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Web-Based Patient Education

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53621. Use of lipid-lowering drugs in older adults with and without dementia: a community-based epidemiological study. (PubMed)

Use of lipid-lowering drugs in older adults with and without dementia: a community-based epidemiological study. To compare the use of lipid-lowering drugs in community-dwelling older adults with and without dementia.Comparison of lipid-lowering drug use by demented cases and nondemented controls based on secondary analysis of data from a longitudinal epidemiologic study.Longitudinal study of a largely rural, low- socioeconomic-status, community-based cohort of older persons residing in the mid (...) Clinical Dementia Rating (CDR).One hundred seventy participants (20.1% of total subject cohort) had dementia, with a CDR of 0.5 or greater. Mean ages of demented and nondemented individuals were 83.5 +/- 5.1 and 79.8 +/- 4.2, respectively. Similar proportions, 87.7% and 89.5%, of these groups reported PCP visits in the previous year. Of the total sample, 9.4% (3.5% of the demented and 10.8% of the nondemented) were taking lipid-lowering drugs. After adjustment for age, sex, education, visit with PCP

2002 Journal of the American Geriatrics Society

53622. Hoof kick injuries in unmounted equestrians. Improving accident analysis and prevention by introducing an accident and emergency based relational database. (PubMed)

patients sustained contusions of the extremities, the back, and the trunk. In nine patients an isolated facial injury was diagnosed. Five of nine patients needed referrals to the department of plastic surgery because of the complexity of the facial soft tissue wounds. Three underwent maxillofacial surgery.Clinical: the equestrian community may underestimate the risk of severe injuries attributable to hoof kicks, especially while handling the horse. Educational lectures and the distribution (...) Hoof kick injuries in unmounted equestrians. Improving accident analysis and prevention by introducing an accident and emergency based relational database. To assess injury patterns attributable to horse kicks, to raise the issue of preventive measures, and to evaluate the role of modern accident and emergency department computer software.Data analysis using a new kind of full electronic medical record.Seventeen kicked equestrians were unmounted at the time of injury. Eight of seventeen

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2002 Emergency Medicine Journal

53623. Definitions and competencies for practice-based learning and improvement. (PubMed)

Definitions and competencies for practice-based learning and improvement. The Outcome Project is a long-term initiative by which the Accreditation Council for Graduate Medical Education (ACGME) is increasing emphasis on educational outcomes in the evaluation of residency programs. The ACGME initiated the Outcome Project to "ensure and improve the quality of graduate medical education." In order to assist program directors in emergency medicine (EM) to begin complying with components (...) of the ACGME Outcome Project, the Council of Residency Directors in Emergency Medicine (CORD-EM) convened a consensus conference in March 2002 in conjunction with several other EM organizations. The working group for the competency of Practice-based Learning and Improvement (PBL) defined the components of PBL as: 1) analyze and assess practice experience and perform practice-based improvement; 2) locate, appraise, and utilize scientific evidence related to the patient's health problems and the larger

2002 Academic Emergency Medicine

53624. Systems-based practice: the sixth core competency. (PubMed)

, and case conferences. With appropriate integration and evaluation of this competency into training programs, it is likely that future generations of physicians and patients will reap the benefits of an educational system that is based on well-defined outcomes and a more systemic view of health care. (...) Systems-based practice: the sixth core competency. Systems-Based Practice (SBP) is the sixth competency defined by the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project. Specifically, SBP requires "Residents [to] demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value." This competency can be divided into four subcompetencies, all

2002 Academic Emergency Medicine

53625. Evaluating systems-based practice in emergency medicine. (PubMed)

Evaluating systems-based practice in emergency medicine. The Accreditation Council for Graduate Medical Education has required that training programs initiate an evaluation process to assess resident acquisition of the newly promulgated general competencies (GCs). Certain GCs (e.g., systems-based practice, problem-based learning and improvement) are somewhat more challenging to define and measure than others. Systems-based practice essentially captures the interactions of the emergency medicine (...) resident that expand beyond isolated contact with the patient. Evaluating these various interactions is readily accomplished using a detailed ordinal evaluation form that measures commonly occurring easily identified actions. Examples of measurable items and the method by which they can be integrated into an evaluation device are presented.

