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https://www.readbyqxmd.com/read/29050060/-ambulant-anesthesia-regional-anesthesia-for-ambulatory-patients
#1
Andreas Krier, Jörg Karst
Although regional anesthesia for ambulatory patients is feasible, effective and recommended, general anesthesia, analgosedation and monitored anesthesia care traditionally play a major role in the ambulatory setting. This discrepancy is at least partially caused by a more standardized and predictable process when using general anesthesia. High patient comfort, a low rate of complications and a rapid postoperative recovery are expected by all patients, irrespective of the type of anesthesia chosen and lie in the common interest of the anesthesiologist and the surgeon...
October 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29050058/-ambulant-anesthesia-limits-and-possibilities
#2
Harald Hofer, Frank Vescia
The number of operations carried out on an outpatient basis is increasing in Germany. This trend has been observed for years. The prerequisite is an infrastructure that is in line with guidelines. The competence of the anesthetist must not be restricted to that of a standard specialist anesthetist, but the physician should have experience in ambulatory anesthesia. Well-adjusted comorbidities of the patient are generally not a contraindication for an outpatient procedure. The heavily overweight patient can also be operated on an outpatient basis if he is compliant, comorbidities are well adjusted and intensive postoperative care is ensured...
October 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29049488/concentration-of-potentially-preventable-spending-among-high-cost-medicare-subpopulations-an-observational-study
#3
Jose F Figueroa, Karen E Joynt Maddox, Nancy Beaulieu, Robert C Wild, Ashish K Jha
Background: Little is known about whether potentially preventable spending is concentrated among a subset of high-cost Medicare beneficiaries. Objective: To determine the proportion of total spending that is potentially preventable across distinct subpopulations of high-cost Medicare beneficiaries. Design: Beneficiaries in the highest 10% of total standardized individual spending were defined as "high-cost" patients, using a 20% sample of Medicare fee-for-service claims from 2012...
October 17, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29049457/association-of-patient-frailty-with-increased-morbidity-after-common-ambulatory-general-surgery-operations
#4
Carolyn D Seib, Holly Rochefort, Kathryn Chomsky-Higgins, Jessica E Gosnell, Insoo Suh, Wen T Shen, Quan-Yang Duh, Emily Finlayson
Importance: Frailty is a measure of decreased physiological reserve that is associated with morbidity and mortality in major elective and emergency general surgery operations, independent of chronological age. To date, the association of frailty with outcomes in ambulatory general surgery has not been established. Objective: To determine the association between frailty and perioperative morbidity in patients undergoing ambulatory general surgery operations. Design, Setting, and Participants: A retrospective cohort study was conducted of 140 828 patients older than 40 years of age from the 2007-2010 American College of Surgeons National Surgical Quality Improvement Program Participant Use File who underwent ambulatory and 23-hour-stay hernia, breast, thyroid, or parathyroid surgery...
October 11, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/29049043/challenges-of-healthcare-administration-optimizing-quality-and-value-at-an-affordable-cost-in-pediatric-cardiology
#5
Mitchell I Cohen, Patricio A Frias
PURPOSE OF REVIEW: The purpose of this review is to explore the paradigm shift in healthcare delivery that will need to take place over the next few years away from an emphasis on supply-driven health care to better quality transparent-driven health care whose focus is on the consumer's best interest. RECENT FINDINGS: The current healthcare system is fragmented and costs continue to rise. The best way to contain costs is to improve quality to the consumer, the patient...
October 18, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/29045170/high-glucose-variability-in-hospitalized-patients-with-type-1-diabetes-mellitus
#6
Vikash Dadlani, Shrikant U Tamhane, Aidong Sun, Anu Sharma, Danae A Delivanis, Prabin Thapa, Ricky E Carter, Yogish C Kudva
BACKGROUND: Glucose variability (GV) has been increasingly (or more extensively) studied in patients with type 1 diabetes (T1D) in the ambulatory setting; limited data exist on GV in hospitalized patients with T1D. MATERIALS AND METHODS: Retrospective single center cohort study, we analyzed in-hospital glucose measurements to assess GV in 736 hospitalized patients in different units over a consecutive 5-year period of time. GV was assessed by mean blood glucose (BG), Average daily risk range (ADRR), high BG index, and low BG index...
October 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/29044493/combining-echo-and-natriuretic-peptides-to-guide-heart-failure-care-in-the-outpatient-setting-a-position-paper
#7
REVIEW
Frank Lloyd Dini, Erberto Carluccio, Fabrizio Montecucco, Gian Marco Rosa, Paolo Fontanive
BACKGROUND: Chronic heart failure (HF) is a relevant and growing public health problem. Although the prognosis has recently improved, it remains a lethal disease, with a mortality that equals or exceeds that of many malignancies. Furthermore, chronic HF is costly, representing a large and growing drain on healthcare resources. METHODS: This narrative review is based on the material searched for and obtained via PubMed up to May 2017. The search terms we used were: "heart failure, echocardiography, natriuretic peptides" in combination with "treatment, biomarkers, guidelines"...
