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https://www.readbyqxmd.com/read/29438727/is-cohorting-the-only-solution-to-control-carbapenemase-producing-enterobacteriaceae-outbreaks-a-single-centre-experience
#1
Legeay Clément, Thépot-Seegers Valérie, Pailhoriès Hélène, Hilliquin Delphine, Zahar Jean-Ralph
BACKGROUND: Carbapenemase producing Enterobacteriaceae (CPE) area a major issue. Cohorting can help controlling spread of CPEs in hospitals, but is expensive and hard to implement. AIM: To identify ward variables associated with CPE in-hospital transmission in a hospital where cohorting was never implemented. METHODS: Cohort prospective study, where we compared fourteen consecutive days period regarding in-hospital transmission. Each period met the 2 following conditions: 1) CPE carriers/infected admitted for at least 48h, 2) 80% of relative contact patients were screened at least twice...
February 10, 2018: Journal of Hospital Infection
https://www.readbyqxmd.com/read/29412094/the-need-to-succeed-learning-experiences-resulting-from-the-implementation-of-value-based-healthcare
#2
Kerstin Nilsson, Fredrik Bååthe, Annette Erichsen Andersson, Mette Sandoff
Purpose The aim of this study has been to explore learning experiences from the two first years of the implementation of value-based healthcare (VBHC) at a large Swedish University Hospital. Design/methodology/approach An explorative design was used in this study. Individual open-ended interviews were carried out with 19 members from four teams implementing VBHC. Qualitative analysis was used to analyse the verbatim transcripts of the interviews. Findings Three main themes pinpointing learning experiences emerged through the analysis: resource allocation to support implementation, anchoring to create engagement and dedicated, development-oriented leadership with power of decision...
February 5, 2018: Leadership in Health Services
https://www.readbyqxmd.com/read/29412019/improving-performance-of-mammographic-breast-positioning-in-an-academic-radiology-practice
#3
Sunita Pal, Debra M Ikeda, Robert A Jesinger, L Jake Mickelsen, Christina A Chen, David B Larson
OBJECTIVE: The purpose of this project was to achieve sustained improvement in mammographic breast positioning in our department. MATERIALS AND METHODS: Between June 2013 and December 2016, we conducted a team-based performance improvement initiative with the goal of improving mammographic positioning. The team of technologists and radiologists established quantitative measures of positioning performance based on American College of Radiology (ACR) criteria, audited at least 35 mammograms per week for positioning quality, displayed performance in dashboards, provided technologists with positioning training, developed a supportive environment fostering technologist and radiologist communication surrounding mammographic positioning, and employed a mammography positioning coach to develop, improve, and maintain technologist positioning performance...
February 7, 2018: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29410099/repeat-robotic-endoscopic-mitral-valve-surgery-a-safe-and-effective-strategy
#4
Douglas A Murphy, Emmanuel Moss, Jeffrey Miller, Michael E Halkos
BACKGROUND: Mitral valve reoperation is necessary in a finite percent of patients. With growth in robotic mitral valve surgery, reoperative strategies need to be developed. A review of institutional mitral valve re-operations after a previous robotic approach was undertaken. METHODS: From January 2006 through April 2017, 1853 patients underwent an initial robotic mitral valve surgery by a dedicated robotic team. Fifty-four (2.9%) of these patients required mitral reoperation at our institution over this time period...
February 2, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29402313/the-improve-gap-trial-aiming-to-improve-evidence-based-management-of-community-acquired-pneumonia-study-protocol-for-a-stepped-wedge-randomised-controlled-trial
#5
Elizabeth H Skinner, Melanie Lloyd, Edward Janus, May Lea Ong, Amalia Karahalios, Terry P Haines, Anne-Maree Kelly, Melina Shackell, Harin Karunajeewa
BACKGROUND: Community-acquired pneumonia is a leading worldwide cause of hospital admissions and healthcare resource consumption. The largest proportion of hospitalisations now occurs in older patients, with high rates of multimorbidity and complex care needs. In Australia, this population is usually managed by hospital inpatient general internal medicine units. Adherence to consensus best-practice guidelines is poor. Ensuring evidence-based care and reducing length of stay may improve patient outcomes and reduce organisational costs...
