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Ambulatory education

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https://www.readbyqxmd.com/read/28439357/resident-dyads-providing-transition-care-to-adolescents-and-young-adults-with-chronic-illnesses-and-neurodevelopmental-disabilities
#1
Richard J Chung, Joan Jasien, Gary R Maslow
BACKGROUND: Youth with special health care needs often experience difficulty transitioning from pediatric to adult care. These difficulties may derive in part from lack of physician training in transition care and the challenges health care providers experience establishing interdisciplinary partnerships to support these patients. OBJECTIVE: This educational innovation sought to improve pediatrics and adult medicine residents' interdisciplinary communication and collaboration...
April 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28439353/improving-timely-resident-follow-up-and-communication-of-results-in-ambulatory-clinics-utilizing-a-web-based-audit-and-feedback-module
#2
Joel C Boggan, Aparna Swaminathan, Samantha Thomas, David L Simel, Aimee K Zaas, Jonathan G Bae
BACKGROUND: Failure to follow up and communicate test results to patients in outpatient settings may lead to diagnostic and therapeutic delays. Residents are less likely than attending physicians to report results to patients, and may face additional barriers to reporting, given competing clinical responsibilities. OBJECTIVE: This study aimed to improve the rates of communicating test results to patients in resident ambulatory clinics. METHODS: We performed an internal medicine, residency-wide, pre- and postintervention, quality improvement project using audit and feedback...
April 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28437218/patient-physician-and-practice-characteristics-associated-with-cardiovascular-disease-preventive-care-for-women
#3
Caress A Dean, Lauren D Arnold, Paul J Hauptman, Jing Wang, Keith Elder
BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death for American women. Although CVD preventive care has the potential to reduce a significant number of these deaths, the degree to which healthcare providers deliver such care is unknown. The purpose of this study was to identify patient, physician, and practice characteristics that significantly influence the provision of CVD preventive care during ambulatory care visits for female patients. METHODS: The National Ambulatory Medical Care Survey datasets from 2005 to 2010 were utilized...
February 27, 2017: Journal of Women's Health
https://www.readbyqxmd.com/read/28434459/becoming-parent-and-nurse-high-fidelity-simulation-in-teaching-ambulatory-central-line-infection-prevention-to-parents-of-children-with-cancer
#4
Carol E Heiser Rosenberg, Mary F Terhaar, Judith A Ascenzi, Anna Walbert, K Michelle Kokoszka, Julianne S Perretta, Marlene R Miller
BACKGROUND: Ambulatory central-line infections in children with cancer are life-threatening. Infections are two to three times more frequent in outpatients than inpatients, for whom evidence-based bundles have decreased morbidity. Most cancer care now takes place at home, where parents perform many of the same tasks as nurses. However, parents often feel stressed and unprepared. To address this, high-fidelity simulation, which has been effective for teaching novice nurses, was evaluated for parent central-line education...
May 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28434454/measuring-to-improve-medication-reconciliation-in-a-large-subspecialty-outpatient-practice
#5
Elizabeth Kern, Meg B Dingae, Esther L Langmack, Candace Juarez, Gary Cott, Sarah K Meadows
BACKGROUND: To assess performance in medication reconciliation (med rec)-the process of comparing and reconciling patients' medication lists at clinical transition points-and demonstrate improvement in an outpatient setting, sustainable and valid measures are needed. METHODS: An interdisciplinary team at National Jewish Health (Denver) attempted to improve med rec in an ambulatory practice serving patients with respiratory and related diseases. Interventions, which were aimed at physicians, nurses (RNs), and medical assistants, involved changes in practice and changes in documentation in the electronic health record (EHR)...
May 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28425295/provider-and-patient-determinants-of-generic-levothyroxine-prescribing-an-electronic-health-records-based-study
#6
Robert J Romanelli, Vani Nimbal, Sarah K Dutcher, Xia Pu, Jodi B Segal
BACKGROUND: Despite the availability of generic levothyroxine products for more than a decade, uptake of these products is poor. OBJECTIVE: We sought to evaluate determinants of generic prescribing of levothyroxine. METHODS: In a cross-sectional analysis of electronic health records data between 2010 and 2013, we identified adult patients with a levothyroxine prescription from a primary-care physician (PCP) or endocrinologist. We used mixed-effect logistic regression models with random intercepts for prescribing provider to examine predictors of generic levothyroxine prescribing...
April 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28419020/education-in-the-waiting-room-description-of-a-pediatric-emergency-department-educational-initiative
#7
Sarah Reid, Gina Neto, Sandy Tse, Ken J Farion, Ariyan Marvizi, Lauren Smith, Chantalle Clarkin, Kristina Rohde, Katherine Moreau
OBJECTIVE: The aim of this study was to understand parents' awareness of and reactions to a slide presentation based waiting-room educational initiative. METHODS: This was a prospective observational study at a Canadian tertiary-care pediatric emergency department (ED) with an annual census of 68,000 visits. An anonymous parental survey was developed de novo, and parents were asked to complete the survey during their low-acuity ED visit over a 2-week study period...
