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Crisis management

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https://www.readbyqxmd.com/read/28528621/using-lean-to-rapidly-and-sustainably-transform-a-behavioral-health-crisis-program-impact-on-throughput-and-safety
#1
Margaret E Balfour, Kathleen Tanner, Paul J Jurica, Dawn Llewellyn, Robert G Williamson, Chris A Carson
BACKGROUND: Lean has been increasingly applied in health care to reduce waste and improve quality, particularly in fast-paced and high-acuity clinical settings such as emergency departments. In addition, Lean's focus on engagement of frontline staff in problem solving can be a catalyst for organizational change. In this study, ConnectionsAZ demonstrates how they applied Lean principles to rapidly and sustainably transform clinical operations in a behavioral health crisis facility. METHODS: A multidisciplinary team of management and frontline staff defined values-based outcome measures, mapped the current and ideal processes, and developed new processes to achieve the ideal...
June 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28528376/isometric-handgrip-as-an-adjunct-for-blood-pressure-control-a-primer-for-clinicians
#2
REVIEW
Cheri L McGowan, David N Proctor, Ian Swaine, Robert D Brook, Elizabeth A Jackson, Phillip D Levy
Considered a global health crisis by the World Health Organization, hypertension (HTN) is the leading risk factor for death and disability. The majority of treated patients do not attain evidence-based clinical targets, which increases the risk of potentially fatal complications. HTN is the most common chronic condition seen in primary care; thus, implementing therapies that lower and maintain BP to within-target ranges is of tremendous public health importance. Isometric handgrip (IHG) training is a simple intervention endorsed by the American Heart Association as a potential adjuvant BP-lowering treatment...
June 2017: Current Hypertension Reports
https://www.readbyqxmd.com/read/28527610/multidisciplinary-delphi-development-of-a-scale-to-evaluate-team-function-in-obstetric-emergencies-the-petra-scale
#3
Mrinalini Balki, David Hoppe, David Monks, Mary Ellen Cooke, Lynn Sharples, Rory Windrim
OBJECTIVE: The objective of this study was to develop a new interdisciplinary teamwork scale, the Perinatal Emergency: Team Response Assessment (PETRA), for the management of obstetric crises, through consensus agreement of obstetric caregivers. METHODS: This prospective study was performed using expert consensus, based on a Delphi method. The study investigators developed a new PETRA tool, specifically related to obstetric crisis management, based on the existing literature and discussions among themselves...
June 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/28524378/psychometric-characteristics-of-the-mental-health-crisis-assessment-scale-in-youth-with-autism-spectrum-disorder
#4
Luther G Kalb, Louis P Hagopian, Alden L Gross, Roma A Vasa
BACKGROUND: Youth with autism spectrum disorder (ASD) exhibit high rates of psychopathology. These symptoms can pose a risk of injury to self or others when the child is in crisis. Despite this danger, there are no instruments available to identify those with ASD who are at risk or actively in crisis. This study examined the psychometric properties of the Mental Health Crisis Assessment Scale (MCAS), a 28 item parent report measure. METHODS: The MCAS was administered to the parents of 606 children and young adults (aged 3-25 years, M age = 13 years, SD = 5 years) enrolled in the Interactive Autism Network, an online registry of families raising a child with ASD...
May 19, 2017: Journal of Child Psychology and Psychiatry, and Allied Disciplines
https://www.readbyqxmd.com/read/28524032/-preoperative-risk-factors-analysis-of-pulmonary-hypertension-crisis-during-perioperative-period-for-caesarean-section-of-woman-with-severe-pulmonary-hypertension
#5
Chunlei Zhang, Yaguang Liu, Enming Qing, Jun Ma
OBJECTIVE: To analyze preoperative risk factors of perioperative pulmonary hypertension crisis (PHC) for pregnant woman with severe pulmonary artery hypertension (PAH), and approach its clinical value. METHODS: A retrospective analysis was conducted. The clinical data from 152 pregnant women with severe PAH underwent cesarean delivery admitted to Beijing Anzhen Hospital from January 1st 2008 to December 31st 2016 was collected. The patients were divided into two groups according to with perioperative PHC or not...
