Subjects -> MEDICAL SCIENCES (Total: 8690 journals)
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MEDICAL SCIENCES (2415 journals)            First | 3 4 5 6 7 8 9 10 | Last

Showing 1201 - 1400 of 3562 Journals sorted alphabetically
Journal of Evaluation In Clinical Practice     Hybrid Journal   (Followers: 6)
Journal of Evidence-Based Healthcare     Open Access   (Followers: 1)
Journal of Evidence-Based Integrative Medicine     Open Access   (Followers: 18)
Journal of Evidence-Based Medicine     Partially Free   (Followers: 4)
Journal of Exercise Science & Fitness     Open Access   (Followers: 29)
Journal of Experimental and Clinical Anatomy     Open Access   (Followers: 2)
Journal of Family and Community Medicine     Open Access   (Followers: 3)
Journal of Family Medicine and Primary Care     Open Access   (Followers: 11)
Journal of Foot and Ankle Research     Open Access   (Followers: 6)
Journal of Forensic Science and Research     Open Access   (Followers: 2)
Journal of Gandaki Medical College-Nepal     Open Access  
Journal of Generic Medicines     Hybrid Journal   (Followers: 2)
Journal of Geographical Sciences     Hybrid Journal   (Followers: 1)
Journal of Global Antimicrobial Resistance     Hybrid Journal   (Followers: 3)
Journal of Hand Therapy     Hybrid Journal   (Followers: 19)
Journal of Head & Neck Physicians and Surgeons     Open Access   (Followers: 2)
Journal of Health & Medical Informatics     Open Access   (Followers: 62)
Journal of Health and Biological Sciences     Open Access   (Followers: 1)
Journal of Health Design     Open Access   (Followers: 1)
Journal of Health Economics and Outcomes Research     Open Access   (Followers: 1)
Journal of Health Promotion and Behavior     Open Access  
Journal of Health Research and Reviews     Open Access  
Journal of Health Science and Medical Research     Open Access  
Journal of Health Science Research     Open Access  
Journal of Health Sciences     Open Access   (Followers: 1)
Journal of health sciences     Open Access  
Journal of Health Sciences / Sağlık Bilimleri Dergisi     Open Access  
Journal of Health Sciences and Medicine     Open Access  
Journal of Health Sciences and Medicine     Open Access   (Followers: 6)
Journal of Health Sciences and Surveillance System     Open Access  
Journal of Health Sciences Scholarship     Open Access  
Journal of Health Specialties     Open Access  
Journal of Health Studies     Open Access  
Journal of Healthcare Informatics Research     Hybrid Journal   (Followers: 1)
Journal of Heavy Metal Toxicity and Diseases     Open Access  
Journal of Helminthology     Hybrid Journal   (Followers: 2)
Journal of Herbs Spices & Medicinal Plants     Hybrid Journal  
Journal of HIV for Clinical and Scientific Research     Open Access   (Followers: 2)
Journal of Hospital Medicine     Hybrid Journal   (Followers: 11)
Journal of Huazhong University of Science and Technology [Medical Sciences]     Hybrid Journal  
Journal of Human Hypertension     Hybrid Journal   (Followers: 3)
Journal of Human Rhythm     Open Access  
Journal of Human Transcriptome     Open Access  
Journal of Ideas in Health     Open Access  
Journal of Inflammation     Open Access   (Followers: 2)
Journal of Inflammation Research     Open Access  
Journal of Injury and Violence Research     Open Access   (Followers: 6)
Journal of Innovation in Health Informatics     Open Access   (Followers: 17)
Journal of Institute of Medicine     Open Access  
Journal of Insulin Resistance     Open Access   (Followers: 1)
Journal of Interactional Research in Communication Disorders     Hybrid Journal   (Followers: 5)
Journal of Interferon & Cytokine Research     Hybrid Journal   (Followers: 3)
Journal of International Medical Research     Open Access   (Followers: 3)
Journal of Interventional Medicine     Open Access   (Followers: 1)
Journal of Investigative Medicine     Hybrid Journal   (Followers: 3)
Journal of Islamabad Medical & Dental College     Open Access   (Followers: 2)
Journal of Istanbul Faculty of Medicine     Open Access  
Journal of Karnali Academy of Health Sciences     Open Access   (Followers: 1)
Journal of Kathmandu Medical College     Open Access   (Followers: 1)
Journal of King Abdulaziz University : Medical Sciences     Open Access   (Followers: 2)
Journal of Laboratory Medicine     Hybrid Journal   (Followers: 27)
Journal of Laryngology and Voice     Open Access   (Followers: 11)
Journal of Lasers in Medical Sciences     Open Access  
Journal of Law, Medicine & Ethics     Hybrid Journal   (Followers: 28)
Journal of Legal Medicine     Hybrid Journal   (Followers: 7)
Journal of Limb Lengthening & Reconstruction     Open Access  
Journal of Lumbini Medical College     Open Access   (Followers: 1)
Journal of Mahatma Gandhi Institute of Medical Sciences     Open Access  
Journal of Manipulative and Physiological Therapeutics     Hybrid Journal   (Followers: 6)
Journal of Manmohan Memorial Institute of Health Sciences     Open Access   (Followers: 1)
Journal of Marine Medical Society     Open Access  
Journal of Materials Science : Materials in Medicine     Hybrid Journal   (Followers: 4)
Journal of Maternal and Child Health     Open Access  
Journal of Mechanics in Medicine and Biology     Hybrid Journal  
Journal of Medical and Biological Engineering     Hybrid Journal   (Followers: 4)
Journal of Medical and Biomedical Sciences     Open Access   (Followers: 2)
Journal of Medical Case Reports     Open Access   (Followers: 1)
Journal of Medical Cases     Open Access   (Followers: 6)
Journal of Medical Colleges of PLA     Full-text available via subscription  
Journal of Medical Disorders     Open Access  
Journal of Medical Economics     Hybrid Journal   (Followers: 8)
Journal of Medical Education and Curricular Development     Open Access   (Followers: 6)
Journal of Medical Ethics     Partially Free   (Followers: 27)
Journal of Medical Ethics and History of Medicine     Open Access   (Followers: 19)
Journal of Medical Humanities     Hybrid Journal   (Followers: 21)
Journal of Medical Hypotheses and Ideas     Open Access  
Journal of Medical Imaging and Health Informatics     Full-text available via subscription   (Followers: 1)
Journal of Medical Investigation and Practice     Open Access  
Journal of Medical Laboratory and Diagnosis     Open Access  
Journal of Medical Law and Ethics     Full-text available via subscription   (Followers: 17)
Journal of Medical Microbiology     Full-text available via subscription   (Followers: 6)
Journal of Medical Sciences     Open Access  
Journal of Medical Sciences     Open Access  
Journal of Medical Screening     Hybrid Journal   (Followers: 6)
Journal of Medical Signals and Sensors     Open Access   (Followers: 3)
Journal of Medical Society     Open Access  
Journal of Medical Systems     Hybrid Journal  
Journal of Medical Toxicology     Hybrid Journal   (Followers: 6)
Journal of Medical Ultrasound     Open Access   (Followers: 2)
Journal of Medicinal Botany     Open Access  
Journal of Medicinal Chemistry     Hybrid Journal   (Followers: 207)
