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1 |
Canadian family physician knowledge and attitudes toward laboratory utilization management
دانش پزشک خانواده در کانادا و نگرش نسبت به مدیریت بهره وری آزمایشگاه-2016 Objectives: Mitigation of unnecessary and redundant laboratory testing is an important quality assurance
priority for laboratories and represents an opportunity for cost savings in the health care system. Family physicians represent the largest utilizers of laboratory testing by a large margin. Engagement of family physicians is
therefore key to any laboratory utilization management initiatives. Despite this, family physicians have been
largely excluded from the planning and implementation of such initiatives. Our purposes were to (1) assess
the importance of lab management issues to family physicians, and (2) attempt to define the types of initiatives
most acceptable to family physicians.
Design and methods: We invited all Alberta family practice residents and practicing physicians to participate in a self-administered online electronic survey. Survey questions addressed the perceived importance of lab misutilization, prevalence of various types of misutilization, acceptability of specific approaches to quality control, and responsibility of various parties to address this issue. Results: Of 162 respondents, 95% considered lab misutilization to be either important or very important. Many physicians placed the responsibility for addressing lab misutilization issues on multiple parties, including patients, but most commonly the ordering physician (97%). Acceptability for common strategies for quality improvement in lab misutilization showed a wide range (35%–98%). Conclusions: These responses could serve as a framework for laboratories to begin discussions on this important topic with primary care groups. Keywords: Alberta | Cost savings | Family practice | Laboratories | Quality improvement |
مقاله انگلیسی |
2 |
The radiological diagnosis of frontotemporal dementia in everyday practice: an audit of reports, review of diagnostic criteria, and proposal for service improvement
تشخیص رادیولوژیک فراموشی پیشانی گیجگاهی در عمل روزمره: حسابرسی از گزارش ها، مروری بر معیارهای تشخیصی، و پیشنهاد برای بهبود خدمات-2016 AIM: To investigate how commonly valuable diagnostic information regarding the frontotemporal dementias (FTDs) may be missed on routine radiological reporting.
MATERIALS AND METHODS: The magnetic resonance imaging (MRI) examination results of a series of 39 consecutive patients in whom the diagnosis was initially thought to be a form of FTD were audited. Twenty-two patients satisfied formal diagnostic criteria for subtypes of FTD. The initial non-specialist radiological reports of the MRI examinations were compared with those of a radiologist who specifically examined the images for the possibility of atypical dementia. RESULTS: Six of the 22 original reports provided a full and accurate description of the radiological findings, while two provided a fully accurate interpretation. CONCLUSION: Valuable diagnostic information may be missed unless clinicians and radiologists jointly review and discuss brain imaging in cases of dementia. The use of standardised scales may enhance the reporting of MRI examinations for dementia. |
مقاله انگلیسی |
3 |
Injured patients with very high blood alcohol concentrations
بیماران دارای جراحت با غلظت الکل خون بسیار بالا-2016 Objective: Most data regarding high blood alcohol concentrations (BAC) 400 mg/dL have been from
alcohol poisoning deaths. Few studies have described this group and reported their alcohol consumption
patterns or outcomes compared to other trauma patients. We hypothesised trauma patients with very
high BACs arrived to the trauma centre with less severe injuries than their sober counterparts.
