RESUMO
OBJECTIVE: With the myriad of cases presented to clinicians every day at our integrated academic health system, clinical questions are bound to arise. Clinicians need to recognize these knowledge gaps and act on them. However, for many reasons, clinicians might not seek answers to these questions. Our goal was to investigate the rationale and process behind these unanswered clinical questions. Subsequently, we explored the use of biomedical information resources among specialists and primary care providers and identified ways to promote more informed clinical decision making. METHODS: We conducted a survey to assess how practitioners identify and respond to information gaps, their background knowledge of search tools and strategies, and their usage of and comfort level with technology. RESULTS: Most of the 292 respondents encountered clinical questions at least a few times per week. While the vast majority often or always pursued answers, time was the biggest barrier for not following through on questions. Most respondents did not have any formal training in searching databases, were unaware of many digital resources, and indicated a need for resources and services that could be provided at the point of care. CONCLUSIONS: While the reasons for unanswered clinical questions varied, thoughtful review of the responses suggested that a combination of educational strategies, embedded librarian services, and technology applications could help providers pursue answers to their clinical questions, enhance patient safety, and contribute to patient-based, self-directed learning.
Assuntos
Comportamento de Busca de Informação , Medicina , Médicos de Atenção Primária , Competência Clínica , Humanos , Internato e Residência/estatística & dados numéricos , Informática Médica , Medicina/estatística & dados numéricos , Médicos de Atenção Primária/psicologia , Médicos de Atenção Primária/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
Cranial dermoid cysts are rare, embryologic tumors containing fat, hair, and other ectodermal elements. They occur most frequently in the posterior fossa and are typically diagnosed as incidental findings on brain imaging done for an unrelated reason. Traumatic rupture of a previously unidentified intracranial dermoid cyst can mimic symptoms of post-concussion syndrome and should be ruled out with magnetic resonance imaging (MRI). Surgical intervention after traumatic rupture may not result in complete symptom control due to the persistence of dermoid cyst debris in the subarachnoid space. Here, we present the clinical scenario and radiological features of a ruptured dermoid cyst due to trauma, highlighting a rare complication of a classically benign lesion.
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BACKGROUND: Dysphagia is a common complication seen in acute ischemic stroke patients, and can lead to morbidity and mortality. As such, quality measures have been instituted to track adherence to dysphagia screening in all stroke patients. In our 217-bed community hospital, we were faced with a low rate in successfully screening for dysphagia. METHODS: Quality control interventions were implemented after an analysis of the reasons for dysphagia screening failures was performed. Interventions included online educational sessions for nurses, face-to-face sessions with medical residents, distribution of educational laminated cards, changing the method of documenting the dysphagia screen in our electronic record and others. RESULTS: There was an increase of rates of screening for dysphagia from 67% to 91%. CONCLUSION: We conclude that failure analysis, implementation of quality control measures to address the cause of failures and re-evaluating success rates periodically was effective to address this problem.
Assuntos
Isquemia Encefálica , Transtornos de Deglutição , Acidente Vascular Cerebral , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Hospitais Comunitários , Humanos , Programas de Rastreamento , Acidente Vascular Cerebral/complicaçõesRESUMO
Medication errors occur despite best intentions and are often the result of medication discrepancies. Medication reconciliation reduces the likelihood of errors by addressing medication discrepancies that result from multiple points of care, transitions in care, or patient report. Providers and practices may feel overwhelmed by new record systems and regulatory requirements, but multiple resources are available to assist providers to perform medication reconciliation with their patients. Providers and practices should implement medication reconciliation strategies, such as adoption of a multidisciplinary approach, engagement of patients to track medications, and identification of patients who are at high risk for medication list discrepancies and errors. Medication reconciliation will ultimately improve quality of care.
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Erros de Medicação/prevenção & controle , Reconciliação de Medicamentos/métodos , Recursos em Saúde , HumanosRESUMO
Patient registries are a resource to better study neurologic disease and may facilitate the development of future treatments. Clinicians should become comfortable with the strengths and limitations of patient registries and be able to discuss them with their patients. This article discusses the use of patient registries through the example of registries for patients with neuromuscular disease.
Assuntos
Miastenia Gravis/diagnóstico , Miastenia Gravis/tratamento farmacológico , Sistema de Registros , Idoso , Inibidores da Colinesterase/uso terapêutico , Feminino , Humanos , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/tratamento farmacológico , Brometo de Piridostigmina/uso terapêuticoRESUMO
Providers are expressing a desire for more efficient ways to retrieve relevant clinical data from the Electronic Health Record. In an effort to improve our Electromyography and Nerve Conduction Study reports, we surveyed referring providers on the effects of having the IMPRESSION at the start of the report. Our survey respondents felt that using this format for an Electromyography and Nerve Conduction Study report significantly improved the quality of the report while saving them time and/or mouse clicks when interpreting the report. Electro diagnosticians might consider using this format for their Electromyography and Nerve Conduction Study reports to improve referring provider satisfaction.
