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Inpatient management

Eleanor E Friedman, Wayne A Duffus
OBJECTIVES: To examine sociodemographic factors and chronic health conditions of people living with HIV (PLWHIV/HIV+) at least 65 years old and compare their chronic disease prevalence with beneficiaries without HIV. DESIGN: National fee-for-service Medicare claims data (parts A and B) from 2006 to 2009 were used to create a retrospective cohort of beneficiaries at least 65 years old. METHODS: Beneficiaries with an inpatient or skilled nursing facility claim, or outpatient claims with HIV diagnosis codes were considered HIV+...
October 23, 2016: AIDS
Zaid Al-Qurayshi, Adam Hauch, Sudesh Srivastav, Emad Kandil
BACKGROUND: Successful parathyroidectomy requires advanced surgeon experience. We aim to examine population characteristics at risk of being managed by low-volume surgeons. METHODS: A cross-sectional study was performed utilizing the Nationwide Inpatient Sample database, 2004 to 2009. The study population included adult inpatients who underwent parathyroidectomy for primary hyperparathyroidism. RESULTS: A total of 3,503 discharge records were included...
August 4, 2016: American Journal of Surgery
Michèle M Kislan, Adam T Bernstein, Loretta R Fearrington, Timothy J Ives
BACKGROUND: Clinical Pharmacist Practitioners are advanced practicing pharmacists in North Carolina that provide disease-specific management. The purpose of this retrospective cohort study was to compare the efficacy and charges from referrals to a Clinical Pharmacist Practitioner by the primary care provider, to those managed by a primary care provider alone. METHODS: Patients were separated into cohorts depending if they had at least two appointments with a Clinical Pharmacist Practitioner from November 2008 to November 2011...
October 21, 2016: BMC Health Services Research
Lavi Oud
BACKGROUND The demand for critical care services among elderly with dementia outpaces that of their non-dementia elderly counterparts. However, there are scarce data on the corresponding attributes among ICU-managed patients with dementia. MATERIAL AND METHODS We used the Texas Inpatient Public Use Data File to examine temporal trends of the demographics, burden of comorbidities, measures of severity of illness, use of healthcare resources, and short-term outcomes among hospitalizations aged 65 years or older with a reported diagnosis of dementia, who were admitted to ICU (D-ICU hospitalizations) between 2001 and 2010...
October 20, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
A E Cullen, L Bowers, M Khondoker, S Pettit, E Achilla, L Koeser, L Moylan, J Baker, A Quirk, F Sethi, D Stewart, P McCrone, A D Tulloch
AIMS: Within acute psychiatric inpatient services, patients exhibiting severely disturbed behaviour can be transferred to a psychiatric intensive care unit (PICU) and/or secluded in order to manage the risks posed to the patient and others. However, whether specific patient groups are more likely to be subjected to these coercive measures is unclear. Using robust methodological and statistical techniques, we aimed to determine the demographic, clinical and behavioural predictors of both PICU and seclusion...
October 20, 2016: Epidemiology and Psychiatric Sciences
Geoffrey L Dickens, Catherine Frogley, Fiona Mason, Katina Anagnostakis, Marco M Picchioni
BACKGROUND: Clozapine is an atypical antipsychotic medicine which can cause significant side-effects. It is often prescribed off-license in severe cases of borderline personality disorder contrary to national treatment guidelines. Little is known about the experiences of those who take clozapine for borderline personality disorder. We explored the lived-experience of women in secure inpatient care who were prescribed clozapine for borderline personality disorder. FINDINGS: Adult females (N = 20) participated in audio-taped semi-structured interviews...
2016: Borderline Personality Disorder and Emotion Dysregulation
Prashant Kumar Singh, Priyam Saikia, Mangala Lahakar
BACKGROUND AND AIMS: Considering the paucity of regional data, this study was designed to investigate the prevalence of post-operative pain and determine if there exists any correlation between the intensity of post-operative pain and patient's level of satisfaction with their pain management after inpatient abdominal surgery at an academic tertiary care government centre. METHODS: Pain intensity was measured in 120 patients with numeric rating scale at the fifth post-operative hour, second and third post-operative day...
