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Critical access hospitals

Xiaoluan Sun, Jing Wei, Yuan Yao, Qiutong Chen, Daiting You, Xinglu Xu, Jing Dai, Yanping Yao, Jingyi Sheng, Xin Li
OBJECTIVE: China has undertaken several initiatives to improve the accessibility of safe and effective medicines for children. The aim was to determine the availability, price and affordability of essential medicines for children. DESIGN: Cross-sectional survey. SETTING: Six cities of Jiangsu Province, China. PARTICIPANTS: 30 public hospitals and 30 retail pharmacies. PRIMARY AND SECONDARY OUTCOME MEASURES: The WHO/Health Action International standardised methodology was used to collect the availability and price data for 40 essential medicines for children...
October 18, 2018: BMJ Open
Brenda T Pun, Michele C Balas, Mary Ann Barnes-Daly, Jennifer L Thompson, J Matthew Aldrich, Juliana Barr, Diane Byrum, Shannon S Carson, John W Devlin, Heidi J Engel, Cheryl L Esbrook, Ken D Hargett, Lori Harmon, Christina Hielsberg, James C Jackson, Tamra L Kelly, Vishakha Kumar, Lawson Millner, Alexandra Morse, Christiane S Perme, Patricia J Posa, Kathleen A Puntillo, William D Schweickert, Joanna L Stollings, Alai Tan, Lucy D'Agostino McGowan, E Wesley Ely
OBJECTIVE: Decades-old, common ICU practices including deep sedation, immobilization, and limited family access are being challenged. We endeavoured to evaluate the relationship between ABCDEF bundle performance and patient-centered outcomes in critical care. DESIGN: Prospective, multicenter, cohort study from a national quality improvement collaborative. SETTING: 68 academic, community, and federal ICUs collected data during a 20-month period...
October 18, 2018: Critical Care Medicine
Akanksha Thakkar, Stephanie Fuentes-Rojas, Eunice Karanja, Ebun Ebunlomo, Allison Millette, Christine H Lee, Y Serena Shen-Lin, Gary Monteiro, Thomas MacGillivray, C Huie Lin
PURPOSE OF THE REVIEW: The purpose of this review is to illustrate specific challenges and opportunities in the building of an adult congenital heart disease (ACHD) program and to highlight critical components and important allies. RECENT FINDINGS: With more than 1.4 million adults with congenital heart disease in the USA alone, access to specialized, compassionate, high-quality comprehensive care requires a shift toward more aggressive expansion of ACHD care, especially in the context of sparse ACHD provider representation in the vast majority of adult medical centers...
October 11, 2018: Current Cardiology Reports
Yuri D Udalov, Irina V Vasilyeva, Alexander V Gordienko, Sergey A Bakharev
At the present moment, there is no uniform approach to the decision to conduct a planned surgical intervention in case of oncosurgical pathology, with appropriate recommendations in different sources. Consequently, in modern medicine, there is a particular problem of an objective assessment of the patient's physical condition and a risk assessment of an upcoming surgical intervention for developing an individualized tactic of preparation for surgical treatment for each particular patient. The need for introduction of new approaches and technologies, as well as treatment regimens, that allow us to take a fresh look at the possibilities of solving the problems of predicting critical outcomes of planned operations, determined the purpose of our study...
2018: Studies in Health Technology and Informatics
Catherine Lunt, Christopher Dowrick, Mari Lloyd-Williams
PURPOSE OF REVIEW: For older people with long-term conditions, regular structured activities within a community setting meeting others are thought to improve well being and quality of life. Historically local authority-run day care centres were widely available, but austerity measures have meant that in many areas, such provision has been markedly reduced and different models of day care services are being developed. There is little known about outcomes of day care provision for older people with long-term conditions...
