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Physician assistants and quality of care

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https://www.readbyqxmd.com/read/27926687/an-initiative-to-standardize-the-identification-of-and-acute-response-to-postoperative-lower-extremity-neurological-deficits-effects-on-provider-knowledge-confidence-and-communication-skills
#1
Peter B Derman, Sravisht Iyer, Matthew Garner, Steven Orr, Karla J Felix, Allison Goldberg, Titilayo Ologhobo, Minlun Wu, Laura Robbins, Charles Cornell
BACKGROUND: Although relatively uncommon, neurological deficits following hip and knee arthroplasty can have permanent and debilitating consequences. This study was conducted to quantify the effectiveness of an educational curriculum aimed at standardizing the identification of and acute response to postoperative neurological deficits in the inpatient setting, specifically with respect to improvements in clinician knowledge, confidence levels, and communication skills. METHODS: A multidisciplinary committee at a single, high-volume academic institution created an algorithm delineating the appropriate clinical actions and escalation procedures in the setting of a postoperative neurological deficit for each clinical practitioner involved in care for patients who undergo arthroplasty...
December 7, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27921257/impact-of-community-health-workers-on-use-of-healthcare-services-in-the-united-states-a-systematic-review
#2
Helen E Jack, Sophia D Arabadjis, Lucy Sun, Erin E Sullivan, Russell S Phillips
BACKGROUND: As the US transitions to value-based healthcare, physicians and payers are incentivized to change healthcare delivery to improve quality of care while controlling costs. By assisting with the management of common chronic conditions, community health workers (CHWs) may improve healthcare quality, but physicians and payers who are making choices about care delivery also need to understand their effects on healthcare spending. METHODS: We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycINFO, Embase, and Web of Science from the inception of each database to 22 June 2015...
December 5, 2016: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/27905305/regional-variation-in-the-practice-of-euthanasia-and-physician-assisted-suicide-in-the-netherlands
#3
J J E Koopman, H Putter
BACKGROUND: The practice of euthanasia and physicianassisted suicide has been compared between countries, but it has not been compared between regions within the Netherlands. This study assesses differences in the frequencies, characteristics, and trends of euthanasia and physician-assisted suicide between five regions in the Netherlands and tries to explain the differences by demographic, socioeconomic, and health-related differences between these regions. METHODS: Data on the frequencies, characteristics, and trends of euthanasia and physician-assisted suicide for each region and each year from 2002 through 2014 were derived from the annual reports of the Regional Review Committees...
November 2016: Netherlands Journal of Medicine
https://www.readbyqxmd.com/read/27896467/audit-of-geriatric-hip-fracture-care-a%C3%A2-slovenian-trauma-center-analysis
#4
Dejan Krušič, Drago Brilej, Colin Currie, Radko Komadina
BACKGROUND: The aim was to describe an audit of hip fracture patient care and outcomes in a Slovenian healthcare setting prior to the implementation of the Geriatric Fracture Center (GFC) model of care. METHODS: The Fragility Fracture Network (FFN) hip fracture audit database was used to collect data on hip fracture care in elderly patients. Epidemiological data were submitted as well as fracture type, prefracture residence and mobility prior to the fracture. The timeline of events and acute care data were also collected...
November 28, 2016: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/27873322/non-medical-prescribing-versus-medical-prescribing-for-acute-and-chronic-disease-management-in-primary-and-secondary-care
#5
REVIEW
Greg Weeks, Johnson George, Katie Maclure, Derek Stewart
BACKGROUND: A range of health workforce strategies are needed to address health service demands in low-, middle- and high-income countries. Non-medical prescribing involves nurses, pharmacists, allied health professionals, and physician assistants substituting for doctors in a prescribing role, and this is one approach to improve access to medicines. OBJECTIVES: To assess clinical, patient-reported, and resource use outcomes of non-medical prescribing for managing acute and chronic health conditions in primary and secondary care settings compared with medical prescribing (usual care)...
November 22, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27870547/prescribers-perceptions-of-medication-discontinuation-survey-instrument-development-and-validation
#6
Amy Linsky, Steven R Simon, Kelly Stolzmann, Barbara G Bokhour, Mark Meterko
OBJECTIVES: Primary care providers (PCPs) and clinical pharmacists have concerns about the adverse consequences of using medications inappropriately and generally support the notion of reducing unnecessary drugs. Despite this attitude, many factors impede clinicians' ability to discontinue medication in clinical settings. We sought to develop a survey instrument that assesses PCPs' and pharmacists' experiences, attitudes, and beliefs toward medication discontinuation. STUDY DESIGN: Survey development and psychometric assessment...
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27864915/identification-of-emergency-department-visits-in-medicare-administrative-claims-approaches-and-implications
#7
Arjun K Venkatesh, Hao Mei, Keith Kocher, Mike Granovsky, Ziad Obermeyer, Erica Spatz, Craig Rothenberg, Harlan Krumholz, Zhenqui Lin
OBJECTIVES: Administrative claims datasets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital-based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare dataset and to compare this definition to existing operational definitions used by researchers and policymakers...
