4 results on '"Alissa Detz"'
Search Results
2. Language Concordance, Interpersonal Care, and Diabetes Self-Care in Rural Latino Patients
- Author
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Christine Noguera, Fatima Nunez de Jaimes, Alissa Detz, Chi-Hong Tseng, Carol M. Mangione, Leo S. Morales, and Gerardo Moreno
- Subjects
Adult ,Male ,medicine.medical_specialty ,Cross-sectional study ,Concordance ,Clinical Sciences ,MEDLINE ,Language barrier ,Interpersonal communication ,Rural Health ,Basic Behavioral and Social Science ,California ,Nursing ,Clinical Research ,Diabetes mellitus ,General & Internal Medicine ,Patient-Centered Care ,parasitic diseases ,Health care ,Behavioral and Social Science ,Internal Medicine ,Diabetes Mellitus ,Medicine ,Humans ,cardiovascular diseases ,Metabolic and endocrine ,Original Research ,Aged ,Physician-Patient Relations ,diabetes ,business.industry ,communication ,Rural health ,Communication Barriers ,Community Health Centers ,Hispanic or Latino ,Health Services ,Middle Aged ,medicine.disease ,Self Care ,Cross-Sectional Studies ,Diabetes Mellitus, Type 2 ,Socioeconomic Factors ,Family medicine ,language barriers ,Female ,Hispanic Americans ,business ,Type 2 - Abstract
BackgroundInterpersonal care (IPC) is increasingly emphasized as health care systems focus on implementing patient-centered care. Language barriers may be a particularly important influence on IPC ratings among rural Spanish-speaking Latinos.ObjectiveTo examine the associations between provider Spanish fluency and Spanish-speaking patients' ratings of IPC and between patient-provider language concordance and patient engagement in diabetes self-care activities.DesignCross-sectional survey combined with chart reviews.Setting/participantsTwo hundred fifty Latino adults with diabetes receiving care at safety-net community health centers in two rural California counties.Main measuresUsing a validated questionnaire, we assessed patient ratings of IPC in three areas: communication, decision-making, and interpersonal style. Patient-provider language concordance was measured by physician self-reported fluency in Spanish. We measured participation in diabetes self-care activities by patient self-report. The survey response rate was 68%.Key resultsPatients with language-concordant providers had more favorable IPC ratings (20% to 41% of language-discordant patients had optimal scores for IPC scales vs. 35% to 69% of language-concordant patients, p
- Published
- 2014
3. Signal and noise: Applying a laboratory trigger tool to identify adverse drug events among primary care patients
- Author
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Urmimala Sarkar, Alissa Detz, Claire Horton, Stacey Brenner, and Andrea López
- Subjects
Adult ,Male ,Drug ,Pediatrics ,medicine.medical_specialty ,Drug-Related Side Effects and Adverse Reactions ,media_common.quotation_subject ,Population ,030204 cardiovascular system & hematology ,diagnostic errors ,03 medical and health sciences ,0302 clinical medicine ,Ambulatory care ,Predictive Value of Tests ,medicine ,Electronic Health Records ,Humans ,Mass Screening ,030212 general & internal medicine ,education ,Mass screening ,Original Research ,Aged ,Quality of Health Care ,Retrospective Studies ,media_common ,education.field_of_study ,Hematologic Tests ,Primary Health Care ,business.industry ,Health Policy ,Medical record ,Retrospective cohort study ,Middle Aged ,3. Good health ,Patient safety ,Trigger tool ,Predictive value of tests ,Emergency medicine ,Female ,business - Abstract
Background The extent of outpatient adverse drug events (ADEs) remains unclear. Trigger tools are used as a screening method to identify care episodes that may be ADEs, but their value in a population with high chronic-illness burden remains unclear. Methods The authors used six abnormal laboratory triggers for detecting ADEs among adults in outpatient care. Eligible patients were included if they were >18 years, sought primary or urgent care between November 2008 and November 2009 and were prescribed at least one medication. The authors then used the clinical / administrative database to identity patients with these triggers. Two physicians conducted in-depth chart review of any medical records with identified triggers. Results The authors reviewed 1342 triggers representing 622 unique episodes among 516 patients. The trigger tool identified 91 (15%) ADEs. Of the 91 ADEs included in the analysis, 49 (54%) occurred during medication monitoring, 41 (45%) during patient self-administration, and one could not be determined. 96% of abnormal international normalised ratio triggers were ADEs, followed by 12% of abnormal blood urea nitrogen triggers, 9% of abnormal alanine aminotransferase triggers, 8% of abnormal serum creatinine triggers and 3% of aspartate aminotransferase triggers. Conclusions The findings imply that other tools such as text triggers or more complex automated screening rules, which combine data hierarchically are needed to effectively screen for ADEs in chronically ill adults seen in primary care.
- Published
- 2012
4. Levamisole Contaminated Cocaine Induced Cutaneous Vasculitis Syndrome
- Author
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Kellee T James, Zlatan Coralic, Hemal K. Kanzaria, and Alissa Detz
- Subjects
cutaneous vasculitis ,medicine.medical_specialty ,cocaine ,lcsh:Medicine ,Diagnostic Acumen ,Images in Emergency Medicine ,Eschar ,Cocaine ,Tongue ,emergency medicine ,Biopsy ,Medicine ,Past medical history ,levamisole ,medicine.diagnostic_test ,business.industry ,lcsh:R ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Cutaneous Vasculitis ,General Medicine ,Hepatitis C ,lcsh:RC86-88.9 ,Levamisole ,medicine.disease ,Rash ,Surgery ,medicine.anatomical_structure ,Emergency Medicine ,medicine.symptom ,Headaches ,business ,medicine.drug - Abstract
A 40-year-old woman presented to the emergency department with a chief complaint of a painful rash. She had noticed lesions on her skin accompanied by burning pain that intensified over a 24-hour period. The patient admitted to smoking “crack” cocaine 4 days prior to presentation. She reported having similar symptoms previously. Her complicated past medical history was significant for hepatitis C, anti-phospholipid antibody syndrome, migraine headaches, and chronic lower back pain. She endorsed smoking cigarettes and polysubstance abuse (marijuana, heroin, and daily cocaine use). The patient’s exam was notable for retiform purpuric skin lesions with eschar on her left external pinnae (Figure 1), tongue, roof of her mouth, and bilaterally on her upper and lower extremities (Figure 2). Pus was expressible on palpation of the tibial skin lesions. Laboratory evaluation revealed a white blood cell count of 3.1×109 cells/L and a positive urine toxicology screen for cocaine. A biopsy obtained from her right thigh during a prior similar presentation showed luminally-thrombosed fibrin-containing small vessels surrounded by neutrophils and nuclear dust. The adjacent dermis contained extravasated erythrocytes. Figure 1. Retiform purpuric skin lesions with eschar on pinnae. Figure 2. Retiform purpuric skin lesions with eschar on lower extremities. A vasculitic syndrome associated with levamisole-adulterated cocaine has become increasingly recognized. This syndrome is characterized by purpuric lesions in a retiform pattern that may become necrotic and are commonly distributed on the ears, face, and extremities,1 as evidenced by our patient. Typical laboratory findings include agranulocytosis, leukocopenia, and the production of anti-neutrophil cytoplasmic antibodies.1 There is no evidence for the optimal treatment of levamisole-induced cutaneous vasculitis syndrome. Steroids have been used, but have an unclear benefit. 2 Permanent discontinuation of levamisole-adulterated cocaine use should be advocated. When appropriate, surgical debridement has been used to contain the progression of necrotic tissue spread.2
- Published
- 2013
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