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High-value care

Jason A Brant, Steven J Eliades, Hannah Kaufman, Jinbo Chen, Michael J Ruckenstein
OBJECTIVE: To evaluate high-performing cochlear implant patients' performance on AzBio sentence testing. METHODS: Retrospective review of prospectively collected database at a tertiary care hospital. Unilateral cochlear implant patients with AzBio testing were included. The primary outcome of interest was AzBio performance scores in quiet and at +10 and +5 decibels signal to noise (dB S/N). RESULTS: One hundred eighty five subjects met inclusion criteria with scores for AzBio in quiet, 114 at +10 dB S/N, and 66 at +5 dB S/N...
March 19, 2018: Otology & Neurotology
Yanhua Wu, Yuanhan Chen, Shaowen Li, Wei Dong, Huaban Liang, Miaoyi Deng, Yingnan Chen, Shixin Chen, Xinling Liang
PURPOSE: To investigate the application value of "electronic alerts" ("e-alerts") for acute kidney injury (AKI) among high-risk wards of hospitals. METHODS: A prospective, randomized, controlled study was conducted. We developed an e-alert system for AKI and ran the system in intensive care units and divisions focusing on cardiovascular disease. The e-alert system diagnosed AKI automatically based on serum creatinine levels. Patients were assigned randomly to an e-alert group (467 patients) or non-e-alert group (408 patients)...
March 19, 2018: International Urology and Nephrology
Natalie Koch Levy, Natasha A Orzeck-Byrnes, Sneha R Aidasani, Dana N Moloney, Lisa H Nguyen, Agnes Park, Lu Hu, Aisha T Langford, Binhuan Wang, Mary Ann Sevick, Erin S Rogers
BACKGROUND: The Mobile Insulin Titration Intervention (MITI) program helps patients with type 2 diabetes find their correct basal insulin dose without in-person care. Requiring only basic cell phone technology (text messages and phone calls), MITI is highly accessible to patients receiving care in safety-net settings. MITI was shown in a randomized controlled trial (RCT) to be efficacious at a New York City (NYC) safety-net clinic where patients often have challenges coming for in-person care...
March 19, 2018: Journal of Medical Internet Research
Sarah Hindenberg, Melanie Keßler, Sabine Zielinsky, Judith Langenstein, Andreas Moritz, Natali Bauer
BACKGROUND: Species-specific point-of-care tests (POCT) permit a rapid analysis of canine C-reactive protein (CRP), enabling veterinarians to include CRP in clinical decisions. Aim of the study was to evaluate a novel POCT for canine CRP (Point Strip™ Canine CRP Assay) run on a small in-house-analyzer (Point Reader™ V) using lithium heparin plasma and to compare assay performance to an already established canine CRP assay (Gentian Canine CRP Immunoassay) run on two different bench top analyzers serving as reference methods (ABX Pentra 400, AU 5800)...
March 20, 2018: BMC Veterinary Research
Mohammad Abu-Zaineh, Maame Esi Woode, Rita Giacaman
BACKGROUND: Interest in the Senian capability framework as an alternative approach to wellbeing measurement has increased in recent decades. The aim of this study was to look at the extent to which an individual's capability to achieve wellbeing in one dimension is associated with his or her attempt to achieve wellbeing in another dimension in a fragile setting affected by conflict. METHODS: Capability is defined as the ability to achieve health, knowledge, and wealth and is measured as latent variables using a structural equation model...
February 21, 2018: Lancet
Meredith B Rosenthal, Carrie H Colla, Nancy E Morden, Thomas D Sequist, Alexander J Mainor, Zhonghe Li, Kevin H Nguyen
OBJECTIVES: A substantial portion of healthcare spending is wasted on services that do not directly improve patient health and that cause harm in some cases. Features of health insurance coverage, including enrollment in high-deductible health plans (HDHPs) or health maintenance organizations (HMOs), may provide financial and nonfinancial mechanisms to potentially reduce overuse of low-value healthcare services. STUDY DESIGN: Using 2009 to 2013 administrative data from 3 large commercial insurers, we examined patient characteristics and health insurance plan types associated with overuse of 6 healthcare services identified by the Choosing Wisely campaign...
March 2018: American Journal of Managed Care
Nikhil Satchidanand, Timothy J Servoss, Ranjit Singh, Angela M Bosinski, Penny Tirpak, Linda L Horton, Bruce J Naughton
BACKGROUND: Early, data-driven discussion surrounding palliative care can improve care delivery and patient experience. OBJECTIVE: To develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course. DESIGN: Retrospective Electronic Health Record (EHR) review. SETTING: Four urban and suburban hospitals in a Western New York hospital system...
