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inpatient medicine

Pamela Ginex, Mary Montefusco, Glenn Zecco, Nicole Trocchia Mattessich, Jacquelyn Burns, Jane Hedal-Siegel, Jane Kopelman, Kay See Tan
BACKGROUND: Animal-facilitated therapy (AFT) is a complementary medicine intervention. To the authors' knowledge, no study has investigated the benefits of an AFT program in an adult surgical oncology setting. OBJECTIVES: The purpose of this study is to assess the effects of an AFT program on patients and staff on a surgical oncology unit. METHODS: A quasiexperimental design was used for the patient group, and a pre-/post-test design was used for the staff group...
April 1, 2018: Clinical Journal of Oncology Nursing
Zornitza Stark, Sebastian Lunke, Gemma R Brett, Natalie B Tan, Rachel Stapleton, Smitha Kumble, Alison Yeung, Dean G Phelan, Belinda Chong, Miriam Fanjul-Fernandez, Justine E Marum, Matthew Hunter, Anna Jarmolowicz, Yael Prawer, Jessica R Riseley, Matthew Regan, Justine Elliott, Melissa Martyn, Stephanie Best, Tiong Y Tan, Clara L Gaff, Susan M White
PurposeThe purpose of the study was to implement and prospectively evaluate the outcomes of a rapid genomic diagnosis program at two pediatric tertiary centers.MethodsRapid singleton whole-exome sequencing (rWES) was performed in acutely unwell pediatric patients with suspected monogenic disorders. Laboratory and clinical barriers to implementation were addressed through continuous multidisciplinary review of process parameters. Diagnostic and clinical utility and cost-effectiveness of rWES were assessed.ResultsOf 40 enrolled patients, 21 (52...
March 15, 2018: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Mackensie A Yore, Matthew C Strehlow, Lily D Yan, Elizabeth A Pirrotta, Joan L Woods, Koy Somontha, Yim Sovannra, Lauren Auerbach, Rebecca Backer, Christophe Grundmann, Swaminatha V Mahadevan
BACKGROUND: Emergency medicine is a young specialty in many low- and middle-income countries (LMICs). Although many patients seeking emergency or acute care are children, little information is available about the needs and current treatment of this group in LMICs. In this observational study, we sought to describe characteristics, chief complaints, management, and outcomes of children presenting for unscheduled visits to two Cambodian public hospitals. METHODS: Children enrolled in the study presented without appointment for treatment at one of two Cambodian public referral hospitals during a 4-week period in 2012...
March 13, 2018: International Journal of Emergency Medicine
Barbara P Yawn, Peter C Wollan, Matthew A Rank, Susan L Bertram, Young Juhn, Wilson Pace
PURPOSE: The purpose of this study was to assess patient and practice outcomes after introducing the Asthma APGAR (Activities, Persistent, triGGers, Asthma medications, Response to therapy) tools into primary care practices. METHODS: We used a pragmatic cluster-randomized controlled design in 18 US family medicine and pediatric practices to compare outcomes in patients with persistent asthma aged 5 to 45 years after introduction of the Asthma APGAR tools vs usual care...
March 2018: Annals of Family Medicine
Suprakash Chaudhury, Ajay Kumar Bakhla, Subhas Soren
Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS; Ranchi Indian Mental Hospital; Ranchi Manasik Aryogyashala) traces its origin from a lunatic asylum for Indian soldiers established at Munghyr in Bihar in 1795 and thus is the first mental hospital in India established by the British purely for Indian patients as well as the second oldest functioning mental hospital in India. The hospital made great strides in improving patients care and using modern methods of assessment and treatment as well as education and research during the tenure of Dr J E Dhunjibhoy the first Indian medical superintendent...
February 2018: Indian Journal of Psychiatry
Christopher W Baugh, Carol L Clark, Jason W Wilson, Ian G Stiell, Abraham G Kocheril, Krista K Luck, Troy D Myers, Charles V Pollack, Steven K Roumpf, Gery F Tomassoni, James M Williams, Brian B Patel, Fred Wu, Jesse M Pines
Atrial fibrillation and flutter (AF) is a common condition among emergency department (ED) patients in the United States (US). Traditionally, ED care for primary complaints related to AF focus on rate control, and patients are often admitted to an inpatient setting for further care. Inpatient care may include further telemetry monitoring and diagnostic testing, rhythm control, a search for identification of AF etiology, and stroke prophylaxis. However, many patients are eligible for safe and effective outpatient management pathways...
March 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Chantal F Hillebregt, Eline W M Scholten, Marjolijn Ketelaar, Marcel W M Post, Johanna M A Visser-Meily
INTRODUCTION: Many patients and family members experience a large gap between the protected environment during inpatient medical rehabilitation and life in the community after discharge. They feel insufficiently prepared to cope with the consequences of their disability in daily life. This study protocol describes the design measuring the effectiveness and implementation of family group conferences on the empowerment of patients with a high risk of chronic disability and their significant others...
