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https://www.readbyqxmd.com/read/28445024/an-economic-evaluation-of-the-enhanced-recovery-after-surgery-eras-multisite-implementation-program-for-colorectal-surgery-in-alberta
#1
Nguyen X. Thanh, Anderson W. Chuck, Tracy Wasylak, Jeannette Lawrence, Peter Faris, Olle Ljungqvist, Gregg Nelson, Leah M. Gramlich
BACKGROUND: In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites. METHODS: We assessed the impact of ERAS on patients’ health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions...
December 1, 2016: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28441944/effects-of-unconditional-cash-transfers-on-the-outcome-of-treatment-for-severe-acute-malnutrition-sam-a-cluster-randomised-trial-in-the-democratic-republic-of-the-congo
#2
Emmanuel Grellety, Pélagie Babakazo, Amina Bangana, Gustave Mwamba, Ines Lezama, Noël Marie Zagre, Eric-Alain Ategbo
BACKGROUND: Cash transfer programs (CTPs) aim to strengthen financial security for vulnerable households. This potentially enables improvements in diet, hygiene, health service access and investment in food production or income generation. The effect of CTPs on the outcome of children already severely malnourished is not well delineated. The objective of this study was to test whether CTPs will improve the outcome of children treated for severe acute malnutrition (SAM) in the Democratic Republic of the Congo over 6 months...
April 26, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28441684/development-of-consensus-based-best-practice-guidelines-for-postoperative-care-following-posterior-spinal-fusion-for-adolescent-idiopathic-scoliosis
#3
Nicholas D Fletcher, Michael P Glotzbecker, Michelle Marks, Peter O Newton
STUDY DESIGN: Delphi process with multiple iterative rounds using a nominal group technique. OBJECTIVE: The aim of this study was to use expert opinion to achieve consensus on various aspects of postoperative care following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: Significant variability exists in postoperative care following PSF for AIS, despite a relatively healthy patient population and continuously improving operative techniques...
May 1, 2017: Spine
https://www.readbyqxmd.com/read/28440780/frequency-and-management-of-diabetes-and-hyperglycemia-at-emergency-departments-the-gluce-urg-study
#4
Esther Álvarez-Rodríguez, Inmaculada Laguna Morales, Alicia Rosende Tuya, Raquel Tapia Santamaría, Alfonso Martín Martínez, Pascual López Riquelme, Raúl Merinero Palomares, Isabel Portero Sánchez
INTRODUCTION: Hyperglycemia is a common finding at hospital emergency rooms in diabetic patients, but few data are available on its frequency, management, and subsequent impact based on the assessment made at Emergency rooms. OBJECTIVES: To ascertain the frequency of diabetes mellitus and hyperglycemia in patients admitted from Emergency rooms. Second, to describe management of hyperglycemia at Emergency rooms, and to analyze its potential impact on the course and management of patients during admission...
February 2017: Endocrinol Diabetes Nutr
https://www.readbyqxmd.com/read/28438402/effects-of-ultrasonic-and-hydrodynamic-cavitation-on-the-treatment-of-cork-wastewater-by-flocculation-and-fenton-processes
#5
Zhilin Wu, Francisco J Yuste-Córdoba, Pedro Cintas, Zhansheng Wu, Luisa Boffa, Stefano Mantegna, Giancarlo Cravotto
This paper reports that ultrasonic (US) and hydrodynamic cavitation (HC) are efficient strategies for the environmental remediation of cork wastewater (CW). It is necessary to remove toxic, inhibitory or refractory organic matter from CW using physical and chemical techniques (pre-treatment) prior to performing conventional biological treatment. After this biological treatment, it is also critical to further decontaminate (post-treatment) in order to meet the discharge limitation. The pre-treatment of diluted CW using Fenton oxidation (FE) alone led to COD and polyphenol (PP) removal values of 30% and 61%, respectively, while HC and US resulted in 83-90% increases in COD reduction and 26-33% increases in PP reduction...
