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https://www.readbyqxmd.com/read/29150897/determining-best-outcomes-from-community-acquired-pneumonia-and-how-to-achieve-them
#1
REVIEW
Jane Hadfield, Lesley Bennett
Community-acquired pneumonia (CAP) is a common acute medical illness with a standard, effective treatment that was introduced before the evidenced-based medicine era. Mortality rates have improved in recent decades but improvements have been minimal when compared to other conditions such as acute coronary syndromes. The standardized approach to treatment makes CAP a target for comparative performance and outcome measures. While easy to collect, simplistic outcomes such as mortality, readmission and length of stay are difficult to interpret as they can be affected by subjective choices and health care resources...
November 17, 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/29149456/effect-of-a-thermal-care-bundle-on-the-prevention-detection-and-treatment-of-perioperative-inadvertent-hypothermia
#2
Jed Duff, Kim Walker, Karen-Leigh Edward, Nicholas Ralph, Jo-Ann Giandinoto, Kimberley Alexander, Jeffrey Gow, John Stephenson
AIMS AND OBJECTIVES: To improve the prevention, detection, and treatment of perioperative inadvertent hypothermia (PIH) in adult surgical patients by implementing a Thermal Care Bundle. BACKGROUND: Keeping patients normothermic perioperatively prevents adverse surgical outcomes. Hypothermia leads to serious complications including increased risk of surgical bleeding, surgical site infections, and morbid cardiac events. The Thermal Care Bundle consists of three elements: 1) assess risk; 2) record temperature; and (3) actively warm...
November 17, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29148002/targeting-zero-catheter-related-bloodstream-infections-in-pediatric-intensive-care-unit-a-retrospective-matched-case-control-study
#3
Daniele G Biasucci, Mauro Pittiruti, Alessandra Taddei, Enzo Picconi, Alessandro Pizza, Davide Celentano, Marco Piastra, Giancarlo Scoppettuolo, Giorgio Conti
INTRODUCTION: The aim of this study was to evaluate the effectiveness and safety of a new three-component 'bundle' for insertion and management of centrally inserted central catheters (CICCs), designed to minimize catheter-related bloodstream infections (CRBSIs) in critically ill children. METHODS: Our 'bundle' has three components: insertion, management, and education. Insertion and management recommendations include: skin antisepsis with 2% chlorhexidine; maximal barrier precautions; ultrasound-guided venipuncture; tunneling of the catheter when a long indwelling time is expected; glue on the exit site; sutureless securement; use of transparent dressing; chlorhexidine sponge dressing on the 7th day; neutral displacement needle-free connectors...
November 8, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/29147056/organizing-integrated-health-care-services-to-meet-older-people-s-needs
#4
Islene Araujo de Carvalho, JoAnne Epping-Jordan, Anne Margriet Pot, Edward Kelley, Nuria Toro, Jotheeswaran A Thiyagarajan, John R Beard
In most countries, a fundamental shift in the focus of clinical care for older people is needed. Instead of trying to manage numerous diseases and symptoms in a disjointed fashion, the emphasis should be on interventions that optimize older people's physical and mental capacities over their life course and that enable them to do the things they value. This, in turn, requires a change in the way services are organized: there should be more integration within the health system and between health and social services...
November 1, 2017: Bulletin of the World Health Organization
https://www.readbyqxmd.com/read/29138649/-clinical-and-electrocardiographic-aspect-of-pulmonary-embolism-masking-aortic-dissection-revealed-by-thoracic-ct-angiography
#5
Daniella Rakotoniaina Masinarivo, Jenny Larissa Rakotomanana
We here report the case of a 52-year old hypertensive, obese woman (BMI 32,46 kg/m(2)) with a past history of smoking and without evidence-based risk factors of venous thromboembolism, hospitalized for left chest pain radiating to the dorsolumbar region associated with dyspnoea. Clinical examination on hopitalization showed left blood pressure 100/60 mmHg, tachycardia 100/min, oxygen desaturation index at 88% with the patient breathing ambient air, normal cardiopulmonary auscultation, peripheral pulses palpable and no symptoms of phlebitis of the lower limbs...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/29135882/early-effects-of-medicare-s-bundled-payment-for-care-improvement-bpci-program-for-lumbar-fusion
#6
Timothy S Carey, Darren DeWalt
No abstract text is available yet for this article.
