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Critical access hospitals

Manuel Algora, Gloria Grabski, Anna Liza Batac-Castro, James Gibbs, Nyaradzo Chada, Sharhabil Humieda, Shafeeq Ahmad, Peter Anderson, Priscila I Figueroa, Imran Mirza, Laila AbdelWareth
CONTEXT: - Opening a new hospital is a once in a lifetime experience and can be very inspiring for those involved in its activation. However, establishing a safe transfusion practice in a greenfield environment comes with unique challenges and opportunities. OBJECTIVE: - To highlight critical activation components such as on-boarding of new personnel, establishing clinical practices, and integrating critical laboratory software. DESIGN: - Our staff initially faced challenges in standardizing transfusion medicine clinical practice inside the laboratory...
August 13, 2018: Archives of Pathology & Laboratory Medicine
Owen D Gustafson, Matthew J Rowland, Peter J Watkinson, Stuart McKechnie, Simon Igo
OBJECTIVES: Identify the prevalence of shoulder impairment in ICU survivors within 6 months of discharge from ICU. Evaluate the impact of shoulder impairment on upper limb functional status in patients treated on an ICU. Identify risk factors for the development of shoulder impairment. DESIGN: Prospective cohort study. SETTING: A tertiary care medical-surgical-trauma ICU at a U.K. hospital over 18 months, with a further 6-month follow-up after hospital discharge...
August 7, 2018: Critical Care Medicine
Rachel C Heenan, Thomas Volkman, Simon Stokes, Shidan Tosif, Hamish Graham, Andrea Smith, David Tran, Georgia Paxton
AIM: To examine refugee health assessments in Syrian and Iraqi children in the context of changes to offshore immigration screening, updated Australian refugee health guidelines and the primary care refugee health model in Victoria. METHODS: This is a retrospective audit of Syrian and Iraqi children aged 0-17 years attending a specialist immigrant health service from January 2015 to September 2017. RESULTS: We saw 128 children (7 months-16 years, 64...
August 9, 2018: Journal of Paediatrics and Child Health
Magdalena Hoffmann, Anna K Holl, Harald Burgsteiner, Philipp Eller, Thomas R Pieber, Karin Amrein
A patient's admission to an intensive care unit (ICU) has a significant impact on family members and other relatives. In order for them to be able to cope with such a stressful situation, the availability of appropriate understandable and accessible information is crucial. The information asymmetry between relatives and medical professionals may adversely affect satisfaction of relatives and their risk of subsequent anxiety, depression and stress symptoms. The aim of this study was therefore to understand which topics are most important to the relatives of ICU patients and to quantify the perceptions of medical professionals regarding the information needs of relatives...
August 9, 2018: Wiener Klinische Wochenschrift
Tiffany Patterson, Alexander Perkins, Gavin D Perkins, Tim Clayton, Richard Evans, Hanna Nguyen, Karen Wilson, Mark Whitbread, Johanna Hughes, Rachael T Fothergill, Joanne Nevett, Iris Mosweu, Paul McCrone, Miles Dalby, Roby Rakhit, Philip MacCarthy, Divaka Perera, Jerry P Nolan, Simon R Redwood
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a global public health issue. There is wide variation in both regional and inter-hospital survival rates from OHCA and overall survival remains poor at 7%. Regionalization of care into cardiac arrest centers (CAC) improves outcomes following cardiac arrest from ST elevation myocardial infarction (STEMI) through concentration of services and greater provider experience. The International Liaison Committee on Resuscitation (ILCOR) recommends delivery of all post-arrest patients to a CAC, but that randomized controlled trials are necessary in patients without ST elevation (STE)...
August 6, 2018: American Heart Journal
Sarah C Haight, Jean Y Ko, Van T Tong, Michele K Bohm, William M Callaghan
Opioid use by pregnant women represents a significant public health concern given the association of opioid exposure and adverse maternal and neonatal outcomes, including preterm labor, stillbirth, neonatal abstinence syndrome, and maternal mortality (1,2). State-level actions are critical to curbing the opioid epidemic through programs and policies to reduce use of prescription opioids and illegal opioids including heroin and illicitly manufactured fentanyl, both of which contribute to the epidemic (3). Hospital discharge data from the 1999-2014 Healthcare Cost and Utilization Project (HCUP) were analyzed to describe U...
