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https://www.readbyqxmd.com/read/28633767/temporal-variation-in-ankle-fractures-and-orthopedic-resident-program-planning-in-an-urban-level-1-trauma-center
#1
Aaron Wynkoop, Osy Ndubaku, Norman Walter, Theresa Atkinson
Previous studies have described the mechanism of ankle fractures, their seasonal variation, and fracture patterns but never in conjunction. In addition, the cohorts previously studied were either not from trauma centers or were often dominated by low-energy mechanisms. The present study aimed to describe the epidemiology of ankle fractures presenting to an urban level 1 trauma center. The records from an urban level 1 trauma center located in the Midwestern United States were retrospectively reviewed, and the injury mechanism and energy, time of injury, day of week, month, and patient characteristics (age, gender, comorbidities, smoking status) were collected...
July 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/28629348/applying-the-plan-do-study-act-pdsa-approach-to-a-large-pragmatic-study-involving-safety-net-clinics
#2
Jennifer Coury, Jennifer L Schneider, Jennifer S Rivelli, Amanda F Petrik, Evelyn Seibel, Brieshon D'Agostini, Stephen H Taplin, Beverly B Green, Gloria D Coronado
BACKGROUND: The Plan-Do-Study-Act (PDSA) cycle is a commonly used improvement process in health care settings, although its documented use in pragmatic clinical research is rare. A recent pragmatic clinical research study, called the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), used this process to optimize the research implementation of an automated colon cancer screening outreach program in intervention clinics. We describe the process of using this PDSA approach, the selection of PDSA topics by clinic leaders, and project leaders' reactions to using PDSA in pragmatic research...
June 19, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28627039/consensus-building-on-developing-dysphagia-competence-a-north-west-of-england-perspective
#3
Susan Guthrie, John Lancaster, Jois Stansfield
BACKGROUND: Dysphagia has been an increasing area of practice for speech and language therapists (SLTs) for over 20 years, and throughout that period there has been debate about how practical skills in dysphagia can best be developed. The implementation of the new Royal College of Speech and Language Therapists (RCSLT) framework was considered from a regional perspective seeking to establish consensus across different speech and language therapy settings. AIM: To explore practical solutions to the development of dysphagia competency in new graduates whilst acknowledging the wide variation in staffing and clinical dysphagia experience across the geographical and clinical landscape in the North West of England...
June 19, 2017: International Journal of Language & Communication Disorders
https://www.readbyqxmd.com/read/28625562/do-trauma-courses-change-practice-a-qualitative-review-of-20-courses-in-east-central-and-southern-africa
#4
Rele Ologunde, Grace Le, Jim Turner, Hemant Pandit, Noel Peter, David Maurer, Sam Hodgson, Joseph Larvin, Chris Lavy
BACKGROUND: Trauma courses have been shown to improve clinical knowledge and patient outcomes. However, little is known about the individual drivers of change in practice amongst course participants in their home clinic environment. METHODS: Front-line healthcare workers participated in a two-day Primary Trauma Care (PTC) course. Immediately after the course participants completed an evaluation survey on intended change in the management of trauma patients. Six months after the course, participants completed a survey on actual changes that had occurred...
June 13, 2017: Injury
https://www.readbyqxmd.com/read/28625430/sensorimotor-and-executive-function-slowing-in-anesthesiology-residents-after-overnight-shifts
#5
George W Williams, Bairavi Shankar, Eliana M Klier, Alice Z Chuang, Salma El Marjiya-Villarreal, Omonele O Nwokolo, Aanchal Sharma, Anne B Sereno
STUDY OBJECTIVE: Medical residents working overnight call shifts experience sleep deprivation and circadian clock disruption. This leads to deficits in sensorimotor function and increases in workplace accidents. Using quick tablet-based tasks, we investigate whether measureable executive function differences exist following a single overnight call versus routine shift, and whether factors like stress, rest and caffeine affect these measures. DESIGN: A prospective, observational, longitudinal, comparison study was conducted...
