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https://www.readbyqxmd.com/read/28214994/cancelled-primary-care-appointments-a-prospective-cohort-study-of-diabetic-patients
#1
Sara McComb, Zhiyi Tian, Laura Sands, Ayten Turkcan, Lingsong Zhang, Shree Frazier, Mark Lawley
Patients scheduled for primary care appointments often cancel or no show. For diabetic patients, nonattendance can affect continuity of care and result in higher emergency department (ED) and hospital use. Nonattendance also impacts appointment scheduling, patient access, and clinic work load. While no show has received significant attention, little research has addressed the prevalence and impact of appointment cancellation. Data on 46,710 appointments for 7586 adult diabetic patients was used to conduct a prospective cohort study examining primary care appointment behavior...
April 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28210361/estimating-the-cost-of-care-for-emergency-department-syncope-patients-comparison-of-three-models
#2
Marc A Probst, John K McConnell, Robert E Weiss, Amber L Laurie, Annick N Yagapen, Michelle P Lin, Jeffrey M Caterino, Manish N Shah, Benjamin C Sun
INTRODUCTION: We sought to compare three hospital cost-estimation models for patients undergoing evaluation for unexplained syncope using hospital cost data. Developing such a model would allow researchers to assess the value of novel clinical algorithms for syncope management. METHODS: We collected complete health services data, including disposition, testing, and length of stay (LOS), on 67 adult patients (age 60 years and older) who presented to the emergency department (ED) with syncope at a single hospital...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28210351/cross-continuum-tool-is-associated-with-reduced-utilization-and-cost-for-frequent-high-need-users
#3
Lauran Hardin, Adam Kilian, Leslie Muller, Kevin Callison, Michael Olgren
INTRODUCTION: High-need, high-cost (HNHC) patients can over-use acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased U.S. healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care. We targeted HNHC patients and identified root causes of frequent healthcare utilization. We developed a cross-continuum intervention process and a succinct tool called a Complex Care Map (CCM)© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28206929/disparities-in-mangement-of-patients-with-benign-colorectal-disease-impact-of-urbanization-and-specialized-care
#4
Viraj Pandit, Mazhar Khalil, Bellal Joseph, Jana Jandova, Tahereh Orouji Jokar, Ansab Abbas Haider, Bardiya Zangbar, Asad Asim, Ahmed Hassan, Valentine Nfonsam
: Disparities in the management of patients with various medical conditions are well established. Colorectal diseases continue to remain one of the most common causes for surgical intervention. The aim of this study was to assess disparities (rural versus urban) in the surgical management of patients with noncancerous benign colorectal diseases. We hypothesized that there is no difference among rural versus urban centers (UC) in the surgical management for noncancerous benign colorectal diseases...
November 1, 2016: American Surgeon
https://www.readbyqxmd.com/read/28196489/what-is-a-hospital-bed-day-worth-a-contingent-valuation-study-of-hospital-chief-executive-officers
#5
Katie Page, Adrain G Barnett, Nicholas Graves
BACKGROUND: Decreasing hospital length of stay, and so freeing up hospital beds, represents an important cost saving which is often used in economic evaluations. The savings need to be accurately quantified in order to make optimal health care resource allocation decisions. Traditionally the accounting cost of a bed is used. We argue instead that the economic cost of a bed day is the better value for making resource decisions, and we describe our valuation method and estimations for costing this important resource...
February 14, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28195093/molecular-identification-of-candida-species-isolated-from-cases-of-neonatal-candidemia-using-polymerase-chain-reaction-restriction-fragment-length-polymorphism-in-a-tertiary-care-hospital
#6
Akeela Fatima, Gulnaz Bashir, Tehmeena Wani, Abiroo Jan, Amrish Kohli, Mosin S Khan
CONTEXT: Candida spp. is an emerging cause of bloodstream infections worldwide. Delay in speciation of Candida isolates by conventional methods and resistance to antifungal drugs in various Candida species are responsible for the increase in morbidity and mortality due to candidemia. Hence, the rapid identification of Candida isolates is very important for the proper management of patients with candidemia. AIMS: The aim was to re-evaluate the identification of various Candida spp...
