Introducing antimicrobial stewardship to the outpatient clinics of a suburban academic health system.

Objective: To establish an antimicrobial stewardship program in the outpatient setting.

Design: Prescribers of antimicrobials were asked to complete a survey regarding antimicrobial stewardship. We also monitored their compliance with appropriate prescribing practices, which were shared in monthly quality improvement reports.

Moral Elevation, Physician Role Models, and Selected Markers of Professional Identity Formation and Well-Being: A Secondary Analysis from Two National Surveys.

Objectives: Moral elevation is the underlying emotion that arises when witnessing admirable acts, and it is theorized to be the psychological mechanism driving the impact that positive clinical role models have on medical students' professional identity formation (eg, growth in professional virtues, higher sense of meaning, and well-being). This proof-of-concept study explores the development of the Moral Elevation Scale in Medicine by testing the association of moral elevation with various markers of professional identity formation.

Methods: A secondary data analysis of two nationally representative samples of 960 medical students and 2000 physicians was performed.

A Rare Case of Monomicrobial Necrotizing Fasciitis Associated With an Initial Acute Compartment Syndrome.

In this article we report a rare case of necrotizing fasciitis presenting with the possible initial symptom of compartment syndrome. After treatment with broad spectrum and targeted antibiotics in addition to multiple fasciotomies, surgical debridement, and grafts the patient went on to uneventful healing within 6 months. This case report highlights the possibility of a compartment syndrome as the only initial symptom of a monomicrobial necrotizing soft tissue infection.

Moral Controversy and Working with Colleagues with a Shared Ethical/Moral Outlook: A National Survey of US Primary Care Physicians.

Objectives: This study assesses physicians' attitudes on the importance of working with colleagues who share the same ethical or moral outlook regarding morally controversial healthcare practices and examines the association of physicians' religious and spiritual characteristics with these attitudes.

Methods: We conducted a secondary data analysis of a 2009 national survey that was administered to a stratified random sample of 1504 US primary care physicians (PCPs). In that dataset, physicians were asked: "For you personally, how important is it to work with colleagues who share your ethical/moral outlook regarding morally controversial health care practices?" We examined associations between physicians' religious/spiritual characteristics and their attitudes toward having a shared ethical/moral outlook with colleagues.

The Chinatown Patient Navigation Program: Adaptation and Implementation of Breast and Cervical Cancer Patient Navigation in Chicago's Chinatown.

Background: As health care reform continues within the United States, navigators may play increasingly diverse and vital roles across the health care continuum. The growing interest in patient navigation programs for underserved populations calls for detailed descriptions of intervention components to facilitate implementation and dissemination efforts.

Methods: In Chicago's Chinatown, Chinese immigrant women face language, cultural, and access barriers in obtaining breast and cervical cancer screening and follow-up.

'There's nothing you can do … it's like that in Chinatown': Chinese immigrant women's perceptions of experiences in Chicago Chinatown healthcare settings.

Chinese American women living in linguistically isolated communities are among the least likely to utilize healthcare services. Qualitative research methods can help identify health system vulnerability points to improve local healthcare delivery for this population. We conducted 6 focus groups among 56 Chinese-speaking adult women in Chicago's Chinatown between July and August 2014 to explore their perceptions of experiences receiving medical care and interacting with healthcare providers in Chinatown healthcare settings.

Physicians' Religious Characteristics and Their Perceptions of the Psychological Impact of Patient Prayer and Beliefs at the End of Life: A National Survey.

Background:: Physicians who are more religious or spiritual may report more positive perceptions regarding the link between religious beliefs/practices and patients' psychological well-being.

Methods:: We conducted a secondary data analysis of a 2010 national survey of US physicians from various specialties (n = 1156). Respondents answered whether the following patient behaviors had a positive or negative effect on the psychological well-being of patients at the end of life: (1) praying frequently, (2) believing in divine judgment, and (3) expecting a miraculous healing.

Characteristics of Medical Students with Physician Relatives: A National Study.

This article was migrated. The article was marked as recommended. Background Little is known regarding U.

Premature Ventricular Contractions Producing Brockenbrough-Braunwald Sign in Obstructive Cardiomyopathy.

Increased dynamic flow in hypertrophic obstructive cardiomyopathy depicts a classic sign on invasive pressure tracings of the aorta and left ventricle, simultaneously known as the Brockenbrough-Braunwald sign, which is demonstrated in the presented case.

