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https://www.readbyqxmd.com/read/29331476/factors-associated-with-withdrawal-from-maintenance-dialysis-a-case-control-analysis
#1
James B Wetmore, Heng Yan, Yan Hu, David T Gilbertson, Jiannong Liu
BACKGROUND: Little is known about differences in the clinical course between patients receiving maintenance dialysis who do and do not withdraw from dialysis therapy. STUDY DESIGN: Case-control analysis. SETTING & PARTICIPANTS: US patients with Medicare coverage who received maintenance hemodialysis for 1 year or longer in 2008 through 2011. PREDICTORS: Comorbid conditions, hospitalizations, skilled nursing facility stays, and a morbidity score based on durable medical equipment claims...
January 10, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29325725/who-goes-to-inpatient-rehabilitation-or-skilled-nursing-facilities-unexpectedly-following-total-knee-arthroplasty
#2
Alexander J Rondon, Timothy L Tan, Max R Greenky, Karan Goswami, Noam Shohat, Jessica L Phillips, James J Purtill
BACKGROUND: Inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) represent a significant portion of post-operative expenses of bundled payments for total knee arthroplasty (TKA). Although many surgeons no longer routinely send patients to IRFs or SNFs, some patients are unable to be discharged directly home. This study identified patient factors for discharge to post-acute care facilities with an institutional protocol of discharging TKA patients home. METHODS: A retrospective review of patients undergoing primary unilateral TKA at a single institution from 2012 to 2017 was performed...
December 21, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29324430/a-prospective-multicenter-study-to-compare-a-disposable-high-fluid-capacity-underpad-to-nonpermeable-disposable-reusable-containment-products-on-incontinence-associated-dermatitis-rates-among-skilled-nursing-facility-residents
#3
Glenda Motta, Catherine T Milne
Due to the high prevalence of incontinence among skilled nursing facility (SNF) residents, incontinence-associated derma- titis (IAD) is a common occurrence. In addition, facility staff may mistakenly identify IAD as a pressure injury. A prospective, descriptive, multicenter study was conducted in 3 Connecticut facilities to evaluate the effect of substituting a disposable, high- uid capacity underpad for nonpermeable disposable and reusable containment products on the rate of IADs. Residents with and without IAD but with high IAD risk scores who were bed- or chairbound or ambulatory and used disposable nonpermeable briefs and underpads or reusable, laundered containment products when in bed longer than 2 hours were randomly enrolled and observed for a 4-week period...
December 2017: Ostomy/wound Management
https://www.readbyqxmd.com/read/29321120/evaluating-vancomycin-and-piperacillin-tazobactam-in-emergency-department-patients-with-severe-sepsis-and-septic-shock
#4
Christina Le, Frank Chu, Ronald Dunlay, Julian Villar, Peter Fedullo, Gabriel Wardi
STUDY OBJECTIVE: To determine the frequency and cause of inadequate initial antibiotic therapy with vancomycin and piperacillin-tazobactam in patients with severe sepsis and septic shock in the emergency department (ED), characterize its impact on patient outcomes, and identify patients who would benefit from an alternative initial empiric regimen. METHODS: Retrospective cohort study conducted between 2012 and 2015 in which 342 patients with culture-positive severe sepsis or septic shock who received initial vancomycin and piperacillin-tazobactam were reviewed to determine appropriateness of antimicrobial therapy, risk factors for inappropriate use, and outcome data...
December 29, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29318081/-hidden-preoperative-blood-loss-with-extracapsular-versus-intracapsular-hip-fractures-what-is-the-difference
#5
Katharine D Harper, Paul Navo, Frederick Ramsey, Sainabou Jallow, Saqib Rehman
Purpose: Excessive blood loss with hip fracture management has been shown to result in increased rates of complications. Our goal is to compare blood loss and transfusion rates between patients with intracapsular and extracapsular (both intertrochanteric (IT) and subtrochanteric (ST)) hip fractures. Methods: 472 patients were evaluated over a five-year period. Those who presented to the hospital with a proximal femur fracture (femoral neck, IT or ST) were considered for the study...
