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Self-measured blood pressure monitoring (SMBP), the regular measurement of blood pressure by a patient outside the clinical setting, plus additional support, is a proven, cost-effective but underutilized strategy to improve hypertension outcomes. To accelerate SMBP use, the Centers for Disease Control and Prevention (CDC) funded the National Association of Community Health Centers, the YMCA of the USA, and Association of State and Territorial Health Officials to develop cross-sector care models to offer SMBP to patients with hypertension. The project aimed to increase the use of SMBP through the coordinated action of health department leaders, community organizations and clinical providers. From 1/31/2017 to 6/30/2018, nine health centers in Kentucky, Missouri, and New York partnered with seven local Y associations (local Y) and their local health departments to design and implement care models that adapted existing primary care SMBP practices by leveraging capacities and resources in community and public health organizations. Nine collaborative care models emerged, shaped by available community assets, strategic priorities, and organizational culture. Overall, 1421 patients were recommended for SMBP; of those, 795 completed at least one cycle of SMBP (BP measurements morning and evening for at least three consecutive days). Of those recommended for SMBP, 308 patients were referred to a local Y to receive additional SMBP and healthy lifestyle support. Community and public health organizations can be brought into the health care delivery process and can play valuable roles in supporting patients in SMBP.

Context Federally funded Community, Migrant, and Homeless Health Centers provide health services to the most vulnerable communities in the United States. However, little is known about their capabilities and processes for providing vaccinations to adults. Program We conducted the first national survey of health centers assessing their inventory, workflow, capacity for, and barriers to provision of routinely recommended adult vaccines. In addition, we asked health center leaders' perceptions regarding best practices and policy recommendations for adult vaccinations. Implementation A survey was developed on the basis of domains elicited from advisory panels and focus groups and was sent electronically to leaders of 762 health centers throughout the United States and its territories; data were collected and analyzed in 2018. Evaluation A total of 319 survey responses (42%) were obtained. Health centers reported stocking most routinely recommended vaccines for adults; zoster vaccines were not stocked regularly due to supply and storage issues. Respondents most commonly reported adequate reimbursement for vaccination services from private insurance and Medicaid. Most vaccinations were provided during primary care encounters; less than half of health centers reported providing vaccines during specialist visits. Vaccines administered at the health center were most commonly documented in an open field of the electronic health record (96%) or in an immunization information system (72%). Recommendations for best practices related to better documentation of vaccinations and communication with immunization information systems were provided. Discussion Health centers provide most adult vaccines to their patients despite financial and technological barriers to optimal provisioning. Further studies at point of care could help identify mechanisms for system improvements.

Background Lecture capture technology is widely available in undergraduate medical education and seems to impact class attendance. Further, there is limited understanding about faculty perceptions related to lecture capture and student attendance and how faculty advise students on issues of attendance in an environment where lecture capture is available and attendance is not required. Objective The purpose of the current study was to characterize faculty perceptions and preferences about student attendance, investigate faculty advising practices about attendance, and evaluate the potential impacts of low student attendance on faculty job satisfaction and teaching. Method A 15-min electronic survey was created and emailed to all on-campus teaching faculty at a medical school. The survey included demographic, close-ended (with Likert and Likert-like scales), and open-ended questions. Results All 35 faculty members were invited to participate in the survey, and 26 (77%) responded. Faculty advising practices on student attendance varied, but most faculty indicated they advised students to attend class if the student expressed loneliness. A majority (15/26, 58%) disagreed or strongly disagreed that student attendance indicated level of professionalism, and many (12/26, 46%) believed that lecture capture was an effective alternative to attending class. Most faculty (19/26, 73%) agreed or strongly agreed they felt more job satisfaction with higher student attendance. A majority (15/26, 58%) also agreed or strongly agreed they would prefer to incorporate active learning in large-group sessions when student attendance was mandatory. Conclusion Faculty member willingness to incorporate active-learning sessions and job satisfaction were influenced by student classroom attendance in the current study. Given the varied options for content delivery, these factors should be taken into account when institutions create attendance policies. These policies should balance the satisfaction of the faculty with the need to encourage autonomy and flexibility for the adult student learners.

Purpose Social determinants of health (SDH) are responsible for significant health disparities, morbidity and mortality. It is important to acculturate trainees to identify and document SDH. This can elevate their perceptions related to the importance and relevance of SDH. Documentation can encourage trainees to see SDH as factors which medical providers should address. Patients and methods Researchers devised a novel approach to demonstrate the value of SDH to undergraduate medical students. Proprietary diagnostic codes for SDH and procedure codes for action taken to address them, were developed. Students were encouraged to log these into electronic records for clinical encounters. Students' voluntary use of these codes was evaluated. Additionally, students were surveyed on their familiarity with the concept of SDH, their perceptions of the importance of SDH, as well as documenting SDH, twice in the study period, and results were compared. In their second year of use, proprietary codes were compared to newly available SDH related ICD-10 codes. Results Students utilized proprietary codes more often than SDH related ICD-10 codes. Over 20,000 codes were logged. Comparison of survey items showed modest increases in students' positive perception about the role of SDH in patient health. Conclusion Students' voluntary logging of SDH codes demonstrates they perceived these factors to be important and relevant to patient encounters. Future analyses will examine students' knowledge, attitudes, beliefs and practice patterns related to SDH.

