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Scott FI, Ehrlich O, Wood D, Viator C, Rains C, DiMartino L, McArdle J, Adams G, Barkoff L, Caudle J, Cheng J, Kinnucan J, Persley K, Sariego J, Shah S, Heller C, Rubin DT. Creation of an Inflammatory Bowel Disease Referral Pathway for Identifying Patients Who Would Benefit From Inflammatory Bowel Disease Specialist Consultation. Inflamm Bowel Dis 2023; 29:1177-1190. [PMID: 36271884 PMCID: PMC10393070 DOI: 10.1093/ibd/izac216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Indexed: 08/03/2023]
Abstract
BACKGROUND Recommendations regarding signs and symptoms that should prompt referral of patients with inflammatory bowel disease (IBD) to an IBD specialist for a consultation could serve to improve the quality of care for these patients. Our aim was to develop a consult care pathway consisting of clinical features related to IBD that should prompt appropriate consultation. METHODS A scoping literature review was performed to identify clinical features that should prompt consultation with an IBD specialist. A panel of 11 experts was convened over 4 meetings to develop a consult care pathway using the RAND/UCLA Appropriateness Method. Items identified via scoping review were ranked and were divided into major and minor criteria. Additionally, a literature and panel review was conducted assessing potential barriers and facilitators to implementing the consult care pathway. RESULTS Of 43 features assessed, 13 were included in the care pathway as major criteria and 15 were included as minor criteria. Experts agreed that stratification into major criteria and minor criteria was appropriate and that 1 major or 2 or more minor criteria should be required to consider consultation. The greatest barrier to implementation was considered to be organizational resource allocation, while endorsements by national gastroenterology and general medicine societies were considered to be the strongest facilitator. CONCLUSIONS This novel referral care pathway identifies key criteria that could be used to triage patients with IBD who would benefit from IBD specialist consultation. Future research will be required to validate these findings and assess the impact of implementing this pathway in routine IBD-related care.
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Affiliation(s)
- Frank I Scott
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Dallas Wood
- RTI International, Research Triangle Park, NC, USA
| | | | - Carrie Rains
- RTI International, Research Triangle Park, NC, USA
| | | | - Jill McArdle
- RTI International, Research Triangle Park, NC, USA
| | | | | | - Jennifer Caudle
- Department of Family Medicine, Rowan University School of Osteopathic Medicine, Sewell, NJ, USA
| | | | - Jami Kinnucan
- Section of Gastroenterology and Hepatology Mayo Clinic, Jacksonville, FL, USA
| | | | - Jennifer Sariego
- Penn Medicine At Home, University of Pennsylvania Health System, Bala Cynwd, PA, USA
| | - Samir Shah
- Division of Gastroenterology, Brown University, Providence, RI, USA
| | | | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
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Rodzinka M, Seebohm A, Pozniak E, Mosch L, De Luca L, McArdle J, Griebenow R, Velcheva M. Regulating for Bias in Medical Education - Reaction to the Pharmaceutical Industry Updated EFPIA Code of Practice. J Eur CME 2019; 8:1685771. [PMID: 31807368 PMCID: PMC6882466 DOI: 10.1080/21614083.2019.1685771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 12/03/2022] Open
Abstract
The European Federation of Pharmaceutical Industries and Associations (EFPIA) representing the pharmaceutical industry operating in Europe, introduced three codes of conduct between 2007 and 2013, which had a common goal of self-regulating interactions with healthcare professionals and patient organisations. This former set of rules was appreciated as a first self-regulatory step, although self-regulation itself is still considered by many stakeholders as insufficient to provide thorough transparency. EFPIA agreed to replace the separate codes with a new, consolidated EFPIA Code of Practice. The consolidated Code was broadened to include a new section on medical education that outlines the scope of member companies' engagement in “medical education activities?. This new section is controversial as it explicitly confirms that EFPIA members can be involved in medical education. In our view “independent Medical Education“ per se prevents industry from “organising“ events, i.e. industry must not influence content, presentation, choice of lecturers or publication of results. What is more, only events respecting this key principle (amongst others) can be recognised for purposes of continuing medical education/continuing professional development (CME/CPD). A substantial portion of the medical education is currently funded by the pharmaceutical and medical device industries. This practice carries a significant risk to public and personal health, especially if it is not adequately safeguarded by a high standard of accreditation. We are most concerned by the fact that EFPIA, representing the pharmaceutical industry, is trying to broaden the approach to medical education, to include activities that are not independently evaluated as free from undue influence and conflicts of interest. We believe that in order to preserve scientific integrity and independence, pharmaceutical companies must not be granted the right to influence the content of medical education.
