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Background The incidence of ischemic stroke has increased among adults aged 18 to 64 years, yet little is known about relationships between specific risk factors and outcomes. This study investigates in‐hospital and long‐term outcomes in patients with stroke aged Methods and Results Consecutive patients aged Conclusions Focused secondary prevention and risk factor management may be needed to address poor long‐term outcomes for patients with stroke aged

Evidence suggests exercise is “good medicine” after stroke, yet consensus is lacking on the time to initiate, type, exertion level, and duration per session. It remains a challenge to identify outcome measures for stroke−exercise trials that are sufficiently sensitive to intervention parameters. Cerebrovascular assessments, namely cerebral blood flow and intracranial pulsatility, are herein discussed as examples of quantitative brain-specific measures that may be useful to monitor exercise-related brain changes and help to guide stroke rehabilitation interventions. Novelty: Cerebral blood flow and arterial stiffness are potential vascular targets for stroke exercise trials.

Background In 2009 the I-PASS Study Group was formed by patient safety, medical education, health services research, and clinical experts from multiple institutions in the United States and Canada. When the I-PASS Handoff Program, which was developed by the I-PASS Study Group, was implemented in nine hospitals, it was associated with a 30% reduction in injuries due to medical errors and significant improvements in handoff processes, without any adverse effects on provider work flow. Methods To effectively disseminate and adapt I-PASS for use across specialties and disciplines, a series of federally and privately funded dissemination and implementation projects were carried out following the publication of the initial study. The results of these efforts have informed ongoing initiatives intended to continue adapting and scaling the program. Results As of this writing, I-PASS Study Group members have directly worked with more than 50 hospitals to facilitate implementation of I-PASS. To further disseminate I-PASS, Study Group members delivered hundreds of academic presentations, including plenaries at scientific meetings, workshops, and institutional Grand Rounds. Some 3,563 individuals, representing more than 500 institutions in the 50 states in the United States, the District of Columbia, Puerto Rico, and 57 other countries, have requested access to I-PASS materials. Most recently, the I-PASSSM Patient Safety Institute has developed a virtual immersion training platform, mobile handoff observational tools, and processes to facilitate further spread of I-PASS. Conclusion Implementation of I-PASS has been associated with substantial improvements in patient safety and can be applied to a variety of disciplines and types of patient handoffs. Widespread implementation of I-PASS has the potential to substantially improve patient safety in the United States and beyond.

Medical-legal partnerships (MLPs) bring together medical professionals and lawyers to address social causes of health disparities, including access to adequate food, housing and income.Eighty-one MLPs offer legal services for patients whose basic needs are not being met.Besides providing legal help to patients and working on policy advocacy, MLPs educate residents (29 residency programs), health care providers (160 clinics and hospitals) and medical students (25 medical schools) about how social conditions affect health and screening for unmet basic needs, and how these needs can often be impacted by enforcing federal and state laws. These curricula include medical school courses, noon conferences, advocacy electives and CME courses.Four example programs are described in this paper. Established MLPs have changed knowledge (MLP | Boston-97% reported screening for two unmet needs), attitudes (Stanford reported reduced concern about making patients "nervous" with legal questions from 38% to 21%) and behavior (NY LegalHealth reported increasing resident referrals from 15% to 54%) after trainings. One developing MLP found doctors experienced difficulty addressing social issues (NJ LAMP-67% of residents felt uncomfortable).MLPs train residents, students and other health care providers to tackle socially caused health disparities.

Author(s): Barrett, J Christian; Alweis, Richard; Frank, Michael; O'Connor, Alec; McConville, John F; Adams, Nancy Day; Arfons, Lisa; Bernard, Sheilah; Bradley, Thomas; Buckley, John D; Cohen, Ellen; Cornett, Patricia; Elkins, Stephanie; Kopelman, Richard; Luther, Vera P; Petrusky, Jiselle; McNeill, Diana B; Omar, Bassam; Palapiano, Nancy; Roth, Teresa; Satko, Scott; Fried, Ethan D; Muchmore, Elaine A

For reproductive health professionals, a combination of clinical and social science, presented in a variety of credible, interactive formats and featuring some type of mentoring and longer-term evaluation and follow-up, provides the richest platform for learning. There is growing support in the literature for this approach to improve clinician knowledge, competence and practice. ARHP is incorporating new educational platforms for all of its programs, including the annual Reproductive Health Clinical Conference. ARHP leaders plan to continue in-depth evaluation and experimentation to work toward improved provider performance and the best possible patient outcomes. There is a strong need for more research to inform this promising area, but we are on the right track.

