Academic Center (academic + center)

Distribution by Scientific Domains
Medical Sciences93%

Selected Abstracts

Emergency Department Information System Implementation and Process Redesign Result in Rapid and Sustained Financial Enhancement at a Large Academic Center

ACADEMIC EMERGENCY MEDICINE, Issue 5 2010
Jason S. Shapiro MD
Abstract Objectives:, The objectives were to measure the financial impact of implementing a fully integrated emergency department information system (EDIS) and determine the length of time to "break even" on the initial investment. Methods:, A before-and-after study design was performed using a framework of analysis consisting of four 15-month phases: 1) preimplementation, 2) peri-implementation, 3) postimplementation, and 4) sustained effects. Registration and financial data were reviewed. Costs and rates of professional and facility charges and receipts were calculated for the phases in question and compared against monthly averages for covariates such as volume, collections rates, acuity, age, admission rate, and insurance status with an autoregressive time series analysis using a segmented model. The break-even point was calculated by measuring cumulative monthly receipts for the last three study phases in excess of the average monthly receipts from the preimplementation phase, corrected for change in volume, and then plotting this against cumulative overall cost. Results:, Time to break even on the initial EDIS investment was less than 8 months. Total revenue enhancement at the end of the 5-year study period was $16,138,953 with an increase of 69.40% in charges and 70.06% in receipts. This corresponds to an increase in receipts per patient from $50 to $90 for professional services and $131 to $183 for facilities charges. Other than volume, there were no significant changes in trends for covariates between the preimplementation and sustained-effects periods. Conclusions:, A comprehensive EDIS implementation with process redesign resulted in sustained increases in professional and facility revenues and a rapid initial break-even point. ACADEMIC EMERGENCY MEDICINE 2010; 17:527,535 © 2010 by the Society for Academic Emergency Medicine [source]

Nerve of Origin, Tumor Size, Hearing Preservation, and Facial Nerve Outcomes in 359 Vestibular Schwannoma Resections at a Tertiary Care Academic Center

THE LARYNGOSCOPE, Issue 12 2007
Abraham Jacob MD
Abstract Objective: To determine nerve of origin, tumor size, hearing preservation rates, and facial nerve outcomes in a retrospective cohort study of patients undergoing translabyrinthine (TL), middle cranial fossa (MCF), and retrosigmoid/suboccipital (SO) approaches to vestibular schwannomas (VS). Study Design: Retrospective. Methods: Chart review. Results: Patient charts from 231 TL, 70 MCF, 53 SO, and 5 combined TL/SO procedures for VS were evaluated in 356 patients. The inferior vestibular nerve (IVN) was the nerve of origin in 84 of 359 cases (23.3%), while the superior vestibular nerve (SVN) was the nerve of origin in 36 patients (10%). In 239 of 359 cases (66.6%), the nerve of origin was not identified. Forty patients undergoing hearing preservation surgery had hearing results and nerve of origin data available for review. Functional hearing (<50dB PTA and >50% speech discrimination) was preserved in 10 of 15 patients (75%) with SVN tumors, while only 7 of 25 patients (28%) with IVN tumors retained functional hearing. Facial nerve outcomes and nerve of origin were recorded simultaneously in 109 patients. Seventy-one of 74 patients (95%) patients with IVN tumors achieved a House-Brackmann (HB) grade I,III, while 35 of 35 patients (100%) with SVN tumors retained HB I,III facial function. Looking at tumor size versus hearing preservation, functional hearing was preserved in 22 of 49 patients (45%) with <1-cm tumors, and 4 of 20 patients (20%) with 1- to 1.5-cm tumors. For all cases with documented facial nerve function, HB I,III were achieved in 96% of SO, 94% of MCF, and 88% of TL procedures. Conclusions: Our retrospective data indicated that IVN tumors were twice as common as SVN tumors. The nerve of origin did not affect facial nerve outcomes but did impact hearing preservation rates. Patients with tumors <1 cm in size had the best chance for hearing preservation. Overall facial nerve preservation was excellent with >90% achieving HB 1 to 3 function at final follow-up. [source]

