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4521. The importance of handovers in care homes

homes had been much less researched, which seems out of balance with the importance of the sector as I outlined in the introduction above. Handovers were seen as important by the staff interviewed. They were seen as fulfilling a range of purposes. In addition to basic communication about residents and care issues, some saw them as: matching skills to needs and allocating work, teambuilding, staff training, addressing some staff issues organising good person-centred care. It is difficult to prescribe (...) information down to colleagues in the homes. This variation in how information is shared and with whom may be related to the size of the homes (the smallest supported 22 residents whilst the largest had 150) and trying to find an approach that efficiently fitted local needs. However, the sense was more that it was down to local preferences about how to organise them. Structure, tone and how information was recorded in handovers also varied across the homes. In part this arose from some having electronic

2017 The Social Care Elf

4522. It’s time to reset the medical malpractice insurance conversation

have never been under greater pressure. In this environment, medical malpractice insurers must evolve to meet the changing needs of the profession. Practitioners struggling to heal patients and stay in business need more than an insurer that simply reacts to claims. We should offer tools and services that provide guidance. For example, we have created an extensive library of articles and resources openly available to all health care providers to help them understand and comply with electronic (...) them stay current with emerging best practices in patient care. For example, we analyze data captured from our claims experience with more than 78,000 members and translate it into actionable reports that are shared free of charge with all health care providers. We have published reports on cardiology, anesthesiology, emergency medicine, orthopedics, obstetrics, hospital medicine, internal medicine, plastic surgery, and electronic health record claims. In upcoming reports, we will focus on opioid

2017 KevinMD blog

4523. That’s it: MACRA must die!

simple measure that assesses a physician’s performance on the most basic aspect of diabetes management. But in the current health care environment, where rising drug prices, high-deductible insurance policies and more restrictive medication formularies limit some patients’ access to even the most basic prescriptions, taking care of diabetes can be almost impossible. Many of my patients who use insulin now tell me they can no longer afford it! How can I be held responsible for “quality” when my (...) information, is just the government’s wildly unpopular electronic health record (EHR) “meaningful use” program with a new name! Meaningful use, which started in 2011, forced a generation of physicians to purchase and use what often turned out to be exceedingly expensive and unusable EHR software programs. Many of those physicians now work late into the evening just to keep up with basic documentation using their unwieldy EHRs. Meaningful use placed demands on EHR software that many programs were simply

2017 KevinMD blog

4524. Your on-call doctor probably didn’t receive training in telephone medicine

about a patient’s intensity of illness from simple observation. There is no opportunity to perform a physical examination. Prior medical records may not be available, although many electronic medical record systems to do permit remote access. During my three years of internal medicine training and my two years of gastroenterology fellowship, I received not a whit of training in phone medicine. This was a gaping oversight in medical education considering how important these skills are to practicing (...) physicians. I use them every day. I confess that during my first several months on the job, there were many anxious moments for me as I fielded phone calls from anxious and sick patients. It would have been easier had my educators given me a few pointers. Understandably, patients who are calling physicians off hours are not aware of the handicaps that these doctors face. Patients often seem to feel that even on a phone call, we somehow have our full toolboxes available and can make diagnoses or prescribe

2017 KevinMD blog

4525. You’ve heard of Brexit? Here’s what they call doctors who are leaving.

. The Government Accountability Office in partnership with the DHHS has been assisting with the implementation of electronic health records (EHR) nationwide, while at the same time comparing and selecting programs for providers. So to recap, Congress has been working on a “doc fix” system in conjunction with every lobby possible on the planet except that of practicing physicians since 1997. They “repealed and replaced” SGR (first disaster) with the atrocity known as MACRA, which will end in a mass DRexit (...) entry clerks to treat conditions instead of people. Imagine if we just called in prescriptions for hypertension, diabetes or even started chemotherapy regimens without seeing patients at all? MACRA pays us more for “doing less,” so now we can practice “drive-by medicine.” I wonder if health outcomes will improve and mortality will be lower when compared with “drive-by shootings.” Controlling costs involves four major pillars of change to our health care system, about which I have been writing

