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https://www.readbyqxmd.com/read/29141183/functional-outcomes-of-acute-inpatient-rehabilitation-in-patients-with-chronic-graft-versus-host-disease
#1
Jason Leung, Sean Smith, Claire Kalpakjian
BACKGROUND: Growing numbers of allogeneic stem cell transplants (HSCT) and improved post-transplant care have led to an increase of individuals with chronic graft versus host disease (cGVHD). Although cGVHD leads to functional impairment for many, there is limited literature regarding the benefits of acute inpatient rehabilitation for cGVHD patients. OBJECTIVE: To assess Functional Independence Measure (FIM) outcomes of cGVHD patients during acute inpatient rehabilitation, and to compare inpatient rehabilitation outcomes to burn patients, a rehabilitation patient population with similar co-morbidities...
November 12, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/29121105/economic-evaluation-of-the-one-hour-rule-out-and-rule-in-algorithm-for-acute-myocardial-infarction-using-the-high-sensitivity-cardiac-troponin-t-assay-in-the-emergency-department
#2
Apoorva Ambavane, Bertil Lindahl, Evangelos Giannitis, Julie Roiz, Joan Mendivil, Lutz Frankenstein, Richard Body, Michael Christ, Roland Bingisser, Aitor Alquezar, Christian Mueller
BACKGROUND: The 1-hour (h) algorithm triages patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED) towards "rule-out," "rule-in," or "observation," depending on baseline and 1-h levels of high-sensitivity cardiac troponin (hs-cTn). The economic consequences of applying the accelerated 1-h algorithm are unknown. METHODS AND FINDINGS: We performed a post-hoc economic analysis in a large, diagnostic, multicenter study of hs-cTnT using central adjudication of the final diagnosis by two independent cardiologists...
2017: PloS One
https://www.readbyqxmd.com/read/29120004/nerve-traction-injury-after-subacute-revision-external-fixation-of-a-tibial-plateau-fracture
#3
Lauren E Wessel, Alexander B Christ, David Helfet, David S Wellman
Nerve traction injuries are common clinical entities that can be confused with nerve palsies secondary to alternate etiologies. Common mechanisms of nerve injury include direct laceration, crush injury, compression injury, elevated compartment pressures, or traction injury. Traction injuries commonly occur after trauma or aberrant patient positioning; however, traction injury following external fixation for lower extremity injury is rare. This case report describes a 42-year-old man who initially sustained a Schatzker VI tibial plateau fracture that required revision of external fixation for pin-site infection as soft tissues recovered from the initial trauma...
November 8, 2017: Orthopedics
https://www.readbyqxmd.com/read/29090028/evaluation-of-the-effect-of-statins-on-post-surgical-patients-with-acute-kidney-injury
#4
Abkhiz Saeed, Valizade Hasanloei Mohammad Amin, Mahoori Alireza, Hooshiar Hadi, Alizadeh Osalou Rahimeh
INTRODUCTION: Acute kidney injury is the sudden and almost complete loss of renal function with reduced glomerular filtration rate, and it occurs whenever the kidneys are unable to excrete metabolic waste products. METHOD: This randomized double-blinded clinical trial was performed in an intensive care unit (ICU) of a university educational hospital. After randomization with a random assigning table of numbers, patients were divided into two groups: an intervention group and a control group...
June 2017: Mædica
https://www.readbyqxmd.com/read/29083975/factors-associated-with-direct-health-care-costs-among-patients-with-migraine
#5
Machaon Bonafede, Qian Cai, Katherine Cappell, Gilwan Kim, Sandhya J Sapra, Neel Shah, Katherine Widnell, Paul Winner, Pooja Desai
BACKGROUND: Migraine imposes substantial economic burden on patients and the health care system. Approximately 18% of women and 6% of men suffer from migraine in the United States. This is a heterogeneous group, and little data are available to evaluate factors associated with migraine costs. OBJECTIVE: To evaluate characteristics associated with high costs among commercially insured patients with migraine. METHODS: This retrospective analysis identified patients with migraine in the Truven Health MarketScan Research Databases between January 2008 and June 2013...
