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Inpatient teaching unit

Sarah Armenia, Loka Thangamathesvaran, Akia D Caine, Neil King, Anastasia Kunac, Aziz M Merchant
Introduction  High-fidelity team-based simulation has been identified as an effective way of teaching and evaluating both technical and nontechnical skills. Several studies have described the benefits of this modality in a variety of acute care settings, but a lack of standardized methodologies has resulted in heterogeneous findings. Few studies have characterized high fidelity simulation across a broad range of acute care settings and integrated the latest evidence on its educational and patient impact. Methods  The MEDLINE, EMBASE, Cochrane Library, and PsycINFO databases were searched for empirical studies from the last 10 years, investigating high fidelity team-based simulation in surgical, trauma, and critical care training curricula...
July 2018: Surgery Journal
Jo Hill, Adam Gerace, Candice Oster, Shahid Ullah
Objective The aims of the present study were to establish rates of resuscitation order documentation of patients aged ≥65 years from both psychogeriatric and general medical units and to compare patients on predictors of resuscitation status, particularly examining the effect of depression. Methods A retrospective case note audit of psychogeriatric (n = 162) and general medical (n = 135) unit admissions within a tertiary teaching hospital was performed. Multivariate logistic regression was used to determine significant clinical and demographic predictors of resuscitation status...
August 14, 2018: Australian Health Review: a Publication of the Australian Hospital Association
Shanan Mahal, Sorabh Datta, Virendrasinh Ravat, Priya Patel, Bipin Saroha, Rikinkumar S Patel
Objective This study aimed to determine the differences in hospitalization outcomes among patients admitted for congestive cardiac failure (CCF) with underlying subclinical hypothyroidism (SCH). Methods This retrospective case-control study used data from the nationwide inpatient sample (NIS) for the years 2012-2014. We identified cases with CCF as the primary diagnosis and SCH as the secondary diagnosis using validated ICD-9-CM codes and controls with CCF only. The differences in hospitalization outcomes and hospital characteristics were quantified using the multinomial logistic regression model (adjusted odds ratio (aOR))...
June 8, 2018: Curēus
Carlin Callaway, Craig Cunningham, Shawna Grover, Kenneth R Steele, Andrea McGlynn, Vorachai Sribanditmongkol
BACKGROUND: Bedside handoffs, the teach-back method, and discharge bundles have been shown to contribute to empowering patients to actively engage in their treatment. OBJECTIVES: The objectives were to identify patient activation scores, patient readmission rates, and nursing staff satisfaction before and after implementing bedside handoffs, the teach-back method, and discharge bundles on an inpatient oncology unit at a large military treatment facility. METHODS: A series of three cycles using the Plan-Do-Study-Act framework guided implementation of the multifaceted approach...
August 1, 2018: Clinical Journal of Oncology Nursing
Larrie Greenberg
The challenging and changing face of medicine over the last 45 years of the author's career has dictated where faculty members' primary interaction with patients occurs, how they teach trainees, and how they measure educational outcomes. The transfer of patient care from the inpatient to the ambulatory setting in the late 20 century was instrumental in creating a "new' model for faculty; that is, the clinician educator (CE). This individual has been defined as a faculty member whose primary responsibility as part of the academic mission is patient care and whose focus is on the theoretical constructs that inform excellent teaching and effective learning, applying these to create and inform educational scholarship...
July 17, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Tiffany P Baugh, C W David Chang
Objectives The purpose of this study is to describe the demographics of children undergoing inpatient management of epistaxis and recognize the clinical circumstances that may necessitate embolization or ligation for epistaxis management. Study Design and Setting Cross-sectional analysis of a national database. Subjects and Methods A review of data reported by hospitals in the United States to the Healthcare Cost and Utilization Project Kids' Inpatient Database with a diagnosis of epistaxis was conducted ( International Classification of Diseases, Ninth Revision [ ICD-9] code 784...
July 1, 2018: Otolaryngology—Head and Neck Surgery
C Alix Timko, Tiffanie J Goulazian, Kathleen Kara Fitzpatrick, Daniel Rodriguez
Background: Anorexia nervosa (AN) is a severe psychiatric condition characterized by low body weight, fear of weight gain/becoming fat and/or behavior that interferes with weight gain, and body disturbance. Though there have been recent advances in the treatment of AN, there continues to be an urgent need to increase treatment options. Cognitive remediation therapy (CRT) has been successfully used as an adjunctive treatment for individuals with AN. In this study, we pilot the use of CRT plus an innovative parent involvement component as a pre-treatment intervention on a medical unit...
