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Critical care quality

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https://www.readbyqxmd.com/read/28328786/high-quality-randomized-controlled-trials-in-pediatric-critical-care-a-survey-of-barriers-and-facilitators
#1
Mark Duffett, Karen Choong, Jennifer Foster, Maureen Meade, Kusum Menon, Melissa Parker, Deborah J Cook
OBJECTIVES: High-quality, adequately powered, randomized controlled trials are needed to inform the care of critically ill children. Unfortunately, such evidence is not always available. Our objective was to identify barriers and facilitators of conducting high-quality randomized controlled trials in pediatric critical care, from the perspective of trialists in this field. DESIGN: Self-administered online survey. Respondents rated the importance of barriers and effectiveness of facilitators on seven-point scales...
March 21, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28328654/outcomes-for-children-receiving-noninvasive-ventilation-as-the-first-line-mode-of-mechanical-ventilation-at-intensive-care-admission-a-propensity-score-matched-cohort-study
#2
Jenny V Morris, Padmanabhan Ramnarayan, Roger C Parslow, Sarah J Fleming
OBJECTIVES: To compare outcomes of children receiving noninvasive ventilation with those receiving invasive ventilation as first-line mode of mechanical ventilation following unplanned intensive care admission. DESIGN: Propensity score-matched cohort study analyzing data prospectively collected by the Pediatric Intensive Care Audit Network over 8 years (2007-2014). SETTING: Thirty-one PICUs in the United Kingdom and Ireland; twenty-one of whom submitted Pediatric Critical Care Minimum Dataset data for the entire study period...
March 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28327170/critical-attitudes-and-beliefs-towards-guidelines-amongst-palliative-care-professionals-results-from-a-national-survey
#3
Helen Kalies, Rieke Schöttmer, Steffen T Simon, Raymond Voltz, Alexander Crispin, Claudia Bausewein
BACKGROUND: Little is known about palliative care professionals' attitudes towards guidelines. In 2015, the German Association for Palliative Medicine (DGP) published an evidence based guideline for palliative care in adults with incurable cancer. Before publication we conducted a national survey among members of the DGP to detect possible barriers and facilitators for its implementation. The aim of the present publication was to evaluate critical attitudes and beliefs which could hinder the effective implementation of the new guideline and to evaluate differences within professional groups and medical specialisations...
March 21, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28326415/help-my-rating-looks-bad-coding-comorbidities-in-arthroplasty
#4
Joseph D Galloway, Frank R Voss
In medicine today, there is a trend toward increasing transparency. Higher quality and better value are being sought, and one of the methods being used is publicly reported health care outcomes. However, there is a problem that comes from our loss of anonymity. Physicians who are being individually watched have to choose between doing what is best for the patient and doing what would look good when it is publicly reported. Often this might mean choosing not to treat a particularly sick patient who is unlikely to have a good outcome...
September 2016: Arthroplasty Today
https://www.readbyqxmd.com/read/28326148/patient-safety-learning-systems-a-systematic-review-and-qualitative-synthesis
#5
(no author information available yet)
BACKGROUND: A patient safety learning system (sometimes called a critical incident reporting system) refers to structured reporting, collation, and analysis of critical incidents. To inform a provincial working group's recommendations for an Ontario Patient Safety Event Learning System, a systematic review was undertaken to determine design features that would optimize its adoption into the health care system and would inform implementation strategies. METHODS: The objective of this review was to address two research questions: (a) what are the barriers to and facilitators of successful adoption of a patient safety learning system reported by health professionals and (b) what design components maximize successful adoption and implementation? To answer the first question, we used a published systematic review...
2017: Ontario Health Technology Assessment Series
https://www.readbyqxmd.com/read/28325751/smartphone-based-geofencing-to-ascertain-hospitalizations
#6
Kaylin T Nguyen, Jeffrey E Olgin, Mark J Pletcher, Madelena Ng, Leanne Kaye, Sai Moturu, Rachel A Gladstone, Chaitanya Malladi, Amy H Fann, Carol Maguire, Laura Bettencourt, Matthew A Christensen, Gregory M Marcus
BACKGROUND: Ascertainment of hospitalizations is critical to assess quality of care and the effectiveness and adverse effects of various therapies. Smartphones, mobile geolocators that are ubiquitous, have not been leveraged to ascertain hospitalizations. Therefore, we evaluated the use of smartphone-based geofencing to track hospitalizations. METHODS AND RESULTS: Participants aged ≥18 years installed a mobile application programmed to geofence all hospitals using global positioning systems and cell phone tower triangulation and to trigger a smartphone-based questionnaire when located in a hospital for ≥4 hours...