November 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29077798/respiratory-symptoms-in-hospital-cleaning-staff-exposed-to-a-product-containing-hydrogen-peroxide-peracetic-acid-and-acetic-acid
#6
Brie Hawley, Megan Casey, Mohammed Abbas Virji, Kristin J Cummings, Alyson Johnson, Jean Cox-Ganser
Cleaning and disinfecting products consisting of a mixture of hydrogen peroxide (HP), peracetic acid (PAA), and acetic acid (AA) are widely used as sporicidal agents in health care, childcare, agricultural, food service, and food production industries. HP and PAA are strong oxidants and their mixture is a recognized asthmagen. However, few exposure assessment studies to date have measured HP, PAA, and AA in a health care setting. In 2015, we performed a health and exposure assessment at a hospital where a new sporicidal product, consisting of HP, PAA, and AA was introduced 16 months prior...
October 25, 2017: Annals of Work Exposures and Health
https://www.readbyqxmd.com/read/29066874/optimization-of-drug-therapy-in-elderly-individuals-admitted-to-a-geriatric-unit
#7
Antoine Piau, Yoann Huet, Adeline Gallini, Laurine Andre, Bruno Vellas, Fati Nourhashemi
BACKGROUND: A substantial share of adverse drug events involves inappropriate prescribing (IP). Specialized geriatric units are supposed to pay particular attention to prescribing appropriateness and to promoting a higher prescribing quality. OBJECTIVE: The objective of this study was to evaluate the reality of such assessment and optimization in real life (usual care) in a population of elderly individuals admitted to a geriatric unit. METHOD: This is an observational study including all older patients admitted to an acute geriatric unit over a 6-month period...
2017: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/29061618/critical-care-cycling-study-cyclist-trial-protocol-a-randomised-controlled-trial-of-usual-care-plus-additional-in-bed-cycling-sessions-versus-usual-care-in-the-critically-ill
#8
Marc R Nickels, Leanne M Aitken, James Walsham, Adrian G Barnett, Steven M McPhail
INTRODUCTION: In-bed cycling with patients with critical illness has been shown to be safe and feasible, and improves physical function outcomes at hospital discharge. The effects of early in-bed cycling on reducing the rate of skeletal muscle atrophy, and associations with physical and cognitive function are unknown. METHODS AND ANALYSIS: A single-centre randomised controlled trial in a mixed medical-surgical intensive care unit (ICU) will be conducted. Adult patients (n=68) who are expected to be mechanically ventilated for more than 48 hours and remain in ICU for a further 48 hours from recruitment will be randomly allocated into either (1) a usual care group or (2) a group that receives usual care and additional in-bed cycling sessions...
October 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/29056247/haemato-oncology-patients-perceptions-of-health-related-quality-of-life-after-critical-illness-a-qualitative-phenomenological-study
#9
Geraldine O'Gara, Simon Tuddenham, Natalie Pattison
INTRODUCTION: Haemato-oncology patients often require critical care support due to side-effects of treatment. Discharge can mark the start of an uncertain journey due to the impact of critical illness on health-related quality of life. Qualitatively establishing needs is a priority as current evidence is limited. AIMS: To qualitatively explore perceptions of haemato-oncology patients' health-related quality of life after critical illness and explore how healthcare professionals can provide long-term support...
October 19, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29051001/episode-based-payment-variation-for-urological-cancer-surgery
#10
Chad Ellimoottil, Jonathan Li, Zaojun Ye, James M Dupree, Hye Sung Min, Deborah Kaye, Lindsey A Herrel, David C Miller
OBJECTIVE: To investigate payment variation for three common urological cancer surgeries and evaluate the potential for applying bundled payment programs to these procedures. METHODS: Using 2008-2011 Surveillance, Epidemiology, and End Results-Medicare linked data, we identified all beneficiaries aged greater than 65 years who underwent cystectomy, prostatectomy, or nephrectomy for cancer. Total episode payments were determined by aggregating hospital, professional, and post-acute care claims from the index surgical hospitalization through 90 days post-discharge...
