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Hooten R, Luis Marquez J, Goldlist K, Urcis R, Adams M, Matthias KR, Nix DE, Al Mohajer M. Overprescription of antibiotics in patients with community-acquired pneumonia in the intensive care unit. Avicenna J Med 2019; 9:107-110. [PMID: 31404133 PMCID: PMC6647917 DOI: 10.4103/ajm.ajm_189_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: We aimed to assess factors associated with therapy failure in patients with community-acquired pneumonia in the intensive care unit (ICU). Methods: Electronic charts of patients with International Classification of Diseases, Ninth Revision, codes of pneumonia who were admitted to the ICU at a tertiary academic medical center in Southern Arizona were reviewed. Results: Antipseudomonal coverage and anti-methicillin-resistant Staphylococcus aureus (MRSA) coverage were often prescribed (58.4% and 54.1%, respectively). Antipseudomonal coverage was rarely necessary as pseudomonal pneumonia was found in only one case (0.9%). Antipseudomonal and anti-MRSA coverage was not associated with improved outcomes. Conclusion: Overprescription of antibiotics in this population remains a significant problem. More work is needed to further limit unnecessary antibiotic use.
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Affiliation(s)
- Rorak Hooten
- Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jose Luis Marquez
- Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Kady Goldlist
- Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Rafael Urcis
- Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Matthew Adams
- Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Kathryn R Matthias
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - David E Nix
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Mayar Al Mohajer
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Mira JJ, Caro Mendivelso J, Carrillo I, González de Dios J, Olivera G, Pérez-Pérez P, Nebot C, Silvestre C, Agra Y, Fernandez A, Valencia-Martín JL, Ariztegui A, Aranaz J. Low-value clinical practices and harm caused by non-adherence to 'do not do' recommendations in primary care in Spain: a Delphi study. Int J Qual Health Care 2019; 31:519-526. [PMID: 30252074 DOI: 10.1093/intqhc/mzy203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/16/2018] [Accepted: 08/31/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To determine the non-adherence to the primary care 'do not do' recommendations (DNDs) and their likelihood to cause harm. DESIGN Delphi study. SETTING Spanish National Health System. PARTICIPANTS A total of 128 professionals were recruited (50 general practitioners [GPs], 28 pediatricians [PEDs], 31 nurses who care for adult patients [RNs] and 19 pediatric nurses [PNs]). INTERVENTIONS A selection of 27 DNDs directed at GPs, 8 at PEDs, 9 at RNs and 4 at PNs were included in the Delphi technique. A 10-point scale was used to assess whether a given practice was still present and the likelihood of it causing of an adverse event. MAIN OUTCOME MEASURE Impact calculated by multiplying an event's frequency and likelihood to cause harm. RESULTS A total of 100 professionals responded to wave 1 (78% response rate) and 97 of them to wave 2 (97% response rate). In all, 22% (6/27) of the practices for GPs, 12% (1/8) for PEDs, 33% (3/9) for RNs and none for PNs were cataloged as frequent. A total of 37% (10/27) of these practices for GPs, 25% (2/8) for PEDs, 33% (3/9) for RNs and 25% (1/4) for PNs were considered as potential causes of harm. Only 26% (7/27) of the DNDs for GPs showed scores equal to or higher than 36 points. The impact measure was higher for ordering benzodiazepines to treat insomnia, agitation or delirium in elderly patients (mean = 57.8, SD = 25.3). CONCLUSIONS Low-value and potentially dangerous practices were identified; avoiding these could improve care quality.
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Affiliation(s)
- José Joaquín Mira
- Alicante-Sant Joan Health District, Consellería de Sanidad, Alicante, Spain.,Universidad Miguel Hernández de Elche, Elche, Spain.,REDISEC, Red de Servicios de Salud Orientados a Enfermedades Crónicas, Valencia, Spain
| | | | | | - Javier González de Dios
- Hospital General Universitario de Alicante, Consellería de Sanidad, Alicante, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Alicante, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Guadalupe Olivera
- Hospital Clínico San Carlos, Servicio Madrileño de Salud, Madrid, Spain
| | - Pastora Pérez-Pérez
- Observatorio para la Seguridad del Paciente, Agencia de Calidad Sanitaria de Andalucía, Sevilla, Spain
| | - Cristina Nebot
- Centro de Salud Fuente de San Luis, Dr. Peset Health District, Consellería de Sanidad, Valencia, Spain
| | - Carmen Silvestre
- Servicio de Efectividad y Seguridad Asistencial, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Yolanda Agra
- Area de Seguridad del Paciente, Ministerio de Sanidad, Consumo y Bienestar Social, Madrid, Spain
| | - Ana Fernandez
- Servicio de Efectividad y Seguridad Asistencial, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - José L Valencia-Martín
- Hospital Universitario Ramón y Cajal, Servicio Madrileño de Salud, Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ana Ariztegui
- Servicio de Efectividad y Seguridad Asistencial, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Jesús Aranaz
- Hospital Universitario Ramón y Cajal, Servicio Madrileño de Salud, Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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O’Keeffe M, Traeger AC, Hoffmann T, Ferreira GE, Soon J, Maher C. Can nudge-interventions address health service overuse and underuse? Protocol for a systematic review. BMJ Open 2019; 9:e029540. [PMID: 31239308 PMCID: PMC6597741 DOI: 10.1136/bmjopen-2019-029540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/15/2019] [Accepted: 05/24/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Nudge-interventions aimed at health professionals are proposed to reduce the overuse and underuse of health services. However, little is known about their effectiveness at changing health professionals' behaviours in relation to overuse or underuse of tests or treatments. OBJECTIVE The aim of this study is to systematically identify and synthesise the studies that have assessed the effect of nudge-interventions aimed at health professionals on the overuse or underuse of health services. METHODS AND ANALYSIS We will perform a systematic review. All study designs that include a control comparison will be included. Any qualified health professional, across any specialty or setting, will be included. Only nudge-interventions aimed at altering the behaviour of health professionals will be included. We will examine the effect of choice architecture nudges (default options, active choice, framing effects, order effects) and social nudges (accountable justification and pre-commitment or publicly declared pledge/contract). Studies with outcomes relevant to overuse or underuse of health services will be included. Relevant studies will be identified by a computer-aided search of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, CINAHL, Embase and PsycINFO databases. Two independent reviewers will screen studies for eligibility, extract data and perform the risk of bias assessment using the criteria recommended by the Cochrane Effective Practice and Organisation of Care (EPOC) group. We will report our results in a structured synthesis format, as recommended by the Cochrane EPOC group. ETHICS AND DISSEMINATION No ethical approval is required for this study. Results will be presented at relevant scientific conferences and in peer-reviewed literature.
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Affiliation(s)
- Mary O’Keeffe
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Giovanni Esteves Ferreira
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jason Soon
- Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - Christopher Maher
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Omodaka T, Ohsawa T, Tajika T, Shiozawa H, Hashimoto S, Ohmae H, Shitara H, Ichinose T, Sasaki T, Hamano N, Takagishi K, Chikuda H. Relationship Between Lower Limb Tightness and Practice Time Among Adolescent Baseball Players With Symptomatic Osgood-Schlatter Disease. Orthop J Sports Med 2019; 7:2325967119847978. [PMID: 31192270 PMCID: PMC6540499 DOI: 10.1177/2325967119847978] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Osgood-Schlatter disease (OSD) is characterized by traction apophysitis of the tibial tuberosity. Few studies on symptomatic and asymptomatic OSD have correlated findings with clinical examination. Purpose: To investigate the relationship between lower limb tightness and practice time among adolescent baseball players with symptomatic OSD. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The study participants were 402 male baseball players (N = 804 knees) with a mean ± SD age of 10.9 ± 1.5 years (range, 7-14 years). Participant age, height, body weight, body mass index, practice time per week, range of motion of the hip and ankle joints, heel-buttock distance (HBD), and straight-legged raise angle were evaluated. Tibial tuberosity development, as assessed with ultrasonography, was classified into 4 stages: cartilaginous, apophyseal, epiphyseal, and bony. Knees that were classified as apophyseal or epiphyseal were investigated. Participants were divided into 3 groups: non-OSD, asymptomatic OSD, and symptomatic OSD. Results: Of 400 knees in the apophyseal and epiphyseal stages, 23 knees had asymptomatic OSD, and 11 had symptomatic OSD. Players with symptomatic OSD practiced for significantly longer than the non-OSD group (P = .001) and asymptomatic OSD group (P = .001). Players with symptomatic OSD also had a larger HBD (P = .006) and smaller range of motion regarding internal rotation of hip (P = .023) and dorsiflexion of the ankle (P = .013) than the non-OSD group. Conclusion: Players with symptomatic OSD had longer practice times than the non-OSD and asymptomatic OSD players. Symptomatic OSD was also associated with tightness of the lower limbs as assessed by the HBD and range of motion in the hip and ankle joints.
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Affiliation(s)
- Takuya Omodaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Takashi Ohsawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hiroyuki Shiozawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Syogo Hashimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hiroaki Ohmae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
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Abstract
Background Injuries continue to rise among youth baseball players despite extensive research into prevention and the availability of throwing guidelines such as Pitch Smart. More research is needed to understand whether adherence to the current guidelines decreases injuries. Purpose To understand the degree to which parents are aware of the Pitch Smart guidelines, whether parents adhere to the guidelines, and whether adherence results in decreased injuries in youth baseball players. Study Design Cross-sectional study. Methods An anonymous, internet-based survey consisting of 44 items was distributed to parents of adolescent baseball players affiliated with various youth baseball organizations across the midwestern United States; 15 items on the survey served as assessment questions of the Pitch Smart guidelines. Absolute and percentage correct scores were calculated and compared by use of a Student t test. A chi-square analysis was used to compare discrete data. A binary logistic regression analysis was conducted to determine whether showcase participation predicted player injury. Results A total of 853 parents completed the survey. The mean ± SD age of the players on whom parents reported was 11.37 ± 3.5 years (range, 6-20 years). Among the cohort, 422 players regularly pitched. Regarding Pitch Smart guidelines, the percentage of correct answers by parents was 55.44% ± 0.3% for a player with a reported injury history and 62.14% ± 0.2% for a player without an injury history (P = .012). The number of correct answers was 8.03 ± 4.0 for the group with an injury history and 9.17 ± 3.2 for the group with no history of injury (P = .004). Binary logistic regression analysis, which controlled for age, indicated that showcase participation (P = .001, β = 1.043 ± 0.026, R2 = 0.178) was a significant predictor of player injury. Conclusion Pitchers are at an increased risk of injury compared with nonpitchers. Parents who are knowledgeable about the Pitch Smart throwing guidelines and actively follow them are significantly less likely to have a child with an injury. Excessive showcase participation is predictive of player injury when the analysis controls for age.
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Affiliation(s)
- Luke Zabawa
- University of Illinois at Chicago Medical College, Chicago, Illinois, USA
| | - Jeremy A Alland
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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106
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Abstract
OBJECTIVES Percutaneous coronary interventions do not provide a benefit over medical therapy for stable patients. However, an overuse of cardiac catheterisation (CC) for stable coronary artery disease (CAD) is documented in Germany and other countries. In this study, we aim to understand patient factors that foster this overuse. DESIGN Our study is an exploratory qualitative interview study with narrative, structured interviews. The interviews were analysed using qualitative content analysis by Mayring. SETTING The interviews were conducted in two German teaching practices. PARTICIPANTS 24 interviews with 25 patients were conducted; 17 (68%) patients were male, the average age was 73.9 years (range 53-88 years). All patients suffered from CAD and had undergone at least one CC. Patients with known anxiety disorders were excluded from the study. RESULTS The analysis identified six patient factors which contributed to or prevented the overuse of CC: (1) unquestioned acceptance of prescheduled appointments for procedures/convenience; (2) disinterest in and/or lack of disease-specific knowledge; (3) helplessness in situations with varying opinions on the required care; (4) fear of another cardiac event, (5) patient-physician relationship and (6) the patient's experience that repeat interventions did not result in a change of health status or care. CONCLUSIONS Conducted in a country with documented overuse of CC, we showed that most patients trusted their physicians' recommendations for repeat coronary angiographies even if they were asymptomatic. Strategies to align physician adherence with guidelines and corresponding patient information are needed to prevent overuse.
