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https://www.readbyqxmd.com/read/28811042/understanding-readmissions-in-children-undergoing-surgery-a-pediatric-nsqip-analysis
#1
Afif N Kulaylat, Dorothy V Rocourt, Anthony Y Tsai, Kathryn L Martin, Brett W Engbrecht, Mary C Santos, Robert E Cilley, Christopher S Hollenbeak, Peter W Dillon
BACKGROUND: Readmission is increasingly being utilized as an important clinical outcome and measure of hospital quality. Our aim was to delineate rates, risk factors, and reasons for unplanned readmission in pediatric surgery. MATERIALS AND METHODS: Retrospective review of pediatric patients (n=130,274) undergoing surgery (2013-2014) at hospitals enrolled in the Pediatric National Surgical Quality Improvement Program (NSQIP-P) was performed. Logistic regression was used to model factors associated with unplanned 30-day readmission...
July 31, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28803034/variations-in-the-costs-of-radical-cystectomy-for-bladder-cancer-in-the-usa
#2
Jeffrey J Leow, Alexander P Cole, Thomas Seisen, Joaquim Bellmunt, Matthew Mossanen, Mani Menon, Mark A Preston, Toni K Choueiri, Adam S Kibel, Benjamin I Chung, Maxine Sun, Steven L Chang, Quoc-Dien Trinh
BACKGROUND: Radical cystectomy (RC) for muscle-invasive bladder cancer (BCa) has potential for serious complications, prolonged length of stay and readmissions-all of which may increase costs. Although variations in outcomes are well described, less is known about determinants driving variation in costs. OBJECTIVE: To assess surgeon- and hospital-level variations in costs and predictors of high- and low-cost RC. DESIGN, SETTING, AND PARTICIPANTS: Cohort study of 23 173 patients who underwent RC for BCa in 208 hospitals in the USA from 2003 to 2015 in the Premier Healthcare Database...
August 9, 2017: European Urology
https://www.readbyqxmd.com/read/28799870/vitamin-d-status-and-3-month-glasgow-outcome-scale-scores-in-patients-in-neurocritical-care-prospective-analysis-of-497-patients
#3
Jian Guan, Michael Karsy, Andrea A Brock, Ilyas M Eli, Gabrielle M Manton, Holly K Ledyard, Gregory W J Hawryluk, Min S Park
OBJECTIVE Vitamin D deficiency has been associated with a variety of negative outcomes in critically ill patients, but little focused study on the effects of hypovitaminosis D has been performed in the neurocritical care population. In this study, the authors examined the effect of vitamin D deficiency on 3-month outcomes after discharge from a neurocritical care unit (NCCU). METHODS The authors prospectively analyzed 25-hydroxy vitamin D levels in patients admitted to the NCCU of a quaternary care center over a 6-month period...
August 11, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28798015/morbidity-and-mortality-conference-for-percutaneous-coronary-intervention
#4
Jacob A Doll, Robert Overton, Manesh R Patel, Sunil V Rao, Michael H Sketch, J Kevin Harrison, James E Tcheng
BACKGROUND: Morbidity and mortality conference is a common educational and quality improvement activity performed in cardiac catheterization laboratories, but best practices for case selection and for maximizing the effectiveness of peer review have not been determined. METHODS AND RESULTS: We reviewed the 10-year percutaneous coronary intervention morbidity and mortality conference experience of an academic medical center. Cases were triggered for review by the occurrence of prespecified procedural events...
August 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28795911/the-development-of-eras-across-surgical-specialties
#5
James C Senturk, Gentian Kristo, Jason Gold, Ronald Bleday, Edward Whang
BACKGROUND: Enhanced recovery after surgery (ERAS(®)) principles have gained traction in variety of surgical disciplines. The promise of a reduced length of stay without compromising patient safety or increasing readmission rates has produced a body of literature examining the implementation of ERAS in the care of general, thoracic, urologic, and gynecologic surgery patients. METHODS: We performed a review of the literature pertaining to studies of ERAS implementation across colorectal surgery, general surgery, thoracic surgery, urology, and gynecology...