Method: Historical cohort of 46,222 patients admitted to a major trauma centre between January 1, 2002 and October 31, 2011. BAC was categorised into ordinal groups by 100 mg/dL intervals. Alcohol questionnaire data on frequency and quantity was captured in the BAC 400 mg/dL group. The primary analysis was for BAC 400 mg/dL. Results: BAC was recorded in 44,502 (96.3%) patients. Those with a BAC 400 mg/dL accounted for 1.1% (147) of BAC positive cases. These patients had the lowest proportion of severe trauma and in-hospital death in comparison with the other alcohol groups (p < 0.001). In adjusted analysis, the risk for severe injury increased with the BAC groups between 1 and 199 mg/dL and was not different or decreased for groups above 200 mg/dL in reference to the BAC negative group (test for trend p = 0.001). BAC 400 group encountered more injuries caused by blunt trauma in comparison with the other alcohol groups (p < 0.001), and the group comprised mainly of falls. Admission Glasgow Coma Scale was a poor predictor for traumatic brain injury in the high BAC group. Readmission occurred in 22.4% (33) of patients the BAC 400 group. The majority of these patients reported drinking alcohol 4 or more days per week (81, 67.5%) and five or more drinks per day (79, 65.8%), evident of risky alcohol use. Conclusions: Most traumas admitted with BAC 400 mg/dL survived and their injuries were less severe than their less intoxicated and sober counterparts. They also had evidence for risky alcohol use and nearly one-quarter returned to the trauma centre with another injury over the study period. Recognition of this highest BAC group presents an opportunity to provide focused care for their risky alcohol use. Keywords: Injury | Injury prevention | Blood alcohol level | Ethanol | Trauma recidivism | Alcohol consumption | Alcohol use disorder | Blunt trauma | Forensic toxicology | Alcohol poisoning |
مقاله انگلیسی |
4 |
Use of a discrete-event simulation in a Kaizen event: A case study in healthcare
استفاده از یک شبیه سازی رویداد گسسته در یک رویداد کایزن: مطالعه موردی در بهداشت و درمان-2016 Article history:Received 10 March 2014Accepted 23 August 2015 Available online 31 August 2015Keywords:Discrete-event simulation Business gameLean approach Kaizen event Outpatient clinicTo improve service delivery, healthcare facilities look toward operations research techniques, discrete event simulation and continuous improvement approaches such as Lean manufacturing. Lean management often includes a Kaizen event to facilitate the acceptance of the project by the employees. Business game is also used as a tool to increase understanding of Lean management concepts. In this paper, we study how a business game can be used jointly with discrete event simulation to test scenarios defined by team members during a Kaizen event. The aim is to allow a rapid and successful implementation of the solutions developed during the Kaizen. Our approach has been used to improve patients’ trajectory in an outpatient hematology–oncology clinic. Patient delays before receiving their treatment were reduced by 74 percent after 19 weeks.© 2015 Elsevier B.V. and Association of European Operational Research Societies (EURO) within the International Federation of Operational Research Societies (IFORS). All rights reserved.
Keywords: Discrete-event simulation | Business game | Lean approach | Kaizen event | Outpatient clinic |
مقاله انگلیسی |
5 |
Compliance with standard precautions: Results of a French national audit
انطباق با اقدامات احتیاطی استاندارد: نتایجی از تفتیش ملی فرانسه-2016 Background: Standard precautions(SPs)aim to reducetherisk of cross-transmission ofmicroorganisms. The
objectives of the present study were to assess institutional policies for SPs promotion, available resources for
SPs implementation, and education of health care workers (HCWs) and their compliance with SPs.
