scholarly journals A patient and family reporting system for perceived ambulatory note mistakes: experience at 3 U.S. healthcare centers

2019 ◽  
Vol 26 (12) ◽  
pp. 1566-1573 ◽  
Author(s):  
Fabienne C Bourgeois ◽  
Alan Fossa ◽  
Macda Gerard ◽  
Marion E Davis ◽  
Yhenneko J Taylor ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Relevance ◽  
Potential Role ◽  
Reporting System ◽  
Medical Center ◽  
Descriptive Statistics ◽  
Medical Problems ◽  
Electronic Reporting ◽  
Reporting Systems

Abstract Objective The study sought to test a patient and family online reporting system for perceived ambulatory visit note inaccuracies. Materials and Methods We implemented a patient and family electronic reporting system at 3 U.S. healthcare centers: a northeast urban academic adult medical center (AD), a northeast urban academic pediatric medical center (PED), and a southeast nonprofit hospital network (NET). Patients and families reported potential documentation inaccuracies after reading primary care and subspecialty visit notes. Results were characterized using descriptive statistics and coded for clinical relevance. Results We received 1440 patient and family reports (780 AD, 402 PED, and 258 NET), and 27% of the reports identified a potential inaccuracy (25% AD, 35% PED, 28% NET). Among these, patients and families indicated that the potential inaccuracy was important or very important in 58% of reports (55% AD, 55% PED, 71% NET). The most common types of potential inaccuracies included description of symptoms (21%), past medical problems (21%), medications (18%), and important information that was missing (15%). Most patient- and family-reported inaccuracies resulted in a change to care or to the medical record (55% AD, 67% PED, data not available at NET). Discussion About one-quarter of patients and families using an online reporting system identified potential documentation inaccuracies in visit notes and more than half were considered important by patients and clinicians, underscoring the potential role of patients and families as ambulatory safety partners. Conclusions Partnering with patients and families to obtain reports on inaccuracies in visit notes may contribute to safer care. Mechanisms to encourage greater use of patient and family reporting systems are needed.

The Role of Clostridium septicum in Paraneoplastic Sepsis

2000 ◽  
Vol 124 (3) ◽  
pp. 353-356
Author(s):  
J. Peter R. Pelletier ◽  
Julie A. Plumbley ◽  
Elizabeth A. Rouse ◽  
Stephen J. Cina
Keyword(s):  
Medical Center ◽  
Case Series ◽  
Teaching Hospitals ◽  
Clostridium Septicum ◽  
Medical Problems ◽  
Exclusion Criteria ◽  
Cyclic Neutropenia ◽  
The Past ◽  
Associated Conditions

Abstract Context.—Clostridium septicum infections are rare but often associated with serious if not fatal outcomes. Clostridium septicum infection does not appear to be associated with a single specific defect in cellular or humoral immunity. It has been associated with multiple medical problems, including but not limited to leukemia, malignancy of the bowel, other solid tumors, cyclic neutropenia with enterocolitis, diabetes mellitus, and severe arteriosclerosis. Most cases of C septicum are associated with malignancy, and mortality approaches 100% if care is not rendered within 12 to 24 hours. Objectives.—To evaluate outcomes of patients with C septicum bacteremia, whether treated medically or surgically or both, and to note associated conditions. Design.—Retrospective evaluation of patients found to have C septicum bacteremia in the past 6 years. Setting.—Two teaching hospitals, Brooke Army Medical Center (250 beds) and Wilford Hall Medical Center (292 beds), were the source of our patients. Patients.—All patients found to have C septicum bacteremia during hospitalization or postmortem examination were included in the study. There were no exclusion criteria. Main Outcome Measure.—Mortality associated with C septicum infection. Results.—In our case series, mortality was 33%, which is slightly lower than reported in prior studies (43%–70%). Conclusion.—Presumptive identification based on Gram stain, awareness of C septicum infection as a paraneoplastic syndrome, and prompt, clear communication between laboratory personnel and clinicians are necessary for early diagnosis of C septicum infection. Early institution of antibiotic therapy improves prognosis.

