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CMOs look at need for blood cultures before prescribing antibiotics.
Ikizler TA
(2015) Nephrol News Issues 29: 32-3
MeSH Terms: Algorithms, Ambulatory Care Facilities, Anti-Bacterial Agents, Bacteremia, Humans, Physician Executives, Practice Patterns, Physicians', Renal Dialysis, United States
Added November 5, 2015
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1 Members
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9 MeSH Terms
Use of Six Sigma for eliminating missed opportunities for prevention services.
Gittner LS, Husaini BA, Hull PC, Emerson JS, Tropez-Sims S, Reece MC, Zoorob R, Levine RS
(2015) J Nurs Care Qual 30: 254-60
MeSH Terms: Ambulatory Care Facilities, Evidence-Based Nursing, Female, Humans, Male, Medical Staff, Minority Groups, Nurse Administrators, Organizational Case Studies, Preventive Health Services, Primary Health Care, Quality Improvement, Total Quality Management
Show Abstract · Added February 21, 2017
Delivery of primary care preventative services can be significantly increased utilizing Six Sigma methods. Missed preventative service opportunities were compared in the study clinic with the community clinic in the same practice. The study clinic had 100% preventative services, compared with only 16.3% in the community clinic. Preventative services can be enhanced to Six Sigma quality when the nurse executive and medical staff agree on a single standard of nursing care executed via standing orders.
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13 MeSH Terms
Psychometric properties of the brief health literacy screen in clinical practice.
Wallston KA, Cawthon C, McNaughton CD, Rothman RL, Osborn CY, Kripalani S
(2014) J Gen Intern Med 29: 119-26
MeSH Terms: Academic Medical Centers, Adult, Aged, Ambulatory Care Facilities, Educational Measurement, Female, Health Literacy, Humans, Male, Mass Screening, Middle Aged, Nursing Service, Hospital, Patient Admission, Primary Care Nursing, Psychometrics, ROC Curve, Reproducibility of Results, Tennessee
Show Abstract · Added December 10, 2013
BACKGROUND - The three-item Brief Health Literacy Screen (BHLS) has been validated in research settings, but not in routine practice, administered by clinical personnel.
OBJECTIVE - As part of the Health Literacy Screening (HEALS) study, we evaluated psychometric properties of the BHLS to validate its administration by clinical nurses in both clinic and hospital settings.
PARTICIPANTS - Beginning in October 2010, nurses in clinics and the hospital at an academic medical center have administered the BHLS during patient intake and recorded responses in the electronic health record.
MEASURES - Trained research assistants (RAs) administered the short Test of Functional Health Literacy in Adults (S-TOFHLA) and re-administered the BHLS to convenience samples of hospital and clinic patients. Analyses included tests of internal consistency reliability, inter-administrator reliability, and concurrent validity by comparing the nurse-administered versus RA-administered BHLS scores (BHLS-RN and BHLS-RA, respectively) to the S-TOFHLA.
KEY RESULTS - Cronbach's alpha for the BHLS-RN was 0.80 among hospital patients (N = 498) and 0.76 among clinic patients (N = 295), indicating high internal consistency reliability. Intraclass correlation between the BHLS-RN and BHLS-RA among clinic patients was 0.77 (95 % CI 0.71-0.82) and 0.49 (95 % CI 0.40-0.58) among hospital patients. BHLS-RN scores correlated significantly with BHLS-RA scores (r = 0.33 among hospital patients; r = 0.62 among clinic patients), and with S-TOFHLA scores (r = 0.35 among both hospital and clinic patients), providing evidence of inter-administrator reliability and concurrent validity. In regression models, BHLS-RN scores were significant predictors of S-TOFHLA scores after adjustment for age, education, gender, and race. Area under the receiver operating characteristic curve for BHLS-RN to predict adequate health literacy on the S-TOFHLA was 0.71 in the hospital and 0.76 in the clinic.
