Johannesenlane4432
Medical student note writing is an important part of the training process but has suffered in the electronic health record (EHR) era as a result of student notes being excluded from the billable encounter. The 2018 CMS billing changes allow for medical student notes to be used for billable services provided that physical presence requirements are met, and attending physicians satisfy performance requirements and verify documentation. This has the potential to improve medical student engagement and decrease physician documentation burden.
Our institution implemented medical student notes as part of the billable encounter in August 2018 with support of our compliance department. Note characteristics including number, type, length, and time in note were analyzed before and after implementation. Rotating medical students were surveyed regarding their experience following implementation.
There was a statistically significant increase in the number of student-authored notes following implementation. Attending physicians' interactions with student notes greatly increased following the change (4% of student notes reviewed vs. 84% of student notes). Surveyed students reported that having their notes as part of the billable record made their notes more meaningful and enhanced their learning. The majority of surveyed students also agreed that they received more feedback following the change.
Medical students are interested in writing notes for education and feedback. Inclusion of their notes as part of the billable record can facilitate their learning and increase their participation in the note writing process.
Medical students are interested in writing notes for education and feedback. Inclusion of their notes as part of the billable record can facilitate their learning and increase their participation in the note writing process.
Patients who use patient portals may be more engaged and empowered in their care; however, differences in who accesses patient portals remain. The characteristics of who uses patient portals more frequently and who perceives them as useful may also differ, as well as which functions people use.
We assessed the characteristics of patient portal users to examine who uses them more frequently and who perceives them as useful. In addition, we wanted to see if those who use them more frequently or perceive them to be more useful use different functions or more functions of patient portals.
Pooled cross-sectional data from 2017 to 2018 Health Information National Trends Survey (HINTS) were used. Ordinal regression models were developed to assess frequency of use and perceived usefulness by demographics, and multivariable logistic regression models were used to examine the association between the use of 10 patient portal functions and frequency of use and perceived usefulness of patient portals.
The odds of ortals.This case series aimed to analyze the outcomes of patients referred for salvage pulmonary resections after treatment with chemotherapy and immunotherapy for previously metastatic or unresectable tumors.From October 2016, after multidisciplinary board discussion, eight patients (median 67 years, range 52-78 years) underwent medical treatment due to advanced-stage diseases (stage cIIIA-cIVa). Four patients underwent cisplatin-based chemotherapy and, due to progression, were moved to an immunotherapy second line (nivolumab two patients and pembrolizumab two patients). Instead, four patients underwent combined cisplatin-based chemotherapy and immune checkpoint inhibitors (atezolizumab two patients and pembrolizumab two patients). After a multidisciplinary evaluation for salvage surgery, six patients underwent lobectomies, one patient underwent left pneumonectomy, and one patient underwent upper right lobectomy enlarged to the posterior arches of four ribs. The median duration of surgery was 179 minutes (range 122-246 minutes). At the final pathological stage, three patients showed a complete major response (ypT0 ypN0), one patient was ypT1a ypN0, one ypT3 ypN0, 2 ypT3 ypN1, and one ypT4 ypN0. The hospital length of stay was 6 days (range 3-23 days). Two patients had a postoperative complication. At the time of follow-up (median 15.3 months [range 1-32 months]), six patients were alive without evidence of the recurrence. Two patients died due to recurrence progression (N3 lymph nodes involvement) of the disease after 6 and 32 months.In stage IIIB-IVA nonsmall cell lung cancer, salvage lung surgeries after chemotherapy and immunotherapy are feasible, with high rates of R0 resection. Surgery can be technically tricky without significant morbidity and encouraging outcomes (even with a short-interval follow-up).
Systemic inflammation contributes to cardiac surgery-associated acute kidney injury (AKI). Cardiomyocytes and other organs experience hypothermia and hypoxia during cardiopulmonary bypass (CPB), which induces the secretion of cold-inducible RNA-binding protein (CIRP). Extracellular CIRP may induce a proinflammatory response.
The serum CIRP levels in 76 patients before and after cardiac surgery were determined to analyze the correlation between CIRP levels and CPB time. The risk factors for AKI after cardiac surgery and the in-hospital outcomes were also analyzed.
The difference in the levels of CIRP (ΔCIRP) after and before surgery in patients who experienced cardioplegic arrest (CA) was 26-fold higher than those who did not, and 2.7-fold of those who experienced CPB without CA. The ΔCIRP levels were positively correlated with CPB time (
= 0.574,
< 0.001) and cross-clamp time (
= 0.54,
< 0.001). Multivariable analysis indicated that ΔCIRP (odds ratio 1.003; 95% confidence interval 1.000-1.006;
= 0.027) was an independent risk factor for postoperative AKI. Patients who underwent aortic dissection surgery had higher levels of CIRP and higher incidence of AKI than other patients. The incidence of AKI and duration of mechanical ventilation in patients whose serum CIRP levels more than 405 pg/mL were significantly higher than those less than 405 pg/mL (65.8 vs. 42.1%,
= 0.038; 23.1 ± 18.2 vs. 13.8 ± 9.2 hours,
= 0.007).