February 5, 2018: Trials
https://www.readbyqxmd.com/read/29401336/cavh-in-the-combat-environment-a-case-report-and-lessons-learned-in-southern-afghanistan
#6
Jacob Glaser, Joseph Zeman, Stephen Noble, Nathanial Fernandez
Background: Acute kidney injury is a common complication of both civilian and military trauma. The lack of dedicated resources restrict dialysis in the forward setting. We report a case of a combat polytrauma and renal failure, using continuous arteriovenous hemofiltration to clear uremia and remove volume, allowing for ventilator liberation and safe disposition. Materials and Methods: The patient presented with traumatic lower extremity injuries and abdominal wounds and developed acute post-traumatic renal failure...
January 1, 2018: Military Medicine
https://www.readbyqxmd.com/read/29394430/development-and-implementation-of-an-inpatient-otolaryngology-consultation-service-at-an-academic-medical-center
#7
Matthew G Huddle, Nyall R London, C Matthew Stewart
OBJECTIVES: To design and implement a formal otolaryngology inpatient consultation service that improves satisfaction of consulting services, increases educational opportunities, improves the quality of patient care, and ensures sustainability after implementation. METHODS: This was a retrospective cohort study in a large academic medical center encompassing all inpatient otolaryngology service consultations from July 2005 to June 2014. Staged interventions included adding fellow coverage (July 2007 onward), intermittent hospitalist coverage (July 2010 onward), and a physician assistant (October 2011 onward)...
February 2018: Southern Medical Journal
https://www.readbyqxmd.com/read/29389822/management-of-intestinal-failure-in-middle-income-countries-for-children-and-adults
#8
Gabriel E Gondolesi, Francisco Pattín, Hamed Nikkoupur
PURPOSE OF REVIEW: Intestinal failure is a life-threatening medical condition that remains as a rare or orphan disease in most countries. The prevalence of intestinal failure and the therapeutic options available in middle-income countries (MIC) remain unclear. We aim to provide an overview on the current differences in management of intestinal failure patients in MIC from Latin America and Asia. RECENT FINDINGS: In order to fulfil the challenge, and after facing the difficulties of going over a topic with scarce available data, from countries with an extreme variety of social and economic problems, which are closely related to the treatment of intestinal failure patients, we have used both the existing publications and personal surveys to draft this document...
January 30, 2018: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/29386002/extended-left-hepatectomy-for-intrahepatic-cholangiocarcinoma-hepatic-vein-reconstruction-with-in-situ-hypothermic-perfusion-and-extracorporeal-membrane-oxygenation
#9
Deniz Balci, Menekse Ozcelik, Elvan Onur Kirimker, Arda Cetinkaya, Evren Ustuner, Mehmet Cakici, Bahadir Inan, Zekeriyya Alanoglu, Sadik Bilgic, Ahmet Ruchan Akar
BACKGROUND: Liver resection for intrahepatic cholangiocarcinoma (ICC) with invasion of the inferior vena cava (IVC) and hepatic veins (HV) is a challenging procedure. CASE PRESENTATION: We report a case of a 63-year-old woman with a 6-cm, centrally located liver mass. Her biochemistry results were normal except for a Ca19-9 level of 1199 U/ml. The liver biopsy was consistent with ICC and 60% macrosteatosis. Abdominal CT scans revealed a large central mass invading the left HV, middle HV and right HV, infringing on their junction with the vena cava...
