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"Intermediate Care"

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https://www.readbyqxmd.com/read/27894709/external-validation-in-an-intermediate-unit-of-a-respiratory-decompensation-model-trained-in-an-intensive-care-unit
#1
Holly N Blackburn, Matthew T Clark, Travis J Moss, Jeffrey S Young, J Randall Moorman, Douglas E Lake, J Forrest Calland
BACKGROUND: Preventing urgent intubation and upgrade in level of care in patients with subclinical deterioration could be of great utility in hospitalized patients. Early detection should result in decreased mortality, duration of stay, and/or resource use. The goal of this study was to externally validate a previously developed, vital sign-based, intensive care unit, respiratory instability model on a separate population, intermediate care patients. METHODS: From May 2014 to May 2016, the model calculated relative risk of adverse events every 15 minutes (n = 373,271 observations) for 2,050 patients in a surgical intermediate care unit...
November 25, 2016: Surgery
https://www.readbyqxmd.com/read/27869887/-anmco-position-paper-hospital-discharge-planning
#2
Mauro Mennuni, Michele Massimo Gulizia, Gianfranco Alunni, Antonio Francesco Amico, Francesco Maria Bovenzi, Roberto Caporale, Furio Colivicchi, Andrea Di Lenarda, Giuseppe Di Tano, Sabrina Egman, Francesco Fattirolli, Domenico Gabrielli, Giovanna Geraci, Giovanni Gregorio, Gian Francesco Mureddu, Federico Nardi, Donatella Radini, Carmine Riccio, Fausto Rigo, Marco Sicuro, Stefano Urbinati, Guerrino Zuin
Hospital discharge is often poorly standardized and is characterized by discontinuity and fragmentation of care, putting patients at high risk of post-discharge adverse events and early readmission. The present ANMCO position paper reviews the modifiable components of the hospital discharge process related to adverse events or rehospitalizations and suggests the optimal methods for redesign the whole discharge process. The key principles for proper hospital discharge or transfer of care acknowledge that hospital discharge:- is not an isolated event, but a process that has to be planned immediately after admission, ensuring that the patient and the caregiver understand and contribute to the planned decisions as equal partners;- is facilitated by a comprehensive systemic approach that begins with a multidimensional evaluation process;- must be organized by an operator who is responsible for the coordination of all phases of the hospital patient pathway, involving afterwards the physician and transferring to them the information and responsibility;- is the result of an integrated multidisciplinary team approach;- uses appropriately the transitional and intermediate care services;- is carried out in an organized system of care and continuum of services;- programs the passage of information to after-discharge services...
September 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/27865022/exploring-the-experiences-of-patients-attending-day-hospitals-in-the-rural-scotland-capturing-the-patient-s-voice
#3
Elizabeth Adamson, Janette Pow, Fiona Houston, Pamela Redpath
AIM: The aim of the study was to understand the meaning of person-centred compassionate care for people attending Day Hospitals in rural Scotland BACKGROUND: Increasing numbers of older people are living with chronic conditions and require support to live at home. Intermediate care services such as Day Hospitals can enable this. Much previous research about Day Hospitals focused on organizational aspects of care. This study set out to capture the voice of the patient using this service...
November 16, 2016: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/27858510/patterns-of-naloxone-use-in-hospitalized-patients
#4
Lisa Yung, Kelly C Lee, Chih Hsu, Timothy Furnish, Rabia S Atayee
OBJECTIVES: Naloxone is indicated for reversal of opioid-induced respiratory depression. The objective of this study is to evaluate patterns of naloxone use in hospitalized patients. METHODS: Retrospective chart review at the University of California, San Diego Health. Subjects included adults ≥18 years old who were admitted to and received naloxone in the medical-surgical, telemetry, intermediate care, or obstetrics/gynecology units from May 1(st), 2014 to April 30(th), 2015...
December 1, 2016: Postgraduate Medicine
https://www.readbyqxmd.com/read/27850166/526-do-intermediate-care-units-alter-intensive-care-utilization-for-children-with-medical-complexity
#5
Melanie Silverman, Danielle DeCourcey
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27829295/an-exploration-of-mental-capacity-assessment-within-acute-hospital-and-intermediate-care-settings-in-england-a-focus-group-study
#6
Mark Jayes, Rebecca Palmer, Pamela Enderby
PURPOSE: To explore approaches to the assessment of mental capacity within acute hospital and intermediate care settings in England. METHODS: Two focus group interviews were conducted with multidisciplinary staff (n = 13) within a large hospital trust. Data were analysed using a Framework approach. RESULTS: Three main themes were identified: (i) the assessment process; (ii) staff experience of assessment; (iii) assessing capacity for patients with communication difficulties...