August 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28625030/the-clinical-nutrition-research-agenda-in-indonesia-and-beyond-ecological-strategy-for-food-in-health-care-delivery
#6
Widjaja Lukito, Lindawati Wibowo, Mark L Wahlqvist
Despite progress with the food-associated health agenda in the public health and clinical domains, much remains to be done in Indonesia. There are reasons to be optimistic which include economic development, increasing literacy, progress towards universal health coverage and community organizational arrangements across the archipelago which focus on health through some 10,000 puskesmas. These community health centres are variably staffed with voluntary cadres from the community, bidans (nurses) and general medical practitioners...
June 2017: Asia Pacific Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28622763/treatment-decisions-and-mortality-in-hiv-positive-presumptive-smear-negative-tb-in-the-xpert%C3%A2-mtb-rif-era-a-cohort-study
#7
Sabine M Hermans, Juliet A Babirye, Olive Mbabazi, Francis Kakooza, Robert Colebunders, Barbara Castelnuovo, Christine Sekaggya-Wiltshire, Rosalind Parkes-Ratanshi, Yukari C Manabe
BACKGROUND: The Xpert™ MTB/RIF (XP) has a higher sensitivity than sputum smear microscopy (70% versus 35%) for TB diagnosis and has been endorsed by the WHO for TB high burden countries to increase case finding among HIV co-infected presumptive TB patients. Its impact on the diagnosis of smear-negative TB in a routine care setting is unclear. We determined the change in diagnosis, treatment and mortality of smear-negative presumptive TB with routine use of Xpert MTB/RIF (XP). METHODS: Prospective cohort study of HIV-positive smear-negative presumptive TB patients during a 12-month period after XP implementation in a well-staffed and trained integrated TB/HIV clinic in Kampala, Uganda...
June 16, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28617622/treatment-and-communication-that-is-what-matters-an-analysis-of-complaints-regarding-end-of-life-care
#8
Jiska Cohen-Mansfield, Michal Skornick-Bouchbinder, Rinat Cohen, Shai Brill
BACKGROUND: Investigating complaints concerning end-of-life (EoL) care is a necessary step for improving the quality of life at its final stage. OBJECTIVE: We aimed to classify and quantify the aspects of EoL care that require improvement by analyzing caregivers' feedback on the care their relatives received before death. DESIGN: A survey of primary family caregivers of deceased patients. SETTING/SUBJECTS: Relatives of decedents were recruited through two geriatric medical centers and from persons contacted for other studies, who reported losing a relative...
June 15, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28617264/the-professional-quality-criteria-of-italian-breast-screening-radiologists-results-from-a-national-survey-comparing-the-programmes-started-in-2000-2012-versus-the-ones-started-in-1990-1999
#9
Doralba Morrone, Livia Giordano, Franca Artuso, Daniela Bernardi, Chiara Fedato, Alfonso Frigerio, Daniela Giorgi, Carlo Naldoni, Gianni Saguatti, Daniela Severi, Mario Taffurelli, Daniela Terribile, Leonardo Ventura, Lauro Bucchi
INTRODUCTION: In Italy, due to increasing healthcare budget and staff shortages, the recently created regional mammography screening programmes were established under worse radiology practice quality criteria than the previously created programmes. METHODS: Using available data from a national questionnaire survey conducted at the end of 2013 and involving 222 responder radiologists, we compared the main professional quality standards of radiologists working in the screening programmes established during the period 2000-2012 with those working in the screening programmes created from 1990 to 1999...
