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post acute care management

Elina Tiippana, Kaisa Nelskylä, Eija Nilsson, Eero Sihvo, Matti Kataja, Eija Kalso
Background and aims Thoracotomies can cause severe pain, which persists in 21-67% of patients. We investigated whether NSAID + intravenous patient-controlled analgesia (IV-PCA) with morphine is an efficacious alternative to thoracic epidural analgesia (TEA). We also wanted to find out whether an extended controlled pain management protocol within a clinical study can decrease the incidence of persistent post-thoracotomy pain. Methods Thirty thoracotomy patients were randomized into 3 intervention groups with 10 patients in each...
December 29, 2017: Scandinavian Journal of Pain
Diane Ceravolo, Deborah A Raines
PURPOSE: To examine the impact of a mindfulness intervention on nurse managers in an acute care hospital. DESIGN: A pre/post intervention design with three data collection points: prior to, at the conclusion of, and at 3 months following the intervention. METHOD: A survey to measure the impact of a mindfulness workshops on nurse managers' perception of professional quality of life, burnout, and perceived wellness. FINDINGS: There were significant changes in the scores on the compassion satisfaction (T-1 mean 3...
June 1, 2018: Journal of Holistic Nursing: Official Journal of the American Holistic Nurses' Association
Estelle Everett, Nestoras Mathioudakis
PURPOSE OF REVIEW: Hyperglycemia occurs frequently in hospitalized patients with stroke and peripheral vascular disease (PVD). Guidelines for inpatient glycemic management are not well established for this patient population. We will review the clinical impact of hyperglycemia in this acute setting and review the evidence for glycemic control. RECENT FINDINGS: Hyperglycemia in acute stroke is associated with poor short and long-term outcomes, and perioperative hyperglycemia in those undergoing revascularization for PVD is linked to increased post-surgical complications...
June 16, 2018: Current Diabetes Reports
Aldo L Schenone, Venu Menon
PURPOSE OF REVIEW: This is an in-depth review on the mechanism of action, clinical utility, and drug-drug interactions of colchicine in the management of pericardial disease. RECENT FINDINGS: Recent evidence about therapeutic targets on pericarditis has demonstrated that NALP3 inflammasome blockade is the cornerstone in the clinical benefits of colchicine. Such benefits extend from acute and recurrent pericarditis to transient constriction and post-pericardiotomy syndrome...
June 14, 2018: Current Cardiology Reports
Steven Schmitt, Ann T MacIntyre, Susan C Bleasdale, J Trees Ritter, Sandra B Nelson, Elie F Berbari, Steven D Burdette, Angela Hewlett, Matthew Miles, Philip A Robinson, Javeed Siddiqui, Robin Trotman, Lawrence Martinelli, Gary Zeitlin, Andrés Rodriguez, Mark W Smith, Daniel P McQuillen
Background: Intervention by infectious diseases (ID) physicians improves outcomes for inpatients in Medicare, but patients with other insurance types could fare differently. We assessed whether ID involvement leads to better outcomes among privately insured patients under age 65 hospitalized with common infections. Methods: We performed a retrospective analysis of administrative claims data from community hospital and post-discharge ambulatory care. Patients were privately insured individuals under 65 years old with an acute-care stay in 2014 for selected infections, classed as having early (by day 3) or late (after day 3) ID intervention, or none...
June 13, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Aminu K Bello, Christine M Ribic, Serge H Cournoyer, Mercedeh Kiaii, Martine LeBlanc, Melanie Poulin-Costello, David N Churchill, Norman Muirhead
Background: Several studies have demonstrated harm associated with using erythropoiesis-stimulating agents (ESA) to achieve higher hemoglobin (Hb) levels. Subsequently, more conservative use of ESAs has changed anemia therapy in patients with chronic renal failure. Objective: The objectives were to identify transfusion rates in hemodialysis (HD) patients during the first year of therapy, to identify factors associated with the probability of transfusion, describe reasons for the transfusions, and identify the Hb values associated with each transfusion...