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Affiliation(s)
| | | | | | - Lina Mosch
- European Medical Students' Association, Brussels, Belgium
| | - Lara De Luca
- European Medical Students' Association, Brussels, Belgium
| | | | - Reinhard Griebenow
- Continuing Medical Education - European Accreditators Registered Association, Cologne, Germany
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Biese K, Massing M, Platts-Mills TF, Young J, McArdle J, Dayaa JA, Simpson R. Predictors of 30-Day Return Following an Emergency Department Visit for Older Adults. N C Med J 2019; 80:12-18. [PMID: 30622198 DOI: 10.18043/ncm.80.1.12] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Older adults who are discharged following emergency department evaluation are at increased risk for functional decline and health care utilization, and are likely to benefit from close follow-up and additional care services. Understanding factors associated with a return emergency department visit within 30 days among older fee-for-service Medicare beneficiaries discharged to the community may assist in identifying patients at greatest need for interventions.METHOD Predictors from Medicare data and public sources were evaluated in a retrospective data analysis of North and South Carolina residents (2011-2012) aged ≥ 65 years using Cox regression proportion hazards ratios (HR) and 95% confidence intervals (CI) for time-to-30-day return events.RESULTS 30-day return rates varied markedly among the 167 emergency department facilities studied (18%-39%). Predictors of 30-day return included: age (85+ versus 65-74; HR, 1.24; 95% CI, 1.22-1.27); male sex (HR, 1.11; 95% CI, 1.14-1.10); non-white race (HR, 1.07; 95% CI, 1.05-1.09); Medicaid eligibility (HR, 1.20; 95% CI, 1.18-1.22); Charlson Score (3+ vs. 0; HR, 1.33; 95% CI, 1.30-1.36); and prior emergency department encounter (3+ vs. 0; HR, 2.35; 95% CI 2.30-2.41).LIMITATIONS This study was limited to Medicare beneficiaries in North Carolina and South Carolina, 2011-2012. Administrative claims data are limited to information required for financial reimbursement. Because we limited our study to older fee-for-service patients, our findings may not be generalizable to managed care patients and other age groups. Patients transferred to another emergency department or facility were not included in the analysis.CONCLUSION Factors predicting 30-day return to the emergency department or hospitalization suggest the potential for care transition improvement efforts to better meet patient needs, thereby potentially improving post-emergency department outcomes.
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Affiliation(s)
- Kevin Biese
- associate professor, Department of Emergency Medicine; clinical associate professor, Department of Internal Medicine, Division of Geriatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mark Massing
- director, Data & Analytics, North Carolina Community Health Center Association, Raleigh, North Carolina
| | - Timothy F Platts-Mills
- vice-chair of Research, Department of Emergency Medicine; adjunct assistant professor, Department of Internal Medicine, Division of Geriatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Josh Young
- analyst, The Carolinas Center for Medical Excellence, Cary, North Carolina
| | - Jill McArdle
- director of Federal Programs and Services, The Carolinas Center for Medical Excellence, Cary, North Carolina
| | - Joseph A Dayaa
- research associate, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ross Simpson
- professor, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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McArdle J, Sorensen A, Fowler CI, Sommerness S, Burson K, Kahwati L. Strategies to Improve Management of Shoulder Dystocia Under the AHRQ Safety Program for Perinatal Care. J Obstet Gynecol Neonatal Nurs 2018; 47:191-201. [PMID: 29304317 DOI: 10.1016/j.jogn.2017.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. DESIGN Mixed-methods implementation evaluation. SETTING/LOCAL PROBLEM Labor and delivery units (N = 18) in 10 states participating in the Safety Program for Perinatal Care (SPPC). Shoulder dystocia is unpredictable, requiring rapid and coordinated action. PARTICIPANTS Key informants were labor and delivery unit staff who implemented SPPC safety strategies. INTERVENTION/MEASUREMENTS The SPPC was implemented by using the TeamSTEPPS teamwork and communication framework and tools, applying safety science principles (standardization, independent checks, and learn from defects) to shoulder dystocia management, and establishing an in situ simulation program focused on shoulder dystocia to practice teamwork and communication skills. Unit staff received training, a toolkit, technical assistance, and unit-specific feedback reports. Quantitative data on unit-reported process improvement measures and qualitative data from staff interviews were used to understand changes in use of safety principles, teamwork/communication, and in situ simulation. RESULTS Use of shoulder dystocia safety strategies improved on the units. Differences between baseline and follow-up (10 months) were as follows: in situ simulation (50% vs. 89%), teamwork and communication (67% vs. 94%), standardization (67% to 94%), learning from defects (67% vs. 89%), and independent checks (56% vs. 78%). Interview data showed reasons to address management of shoulder dystocia, various approaches to implement safety practices, and facilitators and barriers to implementation. CONCLUSION Successful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The SPPC strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.
