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991.
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Effect of Physician Delegation to Other Healthcare Providers on the Quality of Care for Geriatric Conditions
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Brian J. Lichtenstein MD David B. Reuben MD Arun S. Karlamangla MD PhD Weijuan Han MSPH Carol P. Roth RN MPH Neil S. Wenger MD MPH 《Journal of the American Geriatrics Society》2015,63(10):2164-2170
The quality of care of older adults in the United States has been consistently shown to be inadequate. This gap between recommended and actual care provides an opportunity to improve the value of health care for older adults. Prior work from the Assessing Care of Vulnerable Elders (ACOVE) investigators first defined, and then sought to improve, clinical practice for common geriatric conditions. A critical component of the ACOVE intervention for practice improvement was an emphasis on the delegation of specific care processes, but the independent effect of delegation on the quality of care has not been evaluated. This study analyzed the pooled results of prior ACOVE projects from 1998 to 2010. Totaled, these studies included 4,776 individuals aged 65 and older of mixed demographic backgrounds and 16,204 ACOVE quality indicators (QIs) for three geriatric conditions: falls, urinary incontinence, and dementia. In unadjusted analyses, QI pass probabilities were 0.36 for physician‐performed tasks, 0.55 for nurse practitioner (NP)‐, physician assistant (PA)‐, and registered nurse (RN)‐performed tasks; and 0.61 for medical assistant– and licensed vocational nurse–performed tasks. In multiply adjusted models, the independent pass‐probability effect of delegation to NPs, PAs, and RNs was 1.37 (P = .05). These findings suggest that delegation of selected tasks to nonphysician healthcare providers is associated with higher quality of care for these geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions in older adults. 相似文献
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Concurrent cetuximab versus platinum‐based chemoradiation for the definitive treatment of locoregionally advanced head and neck cancer
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996.
Dermatomyositis paraneoplastic syndrome before symptomatic tonsillar squamous cell carcinoma: A case report
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Comparative effectiveness of a bioengineered living cellular construct vs. a dehydrated human amniotic membrane allograft for the treatment of diabetic foot ulcers in a real world setting
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Robert S. Kirsner MD PhD Michael L. Sabolinski MD Nathan B. Parsons RN BSN Michelle Skornicki MPH William A. Marston MD 《Wound repair and regeneration》2015,23(5):737-744
We evaluated the comparative effectiveness of a bioengineered living cellular construct (BLCC) and a dehydrated human amnion/chorion membrane allograft (dHACM) for the treatment of diabetic foot ulcers (DFUs). Using a wound care–specific electronic medical record database, we assessed real‐world outcomes in 218 patients with 226 DFUs receiving treatment in 2014 at 99 wound care centers. The analysis included DFUs ≥1 and <25 cm2 with duration <=1 year and area reduction ≤20% in 14 days prior to treatment (N=163, BLCC; N=63, dHACM). The average baseline areas and durations were 6.0 cm2 and 4.4 months for BLCC and 5.2 cm2 and 4.6 months for dHACM, respectively. Patients treated with dHACM had more applications compared to those treated with BLCC (median 3.0 vs. 2.0) (p=0.003). A Cox model adjusted for key covariates including area and duration found the median time to closure for BLCC was 13.3 weeks compared to 26 weeks for dHACM, and the proportion of wounds healed were significantly higher for BLCC by 12 weeks (48% vs. 28%) and 24 weeks (72% vs. 47%) (p=0.01). Treatment with a bioengineered living cellular technology increased the probability of healing by 97% compared with a dehydrated amniotic membrane (hazard ratio = 1.97 [95% confidence interval 1.17, 3.33], p=0.01). 相似文献
998.
Singh Simron Dey Chris Kennecke Hagen Kocha Walter Maroun Jean Metrakos Peter Mukhtar Tariq Pasieka Janice Rayson Daniel Rowsell Corwyn Sideris Lucas Wong Ralph Law Calvin 《Annals of surgical oncology》2015,22(8):2685-2699
Annals of Surgical Oncology - Pancreatic neuroendocrine tumors (pNETs) are rare heterogeneous tumors that have been steadily increasing in both incidence and prevalence during the past few decades.... 相似文献
999.
Lymphocyte subsets in primary sclerosing cholangitis 总被引:4,自引:0,他引:4
Keith D. Lindor MD Dr. Russell H. Wiesner MD Jerry A. Katzmann PhD Nicholas F. Larusso MD Sandra J. Beaver RN 《Digestive diseases and sciences》1987,32(7):720-725
As an initial step in testing the hypothesis that immunoregulatory abnormalities are important in the pathogenesis of primary sclerosing cholangitis, we determined the number and percentage of lymphocyte subsets in the peripheral blood of 33 patients with primary sclerosing cholangitis. In these patients, when compared with normal and diseased controls, there was a significant reduction in the total number of circulating T cells because of a disproportionate decrease in Leu-2a (suppressor/cytotoxic) cells. This decrease resulted in a significantly increased ratio of Leu-3a to Leu-2a cells. Patients with cirrhosis had significantly higher Leu-3a/Leu-2a (helper/suppressor) ratios than did noncirrhotic patients; both disease groups, however, had ratios that were significantly higher than controls. The number and percentage of B cells were significantly increased. Alterations in the percentage of B cells correlated significantly with histologic stage and concentrations of gamma globulin, serum IgG, and bilirubin. We conclude that these abnormalities are suggestive of a defect in immunoregulation in primary sclerosing cholangitis, which is not secondary to advanced liver disease alone and appears to be independent of chronic ulcerative colitis,or obstructive jaundice.Presented at the Annual Meeting of the American Gastroenterologic Association, New Orleans, Louisiana, May 19–25, 1984.This work was supported by the Mayo Foundation and Sandoz Inc., East Hanover, New Jersey. 相似文献
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