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1.
Br J Anaesth ; 124(3): e63-e69, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31980155

RESUMO

The under-representation of women in academic leadership roles, including in anaesthesiology, is a well-documented phenomenon that has persisted for decades despite more women attending medical school, participating in anaesthesiology residencies, and joining academic faculties. The percentage of female anaesthesiologists who hold senior academic ranks or leadership roles, such as chair, lags behind the percentage of female anaesthesiologists overall. Trends towards increasing the numbers of women serving in educational leadership roles, specifically residency programme directors, suggest that there are areas in which academic anaesthesiology has been, and can continue, improving gender imbalance. Continued institutional efforts to recruit women into anaesthesiology, reduce gender bias, and promote interventions that foster gender equity in hiring and promotion will continue to benefit women, academic anaesthesiology departments, and the healthcare system overall.


Assuntos
Anestesiologia/tendências , Internato e Residência/tendências , Médicas/tendências , Sexismo/tendências , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/tendências , Anestesiologia/educação , Anestesiologia/organização & administração , Escolha da Profissão , Mobilidade Ocupacional , Educação de Pós-Graduação em Medicina/organização & administração , Educação de Pós-Graduação em Medicina/tendências , Feminino , Humanos , Internato e Residência/organização & administração , Liderança , Médicas/estatística & dados numéricos , Faculdades de Medicina/organização & administração , Faculdades de Medicina/tendências , Sexismo/prevenção & controle , Estados Unidos
4.
Pediatrics ; 144(5)2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31548337

RESUMO

Gender bias and discrimination have profound and far-reaching effects on the health care workforce, delivery of patient care, and advancement of science and are antithetical to the principles of professionalism. In the quest for gender equity, medicine, with its abundance of highly educated and qualified women, should be leading the way. The sheer number of women who comprise the majority of pediatricians in the United States suggests this specialty has a unique opportunity to stand out as progressively equitable. Indeed, there has been much progress to celebrate for women in medicine and pediatrics. However, many challenges remain, and there are areas in which progress is too slow, stalled, or even regressing. The fair treatment of women pediatricians will require enhanced and simultaneous commitment from leaders in 4 key gatekeeper groups: academic medical centers, hospitals, health care organizations, and practices; medical societies; journals; and funding agencies. In this report, we describe the 6-step equity, diversity, and inclusion cycle, which provides a strategic methodology to (1) examine equity, diversity, and inclusion data; (2) share results with stakeholders; (3) investigate causality; (4) implement strategic interventions; (5) track outcomes and adjust strategies; and (6) disseminate results. Next steps include the enforcement of a climate of transparency and accountability, with leaders prioritizing and financially supporting workforce gender equity. This scientific and data-driven approach will accelerate progress and help pave a pathway to better health care and science.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Renda/estatística & dados numéricos , Pediatria , Médicas/estatística & dados numéricos , Sexismo/tendências , Centros Médicos Acadêmicos/tendências , Políticas Editoriais , Feminino , Humanos , Liderança , Pediatria/estatística & dados numéricos , Pediatria/tendências , Publicações Periódicas como Assunto , Médicas/tendências , Faculdades de Medicina/organização & administração , Sexismo/estatística & dados numéricos , Estados Unidos
5.
Anesth Analg ; 129(3): e83-e85, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31425214

RESUMO

While significant literature exists on hospital-based "code calls," there is a lack of research on calls for help in the operating room (OR). The purpose of this study was to quantify the rate and nature of calls for help in the OR of a tertiary care hospital. For a 1-year period, all calls were recorded in the main OR at The University of California, Irvine Medical Center. The average rate of calls per 1000 anesthesia hours was 1.4 (95% CI, 1.1-1.8), corresponding to a rate of 5.0 (3.8-6.5) calls per 1000 cases. Airway (44%), cardiac (32%), and hemorrhagic (11%) emergencies were the most common etiologies. Thirty-day mortality approached 11% for patients who required a call for help in the OR.


