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Transitions in the hospital

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https://www.readbyqxmd.com/read/28338416/impact-of-a-complex-care-management-model-on-cost-and-utilization-among-adolescents-and-young-adults-with-special-care-and-health-needs
#1
Daniel D Maeng, Susan R Snyder, Thomas W Davis, Janet F Tomcavage
Adolescents and young adults with special care and health needs in the United States-many of whom have Medicaid coverage-at the transition phase between pediatric and adult care often experience critical care gaps. To address this challenge, a new model-referred to as Comprehensive Care Clinic (CCC)-has been developed and implemented by Geisinger Health System since 2012. CCC comprises a care team, consisting of a generalist physician, advanced practitioner, pharmacist, and a nurse case manager, that develops and closely follows a coordinated care plan...
March 24, 2017: Population Health Management
https://www.readbyqxmd.com/read/28337826/diagnostic-outcome-of-contrast-videofluoroscopic-swallowing-studies-in-216-dysphagic-dogs
#2
Rachel E Pollard, Stanley L Marks, Diane M Cheney, Cecily M Bonadio
Determining the anatomic and functional origin for dysphagia is critical for development of an appropriate therapeutic plan and determination of the prognosis. The purpose of this retrospective study was to report the quantitative and qualitative outcome of contrast videofluoroscopic swallowing studies in a large cohort of dysphagic dogs presenting to a tertiary veterinary care hospital. The videofluoroscopic swallowing studies were reviewed to generate values for pharyngeal constriction ratio, timing of swallowing events (maximum pharyngeal contraction, opening of upper esophageal sphincter, closing of upper esophageal sphincter, and reopening of epiglottis), type of esophageal peristalsis generated, and esophageal transit time...
March 23, 2017: Veterinary Radiology & Ultrasound
https://www.readbyqxmd.com/read/28337719/an-early-health-economic-analysis-of-the-potential-cost-effectiveness-of-an-adherence-intervention-to-improve-outcomes-for-patients-with-cystic-fibrosis
#3
Paul Tappenden, Susannah Sadler, Martin Wildman
BACKGROUND: Cystic fibrosis (CF) negatively impacts upon health-related quality of life and survival. Adherence to nebulised treatments is low; improving adherence is hypothesised to reduce rates of exacerbation requiring intravenous antibiotics and lung function decline. OBJECTIVE: A state transition model was developed to assess the cost effectiveness of an intervention aimed at increasing patient adherence to nebulised and inhaled antibiotics compared with current CF care, in advance of the forthcoming CFHealthHub randomised controlled trial (RCT)...
March 23, 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/28334591/crossing-the-communication-chasm-challenges-and-opportunities-in-transitions-of-care-from-the-hospital-to-the-primary-care-clinic
#4
Nicholas A Rattray, Jason J Sico, LeeAnn M Cox, Alissa L Russ, Marianne S Matthias, Richard M Frankel
BACKGROUND: Transitions of care from specialty and acute settings to primary care abound. Compared to the continuity in end-of-shift handoffs, care transitions involve provider communication between practices and facilities with their own cultures and bureaucracies. Using the transition from acute care to outpatient primary care for stroke/transient ischemic attack (TIA) patients as a case study, this qualitative research explored communication practices and institutional arrangements among clinical providers responsible for longitudinal management of hypertension...
March 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28334566/improving-communication-with-primary-care-physicians-at-the-time-of-hospital-discharge
#5
Lauren A Destino, Amy Dixit, Julie L Pantaleoni, Matthew S Wood, Natalie M Pageler, Joe Kim, Terry S Platchek
BACKGROUND: Communication with primary care physicians (PCPs) at the time of a patient's hospital discharge is important to safely transition care to home. The goal of this quality improvement initiative was to increase discharge communication to PCPs at an academic children's hospital. METHODS: A multidisciplinary team at Lucile Packard Children's Hospital Stanford used Lean A3 problem solving methodology to address the problem of inadequate discharge communication with PCPs...
February 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28334559/design-and-hospitalwide-implementation-of-a-standardized-discharge-summary-in-an-electronic-health-record
#6
Shannon M Dean, Andrea Gilmore-Bykovskyi, Joel Buchanan, Brad Ehlenfeldt, Amy J H Kind
BACKGROUND: The hospital discharge summary is the primary method used to communicate a patient's plan of care to the next provider(s). Despite the existence of regulations and guidelines outlining the optimal content for the discharge summary and its importance in facilitating an effective transition to posthospital care, incomplete discharge summaries remain a common problem that may contribute to poor posthospital outcomes. Electronic health records (EHRs) are regularly used as a platform on which standardization of content and format can be implemented...
December 2016: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28333697/medication-reconciliation-during-hospitalization-and-in-hospital-home-interface-an-observational-retrospective-study
#7
Elisabetta Volpi, Alessandro Giannelli, Giulio Toccafondi, Monica Baroni, Sara Tonazzini, Stefania Alduini, Stefania Biagini, Rosa Gini, Tommaso Bellandi, Michele Emdin
OBJECTIVE: Medication errors are one of the leading causes of patient harms. Medication reconciliation is a fundamental process that to be effective, it should be embraced during each single care transition. Our objectives were to investigate current medication reconciliation practices in the 2 Fondazione Toscana Gabriele Monasterio hospitals and comprehensively assess the quality of medication reconciliation practices between inpatient and outpatient care by analyzing the medication patterns 6 months before admission, during hospitalization, and 9 months after discharge for a selected group of patients with cardiovascular diseases...
