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https://www.readbyqxmd.com/read/28342656/nurses-are-as-specific-and-are-earlier-in-calling-in-hospital-stroke-alerts-compared-to-physicians
#1
Pravin George, Dolora R Wisco, James Gebel, Ken Uchino, Christopher R Newey
INTRODUCTION: In-hospital stroke alerts are typically activated by nurses or physicians when a patient's neurological status acutely changes from baseline. It is unclear if knowledge of stroke symptoms translates to accurate activation of the acute stroke team. We hypothesized that nurses who activate the stroke alert system would correctly identify as great a proportion of acute strokes as physicians. We also investigated the time to activation of these in-hospital stroke alerts. METHODS: We retrospectively reviewed consecutive inpatient stroke team calls over a 12-month period at a single, tertiary care center...
March 22, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28342626/understanding-the-health-care-utilization-of-children-who-require-medical-technology-a-descriptive-study-of-children-who-require-tracheostomies
#2
Regena Spratling
Children who require medical technology have complex chronic illnesses. This medical technology, including ventilators, oximeters, tracheostomy tubes, and feeding tubes, allows children and their families to live at home; however, the management of the children's care by informal caregivers is complex with the need for intensive, specialized care. The purpose of this study was to examine the sociodemographic and clinical characteristics that affect health care utilization in a population of children who require medical technology...
April 2017: Applied Nursing Research: ANR
https://www.readbyqxmd.com/read/28340241/pragmatic-trial-informatics-a-perspective-from-the-nih-health-care-systems-research-collaboratory
#3
Rachel L Richesson, Beverly B Green, Reesa Laws, Jon Puro, Michael G Kahn, Alan Bauck, Michelle Smerek, Erik G Van Eaton, Meredith Zozus, W Ed Hammond, Kari A Stephens, Greg E Simon
Pragmatic clinical trials (PCTs) are research investigations embedded in health care settings designed to increase the efficiency of research and its relevance to clinical practice. The Health Care Systems Research Collaboratory, initiated by the National Institutes of Health Common Fund in 2010, is a pioneering cooperative aimed at identifying and overcoming operational challenges to pragmatic research. Drawing from our experience, we present 4 broad categories of informatics-related challenges: (1) using clinical data for research, (2) integrating data from heterogeneous systems, (3) using electronic health records to support intervention delivery or health system change, and (4) assessing and improving data capture to define study populations and outcomes...
March 14, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28340229/meaningful-use-in-the-safety-net-a-rapid-ethnography-of-patient-portal-implementation-at-five-community-health-centers-in-california
#4
Sara L Ackerman, Urmimala Sarkar, Lina Tieu, Margaret A Handley, Dean Schillinger, Kenneth Hahn, Mekhala Hoskote, Gato Gourley, Courtney Lyles
Objective: US health care institutions are implementing secure websites (patient portals) to achieve federal Meaningful Use (MU) certification. We sought to understand efforts to implement portals in "safety net" health care systems that provide services for low-income populations. Materials and Methods: Our rapid ethnography involved visits at 4 California safety net health systems and in-depth interviews at a fifth. Visits included interviews with clinicians and executives ( n  = 12), informal focus groups with front-line staff ( n  = 35), observations of patient portal sign-up procedures and clinic work, review of marketing materials and portal use data, and a brief survey ( n  = 45)...
March 15, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28340128/crossing-the-health-it-chasm-considerations-and-policy-recommendations-to-overcome-current-challenges-and-enable-value-based-care
#5
Julia Adler-Milstein, Peter J Embi, Blackford Middleton, Indra Neil Sarkar, Jeff Smith
While great progress has been made in digitizing the US health care system, today's health information technology (IT) infrastructure remains largely a collection of systems that are not designed to support a transition to value-based care. In addition, the pursuit of value-based care, in which we deliver better care with better outcomes at lower cost, places new demands on the health care system that our IT infrastructure needs to be able to support. Provider organizations pursuing new models of health care delivery and payment are finding that their electronic systems lack the capabilities needed to succeed...
