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Continuous quality improvement methodology: a case study on multidisciplinary collaboration to improve chlamydia screening

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family medicine and Community Health 2019年第2期7卷 63-69页

作者： Allison Ursu Grant Greenberg Michael McKee department of family medicine University of Michigan Medical SchoolAnn ArborMichiganUSA department of family medicine Lehigh Valley Health NetworkAllentownPennsylvaniaUSA family medicine University of Michigan Medical SchoolAnn ArborMIUnited States

This article illustrates quality improvement(QI)methodology using an example intended to improve chlamydia screening in *** projects in healthcare provide great opportunities to improve patient quality and safety in a real-world healthcare setting,yet many academic centres lack training programmes on how to conduct QI *** choice of chlamydia screening was based on the significant health burden chlamydia poses despite simple ways to screen and *** the University of Michigan,we implemented a multidepartment process to improve the chlamydia screening rates using the plan-do-check-act *** to guide QI projects include the following:(1)assemble a motivated team of stakeholders and leaders;(2)identify the problem that is considered a high priority;(3)prepare for the project including support and resources;(4)set a goal and ways to evaluate outcomes;(5)identify the root cause(s)of the problem and prioritise based on impact and effort to address;(6)develop a countermeasure that addresses the selected root cause effectively;(7)pilot a small-scale project to assess for possible modifications;(8)large-scale roll-out including education on how to implement the project;and(9)assess and modify the process with a feedback *** this nine-step process,chlamydia screening rates increased from 29%to 60%.QI projects differ from most clinical research projects by allowing clinicians to directly improve patients’health while contributing to the medical science *** may interest clinicians wishing to conduct relevant research that can be disseminated through academic channels.

关键词： chlamydia screening education

Enhancing your scholarship as a family medicine junior faculty member

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family medicine and Community Health 2020年第3期8卷 42-46页

作者： Lisa K Rollins department of family medicine University of VirginiaCharlottesvilleVirginiaUSA

family medicine faculty are often expected to produce some form of scholarship as members of academic ***,this can be challenging given a range of contextual factors,including limited research capacity in many departments,increased competition for funding and individual challenges around balancing multiple roles,unclear expectations and lack of mentorship,to name a *** purpose of this reflection is to discuss seven content areas that might be addressed by faculty in order to promote scholarship,particularly among junior *** include:1)knowing your academic track and its associated expectations by rank,as well as the scholarship expectations within your department;2)considering your personal goals,interests,professional development needs and the relationship between meaningful work and burnout;3)starting small and building towards a niche content area;4)finding collaborators and the benefits of collaboration;5)seeking alignment between your scholarship and work that you already are performing;6)educating yourself about available outlets for scholarship and 7)seeking mentorship.

关键词： seeking yourself faculty

Weight loss maintenance after bariatric surgery

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World Journal of Clinical Cases 2023年第18期11卷 4241-4250页

作者： Young-Hye Cho Youngin Lee Jung In Choi Sae Rom Lee Sang Yeoup Lee department of family medicine Pusan National University School of MedicineYangsan 50612South Korea department of family medicine Pusan National University Yangsan HospitalYangsan 50612South Korea family medicine and Biomedical Research Institute Pusan National University Yangsan HospitalYangsan 50612South Korea department of Medical Education Pusan National University School of MedicineYangsan 50612South Korea

Metabolic and bariatric surgery(MBS)is an effective treatment for patients with morbid obesity and its ***,many patients experience weight regain(WR)after achieving their nadir *** the definition of WR is challenging as postoperative WR has various *** factors for WR after MBS include anatomical,racial,hormonal,metabolic,behavioral,and psychological factors,and evaluating such factors preoperatively is ***-term regular follow-up and timely treatment by a multidisciplinary team are important because WR after surgery is *** lifestyle interventions that focus on appropriate dietary education,physical activity education or interventions,and behavioral psychological interventions are suggested,more well-designed studies are needed because studies evaluating intervention methods and the effectiveness of WR prevention are *** drugs can be used to prevent and manage patients with WR after MBS;however,more research is needed to determine the timing,duration,and type of anti-obesity drugs used to prevent WR.

