Inappropriate transfers are a potentially large problem. Some inappropriate transfers may be associated with poor quality of care in SNFs. This study demonstrates that structured implicit review meets criteria for reliable assessment of inappropriate transfer rates. Structured implicit review may be a valuable tool for identifying inappropriate transfers from SNFs to EDs and hospitals.

Previously the subject of much debate, there is now consensus that diastolic heart failure (DHF) represents a distinct form of heart failure. Epidemiologic data indicate that DHF is common. Indeed, there is evidence that, among elderly persons, DHF is more common than systolic heart failure (SHF). Like SHF, DHF is associated with significant morbidity, mortality, and cost; however, few clinical trials focusing on isolated DHF have been completed. Much of the treatment of DHF is based on current concepts of the pathophysiology of DHF, small clinical studies, and experience gained from treating patients with SHF. The diagnosis of DHF is clinical; data supporting the establishment of a diagnosis of DHF are limited. Differences exist in prognosis and treatment between diastolic and systolic heart failure. This article reviews diastolic heart failure with emphasis on evidence-based management, aimed at primary care physicians who routinely provide care to patients with DHF. (J Am Board Fam Pract 2005;18:189 -98.)

Background: Pregnancy is a high-risk indication for influenza vaccination; however, rates of vaccination fall short of Centers for Disease Control and Prevention-recommended guidelines.Methods: Brief educational sessions with family physicians and obstetricians were undertaken in the fall of 2002. Notes reading "Think Flu Vaccine" were placed on active obstetric charts during the study period. Charts were reviewed at the end of influenza season for documentation of discussion or administration of influenza vaccination. Charts for the same period during the previous 2 years were also reviewed for baseline.Results

Purpose:The Centers for Disease Control (CDC) identify women in their second and third trimesters as a high-risk population warranting influenza vaccination. This study attempted to characterize understanding of these guidelines and obstacles to their implementation in a suburban community.Methods: Family physicians and obstetricians with admitting privileges to a community-based hospital were surveyed regarding estimated vaccine availability and administration in their practices and regarding knowledge of indications and contraindications to influenza vaccination in pregnancy.Results Every year, the influenza virus affects 10% to 20% of the US population, with hundreds of thousands of patients hospitalized because of influenza infection and complications.

Background: Pregnant women and their fetuses are known to be at increased risk for influenza-associated morbidity and mortality. The Advisory Committee on Immunization Practices and others have recommended influenza vaccination for all pregnant women at any gestational age, but vaccination rates for pregnant women remain low, near 45%.Methods: A retrospective chart review was performed at each of 4 sites during the 2010 to 2011 and 2011 to 2012 influenza seasons to examine the rates of flu vaccination offering and provision. The 4 separate clinics used for this study included 3 sites within a large university academic center and one private community practice. A nurse-driven (licensed vocational nurse or medical assistant staff) protocol for offering the flu vaccine was used at one site the first year of review and then used at 2 sites during the second year of review. We compared the vaccination offering and provision rates when nursedriven or physician-driven protocols were used.Results: With the nurse-driven protocol, the average offering rate was 99.7%, but of those who were offered the vaccine, only 38.2% received it, for a total effective vaccination rate of 38.1% of the patients. With the physician-driven protocol, 54.5% patients were offered the vaccine, and 70.7% of those received it, for an effective total vaccination rate of 38.5%.