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https://www.readbyqxmd.com/read/28098628/the-abcdef-bundle-science-and-philosophy-of-how-icu-liberation-serves-patients-and-families
#1
E Wesley Ely
Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new survivors comes de novo suffering and disability called "the postintensive care syndrome." Patients with postintensive care syndrome are robbed of their normal cognitive, emotional, and physical capacity and cannot resume their previous life. The ICU Liberation Collaborative is a real-world quality improvement initiative being implemented across 76 ICUs designed to engage strategically the ABCDEF bundle through team- and evidence-based care...
February 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28093837/effects-of-simulation-education-on-oral-care-practices%C3%A2-%C3%A2-a-randomized-controlled-trial
#2
Miia M Jansson, Hannu P Syrjälä, Pasi P Ohtonen, Merja H Meriläinen, Helvi A Kyngäs, Tero I Ala-Kokko
BACKGROUND: Implementation of evidence-based oral care protocols, nurse education programmes and assessment tools may reduce the risk of developing ventilator-associated pneumonia by increasing critical care nurses' knowledge and skills in adhering to current oral care recommendations. AIMS: To evaluate the longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on critical care nurses' knowledge and skills in adhering to current oral care recommendations...
January 16, 2017: Nursing in Critical Care
https://www.readbyqxmd.com/read/28090046/an-isolated-case-of-late-onset-amyloidogenic-transthyretin-type-familial-amyloid-polyneuropathy-associated-with-a-mutant-transthyretin-substituting-methionine-for-valine-at-position-30-showing-latent-progressive-cardiac-involvement-confirmed-by-serial-annual
#3
Chikako Sato, Tomofumi Takaya, Shumpei Mori, Kohei Hasegawa, Fumitaka Soga, Hidekazu Tanaka, Yoshiaki Watanabe, Tatsuya Nishii, Atsushi K Kono, Yukiko Morinaga, Hatsue Ishibashi-Ueda, Ken-Ichi Hirata
Late-onset amyloidogenic transthyretin (ATTR) type familial amyloid polyneuropathy (FAP) shows features distinct from those of early-onset hereditary ATTR type FAP. We herein describe an asymptomatic 68-year-old man with late-onset ATTR type FAP whose serial annual electrocardiograms demonstrated progressive left bundle branch block. Latent but severe cardiac involvement seems to be one feature of late-onset ATTR type FAP, similar to senile systemic amyloidosis (SSA). Early differential diagnosis of late-onset ATTR type FAP from SSA is important because, currently, only the former has new therapeutic options available in Japan...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28074438/is-there-variation-in-procedural-utilization-for-lumbar-spine-disorders-between-a-fee-for-service-and-salaried-healthcare-system
#4
Andrew J Schoenfeld, Heeren Makanji, Wei Jiang, Tracey Koehlmoos, Christopher M Bono, Adil H Haider
BACKGROUND: Whether compensation for professional services drives the use of those services is an important question that has not been answered in a robust manner. Specifically, there is a growing concern that spine care practitioners may preferentially choose more costly or invasive procedures in a fee-for-service system, irrespective of the underlying lumbar disorder being treated. QUESTIONS/PURPOSES: (1) Were proportions of interbody fusions higher in the fee-for-service setting as opposed to the salaried Department of Defense setting? (2) Were the odds of interbody fusion increased in a fee-for-service setting after controlling for indications for surgery? METHODS: Patients surgically treated for lumbar disc herniation, spinal stenosis, and spondylolisthesis (2006-2014) were identified...
January 10, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28069851/less-intense-postacute-care-better-outcomes-for-enrollees-in-medicare-advantage-than-those-in-fee-for-service
#5
Peter J Huckfeldt, José J Escarce, Brendan Rabideau, Pinar Karaca-Mandic, Neeraj Sood
Traditional fee-for-service (FFS) Medicare's prospective payment systems for postacute care provide little incentive to coordinate care or control costs. In contrast, Medicare Advantage plans pay for postacute care out of monthly capitated payments and thus have stronger incentives to use it efficiently. We compared the use of postacute care in skilled nursing and inpatient rehabilitation facilities by enrollees in Medicare Advantage and FFS Medicare after hospital discharge for three high-volume conditions: lower extremity joint replacement, stroke, and heart failure...
