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https://www.readbyqxmd.com/read/28817750/the-surgeon-on-service-model-for-timely-economically-viable-inpatient-care-of-tracheostomy-patients-in-academic-pediatric-otolaryngology
#1
Jennifer M Lavin, James W Schroeder, Dana M Thompson
Importance: The traditional practice model for pediatric otolaryngologists at high-volume academic centers is to simultaneously balance outpatient care responsibilities with those of the inpatient service, emergency department, and ambulatory care clinics. This model leads to challenges with care coordination, timeliness of nonemergency operative care, and consistent participation in care and consultation at the attending surgeon level. The "surgeon on service" (SOS) model-where faculty members rotate to manage the inpatient service in lieu of outpatient responsibilities-has been described as one method to address this conundrum...
August 17, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/28817481/incorporating-dynamic-assessment-of-fluid-responsiveness-into-goal-directed-therapy-a-systematic-review-and-meta-analysis
#2
Joseph M Bednarczyk, Jason A Fridfinnson, Anand Kumar, Laurie Blanchard, Rasheda Rabbani, Dean Bell, Duane Funk, Alexis F Turgeon, Ahmed M Abou-Setta, Ryan Zarychanski
OBJECTIVE: Dynamic tests of fluid responsiveness have been developed and investigated in clinical trials of goal-directed therapy. The impact of this approach on clinically relevant outcomes is unknown. We performed a systematic review and meta-analysis to evaluate whether fluid therapy guided by dynamic assessment of fluid responsiveness compared with standard care improves clinically relevant outcomes in adults admitted to the ICU. DATA SOURCES: Randomized controlled trials from MEDLINE, EMBASE, CENTRAL, clinicaltrials...
September 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28817298/radical-prostatectomy-innovation-and-outcomes-at-military-and-civilian-institutions
#3
Jeffrey J Leow, Joel S Weissman, Linda Kimsey, Andrew Hoburg, Lorens A Helmchen, Wei Jiang, Nathanael Hevelone, Stuart R Lipsitz, Louis L Nguyen, Steven L Chang
OBJECTIVES: Limited data are available regarding the impact of the type of healthcare delivery system on technology diffusion and associated clinical outcomes. We assessed the adoption of minimally invasive radical prostatectomy (MIRP), a recent clinical innovation, and whether this adoption altered surgical morbidity for prostate cancer surgery. STUDY DESIGN: Retrospective review of administrative data from TRICARE, the healthcare program of the United States Military Health System...
June 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28816896/factors-associated-with-adverse-events-in-inpatient-elective-spine-knee-and-hip-orthopaedic-surgery
#4
Dov B Millstone, Anthony V Perruccio, Elizabeth M Badley, Y Raja Rampersaud
BACKGROUND: Orthopaedic procedures for degenerative musculoskeletal conditions (predominantly osteoarthritis and spinal stenosis) represent an increasing burden on the health-care system. These procedures are also associated with adverse event rates and related cost. The objective of this study was to identify risk factors for adverse events associated with orthopaedic surgeries as captured within a common clinical point-of-care system for documenting adverse events (Orthopaedic Surgical AdVerse Events Severity [OrthoSAVES] system)...
August 16, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28816890/improving-timeliness-of-%C3%AE-agonist-and-corticosteroid-administration-in-patients-with-acute-wheezing
#5
Mandisa McIver, William Stoudemire, Cherrelle Smith-Ramsey, Mousumee Panigrahi, Christine Walsh-Kelly
OBJECTIVE: Timely delivery of β-agonists and steroids to patients with acute recurrent wheezing is a key component of the National Heart, Lung, and Blood Institute recommended emergency department (ED) asthma care. We conducted an ED improvement initiative to standardize asthma care and improve time to treatments. METHODS: Our multidisciplinary team identified key contributing factors to timeliness, developed key driver diagrams, implemented and refined a management pathway, designed and executed rapid cycle improvements, and implemented interventions...