April 13, 2017: Ultrasonics Sonochemistry
https://www.readbyqxmd.com/read/28438182/forced-fluid-removal-versus-usual-care-in-intensive-care-patients-with-high-risk-acute-kidney-injury-and-severe-fluid-overload-ffaki-study-protocol-for-a-randomised-controlled-pilot-trial
#6
Rasmus E Berthelsen, Theis Itenov, Anders Perner, Jens-Ulrik Jensen, Michael Ibsen, Andreas Emil Kryger Jensen, Morten Bestle
BACKGROUND: Intravenous administration of fluids is an essential part of critical care. While some fluid administration is likely beneficial, there is increasing observational evidence that the development of fluid overload is associated with increased mortality. There are no randomised trials to confirm this association in patients with acute kidney injury. We aim to perform a pilot trial to test the feasibility of forced fluid removal compared to standard care in patients with acute kidney injury and severe fluid overload, the FFAKI trial...
April 24, 2017: Trials
https://www.readbyqxmd.com/read/28435918/cost-analysis-of-adolescent-idiopathic-scoliosis-surgery-early-discharge-decreases-hospital-costs-much-less-than-intraoperative-variables-under-the-control-of-the-surgeon
#7
Brandon L Raudenbush, David P Gurd, Ryan C Goodwin, Thomas E Kuivila, R Tracy Ballock
BACKGROUND: Spinal fusion surgery for the treatment of adolescent idiopathic scoliosis (AIS) is increasing. Health systems and surgeons are decreasing hospital length of stay (LOS) to decrease costs. The purpose of this study was to review the contribution of an accelerated discharge protocol on the total cost of a single episode of care related to the surgical treatment of AIS at a single institution. METHODS: A retrospective cost analysis was performed over an 18-month period, from January 2014 through June 2015, before and after the institution of an accelerated discharge program...
March 2017: Journal of Spine Surgery (Hong Kong)
https://www.readbyqxmd.com/read/28435499/the-fast-and-the-furious-low-risk-chest-pain-and-the-rapid-rule-out-protocol
#8
REVIEW
Maite Anna Huis In 't Veld, Louise Cullen, Simon A Mahler, Barbra E Backus, Zachary D W Dezman, Amal Mattu
Accelerated diagnostic pathways (ADP) have been designed to identify low-risk chest pain patients in the emergency department. This review article discusses the Asia-Pacific Evaluation of Chest Pain Trial (ASPECT) score, the Accelerated Diagnostic Protocol for Chest Pain Trial (ADAPT) score, the Emergency Department Assessment of Chest Pain Score (EDACS), the HEARTScore and the HEART pathway. These ADPs have been validated in various studies and aid the emergency provider with identifying the low-risk chest pain patient who is appropriate for discharge home, while at the same time highlighting those patients who would benefit from further in-patient work up...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435481/a-patient-centered-emergency-department-management-strategy-for-sickle-cell-disease-super-utilizers
#9
Grant G Simpson, Hallie R Hahn, Alex A Powel, Robert R Leverence, Linda A Morris, Lara G Thompson, Marc S Zumberg, Deepa J Borde, Joseph A Tyndall, Jonathan J Shuster, Donald M Yealy, Brandon R Allen
INTRODUCTION: A subpopulation of sickle-cell disease patients, termed super-utilizers, presents frequently to emergency departments (EDs) for vaso-occlusive events and may consume disproportionate resources without broader health benefit. To address the healthcare needs of this vulnerable patient population, we piloted a multidisciplinary intervention seeking to create and use individualized patient care plans that alter utilization through coordinated care. Our goals were to assess feasibility primarily, and to assess resource use secondarily...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435128/randomized-trial-on-fast-track-care-in-colorectal-surgery-for-deep-infiltrating-endometriosis
#10
Marco Scioscia, Marcello Ceccaroni, Irene Gentile, Roberto Rossini, Roberto Clarizia, Davide Brunelli, Giacomo Ruffo
STUDY OBJECT: To study the application of a fast-track care protocol in colorectal surgery for deep infiltrating endometriosis. Bowel endometriosis is an infrequent but not rare condition that often needs intestinal surgery and imposes a high economic burden on society. DESIGN: Prospective randomized trial (Canadian Task Force I). SETTING: Tertiary referral center. PATIENTS: We randomly assigned 227 patients with preoperative evidence of bowel endometriosis to a fast-track (no preoperative bowel preparation, early restoration of diet, no postoperative antibiotics, and early post-operative mobilization) or conventional care for laparoscopic intestinal surgery...
