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Non-ST elevation myocardial infarction in pregnancy-a critical review of current evidence and guidelines
We present a case of a 37-year-old female with a background of hypertension and hyperlipidemia who presented with Non-ST segment elevation myocardial infarction (NSTEMI). The urine pregnancy test that was performed turned positive with an estimated gestational age of four weeks. After counselling on the potential risks and benefits, a diagnostic angiogram was performed which revealed triple vessel disease with critical stenosis in all three vessels. Percutaneous coronary intervention (PCI) was performed successfully with precautions taken to minimize radiation exposure to the fetus. In such cases, there is a fundamental tr...
Source: Reviews in Cardiovascular Medicine - December 27, 2021 Category: Cardiology Authors: Ke Xuan Jessica Ng Ki Fung Cliff Li Chong Keat Tan Paul Jl Ong Source Type: research

The Impact of Telemedicine on Quality of Care for Patients with Diabetes After March 2020
ConclusionsPatients with diabetes utilizing telemedicine performed similarly on a composite measure of diabetes care quality compared to before the pandemic. Those not utilizing telemedicine had reductions. Telemedicine use maintained quality of care for patients with diabetes during the first 9 months of the COVID-19 pandemic.
Source: Journal of General Internal Medicine - January 28, 2022 Category: Internal Medicine Source Type: research

Effective Facilitator Strategies for Supporting Primary Care Practice Change: A Mixed Methods Study
CONCLUSIONS: Facilitation strategies that differentiate more and less effective facilitators have implications for enhancing facilitator development and training, and can assist all facilitators to more effectively support practice changes.PMID:36228060 | DOI:10.1370/afm.2847
Source: Annals of Family Medicine - October 13, 2022 Category: Primary Care Authors: Shannon M Sweeney Andrea Baron Jennifer D Hall David Ezekiel-Herrera Rachel Springer Rikki L Ward Miguel Marino Bijal A Balasubramanian Deborah J Cohen Source Type: research

Organizational Factors Associated with Guideline Concordance of Chronic Disease Care and Management Practices
Conclusions: There are mutable organizational attributes connected-guideline concordant chronic disease care in primary care. Research and policy reform are needed to promote and study how to achieve widespread adoption of these functions and organizational attributes that may be central to achieving equity and improving chronic disease prevention.
Source: Journal of the American Board of Family Medicine - December 23, 2022 Category: Primary Care Authors: Cohen, D. J., Wyte-Lake, T., Bonsu, P., Albert, S. L., Kwok, L., Paul, M. M., Nguyen, A. M., Berry, C. A., Shelley, D. R. Tags: Original Research Source Type: research

Eliminating Medication Copayments Reduces Disparities In Cardiovascular Care Disparities
Substantial racial and ethnic disparities in cardiovascular care persist in the United States. For example, African Americans and Hispanics with cardiovascular disease are 10–40 percent less likely than whites to receive secondary prevention therapies, such as aspirin and beta-blockers. Lowering copayments for these therapies improves outcomes among all patients who have had a myocardial infarction, but the impact of lower copayments on health disparities is unknown. Using self-reported race and ethnicity for participants in the Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) trial, w...
Source: Health Affairs - May 5, 2014 Category: Global & Universal Authors: Choudhry, N. K., Bykov, K., Shrank, W. H., Toscano, M., Rawlins, W. S., Reisman, L., Brennan, T. A., Franklin, J. M. Tags: Access To Care, Health Promotion/Disease Prevention, Health Reform, Insurance Coverage, Pharmaceuticals, Physicians, Public Health, Quality Of Care, Health Spending, Evidence-Based Medicine, Cardiovascular Disease, Affordable Care Act Disparities Source Type: research

Management of hemichorea hemiballismus syndrome in an acute palliative care setting
We describe a case of HCHB presenting to a palliative care setting. A 63-year-old diabetic and hypertensive lady, with history of ovarian cancer presented to Palliative Medicine outpatient clinic with two days history of right HCHB. Blood investigations and brain imaging showed high blood sugar levels and lacunar subcortical stroke. Blood sugar levels were controlled with human insulin and Aspirin. Clopidogrel and Atorvastatin were prescribed for the management of lacunar stroke. HCHB reduced markedly post-treatment, leading to significant reduction in morbidity and improvement in quality of life. The symptoms completely r...
Source: Indian Journal of Palliative Care - January 28, 2015 Category: Palliative Care Authors: Anuja DamaniArunangshu GhoshalNaveen SalinsJayita DeodharMary Ann Muckaden Source Type: research

