Academic Health Care Center Research Articles

Inpatient fall prevention from the patient's perspective: A qualitative study

AimThe aim of this study was to describe the patient's perspective of fall prevention in an acute care setting to aid in the design of patient centered strategies. BackgroundFalls are one of the most common adverse events in hospitals and can lead to preventable patient harm, increased length of stay, and increased healthcare costs. There is a need to understand fall risk and prevention from the patients' perspectives; however, research in this area is limited. MethodsTo understand the patient perspective, semi-structured interviews were conducted with twelve patients at an academic healthcare center. ResultsQualitative analysis revealed three major themes: (1) how I see myself, (2) how I see the interventions; and (3) how I see us. The theme “How I see myself” describes patients' beliefs of their own fall risk and includes the sub-themes of awareness, acceptance/rejection, implications, emotions, and personal plan. Interventions, such as fall alarms, are illustrated in the theme “How I see the interventions” and includes the subthemes what I see and hear and usefulness of equipment. Finally, “How I see us” describes barriers to participating in the fall prevention plan. ConclusionsMost fall prevention programs favor clinician-led plan development and implementation. Patient fall assessments needs to shift from being clinician-centric to patient-centric. Nurses must develop relationships with patients to facilitate understanding of their needs. Developing these truly patient-centered programs may reduce the over-reliance on bed alarms and allow for implementation of strategies aimed to mitigate modifiable risk factors leading to falls.

Interprofessional educator development : Build it and they will come.

BackgroundWe describe an interprofessional educator development program, designed intentionally, that was implemented at an academic healthcare centre. In 2014, we purposefully adapted our pre-existing educator development program to be able to include all interprofessional educators at our institution. The program’s goals were to enhance educator skills, a common need due to requirements of accreditation, and to create a local interprofessional community of teachers. The framework of the program was based upon adult learning principles, reflective practice, experiential learning and peer groups, all key characteristics of faculty development programs. It was also longitudinal and immersive. Kirkpatrick’s program evaluation model was used for identifying results; participants’ self-reported evaluation forms were collected and their narrative comments were analyzed.ResultsAfter we opened our educator program to all interprofessional staff, our number of program participants increased. The interprofessional participants included, but was not limited to, physicians, physician trainees, nurses, physician assistants, audiologists, perfusionists, and basic science researchers. Our number of program sessions and program faculty were expanded. Our interprofessional participants reported that they were able to learn essential knowledge, skills and attitudes for their growth and development as educators, in the context of an interprofessional community, while also appreciating the diversity of their peers.DiscussionWe share our insights with the redesign and implementation of an interprofessional educator program so that others can learn from our experiences. Key takeaways include using a conceptual framework for teaching effectiveness, involving interprofessional stakeholders and obtaining their perspectives, reviewing interprofessional literature and competencies, and highlighting best practices across the disciplines.

Overview of pharmacovigilance practices at the largest academic healthcare system in the State of Qatar.

Adverse Drug Reactions (ADRs) are major global concern, adversely impacting patient safety and health outcomes. ADRs cause significant morbidity and mortality among hospitalised patients, causing greater length of hospital stay, increased healthcare costs and patient dissatisfaction to the treatments. Pharmacovigilance (PV), a process of detecting, monitoring and preventing drug-related harm, plays a vital role to ensure patient safety. ADR reporting is the cornerstone of PV. PV practices in Qatar are relatively new and are evolving rapidly. The purpose of this article is to explore the medication safety practices (notably ADR reporting) at the largest academic healthcare center in Qatar. The article further provides evidence on how information related to ADRs are generated and interpreted. Furthermore, it describes how a designated center for monitoring medication safety activities was established at the largest healthcare provider in Qatar.

Carolina Care at University of North Carolina Health Care: Implementing a Theory-Driven Care Delivery Model Across a Healthcare System.

Patient satisfaction is a key component of healthcare organizations' performance. Providing a consistent, positive patient experience across a system can be challenging. This article describes an organization's approach to achieving this goal by implementing a successful model developed at the flagship academic healthcare center across an 8-hospital system. The Carolina Care at University of North Carolina Health Care initiative has resulted in substantive qualitative and quantitative benefits including higher patient experience scores for both overall rating and nurse communication.

Usage and accuracy of medication data from nationwide health information exchange in Quebec, Canada.

