scholarly journals FIVE YEAR REPORT ON THE MEDICAL FOLLOW UP OF MARSHALLESE RECEIVING SPECIAL MEDICAL CARE RELATED TO 1954 BRAVO FALLOUT RADIATION (JANUARY 1992-1996).

1999 ◽  
Author(s):  
A.N. VASWANI ◽  
J. HOWARD
Keyword(s):  
Medical Care ◽  
Fallout Radiation

Evaluation of medical care for Diabetic and Hypertensive patients in primary care in Mexico: Observational retrospective study (Preprint)

2020 ◽  
Author(s):  
Agustin Lara-Esqueda ◽  
Sergio A Zaizar-Fregoso ◽  
Violeta M Madrigal-Perez ◽  
Mario Ramirez-Flores ◽  
Daniel A Montes-Galindo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Medical Care ◽  
Serum Lipids ◽  
Quality Care ◽  
Premature Death ◽  
Current Standard ◽  
Anonymized Data ◽  
Quality Of Medical Care

BACKGROUND Diabetes Mellitus is a worldwide health problem and the leading cause of premature death with increasing prevalence over time. Usually, along with it, Hypertension presents and acts as another risk factor that increases mortality risk. Both diseases impact the country's health while also producing an economic burden for society, causing billions of dollars to be invested in their management. OBJECTIVE The present study evaluated the quality of medical care for patients diagnosed with diabetes mellitus (DM), hypertension (HBP), and both pathologies (DM+HBP) within a public health system in Mexico, according to the official Mexican standard for each pathology. METHODS 45,498 patients were included from 2012 to 2015. All information was taken from the electronic medical records database, exported as anonymized data for research purposes. Each patient record was compared against the standard to test the quality of medical care. RESULTS Glycemia with hypertension goals reached 29.6% in DM+HBP, 48.6% in DM, and 53.2% in HBP. The goals of serum lipids were reached by 3% in DM+HBP, 5% in DM, and 0.2% in HBP. Glycemia, hypertension, and LDL cholesterol reached 0.04%. 15% of patients had an undiagnosed disease of diabetes or hypertension. Clinical follow-up examinations reached 20% for foot examination and clinical eye examination in the whole population. Specialty referral reached 1% in angiology or cardiology in the whole population. CONCLUSIONS Goals for glycemic and hypertension reached 50% in the overall population, while serum lipids, clinical follow-up examinations, and referral to a specialist were deficient. Patients who had both diseases had more consultations, better control for hypertension and lipids, but inferior glycemic control. Overall, quality care for DM and/or HBP has not been met according to the standards. While patients with DM and HBP do not have a current standard to evaluate their own needs.

Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomised clinical trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tzikas ◽  
A Samaras ◽  
A Kartas ◽  
D Vasdeki ◽  
G Fotos ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Medical Care ◽  
Oral Anticoagulation ◽  
Intervention Group ◽  
Control Group ◽  
Motivational Intervention ◽  
Clinical Events ◽  
Secondary Outcomes

Abstract Background Oral anticoagulation (OAC) is paramount to effective thromboprophylaxis; yet adherence to OAC remains largely suboptimal in patients with atrial fibrillation (AF). Purpose We aimed to assess the impact of an educational, motivational intervention on the adherence to OAC in patients with non-valvular AF. Methods Hospitalised patients with non-valvular AF who received OAC were randomly assigned to usual medical care or a proactive intervention, comprising motivational interviewing and tailored counseling on medication adherence. The primary study outcome was adherence to OAC at 1-year, evaluated as Proportion of Days Covered (PDC) by OAC regimens and assessed through nationwide prescription registers. Secondary outcomes included the rate of persistence to OAC, gaps in treatment, proportion of VKA-takers with labile INR (defined as time to therapeutic range<70%) and clinical events. Results A total of 1009 patients were randomised, 500 in the intervention group and 509 in the control group. At 1-year follow-up, 77.2% (386/500) of patients in the intervention group had good adherence (PDC>80%), compared with 55% (280/509) in the control group (adjusted odds ratio 2.84, 95% confidence interval 2.14–3.75; p<0.001). Mean PDC±SD was 0.85±0.26 and 0.75±0.31, respectively (p<0.001). Patients that received the intervention were more likely to persist in their OAC therapy at 1 year, while usual medical care was associated with more major (≥3 months) treatment gaps [Figure]. Among 212 VKA-takers, patients in the intervention group were less likely to have labile INR compared with those in the control group [21/120 (17.1%) vs 34/92 (37.1%), OR 0.33 95% CI 1.15–0.72, p=0.005]. Clinical events over a median follow-up period of 2 years occurred at a numerically lower, yet non-significant, rate in the intervention group [Table]. Conclusions In patients receiving OAC therapy for non-valvular AF, a motivational intervention significantly improved patterns of medication adherence, without significantly affecting clinical outcomes. Primary and secondary outcomes Funding Acknowledgement Type of funding source: None