Campbell AM, Ikonne US, Whelihan KE, Lewis JH. Adv Med Educ Pract. 2019;10:759– 768. Page 761, Faculty perspectives about professionalism, job satisfaction, and active learning section, fourth sentence, the text “Ten disagreed that students who regularly attended large-group sessions had better academic performance” should read “Ten agreed that students who regularly attended large-group sessions had better academic performance”. Table 3 on page 763, the values in the Students who attend large group sessions regularly have better academic performance and Active-learning sessions are more effective with higher attendance rows are incorrect. The correct Table 3 is shown in Download Article.The authors apologize for these errors and advise they donot affect the scientific conclusions of the paper. Read the original article

Objective: To systematically review the literature regarding rest and return to activity after sport-related concussion. Data Sources: The search was conducted in the Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, Educational Resources Information Center, Ovid MEDLINE, and PubMed using terms related to concussion, mild traumatic brain injury, physical and cognitive rest, and return to activity. Study Selection: Studies were included if they were published in English; were original research; and evaluated the use of, compliance with, or effectiveness of physical or cognitive rest or provided empirical evidence supporting the graded return-to-activity progression. Data Extraction: The study design, patient or participant sample, interventions used, outcome measures, main results, and conclusions were extracted, as appropriate, from each article. Data Synthesis: Articles were categorized into groups based on their ability to address one of the primary clinical questions of interest: use of rest, rest effectiveness, compliance with recommendations, or outcome after graded return-to-activity progression. A qualitative synthesis of the results was provided, along with summary tables. Conclusions: Our main findings suggest that rest is underused by health care providers, recommendations for rest are broad and not specific to individual patients, an initial period of moderate physical and cognitive rest (eg, limited physical activity and light mental activity) may improve outcomes during the acute postinjury phase, significant variability in the use of assessment tools and compliance with recommended return-to-activity guidelines exists, and additional research is needed to empirically evaluate the effectiveness of graded return-to-activity progressions. Furthermore, there is a significant need to translate knowledge of best practices in concussion management to primary care providers.

Intro This project aimed to teach third grade students the differences between viral and bacterial infections through active learning. Presentation effectiveness and students’ retention of information were assessed using a game and post-quiz. This project addresses the school’s concern about the misunderstanding of causes and treatments of illnesses. Methods Students took a pre-quiz in order to establish their base knowledge of bacterial and viral infections. A question and answer style presentation was utilized to teach differences between viral and bacterial illnesses, as well as the appropriate management of each. An interactive game of “doctor and patient” was then played, during which students were given a bacterial or viral infection scenario and choose associated symptoms and management utilizing pre-made answer cards. Finally, a post-quiz was administered to determine short-term change in knowledge. Students were given an informational magnet and flyer to share with parents or guardians to re-enforce the information. Results Of the 20 participants that took the pre-quiz, only a subset of 18 were available to take the post-quiz. The overall analysis of post-test questions portrayed an increased number of correct answers after the presentation and game. Individually, question two was trending towards significance, with a p value of .08. Despite a lack of significance, students overall scored higher on the post-quiz and were better able to distinguish between types of infections and determine proper management. Conclusion Parents often seek the use of antibiotics for their children even when viral infections are present, which do not warrant antibiotic interventions. Understanding the signs, symptoms, and differences between viral and bacterial infections may help community members seek appropriate care and may reduce requests for antibiotics. It is more likely that community members will use antibiotics correctly if they have a better understanding of when they are warranted. In future studies, with larger parameters, a significant difference can be made in children and their families’ understanding of antibiotics, reducing misuse and misunderstanding within the community as a whole. Limitations Given the overall small sample size in our study, the data were limited statistically and may not be generalizable. Additionally, two students that took the pre-test quiz were not available to take the post- test, further limiting our sample size. We did not pair data between the pre-test and post-test due to a desire to preserve student anonymity. This pairing may have allowed for further analysis of specific results.

Research Objectives To prevent health complications, patients with type 2 diabetes mellitus should be regularly seen by their medical provider and routinely checked for hemoglobin A1c levels. However, many patients do not return for routine visits. The objective was to evaluate the efficacy of two communication modalities in scheduling patient appointments. Study Design/Methods Patients with a hemoglobin A1c > 9.0 not seen in clinic in >6 months were randomly assigned to a control or experimental group. All participants received an initial text message offering help with scheduling an appointment. The control group was contacted via a second text message and the experimental group was contacted via phone call. Additionally, the experimental group was asked to identify perceived healthcare barriers. In addition to the reported barriers, data included patients who scheduled and kept appointments in each group when data was available. Chi-squared test (p-value of

Context Lecture capture technology is widely available in undergraduate medical education and impacts class attendance. There is a limited understanding of faculty perceptions related to lecture ca...

