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https://www.readbyqxmd.com/read/28079629/duration-of-pneumonia-therapy-and-the-role-of-biomarkers
#1
Katerina Kaziani, Adamantia Sotiriou, George Dimopoulos
PURPOSE OF REVIEW: Increasing antimicrobial resistance is a worldwide phenomenon that is threatening public health. Lower respiratory infections are one of the leading causes of morbidity that contribute to antibiotic consumption and thus the emergence of multidrug-resistant microbial strains. The goal of shortening antibiotic regimens' duration in common bacterial infections has been prioritized by antimicrobial stewardship programs as an action against this problem. RECENT FINDINGS: Data coming from randomized controlled trials, meta-analyses, and systematic reviews support the shortening of antimicrobial regimens in community-acquired, hospital-acquired, and ventilator-associated pneumonia...
January 12, 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/28078188/new-innovations-for-deep-partial-thickness-burn-treatment-with-acell-matristem-matrix
#2
Justine S Kim, Alexander J Kaminsky, J Blair Summitt, Wesley P Thayer
Objective: Burn injuries remain a large financial burden on the healthcare system. According to CDC statistics (2010), nonfatal and hospitalized burns in the U.S. cost $1.8 billion for an annual incidence of ∼486,000 cases. To date, no technique proves to be the ideal therapy of deep partial-thickness burns. In this study, we review a trial usage of ACell (ACell, Inc.) wound matrix on deep partial-thickness burns. Approach: Burn patients were admitted through the Vanderbilt Emergency Department. Three were consented to receive ACell therapy...
December 1, 2016: Advances in Wound Care
https://www.readbyqxmd.com/read/28069638/feasibility-and-predictors-of-early-discharge-after-percutaneous-edge-to-edge-mitral-valve-repair
#3
Corrado Tamburino, Sergio Buccheri, Antonio Popolo Rubbio, Salvatore Scandura, Maria Elena Di Salvo, Sarah Mangiafico, Sebastiano Immé, Giuseppe Caruso, Matteo Scalia, Antonio Condorelli, Marco Barbanti, Piera Capranzano, Davide Capodanno, Carmelo Grasso
BACKGROUND: Percutaneous edge-to-edge mitral valve repair (PMVR) recently emerged as an effective treatment modality for patients with severe mitral regurgitation (MR). Length of postprocedural hospital stay may represent a modifiable cost associated with percutaneous treatment. We looked at feasibility, predictors and safety of early discharge (ED), defined as hospital discharge within 72 hours, in patients undergoing PMVR. METHODS AND RESULTS: Consecutive patients treated with MitraClip from October 2008 to December 2015 were analysed...
January 9, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28055287/epidemiology-treatment-and-economics-of-patients-presenting-to-the-emergency-department-for-skin-and-soft-tissue-infections
#4
Kristin E Linder, David P Nicolau, Michael D Nailor
OBJECTIVES: Skin and soft tissue infections (SSTIs) are among the most common bacterial diseases and represent a significant disease burden. The purpose of this study was to describe the real-world management of patients with SSTIs presenting to the emergency department (ED). METHODS: This is a retrospective cohort study. Adult patients identified with a primary diagnosis of SSTI determined by ICD-9 codes were assessed from index presentation for up to 30 days. Records were reviewed 30 days prior to inclusion to ensure index hospitalization was captured...
January 5, 2017: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/28055062/cost-of-joint-replacement-using-bundled-payment-models
#5
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/28043480/the-integrated-comprehensive-care-program-a-novel-home-care-initiative-after-major-thoracic-surgery
#6
Yaron Shargall, Wael C Hanna, Laura Schneider, Colin Schieman, Christian J Finley, Anna Tran, Shantel Demay, Carolyn Gosse, James M Bowen, Gord Blackhouse, Kevin Smith
The objective of the study was to evaluate the Integrated Comprehensive Care (ICC) program, a novel health system integration initiative that coordinates home care and hospital-based clinical services for patients undergoing major thoracic surgery relative to traditional home care delivery. Methods included a pilot retrospective cohort analysis that compared the intervention cohort (ICC), composed of all patients undergoing major thoracic surgery in the 2012-2013 fiscal year with a control cohort, who underwent surgery in the year before the initiation of ICC...