January 2017: Indian Journal of Pathology & Microbiology
https://www.readbyqxmd.com/read/28193535/the-utility-of-nurse-managed-extracorporeal-life-support-in-an-adult%C3%A2-cardiac-intensive-care-unit
#7
Amy E Hackmann, Luke M Wiggins, Glenn P Grimes, Richard M Fogel, Felicia A Schenkel, Mark L Barr, Michael E Bowdish, Mark J Cunningham, Vaughn A Starnes
BACKGROUND: The use of extracorporeal life support (ECLS) worldwide has increased exponentially since 2009. The patient requiring ECLS demands an investment of hospital resources, including personnel. Educating bedside nurses to manage ECLS circuits broadens the availability of trained providers. METHODS: Experienced cardiothoracic intensive care unit (CTICU) nurses underwent training to manage ECLS circuits, including volume assessment, treatment of arterial blood gas values, the physiology of ECLS, and recognition of common emergencies...
February 10, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28193257/bell-s-palsy-in-children-bellpic-protocol-for-a-multicentre-placebo-controlled-randomized-trial
#8
Franz E Babl, Mark T Mackay, Meredith L Borland, David W Herd, Amit Kochar, Jason Hort, Arjun Rao, John A Cheek, Jeremy Furyk, Lisa Barrow, Shane George, Michael Zhang, Kaya Gardiner, Katherine J Lee, Andrew Davidson, Robert Berkowitz, Frank Sullivan, Emily Porrello, Kim Marie Dalziel, Vicki Anderson, Ed Oakley, Sandy Hopper, Fiona Williams, Catherine Wilson, Amanda Williams, Stuart R Dalziel
BACKGROUND: Bell's palsy or acute idiopathic lower motor neurone facial paralysis is characterized by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. While there is high level evidence in adults demonstrating an improvement in the rate of complete recovery of facial nerve function when treated with steroids compared with placebo, similar high level studies on the use of steroids in Bell's palsy in children are not available. The aim of this study is to assess the utility of steroids in Bell's palsy in children in a randomised placebo-controlled trial...
February 13, 2017: BMC Pediatrics
https://www.readbyqxmd.com/read/28169925/hospital-teaching-status-and-medicare-expenditures-for-complex-surgery
#9
Jason C Pradarelli, Christopher P Scally, Hari Nathan, Jyothi R Thumma, Justin B Dimick
OBJECTIVE: To evaluate the relationship between hospital teaching intensity, Medicare payments, and perioperative outcomes. BACKGROUND: Several emerging payment policies penalize hospitals for low-value healthcare. Teaching hospitals may be at a disadvantage given the perception that they deliver care less efficiently. METHODS: Using Medicare Provider and Analysis Review files, we studied patients from age 65 to 100 years who underwent abdominal aortic aneurysm (AAA) repair (n = 71,422), pulmonary resection (n = 93,056), or colectomy (n = 277,619) from 2009 to 2012...
March 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28166064/incidence-and-risk-factors-of-surgical-site-infections-in-kathmandu-university-hospital-kavre-nepal
#10
S Shrestha, P Wenju, R Shrestha, R M Karmacharya
Background Surgical site infections (SSI) are the common nosocomial infection in surgical patients, and are a significant source of postoperative morbidity resulting in increased hospital stay, morbidity and cost. Objective The objective of this study was to obtain the incidence of SSI and determine various risks factors influencing the SSI rate with special reference to the National Nosocomial Infections Surveillance System risk index in Kathmandu University Hospital, Kavre, Nepal. Method Six hundred and thirty eight patients who underwent various surgeries in Dhulikhel Hospital, Kathmandu University Hospital during a three-month period were included...