关键词： Metabolic and bariatric surgery Weight regain Obesity Roux-en-Y gastric bypass Laparoscopic sleeve gastrectomy

Curriculum development: a how to primer

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family medicine and Community Health 2019年第2期7卷 24-29页

作者： Jill Schneiderhan Timothy C Guetterman Margaret L Dobson department of family medicine University of MichiganAnn ArborMichiganUSA

Curriculum development is a topic everyone in the field of medical education will *** to the breadth of ages and types of care provided in family medicine,family medicine faculty in particular need to be facile in developing effective curricula for medical students,residents,fellows and for faculty *** the area of medical education,changing and evolving learning environments,as well as changing requirements necessitate new and innovative curricula to address these evolving *** process of developing a medical education curriculum can seem daunting but when broken down into smaller components can become very straightforward and easy to *** paper focuses on the curriculum development process using a six-step approach:performing a needs assessment,determining content,writing goals and objectives,selecting the educational strategies,implementing the curriculum and,finally,evaluating the *** process may serve as a template for family medicine educators,and all medical educators looking to design(or redesign)their own medical education curriculum.

关键词： everyone looking straight

Relationship between hyperuricemia and metabolic syndrome

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2007年第8期8卷 593-598页

作者： CHEN Li-ying ZHU Wen-hua CHEN Zhou-wen DAI Hong-lei REN Jing-jing CHEN Jian-hua CHEN Lei-qian FANG Li-zheng department of family medicine Sir Run Run Shaw Hospital School of Medicine Zhejiang University Hangzhou 310016 China

Objective: To investigate the relationship between metabolic syndrome and hyperuricemia. Methods: A total of 2 374 subjects who received health examination in our hospital from Jan. 2004 to Dec. 2006 were enrolled in our study. Hyperuricemia is defined as ≥7 mg/dl (in men) or ≥6.0 mg/dl (in women). Metabolic syndrome was defined using AHA/NHLBI (American Heart Association/National Heart, Lung, and Blood Institute) criteria. Results: (1) The overall prevalence of hyperuricemia was 13.10%. The condition was more common in men than in women (19.07% vs 3.42%). (2) Among men, uric acid concentration is statistically significantly positively correlated with waist circumference, blood pressure, and triglyceride. Uric acid is negatively correlated with serum high-density lipoprotein-cholesterol (HDL-C). Uric acid concentration is most strongly correlated with serum triglyceride (r=0.379) and waist circumference (r=0.297). Among women, statistically significant positive correlations were noted for the serum uric acid concentrations with waist circumference, triglyceride and fasting plasma glucose. Serum triglyceride (r=0.329) and waist circumference (r=0.234) are most strongly correlated with uric acid concentrations. (3) Men with hyperuricemia had a 1.634-fold increased risk of metabolic syndrome as compared with those without hyperuricemia odds ratio (OR)=1.634, P=0.000. Women with hyperuricemia had a 1.626-fold increased risk of metabolic syndrome (OR=1.626, P=0.000) as compared with those without hyperuricemia. Conclusion: Hyperuricemia is prevalent among Chinese population. Additionally, serum uric acid is positively associated with metabolic syndrome.

关键词： Hyperuricemia Metabolic syndrome Triglyceride

Correlation between non-alcoholic fatty liver with metabolic risk factors and brachial-ankle pulse wave velocity

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World Journal of Gastroenterology 2015年第35期21卷 10192-10199页

作者： Wen-Hua Zhu Li-Zheng Fang Chong-Rong Lu Hong-Lei Dai Jian-Hua Chen Qiao-Hua Qiao Li-Ying Chen department of family medicine Sir Run Run Shaw HospitalZhejiang University School of Medicine Sir Run Run Shaw Institute of Clinical medicine Zhejiang University

