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https://www.readbyqxmd.com/read/27933399/implementation-of-clinical-decision-support-in-young-children-with-acute-gastroenteritis-a-randomized-controlled-trial-at-the-emergency-department
#1
Dorien Geurts, Evelien de Vos-Kerkhof, Suzanne Polinder, Ewout Steyerberg, Johan van der Lei, Henriëtte Moll, Rianne Oostenbrink
: Acute gastroenteritis (AGE) is one of the most frequent reasons for young children to visit emergency departments (EDs). We aimed to evaluate (1) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and (2) the impact on diagnostics, treatment, and costs compared with usual care by attending physician. A randomized controlled trial was performed in 222 children, aged 1 month to 5 years at the ED of the Erasmus MC-Sophia Children's hospital in The Netherlands ( 2010-2012)...
December 8, 2016: European Journal of Pediatrics
https://www.readbyqxmd.com/read/27933152/ensuring-availability-of-in-date-and-fit-for-purpose-emergency-guidelines-in-all-anaesthetic-areas-throughout-the-south-east-scotland-deanery
#2
Elise Hindle
Our aim was to institute a system whereby emergency anaesthetic guidelines are available in >90% of appropriate clinical areas throughout each of the acute hospital sites in three health board administrative regions, and whereby >90% of available guidelines are deemed to be in date and fit for purpose. Our objective was to achieve these targets within 6 months. Using quality improvement methodology, we inventoried available emergency anaesthetic guidelines in 132 locations throughout seven acute care hospitals...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27933150/implementing-mobile-devices-to-reduce-non-rostered-workload-for-junior-doctors
#3
Allan Plant, Suzanne Round, Joe Bourne
There is a large body of evidence demonstrating the detrimental effect of long work hours on the performance, mood, and job satisfaction of junior doctors. By extension these effects carry over into the realm of patient safety, compromising the quality of care provision. House officers in the general surgery department of Tauranga Hospital, New Zealand are often required to arrive at work well before their rostered start time of 7.30am to hand write the results of clinical investigations on their patient lists...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27929206/acute-bronchitis
#4
Scott Kinkade, Natalie A Long
Cough is the most common illness-related reason for ambulatory care visits in the United States. Acute bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia. Pneumonia should be suspected in patients with tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, and radiography is warranted. Pertussis should be suspected in patients with cough persisting for more than two weeks that is accompanied by symptoms such as paroxysmal cough, whooping cough, and post-tussive emesis, or recent pertussis exposure...
October 1, 2016: American Family Physician
https://www.readbyqxmd.com/read/27928375/a-randomised-controlled-trial-of-treatment-for-post-stroke-homonymous-hemianopia-screening-and-recruitment
#5
Fiona J Rowe, Elizabeth J Conroy, P Graham Barton, Emma Bedson, Emma Cwiklinski, Caroline Dodridge, Avril Drummond, Marta Garcia-Finana, Claire Howard, Stevie Johnson, Claire MacIntosh, Carmel P Noonan, Alex Pollock, Janet Rockliffe, Catherine M Sackley, Tracey Shipman
The authors report the screening process and recruitment figures for the VISION (Visual Impairment in Stroke; Intervention Or Not) trial. This is a prospective, randomised, single-blinded, three-arm controlled trial in 14 UK acute hospital stroke units. Stroke teams identified stroke survivors suspected as having homonymous hemianopia. Interventions included Fresnel prisms versus visual search training versus standard care (information only). Primary outcome was change in visual field assessment from baseline to 26 weeks...
February 2016: Neuro-ophthalmology
https://www.readbyqxmd.com/read/27926675/improvement-in-total-joint-replacement-quality-metrics-year-one-versus-year-three-of-the-bundled-payments-for-care-improvement-initiative
#6
John M Dundon, Joseph Bosco, James Slover, Stephen Yu, Yousuf Sayeed, Richard Iorio
BACKGROUND: In January 2013, a large, tertiary, urban academic medical center began participation in the Bundled Payments for Care Improvement (BPCI) initiative for total joint arthroplasty, a program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. Medicare Severity-Diagnosis Related Groups (MS-DRGs) 469 and 470 were included. We participated in BPCI Model 2, by which an episode of care includes the inpatient and all post-acute care costs through 90 days following discharge...