The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis

EXPERIMENTAL DERMATOLOGY, Issue 1 2001
J. M. Hanifin
Abstract:Objective, To test the reliability of the eczema area and severity index (EASI) scoring system by assessing inter- and intra-observer consistency. Design: Training of evaluators, application, and assessment over 2 consecutive days. Setting, An academic center. Patients, Twenty adults and children with atopic dermatitis (AD); cohort 1 (10 patients ,8 years) and cohort 2 (10 patients <8 years). Interventions, None. Main outcome measure, The EASI was used by 15 dermatologist evaluators to assess atopic dermatitis in cohort 1 and cohort 2 on 2 consecutive days. Inter- and intraobserver reliability were analyzed. Results, Overall intra-evaluator reliability of the EASI was in the fair-to-good range. Inter-evaluator reliability analyses indicated that the evaluators assessed the patients consistently across both study days. Conclusions, This study demonstrated that the EASI can be learned quickly and utilized reliably in the assessment of severity and extent of AD. There was consistency among the evaluators between consecutive days of evaluation. These results support the use of the EASI in clinical trials of therapeutic agents for AD. [source]

Factors influencing long-term survival following salvage total laryngectomy after initial radiotherapy or conservative surgery,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2006
B. Zach Fowler MD
Abstract Background. This retrospective study investigated survival outcomes of salvage total laryngectomy (STL) after initial radiation therapy (RT) or larynx conservation surgery (CS) at an academic center. Methods. A chart review yielded 64 patients with STL: 53 with RT failures, six with CS failures, and five after RT + CS. Median potential follow-up after STL was 9.4 years (mean, 9.2 years; range, 0.3,17.4 years). Results. Five- and 10-year actuarial overall survival (OS) after STL was 65.2% and 37.7%, respectively. Mean survival after STL was 7.2 years (median, 6.8 years; range, 0.2,17.4 years). No significant survival difference was found between the three treatment groups (p = .50). For 21 patients with nodes assessed at STL, 9-year OS was 45.4% for patients with N0 disease versus 26.7% for patients with N+ disease (p = .25). Conclusion. These data suggest that STL after radiation failure is associated with equivalent long-term survival as STL after RT + CS or after failure of CS alone. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source]

Ruptured internal jugular vein: A postoperative complication of modified/selected neck dissection

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2003
Suzanne S. Cleland-Zamudio MD
Abstract Background. Postoperative hemorrhage from the internal jugular vein after a modified or selective neck dissection is an infrequent, yet potentially life-threatening, complication. Despite the increasing frequency of modified or selective neck dissections, this complication has not been previously highlighted in the literature. Setting. Tertiary referral academic center. Material and Methods. The records of six patients who experienced this complication were reviewed and analyzed for risk factors that might predict its occurrence. Results. Common risk factors included postoperative pharyngeal fistula formation, significant tobacco history, and poor nutritional status. A more complete circumferential dissection of the vein low in the neck in the presence of hypopharyngeal fistula may place it at a higher risk for rupture. Conclusions. Patients who have a complete circumferential dissection of the internal jugular vein low in the neck and go on to have fistulas develop may be more prone to internal jugular vein rupture. © 2003 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source]

The advanced practice nurse,nephrologist care model: Effect on patient outcomes and hemodialysis unit team satisfaction

HEMODIALYSIS INTERNATIONAL, Issue 3 2004
Lori Harwood
Abstract The tertiary care nurse practitioner/clinical nurse specialist (NP/CNS) is an advanced practice nurse with a relatively new role within the health-care system. It is stated that care provided by the NP/CNS is cost-effective and of high quality but little research exists to document these outcomes in an acute-care setting. The clinical coverage pattern by nephrologists and NP/CNS of a hemodialysis unit in a large academic center allowed such a study. Two NP/CNS plus a nephrologist followed two of three hemodialysis treatment shifts per day; only a nephrologist followed the third shift. The influence of this care pattern of patients was examined using a cross-sectional review of outcomes such as adequacy of delivered dialysis, anemia management, phosphate control, hospitalizations, etc. In addition, the level of satisfaction of the dialysis team and perceptions of care delivered with the care models was assessed. The care model staff-to-patient-number ratio was similar in both groups (1:27 for NP/CNS plus nephrologist; 1:29 for nephrologist alone). Patient demographics were similar in both groups but the NP/CNS,nephrologist group had patients with more comorbidities. No statistically significant (p < 0.05) differences existed between the groups in patient laboratory data, adherence to standards, medications, inter- and intradialytic blood pressure, achievement of target postdialysis weights, and hospitalizations or emergency room visits. Significantly more adjustments were made to target weights and medications and more investigations were ordered by the NP/CNS,nephrologist team. Team satisfaction and perceptions of care delivery were higher with the NP/CNS,nephrologist model. It is concluded that the NP/CNS,nephrologist care model may increase the efficiency of the care provided by nephrologists to chronic hemodialysis patients. The model may also be a solution to the problem of providing nephrologic care to an ever-growing hemodialysis population. [source]

