The model predicts that treating asymptomatic hyperuricemia with allopurinol is most effective in preventing VE at a serum urate above 7.0 mg/dl in men and 5.0 mg/dl in women.
IntroductionAt Brigham and Women's Hospital, we identified the need for a comprehensive training program designed to prepare frontline staff to safely manage a patient with Ebola viral disease (EVD). The primary goal of this program was to ensure the safety of staff, patients, and the general public by training staff in the correct use of personal protective equipment (PPE) before, during, and after care of patients with EVD.MethodsWe delivered a 4-hour experiential training program to frontline health care professionals who would be expected to care for a patient with EVD. The program occurred in a simulation center with multiple flexible spaces and consisted of demonstration, multiple skills practice sessions, and a patient simulation case. We analyzed completed pre- and posttraining questionnaires. The questionnaire assessed their subjective level of confidence in three key areas: donning and doffing PPE, performing clinical skills while wearing PPE, and management of a contamination breach.ResultsThis program was effectively deployed in the STRATUS Center for Medical Simulation over a 4-month period, with 220 health care professionals participating in the training and 195 participants completing the pre-/posttraining questionnaires. Our intervention significantly increased the confidence of participants on each primary objective (p = .001 for all three stations).DiscussionThis interprofessional simulation-based program has been shown to be a well-received method of training clinicians to manage patients collaboratively during an EVD outbreak. Our intent is that the skills taught in this training program would also be transferable to management of other infectious diseases in the clinical setting.
diagnosis, and 27.5% occurred on the same day as the diagnosis. Conversely, only 29% of physical therapy visits began within 30 days of the diagnosis, and 45% occurred after 90 days. Within the 1-year timeframe, 5.0% underwent arthroscopic surgery and 4.6% underwent knee arthroplasty. Only 8% of patients that underwent arthroplasty and 26% of patients that underwent arthroscopy had physical therapy prior to their respective surgeries. Conclusions: Clinical practice patterns within the MHS do not seem to follow established guidelines for the use of physical therapy. These findings corroborate other findings of poor adherence with guidelines in the civilian healthcare system. When the initial choice for conservative treatment is between a corticosteroid injection or physical therapy, it seems that corticosteroid injection is more frequently chosen. There appears to be underutilization of a trial of physical therapy prior to surgical management for knee OA.Purpose: Osteoarthritis (OA) is a degenerative joint disease involving the cartilage, joint ligament, and subarticular bone and is a leading cause of disability and functional impairment in the United States (US). Erosive hand OA (EHOA) is a less common, more severe subtype of hand OA with inflammatory flares like swelling, redness, warmth and functional limitation of interphalangeal joints. Studies have reported significant relationship between patients' perception of their OA severity and impact on work productivity. However, there is lack of evidence on impact of EHOA on work productivity. This study sought to evaluate the loss of productivity at work and home in patients with EHOA using data collected from a prospective cross-sectional survey of the US representative population. Methods: Data was derived from a 2014 cross-sectional, internetbased survey of adults aged 18 to 85 years. All participants provided informed consent prior to participation in the survey and no personally identifiable information (PII) was collected. From completed surveys of 100,000 members of an online panel, participants with EHOA were identified based on their response to the question -"Has a doctor ever told you that you have any of the following health conditions?" Severity of EHOA was assessed by participants' response to the survey question -"How would you rate the severity of your condition?" (mild vs. moderate vs. severe). Work productivity loss was assessed by administering the work productivity and activity impairment (WPAI) questionnaire. WPAI has four domains: absenteeism (% time missed from work), presenteeism (% impairment while working/reduced onthe-job effectiveness), overall work impairment (% overall work impairment due to health problems) and activity impairment (% impairment in regular daily activities other than paid work). Higher domain scores indicate greater impairment. Weighting methodology was used in these analyses for results to be representative of the US general population. Results: The survey identified a sample of 245 patients with EHOA. Patients were ...
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