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https://www.readbyqxmd.com/read/29676952/associations-between-patient-characteristics-and-a-new-early-do-not-attempt-resuscitation-order-after-intracerebral-hemorrhage
#1
Jessica McFarlin, Claire E Hailey, Wenjing Qi, Peter G Kranz, Weiping Sun, Wei Sun, Marisa Gray, Kon Kam King Nicolas, Daniel T Laskowitz, Michael L James
BACKGROUND: Decisions to limit care, including use of a do-not-resuscitate (DNR) order, are associated with increased risk of death after intracerebral hemorrhage (ICH). Given the value that patient surrogates place on the physician's perception of prognosis, understanding prognostic indicators that influence clinical judgment of outcomes is critical. OBJECTIVE: The purpose of this study was to understand the patient variables and comorbid illnesses associated with DNR orders placed on patients within 72 hours after ICH...
April 20, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29676782/evaluation-of-the-cincinnati-veterans-affairs-medical-center-hospital-in-home-program
#2
Shubing Cai, Andrew Grubbs, Rajesh Makineni, Bruce Kinosian, Ciaran S Phibbs, Orna Intrator
OBJECTIVES: To examine hospital readmissions, costs, mortality, and nursing home admissions of veterans who received Hospital-in-Home (HIH) services. DESIGN: Retrospective cohort study. SETTING: Cincinnati Veterans Affairs Medical Center (VAMC). PARTICIPANTS: Study cohort included veterans who received HIH services as an alternative to inpatient care between October 1, 2012, and November 30, 2015, and non-HIH veterans who were hospitalized for similar conditions in the Cincinnati VAMC during the same period...
April 20, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29676777/do-not-resuscitate-orders-in-older-adults-during-hospitalization-a-propensity-score-matched-analysis
#3
Karishma Patel, Liron Sinvani, Vidhi Patel, Andrzej Kozikowski, Christopher Smilios, Meredith Akerman, Kinga Kiszko, Sutapa Maiti, Negin Hajizadeh, Gisele Wolf-Klein, Renee Pekmezaris
OBJECTIVES: To explore the effect of the presence and timing of a do-not-resuscitate (DNR) order on short-term clinical outcomes, including mortality. DESIGN: Retrospective cohort study with propensity score matching to enable direct comparison of DNR and no-DNR groups. SETTING: Large, academic tertiary-care center. PARTICIPANTS: Hospitalized medical patients aged 65 and older. MEASUREMENTS: Primary outcome was in-hospital mortality...
April 20, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29676657/new-hong-kong-statute-protects-factual-statements-in-medical-apologies-from-use-in-litigation
#4
Gilberto Kk Leung, Gerard Porter
Providing an apology which contains a factual explanation following a medical adverse incident may facilitate an amicable settlement and improve patient experience. Numerous apology laws exist with the aim of encouraging an apology but the lack of explicit and specific protection for factual admissions included in "full" apologies can give rise to legal disputes and deter their use. The new Hong Kong Apology Ordinance expressly prohibits the admission of a statement of fact in an apology as evidence of fault in a wide range of applicable proceedings and thus provides the clearest and most comprehensive apology protection to date...
January 1, 2018: Medico-legal Journal
https://www.readbyqxmd.com/read/29676518/hospital-based-care-utilization-of-children-with-medical-complexity-in-japan
#5
Yui Yamaoka, Nanako Tamiya, Akimitsu Watanabe, Yayoi Miyazono, Ryuta Tanaka, Akemi Matsuzawa, Ryo Sumazaki
BACKGROUND: Few researches have been reported hospital-based care utilization of children with medical complexity (CMC) in Japan. This study examined frequency and differences of hospital-based care utilization among moderate and severe CMC in Japan. METHODS: This study utilized medical records of three pediatric tertiary hospitals in one prefecture, 2014. We examined the numbers of outpatient visits and admissions to the hospital for CMC during 5 years after medical care at home was introduced...
