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Transitions in care

Bertram Baenziger, Najia Nadi, Ramon Doerig, Peter Proemmel, Brigitta Gahl, Daniel Hodel, Oliver N Hausmann
BACKGROUND: There are only a few prospective clinical trials investigating the effects of different anesthetic techniques on clinical outcomes after lumbar spine surgery. The purpose of this study was to evaluate clinical outcomes in patients receiving general (GA) and regional anesthesia (RA) for lumbar spine surgery. METHODS: This was a single-center, 2-arm, trial in which 100 patients undergoing lumbar spine surgery were randomized to receive either RA or GA (50 per group)...
October 16, 2018: Journal of Neurosurgical Anesthesiology
Susana Miguel, Joana Romeiro, Helga Martins, Tiago Casaleiro, Sílvia Caldeira, T Heather Herdman
PURPOSE: This article explores the current structure of NANDA-I nursing diagnoses (ND) labels. METHODS: Critical analysis of the ND labels, as categorized in the NANDA-I terminology. FINDINGS: Most of the 244 ND labels are composed of terms from the focus and judgment axes. CONCLUSIONS: The specificity of the human responses toward health and life transitions may not be totally represented in the two most common axes, as categorized within taxonomy II...
October 18, 2018: International Journal of Nursing Knowledge
Deborah S Keller, Jianying Zhang, Manish Chand
BACKGROUND: Opioids are a mainstay for postsurgical pain management, but have associated complications and costs, and contribute to the opioid epidemic. While efforts to reduce opioid use exist, little study has been done on opioid utilization and its impact across surgical approaches. Our goal was to evaluate the impact of opioid utilization on quality measures and costs after open and laparoscopic colorectal surgery. METHODS: The Premier database was reviewed for inpatient colorectal procedures from January 01, 2014, to September 30, 2015...
October 17, 2018: Surgical Endoscopy
Anders Bremer, Tova Dahné, Lovisa Stureson, Kristofer Årestedt, Ingela Thylén
BACKGROUND: Out-of-hospital cardiac arrest survivors suffer from psychological distress and cognitive impairments. They experience existential insecurity and vulnerability and are striving to return to a life in which well-being and the meaning of life have partly changed. However, research highlighting the experiences of in-hospital cardiac arrest survivors is lacking. This means that evidence for postresuscitation care has largely been extrapolated from studies on out-of-hospital cardiac arrest survivors, without considering potential group differences...
October 17, 2018: Scandinavian Journal of Caring Sciences
Derek W Brown, Todd Atwood, Kevin Moore, Robert MacAulay, James Murphy, Arno Mundt, Todd Pawlicki
OBJECTIVES: To develop a training program designed to meet the specific needs of medical physicists as they transition into a clinical role with direct patient care responsibilities. MATERIALS AND METHODS: The training program was designed in collaboration with the faculty at the UC San Diego School of Medicine and incorporates training techniques that have been shown to be effective in improving communication skills. The program emphasizes experiential, practice-based learning over didactic presentations...
October 17, 2018: Journal of Applied Clinical Medical Physics
Patrick Brzoska, Oliver Razum
BACKGROUND: So far little is known about the utilization of medical rehabilitation among non-German nationals and ethnic German resettlers. OBJECTIVE: The aim of this study was to examine the utilization of medical rehabilitation in non-German nationals and ethnic German resettlers prior to disability retirement. MATERIAL AND METHODS: Routine data from the German statutory pension insurance scheme were used. Information on 17,369 individuals who retired due to disability in 2015 was available...
October 16, 2018: Zeitschrift Für Gerontologie und Geriatrie
Siyan Yi, Sovannary Tuot, Khuondyla Pal, Vohith Khol, Say Sok, Pheak Chhoun, Laura Ferguson, Gitau Mburu
BACKGROUND: Adolescents living with HIV experience worse HIV care outcomes compared to adults, especially during transition from pediatric to adult care. However, data regarding adolescents are limited. This paper describes and compares characteristics of male and female adolescents living with HIV preparing for transition from pediatric to adult care in Cambodia. METHODS: This cross-sectional study was conducted in August 2016 among 328 adolescents aged 15-17, randomly selected from 11 antiretroviral therapy (ART) clinics...