Journal of Medicine     Open Access   (Followers: 1)
Journal of Medicine and Biomedical Research     Open Access   (Followers: 1)
Journal of Medicine and Philosophy     Hybrid Journal   (Followers: 9)
Journal of Medicine and the Person     Hybrid Journal  
Journal of Medicine in Scientific Research     Open Access  
Journal of Medicine in the Tropics     Open Access  
Journal of Medicine Research and Development     Open Access   (Followers: 3)
Journal of Medicine, Physiology and Biophysics     Open Access   (Followers: 5)
Journal of Medicines Development Sciences     Open Access   (Followers: 1)
Journal of Metabolomics & Systems Biology     Open Access   (Followers: 2)
Journal of Mind and Medical Sciences     Open Access   (Followers: 1)
Journal of Molecular Medicine     Hybrid Journal   (Followers: 11)
Journal of Movement Disorders     Open Access   (Followers: 2)
Journal of Multidisciplinary Research in Healthcare     Open Access   (Followers: 2)
Journal of Muscle Research and Cell Motility     Hybrid Journal   (Followers: 1)
Journal of Nanotechnology in Engineering and Medicine     Full-text available via subscription   (Followers: 6)
Journal of Nanotheranostics     Open Access   (Followers: 1)
Journal of Natural Medicines     Hybrid Journal  
Journal of Natural Science, Biology and Medicine     Open Access   (Followers: 3)
Journal of Nature and Science of Medicine     Open Access   (Followers: 4)
Journal of Negative and No Positive Results     Open Access  
Journal of Nepalgunj Medical College     Open Access  
Journal of Neurocritical Care     Open Access  
Journal of Neurodegenerative Diseases     Open Access   (Followers: 2)
Journal of Neurorestoratology     Open Access  
Journal of Neuroscience and Neurological Disorders     Open Access  
Journal of Nobel Medical College     Open Access  
Journal of Obesity and Bariatrics     Open Access   (Followers: 2)
Journal of Occupational Health     Open Access  
Journal of Occupational Therapy Education     Open Access   (Followers: 12)
Journal of Ocular Biology, Diseases, and Informatics     Hybrid Journal  
Journal of Oral Biology and Craniofacial Research     Full-text available via subscription  
Journal of Oral Health and Craniofacial Science     Open Access  
Journal of Orofacial Sciences     Open Access  
Journal of Otorhinolaryngology, Hearing and Balance Medicine     Open Access   (Followers: 1)
Journal of Ovarian Research     Open Access  
Journal of Ozone Therapy     Open Access  
Journal of Palliative Medicine     Hybrid Journal   (Followers: 47)
Journal of Paramedical Sciences & Rehabilitation     Open Access  
Journal of Parkinsonism and Restless Legs Syndrome     Open Access   (Followers: 2)
Journal of Parkinson’s Disease and Alzheimer’s Disease     Open Access   (Followers: 1)
Journal of Participatory Medicine     Open Access  
Journal of Patan Academy of Health Sciences     Open Access  
Journal of Pathogens     Open Access   (Followers: 1)
Journal of Patient Experience     Open Access  
Journal of Patient Safety and Risk Management     Hybrid Journal   (Followers: 2)
Journal of Patient-Centered Research and Reviews     Open Access  
Journal of Patient-Reported Outcomes     Open Access  
Journal of Periodontal Research     Hybrid Journal  
Journal of Personalized Medicine     Open Access   (Followers: 3)
Journal of Pest Science     Hybrid Journal   (Followers: 1)
Journal of Pharmaceutical Policy and Practice     Open Access   (Followers: 4)
Journal of Physiobiochemical Metabolism     Hybrid Journal   (Followers: 2)
Journal of Physiology-Paris     Hybrid Journal   (Followers: 2)
Journal of Pioneering Medical Sciences     Open Access  
Journal of Postgraduate Medicine     Open Access  
Journal of Pregnancy     Open Access   (Followers: 4)
Journal of Prevention & Intervention Community     Hybrid Journal   (Followers: 7)
Journal of Preventive Medicine and Public Health     Open Access  
Journal of Primary Prevention     Hybrid Journal   (Followers: 7)
Journal of Prosthodontic Research     Full-text available via subscription   (Followers: 1)
Journal of Prosthodontics     Hybrid Journal   (Followers: 2)
Journal of Receptor, Ligand and Channel Research     Open Access   (Followers: 1)
Journal of Regenerative Medicine     Partially Free   (Followers: 4)
Journal of Research in Medical Sciences     Open Access   (Followers: 2)
Journal of Science and Applications : Biomedicine     Open Access   (Followers: 1)
Journal of Science and Technology (Ghana)     Open Access   (Followers: 3)
Journal of Scientific Innovation in Medicine     Open Access  
Journal of Scientific Perspectives     Open Access   (Followers: 1)
Journal of Sensory Studies     Hybrid Journal   (Followers: 4)
Journal of Shaheed Suhrawardy Medical College     Open Access  
Journal of Shoulder and Elbow Arthroplasty     Open Access  
Journal of Sleep Disorders : Treatment & Care     Hybrid Journal   (Followers: 10)
Journal of South American Earth Sciences     Hybrid Journal   (Followers: 5)
Journal of Spinal Cord Medicine     Hybrid Journal   (Followers: 5)
Journal of Spinal Disorders & Techniques     Hybrid Journal   (Followers: 2)
Journal of Sports Medicine and Allied Health Sciences : Official Journal of the Ohio Athletic Trainers Association     Open Access   (Followers: 1)
Journal of Stem Cell Therapy and Transplantation     Open Access   (Followers: 1)
Journal of Stomal Therapy Australia     Full-text available via subscription   (Followers: 1)
Journal of Strength and Conditioning Research     Hybrid Journal   (Followers: 77)
Journal of Substance Use     Hybrid Journal   (Followers: 15)
Journal of Surgical Academia     Open Access   (Followers: 1)
Journal of Surgical and Clinical Research     Open Access  
Journal of Surgical Case Reports     Open Access  
Journal of Surgical Education     Full-text available via subscription   (Followers: 3)
Journal of Surgical Technique and Case Report     Open Access  
Journal of Systemic Therapies     Full-text available via subscription   (Followers: 3)
Journal of Taibah University Medical Sciences     Open Access  
Journal of Telemedicine and Telecare     Hybrid Journal   (Followers: 12)
Journal of The Academy of Clinical Microbiologists     Open Access  
Journal of the American Association for Laboratory Animal Science     Full-text available via subscription   (Followers: 9)
Journal of the American College of Certified Wound Specialists     Hybrid Journal   (Followers: 2)
Journal of the American College of Clinical Wound Specialists     Hybrid Journal   (Followers: 2)
Journal of the American Medical Directors Association     Hybrid Journal   (Followers: 5)
Journal of the American Medical Informatics Association : JAMIA     Hybrid Journal   (Followers: 36)
Journal of the American Podiatric Medical Association     Full-text available via subscription   (Followers: 7)
Journal of the Anatomical Society of India     Full-text available via subscription  
Journal of the Anus, Rectum and Colon     Open Access  
Journal of The Arab Society for Medical Research     Open Access  