August 10, 2018: MMWR. Morbidity and Mortality Weekly Report
(no author information available yet)
This final rule updates the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs), which include psychiatric hospitals and excluded psychiatric units of an acute care hospital or critical access hospital. These changes are effective for IPF discharges occurring during the fiscal year (FY) beginning October 1, 2018 through September 30, 2019 (FY 2019). This final rule also updates the IPF labor-related share, the IPF wage index for FY 2019, and the International Classification of Diseases 10th Revision, Clinical Modification (ICD- 10-CM) codes for FY 2019...
August 6, 2018: Federal Register
Theodore T Redman, Elliot M Ross
BACKGROUND: Cadaver training for prehospital surgical procedures is a valid training model. The limitation to date has been that perfused cadavers have only been used in wet laboratories in hospitals or university centers. We endeavor to describe a transportable central-perfused cadaver model suitable for training in the battlefield environment. Goals of design were to create a simple, easily reproducible, and realistic model to simulate procedures in field and austere conditions. METHODS: We conducted a review of the published literature on cadaver models, conducted virtual-reality simulator training, performed interviews with subject matter experts, and visited the laboratories at the Centre for Emergency Health Sciences in Spring Branch, TX, the Basic Endovascular Skills in Trauma laboratory in Baltimore, MD, and the Fresh Tissue Dissection Laboratory at Los Angeles County and University of Southern California, Keck School of Medicine, Los Angeles, CA...
July 28, 2018: Journal of Emergency Medicine
E Alnuaimi, M Al Halabi, A Khamis, M Kowash
AIM: The aim of this study was to estimate the prevalence of oral health problems in leukaemic paediatric patients in the United Arab Emirates (UAE) and correlate it to the phase of chemotherapy. MATERIALS AND METHODS: Medical records of 120 paediatric leukaemic patients (age below 15 years) in the UAE were reviewed for the occurrence of oral health problems. Records from the three main hospitals that provide cancer therapy were accessed after obtaining the required permissions...
September 2018: European Journal of Paediatric Dentistry: Official Journal of European Academy of Paediatric Dentistry
Diane Pilkey, Christy Edwards, Rachel Richards, Lenora M Olson, Michael Ely, Elizabeth A Edgerton
PURPOSE: Critical Access Hospitals (CAHs), often the first point of access for emergency care, see few children and are challenged to remain proficient in caring for pediatric patients. Our analysis provides guidance to facilitate increasing CAHs staffs' ability to provide effective pediatric emergency care. METHODS: The National Pediatric Readiness Project (NPRP) assessment of 4,146 emergency departments (EDs) was linked with the CAHs list from Centers for Medicare and Medicaid Services...
July 30, 2018: Journal of Rural Health
Zahra Zare, Mohamad Jebraeily
Introduction: In recent years patient self-care has emerged as an important component of disease management programs. The ICT tools facilitate the self-care process with improved access to information resources, effective communication between patients and healthcare professionals, and social support services. Aim: The purpose of this study was identifying the perception of patients from the application of information communication technology in self-care in educational centers of Urmia University of Medical Sciences...
June 2018: Acta Informatica Medica: AIM
Annie Yang, Susan Chimonas, Peter B Bach, David J Taylor, Allison Lipitz-Snyderman
PURPOSE: Access to comparative information on hospitals' quality of cancer care is limited. Patients' interest in using this information when selecting a hospital for cancer surgery and the specific data they would desire are unknown. This study gauges patients' demand for comparative information on hospitals' quality of cancer surgery. METHODS: We conducted a cross-sectional, national survey of 3,334 US residents who had received cancer surgery. The outcomes were patients' reported likelihood of using a list of best hospitals for cancer surgery and patients' reported interest in information about specific clinical outcomes, including 4-year survival after surgery, 30-day mortality after surgery, and rate of complications from surgery...
August 2018: Journal of Oncology Practice
Lalin Navaratne, Jasim Al-Musawi, Asuncion Acosta Mérida, Jaime Vilaça, Alberto Martinez Isla
PURPOSE: During laparoscopic common bile duct exploration (LCBDE) where Calot's triangle cannot be safely dissected due to a 'frozen' hepatic hilum secondary to severe inflammation or fibrosis, the preferred transcystic approach to the common bile duct (CBD) is precluded. The aim of this paper is to describe a safe method of accessing the CBD via a trans-infundibular approach (TIA) in complex cases where conventional access to the cystic duct or CBD is denied. METHODS: A retrospective review of 154 consecutive patients who underwent LCBDE at a single centre between 2014 and 2018 was performed...
