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https://www.readbyqxmd.com/read/29166565/hospital-based-physicians-intubation-decisions-and-associated-mental-models-when-managing-a-critically-and-terminally-ill-older-patient
#1
Shannon Haliko, Julie Downs, Deepika Mohan, Robert Arnold, Amber E Barnato
BACKGROUND: Variation in the intensity of acute care treatment at the end of life is influenced more strongly by hospital and provider characteristics than patient preferences. OBJECTIVE: We sought to describe physicians' mental models (i.e., thought processes) when encountering a simulated critically and terminally ill older patient, and to compare those models based on whether their treatment plan was patient preference-concordant or preference-discordant. METHODS: Seventy-three hospital-based physicians from 3 academic medical centers engaged in a simulated patient encounter and completed a mental model interview while watching the video recording of their encounter...
November 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/29165957/inpatient-dialysis-unit-project-development-redesigning-acute-hemodialysis-care
#2
Jennifer Day
Executive leaders of an acute care hospital performed a market and financial analysis, and created a business plan to establish an inpatient hemodialysis unit operated by the hospital to provide safe, high-quality, evidence-based care to the population of individuals experiencing end stage renal disease (ESRD) within the community. The business plan included a SWOT (Strengths - Weaknesses - Opportunities - Threats) analysis to assess advantages of the hospital providing inpatient hemodialysis services versus outsourcing the services with a contracted agency...
May 2017: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
https://www.readbyqxmd.com/read/29165860/rehabilitation-and-convalescent-hospital-stay-in-new-south-wales-an-analysis-of-3-979-women-aged-75
#3
Catherine Chojenta, Julie Byles, Balakrishnan Kichu Nair
OBJECTIVES: With a rapidly ageing population, it is imperative to examine health service costs and plan appropriately for the future. This paper determines the factors related to extended hospital stay for 'Rehabilitation' or 'Convalescence', as defined by ICD-10 coding, in acute hospital settings for older women in New South Wales, Australia. METHODS: Participants were from the 1921-26 cohort of the Australian Longitudinal Study on Women's Health. For this analysis, self-reported survey data were linked to the NSW Admitted Patient Data Collection and the National Death Index...
November 22, 2017: Australian and New Zealand Journal of Public Health
https://www.readbyqxmd.com/read/29164170/impact-of-procalcitonin-guided-antibiotic-management-on-antibiotic-exposure-and-outcomes-real-world-evidence
#4
Michael R Broyles
Background: Delayed pathogen identification and nonspecific clinical findings make definitive decisions regarding antibiotics challenging. The stimuli of bacterial toxins and inflammation make procalcitonin (PCT) unique in its ability to differentiate bacterial infection from other causes of inflammation, and thus it is useful for antibiotic management. The objective of our study was to evaluate the impact of a PCT algorithm (PCT-A) on current practice. Methods: A single-center, retrospective cohort study was conducted to evaluate the impact of adding PCT-A to stewardship practices...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/29164125/malnutrition-upon-hospital-admission-in-geriatric-patients-why-assess-it
#5
Paolo Orlandoni, Claudia Venturini, Nikolina Jukic Peladic, Annarita Costantini, Mirko Di Rosa, Claudia Cola, Natascia Giorgini, Redenta Basile, Donata Fagnani, Debora Sparvoli, Serenella David
Objective: To assess the prevalence of malnutrition according to the new ESPEN definition in a population of geriatric hospital patients and to determine how malnutrition affects the length of hospital stay (LOS) and hospital mortality. Design: A retrospective analysis of data gathered during nutritional screening surveys carried out three consecutive years, from 2012 to 2014, in an Italian geriatric research hospital (INRCA, Ancona) was performed. On the day of the study, demographic data, data on clinical conditions and the nutritional status of newly admitted patients were collected...
