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https://www.readbyqxmd.com/read/27933151/improving-asthma-care-in-a-pediatric-resident-clinic
#1
Julia Lee, Albina Gogo, Daniel Tancredi, Erik Fernandez Y Garcia, Ulfat Shaikh
There is variation in pediatric asthma management in the outpatient setting. Adherence to national asthma guidelines provides a systematic standardized approach to asthma management. There is a gap between usual and guideline-consistent asthma care in resident clinics. Practice improvement modules aimed at improving resident physician adherence to asthma care guidelines have not been consistently utilized and have not yet been studied. Our aim was to increase guideline consistent care in our pediatric resident clinic in a twelve-month period via increasing performance on the following measures to 75%: spirometry testing; influenza immunization recommendation; level of control assessed through the use of a standardized questionnaire; appropriate medications per national guideline; and use of written asthma action plans...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27932381/improving-the-efficiency-of-care-for-pediatric-patients-hospitalized-with-asthma
#2
Kathleen W Bartlett, Victoria M Parente, Vanessa Morales, Jillian Hauser, Heather S McLean
BACKGROUND: Asthma exacerbations are a leading cause of hospitalization among children. Despite the existence of national pediatric asthma guidelines, significant variation in care persists. At Duke Children's Hospital, we determined that our average length of stay (ALOS) and cost for pediatric asthma admissions exceeded that of our peers. Our aim was to reduce the ALOS of pediatric patients hospitalized with asthma from 2.9 days to 2.6 days within 12 months by implementing an asthma pathway within our new electronic health record...
December 8, 2016: Hospital Pediatrics
https://www.readbyqxmd.com/read/27925424/evaluation-of-an-institutional-project-to-improve-venous-thromboembolism-prevention
#3
REVIEW
Christina A Minami, Anthony D Yang, Mila Ju, Eckford Culver, Kathryn Seifert, Lindsey Kreutzer, Terri Halverson, Kevin J O'Leary, Karl Y Bilimoria
BACKGROUND: Northwestern Memorial Hospital (NMH) was historically a poor performer on the venous thromboembolism (VTE) outcome measure. As this measure has been shown to be flawed by surveillance bias, NMH embraced process-of-care measures to ensure appropriate VTE prophylaxis to assess healthcare-associated VTE prevention efforts. OBJECTIVE: To evaluate the impact of an institution-wide project aimed at improving hospital performance on VTE prophylaxis measures...
December 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/27922719/markov-mixed-effects-modeling-using-electronic-adherence-monitoring-records-identifies-influential-covariates-to-hiv-preexposure-prophylaxis
#4
Kumpal Madrasi, Ayyappa Chaturvedula, Jessica E Haberer, Mark Sale, Michael J Fossler, David Bangsberg, Jared M Baeten, Connie Celum, Craig W Hendrix
Adherence is a major factor in the effectiveness of preexposure prophylaxis (PrEP) for HIV prevention. Modeling patterns of adherence helps to identify influential covariates of different types of adherence as well as to enable clinical trial simulation so that appropriate interventions can be developed. We developed a Markov mixed-effects model to understand the covariates influencing adherence patterns to daily oral PrEP. Electronic adherence records (date and time of medication bottle cap opening) from the Partners PrEP ancillary adherence study with a total of 1147 subjects were used...
December 6, 2016: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/27895069/association-between-poorer-cognitive-function-and-reduced-objectively-monitored-medication-adherence-in-patients-with-heart-failure
#5
Mary A Dolansky, Misty A W Hawkins, Julie T Schaefer, Abdus Sattar, John Gunstad, Joseph D Redle, Richard Josephson, Shirley M Moore, Joel W Hughes
BACKGROUND: Subclinical cognitive impairment is prevalent in heart failure (HF); however, its role in important clinical outcomes, such as HF treatment adherence, is unclear. Given the complex polypharmacy in HF treatment, cognitive deficits may be important in predicting medication management. Thus, the objective of the current study was to examine the impact of cognitive function on medication adherence among community-dwelling patients with HF using objective assessments. METHODS AND RESULTS: A prospective observational cohort design of 309 community-dwelling patients with HF (59...