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Affiliation(s)
- Anna Herwig
- Institute for General Medicine, University Hospital Essen, Essen, Germany
| | - Dorothea Dehnen
- Institute for General Medicine, University Hospital Essen, Essen, Germany
| | - Birgitta Weltermann
- Institute for General Medicine, University Hospital Essen, Essen, Germany
- Institute for General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
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107
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Abstract
OBJECTIVE To assess hospital unit culture and clinician attitudes associated with varying rates of primary cesarean delivery. DATA SOURCES/STUDY SETTING Intrapartum nurses, midwives, and physicians recruited from 79 hospitals in California participating in efforts to reduce cesarean overuse. STUDY DESIGN Labor unit culture and clinician attitudes measured using a survey were linked to the California Maternal Data Center for birth outcomes and hospital covariates. METHODS Association with primary cesarean delivery rates was assessed using multivariate Poisson regression adjusted for hospital covariates. PRINCIPAL FINDINGS 1718 respondents from 70 hospitals responded to the Labor Culture Survey. The "Unit Microculture" subscale was strongly associated with primary cesarean rate; the higher a unit scored on 8-items describing a culture supportive of vaginal birth (eg, nurses are encouraged to spend time in rooms with patients, and doulas are welcomed), the cesarean rate decreased by 41 percent (95% CI = -47 to -35 percent, P < 0.001). Discordant attitudes between nurses and physicians were associated with increased cesarean rates. CONCLUSIONS Hospital unit culture, clinician attitudes, and consistency between professions are strongly associated with primary cesarean rates. Improvement efforts to reduce cesarean overuse must address culture of care as a key part of the change process.
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Affiliation(s)
- Emily White VanGompel
- The University of Chicago Pritzker School of MedicineEvanstonIllinois
- NorthShore University HealthSystemEvanstonIllinois
| | - Susan Perez
- Department of Kinesiology and Health ScienceCalifornia State University, SacramentoSacramentoCalifornia
| | - Avisek Datta
- NorthShore University HealthSystemEvanstonIllinois
| | - Chi Wang
- Biostatistics and ResearchNorthShore University HealthSystemEvanstonIllinois
| | - Valerie Cape
- California Maternal Quality Care CollaborativeStanford UniversityStanfordCalifornia
| | - Elliott Main
- Department of Obstetrics and GynecologyStanford University School of MedicineStanfordCalifornia
- California Maternal Quality Care CollaborativeStanford University School of MedicineStanfordCalifornia
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108
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Boehlen FH, Freigofas J, Herzog W, Meid AD, Saum KU, Schoettker B, Brenner H, Haefeli WE, Wild B. Evidence for underuse and overuse of antidepressants in older adults: Results of a large population-based study. Int J Geriatr Psychiatry 2019; 34:539-547. [PMID: 30623499 DOI: 10.1002/gps.5047] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/29/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Depression is common among elderly people. However, diagnosis and adequate treatment is frequently difficult. Research on underuse and overuse of antidepressants in elderly persons is scarce. This study investigates the utilization and appropriateness of pharmacological and psychological depression treatment in a large cohort of community-dwelling adults. METHODS A subsample of 3117 participants (aged 55-85 y) of the third follow-up (2008-2010) of the large population-based German ESTHER study was included. Depression was assessed using the eight-item Patient Health Questionnaire (PHQ-8). In the course of a home visit, study doctors collected complete information on medication. Logistic regression analyses were conducted to determine the relationship of depression with both underuse and overuse of antidepressants. The analyses were then adjusted for socioeconomic variables, psychosomatic comorbidities, and motivation to seek help. RESULTS One hundred sixty-three participants (5.2%; 95% confidence interval [CI], 4.5-6.1) fulfilled the criteria for major depression. Underuse of antidepressants was present in 126 depressed participants (77.3%; 70.1-83.5). Persons who were motivated to seek help, who had an established depression diagnosis, or who were taking more than five different medications had lower odds of underuse. Anxiety was associated with higher odds for underuse. Overuse of antidepressants (prescription without clinical indication) was found in 96 cases (41.7%; 35.3-48.4) of all antidepressant prescriptions. CONCLUSIONS Depression treatment in older adults is frequently insufficient; it appears to depend on diagnosis as well as the patients' motivation to seek help. Education regarding the diagnosis of depression in the elderly as well as guidelines for appropriate treatment is needed.
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Affiliation(s)
- Friederike H Boehlen
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Freigofas
- Department of Clinical Pharmacology and Pharmacoepidemiology, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ben Schoettker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany
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109
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Xie A, Woods-Hill CZ, King AF, Enos-Graves H, Ascenzi J, Gurses AP, Klaus SA, Fackler JC, Milstone AM. Work System Assessment to Facilitate the Dissemination of a Quality Improvement Program for Optimizing Blood Culture Use: A Case Study Using a Human Factors Engineering Approach. J Pediatric Infect Dis Soc 2019; 8:39-45. [PMID: 29165616 DOI: 10.1093/jpids/pix097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/27/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND Work system assessments can facilitate successful implementation of quality improvement programs. Using a human factors engineering approach, we conducted a work system assessment to facilitate the dissemination of a quality improvement program for optimizing blood culture use in pediatric intensive care units at 2 hospitals. METHODS Semistructured face-to-face interviews were conducted with clinicians from Johns Hopkins All Children's Hospital and University of Virginia Medical Center. Interview data were analyzed using qualitative content analysis. RESULTS Blood culture-ordering practices are influenced by various work system factors, including people, tasks, tools and technologies, the physical environment, organizational conditions, and the external environment. A clinical decision-support tool could facilitate implementation by (1) standardizing blood culture-ordering practices, (2) ensuring that prescribing clinicians review the patient's condition before ordering a blood culture, (3) facilitating critical thinking, and (4) empowering nurses to communicate with physicians and advocate for adherence to blood culture-ordering guidelines. CONCLUSION The success of interventions for optimizing blood culture use relies heavily on the local context. A work system analysis using a human factors engineering approach can identify key areas to be addressed for the successful dissemination of quality improvement interventions.
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Affiliation(s)
- Anping Xie
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland.,Department of Anesthesiology and Critical Care Medicine
| | - Charlotte Z Woods-Hill
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Pennsylvania
| | - Anne F King
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Heather Enos-Graves
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland
| | - Judy Ascenzi
- Department of Pediatrics, Johns Hopkins Nursing, Baltimore, Maryland
| | - Ayse P Gurses
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland.,Department of Anesthesiology and Critical Care Medicine
| | | | | | - Aaron M Milstone
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland.,Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Mortazavi SMJ, Malakoutikhah M, Zare A, Tajvar A, Derakhshan Jazari M. Commentary regarding "Factors associated with mental health among high school students in Iran: Does mobile phone overuse associate with poor mental health?". J Child Adolesc Psychiatr Nurs 2019; 32:102-103. [PMID: 30865327 DOI: 10.1111/jcap.12226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/24/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Seyed Mohammad Javad Mortazavi
- Department of Medical Physics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Diagnostic Imaging, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Mahdi Malakoutikhah
- Department of Occupational Health, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Asma Zare
- Department of Occupational Health, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolhamid Tajvar
- Department of Occupational Health, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Derakhshan Jazari
- Department of Occupational Health, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
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111
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Mira JJ, Carrillo I, Gea Velázquez de Castro MT, Silvestre C, Olivera G, Caro-Mendivelso J, Pérez-Pérez P, Agra Y, Fernández AM, Aranaz-Andrés JM. SOBRINA Spanish study-analysing the frequency, cost and adverse events associated with overuse in primary care: protocol for a retrospective cohort study. BMJ Open 2019; 9:e023399. [PMID: 30837247 PMCID: PMC6429720 DOI: 10.1136/bmjopen-2018-023399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Several institutions and quality national agencies have fostered the creation of recommendations on what not to do to reduce overuse in clinical practice. In primary care, their impact has hardly been studied. The frequency of adverse events (AEs) associated with doing what must not be done has not been analysed, either. The aim of this study is to measure the frequency of overuse and AEs associated with doing what must not be done (commission errors) in primary care and their cost. METHODS AND ANALYSIS A coordinated, multicentric, national project. A retrospective cohort study using computerised databases of primary care medical records from national agencies and regional health services will be conducted to analyse the frequency of the overuse due to ignore the do-not-do recommendations, and immediately afterwards, depending on their frequency, a representative random sample of medical records will be reviewed with algorithms (triggers) that determine the frequency of AEs associated with these recommendations. Cost will determine by summation of the direct costs due to the consultation, pharmacy, laboratory and imaging activities according to the cases. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of Primary Care Research of the Valencian Community. We aim to disseminate the findings through international peer-reviewed journals and on the website (http://www.nohacer.es/). Outcomes will be used to incorporate algorithms into the electronic history to assist in making clinical decisions. TRIAL REGISTRATION NUMBER NCT03482232; Pre-results.
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Affiliation(s)
- José Joaquín Mira
- Department of Health Psychology, Universidad Miguel Hernández de Elche, Elche, Spain
- Salud Alicante-Sant Joan Health District, Alicante, Spain
| | - Irene Carrillo
- Department of Health Psychology, Universidad Miguel Hernández de Elche, Elche, Spain
| | | | - Carmen Silvestre
- Servicio de Efectividad y Seguridad Asistencial, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Guadalupe Olivera
- Hospital Clínico San Carlos, Comunidad de Madrid Servicio Madrileño de Salud, Madrid, Spain
| | | | - Pastora Pérez-Pérez
- Patient Safety Observatory, AndalusianAgency for Health Care Quality, Seville, Spain
| | - Yolanda Agra
- Área de Seguridad del Paciente, Ministerio de Sanidad Servicios Sociales e Igualdad, Madrid, Spain
| | - Ana Mª Fernández
- Servicio de Efectividad y Seguridad Asistencial, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Jesús Maria Aranaz-Andrés
- Preventive Medicine and Public Health, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, Madrid, Spain
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Norton R, Honstad C, Joshi R, Silvis M, Chinchilli V, Dhawan A. Risk Factors for Elbow and Shoulder Injuries in Adolescent Baseball Players: A Systematic Review. Am J Sports Med 2019; 47:982-990. [PMID: 29630388 DOI: 10.1177/0363546518760573] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence of shoulder and elbow injuries among adolescent baseball players is on the rise. These injuries may lead to surgery or retirement at a young age. PURPOSE To identify independent risk factors for elbow and shoulder injuries in adolescent baseball players. A secondary aim was to determine whether the literature supports the Major League Baseball and USA Baseball Pitch Smart guidelines. STUDY DESIGN Systematic review. METHODS A systematic review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines utilizing MEDLINE, SPORTDiscus, and Web of Science. Because of study heterogeneity, a quantitative synthesis was not performed. A qualitative review was performed on 19 independent risk factors for elbow and shoulder injuries in adolescent baseball players. Level of evidence was assigned per the Oxford Centre for Evidence-Based Medicine Working Group, and risk of bias was graded per the Newcastle-Ottawa Scale. RESULTS Twenty-two articles met criteria for inclusion. Of the 19 independent variables that were analyzed, age, height, playing for multiple teams, pitch velocity, and arm fatigue were found to be independent risk factors for throwing arm injuries. Pitches per game appears to be a risk factor for shoulder injuries. Seven independent variables (innings pitched per game, showcase participation, games per year, training days per week, pitch type, shoulder external rotation, and shoulder total range of motion) do not appear to be significant risk factors. The data were inconclusive for the remaining 6 variables (weight, months of pitching per year, innings or pitches per year, catching, shoulder horizontal adduction, and glenohumeral internal rotation deficit). CONCLUSION The results from this study demonstrate that age, height, playing for multiple teams, pitch velocity, and arm fatigue are clear risk factors for throwing arm injuries in adolescent baseball players. Pitches per game appears to be a risk factor for shoulder injuries. Other variables are either inconclusive or do not appear to be specific risk factors for injuries.