October 8, 2018: Current Opinion in Supportive and Palliative Care
Charissa K Eaton
This study examines the profession primarily responsible for discharge planning in all hospitals serving older adults in Minnesota. Quantitative analyses determined that the majority of hospitals in Minnesota serving older adults are small, rural hospitals with critical access designations, are private nonprofit, and are affiliated with a health care system. Social workers are primarily responsible for discharge planning in half of the hospitals, nurses in a quarter and either a nurse/social worker team or both nurse and social worker separately in the remaining quarter...
November 2018: Social Work in Health Care
Ling Xu, Zhuo Zhang, Qianxin Liu, Bin Zhou, Yinhua Liu, Qian Xiang, Sainan Zhu, Xuening Duan, Yimin Cui
Prognostic assessment after preoperative systemic therapy (PST) is critical to develop a therapeutic strategy for breast cancer management. Currently, a clinical-pathologic staging system that incorporates ER status and nuclear grading (CPS + EG), and the Neo-Bioscore system that includes HER2 status into CPS + EG, are used to predict outcomes in patients with breast cancer after PST. While HER2-positive is recognized as a favorable factor in the Neo-Bioscore system based on results in patients administered one year of trastuzumab as anti-HER2 therapy, most HER2-positive cases have difficulty accessing anti-HER2 treatment in China...
September 17, 2018: Thoracic Cancer
James S Lee, Simon W P Roberts, Kanya Götsch, Ulrike Moeller, Laura Hawryluck
Critical care medicine is far from the first medical field to come to mind when humanitarian action is mentioned, yet both critical care and humanitarian action share a fundamental purpose to save lives and ease suffering of people caught in acute crises. Critically ill children and adults will be present regardless of resources limitations, irrespective of geography, regional/cultural contexts, insecurity or socioeconomic status and they may be even more prevalent in a humanitarian crisis. Critical care is not limited to the walls of a hospital and all hospitals will have critically ill patients regardless of designating a specific ward an Intensive Care Unit...
October 5, 2018: American Journal of Respiratory and Critical Care Medicine
Ngan Do, Young Kyung Do
Although many public hospital physicians in Vietnam offer private service on the side, little is known about the magnitude and nature of the phenomenon so-called dual practice, let alone the dynamics between the public and private health sectors. This study investigates how and to what degree public hospital physicians engage in private practice. It also examines the commitment of dual practitioners to the public sector. The analysis is based on a hospital-based survey of 483 physicians at 10 public hospitals in four provinces of Vietnam...
October 1, 2018: Health Policy and Planning
Amir Nutman, Dror Marchaim
BACKGROUND: Studying hospital outbreaks by using molecular tools, i.e. synthesizing the molecular-epidemiology data to its appropriate clinical-epidemiological context, is crucial in order to identify infection source, infer transmission dynamics and allocate appropriately prevention resources and implement appropriate control measures. Whole-genome sequencing (WGS) of pathogens has become the gold standard, as it is becoming more accessible and affordable. Consequently, sequencing of the full pathogen genome via WGS and major progress in fit-for-purpose genomic data analysis tools and interpretation is revolutionizing the field of outbreak investigations in hospitals...
October 1, 2018: Clinical Microbiology and Infection
Emanuele Amodio, Luca Cavalieri d'Oro, Elisabetta Chiarazzo, Carlo Picco, Maurizio Migliori, Isabella Trezzi, Silvano Lopez, Oliviero Rinaldi, Massimo Giupponi
Background: Hospital emergency departments (ED) can contribute to improve health outcomes and reduce costs of health care system. This study evaluated ED admissions during a twelve months period, analyzing characteristics of patients who underwent to emergency care in order to understand factors involved in ED overcrowding and promote adequate management. Methods: This retrospective study analyzed a twelve months window, with in-depth focus on December/January when almost all EDs reported overcrowding. All ED admissions were recorded in electronic schedules including: demographic characteristics, time/date of the access, incoming triage code, diagnosis, performed procedures, discharge, time/date of discharge...
