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Michelle M Valdez, Maureen Liwanag, Charles Mount, Rechell Rodriguez, Elisea Avalos-Reyes, Andrew Smith, David Collette, Michael Starsiak, Richard Green
Introduction: Inefficiencies in the command approval process for publications and/or presentations negatively impact DoD Graduate Medical Education (GME) residency programs' ability to meet ACGME scholarly activity requirements. A preliminary review of the authored works approval process at Naval Medical Center San Diego (NMCSD) disclosed significant inefficiency, variation in process, and a low level of customer satisfaction. In order to facilitate and encourage scholarly activity at NMCSD, and meet ACGME requirements, the Executive Steering Council (ESC) chartered an interprofessional team to lead a Lean Six Sigma (LSS) Rapid Improvement Event (RIE) project...
March 14, 2018: Military Medicine
Chad M Hodge, Scott P Narus
Objective: Problem list data is a driving force for many beneficial clinical tools, yet these data remain underutilized. We performed a systematic literature review, pulling insights from previous research, aggregating insights into themes, and distilling themes into actionable advice. We sought to learn what changes we could make to existing applications, to the clinical workflow, and to clinicians' perceptions that would improve problem list utilization and increase the prevalence of problems data in the electronic medical record...
March 14, 2018: Journal of the American Medical Informatics Association: JAMIA
Brian Shiner, Christine Leonard Westgate, Vanessa Simiola, Richard Thompson, Paula P Schnurr, Joan M Cook
Objective: Available studies on implementation of evidence-based psychotherapy (EBP) for patients attending Department of Veterans Affairs (VA) residential post-traumatic stress disorder (PTSD) programs rely on therapist self-report of EBP delivery. Patient-level data on receipt of EBP are needed both to corroborate therapist self-report and to understand patient factors that predict receipt of EBPs for PTSD. Materials and Methods: We identified 159 therapists from 38 VA residential PTSD programs who responded to a survey about EBP implementation during the 2015 fiscal year (FY15)...
March 14, 2018: Military Medicine
Carol H Wysham, Dominic Pilon, Mike Ingham, Marie-Hélène Lafeuille, Bruno Emond, Rhiannon Kamstra, Michael Pfeifer, Patrick Lefebvre
OBJECTIVE: To compare glycated hemoglobin (HbA1c) control and medication costs between patients with type 2 diabetes mellitus (T2DM) treated with canagliflozin 300 mg (CANA) or a glucagon-like peptide 1 receptor agonist (GLP-1 RA) in a real-world setting. METHODS: Adults with T2DM newly initiated on CANA or a GLP-1 RA (index date) were identified from IQVIA™ Real-World Data Electronic Medical Records U.S. database (March 29, 2012-April 30, 2016). Inverse probability of treatment weighting accounted for differences in baseline characteristics...
March 2018: Endocrine Practice
Maya Balakrishnan, Rollin George, Ashish Sharma, David Y Graham, Hoda M Malaty
BACKGROUND: The USA has among the lowest gastric cancer incidence rates worldwide. AIM: To investigate whether increasing immigration from high cancer incidence countries has altered the GC incidence in a large US metropolitan area. METHODS: This was a retrospective cohort study among an underprivileged, multiethnic population in Texas. Gastric cancer cases diagnosed during 2005-2015 were identified using the cancer registry of the public medical care system for Harris County...
March 15, 2018: Digestive Diseases and Sciences
Emanuele F Osimo, Rudolf N Cardinal, Peter B Jones, Golam M Khandaker
Low-grade inflammation is a risk factor for depression, psychosis and other major psychiatric disorders. It is associated with poor response to antidepressant and antipsychotics, and could potentially be a treatment target. However, there is limited data on the prevalence of low-grade inflammation in major psychiatric disorders, and on the characteristics of patients who show evidence of inflammation. We examined the prevalence of low-grade inflammation and associated socio-demographic and clinical factors in acute psychiatric inpatients...
March 1, 2018: Psychoneuroendocrinology
Khe Foon Hew, Chung Kwan Lo
BACKGROUND: The use of flipped classroom approach has become increasingly popular in health professions education. However, no meta-analysis has been published that specifically examines the effect of flipped classroom versus traditional classroom on student learning. This study examined the findings of comparative articles through a meta-analysis in order to summarize the overall effects of teaching with the flipped classroom approach. We focused specifically on a set of flipped classroom studies in which pre-recorded videos were provided before face-to-face class meetings...
