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"Intermediate Care"

Alfreda Holloway-Beth, Linda Forst, Julia Lippert, Sherry Brandt-Rauf, Sally Freels, Lee Friedman
BACKGROUND: Current research regarding injuries caused during interactions between police officers and civilians is conducted intermittently or on a very narrow sample frame which provides very little clinical information about the injuries suffered or the adverse outcomes. The aim of this study is to identify comorbid risk factors and describe acute outcomes of medically treated traumatic injuries occurring as a result of contact with law enforcement personnel. METHODS: For this retrospective study, patients injured as a result of contact with law enforcement personnel were identified using ICD-9 external cause of injury codes from medical record databases of patients treated in all hospitals and trauma units in Illinois between 2000 and 2009...
December 2016: Injury Epidemiology
Anne Horner
How did you become an older people's nurse? I have never seen it as a specialty, but as part of my job as a nurse. I work in the Bournemouth area, as nurse consultant intermediate care at Dorset HealthCare University NHS Foundation Trust, where we have a large older population.
September 29, 2016: Nursing Older People
Jean-Pascal Devailly, Laurence Josse
OBJECTIVE: In all countries, the boundaries are ambiguous between acute and post-acute as well as defining the dimensions of care. The aim of this study is to analyze relations between segmentation of care and payment systems. In the new prospective payment system implemented in French SSR, the grouping unit is inpatient stay and the week for day hospitalization. In 1991, the field of SSR mixed structures as diverse in their purposes as public or private hospital units of rehabilitation and "nursing homes"...
September 2016: Annals of Physical and Rehabilitation Medicine
Christian Graß, Federica Stretti, Waseem Zakhary, Edwin Turton, Sophia Sgouoropoulou, Meinhard Mende, Joerg Ender
BACKGROUND: Fast track (FT) treatment in cardiac anaesthesia is state of the art. Aim of our study was to compare FT treatment in a post anaesthetic care unit (PACU) with limited opening hours with a PACU opened for unlimited hours. Primary endpoints were extubation time (ET), length of stay (LOS) in PACU and LOS in intermediate care unit (IMC). Secondary endpoints were FT success/failure, hospital LOS, re- intubation and in hospital mortality. METHODS: At our institution, FT is usually managed in a PACU with limited opening hours from 10am to 10pm, Monday to Friday (PACU12)...
September 27, 2016: Minerva Anestesiologica
J Amblàs-Novellas, S A Murray, J Espaulella, J C Martori, R Oller, M Martinez-Muñoz, N Molist, C Blay, X Gómez-Batiste
OBJECTIVES: 2 innovative concepts have lately been developed to radically improve the care of patients with advanced chronic conditions (PACC): early identification of palliative care (PC) needs and the 3 end-of-life trajectories in chronic illnesses (acute, intermittent and gradual dwindling). It is not clear (1) what indicators work best for this early identification and (2) if specific clinical indicators exist for each of these trajectories. The objectives of this study are to explore these 2 issues...
September 19, 2016: BMJ Open
Jessica M Harwood, Francisca Azocar, Amber Thalmayer, Haiyong Xu, Michael K Ong, Chi-Hong Tseng, Kenneth B Wells, Sarah Friedman, Susan L Ettner
OBJECTIVE: The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA's impact on BH expenditures and utilization among "carve-in" enrollees. METHODS: We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers...
September 14, 2016: Medical Care
Louise Rose, Neill K Adhikari, Joseph Poon, David Leasa, Douglas A McKim
BACKGROUND: Critically ill mechanically ventilated patients experience impaired airway clearance due to ineffective cough and impaired secretion mobilization. Cough augmentation techniques, including mechanical insufflation-exsufflation (MI-E), manually assisted cough, and lung volume recruitment, improve cough efficiency. Our objective was to describe use, indications, contraindications, interfaces, settings, complications, and barriers to use across Canada. METHODS: An e-mail survey was sent to nominated local survey champions in eligible Canadian units (ICUs, weaning centers, and intermediate care units) with 4 telephone/e-mail reminders...