2017: Frontiers in Nutrition
https://www.readbyqxmd.com/read/29164024/a-clinical-practice-guideline-for-the-management-of-patients-with-acute-spinal-cord-injury-and-central-cord-syndrome-recommendations-on-the-timing-%C3%A2-24-hours-versus-24-hours-of-decompressive-surgery
#6
Michael G Fehlings, Lindsay A Tetreault, Jefferson R Wilson, Bizhan Aarabi, Paul Anderson, Paul M Arnold, Darrel S Brodke, Anthony S Burns, Kazuhiro Chiba, Joseph R Dettori, Julio C Furlan, Gregory Hawryluk, Langston T Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Ralph J Marino, Allan R Martin, Eric Massicotte, Geno Merli, James W Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C Skelly, Eve C Tsai, Alexander Vaccaro, Albert Yee, James S Harrop
Objective: To develop recommendations on the timing of surgical decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome. Methods: A systematic review of the literature was conducted to address key relevant questions. A multidisciplinary guideline development group used this information, along with their clinical expertise, to develop recommendations for the timing of surgical decompression in patients with SCI and central cord syndrome...
September 2017: Global Spine Journal
https://www.readbyqxmd.com/read/29162345/postacute-care-after-pediatric-hospitalizations-for-a-primary-mental-health-condition
#7
James C Gay, Bonnie T Zima, Tumaini R Coker, Stephanie K Doupnik, Matthew Hall, Jonathan Rodean, Margaret O'Neill, Rustin Morse, Kris P Rehm, Jay G Berry, Naomi S Bardach
OBJECTIVES: To determine the proportion of US children hospitalized for a primary mental health condition who are discharged to postacute care (PAC); whether PAC discharge is associated with demographic, clinical, and hospital characteristics; and whether PAC use varies by state. STUDY DESIGN: Retrospective cohort study of a nationally representative sample of US acute care hospitalizations for children ages 2-20 years with a primary mental health diagnosis, using the 2009 and 2012 Kids' Inpatient Databases...
November 18, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29161977/coordinated-care-organizations-neonatal-and-infant-outcomes-in-oregon
#8
S Marie Harvey, Lisa P Oakley, Jangho Yoon, Jeff Luck
In 2012, Oregon's Medicaid program implemented a comprehensive accountable care model delivered through coordinated care organizations (CCOs). Because CCOs are expected to improve utilization of services and health outcomes, neonatal and infant outcomes may be important indicators of their impact. Estimating difference-in-differences models, we compared prepost CCO changes in outcomes (e.g., low birth weight, abnormal conditions, 5-minute Apgar score, congenital anomalies, and infant mortality) between Medicaid and non-Medicaid births among 99,924 infants born in Oregon during 2011 and 2013...
November 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29161406/evaluation-of-the-bacterioscan-216dx-for-standalone-preculture-screen-of-preserved-urine-specimens-in-a-clinical-setting
#9
Amity L Roberts, Upasana Joneja, Tatiana Villatoro, Eileen Andris, Judith A Boyle, James Bondi
Background: The BacterioScan 216Dx laser microbial growth monitoring system was evaluated as an option for preurine culture screening of preserved urine specimens at an acute care medical center. Methods: The BacterioScan 216Dx system performance characteristics and the economic impact (cost effectiveness) for the laboratory were assessed. Urinalysis performance compared to urine culture was assessed if urinalysis was ordered as part of the patient care set. Results: When compared to urine culture, the BacterioScan had an overall performance with corresponding 95% confidence intervals of 76% (68-83) sensitivity, 84% (80-87) specificity, 55% (48-63) positive predictive value, and 93% (90-95) negative predictive value for 610 randomly selected preserved urine specimens...
November 17, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29159719/effect-of-a-real-time-electronic-dashboard-on-a-rapid-response-system
#10
Grant S Fletcher, Barry A Aaronson, Andrew A White, Reena Julka
A rapid response system (RRS) may have limited effectiveness when inpatient providers fail to recognize signs of early patient decompensation. We evaluated the impact of an electronic medical record (EMR)-based alerting dashboard on outcomes associated with RRS activation. We used a repeated treatment study in which the dashboard display was successively turned on and off each week for ten 2-week cycles over a 20-week period on the inpatient acute care wards of an academic medical center. The Rapid Response Team (RRT) dashboard displayed all hospital patients in a single view ranked by severity score, updated in real time...
