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https://www.readbyqxmd.com/read/28106610/-opt-out-and-access-to-anesthesia-care-for-elective-and-urgent-surgeries-among-u-s-medicare-beneficiaries
#1
Eric C Sun, Franklin Dexter, Thomas R Miller, Laurence C Baker
BACKGROUND: In 2001, the Centers for Medicare and Medicaid Services issued a rule allowing U.S. states to "opt out" of the regulations requiring physician supervision of nurse anesthetists in an effort to increase access to anesthesia care. Whether "opt out" has successfully achieved this goal remains unknown. METHODS: Using Medicare administrative claims data, we examined whether "opt out" reduced the distance traveled by patients, a common measure of access, for patients undergoing total knee arthroplasty, total hip arthroplasty, cataract surgery, colonoscopy/sigmoidoscopy, esophagogastroduodenoscopy, appendectomy, or hip fracture repair...
January 19, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28100142/reduction-in-jail-emergency-department-visits-and-closure-after-implementation-of-on-site-urgent-care
#2
Erick Eiting, Carrie S Korn, Erin Wilkes, Glenn Ault, Sean O Henderson
This descriptive study evaluates the impact of implementation of full service on-site urgent care services at the Los Angeles County Jail (LACJ) by examining the number of patients seen at the referral hospital, Los Angeles County + University of Southern California Medical Center (LAC+USC), and the number of hours that the referral hospital was closed to transfers in the periods before and after the development of the LACJ Urgent Care. The appropriate utilization of public resources is a critical priority for an overburdened county medical health care system...
January 2017: Journal of Correctional Health Care
https://www.readbyqxmd.com/read/28098545/increase-in-urgent-care-center-visits-for-sexually-transmitted-infections-united-states-2010-2014
#3
William S Pearson, Guoyu Tao, Karen Kroeger, Thomas A Peterman
During 2010-2014, urgent care centers saw a ≈2-fold increase in the number of visits for chlamydia and gonorrhea testing and a >3-fold increase in visits by persons with diagnosed sexually transmitted infections. As urgent care becomes more popular, vigilance is required to ensure proper management of these diseases.
February 2017: Emerging Infectious Diseases
https://www.readbyqxmd.com/read/28097296/long-term-postprocedural-outcomes-of-palliative-emergency-stenting-vs-stoma-in-malignant-large-bowel-obstruction
#4
Jonathan S Abelson, Heather L Yeo, Jialin Mao, Jeffrey W Milsom, Art Sedrakyan
Importance: Colonic stenting was introduced for palliation of malignant large-bowel obstruction (MLBO) more than 20 years ago but remains controversial. Objective: To compare outcomes after palliative stenting vs stoma creation in patients with MLBO requiring emergency management. Design, Setting, and Participants: This observational cohort study assessed 345 patients from New York State with an urgent or emergency admission to the hospital for obstruction secondary to colorectal cancer and who underwent stenting or stoma creation from October 1, 2009, through December 31, 2013...
January 11, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28086826/offering-patients-therapy-options-in-unplanned-start-options-implementation-of-an-educational-program-is-feasible-and-effective
#5
Anna Machowska, Mark Dominik Alscher, Satyanarayana Reddy Vanga, Michael Koch, Michael Aarup, Abdul Rashid Qureshi, Bengt Lindholm, Peter Rutherford
BACKGROUND: Patients with unplanned dialysis start (UPS) have worse clinical outcomes than non-UPS patients, and receive peritoneal dialysis (PD) less frequently. In the OPTiONS study of UPS patients, an educational programme (UPS-EP) aiming at improving care of UPS patients by facilitating care pathways and enabling informed choice of dialysis modality was implemented. We here report on impact of UPS-EP on modality choice and clinical outcomes in UPS patients. METHODS: This non-interventional, prospective, multi-center, observational study included 270 UPS patients from 26 centers in 6 European countries (Austria, Germany, Denmark, France, United Kingdom and Sweden) who prior to inclusion presented acutely, or were being followed by nephrologists but required urgent dialysis commencement by an acutely placed CVC or PD catheter...
