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Critical access hospitals

Sarah Switzer, Soo Chan Carusone, Adrian Guta, Carol Strike
Recently, scholars have begun to critically interrogate the way community participation functions discursively within community-based participatory research (CBPR) and raise questions about its function and limits. Community advisory committees (CACs) are often used within CBPR as one way to involve community members in research from design to dissemination. However, CACs may not always be designed in ways that are accessible for communities experiencing the intersections of complex health issues and marginalization...
November 30, 2018: Qualitative Health Research
Angelina Prima Kurniati, Eric Rojas, David Hogg, Geoff Hall, Owen A Johnson
There is a growing body of literature on process mining in healthcare. Process mining of electronic health record systems could give benefit into better understanding of the actual processes happened in the patient treatment, from the event log of the hospital information system. Researchers report issues of data access approval, anonymisation constraints, and data quality. One solution to progress methodology development is to use a high-quality, freely available research dataset such as Medical Information Mart for Intensive Care III, a critical care database which contains the records of 46,520 intensive care unit patients over 12 years...
November 29, 2018: Health Informatics Journal
M Vasco, S Pandya, D Van Dyk, D G Bishop, R Wise, R A Dyer
Maternal critical care reflects interdisciplinary care in any hospital area according to the severity of illness of the pregnant woman. The admission rate to intensive care units is below 1% (0.08-0.76%) of deliveries in high-income countries, and ranges from 0.13% to 4.6% in low middle-income countries. Mortality in these patients is high and varies from 0% to 4.9% of admissions in high-income countries, and from 2% to 43.6% in low middle-income countries. Obstetric haemorrhage, sepsis, preeclampsia, human immunodeficiency virus complications and tropical diseases are the main reasons for intensive care unit admission in low middle-income countries...
September 29, 2018: International Journal of Obstetric Anesthesia
Zeyad Aljeboori, Alexandra Gorelik, Emily Jenkins, Thomas McFarlane, Jai Darvall
OBJECTIVES: There is an increasing incidence of invasive candidal infections in critically ill patients worldwide, which has prompted development of various risk prediction rules, both clinical and microbiological. To date, however, there is a lack of research into how cumulative risk factors over time affect transition to candidaemia. The aim of this study was to investigate the association of risk factor accumulation over time with candidaemia in a cohort of critically ill, non-neutropenic adult patients...
December 2018: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Nizar K Wehbi, Rajvi Wani, Yangyuna Yang, Fernando Wilson, Sharon Medcalf, Brian Monaghan, Jennifer Adams, Paul Paulman
Background: Training emergency medical services (EMS) workforce is challenging in rural and remote settings. Moreover, critical access hospitals (CAHs) struggle to ensure continuing medical education for their emergency department (ED) staff. This project collected information from EMS and ED providers across Nebraska to identify gaps in their skills, knowledge, and abilities and thus inform curriculum development for the mobile simulation-based training program. Methods: The needs assessment used a three-step process: (1) four facilitated focus group sessions were conducted in distinct geographical locations across Nebraska to identify participants' perceived training gaps; (2) based on the findings from the focus group, a needs assessment survey was constructed and sent to all EMS and ED staff in Nebraska; and (3) 1395 surveys were completed and analyzed...
2018: Advances in Simulation
Margareth Crisóstomo Portela, Sheyla Maria Lemos Lima, Lenice Gnocchi da Costa Reis, Mônica Martins, Emma-Louise Aveling
BACKGROUND: Maternal morbidity and mortality are still serious public health concerns in Brazil, and access to quality obstetric care is one critical point of this problem. Despite efforts, obstetric care quality problems and sub-optimal/poor outcomes persist. The study aimed to identify contextual elements that would potentially affect the implementation of an obstetric care quality improvement intervention. METHODS: A qualitative study was conducted in three public maternity hospitals of a large Brazilian city, with high annual volume of births and buy-in from high-level managers...
