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https://www.readbyqxmd.com/read/28742681/targeting-value-driven-quality-improvement-for-laparoscopic-cholecystectomy-in-michigan
#1
Kyle H Sheetz, Brooke Kenney, James M Dupree, Darrell A Campbell, Michael J Englesbe
OBJECTIVE: The purpose of this study was to evaluate complete episode expenditures for laparoscopic cholecystectomy, a common and lower-risk operation, to characterize novel targets for value-based quality improvement. SUMMARY BACKGROUND DATA: Despite enthusiasm for improving the overall value of surgical care, most efforts have focused on high-risk inpatient surgery. METHODS: We identified 19,213 patients undergoing elective laparoscopic cholecystectomy from 2012 to 2015 using data from Medicare and a large private payer...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28742186/l%C3%A3-sa-cystor-i-lilla-b%C3%A3-ckenet-%C3%A2-ov%C3%A3-ntat-operationsfynd-vid-buksm%C3%A3-rta
#2
Lovisa Brehmer, Maria Krång Lundekvam, Emelie Sternö, Anna-Maria Iglesias
Loose peritoneal cysts - unexpected finding at laparoscopic surgery for suspected extrauterine pregnancy, a case report A 29 year old woman was admitted to inpatient care in the 7th week of pregnancy due to three previous episodes of abdominal pain. At admission a suspected pseudogestational sac and 2 × 3 centimetres of fluid in the cul-de-sac was noted at vaginal ultrasound examination. After two days she again developed pain and a laparoscopy was performed due to suspected extrauterine pregnancy. Instead, three clusters of thin-walled, clear cysts was found lying loose in the cul-de-sac...
July 19, 2017: Läkartidningen
https://www.readbyqxmd.com/read/28739038/anesthetic-and-perioperative-management-of-patients-with-brugada-syndrome
#3
REVIEW
Gregory Dendramis, Claudia Paleologo, Giuseppe Sgarito, Umberto Giordano, Roberto Verlato, Adrian Baranchuk, Pedro Brugada
Brugada syndrome (BrS) is an arrhythmogenic disease reported to be one among the leading causes of cardiac death in subjects under the age of 40 years. In these patients, episodes of lethal arrhythmias may be induced by several factors or situations, and for this reason, management during anesthesia and surgery must provide some precautions and drugs restrictions. To date, it is difficult to formulate guidelines for anesthetic management of patients with BrS because of the absence of prospective studies, and there is not a definite recommendation for neither general nor regional anesthesia, and there are no large studies in merit...
June 28, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28738847/longitudinal-genomic-surveillance-of-multidrug-resistant-escherichia-coli-carriage-in-a-long-term-care-facility-in-the-united-kingdom
#4
Hayley J Brodrick, Kathy E Raven, Teemu Kallonen, Dorota Jamrozy, Beth Blane, Nicholas M Brown, Veronique Martin, M Estée Török, Julian Parkhill, Sharon J Peacock
BACKGROUND: Residents of long-term care facilities (LTCF) may have high carriage rates of multidrug-resistant pathogens, but are not currently included in surveillance programmes for antimicrobial resistance or healthcare-associated infections. Here, we describe the value derived from a longitudinal epidemiological and genomic surveillance study of drug-resistant Escherichia coli in a LTCF in the United Kingdom (UK). METHODS: Forty-five of 90 (50%) residents were recruited and followed for six months in 2014...
July 25, 2017: Genome Medicine
https://www.readbyqxmd.com/read/28738787/procalcitonin-guided-antibiotic-therapy-in-critically-ill-adults-a-meta-analysis
#5
Tao Zhang, Yan Wang, Qianting Yang, Yalin Dong
BACKGROUND: As a novel biomarker of inflammation, procalcitonin (PCT) has proven useful to guide antibiotic therapy in intensive care unit (ICU). However, there are controversial on mortality. The aim of this study was to evaluate the utility of PCT-guided antibiotic therapy in critically ill adults and determine whether studies are sufficient. METHODS: A systematic search in PubMed, Embase and Cochrane was performed. We included only randomized controlled trials which compared the safety and efficacy between PCT-guided or standard antibiotic therapy groups in ICU adults...
