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Clinical decision unit

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https://www.readbyqxmd.com/read/29679403/nature-and-scope-of-certified-nurse-midwifery-practice-in-one-large-state-in-the-united-states
#1
Marie Hastings-Tolsma, Sarah Wilcox Foster, Mary C Brucker, Priscilla Nodine, Rebecca Burpo, Barbara Camune, Jackie Griggs, Tiffany J Callahan
AIMS AND OBJECTIVES: To describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers. BACKGROUND: Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives' work environment and scope of practice. DESIGN: Mixed methods research utilizing prospective descriptive survey and interview...
April 21, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29678147/protocol-based-evaluation-for-feasibility-of-extubation-compared-to-clinical-scoring-systems-after-major-oral-cancer-surgery-safely-reduces-the-need-for-tracheostomy-a-retrospective-cohort-study
#2
Axel Schmutz, Rolf Dieterich, Johannes Kalbhenn, Pit Voss, Torsten Loop, Sebastian Heinrich
BACKGROUND: Despite risks, complications and negative impact to quality of life, tracheostomy is widely used to bypass upper airway obstruction after major oral cancer surgery (MOCS). Decision to tracheostomy is frequently based on clinical scoring systems which mainly have not been validated by different cohorts. Delayed extubation in the Intensive Care Unit (ICU) may be a suitable alternative in selected cases. We hypothesize that delayed routine ICU extubation after MOCS instead of scoring system based tracheostomy is safe, feasible and leads to lower tracheostomy rates...
April 20, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29678002/midlevel-maternity-providers-preferences-of-a-childbirth-monitoring-tool-in-low-income-health-units-in-uganda
#3
Michael S Balikuddembe, Peter K Wakholi, Nazarius M Tumwesigye, Thorkild Tylleskär
A third of women in childbirth are inadequately monitored, partly due to the tools used. Some stakeholders assert that the current labour monitoring tools are not efficient and need improvement to become more relevant to childbirth attendants. The study objective was to explore the expectations of maternity service providers for a mobile childbirth monitoring tool in maternity facilities in a low-income country like Uganda. Semi-structured interviews of purposively selected midwives and doctors in rural-urban childbirth facilities in Uganda were conducted before thematic data analysis...
2018: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/29676787/turning-high-risk-individuals-an-economic-evaluation-of-repositioning-frequency-in-long-term-care
#4
Petros Pechlivanoglou, Mike Paulden, Ba' Pham, Josephine Wong, Susan D Horn, Murray Krahn
Recent evidence suggests that less frequent repositioning of long-term care residents at moderate to high risk of developing pressure ulcers (PrUs) is noninferior to current repositioning standards in preventing PrUs, but the long-term health and economic consequences of less frequent repositioning have not been adequately estimated. Our objective was to estimate the cost-effectiveness of different repositioning strategies (2-, 3-, 4-hour intervals). We conducted a cost-utility analysis using a lifetime horizon based on data from a randomized clinical trial and the literature...
April 20, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29676584/current-practice-of-ototoxicity-management-across-the-united-kingdom-uk
#5
Devina Maru, Ghada-Al Malky
OBJECTIVE: Effective management of patients diagnosed with ototoxicity is needed to reduce hearing and balance damage which affects communication and life quality. Despite widespread recommendations to monitor and manage ototoxicity in an early and effective manner, there is limited evidence to support the actual implementation of these recommendations for affected patient groups in healthcare services across the UK with limited publications available. In this study, an online questionnaire analysed the current practice of ototoxicity management and patient pathways across the UK once the diagnosis of ototoxicity was confirmed, targeting Audiologists, ENTs/AVPs and GPs...