March 8, 2018: BMJ Open
Yun Dong, Dax Steins, Shanbin Sun, Fei Li, James D Amor, Christopher J James, Zhidao Xia, Helen Dawes, Hooshang Izadi, Yi Cao, Derick T Wade
BACKGROUND: Practicing activities improves recovery after stroke, but many people in hospital do little activity. Feedback on activity using an accelerometer is a potential method to increase activity in hospital inpatients. This study's goal is to investigate the effect of feedback, enabled by a Smart watch, on daily physical activity levels during inpatient stroke rehabilitation and the short-term effects on simple functional activities, primarily mobility. METHODS/DESIGN: A randomized controlled trial will be undertaken within the stroke rehabilitation wards of the Second Affiliated hospital of Anhui University of Traditional Chinese Medicine, Hefei, China...
March 9, 2018: Trials
Amina Delpeuch, Marc Ruivard, Armand Abergel, Olivier Aumaitre, Stéphane Boisgard, Sandrine Bagel, Valérie Sautou
Background Intravenous (IV) iron preparations bypass the difficulties (malabsorption and side effects) associated with oral iron for the treatment of iron deficiency anaemia (IDA). Ferric carboxymaltose (FCM) can be administered as a single infusion over short periods of time but is more expensive than iron sucrose (IS) when the patients are hospitalized. Objectives To evaluate the appropriateness of FCM prescriptions and to establish the economic impact of this management (including disease coding) compared to the use of IV IS...
March 8, 2018: International Journal of Clinical Pharmacy
M E Ogunsanya, S O Nduaguba, C M Brown
Objectives The objective of this paper is to describe the annual direct medical expenditures for cutaneous lupus erythematosus (CLE) patients, and to estimate the incremental health care expenditures and utilization associated with depression among adults with CLE, while controlling for covariates. Methods Using the 2014 Medical Expenditure Panel Survey (MEPS), we compared CLE patients with and without depression to determine differences in: (a) health care utilization-inpatient, outpatient, office-based and emergency room (ER) visits, and prescriptions filled; and (b) expenditures-total costs, inpatient, outpatient, office-based, ER, and prescription medication costs, and other costs using demography-adjusted and comorbidity-adjusted multivariate models (age, gender, race/ethnicity, marital status, education, perception of health status, poverty category, smoking status, and Charlson Comorbidity Index)...
January 1, 2018: Lupus
Axel John, André Baumgart, Thomas Worst, Julia Heinzelbecker
OBJECTIVE: The study aimed to calculate direct medical costs (DMC) during the first year of diagnosis and to evaluate the impact of guideline changes on treatment costs in clinical stage (CS) I testicular germ cell tumor (TGCT) patients in a German healthcare system. MATERIALS AND METHODS: Healthcare expenditures as DMC during the first year of diagnosis for 307 TGCT patients in CS I treated at our institution from 1987 to 2013 were calculated from the statutory health insurance perspective using patient level data...
March 7, 2018: Urologia Internationalis
Kathryn B Anderson, Sriluck Simasathien, Veerachai Watanaveeradej, Alden L Weg, Damon W Ellison, Detchvijitr Suwanpakdee, Chonticha Klungthong, Thipwipha Phonpakobsin, Phirangkul Kerdpanich, Danabhand Phiboonbanakit, Robert V Gibbons, Stefan Fernandez, Louis R Macareo, In-Kyu Yoon, Richard G Jarman
Early diagnosis of influenza infection maximizes the effectiveness of antiviral medicines. Here, we assess the ability for clinical characteristics and rapid influenza tests to predict PCR-confirmed influenza infection in a sentinel, cross-sectional study for influenza-like illness (ILI) in Thailand. Participants meeting criteria for acute ILI (fever > 38°C and cough or sore throat) were recruited from inpatient and outpatient departments in Bangkok, Thailand, from 2009-2014. The primary endpoint for the study was the occurrence of virologically-confirmed influenza infection (based upon detection of viral RNA by RT-PCR) among individuals presenting for care with ILI...
2018: PloS One
Corrie E McDaniel, Wren Haaland, Joshua Parlaman, Chuan Zhou, Arti D Desai
OBJECTIVES: The majority of children with community acquired pneumonia (CAP) are primarily evaluated in community hospital emergency departments (EDs); however, studies on the management of pediatric CAP have largely targeted care provided in free-standing children's hospital EDs or inpatient settings. The objectives of this study were to examine whether implementation of a CAP pathway within three community hospital EDs and inpatient units improved process measures related to appropriate laboratory testing and antibiotic prescribing, and to compare performance on these measures between the community hospitals and a free-standing children's hospital...