December 2016: Circulation. Heart Failure
https://www.readbyqxmd.com/read/27889904/how-to-screen-for-non-adherence-to-antihypertensive-therapy
#6
REVIEW
Pankaj Gupta, Prashanth Patel, Robert Horne, Heather Buchanan, Bryan Williams, Maciej Tomaszewski
The quality of assessment of non-adherence to treatment in hypertensive is poor. Within this review, we discuss the different methods used to assess adherence to blood-pressure-lowering medications in hypertension patients. Subjective reports such as physicians' perceptions are inaccurate, and questionnaires completed by patients tend to overreport adherence and show a low diagnostic specificity. Indirect objective methods such as pharmacy database records can be useful, but they are limited by the robustness of the recorded data...
December 2016: Current Hypertension Reports
https://www.readbyqxmd.com/read/27859979/diabetes-conflict-outstrips-the-positive-impact-of-self-efficacy-on-youth-adherence-and-glycemic-control-in-type-1-diabetes
#7
Amy E Noser, Lindsay Huffhines, Mark A Clements, Susana R Patton
OBJECTIVE: To examine whether self-efficacy buffers the deleterious consequences of diabetes-specific family conflict on self-monitoring blood glucose (SMBG) and glycated hemoglobin (HbA1c) in youth with type 1 diabetes mellitus (T1DM). METHODS: A total of 129 youth with T1DM (aged 10-16 years) completed measures of diabetes-specific family conflict and self-efficacy for diabetes management, and their blood glucose meter data and HbA1c were extracted from the electronic medical record...
November 17, 2016: Pediatric Diabetes
https://www.readbyqxmd.com/read/27858570/multidisciplinary-optimization-of-oral-chemotherapy-delivery-at-the-university-of-wisconsin-carbone-cancer-center
#8
Daniel L Mulkerin, Jason J Bergsbaken, Jessica A Fischer, Mary J Mulkerin, Aaron M Bohler, Mary S Mably
PURPOSE: Use of oral chemotherapy is expanding and offers advantages while posing unique safety challenges. ASCO and the Oncology Nursing Society jointly published safety standards for administering chemotherapy that offer a framework for improving oral chemotherapy practice at the University of Wisconsin Carbone Cancer Center. METHODS: With the goal of improving safety, quality, and uniformity within our oral chemotherapy practice, we conducted a gap analysis comparing our practice against ASCO/Oncology Nursing Society guidelines...
October 2016: Journal of Oncology Practice
https://www.readbyqxmd.com/read/27835622/real-time-electronic-adherence-monitoring-plus-follow-up-improves-adherence-compared-with-standard-electronic-adherence-monitoring
#9
Jessica E Haberer, Nicholas Musinguzi, Alexander C Tsai, Yap Boum, Bosco M Bwana, Conrad Muzoora, Peter W Hunt, Jeffrey N Martin, David R Bangsberg
The impact of real-time electronic monitoring on antiretroviral therapy adherence warrants further study. We conducted an analysis of cohort participants that initially involved standard electronic adherence monitoring (EAM), followed by real-time EAM and home visits for sustained at least 48-h adherence interruptions. Immediately after switching between the two types of EAM, mean adherence among 112 participants increased from 84% to 93% and remained elevated for 6 months (P < 0.001). Real-time EAM is a promising approach for improving adherence...
January 2, 2017: AIDS
https://www.readbyqxmd.com/read/27818309/telemonitoring-adherence-to-medications-in-heart-failure-patients-team-hf-a-pilot-randomized-clinical-trial
#10
Benjamin D Gallagher, Nathalie Moise, Mytra Haerizadeh, Siqin Ye, Vivian Medina, Ian M Kronish
BACKGROUND: Medication nonadherence contributes to hospitalizations in recently discharged patients with heart failure (HF). We aimed to test the feasibility of telemonitoring medication adherence in patients with HF. METHODS AND RESULTS: We randomized 40 patients (1:1) hospitalized for HF to 30 days of loop diuretic adherence monitoring with telephonic support or to passive adherence monitoring alone. Eighty-three percent of eligible patients agreed to participate...