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Similar Journals
Journal Cover
Journal of Patient-Centered Research and Reviews
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2330-068X - ISSN (Online) 2330-0698
Published by Aurora Health Care Homepage  [1 journal]
  • Abstracts From the 24th Annual Health Care Systems Research Network
           Conference, April 11–13, 2018, Minneapolis, Minnesota

    • Abstract: Founded in 1994, the Health Care Systems Research Network (HCSRN) is a consortium of 18 research centers that are housed in community-based health systems. The organization's annual conference serves as a venue for research teams to disseminate scientific findings, stimulate new collaborations, and share insights about conducting research in real-world care-delivery settings. Abstracts accepted for presentation at HCSRN 2018 are published within this supplement of the Journal of Patient-Centered Research and Reviews.
      PubDate: Fri, 30 Mar 2018 06:15:51 PDT
       
  • 2017 JPCRR Peer Reviewers

    • Abstract: Journal of Patient-Centered Research and Reviews' annual reviewer acknowledgment.
      PubDate: Tue, 30 Jan 2018 13:05:30 PST
       
  • Community Health, Advocacy, and Managing Populations (CHAMP) Longitudinal
           Residency Education and Evaluation

    • Authors: Kjersti E. Knox et al.
      Abstract: Purpose: Longitudinal education initiatives designed to prepare residents to address health disparities and social determinants of health (SDH) are needed. This report addresses this gap by describing a family medicine residency’s Community Health, Advocacy, and Managing Populations (CHAMP) curriculum and its evaluation by learners, faculty, and community partners. The CHAMP longitudinal curriculum is explicitly designed to prepare residents to address health disparities and SDH. We report early outcomes, including community partner feedback, of this innovative curriculum.Methods: Data were obtained through standardized rotation evaluations, thematic analysis of structured group and individual interviews, and aggregated competency milestone data. Kirkpatrick’s four-level model to evaluate effectiveness of training was used to frame design and analysis of learner, faculty, and community partner evaluations.Results: Twenty residents have completed the year-one curriculum, 8 residents the year-two curriculum, and 8 residents the year-two and year-three elective. Community partners, residents, faculty, and leadership all were satisfied with the curriculum, particularly regarding relationship building and mentorship. Overall satisfaction with the rotation, quantitatively and qualitatively, was positive. Competency milestone ratings improved within each year of training: first-year residents by 0.6 (3.0 for 2015–2016 and 3.6 for 2016–2017) and second-year residents by 0.1 (5.2 vs 5.3).Conclusions: The CHAMP curriculum uniquely a) spans all three years of residency; b) combines block mandatory rotations with a longitudinal elective experience; and c) integrates community health, advocacy, and managing populations to meet accreditation requirements and prepare residents to address health disparities and SDH.
      PubDate: Tue, 30 Jan 2018 13:05:24 PST
       
  • Needs Assessment for Creating a Patient-Centered, Community-Engaged Health
           Program for Homeless Pregnant Women

    • Authors: Tegan Ake et al.
      Abstract: Purpose: Women who experience homelessness during pregnancy have poorer birth outcomes than the general population. This exploratory research describes the needs assessment of homeless women currently living at a shelter in Milwaukee, Wisconsin, to identify unmet needs related to maternal and infant perinatal health as the first step in designing a mutually beneficial patient-centered service-learning program for medical students to address these needs.Methods: Two 1-hour focus groups were held at a shelter for women who are homeless and/or victims of domestic violence. A total of 13 women participated in each session; four medical students and a physician served as facilitators and scribes at each session. The facilitators alternated asking predetermined open- and close-ended questions, followed by discussion among participants. Questions elicited experiences during pregnancy, what went well, what women living in the shelter struggled with, and what support they wished for but did not have. Scribes captured the conversation through hand-written notes and used content analysis in order of frequency.Results: Thirteen themes were identified. The 5 most frequently identified themes were a need for pregnancy education, access/transportation, baby care, advocacy, and material necessities. Participating shelter residents and the medical students expressed interest in working with one another and forming a long-term partnership with the shelter.Conclusions: Results of this needs assessment will inform the creation of a new shelter-based medical education program that will meet homeless women’s needs while preparing medical students for patient-centered, community-responsive care.
      PubDate: Tue, 30 Jan 2018 13:05:18 PST
       
  • Challenges of Refugee Health Care: Perspectives of Medical Interpreters,
           Case Managers, and Pharmacists

