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https://www.readbyqxmd.com/read/29238847/which-pre-hospital-triage-parameters-indicate-a-need-for-immediate-evaluation-and-treatment-of-severely-injured-patients-in-the-resuscitation-area
#1
K O Jensen, R Heyard, D Schmitt, L Mica, C Ossendorf, H P Simmen, G A Wanner, C M L Werner, L Held, K Sprengel
PURPOSE: To find ways to reduce the rate of over-triage without drastically increasing the rate of under-triage, we applied a current guideline and identified relevant pre-hospital triage predictors that indicate the need for immediate evaluation and treatment of severely injured patients in the resuscitation area. METHODS: Data for adult trauma patients admitted to our level-1 trauma centre in a one year period were collected. Outpatients were excluded. Correct triage for trauma team activation was identified for patients with an ISS or NISS ≥ 16 or the need for ICU treatment due to trauma sequelae...
December 13, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29236303/impact-of-antimicrobial-stewardship-program-on-hospitalized-patients-at-the-intensive-care-unit-a-prospective-audit-and-feedback-study
#2
Maher R Khdour, Hussein O Hallak, Mamoon Al-Deyab, Mowafq A Nasif, Aliaa M Khalili, Ahamad A Dallashi, Mohammad B Khofash, Michael G Scott
AIMS: Inappropriate use of antibiotics is one of the most important factors contributing to the emergence of drug resistant pathogens. The purpose of this study was to measure the clinical impact of Antimicrobial Stewardship Program (ASP) interventions on hospitalized patients at the Intensive care unit at Palestinian Medical Complex. METHODS: A prospective audit with intervention and feedback by ASP team within 48-72h of antibiotic administration began in Sep, 2015...
December 13, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29231234/feasibility-acceptability-and-effectiveness-of-integrated-care-for-copd-patients-a-mixed-methods-evaluation-of-a-pilot-community-based-programme
#3
Tania Carron, Pierre-Olivier Bridevaux, Karin Lörvall, Rachel Parmentier, Jean-Bernard Moix, Vincent Beytrison, Raymond Pernet, Constance Rey, Pierre-Yves Roberfroid, Prashant N Chhajed, Thomas Dieterle, Ladina Joos Zellweger, Malcolm Kohler, Sabrina Maier, David Miedinger, Robert Thurnheer, Pascal Urwyler, Jean-Marie Tschopp, Emilie Zuercher, Jörg Daniel Leuppi, Bernard Burnand, Isabelle Peytremann-Bridevaux
QUESTION UNDER STUDY: The aim of this study was to assess the feasibility, acceptability and effectiveness of a pilot COPD integrated care programme implemented in Valais, Switzerland. METHODS: The programme was adapted from the self-management programme Living Well with COPD, and included the following elements: self-management patient-education group sessions, telephone and medical follow-ups, multidisciplinary teams, training of healthcare professionals, and evidence-based COPD care...
December 12, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/29217525/integration-of-mobile-devices-to-facilitate-patient-care-and-teaching-during-family-centered-rounds
#4
Angela S Byrd, Pamela M McMahon, Richard J Vath, Michael Bolton, Melissa Roy
OBJECTIVES: The increasing prevalence of mobile devices in clinical settings has the potential to improve both patient care and education. The benefits are particularly promising in the context of family-centered rounds in inpatient pediatric settings. We aimed to increase mobile device usage by inpatient rounding teams by 50% in 6 months. We hoped to demonstrate that use of mobile devices would improve access to patient care and educational information and to determine if use would improve efficiency and perceptions of clinical teaching...
December 7, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/29208056/importation-mitigation-and-genomic-epidemiology-of-candida-auris-at-a-large-teaching-hospital
#5
Emil P Lesho, Melissa Z Bronstein, Patrick McGann, Jason Stam, Yoon Kwak, Rosslyn Maybank, Jodi McNamara, Megan Callahan, Jean Campbell, Mary K Hinkle, Edward E Walsh
OBJECTIVE Candida auris (CA) is an emerging multidrug-resistant pathogen associated with increased mortality. The environment may play a role, but transmission dynamics remain poorly understood. We sought to limit environmental and patient CA contamination following a sustained unsuspected exposure. DESIGN Quasi-experimental observation. SETTING A 528-bed teaching hospital. PATIENTS The index case patient and 17 collocated ward mates. INTERVENTION Immediately after confirmation of CA in the bloodstream and urine of a patient admitted 6 days previously, active surveillance, enhanced transmission-based precautions, environmental cleaning with peracetic acid-hydrogen peroxide and ultraviolet light, and patient relocation were undertaken...