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Doenças do Sistema Nervoso/terapia , Neurologia/normas , Avaliação de Resultados em Cuidados de Saúde/normas , Melhoria de Qualidade/normas , Humanos , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/psicologia , Neurologia/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Relações Médico-Paciente , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade de Vida/psicologiaAssuntos
Encefalopatias/patologia , Encefalopatias/fisiopatologia , Calcinose/patologia , Calcinose/fisiopatologia , Transtorno Bipolar/complicações , Encefalopatias/complicações , Calcinose/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Tomografia Computadorizada por Raios XRESUMO
In an effort to represent transgender patients more adequately in our electronic health record, we convened a multidisciplinary team to customize a new electronic Social History module based on our vendor's design. This Social History module will better serve our transgender patients and their health care providers.
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Registros Eletrônicos de Saúde/normas , Pessoas Transgênero , Registros Eletrônicos de Saúde/organização & administração , Feminino , Identidade de Gênero , Humanos , Masculino , Anamnese/normasAssuntos
Neuro-Otologia/normas , Melhoria de Qualidade , Doenças Vestibulares/terapia , Feminino , Humanos , Masculino , Neurologia/normas , Neurologia/tendências , Neuro-Otologia/tendências , Segurança do Paciente , Medição de Risco , Sociedades Médicas , Resultado do Tratamento , Doenças Vestibulares/diagnóstico , Neuronite Vestibular/diagnóstico , Neuronite Vestibular/terapiaRESUMO
This article describes a patient with a painful diabetic peripheral neuropathy. Features of his history, examination, and diagnostic workup are presented. His treatment course is described as guided by the AAN's evidence-based guideline on the treatment of painful diabetic neuropathy. Lastly, features of coding for diabetic peripheral neuropathy are reviewed.
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Analgésicos/uso terapêutico , Neuropatias Diabéticas/tratamento farmacológico , Guias de Prática Clínica como Assunto , Amitriptilina/uso terapêutico , Codificação Clínica , Neuropatias Diabéticas/classificação , Neuropatias Diabéticas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pregabalina , Ácido gama-Aminobutírico/análogos & derivados , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. This article describes the presentation and physical examination of a patient with BPPV. The case is then used to explore various features of the diagnosis, examination, and management of BPPV, with a focus on the 2008 AAN practice parameter on therapies for BPPV.
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Vertigem/terapia , Vertigem Posicional Paroxística Benigna , Feminino , Humanos , Pessoa de Meia-Idade , Exame Físico/métodos , Guias de Prática Clínica como Assunto , Vertigem/diagnósticoAssuntos
Neurologia/normas , Melhoria de Qualidade/normas , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral , Humanos , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/normas , Acidente Vascular Cerebral/epidemiologiaAssuntos
Dieta Livre de Glúten/efeitos adversos , Polineuropatias/etiologia , Células Receptoras Sensoriais/fisiologia , Deficiência de Tiamina/etiologia , Adulto , Eletrodiagnóstico , Feminino , Humanos , Condução Nervosa/fisiologia , Polineuropatias/fisiopatologia , Deficiência de Tiamina/fisiopatologiaRESUMO
INTRODUCTION: Saphenous mononeuropathy has been a well recognized consequence of lower extremity surgery. However, this complication has not been previously described with popliteal vein aneurysm repair. CASE PRESENTATION: We report the case of a 42-year-old woman with a saphenous mononeuropathy after popliteal vein aneurysm repair. Her saphenous neuropathy was confirmed by nerve conduction studies. Her case gives us an opportunity to review saphenous mononeuropathy and its many different etiologies. We also review the role of electrodiagnostic studies in the diagnosis of saphenous mononeuropathy. CONCLUSIONS: Though this particular iatrogenic injury has not previously been described, both neurologists and surgeons should be aware of this complication following popliteal vein aneurysm resection with saphenous vein interposition.
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Aneurisma/cirurgia , Mononeuropatias/diagnóstico , Mononeuropatias/etiologia , Veia Poplítea/cirurgia , Complicações Pós-Operatórias , Adulto , Eletrodiagnóstico , Feminino , Humanos , Mononeuropatias/fisiopatologia , Condução NervosaRESUMO
A term female infant was evaluated for global developmental delay, hypotonia, hyporeflexia, diffuse weakness including facial muscles, and visual impairment with optic nerve hypoplasia. In the absence of family history or perinatal concerns, an extensive investigation was performed, including lab studies, muscle biopsy, brain MRI and focused genetic testing. This revealed elevated serum CK, a structurally abnormal brain, and a dystrophic-appearing muscle biopsy with evidence of a glycosylation defect in the alpha-dystroglycan complex. Of the 6 known related genes, testing of the POMGnT1 gene showed three heterozygous missense mutations. Thus her history, examination, biopsy specimen, imaging, laboratory, and genetic studies are all consistent with the diagnosis of Muscle-Eye-Brain (MEB) disease. MEB is one of an emerging spectrum of congenital disorders that involve both central and peripheral nervous systems, described further in this case report.