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physician hospital agreements

Christopher W Baugh, Carol L Clark, Jason W Wilson, Ian G Stiell, Abraham G Kocheril, Krista K Luck, Troy D Myers, Charles V Pollack, Steven K Roumpf, Gery F Tomassoni, James M Williams, Brian B Patel, Fred Wu, Jesse M Pines
Atrial fibrillation and flutter (AF) is a common condition among emergency department (ED) patients in the United States (US). Traditionally, ED care for primary complaints related to AF focus on rate control, and patients are often admitted to an inpatient setting for further care. Inpatient care may include further telemetry monitoring and diagnostic testing, rhythm control, a search for identification of AF etiology, and stroke prophylaxis. However, many patients are eligible for safe and effective outpatient management pathways...
March 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Michelle Greiver, Frank Sullivan, Sumeet Kalia, Babak Aliarzadeh, Deepak Sharma, Steven Bernard, Christopher Meaney, Rahim Moineddin, David Eisen, Navid Rahman, Tony D'Urzo
Patients with chronic obstructive pulmonary disease (COPD) or heart failure (HF) are frequently cared for in hospital and in primary care settings. We studied labeling agreement for COPD and HF for patients seen in both settings in Toronto, Canada. This was a retrospective observational study using linked hospital-primary care electronic data from 70 family physicians. Patients were 20 years of age or more and had at least one visit in both settings between 1 January 2012 and 31 December 2014. We recorded labeling concordance and associations with clinical factors...
March 9, 2018: NPJ Primary Care Respiratory Medicine
Gérald Chanques, E Wesley Ely, Océane Garnier, Fanny Perrigault, Anaïs Eloi, Julie Carr, Christine M Rowan, Albert Prades, Audrey de Jong, Sylvie Moritz-Gasser, Nicolas Molinari, Samir Jaber
BACKGROUND: One third of patients admitted to an intensive care unit (ICU) will develop delirium. However, delirium is under-recognized by bedside clinicians without the use of delirium screening tools, such as the Intensive Care Delirium Screening Checklist (ICDSC) or the Confusion Assessment Method for the ICU (CAM-ICU). The CAM-ICU was updated in 2014 to improve its use by clinicians throughout the world. It has never been validated compared to the new reference standard, the Diagnostic and Statistical Manual of Mental Disorders 5th version (DSM-5)...
March 1, 2018: Annals of Intensive Care
Sara Fokdal Lehn, Jette Thuesen, Gitte Bunkenborg, Ann-Dorthe Zwisler, Morten Hulvej Rod
BACKGROUND: Numerous studies emphasize the importance of context in implementation. Successful implementation across the health care system depends on conditions and requirements that are often presented to health professionals through text-based materials and might present contradictory expectations to the work of health professionals. In this study, we operationalize institutional context as the text-based material, which from the perspective of health professionals, influence health care work...
March 1, 2018: Implementation Science: IS
Michael A Franklin
Recent and rapid advances in the implementation of technology have greatly affected the quality and efficiency of healthcare delivery in the United States. Simultaneously, diverse generational pressures-including the consumerism of millennials and unsustainable growth in the costs of care for baby boomers-have accelerated a revolution in healthcare delivery that was marked in 2010 by the passage of the Affordable Care Act.Against this backdrop, Maryland and the Centers for Medicare & Medicaid Services entered into a partnership in 2014 to modernize the Maryland All-Payer Model...
April 2018: Frontiers of Health Services Management
Anton Gard, Bertil Lindahl, Gorav Batra, Nermin Hadziosmanovic, Marcus Hjort, Karolina Elisabeth Szummer, Tomasz Baron
OBJECTIVE: The universal definition of myocardial infarction (MI) differentiates MI due to oxygen supply/demand mismatch (type 2) from MI due to plaque rupture (type 1) as well as from myocardial injuries of non-ischaemic or multifactorial nature. The purpose of this study was to investigate how often physicians agree in this classification and what factors lead to agreement or disagreement. METHODS: A total of 1328 patients diagnosed with MI at eight different Swedish hospitals 2011 were included...
February 16, 2018: Heart: Official Journal of the British Cardiac Society
Kyla N Brown, Jeanna Parsons Leigh, Hasham Kamran, Sean M Bagshaw, Rob A Fowler, Peter M Dodek, Alexis F Turgeon, Alan J Forster, Francois Lamontagne, Andrea Soo, Henry T Stelfox
BACKGROUND: Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks. METHODS: This was a prospective cohort study in ten Canadian hospitals. We analyzed physician progress notes for consenting adult patients transferred from a medical-surgical ICU to hospital ward...