December 6, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/29203501/effect-of-a-newly-designed-observation-response-and-discharge-chart-in-the-post-anaesthesia-care-unit-on-patient-outcomes-a-quasi-expermental-study-in-australia
#6
Maryann Street, Nicole M Phillips, Mohammadreza Mohebbi, Bridie Kent
OBJECTIVES: This study aimed to evaluate whether use of a discharge criteria tool for nursing assessment of patients in Post Anaesthesia Care Unit (PACU) would enhance nurses' recognition and response to patients at-risk of deterioration and improve patient outcomes. METHODS: A prospective non-randomised pre-post intervention study was conducted in three hospitals in Australia. Participants were adults undergoing elective surgery before (n=723) and after (n=694) implementation of the Post-Anaesthetic Care Tool (PACT)...
December 3, 2017: BMJ Open
https://www.readbyqxmd.com/read/29195494/implementation-of-a-workplace-intervention-using-financial-rewards-to-promote-adherence-to-physical-activity-guidelines-a-feasibility-study
#7
Elena Losina, Savannah R Smith, Ilana M Usiskin, Kristina M Klara, Griffin L Michl, Bhushan R Deshpande, Heidi Y Yang, Karen C Smith, Jamie E Collins, Jeffrey N Katz
BACKGROUND: We designed and implemented the Brigham and Women's Wellness Initiative (B-Well), a single-arm study to examine the feasibility of a workplace program that used individual and team-based financial incentives to increase physical activity among sedentary hospital employees. METHODS: We enrolled sedentary, non-clinician employees of a tertiary medical center who self-reported low physical activity. Eligible participants formed or joined teams of three members and wore Fitbit Flex activity monitors for two pre-intervention weeks followed by 24 weeks during which they could earn monetary rewards...
December 1, 2017: BMC Public Health
https://www.readbyqxmd.com/read/29193548/rephill-protocol-for-a-randomised-controlled-trial-of-pre-hospital-blood-product-resuscitation-for-trauma
#8
I M Smith, N Crombie, J R Bishop, A McLaughlin, D N Naumann, M Herbert, J M Hancox, G Slinn, N Ives, M Grant, G D Perkins, H Doughty, M J Midwinter
OBJECTIVES: To describe the 'Resuscitation with Pre-HospItaL bLood products' trial (RePHILL) - a multi-centre randomised controlled trial of pre-hospital blood product (PHBP) administration vs standard care for traumatic haemorrhage. BACKGROUND: PHBP are increasingly used for pre-hospital trauma resuscitation despite a lack of robust evidence demonstrating superiority over crystalloids. Provision of PHBP carries additional logistical and regulatory implications, and requires a sustainable supply of universal blood components...
November 28, 2017: Transfusion Medicine
https://www.readbyqxmd.com/read/29180591/developing-outcome-measures-assessing-wound-management-and-patient-experience-a-mixed-methods-study
#9
Daisy Elliott
OBJECTIVES: To develop outcome measures to assess practical management of primary surgical wounds and patient experience. DESIGN: Mixed methods, including qualitative interviews and data extraction from published randomised controlled trials (RCTs). SETTING: Two university-teaching NHS hospitals and three district NHS hospitals in the South West and Midlands regions of England. PARTICIPANTS: Sixty-four patients and 15 healthcare professionals from abdominal general surgical specialities and obstetrics (caesarean section)...
