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Mallika L. Mendu Louise I. Schneider Ayal A. Aizer Karandeep Singh David E. Leaf Thomas H. Lee Sushrut S. Waikar 《Clinical journal of the American Society of Nephrology》2014,9(9):1526-1535
Background and objectives
CKD is associated with significant morbidity, mortality, and financial burden. Practice guidelines outlining CKD management exist, but there is limited application of these guidelines. Interventions to improve CKD guideline adherence have been limited. This study evaluated a new CKD checklist (a tool outlining management guidelines for CKD) to determine whether implementation in an academic primary care clinic improved adherence to guidelines.Design, setting, participants, & measurements
During a 1-year period (August 2012–August 2013), a prospective study was conducted among 13 primary care providers (PCPs), four of whom were assigned to use a CKD checklist incorporated into the electronic medical record during visits with patients with CKD stages 1–4. All providers received education regarding CKD guidelines. The intervention and control groups consisted of 105 and 263 patients, respectively. Adherence to CKD management guidelines was measured.Results
A random-effects logistic regression analysis was performed to account for intra-group correlation by PCP assignment and adjusted for age and CKD stage. CKD care improved among patients whose PCPs were assigned to the checklist intervention compared with controls. Patients in the CKD checklist group were more likely than controls to have appropriate annual laboratory testing for albuminuria (odds ratio [OR], 7.9; 95% confidence interval [95% CI], 3.6 to 17.2), phosphate (OR, 3.5; 95% CI, 1.5 to 8.3), and parathyroid hormone (OR, 8.1; 95% CI, 4.8 to 13.7) (P<0.001 in all cases). Patients in the CKD checklist group had higher rates of achieving a hemoglobin A1c target<7% (OR, 2.7; 95% CI, 1.4 to 5.1), use of an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker (OR, 2.1; 95% CI, 1.0 to 4.2), documentation of avoidance of nonsteroidal anti-inflammatory drugs (OR, 41.7; 95% CI, 17.8 to 100.0), and vaccination for annual influenza (OR, 2.1; 95% CI, 1.1 to 4.0) and pneumococcus (OR, 4.7; 95% CI, 2.6 to 8.6) (P<0.001 in all cases).Conclusions
Implementation of a CKD checklist significantly improved adherence to CKD management guidelines and delivery of CKD care. 相似文献33.
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Leaf Justin B. Cihon Joseph H. Leaf Ronald McEachin John Liu Nicholas Russell Noah Unumb Lorri Shapiro Sydney Khosrowshahi Dara 《Journal of autism and developmental disorders》2022,52(6):2838-2853
Journal of Autism and Developmental Disorders - For over 50 years, intervention methods informed by the principles of applied behavior analysis (ABA) have been empirically researched and... 相似文献
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David T. Takeuchi Hsu-Sung Kuo Kathleen Kim Philip J. Leaf 《Journal of community psychology》1989,17(4):319-329
Standardized instruments are often used to assess the need for mental health services in a community. Such instruments are usually standardized on Caucasian samples and are generally assumed to be appropriate for different ethnocultural minorities. However, this assumption may be in error because cultural groups vary in their expression, manifestation, and reporting of symptoms. This article analyzes the responses to a standardized instrument, the Symptom Checklist (SCL), for four ethnic groups in Hawai'i: Caucasians, Filipinos, Japanese, and Native Hawaiians. Factor analysis using a procrustes rotation was used to force the data to fit into the five hypothesized factors of the SCL (somatization, obsessive-compulsive, interpersonal sensitivity, depression, and anxiety). It showed that the scale item loadings generally did not correspond to the hypothesized factors. Among the ethnic groups, Caucasians appeared to have the best fit between the empirical and hypothesized factors whereas Native Hawaiians had the worst fit. Our results reinforce the importance of assessing established psychiatric symptom scales prior to their use on different ethnocultural minorities. 相似文献
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目的 探讨用改进的倒谱方法估计平均骨小梁间距(mean trabecular bone spacing,MTBS)的可行性.方法 提出了一种基于反向滤波器的改进的倒谱分析方法用于估计MTBS,并将该方法应用于仿真及离体牛胫骨松质骨中的实验信号.结果 改进的倒谱方法能有效减少超声换能器脉冲响应和组织散射特性对倒谱的干扰,而且实现简单,计算量小.结论 相比于传统的倒谱方法,改进的倒谱方法在估计MTBS时, 对弥散散射和噪声有更强的鲁棒性,因此估计MTBS的精度更高. 相似文献
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