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Ambulatory education

Christine N Runyan
The New England Journal of Medicine Catalyst recently published an article entitled "It's Time to Treat Physical and Mental Health With Equal Intent" (Compton-Phillips & Mohta, 2018). The article describes a survey of the NEJM Catalyst Insights Council, a qualified group ( n =565) of U.S. executives, clinical leaders, and clinicians who are directly involved in health care delivery. Ninety nine percent of council members responded that mental health should not only be integrated into ambulatory medical care settings but also embrace a "shared concept of mutual responsibility" (p...
June 2018: Families, Systems & Health: the Journal of Collaborative Family Healthcare
Gary L Beck Dallaghan, Joy Higgins, Adam Reinhardt
Background: Direct observations with focused feedback are critical components for medical student education. Numerous challenges exist in providing useful comments to students during their clerkships. Students' evaluations of the clerkship indicated they were not receiving feedback from preceptors or house officers. Objective: To encourage direct observation with feedback, Structured Patient Care Observation (SPCO) forms were used to evaluate third-year medical students during patient encounters...
January 2018: Journal of Medical Education and Curricular Development
Christian von Kiel, Matthias Dreher, Konstantinos Triantafyllias, Peter Heinz, Andreas Schwarting
BACKGROUND: Giant cell arteritis (GCA) is one of the most common forms of inflammatory vasculitis in older patients. Because of possible irreversible vision deterioration, a fastest possible diagnosis and therapy is of absolute importance. To date, there are still no reliable data to obtain an initial assessment of the outpatient health care situation of patients diagnosed with GCA in Rhineland-Palatinate. METHODS: The specialists (neurologists, rheumatologists, ophthalmologists and general practitioners) participating in the statewide rheumatology network ADAPTHERA were questioned with the help of a questionnaire regarding disease frequency, activity, drug therapy and possible comorbidities...
June 4, 2018: Zeitschrift Für Rheumatologie
Carolina Almeida, Vânia Vieira Borba, Lèlita Santos
PURPOSE: Orthorexia Nervosa (ON) is described as an obsessive behaviour motivated by great concern for following a healthy diet. Although it was first described in 1997, ON remains inconspicuous and poorly characterized in the literature. The aims of this study were to evaluate the prevalence of ON in a sample of ambulatory individuals and to investigate their common characteristics, attempting to better characterize this entity. METHODS: A non-random sample of 193 adult gym members answered a questionnaire based on a Portuguese version of ORTO-15, supplemented with additional questions...
May 28, 2018: Eating and Weight Disorders: EWD
Brianna K Crawley, Salem Dehom, Cedric Thiel, Jin Yang, Andrea Cragoe, Iman Mousselli, Priya Krishna, Thomas Murry
Importance: An aging population experiences an increase in age-related problems, such as presbyphonia. The causes of pathologic presbyphonia are incompletely understood. Objective: To determine what distinguishes pathologic presbyphonia from presbylaryngis. Design, Setting, and Participants: This was a cohort study at an outpatient otolaryngology subspecialty clinic of a tertiary academic referral center. Participants were consecutive consenting adults older than 74 years without laryngeal pathologic abnormalities who visited the clinic as participants or companions...
May 17, 2018: JAMA Otolaryngology—Head & Neck Surgery
Justine M Naylor, Natasha Pocovi, Joseph Descallar, Kathryn A Mills
OBJECTIVE: This study aimed to describe the: rates of participation in regular physical activity (PA) pre- and 3-years following knee or hip arthroplasty; factors associated with participation post-surgery; and types of activity undertaken. METHODS: A previously acquired, multicentre, prospective cohort of knee or hip arthroplasty recipients was followed-up 3-years post-surgery. Regular participation in PA was defined as participation in PA ≥1 times/week, excluding incidental activities...
May 25, 2018: Arthritis Care & Research
Carma Ayala, Jing Fang, Cecily Luncheon, Sallyann Coleman King, Tiffany Chang, Matthew Ritchey, Fleetwood Loustalot
Stroke is a leading cause of mortality and disability in the United States (1,2). Approximately 800,000 American adults experience a stroke each year (2,3). Currently, approximately 6 million stroke survivors live in the United States (2). Participation in stroke rehabilitation (rehab), which occurs in diverse settings (i.e., in-hospital, postacute care, and outpatient settings), has been determined to reduce stroke recurrence and improve functional outcomes and quality of life (3,4). Despite longstanding national guidelines recommending stroke rehab, it remains underutilized, especially in the outpatient setting...
