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La Crosse, WI, United States

Sharma U.,Mayo Clinic Health System | Klocke D.,Mayo Medical School
Journal of Interprofessional Care | Year: 2014

Historically, medicine and nursing has had a hierarchical and patriarchal relationship, with physicians holding monopoly over knowledge-based practice of medical care, thus impeding interprofessional collaboration. Power gradient prevents nurses from demanding cooperative patient rounding. We surveyed attitudes of nursing staff at our tertiary care community hospital, before and after implementation of a patient-centered interprofessional (hospitalist-nurse) rounding process for patients. There was a substantial improvement in nursing staff satisfaction related to the improved communication (7%-54%, p < 0.001) and rounding (3%-49%, p < 0.001) by hospitalist providers. Patient-centered rounding also positively impacted nursing workflow (5%-56%, p < 0.001), nurses' perceptions of value as a team member (26%-56%, p = 0.018) and their job satisfaction (43%-59%, p = 0.010). Patient-centered rounding positively contributed to transforming the hospitalist-nurse hierarchical model to a team-based collaborative model, thus enhancing interprofessional relationships. © 2014 Informa UK Ltd.

Lee S.,Mayo Clinic Health System | Bellolio M.F.,Mayo Medical School | Hess E.P.,Mayo Medical School | Erwin P.,Mayo Medical School | And 2 more authors.
Journal of Allergy and Clinical Immunology: In Practice | Year: 2015

Background: A biphasic reaction is a potentially life-threatening recurrence of symptoms after initial resolution of anaphylaxis without re-exposure to the trigger. The infrequent nature of these reactions has made them difficult to study and predict. Objective: The aim of this study was to evaluate the time of onset and predictors of biphasic anaphylactic reactions. Method: Original research studies that described biphasic reactions in case series or cohort studies were included. Studies that did not describe biphasic reactions and case series with less than 2 biphasic reactions were excluded. Data sources included MEDLINE, EMBASE, Web of Science, and Scopus from inception to January 2014 and bibliographies of included articles. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for dichotomous variables. Inconsistency among studies was assessed with the I2 statistic. Results: Twenty-seven observational studies that enrolled 4114 patients with anaphylaxis and 192 patients with biphasic reactions were included. The median time of symptom onset was 11 (range 0.2 to 72.0) hours. Food as the inciting trigger was associated with decreased risk (pooled OR 0.62, 95% CI: 0.4 to 0.94, I2 = 0%) and an unknown inciting trigger with increased risk (pooled OR 1.72, 95% CI: 1.0 to 2.95, I2 = 61%). Initial presentation with hypotension (pooled OR 2.18, 95% CI: 1.14 to 4.15, I2 = 79%) was also associated with the development of a biphasic reaction. Conclusion: Biphasic anaphylatic reactions were less likely among patients with food as an inciting trigger. Patients who present with hypotension or have an unknown inciting trigger may be at increased risk of a biphasic reaction. Clinicians should tailor observation periods for patients individually based on clinical characteristics. © 2015 American Academy of Allergy, Asthma & Immunology.

Theel E.S.,Mayo Medical School | Ramanan P.,Mayo Clinic Health System
Journal of Clinical Microbiology | Year: 2014

Histoplasma urine antigen (UAg) detection is an important biomarker for histoplasmosis. The clinical significance of low-positive (<0.6 ng/ml) UAg results was evaluated in 25 patients without evidence of prior Histoplasma infection. UAg results from 12/25 (48%) patients were considered falsely positive, suggesting that low-positive UAg values should be interpreted cautiously. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Warner N.,Mayo Clinic Health System
Current Opinion in Ophthalmology | Year: 2016

PURPOSE OF REVIEW: Myopia is progressing at faster than predicted rates for reasons that are still unknown. The public health consequences worldwide, are also becoming a burden on healthcare costs. There have been numerous studies published attempting to determine the cause of myopia progression and methods of prevention. RECENT FINDINGS: The review examines recent articles that have tried to explain myopia progression and the increase in prevalence across the globe. Additionally, this review provides up-to-date research on current treatment options and their efficacy. SUMMARY: Although this topic has been an increased area of study recently, even more studies are needed to find a definitive treatment for the prevention of myopia. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Kattel S.,Mayo Clinic Health System
Journal of Patient Safety | Year: 2016

BACKGROUND: Prompt, complete, and accurate information transfer at the time of discharge between hospital-based and primary care providers (PCPs) is needed for the provision of safe and effective care. PURPOSE OF THE STUDY: To evaluate timeliness, quality, and interventions to improve timeliness and quality of hospital discharge summaries. DATA SOURCES: PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus database published in English between January 2007 and February 2014 were searched. We also hand-searched bibliographies of relevant articles. STUDY SELECTION: Observational studies investigating transfer of information at hospital discharge (n = 7) and controlled studies evaluating interventions to improve timeliness and quality of discharge information (n = 12) were included. DATA EXTRACTION: We extracted data on availability, timeliness, and content of hospital discharge summaries and on the effectiveness of interventions targeting discharge summaries. Results of studies are presented narratively and using descriptive statistics. DATA SYNTHESIS: Across the studies, discharge summaries were completed within 48 hours in a median of 67% and were available to PCPs within 48 hours only 55% of the time. Most of the time, discharge summaries included demographics, primary diagnosis, hospital course, and discharge instructions. However, information was limited to pending test results (25%), diagnostic tests performed (60%), and postdischarge medications (78%). In 6 interventional studies, implementation of electronic discharge summaries was associated with improvement in timeliness but not quality. CONCLUSIONS: Delayed or insufficient transfer of discharge information between hospital-based providers and PCPs remains common. Creation of electronic discharge summaries seems to improve timeliness and availability but does not consistently improve quality. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved

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