January 1, 2018: American Journal of Hospice & Palliative Care
Nanjela Chindima, Panji Nkhoma, Musalula Sinkala, Mildred Zulu, Doris Kafita, Marah Simakando, Florence Mwaba, Hamakwa Mantina, Mubanga Mutale
Context: Sickle cell disease is a group of hemoglobin (Hb) disorders resulting from the inheritance of the sickle β-globin gene. It is the most common pathological Hb mutation worldwide with 75% being born in Sub-Saharan Africa. Aims: This study aims to determine if dried blood spots (DBSs) can be used for diagnosis of sickle cell in newborns. In Zambia, there is no neonatal screening program for sickle cell anemia (SCA), yet it has been proved that early diagnosis by newborn screening (NBS) using DBSs and access to comprehensive care results in survival to adulthood of over 96% of sickle cell patients...
January 2018: International Journal of Applied and Basic Medical Research
Laurie E Powers, Ann Fullerton, Jessica Schmidt, Sarah Geenen, Molly Oberweiser-Kennedy, JoAnn Dohn, May Nelson, Rosemary Iavanditti, Jennifer Blakeslee
Research clearly documents the serious challenges and poor outcomes experienced by many young people exiting foster care, as well as compounded disparities for the high percentage of youth in care who are identified with disabilities and/or mental health challenges. However, very little research has been conducted to specify or validate effective models for improving the transition trajectories of youth exiting care. Evidence suggests the My Life self-determination enhancement model offers a promising approach for supporting youths' self-determined and positive transition to adulthood...
February 2018: Children and Youth Services Review
Elizabeth C Briere, Tracy Pondo, Mark Schmidt, Tami Skoff, Nong Shang, Alison Naleway, Stacey Martin, Michael L Jackson
PURPOSE: Despite high national vaccination coverage with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines among U.S. adolescents, rates of adolescent pertussis disease are increasing. We estimated the duration of protection after Tdap vaccination and the possible effects of the change from whole-cell to acellular childhood pertussis vaccines in the United States during the 1990s. METHODS: We conducted a retrospective cohort analysis among 11- to 18-year-olds enrolled in two integrated health-care delivery systems during 2005-2012...
March 15, 2018: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
C Guillot, C Le Reun, H Behal, J Labreuche, M Recher, A Duhamel, S Leteurtre
BACKGROUND: Viral bronchiolitis is the leading cause of hospitalization in children during the first 12 months of life. There is evidence to support the use of noninvasive ventilation in bronchiolitis. A recent respiratory management of bronchiolitis is the use of high-flow nasal cannula (HFNC) therapy. The primary objective of this study was to evaluate the use of HFNC as the first-line treatment for children with severe bronchiolitis and the secondary objective was to identify factors for HFNC therapy failure...
March 15, 2018: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Sophie Pils, Stephanie Springer, Rudolf Seemann, Verena Wehrmann, Christof Worda, Johannes Ott
PURPOSE: To review our experience in ultrasound fetal weight estimation in our large population of triplet pregnancies. METHODS: Ninety-seven triplet pregnancies were retrospectively included between January 2003 and January 2017. Sonographic fetal weight estimation using Hadlock's and Schild's formulas was compared to actual birth weight in a tertiary-care center in Vienna, Austria. Statistical analyses were performed using a stepwise linear regression model and crosstabs...
March 17, 2018: Archives of Gynecology and Obstetrics
Nitika Paudel, Kevin P Bethke, Lilian C Wang, Jonathan B Strauss, John P Hayes, Eric D Donnelly
PURPOSE: The current standard of care for women diagnosed with early stage breast cancer is breast-conserving surgery (BCS) followed by external beam radiation therapy, commonly delivered over 3-6 weeks. As an alternative, select patients can undergo intra-operative radiation therapy (IORT) at the time of BCT. This technique delivers a single fraction of radiation at the time of surgery, enabling patients to undergo both surgery and radiation in a single session. Our current study analyzed the value of incorporating breast MRI into the routine work-up of patients deemed eligible for IORT, to quantify the impact on patient eligibility and requirement for additional work-up...
