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https://www.readbyqxmd.com/read/28513869/transition-of-intravenous-treprostinil-to-oral-therapy-in-a-patient-with-functional-class-iv-chronic-thromboembolic-pulmonary-hypertension
#1
Kristina M Thurber, Breann M Williams, Ruth E Bates, Robert P Frantz
Chronic thromboembolic pulmonary hypertension (CTEPH) occurs when pulmonary emboli fail to resolve with anticoagulation. For patients with inoperable or residual CTEPH, riociguat is currently the only therapy approved by the United States Food and Drug Administration. However, some patients with CTEPH may require therapy beyond riociguat, such as intravenous prostacyclins, which can present significant administration challenges in patients with complex comorbid conditions. We describe a 42-year-old man with T12 paraplegia complicated by CTEPH (functional class IV with substantial right ventricular dysfunction) and severe pressure ulcers...
May 17, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28511055/professional-midwifery-in-guatemala-a-qualitative-exploration-of-perceptions-attitudes-and-expectations-among-stakeholders
#2
Anna Summer, Sylvia Guendelman, Edgar Kestler, Dilys Walker
BACKGROUND: Despite recommendations that women give birth with a skilled birth attendant (SBA), 70% of births in Guatemala occur outside health facilities with informally trained traditional birth attendants (TBAs). To increase SBA in rural, indigenous communities, a professional midwifery school accredited by the government is scheduled to open in 2017. Drawing from Filby's model on barriers to the successful integration of professional midwifery into health systems, this paper aims to identify threats - and facilitators-toward professional midwifery's re-introduction in Guatemala...
May 4, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28506606/metabolic-syndrome-and-in-hospital-outcomes-among-pancreatic-cancer-patients
#3
Neomi Vin Raviv, Swati Sakhuja, Megan Schlachter, Tomi Akinyemiju
AIMS: Metabolic Syndrome (MetS) is an important etiologic and prognostic factor for pancreatic cancer, but few studies have assessed health outcomes among hospitalized pancreatic cancer patients. We examined the associations between MetS and in-hospital outcomes, i.e. pancreatic resection, post-surgery complications, in-hospital mortality and discharge disposition among hospitalized patients with pancreatic cancer. METHODS: Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) dataset from 2007 to 2011, we obtained data on 47,386 patients hospitalized with a primary diagnosis of pancreatic cancer...
April 25, 2017: Diabetes & Metabolic Syndrome
https://www.readbyqxmd.com/read/28497099/acetabular-fractures-in-the-senior-population-epidemiology-mortality-and-treatments
#4
Reza Firoozabadi, William W Cross, James C Krieg, Milton L Chip Routt
BACKGROUND: Management of acetabular fractures in the senior population can be one of the most challenging injuries to manage. Furthermore, treating surgeons have a paucity of information to guide the treatment in this patient population. THE PURPOSE OF THIS STUDY WAS TO DETERMINE: (1) demographic and epidemiologic data, (2) mortality rates for nonoperative compared to operative management at different time points, (3) common fracture configurations, and (4) fracture fixation strategies in senior patients treated with acetabular fractures...
March 2017: Archives of Bone and Joint Surgery
https://www.readbyqxmd.com/read/28490421/patientvoice-development-of-a-preparatory-pre-chemotherapy-online-communication-tool-for-older-patients-with-cancer
#5
Sandra van Dulmen, Jeanine A Driesenaar, Julia Cm van Weert, Mara van Osch, Janneke Noordman
BACKGROUND: Good communication around cancer treatment is essential in helping patients cope with their disease and related care, especially when this information is tailored to one's needs. Despite its importance, communication is often complex, in particular in older patients (aged 65 years or older). In addition to the age-related deterioration in information and memory processing older patients experience, communication is also complicated by their required yet often unmet role of being an active, participatory patient...
May 10, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28486654/oxygen-availability-and-nursing-capacity-for-oxygen-therapy-in-ugandan-paediatric-wards
#6
Juliet Nabwire, Sophie Namasopo, Michael Hawkes
Oxygen is essential, life-saving, supportive treatment for children with hypoxaemia but is not available in many resource-constrained health facilities. We conducted a cross-sectional survey of oxygen availability and nurses' skills for oxygen administration at the paediatric wards of 11 district hospitals in eastern Uganda. Functional oxygen delivery was available at the paediatric wards of only 2 of 11 (18%) hospitals. Of the six concentrators found, two did not function at all and two produced a stream of O2 <80% pure...