March 15, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28340053/does-the-regulatory-environment-for-e-cigarettes-influence-the-effectiveness-of-e-cigarettes-for-smoking-cessation-longitudinal-findings-from-the-itc-four-country-survey
#6
Hua-Hie Yong, Sara C Hitchman, K Michael Cummings, Ron Borland, Shannon M L Gravely, Ann McNeill, Geoffrey T Fong
Introduction: To date, no studies have explored how different regulatory environments may influence the effectiveness of ECs as a smoking cessation aid. Objective: This study compares the real-world effectiveness of adult smokers using ECs for quitting compared with quitting unassisted or quitting with NRT and/or prescription medications in two countries with restrictive policies towards ECs (i.e., Canada and Australia) versus two countries with less restrictive policies (i...
March 4, 2017: Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco
https://www.readbyqxmd.com/read/28340030/effects-of-consumer-oriented-health-information-technologies-in-diabetes-management-over-time-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#7
Da Tao, Tieyan Wang, Tieshan Wang, Shuang Liu, Xingda Qu
Objective: To reveal the effects of consumer-oriented health information technologies (CHITs) on patient outcomes in diabetes management over time through systematic review and meta-analysis. Methods: We searched 5 electronic databases (from database inception to July 2016) for studies that reported on randomized controlled trials examining the effects of CHITs on glycemic control and other patient outcomes in diabetes management. Data were analyzed using either meta-analysis or a narrative synthesis approach...
March 9, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28339932/utilizing-patient-geographic-information-system-data-to-plan-telemedicine-service-locations
#8
Neelkamal Soares, Joseph Dewalle, Ben Marsh
Objective: To understand potential utilization of clinical services at a rural integrated health care system by generating optimal groups of telemedicine locations from electronic health record (EHR) data using geographic information systems (GISs). Methods: This retrospective study extracted nonidentifiable grouped data of patients over a 2-year period from the EHR, including geomasked locations. Spatially optimal groupings were created using available telemedicine sites by calculating patients' average travel distance (ATD) to the closest clinic site...
March 3, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28339791/bridg-a-domain-information-model-for-translational-and-clinical-protocol-driven-research
#9
Lauren B Becnel, Smita Hastak, Wendy Ver Hoef, Robert P Milius, MaryAnn Slack, Diane Wold, Michael L Glickman, Boris Brodsky, Charles Jaffe, Rebecca Kush, Edward Helton
Background: It is critical to integrate and analyze data from biological, translational, and clinical studies with data from health systems; however, electronic artifacts are stored in thousands of disparate systems that are often unable to readily exchange data. Objective: To facilitate meaningful data exchange, a model that presents a common understanding of biomedical research concepts and their relationships with health care semantics is required. The Biomedical Research Integrated Domain Group (BRIDG) domain information model fulfills this need...
February 26, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28339692/decrease-in-unnecessary-vitamin-d-testing-using-clinical-decision-support-tools-making-it-harder-to-do-the-wrong-thing
#10
Andrew H Felcher, Rachel Gold, David M Mosen, Ashley B Stoneburner
Objective: To evaluate the impact of clinical decision support (CDS) tools on rates of vitamin D testing. Screening for vitamin D deficiency has increased in recent years, spurred by studies suggesting vitamin D's clinical benefits. Such screening, however, is often unsupported by evidence and can incur unnecessary costs. Materials and Methods: We evaluated how rates of vitamin D screening changed after we implemented 3 CDS tools in the electronic health record (EHR) of a large health plan: (1) a new vitamin D screening guideline, (2) an alert that requires clinician acknowledgement of current guidelines to continue ordering the test (a "hard stop"), and (3) a modification of laboratory ordering preference lists that eliminates shortcuts...