November 19, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27855151/advances-in-the-care-of-children-with-lupus-nephritis
#8
Scott E Wenderfer, Natasha M Ruth, Hermine I Brunner
The care of children with lupus nephritis (LN) has changed dramatically over the past 50 years. The majority of patients with childhood-onset systemic lupus erythematosus (cSLE) develop LN. In the 1960's, prognosis in children was worse than in adults; therapies were limited and toxic. Nearly half of cases resulted in death within 2-years. Since this time, several diagnostic recommendations and disease-specific indices have been developed to assist physicians caring for patients with LN. Pediatric researchers are validating and adapting these indices and guidelines for the treatment of LN in cSLE...
November 17, 2016: Pediatric Research
https://www.readbyqxmd.com/read/27852291/shifting-human-resources-for-health-in-the-context-of-art-provision-qualitative-and-quantitative-findings-from-the-lablite-baseline-study
#9
Misheck J Nkhata, Margaret Muzambi, Deborah Ford, Adrienne K Chan, George Abongomera, Harriet Namata, Ivan Mambule, Annabelle South, Paul Revill, Caroline Grundy, Travor Mabugu, Levison Chiwaula, James Hakim, Cissy Kityo, Andrew Reid, Elly Katabira, Sumeet Sodhi, Charles F Gilks, Diana M Gibb, Janet Seeley, Fabian Cataldo
BACKGROUND: Lablite is an implementation project supporting and studying decentralized antiretroviral therapy (ART) rollout to rural communities in Malawi, Uganda and Zimbabwe. Task shifting is one of the strategies to deal with shortage of health care workers (HCWs) in ART provision. Evaluating Human Resources for Health (HRH) optimization is essential for ensuring access to ART. The Lablite project started with a baseline survey whose aim was to describe and compare national and intercountry delivery of ART services including training, use of laboratories and clinical care...
November 16, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27846030/efficacy-of-monitoring-devices-in-support-of-prevention-of-pressure-injuries-systematic-review-and-meta-analysis
#10
Gurjot S Walia, Alison L Wong, Andrea Y Lo, Gina A Mackert, Hannah M Carl, Rachel A Pedreira, Ricardo Bello, Carla S Aquino, William V Padula, Justin M Sacks
GENERAL PURPOSE: To present a systematic review of the literature assessing the efficacy of monitoring devices for reducing the risk of developing pressure injuries. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1...
December 2016: Advances in Skin & Wound Care
https://www.readbyqxmd.com/read/27845485/physician-assisted-suicide-and-clinical-vulnerability-a-slippery-slope
#11
F Monacelli, M Martini, P Odetti, R Ciliberti
AIMS: The Belgian case of a 24 years' woman affected by resistant depression, who obtained the legal right to assisted suicide rehearsed ethical issues. From the famous Chabot case of the Dutch court in 1994, accumulating legal evidence indicates that the unbearable psychiatric suffering may be equate to the physical struggle of end of life patients. The Belgian law has addressed assisted suicide as an option in case of unbearable psychic suffering with no future prospective. DESIGN: It is unlikely that the practice of euthanasia may be mechanistically reduced to the provision of a suicide as alleviating the burden of suffering in depression is a long life commitment; moreover, the principle of patient's self determination and autonomy is highly debatable: the closure to the future, the hopelessness and the suicidal ideation represent per se core features of depression...
September 2016: La Clinica Terapeutica
https://www.readbyqxmd.com/read/27844200/-education-within-the-dutch-national-care-for-the-elderly-programme
#12
Barth Oeseburg, Jos Schols, Marcel Olde Rikkert, Henriëtte van der Horst, Dini Smilde-van den Doel, Sophia de Rooij, Bianca Buurman-van Es, Marieke Schuurmans, Jacobijn Gussekloo
The Netherlands Organisation of Health Research and Development started in 2008 the Dutch National Care for the Elderly Programme (in Dutch abbreviated as NPO) with the aim to improve the quality of life for the frail older people through better quality of care (health, social, community) which is tailored to the needs and wants of older people. The delivery of good care is related with competent professional behaviour which is inextricably linked to the education of professionals. This article presents an overview of 32 educational programmes developed within the NPO...
December 2016: Tijdschrift Voor Gerontologie en Geriatrie
https://www.readbyqxmd.com/read/27834513/development-and-implementation-of-non-medical-practitioners-in-acute-care
#13
Jenny Abraham, Becky Whiteman, Jane Coad, Rosie Kneafsey
The purpose of this article is to discuss the evolving workforce required to deliver quality healthcare in NHS acute care settings within the UK. The development and implementation of non-medical practitioner (NMP) roles, such as advanced clinical practitioners, surgical care practitioners, surgical first assistants, physician associates and physician assistants in anaesthesia are discussed in relation to training, regulation, governance and evaluation in clinical practice.
