provide therapeutic education and medical follow up, only 19% referred their patients to a nutritionist or dietician. Lastly, 93.4% of respondents favoured the implementation of a local therapeutic education program targeting prediabetic individuals.
Conclusion: Prediabetes management in primary care can be made more effective by improving GPs’ knowledge of prediabetes and official guidelines, facilitating referral of prediabetic patients to lifestyle specialists and implementing local therapeutic education programs.
keywords: Prediabetes | Primary Health Care | Secondary Prevention | Health Knowledge | Attitudes | Practice | Diabetes Mellitus.
مقاله انگلیسی
3 Knowledge of health workers relating to sepsis awareness and management in Lambaréné, Gabon
دانش کارکنان بهداشتی در رابطه با آگاهی و مدیریت سپسیس در لامبارن، گابن-2021
Background In 2016, the third international consensus definitions for sepsis and septic shock (Sepsis-3) task force provided revised definitions for sepsis and septic shock. This study explores knowledge regarding sepsis among health workers in Lambarene, Gabon.
Methods We conducted a self-administered questionnaire-based survey about sepsis among health workers from the referral regional hospital, the research center, and primary care health facilities in the Lambar´en´ e region. Participants were from the referral regional hospital, the research center, and primary health care facilities. A score of one was given to each correct answer. The global score out of a possible score of twenty was calculated, and the proportion of correct responses was determined.
Results A total of 115 health workers (physicians, nurses and assistant nurses) completed the questionnaire, of which 48.7% (56/115) provided a valid definition of sepsis, but 74% (85/115) had never heard about the quick Sequential Organ Failure Assessment (qSOFA) score. The proportion of correct answers was comparable across the three health profession categories. The median global score across all health workers was 11 [IQR, 9-14.5] out of 20. Physicians attained higher global scores [14 (IQR, 11-15)] than assistant nurses [11 (IQR, 8-13), P=0.007]; their global score was comparable to that of nurses.
Conclusion There are considerable knowledge gaps regarding sepsis among health workers in Lambarene, potentially impairing the prompt recognition and management of sepsis. There is a need to establish periodic uptodate training to improve sepsis knowledge.
keywords: کارکنان بهداشت | دانش | گابون | Qsofa | سپسیس | Health workers | Knowledge | Gabon | qSOFA | Sepsis
مقاله انگلیسی
4 ECG AI-Guided Screening for Low Ejection Fraction (EAGLE): Rationale and design of a pragmatic cluster randomized trial
غربالگری هدایت شده با هوش مصنوعی ECG برای کسر کم دفع (EAGLE): منطق و طراحی یک آزمایش تصادفی خوشه عملی-2020
Background A deep learning algorithm to detect low ejection fraction (EF) using routine 12-lead electrocardiogram (ECG) has recently been developed and validated. The algorithm was incorporated into the electronic health record (EHR) to automatically screen for low EF, encouraging clinicians to obtain a confirmatory transthoracic echocardiogram (TTE) for previously undiagnosed patients, thereby facilitating early diagnosis and treatment. Objectives To prospectively evaluate a novel artificial intelligence (AI) screening tool for detecting low EF in primary care practices. Design The EAGLE trial is a pragmatic two-arm cluster randomized trial (NCT04000087) that will randomize N100 clinical teams (i.e., clusters) to either intervention (access to the new AI screening tool) or control (usual care) at 48 primary care practices across Minnesota and Wisconsin. The trial is expected to involve approximately 400 clinicians and 20,000 patients. The primary endpoint is newly discovered EF ≤50%. Eligible patients will include adults who undergo ECG for any reason and have not been previously diagnosed with low EF. Data will be pulled from the EHR, and no contact will be made with patients. A positive deviance qualitative study and a post-implementation survey will be conducted among select clinicians to identify facilitators and barriers to using the new screening report. Summary This trial will examine the effectiveness of the AI-enabled ECG for detection of asymptomatic low EF in routine primary care practices and will be among the first to prospectively evaluate the value of AI in real-world practice. Its findings will inform future implementation strategies for the translation of other AI-enabled algorithms. (Am Heart J 2020;219:31-6.)