April 2016: Kathmandu University Medical Journal (KUMJ)
https://www.readbyqxmd.com/read/28156482/implementing-an-emergency-department-emr-trigger-tool-for-palliative-medicine-consultation-and-its-effect-on-length-of-stay-and-health-care-costs-a-retrospective-study
#11
Felix Rivera, Wendy Edwards
: 167 Background: Several studies have shown that palliative medicine consultation can improve multiple patient-centered outcomes, especially when provided early. Our goal is to show that our electronic health record (EHR) trigger tool is a cost-effective way for hospitals to identify patients who may benefit from early consultation, improving outcomes such as hospital length of stay and facilitating appropriate disposition for patients with metastatic cancer. METHODS: Retrospective chart review of 721 patients at an urban community hospital who were identified by a trigger system integrated into the Emergency Department (ED) EHR...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152001/does-non-adherence-to-dmards-influence-hospital-related-healthcare-costs-for-early-arthritis-in-the-first-year-of-treatment
#12
Annelieke Pasma, Charlotte Schenk, Reinier Timman, Adriaan van 't Spijker, Cathelijne Appels, Willemijn H van der Laan, Bart van den Bemt, Robert Goekoop, Johanna M W Hazes, Jan J V Busschbach
INTRODUCTION: Non-adherence to disease-modifying antirheumatic drugs (DMARDs) is suspected to relate to health care costs. In this study we investigated this relation in the first year of treatment. METHODS: In a multi-center cohort study with a one year follow up, non-adherence was continuously measured using electronic monitored medication jars. Non-adherence was defined as the number of days with a negative difference between expected and observed opening of the container...
2017: PloS One
https://www.readbyqxmd.com/read/28150313/improved-outcomes-and-reduced-costs-associated-with-a-health-system-wide-patient-blood-management-program-a-retrospective-observational-study-in-four-major-adult-tertiary-care-hospitals
#13
Michael F Leahy, Axel Hofmann, Simon Towler, Kevin M Trentino, Sally A Burrows, Stuart G Swain, Jeffrey Hamdorf, Trudi Gallagher, Audrey Koay, Gary C Geelhoed, Shannon L Farmer
BACKGROUND: Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes. STUDY DESIGN AND METHODS: This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications...
February 2, 2017: Transfusion
https://www.readbyqxmd.com/read/28141672/conducting-community-health-needs-assessments-in-the-local-public-health-department-a-comparison-of-random-digit-dialing-and-the-community-assessment-for-public-health-emergency-response
#14
Kahler Stone, Allison Sierocki, Vaidehi Shah, Kelly R Ylitalo, Jennifer A Horney
CONTEXT: Community health needs assessments (CHNAs) are now required by the Affordable Care Act (ACA) for nonprofit hospitals and the Public Health Accreditation Board (PHAB) for local health departments that seek accreditation. Currently, various primary data collection methods exist that meet the ACA and PHAB requirements. OBJECTIVE: To compare 2 CHNA data collection methods implemented in the same geographical area from a local health department perspective. DESIGN AND SETTING: Two community surveys, one door-to-door and one telephone, in the 76706 zip code area of McLennan County, Texas...
January 30, 2017: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/28130687/fluid-administration-in-severe-sepsis-and-septic-shock-patterns-and-outcomes-an-analysis-of-a-large-national-database
#15
Paul E Marik, Walter T Linde-Zwirble, Edward A Bittner, Jennifer Sahatjian, Douglas Hansell
PURPOSE: The optimal strategy of fluid resuscitation in the early hours of severe sepsis and septic shock is controversial, with both an aggressive and conservative approach being recommended. METHODS: We used the 2013 Premier Hospital Discharge database to analyse the administration of fluids on the first ICU day, in 23,513 patients with severe sepsis and septic shock, who were admitted to an ICU from the emergency department. Day 1 fluid was grouped into categories 1 L wide, starting with 1-1...