April 2017: Annali Dell'Istituto Superiore di Sanità
https://www.readbyqxmd.com/read/28617206/utilization-patterns-at-a-specialized-children-s-comprehensive-psychiatric-emergency-program
#10
Ruth Gerson, Jennifer Havens, Mollie Marr, Amy Storfer-Isser, Mia Lee, Carolena Rojas Marcos, Michelle Liu, Sarah McCue Horwitz
OBJECTIVE: Most youths experiencing a psychiatric crisis present to emergency departments (EDs) that lack the specialized staff to evaluate them, so youths are often discharged without appropriate mental health assessment or treatment. To better understand the needs of this population, this study described clinical details and disposition associated with visits for psychiatric emergencies to a specialized ED staffed 24/7 by child psychiatrists. METHODS: Through retrospective chart review, 1,180 visits to the ED during its first year of operation were reviewed for clinical characteristics, prior service utilization, and demographic characteristics...
June 15, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28611873/the-economics-of-an-admissions-holding-unit
#11
Kraftin E Schreyer, Richard Martin
INTRODUCTION: With increasing attention to the actual cost of delivering care, return-on-investment calculations take on new significance. Boarded patients in the emergency department (ED) are harmful to clinical care and have significant financial opportunity costs. We hypothesize that investment in an admissions holding unit for admitted ED patients not only captures opportunity cost but also significantly lowers direct cost of care. METHODS: This was a three-phase study at a busy urban teaching center with significant walkout rate...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28610523/nursing-workforce-crisis-is-self-inflicted
#12
James Buchan
For years this country has been sleepwalking towards a major nursing shortage that is self-inflicted. The Brexit vote was a wake-up call, but it has merely quickened the pace towards a staffing crisis that was already coming.
June 14, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28608513/out-of-office-hours-elective-surgical-intensive-care-admissions-and-their-associated-complications
#13
David J R Morgan, Kwok Ming Ho, Yang Jian Ong, Marlene L Kolybaba
BACKGROUND: The 'weekend' effect is a controversial theory that links reduced staffing levels, staffing seniority and supportive services at hospitals during 'out-of-office hours' time periods with worsening patient outcomes. It is uncertain whether admitting elective surgery patients to intensive care units (ICU) during 'out-of-office hours' time periods mitigates this affect through higher staffing ratios and seniority. METHODS: Over a 3-year period in Western Australia's largest private hospital, this retrospective nested-cohort study compared all elective surgical patients admitted to the ICU based on whether their admission occurred 'in-office hours' (Monday-Friday 08...
June 12, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28607678/choosing-wisely-a-quality-improvement-initiative-to-decrease-unnecessary-preoperative-testing
#14
John Matulis, Stephen Liu, John Mecchella, Frederick North, Alison Holmes
Dartmouth-Hitchcock Medical Center is a rural, academic medical center in the northeastern United States; its General Internal Medicine (GIM) division performs about 900 low and intermediate surgical risk preoperative evaluations annually. Routine preoperative testing in these evaluations is widely considered a low-value service. Our baseline data sample showed unnecessary testing rates of approximately 36%. A multi-disciplinary team used a micro-systems approach to analyze the existing process and formulate a rapid cycle improvement strategy...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28606168/direct-cost-comparison-of-minimally-invasive-punch-technique-versus-traditional-approaches-for-percutaneous-bone-anchored-hearing-devices
#15
Yaeesh Sardiwalla, Nicholas Jufas, David P Morris
BACKGROUND: Minimally Invasive Ponto Surgery (MIPS) was recently described as a new technique to facilitate the placement of percutaneous bone anchored hearing devices. The procedure has resulted in a simplification of the surgical steps and a dramatic reduction in surgical time while maintaining excellent patient outcomes. Given these developments, our group sought to move the procedure from the main operating suite where they have traditionally been performed. This study aims to test the null hypothesis that MIPS and open approaches have the same direct costs for the implantation of percutaneous bone anchored hearing devices in a Canadian public hospital setting...
