Potential Side Effects and Adverse Events of Antipsychotic Use for Residents With Dementia in Assisted Living: Implications for Prescribers, Staff, and Families.
dementia; Alzheimer's disease; family; SYMPTOMS; medication; Alzheimer’s disease; assisted living; ALZHEIMERS-DISEASE; BENEFITS; CARE; INVOLVEMENT; MEDICATIONS; MORTALITY; NURSING-HOME RESIDENTS; PREVALENCE; RISK
Antipsychotic medications are frequently prescribed to assisted living (AL) residents who have dementia, although there is a lack of information about the potential side effects and adverse events of these medications among this population. Oversight and monitoring by family members is an important component of AL care, and it is important to understand family awareness of antipsychotic use and reports of potential side effects and adverse events. This cross-sectional, descriptive study of family members of 283 residents with dementia receiving antipsychotic medications in 91 AL communities found high rates (93%) of symptoms that could be potential side effects and a 6% rate of potential adverse events. The majority of families were aware their relative was taking an antipsychotic. Findings suggest that obtaining family perspectives of potential side effects and adverse events related to medication use may contribute to overall improvement in the safety of AL residents living with dementia.
Beeber AS; Zimmerman S; Wretman CJ; Palmertree S; Patel K; Sloane PD
Journal Of Applied Gerontology : The Official Journal Of The Southern Gerontological Society
2021
2021-06-23
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1177/07334648211023678" target="_blank" rel="noreferrer noopener">10.1177/07334648211023678</a>
Medical decision-making in the physician hierarchy: A pilot pedagogical evaluation
education; clinical judgment; medical judgment; simulation; care; decision-making; medical education; students; improve; knowledge retention; medical judgment; Skill retention
Purpose: Recently, the American College of Graduate Medical Education included medical decision-making as a core competency in several specialties. To date, the ability to demonstrate and measure a pedagogical evolution of medical judgment in a medical education program has been limited. In this study, we aim to examine differences in medical decision-making of physician groups in distinctly different stages of their postgraduate career. Methods: The study recruited physicians with a wide spectrum of disciplines and levels of experience to take part in 4 medical simulations divided into 2 categories, abdominal pain (biliary colic [BC] and renal colic [RC]) or chest pain (cardiac ischemia with ST-segment elevation myocardial infarction [STEMI] and pneumothorax [PTX]). Evaluation of medical decision-making used the Medical Judgment Metric (MJM). The targeted selection criteria for the physician groups are administrative physicians (APs), representing those with the most experience but whose current duties are largely administrative; resident physicians (RPs), those enrolled in postgraduate medical or surgical training; and mastery level physicians (MPs), those deemed to have mastery level experience. The study measured participant demographics, physiological responses, medical judgment scores, and simulation time to case resolution. Outcome differences were analyzed using Fisher exact tests with post hoc Bonferroni-adjustedztests and single-factor analysis of variance F tests with post hoc Tukey honestly significant difference, as appropriate. The significance threshold was set atP < .05. Effect sizes were determined and reported to inform future studies. Results: A total of n = 30 physicians were recruited for the study with n = 10 participants in each physician group. No significant differences were found in baseline demographics between groups. Analysis of simulations showed a significant (P = .002) interaction for total simulation time between groups RP: 6.2 minutes (+/- 1.58); MP: 8.7 minutes (+/- 2.46); and AP: 10.3 minutes (+/- 2.78). The AP MJM scores, 12.3 (+/- 2.66), for the RC simulation were significantly (P = .010) lower than the RP 14.7 (+/- 1.15) and MP 14.7 (+/- 1.15) MJM scores. Analysis of simulated patient outcomes showed that the AP group was significantly less likely to stabilize the participant in the RC simulation than MP and RP groups (P = .040). While not significant, all MJM scores for the AP group were lower in the BC, STEMI, and PTX simulations compared with the RP and MP groups. Conclusions: Physicians in distinctly different stages of their respective postgraduate career differed in several domains when assessed through a consistent high-fidelity medical simulation program. Further studies are warranted to accurately assess pedagogical differences over the medical judgment lifespan of a physician.
Rosasco J; McCarroll ML; Gothard MD; Myers Jerry; Hughes P; Schwartz A; George RL; Ahmed RA
Journal of Medical Education and Curricular Development
2020
2020-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1177/2382120520925061" target="_blank" rel="noreferrer noopener">10.1177/2382120520925061</a>
Using the social ecological model to identify drivers of nutrition risk in adult day settings serving East Asian older adults
education; support; united-states; care; impact; guidelines; programs; perspective; community; malnutrition
Adult day care (ADC) centers provide community-based care (including meals) to frail, ethnically diverse older adults, many of whom are at risk for malnutrition. To support the development of interventions to benefit ADC users, the authors aimed to identify barriers and facilitators of healthy nutrition among ADC users born in Vietnam and China. Semi-structured qualitative interviews were conducted among ADC stakeholders to identify barriers and facilitators. Data were analyzed using Braun and Clarke's six-step method and organized within the framework of the Social Ecological Model. Facilitators of good nutrition included adherence to traditional diet at the ADC center, peer networks, and access to ethnic grocers. Poor health, family dynamics, and loneliness all contributed to poor nutrition, as did the restrictive nature of nutrition programs serving ADC users in the United States. Individual, relationship, organizational, community, and policy level factors play a role in ADC users' nutritional status. Targeted nutrition interventions should leverage culturally congruent relationships between ADC users and staff and include advocacy for enhancement of federal programs to support this population.
