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A review of adult asthma and the effectiveness of education programs in reducing symptoms

Family Medicine and Community Health 2015年第2期3卷 54-61页

作者： William Brett Perkison mohamad sidani Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA

Asthma is a chronic inflammatory disease that occurs in children and adults.The National Heart,Lung,and Blood Institute(NHLBI)recommends asthma self-management education to be essential in providing patients with the skills necessary to control asthma and improve outcomes.A number of studies have been conducted to assess the effectiveness of these educational programs in children;however,such studies have not demonstrated efficacy in adult populations.This review explores the epidemiology of asthma,the different categories of asthma based on demographic differences,and environmental triggers of asthma.We also discuss common medical options that are available to treat asthma.We then describe the components of an asthma education program and the effectiveness in improving patient outcomes.The literature review was conducted using the National Library of Medicine Pub Med search engine.Comprehensive reviews were focused on the English literature involving human subjects in the last 5 years.Randomized controlled trials were selected for a citation on each subject when available.The Expert Panel Report 3(EPR-3;Guidelines for the Diagnosis and Management of Asthma-Report 2007)was used as the primary reference source for standard of care treatment guidelines.Search terms included asthma,motivational interviewing,irritant-induced asthma,asthma education,home intervention,telemedicine,nitric oxide,asthma action plan,occupational asthma,IgE-mediated asthma,asthma guidelines,asthma prevalence,and asthma treatment.

关键词： Asthma asthma education home intervention occupational asthma irritant-induced asthma

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Adult immunization improvement in an underserved family medicine practice

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Family Medicine and Community Health 2015年第2期3卷 2-7页

作者： mohamad sidani Jaden Harris Roger J.Zoorob Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA

Objective:Vaccines prevent many cases of infectious disease,yet immunization campaigns are hindered by various barriers.This work presents the results of a quality improvement project addressing barriers to vaccine compliance in an underserved teaching practice by reducing missed opportunities and increasing provider and patient compliance rates for pneumococcal,Tdap,influenza,and zoster vaccines in adults.Methods:The study intervention aimed to address patient knowledge,provider knowledge and skills,proactive care coordination,and outreach and counselling of high-risk groups.Aggre-gate patient data from intervention at year-end were compared to the prior year.Outcome targets were as follows:improved vaccination rates by one-half of the difference between baseline and Healthy People 2020 goals;reduced patient refusals by 10%;and reduced missed opportunities by 50%.Results:All of the vaccination rates improved,but with mixed results regarding the target outcomes.The rates of vaccine refusal were mixed in terms of the direction of the change,the significance,and achieving targets.Missed opportunities all improved,but the significance was mixed and none reached targets.Conclusion:This project has helped to identify patient and provider knowledge of vacci-nation as a key to increasing compliance,and missed opportunities as the greatest challenge in achieving targets.The burden of documentation is significant on providers,and future work should focus on methods to improve the ease of documentation.Clinical outcomes and improvements were encouraging;however,it is clear that there remain challenges to reaching Healthy People 2020 goals within the study population and nationally.

关键词： Immunization vaccine practice improvement pneumococcal Tdap influenza zoster

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Temporal trends in colorectal cancer incidence among Asian American populations in the United States, 1994-2013

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Family Medicine and Community Health 2017年第1期5卷 56-64页

作者： Haijun Wang Maria C.Mejia de Grubb Sandra J.Gonzalez mohamad sidani Jianping Ma Roger J.Zoorob Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA Shenzhen Nanshan Center for Chronic Disease Control ShenzhenGuangdongChina

Objective:To investigate the incidence and trends in colorectal cancer(CRC)among Asian American populations in the United States.Methods:CRC incidence data from 1994 through 2013 were obtained from 13 Surveillance,Epidemiology,and End Results registries.SEER*Stat and IBM SPSS Statistics were used.Results:The age-adjusted incidence of CRC among Asian Americans decreased from 45.6 per 100,000 in 1994 to 33.0 per 100,000 in 2013,with the annual percent change being−1.8%(P<0.05).The incidences were higher for men,the elderly(aged 60 years or older),and several geographic areas.For those younger than 70 years,the rectal site was more affected compared with those aged 70 years or older,in whom the proximal site were more affected.Most patients presented with localized and regional stages.Men,80 years or older,in situ stage,and some geo-graphic areas such as Connecticut and California experienced significant incidence decreases in the 20-year observation period.Conclusion:Although CRC incidence has declined among Asian American populations in the United States in the past 2 decades,there are persistent differences by age and geographic areas.Further research is needed to guide the design and implementation of tailored strategies to reduce CRC outcome differences across Asian American populations.

关键词： Colorectal cancer proximal colon distal colon rectal cancer incidence trend

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Case-based audit and feedback around a decision aid improved antibiotic choice and duration for uncomplicated cystitis in primary care clinics

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Family Medicine and Community Health 2021年第3期9卷 10-18页

作者： Larissa Grigoryan Roger Zoorob George Germanos mohamad sidani Matthew Horsfield Fareed Khan Mohammad Zare Melanie Goebel Robert Atmar Barbara Trautner Family and Community Medicine Baylor College of MedicineHoustonTexasUSA Internal Medicine Desert Regional Medical CenterPalm SpringsCaliforniaUSA Family and Community Medicine University of Texas McGovern Medical SchoolHoustonTexasUSA Section of Infectious Diseases Department of MedicineBaylor College of MedicineHoustonTexasUSA Center for Innovations in Quality Effectiveness and SafetyMichael E.DeBakey Veterans Affairs Medical Center and Department of MedicineBaylor College of MedicineMichael E DeBakey VA Medical CenterHoustonTexasUSA

Objectives The objective of our study was to evaluate the impact of a multifaceted stewardship intervention on adherence to the evidence-based practice guidelines on treatment of uncomplicated cystitis in primary care.We hypothesised that our intervention would increase guideline adherence in terms of antibiotic choice and duration of treatment.Design A preintervention and postintervention comparison with a contemporaneous control group was performed.During the first two study periods,we obtained baseline data and performed interviews exploring provider prescribing decisions for cystitis at both clinics.During the third period in the intervention clinic only,the intervention included a didactic lecture,a decision algorithm and audit and feedback.We used a difference-in differences analysis to determine the effects of our intervention on the outcome and guideline adherence to antibiotic choice and duration.Setting Two family medicine clinics(one intervention and one control)were included.Participants All female patients with uncomplicated cystitis attending the study clinics between 2016 and 2019.Results Our sample included 932 visits representing 812 unique patients with uncomplicated cystitis.The proportion of guideline-adherent antibiotic regimens increased during the intervention period(from 33.2%(95%CI 26.9 to 39.9)to 66.9%(95%CI 58.4 to 74.6)in the intervention site and from 5.3%(95%CI 2.3 to 10.1)to 17.0%(95%CI 9.9 to 26.6)in the control site).The increase in guideline adherence was greater in the intervention site compared with the control site with a difference-in differences of 22 percentage points,p=0.001.Conclusion A multifaceted intervention increased guideline adherence for antibiotic choice and duration in greater magnitude than similar trends at the control site.Future research is needed to facilitate scale-up and sustainability of case-based audit and feedback interventions in primary care.

关键词： cystitis audit representing

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