Laparoscopic radical prostatectomy: Transfer validity

INTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2010
Tibet Erdogru
Objectives: The impact of a formal fellowship training program on the independent practice of the trainees (i.e. transfer validity) has not been evaluated. We analyzed the transfer validity of a structured curriculum in an in-door as well as an out-door setting. Methods: After completing their training, two fourth generation laparoscopic surgeons who started at the same time compared operative parameters and oncological outcomes in their independent practice, prospectively analyzing the next 100 patients in each. One surgeon continued laparoscopic radical prostatectomy (LRP) in the same center of excellence (Group-In), whereas the other implemented the procedure in a separate academic center (Group-Out). Results: The demographics for both groups (Group-In vs Group-Out) were similar regarding age, prostate volume and preoperative prostate-specific antigen levels. Mean operation times (214.8 vs 224.2 min; P = 0.494) and estimated blood loss (472.4 vs 402.6 mL; P = 0.109) did not differ significantly in both groups as well as complication rate (20 vs 24%), median catheter time (8 vs 8.5 days) and continence rates at 12 months (95 vs 95.5%). According to the pathological stages, the rates of positive surgical margins were similar for pT2 (3.2 vs 4.3%) and pT3 (42.8 vs 45.2%), respectively. Conclusions: With a well designed, long-term preclinical and clinical fellowship training program, LRP techniques can be efficiently transferred from the center of excellence to other centers with no significant impact on surgical, functional and oncological outcomes. [source]

Flexible Endoscopic Clip-Assisted Zenker's Diverticulotomy: The First Case Series (With Videos),

THE LARYNGOSCOPE, Issue 7 2008
Shou-jiang Tang MD
Abstract Background: In treating Zenker's diverticulum (ZD), there are potential risks associated with performing flexible endoscopic diverticulotomy without suturing or stapling. We recently introduced flexible endoscopic clip-assisted diverticulotomy (ECD) in treating ZD by securing the septum prior to dissection. Objective: To evaluate the feasibility and safety of ECD for complete septum dissection. Study Design: Case series at an academic center. Seven consecutive patients (mean age 71 y; range 48,91 y) with symptomatic ZD of various craniocaudal sizes based on radiographic measurements (mean 2.6 cm; range 0.8 cm,4.5 cm) were included. The mean depth of the septum was 1.73 cm (range 0.3 cm,3.1 cm). The mean duration of symptoms was 4.8 years (range 0.5,10 y). Methods: After endoclips were placed on either side of the cricopharyngeal bar, the septum was dissected between these two clips down to the inferior end of the diverticulum with a needle-knife. Procedures including "one-step ECD" (n = 1), "stepwise ECD" (n = 3), and "bottom ECD" (n = 2) were performed based on the septum depth of the ZD during endoscopy. ECD was not performed on one patient due to severe mucosal fragility of the esophageal inlet. Iatrogenic blunt dissection of the septum by the endoscopic hood occurred secondary to patient retching during the procedure. Main outcome measurements were symptom resolution and complications. Results: All patients (n = 6) who underwent ECD had complete resolution of esophageal symptoms at a minimum 6-month follow-up. There were no procedural complications. The patient who did not undergo ECD developed an esophageal perforation. She was managed conservatively without surgical intervention. On follow-up, her dysphagia was completely resolved. Conclusions: ECD is feasible, safe, and effective for complete septum dissection. ECD and endoscopic stapler-assisted diverticulotomy are complimentary rather than competing strategies in approaching ZD. Study limitations include the case series design and limited follow-up period. [source]