March 22, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/28333613/collaborative-management-of-neurocognitive-disorders-in-primary-care-explorations-of-an-attempt-at-culture-change
#8
Lewis Mehl-Madrona, Barbara Mainguy
INTRODUCTION: Minor neurocognitive disorder (MiND; previously mild cognitive impairment) is a transitional zone between normal cognitive function and early stages of major neurocognitive disorder (previously called dementia). Of people with MiND, 5% to 10% progress to major neurocognitive disorder. Simple interventions such as memory activities, balance exercises, and anti-inflammatory diets have been shown to improve cognitive ability. Also, education and support in group settings have proved beneficial for patients with MiND...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333312/establishment-maintenance-and-functional-integrity-of-the-blood-testis-barrier-in-organotypic-cultures-of-fresh-and-frozen-thawed-prepubertal-mouse-testes
#9
C Rondanino, A Maouche, L Dumont, A Oblette, N Rives
STUDY QUESTION: Can the spatio-temporal formation of an intact blood-testis barrier (BTB), which is essential for the progression of spermatogenesis, be reproduced in cultures of fresh or frozen/thawed prepubertal mouse testes? SUMMARY ANSWER: Organotypic cultures allow the establishment and maintenance of major BTB components and the formation of a functional BTB in mouse testicular tissues. WHAT IS KNOWN ALREADY: In vitro maturation of prepubertal testicular tissues is a promising approach to restore fertility in adult survivors of childhood cancer...
March 17, 2017: Molecular Human Reproduction
https://www.readbyqxmd.com/read/28331328/preliminary-evaluation-of-a-formulation-driven-cognitive-behavioral-guided-self-help-fcbt-gsh-for-crisis-and-transitional-case-management-clients
#10
Farooq Naeem, Rupinder K Johal, Claire Mckenna, Olivia Calancie, Tariq Munshi, Tariq Hassan, Amina Nasar, Muhammad Ayub
BACKGROUND: Cognitive behavioral therapy (CBT) is found to be effective for common mental disorders and has been delivered in self-help and guided self-help formats. Crisis and transitional case management (TCM) services play a vital role in managing clients in acute mental health crises. It is, therefore, an appropriate setting to try CBT in guided self-help format. METHODS: This was a preliminary evaluation of a formulation-driven cognitive behavioral guided self-help...
2017: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/28329433/understanding-maternal-postpartum-needs-a-descriptive-survey-of-current-maternal-health-services
#11
Mona Ma Almalik
OBJECTIVE: To assess mothers' learning needs and concerns after giving birth and to examine whether these needs were met at 6-8 weeks postpartum. BACKGROUND: Women experience many physiologic and psychological changes during postpartum period which is considered a vital transitional time. Exploring and meeting women's needs help woman to pass this period with little complications and enhance health care provider's ability to provide appropriate care following childbirth...
March 22, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28329352/costs-and-consequences-of-early-hospital-discharge-after-major-inpatient-surgery-in-older-adults
#12
Scott E Regenbogen, Anne H Cain-Nielsen, Edward C Norton, Lena M Chen, John D Birkmeyer, Jonathan S Skinner
Importance: As prospective payment transitions to bundled reimbursement, many US hospitals are implementing protocols to shorten hospitalization after major surgery. These efforts could have unintended consequences and increase overall surgical episode spending if they induce more frequent postdischarge care use or readmissions. Objective: To evaluate the association between early postoperative discharge practices and overall surgical episode spending and expenditures for postdischarge care use and readmissions...
March 22, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28328968/c-reactive-protein-and-n-terminal-prohormone-brain-natriuretic-peptide-as-biomarkers-in-acute-exacerbations-of-copd-leading-to-hospitalizations
#13
Yu-Wei Roy Chen, Virginia Chen, Zsuzsanna Hollander, Jonathon A Leipsic, Cameron J Hague, Mari L DeMarco, J Mark FitzGerald, Bruce M McManus, Raymond T Ng, Don D Sin
There are currently no accepted and validated blood tests available for diagnosing acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In this study, we sought to determine the discriminatory power of blood C-reactive protein (CRP) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) in the diagnosis of AECOPD requiring hospitalizations. The study cohort consisted of 468 patients recruited in the COPD Rapid Transition Program who were hospitalized with a primary diagnosis of AECOPD, and 110 stable COPD patients who served as controls...
2017: PloS One
https://www.readbyqxmd.com/read/28327147/medical-student-changes-in-self-regulated-learning-during-the-transition-to-the-clinical-environment
#14
Kenneth K Cho, Brahm Marjadi, Vicki Langendyk, Wendy Hu
BACKGROUND: Self-regulated learning (SRL), which is learners' ability to proactively select and use different strategies to reach learning goals, is associated with academic and clinical success and life-long learning. SRL does not develop automatically in the clinical environment and its development during the preclinical to clinical learning transition has not been quantitatively studied. Our study aims to fill this gap by measuring SRL in medical students during the transitional period and examining its contributing factors...