April 20, 2018: International Journal of Audiology
https://www.readbyqxmd.com/read/29674373/study-protocol-quantitative-fibronectin-to-help-decision-making-in-women-with-symptoms-of-preterm-labour-quids-part-2-uk-prospective-cohort-study
#6
Sarah Jane Stock, Lisa M Wotherspoon, Kathleen Anne Boyd, Rachel K Morris, Jon Dorling, Lesley Jackson, Manju Chandiramani, Anna L David, Asma Khalil, Andrew Shennan, Victoria Hodgetts Morton, Tina Lavender, Khalid Khan, Susan Harper-Clarke, Ben Mol, Richard D Riley, John Norrie, Jane Norman
INTRODUCTION: The aim of the QUIDS study is to develop a decision support tool for the management of women with symptoms and signs of preterm labour, based on a validated prognostic model using quantitative fetal fibronectin (fFN) concentration, in combination with clinical risk factors. METHODS AND ANALYSIS: The study will evaluate the Rapid fFN 10Q System (Hologic, Marlborough, Massachusetts, USA) which quantifies fFN in a vaginal swab. In QUIDS part 2, we will perform a prospective cohort study in at least eight UK consultant-led maternity units, in women with symptoms of preterm labour at 22+0  to 34+6 weeks gestation to externally validate a prognostic model developed in QUIDS part 1...
April 19, 2018: BMJ Open
https://www.readbyqxmd.com/read/29673362/problems-maintaining-collaborative-approaches-with-excluded-populations-in-a-randomised-control-trial-lessons-learned-implementing-housing-first-in-france
#7
Pauline Rhenter, Aurélie Tinland, Julien Grard, Christian Laval, Jean Mantovani, Delphine Moreau, Benjamin Vidaud, Tim Greacen, Pascal Auquier, Vincent Girard
BACKGROUND: In 2006, a local collective combating homelessness set up an 'experimental squat' in an abandoned building in Marseille, France's second largest city. They envisioned the squat as an alternative to conventional health and social services for individuals experiencing long-term homelessness and severe psychiatric disorders. Building on what they learned from the squat, some then joined a larger coalition that succeeded in convincing national government decision-makers to develop a scientific, intervention-based programme based on the Housing First model...
April 19, 2018: Health Research Policy and Systems
https://www.readbyqxmd.com/read/29672356/improving-documentation-of-inpatient-problem-list-in-electronic-health-record-a-quality-improvement-project
#8
Prabi Rajbhandari, Moises Auron, Sarah Worley, Michelle Marks
BACKGROUND: The problem list is critical in electronic documentation. It is a powerful tool for clinical decision-making because it provides a concise view of all patient problems in one place and is also a criterion for the Medicare meaningful use incentive program. OBJECTIVE: To measure the rate of utilization of problem list in electronic health records (EHR) in a pediatric hospital medicine unit and implement sequential interventions to increase the rate of use of problem list to more than 80% by the end of 2015, as measured by at least one documented hospital problem at discharge...
April 19, 2018: Journal of Patient Safety
https://www.readbyqxmd.com/read/29672327/the-affordable-care-act-decreased-the-proportion-of-uninsured-patients-in-a-safety-net-orthopaedic-clinic
#9
Joseph A Gil, Avi D Goodman, Justin Kleiner, Robin N Kamal, Laurence C Baker, Edward Akelman
BACKGROUND: The Patient Protection and Affordable Care Act (ACA) was approved in 2010, substantially altering the economics of providing and receiving healthcare services in the United States. One of the primary goals of this legislation was to expand insurance coverage for under- and uninsured residents. Our objective was to examine the effect of the ACA on the insurance status of patients at a safety net clinic. Our institution houses a safety net clinic that provides the dominant majority of orthopaedic care for uninsured patients in our state...
May 2018: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/29669707/a-web-based-decision-tool-to-improve-contraceptive-counseling-for-women-with-chronic-medical-conditions-protocol-for-a-mixed-methods-implementation-study
#10
Justine P Wu, Laura J Damschroder, Michael D Fetters, Brian J Zikmund-Fisher, Benjamin F Crabtree, Shawna V Hudson, Mack T Ruffin Iv, Juliana Fucinari, Minji Kang, L Susan Taichman, John W Creswell
BACKGROUND: Women with chronic medical conditions, such as diabetes and hypertension, have a higher risk of pregnancy-related complications compared with women without medical conditions and should be offered contraception if desired. Although evidence based guidelines for contraceptive selection in the presence of medical conditions are available via the United States Medical Eligibility Criteria (US MEC), these guidelines are underutilized. Research also supports the use of decision tools to promote shared decision making between patients and providers during contraceptive counseling...