March 2018: Surgical Oncology
Antonio Cano-Vindel, Roger Muñoz-Navarro, Leonardo Adrián Medrano, Paloma Ruiz-Rodríguez, César González-Blanch, María Dolores Gómez-Castillo, Antonio Capafons, Fernando Chacón, Francisco Santolaya
BACKGROUND: The Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report consisting of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (GAD-2). The aim of the present study is to determine the psychometric properties of a computerized version of the PHQ-4 used to detect emotional disorders (anxiety and depression) in the primary care setting. METHOD: A total of 1052 patients with suspected anxiety, depression, or somatic symptoms were recruited from 28 primary care centres participating in the PsicAP trial and completed the full version of the computerized PHQ...
February 16, 2018: Journal of Affective Disorders
Jennifer Gubitosa, Vito Rizzi, Angela Lopedota, Paola Fini, Anna Laurenzana, Gabriella Fibbi, Fiorenza Fanelli, Andrea Petrella, Valentino Laquintana, Nunzio Denora, Roberto Comparelli, Pinalysa Cosma
HYPOTHESIS: The interesting properties of Gold Nanoparticles (AuNPs) make them attractive for different application fields such as cosmetology, medicine and clinical nanotechnologies. In this work a fast, easy and eco-friendly method for the AuNPs synthesis is proposed by using the Punica Granatum Juice (PGJ) with potential dermatological and cosmetic applications. The AuNPs antioxidant activity, due to the presence of phenols from the juice, and their use as booster for improving the Sun Protection Factor (SPF) in commercial sunscreen formulations, are thus expounded...
March 9, 2018: Journal of Colloid and Interface Science
Suad Sivić, Larisa Gavran, Salih Tandir, Elvir Peštalić
Aim To determine most common factors making patients with high blood pressure seek professionally unacceptable treatment of hypertension at the Emergency Department. Methods The survey was conducted at the Emergency Department of the Primary Health Care in Gradačac on randomly selected 207 patients who requested medical help because of high blood pressure. For all patients arterial blood pressure and body mass index (BMI) were measured. A survey about knowledge and attitudes regarding habits that affect high blood pressure as well as the socio-economic conditions was made...
February 1, 2018: Medicinski Glasnik
Michael E Berend, Wesley G Lackey, Joshua L Carter
BACKGROUND: Perhaps, the most significant developments in joint arthroplasty in the past decade have been in the area of multimodal perioperative management reducing pain, nausea, and length of stay leading to outpatient arthroplasty. METHODS: Over a 2-year period, we performed 1230 arthroplasty cases including partial knee, total hip, total knee, and selected revision cases. RESULTS: Patient satisfaction ranged from 98% to 100% great/good...
February 9, 2018: Journal of Arthroplasty
Callum G Fraser
Colonoscopy is a relatively scarce resource in many countries, including Scotland, and a simple investigation which would aid general practitioners in particular in decision-making as to which patients presenting with lower bowel symptoms warranted referral would be of much help. Faecal immunochemical tests for haemoglobin (FIT) have many advantageous characteristics and are now proven to be of considerable value in the timely assessment of patients with symptoms of lower bowel disease. Quantitative FIT provide numerical estimates of faecal haemoglobin concentration (f-Hb) and, at low f-Hb cut-off, FIT have high sensitivity for colorectal cancer (CRC) and could be used as a rule-in test to stimulate rapid referral, especially when symptoms are suggestive of serious bowel disease...
March 13, 2018: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Kristen A Calabro, Mehul V Raval, David H Rothstein
As healthcare systems increasingly shift focus toward providing high-quality and high-value care to patients, there has been a simultaneous growth in assessing the patient's experience through patient-reported outcomes. Along with well-known patient reported outcomes such as health-related quality of life and current health state, patient satisfaction can be a valuable assessment of quality. Patient and family satisfaction measures not only affect a patient's clinical course and influence overall patient compliance, but are increasingly used to gauge physician performance and guide reimbursement...
April 2018: Seminars in Pediatric Surgery
Laura Miller, Gerardo J Pacheco, Jud C Janak, Rose C Grimm, Nicole A Dierschke, Janice Baker, Jean A Orman
Background: Military working dogs (MWDs) are a major asset in the theater of operations. Their unique abilities make them ideal for tasks such as tracking, patrol, and scent detection. MWDs deployed to a war zone are exposed to harsh environments and battlefield dangers that increase their risk of disease, injuries, and death. Although canines have been used extensively in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), no published studies have reported detailed causes of death among MWDs deployed to these conflicts...
March 14, 2018: Military Medicine
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