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Affiliation(s)
- Ryan Norton
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Christopher Honstad
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Rajat Joshi
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Matthew Silvis
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Vernon Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Aman Dhawan
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Dwivedi S, Edukulla J, Rajendra S, Murali S, Sorser SA, Piper MS, Piper M, Warren BJ, Ramchandani H. Educational intervention can improve appropriateness of acid suppression therapy in hospitalized geriatric patients. J Community Hosp Intern Med Perspect 2019; 9:5-8. [PMID: 30788067 PMCID: PMC6374937 DOI: 10.1080/20009666.2019.1571881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/08/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Inappropriate use of acid suppression (AST) therapy may lead to unnecessary harms, especially in the geriatric population. Despite this, AST remains one of the most commonly prescribed medications in the hospital. Therefore, we aimed to assess its prevalence and create educational intervention to improve the appropriateness of inpatient acid suppression therapy. Methods: Using a time-series design, we established a historical control by performing a retrospective chart. Accepted indications for AST were based on those endorsed by the USA Food and Drug Administration and literature review. Inclusion criteria were: (1) age ≥ 65; (2) acid suppression therapy-initiated in the hospital; and (3) patients admitted to the medicine teaching services. We then created an educational intervention, which consisted of lectures and distribution of information pocket cards to residents. Data was collected for two months after the intervention. We used a two-tail fisher exact test and student’s t-test to analyze our results. Results: 65% of geriatric patients were inappropriately placed on acid suppression therapy, for which 13% were discharged without further indications. After the educational intervention, the inappropriate use of acid suppression therapy decreased to 45% (P < 0.05). Conclusion: There is a significant overuse of AST in hospitalized geriatric patients. Educational interventions are one potential method that may help improve the appropriateness of acid suppression therapy for elderly inpatients.
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Affiliation(s)
- Sankalp Dwivedi
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA.,Department of Gastroenterology, Providence - Providence Park Hospital, Michigan State University, Southfield, MI, USA
| | - Jaya Edukulla
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA
| | - Sindhu Rajendra
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA.,Department of Internal Medicine, Navicent Health Baldwin, Milledgeville, GA, USA
| | - Sandesh Murali
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA.,Department of Internal Medicine, Navicent Health Baldwin, Milledgeville, GA, USA
| | - Serge A Sorser
- Department of Gastroenterology, Providence - Providence Park Hospital, Michigan State University, Southfield, MI, USA
| | - Marc S Piper
- Department of Gastroenterology, Providence - Providence Park Hospital, Michigan State University, Southfield, MI, USA
| | - Michael Piper
- Department of Gastroenterology, Providence - Providence Park Hospital, Michigan State University, Southfield, MI, USA
| | - Bradley J Warren
- Department of Gastroenterology, Providence - Providence Park Hospital, Michigan State University, Southfield, MI, USA
| | - Harsha Ramchandani
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA.,Department of Internal Medicine, Tricity Health Center, Fremont, CA, USA
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114
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Wolfe H, Poole K, Tezanos AGV, English R, Uhl TL. VOLLEYBALL OVERHEAD SWING VOLUME AND INJURY FREQUENCY OVER THE COURSE OF A SEASON. Int J Sports Phys Ther 2019; 14:88-96. [PMID: 30746295 PMCID: PMC6350665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Overuse injuries are common in volleyball; however, few studies exist that quantify the workload of a volleyball athlete in a season. The relationship between workload and shoulder injury has not been extensively studied in women's collegiate volleyball athletes. HYPOTHESIS/PURPOSE This study aims to quantify shoulder workloads by counting overhead swings during practice and matches. The purpose of the current study is to provide a complete depiction of typical overhead swings, serves, and hits, which occur in both practices and matches. The primary hypothesis was that significantly more swings will occur in practices compared to matches. The secondary hypothesis was that greater swing volume and greater musculoskeletal injury frequency will occur in the pre-season than during the season. STUDY DESIGN Prospective cohort. METHODS Researchers observed practice and match videos and counted overhead serves and attacks of 19 women's collegiate volleyball players for two seasons. Serves, overhead hits, and total swings (serves + hits) were the dependent variables; event (matches and practice) along with position (defensive specialists, setter, outside hitter, and middle blocker) were the independent variables. Musculoskeletal injury frequency and swing volume workload were compared across pre-season and competitive season time periods. RESULTS Across all positions except outside hitters twice as many total swings occurred in practices compared to matches (p=.002) resulting in an average of 19 (CI95 16.5, 21.5) more swings in practice than in matches. The average number of total swings during the pre-season 47.1 (CI95 44.1, 50.1) was significantly greater than average swings per session during the competitive season 37.7 (CI95 36.4, 38.9) (p < 0.001) resulting in a mean difference of 9.4 (CI95 6.1, 12.7) swings. The number of athletes limited in participation or out due to a musculoskeletal injury during the pre-season (2.9%) was greater than during the season (1.1%) (p=0.042). CONCLUSION These findings support the primary hypothesis that women's collegiate volleyball athletes swing more during practices than in matches. The higher average number of serves in the pre-season and the greater frequency of musculoskeletal injuries requiring participation restriction or removal from participation suggest that a concordant relationship may exist between workload and injury variables. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Heather Wolfe
- Director of Sports Medicine, Associate Athletic Trainer, Lincoln University Department of Athletics and NovaCare Rehabilitation, Lincoln University, PA, USA
| | - Katherine Poole
- University of Kentucky Athletics Association, Head Volleyball Athletic Trainer, University of Kentucky, Lexington, KY, USA
| | | | - Robert English
- Division of Physical Therapy, Department of Rehabilitation Sciences, College of Health Science, University of Kentucky, Lexington, KY, USA
| | - Tim L. Uhl
- Division of Athletic Training, Department of Rehabilitation Sciences, College of Health Science, University of Kentucky, Lexington, KY, USA
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Bobo WV, Grossardt BR, Lapid MI, Leung JG, Stoppel C, Takahashi PY, Hoel RW, Chang Z, Lachner C, Chauhan M, Flowers L, Brue SM, Frye MA, St. Sauver J, Rocca WA, Sutor B. Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population. Pharmacol Res Perspect 2019; 7:e00461. [PMID: 30693088 PMCID: PMC6344796 DOI: 10.1002/prp2.461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/07/2018] [Accepted: 12/18/2018] [Indexed: 12/20/2022] Open
Abstract
The purpose of this study was to estimate the extent of potential antidepressant overprescribing in a geographically defined U.S. population, and to determine the indications and factors that account for it. We conducted a cohort study of new antidepressant prescriptions for elderly residents of Olmsted County, Minnesota, 2005-2012, using the Rochester Epidemiology Project medical records-linkage system. Indications for antidepressants were abstracted from health records for all cohort members. Potential antidepressant overprescribing was defined based on regulatory approval, the level of evidence identified from a standardized drug information database, and multidisciplinary expert review. Predictors of potential antidepressant overprescribing were investigated using logistic regression models, stratified by general antidepressant indication (general medical indication, specific psychiatric diagnosis, and non-specific psychiatric symptoms). Potential antidepressant overprescribing occurred in 24% of 3199 incident antidepressant prescriptions during the study period, and involved primarily newer antidepressants that were prescribed for non-specific psychiatric symptoms and subthreshold diagnoses. Potential antidepressant overprescribing was associated with nursing home residence, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, having greater use of urgent or acute care services in the year preceding the index antidepressant prescription, and being prescribed antidepressants via telephone, e-mail, or patient portal. In conclusion, potential antidepressant overprescribing occurred in elderly persons and involved mainly newer antidepressants used for non-specific psychiatric symptoms and subthreshold diagnoses, and was associated with indicators of higher clinical complexity or severity and with prescribing without face-to-face patient contact.
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Affiliation(s)
- William V. Bobo
- Department of Psychiatry & PsychologyMayo ClinicJacksonvilleFlorida
| | - Brandon R. Grossardt
- Division of Biomedical Statistics and InformaticsDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesota
| | - Maria I. Lapid
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | | | - Cynthia Stoppel
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | - Paul Y. Takahashi
- Department of Primary Care Internal MedicineMayo ClinicRochesterMinnesota
| | - Robert W. Hoel
- Department of Pharmacy ServicesMayo ClinicRochesterMinnesota
| | - Zheng Chang
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | | | - Mohit Chauhan
- Department of Psychiatry & PsychologyMayo ClinicJacksonvilleFlorida
| | - Lee Flowers
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | - Scott M. Brue
- Biomedical Informatics Support SystemMayo ClinicRochesterMinnesota
| | - Mark A. Frye
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | - Jennifer St. Sauver
- Division of EpidemiologyDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesota
| | - Walter A. Rocca
- Division of EpidemiologyDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesota
- Department of NeurologyMayo ClinicRochesterMinnesota
| | - Bruce Sutor
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
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DiFrancisco-Donoghue J, Balentine J, Schmidt G, Zwibel H. Managing the health of the eSport athlete: an integrated health management model. BMJ Open Sport Exerc Med 2019; 5:e000467. [PMID: 30792883 PMCID: PMC6350739 DOI: 10.1136/bmjsem-2018-000467] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives eSport is a form of electronic gaming, also known as professional or competitive video gaming, and is growing at a rapid pace worldwide. Over 50 US colleges have established varsity gaming teams over the past three years; some colleges offer eSport scholarships as they do for traditional sports. There is little objective research on the health habits of these players who are often placed under the direction of the athletics department on college campuses, and there is currently no health management model on how to treat these new athletes. Methods Anonymous electronic surveys were sent to 65 collegiate eSport players from nine universities across the USA and Canada inquiring about gaming and lifestyle habits, and musculoskeletal complaints due to eSport competition. Results Players practiced between 3 and 10 hours per day. The most frequently reported complaint was eye fatigue (56%), followed by neck and back pain (42%). eSport athletes reported wrist pain (36%) and hand pain (32%). Forty per cent of participants do not participate in any form of physical exercise. Among the players surveyed, only 2% had sought medical attention. Conclusion eSport players, just like athletes in traditional sports, are susceptible to overuse injuries. The most common complaint was eye fatigue, followed by neck and back pain. This study shows eSport athletes are also prone to wrist and hand pain. This paper proposes a health management model that offers a comprehensive medical team approach to prevent and treat eSport athletes.
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Affiliation(s)
- Joanne DiFrancisco-Donoghue
- Department of Osteopathic Medicine, New York Institute of Technology College of Osteopathic Medicine (NYIT-COM), New York City, New York, USA.,Center for Sports Medicine NYIT-COM, New York City, New York, USA
| | - Jerry Balentine
- Office of the Vice President NYIT-COM, New York City, New York, USA
| | - Gordon Schmidt
- Office of the Dean NYIT-School of Health Professions, New York City, New York, USA
| | - Hallie Zwibel
- Center for Sports Medicine NYIT-COM, New York City, New York, USA.,Department of Family Medicine, NYIT-COM, New York City, New York, USA
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Hall SF, Webber C, Groome PA, Booth CM, Nguyen P, DeWit Y. Do doctors who order more routine medical tests diagnose more cancers? A population-based study from Ontario Canada. Cancer Med 2019; 8:850-859. [PMID: 30609320 PMCID: PMC6382726 DOI: 10.1002/cam4.1925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 11/20/2018] [Accepted: 11/23/2018] [Indexed: 12/20/2022] Open
Abstract
Background The overuse of medical tests leads to higher costs, wasting of resources, and the potential for overdiagnosis of disease. This study was designed to determine whether the patients of family doctors who order more routine medical tests are diagnosed with more cancers. Method A retrospective population‐based cross‐sectional study using administrative health care data in Ontario Canada. We investigated the ordering of 23 routine laboratories and imaging tests 2008‐20012 by 6849 Ontario family physicians on their 4.9 million rostered adult patients. We compared physicians’ test utilization and calculated case‐mix adjusted observed to expected (O:E) utilization ratios to categorize physicians as Typical, Higher or Lower testers. Age‐sex standardized rates (cases/10 000 patient years) and Rate Ratios were determined for cancers of the thyroid, prostate, breast, lymphoma, kidney, melanoma, uterus, ovary, lung, esophagus, and pancreas for each tester group. Results There was wide variation in the use of the 23 tests by Ontario physicians. 26% and 24% of physicians were deemed Higher Testers for laboratory and imaging tests, while 41% and 38% were Typical Testers. The patients of higher test users were diagnosed with more cancers of thyroid (laboratory [RR 1.61, 95% CI 1.39‐1.87] and imaging [RR 2.08, 95% CI 0.88‐2.30]) and prostate (laboratory [RR 1.10, 95% CI 1.03‐1.18] and imaging [RR 1.05, 95% CI 1.00‐1.10]). Conclusion There is a wide variation in the ordering of routine and common medical tests among Ontario family doctors. The patients of higher testers were diagnosed with more thyroid and prostate cancers.
