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https://www.readbyqxmd.com/read/29029947/a-neurological-emergency-trolley-reduces-turnaround-time-for-high-risk-medications-in-a-general-intensive-care-unit
#1
Henry Ajzenberg, Paula Newman, Gail-Anne Harris, Marnie Cranston, J Gordon Boyd
OBJECTIVES: To reduce medication turnaround times during neurological emergencies, a multidisciplinary team developed a neurological emergency crash trolley in our intensive care unit. This trolley includes phenytoin, hypertonic saline and mannitol, as well as other equipment. The aim of this study was to assess whether the cart reduced turnaround times for these medications. RESEARCH METHODOLOGY/DESIGN: In this retrospective cohort study, medication delivery times for two year epochs before and after its implementation were compared...
October 10, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29028970/poor-obstetric-and-infant-outcomes-in-hiv-infected-pregnant-women-with-tuberculosis-in-south-africa-the-tshepiso-study
#2
Nicole Salazar-Austin, Jennifer Hoffmann, Silvia Cohn, Fildah Mashabela, Ziyaad Waja, Sanjay Lala, Christopher Hoffmann, Kelly E Dooley, Richard E Chaisson, Neil Martinson
Background: Prior to the wide availability of antiretroviral therapy, tuberculosis (TB) and HIV disease among pregnant women resulted in poor maternal and neonatal outcomes including high rates of mother-to-child transmission of both HIV and TB. We aimed to describe the impact of TB among HIV-infected mothers on obstetric and infant outcomes in a population with access to antiretroviral therapy. Methods: In this prospective cohort study, we followed HIV-infected pregnant women with and without TB disease from January 2011 through January 2014 in Soweto, South Africa...
September 26, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29025824/development-of-an-evidence-based-complex-intervention-for-community-rehabilitation-of-patients-with-hip-fracture-using-realist-review-survey-and-focus-groups
#3
Jessica Louise Roberts, Nafees Ud Din, Michelle Williams, Claire A Hawkes, Joanna M Charles, Zoe Hoare, Val Morrison, Swapna Alexander, Andrew Lemmey, Catherine Sackley, Phillipa Logan, Clare Wilkinson, Jo Rycroft-Malone, Nefyn H Williams
OBJECTIVES: To develop an evidence and theory-based complex intervention for improving outcomes in elderly patients following hip fracture. DESIGN: Complex-intervention development (Medical Research Council (MRC) framework phase I) using realist literature review, surveys and focus groups of patients and rehabilitation teams. SETTING: North Wales. PARTICIPANTS: Surveys of therapy managers (n=13), community and hospital-based physiotherapists (n=129) and occupational therapists (n=68) throughout the UK...
October 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/29024333/united-we-stand-divided-we-conquer-pilot-study-of-multidisciplinary-general-medicine-heart-failure-care-program
#4
Omar Wahbi Izzettin, Ingrid Hopper, Edward Ritchie, Vathy Nagalingam, Ar Kar Aung
BACKGROUND: Heart failure care and education require a multifaceted approach to ensure appropriate transition from inpatient to outpatient care. AIMS: To explore the feasibility of a multidisciplinary heart failure care model, General Medicine Heart Failure Care Program (GM-HFCP) within a General Medical Unit (GMU). METHODS: Prospective non-randomised before-and-after observational quality improvement intervention over a 6-month period. All consecutive patients admitted to GMU at Alfred Hospital with diagnosis of acute decompensated heart failure were included...
October 11, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/29020166/long-term-impact-of-an-educational-antimicrobial-stewardship-program-on-hospital-acquired-candidemia-and-multidrug-resistant-bloodstream-infections-a-quasi-experimental-study-of-interrupted-time-series-analysis
#5
José Molina, Germán Peñalva, María V Gil-Navarro, Julia Praena, José A Lepe, María A Pérez-Moreno, Carmen Ferrándiz, Teresa Aldabó, Manuela Aguilar, Peter Olbrich, Manuel E Jiménez-Mejías, María L Gascón, Rosario Amaya-Villar, Olaf Neth, María J Rodríguez-Hernández, Antonio Gutiérrez-Pizarraya, José Garnacho-Montero, Cristina Montero, Josefina Cano, Julián Palomino, Raquel Valencia, Rocío Álvarez, Elisa Cordero, Marta Herrero, José M Cisneros
Background: The global crisis of bacterial resistance urges the scientific community to implement intervention programs in healthcare facilities to promote an appropriate use of antibiotics. However, the clinical benefits or the impact on resistance of these interventions has not been definitively proven. Methods: We designed a quasi-experimental intervention study with an interrupted time-series analysis. A multidisciplinary team conducted a multifaceted educational intervention in our tertiary-care hospital over a five-year period...