    • Authors: Fabiana Kotovicz et al.
      Abstract: Purpose: Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin.Methods: Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board.Results: Four overarching themes regarding health care for refugee patients were identified: 1) difficulty balancing the dynamic of autonomy versus support for refugees; 2) educational needs of refugee families outpacing available resources; 3) challenges for refugees developing trust; and 4) diversity of cultures, education levels, and experiences among refugee families. Language barriers in accessing health care services and insufficient time to meet educational needs of refugees were major challenges outside of the clinic visit setting. Poor health literacy and difficulties communicating health needs and building trust within the interactive triad of refugee, physician, and interpreter impacted clinic visits.Conclusions: Refugee patients and other participants in refugee care work to navigate a complicated path to equitable health care for a vulnerable population. Continued pursuit of strategies that increase time allocation, education, and support for all parties are needed as we seek to improve health outcomes for newly arrived refugee families.
      PubDate: Tue, 30 Jan 2018 13:05:12 PST
       
  • Facilitating Factors and Barriers to Weight Management in Women: Physician
           Perspectives

    • Authors: Renee E. Walker et al.
      Abstract: Purpose: The complexity of addressing overweight and obesity in women has been an ongoing public health and health care challenge. While the mechanism for addressing overweight and obesity in women remains unclear, it has been speculated that disparities in overweight and obesity by race and gender contribute to the complexity. The purpose of the present study was to examine perceptions of primary care physicians when discussing weight management with their patients.Methods: We conducted focus group discussions exploring facilitators and barriers to discussing weight management and weight loss among women patients. Participants included 18 family medicine and internal medicine physicians who were recruited using a snowball sampling technique from two large urban institutions. Focus group discussions were transcribed verbatim. Responses were then codified and analyzed in frequency of occurrence using specialized computer software.Results: Nine themes emerged from group discussions. These recurring themes reflected three overarching critical points: 1) potential utility of the primary care setting to address weight management; 2) the importance of positive patient-provider communication in supporting weight loss efforts; and 3) acknowledgement of motivation as intrinsic or extrinsic, and its role in obesity treatment.Conclusions: Physician perceptions of their own lack of education or training and their inability to influence patient behaviors play crucial roles in discussing weight management with patients.
      PubDate: Tue, 30 Jan 2018 13:05:06 PST
       
  • In-Home Delivery of Constraint-Induced Movement Therapy via Virtual
           Reality Gaming

    • Authors: Alexandra L. Borstad et al.
      Abstract: Purpose: People with chronic hemiparesis are frequently dissatisfied with the recovery of their hand and arm, yet many lack access to effective treatments. Constraint-induced movement therapy (CI therapy) effectively increases arm function and spontaneous use in persons with chronic hemiparesis. The purpose of this study was to determine the feasibility and measure safety and outcomes of an in-home model of delivering CI therapy using a custom, avatar-based virtual reality game.Methods: Seventeen individuals with chronic hemiparesis participated in this pretest/posttest quasi-experimental design study. The 10-day intervention had three components: 1) high-repetition motor practice using virtual reality gaming; 2) constraint of the stronger arm via a padded restraint mitt; and 3) a transfer package to reinforce arm use. Feasibility of the intervention was evaluated through comparison to traditional CI therapy and through participants’ subjective responses. The primary outcome measures were the Wolf Motor Function Test (WMFT) and the Motor Activity Log quality of movement scale (MAL-QOM).Results: On average, participants completed 17.2 ± 8 hours and 19,436 repetitions of motor practice. No adverse events were reported. Of 7 feasibility criteria, 4 were met. WMFT rate and MAL-QOM increased, with effect size (Cohen’s d) of 1.5 and 1.1, respectively.Conclusions: This model of delivering CI therapy using a custom, avatar-based virtual reality game was feasible, well received, and showed preliminary evidence of being a safe intervention to use in the home for persons with chronic hemiparesis.
      PubDate: Tue, 30 Jan 2018 13:04:57 PST
       
  • Imagine a World …

    • Authors: David A. Nelson
      Abstract: The author and issue editor introduces the second half of Journal of Patient-Centered Research and Reviews’ two-part series on health disparities and inequities in the United States. The chasm between an ideal health care system and the current reality may appear vast, and closing it insurmountable at times, but acknowledging and working to address the many health conditions that disproportionately affect specific patient populations is one step health providers and researchers can take toward closing the gap.
      PubDate: Tue, 30 Jan 2018 13:04:51 PST
       
  • Relative Associations of Age, Height, and Weight on Sinus of Valsalva and
           Mid-Ascending Aorta: An Imaging and Epidemiology Study

    • Authors: Mirza Nubair Ahmad et al.
      Abstract: Background: Prior studies show ascending aorta diameter varies with age, height and weight, but they did not evaluate relative influence of these variables on aortic diameter. Since height is genetically determined, and genetic disorders like Marfan syndrome are predominantly associated with sinus of Valsalva (SOV) dilation, we hypothesized height may have stronger association with SOV.Purpose: Based on anecdotal observation, since age, weight and obesity are acquired attributes, we hypothesized age, weight and body mass index may have greater association with mid-ascending aorta (MAA) diameter, even in normal patients.Methods: We evaluated echocardiographic studies of patients ≥ 15 years old that were done in the last 4 years to measure SOV and MAA diameter in normal patients (defined as: medical records and echocardiograms did not reveal any of the 28 aortic dilation risk factors listed in the American Heart Association 2010 guidelines).Results: Of 65,843 patients, 3,201 were identified as normal. SOV measurements were available in 2,046, MAA in 2,334. Age had stronger correlation with MAA (β = 0.50; r = 0.52; P < 0.001) than SOV (β = 0.33; r = 0.35; P < 0.001). Weight was similarly correlated with diameters of SOV (r = 0.37; P < 0.001) and MAA (r = 0.37; P < 0.001). Height had stronger correlation with SOV diameter (β = 0.41; r = 0.38; P < 0.001) than MAA (β = 0.26; r = 0.25; P < 0.001).Conclusion: These data suggest that in normal subjects, age, weight and body mass index have stronger associations with the mid-ascending aorta, whereas height has a stronger association with the sinus of Valsalva.
      PubDate: Thu, 02 Nov 2017 12:57:42 PDT
       
