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https://www.readbyqxmd.com/read/29457233/market-language-moral-language
#1
Susan Dorr Goold
Those who advocate higher out-of-pocket spending, especially high deductibles, to keep health care costs better controlled without losing quality use market language to talk about how people should think about health care. Consumers-that is, patients-should hunt for bargains. Clip coupons. Shop around. Patients need to have more "skin in the game." Consumer-patients will then choose more carefully and prudently and use less unnecessary health care. Unfailingly, "skin" refers to having money at stake...
January 2018: Hastings Center Report
https://www.readbyqxmd.com/read/29456212/the-epidemiology-of-acute-peritonitis-in-end-stage-renal-disease-patients-on-peritoneal-dialysis-in-qatar-an-8-year-follow-up-study
#2
Abdullah Hamad, Hany Ismail, Mohamed Elsayed, Ahmad Kaddourah, Hanaa Ahmed, Rania Ibrahim, Ahlam Ali, Fadwa Alali
Acute peritonitis (AP) is a common and devastating complication in end-stage renal disease patients on peritoneal dialysis (PD). We are reporting an epidemiologic study of AP in Qatar over 8-year follow-up. We retrospectively reviewed medical records of all PD patients in Qatar from 2007 to 2014. The analysis was conducted to report epidemiology, outcome, and associated risk factors of AP. We had 318 AP episodes in 180 patients between 2007 and 2014. Six (3.3%) patients died as a result AP. Six cases of fungal peritonitis were reported...
January 2018: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/29454549/technology-advances-to-improve-response-to-cardiac-resynchronization-therapy-what-clinicians-should-know
#3
Angelo Auricchio, Ward A Heggermont
Cardiac resynchronization therapy (CRT) is a well-established treatment for symptomatic heart failure patients with reduced left ventricular ejection fraction, prolonged QRS duration, and abnormal QRS morphology. The ultimate goals of modern CRT are to improve the proportion of patients responding to CRT and to maximize the response to CRT in patients who do respond. While the rate of CRT nonresponders has moderately but progressively decreased over the last 20 years, mostly in patients with left bundle branch block, in patients without left bundle branch block the response rate is almost unchanged...
February 14, 2018: Revista Española de Cardiología
https://www.readbyqxmd.com/read/29453481/ventilator-associated-pneumonia-and-role-of-nurses-in-its-prevention
#4
Chadani Osti, Deepa Wosti, Bimala Pandey, Qinghua Zhao
Ventilator-associated pneumonia (VAP) is one of the most frequent nosocomial infections among ventilated patients in ICUs, associated with an increase in days of ICU stay, morbidity, and mortality. Its prevention is a significant concern in every hospital. Most of the interventions and prevention strategies are part of routine nursing care. Nurses have different vital roles such as care provider, manager, educator, coordinator, and evaluator in preventing VAP. Lack of knowledge of infection prevention and proper nursing care among nurses may become a barrier in adhering to evidence-based guidelines for preventing ventilator-associated pneumonia...
October 2017: JNMA; Journal of the Nepal Medical Association
https://www.readbyqxmd.com/read/29452972/does-preoperative-opioid-use-increase-the-risk-of-early-revision-total-hip-arthroplasty
#5
Nicholas A Bedard, David E DeMik, S Blake Dowdle, Jessell M Owens, Steve S Liu, John J Callaghan
BACKGROUND: The purpose of this study is to evaluate the impact of preoperative opioid use on the risk of subsequent revison after primary total hip arthroplasty (THA). METHODS: The Humana database was queried for unilateral THA between 2007-2015. Patients were tracked for the occurrence of an ipsilateral revision THA for 2. Factors analyzed included preoperative opioid use (defined as a history of opioid prescription filled within 3 months preceding primary THA), age, sex, diabetes, anxiety/depression, chronic kidney disease, and obesity (body mass index > 30 kg/m 2 )...
