Community Health: A Patient Satisfaction Inquiry at Puentes de Salud, a Health and Wellness Clinic Centering the Latinx Community in Philadelphia, PA

Free healthcare clinic models contribute the health and wellness of a community providing essential preventative and acute healthcare screening and diagnosis, mitigating negative health outcomes and higher healthcare costs for the individual. Current research supports optimizing community health through knowledge gained from frequent assessment of patient satisfaction and perceived barriers to healthcare. This study examined the level of patient satisfaction at Puentes de Salud (Puentes), a nonprofit healthcare clinic serving Philadelphia’s Latinx migrant community. Utilizing a validated and reliable survey instrument that captures patient satisfaction with healthcare, Spanish or English- speaking patients (n= 79) 18-89 years of age completed a self-administered survey. In addition, a demographic questionnaire with open ended clinic inquiry questions was developed to assesses healthcare access barriers. Participants reported a higher level of satisfaction with higher number of clinic visits but did not report higher scores with more years associated with the clinic. Appointment reminders, improving communication/ answering phone calls, and access to specialty services were suggested to optimize participant health. Improving patient satisfaction and identifying perceived barriers to healthcare presents a unique opportunity to incorporate community needs at Puentes to ensure future growth and utilization of the clinic

Psychometric Properties of the Kansas City Cardiomyopathy Questionnaire (KCCQ)

BACKGROUND: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a well-established instrument used to evaluate the health status of heart failure (HF) patients. There has been a lack of clarity about the best way to conceptualize the KCCQ. The purpose of this investigation of the KCCQ was to: (1) explore the factor structure with an exploratory factor analyses; (2) perform reliability and validity testing to determine the best factor solution for item groupings; and (3) determine the most meaningful components of health status captured by the KCCQ. METHODS AND RESULTS: A secondary analysis of data from 280 adults with stage-C HF enrolled from three US northeastern sites was conducted to test the KCCQ subscale structure. Criterion-related validity for the Self-efficacy subscale was tested with the Dutch Heart Failure Knowledge Scale and the Self-care of Heart Failure Index Self-care Confidence Scale. Overall, internal consistency reliability (Cronbach\u27s alpha) for the KCCQ and subscales was 0.92, social interference (seven items, 0.90), physical limitation (four items, 0.84), symptoms (eight items, 0.86), independent care (two items, 0.80), and self-efficacy (two items, 0.63). Two items failed to correspond to a previously identified factor so the independent care subscale was added. Items intending to measure quality of life were loaded in the social interference subscale. CONCLUSIONS: We recommend eliminating the quality of life subscale and including those items in the social interference subscale, and eliminating the self-efficacy items and re-evaluating the items related to independent care

Ketorolac Use and Incidence of Postoperative Bleeding in an ERAS Colorectal Surgical Population: A Quality Analysis of Practice

Background Ketorolac is an effective analgesic adjunct and is currently used in Enhanced Recovery After Surgery (ERAS) protocols. However, investigation into its safety profile is warranted in specific surgical populations. This Quality Improvement (QI) study sought to examine the association of ketorolac to increased postoperative bleeding risk, increased postoperative renal impairment, and 30-day readmission within an ERAS protocol for colorectal surgery. Methods A retrospective review was conducted of 158 patients enrolled in an existing ERAS protocol for colorectal surgery with at least one dose of ketorolac administered in the perioperative period. Outcomes of postoperative bleeding, 30-day readmission, and preoperative/postoperative serum creatinine levels were assessed. Results There was no statistically significant difference in the incidence of postoperative bleeding compared to a known population. There was a significant association of 30-day readmissions with documented evidence of bleeding (P = 0.037). There was no significant change in the preoperative and postoperative serum creatinine. Multivariate logistic regression analysis found no association of postoperative bleeding with pre-existing chronic non-steroidal anti-inflammatory drug (NSAID) use or preoperative serum creatinine. Conclusions Ketorolac is not associated with an increased risk of postoperative bleeding in colorectal ERAS surgical patients. However, postoperative bleeding does predict the likelihood for 30-day readmissions

Advancing a National Agenda to Eliminate Disparities in Pain Care: Directions for Health Policy, Education, Practice, and Research

Abstract available at publisher's web site

The ACTTION-APS-AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions.

Objective: With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (e.g., pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain. Setting: Consensus report following expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM). Methods: As a complement to a taxonomy recently developed for chronic pain, the ACTTION public-private partnership with the US Food and Drug Administration, the APS, and the AAPM convened a consensus meeting of experts to develop an acute pain taxonomy using prevailing evidence. Key issues pertaining to the distinct nature of acute pain are presented followed by the agreed-upon taxonomy. The ACTTION-APS-AAPM Acute Pain Taxonomy will include the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Future efforts will consist of working groups utilizing this taxonomy to develop diagnostic criteria for a comprehensive set of acute pain conditions. Perspective: The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) is a multidimensional acute pain classification system designed to classify acute pain along the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Conclusions: Significant numbers of patients still suffer from significant acute pain, despite the advent of modern multimodal analgesic strategies. Mismanaged acute pain has a broad societal impact as significant numbers of patients may progress to suffer from chronic pain. An acute pain taxonomy provides a much-needed standardization of clinical diagnostic criteria, which benefits clinical care, research, education, and public policy. For the purposes of the present taxonomy, acute pain is considered to last up to seven days, with prolongation to 30 days being common. The current understanding of acute pain mechanisms poorly differentiates between acute and chronic pain and is often insufficient to distinguish among many types of acute pain conditions. Given the usefulness of the AAPT multidimensional framework, the AAAPT undertook a similar approach to organizing various acute pain conditions

Simplified Airway Risk Index and The Electronic Health Record

Abstract Background and Relevance: Despite advanced airway management practices, unanticipated airway complications remain. Intubation failures are estimated at 0.1%, and difficult tracheal intubation at 7.4%.1 Critical care nurses, intensivists and anesthesia providers must be aware of potential factors for high risk for airway management. Local Problem and Purpose/Objectives: Intubation complications may cause comorbidities and death.1 A quality improvement (QI) project examined discrepancies between a standardized checklist, the Simplified Airway Risk Index (SARI), and electronic health record (EHR) documentation. Methods: This descriptive QI project conforming to SQUIRE 2.0 Guidelines was conducted in an academic medical center and involved a systematic evaluation of airway management risk in 120 critically ill patients. SARI scoring criteria (high-risk score ≥ 4) was obtained from EHR information and patient assessments performed by specially trained critical care nurses. Interventions: A DNP Nurse Anesthesia student collected and validated all findings. After determining a SARI risk score, a review of EHR documentation was conducted to support SARI scores. Data was analyzed using descriptive statistics, intraclass correlation coefficient (ICC), and linear regression analysis. Results: The SARI classified 23.3% (n = 28) of patients as high risk for difficult airway management, but only 2.5% (n = 3) of patients were identified in the EHR (ICC = .006, P = .448 indicating poor reliability between data sources). Neither age, gender or body mass index predicted SARI scores (P = .935). Conclusions: The discrepancy between the SARI scoring and EHR documentation supports the need for standardized methods to identify airway management risks