July 2016: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28034587/factors-that-affect-cost-and-clinical-outcome-of-endovascular-aortic-repair-for-abdominal-aortic-aneurysm
#7
Monica S O'Brien-Irr, Linda M Harris, Hasan H Dosluoglu, Gregory S Cherr, Mariel Rivero, Sonya Noor, G Richard Curl, Maciej L Dryjski
OBJECTIVE: This study evaluated the effect of indication for use (IFU), additional graft components, and percutaneous closure of endovascular aortic repair (PEVAR) on clinical outcomes and cost of endovascular aortic repair (EVAR). METHODS: Clinical and financial data were obtained for all elective EVARs completed at a university-affiliated medical center between January 2012 and June 2013. Data were analyzed by χ(2), Student t-test for independent samples, and Kaplan-Meier survival...
December 26, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28030520/parent-perceptions-on-transfers-to-pediatric-emergency-departments-and-the-role-of-telemedicine
#8
Cynthia J Mollen, Mira Henien, Lisa M Jacobs, Sage Myers
OBJECTIVE: Real-time audiovisual consultation (telemedicine) has been proven feasible and is a promising alternative to interfacility transfer. We sought to describe caregiver perceptions of the decision to transfer his or her child to a pediatric emergency department and the potential use of telemedicine as an alternative to transfer. METHODS: Semistructured interviews of caregivers of patients transferred to a pediatric emergency department. Purposive sampling was used to recruit caregivers of patients who were transferred from varying distances and different times of the day...
December 28, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28017523/healthcare-resource-use-direct-and-indirect-costs-of-hypoglycemia-in-type-1-and-type-2-diabetes-and-nationwide-projections-results-of-the-hypos-1-study
#9
C B Giorda, M C Rossi, O Ozzello, S Gentile, A Aglialoro, A Chiambretti, F Baccetti, F M Gentile, F Romeo, G Lucisano, A Nicolucci
BACKGROUND AND AIMS: To obtain an accurate picture of the total costs of hypoglycemia, including the indirect costs and comparing the differences between type 1 (T1DM) and type 2 diabetes mellitus (T2DM). METHODS AND RESULTS: HYPOS-1 was a multicenter, retrospective cohort study which analyzed the data of 2229 consecutive patients seen at 18 diabetes clinics. Data on healthcare resource use and indirect costs by diabetes type were collected via a questionnaire. The domains of inpatient admission and hospital stay, work days lost, and third-party assistance were also explored...
November 18, 2016: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD
https://www.readbyqxmd.com/read/28008467/readmissions-after-laparoscopic-cholecystectomy-in-a-uk-district-general-hospital
#10
Olugbenga Awolaran, Tabitha Gana, Nehemiah Samuel, Kenneth Oaikhinan
INTRODUCTION: Laparoscopic cholecystectomy is the gold standard for the treatment of symptomatic gallstones and its practice as day case where possible is considered the standard over the last decade. However, readmission after surgery is recognised as a new problem. AIM: The aim of this cohort observational study was to investigate the readmission rate in a district general hospital and identify the causes of readmission in order to explore ways by which this can be reduced or managed more cost effectively...
December 23, 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/27998195/healthcare-utilization-and-costs-in-patients-with-tuberous-sclerosis-complex-related-renal-angiomyolipoma
#11
Xue Song, Zhimei Liu, Katherine Cappell, Christopher Gregory, Qayyim Said, Judith Prestifilippo, Hearns Charles, John Hulbert, John Bissler
OBJECTIVE: To quantify healthcare utilization and costs in patients with tuberous sclerosis complex (TSC) and renal angiomyolipoma in a matched cohort of patients without TSC or angiomyolipoma. METHODS: Administrative data from the MarketScan® Research Databases were used to select patients with TSC and renal angiomyolipoma during 1/1/2000-3/31/2013 from the Commercial database and 1/1/2000-6/30/2012 from the Medicaid database. Patients were required to have at least 30 days of follow-up from initiation into the study, and were followed until inpatient death, end of insurance coverage, or the end of study...