April 18, 2017: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/28433247/outpatient-laparoscopic-appendectomy-feasible-in-a-public-county-hospital
#11
David R Rosen, Kenji Inaba, Paul J Oh, Adam C Gutierrez, Aaron M Strumwasser, Subarna Biswas, Melody Cala, Glenn T Ault
BACKGROUND: Outpatient laparoscopic appendectomy is being used increasingly as a treatment option for acute, uncomplicated appendicitis. This was a prospective validation study in a large, urban, public safety-net hospital. STUDY DESIGN: From 2014 to 2016, all patients undergoing laparoscopic appendectomy for acute, uncomplicated appendicitis were enrolled in a prospective observational trial. Standard baseline perioperative practice (control group) was documented for 1 year...
March 13, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28433223/risk-of-intraatrial-thrombi-after-thoracoscopic-ablation-in-absence-of-heparin-and-appendage-closure
#12
Petr Budera, Pavel Osmancik, Dalibor Herman, David Talavera, Robert Petr, Zbynek Straka
BACKGROUND: Catheter and surgical ablation of atrial fibrillation (AF) can be associated with a risk of thromboembolic events. The goal of this study was to assess optimal anticoagulation management during thoracoscopic ablation of AF. METHODS: Fifty-two patients with persistent or long-standing persistent AF underwent hybrid ablation consisting of thoracoscopic ablation followed by electrophysiologic (EP) evaluation and consecutive ablation if indicated. The thoracoscopic ablation was performed using three different anticoagulation protocols: (1) without periprocedural heparin and without occlusion of the left atrial appendage; (2) with periprocedural heparin but without left atrial appendage occlusion; and (3) with periprocedural heparin and left atrial appendage occlusion...
April 19, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28431366/efficacy-and-safety-of-a-video-eeg-protocol-for-genetic-generalized-epilepsies
#13
Luciana Rodrigues De Marchi, Jeana Torres Corso, Ana Carolina Zetehaku, Carina Gonçalves Pedroso Uchida, Mirian Salvadori Bittar Guaranha, Elza Márcia Targas Yacubian
INTRODUCTION: Video-EEG has been used to characterize genetic generalized epilepsies (GGE). For best performance, sleep recording, photic stimulation, hyperventilation, and neuropsychological protocols are added to the monitoring. However, risks and benefits of these video-EEG protocols are not well established. The aim of this study was to analyze the efficacy and safety of a video-EEG neuropsychological protocol (VNPP) tailored for GGE and compare its value with that of routine EEG (R-EEG)...
April 18, 2017: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/28430046/an-outpatient-methadone-weaning-program-by-a-neonatal-intensive-care-unit-for-neonatal-abstinence-syndrome
#14
Andrew Lai, Patrick Philpot, Jenny Boucher, Andrew Meyer
Through retrospective chart review, this study described characteristics and length of stay for a cohort of newborns discharged on methadone following an inpatient weaning for neonatal abstinence syndrome (NAS). Data were assessed for all term infants born between January 1, 2010, and December 31, 2014, admitted to the hospital with a co-diagnosis of NAS at discharge, for gestational age, length of stay, days on treatment protocol before discharge, time to once-daily interval methadone dosing, and hospital charges, as well as for categorical characteristics...
April 21, 2017: Population Health Management
https://www.readbyqxmd.com/read/28428892/a-comparison-of-earlier-and-enhanced-rehabilitation-of-mechanically-ventilated-patients-in-critical-care-compared-to-standard-care-rehab-study-protocol-for-a-single-site-randomised-controlled-feasibility-trial
#15
Catherine Snelson, Charlotte Jones, Gemma Atkins, James Hodson, Tony Whitehouse, Tonny Veenith, David Thickett, Emma Reeves, Aisling McLaughlin, Lauren Cooper, David McWilliams
BACKGROUND: Mortality from critical illness is improving, but survivors suffer from prolonged weakness and psychological and cognitive impairments. Maximising the recovery after critical illness has been highlighted as a research priority, especially in relation to an ageing population who present with higher rates of pre-morbid disability. Small studies have shown that starting rehabilitation early within the intensive care unit (ICU) improves short-term outcomes. Systematic reviews have highlighted the need for robust multicentre randomised controlled trials with longer term follow-up...
