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https://www.readbyqxmd.com/read/28339598/high-postdischarge-morbidity-in-ugandan-children-with-severe-malarial-anemia-or-cerebral-malaria
#1
Robert O Opoka, Karen E S Hamre, Nathan Brand, Paul Bangirana, Richard Idro, Chandy C John
Summary: Postdischarge readmission and outpatient illnesses are frequent in children with severe malarial anemia or cerebral malaria. Trials of postdischarge malaria prophylaxis in children with severe malaria should be considered. Background: Cerebral malaria (CM) and severe malarial anemia (SMA) account for a substantial proportion of malaria-related deaths in sub-Saharan Africa. However, postdischarge morbidity in children with CM or SMA has not been well established...
October 7, 2016: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/28330941/nurse-driven-clinical-pathway-for-inpatient-asthma-a-randomized-controlled-trial
#2
Catherine M Pound, Victoria Gelt, Salwa Akiki, Kaylee Eady, Katherine Moreau, Franco Momoli, Barbara Murchison, Roger Zemek, Brett Mulholland, Tom Kovesi
OBJECTIVE: We examined the impact of a nurse-driven clinical pathway on length of stay (LOS) for children hospitalized with asthma. METHODS: We conducted a randomized controlled trial involving children hospitalized with asthma. Nurses of children in the intervention group weaned salbutamol frequency using an asthma scoring tool, whereas physicians weaned salbutamol frequency for the control group patients as per standard care. The primary outcome was LOS in hours...
March 22, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28329352/costs-and-consequences-of-early-hospital-discharge-after-major-inpatient-surgery-in-older-adults
#3
Scott E Regenbogen, Anne H Cain-Nielsen, Edward C Norton, Lena M Chen, John D Birkmeyer, Jonathan S Skinner
Importance: As prospective payment transitions to bundled reimbursement, many US hospitals are implementing protocols to shorten hospitalization after major surgery. These efforts could have unintended consequences and increase overall surgical episode spending if they induce more frequent postdischarge care use or readmissions. Objective: To evaluate the association between early postoperative discharge practices and overall surgical episode spending and expenditures for postdischarge care use and readmissions...
March 22, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28316980/clinical-and-prognostic-significance-of-positive-hepatojugular-reflux-on-discharge-in-acute-heart-failure-insights-from-the-escape-trial
#4
Hesham R Omar, Maya Guglin
Background. There has been a decline in emphasis of the value of physical examination in heart failure (HF) with increased reliance on cardiac imaging. We aim to study the clinical and prognostic significance of positive hepatojugular reflux (HJR) on discharge in patients hospitalized with HF. Methods. Using the ESCAPE trial data, patients were compared according to the presence or absence of a positive HJR on discharge. The primary study endpoints were all-cause mortality and a composite endpoint of death, rehospitalization, and cardiac transplant during the first 6 months after discharge...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28298373/prognostic-impact-of-in-hospital-and-postdischarge-heart-failure-in-patients-with-acute-myocardial-infarction-a-nationwide-analysis-using-data-from-the-cardiovascular-disease-in-norway-cvdnor-project
#5
Gerhard Sulo, Jannicke Igland, Ottar Nygård, Stein Emil Vollset, Marta Ebbing, Neil Poulter, Grace M Egeland, Charlotte Cerqueira, Torben Jørgensen, Grethe S Tell
BACKGROUND: Heart failure (HF) is a serious complication of acute myocardial infarction (AMI). We explored the excess mortality associated with HF as an early or late complication of AMI and describe changes over time in such excess mortality. METHODS AND RESULTS: All patients hospitalized with an incident AMI and without history of prior HF hospitalization were followed up to 1 year after AMI discharge for episodes of HF. New HF episodes were classified as in-hospital HF if diagnosed during the AMI hospitalization or postdischarge HF if diagnosed within 1 year after discharge from the incident AMI...