December 20, 2016: Journal of Medical Economics
https://www.readbyqxmd.com/read/27986531/patient-function-and-the-value-of-surgical-care-for-kidney-cancer
#12
Hung-Jui Tan, Joseph D Shirk, Karim Chamie, Mark S Litwin, Jim C Hu
PURPOSE: Frailty and functional status have emerged as significant predictors of morbidity and mortality for patients undergoing cancer surgery. To articulate their impact on value (i.e., quality per cost), we compared perioperative outcomes and expenditures according to patient function for older adults undergoing kidney cancer surgery. MATERIALS AND METHODS: Using linked SEER-Medicare data, we identified 19,129 elderly patients with kidney cancer treated with non-ablative surgery from 2000-2009...
December 13, 2016: Journal of Urology
https://www.readbyqxmd.com/read/27977002/supporting-heart-failure-patient-transitions-from-acute-to-community-care-with-home-telemonitoring-technology-a-protocol-for-a-provincial-randomized-controlled-trial-tec4home
#13
(no author information available yet)
BACKGROUND: Seniors with chronic diseases such as heart failure have complex care needs. They are vulnerable to their condition deteriorating and, without timely intervention, may require multiple emergency department visits and/or repeated hospitalizations. Upon discharge, the transition from the emergency department to home can be a vulnerable time for recovering patients with disruptions in the continuity of care. Remote monitoring of heart failure patients using home telemonitoring, coupled with clear communication protocols between health care professionals, can be effective in increasing the safety and quality of care for seniors with heart failure discharged from the emergency department...
December 18, 2016: JMIR Research Protocols
https://www.readbyqxmd.com/read/27955985/quarterly-reporting-of-computed-tomography-ordering-history-reduces-the-use-of-imaging-in-an-emergency-department
#14
Richard Ehrlichman, Zachary Dezman, Joel Klein, Jean Jeudy, Daniel Lemkin
BACKGROUND: Computed tomography (CT) is a useful and necessary part of many emergency department (ED) assessments. However, the costs of imaging and the health risks associated with radiation exposure have sparked national efforts to reduce CT ordering in EDs. STUDY OBJECTIVE: We analyzed CT ordering habits prior to and following implementation of a feedback tool at a community hospital. METHODS: In this intervention study, we identified the CT-ordering habits of physicians and mid-level care providers (physician assistants and nurse practitioners) at baseline and after implementation of a system that sent quarterly feedback reports comparing their ordering habits with those of their peers...
December 9, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27940191/the-power-of-flash-mob-research-conducting-a-nationwide-observational-clinical-study-on-capillary-refill-time-in-a-single-day
#15
Jelmer Alsma, Jan Lcm van Saase, Prabath Wb Nanayakkara, Wem Ineke Schouten, Anique Baten, Martijn P Bauer, Frits Holleman, Jack Jm Ligtenberg, Patricia M Stassen, Karin A Kaasjager, Harm Haak, Frank H Bosch, Stephanie Ce Schuit
BACKGROUND: Capillary refill time (CRT) is a clinical test used to evaluate the circulatory status of patients, and there are various methods to assess CRT. Conventional clinical research often demands large numbers of patients, making it costly, labor-intensive and time consuming. We studied the interobserver agreement on CRT in a nationwide study using a novel methodology of research called 'Flash Mob Research' (FMR). METHODS: Physicians in the Netherlands were recruited by word-of-mouth, conventional media and social media to participate in a nationwide, single-day, "nine-to-five", multi-center, cross-sectional, observational study to evaluate CRT...
December 6, 2016: Chest
https://www.readbyqxmd.com/read/27936053/predicting-30-day-readmissions-in-an-asian-population-building-a-predictive-model-by-incorporating-markers-of-hospitalization-severity
#16
Lian Leng Low, Nan Liu, Sijia Wang, Julian Thumboo, Marcus Eng Hock Ong, Kheng Hock Lee
BACKGROUND: To reduce readmissions, it may be cost-effective to consider risk stratification, with targeting intervention programs to patients at high risk of readmissions. In this study, we aimed to derive and validate a prediction model including several novel markers of hospitalization severity, and compare the model with the LACE index (Length of stay, Acuity of admission, Charlson comorbidity index, Emergency department visits in past 6 months), an established risk stratification tool...