2002 Academic Emergency Medicine

53626. Economic and policy analysis of university-based drug "detailing". (PubMed)

Economic and policy analysis of university-based drug "detailing". The cost-effectiveness of quality assurance programs is often poorly documented, especially for innovative approaches. The authors analyzed the economic effects of an experimental educational outreach program designed to reduce inappropriate drug prescribing, based on a four-state randomized controlled trial (N = 435 physicians). Primary care physicians randomized into the face-to-face group were offered two individualized (...) educational sessions with clinical pharmacists, lasting an average of 18 minutes each, concerning optimal use of three drug groups that are often used inappropriately. After the program, expenditures for target drugs prescribed by these physicians to Medicaid patients decreased by 13%, compared with controls (P = 0.002); this effect was stable over three quarters. Implementation of this program for 10,000 physicians would lead to projected drug savings (to Medicaid only) of $2,050,000, compared

1986 Medical Care Controlled trial quality: uncertain

53627. A comparison of methods for increasing compliance within a general practitioner based screening project for colorectal cancer and the effect on practitioner workload. (PubMed)

A comparison of methods for increasing compliance within a general practitioner based screening project for colorectal cancer and the effect on practitioner workload. Screening for colorectal cancer by testing for faecal occult blood (FOBT) is effective for early diagnosis, but the success of a screening programme also depends on compliance. The aims of this study were to assess the effect of health education on compliance and to assess any addition to general practitioner workload (...) that resulted. Altogether 3860 patients were recruited and randomly allocated to test or control group. The test group was further divided into subgroups, some of which received health education. Compliance with FOBT was 54.7% (210/384) in the subgroup receiving only the doctor's letter, which fell to 48.1% (743/1544) in the group receiving health education. General practitioner consultation rates were similar in test and control groups.

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1988 Journal of epidemiology and community health Controlled trial quality: uncertain

53628. A randomized controlled trial assessing the impact of problem-based versus didactic teaching methods in CME. (PubMed)

A randomized controlled trial assessing the impact of problem-based versus didactic teaching methods in CME. A Continuing Medical Education short course was designed to examine the effect of presenting topics in three learning formats - traditional lectures, large-group, case discussions or small-group, problem-solving sessions, on knowledge and performance of family physicians. The physicians in the small group session rated the CME short course higher and performed better on one aspect (...) of patient management than the lecture or large group physicians but there were no other differences between groups on knowledge or physician performance.

1988 Research in medical education : proceedings of the ... annual Conference. Conference on Research in Medical Education Controlled trial quality: uncertain

53629. Effective control of hypercholesterolemia in children with dietary interventions based in pediatric practice. (PubMed)

with hypercholesterolemia (> 185 mg/dl) two interventions: one single or four multiple 90-min sessions of family-oriented nutritional education, based in pediatric practices. We examined total cholesterol, 3-day food records, height and weight, and in the multisession group high-density lipoprotein cholesterol and triglycerides at the beginning and at intervals of 8.5-9 and 21 to 33 weeks (single-session and multisession groups, respectively).Total cholesterol was lowered equally in both treatment groups over (...) Effective control of hypercholesterolemia in children with dietary interventions based in pediatric practice. Based on recent recommendations, the number of hypercholesterolemic children who would require dietary therapy could overwhelm current preventive pediatric cardiology resources. No previous studies have established the efficacy of such therapy in the pediatrician's office. The purpose of this study was to evaluate two programs of office-based therapy.We randomly assigned 295 children

1993 Preventive Medicine Controlled trial quality: uncertain

53630. The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial. (PubMed)

The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial. The present multicentre study evaluates the differences in efficacy between a 3 month rehabilitation programme including drug treatment, and a 3 month control period of drug treatment only, for asthmatic patients and patients with chronic obstructive pulmonary disease (COPD). The programme was run by physiotherapists in eight local practices, and included (...) exercise training, patient education, breathing retraining, evacuation of mucus, relaxation techniques, and recreational activities. In a randomized controlled trial with a cross-over design, the effects of rehabilitation were evaluated 3 and 6 months after baseline measurements in terms of exercise tolerance and quality of life (QOL). Exercise tolerance was assessed using submaximal cycle ergometer tests and 6 min walking tests. QOL was evaluated by means of the Chronic Respiratory Disease

1997 The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology Controlled trial quality: uncertain

53631. Improving office-based physician's prevention practices for sexually transmitted diseases. (PubMed)

of physicians of the combined intervention group reported an increase in counseling patients about reducing risky sexual behavior compared with 53% of the group receiving only educational materials and 42% of the control group (P < or = 0.001).Mailed educational materials combined with an office visit by a simulated patient instructor for role-play and feedback on clinical performance increased the frequency of office-based physicians' risk assessment and risk reduction counseling of patients for sexually (...) Improving office-based physician's prevention practices for sexually transmitted diseases. To determine whether office-based interventions increase primary care physicians' risk assessment of and counseling practices for patients regarding sexually transmitted diseases and the human immunodeficiency virus (HIV).Randomized controlled clinical trial.Washington, D.C., Metropolitan Statistical Area.Office-based primary care physicians (family or general practice, internal medicine, and obstetrics