October 2016: Respiratory Care
A Rocca, J-M Pignat, L Berney, J Jöhr, D Van de Ville, R T Daniel, M Levivier, L Hirt, A R Luft, E Grouzmann, K Diserens
BACKGROUND: Patients who experience severe brain injuries are at risk of secondary brain damage, because of delayed vasospasm and edema. Traditionally, many of these patients are kept on prolonged bed rest in order to maintain adequate cerebral blood flow, especially in the case of subarachnoid hemorrhage. On the other hand, prolonged bed rest carries important morbidity. There may be a clinical benefit in early mobilization and our hypothesis is that early gradual mobilization is safe in these patients...
September 13, 2016: BMC Neurology
Stephanie E Giancola, Ai Thi Nguyen, Binh Le, Omar Ahmed, Catherine Higgins, James A Sizemore, Kara W Orwig
This retrospective study aimed to validate the concordance between nasal swab methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) test and respiratory culture and to determine the number of potentially preventable days of anti-MRSA therapy in patients with pneumonia. Two hundred adult inpatients in the intensive and intermediate care units were included. The nasal swab MRSA PCR test was positive in 55 (27.5%) patients. MRSA was isolated from respiratory culture in 21 (10.5%) patients...
November 2016: Diagnostic Microbiology and Infectious Disease
Jed D Gonzalo, Judy Himes, Brian McGillen, Vicki Shifflet, Erik Lehman
BACKGROUND: Interprofessional collaboration improves the quality of medical care, but integration into inpatient workflow has been limited. Identification of systems-based factors promoting or diminishing bedside interprofessional rounds (BIR), one method of interprofessional collaboration, is critical for potential improvements in collaboration in hospital settings. The objective of this study was to determine whether the percentage of bedside interprofessional rounds in 18 hospital-based clinical units is attributable to spatial, staffing, patient, or nursing perception characteristics...
2016: BMC Health Services Research
Trond Kongsvik, Kristin Halvorsen, Tonje Osmundsen, Gudveig Gjøsund
BACKGROUND: Patient safety has gained less attention in primary care in comparison to specialised care. We explore how local medical centres (LMCs) can play a role in strengthening patient safety, both locally and in transitions between care levels. LMCs represent a form of intermediate care organisation in Norway that is increasingly used as a strategy for integrated care policies. The analysis is based on institutional theory and general safety theories. METHODS: A qualitative design was applied, involving 20 interviews of nursing home managers, managers at local medical centres and administrative personnel...
2016: BMC Health Services Research
Claudia T Matthaeus-Kraemer, Daniel O Thomas-Rueddel, Daniel Schwarzkopf, Hendrik Rueddel, Bernhard Poidinger, Konrad Reinhart, Frank Bloos
PURPOSE: The purpose was to identify barriers to the early detection and timely management of severe sepsis throughout the emergency department (ED), general ward (GW), intermediate care unit (IMC), and the intensive care unit (ICU). MATERIALS AND METHODS: Five multicenter focus group discussions with 29 clinicians were conducted. Discussions were based on a moderation guide were recorded and transcribed. Qualitative analysis was performed according to the principles of the concept mapping method and the framework approach...
July 9, 2016: Journal of Critical Care
Sónia Martins, José Artur Paiva, Mário R Simões, Lia Fernandes
OBJECTIVE: Among cognitive reserve markers, educational attainment is the most widely studied, with several studies establishing a strong association with risk of dementia. However, it has not yet been fully examined in delirium. This study aims to analyse the relationship between educational attainment and delirium. METHODS: The study included elderly hospitalised patients admitted (≥48 h) into an intermediate care unit (IMCU) of Intensive Care Medicine Service...
August 9, 2016: Acta Neuropsychiatrica
James B McCarthy, Shira R Weiss, Kristin T Segovich, Baptiste Barbot
Despite established differences in cognitive functioning of adults with mood disorder-related psychosis and those with non-affective psychotic disorders, there is limited evidence of the impact of psychotic symptoms on the cognitive functioning of children and adolescents with mood disorders. This study investigates IQ, working memory, and processing speed scores in 80 child and adolescent inpatients discharged from an intermediate care state psychiatric hospital, using a retrospective chart review. Associations between diagnosis based on DSM-IV criteria (7 with Major Depression- MDD; 43 with Bipolar Disorders-BD, and 30 with Mood Disorders Not Otherwise Specified-NOS), presence of current psychotic features, and cognitive functioning (WISC-IV IQ, Coding, Symbol Search, and Digit Span) were investigated using Multivariate Analyses of Variance...