January 13, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28075695/lessons-from-launching-the-diabetes-prevention-program-in-a-large-integrated-health-care-delivery-system-a-case-study
#6
Colin D Rehm, Melinda E Marquez, Elizabeth Spurrell-Huss, Nicole Hollingsworth, Amanda S Parsons
There is urgent need for health systems to prevent diabetes. To date, few health systems have implemented the evidence-based Diabetes Prevention Program (DPP), and the few that have mostly partnered with community-based organizations to implement the program. Given the recent decision by the Centers for Medicare & Medicaid Services to reimburse for diabetes prevention, there is likely much interest in how such programs can be implemented within large health systems or how community partnerships can be expanded to support DPP implementation...
January 11, 2017: Population Health Management
https://www.readbyqxmd.com/read/28074548/annual-report-of-the-perinatology-committee-japan-society-of-obstetrics-and-gynecology-2015-proposal-of-urgent-measures-to-reduce-maternal-deaths
#7
Satoru Takeda, Jun Takeda, Keisuke Murakami, Takahiko Kubo, Hiromi Hamada, Maki Murakami, Shintaro Makino, Hiroaki Itoh, Takashi Ohba, Katsuhiko Naruse, Hiroaki Tanaka, Naohiro Kanayama, Shigeki Matsubara, Hiroshi Sameshima, Tomoaki Ikeda
Perinatal care in Japan has progressed rapidly in recent decades, remarkably reducing maternal, perinatal and neonatal mortality rates. This is attributable not only to the sustained efforts and dedication of past obstetricians and midwives, but also to the collective results achieved by the Japan Society of Obstetrics and Gynecology and healthcare administration, including research on advanced medical care, education, medical care improvements and establishing perinatal care centers. Although the maternal mortality rate was in steady decline until 2007 (3...
January 2017: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/28060178/assessment-of-splints-applied-for-pediatric-fractures-in-an-emergency-department-urgent-care-environment
#8
Joshua M Abzug, Brandon S Schwartz, Aaron J Johnson
BACKGROUND: Fractures are common in the pediatric population. The initial evaluation is rarely by an orthopaedic surgeon, but commonly an emergency room or urgent care center physician/extender. This typically involves splint application by a nonorthopaedist to immobilize the extremity and provide stabilization. Iatrogenic injuries from inappropriate splint placement are a potential public health and legal concern that can lead to complications. The primary purpose of this study was to prospectively evaluate the adequacy of all splints placed on patients who presented to a pediatric orthopaedic office; secondary outcomes included assessing prevalence and types of complications that were associated with inadequate splints...
January 5, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28031406/complications-of-the-arteriovenous-fistula-a-systematic-review
#9
Ahmed A Al-Jaishi, Aiden R Liu, Charmaine E Lok, Joyce C Zhang, Louise M Moist
The implementation of patient-centered care requires an individualized approach to hemodialysis vascular access, on the basis of each patient's unique balance of risks and benefits. This systematic review aimed to summarize current literature on fistula risks, including rates of complications, to assist with patient-centered decision making. We searched Medline from 2000 to 2014 for English-language studies with prospectively captured data on ≥100 fistulas. We assessed study quality and extracted data on study design, patient characteristics, and outcomes...
December 28, 2016: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28030459/implementation-and-sequencing-of-practice-transformation-in-urban-practices-with-underserved-patients
#10
Denise D Quigley, Zachary S Predmore, Alex Y Chen, Ron D Hays
BACKGROUND: Patient-centered medical home (PCMH) has gained momentum as a model for primary-care health services reform. METHODS: We conducted interviews at 14 primary care practices undergoing PCMH transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. RESULTS: We found clinics pursued a common sequence of changes in PCMH transformation: Clinics began with National Committee for Quality Assurance (NCQA) level 3 recognition, adding care coordination staff, reorganizing data flow among teams, and integrating with a centralized quality improvement and accountability infrastructure...