Sadarangani TR; Johnson JJ; Chong SK; Brody A; Trinh-Shevrin C
Research in Gerontological Nursing
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.3928/19404921-20191210-02" target="_blank" rel="noreferrer noopener">10.3928/19404921-20191210-02</a>
Callitrichid responses to dead and dying infants: the effects of paternal bonding and cause of death.
Animacy detection; care; common marmosets; Dead-infant carrying; Death; female; Infanticide; Marmoset; Quantitative methods; tamarins; Thanatology
Many primates show responses to dead infants, yet testing explanations for these behaviors has been difficult. Callitrichids present a unique opportunity to delineate between hypotheses, since unlike most species, male caretakers form closer social bonds with infants than mothers. Callitrichids are also known to commit infanticide, leaving obvious wounds that may enable them to more readily recognize death. We present: (1) a case study of a wild common marmoset (Callithrix jacchus) group responding to an infant's natural death, and (2) a review of published infant deaths across callitrichids (N = 16), testing for trends in the sex of reacting individuals and cause of death. In our case study, several group members frequently interacted with the dead infant, attempting to carry it. However, the strongest response was from a male that remained with the corpse for ~ 3 h, despite his group leaving the area. Across callitrichid species, corpse interactions were significantly sex-biased: 100% (N = 6) of accidental deaths involved corpse interaction by males (p = 0.007), compared to 60% (N = 3 of 5) by females (p = 0.095). Cause of death also played a significant role, with individuals attempting to carry dead infants in 100% (N = 6) of accidental deaths, but only 11.1% (N = 1 of 9) of infanticides (p = 0.001). Although the available literature is small and potentially subject to publication biases, these data support the idea that visually obvious wounds may influence callitrichids' perception of dead conspecifics. Additionally, male-biased patterns of corpse interaction in callitrichids indicate that social bonds likely shape reactions to the dead, in addition to kinship. While published data on primate thanatology are limited, this study demonstrates quantitative approaches that can provide empirical insights into primates' responses to dead conspecifics.
Thompson Cynthia L; Hrit Rebecca; Melo Leonardo C O; Vinyard Christopher J; Bottenberg Kimberly N; de Oliveira Maria A B
Primates; journal of primatology
2020
2020-05-14
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1007/s10329-020-00824-3" target="_blank" rel="noreferrer noopener">10.1007/s10329-020-00824-3</a>
Trajectories Of Daily Ptsd Symptoms In Recent Traumatic Injury Victims
assessment; care; checklist pcl; ecological momentary; growth analysis; latent class; posttraumatic stress disorder (PTSD); posttraumatic stress disorder (PTSD); Psychiatry; Psychology; PTSD symptom trajectories; resilience; scale; survivors; traumatic injury
Objective: Prior research has identified different PTSD symptom (PTSS)trajectories over months and years posttrauma that warrant different levels of clinical attention. Earlier identification of at-risk trauma victims can facilitate efficient and appropriate intervention efforts. Method: Using latent class growth analysis, we examined daily PTSS trajectories beginning 6 weeks postinjury in 68 injury victims. Resulting classes were compared on key characteristics at 6 and 21 weeks postinjury. Results: Three trajectories were identified: a nonreactive class (67.8%) with low initial symptom levels that remained low, a moderate-stable class (27.9%) with elevated symptom levels that remained constant, and a severe-increasing class (4.4%) with high symptom levels that increased. Conclusions: High-risk injury victims can be identified by their daily PTSS, allowing for early identification of those at risk for elevated distress and in greater need for intervention.
Hruska B; Pacella M L; George R L; Delahanty D L
Psychological Trauma-Theory Research Practice and Policy
2016
2016-11
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1037/tra0000145" target="_blank" rel="noreferrer noopener">10.1037/tra0000145</a>
Estimating The Cost Of Primary Care Training In Ambulatory Settings
Business & Economics; care; cost and cost analysis; efficiency; Health Care Sciences & Services; medical education; medical-care; primary; selection models; variables
The Balanced Budget Act of 1997 legislated the idea of reimbursing ambulatory sites for training medical professionals. However, very little is known about the costs of training in such settings. This paper assesses the cost of primary care training in ambulatory settings. Selection models were used to separate the cost of teaching from the cost of infrastructural differences between teaching and non-teaching sites. A probit equation modelled the likelihood of an ambulatory site having a teaching programme and a cost function related total medical practice costs to clinical output, the presence of a health professions educational programme, the price of resources used, characteristics of the medical practice and location. Data on 184 community health centres (CHCs), group practices, health maintenance organizations (HMOs) and outpatient clinics were used. Teaching sites were found to have 36% higher operating costs than their non-teaching counterparts: 38% of these higher costs were due to infrastructural differences and 62% were the 'pure' costs of teaching, i.e. the costs of teaching the net of infrastructural effects. Copyright (C) 2000 John Wiley & Sons, Ltd.