Concerns and difficulties associated with the COVID-19 pandemic among older adults with cancer in Mexico.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12042-12042
Author(s):  
Sofia Sánchez-Román ◽  
Yanin Chavarri Guerra ◽  
Andrea Morales Morales Alfaro ◽  
Daniela Ramirez Maza ◽  
Andrea de la O Murillo ◽  
...  
Keyword(s):  
Older Adults ◽  
Developing Countries ◽  
Medical Care ◽  
Cancer Care ◽  
Significant Proportion ◽  
Stage Iv ◽  
Well Being ◽  
Public Hospitals ◽  
The Individual

12042 Background: The COVID-19 pandemic has impacted the well-being of people not only due to the disease but also because of stay-at-home orders, social distancing, unemployment, and different kinds of loses. Older adults have particularly suffered during the pandemic, with increased health-related concerns and anxiety leading to increased vulnerability. However, little is known about the effects of the pandemic on older adults with cancer living in developing countries. They are facing issues related to their diagnosis and treatment, as well as the effects of the pandemic on their care and on the well-being of their families. To improve care for this vulnerable population, we studied the concerns and difficulties associated with COVID-19 among older Mexican adults with cancer. Methods: We included patients age ≥65 with the 10 most common tumors in Mexico according to GLOBOCAN and within 3-24 months of cancer diagnosis at two public hospitals in Mexico City. Patients were contacted telephonically and asked to complete a survey reporting the difficulties encountered during the COVID-19 pandemic and to rate their concerns associated with cancer care management using a 0-10 Likert-type scale, with higher ratings meaning increased concerns. Focused interviews were used to describe the individual experience of selected patients and their relatives related to COVID-19 and cancer care. Results: Between April 20, 2020 and December 1, 2021, 67 patients (mean age 71.9, min 65, max 90; 35.8% female; 62.7% living with a partner) were included. The most common tumors were prostate (43%), colon (16%), and lung (12%). 46% had Stage IV disease, and 61% had a life expectancy of more than a year. Twenty-five percent of patients reported encountering at least one difficulty in obtaining cancer care due to the COVID-19 pandemic. 43% of the patients reported difficulties with accessing follow-up cancer care; 39% reported issues with obtaining medications, including chemotherapy; and 34% reported problems obtaining medical care in general, including oncology visits. Regarding concerns, 33% of the patients reported being “very worried” or “extremely worried” about the COVID-19 pandemic. The most relevant concerns were related to getting infected with COVID-19 (or having a family member who became infected) (mean rating 7.9, SD 2.9); not being able to pay for cancer treatments or medical care (mean rating 6.9, SD 3.5); and worsening of cancer due to delayed care during the pandemic (mean rating 6.6, SD 3.7). Conclusions: A significant proportion of older adults with cancer in Mexico faced difficulties obtaining cancer treatment and follow-up care during the COVID-19 pandemic. Their most relevant concerns included getting infected, financial losses, and progression of disease. Creating systems to provide continued cancer care for vulnerable populations in developing countries is essential to face the COVID-19 pandemic.

Delivering the Diagnosis of Sex Chromosome Aneuploidy: Experiences and Preferences of Parents and Individuals

2018 ◽  
Vol 58 (3) ◽  
pp. 336-342
Author(s):  
Carolina Jaramillo ◽  
Christina Nyquist ◽  
Kirsten A. Riggan ◽  
Jason Egginton ◽  
Sean Phelan ◽  
...  
Keyword(s):  
Medical Care ◽  
Sex Chromosome ◽  
Genetic Diagnosis ◽  
Accurate Information ◽  
Misleading Information ◽  
Telephone Interviews ◽  
Care And Support ◽  
Follow Up Care ◽  
Sex Chromosome Aneuploidies