Methods: A multisite mixed-methods audit was conducted in 2011. Self-assessment questionnaires were administered at institution, ward, and HCW levels in French health care facilities (HCFs). Results were given as percentage of objectives achieved (POA) or percentage of “never or sometimes,” “often,” and “always” responses for each question. Results: A total of 1599 HCFs participated, including 14,968 wards and 203,840 HCWs. At an institutional level, the POA was 88%, covering SPs promotion (91%), procedures (99%), and SPs evaluation (63%). At the ward level, the POA was 94%, covering procedures (95%) and resources (93%). HCWs reported the best compliance for changing gloves between patients (94.5% “always”), and the worst compliance for the use of gloves for intramuscular injection and the use of eye protection in cases of blood exposure risk (34.5% and 24.4% of “always,” respectively). Conclusions: A literature review found no other study of SPs that included such a large study group. These results led to SPs promotion actions at local and regional levels. Reinforcement of SPs observance will be prioritized in the next national program from the French Ministry of Health. Key Words: Assessment | France | Hand hygiene | Health care workers | National audit | Standard precautions |
مقاله انگلیسی |
6 |
From innovation to infection prevention
از نوآوری تا پیشگیری از عفونت-2016 Despite evidence for interventions that reduce health careassociated infections, there remains a significant gap between
evidence and practice. Furthermore, there are limited data on the
optimal strategies for bridging that gap; that is, for improving provider uptake of evidence-based prevention strategies across different
settings.1 The Association for Professionals in Infection Control and
Epidemiology (APIC) has developed 2 programs that are aligned with
the association’s strategic plan to help bridge this gap:2 the Heroes
of Infection Prevention awards (Heroes) and the Heroes Implementation Research Scholar Award Program. The Heroes program awards
members who have successfully developed and applied innovative infection prevention programs. The Heroes Implementation
Research Scholar award promotes research in implementation
science, which is the study of strategies to adopt and promote the
integration of research findings and evidence into practice in specific settings. |
مقاله انگلیسی |
7 |
Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa
نارسایی های غذایی، افسردگی، و نقش اصلاح حمایت اجتماعی: شواهدی از یک، هم گروهی آینده نگر مبتنی بر جمعیت زنان باردار در حومه شهری آفریقای جنوبی-2016 Rationale: Food insecurity has emerged as an important, and potentially modifiable, risk factor for depression. Few studies have brought longitudinal data to bear on investigating this association in sub- Saharan Africa.Objective: To estimate the association between food insufficiency and depression symptom severity, and to determine the extent to which any observed associations were modified by social support.Methods and results: We conducted a secondary analysis of population-based, longitudinal data collected from 1238 pregnant women during a three-year cluster-randomized trial of a home visiting intervention in Cape Town, South Africa. Surveys were conducted at baseline, 6 months, 18 months, and 36 months (85% retention). A validated, single-item food insufficiency measure inquired about the number of days of hunger in the past week. Depression symptom severity was measured using the Xhosa version of the 10- item Edinburgh Postnatal Depression Scale. In multivariable regression models with cluster-correlatedrobust estimates of variance, lagged food insufficiency had a strong and statistically significant associ- ation with depression symptom severity (b ¼ 0.70; 95% CI, 0.46e0.94), suggesting a 6.5% relative dif- ference in depression symptom severity per day of hunger. In stratified analyses, food insufficiency had a statistically significant association with depression only among women with low levels of instrumental support. Using quantile regression, we found that the adverse impacts of food insufficiency wereexperienced to a greater degree by women in the upper end of the conditional distribution of depression symptom severity. Estimates from fixed-effects regression models and fixed-effects quantile regression models, accounting for unobserved confounding by time-invariant characteristics, were similar.Conclusions: Food insufficiency was associated with depression symptom severity, particularly for women in the upper end of the conditional depression distribution. Instrumental social support buffered women against the adverse impacts of food insufficiency.© 2016 Elsevier Ltd. All rights reserved.
Keywords: Food insufficiency | Depression | Social support | South Africa |
مقاله انگلیسی |
8 |
Socially anxious smokers experience greater negative affect and withdrawal during self-quit attempts
Socially anxious smokers experience greater negative affect and withdrawal during self-quit attempts-2016 Despite evidence of a strong and consistent relation between smoking and elevated social anxiety, strikingly little empirical work has identified mechanisms underlying the smoking-social anxiety link. Persons with elevated so- cial anxiety may rely on smoking to cope with more severe nicotine withdrawal and post-quit negative mood states; yet, no known studies have investigated the relation of social anxiety to withdrawal severity. The current study examined the relation of social anxiety to post-quit nicotine withdrawal severity among 51 (33.3% female, Mage = 34.6) community-recruited smokers during the first two weeks following an unaided (i.e., no treatment) cessation attempt. Ecological momentary assessment was used to collect multiple daily ratings of withdrawal and negative mood states. Baseline social anxiety was related to increases in negative affect during the monitor- ing period and remained significantly related to post-quit withdrawal after controlling for negative affect, gender, lapses, and substance use. Persons with elevated social anxiety experience more severe post-quit withdrawal symptoms and increases in negative affect during a cessation attempt and may therefore benefit from interven- tion and treatment strategies geared toward helping them learn to cope with withdrawal and negative affect to improve cessation rates among these vulnerable smokers.© 2016 Elsevier Ltd. All rights reserved.
