scholarly journals Smartphone Camera to Image the Retina for Primary Care MDs and Diabetologists

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A401-A401
Author(s):  
Chap-Kay Kendra Lau ◽  
Gloria Wu
Keyword(s):  
Primary Care ◽  
Retinal Images ◽  
Inclusion Criteria ◽  
Start Time ◽  
Future Studies ◽  
Primary Care Settings ◽  
Fundus Imaging ◽  
The Us ◽  
The Difference ◽  
Diagnosis Of Hypertension

Abstract Background: Imaging is an important tool for diagnosis of hypertension and diabetes for all physicians. In the US, 300 million smartphones were purchased in 2019. Purpose: A smartphone-based ophthalmoscope for fundus imaging was compared to an office based retina camera to evaluate the average time spent on each device. Methods: Inclusion criteria: Patients with 20/20-20/50 vision, informed consent was obtained. D-Eye/iphone digital direct ophthalmoscope (Padova, Italy) was used on the dilated and undilated eyes of patients, video recorded to attain an image of the optic nerve and internally timed in the iPhone. Optos (Marlborough, MA) was then used to take retinal images of both dilated and undilated eyes of patients for comparison. The start time and end time was recorded from the timestamp of the 1st and last image taken on Optos, then the difference between both timestamps was calculated to obtain time spent on Optos. Results: For dilated patients (n=12, 24 eyes), the average time taken to obtain a clear video of both eyes using D-Eye was 28.08 seconds. The average time to take images of both eyes using Optos was 1.83 minutes. For undilated patients (n=10, 20 eyes), the average time of a clear video of both eyes using D-Eye was 29.8 seconds. The average time to take clear images of both eyes using Optos was 1.2 minutes. Conclusion: The portable D-Eye attachment may be useful at primary care settings, eye MD offices, bedside, ER, and wheelchair patients for evaluation and diagnosis. The D-Eye attachment for the smartphone is useful for imaging both dilated and undilated eyes. We look forward to future studies of the D-Eye for more complex retinal images.

scholarly journals Medicines Related Problems (MRPs) Originating in Primary Care Settings in Older Adults - A Systematic Review

2021 ◽  
pp. 089719002110236
Author(s):  
Rosetta Chinyere Ude-Okeleke ◽  
Zoe Aslanpour ◽  
Soraya Dhillon ◽  
Nkiruka Umaru
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Library Science ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Data Bases ◽  
Primary Care Settings ◽  
Preventative Interventions ◽  
Use Of Health Services

Background: As people age, they become increasingly vulnerable to the untoward effects of medicines due to changes in body systems. These may result in medicines related problems (MRPs) and consequent decline or deterioration in health. Aim: To identify MRPs, indicators of deterioration associated with these MRPs, and preventative interventions from the literature. Design and Setting: Systematic review of primary studies on MRPs originating in Primary Care in older people. Methods: Relevant studies published between 2001 and April 2018 were obtained from Medline (via PubMed), CINAHL, Embase, Psych Info, PASCAL, Scopus, Cochrane Library, Science Direct, and Zetoc. Falls, delirium, pressure ulcer, hospitalization, use of health services and death were agreed indicators of deterioration. The methodological quality of included studies was assessed using the Down and Black tool. Results: There were 1858 articles retrieved from the data bases. Out of these, 21 full text articles met inclusion criteria for the review. MRPs identified were medication error, potentially inappropriate medicines, adverse drug reaction and non-adherence. These were associated with indicators of deterioration. Interventions that involved doctors, pharmacists and patients in planning and implementation yielded benefits in halting MRPs. Conclusion: This Systematic review summarizes MRPs and associated indicators of deterioration. Appropriate interventions appeared to be effective against certain MRPs and their consequences. Further studies to explore deterioration presented in this systematic review is imperative.

scholarly journals Influence of organisational attributes on registered nurse contributions to well-child care: a scoping review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e052634
Author(s):  
Suzanne Braithwaite ◽  
Julia Lukewich ◽  
Danielle Macdonald ◽  
Joan Tranmer
Keyword(s):  
Primary Care ◽  
Child Care ◽  
Scoping Review ◽  
Full Text ◽  
Registered Nurse ◽  
Universal Access ◽  
Secondary Analysis ◽  
Inclusion Criteria ◽  
Well Child Care ◽  
Primary Care Settings