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Prescott C, Gruenewald T, Peters K, Achorn D, Gatz M, McArdle J. SELF-ADMINISTERED ADAPTIVE TESTS OF COGNITIVE ABILITIES BY COMPUTER TABLET AND THE INTERNET. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- C. Prescott
- University of Southern California, Los Angeles, California,
| | | | - K. Peters
- University of Southern California, Los Angeles, California,
| | - D. Achorn
- American Institutes for Research, Washington, District of Columbia
| | - M. Gatz
- University of Southern California, Los Angeles, California,
| | - J. McArdle
- University of Southern California, Los Angeles, California,
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Simmons D, Deakin T, Walsh N, Turner B, Lawrence S, Priest L, George S, Vanterpool G, McArdle J, Rylance A, Terry G, Little P. Diabetes UK Position Statement. Competency frameworks in diabetes. Diabet Med 2015; 32:576-84. [PMID: 25611804 DOI: 10.1111/dme.12702] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/28/2022]
Abstract
The quality, skills and attitudes of staff working in the healthcare system are central to multidisciplinary learning and working, and to the delivery of the quality of care patients expect. Patients want to know that the staff supporting them have the right knowledge and attitudes to work in partnership, particularly for conditions such as diabetes where 95% of all care is delivered by the person with diabetes themselves. With the current changes in the NHS structures in England, and the potential for greater variation in the types of 'qualified provider', along with the recent scandal at Mid-Staffordshire Hospital, staff need to be shown to be competent and named/accredited or recognized as such. This will help to restore faith in an increasingly devolved delivery structure. The education and validation of competency needs to be consistently delivered and assured to ensure standards are maintained for different roles and disciplines across each UK nation. Diabetes UK recommends that all NHS organizations prioritize healthcare professional education, training and competency through the implementation of a National Diabetes Competency Framework and the phased approach to delivery to address this need.
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Affiliation(s)
- D Simmons
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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McArdle J. The role of the Quality Improvement Organization. N C Med J 2013; 74:148-150. [PMID: 23802481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Quality Improvement Organizations (QIOs) are an unbiased source of quality improvement support and expertise for health care professionals and institutions across the nation. The Carolinas Center for Medical Excellence, the QIO in North Carolina and South Carolina, is supporting the advancement of the National Quality Strategy.
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Affiliation(s)
- Jill McArdle
- The Carolinas Center for Medical Excellence, 100 Regency Forest Dr, Ste 200, Cary, NC 27518, USA.
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Abstract
We report a 34-year-old woman who developed clinical botulism after the cosmetic use of an unapproved botulinum toxin type A. Electrophysiologic findings demonstrated complete denervation with complete electrical silence. She had a lengthy recovery but was able to ambulate by discharge.
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Affiliation(s)
- N Souayah
- Departments of Neurology, New Jersey Medical School of the University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA.