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Affiliation(s)
- Stephen F Hall
- Division of Cancer Care and Epidemiology, Department of Otolaryngology, Queen's University, Kingston, Ontario, Canada
| | - Colleen Webber
- Division of Cancer Care and Epidemiology, Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Patti A Groome
- Division of Cancer Care and Epidemiology, Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Paul Nguyen
- ICES Queens, Queen's University, Kingston, Ontario, Canada
| | - Yvonne DeWit
- ICES Queens, Queen's University, Kingston, Ontario, Canada
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118
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Pichot C, Gentric A. Observational Study Investigating the Prescription of Lipid-Lowering Drugs for Primary and/or Secondary Prevention in Residents Aged 80 Years and Over Institutionalized in Nursing Homes in Brest. J Nutr Health Aging 2019; 23:1043-1047. [PMID: 31781736 DOI: 10.1007/s12603-019-1292-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the prescription of lipid-lowering therapy in nursing home residents aged 80 and older. DESIGN Observational descriptive study, led in Brest, France, between February and May 2017. SETTING 15 nursing homes in Brest, France. PARTICIPANTS Nursing home residents, aged 80 and older, treated with a lipid-lowering therapy for primary and / or secondary prevention. MEASUREMENTS The primary endpoint was to observe the frequency of prescription of lipid-lowering therapy at the time of the study. The secondary endpoints were to analyse the relevance of these prescriptions regarding the latest French recommendations and current literature data and to evaluate the monitoring of treatment. RESULTS 213 of the 1121 included residents (19%) were treated with a lipid-lowering drugs. A total of 141 prescriptions (66.2%) were considered irrelevant. In the past 12 months, monitoring of lipids, liver and muscle enzymes was observed respectively in 41.3%, 60.1% and 9.4% of residents. CONCLUSION lipid-lowering prescription was not optimal in nursing homes. The results highlighted inadequate treatment monitoring and a gap between the French National Authority for Health (HAS) recommendations and actual practice.
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Affiliation(s)
- C Pichot
- C. Pichot, Service de médecine interne gériatrique, hôpital de la Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest, France,
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Zhou M, Oakes AH, Bridges JFP, Padula WV, Segal JB. Regional Supply of Medical Resources and Systemic Overuse of Health Care Among Medicare Beneficiaries. J Gen Intern Med 2018; 33:2127-2131. [PMID: 30229364 PMCID: PMC6258607 DOI: 10.1007/s11606-018-4638-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/30/2018] [Accepted: 07/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Overuse of health care resources has been identified as the leading contributor to waste in the US health care system. OBJECTIVE To explore health care system factors associated with regional variation in systemic overuse of health care resources as measured by the Johns Hopkins Overuse Index (JHOI) which aggregates systemic overuse of 20 health care services. DESIGN Using Medicare fee-for-service claims data from beneficiaries age 65 or over in 2008, we calculated the JHOI for the 306 hospital referral regions in the United States. We used ordinary least squares regression and multilevel models to estimate the association of JHOI scores and characteristics of regional health care delivery systems listed in the Area Health Resource File and Dartmouth Atlas. KEY RESULTS Regions with a higher density of primary care physicians had lower JHOI scores, indicating less systemic overuse (P < 0.001). Regional characteristics associated with higher JHOI scores, indicating more systemic overuse, included number per 1000 residents of acute care hospital beds (P = 0.002) and of hospital-based anesthesiologists, pathologists, and radiologists (P = 0.02). CONCLUSIONS Regional variations in health care resources including the clinician workforce are associated with the intensity of systemic overuse of health care. The role of primary care doctors in reducing health care overuse deserves further attention.
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Affiliation(s)
- Mo Zhou
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA.,Center for Health Services and Outcomes Research of the Bloomberg School of Public Health, Baltimore, USA
| | - Allison H Oakes
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA.,Center for Health Services and Outcomes Research of the Bloomberg School of Public Health, Baltimore, USA
| | - John F P Bridges
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA.,Center for Health Services and Outcomes Research of the Bloomberg School of Public Health, Baltimore, USA
| | - William V Padula
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA.,Center for Health Services and Outcomes Research of the Bloomberg School of Public Health, Baltimore, USA
| | - Jodi B Segal
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA. .,Center for Health Services and Outcomes Research of the Bloomberg School of Public Health, Baltimore, USA. .,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Lightbody CJ, Campbell JN, Herbison GP, Osborne HK, Radley A, Taylor DR. Impact of a treatment escalation/limitation plan on non-beneficial interventions and harms in patients during their last admission before in-hospital death, using the Structured Judgment Review Method. BMJ Open 2018; 8:e024264. [PMID: 30385448 PMCID: PMC6252685 DOI: 10.1136/bmjopen-2018-024264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/25/2018] [Accepted: 09/13/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To assess the effect of using a treatment escalation/limitation plan (TELP) on the frequency of harms in 300 patients who died following admission to hospital. DESIGN A retrospective case note review of 300 unselected, consecutive deaths comprising: (1) patients with a TELP in addition to a do-not-attempt cardiopulmonary resuscitation order (DNACPR); (2) those with DNACPR only; and (3) those with neither. Patient deaths were classified retrospectively as 'expected' or 'unexpected' using the Gold Standard Framework Prognostic Indicator Guidance. SETTING Medical, surgical and intensive care units of a district general hospital. OUTCOMES The primary outcome was the between-group difference in rates of harms, non-beneficial interventions (NBIs) and clinical 'problems' identified using the Structured Judgement Review Method. RESULTS 289 case records were evaluable. 155 had a TELP and DNACPR (54%); 113 had DNACPR only (39%); 21 had neither (7%). 247 deaths (86%) were 'expected'. Among patients with 'expected' deaths and using the TELP/DNACPR as controls (incidence rate ratio (IRR)=1.00), the IRRs were: for harms, 2.99 (DNACPR only) and 4.00 (neither TELP nor DNACPR) (p<0.001 for both); for NBIs, the corresponding IRRs were 2.23 (DNACPR only) and 2.20 (neither) (p<0.001 and p<0.005, respectively); for 'problems', 2.30 (DNACPR only) and 2.76 (neither) (p<0.001 for both). The rates of harms, NBIs and 'problems' were significantly lower in the group with a TELP/DNACPR compared with 'DNACPR only' and 'neither': harms (per 1000 bed days) 17.1, 76.9 (p<0.001) and 197.8 (p<0.001) respectively; NBIs: 27.4, 92.1 (p<0.001) and 172.4 (p<0.001); and 'problems': 42.3, 146.2 (p<0.01) and 333.3 (p<0.001). CONCLUSIONS The use of a TELP was associated with a significant reduction in harms, NBIs and 'problems' in patients admitted acutely and who subsequently died, especially if they were likely to be in the last year of life.
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Affiliation(s)
- Calvin J Lightbody
- Department of Emergency Medicine, University Hospital Hairmyres, NHS Lanarkshire, East Kilbride, UK
| | - Jonathan N Campbell
- Department of Medicine,, University Hospital Wishaw, NHS Lanarkshire, Wishaw, UK
| | - G Peter Herbison
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Heather K Osborne
- Department of Emergency Medicine, University Hospital Hairmyres, NHS Lanarkshire, East Kilbride, UK
| | - Alice Radley
- Department of Emergency Medicine, University Hospital Hairmyres, NHS Lanarkshire, East Kilbride, UK
| | - D Robin Taylor
- Department of Medicine,, University Hospital Wishaw, NHS Lanarkshire, Wishaw, UK
- Usher Institute of Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Abstract
Objective To determine the independent association of patient- and surgery-specific risk with receipt of outpatient preoperative testing. Methods Using administrative data from 2010-2013 (Marketscan® Commercial Claims and Encounters), we constructed a retrospective cohort of 678,368 privately-insured, non-elderly US adults who underwent one of ten operations, including one lower-risk and one higher-risk operation from five surgical specialties. Outcomes were receipt of nine outpatient tests in the 30 days before surgery and cost of those tests. Patient-specific risk was based on Revised Cardiac Risk Index (RCRI) and, alternatively, the Charlson Comorbidity Index (CCI). Surgery-specific risk was based on operation (higher- versus lower-risk within each specialty). Multivariable logistic regression models were constructed to measure the independent association of patient- and surgery-specific risk with the receipt of tests. Results Receipt of tests ranged from 0.9% (pulmonary function tests) to 46.8% (blood counts), and 65.2% of patients received at least one test. Mean cost per patient for all tests was $124.38. Higher RCRI was strongly associated (Odds Ratio (OR) >2) with receipt of stress tests and echocardiograms, and more modestly associated [OR <2] with receipt of most other tests. Undergoing higher-risk operations was strongly associated with receipt of most tests. Results were similar using the CCI for patient-specific risk. Conclusion Surgery-specific risk is strongly associated with receipt of most preoperative tests, which is consistent with preoperative testing protocols based as much or more on the planned operation as on patient-specific risk factors. Whether this pattern of preoperative testing represents optimal care is uncertain.
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Bliekendaal S, Moen M, Fokker Y, Stubbe JH, Twisk J, Verhagen E. Incidence and risk factors of medial tibial stress syndrome: a prospective study in Physical Education Teacher Education students. BMJ Open Sport Exerc Med 2018; 4:e000421. [PMID: 30364458 PMCID: PMC6196946 DOI: 10.1136/bmjsem-2018-000421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 11/24/2022] Open
Abstract
Objective Medial tibial stress syndrome (MTSS) is a common lower extremity overuse injury often causing long-term reduction of sports participation. This study aimed to investigate the incidence and risk factors of MTSS in first-year Dutch Physical Education Teacher Education (PETE) students. Methods This prospective study consisted of physical measures at baseline (height, weight, fat percentage, 3000 m run test, navicular drop test, hip internal and external range of motion, hip adduction and adduction strength, single leg squat and shin palpation), an intake questionnaire at baseline (age, sport participation, presence of MTSS, MTSS history, insole use and use of supportive shoes) and an MTSS registration procedure during the academic year of 2016–2017 (10 months) using a validated questionnaire. In total 221 first-year PETE students were included, of whom 170 (77%) were male and 51 (23%) female. The evaluation of risk factors was conducted with univariable and multivariable logistic generalised estimating equation analyses. Results In total 55 (25%) subjects, 35 (21%) men and 20 (39%) women, developed MTSS during the follow-up period. The associated risk factors were female sex (OR=3.14, 95% CI 1.39 to 7.11), above-average age (OR=0.31, 95% CI 0.13 to 0.76), above-average body mass index (OR=2.29, 95% CI 1.02 to 5.16) and history of MTSS (OR=5.03, 95% CI 1.90 to 13.30). Conclusion The incidence of MTSS is high in PETE students. Several risk factors were identified. These results demonstrate the need for prevention and may provide direction to preventive intervention design.
