Stanleyphillips0471
To determine actions taken by community pharmacies to be successful under a value-based pharmacy program (VBPP).
An exploratory sequential mixed methods approach was used to evaluate pharmacies participating in the VBPP, with qualitative data collected and analyzed in the first phase, followed by quantitative measurement through a 30-item survey instrument in the second phase.
The qualitative data showed that participating pharmacies were more involved with adherence and cardiovascular and diabetes metrics than with other metrics. Depression metrics received the lowest overall involvement. For total cost of care, different approaches were used; 5 pharmacies used the dashboard to identify likely high-cost patients they could try to manage, and 4 pharmacies monitored adherence to avoid complications that could contribute to increased cost. For the survey response rate was 72.6% (n= 53). The mean perception of level of success was 53.06 ± 20.15 (mean ± SD). Activities with the highest priority were adherenmercial value-based payment program. The pharmacies tended to build on care processes already established (e.g., medication adherence, patients with diabetes or cardiovascular conditions) and developed new processes to address emerging metrics and associated patient needs (e.g., collecting and documenting blood pressure and hemoglobin A1c levels). Future research is needed to identify best practices for patient care and pharmacy success under broad VBPPs such as the one studied here.This report presents a case description of sternalis muscle which is an accessory muscle of anterior thoracic wall. A 56-year-old woman underwent mastectomy for breast cancer along with free flap reconstruction, revealing the presence of aberrant sternalis muscle. It was divided transversely during partial rib resection to expose internal mammary vessels. The case proceeded with successful flap transfer. Clinical implications of this anatomic variation is discussed. The authors conclude that plastic surgeons should be aware of this muscular anomaly.
Anti-inflammatory therapy targeting interleukin (IL)-1β reduced cardiovascular events in a randomized trial. We evaluated the relationship between IL-1β mRNA expression in epicardial adipose tissue (EAT) and clinically-assessed coronary atherosclerosis on computed tomography (CT).
We studied 45 patients before cardiac surgery (coronary artery bypass grafting [CABG], n=18; non-CABG, n=27). EAT volume, the coronary calcium score (CCS), and the presence of non- and/or partially-calcified coronary plaques (NCPs) and high-risk coronary plaques (HRPs; minimum CT density <30 Hounsfield units and vascular remodeling index >1.1) on CT angiography were assessed. EAT samples were obtained during cardiac surgery. MGCD0103 IL-1β mRNA expression in EAT was measured using quantitative real-time PCR and normalized to that of β-actin in each patient.
There was no difference in IL-1β mRNA levels between patients who were scheduled for CABG and non-CABG surgery or among subgroups based on the CCS. However, patients with NCPs (median [interquartile range], 4.1[2.0-11.6]E-4 versus 1.8[0.6-4.5]E-4, p=0.024) and HRP (7.6[3.0-20.4]E-4 versus 1.9[0.7-4.3]E-4, p=0.0023) had higher IL-1β mRNA levels than those without these plaques. On multivariate analysis adjusted for age, sex, coronary risk factors, statin therapy, CCS, and EAT volume, the presence of HRPs was significantly correlated with elevated IL-1β mRNA levels in EAT (β=0.39, p=0.047).
Our data suggest a contribution of EAT to coronary atherosclerosis through molecular behavior, such as IL-1β gene expression, which may be a new therapeutic target.
Our data suggest a contribution of EAT to coronary atherosclerosis through molecular behavior, such as IL-1β gene expression, which may be a new therapeutic target.Chronic non cirrhotic extrahepatic portal vein obstruction (EHPVO) refers to the cavernomatous transformation of the portal vein (the so-called "portal cavernoma") which occurs following acute thrombosis of the portal vein in the absence of recanalization. In adults, EHPVO mainly occurs following thrombosis, while in children it may be related to congenital malformations and/or neonatal umbilical venous catheterization. However, 50% of the cases of EHPVO remain idiopathic [1]. Risk factors and associated diseases should be investigated (chapter 1). Indeed, the presence of a thrombophilic alteration, in particular myeloproliferative neoplasm impacts prognosis and determine a causal treatment.
We sought to characterize the interactions of burnout with internal and external factors over the past 5 years for surgery residents at our institution. We hypothesized that burnout levels would be consistent among years, inversely related to emotional intelligence (EI) and job resources, and directly related to disruptive behaviors.
General surgery residents at a single institution were invited to complete a survey each year from 2015 to 2019 that included a combination of the 22-item Maslach-Burnout Inventory, 30-item trait EI questionnaire, as well as focused questions assessing disruptive behaviors (8 items), job resources (8 items), and demographic characteristics. Burnout was defined as scoring high in depersonalization (≥ 10 points) or emotional exhaustion (≥ 27 points). Student's t tests and Wilcoxon tests were used to compare continuous variables; chi-square and Fisher's exact tests were used to compare categorical variables, as appropriate. Spearman's rho was used to calculate correlation. A logg and professional development. Disruptive behaviors lead to increase burnout rates.
