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https://www.readbyqxmd.com/read/28340230/determinants-of-opioid-prescribing-for-nonmalignant-chronic-pain-in-us-outpatient-settings
#1
Rafia S Rasu, Maureen E Knell
Study Objectives.:  Identify prescribing trends for opioid use in non-malignant chronic pain (NMCP) from the National Ambulatory Medical Care Survey (NAMCS). Determine predictors of opioid use based on patient-specific factors. Design.:  This cross-sectional study analyzed NAMCS data from 2000 to 2007. Pain medications prescribed were retrieved using NAMCS drug codes. Multivariate logistic models examined determinants of opioid prescribing among NMCP patients...
March 14, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28301279/integrating-palliative-care-services-in-ambulatory-oncology-an-application-of-the-edmonton-symptom-assessment-system
#2
Sherri L Rauenzahn, Susanne Schmidt, Ifeoma O Aduba, Jessica T Jones, Nazneen Ali, Laura L Tenner
PURPOSE: Research in palliative care demonstrates improvements in overall survival, quality of life, symptom management, and reductions in the cost of care. Despite the American Society of Clinical Oncology recommendation for early concurrent palliative care in patients with advanced cancer and high symptom burden, integrating palliative services is challenging. Our aims were to quantitatively describe the palliative referral rates and symptom burden in a South Texas cancer center and establish a palliative referral system by implementing the Edmonton Symptom Assessment Scale (ESAS)...
March 16, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28295871/promoting-resource-stewardship-reducing-inappropriate-free-thyroid-hormone-testing
#3
Julie A Gilmour, Alanna Weisman, Steven Orlov, Robert J Goldberg, Alyse Goldberg, Hayley Baranek, Geetha Mukerji
RATIONALE: Free thyroxine (fT4) and free triiodothyronine (fT3) tests are often ordered when not clinically warranted. Preventing laboratory overuse by reducing inappropriate fT4 and fT3 testing is one strategy to promote resource stewardship. OBJECTIVES: (1) To characterize the frequency of inappropriate fT4 and fT3 testing and (2) to implement a quality improvement strategy aimed at reducing the number of these tests performed. METHODS: Quality improvement tools were used to create sequential change ideas: (1) education of physicians regarding appropriate indications for ordering fT4/fT3 and (2) implementation of a hospital-wide laboratory and forced-function system with a reflex fT4...
March 14, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28293685/healthcare-team-perceptions-of-a-portal-for-parents-of-hospitalized-children-before-and-after-implementation
#4
Michelle M Kelly, Shannon M Dean, Pascale Carayon, Tosha B Wetterneck, Peter L T Hoonakker
BACKGROUND: Patient electronic health record (EHR) portals can enhance patient and family engagement by providing information and a way to communicate with their healthcare team (HCT). However, portal implementation has been limited to ambulatory settings and met with resistance from HCTs. OBJECTIVE: We evaluated HCT perceptions before and 6-months after implementation of an inpatient EHR portal application on a tablet computer given to parents of hospitalized children...
March 15, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28284190/notifiable-condition-reporting-practices-implications-for-public-health-agency-participation-in-a-health-information-exchange
#5
Debra Revere, Rebecca H Hills, Brian E Dixon, P Joseph Gibson, Shaun J Grannis
BACKGROUND: The future of notifiable condition reporting in the United States is undergoing a transformation with the increasing development of Health Information Exchanges which support electronic data-sharing and -transfer networks and the wider adoption of electronic laboratory reporting. Communicable disease report forms originating in clinics are an important source of surveillance data for public health agencies. However, problems of poor data quality and delayed submission of reports to public health agencies are common...
March 11, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28282465/are-community-based-nurse-led-self-management-support-interventions-effective-in-chronic-patients-results-of-a-systematic-review-and-meta-analysis
#6
Azzurra Massimi, Corrado De Vito, Ilaria Brufola, Alice Corsaro, Carolina Marzuillo, Giuseppe Migliara, Maria Luisa Rega, Walter Ricciardi, Paolo Villari, Gianfranco Damiani
The expansion of primary care and community-based service delivery systems is intended to meet emerging needs, reduce the costs of hospital-based ambulatory care and prevent avoidable hospital use by the provision of more appropriate care. Great emphasis has been placed on the role of self-management in the complex process of care of patient with long-term conditions. Several studies have determined that nurses, among the health professionals, are more recommended to promote health and deliver preventive programs within the primary care context...
2017: PloS One
https://www.readbyqxmd.com/read/28279654/bloodstream-amyloid-beta-1-40-peptide-cognition-and-outcomes-in-heart-failure
#7
Antoni Bayes-Genis, Jaume Barallat, Marta de Antonio, Mar Domingo, Elisabet Zamora, Joan Vila, Isaac Subirana, Paloma Gastelurrutia, M Cruz Pastor, James L Januzzi, Josep Lupón
INTRODUCTION AND OBJECTIVES: In the brain, amyloid-beta generation participates in the pathophysiology of cognitive disorders; in the bloodstream, the role of amyloid-beta is uncertain but may be linked to sterile inflammation and senescence. We explored the relationship between blood levels of amyloid-beta 1-40 peptide (Aβ40), cognition, and mortality (all-cause, cardiovascular, and heart failure [HF]-related) in ambulatory patients with HF. METHODS: Bloodstream Aβ40 was measured in 939 consecutive patients with HF...