January 28, 2018: Critical Care: the Official Journal of the Critical Care Forum
Tomohiro F Nishijima, Allison M Deal, Grant R Williams, Hanna K Sanoff, Kirsten A Nyrop, Hyman B Muss
BACKGROUND: The decision whether to treat older adults with advanced cancer with standard therapy (ST) or reduced therapy (RT) is complicated by heterogeneity in aging. We assessed the potential utility of the chemotherapy toxicity risk score (CTRS) [J Clin Oncol 2011;29:3457-3465] for treatment decisions in older adults. MATERIALS AND METHODS: This was a prospective observational study of patients aged ≥65 years receiving first-line chemotherapy for advanced cancer for which combination chemotherapy is the standard of care...
January 25, 2018: Oncologist
Sean M O'Neill, Sarah Seresinghe, Arun Sharma, Tara A Russell, L'Orangerie Crawford, Stanley K Frencher
PROBLEM DEFINITION: Stewarding of physician privileges wisely is imperative, but no guidelines exist for how to incorporate system-level factors in privileging decisions. A newly opened, safety-net community hospital tailored the scope of surgical practice through review of physician privileges. Martin Luther King, Jr. Community Hospital is a public-private partnership, safety-net institution in South Los Angeles that opened in July 2015. It has 131 beds, including a 28-bed emergency department, a 20-bed ICU, and 5 operating rooms...
January 2018: Joint Commission Journal on Quality and Patient Safety
Parinya Srihatrai, Thanita Hlowchitsieng
PURPOSE: The aim is to evaluate the diagnostic accuracy of digital fundus photography in diabetic retinopathy (DR) screening at a single university hospital. METHODS: This was a cross-sectional hospital-based study. One hundred and ninety-eight diabetic patients were recruited for comprehensive eye examination by two ophthalmologists. Five-field fundus photographs were taken with a digital, nonmydriatic fundus camera, and trained primary care physicians then graded the severity of DR present by single-field 45° and five-field fundus photography...
January 2018: Indian Journal of Ophthalmology
Vidya P Menon, Preetha Prasanna, Fabia Edathadathil, Sabarish Balachandran, Merlin Moni, Dipu Sathyapalan, Rajesh D Pai, Sanjeev Singh
QUALITY PROBLEM OR ISSUE: To assess impact of medical emergency team (MET) in reducing "out-of-ICU" cardiopulmonary arrests and identify barriers to its optimal utilization. INITIAL ASSESSMENT: Frequently observed critical clinical signs and laboratory values of "out-of-ICU" crashes were used to develop Amrita Early Warning Criteria. CHOICE OF SOLUTION: A physician-led MET was established to respond to code MET, activated by a primary nurse...
January 2018: Quality Management in Health Care
Andrew B Rosenkrantz, James S Babb, Gregory N Nicola, Ezequiel Silva, Wenyi Wang, Richard Duszak
PURPOSE: The Medicare Access and CHIP Reauthorization Act (MACRA) provides CMS flexibility to evaluate radiologists using hospital outpatient quality measures in place of conventional physician measures. We explore radiologist characteristics associated with variation in performance in two such measures: abdomen and chest CT "double scan" rates (percentage of total examinations performed both with and without intravenous contrast). METHODS: Radiologists' claims for abdomen and chest CT examinations in a facility setting were identified using 2014 Medicare Physician and Other Supplier data...
December 21, 2017: Journal of the American College of Radiology: JACR
F J Dalgard, Å Svensson, U Gieler, L Tomas-Aragones, L Lien, F Poot, G B E Jemec, L Misery, C Szabo, D Linder, F Sampogna, A W M Evers, J Anders Halvorsen, F Balieva, J Szepietowski, A Lvov, S E Marron, I K Alturnay, A Y Finlay, S S Salek, J Kupfer
BACKGROUND: It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians not trained as psychiatrist underdiagnose depression. This has not been explored among dermatologists. OBJECTIVES: To estimate the concordance between clinical assessment of depression and anxiety by a dermatologist and assessment with the Hospital Anxiety and Depression Scale...
