Medicine and Health Sciences Commons^™

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Terry Frederick

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics.

Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics.

Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine …

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Jacob Bidwell, MD

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics. Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics. Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine …

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Aurora Family Medicine Residents

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics. Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics. Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine …

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Lisa Sullivan Vedder, MD

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics.

Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics.

Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine …

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Deborah Simpson, PhD

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics.

Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics.

Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine …

Don’T Leave Without Them: Dispensing Asthma Medications To Pediatric Patients Upon Discharge Is Associated With Decreased Hospital Readmissions, Kelly J. Hiteshew, Thaddeus T. Franz, Kristen Lamberjack, Aleda M.H. Chen

Kelly J. Wright, R.Ph., Pharm.D.

Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution’s outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy. Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During …

Asthma Knowledge, Control, And Administration Techniques In Hispanic Caregivers Of Pediatrics, Kelly J. Wright, Joshua Arnold, Rachel Culp, Kyle Hultz, Benjamin Robertson, Jon Wilkie, Amy Wuobio

Kelly J. Wright, R.Ph., Pharm.D.

Objectives: The objectives of this study were to (1) describe asthma knowledge, control, and administration techniques in Hispanic caregivers of pediatric asthma patients in primary care clinics and (2) determine the association between asthma knowledge and control. Methods: A pilot, cross-sectional study was conducted by administering a survey to Spanish-speaking primary caregivers of children under 12 years old with a current diagnosis of asthma. The survey contained: demographic questions (8 items), a modified version of the Asthma Control Test (ACT, 5 self-assessment items, 5-point, Likert-type scale), knowledge (21 items, correct/incorrect response), and inhaler use (1 item, rank ordering steps for …

Don’T Leave Without Them: Dispensing Asthma Medications To Pediatric Patients Upon Discharge Is Associated With Decreased Hospital Readmissions, Kelly J. Hiteshew, Thaddeus T. Franz, Kristen Lamberjack, Aleda M.H. Chen

Kelly J. Wright, R.Ph., Pharm.D.

Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution’s outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy. Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During …

Asthma In Pregnancy: Pathophysiology, Diagnosis And Management., Abbey Hardy-Fairbanks, Emily Baker

Abbey J Hardy-Fairbanks

Asthma is a common, potentially serious, even life-threatening, chronic medical condition seen amongst nearly all groups of patients, regardless of ethnicity and socioeconomic circumstances. This article addresses the group of pregnant women with symptomatic asthma as well as those whose asthma is asymptomatic as a result of good control. The incidence, the pathophysiologic changes of pregnancy, and the interplay between these changes and asthma are reviewed in this article. The classification of these patients and appropriate management strategies are discussed.

Serum 25-Hydroxyvitamin D Levels Do Not Correlate With Asthma Severity In A Case-Controlled Study Of Children And Adolescents, Jennifer Menon, Louise Maranda, Benjamin U. Nwosu

Benjamin U. Nwosu

Background: There is no consensus on the association between vitamin D and asthma.

Objective: To determine the relationship between 25-hydroxyvitamin D [25(OH)D] levels and asthma symptom severity in children and adolescents.

Methods: A retrospective, case-control study of 263 subjects of ages 2–19 years with asthma who were compared to 284 non-asthmatic controls of similar ages. Subjects were excluded if they had diseases of calcium or vitamin D metabolism or were receiving calcium or vitamin D supplementation. Serum 25(OH)D was measured in all subjects. Asthma symptom severity, usually stratified into 6 steps, was stratified into five steps [1–5] based on the …

Exposure To Indoor Biomass Fuel Pollutants And Asthma Prevalence In Southeastern Kentucky: Results From The Burden Of Lung Disease (Bold) Study, Anna C. Barry, David M. Mannino, Claudia Hopenhayn, Heather Bush

David M. Mannino

BACKGROUND:

Asthma is a chronic inflammatory respiratory disease, characterized by episodic and reversible airflow obstruction and airway hyperresponsiveness and is influenced by both genetic and environmental factors.

METHODS:

The Burden of Obstructive Lung Disease (BOLD) survey was used to determine the prevalence of self-reported asthma in a target population of 325,000 adults aged > or =40 in Southeastern Kentucky. Postbronchodilator spirometry was used to classify subjects based on lung function. Risk factors for asthma in this population, in particular indoor usage of biomass fuels, were evaluated.