November 26, 2017: BMJ Open
https://www.readbyqxmd.com/read/29173283/using-lean-quality-improvement-tools-to-increase-delivery-of-evidence-based-tobacco-use-treatment-in-hospitalized-neurosurgical-patients
#10
Laurel Sisler, Oluwaseun Omofoye, Karina Paci, Eldad Hadar, Adam O Goldstein, Carol Ripley-Moffitt
BACKGROUND: Health care providers routinely undertreat tobacco dependence, indicating a need for innovative ways to increase delivery of evidence-based care. Lean, a set of quality improvement (QI) tools used increasingly in health care, can help streamline processes, create buy-in for use of evidence-based practices, and lead to the identification of solutions on the basis of a problem's root causes. To date, no published research has examined the use of Lean tools in tobacco dependence...
December 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/29170197/-the-more-we-change-the-more-we-remain-the-same-female-feticide-continues-unabated-in-india
#11
Sudip Bhattacharya, Amarjeet Singh
In North India, preference for sons has been blamed for repeated incidents of female feticide, despite the legislation in the form of the Pre-Conception and Pre-Natal Diagnostic Techniques Act, 2002. We describe how a team of local private doctors offer package deals to pregnant women and their families in rural areas. The fetal sex is determined at night using a portable ultrasonography machine.If the fetus is a girl, an immediate induced abortion is offered in the clients' home. If complications arise, women are advised to attend hospital...
November 23, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29163728/results-of-a-quality-improvement-project-aimed-at-eliminating-healthcare-waste-by-changing-medical-resident-test-ordering-behavior
#12
Sushilkumar Satish Gupta, Radhika Voleti, Vimbai Nyemba, Selma Demir, Olaoluwatomi Lamikanra, Nomsa Musemwa, Angela Saverimuthu, Kamaldeen Agoro, Robert D Kalter, Peter Homel, Melvyn Hecht, Lawrence B Wolf, Edward K Chapnick, Michael G Kantrowitz, Stephan L Kamholz
Background: In light of rising healthcare costs and evidence of inefficient use of medical resources, there is growing interest in reducing healthcare waste by clinicians. Unwarranted lab tests may lead to further tests, prolonged hospital stays, unnecessary referrals and procedures, patient discomfort, and iatrogenic anemia, resulting in significant economic and clinical effects. Blood tests are essential in guiding medical decisions, but they are also associated with significant financial and clinical costs...
December 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/29161399/global-lessons-developing-military-trauma-care-and-lessons-for-civilian-practice
#13
T Woolley, J A Round, M Ingram
The wars in Iraq and Afghanistan have helped to shape the modern Defence Medical Services. Many lessons were learnt including the need for rapid haemorrhage control, senior decision-making and the evolution of deployed transfusion support. These changes were implemented simultaneously with a coherent, end-to-end medical plan from point of wounding through to rehabilitation. Implementation of the medical plan is harmonious with the NHS trauma pathway, and is key to ensuring effective delivery. Military anaesthetists have a long pre-deployment training pathway starting with a Certificate of Completion of Training (CCT) in anaesthesia and/or critical care, and with an emphasis on military skills related to their specific role...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29159555/use-of-a-hands-free-instantaneous-closed-loop-communication-device-improves-perception-of-communication-and-workflow-integration-in-an-academic-teaching-hospital-a-pilot-study
#14
Daniel Z Fang, Teja Patil, Ilana Belitskaya-Levy, Marianne Yeung, Keith Posley, Nazima Allaudeen
Efficient and effective communication between providers is critical to quality patient care within a hospital system. Hands free communication devices (HFCD) allow instantaneous, closed-loop communication between physicians and other members of a multidisciplinary team, providing a communication advantage over traditional pager systems. HFCD have been shown to decrease emergency room interruptions, improve nursing communication, improve speed of information flow, and eliminate health care waste. We evaluated the integration of an HFCD with an existing alphanumeric paging system on an acute inpatient medicine service...
November 17, 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/29157000/pre-injury-psychosocial-and-demographic-predictors-of-long-term-functional-outcomes-post-tbi
#15
Katharine S Seagly, Rochelle L O'Neil, Robin A Hanks
OBJECTIVE: To determine whether pre-injury psychosocial and demographic factors differentially influence long-term functional outcomes post-TBI. SETTING: Urban rehabilitation hospital. PARTICIPANTS: 149 individuals, ages 16-75, who sustained a mild complicated, moderate or severe TBI, were enrolled in a TBI Model System (TBIMS), and had functional outcome data five-15 years post-injury. DESIGN: Archival data were analysed with SPSS-18 using multiple regression to determine amount of variance accounted for in five functional domains...