A large amount of CIRP was released during cardiac surgery. The secreted CIRP was associated with the increased risk of AKI after cardiac surgery.
A large amount of CIRP was released during cardiac surgery. The secreted CIRP was associated with the increased risk of AKI after cardiac surgery.
This study aimed to assess the relation between the insertion torque and implant stability quotient (ISQ recorded immediately and 6 months after implant placement).
Twenty-five patients over the age of 18 years were selected for this study. One implant was placed per patient after tooth extraction. The implant site needed 15 mm in height and 8 mm in width. All implants had the same size (11.5 × 3.75 mm) and brand (Hexagonal Morse cone, DSP Biomedical). The insertion torque (Ncm) and resonance frequency analysis (ISQ value) (Osstell Mentor) were used to assess the primary stability (on the day of surgery). After 6 months, ISQ value was used to assess the secondary stability of each implant.
The insertion torque data were correlated with ISQ measurements by using Pearson's correlation. The significance level was 5%.
There was a positive correlation between insertion torque and initial ISQ (correlation 0.457;
= 0.022); however, no correlation was found between insertion torque and final ISQ (
= 0.308).
The present study demonstrated that there is a positive correlation between the insertion torque and the initial ISQ. Therefore, the higher the insertion torque, the higher the initial ISQ (or vice versa).
The present study demonstrated that there is a positive correlation between the insertion torque and the initial ISQ. Therefore, the higher the insertion torque, the higher the initial ISQ (or vice versa).
The study aimed to evaluate the bond strength between lithium disilicate ceramic and resinous cement when silane (Prosil, FGM) was applied in different amounts of layers under heating or not.
Sixty IPS E-max CAD ceramic (Ivoclar) was used. They were conditioned with 10% hydrofluoric acid for 20 seconds. The samples were distributed in six groups (
= 10) 1Sil, 1 layer of silane without heating; 1SilAq, 1 layer of silane with heating; 2Sil, 2 layers without heating; 2SilAq, 2 layers with heating; 3Sil, 3 layers without heating; and 3SilAq, 3 layers with heating. After each layer, a jet of cold air was applied for 20 seconds in groups 1Sil, 2Sil, 3Sil, and jet of hot air (50°C) in groups 1SilAq, 2SilAq, and 3SilAq. Subsequently, an adhesive layer was applied, and fourcylinders were made on the ceramic with a resin cement AllCemVeneer and photoactivated for 20 seconds. The samples were stored at 37°C for 24 hours and analyzed to the microshear test at EMIC.
Data were submitted to ANOVA and Tukey's test (α = 0.05).
The results showed that there was no statistical interaction between the factors studied. The "heating" factor was not statistically significant; however, the "silane layers" factor showed differences between groups. The analysis of the results showed that the use of one (66%) or two layers (67%) of silane regardless of heating, produced higher values of bond strength, when compared with the group of three layers (62%).
The use of silane with one or two layers provided a greater bond strength between lithium disilicate ceramic and resinous cement and that the heating did not influence the results.
The use of silane with one or two layers provided a greater bond strength between lithium disilicate ceramic and resinous cement and that the heating did not influence the results.
This survey was conducted on behalf of the German Respiratory Society (DGP) section 12. The aim was to assess the means of achieving tobacco cessation and prescription of exercise training on an outpatient basis after discharge from pulmonary rehabilitation clinic as part of aftercare of pulmonary rehabilitation programs in Germany.
We contacted all pulmonary rehabilitation clinics in Germany. Of the 67 clinics we identified, 62 fulfilled the inclusion criteria; 39 clinics (62.9 %) agreed to participate and returned the completed questionnaires.
Each clinic rated ambulatory exercise training sessions as effective aftercare. In each case, slightly above 50 % of the sample informed their patients via standardized talks or information brochures. In 38.5 % of the clinics, ambulatory exercise in groups was provided as aftercare. The number of patients who received prescription for aftercare at the end of the rehabilitation program ranged between 0 % and 100 %. Rapamycin Only a quarter of the clinics had ever been a cessation and exercise training programs for their inpatients; however, there are still areas of improvement as far as providing care after discharge from a rehabilitation clinic is concerned with regard to smoking cessation and prescription of ambulatory exercise training.
This survey emphasizes that most of the pulmonary rehabilitation clinics in Germany have already achieved a good standard regarding tobacco cessation and exercise training programs for their inpatients; however, there are still areas of improvement as far as providing care after discharge from a rehabilitation clinic is concerned with regard to smoking cessation and prescription of ambulatory exercise training.
