scholarly journals Delivery and Measurement of High-Value Care in Standardized Patient Encounters

2017 ◽  
Vol 9 (5) ◽  
pp. 645-649 ◽  
Author(s):  
Jennifer DeLuca Baldwin ◽  
Jaclyn Cox ◽  
Zhao Helen Wu ◽  
Anne Kenny ◽  
Steven Angus
Keyword(s):  
Social History ◽  
Communication Skills ◽  
Clinical Skills ◽  
Univariate Analysis ◽  
Health Care Expenditures ◽  
Knowledge Based ◽  
Skills Laboratory ◽  
Communication Score ◽  
Artery Disease ◽  
Standardized Patient Encounters

ABSTRACT Background  Residencies have incorporated high-value care (HVC) training to contain health care expenditures. Assessment methods of HVC curricula are limited. Objective  In our clinical skills laboratory, we evaluated the effectiveness of HVC curricula using standardized patients (SPs) to determine if there is a correlation with performance in counseling, history and physical, HVC knowledge, and demographics. Methods  Through ambulatory cases, SPs evaluated postgraduate year 2 (PGY-2) residents using checklists to determine if they obtained the chief complaint, medical and social history, focused physical examination, and conveyed information regarding patient management. Investigators scored knowledge-based questions on the need for imaging in low back pain, annual stress testing in coronary artery disease, and chest x-ray for gastroesophageal reflux disease. Univariate analysis was used to calculate percentage distribution of residents' ordering of inappropriate tests. Results  All 56 PGY-2 residents participated in the study and completed at least 2 of 3 HVC cases. Analysis showed that 48% (27 of 56) ordered at least 1 inappropriate test. Residents who ordered unnecessary testing had similar performance in history and physical as well as knowledge of HVC. Inappropriate ordering was significantly associated with poorer performance in counseling (mean percentage counseling score of 68% versus 56% for those who ordered inappropriately, P < .001) and communication skills (mean percentage communication score of 74% versus 71% for those who ordered inappropriately, P < .003). There were no patterns for ordering by demographics. Conclusions  Our evaluation of residents during SP encounters found a correlation between the use of inappropriate testing and lower counseling and communication skills.

Predictors of Faster Decline of Residual Renal Function in Taiwanese Peritoneal Dialysis Patients

2008 ◽  
Vol 28 (3_suppl) ◽  
pp. 191-195 ◽  
Author(s):  
Chia-Te Liao ◽  
Chih-Chung Shiao ◽  
Jenq-Wen Huang ◽  
Kuan-Yu Hung ◽  
Hsueh-Fang Chuang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Clinical Laboratory ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Residual Renal Function ◽  
Measure Data ◽  
Chi Square ◽  
Artery Disease

⋄ Objective Loss of residual renal function (RRF) in peritoneal dialysis (PD) patients is a powerful predictor of mortality. The present study was conducted to determine the predictors of faster decline of RRF in PD patients in Taiwan. ⋄ Methods The study enrolled 270 patients starting PD between January 1996 and December 2005 in a single hospital in Taiwan. We calculated RRF as the mean of the sum of 24-hour urea and creatinine clearance. The slope of the decline of residual glomerular filtration rate (GFR) was the main outcome measure. Data on demographic, clinical, laboratory, and treatment parameters; episodes of peritonitis; and hypotensive events were analyzed by Student t-test, Mann–Whitney U-test, and chi-square, as appropriate. All variables with statistical significance were included in a multivariate linear regression model to select the best predictors ( p < 0.05) for faster decline of residual GFR. ⋄ Results All patients commencing PD during the study period were followed for 39.4 ± 24.0 months (median: 35.5 months). The average annual rate of decline of residual GFR was 1.377 ± 1.47 mL/min/m2. On multivariate analysis, presence of diabetes mellitus ( p < 0.001), higher baseline residual GFR ( p < 0.001), hypotensive events ( p = 0.001), use of diuretics ( p = 0.002), and episodes of peritonitis ( p = 0.043) independently predicted faster decline of residual GFR. Male sex, old age, larger body mass index, and presence of coronary artery disease or congestive heart failure were also risk factors on univariate analysis. ⋄ Conclusions Our results suggested that diabetes mellitus, higher baseline residual GFR, hypotensive events, and use of diuretics are independently associated with faster decline of residual GFR in PD patients in Taiwan.