May 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28516363/posterior-reversible-encephalopathy-syndrome-presenting-in-the-anterior-circulation-with-malignant-intracranial-hypertension-requiring-surgical-decompression-a-case-report-and-literature-review
#6
S Hernández-Durán, A Barrantes-Freer, V Rohde, C von der Brelie
Posterior reversible encephalopathy syndrome (PRES) is thought to result from endothelial dysfunction and breakdown of the blood-brain barrier with subsequent vasogenic edema. Abrupt hypertension has been identified as one of its risk factors. We present a rare case of PRES in the anterior circulation with sudden onset of left hemiparesis and rapid neurological deterioration on the basis of hypertensive crisis. Due to refractory intracranial hypertension, the patient required emergent right decompressive craniectomy...
May 17, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28516329/screening-for-lipoprotein-receptor-related-protein-4-agrin-and-titin-antibodies-and-exploring-the-autoimmune-spectrum-in-myasthenia-gravis
#7
Isabell Cordts, Nicolas Bodart, Kathi Hartmann, Katerina Karagiorgou, John S Tzartos, Lin Mei, Jens Reimann, Philip Van Damme, Michael H Rivner, Alain Vigneron, Joachim Weis, Jörg B Schulz, Socrates J Tzartos, Kristl G Claeys
In autoimmune myasthenia gravis (MG), the identification of antibodies and characterization of serological subgroups is of great importance for diagnosis and management of the disease. Our aims were to study the frequency of antibodies against lipoprotein-related protein 4 (LRP4), agrin, and titin using the most recent techniques, and to characterize corresponding clinical features and autoimmune diseases (AID) in 100 MG-patients. The antibody frequencies in the 55 AChR-antibody positive patients were 7% LRP4, 5% agrin, 53% titin, and in the 45 AChR-antibody negative patients 2% MuSK, 2% LRP4, 2% agrin, and 27% titin...
May 17, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28515525/management-of-an-intraoperatively-damaged-endotracheal-tube-in-a-case-of-difficult-airway-using-fibre-optic-bronchoscope-with-minimal-apnoea-period
#8
Jayachandran Himarani, S Mary Nancy, V B Krishna Kumar Raja, S Shanmuga Sundaram
Damage to the endotracheal tube (ETT) is common in head and neck surgeries, especially in maxillary osteotomy. Airway management in such a crisis is crucial as there is risk of aspiration of blood into lungs, hypoxia and apnoea. This case illustrates a patient with an anticipated difficult airway who had an intraoperative damage to the ETT and was successfully managed by re-intubation with fiberoptic bronchoscope in a minimal apnoea period of <15 s using a new technique.
April 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28508000/knowledge-and-attitude-of-iranian-red-crescent-society-volunteers-in-dealing-with-chemical-attacks
#9
Maryam Nadjafi, Siavash Hamzeh Pour
OBJECTIVE: To evaluate the knowledge, attitude, and preparedness of Mahabad Red Crescent Society volunteers in dealing with chemical attacks. METHODS: This prospective cross-sectional study was conducted on 120 Red Crescent Society volunteers in Mahabad City, Iran, during 2014-2015.The knowledge of the volunteers was evaluated and rated using a questionnaire as poor, moderate, and good. Also, the attitude of the volunteers towards the chemical attacks and their preparedness were rated as appropriate and inappropriate using a questionnaire...
April 2017: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/28503359/maintaining-maternal-and-child-health-services-during-the-ebola-outbreak-experience-from-pujehun-sierra-leone
#10
GianLuca Quaglio, Damiano Pizzol, David Bome, Atiba Kebbie, Zainab Bangura, Vandi Massaquoi, Clara Frasson, Donata Dalla Riva, Giovanni Putoto
BACKGROUND: During the Ebola outbreak the overall confidence of the population in the national health system declined in Sierra Leone, with a reduction in the use of health services. The objective of this study is to provide information on understanding of how Ebola impacted maternal and child health services in Sierra Leone. Data come from an operational setting which is representative of the communities affected by the outbreak. METHODS: By integrating hospital registers and contact tracing form data with healthcare workers and local population interviews, the transmission chain was reconstructed...