July 29, 2018: Langenbeck's Archives of Surgery
Melissa Giesbrecht, Kelli I Stajduhar, Ashley Mollison, Bernie Pauly, Sheryl Reimer-Kirkham, Ryan McNeil, Bruce Wallace, Naheed Dosani, Caelin Rose
The process of dying pronounces inequities, particularly for structurally vulnerable populations. Extending recent health geography research, we critically explore how the 'places' of formal healthcare settings shape experiences of, and access to, palliative care for the structurally vulnerable (e.g., homeless, substance users). Drawing on 30 months of ethnographic data, thematic findings reveal how symbolic, aesthetic, and physical elements of formal healthcare 'places' intersect with social relations of power to produce, reinforce, and amplify structural vulnerability and thus, inequities in access to care...
July 25, 2018: Health & Place
Mark Putland, Michael Noonan, Alexander Olaussen, Peter Cameron, Mark Fitzgerald
OBJECTIVE: Regionalised civilian trauma systems improve patient outcomes, but may deskill clinicians outside major trauma services (MTSs). We aimed to characterise experience and confidence in trauma management among emergency physicians working in MTS to those working elsewhere. METHODS: Emergency physicians working within the Victorian State Trauma System were surveyed about their pre- and post-fellowship training experience, their estimated hours per fortnight in different centres, the frequency of performance/supervision of critical emergency skills and their confidence in a range of trauma skills...
July 28, 2018: Emergency Medicine Australasia: EMA
John E Jesus, Kenneth D Marshall, Chadd K Kraus, Arthur R Derse, Eileen F Baker, Jolion McGreevy
BACKGROUND: Whether emergency physicians should utilize critical care resources for patients with advance care planning directives is a complex question. Because the cost of intensive care unit (ICU)-level care, in terms of human suffering and financial burden, can be considerable, ICU-level care ought to be provided only to those patients who would consent and who would benefit from it. OBJECTIVES: In this article, we discuss the interplay between clinical indications, patient preferences, and advance care directives, and make recommendations about what the emergency physician must consider when deciding whether a patient with an advance care planning document should be admitted to the ICU...
July 24, 2018: Journal of Emergency Medicine
Andreas Hohn, Uwe Trieschmann, Jeremy Franklin, Jan-Nicolas Machatschek, Jost Kaufmann, Holger Herff, Jochen Hinkelbein, Thorsten Annecke, Bernd W Böttiger, Stephan A Padosch
BACKGROUND: Peri-operative critical events are still a major problem in paediatric anaesthesia care. Access to more experienced healthcare teams might reduce the adverse event rate and improve outcomes. OBJECTIVE: The current study analysed incidences of peri-operative paediatric cardiac arrest before and after implementation of a specialised paediatric anaesthesia team and training programme. DESIGN: Retrospective cohort study with before-and-after analysis...
July 25, 2018: European Journal of Anaesthesiology
Kevin J Bennett, Janice C Probst, Jarrod C Bullard, Elizabeth Crouch
The purpose was to examine factors associated with transfers and readmissions among Medicare patients initially presenting at rural facilities. Data from the 2013 Medicare Claims file were used to identify fee-for-service patients with a hospital admission (n = 298,783) or an emergency department visit immediately followed by a hospital admission (117,416), for a total of 416,199. Transfers were defined as hospitalization at a different facility within 1 day of a discharge from a prior inpatient or emergency department encounter...
July 26, 2018: Population Health Management
Nicole A Errett, Alexa Tanner, Xuesi Shen, Stephanie E Chang
OBJECTIVE: This study aimed to identify maritime transportation disruption impacts on available health care supplies and workers necessary to deliver hospital-based acute health care in geographically isolated communities post-disaster. METHODS: Semi-structured interviews were conducted with 25 key informants knowledgeable about the hospital-based acute health care supply chain and workforce emergency management plans and procedures in 2 coastal communities in British Columbia...
July 26, 2018: Disaster Medicine and Public Health Preparedness
Brett A Faine, Sanjana Dayal, Rahul Kumar, Steven R Lentz, Enrique C Leira
INTRODUCTION: Rural and critical access hospitals rely on the "drip and ship" practice using helicopter emergency medical services (HEMS). But those helicopter flights are an unusual environment with physical factors such as vibration and accelerations that could potentially affect the stability, and pharmacological properties of IV rtPA, an issue that has not been previously addressed. MATERIALS AND METHODS: This was a prospective cohort study of consecutive acute ischemic stroke patients receiving IV rtPA through a Comprehensive Stroke Center from November 2015 to February 2017 to measure the effects of HEMS on the integrity and activity of rtPA by collecting residual medication left in the vial...
July 20, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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