The Effects of Smoking on Short-Term Quality of Life Outcomes in Sinus Surgery,

THE LARYNGOSCOPE, Issue 12 2007
Subinoy Das MD
Abstract Objective: The purpose of this study was to prospectively compare the short-term benefit of endoscopic sinus surgery for smokers and nonsmokers using a disease specific, clinically validated, quality of life outcomes measure, the Sinonasal Outcomes Test-20 (SNOT-20). Study Design: Prospective clinical trial. Methods: A total of 235 patients were prospectively enrolled at a single tertiary academic center. Preoperative SNOT-20 scores and comprehensive demographic data were obtained. All patients underwent endoscopic sinus surgery under the supervision of the senior author. Preoperative SNOT-20 scores were compared to short-term postoperative SNOT-20 scores. Results: Short-term postoperative results were available for 221 patients for comparison. Preoperative SNOT-20 scores in 49 smokers (mean: 27.8) and 172 nonsmokers (mean: 26.2) were statistically similar. Both smokers and nonsmokers achieved a highly significant reduction in SNOT-20 scores at short-term follow-up evaluations. (P < .0005) Smokers achieved a greater reduction in SNOT-20 scores (mean difference: 22.1) at short-term follow-up compared to nonsmokers (mean difference: 16.1). This result was statistically significant (P < .044). Conclusions: This study confirms that smokers and nonsmokers achieve a highly significant short-term benefit from endoscopic sinus surgery using a clinically-validated symptom severity scale in a prospective study. Interestingly, smokers achieved a greater short-term benefit than nonsmokers did. This study calls into question the notion that current smokers are poorer candidates for endoscopic sinus surgery. Further prospective studies to confirm these results and provide long-term analysis should be performed. [source]

Congenital Cholesteatoma: Risk Factors for Residual Disease and Retraction Pockets,A Report on 117 Cases,

THE LARYNGOSCOPE, Issue 4 2007
Diane S. Lazard MD
Abstract Objectives: To define predictors of residuals and retraction pockets (RP) in children operated on for congenital cholesteatoma (CC). Design and Setting: Retrospective review (1996,2005), academic center. Patients: One hundred seventeen patients treated for CC corresponding to modified Derlacki's criteria were included (median age, 6.5 yr). No case of RP at time of diagnosis, with a mean follow-up of 2.5 years after last surgery. Main Outcome Measures: Clinical and surgical data influencing outcome. Multivariate analysis. Results: Two groups were defined after CC removal: group I (12 cases), no second look required and no case of subsequent re-intervention; group II (105 cases), planned second look always performed (mean delay, 12.1 mo), no difference of sex ratio (M/F = 2). Group I patients were younger than in group II (3.3 vs. 5.9 yr, P < .001). All of them had a normal contralateral eardrum and a disclosure of CC by routine examination (vs. 19% in group II, P < .001). In group I, the mass occupied one or two anterior quadrants (41.6% and 58.4%, respectively) versus more than two quadrants in 46.6% in group II. Residuals and RP rates were 41% and 15%, respectively (only in group II). Predictors for residuals were atticotomy (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.3,6.7) and destruction of stapes (OR 4.3, 95% CI 1.7,10.5). Predictors for RP were eustachian tube extension (OR 6.8, 95% CI 1.7,26.8) and nonreconstructed atticotomy (OR 5.9, 95% CI 1.1,30.9). Conclusions: Young children with small CC had no recurrences. Residuals were more frequent in case of atticotomy and stapes destruction. RP occurred especially in cases of eustachian tube extension and if cartilage tympanoplasty was not performed. Tympanic and canal wall reinforcement should be considered in extensive CC. [source]

The Effect of Emergency Department Crowding on Patient Satisfaction for Admitted Patients

