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Evaluation of a pharmacist-led intervention to improve statin use in persons with diabetes
No full textBACKGROUND: The Statin Use in Persons with Diabetes (SUPD) measure, developed and endorsed by the Pharmacy Quality Alliance and National Quality Forum, has been adopted by the Centers for Medicare & Medicaid Services as part of the star rating measure set. It was added as a display measure in 2015 and, as of 2019, has become a star measure. Clinical pharmacy specialists (CPS) embedded in the patient-centered medical home (PCMH) are well positioned to review and recommend statin therapy for patients with diabetes in order to improve patient care and health plan performance. OBJECTIVE: To improve rates of statin prescribing and performance on the SUPD measure in the Denver Health Medical Plan (DHMP) population with diabetes by creating a CPS-led intervention to initiate statin prescriptions in eligible patients. METHODS: Between February 1, 2018, and December 31, 2018, DHMP patients who met SUPD measure criteria (aged ≥40 and ≤75 years, dispensing events for at least 2 diabetes mellitus medication fills, and no statin prescribed) were identified by the health plan chart review and contacted by CPS as appropriate. For patients eligible and agreeable to statin therapy, the CPS initiated the statin prescription. Descriptive statistics were used to summarize outreach and statin prescribing data. Prescription drug event data were also collected from the health plan to verify SUPD measure performance. RESULTS: At the start of 2018, DHMP\u27s performance on the SUPD measure was 65.7% (Medicare Advantage Part D national average was 68.5%). Of the 326 patients whose charts were reviewed and who were contacted, 275 (84.4%) were eligible for statin initiation, and of these, 115 (41.8%) were prescribed statin therapy. The increase in statin prescribing and dispensing increased DHMP\u27s performance on the SUPD measure to 87.1% at the end of 2018, which correlates with a 5-star rating based on the 2019 cut points. CONCLUSIONS: CPS embedded in the PCMH setting are well positioned to participate in and positively affect population health initiatives such as the SUPD measure. Appropriate prescribing of statin therapy by CPS for patients included in the SUPD measure ensures that they are on key medication therapy for mitigating atherosclerotic cardiovascular disease and may improve a health plan\u27s Medicare star rating
Effects of Adding a Neurodynamic Mobilization to Motor Control Training in Patients with Lumbar Radiculopathy Due to Disc Herniation: A Randomized Clinical Trial
No full textObjective The aim of the study was to investigate the effects of the inclusion of neural mobilization into a motor control exercise program on pain, related disability, neuropathic symptoms, straight leg raise, and pressure pain threshold in lumbar radiculopathy. Design This is a randomized clinical trial. Methods Individuals with low back pain, with confirmed disc herniation, and lumbar radiculopathy were randomly assigned to receive eight sessions of either neurodynamic mobilization plus motor control exercises (n = 16) or motor control exercises alone (n = 16). Outcomes included pain, disability, neuropathic symptoms, straight leg raise, and pressure pain threshold at baseline, after four visits, after eight visits, and after 2 mos. Results There were no between-groups differences for pain, related disability, or pressure pain threshold at any follow-up period because both groups get similar and large improvements. Patients assigned to the neurodynamic program group experienced better improvements in neuropathic symptoms and the straight leg raise compared with the motor control exercise group (P \u3c 0.01). Conclusions The addition of neurodynamic mobilization to a motor control exercise program leads to reductions in neuropathic symptoms and mechanical sensitivity (straight leg raise) but did not result in greater changes of pain, related disability, or pressure pain threshold over motor control exercises program alone in subjects with lumbar radiculopathy. Future trials are needed to further confirm these findings because between-groups differences did not reach clinically relevance
A Trust Model for Cloud: Results from a Survey
No full textThis research proposes a cloud consumer trust model that focuses on decision making and the value of our data. The value consumers place on data plays a critical role in how consumers trust. The research was validated with a questionnaire and statistical power analysis. Few cloud trust models appear to be validated against real world data, and none, that we found, accomplish an a-priori statistical power analysis. Results indicated consumers were interested in data location, third party access and most surprisingly unbiased/expert organization recommendations were more important than family and friends recommendations
Ethics in analytics and social media
No full textIn Data Sciences and Computing, bias, conscious or subconscious, can be introduced in a variety of ways. The need for ethics is essential as bias can be found in the data collection phase of big data, analysis phase, and insight phase. Bias can also be found in the outcome phase, assessment phase and improvement phase., Analysts must be aware of possible bias to prevent it in their analysis. With the introduction of social computing, bias, today considered “fake news”, must also be considered. Bias can be a big issue with sites like Facebook, Twitter and even the news media. It has been found that our young, particularly college students, can easily be swayed by social media information, including information that is ultimately proven incorrect. This can be dangerous to society. We have seen countries, for example, China, Saudi Arabia among others blocking social media sites
Peripheral Intravenous Education for Nurses
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Title: Peripheral Intravenous Education for Nurses
Problem: Nurses are entering the field with little to no experience with peripheral intravenous (PIV) insertions and lack the requisite confidence and skill level needed to insert and maintain PIV lines. This greatly impacts patient satisfaction and the ability to provide care in a timely manner. The vascular access team (VAT) is also inundated with calls for PIV insertions and this prevents the team from being able to focus on central line insertions, care, and maintenance.
