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Sharisse M. Arnold Rehring Liza M. Reifler Jennifer H. Seidel Karen A. Glenn John F. Steiner 《Academic pediatrics》2019,19(5):572-580
ObjectiveClinical specialty societies recommend long-acting reversible contraceptives (LARCs) as first-line contraception for adolescent women. We evaluated whether a combined educational and process improvement intervention enhanced LARC placement in primary care within an integrated health care system.MethodsThe intervention included journal clubs, live continuing education, point-of-care guidelines, and new patient materials. We conducted a retrospective cohort study across 3 time periods: baseline (January 2013?September 2015), early implementation (October 2015–March 2016), and full implementation (April 2016–June 2017). The primary outcome was the proportion of LARCs placed by primary care clinicians among women aged 13 to 18 years compared with gynecology clinicians.ResultsKaiser Foundation Health Plan of Colorado cared for approximately 20,000 women aged 13 to 18 years in each calendar quarter between 2013 and 2017. Overall, LARC placement increased from 7.0 per 1000 members per quarter at baseline to 13.0 per 1000 during the full intervention. Primary care clinicians placed 6.2% of all LARCs in 2013, increasing to 32.1% by 2017 (P < .001), including 45.5% of contraceptive implants. Clinicians who attended educational sessions were more likely to adopt LARCs than those who did not (17.9% vs 6.4% respectively, P = .009). Neither overall LARC placement rates (relative risk, 1.9; 95% confidence interval, 0.7?5.6) nor contraceptive implant rates (relative risk, 3.0; 95% confidence interval, 0.9?9.8) increased significantly in clinicians who attended educational activities.ConclusionsThis multimodal intervention was associated with increased LARC placement for adolescent women in primary care. The combination of education and process improvement is a promising strategy to promote clinician behavior change. 相似文献
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The specific role of postsynaptic activity for the generation of a functional magnetic resonance imaging (fMRI) response was determined by a simultaneous measurement of generated field excitatory postsynaptic potentials (fEPSPs) and blood oxygen level-dependent (BOLD) response in the rat hippocampal CA1 region during electrical stimulation of the contralateral CA3 region. The stimulation electrode was placed either in the left CA3a/b or CA3c, causing the preferentially basal or apical dendrites of the pyramidal cells in the right CA1 to be activated. Consecutive stimulations with low-intensity stimulation trains (i.e., 16 pulses for 8 seconds) resulted in clear postsynaptic responses of CA1 pyramidal cells, but in no significant BOLD responses. In contrast, consecutive high-intensity stimulation trains resulted in stronger postsynaptic responses that came along with minor (during stimulation of the left CA3a/b) or substantial (during stimulation of the left CA3c) spiking activity of the CA1 pyramidal cells, and resulted in the generation of significant BOLD responses in the left and right hippocampus. Correlating the electrophysiologic parameters of CA1 pyramidal cell activity (fEPSP and spiking activity) with the resultant BOLD response revealed no positive correlation. Consequently, postsynaptic activity of pyramidal cells, the most abundant neurons in the CA1, is not directly linked to the measured BOLD response. 相似文献
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Jessica Roberts MBBS Jason Powell MBBS MClinRes PhD MRCS Jacob Begbie MBBS MRes Gerard Siou MBBS MD FRCS Claire McLarnon MBBS MSc FRCS Andrew Welch MBBS FRCS Michael McKean MBChB MD FRCPCH Mathew Thomas MBChB MRCPCH PhD Anne-Marie Ebdon MBBS MRCPCH FRACP Samantha Moss MBBS MRCPCH MD Rachel S. Agbeko MSc MD PhD FRCPCH FFICM Jonathan H. Smith MBChB MRCP FRCA Malcolm Brodlie MB ChB PhD MRCPCH Christopher O'Brien MBBS FRCPCH Steven Powell MBBS MSc FRCS 《The Laryngoscope》2020,130(5):E375-E380
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Daniel J. Snyder Thomas R. Kroshus Aakash Keswani Evan B. Garden Karl M. Koenig Kevin J. Bozic David S. Jevsevar Jashvant Poeran Calin S. Moucha 《The Journal of arthroplasty》2019,34(4):613-618