CONCLUSIONS - The BHLS, administered by nurses during routine clinical care, demonstrates adequate reliability and validity to be used as a health literacy measure.
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18 MeSH Terms
Self-reported dietary intake and appetite predict early treatment outcome among low-BMI adults initiating HIV treatment in sub-Saharan Africa.
Koethe JR, Blevins M, Bosire C, Nyirenda C, Kabagambe EK, Mwango A, Kasongo W, Zulu I, Shepherd BE, Heimburger DC
(2013) Public Health Nutr 16: 549-58
MeSH Terms: Adult, Ambulatory Care Facilities, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Appetite, Body Mass Index, CD4 Lymphocyte Count, Culture, Diet, Energy Intake, Female, HIV Infections, Humans, Hunger, Male, Malnutrition, Observation, Prospective Studies, Risk Factors, Self Report, Survivors, Treatment Outcome, Zambia
Show Abstract · Added May 27, 2014
OBJECTIVE - Low BMI is a major risk factor for early mortality among HIV-infected persons starting antiretrovial therapy (ART) in sub-Saharan Africa and the common patient belief that antiretroviral medications produce distressing levels of hunger is a barrier to treatment adherence. We assessed relationships between appetite, dietary intake and treatment outcome 12 weeks after ART initiation among HIV-infected adults with advanced malnutrition and immunosuppression.
DESIGN - A prospective, observational cohort study. Dietary intake was assessed using a 24 h recall survey. The relationships of appetite, intake and treatment outcome were analysed using time-varying Cox models.
SETTING - A public-sector HIV clinic in Lusaka, Zambia.
SUBJECTS - One hundred and forty-two HIV-infected adults starting ART with BMI <16 kg/m2 and/or CD4+ lymphocyte count <50 cells/μl.
RESULTS - Median age, BMI and CD4+ lymphocyte count were 32 years, 16 kg/m2 and 34 cells/μl, respectively. Twenty-five participants (18%) died before 12 weeks and another thirty-three (23%) were lost to care. A 500 kJ/d higher energy intake at any time after ART initiation was associated with an approximate 16% reduction in the hazard of death (adjusted hazard ratio = 0.84; P = 0.01), but the relative contribution of carbohydrate, protein or fat to total energy was not a significant predictor of outcome. Appetite normalized gradually among survivors and hunger was rarely reported.
CONCLUSIONS - Poor early ART outcomes were strikingly high in a cohort of HIV-infected adults with advanced malnutrition and mortality was predicted by lower dietary intake. Intervention trials to promote post-ART intake in this population may benefit survival and are warranted.
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23 MeSH Terms
Professional outcomes of completing a clinical nutrition fellowship: Cleveland Clinic's 16-year experience.
Rivera R, Kirby DF, Steiger E, Seidner DL
(2010) Nutr Clin Pract 25: 497-501
MeSH Terms: Academic Medical Centers, Ambulatory Care Facilities, Attitude of Health Personnel, Career Choice, Clinical Competence, Data Collection, Education, Medical, Continuing, Fellowships and Scholarships, Gastroenterology, Humans, Motivation, Nutritional Sciences, Ohio, Physicians, Professional Practice
Show Abstract · Added September 30, 2015
BACKGROUND - Cleveland Clinic has trained 17 physician nutrition specialists since the establishment of its clinical nutrition fellowship (CNF) in 1994. The paths taken by the graduates and whether they continue to practice clinical nutrition are largely unknown.
METHODS - To investigate the professional outcomes of completing a CNF, a survey of graduates was conducted.
RESULTS - Fifty-seven percent of respondents (n = 8) applied to another fellowship prior to applying to a CNF. The 2 most common reasons for applying to a CNF were to increase knowledge of clinical nutrition and increase the chance of acquiring a gastroenterology fellowship. Eighty-five percent (n = 10) of graduates found the CNF to be valuable. Eighty-six percent (n = 12) went on to complete a gastroenterology fellowship, and 67% (n = 8) of graduates believed that completing a CNF increased their chances of gaining acceptance to a gastroenterology fellowship. Only 42% (n = 6) of the graduates currently hold professions that specifically dictate the use of clinical nutrition, but 61% (n = 8) reported using clinical nutrition in their daily or weekly practice. Fifty percent (n = 7) of graduates believed that completing a CNF made them more competitive job candidates, but only 21% (n = 3) said that their extra training is reflected in their current salary.
