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  1. Article ; Online: Bringing Reproductive Health Guidelines Into Fellowship Training: A National Survey of Adult and Pediatric Rheumatology Fellows and Program Directors.

    Rubino, Selene / Battistone, Michael J / Ardoin, Stacy P / Berlan, Elise D / Carandang, Kristine / Chiseri, Kate / Kavanaugh, Arthur / White, Whitney / Wise, Kelly A / Wong, Andrew L / Marston, Bethany / Clowse, Megan E B

    Arthritis care & research

    2023  

    Abstract: Objective: This study seeks to assess rheumatology fellows' (RFs') and program directors' (PDs') interests in different educational tools and methods and to facilitate curriculum development for reproductive health related to rheumatic disease.: ... ...

    Abstract Objective: This study seeks to assess rheumatology fellows' (RFs') and program directors' (PDs') interests in different educational tools and methods and to facilitate curriculum development for reproductive health related to rheumatic disease.
    Methods: Constructs were conceptualized in four dimensions: 1) RF and PD confidence in their current curriculum relating to the American College of Rheumatology (ACR) Reproductive Health Guidelines (RHGs), 2) personal interest in this topic, 3) opinions of the importance of this topic, and 4) interest in a range of learning materials and educational experiences. The final survey was distributed to 753 RFs and 179 PDs in the United States using the ACR Committee on Training and Workforce email list.
    Results: Response rates were 13% (n = 98) for RFs and 25% (n = 44) for PDs. Both groups indicated more interest in the topic than confidence in their curriculum and rated summary sheets, question banks, didactics, and online modules higher than nine other educational tools or methods. Despite interest in the topic, 38% of RF respondents and 24% of PD respondents were unaware of the recently published ACR RHGs.
    Conclusion: RFs and PDs consider reproductive health very important and report high personal interest in this topic. In contrast, both groups indicated lower confidence in current curricula, and substantial proportions of both groups were unaware of recently published guidelines. RFs' and PDs' interests in specific educational modalities are aligned. Curriculum development efforts should prioritize summary sheets, question banks, didactics, and online modules. Efforts are needed to address the educational needs of practicing rheumatologists and other professionals caring for patients with rheumatic disease.
    Language English
    Publishing date 2023-07-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 645059-3
    ISSN 2151-4658 ; 0893-7524 ; 2151-464X
    ISSN (online) 2151-4658
    ISSN 0893-7524 ; 2151-464X
    DOI 10.1002/acr.25203
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Preventing Teen Pregnancies on Teratogenic Drugs by Quality Improvement and Behavioral Economics.

    Mruk, Veronica M / Wise, Kelly A / Driest, Kyla / Oberle, Edward J / Ardoin, Stacy P / Yildirim-Toruner, Cagri / Sivaraman, Vidya / Stevens, Jack / McGinnis, Alec / Gallup, James / Mitchell, Brockton / Lemle, Stephanie / Jones, Sarah / Maher, Jackie / Berlan, Elise D / Barbar-Smiley, Fatima

    Pediatrics

    2022  

    Abstract: Background: Adolescents with chronic disease engage in sexual activity similar to their healthy peers, with generally low utilization of contraception. Adolescents with rheumatic diseases prescribed teratogenic medications may be at risk for unplanned ... ...

    Abstract Background: Adolescents with chronic disease engage in sexual activity similar to their healthy peers, with generally low utilization of contraception. Adolescents with rheumatic diseases prescribed teratogenic medications may be at risk for unplanned pregnancy.
    Methods: Using structured quality improvement (QI) methods with behavior economic (BE) principles, a multidisciplinary team aimed to implement pregnancy prevention processes for females on high-risk medications. We leveraged BE-inspired interventions including improved accessibility of consents, utilizing distinctly colored consent forms, real-time reminders, peer comparison, and audit and feedback. Our primary aim was to increase the number of days between pregnancies for postmenarcheal females followed in rheumatology clinics who were taking teratogenic medications. Phase 1 focused on annual consenting of female adolescents prescribed teratogenic drugs. Phase 2 emphasized sexual history screening and pregnancy prevention planning at every clinic visit for females ≥12 years on teratogenic medications.
    Results: We increased the days between pregnancies for female adolescents prescribed teratogenic medications from 52 days to >900 days by using QI methodology with BE strategies. In phase 1, annual consents for postmenarcheal patients on teratogenic medications improved from 0% in 2017 to 95% in 2021. In phase 2, sexual history screening and pregnancy prevention planning at every clinic visit improved from 2% in 2019 to over 78% in 2021.
    Conclusions: A multiphase, multidisciplinary QI project with integration of behavior economic strategies can improve patient and caregiver counseling to prevent unplanned pregnancies for adolescents on teratogenic medications.
    Language English
    Publishing date 2022-12-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2021-054294
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Previsit Planning Improves Pneumococcal Vaccination Rates in Childhood-Onset SLE.

    Sivaraman, Vidya / Wise, Kelly A / Cotton, William / Barbar-Smiley, Fatima / AlAhmed, Ohoud / MacDonald, Darby / Lemle, Stephanie / Yildirim-Toruner, Cagri / Ardoin, Stacy P / Ardura, Monica I

    Pediatrics

    2020  Volume 145, Issue 1

    Abstract: Background: Childhood-onset systemic lupus erythematosus (c-SLE) is a complex autoimmune disease that requires systemic immunosuppressive therapy. Infections are the second leading cause of death in these patients, with invasive pneumococcal infections ... ...