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Affiliation(s)
- Sander Bliekendaal
- Amsterdam University of Applied Sciences, Centre for Applied Research in Sports and Nutrition, Amsterdam, The Netherlands
| | - Maarten Moen
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Young Fokker
- Amsterdam University of Applied Sciences, Centre for Applied Research in Sports and Nutrition, Amsterdam, The Netherlands
| | - Janine H Stubbe
- Codarts University of the Arts, Rotterdam, The Netherlands.,Performing Artist and Athlete Research Lab (PEARL), Rotterdam, The Netherlands.,Rotterdam Arts and Science Lab (RASL), Rotterdam, The Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports & Department of Public and Occupational Health, Amsterdam Movement Science, VU University Medical Center, Amsterdam, The Netherlands.,UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM) Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,School of Physical Education, Faculty of Physical Therapy & Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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123
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Affiliation(s)
- Jodi B Segal
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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124
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Schermann H, Karakis I, Ankory R, Kadar A, Yoffe V, Shlaifer A, Yanovich R. Musculoskeletal Injuries Among Female Soldiers Working With Dogs. Mil Med 2018; 183:e343-e348. [PMID: 29788209 DOI: 10.1093/milmed/usy105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/30/2018] [Accepted: 04/26/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Female soldiers serving in the Israeli Defense Forces canine unit may be at increased risk of overuse injuries related to working with military dogs. We hypothesized that this particular type of occupational exposure may lead to an increased strain of the upper extremity due to such non-physiologic motions as pulling the dog's strap or resisting the sudden pulling by the dog, and may result in an increased rate of overuse injuries. MATERIALS AND METHODS We compared incidence of overuse injuries in a retrospective cohort of female soldiers who served either in the military working dogs' unit (MWD), or in the light infantry battalions (Infantry) from 2005 to 2015. We compared injury incidence of both groups during two periods: 5 mo of basic training (neither worked with dogs) and 19 or more months of combat service. Incidence was calculated as number of diagnoses per person-months (rate ratios, RR); each diagnosis counted once per study subject. We used RR confidence intervals to compare incidence of injuries between groups. RESULTS There were 3,443 person-months in the MWD group and 194,590 person-months in the Infantry group. There was no difference in injury incidence between groups during the initial period of basic training. During the second period, MWDs had higher incidence of upper limb (RR = 1.45, p = 0.048) and hip (RR = 3.6, p < 0.0001) injuries. The association between service with dogs and upper limb injuries remained significant (RR = 1.09, p = 0.005) after adjusting for confounding variables in the multivariate regression analysis. Other independent predictors of the upper limb overuse injuries included each additional month of service (RR = 1.003, p = 0.008), Eastern European origin compared with Israeli-born recruits (RR = 0.97, p = 0.03), increased body weight in increments of 10 kg (RR = 1.008, p = 0.03), anemia (RR = 1.02, p = 0.02) and fatigue (RR = 1.05, p ≤ 0.0001). CONCLUSIONS We found that service in the MWD unit was associated with increased risk of upper limb injuries. Identification of the exact mechanism of injury and targeted interventions, as well as treatment of anemia and fatigue may lead to reduction of injuries in this unit.
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Affiliation(s)
- Haggai Schermann
- Department of Orthopedic Surgery, Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center Affiliated with Tel Aviv University, Tel Aviv, Israel.,Department of Military Physiology, Heller Institute of Medical Research, Sheba Medical Center Affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Isabella Karakis
- Environmental Epidemiology Department, Public Health Services, Ministry of Health, Israel.,School of Health Professionals, Ashkelon Academic College, Ashkelon, Israel
| | - Ran Ankory
- Department of Orthopedic Surgery, Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Assaf Kadar
- Department of Orthopedic Surgery, Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Victoria Yoffe
- Department of Orthopedic Surgery, Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Amir Shlaifer
- Department of Orthopedic Surgery, Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ran Yanovich
- Department of Orthopedic Surgery, Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center Affiliated with Tel Aviv University, Tel Aviv, Israel.,Unit of Military Physiology, The Warrior Health Research Institute, Israel Defense Forces, Medical Corps, Tel Hashomer, Israel
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125
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Meng D, O'Sullivan K, Darlow B, O'Sullivan PB, Ekås GR, Forster BB. MRI for degenerative meniscal lesions: cease and desist! A three-step action plan. Br J Sports Med 2018; 53:1139-1140. [PMID: 30108063 DOI: 10.1136/bjsports-2018-099663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Dylan Meng
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland.,Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Peter B O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Guri Ranum Ekås
- Division of Orthopaedic Surgery, Oslo University Hospital/University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway
| | - Bruce B Forster
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Objectives To assess self-reported chronic injuries in climbing and possible connections with gender, experience and style of climbing. Method Retrospective survey. Setting Web-based questionnaire. Participants 667 active climbers (385 with chronic injuries, 289 males and 96 females). Main outcome measure Climbers who had experienced at least one chronic injury during the last 6 months. Result About 2/3 of male outdoor climbers had experienced a chronic injury. The three most frequent sites of injury were fingers (41.3%), shoulders (19.4%) and elbows (17.7%). The most frequent injury for the females were fingers (29.2%), shoulder (21.9%), wrist (12.5%), elbow (11.5%) and foot/ankle (10.4%). The most frequent injuries for the male were fingers (45.3%), elbow (19.7%) and shoulder (18.7%). Respondents who preferred outdoor climbing were more prone to injury than others. Conclusion Fingers were the most prevalent site of injury regardless of level of experience, gender and whether level of expertise is reported in terms of bouldering or route climbing. There seems to be a gender difference in respect of site of injury prevalence and a different prevalence of injuries according to style of climbing and different levels of expertise. Furthermore, the use of the suggested way of reporting levels of expertise to compare between bouldering and route climbing seems to be robust with no huge differences in terms of incidence level of different injuries.
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Affiliation(s)
- Gudmund Grønhaug
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway
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Messier SP, Martin DF, Mihalko SL, Ip E, DeVita P, Cannon DW, Love M, Beringer D, Saldana S, Fellin RE, Seay JF. A 2-Year Prospective Cohort Study of Overuse Running Injuries: The Runners and Injury Longitudinal Study (TRAILS). Am J Sports Med 2018; 46:2211-2221. [PMID: 29791183 DOI: 10.1177/0363546518773755] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The National Center for Injury Prevention and Control, noting flaws in previous running injury research, called for more rigorous prospective designs and comprehensive analyses to define the origin of running injuries. PURPOSE To determine the risk factors that differentiate recreational runners who remain uninjured from those diagnosed with an overuse running injury during a 2-year observational period. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Inclusion criteria were running a minimum of 5 miles per week and being injury free for at least the past 6 months. Data were collected at baseline on training, medical and injury histories, demographics, anthropometrics, strength, gait biomechanics, and psychosocial variables. Injuries occurring over the 2-year observation period were diagnosed by an orthopaedic surgeon on the basis of predetermined definitions. RESULTS Of the 300 runners who entered the study, 199 (66%) sustained at least 1 injury, including 73% of women and 62% of men. Of the injured runners, 111 (56%) sustained injuries more than once. In bivariate analyses, significant ( P ≤ .05) factors at baseline that predicted injury were as follows: Short Form Health Survey-12 mental component score (lower mental health-related quality of life), Positive and Negative Affect Scale negative affect score (more negative emotions), sex (higher percentage of women were injured), and knee stiffness (greater stiffness was associated with injury); subsequently, knee stiffness was the lone significant predictor of injury (odds ratio = 1.18) in a multivariable analysis. Flexibility, quadriceps angle, arch height, rearfoot motion, strength, footwear, and previous injury were not significant risk factors for injury. CONCLUSION The results of this study indicate the following: (1) among recreational runners, women sustain injuries at a higher rate than men; (2) greater knee stiffness, more common in runners with higher body weights (≥80 kg), significantly increases the odds of sustaining an overuse running injury; and (3) contrary to several long-held beliefs, flexibility, arch height, quadriceps angle, rearfoot motion, lower extremity strength, weekly mileage, footwear, and previous injury are not significant etiologic factors across all overuse running injuries.
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Affiliation(s)
- Stephen P Messier
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - David F Martin
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Shannon L Mihalko
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Paul DeVita
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
| | - D Wayne Cannon
- Wayne Cannon Physical Therapy and Associates, Winston-Salem, North Carolina, USA
| | - Monica Love
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Danielle Beringer
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Santiago Saldana
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca E Fellin
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Joseph F Seay
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
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McDonagh MS, Peterson K, Winthrop K, Cantor A, Lazur BH, Buckley DI. Interventions to reduce inappropriate prescribing of antibiotics for acute respiratory tract infections: summary and update of a systematic review. J Int Med Res 2018; 46:3337-3357. [PMID: 29962311 PMCID: PMC6134646 DOI: 10.1177/0300060518782519] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective Antibiotic overuse contributes to antibiotic resistance and adverse
consequences. Acute respiratory tract infections (RTIs) are the most common
reason for antibiotic prescribing in primary care, but such infections often
do not require antibiotics. We summarized and updated a previously performed
systematic review of interventions to reduce inappropriate use of
antibiotics for acute RTIs. Methods To update the review, we searched MEDLINE®, the Cochrane Library (until
January 2018), and reference lists. Two reviewers selected the studies,
extracted the study data, and assessed the quality and strength of
evidence. Results Twenty-six interventions were evaluated in 95 mostly fair-quality studies.
The following four interventions had moderate-strength evidence of
improved/reduced antibiotic prescribing and low-strength evidence of no
adverse consequences: parent education (21% reduction, no increase return
visits), combined patient/clinician education (7% reduction, no change in
complications/satisfaction), procalcitonin testing for adults with RTIs of
the lower respiratory tract (12%–72% reduction, no increased adverse
consequences), and electronic decision support systems (24%–47% improvement
in appropriate prescribing, 5%–9% reduction, no increased
complications). Conclusions The best evidence supports use of specific educational interventions,
procalcitonin testing in adults, and electronic decision support to reduce
inappropriate antibiotic prescribing for acute RTIs without causing adverse
consequences.
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Affiliation(s)
- Marian S McDonagh
- 1 The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Kim Peterson
- 1 The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.,6 Evidence-based Synthesis Program (ESP) Coordinating Center, VA Portland Health Care System, Portland, OR, USA
| | - Kevin Winthrop
- 2 Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA.,3 Department of Ophthalmology, Casey Eye Institute, Portland, OR, USA.,5 Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amy Cantor
- 1 The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.,4 Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Brittany H Lazur
- 1 The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - David I Buckley
- 1 The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.,4 Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.,5 Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
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Haverkamp MH, Peiris D, Mainor AJ, Westert GP, Rosenthal MB, Sequist TD, Colla CH. ACOs with risk-bearing experience are likely taking steps to reduce low-value medical services. Am J Manag Care 2018; 24:e216-e221. [PMID: 30020757 PMCID: PMC6594369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Accountable care organizations (ACOs) are groups of healthcare providers responsible for quality of care and spending for a defined patient population. The elimination of low-value medical services will improve quality and reduce costs and, therefore, ACOs should actively work to reduce the use of low-value services. We set out to identify ACO characteristics associated with implementation of strategies to reduce overuse. STUDY DESIGN Survey analysis. METHODS We used the National Survey of ACOs to determine the percentage of responding ACOs aware of the Choosing Wisely campaign and to what degree ACOs have taken steps to reduce the use of low-value services. We identified characteristics of ACOs associated with implementing low-value care-reducing strategies using 3 statistical models (stepwise and LASSO logistic regression and random forest). RESULTS Responding executives of 155 of 267 ACOs (58%) were aware of Choosing Wisely. Eighty-four of those 155 ACO leaders said that their ACOs also actively implemented strategies to reduce the use of low-value services, largely through educating physicians and stimulating shared decision making. All 3 models identified the presence of at least 1 commercial payer contract and prior joint experience pursuing risk-based payment contracts as the most important predictors of an ACO actively implementing strategies to reduce low-value care. CONCLUSIONS In the first year of implementation, just one-third of ACOs had taken steps to reduce the use of low-value medical services. Safety-net ACOs and those with little experience as a risk-bearing organization need more time and support from healthcare payers and the Choosing Wisely campaign to prioritize the reduction of overuse.