April 18, 2018: JMIR Research Protocols
https://www.readbyqxmd.com/read/29667509/the-involvement-of-cancer-patients-in-the-four-stages-of-decision-making-preceding-continuous-sedation-until-death-a-qualitative-study
#11
Lenzo Robijn, Jane Seymour, Luc Deliens, Ida Korfage, Jayne Brown, Peter Pype, Agnes Van Der Heide, Kenneth Chambaere, Judith Rietjens
BACKGROUND: Involving patients in decision-making is considered to be particularly appropriate towards the end of life. Professional guidelines emphasize that the decision to initiate continuous sedation should be made in accordance with the wishes of the dying person and be preceded by their consent. AIM: To describe the decision-making process preceding continuous sedation until death with particular attention to the involvement of the person who is dying. DESIGN: Qualitative case studies using interviews...
April 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29667311/how-japanese-nurses-participate-in-decision-making-infants-with-congenital-life-threatening-conditions
#12
Sohei Shitaya, Nobue Nakamura, Naho Sato
BACKGROUND: In Japan, owing to the progress in medical technology, more children with congenital life-threatening conditions survive than ever before. Nurses who care for these children may also influence decision making in difficult situations. AIM: We aimed to describe Japanese nurses' approach toward medical decision making when caring for families of infants with congenital life-threatening conditions. Frequently, these nurses must care for and support parents with ambivalent feelings...
April 2018: International Journal of Nursing Practice
https://www.readbyqxmd.com/read/29666073/ventricular-assist-device-utilization-in-heart-transplant-candidates-nationwide-variability-and-impact-on-waitlist-outcomes
#13
Lauren K Truby, A Reshad Garan, Raymond C Givens, Koji Takeda, Hiroo Takayama, Pauline N Trinh, Melana Yuzefpolskaya, Maryjane A Farr, Yoshifumi Naka, Paolo C Colombo, Veli K Topkara
BACKGROUND: Continuous-flow left ventricular assist devices (CF-LVADs) have become a standard treatment choice in advanced heart failure patients. We hypothesized that practice patterns with regards to CF-LVAD utilization vary significantly among transplant centers and impact waitlist outcomes. METHODS AND RESULTS: The United Network for Organ Sharing registry was queried to identify adult patients who were waitlisted for heart transplantation (HT) between 2008 and 2015...
April 2018: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29665763/neuroimaging-radiological-interpretation-system-niris-for-acute-traumatic-brain-injury-tbi
#14
Max Wintermark, Ying Li, Victoria Y Ding, Yingding Xu, Bin Jiang, Robyn L Ball, Michael Zeineh, Alisa Gean, Pina Sanelli
To develop an outcome-based NeuroImaging Radiological Interpretation System (NIRIS) for acute traumatic brain injury (TBI) patients that would standardize the interpretation of non-contrast head CTs and consolidate imaging findings into ordinal severity categories that would inform specific patient management actions and that could be used as a clinical decision support tool. We retrospectively identified all patients transported to our emergency department by ambulance or helicopter, for whom a trauma alert was triggered per established criteria and who underwent a non-contrast head CT due to suspicion of TBI, between November 2015 and April 2016...
April 18, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29665338/parental-experience-of-sleep-disordered-breathing-in-infants-with-cleft-palate-comparing-parental-and-clinical-priorities
#15
Karen Davies, Yin-Ling Lin, Anne-Marie Glenny, Peter Callery, Iain A Bruce
OBJECTIVE: To identify outcomes relating to sleep-disordered breathing (SDB) that are relevant to parents, during the early weeks of caring for infants with cleft palate (CP), and compare these with clinical outcomes identified in a systematic search of research literature. DESIGN: A qualitative study using telephone/face-to-face interviews with parents explored their understanding of breathing and respiratory effort in infants with CP. SETTING: Care provided by 3 specialist cleft centers in the United Kingdom, with study conducted in parents' homes...