October 16, 2017: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/29042849/does-coordinated-postpartum-care-influence-costs
#8
Elisabeth Zemp, Andri Signorell, Elisabeth Kurth, Oliver Reich
QUESTIONS UNDER STUDY: To investigate changes to health insurance costs for post-discharge postpartum care after the introduction of a midwife-led coordinated care model. METHODS: The study included mothers and their newborns insured by the Helsana health insurance group in Switzerland and who delivered between January 2012 and May 2013 in the canton of Basel Stadt (BS) (intervention canton). We compared monthly post-discharge costs before the launch of a coordinated postpartum care model (control phase, n = 144) to those after its introduction (intervention phase, n = 92)...
March 31, 2017: International Journal of Integrated Care
https://www.readbyqxmd.com/read/29040495/applying-sequence-clustering-techniques-to-explore-practice-based-ambulatory-care-pathways-in-insurance-claims-data
#9
Verena Vogt, Stefan M Scholz, Leonie Sundmacher
Background: Care pathways are a widely used mean to ensure well-coordinated and high quality care by defining the optimal timing and interval of health services for a specific indication. However, evidence on common sequences of services actually followed by patients has rarely been quantified. This study aims to explore whether sequence clustering techniques can be used to empirically identify typical treatment sequences in ambulatory care for heart failure (HF) patients and compare their effectiveness...
October 12, 2017: European Journal of Public Health
https://www.readbyqxmd.com/read/29039720/trends-in-the-contribution-of-emergency-departments-to-the-provision-of-health-care-in-the-usa
#10
David Marcozzi, Brendan Carr, Alisha Liferidge, Nicole Baehr, Brian Browne
Traditional approaches to assessing the health of populations focus on the use of primary care and the delivery of care through patient-centered homes, managed care resources, and accountable care organizations. The use of emergency departments (EDs) has largely not been given consideration in these models. Our study aimed to determine the contribution of EDs to the health care received by Americans between 1996 and 2010 and to compare it with the contribution of outpatient and inpatient services using National Ambulatory Medical Care Survey and National Hospital Discharge Survey databases...
January 1, 2017: International Journal of Health Services: Planning, Administration, Evaluation
https://www.readbyqxmd.com/read/29039691/inefficiency-dignity-and-patient-experience-is-it-time-for-separate-outpatient-diagnostics
#11
Timothy E Murray, Jack J Halligan, Michael J Lee
There is national and international variation in the location of diagnostic imaging centres relative to hospitals. Traditionally diagnostic imaging is performed within a hospital, catering for both inpatient and outpatients. This creates a two-tiered system catering for unstable, complex and emergent inpatients, in addition to typically well, ambulatory outpatients with less complex needs who are often attending an acute hospital for the specific purpose of diagnostic imaging. In both the United Kingdom and the Republic of Ireland, most radiology is provided on-campus by medium-sized state-funded hospitals, reflecting the allocation of resources nationally...
October 17, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/29039627/beliefs-endorsement-and-application-of-homeopathy-disclosed-a-survey-among-ambulatory-care-physicians
#12
Stefan Markun, Marc Maeder, Thomas Rosemann, Sima Djalali
BACKGROUND: Explanation models for the effectiveness of homeopathy are not supported by natural sciences and the aggregated evidence from clinical trials is unconvincing. From this standpoint, placebo effects seem the most obvious explanation for the therapeutic effects experienced in homeopathy. Still, many physicians continue to prescribe homeopathic treatments. OBJECTIVES: Whether physicians who prescribe homeopathic treatments aim to achieve placebo effects or actually believe in specific effects is poorly understood...
October 17, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/29039292/an-innovative-short-stay-health-care-model-for-treatment-of-uncomplicated-vaso-occlusive-crisis-in-adult-sickle-cell-disease-patients-in-canada-to-reduce-emergency-department-utilization
#13
Andrew Binding, Richard Ward, Chai Phua, Veronique Naessens, Tara O'Brien, Sacha Bhatia, Hayley Baranek, Husayn Marani, Geetha Mukerji
OBJECTIVES: Patients with sickle cell disease (SCD) with vaso-occlusive crises (VOC) often visit the emergency department (ED) for management of painful episodes. The primary objective of this pilot study was to evaluate the acceptability of a short-stay model for treatment of VOC in SCD outside of the ED in Toronto, Canada. Secondary objectives were to assess patient satisfaction of this model, barriers to its use and comparison of clinical outcomes to a historical control. METHODS: Adult SCD patients with symptoms of an uncomplicated VOC between October 2014 to July 2016 were managed according to best practice recommendations in a short-stay unit as an alternative to the local emergency room...
October 17, 2017: CJEM
https://www.readbyqxmd.com/read/29038725/caregiving-burden-of-children-with-chronic-diseases
#14
Pegah Piran, Zahra Khademi, Narges Tayari, Nafise Mansouri
BACKGROUND: The care demands of children with chronic diseases can affect caregivers' health by imposing caregiving burden to them. The health status of caregivers plays a vital role in the quality of care provided to such children and in their quality of life. OBJECTIVE: To determine caregiving burden in caregivers and to identify relevant influential factors. METHODS: In this cross-sectional study, a total number of 249 caregivers of children with chronic diseases who referred to hospitalization and ambulatory departments of Bandar Abbas, Iran in 2016 were selected using convenience sampling method...