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Affiliation(s)
- Margje H Haverkamp
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Kresge Bldg, Rm 431, 677 Huntington Ave, Boston, MA 02115.
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Stubbe JH, Richardson A, van Rijn RM. Prospective cohort study on injuries and health problems among circus arts students. BMJ Open Sport Exerc Med 2018; 4:e000327. [PMID: 30018784 PMCID: PMC6045708 DOI: 10.1136/bmjsem-2017-000327] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2018] [Indexed: 11/13/2022] Open
Abstract
Aim The amount of injuries, illnesses and mental health problems was calculated among circus arts students, using a method designed to capture more than just time-loss and/or medical injuries. Furthermore, injury incidence rate, injury incidence proportions, anatomical injury location and severity of injuries were assessed. Methods A total of 44 first-year, second-year and third-year circus arts students were prospectively followed during one academic year. Every month, all students were asked to complete questionnaires by using the online Performing Artist and Athlete Health Monitor, which includes the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Results In total, 41 students completed the entire follow-up period. The response rate was 82.9%. During the academic year, all (100%) students reported a health problem. A total of 261 health problems were reported consisting of 184 injuries (70.5%), 51 illnesses (19.5%), 15 mental problems (5.0%) and 11 other health problems (3.1%). The injury incidence rate was 3.3 injuries per 1000 hours (95% CI 2.7 to 3.9). Monthly incidence proportion for substantial injuries (ie, problems leading to moderate or severe reductions in training volume or in performance or complete inability to participate in activities) ranged from 6.8% to 34.1%. Shoulder (n=51; 27.7%), lower back (n=29; 15.8%), wrist (n=26; 14.1%) and ankle (n=17; 9.2%) were the most reported injuries. The average duration of the injuries was 6.9 days (median=2.0; SD=15.0). Conclusions We implemented a new registration method for circus artists, which captures a complete picture of the burden of health problems in circus students. Our study showed that the burden of injuries is high in this population.
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Affiliation(s)
- Janine H Stubbe
- Codarts, University of the Arts, Rotterdam, The Netherlands.,Performing Artist and Athlete Research Lab (PEARL), Rotterdam, The Netherlands.,Rotterdam Arts and Science Lab (RASL), Rotterdam, The Netherlands
| | - Angelo Richardson
- Codarts, University of the Arts, Rotterdam, The Netherlands.,Performing Artist and Athlete Research Lab (PEARL), Rotterdam, The Netherlands
| | - Rogier M van Rijn
- Codarts, University of the Arts, Rotterdam, The Netherlands.,Performing Artist and Athlete Research Lab (PEARL), Rotterdam, The Netherlands
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131
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Djulbegovic B, Elqayam S, Dale W. Rational decision making in medicine: Implications for overuse and underuse. J Eval Clin Pract 2018; 24:655-665. [PMID: 29194876 PMCID: PMC6001794 DOI: 10.1111/jep.12851] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022]
Abstract
In spite of substantial spending and resource utilization, today's health care remains characterized by poor outcomes, largely due to overuse (overtesting/overtreatment) or underuse (undertesting/undertreatment) of health services. To a significant extent, this is a consequence of low-quality decision making that appears to violate various rationality criteria. Such suboptimal decision making is considered a leading cause of death and is responsible for more than 80% of health expenses. In this paper, we address the issue of overuse or underuse of health care interventions from the perspective of rational choice theory. We show that what is considered rational under one decision theory may not be considered rational under a different theory. We posit that the questions and concerns regarding both underuse and overuse have to be addressed within a specific theoretical framework. The applicable rationality criterion, and thus the "appropriateness" of health care delivery choices, depends on theory selection that is appropriate to specific clinical situations. We provide a number of illustrations showing how the choice of theoretical framework influences both our policy and individual decision making. We also highlight the practical implications of our analysis for the current efforts to measure the quality of care and link such measurements to the financing of health care services.
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Affiliation(s)
- Benjamin Djulbegovic
- Department of Supportive Care MedicineCity of HopeDuarteCaliforniaUSA
- Department of HematologyCity of Hope, DuarteCaliforniaUSA
| | - Shira Elqayam
- School of Applied Social Sciences, Division of PsychologyDe Montfort UniversityLeicesterUK
| | - William Dale
- Department of Supportive Care MedicineCity of HopeDuarteCaliforniaUSA
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Cho HJ, Wray CM, Maione S, Macharet F, Bansal A, Lacy ME, Tsega S. Right Care in Hospital Medicine: Co-creation of Ten Opportunities in Overuse and Underuse for Improving Value in Hospital Medicine. J Gen Intern Med 2018; 33:804-6. [PMID: 29497987 DOI: 10.1007/s11606-018-4371-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
The potential factors associated with overuse injuries and pain in cyclists that are supported by evidence remain unclear. Our study aimed at assessing, using a systematic search of the most updated evidence, the main factors related to overuse knee-related pain and/or injuries in cyclists. The search assessed any potential mechanism related to knee pain or injury that could be used in the clinical practice. Databases were searched (i.e., PubMed, Scopus, Web of Science, and EBSCO). Studies were included if they presented results from original studies. They had to include, preferably but not limited to, recreational and/or competitive cyclists with or without knee pain. Quality of articles was assessed. Eleven articles were deemed eligible for full text appraisal. Studies involved generally the assessment of biomechanical outcomes associated with knee pain in cyclists. Overall, studies showed that cyclists with knee pain present larger knee adduction and larger ankle dorsiflexion and differences in activation for hamstrings and quadriceps muscles. Unclear results were observed for knee moments and no differences were observed for knee flexion angle, tibiofemoral and patellofemoral forces. It is important to state that varied types of knee pain were mixed in most studies, with 2 focused on anterior-related pain. Cyclists with overuse-related pain or injuries on their knees presented an increased medial projection of their knees and an altered activation of the Vastus Medialis and Vastus Lateralis muscles. However, this limited evidence is based on retrospective studies comparing cyclists with and without pain, which limits the conclusion on how cyclists develop knee pain and what are the main options for treatment of knee pain.
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Affiliation(s)
- Rodrigo Rico Bini
- La Trobe Rural Health School, La Trobe University, Flora Hill Campus, Bendigo, VIC, Australia
| | - Alice Flores Bini
- La Trobe Rural Health School, La Trobe University, Flora Hill Campus, Bendigo, VIC, Australia
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134
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Sharma R, Pannikottu J, Xu Y, Tung M, Nothelle S, Oakes AH, Segal JB. Factors Influencing Overuse of Breast Cancer Screening: A Systematic Review. J Womens Health (Larchmt) 2018; 27:1142-1151. [PMID: 29708809 DOI: 10.1089/jwh.2017.6689] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Excessive breast cancer screening with mammography or other modalities often burdens patients with false-positive results and costs. Yet, screening patients beyond the age at which they will benefit or at too frequent intervals persists. This review summarizes the factors associated with overuse of breast cancer screening. METHODS We searched Medline and Embase from January 1998 to March 2017 for articles addressing the overuse of breast cancer screening and hand-searched the reference lists of included articles. Studies were included if they were written in English, pertained to a U.S. population, and identified a factor associated specifically with overuse of breast imaging. Paired reviewers independently screened abstracts, extracted data, and assessed quality. RESULTS We included 15 studies: 3 cohort, 5 cross-sectional, 6 surveys, and 1 in-depth interview. White women (non-Hispanic) were less vulnerable than other racial groups to overuse in 3 of 5 studies. Physician specialty was consistently associated with screening overuse in three of three studies. Abundant access to primary care and a patient desire for screening were associated with breast cancer screening overuse. Lower self-confidence, lower risk taking tendencies, higher perception of conflict in expert recommendations, and a belief in screening effectiveness were clinician traits associated with overuse of screening in the surveys. CONCLUSIONS The literature supports that liberal access to care and clinicians' recommendations to screen, possibly influenced by conflicting guidelines, increase excessive breast cancer screening. Overuse might conceivably be reduced with more concordance across guidelines, physician education, patient involvement in decision-making, thoughtful insurance restrictions, and limitations on the supply of services; however, these will need careful testing regarding their impact.
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Affiliation(s)
- Ritu Sharma
- 1 Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland
| | - Jean Pannikottu
- 2 Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Yunwen Xu
- 1 Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland
| | - Monica Tung
- 2 Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Stephanie Nothelle
- 2 Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Allison H Oakes
- 1 Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland
| | - Jodi B Segal
- 1 Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland.,2 Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.,3 Johns Hopkins University Center for Health Services and Outcomes Research , Baltimore, Maryland
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Arab-Zozani M, Pezeshki MZ, Khodayari-Zarnaq R, Janati A. Medical overuse in the Iranian healthcare system: a systematic review protocol. BMJ Open 2018; 8:e020355. [PMID: 29666133 PMCID: PMC5905767 DOI: 10.1136/bmjopen-2017-020355] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 03/10/2018] [Accepted: 03/13/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Lack of resources is one of the main problems of all healthcare systems. Recent studies have shown that reducing the overuse of medical services plays an important role in reducing healthcare system costs. Overuse of medical services is a major problem in the healthcare system, and it threatens the quality of the services, can harm patients and create excess costs for patients. So far, few studies have been conducted in this regard in Iran. The main objective of this systematic review is to perform an inclusive search for studies that report overuse of medical services in the Iranian healthcare system. METHOD AND ANALYSIS An extensive search of the literature will be conducted in six databases including PubMed, Embase, Scopus, Web of Science, Cochrane and Scientific Information Database using a comprehensive search strategy to identify studies on overuse of medical care. The search will be done without time limit until the end of 2017, completed by reference tracking, author tracking and expert consultation. The search will be conducted on 1 February 2018. Any study that reports an overuse in a service based on a specific standard will be included in the study. Two reviewers will screen the articles based on the title, abstract and full text, and extract data about type of service, clinical area and overuse rate. Quality appraisal will be assessed using the Joanna Briggs Institute checklist. Potential discrepancies will be resolved by consulting a third author. ETHICS AND DISSEMINATION Recommendations will be made to the Iranian MOHME (Ministry of Health and Medical Education) in order to make better evidence-based decisions about medical services in the future. PROSPERO REGISTRATION NUMBER CRD42017075481.
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Affiliation(s)
- Morteza Arab-Zozani
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Zakaria Pezeshki
- Social Determinants of Health Research Center, Department of Community and Family Medicine, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Khodayari-Zarnaq
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Janati
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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136
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Abstract
Background Linburg-Comstock anomaly is typically defined as a tenosynovial interconnection between flexor pollicis longus and flexor digitorum profundus tendon of the second finger. There are several studies stating that the current anomaly is congenital or acquired. The aim of this study is to reveal whether overuse, which is mostly reported as an acquired etiologic factor, effective in development of the current anomaly. Methods Three hundred thirteen medical secretaries who work with computer keyboard at least 6 hours a day were defined as study group. Three hundred twenty-three volunteers without jobs who necessitate continuous and repetitive hand and finger activities were defined as control group. All individuals were examined by an orthopaedic surgeon. Additionally, cases with Linburg-Comstock anomaly were evaluated in respect of forearm pain and subjective findings of carpal tunnel syndrome. Results Linburg-Comstock anomaly was determined in 27.8% cases of medical secretary group and in 32.2% of healthy control group. In medical secretaries with Linburg-Comstock anomaly, 25.3% had forearm pain and 5.7% had findings of carpal tunnel syndrome. In control group with Linburg-Comstock anomaly, 21.2% had forearm pain and 13.5% had findings of carpal tunnel syndrome. No relationship was found between overuse of the hand and Linburg-Comstock anomaly and the symptoms accompanying the anomaly. Conclusions The current study reveals that overuse is not an etiologic factor in Linburg-Comstock anomaly existence and related symptoms. We think that the current anomaly develops on congenital basis rather than acquired factors.