IntroductionUniversal access to preventative healthcare is essential to children’s health. Registered nurses (RN) are well positioned to deliver well-child care within primary care settings; however, RN role implementation varies widely in this sector and the scope of literature that examines the influence of organisational attributes on nursing contributions to well-child care is not well understood. The aim of this scoping review is to identify the scope and characteristics of the literature related to organisational attributes that act as barriers to, or facilitators for RN delivery of well-child care within the context of primary care in high-income countries.Methods and analysisThe Joanna Briggs Institute scoping review methodology will be used to conduct this review. Databases that will be accessed include Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE and Embase. Inclusion criteria includes articles with a focus on RNs who deliver well-child care in primary care settings. Literature that meets this inclusion criteria will be included in the study. Covidence software platform will be used to review citations and full-text articles. Titles, abstracts and full-text articles will be reviewed independently by two reviewers. Any disagreements that arise between the reviewers will be resolved through discussion, or with an additional reviewer. Data will be extracted and organised according to the dimensions outlined in the nursing care organisation conceptual framework (NCOF). Principles of the ‘best fit’ framework synthesis will guide the data analysis approach and the NCOF will act as the framework for data coding and analysis.Ethics and disseminationThis scoping review will undertake a secondary analysis of data already published and does not require ethical approval. Findings will be disseminated via peer-reviewed publications and conference presentations targeting stakeholders involved in nursing practice and the delivery of well-child care.Trial registration detailsBraithwaite, S., Tranmer, J., Lukewich, J., & Macdonald, D. (2021, March 31). Protocol for a Scoping Review of the Influence of Organisational Attributes on Registered Nurse Contributions to Well-child Care. https://doi.org/10.17605/OSF.IO/UZYX5.

scholarly journals Application of artificial intelligence to electronic health records for early detection and diagnosis of cancer in primary care: a Systematic Review (Preprint)

2020 ◽  
Author(s):  
Owain Tudor Jones ◽  
Natalia Calanzani ◽  
Smiji Saji ◽  
Stephen W Duffy ◽  
Jon Emery ◽  
...  
Keyword(s):  
Primary Care ◽  
Early Detection ◽  
Electronic Health Records ◽  
Inclusion Criteria ◽  
Implementation Barriers ◽  
Health Records ◽  
Primary Care Settings ◽  
Primary Care Data ◽  
Diagnosis Of Cancer ◽  
Electronic Health

BACKGROUND More than 17 million people worldwide, including 360,000 people in the UK, were diagnosed with cancer in 2018. Cancer prognosis and disease burden is highly dependent on disease stage at diagnosis. Most people diagnosed with cancer first present in primary care settings, where improved assessment of the (often vague) presenting symptoms of cancer could lead to earlier detection, and improved outcomes for patients. There is accumulating evidence that artificial intelligence (AI) can assist clinicians in making better clinical decisions in some areas of healthcare. OBJECTIVE We aimed to systematically review AI technologies based on electronic health record (EHR) data that may facilitate the earlier diagnosis of cancer in primary care settings. We evaluated the quality of the evidence, the phase of development the AI technologies have reached, the gaps that exist in the evidence, and the potential for use in primary care. METHODS We searched Medline, Embase, SCOPUS, and Web of Science databases from 1st January 2000 to 11th June 2019 (PROSPERO ID CRD42020176674), and included all studies providing evidence for accuracy or effectiveness of applying AI technologies to early detection of cancer using electronic health records. We included all study designs, in all settings and all languages. We extended these searches through a scoping review of commercial AI technologies. The main outcomes assessed were measures of diagnostic accuracy for cancer. RESULTS We identified 10,456 studies: 16 met the inclusion criteria, representing the data of 3,862,910 patients. 13 studies described the initial development and testing of AI algorithms and three studies described the validation of an AI technology in independent datasets. One study was based on prospectively collected data; only three studies were based on primary care data. We found no data on implementation barriers or cost-effectiveness. Risk-of-bias assessment highlighted a wide range in study quality. The additional scoping review of commercial AI tools identified 21 technologies, only one meeting our inclusion criteria. Meta-analysis was not undertaken due to heterogeneity of AI modalities, dataset characteristics and outcome measures. CONCLUSIONS Applying AI technologies to electronic health records for early detection of cancer in primary care is at an early stage of maturity. Further evidence is needed on performance using primary care data, implementation barriers and cost-effectiveness before widespread adoption into routine primary care clinical practice can be recommended. This study was supported by funding from the NIHR Cancer Policy Research Programme and Cancer Research UK.

