Referrals, etiology, prevalence, symptoms, and treatments of chronic cough: A survey of allergy specialists.

BACKGROUND: Chronic cough (CC) affects 11% of the US adult population, and these patients experience persistent symptoms despite adherence to recommended treatment protocols. Further research is needed to identify effective therapies to treat CC. OBJECTIVE: To describe the referral sources, etiology, prevalence, symptoms, and treatments for patients diagnosed with having CC who present to allergy specialists (AS). METHODS: An online survey was administered to 177 AS. The survey queried each AS experience with patients with CC, including the prevalence of CC, source of referrals for patients with CC, and perceived efficacy of treatments. RESULTS: A total of 103 (58%) AS reported that the patients with CC they treated were primarily of female sex (58.26%) and White (65.69%). Family physicians, nurse practitioners, physician assistants, and primary care internists were the most common source of referrals of patients with CC to AS. Furthermore, 20% of the respondents reported a complete resolution of the symptoms for more than 75% of their patients with CC. The top 4 "very common complaints" reported by the patients with CC were social embarrassment, loss of sleep, decreased quality of life, and sleep disruption. The top 4 most frequent treatments prescribed for CC were antireflux treatments, inhaled corticosteroids alone or in combination with long-acting ß-agonist, short-acting bronchodilators, and first-generation antihistamines. None of the therapies were rated "very effective" in greater than 50% of the patients with CC. CONCLUSION: The available treatments for CC do not effectively resolve the symptoms of this condition, and additional treatments need to be developed.

Attaining Quality Matters Certification for a Registered Nurse-Bachelor of Science in Nursing Program.

Increased demand for nurses and improved technology have increased the development and popularity of online education programs over the past two decades; however, the online format has revealed numerous pedagogical and implementation challenges. One primary challenge is the lack of structural design standards across all courses in the program. The lack of standardization is linked to decreased student outcomes, satisfaction, and retention. The Quality Matters course design rubric and program certification provide a methodical process to standardize the format of all courses in an online education program. The Quality Matters course rubric is designed to increase student and faculty engagement and reduce variability in course design. At the current university, the application of Quality Matters processes and standards was first trialed with a few individual courses. Following the trial, faculty and administration decided to begin the process of seeking Quality Matters certification for the entire registered nurse-bachelor of science in nursing program. This article describes the process of attaining Quality Matters program certification for an online registered nurse-bachelor of science in nursing program. The nursing process and the Human Performance Technology evaluation model were used as appraisal frameworks guiding this program's QM certification process.

The effect of gender on transformational leadership and job satisfaction among Saudi nurses.

AIM: To compare nurses' job satisfaction and perceptions of transformational leadership style of their manager among four different nurse/manager gender dyads in Saudi Arabia. BACKGROUND: Women and men differ on many behavioural characteristics and are influenced by the cultural environment. Understanding these differences may have an impact on leadership behaviours and job satisfaction. DESIGN: A descriptive analysis of one-time survey data collected in 2011 from Saudi nurses employed in six general public hospitals located in three cities. METHOD: Three hundred and eight (51.3%) of 600 Saudi nurses solicited to participate completed anonymous questionnaires that measured their job satisfaction and perceptions of transformational leadership style of their manager. FINDINGS: Factorial ANOVA tested the main effects of gender of the nurse, gender of the manager and the interaction term on the nurse's job satisfaction, and perceived transformational leadership style of their manager. These analyses indicated a main effect of gender of the manager on both job satisfaction and perceived transformational leadership style of the manager (p < .05) with no significant effect of the gender of the nurse or the interaction term on these variables. Post hoc analysis indicated that nurses regardless of their gender reported higher job satisfaction and perceived transformational leadership style of their manager when their manager was male. CONCLUSION: These findings contrast with what other researchers have reported that nurse job satisfaction and perceived leadership characteristics of their manager are independent of the gender of the manager. These perceptions of Saudi nurses may be a result of "sex-role spillover" in a male-dominated, gender-segregated society.

Prehabilitation influences exercise-related psychological constructs such as self-efficacy and outcome expectations to exercise.

