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1.
Life (Basel) ; 13(1)2022 Dec 25.
Article in English | MEDLINE | ID: mdl-36676013

ABSTRACT

A key step prior to clear aligner therapy (CAT) is the clinical examination and case selection, which includes understanding the specific orthodontic problem to be managed and the wider evaluation of oral health. Seeking CAT may further differ along sociodemographic parameters or across countries, as may perceived orthodontic treatment needs and oral health. We aimed to characterize patients seeking CAT across five European countries. Anonymized real-life data from one large CAT provider (DrSmile, Berlin, Germany) was retrospectively sampled for the period 1 November 2021-31 December 2021. A total of 15,015 patients (68.4% females, 31.6% males, with an age range of 18-81 years, median 30.0 years) were included. The cross-national comparison revealed a significant difference in gender distribution (p < 0.001/Chi-square), with the highest proportion of males in Italy (434/1199, 36.2%) and the lowest in Poland (457/1600, 28.6%); generally, more females sought CAT. The largest motivational factor in all countries for seeking CAT was crowding, in both males and females. By and large, patients paid out of pocket for CAT. The prevalence of caries, periodontitis, and craniomandibular dysfunction as well as the numbers of missing teeth were generally low, albeit with significant differences between sociodemographic groups and countries for caries and periodontitis. Patients seeking CAT showed a low prevalence in oral conditions but differed in their sociodemographic characteristics across countries. Dentists and orthodontists should consider these country-specific differences when planning CAT.

2.
Am Surg ; : 31348221148371, 2023 Jan 09.
Article in English | MEDLINE | ID: mdl-36621913

ABSTRACT

BACKGROUND: Opioid addiction remains a public health crisis. We aimed to create an electronic medical record (EMR) based protocol to decrease post-operative prescribing of opioid medications and streamline the ordering process while maintaining adequate pain control. METHODS: An order set was created to minimize opioid prescriptions. The post-operative prescribing practices for minor urologic procedures (MUOs) over 6-week periods at three time points were compared: one period before and two periods after implementation of the order set. RESULTS: 72 MUOs were performed in the pre-implementation, 52 in post-implementation, and 60 in the long-term period. Opioid medications were prescribed for 66 patients (91.7%) pre-implementation, 23 patients (44.2%) post-implementation, and 45 patients (75.0%) at the long-term time point (P < .0001 and P = .015 respectively). The mean morphine milligram equivalent (MME) prescribed was 81.52 units before implementation, 38.74 units after, and 24.21 units at the long-term time point (P = .0002 and P < .0001 respectively). DISCUSSION: The integration of a post-operative prescribing order set into our EMR substantially decreased opioid prescribing after MUO while streamlining the ordering process to improve efficiency.

3.
Cureus ; 14(12): e32176, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36605059

ABSTRACT

INTRODUCTION: With emergency department utilization rising at a dramatic rate, orthopedic urgent care centers (oUCCs) have become increasingly popular. The financial viability and basic advantages of oUCCs have been described in the literature, but little is known about the characteristics of patients treated and the diagnoses encountered. The purpose of this study is to report and evaluate the patients and diagnoses that are most commonly seen in an oUCC so that future care may be better tailored to the needs of the patients seeking these services. MATERIALS AND METHODS: All patients seen at a single suburban oUCC in its first and fifth years of operation (2014 and 2019) were identified. The medical records were reviewed to assess patient demographics, diagnoses encountered, and services rendered. The clinical courses of patients treated were also reviewed to identify those who underwent eventual surgery for their presenting complaint. RESULTS: A total of 24,756 patient visits occurred during the study period, and the number of visits nearly doubled between the first and fifth years (8,301 in 2014 and 16,455 in 2019). The most common diagnoses encountered were lower leg pain, back pain, and foot/ankle pain. Radiographs were obtained in 17,236 visits (70%), most commonly of the knee, elbow, foot, or ankle. A total of 1,334 patients (5.4%) underwent eventual surgery for their presenting complaint - defined as a surgical conversion. Of all the orthopedic subspecialties, sports medicine had the highest rate of surgical conversion (29% of all conversions). The surgical conversion rate increased slightly from year one (4.7%) to year five (5.8%). CONCLUSIONS: OUCCs are an effective means of expanding access to care for patients and increasing the volume of an orthopedic practice. Continued monitoring of the types of patients seen within oUCCs will further optimize care delivery.

