Background: Personal financial literacy is associated with successfully managing debt, investing for retirement, and coping with financial strain. Though medical students occupy a financially unique niche due to high debt, little is known about their financial literacy. In this study, the authors' objective was to assess financial literacy among medical students and to evaluate demographic, educational, and financial factors associated with financial literacy.
BACKGROUND Hospital evidence‐based practice centers (EPCs) synthesize and disseminate evidence locally, but their impact on institutional decision making is unclear. OBJECTIVE To assess the evidence synthesis activities and impact of a hospital EPC serving a large academic healthcare system. DESIGN, SETTING, AND PARTICIPANTS Descriptive analysis of the EPC's database of rapid systematic reviews since EPC inception (July 2006–June 2014), and survey of report requestors from the EPC's last 4 fiscal years. MEASUREMENTS Descriptive analyses examined requestor and report characteristics; questionnaire examined report usability, impact, and requestor satisfaction (higher scores on 5‐point Likert scales reflected greater agreement). RESULTS The EPC completed 249 evidence reviews since inception. The most common requestors were clinical departments (29%, n = 72), chief medical officers (19%, n = 47), and purchasing committees (14%, n = 35). The most common technologies reviewed were drugs (24%, n = 60), devices (19%, n = 48), and care processes (12%, n = 31). Mean report completion time was 70 days. Thirty reports (12%) informed computerized decision support interventions. More than half of reports (56%, n = 139) were completed in the last 4 fiscal years for 65 requestors. Of the 64 eligible participants, 46 responded (72%). Requestors were satisfied with the report (mean = 4.4), and agreed it was delivered promptly (mean = 4.4), answered the questions posed (mean = 4.3), and informed their final decision (mean = 4.1). CONCLUSIONS This is the first examination of evidence synthesis activities by a hospital EPC in the United States. Our findings suggest hospital EPCs can efficiently synthesize and disseminate evidence addressing a range of clinical topics for diverse stakeholders, and can influence local decision making. Journal of Hospital Medicine 2016;11:185–192. © 2015 Society of Hospital Medicine
showed focal changes. Alternating histologic changes were seen in only 3 nonmosaic cases (4.41%) (Darier disease in 1 and Dowling-Degos disease in 2). Overall, focal changes with skipping of epidermis was seen significantly more frequently in blaschkoid dermatoses (in 37.7% vs in 4.41% [P \.001]).Roughly one-third of the blaschkoid dermatoses in our study showed an alternating histologic pattern, which is significantly greater than in nonmosaic dermatoses. Of these, linear EHK and ILVEN showed the pattern most consistently. In a large study of 167 epidermal nevi that included several variants such as EHK, psoriasiform ILVEN, porokeratosis-like, focal acantholytic dyskeratosis, and nevus comedonicus, alternating histologic changes were reported only for ILVEN. 2 Recently, Ross et al 1 described this finding in mosaic EHK. The basis of this histologic pattern is not clear. Actinic keratosis shows an alternating pattern of parakeratosis due to the sparing of follicular structures, 3 whereas the cornoid lamellae in porokeratotic eccrine ostial and dermal duct nevus overlie acrosyringia 4 ; however, a relationship with adnexal structures was not seen in any of our cases. Mosaicism is characterized by mutant and nonmutant cell lines in an organism. Our findings raise the question whether this coexistence of 2 cell populations extends to the tissue level even within lesional skin in mosaic disorders. Gene and expression studies may help answer this question. Also, why only some blaschkoid dermatoses show this distinctive histologic pattern is not clear. Our study is limited by the retrospective study design and the relatively small number of individual entities.
Background: In 2006, our healthcare system created a hospital Evidence-based Practice Center (EPC) to support the local delivery of high-quality, safe and high value patient care. Since then, the importance of healthcare staff work life has also been highlighted, and together these four elements form the Quadruple Aim framework. Synergistic to this Aim, the Magnet ® program promotes and recognizes organizational nursing excellence.Objective: To examine the EPC's work to inform nursing policy and practice in support of the goals of the Quadruple Aim framework and Magnet ® designation.Methods: Methods used included the following: (1) descriptive analysis of the hospital EPC's database of rapid reviews; and (2) administration of a 40-item electronic questionnaire to nurses who requested an EPC review during fiscal years (FY) 2015 and 2016.Results: Of 308 rapid reviews completed in the EPC's first 10 years, 59 (19%) addressed nursing topics. The proportion of reviews relevant to nursing increased from 5% (2/39) in the center's first 2 years to 44% (25/60) in FY 2015-2016. The majority of nursing reviews (39/59) examined processes of care. Of 23 nurses eligible to participate in the survey, 21 responded (91%). Nurses with administrative or managerial responsibilities requested 70% of reviews; clinical nurse specialists and bedside nurses requested 17% and 9%, respectively. Reviews were used to support clinical program development (48%), provide clinical guidance (33%), update nursing policies or procedures (24%) and develop training and curricula (24%). Nurses were satisfied with the hospital EPC reviews (mean; 4.7/5), and 95% indicated they were likely to request a future review.Linking Evidence to Action: A dedicated hospital EPC in partnership with nursing offers a unique mechanism for promoting a culture of evidence-based practice. Nurses at all organizational levels use the services of a hospital EPC to inform nursing policy and practice and are highly satisfied with the process, supporting the Quadruple Aim and Magnet ® designation.
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