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https://www.readbyqxmd.com/read/28319990/a-decision-support-approach-for-provider-scheduling-in-a-patient-centered-medical-home
#1
Renata Konrad, Sarah Ficarra, Catherine Danko, Rachel Wallace, Cliona Archambeault
The patient-centered medical home (PCMH) has been proposed as a viable and medically effective model of primary care delivery. The fundamental principles of a PCMH address increased access and offer new ways to organize a practice. Creating provider schedules able to satisfy the operational and organizational constraints imposed by this type of delivery model is a challenging, complex, and time-consuming task.This article presents a two-step approach for scheduling providers and prospectively assessing the consequences of various schedules on patient throughput without experimenting on the real-world system...
January 2017: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/28301693/the-clue
#2
Tyler Tate
As I stood outside of Carlos's room, I felt caught on the horns of a dilemma. It seemed impossible to truly "be there" for Carlos without sacrificing my other intern duties. This tension pervaded much of my residency training, as I often found myself spending more time completing chart notes, answering pages, and giving sign out than I did at the bedside with my patients. I knew I had a duty to "do my job"-I could not let my team down. But what about my duty to Carlos, a duty to act on my intuition and try to "get to the bottom" of his illness, if that was even possible? And what about my thirteen other patients? Wasn't I was their doctor as well? I have spent countless hours studying the ethical frameworks for medical rationing...
March 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28291472/self-reported-sleep-during-u-s-navy-operations-and-the-impact-of-deployment-related-factors
#3
Elizabeth Harrison, Gena L Glickman, Shiloh Beckerley, Marcus K Taylor
Sleep disruption is a growing concern among military personnel. Very little is known, however, regarding sleep and associated factors in military members serving in combat environments. We sought to quantify the prevalence of sleep disruption among military personnel serving in a combat zone during Operation Enduring Freedom, utilizing a cross-sectional survey of active duty and reserve U.S. Navy personnel in the Afghanistan combat theater (N = 6,118). Survey sleep measures included total hours of sleep per day, total hours of sleep needed to feel well rested, difficulty falling asleep, and difficulty staying asleep...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28291466/development-of-a-portable-tool-for-screening-neuromotor-sequelae-from-repetitive-low-level-blast-exposure
#4
Christopher K Rhea, Nikita A Kuznetsov, Scott E Ross, Benjamin Long, Jason T Jakiela, Jason M Bailie, Matthew A Yanagi, F Jay Haran, W Geoffrey Wright, Rebecca K Robins, Paul D Sargent, Joshua L Duckworth
Blast exposure is a prevalent cause of mild traumatic brain injury (mTBI) in military personnel in combat. However, it is more common for a service member to be exposed to a low-level blast (LLB) that does not result in a clinically diagnosable mTBI. Recent research suggests that repetitive LLB exposure can result in symptomology similar to symptoms observed after mTBI. This manuscript reports on the use of an Android-based smartphone application (AccWalker app) to capture changes in neuromotor functioning after blast exposure...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28290948/mortality-surveillance-for-infectious-diseases-in-the-u-s-department-of-defense-1998-2013
#5
Robert N Potter, Ladd A Tremaine, Joel C Gaydos
INTRODUCTION: The Mortality Surveillance Division (MSD) of the U.S. Armed Forces Medical Examiner System was established in 1998 to improve surveillance for all military deaths although emphasizing deaths from infectious diseases. Establishment of the MSD was part of the 1997 Department of Defense initiative to improve surveillance and response for emerging infectious diseases. Before 1998, mortality surveillance was limited to compiling information from death certificates, a system that provided limited useful information and lacked the timeliness needed to take meaningful action to address emerging infectious disease threats...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28277169/predicted-endurance-times-during-overhead-work-influences-of-duty-cycle-and-tool-mass-estimated-using-perceived-discomfort
#6
Deepti Sood, Maury A Nussbaum, Kris Hager, Helen C Nogueira
A need for overhead work remains in several industries and such work is an important risk factor for shoulder musculoskeletal problems. In this study, we evaluated the effects of duty cycle and tool mass on endurance times during overhead work. A psychophysical approach was used, via a new methodology that was implemented to more efficiently estimate endurance times (rather than through direct measurements). Participants performed a simulated overhead task in specified combinations of tool mass and duty cycle...
February 21, 2017: Ergonomics
https://www.readbyqxmd.com/read/28273219/evaluation-of-care-for-traffic-accidents-victims-made-by-on-duty-emergency-physicians-and-surgeons-in-the-emergency-room
#7
Vlaudimir Dias Marques, Mauricio Medeiros Lemos, Cesar Orlando Peralta Bandeira, Amélia Cristina Seidel, Sandra Maria Peloso, Maria Dalva DE Barros Carvalho
OBJECTIVE: to evaluate the care for victims of traffic accidents by on call emergency physicians and/or surgeons in the emergency room. METHODS: we conducted a retrospective, descriptive and exploratory study on the care for traffic accidents victims in the urban area of ​​Maringá-PR, between July 2013 and July 2014 in reference hospitals. We assessed demographics and vocational training through a questionnaire sent to the attending physicians. RESULTS: of the 688 records evaluated, 99% of patients had a prehospital Revised Trauma Score of 12...
