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[PMID]:28459897
[Au] Autor:Graber CJ; Jones MM; Chou AF; Zhang Y; Goetz MB; Madaras-Kelly K; Samore MH; Glassman PA
[Ad] Endereço:Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA; David Geffen School of Medicine at the University of California, Los Angeles, CA.
[Ti] Título:Association of Inpatient Antimicrobial Utilization Measures with Antimicrobial Stewardship Activities and Facility Characteristics of Veterans Affairs Medical Centers.
[So] Source:J Hosp Med;12(5):301-309, 2017 May.
[Is] ISSN:1553-5606
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. OBJECTIVE: To determine associations between ASPs and facility characteristics, and inpatient antimicrobial utilization measures in the Veterans Affairs (VA) system in 2012. DESIGN: In 2012, VA administered a survey on antimicrobial stewardship practices to designated ASP contacts at VA acute care hospitals. From the survey, we identified 34 variables across 3 domains (evidence, organizational context, and facilitation) that were assessed using multivariable least absolute shrinkage and selection operator regression against 4 antimicrobial utilization measures from 2012: aggregate acute care antimicrobial use, antimicrobial use in patients with non-infectious primary discharge diagnoses, missed opportunities to convert from parenteral to oral antimicrobial therapy, and double anaerobic coverage. SETTING: All 130 VA facilities with acute care services. RESULTS: Variables associated with at least 3 favorable changes in antimicrobial utilization included presence of postgraduate physician/pharmacy training programs, number of antimicrobial-specific order sets, frequency of systematic de-escalation review, presence of pharmacists and/or infectious diseases (ID) attendings on acute care ward teams, and formal ID training of the lead ASP pharmacist. Variables associated with 2 unfavorable measures included bed size, the level of engagement with VA Antimicrobial Stewardship Task Force online resources, and utilization of antimicrobial stop orders. CONCLUSIONS: Formalization of ASP processes and presence of pharmacy and ID expertise are associated with favorable utilization. Systematic de-escalation review and order set establishment may be high-yield interventions. Journal of Hospital Medicine 2017;12:301-309.
[Mh] Termos MeSH primário: Anti-Infecciosos/uso terapêutico
Gestão de Antimicrobianos/normas
Revisão de Uso de Medicamentos/normas
Hospitalização
Hospitais de Veteranos/normas
United States Department of Veterans Affairs/normas
[Mh] Termos MeSH secundário: Gestão de Antimicrobianos/métodos
Revisão de Uso de Medicamentos/métodos
Hospitalização/tendências
Seres Humanos
Serviço de Farmácia Hospitalar/métodos
Serviço de Farmácia Hospitalar/normas
Inquéritos e Questionários
Estados Unidos/epidemiologia
Veteranos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Infective Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.12788/jhm.2730


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[PMID]:29414272
[Au] Autor:Raskind MA; Peskind ER; Chow B; Harris C; Davis-Karim A; Holmes HA; Hart KL; McFall M; Mellman TA; Reist C; Romesser J; Rosenheck R; Shih MC; Stein MB; Swift R; Gleason T; Lu Y; Huang GD
[Ad] Endereço:From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studie
[Ti] Título:Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans.