Osteoarthritis (OA) is a clinical condition affecting more than 27 million Americans. There is no known cure for OA other than replacing the diseased joint with a joint prosthesis, a process called total knee arthroplasty (TKA). The TKA projections for the year 2016 are 1,046,000, and this number is predicted to increase by 600% to more than 3.4 million cases by 2030. The purpose of this study was to determine whether knee OA patients who engage in guided exercise (prehabilitation) before their TKA report higher levels of self-efficacy to exercise (SEE) and higher outcome expectations for exercise (OEE) than those who do not. Thirty-one participants were randomized into 2 groups (16 in prehabilitation group [PRE] and 15 in control group [CON]), all participants completed the protocol (22 women and 9 men). The PRE group participated in an exercise intervention (prehabilitation) 3 times per week for 8 weeks before TKA. One-way repeated measures analysis of variance was used to investigate the effects of group (PRE vs. CON), time (baseline T1, T2, T3, and T4), and the interaction of group and time on the dependent variables of SEE and OEE. This analysis indicated that SEE did not change over time (p = 0.62) or between the groups (p = 0.86). The analysis of the OEE indicated a significant time effect (p = 0.008). Post hoc analysis indicated that the CON group significantly declined between T2 and T4. The PRE group did not significantly change their OEE over the 4 data collection points of the study.

In Vitro and In Vivo Testing of Microbe Growth on Antimicrobial Nursing Scrubs.

Around 5% to 10% of hospitalized patients develop a hospital-acquired infection (HAI). Scrubs are a potential vector of HAIs. To compare the antimicrobial characteristics of scrubs with and without an antimicrobial fabric coating, as tested in the laboratory (in vitro) and hospital (in vivo) environments. Two protocols were conducted to address the purpose. The in vitro protocol was a laboratory study that involved observing the microbe growth after inoculating coated and uncoated scrub fabric swatches with S. aureus and then processing them in moist and dry environments. The in vivo protocol was a clinical trial that measured microbe growth on coated and uncoated scrubs prior to and following nursing staff completing a 12-hr shift on an acute care unit, as measured by colony forming units (CFUs). For high-humidity environments, the in vitro study indicated that swatches treated with an antimicrobial coating exhibited minimal microbe growth, while untreated swatches exhibited significant microbe growth. For low-humidity environments, coated and uncoated swatches were all found to exhibit minimal microbe growth. In the in vivo study, the CFUs increased on scrubs worn by nurses over a 12-hr shift with no significant difference in CFUs for coated and uncoated scrubs. For bacteria in a warm and moist environment, the antimicrobial coating was found to be important for inhibiting growth. For bacteria in a warm and dry environment, both coated and uncoated fabrics performed similarly as measured at 24 hr, with minimal bacterial growth observed. In a hospital environment, microbe growth was observed, but no significant difference was detected when comparing coated and uncoated scrubs. This may have been due to the short time between exposure and culturing the scrubs for analysis immediately at the end of the shift not allowing for enough time to kill or inhibit growth. Contact time between the bacteria and scrub fabric (coated or uncoated) in the in vivo study more directly correlated with the 0-hr observations for the in vitro study, suggesting that the ineffectiveness of the treated scrubs in the clinical results may be due in part to short residence times before collection.

Acute effects of massage or active exercise in relieving muscle soreness: randomized controlled trial.