November 26, 2018: BMC Pregnancy and Childbirth
Adam Tanious, Nirmani Karunathilake, Joel Toro, Afif Abu-Hanna, Laura T Boitano, Timothy Fawcett, Brian Graves, Peter Nelson
OBJECTIVE: Racial and ethnic disparities are a critical issue in access to care within all fields of medicine. We hypothesized that analysis of a statewide administrative dataset would demonstrate disparities based on race with respect to access to this latest technology and the associated outcomes following EVAR. METHODS: Utilizing de-identified data from the Florida State Agency for Health Care Administration, we identified patients based on ICD-9 procedure codes who underwent EVAR between the years 2000-2014...
November 23, 2018: Annals of Vascular Surgery
Jered Windorski, Jared Reyes, Stephen D Helmer, Jeanette G Ward, James M Haan
BACKGROUND: Critical access hospitals (CAH) serve a key role in providing medical care to rural patients. The purpose of this study was to assess effectiveness of CAHs in initial care of trauma patients. METHODS: A 5-year retrospective review was conducted of all adult trauma patients who were transported directly to a level I trauma facility or were transported to a CAH then transferred to a level I trauma facility after initial resuscitation. RESULTS: Of 1478 patients studied, 1084 were transferred from a CAH with 394 transported directly to the level I facility...
November 14, 2018: American Journal of Surgery
Marie A Chisholm-Burns, Christina A Spivey, Logan R Pickett
Optimizing wellness and health are the most critical goals for patients post solid-organ transplantation. Low health literacy has important implications for wellness and health, increasing patient risk for negative health outcomes. More than 30% of the general US patient population has low health literacy, and solid-organ transplant recipients (SOTRs) may be especially vulnerable to low health literacy and its adverse impact on health outcomes. A comprehensive literature review was conducted and a model was adapted to better depict factors associated with low health literacy...
2018: Patient Preference and Adherence
Katherine M French, Sasha Z Gonzalez, Scott E Sherman, Alissa R Link, Sadozai Zoe Malik, Chi-Hong Tseng, Saahil A Jumkhawala, Briesny Tejada, Andrew White, Joseph A Ladapo
BACKGROUND: Smoking is the leading preventable cause of death in the United States, but evidence-based smoking cessation therapy is underutilized. Financial incentive strategies represent an innovative approach for increasing the use of counseling and pharmacotherapy. If effective, they could supplement or supplant resource-intensive policy options, particularly in populations for whom smoking has substantial societal costs. FIESTA (Financial IncEntives for Smoking TreAtment) will randomize hospitalized smokers to receive usual smoking cessation care alone or usual smoking care augmented with financial incentives...
November 21, 2018: Trials
Onyinye Oyeka, Fred Ullrich, Keith Mueller
Purpose: This policy brief updates a RUPRI Center brief published in 20141 and documents the continued growth in system affiliation by both metropolitan and non-metropolitan hospitals. Key Findings: (1) From 2007 to 2016, hospital system affiliation continued to increase across all categories of hospital size, metropolitan/non-metropolitan location, and Critical Access Hospital (CAH)status. (2) From 2007 to 2016, hospital system affiliation increased in all census regions except in the West census region among non-metropolitan hospitals...
October 1, 2018: Rural Policy Brief
Medhat Fanous, Anja Jaehne, David Lorenson, Sarah Williams
No abstract text is available yet for this article.
September 1, 2018: American Surgeon
D E Austin, B Burns, D Lowe, B Cartwright, A Clarke, M Dennis, M D'Souza, R Nathan, P G Bannon, D Gattas, M Connellan, P Forrest
In New South Wales, a coordinated extracorporeal membrane oxygenation (ECMO) retrieval program has been in operation since 2007. This study describes the characteristics and outcomes of patients transported by this service. We performed a retrospective observational study and included patients who were transported on ECMO to either of two adult tertiary referral hospitals in Sydney, New South Wales, between February 28, 2007 and February 29, 2016. One hundred and sixty-four ECMO-facilitated transports occurred, involving 160 patients...
November 2018: Anaesthesia and Intensive Care
Yemisrach A Tefera, Kinfe G Bishu, Mulugeta Gebregziabher, Aprill Z Dawson, Leonard E Egede
BACKGROUND: Knowledge, self-care and access to diabetes-related resources is critical to diabetes management. However, there is paucity of data on source of education, source of care, and access to diabetes-related resources in the developing world, including Ethiopia. OBJECTIVE: To examine source of education, source of care, access to diabetes-related resources, and correlates of diabetes knowledge in a random sample of adults with diabetes in Ethiopia. METHODS: A sample of 337 subjects was selected using systematic random sampling...