November 20, 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/29157932/-find-your-1-prevalence-and-mortality-of-a-community-cohort-of-people-with-advanced-chronic-disease-and-palliative-needs
#11
Carles Blay, Joan Carles Martori, Esther Limón, Ramon Oller, Laura Vila, Xavier Gómez-Batiste
OBJECTIVE: To determine the prevalence and profiles of people with advanced chronic diseases in Primary Care and to analyse the elements related to their mortality in order to orient strategies for improvement in this level of care. DESIGN: An observational, analytical and prospective study during 3 years conducted on a cohort of patients with palliative needs. LOCATION: Three Primary Care teams of Osona (Catalonia). PARTICIPANTS: A total of 251 people identified as advanced patients using a systematic population-based strategy that included the NECPAL tool...
November 17, 2017: Atencion Primaria
https://www.readbyqxmd.com/read/29156330/hospital-and-demographic-characteristics-associated-with-inpatient-neurological-services-in-the-united-states
#12
Katherine A Fu, Ali Razmara, Steven Y Cen, Amytis Towfighi, William J Mack, Nerses Sanossian
OBJECTIVE: To determine nationwide availability and factors associated with inpatient neurological services. PATIENTS AND METHODS: Using the 2011 American Hospital Association survey, we determined the proportion of hospitals that provided inpatient neurological services. Demographic and household data from the 2010 national census and survey results were utilized to determine regional factors associated with the availability of inpatient neurologic services. Using rate ratios, the association was estimated using Poisson regression...
November 7, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/29155982/economic-and-survival-burden-of-dysphagia-among-inpatients-in-the-united-states
#13
D A Patel, S Krishnaswami, E Steger, E Conover, M F Vaezi, M R Ciucci, D O Francis
The inpatient burden of dysphagia has primarily been evaluated in patients with stroke. It is unclear whether dysphagia, irrespective of cause, is associated with worse clinical outcomes and higher costs compared to inpatients with similar demographic, hospital, and clinical characteristics without dysphagia. The aim of this study is to assess how a dysphagia diagnosis affects length of hospital stay (LOS), costs, discharge disposition, and in-hospital mortality among adult US inpatients. Annual and overall dysphagia prevalence, LOS, hospital charges, inpatient care costs, discharge disposition, and in-hospital mortality were measured using the AHRQ Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (2009-2013)...
November 16, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29155611/can-chemotherapy-related-acute-care-visits-be-accurately-identified-in-administrative-data
#14
Monika K Krzyzanowska, Katherine Enright, Rahim Moineddin, Lingsong Yun, Melanie Powis, Mohammed Ghannam, Eva Grunfeld
PURPOSE: There is increasing interest in using administrative data to examine treatment-related complications that lead to emergency department (ED) visits or hospitalizations (H). The purpose of this study was to evaluate the reliability of billing codes for identifying chemotherapy-related acute care visits (CRVs) among women with early-stage breast cancer. MATERIALS AND METHODS: The cohort was identified by using deterministically linked health databases and consisted of women who were diagnosed with early-stage breast cancer who started adjuvant chemotherapy between 2007 and 2009 in Ontario, Canada...
November 20, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/29154381/interhospital-transfer-and-receipt-of-specialty-procedures
#15
Stephanie K Mueller, Jie Zheng, John Orav, Jeffrey L Schnipper
The practice of transferring patients between acute care hospitals is variable and largely nonstandardized. Although often-cited reasons for transfer include providing patients access to specialty services only available at the receiving institution, little is known about whether and when patients receive such specialty care during the transfer continuum. We performed a retrospective analysis using 2013 100% Master Beneficiary Summary and Inpatient claims files from Centers for Medicare and Medicaid Services...
