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https://www.readbyqxmd.com/read/29913175/implementation-of-an-urogynecology-specific-enhanced-recovery-after-surgery-eras-pathway
#1
Charelle M Carter-Brooks, Angela L Du, Kristine M Ruppert, Anna L Romanova, Halina M Zyczynski
OBJECTIVES: ERAS protocols were developed for colorectal surgery to hasten post-op recovery. Variations of the protocol are being adopted for gynecologic procedures despite limited population and procedure-specific outcome data. Our objective was to evaluate if implementation of an ERAS pathway would facilitate reduced length of admission in an urogynecology population. MATERIALS AND METHODS: In this retrospective analysis of patients undergoing pelvic floor reconstructive surgery by 7 female pelvic medicine and reconstructive surgeons we compared same day discharge, length of admission and post-op complications before and after implementation of an ERAS pathway at a tertiary-care hospital...
June 15, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29903672/evaluation-of-tranexamic-acid-in-trauma-patients-a-retrospective-quantitative-analysis
#2
Michelle Ng, Jerrold Perrott, Sarah Burgess
INTRODUCTION: Tranexamic acid (TXA) has been shown to decrease mortality in adult trauma patients with or at significant risk of hemorrhage when administered within 3 h of injury. The use and appropriateness of TXA in adult trauma patients presenting to Royal Columbian Hospital (RCH) was investigated. METHODS: This retrospective chart review utilized the British Columbia Trauma Registry to identify 100 consecutive trauma patients that presented to the emergency department at RCH between April 2012 to June 2015 and met the following indications for TXA: systolic blood pressure <90 mm Hg and/or heart rate >110 bpm and presentation within 8 h of injury...
June 5, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29901654/patient-and-physician-experience-with-interhospital-transfer-a-qualitative-study
#3
Stephanie K Mueller, Evan Shannon, Anuj Dalal, Jeffrey L Schnipper, Patricia Dykes
OBJECTIVES: Although existing data suggest marked variability in interhospital transfer (IHT), little is known about specific factors that may impact the quality and safety of this care transition. We aimed to explore transferred patients' and involved physicians' experience with IHT to better understand the components of the transfer continuum and identify potential targets for improvement. METHODS: We performed a qualitative study using individual interviews of adult patients recently transferred to cardiology, general medicine, and oncology services at a tertiary care academic medical center, as well as their transferring physician, accepting attending physician, and accepting/admitting resident physician...
June 12, 2018: Journal of Patient Safety
https://www.readbyqxmd.com/read/29893435/dyspnea-and-self-management-strategies-in-patients-admitted-to-the-emergency-department-a-study-of-patients-experiences
#4
Karoline Stentoft Rybjerg Larsen, Annemette Krintel Petersen, Marianne Lisby, Marie Veje Knudsen
AIMS AND OBJECTIVE: To explore patients' experiences of acute dyspnea, physical functioning, and perspectives on course of illness prior to admission to the emergency department. BACKGROUND: Many emergency admissions are considered unnecessary and avoidable. In this perspective, it seems relevant to gain insight into the patients' perspective on acute dyspnea and the need for emergency admission. However, only few studies have investigated reasons for emergency admission from a patient perspective...
June 12, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29890836/high-acuity-rural-transport-findings-from-a-qualitative-investigation
#5
Jude Kornelsen, Brent Hobbs, Holly Buhler, Rebecca Kaus, Kari Grant, Scott C Lamont, Stefan Grzybowski
INTRODUCTION: The High Acuity Response Team (HART) was introduced in British Columbia (BC), Canada, to fill a gap in transport for rural patients that was previously being met by nurses and physicians leaving their communities to escort patients in need of critical care. The HART team consists of a critical care registered nurse (CCRN) and registered respiratory therapist (RRT) and attends acute care patients in rural sites by either stabilizing them in their community or transporting them...
