The effective redesign of primary care delivery systems to improve diabetes care requires an understanding of which particular components of delivery consistently lead to better clinical outcomes. We ...identified associations between common systems of care management (SysCMs) and the frequency of meeting standardized performance targets for Optimal Diabetes Care (NQF#0729) in primary care practices.
A validated survey of 585 eligible family or general internal medicine practices seeing ≥30 adult patients with diabetes in or near Minnesota during 2017 evaluated the presence of 62 SysCMs. From 419 (72%) practices completing the survey, NQF#0729 was determined in 396 (95%) from electronic health records, including 215,842 patients with type 1 or type 2 diabetes.
Three SysCMs were associated with higher rates of meeting performance targets across all practices:
) a systematic process for shared decision making with patients (
= 0.001),
) checklists of tests or interventions needed for prevention or monitoring of diabetes (
= 0.002), and
) physician reminders of guideline-based age-appropriate risk assessments due at the patient visit (
= 0.002). When all three were in place, an additional 10.8% of the population achieved recommended performance measures. In subgroup analysis, 15 additional SysCMs were associated with better care in particular types of practices.
Diabetes care outcomes are better in primary care settings that use a patient-centered approach to systematically engage patients in decision making, remind physicians of age-appropriate risk assessments, and provide checklists for recommended diabetes interventions. Practice size and location are important considerations when redesigning delivery systems to improve performance.
Introduction. The foramen Vesalius is a variable foramen located at the skull base, anteromedial to the foramen ovale behind and lateral to the foramen rotundum. This foramen is also known as ...emissary sphenoidal foramen. The aim of the research was to determine the anatomical characteristics of the foramen Vesalius in adult human skulls and foramina classification according to their type, shape, and sex distribution. Material and Methods. The study included 26 dry adult human skulls of both sexes from the collection of the Department of Anatomy, Faculty of Medicine of the University of Novi Sad. The skulls were macroscopically analyzed according to the presence or absence of the foramen Vesalius. Results. The foramen Vesalius was found in 16 skulls (61.54%) and it was absent in 10 skulls (38.46%). The incidence of bilateral and unilateral foramen Vesalius was 87.5% (14 skulls) and 12.5% (2 skulls), respectively. The foramen Vesalius was found in 10 male skulls (62.5%) and in 6 female skulls (37.5%). Conclusion. Based on the morphological analysis of the skulls, the study showed that the foramen of Vesalius can be unilateral or bilateral. The bilateral foramen was more common and it was usually round and symmetrical. In regard to the sex prevalence, the foramen was more prevalent in male than in female skulls. The results of the study showed that foramen Vesalius is not an uncommon anatomical variation, and its presence and morphological appearance are important information for physicians in various fields. Key words: Skull Base; Sphenoid Bone; Cranial Fossa, Middle; Anatomic Variation; Adult Sazetak Uvod. Vezalijusov otvor je varijabilan otvor koji se nalazi na bazi lobanje, ispred i unutra od ovalnog otvora, a spolja od okruglog otvora. Vezalijusov otvor je poznat jos i po nazivu emisarni sfenoidalni otvor. Cilj ovog rada bila je morfoloska analiza Vezalijusovog otvora na lobanji odraslog coveka i klasifikacija otvora u odnosu na tip, oblik i polnu zastupljenost. Materijal i metode. U istrazivanju je korisceno 26 suvih ljudskih lobanja, koje pripadaju Zavodu za anatomiju Medicinskog fakulteta Novi Sad, Univerziteta u Novom Sadu. Lobanje su makroskopski analizirane na prisustvo ili odsustvo Vezalijusovog otvora. Rezultati. Vezalijusov otvor je bio prisutan na 16 (61,54%), a odsutan na 10 (38,46%) lobanja. Incidencija obostrano prisutnog otvora bila je 87,5% (14 lobanja), a jednostrano prisutnog 12,5% (dve lobanje). Vezalijusov otvor je bio prisutan na 10 lobanja muskog pola (62,5%) i sest lobanja zenskog pola (37,5%). Zakljucak. Na osnovu morfoloske analize lobanja, studija je pokazala da Vezalijusov otvor moze biti jednostrano i/ili obostrano prisutan. Otvor je bio cesce prisutan obostrano i obicno je bio okrugao i simetrican. Otvor je bio zastupljeniji kod lobanja muskog nego kod lobanja zenskog pola. Iz rezultata ove studije, moze se zakljuciti da Vezalijusov otvor nije retka anatomska varijacija, a njegovo prisustvo i morfoloski izgled predstavljaju vazne informacije za lekare iz razlicitih oblasti. Kljucne reci: baza lobanje; sfenoidna kost; srednja kranijalna jama; anatomske varijacije; odrasla osoba
The AJT Report Pondrom, Sue
American journal of transplantation,
November 2014, 2014-11-00, 20141101, Letnik:
14, Številka:
11
Journal Article
Recenzirano
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In this edition of “The AJT Report,” we review a new international treaty that will enact legislation to consistently and harshly punish participants of organ trafficking. Also this month, we talk to ...David Klassen, the first‐ever chief medical officer for UNOS, about his goals for his new role.
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