2018: Canadian Journal of Kidney Health and Disease
Nicole Lay Tin Tan, Justin Lindley Hunt, Stella May Gwini
BACKGROUND: Enhanced recovery after surgery programs may improve recovery and reduce duration of hospital stay after joint replacement surgery. However, uptake is incomplete, and the relative importance of program components is unknown. This before-and-after quality improvement study was designed to determine whether adding 'non-surgical' components, to pre-existing 'surgical' components, in an Australian private healthcare setting, would improve patient recovery after total hip replacement...
June 13, 2018: BMC Anesthesiology
Nicole J Brandt, Chad Worz, Sharon F Clackum
Skilled nursing facilities and nursing homes are a care setting that offers increasing opportunities for pharmacists to be leaders when addressing the new updated Centers for Medicare and Medicaid Services requirements coupled with the enhanced quality measures reporting. Additionally, the complexity of the medication-related needs and comorbidities of the patients served in long-term care facilities promotes pharmacists practicing to the top of their license. Medication stewardship needs to be an interdisciplinary team activity led by the pharmacist...
June 11, 2018: Pharmacotherapy
Michelle Ma, Katie Falloon, Po-Hung Chen, Behnam Saberi, Aliaksei Pustavoitau, Elif Ozdogan, Zhiping Li, Benjamin Philosophe, Andrew M Cameron, Ahmet Gurakar
Acute alcoholic hepatitis is a syndrome of jaundice and hepatic decompensation that occurs with excessive alcohol consumption. The diagnosis can be made with a combination of clinical characteristics and laboratory studies, though biopsy may be required in unclear cases. Acute alcoholic hepatitis can range from mild to severe disease, as determined by a Maddrey discriminant function ≥32. Mild forms can be managed with supportive care and abstinence from alcohol. While mild form has an overall good prognosis, severe alcoholic hepatitis is associated with an extremely high short-term mortality of up to 50%...
January 1, 2018: Journal of Intensive Care Medicine
Beverley Duff, Debbie Massey, Russell Gooch, Marianne Wallis
Nurses are ideally positioned to recognise and respond to patient deterioration. However, premonitory signs of patient deterioration are often overlooked, not managed, or not communicated in a timely fashion. Education programs aimed at improving nurses' technical and non-technical skills have been developed, however, the outcomes of these educational strategies remain unclear. A quasi-experimental time series design was used in this study to evaluate the impact of a multi-modal education program (DeTER) on acute care nurses' technical and non-technical skill development and recognition and response to patient deterioration...
May 24, 2018: Nurse Education in Practice
Joanne Kacperski
Concussion, now most often referred to as mild traumatic brain injury in recent literature, is common in pediatrics, and headache is often the most common complaint post-injury. Although most children and adolescents recover within 1-2 weeks, some develop frequent and debilitating headaches that can last for months or longer. Most clinicians would agree on the importance of managing both acute and persistent posttraumatic headaches appropriately to speed recovery, minimize disability, maximize function, and improve quality of life, but there are no well-established guidelines to instruct physicians in doing so...
June 7, 2018: Paediatric Drugs
W Schmelling, J N Poulsen, L Christrup, P Gazerani
Aims A fast-track based surgical treatment reduces morbidity and hospital stay by providing early mobilization. Sufficient postoperative pain management is mandatory for early mobilization and optimal utilization of rehabilitation measures. Insufficient postoperative pain management is however a widespread problem. Lack of knowledge about pain and pain treatment among health care professionals and general community has been considered as a major potential contributor in insufficient pain management. It has been suggested that severe postoperative pain might imply a potential risk of developing chronic pain...
December 29, 2017: Scandinavian Journal of Pain
Kartavya Sharma, Daniel J Johnson, Brenda Johnson, Steven M Frank, Robert D Stevens
BACKGROUND: There is uncertainty regarding the effect of anemia and red blood cell transfusion on functional outcome following acute ischemic stroke. We studied the relationship of hemoglobin parameters and red cell transfusion with post stroke functional outcome after adjustment for neurological severity and medical comorbidities. METHODS: Retrospective cohort study of 536 patients discharged with a diagnosis of ischemic stroke from a tertiary care hospital between January 2012 and April 2015...
