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Resource utilization

Shoaib Faruqi, Nalla Kishore, Richard Bodington, Salim Meghjee, Muthu Thirumaran
AIMS: In this retrospective study we assess the diagnostic yield of computed tomography pulmonary angiogram (CTPA) and the incidence of alterative and incidental diagnoses. METHODS: The results of all CTPA scans performed in our trust over a period of 18 months were reviewed and all diagnoses noted. Data collected was descriptively analysed. RESULTS: A total of 1138 scans were performed (56.5% men, mean age 59 years). A diagnosis of pulmonary embolism (PE) was made in 20...
2016: Acute Medicine
Michael Bobian, Aron Kandinov, Nour El-Kashlan, Peter F Svider, Adam J Folbe, Ross Mayerhoff, Jean Anderson Eloy, S Naweed Raza
OBJECTIVES/HYPOTHESIS: Despite the increasing role of mobile applications (apps) in patient education, there has been little inquiry evaluating the quality of these resources. Because poor health literacy has been associated with inferior health outcomes, evaluating the quality of patient education materials takes on great importance. Our objective was to employ validated readability tools for the evaluation of gastroesophageal reflux (GERD) mobile apps. METHODS: GERD-specific apps found in the Apple App Store (Apple Inc...
October 18, 2016: Laryngoscope
Erina Takai, Yasushi Totoki, Hiromi Nakamura, Mamoru Kato, Tatsuhiro Shibata, Shinichi Yachida
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies. The genomic landscape of the PDAC genome features four frequently mutated genes (KRAS, CDKN2A, TP53, and SMAD4) and dozens of candidate driver genes altered at low frequency, including potential clinical targets. Circulating cell-free DNA (cfDNA) is a promising resource to detect molecular characteristics of tumors, supporting the concept of "liquid biopsy".We determined the mutational status of KRAS in plasma cfDNA using multiplex droplet digital PCR in 259 patients with PDAC, retrospectively...
2016: Advances in Experimental Medicine and Biology
Lucas Brien Chartier, Licinia Simoes, Meredith Kuipers, Barb McGovern
Over the last decade, patient volumes in the emergency department (ED) have grown disproportionately compared to the increase in staffing and resources at the Toronto Western Hospital, an academic tertiary care centre in Toronto, Canada. The resultant congestion has spilled over to the ED waiting room, where medically undifferentiated and potentially unstable patients must wait until a bed becomes available. The aim of this quality improvement project was to decrease the 90th percentile of wait time between triage and bed assignment (time-to-bed) by half, from 120 to 60 minutes, for our highest acuity patients...
2016: BMJ Quality Improvement Reports
Christine Elizabeth Friesen, Patrick Seliske, Andrew Papadopoulos
Objectives. Socioeconomic status (SES) is a comprehensive indicator of health status and is useful in area-level health research and informing public health resource allocation. Principal component analysis (PCA) is a useful tool for developing SES indices to identify area-level disparities in SES within communities. While SES research in Canada has relied on census data, the voluntary nature of the 2011 National Household Survey challenges the validity of its data, especially income variables. This study sought to determine the appropriateness of replacing census income information with tax filer data in neighbourhood SES index development...
2016: Online Journal of Public Health Informatics
Quynh C Nguyen, Dapeng Li, Hsien-Wen Meng, Suraj Kath, Elaine Nsoesie, Feifei Li, Ming Wen
BACKGROUND: Studies suggest that where people live, play, and work can influence health and well-being. However, the dearth of neighborhood data, especially data that is timely and consistent across geographies, hinders understanding of the effects of neighborhoods on health. Social media data represents a possible new data resource for neighborhood research. OBJECTIVE: The aim of this study was to build, from geotagged Twitter data, a national neighborhood database with area-level indicators of well-being and health behaviors...
October 17, 2016: JMIR Public Health and Surveillance
Bhim Mani Adhikari, Martin Norgaard, Kristen M Quinn, Jenine Ampudia, Justin Squirek, Mukesh Dhamala
Musical improvisation offers an excellent experimental paradigm for the study of real-time human creativity. It involves moment-to-moment decision-making, monitoring of one's performance, and utilizing external feedback to spontaneously create new melodies or variations on a melody. Recent neuroimaging studies have begun to study the brain activity during musical improvisation, aiming to unlock the mystery of human creativity. What brain resources come together and how these are utilized during musical improvisation is not well understood...