مقاله انگلیسی
5 Increasing collaboration on substance use disorder research with primary care practices through the National Drug Abuse Treatment Clinical Trials Network
افزایش همکاری در زمینه تحقیق اختلال در مصرف مواد با اقدامات مراقبت های اولیه از طریق شبکه ملی آزمایش های بالینی درمان سوء مصرف مواد-2020
Background: The National Drug Abuse Treatment Clinical Trials Network (CTN) called for its national nodes to promote the translation of evidence-based interventions from substance use disorder (SUD) research into clinical practices. This collaborative demonstration project engaged CTN-affiliated practice-based research networks (PBRNs) in research that describes aspects of opioid prescribing in primary care. Methods: Six PBRNs queried electronic health records from a convenience sample of 134 practices (84 participants) to identify the percent of adult patients with an office visit who were prescribed an opioid medication from October 1, 2015, to September 30, 2016, and, of those, the percent also prescribed a sedative in that year. Seven PBRNs sent an e-mail survey to a convenience sample of 108 practices (58 participants) about their opioid management policies and procedures during the project year. Results: Of 561,017 adult patients with a visit to one of the 84 clinics in the project year, 22.9% (PBRN range 3.1%–25.4%) were prescribed opioid medications, and 52.1% (PBRN range 8.5%–60.6%) of those were prescribed a sedative in the same year. Of the 58 practices returning a survey (45.3% response rate), 98.1% had formal written treatment agreements for chronic opioid therapy, 68.5% had written opioid prescribing policies, and 43.4% provided reports to providers with feedback on opioid management. Only 24.1% were providing buprenorphine for OUD. Conclusion: CTN-affiliated PBRNs demonstrated their ability to collaborate on a project related to opioid management; results highlight the important role for PBRNs in OUD treatment, research, and the need for interventions and additional policies addressing opioid prescribing in primary care practice.
Keywords: Prescribing patterns | Opioids | Primary care | Electronic health records | Practice-based research
مقاله انگلیسی
6 Improving breast cancer care coordination and symptom management by using AI driven predictive toolkits
بهبود هماهنگی مراقبت از سرطان پستان و مدیریت علائم با استفاده از ابزارهای پیش بینی کننده هوش مصنوعی-2020
Integrated breast cancer care is complex, marked by multiple hand-offs between primary care and specialists over an extensive period of time. Communication is essential for treatment compliance, lowering error and complication risk, as well as handling co-morbidity. The director role of care, however, becomes often unclear, and patients remain lost across departments. Digital tools can add significant value to care communication but need clarity about the directives to perform in the care team. In effective breast cancer care, multidisciplinary team meetings can drive care planning, create directives and structured data collection. Subsequently, nurse navigators can take the director’s role and become a pivotal determinant for patient care continuity. In the complexity of care, automated AI driven planning can facilitate their tasks, however, human intervention stays needed for psychosocial support and tackling unexpected urgency. Care allocation of patients across centres, is often still done by hand and phone demanding time due to overbooked agenda’s and discontinuous system solutions limited by privacy rules and moreover, competition among providers. Collection of complete outcome information is limited to specific collaborative networks today. With data continuity over time, AI tools can facilitate both care allocation and risk prediction which may unveil non-compliance due to local scarce resources, distance and costs. Applied research is needed to bring AI modelling into clinical practice Keywords: Care coordination | Symptom management | Predictive tools | Care allocation | Nurse navigator | Multidisciplinary discussion
مقاله انگلیسی
7 Qualitative evaluation of A Safer Ramadan, a structured education programme that addresses the safer observance of Ramadan for Muslims with Type 2 diabetes
ارزیابی کیفی A Safer Ramadan ، یک برنامه آموزشی ساختاری که به رعایت ایمن تر ماه رمضان برای مسلمانان مبتلا به دیابت نوع 2 می پردازد-2020
Aims: Muslims can choose to fast during Ramadan. Guidelines exist for providing clinical support for this group, but there is a lack of culturally tailored diabetes management interventions to provide guidance. The study evaluates the implementation of a programme developed to meet this need. Methods: A Safer Ramadan is a multi-faceted package comprising a self-management and community awareness programme, and healthcare professional training. Implementation of the programme took place in two cities in the UK, prior to Ramadan 2017. Uptake and attendance were determined, and qualitative interviews and focus groups were completed with people attending the programme, and with various stakeholders involved in implementation and delivery. Results: Success of the implementation varied and engagement by primary care was limited. Three central themes emerged from the interviews highlighting barriers and facilitators of the programme implementation. These were the referral pathway, programme content and feedback on the delivery of the programme. Conclusions: Provision of interventions that provide support and education for Muslims during Ramadan was implemented in communities and valued by GPs and practice nurses. However, heavy workloads to support delivery made it difficult for practices to engage. Recommendations for future delivery of the programme indicate that greater attention should be given to marketing and its supporting practices. Furthermore, training for practice nurses to support patients prior to Ramadan and provision of funding is required.