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Colón-Emeric C, Schenck A, Gorospe J, McArdle J, Dobson L, Deporter C, McConnell E. Translating evidence-based falls prevention into clinical practice in nursing facilities: Results and lessons from a quality improvement collaborative. J Am Geriatr Soc 2006; 54:1414-8. [PMID: 16970651 PMCID: PMC1839839 DOI: 10.1111/j.1532-5415.2006.00853.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the changes in process of care before and after an evidence-based fall reduction quality improvement collaborative in nursing facilities. DESIGN Natural experiment with nonparticipating facilities serving as controls. SETTING Community nursing homes. PARTICIPANTS Thirty-six participating and 353 nonparticipating nursing facilities in North Carolina. INTERVENTION Two in-person learning sessions, monthly teleconferences, and an e-mail discussion list over 9 months. The change package emphasized screening, labeling, and risk-factor reduction. MEASUREMENTS Compliance was measured using facility self-report and chart abstraction (n = 832) before and after the intervention. Fall rates as measured using the Minimum Data Set (MDS) were compared with those of nonparticipating facilities as an exploratory outcome. RESULTS Self-reported compliance with screening, labeling, and risk-factor reduction approached 100%. Chart abstraction revealed only modest improvements in screening (51% to 68%, P < .05), risk-factor reduction (4% to 7%, P = .30), and medication assessment (2% to 6%, P = .34). There was a significant increase in vitamin D prescriptions (40% to 48%, P=.03) and decrease in sedative-hypnotics (19% to 12%, P = .04) but no change in benzodiazepine, neuroleptic, or calcium use. No significant changes in proportions of fallers or fall rates were observed according to chart abstraction (28.6% to 37.5%, P = .17), MDS (18.2% to 15.4%, P = .56), or self-report (6.1-5.6 falls/1,000 bed days, P = .31). CONCLUSION Multiple-risk-factor reduction tasks are infrequently implemented, whereas screening tasks appear more easily modifiable in a real-world setting. Substantial differences between self-reported practice and medical record documentation require that additional data sources be used to assess the change-in-care processes resulting from quality improvement programs. Interventions to improve interdisciplinary collaboration need to be developed.
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Affiliation(s)
- Cathleen Colón-Emeric
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA.
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Goff DC, Massing MW, Bertoni AG, Davis J, Ambrosius WT, McArdle J, Duren-Winfield V, Sueta CA, Croft JB. Enhancing quality of heart failure care in managed Medicare and Medicaid in North Carolina: results of the North Carolina Achieving Cardiac Excellence (NC ACE) Project. Am Heart J 2005; 150:717-24. [PMID: 16209973 DOI: 10.1016/j.ahj.2004.12.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Accepted: 12/10/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate an intervention to improve the quality of care of patients with heart failure in managed Medicare and Medicaid plans in North Carolina. BACKGROUND Utilization of angiotensin-converting enzyme inhibitors (ACE-I) and beta-adrenergic receptor blockers (BB) in heart failure (HF) patients remains suboptimal despite evidence-based guidelines supporting their use. METHODS Managed care plans identified adult patients with HF during 2000 (preintervention) and from July 1, 2001, through June 30, 2002 (postintervention). Outpatient medical records were reviewed to obtain data regarding type of heart failure, demographics, comorbidities, and therapies. The intervention consisted of guideline summary dissemination, performance audit with feedback, patient-specific chart reminders, and patient activation mailings. RESULTS We sampled 1613 patients from 5 plans during the preintervention period and 1528 patients during the postintervention period. Assessment of left ventricular function (LVF) increased from 88.2% to 92.5% of patients (P < .0001). Among patients with moderate to severe left ventricular systolic dysfunction, there was no substantive change in treatment with ACE-I or vasodilators, whereas, appropriate treatment with BB increased from 48.3% (with another 11.9% with documented contraindications) to 67.9% (with another 7.5% with documented contraindications). The quality gap decreased from 39.8% to 24.6% (P < .0001). CONCLUSION LVF assessment improved despite high preintervention rates. Treatment rates with ACE-I and vasodilators remained high, but did not improve. Treatment rates with BB improved substantially translating into a significant public health benefit. Health-care payers should consider development of financial incentives to encourage collaborative quality improvement programs.