Assuntos
Centros Médicos Acadêmicos/tendências , Serviços Médicos de Emergência/tendências , Salas Cirúrgicas/tendências , Centros de Atenção Terciária/tendências , Centros Médicos Acadêmicos/métodos , Estudos de Coortes , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Masculino , Salas Cirúrgicas/métodos , Estudos Prospectivos
8.
JAMA Netw Open ; 2(4): e192200, 2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-30977857

RESUMO

Importance: In response to rapidly growing interest in population health, academic medical centers are launching department-level initiatives that focus on this evolving discipline. This trend, with its potential to extend the scope of academic medicine, has not been well characterized. Objective: To describe the emergence of departments of population health at academic medical centers in the United States, including shared areas of focus, opportunities, and challenges. Design, Setting, and Participants: This qualitative study was based on a structured in-person convening of a working group of chairs of population health-oriented departments on November 13 and 14, 2017, complemented by a survey of core characteristics of these and additional departments identified through web-based review of US academic medical centers. United States medical school departments with the word population in their name were included. Centers, institutes, and schools were not included. Main Outcomes and Measures: Departments were characterized by year of origin, areas of focus, organizational structure, faculty size, teaching programs, and service engagement. Opportunities and challenges faced by these emerging departments were grouped thematically and described. Results: Eight of 9 population health-oriented departments in the working group were launched in the last 6 years. The 9 departments had 5 to 97 full-time faculty. Despite varied organizational structures, all addressed essential areas of focus spanning the missions of research, education, and service. Departments varied significantly in their relationships with the delivery of clinical care, but all engaged in practice-based and/or community collaboration. Common attributes include core attention to population health-oriented research methods across disciplines, emphasis on applied research in frontline settings, strong commitment to partnership, interest in engaging other sectors, and focus on improving health equity. Tensions included defining boundaries with other academic units with overlapping areas of focus, identifying sources of sustainable extramural funding, and facilitating the interface between research and health system operations. Conclusions and Relevance: Departments addressing population health are emerging rapidly in academic medical centers. In supporting this new framing, academic medicine affirms and strengthens its commitment to advancing population health and health equity, to improving the quality and effectiveness of care, and to upholding the social mission of medicine.


Assuntos
Centros Médicos Acadêmicos/tendências , Saúde da População , Faculdades de Medicina/tendências , Humanos , Pesquisa Qualitativa , Estados Unidos
9.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31028159

RESUMO

OBJECTIVES: Unintended extubations (UEs) lead to significant morbidity in neonates. A quality improvement project was initiated in response to high rates in our level IV NICU. We targeted creating and sustaining UE rates below the published standard of 1 per 100 ventilator days. METHODS: This project spanned 4 time periods: baseline, epoch 1 (December 2010-May 2012), sustain, and epoch 2 (May 2015-December 2017) by using standard quality improvement methodology. Epoch 1 interventions included real-time analysis of UE events, standardization of taping, patient positioning and movement, accurate event reporting, and change in nomenclature. Epoch 2 interventions included reduction in daily chest radiographs (CXRs) and development of a high-risk tool. Patient and event characteristics were statistically compared across time points. RESULTS: Of the 612 UE events recorded over 10 years, 249 UEs occurred from May 2011 to 2017 involving 184 unique patients. UE rates decreased by 43% (from 1.75 to 0.99 per 100 ventilator days; epoch 1) and were sustained until a notable spike. Epoch 2 interventions led to a further 31% rate reduction. Single CXR use decreased by half. Median corrected gestational age at the time of an event was 35 weeks (interquartile range: 29-41). Seventy percent of infants experiencing an UE required reintubation, 29% had a previous event, and 9% had a code event. CONCLUSIONS: A decrease in UE below benchmarks can be achieved and sustained by standardization and mitigation interventions. This decline was also accompanied by a reduction in use of CXRs without increasing UE events.


Assuntos
Centros Médicos Acadêmicos/tendências , Extubação/tendências , Unidades de Terapia Intensiva Neonatal/tendências , Intubação Intratraqueal/tendências , Melhoria de Qualidade/tendências , Centros Médicos Acadêmicos/normas , Extubação/normas , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/normas , Intubação Intratraqueal/normas , Masculino , Melhoria de Qualidade/normas
10.
Acad Med ; 94(6): 763-767, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30893063

