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https://www.readbyqxmd.com/read/28410366/brief-educational-interventions-to-improve-performance-on-novel-quality-metrics-in-ambulatory-settings-in-kenya-a-multi-site-pre-post-effectiveness-trial
#1
Robert Ryan Korom, Stephanie Onguka, Peter Halestrap, Maureen McAlhaney, Mary Adam
BACKGROUND: The quality of primary care delivered in resource-limited settings is low. While some progress has been made using educational interventions, it is not yet clear how to sustainably improve care for common acute illnesses in the outpatient setting. Management of urinary tract infection is particularly important in resource-limited settings, where it is commonly diagnosed and associated with high levels of antimicrobial resistance. We describe an educational programme targeting non-physician health care providers and its effects on various clinical quality metrics for urinary tract infection...
2017: PloS One
https://www.readbyqxmd.com/read/28401122/quality-indicators-for-the-detection-and-management-of-chronic-kidney-disease-in-primary-care-in-canada-derived-from-a-modified-delphi-panel-approach
#2
Karen Tu, Lindsay Bevan, Katie Hunter, Jess Rogers, Jacqueline Young, Gihad Nesrallah
BACKGROUND: The detection and management of chronic kidney disease lies within primary care; however, performance measures applicable in the Canadian context are lacking. We sought to develop a set of primary care quality indicators for chronic kidney disease in the Canadian setting and to assess the current state of the disease's detection and management in primary care. METHODS: We used a modified Delphi panel approach, involving 20 panel members from across Canada (10 family physicians, 7 nephrologists, 1 patient, 1 primary care nurse and 1 pharmacist)...
January 2017: CMAJ Open
https://www.readbyqxmd.com/read/28391236/study-on-the-utility-of-a-statewide-counselling-programme-for-improving-mortality-outcomes-of-patients-with-staphylococcus-aureus-bacteraemia-in-thuringia-support-a-study-protocol-of-a-cluster-randomised-crossover-trial
#3
S Weis, S Hagel, R P H Schmitz, A Scherag, F M Brunkhorst, C Forstner, B Löffler, M W Pletz
INTRODUCTION: Staphylococcus aureus bacteraemia (SAB) is a frequent infection with high mortality rates. It requires specific diagnostic and therapeutic management such as prolonged intravenous administration of antibiotics and aggressive search for and control of infectious sources. Underestimation of disease severity frequently results in delayed or inappropriate management of patients with SAB leading to increased mortality rates. According to observational studies, patient counselling by infectious disease consultants (IDC) improves survival and reduces the length of hospital stay as well as complication rates...
April 8, 2017: BMJ Open
https://www.readbyqxmd.com/read/28379935/simulation-fellowship-programs-an-international-survey-of-program-directors
#4
Brenda Natal, Demian Szyld, Scott Pasichow, Zia Bismilla, Jonathan Pirie, Adam Cheng
PURPOSE: To report on the evolution of simulation-based training (SBT) by identifying the composition and infrastructure of existing simulation fellowship programs, describing the current training practices, disclosing existing program barriers, and highlighting opportunities for standardization. METHOD: Investigators conducted a cross-sectional survey study among English-speaking simulation fellowship program directors (September 2014-September 2015). They identified fellowships through academic/institutional Web sites, peer-reviewed literature, Web-based search engines, and snowball sampling...
April 4, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28360250/development-of-the-brussels-infant-and-toddler-stool-scale-bitss-protocol-of-the-study
#5
Yvan Vandenplas, Hania Szajewska, Marc Benninga, Carlo Di Lorenzo, Christophe Dupont, Christophe Faure, Mohamed Miqdadi, Seksit Osatakul, Carmen Ribes-Konickx, Miguel Saps, Raanan Shamir, Annamaria Staiano
INTRODUCTION: The Bristol Stool Form Scale (BSS) which consists of 7 photographs of different stool forms allows assessment of stool consistency (scale 1 for hard lumps to scale 7 for watery stools), in an objective manner in adults. The BSS is also sometimes used to characterise the stools of infants and young children. Despite its use, there is general agreement among paediatric gastroenterologists that the BSS is not adequate to be used in infants and young children who wear diapers; thus, a new scale specifically designed for this population is needed...
