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https://www.readbyqxmd.com/read/29452440/operative-time-and-flap-failure-in-unilateral-and-bilateral-free-flap-breast-reconstruction
#1
Alvin C Kwok, Kyle Edwards, Daniel P Donato, Eric Tatro, Yizhe Xu, Angela P Presson, Jayant P Agarwal
BACKGROUND: There is an increasing trend toward bilateral breast reconstruction. Using the National Surgical Quality Improvement Program (NSQIP) database, we sought to understand the association between unilateral and bilateral free flap breast reconstruction and operative time and flap failure. METHODS: We selected a cohort of patients undergoing free flap breast reconstruction using the 2005 to 2010 NSQIP database. Cases were divided into unilateral and bilateral reconstruction...
February 16, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29450524/effect-of-a-quality-improvement-intervention-on-clinical-outcomes-in-patients-in-india-with-acute-myocardial-infarction-the-acs-quik-randomized-clinical-trial
#2
Mark D Huffman, Padinhare P Mohanan, Raji Devarajan, Abigail S Baldridge, Dimple Kondal, Lihui Zhao, Mumtaj Ali, Mangalath N Krishnan, Syam Natesan, Rajesh Gopinath, Sunitha Viswanathan, Joseph Stigi, Johny Joseph, Somanathan Chozhakkat, Donald M Lloyd-Jones, Dorairaj Prabhakaran
Importance: Wide heterogeneity exists in acute myocardial infarction treatment and outcomes in India. Objective: To evaluate the effect of a locally adapted quality improvement tool kit on clinical outcomes and process measures in Kerala, a southern Indian state. Design, Setting, and Participants: Cluster randomized, stepped-wedge clinical trial conducted between November 10, 2014, and November 9, 2016, in 63 hospitals in Kerala, India, with a last date of follow-up of December 31, 2016...
February 13, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29449297/delivering-safe-and-effective-test-result-communication-management-and-follow-up-a-mixed-methods-study-protocol
#3
Maria R Dahm, Andrew Georgiou, Johanna I Westbrook, David Greenfield, Andrea R Horvath, Denis Wakefield, Ling Li, Ken Hillman, Patrick Bolton, Anthony Brown, Graham Jones, Robert Herkes, Robert Lindeman, Michael Legg, Meredith Makeham, Daniel Moses, Dauda Badmus, Craig Campbell, Rae-Anne Hardie, Julie Li, Euan McCaughey, Gorkem Sezgin, Judith Thomas, Nasir Wabe
INTRODUCTION: The failure to follow-up pathology and medical imaging test results poses patient-safety risks which threaten the effectiveness, quality and safety of patient care. The objective of this project is to: (1) improve the effectiveness and safety of test-result management through the establishment of clear governance processes of communication, responsibility and accountability; (2) harness health information technology (IT) to inform and monitor test-result management; (3) enhance the contribution of consumers to the establishment of safe and effective test-result management systems...
February 15, 2018: BMJ Open
https://www.readbyqxmd.com/read/29448818/managing-in-hospital-quality-improvement-an-importance-performance-analysis-to-set-priorities-for-st-elevation-myocardial-infarction-care
#4
Daan Aeyels, Deborah Seys, Peter R Sinnaeve, Marc J Claeys, Sofie Gevaert, Danny Schoors, Walter Sermeus, Massimiliano Panella, Luk Bruyneel, Kris Vanhaecht
BACKGROUND: A focus on specific priorities increases the success rate of quality improvement efforts for broad and complex-care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes ST-elevation myocardial infarction care relevant to consider for importance-performance analysis. AIMS: The purpose of this study was to identify quality improvement priorities in ST-elevation myocardial infarction care...