December 16, 2017: British Journal of Dermatology
Maren R Hov, Jo Røislien, Thomas Lindner, Erik Zakariassen, Kristi C G Bache, Volker M Solyga, David Russell, Christian G Lund
BACKGROUND: Cerebral revascularization in acute stroke requires robust diagnostic tools close to symptom onset. The quantitative National Institute of Health Stroke Scale (NIHSS) is widely used in-hospital, whereas shorter and less specific stroke scales are used in the prehospital field. This study explored the accuracy and potential clinical benefit of using NIHSS prehospitally. PATIENTS AND METHODS: Thirteen anesthesiologists trained in prehospital critical care enrolled patients with suspected acute stroke in a mobile stroke unit...
December 12, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
C Schröter, F Urbanek, C Frömke, M Winkelmann, P Mommsen, C Krettek, C Zeckey
PURPOSE: Prehospital estimation of injury severity is essential for prehospital therapy, deciding on the destination hospital and the associated emergency room care. The aim of this study was to compare prehospital estimates of the abbreviated injury scale (AIS) and the Injury Severity Score (ISS) by emergency physicians with the values of AIS and ISS of injury severity determined at the conclusion of diagnostics. METHODS: In this prospective study, the ISS was determined prehospital by emergency physicians...
December 12, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Ling Xu, Hsin-Yi Hsiao, Wenchen Denq, Iris Chi
BACKGROUND: Acknowledging increasing demand of dementia care for patients in China, this paper aims to understand the training needs of dementia care from the perspectives of mental health providers by examining who should be the trainees, what should be the contents of training, and how to deliver the training in China. METHODS: Using purposive sampling, data were gathered via four focus group discussions with 40 mental health providers in Beijing, China, in 2011...
December 10, 2017: International Psychogeriatrics
Brian K Bednarski, Rebecca S Slack, Matthew Katz, Y Nancy You, John Papadopolous, Miguel A Rodriguez-Bigas, John M Skibber, Surena F Matin, George J Chang
BACKGROUND: Ileostomies are a routine part of the care of patients with rectal cancer, but are associated with significant risk for dehydration, readmission, and acute kidney injury. Telemedicine has proven beneficial in decreasing readmission in chronic medical illnesses, but its utility in patients with an ileostomy is not well studied. OBJECTIVE: The purpose of this study was to evaluate the feasibility of televideoconferencing in the assessment of ileostomy output...
January 2018: Diseases of the Colon and Rectum
Elvira Moreno Barriga, Irene Pueyo Ferrer, Miquel Sánchez Sánchez, Montserrat Martín Baranera, Josep Masip Utset
OBJECTIVES: To analyze agreement between diagnoses issued by the Mediktor application and those of an attending physician, and to evaluate the usefulness of this application in patients who seek emergency care. MATERIAL AND METHODS: Prospective observational study in a tertiary care university hospital emergency department. Patients with medical problems and surgical conditions (surgery and injuries) who did not require immediate emergency care responded to the Mediktor questions on a portable computer tablet...
2017: Emergencias: Revista de la Sociedad Española de Medicina de Emergencias
Ann S O'Malley, Deborah Peikes, Claire Wilson, Rachel Gaddes, Victoria Peebles, Timothy J Day, Janel Jin
OBJECTIVES: Risk-stratified care management is a cornerstone of patient-centered medical home models, but studies on patients' perspectives of care management are scarce. We explored patients' experiences with care management, what they found useful, and what needs improvement. STUDY DESIGN: Semi-structured qualitative telephone interviews. METHODS: We interviewed 43 high-risk patients or their caregivers who were receiving care management from 11 practices in CMS' Comprehensive Primary Care initiative, provided by nurse care managers (9 practices) or the physician (2 [solo] practices)...
November 2017: American Journal of Managed Care
Annelie Augustinsson, Carolina Ellberg, Ulf Kristoffersson, Åke Borg, Håkan Olsson
BACKGROUND: The main objectives of this study were to evaluate the concordance between self-reported and registry-reported information regarding family history of breast cancer (BC), ovarian cancer (OvC) and other types of cancer in first-degree relatives of patients with early onset BC, and to determine the frequency of mutation carriers and non-mutation carriers. The secondary objective was to describe tumor characteristics for each mutation group. MATERIAL AND METHODS: Between 1993 and 2013, 231 women who were ≤35 years old when diagnosed with BC were registered at the Oncogenetic Clinic at Skåne University Hospital in Lund, Sweden...
November 22, 2017: Acta Oncologica
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