October 2016: Indian Journal of Anaesthesia
Nathanael Heckmann, Alexander Bradley, Lakshmanan Sivasundaram, Ram Kiran Alluri, Eric W Tan
BACKGROUND: Several studies have examined the effect of insurance on the management of various orthopedic conditions. The purpose of our study was to assess the effect of insurance and other demographic factors on the operative management of tibiotalar osteoarthritis. METHODS: The National Inpatient Sample (NIS) database was used to identify patients who underwent a total ankle arthroplasty (TAA) or tibiotalar arthrodesis (TTA) for tibiotalar osteoarthritis. Insurance status was identified for each patient, and the proportions of each insurance type were computed for each operative modality...
October 18, 2016: Foot & Ankle International
Beatrice I Amboko, Philip Ayieko, Morris Ogero, Thomas Julius, Grace Irimu, Mike English
BACKGROUND: Up to 90 % of the global burden of malaria morbidity and mortality occurs in sub-Saharan Africa and children under-five bear a disproportionately high malaria burden. Effective inpatient case management can reduce severe malaria mortality and morbidity, but there are few reports of how successfully international and national recommendations are adopted in management of inpatient childhood malaria. METHODS: A descriptive cross-sectional study of inpatient malaria case management practices was conducted using data collected over 24 months in five hospitals from high malaria risk areas participating in the Clinical Information Network (CIN) in Kenya...
October 18, 2016: Malaria Journal
Cedric Mabire, Andrew Dwyer, Antoine Garnier, Joanie Pellet
BACKGROUND: Inadequate discharge planning for the growing elderly population poses significant challenges for health services. Effective discharge planning interventions have been examined in several studies, but little information is available on nursing's role or the specific components of these interventions. Despite the research published on the importance of discharge planning, the impact on patient's health outcomes still needs to be proven in practice. OBJECTIVES: To determine the best available evidence on the effectiveness of discharge planning interventions involving at least one nurse on health-related outcomes for elderly inpatients discharged home and to assess the relative impact of individual components of discharge planning interventions...
September 2016: JBI Database of Systematic Reviews and Implementation Reports
Jana G Hashash, Randi Sigal, Pamela Wein-Levy, Eva M Szigethy, Joy J Merusi, Miguel D Regueiro
Patients with inflammatory Bowel Disease (IBD) often require hospitalization and this experience is stressful. Health care providers frequently do not have adequate time to address the emotional impact of the hospitalization on the patient and family. Nonmedical support for inpatients was identified as an unmet need by a Crohn's disease patient's family. This led to the development of a volunteer peer specialist network, IBD Connect, where peer volunteers visit hospitalized patients with IBD to offer emotional support and educational materials...
November 2016: Inflammatory Bowel Diseases
Debbie Selby, Dori Seccaraccia, Jim Huth, Kristin Kurrpa, Margaret Fitch
OBJECTIVE: The goal of this study was to explore healthcare professionals' (HCPs') perception of their role in provision of spiritual care, in addition to attempting to identify a simple question(s) to help identify spiritual distress. BACKGROUND: Spirituality is well recognized as important to whole-person care, particularly in those with terminal illnesses. Understanding the role of front-line providers in the identification and management of spiritual distress, however, remains challenging...
October 18, 2016: Journal of Palliative Medicine
Steven Steinhubl
Despite having the basic tools necessary to appropriately identify and manage individuals with hypertension for over half a century it remains the single greatest contributing risk factor to morbidity and mortality worldwide today. Since diagnosis and effective treatment availability are not issues, this major failing in care can be attributed to inadequate systems of care: systems that have led to only <20% of hypertensive individuals globally having their blood pressure adequately controlled. Even in the US, where it is one of the most common reasons for a primary care visit, and with over $42...
September 2016: Journal of Hypertension
Peter J Kelly, Gregory W Albers, Anastasios Chatzikonstantinou, Gian Marco De Marchis, Julia Ferrari, Paul George, Mira Katan, Michael Knoflach, Jong S Kim, Linxin Li, Eun-Jae Lee, Jean-Marc Olivot, Francisco Purroy, Nicolas Raposo, Peter M Rothwell, Vijay K Sharma, Bo Song, Georgios Tsivgoulis, Cathal Walsh, Yuming Xu, Aine Merwick
BACKGROUND: Identification of patients at highest risk of early stroke after transient ischaemic attack has been improved with imaging based scores. We aimed to compare the validity and prognostic utility of imaging-based stroke risk scores in patients after transient ischaemic attack. METHODS: We did a pooled analysis of published and unpublished individual-patient data from 16 cohort studies of transient ischaemic attack done in Asia, Europe, and the USA, with early brain and vascular imaging and follow up...