January 2017: Quality Management in Health Care
https://www.readbyqxmd.com/read/28028269/-promoting-appropriate-pharmacotherapy-for-home-care-patients-coordination-between-regional-comprehensive-support-centers-and-pharmacies
#11
Yasunori Ohno, Takashi Heima, Takao Ishikawa, Tomoko Kuramitsu, Hitomi Yamakage, Masayoshi Hirohara, Kazuki Kushida
Japan is rapidly developing into an aged society, and its construction of a regional comprehensive care system is urgently needed for the baby boomer generation, who will reach 75 years of age in 2025. As part of providing medical care and longterm caregiving in a regional comprehensive care system, ordinary citizens will be supported in their local neighborhoods by multidisciplinary care, team medicine, and information sharing. However, pharmacists visit only once or twice per month; therefore, it can be difficult for them to grasp the overall status of patients' lifestyles...
December 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28007319/nasal-flaring-as-a-clinical-sign-of-respiratory-acidosis-in-patients-with-dyspnea
#12
José Gregorio Zorrilla-Riveiro, Anna Arnau-Bartés, Ramón Rafat-Sellarés, Dolors García-Pérez, Arantxa Mas-Serra, Rafael Fernández-Fernández
OBJECTIVE: To determine whether the presence of nasal flaring is a clinical sign of respiratory acidosis in patients attending emergency departments for acute dyspnea. METHODS: Single-center, prospective, observational study of patients aged over 15 requiring urgent attention for dyspnea, classified as level II or III according to the Andorran Triage Program and who underwent arterial blood gas test on arrival at the emergency department. The presence of nasal flaring was evaluated by two observers...
December 10, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28005912/benchmarking-prehospital-and-emergency-department-care-for-argentine-children-with-traumatic-brain-injury-for-the-south-american-guideline-adherence-group
#13
Monica S Vavilala, Silvia B Lujan, Qian Qiu, Gustavo J Petroni, Nicolás M Ballarini, Nahuel Guadagnoli, María Alejandra Depetris, Gabriela A Faguaga, Gloria M Baggio, Leonardo O Busso, Mirta E García, Osvaldo R González Carrillo, Paula L Medici, Silvia S Sáenz, Elida E Vanella, Anthony Fabio, Michael J Bell
OBJECTIVE: There is little information on the type of early care provided to children with traumatic brain injury (TBI) in low middle income countries. We benchmarked early prehospital [PH] and emergency department [ED] pediatric TBI care in Argentina. METHODS: We conducted a secondary analysis of data from patients previously enrolled in a prospective seven center study of children with TBI. Eligible participants were patients 0-18 years, and had diagnosis of TBI (admission Glasgow Coma scale score [GCS] < 13 or with GCS 14-15 and abnormal head CT scan within 48 hours of admission, and head AIS > 0)...
2016: PloS One
https://www.readbyqxmd.com/read/27992865/a-current-estimation-of-the-early-risk-of-stroke-after-transient-ischemic-attack-a-systematic-review-and-meta-analysis-of-recent-intervention-studies
#14
Joan Valls, Maranta Peiro-Chamarro, Serafí Cambray, Jessica Molina-Seguin, Ikram Benabdelhak, Francisco Purroy
OBJECTIVE: Recent studies have demonstrated that there is a decrease in the risk of subsequent stroke after transient ischemic attack (TIA) when urgent care (UC) is administered. However, no meta-analysis has been developed with contemporaneous TIA studies. We perform a systematic review and a meta-analysis to establish the risk of early stroke recurrence (SR) considering data from studies that offered UC to TIA patients. METHODS: We searched for studies, without language restriction, from January 2007 to January 2015 according to PRISMA guidelines...
December 20, 2016: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/27925080/technological-innovation-for-peripheral-venipuncture-ultrasound-training
#15
Andrey Maciel de Oliveira, Mitzy Tannia Reichembach Danski, Edivane Pedrolo
Objective: to evaluate the training of nurses in the use of ultrasound in peripheral venipuncture. Method: descriptive research of quantitative approach performed with nurses as part of an analytical cross-sectional study in two patient care centers: an intensive care unit and an adult emergency center. Results: the results showed contributions of training for professional skill and visibility of nurses, requiring, however, more time for complete assimilation of this technological innovation as a safer clinical practice...