August 14, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28816834/effect-of-amantadine-on-agitation-in-critically-ill-patients-with-traumatic-brain-injury
#6
Jawaher A Gramish, Brian J Kopp, Asad E Patanwala
OBJECTIVE: This study aimed to compare the presence of agitation in traumatic brain injury patients treated with amantadine with those not treated with amantadine in the intensive care unit (ICU). METHODS: This was a retrospective cohort study conduced in a trauma ICU of a tertiary care institution in the United States. Patients who received amantadine were compared with patients who did not receive amantadine. The primary outcome measure was the presence of agitation, defined as the Richmond Agitation Sedation Scale score of +2 or higher...
August 14, 2017: Clinical Neuropharmacology
https://www.readbyqxmd.com/read/28816101/measurement-of-total-hemoglobin-reduces-red-cell-transfusion-in-hospitalized-patients-undergoing-cardiac-surgery-a-retrospective-database-analysis
#7
Christopher Craver, Kathy W Belk, Gerard J Myers
INTRODUCTION: Historically, perioperative hemoglobin monitoring has relied on calculated saturation, using blood gas devices that measure plasma hematocrit (Hct). Co-oximetry, which measures total hemoglobin (tHb), yields a more comprehensive assessment of hemodilution. The purpose of this study was to examine the association of tHb measurement by co-oximetry and Hct, using conductivity with red blood cell (RBC) transfusion, length of stay (LOS) and inpatient costs in patients having major cardiac surgery...
August 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28815825/the-prevalence-and-specific-characteristics-of-hospitalised-pressure-ulcer-patients-a-multicentre-cross-sectional-study
#8
Qing Zhou, Ting Yu, Yuan Liu, Ruifen Shi, Suping Tian, Chaoxia Yang, Huaxiu Gan, Yanying Zhu, Xia Liang, Ling Wang, Zhenhua Wu, Jinping Huang, Ailing Hu
OBJECTIVE: The present study aimed to ascertain the pressure ulcer prevalence in secondary and tertiary general hospitals in different areas of Guangdong Province in China and explore the possible risk factors that are related to pressure ulcers. BACKGROUND: Few multicentre studies have been conducted on pressure ulcer prevalence in Chinese hospitals. DESIGN: A cross-sectional study design was used. METHODS: Data from a total of 25,264 patients were included in the analysis at 25 hospitals in China...
August 17, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28815616/predictors-of-complicated-airway-foreign-body-extraction
#9
Phayvanh P Sjogren, Tyler J Mills, Adrianna D Pollak, Harlan R Muntz, Jeremy D Meier, J Fredrik Grimmer
OBJECTIVES: To evaluate outcomes of foreign body aspiration (FBA) and to investigate surgeon and hospital volume as risk factors for a complicated course. STUDY DESIGN: Retrospective case series. METHODS: Children with FBA in a multihospital network were identified from January 2005 to September 2015. Demographic information, surgeon, and hospital location were reviewed. Mean operative time and hospital length of stay were recorded. Cases requiring intensive care unit admission, hospital stay greater than 24 hours, need for more than one bronchoscopy, operative time greater than 1 hour, or death were considered "complicated...
August 16, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28815161/trends-and-cost-of-posterior-cervical-fusions-with-and-without-recombinant-human-bone-morphogenetic-protein-2-in-the-us-medicare-population
#10
Sue Lynn Myhre, Zorica Buser, Hans-Joerg Meisel, Darrel S Brodke, S Tim Yoon, Jeffrey C Wang, Jong-Beom Park, Jim A Youssef
STUDY DESIGN: Retrospective database review. OBJECTIVE: To analyze and report the trends and cost of posterior cervical fusions (PCFs) with and without off-label recombinant human bone morphogenetic protein-2 (rhBMP-2) in the Medicare population. METHODS: Patient records from the PearlDiver database were retrospectively reviewed from January 1, 2005, to December 31, 2012, to distinguish individuals who underwent a PCF with or without rhBMP-2...