February 13, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29452631/the-evaluation-of-the-implementation-of-the-vascular-preventative-bundle-and-development-of-suggested-interventions-for-improvement-and-sustainability
#6
Jennifer Franklin, Kathleen Turner, John S Hudson, Kimberly Guest, Ellen D Dillavou
Postoperative infections can complicate patient care and increase health care costs. A vascular preventative bundle was implemented at a large teaching/research intensive hospital to decrease surgical site infections (SSIs) with vascular surgery patients. The aim of this study was to measure fidelity to the bundle and determine if implementation of the vascular SSI bundle reduced the rate of SSIs. Three periods of data were collected, and they are identified as preimplementation (period 1), early implementation (period 2), and postimplementation (period 3)...
March 2018: Journal of Vascular Nursing: Official Publication of the Society for Peripheral Vascular Nursing
https://www.readbyqxmd.com/read/29452560/health-care-efficiencies-consolidation-and-alternative-models-vs-health-care-and-antitrust-regulation-irreconcilable-differences
#7
Michael W King
Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation...
November 2017: American Journal of Law & Medicine
https://www.readbyqxmd.com/read/29451464/bundled-payment-for-bundles-of-joy
#8
Lola Butcher
Episode payments for maternity care, however, are particularly challenging for many reasons, including the fact that a full course of care starts with one patient and usually ends with at least two. Something needs to be done, because pregnancy, labor, and birth account for seven of the top 20 most expensive hospitalized conditions.
February 2018: Managed Care
https://www.readbyqxmd.com/read/29447023/designing-a-low-cost-single-supply-ecg-system-for-suppression-of-movement-artifact-from-contaminated-magnetocardiogram
#9
Rajesh Patel, S Sengottuvel, K Gireesan, M P Janawadkar, T S Radhakrishnan
Measurement of the late potentials and His-bundle activity is crucial for many clinical studies using the noncontact and noninvasive magnetocardiography (MCG) technique; these weak signals are extracted by averaging many cardiac cycles aligned using the R-peak of the cardiac cycle identified using an electrocardiography (ECG) lead. ECG is measured simultaneously with MCG using a conventional dual-supply ECG amplifier, which requires either two separate batteries or a single battery with a switching voltage inverter circuit for its proper operation...
February 1, 2018: SLAS Technology
https://www.readbyqxmd.com/read/29444816/quality-improvement-effort-to-reduce-hypothermia-among-high-risk-infants-on-a-mother-infant-unit
#10
Christine Andrews, Colleen Whatley, Meaghan Smith, Emily Caron Brayton, Suzanne Simone, Alison Volpe Holmes
BACKGROUND AND OBJECTIVE: Neonatal hypothermia is common in low birth weight (LBW) (<2500 g) and late-preterm infants (LPIs) (34 0/7-36 6/7 weeks' gestation). It can be a contributory factor for newborn admission to a NICU, resulting in maternal-infant separation and increased resource use. Our objective was to study the efficacy of a quality-improvement bundle of hypothermia preventive measures for LPIs and/or LBW infants in a mother-infant unit. METHODS: We conducted plan-do-study-act (PDSA) cycles aimed at decreasing environmental hypothermia for LPIs and/or LBW infants in a mother-infant unit with no other indications for NICU-level care...
February 14, 2018: Pediatrics
https://www.readbyqxmd.com/read/29442297/a-single-center-cost-analysis-of-treating-primary-and-metastatic-brain-cancers-with-either-brain-laser-interstitial-thermal-therapy-litt-or-craniotomy
#11
Eric C Leuthardt, Jeff Voigt, Albert H Kim, Pete Sylvester
BACKGROUND: Brain laser interstitial thermal therapy (LITT) under magnetic resonance imaging (MRI) guidance has recently gained US clinical approval for the ablation of soft, neurological tissue. LITT is a minimally invasive alternative to craniotomy. OBJECTIVE: While safety and efficacy are the focus of most current LITT studies, it is unclear how acute care costs (inpatient care ± aftercare) of LITT compare to craniotomy in an academic medical center. Therefore, the purpose of this analysis is to examine these costs of using brain LITT under MRI guidance compared to craniotomy in complex anatomies...