June 2018: Rural and Remote Health
https://www.readbyqxmd.com/read/29885310/evaluation-of-bd-vacutainer%C3%A2-barricor%C3%A2-blood-collection-tubes-for-routine-chemistry-testing-on-a-roche-cobas%C3%A2-8000-platform
#6
Jeffrey E Fournier, Victoria Northrup, Claudette Clark, Jacqueline Fraser, Michael Howlett, Paul Atkinson, Jennifer L Shea
INTRODUCTION: Barricor™ Vacutainers® are a novel non-gel separator blood collection tube. These tubes enable faster pre-analytical processing which could reduce turnaround time and be beneficial in an acute care setting. We sought to evaluate the bias, stability, and integrity of plasma generated from these tubes compared to Plasma Separator Tubes™ (PST) for 50 routine chemistry analytes on a Roche Cobas® 8000 analyzer. METHODS: Paired samples were collected from 150 patients originating in the emergency department and outpatient collections at the Saint John Regional Hospital...
June 6, 2018: Clinical Biochemistry
https://www.readbyqxmd.com/read/29882463/joint-bap-napicu-evidence-based-consensus-guidelines-for-the-clinical-management-of-acute-disturbance-de-escalation-and-rapid-tranquillisation
#7
Maxine X Patel, Faisil N Sethi, Thomas Re Barnes, Roland Dix, Luiz Dratcu, Bernard Fox, Marina Garriga, Julie C Haste, Kai G Kahl, Anne Lingford-Hughes, Hamish McAllister-Williams, Aileen O'Brien, Caroline Parker, Brodie Paterson, Carol Paton, Sotiris Posporelis, David M Taylor, Eduard Vieta, Birgit Völlm, Charlotte Wilson-Jones, Laura Woods
The British Association for Psychopharmacology and the National Association of Psychiatric Intensive Care and Low Secure Units developed this joint evidence-based consensus guideline for the clinical management of acute disturbance. It includes recommendations for clinical practice and an algorithm to guide treatment by healthcare professionals with various options outlined according to their route of administration and category of evidence. Fundamental overarching principles are included and highlight the importance of treating the underlying disorder...
May 1, 2018: Journal of Psychopharmacology
https://www.readbyqxmd.com/read/29876832/designing-for-impact-identifying-stakeholder-driven-interventions-to-support-recovery-after-major-cancer-surgery
#8
Carmit McMullen, Matthew Nielsen, Alison Firemark, Patricia Merino Price, Denise Nakatani, Jean Tuthill, Ruth McMyn, Anobel Odisho, Michael Meyers, David Shibata, Scott Gilbert
PURPOSE: Complex bladder and colorectal cancer surgeries are associated with significant patient morbidity, yet few resources exist to prepare patients for the high levels of distress and complications they may experience. After ethnographic research to identify design challenges, we held a user-centered design (UCD) workshop to begin to develop patient- and caregiver-centered interventions to support preparation for and recovery after complex cancer surgery. METHODS: Concepts that emerged from brainstorming sessions were visually represented on storyboards and rated...
June 6, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29873588/catch-and-release-evaluating-the-safety-of-non-fatal-heroin-overdose-management-in-the-out-of-hospital-environment
#9
Nathan C Stam, Jennifer L Pilgrim, Olaf H Drummer, Karen Smith, Dimitri Gerostamoulos
BACKGROUND: The aim of this study was to investigate the safety of the management of non-fatal heroin overdose in the out-of-hospital environment; irrespective of whether or not naloxone had been administered. Heroin toxicity-related deaths as well as heroin intoxication-related traumatic deaths following patient-initiated refusal of transport were investigated. METHODS: Heroin-related deaths in the state of Victoria, Australia between 1 January 2012 and 31 December 2013 were investigated and data linkage to pre-hospital Emergency Medical Services performed, in order to identify whether the death was related to the last episode of care by paramedics...
June 6, 2018: Clinical Toxicology
https://www.readbyqxmd.com/read/29866144/standardised-data-reporting-from-pre-hospital-advanced-airway-management-a-nominal-group-technique-update-of-the-utstein-style-airway-template
#10
G A Sunde, A Kottmann, J K Heltne, M Sandberg, M Gellerfors, A Krüger, D Lockey, S J M Sollid
BACKGROUND: Pre-hospital advanced airway management with oxygenation and ventilation may be vital for managing critically ill or injured patients. To improve pre-hospital critical care and develop evidence-based guidelines, research on standardised high-quality data is important. We aimed to identify which airway data were most important to report today and to revise and update a previously reported Utstein-style airway management dataset. METHODS: We recruited sixteen international experts in pre-hospital airway management from Australia, United States of America, and Europe...