August 7, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28985692/comprehensive-blood-conservation-program-in-a-new-congenital-cardiac-surgical-program-allows-bloodless-surgery-for-the-jehovah-witness-and-a-reduction-for-all-patients
#6
Vincent Olshove, Nicole Berndsen, Veena Sivarajan, Pooja Nawathe, Alistair Phillips
BACKGROUND: Cardiac surgery on Jehovah's Witnesses (JW) can be challenging, given the desire to avoid blood products. Establishment of a blood conservation program involving the pre-, intra- and post-operative stages for all patients may lead to a minimized need for blood transfusion in all patients. METHODS: Pre-operatively, all JW patients were treated with high dose erythropoietin 500 IU/kg twice a week. JW patients were compared to matching non-JW patients from the congenital cardiac database, two per JW to serve as control...
October 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28982529/implementation-of-early-diagnosis-and-intervention-guidelines-for-cerebral-palsy-in-a-high-risk-infant-follow-up-clinic
#7
Rachel Byrne, Garey Noritz, Nathalie L Maitre
BACKGROUND: Cerebral palsy is the most common physical disability in childhood, and is mostly diagnosed after age 2 years. Delays in diagnosis can have negative long-term consequences for children and parents. New guidelines for early cerebral palsy diagnosis and intervention were recently published, after systematic review of the evidence by international multidisciplinary experts aiming to decrease age at diagnosis. The current study tested the feasibility of implementing these guidelines in an American clinical setting...
August 30, 2017: Pediatric Neurology
https://www.readbyqxmd.com/read/28978554/association-of-pediatric-medical-emergency-teams-with-hospital-mortality
#8
Shelby Kutty, Philip G Jones, Quentin Karels, Navya Joseph, John A Spertus, Paul S Chan
Background -Implementation of a medical emergency teams has been identified as a potential strategy to reduce hospital deaths, as these teams respond to patients with acute physiological decline in an effort to prevent in-hospital cardiac arrest. However, prior studies of the association between medical emergency teams and hospital mortality have been limited and typically have not accounted for pre-implementation mortality trends. Methods -Within the Pediatric Health Information System (PHIS) for freestanding pediatric hospitals, annual risk-adjusted mortality rates were calculated for sites between 2000 and 2015...
October 4, 2017: Circulation
https://www.readbyqxmd.com/read/28964298/implementation-of-a-perioperative-surgical-home-protocol-for-pediatric-patients-presenting-for-adenoidectomy
#9
Vidya T Raman, Dmitry Tumin, Joshua Uffman, Arlyne K Thung, Candice Burrier, Kris R Jatana, Charles Elmaraghy, Joseph D Tobias
INTRODUCTION: The perioperative surgical home (PSH) is a patient-centered model designed to improve health, streamline the delivery of health care, and reduce the cost of care. Following the national introduction of PSH in 2014 by the ASA, adult hospitals have reported success with this model, with studies validating the benefits of PSH including reducing length of stay, lowering costs, and improving patient satisfaction. METHODS: Eligible patients, ranging in age from 16-35 months of age, were identified by the pre-admission testing (PAT) registered nurses (RNs) and faculty anesthesiologists upon review of the patient history...
October 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28964282/adherence-to-swedish-guidelines-for-pain-treatment-in-relation-to-pediatric-tonsil-surgery-a-survey-of-the-multidisciplinary-team
#10
F Alm, M Jaensson, S Lundeberg, E Ericsson
BACKGROUND: Pain management in children after tonsil surgery is essential, and optimal pain treatment has been discussed for many years. Data from the National Tonsil Register in Sweden (NTRS) and a national mapping have demonstrated the need for national pain treatment guidelines for pediatric tonsil surgery. As a result, Swedish national guidelines, together with updated patient information on the website tonsilloperation.se, were developed and implemented in 2013. OBJECTIVES: The objective of this study was to evaluate the professionals' opinions of and adherence to pain treatment guidelines for pediatric tonsil surgery patients in a two-year follow-up...