November 2016: Lancet Neurology
Xiaoshu Li, Fangyuan Gao, Huimin Liu, Henghui Zhang, Yao Liu, Xieqiong Ye, Mingfan Geng, Le Sun, Rui Wang, Yuxin Li, Yuyong Jiang, Xiaojing Wang, Guiqin Zhou, Zhiyun Yang, Ang Li, Hui Zeng, Xianbo Wang
AIM: Hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) has significant morbidity and mortality. There is no standard approach for the management of HBV-related ACLF with nucleos(t)ide analogs. Our objective was to compare the short-term mortality between entecavir (ETV) and lamivudine (LAM) in patients with HBV-related ACLF. METHODS: We recruited 311 inpatients with HBV-related ACLF from December 2002 to January 2015. The patients were treated with ETV (n=143) or LAM (n=168)...
October 4, 2016: European Journal of Gastroenterology & Hepatology
Derenda Lovelace, Diane Hancock, Sabrina S Hughes, Phyllis R Wyche, Claire Jenkins, Cindy Logan
BACKGROUND: In 2011, the Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) in Richmond, VA, had a cumulative readmission rate and emergency department (ED) revisits for discharged Veterans of 1 in 5. In 2012, a transitional care program (TCP) was implemented to improve care coordination and outcomes among Veterans, with an emphasis on geriatric patients with chronic disease. This TCP was created with an interdisciplinary approach using intensive case management interventions, with a goal of reducing Veteran ED and hospital revisits by 30%...
November 2016: Professional Case Management
Alan N Barkun, Viviane Adam, Yidan Lu, Yen-I Chen, Myriam Martel
GOALS: We compared the cost-effectiveness of traditional recommended endoscopic hemostatic therapies and Hemospray alone or in combination when treating nonvariceal upper gastrointestinal bleeding (NVUGIB). BACKGROUND: Hemospray (TC-325) is a novel endoscopic hemostatic powder, achieving hemostasis through adherence to actively bleeding biological surfaces. STUDY: A decision tree of patients with NVUGIB assessed 4 possible treatment strategies: traditional therapy alone (T), Hemospray alone (H), traditional therapy completed by Hemospray if needed (T+H), or Hemospray completed by traditional therapy if needed (H+T)...
October 4, 2016: Journal of Clinical Gastroenterology
Kartik Sampath, Timothy B Gardner
Acute pancreatitis represents one of the most common gastrointestinal illnesses requiring inpatient hospitalization. An estimated twenty percent of these patients eventually develop pancreatic necrosis. Necrosis management consists of surveillance imaging, where necrosectomy is indicated for symptomatic or infected walled off necrosis (WON). Over the past two decades, the standard of care to manage WON has switched from an open operative approach to an endoscopic, minimally-invasive, step-up method [1] [2]...
October 16, 2016: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Monika Bolina, C Allyson Jones, Sheri Koshman, Erin Heintz, Cheryl A Sadowski
BACKGROUND: Functional skills can affect the ability of older adults to appropriately manage their medication regimens. Research evaluating a patient's functional ability or the assessment of medication management is limited. OBJECTIVES: Our objective was to describe the documented components of functional medication management (FMM) in adults aged ≥65 years during an acute hospital stay. The secondary objective was to describe the characteristics of the healthcare providers (HCP) who document FMM...
September 12, 2016: Drugs—Real World Outcomes
Michelle K Haas, Kristen Dalton, Bryan C Knepper, Sarah A Stella, Lilia Cervantes, Connie S Price, William J Burman, Philip S Mehler, Timothy C Jenkins
Background.  Syndrome-specific interventions are a recommended approach to antibiotic stewardship, but additional data are needed to understand their potential impact. We implemented an intervention to improve the management of inpatient community-acquired pneumonia (CAP) and evaluated its effects on antibiotic and resource utilization. Methods.  A stakeholder group developed and implemented a clinical practice guideline and order set for inpatient, non-intensive care unit CAP recommending a short course (5 days) of a fluoroquinolone-sparing antibiotic regimen in uncomplicated cases...
October 2016: Open Forum Infectious Diseases
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