Journal of primary care & community health
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J Prim Care Community Health · Jan 2020
Practice GuidelineGuidelines for Frontline Health Care Staff Safety for COVID-19.
This document establishes safety guidelines for physicians, nurses, and allied health care and facility staff who may be exposed to patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a health care facility. SARS-CoV-2 infection is highly contagious and places health care workers at risk for infection resulting in coronavirus disease (COVID-19). Physicians, nurses, and allied health care and facility staff in all frontline environments must be provided and utilize necessary personal protective equipment (PPE). ⋯ The establishment of these guidelines is necessary in this viral pandemic since such directives can create a standard of safety that is universally accepted. These guidelines establish a framework to provide consistency among health care facilities and staff from the time the staff member arrives at the health care facility until they return home. These guidelines provide a practical description of the minimum necessary protection for physicians, nurses, and allied health care and facility staff against SARS-CoV-2 infection.
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J Prim Care Community Health · Jan 2020
Utilizing the Learning Health System Adaptation to guide Family Medicine Practice to COVID-19 response.
COVID-19 supportive quarantine care in the community is managed by primary care practices. There is no current guidance on how a primary care practice with high volumes of patients screened for COVID-19 can re-configure itself to become responsive to the pandemic. We examined Learning Health System guidance from the National Academies of Science, Engineering and Medicine and adapted it to our primary care practice to create an efficient, effective, adaptive response to the COVID-19 pandemic. We suggest evaluating this response in the future for effectiveness and efficiency.
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J Prim Care Community Health · Jan 2020
A Case-Control Study: The Impact of Unintentional Discrepancies and Pharmacist Discharge Prescription Review on 30-Day Hospital Readmission.
Introduction: Medication discrepancies on hospital discharge are common and occur despite the use of technology to generate electronically created discharge (e-discharge) prescriptions, justifying pharmacist involvement. No published studies have focused on medication discrepancies as a risk factor for readmission. The aim was to explore the relationship between medication discrepancies on discharge and readmission rates, and how both are affected by pharmacist intervention. ⋯ Conclusions: Pharmacist review of the e-discharge prescription did not affect the readmission rate. A LACE score of 12 or greater was associated with a higher risk of readmission. Future studies are needed to identify patient groups at high risk of readmission and to determine pharmacist interventions that could reduce readmission rates.
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J Prim Care Community Health · Jan 2020
Review Case ReportsManagement of Restless Legs Syndrome in Pregnancy and Lactation.
Restless legs syndrome (RLS) affects about 20% of all pregnant women. RLS symptoms are usually moderate to severe in intensity during pregnancy and can result in insomnia, depression, and other adverse outcomes. Although iron deficiency has been implicated as a potential etiological factor, other mechanisms can also play a role. ⋯ We review the literature on the prevalence, diagnosis, course, possible underlying pathophysiologic mechanisms and complications of RLS in pregnancy. We describe current best evidence on the efficacy, and safety of nonpharmacologic therapies, oral and intravenous iron supplementation, as well as other medication treatments for RLS in pregnancy and lactation. We highlight gaps in the literature and provide a practical guide for the clinical management of RLS in pregnancy and during breastfeeding.
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J Prim Care Community Health · Jan 2020
Randomized Controlled Trial Multicenter StudyPatient-Reported Outcomes from a 1-Year, Real-World, Head-to-Head Comparison of OnabotulinumtoxinA and Topiramate for Headache Prevention in Adults With Chronic Migraine.
Chronic migraine (CM) is associated with impaired health-related quality of life and substantial socioeconomic burden, but many people with CM are underdiagnosed and do not receive appropriate preventive treatment. OnabotulinumtoxinA and topiramate have demonstrated efficacy (treatment benefit under ideal conditions) for the prevention of headaches in people with CM in clinical trials, but real-world studies suggest markedly different clinical effectiveness (treatment benefit based on a blend of efficacy and tolerability). This study sought to evaluate patient-reported outcomes (PROs) of onabotulinumtoxinA versus topiramate immediate release for people with CM. ⋯ OnabotulinumtoxinA treatment had more favorable real-world effectiveness than topiramate on depression, headache impact, functioning and daily living, activity, and work productivity. The overall study results suggest that the beneficial effects on a range of PROs are the result of improved effectiveness when onabotulinumtoxinA is used as preventive treatment for CM.