RESUMO

There is an increasing need for academic health centers (AHCs) to engage communities across their clinical, research, and educational missions. Although AHCs have a long-standing history of community service, a more comprehensive approach to working with communities is required to respond to shifts toward a population health paradigm, funder requirements for community engagement in research, and demands that medical education focus more on social and environmental determinants of health. Community engagement has been employed at many AHCs, though often in limited ways or relying heavily on students and faculty interested in serving communities. This limited involvement has been due, in part, to lack of infrastructure to support engagement, resource constraints, and the lack of a clear value proposition for long-term investments in community partnerships. However, there are compelling reasons for AHCs to take an enterprise-wide approach to working with communities. An enterprise-wide approach to community engagement will require reconsideration of communities, moving from viewing them as people or groups in need of service to seeing them as assets who can help AHCs better understand and address social determinants of health, enhance students' and trainees' ability to provide care, and increase the relevance and potential impact of research discoveries. To accomplish this, AHCs will need to establish the necessary infrastructure to support long-term community partnerships, adapt policies to support and reward engaged scholarship and teaching, and consider new ways of integrating community members in roles as advisors and collaborators across the AHC.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Integração Comunitária/tendências , Educação Médica/métodos , Centros Médicos Acadêmicos/tendências , Cultura , Docentes de Medicina/normas , Bolsas de Estudo , Recursos em Saúde , Humanos , Qualidade da Assistência à Saúde , Seguridade Social
12.
Urol Oncol ; 37(3): 180.e1-180.e9, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30482434

RESUMO

OBJECTIVES: We assessed recent trends in both urinary diversion after radical cystectomy for bladder cancer in the United States and patient- and hospital-related characteristics. We also identified variables associated with undergoing continent diversion. MATERIALS AND METHODS: We queried the National Cancer Database and identified 27,170 patients who underwent radical cystectomy with urinary diversion from 2004 to 2013. Patient demographics, socioeconomic variables, and hospital-related factors were compared between incontinent and continent diversion and trended over time. Multivariable logistic regression was used to identify variables associated with undergoing continent diversion. RESULTS: Overall, 23,224 (85.5%) and 3,946 (14.5%) patients underwent incontinent and continent diversion, respectively. Continent diversion declined from 17.2% in 2004 to 2006 to 12.1% in 2010 to 2013 (P < 0.01). When analyzing high-volume facilities, those performing ≥75% minimally invasive radical cystectomy had fewer continent diversions (10.2%) compared to centers with higher rate of open approach (19.7%), P < 0.01. Higher income, facility located in the West, academic programs, high-volume facilities, and patients traveling >60 miles for care were significantly associated with undergoing continent diversion. Rate of continent diversion has declined in most patient- and hospital-related subgroups. Compared to 2004 to 2006, patients in 2010 to 2013 were more likely to be older, have more comorbidities, and be operated on at a high-volume academic facility. CONCLUSION: The rate of continent diversion has declined to 12.1% in the United States. Hospital volume and type, patient income, distance traveled for care, and geography are significantly associated with undergoing continent diversion. Even among high-volume and academic centers, the rate of continent diversion is declining.


Assuntos
Padrões de Prática Médica/tendências , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/tendências , Coletores de Urina/tendências , Centros Médicos Acadêmicos/estatística & dados numéricos , Centros Médicos Acadêmicos/tendências , Idoso , Idoso de 80 Anos ou mais , Cistectomia/métodos , Cistectomia/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Alto Volume de Atendimentos/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Fatores Socioeconômicos , Centros de Atenção Terciária/estatística & dados numéricos , Centros de Atenção Terciária/tendências , Estados Unidos , Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Derivação Urinária/estatística & dados numéricos , Coletores de Urina/estatística & dados numéricos
13.
World Neurosurg ; 121: e892-e897, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30315984

RESUMO

BACKGROUND: Factors affecting academic productivity of neurosurgeons are increasingly being studied. In the current investigation, we retrospectively reviewed a cohort of early career neurosurgeons to determine if their medical education, residency training, or academic employer had the most influence on a young academician's productivity. METHODS: We studied early career neurosurgeons who completed residency in U.S.-based neurosurgical training programs between 2010 and 2014. The ranking of an individual subject's medical school, residency, and current academic employer were analyzed for correlation with his or her current h-index. RESULTS: The neurosurgeons with the highest h-indexes are more likely to have attended elite medical schools, have trained in high-ranking residency programs, and work for prestigious university departments (P < 0.0001). Furthermore, we identified a positive correlation between the subjects' academic productivity and the ranking of all the institutions throughout their medical education, training, and current employment. The strongest correlation was with the rank of their residency program (ρ = 0.52). CONCLUSIONS: There is a correlation between the early career academic neurosurgeons' h-indexes and the ranking of all the institutions throughout their education, training, and current employment, but the strongest correlation was with the academic productivity of their residency program.