January 31, 2018: BMC Surgery
https://www.readbyqxmd.com/read/29360092/management-of-necrotizing-otitis-externa-our-experience-with-forty-three-patients
#10
Sunil Sharma, Tumena Corrah, Arvind Singh
OBJECTIVE: To assess the impact of the introduction of a dedicated management protocol of necrotizing otitis externa patients with joint care between otorhinolaryngology and infectious diseases. MATERIALS AND METHODS: Retrospective review of case notes and the otorhinolaryngology department database of all adults admitted with necrotizing otitis externa at our teaching hospital over a 5-year period. The patients were split into two groups (first group of 10 patients prior to the introduction of the dedicated management protocol, and a second group of 33 patients managed after the introduction of this protocol)...
December 2017: Journal of International Advanced Otology
https://www.readbyqxmd.com/read/29351792/successful-recruitment-to-trials-findings-from-the-scimitar-trial
#11
Emily Peckham, Catherine Arundel, Della Bailey, Tracy Callen, Christina Cusack, Suzanne Crosland, Penny Foster, Hannah Herlihy, James Hope, Suzy Ker, Tayla McCloud, Crystal-Bella Romain-Hooper, Alison Stribling, Peter Phiri, Ellen Tait, Simon Gilbody
BACKGROUND: Randomised controlled trials (RCT) can struggle to recruit to target on time. This is especially the case with hard to reach populations such as those with severe mental ill health. The SCIMITAR+ trial, a trial of a bespoke smoking cessation intervention for people with severe mental ill health achieved their recruitment ahead of time and target. This article reports strategies that helped us to achieve this with the aim of aiding others recruiting from similar populations...
January 19, 2018: Trials
https://www.readbyqxmd.com/read/29351705/percutaneous-endoscopic-rendezvous-procedure-for-the-management-of-bile-duct-injuries-after-cholecystectomy-short-and-long-term-outcomes
#12
Anne Marthe Schreuder, Klaske A C Booij, Philip R de Reuver, Otto M van Delden, Krijn P van Lienden, Marc G Besselink, Olivier R Busch, Dirk J Gouma, Erik A J Rauws, Thomas M van Gulik
BACKGROUND:  Bile duct injury (BDI) remains a daunting complication of laparoscopic cholecystectomy. In patients with complex BDI, a percutaneous-endoscopic rendezvous procedure may be required to establish bile duct continuity. The aim of this study was to assess short- and long-term outcomes of the rendezvous procedure. METHODS:  All consecutive patients with BDI referred to our tertiary referral center between 1995 and 2016 were analyzed. A rendezvous procedure was performed when endoscopic or radiologic intervention failed, and when deemed feasible by a dedicated multidisciplinary team including hepatopancreaticobiliary surgeons, gastrointestinal endoscopists, and interventional radiologists...
January 19, 2018: Endoscopy
https://www.readbyqxmd.com/read/29346039/evaluation-of-a-french-regional-telemedicine-network-dedicated-to-neurological-emergencies-a-14-year-study
#13
Elisabeth Medeiros de Bustos, Eric Berthier, Didier Chavot, Benjamin Bouamra, Thierry Moulin
BACKGROUND: Equality in healthcare between urban and rural areas is problematic in France. Telemedicine networks are expected to improve equality in expertise assessment. We aimed to evaluate the use and impact of a regional rural French telemedicine network, dedicated to medical and surgical neurological emergencies, on interhospital patient transfers. METHODS: Eight community hospital emergency departments were remotely connected to the only university hospital in Franche-Comté, France...
January 18, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/29344427/top-10-myths-about-telepsychiatry
#14
Donna Vanderpool
This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation, education and onsite risk management audits, and other resources to healthcare providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company...
September 2017: Innovations in Clinical Neuroscience
https://www.readbyqxmd.com/read/29335397/pediatric-renal-transplantation-focus-on-current-transition-care-and-proposal-of-the-rise-to-transition-protocol
#15
Rupesh Raina, Joseph Wang, Vinod Krishnappa, Maria Ferris
The transition from pediatric to adult medical services is an important time in the life of an adolescent or young adult with a renal transplant. Failure of proper transition can lead to medical non-adherence and subsequent loss of graft and/or return to dialysis. The aim of this study was to conduct a systematic review and survey to assess the challenges and existing practices in transition of renal transplant recipient children to adult services, and to develop a transition protocol. We conducted a literature review and performed a survey of pediatric nephrologists across the United States to examine the current state of transition care...