(1) To describe the usage of medication data from the Health Information Exchange (HIE) at the health care system level in the province of Quebec; (2) To assess the accuracy of the medication list obtained from the HIE. A descriptive study was conducted utilizing usage data obtained from the Ministry of Health at the individual provider level from January 1 to December 31, 2015. Usage patterns by role, type of site, and tool used to access the HIE were investigated. The list of medications of 111 high risk patients arriving at the emergency department of an academic healthcare center was obtained from the HIE and compared with the list obtained through the medication reconciliation process. There were 31 022 distinct users accessing the HIE 11 085 653 times in 2015. The vast majority of pharmacists and general practitioners accessed it, compared to a minority of specialists and nurses. The top 1% of users was responsible of 19% of access. Also, 63% of the access was made using the Viewer application, while using a certified electronic medical record application seemed to facilitate usage. Among 111 patients, 71 (64%) had at least one discrepancy between the medication list obtained from the HIE and the reference list. Early adopters were mostly in primary care settings, and were accessing it more frequently when using a certified electronic medical record. Further work is needed to investigate how to resolve accuracy issues with the medication list and how certain tools provide different features.

Testing the Timing: Time Factor in Radiation Treatment for Head and Neck Cancers.

Overall radiation treatment time has long been recognized as an important factor in head and neck tumor control. The concern of tumor growth in waiting time either before starting radiotherapy or during treatment is substantial given its negative impact on clinical outcome. There is an overwhelming evidence that increasing the time to initiate treatment increases the tumor burden and worsens the prognosis. This effect is more pronounced especially in patients with an early stage cancer disease. Delay in treatment initiation is contributed by both health care- and patient-related factors. Health care-related factors include advancement in diagnostic modalities and transfer of patient to academic health care centers accompanied by delayed referrals and long-awaited appointments. Patient-related factors include delayed reporting time and socioeconomic factors. An efficient transition of care along with access of cancer care modalities to community health care centers will not only improve the quality of care in secondary health care centers but also help decrease the patient burden in tertiary centers. A quick and well-structured multidisciplinary appointment program is fundamental in shortening the time required for patient referrals, thus increasing the optimal survival time for Head and Neck cancer patients with early initiation of treatment.

Psychological Impacts of Skin Diseases in Comparison to Chronic Diseases

Background: Suffering from skin diseases is more than a cosmetic nuisance. Patients with chronic skin diseases often experience significant psychological and social distress and fear of stigma. The aim of this study was to determine the psychological impact (depression, anxiety and stress) of skin diseases in comparison to chronic diseases among patients at an academic tertiary healthcare centre in Jeddah, Saudi Arabia. Methods: A cross sectional study involving 125 patients with chronic skin-related disorders recruited from the dermatology clinic at King Abdulaziz University Hospital (KAUH) and 100 patients with non-skin-related chronic disease were recruited from the medical, surgical and day care clinics at KAUH using the self-administered Depression Anxiety Stress Scales (DASS) Arabic questionnaire. Results: There was no significant difference in the level of depression, anxiety and stress in the group of subjects with skin diseases in comparison to the group with chronic diseases. However, subjects who have chronic disease were more likely to have severe and extremely severe stress compared to those who have skin disease when the levels of depression, anxiety and depression were categorized into normal, mild, moderate, severe and extremely severe levels. Conclusions: The association of depression, anxiety and stress in skin diseases are similar to chronic diseases. Subjects who have chronic disease were more likely to have severe and extremely severe stress compared to those who have skin disease. Patients with skin diseases need to be assessed regarding the psychological impact of their diseases.

Epidemiology of Joint Dislocations and Ligamentous/Tendinous Injuries among 2,700 Patients: Five-year Trend of a Tertiary Center in Iran.