October 16, 2018: BMC Health Services Research
Els Devriendt, Pieter Heeren, Steffen Fieuws, Nathalie I H Wellens, Mieke Deschodt, Johan Flamaing, Marc Sabbe, Koen Milisen
BACKGROUND: International guidelines recommend adapting the classic emergency department (ED) management model to the needs of older adults in order to ameliorate post-ED outcomes among this vulnerable group. To improve the care for older ED patients and especially prevent unplanned ED readmissions, the URGENT care model was developed. METHODS: The URGENT care model is a nurse-led, comprehensive geriatric assessment based care model in the ED with geriatric follow-up after ED discharge...
October 16, 2018: BMC Geriatrics
Steven D McCarus
The advancement of surgical innovation for both devices and techniques has directly impacted the number of hysterectomy options available to patients. These advancements have led to an expansion of options that has been exceptionally impactful for minimally invasive surgery. For individuals who are diagnosed with a health condition or disease that requires a hysterectomy, these advances allow the surgeon to consider an expanded variety of procedures that may improve patients' outcomes and accommodate patient preferences...
October 16, 2018: Surgical Technology International
Megan A Clarke, Li C Cheung, Philip E Castle, Mark Schiffman, Diane Tokugawa, Nancy Poitras, Thomas Lorey, Walter Kinney, Nicolas Wentzensen
Importance: As cervical cancer screening transitions to primary human papillomavirus (HPV) testing, effective triage and management of HPV-positive women is critical to avoid unnecessary colposcopy referral and associated harms while maintaining high sensitivity for cervical precancer. Triage with p16/Ki-67 dual-stain (DS) testing has shown high sensitivity and specificity for detection of cervical precancers; however, longitudinal studies are needed to determine the long-term risk of precancer following a negative DS result...
October 11, 2018: JAMA Oncology
Grace Xiong, Chase G Bennett, Loretta Chou, Robin N Kamal
BACKGROUND: Quality measures may be operationalized in payment models or quality reporting programs to assess foot and ankle surgeons, but if existing measures allow accurate representation of a foot and ankle surgeon's practice is unclear. METHODS: National quality measures databases, clinical guidelines, and MEDLINE/PubMed were systematically reviewed for quality measures relevant to foot and ankle care. Measures meeting internal criteria were categorized by clinical diagnosis, National Quality Strategy priority, and Donabedian domain...
October 15, 2018: Journal of the American Academy of Orthopaedic Surgeons
Jing Zheng, Hao Yu
Eco-product is scarce product with consequences on human health, economy and society all over the world. In order to understand the effective supply of eco-product and figure out its law of scale efficiency, panel data from 2004 to 2015 with labor force, capital, resource, and energy source was carefully selected as the input variables and GDP, sustainable product, and undesirable output as the output variables, the scale efficiency and its differences of effective supply of eco-product in China were measured in this study...
October 2018: Ying Yong Sheng Tai Xue Bao, the Journal of Applied Ecology
Don Li, Douglas Elliffe, Michael J Hautus
A multivariate analysis is concerned with more than one dependent variable simultaneously. Models that generate event records have a privileged status in a multivariate analysis. From a model that generates event records, we may compute predictions for any dependent variable associated with those event records. However, because of the generality that is afforded to us by these kinds of models, we must carefully consider the selection of dependent variables. Thus, we present a conditional compromise heuristic for the selection of dependent variables from a large group of variables...
October 16, 2018: Journal of the Experimental Analysis of Behavior
Jiaxing Huang, Weiting Liao, Jing Zhou, Pengfei Zhang, Feng Wen, Xinyuan Wang, Mengxi Zhang, Kexun Zhou, Qiuji Wu, Qiu Li
Background: The effectiveness of gemcitabine plus capecitabine compared with gemcitabine monotherapy for resected pancreatic cancer has been evaluated in the ESPAC-4 trial. We aimed to assess the cost-effectiveness of these adjuvant regimens on resected pancreatic cancer. Methods: A Markov model was established to simulate the disease process of resected pancreatic cancer (relapse-free survival, progressive disease, and death). The efficacy and toxicity profiles were collected from the ESPAC-4 trial...