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Affiliation(s)
- Tugrul Bulut
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Mesut Tahta
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Tahir Ozturk
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Eyup Cagatay Zengin
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Cem Ozcan
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Muhittin Sener
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
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Predmore Z, Pannikottu J, Sharma R, Tung M, Nothelle S, Segal JB. Factors Associated With the Overuse of Colorectal Cancer Screening: A Systematic Review. Am J Med Qual 2018; 33:472-480. [PMID: 29546768 DOI: 10.1177/1062860618764302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This systematic review examined factors associated with overuse of colorectal cancer (CRC) screening. The authors searched MEDLINE and EMBASE from January 1998 to March 2017. Studies were included if they were written in English, contained original data, involved a US population, and examined factors potentially associated with overuse of CRC screening. Paired reviewers independently screened abstracts, assessed quality, and extracted data. In 8 studies, the associations between patient factors, including age, sex, race, and number of comorbidities, were tested and were inconsistently associated with CRC screening overuse. Overuse of screening was greater in the Northeast/Mid-Atlantic regions and in urban areas and was lower in academically affiliated centers. Although the literature supports important overuse of CRC screening, it remains unclear what drives these practices. Future research should thoroughly explore these factors and test the impact of interventions to reduce overuse of screening.
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Affiliation(s)
- Zachary Predmore
- 1 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jean Pannikottu
- 2 Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ritu Sharma
- 2 Johns Hopkins University School of Medicine, Baltimore, MD
| | - Monica Tung
- 1 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Stephanie Nothelle
- 1 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jodi B Segal
- 1 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.,2 Johns Hopkins University School of Medicine, Baltimore, MD.,3 Johns Hopkins University Center for Health Services and Outcomes Research, Baltimore, MD
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138
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Reid M, Cormack SJ, Duffield R, Kovalchik S, Crespo M, Pluim B, Gescheit DT. Improving the reporting of tennis injuries: the use of workload data as the denominator? Br J Sports Med 2018; 53:1041-1042. [PMID: 29467157 DOI: 10.1136/bjsports-2017-098625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Machar Reid
- Game Insight Group, Tennis Australia, Melbourne, Victoria, Australia
| | - Stuart J Cormack
- School of Exercise Science, Australian Catholic University, Sydney, New South Wales, Australia
| | - Rob Duffield
- Sport and Exercise Discipline Group, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Stephanie Kovalchik
- Game Insight Group, Tennis Australia, Melbourne, Victoria, Australia.,Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Victoria, Australia
| | - Miguel Crespo
- Development Department, International Tennis Federation, London, UK
| | | | - Danielle T Gescheit
- Game Insight Group, Tennis Australia, Melbourne, Victoria, Australia.,School of Exercise Science, Australian Catholic University, Sydney, New South Wales, Australia
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139
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Saggini R, Migliorini M, Carmignano SM, Ancona E, Russo C, Bellomo RG. Inferior heel pain in soccer players: a retrospective study with a proposal for guidelines of treatment. BMJ Open Sport Exerc Med 2018. [PMID: 29527319 PMCID: PMC5841518 DOI: 10.1136/bmjsem-2015-000085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The cause of heel pain among soccer players is multifactorial and is related to repetitive microtrauma due to impact forces involving technical moves, but also the playground, the exercise mode, the recovery time, the climatic conditions and the footwear used. Aim To investigate the aetiology of plantar heel pain of soccer players with the objective of proposing an example of guidelines for treatment. Methods We investigated the prevalence and characteristics of inferior heel pain of 1473 professional, semiprofessional and amateur players. All evaluated subjects were submitted to a specific rehabilitation protocol that involved advanced physical therapies and viscoelastic insoles depending on the aetiology of pain. Results Clinical and instrumental examinations revealed that 960 of 1473 athletes had inferior heel pain. These patients were divided into seven groups based on aetiology: sural nerve compression, abductor digiti minimi compression, atrophy and inflammation of the fat pad, plantar fasciitis, stress injury of the heel spur, stress fracture of the heel bone and heel spur. The proposed rehabilitation treatment aims for a reduction of pain and an early return to sports, with excellent results. Conclusions According to what was observed in the present study, related also to the specific treatment of inferior heel pain, and considering the technological progress achieved in recent years, we can now propose an integrated therapeutic approach to treatment of heel pain, properly differentiated according to specific aetiology.
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Affiliation(s)
- Raoul Saggini
- Department of Medical Oral and Biotechnological Sciences, 'G d'Annunzio' University, Chieti, Italy
| | - Maurizio Migliorini
- Dipartimento di Medical Orale and Biotechnological Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | | | - Emilio Ancona
- School of Specialty in PRM, 'G d'Annunzio' University, Chieti, Italy
| | - Chiara Russo
- School of Specialty in PRM, 'G d'Annunzio' University, Chieti, Italy
| | - Rosa Grazia Bellomo
- Department of Medicine and Science of Aging, 'G d'Annunzio' University, Chieti, Italy
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140
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Hollander K, Baumann A, Zech A, Verhagen E. Prospective monitoring of health problems among recreational runners preparing for a half marathon. BMJ Open Sport Exerc Med 2018; 4:e000308. [PMID: 29387447 PMCID: PMC5783030 DOI: 10.1136/bmjsem-2017-000308] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 01/01/2023] Open
Abstract
Objectives While the health benefits of running are legitimately advocated, participation in running can also lead to health problems. There is a high range of reported prevalence rates especially of running-related overuse injuries in high-level athletes and during competition. Little consensus exists for acute injuries and illnesses especially in recreational runners. Therefore, the aim of this study was to record the prevalence of health problems in recreational long-distance runners preparing for an event. Methods Recreational runners aged 18–65 years who were registered 13 weeks prior to a half-marathon running event were invited to take part in this study. Participants were prospectively monitored weekly over 13 weeks by applying a standardised surveillance system for injuries and illnesses (Oslo Sports Trauma Research Center questionnaire). From this, prevalence and severity of acute and overuse injuries, as well as illnesses, were calculated. Results We received 3213 fully answered questionnaires from 327 participants (40.7% female, 40.9±11.7 years of age, 31.5±21.1 km weekly mileage, 8.3±7.8 years of running experience). At any point in time over the preparation phase, 37.3% of the participants had health problems. Overuse injuries were the major burden (18%). They were followed by illnesses (14.1%) and acute injuries (7.9%). The median weekly severity score was 56.5 (IQR 37.0–58.0). Conclusion The high prevalence of health problems in our cohort suggests that future efforts are needed to further specify the underlying mechanism and develop adequate prevention strategies for recreational runners.
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Affiliation(s)
- Karsten Hollander
- Department of Sports and Exercise Medicine, Institute of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Antje Baumann
- Institute for Human Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Astrid Zech
- Department of Sport Science, Friedrich-Schiller-Universitat Jena, Jena, Germany
| | - Evert Verhagen
- Institute for Human Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Public and Occupational Health, EMGO, School of Medical Sciences, VU University Medical Center, Amsterdam, The Netherlands
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141
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Abstract
PURPOSE To examine whether nurses in Israel think there is overuse of health services, the reasons behind the issue, and ways to reduce the overuse. DESIGN This was a qualitative study using semistructured interviews. A convenience sample of community care nurses from health clinics across Israel was interviewed. Interviews focused on common areas of overuse, outcomes of overuse, causes of overuse, and potential ways to address the issue. Interviews were recorded, transcribed, and analyzed thematically. FINDINGS Overuse of antibiotics, imaging, blood tests, and prenatal surveillance were cited as main areas of health service overuse. Participants stated that negative outcomes of overuse could be seen at patient, health system, and population levels. Factors influencing overuse included patient satisfaction, physician fears, and insecurities. Potential interventions included improving physicians' diagnostic confidence, increasing appointment times, providing patients with more treatment information, and implementing a unified computerized system across medical institutions. CONCLUSIONS Nurses mentioned physicians and patients as main actors in influencing overuse; hence, those populations should be researched further. The health system was identified as the responsible party to address the issue. Health system leaders must consider potential barriers, and investigate interventions that match current culture and context within the health system. CLINICAL RELEVANCE Nurses can play an essential role in limiting overuse and mitigating subsequent harms to patients.
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Affiliation(s)
- Moriah E Ellen
- Senior Lecturer, Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Assistant Professor, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; and Investigator, McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | - Saritte Perlman
- Research Assistant, Jerusalem College of Technology, Jerusalem, Israel
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- The nursing students research group members include: Naama Eyall, Emuna Faig, Tal Hartuv, Moriyah Melamed, Lital Trabelsi, Herut Sapir, Shira Shtern, Yeshua Taubenblat, Atara Tauber
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142
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Hainline B. Peripheral nerve injury in sport: an overview. Handb Clin Neurol 2018; 158:381-384. [PMID: 30482366 DOI: 10.1016/b978-0-444-63954-7.00036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Peripheral nerve injury in sport results from acute trauma or repetitive overuse. Repetitive overuse injuries must be assessed with the broad context of tissue overload, kinetic chain continuum, periodization, recovery, equipment, and sport-specific biomechanics. Simply diagnosing the anatomic location and extent of nerve injury is inadequate. Management must consider all contributors to nerve injury. This chapter provides an overview of emerging information for assessing and managing peripheral nerve injury in sport.
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Affiliation(s)
- Brian Hainline
- National Collegiate Athletic Association, Indianapolis, IN, United States.
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143
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Abstract
Importance Overuse of medical care is a well-recognized problem. Objective To identify and highlight original research articles published in 2016 that are most relevant to understanding medical overuse or strategies to reduce it. Evidence Review A structured review of English-language articles on PubMed published in 2016 coupled with examination of tables of contents of high-impact journals to identify articles related to medical overuse in adults. These articles were appraised for their importance to medicine. Findings This study considered 2252 articles, 1224 of which addressed medical overuse. Of these, 122 were deemed most relevant based on originality, methodologic quality, and number of patients potentially affected. The 10 most influential articles were selected by author consensus. Select findings from the studies include the lack of benefit of transesophageal echocardiography in the workup of cryptogenic stroke, increasing use of computed tomography in the emergency department from 2.2% to 9.4% from 2001 to 2010, and carotid ultrasonography and revascularization being performed for uncertain or inappropriate indications with 95% frequency. Likewise, services for which harms are likely to outweigh benefits include treatment for early-stage prostate cancer, which provides no mortality benefit but increases absolute risk of erectile dysfunction by 10% to 30%, oxygen for patients with moderate chronic obstructive pulmonary disease, surgery for meniscal tear with mechanical symptoms, and nutritional interventions for inpatients with malnutrition. This review highlights 2 methods for reducing overuse: clinician audit and feedback with peer comparison for antibiotic use (reduction in inappropriate antibiotic use from 20% to 4%) and a practical and sensible shared decision-making tool for low-risk chest pain (reduction in emergency department workup from 52% to 37%). Conclusions and Relevance The body of empirical work continues to expand related to medical services that are provided for inappropriate or uncertain indications. Engaging patients in conversations aimed at shared decision making and giving practitioners feedback about their performance relative to peers appear to be useful in reducing overuse.
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Affiliation(s)
- Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
- Department of Hospital Epidemiology, Veterans Affairs Maryland Health Care System, Baltimore
| | - Sanket S Dhruva
- Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut
- Department of Veterans Affairs, West Haven, Connecticut
| | - Eric R Coon
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Scott M Wright
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deborah Korenstein
- Department of Medicine and Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York
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144
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D'Souza E, Krejany C, Meng R, Jiwa M. How are junior doctors managing patients with self-limiting illnesses at their first presentation? A video vignette study. Postgrad Med J 2017; 94:220-225. [PMID: 29222351 DOI: 10.1136/postgradmedj-2016-134625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 11/09/2017] [Accepted: 11/25/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE To conduct a video vignette survey of medical students and doctors investigating test ordering for patients presenting with self-limiting or minor illness. METHODS Participants were shown six video vignettes of common self-limiting illnesses and invited to devise investigation and management plans for the patients' current presentation. The number of tests ordered was compared with those recommended by an expert panel. A Theory of Planned Behaviour Questionnaire explored participants' beliefs and attitudes about ordering tests in the context of self-limiting illness. RESULTS Participants (n=61) were recruited from across Australia. All participants ordered at least one test that was not recommended by the experts in most cases. Presentations that focused mainly on symptoms (eg, in cases with bowel habit disturbance and fatigue) resulted in more tests being ordered. A test not recommended by experts was ordered on 54.9% of occasions. With regard to attitudes to test ordering, junior doctors were strongly influenced by social norms. The number of questionable tests ordered in this survey of 366 consultations has a projected cost of $17 000. CONCLUSIONS This study suggests that there is some evidence of questionable test ordering by these participants with significant implications for costs to the health system. Further research is needed to explore the extent and reasons for test ordering by junior doctors across a range of clinical settings.
