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https://www.readbyqxmd.com/read/27906733/routine-inpatient-human-immunodeficiency-virus-screening-missed-prevention-opportunities
#1
Daniel C Baker
PURPOSE/OBJECTIVES: This article reviews the current guidelines for human immunodeficiency virus (HIV) screening among inpatients and explores adherence to the guidelines and barriers to their implementation. BACKGROUND: In 2006, the Centers for Disease Control and Prevention released updated recommendations suggesting HIV screening for all patients in all healthcare settings. DESCRIPTION: A nonsystematic review of current HIV screening guidelines, as well as research and nonresearch literature, addressing rates of inpatient screening was performed...
January 2017: Clinical Nurse Specialist CNS
https://www.readbyqxmd.com/read/27906601/association-between-pre-operative-cefazolin-dose-and-surgical-site-infection-in-obese-patients
#2
William J Peppard, David G Eberle, Nathan W Kugler, Danielle M Mabrey, John A Weigelt
BACKGROUND: A fixed dose of cefazolin results in serum concentrations that decrease as body mass increases. Current national guidelines suggest a pre-operative cefazolin dose of two grams may be insufficient for patients ≥120 kg; thus a three gram dose is recommended. These recommendations, however, are based on pharmacokinetic rather than outcome data. We evaluate the efficacy of pre-operative cefazolin two gram and three gram doses as measured by the rate of surgical site infection (SSI)...
December 1, 2016: Surgical Infections
https://www.readbyqxmd.com/read/27904816/an-unusual-presentation-of-nocardiosis-in-an-allogeneic-transplant-recipient
#3
Uroosa Ibrahim, Amina Saqib, Farhan Mohammad, Terenig Terjanian
Nocardiosis is a rare cause of opportunistic infection post hematopoietic stem cell transplant (HSCT) occurring in about 0.3% of patients. The risk factors include delayed immune reconstitution, prolonged neutropenia, and graft-versus-host disease. The most common site of infection is the lung, followed by the brain and the skin. Concomitant pulmonary and central nervous system (CNS) nocardiosis is an extremely rare entity as presented in our case. We present the case of a 72-year-old male at 137 days post transplant presenting with complaints of headache and slurred speech...
October 17, 2016: Curēus
https://www.readbyqxmd.com/read/27901635/relational-principles-in-the-care-of-suicidal-inpatients-experiences-of-therapists-and-mental-health-nurses
#4
Julia Hagen, Heidi Hjelmeland, Birthe Loa Knizek
This study explored and compared therapists' and mental health nurses' experiences of caring for suicidal inpatients in light of ethics of care and ethics of justice. Analysis of interview data from eight therapists and eight mental health nurses indicates two approaches: "connection and care" and "duty and control," reflecting aspects of both ethical perspectives. There are some differences between the two professional groups, and sometimes there might be conflicts between the two approaches and ethical perspectives...
November 30, 2016: Issues in Mental Health Nursing
https://www.readbyqxmd.com/read/27899520/is-adherence-to-the-american-college-of-chest-physicians-recommended-anticoagulation-treatment-duration-associated-with-different-outcomes-among-patients-with-venous-thromboembolism
#5
Alex C Spyropoulos, Ron Preblick, Winghan J Kwong, Melissa Lingohr-Smith, Jay Lin
Clinical and economic outcomes associated with venous thromboembolism (VTE) patient adherence to the American College of Chest Physicians (ACCP) anticoagulant (AC) treatment guidelines are incompletely understood. Patients with ≥1 inpatient or ≥2 separate outpatient claims for deep vein thrombosis and/or pulmonary embolism, based on International Classification of Diseases, Ninth Revision, Clinical Modification codes, were identified from the IMS PharMetrics Plus database. Patients had continuous insurance coverage for 12 months before (baseline) and after (follow-up) the index event (first VTE claim) but no baseline VTE claims...