2017 KevinMD blog

4526. NICE one? Is NHS guidance on substance misuse fit for purpose?

highs or novel psychoactive substances (NPS) have emerged as a group of drugs that cause a range of problems, which workers in a range of settings will encounter. is one example of innovation in the field which offers evidence based guidance on NPS for drugs workers Misuse of prescription drugs is not mentioned in the guidance, despite recent evidence that across Europe the United Kingdom has some of the highest levels of misuse of these drugs (Novak et al, 2016). Although the last decade has seen (...) and knowledge. The decade old NICE guidance has a long list of gaps in the substances it covers. Digital interventions The last decade has seen significant innovations in technology. The Mental Elf being a good example of the way information about health and evidence is now communicated. In parallel, online or electronic methods of delivering health care have developed. Breaking Free Online is one example of a drug treatment innovation, which has accumulating evidence of reaching groups that don’t usually

2016 The Mental Elf

4527. Value-based pay is doomed to fail. Here’s why.

requires that doctors use computerized electronic health records according to government standards and that they perform a number of quality-improvement projects every year. Physicians whose ratings are in the top fifty percent will receive an increase in their rate of pay, and those in the lower fifty percent will receive a penalty. Again, seems to make sense, right? Physicians will be paid for higher quality and lower cost. Everybody should be happy. I hate to be a kill-joy, but there just may (...) consider it one of my specialties. I monitor my patients’ hemoglobin A1c levels religiously and make every attempt to keep it under control. Of course, many diabetics require insulin to control their glucose levels. Lately, patients are complaining that their insulin has become too expensive. These patients tend to be older (they have type 2 diabetes), and most are covered under Medicare D prescription plans. Still, they are being forced to pay hundreds of dollars per month for their insulin. More

2017 KevinMD blog

4528. Classification of patients with low back-related leg pain: a systematic review

work and higher health care costs than pain in the back alone. The reason for undertaking this systematic review was firstly to identify and appraise existing classification systems for patients with low back-related leg pain and secondly to summarise how leg pain due to nerve root involvement (commonly called sciatica), is identified and described in the various classification systems. Following our search of electronic databases and reference lists of eligible studies and reviews, we identified (...) with the research and are constructive and respectful. We do not prescribe treatments. Promotion of your particular therapy in the comments section is not appropriate here either - that is not the point of BiM. Finally, all the comments that are made reflect the views of the person who made them and are not endorsed by BiM or members of the BiM research group. Copyright © 2019 · on · · Send to Email Address Your Name Your Email Address Post was not sent - check your email addresses! Email check failed, please

2017 Body in Mind blog

4529. Music therapy for depression in older adults: How can I be sure of you?

by searching PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO and the other electronic databases that are used time after time. To be included in the analysis, studies had to be randomised controlled trials as defined in the Cochrane Handbook, i.e. trials in which participants were allocated to conditions using true randomisation. The systematic review included studies involving people aged 60 or older with clinical diagnosis of depression, identified using any diagnostic (...) on its efficacy, music therapy must be studied in more specific groups. Ultimately, this would also help with deciding who should be ‘prescribed’ it. Music therapy might make people feel better in the short term, it might be low cost, but to be considered a true therapy it has to work, and while two out of three ain’t bad, the last one is important. A key result from this analysis was that while music therapy had no significant impact on depressive symptoms compared to standard therapy, it seemed

2016 The Mental Elf

4530. Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study. Full Text available with Trip Pro

cohort study aggregating electronic health record data on >1.2 million pediatric patients from 196 ambulatory clinics across 27 states. Demographic, diagnosis, blood pressure (BP), height, weight, and medication prescription data extracted. Main outcome measures include proportion of pediatric patients with ≥3 visits with abnormal BPs, documented hypertension and prehypertension diagnoses, and prescribed antihypertensive medications. Marginal standardization via logistic regression produced adjusted (...) , and number and magnitude of abnormal BPs were associated with diagnosis rates. Of 2813 diagnosed, persistently hypertensive patients, 158 (5.6%) were prescribed antihypertensive medication within 12 months of diagnosis (angiotensin-converting enzyme inhibitors/angiotensin receptive blockers [35%], diuretics [22%], calcium channel blockers [17%], and β-blockers [10%]).Hypertension and prehypertension were infrequently diagnosed among pediatric patients. Guidelines for diagnosis and initial medication

2016 Pediatrics

4531. Expert consensus on metrics to assess the impact of patient-level antimicrobial stewardship interventions in acute care settings. Full Text available with Trip Pro