March 15, 2018: BMC Medical Education
Chiara Anna Parente, Domenico Salvatore, Giampiero Maria Gallo, Fabrizio Cipollini
BACKGROUND: In almost all healthcare systems, no-shows (scheduled appointments missed without any notice from patients) have a negative impact on waiting lists, costs and resource utilization, impairing the quality and quantity of cares that could be provided, as well as the revenues from the corresponding activity. Overbooking is a tool healthcare providers can resort to reduce the impact of no-shows. METHODS: We develop an overbooking algorithm, and we assess its effectiveness using two methods: an analysis of the data coming from a practical implementation in an healthcare center; a simulation experiment to check the robustness and the potential of the strategy under different conditions...
March 15, 2018: BMC Health Services Research
Ioannis A Tsalafoutas
OBJECTIVE: To investigate whether electronic collimation software, which is available in all digital X-ray systems, may comprise an overexposure risk. METHODS: In the context of surveys on Diagnostic Reference Levels carried out in two radiographic facilities, along with data on exposure factors, the radiographic field sizes were also recorded. In one facility (Unit A), a wireless flat panel detector is used with a conventional X-ray unit, while in the other, a fully digital system is installed (Unit B)...
March 15, 2018: British Journal of Radiology
Anna Therese Bjerkreim, Andrej Netland Khanevski, Solveig Bergliot Glad, Lars Thomassen, Halvor Naess, Nicola Logallo
Background: Intracerebral hemorrhage (ICH) is the most severe form of stroke, but data on readmission after ICH are sparse. We aimed to determine frequency, causes, and predictors of 30-day readmission after ICH. Materials and Methods: This retrospective cohort study includes all spontaneous ICH survivors admitted to the stroke unit at Haukeland University Hospital in Bergen in Norway from July 2007 to December 2013. Patients were followed by review of electronic medical charts, and the first unplanned readmission within 30 days after discharge was used as final outcome...
March 2018: Brain and Behavior
Koshonna Brown, Ted Thurn, Lun Xin, William Liu, Remon Bazak, Si Chen, Barry Lai, Stefan Vogt, Chris Jacobsen, Tatjana Paunesku, Gayle E Woloschak
Titanium dioxide (TiO2 ) nanoparticles are produced for many different purposes, including development of therapeutic and diagnostic nanoparticles for cancer detection and treatment, drug delivery, induction of DNA double-strand breaks, and imaging of specific cells and subcellular structures. Currently, the use of optical microscopy, an imaging technique most accessible to biology and medical pathology, to detect TiO2 nanoparticles in cells and tissues ex vivo is limited with low detection limits, while more sensitive imaging methods (transmission electron microscopy, X-ray fluorescence microscopy, etc...
January 2018: Nano Research
Anne Liu, An Le, Jian Zhang, Chris Wong, Clifford Wong, Linda Henry, Mindie H Nguyen
OBJECTIVES: Data on liver and non-liver co-morbidities in chronic hepatitis B (CHB) patients are limited. This study analyzes the prevalence of co-morbidities in a multicenter CHB cohort evaluated over 15 years. METHODS: This study included 2734 consecutive adult American CHB patients from a university medical center and several community primary care clinics. Data were analyzed by time periods (patients in each time period were unique without overlapping): 2000-2005 (n = 885), 2006-2010 (n = 888), and 2011-2015 (n = 961)...
March 14, 2018: Clinical and Translational Gastroenterology
Catriona Crossan, Hakim-Moulay Dehbi, Hilarie Williams, Neil Poulter, Anthony Rodgers, Stephen Jan, Simon Thom, Joanne Lord
INTRODUCTION: The 'Use of a Multi-drug Pill in Reducing cardiovascular Events' (UMPIRE) trial was a randomised controlled clinical trial evaluating the impact of a polypill strategy on adherence to indicated medication in a population with established cardiovascular disease (CVD) of or at high risk thereof. The aim of Researching the UMPIRE Processes for Economic Evaluation in the National Health Service (RUPEE NHS) is to estimate the potential health economic impact of a polypill strategy for CVD prevention within the NHS using UMPIRE trial and other relevant data...
