Enhancing Patient Compliance in Pediatrics

1996 ◽  
Vol 17 (4) ◽  
pp. 128-134
Author(s):  
Gregory S. Liptak
Keyword(s):  
Emergency Department ◽  
Medical Education ◽  
Rheumatic Fever ◽  
Acute Otitis Media ◽  
Streptococcal Pharyngitis ◽  
Pediatric Care ◽  
Pediatric Residency ◽  
Health Advice ◽  
Advanced Treatments

The Challenge Pediatric care has become exceedingly complex, but no matter how technologically advanced treatments become, they can be only as effective as compliance with their use. Compliance, or adherence, defined as the extent to which a person's behavior coincides with medical or health advice, is crucial for the treatment of illness, the prevention of disease, and the promotion of health. Unfortunately, noncompliance is extremely common. For example, in a study of the use of penicillin for acute otitis media and "strep" throat, Charney et al1 found that only 43% of the children complied with the regimen. Gordis and associates2 found that compliance with penicillin used for chronic rheumatic fever prophylaxis was only 36%. Eney and Goldstein3 showed that compliance with theophylline in children being evaluated in an emergency department for asthma was only 11%. Compliance decreases over the course of treatment, not only for long-term interventions, but for brief ones as well. For example, Bergman and Werner4 found that 56% of individuals being treated with penicillin for streptococcal pharyngitis had stopped taking the medication by day 3, 71% by day 6, and 82% by day 9 of the treatment course. Although compliance is so important, it is largely neglected in medical education, including pediatric residency training.

scholarly journals Management of acute open tendo-achilles injuries in Indian lavatory pans

2006 ◽  
Vol 39 (01) ◽  
pp. 29-33
Author(s):  
S Chatterjee Sasanka ◽  
Sarkar Arindam ◽  
Misra Ashutosh
Keyword(s):  
Emergency Department ◽  
Medical Education ◽  
Stainless Steel ◽  
Plastic Surgery ◽  
Graduate Medical Education ◽  
Gradual Increase ◽  
Long Term Results ◽  
Post Graduate ◽  
Flap Cover

AbstractInjuries to the Tendo-achilles are common but rarely do they present directly to plastic surgeons. Eighteen patients with acute tendo-achilles injury due to fall in the lndian type of lavatory pan came directly to the emergency department of Institute of Post Graduate Medical Education and Research, Kolkata and subsequently were treated in the Department of Plastic Surgery. Direct repair with prolene or stainless steel (SS) wires with or without flap cover were performed for management. Exercises were started 1 month later with gradual increase in activity. Complications were minor and temporary in nature. Long term results in the form of performing previous activities were excellent.

scholarly journals Automated Reporting of Trainee Metrics Using Electronic Clinical Systems

2017 ◽  
Vol 9 (3) ◽  
pp. 361-365 ◽  
Author(s):  
Jonathan C. Levin ◽  
Jonathan Hron
Keyword(s):  
Emergency Department ◽  
Pediatric Care ◽  
Care Hospital ◽  
Medical Systems ◽  
Clinical Exposure ◽  
Objective Performance Measures ◽  
Program Leadership ◽  
Hospital Systems ◽  
Enterprise Data Warehouse

ABSTRACT Background  The Accreditation Council for Graduate Medical Education has called for increased emphasis on reporting objective performance measures to trainees and programs. However, reporting of objective measures, including clinical volume, is largely omitted from training programs. Objective  To use automated electronic medical systems at a tertiary pediatric care hospital to create a dashboard that reports objective trainee and program metrics, including clinical volume and diagnoses in a pediatrics residency. Methods  We queried an enterprise data warehouse that aggregates data daily from multiple hospital systems to identify patient encounters during which senior pediatrics residents at Boston Children's Hospital had entered documentation over a 9-month period. From this query, we created a filterable dashboard to display clinical volume and diagnosis data by individual resident and in aggregate. Results  A total of 44 of 45 senior residents (98%) in the program were included in analysis. We identified 12 198 patient encounters during which a senior pediatrics resident had entered documentation; these included a median of 332 inpatient encounters per resident, 122 emergency department encounters, and 84 outpatient encounters. The most common diagnoses stratified by clinical site were: inpatient – dehydration (median = 61); emergency department – long-term/current drug therapy (median = 16); and outpatient – encounter for immunization (median = 48). Conclusions  We used electronic health record systems to generate performance dashboards for trainees in a pediatrics residency across different sites of care with reported volume by diagnosis. Our dashboards provide feedback to program leadership regarding individual and aggregate trainee experience and allow individual trainees to compare their clinical exposure to peers.

scholarly journals Separating Acute Rheumatic Fever from Nonrheumatic Streptococcal Myocarditis