December 7, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27925447/rehospitalization-of-preterm-infants-according-to-the-discharge-risk-level
#7
Burcu Aykanat Girgin, Güler Cimete
PURPOSE: The rehospitalization rate of preterm infants is between 22 and 52% within the first year after discharge. The purpose of this study was to investigate the rehospitalization of preterm infants within 2 months following discharge, considering the level of risks originating from the infant, parents, and the social factors. DESIGN AND METHODS: The sample was composed of 238 preterm infants and their parents. The data were collected with a Descriptive Information Form, the Post-Discharge Infant Follow-up Form, and the Neonatal Discharge Assessment Tool (N-DAT)...
December 7, 2016: Journal for Specialists in Pediatric Nursing: JSPN
https://www.readbyqxmd.com/read/27924688/susceptibility-to-vaccine-preventable-diseases-and-vaccination-adherence-among-healthcare-workers-in-italy-a-cross-sectional-survey-at-a-regional-acute-care-university-hospital-and-a-systematic-review
#8
Umberto Leone Roberti Maggiore, Carolina Scala, Alessandra Toletone, Nicoletta Debarbieri, Mauro Perria, Beatrice D'Amico, Alfredo Montecucco, Mariano Martini, Guglielmo Dini, Paolo Durando
Healthcare Workers (HCWs) have an increased risk both to acquire and to spread vaccine preventable diseases (VPDs) both to their colleagues and, especially, to vulnerable patients. The prevention of occupational hazards among HCWs is based on proper adoption of the standard and additional precautions, immunizations, and secondary preventive measures, such as post-exposure prophylaxis. Moreover, HCWs are often referred to as the most trusted source of vaccine-related information for their patients. In the present article, we report the findings of a cross-sectional study investigating the compliance to vaccinations among HCWs employed at the Obstetric Unit of a regional acute-care University Hospital in Northern Italy...
December 7, 2016: Human Vaccines & Immunotherapeutics
https://www.readbyqxmd.com/read/27924176/our-clinical-experience-of-self-expanding-metal-stent-for-malignant-central-airway-obstruction
#9
Akash Verma, Chee Kiang Phua, Qiu Mei Wu, Wen Yuan Sim, Audrey Wee Chuan Rui, Soon Keng Goh, Benjamin Ho, Ai Ching Kor, Andrew S Y Wong, Albert Y H Lim, Dessmon Y H Tai, John Abisheganaden
BACKGROUND: We studied the safety, effectiveness, and limitations of airway stenting using self-expanding metal stent (SEMS) in patients with malignant central airway obstruction (CAO). METHODS: A retrospective review of records of patients undergoing SEMS placement for malignant CAO during year 2013 - 2014 was done. RESULTS: Sixteen patients (11 males and five females) underwent SEMS placement for malignant CAO. Median (range) age was 66 (54 - 78) years...
January 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/27923754/successful-coil-embolization-of-pediatric-carotid-cavernous-fistula-due-to-ruptured-post-traumatic-giant-internal-carotid-artery-aneurysm
#10
Daisuke Wajima, Ichiro Nakagawa, Hun Soo Park, Shohei Yokoyama, Takeshi Wada, Kimihiko Kichikawa, Hiroyuki Nakase
BACKGROUND: The goal of the treatment of direct carotid cavernous fistula (CCF) is to occlude the arteriovenous shunt and to preserve the patency of the concerned internal carotid artery (ICA). However, for the ipsilateral post-traumatic fragile cerebrum, coil embolization plus parent artery occlusion for the high flow direct CCF would be better for the prevention of hyper-perfusion syndrome and the intracranial hemorrhage. We experienced such a case and managed it successfully. CASE DESCRIPTION: A 6-year-old boy was suffered from severe head trauma caused by being hit by a car...
