Dr. Leonard  Feldman  Md image

Dr. Leonard Feldman Md

974 Mud Bay Rd
Haines AK 99827
907 663-3009
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: AA1878
NPI: 1831285519
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Primary Care Providers' Comfort Levels in Caring for Patients with Sickle Cell Disease. - Southern medical journal
The purpose of this study was to determine the comfort levels of primary care providers in caring for individuals with sickle cell disease (SCD) and determine factors that improved or lessened provider comfort.We surveyed providers at the annual Johns Hopkins Community Physicians retreat. The survey consisted of 19 questions and measured comfort levels in four domains: providing ambulatory care to individuals with SCD, managing SCD comorbidities, managing SCD-specific issues, and managing chronic pain. We conducted bivariate analyses to identify any demographic or practice characteristics associated with comfort levels. Multivariable analyses were conducted to identify independent correlates of physician comfort.The majority of respondents lacked confidence with each of the four aspects of caring for individuals with SCD. Having treated patients with SCD and using knowledge from residency were both independently associated with increased confidence when providing ambulatory care and managing SCD-specific issues in multivariable analyses.The delivery of high-quality care to adults with SCD in primary care may be limited because of a lack of provider comfort in providing that care. Because provider reliance on knowledge gained from residency significantly affected the management of patients with SCD, it is essential that continuing medical education on SCD is readily available to ensure that providers are using current information and knowledge. In addition, as comfort increases with the number of patients with SCD in a provider's panel, it may be beneficial to identify a subset of primary care providers interested in SCD and refer patients to those providers.
Assessing intern handover processes. - The clinical teacher
New standards for resident work hours set in 2011 changed the landscape of patient care in teaching hospitals, and resulted in new challenges for US residency training programmes to overcome. One such challenge was a dramatic increase in the number of patient handovers performed by residents. As a result, there is a renewed focus for clinical teachers to develop educational strategies to optimise the patient handover process and improve the quality of patient care and safety.In order to investigate current gaps in resident handovers, we examined the handover processes performed by medicine interns at two academic medical centres in Baltimore, Maryland, USA. We used trained observers to collect data on whether handovers were conducted face to face, with questions asked, in private locations, with written documentation, and without distractions or interruptions. Results were analysed using chi-square tests, and adjusted for clustering at the observer and intern levels.Interns successfully conducted handovers face to face (99.5%), asked questions (85.3%), used private locations (91%), included written handover documentation (95.8%) and did not experience distractions for the majority of the time (87.7%); however, interruptions were pervasive, occurring 41.3 per cent of the time. In order to investigate current gaps in resident handovers, we examined the handover processes performed by medicine interns DISCUSSION: Interns conducted patient handovers face to face, with questions asked, in private locations, with written documentation and without distractions the majority of the time; however, interruptions during the handover process were common. Exploring gaps at the individual programme level is a critical first step to develop effective teaching strategies to optimise handovers in residency.© 2015 John Wiley & Sons Ltd.
Contactless Determination of Electrical Conductivity of One-Dimensional Nanomaterials by Solution-Based Electro-orientation Spectroscopy. - ACS nano
Nanowires of the same composition, and even fabricated within the same batch, often exhibit electrical conductivities that can vary by orders of magnitude. Unfortunately, existing electrical characterization methods are time-consuming, making the statistical survey of highly variable samples essentially impractical. Here, we demonstrate a contactless, solution-based method to efficiently measure the electrical conductivity of 1D nanomaterials based on their transient alignment behavior in ac electric fields of different frequencies. Comparison with direct transport measurements by probe-based scanning tunneling microscopy shows that electro-orientation spectroscopy can quantitatively measure nanowire conductivity over a 5-order-of-magnitude range, 10(-5)-1 Ω(-1) m(-1) (corresponding to resistivities in the range 10(2)-10(7) Ω·cm). With this method, we statistically characterize the conductivity of a variety of nanowires and find significant variability in silicon nanowires grown by metal-assisted chemical etching from the same wafer. We also find that the active carrier concentration of n-type silicon nanowires is greatly reduced by surface traps and that surface passivation increases the effective conductivity by an order of magnitude. This simple method makes electrical characterization of insulating and semiconducting 1D nanomaterials far more efficient and accessible to more researchers than current approaches. Electro-orientation spectroscopy also has the potential to be integrated with other solution-based methods for the high-throughput sorting and manipulation of 1D nanomaterials for postgrowth device assembly.