January 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28068138/payment-reform-in-the-patient-centered-medical-home-enabling-and-sustaining-integrated-behavioral-health-care
#6
Benjamin F Miller, Kaile M Ross, Melinda M Davis, Stephen P Melek, Roger Kathol, Patrick Gordon
The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet...
January 2017: American Psychologist
https://www.readbyqxmd.com/read/28060238/single-institution-early-experience-with-the-bundled-payments-for-care-improvement-initiative
#7
Richard Iorio, Joseph Bosco, James Slover, Yousuf Sayeed, Joseph D Zuckerman
The Centers for Medicare & Medicaid Services (CMS) implemented the Bundled Payments for Care Improvement (BPCI) initiative in 2011. Through BPCI, organizations enlisted into payment agreements that include both performance and financial accountability for episodes of care. To succeed, BPCI requires quality maintenance and care delivery at lower costs. This necessitates physicians and hospitals to merge interests. Orthopaedic surgeons must assume leadership roles in cost containment, surgical safety, and quality assurance to deliver cost-effective care...
January 4, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28060228/risk-adjusted-hospital-outcomes-in-medicare-total-joint-replacement-surgical-procedures
#8
Donald E Fry, Michael Pine, Susan M Nedza, David G Locke, Agnes M Reband, Gregory Pine
BACKGROUND: Comparative measurement of hospital outcomes can define opportunities for care improvement and will assume great importance as alternative payment models for inpatient total joint replacement surgical procedures are introduced. The purpose of this study was to develop risk-adjusted models for Medicare inpatient and post-discharge adverse outcomes in elective lower-extremity total joint replacement and to apply these models for hospital comparison. METHODS: Hospitals with ≥50 qualifying cases of elective total hip replacement and total knee replacement from the Medicare Limited Data Set database of 2010 to 2012 were studied...
January 4, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28059916/does-hospital-transfer-impact-outcomes-after-colorectal-surgery
#9
Christopher J Chow, Wolfgang B Gaertner, Christine C Jensen, Bradford Sklow, Robert D Madoff, Mary R Kwaan
BACKGROUND: With increasing public reporting of outcomes and bundled payments, hospitals and providers are scrutinized for morbidity and mortality. The impact of patient transfer before colorectal surgery has not been well characterized in a risk-adjusted fashion. OBJECTIVE: We hypothesized that hospital-to-hospital transfer would independently predict morbidity and mortality beyond traditional predictor variables. DESIGN: We constructed a retrospective cohort of 158,446 patients who underwent colorectal surgery using the 2009-2013 American College of Surgeons National Surgical Quality Improvement Program database...
February 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28055062/cost-of-joint-replacement-using-bundled-payment-models
#10
Amol S Navathe, Andrea B Troxel, Joshua M Liao, Nan Nan, Jingsan Zhu, Wenjun Zhong, Ezekiel J Emanuel
Importance: Medicare launched the mandatory Comprehensive Care for Joint Replacement bundled payment model in 67 urban areas for approximately 800 hospitals following its experience in the voluntary Acute Care Episodes (ACE) and Bundled Payments for Care Improvement (BPCI) demonstration projects. Little information from ACE and BPCI exists to guide hospitals in redesigning care for mandatory joint replacement bundles. Objective: To analyze changes in quality, internal hospital costs, and postacute care (PAC) spending for lower extremity joint replacement bundled payment episodes encompassing hospitalization and 30 days of PAC...