November 3, 2016: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/27815524/staar-a-randomised-controlled-trial-of-electronic-adherence-monitoring-with-reminder-alarms-and-feedback-to-improve-clinical-outcomes-for-children-with-asthma
#11
Robert W Morton, Heather E Elphick, Alan S Rigby, William J Daw, David A King, Laurie J Smith, Mark L Everard
BACKGROUND: Suboptimal adherence to inhaled steroids is common in children with asthma and is associated with poor disease control, reduced quality of life and even death. Previous studies using feedback of electronically monitored adherence data have demonstrated improved adherence, but have not demonstrated a significant impact on clinical outcomes. The aim of this study was to determine whether introduction of this approach into routine practice would result in improved clinical outcomes...
November 4, 2016: Thorax
https://www.readbyqxmd.com/read/27811583/cognitive-function-predicts-risk-for-clinically-significant-weight-gain-in-adults-with-heart-failure
#12
Mary A Dolansky, Misty A W Hawkins, Julie T Schaefer, John Gunstad, Abdus Sattar, Joseph D Redle, Anton Vehovec, Richard Josephson, Shirley M Moore, Joel W Hughes
BACKGROUND: Few investigators have examined whether cognitive deficits predict poorer self-care of weight management recommendations and weight gain in adults with heart failure. OBJECTIVE: The purposes of this study were (1) to examine whether cognition is associated with adherence to daily weighing and weight gain incidence and (2) to explore self-reported symptom perception and management when a weight increase occurs. METHODS: In this observational study, participants completed neuropsychological testing, were given an electronic scale, and were instructed to record their weight for 21 days...
November 2, 2016: Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/27797932/tangled-up-in-blue-unraveling-the-links-between-emotional-distress-and-treatment-adherence-in-type-2-diabetes
#13
Jeffrey S Gonzalez, Naomi S Kane, Deborah H Binko, Amit Shapira, Claire J Hoogendoorn
OBJECTIVE: We conducted comprehensive assessments of emotional distress to examine relations with diabetes medication adherence over time. RESEARCH DESIGN AND METHODS: Ethnically and socioeconomically diverse adults treated for type 2 diabetes completed validated self-reports (SRs) for diabetes distress and depression, were administered semistructured depression interviews, and provided blood samples for A1C. Medication adherence among 104 participants was electronically monitored (EM) over the subsequent 3 months; validated SRs of medication adherence were also obtained...
October 17, 2016: Diabetes Care
https://www.readbyqxmd.com/read/27756209/rationale-and-design-of-mdot-hua-study-a-randomized-trial-to-assess-the-effect-of-mobile-directly-observed-therapy-on-adherence-to-hydroxyurea-in-adults-with-sickle-cell-anemia-in-tanzania
#14
Abel Makubi, Philip Sasi, Mariam Ngaeje, Enrico M Novelli, Bruno P Mmbando, Mark T Gladwin, Julie Makani
BACKGROUND: Hydroxyurea (HU) has been demonstrated to be efficacious in reducing complications in individuals with sickle cell anemia (SCA) but poor adherence is a barrier. Directly Observed Therapy (DOT) has been shown to improve adherence in various chronic diseases but there is limited data in adults with SCA. METHODS AND DESIGN: To examine the effect of mobile-directly observed therapy (mDOT) on adherence to HU (mDOT-HuA) in adults with SCA at Muhimbili National Hospital in Tanzania...
October 18, 2016: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/27755160/improving-adherence-to-asthma-medications-current-knowledge-and-future-perspectives
#15
Kathryn V Blake
PURPOSE OF REVIEW: Poor adherence to asthma controller medications, particularly inhaled corticosteroids, has been well known for decades and is a major cause of uncontrolled asthma and increased healthcare utilization. This review presents recent evidence on factors leading to nonadherence in specific age groups, parents of young children, adolescents and young adults, adults, and the elderly. Novel management strategies including electronic sensors with associated smart phone applications for adherence improvement are discussed...