Quality improvement process in a sickle cell infusion center. - The American journal of medicine
The American Pain Society recommends that individuals experiencing sickle cell crisis receive parenteral pain medication within 30 minutes of assessment. We examined factors affecting achievement of this standard at the Johns Hopkins Sickle Cell Infusion Center.Baseline patient care time intervals and data on variables affecting the ability to achieve the American Pain Society goal were measured. Time to first parenteral opiate administration was modeled using simple and multivariable linear regression.Mean time from initial assessment to first dose was initially 41 minutes. Increased nurse to patient ratio decreased time to first dose.Of the factors associated with improved times to first dose, only nurse to patient ratio is amenable to process change, suggesting it as a potential target for future interventions.Copyright © 2015 Elsevier Inc. All rights reserved.
Oxygen incorporation in rubrene single crystals. - Scientific reports
Single crystal rubrene is a model organic electronic material showing high carrier mobility and long exciton lifetime. These properties are detrimentally affected when rubrene is exposed to intense light under ambient conditions for prolonged periods of time, possibly due to oxygen up-take. Using photoelectron, scanning probe and ion-based methods, combined with an isotopic oxygen exposure, we present direct evidence of the light-induced reaction of molecular oxygen with single crystal rubrene. Without a significant exposure to light, there is no reaction of oxygen with rubrene for periods of greater than a year; the crystal's surface (and bulk) morphology and chemical composition remain essentially oxygen-free. Grand canonical Monte Carlo computations show no sorbtion of gases into the bulk of rubrene crystal. A mechanism for photo-induced oxygen inclusion is proposed.
Inpatient safety outcomes following the 2011 residency work-hour reform. - Journal of hospital medicine
The impact of the 2011 residency work-hour reforms on patient safety is not known.To evaluate the association between implementation of the 2011 reforms and patient safety outcomes at a large academic medical center.Observational study using difference-in-differences estimation strategy to evaluate whether safety outcomes improved among patients discharged from resident and hospitalist (nonresident) services before (2008-2011) and after (2011-2012) residency work-hour changes.All adult patients discharged from general medicine services from July 2008 through June 2012.Outcomes evaluated included length of stay, 30-day readmission, intensive care unit (ICU) admission, inpatient mortality, and presence of Maryland Hospital Acquired Conditions. Independent variables included time period (pre- vs postreform), resident versus hospitalist service, patient age at admission, race, gender, and case mix index.Patients discharged from the resident services in the postreform period had higher likelihood of an ICU stay (5.7% vs 4.5%, difference 1.4%; 95% confidence interval [CI]: 0.5% to 2.2%), and lower likelihood of 30-day readmission (17.2% vs 20.1%, difference 2.8%; 95 % CI: 1.3 to 4.3%) than patients discharged from the resident services in the prereform period. Comparing pre- and postreform periods on the resident and hospitalist services, there were no significant differences in patient safety outcomes.In the first year after implementation of the 2011 work-hour reforms relative to prior years, we found no change in patient safety outcomes in patients treated by residents compared with patients treated by hospitalists. Further study of the long-term impact of residency work-hour reforms is indicated to ensure improvement in patient safety.© 2014 Society of Hospital Medicine.
