Translating CKD Research into Primary Care Practice: a Group-Randomized Study

AbstractBackgroundChronic kidney disease (CKD) is common in the primary care setting. Early interventions may prevent progression of renal disease and reduce risk for cardiovascular complications, yet quality gaps have been documented. Successful approaches to improve identification and management of CKD in primary care are needed.ObjectiveTo assess whether implementation of a primary care improvement model results in improved identification and management of CKDDesign18-month group-randomized studyParticipants21 primary care practices in 13 US states caring for 107,094 patientsInterventionsTo promote implementation of CKD improvement strategies, intervention practices received clinical quality measure (CQM) reports at least quarterly, hosted an on-site visit and 2 webinars, and sent clinician/staff representatives to a “best practice” meeting. Control practices received CQM reports at least quarterly.Main MeasuresChanges in practice adherence to a set of 11 CKD CQMsKey ResultsWe observed significantly greater improvements among intervention practices forannual screening for albuminuria in patients with diabetes or hypertension (absolute change 22% in the intervention group vs. − 2.6% in the control group,p 
Source: Journal of General Internal Medicine - Category: Internal Medicine Source Type: research

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Authors: Tomiyama H, Shiina K Abstract The brachial-ankle pulse wave velocity (brachial-ankle PWV), which is measured simply by wrapping pressure cuffs around the four extremities, is a simple marker to assess the stiffness of the medium- to large- sized arteries. The accuracy and reproducibility of its measurement have been confirmed to be acceptable. Risk factors for cardiovascular disease, especially advanced age and high blood pressure, are reported to be associated with an increase of the arterial stiffness. Furthermore, arterial stiffness might be involved in a vicious cycle with the development/progression o...
Source: Journal of Atherosclerosis and Thrombosis - Category: Cardiology Tags: J Atheroscler Thromb Source Type: research
Conclusion We found that the CMQCC admission risk assessment criteria stratified women by increasing rates of severe postpartum hemorrhage in our sample, which enables early preparation for many postpartum hemorrhages. However, the CMQCC risk factors missed a substantial proportion of postpartum hemorrhages. Efforts to improve postpartum hemorrhage risk assessment using present-on-admission risk factors should consider inclusion of other nonobstetrical factors. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract&nbs...
Source: American Journal of Perinatology - Category: Perinatology & Neonatology Authors: Tags: Original Article Source Type: research
AbstractBackgroundThe purpose of this study was to measure trends in the use of tranexamic acid (TXA) during delivery in the United States and to evaluate demographic data and morbidity outcomes among these patients.MethodsThis retrospective cohort study includes data from 19 hospitals in the Universal Health Services network. We compared rates of TXA use between January 2015 and June 2019 across geographic sectors. We also evaluated associations of demographic variables and perinatal outcomes of women who received TXA.Results209 cases of TXA use were found from analysis of 101,564 deliveries. TXA use increased over time a...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
AbstractHeart failure with preserved ejection fraction (HFpEF) is a complex heterogeneous disease for which our pathophysiological understanding is still limited and specific prevention and treatment strategies are lacking. HFpEF is characterised by diastolic dysfunction and cardiac remodelling (fibrosis, inflammation, and hypertrophy). Recently, microvascular dysfunction and chronic low-grade inflammation have been proposed to participate in HFpEF development. Furthermore, several recent studies demonstrated the occurrence of generalized lymphatic dysfunction in experimental models of risk factors for HFpEF, including obe...
Source: Basic Research in Cardiology - Category: Cardiology Source Type: research
AbstractThe Collaborative Care Model (CoCM), in which social workers, primary care physicians, and a consulting psychiatrist work as a team, is an established approach to the treatment of common mental health conditions in primary care settings. Following implementation of a CoCM depression care program at our hospital-based academic primary care practice, we observed a low rate of retention with the use of problem solving therapy/behavioral activation (PST/BA). Our aim in this study was to evaluate the effectiveness of interpersonal psychotherapy (IPT), an evidence-based, flexible strategy that focuses on the relationship...
Source: Psychiatric Quarterly - Category: Psychiatry Source Type: research
AbstractObjectiveClinical and laboratory biomarkers to predict the severity of coronavirus disease 2019 (COVID-19) are essential in this pandemic situation of which resource allocation must be urgently prepared especially in the context of respiratory support readiness. Lymphocyte count has been a marker of interest since the first COVID-19 publication. We conducted a systematic review and meta-analysis in order to investigate the association of lymphocyte count on admission and the severity of COVID-19. We would also like to analyze whether patient characteristics such as age and comorbidities affect the relationship betw...
Source: Journal of Intensive Care - Category: Intensive Care Source Type: research
AbstractRetinol-binding protein-4 (RBP-4) along with the lipid profile plays crucial roles in Acute coronary syndrome (ACS). The study aimed to investigate the correlation of RBP-4, lipoprotein combine index (LCI), and RBP-4  + LCI with ACS. 163 ACS and 77 non-CAD in patients were consecutively enrolled in this study. The serum level of RBP-4 was measured via enzyme-linked immunosorbent assay. LCI was calculated using the formula: total cholesterol × triglyceride × low-density lipoprotein cholesterol/high- density lipoprotein cholesterol. RBP-4 ≥4 ng/ml, LCI &ge...
Source: Heart and Vessels - Category: Cardiology Source Type: research
CONCLUSIONS: Prediabetes among HIV-infected individuals receiving ART is common. The agreements of glycemia estimation methods are minimal to weak. HbA1c may underestimate prediabetes prevalence. Using FPG together with HbA1c increases the detection rate to approximately three-quarters of prediabetes patients. HIV-infected individuals who had hypertension and hypertriglyceridemia should be regularly assessed for prediabetes. Trial registration ClinicalTrial.gov, NCT03545217. Registered 1 June 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03545217. PMID: 32448349 [PubMed - in process]
Source: AIDS Research and Therapy - Category: Infectious Diseases Authors: Tags: AIDS Res Ther Source Type: research
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an RNA betacoronavirus, is a novel respiratory pathogen whose ominous progression has been implicated in disease that ranges from respiratory failure and acute respiratory distress syndrome (ARDS) to multi-organ dysfunction.1,2 Among the most susceptible populations at risk for severe infection are patients with cardiovascular comorbidities, such as hypertension, diabetes mellitus, coronary artery disease, and cardiomyopathy, who have a higher representation among nonsurvivors.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Letter to the Editor Source Type: research
Authors: Ameratunga R, Lehnert K, Leung E, Comoletti D, Snell R, Woon ST, Abbott W, Mears E, Steele R, McKee J, Muscroft-Taylor A, Ameratunga S, Medlicott N, Das S, Rolleston W, Quiñones-Mateu M, Petousis-Harris H, Jordan A Abstract COVID-19 is a new zoonotic disease caused by the SARS-CoV-2 virus. Since its emergence in Wuhan City, China, the virus has rapidly spread across the globe causing calamitous health, economic and societal consequences. It causes disproportionately severe disease in the elderly and those with co-morbidities, such as hypertension and diabetes. There is currently no proven treatment ...
Source: New Zealand Medical Journal - Category: General Medicine Tags: N Z Med J Source Type: research
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