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Hospital care

P Maxwell Courtney, David C Markel
With renewed focus on achieving value for patients in total hip and knee arthroplasty, payors, hospitals, and physicians strive to provide quality care while minimizing cost. Large registry datasets have gained popularity in the United States to track implant survivorship and outcomes after joint replacement. Partnerships among surgeons, insurers, and health systems have improved on earlier administrative datasets from Medicare to measure quality and outcomes. Participation in state and national registries can help surgeons and hospitals gain a financial advantage in several insurers' quality programs and alternative payment models...
October 24, 2016: Journal of Knee Surgery
Michel A Thibodeau, Josie Geller, Megumi Iyar
Collaboration is more acceptable and likely to produce favorable outcomes when providing care to individuals with eating disorders compared to directive care. We developed two self-report instruments that assess the extent to which carers (e.g., family, friends) of individuals with eating disorders provide collaborative vs. directive support (Support Behaviors Scale; SBH) and the extent to which carers believe that such approaches are helpful (Support Beliefs Scale; SBL). Participants were mothers, fathers, partners, friends and siblings (N=141) of eating disorder patients in hospital or residential treatment...
October 20, 2016: Eating Behaviors
Anthony A Iwuafor, Folasade T Ogunsola, Rita O Oladele, Oyin O Oduyebo, Ibironke Desalu, Chukwudi C Egwuatu, Agwu U Nnachi, Comfort N Akujobi, Ita O Ita, Godwin I Ogban
BACKGROUND: Infections are common complications in critically ill patients with associated significant morbidity and mortality. AIM: This study determined the prevalence, risk factors, clinical outcome and microbiological profile of hospital-acquired infections in the intensive care unit of a Nigerian tertiary hospital. MATERIALS AND METHODS: This was a prospective cohort study, patients were recruited and followed up between September 2011 and July 2012 until they were either discharged from the ICU or died...
2016: PloS One
Jochen Meyburg, Mona-Lisa Dill, Chani Traube, Gabrielle Silver, Rebecca von Haken
OBJECTIVE: Intensive care delirium is a substantial problem in adults. Intensive care delirium is increasingly recognized in pediatrics in parallel with the development of specific scoring systems for children. However, little is known about the fluctuating course of intensive care delirium in children after surgery and possible implications on diagnostic and therapeutic strategies. DESIGN: Patients that needed treatment in the PICU following elective surgery were screened for intensive care delirium with the Cornell Assessment of Pediatric Delirium...
October 21, 2016: Pediatric Critical Care Medicine
Anthony R Cai, Erica I Hodgman, Puneet B Kumar, Alvand J Sehat, Alexander L Eastman, Steven E Wolf
A significant proportion of patients appeared to arrive at our American Burn Association-verified burn center intubated without clear benefit. The current study aims to evaluate regional prehospital intubation practices and their outcomes. All consecutive admissions from November 2012 to June 2014 were reviewed for data points associated with intubation. Demographics and outcomes for patients who were intubated before arrival or within 24 hours of admission were compared using χ, Fisher's exact test, and the Kruskal-Wallis test as appropriate...
October 17, 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
Brian E Lacy, Michael D Crowell, Carole Mathis, David Bauer, Leslie J Heinberg
BACKGROUND AND AIMS: Gastroparesis (GP) patients suffer from recurrent symptoms of nausea, vomiting, early satiety, and abdominal pain. The impact of GP on quality of life (QoL), health care utilization and daily activities is not well understood. MATERIALS AND METHODS: Part 1: 398 adult patients (≥18 y) with documented GP (symptoms >6 mo) were surveyed to assess QoL and pain using the Short Form 36 and McGill pain questionnaires. Part 2: 491 adult GP patients were surveyed to evaluate employment status, work and daily activities, medication use, physician visits, diagnostic testing, emergency room visits, and hospitalizations related to their GP symptoms...
October 21, 2016: Journal of Clinical Gastroenterology
Puneeta Tandon, K Rajender Reddy, Jacqueline G O'Leary, Guadalupe Garcia-Tsao, Juan G Abraldes, Florence Wong, Scott W Biggins, Benedict Maliakkal, Michael B Fallon, Ram M Subramanian, Paul Thuluvath, Patrick S Kamath, Leroy R Thacker, Jasmohan S Bajaj
BACKGROUND AND AIMS: Identification of patients with cirrhosis at risk for death within 3 months of discharge from the hospital is essential to individualize post-discharge plans. The objective of the study was to identify an easy-to-use prognostic model based on the Karnofsky Performance Status (KPS). METHODS: NACSELD consists of 16 tertiary-care hepatology centers that prospectively enroll non-electively admitted cirrhotic patients. Patients enrolled had KPS assessed one week post-discharge...