November 2016: Revista Brasileira de Enfermagem
https://www.readbyqxmd.com/read/27903774/-they-shouldn-t-be-coming-to-the-ed-should-they-a-descriptive-service-evaluation-of-why-patients-with-palliative-care-needs-present-to-the-emergency-department
#16
Emilie Green, Sarah Ward, Will Brierley, Ben Riley, Henna Sattar, Tim Harris
BACKGROUND: Patients with palliative care needs frequently attend the emergency department (ED). There is no international agreement on which patients are best cared for in the ED, compared to the primary care setting or direct admission to the hospital. This article presents the quantitative phase of a mixed-methods service evaluation, exploring the reasons why patients with palliative care needs present to the ED. METHODS: This is a single-center, observational study including all patients under the care of a specialist palliative care team who presented to the ED over a 10-week period...
November 30, 2016: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27886989/u-s-department-of-defense-multiple-parameter-biodosimetry-network
#17
William F Blakely, Alexander Romanyukha, Selena M Hayes, Ricardo A Reyes, H Michael Stewart, Matthew H Hoefer, Anthony Williams, Thad Sharp, L Andrew Huff
The U.S. Department of Defense (USDOD) service members are at risk of exposure to ionizing radiation due to radiation accidents, terrorist attacks and national defense activities. The use of biodosimetry is a standard of care for the triage and treatment of radiation injuries. Resources and procedures need to be established to implement a multiple-parameter biodosimetry system coupled with expert medial guidance to provide an integrated radiation diagnostic system to meet USDOD requirements. Current USDOD biodosimetry capabilities were identified and recommendations to fill the identified gaps are provided...
December 2016: Radiation Protection Dosimetry
https://www.readbyqxmd.com/read/27870667/the-role-of-dedicated-musculoskeletal-urgent-care-centers-in-reducing-cost-and-improving-access-to-orthopaedic-care
#18
Travis J Anderson, Peter L Althausen
OBJECTIVES: Over the past few years, the United States has seen the rapid growth of dedicated musculoskeletal urgent care centers owned and operated by individual orthopaedic practices. In June of 2014, our practice opened the first dedicated orthopaedic urgent care in the region staffed by physician assistants and supervised by orthopaedic surgeons. Our hypothesis is that such centers can safely improve orthopaedic care for ambulatory orthopaedic injuries, decrease volume for overburdened emergency departments (EDs), reduce wait times and significantly decrease the cost of care while improving access to orthopaedic specialists...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27867883/demographic-details-clinical-features-and-nutritional-characteristics-of-young-adults-with-type-1-diabetes-mellitus-a-south-indian-tertiary-center-experience
#19
Mini Joseph, Asha H Shyamasunder, Riddhi D Gupta, Vijayalakshmi Anand, Nihal Thomas
CONTEXT: Type 1 diabetes mellitus (T1DM) accounts for 5-10% of all diagnosed diabetes and the highest incidence is found in India. AIMS: The main objectives were to study the demographic, clinical, and nutritional characteristics of young adults with T1DM and its effect glycosylated hemoglobin levels. SUBJECTS AND METHODS: This cross-sectional study was conducted among young adults with T1DM (18-45 years of age) in a tertiary hospital in South India...
November 2016: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27858564/preparing-for-value-based-payment-a-stepwise-approach-for-cancer-centers
#20
Kerin B Adelson, Salimah Velji, Kavita Patel, Basit Chaudhry, Catherine Lyons, Rogerio Lilenbaum
Most cancer centers are ill-equipped to pursue value-based payment (VBP) because of limited information on their population's cost of care. Herein, we outline the stepwise approach used by Smilow Cancer Hospital at Yale-New Haven in our pursuit of better value care. First, we addressed institutional barriers. A move toward value required demonstration to Yale-New Haven Health System leadership that OCM would improve patient care, fund new infrastructure, and provide the opportunity to gain experience with VBP without a major threat to the financial stability of the health system...
October 2016: Journal of Oncology Practice
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