March 29, 2017: BMJ Open
https://www.readbyqxmd.com/read/28360244/evaluation-of-an-alternative-care-provider-clinic-for-severe-sleep-disordered-breathing-a-study-protocol-for-a-randomised-controlled-trial
#6
Ada Ip-Buting, Jenny Kelly, Maria J Santana, Erika D Penz, W Ward Flemons, Willis H Tsai, Kristin L Fraser, Patrick J Hanly, Sachin R Pendharkar
INTRODUCTION: Despite the high prevalence of sleep-disordered breathing (SDB) and the significant health consequences associated with untreated disease, access to diagnosis and treatment remains a challenge. Even patients with severe SDB (severe obstructive sleep apnoea or hypoventilation), who are at particularly high risk of adverse health effects, are subject to long delays. Previous research has demonstrated that, within a sleep clinic, management by alternative care providers (ACPs) is effective for patients with milder forms of SDB...
March 29, 2017: BMJ Open
https://www.readbyqxmd.com/read/28344717/a-digital-peer-to-peer-learning-platform-for-clinical-skills-development
#7
Jesse Basnak, Jennifer Ortynski, Meghan Chow, Emeka Nzekwu
BACKGROUND: Due to constraints in time and resources, medical curricula may not provide adequate opportunities for pre-clerkship students to practice clinical skills. To address this, medical students at the University of Alberta developed a digital peer-to-peer learning initiative. The initiative assessed if students can learn clinical skills from their peers in co-curricular practice objective structured clinical exams (OSCEs). METHODS: A total of 144 first-year medical students participated...
February 2017: Canadian Medical Education Journal
https://www.readbyqxmd.com/read/28335776/challenges-and-strategies-to-improve-the-availability-and-geographic-accessibility-of-physicians-in-portugal
#8
Ana Paula Cavalcante de Oliveira, Gilles Dussault, Isabel Craveiro
BACKGROUND: Shortages of physicians in remote, rural and other underserved areas and lack of general practitioners limit access to health services. The aims of this article are to identify the challenges faced by policy and decision-makers in Portugal to guarantee the availability and geographic accessibility to physicians in the National Health Service and to describe and analyse their causes, the strategies to tackle them and their results. We also raise the issue of whether research evidence was used or not in the process of policy development...
March 23, 2017: Human Resources for Health
https://www.readbyqxmd.com/read/28319484/nonpharmacologic-management-of-hypertension-a-multidisciplinary-approach
#9
Cemal Ozemek, Shane A Phillips, Dejana Popovic, Deepika Laddu-Patel, Ibra S Fancher, Ross Arena, Carl J Lavie
PURPOSE OF REVIEW: Nonpharmacologic lifestyle modification interventions (LMIs), such as increasing physical activity, dietary modification, weight-loss, reducing alcohol consumption and smoking cessation, are effective strategies to lower resting blood pressures (BPs) in prehypertensive or hypertensive patients. However, the limited time shared between a physician and a patient is not adequate to instill an adoption of LMI. The purpose of this review is to therefore highlight evidence-based BP lowering, LMI strategies that can feasibly be implemented in clinical practices...
March 17, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28302637/protocol-for-determining-primary-healthcare-practice-characteristics-models-of-practice-and-patient-accessibility-using-an-exploratory-census-survey-with-linkage-to-administrative-data-in-nova-scotia-canada
#10
Emily Gard Marshall, Richard J Gibson, Beverley Lawson, Frederick Burge
INTRODUCTION: There is little evidence on how primary care providers (PCPs) model their practices in Nova Scotia (NS), Canada, what services they offer or what accessibility is like for the average patient. This study will create a database of all family physicians and primary healthcare nurse practitioners in NS, including information about accessibility and the model of care in which they practice, and will link the survey data to administrative health databases. METHODS AND ANALYSIS: 3 census surveys of all family physicians, primary care nurse practitioners (ie, PCPs) and their practices in NS will be conducted...