November 10, 2016: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/27833464/urology-group-compensation-and-ancillary-service-models-in-an-era-of-value-based-care
#14
Neal D Shore, Dana Jacoby
Changes involving the health care economic landscape have affected physicians' workflow, productivity, compensation structures, and culture. Ongoing Federal legislation regarding regulatory documentation and imminent payment-changing methodologies have encouraged physician consolidation into larger practices, creating affiliations with hospitals, multidisciplinary medical specialties, and integrated delivery networks. As subspecialization and evolution of care models have accelerated, independent medical groups have broadened ancillary service lines by investing in enterprises that compete with hospital-based (academic and nonacademic) entities, as well as non-physician- owned multispecialty enterprises, for both outpatient and inpatient services...
2016: Reviews in Urology
https://www.readbyqxmd.com/read/27818414/an-innovative-approach-to-enhancing-access-to-medical-screening-for-miners-using-a-mobile-clinic-with-telemedicine-capability
#15
Kandace Evans, Shawn Lerch, Tawny Wilson Boyce, Orrin B Myers, Elizabeth Kocher, Linda S Cook, Akshay Sood
Inadequate access to medical care in underserved and geographically isolated rural communities may limit the delivery of quality screening care to miners. Use of mobile screening clinics, manned by a physician assistant or nurse practitioner, is one way to improve their access. Miners demonstrate a high level of satisfaction with services provided by the mobile screening clinic. The addition of telemedicine to mobile screening clinics allows miners to have access to university-based specialist care and provides an opportunity to specialists to tele-mentor other providers...
2016: Journal of Health Care for the Poor and Underserved
https://www.readbyqxmd.com/read/27803586/the-role-of-indian-gynecologists-in-oncofertility-care-and-counselling
#16
Nalini Mahajan, Madhuri Patil, Surleen Kaur, Simrandeep Kaur, Padmaja Naidu
Oncofertility is gaining importance because of increasing cancer incidence, high survivorship, the need to provide a good quality of life to survivors and the desire of patients to preserve their fertility. Disseminating information about the effect of cancer and cancer treatment on fertility and the availability and effectiveness of fertility preservation techniques is critical. Gynaecologists in India act as family physicians and are in a unique position to guide cancer patients on issues of fertility and fertility preservation...
July 2016: Journal of Human Reproductive Sciences
https://www.readbyqxmd.com/read/27792075/reducing-inappropriate-antibiotic-prescribing-for-adults-with-acute-bronchitis-in-an-urgent-care-setting-a-quality-improvement-initiative
#17
Tamara L Link, Mary L Townsend, Eugene Leung, Sekhar Kommu, Rhonda Y Vega, Cristina C Hendrix
Acute bronchitis is a predominantly viral illness and, according to clinical practice guidelines, should not be treated with antibiotics. Despite clear guidelines, acute bronchitis continues to be the most common acute respiratory illness for which antibiotics are incorrectly prescribed. Although the national benchmark for antibiotic prescribing for adults with acute bronchitis is 0%, a preliminary record review before implementing the intervention at the project setting showed that 96% (N = 30) of adults with acute bronchitis in this setting were prescribed an antibiotic...
October 2016: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/27773426/peritoneal-or-hemodialysis-for-the-frail-elderly-patient-the-choice-of-2-evils
#18
Edwina A Brown, Frederic O Finkelstein, Osasuyi U Iyasere, Alan S Kliger
Management of older people on dialysis requires focus on the wider aspects of aging as well as dialysis. Almost all frail and older patients receiving dialysis will default to in-center hemodialysis, although the availability of assisted peritoneal dialysis enables dialysis at home. As with any disease management decision, patients approaching end-stage renal disease need all the appropriate facts about their prognosis, the natural history of their disease without dialysis, and the resulting outcomes and complications of the different dialysis modalities...
October 20, 2016: Kidney International
https://www.readbyqxmd.com/read/27770490/point-of-care-ultrasound-for-diagnosis-of-abscess-in-skin-and-soft-tissue-infections
#19
Sathyaseelan Subramaniam, Jacqueline Bober, Jennifer Chao, Shahriar Zehtabchi
BACKGROUND: Traditionally, emergency department (ED) physicians rely on their clinical examination to differentiate between cellulitis and abscess when evaluating skin and soft tissue infections (SSTI). Management of an abscess requires incision and drainage, whereas cellulitis generally requires a course of antibiotics. Misdiagnosis often results in unnecessary invasive procedures, sedations (for incision and drainage in pediatric patients), or a return ED visit for failed antibiotic therapy...
November 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27763399/vsed-death-with-dignity-or-without
#20
Mark Corbett
Conceivably, in an ideal world, all patients with a life-limiting illness would receive optimal hospice and palliative care so that no one would ever wish to hasten their own death. The reality, however, is that despite provision of optimal hospice and palliative care, individuals with terminal illness experience suffering, loss of meaning, or deterioration in quality of life to the extent where they express the desire to expedite the dying process. While there has been extensive discussion surrounding physician-assisted death (PAD), there has been less attention paid to the practice of voluntary stopping eating and drinking (VSED) near the end of life...
2016: Narrative Inquiry in Bioethics
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