March 21, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/28325798/management-of-inpatient-hyperglycemia-and-diabetes-in-older-adults
#15
Guillermo E Umpierrez, Francisco J Pasquel
Adults aged 65 years and older are the fastest growing segment of the U.S. population, and their number is expected to double to 89 million between 2010 and 2050. The prevalence of diabetes in hospitalized adults aged 65-75 years and over 80 years of age has been estimated to be 20% and 40%, respectively. Similar to general populations, the presence of hyperglycemia and diabetes in elderly patients is associated with increased risk of hospital complications, longer length of stay, and increased mortality compared with subjects with normoglycemia...
April 2017: Diabetes Care
https://www.readbyqxmd.com/read/28324902/dysphagia-management-in-the-schools-past-present-and-future
#16
Cynthia R O'Donoghue, Elizabeth E Nottingham
As the number of speech-language pathologists (SLPs) responsible for swallowing and feeding services in the educational setting increases, guidance informing this specialized practice continues to emerge. Although SLPs have provided dysphagia management for children in medical settings for many years, the extension of dysphagia services to the schools is comparatively new. This shift in care delivery for what was previously a hospital-based practice is now occurring more frequently, and in an environment void of extensive medical supports (i...
April 2017: Seminars in Speech and Language
https://www.readbyqxmd.com/read/28322638/barriers-in-transitioning-patients-with-severe-obesity-from-hospitals-to-nursing-homes
#17
Christine Bradway, Holly C Felix, Tonya Whitfield, Xiaocong Li
This cross-sectional, descriptive study explored perspectives of discharge planners regarding transitions of hospitalized patients who are severely obese seeking discharge to a nursing home. Attention has been focused on care transitions regarding high hospital readmission rates, yet specific needs of patients who are severely obese have been largely overlooked. Ninety-seven (response rate 39.8%) discharge planners returned surveys addressing frequency of, and issues encountered when, arranging placements. Community and hospital characteristics were also collected...
December 1, 2017: Western Journal of Nursing Research
https://www.readbyqxmd.com/read/28322632/cost-effectiveness-of-a-care-transition-intervention-among-multimorbid-patients
#18
Lani Zimmerman, Fernando A Wilson, Myra S Schmaderer, Leeza Struwe, Bunny Pozehl, Audrey Paulman, Lisa C Bratzke, Kim Moore, Libby Raetz, Barb George
The purpose of this pilot study was to assess the cost-effectiveness of four different doses (based on patients' level of cognition and activation) of a home-based care transitions intervention compared with usual care at 2 and 6 months after hospital discharge to home for 126 adult patients with three or more chronic diseases. Health care utilization was measured, and a cost-effectiveness analysis was used to estimate incremental costs and quality-adjusted life-years associated with each intervention arm. At 6 months, results from this pilot study are very promising and support cost-effectiveness for Group 2-low cognition/high activation, Group 3-normal cognition/low activation, and Group 4-normal cognition/high activation patients...
October 1, 2016: Western Journal of Nursing Research
https://www.readbyqxmd.com/read/28320854/nonsteroidal-mineralocorticoid-receptor-antagonist-finerenone-protects-against-acute-kidney-injury-mediated-chronic-kidney-disease-role-of-oxidative-stress
#19
Lionel Lattenist, Sebastian M Lechner, Smail Messaoudi, Alan Le Mercier, Soumaya El Moghrabi, Sonia Prince, Norma A Bobadilla, Peter Kolkhof, Frédéric Jaisser, Jonatan Barrera-Chimal
Acute kidney injury induced by ischemia/reperfusion (IR) is a frequent complication in hospitalized patients. Mineralocorticoid receptor antagonism has shown to be helpful against renal IR consequences; however, the potential benefit of novel nonsteroidal mineralocorticoid receptor antagonists such as finerenone has to be further explored. In this study, we evaluated the efficacy of finerenone to prevent the acute and chronic consequences of ischemic acute kidney injury. For the acute study (24 hours), 18 rats were divided into sham, bilateral renal ischemia of 25 minutes, and rats that received 3 doses of finerenone at 48, 24, and 1 hour before the ischemia...
March 20, 2017: Hypertension
https://www.readbyqxmd.com/read/28319325/transitions-to-and-from-long-term-care-facilities-and-length-of-completed-stay-reuse-of-population-based-survey-data
#20
Joanna B Broad, Thomas Lumley, Toni Ashton, Peter B Davis, Michal Boyd, Martin J Connolly
OBJECTIVE: This article estimates length of completed stay and resident transitions for RAC residents over 12 months in Auckland. METHODS: Data from a census-type survey of nursing home residents (n = 6816) were linked with national mortality data. Transitions described include entry to residential aged care (RAC), movement between RAC facilities and deaths. RESULTS: When reweighted for missing data and adjusted for length bias, an estimated 9676 residents (95% CI 8368-10 985) used care over a 12-month period...
March 20, 2017: Australasian Journal on Ageing
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