November 28, 2016: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/27896444/is-all-hypoglycaemia-treated-as-equal-an-observational-study-of-how-the-type-of-diabetes-and-treatment-prescribed-prior-to-admission-influences-quality-of-treatment-of-inpatient-hypoglycaemia
#6
Gregory C Jones, Jansher Khan, Christopher A R Sainsbury
AIMS: Inpatient hypoglycaemia is common and associated with adverse outcomes. There is often increased vigilance of hypoglycaemia in inpatients with type 1 diabetes (T1DM) compared to type 2 diabetes (T2DM). We aimed to investigate this apparent discrepancy, utilising the time to repeat (TTR) capillary blood glucose (CBG) measurement as a surrogate for engagement with guidelines stating that CBG should be rechecked following intervention within 15 min of an initial CBG of <4 mmol/L...
November 28, 2016: Acta Diabetologica
https://www.readbyqxmd.com/read/27894036/efficacy-of-an-adjunctive-brief-psychodynamic-psychotherapy-to-usual-inpatient-treatment-of-depression-results-of-a-randomized-controlled-trial
#7
Yves de Roten, Gilles Ambresin, Fabrice Herrera, Sylfa Fassassi, Nicolas Fournier, Martin Preisig, Jean-Nicolas Despland
BACKGROUND: For severe and chronic depression, inpatient treatment may be necessary. Current guidelines recommend combined psychological and pharmacological treatments for moderate to severe depression. Results for positive effects of combined treatment for depressed inpatients are still ambiguous. METHODS: This randomised controlled trial examined the efficacy of adding an intensive and brief psychodynamic psychotherapy (IBPP) to treatment-as-usual (TAU) for inpatients with DSM-IV major depressive episode...
November 17, 2016: Journal of Affective Disorders
https://www.readbyqxmd.com/read/27893528/management-of-older-inpatients-who-refuse-nonpsychiatric-medication-within-birmingham-and-solihull-mental-health-nhs-foundation-trust-audit
#8
Eno Umotong
The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines...
December 2016: Journal of Nervous and Mental Disease
https://www.readbyqxmd.com/read/27888429/inappropriateness-of-diagnostic-imaging-examinations-in-the-inpatient-setting-a-case-study-research
#9
Ettore Squillaci, Francesca Bolacchi, Jacopo Scaggiante, Francesca Ricci, Luca Pugliese, Alberto Bergamini, Francesco Garaci, Roberto Floris
OBJECTIVE: The purpose of our study was to audit the clinical appropriateness of the prescriptions of whole body CT (WB-CT), PET-CT and chest X-rays (CXRs) performed at Tor Vergata University Hospital in the inpatient setting. MATERIALS AND METHODS: WB-CT, PET-CT and CXRs examinations were retrospectively analysed in the period between January and December 2014. CXR examinations were divided into bedside CXRs and traditional CXRs. The appropriateness of the examinations was defined according the American College of Radiology Appropriateness Criteria...
November 25, 2016: La Radiologia Medica
https://www.readbyqxmd.com/read/27882835/health-care-costs-for-patients-with-heart-failure-escalate-nearly-3-fold-in-final-months-of-life
#10
Engels N Obi, Jason P Swindle, Stuart J Turner, Patricia A Russo, Aylin Altan
BACKGROUND: Heart failure (HF) is a severe chronic disease with growing prevalence and health care burden as well as high mortality. End-of-life cost data for patients with HF may inform disease and medication therapy management. OBJECTIVES: To (a) characterize a real-world sample of patients with HF who died; (b) estimate health care costs for 6 months and semiannually for 24 months, before death; and (c) examine associations between patient characteristics and predeath health care costs...