November 10, 2017: Spine
https://www.readbyqxmd.com/read/29129345/defining-value-based-care-in-cardiac-and-vascular-anesthesiology-the-past-present-and-future-of-perioperative-cardiovascular-care
#7
REVIEW
Lavinia M Kolarczyk, Harendra Arora, Michael W Manning, David A Zvara, Robert S Isaak
Health care reimbursement models are transitioning from volume-based to value-based models. Value-based models focus on patient outcomes both during the hospital admission and postdischarge. These models place emphasis on cost, quality of care, and coordination of multidisciplinary services. Perioperative physicians are challenged to evaluate traditional practices to ensure coordinated, cost-effective, and evidence-based care. With the Centers for Medicare and Medicaid Services planned introduction of bundled payments for coronary artery bypass graft surgery, cardiovascular anesthesiologists are financially responsible for postdischarge outcomes...
September 28, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29128234/skilled-nursing-facility-partnerships-may-decrease-90-day-costs-in-a-total-joint-arthroplasty-episode-under-the-bundled-payments-for-care-improvement-initiative
#8
Omar A Behery, Shalen Kouk, Kevin K Chen, Kathleen A Mullaly, Joseph A Bosco, James D Slover, Richard Iorio, Ran Schwarzkopf
BACKGROUND: The Bundled Payments for Care Improvement initiative was developed to reduce costs associated with total joint arthroplasty through a single payment for all patient care from index admission through a 90-day post-discharge period, including care at skilled nursing facilities (SNFs). The aim of this study is to investigate whether forming partnerships between hospitals and SNFs could lower the post-discharge costs. We hypothesize that institutionally aligned SNFs have lower post-discharge costs than non-aligned SNFs...
October 16, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29123562/the-role-of-occupational-and-physiotherapy-in-multi-modal-approach-to-tackling-delirium-in-the-intensive-care
#9
REVIEW
Jenny Rains, Nigel Chee
The presence of delirium within critical care remains a long-standing challenge for patients and clinicians alike. A myriad of pre-disposing and precipitating factors lead to this patient cohort being high risk for developing delirium during their critical care stay. Until now, non-pharmacological management of these patients usually encompasses a 'bundle' of principles to reduce delirium days. These bundles have limited focus on the entire multi-disciplinary team (including occupational therapists and physiotherapists) who could assist with the reduction of delirium...
November 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/29112710/interventions-to-reduce-the-incidence-of-hospital-onset-clostridium-difficile-infection-an-agent-based-modeling-approach-to-evaluate-clinical-effectiveness-in-adult-acute-care-hospitals
#10
Anna K Barker, Oguzhan Alagoz, Nasia Safdar
Background: Despite intensified efforts to reduce hospital-onset Clostridium difficile infection (C. difficile; HO-CDI), its clinical and economic impacts continue to worsen. Many institutions have adopted bundled interventions that vary considerably in composition, strength of evidence, and effectiveness. Considerable gaps remain in our knowledge of intervention effectiveness and disease transmission, which hinders HO-CDI prevention. Methods: We developed an agent-based model of C...
November 3, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29112077/technologic-distractions-part-2-a-summary-of-approaches-to-manage-clinical-alarms-with-intent-to-reduce-alarm-fatigue
#11
Bradford D Winters, Maria M Cvach, Christopher P Bonafide, Xiao Hu, Avinash Konkani, Michael F O'Connor, Jeffrey M Rothschild, Nicholas M Selby, Michele M Pelter, Barbara McLean, Sandra L Kane-Gill
OBJECTIVE: Alarm fatigue is a widely recognized safety and quality problem where exposure to high rates of clinical alarms results in desensitization leading to dismissal of or slowed response to alarms. Nonactionable alarms are thought to be especially problematic. Despite these concerns, the number of clinical alarm signals has been increasing as an everincreasing number of medical technologies are added to the clinical care environment. DATA SOURCES: PubMed, SCOPUS, Embase, and CINAHL...