December 3, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27923537/using-acute-kidney-injury-severity-and-scoring-systems-to-predict-outcome-in-patients-with-burn-injury
#11
George Kuo, Shih-Yi Yang, Shiow-Shuh Chuang, Pei-Chun Fan, Chih-Hsiang Chang, Yen-Chang Hsiao, Yung-Chang Chen
BACKGROUND/PURPOSE: Acute kidney injury (AKI) is a frequent complication of severe burn injury and is associated with mortality. The definition of AKI was modified by the Kidney Disease Improving Global Outcomes Group in 2012. So far, no study has compared the outcome accuracy of the new AKI staging guidelines with that of the complex score system. Hence, we compared the accuracy of these approaches in predicting mortality. METHODS: This was a post hoc analysis of prospectively collected data from an intensive care burn unit in a tertiary care university hospital...
December 3, 2016: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/27922789/the-impact-of-stress-on-acute-wound-healing
#12
Julie Brown
Within the literature there is an accumulating body of evidence to suggest that psychological stress may have a negative impact on wound healing. This article examines the psychoneuroimmulogy theory associated with stress and acute wound healing with reference to caring for patients with surgical wounds. The evidence reviewed in this article highlights the value of understanding individual patient need for reducing stress pre and post operatively to benefit the healing process.
December 2016: British Journal of Community Nursing
https://www.readbyqxmd.com/read/27920753/neuroproteomics-and-systems-biology-approach-to-identify-temporal-biomarker-changes-post-experimental-traumatic-brain-injury-in-rats
#13
Firas H Kobeissy, Joy D Guingab-Cagmat, Zhiqun Zhang, Ahmed Moghieb, Olena Y Glushakova, Stefania Mondello, Angela M Boutté, John Anagli, Richard Rubenstein, Hisham Bahmad, Amy K Wagner, Ronald L Hayes, Kevin K W Wang
Traumatic brain injury (TBI) represents a critical health problem of which diagnosis, management, and treatment remain challenging. TBI is a contributing factor in approximately one-third of all injury-related deaths in the United States. The Centers for Disease Control and Prevention estimate that 1.7 million people suffer a TBI in the United States annually. Efforts continue to focus on elucidating the complex molecular mechanisms underlying TBI pathophysiology and defining sensitive and specific biomarkers that can aid in improving patient management and care...
2016: Frontiers in Neurology
https://www.readbyqxmd.com/read/27919450/development-and-validation-of-a-prediction-model-for-patients-discharged-to-post-acute-care-after-colorectal-cancer-surgery
#14
Elizabeth A Bailey, Rebecca L Hoffman, Christopher Wirtalla, Giorgos Karakousis, Rachel R Kelz
BACKGROUND: As payment shifts toward bundled reimbursement, decreasing unnecessary inpatient care may provide cost savings. This study examines the association between discharge status, hospital duration of stay, and cost for colorectal operation patients without complications and uses risk factors to predict the need for post-acute care. METHODS: We used the New York Statewide Planning and Research Cooperative System and the California Healthcare Cost and Utilization Project State Inpatient Databases to identify all patients who underwent operative resection for colorectal cancer in 2009-2010 and were discharged to home or post-acute care...
December 2, 2016: Surgery
https://www.readbyqxmd.com/read/27919270/delayed-hyperbaric-oxygen-therapy-for-air-emboli-after-open-heart-surgery-case-report-and-review-of-a-success-story
#15
Eva Niyibizi, Guillaume Elyes Kembi, Claude Lae, Rodrigue Pignel, Tornike Sologashvili
BACKGROUND: The current case describes a rare diagnosis of iatrogenic air emboli after elective cardiopulmonary bypass that was successfully treated with delayed hyperbaric oxygen therapy, with good clinical evolution in spite of rare complications. CASE PRESENTATION: A 35 years old male was admitted to the intensive care unit (ICU) for post-operative management after being placed on cardiopulmonary bypass (CPB) for an elective ventricular septal defect closure and aortic valvuloplasty...