The epidemiology of traumatic dislocations and ligamentous/tendinous injuries is poorly understood. In this study, we aimed to evaluate the prevalence and distribution of various dislocations and ligamentous/tendinous injuries in a tertiary orthopedic hospital in Iran. Musculoskeletal injuries in an academic tertiary health care center in Tehran February 2005 to October 2010 were recorded. The demographic details of patients with pure dislocations and ligamentous/tendinous injuries were extracted and the type and site of injuries were classified according to their specific age/gender groups. Among 18,890 admitted patients, 628 (3.3%) were diagnosed with dislocations and 2.081 (11%) with ligamentous/tendinous injuries. The total male/female ratio was 4.2:1 in patients with dislocations and 1.7:1 in patients with ligamentous/tendinous injuries. Shoulder was the most prevalent site of dislocation (50.6%), followed by fingers (10.1%), toes (7.6%), hip (7.3%), and elbow (6.5%). Ankle was the most common site of ligamentous/tendinous injury (53.5%), followed by midfoot (12.3%), knee (8.3%), hand (7%), and shoulder (5%). The mean ages of the patients in dislocations and ligamentous/tendinous injuries were 35.0±18.2 and 31.3± 15.1, respectively. There was no seasonal variation. Shoulder dislocation and ankle ligamentous injury are the most frequent injuries especially in younger population and have different distribution patterns in specific age and sex groups. Epidemiologic studies can help develop and evaluate the injury prevention strategies, resource allocation, and training priorities.

A Worksite Wellness Intervention: Improving Happiness, Life Satisfaction, and Gratitude in Health Care Workers.

ObjectiveTo assess the effect of a 12-week Stress Management and Resilience Training (SMART) program on happiness, life satisfaction, gratitude, mindfulness, spirituality, and stress in health care workers.Participants and MethodsParticipants were members of an employee wellness center at an academic health care center. Participants were enrolled as cohorts of 12 to 18 individuals and received the intervention at an employee wellness center from February 19, 2013, to February 27, 2017. The study was designed as a prospective, nonrandomized, single-arm clinical trial that included a 3-month in-person SMART program (defined as the intervention), with an additional 3-month postintervention follow-up period (6 months total). Outcomes were assessed at baseline (T0), end of intervention (T3), and after the postintervention follow-up period (T6) and included Subjective Happiness Survey, Satisfaction with Life Scale, Gratitude Scale, Mindful Attention Awareness Scale, Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being, and Perceived Stress Scale.ResultsOf the 110 participants who enrolled and provided consent, 98 participants (89%) completed the T0 and T3 assessments and 85 participants (77%) completed the T0, T3, and T6 assessments. On comparing the T0 and T6 responses, we observed statistically significant improvements (P<.001) in all the domains studied: subjective happiness (baseline average, 4.6; T6 average, 5.5; average difference, 0.9; 95% CI, 0.6-1.0), life satisfaction (baseline average, 22.8; T6 average, 27.5; average difference, 4.7; 95% CI, 3.6-5.9); gratitude (baseline average, 35.8; T6 average, 39.3; average difference, 3.5; 95% CI, 2.6-4.5), mindfulness (baseline average, 3.5; T6 average, 4.2; average difference, 0.7; 95% CI, 0.6-0.9), Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being (baseline average, 29.9; T6 average, 37.4; average difference, 7.5; 95% CI, 6.0-9.2), and percentage of people reporting high stress (baseline, 97.6%; T6, 67.1%). Similar results were observed when comparing the T0 and T3 responses.ConclusionIn health care workers, training in the SMART program was associated with statistically significant improvements in happiness, satisfaction with life, gratitude, mindfulness, spirituality, and stress (P<.001). Given the importance of stress in the workplace, larger randomized trials and broader dissemination of the program in health care workers is warranted.

The utilization of nonprescription medications in Saudi patients with cardiovascular diseases

BackgroundCardiovascular diseases (CVDs) are the most common cause of disease-related death in Saudi Arabia. The incidence of CVDs continues to increase, presenting a major health care problem. Nonprescription medications are widely used by patients with CVD and may cause adverse drug events, either by worsening the disease or by harmfully interacting with prescribed medications. We investigated the patterns of nonprescription medication utilization and the factors associated with their use in patients with CVD. MethodsThis was a cross-sectional study conducted at the Cardiology Clinics of an academic tertiary health care center. Participants were asked about their sociodemographic characteristics, medical history and frequency of using nonprescription medications including over-the-counter (OTC) products, dietary supplements, and herbal products. Moreover, we investigated the participants’ sources of information about nonprescription medications. Multivariate logistic regression analysis was conducted to examine the predictors of nonprescription medication use. ResultsA total of 209 participants were interviewed. The mean age of the participants was 56±15 years, and 110 (52.6%) were female. Of the 209 participants, 116 (55%) reported routine use of nonprescription medications. Black seeds and garlic were the most frequently used herbal products. Acetaminophen, cold/cough remedies, and ibuprofen were the most commonly reported OTC drugs. Of the surveyed patients, 54 (46.5%) used nonprescription medications to manage cardiovascular conditions specifically. Compared with other comorbidities, diabetes mellitus was associated with a higher use of nonprescription medications. ConclusionIn patients with CVD, the routine use of nonprescription medications was common for a number of reasons. Health care providers should proactively discuss nonprescription use with their CVD patients to avoid potential harmful outcomes.