Assuntos
Centros Médicos Acadêmicos/métodos , Escolha da Profissão , Educação de Pós-Graduação em Medicina/tendências , Neurocirurgia/educação , Centros Médicos Acadêmicos/estatística & dados numéricos , Centros Médicos Acadêmicos/tendências , Estudos de Coortes , Feminino , Humanos , Masculino , Estatísticas não Paramétricas , Estados Unidos
14.
Am J Surg ; 217(6): 1089-1093, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30471811

RESUMO

BACKGROUND: Surgical site infections (SSI) are a source of patient morbidity and increased cost. In 2007, our organization discovered an SSI rate of 18% after colorectal surgery (CRS), corresponding to an ACS NSQIP benchmarked high outlier. METHODS: From 2007 to 2016, surgeons championed a stepwise, multidisciplinary improvement pathway for SSI reduction. NSQIP was used to track SSI rates and estimate cost savings. RESULTS: From 2007 to 2016, 1508 patients underwent CRS at our facility. In 2007, our SSI rate was 18%. In 2016, the SSI rate was 7%, corresponding to a NSQIP benchmarked exemplary performance. 54 patients avoided the morbidity of a SSI. The expense of SSI reduction implementation was $180,000. Cost savings was estimated at $1.3 million. CONCLUSIONS: Our approach reduced SSI rates by 58% over ten years. We observed a significant morbidity reduction and cost savings. Our strategy could be adopted within other medical centers focused on CRS SSI improvement.


Assuntos
Centros Médicos Acadêmicos/normas , Redução de Custos/estatística & dados numéricos , Custos Hospitalares/tendências , Assistência Perioperatória/normas , Melhoria de Qualidade/tendências , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Centros Médicos Acadêmicos/tendências , Adulto , Idoso , Benchmarking , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/economia , Assistência Perioperatória/métodos , Melhoria de Qualidade/economia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/economia , Wisconsin
15.
Am J Ophthalmol ; 198: 54-62, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30308206

RESUMO

PURPOSE: To evaluate the laboratory results and prognostic factors of poor clinical outcomes in microbial keratitis cases over 15 years at Saint Louis University. DESIGN: Retrospective cohort and trend study. METHODS: Microbiological and clinical information from culture-positive cases seen at Saint Louis University from 1999 to 2013 were reviewed retrospectively. Statistical analyses were used to determine microbiological and antibiotic susceptibility trends. Prognostic factors of poor clinical outcome from the literature were used to create multivariate regression models to describe our cohort. RESULTS: Gram-positive organisms predominated (48%), followed by gram-negative organisms (34%) and fungi (16%). The most commonly isolated organism was Pseudomonas aeruginosa (21%). Oxacillin-resistant rates of Staphylococcus aureus and coagulase-negative staphylococci were 45% and 43%, respectively. Only the proportion of Pseudomonas changed significantly over time (P = .02). The only antibiotic found to lose efficacy over time was gentamicin for gram-positive organisms (P = .005). Multivariate logistic regression analyses revealed that major complications were associated with large ulcers (P < .006), fungal cases (P < .001), and comorbid ophthalmic conditions (P < .001). Poor healing was associated with large ulcers (P < .001) and fungal cases (P < .001). Lastly, poor visual outcome was associated with large ulcers (P < .01) and age ≥ 60 years (P < .02). CONCLUSIONS: In the St Louis area, oxacillin-resistant organisms, Pseudomonas aeruginosa, and fungi are commonly recovered from microbial keratitis cases with a disproportionally high incidence. Hence, empiric antibiotic choice should reflect these trends. Special care needs to be taken for patients with large ulcers and fungal infections, as well as elderly patients with comorbid ophthalmic conditions, as these patients have worse clinical outcomes.


Assuntos
Bactérias/isolamento & purificação , Úlcera da Córnea , Infecções Oculares Bacterianas , Infecções Oculares Fúngicas , Fungos/isolamento & purificação , Centros Médicos Acadêmicos/tendências , Adulto , Idoso , Antibacterianos/uso terapêutico , Técnicas de Laboratório Clínico , Úlcera da Córnea/tratamento farmacológico , Úlcera da Córnea/epidemiologia , Úlcera da Córnea/microbiologia , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/epidemiologia , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/epidemiologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Seguimentos , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Missouri/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Acuidade Visual/fisiologia
16.
Anesth Analg ; 128(2): 335-341, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29958214

