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https://www.readbyqxmd.com/read/28647838/preoperative-education-for-hip-and-knee-replacement-never-stop-learning
#1
REVIEW
Paul K Edwards, Simon C Mears, C Lowry Barnes
PURPOSE OF REVIEW: Participation in alternative payment models has focused efforts to improve outcomes and patient satisfaction while also lowering cost for elective hip and knee replacement. The purpose of this review is to determine if preoperative education classes for elective hip and knee replacement achieve these goals. RECENT FINDINGS: Recent literature demonstrates that patients who attend education classes prior to surgery have decreased anxiety, better post-operative pain control, more realistic expectations of surgery, and a better understanding of their surgery...
June 24, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28647442/the-impact-of-the-transition-from-volume-to-value-on-heart-failure-care-implications-of-novel-payment-models-and-quality-improvement-initiatives
#2
REVIEW
Dushyanth Srinivasan, Nihar R Desai
In response to wide variation in quality and outcomes as well as escalating health care costs, the U.S. health care system is transitioning away from a volume based payment system to a quality- and value-based system. Medicare, the largest insurer and payer of healthcare, has accelerated the movement towards value-based care with the development and implementation of myriad alternative payment models and pay for performance programs as part of the Affordable Care Act. Given that heart failure affects a significant number of Medicare patients and these patients account for a disproportionate amount of healthcare utilization and spending, heart failure has become a focal point for these initiatives...
June 21, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/28644939/an-economic-analysis-of-mac-versus-walant-a-trigger-finger-release-surgery-case-study
#3
Jason L Codding, Suneel B Bhat, Asif M Ilyas
BACKGROUND: There has been recent interest in wide awake hand surgery, also referred to as "wide awake local anesthesia with no tourniquet" (WALANT) surgery. Using a model of single trigger finger release (TFR) surgery, a hypothesis was made that WALANT would result in decreased hospital time and cost than patients receiving sedation with monitored anesthetic care (MAC). METHODS: Consecutive cases of single TFR surgery with MAC were compared with WALANT. All surgeries were performed in the same manner, at the same facility, and by the same surgeon...
July 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28644167/care-bundles-easing-the-transition-to-long-term-care
#4
Helen C Clancy
No abstract text is available yet for this article.
July 2017: Nursing Management
https://www.readbyqxmd.com/read/28639549/integrated-comprehensive-care-a-case-study-in-nursing-leadership-and-system-transformation
#5
Laura Wheatley, Winnie Doyle, Cheryl Evans, Carolyn Gosse, Kevin Smith
Calls for transformational change of our healthcare system are increasingly clear, persuasive and insistent. They resonate at all levels, with those who fund, deliver, provide and receive care, and they are rooted in a deep understanding that the system, as currently rigidly structured, most often lacks the necessary flexibility to comprehensively meet the needs of patients across the continuum of care. The St. Joseph's Health System (SJHS) Integrated Comprehensive Care (ICC) Program, which bundles care and funding across the hospital to home continuum, has reduced fragmentation of care, and it has delivered improved outcomes for patients, providers and the system...
2017: Nursing Leadership
https://www.readbyqxmd.com/read/28630850/anterior-dislocation-of-elbow-with-neurovascular-injury-a-rare-case-report
#6
S Kailash, S Shanmuganathan
INTRODUCTION: Anterior elbow dislocation is an infrequent lesion, produced by direct trauma to the proximal ulna after a fall on the elbow in flexion and injury to the neurovascular bundle is not infrequent. Authors report a case of acute anterior dislocation of the elbow joint with neurovascular injury. CASE REPORT: A 30-year-old male admitted with a history of accidental fall followed by pain, swelling over his left elbow. Clinical, radiological, Doppler investigations revealed anterior dislocation of the elbow with brachial artery injury with posterior interosseous nerve palsy without any bony injury...
January 2017: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/28629906/can-bundled-payments-be-successful-in-the-medicaid-population-for-primary-joint-arthroplasty
#7
P Maxwell Courtney, Tori Edmiston, Brian Batko, Brett R Levine
BACKGROUND: Although some bundled payment models have had success in total joint arthroplasty, concerns exist about access to care for higher cost patients who use more resources. The purpose of this study is to determine whether Medicaid patients have increased hospital costs and more resource utilization in a 90-day episode of care than Medicare or privately insured patients. METHODS: We retrospectively reviewed a consecutive series of 7268 primary hip and knee arthroplasty patients at a single institution...
May 25, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28622969/probability-of-undiagnosed-obstructive-sleep-apnea-does-not-correlate-with-adverse-pulmonary-events-nor-length-of-stay-in-hip-and-knee-arthroplasty-using-intrathecal-opioid
#8
Matthew J Thompson, Bryce N Clinger, Robert M Simonds, Camille J Hochheimer, Laura A Lahaye, Gregory J Golladay
BACKGROUND: Recent emphasis on bundled payments and outcomes tracking has increased the focus on preoperative optimization in patients undergoing elective lower extremity arthroplasty. Since patients with obstructive sleep apnea (OSA) have an increased risk of adverse perioperative pulmonary events, screening for undiagnosed OSA is sometimes included as part of preoperative risk assessment. However, there are limited data regarding quantification of OSA risk in lower extremity arthroplasty patients, and little is known about the utility of quantitative OSA screening and the risk of pulmonary complications in hip and knee arthroplasty patients who receive intrathecal morphine anesthetic...