November 8, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29153536/frailty-in-hospitalized-older-adults-comparing-different-frailty-measures-in-predicting-short-and-long-term-patient-outcomes
#16
Edward Chong, Esther Ho, Jewel Baldevarona-Llego, Mark Chan, Lynn Wu, Laura Tay, Yew Yoong Ding, Wee Shiong Lim
OBJECTIVES: Data for the assessment of frailty in acutely ill hospitalized older adults remains limited. Using the Frailty Index (FI) as "gold standard," we compared (1) the diagnostic performance of 3 frailty measures (FRAIL, Clinical Frailty Scale [CFS], and Tilburg Frailty Indicator [TFI]) in identifying frailty, and (2) their ability to predict negative outcomes at 12 months after enrollment. DESIGN: Prospective cohort study. PARTICIPANTS: We recruited 210 patients (mean age 89...
November 15, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29153252/antimicrobial-stewardship-in-pediatric-post-acute-care-facilities
#17
Candace L Johnson, Meaghan Jain, Lisa Saiman, Natalie Neu
Providers in pediatric post-acute care facilities were surveyed about knowledge of and resources for antimicrobial stewardship. All agreed that antibiotics were overused in such pediatric facilities, but 60% had not implemented stewardship strategies. Lack of treatment guidelines (47%) was identified as the most common barrier to antimicrobial stewardship.
November 15, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/29152607/use-of-post-acute-care-after-hospital-discharge-in-urban-and-rural-hospitals
#18
Robert E Burke, Christine D Jones, Eric A Coleman, Jason R Falvey, Jennifer E Stevens-Lapsley, Adit A Ginde
Objectives: Geographic variation in the use of post-acute care (PAC - skilled nursing facility and home health care) after hospital discharge is substantial, but reasons for this remain largely unexplored. PAC use in urban hospitals compared to rural hospitals may be one key contributor. We aimed to describe PAC use, explore substitution of one type of PAC for another, and identify how PAC use varies by diagnosis in urban and rural settings. Study Design: Secondary analysis of the 2012 National Inpatient Sample including adult discharges to PAC after a hospitalization...
March 2017: Am J Accountable Care
https://www.readbyqxmd.com/read/29151557/-development-of-the-transition-shock-scale-for-newly-graduated-nurses
#19
Eun Young Kim, Jung Hee Yeo, Kyeong Im Yi
PURPOSE: The purpose of this study was to develop a scale to assess the transition shock experienced by newly graduated nurses, and test the validity and reliability of the scale. METHODS: The initial items were identified through a review of literature and in-depth interviews with nine newly graduated nurses. Content validation of the items was evaluated by five nurse professors and three nurses. Participants were 269 newly graduated nurses who worked at six acute care hospitals in Busan, Ulsan, and Yangsan, South Korea...
October 2017: Journal of Korean Academy of Nursing
https://www.readbyqxmd.com/read/29148338/comprehensive-support-for-family-caregivers-impact-on-veteran-health-care-utilization-and-costs
#20
Courtney Harold Van Houtven, Valerie A Smith, Karen M Stechuchak, Megan Shepherd-Banigan, Susan Nicole Hastings, Matthew L Maciejewski, Gilbert Darryl Wieland, Maren K Olsen, Katherine E M Miller, Margaret Kabat, Jennifer Henius, Margaret Campbell-Kotler, Eugene Z Oddone
This study aimed to examine the early impact of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) on Veteran health care utilization and costs. A pre-post cohort design including a nonequivalent control group was used to understand how Veterans' use of Veteran Affairs health care and total health care costs changed in 6-month intervals up to 3 years after PCAFC enrollment. The control group was an inverse probability of treatment weighted sample of Veterans whose caregivers applied for, but were not accepted into, PCAFC...
March 1, 2017: Medical Care Research and Review: MCRR
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