International integrative primary care outcomes study (IIPCOS-2): an international research project of homeopathy in primary care

2000 ◽  
Vol 89 (S 01) ◽  
pp. S10-S13 ◽  
Author(s):  
M Heger ◽  
DS Riley ◽  
M Haidvogl
Keyword(s):  
Primary Care ◽  
Conventional Treatment ◽  
Primary Treatment ◽  
Primary Objective ◽  
Lessons Learned ◽  
Homeopathic Treatment ◽  
Runny Nose ◽  
Related Quality ◽  
Outcomes Study

AbstractObjective: The primary objective is to evaluate the effectiveness of homeopathic treatment compared to conventional treatment for respiratory and ear complaints commonly seen in the primary care setting: runny nose, sore throat, ear pain, sinus pain, and cough.Method: This study is an international, multi-center, prospective, outcomes study on the effectiveness of homeopathic treatment compared to conventional treatment. The participating investigators will be divided into three groups:A total of 2400 patients will be recruited. Consecutive patients, age one month or older, presenting with one of the five chief complaints, and onset of symptoms less than seven days will be included into the study. Prior to enrolment into the trial each patient must provide written informed consent. Patient outcome will be measured using the Integrative Medicine Outcomes Scale (IMOS) at 7-, 14- and 28-d telephone follow-up. In addition, covariate data related to the following will be collected: patient demographics and medical history, patient preference for treatment and willingness to be randomized, health-related quality of life, primary treatment and adjunctive therapies prescribed, adverse events, type and length of consultation, follow-up recommendation, patient compliance, patient satisfaction with treatment, and patient willingness to choose therapy and health care provider again. The main outcome criterion will be the response rate according to the IMOS after 14 days of treatment.Results: Preliminary interim results will be presented.Conclusions: Lessons learned from the study will be discussed.

Improving developmental care in primary practice for disadvantaged children

2018 ◽  
Vol 104 (4) ◽  
pp. 372-380 ◽  
Author(s):  
Karen Margaret Edmond ◽  
Scarlette Tung ◽  
Kimberley McAuley ◽  
Natalie Strobel ◽  
Daniel McAullay
Keyword(s):  
Primary Care ◽  
Geographic Location ◽  
Primary Objective ◽  
Developmental Care ◽  
Disadvantaged Children ◽  
Continuous Quality ◽  
Primary Care Settings ◽  
Mental Stimulation ◽  
Primary Practice

Our primary objective was to assess if sustained participation in continuous quality improvement (CQI) activities could improve delivery of ‘basic developmental care’ to disadvantaged children in primary care settings. Secondary objectives were to assess if delivery of developmental care differed by age and geographic location.Data were analysed using multivariable logistic regression and generalised estimating equations. 109 indigenous primary care centres across Australia from 2012 to 2014 and2466 client files from indigenous children aged 3–59 months were included. Outcome measures were delivery of basic developmental care.We found that the proportion of children who received basic developmental care ranged from 55% (advice about physical and mental stimulation of child) (1279, 55.1%) to 74% (assessment of developmental milestones) (1510, 73.7%). Ninety-three per cent (92.6%, 88) of children received follow-up care. Centres with sustained CQI participation (completed three or more consecutive audit cycles) (508, 53.9%) were twofold more likely to deliver basic developmental care compared with centres without sustained CQI (completed less than three consecutive audit cycles) (118, 31.0%) (adjusted OR (aOR) 2.37, 95% CI 1.33 to 4.23). Children aged 3–11 months (229, 54.9%) were more likely to receive basic developmental care than children aged 24–59 months (151, 38.5%) (aOR 2.42, 95% CI 1.67 to 3.51). Geographic location had little effect (aOR 0.68, 95% CI 0.30 to 1.53). Overall our study found that sustained CQI can improve basic developmental care in primary care settings. However, many disadvantaged children are not receiving services. Improved resourcing of developmental care and CQI in primary care centres is needed.

scholarly journals Usefulness of Home Screening for Promoting Awareness of Impaired Glycemic Status and Utilization of Primary Care in a Low Socio-Economic Setting: A Follow-Up Study in Reunion Island

2021 ◽  
Author(s):  
Adrian Fianu ◽  
Éric Doussiet ◽  
Nadège Naty ◽  
Sylvaine Porcherat ◽  
Corinne Mussard ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetes Prevention ◽  
Healthcare Access ◽  
Primary Objective ◽  
Reunion Island ◽  
Glycemic Status ◽  
Literacy Interventions ◽  
Follow Up Study ◽  
Réunion Island

