11 results on '"Alissa Detz"'
Search Results
2. Sa1643 – Identification of Primary Care Patients At Risk of Nonalcoholic Steatohepatitis (NASH) with Advanced Fibrosis Using the Nafld Fibrosis Score and Abdominal Ultrasound
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Edward W. Holt, Namphuong Tran, and Alissa Detz
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Nonalcoholic steatohepatitis ,medicine.medical_specialty ,Hepatology ,business.industry ,Abdominal ultrasound ,Internal medicine ,Fibrosis score ,Gastroenterology ,medicine ,Primary care ,business ,Advanced fibrosis - Published
- 2019
3. Improving Health Care for the Future Uninsured in Los Angeles County: A Community-Partnered Dialogue
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Hemal K. Kanzaria, Loretta Jones, Anish P. Mahajan, Alissa Detz, Elizabeth S. Barnert, Sharat P. Iyer, Gery Ryan, Efrain Talamantes, Timothy J. Daskivich, and Andrea Jones
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CARE Act ,Medically Uninsured ,Epidemiology ,business.industry ,Patient Protection and Affordable Care Act ,Participatory action research ,Original Report: Public Health ,General Medicine ,Los Angeles ,Public-Private Sector Partnerships ,Health Services Accessibility ,Local community ,Nursing ,General partnership ,Health care ,Medicine ,Humans ,Misinformation ,Community Health Services ,business ,Qualitative research - Abstract
Objectives: To understand the health care access issues faced by Los Angeles (LA) County’s uninsured and residually uninsured after implementation of the Affordable Care Act (ACA) and to identify potential solutions using a community-partnered dialogue.Design: Qualitative study using a community-partnered participatory research framework.Setting: Community forum breakout discussion.Discussants: Representatives from LA County health care agencies, community health care provider organizations, local community advocacy and service organizations including uninsured individuals, and the county school district.Main Outcome Measures: Key structural and overarching value themes identified through community-partnered pile sort, c-coefficients measuring overlap between themes.Results: Five overarching value themes were identified – knowledge, trust, quality, partnership, and solutions. Lack of knowledge and misinformation were identified as barriers to successful enrollment of the eligible uninsured and providing health care to undocumented individuals. Discussants noted dissatisfaction with the quality of traditional sources of health care and a broken cycle of trust and disengagement. They also described inherent trust by the uninsured in “outsider” community-based providers not related to quality.Conclusions: Improving health care for the residually uninsured after ACA implementation will require addressing dissatisfaction in safety-net providers, disseminating knowledge and providing health care through trusted nontraditional sources, and using effective and trusted partnerships between community and health care agencies with mutual respect. Community-academic partnerships can be a trusted conduit to discuss issues related to the health care of vulnerable populations. Ethn Dis. 2015; 25(4)487- 494; doi:10.18865/ed.25.4.487
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- 2015
4. Language Concordance, Interpersonal Care, and Diabetes Self-Care in Rural Latino Patients
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Christine Noguera, Fatima Nunez de Jaimes, Alissa Detz, Chi-Hong Tseng, Carol M. Mangione, Leo S. Morales, and Gerardo Moreno
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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
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- 2014
5. Infectious complication of Blunt head injury
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Hemal K. Kanzaria and Alissa Detz
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Male ,medicine.medical_specialty ,Brain Abscess ,Critical Care and Intensive Care Medicine ,Head trauma ,Blunt ,Infectious complication ,Head Injuries, Closed ,medicine ,Humans ,integumentary system ,Skull Fractures ,business.industry ,Head injury ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Rural hospital ,Anti-Bacterial Agents ,Skull ,medicine.anatomical_structure ,Emergency Medicine ,Forehead ,Physical exam ,business ,Tomography, X-Ray Computed - Abstract
A middle-aged man presented to a rural hospital in South Africa with a history of head trauma. He reported being attacked and stoned 2 weeks prior, and subsequently noticed drainage from a wound he sustained during the assault. On physical exam, he had a 3 cm×2 cm forehead wound with purulent drainage. Neurologic exam showed no focal deficits. Lateral and frontal skull films …
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- 2013
6. Long-Term Doctor-Patient Relationships: Patient Perspective From Online Reviews
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Andrea López, Alissa Detz, and Urmimala Sarkar
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Adult ,medicine.medical_specialty ,020205 medical informatics ,Patients ,Doctor patient ,media_common.quotation_subject ,social media ,Health Informatics ,02 engineering and technology ,Primary care ,lcsh:Computer applications to medicine. Medical informatics ,Health Services Accessibility ,03 medical and health sciences ,primary care ,0302 clinical medicine ,Nursing ,0202 electrical engineering, electronic engineering, information engineering ,Medicine ,Personality ,Humans ,Social media ,030212 general & internal medicine ,Big Five personality traits ,Competence (human resources) ,media_common ,Original Paper ,Internet ,Physician-Patient Relations ,business.industry ,lcsh:Public aspects of medicine ,lcsh:RA1-1270 ,Continuity of Patient Care ,3. Good health ,Office staff ,Family medicine ,qualitative ,lcsh:R858-859.7 ,The Internet ,Clinical Competence ,business - Abstract