2017: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/28424822/rapid-non-contrast-magnetic-resonance-imaging-for-post-appendectomy-intra-abdominal-abscess-in-children
#16
Megan H Lee, Eric P Eutsler, Elizabeth F Sheybani, Geetika Khanna
BACKGROUND: Acute appendicitis, especially if perforated at presentation, is often complicated by postoperative abscess formation. The detection of a postoperative abscess relies primarily on imaging. This has traditionally been done with contrast-enhanced computed tomography. Non-contrast magnetic resonance imaging (MRI) has the potential to accurately detect intra-abdominal abscesses, especially with the use of diffusion-weighted imaging (DWI). OBJECTIVE: To evaluate our single-center experience with a rapid non-contrast MRI protocol evaluating post-appendectomy abscesses in children with persistent postsurgical symptoms...
April 20, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28424074/implementation-and-adaptation-of-the-re-engineered-discharge-red-in-five-california-hospitals-a-qualitative-research-study
#17
S E Mitchell, G M Weigel, V Laurens, J Martin, B W Jack
BACKGROUND: Project Re-Engineered Discharge (RED) is an evidence-based strategy to reduce readmissions disseminated and adapted by various health systems across the country. To date, little is known about how adapting Project RED from its original protocol impacts RED implementation and/or sustainability. The goal of this study was to identify and characterize contextual factors influencing how five California hospitals adapted and implemented RED and the subsequent impact on RED program sustainability...
April 19, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28424063/clinical-and-cost-effectiveness-analysis-of-early-detection-of-patients-at-nutrition-risk-during-their-hospital-stay-through-the-new-screening-method-cipa-a-study-protocol
#18
José Pablo Suárez-Llanos, Néstor Benítez-Brito, Laura Vallejo-Torres, Irina Delgado-Brito, Adriá Rosat-Rodrigo, Carolina Hernández-Carballo, Yolanda Ramallo-Fariña, Francisca Pereyra-García-Castro, Juan Carlos-Romero, Nieves Felipe-Pérez, Jennifer García-Niebla, Eduardo Mauricio Calderón-Ledezma, Teresa de Jesús González-Melián, Ignacio Llorente-Gómez de Segura, Manuel Ángel Barrera-Gómez
BACKGROUND: Malnutrition is highly prevalent in hospitalized patients and results in a worsened clinical course as well as an increased length of stay, mortality, and costs. Therefore, simple nutrition screening systems, such as CIPA (control of food intake, protein, anthropometry), may be implemented to facilitate the patient's recovery process. The aim of this study is to evaluate the effectiveness and cost-effectiveness of implementing such screening tool in a tertiary hospital, consistent with the lack of similar, published studies on any hospital nutrition screening system...
April 20, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28419032/formal-physical-therapy-after-total-hip-arthroplasty-is-not-required-a-randomized-controlled-trial
#19
Matthew S Austin, Brian T Urbani, Andrew N Fleischman, Navin D Fernando, James J Purtill, William J Hozack, Javad Parvizi, Richard H Rothman
BACKGROUND: The value of formal physical therapy after total hip arthroplasty is unknown. With substantial changes that have occurred in surgical and anesthesia techniques, self-directed therapy may be efficacious in restoring function to patients undergoing total hip arthroplasty. METHODS: We conducted a single-center, randomized trial of 120 patients undergoing primary, unilateral total hip arthroplasty who were eligible for direct home discharge. The experimental group followed a self-directed home exercise program for 10 weeks...
April 19, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28416020/patient-and-family-centered-performance-measures-focused-on-actionable-processes-of-care-for-persistent-and-chronic-critical-illness-protocol-for-a-systematic-review
#20
Louise Rose, Laura Istanboulian, Laura Allum, Lisa Burry, Craig Dale, Nicholas Hart, Claire Kydonaki, Pam Ramsay, Natalie Pattison, Bronwen Connolly
BACKGROUND: Approximately 5 to 10% of critically ill patients transition from acute critical illness to a state of persistent and in some cases chronic critical illness. These patients have unique and complex needs that require a change in the clinical management plan and overall goals of care to a focus on rehabilitation, symptom relief, discharge planning, and in some cases, end-of-life care. However, existing indicators and measures of care quality, and tools such as checklists, that foster implementation of best practices, may not be sufficiently inclusive in terms of actionable processes of care relevant to these patients...
April 17, 2017: Systematic Reviews
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