June 2, 2016: PLoS Currents
https://www.readbyqxmd.com/read/28495250/austerity-and-its-implications-for-immigrant-health-in-france
#11
Carolyn Sargent, Laurence Kotobi
The ongoing economic crisis in France increasingly has affected immigrant rights, including access to health care. Consistent with a 2014 League Against Cancer survey, we identify the ways in which sickness produces a "double penalty" for immigrants with serious illness. Immigrants with chronic illnesses such as cancer, diabetes, and other debilitating conditions divert vital funds from daily needs to deal with sickness and loss of work while at the same time national austerity measures shred the state's traditional safety net of social services and support...
May 4, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28494782/health-workforce-and-governance-the-crisis-in-nigeria
#12
Davies Adeloye, Rotimi Adedeji David, Adenike Ayobola Olaogun, Asa Auta, Adedapo Adesokan, Muktar Gadanya, Jacob Kehinde Opele, Oluwafemi Owagbemi, Alexander Iseolorunkanmi
BACKGROUND: In Nigeria, several challenges have been reported within the health sector, especially in training, funding, employment, and deployment of the health workforce. We aimed to review recent health workforce crises in the Nigerian health sector to identify key underlying causes and provide recommendations toward preventing and/or managing potential future crises in Nigeria. METHODS: We conducted a scoping literature search of PubMed to identify studies on health workforce and health governance in Nigeria...
May 12, 2017: Human Resources for Health
https://www.readbyqxmd.com/read/28494619/improving-quality-of-care-for-end-stage-respiratory-disease-changes-in-attitude-changes-in-service
#13
D Robin Taylor, Scott A Murray
The illness trajectory for many patients with severe respiratory disease is characterized by steady decline. Yet most healthcare resources are poured into managing acute exacerbations that are only temporarily effective. Further, 'bad deaths' can result from inappropriate medical interventions at times of crisis. In this article, we describe a range of changes in attitudes, behaviour and service provision that together focus on improving quality of care for respiratory patients with frequent crises. These changes include prognostic conversations, developing and implementing anticipatory care plans both in hospital and in the outpatient settings, and establishing a supportive care clinic devoted to complex disease and optimizing palliative care...
January 1, 2017: Chronic Respiratory Disease
https://www.readbyqxmd.com/read/28493407/first-person-perspective-video-to-enhance-simulation
#14
Junaid Fukuta, Justin Morgan
BACKGROUND: Simulation training is increasingly being used as part of the undergraduate medical curriculum, but it remains time and faculty member intensive. To improve efficacy, videos have been used prior to the simulation of practical procedures; however, using videos prior to simulation training concerning the management of patients who are unwell has not been investigated. The aim of this project was to see whether clinical decision-making and non-technical skills can be improved if a video is used prior to simulation training, and uniquely to enhance the authenticity we filmed it using a first-person perspective...
May 10, 2017: Clinical Teacher
https://www.readbyqxmd.com/read/28488993/physician-guide-to-appropriate-opioid-prescribing-for-noncancer-pain
#15
Timothy Munzing
Prescription opioid use for relief of noncancer pain has risen dramatically in the last 15 years, contributing to a quadrupling of opioid overdoses and prescription opioid-related deaths. This crisis is resulting in heightened attention by health care professionals and organizations, law enforcement, and the government. In this article, I highlight key topics in the management of patients using opioids (or potentially needing opioids) in outpatient clinical practice; federal and state law enforcement actions regarding physicians' illegal prescribing of opioids; multimodal approaches to pain control; nonmedication management of pain; response strategies when suspecting a patient of diverting or misusing opioids; and warning signs for abuse or diversion...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28488612/analysis-of-mortality-and-related-factors-in-2195-adult-myasthenia-gravis-patients-in-a-10-year-follow-up-study
#16
Chanchan Liu, Qiong Wang, Zhandong Qiu, Jing Lin, Bo Chen, Yue Li, Mengcui Gui, Min Zhang, Mingshan Yang, Wei Wang, Bitao Bu
OBJECTIVE: To analyze the mortality and potential risk factors for death in myasthenia gravis (MG) patients. MATERIALS AND METHODS: A total of 2195 adult patients with MG (aged older than 18 years) diagnosed during the period between 2003 and 2013 were followed-up and retrospectively reviewed. RESULTS: During the 10-year follow-up, 129 patients died and the total mortality rate was 5.88%. The risk factors associated with MG-related deaths were duration of the disease, occurrence of myasthenic crisis, severity of disease that included the Myasthenia Gravis Foundation of America (MGFA) grade III and IV at onset, elevation of acetylcholine receptor antibody (AchR-abs) titers, presence of thymic pathology, and failure of administrating immunosuppressants (P < 0...