March 15, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28296033/predictors-of-post-hospitalization-recovery-of-renal-function-among-patients-with-acute-kidney-injury-requiring-dialysis
#6
Russell Pajewski, Patrick Gipson, Michael Heung
INTRODUCTION: Acute kidney injury (AKI) requiring dialysis complicates 1% of all hospital admissions, and up to 30% of survivors will still require dialysis at hospital discharge. There is a paucity of data to describe the postdischarge outcomes or to guide evidence-based dialysis management of this vulnerable population. METHODS: Single-center, retrospective analysis of 100 consecutive patients with AKI who survived to hospital discharge and required outpatient dialysis...
March 13, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28296028/impact-of-hospital-volume-on-long-term-neurological-outcome-in-patients-undergoing-carotid-artery-stenting
#7
Chi-Sheng Hung, Chih-Fan Yeh, Mao-Shin Lin, Ying-Hsien Chen, Ching-Chang Huang, Hung-Yuan Li, Hsien-Li Kao
BACKGROUND: The impact of hospital volume on long-term outcome after carotid artery stenting (CAS) remains unknown. OBJECTIVES: We designed a nationwide cohort study to elucidate the impact of hospital volume on the incidence of stroke after CAS. METHODS: The Taiwan National Health Insurance Research database was used to identify all patients admitted for CAS from 2008 to 2012. We defined high-volume hospitals as those performing more than 20 CAS per year...
March 15, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28291891/effect-of-inpatient-rehabilitation-vs-a-monitored-home-based-program-on-mobility-in-patients-with-total-knee-arthroplasty-the-hiho-randomized-clinical-trial
#8
RANDOMIZED CONTROLLED TRIAL
Mark A Buhagiar, Justine M Naylor, Ian A Harris, Wei Xuan, Friedbert Kohler, Rachael Wright, Renee Fortunato
Importance: Formal rehabilitation programs, including inpatient programs, are often assumed to optimize recovery among patients after undergoing total knee arthroplasty. However, these programs have not been compared with any outpatient or home-based programs. Objective: To determine whether 10 days of inpatient rehabilitation followed by a monitored home-based program after total knee arthroplasty provided greater improvements than a monitored home-based program alone in mobility, function, and quality of life...
March 14, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28291730/association-between-clinical-pathways-leading-to-medical-management-and-prognosis-in-patients-with-nsteacs
#9
Héctor Bueno, Stuart Pocock, Jesús Medina, Nicolas Danchin, Lieven Annemans, Muriel Licour, John Gregson, Ana María Vega, Frans van de Werf
INTRODUCTION AND OBJECTIVES: A large proportion of patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) are initially selected for medical management (MM) and do not undergo coronary revascularization during or immediately after the index event. The aim of this study was to explore the clinical pathways leading to MM in NSTEACS patients and their influence on prognosis. METHODS: Patient characteristics, pathways leading to MM, and 2-year outcomes were recorded in a prospective cohort of 5591 NSTEACS patients enrolled in 555 hospitals in 20 countries across Europe and Latin America...
March 10, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28291598/identifying-radiology-s-place-in-the-expanding-landscape-of-episode-payment%C3%A2-models
#10
Andrew B Rosenkrantz, Joshua A Hirsch, Bibb Allen, H Benjamin Harvey, Gregory N Nicola
The current fee-for-service system for health care reimbursement in the United Stated is argued to encourage fragmented care delivery and a lack of accountability that predisposes to insufficient focus on quality as well as unnecessary or duplicative resource utilization. Episode payment models (EPMs) seek to improve coordination by linking payments for all services related to a patient's condition or procedure, thereby improving quality and efficiency of care. The CMS Innovation Center has implemented a broadening array of EPMs...