May 25, 2018: MMWR. Morbidity and Mortality Weekly Report
Robert Rope, Nishantha Nanayakkara, Abdul Wazil, Sewmini Dickowita, Rajitha Abeyeskera, Lishanthe Gunerathne, Dinuka Adoosoriya, Nishamani Karunasena, Charaka Ratnayake, Shuchi Anand, Anjali Saxena
BACKGROUND: Despite growing need, treatment for end-stage renal disease is limited in low- and middle-income countries due to resource restraints. We describe the development of an educational curriculum and quality improvement program to support continuous ambulatory peritoneal dialysis (CAPD) performed primarily by non-nephrology providers in Sri Lanka. METHODS: We developed a program of education, outcome tracking, and expert consultation to support providers in Kandy, Sri Lanka...
May 23, 2018: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Macda Gerard, Hannah Chimowitz, Alan Fossa, Fabienne Bourgeois, Leonor Fernandez, Sigall K Bell
BACKGROUND: OpenNotes, a national initiative to share clinicians' visit notes with patients, can improve patient engagement, but effects on vulnerable populations are not known very well. OBJECTIVE: Our aim is to examine the importance of visit notes to nonwhite and less educated patients. METHODS: Patients at an urban academic medical center with an active patient portal account and ≥1 available ambulatory visit note over the prior year were surveyed during June 2016 until September 2016...
May 24, 2018: Journal of Medical Internet Research
O Ayach, G Sarlon Bartoli, F Silhol, C Demari, B Vaïsse
OBJECTIVE: The evaluation of automated office blood pressure (AOBP) measurement compared to 24-hour ambulatory BP monitoring (ABPM), Home BP measurement and manual BP. PATIENTS AND METHODOLOGY: A total of 123 hypertensive patients were included. Overall, 68 completed the 4 measurement: Manual BP in the office (Omron 705 CP 3 measurements), ABPM (Spacelab of 96 measurement/per 24hours), Home BP (18 measurement during 3 days), AOBP using the SPRINT methodology: lying patient, isolated with an automatic measurement (Dinamap) every minutes during 8minutes (average of the last 3 measurement)...
May 21, 2018: Annales de Cardiologie et D'angéiologie
Verena Brekle, Christel Weiß, Zvonimir Kolobaric, Claudia Schulz-Weidhaas, Roger Vogelmann
BACKGROUND: Globalization and climate change increase the likelihood of a global spread of high consequence infectious diseases. OBJECTIVES: We analyzed how outpatient physicians in Germany were prepared to recognize and handle potential Ebola virus-infected patients during the recent Ebola outbreak in West Africa. MATERIALS AND METHODS: Outpatient physicians participated in 2 anonymous surveys (n=166 and 129, respectively) and were asked, among others, about their knowledge of Ebola virus disease, their subjective perception of their own knowledge and the practical implementation in their daily routine...
May 22, 2018: Das Gesundheitswesen
Sigall K Bell, Patricia Folcarelli, Alan Fossa, Macda Gerard, Marvin Harper, Suzanne Leveille, Caroline Moore, Kenneth E Sands, Barbara Sarnoff Lee, Jan Walker, Fabienne Bourgeois
BACKGROUND: Ambulatory safety risks including delayed diagnoses or missed abnormal test results are difficult for clinicians to see, because they often occur in the space between visits. Experts advocate greater patient engagement to improve safety, but strategies are limited. Patient access to clinical notes ("OpenNotes") may help close the safety gap between visits. METHODS: We surveyed patients and families who logged on to the patient portal and had at least one ambulatory note available in the past 12 months at two academic hospitals during June to September 2016, focusing on patient-reported effects of OpenNotes on safety knowledge, behaviors, and attitudes...
April 27, 2018: Journal of Patient Safety
(no author information available yet)
The definition of ambulatory surgery is that the patient is admitted, operated and discharged within a day (24 hours) , but does not include outpatient surgery. It can shorten the average hospital stay, reduce medical expenses, accelerate the recovery of patients, and has been approved to have great social and economic benefits.The main contents of this consensus include: (1)the establishment of ambulatory biliary surgery system, which involves the facilities building, team building, the construction of management systems, operation management, operation state analysis and benefit evaluation; (2)Patient selection criteria, pre-hospital assessment, surgical scheduling, preoperative education, anesthesia and management of adverse reactions after anesthesia, intraoperative application of general surgical principles and postoperative emergency plans, perioperative nursing; (3)Discharge criteria and pre-discharge assessment, post-discharge follow-up and rehabilitation guidance; (4) quality and safety control index system of ambulatory biliary surgery...