Hogan A J; Franzini L; Boex J R
Health Economics
2000
2000-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1002/1099-1050(200012)9:8%3C715::aid-hec573%3E3.3.co;2-j" target="_blank" rel="noreferrer noopener">10.1002/1099-1050(200012)9:8%3C715::aid-hec573%3E3.3.co;2-j</a>
Saucerization Biopsy Of Pigmented Lesions
care; current therapy; cutaneous melanoma; Dermatology; diagnosis; excision; initial biopsy; malignant-melanoma; prognosis; stage-i; survival
Ho J; Brodell R T; Helms S E
Clinics in Dermatology
2005
2005-11
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.clindermatol.2005.06.004" target="_blank" rel="noreferrer noopener">10.1016/j.clindermatol.2005.06.004</a>
Public Health And Emergency Medicine
care; disease; Emergency Medicine
Hauswald M; Gerson L W; Kerr N L
Academic Emergency Medicine
2009
2009-11
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1111/j.1553-2712.2009.00541.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2009.00541.x</a>
Performance Measurement In Community-acquired Pneumonia: Consequences Intended And Unintended
america; antibiotics; care; guidelines; hospitals; Immunology; Infectious Diseases; infectious-diseases-society; Microbiology; quality
File T M; Gross P A
Clinical Infectious Diseases
2007
2007-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1086/512436" target="_blank" rel="noreferrer noopener">10.1086/512436</a>
Acute Bronchitis: An Indication For Antibiotic Avoidance
adults; care; community-acquired pneumonia; Infectious Diseases; physicians; respiratory-tract infections; trends
File T M
Current Opinion in Infectious Diseases
1999
1999-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00001432-199904000-00001" target="_blank" rel="noreferrer noopener">10.1097/00001432-199904000-00001</a>
Preventing Unintended Pregnancy: Pharmacists' Roles In Practice And Policy Via Partnerships
adolescents; attitudes; breast; care; contraceptives; direct access; emergency contraception; hormonal contraceptives; knowledge; pelvic examination; pharmacists; Pharmacology & Pharmacy; Pregnancy; united-states
Farris K B; Ashwood D; McIntosh J; DiPietro N A; Maderas N M; Landau S C; Swegle J; Solemani O
Journal of the American Pharmacists Association
2010
2010-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1331/JAPhA.2010.09195" target="_blank" rel="noreferrer noopener">10.1331/JAPhA.2010.09195</a>
Retrospective Evaluation Of The Advanced Nursing Education Expansion Program
Affordable Care Act; care; family nurse practitioner; Medicine; nurse-midwife; Nursing; physicians; practitioners; primary; primary-care; workforce
Doyle J M; Zangaro G A; Howie B A; Bigley M B
Jnp-Journal for Nurse Practitioners
2017
2017-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.nurpra.2017.04.019" target="_blank" rel="noreferrer noopener">10.1016/j.nurpra.2017.04.019</a>
Teaching Women's Health Skills - Confidence, Attitudes, And Practice Patterns Of Academic Generalist Physicians
care; confidence; General & Internal Medicine; Health Care Sciences & Services; internal-medicine; need; preferences; primary care faculty; residency training; residents; women's health
Dixon J G; Bognar B A; Keyserling T C; DuPre C T; Xie S X; Wickstrom G C; Kolar M M
Journal of General Internal Medicine
2003
2003-06
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1046/j.1525-1497.2003.10511.x" target="_blank" rel="noreferrer noopener">10.1046/j.1525-1497.2003.10511.x</a>
Insurance Status And The Variable Management Of Children Presenting To The Emergency Department With Bronchiolitis
asthma; bronchiolitis; care; coverage; Emergency Medicine; health-insurance; hospitalizations; infants; insurance; Pediatrics; respiratory syncytial virus; serious bacterial-infection; socioeconomic-status; united-states; us children
Damore D; Mansbach J M; Clark S; Ramundo M; Camargo C A
Pediatric Emergency Care
2010
2010-10
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/PEC.0b013e3181f39861" target="_blank" rel="noreferrer noopener">10.1097/PEC.0b013e3181f39861</a>
Increasing lipid adherence to goal
atherosclerosis; cholesterol; Goals; therapy; guidelines; disease; Pharmacology & Pharmacy; Lipids; program; risk; population; care; impact; trials; guidelines; Assistant; Calculator; Personal Digital
BACKGROUND: In April 2004, the National Cholesterol Education Program Adult Treatment Panel III Guidelines for management of high cholesterol encouraged even lower levels of low-density lipoprotein (LDL) than previous guidelines for high and very high risk groups. Assessing patients' risk factors to determine LDL goals is the first step to help guide therapy. OBJECTIVE: To determine whether the use of the Mobile Lipid Clinic Personal Digital Assistant (PDA) Calculator during office visits will increase the number of patients achieving their LDL goal compared to using electronic medical records or conventional methods. METHODS: Four family medicine residency programs affiliated with the Northeastern Ohio Network participated with each site using a different method. The PDA site used the Mobile Lipid Clinic Calculator, the second site used electronic health records (EHRs), the control site used usual care methods, and the transition site moved from paper charts to EHRs during the study. In 2006, baseline chart reviews were conducted to randomly enroll 100 patients per site (aged 40-75 years) with LDL levels at least 10% above goal. In 2007, follow-up chart reviews were conducted on the same patients to determine reductions in LDL and the percent of patients that reached their LDL goals. RESULTS: The percentage reaching their LDL goal and option goal were as follows: PDA site 27% and 12%, EHR site 19% and 3%, control site 4% and 1%, transition site 32% and 12%. Cholesterol-lowering medication usage increased significantly from 38% at baseline to 47% at follow-up (chi(2) = 149.5, P < 0.0001). CONCLUSIONS Using a PDA tool can be just as effective as EHRs in getting patients to their LDL goal and is better than some conventional methods, suggesting the benefit of utilizing technology to improve patient care and health outcomes. (C) 2008 National Lipid Association. All rights reserved.