October 18, 2016: Brain Connectivity
Alexander Y Li, Tej D Azad, Anand Veeravagu, Inderpreet Bhatti, Amy Li, Tyler Cole, Atman Desai, John K Ratliff
STUDY DESIGN: Propensity score matched retrospective study using a nationwide longitudinal database. OBJECTIVE: To quantify the longitudinal economic impact of venous thromboembolism (VTE) complications in spinal fusion patients. SUMMARY OF BACKGROUND DATA: VTE is a rare and serious complication that may occur after spine surgery. The long-term socioeconomic impact understanding of these events has been limited by small sample sizes and a lack of longitudinal follow-up...
October 12, 2016: Clinical Spine Surgery
Tauheed A Farooqui, Marguerite A Renouf, Steven J Kenway
Urban areas will need to pursue new water servicing options to ensure local supply security. Decisions about how best to employ them are not straightforward due to multiple considerations and the potential for problem shifting among them. We hypothesise that urban water metabolism evaluation based a water mass balance can help address this, and explore the utility of this perspective and the new insights it provides about water servicing options. Using a water mass balance evaluation framework, which considers direct urban water flows (both 'natural' hydrological and 'anthropogenic' flows), as well as water-related energy, we evaluated how the use of alternative water sources (stormwater/rainwater harvesting, wastewater/greywater recycling) at different scales influences the 'local water metabolism' of a case study urban development...
October 6, 2016: Water Research
Derenda Lovelace, Diane Hancock, Sabrina S Hughes, Phyllis R Wyche, Claire Jenkins, Cindy Logan
BACKGROUND: In 2011, the Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) in Richmond, VA, had a cumulative readmission rate and emergency department (ED) revisits for discharged Veterans of 1 in 5. In 2012, a transitional care program (TCP) was implemented to improve care coordination and outcomes among Veterans, with an emphasis on geriatric patients with chronic disease. This TCP was created with an interdisciplinary approach using intensive case management interventions, with a goal of reducing Veteran ED and hospital revisits by 30%...
November 2016: Professional Case Management
Jason K Hou, Christoph Gasche, Noam Z Drazin, Sarah Alandra Weaver, Orna G Ehrlich, Ridhima Oberai, Sophie Zapala, Corey A Siegel, Gil Melmed
BACKGROUND: Anemia is a common complication among patients with inflammatory bowel diseases (IBD) and is associated with high rates of IBD-related complications, resource utilization, and impaired quality of life. Despite practice guidelines for anemia in patients with IBD, gaps remain in the perceptions of anemia among health care providers. The aims of this study were to identify gaps in care and to develop a care pathway for anemia in patients with IBD. METHODS: The Crohn's & Colitis Foundation of America anemia care pathway was developed by a committee using principles of cognitive task analysis...
September 30, 2016: Inflammatory Bowel Diseases
Andrew A Udy, Chelsey Vladic, Edward Robert Saxby, Jeremy Cohen, Anthony Delaney, Oliver Flower, Matthew Anstey, Rinaldo Bellomo, David James Cooper, David V Pilcher
OBJECTIVE: The primary aim of this study was to describe in-hospital mortality in subarachnoid hemorrhage patients requiring ICU admission. Secondary aims were to identify clinical characteristics associated with inferior outcomes, to compare subarachnoid hemorrhage mortality with other neurological diagnoses, and to explore the variability in subarachnoid hemorrhage standardized mortality ratios. DESIGN: Multicenter, binational, retrospective cohort study. SETTING: Data were extracted from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database...
October 3, 2016: Critical Care Medicine
Feng Xie, Eleanor Pullenayegum, A Simon Pickard, Juan Manuel Ramos Goñi, Min-Woo Jo, Ataru Igarashi
Discrete choice experiments (DCEs) are a promising alternative to more resource-intensive preference elicitation methods such as time trade-off (TTO), as pairwise comparisons are more amenable to online completion, which can save time and money. However, modeling DCE data produces latent utilities which are on an unknown scale. Therefore, latent utilities need to be transformed to a full health-dead scale before they can be used in quality-adjusted life year calculations. We aimed to explore transformation functions from DCE-derived latent utilities to TTO-derived health utilities...