Purpose: The purpose of this project was to provide education and mentoring to new nurses with 0-5 years of experience that focused on insertion techniques as well as care and maintenance of peripheral intravenous lines.
Goal: The success of this project would show that education and mentoring can help improve nursing confidence and skill level with PIV insertion, increase first attempt success rate, and ultimately affect patient satisfaction. Although patient satisfaction is not a data point that is tracked in this study, it is a dependent variable that can be affected downstream.
Objective: Improve nurse-reported self-efficacy and skill level with PIV placement and care and to reduce the number of calls to the VAT for PIV access by 10%.
Plan: Provide a one-hour educational offering to all nurses, on an acute care inpatient unit, with 0-5 years nursing experience. A pre-intervention survey was completed by all participants prior to the class and a post intervention survey was completed immediately following the class and again at on month post intervention. VAT calls data was also evaluated for one month pre-intervention, the month during the intervention, and one month post intervention.
Outcomes/Results: There was a statistically significant change in the mean scores from the pre-aggregate data to the first post-aggregate survey data. With a p-value of 0.003 and a positive shift in the mean scores, the intervention was effective, and the nurse-reported self-efficacy improved. There was also a statistically significant change from the post-aggregate 1 survey data to the post-aggregate 2 survey data. With a p-value of 0.012 and a negative shift in the mean scores, although the intervention was successful, the knowledge was not retained. There was also a 10.5% decrease in calls to the VAT in the one-month post-intervention
The Role of Practice-Based Evidence and Feedback Informed Treatment for Improving Therapy Outcomes
Get PDFAttrition rates and deterioration of counselling and psychotherapy clients are two major concerns for those delivering psychological therapies across differential modalities. While a variety of correlations are said to contribute to attrition and deterioration such as, client, therapist and clinical level, identifying and improving outcomes for this cohort of people in routine practice is difficult. Even with the addition of hundreds of empirically supported treatments added to the profession, outcomes have not improved in line with these new approaches. Methods to limit the extent of poor outcomes has been established in the extent literature, thus, practice-based evidence is put forward focusing on Feedback Informed Treatment (FIT
Lumbar intervertebral kinematics during an unstable sitting task and its association with standing-induced low back pain
No full textPeople developing transient low back pain during standing have altered control of their spine and hips during standing tasks, but the transfer of these responses to other tasks has not been assessed. This study used video fluoroscopy to assess lumbar spine intervertebral kinematics of people who do and do not develop standing-induced low back pain during a seated chair-tilting task. A total of 9 females and 8 males were categorized as pain developers (5 females and 3 males) or nonpain developers (4 females and 5 males) using a 2-hour standing exposure; pain developers reported transient low back pain and nonpain developers did not. Participants were imaged with sagittal plane fluoroscopy at 25 Hz while cyclically tilting their pelvises anteriorly and posteriorly on an unstable chair. Intervertebral angles, relative contributions, and anterior-posterior translations were measured for the L3/L4, L4/L5, and L5/S1 joints and compared between sexes, pain groups, joints, and tilting directions. Female pain developers experienced more extension in their L5/S1 joints in both tilting directions compared with female nonpain developers, a finding not present in males. The specificity in intervertebral kinematics to sex-pain group combinations suggests that these subgroups of pain developers and nonpain developers may implement different control strategies
“Over-the-counter” cannabidiol (CBD) sold in the community pharmacy setting in Colorado