2018: Cancer Management and Research
Kaja Põlluste, Elise Kosunen, Tuomas Koskela, Kari J Mattila, Willemijn L A Schäfer, Wienke G W Boerma, Margus Lember
INTRODUCTION: Since the early 1990s, the Estonian and Finnish health systems have undergone various changes which are expected to have impacted the type and range of services provided by general practitioners (GPs). OBJECTIVE: To compare GP services between Estonia and Finland in 1993 and 2012 and draw a parallel with transformations occurred in the health systems of both countries during these two decades. METHODS: Data were collected through surveys among 129 and 288 GPs from Estonia and Finland in 2012 and 139 Estonian and 239 Finnish GPs in 1993...
October 9, 2018: Health Policy
Daniel Z Mansour, Joseph G Marek, Rachelle Shelly Spiro, Nicole J Brandt
The Chesapeake Regional Information System for our Patients (CRISP) is a health information exchange in Maryland that is designed to improve communication among members of the health care team including physicians, nurses, and other health professionals. Senior care pharmacists gained access to CRISP through successful collaborative efforts at both the state and national levels. This involved efforts to address medication-related problems that continue to be a concern during transitions of care, especially for older, vulnerable adults...
October 1, 2018: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
Kristina K Davis, Aisha Syeda
Patient and Family Engagement in Primary Care and Safe Transitions to New Appointments are both recent toolkits developed for the Agency for Healthcare Research and Quality (AHRQ). Both available on AHRQ's Patient Safety Tools and Resources webpage, these tools were designed to be used by clinicians, staff, patients, and family members in outpatient settings. While designed broadly for any staff, the techniques and skills necessary to use the toolkits fully align well with the role of health educators building on core skills already employed...
November 2018: Health Promotion Practice
Alexandre Magdzinski, Alvaro Marte, Madalina Boitor, Jacki Raboy-Thaw, Bobby Paré, Céline Gélinas
PURPOSE: To describe how clinicians were prepared for the transition to a novel single patient room (SPR) intensive care unit (ICU) and their work experience during this transition. MATERIALS AND METHODS: In this qualitative descriptive study, four focus groups were conducted six months post-move with a multidisciplinary group of 29 clinicians at a hospital in Montreal, Canada. The interview guide was derived from a readiness for change conceptual framework. Audio recordings were transcribed verbatim and analyzed via thematic analysis...
September 23, 2018: Journal of Critical Care
Mimi Kim, Joan T Merrill, Kenneth Kalunian, Leslie Hanrahan, Peter Izmirly
Objective: To evaluate response duration and identify predictors of transitioning into and out of the response state in patients with SLE receiving standard of care (SoC) in 52-week clinical trials. Methods: A multistate model (MSM) allowing for bidirectional transitions between response and non-response states was fit to data on 759 patients with SLE with active disease randomised to SoC. The probability of being in response at 52 weeks, average duration of response (sojourn time) and mean total time in response for SLE Responder Index (SRI-4, SRI-5, SRI-6) and BILAG-based Composite Lupus Assessment (BICLA) were estimated...
2018: Lupus Science & Medicine
Kerri Lynn Schellenberg, Gregory Hansen
Purpose: Multidisciplinary clinics (MDC) have become the standard of care for management of amyotrophic lateral sclerosis (ALS). No studies however, have captured patients' perspectives during a transition to ALS MDCs. Recently, an ALS MDC emerged from a single-physician clinic in Saskatoon, Canada, providing patients with a unique exposure to two different models of care. Patients and methods: Fifteen patients with ALS participated in semi-structured interviews that were digitally recorded and transcribed...
2018: Journal of Multidisciplinary Healthcare
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