Davidson E; Uhlenhake E; McCord G
Journal of Clinical Lipidology
2008
2008-10
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.jacl.2008.06.010" target="_blank" rel="noreferrer noopener">10.1016/j.jacl.2008.06.010</a>
Depression in family medicine faculty
stress; General & Internal Medicine; physicians; predictors; Mental Health; care; quality; Job satisfaction; general-practitioners
(B) under bar(a) under bar(c) under bar(k) under bar(g) under bar(r) under bar(o) under bar(u) under bar(n) under bar(d) under bar (a) under bar(n) under bar(d) under bar (O) under bar(b) under bar(j) under bar(e) under bar(c) under bar(t) under bar(i) under bar(v) under bar(e) under bar(s) under bar: Depression among family medicine faculty may contribute to decreased effectiveness in patient care, decreased effectiveness in teaching, and career changes. The present study determined the nationwide prevalence of depression and related risk factors among family medicine residency program faculty. (M) under bar(e) under bar(t) under bar(h) under bar(o) under bar(d) under bar(s) under bar: All full-time US family medicine faculty, program directors, and behavioral scientists listed as members of the Society of Teachers of Family Medicine in October 2000 were surveyed. The survey included demographics, clinical practice characteristics, the Beck Depression Inventory II, the Social Readjustment Rating Scale (SRRS), and a scale to measure stress within the residency program. (R) under bar(e) under bar(s) under bar(u) under bar(l) under bar(t) under bar(s) under bar: Surveys were completed by 1,418 faculty members. Seven percent of survey respondents scored mildly depressed, and 5% scored moderately to severely depressed. Seven percent Of respondents scored highly stressed on the SRRS. Significant predictors of depression scores included being single, being a member of an underrepresented minority group, having increased stress scores, and having a greater amount of time devoted to teaching. (C) under bar(o) under bar(n) under bar(c) under bar(l) under bar(u) under bar(s) under bar(i) under bar(o) under bar(n) under bar(s) under bar: Program directors and department chairs need to be aware of the prevalence of depression among faculty, since it may affect their performance of patient care and teaching responsibilities.
Costa A J; Schrop S L; McCord G; Ritter C
Family Medicine
2005
2005-04
Journal Article or Conference Abstract Publication
n/a
HARD CHOICES - THE GYNECOLOGIC CANCER-PATIENTS END-OF-LIFE PREFERENCES
attitudes; physicians; Oncology; perspective; Obstetrics & Gynecology; care; quality; cardiopulmonary resuscitation
Few reports in gynecologic literature have addressed patient preferences about terminal care. In light of the current discussions about end-of-life decision-making, a study was designed to assess the desires of patients with gynecologic cancer. A questionnaire was completed by 108 patients under treatment for gynecologic cancer at the University of Michigan Medical Center and by 39 patients from the routine gynecology clinic at the same institution. Participants were asked about their reactions to a poor prognosis, their desires for the location of terminal care, and their preferences for withdrawing or withholding life-sustaining technologies. Five percent of these cancer patients anticipated giving up the fight against their disease. Seventy-eight percent specifically expressed resolve to continue the fight against their disease. Feedback from these patients about their end-of-life preferences served to define the concept ''fight.'' A majority preferred to receive care at home. Ninety percent of these cancer patients could envision their conditions deteriorating to the point that they would not want ventilator support. Thirty-four percent could envision refusing surgery for another life-threatening condition; 37%, a time when artificial nutrition would be refused; 22%, a time when antibiotics would be rejected. This study suggests that limiting the use of artificial respiratory support while continuing the use of artificial nutrition and hydration support would be consistent with the preferences of gynecologic cancer with end-stage disease. (C) 1994 Academic Press, Inc.
Brown D; Roberts J A; Elkins T E; Larson D; Hopkins M
Gynecologic Oncology
1994
1994-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1006/gyno.1994.1306" target="_blank" rel="noreferrer noopener">10.1006/gyno.1994.1306</a>
Should trauma surgeons render definitive vascular repair in peripheral vascular injuries?
arterial trauma; care; extremity; management; Surgery
Our hypothesis is that in an established Level I trauma center general trauma surgeons should repair peripheral vascular injuries even in stable patients when there is time for a vascular consult. We reviewed all penetrating peripheral vascular injuries in stable patients operated on by nine experienced general trauma surgeons (1993-1996). Outcome measures were amputation, nerve damage, and vascular complications. There were 43 patients with 44 peripheral vascular injuries identified. Sixty per cent were from stab wounds. There were 27 arterial injuries (carotid four, subclavian one, vertebral two, axillary three, brachial eight, ulnar one, radial two, femoral five, and anterior tibial one). There were three venous injuries (one each subclavian, axillary, and popliteal). There were 14 combined injuries (vertebral two, femoral nine, and popliteal three). There were no mortalities. Morbidity was limited to patients with lower extremity injuries. In the nine patients with combined femoral vessel injury there were three complications (nerve damage, thrombosed arterial repair, and thrombosed venous repair). In the four patients with popliteal venous injuries there were two complications, both venous thrombosis. Our early arterial patency rate was 97.6 per cent. These data support the hypothesis that general surgeons with trauma experience can provide effective treatment of peripheral vascular injuries. The significance of these findings in improving the image of trauma surgery as a career is discussed.