Massage is commonly believed to be the best modality for relieving muscle soreness. However, actively warming up the muscles with exercise may be an effective alternative. The purpose of this study was to compare the acute effect of massage with active exercise for relieving muscle soreness. Twenty healthy female volunteers (mean age 32 years) participated in this examiner-blind randomized controlled trial (ClinicalTrials.gov NCT01478451). The participants performed eccentric contractions for the upper trapezius muscle on a Biodex dynamometer. Delayed onset muscle soreness (DOMS) presented 48 hours later, at which the participants (a) received 10 minutes of massage of the trapezius muscle or (b) performed 10 minutes of active exercise (shoulder shrugs 10 × 10 reps) with increasing elastic resistance (Thera-Band). First, 1 treatment was randomly applied to 1 shoulder while the contralateral shoulder served as a passive control. Two hours later, the contralateral resting shoulder received the other treatment. The participants rated the intensity of soreness (scale 0-10), and a blinded examiner took measures of pressure pain threshold (PPT) of the upper trapezius immediately before treatment and 0, 10, 20, and 60 minutes after treatment 48 hours posteccentric exercise. Immediately before treatment, the intensity of soreness was 5.0 (SD 2.2) and PPT was 138 (SD 78) kPa. In response to treatment, a significant treatment by time interaction was found for the intensity of soreness (p < 0.001) and PPT (p < 0.05). Compared with control, both active exercise and massage significantly reduced the intensity of soreness and increased PPT (i.e., reduced pain sensitivity). For both types of treatment, the greatest effect on perceived soreness occurred immediately after treatment, whereas the effect on PPT peaked 20 minutes after treatment. In conclusion, active exercise using elastic resistance provides similar acute relief of muscle soreness as compared with that using massage. Coaches, therapists, and athletes can use either active warm-up or massage to reduce DOMS acutely, for example, to prepare for competition or strenuous work, but should be aware that the effect is temporary, that is, the greatest effects occurs during the first 20 minutes after treatment and diminishes within an hour.

Verbal abuse of pediatric nurses by patients and families.

OBJECTIVE: The purpose of this study was to determine the extent to which nurses practicing in a pediatric hospital encounter verbal abuse by patients and families and their reactions to this abuse. BACKGROUND: Verbal abuse, the most common type of workplace violence against nurses results in declining morale and job satisfaction, and can negatively impact nurse turnover and quality of patient care. METHODS: The study employed a concurrent triangulation strategy using mixed methods. The 162 nurses who volunteered completed a 3-part questionnaire, and a subgroup participated in one of three focus groups. RESULTS: Eighty-two percent of subjects reported verbal abuse an average of 4 times per month. The majority of these continued to think about the incident for a few hours (25%), a few days (36%), or a week or more (12%). Nearly half reported feeling angry or powerless and 14% said they thought of leaving their position. CONCLUSIONS: The findings of this study described the nature and scope of the problem, and prompted improvement in processes and education to support nurses.

The Effect of a Mobile Health App on Treatment Adherence and Revenue at Physical Health Clinics: Retrospective Record Review.

BACKGROUND: A significant number of patients do not adhere to their prescribed course of physical therapy or discharge themselves from care. Adhering to prescribed physical therapy, including attending physical therapy clinic appointments, contributes to patients achieving the goals of therapy including reducing pain and increasing functionality. Web-based platforms have been demonstrated to be effective means for managing clinical patients with musculoskeletal pain, similar to managing them in person. Behavior change techniques introduced through digital or web-based platforms can reduce nonadherence with prescribed physical therapy and improve patient outcomes. Literature also indicates that a phone-based app provided to patients, which includes a reward-incentive gamification to complement their care, contributed to a greater number of kept appointments in a physical therapy clinic. OBJECTIVE: This study aims to compare the rate of provider discharge with self-discharge and the number of clinic visits among patients attending a physical health clinic who did and did not choose to adopt a phone-based app to complement their care. A secondary purpose was to compare the revenue generated by patients attending a physical health clinic who did and did not choose to adopt a phone-based app to complement their care. METHODS: A retrospective analysis of all new outpatient medical records (N=5328) from a multisite physical health practice was conducted between January 2018 and December 2019. Patients in the sample self-selected the 2018 Usual Care, the 2019 Usual Care, or the 2019 Kanvas App groups. Kanvas is a customized private practice app, designed for patient engagement with their specific health care provider. This app included a gamification system that provided rewards to the patient for attending their scheduled clinic appointments. According to their medical record, each patient was classified as completing their prescribed therapy (provider discharged) or not completing their prescribed therapy (self-discharged). Additionally, the total number of clinic visits each patient attended, the total charges for services, and the total payments received by the clinic per patient were extracted from each patient's medical record. RESULTS: Patients in the 2019 Kanvas App Group exhibited a higher rate of provider discharge compared to patients who did not adopt the app. This greater rate of provider discharges among the patients who adopted the Kanvas app likely contributed to this group attending more clinic visits (13.21, SD 12.09) than the other study groups who did not download the app (10.72, SD 9.80 to 11.35, SD 11.10). This greater number of clinic visits in turn contributed to the patients who adopted the app generating more clinic charges and payments. CONCLUSIONS: Future investigators need to employ more rigorous methods to confirm these findings, and clinicians need to weigh the anticipated benefits against the cost and staff involvement in managing the Kanvas app.