Exploring the actual and potential role of the primary care nurse in the prevention of cancer: a mixed methods study

2013 ◽  
Vol 23 (3) ◽  
pp. 288-299 ◽  
Author(s):  
S. McIlfatrick ◽  
S. Keeney ◽  
H. McKenna ◽  
N. McCarley ◽  
G. McIlwee
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Potential Role ◽  
Mixed Methods Study ◽  
Care Nurse ◽  
Primary Care Nurse ◽  
Prevention Of Cancer

The chronically mentally ill in primary care

1985 ◽  
Vol 15 (2) ◽  
pp. 265-273 ◽  
Author(s):  
Darrel A. Regier ◽  
Jack D. Burke ◽  
Ronald W. Manderscheid ◽  
Barbara J. Burns
Keyword(s):  
Primary Care ◽  
Mental Disorder ◽  
Mentally Ill ◽  
Primary Care Physicians ◽  
Service Needs ◽  
Medical Problems ◽  
Chronically Mentally Ill ◽  
Severe Impairment ◽  
Primary Care Patients

SynopsisThe role of primary care physicians in addressing the needs of chronically mentally ill patients is examined from three perspectives: (1) assessing community prevalence; (2) treating chronic medical problems in the context of other human service needs; and (3) treating specific types of chronic mental disorders. About 30% of primary care patients were found to have at least one Research Diagnostic Criteria mental disorder, five-sixths of which had a duration greater than 1 year. However, about 9% of patients had some impairment and 2% had severe impairment associated with a mental disorder. Although affective disorders have the highest overall rates, personality, psychotic, and anxiety disorders contribute the greatest proportion of severe disability.

Cannabinoids in the Treatment of Back Pain

Neurosurgery ◽  
2020 ◽  
Vol 87 (2) ◽  
pp. 166-175 ◽  
Author(s):  
Teddy E Kim ◽  
Robert K Townsend ◽  
Charles L Branch ◽  
Edgar A Romero-Sandoval ◽  
Wesley Hsu
Keyword(s):  
Back Pain ◽  
Potential Role ◽  
Chronic Back Pain ◽  
Significant Risk ◽  
The United States ◽  
Medical Problems ◽  
Delivery Methods ◽  
Opioid Medications ◽  
Safety Considerations

Abstract Marijuana is increasingly utilized for the treatment of multiple medical problems, including back pain, in the United States. Although there is strong preclinical evidence supporting the promise of cannabinoids in the treatment of back pain, there is a paucity of clinical data supporting their use in clinical practice. Opioids are an important medication for the treatment of acute and chronic back pain, but utilization of opioid-based regimens have likely contributed to the growing opioid epidemic. The significant risk of morbidity, mortality, and dependence secondary to opioid medications have increased the interest in nonopioid medications, including cannabinoid-based pain regimens, in treating back pain. This review will provide an overview on the pharmacology, drug delivery methods, clinical evidence, and safety considerations critical to understanding the potential role of cannabinoids in the treatment of back pain.

Potential role of abbreviated MRI for breast cancer screening in an academic medical center

2019 ◽  
Vol 25 (4) ◽  
pp. 604-611 ◽  
Author(s):  
Vandana Dialani ◽  
Irene Tseng ◽  
Priscilla J. Slanetz ◽  
Valerie Fein‐Zachary ◽  
Jordana Phillips ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Potential Role ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical

scholarly journals Barriers to the success of an electronic pharmacovigilance reporting system in Kenya: an evaluation three years post implementation

2017 ◽  
Vol 25 (6) ◽  
pp. 627-634 ◽  
Author(s):  
Oscar O Agoro ◽  
Sarah W Kibira ◽  
Jenny V Freeman ◽  
Hamish S F Fraser
Keyword(s):  
Reporting System ◽  
Health Management ◽  
Free Text ◽  
Key Factors ◽  
Electronic Reporting ◽  
Reporting Systems ◽  
Government Hospitals ◽  
Pharmacovigilance Center ◽  
Context Specific ◽  
Reporting Rates