May 8, 2017: Journal of Tropical Pediatrics
https://www.readbyqxmd.com/read/28476495/outcomes-over-90-day-episodes-of-care-in-medicare-fee-for-service-beneficiaries-receiving-joint-arthroplasty
#7
Addie Middleton, Yu-Li Lin, James E Graham, Kenneth J Ottenbacher
BACKGROUND: In an effort to improve quality and reduce costs, payments are being increasingly tied to value through alternative payment models, such as episode-based payments. The objective of this study was to better understand the pattern and variation in outcomes among Medicare beneficiaries receiving lower extremity joint arthroplasty over 90-day episodes of care. METHODS: Observed rates of mortality, complications, and readmissions were calculated over 90-day episodes of care among Medicare fee-for-service beneficiaries who received elective knee arthroplasty and elective or nonelective hip arthroplasty procedures in 2013-2014 (N = 640,021)...
March 30, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28475644/measuring-three-aspects-of-motivation-among-health-workers-at-primary-level-health-facilities-in-rural-tanzania
#8
Miho Sato, Deogratias Maufi, Upendo John Mwingira, Melkidezek T Leshabari, Mayumi Ohnishi, Sumihisa Honda
BACKGROUND: The threshold of 2.3 skilled health workers per 1,000 population, published in the World Health Report in 2006, has galvanized resources and efforts to attain high coverage of skilled birth attendance. With the inception of the Sustainable Development Goals (SDGs), a new threshold of 4.45 doctors, nurses, and midwives per 1,000 population has been identified. This SDG index threshold indicates the minimum density to respond to the needs of health workers to deliver a much broader range of health services, such as management of non-communicable diseases to meet the targets under Goal 3: Ensure healthy lives and promote well-being for all people of all ages...
2017: PloS One
https://www.readbyqxmd.com/read/28472817/fistula-isolation-and-the-use-of-negative-pressure-to-promote-wound-healing-a-case-study
#9
Kersten E Reider
BACKGROUND: A 54-year-old morbidly obese woman with a small bowel obstruction and large ventral hernia was admitted to hospital. She underwent an exploratory laparotomy, lysis of adhesions, and ventral hernia repair with mesh placement. She subsequently developed an enteroatmospheric fistula; several months of hospital care was required to effectively manage the wound and contain effluent from the fistula. METHODS: Several approaches were used to manage output from the fistula during her hospital course...
May 2017: Journal of Wound, Ostomy, and Continence Nursing
https://www.readbyqxmd.com/read/28471793/assessment-of-activity-of-daily-living-among-older-adult-patients-in-home-healthcare-and-skilled-nursing-facilities-an-integrative-review
#10
Zainab Toteh Osakwe, Elaine Larson, Mansi Agrawal, Jinjing Shang
Older adult's ability to self-manage illness is dependent on their ability to perform activities of daily living (ADL). Forty-five percent of those older than 65 years will have ongoing clinical needs after hospital discharge and require postacute care (PAC) services in settings such as home healthcare (HHC) and skilled nursing facilities (SNF). The Improving Medicare Post-Acute Care Transformation Act of 2014 requires PAC providers to begin collecting and reporting ADL data to build a coordinated approach to payment and standardize patient assessments and quality measurement...
May 2017: Home Healthcare Now
https://www.readbyqxmd.com/read/28465128/nursing-home-physicians-assessments-of-barriers-and-strategies-for-end-of-life-care-in-norway-and-the-netherlands
#11
Anette Fosse, Sytse Zuidema, Froukje Boersma, Kirsti Malterud, Margrethe Aase Schaufel, Sabine Ruths
OBJECTIVES: Working conditions in nursing homes (NHs) may hamper teamwork in providing quality end-of-life (EOL) care, especially the participation of NH physicians. Dutch NH physicians are specialists or trainees in elderly care medicine with NHs as the main workplace, whereas in Norway, family physicians usually work part time in NHs. Thus, we aimed at assessing and comparing NH physicians' perspectives on barriers and strategies for providing EOL care in NHs in Norway and in The Netherlands...
April 29, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28463059/using-the-eco-map-and-ecosystems-perspective-to-guide-skilled-nursing-facility-discharge-planning
#12
V J Miller, N L Fields, G Adorno, A Smith-Osborne
No abstract text is available yet for this article.
May 2, 2017: Journal of Gerontological Social Work
https://www.readbyqxmd.com/read/28457493/nursing-home-care-trajectories-for-older-adults-following-in-hospital-palliative-care-consultation
#13
Joan G Carpenter, Patricia H Berry, Mary Ersek
Palliative care consultation (PCC) during hospitalization is increasingly common for older adults with life-limiting illness discharged to nursing homes. The objective of this qualitative descriptive study was to describe the care trajectories and experiences of older adults admitted to a nursing home following a PCC during hospitalization. Twelve English-speaking adults, mean age 80 years, who received a hospital PCC and discharge to a nursing home without hospice. Data were collected from medical records at five time points from hospital discharge to 100 days after nursing home admission and care trajectories were mapped...
