This study is an example of the focused reviews performed within the VA's physician peer review program (MEDIPRO). Studies of this nature are conducted throughout the nation on the VA Medical District level. The s...
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This study is an example of the focused reviews performed within the VA's physician peer review program (MEDIPRO). Studies of this nature are conducted throughout the nation on the VA Medical District level. The study topics, criteria, data analysis and findings are the purview of the physician boards who are responsible for sharing study outcomes with district hospitals. The MEDIPRO process identifies strengths as well as opportunities for improvement and emphasizes educational approaches to resolving quality of care problems.
Long-acting benzodiazepines (LABZs) are relatively contraindicated for elderly patients because they increase the risk of impaired cognitive function, falls, and hip fractures. The purpose of this study was to identif...
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Long-acting benzodiazepines (LABZs) are relatively contraindicated for elderly patients because they increase the risk of impaired cognitive function, falls, and hip fractures. The purpose of this study was to identify the characteristics of physicians who frequently prescribe LABZs for elderly patients. The authors examined the prescribing profile of 4,976 physicians who saw at least 20 elderly Quebec medicare registrants in 1990. Physicians who frequently prescribed LABZs for their elderly patients were more likely to have graduated before 1979, to be general practitioners as opposed to specialists, to practice in long-term care settings, and to have graduated from a medical school in Quebec as opposed to other schools in Quebec, in other provinces, or in other countries. The authors have identified several characteristics of physicians who frequently prescribed LABZs for the elderly. Strategies to improve prescribing in this field should target this group of physicians.
Hypertension is one of the major treatable factors contributing to the burden of disease worldwide. However, despite national programs to encourage detection and treatment, there are still shortcomings in hypertension...
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Hypertension is one of the major treatable factors contributing to the burden of disease worldwide. However, despite national programs to encourage detection and treatment, there are still shortcomings in hypertension management. A large proportion of these can be attributed to socioeconomic factors, professional shortcomings, and patient noncompliance with management regimens. The Evaluation and interventions for Systolic Blood pressure Elevation-Regional and Global (EISBERG) project was conceived to examine the reasons for suboptimal management of hypertension in more detail. Emphasis was placed on control of elevated systolic blood pressure because this is often neglected despite evidence that it is more important than diastolic pressure in predicting cardiovascular risk. The goals of the project include analysis of the relative importance of systolic and diastolic blood pressure as cardiovascular risk factors, identification of any necessary changes in practice, and the development and implementation of programs to promote appropriate changes in practice or attitudes. The three components of the initiative are a formal collection of epidemiologic evidence to examine the relation between systolic blood pressure and outcome;a cross-sectional, quantitative database (CardioMonitor) providing information on the treatment of patients with cardiovascular diseases including hypertension in seven countries, and qualitative research into hypertension management to assess attitudes, awareness, and knowledge among primary care physicians, patients and their carers. The study showed more effort was directed toward control of diastolic than systolic blood pressure. Adequate control of systolic blood pressure was seldom achieved. Blood pressure targets tended to be raised in elderly patients in conflict with recommendations and evidence that there is greater benefit in treating hypertension more aggressively in this population. Despite awareness of guidelines for treating hype
Objectives. Questionnaires (984) were submitted to pediatric radiologists to determine how often odontoid fractures were missed on lateral views and detected on open-mouth odontoid views in children under 5 years. Oth...
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Objectives. Questionnaires (984) were submitted to pediatric radiologists to determine how often odontoid fractures were missed on lateral views and detected on open-mouth odontoid views in children under 5 years. Other questions relating to imaging protocols of the odontoid also were included, and there were 432 respondents. Results. Of these, 161 respondents indicated that an open-mouth odontoid View was not routinely included in their imaging protocol. Conclusions. There was considerable variability on how the problem of imaging of the odontoid was addressed, but overall there were enough data to begin to consider the concept that the open-mouth odontoid might not be needed in patients under 5 years of age if a lateral view is normal.
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