Caffeine intake reduces incident atrial fibrillation at a population level

2018 ◽  
Vol 25 (10) ◽  
pp. 1055-1062 ◽  
Author(s):  
Edoardo Casiglia ◽  
Valérie Tikhonoff ◽  
Federica Albertini ◽  
Federica Gasparotti ◽  
Alberto Mazza ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Univariate Analysis ◽  
Population Level ◽  
Caffeine Intake ◽  
General Belief ◽  
The Third ◽  
Chronic Caffeine ◽  
Artery Disease ◽  
Cox Analysis

Background The general belief is that caffeine increases the risk of hyperkinetic arrhythmias, including atrial fibrillation. The aim of this study is to investigate the effect of chronic caffeine intake on incident atrial fibrillation in general population. Design and methods A population cohort of 1475 unselected men and women observed for 12 years and left free to intake food or beverages containing caffeine was studied. Subjects were stratified into tertiles of caffeine intake both in the whole cohort and after genotyping for the –163C > A polymorphism of the CYP1A2 gene, regulating caffeine metabolism. Results In the whole cohort, the 12-year incidence of atrial fibrillation was significantly lower in the third (2.2%) than in the first (10.2%) or second (5.7%) tertile of caffeine intake ( P < 0.001). The same trend was observed in all genotypes; the apparently steeper reduction of atrial fibrillation in slow caffeine metabolisers found at univariate analysis was proved wrong by multivariate Cox analysis. Age, chronic pulmonary disease, history of heart failure and of coronary artery disease, and systolic blood pressure − but not the genotype or the caffeine ×  CYP1A2 interaction term − were significant confounders of the association between incident atrial fibrillation and being in the third tertile of caffeine intake (hazard ratio 0.249, 95% confidence intervals 0.161–0.458, P < 0.01). Conclusions A higher caffeine intake (>165 mmol/day or > 320 mg/day) is associated with a lower incidence of atrial fibrillation in the 12-year epidemiological prospective setting based on the general population.

Teaching Tip: Designing Flipped Classrooms to Enhance Learning in the Clinical Skills Laboratory

2021 ◽  
pp. e20210043
Author(s):  
Sarah Baillie ◽  
Annelies Decloedt ◽  
Molly Frendo Londgren
Keyword(s):  
Student Engagement ◽  
Flipped Classroom ◽  
Clinical Skills ◽  
Face To Face ◽  
Use Of Time ◽  
Skills Laboratory ◽  
The Face ◽  
Expected Benefits ◽  
Time Required ◽  
Effective Use

Flipped classroom is an educational technique in which content is delivered online for students to study at their own pace in preparation for in-class learning. Benefits include increased flexibility, enhanced student engagement and satisfaction, and more effective use of time spent during face-to-face teaching. However, the development and implementation of flipped classroom teaching are also associated with challenges, including time required to develop learning materials and getting students to engage with the preparatory work. This teaching tip describes a structured approach to designing and implementing the flipped classroom approach for clinical skills to allow a greater focus on practicing the hands-on skills and the provision of feedback during the laboratory session. First, the rationale for flipping the classroom and the expected benefits should be considered. On a practical level, decisions need to be made about what to include in the flipped component, how it will complement the face-to-face class, and how the resources will be created. In the design phase, adopting a structured template and aligning with established pedagogical principles is helpful. A well-designed flipped classroom motivates learners by including different elements such as quality educational media (e.g., videos), the opportunity to self-assess, and well-defined connections to relevant knowledge and skills. Student engagement with the flipped material can be promoted through different strategies such as clear communication to manage student expectations and adapting the delivery of the face-to-face component. Finally, gathering feedback and evaluating the initiative are important to inform future improvements.

A Case of Myopericarditis and the HPV vaccine

2021 ◽  
Vol 9 (12) ◽  
Author(s):  
Angela Pegram ◽  
Tara Bush
Keyword(s):  
Human Papillomavirus ◽  
Social History ◽  
Hpv Vaccine ◽  
Package Insert ◽  
Human Papillomavirus Vaccine ◽  
T Wave ◽  
Dose Number ◽  
Males And Females ◽  
Artery Disease ◽  
Papillomavirus Vaccine