March 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/28302548/availability-use-and-barriers-to-cardiac-rehabilitation-in-lmic
#11
Loheetha Ragupathi, Judy Stribling, Yuliya Yakunina, Valentin Fuster, Mary Ann McLaughlin, Rajesh Vedanthan
BACKGROUND: Cardiac rehabilitation (CR) is a cornerstone of secondary prevention of ischemic heart disease. It is critically important in low- and middle-income countries (LMIC), where the burden of ischemic heart disease is substantial and growing. However, the availability and utilization of CR in LMIC is not systematically known. OBJECTIVES: This study sought to characterize the availability, use, and barriers to the use of CR. METHODS: Electronic databases (Cochrane Library, EMBASE, PubMed, Web of Science) were searched from January 1, 1980 to May 31, 2013 for articles on CR in LMIC...
March 13, 2017: Global Heart
https://www.readbyqxmd.com/read/28284760/a-peer-review-process-as-part-of-the-implementation-of-clinical-pathways-in-radiation-oncology-does-it-improve-compliance
#12
Brian J Gebhardt, Dwight E Heron, Sushil Beriwal
PURPOSE: Clinical pathways are patient management plans that standardize evidence-based practices to ensure high-quality and cost-effective medical care. Implementation of a pathway is a collaborative process in our network, requiring the active involvement of physicians. This approach promotes acceptance of pathway recommendations, although a peer review process is necessary to ensure compliance and to capture and approve off-pathway selections. We investigated the peer review process and factors associated with time to completion of peer review...
January 19, 2017: Practical Radiation Oncology
https://www.readbyqxmd.com/read/28283485/quit-emr-trial-a-prospective-observational-multicentre-study-to-evaluate-quality-and-24%C3%A2-hours-post-transport-morbidity-of-interhospital-transportation-of-critically-ill-patients-study-protocol
#13
Ulrich Strauch, Dennis C J J Bergmans, Joachim Habers, Jochen Jansen, Bjorn Winkens, Dirk J Veldman, Paul M H J Roekaerts, Stefan K Beckers
INTRODUCTION: It is widely accepted that transportation of critically ill patients is high risk. Unfortunately, however, there are currently no evidence-based criteria with which to determine the quality of various interhospital transport systems and their impact on the outcomes for patients. We aim to rectify this by assessing 2 scores which were developed in our hospital in a prospective, observational study. Primarily, we will be examining the Quality of interhospital critical care transportation in the Euregion Meuse-Rhine (QUIT EMR) score, which focuses on the quality of the transport system, and secondarily the SEMROS (Simplified EMR outcome score) which detects changes in the patient's clinical condition in the 24 hours following their transportation...
March 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28283118/a-protocol-to-develop-practice-guidelines-for-primary-care-medical-service-trips
#14
Christopher Dainton, Charlene H Chu, Henry Lin, William Cherniak, Lawrence C Loh
BACKGROUND: North American clinicians are increasingly participating in medical service trips (MSTs) that provide primary healthcare in Latin America and the Caribbean. Literature reviews have shown that the existence and use of evidence-based guidelines by these groups are limited, which presents potential for harm. OBJECTIVE: This paper proposes a 5-step methodology to develop protocols for diagnosis and treatment of conditions encountered by MST clinicians. METHODS: We reviewed the 2010 American College of Physicians guidance statement on guidelines development and developed our own adaptation...
September 2016: Annals of Global Health
https://www.readbyqxmd.com/read/28274216/primary-care-physicians-educational-needs-and-learning-preferences-in-end-of-life-care-a-focus-group-study-in-the-uk
#15
Lucy Ellen Selman, Lisa Jane Brighton, Vicky Robinson, Rob George, Shaheen A Khan, Rachel Burman, Jonathan Koffman
BACKGROUND: Primary care physicians (General Practitioners (GPs)) play a pivotal role in providing end of life care (EoLC). However, many lack confidence in this area, and the quality of EoLC by GPs can be problematic. Evidence regarding educational needs, learning preferences and the acceptability of evaluation methods is needed to inform the development and testing of EoLC education. This study therefore aimed to explore GPs' EoLC educational needs and preferences for learning and evaluation...