March 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28325583/optimizing-endometrial-cancer-follow-up-and-survivorship-care-for-rural-and-other-underserved-women-patient-and-provider-perspectives
#7
Teresa L Rutledge, Miria Kano, Dolores Guest, Andrew Sussman, Anita Y Kinney
OBJECTIVES: This study describes patient and provider attitudes on transitioning cancer surveillance visits and treatment of comorbid conditions to the primary care setting in a rural patient population as a strategy for minimizing financial and travel related barriers for patients while simultaneously enhancing quality and availability of health care options. METHODS: Focus group discussions and telephone interviews were conducted with endometrial cancer (EC) survivors and primary care providers (PCPs) to provide insights into post-treatment follow-up practices and the acceptability of transitioning follow-up to primary care setting utilizing a cancer survivorship care plan model...
March 18, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28325458/chronic-subdural-hematoma-icu-management
#8
REVIEW
Jeremy T Ragland, Kiwon Lee
Patients with cSDH presenting with new or worsening neurological deficits, especially if they are debilitating and adversely affecting quality of life require urgent medical and surgical attention. Neurological and neurosurgical critical care team need to stabilize the patient by reversing any underlying coagulopathy states in order to prevent further hematoma expansion.In the event of brain herniation and presumed ICP elevation and CPP compromise, step-wise ICP management should be instituted promptly.Seizure prophylaxis treatment is reasonable...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28322634/end-of-life-decision-support-in-the-icu
#9
Grant Pignatiello, Ronald L Hickman, Breanna Hetland
Determining effective decision support strategies that enhance quality of end-of-life decision making in the intensive care unit is a research priority. This systematic review identified interventional studies describing the effectiveness of decision support interventions administered to critically ill patients or their surrogate decision makers. We conducted a systematic literature search using PubMed, CINAHL, and Cochrane. Our search returned 121 articles, 22 of which met the inclusion criteria. The search generated studies with significant heterogeneity in the types of interventions evaluated and varied patient and surrogate decision-maker outcomes, which limited the comparability of the studies...
November 1, 2016: Western Journal of Nursing Research
https://www.readbyqxmd.com/read/28321321/associations-between-fluid-balance-and-outcomes-in-critically-ill-children-a-protocol-for-a-systematic-review-and-meta-analysis
#10
Rashid Alobaidi, Catherine Morgan, Rajit K Basu, Erin Stenson, Robin Featherstone, Sumit R Majumdar, Sean M Bagshaw
BACKGROUND: Fluid therapy is a mainstay during the resuscitation of critically ill children. After initial stabilization, excessive fluid accumulation may lead to complications of fluid overload, which has been independently associated with increased risk for mortality and major morbidity in critically ill children. OBJECTIVES: Perform an evidence synthesis to describe the methods used to measure fluid balance, define fluid overload, and evaluate the association between fluid balance and outcomes in critically ill children...
2017: Canadian Journal of Kidney Health and Disease
https://www.readbyqxmd.com/read/28320459/risk-factors-for-pressure-injury-development-in-critically-ill-patients-in-the-intensive-care-unit-a-systematic-review-protocol
#11
Fiona Coyer, Nahla Tayyib
BACKGROUND: Pressure injuries (PIs) create a significant burden in the health care system. Up to 49% of critically ill patients develop PIs. Identifying and understanding potential risk factors is essential to the provision of effective targeted prevention strategies to mitigate risk. The objectives of this review are to identify patient-centred clinical factors that may be associated with PI development in the adult intensive care environment and to determine the effect size of the relationship between identified factors and PI development in this unique population...
March 20, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28320372/effects-of-interdisciplinary-teamwork-on-patient-reported-experience-of-cancer-care
#12
Dominique Tremblay, Danièle Roberge, Nassera Touati, Elizabeth Maunsell, Djamal Berbiche
BACKGROUND: Interdisciplinary teamwork (ITW) is deemed necessary for quality cancer care practices. Nevertheless, variation in ITW intensity among cancer teams is understudied, and quantitative evidence of the effect of different ITW intensities among cancer teams on patients' perceived experience of care is limited. This study aims to compare patient-reported experience measures (PREMs) of cancer outpatients followed by teams characterized by high vs. low ITW intensity. METHODS: The study is designed as an ex post facto quasi-experimental study...
March 20, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28320325/-was-that-a-success-or-not-a-success-a-qualitative-study-of-health-professionals-perspectives-on-support-for-people-with-long-term-conditions
#13
John Owens, Vikki A Entwistle, Alan Cribb, Zoë C Skea, Simon Christmas, Heather Morgan, Ian S Watt
BACKGROUND: Support for self-management (SSM) is a prominent strand of health policy internationally, particularly for primary care. It is often discussed and evaluated in terms of patients' knowledge, skills and confidence, health-related behaviours, disease control or risk reduction, and service use and costs. However, these goals are limited, both as guides to professional practice and as indicators of its quality. In order to better understand what it means to support self-management well, we examined health professionals' views of success in their work with people with long-term conditions...
