Evaluation and Management of Toxicodendron Dermatitis in the Emergency Department: A Review of Current Practices.

Toxicodendron dermatitis is an underappreciated disease seen in the emergency department. Although self-limiting, symptoms can be distressing and can last for weeks if untreated, particularly with re-exposure. Continuing research has improved our understanding of specific inflammatory markers that are associated with exposure to urushiol-the compound responsible for Toxicodendron dermatitis-although consensus for treatment remains varied and poorly supported. Owing to the lack of recent primary literature on the topic, many providers rely on historical precedent, expert opinion, and personal experience when treating this disease. This article provides a narrative review of the literature currently available on the effects of urushiol on key molecular and cellular functions and the prevention and treatment of Toxicodendron dermatitis.

The Enneagram and its application in medical education.

Personality testing has become increasingly popular in healthcare with multiple modalities and implementations. Although personality testing has been utilized to inform various facets of graduate medical education, little is known about how the Enneagram can be utilized throughout postgraduate training. This narrative review explores the use of personality testing in graduate medical education, how personality testing has been used in the workplace, what research is available showing its use in medical residencies, and the need for additional studies on the Enneagram's use in these areas. We conclude the Enneagram may serve as a valuable tool that can be used in postgraduate medical education to improve learning, interpersonal relationships, and teaming.

Emergency department discharge prescription errors in an academic medical center.

This study described discharge prescription medication errors written for emergency department patients. This study used content analysis in a cross-sectional design to systematically categorize prescription errors found in a report of 1000 discharge prescriptions submitted in the electronic medical record in February 2015. Two pharmacy team members reviewed the discharge prescription list for errors. Open-ended data were coded by an additional rater for agreement on coding categories. Coding was based upon majority rule. Descriptive statistics were used to address the study objective. Categories evaluated were patient age, provider type, drug class, and type and time of error. The discharge prescription error rate out of 1000 prescriptions was 13.4%, with "incomplete or inadequate prescription" being the most commonly detected error (58.2%). The adult and pediatric error rates were 11.7% and 22.7%, respectively. The antibiotics reviewed had the highest number of errors. The highest within-class error rates were with antianginal medications, antiparasitic medications, antacids, appetite stimulants, and probiotics. Emergency medicine residents wrote the highest percentage of prescriptions (46.7%) and had an error rate of 9.2%. Residents of other specialties wrote 340 prescriptions and had an error rate of 20.9%. Errors occurred most often between 10:00 am and 6:00 pm.

Pre and post hoc analysis of electronic health record implementation on emergency department metrics.

Longitudinal time-based emergency department (ED) performance measures were quantified 12 months before and 12 months after (March 2012-February 2014) implementation of a Meditech 6.0® electronic health record (EHR) at a single urban academic ED. Data assessed were length of stay from door to door, door to admission, door to bed, bed to provider, provider to disposition, and disposition to admission, as well as number of patients leaving against medical advice and number of patients leaving without being seen. Analysis of variance was used to compare levels before and after EHR implementation for each variable, with adjustments made for the number of admissions, transfers, and month. No difference was seen in monthly volume, admissions, or transfers. Implementation of an EHR resulted in a sustained increase in ED time metrics for mean length of stay and times from door to door, door to admission, door to bed, and provider to disposition. Decreased ED time metrics were seen in bed-to-provider and disposition-to-admit times. The number of patients who left against medical advice increased after implementation, but the number of patients who left without being seen was not significantly different. Thus, EHR implementation was associated with an increase in time with most performance metrics. Although general times trended back to near preimplementation baselines, most ED time metrics remained elevated beyond the study length of 12 months. Understanding the impact of EHR system implementation on the overall performance of an ED can help departments prepare for potential adverse effects of such systems on overall efficiency.

Applied Sports Nutrition Support, Dietary Intake and Body Composition Changes of a Female Athlete Completing 26 Marathons in 26 Days: A Case Study.

