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https://www.readbyqxmd.com/read/28108823/which-clinical-and-patient-factors-influence-the-national-economic-burden-of-hospital-readmissions-after-total-joint-arthroplasty
#1
Steven M Kurtz, Edmund C Lau, Kevin L Ong, Edward M Adler, Frank R Kolisek, Michael T Manley
BACKGROUND: The Affordable Care Act of 2010 advanced the economic model of bundled payments for total joint arthroplasty (TJA), in which hospitals will be financially responsible for readmissions, typically at 90 days after surgery. However, little is known about the financial burden of readmissions and what patient, clinical, and hospital factors drive readmission costs. QUESTIONS/PURPOSES: (1) What is the incidence, payer mix, and demographics of THA and TKA readmissions in the United States? (2) What patient, clinical, and hospital factors are associated with the cost of 30- and 90-day readmissions after primary THA and TKA? (3) Are there any differences in the economic burden of THA and TKA readmissions between payers? (4) What types of THA and TKA readmissions are most costly to the US hospital system? METHODS: The recently developed Nationwide Readmissions Database from the Healthcare Cost and Utilization Project (2006 hospitals from 21 states) was used to identify 719,394 primary TJAs and 62,493 90-day readmissions in the first 9 months of 2013 based on International Classification of Diseases, 9th Revision, Clinical Modification codes...
January 20, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28108581/reduced-emergency-department-utilization-by-patients-with-epilepsy-using-qi-methodology
#2
Anup D Patel, Eric G Wood, Daniel M Cohen
BACKGROUND: Epilepsy or seizure care is the most common neurologic condition that presents to an emergency department (ED) and accounts for a large number of annual cases. Our aim was to decrease seizure-related ED visits from our baseline of 17 ED visits per month per 1000 patients to 13.6 ED visits per month per 1000 patients (20%) by July 2014. METHODS: Our strategy was to develop a quality improvement (QI) project utilizing the Institute for Healthcare Improvement model...
January 20, 2017: Pediatrics
https://www.readbyqxmd.com/read/28107227/structural-level-differences-in-the-mother-to-child-hiv-transmission-rate-in-south-africa-a-multilevel-assessment-of-individual-health-facility-and-provincial-level-predictors-of-infant-hiv-transmission
#3
S Woldesenbet, D J Jackson, C J Lombard, T H Dinh, V Ramokolo, T Doherty, G G Sherman, Y Pillay, A E Goga
OBJECTIVES: In 2010, South Africa reported an early mother to child transmission (MTCT) rate of 3.5% at 4-8 weeks postpartum. Provincial early MTCT rates ranged from 1.4% (95% confidence interval [CI]: 0.1-3.4%) to 5.9% (95% CI: 3.8-8.0%). We sought to determine reasons for these geographic differences in MTCT rates. METHODS: This study employed multilevel modelling using 2010 South African PMTCT evaluation (SAPMTCTE) data from 530 facilities. Interview data and infant blood samples were collected from 3085 mother-infant pairs at 4-8 weeks postpartum...
January 18, 2017: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/28107108/testing-a-model-of-sodium-reduction-in-hypertensive-older-thai-adults
#4
Pratsani Srikan, Bonnie Callen, Kenneth Phillips, Abbas Tavakoli, Ralph Brockett, Somchit Hanucharurnkul, Lora Beebe
Hypertensive older adults will benefit if there is a clear understanding of the factors related to sodium reduction. That would raise awareness of the causes, consequently reducing many health risks, lowering health care costs, and diminishing economic and social burden from high blood pressure. This study explored predictors of urinary sodium excretion. A cross-sectional, correlational study was conducted in 312 hypertensive older Thai adults. Questionnaires related to knowledge, self-care agency, self-care behavior of sodium reduction, and 24-hour urinary sodium analyses were used, followed by the application of structural equation modeling and the Analysis of Moment Structures program...
