Anjali Patwardhan

Are patient surveys valuable as a service-improvement tool in health services? An overview

Correspondence: Anjali Patwardhan 831 East Mound Street, Columbus, OH 43205, USA Tel +1 614 266 2187 Email doctoranjali@hotmail.com Abstract: Improving the quality of care in international health services was made a high priority in 1977. The World Health Assembly passed a resolution to greatly improve “Health for all” by the year 2000. Since 1977, the use of patient surveys for quality improvement has become a common practice in the health-care industry. The use of surveys reflects the concept that patient satisfaction is closely linked with that of organizational performance, which is in turn closely linked with organizational culture. This article is a review of the role of patient surveys as a quality-improvement tool in health care. The article explores the characteristics, types, merits, and pitfalls of various patient surveys, as well as the impact of their wide-ranging application in dissimilar scenarios to identify gaps in service provision. It is demonstrated that the conducting of patient surveys and using the results to improve the quality of care are two different processes. The value of patient surveys depends on the interplay between these two processes and several other factors that can influence the final outcome. The article also discusses the business aspect of the patient surveys in detail. Finally, the authors make future recommendations on how the patient survey tool can be best used to improve the quality of care in the health-care sector.

NOVEL REAGENTS FOR TARGETED CLEAVAGE OF RNA SEQUENCES : TOWARDS A NEW FAMILY OF INORGANIC PHARMACEUTICALS

Copper kanamycin degrades cognate RNA targets at concentrations as low as picomolar levels at physiological pH and temperature, but shows no chemistry with random RNA or DNA molecules, thereby demonstrating potential for development as a novel antiviral agent.

Gene copy-number variations (CNVs) of complement C4 and C4A deficiency in genetic risk and pathogenesis of juvenile dermatomyositis

Objective Complement-mediated vasculopathy of muscle and skin are clinical features of juvenile dermatomyositis (JDM). We assess gene copy-number variations (CNVs) for complement C4 and its isotypes, C4A and C4B, in genetic risks and pathogenesis of JDM. Methods The study population included 105 patients with JDM and 500 healthy European Americans. Gene copy-numbers (GCNs) for total C4, C4A, C4B and HLA-DRB1 genotypes were determined by Southern blots and qPCRs. Processed activation product C4d bound to erythrocytes (E-C4d) was measured by flow cytometry. Global gene-expression microarrays were performed in 19 patients with JDM and seven controls using PAXgene-blood RNA. Differential expression levels for selected genes were validated by qPCR. Results Significantly lower GCNs and differences in distribution of GCN groups for total C4 and C4A were observed in JDM versus controls. Lower GCN of C4A in JDM remained among HLA DR3-positive subjects (p=0.015). Homozygous or heterozygous C4A-deficiency was present in 40.0% of patients with JDM compared with 18.2% of controls (OR=3.00 (1.87 to 4.79), p=8.2×10−6). Patients with JDM had higher levels of E-C4d than controls (p=0.004). In JDM, C4A-deficient subjects had higher levels of E-C4d (p=0.0003) and higher frequency of elevated levels of multiple serum muscle enzymes at diagnosis (p=0.0025). Microarray profiling of blood RNA revealed upregulation of type I interferon-stimulated genes and lower abundance of transcripts for T-cell and chemokine function genes in JDM, but this was less prominent among C4A-deficient or DR3-positive patients. Conclusions Complement C4A deficiency appears to be an important factor for the genetic risk and pathogenesis of JDM, particularly in patients with a DR3-positive background.

Highly specific oxidative damage of double-strand DNA by copper aminoglycosides

Oxidative cleavage of double-strand DNA, mediated by either Cu2+-neamine 1 or Cu2+-kanamycin A 2, is shown to follow a highly specific C-4′ H mediated pathway and suggests a mechanism for efficient double-strand scission of duplex DNA.

Improving the influenza vaccination rate in patients visiting pediatric rheumatology clinics using automatic best practice alert in electronic patient records

Purpose Children with rheumatic disease who are infected with influenza have increased rates of complications. Influenza related morbidity and mortality can be reduced by improving the flu vaccination rate. The purpose of the study is to look at the effectiveness of single information technology intervention in improving flu vaccination rate in children with rheumatic diseases. of rheumatology clinic patients from a large pediatric which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

PReS-FINAL-2351: Children with probable SLE by ACR criteria may need more aggressive lupus treatment early in the disease course

The pediatric lupus patients are required to meet the American College of Rheumatology (ACR) minimum criteria to be included in the research cohort and considered for aggressive therapy. This approach may delay early aggressive therapy.

Pres-FINAL-2009: Pediatric rheumatology practitioners experience with biologics in juvenile dermatomyositis: survey results

Over half (57%) of the respondents currently managed 1-10 patients with JDM; 10% of respondents reported ≥20 patients with JDM in their practice. Sixty-one percent of respondents had used biologics in patients with JDM, with 32%, 5%, and 4% prescribing rituximab, etanercept and infliximab, respectively; 17% had prescribed more than one biologic. The majority of respondents (89%) had used biologics in combination with other therapies, while 11% had used biologics as monotherapy in JDM. The biologics used by the respondents were, rituximab, infliximab, etanercept and anakinra and abatacept. Among the respondents that used biologics, uncontrolled disease was the primary rationale for prescribing this medication. Over half of respondents used biologics after the patients failed other therapies; 11% of respondents used biologics for systemic (internal organ) involvement and 15% had used biologics for severe ulcerative disease. Seventy-three percent of respondents that used biologics noted improvement, while 10% reported worsening disease. Over half (53%) of respondents that used biologics noted improvement in calcinosis, while 64% reported side effects (common and uncommon). Among the respondents that had not used biologics (39%) in JDM, 88% would use this therapy if the opportunity arose; nearly half (47%) of these respondents had not used biologics because of uncertainty regarding effectiveness in JDM. Seventy percent of practitioners recommended that biologics be formally studied in patients with JDM; 24% of respondents were unsure and 6% felt biologics should not be studied in patients with JDM. Conclusion Several PR have used biologics in the management of pediatric patients with JDM. Among respondants that have not used biologics in this patient population, most would be interested in prescribing biologics. This survey supports the rationale for considering clinical trials and consensus protocols to elucidate the safety and effectiveness of biologics in children with JDM. Further information will be gathered by the CARRA JDM Subcommittee on Biologics through second survey to prioritize specific medications for investigation.