2018: Pilot and Feasibility Studies
Joseph Bernstein, Loren Mead
The United States Veterans Health Administration (VHA) serves more than 9 million enrolled Veterans each year. Although most of the care that the VHA sponsors is delivered within its own facilities, there has been a call for "privatizing" some or all of these services. Under such an arrangement, the Department of Veterans Affairs would pay non-VHA providers to deliver care in facilities open to the general public. Privatization is hotly contested on political grounds and is not resolved. Yet the question whether the VHA should be privatized cannot be resolved without first establishing that this policy change is even feasible...
2018: PloS One
Hayley J Wilson, Fahad Khokhar, David A Enoch, Nicholas M Brown, Jag Ahluwalia, Gordon Dougan, M Estée Török
Infections with carbapenemase-producing Enterobacteriaceae (CPE) and vancomycin-resistant enterococci (VRE) are associated with increased morbidity and mortality, but the carriage rates of CRE and VRE among hospital inpatients is unknown. We conducted a point-prevalence survey to determine CPE and VRE carriage rates in hospitalised adults. 818/960 (85.2%) adult inpatients were invited to participate in the study. 595/818 (72.7%) consented and provided specimens. Of 540 samples tested, none were positive for CPE...
June 30, 2018: Journal of Hospital Infection
Andrew S Oseran, Sydney E Howard, Daniel M Blumenthal
Importance: Medicare's Bundled Payments for Care Improvement (BPCI) is a voluntary pilot program evaluating bundled payments for several common cardiovascular conditions. Evaluating the external validity of this program is important for understanding the effects of bundled payments on cardiovascular care. Objective: To determine whether participants in BPCI cardiovascular bundles are representative of US acute care hospitals and identify factors associated with participation...
June 27, 2018: JAMA Cardiology
S Keddie, V Bharambe, A Jayakumar, A Shah, V Sanchez, A Adams, S Gnanapavan
BACKGROUND AND PURPOSE: Central nervous system (CNS) tuberculosis (TB) accounts for over 4% of all TB notifications in the UK and causes death or significant disability in over half of those affected. Tumour necrosis factor alpha is a critical cytokine involved in the neuropathogenesis of CNS TB. Thalidomide has been trialled in CNS TB due to its immunomodulatory and immune reconstitution effects through the inhibition of tumour necrosis factor alpha. Despite animal models demonstrating dramatic improvement in survival, studies in paediatric patients have been associated with higher levels of mortality...
June 23, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Rosh K V Sethi, Daniel G Deschler
PURPOSE: Operating room (OR) procedures represent one quarter of hospitalizations, yet OR-related stays account for nearly 50% of hospital costs. Understanding trends in inpatient parotidectomy, associated charges, and key outcomes including length of stay is imperative in the era of evolving health reform. MATERIALS AND METHODS: The Nationwide Inpatient Sample (NIS) was queried for patients who underwent inpatient parotidectomy (ICD9-CM procedure code 26.31 and 26...
June 7, 2018: American Journal of Otolaryngology
André R Maddison, Shiraz Malik, Andrew Smaggus
Inpatient palliative care consultation has been demonstrated to improve quality of life as well as decrease hospital readmissions, intensive care unit transfers, and hospital costs for people with a life limiting illness. The clinical teaching units (CTUs) at London Health Sciences Centre (LHSC) routinely admit patients with noncurable cancer as well as end-stage heart, lung, liver, or kidney disease. However, the use of inpatient palliative care consultations for CTU patients remains unexamined. We conducted a descriptive study of all patients referred from LHSC CTU from both University and Victoria hospital to inpatient palliative care over a 1-year period from August 2013 to July 2014...
January 1, 2018: Journal of Palliative Care
Adil A Shah, Cheryl K Zogg, Abdul Rehman, Asad Latif, Hasnain Zafar, Amarah Shakoor, Nabil Wasif, Alyssa B Chapital, Robert Riviello, Awais Ashfaq, Mallory Williams, Edward E Cornwell, Adil H Haider
INTRODUCTION: Access to surgical care is an essential element of health-systems strengthening. This study aims to compare two diverse healthcare settings in South Asia and the United States (US). METHODS: Patients at the Aga Khan University Hospital (AKUH), Pakistan were matched to patients captured in the US Nationwide Inpatient Sample (US-NIS) from 2009 to 2011. Risk-adjusted differences in mortality, major morbidity, and LOS were compared using logistic and generalized-linear (family gamma, link log) models after coarsened-exact matching...