Heart Rate Response and Flexibility Following Single Bout of Training Using a Seated Elliptical Trainer Among Younger and Older Adults.

The purpose of this study was to compare the effect of a 30-minute activity session using a seated elliptical trainer on heart rate response, knee and ankle range of motion and satisfaction among older and younger adults. Prior to and following completing a 30-minute bout of activity using a seated elliptical trainer, each participant's leg flexibility was assessed. During every minute of the activity, the participant's heart rate was recorded. Following the activity, the participants reported their satisfaction with the trainer. Older participants exhibited a greater heart rate response relative to their estimated maximum heart rate during and reported greater satisfaction with the elliptical trainer compared with younger participants. Both groups increased their leg flexibility following use of the trainer. Nurses could prescribe 30 minutes of activity using a seated elliptical trainer to employees in sedentary occupations to improve cardiovascular health and leg flexibility particularly among older adults.

Predicting the Onset of Sepsis Using Vital Signs Data: A Machine Learning Approach.

Sepsis is a major cause of mortality among hospitalized patients. Existing sepsis prediction methods face limitations due to their reliance on laboratory results and Electronic Medical Records (EMRs). This work aimed to develop a sepsis prediction model utilizing continuous vital signs monitoring, offering an innovative approach to sepsis prediction. Data from 48,886 Intensive Care Unit (ICU) patient stays were extracted from the Medical Information Mart for Intensive Care -IV dataset. A machine learning model was developed to predict sepsis onset based solely on vital signs. The model's efficacy was compared with the existing scoring systems of SIRS, qSOFA, and a Logistic Regression model. The machine learning model demonstrated superior performance at 6 hrs prior to sepsis onset, achieving 88.1% sensitivity and 81.3% specificity, surpassing existing scoring systems. This novel approach offers clinicians a timely assessment of patients' likelihood of developing sepsis.

Prehabilitation and quality of life three months after total knee arthroplasty: a pilot study.

Knee osteoarthritis (OA), which affects over 27 million Americans, decreases the individual's quality of life through decreasing mobility, deconditioning, reducing functional ability, and increasing knee pain. The present aim was to assess whether such patients engaging in exercise prior to surgery ("prehabilitation"; preoperative exercise intervention) rate higher quality of life 3 mo. after their surgery compared with ratings by patients who did not engage in prehabilitation. Standard populations consist of OA patients that do not participate in any preoperative exercise programs, such as a prehabilitation exercise intervention. 18 knee osteoarthritis patients were randomly assigned to a control or a prehabilitation group. The latter group participated in an exercise intervention three times per week, once at home and twice at the physical therapy lab, for 8 wk. prior to their surgery. The control group participated in their usual preoperative care prescribed by the physician for all patients. Eight health-related quality of life domains were assessed at 3 mo. post surgery. These preliminary findings suggest efficacy of prehabilitation in facilitating quality of life of total knee arthroplasty (TKA) patients 3 mo. after surgery.

Understanding stress in the operating room: a step toward improving the work environment.

Job-related stress is an important factor predicting staff satisfaction and position turnover among nursing staff, particularly in the operating room. The purpose of this study was to examine the perceived amount of stress elicited by events in the perioperative environment, the frequency of those events, and the impact of those events on the perceived stress of operating room nurses (ORNs) and operating room technologists (ORTs). The Survey on Stress in the OR instrument, which was used to query the subjects, exhibited high internal consistency of all items. The findings indicated that the ORNs and the ORTs exhibited remarkable similarities between stressful events perceived as high and low impact. The two groups agreed that the highest impact stressful event was "pressure to work more quickly." Using the results of this study, OR administrators may be able to redesign the OR environment to minimize the impact of stressful events and thereby improve job satisfaction and minimize nursing staff turnover.