April 14, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28622186/a-90-day-bundled-payment-for-primary-single-level-lumbar-discectomy-decompression-what-does-big-data-say
#9
Nikhil Jain, Sohrab S Virk, Frank M Phillips, Elizabeth Yu, Safdar N Khan
Episode-based bundling may become the major form of reimbursement for many elective spine procedures. As the amount for a 90-day episode of care is not known for a lumbar discectomy, we analyzed the previous reimbursements from Commercial payers (2007-Q2 2015), Medicare Advantage (2007-Q2 2015), and Medicare (2005-2012) for a primary single-level lumbar discectomy/decompression. Distribution of payments among various service providers was studied and a 90-day bundle was simulated. Depending on the payer type, the average facility costs constituted 59...
June 15, 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28620749/bundles-prevent-surgical-site-infections-after-colorectal-surgery-meta-analysis-and-systematic-review
#10
Aleksander Zywot, Christine S M Lau, H Stephen Fletcher, Subroto Paul
INTRODUCTION: Colorectal surgeries (CRS) have one of the highest rates of surgical site infections (SSIs) with rates 15 to >30%. Prevention "bundles" or sets of evidence-based interventions are structured ways to improve patient outcomes. The aim sof this study is to evaluate CRS SSI prevention bundles, bundle components, and implementation and compliance strategies. METHODS: A meta-analysis of studies with pre- and post-implementation data was conducted to assess the impact of bundles on SSI rates (superficial, deep, and organ/space)...
June 15, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28618046/open-label-randomized-controlled-trial-about-application-of-bundle-care-in-prevention-of-unplanned-extubation-of-nasobiliary-drainage-catheter-after-endoscopic-retrograde-cholangiopancreatography
#11
Chun-Mei Zhao, Jun-Bo Qian, Chun-Mei Zhang, Gang Lin
OBJECTS: To observe the effects of bundle care on preventing unplanned extubation (UEX) of nasobiliary drainage catheter after endoscopic retrograde cholangiopancreatography (ERCP). BACKGROUND: Preventing UEX has become a difficult problem for nursing staff because the catheter is stiff, fine and long. DESIGN: A total of 114 cases that experienced nasobiliary drainage after ERCP for the first time in our hospital from April 2015 to July 2016, were enrolled in this study...
June 15, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28615965/impact-of-a-value-based-insurance-design-for-physical-therapy-to-treat-back-pain-on-care-utilization-and-cost
#12
Daniel D Maeng, Anthony Graboski, Peiling L Allison, Dorothy Y Fisher, John B Bulger
OBJECTIVE: To assess the impact of a value-based insurance design providing enhanced access to physical therapy (PT) for treatment of back pain on treatment patterns and cost of care. STUDY DESIGN: A retrospective analysis of claims data obtained from Geisinger Health Plan (GHP). In April 2013, GHP began offering "PT bundle" - i.e., a bundle of up to five PT visits for a single one-time copay that can be renewed for another bundle of five PT visits - for its employer-based plan members with back pain...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28614365/modelling-community-control-strategies-to-protect-hospital-resources-during-an-influenza-pandemic-in-ottawa-canada
#13
Patrick Saunders-Hastings, Bryson Quinn Hayes, Robert Smith, Daniel Krewski
BACKGROUND: A novel influenza virus has emerged to produce a global pandemic four times in the past one hundred years, resulting in millions of infections, hospitalizations and deaths. There is substantial uncertainty about when, where and how the next influenza pandemic will occur. METHODS: We developed a novel mathematical model to chart the evolution of an influenza pandemic. We estimate the likely burden of future influenza pandemics through health and economic endpoints...
2017: PloS One
https://www.readbyqxmd.com/read/28607677/design-and-implementation-of-a-trauma-care-bundle-at-a-community-hospital
#14
Ryan Andres, Elan Hahn, Steffen de Kok, Rafi Setrak, Jeffrey Doyle, Allison Brown
The Niagara Health System (NHS) in Ontario, Canada is comprised of three non-designated trauma center (NTC) hospitals which provide primary care to approximately 100 trauma patients annually. NTCs often lack standardized resources such as trauma surgeons, trauma-trained emergency room physicians, Advanced Trauma Life Support certified staff, trauma protocols, and other resources commonly found at designated trauma centers. Studies indicate that these differences contribute to poorer outcomes for trauma patients treated at community hospitals in Ontario, including the NTC hospitals of the NHS...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28606085/care-cascade-structural-intervention-versus-standard-of-care-in-the-diagnosis-and-treatment-of-hiv-in-china-a-cluster-randomized-controlled-trial-protocol
#15
Yurong Mao, Zunyou Wu, Jennifer M McGoogan, David Liu, Diane Gu, Lynda Erinoff, Walter Ling, Paul VanVeldhuisen, Roger Detels, Albert L Hasson, Robert Lindblad, Julio S G Montaner, Zhenzhu Tang, Yan Zhao
BACKGROUND: The high rate of attrition along the care cascade of infection with human immunodeficiency virus (HIV) results in lost opportunities to provide timely antiretroviral therapy (ART) and to prevent unnecessarily high mortality. This study aims to assess the effectiveness of a structural intervention, the one-stop ("One4All") strategy that streamlines China's HIV care cascade with the intent to improve testing completeness, ART initiation, viral suppression, and mortality. METHOD: A two-arm, cluster-randomized controlled trial was implemented in twelve county hospitals in Guangxi China to test the effectiveness of the One4All strategy (intervention arm) compared to the current standard of care (SOC; control arm)...