July 24, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28737623/an-observational-study-of-severe-pertussis-in-100-infants-%C3%A2-120-days-of-age
#6
James D Cherry, Kristen Wendorf, Brooke Bregman, Deborah Lehman, Delma Nieves, John S Bradley, Wilbert H Mason, Linette Sande-Lopez, Merrick Lopez, Myke Federman, Tempe Chen, Dean Blumberg, Samantha Johnston, Hayden T Schwenk, Peggy Weintrub, Kevin K Quinn, Kathleen Winter, Kathleen Harriman
BACKGROUND: Pertussis in young infants is a unique, severe, afebrile, cough illness that is frequently fatal. METHODS: All pertussis cases ≤ 120 days of age admitted to a pediatric intensive care unit (PICU) in California between October 1, 2013 and April 25, 2015 were evaluated. RESULTS: Of 100 pertussis patients ≤ 120 days of age admitted to PICU's, there were 5 deaths. The white blood cell (WBC) counts in the fatal cases were significantly higher than in the non-fatal cases...
July 20, 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/28737597/a-prospective-study-of-the-association-between-clinically-significant-bleeding-in-picu-patients-and-thrombocytopenia-or-prolonged-coagulation-times
#7
Paul C Moorehead, Nicholas J Barrowman, Janelle Cyr, Jamie Ray, Robert Klaassen, Kusum Menon
OBJECTIVE: There are no proven methods to predict the risk of clinically significant bleeding in the PICU. A retrospective study identified platelet count as a risk marker for clinically significant bleeding. We conducted a study to examine any association of platelet count, international normalized ratio, and activated partial thromboplastin time with bleeding risk in PICU patients. DESIGN: Prospective observational cohort study. SETTING: The PICU at the Children's Hospital of Eastern Ontario, a university-affiliated tertiary care pediatric center...
July 21, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28737596/creating-a-controlled-arterio-venous-shunt-by-reversing-the-extracorporeal-membrane-oxygenation-blood-flow-a-strategy-for-weaning-patients-off-veno-arterial-extracorporeal-membrane-oxygenation
#8
Christian Adrian Mattke, Emma Haisz, Nischal Pandya, Anthony Black, Prem Venugopal
OBJECTIVES: To assess whether reversing the veno-arterial extracorporeal membrane oxygenation blood flow (thereby creating a controlled arterio-venous shunt) can be used to wean children off extracorporeal membrane oxygenation. The standard practice for weaning patients off VA extracorporeal membrane oxygenation is to gradually reduce the blood flows delivered through the extracorporeal membrane oxygenation pump to a minimum level followed by either insertion of an "arterio-venous bridge" and clamping of the blood flow to the patient or direct decannulation...
July 21, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28737523/perioperative-management-of-severe-congenital-protein-c-deficiency
#9
Kentaro Watanabe, Motohiro Kato, Tetsuya Ishimaru, Mitsuteru Hiwatari, Tomonori Suzuki, Yoshihiro Minosaki, Junko Takita, Jun Fujishiro, Akira Oka
: Perioperative care of congenital protein C deficiency has not been well established. Here, we describe a patient with congenital protein C deficiency who underwent laparoscopic fundoplication and gastrostomy at 2 years of age. Preoperatively, we stopped warfarin, administered fresh frozen plasma, and activated protein C. These procedures were performed without bleeding or clotting events, and at 3 days after the procedures, we restarted warfarin. Several episodes of abdominal hemorrhage and purpura fulminans occurred 2-4 weeks postoperatively, and the events were managed conservatively...
July 21, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28736912/performance-of-the-index-of-dental-anxiety-and-fear-in-a-population-based-sample-of-adults
#10
H Ibrahim, K M Lyons, J M Armfield, W M Thomson
BACKGROUND: The Index of Dental Anxiety and Fear (IDAF-4C) was introduced to overcome the theoretical and practical shortcomings of previously developed dental fear measures. This new scale has not been tested on population samples other than in its country of origin, Australia. The aim of this study was to validate the IDAF-4C in a different cultural setting and to determine the prevalence and sociodemographic associations of dental anxiety. METHODS: A cross sectional study of a representative New Zealand adult population sample was undertaken...
