Health literacy, generally defined as an individual's skill in obtaining and understanding information related to their health, has been shown to have significant impact on patient outcomes. Low health literacy is associated with higher rates of hospitalization and health care resource utilization, higher prevalence and severity of chronic disease, and worsened global measures of health including mortality. Poor health literacy is prevalent in the United States; as many as 36 percent of the population demonstrates limited health literacy. Rates are higher in certain subgroups such as the elderly, minorities, and those of low education or socioeconomic status. Given the wide prevalence and far-ranging effects on long-term health outcomes, efforts to improve health literacy nationally clearly offer significant benefits across the population. This study surveyed ambulatory patients at four clinic sites within the UCSD health care system. Patients were offered participation in the survey based on availability while waiting for clinical appointments; no compensation or other reward for participation was offered. The survey included ten different platforms or categories of online source; for each source patients were asked to rate how often they used it, their level of trust in the source, and degree to which that source ultimately impacted their health care decisions. The order that sources were listed within survey questions was varied between copies of the survey. Responses were analyzed using repeated measures ANVOA to establish the significance of variation in responses for each measure.
This article analyzes the current available literature on high-fidelity simulation as an educational tool in teaching acute neurology and neurocritical care skills to trainees. Twenty-five studies were found to be published in peer-reviewed journals. While every study had a common target of educating learners on appropriate acute neurology evaluation, diagnosis, and management, there exists significant heterogeneity in the chosen topics, implemented procedures, and assessments of learner outcomes. Overall findings suggest that there is considerably significant evidence for the effectiveness and utility of simulation-based education when it comes to the teaching of acute and critical neurological emergencies to trainees and even practicing providers. Existing literature is summarized, current trends are discussed, and recommendations for areas of future research are included.
Enrichment activities are known to enhance youth development, and are especially beneficial for at-risk youth who have not consistently had the social capital to receive such enrichment throughout the critical periods of their development. The National Institute of Justice has published many studies demonstrating the benefit of enrichment activities for disadvantaged youth. Enrichment activities promote self-esteem and sense of discipline and well-being, which impacts mental health and risk taking behaviors such as substance abuse. With the goal of achieving the aforementioned impact, juvenile detention centers offer enrichment programs as part of the rehabilitation process. My goal for this project was to further investigate the availability, equity and impact of such programs on mental health outcomes for at risk youth, I completed a needs assessment. The following needs assessment report summarizes my findings.
Background: prescription opioid related deaths have increased dramatically over the past 17 years. Although emergency physicians (EPs) have not been the primary force behind this rise, previous literature has suggested that EPs could improve their opioid prescribing practices. We designed this study to evaluate the trend in emergency department (ED) opioid prescriptions over time during the US opioid epidemic. Methods: we conducted a retrospective cohort study from July 1, 2012 to June 30, 2018, evaluating all adult patients who presented to two study EDs for a pain-related complaint and received an analgesic prescription upon ED discharge. We compared these data to trends in lay media and medical literature regarding the opioid epidemic. We also evaluated the incidence of repeat ED visits based on the type of analgesic prescriptions provided. Results: opioid prescriptions decreased from 37.76% to 13.29% over the six year study period. This coupled with an increase in non-opioid medications from 6.12% to 11.33% and an incrase in "no prescription" from 56.12% to 75.37%. This corresponded with an increase in the number of publications on the opioid epidemic within the lay-public and medical literature. Additionally, those patients that received no opiates were less likely to require a repeat ED visit. Conclusions: ED physicians are prescribing less opiates, while increasing the amount of non-narcotic analgesic prescriptions. This may be in response to the literature suggesting that prescription opioids play a large role in the opioids crisis. This decrease in opioid prescriptions did not increase the need for repeat ED visits.