April 20, 2018: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/29675758/the-prognostic-impact-of-abdominal-surgery-in-cancer-patients-with-neutropenic-enterocolitis-a-systematic-review-and-meta-analysis-on-behalf-the-groupe-de-recherche-en-r%C3%A3-animation-respiratoire-du-patient-d-onco-h%C3%A3-matologie-grrr-oh
#6
REVIEW
Colombe Saillard, Lara Zafrani, Michael Darmon, Magali Bisbal, Laurent Chow-Chine, Antoine Sannini, Jean-Paul Brun, Jacques Ewald, Olivier Turrini, Marion Faucher, Elie Azoulay, Djamel Mokart
Neutropenic enterocolitis (NE) is a diagnostic and therapeutic challenge associated with high mortality rates, with controversial opinions on its optimal management. Physicians are usually reluctant to select surgery as the first-choice treatment, concerns being raised regarding the potential risks associated with abdominal surgery during neutropenia. Nevertheless, no published studies comforted this idea, literature is scarce and surgery has never been compared to medical treatment. This review and meta-analysis aimed to determine the prognostic impact of abdominal surgery on outcome of neutropenic cancer patients presenting with NE, versus medical conservative treatment...
April 19, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29674397/massive-haemoptysis-secondary-to-mycotic-pulmonary-artery-aneurysm-in-subacute-invasive-aspergillosis
#7
Shahbaz Piracha, Asad Mahmood, Noman Qayyum, Muhammad Badar Ganaie
A 68-year-old man, presented with 3 week history of infective symptoms and mild haemoptysis. Past medical history included severe emphysema and a chronic right upper lobe (RUL) cavity. He was discharged from follow-up a year ago in view of clinical and radiological stability; previous bronchoscopic examinations yielded no specific diagnosis. CT scan on admission confirmed complex cavitary consolidation of RUL. He developed massive haemoptysis requiring intubation and ventilation. CT pulmonary angiogram (CTPA) revealed 16 mm RUL pulmonary artery (PA) aneurysm which was successfully embolized...
April 19, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29674328/catastrophic-circulatory-collapse-after-inadvertent-subcutaneous-injection-of-treprostinil
#8
John J Radosevich, Mohan Dutt, Jeremy Feldman
PURPOSE: A case of life-threatening cardiovascular collapse after inadvertent subcutaneous injection of undiluted treprostinil is reported. SUMMARY: A 29-year-old, 76-kg woman with group 1 pulmonary arterial hypertension managed with subcutaneous treprostinil infusion arrived at the emergency department (ED) with headache, nausea, vomiting, and a syncopal episode. Her vital signs were stable on presentation. Admission orders were placed, and the appropriate 3-mL syringe containing 7...
April 19, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29672398/evaluating-quality-metrics-and-cost-after-discharge-a-population-based-cohort-study-of-value-in-health-care-following-elective-major-vascular-surgery
#9
Charles de Mestral, Konrad Salata, Mohamad A Hussain, Ahmed Kayssi, Mohammed Al-Omran, Graham Roche-Nagle
BACKGROUND: Early readmission to hospital after surgery is an omnipresent quality metric across surgical fields. We sought to understand the relative importance of hospital readmission among all health services received after hospital discharge. OBJECTIVE: The aim of this study was to characterize 30-day postdischarge cost and risk of an emergency department (ED) visit, readmission, or death after hospitalization for elective major vascular surgery. METHODS: This is a population-based retrospective cohort study of patients who underwent elective major vascular surgery - carotid endarterectomy, EVAR, open AAA repair, bypass for lower extremity peripheral arterial disease - in Ontario, Canada, between 2004 and 2015...
April 18, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29672395/an-educational-implementation-process-staff-survey-lessons-learned
#10
Barbara Delmore, Martha Kent
OBJECTIVE: To evaluate the education process for the effective use of the Munro Pressure Ulcer Risk Assessment Scale by practicing perioperative staff at an urban tertiary medical center. Given that pressure injury formation is tied to the surgical process, there is a need for a pressure injury risk assessment scale that addresses the uniqueness of the perioperative process. METHODS: Participants were staff who worked in the surgical admissions area, the main operating room, and the main postanesthesia care unit...