July 24, 2017: Australian Dental Journal
https://www.readbyqxmd.com/read/28734712/-candidemia-in-pediatrics-species-distribution-and-antifungal-susceptibility
#11
Luciana B Guzzetti, Cecilia M Vescina, M Florencia Gil, Blanca M Gatti
Serious infections caused by Candida yeasts are frequent in the hospital population. Due to differences in species distribution and antifungal susceptibility testing depending on the geographic area and the type of patient, it is important to study the epidemiology of each institution. For this purpose, we conducted a retrospective, descriptive study on the occurrence of candidemia in the Children's Hospital "Superiora Sor María Ludovica" of the city of La Plata. In a 6-year period (2010-2015), 177 candidemia episodes were recorded...
July 19, 2017: Revista Argentina de Microbiología
https://www.readbyqxmd.com/read/28733926/perioperative-management-of-endocrine-insufficiency-after-total-pancreatectomy-for-neoplasia
#12
REVIEW
Ajay V Maker, Raashid Sheikh, Vinita Bhagia
PURPOSE: Indications for total pancreatectomy (TP) have increased, including for diffuse main duct intrapapillary mucinous neoplasms of the pancreas and malignancy; therefore, the need persists for surgeons to develop appropriate endocrine post-operative management strategies. The brittle diabetes after TP differs from type 1/2 diabetes in that patients have absolute deficiency of insulin and functional glucagon. This makes glucose management challenging, complicates recovery, and predisposes to hospital readmissions...
July 21, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28730744/improving-hospital-discharge-arrangements-for-people-who-are-homeless-a-realist-synthesis-of-the-intermediate-care-literature
#13
REVIEW
Michelle Cornes, Martin Whiteford, Jill Manthorpe, Joanne Neale, Richard Byng, Nigel Hewett, Michael Clark, Alan Kilmister, James Fuller, Robert Aldridge, Michela Tinelli
This review presents a realist synthesis of "what works and why" in intermediate care for people who are homeless. The overall aim was to update an earlier synthesis of intermediate care by capturing new evidence from a recent UK government funding initiative (the "Homeless Hospital Discharge Fund"). The initiative made resources available to the charitable sector to enable partnership working with the National Health Service (NHS) in order to improve hospital discharge arrangements for people who are homeless...
July 20, 2017: Health & Social Care in the Community
https://www.readbyqxmd.com/read/28728644/differential-associations-of-upps-p-impulsivity-traits-with-alcohol-problems
#14
Kayleigh N McCarty, David H Morris, Laura E Hatz, Denis M McCarthy
OBJECTIVE: The UPPS-P model posits that impulsivity comprises five factors: positive urgency, negative urgency, lack of planning, lack of perseverance, and sensation seeking. Negative and positive urgency are the traits most consistently associated with alcohol problems. However, previous work has examined alcohol problems either individually or in the aggregate, rather than examining multiple problem domains simultaneously. Recent work has also questioned the utility of distinguishing between positive and negative urgency, as this distinction did not meaningfully differ in predicting domains of psychopathology...
July 2017: Journal of Studies on Alcohol and Drugs
https://www.readbyqxmd.com/read/28728045/postdiagnosis-neurological-care-for-patients-with-psychogenic-nonepileptic-spells-pnes
#15
Chloe E Hill, Hannah Schwartz, Nabila Dahodwala, Brian Litt, Kathryn A Davis
OBJECTIVE: This study investigated continuity of neurological care for patients discharged from the epilepsy monitoring unit (EMU) with a diagnosis of psychogenic nonepileptic spells (PNES). Because PNES are seizure-like episodes that cannot be explained by abnormal electrical brain activity, they are challenging for patients to understand and accept. Consequently, after diagnosis, patients commonly fail to start recommended psychotherapy and instead pursue redundant medical care. As consistent relationships with healthcare providers may help, we instituted standard follow-up for patients diagnosed with PNES...