June 12, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28605525/infectious-diseases-team-for-the-early-management-of-severe-sepsis-and-septic-shock-in-the-emergency-department
#16
Pierluigi Viale, Sara Tedeschi, Luigia Scudeller, Luciano Attard, Lorenzo Badia, Michele Bartoletti, Alessandra Cascavilla, Francesco Cristini, Nicola Dentale, Giovanni Fasulo, Giorgio Legnani, Filippo Trapani, Fabio Tumietto, Gabriella Verucchi, Giulio Virgili, Andrea Berlingeri, Simone Ambretti, Chiara De Molo, Mara Brizi, Mario Cavazza, Maddalena Giannella
Background.: To assess the impact on all-cause 14-day survival of the implementation of an infectious disease (ID) team for the early management of severe sepsis/septic shock (SS/SS) in the Emergency Department (ED). Methods.: A quasi-experimental pre-post study was carried-out at the general ED of our 1,420-bed teaching hospital. During the pre phase (June 2013-July 2014) all consecutive adult patients with SS/SS were managed according to standard-of-care and data were prospectively collected...
June 12, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28599698/implementation-of-ventilator-bundle-in-pediatric-intensive-care-unit-of-a-developing-country
#17
Anwarul Haque, Quratulain Riaz, Syed Asad Ali
The aim of this study was to assess the frequency of VAP(ventilator associated pneumonia) after strict implementation of ventilator bundle in PICU. Medical records of all children (age 1 month - 16 years) were retrospectively reviewed, who were on mechanical ventilation (MV) for more than 48 hours and received all key components of "ventilator bundle" from January 2012 to December 2014. Out of 1050, 565 (54%) patients were enrolled. The mean age was 4.02 SD 4.29 years and 62 (69%) were male. The indications of MV were respiratory illness (54%), neurological illness (31%), shock (9%), and postoperative care (6%)...
May 2017: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/28598316/how-do-the-epidemiology-of-paediatric-methicillin-resistant-staphylococcus-aureus-and-methicillin-susceptible-staphylococcus-aureus-bacteraemia-differ
#18
Julia Abernethy, Mike Sharland, Alan P Johnson, Russell Hope
PURPOSE: To examine whether the epidemiology of bacteraemia caused by methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) differed in children aged <1 year and in comparison to older age groups. METHODOLOGY: English mandatory MRSA and MSSA surveillance data from 2006 and 2011, respectively, were collected. Epidemiological information was descriptively analysed in relation to methicillin susceptibility and patient age...
June 9, 2017: Journal of Medical Microbiology
https://www.readbyqxmd.com/read/28593582/morphological-size-evaluation-of-the-mid-substance-insertion-areas-and-the-fan-like-extension-fibers-in-the-femoral-acl-footprint
#19
Makoto Suruga, Takashi Horaguchi, Takanori Iriuchishima, Yoshiyuki Yahagi, Genki Iwama, Yasuaki Tokuhashi, Shin Aizawa
PURPOSE: The purpose of this study was to evaluate the detailed anatomy of the femoral anterior cruciate ligament (ACL) insertion site, with special attention given to the morphology of the mid-substance insertion areas and the fan-like extension fibers. METHODS: Twenty-three non-paired human cadaver knees were used (7 Males, 16 Females, median age 83, range 69-96). All soft tissues around the knee were resected except the ligaments. The ACL was divided into antero-medial (AM) and postero-lateral (PL) bundles according to the difference in macroscopic tension patterns...
June 7, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/28590385/post-discharge-care-duration-charges-and-outcomes-among-medicare-patients-after-primary-total-hip-and-knee-arthroplasty
#20
Karthikeyan E Ponnusamy, Zan Naseer, Mostafa H El Dafrawy, Louis Okafor, Clayton Alexander, Robert S Sterling, Harpal S Khanuja, Richard L Skolasky
BACKGROUND: In April 2016, the U.S. Centers for Medicare & Medicaid Services initiated mandatory 90-day bundled payments for total hip and knee arthroplasty for much of the country. Our goal was to determine duration of care, 90-day charges, and readmission rates by discharge disposition and U.S. region after hip or knee arthroplasty. METHODS: Using the 2008 Medicare Provider Analysis and Review database 100% sample, we identified patients who had undergone elective primary total hip or knee arthroplasty...
June 7, 2017: Journal of Bone and Joint Surgery. American Volume
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