November 3, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29111416/evidence-that-a-regional-surgical-collaborative-can-transform-care-surgical-site-infection-prevention-practices-for-colectomy-in-michigan
#12
Joceline V Vu, Stacey D Collins, Elizabeth Seese, Samantha Hendren, Michael J Englesbe, Darrell A Campbell, Greta L Krapohl
BACKGROUND: Surgical site infections (SSI) after colectomy are associated with increased morbidity and health care use. Since 2012, the Michigan Surgical Quality Collaborative (MSQC) has promoted a "bundle" of care processes associated with lower SSI risk, using an audit-and-feedback system for adherence, face-to-face meetings, and support for quality improvement projects at participating hospitals. The purpose of this study was to determine whether practices changed over time. STUDY DESIGN: We previously found 6 processes of care independently associated with SSI in colectomy...
October 28, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29108783/implementation-of-a-national-bundle-care-program-to-reduce-central-line-associated-bloodstream-infections-in-intensive-care-units-in-taiwan
#13
Chih-Cheng Lai, Cong-Tat Cia, Hsiu-Tzy Chiang, Yung-Chung Kung, Zhi-Yuan Shi, Yin-Ching Chuang, Chun-Ming Lee, Wen-Chien Ko, Po-Ren Hsueh
BACKGROUND/PURPOSE: This study assessed the effect of the central line bundle on the rate of central line-associated bloodstream infections (CLABSI) in intensive care units (ICUs) in Taiwan. METHODS: This national study was conducted in 27 ICUs with 404 beds total, including 15 medical ICUs, 11 surgical ICUs, and one mixed ICU. The study period was divided into two phases: a pre-intervention (between June 1, 2011 and October 31, 2011) and intervention phase (between December 1, 2011 and October 31, 2012)...
October 25, 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
https://www.readbyqxmd.com/read/29107492/is-rapid-recovery-hip-and-knee-replacements-possible-and-safe-in-the-octogenarian-patient
#14
Paul K Edwards, James R Kee, Simon C Mears, C Lowry Barnes
BACKGROUND: Rapid recovery programs are now aimed to reduce costs of hip and knee arthroplasties by discharging patients directly home, shortening hospital length of stay (LOS), and reducing readmission rates. Although patients aged 80 years and older are included in the Medicare bundle, little work has been performed to determine if older patients can safely participate in rapid recovery programs. METHODS: We retrospectively reviewed 2482 patients undergoing primary and revision total hip and knee arthroplasties (THA and TKA) who all participated in a multifaceted rapid recovery program...
October 6, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29107491/readmission-reoperation-and-complications-total-hip-vs-total-knee-arthroplasty
#15
Jaiben George, Morad Chughtai, Anton Khlopas, Alison K Klika, Wael K Barsoum, Carlos A Higuera, Michael A Mont
BACKGROUND: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are currently grouped under the same Diagnosis-Related Group (DRG). With the introduction of bundled payments, providers are accountable for all the costs incurred during the episode of care, including the costs of readmissions and management of complications. However, it is unclear whether readmission rates and short-term complications are similar in primary THA and TKA. METHODS: The National Surgical Quality Improvement Project database was queried from 2011 to 2015 to identify 248,150 primary THA/TKA procedures using Current Procedural Terminology codes...