March 10, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28291091/impact-of-acute-kidney-injury-in-patients-hospitalized-with-pneumonia
#11
Lakhmir S Chawla, Richard L Amdur, Charles Faselis, Ping Li, Paul L Kimmel, Carlos E Palant
OBJECTIVES: Pneumonia is a common cause of hospitalization and can be complicated by the development of acute kidney injury. Acute kidney injury is associated with major adverse kidney events (death, dialysis, and durable loss of renal function [chronic kidney disease]). Because pneumonia and acute kidney injury are in part mediated by inflammation, we hypothesized that when acute kidney injury complicates pneumonia, major adverse kidney events outcomes would be exacerbated. We sought to assess the frequency of major adverse kidney events after a hospitalization for either pneumonia, acute kidney injury, or the combination of both...
April 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28288076/impact-of-multisystem-health-care-on-readmission-and-follow-up-among-veterans-hospitalized-for-chronic-obstructive-pulmonary-disease
#12
Seppo T Rinne, Anashua R Elwy, Lori A Bastian, Edwin S Wong, Renda S Wiener, Chuan-Fen Liu
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the most common causes of readmission at Veterans Affairs (VA) hospitals. Previous studies demonstrate worse outcomes for veterans with multisystem health care, though the impact of non-VA care on COPD readmissions is unknown. OBJECTIVE: To examine the association of use of non-VA outpatient care with 30-day readmission and 30-day follow-up among veterans admitted to the VA for COPD. DESIGN: This is a retrospective cohort study using VA administrative data and Medicare claims...
March 10, 2017: Medical Care
https://www.readbyqxmd.com/read/28285902/continued-inpatient-care-after-primary-total-knee-arthroplasty-increases-30-day-post-discharge-complications-a-propensity-score-adjusted-analysis
#13
Alexander S McLawhorn, Michael C Fu, William W Schairer, Peter K Sculco, Catherine H MacLean, Douglas E Padgett
BACKGROUND: Discharge destination, either home or skilled care facility, after total knee arthroplasty (TKA) may be associated with significant variation in postacute care outcomes. The purpose of this study was to characterize the 30-day postdischarge outcomes after primary TKA relative to discharge destination. METHODS: All primary unilateral TKAs performed for osteoarthritis from 2011-2014 were identified in the National Surgical Quality Improvement Program database...
February 1, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28277409/randomized-controlled-trial-of-two-alcohol-based-preparations-for-surgical-site-antisepsis-in-colorectal-surgery
#14
Robyn B Broach, Emily C Paulson, Charles Scott, Najjia N Mahmoud
OBJECTIVE: To compare 2 alcohol-based, dual-action skin preparations for surgical site infection (SSI) prevention in elective colorectal surgery. BACKGROUND: Colorectal surgery is associated with the highest SSI rate among elective surgical procedures. Although evidence indicates that alcohol-based skin preparations are superior in SSI prevention, it is not clear if different alcohol-based preparations are equivalent in clean-contaminated colorectal procedures. METHODS: We performed a blinded, randomized, noninferiority trial comparing iodine povacrylex-alcohol (IPA) and chlorhexidine-alcohol for elective, clean-contaminated colorectal surgery...
March 8, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28267980/postoperative-extracorporeal-membrane-oxygenation-support-for-acute-type-a-aortic-dissection
#15
Ting-Wei Lin, Meng-Ta Tsai, Yu-Ning Hu, Wei-Hung Lin, Wei-Ming Wang, Chwan-Yau Luo, Jun-Neng Roan
BACKGROUND: Few studies have investigated the use of postoperative extracorporeal membrane oxygenation (ECMO) in acute type A aortic dissection (aTAAD). We identified aTAAD surgical patients at risk of ECMO implantation postoperatively and analyzed the prognosis of these patients. METHODS: We retrospectively reviewed 162 consecutive aTAAD patients undergoing operations from January 2008 to December 2015. Patient data were analyzed for risk factors leading to an ECMO requirement...