Porter J M; Ivatury R R
American Surgeon
2001
2001-05
Journal Article
n/a
Oculocutaneous Albinism in Sub-Saharan Africa: Adverse Sun-Associated Health Effects and Photoprotection
Biochemistry & Molecular Biology; Biophysics; care; children; community; Nigeria; northern tanzania; population; program; skin cancer; southern-africa; zimbabwe
Oculocutaneous albinism (OCA) is a genetically inherited autosomal recessive condition. Individuals with OCA lack melanin and therefore are susceptible to the harmful effects of solar ultraviolet radiation, including extreme sun sensitivity, photophobia and skin cancer. OCA is a grave public health issue in sub-Saharan Africa with a prevalence as high as 1 in 1000 in some tribes. This article considers the characteristics and prevalence of OCA in sub-Saharan African countries. Sun-induced adverse health effects in the skin and eyes of OCA individuals are reviewed. Sun exposure behavior and the use of photoprotection for the skin and eyes are discussed to highlight the major challenges experienced by these at-risk individuals and how these might be best resolved.
Wright C Y; Norval M; Hertle R W
Photochemistry and Photobiology
2015
2015-01
Journal Article
<a href="http://doi.org/10.1111/php.12359" target="_blank" rel="noreferrer noopener">10.1111/php.12359</a>
Emergency Department Performance Measures Updates: Proceedings of the 2014 Emergency Department Benchmarking Alliance Consensus Summit
care; costs; Emergency Medicine; operations; outcomes; patient satisfaction; project; publication guidelines; quality improvement; risk; stay
ObjectivesThe objective was to review and update key definitions and metrics for emergency department (ED) performance and operations. MethodsForty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus. ResultsA comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency. ConclusionsStandardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers. (C) 2015 by the Society for Academic Emergency Medicine
Wiler J L; Welch S; Pines J; Schuur J; Jouriles N; Stone-Griffith S
Academic Emergency Medicine
2015
2015-05
Journal Article
<a href="http://doi.org/10.1111/acem.12654" target="_blank" rel="noreferrer noopener">10.1111/acem.12654</a>
Use of child reports of daily functioning to facilitate identification of psychosocial problems in children
agreement; behavioral-problems; care; community; depression; General & Internal Medicine; informants; management; parent; sample; symptoms
Background: Despite the availability of effective screening measures, physicians fail to identify and manage many children with psychosocial problems. Physicians are most likely to identify children with psychosocial problems when parents voice concerns about their child's functioning. However, few parents express concerns to their child's physician, and children's perspectives of their own functioning are rarely considered. This study evaluated the potential utility of children's reports of their own functioning. Methods: The Child Functioning Scale (CFS) was completed by 107 parents and children and compared with the Pediatric Symptom Checklist (PSC) and physician reports on the psychosocial status of each child. Results: Physicians identified 20% of the children identified by the PSC. Children's self-reported problems on the CFS would have identified 53.3% of these children. Additionally. 11.2% of children who did not meet criteria on the PSC self-reported problems in daily functioning. Conclusion: Collecting information about children's perceptions of their own daily functioning could provide physicians with an additional tool for the assessment of psychosocial problems.
Wildman B G; Kinsman A M; Smucher W D
Archives of Family Medicine
2000
2000-07
Journal Article
<a href="http://doi.org/10.1001/archfami.9.7.612" target="_blank" rel="noreferrer noopener">10.1001/archfami.9.7.612</a>
The six-item screeinier to detect cognitive impairment in older emergency department patients
care; cognitive impairment; delirium; diagnostic testing; elderly emergency; Emergency Medicine; geriatrics; mental status; Mini-Mental State; prevalence
Background: Cognitive impairment due to delirium or dementia is common in older emergency department (ED) patients. To prevent errors, emergency physicians (EPs) should use brief, sensitive tests to evaluate older patient's mental status. Prior studies have shown that the Six-Item Screener (SIS) meets these criteria. Objectives: The goal was to verify the performance of the SIS in a large, multicenter sample of older ED patients. Methods: A prospective, cross-sectional study was conducted in three urban academic medical center EDs. English-speaking ED patients :65 years old were enrolled. Patients who received medications that could affect cognition, were too ill, were unable to cooperate, were previously enrolled, or refused to participate were excluded. Patients were administered either the SIS or the Mini-Mental State Examination (MMSE), followed by the other test 31) minutes later. An MMSE of 23 or less was the criterion standard for cognitive impairment; the SIS cutoff was 4 or less for cognitive impairment. Standard operator characteristics of diagnostic tests were calculated with 95% confidence intervals (CIs), and a receiver operating characteristic curve was plotted. Results: The authors enrolled 352 subjects; III were cognitively impaired by MMSE (32%, 95% CI = 27% to 37%). The SIS was 63% sensitive (95% CI = 53% to 72%) and 81% specific (95% CI = 75% to 85%). The area under the receiver operating characteristic curve was 0.77 (95% CI = 0.72 to 0.83). Conclusions: The sensitivity of the SIS was lower than in prior studies. The reasons for this lower sensitivity are unclear. Further study is needed to clarify the ideal brief mental status test for ED use.