A comparison between urban academic health care center and rural community faculty members in approaches to IPE

Abstract The objective of this study is to compare attitudes and approaches to interprofessional education (IPE) between urban and rural faculty and includes description of barriers for teaching collaborative team-based care. A qualitative comparison of interview data comparing rural community based physician and pharmacy faculty members with their academic health center counterparts found a shared interest in IPE. The groups differed, however, in their methods of teaching IPE. Some of these differences appear to be driven by the differences in nature of the two types of practices. There is some evidence that lack of preparation for teaching IPE is greater among rural community than among academic health care center faculty members, suggesting an opportunity for focused faculty development efforts in this area. This is a compelling issue as health care education programs continually seek preceptors for clinical experiences that provide learners with exposure to interprofessional team-based practice in a variety of settings.

Using spinopelvic parameters to estimate residual lumbar lordosis assuming previous lumbosacral fusion—a study of normative values

Background ContextPelvic incidence (PI)=pelvic tilt (PT)+sacral slope (SS) is an established trigonometric equation which can be expanded from studying the fixed pelvis with the spine to a fixed spinopelvic complex with the remnant spine, in scenarios of spinopelvic fusion or ankylosis. For a fixed spinopelvic complex, we propose the equation termed: lumbar incidence (LI)=lumbar tilt (LT)+lumbar slope (LS). PurposeThis study aimed to establish reference values for LI, LT, and LS at each lumbar vertebral level, and to show how LI can be used to determine residual lumbar lordosis (rLL). Study DesignThis is a cross-sectional study of prospectively collected data, conducted at a single academic tertiary health-care center. Patient SampleThe study included 53 healthy patients aged 19–35 with first episode mechanical low back pain for a period of <3 months. Patients with previous spinal intervention, those with known or suspected spinal pathologies, and those who were pregnant, were excluded. Outcome MeasuresRadiological measurements of LI, LT, LS, and rLL. MethodsAll patients had full-body lateral standing radiographs obtained via a slot scanner. Basic global and regional radiographic parameters, spinopelvic parameters, and the aforementioned new parameters were measured. LI was correlated with rLL at each level by plotting LI against rLL on scatter plots and drawing lines-of-best-fit through the datapoints. ResultsThe mean value of L5I was 22.82°, L4I was 6.52°, L3I was −0.92°, L2I was −5.56°, and L1I was −5.95°. LI turns negative at L3, LS turns negative at the L3/L4 apex, and LT remains positive throughout the lumbar spine. We found that the relationship of LI with its corresponding rLL follows a parabolic trend. Thus, rLL can be determined from the linear equations of the tangents to the parabolic lumbar spine. We propose the LI−rLL method for determining rLL as the LI recalibrates via spinopelvic compensation post instrumentation, and thus the predicted rLL will be based on this new equilibrium, promoting restoration of harmonized lordosis. The rLL-to-LI ratio is a simplified, but less accurate, method of deriving rLL from LI. ConclusionsThis study demonstrates the extended use of PI=PT+SS proposed as LI=LT+LS. These new spinopelvic reference values help us better understand the position of each vertebra relative to the hip. In situations when lumbar vertebrae are fused or ankylosed to the sacrum to form a single spinopelvic complex, LI can be used to determine rLL, to preserve spinal harmony within the limits of compensated body balance.