October 24, 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Cunlin Wang, Robert Kane, Mark Levenson, Jeffrey Kelman, Michael Wernecke, Joo-Yeon Lee, Steven Kozlowski, Carmen Dekmezian, Zhiwei Zhang, Aliza Thompson, Kimberly Smith, Yu-Te Wu, Yuqin Wei, Yoganand Chillarige, Qin Ryan, Chris Worrall, Thomas E MaCurdy, David J Graham
Importance: In 2011, the US Centers for Medicare & Medicaid Services (CMS) changed its reimbursement policy for hemodialysis to a bundled comprehensive payment system that included the cost of erythrocyte-stimulating agents (ESAs). Also in 2011, the US Food and Drug Administration revised the drug label for ESAs, recommending more conservative dosing in patients with chronic kidney disease. In response to concerns that these measures could have adverse effects on patient care and outcomes, the CMS and the FDA initiated a collaboration to assess the effect...
October 24, 2016: JAMA Internal Medicine
Joseph Y Ting, Anne Synnes, Ashley Roberts, Akhil Deshpandey, Kimberly Dow, Eugene W Yoon, Kyong-Soon Lee, Simon Dobson, Shoo K Lee, Prakesh S Shah
Importance: Excessive antibiotic use has been associated with altered bacterial colonization and may result in antibiotic resistance, fungemia, necrotizing enterocolitis (NEC), and mortality. Exploring the association between antibiotic exposure and neonatal outcomes other than infection-related morbidities may provide insight on the importance of rational antibiotic use, especially in the setting of culture-negative neonatal sepsis. Objective: To evaluate the trend of antibiotic use among all hospitalized very low-birth-weight (VLBW) infants across Canada and the association between antibiotic use rates (AURs) and mortality and morbidity among neonates without culture-proven sepsis or NEC...
October 24, 2016: JAMA Pediatrics
Teryl K Nuckols, Emmett Keeler, Sally C Morton, Laura Anderson, Brian Doyle, Marika Booth, Roberta Shanman, Jonathan Grein, Paul Shekelle
Importance: Although quality improvement (QI) interventions can reduce central-line-associated bloodstream infections (CLABSI) and catheter-related bloodstream infections (CRBSI), their economic value is uncertain. Objective: To systematically review economic evaluations of QI interventions designed to prevent CLABSI and/or CRBSI in acute care hospitals. Evidence Review: A search of Ovid MEDLINE, Econlit, Centre for Reviews & Dissemination, New York Academy of Medicine's Grey Literature Report, Worldcat, prior systematic reviews (January 2004 to July 2016), and IDWeek conference abstracts (2013-2016), was conducted from 2013 to 2016...
October 24, 2016: JAMA Internal Medicine
Vivek Verma, Amy C Moreno, Steven H Lin
Radiation therapy (RT) as part of multidisciplinary oncologic care has been marked by profound advancements over the past decades. As part of multimodality therapy for esophageal cancer (EC), a prime goal of RT is to minimize not only treatment toxicities, but also postoperative complications and hospitalizations. Herein, discussion commences with the historical approaches to treating EC, including seminal trials supporting multimodality therapy. Subsequently, the impact of RT techniques, including three-dimensional conformal RT, intensity-modulated RT, and proton beam therapy, is examined through available data...
October 21, 2016: Journal of Clinical Medicine
Celia Laur, Hannah Marcus, Sumantra Ray, Heather Keller
Understanding the knowledge, attitudes, and practices (KAP) of hospital staff is needed to improve care activities that support the detection/prevention/treatment of malnutrition, yet quality measures are lacking. The purpose was to develop (study 1) and assess the administration and discriminative potential (study 2) of using such a KAP measure in acute care. In study 1, a 27-question KAP questionnaire was developed, face validated (n = 5), and tested for reliability (n = 35). Kappa and Intraclass Correlation (ICC) were determined...
October 20, 2016: Healthcare (Basel, Switzerland)
Ali Ghanchi
On Friday, November 13, 2015, Paris was subjected to a multiple terrorist attack that caused widespread carnage. Although French emergency planning, response, and resilience procedures (Plan Blanc) anticipated crisis management of a major incident, these had to be adapted to the local context of Pitié-Salpêtrière University Teaching Hospital. Health care workers had undergone Plan Blanc training and exercises and it was fortunate that such a drill had occurred on the morning of the attack. The procedures were observed to work well because this type of eventuality had been fully anticipated, and staff performance exceeded expectations owing to prior in-depth training and preparations...
