Increasing Influenza Vaccination Rates in a Primary Care Clinic: A Quality Improvement Study

Background According to the most recent CDC statistics, the influenza virus kills between 12,000 and 56,000 people per year in the United States. Although influenza vaccination is recommended each year, only about half of all Americans are actually receiving the vaccine annually. The goal of this quality improvement project was to increase influenza vaccination rates at a large academic medical center in Kentucky. At baseline, there was no standardized screening protocol in place prior to this study. Methods This study implemented a pre-test post-test design to evaluate the impact of a process change intervention on vaccination status from September 1, 2017 to February 28, 2018. Participants for this study were taken from the list of all patients currently active at this clinic via the electronic medical record. This study was conducted in four phases, using the Plan Do Study Act (PDSA) improvement model as a guide. Focus groups were held with clinic staff to establish a process change for influenza vaccination. Chart audits were done monthly and changes were made based on feedback from clinic staff and vaccination rates. Results Starting vaccination rates at the clinic were 0.65% in October 2017. The first full month of entire clinic compliance with the standardized process was February 1, 2018 to February 28, 2018, with vaccination rates of 30.42%. This was a 29.77% increase in vaccination rates during the study and a 5.2% increase from the 2016-2017 influenza vaccination rates of 25%. Conclusion Through a team based practice improvement process, overall vaccination rates increased at this clinic. MACRA reimbursement requirements were achieved at this clinic due to this vaccination increase. Creating a standardized screening and vaccination protocol was feasible and effective in increasing vaccination rates within this clinic

Balcones en la vivienda contemporánea. Conceptualización para el desarrollo de una taxonomía del balcón contemporáneo

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Phone contacts and treatment discontinuation predict survival cancer patients in a subsidized drug access program

Aim: Survival of patients with Hodgkin’s lymphoma is lower in in low- and middle-income countries, but factors leading to these outcomes are poorly understood. The objective of this study was to identify predictive factors associated with overall survival among cancer patients undergoing therapy in seven low- and middle-income countries. Materials & methods: A multicenter cohort was conducted in Egypt, Malaysia, Mexico, Peru, Philippines, Thailand and Ukraine. Results. A total of 460 patients were included. Phone-based support during patient follow-up and number of patients seen by the physician provided a positive impact, while the number of adverse events remains a predictor of death and physician decision to stop treatment. Conclusion: Furthers research on the potential benefit of phone-based programs to support patients with chronic diseases treatments should be explored in less developed countries

Ability to pay for medication: a clustering analysis of 1404 patients with the Patient Financial Eligibility Tool

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Factors impacting self-management ability in patients with chronic diseases in the United Arab Emirates, 2019

International audienceAim: Poor adherence to chronic disease therapy is a critical global problem that negatively effects the long-term therapy for chronic diseases, resulting in negative population health and economic effects. The WHO multidimensional model proposed a systems-based approach for improving adherence to chronic disease therapy. Patients & methods: In the current study, the WHO five-dimension framework was used to evaluate factors among, chronic-disease patients in the United Arab Emirates. Results: We show that patient’s understanding of disease, involvement in treatment decision, age more than 40 years, time spent with physician and fear of how patients were perceived by others were the most predictive factors associated with a high ability to self-manage a chronic disease. Conclusion: Sociocultural factors have an indirect impact on disease self-management

Au Diffusion in Amorphous and Polycrystalline Ni0.55nb0.45

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ATR (ataxia telangiectasia mutated- and Rad3-related kinase) is activated by mild hypothermia in mammalian cells and subsequently activates p53

In vitro cultured mammalian cells respond to mild hypothermia (27–33 °C) by attenuating cellular processes and slowing and arresting the cell cycle. The slowing of the cell cycle at the upper range (31–33 °C) and its complete arrest at the lower range (27–28 °C) of mild hypothermia is effected by the activation of p53 and subsequent expression of p21. However, the mechanism by which cold is perceived in mammalian cells with the subsequent activation of p53 has remained undetermined. In the present paper, we report that the exposure of Chinese-hamster ovary-K1 cells to mildly hypothermic conditions activates the ATR (ataxia telangiectasia mutated- and Rad3-related kinase)–p53–p21 signalling pathway and is thus a key pathway involved in p53 activation upon mild hypothermia. In addition, we show that although p38MAPK (p38 mitogen-activated protein kinase) is also involved in activation of p53 upon mild hypothermia, this is probably the result of activation of p38MAPK by ATR. Furthermore, we show that cold-induced changes in cell membrane lipid composition are correlated with the activation of the ATR–p53–p21 pathway. Therefore we provide the first mechanistic detail of cell sensing and signalling upon mild hypothermia in mammalian cells leading to p53 and p21 activation, which is known to lead to cell cycle arrest