January 16, 2018: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/29329310/medication-discrepancies-across-multiple-care-transitions-a-retrospective-longitudinal-cohort-study-in-italy
#16
Marco Bonaudo, Maria Martorana, Valerio Dimonte, Alessandra D'Alfonso, Giulio Fornero, Gianfranco Politano, Maria Michela Gianino
PURPOSE: Medication discrepancies are defined as unexplained differences among regimens across different sites of care. The problem of medication discrepancies that occur during the entire care pathway from hospital admission to a local care setting discharge (namely all types of settings dedicated to formal care other than hospitals) has received little attention in the medical literature. The present study aims to (1) determine the prevalence of medication discrepancies that occur during the entire care pathway from hospital admission to local care setting discharge, (2) describe the discrepancy and medication type, and (3) identify potential risk factors for experiencing medication discrepancies in patient care transitions...
2018: PloS One
https://www.readbyqxmd.com/read/29328742/pragmatic-recycling-of-paper-and-cardboard-in-the-operating-theatre-an-audit
#17
Douglas Ra McKendrick, Lorraine J Snedden, Rozel Bunch, Hazel McGregor
Despite recent legislation introduced in Scotland and motivated recycling at home, very little recycling exists within theatre environments. This study audited the introduction of recycling of paper and cardboard. All waste within a single operating theatre was collected by a dedicated team for 20 surgical cases. The collection of clean paper and cardboard packaging was limited to the theatre preparation room (TPR) and anaesthetic room (AR). No waste segregation was attempted within the operating theatre itself...
March 2017: Journal of Perioperative Practice
https://www.readbyqxmd.com/read/29325162/an-analysis-of-adverse-events-in-the-rehabilitation-department-using-the-veterans-affairs-root-cause-analysis-system
#18
Gregory W Hagley, Peter D Mills, Brian Shiner, Robin R Hemphill
Background: Root cause analyses (RCA) are often completed in health care settings to determine causes of adverse events (AEs). RCAs result in action plans designed to mitigate future patient harm. National reviews of RCA reports have assessed the safety of numerous health care settings and suggested opportunities for improvement. However, few studies have assessed the safety of receiving care from physical therapists, occupational therapists, or speech and language pathology pathologists...
January 9, 2018: Physical Therapy
https://www.readbyqxmd.com/read/29324517/long-term-care-of-transplant-recipients-de-novo-neoplasms-after-liver-transplantation
#19
Patrizia Burra, Sarah Shalaby, Alberto Zanetto
PURPOSE OF REVIEW: Since the first liver transplantation in the early 1960s, there have been significant improvements in the recipients' long-term outcome. Patients who have undergone transplantation are exposed to a high risk of developing neoplastic disease, not only because of their chronic immunosuppression, but also related to physiological aging, lifestyle, chronic viral infections, liver disease cause, and carcinogenic immunosuppressants. The present review covers the latest and most relevant data on de novo neoplasms after liver transplantation, and discusses their implications for clinical practice...
January 9, 2018: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/29319644/improving-thermoregulation-for-trauma-patients-in-the-emergency-department-an-evidence-based-practice-project
#20
Ada Saqe-Rockoff, Finn D Schubert, Amanda Ciardiello, Elizabeth Douglas
Extensive evidence exists on the association between hypothermia and increased morbidity and mortality in trauma patients. Gaps in practice related to temperature assessment have been identified in literature, along with limited personnel knowledge regarding management of patients with accidental hypothermia. An interdisciplinary team identified gaps in practice in our institution regarding temperature assessment and documentation of rewarming and initiated an evidence-based practice project to change practice at our institution...
January 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
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