May 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Stephen L Davidow, Jignesh Sheth, Constance S Sixta, Linda Thomas-Hemak
More than 105 million referrals of Medicare beneficiaries to specialists occur annually. Different settings and electronic health records have made care coordination complex. PCPI (formerly American Medical Association-convened Physicians Consortium for Performance Improvement) and The Wright Center for Graduate Medical Education sponsored the Closing the Referral Loop pilot project. Twelve dyads of primary care and specialist physicians sought to improve ambulatory referrals by mapping the referral process, and using care compacts, metrics, and electronic health records...
May 15, 2018: Journal of Ambulatory Care Management
Karla Seaman, Rosemary Saunders, Helen Dugmore, Claire Tobin, Rachel Singer, Fiona Lake
AIM AND OBJECTIVES: To examine students' beliefs, behaviours and attitudes in relation to interprofessional socialisation, and their expectations and experience, before and after a two-week clinical placement in ambulatory care. BACKGROUND: Interprofessional clinical placements for students are important for developing an understanding of interprofessional collaboration and identity, for the benefit of patient care. Ambulatory care environment involves collaborative management of complex chronic problems...
May 12, 2018: Journal of Clinical Nursing
Kathy Goggin, Andrea Bradley-Ewing, Angela L Myers, Brian R Lee, Emily A Hurley, Kirsten B Delay, Sarah Schlachter, Areli Ramphal, Kimberly Pina, David Yu, Kirsten Weltmer, Sebastian Linnemayr, Christopher C Butler, Jason G Newland
INTRODUCTION: Children with acute respiratory tract infections (ARTIs) are prescribed up to 11.4 million unnecessary antibiotic prescriptions annually. Inadequate parent-provider communication is a chief contributor, yet efforts to reduce overprescribing have only indirectly targeted communication or been impractical. This paper describes our multisite, parallel group, cluster randomised trial comparing two feasible interventions for enhancing parent-provider communication on the rate of inappropriate antibiotic prescribing (primary outcome) and revisits, adverse drug reactions and parent-rated quality of shared decision-making, parent-provider communication and visit satisfaction (secondary outcomes)...
May 9, 2018: BMJ Open
Sara C Keller, Pranita D Tamma, Sara E Cosgrove, Melissa A Miller, Heather Sateia, Julie Szymczak, Ayse P Gurses, Jeffrey A Linder
INTRODUCTION: In the United States, most antibiotics are prescribed in ambulatory settings. Human factors engineering, which explores interactions between people and the place where they work, has successfully improved quality of care. However, human factors engineering models have not been explored to frame what is known about ambulatory antibiotic stewardship (AS) interventions and barriers and facilitators to their implementation. METHODS: We conducted a systematic review and searched OVID MEDLINE, Embase, Scopus, Web of Science, and CINAHL to identify controlled interventions and qualitative studies of ambulatory AS and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2...
May 2018: Journal of the American Board of Family Medicine: JABFM
Victoria Tolentino, Elizabeth Unni, Jaime Montuoro, Diane Bezzant-Ogborn, Deanna Kepka
OBJECTIVES: To evaluate Utah community pharmacists' knowledge and attitudes toward recommendation of human papillomavirus (HPV) vaccine, to determine whether the knowledge and attitude of pharmacists regarding the HPV vaccine influence their recommendation behaviors, and to capture any self-identified barriers to recommending the HPV vaccine. DESIGN: A cross-sectional anonymous 73-item survey was developed and administered to community, outpatient, and ambulatory care pharmacists...
May 5, 2018: Journal of the American Pharmacists Association: JAPhA
J Stepczynski, S R Holt, M S Ellman, D Tobin, Benjamin R Doolittle
PURPOSE: In recent years, with an increasing emphasis on time spent in ambulatory training, educators have focused attention on improving the residents' experience in continuity clinic. The authors sought to review the factors associated with physician trainee satisfaction with outpatient ambulatory training. METHODS: A systematic literature review was conducted for all English language articles published between January 1980 and December 2016 in relevant databases, including Medline (medicine), CINAHL (nursing), PSYCHinfo (psychology), and the Cochrane Central Register of Controlled Clinical Trials...
May 7, 2018: Journal of General Internal Medicine
Edimar Alcides Bocchi, Fátima das Dores da Cruz, Sara MIchelly Brandão, Victor Issa, Silvia Moreira Ayub-Ferreira, Hans-Peter Brunner-La Rocca, Sandra Sanders-van Wijk
BACKGROUND: Published studies have generated mixed, controversial results regarding the cost-effectiveness of heart failure-disease management programs (HF-DMP). This study assessed the cost-effectiveness of an HF-DMP in ambulatory patients compared with usual care (UC). METHODS: In the prospective, randomized REMADHE trial, we evaluated incremental costs per quality-adjusted life-year (QALY) and life-year (LY) gained as effectiveness ratios (ICERs) over a study period of 2...
April 30, 2018: Journal of Cardiac Failure
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