Summer 2009 - Volume 13 Number 3
5-2-1–Almost None: Parents' Perceptions of Changing Health-Related Behaviors in Their Obese Child
Clinical guidelines to prevent childhood overweight and obesity are clear but parents' perception of these key messages are less clear. Parents from 193 families indicated the importance of changing eating habits and increasing physical activity (63%), however eliminating sugary drinks (4%) was the only actionable behavior in the 5-2-1–Almost None message parents felt significantly more confident they could achieve.
Using Implementation and Dissemination Concepts to Spread 21st-Century Well-Child Care at a Health Maintenance Organization
Twenty-First Century Well-Child Care is a parent-centered, team-based, primary care model that includes online previsit assessments, facilitated through a Web-based diagnostic, management, tracking, and resource information tool. Validated models of team-based health care have multiple components that must be made compatible with complex sociotechnical systems-- interpersonal communication, work, coordination, and judgment
Use of a Computerized Medical Database and Reminder Letters to Increase Preventive Care Use in Kaiser Permanente Patients
Patients not seen by their primary care physician in more than one year ("low-utilizing patients") and overdue for preventive health care services were identified using Kaiser Permanente's electronic medical database. Outreach letters that target these patients may be an efficient and cost-effective way of improving patient use rates of preventive health care
A pilot program targeted at parents of newborns tested the hypothesis that education, specifically group education with phone follow-up, could reduce unnecessary newborn office visits while simultaneously increasing member satisfaction. Satisfaction was significantly higher in the intervention group, and there were 52% fewer unnecessary visits by parents, with even greater reduction in visits among those participating in at least one follow-up conference call
Nursing Responses to Transcultural Encounters: What Nurses Draw on When Faced with a Patient from Another Culture
In exploring nurses' experiences when they encounter patients from cultures other than their own and their perception of what helps them deliver culturally competent care, this research confirmed that nurses are drawing heavily on prior experience, including family experiences and experiences with friends and coworkers from different cultures. Schools of nursing are also providing valuable preparation for working with diverse populations
Laparoscopic Repair of Incisional and Other Complex Abdominal Wall Hernias.
Incisional hernia is one of the most common complications of abdominal surgery, with a reported occurrence rate of up to 20% after laparotomy, and with recurrence rates after primary repair reported to range from 24% to 54%. This review discusses standardized, well-researched techniques, and the group's surgical experience that have contributed to lowering reported recurrence rates after laparoscopic ventral hernia repair to <10%
During this interview, Dr Weed describes his electronic tool for applying medical knowledge to patient data--"coupling"--to aid the accuracy and completeness of diagnostics and treatment. In addition, he describes his view of the failing of the current medical education system, which fosters a misplaced faith in the efficacy of a physician's intellect
Biostatistics 101: Understanding Data
Research studies can generate complex data and results that require analysis to demonstrate the effect of therapies and interventions, to establish the efficacy or limitation of treatments, and to prove or to refute a scientific hypothesis. An understanding of biostatistics is critical to the researcher investigating clinical questions. Equally important is an appreciation of statistics by the reader and interpreter of published studies. This article, the first of a three-part series on statistics for clinicians, notes: types of data: quantitative (continuous or discrete) and qualitative (ordered or discrete); and describes data as measurements of the center and the distribution
Successful Treatment with Intravenous Immunoglobulin of Acute Flaccid Paralysis Caused by West Nile Virus
West Nile virus is one of the leading causes of insect-borne encephalitis and acute flaccid paralysis in the US. Acute flaccid paralysis manifests itself as a Guillain-Barré-like syndrome with generalized weakness and shortness of breath. We report a case involving a patient who presented with acute flaccid paralysis because of West Nile virus infection and was successfully treated with intravenous immunoglobulin from Israeli donors
Responding to the Language Challenge: Kaiser Permanente's Approach
A qualitative case study of the Kaiser Permanente San Francisco Medical Center's approach to developing linguistic access services and subsequent organizationwide initiatives: language-specific care modules focused on Chinese- and Spanish-speaking patients, a centralized Multicultural Services Center, improving interpreter services, optimizing use of bilingual staff, and creating a translation infrastructure
Image Diagnosis: Abnormal Plain Films from the Emergency Department
In image 1, acute epiglottitis looks like a thumbprint at the level of the hyoid bone. Although now relatively rare in children, it can occur in adults and remains an airway emergency. In image 2, free air under both hemidiaphragms is an ominous sign. Although it may be present in postoperative patients and has been reported following vigorous sexual activities
The risk for acute phosphate nephropathy is increased in patients with underlying chronic kidney disease, older age, and female sex; in patients taking angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, diuretics, nonsteroidal anti-inflammatory drugs; and after exposure to sodium-phosphate bowel-cleansing solutions
The Importance of Accurate Blood Pressure Measurement
The most important commonly performed office test is blood pressure measurement, yet it is considerably undervalued. Populationwide, small inaccuracies in blood pressure measurement can have considerable consequences. Overestimating true blood pressure by 5 mm Hg would lead to inappropriate treatment with antihypertension medication in almost 30 million Americans, with attendant exposure to adverse drug effects, the psychological effects of misdiagnosis, and unnecessary cost.
Most people in the West and the East wish to die at home; however, about 50% of Americans die in acute care hospitals. For better care of the dying elderly, this article is written to help American physicians understand the unique aspects of East Asian Confucian Ethics--the relational autonomy of family, Confucian creative self-transformation, and the unity of transcendence and the human being
The incidence of chronic kidney disease in Ethiopia is rising because of high blood pressure and diabetes mellitus; End Stage Renal Disease remains mostly fatal. Treatment considered the norm in industrialized countries is limited in Africa--dialysis is dependent on the availability of funding and charitable contributions; few governments cover the cost of renal replacement therapy
The World Health Organization's Evidenced-Based Approach to Chronic Diseases: Primary Prevention or Caring for End-Stage Disease?
Several hundred evidence-based (EB), national and global Clinical Practice Guidelines have been mapped by the World Health Organization (WHO) in the past ten years, allowing simulation and analysis of the health services' resource requirements of various countries. This approach reflects a balance between primary prevention interventions (eg, as demonstrated for hypertension and diabetes) and investing in ongoing EB Medicine treatment. Examples are cited from personal experience with WHO initiatives in Kyrgyzstan and Mexico
The Perfect System
Health care needs and deserves the perfect computer system. Here are ten criteria, detailed in a chapter from Health Care Will Not Reform Itself, for that ultimate American health care database system design: 1) patient focused, 2) complete, 3) accessible by all relevant parties, 4) current, 5) easy to use, 6) linked to care improvement programs, 7) accessible to patients as well as caregivers, 8) transportable, 9) interoperable, 10) confidential
On the Cover
Diagnosis: Atrial Flutter