Keywords: Ramadan | Structured education | Muslims
مقاله انگلیسی
8 Improving compliance with diabetes care using a novel mnemonic: Aquality improvement project in an urban primary care clinic
رویکرد بهبود انطباق با مراقبت از دیابت با استفاده از یک حفظی: پروژه بهبود کیفیت در یک کلینیک مراقبت های اولیه شهری-2020
Aim: The aim of this quality improvement project was to improve compliance with the delivery of multi-dimensional patient-centered diabetes care using a streamlined mnemonic based on established diabetesguidelines.Methods: Using the Institute for Healthcare Improvement (IHI) model for improvement, four rapid plan-do-study-act cycles primarily implemented different tests of change over eight weeks using a streamlinedmnemonic – the LLaVES (lifestyle, laboratory tests, vaccination, examination, social/psychosocial) bundlefor screening and case management of patients with diabetes. Secondary to the LLaVES bundle, tests ofchange were also conducted for clinic team members and patients. Team member engagement utilizeda best-practice toolkit for effective communication. Patient engagement implemented validated modelsto evaluate knowledge of diabetes and stage of change. Data were analyzed using run charts to evaluatethe impact of interventions on outcomes. Overall compliance was measured as the diabetes manage-ment compliance rate (DMCR), composed of LLaVES implementation, team engagement, and patientengagement scores.Results: The diabetes management compliance rate increased by 72.2%, from a baseline of 49% to 84.4% ineight weeks. Team engagement increased from 76.6% to 92% while patient engagement increased from70.4% to 87.4%.Conclusions: Diabetes management is complex and requires team and patient engagement to implementa structured and multidimensional process. Composed of established, high-level evidence interventions,the LLaVES bundle is one approach to systematize complex care while taking into account the specificand unique challenges of a health care organization.
Keywords:Quality improvement | LLaVES | Complex diabetes care
مقاله انگلیسی
9 Opportunities for improving hypertensive disorders of pregnancy (HDP) management in primary care settings: A review of international published guidelines in the context of pregnancy care in Indonesia
فرصت ها برای بهبود اختلالات فشار خون بالا در مدیریت بارداری (HDP) در مراقبت های اولیه: بررسی دستورالعمل های منتشر شده بین المللی در زمینه مراقبت از بارداری در اندونزی-2020
Almost all of global maternal mortality caused by HDP occurs in low to middle-income countries (LMIC). However, limited guidance is available to local primary care practitioners who are usually the main health care providers. This review examined existing international practice guidelines to identify potential practices to improve HDP management in Indonesian primary care settings. We performed structured literature search strategies and snowballing searches in six databases (MEDLINE, Web of Science, EMBASE, CINAHL, Cochrane reviews and Google Scholar) for guidelines that were published between 2007 and 2018 using relevant keywords and phrases of ‘guidelines’, ‘hypertensive disorders of pregnancy’ or ‘preeclampsia’ and ‘primary care’. The AGREE II instrument was used to assess quality and reporting of the eligible guidelines. Thematic analysis was performed on all of the guidelines and the results were discussed among the project investigators. Sixteen international practice guidelines or similar management recommendations were reviewed. Almost all of them were partially applicable, with some managements potentially able to be adopted to Indonesian primary care settings. Three main themes for improving HDP management were identified, namely clinical management, care planning, and professional communication. These potential improvements in managing women with HDP in Indonesia may also be relevant in other LMIC. Further contextualisation is required to facilitate their adoption in practice settings.
Keywords: High blood pressure | Pregnancy | Preeclampsia | General practitioners | Midwives | Primary care
مقاله انگلیسی
10 Japanese residential care quality and perceived competency in institutionalized adolescents: A preliminary assessment of the dimensionality of care provision
کیفیت مراقبت اقامتی ژاپنی ها و صلاحیت مشاهده شده در نوجوانان پناهگاهی: یک بررسی مقدماتی روی بُعدی بودن تامین مراقبت-2018
Although early institutionalization has been shown to have broad, detrimental effects on child developmental outcomes, there have been few attempts to systematic measure which aspects of the institution and caregiving environment associate with negative psychological outcomes. The current study uses a culturally and contextually modified early adolescent version of the Home Observation for Measurement of the Environment Inventory (EA-HOME-JP) in Japanese child welfare institutions (CWIs) to provide preliminary data on relevant variables in the caregiving environment that associate with domains of perceived self-competency. Forty-six children and young people (Agemean = 13 years 9 months) and their 35 primary caregivers from 11 CWIs were interviewed using EA-HOME-JP. Children and young people also self-reported on their perceived cognitive, physical, social competencies, and sense of self-worth. Participants within the same residential environments exhibited marked variation across each EA-HOME-JP subscale suggesting that the same rearing environment can be experienced differently by different individuals. Interestingly, EA-HOME-JP scores did not vary with care type (large-ward, middle-ward, and family-like), Instead, CWIs grouped within the same care type showed significant variation to one another on EA-HOME-JP subscales. Importantly, EA-HOME-JP scores, rather than care type, associated with aspects of competency (cognitive competency and sense of self-worth). As these findings are based on a small number of participants, they will require further replication in larger samples ascertained from other regions in Japan. Ultimately, these data may contribute to considerations over optimal packages of residential rearing in Japan.
keywords: HOME Inventory |Adolescent |Rearing environment |Residential care |Japan
مقاله انگلیسی
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