August 10, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/28794008/long-term-employment-outcomes-following-rehabilitation-for-significant-neurological-impairment-in-uk-military-personnel-a-3-year-study
#6
Sardar Bahadur, J McRann, E McGilloway
BACKGROUND: Returning to employment is a major modifiable factor affecting long-term health in brain injury which neurological and vocational rehabilitation attempts to address. In military patients, little is known about long-term employability, whether employment is sustained and how they fare in civilian roles. METHODS: A telephone review was undertaken of every military patient having undergone inpatient neurorehabilitation between 2012 and 2014. This was compared to their employment outcomes one to three years post discharge...
August 9, 2017: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/28768645/utilization-of-statins-beyond-the-initial-period-after-stroke-and-1-year-risk-of-recurrent-stroke
#7
Meng Lee, Jeffrey L Saver, Yi-Ling Wu, Sung-Chun Tang, Jiann-Der Lee, Neal M Rao, Hui-Hsuan Wang, Jiann-Shing Jeng, Tsong-Hai Lee, Pei-Chun Chen, Bruce Ovbiagele
BACKGROUND: In-hospital discontinuation of statins has been linked to poorer early stroke outcomes, but the consequences of postdischarge discontinuation or dose reduction of statin treatment are unknown. The objective of this study was to explore the effects of statin discontinuation or statin dose reduction on recurrent stroke risk. METHODS AND RESULTS: We conducted a nationwide cohort study using the data from the Taiwan National Health Insurance Research Database...
August 2, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28767560/variation-in-bariatric-surgery-episode-costs-in-the-commercially-insured-implications-for-bundled-payments-in-the-private-sector
#8
Alexander C Kelsall, Ruth Cassidy, Amir A Ghaferi
OBJECTIVE: To describe hospital-level variation in roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Michigan. BACKGROUND: Bariatric surgery is an increasingly prevalent elective surgical procedure that will likely be considered for future bundled payment programs, both public and private. Past research in the Medicare population found that the index hospitalization is responsible for the majority of payment variation among hospitals. However, this research largely excluded SG, now the most commonly performed bariatric surgery procedure nationally...
August 1, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28763825/-representation-of-internal-medicine-in-g-drg-system-analysis-of-reasons-for-prolonged-length-of-stay
#9
Kristina Siam, Norbert Roeder, Ulrich R Fölsch, Hans-Friedrich Spies
Background There is an ongoing discussion within the German Society of Internal Medicine (DGIM) and the Professional Association of German Internists (BDI) about the appropriate depiction and remuneration of internal medicine in the G-DRG. Method Therefore, cases with a significantly prolonged length of stay were analyzed in a multicenter study. 124 cases from 6 hospitals were collected for evaluation. Results The results show that the observed prolongation of hospitalization was mainly due to medical reasons...
August 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28759409/head-growth-trajectory-and-neurodevelopmental-outcomes-in-preterm-neonates
#10
Kamini Raghuram, Junmin Yang, Paige T Church, Zenon Cieslak, Anne Synnes, Amit Mukerji, Prakesh S Shah
OBJECTIVES: To evaluate the association between head growth (HG) during neonatal and postdischarge periods and neurodevelopmental outcomes of preterm neonates of <29 weeks gestational age. METHODS: We conducted a retrospective cohort study of infants <29 weeks gestational
age admitted between 2009 and 2011 to participating Canadian Neonatal Network
units and followed by Canadian Neonatal Follow-Up Network clinics. Differences in head circumference (ΔHC) z score were calculated for 3 time periods, which include admission to discharge, discharge to follow-up at 16-36 months, and admission to follow-up...