Context Some medical educators have noted a decline in classroom attendance. Understanding student preferences for content delivery and the relationship between student attendance and learning outcomes may enhance curricular design and best practices for technology-supported learning. Objective To measure the attendance of first-year osteopathic medical students, evaluate the relationship between classroom attendance and aggregate mean course grades, and characterize factors that influence attendance decisions when recorded lectures are available. Methods In nonmandatory class sessions during the 2015-2016 academic year, student attendance data were collected using audience response technology and were linked to course grades. Pearson product moment and partial correlations, controlling for Medical College Admissions Test scores, were calculated to quantify the relationship between classroom attendance and aggregate mean course grades. Students were surveyed to characterize factors influencing attendance decisions and compare the perceived convenience, efficiency, and effectiveness of classroom attendance vs lecture capture technology. The preferred modality for receiving didactic content was assessed, and open-ended questions were included about the advantages or disadvantages of lecture capture, classroom attendance, and podcasts. Responses were analyzed using open and axial coding. Results A 78% reduction in first-year student classroom attendance was measured from the beginning to the end of the academic year (Pr=0.17; P=.29) and the partial correlation between them after controlling for admission test scores (r=0.18; P=.08) were not significant, except in the Neuromusculoskeletal A course (r=0.22; P=.027). Students regarded lecture capture recordings as more convenient, efficient, and effective than classroom attendance, and podcasting was the preferred method of content delivery. Major themes associated with the open-ended questions were effective or ineffective time management, enhanced interaction, learning advantages or challenges, and positive or negative content characteristics. Conclusion First-year classroom attendance decreased significantly during the academic year, but the authors found no significant relationship between attendance and aggregate mean course grades. Students regarded lecture capture recordings as a practical alternative to attending class; however, podcasts were the preferred modality for receiving didactic content. These findings may help in developing learning-centered curricula at colleges of osteopathic medicine.

Background The social determinants of health (SDH) are conditions that shape the overall health of an individual on a continuous basis. As momentum for addressing social factors in primary care settings grows, provider ability to identify, treat and assess these factors remains unknown. Community health centers care for over 20-million of America’s highest risk populations. This study at three centers evaluates provider ability to identify, treat and code for the SDH. Methods Investigators utilized a pre-study survey and a card study design to obtain evidence from the point of care. The survey assessed providers’ perceptions of the SDH and their ability to address them. Then providers filled out one anonymous card per patient on four assigned days over a 4-week period, documenting social factors observed during encounters. The cards allowed providers to indicate if they were able to: provide counseling or other interventions, enter a diagnosis code and enter a billing code for identified factors. Results The results of the survey indicate providers were familiar with the SDH and were comfortable identifying social factors at the point of care. A total of 747 cards were completed. 1584 factors were identified and 31 % were reported as having a service provided. However, only 1.2 % of factors were associated with a billing code and 6.8 % received a diagnosis code. Conclusions An obvious discrepancy exists between the number of identifiable social factors, provider ability to address them and documentation with billing and diagnosis codes. This disparity could be related to provider inability to code for social factors and bill for related time and services. Health care organizations should seek to implement procedures to document and monitor social factors and actions taken to address them. Results of this study suggest simple methods of identification may be sufficient. The addition of searchable codes and reimbursements may improve the way social factors are addressed for individuals and populations. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0526-8) contains supplementary material, which is available to authorized users.

Objective To systematically review the literature regarding healthcare provider compliance with and the effectiveness of the graded return-to-activity progression. Design Systematic Review. Search strategy An electronic search was conducted in 6 databases. Search terms included: brain concussion AND-rest; concuss*AND-sports-AND-rest, -sports-AND-return-to-play; mild traumatic brain injury AND-return-to-activity, -return-to-play; recurrent concussion-AND-sport. Hand searches were also performed. Study selection After removal of duplicates, initial screen of titles and abstracts was completed by 3 authors, followed by full text review. Articles were included if they were in English and original studies related to the clinical questions. Reviews, editorials, commentaries, and animal research were excluded. Data extraction The initial search yielded 2851 articles, with 1239 undergoing title/abstract screen, 143 undergoing full-text review, and 21 included in the review. Study design, patient/participant, instrumentation/interventions utilised, outcome measures, main results, and conclusions were extracted. Strength of recommendation (SOR) as outlined by the Oxford Centre for Evidence-Based Medicine was assigned to the body of literature. Data synthesis Articles were categorised based on their ability to answer one of the clinical questions of interest and the conclusions were summarised using a qualitative synthesis of the findings. Data were not appropriate for meta-analysis due to the observational nature of many included studies and heterogeneity of the patients, participants, interventions and outcomes. Conclusions The review identified that significant variability in the use of assessment tools and compliance with recommended return-to-activity guidelines exists (SOR=B) and there is little evidence to support the effectiveness of the graded return-to-activity progression (SOR=D). Competing interests None.