AIM: To assess the relationship between non-alcoholic fatty liver disease(NAFLD) with metabolic risk factors and brachial ankle pulse wave velocity(ba PWV). METHODS: A total of 8603 subjects(6662 males and 1941 females) were enrolled during an annual health check-up. Fatty liver was examined using a Philips HD 11 XE multi-function color Doppler diagnostic instrument, and ba PWV was determined using a novel arteriosclerosis detection device. Blood pressure(BP), fasting plasma glucose(FPG), waist circumference( W C), p l a s m a t r i g l y c e r i d e s( TG), h i g h- d e n s i t y lipoprotein(HDL), total cholesterol(TC), low-density lipoprotein(LDL) and uric acid(UA) were measured using standard methods. The relationship between fatty liver with metabolic risk factors and ba PWV was analyzed using regression analysis and the χ2 test. RESULTS: The values and abnormal rates of ba PWV were significantly different between NAFLD patients and non-NAFLD subjects(P < 0.001). In addition, the values of ba PWV were different by gender between NAFLD patients and non-NAFLD subjects. The OR values in females, males, and the entire population were 3.33, 1.67, and 2.13, respectively(P < 0.001). The incidence of high ba PWV increased with increasing degree of NAFLD(levels 0, 1, 2, and 3)(P < 0.001), which was 45.9%, 54.5%, 60.2%, and 71.4% in malesand 27.0%, 49.1%, 55.60%, and 60.0% in females(P < 0.001), respectively. Logistic regression analysis showed that the OR value for ba PWV in the nonmetabolic syndrome group and the metabolic syndrome group was 1.28 vs 1.14(males) and 2.55 vs 0.98(females). The OR values for ba PWV in the non-high-BP and high-BP, non-high-WC and high-WC, non-high-FPG and high-FPG, non-high-TG and high-TG, non-high-HDL and high-HDL, non-high-TC and high-TC, non-high-LDL and high-LDL, non-high-UA and high-UA groups were 3.38 vs 1.19, 3.50 vs 1.44, 2.80 vs 2.30, 3.29 vs 1.88, 3.03 vs 3.28, 3.35 vs 2.70, 3.93 vs 1.66, and 3.20 vs 2.34, respectively, in females

关键词： Non-alcoholic fatty liver Metabolic risk factors B

The burden of prostatic calculi is more important than the presence

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Asian Journal of Andrology 2017年第4期19卷 482-485页

作者： Bumsoo Park Seol Ho Choo department of Urology Kangnam General Hospital Yongin Korea department of family medicine Henry Ford Hospital Wayne State University School of Medicine Detroit MI United States department of Urology Ajou University School of Medicine Suwon Korea

Prostatic calculi are a common finding on transrectal prostate ultrasound. However, it remains unclear whether they are significantly associated with lower urinary tract symptoms （LUTS）. Our objective was to evaluate the association between prostatic calculi and LUTS with a focus on ＂calculi burden＂ because no studies have investigated prostatic calculi using ＂calculi burden＂ as an indicator. A total of 606 participants who received transrectal prostate ultrasound were divided into two groups according to the presence of prostatic calculi. ＂Calculi burden＂ was defined as the sum of the transverse diameters of all visible calculi within the prostate. The International Prostatic Symptom Score （IPSS） and a quality of life （QoL） score were collected. Both groups were compared, and a multivariate analysis was performed to predict moderate/severe LUTS. Linear correlation was evaluated between calculi burden and IPSS in the calculi group. No differences in total IPSS, voiding IPSS, or QoL score were detected between the two groups, but storage IPSS was significantly higher in the calculi group than that of controls. The multivariate analysis showed that the presence of prostatic calculi was not an independent predictor of moderate/severe LUTS. A positive linear correlation was detected between calculi burden and storage IPSS in calculi group （r = O. 148）. However, no correlation was found between calculi burden and total IPSS, voiding IPSS, or QoL score. Our results showed that the presence of prostatic calculi was not a significant factor predicting moderate/severe LUTS. However, an increased calculi burden may be associated with aggravating storage symptoms.