March 20, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28319308/concepts-models-and-measurement-of-continuity-of-care-in-mental-health-services-a-systematic-appraisal-of-the-literature
#14
REVIEW
Nick Weaver, Michael Coffey, Jeanette Hewitt
INTRODUCTION: The increased complexity of community mental health services, and associated fragmentation of traditional dividing lines between services, has underscored the centrality of care continuity and coordination in modern mental healthcare. However, clarification of the key features of the care continuity concept has proved difficult and a consensus has not been reached. AIM/QUESTION: This review draws together and critically examines latest evidence concerning concepts, models and scales based on a multi-dimensional understanding of care continuity...
March 20, 2017: Journal of Psychiatric and Mental Health Nursing
https://www.readbyqxmd.com/read/28317097/engagement-in-advance-care-planning-and-surrogates-knowledge-of-patients-treatment-goals
#15
Terri R Fried, Maria Zenoni, Lynne Iannone, John O'Leary, Brenda T Fenton
OBJECTIVES: A key objective of advance care planning (ACP) is improving surrogates' knowledge of patients' treatment goals. Little is known about whether ACP outside of a trial accomplishes this. The objective was to examine patient and surrogate reports of ACP engagement and associations with surrogate knowledge of goals. DESIGN: Cohort study SETTING: Primary care in a Veterans Affairs Medical Center. PARTICIPANTS: 350 community-dwelling veterans age ≥55 years and the individual they would choose to make medical decisions on their behalf, interviewed separately...
March 20, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28316557/achieving-prudent-dementia-care-palliare-an-international-policy-and-practice-imperative
#16
Debbie Tolson, Anne Fleming, Elizabeth Hanson, Wilson de Abreu, Manuel Lillo Crespo, Rhoda Macrae, Graham Jackson, Simona Hvalič-Touzery, Iva Holmerová, Pirkko Routasalo
This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources...
December 31, 2016: International Journal of Integrated Care
https://www.readbyqxmd.com/read/28314968/-when-is-cytoreductive-nephrectomy-not-beneficial-for-patients-with-metastatic-renal-cell-carcinoma
#17
Martin Schostak
Primary tumor resection in patients with synchronous metastatic renal cell carcinoma and a good performance status corresponds to a guideline recommendation which, however, is based on weak data from the era of cytokine therapy. This article presents arguments that weigh heavily against cytoreductive nephrectomy. From a molecular genetic viewpoint, the intervention eliminates only the easiest adversary but cannot prevent cancer-related death. Therefore, benefits and risks must be carefully and critically considered...
March 17, 2017: Der Urologe. Ausg. A
https://www.readbyqxmd.com/read/28304270/intervention-fidelity-in-interventions-an-integrative-literature-review
#18
Sarah Ibrahim, Souraya Sidani
BACKGROUND: Complex interventions are frequently used in health care by various providers. It is important for researchers and clinicians to monitor and assess intervention fidelity which refers to the degree to which an intervention is implemented as originally planned and intended to draw valid conclusions about whether the intervention produces the intended outcomes. PURPOSE: The authors undertook a review of the current literature of intervention fidelity, critically appraised the utility of the existing conceptual frameworks for intervention fidelity, and proposed an alternative framework for intervention fidelity and complex interventions...
August 1, 2016: Research and Theory for Nursing Practice
https://www.readbyqxmd.com/read/28304268/empirical-evaluation-of-international-health-system-data-interoperability-mapping-the-wanda-horta-theory-to-the-omaha-system-ontology
#19
Lisiane Pruinelli, Amalia de Lucena, Karen A Monsen
Structured health care data has played a critical role in improving quality of care and achieving better patient outcomes. Despite increased use of terminology standards within the electronic health records (EHRs), there is a need to map multi-institutional data that represent patient observations to develop standardized information models. The purpose of this study was to conduct an empirical evaluation of the potential for international health system data interoperability with the Wanda Horta theory using the Omaha System ontology...
August 1, 2016: Research and Theory for Nursing Practice
https://www.readbyqxmd.com/read/28304241/wireless-teleophthalmology-a-novel-low-cost-flexible-network-architecture-and-its-performance-evaluation-for-remote-eye-care-solutions
#20
Shashwat Pathak, Basant Kumar
INTRODUCTION: This article proposes a novel, cost-effective, flexible, and easy-to-deploy wireless teleophthalmology network architecture and performance evaluation for its potential use in remote areas. This study has used practical telecommunication standards, which is widely deployed throughout India. METHODS: In the proposed scenario, patient's eye images are obtained using a specified imaging modality, and then sent to a server at the primary eye care centre (PECC) using ZigBee a short-range wireless network...
March 17, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
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