4.
Eur J Ophthalmol ; : 11206721221149757, 2023 Jan 03.
Article in English | MEDLINE | ID: mdl-36597670

ABSTRACT

PURPOSE: To conduct a review of glaucoma management in France. METHOD: A 15-question survey was sent to ophthalmologists listed in the journal Réalités Ophtalmologiques and the Syndicat National des Ophtalmologues de France. RESULTS: 459/471 responses were analyzed. Gonioscopy was performed by 64.7% of respondents with a Goldmann three-mirror lens, by 51.4% with a four-mirror lens, and 8.2% preferred to perform the procedure with anterior segment imaging. The visual field was reported to be interpreted without difficulty by 87.8% of the practitioners, and 54.0% utilize a progression software. Ultrasound biomicroscopy was reported to be interpreted without difficulty by 20.0% of practitioners. In cases of severe ocular hypertonia with flat bleb in early postoperative trabeculectomy, 61.7% chose ocular massage as a first-line treatment, 52.9% chose laser suture lysis, 50.5% utilized needling, and 24.8% employed hypotonizing eyedrops. In case of severe ocular hypertonia with flat bleb in early postoperative deep sclerectomy, 53.2% chose goniopuncture as their first treatment, 34.4% employed needling, 31.8% utilized ocular massage, and 23.3% chose hypotonizing eyedrops. The selective laser trabeculoplasty is used as soon as the diagnosis is made by 37.5%, in association with a mono or dual therapy by 93.2%, after trying different combinations of eyedrops by 45.5%, when the visual field deteriorates despite a normalized intraocular pressure by 46.6%, and in cases of hypertonia after filtering surgery by 19.2%. Concerning management for primary angle-closure glaucoma, 80.8% considered peripheral iridotomy, and 18.7% utilized cataract surgery. CONCLUSION: The diversity of responses concerning glaucoma management should draw attention to the need for standardized practices.

5.
Eur J Ophthalmol ; : 11206721221146680, 2022 Dec 22.
Article in English | MEDLINE | ID: mdl-36562094

ABSTRACT

INTRODUCTION: The purpose of this investigation was to report swept source-optical coherence tomography angiography (SS-OCTA) quantitative information of retinal and choroidal microvascularization in patients with dyslipidemia (DL). METHODS: We performed a retrospective study. The study enrolled 37 eyes of 20 patients with DL and 40 eyes of 23 healthy subjects. OCTA quantitative parameters (vessel density (VD) and foveal avascular zone (FAZ) area of superficial capillary plexus (SCP), middle capillary plexus (MCP), deep capillary plexus (DCP) and choriocapillaris (CC)) in 6 mm × 6 mm and 4,5 mm × 4,5 mm cubes were recorded. RESULTS: No differences in VD in SCP, MCP and DCP were demonstrated between DL group and control group (p > 0,05). Conversely, VD in the central region at CC was diminished in patients with DL in both cubes (p < 0,05). Moreover, total VD in CC was decreased in the DL group in 6 mm × 6 mm cube (p < 0,05). Regarding FAZ area, we demonstrated and enlargement of FAZ in each retinal capillary plexus, but it did not reach statistical significance (p > 0,05). CONCLUSION: We objectified a diminution of VD in the CC, suggesting that DL mainly affects the choroidal microvasculature. Nonetheless, further studies with a larger population are needed.

6.
Pharmacy (Basel) ; 10(6)2022 Dec 17.
Article in English | MEDLINE | ID: mdl-36548331

ABSTRACT

Several studies have demonstrated the benefit of clinical pharmacy services in primary care. However, studies are limited on providers' perceived value of embedded primary care pharmacy teams. The purpose of this project was to determine how primary care clinical pharmacists and technicians provide value to medical providers. Primary care providers in University of Utah health clinics where primary care clinical pharmacists are embedded were invited to participate in one-on-one, semi-structured interviews. Interview sessions were recorded, transcribed, and de-identified. The transcripts were coded and analyzed to determine common themes. Questions were on various topics, including what is of greatest value to them, pharmacy integration into care teams, provider burnout, provider happiness at work, provider workload, and provider retention in the health system. In total, 25 interviews were conducted from nine different clinics (response rates of 19.7% for providers and 81.8% for clinics). Coding revealed themes of increased job satisfaction, enhanced patient care, decreased workload and burnout, and a desire for increased access to clinical pharmacy services. The responses related to clinical pharmacists in primary care were overwhelmingly positive, and providers almost unanimously expressed the need for more pharmacy services in primary care.