June 2017: Global Spine Journal
https://www.readbyqxmd.com/read/28815083/routine-jejunostomy-tube-feeding-following-esophagectomy
#11
Teus J Weijs, Hanneke W J van Eden, Jelle P Ruurda, Misha D P Luyer, Elles Steenhagen, Grard A P Nieuwenhuijzen, Richard van Hillegersberg
BACKGROUND: Malnutrition is an important problem following esophagectomy. A surgically placed jejunostomy secures an enteral feeding route, facilitating discharge with home-tube feeding and long-term nutritional support. However, specific complications occur, and data are lacking that support its use over other enteral feeding routes. Therefore routine jejunostomy tube feeding and discharge with home-tube feeding was evaluated, with emphasis on weight loss, length of stay and re-admissions...
July 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28815080/mckeown-or-ivor-lewis-totally-minimally-invasive-esophagectomy-for-cancer-of-the-esophagus-and-gastroesophageal-junction-systematic-review-and-meta-analysis
#12
Frans van Workum, Gijs H Berkelmans, Bastiaan R Klarenbeek, Grard A P Nieuwenhuijzen, Misha D P Luyer, Camiel Rosman
BACKGROUND: Minimally invasive esophagectomy (MIE) has consistently been associated with improved perioperative outcome and similar oncological safety compared to open esophagectomy. However, it is currently unclear what type of MIE is preferred for patients with resectable esophageal cancer. METHODS: Literature was searched in Medline, Embase and the Cochrane library combining relevant search terms. Articles that included patients undergoing totally minimally invasive esophagectomy (TMIE) or hybrid minimally invasive esophagectomy (HMIE) and compared McKeown with Ivor Lewis procedures were included...
July 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28815075/the-feeding-route-after-esophagectomy-a-review-of-literature
#13
REVIEW
Gijs H Berkelmans, Frans van Workum, Teus J Weijs, Grard A Nieuwenhuijzen, Jelle P Ruurda, Ewout A Kouwenhoven, Marc J van Det, Camiel Rosman, Richard van Hillegersberg, Misha D Luyer
Enhanced recovery programs effectively optimize perioperative care and reduce postoperative morbidity. In esophagectomy, several components of the ERAS program are successfully introduced. However, timing and type of postoperative feeding remain a matter of debate. Adequate nutritional support is essential in patients undergoing an esophagectomy. These patients often present with weight loss and their eating pattern is strongly altered by the procedure and reconstruction. Total parenteral nutrition (TPN) is associated with severe septic complications and enteral nutrition (EN) does not increase major complications...
July 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28814489/right-ventricular-outflow-tract-stent-versus-bt-shunt-palliation-in-tetralogy-of-fallot
#14
Daniel Quandt, Bharat Ramchandani, Gemma Penford, John Stickley, Vinay Bhole, Chetan Mehta, Timothy Jones, David James Barron, Oliver Stumper
OBJECTIVE: This study sets out to compare morbidity, mortality and reintervention rates after stenting of the right ventricular outflow tract (RVOT) versus modified Blalock-Taussig shunt (mBTS) for palliation in patients with tetralogy of Fallot (ToF)-type lesions. METHODS: Retrospective case review study evaluating 101 patients (64 males) with ToF lesions who underwent palliation with either mBTS (n=41) or RVOT stent (n=60) to augment pulmonary blood flow over a 10-year period...
August 16, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28814393/soya-maize-and-sorghum-based-ready-to-use-therapeutic-food-with-amino-acid-is-as-efficacious-as-the-standard-milk-and-peanut-paste-based-formulation-for-the-treatment-of-severe-acute-malnutrition-in-children-a-noninferiority-individually-randomized-controlled
#15
Paluku Bahwere, Peter Akomo, Mwawi Mwale, Hitoshi Murakami, Chrissy Banda, Sylvester Kathumba, Chimwemwe Banda, Solomon Jere, Kate Sadler, Steve Collins
Background: Development of more cost-effective ready-to-use therapeutic food (RUTF) is a global public health priority. To date, previous lower-cost recipes have been less effective than the standard peanut and milk (PM)-based RUTF, particularly in children aged <24 mo.Objective: We aimed to compare the efficacy of the PM-RUTF to a milk-free soya, maize, and sorghum (FSMS)-RUTF enriched with crystalline amino acids without cow milk powder and a milk, soya, maize, and sorghum (MSMS)-RUTF containing 9.3% skim cow milk powder...