Analysis of a panel-based pharmacogenomics testing program among members of a commercial and Medicare client of a pharmacy benefits manager.

BACKGROUND: Although the field of pharmacogenomics (PGx) has existed for decades, use of pharmacogenomic information by providers to optimize medication therapy for patients has had relatively slow adoption. There are many factors that have contributed to the slow adoption of PGx testing, but it is partially due to a lack of coverage by payers. If PGx testing is covered by payers, frequently only testing of a specific gene is covered, rather than a panel of many genes. As a result, little is known about how coverage of a panel-based PGx test will affect a member's medication therapy. OBJECTIVES: To determine how giving providers specific medication optimization recommendations, based on results of a panel-based PGx test, impacted members' medication regimens. METHODS: Pharmacy claims data were retrospectively reviewed for this exploratory study. Members who participated in PGx testing were in the intervention group and members who chose not to participate in the PGx testing, but who were eligible to participate, were in the control group. PGx test results, including suggested medication changes, were mailed to providers. To determine if providers adopted the suggested medication changes, pharmacy claims data were analyzed retrospectively for the 4-month period preceding and following the date from which recommendations were provided to prescribers. RESULTS: Of the 101 members included in the analysis, 50 were in the intervention group and 51 were in the control group. In the intervention group, members were taking in a total of 352 medications; 165 of the medications had PGx guidance. Based on the PGx test results, 62 of these medications (37.6%) had recommendations. Of members who received PGx testing, 76% had at least 1 recommended change. When pharmacist recommendations were made, a change was made to the medication 27% of the time. There was a statistically significant difference between the number of medication changes in the PGx group and the control group (P = 0.024). CONCLUSIONS: Recommendations based on PGx testing can lead to changes in medications and an optimized medication regimen for members. DISCLOSURES: The authors have no conflicts to disclose that may present a potential conflict of interest.

Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis.

Preparing for the stress of total knee arthroplasty (TKA) surgery by exercise training (prehabilitation) may improve strength and function before surgery and, if effective, has the potential to contribute to postoperative recovery. Subjects with severe osteoarthritis (OA), pain intractable to medicine and scheduled for TKA were randomized into a usual care (UC) group (n = 36) or usual care and exercise (UC + EX) group (n = 35). The UC group maintained normal daily activities before their TKA. The UC + EX group performed a comprehensive prehabilitation program that included resistance training using bands, flexibility, and step training at least 3 times per week for 4-8 weeks before their TKA in addition to UC. Leg strength (isokinetic peak torque for knee extension and flexion) and ability to perform functional tasks (6-minute walk, 30 second sit-to-stand repetitions, and the time to ascend and descend 2 flights of stairs) were assessed before randomization at baseline (T1) and 1 week before the subject's TKA (T2). Repeated-measures analysis of variance indicated a significant group by time interaction (p < 0.05) for the 30-second sit-to-stand repetitions, time to ascend the first flight of stairs, and peak torque for knee extension in the surgical knee. Prehabilitation increased leg strength and the ability to perform functional tasks for UC + EX when compared to UC before TKA. Short term (4-8 weeks) of prehabilitation was effective for increasing strength and function for individuals with severe OA. The program studied is easily transferred to a home environment, and clinicians working with this population should consider prehabilitation before TKA.

The effects of a closed-chain, eccentric training program on hamstring injuries of a professional football cheerleading team.