January 1, 2018: Cleft Palate-craniofacial Journal
https://www.readbyqxmd.com/read/29664202/training-psychologists-for-rural-practice-exploring-opportunities-and-constraints
#16
Marisa Elena Domino, Ching-Ching Claire Lin, Joseph P Morrissey, Alan R Ellis, Erin Fraher, Erica L Richman, Kathleen C Thomas, Mitchell J Prinstein
PURPOSE: To examine trends in the psychologist workforce and training opportunities, including factors that may influence the decision of clinical psychologists to practice in rural settings. METHODS: We use a mixed-methods approach to examine the psychologist workforce nationally and in North Carolina (NC), including (1) an analysis of the location of programs awarding doctoral degrees; (2) an analysis of the practice, demographic, and educational characteristics of the psychologist workforce; and (3) interviews with directors of doctoral programs in clinical psychology to understand where current graduates are getting jobs and why they may or may not be choosing to practice in rural communities...
April 17, 2018: Journal of Rural Health
https://www.readbyqxmd.com/read/29656722/toward-a-contingency-model-for-hospital-based-health-technology-assessment-evidence-from-adhophta-project
#17
Americo Cicchetti, Valentina Iacopino, Silvia Coretti, Alessandra Fiore, Marco Marchetti, Laura Sampietro-Colom, Kristian Kidholm, Jean-Blaise Wasserfallen, Rabia Kahveci, Esa Halmesmäki, Magdalene Rosenmöller, Claudia Wild, Raul-Allan Kivet
OBJECTIVES: Hospital-based health technology assessment (HB-HTA) is becoming increasingly relevant because of its role in managing the introduction and withdrawal of health technologies. The organizational arrangement in which HB-HTA activities are conducted depends on several contextual factors, although the dominant models have several similarities. The aims of this study were to explore, describe, interpret, and explain seven cases of the application of HB-HTA logic and to propose a classification for HB-HTA organizational models which may be beneficial for policy makers and HTA professionals...
April 16, 2018: International Journal of Technology Assessment in Health Care
https://www.readbyqxmd.com/read/29656490/cross-cultural-adaptation-reliability-and-validity-of-the-spanish-version-of-the-neonatal-skin-risk-assessment-scale
#18
Pablo García-Molina, Evelin Balaguer López, José Verdú, Andreu Nolasco, Francisco P García Fernández
AIM: To adapt the Neonatal Skin Risk Assessment Scale to the Spanish context and to test its validity and reliability. BACKGROUND: Currently, in Spain there are no validated scales to evaluate the risk of pressure ulcers in infants. METHOD: The research was performed in 10 neonatal units. Overall, we use an observational study design, but divided it in to three stages. In the first stage, the transcultural adaptation of the scale and its content validation was performed...
April 14, 2018: Journal of Nursing Management
https://www.readbyqxmd.com/read/29655399/system-outcomes-associated-with-a-pediatric-emergency-department-clinical-decision-unit
#19
Derin Karacabeyli, Garth D Meckler, David K Park, Quynh Doan
CLINICIAN'S CAPSULE What is known about the topic? Clinical decision units (CDUs) may reduce short-stay hospitalizations (<48 hours), which are associated with longer lengths of stay, increased staffing needs and higher costs. What did this study ask? What are the disposition outcomes and emergency department (ED) return rates following CDU care? Has CDU implementation changed short-stay hospitalization rates? What did this study find? Most CDU patients were discharged, and short-stay hospitalization rate significantly decreased by 0...
April 15, 2018: CJEM
https://www.readbyqxmd.com/read/29652736/recommendations-and-extraction-of-clinical-variables-of-pediatric-multiple-sclerosis-using-common-data-elements
#20
Pamela Newland, John M Newland, Verna L Hendricks-Ferguson, Judith M Smith, Brant J Oliver
PURPOSE: The purpose of this article was to demonstrate the feasibility of using common data elements (CDEs) to search for information on the pediatric patient with multiple sclerosis (MS) and provide recommendations for future quality improvement and research in the use of CDEs for pediatric MS symptom management strategies Methods: The St. Louis Children's Hospital (SLCH), Washington University (WU) pediatrics data network was evaluated for use of CDEs identified from a database to identify variables in pediatric MS, including the key clinical features from the disease course of MS...
April 12, 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
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