May 2018: Advances in Skin & Wound Care
https://www.readbyqxmd.com/read/29672375/a-retrospective-study-of-non-ventilator-associated-hospital-acquired-pneumonia-incidence-and-missed-opportunities-for-nursing-care
#11
Mary Tesoro, Diane J Peyser, Farley Villarente
OBJECTIVE: To determine non-ventilator-associated hospital-acquired pneumonia (NV-HAP) incidence, assess negative impacts on patient outcomes and cost, and identify missed preventive nursing care opportunities. BACKGROUND: NV-HAP is inadequately studied and underreported. Missed nursing care opportunities, particularly oral care, may aid NV-HAP prevention. METHODS: This descriptive, observational, retrospective chart review identified adult NV-HAP cases and associated demographic and hospital care data...
May 2018: Journal of Nursing Administration
https://www.readbyqxmd.com/read/29672319/the-use-of-low-calcium-hemodialysis-in-the-treatment-of-hypercalcemic-crisis
#12
Sinan Trabulus, Meric Oruc, Emre Ozgun, Mehmet Riza Altiparmak, Nurhan Seyahi
BACKGROUND: We reviewed the results of low-calcium hemodialysis (LCHD; 1.25 mmol/L) in the treatment of 42 cases admitting with hypercalcemic crisis. METHODS: All patients (≥18 years) who started LCHD due to hypercalcemia between 2002 and 2017 were retrospectively analyzed. Biochemical data were obtained at the beginning of the first hemodialysis and at the end of the last hemodialysis. -"Refractory" cases were defined as patients having albumin corrected serum total calcium (SCatotal) levels above 10...
April 19, 2018: Nephron
https://www.readbyqxmd.com/read/29671913/measuring-the-financial-and-productivity-burden-of-paediatric-hospitalisation-on-the-wider-family-network
#13
Virginia Mumford, Melissa T Baysari, Djala Kalinin, Magdalena Z Raban, Cheryl McCullagh, Jonathon Karnon, Johanna I Westbrook
AIM: To estimate the non-medical out-of-pocket costs for families with a child in hospital. METHODS: This study was a survey of 225 parents of paediatric inpatients on nine wards of an Australian public paediatric teaching hospital on two separate days. Our primary outcomes were the costs associated with: (i) time taken off work to care for the child in hospital; (ii) time off work or contributed by family and friends to care for other dependents; and (iii) travel, meals, accommodation and incidental expenses during the child's stay...
April 19, 2018: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/29671705/explicit-versus-implicit-evaluation-to-detect-inappropriate-medication-use-in-geriatric-outpatients
#14
Gulistan Bahat, Birkan Ilhan, Ilker Bay, Cihan Kilic, Pinar Kucukdagli, Meryem Merve Oren, Mehmet Akif Karan
AIM: The rates and reasons why clinicians decide not to follow recommendations from explicit-criteria have been studied scarce. We aimed to compare STOPP version 2 representing one of the most commonly used excplicit tool with the implicit comprehensive geriatric assessment mediated clinical evaluation considered as gold standard. METHODS: Two hundred and six (n = 206) outpatients ≥65 years old were included. The study was designed as retrospective, cross-sectional, and randomised...
April 19, 2018: Aging Male: the Official Journal of the International Society for the Study of the Aging Male
https://www.readbyqxmd.com/read/29671399/automatic-infection-detection-based-on-electronic-medical-records
#15
Huaixiao Tou, Lu Yao, Zhongyu Wei, Xiahai Zhuang, Bo Zhang
BACKGROUND: Making accurate patient care decision, as early as possible, is a constant challenge, especially for physicians in the emergency department. The increasing volumes of electronic medical records (EMRs) open new horizons for automatic diagnosis. In this paper, we propose to use machine learning approaches for automatic infection detection based on EMRs. Five categories of information are utilized for prediction, including personal information, admission note, vital signs, diagnose test results and medical image diagnose...