October 16, 2017: Urology
https://www.readbyqxmd.com/read/29050383/early-detection-of-consciousness-in-patients-with-acute-severe-traumatic-brain-injury
#11
Brian L Edlow, Camille Chatelle, Camille A Spencer, Catherine J Chu, Yelena G Bodien, Kathryn L O'Connor, Ronald E Hirschberg, Leigh R Hochberg, Joseph T Giacino, Eric S Rosenthal, Ona Wu
See Schiff (doi:10.1093/awx209) for a scientific commentary on this article. Patients with acute severe traumatic brain injury may recover consciousness before self-expression. Without behavioural evidence of consciousness at the bedside, clinicians may render an inaccurate prognosis, increasing the likelihood of withholding life-sustaining therapies or denying rehabilitative services. Task-based functional magnetic resonance imaging and electroencephalography techniques have revealed covert consciousness in the chronic setting, but these techniques have not been tested in the intensive care unit...
September 1, 2017: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/29035085/lung-microbiota-is-related-to-smoking-status-and-to-development-of-ards-in-critically-ill-trauma-patients
#12
Ariane R Panzer, Susan V Lynch, Chaz Langelier, Jason D Christie, Kathryn McCauley, Mary Nelson, Christopher K Cheung, Neal L Benowitz, Mitchell J Cohen, Carolyn S Calfee
RATIONALE: Cigarette smoking is associated with increased risk of acute respiratory distress syndrome (ARDS) in patients following severe trauma; however, mechanisms underlying this association are unknown. OBJECTIVES: To determine whether cigarette smoking contributes to ARDS development following trauma by altering community composition of the lung microbiota Methods: We studied lung microbiota of mechanically ventilated patients admitted to the intensive care unit (ICU) following severe blunt trauma using 16S rRNA gene amplicon sequencing of endotracheal aspirate (ETA) samples obtained upon ICU admission (n=74) and at 48 hours post-admission (n=30)...
October 16, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29031542/complications-and-30-day-readmission-rates-after-craniotomy-craniectomy-a-single-institutional-study-of-243-consecutive-patients
#13
Aladine A Elsamadicy, Amanda Sergesketter, Owoicho Adogwa, Michael Ongele, Oren N Gottfried
Early hospital readmission has become a proxy for quality of care and contributes significantly to high health care costs in the United States, with more than $20 billion health care dollars are spent on 30-day readmission annually. Cranial neurosurgical procedures (i.e., craniotomy, craniectomy) are associated with high readmission rates; however, studies examining readmission after cranial procedures are limited and relatively unknown. The aim of this study is to identify the drivers of 30-day unplanned readmission in consecutive patients undergoing craniotomies and craniectomies...
October 11, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29024333/united-we-stand-divided-we-conquer-pilot-study-of-multidisciplinary-general-medicine-heart-failure-care-program
#14
Omar Wahbi Izzettin, Ingrid Hopper, Edward Ritchie, Vathy Nagalingam, Ar Kar Aung
BACKGROUND: Heart failure care and education require a multifaceted approach to ensure appropriate transition from inpatient to outpatient care. AIMS: To explore the feasibility of a multidisciplinary heart failure care model, General Medicine Heart Failure Care Program (GM-HFCP) within a General Medical Unit (GMU). METHODS: Prospective non-randomised before-and-after observational quality improvement intervention over a 6-month period. All consecutive patients admitted to GMU at Alfred Hospital with diagnosis of acute decompensated heart failure were included...
October 11, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28990334/what-s-next-for-acute-heart-failure-research
#15
Sean P Collins, Phillip D Levy, Gregory J Fermann, Michael M Givertz, Jennifer M Martindale, Peter S Pang, Alan B Storrow, Deborah D Diercks, G Michael Felker, Gregg C Fonarow, David J Lanfear, Daniel J Lenihan, JoAnn M Lindenfeld, W Frank Peacock, Douglas M Sawyer, John R Teerlink, Javed Butler
Each year over one million patients with acute heart failure (AHF) present to a United States emergency department (ED). The vast majority are hospitalized for further management. The length of stay and high postdischarge event rate in this cohort have changed little over the past decade. Therapeutic trials have failed to yield substantive improvement in postdischarge outcomes; subsequently, AHF care has changed little in the past 40 years. Prior research studies have been fragmented as either "inpatient" or "ED-based...