January 20, 2017: Journal of Nutrition in Gerontology and Geriatrics
https://www.readbyqxmd.com/read/28107090/cost-effectiveness-analysis-in-the-spanish-setting-of-the-peak-trial-of-panitumumab-plus-mfolfox6-compared-with-bevacizumab-plus-mfolfox6-for-first-line-treatment-of-patients-with-wild-type-ras-metastatic-colorectal-cancer
#5
Fernando Rivera, Manuel Valladares, Salvador Gea, Noemí López-Martínez
OBJECTIVE: To assess the cost-effectiveness of panitumumab in combination with mFOLFOX6 (oxaliplatin, 5-fluorouracil and leucovorin) versus bevacizumab in combination with mFOLFOX6 as first-line treatment of patients with wild-type RAS metastatic colorectal cancer (mCRC) in Spain. METHODS: A semi-Markov model was developed including the following health states: Progression free; Progressive disease: Treat with best supportive care; Progressive disease: Treat with subsequent active therapy; Attempted resection of metastases; Disease free after metastases resection; Progressive disease: after resection and relapse; Death...
January 20, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28106259/selection-on-parental-performance-opposes-selection-for-larger-body-mass-in-a-wild-population-of-blue-tits
#6
Caroline E Thomson, Florian Bayer, Nicholas Crouch, Samantha Farrell, Elizabeth Heap, Elizabeth Mittell, Mar Zurita-Cassinello, Jarrod D Hadfield
There is abundant evidence in many taxa for positive directional selection on body size, and yet little evidence for microevolutionary change. In many species, variation in body size is partly determined by the actions of parents, so a proposed explanation for stasis is the presence of a negative genetic correlation between direct and parental effects. Consequently, selecting genes for increased body size would result in a correlated decline in parental effects, reducing body size in the following generation...
January 20, 2017: Evolution; International Journal of Organic Evolution
https://www.readbyqxmd.com/read/28105878/understanding-performance-management-in-primary-care
#7
Lisa Rogan, Ruth Boaden
Purpose Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care. Design/methodology/approach Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management...
February 13, 2017: International Journal of Health Care Quality Assurance
https://www.readbyqxmd.com/read/28105519/translating-hba1c-measurements-into-estimated-average-glucose-values-in-pregnant-women-with-diabetes
#8
Graham R Law, Mark S Gilthorpe, Anna L Secher, Rosemary Temple, Rudolf Bilous, Elisabeth R Mathiesen, Helen R Murphy, Eleanor M Scott
AIMS/HYPOTHESIS: This study aimed to examine the relationship between average glucose levels, assessed by continuous glucose monitoring (CGM), and HbA1c levels in pregnant women with diabetes to determine whether calculations of standard estimated average glucose (eAG) levels from HbA1c measurements are applicable to pregnant women with diabetes. METHODS: CGM data from 117 pregnant women (89 women with type 1 diabetes; 28 women with type 2 diabetes) were analysed...
January 19, 2017: Diabetologia
https://www.readbyqxmd.com/read/28104698/periconceptional-maternal-one-carbon-biomarkers-are-associated-with-embryonic-development-according-to-the-carnegie-stages
#9
F Parisi, M Rousian, A H J Koning, S P Willemsen, I Cetin, R P M Steegers-Theunissen
STUDY QUESTION: Is periconceptional maternal one-carbon (I-C) metabolism associated with embryonic morphological development in non-malformed ongoing pregnancies? SUMMARY ANSWER: Serum vitamin B12, red blood cell (RBC) folate and plasma total homocysteine (tHcy) are associated with embryonic development according to the Carnegie stages. WHAT IS KNOWN ALREADY: Derangements in maternal I-C metabolism affect reproductive and pregnancy outcomes, as well as future health of the offspring...
January 18, 2017: Human Reproduction
https://www.readbyqxmd.com/read/28104551/a-framework-for-analysis-of-linear-ultrasound-videos-to-detect-fetal-presentation-and-heartbeat
#10
M A Maraci, C P Bridge, R Napolitano, A Papageorghiou, J A Noble
Confirmation of pregnancy viability (presence of fetal cardiac activity) and diagnosis of fetal presentation (head or buttock in the maternal pelvis) are the first essential components of ultrasound assessment in obstetrics. The former is useful in assessing the presence of an on-going pregnancy and the latter is essential for labour management. We propose an automated framework for detection of fetal presentation and heartbeat from a predefined free-hand ultrasound sweep of the maternal abdomen. Our method exploits the presence of key anatomical sonographic image patterns in carefully designed scanning protocols to develop, for the first time, an automated framework allowing novice sonographers to detect fetal breech presentation and heartbeat from an ultrasound sweep...