April 11, 2018: BMC Bioinformatics
https://www.readbyqxmd.com/read/29671278/evaluation-of-the-impact-of-an-institution-specific-dofetilide-initiation-protocol-on-mean-hospital-length-of-stay-and-cost-for-dofetilide-initiation
#16
Steven P Kennedy, Hanna Iaizzo, Evgueni Fayn, Dalip Singh
BACKGROUND: Dofetilide is a class III antiarrhythmic drug indicated for the conversion and maintenance of normal sinus rhythm in symptomatic patients with atrial fibrillation/atrial flutter. Delay in initiation of dofetilide therapy may increase the duration of hospitalization from two nights to three nights to complete US Food and Drug Administration-required monitoring. Therefore, substantial cost savings may be associated with implementation of an institution-specific dofetilide initiation protocol in order to reduce hospitalization to two nights...
April 18, 2018: PharmacoEconomics Open
https://www.readbyqxmd.com/read/29670346/prediction-of-severe-exacerbations-and-mortality-in-copd-the-role-of-exacerbation-history-and-inspiratory-capacity-total-lung-capacity-ratio
#17
João Cardoso, Ricardo Coelho, Carla Rocha, Constança Coelho, Luísa Semedo, A Bugalho Almeida
Background: Severe exacerbations and mortality are major outcomes in COPD, and risk factors for these events are actively searched for. Several predictors of mortality have been identified in COPD. The inspiratory capacity/total lung capacity (IC/TLC) ratio has been shown to be a strong predictor of all cause and respiratory mortality in patients with COPD. The major objectives of this study were to analyze which clinical parameters, including lung volumes, were the best predictors of the 5-year cumulative risk of hospital admissions or death and the 5-year risk of exacerbations, in stable COPD patients...
2018: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/29669574/effects-of-modifiable-prehospital-factors-on-survival-after-out-of-hospital-cardiac-arrest-in-rural-versus-urban-areas
#18
Wenche Torunn Mathiesen, Conrad Arnfinn Bjørshol, Jan Terje Kvaløy, Eldar Søreide
BACKGROUND: The modifiable prehospital system factors, bystander cardiopulmonary resuscitation (CPR), emergency medical services (EMS), response time, and EMS physician attendance, may affect short- and long-term survival for both rural and urban out-of-hospital cardiac arrest (OHCA) patients. We studied how such factors influenced OHCA survival in a mixed urban/rural region with a high survival rate after OHCA. METHODS: We analyzed the association between modifiable prehospital factors and survival to different stages of care in 1138 medical OHCA patients from an Utstein template-based cardiac arrest registry, using Kaplan-Meier type survival curves, univariable and multivariable logistic regression and mortality hazard plots...
April 18, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29668982/improved-medical-treatment-and-surgical-surveillance-of-children-and-adolescents-with-ulcerative-colitis-in-the-united-kingdom
#19
Marcus Karl-Keinz Auth, Su K Bunn, Aimee Leanne Protheroe, Linda Jane Williams, John M Fell, Rafeeq Muhammed, Nicholas Michael Croft, R Mark Beattie, Anne Willmott, Christine Spray, Babu Vadamalayan, Astor Rodrigues, John Puntis, Anna Jane Pigott, David C Wilson, Sally Mitton, Mark Furman, Charlie Charlton, Sonny K F Chong, Richard K Russell
Background: Pediatric ulcerative colitis (UC) presents at an earlier age and increasing prevalence. Our aim was to examine morbidity, steroid sparing strategies, and surgical outcome in children with active UC. Methods: A national prospective audit was conducted for the inpatient period of all children with UC for medical or surgical treatment in the United Kingdom (UK) over 1 year. Thirty-two participating centers recruited 224 children in 298 admissions, comparisons over 6 years were made with previous audits...
April 13, 2018: Inflammatory Bowel Diseases
https://www.readbyqxmd.com/read/29668690/aspirin-use-and-long-term-rates-of-sepsis-a-population-based-cohort-study
#20
Joann Hsu, John P Donnelly, Ninad S Chaudhary, Justin X Moore, Monika M Safford, Junghyun Kim, Henry E Wang
OBJECTIVE: Sepsis is the syndrome of life-threatening organ dysfunction resulting from dysregulated host response to infection. Aspirin, an anti-inflammatory agent, may play a role in attenuating the inflammatory response during infection. We evaluated the association between aspirin use and long-term rates of sepsis as well as sepsis outcomes. METHODS: We analyzed data from 30,239 adults ≥45 years old in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort...
2018: PloS One
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