The aim of this case study is to describe the nutrition practices of a female recreational runner (VO2max 48.9 ml·kg-1·min-1) who completed 26 marathons (42.195 km) in 26 consecutive days. Information relating to the nutritional intake of female runners during multi-day endurance events is extremely limited, yet the number of people participating year-on-year continues to increase. This case study reports the nutrition intervention, dietary intake, body composition changes and performance in the lead-up and during the 26 days. Prior to undertaking the 26 marathon challenge, three consultations were held between the athlete and a sports nutrition advisor; planning and tailoring the general diet and race-specific strategies to the endurance challenge. During the marathons, the mean energy and fluid intake was 1039.7 ± 207.9 kcal (607.1 - 1453.2) and 2.39 ± 0.35 L (1.98 - 3.19). Mean hourly carbohydrate intake was 38.9 g·hr-1. 11 days following the completion of the 26 marathons, body mass had reduced by 4.6 kg and lean body mass increasing by 0.53 kg when compared with 20 days prior. This case study highlights the importance of providing general and event-specific nutrition education when training for such an event. This is particularly prudent for multi-day endurance running events.

Validation of a survey tool assessing effectiveness of an educational intervention on the caring behaviors and referral activities of community pharmacists for migraineurs.

BACKGROUND: Community pharmacists are in an ideal position to ameliorate migraineur under-consulting, under-diagnosis, and under-treatment. Contemporary education/training on developing therapeutic alliances with patients and in advanced pharmacotherapy may further motivate pharmacists to impact the care of migraineurs. OBJECTIVES: The objectives of this study were to assess pharmacists' perceptions of a migraine training program and their self-assessment of subsequent impact on patient care and to develop and assess a tool evaluating the impact of the training program from the patients' perspectives: (1) for patients diagnosed with migraines - identify perceptions of care by pharmacists who have undergone specialty training in migraine vs. pharmacists who have not; and (2) for patients with recurrent headaches and not diagnosed with migraines - identify perceptions of pharmacist effectiveness and thoroughness, after specialty training, to identify a potential migraine diagnosis and referral for advanced care vs. pharmacists that have not undergone specialty training. METHODS: This study employed a mixed method survey design using community pharmacies from the Tulsa, Oklahoma and Pittsburgh, Pennsylvania greater metropolitan areas. Pharmacists from intervention pharmacies received specialty training on migraine and were surveyed on their current practices and about the education program. Approximately 1 month after the training, control and intervention pharmacists were surveyed on current practices. Additionally, patients from both pharmacies were surveyed to assess Migraine Disability Assessment (MIDAS) and pharmacists' delivery of care derived from the Pharmacists' Care of Migraineurs Scale (PCMS). Surveys were handed out for a period of 3-months. RESULTS: There were 16 pharmacists and 61 patients recruited. There was no difference in patient perceptions of pharmacists' care or in patient self-perceptions between migraineurs and recurrent headache sufferers. Ninety-two percent of pharmacists agreed that the program could be transferred to an internet-based educational program. The 14-item patient survey, however, demonstrated good internal consistency reliability, with each question having a Cronbach's alpha 0.80 or higher. CONCLUSIONS: There are few studies evaluating the role and potential impact community pharmacists can have on patients suffering from migraines or recurrent headaches. While no difference was found between the groups, the internal reliability of the survey questions and the need to address needs of migraineurs warrants tool dissemination and a larger-scale study.

Assessing health literacy practices in a community pharmacy environment: experiences using the AHRQ Pharmacy Health Literacy Assessment Tool.