RESUMO

BACKGROUND: The use of cognitive aids, such as emergency manuals (EMs), improves team performance on critical steps during crisis events. In our large academic anesthesia practice, we sought to broadly implement an EM and subsequently evaluate team member performance on critical steps. METHODS: We observed the phases of implementing an EM at a large academic anesthesia practice from 2013 to 2016, including the formation of the EM implementation team, identification of preferred EM characteristics, consideration of institution-specific factors, selection of the preferred EM, recognition of logistical barriers, and staff education. Utilization of the EM was tested in a regular clinical environment with all available resources using a standardized verbal simulation of 3 crisis events both preimplementation and 6 months postimplementation. Individual members of the anesthesia team were asked to verbalize interventions for specific crisis events over 60 seconds. RESULTS: We introduced a customized version of the Stanford Emergency Manual on January 26, 2015. Fifty-nine total participants (equal proportion of anesthesiology attending physicians, resident physicians, certified registered nurse anesthetists, and student registered nurse anesthetist staff) were surveyed in the preimplementation phase and 60 in the 6-month postimplementation phase. In the postimplementation phase, a minority (41.7%) utilized the EM for the verbal-simulated crisis events. Those who used the EM performed better than those who did not (median 21.0 critical steps out of a possible 30 total steps [70.0%], interquartile range 19-25 vs 18.0 critical steps verbalized [60.0%], interquartile range 16-20; P < .001). Among all subjects, the median number of critical steps verbalized was 16 (53.3%) preimplementation and 19.5 critical steps (65.0%) postimplementation. CONCLUSIONS: Implementation of an EM in a large academic anesthesia practice is not without challenges. While full integration of the EM was not achieved 6 months after implementation, verbalization of critical steps on 3 simulated crisis events improved when the EM was utilized.


Assuntos
Centros Médicos Acadêmicos/normas , Anestesia/normas , Competência Clínica/normas , Serviços Médicos de Emergência/normas , Manuais como Assunto/normas , Centros Médicos Acadêmicos/tendências , Anestesia/tendências , Serviços Médicos de Emergência/tendências , Humanos , Fluxo de Trabalho
17.
BMC Musculoskelet Disord ; 19(1): 395, 2018 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-30414610

RESUMO

BACKGROUND: We hypothesized, that periprosthetic joint infection (PJI) accounts for the major proportion of first (primary) and repeated (secondary) Total Knee Arthroplasty revisions at our university referral arthroplasty center. METHODS: One thousand one hundred forty-three revisions, performed between 2008 and 2016 were grouped into primary (55%) and secondary (45%) revisions. The rate of revision indications was calculated and indications were categorized by time after index operation. The odds ratios of the indications for primary versus secondary revision were calculated. RESULTS: In the primary revision group PJI accounted for 22.3%, instability for 20.0%, aseptic loosening for 14.9% and retropatellar arthrosis for 14.2%. PJI (25.6%) was the most common indication up to 1 year after implantation, retropatellar arthrosis (26.8%) 1-3 years and aseptic loosening (25.6%) more than 3 years after implantation. In the secondary revision group PJI accounted for 39.7%, aseptic loosening for 16.2% and instability for 13.2%. PJI was the most common indication at any time of revision with 43.8% up to one, 35.4% 1-3 years and 39.4% more the 3 years after index operation. The odds ratios in repeated revision were 2.32 times higher (p = 0.000) for PJI. For instability and retropatellar arthrosis the odds ratios were 0.60 times (p = 0.006) and 0.22 times (p = 0.000) lower. CONCLUSIONS: PJI is the most common indication for secondary TKA revision and within one year after primary TKA. Aseptical failures such as instability, retropatellar arthrosis and aseptical loosening are the predominant reasons for revision more than one year after primary TKA.


Assuntos
Centros Médicos Acadêmicos/tendências , Artroplastia do Joelho/tendências , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/cirurgia , Encaminhamento e Consulta/tendências , Reoperação/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico , Reoperação/métodos , Estudos Retrospectivos , Adulto Jovem
18.
J Alzheimers Dis ; 66(1): 249-261, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30282355