  • Positive Impact on Patient Satisfaction and Caregiver Identification Using
           Team Facecards: A Quality Improvement Study

    • Authors: Nicole M. Martin et al.
      Abstract: Background: Patients satisfaction is an increasingly important metric in measuring the quality of care that hospitals and physicians provide. It can be difficult for patients to remember their providers and their roles, all of which may potentially impact a patient’s overall satisfaction.Purpose: To see if giving facecards with pictures and names of caregivers and description of roles improved patient satisfaction and identification of care team members.Methods: Team facecards were designed and distributed to the patients during the interventional period of the study. Patients’ identification of team members, the role of each physician and overall satisfaction was measured using a longitudinal prospective survey. Patients in the control arm of the study took the same survey but did not receive team facecards.Results: A total of 192 patients completed the survey. They were divided into a control group (n = 96, 50%) and an interventional group (n = 96, 50%) during the period of the study (February 2016–August 2016). Patients who received the intervention were more likely to identify: their team attending (71 [74%] in the interventional group vs [34.4%] in the control group; P < 0.001); team resident (40 [40.7%] in the interventional group vs 25 [26%] in the control group; P = 0.0222); team intern (42 [43.8%] in the interventional group vs 19 [19.8%] in the control group; P = 0.0004). Patients in the interventional group reported slightly higher level of satisfaction (72 [75%] reported level of satisfaction> 9 on a scale of 1 to 10 in the interventional group vs 59 [61.5%] in the control group).Conclusion: Use of facecards improves patient identification of primary team members and roles; however, patients still lack enough knowledge of provider roles. Use of facecards showed a slight improvement on overall patient satisfaction.
      PubDate: Thu, 02 Nov 2017 12:57:37 PDT
       
  • Six-Year Experience of Influenza Vaccination as a Condition of Employment
           for a Large Regional Health Care System

    • Authors: John R. Brill et al.
      Abstract: Background: Influenza remains a significant contributor to morbidity and mortality in the United States. Health care workers (HCW) can be both victims and vectors of influenza. Influenza vaccination of HCW is protective for both caregivers and patients, but voluntary programs generally fail to achieve rates recommended by the Centers for Disease Control and Prevention. Despite a complex, multifaceted influenza program initiated in 1996 that included significant education and promotion as well as free on-site vaccination, annual Aurora Health Care caregiver immunization rates remained in the mid-70s until adoption of a “condition of employment” strategy in 2011.Purpose: Discuss the annual effectiveness of the program at achieving caregiver vaccination.Methods: A steering committee and subgroups meet regularly to evaluate exemption requests, vaccine supply/distribution/ordering, immunization rates and general program overview. In July 2016, an online wellness survey of influenza program perceptions was offered to all Aurora caregivers.Results: In the 2016–2017 flu season, 97.3% of HCW were vaccinated. New medical exemption requests have varied from 72 to 127 per year, with a decreasing trend again reflecting the prevalence of permanent exemption. The number of approved annual religious exemptions grew from 39 in 2011 to 64 in 2016– 2017. Since the initial year of implementation, when resignation of 11 HCW was attributed to the vaccination requirement, the number of such resignations has dwindled to 2. Caregiver perceptions: 1,931 caregivers completed the online survey (approximately 6.4% of all employees). A 5-point Likert scale was used to assess level of agreement with several statements. Caregivers expressed the highest level of agreement with the statement that “the program makes it convenient to get vaccinated” (89% agree or strongly agree) and the lowest level agreement with “the program keeps me healthier” (54% agree or strongly agree).Conclusion: An influenza program as a condition of employment leads to high levels of immunization of HCW, with minimal impact on HCW retention and satisfactory satisfaction among HCW.
      PubDate: Thu, 02 Nov 2017 12:57:30 PDT
       
  • FMT Placed by Colonoscopy: Systematic Review and Meta-Analysis

    • Authors: Nadia Huq et al.
      Abstract: Background: Fecal transplants are successful in the treatment of recurrent or refractory Clostridium difficile infections (CDI), but there is no consensus on the best method of instillation. Studies have shown greater success with lower gastrointestinal tract placement, but technical aspects of placement are not validated.Purpose: This review aims to identify common traits and procedural techniques of successful fecal microbiota transplant (FMT) therapy via colonoscopy.Methods: An electronic search was conducted using OVID Medline and PubMed for articles published from January 2010 to January 2016. The primary outcome of interest was cure by FMT placed via colonoscopy.Results: Of the 337 articles reviewed, we included 24 studies, from which 11 case reports were excluded from data analysis. The resultant data included 366 patients (64% female). Point estimate for cure of CDI after FMT for patients over 65 years of age (9%) was 84.6% (95% confidence interval [CI]: 0.58–0.96; P < 0.016), cure over the age of 18 with no upper limit specified on age (74%) was 85.4% (95% CI: 0.76–0.91; P < 0.001) and, for those identified strictly as 18–65 years old (17%), cure was 93% (95% CI: 0.83–0.98; P < 0.001). Patients who stopped antibiotics at least 48 hours prior to FMT (37%) had a cure rate of 86% (95% CI: 0.78–0.91; P < 0.001) compared to 95% (95% CI: 0.90–0.98; P < 0.001) in patients who stopped antibiotics at least 24 hours prior to FMT (43%) and 81% (95% CI: 0.53–0.94; P < 0.035) in those who stopped less than 24 hours prior to FMT (15%). In studies that specified use of GoLYTELY® prep prior to colonoscopy (58%), cure was 91% (95% CI: 0.85–0.95; P < 0.001); whereas those using a split 2-L polyethylene glycol prep (21%) had 79% cure (95% CI: 0.61–0.90; P < 0.004). Placement of FMT throughout the colon (6.8%) had 96% cure (95% CI: 0.77–0.99; P < 0.002) versus terminal ileum to cecum placement (59%) at 88% cure (95% CI: 0.78–0.94; P < 0.001) and cecum to ascending colon (28%) at 86% cure (95% CI: 0.63–0.95; P < 0.006). Studies that specified the use of loperamide after FMT (21%) had a cure of 85% (95% CI: 0.63–0.95; P < 0.004).Conclusion: FMT placed by colonoscopy has a role in the cure of recurrent or refractory CDI. Stopping antibiotics 24 hours prior to FMT results in higher percentage cure (95%). Distribution of FMT throughout the colon has better outcomes than FMT instillation at other locations. Effect of loperamide post-FMT placement is not conclusive due to the low percentage of reported use. Prospective studies are recommended to study these factors for confirmation of effects.
      PubDate: Thu, 02 Nov 2017 12:57:24 PDT
       