February 1, 2018: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/29447822/are-validated-patient-reported-outcomes-used-on-children-in-pediatric-otolaryngology-a-systematic-review
#5
Kevin Wong, Jacquelyn Piraquive, Chelsea A Troiano, Anita Sulibhavi, Kenneth M Grundfast, Jessica R Levi
OBJECTIVES: Review the pediatric otolaryngology literature to 1) identify studies in which children completed patient-reported outcome (PRO) measures and 2) appraise the psychometric quality and validity of these PROs as they apply to pediatrics. METHODS: In October 2016, a systematic review was performed by two reviewers on PubMed/MEDLINE and EMBASE for all otolaryngology-related studies that utilized PROs in children. Inclusion criteria included articles that required children (age<18) to complete PROs...
February 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29447405/the-representation-of-vulnerable-populations-in-quality-improvement-studies
#6
Asaph Rolnitsky, Maksim Kirtsman, Hanna R Goldberg, Michael Dunn, Chaim M Bell
Purpose: A mapping review to quantify representation of vulnerable populations, who suffer from disparity and often inequitable healthcare, in quality improvement (QI) research. Data sources: Studies published in 2004-2014 inclusive from Medline, Embase and Cochrane databases for English language research with the terms 'quality improvement' or 'quality control' or 'QI' and 'plan-do-study-act' or 'PDSA' in the years 2004-2014 inclusively. Study selection: Published clinical research that was a QI-themed, as identified by its declared search terms, MESH terms, abstract or title...
February 13, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29447402/intraoperative-endotracheal-cuff-pressure-study-how-education-and-availability-of-manometers-help-guide-safer-pressures
#7
Gregory J Stevens, Joel W Warfel, James K Aden, Scott D Blackwell
Introduction: Endotracheal intubation is a medical procedure that is often indicated in both the perioperative and critical care environments. Cuffed endotracheal tubes (ETT) allow for safer and more efficient delivery of positive pressure ventilation, as well as create a barrier to reduce the risk of micro-aspiration and anesthetic pollution in the operating room environment. Over-inflation of the endotracheal cuff can lead to serious and harmful sequelae. This study aimed to assess if departmental education paired with ready access to a manometer to assess cuff pressure would result in an improvement in the proportion of ETT cuff pressures in the goal range...
February 13, 2018: Military Medicine
https://www.readbyqxmd.com/read/29447364/salzburg-global-seminar-session-565-better-health-care-how-do-we-learn-about-improvement
#8
M Rashad Massoud, Leighann E Kimble, Don Goldmann, John Ovretveit, Nancy Dixon
A fundamental question for the field of healthcare improvement is the extent to which the results achieved can be attributed to the changes that were implemented and whether or not these changes are generalizable. Answering these questions is particularly challenging because the healthcare context is complex, and the interventions themselves tend to be complex and multi-dimensional. The Salzburg Global Seminar Session 565-'Better Health Care: How do we learn about improvement?' was convened to address questions of attribution, generalizability and rigor, and to think through how to approach these concerns in the field of quality improvement...
February 13, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29447351/research-versus-practice-in-quality-improvement-understanding-how-we-can-bridge-the-gap
#9
Lisa R Hirschhorn, Rohit Ramaswamy, Mahesh Devnani, Abraham Wandersman, Lisa A Simpson, Ezequiel Garcia-Elorrio
The gap between implementers and researchers of quality improvement (QI) has hampered the degree and speed of change needed to reduce avoidable suffering and harm in health care. Underlying causes of this gap include differences in goals and incentives, preferred methodologies, level and types of evidence prioritized and targeted audiences. The Salzburg Global Seminar on 'Better Health Care: How do we learn about improvement?' brought together researchers, policy makers, funders, implementers, evaluators from low-, middle- and high-income countries to explore how to increase the impact of QI...
February 13, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29447071/a-social-media-intervention-to-improve-hypoglycaemia-management-at-a-multi-centre-hospital-a-quality-improvement-pilot-for-clinical-nurses
#10
Filomena De Sousa, Jennifer Jackson, Ruth Knight, Edith Cloutier, Rosemary Basa, Anne Fourney, Kathleen Devecseri
BACKGROUND: Hypoglycaemia is associated with increased mortality, length of stay, readmission and adverse events. Nursing management of hypoglycaemia is a challenge, despite established best practice guidelines. Social media is an effective tool for sharing information, and had potential to overcome barriers to clinical education at a multi-centre hospital. AIMS: The purpose of this quality improvement intervention was to create and disseminate social media posts about best practices in hypoglycaemia management...