November 20, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/29156483/-interventions-for-assisting-geriatric-patients-with-frailty-before-surgery
#16
Jörn Kiselev
Frailty is a complex syndrome leading to a higher vulnerability in elderly patients, especially during and after surgery. It is characterized by the simultaneous presence of at least three of five phenotypical symptoms: unintentional weight loss, exhaustion, muscle weakness, slow walking speed, and low activity levels. The presence of two of these symptoms is often labelled as pre-frailty.By identifying these symptoms of frailty, medical teams can plan and perform suitable interventions prior to a planned surgery in order to lower these risk factors and to avoid complications, such as delir, hospital re-admission, loss of independence, and increased mortality...
November 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29153825/clinician-and-manager-perceptions-of-factors-leading-to-ward-patient-clinical-deterioration
#17
Joshua Allen, Daryl Jones, Judy Currey
BACKGROUND: Improving the timely recognition and response to clinical deterioration is a critical challenge for clinicians, educators, administrators and researchers. Clinical deterioration leading to Rapid Response Team review is associated with poor patient outcomes. A range of factors associated with clinical deterioration and its outcomes have been identified, and may help with early identification of deteriorating patients. However, the relative importance of each factor on the development of clinical deterioration is unknown...
November 16, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29140848/mortality-trends-after-a-voluntary-checklist-based-surgical-safety-collaborative
#18
Alex B Haynes, Lizabeth Edmondson, Stuart R Lipsitz, George Molina, Bridget A Neville, Sara J Singer, Aunyika T Moonan, Ashley Kay Childers, Richard Foster, Lorri R Gibbons, Atul A Gawande, William R Berry
OBJECTIVE: To determine whether completion of a voluntary, checklist-based surgical quality improvement program is associated with reduced 30-day postoperative mortality. BACKGROUND: Despite evidence of efficacy of team-based surgical safety checklists in improving perioperative outcomes in research trials, effective methods of population-based implementation have been lacking. The Safe Surgery 2015 South Carolina program was designed to foster state-wide engagement of hospitals in a voluntary, collaborative implementation of a checklist program...
December 2017: Annals of Surgery
https://www.readbyqxmd.com/read/29140185/thrombolysis-improving-door-to-needle-times-for-ischemic-stroke-treatment-a-narrative-review
#19
Noreen Kamal, Eric E Smith, Thomas Jeerakathil, Michael D Hill
Background The effectiveness of thrombolysis is highly time dependent. For this reason, short target times have been set to reduce time to treatment from hospital arrival, which is called door-to-needle time. Summary of review There has been considerable work done at single centers and across multiple hospitals to improve door-to-needle time. There have been reductions of 8 to 47 min when applying one or more improvement strategies at single centers, and there have been many multi-hospital initiatives. The delays to treatment have been attributed to both patient and hospital factors, and strategies to address these delays have been proven to reduce door-to-needle time...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29137582/the-effectiveness-of-regional-anaesthesia-before-and-after-the-introduction-of-a-dedicated-regional-anaesthesia-service-incorporating-a-block-room
#20
A Chin, L Heywood, P Iu, A M Pelecanos, M J Barrington
Dedicated regional anaesthesia services incorporating block rooms and/or block teams may facilitate theatre efficiency and improve training in regional anaesthesia. Currently, it is unknown if a dedicated regional anaesthesia service improves the effectiveness of regional anaesthesia. In November 2013, the Royal Brisbane and Women's Hospital established a dedicated regional anaesthesia service comprising a block team and a block room. Pre-intervention (conventional model of care) registry data was retrospectively compared with post-intervention (dedicated regional anaesthesia service) audit data, with regard to pain and opioid requirement in the post-anaesthesia care unit (PACU)...
November 2017: Anaesthesia and Intensive Care
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