June 12, 2017: Journal of Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/28606003/patient-satisfaction-is-linked-to-nursing-workload-in-a-singapore-hospital
#16
Mien Li Goh, Emily N K Ang, Yiong-Huak Chan, Hong-Gu He, Katri Vehviläinen-Julkunen
No studies have examined the association between patient satisfaction and the allocation of nursing care hours using a workload management system. The aim of this study is to examine the correlation between inpatients' perceived satisfaction with nursing care and nursing workload management in a Singapore hospital. A secondary data analysis was performed based on the results of 270 patients' perceived satisfaction measured by the Revised Humane Caring Scale and nursing workload management data extracted from the TrendCare Patient Acuity System...
June 1, 2017: Clinical Nursing Research
https://www.readbyqxmd.com/read/28602581/substance-use-disorder-treatment-services-for-women-in-the-veterans-health-administration
#17
Christine Timko, Katherine J Hoggatt, Frances M Wu, Amanda Tjemsland, Michael Cucciare, Amy Rubin, Tracy L Simpson
PURPOSE: The present study used national Veterans Health Administration (VHA) facility-level data to examine the extent of women's specialty substance use disorder (SUD) treatment programming in the VHA. In addition, the study compared facilities with women's specialty SUD programming with facilities without to determine whether having this programming was associated with serving other special patient populations, treatment staffing, and breadth of service provision. METHODS: The study used data from the VHA Program Evaluation and Resource Center's Drug and Alcohol Program Survey, conducted in 2015 (100% response rate among VHA specialty SUD treatment programs)...
June 8, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/28599196/understanding-and-addressing-missed-care-in-clinical-placements-implications-for-nursing-students-and-nurse-educators
#18
Annamaria Bagnasco, Fiona Timmins, Jan M A de Vries, Giuseppe Aleo, Milko Zanini, Gianluca Catania, Loredana Sasso
This paper addresses the issue of substandard care and its effects on healthcare practice. It explores some recent concerns about the problem in nursing, its potential effects on students, how it can be conceptualised and what action needs to be, by both nurses and educators to prevent it. Recent healthcare scandals have tarnished the public image of nursing, and are also likely to influence nursing students' images, expectations and experiences of nursing. While much attention has been paid to the examination of such lapses in care, and potential corrective actions, little attention has been paid to the potential or actual effect on nursing students in practice...
May 23, 2017: Nurse Education Today
https://www.readbyqxmd.com/read/28598227/integration-of-a-palliative-care-intervention-into-community-practice-for-lung-cancer-a-study-protocol-and-lessons-learned-with-implementation
#19
Huong Q Nguyen, Thomas Cuyegkeng, Tieu O Phung, Karisa Jahn, Tami Borneman, Mayra Macias, Nora Ruel, Betty Ferrell
BACKGROUND: A notable gap in the evidence base for outpatient palliative care (PC) for cancer is that most trials were conducted in specialized oncology or academic centers with limited translation and further evaluation in "real-world" settings. Health systems are desperate for guidance regarding the most effective and sustainable PC service models. OBJECTIVE: Describe the study protocol to evaluate the dissemination of a previously tested nurse-led PC intervention (PCI) for patients with lung cancer and their family caregiver in community-based settings, lessons learned in adapting and implementing the PCI, and implications for future dissemination-translational efforts Design: Two-group, prospective sequential, quasi-experimental design with Phase 1 (Usual care) followed by Phase 2 (Intervention) setting/subjects...
June 9, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28597362/a-system-wide-approach-to-physician-efficiency-and-utilization-rates-for-non-operating-room-anesthesia-sites
#20
Mitchell H Tsai, Tinh T Huynh, Max W Breidenstein, Stephen E O'Donnell, Jesse M Ehrenfeld, Richard D Urman
There has been little in the development or application of operating room (OR) management metrics to non-operating room anesthesia (NORA) sites. This is in contrast to the well-developed management framework for the OR management. We hypothesized that by adopting the concept of physician efficiency, we could determine the applicability of this clinical productivity benchmark for physicians providing services for NORA cases at a tertiary care center. We conducted a retrospective data analysis of NORA sites at an academic, rural hospital, including both adult and pediatric patients...
July 2017: Journal of Medical Systems
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