March 6, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28270272/implementation-and-assessment-of-an-ambulatory-prescribing-guidance-tool-to-improve-patient-safety-in-the-geriatric-population
#8
Daniel J Ruhland, Jessica M Bellone, Erin Wilkes
OBJECTIVE: The purpose of this study was to assess the effects of a clinical decision support (CDS) tool aimed at decreasing the prescribing of glyburide, a potentially inappropriate medication (PIM), in patients 65 years of age and older. DESIGN: Quasi-experimental, pre-post intervention study. SETTING: Ambulatory care clinics of an academic medical center. INTERVENTION: The tool appeared to providers when entering new prescriptions or refills for glyburide...
March 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28261405/successful-implementation-of-a-direct-observation-program-in-an-ambulatory-block-rotation
#9
Jeremy Smith, Elizabeth Jacobs, Zhanhai Li, Bennett Vogelman, Yingqi Zhao, David Feldstein
BACKGROUND : Direct observation of clinical skills is a cornerstone of competency-based education and training. Ensuring direct observation in a consistent fashion has been a significant challenge for residency programs. OBJECTIVE : The purpose of this study was to evaluate the effects of a novel evaluation system, designed to achieve ongoing direct observation of residents, examine changes in resident observation practices, and understand faculty attitudes toward direct observation and the evaluation system...
February 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28261403/jgme-aliem-hot-topics-in-medical-education-analysis-of-a-multimodal-online-discussion-about-team-based-learning
#10
Jeff Riddell, Catherine Patocka, Michelle Lin, Jonathan Sherbino
BACKGROUND : Team-based learning (TBL) is an instructional method that is being increasingly incorporated in health professions education, although use in graduate medical education (GME) has been more limited. OBJECTIVE : To curate and describe themes that emerged from a virtual journal club discussion about TBL in GME, held across multiple digital platforms, while also evaluating the use of social media in online academic discussions. METHODS : The Journal of Graduate Medical Education (JGME) and the Academic Life in Emergency Medicine blog facilitated a weeklong, open-access, virtual journal club on the 2015 JGME article "Use of Team-Based Learning Pedagogy for Internal Medicine Ambulatory Resident Teaching...
February 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28255097/patient-and-provider-perspectives-on-the-design-and-implementation-of-an-electronic-consultation-system-for-kidney-care-delivery-in-canada-a-focus-group-study
#11
Aminu K Bello, Anita E Molzahn, Louis P Girard, Mohamed A Osman, Ikechi G Okpechi, Jodi Glassford, Stephanie Thompson, Erin Keely, Clare Liddy, Braden Manns, Kailash Jinda, Scott Klarenbach, Brenda Hemmelgarn, Marcello Tonelli
OBJECTIVES: We assessed stakeholder perceptions on the use of an electronic consultation system (e-Consult) to improve the delivery of kidney care in Alberta. We aim to identify acceptability, barriers and facilitators to the use of an e-Consult system for ambulatory kidney care delivery. METHODS: This was a qualitative focus group study using a thematic analysis design. Eight focus groups were held in four locations in the province of Alberta, Canada. In total, there were 72 participants in two broad stakeholder categories: patients (including patients' relatives) and providers (including primary care physicians, nephrologists, other care providers and policymakers)...
March 2, 2017: BMJ Open
https://www.readbyqxmd.com/read/28253430/moral-distress-in-nurses-providing-direct-patient-care-at-an-academic-medical-center
#12
Janet Sirilla, Kathrynn Thompson, Todd Yamokoski, Mark D Risser, Esther Chipps
BACKGROUND: Moral distress is the psychological response to knowing the appropriate action but not being able to act due to constraints. Previous authors reported moral distress among nurses, especially those that work in critical care units. AIMS: The aims of this study were: (1) to examine the level of moral distress among nurses who work at an academic health system, (2) to compare the level of moral distress in nurses who work across specialty units at an academic health system, (3) to compare moral distress by the demographic characteristics of nurses and work experience variables, and (4) to identify demographic characteristics and type of clinical setting that may predict which nurses are at high risk for moral distress...
March 2, 2017: Worldviews on Evidence-based Nursing
https://www.readbyqxmd.com/read/28248417/biology-of-falls-preliminary-cohort-study-suggesting-a-possible-role-for-oxidative-stress
#13
Joe Verghese, Emmeline Ayers
BACKGROUND: Biological underpinnings of falls in older adults are not well established. OBJECTIVES: To examine the validity of selected oxidative stress and inflammatory biomarkers for predicting incident falls in community-dwelling older adults. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: 266 non-demented and ambulatory community-dwelling older adults (mean age 78 years, 55% women). MEASUREMENTS: Oxidative stress (malondialdehyde) and inflammatory (interleukin-6 [IL-6]) biomarkers were selected based on associations with fall risk factors, and values were log-transformed to account for non-normal distributions...