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Laith A. Derbas ◽  
Anweshan Samanta ◽  
Srinivasa Potla ◽  
Moustafa Younis ◽  
Laura M. Schmidt ◽  
...  
Keyword(s):  
Rheumatic Fever ◽  
Cardiac Mri ◽  
Heart Valves ◽  
Acute Rheumatic Fever ◽  
Group A Streptococcus ◽  
Anterior Wall ◽  
Streptococcal Pharyngitis ◽  
Systemic Involvement ◽  
Reduced Ejection Fraction

Introduction. Streptococcal pharyngitis has been historically complicated with systemic involvement manifesting as acute rheumatic fever, which is a serious condition that can lead to permanent damage to heart valves. A recent association between streptococcal pharyngitis and nonrheumatic heart disease is emerging in literature. We present a case of nonrheumatic streptococcal myocarditis diagnosed using cardiac MRI. Case Presentation. A 25-year-old male, presented with complaints of sore throat, nonproductive cough, fever, pleuritic chest pain, and progressive dyspnea for four days. The patient had elevated troponins at presentation of 0.47 (ng/L) that peaked at 4.0 (ng/L). ECG showed sinus rhythm and ST elevations in leads V2, V3, V4, and V5. NT-Pro-BNP was 1740. Transthoracic echocardiogram (TTE) showed reduced ejection fraction (EF) of 37% and global hypokinesis. The rapid strep test was positive for group A streptococcus and C-reactive protein was elevated at 161. Cardiac MRI demonstrated an EF of 53% and edema in the anterior wall without delayed gadolinium enhancement. Cardiac catheterization showed normal coronaries. Discussion. According to modified Jones criteria, the patient did not meet the full major or minor criteria to be diagnosed with acute rheumatic fever. The course of the nonrheumatic myocarditis is favorable and includes a full recovery of cardiac function, no involvement of cardiac valves, or long-term use of antibiotics. Conclusion. It is crucial to make a separate distinction between acute rheumatic fever and nonrheumatic myocarditis because this will have huge implications on management and long-term use of antibiotics. Cardiac imaging modalities can aid in distinction between the two disease entities.

scholarly journals Pedagogical Strategies for the Enhancement of Medical Education

2021 ◽  
Author(s):  
Mohammad B. Azzam ◽  
Ronald A. Easteal
Keyword(s):  
Medical Education ◽  
Cognitive Science ◽  
Retrieval Practice ◽  
Memory Storage ◽  
Long Term Memory ◽  
Memory And Learning ◽  
Pedagogical Strategies ◽  
Term Memory ◽  
Sleep Consolidation

AbstractClearly, memory and learning are essential to medical education. To make memory and learning more robust and long-term, educators should turn to the advances in neuroscience and cognitive science to direct their efforts. This paper describes the memory pathways and stages with emphasis leading to long-term memory storage. Particular stress is placed on this storage as a construct known as schema. Leading from this background, several pedagogical strategies are described: cognitive load, dual encoding, spiral syllabus, bridging and chunking, sleep consolidation, and retrieval practice.

Graduate Medical Education in Otolaryngology: Making Dollars and Sense of Reform

2021 ◽  
pp. 019459982110042
Author(s):  
Jenny X. Chen ◽  
Shivani A. Shah ◽  
Vinay K. Rathi ◽  
Mark A. Varvares ◽  
Stacey T. Gray
Keyword(s):  
Medical Education ◽  
Graduate Medical Education ◽  
Resident Training ◽  
Short Term ◽  
Graduate Medical ◽  
Departmental Leadership ◽  
Key Stakeholders ◽  
The Face ◽  
Funding Cuts

Graduate medical education (GME) is funded by the Centers for Medicare and Medicaid Services through both direct and indirect payments. In recent years, stakeholders have raised concerns about the growth of spending on GME and distribution of payment among hospitals. Key stakeholders have proposed reforms to reduce GME funding such as adjustments to statutory payment formulas and absolute caps on annual payments per resident. Otolaryngology departmental leadership should understand the potential effects of proposed reforms, which could have significant implications for the short-term financial performance and the long-term specialty workforce. Although some hospitals and departments may elect to reduce resident salaries or eliminate positions in the face of GME funding cuts, this approach overlooks the substantial Medicare revenue contributed by resident care and high cost of alternative labor sources. Commitment to resident training is necessary to align both the margin and mission of otolaryngology departments and their sponsoring hospitals.

scholarly journals Relative Humidity Affects Acute Otitis Media Visits of Preschool Children to the Emergency Department