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Affiliation(s)
- Eugene D'Souza
- School of Medicine, Melbourne Clinical School, The University of Notre Dame, Sydney, Australia
| | - Catherine Krejany
- School of Medicine, Melbourne Clinical School, The University of Notre Dame, Sydney, Australia
| | - Rosie Meng
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, Australia
| | - Moyez Jiwa
- School of Medicine, Melbourne Clinical School, The University of Notre Dame, Sydney, Australia
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145
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Johnston TE, Baskins TA, Koppel RV, Oliver SA, Stieber DJ, Hoglund LT. THE INFLUENCE OF EXTRINSIC FACTORS ON KNEE BIOMECHANICS DURING CYCLING: A SYSTEMATIC REVIEW OF THE LITERATURE. Int J Sports Phys Ther 2017; 12:1023-33. [PMID: 29234554 DOI: 10.26603/ijspt20171023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The knee is susceptible to injury during cycling due to the repetitive nature of the activity while generating torque on the pedal. Knee pain is the most common overuse related injury reported by cyclists, and intrinsic and extrinsic factors can contribute to the development of knee pain. Purpose Due to the potential for various knee injuries, this purpose of this systematic review of the literature was to determine the association between biomechanical factors and knee injury risk in cyclists. Study Design Systematic review of the literature. Methods Literature searches were performed using CINAHL, Ovid, PubMed, Scopus and SPORTDiscus. Quality of studies was assessed using the Downs and Black Scale for non-randomized trials. Results Fourteen papers were identified that met inclusion and exclusion criteria. Only four studies included cyclists with knee pain. Studies were small with sample sizes ranging from 9-24 participants, and were of low to moderate quality. Biomechanical factors that may impact knee pain include cadence, power output, crank length, saddle fore/aft position, saddle height, and foot position. Changing these factors may lead to differing effects for cyclists who experience knee pain based on specific anatomical location. Conclusion Changes in cycling parameters or positioning on the bicycle can impact movement, forces, and muscle activity around the knee. While studies show differences across some of the extrinsic factors included in this review, there is a lack of direct association between parameters/positioning on the cycle and knee injury risk due to the limited studies examining cyclists with and without pain or injury. The results of this review can provide guidance to professionals treating cyclists with knee pain, but more research is needed. Level of Evidence 3a.
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146
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Abstract
Some medical diagnostic and therapeutic interventions are non-beneficial or even harmful. The Choosing Wisely campaign has encouraged the generation of "top five" lists of unnecessary low-value services in different specialist areas. In the USA alone, where the campaign was launched, these lists include a total of 450 evidence-based recommendations. Medical scientific societies in further countries such as Canada, Australia, New Zealand, England, Switzerland and Germany have since initiated Choosing Wisely campaigns. Besides implementing top five lists, these aim to change attitudes, expectations and practices in the culture of medicine. The field of internal medicine has initiated change in Switzerland (Swiss Society of General Internal Medicine: Smarter Medicine) and Germany (German Society of Internal Medicine: Klug entscheiden). Formulating Choosing Wisely principles in managing complex patients with multiple concurrent acute or chronic diseases, i. e., multimorbidity (MM), will present a particular challenge. Research is needed to determine the primary sources of overuse in specific combinations of diseases (i. e., MM clusters) and spearhead corresponding recommendations. National Choosing Widely campaigns may serve as a forerunner to a more global initiative.
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Affiliation(s)
- Edouard J Battegay
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland.
| | - Marcus Cheetham
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
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147
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Perez SL, Backman D, Ginsburg M. Assessing social values for California's efforts to reduce the overuse of unnecessary medical care. Health Expect 2017; 21:501-507. [PMID: 29144599 PMCID: PMC5867318 DOI: 10.1111/hex.12644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 12/12/2022] Open
Abstract
Background A partnership of large health‐care purchasers created a workgroup to reduce the overuse of harmful and wasteful medical care in California. Objective Employ a civic engagement process to identify the social values important to the public in considering different strategies to reduce overuse. Intervention Use of deliberation techniques for 3 case examples that explore possible strategies: physician oversight, physician compensation, increased patient cost‐sharing or taking no definitive action. Results Five themes were identified, including strong support for physicians’ leadership role to reduce overuse; nuanced enthusiasm for increasing patient cost‐sharing to discourage excessive demand; and marked disapproval of physician compensation as a motivator. Conclusion Most but not all of the perspectives voiced by participants are congruent with efforts to reduce overuse that is being initiated or discussed at the state, provider and health plan level. As health‐care policymakers and leaders consider more targeted approaches to reducing overuse, these findings will inform decision‐making.
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Affiliation(s)
- Susan L Perez
- Department of Kinesiology and Health Science, California State University, Sacramento, CA, USA
| | - Desiree Backman
- California Department of Health Care Services and University of California, Davis Institute for Population Health Improvement, Sacramento, CA, USA.,University California Davis Medical Center, California Department of Health Care Services, Sacramento, CA, USA
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148
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Piau A, Huet Y, Gallini A, Andre L, Vellas B, Nourhashemi F. Optimization of drug therapy in elderly individuals admitted to a geriatric unit. Clin Interv Aging 2017; 12:1691-1696. [PMID: 29066874 PMCID: PMC5644527 DOI: 10.2147/cia.s132309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background A substantial share of adverse drug events involves inappropriate prescribing (IP). Specialized geriatric units are supposed to pay particular attention to prescribing appropriateness and to promoting a higher prescribing quality. Objective The objective of this study was to evaluate the reality of such assessment and optimization in real life (usual care) in a population of elderly individuals admitted to a geriatric unit. Method This is an observational study including all older patients admitted to an acute geriatric unit over a 6-month period. As part of usual care, the geriatrician is supposed to detect potentially inappropriate medication and potential prescribing omission using validated tools. The primary outcome was the prevalence rate of therapeutic modifications motivated by treatment optimization (stop, switch, or introduction). Multivariate logistic regression analyses were performed to identify the factors associated with therapeutic discontinuation. Results A total of 216 patients were included. The mean age was 85.7 years. Included patients had an average of 7.2±3.3 drugs at admission and 5.8±2.7 at discharge. IP was highly prevalent in our study where about 63% of the patients had experienced at least one modification because of overuse. The most commonly discontinued medications were drugs used to treat gastroesophageal reflux disease and peptic ulcer disease and serotonin reuptake inhibitor antidepressants. The most commonly introduced medications were analgesics and warfarin. By using multivariate analysis, we found that patient age and number of drugs on admission were significantly associated with medication discontinuation during hospital stay. Conclusion In this real-life study of all patients admitted to a Geriatric Post Emergency Unit, 83% of the patients had a treatment modification during hospital stay. The most original result of our study is the clear reduction in polypharmacy during hospitalization.
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Affiliation(s)
- Antoine Piau
- Gérontopôle, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Yoann Huet
- Gérontopôle, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Adeline Gallini
- UMR1027, INSERM-University of Toulouse, Toulouse, France.,Department of Epidemiology and Public Health, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Laurine Andre
- Gérontopôle, Centre Hospitalier Universitaire Toulouse, Toulouse, France.,UMR1027, INSERM-University of Toulouse, Toulouse, France.,Department of Epidemiology and Public Health, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Bruno Vellas
- Gérontopôle, Centre Hospitalier Universitaire Toulouse, Toulouse, France.,UMR1027, INSERM-University of Toulouse, Toulouse, France.,Department of Epidemiology and Public Health, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Fati Nourhashemi
- Gérontopôle, Centre Hospitalier Universitaire Toulouse, Toulouse, France.,UMR1027, INSERM-University of Toulouse, Toulouse, France.,Department of Epidemiology and Public Health, Centre Hospitalier Universitaire Toulouse, Toulouse, France
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149
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Abstract
Overdiagnosis is a growing problem worldwide. Overdiagnosis is the diagnosis of deviations, abnormalities, risk factors, and pathologies that in themselves would never cause symptoms (this applies only to risk factors and pathology), would never lead to morbidity, and would never be the cause of death. Overdiagnosis is often misinterpreted as overutilization or overtreatment. Overutilization, overtreatment, and overdiagnosis are interrelated but three distinct topics. Overutilization (establishment of standard practice that does not provide net benefit) does not have to lead to overdiagnosis or overtreatment, but the risk exists. Treatment of overdiagnosed conditions is one category of overtreatment. Another is when the best available evidence shows that the treatment has no beneficial effect. Overdiagnosis can be caused by overutilization and is nearly always followed by overtreatment. Treating an overdiagnosed condition cannot improve the patient’s prognosis, and therefore can only be harmful. At the individual level, we can never be sure if the person is overdiagnosed. However, experiences and thoughts of individuals who are most likely overdiagnosed can be explored in qualitative interviews, e.g. men with a small screening detected abdominal aortic aneurism. In longitudinal surveys, the degree and length of psychosocial consequences associated with overdiagnosis can be estimated. In high-quality RCTs, the magnitude of overdiagnosis can be quantified, and in cohort studies, we can find indications of overdiagnosis. Finally, we can conduct research about the consequences of overdiagnosis in at least eight different areas: financial strain, hassles/inconveniences, medical costs, opportunity costs, physical harms, psychological harms, societal costs and work-related costs.
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Affiliation(s)
- John Brodersen
- a Section of General Practice, Department of Public Health , Faculty of Health Sciences, University of Copenhagen , Denmark.,b Research Unit for General Practice, Department of Public Health , Faculty of Health Sciences, University of Copenhagen , Denmark.,c Primary Health Care Research Unit, Region Zealand , Denmark
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150
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Abstract
INTRODUCTION Overuse of cardiac catheterisation (CC) for stable coronary artery disease (CAD) is documented in Germany and other regions, although percutaneous coronary interventions do not provide a benefit over medical therapy for stable patients. Various studies investigated health system, physician and patient factors driving non-adherence to guidelines which recommend a stepwise approach with invasive procedures only in case of signs of ischaemia in non-invasive testing. In a larger-scale project, we aim to better understand the patients' perspective in order to develop an intervention that enhances patient's acceptance of this stepwise diagnostic approach for stable CAD. As a first step, this qualitative study aims to identify patient factors that prevent and promote the described overuse. METHODS AND ANALYSIS The exploratory qualitative interview study will include about 20 patients with stable CAD and a history of acute coronary syndrome from two German teaching practices. Narrative, structured interviews designed to last 30 to 90 min will be conducted. The interviews will be analysed using qualitative content analysis by Mayring. The analysis will address the following questions: (1) What are reasons for stable patients to undergo CC? (2) How do patients deal with their heart disease (secondary prevention)? (3) Which processes do patients describe regarding decision-making for non-invasive and invasive coronary procedures? (4) What information needs exist on behalf of patients to better understand the stepwise diagnostic approach outlined in guidelines and thereby avoid low-appropriate CCs? Based on these data, empirical typification will be conducted. ETHICS AND DISSEMINATION Ethical approval for the study was obtained. All participants will provide written informed consent. Data will be pseudonymised for analysis. The findings will contribute to the development of an appropriate intervention. Results will be disseminated by conference presentations and journal publications.
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Affiliation(s)
- Anna Herwig
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Birgitta Weltermann
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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