[So] Source:N Engl J Med;378(6):507-517, 2018 02 08.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In randomized trials, prazosin, an α -adrenoreceptor antagonist, has been effective in alleviating nightmares associated with post-traumatic stress disorder (PTSD) in military veterans. METHODS: We recruited veterans from 13 Department of Veterans Affairs medical centers who had chronic PTSD and reported frequent nightmares. Participants were randomly assigned to receive prazosin or placebo for 26 weeks; the drug or placebo was administered in escalating divided doses over the course of 5 weeks to a daily maximum of 20 mg in men and 12 mg in women. After week 10, participants continued to receive prazosin or placebo in a double-blind fashion for an additional 16 weeks. The three primary outcome measures were the change in score from baseline to 10 weeks on the Clinician-Administered PTSD Scale (CAPS) item B2 ("recurrent distressing dreams"; scores range from 0 to 8, with higher scores indicating more frequent and more distressing dreams); the change in score from baseline to 10 weeks on the Pittsburgh Sleep Quality Index (PSQI; scores range from 0 to 21, with higher scores indicating worse sleep quality); and the Clinical Global Impression of Change (CGIC) score at 10 weeks (scores range from 1 to 7, with lower scores indicating greater improvement and a score of 4 indicating no change). RESULTS: A total of 304 participants underwent randomization; 152 were assigned to prazosin, and 152 to placebo. At 10 weeks, there were no significant differences between the prazosin group and the placebo group in the mean change from baseline in the CAPS item B2 score (between-group difference, 0.2; 95% confidence interval [CI], -0.3 to 0.8; P=0.38), in the mean change in PSQI score (between-group difference, 0.1; 95% CI, -0.9 to 1.1; P=0.80), or in the CGIC score (between-group difference, 0; 95% CI, -0.3 to 0.3; P=0.96). There were no significant differences in these measures at 26 weeks (a secondary outcome) or in other secondary outcomes. At 10 weeks, the mean difference between the prazosin group and the placebo group in the change from baseline in supine systolic blood pressure was a decrease of 6.7 mm Hg. The adverse event of new or worsening suicidal ideation occurred in 8% of the participants assigned to prazosin versus 15% of those assigned to placebo. CONCLUSIONS: In this trial involving military veterans who had chronic PTSD, prazosin did not alleviate distressing dreams or improve sleep quality. (Funded by the Department of Veterans Affairs Cooperative Studies Program; PACT ClinicalTrials.gov number, NCT00532493 .).
[Mh] Termos MeSH primário: Antagonistas de Receptores Adrenérgicos alfa 1/administração & dosagem
Sonhos/efeitos dos fármacos
Prazosina/administração & dosagem
Transtornos do Sono-Vigília/tratamento farmacológico
Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico
Veteranos
[Mh] Termos MeSH secundário: Antagonistas de Receptores Adrenérgicos alfa 1/efeitos adversos
Adulto
Terapia Combinada
Relação Dose-Resposta a Droga
Método Duplo-Cego
Feminino
Hospitais de Veteranos
Seres Humanos
Masculino
Meia-Idade
Prazosina/efeitos adversos
Escalas de Graduação Psiquiátrica
Psicoterapia
Sono/efeitos dos fármacos
Transtornos de Estresse Pós-Traumáticos/psicologia
Transtornos de Estresse Pós-Traumáticos/terapia
Ideação Suicida
Falha de Tratamento
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
[Nm] Nome de substância:
0 (Adrenergic alpha-1 Receptor Antagonists); XM03YJ541D (Prazosin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180208
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1507598


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[PMID]:25816378
[Au] Autor:Locatelli SM; Turcios S; LaVela SL
[Ad] Endereço:Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA Center for Evaluation of Practices and Experiences of Patient-Centered Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA sara.locatelli@va.gov.
[Ti] Título:Optimizing the patient-centered environment: results of guided tours with health care providers and employees.
[So] Source:HERD;8(2):18-30, 2015.