Early antithrombotic therapy is safe and effective in patients with blunt cerebrovascular injury and solid organ injury or traumatic brain injury
CONCLUSION: Initiation of early AT for patients with BCVI and concomitant TBI or SOI does not increase risk of worsening TBI or SOI above baseline. Close monitoring is required, but our results suggest that appropriate antiplatelet or heparin therapy should not be withheld in patients with BCVI and concomitant TBI or SOI. In fact, prompt treatment with either antiplatelet or heparin therapy remains the mainstay for prevention of stroke-related morbidity and mortality in these patients. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - June 22, 2016 Category: Orthopaedics Tags: Original Articles Source Type: research

Prescription audit of NSAIDs and gastroprotective strategy in elderly in primary care.
CONCLUSIONS: The rational choice of NSAIDs and physicians' adherence to gastroprotective measures was suboptimal in primary care. The choice of NSAIDs and gastroprotective strategy in elderly be guided by the CV and gastrointestinal adverse events likelihood due to the NSAIDs and risk profile of patients for such adverse events. PMID: 28885223 [PubMed - in process]
Source: International Journal of Risk and Safety in Medicine - September 10, 2017 Category: Drugs & Pharmacology Tags: Int J Risk Saf Med Source Type: research

Does Ownership Make a Difference in Primary Care Practice?
Conclusions: Primary care practice ownership was associated with differences in quality improvement process measures, with FQHCs reporting the highest use of such quality-improvement strategies. ABCS were mostly unrelated to ownership, suggesting a complex path between quality improvement strategies and outcomes.
Source: Journal of the American Board of Family Medicine - May 7, 2019 Category: Primary Care Authors: Lindner, S., Solberg, L. I., Miller, W. L., Balasubramanian, B. A., Marino, M., McConnell, K. J., Edwards, S. T., Stange, K. C., Springer, R. J., Cohen, D. J. Tags: Original Research Source Type: research

Beijing's diagnosis-related group payment reform pilot: Impact on quality of acute myocardial infarction care
This study explored whether this payment pilot improved quality and reduced costs of acute myocardial infarction (AMI) care in hospitals implementing DRG payment as compared to control hospitals. A difference-in-difference study design was used with regression and considered several quality indicators including aspirin at arrival, aspirin at discharge, β-blocker at arrival, β-blocker at discharge, statin at discharge, in-hospital mortality, and 30-day readmission rates. DRG payment mechanisms without specific mechanisms to promote care quality did not improve quality of AMI care. Future studies should study the impact of...
Source: Social Science and Medicine - October 6, 2019 Category: Psychiatry & Psychology Source Type: research

Practice Transformation Support and Patient Engagement to Improve Cardiovascular Care: From EvidenceNOW Southwest (ENSW)
Conclusions: Practice transformation support can assist practices with improving quality of care. Patient engagement in practice transformation can further enhance practices' implementation of aspects of new models of care.
Source: Journal of the American Board of Family Medicine - September 27, 2020 Category: Primary Care Authors: Dickinson, W. P., Nease, D. E., Rhyne, R. L., Knierim, K. E., Fernald, D. H., de la Cerda, D. R., Dickinson, L. M. Tags: Original Research Source Type: research

A Retrospective Look at Patient, Procedural, and Follow-up Characteristics Associated With WATCHMAN Implantation
This study used a retrospective design to review data previously collected and entered into the National Cardiovascular Data Registry database.RESULTS: During a 2-year period, 41 patients underwent the WATCHMAN procedure at our facility. The most common indication for the procedure in this population of patients with nonvalvular AF on oral anticoagulants was bleeding in the gastrointestinal or genitourinary systems. (Gastrointestinal/genitourinary bleed does not limit candidacy for surgical closure of the LAA.) There was only 1 postprocedure adverse event that included a groin hematoma. A transesophageal echocardiogram at ...
Source: Dimensions in Critical Care Nursing - October 4, 2021 Category: Nursing Authors: Susan B Fowler Mary Janette Sendin Source Type: research