April 18, 2017: Pediatric Emergency Care
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
#8
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/28401027/beneficial-effects-of-childhood-selective-dorsal-rhizotomy-in-adulthood
#9
T S Park, Caleb Edwards, Jenny L Liu, Deanna M Walter, Matthew B Dobbs
 Selective dorsal rhizotomy (SDR) has been used to treat children with spastic cerebral palsy (CP) for over three decades. However, little is known about the outcomes of childhood SDR in adults.  Objectives: 1) To study the effects of childhood SDR on the quality of life and ambulatory function in adult life. 2) To determine late side effects of SDR in adults.   Methods: Adults (> 17.9 years) who underwent SDR in childhood (2 - 17.9 years) between 1987 and 2013 were surveyed in 2015. Patients completed a survey, including questions on demographic information, quality of life, health, surgical outcomes, motor function, manual ability, pain, braces/orthotics, post-SDR treatment, living situation, education level, work status, and side effects of SDR...
March 5, 2017: Curēus
https://www.readbyqxmd.com/read/28391289/sleep-to-lower-elevated-blood-pressure-a-randomized-controlled-trial-slept
#10
Emer R McGrath, Colin A Espie, Alice Power, Andrew W Murphy, John Newell, Caroline Kelly, Niamh Duffy, Patricia Gunning, Irene Gibson, Sophie Bostock, Martin J O'Donnell
BACKGROUND: Impaired sleep quality is common and associated with an increased risk of cardiovascular disease (CVD), thought to be mediated through adverse effects on established vascular risk factors, particularly hypertension. We determined if a web-delivered sleep intervention (sleep-hygiene education, stimulus control, and cognitive behavioral therapy) reduces blood pressure compared to vascular risk factor education (standard care) alone. METHODS: Phase II randomized, blinded, controlled trial of 134 participants without CVD with mild sleep impairment and blood pressure 130-160/<110 mm Hg...
March 1, 2017: American Journal of Hypertension
https://www.readbyqxmd.com/read/28379934/electronic-medical-records-medical-students-and-ambulatory-family-physicians-a-multi-institution-study
#11
Jordan White, David Anthony, Vince WinklerPrins, Steven Roskos
PURPOSE: Medical students commonly encounter electronic medical records (EMRs) in their ambulatory family medicine clerkships, but how students interact with this technology varies tremendously and presents challenges to students and preceptors. Little research to date has evaluated the impact of EMRs on medical student education in the ambulatory setting; this three-institution study aimed to identify behaviors of ambulatory family medicine preceptors as they relate to EMRs and medical students...
April 4, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28369293/report-on-mortality-from-gluteal-fat-grafting-recommendations-from-the-aserf-task-force
#12
M Mark Mofid, Steven Teitelbaum, Daniel Suissa, Arturo Ramirez-Montañana, Denis C Astarita, Constantino Mendieta, Robert Singer
Background: Gluteal fat grafting is among the fastest growing aesthetic procedures in the United States and around the world. Given numerous anecdotal and published reports of fatal and nonfatal pulmonary fat embolism resulting from this procedure, the Aesthetic Surgery Education and Research Foundation (ASERF) formed a Task Force to study this complication. Objectives: To determine the incidence of fatal and nonfatal pulmonary fat embolism associated with gluteal fat grafting and provide recommendations to decrease the risks of the procedure...
March 21, 2017: Aesthetic Surgery Journal
https://www.readbyqxmd.com/read/28364457/sleep-wake-concordance-in-couples-is-inversely-associated-with-cardiovascular-disease-risk-markers
#13
Heather E Gunn, Daniel J Buysse, Karen A Matthews, Christopher E Kline, Matthew R Cribbet, Wendy M Troxel
Aim: To determine whether interdependence in couples' sleep (sleep-wake concordance i.e., whether couples are awake or asleep at the same time throughout the night) is associated with two markers of cardiovascular disease (CVD) risk, ambulatory blood pressure (BP) and systemic inflammation. Methods: This community-based study is a cross-sectional analysis of 46 adult couples, aged 18-45 years, without known sleep disorders. Percent sleep-wake concordance, the independent variable, was calculated for each individual using actigraphy...
January 1, 2017: Sleep
https://www.readbyqxmd.com/read/28351062/using-national-health-care-databases-and-problem-based-practice-analysis-to-inform-integrated-curriculum-development
#14
Amy J Baker, Mark R Raymond, Steven A Haist, John R Boulet
One challenge when implementing case-based learning, and other approaches to contextualized learning, is determining which clinical problems to include. This article illustrates how health care utilization data, readily available from the National Center for Health Statistics (NCHS), can be incorporated into an educational needs assessment to identify medical problems physicians are likely to encounter in clinical practice. The NCHS survey data summarize patient demographics, diagnoses, and interventions for tens of thousands of patients seen in various settings, including emergency departments (EDs), clinics, and hospitals...
April 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28347984/trends-in-the-diagnosis-and-management-of-hypertension-repeated-primary-care-survey-in-south-west-england
#15
Natasha Mejzner, Christopher E Clark, Lindsay Fp Smith, John L Campbell
BACKGROUND: Previous surveys identified a shift to nurse-led care in hypertension in 2010. In 2011 the National Institute for Health and Care Excellence (NICE) recommended ambulatory (ABPM) or home (HBPM) blood pressure (BP) monitoring for diagnosis of hypertension. AIM: To survey the organisation of hypertension care in 2016 to identify changes, and to assess uptake of NICE diagnostic guidelines. DESIGN AND SETTING: Questionnaires were distributed to all 305 general practices in South West England...
March 27, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/28340230/determinants-of-opioid-prescribing-for-nonmalignant-chronic-pain-in-us-outpatient-settings
#16
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
#17
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)...
April 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28295871/promoting-resource-stewardship-reducing-inappropriate-free-thyroid-hormone-testing
#18
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
#19
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
#20
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
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