December 2016: Revista do Colégio Brasileiro de Cirurgiões
https://www.readbyqxmd.com/read/28265525/a-study-of-emotional-intelligence-among-postgraduate-medical-students-in-delhi
#8
Rajkrishna Ravikumar, O P Rajoura, Rahul Sharma, Manjeet S Bhatia
CONTEXT: The importance of emotional intelligence (EI) in the successful practice of medicine has been well established. However, efforts to study the same in India, especially in doctors and medical students, are lacking. This study has measured the emotional intelligence of postgraduate medical students in Delhi and aimed to identify some of the factors affecting it. METHODS: A cross-sectional analytical study, using the Schutte's Self-Report Emotional Intelligence Test, to measure the EI of 200 postgraduate medical students of two medical colleges in Delhi...
January 22, 2017: Curēus
https://www.readbyqxmd.com/read/28261407/factors-influencing-residency-program-selection-by-medical-students-pursuing-obstetrics-and-gynecology
#9
Meredith J Alston, Torri D Metz, Russell Fothergill, Amy Meg Autry, Sarah A Wagner, Amanda A Allshouse, Alyssa Stephenson-Famy
BACKGROUND : Little is known about the factors that influence medical student selection of obstetrics and gynecology (ob-gyn) residency programs. OBJECTIVE : We assessed the factors influencing residency program selection by fourth-year medical students pursuing ob-gyn training. METHODS : A voluntary, anonymous, 19-question survey of residency selection factors was distributed to all fourth-year medical students interviewing at 1 of 5 academic ob-gyn departments for a residency position during the 2013-2014 interview season...
February 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28259336/shift-schedules-and-intern-work-hours-patient-numbers-conference-attendance-and-sleep-at-a-single-pediatric-residency-program
#10
Irene Kocolas, Kristen Day, Marta King, Adam Stevenson, Xiaoming Sheng, Wendy Hobson, Jaime Bruse, James Bale
OBJECTIVE: The effects of 2011 Accreditation Council on Graduate Medical Education (ACGME) duty hour standards on intern work hours, patient load, conference attendance, and sleep have not been fully determined. We prospectively compared intern work hours, patient numbers, conference attendance, sleep duration, pattern, and quality in a 2011 ACGME duty hour-compliant shift schedule with a 2003 ACGME duty hour-compliant call schedule at a single pediatric residency program. METHODS: Interns were assigned to shift or call schedules during 4 alternate months in the winter of 2010-2011...
March 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28240580/gender-differences-and-predictors-of-work-hours-in-a-sample-of-ontario-dentists
#11
Julia C McKay, Atyub Ahmad, Jodi L Shaw, Faahim Rashid, Alicia Clancy, Courtney David, Rafael Figueiredo, Carlos Quiñonez
PURPOSE: To determine the influence of gender on weekly work hours of Ontario dentists. METHODS: In 2012, a 52-item survey was sent to a random sample of 3000 Ontario dentists (1500 men and 1500 women) to collect information on personal, professional and sociodemographic characteristics. The resulting data were analyzed using descriptive statistics and linear regression modeling. RESULTS: The 867 respondents included 463 men, 401 women and 3 people whose gender was unreported, yielding a response rate of 29%...
November 2016: Journal—Canadian Dental Association, Journal de L'Association Dentaire Canadienne
https://www.readbyqxmd.com/read/28217574/india-in-search-of-right-universal-health-coverage-uhc-model-the-risks-of-implementing-uhc-in-the-absence-of-political-demand-by-the-citizen
#12
EDITORIAL
Raman Kumar, Pritam Roy
Amid the global push for Universal Health Coverage (UHC), the agenda is being set for India's health care. In the absence of a constitutional mandate, a national policy and citizen-led political demand for UHC, there exist specific risks in rushing toward its implementation in India. As the debate of UHC continues, the health-care delivery system in India is at cross roads. UHC in India could take two different trajectories. The first one takes India toward becoming "Global Bazaar" of morbidity and ill health, founded on the pillars of a vibrant rapidly multiplying healthcare industry...
July 2016: Journal of Family Medicine and Primary Care
https://www.readbyqxmd.com/read/28212590/the-july-effect-on-maternal-peripartum-complications-before-and-after-resident-duty-hour-reform-a-population-based-retrospective-cohort-study
#13
Ithan D Peltan, Crystal E Brown, Alson K Burke, Eric J Chow, Ali Rowhani-Rahbar, Matthew R Crull
Objective To compare maternal birth complications early versus late in the academic year and to evaluate the impact of resident work hour limitation on the "July effect." Study Design We conducted a retrospective, population-based cohort study of 628,414 singleton births in Washington State from 1987 to 2012 measuring the adjusted risk of maternal peripartum complications early (July/August) versus late (April/May) in the academic year. To control for seasonal outcome variation unrelated to trainees' involvement in care as well as long-term trends in maternal complications unrelated to variation in trainees' effect on outcomes across the academic year, we employed difference-in-differences methods contrasting outcomes at teaching to nonteaching hospitals for deliveries before and after restriction of resident work hours in July 2003...