Background: Low socio-economic settings are characterized by high prevalence of diabetes and difficulty in accessing healthcare. In these contexts, proximity health services could improve healthcare access for diabetes prevention. Our primary objective was to evaluate the usefulness of home screening for promoting awareness of impaired glycemic status and utilization of primary care among adults aged 18-79 in a low socio-economic setting. Methods: This follow-up study was conducted in 2015-2016 in Reunion Island, a French overseas department in the Indian Ocean. Enrollment and screening occurred on the same day at the home of participants (N=907). Impaired glycemic status was defined as [glycated hemoglobin (HbA1c) ≥5.7%] OR [fasting capillary blood glucose (FCBG) ≥1.10 g/L] OR [HbA1c=5.5-5.6% and FCBG=1.00-1.09 g/L]. Medical, socio-cultural, and socio-economic characteristics were collected via a face-to-face questionnaire. A one-month telephone follow-up survey was conducted to determine whether participants had consulted a general practitioner (GP) for confirmation of screening results. A multinomial polytomous logistic regression model was used to identify factors independently associated with non-use of GP consultation for confirmation of screening results and nonresponse to the telephone follow-up survey. Results: Prevalence of glycemic abnormalities was 46.0% (95% CI = 42.7-49.2%). Among participants with impaired glycemic status (N=417), 77.7% (95% CI=73.7-81.7%) consulted a GP for confirmation of screening results, 12.5% (95% CI=9.3-15.6%) did not, and 9.8% failed to respond to the follow-up survey. Factors independently associated with non-use of GP consultation for confirmation of screening results were self-reported unwillingness to consult a GP (adjusted odds ratio [OR]: 4.86, 95% CI=1.70-13.84), usual GP consultation frequency of less than once a year (adjusted OR: 4.13, 95% CI=1.56-10.97), and age 18-39 years (adjusted OR: 3.09, 95% CI=1.46-6.57). Conclusion: Home screening for glycemic abnormalities is a useful proximity health service for diabetes prevention in low socio-economic settings. Further efforts, including health literacy interventions, are needed to increase utilization of primary care.

scholarly journals Can the STarT Back Tool predict health-related quality of life and work ability after an acute/subacute episode with back or neck pain? A psychometric validation study in primary care

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e021748 ◽  
Author(s):  
Malin H Forsbrand ◽  
Birgitta Grahn ◽  
Jonathan C Hill ◽  
Ingemar F Petersson ◽  
Charlotte Post Sennehed ◽  
...  
Keyword(s):  
Primary Care ◽  
Neck Pain ◽  
Work Ability ◽  
Risk Group ◽  
Predictive Ability ◽  
Related Quality ◽  
Long Term Follow Up ◽  
Health Related

ObjectivesThe predictive ability of the STarT Back Tool (SBT) has not yet been examined among acute/subacute back and/or neck pain in a primary care setting in respect to health-related quality of life (HRQoL) and work ability outcomes. The aim of this study was to evaluate the SBT’s predictive validity for HRQoL and work ability outcomes at long-term follow-up in a population with acute/subacute back and/or neck pain.SettingProspective data from 35 primary care centres in south Sweden during 2013.ParticipantsPatients (n=329) with acute/subacute back and/or neck pain, aged 18–67 years, not on sick leave or <60 days of sick leave completed the SBT when applying for physiotherapy treatment. Long-term follow-up measures (median 13 months, range 11–27 months) of HRQoL (EQ-5D) and work ability (Work Ability Score) was completed by 238 patients (72%).OutcomesThe predictive ability of the SBT for HRQoL and work ability outcomes was examined using Kruskal-Wallis test, logistic regression and area under the curve (AUC).ResultsBased on SBT risk group stratification, 103 (43%), 107 (45%) and 28 (12%) patients were considered as low, medium and at high risk, respectively. There were statistically significant differences in HRQoL (p<0.001) and work ability (p<0.001) at follow-up between all three SBT risk groups. Patients in the high risk group had a significantly increased risk of having poor HRQoL (OR 6.16, 95% CI 1.50 to 25.26) and poor work ability (OR 5.08, 95% CI 1.75 to 14.71) vs the low risk group at follow-up. The AUC was 0.73 (95% CI 0.61 to 0.84) for HRQoL and 0.68 (95% CI 0.61 to 0.76) for work ability.ConclusionsThe SBT is an appropriate tool for identifying patients with a poor long-term HRQoL and/or work ability outcome in a population with acute/subacute back and/or neck pain, and maybe a useful adjunct to primary care physiotherapy assessment and practice.Trial registration numberNCT02609750; Results.

scholarly journals Changes in health-related quality of life before and after a 12-month enhanced primary care model among chronically ill primary care patients in Australia.