Abstract Objective Electronic pharmacovigilance reporting systems are being implemented in many developing countries in an effort to improve reporting rates. This study sought to establish the factors that acted as barriers to the success of an electronic pharmacovigilance reporting system in Kenya 3 years after its implementation. Materials and Methods Factors that could act as barriers to using electronic reporting systems were identified in a review of literature and then used to develop a survey questionnaire that was administered to pharmacists working in government hospitals in 6 counties in Kenya. Results The survey was completed by 103 out of the 115 targeted pharmacists (89.5%) and included free-text comments. The key factors identified as barriers were: unavailable, unreliable, or expensive Internet access; challenges associated with a hybrid system of paper and electronic reporting tools; and system usability issues. Coordination challenges at the national pharmacovigilance center and changes in the structure of health management in the country also had an impact on the success of the electronic reporting system. Discussion Different personal, organizational, infrastructural, and reporting system factors affect the success of electronic reporting systems in different ways, depending on the context. Context-specific formative evaluations are useful in establishing the performance of electronic reporting systems to identify problems and ensure that they achieve the desired objectives. Conclusion While several factors hindered the optimal use of the electronic pharmacovigilance reporting system in Kenya, all were considered modifiable. Effort should be directed toward tackling the identified issues in order to facilitate use and improve pharmacovigilance reporting rates.

scholarly journals The Role of Angiotensin Converting Enzyme 1 Insertion/Deletion Genetic Polymorphism in the Risk and Severity of COVID-19 Infection

2021 ◽  
Vol 8 ◽  
Author(s):  
Halim Saad ◽  
Karna Jabotian ◽  
Carine Sakr ◽  
Rami Mahfouz ◽  
Imad Bou Akl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Genetic Polymorphism ◽  
Potential Role ◽  
Medical Center ◽  
Positive Association ◽  
American University ◽  
American University Of Beirut ◽  
Increased Risk ◽  
Study Population

Background: Individuals infected with the COVID-19 virus present with different symptoms of varying severity. In addition, not all individuals are infected despite exposure. Risk factors such as age, sex, and comorbidities play a major role in this variability; however, genetics may also be important in driving the differences in the incidence and prognosis of the disease. An Insertion/Deletion (I/D) polymorphism in the ACE1 gene (rs1799752) may explain these genetic differences. The aims of this study were to determine the potential role of ACE1 I/D genetic polymorphism in the risk of contracting COVID-19 as well as predicting the severity of COVID-19 infection.Methods: Three-hundred and eighty-seven non-related Lebanese subjects, 155 controls and 232 cases, who presented to the American University of Beirut Medical Center (AUBMC) for COVID-19 PCR testing were recruited. Clinical data were collected via filling a questionnaire and accessing the medical records. Peripheral blood was withdrawn for DNA isolation, and genotyping performed with standard PCR followed by band visualization on agarose gel.Results: In our study population, previously described risk factors such as gender, age, and comorbidities were associated with increase in disease susceptibility and severity. ACE1 I was the least common allele, and there was a positive association between ACE1 I and the risk of contracting the COVID-19 disease. More specifically, the frequency of II genotype was significantly higher among cases when compared to controls (P = 0.035) with individuals with the II genotype having greater risk for contracting the COVID-19 disease: OR = 2.074, P = 0.048 in the multivariate analysis. As for disease severity, the DD genotype and D allele were associated with increased risk for developing severe symptoms (OR = 2.845, P = 0.026 and OR = 2.359, P = 0.014, respectively), and the DD genotype with necessitating hospitalization (OR = 2.307, P = 0.042). In parallel, D allele carriers showed a significantly increased risk for developing hypoxia: OR = 4.374, P = 0.045.Conclusion: We found a positive association between ACE1 I and the risk of contracting the COVID-19 disease, and between ACE1 D and a worse outcome of the COVID-19 infection. Therefore, genotyping for ACE1 I/D polymorphism could be used to assess risk and predict severity for better prognosis and management of the disease.