CONCLUSIONS - It appears that CNFs are being used as a method of subsequently acquiring a gastroenterology or other medical fellowships. Although not working in defined clinical nutrition professions, >50% of graduates continue to apply their CNF skills after completing their training. A small percentage have found dedicated nutrition-based clinical professions.
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15 MeSH Terms
Is it always wrong to perform futile CPR?
Choma DP, Cavanaugh KL, Dwyer JP
(2010) N Engl J Med 362: 2036; author reply 2036-7
MeSH Terms: Ambulatory Care Facilities, Cardiopulmonary Resuscitation, Humans, Medical Futility, Renal Dialysis
Added August 19, 2013
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5 MeSH Terms
Buckle fractures in children: Is urgent treatment necessary?
Bennett DL, Mencio GA, Hernanz-Schulman M, Nealy BJ, Damon B, Kan JH
(2009) J Fam Pract 58: E1-6
MeSH Terms: Adolescent, Ambulatory Care Facilities, Child, Child, Preschool, Cohort Studies, Costs and Cost Analysis, Emergency Medical Services, Emergency Treatment, Female, Fractures, Bone, Health Care Costs, Humans, Infant, Male, Orthopedic Procedures, Referral and Consultation, Retrospective Studies, Time Factors
Show Abstract · Added May 29, 2014
PURPOSE - To determine whether the clinical outcome of buckle fractures in children differs between those treated acutely on the same day of trauma and those treated subacutely, and whether a change in practice patterns based on these data would result in cost savings.
METHODS - In this retrospective cohort study-approved by the institutional review board-we reviewed the cases of 341 consecutive patients younger than 18 years of age seen by the pediatric orthopedic clinic for treatment of isolated extremity buckle fractures between July 1, 2004 and August 31, 2007. Time from injury to treatment was used to divide patients into 2 groups: acute (1 day or less; n=155) and subacute treatment (more than 1 day; n=186). Clinical outcome at final orthopedic follow-up was recorded for each patient. We defined adverse outcome as fractures requiring manipulation, clinically apparent deformity, or functional impairment. Charge analysis compared differences in management costs for patients with buckle fractures presenting initially to the emergency department (ED) and those seen solely in the orthopedic clinic.
RESULTS - No adverse outcomes were identified in either acute or subacute treatment groups. Total clinical visits did not vary (acute, 3.2 vs subacute, 3.1; P=.051). Presence of mild angulation of fractures on radiographs did not differ significantly between acute and subacute management groups at initial presentation (6.5% vs 8.6%; P=.541) or at final follow-up (12.2% vs 12.4%; P=1.0). A cost savings of approximately $3000 could have been realized for each patient referred to the ED who might otherwise have been seen subacutely in the orthopedic clinic.
CONCLUSIONS - No adverse clinical outcomes resulted from subacute treatment of stable buckle fractures. Cost and time savings may be realized with subacute management of buckle fractures without affecting clinical outcome.
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18 MeSH Terms
Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings.
Grijalva CG, Nuorti JP, Griffin MR
(2009) JAMA 302: 758-66
MeSH Terms: Acute Disease, Adolescent, Adult, Ambulatory Care Facilities, Anti-Bacterial Agents, Child, Child, Preschool, Drug Utilization, Female, Health Care Surveys, Humans, Infant, Male, Otitis Media, Practice Patterns, Physicians', Respiratory Tract Infections, United States, Young Adult
Show Abstract · Added July 27, 2018
CONTEXT - During the 1990s, antibiotic prescriptions for acute respiratory tract infection (ARTI) decreased in the United States. The sustainability of those changes is unknown.