Focus on transitions of care: description and evaluation of an educational intervention for internal medicine residents. - American journal of medical quality : the official journal of the American College of Medical Quality
Transitions of care between physicians and from inpatient to outpatient settings leave patients vulnerable to medical errors and adverse events. A transitions of care workshop consisting of 2 sessions, Sign-Out Success (SOS) and Transition To Home (TTH), taught sign-out and discharge skills to incoming internal medicine interns during orientation. The workshop used role-playing exercises, didactics, demonstrations, and peer and self-evaluations. Interns completed a survey at 3 months post workshop. Using pre-post workshop measures, SOS increased the quality of intern-rated sign-outs (P = .004). Interns reported more confidence in their ability to effectively sign out (P = .016) and a greater understanding of problems that might arise while on call (P = .012). TTH increased intern-reported confidence in their ability to communicate discharge instructions (P < .001) and to verify patient understanding of instructions (P < .001). A majority reported using SOS and TTH skills 3 months post workshop. This workshop may be replicable at other institutions.© 2013 by the American College of Medical Quality.
Variability in hand hygiene practices among internal medicine interns. - American journal of infection control
Hand hygiene compliance remains suboptimal among physicians despite quality improvement efforts. We observed hand hygiene compliance among 29 medicine interns at 2 large academic institutions. Overall compliance was 75%. Although 4 interns averaged <40% compliance, 14 averaged at least 80%. Given variability observed among individuals in the same training programs, targeting those with poor performance may be important in improving overall compliance.Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
Do internal medicine interns practice etiquette-based communication? A critical look at the inpatient encounter. - Journal of hospital medicine
Etiquette-based communication may improve the inpatient experience but is not universally practiced. We sought to determine the extent to which internal medicine interns practice behaviors that characterize etiquette-based medicine. Trained observers evaluated the use of 5 key communication strategies by internal medicine interns during inpatient clinical encounters: introducing one's self, explaining one's role in the patient's care, touching the patient, asking open-ended questions, and sitting down with the patient. Participants at 1 site then completed a survey estimating how frequently they performed each of the observed behaviors. A convenience sample of 29 interns was observed on a total of 732 patient encounters. Overall, interns introduced themselves 40% of the time and explained their role 37% of the time. Interns touched patients on 65% of visits, asked open-ended questions on 75% of visits, and sat down with patients during 9% of visits. Interns at 1 site estimated introducing themselves and their role and sitting with patients significantly more frequently than was observed (80% vs 40%, P < 0.01; 80% vs 37%, P < 0.01; and 58% vs 9%, P < 0.01, respectively). Resident physicians introduced themselves to patients, explained their role, and sat down with patients infrequently during observed inpatient encounters. Residents surveyed tended to overestimate their own practice of etiquette-based medicine.© 2013 Society of Hospital Medicine.
Residency schedule, burnout and patient care among first-year residents. - Postgraduate medical journal
The 2011 US Accreditation Council for Graduate Medical Education (ACGME) mandates reaffirm the need to design residency schedules to augment patient safety and minimise resident fatigue.To evaluate which elements of the residency schedule were associated with resident burnout and fatigue and whether resident burnout and fatigue were associated with lower perceived quality of patient care.A cross-sectional survey of first-year medicine residents at three hospitals in May-June 2011 assessed residency schedule characteristics, including hours worked, adherence to 2003 work-hour regulations, burnout and fatigue, trainee-reported quality of care and medical errors.Response rate was 55/76 (72%). Forty-two of the 55 respondents (76%) met criteria for burnout and 28/55 (51%) for fatigue. After adjustment for age, gender and residency programme, an overnight call was associated with higher burnout and fatigue scores. Adherence to the 80 h working week, number of days off and leaving on time were not associated with burnout or fatigue. Residents with high burnout scores were more likely to report making errors due to excessive workload and fewer reported that the quality of care provided was satisfactory.Burnout and fatigue were prevalent among residents in this study and associated with undesirable personal and perceived patient-care outcomes. Being on a rotation with at least 24 h of overnight call was associated with higher burnout and fatigue scores, but adherence to the 2003 ACGME work-hour requirements, including the 80 h working week, leaving on time at the end of shifts and number of days off in the previous month, was not. Residency schedule redesign should include efforts to reduce characteristics that are associated with burnout and fatigue.

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