June 2018: American Journal of Surgery
Maria Castaldi, John McNelis
INTRODUCTION: Inadequate electronic medical record (EMR) documentation remains a significant source of revenue loss. The Department of Surgery in a trauma and tertiary care teaching hospital developed a revenue optimization initiative for inpatients on general, vascular, and trauma surgery and surgical intensive care unit services to enhance clinical documentation and increase revenue capture. METHODS: Clinical documentation management program included six trained clinical documentation specialists (CDSs), five physician assistants (PAs), directors of health information management (HIM), and two surgical champions...
May 18, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
Ming Chen, Amie Goodin, Hong Xiao, Qiong Han, Driss Raissi, Joshua Brown
Variation in the use of inferior vena cava filters (IVCFs) across hospitals has been observed, suggesting differences in quality of care. Hospitalization metrics associated with venous thromboembolism (VTE) patients have not been compared based on IVCF utilization rates using a national sample. We conducted a descriptive retrospective study using the Nationwide Readmissions Database (NRD) to delineate the variability of hospitalization metrics across the hospital quartiles of IVCF utilization for VTE patients...
August 2018: Vascular Medicine
Michael Ross Townsend, Adeeb Jaber, Hanina Abi Nader, Shaker M Eid, Kathleen Schwarz
OBJECTIVE: To assess factors associated with timing of hepatoportoenterostomy (HPE) and adverse perioperative outcomes in patients with biliary atresia in the US. STUDY DESIGN: We examined hospitalizations in infants aged <1 year using the National Inpatient Sample database for 2000-2011. We identified cases using the International Classification of Diseases, Ninth Revision, Clinical Modification codes for biliary atresia and HPE. Multivariable logistic regression models were used to examine association between select factors and age at HPE, as well as adverse perioperative outcomes...
August 2018: Journal of Pediatrics
Tennison L Malcolm, Kiran Chatha, Adam P Breceda, Eric Guo, Darren J Friedman, Vani J Sabesan, Wael K Barsoum
BACKGROUND: There is a growing population of patients with history of solid organ transplant (SOT) surgery among total joint patients. Patients with history of SOT have been found to have longer lengths of stay and higher inpatient hospital costs and complications rates after hip and knee arthroplasty. The purpose of this study was to determine whether this is true for shoulder arthroplasty in SOT patients. METHODS: The Nationwide Inpatient Sample was queried to describe relative demographic, hospital, and clinical characteristics, perioperative complications, length of stay, and total costs for patients with a history of SOT (International Classification of Diseases-9th Edition-Clinical Modificiation V42...
August 2018: Journal of Shoulder and Elbow Surgery
Michael J McGinity, Ramesh Grandhi, Joel E Michalek, Jesse S Rodriguez, Aron M Trevino, Ashley C McGinity, Ali Seifi
BACKGROUND: Recent interest in the study of concussion and other neurological injuries has heightened awareness of the medical implications of American tackle football injuries amongst the public. OBJECTIVE: Using the National Emergency Department Sample (NEDS) and the National Inpatient Sample (NIS), the largest publicly available all-payer emergency department and inpatient healthcare databases in the United States, we sought to describe the impact of tackle football injuries on the American healthcare system by delineating injuries, specifically neurological in nature, suffered as a consequence of tackle football between 2010 and 2013...
2018: PloS One
Smit Patel, Neil U Parikh, Ravikumar Aalinkeel, Jessica L Reynolds, Rashmi Dmello, Stanley A Schwartz, Supriya D Mahajan
We evaluated national trends of in-hospital discharge rates, mortality outcomes, health care costs, length of stay in HIV patients with cognitive disorders. Neurological involvement in HIV is commonly associated with cognitive impairment termed as HIV-associated neurocognitive disorder (HAND) which includes a spectrum of neurocognitive dysfunction associated with HIV infection. Although severe and progressive neurocognitive impairment has become rare in HIV patients in the era of potent antiretroviral therapy, a majority of HIV patients have mild to moderate degree of neurocognitive impairment...
April 28, 2018: AIDS and Behavior
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