June 4, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29859121/critcomms-a-national-cross-sectional-questionnaire-based-study-to-investigate-prehospital-handover-practices-between-ambulance-clinicians-and-specialist-prehospital-teams-in-scotland
#11
David Fitzpatrick, Michael McKenna, Edward A S Duncan, Colville Laird, Richard Lyon, Alasdair Corfield
BACKGROUND: Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Improving the accuracy and quality of handover may reduce associated mortality and morbidity. Although the practice of handover between Ambulance and Emergency Department clinicians has received some attention over recent years there is little evidence to support handover best practice within the prehospital domain. Further research is therefore urgently required to understand the most appropriate way to deliver clinical information exchange in the pre-hospital environment...
June 1, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29843772/effectiveness-of-a-standardized-electronic-admission-order-set-for-acute-exacerbation-of-chronic-obstructive-pulmonary-disease
#12
Sachin R Pendharkar, Maria B Ospina, Danielle A Southern, Naushad Hirani, Jim Graham, Peter Faris, Mohit Bhutani, Richard Leigh, Christopher H Mody, Michael K Stickland
BACKGROUND: Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life. We sought to determine whether an evidence-based computerized AECOPD admission order set could improve quality and reduce length of stay. METHODS: The order set was designed by a provincial COPD working group and implemented voluntarily among three physician groups in a Canadian tertiary-care teaching hospital...
May 30, 2018: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/29843519/experience-and-views-of-oncology-and-palliative-care-professionals-on-a-corounding-model-of-care-for-inpatients-with-advanced-cancer
#13
Grace Meijuan Yang, Sungwon Yoon, Yung Ying Tan, Karen Liaw
BACKGROUND: Palliative care is associated with better outcomes in advanced cancer, but there is limited research comparing different models of palliative care delivery alongside oncology care. For inpatients with cancer, palliative care is mostly delivered through a consult service, primarily relying on oncologist-initiated referrals to a separate specialist palliative care team. In our hospital setting, we piloted a palliative care and oncology corounding model of care. AIM: To explore the views and experience of oncology and palliative care professionals on the corounding model compared to an inpatient consult service...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29805120/international-medical-electives-in-selected-african-countries-a-phenomenological-study-on-host-experience
#14
Elspeth M Fotheringham, Pippa Craig, Elina Tor
Objectives: To explore the host experience on international medical electives at a selection of hospitals in low- and middle-income countries in Africa. Outcomes of the study may inform and improve the preparation of global health curriculum, pre-elective training and debriefing for international medical electives. Methods: A descriptive phenomenological study was undertaken, involving semi-structured interviews with ten elective hosts at seven study sites in three African countries...
May 23, 2018: International Journal of Medical Education
https://www.readbyqxmd.com/read/29799325/the-relationship-between-guideline-recommended-initiation-of-therapy-outcomes-and-cost-for-patients-with-metastatic-non-small-cell-lung-cancer
#15
Adrianne Casebeer, Dana Drzayich Antol, Richard W DeClue, Sari Hopson, Yong Li, Raya Khoury, Todd Michael, Marina Sehman, Aparna Parikh, Stephen Stemkowski, Mikele Bunce
BACKGROUND: Guideline-recommended therapy for metastatic non-small cell lung cancer (mNSCLC) encourages evidence-based treatment; however, there is a knowledge gap regarding the influence of guideline-recommended initiation of therapy on outcomes and cost. OBJECTIVE: To investigate if lack of guideline-recommended initiation of first-line systemic therapy was associated with worse patient outcomes and increased costs for patients with mNSCLC. METHODS: In this retrospective analysis, 1,344 Medicare patients with mNSCLC were identified from Humana data...