March 1, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28238289/challenges-to-safe-injection-practices-in-ambulatory-care
#14
Laura Anderson, Benjamin Weissburg, Kelli Rogers, Jackson Musuuza, Nasia Safdar, Daniel Shirley
Most recent infection outbreaks caused by unsafe injection practices in the United States have occurred in ambulatory settings. We utilized direct observation and a survey to assess injection practices at 31 clinics. Improper vial use was observed at 13 clinics (41.9%). Pharmacy support and healthcare worker education may improve injection practices. Infect Control Hosp Epidemiol 2017;1-3.
February 27, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28223781/factors-influencing-the-exit-knowledge-of-patients-for-dispensed-drugs-at-outpatient-pharmacy-of-hiwot-fana-specialized-university-hospital-eastern-ethiopia
#15
Nigatu Hirko, Dumessa Edessa
BACKGROUND: A satisfactory counseling process between the patient and pharmacist is critical for rational use of dispensed drug(s) and is highly influenced by many factors including the experience of pharmacist in dispensing process. To improve patients' knowledge of dispensed drugs, it is necessary to understand the factors that optimize a pharmacist interaction with a patient in each activity of the dispensing process. Therefore, the aim of this study was to identify the pharmacist and patient factors that influence knowledge of dispensed drugs by ambulatory patients at Hiwot Fana Specialized University Hospital, Harar, Ethiopia...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28222647/medication-literacy-status-of-outpatients-in-ambulatory-care-settings-in-changsha-china
#16
Feng Zheng, Siqing Ding, Aijing Luo, Zhuqing Zhong, Yinglong Duan, Zhiying Shen
Objective To assess medication literacy status and to examine risk factors of inadequate medication literacy of outpatients in ambulatory care settings. Methods Study participants were recruited randomly from outpatient departments in four tertiary hospitals (Xiangya Hospital of Central South University, Second Xiangya Hospital of Central South University, Third Xiangya Hospital of Central South University, People's Hospital of Hunan Province) in Changsha, Hunan, China, between October 2014 and January 2015...
February 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28201956/hiv-screening-and-the-affordable-care-act
#17
Greg Carter, Christopher Owens, Hsien-Chang Lin
Men continue to bear disproportionate accounts of HIV diagnoses. The Patient Protection and Affordable Care act aims to address health care disparities by recommending preventative services, including HIV screening, expanding community health centers, and increasing the healthcare workforce. This study examined the decision making of physician and primary care health providers to provide HIV screenings. A quasi-experimental design was used to estimate the effects of the Affordable Care Act on provider-initiated HIV screening...
March 2017: American Journal of Men's Health
https://www.readbyqxmd.com/read/28192580/a-brief-resolved-unexplained-event-and-congenital-neurosyphilis
#18
Justin Triemstra, Kelsey Reno, Rebecca Chohlas-Wood, Colleen Nash
Brief resolved unexplained event (BRUE) is a common pediatric problem that presents to ambulatory and emergency settings. Infants presenting with a BRUE can be separated into low- and high-risk groups per recent guidelines. Most low-risk infants who present with a BRUE can be discharged home with anticipatory guidance and education provided to the caregivers; however, high-risk infants should undergo further testing and observation to determine the cause of their event. Congenital neurosyphilis can be a rare cause of a BRUE...
February 1, 2017: Pediatric Annals
https://www.readbyqxmd.com/read/28187730/adherence-to-treatment-guidelines-the-association-between-stroke-risk-stratified-comparing-chads2-and-cha2ds2-vasc-score-levels-and-warfarin-prescription-for-adult-patients-with-atrial-fibrillation
#19
Scott A Chapman, Catherine A St Hill, Meg M Little, Michael T Swanoski, Shellina R Scheiner, Kenric B Ware, M Nawal Lutfiyya
BACKGROUND: Ischemic stroke is a risk associated with atrial fibrillation (AF) and is estimated to occur five times more often in afflicted patients than in those without AF. Anti-thrombotic therapy is recommended for the prevention of ischemic stroke. Risk stratification tools, such as the CHADS2, and more recently the CHA2DS2-VASc, for predicting stroke in patients with AF have been developed to determine the level of stroke risk and assist clinicians in the selection of antithrombotic therapy...
February 11, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28152808/ambulatory-redesign-strategies-for-quality-improvement-in-patient-care
#20
Catherine A Lyons, Nancy Smith, Maureen McGlennon, Terri L Parker, Carolyn Truini, Maureen Major-Campos, Jill Lacy, Karen Michaels, Vanna Dest, Richard Lisitano, Kerin B Adelson, Rogerio Lilenbaum
85 Background: Growing outpatient volume poses patient flow challenges, making it difficult to accommodate the complexities of academic medical practice. Volume increases create operational inefficiencies like delays in lab turnaround time (TAT) and limited rooming capacity resulting in delays in patient access and reduced provider productivity. These bottlenecks negatively impact patient satisfaction. METHODS: Four multidisciplinary teams assessed barriers to patient flow in the lab, rooming and scheduling process...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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