December 5, 2016: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/27918156/-cesarean-section-incidence-and-vaginal-birth-success-rate-at-term-pregnancy-after-myomectomy
#16
L Mekiňová, P Janků, E Filipinská, J Kadlecová, P Ventruba
OBJECTIVE: To compare the incidence of primary and acute cesarean section (CS) and to compare success rate of vaginal delivery. To determine the frequency of maternal complications and evaluation of post-partum condition of the newborn. STUDY DESIGN: Prospective, pilot, cohort study. SETTING: Department of Gynecology and Obstetrics Masaryk University and University Hospital Brno. METHODS: Analysis of patients with physiologically ongoing singleton pregnancy and term delivery, vertex presentation...
2016: Ceská Gynekologie
https://www.readbyqxmd.com/read/27914968/segmenting-high-cost-medicare-patients-into-potentially-actionable-cohorts
#17
Karen E Joynt, Jose F Figueroa, Nancy Beaulieu, Robert C Wild, E John Orav, Ashish K Jha
BACKGROUND: Providers are assuming growing responsibility for healthcare spending, and prior studies have shown that spending is concentrated in a small proportion of patients. Using simple methods to segment these patients into clinically meaningful subgroups may be a useful and accessible strategy for targeting interventions to control costs. METHODS: Using Medicare fee-for-service claims from 2011 (baseline year, used to determine comorbidities and subgroups) and 2012 (spending year), we used basic demographics and comorbidities to group beneficiaries into 6 cohorts, defined by expert opinion and consultation: under-65 disabled/ESRD, frail elderly, major complex chronic, minor complex chronic, simple chronic, and relatively healthy...
November 30, 2016: Healthcare
https://www.readbyqxmd.com/read/27914720/improving-publication-quality-and-quantity-for%C3%A2-acute-care-authors-from-low-and-middle-income-settings
#18
Stevan R Bruijns, Megan Banner, Gabrielle A Jacquet
STUDY OBJECTIVE: Researchers from low- and middle-income countries have limited access to publishing and editing resources. This study describes a journal-initiated platform to improve publication quantity and quality in Sub-Saharan Africa emergency care research: Author Assist. METHODS: This is a descriptive report of a quality improvement project of referrals to the African Journal of Emergency Medicine's (AfJEM's) Author Assist program between January 2011 and December 2015...
November 30, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27914495/quantitative-increase-in-frailty-is-associated-with-diminished-survival-after-transcatheter-aortic-valve-replacement
#19
Dhaval Chauhan, Nicky Haik, Aurelie Merlo, Bruce J Haik, Chunguang Chen, Marc Cohen, Anne Mosenthal, Mark Russo
BACKGROUND: The purpose of this study is to assess the impact of frailty index comprised of commonly used frailty metrics on outcomes following transcatheter aortic valve replacement (TAVR) outcomes, including mortality, length of stay, and discharge destination. METHODS AND RESULTS: Retrospective data collection was performed for 342 consecutive patients who underwent TAVR at a single center from May 15, 2012, to September 17, 2015. Frailty index score was calculated using 15-ft walk test, Katz activities of daily living, preoperative serum albumin, and dominant handgrip strength...
December 2016: American Heart Journal
https://www.readbyqxmd.com/read/27912248/mean-arterial-blood-pressure-management-of-acute-spinal-cord-injured-patients-during-the-pre-hospital-and-early-admission-period
#20
Jin Wee Tee, Farhaan Altaf, Lise M Belanger, Tamir Ailon, John Street, Scott J Paquette, Michael C Boyd, Charles G Fisher, Marcel F Dvorak, Brian K Kwon
The optimization and maintenance of mean arterial blood pressure (MAP) and the general avoidance of systemic hypotension for the first 5 to 7 days following acute traumatic SCI is considered to be important for minimizing secondary spinal cord ischemic damage. The characterization of hemodynamic parameters in the immediate post-injury stage prior to admission to a specialized spine unit has not been previously reported. Here we describe the blood pressure management of 40 acute tSCI patients in the early post-injury phases of care prior to their arrival in a specialized spinal injury high dependency unit (HDU), intensive care unit (ICU) or operating room (OR)...
December 2, 2016: Journal of Neurotrauma
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