  • Robustness of a Newly Proposed Risk Schema for Lymphatic Dissemination in
           Endometrioid Endometrial Cancer

    • Authors: Danielle M. Greer et al.
      Abstract: Background: Surgical management for endometrioid endometrial cancer (EEC) includes complete lymph node dissection for all patients at risk of lymphatic dissemination. The standard risk schema, defined by Mayo Clinic, identifies low-risk patients as those with grade 1/2 EEC, myometrial invasion (MI) ≤ 50%, and tumor diameter (TD) ≤ 2 cm. We recently proposed (and published) a risk schema containing modified forms of grade, MI and TD that suggests a significant decrease in false-negative rate and need for lymphadenectomy in low-risk women.Purpose: Evaluate robustness of our proposed schema for lymphatic dissemination risk stratification in a subsequent EEC patient cohort.Methods: We retrospectively applied the proposed schema to patients diagnosed with stage I–III EEC during 2014–2015 who underwent pelvic and/or para-aortic lymph node removal. Cancer Registry data were confirmed via chart review. Consistent with the cohort studied during model development, the validation cohort included non-Hispanic white or black patients with complete data describing TD (≤ 50 mm or> 50 mm), MI (≤ 33%,> 33% to ≤ 66%, or> 66%) and grade (1 or 2–3).Results: In the validation cohort, 29 (11.7%) of the 247 EEC patients were node-positive (vs 9.2% of 737 patients in the development cohort). Risk stratification using the proposed schema produced similar false-positive rates during model development (57.2%) and validation (54.6%), both 20% lower than when using the standard schema (76.2% and 74.3%, respectively). False-negative rates, however, were noticeably different between development and validation cohorts using both the proposed (0% and 13.8%) and standard (1.47% and 6.90%) schemas, suggesting a shift toward low-risk classification in node-positive patients of the validation cohort.Conclusion: Application of the proposed risk stratification schema to an alternative patient cohort verified the utility of modified risk criteria, including TD with 50-mm cutoff, for identifying low-risk EEC patients who may not require node evaluation. However, in the validation cohort, greater prevalence of lymph node metastasis and low-risk classification of node-positive patients was observed. Discrepancy between cohorts is likely due to greater utilization of sentinel lymph node mapping during the validation period, allowing for increased detection of low-volume metastases. Continued model development and validation is needed, especially to account for the increased sensitivity of new technologies.
      PubDate: Thu, 02 Nov 2017 12:57:19 PDT
       
  • Quality Improvement Study for Postpartum Hypertension Readmissions

    • Authors: Molly K. Lepic et al.
      Abstract: Background: Hospital readmission rates are a focus of the Centers for Medicare and Medicaid Services. This was identified as a system opportunity to improve health care quality and patient education in order to reduce preventable readmissions. In 2009, 27% of obstetric readmissions were due to hypertensive disease, and preventable readmissions regarding hypertension are flagged as an area for quality improvement in our health care system. There is limited evidence on specific management of postpartum hypertension.Purpose: Identify risk factors in our community and reduce postpartum readmissions for hypertension within our hospital.Methods: We performed a retrospective chart review from November 2014 to November 2015. We collected demographic data, comorbidities and information regarding hospitalization and readmission. In this, we identified 28 readmissions for postpartum hypertension, representing 57% of obstetric readmissions and noted that discharge instructions and blood pressure monitoring postpartum were two areas for improvement. Only 18% had printed instructions regarding postpartum hypertension. Via multidisciplinary education sessions, we aimed to increased surveillance for postpartum vitals for at-risk patients and provide appropriate verbal and written precautions for signs and symptoms of de novo or worsening hypertensive disease. We also improved access to care by scheduling blood pressure checks within 72 hours of discharge and utilization of visiting nursing services for blood pressure checks. The same measures were then recollected for readmissions from June 2016 to December 2016.Results: After intervention, 61% of readmissions were related to hypertension, with 31 readmissions. Overall, there was a significant improvement in written discharge instructions regarding postpartum hypertension, with 94% receiving written instructions. At discharge, 33% had blood pressure checks and 13% had visiting nursing services arranged.Conclusion: Postpartum hypertension is more recognized, and readmissions are becoming more common. We increased efforts to optimize medical management of hypertension and reduce preventable readmissions. Improvement in discharge instructions for patients did not decrease overall admission for postpartum hypertension but may have improved overall patient care. Overall cost analysis would be beneficial to see further economic impact.
      PubDate: Thu, 02 Nov 2017 12:57:13 PDT
       
  • Brain Imaging in Older Patients With Delirium

    • Authors: Laila M. Hasan et al.
      Abstract: Background: Delirium is a common, serious and costly condition in older patients admitted to the hospital. This study describes the prevalence and results of brain imaging among a cohort of older hospitalized patients with and without delirium.Purpose: Investigate the frequency and results of brain imaging in older patients with delirium as compared to those without delirium.Methods: This was a cross-sectional study. Data were collected on hospitalized patients age 65 years or older who were admitted to 3 hospitals in Milwaukee, Wisconsin, during a 1-month period in the fall of 2013. Subjects were tested for delirium via the “Confusion Assessment Method” by researchers for another study. The collected data included demographics, presence of delirium, computed tomography (CT) and magnetic resonance imaging (MRI), and results of the imaging procedures. The imaging studies were done as a part of their medical care. The authors reviewed the radiologist’s final readings of the imaging studies. For all categorical variables, chi-squared/Fisher’s test was used with alpha of 0.05.Results: A total of 92 patients were included in the study. Prevalence of delirium was 17.4%. Mean age was 77 years. Overall, 24% had a CT and 9% an MRI, with the most common abnormal finding being chronic microvascular changes (13%). CT scan was performed in 44% of patients with delirium and 20% of patients without delirium (P = 0.04). MRI was performed in zero patients with delirium and 11% without delirium (P = 0.34). When patients with delirium were compared with patients without delirium, respectively: normal imaging was described in 1 vs 2 patients (P = 0.70); cerebral atrophy in 3 vs 6 (P = 0.99); chronic microvascular changes in 2 vs 10 (P = 0.17); and acute hematoma (subdural or intraparenchymal) in 3 (43%) vs 0 (P = 0.02).Conclusion: In this limited study, patients with delirium were noted to be more likely to have had a CT scan. Older patients with delirium had a variety of findings on brain imaging, some of which were more clinically relevant. No specific imaging changes were diagnostic for delirium.
      PubDate: Thu, 02 Nov 2017 12:57:08 PDT
       