January 2017: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/27754161/pl-03-2-remote-blood-pressure-monitoring-in-hypertension-care-practice-of-hypertension-by-teletransmission-of-home-blood-pressure
#16
Yutaka Imai
It has been confirmed that clinical significance of home blood pressure measurements (HBPM) is higher than clinic BP measurements and ambulatory BP monitoring. However, several drawbacks of HBPM have also been mentioned, e.g. selection and reporting biases, difficulties of calculation of multiple measurements, difficulties of onsite judgement of numerous recordings, etc. Recent devices for HBPM incorporate memory function. This function can overcome such drawbacks of HBPM. These memorized data can transmit, storage, retrieve, be arithmetic and control, be judged based on algorithm and be got feedback...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27750142/assessment-of-the-cortisol-awakening-response-real-time-analysis-and-curvilinear-effects-of-sample-timing-inaccuracy
#17
Nina Smyth, Lisa Thorn, Frank Hucklebridge, Angela Clow, Phil Evans
The cortisol awakening response (CAR) is typically measured in the domestic setting. Moderate sample timing inaccuracy has been shown to result in erroneous CAR estimates and such inaccuracy has been shown partially to explain inconsistency in the CAR literature. The need for more reliable measurement of the CAR has recently been highlighted in expert consensus guidelines where it was pointed out that less than 6% of published studies provided electronic-monitoring of saliva sampling time in the post-awakening period...
September 30, 2016: Psychoneuroendocrinology
https://www.readbyqxmd.com/read/27746732/patterns-of-non-adherence-to-supplementation-with-calcium-and-vitamin-d-in-persistent-postmenopausal-women-are-similar-at-start-and-1-year-later-a-qualitative-longitudinal-study
#18
Tereza Touskova, Magda Vytrisalova, Vladimir Palicka, Tereza Hendrychova, Yang-Ti Chen, Leos Fuksa
Background: Osteoporosis is a chronic disease and adherence can fluctuate over time. Therefore, longer observation is necessary to investigate the stability of patients' adherence. The study aim was to compare the overall adherence (OA) to supplementation with the fixed combination of calcium and vitamin D (Ca/D) in postmenopausal women at baseline and after 1 year, and to evaluate the fluctuation of the OA in individual months. Furthermore, we studied whether adherence is influenced by signing of informed consent and routine medical check-up...
2016: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/27733666/the-impacts-of-a-pharmacist-managed-outpatient-clinic-and-chemotherapy-directed-electronic-order-sets-for-monitoring-oral-chemotherapy
#19
Brandon Battis, Linda Clifford, Mostaqul Huq, Edrick Pejoro, Scott Mambourg
OBJECTIVES: Patients treated with oral chemotherapy appear to have less contact with the treating providers. As a result, safety, adherence, medication therapy monitoring, and timely follow-up may be compromised. The trend of treating cancer with oral chemotherapy agents is on the rise. However, standard clinical guidance is still lacking for prescribing, monitoring, patient education, and follow-up of patients on oral chemotherapy across the healthcare settings. The purpose of this project is to establish an oral chemotherapy monitoring clinic, to create drug and lab specific provider order sets for prescribing and lab monitoring, and ultimately to ensure safe and effective treatment of the veterans we serve...
October 12, 2016: Journal of Oncology Pharmacy Practice
https://www.readbyqxmd.com/read/27730181/factors-associated-with-medication-adherence-in-school-aged-children-with-asthma
#20
Amy H Y Chan, Alistair W Stewart, Juliet M Foster, Edwin A Mitchell, Carlos A Camargo, Jeff Harrison
Adherence to preventive asthma treatment is poor, particularly in children, yet the factors associated with adherence in this age group are not well understood. Adherence was monitored electronically over 6 months in school-aged children who attended a regional emergency department in New Zealand for an asthma exacerbation and were prescribed twice-daily inhaled corticosteroids. Participants completed questionnaires including assessment of family demographics, asthma responsibility and learning style. Multivariable analysis of factors associated with adherence was conducted...
January 2016: ERJ Open Research
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