A pharmacy liaison-patient navigation intervention to reduce inpatient and emergency department utilization among primary care patients in a Medicaid accountable care organization: A pragmatic trial protocol.

OBJECTIVE: To determine whether employing the services of a pharmacy liaison to promote medication adherence (usual care), relative to a pharmacy liaison with training in motivational interviewing and as a patient navigator who systematically screens for health-related social needs and provides targeted navigation services to connect patients with appropriate community resources in partnership with a community-based organization (enhanced usual care), will reduce inpatient hospital admissions and emergency department visits among patients who are members of a Medicaid ACO and receive primary care at a large urban safety-net hospital. BACKGROUND: Prior studies have demonstrated only modest effects in reducing utilization among safety-net patient populations. Interventions that address health-related social needs have the potential to reduce utilization in these populations. DESIGN/METHODS: Assignment to treatment condition is by medical record number (odd vs. even) and is unblinded (NCT03919084). Adults age 18-64 within the 3rd to 10th percentile for health care utilization and cost among Medicaid Accountable Care Organization membership attending a primary care visit in the general internal medicine practice at Boston Medical Center enrolled. DISCUSSION: Our study will advance the field in two ways: 1) by providing evidence about the effectiveness of pharmacy liaisons who also function as patient navigators; and 2) by de-implementing patient navigators. Patients in the enhanced usual care arm will no longer receive the services of a clinic-based patient navigator. In addition, our study includes a novel collaboration with a community-based organization, and focuses on an intermediate-cost patient population, rather than the most costly patient population.

[Cyclosporosis: an emergent parasitosis. (II) Microbiological diagnosis through a new staining technique]. / Ciclosporosis: una parasitosis emergente. (II) Diagnóstico microbiológico mediante una nueva técnica de coloración.

PURPOSE: Describe a new staining technique for the diagnosis of Cyclospora infection through lab tests. A differential microscopic diagnosis between Cyclospora and Blastocystis hominis is conducted. MATERIALS AND METHODS: The research was conducted by using fecal samples referred to a private lab in the city of Lima, Peru. A direct fresh assay was made by using a saline solution and Lugol's solution. Very thin fecal smear were prepared, and a staining technique using gentian violet was applied. RESULTS: Microphotography of Cyclospora cysts are shown with the fresh assay method and the new staining technique. Moreover the morphological and structural differences between Cyclospora and Blastocystis hominis were shown: the latter is larger, shows poor staining, and has vacuoles. CONCLUSIONS: The routine use of this technique is recommended for all fecal tests due to its simplicity and low cost, and because it allows a quick diagnosis of this type of infection that has a high prevalence in our country so it may be treated prematurely and specifically.

[Cyclosporosis: an emergent parasitosis. (I) Clinical and epidemiological aspects]. / Ciclosporosis: una parasitosis emergente. (I) Aspectos clínicos y epidemiológicos.

PURPOSE: Determine the prevalence of Cyclospora cayetanensis in asymptomatic patients consulting a physician, or dwellers of marginal urban settlements surrounding Lima, Peru. MATERIALS AND METHODS: The population was composed of 3,259 individuals: 2,968 individuals between 1 month and 87 years of age, who consulted a private physician because of digestive disorders, particularly diarrhea, and 291 individuals between 5 months and 75 years of age from marginal areas, all apparently healthy. The presence of Cyclospora was investigated through "fresh" microscopic techniques using a saline solution and Lugols solution. A new staining technique described in other publication was used. A record was created containing all clinical and epidemiological data, which were assessed statistically. RESULTS: Cycloscopora incidence was 7.3% in the first group, and 41.6% in the second group. A higher rate was observed in young and elder adults up to 60-year-old. No major seasonal incidence was found. Clinical signs/symptoms for individuals consulting a private physician were mainly diarrhea and abdominal pain while individuals from marginal urban areas mainly showed meteorism, abdominal plain, occasional diarrhea and general symptoms such as fatigue and weight loss. CONCLUSIONS: Cyclospora showed a high incidence, particularly in marginal urban areas. Two types of clinical signs/symptoms were found: an acute and very severe condition that can cause dehydration, and a chronic condition with several digestive signs/symptoms, particularly meteorism and abdominal pain. Individuals consulting a private physician show acute and chronic episodes while individuals from marginal urban areas do show a chronic condition. Apparently individuals showing acute episodes are immunologically exposed to the parasite, but they do not acquire immunity later in spite of the treatment because they may become re-infected from time to time. However, individuals showing chronic episodes apparently keep a host-parasite balance due to a permanent contact with the parasite. The contamination source appears to be the water. Therefore all required epidemiological actions shall be taken to prevent this problem from reaching higher dimensions.