February 15, 2018: Contemporary Nurse
https://www.readbyqxmd.com/read/29446500/building-the-foundation-to-generate-a-fundamental-care-standardized-data-set
#11
Lianne Jeffs, Åsa Muntlin Athlin, Jack Needleman, Debra Jackson, Alison Kitson
Considerable transformation is occurring in healthcare globally with organizations focusing on achieving the quadruple aim of improving the experience of care, the health of populations, and the experience of providing care while reducing per capita costs of health care. In response, health care organizations are employing performance measurement and quality improvement methods to achieve the quadruple aim. Despite the plethora of measures available to health managers, there is no standardized data set and virtually no indicators reflecting how patients actually experience the delivery of fundamental care, such as nutrition, hydration, mobility, respect, education, and psychosocial support...
February 15, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29446244/systematic-review-of-the-use-of-statistical-process-control-methods-to-measure-the-success-of-pressure-ulcer-prevention
#12
Michael Clark, Trudie Young, Maureen Fallon
Successful prevention of pressure ulcers is the end product of a complex series of care processes including, but not limited to, the assessment of vulnerability to pressure damage; skin assessment and care; nutritional support; repositioning; and the use of beds, mattresses, and cushions to manage mechanical loads on the skin and soft tissues. The purpose of this review was to examine where and how Statistical Process Control (SPC) measures have been used to assess the success of quality improvement initiatives intended to improve pressure ulcer prevention...
February 15, 2018: International Wound Journal
https://www.readbyqxmd.com/read/29444853/interprofessional-teamwork-innovation-model-itim-to-promote-communication-and-patient-centred-coordinated-care
#13
Jing Li, Preetham Talari, Andrew Kelly, Barbara Latham, Sherri Dotson, Kim Manning, Lisa Thornsberry, Colleen Swartz, Mark V Williams
BACKGROUND: Despite recommendations and the need to accelerate redesign of delivery models to be team-based and patient-centred, professional silos and cultural and structural barriers that inhibit working together and communicating effectively still predominate in the hospital setting. Aiming to improve team-based rounding, we developed, implemented and evaluated the Interprofessional Teamwork Innovation Model (ITIM). METHODS: This quality improvement (QI) study was conducted at an academic medical centre...
February 14, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29444816/quality-improvement-effort-to-reduce-hypothermia-among-high-risk-infants-on-a-mother-infant-unit
#14
Christine Andrews, Colleen Whatley, Meaghan Smith, Emily Caron Brayton, Suzanne Simone, Alison Volpe Holmes
BACKGROUND AND OBJECTIVE: Neonatal hypothermia is common in low birth weight (LBW) (<2500 g) and late-preterm infants (LPIs) (34 0/7-36 6/7 weeks' gestation). It can be a contributory factor for newborn admission to a NICU, resulting in maternal-infant separation and increased resource use. Our objective was to study the efficacy of a quality-improvement bundle of hypothermia preventive measures for LPIs and/or LBW infants in a mother-infant unit. METHODS: We conducted plan-do-study-act (PDSA) cycles aimed at decreasing environmental hypothermia for LPIs and/or LBW infants in a mother-infant unit with no other indications for NICU-level care...
February 14, 2018: Pediatrics
https://www.readbyqxmd.com/read/29444781/do-quality-improvement-initiatives-for-diabetes-care-address-social-inequities-secondary-analysis-of-a-systematic-review
#15
Jacquie Boyang Lu, Kristin J Danko, Michael D Elfassy, Vivian Welch, Jeremy M Grimshaw, Noah M Ivers
BACKGROUND: Socially disadvantaged populations carry a disproportionate burden of diabetes-related morbidity and mortality. There is an emerging interest in quality improvement (QI) strategies in the care of patients with diabetes, however, the effect of these interventions on disadvantaged groups remains unclear. OBJECTIVE: This is a secondary analysis of a systematic review that seeks to examine the extent of equity considerations in diabetes QI studies, specifically quantifying the proportion of studies that target interventions toward disadvantaged populations and conduct analyses on the impact of interventions on disadvantaged groups...