Multi- and univariate analyses of the weekend effect for elective lower-limb joint replacements

Introduction The weekend effect is a perceived difference in outcome between medical care provided at the weekend when compared to that of a weekday. Clearly multifactorial, this effect remains incompletely understood and variable in different clinical contexts. In this study we analyse factors relevant to the weekend effect in elective lower-limb joint replacement at a large NHS multispecialty academic healthcare centre. Materials and Methods We reviewed the electronic medical records of 352 consecutive patients who received an elective primary hip or knee arthroplasty. Patient, clinical and time-related variables were extracted from the records. The data were anonymised, then processed using a combination of uni- and multivariate statistics. Results There is a significant association between the selected weekend effect outcome measure (postoperative length of stay) and patient age, American Society of Anesthesiologists classification, time to first postoperative physiotherapy and time to postoperative radiography but not day of the week of operation. Discussion We were not able to demonstrate a weekend effect in elective lower-limb joint replacement at our institution nor identify a factor that would require additional weekend clinical medical staffing. Rather, resource priorities would seem to include measures to optimise at-risk patients preoperatively and measures to reduce time to physiotherapy and radiography postoperatively. Conclusions Our findings imply that postoperative length of stay could be minimised by strategies relating to patient selection and access to postoperative services. We have also identified a powerful statistical methodology that could be applied to other service evaluations in different clinical contexts.

Abstract A67: Addressing rural disparities: Community outreach to assess the need for cancer prevention, screening, and access to treatment in rural Utah

Abstract Background/Purpose The purpose of this study is to collect community health needs assessment data specific to rural Utah as part of designing tailored prevention and education programs. Cancer prevention, screening, and access to treatment in Rural Utah presents a unique set of challenges. Utah is a large state with vast and sparsely populated areas. More than 96% of the state is defined as either rural (&amp;lt;100 persons/sq. mile) or frontier (&amp;lt;7 persons/sq. mile). In Utah, these populations contend with great distances from academic health care centers, lack of ready access to care, and lack of education and available reliable health information; resulting in poor cancer health outcomes, lower cancer screening rates, and higher rates of tobacco use. Since 1999, Community Outreach and Prevention Education (COPE) at Huntsman Cancer Institute (HCI) has successfully disseminated information about cancer prevention to &amp;gt;1 million people. With funding from the National Cancer Institute, HCI has expanded COPE efforts to address known cancer disparities in 4 identified Utah health districts via a Community Health Educator (CHE). The first phase of the three-year grant is underway. Data collection methods, and findings will be described. Methods The COPE program expansion targets Tooele, Tri-County, Central, and Southeastern Utah health districts. Each have poor rankings in cancer mortality, early detection, and health behaviors, with limited contact from HCI's research, clinical, and education programs. The 3 phases of expansion include: • Year 1: partnership building, community health needs assessment (CHNA) • Year 2: evidence-based intervention strategies, program implementation • Year 3: program evaluation, sustainability During year 1, knowledge, beliefs, intentions, and behaviors related to cancer prevention and screening were collected via stakeholder interviews, focus groups with community members, short surveys, and follow-up e-mail/telephone questionnaires. The CDCynergy Lite planning model and theory of planned behavior guided the CHNA instruments. Results/Findings Rural data and outcomes from community members and key stakeholders will be shared. Discussion The results of the CHNA will contribute to evidence-based intervention strategies and will be used to implement tailored and culturally appropriate programs to improve these needs and evaluate effectiveness. Results/findings from year 1 also provide opportunities for HCI researchers and other community organizations to expand their work in the targeted districts. Citation Format: Jennyffer Morales, Ana Maria Lopez, Garrett Harding, Jeff Yancy, Donna Branson. Addressing rural disparities: Community outreach to assess the need for cancer prevention, screening, and access to treatment in rural Utah. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A67.

Management of Adult Growth Hormone Deficiency at Peking Union Medical College Hospital: A Survey among Physicians.

<strong>Objective</strong> To evaluate physicians' attitude and knowledge about the management of adult growth hormone deficiency (AGHD) at Peking Union Medical College Hospital and impact factors associated with better decision-making.<strong>Methods</strong> A 21-question anonymous survey was distributed and collected at Peking Union Medical College Hospital, a major teaching hospital in Chinese Academy of Medical Sciences. Data of physicians' educational background, clinical training, patient workload per year and continuing medical education in AGHD were collected. Factors associated with appropriate answers were further analyzed by multivariate regression models.<strong>Results</strong> One hundred and eighteen internal medicine residents, endocrine fellows, attending physicians and visiting physicians responded to the survey. Among them, 44.9% thought that AGHD patients should accept recombinant human growth hormone replacement therapy. Moreover, 56.8% selected insulin tolerance test and growth hormone-releasing hormone-arginine test for the diagnosis of AGHD. Logistic regression analysis of physician demographic data, educational background, and work experience found no consistent independent factors associated with better decision-making, other than continued medical education, that were associated with treatment choice.<strong>Conclusions</strong> The physicians' reported management of AGHD in this major academic healthcare center in Beijing was inconsistent with current evidence. High quality continued medical education is required to improve Chinese physician management of AGHD.