Likert scale for association with 4 criteria: improved antimicrobial prescribing, improved patient care, utility in targeting stewardship efforts, and feasibility in hospitals with electronic health records. Experts further refined, added, or removed metrics during structured teleconferences and re-rated the retained metrics. Six metrics were rated >6 in all criteria: 2 measures of Clostridium difficile incidence, incidence of drug-resistant pathogens, days of therapy over admissions, days of therapy

2016 Clinical Infectious Diseases

4532. Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia. Full Text available with Trip Pro

Australia were purposefully selected to obtain a maximum variation sample. Twenty-six HCPs, from relevant medical, dentistry, nursing, pharmacy and allied health backgrounds, were interviewed between October 2013 and February 2014. Fourteen were prescribers and 12 practiced in primary care. Interviews were digitally audio-taped, transcribed verbatim and analysed using a constant comparison approach.most participants did not routinely use structured approaches to incorporate patients' preferences (...) in clinical decision-making, address conflicting prescriber advice, assess patients' adherence to treatment plans or seek to optimise care plans. Most HCPs were either unaware of medical decision aids and measurements tools to support these processes or disregarded them as not being user-friendly. Challenges with coordination and continuity of care, pressures of workload and poorly defined individual responsibilities for care, all contributed to participants' avoiding ownership of multimorbidity

2016 Age and ageing

4533. Prevention and treatment of venous thromboembolism in patients with solid brain neoplasms: results of a survey among Italian physicians. (Abstract)

prescribe primary thromboprophylaxis (usually with heparin) in non-surgical patients with solid brain neoplasms and brain metastases in concomitance with high-risk conditions. Full-dose anticoagulation with either low-molecular-weight heparin or fondaparinux is the preferred option for acute VTE (69.6%), while a reduced dose is chosen by 21.0% of physicians. The presence of a highly vascular brain neoplasm histotype mandates the prescription of a reduced-dose antithrombotic regimen in a minority (...) -choice questions regarding primary VTE prevention in non-surgical patients during high-risk conditions and VTE secondary prevention in patients with a solid brain neoplasm or cerebral metastases was sent via electronic mail to all the members (n = 2420) of the Italian Federation of the Internal Medicine Hospital Executives' Associations (FADOI) in June 2015. Three hundred and fifty two physicians (14.5%) returned it (participants' median age 51 years; females 46.9%). The majority of respondents

2016 Internal and emergency medicine

4534. Costs of perennial allergic rhinitis and allergic asthma increase with severity and poor disease control. (Abstract)

, in France.Using Electronic Health Records (EHRs), we identified in 2010 two cohorts of PAR patients, based on General Practitioners' diagnoses and prescribing data, with and without concomitant AA. For each patient, the EHRs were linked to corresponding claims data with MRU and costs during years 2011 to 2013. Predefined subgroup analyses were performed according to severity of PAR and level of AA control.The median annual cost reimbursed by social security system for a patient with PAR, and no AA was 159

2016 Allergy

4535. Choice of Moisturiser for Eczema Treatment (COMET): feasibility study of a randomised controlled parallel group trial in children recruited from primary care. Full Text available with Trip Pro

Patient-Oriented Eczema Measure scores and were more likely to withdraw than self-referrals. Parents of 20 (10%) of all the randomised participants reported using the allocated emollient daily for 84 days. The use of other non-study emollients was common. Completeness of data collected by parent-held daily diaries and at monthly study visits was good. Daily diaries were liked (81%) but mainly completed on paper rather than via electronic ('app') form. Major costs drivers were general practitioner (...) consultations and eczema-related prescriptions. Observer unblinding was infrequent, and occurred at the baseline or first follow-up visit through accidental disclosure.It is feasible in a primary care setting to recruit and randomise young children with eczema to emollients, follow them up and collect relevant trial data, while keeping observers blinded to their allocation. However, reported use of emollients (study and others) has design implications for future trials.ISRCTN21828118/EudraCT2013-003001-26