关键词： calculi lower urinary tract symptoms prostate prostatitis

Systematic review and meta-analysis of colon cleansing preparations in patients with inflammatory bowel disease

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World Journal of Gastroenterology 2017年第32期23卷 5994-6002页

作者： Sophie Restellini Omar Kherad Talat Bessissow Charles Ménard Myriam Martel Maryam Taheri Tanjani Peter L Lakatos Alan N Barkun division of gastroenterology department of medicine mcgill university health center division of internal medicine department of medicine la tour hospital and university of geneva division of gastroenterology department of medicine university of sherbrooke department of family medicine queens universitykingston department of clinical epidemiology mcgill university and the mcgill university health center

AIM To performed a systematic review and meta-analysis to determine any possible differences in terms of effectiveness, safety and tolerability between existing colon-cleansing products in patients with inflammatory bowel *** Systematic searches were performed( January 1980-September 2016) using MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge for randomized trials assessing preparations with or without adjuvants, given in split and non-split dosing, and in high(> 3 L) or low-volume(2 L or less) regimens. Bowel cleansing quality was the primary outcome. Secondary outcomes included patient willingness-torepeat the procedure and side effects/*** Out of 439 citations, 4 trials fulfilled our inclusion criteria(n = 449 patients). One trial assessed the impact of adding simethicone to polyethylene glycol(PEG) 4 L with no effect on bowel cleansing quality, but a better tolerance. Another trial compared senna to castor oil, again without any differences in term of bowel cleansing. Two trials compared the efficacy of PEG high-volume vs PEG low-volume associated to an adjuvant in split-dose regimens: PEG low-dose efficacy was not different to PEG high-dose; OR = 0.84(0.37-1.92). A higher proportion of patients were willing to repeat low-volume preparations vs high-volume; OR = 5.11(1.31-20.0). CONCLUSION In inflammatory bowel disease population, PEG lowvolume regimen seems not inferior to PEG high-volume to clean the colon, and yields improved willingness-torepeat. Further additional research is urgently required to compare contemporary products in this population.

关键词： Inflammatory bowel disease Polyethylene glycol Colonoscopy Meta-analysis

Systematic overview of hepatitis C infection in the Middle East and North Africa

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World Journal of Gastroenterology 2018年第27期24卷 3038-3054页

作者： Karima Chaabna Sohaila Cheema Amit Abraham Hekmat Alrouh Albert B Lowenfels Patrick Maisonneuve Ravinder Mamtani Institute for Population Health Weill Cornell Medicine-Qatar department of Surgery and the department of family medicine New York Medical College Division of Epidemiology and Biostatistics European Institute of Oncology

AIM To assess the quality of and to critically synthesize the available data on hepatitis C infections in the Middle East and North Africa(MENA) region to map evidence *** We conducted an overview of systematic reviews(SRs) following an a priori developed protocol(CRD42017076736). Our overview followed the preferred reporting items for systematic reviews and metaanalyses guidelines for reporting SRs and abstracts and did not receive any funding. Two independent reviewers systematically searched MEDLINE and conducted a multistage screening of the identified articles. Out of 5758 identified articles, 37 SRs of hepatitis C virus(HCV) infection in populations living in 20 countries in the MENA region published between 2008 and 2016 were included in our overview. The nine primary outcomes of interest were HCV antibody(anti-) prevalences and incidences in different at-risk populations; the HCV viremic(RNA positive) rate in HCV-positive individuals; HCV viremic prevalence in the general population(GP); the prevalence of HCV co-infection with the hepatitis B virus, human immunodeficiency virus, or schistosomiasis; the HCV genotype/subtype distribution; and the risk factors for HCV transmission. The conflicts of interest declared by the authors of the SRs were also extracted. Good quality outcomes reported by the SRs were defined as having the population, outcome, study time and setting defined as recommended by the PICOTS framework and a sample size > *** We included SRs reporting HCV outcomes with different levels of quality and precision. A substantial proportion of them synthesized data from mixed populations at differing levels of risk for acquiring HCV or at different HCV infection stages(recent and prior HCV transmissions). They also synthesized the data over long periods of time(e.g., two decades). Anti-HCV prevalence in the GP varied widely in the MENA region from 0.1%(study dates not reported) in the United Arab Emirates to 2.1%-13.5%(2003-2006) in

关键词： Hepatitis C meta-research risk factors incidence genotype Middle East and North Africa systematic review Micro-elimination Pakistan Gulf Cooperation Council