2020 ◽  
Author(s):  
James John ◽  
W Kathy Tannous ◽  
Amanda Jones
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Health Related Quality ◽  
Before And After ◽  
Related Quality ◽  
Health Related ◽  
Primary Care Patients ◽  
Baseline Covariates

Abstract Purpose: Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called ‘WellNet’. Methods: This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol five dimensions five levels (EQ-5D-5L) instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up. Results: Out of 616 patients, 417 (68%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). The multivariable regression models determined that baseline EQ-5D scores and positive diagnosis of a respiratory illness were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID.Conclusion: Patient-tailored chronic disease management (CDM) plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.

scholarly journals Changes in health-related quality of life before and after a 12-month enhanced primary care model among chronically ill primary care patients in Australia.

2020 ◽  
Author(s):  
James John ◽  
Kathy Tannous ◽  
Amanda Jones
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Statistical Significance ◽  
Health Related Quality ◽  
Before And After ◽  
Related Quality ◽  
Health Related ◽  
Primary Care Patients

Abstract Purpose: Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called ‘WellNet’. Methods: This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol EQ-5D-5L instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Per-protocol (Model 1) and multiple imputation models (Model 2), the latter using a fully conditional specification (FCS) of Markov Chain Monte Carlo (MCMC) algorithm was analysed. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up. Results: Out of 616 patients, 417 (69%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). However, the imputed model failed to meet statistical significance. The multivariable regression models determined that baseline EQ-5D scores, positive diagnosis of a respiratory illness, and private health insurance status were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID.Conclusion: Patient-tailored CDM plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.

scholarly journals Enhancing self-management of multimorbidity in primary care: A randomised controlled trial

2020 ◽  
pp. bjgp20X714185
Author(s):  
Lynn O' Toole ◽  
Deirdre Connolly ◽  
Fiona Boland ◽  
Susan Smith
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Self Management ◽  
Activity Participation ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Secondary Outcomes

Abstract Background: Effective primary care interventions for multimorbidity are needed. Aim: To evaluate the effectiveness of a group-based six-week occupational therapy led self-management support programme (OPTIMAL) for patients with multimorbidity. Design and Setting: A pragmatic parallel randomised trial across eight primary care teams in Eastern Ireland with 149 patients with multimorbidity. The intervention was OPTIMAL with a usual care comparison. Methods: Primary outcomes were health-related quality of life (EQ5D) and frequency of activity participation (FAI). Secondary outcomes included independence in activities of daily living, occupational performance and satisfaction, anxiety and depression, self-efficacy and healthcare utilisation. Complete case linear regression analyses were conducted. Age (<65/ ≥65 years) and the number of chronic conditions (<4/ ≥4) were explored further. Results: 124 participants (83%) and 121 (81%) participants had complete data at immediate and six-month post-intervention follow-up. Intervention participants had a significant improvement in EQ-VAS at immediate follow-up (Adjusted MD=7.86; 95% CI 0.92 to 14.80) but no difference in the index score (Adjusted MD= 0.04; 95% CI -0.06 to 0.01) or FAI (Adjusted MD = 1.22; 95% CI -0.84 to 3.29). At six-month follow-up there were no differences in primary outcomes. There were mixed results for secondary outcomes. Pre-planned sub-group analyses suggested participants aged <65 years were more likely to benefit. Conclusions: OPTIMAL was not effective in improving health related quality of life or activity participation at six-month follow up. Pre-planned sub-group analyses results suggest that future research should target younger adults (age <65 years) with multimorbidity.

Phase II trial of stereotactic ablative radiation (SAbR) for oligoprogressive kidney cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 4564-4564
Author(s):  
Raquibul Hannan ◽  
Michael Christensen ◽  
Aurelie Garant ◽  
Hans J. Hammers ◽  
Waddah Arafat ◽  
...  
Keyword(s):  
Phase Ii ◽  
Local Control ◽  
Systemic Therapy ◽  
Kinase Inhibitor ◽  
Primary Objective ◽  
Related Quality ◽  
Health Related ◽  
Secondary Endpoints ◽  
Grade 3

