All Articles

Evidence of a Patient Centered Medical Home (PCMH) Improving the Health of Chronically Ill Patients in the Mississippi Delta

Abstract:

Using proprietary data of patient records from four medical clinics in the Mississippi Delta, this research utilizes a natural experiment design to explore if the patient centered medical home (PCMH) has a positive effect on chronic disease maintenance for low SES, majority African-American patients in a rural and medically underserved region. The patients are divided into two cohorts, those attending PCMH clinics (level 2) and those attending non-PCMH clinics. Each cohort is comprised of similar demographic, socioeconomic, and health (large proportion of diabetics) characteristics. HbA1c scores of the cohorts are compared at two time periods, baseline and six-month follow-up. PCMH patients report more uncontrolled diabetes at baseline but the trend reverses at follow-up, providing evidence that the PCMH model of primary care produces positive health outcomes for patients with diabetes in the sample area.

Where Do You Sit in Class? A Study of Spatial Positioning During Two Courses of Different Duration

Abstract:

The objective of this study was to study the selection of seat location by individuals in a group in a confined environment and to identify the factors leading people to prefer one location to another. We analyzed the seating location of students in a lecture hall over the course of two academic programs of different durations (19 days and 44 days). The goal was to determine the rate at which participants would settle into a specific seat location. Unobtrusive photography was used to collect objective data on an hourly basis. Results showed that in both courses participants began to settle into a specific location from the second day of class. Twenty percent of the participants had settled after 4-7 days or 15.5 hours in class. Settling continued for the duration of the shorter course. However, in the longer course settling stopped after 28.5 days on average. The plateau in the number of settlers depended on the number of days, not on the time actually spent in cl...

New Knowledge and Research Needs for End-of-Life Care Among Elderly Persons in Long-Term Care Settings

Abstract:

Given the aging of the population, an increase in the number of persons in need of long-term care and end-of-life care can be expected in the coming years. The scientific literature underlines the lack of end-of-life care for elderly people in long-term care centres. The aim of this study is to explore needs in terms of new knowledge and research on end-of-life care for elderly persons in long-term care settings, from the perspective not only of the scientific and international community, but also of Quebec professionals concerned by the issue. An online survey using the LimeSurvey® tool was conducted in 2015 among health professionals involved in end-of-life care for elderly persons in long-term care settings in Quebec. 208 professionals rated the priority of new knowledge and research needs related to 1) health professionals; 2) delivery and quality of care; 3) residents and their loved ones; and 4) organization and management of care. The results show that the...

Unusual Presentation Of Tracheoesophageal Fistula With Meconium Aspiration Syndrome In A Preterm Infant

Abstract:

Congenital malformations usually occur during organogenesis and result in complete or partial absence of an anatomical part or alteration in its normal configuration. Major structural anomalies occur in 2-3% of live births.The reported global incidence of tracheoesophageal fistula is roughly 1 in 2,500 live births and in Pakistan, incidence is only reported by those tertiary care centers which have paediatric surgery facilities available.We report a case of esophageal atresia (OA) with tracheoesophageal fistula (TEF) associated with meconium aspiration syndrome (MAS) in an infant. Reporting this anomaly highlights the importance of early diagnosis and thorough clinical examination of a newborn, signifying that a meticulous prenatal workup should be conducted. TEF/OA should be suspected in any newborn presenting with respiratory distress, especially cough, emesis and/or cyanosis during feeds, history of polyhydrominos and inability to pass nasogastric tube. The par...

The Relationship of Chronic Pain to Attitudes Toward Sucide and Physician-Assisted Suicide among Latino and Non Hispanic White Elders

Abstract:

The objective of this study was to examine differences between Latino and White older adults in attitudes toward suicide and physician-assisted suicide in chronic pain scenarios.

We used a cross sectional study design at four outpatient care sites in San Antonio, Texas. The study sample included 204 subjects (106 Whites and 98 Latinos), 60 years of age and older, with Mini Mental State Examination scores of 24 or higher. No statistically significant between ethnic group differences in attitudes toward suicide or physician-assisted suicide in chronic pain scenarios were found. However, separate analyses by ethnic group showed that the factors associated with these attitudes differed between ethnic groups, with attitudes among Whites significantly and negatively associated with religiosity and those among Latinos significantly and positively associated with depression, while acculturation was significantly and negatively associated with attitudes t...

Dietary Advice on Prescription (DAP). A Pedagogical Model for Better Dietary Habits Tested in a Two-Year Randomized Clinical Trial. 

Abstract:

There Is A Gap Between What We Know And What We Do, Such As Knowing What We Should Eat And What We Actually Eat, A So-Called “Attitude/Behavior Gap”. It Is Not Necessary To Go From A Change In Attitude To A Change In Behavior. It Is Possible To Do The Opposite; In Other Words, It Is Possible To Go From A Change In Behavior To A Change In Attitude. The Objective Of This Paper Is To Describe And Explain The Concept Of Dietary Advice On Prescription (DAP) And Present The Reasons And Evidences For The DAP Messages. Dietary Advice On Prescription (DAP) Starts With Discussing Behaviors Related To Dietary Habits And Then Goes From Behaviors Towards Attitudes. DAP Is A Theory-Based Pedagogical Model That Deals With Behaviors Related To Why, How And When We Eat, Rather Then What We Eat. The DAP Model Is A Method That Quickly Leads The Client Onto A Track That Yields Autonomy, Respects The Client’s Integrity, Gives Confirmation, Emphasizes The Delight And Pleasure Of ...

A Randomized Controlled Biofeedback Intervention Study On Heart Rate Variability In Unemployed Subjects

Abstract:

Unemployment is a chronic stressor which is associated with higher levels of impaired physical and mental wellbeing, e.g. reduced heart rate variability (HRV) and decline in self-esteem and self-efficacy. The present study investigated the effectivity of a HRV-biofeedback-training in increasing HRV and general self-efficacy.

Supporting Quality Data Systems:  Lessons Learned from Early Implementation of Routine Viral Load Monitoring at a Large Clinic in Lilongwe, Malawi

Abstract:

Successful viral load programs rely on the presence of data systems and high quality of patient data. Using a cohort of 49 patients at Partners in Hope, a large, urban HIV clinic in Malawi, we performed a quality improvement assessment of a new viral load program with a focus on accuracy of data collected from patients as well as adherence to Malawi HIV Guidelines in regard to response to elevated viral loads (≥1,000 copies/mL). Data were obtained from three parallel medical record systems to investigate the proportion of patients with a repeat viral load and whether the three data systems agreed in regard to sociodemographic and clinical data. Fewer than 30% of patients had a repeat viral load within six months, as recommended in the Malawi HIV Guidelines. There were significant problems with data agreement across the three parallel databases used for care.  Date of birth was consistent for 55.1% (N=27) of patients, while a different date of birth was noted i...

Antibiotic Resistance in the Elderly

Abstract:

This is a short communication article on antibiotic resistance in the elderly. The elderly is prone to infections and therefore the use of antibiotics in the elderly is common. Literature review was done using Medline, Google and PubMed.

Differentiating Depression from Apathy in Chronic Kidney Disease: A Prospective Study

Abstract:

Emotional deterioration is frequently found in patients with chronic kidney disease, but some patients are affected by depressed mood without fulfilling the criteria of a depressive disorder. Those patients might rather suffer from an apathy symptom. Apathy as a symptom of a medical disease is accompanied by loss of motivation and interest, cognitive impairments, and emotional distress. Our study tested how groups of apathetic and depressed chronic kidney disease patients responded to a single haemodialysis session on measures of mood.