[Is] ISSN:1937-5867
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To examine providers' perspectives on the care environment and patient-centered care (PCC) through the eyes of the veteran patient, using guided tours qualitative methodology. BACKGROUND: Environmental factors, such as attractiveness and function, have the potential to improve patients' experiences. Participatory qualitative methods allow researchers to explore the environment and facilitate discussion. METHODS: Guided tours were conducted with 25 health care providers/employees at two Veterans Affairs (VA) health care facilities. In guided tours, participants lead the researcher through an environment, commenting on their surroundings, thoughts, and feelings. The researcher walks along with the participant, asking open-ended questions as needed to foster discussion and gain an understanding of the participant's view. Participants were asked to walk through the facility as though they were a veteran. Tours were audio recorded, with participant permission, and transcribed verbatim by research assistants. Three qualitative researchers were responsible for codebook development and coding transcripts and used data-driven coding approaches. RESULTS: Participants discussed physical appearance of the environment and how that influences perceptions about care. Overall, participants highlighted the need to shed the "institutional" appearance. Differences between VA and non-VA health care facilities were discussed, including availability of private rooms and staff to assist with navigating the facility. They reviewed resources in the facility, such as the information desk to assist patients and families. Finally, they offered suggestions for future improvements, including improvements to waiting areas and quiet areas for patients to relax and "get away" from their rooms. CONCLUSIONS: Participants highlighted many small changes to the care environment that could enhance the patient experience. Additionally, they examined the environment from the patient's perspective, to identify elements that enhance, or detract from, the patient's care experience.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Pessoal de Saúde/psicologia
Hospitais de Veteranos/normas
Decoração de Interiores e Mobiliário/normas
Assistência Centrada no Paciente/normas
Quartos de Pacientes/normas
[Mh] Termos MeSH secundário: Adulto
Feminino
Hospitais de Veteranos/organização & administração
Seres Humanos
Entrevistas como Assunto
Diretórios de Sinalização e Localização/normas
Masculino
Assistência Centrada no Paciente/métodos
Assistência Centrada no Paciente/organização & administração
Quartos de Pacientes/organização & administração
Pesquisa Qualitativa
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150328
[St] Status:MEDLINE
[do] DOI:10.1177/1937586714565610


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[PMID]:28459333
[Au] Autor:Rinne ST; Hebert PL; Wong ES; Au DH; Bastian LA; Nembhard IM; Neely EL; Sulc CA; Liu CF
[Ad] Endereço:1 Department of Veterans Affairs Bedford, Massachusetts.
[Ti] Título:Organizational Practices Affecting Chronic Obstructive Pulmonary Disease Readmissions.
[So] Source:Am J Respir Crit Care Med;195(9):1269-1272, 2017 05 01.
[Is] ISSN:1535-4970
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Corticosteroides/uso terapêutico
Assistência Ambulatorial/utilização
Broncodilatadores/uso terapêutico
Fidelidade a Diretrizes/organização & administração
Hospitais de Veteranos/organização & administração
Readmissão do Paciente/estatística & dados numéricos
Doença Pulmonar Obstrutiva Crônica/terapia
Respiração Artificial/utilização
[Mh] Termos MeSH secundário: Administração por Inalação
Idoso
Progressão da Doença
Retroalimentação
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Medicaid
Medicare
Meia-Idade
Política Organizacional
Guias de Prática Clínica como Assunto
Autocuidado
Estados Unidos
United States Department of Veterans Affairs
[Pt] Tipo de publicação:LETTER; RESEARCH SUPPORT, NON-U.S. GOV'T; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Bronchodilator Agents)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171218
[Lr] Data última revisão:
171218
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1164/rccm.201609-1783LE


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[PMID]:28925176
[Au] Autor:Lipshy KA; Britt LD
[Ti] Título:How do we improve patient safety? A look at the issues and an interview with Dr. Britt.
[So] Source:Bull Am Coll Surg;102(2):22-9, 2017 02.
[Is] ISSN:0002-8045
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hospitais de Veteranos/normas
Segurança do Paciente/normas
Melhoria de Qualidade
Procedimentos Cirúrgicos Operatórios/normas
[Mh] Termos MeSH secundário: Seres Humanos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170920
[St] Status:MEDLINE


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[PMID]:28925177
[Au] Autor:Lipshy KA
[Ti] Título:Conversation with Dr. Britt.
[So] Source:Bull Am Coll Surg;102(2):30-2, 2017 02.