July 17, 2017: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/28727175/the-cost-of-treating-diabetic-ketoacidosis-in-the-uk-a-national-survey-of-hospital-resource-use
#16
K K Dhatariya, C Skedgel, R Fordham
AIM: Diabetic ketoacidosis is a commonly encountered metabolic emergency. In 2014, a national survey was conducted looking at the management of diabetic ketoacidosis in adult patients across the UK. The survey reported the clinical management of individual patients as well as institutional factors that teams felt were important in helping to deliver that care. However, the costs of treating diabetic ketoacidosis were not reported. METHODS: We used a 'bottom up' approach to cost analysis to determine the total expense associated with treating diabetic ketoacidosis in a mixed population sample...
July 20, 2017: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/28726598/pandemic-related-health-behavior-repeat-episodes-of-influenza-like-illness-related-to-the-2009-h1n1-influenza-pandemic
#17
O Mgbere, K Ngo, S Khuwaja, M Mouzoon, A Greisinger, R Arafat, J Markee
The Houston Health Department (HHD) in Texas tracks influenza-like illness (ILI) in the community through its Influenza Sentinel Surveillance Program, which began in 2008. After the influenza A(H1N1) pandemic (pH1N1) in 2009, investigators sought to assess the feasibility of this program as a non-traditional data source for tracking and monitoring care-seeking activities. Through the process of characterizing and describing patients who had 'return visits', or who were considered the heaviest ILI-related care-utilizers, the investigators sought to understand the strengths and limitations of this data source...
July 20, 2017: Epidemiology and Infection
https://www.readbyqxmd.com/read/28725856/association-between-medicare-star-ratings-for-patient-experience-and-medicare-spending-per-beneficiary-for-us-hospitals
#18
Stephen Trzeciak, John P Gaughan, Joshua Bosire, Mark Angelo, Adam S Holzberg, Anthony J Mazzarelli
OBJECTIVE: To test the association between patient experience and Centers for Medicare and Medicaid Services (CMS) spending at the hospital level. METHODS: Using CMS Hospital Compare data set, we analyzed 2014 data for CMS patient experience star ratings and the hospital Medicare Spending per Beneficiary (MSPB) Measure, which assesses price-standardized, risk-adjusted payments for services provided to Medicare beneficiaries for an episode of care from 3 days before hospital admission to 30 days following discharge...
March 2017: Journal of patient experience
https://www.readbyqxmd.com/read/28725850/how-can-home-care-patients-and-their-caregivers-better-manage-fall-risks-by-leveraging-information-technology
#19
Dari Alhuwail, Güneş Koru, Eun-Shim Nahm
OBJECTIVES: From the perspectives of home care patients and caregivers, this study aimed to (a) identify the challenges for better fall-risk management during home care episodes and (b) explore the opportunities for them to leverage health information technology (IT) solutions to improve fall-risk management during home care episodes. METHODS: Twelve in-depth semistructured interviews with the patients and caregivers were conducted within a descriptive single case study design in 1 home health agency (HHA) in the mid-Atlantic region of the United States...
December 2016: Journal of patient experience
https://www.readbyqxmd.com/read/28724552/cost-of-injury-care-in-india-cross-sectional-analysis-of-national-sample-survey-2014
#20
J P Tripathy, J Jagnoor, B M Prasad, R Ivers
BACKGROUND: Injuries account for nearly 10% of total deaths in India and this burden is likely to rise. We aimed to estimate the out-of-pocket (OOP) expenditure and catastrophic expenditure due to hospitalisation or outpatient care as a result of any injury and factors associated with incurring catastrophic expenditure. METHODS: Secondary analysis of nationally representative data for India collected by National Sample Survey Organization in 2014, reporting on health service utilisation and healthcare-related OOP expenditure by income quintiles and by type of health facility (public or private)...
July 19, 2017: Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention
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