    Abstract Background: Childhood-onset systemic lupus erythematosus (c-SLE) is a complex autoimmune disease that requires systemic immunosuppressive therapy. Infections are the second leading cause of death in these patients, with invasive pneumococcal infections being a major preventable cause of morbidity and mortality. Pneumococcal vaccination is recommended in this population; however, vaccination rates remain low.
    Methods: The plan-do-study-act method of quality improvement was applied. We calculated baseline vaccination rates for pneumococcal conjugate and pneumococcal polysaccharide vaccines in patients with c-SLE in the rheumatology clinic from January 2015 to August 2016. We developed an age-based algorithm to simplify the vaccination guidelines. The clinical pharmacist and nurses performed weekly previsit planning to update vaccine records, make targeted recommendations, and ensure vaccine availability. The primary outcome measure was the percentage patients with of c-SLE seen per month who had received age-appropriate pneumococcal vaccination.
    Results: The percentage of children receiving at least 1 pneumococcal vaccine increased from 24.9% to 92.7% by 12 months. By 18 months, the compliance rate with both pneumococcal vaccines increased from 2.5% to 87.3%, with sustained results. No serious adverse events or disease flares were reported.
    Conclusions: By identifying the major barriers to pneumococcal vaccination in our population with c-SLE, we significantly improved vaccination rates while decreasing time burden on providers. We attribute our success to a team-based quality improvement approach and plan to implement alerts in the electronic health record to streamline the process.
    MeSH term(s) Adolescent ; Adult ; Age Factors ; Age of Onset ; Algorithms ; Child ; Electronic Health Records ; Female ; Health Plan Implementation ; Health Services Accessibility ; Humans ; Immunosuppressive Agents/therapeutic use ; Lupus Erythematosus, Systemic/complications ; Lupus Erythematosus, Systemic/drug therapy ; Male ; Nursing Staff ; Outcome Assessment, Health Care ; Patient Care Team/organization & administration ; Pharmacists ; Pneumococcal Infections/microbiology ; Pneumococcal Infections/prevention & control ; Pneumococcal Vaccines/administration & dosage ; Pneumococcal Vaccines/immunology ; Practice Guidelines as Topic ; Quality Improvement ; Vaccination/statistics & numerical data ; Vaccination/trends ; Vaccines, Conjugate/administration & dosage ; Vaccines, Conjugate/immunology ; Young Adult
    Chemical Substances Immunosuppressive Agents ; Pneumococcal Vaccines ; Vaccines, Conjugate
    Language English
    Publishing date 2020-01-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2018-3141
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Pharmacist impact on pediatric vaccination errors and missed opportunities in the setting of clinical decision support.

    Wise, Kelly A / Sebastian, Sonya J / Haas-Gehres, Anna C / Moore-Clingenpeel, Melissa D / Lamberjack, Kristen E

    Journal of the American Pharmacists Association : JAPhA

    2017  Volume 57, Issue 3, Page(s) 356–361

    Abstract: Objective: To determine pharmacist impact on vaccination errors and missed opportunities in the pediatric primary care setting with the presence of clinical decision support (CDS) by comparing a clinic with a pharmacist and CDS to a clinic with CDS ... ...

    Abstract Objective: To determine pharmacist impact on vaccination errors and missed opportunities in the pediatric primary care setting with the presence of clinical decision support (CDS) by comparing a clinic with a pharmacist and CDS to a clinic with CDS alone.
    Design: A retrospective chart review of patients' electronic medical records compared vaccination errors and missed opportunities between 2 pediatric primary care clinics.
    Setting: Two urban, pediatric primary care clinics were selected for the study.
    Participants: Encounters were included in the analysis for children presenting for any visit over a 3-month period.
    Intervention: The intervention clinic had a full-time clinical pharmacist and CDS. The comparison clinic had CDS alone.
    Main outcome measures: Vaccination errors were defined as follows: doses administered before minimum recommended age, doses administered before minimum recommended dosing interval, unnecessary doses, and invalid doses for a combination of these reasons. Missed opportunities were defined as vaccine doses due at the date of encounter but not administered, without documented reason for vaccination delay or refusal by provider or patient. The likelihood of missing an opportunity was also assessed for patient age, visit type, and provider type.
    Results: One thousand and twenty patient encounters were randomly selected and reviewed. The vaccination error rate was 0.4% in the comparison group and 0% in the intervention group (P = 0.4995). The number of encounters with a missed opportunity was significantly higher in the comparison group compared with the intervention group (51 vs. 30 encounters with missed opportunities; P = 0.015; adjusted odds ratio, 2.14 [95% CI 1.3-35]).
    Conclusion: Although the use of CDS results in a low rate of vaccination errors, technology cannot be solely relied on for vaccination recommendations in the pediatric population because of the rigidity of CDS configuration. Pharmacists continue to play a vital role to ensure that children are appropriately vaccinated in the primary care setting.
    Language English
    Publishing date 2017-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2118585-2
    ISSN 1544-3450 ; 1544-3191 ; 1086-5802
    ISSN (online) 1544-3450
    ISSN 1544-3191 ; 1086-5802
    DOI 10.1016/j.japh.2017.02.025
    Database MEDical Literature Analysis and Retrieval System OnLINE

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