BackgroundContinuity of patient care is one of the cornerstones of primary care. ObjectiveTo examine publicly available, Internet-based reviews of adult primary care physicians, specifically written by patients who report long-term relationships with their physicians. MethodsThis substudy was nested within a larger qualitative content analysis of online physician ratings. We focused on reviews reflecting an established patient-physician relationship, that is, those seeing their physicians for at least 1 year. ResultsOf the 712 Internet reviews of primary care physicians, 93 reviews (13.1%) were from patients that self-identified as having a long-term relationship with their physician, 11 reviews (1.5%) commented on a first-time visit to a physician, and the remainder of reviews (85.4%) did not specify the amount of time with their physician. Analysis revealed six overarching domains: (1) personality traits or descriptors of the physician, (2) technical competence, (3) communication, (4) access to physician, (5) office staff/environment, and (6) coordination of care. ConclusionsOur analysis shows that patients who have been with their physician for at least 1 year write positive reviews on public websites and focus on physician attributes.
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- 2013
7. Signal and noise: Applying a laboratory trigger tool to identify adverse drug events among primary care patients
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Urmimala Sarkar, Alissa Detz, Claire Horton, Stacey Brenner, and Andrea López
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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.
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- 2012
8. Case 37
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Alissa Detz
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- 2012
9. What patients say about their doctors online: a qualitative content analysis
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Urmimala Sarkar, Andrea López, Alissa Detz, and Neda Ratanawongsa
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medicine.medical_specialty ,Physician-Patient Relations ,business.industry ,education ,Coding (therapy) ,Interpersonal communication ,Affect (psychology) ,Online Systems ,Physicians, Primary Care ,United States ,Competence (law) ,Patient satisfaction ,Patient Satisfaction ,Family medicine ,Internal Medicine ,Urban Health Services ,Medicine ,Humans ,The Internet ,Clinical Competence ,business ,Qualitative Research ,Qualitative research ,Dyad ,Original Research - Abstract
Doctor rating websites are a burgeoning trend, yet little is known about their content. To explore the content of Internet reviews about primary care physicians. Qualitative content analysis of 712 online reviews from two rating websites. We purposively sampled reviews of 445 primary care doctors (internists and family practitioners) from four geographically dispersed U.S. urban locations. We report the major themes, and because this is a large sample, the frequencies of domains within our coding scheme. Most reviews (63%) were positive, recommending the physician. We found a major distinction between global reviews, “Dr. B is a great doctor.” vs. specific descriptions which included interpersonal manner, “She always listens to what I have to say and answers all my questions.”; technical competence “No matter who she has recommended re: MD specialists, this MD has done everything right.”; and/or systems issues such as appointment and telephone access. Among specific reviews, interpersonal manner “Dr. A is so compassionate.” and technical competence “He is knowledgeable, will research your case before giving you advice.” comments tended to be more positive (69% and 80%, respectively), whereas systems-issues comments “Staff is so-so, less professional than should be…” were more mixed (60% positive, 40% negative). The majority of Internet reviews of primary care physicians are positive in nature. Our findings reaffirm that the care encounter extends beyond the patient–physician dyad; staff, access, and convenience all affect patient’s reviews of physicians. In addition, negative interpersonal reviews underscore the importance of well-perceived bedside manner for a successful patient–physician interaction.
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- 2011
10. Quality Measures Based on Presenting Signs and Symptoms of Patients
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Soeren Mattke, Alissa Detz, Robert H. Brook, and Hemal K. Kanzaria
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National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division ,Pediatrics ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,Signs and symptoms ,General Medicine ,Patient Acceptance of Health Care ,United States ,Diagnosis ,medicine ,Humans ,Quality (business) ,business ,Quality Indicators, Health Care ,media_common - Published
- 2015
11. Levamisole Contaminated Cocaine Induced Cutaneous Vasculitis Syndrome
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Kellee T James, Zlatan Coralic, Hemal K. Kanzaria, and Alissa Detz
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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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