[Is] ISSN:0002-8045
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hospitais de Veteranos/normas
Segurança do Paciente/normas
Melhoria de Qualidade
Procedimentos Cirúrgicos Operatórios/normas
[Mh] Termos MeSH secundário: Seres Humanos
Cultura Organizacional
Estados Unidos
[Pt] Tipo de publicação:INTERVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170920
[St] Status:MEDLINE


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[PMID]:28911150
[Au] Autor:Jasuja GK; Bhasin S; Rose AJ; Reisman JI; Hanlon JT; Miller DR; Morreale AP; Pogach LM; Cunningham FE; Park A; Wiener RS; Gifford AL; Berlowitz DR
[Ad] Endereço:Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, Massachusetts 01730.
[Ti] Título:Provider and Site-Level Determinants of Testosterone Prescribing in the Veterans Healthcare System.
[So] Source:J Clin Endocrinol Metab;102(9):3226-3233, 2017 Sep 01.
[Is] ISSN:1945-7197
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Context: Testosterone prescribing rates have increased substantially in the past decade. However, little is known about the context within which such prescriptions occur. Objective: We evaluated provider- and site-level determinants of receipt of testosterone and of guideline-concordant testosterone prescribing. Design: This study was cross-sectional in design. Setting: This study was conducted at the Veterans Health Administration (VA). Participants: Study participants were a national cohort of male patients who had received at least one outpatient prescription within the VA during fiscal year (FY) 2008 to FY 2012. A total of 38,648 providers and 130 stations were associated with these patients. Main Outcome Measure: This study measured receipt of testosterone and guideline-concordant testosterone prescribing. Results: Providers ranging in age from 31 to 60 years, with less experience in the VA [all adjusted odds ratio (AOR), <2; P < 0.01] and credentialed as medical doctors in endocrinology (AOR, 3.88; P < 0.01) and urology (AOR, 1.48; P < 0.01) were more likely to prescribe testosterone compared with older providers, providers of longer VA tenure, and primary care providers, respectively. Sites located in the West compared with the Northeast [AOR, 1.75; 95% confidence interval (CI), 1.45-2.11] and care received at a community-based outpatient clinic compared with a medical center (AOR, 1.22; 95% CI, 1.20-1.24) also predicted testosterone use. Although they were more likely to prescribe testosterone, endocrinologists were also more likely to obtain an appropriate workup before prescribing compared with primary care providers (AOR, 2.14; 95% CI, 1.54-2.97). Conclusions: Our results highlight the opportunity to intervene at both the provider and the site levels to improve testosterone prescribing. This study also provides a useful example of how to examine contributions to prescribing variation at different levels of the health care system.
[Mh] Termos MeSH primário: Prescrições de Medicamentos/estatística & dados numéricos
Uso de Medicamentos/estatística & dados numéricos
Pessoal de Saúde
Hospitais de Veteranos
Testosterona/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Estudos Transversais
Bases de Dados Factuais
Pesquisas sobre Serviços de Saúde
Seres Humanos
Incidência
Modelos Logísticos
Masculino
Meia-Idade
Avaliação de Resultados (Cuidados de Saúde)
Valor Preditivo dos Testes
Estudos Retrospectivos
Estados Unidos
Veteranos/estatística & dados numéricos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
3XMK78S47O (Testosterone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE
[do] DOI:10.1210/jc.2017-00468


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[PMID]:28873140
[Au] Autor:Goto M; Schweizer ML; Vaughan-Sarrazin MS; Perencevich EN; Livorsi DJ; Diekema DJ; Richardson KK; Beck BF; Alexander B; Ohl ME
[Ad] Endereço:Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa.
[Ti] Título:Association of Evidence-Based Care Processes With Mortality in Staphylococcus aureus Bacteremia at Veterans Health Administration Hospitals, 2003-2014.
[So] Source:JAMA Intern Med;177(10):1489-1497, 2017 Oct 01.