Keywords: Social anxiety | Self-quit | Smoking cessation | Nicotine withdrawal | Negative affect | Ecological momentary assessment |
مقاله انگلیسی |
9 |
Different versions of the Alcohol Use Disorders Identification Test (AUDIT) as screening instruments for underage binge drinking
نسخه های مختلف از آزمون شناسایی اختلالات الکل (حسابرسی) به عنوان ابزار غربالگری برای نوشیدن شراب خواری زیر سن قانونی-2016 Background: The changes experienced in recent years in the conceptualization of binge drinking (BD)
make it necessary to revise the usefulness of the existing instruments for its detection among minors.
The AUDIT and its abbreviated versions have shown their utility in different populations and consumption
ranges, but there has been little research into their use in the detection of BD among adolescents. This
study tests the capacity of the AUDIT, AUDIT-C and AUDIT-3 to identify BD adolescents, indicating the
optimal cut-off points for each sex.
Methods: High school students self-administered the AUDIT and completed a weekly self-report of their alcohol intake. BD is classified into different groups according to parameters like the quantity consumed and its frequency in the past six months, adjusting the cut-off points for each case. Results: The results obtained with a sample of 634 adolescents (15–17 years old/52.2% female) indicate that cut-off points of 4 on the AUDIT and 3 on the AUDIT-C show the best fit. Dividing the sample by sexes, the AUDIT and the AUDIT-C would detect BD males with scores of 5 and 4, respectively (with the AUDIT-C being more sensitive), and BD females with a score of 3 on both (the more sensitive being the AUDIT). Conclusions: All three versions are adequate to classify BD adolescents but none of them made it possible to safely differentiate binge drinkers with different consumption intensities. Keywords: Binge drinking | Receiver operating characteristic (ROC) | curve | Underage | Alcohol screening | AUDIT |
مقاله انگلیسی |
10 |
Unhealthy alcohol use in older adults: Association with readmissions and emergency department use in the 30 days after hospital discharge
مصرف الکل ناسالم در افراد مسن: مرتبط با بستری مجدد و استفاده بخش اورژانس در 30 روز پس از ترخیص از بیمارستان-2016 Background: Unhealthy alcohol use could impair recovery of older patients after medical or surgical
hospitalizations. However, no prior research has evaluated whether older patients who screen positive
for unhealthy alcohol use are at increased risk of readmissions or emergency department (ED) visits
within 30 days after discharge. This study examined the association between AUDIT-C alcohol screening
results and 30-day readmissions or ED visits.
Methods: Veterans Affairs (VA) patients age 65 years or older, were eligible if they were hospitalized for a medical or surgical condition (2/1/2009–10/1/2011) and had an AUDIT-C score documented in their VA electronic medical record in the year before they were hospitalized. VA and Medicare data identified VA or non-VA index hospitalizations, readmissions, and ED visits. Primary analyses adjusted for demographics, comorbid conditions, and past-year health care utilization. Results: Among 579,330 hospitalized patients, 13.7% were readmitted and 12.0% visited an ED within 30 days of discharge. In primary analyses, high-risk drinking (n = 7,167) and nondrinking (n = 357,086) were associated with increased probability of readmission (13.8%, 95% CI 13.0–14.6%; and 14.2%, 95% CI 14.1–14.3%, respectively), relative to low-risk drinking (12.9%; 95% CI 12.7–13.0%). Only nondrinkers had increased risk for ED visits. Conclusions: Alcohol screening results indicating high-risk drinking that were available in medical records were modestly associated with risk for 30-day readmissions and were not associated with risk for ED visits. Keywords: Alcohol screening | Quality | Unhealthy alcohol use | Emergency department | Readmissions | Post-discharge care |
مقاله انگلیسی |