ACADEMIC EMERGENCY MEDICINE, Issue 9 2008
Jesse M. Pines MD
Abstract Objectives:, The objective was to study the association between factors related to emergency department (ED) crowding and patient satisfaction. Methods:, The authors performed a retrospective cohort study of all patients admitted through the ED who completed Press-Ganey patient satisfaction surveys over a 2-year period at a single academic center. Ordinal and binary logistic regression was used to study the association between validated ED crowding factors (such as hallway placement, waiting times, and boarding times) and patient satisfaction with both ED care and assessment of satisfaction with the overall hospitalization. Results:, A total of 1,501 hospitalizations for 1,469 patients were studied. ED hallway use was broadly predictive of a lower likelihood of recommending the ED to others, lower overall ED satisfaction, and lower overall satisfaction with the hospitalization (p < 0.05). Prolonged ED boarding times and prolonged treatment times were also predictive of lower ED satisfaction and lower satisfaction with the overall hospitalization (p < 0.05). Measures of ED crowding and ED waiting times predicted ED satisfaction (p < 0.05), but were not predictive of satisfaction with the overall hospitalization. Conclusions:, A poor ED service experience as measured by ED hallway use and prolonged boarding time after admission are adversely associated with ED satisfaction and predict lower satisfaction with the entire hospitalization. Efforts to decrease ED boarding and crowding might improve patient satisfaction. [source]

Retinal nerve fiber layer thickness and central corneal thickness in ocular hypertensive patients and healthy subjects

ACTA OPHTHALMOLOGICA, Issue 2009
AM BRON
Purpose To establish the correlation between central corneal thickness (CCT) and retinal nerve fiber layer (RNFL) thickness in ocular hypertensive patients and healthy subjects. Methods We prospectively collected charts of healthy subjects and ocular hypertensive (OHT) patients in one academic center between 2007 and 2008. OHT patients were defined by two measurements of intraocular pressure superior to 21mmHg without treatment, open angle in gonioscopy, normal appearing optic nerve head and normal visual field test Standard Automated Perimetry (SAP SITA) and Frequency Doubling Technique (FDT). Every patient underwent a standard clinical examination including optic nerve head examination, intraocular pressure, CCT measurement by ultrasonic (US) and anterior segment OCT pachymetry, visual field testing (SAP and FDT), RNFL thickness by scanning laser polarimetry (GDX-VCC) and optical coherence tomography (OCT). Results Eighty healthy subjects and 60 OHT patients were included. A correlation between US CCT and OCT CCT was found in both groups (r2=0.85 and r2= 0.87, p<0.001). There was no significant difference (p>0.15) in GDX-VCC and OCT RNFL thickness in both groups. In controls there was no correlation of any RNFL thickness measurement with the CCT. In OHT patients, the US CCT was weakly correlated with the average TSNIT evaluated by GDX-VCC (r2= 0.04, p<0.02). Conclusion This study did not show any relevant correlation between the RNFL thickness evaluated by GDX-VCC and the US CCT in healthy individuals and in OHT patients with a normal FDT. [source]

Non,housestaff medicine services in academic centers: Models and challenges

JOURNAL OF HOSPITAL MEDICINE, Issue 3 2008
Niraj L. Sehgal MD
Abstract Non,housestaff medicine services are growing rapidly in academic medical centers (AMCs), partly driven by efforts to comply with resident duty hour restrictions. Hospitalists have emerged as a solution to providing these services given their commitment to delivering efficient and high-quality care and the field's rapid growth. However, limited evidence is available on designing these services, including the similarities and differences of existing ones. We describe non,housestaff medicine services at 5 AMCs in order to share our experiences and outline important considerations in service development. We discuss common challenges in building and sustaining these models along with local institutional factors that affect decision making. Keys to success include ensuring an equitable system for scheduling and staffing, fostering opportunities for scholarly activities and academic promotion (defining the "academic hospitalist"), and providing compensation that supports recruitment and retention of hospitalists. With further work hour restrictions expected in the future and increased requests for surgical comanagement, the relationship between AMCs and hospitalists will continue to evolve. To succeed in developing hospitalist faculty who follow long careers in hospital medicine, academic leadership must carefully plan for and evaluate the methods of providing these clinical services while expanding on our academic mission. Journal of Hospital Medicine 2008;3:247,255. © 2008 Society of Hospital Medicine. [source]

Childhood developmental disorders: an academic and clinical convergence point for psychiatry, neurology, psychology and pediatrics