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Affiliation(s)
- David C Goff
- Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
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Sueta CA, Bertoni AG, Massing MW, McArdle J, Duren-Winfield V, Davis J, Croft JB, Goff DC. Managed Care Patients With Heart Failure: Spectrum of Ventricular Dysfunction and Predictors of Medication Utilization. J Card Fail 2005; 11:106-11. [PMID: 15732029 DOI: 10.1016/j.cardfail.2004.06.436] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Heart failure (HF) is a common clinical syndrome resulting in high morbidity and mortality. We examined the spectrum of ventricular dysfunction, and investigated the predictors of angiotensin-converting enzyme (ACE) inhibitor, beta-blocker, and spironolactone prescription in 1613 managed care patients with HF. METHODS AND RESULTS The diagnosis of HF was made by a HF discharge diagnosis or at least 3 physician encounters with a HF diagnosis during 2000. Logistic regression was used to identify predictors of medication prescription. Preserved systolic function was documented in 37%, moderate-severe systolic dysfunction in 31%, mild systolic in 14%, and 18% had inadequate documentation. The mean age was 69 years, 58% were women, 24% African American, and 60% were Medicare patients. Patients without HF type documented were the least aggressively treated. Coronary artery disease, hypertension, and diabetes predicted increased utilization of ACE inhibitor and beta-blocker therapies. History of nephropathy was associated with less ACE inhibitor prescription. Advancing age predicted less utilization of beta-blockers and spironolactone. Neither ethnicity nor gender influenced medication prescription. CONCLUSION Preserved left ventricular function was common. Documentation of significant systolic dysfunction was associated with improved quality of care. Interventions to encourage documentation of HF type and further study of HF with preserved systolic function are warranted.
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Affiliation(s)
- Carla A Sueta
- Medical Review of North Carolina, Cary, North Carolina 27511-8598, USA
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Bertoni AG, Duren-Winfield V, Ambrosius WT, McArdle J, Sueta CA, Massing MW, Peacock S, Davis J, Croft JB, Goff DC. Quality of heart failure care in managed Medicare and Medicaid patients in North Carolina. Am J Cardiol 2004; 93:714-8. [PMID: 15019875 DOI: 10.1016/j.amjcard.2003.11.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2003] [Revised: 11/17/2003] [Accepted: 11/17/2003] [Indexed: 11/24/2022]
Abstract
Use of angiotensin-converting enzyme (ACE) inhibitors and beta-adrenergic receptor blockers in patients with heart failure (HF) remains low despite the results of clinical trials and evidence-based guidelines that support their use. The quality of HF care in managed Medicare and Medicaid programs in North Carolina participating in a HF quality improvement program was assessed. Managed care plans identified adult patients with 1 inpatient or 3 outpatient claims for HF during 2000. A stratified random sample of 971 Medicare and 642 Medicaid patients' outpatient medical records from 5 plans were reviewed by trained nurse abstractors to obtain data regarding type of HF, demographics, comorbidities, and therapies. Left ventricular function assessment was performed in 88% of patients. Among 494 patients with systolic dysfunction, 86% were appropriately treated with respect to ACE inhibitors (73% prescribed, 13% had a documented contraindication). In contrast, beta-blocker therapy was appropriate in 61% (49% prescribed, 12% contraindication). There were no significant differences in drug use by insurance, gender, race, or age. Ventricular function assessment and ACE inhibitor prescription rates are higher than beta-blocker prescription rates among Medicare and Medicaid managed care patients in North Carolina. Opportunities for improvement remain, particularly for beta-blocker use.