[Is] ISSN:2168-6114
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Staphylococcus aureus bacteremia is common and frequently associated with poor outcomes. Evidence indicates that specific care processes are associated with improved outcomes for patients with S aureus bacteremia, including appropriate antibiotic prescribing, use of echocardiography to identify endocarditis, and consultation with infectious diseases (ID) specialists. Whether use of these care processes has increased in routine care for S aureus bacteremia or whether use of these processes has led to large-scale improvements in survival is unknown. Objective: To examine the association of evidence-based care processes in routine care for S aureus bacteremia with mortality. Design, Setting, and Participants: This retrospective observational cohort study examined all patients admitted to Veterans Health Administration (VHA) acute care hospitals who had a first episode of S aureus bacteremia from January 1, 2003, through December 31, 2014. Exposures: Use of appropriate antibiotic therapy, echocardiography, and ID consultation. Main Outcomes and Measures: Thirty-day all-cause mortality. Results: Analyses included 36 868 patients in 124 hospitals (mean [SD] age, 66.4 [12.5] years; 36 036 [97.7%] male), including 19 325 (52.4%) with infection due to methicillin-resistant S aureus and 17 543 (47.6%) with infection due to methicillin-susceptible S aureus. Risk-adjusted mortality decreased from 23.5% (95% CI, 23.3%-23.8%) in 2003 to 18.2% (95% CI, 17.9%-18.5%) in 2014. Rates of appropriate antibiotic prescribing increased from 2467 (66.4%) to 1991 (78.9%), echocardiography from 1256 (33.8%) to 1837 (72.8%), and ID consultation from 1390 (37.4%) to 1717 (68.0%). After adjustment for patient characteristics, cohort year, and other care processes, receipt of care processes was associated with lower mortality, with adjusted odds ratios of 0.74 (95% CI, 0.68-0.79) for appropriate antibiotics, 0.73 (95% CI, 0.68-0.78) for echocardiography, and 0.61 (95% CI, 0.56-0.65) for ID consultation. Mortality decreased progressively as the number of care processes that a patient received increased (adjusted odds ratio for all 3 processes compared with none, 0.33; 95% CI, 0.30-0.36). An estimated 57.3% (95% CI, 48.4%-69.9%) of the decrease in mortality between 2003 and 2014 could be attributed to increased use of these evidence-based care processes. Conclusions and Relevance: Mortality associated with S aureus bacteremia decreased significantly in VHA hospitals, and a substantial portion of the decreasing mortality may have been attributable to increased use of evidence-based care processes. The experience in VHA hospitals demonstrates that increasing application of these care processes may improve survival among patients with S aureus bacteremia in routine health care settings.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Bacteriemia/mortalidade
Medicina Baseada em Evidências/métodos
Previsões
Hospitais de Veteranos/estatística & dados numéricos
Infecções Estafilocócicas/mortalidade
Staphylococcus aureus/isolamento & purificação
[Mh] Termos MeSH secundário: Idoso
Bacteriemia/tratamento farmacológico
Bacteriemia/microbiologia
Causas de Morte/tendências
Feminino
Seguimentos
Mortalidade Hospitalar/tendências
Seres Humanos
Masculino
Estudos Retrospectivos
Fatores de Risco
Infecções Estafilocócicas/tratamento farmacológico
Infecções Estafilocócicas/microbiologia
Taxa de Sobrevida/tendências
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE
[do] DOI:10.1001/jamainternmed.2017.3958


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[PMID]:28817498
[Au] Autor:Jaffa JL; Dufault M; Lavin M
[Ad] Endereço:Marlene Dufault, PhD RN, is Professor of Nursing, College of Nursing, University of Rhode Island, South Kingston, RI. Mary Lavin, DNP APRN-CNP, is Associate Clinical Professor, College of Nursing, University of Rhode Island, South Kingston, RI.
[Ti] Título:An Interprofessional Approach to Amyotrophic Lateral Sclerosis Care.
[So] Source:J Neurosci Nurs;49(5):318-323, 2017 Oct.