March 14, 2018: BMJ Open
Michael Matthew McClay, Stephen S O'Connor, Brittany Nicole Groh, Marissa Baudino, Lisa Venanzi, Angela Shields, Jo Ellen Wilson, John Bone, Stephen Nicolson
OBJECTIVE: Evidence suggests that suicide attempts by self-inflicted gunshot wound (GSW) are underreported and may in turn affect disposition following hospitalization. This study aimed to evaluate the clinical characteristics and use of services among individuals who do not disclose suicidal intent following a self-inflicted GSW. METHODS: Electronic medical record data from 128 survivors of self-inflicted GSWs at a level 1 trauma center were analyzed to identify factors associated with nondisclosure of a suicide attempt to medical staff...
March 15, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
Sana B Ali, Juana Romero, Kevin Morrison, Baria Hafeez, Jessica S Ancker
OBJECTIVES:  Although electronic patient portals are offered by most health care organizations, poor usability and poor fit to patient needs may pose barriers to adoption. We collaborated with an academic hospital to conduct iterative user evaluation of a newly deployed portal designed to deliver inpatient data upon hospital discharge. METHODS:  Three evaluators applied heuristic usability evaluation and conducted 23 individual user testing sessions with patients with chronic disease or managing the care of family members with chronic disease...
January 2018: Applied Clinical Informatics
Vinícius Viana Abreu Montanaro, Thiago Falcão Hora, Creuza Maria da Silva, Carla Verônica de Viana Santos, Maria Inacia Ruas Lima, Edson Marcio Negrão, Daniele Sebestyan Martins Ribeiro, Eleonora Maria de Jesus Oliveira, Gabriel R de Freitas
BACKGROUND: Chagas disease is related to ischemic stroke (IS), although few epidemiological studies have evaluated the associated mortality and recurrence. Our objective is to determine factors associated with mortality and recurrence of IS in patients with IS and Chagas disease. METHODS: We retrospectively studied data obtained from electronic medical records of patients admitted at SARAH Hospitals across Brazil between 2009 and 2013. Using Cox regression analysis for mortality and logistic regression for recurrence, we assessed primary population characteristics and statistical associations between risk factors and outcomes...
March 14, 2018: European Neurology
Carissa A Low, Dana H Bovbjerg, Steven Ahrendt, M Haroon Choudry, Matthew Holtzman, Heather L Jones, James F Pingpank, Lekshmi Ramalingam, Herbert J Zeh, Amer H Zureikat, David L Bartlett
Background: Postoperative ambulation is encouraged to promote timely recovery but is rarely monitored objectively or examined as a predictor of clinical outcomes, despite growing availability of wearable devices that allow passive quantification and remote real-time monitoring of the number of steps taken during recovery. Purpose: To determine whether the number of steps taken during inpatient recovery predicts 30- and 60-day readmission risk after metastatic cancer surgery...
January 5, 2018: Annals of Behavioral Medicine: a Publication of the Society of Behavioral Medicine
James Baker, Andrew Dickman, Stephen Mason, John Ellershaw
BACKGROUND: A continuous subcutaneous infusion (CSCI) is an effective method of multiple drug administration commonly encountered in end of life care when the oral route is compromised. At present, current practice is to limit syringe driver infusion time to a maximum of 24 hours as dictated by available chemical stability data. However, the ability to deliver prescribed medication by a CSCI over 48 hours may have numerous benefits in both patient care and health service resource utilisation...
2018: PloS One
Linda Barstow, Erika Herman, Heidi Phillips, Patrick Maloney
OBJECTIVES: We quantify and describe emergency department antibiotic discharge prescription dosing errors for pediatric patients in a community hospital health system. METHODS: This was a retrospective chart review evaluating emergency department discharge prescriptions written between July 1, 2014, and June 30, 2015. Pediatric patients who received a prescription for an oral antibiotic were included in error analysis if they had a weight updated in the electronic medical record during the encounter...
March 12, 2018: Pediatric Emergency Care
Jihye Seo, Cheol Hyun Kim, Hongmin Chu, Yeonju Moon, Sangkwan Lee
BACKGROUND: Migraine is a common disease of primary headache, which it causes many kinds of secondary diseases or symptoms. The treatment drugs have sometimes shown side effects such as overuse headache, stroke, and cardiovascular disease. Therefore, the demand for complementary and alternative interventions for migraine has increased. Herbal medicines are a representative intervention to treat migraine traditionally. Among these herbal medicines, Banhabaekchulchunma-tang (BBT) and Chongsanggeontong-tang (CGT) have been most commonly used for migraine treatment in traditional clinical practice...
March 2018: Medicine (Baltimore)
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