February 17, 2017: American Journal of Perinatology
https://www.readbyqxmd.com/read/28199265/a-decision-support-approach-for-provider-scheduling-in-a-patient-centered-medical-home
#14
Renata Konrad, Sarah Ficarra, Catherine Danko, Rachel Wallace, Cliona Archambeault
The patient-centered medical home (PCMH) has been proposed as a viable and medically effective model of primary care delivery. The fundamental principles of a PCMH address increased access and offer new ways to organize a practice. Creating provider schedules able to satisfy the operational and organizational constraints imposed by this type of delivery model is a challenging, complex, and time-consuming task.This article presents a two-step approach for scheduling providers and prospectively assessing the consequences of various schedules on patient throughput without experimenting on the real-world system...
January 2017: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/28196342/decreased-salivary-alpha-amylase-levels-are-associated-with-performance-deficits-during-sleep-loss
#15
Maja Pajcin, Siobhan Banks, Jason M White, Jill Dorrian, Gemma M Paech, Crystal Grant, Kayla Johnson, Katie Tooley, Justin Fidock, Gary H Kamimori, Chris B Della Vedova
During sleep deprivation, neurobehavioral functions requiring sustained levels of attention and alertness are significantly impaired. Discrepancies between subjective measures of sleepiness and objective performance during sustained operations have led to interest in physiological monitoring of operator performance. Alertness, vigilance, and arousal are modulated by the wake-promoting actions of the central noradrenergic system. Salivary alpha-amylase (sAA) has been proposed as a sensitive peripheral measure of noradrenergic activity, but limited research has investigated the relationship between sAA and performance...
February 1, 2017: Psychoneuroendocrinology
https://www.readbyqxmd.com/read/28196195/association-of-otolaryngology-resident-duty-hour-restrictions-with-procedure-specific-outcomes-in-head-and-neck-endocrine-surgery
#16
Aaron Smith, Lauren Braden, Jim Wan, Merry Sebelik
Importance: Graduate medical education has undergone a transformation from traditional long work hours to a restricted plan to allow adequate rest for residents. The initial goal of this restriction is to improve patient outcomes. Objective: To determine whether duty hour restrictions had any impact on surgery-specific outcomes by analyzing complications following thyroid and parathyroid procedures performed before and after duty hour reform. Design, Setting, and Participants: Retrospective cross-sectional analysis of the National Inpatient Sample (NIS)...
February 9, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/28186478/meaningful-use-an-electronic-medical-record-tool-for-cerebrospinal-fluid-shunt-history
#17
Lance S Governale, Jeffrey M Hoffman
The care of patients with shunted hydrocephalus can be complicated. The best assessment is provided when all data are available to the neurosurgery practitioner. However, data can be time-consuming to gather, especially in the setting of a busy practice, a trainee environment with duty-hour restrictions, and an electronic medical record (EMR) not specifically designed for the needs of subspecialists. For these reasons, the complete clinical picture, especially the historical component, is sometimes not assembled...
February 10, 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28168797/pre-oncall-key-conditions-training-for-first-year-radiology-registrars
#18
Nicholas I Brown, Paul Leschke, Mandy Way, David D Smith, Perry Cleland
INTRODUCTION: The Royal Australian and New Zealand College of Radiology (RANZCR) recognised the importance of experience in on-call and emergency radiology for first-year registrars by introducing 'Key conditions in Year 1 training'. This list of common radiological pathologies can help to focus preparations for new registrars as they prepare for after-hours duties. METHODS: The Royal Brisbane and Women's Hospital (RBWH) implemented a 12-week formal training programme, based on this curriculum, for new registrars prior to commencing after-hours work...
February 7, 2017: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/28160813/fatigue-and-on-duty-injury-among-police-officers-the-bcops-study
#19
Desta Fekedulegn, Cecil M Burchfiel, Claudia C Ma, Michael E Andrew, Tara A Hartley, Luenda E Charles, Ja K Gu, John M Violanti
INTRODUCTION: Policing involves inherent physical and psychological dangers as well as occupational stressors that could lead to chronic fatigue. Although accounts of adverse events associated with police fatigue are not scarce, literature on the association between chronic fatigue and on-duty injury are limited. METHODS: Participants were officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. A 10-item questionnaire was administered to assess how tired or energetic the officers generally felt irrespective of sleep hours or workload...
February 2017: Journal of Safety Research
https://www.readbyqxmd.com/read/28152699/development-of-an-infusion-nurse-staffing-model-for-outpatient-chemotherapy-centers
#20
(no author information available yet)
103 Background: Nursing roles and responsibilities within ambulatory oncology infusion suites across our health system are not clearly defined and it is not understood what the appropriate staffing ratio should be per site. It is not clear if employees are working to the highest level of their licensure or skill, and if the appropriate activities are performed by the correct department. A standard staffing model to provide efficiency of clinical services and patient safety does not exist, and nursing roles are variable between the sites...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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