RESULTS:

The overall study population was comprised of 508 individuals, with 15.5% reporting current asthma …

Association Of Ambient Ozone Exposure With Airway Inflammation And Allergy In Adults With Asthma, Sumita B. Khatri, Fernando C. Holguin, P. Barry Ryan, David M. Mannino, Serpil C. Erzurum, W. Gerald Teague

David M. Mannino

Rationale

Previous studies have demonstrated associations of high ozone levels with increased epidemiologic as well as lung function measures of asthma activity.

Objectives

In an observational study during the summer months, we hypothesized that higher ambient ozone levels are associated with more frequent symptoms, higher airway and systemic inflammation, as well as worse lung function in asthmatics as compared with non-asthmatic individuals.

Methods

Thirty-eight asthmatics and thirteen healthy control subjects residing in metropolitan Atlanta were enrolled during peak ozone season. Medical histories, quality-of-life questionnaires, spirometry, serum immunoglobulin (IgE), peripheral eosinophil counts, and exhaled nitric oxide (NO) were obtained during study …

The Effect Of Sex On Asthma Control From The National Asthma Survey, James Temprano, David M. Mannino

David M. Mannino

Background Previous studies have demonstrated conflicting results with regard to differences in asthma control between the sexes.

Objective We sought to identify sex differences in short-term and long-term measures of asthma control in adults from the National Asthma Survey.

Methods This study analyzed data from the National Asthma Survey (Four-State sample) sponsored by the National Center for Environmental Health, Centers for Disease Control and Prevention. Asthma control was compared between the sexes based on short-term (recent symptoms, asthma attacks, and albuterol use) and long-term (asthma attacks, work days lost, and urgent-care visits and hospitalizations in the prior year) measures. Composite …

Immunomodulatory Effect Of Cytosine-Phosphate-Guanosine (Cpg)-Oligonucleotides In Nonasthmatic Chronic Rhinosinusitis: An Explant Model, L Tan, T Rogers, N Hatzirodos, L Baker, E Ooi, Peter-John Wormald

Peter-John Wormald

Background: The use of cytosine-phosphate-guanosine-oligodeoxynucleotides (CpG-ODNs) or immunostimulatory sequences (ISSs) in the treatment of airway diseases is gaining interest. Binding of the CpG-ODN ligand to Toll-like receptor 9 (TLR9) triggers a shift from a Th2- to a Th1-type response in the target tissue. In this study, we explored the potential use of CpG-ODN to dampen the predominantly Th2-driven chronic inflammatory state in our cohort of patients. Methods: An in vitro explant model comprising of sinonasal tissue from patients with asthma (n=12) and without asthma (n=11) were stimulated with CpG-ODN or Staphylococcus aureus enterotoxin B (SEB) or CpG-ODN in combination with …

Obstructive Lung Disease Models: What Is Valid, Jill M. Ferdinands, David M. Mannino

David M. Mannino

Use of disease simulation models has led to scrutiny of model methods and demand for evidence that models credibly simulate health outcomes. We sought to describe recent obstructive lung disease simulation models and their validation. Medline and EMBASE were used to identify obstructive lung disease simulation models published from January 2000 to June 2006. Publications were reviewed to assess model attributes and four types of validation: first-order (verification/debugging), second-order (comparison with studies used in model development), third-order (comparison with studies not used in model development), and predictive validity. Six asthma and seven chronic obstructive pulmonary disease models were identified. Seven …

Chronic Disease Medication Use In Managed Care And Indemnity Insurance Plans, Randall S. Stafford, Stephen M. Davidson, Harriet Davidson, Heidi Miracle-Mcmahill, Sybil L. Crawford, David Blumenthal

Sybil L. Crawford

OBJECTIVE: To evaluate the impact of managed care on the use of chronic disease medications. DATA SOURCE: Claims data from 1997 from two indemnity and three independent practice association (IPA) model managed care insurance plans. RESEARCH DESIGN: Cross-sectional analysis of claims data. DATA COLLECTION: Adult patients with diabetes mellitus (DM, n = 26,444), congestive heart failure (CHF, n = 7,978), and asthma (n = 9,850) were identified by ICD-9 codes. Chronic disease medication use was defined through pharmacy claims for patients receiving one or more prescriptions for drugs used in treating these conditions. Using multiple logistic regression we adjusted for …