October 16, 2016: Health Economics
Mark R Zonfrillo, Michelle L Macy, Lawrence J Cook, Tomohiko Funai, Rachel M Stanley, James M Chamberlain, Rebecca M Cunningham, Elizabeth R Alpern
BACKGROUND: Childhood injuries are increasingly treated in emergency departments (EDs) but the relationship between injury severity and ED resource utilization has not been evaluated. The objective of this study was to compare resource utilization for pediatric injury-related ED visits across injury-severity levels and with non-injury visits, using standardized, validated scales. METHODS: A retrospective analysis of 2004-2008 ED visits from the Pediatric Emergency Care Applied Research Network Core Data Project...
December 2016: Injury Epidemiology
Robert Morlock, Pierre Chevalier, Laura Horne, Javier Nuevo, Chris Storgard, Lalitha Aiyer, Dionne M Hines, Xavier Ansolabehere, Fredrik Nyberg
INTRODUCTION: The present study aimed to assess disease control, health resource utilization (HRU), and healthcare costs, and their predictors in gout patients across the USA, UK, Germany, and France. METHODS: Data were extracted from the PharMetrics Plus (USA), Clinical Practice Research Datalink-Hospital Episode Statistics (UK), and Disease Analyzer databases (Germany and France) for adult gout patients over a 3-year period: 2009-2011 (all dates +1 year for France)...
June 2016: Rheumatol Ther
Michelle K Haas, Kristen Dalton, Bryan C Knepper, Sarah A Stella, Lilia Cervantes, Connie S Price, William J Burman, Philip S Mehler, Timothy C Jenkins
Background.  Syndrome-specific interventions are a recommended approach to antibiotic stewardship, but additional data are needed to understand their potential impact. We implemented an intervention to improve the management of inpatient community-acquired pneumonia (CAP) and evaluated its effects on antibiotic and resource utilization. Methods.  A stakeholder group developed and implemented a clinical practice guideline and order set for inpatient, non-intensive care unit CAP recommending a short course (5 days) of a fluoroquinolone-sparing antibiotic regimen in uncomplicated cases...
October 2016: Open Forum Infectious Diseases
Sooyeon Kim, Sage P Kramer, Adam J Dugan, David J Minion, John C Gurley, Daniel L Davenport, Victor A Ferraris, Sibu P Saha
BACKGROUND: Iliac arterial stenting is performed both in the operating room (OR) and the catheterization lab (CL). To date, no analysis has compared resource utilization between these locations. METHODS: Consecutive patients (n = 105) treated at a single center were retrospectively analyzed. Patients included adults with chronic, symptomatic iliac artery stenosis with a minimum Rutherford classification (RC) of 3, treated with stents. Exclusion criteria were prior stenting, acute ischemia, or major concomitant procedures...
October 12, 2016: International Journal of Surgery
Holly Depinet, Karen Copeland, Joseph Gogain, Halim Hennes, Norman A Paradis, Rebecca Andrews-Dickert, Cheryl W Vance, David S Huckins
BACKGROUND: The diagnosis of pediatric acute appendicitis can be difficult. Although scoring systems such as the Pediatric Appendicitis Score (PAS) are helpful, they lack adequate sensitivity and specificity as standalone diagnostics. When used for risk stratification, they often result in large percentages of moderate-risk patients requiring further diagnostic evaluation. METHODS: We applied a biomarker panel (the APPY1 Test) that has high sensitivity and negative predictive value (NPV) to patients with PAS in the moderate-risk range (3-7) and reclassified those patients with a negative result to the low-risk group...
August 10, 2016: American Journal of Emergency Medicine
Victoria Porthé, Ingrid Vargas, Belén Sanz-Barbero, Isabel Plaza-Espuña, Lola Bosch, Maria Luisa Vázquez
Policy measures introduced in Spain during the economic crisis included a reduction in public health expenditure and in healthcare entitlements (RDL16/2012), which affected the general population as a whole, but especially immigrants. This paper analyzes changes in immigrants' access to health care during the economic crisis from the perspective of health professionals (medical and administrative) and immigrants. A qualitative descriptive-interpretative study was conducted in Catalonia through individual interviews with a theoretical sample of health professionals (n=34) and immigrant users (n=20)...
September 19, 2016: Health Policy
Dana A Hayward, Jelena Ristic
Recent studies show that spatial attention is uniquely engaged by the selection history of a stimulus. One example of this process is Automated Symbolic Orienting, which is thought to reflect overlearned spatial links between a behaviorally relevant stimulus and a target event. However, since automated symbolic effects have been found to vary with temporal expectancies about when a target might occur, it is possible that this spatial effect may also depend on processing resources associated with voluntary temporal attention...
October 12, 2016: Acta Psychologica
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