OBJECTIVE - To assess trends in antibiotic prescriptions for ARTI.
DESIGN, SETTING, AND PARTICIPANTS - The National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data (1995-2006) were used to examine trends in antibiotic prescription rates by antibiotic indication and class. Annual survey data and census denominators were combined in 2-year intervals for rate calculations.
MAIN OUTCOME MEASURES - National annual visit rates and antibiotic prescription rates for ARTI, including otitis media (OM) and non-ARTI.
RESULTS - Among children younger than 5 years, annual ARTI visit rates decreased by 17% (95% confidence interval [CI], 9%-24%), from 1883 per 1000 population in 1995-1996 to 1560 per 1000 population in 2005-2006, primarily due to a 33% (95% CI, 22%-43%) decrease in OM visit rates (950 to 634 per 1000 population, respectively). This decrease was accompanied by a 36% (95% CI, 26%-45%) decrease in ARTI-associated antibiotic prescriptions (1216 to 779 per 1000 population). Among persons aged 5 years or older, ARTI visit rates remained stable but associated antibiotic prescription rates decreased by 18% (95% CI, 6%-29%), from 178 to 146 per 1000 population. Antibiotic prescription rates for non-OM ARTI for which antibiotics are rarely indicated decreased by 41% (95% CI, 22%-55%) and 24% (95% CI, 10%-37%) among persons younger than 5 years and 5 years or older, respectively. Overall, ARTI-associated prescription rates for penicillin, cephalosporin, and sulfonamide/tetracycline decreased. Prescription rates for azithromycin increased and it became the most commonly prescribed macrolide for ARTI and OM (10% of OM visits). Among adults, quinolone prescriptions increased.
CONCLUSIONS - Overall antibiotic prescription rates for ARTI decreased, associated with fewer OM visits in children younger than 5 years and with fewer prescriptions for ARTI for which antibiotics are rarely indicated. However, prescription rates for broad-spectrum antibiotics increased significantly.
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MeSH Terms
Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease.
Pogue V, Rahman M, Lipkowitz M, Toto R, Miller E, Faulkner M, Rostand S, Hiremath L, Sika M, Kendrick C, Hu B, Greene T, Appel L, Phillips RA, African American Study of Kidney Disease and Hypertension Collaborative Research Group
(2009) Hypertension 53: 20-7
MeSH Terms: Adolescent, Adult, African Americans, Aged, Ambulatory Care Facilities, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Circadian Rhythm, Cohort Studies, Cross-Sectional Studies, Female, Humans, Hypertension, Renal, Kidney, Kidney Diseases, Male, Middle Aged, Prevalence, Reproducibility of Results, Severity of Illness Index, Young Adult
Show Abstract · Added March 25, 2014
Ambulatory blood pressure (ABP) monitoring provides unique information about day-night patterns of blood pressure (BP). The objectives of this article were to describe ABP patterns in African Americans with hypertensive kidney disease, to examine the joint distribution of clinic BP and ABP, and to determine associations of hypertensive target organ damage with clinic BP and ABP. This study is a cross-sectional analysis of baseline data from the African American Study of Kidney Disease Cohort Study. Masked hypertension was defined by elevated daytime (>or= 135/85 mm Hg) or elevated nighttime (>or= 120/70 mm Hg) ABP in those with controlled clinic BP (<140/90 mm Hg); nondipping was defined by a
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21 MeSH Terms
Dialysis facility ownership and epoetin dosing in hemodialysis patients: a dialysis provider's perspective.
Lazarus JM, Hakim RM
(2007) Am J Kidney Dis 50: 366-70
MeSH Terms: Ambulatory Care Facilities, Anemia, Epoetin Alfa, Erythropoietin, Health Personnel, Hematinics, Humans, Ownership, Recombinant Proteins, Renal Dialysis
Added May 20, 2014
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10 MeSH Terms