Introduction: Human Papillomavirus (HPV) is the underlying etiology of numerous cancers and genital warts in both males and females. Vaccines were developed against HPV to prevent transmission and arrest development of cancers caused by the virus. Gardasil 9â is the newest vaccine, covering 9 serotypes of HPV and is recommended by the CDC for both males and females over 9 years of age in a series of vaccinations. Myopericarditis (including myocarditis and pericarditis) is not reported as an adverse reaction in the Gardasil 9â package insert. Case Report A healthy 18-year-old male with no significant past medical or social history received dose number 3 of HPV vaccine at his physician’s office. Within 24 hours, he developed chills and a fever (normal HPV reactions) and then recovered without sequelae within 48 hours. Three days later, he developed crushing chest pain, with arm tingling and jaw pain. He was triaged directly to the emergency room where he had troponins of greater than 11000 and T wave inversions on his EKG. Other diagnostic tests and labs showed normal heart anatomy and no early coronary artery disease. He was diagnosed with myopericarditis by cardiology. He was treated and recovered fully within 3 months. Discussion Using the WHO tool for adverse vaccine reactions, this case has a consistent causal relationship with vaccination. This is the eleventh case of myopericarditis reported to the Vaccine Adverse Effects Reporting system for the HPV vaccine. Conclusion Although rare, myopericarditis should be considered as a possible adverse effect from the human papillomavirus vaccine.

Relationship between Aortic Atherosclerosis and Dental Loss in an Inner-City Population

Angiology ◽  
2008 ◽  
Vol 60 (3) ◽  
pp. 346-350 ◽  
Author(s):  
Ricardo Castillo ◽  
Aurora Fields ◽  
Ghazanfar Qureshi ◽  
Louis Salciccioli ◽  
John Kassotis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Inner City ◽  
Univariate Analysis ◽  
Ethnically Diverse ◽  
Intima Media Thickness ◽  
City Population ◽  
History Of ◽  
Artery Disease ◽  
Aortic Intima

Prior studies have suggested an association between atherosclerosis and periodontal disease, both of which are more prevalent in certain minority and economically disadvantaged groups. Few studies have addressed the relationship between cardiovascular disease and dentition among ethnically diverse populations. We studied 131 subjects (60% females, age 59 ± 15 years) who were referred for clinically indicated transesophageal echocardiography. Dental loss was more severe in patients with hypertension ( P < .001), diabetes ( P = .05), coronary artery disease ( P = .04), and calcium channel blocker use ( P = .04). On univariate analysis, maximal aortic intima—media thickness (MAIMT) was significantly correlated with dental loss ( r = .40; P < .001). Age was correlated with MAIMT ( R = .41; P < .001) and with dental loss ( r = .57; P < .001). On multivariate analysis, dental loss ( P = .03) and history of coronary artery disease ( P = .04) were independent predictors of MAIMT ( R 2 = .44). In this inner-city predominantly African American population, atherosclerosis and dental loss are age dependent and are interrelated independent of age.

The Development of a Clinical Skills Laboratory at Ross University School of Veterinary Medicine

2018 ◽  
Vol 46 (3) ◽  
pp. 177-183
Author(s):  
Bernard Grevemeyer ◽  
Andrew Knight
Keyword(s):  
Veterinary Medicine ◽  
Student Satisfaction ◽  
Clinical Skills ◽  
Physical Space ◽  
Teaching Staff ◽  
Psychomotor Skills ◽  
Skills Laboratory ◽  
Source Models ◽  
Senior Students

Dedicated clinical skills laboratories (CSLs) that make use of models, mannequins and simulators, are being increasingly established in medical and veterinary schools. These have been commonplace in medical schools for more than two decades, but their incorporation within the teaching of veterinary curricula has occurred much more recently. In 2007, a decision was taken to establish a CSL at Ross University School of Veterinary Medicine. We considered the range of skills that we wished to teach, the physical space and equipment needed, the storage and air conditioning requirements, the facilities needed to deliver PowerPoint lectures and case study presentations, and other essentials necessary to handle cadaver specimens. We converted an appropriate campus building to our needs, hired teaching staff, and started to source models and mannequins for the teaching of veterinary clinical skills. In 2010, 177 senior students completed a survey evaluating their experiences within our CSL. Student satisfaction was generally high, with 95% of respondents feeling that the CSL had improved their psychomotor skills. However, 15% of them felt that the models were insufficiently realistic. Our clinical skills programme has since developed considerably, and it currently offers instruction in a diverse array of surgical, medical and other clinical skills. We hope that this description of our experiences may assist others embarking on similar projects elsewhere.

scholarly journals Gambaran Faktor Risiko Kejadian Penyakit Jantung Koroner di Poliklinik Jantung RSI Siti Rahmah Padang Tahun 2017-2018