Cost-Effectiveness of Group and Internet Cognitive Behavioral Therapy for Insomnia in Adolescents: Results from a Randomized Controlled Trial

To investigate cost-effectiveness of adolescent cognitive behavioral therapy for insomnia (CBTI) in group- and Internet-delivered formats, from a societal perspective with a time horizon of 1 y. Costs and effects data up to 1-y follow-up were obtained from a randomized controlled trial (RCT) comparing Internet CBTI to face-to-face group CBTI. The study was conducted at the laboratory of the Research Institute of Child Development and Education at the University of Amsterdam, and the academic youth mental health care center UvAMinds in Amsterdam. Sixty-two participants meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for insomnia were randomized to face-to-face group CBTI (GT; n = 31, age = 15.6 y ± 1.8, 71.0% girls) or individual Internet CBTI (IT; n = 31, age = 15.4 y ± 1.5, 83.9% girls). The intervention consisted of six weekly sessions and a 2-mo follow up booster-session of CBTI, consisting of psychoeducation, sleep hygiene, restriction of time in bed, stimulus control, cognitive therapy, and relaxation techniques. GT sessions were held in groups of six to eight adolescents guided by two trained sleep therapists. IT consisted of individual Internet therapy with preprogrammed content similar to GT, and guided by trained sleep therapists. Outcome measures were subjective sleep efficiency (SE) ≥ 85%, and quality-adjusted life-years (QALY). Analyses were conducted from a societal perspective. Incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap sampling, and presented in cost-effectiveness planes. Primary analysis showed costs over 1 y were higher for GT but effects were similar for IT and GT. Bootstrapped ICERs demonstrated there is a high probability of IT being cost-effective compared to GT. Secondary analyses confirmed robustness of results. Internet CBTI is a cost-effective treatment compared to group CBTI for adolescents, although effects were largely similar for both formats. Further studies in a clinical setting are warranted. ID: ISRCTN33922163; trial name: Effectiveness of cognitive behavioral therapy for sleeplessness in adolescents; URL: http://www.isrctn.com/ISRCTN33922163.

Overdiagnosis of asthma in children in primary care: a retrospective analysis.

Asthma is one of the most common chronic diseases in childhood. According to guidelines, a diagnosis of asthma should be confirmed using lung function testing in children aged >6 years. Previous studies indicate that asthma in children is probably overdiagnosed. However, the extent has not previously been assessed. To assess the extent and characteristics of confirmed and unconfirmed diagnoses of asthma in children who were diagnosed by their GP as having asthma or who were treated as having asthma. Retrospective analysis in four academic primary healthcare centres in Utrecht, the Netherlands. Routine care registration data of children aged 6-18 years who received a diagnosis of asthma or were treated as having asthma were analysed. In only 16.1% (n = 105) of the children diagnosed with asthma was the diagnosis confirmed with spirometry, whereas in 23.2% (n = 151) the signs and symptoms did give rise to suspected asthma but the children should have undergone further lung function tests. In more one-half (53.5%, n = 349) of the children the signs and symptoms made asthma unlikely and thus they were most likely overdiagnosed. The remaining 7.2% (n = 47) were probably correctly classified as not having asthma. The main reasons for classifying asthma without children undergoing further lung function tests were dyspnoea (31.9%, n = 174), cough (26.0%, n = 142), and wheezing (10.4%, n = 57). Overdiagnosis of childhood asthma is common in primary care, leading to unnecessary treatment, disease burden, and impact on quality of life. However, only in a small percentage of children is a diagnosis of asthma confirmed by lung function tests.