January 10, 2017: Medical Image Analysis
https://www.readbyqxmd.com/read/28103923/risk-adjustment-methods-for-all-payer-comparative-performance-reporting-in-vermont
#11
Karl Finison, MaryKate Mohlman, Craig Jones, Melanie Pinette, David Jorgenson, Amy Kinner, Tim Tremblay, Daniel Gottlieb
BACKGROUND: As the emphasis in health reform shifts to value-based payments, especially through multi-payer initiatives supported by the U.S. Center for Medicare & Medicaid Innovation, and with the increasing availability of statewide all-payer claims databases, the need for an all-payer, "whole-population" approach to facilitate the reporting of utilization, cost, and quality measures has grown. However, given the disparities between the different populations served by Medicare, Medicaid, and commercial payers, risk-adjustment methods for addressing these differences in a single measure have been a challenge...
January 19, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28103824/management-prognosis-and-predictors-of-unfavourable-outcomes-in-patients-newly-hospitalized-for-transient-ischemic-attack-a-real-world-investigation-from-italy
#12
Giovanni Corrao, Federico Rea, Luca Merlino, Paolo Mazzola, Federico Annoni, Giorgio Annoni
BACKGROUND: Understanding the gap between evidence-based recommendations and real-world management is important to inform priority setting and health service planning. METHODS: The 7,776 residents in the Italian Lombardy Region who were newly hospitalized for transient ischemic attack (TIA) during 2008-2009 entered into the cohort and were followed until 2012. Exposure to medical care including selected drugs, diagnostic procedures and laboratory tests was recorded...
January 19, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28103822/emergency-obstetric-and-neonatal-care-availability-use-and-quality-a-cross-sectional-study-in-the-city-of-lubumbashi-democratic-republic-of-the-congo-2011
#13
Abel Mukengeshayi Ntambue, Françoise Kaj Malonga, Karen D Cowgill, Michèle Dramaix-Wilmet, Philippe Donnen
BACKGROUND: While emergency obstetric and neonatal care (EmONC) is a proxy indicator for monitoring maternal and perinatal mortalities, in Democratic Republic of the Congo (DRC), data on this care is rarely available. In the city of Lubumbashi, the second largest in DRC with an estimated population of 1.5 million, the availability, use and quality of EmONC are not known. This study aimed to assess these elements in Lubumbashi. METHODS: This cross-sectional survey was conducted in April and May 2011...
January 19, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28103300/expression-profiling-of-ribosome-biogenesis-factors-reveals-nucleolin-as-a-novel-potential-marker-to-predict-outcome-in-aml-patients
#14
Virginie Marcel, Frédéric Catez, Caroline M Berger, Emeline Perrial, Adriana Plesa, Xavier Thomas, Eve Mattei, Sandrine Hayette, Pierre Saintigny, Philippe Bouvet, Jean-Jacques Diaz, Charles Dumontet
Acute myeloid leukemia (AML) is a heterogeneous disease. Prognosis is mainly influenced by patient age at diagnosis and cytogenetic alterations, two of the main factors currently used in AML patient risk stratification. However, additional criteria are required to improve the current risk classification and better adapt patient care. In neoplastic cells, ribosome biogenesis is increased to sustain the high proliferation rate and ribosome composition is altered to modulate specific gene expression driving tumorigenesis...
2017: PloS One
https://www.readbyqxmd.com/read/28103210/inpatient-hospitalization-costs-associated-with-birth-defects-among-persons-of-all-ages-united-states-2013
#15
Annelise C Arth, Sarah C Tinker, Regina M Simeone, Elizabeth C Ailes, Janet D Cragan, Scott D Grosse
In the United States, major structural or genetic birth defects affect approximately 3% of live births (1) and are responsible for 20% of infant deaths (2). Birth defects can affect persons across their lifespan and are the cause of significant lifelong disabilities. CDC used the Healthcare Cost and Utilization Project (HCUP) 2013 National Inpatient Sample (NIS), a 20% stratified sample of discharges from nonfederal community hospitals, to estimate the annual cost of birth defect-associated hospitalizations in the United States, both for persons of all ages and by age group...
