Health Care Utilization and Pain Outcomes Following Early Imaging for Low Back Pain in Older Adults.

Background: Professional societies have provided inconsistent guidance regarding whether older patients should receive early imaging for low back pain, in the absence of clinical indications. The study assesses the implications of early imaging by evaluating its association with downstream utilization in an elderly population.

Methods: Patients were included if they had a Medicare Advantage plan, had claims-based evidence of low back pain in 2014, and lacked conditions justifying early imaging.

A Bold Goal: More Healthy Days Through Improved Community Health.

Humana, a large health care company, has set a goal of 20% improvement in health in the communities it serves by 2020. The metric chosen for the Bold Goal initiative was the HRQOL-4 version of the Centers for Disease Control and Prevention (CDC) Healthy Days survey. This paper presents the methods for measuring progress, reports results for the first year of tracking, and describes Humana's community-based interventions.

Proficiency in identifying, managing and communicating medical errors: feasibility and validity study assessing two core competencies.

Background: Communication skills and professionalism are two competencies in graduate medical education that are challenging to evaluate. We aimed to develop, test and validate a de novo instrument to evaluate these two competencies.

Methods: Using an Objective Standardized Clinical Examination (OSCE) based on a medication error scenario, we developed an assessment instrument that focuses on distinctive domains [context of discussion, communication and detection of error, management of error, empathy, use of electronic medical record (EMR) and electronic medical information resources (EMIR), and global rating].

Nonrevascularization-based treatments in patients with severe or critical limb ischemia.

Objective: The aim of this systematic review was to synthesize the existing evidence about various nonrevascularization-based therapies used to treat patients with severe or critical limb ischemia (CLI) who are not candidates for surgical revascularization.

Methods: We systematically searched multiple databases through November 2014 for controlled randomized and nonrandomized studies comparing the effect of medical therapies (prostaglandin E1 and angiogenic growth factors) and devices (pumps and spinal cord stimulators). We report odds ratios (ORs) and 95% confidence intervals (CIs) of the outcomes of interest pooling data across studies using the random effects model.

The natural history of untreated severe or critical limb ischemia.

Objective: Critical limb ischemia (CLI) is associated with high morbidity and mortality. Because most patients with CLI will eventually undergo some type of revascularization, the natural history of CLI is not well defined, although it is important to know when patients decide to pursue treatment.

Methods: We systematically searched multiple databases for controlled and uncontrolled studies of patients with CLI who did not receive revascularization with a minimum follow-up of ≥1 year.

Bypass surgery versus endovascular interventions in severe or critical limb ischemia.

Objective: Critical limb ischemia is associated with a significant morbidity and mortality. We systematically reviewed the evidence to compare bypass surgery with endovascular revascularization in patients with critical limb ischemia.

Methods: We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus through October 2014 for comparative studies (randomized and nonrandomized).

Teaching quality improvement in occupational medicine: improving the efficiency of medical evaluation for commercial drivers.

Objective: To describe a successful, resident-led quality improvement (QI) project that improved the efficiency of the Department of Transportation (DOT) medical examination process.

Methods: After learning QI principles through didactics, workshops, and online modules, residents led a QI project to streamline the process of the DOT examination. An interdisciplinary group of key stakeholders collaborated to analyze the process and to design and implement interventions.

Improving sleep: outcomes from a worksite healthy sleep program.

Objective: Unhealthy and inadequate sleep is a common and significant problem impacting absenteeism, presenteeism, health, and productivity. This study aimed at analyzing the effect of a worksite-based healthy sleep program.

Methods: Retrospective analysis of 53 adult members of a worksite wellness center who participated in an 8-week healthy sleep program and completed pre- and postintervention health behavior questionnaires.

Effect of exercise on anthropometric measures and serum lipids in older individuals: a systematic review and meta-analysis.

Objectives: Overweight and obesity are increasing in individuals over age 60 years. This systematic review quantifies the effect of exercise on body mass index (BMI), waist circumference (WC) and lipids in overweight and obese individuals over the age of 60 years.

Settings: Nine randomised controlled trials conducted in Brazil, Great Britain, Iceland, Japan and the USA compared aerobic and/or resistance exercise with a control group.

The association of 9p21-3 locus with coronary atherosclerosis: a systematic review and meta-analysis.

Background: Studies suggest that the 9p21-3 locus may influence susceptibility to myocardial infarction. We performed a systematic review and meta-analysis to assess whether this locus is associated with severity of coronary atherosclerosis and adverse clinical outcomes in those with known coronary disease.

Methods: Multiple electronic databases were searched from inception through August 2012.

Self-report of tobacco use status: comparison of paper-based questionnaire, online questionnaire, and direct face-to-face interview--implications for meaningful use.

Identifying tobacco use status is essential to address use and provide resources to help patients quit. Being able to collect this information in an electronic format will become increasingly important, as the Centers for Medicare and Medicaid Services has included the assessment of tobacco use as part of its Stage 1 Meaningful Use criteria. The objective was to compare the accuracy of online vs.

Improving patient-centered care: agenda-setting in occupational medicine.

Objective: To improve patient satisfaction with care at an occupational medicine clinic by promoting agenda-setting before the visit.

Methods: We distributed agenda-setting form to 77 randomly selected patients attending an occupational health clinic and used another randomly selected sample of 36 patients as control group. Patients completed a survey regarding the acceptability of this procedure and whether they felt clinicians addressed their important concerns.

The effect of coffee consumption on blood pressure and the development of hypertension: a systematic review and meta-analysis.

Context: Coffee is one of the most widely consumed beverages worldwide and is known to acutely raise blood pressure (BP), but the effects of chronic consumption on BP is unclear.

Objectives: To conduct a systematic review and meta-analysis of available randomized controlled trials (RCTs) and cohort studies to assess the effect of chronic coffee consumption on BP and the development of hypertension.

Data Sources: Ovid, MEDLINE (from 1948), EMBASE (from 1988), and all of Web of Science and Scopus.

Improving the efficiency of patient throughput via centralized inpatient scheduling.

Advocate Illinois Masonic Medical Center implemented a centralized scheduling system in order to increase efficiency and throughput, improve customer satisfaction, improve communication between departments,and create a single schedule (IP/ED/OP) per modality. Most resistance for the change came from technologists, so a formal design team was established for each modality, which included a core information systems (IS) team member,the lead technologist of the modality, and the technologist most able to influence the other technologists who might be resistant to change. Overall,throughput increased by 3.