March 2017: PharmacoEconomics Open
https://www.readbyqxmd.com/read/29438070/successfully-reducing-newborn-asphyxia-in-the-labour-unit-in-a-large-academic-medical-centre-a-quality-improvement-project-using-statistical-process-control
#12
Rikke von Benzon Hollesen, Rie Laurine Rosenthal Johansen, Christina Rørbye, Louise Munk, Pierre Barker, Anette Kjaerbye-Thygesen
BACKGROUND: A safe delivery is part of a good start in life, and a continuous focus on preventing harm during delivery is crucial, even in settings with a good safety record. In January 2013, the labour unit at Copenhagen University Hospital, Hvidovre, undertook a quality improvement (QI) project to prevent asphyxia and reduced the percentage of newborns with asphyxia by 48%. METHODS: The change theory consisted of two primary elements: (1) the clinical content, including three clinical bundles of evidence-based care, a 'delivery bundle', an 'oxytocin bundle' and a 'vacuum extraction bundle'; (2) an implementation theory, including improving skills in interpretation of cardiotocography, use of QI methods and participation in a national learning network...
February 3, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29437908/a-quality-improvement-initiative-to-reduce-nicu-transfers-for-neonates-at-risk-for-hypoglycemia
#13
Sherry LeBlanc, Jamie Haushalter, Carl Seashore, Karen S Wood, Michael J Steiner, Ashley G Sutton
BACKGROUND AND OBJECTIVE: Neonatal hypoglycemia is a common problem, often requiring management in the NICU. Nonpharmacologic interventions, including early breastfeeding and skin-to-skin care (SSC), may prevent hypoglycemia and the need to escalate care. Our objective was to maintain mother-infant dyads in the mother-infant unit by decreasing hypoglycemia resulting in NICU transfer. METHODS: Inborn infants ≥35 weeks' gestation with at least 1 risk factor for hypoglycemia were included...
February 8, 2018: Pediatrics
https://www.readbyqxmd.com/read/29434632/conduction-abnormalities-after-transcatheter-aortic-valve-implantation
#14
REVIEW
Panagiotis Karyofillis, Anna Kostopoulou, Sofia Thomopoulou, Martha Habibi, Efthimios Livanis, George Karavolias, Vassilis Voudris
In the last few years, transcatheter aortic valve implantation (TAVI) has become an alternative procedure in patients with severe aortic stenosis and high risk for surgical aortic replacement. Due to the anatomic correlation between aortic valve structure and conduction system of the heart, one of the most common complications after TAVI is conduction system disturbances which including bundle branch block, complete heart block and need for permanent pacemaker implantation. Although these disturbances are usually not lethal, they may have a great influence on patients' state and long term-survival...
January 2018: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/29427997/impact-of-the-international-nosocomial-infection-control-consortium-inicc-s-multidimensional-approach-on-rates-of-central-line-associated-bloodstream-infection-in-14-intensive-care-units-in-11-hospitals-of-5-cities-in-argentina
#15
Victor Daniel Rosenthal, Javier Desse, Diego Marcelo Maurizi, Gustavo Jorge Chaparro, Pablo Wenceslao Orellano, Viviana Chediack, Rafael Cabrera, Daniel Golschmid, Cristina Graciela Silva, Julio Cesar Vimercati, Juan Pablo Stagnaro, Ivanna Perez, María Laura Spadaro, Adriana Miriam Montanini, Dina Pedersen, Teresa Laura Paniccia, Ana María Ríos Aguilera, Raul Cermesoni, Juan Ignacio Mele, Ernesto Alda, Analía Edith Paldoro, Agustín Román Ortta, Bettina Cooke, María Cecilia García, Mora Nair Obed, Cecilia Verónica Domínguez, Pablo Alejandro Saúl, María Cecilia Rodríguez Del Valle, Alberto Claudio Bianchi, Gustavo Alvarez, Ricardo Pérez, Carolina Oyola
OBJECTIVE To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and the INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in 14 intensive care units (ICUs) in Argentina from January 2014 to April 2017. DESIGN This prospective, pre-post surveillance study of 3,940 ICU patients was conducted in 11 hospitals in 5 cities in Argentina. During our baseline evaluation, we performed outcome and process surveillance of CLABSI applying Centers for Disease Control and Prevention/National Health Safety Network (CDC/NHSN) definitions...