  • Improving Obstetrics in Family Medicine Residency Clinics: A Quality
           Improvement Study

    • Authors: Garima Chawla et al.
      Abstract: Background: Prenatal care/deliveries within our family medicine clinics have declined, perhaps because patients are unaware that our clinics provide these services. With lower volumes, clinicians may feel less comfortable with current skills/knowledge of obstetric (OB) care.Purpose: Increase family medicine clinic OB numbers, patient awareness, and clinician comfort/knowledge in OB.Methods: English-facile patients (18–50 years), residents and faculty at Aurora family medicine residency clinics were included. Patients were provided preintervention surveys upon check-in. Residents/faculty were surveyed via Survey Monkey. Changes made based on initial survey results were: 1) increasing systemwide awareness that our caregivers provide OB care, through fliers at emergency departments/urgent cares or posters in clinic waiting rooms; 2) keeping at least one same-day visit for OB patients; 3) distributing standard OB note templates to residents/faculty; and 4) placing patient educational handouts at each clinic. Patients, residents and faculty were reassessed at 9 months postintervention. Surveys were analyzed with Fisher’s exact tests.Results: Respondents to the preintervention survey included 83 patients, 26 residents and 19 faculty; 61 patients, 23 residents and 21 faculty responded to the postintervention survey. On both pre- and post-surveys, patients knew that their providers delivered babies (59% vs 57%, respectively; P = 0.86). However, only 22% and 33% of patients, respectively, had a doctor at our clinics deliver their baby or partner’s baby (P = 0.25). Even so, 95% and 100% of patients, respectively, would recommend their friends or family to our family practice clinics if they became pregnant (P = 0.14). On the pre-survey, 38% of residents felt clinic OB numbers were adequate versus 70% following intervention (P < 0.05). On both pre- and post-surveys, residents planned on incorporating obstetric or prenatal care into their future practice (42% vs 52%, respectively; P = 0.57). On both pre- and post-surveys, faculty felt comfortable with OB skills and knowledge (53% vs 62%, respectively; P = 0.75). Lifestyle was the most common reason faculty gave for why they stopped doing deliveries (37% vs 33%, respectively).Conclusion: Implementation of changes to our OB workflow resulted in non-statistically significant improvements in viewpoints toward OB. Resident feelings of OB number adequacy significantly improved following intervention. Further study in multiple clinics could confirm the effectiveness and reasons for success of our interventions.
      PubDate: Thu, 02 Nov 2017 12:57:03 PDT
       
  • The Lifestyle Initiative: An Innovative Coaching-Based Quality Improvement
           Study to Improve the Health of Aurora Health Care Caregivers and Family
           Members

    • Authors: Tiffany A. Mullen et al.
      Abstract: Background: Self-management support has been shown to improve clinical outcomes. Health coaching, one form of self-management support, empowers patients within the health care system by providing information and through collaboratively developed care plans.Purpose: Assess the impact of The Lifestyle Initiative, a coaching-based health program utilized by Aurora Health Care caregivers or family members.Methods: The Lifestyle Initiative is a coaching-based approach for Aurora caregivers or family members enrolled in Aurora’s health insurance network. Individuals were recruited from the care management database, and all participants had an Aurora primary care provider. Participation was limited to those ≥ 18 years of age who had a diagnosis of type 2 diabetes or hypertension (or both), had glycated hemoglobin (A1c) ≤ 8.0, and were not on insulin. The Lifestyle Initiative was rolled out in three phases. Phase I: health coaching sessions through a standard web- and app-based platform (Noom Health), and access to a stress-management program (HeartMath). Phase II: health coaching sessions through a standard web- and app-based platform co-created by Aurora’s Department of Integrative Medicine and Noom Health, and access to HeartMath; Phase III: health coaching sessions through a standard web- and app-based platform (Noom Health), and a customized web- and app-based platform. Those enrolled in each phase acted as their own controls. Paired t-tests were used to compare pre- and postintervention results of each phase.Results: The majority of Phase I participants (n = 23; mean age 54.4 years) were female (91.3%) and white (52.2%). Preintervention A1c and blood pressure were not statistically different postintervention. However, pre- vs postintervention weights were statistically different (228.2 vs 218.5 lb; P < 0.01), as well as pre- vs postintervention body mass index (37.3 vs 35.7 kg/m2; P < 0.01). The majority of Phase II participants (n = 63; mean age 54.8 years) also were female (81.0%) and white (88.9%). Pre- and postintervention blood pressures were not statistically different. However, pre- vs postintervention A1c (7.2 vs 6.6; P < 0.02), weights (229.6 vs 225.7 lb; P < 0.05), and body mass index (37.1 vs 36.5 kg/m2; P < 0.05) were statistically improved. Phase III data collection is underway.Conclusion: The Lifestyle Initiative health coaching program significantly improves certain health metrics when applied to health system employees and family members with diabetes or hypertension. Further study is needed to explore sustainability and the effects of more robust programs.
      PubDate: Thu, 02 Nov 2017 12:56:57 PDT
       
  • Family Practice Resident Expectations by Year From Faculty and Resident
           Perspectives: A Quality Improvement Initiative