BACKGROUND: The Agency for Healthcare Research and Quality (AHRQ) developed the tool, "Is Our Pharmacy Meeting Patients' Needs? Pharmacy Health Literacy Assessment Tool" to evaluate health literacy preparedness of pharmacy environments from patient, staff, and environmental perspectives. The tool was designed at a clinic-based, outpatient pharmacy of a large, urban, public hospital. Despite the ready availability of this tool and the encouragement of AHRQ to adapt it to other environments, there is no published literature on the dissemination and translation of this tool in the community pharmacy environment. OBJECTIVES: The five objectives of this study were to: (1) pilot the AHRQ tool "Is Our Pharmacy Meeting Patients' Needs? Pharmacy Health Literacy Assessment Tool" in a community pharmacy environment; (2) evaluate and adapt the tool; (3) describe the use of health literacy practices from patient, staff, and independent auditor perspectives using the revised tool; (4) evaluate the effect of a low-intensity educational health literacy awareness program; and (5) identify opportunities to improve health literacy-sensitive practices in the community pharmacy environment. METHOD: The study employed a mixed method, posttest-only control group design using community pharmacies in the Tulsa, OK area. Participants included community pharmacists, staff, patients, and independent auditors. Select pharmacy staff members were invited to receive a health literacy training program delivered by a nationally-recognized health literacy expert to raise awareness of health literacy issues. Approximately eight months after the program, pharmacy staffs were surveyed using a written instrument, patients were interviewed by telephone, and the study investigators performed independent environmental audits in each of the selected pharmacies. Results from auditor evaluations, staff survey responses, and patient interviews were compared for similarities and differences to provide a multidimensional perspective about the use of health literacy-sensitive practices. RESULTS: After piloting and adapting the AHRQ tool for the community pharmacy environment, 60 patients completed telephone interviews, 31 staff members completed surveys, and four independent auditors completed environmental audits in six study pharmacies using the revised data collection instruments. The majority of patients and staff were in agreement that written materials were easy to read. However, the auditors did not report equally high agreement regarding the readability qualities of the written materials. While the majority of staff reported use of literacy-sensitive communication techniques with patients, only a minority of patients reported actual communication with the pharmacist and use of literacy-sensitive communication techniques. At trained pharmacies, a significantly larger proportion of patients reported that the pharmacist spent enough time answering their questions (100% vs. 87%, P = 0.038), but a smaller proportion reported the pharmacists reviewed important information from the written information provided (30% vs. 57%, P = 0.035). A significantly smaller proportion of pharmacy staff also reported using the repeat-back technique at the trained pharmacies (40% vs. 79%, P = 0.035). CONCLUSION: This project is the first to report piloting, revision, and implementation of the AHRQ Health Literacy Assessment Tool in a community pharmacy practice setting. In addition to adapting data collection instruments and implementation strategies, opportunities that target training to facilitate use of literacy-sensitive practices and active patient engagement with literacy-sensitive communication techniques were identified.

Comparison of home monitoring methods for feline urine pH measurement.

BACKGROUND: Monitoring of urine pH, often done in the patient s home, is essential for proper clinical treatment and management of conditions such as urolithiasis. OBJECTIVE: The purpose of this study was to assess the agreement in pH readings between a standard laboratory method and methods readily available for home monitoring. The influence of refrigerated storage on urine pH was also examined. METHODS: Urine samples were obtained by cystocentesis from 40 clinically healthy cats, and pH was measured within 2 hours of collection. Each sample was evaluated using pH paper, urinalysis reagent strip, 2 brands of portable pH meters (Chek-Mite, Corning, Corning, NY, USA; and Checker 1, Hanna Instruments, Woonsocket, RI, USA), and a standard laboratory benchtop pH meter. Urine samples were refrigerated, and a second pH reading was obtained with the laboratory benchtop meter after 24 hours. The degree of agreement was assessed among the different methods, with the laboratory benchtop pH meter as the reference method. RESULTS: The closest agreement was obtained with the Chek-Mite portable pH meter and least agreement with the Checker 1 portable pH meter, which had a constant negative bias of 0.31 units due to expiration of the electrode. As expected, pH paper and reagent strips had poor and intermediate agreement, respectively. The reagent strip method had a negative bias of 0.12 units when compared with the benchtop pH meter and wide disagreement at the low pH end. The reagent strip did not agree strongly with the reference method; only 50% of values were within 0.25 pH units of each other. The difference in pH between 0 hours (6.57 +/- 0.54) and 24 hours of refrigeration (6.61 +/- 0.53) was not considered clinically significant. CONCLUSION: Portable pH meters are excellent for monitoring urine pH at home as long as attention is given to electrode maintenance. Urine can be collected at home and kept refrigerated, and pH may be measured reliably within 24 hours using the reference method or a portable pH meter.