OBJECTIVE: Hamstring injuries are a common occurrence among professional football cheerleaders. The purpose of this study is to identify the effects of an eccentric, closed-chain hamstring exercise intervention on hamstring injury-associated pain during the course of the football season among professional football cheerleaders. METHODS: Forty-three female cheerleaders participated in an eccentric, closed-chain hamstring exercise intervention protocol provided by doctors of chiropractic that incorporated loops of elastic-band or Thera-Band Loops (Hygenic Corporation, Akron, OH) during practice and at home during the regular football season. Hamstring injury-related pain was assessed in June, during team selection; in September, at the start of the season; and in December, at the end of season. No intervention was applied between June and September, although the sample participated in 4 hours of practice 2 to 3 times per week. The intervention was applied to the entire sample regardless of hamstring injury-related pain during the regular football season between September and December. The interventions included 2 exercises and were completed bilaterally 2 times per week at each biweekly practice and were encouraged to be done at least 3 additional times per week at home on nonpractice days. RESULTS: Among the subsample who reported hamstring-related injury pain between June and September, the exercise intervention significantly decreased (P < .007) pain between September (6.07 ± 0.58) and December (3.67 ± 0.65). CONCLUSIONS: The eccentric, closed-chain hamstring exercise intervention reduced hamstring injury-related pain among this group of professional football cheerleaders.

Implementing a virtual journal club in a clinical nursing setting.

Healthcare practice is increasingly focused on delivering care that is based on published research evidence. Staff development nurses can institute journal clubs to teach nursing staff critical appraisal of research articles and ways to translate research findings into clinical practice. Unfortunately, attending meetings regularly is often a challenge for nurses, and relatively few have the knowledge and expertise to adequately critique research articles. One way to bridge the limitations of accessibility and limited research expertise of journal club members is to establish a virtual journal club. This article describes one hospital's experience with developing a virtual journal club.

Effect of a Mobile Health App on Adherence to Physical Health Treatment: Retrospective Analysis.

BACKGROUND: Adherence to prescribed medical interventions can predict the efficacy of the treatment. In physical health clinics, not adhering to prescribed therapy can take the form of not attending a scheduled clinic visit (no-show appointment) or prematurely terminating treatment against the advice of the provider (self-discharge). A variety of interventions, including mobile phone apps, have been introduced for patients to increase their adherence to attending scheduled clinic visits. Limited research has examined the impact of a mobile phone app among patients attending chiropractic and rehabilitation clinic visits. OBJECTIVE: This study aims to compare adherence to prescribed physical health treatment among patients attending a chiropractic and rehabilitation clinic who did and did not choose to adopt a phone-based app to complement their treatment. METHODS: The medical records of new patients who presented for care during 2019 and 2020 at 5 community-based chiropractic and rehabilitation clinics were reviewed for the number of kept and no-show appointments and to determine whether the patient was provider-discharged or self-discharged. During this 24-month study, 36.28% (1497/4126) of patients seen in the targeted clinics had downloaded the Kanvas app on their mobile phone, whereas the remaining patients chose not to download the app (usual care group). The gamification component of the Kanvas app provided the patient with a point every time they attended their visits, which could be redeemed as an incentive. RESULTS: During both 2019 and 2020, the Kanvas app group was provider-discharged at a greater rate than the usual care group. The Kanvas app group kept a similar number of appointments compared with the usual care group in 2019 but kept significantly more appointments than the usual care group in 2020. During 2019, both groups exhibited a similar number of no-show appointments; however, in 2020, the Kanvas app group demonstrated more no-show appointments than the usual care group. When collapsed across years and self-discharged, the Kanvas app group had a greater number of kept appointments compared with the usual care group. When provider-discharged, both groups exhibited a similar number of kept appointments. The Kanvas app group and the usual care group were similar in the number of no-show appointments when provider-discharged, and when self-discharged, the Kanvas app group had more no-show appointments compared with the usual care group. CONCLUSIONS: Patients who did or did not have access to the Kanvas app and were provider-discharged exhibited a similar number of kept appointments and no-show appointments. When patients were self-discharged and received the Kanvas app, they exhibited 3.2 more kept appointments and 0.94 more no-show appointments than the self-discharged usual care group.

Comparing nurse practitioners/physician assistants and physicians in diagnosing pediatric abdominal pain for ESI level 3 patients seen in the emergency department.