October 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28984049/mir-422a-suppresses-smad4-protein-expression-and-promotes-resistance-to-muscle-loss
#16
Richard Paul, Jen Lee, Anna V Donaldson, Martin Connolly, Mohammad Sharif, Samantha Amanda Natanek, Ulrich Rosendahl, Michael I Polkey, Mark Griffiths, Paul R Kemp
BACKGROUND: Loss of muscle mass and strength are important sequelae of chronic disease, but the response of individuals is remarkably variable, suggesting important genetic and epigenetic modulators of muscle homeostasis. Such factors are likely to modify the activity of pathways that regulate wasting, but to date, few such factors have been identified. METHODS: The effect of miR-422a on SMAD4 expression and transforming growth factor (TGF)-β signalling were determined by western blotting and luciferase assay...
October 6, 2017: Journal of Cachexia, Sarcopenia and Muscle
https://www.readbyqxmd.com/read/28974330/anticipating-care-needs-of-patients-after-discharge-from-hospital-frail-and-elderly-patients-without-physiological-abnormality-on-day-of-admission-are-more-likely-to-require-social-services-input
#17
C P Subbe, N Goulden, K Mawdsley, R Smith
INTRODUCTION: Acute admissions to hospital are rising. As a part of a service evaluation we examined pathways of patients following hospital discharge depending on data available on admission to hospital. METHODS: We merged data available on admission to the Wrexham Maelor hospital from an existing data-base in the Acute Medical Unit with follow up data from local social services as part of a data sharing agreement. Patients requiring support by social services post-discharge were matched with patients not requiring social services from the same post-code...
September 30, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28970763/transitional-home-care-program-utilizing-the-integrated-practice-unit-concept-thc-ipu-effectiveness-in-improving-acute-hospital-utilization
#18
Lian Leng Low, Wei Yi Tay, Shu Yun Tan, Elian Hui San Chia, Rachel Marie Towle, Kheng Hock Lee
BACKGROUND: Organizing care into integrated practice units (IPUs) around conditions and patient segments has been proposed to increase value. We organized transitional care into an IPU (THC-IPU) for a patient segment of functionally dependent patients with limited community ambulation. METHODS: 1,166 eligible patients were approached for enrolment into THC-IPU. THC-IPU patients received a comprehensive assessment within two weeks of discharge; medication reconciliation; education using standardized action plans and a dedicated nurse case manager for up to 90 days after discharge...
August 14, 2017: International Journal of Integrated Care
https://www.readbyqxmd.com/read/28970100/early-intensive-hand-rehabilitation-is-not-more-effective-than-usual-care-plus-one-to-one-hand-therapy-in-people-with-sub-acute-spinal-cord-injury-hands-on-a-randomised-trial
#19
Lisa A Harvey, Sarah A Dunlop, Leonid Churilov, Mary P Galea
QUESTION: What is the effect of adding an intensive task-specific hand-training program involving functional electrical stimulation to a combination of usual care plus three 15-minute sessions per week of one-to-one hand therapy in people with sub-acute tetraplegia? DESIGN: A parallel group, randomised, controlled trial. Participants were randomly assigned (1:1) via a computer-generated concealed block randomisation procedure to either a control or experimental intervention...
October 2017: Journal of Physiotherapy
https://www.readbyqxmd.com/read/28931363/a-guideline-based-policy-to-decrease-intensive-care-unit-admission-rates-for-accidental-hypothermia
#20
Herman R Sequeira, Hesham E Mohamed, Neal Hakimi, Dorothy B Wakefield, Jonathan Fine
RATIONALE: Despite guidelines advising passive rewarming for mild accidental hypothermia (AH), patients are frequently admitted to intensive care unit (ICU) for active rewarming using a forced-air warming device. We implemented a new policy at our institution aimed at safely reducing ICU admissions for AH. We analyzed our practice pre- and post-policy intervention and compared our experiences with acute care hospitals in Connecticut. METHODS: A retrospective chart review was performed on 203 participants with AH identified by primary and secondary discharge codes...
January 1, 2017: Journal of Intensive Care Medicine
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