July 2017: Pediatrics
https://www.readbyqxmd.com/read/28756400/perspectives-of-survivors-families-and-researchers-on-key-outcomes-for-research-in-acute-respiratory-failure
#11
Victor D Dinglas, Caroline M Chessare, Wesley E Davis, Ann Parker, Lisa Aronson Friedman, Elizabeth Colantuoni, Clifton O Bingham, Alison E Turnbull, Dale M Needham
BACKGROUND: There is heterogeneity among the outcomes evaluated in studies of survivors of acute respiratory failure (ARF). AIM: To evaluate the importance of specific outcome domains to acute respiratory distress syndrome (ARDS) survivors, their family members and clinical researchers. METHODS: Nineteen outcome domains were identified from the National Institutes of Health's Patient Reported Outcomes Measurement Information System; WHO's International Classification of Functioning, Disability, and Health; Society of Critical Care Medicine's Post-Intensive Care Syndrome (PICS); as well as patient, clinician and researcher input...
July 29, 2017: Thorax
https://www.readbyqxmd.com/read/28753778/the-fate-of-radical-cystectomy-patients-after-hospital-discharge-understanding-the-black-box-of-the-pre-readmission-interval
#12
Naveen Krishnan, Benjamin Li, Bruce L Jacobs, Sapan N Ambani, Tudor Borza, Chang He, Brent K Hollenbeck, Todd Morgan, Khaled S Hafez, Alon Z Weizer, Jeffrey S Montgomery, Cheryl T Lee, Opal Lesse, Mariel S Lavieri, Jonathan E Helm, Ted A Skolarus
BACKGROUND: Radical cystectomy has one of the highest 30-d hospital readmission rates but circumstances leading to readmission remain poorly understood. OBJECTIVE: To examine the postdischarge period and better understand hospital readmission after radical cystectomy. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective cohort study of patients treated with radical cystectomy for bladder cancer from 2005 to 2012 using our institutional database...
August 4, 2016: European Urology Focus
https://www.readbyqxmd.com/read/28747837/evaluation-of-pulmonary-functions-in-preschool-children-born-late-preterm
#13
İlkay Er, Ayla Günlemez, Zeynep Seda Uyan, Metin Aydoğan, Meral Oruç, Olcay Işık, Ayşe Engin Arısoy, Canan Baydemir, Ayşe Sevim Gökalp
AIM: The aim of this study was to evaluate the pulmonary functions of preschool children born late-preterm. MATERIAL AND METHODS: Children aged between 3-7 years who were born at 34(0/7-)36(6/7) weeks' gestation represented the target sample. Patients with a diagnosis of congenital cardiac, pulmonary and/or muscle diseases were excluded. Respiratory symptoms were evaluated using the modified asthma predictive index and International Study of Asthma and Allergies in Childhood criteria for children aged under and over 6 years, respectively...
June 2017: Türk Pediatri Arşivi
https://www.readbyqxmd.com/read/28742770/role-of-the-perioperative-surgical-home-in-optimizing-the-perioperative-use-of-opioids
#14
Thomas R Vetter, Zeev N Kain
Several federal agencies have recently noted that the United States is in the midst of an unprecedented "opioid epidemic," with an increasing number of opioid-related overdoses and deaths. Providers currently face 3 population-level, public health challenges in providing optimal perioperative pain care: (1) the continued lack of overall improvement in the excessive incidence of inadequately treated postoperative pain, (2) minimizing or preventing postoperative opioid-related side effects, and (3) addressing current opioid prescribing patterns, and the accompanying problematic surge in prescription opioid diversion, misuse, abuse, addiction, and overdose...