scholarly journals 2647. Influenza Treatment Rates in UK Primary Care Settings: Real-World Data Analysis of the CPRD, 2003–2018

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S926-S927
Author(s):  
Devika Chawla ◽  
Parul Dayal ◽  
Klaus Kuhlbusch ◽  
Dalia Moawad ◽  
Chris Wallick ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Real World ◽  
Antiviral Treatment ◽  
Patient Characteristics ◽  
Treatment Patterns ◽  
Inclusion Criteria ◽  
Primary Care Settings ◽  
Care Facilities ◽  
Study Inclusion

Abstract Background Influenza remains a significant public health burden, resulting in serious morbidity and mortality globally. The National Institute for Health and Care Excellence (NICE) recommends treatment with antivirals for a broad range of high-risk influenza cases; however, anecdotal reports suggest treatment rates in the United Kingdom remain low. Real-world evidence on influenza treatment patterns in this region is limited. We therefore sought to investigate the proportion of influenza cases presenting to UK primary care facilities that receive antiviral treatment. Methods Data were obtained from the Clinical Practice Research Datalink (CPRD), a database of medical records from 674 primary care facilities in the UK. Cases were eligible for study inclusion if a diagnosis code for influenza or influenza-like illness (ILI) occurred between 1 January 2003 and 31 December 2018, and the medical record had sufficient data quality. Treatment was defined as prescription of an antiviral (oseltamivir, zanamivir, peramivir, or amantadine) within ±10 days of diagnosis. We examined (1) treatment rates, overall and by study year to understand time trends, (2) distribution of antiviral types prescribed, and (3) patient characteristics across treatment status. Results Of the 116,923 cases of influenza that met study inclusion criteria, 10,923 (9.3%) were treated with an antiviral. Treatment rates varied by study year, ranging from <1.0% in 2004 to 24.0% in 2009. The most recent study year (2018) had a treatment rate of 11.2%. Oseltamivir was the most frequent antiviral prescribed, followed by zanamivir. Treated cases of influenza were younger and more likely to be female compared with untreated cases. Conclusion We evaluated real-world estimates of influenza treatment rates over a 16-year period in UK primary care settings, where anecdotal reports suggested low treatment rates. Consistent with these reports, we observed low treatment rates, likely due in part to inclusion criteria and clinical guidelines specifying treatment only for high-risk cases. Subsequent analyses will investigate treatment patterns and patient characteristics in high-risk vs. low-risk cases to provide additional context for observed treatment rates. Disclosures All authors: No reported disclosures.

scholarly journals GEOGRAPHIC DISPARITIES IN LIFE EXPECTANCY AND MORTALITY IN THE U.S.

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S427-S427
Author(s):  
Julia Kravchenko ◽  
H Kim Lyerly
Keyword(s):  
Heart Failure ◽  
Life Expectancy ◽  
Industrialized Countries ◽  
Future Studies ◽  
Factors Analysis ◽  
Low Weight ◽  
The Us ◽  
Quality Of Medical Care ◽  
The Difference

Abstract Although the US has one of the highest per-capita health expenditures in the world, it noticeably lags behind a number of other industrialized countries in terms of life expectancy (LE). These disparities remain unexplained by individual demographic, socioeconomic, and healthcare factors. Analysis of death certificates for 1999-2016 revealed that diseases contributed most to LE variability are myocardial infarction (explained 12.9% of the difference in mortality), heart failure (10.6%), stroke (8.2%), lung cancer (7.5%) and COPD (7.2%). Analysis of histories of diseased patients in Medicare records showed that septicemia (15.7%), low weight (13.8%), renal disease (13.3%), disorders of electrolyte and fluid balance (9.0%) and heart failure (7.3%) contributed most to the disparities. Diseases that substantially contribute to disparities in LE in the US include both common and less-often-discussed diseases. Future studies of variations in treatment patterns, access-to and quality-of medical care for these diseases could provide important insight in observed patterns.

scholarly journals A Web-Based Decision Tool to Improve Contraceptive Counseling for Women With Chronic Medical Conditions: Protocol For a Mixed Methods Implementation Study (Preprint)