June 2, 2018: BMC Neurology
Chikul Mittal, Hsien Chieh Daniel Lee, Kiat Sern Goh, Cheng Kiang Adrian Lau, Leeanna Tay, Chuin Siau, Yik Hin Loh, Teck Kheng Edward Goh, Chit Lwin Sandi, Chien Earn Lee
BACKGROUND: To test a population health program which could, through the application of process redesign, implement multiple evidence-based practices across the continuum of care in a functionally integrated health delivery system and deliver highly reliable and consistent evidence-based surgical care for patients with fragility hip fractures in an acute tertiary general hospital. METHODS: The ValuedCare (VC) program was developed in three distinct phases as an ongoing collaboration between the Geisinger Health System (GHS), USA, and Changi General Hospital (CGH), Singapore, modelled after the GHS ProvenCare® Fragile Hip Fracture Program...
May 30, 2018: Journal of Orthopaedic Surgery and Research
Sachin R Pendharkar, Maria B Ospina, Danielle A Southern, Naushad Hirani, Jim Graham, Peter Faris, Mohit Bhutani, Richard Leigh, Christopher H Mody, Michael K Stickland
BACKGROUND: Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life. We sought to determine whether an evidence-based computerized AECOPD admission order set could improve quality and reduce length of stay. METHODS: The order set was designed by a provincial COPD working group and implemented voluntarily among three physician groups in a Canadian tertiary-care teaching hospital...
May 30, 2018: BMC Pulmonary Medicine
Pallab K Maulik, Sudha Kallakuri, Siddhardha Devarapalli
Background: There are large gaps in the delivery of mental health care in low- and middle-income countries such as India, and the problems are even more acute in rural settings due to lack of resources, remoteness, and lack of infrastructure, amongst other factors. The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health Project was conceived as a mental health services delivery model using technology-based solutions for rural India. This paper reports on the operational strategies used to facilitate the implementation of the intervention...
2018: Wellcome Open Research
S Zullino, T Simoncini
SSRIs are the first choice for the treatment of mood disorders during pregnancy and lactation. Despite the known side effects, the benefits/risks balance suggests their use. Hypertensive disorders of pregnancy (HDP) and Intrauterine growth restriction (IUGR) are the main vascular effects of these drugs, with mechanisms that involves endothelial dysfunction in feto-placental system. These data are supported by animal models, even if preliminary findings are not yet adequately supported by molecular and clinical data...
May 24, 2018: Vascular Pharmacology
Marta Montejo Fernández, Iñaki Benito Manrique, Arantza Montiel Eguía, Javier Benito Fernández
INTRODUCTION AND OBJECTIVE: Although evidence-based guidelines for acute bronchiolitis recommend primarily supportive care unnecessary treatments remain well documented. The objective of this study was to analyse a quality improvement initiative to reduce overuse of unnecessary treatments in infants with acute bronchiolitis in primary care settings. METHOD: To determine the number of unnecessary treatments we reviewed the charts corresponding to infants aged <24 months of age diagnosed with acute bronchiolitis in two Primary Care areas during two bronchiolitis seasons [October-Mars of 2015-2016 (pre-intervention period) and 2016-2017 (post-intervention period)]...
May 23, 2018: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
Sumeet K Asrani, Maria Kouznetsova, Gerald Ogola, Thomas Taylor, Andrew Masica, Brandon Pope, James Trotter, Patrick Kamath, Fasiha Kanwal
BACKGROUND & AIMS: Chronic liver disease (CLD) is a common and expensive condition, and studies of CLD-related hospitalizations have underestimated the true burden of disease. We analyzed data from a large diverse healthcare system to compare time trends in CLD-related hospitalizations with those of congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). METHODS: We collected data from a large healthcare system in Texas on hospitalizations related to CLD (n=27,783), CHF (n=60,415), and COPD (n=34,199) from January 1, 2004 through December 31, 2013...
May 23, 2018: Gastroenterology
Eva A Mistry, Stephan A Mayer, Pooja Khatri
BACKGROUND: It is unclear what factors providers take into account to determine the target blood pressure (BP) after mechanical thrombectomy (MT) in patients who had acute ischemic stroke. We aimed to understand practice patterns of post-MT BP management across institutions in the United States. METHODS: We surveyed StrokeNet institutions providing MT and post-MT care with an online questionnaire, designed to understand institutional post-MT BP management practices...
May 22, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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