7.
J Surg Educ ; 2022 Dec 19.
Article in English | MEDLINE | ID: mdl-36543709

ABSTRACT

OBJECTIVE: To better prepare general surgery residents for handling the business aspects of healthcare, this project evaluation reports on the implementation of a business of healthcare curriculum (BHC) in a general surgery residency program. We evaluated (pre and post curriculum) self-perceived knowledge and attitudes toward common business topics. DESIGN: General surgery residents were administered a 13-item survey (7 Likert-type and 3 open-ended items assessing self-perceived knowledge and attitudes toward BHC, and 3 demographic questions) prior to the start of the curriculum. The curriculum was comprised of four core sessions, which included didactic lectures and group projects, including the creation of a business plan. At the conclusion of the curriculum, a post-test with the same items was administered. A total of 21 residents completed both the pre and post-tests. SETTING: The BHC was a mandatory part of the general surgery residency program and was conducted in Honolulu, Hawaii (University of Hawaii at Manoa). PARTICIPANTS: All general surgery residents, PGY-1 to PGY-5, were required to participate in the curriculum. RESULTS: Statistically significant increases in resident knowledge were found overall and specifically for healthcare reform legislation, differences between practice settings, financial matters, contracting and coding and billing for services. Additionally, responses to open-ended questions showed that residents had a positive attitude toward the curriculum and found it useful. CONCLUSIONS: General surgery residency programs can successfully create an impactful business of healthcare curriculum with minimal cost if volunteers and existing resources are utilized.

8.
Eur J Ophthalmol ; : 11206721221146674, 2022 Dec 18.
Article in English | MEDLINE | ID: mdl-36529872

ABSTRACT

INTRODUCTION: The aim of our study is to report swept-source optical coherence tomography angiography (SS-OCTA) quantitative parameters of retinal and choroidal microvasculature in patients with systemic hypertension (HTN) using a built-in software of SS-OCTA. METHODS: We performed a retrospective study. This study enrolled 93 eyes of 51 subjects with HTN and 71 eyes of 38 healthy subjects. OCTA quantitative parameters (vessel density (VD) and foveal avascular zone (FAZ) area of superficial capillary plexus (SCP), middle capillary plexus (MCP), deep capillary plexus (DCP), total capillary plexus (TCP) and choriocapillaris (CC)) of the OCTA cube of 4,5 mm × 4,5 mm were recorded. RESULTS: A decrease of parafoveal VD in CC, DCP and TCP were demonstrated between HTN group and control group (p < 0,05). Conversely, no differences were demonstrated in parafoveal VD of SCP and MCP (p > 0,05). Subgroup analysis revealed a diminution of central VD at SCP, DCP and TCP in patients taking one antihypertensive drug compared to patients treated with two medications (p < 0,05). Correlation analysis showed a significant, albeit weak, negative correlation between HTN duration, and parafoveal VD in the SCP and FAZ area at SCP, DCP and TCP (p < 0,05 and r < 0,300). CONCLUSION: When normative data are available, OCTA might be used as a potential tool in the prevention and follow-up of end-organ damage secondary to HTN. Nonetheless, further studies are needed to confirm this hypothesis.

9.
Gac. méd. espirit ; 23(3)dic. 2021.
Article in Spanish | LILACS-Express | ID: biblio-1404875

ABSTRACT

RESUMEN Fundamento: Un sistema de gestión de calidad es una valiosa herramienta para perfeccionar los servicios de salud pública. Objetivo: Caracterizar el estado actual de la gestión de la calidad en el servicio de Ortodoncia para contribuir a una atención de calidad en pacientes con anomalías dentomaxilofaciales. Metodología: Se realizó un estudio descriptivo transversal entre septiembre de 2020 y julio de 2021 en la Clínica Estomatológica Docente Provincial de Sancti Spíritus. Se seleccionaron 3 directivos y 12 miembros del equipo básico de ortodoncia. Se midieron las variables: nivel de información y prácticas sobre gestión de la calidad. Se utilizaron métodos del nivel teórico, empírico y de la estadística descriptiva. Resultados: El 50 % de los miembros del equipo básico presentó un nivel bajo de información sobre la gestión de la calidad en el servicio de Ortodoncia. El 100 % de estos y sus directivos, mostraron prácticas medianamente adecuadas en tres de los cinco aspectos evaluados. Conclusiones: El proceso de gestión de la calidad en el servicio Ortodoncia permitió determinar que, aunque existen directivos con experiencia laboral y un equipo básico con preparación científico-técnica, predominaron con el nivel bajo de información, así como las prácticas medianamente adecuadas sobre la gestión de la calidad.