4564 Background: Metastatic renal cell carcinoma (mRCC) patients on systemic therapy may experience oligoprogression. SAbR has been demonstrated to be safe and is associated with high local control rates in mRCC. In this prospective phase II single arm trial, we investigated SAbR to control oligoprogressive mRCC. Methods: Patients with mRCC who demonstrated response to systemic therapy with subsequent radiographic evidence of three or fewer sites of progression were treated with SAbR to all progressive sites. Systemic therapy was held during SAbR at the discretion of the treating oncologist. Follow-up included radiographic imaging at three-month intervals. Sequential SAbR for continued oligoprogression was allowed. The primary objective was extension of ongoing systemic therapy by >6 months in 40% of the patients. Progression was defined by any of these 3 criteria: (1) local failure at a radiated site; (2) progression ineligible for additional SAbR (>3 sites) or involving >30% of metastasis; or (3) progression as clinically determined by treating physicians. An exact binomial test was used to test the probability of postponing systemic therapy. Secondary endpoints focused on overall survival (OS), local control (LC) rates, toxicity, and health-related quality of life (QOL). Results: The trial completed accrual with enrollment of 20 patients who received SAbR to a total of 36 sites. At enrollment four, twelve, three, and one patients were on first, second, third, and fourth line of systemic therapy, respectively. Eleven were on immunotherapy and nine on a tyrosine-kinase inhibitor. Three patients required repeat SAbR to a new site for sequential disease control. At a median follow-up of 8.3 months (interquartile range 3.9 – 15.1), SAbR extended the duration of the ongoing systemic therapy by >6 months in 12 out of 17 patients (70.6%, 95% CI: 48.9%-92.3%). Thirteen out of 20 patients progressed with a median PFS of 8.7 months (95% CI: 3.2-12.4). Five patients died and the OS did not reach the median. LC was 36/36 (100%). Treatment related grade 1 and grade 2 toxicity was experienced by three and one patient, respectively; no grade 3 toxicities were reported. When compared to baseline, no significant decline in QOL was detected. Conclusions: SAbR extended PFS of ongoing systemic by >6 months in oligoprogressive patients with mRCC. SAbR was safe and did not adversely affect QOL. These data support further evaluation of SAbR for oligoproressive mRCC in a prospective randomized setting. Clinical trial information: NCT03696277.

118 Lessons Learned After 500 Cases of Intra-Arterial Chemotherapy for Retinoblastoma

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 225-226
Author(s):  
Elias Atallah ◽  
Stavropoula I Tjoumakaris ◽  
Robert H Rosenwasser ◽  
Pascal Jabbour
Keyword(s):  
Ophthalmic Artery ◽  
Vitreous Hemorrhage ◽  
Primary Treatment ◽  
Lessons Learned ◽  
Response To Treatment ◽  
Complete Regression ◽  
Bilateral Retinoblastoma ◽  
Systemic Side Effects ◽  
Retinal Artery

Abstract INTRODUCTION Intra-arterial chemotherapy has been used in early-childhood retinoblastoma. We present some pearls and pitfalls of this technique in a sizable cohort of retinoblastoma patients. METHODS A retrospective, non-comparative cohort of 500 patients with retinoblastoma was grouped between January 2009 and September 2016. Melphalan was infused under fluoroscopic guidance through the ophthalmic artery with supplementary topotecan or carboplatin or both, for a mean of 3 cycles. The mean follow-up was 20.3 months(SD = 11.3). The International Classification of Retinoblastoma (ICRB) was implemented in the assessment of ocular globe preservation and of the tumor's response to treatment. Grade E patients were almost always treated concomitantly with IV chemotherapy. RESULTS >Of 500 patients (mean of age 35 months), we treated 520 eyes. (n1 = 236; [(67) A, (83) B, (48) C, (18) D and (20) E]) received a primary treatment, (n2 = 95) were treated for their advanced disease, (n3 = 67) had bilateral retinoblastoma and (n4 = 55) were treated for a recurrence after conventional intravenous chemotherapy. Globe preservation was achieved in 87% of primary-treated cases(A [100%]; B [100%]; C [100%]; D [92%]; E [46%]) and in 69% of secondary-treated patients. Postprocedural complications were vitreous hemorrhage (3.2%), retinal artery branch occlusion (0.75%), ophthalmic artery (OA) occlusion (1.7%) and spasm (2.2%), limited choroidal ischemia (1.8%) and optic neuropathy (0.7%). 478(92%) patients had complete regression: small tumors 99%[201/203]; well-defined tumors 97%[173/178] and poorly defined tumors 92%[88/97]. There was no motor, sensitive or ictal complications after the intervention. Patients manifested none of the systemic side effects of the dispensed chemotherapy. CONCLUSION Selective intra-ophtalmic chemotherapy has become a gold standard in the treatment of retinoblastoma, with very low mortality, morbidity related to the procedure and a very high cure rate.

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