January 3, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28045723/rate-dependent-left-bundle-branch-block-in-an-ambulatory-surgery-patient-a-case-report
#11
Ashraf Farag, Justin Tsai, Sam Deeb, Deidre Putman-Garcia, John D Wasnick, Lydia A Conlay
A 52-year-old woman, ASA II (American Society of Anesthesia classification II) scheduled for cholecystectomy in an ambulatory center, exhibited a wide-complex tachycardia with ectopy on the monitor after induction with propofol and succinylcholine. Blood pressure remained stable; amiodarone was administered for presumed ventricular tachycardia. A 12-lead electrocardiogram (ECG) showed a new left bundle branch block (LBBB) at 98 beats per minute (bpm), which resolved when the heart rate slowed. Surgery was postponed, and both the LBBB and ectopy recurred frequently during the next 24 hours in the intensive care unit, particularly at heart rates >90 bpm...
December 30, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/28045146/synthesis-driven-structure-dependent-optical-behavior-in-phase-tunable-nayf4-yb-er-based-motifs-and-associated-heterostructures
#12
Haiqing Liu, Jinkyu Han, Coray McBean, Crystal S Lewis, Prahlad Kumar Routh, Mircea Cotlet, Stanislaus S Wong
Understanding the key parameters necessary for generating uniform Er,Yb co-activated NaYF4 possessing various selected phases (i.e. cubic or hexagonal) represents an important chemical strategy towards tailoring optical behavior in these systems. Herein, we report on a straightforward hydrothermal synthesis in which the separate effects of reaction temperature, reaction time, and precursor stoichiometry in the absence of any surfactant were independently investigated. Interestingly, the presence and the concentration of NH4OH appear to be the most critical determinants of the phase and morphology...
January 18, 2017: Physical Chemistry Chemical Physics: PCCP
https://www.readbyqxmd.com/read/28044333/haemodynamic-monitoring-in-the-peri-operative-period-the-past-the-present-and-the-future
#13
REVIEW
X Watson, M Cecconi
Over recent years there has been an increase in the implementation of goal-directed therapy using minimally invasive haemodynamic monitoring techniques to guide peri-operative care. Since the introduction of the pulmonary artery flotation catheter in the 1980s, various haemodynamic monitors have been developed, each associated with their own benefits and limitations. Goal-directed therapy has been well-established as a standard of care in the peri-operative period and has largely been associated with a reduction in morbidity and mortality...
January 2017: Anaesthesia
https://www.readbyqxmd.com/read/28042074/a-communications-bundle-to-improve-satisfaction-for-critically-ill-patients-and-their-families-a-prospective-cohort-pilot-study
#14
Rana L Awdish, Dana Buick, Maria Kokas, Hanan Berlin, Catherine Jackman, Cari Williamson, Michael P Mendez, Kristen Chasteen
CONTEXT: Communication skills training with simulated patients is used by many academic centers, but how to translate skills learned in simulated settings to improve communication in real encounters has not been described. OBJECTIVE: We developed a communications bundle to facilitate skill transfer from simulation to real encounters and improve patient and/or family satisfaction with physician communication. We tested the feasibility of its use in our hospital's medical intensive care unit (MICU)...
December 29, 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28034774/the-use-of-the-risk-assessment-and-prediction-tool-in-surgical-patients-in-a-bundled-payment-program
#15
James Slover, Kathleen Mullaly, Raj Karia, John Bendo, Patricia Ursomanno, Aubrey Galloway, Richard Iorio, Joseph Bosco
OBJECTIVES: The purpose of this study was to evaluate the relationship between the Risk Assessment and Predictor Tool (RAPT) and patient discharge disposition in an institution participating in bundled payment program for total joint replacement, spine fusion and cardiac valve surgery patients. METHOD: Between April 2014 and April 2015, RAPT scores of 767 patients (535 primary unilateral total joint arthroplasty; 150 cardiac valve replacement; 82 spinal fusions) were prospectively captured...