ABSTRACT Background: A quality management system is a valuable tool for improving public health services. Objective: To describe the current state of orthodontic quality management service to contribute to the patients' quality care with dentofacial abnormalities. Methodology: A descriptive cross-sectional study was conducted between September 2020 and July 2021 at the Sancti Spíritus provincial and teaching stomatology center. Three managers and 12 members of the basic orthodontic team were selected. The following variables were measured: level of information and quality management practices. Theoretical, empirical and descriptive statistical methods were used. Results: 50 % of the basic team members had a low level of information on the orthodontic quality management service. 100 % of them also their managers, showed moderately adequate practices in three of the five aspects evaluated. Conclusions: The orthodontic quality management service allowed us to determine that, although there are managers with work experience and a basic team with scientific-technical preparation, a low level of information prevailed, as well as moderately adequate practices on quality management.

10.
Laryngoscope ; 2022 Dec 13.
Article in English | MEDLINE | ID: mdl-36511340

ABSTRACT

OBJECTIVE(S): This investigation aimed to define the rate of outpatient follow-up after in-hospital consultation, identify factors associated with establishing care, and evaluate an alternative scheduling process to improve outpatient adherence. METHODS: Two-phase, prospective study at an academic, tertiary-care institution from March 2020 to August 2022. First, all patients not previously known to our practice encountered via inpatient consult who warranted outpatient follow-up were prospectively captured. Logistic regression analysis was used to identify demographic, disease, and practice factors predictive of follow-up. Second, a randomized control trial was performed to validate the effects of pre-assigning appointments prior to discharge. RESULTS: Six hundred subjects were included in the final study cohort; 500 in phase-one, and 100 randomized during phase-two. In the phase-one cohort, 54% (n = 272) were lost to follow-up. Multivariate analysis showed increased odds of outpatient follow-up when appointments were pre-assigned before discharge (odds ratio [OR]: 3.69 [95% confidence interval [CI]: 2.29-5.96], p < 0.001), the primary reason for hospitalization was ENT and consult-related (OR: 3.29 [1.92-5.64], p < 0.001), and the diagnosis was one of Oncology (OR: 1.93 [1.02-3.69], p = 0.045) or Pediatrics (OR: 3.36 [1.41-7.98], p = 0.006) subspecialties. During phase-two, subjects randomized for pre-assigned appointments had higher outpatient follow-up (82%) compared to the control group (20%) (p < 0.001). CONCLUSION: Hospital-based consultations represent an important referral pathway for new patients. Disease characteristics may identify patients less likely to follow-up upon discharge. Appointment scheduling protocols, including pre-assigning appointments, are modifiable targets for improving adherence to care. Laryngoscope, 2022.

11.
J Am Board Fam Med ; 2022 Dec 02.
Article in English | MEDLINE | ID: mdl-36460352

ABSTRACT

INTRODUCTION: Comprehensiveness is a defining principle of primary care and Family Medicine but is declining in some settings. This study explores the relationship between practice setting and comprehensiveness among family physicians (FPs). METHODS: Using 2014 to 2016 American Board of Family Medicine survey data to generate scope of practice (SOP) scores (0 to 30) for FPs. We ran univariate and bivariate analyses for services by practice organization type. Our principal independent variable was practice organization type and dependent variable, the SOP score. RESULTS: Among 25,117 total respondents, FPs at rural health centers (RHC) had the widest scope of practice (SOP score of 17.7) whereas FPs in federal, urgent care and other safety net clinics had the narrowest with mean SOP score of 14.0 or less. Higher rates of FPs practicing in Federally Qualified Health Centers and academic health centers were providing a women's health service, except for deliveries, whereas FPs in rural health centers were providing obstetric services (24%). The proportion of FPs providing newborn care was highest in RHCs and lowest in the urgent care setting (85%, vs 26%). A higher proportion of FPs in RHCs provided joint injections and skin procedures than FPs in other practice organizations. CONCLUSIONS: Significant variation in FP comprehensiveness exists across different practice types. FPs in practice types commonly associated with large health systems had narrower breadth of practice, concerning amid increasing practice consolidation. Given associations between comprehensiveness and desirable health care outcomes, policy makers should encourage payment/accountability models that incentivize broader SOP.