October 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28963302/building-a-collaborative-culture-in-cardiothoracic-operating-rooms-pre-and-postintervention-study-protocol-for-evaluation-of-the-implementation-of-teamstepps-training-and-the-impact-on-perceived-psychological-safety
#11
Aaron Benjamin Dahl, Arbi Ben Abdallah, Hersh Maniar, Michael Simon Avidan, Mara L Bollini, George Alexander Patterson, Aaron Steinberg, Katie Scaggs, Brenda V Dribin, Clare H Ridley
INTRODUCTION: The importance of effective communication, a key component of teamwork, is well recognised in the healthcare setting. Establishing a culture that encourages and empowers team members to speak openly in the cardiothoracic (CT) operating room (OR) is necessary to improve patient safety in this high-risk environment. METHODS AND ANALYSIS: This study will take place at Barnes-Jewish Hospital, an academic hospital in affiliation with Washington University School of Medicine located in the USA...
September 27, 2017: BMJ Open
https://www.readbyqxmd.com/read/28959139/a-case-study-on-building-capacity-to-improve-clinical-mentoring-and-maternal-child-health-in-rural-tanzania-the-path-to-implementation
#12
Melissa T Ojemeni, Paulomi Niles, Salum Mfaume, Ntuli A Kapologwe, Linda Deng, Renae Stafford, Marie Jose Voeten, Kokusiima Theonestina, Wendy Budin, Nok Chhun, Allison Squires
BACKGROUND: Tanzania is a low income, East African country with a severe shortage of human resources for health or health workers. This shortage threatens any gains the country is making in improving maternal health outcomes. This paper describes a partnership between Touch Foundation and NYU Rory Meyers College of Nursing - Global, aimed at improving clinical mentorship and capacity among nurses and midwives at two rural hospitals in the Tanzanian Lake Zone Region. Clinical mentoring capacity building and supportive supervision of staff has been shown to be a facilitator of retaining nurses and would be possible to acquire and implement quickly, even in a context of low resources and limited technology...
2017: BMC Nursing
https://www.readbyqxmd.com/read/28946059/pregabalin-as-adjunct-in-a-multimodal-pain-therapy-after-traumatic-foot-amputation-a-case-report-of-a-4-year-old-girl
#13
Stephanie Wössner, Kirsten Weber, Anna C Steinbeck, Markus Oberhauser, Matthias Feuerecker
BACKGROUND AND PURPOSE: The purpose of this case report is to describe a multimodal pain therapeutic concept including the adjunct use of pregabalin in a 4.5 year-old child after forefoot amputation. Phantom limb pain and sensation is a complex pain syndrome that is difficult to treat and prevent. 70-75% of all children develop such a pain syndrome after amputation. We describe here a paediatric patient who underwent forefoot amputation following traumatic foot injury and received multimodal pain therapy including pregabalin...
September 22, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/28939581/protocol-of-a-randomised-controlled-trial-characterising-the-immune-responses-induced-by-varicella-zoster-virus-vzv-vaccination-in-healthy-kenyan-women-setting-the-stage-for-a-potential-vzv-based-hiv-vaccine
#14
Catia T Perciani, Walter Jaoko, Sharon Walmsley, Bashir Farah, Salaheddin M Mahmud, Mario Ostrowski, Omu Anzala, Kavi-Icr Team, Kelly S MacDonald
INTRODUCTION: A protective HIV vaccine would be expected to induce durable effector immune responses at the mucosa, restricting HIV infection at its portal of entry. We hypothesise that use of varicella-zoster virus (VZV) as an HIV delivery vector could generate sustained and robust tissue-based immunity against HIV antigens to provide long-term protection against HIV. Given that HIV uniquely targets immune-activated T cells, the development of human vaccines against HIV must also involve a specific examination of the safety of the vector...
September 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28934403/improving-inpatient-medication-adherence-using-attendant-education-in-a-tertiary-care-hospital-in-uganda
#15
Patricia Alupo, Richard Ssekitoleko, Tracy Rabin, Robert Kalyesubula, Ivan Kimuli, Benjamin E Bodnar
Quality problem: Although widely utilized in resource-rich health care systems, the use of quality improvement (QI) techniques is less common in resource-limited environments. Uganda is a resource-limited country in Sub-Saharan Africa that faces many challenges with health care delivery. These challenges include understaffing, inconsistent drug availability and inefficient systems that limit the provision of clinical care. Initial assessment: Poor adherence to prescribed inpatient medications was identified as a key shortcoming of clinical care on the internal medicine wards of Mulago National Referral Hospital, Kampala, Uganda...