November 10, 2016: Disability and Rehabilitation
https://www.readbyqxmd.com/read/27829011/rehabilitation-profiles-of-older-adult-stroke-survivors-admitted-to-intermediate-care-units-a-multi-centre-study
#7
Laura M Pérez, Marco Inzitari, Terence J Quinn, Joan Montaner, Ricard Gavaldà, Esther Duarte, Laura Coll-Planas, Mercè Cerdà, Sebastià Santaeugenia, Conxita Closa, Miquel Gallofré
BACKGROUND: Stroke is a major cause of disability in older adults, but the evidence around post-acute treatment is limited and heterogeneous. We aimed to identify profiles of older adult stroke survivors admitted to intermediate care geriatric rehabilitation units. METHODS: We performed a cohort study, enrolling stroke survivors aged 65 years or older, admitted to 9 intermediate care units in Catalonia-Spain. To identify potential profiles, we included age, caregiver presence, comorbidity, pre-stroke and post-stroke disability, cognitive impairment and stroke severity in a cluster analysis...
2016: PloS One
https://www.readbyqxmd.com/read/27815556/utility-of-the-necpal-ccoms-ico%C3%A2-tool-and-the-surprise-question-as-screening-tools-for-early-palliative-care-and-to-predict-mortality-in-patients-with-advanced-chronic-conditions-a-cohort-study
#8
Xavier Gómez-Batiste, Marisa Martínez-Muñoz, Carles Blay, Jordi Amblàs, Laura Vila, Xavier Costa, Joan Espaulella, Alicia Villanueva, Ramon Oller, Joan Carles Martori, Carles Constante
BACKGROUND: The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO(©) (NECPAL) tool combines the Surprise Question with additional clinical parameters for a more comprehensive assessment. The capacity of these screening tools to predict mortality is still unknown. AIM: To explore the predictive validity of the NECPAL and SQ to determine 12- to 24-month mortality. DESIGN: Longitudinal, prospective and observational cohort study...
November 4, 2016: Palliative Medicine
https://www.readbyqxmd.com/read/27747539/risk-factors-associated-with-legal-interventions
#9
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
https://www.readbyqxmd.com/read/27682389/a-voice-for-older-patients
#10
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
https://www.readbyqxmd.com/read/27676926/prospective-payment-in-french-post-acute-care-comparison-to-international-funding-of-rehabilitation-systems
#11
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
https://www.readbyqxmd.com/read/27676415/impact-of-opening-hours-of-the-post-anaesthetic-care-unit-on-fast-track-success-in-cardiac-surgery
#12
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
https://www.readbyqxmd.com/read/27645556/identifying-patients-with-advanced-chronic-conditions-for-a-progressive-palliative-care-approach-a-cross-sectional-study-of-prognostic-indicators-related-to-end-of-life-trajectories
#13
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
https://www.readbyqxmd.com/read/27632769/the-mental-health-parity-and-addiction-equity-act-evaluation-study-impact-on-specialty-behavioral-health-care-utilization-and-spending-among-carve-in-enrollees
#14
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
https://www.readbyqxmd.com/read/27624630/cough-augmentation-techniques-in-the-critically-ill-a-canadian-national-survey
#15
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
https://www.readbyqxmd.com/read/27619015/sympathetic-activity-and-early-mobilization-in-patients-in-intensive-and-intermediate-care-with-severe-brain-injuries-a-preliminary-prospective-randomized-study
#16
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
https://www.readbyqxmd.com/read/27591173/clinical-utility-of-a-nasal-swab-methicillin-resistant-staphylococcus-aureus-polymerase-chain-reaction-test-in-intensive-and-intermediate-care-unit-patients-with-pneumonia
#17
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
https://www.readbyqxmd.com/read/27585973/interprofessional-collaborative-care-characteristics-and-the-occurrence-of-bedside-interprofessional-rounds-a-cross-sectional-analysis
#18
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
https://www.readbyqxmd.com/read/27576322/strengthening-patient-safety-in-transitions-of-care-an-emerging-role-for-local-medical-centres-in-norway
#19
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
https://www.readbyqxmd.com/read/27546753/crossing-the-handover-chasm-clinicians-perceptions-of-barriers-to-the-early-detection-and-timely-management-of-severe-sepsis-and-septic-shock
#20
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
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