12.
Endocrine ; 2022 Dec 02.
Article in English | MEDLINE | ID: mdl-36456885

ABSTRACT

PURPOSE: Thirty years into the genomic era, this study sought to explore events that helped transform the clinical landscape of hereditary medullary thyroid cancer (MTC). METHOD: This retrospective analysis of prospectively collected data included all RET carriers referred to a tertiary center for neck surgery that was performed between 1986 and 2021, using descriptive statistics and Poisson regression analysis. RESULTS: Altogether, 496 RET carriers were referred for thyroidectomy (388 carriers) or neck reoperation (108 carriers). Of these, 44 carriers had highest risk mutations (p.Met918Thr), 164 carriers high risk mutations (p.Cys634Arg/Gly/Phe/Ser/Trp/Tyr/insHisGluLeuCys), 116 carriers moderate-high risk mutations (p.Cys609/611/618/620/630Arg/Gly/Phe/Ser/Tyr) and 172 carriers low-moderate risk mutations (p.Glu768Asp, p.Leu790Phe, p.Val804Leu/Met, or p.Ser891Ala). Three event clusters drove referral numbers upward: a string of first reports of causative RET mutations between 1993 and 1998; the international consensus guidelines for diagnosis and therapy of MEN type 1 and type 2 in 2001; and the revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma in 2015. Referrals for neck reoperation declined sluggishly over 30 years, ending in 2018. Index patients continued to be referred into 2021. Referrals for thyroidectomy, grouped in 5-year increments, peaked in 1996-2000 for carriers of highest and high risk mutations, and in 2006-2010 for carriers of moderate-high and low-moderate risk mutations, some 10 years later. CONCLUSION: International management guidelines are critical in building and increasing the pressure towards screening of sporadic-appearing disease and offspring of known gene families by encompassing the complete disease spectrum early on.

13.
J Midwifery Womens Health ; 2022 Nov 25.
Article in English | MEDLINE | ID: mdl-36433687

ABSTRACT

The number of individuals choosing to give birth in a freestanding birth center has doubled since 2004. As many as half of all pregnant persons planning for a birth center birth ultimately develop medical complications and are unable to give birth outside of the hospital. Integrating birth centers into their regional perinatal health care system optimizes outcomes by establishing predetermined pathways for antepartum and intrapartum transfers of care and facilitates ongoing communication and cooperation among clinicians. The Vanderbilt Birth Center is a freestanding birth center that is operated by an academic medical center and partners with a hospital-based midwifery practice that cares for patients transferring from the birth center. Since the inception of the birth center in 2015, the entire perinatal team has worked to improve the process and experience of patient transfer from birth center to hospital care. This article will present strategies implemented through the ongoing collaboration between birth center and hospital health care providers. These include adopting a shared electronic health record, clinical practice guidelines that align across birth sites, preparing birth center patients prenatally for the possibility hospital transfer, the presentation of a united team across birth sites, clear and widely disseminated communication pathways for hospital admission and patient handoff, and ongoing opportunities for interteam communication, collaboration, and education. These strategies may benefit similar midwifery practice models as they seek to partner with larger health care systems and improve the transfer experience for their patients.

14.
J Prim Care Community Health ; 13: 21501319221137251, 2022.
Article in English | MEDLINE | ID: mdl-36398937

ABSTRACT

INTRODUCTION: Implementing patient- and family-centered communication strategies has proven challenging in primary care, particularly for persons with dementia. To address this, we designed SHARING Choices, a multicomponent intervention combining patient and family partnered agenda setting, electronic portal access, and supports for advance care planning (ACP). This qualitative descriptive study describes factors affecting SHARING Choices implementation within primary care. METHODS: Semi-structured interviews or focus groups with patient/family dyads (family, friends, unpaid caregivers) and primary care stakeholders (clinicians, staff, administrators) elicited perceived barriers and facilitators of SHARING Choices implementation. Field notes and interview transcripts were coded using template analysis along the Consolidated Framework for Implementation Research (CFIR) constructs. Content analysis identified themes not readily categorized within CFIR. RESULTS: About 22 dyads, including 14 with cognitive impairment, and 30 stakeholders participated in the study. Participants were receptive to the SHARING Choices components. Enablers of SHARING Choices included adaptability of the intervention, purposive engagement of family (particularly for patients with dementia), consistency with organizational priorities, and the relative advantage of SHARING Choices compared to current practices. Perceived barriers to implementation included intervention complexity, space constraints, workflow, and ACP hesitancy. The ACP facilitator was perceived as supportive in addressing individual and organizational implementation barriers including patient health and technology literacy and clinician time for ACP discussions. CONCLUSIONS: Patients, family, and primary care clinicians endorsed the objectives and individual components of SHARING Choices. Strategies to enhance adoption were to simplify materials, streamline processes, leverage existing workflows, and embed ACP facilitators within the primary care team.