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Affiliation(s)
- Alain G Bertoni
- Department of Public Health Sciences, Winston-Salem, North Carolina, USA
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13
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Goff DC, Massing MW, Bertoni AG, Davis J, Ambrosius WT, McArdle J, Duren-Winfield V, Sueta CA, Croft JB. 1077-73 Enhancing quality of heart failure care in managed medicare and medicaid in North Carolina: Results of the North Carolina achieving cardiac excellence (NC ACE) project. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pastoret PP, Sitrin R, Merten OW, Vincent Falquet JC, Schwanig M, Welin M, Hegger I, Neeleman R, van der Velden T, Urital A, Rene S, Behr-Gross ME, Smith M, McArdle J, Prior S, Schmidt C, Krell T, Chevalier M, Klein H, Rosskopf-Streicher U, Jaekel C. New vaccine production technologies and their impact on the use of animals. Dev Biol (Basel) 2003; 111:219-20. [PMID: 12678245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Goff DC, Sueta CA, Brown DW, McArdle J, Peacock S, Bertoni A. Utilization of ACE-1 and β-blocker therapy in managed care patients with heart failure: NC ACE project. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81547-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Non-neoplastic demyelinating processes of the brain with ring enhancing lesions and mass effect on MRI imaging, mimicking malignant brain tumours, are rare phenomena. We document the case of a 32 year old male with clinical, radiological and initial histological findings, suggestive of a malignant brain tumour. Additional investigations confirmed the diagnosis of multiple sclerosis. This case is significant as the lesion could not be easily distinguished from a malignant brain tumour on imaging alone. Cases such as this illustrate the importance of considering a demyelinating process in the differential diagnosis of tumour-like brain lesions.
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Affiliation(s)
- A Mujic
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
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Subekti DS, Tjaniadi P, Lesmana M, McArdle J, Iskandriati D, Budiarsa IN, Walujo P, Suparto IH, Winoto I, Campbell JR, Porter KR, Sajuthi D, Ansari AA, Oyofo BA. Experimental infection of Macaca nemestrina with a Toronto Norwalk-like virus of epidemic viral gastroenteritis. J Med Virol 2002; 66:400-6. [PMID: 11793394 DOI: 10.1002/jmv.2159] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Norwalk virus (NV) and Norwalk-like viruses (NLVs) are common etiologic agents of viral gastroenteritis. Viral gastroenteritis is a common disease that is highly transmissible, spreading rapidly through families, institutions, and communities. Because methods for in vitro cultivation of Norwalk etiologic agents are not available, information regarding this syndrome has come largely from studies in human volunteers. Sequential passaging of an NLV through an immunoincompetent newborn pigtail macaque (Macaca nemestrina) may allow for the adaptation of a human NLV to a primate host, thus providing an animal model for investigating this disease. A fecal filtrate of human origin containing NLV, Toronto virus P2-A, was obtained from a patient during an epidemic of viral gastroenteritis. The filtrate was administered via nasogastric tube to three newborn pigtailed macaques. Clinical illness, which was characterized by diarrhea, dehydration, and vomiting, occurred in three monkeys. Reverse transcription-polymerase chain reaction (RT-PCR) and oligonucleotide probe analysis of RNA extracted from the stool samples following infection revealed viral RNA in all inoculated monkeys. Infection was also transmitted experimentally by feeding two additional newborn macaques a fecal filtrate prepared from the three previously infected animals. Detection of viral RNA in the stools of animals that received the fecal filtrate indicates that viral replication occurred in association with clinical illness. The susceptibility of Macaca nemestrina to infection with a Norwalk-like agent will facilitate the study of the mechanisms of the pathogenesis of NLV. This system may also have the potential to serve as a vaccine test model for human epidemic viral gastroenteritis.
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Affiliation(s)
- D S Subekti
- U.S. Naval Medical Research Unit, No. 2, American Embassy, Jakarta, Indonesia
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McArdle J. ARDF response to USDA inspections and the inclusion of rats, mice and birds in the AWA. Contemp Top Lab Anim Sci 2001; 40:7. [PMID: 11599499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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McArdle J. Regulations governing the use of laboratory animals. JAMA 2001; 286:304-5. [PMID: 11466093 DOI: 10.1001/jama.286.3.304-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kelley M, McArdle J, Weiser R, Simpson R. How close is North Carolina to meeting Medicare's clinical priorities? N C Med J 2001; 62:212-9. [PMID: 11468985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The analyses upon which this publication is based were performed under Contract No. 500-99-NC03, entitled "Utilization and Quality Control Peer Review Organization for the State of North Carolina," sponsored by the Health Care Financing Administration, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.
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Affiliation(s)
- M Kelley
- Medical Review of North Carolina, PO Box 37309, Raleigh, NC 27627, USA.