Ciclosporosis: una parasitosis emergente (II) diagnóstico microbiológico mediante una nueva técnica de coloración / Cyclosporosis: an emergent parasitosis (II) microbiological diagnosis through a new staining technique

Objetivos: Se describe una nueva técnica de coloración para el diagnóstico de laboratorio de las infecciones por Cyclospora y el Blastocystis hominis. Material y métodos: La investigación se efectuó en heces que fueron remitidas a un laboratorio de atención privada, en la ciudad de Lima, Perú. Se practicó examen directo "en fresco", empleando solución salina y lugol parasitológico. Se prepararon frotices de heces muy delgados y se empleó una técnica de coloración utilizando violeta de genciana. Resultados: Se muestran microfotografías de los quistes de Cyclospora en fresco y mediante la nueva técnica de coloración, así mismo se demuestran las diferencias morfológicas y estructurales entre Cyclospora y Blastocystis hominis. El blastocystis es de mayor tamaño, capta pobremente el colorante y presenta vacuolas. Conclusiones: Se recomienda el empleo rutinario de esta nueva técnica, en todas las investigaciones de heces, por ser sencilla y económica y por permitir hacer un diagnóstico rápido en este tipo de infecciones que tienen una elevada prevalencia en nuestro medio y pueden ser tratadas en forma precoz y específica.

Purpose: Describe a new staining technique for the diagnosis of Cyclosporainfection through lab tests. A differential microscopic diagnosis between Cyclospora and Blastocystis hominis is conducted. Materials and Methods: The research was conducted by using fecal samples referred to a private lab in the city of Lima, Peru. A direct fresh assay was made by using a saline solution and Lugol’s solution. Very thin fecal smear were prepared, and a staining technique using gentian violet was applied. Results: Microphotography of Cyclospora cysts are shown with the fresh assay method and the new staining technique. Moreover the morphological and structural differences between Cyclospora and Blastocystis hominis were shown: the latter is larger, shows poor staining, and has vacuoles. Conclusions: The routine use of this technique is recommended for all fecal tests due to its simplicity and low cost, and because it allows a quick diagnosis of this type of infection that has a highprevalence in our country so it may be treated prematurely and specifically.

Ciclosporosis: una parasitosis emergente (I) aspectos clínicos y epidemiológicos / Cyclosporosis: an emergent parasitosis (I) clinical and epidemiological aspects

Objetivo: Determinar la prevalencia de Cyclospora cayetanensis en pacientes sintomáticos que acudieron a la consulta médica y en pobladores que habitan en asentamientos que rodean a la ciudad de Lima, Perú. Material y métodos: La población completa estuvo compuesta por 3,259 personas: 2,968 entre 1 mes y 87 años de edad, que acudieron a un laboratorio de atención privada por presentar trastornos digestivos, principalmente diarreas y el segundo por 291 pobladores de áreas periféricas, denominadas conos, de 5 meses a 75 años, aparentemente sanos. Se investigó la presencia de Cyclospora mediante técnicas microscópicas "en fresco" con solución salina y lugol y se empleó una nueva técnica de coloración descrita en otra publicación. Se hizo una ficha consignando los datos clínicos y epidemiológicos, que se evaluaron estadísticamente. Resultados: En el primer grupo la incidencia de Cyclospora fue de 7.3 por ciento y en el segundo 41.6 por ciento observándose con más frecuencia en adultos jóvenes y mayores, hasta los 60 años. No se encontró mayor incidencia estacional. Las manifestaciones clínicas de los pacientes que acudieron al laboratorio fueron mayormente diarrea y dolor abdominal, mientras que las personas que provenían de los conos, presentaron principalmente gases, dolor abdominal, diarreas ocasionales y síntomas generales, como cansancio y adelgazamiento. Conclusiones: La Cyclospora mostró una elevada incidencia, especialmente en los conos. Se encontraron dos tipos de manifestaciones clínicas: una aguda, muy severa que puede llevar a la deshidratación, otra crónica con diversas manifestaciones digestivas, principalmente gases y dolor abdominal. Los pacientes que acuden a la consulta médica presentan cuadros agudos y crónicos, mientras que los que habitan en los conos, sí presentan patología ésta es de tipo crónico. Aparentemente los pacientes que presentan cuadros agudos están inmunológicamente expuestos al parásito, pero no se inmunizan...

Purpose: Determine the prevalence of Cyclospora cayetanensis in asymptomatic patients consulting a physician, or dwellers of marginal urban settlements surrounding Lima, Peru. Materials and Methods: The population was composed of 3,259 individuals: 2,968 individuals between 1 month and 87 years of age, who consulted a private physician because of digestive disorders, particularly diarrhea, and 291 individuals between 5 months and 75 years of age from marginal areas, all apparently healthy. The presence of Cyclospora was investigated through “fresh” microscopic techniquesusing a saline solution and Lugol`s solution. A new staining technique described in other publication was used. A record was created containing all clinical and epidemiological data, which were assessed statistically. Results: Cycloscopora incidence was 7.3 per cent in the first group, and 41.6 per cent in the second group. A higher rate was observed in young and elder adults up to 60-yearold. No major seasonal incidence was found. Clinical signs/symptoms for individuals consulting a private physician were mainly diarrhea and abdominal pain while individuals from marginal urban areas mainly showed meteorism, abdominal plain, occasional diarrhea and general symptoms such as fatigue and weight loss. Conclusions: Cyclospora showed a high incidence, particularly in marginal urban areas. Two types of clinical signs/symptoms were found: an acute and very severe condition that can cause dehydration, and a chronic condition with several digestive signs/symptoms, particularly meteorism and abdominal pain. Individuals consulting a private physician show acute and chronic episodes while individuals from marginal urban areas do show a chronic condition. Apparently individuals showing acute episodes are immunologically exposed to the parasite, but they do not acquire immunity later in spite of the treatment because they may become re-infected from time to time. However, individuals showing...