No full textIntroduction: The use of cannabidiol is becoming so popular that even pharmacies now carry over-the-counter (OTC) cannabidiol products in Colorado, USA. Objective: The primary goal of this study was to evaluate cannabidiol products sold in the community pharmacy setting to determine the content of cannabidiol and other active ingredients and the safety information that may be provided to individuals considering the use of these products. Methods: Documentation of cannabidiol products available for purchase in pharmacies was compiled by visiting chain and independent pharmacies within the state of Colorado. Cannabidiol products were documented for claims of use, dose, route, administration, additional ingredients, and cost. Results: In total, 60 cannabidiol products (15 oral, 44 topical, and one transdermal) were found in 35 pharmacies. The concentrations of oral cannabidiol varied from 10 to 60 mg/mL. In total, 13 (87%) of the oral products were labeled as “full spectrum.” Six (40%) of the oral cannabidiol products listed medium-chain triglycerides, a compound with evidence of increasing oral bioavailability. The amount of cannabidiol labeled on topical products varied from 30 mg cannabidiol/15 mL to 1000 mg cannabidiol. Some products did not indicate any quantity of cannabidiol or did provide the amount of hemp extract/oil but did not specify how much cannabidiol was present. In total, 29 (66%) of the topical products contained additional active ingredients: arnica, camphor, capsaicin, menthol, peppermint oil, white willow bark (salicylic acid), tea tree oil, and trolamine salicylate. Only one type of transdermal product for cannabidiol delivery was found, which provided a dose of 20 mg cannabidiol/24 h. Conclusion: The findings of this study illustrate the extensive variability of cannabidiol products and the importance of communication with people considering their use. Counseling those utilizing these products may help to avoid drug–drug or drug–supplement interactions and adverse events
To google or not: Differences on how online searches predict names and faces
No full textWord and face recognition are processes of interest for a large number of fields, including both clinical psychology and computer calculations. The research examined here aims to evaluate the role of an online frequency’s ability to predict both face and word recognition by examining the stability of these processes in a given amount of time. The study will further examine the differences between traditional theories and current contextual frequency approaches. Reaction times were recorded through both a logarithmic transformation and through a Bayesian approach. The Bayes factor notation was employed as an additional test to support the evidence provided by the data. Although differences between face and name recognition were found, the results suggest that latencies for both face and name recognition are stable for a period of six months and online news frequencies better predict reaction time for both classical frequentist analyses. These findings support the use of the contextual diversity approach
Normative values of cervical range of motion for both children and adults: A systematic review
No full textStudy design: Systematic review. Objective: To synthesize studies reporting normative values of active cervical range of motion (ROM) in healthy children and adults. Summary of background data: Evaluating active cervical ROM is part of routine assessment of patients with neck pain. Interpretation of outcomes necessitates having normative data per age category. Currently available normative values differ across studies, perhaps due to (the measurement properties of) the devices used. Methods: A systematic review according to PRISMA guidelines was conducted. Electronic searches included EMBASE, MEDLINE, Web of Science, Cochrane, CINAHL and Google Scholar databases from inception to August 2018. Included studies had to involve healthy subjects in which active cervical ROM was assessed or when determining normative values was the aim of the study. Methodological quality of the included studies was assessed using an adapted version of the QUADAS. A mean value was re-calculated for the total group in case data were presented per gender per age-category only. When possible, data were pooled. Results: From 2151 unique hits, 217 articles were selected for full text assessment, after which 162 articles were excluded. Data were extracted from 55 articles using 16 different measurement devices. Twenty-five studies were rated as being of “low risk of bias”. Only data from studies evaluating the CROM device and Zebris could be pooled. Conclusions: This systematic review revealed that although a large number of studies assessed normative data for active cervical ROM, the methodological quality of most studies was low and the heterogeneity between studies was high. Only the normative data for active cervical ROM using the CROM device seems to be useful. Overall, reference values for measuring active cervical ROM is unclear for most measurement devices. Normative values of cervical range of motion for both children and adults: a systematic review