RESUMO

BACKGROUND: There is a lack of research on the effects of physical activity (PA) on the progression of Alzheimer's disease (AD). OBJECTIVES: We investigated whether PA is associated with progression of dementia and mortality in AD. METHODS: In the present study, 934 patients with mild-to-moderate AD were included. PA was evaluated using a questionnaire written by the caregiver. The outcome measures were the Clinical Dementia Rating-Sum of Boxes (CDR-SB), Seoul-Instrumental Activities of Daily Living (S-IADL), Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI), a global composite score of neuropsychological subtests, and mortality. They were evaluated annually and received a maximum of three follow-up examinations. RESULTS: Between-group differences compared with the no PA group in the change of CDR-SB scores were -0.431 (95% CI = -0.824∼-0.039; p = 0.031) for the moderate PA group (150-750 minutes per week of moderate intensity PA), and -1.148 (-1.656∼-0.639; p < 0.001) for the high PA group (>750 minutes per week). As PA increased, there was a significant trend to slow the rate of increase in the CDR-SB, S-IADL, and CGA-NPI scores. The patients with ≥150 minutes per week for each of non-recreational and recreational PAs had a lower risk of mortality compared to those with <150 minutes per week for each of the PAs (hazard ratio 0.22, 95% CI = 0.05∼0.88; p = 0.033). CONCLUSION: More PA is associated with slower progression of dementia severity, functional decline, and abnormal behavior, and with a lower risk of mortality in AD.


Assuntos
Centros Médicos Acadêmicos/tendências , Doença de Alzheimer/psicologia , Doença de Alzheimer/terapia , Progressão da Doença , Exercício Físico/fisiologia , Exercício Físico/psicologia , Centros Médicos Acadêmicos/métodos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Testes Neuropsicológicos , Sistema de Registros , República da Coreia/epidemiologia
19.
Trans Am Clin Climatol Assoc ; 129: 301-311, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30166724

RESUMO

We are presently seeing exponential advances in medical knowledge and development of therapeutic and diagnostic tools. We have also begun to experience an historic restructuring of our health care system. But health care costs continue to rise, disparities persist, and the chaotic, disjointed, and often thoughtless discourse in Washington threatens to roll back the prior advances. Improvement in patient care will be severely stymied if the threats to academic medical centers are not countered. This paper will explore our present state through the lens of cardiovascular care. It will 1) examine clinical trends; 2) dissect the value and challenges to the Patient Protection and Affordable Care Act; 3) highlight limitations and alternatives to relying on the federal government; and 4) present the Academic Medical System construct, as a structure designed to retain and advance the academic mission.


Assuntos
Centros Médicos Acadêmicos/tendências , Cardiologia/tendências , Doenças Cardiovasculares/terapia , Prestação Integrada de Cuidados de Saúde/tendências , Patient Protection and Affordable Care Act/tendências , Centros Médicos Acadêmicos/economia , Centros Médicos Acadêmicos/legislação & jurisprudência , Cardiologia/economia , Cardiologia/legislação & jurisprudência , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/legislação & jurisprudência , Previsões , Regulamentação Governamental , Custos de Cuidados de Saúde/tendências , Humanos , Patient Protection and Affordable Care Act/economia , Patient Protection and Affordable Care Act/legislação & jurisprudência , Formulação de Políticas , Estados Unidos/epidemiologia
20.
Psychiatry Res ; 267: 160-167, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29908484

RESUMO

U.S. Hispanics, now the single largest minority group in the country, face unique mental health disparities. The current study utilizes Andersen's Behavioral Model of Health Service Use to examine ethnic disparities in receiving a schizophrenia or mood disorder diagnosis at psychiatric hospital admission. Our retrospective cohort study examined electronic health record data at an academic safety-net psychiatric hospital for adult patients (n = 5571) admitted between 2010 and 2013. Logistic regression with block-wise entry of predisposing, enabling and need variables was used to examine ethnic disparities in receiving a schizophrenia diagnosis at admission. The block of need factors was the strongest predictor of receiving a schizophrenia diagnosis compared to predisposing and enabling factors. Compared to non-Hispanic whites, Hispanics and African Americans had a greater likelihood of receiving a schizophrenia diagnosis at admission. Additionally, patients diagnosed with schizophrenia had elevated positive and negative symptoms and were more likely to be male, single/unmarried, homeless, high inpatient service utilizers, involuntarily hospitalized, and to exhibit functional impairment at psychiatric hospital admission. To address elevated positive and negative symptoms of schizophrenia, functional impairment, social withdrawal, and high inpatient service utilization, promising psychosocial interventions should be adapted for racial and ethnic minority populations and utilized as an adjuvant to antipsychotic medication.


Assuntos
Grupos Étnicos , Hospitais Psiquiátricos/tendências , Transtornos do Humor/etnologia , Admissão do Paciente/tendências , Provedores de Redes de Segurança/tendências , Esquizofrenia/etnologia , Centros Médicos Acadêmicos/tendências , Adulto , Estudos de Coortes , Grupos Étnicos/psicologia , Feminino , Pessoas em Situação de Rua/psicologia , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , Estudos Retrospectivos , Esquizofrenia/diagnóstico
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