February 12, 2018: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/29422174/efficacy-of-a-care-bundle-to-prevent-multiple-infections-in-the-intensive-care-unit-a-quasi-experimental-pretest-posttest-design-study
#16
Gulay Yazici, Hulya Bulut
BACKGROUND: Healthcare-associated infections extend hospitalization time, increase treatment costs and increase morbidity-mortality rates. OBJECTIVES: To evaluate the efficacy of a care bundle aimed at preventing three most frequent intensive care unit-acquired infections. MATERIALS AND METHOD: This quasi-experimental study occurred in an 18-bed tertiary care intensive care unit at a university hospital in Turkey. The sample consisted of 120 patients older than 18years and receiving invasive mechanical ventilation therapy, or had a central venous catheter or urinary catheter...
February 2018: Applied Nursing Research: ANR
https://www.readbyqxmd.com/read/29422014/development-of-a-tailored-strategy-to-improve-postpartum-hemorrhage-guideline-adherence
#17
Suzan M de Visser, Mallory D Woiski, Richard P Grol, Frank P H A Vandenbussche, Marlies E J L Hulscher, Hubertina C J Scheepers, Rosella P M G Hermens
BACKGROUND: Despite the introduction of evidence based guidelines and practical courses, the incidence of postpartum hemorrhage shows an increasing trend in developed countries. Substandard care is often found, which implies an inadequate implementation in high resource countries. We aimed to reduce the gap between evidence-based guidelines and clinical application, by developing a strategy, tailored to current barriers for implementation. METHODS: The development of the implementation strategy consisted of three phases, supervised by a multidisciplinary expert panel...
February 8, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29419626/effect-of-a-patency-bundle-on-central-venous-catheter-complications-among-hospitalized-adult-patients-a-best-practice-implementation-project
#18
Vivian Huang
OBJECTIVES: The aim of this project was to improve continuity of care by decreasing central catheter occlusions in adults in two acute care units with high use of central venous catheters. Specific objectives were to introduce a patency bundle and train nurses on thrombolytic administration for timely resolution of catheter occlusions. INTRODUCTION: Central venous catheters are a vital component of medical care of acutely ill hospitalized patients. Occluded catheters delay treatment and can increase infection risk...
February 2018: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29417923/a-bundle-of-measures-to-control-an-outbreak-of-pseudomonas-aeruginosa-associated-with-p-trap-contamination
#19
Houssein Gbaguidi-Haore, Amélie Varin, Pascal Cholley, Michelle Thouverez, Didier Hocquet, Xavier Bertrand
OBJECTIVE To describe an outbreak of multidrug-resistant Pseudomonas aeruginosa in which the hospital waste-pipe system was the likely source of contamination and to report the bundle of measures that facilitated the long-term control of the outbreak. DESIGN Outbreak investigation. SETTING The hematology unit of a tertiary-care referral center. PATIENTS Patients who were colonized or infected with P. aeruginosa belonging to the clonal outbreak. METHODS Patients admitted to our 15-bed stem-cell transplantation hematology unit were screened for P...
February 2018: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/29407007/new-insights-into-the-use-of-the-12-lead-electrocardiogram-for-diagnosing-acute-myocardial-infarction-in-the-emergency-department
#20
REVIEW
David F Miranda, Angie S Lobo, Brooks Walsh, Yader Sandoval, Stephen W Smith
The 12-lead electrocardiogram (ECG) remains the most immediately accessible and widely used initial diagnostic tool for guiding management in patients with suspected myocardial infarction (MI). Although the development of high-sensitivity cardiac troponin assays has improved the rule-in and rule-out and risk stratification of acute MI without ST elevation, the immediate management of the subset of acute MI with acute coronary occlusion depends on integrating clinical presentation and ECG findings. Careful interpretation of the ECG might yield subtle features suggestive of ischemia that might facilitate more rapid triage of patients with subtle acute coronary occlusion or, conversely, in identification of ST-elevation MI mimics (pseudo ST-elevation MI patterns)...
February 2018: Canadian Journal of Cardiology
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