[Is] ISSN:1945-2810
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Amyotrophic lateral sclerosis (ALS) is a progressive fatal neurodegenerative disease that is characterized by the death of motor neurons in the spinal cord, brain stem, and motor cortex that are responsible for voluntary movement. For unknown reasons, military veterans are approximately twice as likely as the public to be given a diagnosis of ALS. Currently, there is no cure for ALS. The only US Food and Drug Administration-approved disease-modifying medication is riluzole (Rilutek), which may slow ALS progression but only minimally increases survival time. Multidisciplinary care in ALS has been shown to improve survival time and improve quality of life. The purpose of this article is to describe the development of an innovative evidence-based interprofessional healthcare program in a Veterans Administration medical center to address the needs of this vulnerable veteran population.
[Mh] Termos MeSH primário: Esclerose Amiotrófica Lateral/diagnóstico
Esclerose Amiotrófica Lateral/terapia
Relações Interprofissionais
[Mh] Termos MeSH secundário: Esclerose Amiotrófica Lateral/tratamento farmacológico
Anticonvulsivantes/uso terapêutico
Hospitais de Veteranos/utilização
Seres Humanos
Riluzol/uso terapêutico
Estados Unidos
Veteranos/psicologia
Veteranos/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticonvulsants); 7LJ087RS6F (Riluzole)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE
[do] DOI:10.1097/JNN.0000000000000309


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[PMID]:28806373
[Au] Autor:Gundlapalli AV; Redd A; Bolton D; Vanneman ME; Carter ME; Johnson E; Samore MH; Fargo JD; O'Toole TP
[Ad] Endereço:*Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System †Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT ‡VA National Center on Homelessness Among Veterans, Philadelphia, PA §Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT ∥Providence Veterans Affairs (VA) Medical Center, Providence, RI ¶Utah State University, Department of Psychology, Logan, UT #Warren Alpert Medical School at Brown University, Providence, RI.
[Ti] Título:Patient-aligned Care Team Engagement to Connect Veterans Experiencing Homelessness With Appropriate Health Care.
[So] Source:Med Care;55 Suppl 9 Suppl 2:S104-S110, 2017 Sep.
[Is] ISSN:1537-1948
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Veterans experiencing homelessness frequently use emergency and urgent care (ED). OBJECTIVE: To examine the effect of a Patient-aligned Care Team (PACT) model tailored to the unique needs of Veterans experiencing homelessness (H-PACT) on frequency and type of ED visits in Veterans Health Administration (VHA) medical facilities. RESEARCH DESIGN: During a 12-month period, ED visits for 3981 homeless Veterans enrolled in (1) H-PACT at 20 VHA medical centers (enrolled) were compared with those of (2) 24,363 homeless Veterans not enrolled in H-PACT at the same sites (nonenrolled), and (3) 23,542 homeless Veterans at 12 non-H-PACT sites (usual care) using a difference-in-differences approach. MEASURE(S): The primary outcome was ED and other health care utilization and the secondary outcome was emergent (not preventable/avoidable) ED visits. RESULTS: H-PACT enrollees were predominantly white males with a higher baseline Charlson comorbidity index. In comparing H-PACT enrollees with usual care, there was a significant decrease in ED usage among the highest ED utilizers (difference-in-differences, -4.43; P<0.001). The decrease in ED visits were significant though less intense for H-PACT enrollees versus nonenrolled (-0.29, P<0.001). H-PACT enrollees demonstrated a significant increase in the proportion of ED care visits that were not preventable/avoidable in the 6 months after enrollment, but had stable rates of primary care, mental health, social work, and substance abuse visits over the 12 months. CONCLUSIONS: Primary care treatment engagement can reduce ED visits and increase appropriate use of ED services in VHA for Veterans experiencing homelessness, especially in the highest ED utilizers.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência/utilização
Pessoas em Situação de Rua
Equipe de Assistência ao Paciente/organização & administração
Assistência Centrada no Paciente/organização & administração
Veteranos/psicologia
[Mh] Termos MeSH secundário: Assistência à Saúde/utilização
Feminino
Hospitais de Veteranos
Seres Humanos
Masculino
Meia-Idade
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170822
[Lr] Data última revisão:
170822
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE
[do] DOI:10.1097/MLR.0000000000000770



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