    • Authors: Alyssa Krueger et al.
      Abstract: Background: The transition from student to physician requires substantial commitment and work from residents as well as guidance from program faculty. The Accreditation Council for Graduate Medical Education (ACGME) has standardized certain academic requirements for U.S. residency programs; however, faculty expectations of residents according to year in the program are less formal and more a hidden curriculum. Setting expectations for residents to consult could better help residents navigate their graduate medical education experience and achieve the level of excellence expected by ACGME.Purpose: Our quality improvement study aimed to: 1) determine what the expectations of family practice residents were based on feedback from faculty members and current residents; and 2) share these expectations with residents.Methods: A preintervention survey was emailed to family medicine program faculty and residents regarding resident expectations according to year in the program. Based on the results of the preintervention survey, expectations were outlined in a handout according to year in the program and were presented to current residents during scheduled didactic time. Residents who responded to the preintervention survey were then asked to respond to the postintervention survey. Fisher exact tests were used to compare preand postintervention survey responses.Results: Overall, 64% (14 of 22) of faculty and 64% (18 of 28) of residents responded to the preintervention survey. While 79% of faculty expressed that they had specific expectations for residents, 77% felt that residents did not know these expectations. Additionally, while residents (94%) believed faculty had expectations of them, only 33% knew what the expectations were. Following intervention, 15 of 18 residents responded, with 79% now reporting they knew what the expectations were (P = 0.02). The handout was found useful by all those queried, and 85% felt it clarified expectations.Conclusion: At baseline, residents and faculty knew there were expectations for residents as they progress through the program, but those expectations were not explicit. Despite the lack of vertical communication, the expectations from both groups were surprisingly similar. A handout delivered electronically and at didactic sessions was deemed useful and clarified expectations.
      PubDate: Thu, 02 Nov 2017 12:56:51 PDT
       
  • Effects of Revision Surgery on Grade of Adverse Local Tissue Reaction
           Following Recall of a Modular Hip Implant

    • Authors: Joseph F. Davies et al.
      Abstract: Background: The Stryker Rejuvenate modular hip implant device allows for greater versatility in matching a patient’s anatomy than conventional implants. Device recalls and in vivo metal hypersensitivity after total hip arthroplasty (THA) are common. However, recall of the Rejuvenate implant represents one of the largest recall volumes to date, highlighting our uncertainty regarding causes of device metal fretting/corrosion and adverse local tissue reaction (ALTR). While devices with metal-on-metal bearings historically were culprits for release of metal debris, more recently developed modular-neck devices add opportunity for adjacent metal components to rub together. With the Rejuvenate device, corrosion or fretting likely occurs at the cobalt-chromium neck and titanium stem interface. Cobalt (Co) and chromium (Cr) particles then irritate tissues locally and cause a gradation of problems or indications of ALTR.Purpose: Quantify the effect of revision surgery on ALTR grade in patients who previously underwent THA receiving the recalled Rejuvenate hip implant.Methods: We conducted a prospective observational study of all patients who underwent THA performed by a single Aurora Health Care orthopedic surgeon using the Rejuvenate implant. Following implant recall in July 2012, patients were notified via letter/phone and asked to visit regularly (every 3–6 months) for lab work, imaging and device assessment. Using repeated measures multinomial logit analysis we examined the effect of revision surgery on abnormal grade of ALTR (ie, grade 1–4 vs 0), adjusting for patient characteristics, device specifications and indicators of post-THA complication (serum Cr ion, Co ion, C-reactive protein, erythrocyte sedimentation rate).Results: In total, 162 hips and 152 unique patients underwent THA during September 2009–May 2012, with 78 hips subsequently revised during 2012–2015. Patients were of median age 62 years (range: 32–90), nearly all non-Hispanic white (89%) and mostly female (58%). Several variables were significantly associated (P < 0.05) with ALTR grade, including occurrence of complication symptoms (eg, pain), patient age, and Co ion concentrations. Revision surgery was the most strongly associated variable with ALTR, with 5 times greater odds of abnormal grade when not undergoing revision (odds ratio: 5.68, 95% confidence interval: 2.69–11.9).Conclusion: Within Aurora, patients who underwent THA with the Stryker Rejuvenate hip implant often experienced the complications of ALTR, but revision surgery reduced the ALTR grade.
      PubDate: Thu, 02 Nov 2017 12:56:45 PDT
       
  • Variations in Practice of Apnea Test for Brain Death: Review From a
           Multihospital Health Care System

    • Authors: Jeffrey Stein et al.
      Abstract: Background: Ventilation encompasses both active and passive processes. Air is initially drawn into the lungs due to a negative intrathoracic pressure created using the respiratory muscles, most importantly the diaphragm. In contrast, expiration is the passive relaxation of the respiratory muscles. Oxygenation occurs when oxygen diffuses across the alveolar-capillary membrane. The ability to oxygenate without ventilation has been termed apneic diffusion oxygenation or apneic oxygenation. We believe it is crucial to keep alveoli open in order for adequate oxygenation to occur. This can be achieved with the aid of positive end-expiratory pressure (PEEP). We investigated this concept in patients who are brain-dead because they cannot ventilate. The stimulus to breathe originates from chemoreceptors in the brainstem. These cells respond to a decrease in pH by triggering the body to take a breath. A positive apnea test confirms that the patient has no functioning brainstem.Purpose: Determine the rate of pO2 and pCO2 changes during different methods of the apnea test and identify variations in practice within Aurora Health Care.Methods: Data were collected retrospectively on brain-dead patients older than 18 years. Data points pulled from Epic medical records included serial arterial blood gases (ABGs) that were completed during the apnea test and patient demographics. The rate of change in pCO2 and pO2 was evaluated using both Mann-Whitney and two-sample t-tests comparing a PEEP valve group to all other oxygenation methods.Results: Eight variations of the test were performed, with median starting CO2 for the oxygenation and PEEP group of 43 and 44 mmHg, respectively (95% confidence interval: 26–53, P = 0.6771). Oxygenation group had a mean CO2 increase of 2.95 mmHg/minute, whereas the PEEP valve group increased at 4.60 mmHg/minute. No statistical significance was found (P = 0.0508). Neither was there significant difference between the rate of desaturation between the oxygenation and PEEP valve group (6.53 mmHg vs 2.60 mmHg, respectively; P = 0.5536).Conclusion: We found no difference in the rate of CO2 increase comparing the oxygenation group to the PEEP valve group. This suggests that there is no significant component of CO2 washout in the lungs using the PEEP valve setup. A superior method of apneic oxygen was not able to be demonstrated with our results due to an insufficient sample size and practice variations. The most common method to perform the apnea test at our institutions is preoxygenation.
      PubDate: Thu, 02 Nov 2017 12:56:40 PDT
       
 
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