1994 Annals of internal medicine Controlled trial quality: uncertain

53632. Randomised controlled trial of general practice based asthma clinics. (PubMed)

Randomised controlled trial of general practice based asthma clinics. To compare the effects on asthma morbidity of asthma clinics based in general practice with standard general practice care.A randomised controlled trial in eight general practices. Patients, general practitioners and outcomes assessors were not blinded to treatment allocation.195 patients with asthma aged 5-64 years; 191 completed the trial.Three asthma clinic sessions over six months involving nurse counselling, education (...) about asthma management, spirometry and consultation with the general practitioner.Patients reporting days lost from work or school, number of days lost, the presence of morning or nocturnal asthma symptoms, use of an action plan, medication use, current smoking, hospitalisation, and emergency visits.Asthma clinics were associated with a greater reduction in nocturnal symptoms, an increase in the ownership of peak flow meters and an increase in the number of patients commencing or resuming smoking

1999 The Medical journal of Australia Controlled trial quality: uncertain

53633. The effect of a peak flow-based action plan in the prevention of exacerbations of asthma. (PubMed)

subjects were recruited after attending an emergency department or a clinic for urgent treatment of asthma.All subjects received evaluation and education for asthma before being randomly allocated to receive no action plan, a symptom-based action plan, or a peak flowmeter and a peak flow-based action plan.Subjects were assessed by questionnaire at 3 and 6 months after enrollment with questions relating to their asthma control and their need for urgent treatment or hospital admission for asthma.At 6 (...) months after enrollment, although all three intervention groups experienced improvement in their asthma control, there was a striking reduction in emergency department visits for asthma only in the peak flow-based action plan group (p=0.006). No significant difference in emergency visits was apparent between the symptom-based action plan and no action plan groups.We conclude that a peak flow-based action plan is effective, at least in the short term, in protecting patients with asthma against severe

1997 Chest Controlled trial quality: uncertain

53634. Home-based management can achieve intensification cost-effectively in type I diabetes. (PubMed)

Home-based management can achieve intensification cost-effectively in type I diabetes. Newly diagnosed insulin-dependent diabetic children are most often admitted to hospital for education and insulin management and subsequently followed in outpatient clinics or office settings. However, most could be managed at home, given adequate family and health care team support and subsequent follow-up facilitated by home-based nursing intervention. We conducted a randomized trial of clinical (...) , psychosocial, and cost effects of home-based management in a 2-year follow-up study of newly diagnosed diabetic children.Sixty three patients were randomly assigned to traditional hospitalization and outpatient follow-up (hospital-based group) or home management (home-based group). Treatment differences between the two groups consisted of duration of initial hospital stay, site and timing of initial teaching, and nature and extent of subsequent nursing follow-up. Metabolic control was assessed by means

1999 Pediatrics Controlled trial quality: uncertain

53635. The effect of a multifaceted physician office-based intervention on older women's mammography use. (PubMed)

. The multifaceted intervention incorporated patient education, physician reminders, and audit-with-feedbackBiennial mammography rates. Patient adherence to physician mammography referral was evaluated in a restricted cohort of women selected from the intervention sample.The mammography rate for the intervention sample increased from 62.7% (baseline) to 73.1% (follow-up), (P<.001), whereas the control sample's rate remained essentially unchanged (68.3 to 69.5%), (P = .34). The intervention patients were 48% more (...) The effect of a multifaceted physician office-based intervention on older women's mammography use. In response to identified low mammography use among older women in three geographic areas in Connecticut, a physician office-based mammography intervention was initiated under the Health Care Financing Administration's Health Care Quality Improvement Program.To evaluate the intervention's impact on older women's mammography use.A quasi-experimental design comparing mammography rates for women