Subject(s)
Advance Care Planning , Dementia , Humans , Aged , Qualitative Research , Communication , Primary Health Care , Dementia/therapy
15.
Scand J Prim Health Care ; : 1-11, 2022 Nov 09.
Article in English | MEDLINE | ID: mdl-36350846

ABSTRACT

OBJECTIVE: When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change. DESIGN: Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September-December 2020, the second round from January-April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2-4 months apart. To analyze the data, we used thematic analysis. RESULTS: The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal. CONCLUSIONS: Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response.Key PointsFacing the COVID-19 pandemic, the primary health care service in Norway had to reorganize to ensure safe patient treatment and maintain infection control.Several GPs experienced challenges in collaboration with the municipalities.There is a need for clarification of responsibilities between GPs and the municipality.

16.
Adv Anesth ; 40(1): 223-239, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36333049

ABSTRACT

Advocating for anesthesiology is a professional responsibility. We need to make the public aware of the role we play in assuring their safety and comfort; and we must also ensure that payment models are fair and commensurate with the quality of our work.


Subject(s)
Anesthesiologists , Anesthesiology , Humans
17.
Fam Pract ; 2022 Oct 29.
Article in English | MEDLINE | ID: mdl-36308304

ABSTRACT

BACKGROUND: Headache disorders are globally prevalent and insufficient treatment contribute to low quality of life, increased disability, and socioeconomic costs. However, headache can to a large extent be treated appropriately by general practitioners. OBJECTIVE: To explore general practitioners' (GPs') management of patients with headache lasting ≥6 months. METHODS: In this retrospective descriptive cross-sectional study based on medical audit, all GPs practicing in Vejle municipality (population 116,992), Denmark, were invited to review their latest 20 patients with headache. Outcome measures were headache diagnostics, treatment, and referrals. Factors associated with referral to neurological treatment were examined by logistic regression. RESULTS: Of 26 invited practices, 19 participated reporting on 367 patients with lasting headache (71.4% women; mean-age 48.5 years). One hundred and sixty-one patients had migraine (44%; IQR: 28-60%), 140 (38%; IQR: 25-44%) had tension-type headache; 243 (66%; IQR: 50-79%) used simple analgesics, 147 (40%; IQR: 29-59%) triptans, 37 (10%; IQR: 0-14%) opioids, 93 (25%; IQR: 20-35%) were prescribed preventive medication; 176 (48%; IQR: 48-59%) were referred to neurologist, and 92 (25%; IQR: 10-37%) were referred to CT or MRI scan. Associated factors for referral were >1 headache diagnosis (aOR 1.75 [95% CI: 1.05-2.95]; P = 0.03), post-traumatic headache (aOR 2.53 [95% CI: 1.25-5.38]; P = 0.01), unspecific headache (aOR 2.04 [95% CI: 1.08-3.93]; P = 0.03), and using preventive treatment (aOR 2.75 [95% CI: 1.68-4.57]; P < 0.001). CONCLUSION: This study provides insights to how GPs manage patients with long-lasting headache. Focus should be on reducing opioids, increasing preventive treatment, and keeping more patients in primary care.