This editorial stresses the importance of the reproductive health field to assertively identify and pursue equitable links between clinical and behavioral science and to put into practice the outcomes from well-designed research projects in order to sustain progress in this field. It states that the reproductive health field needs to intensify their efforts through research into practice and bringing their reproductive health expertise evidence-based research and knowledge of adult learning theory to all clinicians who can make a difference in public health. Copyright © 2011 Elsevier Inc. All rights reserved.

Development and evaluation of research-quality informatics tools for self-management support in personal and provider electronic health records (PHRs and EHRs) may improve patient outcomes by facilitating patient and provider education and communication around goal-setting, prompting consistent evidence-based treatment, and providing reminders and feedback. Nurses on primary care teams are well-positioned to advocate for self-management and monitor the use of these informatics tools. This paper presents a design for integrating goal-setting tools into PHRs and EHRs. Keeping in mind the potential of enhanced self-management support, challenges in basic issues such as user characteristics, practice traditions of data ownership and workflow, and financing are discussed.

Ten patients with 12 symptomatic severe flatfeet were treated with a combined surgical technique. Patients 10 years or older were treated with Evan's calcaneal osteotomy, Young tenosuspension, and tendo achillis lengthening. Patients under age 10 were treated with modified Young tenosuspension, talonavicular desmoplasty and subtalar arthroereisis. Eight of the 10 patients had marked relief in pain and fatigue and were able to perform all physical activities. Radiographic criteria showed improvement for all patients in all categories.

New York County Health Services Review Organization (NYCHSRO), the physicians' professional standards review organization of Manhattan, examined whether diagnostic coding errors identified in Manhattan hospitals would affect reimbursement under a diagnostic-related group (DRG) method of financing inpatient services. A sampling of 1,027 Medicare and Medicaid cases representing discharges from 18 Manhattan hospitals during 1982 and 1983 revealed incorrect DRG assignment for 17.5% of patient record abstracts, but these appear to have been unsystematic rather than deliberate errors. The difference between estimated reimbursement based on original and reabstracted records was not statistically significant either in the aggregate or for specific hospitals. It is emphasized that while New York State's Prospective Hospital Reimbursement Methodology (in effect during the study period) is not solely dependent upon DRG's case-mix is one of several factors used to make adjustments to existing per diem rates. A key recommendation is that hospitals conduct internal monitorings with all involved departments to improve the quality of the data abstracting process.

Excerpt To the Editor:Chambers and colleagues (1) reported cure rates of 94% and 33% in episodes of right-sidedStaphylococcus aureusendocarditis treated with 2 weeks of nafcillin-tobramycin, and va...

• We have developed a simple generalizable model of teaching ambulatory medicine that adopts successful elements of inpatient teaching and addresses deficiencies in traditional ambulatory forums. This model combines resident analysis of the patient encounter via a "clinical encounter form" (CEF) with faculty-led ambulatory medicine rounds (AMR). Its objectives are to integrate teaching and quality assessment; be explicit about the relation between the record and the physician's clinical thinking; teach around every patient; focus on selected aspects of a case in limited time; and permit appropriate rounds preparation by faculty. The CEF-AMR model, like inpatient rounds, allows teaching to be focused on real patient issues; all patients are reviewed and quality is assured, and interesting teaching points can be selected, prepared, and discussed efficiently in limited time. It is the "classroom" complement to faculty "bedside" precepting and has made teaching ambulatory medicine feasible, clinically relevant, and well-informed. Perhaps most importantly, the CEF-AMR model encourages self-analysis of clinical decisions and makes explicit the key elements of clinical judgment. ( Arch Intern Med . 1989;149:2407-2411)