2016: PloS One
https://www.readbyqxmd.com/read/27919450/development-and-validation-of-a-prediction-model-for-patients-discharged-to-post-acute-care-after-colorectal-cancer-surgery
#17
Elizabeth A Bailey, Rebecca L Hoffman, Christopher Wirtalla, Giorgos Karakousis, Rachel R Kelz
BACKGROUND: As payment shifts toward bundled reimbursement, decreasing unnecessary inpatient care may provide cost savings. This study examines the association between discharge status, hospital duration of stay, and cost for colorectal operation patients without complications and uses risk factors to predict the need for post-acute care. METHODS: We used the New York Statewide Planning and Research Cooperative System and the California Healthcare Cost and Utilization Project State Inpatient Databases to identify all patients who underwent operative resection for colorectal cancer in 2009-2010 and were discharged to home or post-acute care...
December 2, 2016: Surgery
https://www.readbyqxmd.com/read/27911959/barriers-to-timely-and-safe-blood-transfusion-for-pph-patients-evidence-from-a-qualitative-study-in-dhaka-bangladesh
#18
Sadika Akhter, Iqbal Anwar, Rashida Akter, Feroza Akhter Kumkum, Monjura Khatun Nisha, Fatema Ashraf, Ferdousi Islam, Nazneen Begum, Mahbub Elahi Chowdhury, Anne Austin, Syed Shariful Islam, Aminur Rahman
BACKGROUND AND OBJECTIVES: In Bangladesh, postpartum hemorrhage (PPH) is the leading cause of maternal mortality accounting for 31% of all blood transfusions in the country. Although safe blood transfusion is one of the 8 signal functions of Comprehensive Emergency Obstetric Care (CEmOC) strategy, most of the designated public sector CEmOC facilities do not have on-site blood storage system. Emergent blood is mainly available from external blood banks. As a result, emergent patients are to rely on an unregulated network of brokers for blood which may raise question about blood safety...
2016: PloS One
https://www.readbyqxmd.com/read/27909374/cardiorespiratory-physiotherapy-around-the-clock-experience-at-a-university-hospital
#19
Marianne Devroey, Catherine Buyse, Michelle Norrenberg, Anne-Marie Ros, Jean-Louis Vincent
Purpose: To document and describe the use of a hospital-wide, 24-hour cardiorespiratory physiotherapy service run by an intensive care unit (ICU) team of physiotherapists. Methods: We prospectively collected data on all non-ICU hospital patients who used the 24-hours-per-day cardiorespiratory physiotherapy service over a 1-year period between July 2013 and June 2014. The ICU physiotherapists documented the reason, origin of referral, time of call, and type and frequency of treatment of each patient. Results: Over the 1-year period, the ICU physiotherapists administered 2,192 out-of-hours cardiorespiratory physiotherapy treatments (n=685 patients) outside the ICU...
2016: Physiotherapy Canada. Physiothérapie Canada
https://www.readbyqxmd.com/read/27907936/early-treatment-for-neonatal-abstinence-syndrome-a-palliative-approach
#20
Jennifer Hudson, Rachel Mayo, Lori Dickes, Liwei Chen, Windsor Westbrook Sherrill, Julie Summey, Bradley Dalton, Kindal Dankovich
Objective To describe medical, safety, and health care utilization outcomes associated with an early treatment model for neonatal opioid withdrawal. Study Design This is a retrospective review of 117 opioid-exposed infants born in a large regional hospital and treated in the level I nursery with methadone initiated within 48 hours of birth. Results For this cohort, mean length of stay was 8.3 days. Hospital safety events were infrequent; there were no medication errors or deaths. Within 30 days of discharge, 14% of infants visited the emergency department; 7% were readmitted...
December 1, 2016: American Journal of Perinatology
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