THE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 1-2 2009
Allan L. Reiss
Background:, Significant advances in understanding brain development and behavior have not been accompanied by revisions of traditional academic structure. Disciplinary isolation and a lack of meaningful interdisciplinary opportunities are persistent barriers in academic medicine. To enhance clinical practice, research, and training for the next generation, academic centers will need to take bold steps that challenge traditional departmental boundaries. Such change is not only desirable but, in fact, necessary to bring about a truly innovative and more effective approach to treating disorders of the developing brain. Methods:, I focus on developmental disorders as a convergence point for transcending traditional academic boundaries. First, the current taxonomy of developmental disorders is described with emphasis on how current diagnostic systems inadvertently hinder research progress. Second, I describe the clinical features of autism, a phenomenologically defined condition, and Rett and fragile X syndromes, neurogenetic diseases that are risk factors for autism. Finally, I describe how the fields of psychiatry, psychology, neurology, and pediatrics now have an unprecedented opportunity to promote an interdisciplinary approach to training, research, and clinical practice and, thus, advance a deeper understanding of developmental disorders. Results:, Research focused on autism is increasingly demonstrating the heterogeneity of individuals diagnosed by DSM criteria. This heterogeneity hinders the ability of investigators to replicate research results as well as progress towards more effective, etiology-specific interventions. In contrast, fragile X and Rett syndromes are ,real' diseases for which advances in research are rapidly accelerating towards more disease-specific human treatment trials. Conclusions:, A major paradigm shift is required to improve our ability to diagnose and treat individuals with developmental disorders. This paradigm shift must take place at all levels , training, research and clinical activity. As clinicians and scientists who are currently constrained by disciplinary-specific history and training, we must move towards redefining ourselves as clinical neuroscientists with shared interests and expertise that permit a more cohesive and effective approach to improving the lives of patients. [source]

What Ever Happened to N-of-1 Trials?

THE MILBANK QUARTERLY, Issue 4 2008
Insiders' Perspectives, a Look to the Future
Context: When feasible, randomized, blinded single-patient (n-of-1) trials are uniquely capable of establishing the best treatment in an individual patient. Despite early enthusiasm, by the turn of the twenty-first century, few academic centers were conducting n-of-1 trials on a regular basis. Methods: The authors reviewed the literature and conducted in-depth telephone interviews with leaders in the n-of-1 trial movement. Findings: N-of-1 trials can improve care by increasing therapeutic precision. However, they have not been widely adopted, in part because physicians do not sufficiently value the reduction in uncertainty they yield weighed against the inconvenience they impose. Limited evidence suggests that patients may be receptive to n-of-1 trials once they understand the benefits. Conclusions: N-of-1 trials offer a unique opportunity to individualize clinical care and enrich clinical research. While ongoing changes in drug discovery, manufacture, and marketing may ultimately spur pharmaceutical makers and health care payers to support n-of-1 trials, at present the most promising resuscitation strategy is stripping n-of-1 trials to their essentials and marketing them directly to patients. In order to optimize statistical inference from these trials, empirical Bayes methods can be used to combine individual patient data with aggregate data from comparable patients. [source]

Knowledge Translation of the American College of Emergency Physicians Clinical Policy on Hypertension

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Jill F. Lehrmann MD
Objectives To determine if dissemination of the American College of Emergency Physicians clinical policy on hypertension to emergency physicians would lead to improvements in blood pressure reassessment and referral of emergency department (ED) patients with elevated blood pressure. Methods Two academic centers implemented a pre-post intervention design, with independent samples at pre and post phases. ED staff were blinded to the investigation. A total of 377 medical records were reviewed before policy dissemination and 402 were reviewed after policy dissemination. Medical records were eligible for review if the patient was at least 18 years of age, was not pregnant, was discharged from the ED, and had a triage systolic blood pressure ,140 mm Hg or diastolic blood pressure ,90 mm Hg. Patient records with a chief complaint of chest pain, shortness of breath, or neurologic complaints were excluded. Demographics, blood pressures, and evidence of discharge referral were abstracted from the medical record. The policy was disseminated after the initial medical record review. Post,policy dissemination medical record review was conducted within two weeks. Results A total of 779 medical records were reviewed. The mean age of patients was 45 years, 55% were male, and 46% were white, 13% Hispanic, 35% African American, and 6% other. No differences in reassessment or referral rates were found between study phases. Blood pressure reassessments were low during both phases: 33% (pre) and 37% (post). Referral rates of patients with elevated blood pressure were very low: 13% (pre) and 7% (post). Conclusions Knowledge of guidelines did not translate into changes in physician practice. Additional systems-based approaches are necessary to effectively translate guidelines into clinical practice. [source]