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Ambulatory education

Robert J Fortuna, Lynn Garfunkel, Michael D Mendoza, Megan Ditty, Julia West, Karen Nead, Brett W Robbins
BACKGROUND : Continuity of care is a critical element of residents' educational experience in primary care programs. OBJECTIVE : We examined how continuity in resident practices compares to nonteaching practices, identified factors associated with increased continuity, and explored the association between continuity and quality measures. METHODS : We analyzed 117 235 patient visits to 4 resident practices (26 resident teams in internal medicine, pediatrics, family medicine, and medicine-pediatrics) and 270 242 visits to nonteaching community practices between July 2013 and May 2014...
October 2016: Journal of Graduate Medical Education
M B D'hooghe, P Haentjens, A Van Remoortel, J De Keyser, G Nagels
OBJECTIVES: The purpose of our study is to investigate whether socioeconomic indicators such as education, financial concerns, employment, and living status are associated with disease progression in relapsing-onset and progressive-onset Multiple Sclerosis (MS). MATERIALS AND METHODS: We performed a cross-sectional survey among individuals with MS, registered by the Flemish MS society and included socioeconomic indicators. A Cox proportional hazard regression was performed with the time from MS onset and from birth to reach an ambulatory disability milestone corresponding to Expanded Disability Status Scale (EDSS) 6 (requiring a cane) as outcome measure, adjusted for gender, age at MS onset, and immunomodulatory treatment...
December 2016: Acta Neurologica Scandinavica
Bayan Sharif-Chan, Dipti Tankala, Christine Leong, Zubin Austin, Marisa Battistella
Objective. To compare peer teaching in a medical and a pharmacy clinical teaching unit and to provide suggestions for future research in pharmacy near-peer teaching. Methods. This exploratory observational study used principles of ethnographic methodology for data collection and analysis. Observations were collected in a large downtown teaching hospital. An average of 4-6 hours per day were spent observing a team of medical trainees from the Faculty (School) of Medicine in the general internal medicine (unit for two weeks, followed by a team of pharmacy trainees in an ambulatory hemodialysis (HD) unit for two weeks...
September 25, 2016: American Journal of Pharmaceutical Education
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
Adel Berbari
The Middle East Region is undergoing a transition from communicable to non-communicable disease. Although the population is to a large extent young, there is also an increasing number of elderly people due to improved health care facilities and socioeconomic status. Similar to developing countries, there is a high burden of cardiovascular risk factors.Hypertension, a major cause of increased morbidity and mortality from cardiovascular events, is quite prevalent, varying from 25-40%, associated with an increased prevalence of obesity, diabetes mellitus and high salt intake...
September 2016: Journal of Hypertension
Anita Mohandas, Chris Summa, W Bradley Worthington, Jason Lerner, Kevin T Foley, Robert J Bohinski, Gregory B Lanford, Carol Holden, Richard N W Wohns
STUDY DESIGN: Delphi Panel expert panel consensus and narrative literature review OBJECTIVE.: To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR)). SUMMARY OF BACKGROUND DATA: Spine surgery in ambulatory settings is becoming a preferred option for both patients and providers. The transition from traditional inpatient environments has been enabled by innovation in anesthesia protocols and surgical technique, as well as favorable economics...
October 6, 2016: Spine
Mark Xavier Cicero, Travis Whitfill, Frank Overly, Janette Baird, Barbara Walsh, Jorge Yarzebski, Antonio Riera, Kathleen Adelgais, Garth D Meckler, Carl Baum, David Christopher Cone, Marc Auerbach
OBJECTIVE: Paramedics and emergency medical technicians (EMTs) triage pediatric disaster victims infrequently. The objective of this study was to measure the effect of a multiple-patient, multiple-simulation curriculum on accuracy of pediatric disaster triage (PDT). METHODS: Paramedics, paramedic students, and EMTs from three sites were enrolled. Triage accuracy was measured three times (Time 0, Time 1 [two weeks later], and Time 2 [6 months later]) during a disaster simulation, in which high and low fidelity manikins and actors portrayed 10 victims...