Simulation has become an integral part of learning new procedures and staying adept at skills already learned. Ultrasound (US) guided peripheral IV (PIV) needle insertion is a skill necessary for EM, Anesthesia, and general practice nurses and physicians. Medical schools, teaching hospitals, and community hospitals universally use simulation amongst their practitioners. Ultrasound POC use is increasing in Emergency Department (ED) and other hospital areas. Most institutions have formalized training to teach residents and nurses proper techniques for POC US use. Training models can vary from commercially available ones costing thousands of dollars to home-made ones that have a short life-span and suboptimal viewing characteristics. 1 Patient safety has been a driving force in changing medical training. "To Err is Human", a landmark study published in 1999 estimated 3% of injuries to hospital patients are caused by medical errors, resulting in between 44,000-98,000 deaths per year. The traditional teaching mantra of "See one, Do one, Teach one" apprenticeship model has been replaced with proficiency-based teaching methods to improve physician training and patient safety.
Clinical reasoning (CR) is essential to a physician's practice of medicine. Although there have clear efforts to incorporate CR into the pre-clinical curriculum at UCSD-SOM, there is a lack of formal CR education during rotations. Thus, the Clinical Reasoning Exercise (CRE) was designed for third year medical students on the inpatient internal medicine service. The CRE is an educational exercise that provides step-by-step guidance through the diagnostic process by utilizing three principles--problem representation, diagnostic schema, and illness scrips. Supplementary materials include narrated PowerPoint/YouTube tutorials (for both students and faculty) as well as an example completed CRE for student reference. The CRE was piloted with six students rotating the Veteran's Association (VA) in February 2019. Students were met in small groups (2-3) to review general aspects and logistics. After the one-month long inpatient rotation, students were sent the link to an anonymous survey. The overall respondent rate was 66% (N=4/6). All four students reported completing one CRE during the 4-week block. Overall, students felt the CRE was a useful exercise that helped educate them on CR/CR principles and helped them systematically approach a clinical problem. However, there was a mixed response as to whether the CRE should be implemented in the future curriculum. The students' main concerns included increasing the number of requirements for the rotation and redundancy with a pre-existing requirement. Going forward, the CRE itself will need to be modified and its position in the curriculum closely reassessed. In addition, a larger sample size is needed to adequately obtain generalizability to the remainder of the third-year class.
As information technology continues to improve, patients are given access to increasing amounts of their health data. Health applications such as Epic MyChart provide an easily accessible archive of information for both patients and, in the case of pediatrics, parents. With increasing amounts of available information there is a concurrent need to provide education about interpretation. This study aimed to create a short, parent-focused, educational video to convey high-yield information regarding growth chart data. A pre- and post-survey were administered in conjunction with the educational video using QR codes at pediatric offices in La Jolla. We found, in general, parents felt well-equipped to be active participants in their child’s health, but identified some areas for improvement regarding perceptions of health.
The aim of this project was to create supplemental education modules to assist in the labor and delivery sessions, Sessions 5 and 6, of the CenteringPregnancy curriculum hosted at Chula Vista Medical Plaza in order to allow participants that are monolingual in Spanish to better understand the processes of labor and delivery. The activities already in place from the curriculum made assumptions about patient understandings of their own anatomy, what uterine contractions are, and stages of labor. By designing education tools that were more visual, barriers in language that prevent understanding of educational content could be overcome. Most importantly, participants could feel empowered in their pregnancies by understanding the physiological changes their bodies would experience during labor and delivery.
We sought to investigate long-term outcomes after revascularization with and without use of cardiopulmonary bypass, and hypothesized off-pump would be comparable to on-pump. Our primary outcome of interest was survival, and secondary outcomes included need for reintervention with new coronary stent, or new diagnosis of myocardial infarction (MI) occurring any time after surgery during the 8-12 year follow up period.
Post-laminectomy pain syndrome refers to persistent leg and/or lumbar back pain after a surgical procedure. The pathophysiology of this syndrome is complex, as often the operation was technically successful. Evaluation with MRI plays a crucial role in the assessment of post- laminectomy pain syndrome, as it provides soft tissue resolution for evaluation for common post- surgical pain generators, including recurrent posterior disc disease and associated narrowing of the spinal canal, lateral recess or neural foramina.