Interpreting objective structured clinical examination (OSCE) scores remains a challenging task.1 It remains unclear how examiners make a decision to score an OSCE the way they do. The examiners' thoughts and decision-making processes remain a hidden part of the OSCE assessment. One cannot assume that all examiners have a shared belief about what is important in an OSCE or what is the aim of an OSCE assessment. These differences are problematic, since they lead to students not getting the 'correct' score for their OSCE.
Using a qualitative case study design,2 this study aims to gain in-depth insight into examiners' perceptions of OSCEs and their role as an examiner. For this purpose, semi-structured interviews with OSCE observers (n = 6) were conducted.
The results show that the perception of examiners on the aim of OSCES and their motivation and task as examiner are crucial in understanding the differences among OSCE scores of examiners. Training and discussion among the examiners are needed to decrease the differences among the OSCE scores of examiners.
The results show that the perception of examiners on the aim of OSCES and their motivation and task as examiner are crucial in understanding the differences among OSCE scores of examiners. Training and discussion among the examiners are needed to decrease the differences among the OSCE scores of examiners.
Medical student education in the era of the COVID-19 outbreak is vastly different than the standard education we have become accustomed to. Medical student assessment is an important aspect of adjusting curriculums in the era of increased virtual learning.
Students took our previously validated free response clinical skills exam (CSE) at the end of the scheduled clerkship as an open-book exam to eliminate any concern for breaches in the honor code and then grades were adjusted based on historic norms. The National Board of Medical Examiners (NBME) shelf exam was taken with a virtual proctor. Students whose clerkship was affected by the COVID-19 pandemic were compared to the students from a similarly timed surgery block the previous 3 years. Primary outcomes included CSE and NBME exam scores. Secondary outcomes included clinical evaluations and the percentage of students who received grades of Honors, High Pass, and Pass. After the surgery clerkship was completed, we surveyed all students who participated nd student dissatisfaction, we would recommend virtual proctoring if available.
During the initial outbreak of COVID-19, we found that an open book exam and a virtually proctored shelf exam was a reasonable option. However, to avoid adjustments and student dissatisfaction, we would recommend virtual proctoring if available.
To investigate the association between a set of comprehensive factors across international literature and rehabilitation length of stay.
A chart audit of 197 Australian hospital rehabilitation unit orthopaedic inpatients (2016-2018) was conducted. Items significantly associated with length of stay throughout univariate regressions were entered into a subsequent hierarchical multiple regression analysis, where variables were regressed against length of stay in two steps. Items which were relevant prior to admission to the rehabilitation unit, or immediately upon admission, were regressed against length of stay during the first step, while variables which emerged during admission were entered during the second step.
Having pressure injuries during rehabilitation (p<.001), limited compliance in rehabilitation programs (p=.007), mental health concerns on admission to rehabilitation (p=.007), being obese (p<.001), and having significant pain impacting function (p=.03) were all independently significantly associated with an increased length of stay. Higher Functional Independence Measure motor (p<.001) subscale scores on admission to rehabilitation were associated with decreased length of stay. A hierarchical multiple regression analysis found that pressure injuries during rehabilitation (p=.002), being obese (p=.04), having mental health concerns on admission to rehabilitation (p=.03), and Functional Independence Measure subscale scores on admission (p=.04) were significantly associated with length of stay.
It is imperative that clinical programs and interventions promoting mental health outcomes, and addressing the distinct needs of obese inpatients, are delivered in the rehabilitation context.
It is imperative that clinical programs and interventions promoting mental health outcomes, and addressing the distinct needs of obese inpatients, are delivered in the rehabilitation context.
Vulvodynia is a disabling condition in which pelvic floor muscles' (PFM) hypertonicity plays an important role.
To evaluate biometric changes in PFM in women with vulvodynia undergoing kinesiotherapy treatment protocol (KTP).
A single-blinded randomized controlled trial of 57 women with vulvodynia randomly assigned to either KTP+amitriptyline or amitriptyline alone (controls) for treatment. Four-dimensional translabial ultrasound assessed PFM regarding symphysis-levator distance at rest, anorectal angle at rest, excursion of the levator plate angle, and levator hiatal narrowing. Volunteers underwent a vaginal examination for a cotton swab test (CST), fulfillment of Friedrich criteria score and PFM power of contraction, and completed a diary of sexual pain and frequency of vaginal intercourse. Outcomes were assessed at baseline and after 8weeks of treatment.
Primary outcomes were differences in biometric parameters assessed by four-dimensional translabial ultrasound after treatment, between groups. Secondary outcomes were changes in clinical variables (CST, Friedrich criteria, PFM power of contraction, frequency of intercourse, and intensity of sexual pain) between groups and correlation analysis between biometric parameters and clinical variables.