October 2016: Disaster Medicine and Public Health Preparedness
Nancy M Heddle, Richard J Cook, Donald M Arnold, Yang Liu, Rebecca Barty, Mark A Crowther, P J Devereaux, Jack Hirsh, Theodore E Warkentin, Kathryn E Webert, David Roxby, Magdalena Sobieraj-Teague, Andrea Kurz, Daniel I Sessler, Priscilla Figueroa, Martin Ellis, John W Eikelboom
Background Randomized, controlled trials have suggested that the transfusion of blood after prolonged storage does not increase the risk of adverse outcomes among patients, although most of these trials were restricted to high-risk populations and were not powered to detect small but clinically important differences in mortality. We sought to find out whether the duration of blood storage would have an effect on mortality after transfusion in a general population of hospitalized patients. Methods In this pragmatic, randomized, controlled trial conducted at six hospitals in four countries, we randomly assigned patients who required a red-cell transfusion to receive blood that had been stored for the shortest duration (short-term storage group) or the longest duration (long-term storage group) in a 1:2 ratio...
October 24, 2016: New England Journal of Medicine
S Santiago-Martínez, A Laín, G Guillén, R Gander, S López-Fernández, F Pumarola, L Seidler, J Lloret
INTRODUCTION: Paediatric LTI is associated with significant morbid-mortality. Although historically first line treatment was surgical, conservative management is making headway. The purpose of this study was to analyze the management and surgical indications of LTI treated at our institution. MATERIAL AND METHODS: Retrospective study of patients with LTI treated between 2007 and 2014. RESULTS: Six out of seven patients, with a median age of 4 years (2-15), had blunt traumas and one had an open trauma...
October 10, 2016: Cirugía Pediátrica: Organo Oficial de la Sociedad Española de Cirugía Pediátrica
Sarah Raz, Jamie C Piercy, Andrew M Heitzer, Brittany N Peters, Julie Bapp Newman, Angela K DeBastos, Noa Ofen, Beau Batton, Daniel G Batton
OBJECTIVES: A limited body of research is available on the relationships between multiplicity of birth and neuropsychological functioning in preterm children who were conceived in the age of assisted reproductive technology and served by the modern neonatal intensive care unit. Our chief objective was to evaluate whether, after adjustment for sociodemographic factors and perinatal complications, twin birth accounted for a unique portion of developmental outcome variance in children born at-risk in the surfactant era...
October 2016: Journal of the International Neuropsychological Society: JINS
Kimberly Fryer, Sharon Keiser, Kenneth Trofatter, Kacey Y Eichelberger, Emily Heberlein
OBJECTIVE: To measure the impact of race/ethnicity on cerclage efficacy, as measured by the prevalence of spontaneous preterm birth (PTB), in a cohort of patients with history-indicated, ultrasound-indicated, and physical-exam indicated cerclages. METHODS: We conducted a retrospective cohort study of patients undergoing history-indicated, ultrasound-indicated, and physical-exam indicated cerclage placement from January 2003 to July 2013 at a tertiary care hospital...
October 23, 2016: Journal of Maternal-fetal & Neonatal Medicine
Y S Choi, E J Lee
: WHAT IS KNOWN ON THE SUBJECT?: Panic disorder patients display various panic-related physical symptoms and catastrophic misinterpretation of bodily sensations, which lower their quality of life by interfering with daily activities. Cognitive behavioural therapy (CBT) is a useful strategy for panic disorder patients to manage symptoms associated with inaccurate cognitive interpretation of situations resulting from the patient's cognitive vulnerability. In South Korea, however, despite the increasing prevalence of panic disorder, CBT is not a common element of nursing care plans for panic disorder patients...
October 24, 2016: Journal of Psychiatric and Mental Health Nursing
Christian Young, Hasantha Gunasekera, Kelvin Kong, Alison Purcell, Sumithra Muthayya, Frank Vincent, Darryl Wright, Raylene Gordon, Jennifer Bell, Guy Gillor, Julie Booker, Peter Fernando, Deanna Kalucy, Simone Sherriff, Allison Tong, Carmen Parter, Sandra Bailey, Sally Redman, Emily Banks, Jonathan C Craig
OBJECTIVE: To describe and evaluate Hearing EAr health and Language Services (HEALS), a New South Wales (NSW) health initiative implemented in 2013 and 2014 as a model for enhanced clinical services arising from Aboriginal health research. METHODS: A case-study involving a mixed-methods evaluation of the origins and outcomes of HEALS, a collaboration among five NSW Aboriginal Community Controlled Health Services (ACCHS), the Sydney Children's Hospitals Network, NSW Health, the Aboriginal Health and Medical Research Council, and local service providers...
October 23, 2016: Australian and New Zealand Journal of Public Health
Emmi Helle, Sture Andersson, Unto Häkkinen, Jutta Järvelin, Janne Eskelinen, Eero Kajantie
BACKGROUND: Early term birth is associated with increased need for hospital care during the early postnatal period. The objective of this study was to assess the morbidity and health care-related costs during the first 3 years of life in children born early term. METHODS: Data come from a population-based birth cohort study in the municipalities of Helsinki, Espoo, and Vantaa, Finland using data from the national medical birth register and outpatient, inpatient, and primary care registers...
October 24, 2016: Paediatric and Perinatal Epidemiology
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