2020 ◽  
Vol 3 (1) ◽  
pp. 20-28
Author(s):  
Yushera Atika Sari ◽  
Wisda Widiastuti ◽  
Betty Fitriyasti
Keyword(s):  
Internal Medicine ◽  
Medical Records ◽  
Univariate Analysis ◽  
Secondary Data ◽  
Sampling Technique ◽  
Cross Sectional ◽  
Long Period ◽  
Survey Results ◽  
Artery Disease ◽  
Descriptive Method

Introduction: CAD occurs indirectly, usually a person will experience a process of narrowing of the coronary arteries in quite a long period of time. Primary survey results that researchers have done at Siti Rahmah Padang Hospital, recorded from 2017-2018 the number of CAD events as many as 115 cases. Aims : To obtain information about an overview of risk factors for the occurrence of coronary artery disease in the heart policlinic of Siti Rahmah Hospital Padang in 2017-2018. Method: This research covers the field of internal medicine and cardiology, this study was conducted at the Islamic hospital Siti Rahmah Padang in May to November 2019. This research used a descriptive method with a cross sectional approach using secondary data from medical records. The affordable population of this study is CAD patients who seek treatment at Siti Rahmah Hospital in Padang in 2017-2018 with 51 samples using Total Sampling technique. Univariate analysis is presented in the form of a frequency distribution table. Results: Based on the results of the study the most age was at the age of 50-59 years, 21 people (41.2%), the most sex was female, 26 people (51%), hypertension, 27 people (52,9%), experienced DM 26 people (51%) were obese, 16 people (31,4%) and hyperlipidemia, 13 people (25,5%). Conclusion : Most age 50-59 years, most sexes of women, most have hypertension, less than half are obese, most have DM and less than half have hyperlipidemia. 

Abstract 14559: Prognostic Utility of Cardiac Markers in Covid-19 Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ahmad Damati ◽  
Kok Hoe Delcos Chan ◽  
Iyad Farouji ◽  
Amr Al-ramahi ◽  
Patel Bhavic ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Univariate Analysis ◽  
Cardiovascular Complications ◽  
Hospitalized Patients ◽  
Multivariable Logistic Regression Analysis ◽  
Cardiac Markers ◽  
Significant Difference ◽  
The Us ◽  
Prognostic Utility ◽  
Artery Disease

Introduction: SARS-CoV-2 infection has been associated with a multiple cardiovascular complications. It is not known if cardiac markers can be used for outcome prediction in the US population. Methods: We conducted a retrospective study on patients ≥ 18 years old with confirmed COVID 19, who were admitted to our hospital between 03/15/2020 and 05/25/2020. Individuals were included if they had a baseline troponin and brain natriuretic peptide (BNP) available, and if their outcome by the end of the study period was well defined as discharge alive, or deceased. Univariate and multivariate logistic regression methods were employed to identify the cardiac markers associated with mortality in COVID-19 patients. Results: The total number of confirmed COVID-19 hospitalized patients during the study period was 348, after excluding patients who did not have cardiac markers available, 233 patients were included in the study, 75 (32%) expired, and 158 (68%) were discharged alive. The median age was 65 years old, and ranged from 22 to 101 years old. 140 males and 93 females. Comorbidities were present in 201 (86%) patients, with hypertension (65%) being the most common, followed by obesity (55%), diabetes mellitus (DM) (44%) and coronary artery disease (27%). Mechanical ventilation was required for 61 patients of whom 42 expired. In univariate analysis, we found a significant difference in history of chronic kidney disease defined by eGFR <45ml/min (p=0.046), DM (p=0.043), initial SOFA (p=0.017), troponin (p=0.001), BNP (p=0.043), CRP (p=<0.0001), LDH (p=<0.0001) and ferritin (p=<0.0001) between survivors and non-survivors. With multivariable logistic regression analysis, the only values that had an odds of survival were a low troponin (odds ratio [OR] 0.17; 95% confidence interval [CI], 0.04-0.52), a low SOFA (OR 0.72, CI 0.50-0.94) and a low CRP (OR 0.87, CI 0.87-0.94). Conclusions: This retrospective cohort study of hospitalized patients with COVID-19 suggests an independent association of increased troponin as risk factor for death in COVID-19 patients. Cardiac troponin has been reported as potential prognostic marker in the China cohort. To our knowledge, we are first to demonstrate the utilization of troponin as mortality predictor in the US population.

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