December 2017: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/29318080/race-and-rehabilitation-destination-after-elective-total-hip-arthroplasty-analysis-of-a-large-regional-data-set
#6
Ernest R Vina, Michael J Kallan, Aliya Collier, Charles L Nelson, Said A Ibrahim
Background: Three-quarters of patients who undergo total hip replacement (THR) receive postsurgical rehabilitation care in an inpatient rehabilitation facility (IRF), a skilled nursing facility (SNF), or through a home health agency. The objectives of this study are to examine racial differences where THR recipients receive postsurgical rehabilitation care and determine whether discharge destination is associated with hospital readmission. Methods: Using the Pennsylvania Health Care Cost Containment Council database, we selected African American (AA) or white adults who underwent THR surgery (n = 68,016)...
December 2017: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/29316600/impact-of-neuromuscular-electrical-stimulation-nmes-on-90-day-episode-costs-and-post-acute-care-utilization-in-total-knee-replacement-patients-with-disuse-atrophy
#7
Sarmistha Pal, Morad Chughtai, Assem A Sultan, Anton Khlopas, Nipun Sodhi, Nicole E George, Jennifer I Etcheson, Chukwuweike U Gwam, Jared M Newman, Linsen T Samuel, Anil Bhave, Joan E DaVanzo, Michael A Mont
INTRODUCTION: This study evaluated differences in: 1) total episode payments, 2) probability of hospital readmission, 3) probability of inpatient rehab facility (IRF) and utilization, and 4) probability of skilled nursing care facility (SNF) utilization in patients who had disuse atrophy and underwent a total knee arthroplasty (TKA) and either did, or did not, receive preoperative home-based neuromuscular electrical stimulation (NMES) therapy. MATERIALS AND METHODS: We used the Medicare limited dataset for a 5% sample of beneficiaries from 2014 and 2015 to construct episodes-of-care for TKA (DRG-470) patients with disuse atrophy who underwent a TKA during the 30 days prior to hospital admission and 90 days post-discharge...
December 22, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/29310151/re-stability-of-geriatric-syndromes-in-hospitalized-medicare-beneficiaries-discharged-to-skilled-nursing-facilities
#8
Tomas L Griebling
No abstract text is available yet for this article.
January 2018: Journal of Urology
https://www.readbyqxmd.com/read/29299352/a-semi-automated-assessment-of-sarcopenia-using-psoas-area-and-density-predicts-outcomes-after-pancreaticoduodenectomy-for-pancreatic-malignancy
#9
Jukes P Namm, Kiran H Thakrar, Chi-Hsiung Wang, Susan J Stocker, Malini D Sur, Jonathan Berlin, William Dale, Mark S Talamonti, Kevin K Roggin
Background: Sarcopenia has been associated with increased adverse outcomes after major abdominal surgery. Sarcopenia defined as decreased muscle volume or increased fatty infiltration may be a proxy for frailty. In conjunction with other preoperative clinical risk factors, radiographic measures of sarcopenia using both muscle size and density may enhance prediction of outcomes after pancreaticoduodenectomy (PD) for malignancy. Methods: Preoperative computed tomography (CT) scans of patients undergoing PD for malignancy were analyzed from a prospective pancreatic surgery database...
December 2017: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/29298176/untapped-potential-using-the-hrs-medicare-linked-files-to-study-the-changing-nursing-home-population
#10
Julie C Lima, Jessica Ogarek, Vincent Mor
BACKGROUND: Nursing home (NH) care in the United States now includes many short-term admissions to skilled nursing facilities (SNFs) for postacute care. OBJECTIVE: To demonstrate the potential of the Health and Retirement Study (HRS) linked to administrative data to study this group. RESEARCH DESIGN: Descriptive retrospective panel study. SUBJECTS: HRS respondents between 2002 and 2010 linked to administrative data from the Centers for Medicare and Medicaid Services (CMS)...
