Primary care payment models and avoidable hospitalizations in Ontario, Canada: A multivalued treatment effects analysis.

Improving access to primary care physicians' services may help reduce hospitalizations due to Ambulatory Care Sensitive Conditions (ACSCs). Ontario, Canada's most populous province, introduced blended payment models for primary care physicians in the early- to mid-2000s to increase access to primary care, preventive care, and better chronic disease management. We study the impact of payment models on avoidable hospitalizations due to two incentivized ACSCs (diabetes and congestive heart failure) and two non-incentivized ACSCs (angina and asthma).

A Case of Malignant Melanotic Schwannoma of the Trigeminal Nerve: A Case Report and Review of Literature.

Intracranial melanotic schwannoma is quite rare, and involvement of the trigeminal nerve is even rarer. Early diagnosis and surgical excision are the mainstays of management. These tumors have a high tendency to recur and there is high possibility of metastasis.

Recurrent Papillary Tumor of Pineal Region Misdiagnosed as Pineocytoma 9-Years Ago.

Primary tumors of the pineal gland occur infrequently with a preponderance of either parenchymal tumors or germ cells tumors. Papillary tumor of the pineal region is a rare neuroepithelial lesion that arises exclusively in the pineal region. They have been designated as either Grade II or Grade III lesions as per the 2016 WHO classification of central nervous system tumors.

Stirring the pot: Switching from blended fee-for-service to blended capitation models of physician remuneration.

In Canada's most populous province, Ontario, family physicians may choose between the blended fee-for-service (Family Health Group [FHG]) and blended capitation (Family Health Organization [FHO] payment models). Both models incentivize physicians to provide after-hours (AH) and comprehensive care, but FHO physicians receive a capitation payment per enrolled patient adjusted for age and sex, plus a reduced fee-for-service while FHG physicians are paid by fee-for-service. We develop a theoretical model of physician labor supply with multitasking to predict their behavior under FHG and FHO, and estimable equations are derived to test the predictions empirically.

Production of physician services under fee-for-service and blended fee-for-service: Evidence from Ontario, Canada.

We examine family physicians' responses to financial incentives for medical services in Ontario, Canada. We use administrative data covering 2003-2008, a period during which family physicians could choose between the traditional fee for service (FFS) and blended FFS known as the Family Health Group (FHG) model. Under FHG, FFS physicians are incentivized to provide comprehensive care and after-hours services.

Family physician remuneration schemes and specialist referrals: Quasi-experimental evidence from Ontario, Canada.

Understanding how family physicians respond to incentives from remuneration schemes is a central theme in the literature. One understudied aspect is referrals to specialists. Although the theoretical literature has suggested that capitation increases referrals to specialists, the empirical evidence is mixed.

Mortality and Hospitalizations in Intensive Dialysis: A Systematic Review and Meta-Analysis.

Background: Survival and hospitalization are critically important outcomes considered when choosing between intensive hemodialysis (HD), conventional HD, and peritoneal dialysis (PD). However, the comparative effectiveness of these modalities is unclear.

Objective: We had the following aims: (1) to compare the association of mortality and hospitalization in patients undergoing intensive HD, compared with conventional HD or PD and (2) to appraise the methodological quality of the supporting evidence.

Meningiomas in children and adolescents: a meta-analysis of individual patient data.

Background: The epidemiological, prognostic, and therapeutic features of child and adolescent meningioma are poorly defined. Clinical knowledge has been drawn from small case series and extrapolation from adult studies. This study was done to pool and analyse the clinical evidence on child and adolescent meningioma.

Use of endoscopic third ventriculostomy in hydrocephalus of tubercular origin.

Purpose: The purpose of this paper was to study the feasibility of endoscopic third ventriculostomy (ETV) as a treatment modality in patients with hydrocephalus of tubercular origin.

Materials And Methods: Literature on ETV in hydrocephalus of tubercular origin has been reviewed, and we have gathered experiences of neurosurgeons from various institutions in our country practicing ETV.

Results: Hydrocephalus, a common complication of tubercular meningitis, may be of communicating type or of obstructive variety.

Meningiomas in children: A study of 18 cases.

Background: Intracranial meningiomas are rare tumors in children accounting for 0.4-4.6% of all primary brain tumors in the age group of 0-18 years.

Internal mammary artery steal syndrome secondary to an anomalous lateral branch.

A 53-year-old male who underwent three-vessel coronary artery bypass grafting had a left internal mammary artery (LIMA) graft to the left anterior descending artery (LAD) and saphenous venous grafts to right coronary artery (RCA) and left circumflex coronary artery. Four years after surgery, he developed exertion angina associated with upper body exercises and even deep breathing at times. Angiographic evaluation revealed an anomalous lateral internal thoracic artery with steal phenomenon documented by adenosine cardiolyte.

Role of postoperative use of adrenergic drugs in occurrence of atrial fibrillation after cardiac surgery.

Background: Use of adrenergic (inotropic and vasopressor) drugs is common after cardiac surgery.

Hypothesis: The study was undertaken to evaluate the role of postoperative adrenergic drug use as a predictor of postoperative atrial fibrillation (AF) after cardiac surgery.

Methods: The study population consisted of 199 patients post cardiac surgery.

Role of postoperative vasopressor use in occurrence of atrial fibrillation after coronary artery bypass grafting.