2021 ◽  
pp. 014556132110091
Author(s):  
Ying-Fang Jiang ◽  
Wen-Wei Luo ◽  
Xin Zhang ◽  
Dong-Dong Ren ◽  
Yi-Bo Huang
Keyword(s):  
Emergency Department ◽  
Preschool Children ◽  
Relative Humidity ◽  
Otitis Media ◽  
Meteorological Factors ◽  
Acute Otitis Media ◽  
Emergency Department Visits ◽  
Preschool Age ◽  
School Age Children ◽  
Cross Sectional

Objective: The associations between climate variables and diseases such as respiratory infections, influenza, pediatric seizure, and gastroenteritis have been long appreciated. Infection is the main reason for acute otitis media (AOM) incidence. However, few previous studies explored the correlation between climatic parameters and AOM infections. The most important meteorological factors, temperature, relative humidity, and fine particulate matter (PM2.5), were included in this study. We studied the relationship between these meteorological factors and the AOM visits. Materials and Methods: It was a retrospective cross-sectional study. A linear correlation and a linear regression model were used to explore the AOM visits and meteorological factors. Results: A total of 7075 emergency department visits for AOM were identified. Relative humidity was found an independent risk factor for the AOM visits in preschool children (regression coefficient = −10.841<0, P = .039 < .05), but not in infants and school-age children. Average temperature and PM2.5 were not correlated with AOM visits. Conclusion: Humidity may have a significant inverse impact on the incidence of AOM in preschool-age children.

Current Models for Inpatient and Emergency Room Ophthalmology Consultation in U.S. Residency Programs

2020 ◽  
Vol 12 (02) ◽  
pp. e171-e174
Author(s):  
Donna H. Kim ◽  
Dongseok Choi ◽  
Thomas S. Hwang
Keyword(s):  
Emergency Department ◽  
Medical Education ◽  
Emergency Room ◽  
Program Directors ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Direct Supervision ◽  
Residency Programs ◽  
Residency Program Directors ◽  
Competency Assessments

Abstract Objective This article examines models of patient care and supervision for hospital-based ophthalmology consultation in teaching institutions. Design This is a cross-sectional survey. Methods An anonymous survey was distributed to residency program directors at 119 Accreditation Council for Graduated Medical Education accredited U.S. ophthalmology programs in the spring of 2018. Survey questions covered consult volume, rotational schedules of staffing providers, methods of supervision (direct vs. indirect), and utilization of consult-dedicated didactics and resident competency assessments. Results Of the 119 program directors, 48 (41%) completed the survey. Programs most frequently reported receiving 4 to 6 consults per day from the emergency department (27, 55.1%) and 4 to 6 consults per day from inpatient services (26, 53.1%). Forty-seven percent of programs reported that postgraduate year one (PGY-1) or PGY-2 residents on a dedicated consult rotation initially evaluate patients. Supervising faculty backgrounds included neuro-ophthalmology, cornea, comprehensive, or a designated chief of service. Staffing responsibility is typically shared by multiple faculty on a daily or weekly rotation. Direct supervision was provided for fewer of emergency room consults (1–30%) than for inpatient consults (71–99%). The majority of programs reported no dedicated didactics for consultation activities (27, 55.1%) or formal assessment for proficiency (33, 67.4%) prior to the initiation of call-related activities without direct supervision. Billing submission for consults was inconsistent and many consults may go financially uncompensated (18, 36.7%). Conclusion The majority of hospital-based ophthalmic consultation at academic centers is provided by a rotating pool of physicians supervising a lower level resident. Few programs validate increased levels of graduated independence using specific assessments.

scholarly journals A Rational Evaluation of the Syncope Patient: Optimizing the Emergency Department Visit

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 514
Author(s):  
Tarek Hatoum ◽  
Robert S. Sheldon
Keyword(s):  
Emergency Department ◽  
Diagnostic Yield ◽  
Clinical Decision ◽  
Emergency Department Visits ◽  
Decision Tools ◽  
Short And Long Term ◽  
Electrocardiogram Ecg ◽  
Structured Approach

Syncope accounts for up to 2% of emergency department visits and results in the hospitalization of 12–86% of patients. There is often a low diagnostic yield, with up to 50% of hospitalized patients being discharged with no clear diagnosis. We will outline a structured approach to the syncope patient in the emergency department, highlighting the evidence supporting the role of clinical judgement and the initial electrocardiogram (ECG) in making the preliminary diagnosis and in safely identifying the patients at low risk of short- and long-term adverse events or admitting the patient if likely to benefit from urgent intervention. Clinical decision tools and additional testing may aid in further stratifying patients and may guide disposition. While hospital admission does not seem to offer additional mortality benefit, the efficient utilization of outpatient testing may provide similar diagnostic yield, preventing unnecessary hospitalizations.

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