March 9, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28258898/prospective-qualitative-and-quantitative-analysis-of-real-time-peer-review-quality-assurance-rounds-incorporating-direct-physical-examination-for-head-and-neck-cancer-radiation-therapy
#16
Carlos E Cardenas, Abdallah S R Mohamed, Randa Tao, Andrew J R Wong, Mussadiq J Awan, Shirly Kuruvila, Michalis Aristophanous, G Brandon Gunn, Jack Phan, Beth M Beadle, Steven J Frank, Adam S Garden, William H Morrison, Clifton D Fuller, David I Rosenthal
PURPOSE: Our department has a long-established comprehensive quality assurance (QA) planning clinic for patients undergoing radiation therapy (RT) for head and neck cancer. Our aim is to assess the impact of a real-time peer review QA process on the quantitative and qualitative radiation therapy plan changes in the era of intensity modulated RT (IMRT). METHODS AND MATERIALS: Prospective data for 85 patients undergoing head and neck IMRT who presented at a biweekly QA clinic after simulation and contouring were collected...
November 19, 2016: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28244918/potential-financial-conflict-of-interest-among-physician-editorial-board-members-of-orthopaedic-surgery-journals
#17
Charles T Mehlman, Kanu Okike, Mohit Bhandari, Mininder S Kocher
BACKGROUND: The practice of medicine is based on evidence from peer-reviewed literature. As can occur with author-related funding, the integrity of the process by which manuscripts are reviewed, edited, and approved for publication may be at risk due to financial conflict of interest. The purpose of our study was to assess potential financial conflict of interest among physician editorial board members of orthopaedic surgery journals. METHODS: We identified the physician editorial board members of 15 orthopaedic surgery journals and searched the 2014 payments that were archived in the Centers for Medicare & Medicaid Services Open Payments system (mandated by the Physician Payments Sunshine Act)...
March 1, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28242768/american-orthopaedic-foot-and-ankle-society-aofas-ankle-hindfoot-score-a-study-protocol-for-the-translation-and-validation-of-the-dutch-language-version
#18
Esther M M Van Lieshout, A Siebe De Boer, Duncan E Meuffels, P Ted Den Hoed, Cornelis H Van der Vlies, Wim E Tuinebreijer, Michael H J Verhofstad
INTRODUCTION: The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score is among the most commonly used instruments for measuring the outcome of treatment in patients who sustained a complex ankle or hindfoot injury. It combines a clinician-reported and a patient-reported part. A valid Dutch version of this instrument is currently not available. Such a translated and validated instrument would allow objective comparison across hospitals or between patient groups, and with shown validity and reliability it may become a quality of care indicator in future...
February 27, 2017: BMJ Open
https://www.readbyqxmd.com/read/28226416/the-contribution-of-the-emergency-department-to-opioid-pain-reliever-misuse-and-diversion-a-critical-review
#19
REVIEW
Tatyana Lyapustina, Renan Castillo, Elise Omaki, Wendy Shields, Eileen McDonald, Richard Rothman, Andrea Gielen
Prescription opioid pain reliever (OPR) misuse and diversion is an important and growing public health problem in the United States that is responsible for significant morbidity and mortality. Emergency physicians are among the top prescribers of OPRs, yet the relative contribution of emergency department (ED) OPR prescriptions to the overall opioid abuse epidemic remains unclear. This study critically reviews seven peer-reviewed studies that specifically identified the ED as a source of OPRs. Of the OPRs prescribed in the ED, approximately 10% are associated with indicators of inappropriate prescribing, and approximately 42% may ultimately be misused; of the OPRs that are diverted, approximately 10% originate from an ED prescription...
February 22, 2017: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/28210564/more-misinformation-on-breast-cancer-screening
#20
COMMENT
Daniel B Kopans
Unfortunately, a great deal of misinformation has accumulated in the breast cancer screening literature that is based on flawed analyses in an effort to reduce access to screening. Quite remarkably, much of this has come from publications in previously highly respected medical journals. In several papers the intervention (mammography screening) is faulted yet the analyses provided no data on who participated in mammography screening, and which cancers were detected by mammography screening. It is remarkable that a highly respected journal can fault an intervention with no data on the intervention...
February 2017: Gland Surgery
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