January 27, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28127715/the-optimal-treatment-of-patients-with-mild-and-moderate-acute-cholecystitis-time-for-a-revision-of-the-tokyo-guidelines
#16
Charlotte S Loozen, Maaike M Blessing, Bert van Ramshorst, Hjalmar C van Santvoort, Djamila Boerma
INTRODUCTION: According to the Tokyo Guidelines, severity of acute cholecystitis is divided into three grades based on the degree of inflammation and the presence of organ dysfunction. These guidelines recommend grade I (mild) acute cholecystitis to be treated with early laparoscopic cholecystectomy and grade II (moderate) acute cholecystitis with delayed cholecystectomy. Yet, several studies have shown that, for acute cholecystitis in general, early cholecystectomy is superior to delayed cholecystectomy in terms of complication rate, duration of hospital stay and costs...
January 26, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28126972/intravenous-lignocaine-infusion-facilitates-acute-rehabilitation-after-laparoscopic-colectomy-in-the-chinese-patients
#17
M Wh Lee, D Yl Or, A Cf Tsang, D Ck Ng, P P Chen, M Hy Cheung, R Sk Li, H T Leong
INTRODUCTION: Intravenous infusion of lignocaine has emerged in recent years as a feasible, cost-effective, and safe method to provide postoperative analgesia. There is, however, no literature about this peri-operative pain control modality in Chinese patients. This study aimed to determine whether peri-operative intravenous lignocaine safely reduces postoperative pain, shortens postoperative ileus, and reduces the length of hospital stay in laparoscopic colorectal surgery. METHODS: Between September 2012 and May 2015, 16 patients who underwent elective laparoscopic resection of colorectal cancer and received a 1% lignocaine infusion for 24 hours postoperatively were studied...
January 27, 2017: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/28126381/the-effect-of-a-short-stay-unit-on-hospital-admission-and-length-of-stay-in-acute-heart-failure-reduce-ahf-study
#18
Òscar Miró, Virginia Carbajosa, W Frank Peacock, Pere Llorens, Pablo Herrero, Javier Jacob, Sean P Collins, Cristina Fernández, Antoni Juan Pastor, Francisco Javier Martín-Sánchez
OBJECTIVE: To determine whether the presence of a short-stay unit(SSU) in a hospital influences the percentage of admissions, length of hospital stay(LOS) and outcomes in emergency department(ED) patients with acute heart failure(AHF). METHOD: Retrospective analysis of AHF patients presenting to one of 34 Spanish ED included in EAHFE registry. Baseline and ED data of patients were collected. Patients were classified into two groups in function of being attended at hospitals with or without a SSU...
January 23, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28123438/a-rare-and-severe-complication-following-thyroid-fine-needle-aspiration-retropharyngeal-cellulitis
#19
Roberto Cesareo, Anda Naciu, Antonio Barberi, Valerio Pasqualini, Giuseppe Pelle, Silvia Manfrini, Gaia Tabacco, Angelo Lauria Pantano, Giuseppe Campagna, Roberto Cianni, Andrea Palermo
INTRODUCTION: Fine needle aspiration (FNA) is the most accurate and cost-effective method for evaluating thyroid nodules. We have reported a rare complication related to the procedure: severe retropharyngeal cellulitis. CASE PRESENTATION: A thirty-five-year-old female was admitted to hospital with hoarseness, laryngeal stridor and dyspnea without fever that emerged about 3 days after a first diagnostic FNA. After the procedure, the patient felt her voice became hoarse and 1 day before presentation began to have dyspnea, without fever...
October 2016: International Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28117114/implementation-of-an-oral-and-maxillofacial-surgery-trauma-team-in-a-major-trauma-centre
#20
J Haq, F Gately, R Bentley
In 2010, King's College Hospital in London was designated as a major trauma centre. To deal with the increasing number of patients, an integrated oral and maxillofacial team of the week was established in 2012 to provide a consultant-led, emergency service dedicated to acute care, and it was anticipated that this would reduce the duration of stay by 0.3 bed-days. To assess the effect of the new system, we compared the duration of stay between 1 October and 31 January 2011-2012 with the same period in 2012-2013...
January 20, 2017: British Journal of Oral & Maxillofacial Surgery
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