June 2018: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29794844/the-impact-of-an-icu-bed-ahead-policy-on-ed-length-of-stay-and-patient-outcomes
#16
Jody C DiGiacomo, L D George Angus, Raina Wallace, Sara Cardozo-Stolberg, Noam Gerber, Swapna Munnangi, Kelley Sookraj, Kathy Skarka
OBJECTIVE: To assess the impact of preassigning a single bed in the surgical intensive care unit (SICU) for the next trauma admission. BACKGROUND: Prolonged emergency department (ED) dwell time before admission to a critical care unit has an adverse effect on patient outcomes and is often due to the lack of an available bed in the intensive care unit (ICU). METHODS: A "Bed Ahead" policy was instituted at an urban level 1 Trauma Public Safety Net Teaching Hospital to preassign 1 SICU bed for the next trauma patient who warrants a critical care admission...
May 23, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29793471/surgical-informed-consent-in-obstetric-and-gynecologic-surgeries-experience-from-a-comprehensive-teaching-hospital-in-southern-ethiopia
#17
Million Teshome, Zenebe Wolde, Abel Gedefaw, Mequanent Tariku, Anteneh Asefa
BACKGROUND: Surgical Informed Consent (SIC) has long been recognized as an important component of modern medicine. The ultimate goals of SIC are to improve clients' understanding of the intended procedure, increase client satisfaction, maintain trust between clients and health providers, and ultimately minimize litigation issues related to surgical procedures. The purpose of the current study is to assess the comprehensiveness of the SIC process for women undergoing obstetric and gynecologic surgeries...
May 24, 2018: BMC Medical Ethics
https://www.readbyqxmd.com/read/29787555/implementation-of-a-ct-scan-practice-guideline-for-pediatric-trauma-patients-reduces-unnecessary-scans-without-impacting-outcomes
#18
Patrick R McGrew, Paul J Chestovich, Jay D Fisher, Deborah A Kuhls, Douglas R Fraser, Purvi P Patel, Chad W Katona, Syed Saquib, John J Fildes
INTRODUCTION: Computed Tomography (CT) scans are useful in the evaluation of trauma patients, but are costly and pose risks from ionizing radiation in children. Recent literature has demonstrated the utility of CT scan guidelines in the management of pediatric trauma. This study objective is to review our treatment of pediatric blunt trauma patients and evaluate CT utilization before and after CT-guideline implementation. METHODS: Our Pediatric Level 2 Trauma Center (TC) implemented a CT scan practice guideline for pediatric trauma patients in March 2014...
May 4, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29779623/educating-emergency-department-staff-on-the-identification-and-treatment-of-human-trafficking-victims
#19
Steven Donahue, Michael Schwien, Danielle LaVallee
INTRODUCTION: Hospitalization is one of the few circumstances in which the lives of trafficking victims intersect with the general population. Based on survivor testimonies, the majority of human trafficking victims may receive medical treatment in a hospital's emergency department while in captivity. With evidenced-based training, ED personnel have a better opportunity to screen persons who are being trafficked and intervene on their behalf. METHODS: This project examined the efficacy of an innovative, evidence-based online training module (HTEmergency...
May 17, 2018: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29776670/-predictors-of-in-hospital-mortality-in-patients-undergoing-elective-surgery-in-a-university-hospital-a-prospective-cohort
#20
Adriene Stahlschmidt, Betânia Novelo, Luiza Alexi Freitas, Sávio Cavalcante Passos, Jairo Alberto Dussián-Sarria, Elaine Aparecida Félix, Patrícia Wajnberg Gamermann, Wolnei Caumo, Luciana Paula Cadore Stefani
INTRODUCTION: Morbidity and mortality associated with urgent or emergency surgeries are high compared to elective procedures. Perioperative risk scores identify the non-elective character as an independent factor of complications and death. The present study aims to characterize the population undergoing non-elective surgeries at the Hospital de Clínicas de Porto Alegre and identify the clinical and surgical factors associated with death within 30 days postoperatively. METHODOLOGY: A prospective cohort study of 187 patients undergoing elective surgeries between April and May 2014 at the Hospital de Clínicas, Porto Alegre...
May 15, 2018: Revista Brasileira de Anestesiologia
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