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McArdle J. Legal protection for rats, mice, and birds: long overdue and the right thing to do. Comp Med 2001; 51:203-4. [PMID: 11924772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- J McArdle
- Alternatives Research & Development Foundation, Eden Prairie, Minnesota 55346-3000, USA
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Abstract
Pathologic splenic rupture in non-Hodgkin's lymphoma (NHL) is a rare event, with 32 cases previously reported. Initial presentation of NHL with this complication is even rarer. We report such a case in an 80-year-old man with mantle cell lymphoma (MCL). It is notable that of the previously reported cases of pathologic rupture, three have occurred in MCL, suggesting that patients with this uncommon subtype of NHL may be particularly vulnerable to pathologic splenic rupture. Following splenectomy the patient's disease behaved in a high-grade fashion. Despite an initially encouraging response, his disease ran an aggressive course and he succumbed within four months. This case demonstrates the presentation of MCL with pathologic splenic rupture, as well as the potentially highly malignant behaviour of the disease.
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Affiliation(s)
- A H Strickland
- Clinical Haematology & Medical Oncology Unit; Royal Hobart Hospital, Hobart, Australia
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McArdle J. Animal Welfare Act's changes deserve praise, not panic. Science 2000; 290:1299c-300c. [PMID: 17787231 DOI: 10.1126/science.290.5495.1299c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Corne J, Chupp G, Lee CG, Homer RJ, Zhu Z, Chen Q, Ma B, Du Y, Roux F, McArdle J, Waxman AB, Elias JA. IL-13 stimulates vascular endothelial cell growth factor and protects against hyperoxic acute lung injury. J Clin Invest 2000; 106:783-91. [PMID: 10995789 PMCID: PMC381393 DOI: 10.1172/jci9674] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hyperoxia is an important cause of acute lung injury. To determine whether IL-13 is protective in hyperoxia, we compared the survival in 100% O(2) of transgenic mice that overexpress IL-13 in the lung and of nontransgenic littermate controls. IL-13 enhanced survival in 100% O(2). One hundred percent of nontransgenic mice died in 4-5 days, whereas 100% of IL-13-overexpressing mice lived for more than 7 days, and many lived 10-14 days. IL-13 also stimulated VEGF accumulation in mice breathing room air, and it interacted with 100% (2) to increase VEGF accumulation further. The 164-amino acid isoform was the major VEGF moiety in bronchoalveolar lavage from transgenic mice in room air, whereas the 120- and 188-amino acid isoforms accumulated in these mice during hyperoxia. In addition, antibody neutralization of VEGF decreased the survival of IL-13-overexpressing mice in 100% (2). These studies demonstrate that IL-13 has protective effects in hyperoxic acute lung injury. They also demonstrate that IL-13, alone and in combination with 100% (2), stimulates pulmonary VEGF accumulation, that this stimulation is isoform-specific, and that the protective effects of IL-13 are mediated, in part, by VEGF.
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Affiliation(s)
- J Corne
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Abstract
Joseph McArdle examines the physiology of pancreatitis, discussing the nurse's contribution to the patient's recovery. He addresses the need for blood glucose monitoring during an acute episode, contrasts the risks associated with venepuncture and capillary sampling and identifies good practice in capillary blood glucose sampling.
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Abstract
This article describes the aetiology of oesophageal varices, the variety of treatment options available and the physiological and psychological nursing needs of patients undergoing these treatment regimes. Its purpose is to produce a balanced overview, looking at nursing care in the acute period and the long-term support required to meet the complex needs of these patients and their carers. After reading this article you should be able to: Identify what lifestyle risk factors are associated with patients who have oesophageal varices. Describe the underlying physiology that promotes the development of oesophageal varices. State what treatment options are available and their associated complications. Recognise the needs of carers and staff when attending to this client group. Prepare an action plan for the long-term support of a patient prone to further bleeding episodes.