January 20, 2017: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/28103182/trends-in-non-fatal-agricultural-injury-in-maine-and-new-hampshire-results-from-a-low-cost-passive-surveillance-system
#16
Erika Scott, Erin Bell, Liane Hirabayashi, Nicole Krupa, Paul Jenkins
: Agriculture is a dangerous industry, and although data on fatal injuries exists, less is known about non-fatal injuries. OBJECTIVES: The purpose of this study is to describe trends in agricultural morbidity in Maine and New Hampshire from 2008-2010 using a newly established passive surveillance system. This passive system is supplied by injury cases gathered from pre-hospital care reports and hospital data. METHODS: Demographics and specifics of the event were recorded for each incident case...
January 19, 2017: Journal of Agromedicine
https://www.readbyqxmd.com/read/28102928/reduction-in-colposcopy-workload-and-associated-clinical-activity-following-hpv-catch-up-vaccination-programme-in-scotland-an-ecological-study
#17
M E Cruickshank, J Pan, S C Cotton, K Kavanagh, C Robertson, K Cuschieri, H Cubie, T Palmer, K G Pollock
OBJECTIVE: To measure patterns of clinical activity at colposcopy before and after vaccinated women entered the Scottish Cervical Screening Programme (SCSP). DESIGN: Population-based observational study using nationally collected data. SETTING: Scottish colposcopy clinics. SAMPLE: All women with a date of birth on or after 1 January 1985 who attended colposcopy in Scotland between 2008-2014. METHODS: Routinely collected data from the Scottish National Colposcopy Clinical Information Audit System (NCCIAS) was extracted, including: referral criteria, referral cervical cytology, colposcopic findings, clinical procedures and histology results...
January 19, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28102790/an-adaptable-instrument-and-method-for-exploring-care-and-compassion
#18
Roger Newham, Louise Terry
Background Narratives, particularly when visual and auditory elements are added to words, reveal more about cultures and behaviours, including those present in professional and service settings. Discourse analysis (DA) enables researchers to explicate meanings and understandings linking culture and behaviour. Aim To explain the development of a DA instrument and method for a research study of caring and compassion as expressed in different media. Discussion The DA instrument assisted in systematic and multi-modal data analysis by several researchers from different countries and backgrounds...
January 23, 2017: Nurse Researcher
https://www.readbyqxmd.com/read/28101897/missed-nursing-care-as-an-art-form-the-contradictions-of-nurses-as-carers
#19
Clare Harvey, Shona Thompson, Maria Pearson, Eileen Willis, Luisa Toffoli
This article draws on the free-text commentaries from trans-Tasman studies that used the MISSCARE questionnaire to explore the reasons why nurses miss care. In this paper, we examine the idea that nurses perpetuate a self-effacing approach to care, at the expense of patient care and professional accountability, using what they describe as the art of nursing to frame their claims of both nursing care and missed nursing care. We use historical dialogue alongside a paradigmatic analysis to examine why nurses allow themselves to continue working within settings that put their professional/personal selves aside in an attempt to deliver care within constraints that make completing care an impossible task...
January 18, 2017: Nursing Inquiry
https://www.readbyqxmd.com/read/28101043/effects-of-disseminated-mycobacterial-infection-on-age-related-macular-degeneration
#20
Geoffrey Collett, Natalia Lopez, Pedro F Lopez
Our patient, in the 7th decade of life, presented with worsening blurry vision over 3 weeks. The pertinent history included nonexudative age-related macular degeneration, recent pulmonary mycobacterial infection, and autoimmune pancreatitis. The patient had decreased visual acuity in both eyes; the remaining findings of our examination were relatively benign. The diagnosis of bilateral exudative age-related macular degeneration was aided by ocular imaging. Not only were exudative changes confirmed, but one modality suggested an underlying occult choroiditis, which presumably fueled a local inflammatory drive leading to evolution of the disease...
September 2016: Case Reports in Ophthalmology
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