October 17, 2016: Prehospital Emergency Care
S Seidu, D H Bodicoat, M J Davies, H Daly, B Stribling, A Farooqi, E M Brady, K Khunti
: Diabetes is an ambulatory care-sensitive condition and a high quality primary care or risk factor control can lead to a decrease in the risk of non-elective hospitalisations while ensuring continuity of care with usual primary care teams. AIMS AND METHODS: In this before and after study, eight primary care practices providing a newer enhanced diabetes model of care in Leicester UK, were compared with matched neighbouring practices with comparable demographic features providing a more expensive integrated specialist-community care diabetes service...
October 10, 2016: Primary Care Diabetes
Ken Nash, Frank Ghinassi, Jaspreet S Brar, Abdulkader Alam, Mary Catherine Bohan, Kalyani Gopalan, Amie Carter, K N Roy Chengappa
OBJECTIVES: 1. A quality performance improvement (QI) project to implement an electronic screening and monitoring tool to record components of the metabolic syndrome (e-MSD) during clinic visits by persons with serious mental illness (SMI). 2. To encourage psychiatrists to use this tool in their documentation. METHODS: Working with the information technology staff, five psychiatrists developed, tested, revised and embedded the e-MSD tool into the medication management document within the electronic health record...
2016: Clinical Schizophrenia & related Psychoses
Mohammad Mahdi Parvizi, Mitra Amini, Mohammad Reza Dehghani, Peyman Jafari, Zahra Parvizi
PURPOSE: Evaluation is the main component in design and implementation of educational activities and rapid growth of educational institution programs. Outpatient medical education and clinical training environment is one of the most important parts of training of medical residents. This study aimed to determine the validity and reliability of the Persian version of Ambulatory Care Learning Educational Environment Measure (ACLEEM) questionnaire, as an instrument for assessment of educational environments in residency medical clinics...
2016: Advances in Medical Education and Practice
Sophie Palmer, Jessica Pudwell, Graeme N Smith, Robert L Reid
OBJECTIVE: To obtain information on women's attitudes and opinions about participation in vaccine and medication trials during pregnancy. METHODS: A quantitative, cross-sectional survey was administered to 110 consenting women over a four-week period in the waiting room of an ambulatory obstetrics and gynaecology clinic in Ontario. RESULTS: The final response rate was 74.8%, with the majority of participants agreeing with statements about the importance of obtaining safety data about products in pregnancy and the importance of a woman having the ability to choose whether to participate in such research...
October 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
H Roux, A Ali, S Lambert, L Radon, C Huas, F Curt, S Berthoz, Nathalie Godart
BACKGROUND: Patients with severe Anorexia Nervosa (AN) whose condition is life-threatening or who are not receiving adequate ambulatory care are hospitalized. However, 40 % of these patients leave the hospital prematurely, without reaching the target weight set in the treatment plan, and this can compromise outcome. This study set out to explore factors predictive of dropout from hospital treatment among patients with AN, in the hope of identifying relevant therapeutic targets. METHODS: From 2009 to 2011, 180 women hospitalized for AN (DSM-IV diagnosis) in 10 centres across France were divided into two groups: those under 18 years (when the decision to discharge belongs to the parents) and those aged 18 years and over (when the patient can legally decide to leave the hospital)...
September 30, 2016: BMC Psychiatry
Sarah M Alyousif, Ahmed A Alsaileek
BACKGROUND: Atrial fibrillation (AF) is the most common chronic rhythm disorder. Patients with AF are at an increased risk of ischemic stroke. Therefore, optimal anticoagulation is essential to reduce the risk of stroke. The aim of this study was to assess the level of anticoagulation control achieved in patients with nonvalvular AF receiving medical care in a tertiary care hospital. METHODS: This was a retrospective cohort study in ambulatory care clinics at tertiary care hospital in Saudi Arabia...
October 2016: Journal of the Saudi Heart Association
Seema R Khurana, Alexandria G Beranger, Elizabeth R Felix
OBJECTIVE: This study investigates the direct comparison of energy cost, efficiency, and effort between an ankle-foot orthosis (AFO) and a functional electrical stimulation (FES) device for foot drop in ambulatory patients with multiple sclerosis. DESIGN: Twenty adults (32-74 years old; 55% female) with a diagnosis of multiple sclerosis resulting in foot drop participated in a crossover, counterbalanced preliminary study. Each participant was tested on different days, with each session consisting of a separate walk trial per prosthetic device...