March 7, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Arjun H Rash, Robert Sheldon, Maoliosa Donald, Cindy Eronmwon, Vikas P Kuriachan
BACKGROUND: Effective communication between the consultants and physicians form an integral foundation of effective and expert patient care. A broad review of the literature has not been undertaken to determine the components of a consultant's letter of most value to the referring physician. We aimed to identify the components of a consultant's letter preferred by referring physicians. METHODS: We searched Embase and MEDLINE (OVID) Medicine (EBM) Reviews and Cochrane Database of Systematic Reviews for English articles with no restriction on initial date to January 6, 2017...
March 5, 2018: Journal of General Internal Medicine
Shazia Mehmood Siddique, Meghan Lane-Fall, Matthew J McConnell, Neha Jakhete, James Crismale, Stefanie Porges, Vandana Khungar, Shivan J Mehta, David Goldberg, Zhiping Li, Thomas Schiano, Linda Regan, Clinton Orloski, Judy A Shea
Patients with cirrhosis have high admission and readmission rates, and it is estimated that a quarter are potentially preventable. Little data are available regarding nonmedical factors impacting triage decisions in this patient population. This study sought to explore such factors as well as to determine provider perspectives on low-acuity clinical presentations to the emergency department, including ascites and hepatic encephalopathy. A survey was distributed in four liver transplant centers to both emergency medicine and hepatology providers, who included attending physicians, house staff, and advanced practitioners; 196 surveys were returned (estimated response rate 50...
March 2018: Hepatology communications
Sajan Patel, Alvin Rajkomar, James D Harrison, Priya A Prasad, Victoria Valencia, Sumant R Ranji, Michelle Mourad
BACKGROUND: Audit and feedback improves clinical care by highlighting the gap between current and ideal practice. We combined best practices of audit and feedback with continuously generated electronic health record data to improve performance on quality metrics in an inpatient setting. METHODS: We conducted a cluster randomised control trial comparing intensive audit and feedback with usual audit and feedback from February 2016 to June 2016. The study subjects were internal medicine teams on the teaching service at an urban tertiary care hospital...
March 5, 2018: BMJ Quality & Safety
Faith Jelagat Lelei-Mailu, Charles Muriuki Mariara
This case report is of a 32-year-old woman of African descent on follow-up for pregnancy in the background of portal hypertension due to liver cirrhosis. She had initially been treated for chronic hepatitis B infection with lamivudine and tenofovir, complicated by portal hypertension and variceal bleeding that thrice required banding. Her pregnancy was uneventful until 31 weeks gestation when she presented with dyspnoea. On examination and investigation, she had oedema, bilateral pleural effusions and ascites...
March 5, 2018: BMJ Case Reports
Charlotte Vaysse, Elodie Chantalat, Odile Beyne-Rauzy, Louise Morineau, Fabien Despas, Jean-Marc Bachaud, Nathalie Caunes, Muriel Poublanc, Elie Serrano, Roland Bugat, Marie-Eve Rougé Bugat, Anne-Laure Fize
BACKGROUND: Oncology involves complex care and multidisciplinary management of patients; however, misinformation and ineffective communication remain problematic. OBJECTIVE: The educational objective of our study was to develop a new teaching method to improve cancer treatment and management by emphasizing the link between hospitals (inpatients) and their surrounding communities (outpatients). METHODS: A team of 22 professionals from public and private institutions developed a small private online course (SPOC)...
March 5, 2018: JMIR Medical Education
Fan Yang, Qing-Wei Chen
We assessed the frailty status of inpatients and analyzed the factors influencing frailty status to explore the reasons for frailty and identify feasible intervention strategies.A total of 1494 geriatric patients aged ≥60 years were recruited as subjects. All patients were hospitalized between September 2014 and August 2015 in the internal medicine units of 3 hospitals in Chongqing and Zunyi in the southwestern area of China. Patients' frailty status was evaluated using the Phenotype of Frailty scale, via face-to-face interviews coupled with physical examinations using simple equipment...
January 2018: Medicine (Baltimore)
Zixin Shu, Wenwen Liu, Huikun Wu, Mingzhong Xiao, Deng Wu, Ting Cao, Meng Ren, Junxiu Tao, Chuhua Zhang, Tangqing He, Xiaodong Li, Runshun Zhang, Xuezhong Zhou
BACKGROUND AND OBJECTIVE: Liver disease is a multifactorial complex disease with high global prevalence and poor long-term clinical efficacy and liver disease patients with different comorbidities often incorporate multiple phenotypes in the clinic. Thus, there is a pressing need to improve understanding of the complexity of clinical liver population to help gain more accurate disease subtypes for personalized treatment. METHODS: Individualized treatment of the traditional Chinese medicine (TCM) provides a theoretical basis to the study of personalized classification of complex diseases...
February 22, 2018: Computer Methods and Programs in Biomedicine
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