January 2, 2018: Medical Care
https://www.readbyqxmd.com/read/29289540/a-randomized-controlled-study-comparing-a-dpp4-inhibitor-linagliptin-and-basal-insulin-glargine-in-patients-with-type-2-diabetes-in-long-term-care-and-skilled-nursing-facilities-linagliptin-ltc-trial
#11
Guillermo E Umpierrez, Saumeth Cardona, David Chachkhiani, Maya Fayfman, Sahebi Saiyed, Heqiong Wang, Priyathama Vellanki, J Sonya Haw, Darin E Olson, Francisco J Pasquel, Theodore M Johnson
OBJECTIVES: Safe and easily implemented treatment regimens are needed for the management of patients with type 2 diabetes mellitus (T2DM) in long-term care (LTC) and skilled nursing facilities. DESIGN: This 6-month open-label randomized controlled trial compared the efficacy and safety of a DPP4 inhibitor (linagliptin) and basal insulin (glargine) in LTC residents with T2DM. SETTINGS: Three LTC institutions affiliated with a community safety-net hospital, US Department of Veterans Affairs and Emory Healthcare System in Atlanta, Georgia...
December 27, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29280708/justifying-rehabilitation-intensity-through-functional-performance-measures-in-postacute-care
#12
Christine Kroll, Thomas Fisher
The Centers for Medicare and Medicaid Services (CMS) has scrutinized the provision of rehabilitation services in skilled nursing facilities (SNFs) for some time. Little research guidance exists on appropriate dosage or rehabilitation intensity (RI) among SNF patients or patients in other postacute care (PAC) settings. CMS developed a PAC assessment, the Continuity Assessment Record and Evaluation (CARE) Tool, in response to questions about what issues drive placement in various PAC settings under Medicare. The ability to adequately assess functional outcomes and correlate them to the RI provided by using the CARE Tool is promising...
January 2018: American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association
https://www.readbyqxmd.com/read/29278991/managing-nonoperable-intracranial-bleeding-associated-with-apixaban-a-series-of-2-cases
#13
Andrew C Faust, Dang M Tran, Catherine Lo, Sophia Lai, Lyndsay Sheperd, Mary Liu, Tina Denetclaw
OBJECTIVE: To report 2 cases of nonoperable intracranial bleeding associated with apixaban managed by 3-factor prothrombin complex concentrate (PCC3). CASE SUMMARIES: Case 1 presented with a 1.3-cm left parieto-occipital hemorrhage and a thin subdural hematoma (SDH) on the left tentorium of the brain about 6 hours after his last dose of apixaban. Case 2 presented with a 4-mm left parafalcine SDH with time of most recent apixaban dose unknown. The patients received 24...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29276557/safety-and-costs-of-stroke-unit-admission-for-select-acute-intracerebral-hemorrhage-patients
#14
Corey R Fehnel, Kimberly M Glerum, Linda C Wendell, N Stevenson Potter, Brian Silver, Muhib Khan, Ali Saad, Shadi Yaghi, Richard N Jones, Karen Furie, Bradford B Thompson
Background and Purpose: There are limited data to guide intensive care unit (ICU) versus dedicated stroke unit (SU) admission for intracerebral hemorrhage (ICH) patients. We hypothesized select patients can be safely cared for in SU versus ICU at lower costs. Methods: We conducted a retrospective cohort study of consecutive patients with predefined minor ICH (≤20 cm3, supratentorial, no coagulopathy) receiving care in either an ICU or an SU. Multiple linear regression and inverse probability weighting were used to adjust for differences in patient characteristics and nonrandom ICU versus SU assignment...
January 2018: Neurohospitalist
https://www.readbyqxmd.com/read/29275990/octogenarians-post-acute-care-use-after-cardiac-valve-surgery-and-recovery-clinical-implications
#15
Elizabeth Edmiston, Mary A Dolansky, Melissa Zullo, Daniel E Forman
Octogenarians receiving cardiac valve surgery is increasing and recovery is challenging. Post-acute care (PAC) services assist with recovery, yet services provided in facilities do not provide adequate cardiac-focused care or long-term self-management support. The purpose of the paper was to report post-acute care discharge rates in octogenarians and propose clinical implications to improve PAC services. Using a 2003 Medicare Part A database, we studied post-acute care service use in octogenarians after cardiac valve surgery...