August 16, 2017: American Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28814345/hospital-characteristics-related-to-the-hospital-length-of-stay-among-inpatients-receiving-invasive-cervical-discectomy-due-to-road-traffic-accidents-under-automobile-insurance-in-south-korea
#16
Kyoung Won Shin, Hyo Jung Lee, Chung Mo Nam, Ki Tae Moon, Eun-Cheol Park
BACKGROUND: In South Korea, people injured in road traffic accidents receive compensation for medical costs through their automobile insurance. However, the automobile insurance system appears to manage health care inefficiently. This study aimed to investigate the factors associated with the hospital length of stay (LOS), which was used as an indicator of healthcare utilization, for inpatients covered by automobile insurance and undergoing invasive cervical discectomy. METHODS: Insurance claims data from 158 hospitals were used...
August 16, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28814260/neonatal-abstinence-syndrome-management-a-review-of-recent-evidence
#17
Matthew Grossman, Carl Seashore, Alison Volpe Holmes
BACKGROUND: The evaluation and management of infants with neonatal abstinence syndrome (NAS), the constellation of opioid withdrawal specific to newborns, has received renewed attention over the past decade during a new epidemic of opioid use, misuse, abuse, and dependence. Infants with NAS often endure long and costly hospital stays. OBJECTIVE: We aim to review recent literature on the management and outcomes of infants with, and at risk for, opioid withdrawal...
August 16, 2017: Reviews on Recent Clinical Trials
https://www.readbyqxmd.com/read/28814254/bronchiolitis-care-in-the-hospital
#18
Jennifer Orr Vincent, Huay-Ying Lo, Susan Wu
BACKGROUND: Viral bronchiolitis is a common cause of hospitalization in young children, but despite a variety of therapeutic options, the mainstay of treatment remains supportive care. OBJECTIVE: To examine the most recent evidence for supportive care measures and pharmacologic options in the treatment of bronchiolitis in the hospital setting Methods: MEDLINE search with expert medical librarian for publications on management and therapies for bronchiolitis Results: Evidence does not support the use of bronchodilators, racemic epinephrine, deep suctioning, systemic corticosteroids, or antibiotics in the absence of a concomitant bacterial infection, as these treatments do not change the course of illness or shorten length of stay (LOS)...
August 16, 2017: Reviews on Recent Clinical Trials
https://www.readbyqxmd.com/read/28813701/uterine-cervical-length-measurement-to-reduce-length-of-stay-in-patients-admitted-for-threatened-preterm-labor-a-randomized-trial
#19
Montse Palacio, Javier Caradeux, Miriam Sánchez, Teresa Cobo, Francesc Figueras, Oriol Coll, Eduard Gratacós, Vicenç Cararach
OBJECTIVE: To study whether knowledge of cervical length (CL) is useful in reducing the length of hospital stay in women admitted because of threatened preterm labor. METHODS: We performed a single-center, parallel, randomized trial at the Hospital Clínic of Barcelona. Inclusion criteria were single pregnancy, gestational age (GA) between 24+0 and 35+6 weeks, Bishop score <6, no parturition within 24-48 h after admission, and no clinical signs of chorioamnionitis, vaginal bleeding, or nonreassuring fetal status...
August 17, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28812380/analysis-of-an-8-hour-acetylcysteine-infusion-protocol-for-repeated-supratherapeutic-ingestion-rsti-of-paracetamol
#20
Anselm Wong, Naren Gunja, Richard McNulty, Andis Graudins
OBJECTIVES: In Australia, the treatment guideline for patients with repeated supratherapeutic ingestion (RSTI) of paracetamol recommends an abbreviated acetylcysteine regimen if the paracetamol concentration is low (<10 mg/L) and alanine aminotransferase (ALT) is normal or static after 8 hours of infusion. There are currently no studies of this recommendation. METHOD: A retrospective review of paracetamol overdose presentations from October 2009 to August 2016 in two hospital toxicology networks was performed...
August 16, 2017: Clinical Toxicology
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