February 19, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28339689/genomic-decision-support-needs-in-pediatric-primary-care
#11
Jeffrey W Pennington, Dean J Karavite, Edward M Krause, Jeffrey Miller, Barbara A Bernhardt, Robert W Grundmeier
Clinical genome and exome sequencing can diagnose pediatric patients with complex conditions that often require follow-up care with multiple specialties. The American Academy of Pediatrics emphasizes the role of the medical home and the primary care pediatrician in coordinating care for patients who need multidisciplinary support. In addition, the electronic health record (EHR) with embedded clinical decision support is recognized as an important component in providing care in this setting. We interviewed 6 clinicians to assess their experience caring for patients with complex and rare genetic findings and hear their opinions about how the EHR currently supports this role...
February 19, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28339559/using-a-stakeholder-engaged-approach-to-develop-and-validate-electronic-clinical-quality-measures
#12
Jill Boylston Herndon, Krishna Aravamudhan, Ronald L Stephenson, Ryan Brandon, Jesley Ruff, Frank Catalanotto, Huong Le
Objective: To describe the stakeholder-engaged processes used to develop, specify, and validate 2 oral health care electronic clinical quality measures. Materials and Methods: A broad range of stakeholders were engaged from conception through testing to develop measures and test feasibility, reliability, and validity following National Quality Forum guidance. We assessed data element feasibility through semistructured interviews with key stakeholders using a National Quality Forum-recommended scorecard...
October 7, 2016: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28338485/creation-of-a-regional-human-milk-assembly-a-model-to-influence-practice-and-policy-change-in-the-nicu
#13
Diane L Spatz, Amanda Evans, Elizabeth Froh
BACKGROUND: The 2011 Surgeon General's Call to Action to Support Breastfeeding highlights a need for optimizing lactation-based education for all health professionals; however, few schools of nursing and medicine offer lactation-based curriculum. In an effort to address these gaps in education and care, the director of the lactation program at a large urban children's hospital developed and instituted the annual regional Human Milk Assembly (HMA), a half-day collaborative meeting of the hospital's regional and referral hospitals' neonatal intensive care unit (NICU) nursing staff, to address lactation-based educational and training needs of all participating institutions...
March 23, 2017: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/28337154/the-reciprocal-relationship-between-suicidality-and-stigma
#14
REVIEW
Bernardo Carpiniello, Federica Pinna
INTRODUCTION: Although suicidality is frequently the cause of stigma, it is conversely true that stigma may be the cause of suicidality. The present paper focuses on the complex relationships that exist between suicidal behavior and stigmatizing attitudes. METHODS: A narrative review of the topic will be presented on the basis of the relevant literature collected from an electronic search of PubMed, ISI Web of Knowledge, and Scopus databases, using stigma, public stigma, structural stigma, perceived stigma, self-stigma, suicide, attempted suicide, and suicidality as key words...
2017: Frontiers in Psychiatry
https://www.readbyqxmd.com/read/28337038/pilot-study-of-methods-for-assessing-unmet-secondary-health-care-need-in-new-zealand
#15
Philip Bagshaw, Susan Bagshaw, Christopher Frampton, Robin Gauld, Terri Green, Charlotte Harris, Andrew Hornblow, Ben Hudson, Antony Raymont, Ann Richardson, Carl Shaw, Les Toop
AIMS: In this pilot study, the primary aim was to compare four potential methods for undertaking a national survey of unmet secondary healthcare need in New Zealand (one collecting data from GPs, and three from community surveys). The secondary aim was to obtain an estimate of the prevalence of unmet secondary healthcare need, to inform sample size calculations for a national survey. METHODS: An electronic system was set up for GPs in Christchurch (Pegasus PHO) and Auckland (Auckland PHO) to record cases of unmet need as encountered in clinics...