February 14, 2018: BMJ Open
https://www.readbyqxmd.com/read/29444733/medically-attended-catheter-complications-are-common-in-patients-with-outpatient-central-venous-catheters
#16
Steven S Spires, Peter F Rebeiro, Mickie Miller, Katie Koss, Patty W Wright, Thomas R Talbot
OBJECTIVE Outpatient central venous catheters (CVCs) are being used more frequently; however, data describing mechanical complications and central-line-associated bloodstream infections (CLABSI) in the outpatient setting are limited. We performed a retrospective observational cohort study to understand the burden of these complications to elucidate their impact on the healthcare system. METHODS Data were retrospectively collected on patients discharged from Vanderbilt University Medical Center with a CVC in place and admitted into the care of Vanderbilt Home Care Services...
February 15, 2018: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/29444671/tailoring-an-educational-program-on-the-ahrq-patient-safety-indicators-to-meet-stakeholder-needs-lessons-learned-in-the-va
#17
Marlena H Shin, Peter E Rivard, Michael Shwartz, Ann Borzecki, Enzo Yaksic, Kelly Stolzmann, Lisa Zubkoff, Amy K Rosen
BACKGROUND: Given that patient safety measures are increasingly used for public reporting and pay-for performance, it is important for stakeholders to understand how to use these measures for improvement. The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) are one particularly visible set of measures that are now used primarily for public reporting and pay-for-performance among both private sector and Veterans Health Administration (VA) hospitals. This trend generates a strong need for stakeholders to understand how to interpret and use the PSIs for quality improvement (QI)...
February 14, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29443863/trauma-induced-insurance-instability-variation-in-insurance-coverage-for-patients-who-experience-readmission-after-injury
#18
Charlotte M Rajasingh, Thomas G Weiser, Lisa M Knowlton, Lakshika Tennakoon, David A Spain, Kristan L Staudenmayer
INTRODUCTION: Traumatic injuries result in a significant disruption to patients' lives, including their ability to work, which may place patients at risk of losing insurance coverage. Our objective was to evaluate the impact of injury on insurance status. We hypothesized that trauma patients with ongoing health needs experience changes in coverage. METHODS: We used the Nationwide Readmission Database (2013-2014), a nationally representative sample of readmissions in the United States...
February 13, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29443839/how-common-and-how-serious-is-clostridium-difficile-colitis-after-geriatric-hip-fracture-findings-from-the-nsqip-dataset
#19
Patawut Bovonratwet, Daniel D Bohl, Glenn S Russo, Nathaniel T Ondeck, Denis Nam, Craig J Della Valle, Jonathan N Grauer
BACKGROUND: Patients with geriatric hip fractures may be at increased risk for postoperative Clostridium difficile colitis, which can cause severe morbidity and can influence hospital quality metrics. However, to our knowledge, no large database study has calculated the incidence of, factors associated with, and effect of C. difficile colitis on geriatric patients undergoing hip fracture surgery. QUESTIONS/PURPOSES: To use a large national database with in-hospital and postdischarge data (National Surgical Quality Improvement Program [NSQIP®]) to (1) determine the incidence and timing of C...
March 2018: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/29443725/pediatric-anesthesia-after-the-anaesthesia-practice-in-children-observational-trial-study-who-should-do-it
#20
Walid Habre
PURPOSE OF REVIEW: This review highlights the requirements for harmonization of training, certification and continuous professional development and discusses the implications for anesthesia management of children in Europe. RECENT FINDINGS: A large prospective cohort study, Anaesthesia PRactice In Children Observational Trial (APRICOT), revealed a high incidence of perioperative severe critical events and a large variability of anesthesia practice across 33 European countries...
February 12, 2018: Current Opinion in Anaesthesiology
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