September 2017: Electronic Physician
https://www.readbyqxmd.com/read/29029967/-10-years-of-external-quality-assurance-in-dialysis-in-germany-results-and-future-prospects
#15
Dorothea Büchtemann, Stefan Meinhold, Peter Follert
BACKGROUND: In 2006, the Federal Joint Committee introduced a quality assurance programme for ambulatory dialysis treatment in Germany. Regarding the impact of chronic dialysis treatment on the quality of life of patients and on health care costs, quality assurance in dialysis is considered highly relevant. The directive on Quality Assurance in Dialysis (QSD-RL) established an external quality assurance programme based on the assessment of certain quality parameters combined with an internal quality management system based on benchmarking parameters in all dialysis practices and centres...
October 10, 2017: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/29029606/patient-centered-professional-practice-models-for-managing-low-back-pain-in-older-adults-a-pilot-randomized-controlled-trial
#16
Christine M Goertz, Stacie A Salsbury, Cynthia R Long, Robert D Vining, Andrew A Andresen, Maria A Hondras, Kevin J Lyons, Lisa Z Killinger, Fredric D Wolinsky, Robert B Wallace
BACKGROUND: Low back pain is a debilitating condition for older adults, who may seek healthcare from multiple providers. Few studies have evaluated impacts of different healthcare delivery models on back pain outcomes in this population. The purpose of this study was to compare clinical outcomes of older adults receiving back pain treatment under 3 professional practice models that included primary medical care with or without chiropractic care. METHODS: We conducted a pilot randomized controlled trial with 131 community-dwelling, ambulatory older adults with subacute or chronic low back pain...
October 13, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/29027313/patient-experiences-with-care-across-various-types-of-mental-health-care-questionnaire-development-measurement-invariance-and-patients-reports
#17
Luk Bruyneel, Sabine Van Houdt, Ellen Coeckelberghs, Walter Sermeus, Else Tambuyzer, Peter Cosemans, Gert Peeters, Kris Van den Broeck, Ilse Weeghmans, Kris Vanhaecht
To describe the development, validation, and findings of a patient experience questionnaire across 7 types of residential and ambulatory mental health care services. Thirty-five items were hypothesized to cover information, participation, therapeutic relationship, personalized care, organization and collaboration, safety, patient rights, outcomes of care, and discharge preparation and after-care. Also included were 2 overall rating items (scoring and recommending the organization). This Dutch questionnaire was applied in 79 organizations in Belgium (N patients = 5,168)...
October 13, 2017: International Journal of Methods in Psychiatric Research
https://www.readbyqxmd.com/read/29027297/factors-associated-with-ambulatory-care-sensitive-emergency-department-visits-for-south-carolina-medicaid-members-with-intellectual-disability
#18
S McDermott, J Royer, J R Mann, B S Armour
INTRODUCTION: Ambulatory care sensitive conditions (ACSCs) can be seen as failure of access or management in primary care settings. Identifying factors associated with ACSCs for individuals with an Intellectual Disability (ID) provide insight into potential interventions. METHOD: To assess the association between emergency department (ED) ACSC visits and a number of demographic and health characteristics of South Carolina Medicaid members with ID. A retrospective cohort of adults with ID was followed from 2001 to 2011...
October 13, 2017: Journal of Intellectual Disability Research: JIDR
https://www.readbyqxmd.com/read/29026754/medication-discrepancies-and-potentially-inadequate-prescriptions-in-elderly-adults-with-polypharmacy-in-ambulatory-care
#19
Juan Víctor Ariel Franco, Sergio Adrián Terrasa, Karin Silvana Kopitowski
OBJECTIVES: The objective of this study is to describe the frequency and type of medication discrepancies (MD) through medication reconciliation and to describe the frequency of potentially inadequate prescription (PIP) medications using screening tool of older persons' prescriptions criteria. DESIGN: Cross-sectional comparison of electronic medical record (EMR) medication lists and patient's self-report of their comprehensive medication histories obtained through telephone interviews...
January 2017: Journal of Family Medicine and Primary Care
https://www.readbyqxmd.com/read/29023433/quickstats-percentage-of-all-visits-by-patients-aged-%C3%A2-65-years-to-office-based-physicians-%C3%A2-made-by-patients-with-hypertension-%C3%A2-by-sex-and-metropolitan-statistical-area-msa-%C3%A2-national-ambulatory-medical-care-survey-united-states-2012-2015
#20
(no author information available yet)
During 2012-2015, patients aged ≥65 years with hypertension documented in the medical record accounted for 54% of all office-based physician visits made by patients aged ≥65 years, with a higher percentage of visits in non-MSAs (59%) than MSAs (53%). Among women, the percentage of visits was also higher in non-MSAs than in MSAs (59% versus 53%). The difference among men was not statistically significant.
October 13, 2017: MMWR. Morbidity and Mortality Weekly Report
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