2000 Journal of the American Geriatrics Society Controlled trial quality: uncertain

53636. Early findings from a community-based, cluster-randomized, controlled oral cancer screening trial in Kerala, India. The Trivandrum Oral Cancer Screening Study Group. (PubMed)

for treatment. Data on oral cancer incidence, stage distribution, survival, and mortality in the study groups are obtained by record linkage with the Trivandrum population-based cancer registry and municipal death registration systems.There were 59,894 eligible subjects in the intervention group and 54,707 in the control group; 31.4% of the former group reported no tobacco or alcohol habits, compared with 44.1% of the latter. The distribution of age, education, occupation, income, and socioeconomic status (...) Early findings from a community-based, cluster-randomized, controlled oral cancer screening trial in Kerala, India. The Trivandrum Oral Cancer Screening Study Group. Oral cancer satisfies the criteria for a suitable disease for screening, and oral visual inspection is a suitable test for oral cancer screening. The efficacy of screening in reducing mortality from oral cancer has not yet been evaluated. The authors describe a cluster-randomized, controlled oral cancer screening trial in southern

2000 Cancer Controlled trial quality: uncertain

53637. Assessing the impact of pediatric-based development services on infants, families, and clinicians: challenges to evaluating the Health Steps Program. (PubMed)

Assessing the impact of pediatric-based development services on infants, families, and clinicians: challenges to evaluating the Health Steps Program. Begun in 1996, the Healthy Steps for Young Children Program (HS) is a new model of pediatric practice that incorporates child development specialists and enhanced developmental services for families of young children. HS is for all families, not just those at high-risk. It is expected to strengthen parents' knowledge, attitudes, and behaviors (...) . It describes the evaluation design and characteristics of the HS sites and sample for the evaluation.The evaluation is following a cohort of children from birth to age 3 at 15 evaluation sites across the country. The sites represent a range of organizational practice settings that include group practices, hospital-based clinics, and health maintenance organization pediatric clinics. The evaluation design relies on 2 comparison strategies. At 6 randomization design sites, 400 children were randomized

2000 Pediatrics Controlled trial quality: uncertain

53638. A clinic-based mammography intervention targeting inner-city women. (PubMed)

participation.A clinic-based program incorporating physician education, provider prompts, patient education materials, and appointment reminders and emphasizing nursing involvement can facilitate adherence to breast cancer screening guidelines among inner-city women. (...) for mammography) during the study period were enrolled in the trial (n = 314).The intervention program emphasized nursing involvement and included physician education, provider prompts, use of audiovisual and printed patient education materials, transportation assistance in the form of bus passes, preappointment telephone or postcard reminders, and rescheduling assistance. Control firm women received usual care.Mammography completion within 8 weeks of clinic visits was significantly higher among intervention

1999 Journal of General Internal Medicine Controlled trial quality: uncertain

53639. Brief physician advice for alcohol problems in older adults: a randomized community-based trial. (PubMed)

drinkers. Twenty-four community-based primary care practices in Wisconsin (43 family physicians and internists) participated in the trial. Of the 6073 patients screened, 105 men and 53 women met inclusion criteria and were randomized into a control group (n = 71) or an intervention group (n = 87). Intervention group patients received two 10- to 15-minute physician-delivered counseling sessions that included advice, education, and contracting using a scripted workbook. A total of 146 patients (92.4 (...) Brief physician advice for alcohol problems in older adults: a randomized community-based trial. Alcohol use in older adults is common. It is associated with depression, hypertension, diabetes, drug interactions, accidents, and increased rates of emergency department visits and hospitalizations.A controlled clinical trial (Project GOAL--Guiding Older Adult Lifestyles) tested the efficacy of brief physician advice in reducing the alcohol use and use of health care services of older adult problem

1999 Journal of Family Practice Controlled trial quality: uncertain

53640. Handwashing compliance by health care workers: The impact of introducing an accessible, alcohol-based hand antiseptic. (PubMed)

Handwashing compliance by health care workers: The impact of introducing an accessible, alcohol-based hand antiseptic. Under routine hospital conditions handwashing compliance of health care workers including nurses, physicians, and others (eg, physical therapists and radiologic technicians) is unacceptably low.To investigate the efficacy of an education/ feedback intervention and patient awareness program (cognitive approach) on handwashing compliance of health care workers; and to compare (...) the acceptance of a new and increasingly accessible alcohol-based waterless hand disinfectant (technical approach) with the standard sink/soap combination.A 6-month, prospective, observational study.One medical intensive care unit (ICU), 1 cardiac surgery ICU, and 1 general medical ward located in a 728-bed, tertiary care, teaching facility.Medical caregivers in each of the above settings.Implementation of an education/ feedback intervention program (6 in-service sessions per each ICU) and patient awareness

2000 Archives of internal medicine Controlled trial quality: uncertain

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