2016 BMJ open Controlled trial quality: predicted high

4536. High-Risk Medications in Hospitalized Elderly Adults: Are We Making It Easy to Do the Wrong Thing? (Abstract)

High-Risk Medications in Hospitalized Elderly Adults: Are We Making It Easy to Do the Wrong Thing? To examine dosages of high-risk medications administered to elderly adults who fall in the hospital and to determine whether electronic default doses are appropriate for elderly adults.Retrospective.Large urban academic hospital.Individuals aged 65 and older experiencing a fall.Prescribed daily dosages and use of high-risk medications (opiates, benzodiazepines, benzodiazepine-receptor agonists (...) (BRAs), sleep medications, muscle relaxants, antipsychotics) administered within 24 hours before a fall were ascertained and compared with published recommended dosages for older adults and the hospital's electronic medical record (EMR) default doses for these drugs.Of 328 falls, 62% occurred in individuals administered at least one high-risk medication within the 24 hours before the fall, with 16% of the falls involving individuals receiving two, and another 16% in individuals receiving three

2016 Journal of the American Geriatrics Society

4537. Evolving use of seizure medications after intracerebral hemorrhage: A multicenter study. Full Text available with Trip Pro

(ICH) across a metropolitan area before and after new outcomes data and revised prescribing guidelines were published.We conducted an observational study using electronic medical record data from 4 academic medical centers in a large US metropolitan area.A total of 3,422 patients with ICH, diagnosed between 2007 and 2012, were included. In 2009, after a publication found an association of phenytoin with higher odds of dependence or death, the use of phenytoin declined from 9.6% in 2009 to 2.2 (...) Evolving use of seizure medications after intracerebral hemorrhage: A multicenter study. Prophylactic medications can be a source of preventable harm, potentially affecting large numbers of patients. Few data exist about how clinicians change prescribing practices in response to new data and revisions to guidelines about preventable harm from a prophylactic medication. We sought to determine the changes in prescribing practice of seizure medications for patients with intracerebral hemorrhage

2016 Neurology

4538. Hypoglycemia in patients with type 2 diabetes newly initiated on basal insulin in the US in a community setting: impact on treatment discontinuation and hospitalization. Full Text available with Trip Pro

Hypoglycemia in patients with type 2 diabetes newly initiated on basal insulin in the US in a community setting: impact on treatment discontinuation and hospitalization. To evaluate the impact of 6 month hypoglycemia on treatment discontinuation and hospitalization of patients initiating basal insulin for type 2 diabetes (T2D) in real-world practice.This was a retrospective cohort study of patient-level data using electronic medical records (EMRs) in the Predictive Health Intelligence diabetes (...) dataset. Data from adult patients with T2D initiating basal insulin glargine, insulin detemir, or Neutral Protamine Hagedorn insulin between January 2008 and March 2014 was analyzed. The date of first basal insulin prescription in an outpatient setting was the index date. A 12 month baseline prior to the index date was established; follow-up was 6-24 months from the index date. Patients were assigned to cohorts by experience of hypoglycemia (International Classification of Diseases, Ninth Revision

2016 Current medical research and opinion

4539. Performance measures of diagnostic codes for detecting opioid overdose in the emergency department. Full Text available with Trip Pro

from January 1, 2012, to December 31, 2014, including clinical determination of whether the visit constituted an opioid overdose event, were abstracted from electronic medical records for patients prescribed long-term opioids for pain from any of six safety net primary care clinics in San Francisco, California. Combinations of ICD-9-CM codes were validated in the detection of overdose events as determined by medical chart review. Both sensitivity and specificity of different combinations of ICD-9

2016 Academic Emergency Medicine

4540. Measuring time utilization of pharmacists in the Birmingham Free Clinic dispensary. Full Text available with Trip Pro

Measuring time utilization of pharmacists in the Birmingham Free Clinic dispensary. Free and charitable clinics are a critical part of America's healthcare safety net. Although informatics tools have the potential to mitigate many of the organizational and service-related challenges facing these clinics, little research attention has been paid to the workflows and potential impact of electronic systems in these settings. In previous work, we performed a qualitative investigation at a free (...) categories occupied almost 95 % of pharmacist time: prescription (Rx) preparation (39.8 %), clinician interaction (21.5 %), EMR operations (14.8 %), and patient interaction (18.7 %). Pharmacists invested the largest portion of time in prescription preparation, with 21.8 % of pharmacist time spent handwriting medication labels. Based on value categorizations made by the pharmacists, the average value quotient was found to be 40.3 %, indicating that pharmacists spend more than half of their time completing

2016 BMC health services research

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