October 30, 2016: Psychiatry Research
Wee Ming Peh, Wann Jia Loh, Ghee Chee Phua, Chian Min Loo
Guidewire retention is a severe but preventable complication from central venous catheter (CVC) insertion. There were three cases of guidewire retention during CVC insertion in the medical intensive care unit (MICU) in Singapore General Hospital, in the period between December 2011 and February 2012. The primary objective of this quality improvement project was to eliminate future incidences of guidewire retention during CVC insertion in the MICU and medical intermediate care area (MICA) via a structured educational program and a cost effective modified CVC set...
2016: BMJ Quality Improvement Reports
Thomas J Smith
BACKGROUND: Prior research documents occupancy and patient care quality (OPCQ) benefits for private room (PR) relative to multi-bed (MB) designs in neonatal intensive care units (NICUs). OBJECTIVE: To extend this research design to four additional types of children's hospital units: a cardiovascular care center (CVCC), an infant care center (ICC), a medical/surgical unit (Med/Surg), and a pediatric intensive care unit (PICU). METHODS: Staff comments, task activities, patient care demands, and perceptual survey rankings for twelve major indicators of OPCQ were assessed with nursing staff on these units plus an NICU...
July 25, 2016: Work: a Journal of Prevention, Assessment, and Rehabilitation
Anne Canny, Frances Robertson, Peter Knight, Adam Redpath, Miles D Witham
BACKGROUND: The Indicator of Relative Need (IoRN) instrument is designed for both health and social care services to measure function and dependency in older people. To date, the tool has not undergone assessment of validity. We report two studies aimed to evaluate psychometric properties of the IoRN. METHODS: The first study recruited patients receiving social care at discharge from hospital, those rehabilitating in intermediate care, and those in a rehabilitation at home service...
2016: BMC Geriatrics
Suma B Hoffman, Natalie Terrell, Colleen Hughes Driscoll, Natalie L Davis
BACKGROUND: Heated humidified high-flow nasal cannula (HFNC) is thought to be comparable with nasal CPAP. The effect of multimodality mid-level respiratory support use in the neonatal ICU is unknown. The objective of this work was to evaluate the effect of introducing HFNC on length of respiratory support and stay. METHODS: A chart review was conducted on subjects at 24-32 weeks gestation requiring mid-level support (HFNC/nasal CPAP) 1 y before and after HFNC implementation...
October 2016: Respiratory Care
Parmenion P Tsitsopoulos, Elias Iosifidis, Charalampos Antachopoulos, Dimitrios M Anestis, Ekaterini Karantani, Angeliki Karyoti, Georgios Papaevangelou, Eftychios Kyriazidis, Emmanuel Roilides, Christos Tsonidis
BACKGROUND: Data on nosocomial bloodstream infections (NBSI) in neurosurgery is limited. This study aimed to analyze the epidemiology, microbiology, outcome, and risk factors for death in neurosurgical patients with NBSI in a multidrug resistant setting. METHODS: Neurosurgical patients with a confirmed NBSI within the period 2003-2012 were retrospectively analyzed. NBSI was diagnosed when a pathogen was isolated from a blood sample obtained after the first 48 h of hospitalization...
September 2016: Acta Neurochirurgica
Sebastià J Santaeugènia, Manuela García-Lázaro, Ana María Alventosa, Alícia Gutiérrez-Benito, Albert Monterde, Joan Cunill
OBJECTIVE: To evaluate the clinical effectiveness of an intermediate care model based on a system of care focused on integrated care pathways compared to the traditional model of geriatric care (usual care) in Catalonia. PATIENTS AND METHODS: The design is a quasi-experimental pre-post non-randomised study with non-synchronous control group. The intervention consists of the development and implementation of integrated care pathways and the creation of specialised interdisciplinary teams in each of the processes...
July 19, 2016: Revista Española de Geriatría y Gerontología
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