November 12, 2018: Journal of the National Medical Association
Matthias Reumann, Andrea Giovannini, Bartosz Nadworny, Christoph Auer, Ivan Girardi, Chiara Marchiori
There are between 6,000 - 7,000 known rare diseases today. Identifying and diagnosing a patient with rare disease is time consuming, cumbersome, cost intensive and requires resources generally available only at large hospital centers. Furthermore, most medical doctors, especially general practitioners, will likely only see one patient with a rare disease if at all. A cognitive assistant for differential diagnosis in rare disease will provide the knowledge on all rare diseases online, help create a list of weighted diagnosis and access to the evidence base on which the list was created...
July 2018: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Melvin Obadha, Jane Chuma, Jacob Kazungu, Edwine Barasa
BACKGROUND: Provider payment mechanisms (PPMs) play a critical role in universal health coverage due to the incentives they create for health care providers to deliver needed services, quality, and efficiency. We set out to explore public, private, and faith-based providers' experiences with capitation and fee-for-service in Kenya and identified attributes of PPMs that providers considered important. METHODS: We conducted a qualitative study in two counties in Kenya...
November 13, 2018: International Journal of Health Planning and Management
Zafer Orkun Toktas, Baran Yilmaz, Murat Şakir Ekşi, Lei Wang, Akin Akakin, Yasin Yener, Murat Konakcı, Emre Ayan, Turker Kılıc, Deniz Konya, Yang D Teng
Purpose: To date, application of intraoperative magnetic resonance imaging (ioMRI) to enhance surgical quality for spinal intramedullary neoplastic lesions has been rarely reported. Moreover, in developing countries or regions, ioMRI accessibility remains very limited. This report describes a technology design of high-field ioMRI accessible for multioperation rooms via a case presentation of an imaging-assisted surgical excision of human cervical spinal cord diffuse glioma. Patient and methods: The patient was a 44-year-old woman with symptomatic and progressive C2-5 intramedullary diffuse glioma (IDG)...
2018: Cancer Management and Research
Patricia E Field, Richard C Franklin, Ruth N Barker, Ian Ring, Peter A Leggat
INTRODUCTION: Morbidity and mortality from heart disease continues to be high in Australia with cardiac rehabilitation (CR) recognised as best practice for people with heart disease. CR is known to reduce mortality, reoccurrence of heart disease, hospital readmissions and costs, and to improve quality of life. Australian Aboriginal and Torres Strait Islanders (Australian First Peoples or Indigenous peoples) have a greater need for CR due to their higher burden of disease. However, CR referral, access and attendance remain low for all people who live in rural and remote areas...
November 2018: Rural and Remote Health
Hawa O Abu, Milena D Anatchkova, Nathaniel A Erskine, Joanne Lewis, David D McManus, Catarina I Kiefe, Heena P Santry
BACKGROUND: Healthcare providers play a critical role in the care transitions. Therefore, efforts to improve this process should be informed by their perspectives. AIM: The study objective was to explore the factors that negatively/positively influence care transitions following an unplanned hospitalization from the perspective of healthcare providers. METHODS: A qualitative study using semi-structured interviews conducted between February and September of 2016 at a single academic medical center...
December 2018: Applied Nursing Research: ANR
Amy M J O'Shea, Spyridon Fortis, Mary Vaughan Sarrazin, Jane Moeckli, W C Yarbrough, Heather Schacht Reisinger
PURPOSE: To evaluate mortality, length of stay, and inter-hospital transfer in the Veteran Health Administration (VHA) among low complexity Intensive Care Unit (ICU) patients. MATERIALS AND METHOD: Retrospective study of adult ICU admissions identified in VHA Medical SAS®; 2010-2015 at Veterans Affairs (VA) Medical Centers. Facilities classified by the Rural Urban Commuting Area code algorithm as large rural (referred to as rural) (N = 6) or urban (N = 33)...
October 19, 2018: Journal of Critical Care
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