Wilber S T; Carpenter C R; Hustey F M
Academic Emergency Medicine
2008
2008-07
Journal Article
<a href="http://doi.org/10.1111/j.1553-2712.2008.00158.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2008.00158.x</a>
Confidence of academic general internists and family physicians to teach ambulatory procedures
academic generalists; ambulatory procedures; care; confidence teaching; General & Internal Medicine; graduate medical education; Health Care Sciences & Services; organizations; reform; residency; residency training; skills
OBJECTIVE: To evaluate and compare the readiness of academic general internal medicine physicians and academic family medicine physicians to perform and teach 13 common ambulatory procedures. DESIGN: Mailed survey. SETTING: Internal medicine and family medicine residency training programs associated with 35 medical schools in 9 eastern states. PARTICIPANTS: Convenience sample of full-time teaching faculty. MEASUREMENTS AND MAIN RESULTS: A total of 331 general internists and 271 family physicians returned completed questionnaires, with response rates of 57% and 65%, respectively. Academic generalists ranked most of the ambulatory procedures as important for primary care physicians to perform; however, they infrequently performed or taught many of the procedures. Overall, compared with family physicians, general internists performed and taught fewer procedures, received less training, and were less confident in their ability to teach these procedures. Physicians' confidence to teach a procedure was strongly associated with training to perform the procedure and performing or precepting a procedure at least 10 times per year. CONCLUSIONS: Many academic general internists do not perform or precept common adult ambulatory procedures. To ensure that residents have the opportunity to learn routine ambulatory procedures, training programs may need to recruit qualified faculty, train current faculty, or arrange for academic specialists or community physicians to teach these skills.
Wickstrom G C; Kelley D K; Keyserling T C; Kolar M M; Dixon J G; Xie S X; Lewis C L; Bognar B A; DuPre C T; Coxe D R; Hayden J; Williams M V
Journal of General Internal Medicine
2000
2000-06
Journal Article
<a href="http://doi.org/10.1046/j.1525-1497.2000.04109.x" target="_blank" rel="noreferrer noopener">10.1046/j.1525-1497.2000.04109.x</a>
PNEUMOCOCCAL BACTEREMIA IN 3 COMMUNITY TEACHING HOSPITALS FROM 1980 TO 1989
adults; care; charleston county; General & Internal Medicine; mortality; Respiratory System; south-carolina
Study objective: To review the clinical and laboratory findings in a large number of patients with pneumococcal bacteremia in the 1980s and identify risk factors associated with increased mortality. Design: Retrospective review of medical records identified by blood culture logbooks and ICD-9 codes. Setting: Three community teaching hospitals affiliated with a medical school in northeastern Ohio. Patients: 385 inpatients with pneumococcal bacteremia admitted between jan 1, 1980 and Dec 31, 1989. Measurements: Important clinical and laboratory information was abstracted from patients' medical records, compiled, computerized, and analyzed. Main results: The patients' mean age was 48 years. The overall mortality was 25 percent. The mortality increased with age, reaching 42 percent in patients over 65 years old. For these elderly patients, the mortality was higher (55 percent) for patients admitted from nursing homes than patients from the community (36 percent). Higher mortality wag also associated with congestive heart failure (p = 0.001), alcoholism/cirrhosis (p = 0.02), diabetes mellitus (p = 0.05), and malignancy (p = 0.02). A platelet count less than 150,000/mm3, renal dysfunction (serum creatinine >2 mg/dl), and the number of lobes involved were also associated with mortality. Patients receiving standard therapy (penicillin, ampicillin, erythromycin, or cephalosporins) had lower mortality. Of the previously specified risk factors for mortality, only age, whether standard therapy was administered, the number of lobes involved, and the serum creatinine level proved to be independent risk factors according to logistic regression. Conclusions: The overall mortality from pneumococcal bacteremia has not decreased during the past 40 years. Risk factors associated with increased mortality were identified. Prevention by immunization with polyvalent pneumococcal polysaccharide vaccine should be practiced more widely.
Watanakunakorn C; Greifenstein A; Stroh K; Jarjoura D G; Blend D; Cugino A; Ognibene A J
Chest
1993
1993-04
Journal Article
<a href="http://doi.org/10.1378/chest.103.4.1152" target="_blank" rel="noreferrer noopener">10.1378/chest.103.4.1152</a>
Factors associated with imaging overuse in the emergency department: A systematic review
care; computed-tomography scans; costs; ct; Emergency department; Emergency Medicine; Health; Health care; Imaging; Overuse; patient; physicians; Quality measurement; radiation-exposure; research agenda; retrospective-analysis; transferred trauma patients
Background: Emergency departments (ED) are sites of prevalent imaging overuse; however, determinants that drive imaging in this setting are not well-characterized. We systematically reviewed the literature to summarize the determinants of imaging overuse in the ED. Methods: We searched MEDLINE (R) and Embase (R) from January 1998 to March 2017. Studies were included if they were written in English, contained original data, pertained to a U.S. population, and identified a determinant associated with overuse of imaging in the ED. Results: Twenty relevant studies were included. Fourteen evaluated computerized tomography (CT) scanning in patents presenting to a regional ED who were then transferred to a level 1 trauma center; incomplete transfer of data and poor image quality were the most frequently described reasons for repeat scanning. Unnecessary pretransfer scanning or repeated scanning after transfer, in multiple studies, was highest among older patients, those with higher Injury Severity Scores (ISS) and those being transferred further. Six studies explored determinants of overused imaging in the ED in varied conditions, with overuse greater in older patients and those having more comorbid diseases. Defensive imaging reportedly influenced physician behavior. Less integration of services across the health system also predisposed to overuse of imaging. Conclusions: The literature is heterogeneous with surprisingly few studies of determinants of imaging in minor head injury or of spine imaging. Older patient age and higher ISS were the most consistently associated with ED imaging overuse. This review highlights the need for precise definitions of overuse of imaging in the ED. (C) 2017 Elsevier Inc. All rights reserved.