March 24, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28336758/evaluation-of-a-pharmacist-led-outpatient-direct-oral-anticoagulant-service
#16
Emily Ashjian, Brian Kurtz, Elizabeth Renner, Robert Yeshe, Geoffrey D Barnes
PURPOSE: The impact of a pharmacist-led direct oral anticoagulant (DOAC) service on prescription appropriateness and patient adherence was simultaneously evaluated. METHODS: In this retrospective analysis, patients age 18 years or older for whom a DOAC was prescribed from September 20, 2013, through December 31, 2014, were identified through electronic medical record review of all DOAC prescriptions within the University of Michigan Health System. Patients had their DOAC therapy managed by a pharmacist-led DOAC service or by their physician (usual care)...
April 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28336507/planking-or-the-lying-down-game-two-case-reports
#17
Stefania Barbieri, Paolo Feltracco, Luca Omizzolo, Rossella Snenghi, Rafi El Mazloum, Gianna Vettore, Mauro Bergamini, Armando Stefanati, Daniele Donato, Cecilia Ferronato, Francesco Maria Avato, Alberto Tredese, Rosa Maria Gaudio
BACKGROUND: The monitoring and management of risks regarding children and young people admitted to the emergency department as a result of dangerous behaviors distributed via the Internet should be based on clinical reasoning and knowledge about these social media-related phenomena. Here we examine 2 cases of teenagers who reported severe injuries while performing the "planking" craze, a challenge that consists in lying face-down stiffly like a board on any kind of surface. OBJECTIVE: Our objective is to examine and describe the Internet craze called planking, also known as the "lying-down game," through 2 case reports from our experience, enriching this study with information gained through discussions with secondary school teenagers...
March 23, 2017: Interactive Journal of Medical Research
https://www.readbyqxmd.com/read/28336165/suspicious-outbreak-of-ventilator-associated-pneumonia-caused-by-burkholderia-cepacia-in-a-surgical-intensive-care-unit
#18
LiPing Guo, Gang Li, Jian Wang, Xia Zhao, Shupeng Wang, Li Zhai, Hongbin Jia, Bin Cao
BACKGROUND: We reviewed Burkholderia cepacia infections in a hospital from 2013-2016 to report a suspicious outbreak that occurred in a surgical intensive care unit in 2015, and to outline the infection control measures adopted thereafter. METHODS: Review of the health care-associated infection data regarding B cepacia via the surveillance system, hospital information system, electronic medical records, and laboratory information system together with the outbreak investigation was managed by the health care-associated infection control team...
March 20, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28334754/rate-of-renal-function-decline-race-and-referral-to-nephrology-in-a-large-cohort-of-primary-care-patients
#19
Farrukh M Koraishy, Denise Hooks-Anderson, Joanne Salas, Jeffrey F Scherrer
Introduction.: Late nephrology referral is associated with adverse outcomes especially among minorities. Research on the association of the rate of chronic kidney disease (CKD) progression with nephrology referral in white versus black patients is lacking. Objectives.: Compute the odds of nephrology referral in primary care and their associations with race and the rate of CKD progression. Methods.: Electronic health record data were obtained from 2170 patients in primary care clinics in the Saint Louis metropolitan area with at least two estimated glomerular filtration rate (eGFR) values over a 7-year observation period...
February 21, 2017: Family Practice
https://www.readbyqxmd.com/read/28334588/applying-the-chronic-care-model-to-improve-care-and-outcomes-at-a-pediatric-medical-center
#20
Jennifer Lail, Pamela J Schoettker, Denise L White, Bhavna Mehta, Uma R Kotagal
BACKGROUND: Cincinnati Children's Hospital Medical Center launched the Condition Outcomes Improvement Initiative in 2012 to help disease-based teams use the principles of improvement science to implement components of the Chronic Care Model and improve outpatient care delivery for populations of children with chronic and complex conditions. The goal was to improve outcomes by 20% from baseline. METHODS: Initiative activities included review of the evidence to choose and measure outcomes, development of condition-specific patient registries and tools for data collection, patient stratification, planning and coordinating care before and after visits, and self-management support...
March 2017: Joint Commission Journal on Quality and Patient Safety
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