December 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27878822/wide-variations-in-blood-product-transfusion-practices-among-providers-who-care-for-patients-with-acute-leukemia-in-the-united-states
#11
Alexander B Pine, Eun-Ju Lee, Mikkael Sekeres, David P Steensma, Daniel Zelterman, Thomas Prebet, Amy DeZern, Rami Komrokji, Mark Litzow, Selina Luger, Richard Stone, Harry P Erba, Guillermo Garcia-Manero, Alfred I Lee, Nikolai A Podoltsev, Lisa Barbarotta, Stephanie Kasberg, Jeanne E Hendrickson, Steven D Gore, Amer M Zeidan
BACKGROUND: Transfusion of blood products is a key component of the supportive management in patients with acute leukemia (AL). However high-quality trial evidence and clinical outcome data to support specific transfusion goals for blood products for patients with AL remain limited leading to diverse transfusion practices. The primary objective of this study was to determine the spectrum of transfusion patterns in a variety of care settings among providers who treat AL patients. STUDY DESIGN AND METHODS: A 31-question survey queried providers caring for AL patients about the existence of institutional guidelines for transfusion of blood products, transfusion triggers for hemoglobin (Hb), platelets (PLTs), and fibrinogen in various settings including inpatient and outpatient and before procedures...
November 22, 2016: Transfusion
https://www.readbyqxmd.com/read/27878507/the-scope-and-value-of-an-anticoagulation-stewardship-program-at-a-community-teaching-hospital
#12
Maura K Wychowski, Christina I Ruscio, Peter A Kouides, Ronald L Sham
To report the impact of an inpatient anticoagulation stewardship program at a community hospital to promote optimal anticoagulant use. The anticoagulation team (ACT) stewardship program consists of two clinical pharmacists and hematologists to provide oversight of anticoagulants, high cost reversal agents including prothrombin complex concentrate (PCC, Kcentra™), and heparin-induced thrombocytopenia (HIT) management. Intervention data and number of charts reviewed were collected. Average cost avoidance data was applied to ACT interventions to estimate cost savings...
November 22, 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27868189/an-evaluation-of-inpatient-morbidity-and-critical-care-provision-in-zambia
#13
P J Dart, J Kinnear, M D Bould, S L Mwansa, Z Rakhda, D Snell
The aim of this study was to objectively measure demand for critical care services in a southern African tertiary referral centre. We carried out a point prevalence study of medical and surgical admissions over a 48-h period at the University Teaching Hospital, Lusaka, recording the following: age; sex; diagnosis; Human Immunodeficiency Virus (HIV) status and National Early Warning Score. One-hundred and twenty medical and surgical admissions were studied. Fifty-four patients (45%) had objective evidence of a requirement for critical care review and potential or probable admission to an intensive care unit, according to the Royal College of Physicians (UK) guidelines...
November 21, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27866915/trends-in-transcranial-doppler-monitoring-in-aneurysmal-subarachnoid-hemorrhage-a-10-year-analysis-of-the-nationwide-inpatient-sample
#14
Gyanendra Kumar, Karen C Albright, John P Donnelly, Angela Hays Shapshak, Mark R Harrigan
BACKGROUND: Transcranial Doppler (TCD) is endorsed by national guidelines for use in aneurysmal subarachnoid hemorrhage (aSAH) for surveillance of cerebral vasospasm (CV). However, nationwide data on utilization of TCD for CV detection and monitoring in aSAH are lacking. METHODS: Analysis of nationwide trends in TCD prevalence was performed using Nationwide Inpatient Sample (NIS) data from 2002 to 2011. Raw counts were converted into weighted counts, which were used to generate national estimates...
November 17, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27864202/implementation-of-inpatient-models-of-pharmacogenetics-programs
#15
Larisa H Cavallari, Craig R Lee, Julio D Duarte, Edith A Nutescu, Kristin W Weitzel, George A Stouffer, Julie A Johnson
PURPOSE: The operational elements essential for establishing an inpatient pharmacogenetic service are reviewed, and the role of the pharmacist in the provision of genotype-guided drug therapy in pharmacogenetics programs at three institutions is highlighted. SUMMARY: Pharmacists are well positioned to assume important roles in facilitating the clinical use of genetic information to optimize drug therapy given their expertise in clinical pharmacology and therapeutics...