Tung M; Sharma R; Hinson J S; Nothelle S; Pannikottu J; Segal J B
American Journal of Emergency Medicine
2018
2018-02
Journal Article
<a href="http://doi.org/10.1016/j.ajem.2017.10.049" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2017.10.049</a>
STRESSORS AND WELL-BEING AMONG CAREGIVERS TO OLDER ADULTS WITH DEMENTIA - THE IN-HOME VERSUS NURSING-HOME EXPERIENCE
alzheimers-disease; burden; care; caregiving stress; family caregiving; family member; Geriatrics & Gerontology; hassles; institutionalization; long-term care; nursing-homes; predictors; scale
Stephens M A P; Kinney J M; Ogrocki P K
Gerontologist
1991
1991-04
Journal Article
<a href="http://doi.org/10.1093/geront/31.2.217" target="_blank" rel="noreferrer noopener">10.1093/geront/31.2.217</a>
DOOR-TO-BALLOON TIMES FROM FREESTANDING EMERGENCY DEPARTMENTS MEET ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION REPERFUSION GUIDELINES
care; Emergency Medicine; freestanding emergency department; global registry; hospital; infarction; interhospital transfer; mortality; percutaneous coronary intervention; perspective; primary angioplasty; randomized-trials; ST-segment elevation myocardial; system; united-states
Background: Freestanding emergency departments (FEDs) introduce a challenge to physicians who care for the patient with an ST-segment elevation myocardial infarction (STEMI) because treatment is highly time dependent. FEDs have no percutaneous coronary intervention (PCI) capabilities, which necessitates transfer to a PCI-capable facility or fibrinolysis. Study Objective: Our aim was to determine the proportion of STEMI patients who arrived to an FED and were subsequently transferred for PCI and met the door-to-balloon reperfusion guidelines of 90 min. Methods: This was a dual-center retrospective cohort review of all patients 18 years and older who were diagnosed with an STEMI and presented to the main hospital-affiliated FEDs. Electronic medical records and emergency medical services documentation were reviewed for all cases since the opening of the FEDs in July 2007 and August 2009, respectively. Key time points were abstracted and statistical evaluation was performed using Fisher's exact test. Results: A total of 47 patients met inclusion criteria. Median door-to-transport time was 34 min (inter-quartile range [IQR] 15 min). Median transport time from the FEDs to the main hospital catheterization laboratory was 21 min (IQR 5 min). Median arrival at the catheterization laboratory-to-balloon time was 25 min (IQR 13 min). Median total door-to-balloon time was 83 min (IQR 10.5 min), with 78.7% meeting the American Heart Association's recommended guidelines of <= 90 min. Conclusion: STEMI patients initially seen at two FEDs achieved door-to-balloon time goals of < 90 min. (C) 2014 Elsevier Inc.
Simon E L; Griffin P; Medepalli K; Griffin G; Williams C J; Hewit M; Lloyd T S
Journal of Emergency Medicine
2014
2014-05
Journal Article
<a href="http://doi.org/10.1016/j.jemermed.2013.08.089" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2013.08.089</a>
Acute otitis media
acute otitis media; antibacterial therapy; antibiotics; bacterial resistance; care; children; efficacy; era; expectations; Infectious Diseases; management; Streptococcus pneumoniae; vaccine
At least 1 episode of acute otitis media is seen in 94% of children before age 2. Attendance in a day-care setting is among the major risk factors. Middle ear fluid may be sterile or may grow viruses and/or bacteria. Accurate diagnosis and distinction from otitis media with effusion is essential for proper management, but physicians often have difficulty in making the correct diagnosis. Since overuse of antibacterial agents contributes to an increase in bacterial resistance, physicians should consider delaying treatment for 2 to 3 days, during which therapy is aimed at controlling pain. High-dose amoxicillin is the preferred antibacterial agent in a young child with a purulent middle ear effusion, but amoxicillin-clavulanate, cefuroxime axetil, and ceftriaxone are options when resistant bacteria are. encountered.
Scott E G; Powell K R
Infections in Medicine
2003
2003-05
Journal Article
<a href="http://doi.org/10.1016/b978-1-4160-4417-8.50020-6" target="_blank" rel="noreferrer noopener">10.1016/b978-1-4160-4417-8.50020-6</a>
Identifying Barriers to Adult Pneumococcal Vaccination: An NFID Task Force Meeting
adult vaccination; care; disease; General & Internal Medicine; influenza; pneumococcal disease; pneumococcal vaccine; pneumonia; Streptococcus pneumoniae; united-states
Pneumococcal infection is common in adults, and invasive disease is associated with a high mortality rate. Pneumococcal polysaccharide vaccine can prevent invasive pneumococcal disease and is recommended for people aged >= 65 years and for younger adults with high-risk chronic conditions; however, vaccination rates are suboptimal in all of these groups. A multidisciplinary task force meeting examined ways to increase vaccination rates in the target populations. Barriers to vaccination include lack of awareness of the disease or vaccine among vaccination candidates and health care providers, failure to assume responsibility for vaccination, competing priorities, incomplete or inaccessible documentation of previous vaccines, and health care system delivery challenges. Efforts to address these barriers should use appropriate methods. For example, potential vaccine recipients might be motivated by a message from a community leader, whereas health care providers are more apt to offer a vaccine when reminded that it is a recommended best practice. All health care providers need to accept responsibility for vaccination so that this preventive measure becomes a high priority in the care of patients at risk for serious pneumococcal infection.