May 2017: Neurology India
https://www.readbyqxmd.com/read/28483589/takotsubo-cardiomyopathy-after-microwave-ablation-for-metastatic-liver-lesions
#17
Mostafa Afennas, Hans Bonnier, Danny Schoors
Takotsubo cardiomyopathy (TCMP) is characterized by transient and reversible left ventricular regional wall motion abnormalities triggered by acute and intense emotional or physical stress. We present a case of a 79 year old woman with a hypertensive crisis after microwave ablation (MWA) for metastatic liver lesions. Initial evaluation suggested an acute coronary syndrome with an ST segment elevation and with elevated serum troponin T. No associated chest pain or dyspnea was present. Further evaluation with ECG, echocardiography, coronarography with left ventricle angiogram and MRI was consistent with an apical ballooning syndrome...
April 29, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28482890/crisis-checklists-for-in-hospital-emergencies-expert-consensus-simulation-testing-and-recommendations-for-a-template-determined-by-a-multi-institutional-and-multi-disciplinary-learning-collaborative
#18
Christian P Subbe, John Kellett, Paul Barach, Catriona Chaloner, Hayley Cleaver, Tim Cooksley, Erik Korsten, Eilish Croke, Elinor Davis, Ashley Jr De Bie, Lesley Durham, Chris Hancock, Jilian Hartin, Tracy Savijn, John Welch
BACKGROUND: 'Failure to rescue' of hospitalized patients with deteriorating physiology on general wards is caused by a complex array of organisational, technical and cultural failures including a lack of standardized team and individual expected responses and actions. The aim of this study using a learning collaborative method was to develop consensus recomendations on the utility and effectiveness of checklists as training and operational tools to assist in improving the skills of general ward staff on the effective rescue of patients with abnormal physiology...
May 8, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28475123/acceptance-and-commitment-therapy-for-inpatients-with-psychosis-the-reach-study-protocol-for-treatment-development-and-pilot-testing
#19
Brandon A Gaudiano, Carter H Davis, Gary Epstein-Lubow, Jennifer E Johnson, Kim T Mueser, Ivan W Miller
Patients with schizophrenia-spectrum disorders frequently require treatment at inpatient hospitals during periods of acute illness for crisis management and stabilization. Acceptance and Commitment Therapy (ACT), a "third wave" cognitive-behavioral intervention that employs innovative mindfulness-based strategies, has shown initial efficacy in randomized controlled trials for improving acute and post-discharge outcomes in patients with psychosis when studied in acute-care psychiatric hospitals in the U.S. However, the intervention has not been widely adopted in its current form because of its use of an individual-only format and delivery by doctoral-level research therapists with extensive prior experience using ACT...
May 5, 2017: Healthcare (Basel, Switzerland)
https://www.readbyqxmd.com/read/28471813/challenging-authority-during-an-emergency-the-effect-of-a-teaching-intervention
#20
Zeev Friedman, Vsovolod Perelman, Duncan McLuckie, Meghan Andrews, Laura M K Noble, Archana Malavade, M Dylan Bould
OBJECTIVES: Previous research has shown that residents were unable to effectively challenge a superior's wrong decision during a crisis situation, a problem that can contribute to preventable mortality. We aimed to assess whether a teaching intervention enabled residents to effectively challenge clearly wrong clinical decisions made by their staff. SUBJECTS AND INTERVENTION: Following ethics board approval, second year residents were randomized to a teaching intervention targeting cognitive skills needed to challenge a superior's decision, or a control group receiving general crisis management instruction...
April 29, 2017: Critical Care Medicine
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