BACKGROUND: Accuracy of emergency department (ED) diagnosis affects care management including tests, discharges, and readmissions. PURPOSE: This retrospective study compared nurse practitioners/physician assistants (NPs/PAs) with physicians (MDs/DOs) on accuracy of diagnosing Emergency Severity Index (ESI) level 3 pediatric abdominal pain (AP) in the ED. Abdominal pain unrelated to trauma is a common ED pediatric visit. METHODOLOGY: Data acquired from four hospital sites of a multistate emergency group examined patients younger than 18 years who were initially admitted for AP ESI level 3. RESULTS: The accuracy of AP ESI level 3 diagnoses was 94.9%, 90.9%, and 96.5% by physicians, NPs/PAs, and a collaboration of NP/PA/physician, respectively (χ2 = 13.187, p < .001). Accuracy of AP ESI level 3 diagnoses was greater with general admissions, intensive care unit admissions, transfers, or left against medical advice (100%) than with those who were discharged (χ2 = 11.058, p = .001). Abdominal pain complaints were segmented into five areas (i.e., AP, back pain, chest pain, epigastric pain, and pelvic pain). Irrespective of provider, those with a final diagnosis of AP or epigastric pain were correctly triaged and those with a final diagnosis of chest or back pain were incorrectly triaged as AP ESI level 3. CONCLUSIONS: When comparing providers in this subset (n = 43), there was no significant difference in the accuracy of assigning AP ESI level 3 (χ2 = 0.467, p = .495). IMPLICATIONS: Only cases with a final diagnosis of pelvic/genitourinary pain saw disparity in the accuracy (27 correct, 16 incorrect, χ2 = 1,681.80, p < .001).

Implementing Continuous Quality Improvement in an Integrated Community Urology Practice: Lessons Learned.

OBJECTIVE: To determine the effectiveness of 2 different continuous quality improvement interventions in an integrated community urology practice. We specifically assessed the impact of audited physician feedback on improving physicians' adoption of active surveillance for low-risk prostate cancer (CaP) and adherence to a prostate biopsy time-out intervention. MATERIALS AND METHODS: The electronic medical records of Genesis Healthcare Partners were analyzed between August 24, 2011 and September 30, 2020 to evaluate the performance of 2 quality interventions: audited physician feedback to improve active surveillance adoption in low-risk CaP patients, and audited physician feedback to promote adherence to an electronic medical records embedded prostate biopsy time-out template. Physician and Genesis Healthcare Partners group adherence to each quality initiative was compared before and after each intervention type using ANOVA testing. RESULTS: For active surveillance, we consistently saw an increase in active surveillance adoption for low risk CaP patients in association with continuous audited feedback (P < .001). Adherence to the prostate biopsy time-out template improved when audited feedback was provided (P < .001). CONCLUSION: The implementation of clinical guidelines into routine clinical practice remains challenging and poses an obstacle to the improvement of United States healthcare quality. Continuous quality improvement should be a dynamic process, and in our experience, audited feedback coupled with education is most effective.

Vascular conductance is reduced after menthol or cold application.

OBJECTIVE: To compare the effects of commercially sold menthol (3.5%) ointment and cold application on blood flow in the forearm. DESIGN: : Prospective counterbalanced design. SETTING: University research laboratory. PARTICIPANTS: Twelve (6 men and 6 women) college-aged students. INTERVENTIONS: Each participant had blood flow measured in the brachial artery for 5 minutes before and 10 minutes after menthol ointment or cold application to the forearm. MAIN OUTCOME MEASURES: Blood velocity, arterial diameter size, and blood pressure were recorded during testing procedures. Vascular conductance was calculated based on these measures and used to describe limb blood flow. RESULTS: We observed a significant reduction (35%; P = 0.004) in vascular conductance within 60 seconds of menthol and cold application to the forearm. Vascular conductance remained significantly reduced for 10 minutes by approximately 19% after both menthol and cold application [F(2.313, 43.594) = 10.328, P < 0.0001]. There was no significant difference between conditions [F(1, 19) = 0.000, P = 0.945]. CONCLUSIONS: The application of a 3.5% menthol ointment significantly reduces conductance in the brachial artery within 60 seconds of application, and this effect is maintained for at least 10 minutes after application. The overall decline in conductance is similar between menthol ointment and cold application.