2018: AIMS Public Health
Emily Jeffery, Pascale Young, Jill Sherriff
BACKGROUND AND OBJECTIVES: Malnutrition is prevalent amongst people with head and neck cancer treated with radiotherapy and can result in reduced tolerance to treatment and increased hospital admissions. Current bestpractice guidelines recommend weekly dietetic review during radiotherapy and fortnightly review for six weeks following radiotherapy to minimize weight loss. The primary aim of this study was to compare percent weight loss during radiotherapy before and after the implementation of weekly dietetic review...
2018: Asia Pacific Journal of Clinical Nutrition
Medhat Fanous, Anja Jaehne, David Lorenson, Sarah Williams
No abstract text is available yet for this article.
September 1, 2018: American Surgeon
Leanne Rachel Male, Adam Noble, Darlene Ann Snape, Peter Dixon, Tony Marson
OBJECTIVES: To establish the appropriateness of a previously developed seizure care pathway by exploring to what extent patients valued the intervention and perceived it as being helpful or not. DESIGN: Qualitative descriptive study, using semistructured, in-depth interviews and thematic template analysis, theoretically informed by critical realism. SETTING: In North West England, a seizure care pathway has been developed in collaboration with a specialist neurology hospital to support clinical management of seizure patients on initial presentation to the emergency department (ED), as well as access to follow-up services on discharge, with the aim of improving patient experience...
September 28, 2018: BMJ Open
Medhat Fanous, Anja Jaehne, David Lorenson, Sarah Williams
No abstract text is available yet for this article.
September 1, 2018: American Surgeon
Brian L Benson, MinhChau Ha, R Brent Stansfield, Tsveti Markova
Background: The Wayne State University Graduate Medical Education (GME) Office and Ascension Crittenton Hospital developed an educational initiative to increase resident awareness of health disparities and local community health priorities. The Plan-Do-Study-Act (PDSA) rapid-cycle performance improvement framework was used for implementation and evaluation. Methods: During the first PDSA cycle, residents attended 5 didactic sessions. During the second PDSA cycle, residents participated in a problem-based learning (PBL) case...
2018: Ochsner Journal
Kate Traynor
No abstract text is available yet for this article.
October 1, 2018: American Journal of Health-system Pharmacy: AJHP
Ethan F Kuperman, Eric L Linson, Kate Klefstad, Evelyn Perry, Kevin Glenn
BACKGROUND: On-site hospitalist care can improve patient care, but it is economically infeasible for small critical access hospitals (CAHs). A telemedicine "virtual hospitalist" may expand CAH capabilities at a fractional cost of an on"site provider. OBJECTIVE: To evaluate the impact of a virtual hospitalist on transfers from a CAH to outside hospitals. DESIGN, SETTING, PATIENTS: A 6-month pilot program providing "virtual hospitalist" coverage to patients at a CAH in rural Iowa...
September 26, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
R Jooste, F Roberts, S Mndolo, D Mabedi, S Chikumbanje, D K Whitaker, E P O'Sullivan
The Lancet Commission on Global Surgery emphasised the importance of access to safe anaesthesia care. Capnography is an essential monitor for safe anaesthesia, but is rarely available in low-income countries. The aim of this study was twofold: to measure the prevalence of capnography in the operating theatres and in intensive care units; and to determine whether its introduction was feasible and could improve the early recognition of critical airway incidents in a low-income country. This is the first project to do this...
September 25, 2018: Anaesthesia
Theodore Miclau, Paul Hoogervorst, David W Shearer, Ashraf N El Naga, Zachary M Working, Claude Martin, Rodrigo Pesántez, Tobias Hüttl, Kodi E Kojima, Michael Schütz
BACKGROUND AND RATIONALE: Although general trauma care systems and their effects on mortality reduction have been studied, little is known of the current state of musculoskeletal trauma delivery globally, particularly in low-income (LI) and low middle-income (LMI) countries. The goal of this study is to assess and describe the development and availability of musculoskeletal trauma care delivery worldwide. MATERIALS & METHODS: A questionnaire was developed to evaluate different characteristics of general and musculoskeletal trauma care systems, including general aspects of systems, education, access to care and pre- and posthospital care...
October 2018: Journal of Orthopaedic Trauma
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