18.
Int J Qual Health Care ; 34(4)2022 Nov 21.
Article in English | MEDLINE | ID: mdl-36281982

ABSTRACT

BACKGROUND: Although cardiac troponin is recommended as the biomarker of choice to evaluate myocardial injury, inappropriate low-value ordering practice is frequent, particularly routine ordering of creatine kinase-myocardial band (CK-MB) tests where troponin is available. OBJECTIVE: The aim of this study was to evaluate the impact of an educational intervention for rational request of cardiac biomarkers in the intensive care unit. METHOD: We conducted a quasi-experimental, pre-post implementation study of an educational program (expository-dialogue presentation and disclosure of a decision algorithm) for rational cardiac biomarker testing in adult critically ill patients. The study was divided into two 12-month periods: pre-intervention (September 2017-August 2018) and post-intervention (October 2018-September 2019). An interrupted time series with a segmented regression model was applied to analyze variation over time in CK-MB and troponin testing. RESULTS: We included 4429 patients: 2181 patients in the pre-intervention period and 2248 patients in the post-intervention period. A reduction in the concomitance of CK-MB and troponin testing was observed (concomitance in 1415 tests in the pre-intervention period vs 348 tests in the post-intervention period). The interrupted time series analysis demonstrated a noticeable immediate reduction in the concomitance of CK-MB with troponin after the intervention (-0.13 tests per patient, P = 0.0016) but not in the secular trend for the concomitance. The proportion of patients with the acute coronary syndrome as a discharge diagnosis was not different between the pre- and post-intervention period. CONCLUSION: Our pre-post interventional study demonstrated a significant decrease in the concomitance of CK-MB and troponin tests. A rational high-value ordering practice of cardiac biomarkers is possible in critically ill patients and might be suitable for educational interventions.


Subject(s)
Acute Coronary Syndrome , Critical Illness , Adult , Humans , Creatine Kinase, MB Form , Troponin , Acute Coronary Syndrome/diagnosis , Biomarkers
19.
J Am Coll Radiol ; 2022 Oct 05.
Article in English | MEDLINE | ID: mdl-36216708

ABSTRACT

Radiology practices characterized as small and rural are challenged to recruit and retain interventional radiologists. Lack of access to interventional radiologic services results in a failure to meet the needs of patients, hospitals, and other community stakeholders. Acknowledging this challenge, the ACR's Commission on General, Small, Emergency and/or Rural Practice and Commission on Interventional and Cardiovascular Imaging and the Society of Interventional Radiology partnered to establish a joint task force to study this issue and identify strategies the ACR and the Society of Interventional Radiology should take to improve small and rural practice recruitment and retention of interventional radiologists. This report describes the deliberations and recommendations of the task force.

20.
Front Rehabil Sci ; 3: 921558, 2022.
Article in English | MEDLINE | ID: mdl-36188955

ABSTRACT

Background: In the second year of the COVID-19 pandemic, Physical and Rehabilitation Medicine (PRM) residents in a developing country continue to face a lack of in-person clinical exposure and learning opportunities. With the unprecedented shift to virtual care, it remains uncertain whether residents can achieve PRM competencies using telerehabilitation as a method of instruction. Objective: To determine the PRM residents' ability to achieve competencies through telerehabilitation, as perceived by different stakeholders (residents, chief residents, training officers, and department heads). Methods: This will be a pilot mixed-methods study, employing concurrent triangulation, in the Department of Rehabilitation Medicine in one large private medical center and one large government hospital in Manila, Philippines. There will be two phases of online data collection upon approval by their respective research ethics board. The first phase will involve an online Likert-scale questionnaire to obtain the residents' self-perceived attainment of competencies and learning of PRM topics and skills specified by the International Society of Physical and Rehabilitation Medicine and the Philippine Board of Rehabilitation Medicine. The results of the survey will then be summarized and presented in a focus group discussion (FGD) with the department heads, training officers, and chief residents of the two institutions in an attempt to explain the residents' perceptions on their competencies achieved through virtual care. Afterwards, the qualitative data obtained from the FGD will then be thematically analyzed, and mixed methods integration will be employed to generate knowledge and recommendations. Discussion: It is hypothesized that the majority of the residents had little to no experience with telerehabilitation pre-pandemic. Suddenly telerehabilitation was used to augment clinical training during the pandemic. It is uncertain whether telerehabilitation can help residents achieve competencies in the different domains of training, namely: patient safety and quality patient care; medical knowledge and procedural skills; interpersonal and communication skills; practice- and systems-based learning and improvement; reintegration of people with disabilities into the society; medical ethics and public health; quality assurance; policies of care and prevention for disabled people; and professionalism. The study results can provide insights on the aspects of a PRM curriculum that may have to be modified to ensure the training program is sensitive and appropriate to the changing training needs of the residents amid the pandemic and similar crises that may disrupt in-person clinical encounters in the future.

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