September 26, 2016: American Journal of Physical Medicine & Rehabilitation
Taeho Greg Rhee, Roni L Evans, Donna D McAlpine, Pamela Jo Johnson
OBJECTIVES: To examine the prevalence of complementary and alternative medicine (CAM) use by race/ethnicity and to identify sociodemographic and health-related factors associated with CAM use among US adults with moderate mental distress (MMD). METHODS: We analyzed data from the 2012 National Health Interview Survey (NHIS). We used data for 6016 noninstitutionalized US adults with MMD (3492 non-Hispanic whites, 953 non-Hispanic blacks, 1078 Hispanics, 268 Asians, and 225 others consisted of American Indian, Alaska Native, and those reporting multiple races)...
September 27, 2016: Journal of Primary Care & Community Health
Paula A M Weigel, Fred Ullrich, Marcia M Ward
PURPOSE: Rural bypass for elective surgical procedures is a challenge for critical access hospitals, yet there are opportunities for rural hospitals to improve local retention of surgical candidates through alternative approaches to developing surgery lines of business. In this study we examine the effect of visiting surgical specialists on the odds of rural bypass. METHODS: Discharge data from the 2011 State Inpatient Databases and State Ambulatory Surgery Databases for Iowa were linked to outreach data from the Office of Statewide Clinical Education Programs and Iowa Physician Information System to model the effect of surgeon specialist supply on rural patients' decision to bypass rural critical access hospitals...
September 28, 2016: Journal of Rural Health
Capucine de Lattre
The regional health network for children and teenagers with disabilities in Rhône-Alpes (R4P) was created in 2007 with the objective of the amelioration of the quality of care. The main projects of the R4P concern training, harmonization of care, communication and research. R4P, as a health network for children with disabilities has two particularities: first, it concerns all type of disabilities, considering that families encounter the same kind of difficulties. Secondly, it includes all types of professionals concerned by children with disabilities: health care professionals of hospital and ambulatory care, social workers, administrations, and education professionals...
September 2016: Annals of Physical and Rehabilitation Medicine
David J T Campbell, Marcello Tonelli, Brenda Hemmelgarn, Chad Mitchell, Ross Tsuyuki, Noah Ivers, Tavis Campbell, Raj Pannu, Eric Verkerke, Scott Klarenbach, Kathryn King-Shier, Peter Faris, Derek Exner, Vikas Chaubey, Braden Manns
BACKGROUND: Chronic diseases result in significant morbidity and costs. Although medications and lifestyle changes are effective for improving outcomes in chronic diseases, many patients do not receive these treatments, in part because of financial barriers, patient and provider-level knowledge gaps, and low patient motivation. The Assessing outcomes of enhanced chronic disease care through patient education and a value-based formulary study (ACCESS) will determine the impact of two interventions: (1) a value-based formulary which eliminates copayment for high-value preventive medications; and (2) a comprehensive self-management support program aimed at promoting health behavior change and medication adherence, combined with relay of information on medication use to healthcare providers, on cardiovascular events and/or mortality in low-income seniors with elevated cardiovascular risk...
September 26, 2016: Implementation Science: IS
Rodolfo Savica, Alexandra M V Wennberg, Clinton Hagen, Kelly Edwards, Rosebud O Roberts, John H Hollman, David S Knopman, Bradley F Boeve, Mary M Machulda, Ronald C Petersen, Michelle M Mielke
BACKGROUND: Previous studies reported that slower gait speed might predict cognitive impairment and dementing illnesses, supporting the role of gait speed as a possible subclinical marker of cognitive impairment. However, the predictive value of other gait parameters for cognitive decline is unclear. OBJECTIVE: To investigate and compare the association with, and prediction of, specific gait parameters for cognition in a population-based sample. METHODS: The analysis included 3,426 cognitively normal participants enrolled in the Mayo Clinic Study of Aging...
September 23, 2016: Journal of Alzheimer's Disease: JAD
Richard E Deichmann, Michael D Morledge, Robin Ulep, Johnathon P Shaffer, Philippa Davies, Mieke L van Driel
BACKGROUND: Inadequate patient adherence to a medication regimen is a major factor in the lack of success in treating hyperlipidemia. Improved adherence rates may result in significantly improved cardiovascular outcomes in populations treated with lipid-lowering therapy. The purpose of this metaanalysis was to evaluate the effectiveness of interventions aimed at improving adherence to lipid-lowering drugs, focusing on measures of adherence and clinical outcomes. METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases through January 14, 2015, and also used the results from previous Cochrane reviews of this title...
2016: Ochsner Journal
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