December 21, 2017: Geriatric Nursing
https://www.readbyqxmd.com/read/29274640/effectiveness-of-the-malnutrition-quality-improvement-initiative-on-practitioner-malnutrition-knowledge-and-screening-diagnosis-and-timeliness-of-malnutrition-related-care-provided-to-older-adults-admitted-to-a-tertiary-care-facility-a-pilot-study
#16
Heidi J Silver, Kelsey Jones Pratt, Michelle Bruno, Joe Lynch, Kristi Mitchell, Sharon M McCauley
BACKGROUND: Malnutrition is present in 30% to 50% of hospitalized patients aged 60 years or older. As few as 3.2% of patients identified as high risk have a malnutrition diagnosis documented by medical providers. The Malnutrition Quality Improvement Initiative (MQii) aims to reduce the burden of hospital malnutrition by improving the process and delivery of care. OBJECTIVE: To evaluate implementing the MQii toolkit of best practice resources for screening, diagnosis, documentation, and timeliness of malnutrition care...
January 2018: Journal of the Academy of Nutrition and Dietetics
https://www.readbyqxmd.com/read/29273434/sex-disparities-in-health-and-health-care-utilization-after-parkinson-diagnosis-rethinking-pd-associated-disability
#17
Michelle E Fullard, Dylan P Thibault, Veronica Todaro, Susan Foster, Lori Katz, Robin Morgan, Drew S Kern, Jason M Schwalb, Enrique Urrea Mendoza, Nabila Dahodwala, Lisa Shulman, Allison W Willis
OBJECTIVE: To examine sex differences and trends in comorbid disease and health care utilization in individuals with newly diagnosed Parkinson disease (PD). DESIGN: Retrospective cohort study. PARTICIPANTS: Over 133,000 Medicare beneficiaries with a new PD diagnosis in 2002 followed through 2008. METHODS: We compared the prevalence and cumulative incidence of common medical conditions, trends in survival and health care utilization between men and women with PD...
December 14, 2017: Parkinsonism & related Disorders
https://www.readbyqxmd.com/read/29249273/30-day-all-cause-hospital-readmission-after-cystectomy-no-worse-for-rural-medicare-residents
#18
Daniel J Sadowski, Hayden Warner, Steven Scaife, Kevin T McVary, Shaheen R Alanee
OBJECTIVE: To evaluate rural/urban disparities in 30-day all-cause hospital admission after cystectomy. MATERIALS AND METHODS: We used the SEER-Medicare database to identify all Medicare beneficiaries who underwent radical cystectomy (ICD-9 codes 57.7, 57.71, 57.79, and 68.8) between the years 1991 and 2009, yielding a total sample size of 15,572. Our primary outcome was 30-day hospital readmission rate. Rural Urban Continuum Codes were used to designate county-level rural status based on patient residence...
December 14, 2017: Urologic Oncology
https://www.readbyqxmd.com/read/29244057/measuring-frailty-in-medicare-data-development-and-validation-of-a-claims-based-frailty-index
#19
Dae Hyun Kim, Sebastian Schneeweiss, Robert J Glynn, Lewis A Lipsitz, Kenneth Rockwood, Jerry Avorn
Background: Frailty is a key determinant of health status and outcomes of health care interventions in older adults that is not readily measured in Medicare data. This study aimed to develop and validate a claims-based frailty index (CFI). Methods: We used data from Medicare Current Beneficiary Survey 2006 (development sample: n = 5,593) and 2011 (validation sample: n = 4,424). A CFI was developed using the 2006 claims data to approximate a survey-based frailty index (SFI) calculated from the 2006 survey data as a reference standard...
December 13, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/29237139/outcomes-of-laparoscopic-colectomy-in-younger-and-older-patients-an-analysis-of-nationwide-readmission-database
#20
Hemalkumar B Mehta, Byron D Hughes, Eric Sieloff, Sneha O Sura, Yong Shan, Deepak Adhikari, Anthony Senagore
BACKGROUND: Prior studies report safety and effectiveness of laparoscopic colectomy in older patients. The study aimed to examine the impact of laparoscopic colectomy on 30-day readmissions, discharge destination, hospital length of stay, and cost in younger (19-65 years) and older adults (>65 years). MATERIALS AND METHODS: We used the nationwide readmission database from 2013 to study adults undergoing elective colectomy. The outcomes were 30-day readmissions, discharge destination for the index hospitalization (routine, skilled nursing facility [SNF]/intermediate care facility [ICF], home healthcare), length of stay, and cost...
December 13, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
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