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Affiliation(s)
- J McArdle
- Royal Liverpool University Hospitals Trust
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Teh BT, McArdle J, Chan SP, Menon J, Hartley L, Pullan P, Ho J, Khir A, Wilkinson S, Larsson C, Cameron D, Shepherd J. Clinicopathologic studies of thymic carcinoids in multiple endocrine neoplasia type 1. Medicine (Baltimore) 1997; 76:21-9. [PMID: 9064485 DOI: 10.1097/00005792-199701000-00002] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Thymic carcinoid is part of the multiple endocrine neoplasia type 1 (MEN1) syndrome occurring predominantly in male patients who were heavy smokers, presenting most commonly in middle age. In contrast with metastatic midgut carcinoids, MEN1-related thymic carcinoid is not associated with carcinoid syndrome, nor is it associated with Cushing syndrome, in contrast with sporadic thymic carcinoids. Local invasion and metastasis are common. Prognosis is poor because of late detection, lack of effective treatment, and the aggressive nature of the tumor. All patients with thymic carcinoids should be investigated for MEN1, including thorough clinical evaluation and family studies. Anterior mediastinal lesions in MEN1 male patients should be considered thymic carcinoids until proven otherwise. All male MEN1 patients and asymptomatic gene carriers should be warned of the risk of thymic carcinoids and the possible link to smoking. Computed tomography (CT) of the chest is recommended on first screening for MEN1 in male patients more than 25 years of age, followed by yearly chest X-rays and chest CT every 3 years. Prophylactic thymectomy should be carried out during subtotal or total parathyroidectomy on MEN1 patients.
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Affiliation(s)
- B T Teh
- Department of Molecular Medicine, Karolinska Hospital, Stockholm, Sweden
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Teh BT, McArdle J, Parameswaran V, David R, Larsson C, Shepherd J. Sporadic primary hyperparathyroidism in the setting of multiple endocrine neoplasia type 1. Arch Surg 1996; 131:1230-2. [PMID: 8911266 DOI: 10.1001/archsurg.1996.01430230112020] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal dominant disease characterized by neoplasia involving the parathyroid glands, the endocrine pancreas, the duodenum, and the anterior pituitary. The most commonly involved gland is the parathyroid gland, which has been found to be abnormal in 90% to 95% of all patients with MEN 1. The disease process is invariably multiglandular and histologically described as either hyperplasia or multiple adenoma, although the histological distinction between the 2 entities remains difficult and controversial. The prevalence of MEN 1 is approximately 0.002 in 100, whereas the prevalence of sporadic primary hyperparathyroidism due to a solitary adenoma is estimated to be as high as 1 in 100.(2.3) We report herein the first case of sporadic primary hyperparathyroidism in the setting of MEN 1 based on clinical, biochemical, pathological, and genetic studies.
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Affiliation(s)
- B T Teh
- Department of Molecular Medicine, Karolinska Hospital, Sweden
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Abstract
Characteristics of Child Behavior Profile (CBP) types were studied in a general population sample of 202 boys aged 6 to 11 years. Parents completed the Child Behavior Checklist and teachers simultaneously rated the Teacher's Report Form. Overall, 39.7% of the boys were classified within a CBP type: 28.8% Internalizing and 10.9% Externalizing. The most common specific type was Somatic Complaints. Teachers rated the Externalizing CBP boys as showing robust externalizing behaviors in school. Also, boys with Externalizing profile types showed severe degrees of psychopathology in both home and school environments. An intraclass correlation of .35 or greater was found to identify boys with sufficiently severe psychopathology to warrant further clinical evaluation. Findings in this general population sample appear consistent with previous results in outpatient samples, and extend our understanding of the validity and clinical value for CBP types.
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Affiliation(s)
- J McArdle
- Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey 17033
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Timoney PJ, Harrington A, McArdle J, O'Reilly P. Survival properties of the causal agent of contagious equine metritis 1977. Vet Rec 1978; 102:152. [PMID: 644850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Timoney P, O'Reilly P, McArdle J, Ward J. Attempted transmission of contagious equine metritis 1977 to other domestic animal species. Vet Rec 1978. [DOI: 10.1136/vr.102.7.152-a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Timoney PJ, O'Reilly PJ, McArdle J, Ward J. Attempted transmission of contagious equine metritis 1977 to other domestic animal species. Vet Rec 1978; 102:152. [PMID: 644849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Timoney PJ, McArdle J, O'Reilly PJ, Ward J. P mirabilis and CEM. Vet Rec 1978; 102:20-1. [PMID: 345595 DOI: 10.1136/vr.102.1.20-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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McArdle J. Impression management by alcoholics. Q J Stud Alcohol 1974; 35:911-6. [PMID: 4413790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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