Meaningful Use of a Confidential Adolescent Patient Portal

PurposeTo design and evaluate the usage of an adolescent patient portal specifically adapted for adolescent health care needs that also satisfied institutional meaningful use guidelines regarding electronic health records. MethodsKey stakeholders at one academic health care center adopted an online portal and opted to designate a patient portal specifically for adolescents to maximize confidentiality in compliance with state privacy laws. This study analyzed aggregate electronic health record data of adolescents' (ages 12–17.9 years) uptake, usage, and functionality of this portal and compared it to parent portal usage for younger children (ages 0–11 years). Differences in means were calculated using paired t tests. ResultsThe portal was used similarly between parents of young children and adolescents, with almost 1,000 enrollees in each group from September 1, 2012 to March 31, 2015. There were no gender differences in enrollment. Adolescents were less likely than parents of younger children to review appointments (73% vs. 85%), laboratory tests (67% vs. 79%), problem lists (40% vs. 78%), or allergies (45% vs. 77%, all p values <.001). Parents of younger children more frequently messaged providers (3,297 messages) although adolescents sent 1,397 confidential messages. ConclusionsInstitutional decisions for implementing meaningful use requirements can align with goals of adolescent health. Patient portals can enhance adolescent health care quality and adolescents readily use a confidential portal. Implementation of meaningful use requirements should be checked against adolescent health care needs to maximize confidentiality and promote health communication.

Use of Computed Tomography in Diagnosing Ventral Hernia Recurrence

Physical examination misses up to one-third of ventral hernia recurrences seen on radiologic imaging. However, tests such as computed tomographic (CT) imaging are subject to interpretation and require validation of interobserver reliability. To determine the interobserver reliability of CT scans for detecting a ventral hernia recurrence among surgeons and radiologists. We hypothesized there would be significant disagreement in the diagnosis of a ventral hernia recurrence among different observers. Our secondary aim was to determine reasons for disagreement in the interpretation of CT scans. One hundred patients who underwent ventral hernia repair from 2010-2011 at an academic health care center with a postoperative CT scan were randomly selected from a larger cohort. This study was conducted from July 2014 to March 2015. Prospective assessment of the presence or absence of a recurrent ventral hernia on CT scans was compared among 9 blinded reviewers and the radiology report. Five reviewers (consensus group) met to discuss all CT scans with disagreement. The discussion was assessed for keywords and key concepts. The remaining 4 reviewers (validation group) read the consensus group recommendations and reassessed the CT scans. Pre- and post-review κ were calculated; the post-review assessments were compared with clinical examination findings. Interobserver reliability in determining hernia recurrence radiographically. Of 100 CT scans, there was disagreement among all 9 reviewers and the radiology report on the presence/absence of a ventral hernia in 73 cases (κ = 0.44; 95% CI, 0.35-0.54; P < .001). Following discussion among the consensus group, there remained disagreement in 10 cases (κ = 0.91; 95% CI, 0.83-0.95; P < .001). Among the validation group, the κ value had a slight improvement from 0.21 (95% CI, 0.12-0.33) to 0.34 (95% CI, 0.23-0.46) (P < .001) after reviewing the consensus group proposals. There was disagreement between clinical examination and the consensus group assessment of CT scans on the presence/absence of a ventral hernia in 25 cases. The concepts most frequently discussed were the absence of an accepted definition for a radiographic ventral hernia and differentiating pseudorecurrence from recurrence. Owing to the high interobserver variability, CT scan was not associated with reliable diagnosing in ventral hernia recurrence. Consensus guidelines and improved communication between surgeon and radiologist may decrease interobserver variability.

Development of a brachytherapy audit checklist tool

To develop a brachytherapy audit checklist that could be used to prepare for Nuclear Regulatory Commission or agreement state inspections, to aid in readiness for a practice accreditation visit, or to be used as an annual internal audit tool. Six board-certified medical physicists and one radiation oncologist conducted a thorough review of brachytherapy-related literature and practice guidelines published by professional organizations and federal regulations. The team members worked at two facilities that are part of a large, academic health care center. Checklist items were given a score based on their judged importance. Four clinical sites performed an audit of their program using the checklist. The sites were asked to score each item based on a defined severity scale for their noncompliance, and final audit scores were tallied by summing the products of importance score and severity score for each item. The final audit checklist, which is available online, contains 83 items. The audit scores from the beta sites ranged from 17 to 71 (out of 690) and identified a total of 7-16 noncompliance items. The total time to conduct the audit ranged from 1.5 to 5 hours. A comprehensive audit checklist was developed which can be implemented by any facility that wishes to perform a program audit in support of their own brachytherapy program. The checklist is designed to allow users to identify areas of noncompliance and to prioritize how these items are addressed to minimize deviations from nationally-recognized standards.