October 5, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29101960/market-evaluation-finances-bundled-payments-and-accountable-care-organizations
#16
REVIEW
Shazia Mehmood Siddique, Shivan J Mehta
To control costs and improve quality, changes in health care delivery and financing have emerged, resulting in shifting of financial risk to providers for the quality and cost of care, including emergence of accountable care organizations and bundled payment models. This article discusses health care financing and delivery models in the context of procedures and surgeries that happen outside of the operating room. It describes the history of health insurance, trends in ambulatory surgery centers, and new payment models that have emerged from the Affordable Care Act and the Medicare Access and Children's Health Insurance Program Reauthorization Act...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29100898/effectiveness-of-national-and-subnational-infection-prevention-and-control-interventions-in-high-income-and-upper-middle-income-countries-a-systematic-review
#17
REVIEW
Lesley Price, Jennifer MacDonald, Lynn Melone, Tracey Howe, Paul Flowers, Kay Currie, Evonne Curran, Valerie Ness, Debbie Waddell, Sarkis Manoukian, Agi McFarland, Claire Kilpatrick, Julie Storr, Anthony Twyman, Benedetta Allegranzi, Jacqui Reilly
Evidence-based guidance for national infection prevention and control (IPC) programmes is needed to support national and global capacity building to reduce health-care-associated infection and antimicrobial resistance. In this systematic review we investigate evidence on the effectiveness of IPC interventions implemented at national or subnational levels to inform the development of WHO guidelines on the core components of national IPC programmes. We searched CENTRAL, CINAHL, Embase, MEDLINE, and WHO IRIS databases for publications between Jan 1, 2000, and April 19, 2017...
October 31, 2017: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/29099397/implementation-of-a-blood-management-program-at-a-tertiary-care-hospital-effect-on-transfusion-practices-and-clinical-outcomes-among-patients-undergoing-surgery
#18
Faiz Gani, Marcelo Cerullo, Aslam Ejaz, Pranjal B Gupta, Vincent M Demario, Fabian M Johnston, Steven M Frank, Timothy M Pawlik
BACKGROUND: Patient blood management (PBM) programs represent a perioperative bundle of care that aim to reduce or eliminate unnecessary transfusions. OBJECTIVE: To evaluate the impact of a PBM program on transfusion practices and clinical outcomes at a single surgical department at a tertiary care hospital in the United States. METHODS: This pre-post, cross-sectional study was performed using data from 17,114 patients undergoing gastrointestinal surgery between 2010 and 2013...
November 2, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/29089025/implementation-of-sepsis-bundles-in-public-hospitals-in-brazil-a-prospective-study-with-heterogeneous-results
#19
Flavia Ribeiro Machado, Elaine Maria Ferreira, Pierre Schippers, Ilusca Cardoso de Paula, Letícia Sandre Vendrame Saes, Francisco Ivanildo de Oliveira, Paula Tuma, Wilson Nogueira Filho, Felipe Piza, Sandra Guare, Cláudia Mangini, Gustavo Ziggiatti Guth, Luciano Cesar Pontes Azevedo, Flavio Geraldo Resende Freitas, Jose Luiz Gomes do Amaral, Nacime Salomão Mansur, Reinaldo Salomão
BACKGROUND: Public hospitals in emerging countries pose a challenge to quality improvement initiatives in sepsis. Our objective was to evaluate the results of a quality improvement initiative in sepsis in a network of public institutions and to assess potential differences between institutions that did or did not achieve a reduction in mortality. METHODS: We conducted a prospective study of patients with sepsis or septic shock. We collected baseline data on compliance with the Surviving Sepsis Campaign 6-h bundles and mortality...
October 31, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29082108/goldmann-v-standard-automated-perimetry-underestimates-central-visual-sensitivity-in-glaucomatous-eyes-with-increased-axial-length
#20
Mieko Yanagisawa, Hiroshi Murata, Masato Matsuura, Yuri Fujino, Kazunori Hirasawa, Ryo Asaoka
PURPOSE: To investigate the effect of axial length (AL) on the structure-function relationship between retinal nerve fiber layer (RNFL) thickness measurements and visual field (VF) sensitivity measured with Goldmann III and V. METHOD: There were 85 eyes of 85 patients with primary open angle glaucoma included in the current study. Optical coherence tomography and VF (Humphrey Field Analyzer 24-2 or 30-2) measurements with Goldmann III and V targets were carried out in all patients...
October 2017: Translational Vision Science & Technology
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