Increased prenatal diagnoses of sex chromosome aneuploidies (SCAs) amid limited knowledge of their prognoses heighten the need to understand how families contend with the implications of an SCA. To explore the experiences of parents and individuals who received a genetic diagnosis of an SCA (excluding Turner syndrome), we conducted semistructured qualitative telephone interviews with 43 participants affected by these conditions. Parents (n = 35) and individuals (n = 8) expressed almost unanimous interest in more optimistic portrayals of their condition from their providers, even when the prognosis is uncertain. While some participants reported success in receiving accurate information from their provider and identifying supportive resources, numerous families received outdated or misleading information about their condition and lacked direction in accessing follow-up care and support. Parents desire greater coordination of their child’s medical care and access to care that approaches an SCA holistically. Opportunities remain to improve the diagnosis and care of individuals with SCAs.

scholarly journals Implementing a Data to Care Strategy to Improve Health Outcomes for People With HIV: A Report From the Care and Prevention in the United States Demonstration Project

2018 ◽  
Vol 133 (2_suppl) ◽  
pp. 60S-74S ◽  
Author(s):  
Patricia Sweeney ◽  
Tamika Hoyte ◽  
Mesfin S. Mulatu ◽  
Jacquelyn Bickham ◽  
Antoine D. Brantley ◽  
...  
Keyword(s):  
United States ◽  
Health Outcomes ◽  
Medical Care ◽  
Treatment Adherence ◽  
Viral Suppression ◽  
The United States ◽  
Health Departments ◽  
State Health ◽  
Improve Health

Objectives: The Care and Prevention in the United States Demonstration Project included implementation of a Data to Care strategy using surveillance and other data to (1) identify people with HIV infection in need of HIV medical care or other services and (2) facilitate linkages to those services to improve health outcomes. We present the experiences of 4 state health departments: Illinois, Louisiana, Tennessee, and Virginia. Methods: The 4 state health departments used multiple databases to generate listings of people with diagnosed HIV infection (PWH) who were presumed not to be in HIV medical care or who had difficulty maintaining viral suppression from October 1, 2013, through September 29, 2016. Each health department prioritized the listings (eg, by length of time not in care, by viral load), reviewed them for accuracy, and then disseminated the listings to staff members to link PWH to HIV care and services. Results: Of 16 391 PWH presumed not to be in HIV medical care, 9852 (60.1%) were selected for follow-up; of those, 4164 (42.3%) were contacted, and of those, 1479 (35.5%) were confirmed to be not in care. Of 794 (53.7%) PWH who accepted services, 694 (87.4%) were linked to HIV medical care. The Louisiana Department of Health also identified 1559 PWH as not virally suppressed, 764 (49.0%) of whom were eligible for follow-up. Of the 764 PWH who were eligible for follow-up, 434 (56.8%) were contacted, of whom 269 (62.0%) had treatment adherence issues. Of 153 PWH who received treatment adherence services, 104 (68.0%) showed substantial improvement in viral suppression. Conclusions: The 4 health departments established procedures for using surveillance and other data to improve linkage to HIV medical care and health outcomes for PWH. To be effective, health departments had to enhance coordination among surveillance, care programs, and providers; develop mechanisms to share data; and address limitations in data systems and data quality.

scholarly journals Licensing and Physician Mental Health: Problems and Possibilities

2007 ◽  
Vol 93 (2) ◽  
pp. 6-11
Author(s):  
Herbert Hendin ◽  
Charles Reynolds ◽  
Dan Fox ◽  
Steven I. Altchuler ◽  
Phillip Rodgers ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Medical Care ◽  
Help Seeking ◽  
Psychiatric Care ◽  
Mental Health Problems ◽  
Health Related ◽  
Seeking Help ◽  
Medical License

ABSTRACT A number of factors appear to discourage physicians from seeking help for mental illness. This reluctance may be exacerbated by fears – well-founded or imagined – that by seeking help, physicians may put their medical license in jeopardy. To examine this risk, an analysis of all state medical board (SMB) license applications was followed by a seven-item survey mailed to SMB executive directors, and 70 percent responded. Follow up interviews were conducted with a sample of those not responding and also with a small group of directors whose responses were problematic. Thirteen of the 35 SMBs responding indicated that the diagnosis of mental illness by itself was sufficient for sanctioning physicians. The same states indicated that they treat physicians receiving psychiatric care differently than they do physicians receiving medical care. In follow-up interviews all 13 indicated that without evidence of impairment or misrepresentation any such sanctioning was likely to be temporary. A significant percentage (37 percent) of states sanction or have the ability to sanction physicians on the basis of information revealed on the licensing application about the presence of a psychiatric condition rather than on the basis of impairment. The same percentage state they treat physicians receiving psychiatric care differently than they do those receiving medical care. Physicians’ perceptions of this apparent discrimination is likely to play a role in their reluctance to seek help for mental health-related conditions. Suggestions are made for how SMBs and state physician health programs and state and county medical societies might collaborate in ways that while protecting patients decreases barriers to physicians help seeking.