December 1, 2016: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/27858189/ambulatory-or-inpatient-management-of-mild-tbi-in-children-a-post-concussion-analysis
#16
Danielle S Wendling-Keim, Adriana König, Hans-Georg Dietz, Markus Lehner
BACKGROUND: Diagnosis and treatment of children with mild traumatic brain injury (mTBI) remain a challenge since initial signs and symptoms do not always indicate the severity of the trauma. Therefore, guidelines regarding the decision upon imaging methods and ambulatory or hospitalized treatment are needed. The goal of our study was to investigate if the standard that was allied from the PECARN rules and is applied in this study can ensure that patients with clinically important brain injury are recognized and leads to outcomes with a low complication rate, a high patient satisfaction and minimal post-concussion syndrome incidence...
November 17, 2016: Pediatric Surgery International
https://www.readbyqxmd.com/read/27849494/inpatient-trauma-focused-treatment-for-veterans-implementation-and-evaluation-of-patient-perceptions-and-outcomes-of-an-integrated-evidence-based-treatment-approach
#17
Deleene S Menefee, Wendy S Leopoulos, Jana K Tran, Ellen Teng, Jill Wanner, Elisabeth Wilde, Stephen McCauley, Susan X Day
BACKGROUND: Practice guidelines for post-traumatic stress disorder (PTSD) treatment suggest that inpatient care may be warranted when the severity of the clinical presentation is marred with significant concerns about suicidality and psychiatric comorbidity. Yet, limited guidance exists on conducting trauma-focused treatment in acute hospital settings beyond the traditional medical or stabilization model. OBJECTIVE: The purpose of this current article is to describe and evaluate the integration of evidence-based treatments (EBTs) for PTSD implemented in two gender-specific, Veterans Affairs inpatient programs...
November 2016: Military Medicine
https://www.readbyqxmd.com/read/27837400/are-readmissions-after-tha-preventable
#18
Douglas S Weinberg, Matthew J Kraay, Steven J Fitzgerald, Vasu Sidagam, Glenn D Wera
BACKGROUND: Readmissions after total joint arthroplasty have become a key quality measure in elective surgery in the United States. The Affordable Care Act includes the Hospital Readmission Reduction Program, which calls for reduced payments to hospitals with excessive readmissions. This policy uses a method to determine excess readmission ratios and calculate readmission payment adjustments to hospitals, however, it is unclear whether readmission rates are an effective quality metric...
November 11, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27836388/plastic-in-patient-study-prospective-audit-of-adherence-to-peripheral-intravenous-cannula-monitoring-and-documentation-guidelines-with-the-aim-of-reducing-future-rates-of-intravenous-cannula-related-complications
#19
Lokesh Yagnik, Angela Graves, Ken Thong
BACKGROUND: Peripheral intravenous cannula (PIVC) insertion is a universal intervention for inpatients and is associated with multiple complications. Effective, simple, reproducible interventions specific to PIVC complication prevention are few and often extrapolated from central venous catheter complication prevention strategies. The objective of this study is to improve compliance with documentation and monitoring PIVC guidelines in the medical ward of a secondary care center. METHODS: This study is a prospective run-in audit of adherence to PIVC documentation and monitoring guidelines between the dates of August 30-November 14, 2014, with data recollection from December 25, 2014-January 30, 2015, after intervention implementation...
November 8, 2016: American Journal of Infection Control
https://www.readbyqxmd.com/read/27836235/closed-loop-insulin-delivery-in-inpatients-with-type-2-diabetes-a-randomised-parallel-group-trial
#20
Hood Thabit, Sara Hartnell, Janet M Allen, Andrea Lake, Malgorzata E Wilinska, Yue Ruan, Mark L Evans, Anthony P Coll, Roman Hovorka
BACKGROUND: We assessed whether fully closed-loop insulin delivery (the so-called artificial pancreas) is safe and effective compared with standard subcutaneous insulin therapy in patients with type 2 diabetes in the general ward. METHODS: For this single-centre, open-label, parallel-group, randomised controlled trial, we enrolled patients aged 18 years or older with type 2 diabetes who were receiving insulin therapy. Patients were recruited from general wards at Addenbrooke's Hospital, Cambridge, UK...
November 8, 2016: Lancet Diabetes & Endocrinology
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