July 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28742713/does-prolonged-enteral-feeding-with-supplemental-omega-3-fatty-acids-impact-on-recovery-post-esophagectomy-results-of-a-randomized-double-blind-trial
#15
Laura A Healy, Aoife Ryan, Suzanne L Doyle, Éadaoin Bríd Ní Bhuachalla, Samantha Cushen, Ricardo Segurado, Thomas Murphy, Narayanasamy Ravi, Claire L Donohoe, John V Reynolds
OBJECTIVE: This randomized controlled trial (RCT) hypothesized that prolonged enteral nutrition (EN) with supplemental eicosapentanoic acid (EPA), an omega-3 fatty acid with immune and anabolic properties, may impact on clinical and nutritional outcomes. BACKGROUND: Esophagectomy is associated with significant weight loss and catabolism, and negatively impacts quality of life (QL). Strategies to counter sustained catabolism have therapeutic rationale. METHODS: This multicenter, double-blind, placebo-controlled RCT was powered on a 5% difference in lean body mass (LBM) at 1 month...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28742645/quality-improvement-in-management-of-acute-coronary-syndrome-continuing-medical-education-and-peer-coaching-improve-antiplatelet-medication-adherence-and-reduce-hospital-readmissions
#16
Amy Larkin, Michael LaCouture, Kathleen Geissel, Peri Barr, Eric R Bates, Christopher P Cannon, Deepak L Bhatt
BACKGROUND: Reducing hospital readmissions and improving patient adherence to antiplatelet medications after an acute coronary syndrome (ACS) event are important goals for improving patient health and decreasing healthcare costs. Nearly half of patients will have a secondary event within 1 year of the initial ACS event. Quality improvement (QI) initiatives that include continuing medical education and peer coaching may improve physician practice patterns and, therefore, patient outcomes...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28739464/prophylactic-groin-wound-vacuum-assisted-therapy-in-vascular-surgery-patients-at-enhanced-risk-for-postoperative-wound-infection
#17
Luke O Pesonen, Brian G Halloran, Abdulhameed Aziz
OBJECTIVE: Vascular groin wounds have higher than expected surgical site infection (SSI) rates and some patients are at enhanced risk. The Wiseman et al. paper suggests an objective scoring system that identifies patients at enhanced risk of postdischarge SSI. We hypothesize that prophylactic groin wound vacuum-assisted closure (VAC) therapy in enhanced risk patients will decrease SSI and readmission and the Wiseman model provides potential evidence that enhanced risk patients can be objectively identified...
July 21, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28739058/acupressure-in-management-of-postoperative-nausea-and-vomiting-in-high-risk-ambulatory-surgical-patients
#18
Debra Hofmann, Carrie Murray, Janet Beck, Rebecca Homann
PURPOSE: The purpose of this randomized blinded placebo-controlled research study was to investigate the effect of acupressure over 24 hours postoperatively for ambulatory surgical patients who are identified as high risk for PONV. DESIGN: A randomized blinded placebo-controlled study design was implemented. METHODS: Study enrollment criteria included four of five risk factors as defined in 2006 by American Society of PeriAnesthesia Nurses PONV/postdischarge nausea and vomiting guidelines: female, PONV history or motion sickness, nonsmoker, and volatile gas general anesthetic...
August 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/28735805/impact-of-definition-and-timeframe-on-capturing-surgery-related-readmissions-after-primary-joint-arthroplasty
#19
Brian P Chen, Johanna Dobransky, Stephane Poitras, Alan Forster, Paul E Beaulé
BACKGROUND: Readmission rate has emerged as an important metric to measure quality, but varying definitions and timeframes are used. We aimed to evaluate the impact of different readmission definitions (postoperative vs postdischarge) and timeframes (30 vs 90-day) on capturing surgery-related readmissions after primary total joint arthroplasty. METHODS: Patients who underwent primary total hip or knee arthroplasty between January 1, 2013 and December 31, 2015 were included...
July 5, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28734555/decisional-and-dispositional-capacity-determinations-neuropsychiatric-illness-and-an-integrated-clinical-paradigm
#20
REVIEW
James A Bourgeois, Mary Ann Cohen, Jennifer M Erickson, Rebecca Weintraub Brendel
BACKGROUND: Assessment of decisional capacity requires thorough clinical review of a patient's current psychiatric symptoms and cognitive processes. The assessment to determine the patient's capacity for self-management postdischarge is a different clinical concept from decisional capacity. OBJECTIVES: Standardized guidelines for capacity determinations (both for informed consent and for disposition) would be helpful to clinicians, patients, and their caregivers...
May 13, 2017: Psychosomatics
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