Rehm S J; File T M; Metersky M; Nichol K L; Schaffner W; Natl Fdn Infect Dis Pneumococcal D
Postgraduate Medicine
2012
2012-05
Journal Article
<a href="http://doi.org/10.3810/pgm.2012.05.2550" target="_blank" rel="noreferrer noopener">10.3810/pgm.2012.05.2550</a>
Effect of Electronic Messaging on Glucose Control and Hospital Admissions Among Patients with Diabetes
care; disparities; Endocrinology & Metabolism; impact; management; online; quality; record
Background: Electronic messaging (EM) is increasingly utilized among patients with diabetes, but it is unclear whether it is associated with improved glycemic control, hospital admissions, or emergency visits. Methods: Patients who were seen over a 1 year period at an academic endocrinology clinic with a diagnosis of diabetes were categorized according to portal activation and whether EMs were actually sent. The association between EM and HbA1c and inpatient or emergency department (ED) visits was further characterized using multivariable (MV) linear or logistic regression models. Results: A total of 867 patients were using EM (active user group), 1207 patients had activated the patient portal but did not use the EM function (active nonuser group), and 1542 patients had not activated the patient portal (inactive group). There were important disparities in race, age, income, and other variables across groups. The HbA1c was 7.7% +/- 1.5%, 8.4% +/- 1.9%, and 8.2% +/- 1.8% among the active user, active nonuser, and inactive groups, respectively (P < 0.0001). After controlling for other factors, EM was associated with a 0.25% (SE 0.04%) lower HbA1c compared with the active nonuser group and a 0.19% (SE 0.04%) lower HbA1c compared with the inactive group (P < 0.0001 for both). However, EM frequency was not associated with HbA1c. EM use was not associated with inpatient or ED visits in MV analysis. Conclusions: EM use was associated with improved glycemic control, even after controlling for electronic portal access and other variables, but not with hospitalizations or emergency visits. EM frequency was not associated with glycemic control, justifying the need for prospective studies.
Petullo B; Noble B; Dungan K M
Diabetes Technology & Therapeutics
2016
2016-09
Journal Article
<a href="http://doi.org/10.1089/dia.2016.0105" target="_blank" rel="noreferrer noopener">10.1089/dia.2016.0105</a>
Diversity in case management modalities: The summit model
care; clients; continuity; Environmental & Occupational; Health; Health Care Sciences & Services; impact; intensive case-management; program; Psychiatry; Public
Though ubiquitous in community mental health agencies, case management suffers from a lack of consensus regarding its definition, essential components, and appropriate application. Meaningful comparisons of various case management models await such a consensus. Global assessments of case management must be replaced by empirical studies of specific interventions with respect to the needs of specific populations. The authors describe a highly differentiated and prescriptive system of case management involving the application of more than one model of service delivery. Such a diversified and targeted system offers an opportunity to study the technology of case management in a more meaningful manner.
Peterson G A; Drone I D; Munetz M R
Community Mental Health Journal
1997
1997-06
Journal Article
<a href="http://doi.org/10.1023/a:1025093612631" target="_blank" rel="noreferrer noopener">10.1023/a:1025093612631</a>
Consensus Development of a Modern Ontology of Emergency Department Presenting Problems-The Hierarchical Presenting Problem Ontology (HaPPy)
care; chief complaint; coded chief complaints; electronic medical-record; emergency; emergency department; Medical Informatics; medicine; ontology; presenting problem; rods; systems; terminologies
Objective Numerous attempts have been made to create a standardized "presenting problem" or "chief complaint" list to characterize the nature of an emergency department visit. Previous attempts have failed to gain widespread adoption as they were not freely shareable or did not contain the right level of specificity, structure, and clinical relevance to gain acceptance by the larger emergency medicine community. Using real-world data, we constructed a presenting problem list that addresses these challenges. Materials and Methods We prospectively captured the presenting problems for 180,424 consecutive emergency department patient visits at an urban, academic, Level I trauma center in the Boston metro area. No patients were excluded. We used a consensus process to iteratively derive our system using real-world data. We used the first 70% of consecutive visits to derive our ontology, followed by a 6-month washout period, and the remaining 30% for validation. All concepts were mapped to Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT). Results Our system consists of a polyhierarchical ontology containing 692 unique concepts, 2,118 synonyms, and 30,613 nonvisible descriptions to correct misspellings and nonstandard terminology. Our ontology successfully captured structured data for 95.9% of visits in our validation data set. Discussion and Conclusion We present the HierArchical Presenting Problem ontologY (HaPPy). This ontology was empirically derived and then iteratively validated by an expert consensus panel. HaPPy contains 692 presenting problem concepts, each concept being mapped to SNOMED CT. This freely sharable ontology can help to facilitate presenting problem-based quality metrics, research, and patient care.
Horng S; Greenbaum N R; Nathanson L A; McClay J C; Goss F R; Nielson J A
Applied Clinical Informatics
2019
2019-05
<a href="https://www.biorxiv.org/content/10.1101/126870v2" target="_blank" rel="noreferrer noopener">10.1055/s-0039-1691842</a>