March 4, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28260538/intervention-to-reduce-broad-spectrum-antibiotics-and-treatment-durations-prescribed-at-the-time-of-hospital-discharge-a-novel-stewardship-approach
#16
Norihiro Yogo, Katherine Shihadeh, Heather Young, Susan L Calcaterra, Bryan C Knepper, William J Burman, Philip S Mehler, Timothy C Jenkins
OBJECTIVE For most common infections requiring hospitalization, antibiotic treatment is completed after hospital discharge. Postdischarge therapy is often unnecessarily broad spectrum and prolonged. We developed an intervention to improve antibiotic selection and shorten treatment durations. DESIGN Single center, quasi-experimental retrospective cohort study METHODS Patients prescribed oral antibiotics at hospital discharge before (July 2012-June 2013) and after (October 2014-February 2015) an intervention consisting of (1) institutional guidance for oral step-down antibiotic selection and duration of therapy and (2) pharmacy audit of discharge prescriptions with real-time prescribing recommendations to providers...
March 6, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28258247/long-term-survival-following-out-of-hospital-cardiac-arrest
#17
Emily Andrew, Ziad Nehme, Rory Wolfe, Stephen Bernard, Karen Smith
OBJECTIVE: Although the factors associated with short-term survival from out-of-hospital cardiac arrest (OHCA) are well established, relatively little is known about the factors that influence long-term survival. In this study, we describe the 15-year survival outcomes of OHCA survivors and examine the influence of peri-arrest factors and 12-month outcomes on long-term survival. METHODS: Survivors of OHCA between 2000 and 2014 identified from the Victorian Ambulance Cardiac Arrest Registry were linked with state-wide death records...
March 3, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28237215/comparison-of-outpatient-vs-inpatient-total-knee-arthroplasty-an-acs-nsqip-analysis
#18
Patawut Bovonratwet, Nathaniel T Ondeck, Stephen J Nelson, Jonathan J Cui, Matthew L Webb, Jonathan N Grauer
BACKGROUND: There has been a recent surge of interest in performing primary total knee arthroplasty (TKA) in the outpatient setting to reduce cost and increase patient satisfaction. Detailed information on the safety of outpatient TKA in large sample sizes is scarce. METHODS: Patients who underwent primary, elective TKA were identified in the 2005-2014 American College of Surgeons National Surgical Quality Improvement Program database. Outpatient procedure was defined as having a hospital length of stay of 0 days, whereas inpatient procedure was defined as having a length of stay ≥1 days...
February 1, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28230616/validating-the-postdischarge-surgical-recovery-scale-13-as-a-measure-of-perceived-postoperative-recovery-after-laparoscopic-sacrocolpopexy
#19
Janet S Carpenter, Michael Heit, Chen X Chen, Ryan Stewart, Jennifer Hamner, Kevin L Rand
OBJECTIVES: No postoperative recovery measurement tools have been validated among women undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse, which impedes development and testing of strategies to improve recovery. The purpose of this study was to evaluate the performance of the Postdischarge Surgical Recovery Scale (PSR) as a measure of perceived recovery in laparoscopic sacrocolpopexy patients. METHODS: Women (N = 120) with stage 2 or higher pelvic organ prolapse undergoing laparoscopic sacrocolpopexy completed a 15-minute postoperative survey (days 7, 14, 42, and 90 [each ± 3 days]) which included the 15-item PSR...
March 2017: Female Pelvic Medicine & Reconstructive Surgery
https://www.readbyqxmd.com/read/28228448/patient-experience-with-discharge-instructions-in-postdischarge-recovery-a-qualitative-study
#20
Molly J Horstman, Whitney L Mills, Levi I Herman, Cecilia Cai, George Shelton, Tareq Qdaisat, David H Berger, Aanand D Naik
OBJECTIVES: We examined the role of discharge instructions in postoperative recovery for patients undergoing colorectal surgery and report themes related to patient perceptions of discharge instructions and postdischarge experience. DESIGN: Semistructured interviews were conducted as part of a formative evaluation of a Project Re-Engineered Discharge intervention adapted for surgical patients. SETTING: Michael E. DeBakey VA Medical Center, a tertiary referral centre in Houston, Texas...
February 22, 2017: BMJ Open
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