Vasopressor use is common after coronary artery bypass grafting surgery. This study evaluated the role of postoperative vasopressor use as a predictor of occurrence of atrial fibrillation after coronary artery bypass grafting and demonstrates that vasopressor use is an independent predictor of such an occurrence.

Cardiac tamponade and superior vena cava syndrome in lung cancer--a case report.

A combination of pericardial effusion with cardiac tamponade and superior vena caval syndrome is an unusual first presentation of carcinoma of lung, although cardiac involvement is often a late finding in widespread malignancy. Clinical identification can be difficult antemortem. Accurate diagnosis and prompt intervention are necessary to prevent adverse outcomes.

Third heart sound: genesis and clinical importance.

Auscultation of third heart sound has been performed for more than a century, an interest that not only persists today, but also has experienced renewed emphasis. Sophisticated study of the third heart sound by current investigative techniques has underscored the value of clinical detection with the time-honored stethoscope. This review re-examines the mechanisms of genesis of third heart sound in regard to the hemodynamic and echocardiographic aspects, and its clinical importance.

Elevated serum cardiac troponin I in rhabdomyolysis.

Objective: To examine the etiology and clinical significance of elevated serum cardiac troponin I (cTnI) in patients with rhabdomyolysis.

Methods: Data on 91 (63 men) consecutive patients with rhabdomyolysis were examined.

Results: The mean age was 57.

Reinforcement as a means for quality improvement in management of coronary syndromes: adherence to evidence-based medicine.

Objective: To study the effect of reinforcement as a quality improvement intervention in the evidence-based management of the coronary syndromes.

Methods: In the pre-intervention phase, the charts of 140 consecutive patients with ICD-9 codes 410-414 for coronary syndromes were reviewed for measurement of total cholesterol on admission and fasting low density lipoprotein (LDL) cholesterol, implementation of aspirin therapy on admission, beta-blockers' use during hospitalization, and treatment with angiotensin converting enzyme (ACE) inhibitors in patients with left ventricular systolic dysfunction. Reinforcement was used as an intervention for quality improvement.

Gender significance of ST-segment deviation detected by ambulatory (Holter) monitoring.

Objective: To evaluate the gender influence in diagnostic and prognostic value of Holter-detected ST-segment deviation.

Methods: Two-hundred seventy-seven consecutive patients (196 men) who underwent coronary angiography for evaluation of chest pain were studied with 24-h Holter monitoring within 72 h of coronary angiography, and were followed up for 65+/-21 months.

Results: Men had a higher prevalence of coronary artery disease (169 of 196, 86%) compared to that of women (54 of 81, 67%), p<0.

Cardiac troponin I predicts myocardial dysfunction and adverse outcome in septic shock.

Objective: The objectives of this study were to determine myocardial injury in patients with septic shock by measuring serum cardiac troponin I (cTnI), to evaluate relationship between elevated cTnI and myocardial dysfunction and to determine if cTnI is a predictor of outcome in these patients.

Methods: Thirty-seven consecutive patients with septic shock were included in the study. Serum cTnI was measured at study entry and after 24 and 48 h.

Right atrial extension of primary venous leiomyosarcoma: pulmonary embolism and Budd-Chiari syndrome at presentation-a case report.

Venous leiomyosarcomas are rare and arise predominantly in the inferior vena cava (IVC). The clinical findings are nonspecific and may precede the diagnosis by several years. IVC leiomyosarcoma is predominantly seen in women.

Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases.

Background: With the advent of echocardiography, cardiac papillary fibroelastoma (CPF) is being increasingly reported. The demographics, clinical characteristics, pathological features, treatment, and prognosis of CPF are examined.

Data Collections: Cases, case series and related articles on the subject in all languages were identified through a comprehensive literature search.

Cardiac tamponade in patients with human immunodeficiency virus disease.

The characteristics of cardiac tamponade in patients with human immunodeficiency virus (HIV) disease were examined by evaluating the cases, case series, and related articles, including autopsy series, identified through a comprehensive literature search. One-hundred eighty-five cases of cardiac tamponade have been reported in patients with HIV disease. Sex data were available in 176 patients, of whom 154 (87%) were males.

HIV-associated coronary artery disease.

Cases, case series, and related articles on coronary artery disease in patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) identified through a comprehensive literature search were examined for clinical characteristics and angiographic findings of HIV-associated coronary artery disease. Among 129 identified cases, 91% were males. The mean age was 42.

Amiodarone for pharmacological cardioversion of recent-onset atrial fibrillation.

The efficacy and safety of amiodarone for pharmacological cardioversion of recent-onset atrial fibrillation was examined by reviewing the trials on the subject identified through a comprehensive literature search. Amiodarone has been used both intravenously (i.v.

Clinical usefulness and prognostic value of elevated cardiac troponin I levels in acute pulmonary embolism.

Background: Right ventricular myocardial ischemia and injury contribute to right ventricular dysfunction and failure during acute pulmonary embolism. The objective of this study was to evaluate the clinical usefulness of cardiac troponin I (cTnI) in the assessment of right ventricular involvement and short-term prognosis in acute pulmonary embolism

Methods: Thirty-eight patients with acute pulmonary embolism were included in the study. Clinical characteristics, right ventricular involvement, and clinical outcome were compared in patients with elevated levels of serum cTnI versus patients with normal levels of serum cTnI.