scholarly journals Attitudes Toward Menopause

1993 ◽  
Vol 17 (3) ◽  
pp. 275-288 ◽  
Author(s):  
Linda Gannon ◽  
Bonnie Ekstrom
Keyword(s):  
Potential Role ◽  
Life Transitions ◽  
The Other ◽  
Medical Problems ◽  
Medical Context ◽  
Positive Attitudes ◽  
And Behavior ◽  
The Impact

This research examined the influence of sociocultural paradigms of menopause on attitudes toward menopause. Five hundred eighty-one women and men, between the ages of 18 and 85, were assigned to one of three groups distinguished by the context within which they expressed their attitudes toward menopause. The contexts were designed to reflect particular paradigms: one group described their attitudes toward three medical problems, including menopause; a second group described their attitudes toward three life transitions, including menopause; and a third group described their attitudes toward three symbols of aging, including menopause. Positive and negative subscales of the attitude questionnaires for menopause were analyzed for context and age/experience. Results indicated that the medical context elicited significantly more negative and fewer positive attitudes than did the other two contexts, particularly among older participants. In general, women's attitudes were more positive than were men's, and attitudes became increasingly positive with age and/or experience. The discussion includes the potential role of attitudes as mediating the impact of sociocultural paradigms on experience and behavior.

Insufficient involvement of the family physician (FP) in the care of chemotherapy-treated cancer patients: A barrier to comprehensive medical care.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17536-e17536
Author(s):  
Eytan Ben-Ami ◽  
Hadar Merom ◽  
Fabienne Sikron ◽  
Jessica Livneh ◽  
Siegal Sadetzki ◽  
...  
Keyword(s):  
Medical Care ◽  
Cancer Patients ◽  
Day Care ◽  
Medical Training ◽  
Medical Center ◽  
Medical Problems ◽  
Care Clinic ◽  
Team Members ◽  
The Family

e17536 Background: Following advancement in the oncology field, increasing numbers of patients are receiving ambulatory active treatment for prolonged periods of time. Many of these patients suffer from additional comorbidities and require comprehensive medical care. We aimed to assess the perception of cancer patients regarding the role of the FP and the oncologist in their care during times of active cancer treatment. Methods: A survey was conducted among 265 consecutive chemotherapy-treated patients at the day care clinic of the Oncology Institute at Sheba Medical Center in Israel. Results: Median age was 60 years (range 22-86), 184 (69%) were woman and 147 (55%) were Israeli born. All patients belonged to one of four Israeli HMOs, 96% had a regular FP and 70% met with him during the prior month. While 78% of the patients evaluated that their FP had sufficient time to devote to them, only 32% and 27% thought their FP was trained to or wished to treat medical problems occurring while receiving chemotherapy. Yet, a majority of patients (76%) stated that involvement of the FP is important to them. Surprisingly, 85% perceived the oncologist as having enough time to devote to their care and 60% perceived him as being capable of dealing with non-oncological problems. However, only 30% stated that the oncologist communicates with the FP. Accordingly, 72% of the patients stated that in the case of an urgent problem they will turn first to the oncology institute and only 9% will turn to their FP. Indeed, 46% had unscheduled visits to the day care facilities during the prior month. Conclusions: Our data indicate lack communication between team members and inadequate medical training as major barriers for comprehensive medical care for chemotherapy-treated cancer patients. This may adversely affect medical care, decrease satisfaction among physicians and increase unnecessary workload. A change of the current situation requires collaboration between FPs and oncologists at the local and national levels and should include standardization of communication measures as well as implementation of required aspects in educational programs of both specialties.

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