PEDIATRIC SCREENING EXAMINATIONS IN PRIVATE PRACTICE

PEDIATRICS ◽  
1968 ◽  
Vol 41 (1) ◽  
pp. 115-119
Author(s):  
Glenn Austin ◽  
William Foster ◽  
John C. Richards
Keyword(s):  
Medical Care ◽  
Patient Care ◽  
Private Practice ◽  
Pediatric Practice ◽  
Paramedical Personnel ◽  
Assistant Physician ◽  
Special Value ◽  
System Review ◽  
Pediatric Screening

A pediatric assistant performs health screening examinations in a private pediatric practice without the presence of the doctor. Only patients between the ages of 6 to 12 years who have no apparent significant problems and who have had a complete physical and history by a pediatrician the year previously are accepted for the screening, which includes a system review, height, weight, visual and hearing testing, hemoglobin, urinalysis, and immunizations. The pediatric assistant, chosen for her ability to communicate with mothers, is of special value in listening to minor complaints. The chart is reviewed by the child's pediatrician and problems are discussed with the assistant. Physician follow-up is accomplished if deemed helpful. This is accepted by patients, allows continuity of personal comprehensive medical care in the pediatric office at a reduced cost, and allows the physician more time for patient care while increasing efficient use of paramedical personnel. Possible misuse of screening examinations, with resulting impersonal and fragmented medical care, is discussed.

P5531A systematic follow-up strategy after percutaneous coronary intervention based on patient risk profile: the prospective POST-PCI registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Ferlini ◽  
R Rossini ◽  
G Musumeci ◽  
N Grieco ◽  
D Trabattoni ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Medical Care ◽  
Independent Predictor ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Risk Profile ◽  
Low Risk ◽  
Old Patients ◽  
Percutaneous Coronary

Abstract Background Redundant clinical and non-invasive examinations after percutaneous coronary intervention (PCI) increase the cost of medical care with no outcome improve. A multidisciplinary consensus document (MCD) providing a follow-up (FU) strategy based on 3 clinical and angiographic risk profile (A high, B intermediate, and C low) has been recently proposed. Aim To evaluate the potential reduction of cardiologic consults (CC), stress tests (ST), and echocardiograms (EC) with the application of the MCD after PCI. Methods The Post-PCI registry is a multicenter, observational, prospective data collection carried out during a four-week period that included consecutive patients undergoing PCI at 31 Italian Hospitals both for acute coronary syndromes (ACS) or stable coronary artery disease (SCAD). FU strategies were left at investigator's discretion. A comparison between the CC, ST and EC performed in the first 12-months with the potential suggested by the MCD was evaluated. Results A total of 1113 patients were included; 12-months follow up was available in 90% of the cases (mean age 68±11 years old, 58% ACS). Based on MCD risk profile 17% were in A, 74% in B and 9% in C strategy. On average observed CC and ST were significantly lower compared to the expected based on MCD (respectively 1.63±1.07 vs 1.91±0.28, and 0.41±0.59 vs 0.61±0.84; on the contrary EC were significantly higher (0.64±0.73 vs 0.34±0.75, all: p<0.001). The excess rate for CC, ST and EC as compared to MCD was respectively 25%, 14% and 8% for the strategy A, 14%, 25% and 50% for the strategy B and 26%, 54% and 40% for the strategy C. At multivariable logistic analysis the MCD strategy was an independent predictor (in a model with age, sex, consulting physician, public or private hospital) of an increased number of cardiac examination in patients at intermediated and low risk [B group OR 2.56 (95% CI 1.38–4.75), C group 27.00 (95% CI 8.13–89.62)]. The other independent predictor was age, with a reduced number of examination for elderly (>75 years old) patients [OR 0.59 (CI 95% 0.43–0.80)]. Conclusion Our data suggest that in a real word population of patients undergoing PCI, a follow-up strategy based on clinical and anatomical risk profile would allow to a reduction of cardiac tests and consultations, particularly in patients at intermediated and low risk leading to an increase of appropriateness of prescription and to a cost reduction of medical care. Acknowledgement/Funding The Post-PCI registry was supported by the Italian Society of Interventional Cardiology (SICI-GISE) receiving an unrestricted grant from Astra Zeneca

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