Courage and Compassion: Virtues in Caring for So-Called "Difficult" Patients.

What, if anything, can medical ethics offer to assist in the care of the "difficult" patient? We begin with a discussion of virtue theory and its application to medical ethics. We conceptualize the "difficult" patient as an example of a "moral stress test" that especially challenges the physician's character, requiring the good physician to display the virtues of courage and compassion. We then consider two clinical vignettes to flesh out how these virtues might come into play in the care of "difficult" patients, and we conclude with a brief proposal for how medical educators might cultivate these essential character traits in physicians-in-training.

Mild Visual Impairment and Its Impact on Self-Care Among Older Adults.

Objective: To determine the prevalence of mild visual impairment (MVI) among urban older adults in primary care settings, and ascertain whether MVI was a risk factor for inadequate performance on self-care health tasks.

Method: We used data from a cohort of 900 older adults recruited from primary care clinics. Self-management skills were assessed using the Comprehensive Health Activities Scale, and vision with corrective lenses was assessed with the Snellen.

Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE.

Prior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction.

Assessing Implicit Cognition Among Patients Lost to Follow-up for HIV Care: A Preliminary Study.

Objective: While a growing body of research indicates that implicit cognitive processes play an important role in a range of health behaviors, the assessment of these impulsive, associative mental processes among patients living with HIV has received little attention. This preliminary study explored how multidimensional scaling (MDS) could be used to assess implicit cognitive processes among patients lost to follow-up for HIV care and develop interventions to improve their engagement.

Method: The sample consisted of 33 patients who were identified as lost to follow up for HIV care at two urban hospitals.

The association of elevated trough serum vancomycin concentrations with obesity.

Background: Obese patients display differences in vancomycin drug disposition, which may complicate attainment of appropriate serum vancomycin concentrations (SVCs). This study was conducted to determine if obesity leads to trough SVCs above the therapeutic range.

Methods: This retrospective cohort study sought to determine the rate and predictors of high (i.

Developing nurse practitioner associated metrics for outcomes assessment.

As nurse practitioners (NPs) assume an increasing role in providing care to hospitalized patients, measuring the impact of their care on patient outcomes and quality of care measures becomes a necessary component of performance evaluation. Developing metrics that relate to quality of care measures as well as patient outcomes based on the specific practices of an NP can help to specifically identify the impact of NP care in hospital and ambulatory care settings. New opportunities have arisen for highlighting NP outcomes that can be used to structure NP-associated metrics including the Hospital Value-Based Purchasing Program and the Joint Commission's practice evaluation standards.

Stroke management: beginnings.

This article outlines the evolution of a stroke program at one large midwestern tertiary care hospital. Implementation of unit-based care coordination, a standard order set, a clinical pathway, a nurse case manager, and ongoing multidisciplinary review were some of the strategies used to demonstrate improvement in outcome measures. Improvements were documented, including computed tomography (CT) scans being performed more quickly when patients arrived at the Emergency Department, decreased costs, decreased readmission rates, and reduced length of stay.

Creating an outcomes framework.

Four constructs used to build a framework for outcomes management for a large midwestern tertiary hospital are described in this article. A system framework outlining a model of clinical integration and population management based in Steven Shortell's work is discussed. This framework includes key definitions of high-risk patients, target groups, populations and community.

Liquid-based cervical-cell collection with brushes and wooden spatulas: a comparison of 100 conventional smears from high-risk women to liquid-fixed cytocentrifuge slides, demonstrating a cost-effective, alternative monolayer slide preparation method.

Our purpose was to demonstrate that 17.5-mm liquid-based cytocentrifuge circle-slides made using a Hettich (Andreas Hettich Co., Tuttlingen, Germany) cytocentrifuge are at least as efficacious as conventional smears for detecting cervical abnormalities.

Endocervical cell collection using cytobrush, liquid-fixation, and cytocentrifugation: A feasibility study using 455 hysterectomy specimens.

Differential uterine curettage may be performed for the evaluation of abnormal uterine bleeding. The purpose of this study was to test the feasibility of substituting cytological methods for differential uterine curettage to evaluate the entire glandular axis of the uterus and the transformation zone. In order to simulate differential uterine sampling, the endocervix was brushed in 455 uteri from which an endometrial cytology sample had been previously collected.