2017 ◽  
Author(s):  
Justine P Wu ◽  
Laura J Damschroder ◽  
Michael D Fetters ◽  
Brian J Zikmund-Fisher ◽  
Benjamin F Crabtree ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Chronic Medical Conditions ◽  
Medical Conditions ◽  
Decision Tool ◽  
Web Based ◽  
Primary Care Settings ◽  
Contraceptive Counseling ◽  
The Us ◽  
Evidence Based Guidelines

BACKGROUND Women with chronic medical conditions, such as diabetes and hypertension, have a higher risk of pregnancy-related complications compared with women without medical conditions and should be offered contraception if desired. Although evidence based guidelines for contraceptive selection in the presence of medical conditions are available via the United States Medical Eligibility Criteria (US MEC), these guidelines are underutilized. Research also supports the use of decision tools to promote shared decision making between patients and providers during contraceptive counseling. OBJECTIVE The overall goal of the MiHealth, MiChoice project is to design and implement a theory-driven, Web-based tool that incorporates the US MEC (provider-level intervention) within the vehicle of a contraceptive decision tool for women with chronic medical conditions (patient-level intervention) in community-based primary care settings (practice-level intervention). This will be a 3-phase study that includes a predesign phase, a design phase, and a testing phase in a randomized controlled trial. This study protocol describes phase 1 and aim 1, which is to determine patient-, provider-, and practice-level factors that are relevant to the design and implementation of the contraceptive decision tool. METHODS This is a mixed methods implementation study. To customize the delivery of the US MEC in the decision tool, we selected high-priority constructs from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework to drive data collection and analysis at the practice and provider level, respectively. A conceptual model that incorporates constructs from the transtheoretical model and the health beliefs model undergirds patient-level data collection and analysis and will inform customization of the decision tool for this population. We will recruit 6 community-based primary care practices and conduct quantitative surveys and semistructured qualitative interviews with women who have chronic medical conditions, their primary care providers (PCPs), and clinic staff, as well as field observations of practice activities. Quantitative survey data will be summarized with simple descriptive statistics and relationships between participant characteristics and contraceptive recommendations (for PCPs), and current contraceptive use (for patients) will be examined using Fisher exact test. We will conduct thematic analysis of qualitative data from interviews and field observations. The integration of data will occur by comparing, contrasting, and synthesizing qualitative and quantitative findings to inform the future development and implementation of the intervention. RESULTS We are currently enrolling practices and anticipate study completion in 15 months. CONCLUSIONS This protocol describes the first phase of a multiphase mixed methods study to develop and implement a Web-based decision tool that is customized to meet the needs of women with chronic medical conditions in primary care settings. Study findings will promote contraceptive counseling via shared decision making and reflect evidence-based guidelines for contraceptive selection. CLINICALTRIAL ClinicalTrials.gov NCT03153644; https://clinicaltrials.gov/ct2/show/NCT03153644 (Archived by WebCite at http://www.webcitation.org/6yUkA5lK8)

Systematic review of outreach clinics in primary care in the UK

2002 ◽  
Vol 7 (3) ◽  
pp. 177-183 ◽  
Author(s):  
John Powell
Keyword(s):  
Primary Care ◽  
Direct Costs ◽  
Consistent Difference ◽  
Inclusion Criteria ◽  
Administrative Costs ◽  
Patients Satisfaction ◽  
Primary Care Settings ◽  
Additional Costs ◽  
The Uk ◽  
Patients Experience

Objectives : To determine the benefits of holding specialist outreach clinics in primary care settings by means of a systematic literature review of UK studies. Methods: Systematic searches of electronic databases, hand searches of journals, and contact with experts. Application of inclusion criteria. Study findings summarised. Results: Fifteen studies met the inclusion criteria. Surveys of general practitioners (GPs), specialists and patients identified the perceived advantages of outreach clinics of improving GP-specialist communication and improving patients' experience and access. Reported disadvantages concerned administrative costs, accommodation costs and inefficient use of specialists' time. Comparative studies showed that more patients expressed a preference for outreach clinics than for hospital-based clinics, and measures of patients' satisfaction and convenience generally were higher for outreach clinics. Studies did not show any consistent difference in health outcome between outreach and hospital-based clinics. Outreach clinics had higher direct costs to the health system than hospital-based clinics. Conclusions: Health care purchasers and providers must decide whether the advantages in terms of patients' experience of outreach clinics are worth the additional costs. They also need to consider issues of equity, which have not been addressed in research to date.

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