December 26, 2016: International Journal of Surgery
https://www.readbyqxmd.com/read/28029501/declining-mortality-due-to-severe-sepsis-and-septic-shock-in-spanish-intensive-care-units-a-two-cohort-study-in-2005-and-2011
#16
B Sánchez, R Ferrer, D Suarez, E Romay, E Piacentini, G Gomà, M L Martínez, A Artigas
OBJECTIVE: To analyze the evolution of sepsis-related mortality in Spanish Intensive Care Units (ICUs) following introduction of the Surviving Sepsis Campaign (SSC) guidelines and the relationship with sepsis process-of-care. DESIGN: A prospective cohort study was carried out, with the inclusion of all consecutive patients presenting severe sepsis or septic shock admitted to 41 Spanish ICUs during two time periods: 2005 (Edusepsis study pre-intervention group) and 2011 (ABISS-Edusepsis study pre-intervention group)...
October 28, 2016: Medicina Intensiva
https://www.readbyqxmd.com/read/28024548/canadian-cardiovascular-society-canadian-cardiovascular-critical-care-society-canadian-association-of-interventional-cardiology-position-statement-on-the-optimal-care-of-the-postarrest-patient
#17
Graham C Wong, Sean van Diepen, Craig Ainsworth, Rakesh C Arora, Jean G Diodati, Mark Liszkowski, Michael Love, Chris Overgaard, Greg Schnell, Jean-Francois Tanguay, George Wells, Michel Le May
Out of hospital cardiac arrest (OHCA) is associated with a low rate of survival to hospital discharge and high rates of neurological morbidity among survivors. Programmatic efforts to institute and integrate OHCA best care practices from the bystander response through to the in-hospital phase have been associated with improved patient outcomes. This Canadian Cardiovascular Society position statement was developed to provide comprehensive yet practical recommendations to guide the in-hospital care of OHCA patients...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28009697/an-intervention-bundle-to-facilitate-return-to-work-for-burn-injured-workers-report-from-a-burn-model-system-investigation
#18
Gretchen J Carrougher, Sabina B Brych, Tam N Pham, Samuel P Mandell, Nicole S Gibran
Rates of return to work (RTW) after burn injury vary. A 2012 systematic review of the burn literature reported that nearly 28% of all adult burn survivors never return to any form of employment. These authors called for interventions designed to assist survivors' ability to function in an employed capacity. In 2010, our burn center outpatient clinic instituted an intervention aimed to return injured workers to employment within 90 days of their insurance claims. The interventions include patient/family education focused on recovery rather than disability, employer contact and education by the vocational rehabilitation (VR) counselor, physician recommendations for work accommodations, provision of employee status letters, and Activity Prescription Forms (APFs)...
January 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/28005410/results-of-a-medicare-bundled-payments-for-care-improvement-initiative-for-copd-readmissions
#19
Surya P Bhatt, J Michael Wells, Anand S Iyer, deNay P Kirkpatrick, Trisha M Parekh, Lauren T Leach, Erica M Anderson, J Greg Sanders, Jessica K Nichols, Cindy C Blackburn, Mark T Dransfield
RATIONALE: Approximately 20% of Medicare beneficiaries hospitalized for acute exacerbations of COPD are readmitted within 30 days of discharge. In addition to implementing penalties for excess readmissions, the United States Centers for Medicare & Medicaid Services (CMS) has developed Bundled Payments for Care Improvement (BPCI) initiatives to improve outcomes and control costs. OBJECTIVES: To evaluate whether a comprehensive COPD multidisciplinary intervention focusing on inpatient, transitional and outpatient care as part of our institution's BPCI participation initiative would reduce 30-day all-cause readmission rates for COPD exacerbations and reduce overall costs...
December 22, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28005124/comprehensive-care-for-joint-replacement-cjr-bundle-expense-in-perioperative-pain-management
#20
Susan D Bear
The implementaion of the Comprehensive Care for Joint Replacement (CJR) model has necessitated value-focused care for a 90-day period. Pain management in joint arthroplasty therefore represents a focused opportunity to achieve lasting change in the delivery of care. To be successful, orthopedic surgeons must integrate approaches that take into account administration route and therapy duration, and various combinations thereof, to achieve improved longer term outcomes for joint arthroplasty patients. In addition, pain management choices must be based on value and not on simple costs, as patient satisfaction scores affect CJR repayments...
November 2016: American Journal of Orthopedics
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