April 27, 2017: Geriatric Nursing
https://www.readbyqxmd.com/read/28455194/improving-medication-information-transfer-between-hospitals-skilled-nursing-facilities-and-long-term-care-pharmacies-for-hospital-discharge-transitions-of-care-a-targeted-needs-assessment-using-the-intervention-mapping-framework
#14
Luiza Kerstenetzky, Matthew J Birschbach, Katherine F Beach, David R Hager, Korey A Kennelty
INTRODUCTION: Patients transitioning from the hospital to a skilled nursing home (SNF) are susceptible to medication-related errors resulting from fragmented communication between facilities. Through continuous process improvement efforts at the hospital, a targeted needs assessment was performed to understand the extent of medication-related issues when patients transition from the hospital into a SNF, and the gaps between the hospital's discharge process, and the needs of the SNF and long-term care (LTC) pharmacy...
April 7, 2017: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/28455180/the-cost-of-unnecessary-hospital-days-for-medicare-joint-arthroplasty-patients-discharging-to-skilled-nursing-facilities
#15
Udai S Sibia, Justin J Turcotte, James H MacDonald, Paul J King
BACKGROUND: The 72-hour Medicare mandate (3-night stay rule) requires a 3-day inpatient stay for patients discharging to skilled nursing facilities (SNFs). Studies show that 48%-64% of Medicare total joint arthroplasty (TJA) patients are safe for discharge to SNFs on postoperative day (POD) #2. The purpose of this study was to extrapolate the financial impact of the 3-night stay rule. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all primary TJAs performed in 2015...
April 5, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28455179/nonelective-primary-total-hip-arthroplasty-the-effect-of-discharge-destination-on-postdischarge-outcomes
#16
Chirag K Shah, Aakash Keswani, Debbie Chi, Alex Sher, Karl M Koenig, Calin S Moucha
BACKGROUND: Medicare has enacted a mandatory bundled payment program for primary total joint arthroplasty that includes nonelective primary total hip arthroplasty (THA). Efficient postacute care management has been identified as an opportunity to improve value for patients. We aimed to identify risk factors for and compare rates of complications by discharge destination and then use those factors to risk-stratify non-elective THA patients. METHODS: Patients who underwent nonelective primary THA from 2011 to 2014 were identified in the American College of Surgeons National Surgical Quality Improvement Program database and categorized into those discharged to skilled nursing facility or inpatient rehabilitation facility vs home self-managed/home health (HHH)...
March 30, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28441373/cost-effectiveness-analysis-of-interventions-to-reduce-risk-of-aspiration-in-elderly-cancer-survivors-residing-in-skilled-nursing-facilities
#17
S Mantravadi
BACKGROUND: Aspiration can occur in patients of any age group, but it can be prevented. The primary population at risk is made up of survivors of cancer because of their increased risk of mucositis, mucosal atrophy, and dysphagia associated with chemotherapy, radiotherapy, and the disease process itself. The rate of incidence of aspiration cannot be quantified, because minor cases of aspiration often go unreported. Sequelae ensuing from aspirations can include pneumonia, end-stage kidney disease, dialysis, and death...
April 2017: Cancer Control: Journal of the Moffitt Cancer Center
https://www.readbyqxmd.com/read/28438261/the-affordable-care-act-and-its-association-with-length-of-stay-and-payer-status-for-trauma-patients-at-a-level-i-trauma-center
#18
Vicente Jose Undurraga Perl, Chris Dodgion, Kyle Hart, Bruce Ham, Martin Schreiber, David Zonies
BACKGROUND: We hypothesized that the ACA would shorten length of stay and increase numbers of insured patients without changing trauma patient outcomes. METHODS: A retrospective review of adult trauma patients admitted to a level I trauma center between 2012 and 2014 was performed. Demographics, length of stay, payer status, discharge disposition, and complications before and after the ACA implementation were analyzed. RESULTS: 4448 trauma patients were admitted during the study period...
April 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28431908/implementation-of-a-person-centered-medical-care-model-in-a-skilled-nursing-facility-a-pilot-evaluation
#19
Kathleen Abrahamson, Jaclyn Myers, Arif Nazir
OBJECTIVES: The objective of this study was to evaluate the feasibility and impact of implementing a person-centered medical care model for post-acute care residents within a skilled nursing facility (SNF). DESIGN: A mixed-method (qualitative and quantitative) pilot evaluation. SETTING: An 89-bed SNF located within a large midwestern city. PARTICIPANTS: Forty SNF post-acute patients admitted to the facility during a 6-month period were enrolled in the pilot evaluation...
April 18, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28425153/nursing-students-preferences-for-clinical-placements-in-the-residential-aged-care-setting
#20
Emma Lea, Annette Marlow, Erika Altmann, Helen Courtney-Pratt
AIMS AND OBJECTIVES: To examine nursing student placement preferences submitted as online comments to a university's placement management system, to inform strategies for positive residential aged care experiences. BACKGROUND: There are predicted shortages of nurses to service an ageing population. Clinical placements undertaken by undergraduate nursing students help shape their attitudes and are a key determinant of career decision-making, yet there is little research about why students prefer particular placement areas...
April 20, 2017: Journal of Clinical Nursing
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