August 1, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28930900/retrospective-evaluation-of-the-impact-of-a-geriatric-trauma-institute-on-fragility-hip-fracture-patient-outcomes
#16
Elizabeth D Katrancha, Jami Zipf, Nancy Abrahams, Richard Schroeder
BACKGROUND: Fragility hip fractures occur in the older than 65-year population at an alarming rate. It is estimated that 260,000 hip fractures occur annually. Patient outcomes following hip fractures are devastating. One of every 5 patients dies within 1 year of injury, and 1 of 3 remains in a nursing home for years after the injury. Published literature recommends an interdisciplinary approach to caring for hip-fractured patients and expediting surgery to improve outcomes. PURPOSE: The purpose of this study was to retrospectively evaluate the impact of the Geriatric Trauma Institute (GTI) on fragility hip fracture patient outcomes...
September 2017: Orthopaedic Nursing
https://www.readbyqxmd.com/read/28894892/using-emergency-trauma-team-activations-to-measure-trauma-activity-and-injury-severity-10%C3%A2-years-of-experience-using-an-australian-major-trauma-centre-registry
#17
M M Dinh, S Roncal, K Curtis, R Ivers
OBJECTIVES: To describe the outcomes of Emergency Department trauma team activations over a 10-year period with respect to injury severity and hospital length of stay. METHODS: This was a retrospective study using trauma registry data at a single Major Trauma Centre in Australia. All trauma team activations and arrivals on pre-hospital major trauma (T1) protocol recorded in the trauma registry between June 2006 and July 2016 were included. The outcome of interest was major trauma, defined as an Injury Severity Score (ISS) >12 or length of stay >3 days or requiring urgent operative intervention or admission to the Intensive Care Unit following trauma...
September 11, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28885446/implementing-a-health-system-wide-patient-blood-management-program-with-a-clinical-community-approach
#18
Steven M Frank, Rajiv N Thakkar, Stanley J Podlasek, K H Ken Lee, Tyler L Wintermeyer, Will W Yang, Jing Liu, Leo C Rotello, Thomas A Fleury, Pat A Wachter, Lisa E Ishii, Renee Demski, Peter J Pronovost, Paul M Ness
BACKGROUND: Patient blood management programs are gaining popularity as quality improvement and patient safety initiatives, but methods for implementing such programs across multihospital health systems are not well understood. Having recently incorporated a patient blood management program across our health system using a clinical community approach, we describe our methods and results. METHODS: We formed the Johns Hopkins Health System blood management clinical community to reduce transfusion overuse across five hospitals...
September 7, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28874123/impact-of-multi-professional-scenario-based-training-on-postpartum-hemorrhage-in-tanzania-a-quasi-experimental-pre-vs-post-intervention-study
#19
Signe Egenberg, Gileard Masenga, Lars Edvin Bru, Torbjørn Moe Eggebø, Cecilia Mushi, Deodatus Massay, Pål Øian
BACKGROUND: Tanzania has a relatively high maternal mortality ratio of 410 per 100,000 live births. Severe postpartum hemorrhage (PPH) is a major cause of maternal deaths, but in most cases, it is preventable. However, most pregnant women that develop PPH, have no known risk factors. Therefore, preventive measures must be offered to all pregnant women. This study investigated the effects of multi-professional, scenario-based training on the prevention and management of PPH at a Tanzanian zonal consultant hospital...
September 5, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28874007/new-horizons-in-comprehensive-geriatric-assessment
#20
S G Parker, A McLeod, P McCue, K Phelps, M Bardsley, H C Roberts, S P Conroy
In this article, we discuss the emergence of new models for delivery of comprehensive geriatric assessment (CGA) in the acute hospital setting. CGA is the core technology of Geriatric Medicine and for hospital inpatients it improves key outcomes such as survival, time spent at home and institutionalisation. Traditionally It is delivered by specialised multidisciplinary teams, often in dedicated wards, but in recent years has begun to be taken up and developed quite early in the admission process (at the 'front door'), across traditional ward boundaries and in specialty settings such as surgical and pre-operative care, and oncology...
September 1, 2017: Age and Ageing
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