Adrb2 Arg16gly Polymorphism, Lung Function, And Mortality: Results From The Atherosclerosis Risk In Community Study, Jill M. Ferdinands, David M. Mannino, Marta L. Gwinn, Molly S. Bray

David M. Mannino

Background

Growing evidence suggests that the Arg16Arg genotype of the beta-2 adrenergic receptor gene may be associated with adverse effects of beta-agonist therapy. We sought to examine the association of beta-agonist use and the Arg16Gly polymorphism with lung function and mortality among participants in the Atherosclerosis Risk in Communities study.

Methodology and Principal Findings

We genotyped study participants and analyzed the association of the Arg16Gly polymorphism and beta-agonist use with lung function at baseline and clinical examination three years later and with all-cause mortality during 10 years of follow-up. Lung function was characterized by percent-predicted forced expiratory volume in 1 …

Cardiorespiratory Hospitalizations Associated With Smoke Exposure During The 1997, Southeast Asian Forest Fires, Joshua A. Mott, David M. Mannino, Clinton J. Alverson, Andrew Kiyu, Jamilah Hashim, Tzesan Lee, Kenneth Falter, Stephen C. Redd

David M. Mannino

We investigated the cardiorespiratory health effects of smoke exposure from the 1997 Southeast Asian Forest Fires among persons who were hospitalized in the region of Kuching, Malaysia. We selected admissions to seven hospitals in the Kuching region from a database of all hospital admissions in the state of Sarawak during January 1, 1995 and December 31, 1998. For several cardiorespiratory disease classifications we used Holt-Winters time-series analyses to determine whether the total number of monthly hospitalizations during the forest fire period (August 1 to October 31, 1997), or post-fire period (November 1, 1997 to December 31, 1997) exceeded forecasted estimates …

Effects Of Diesel Exhaust Emissions And Symptoms Of Asthma, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Risk Factors For Asthma Incidence: A Review Of Recent Prospective Evidence, M. S. King, David M. Mannino, F. Holguin

David M. Mannino

AIM:

The aim of this study is to determine what factors have been shown, in prospective studies, to predict the incidence of asthma.

METHODS:

We performed a systematic review of peer-reviewed literature from 1994 to 2004 to determine what factors predict the development of asthma in both children and adults. This search strategy yielded 40 studies, with 36 providing some estimate of asthma incidence for the total sample and or a specific subgroup.

RESULTS:

Annual estimated incidence of physician-diagnosed asthma ranged from 0.6 to 29.5 per 1000 persons. Risk factors for incident asthma among children included: male sex, atopic sensitization, …

Surveillance For Asthma - United States, 1980-1999, David M. Mannino, David M. Homa, Lara J. Akinbami, Jeanne E. Moorman, Charon Gwynn, Stephen C. Redd

David M. Mannino

Problem/Condition: Asthma, a chronic disease occurring among both children and adults, has been the focus of clinical and public health interventions during recent years. In addition, CDC has outlined a strategy to improve the timeliness and geographic specificity of asthma surveillance as part of a comprehensive public health approach to asthma surveillance.

Reporting Period Covered: This report presents national data regarding self-reported asthma prevalence, school and work days lost because of asthma, and asthma-associated activity limitations (1980--1996); asthma-associated outpatient visits, asthma-associated hospitalizations, and asthma-associated deaths (1980--1999); asthma-associated emergency department visits (1992--1999); and self-reported asthma episodes or attacks (1997--1999).

Description of …

How Much Asthma Is Occupationally Related?, David M. Mannino

David M. Mannino

Asthma is a chronic respiratory disease that is increasing in both prevalence and mortality in developed countries around the world. Occupational exposures to sensitizers and irritants are causes of both asthma cases and asthma exacerbations in adults. The determination of how many cases of asthma may be caused or worsened by occupational exposures is highly dependent on how asthma is defined, what constitutes work-relatedness, and what specific methodology is employed. Surveillance-based methods generally have found the lowest proportion of work-related asthma, ranging from 1-8% of cases. Other types of studies, using exposed-unexposed methodology or interviews of incident asthma cases, have …

Mortality From Asthma In State Of Sao Paulo (1970-92), Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.