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Rosa D, Villa G, Amigoni C, Rossetti AM, Guberti M, Ghirotto L, Manara DF. Role of emotions in the clinical decision-making process of the hospital nurse: A multicentre qualitative study. MethodsX 2024; 12:102590. [PMID: 38322133 PMCID: PMC10844854 DOI: 10.1016/j.mex.2024.102590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
Abstract
While for a long-time emotional reaction and moral distress, have been primarily investigated for the possible outcomes of the nursing decision-making process rather than in terms of their role as antecedents of the final decision taken. The primary study's aim is to explore how inpatient nurses' decision-making takes place in different care settings, with a special focus on the role played by emotions during decision-making. The secondary aim is to explore the subjective experience of hospital nurses in relation to successful and unsuccessful decision-making situations. Multicentre qualitative study, consisting of three phases with different designs: participatory study, grounded theory study, and phenomenological study. Participants will be nurses and may be doctors with various levels of professional experience working in hospital, outpatient, or ward settings. Participants will be recruited through different sampling (purposive and convenience). Data will be collected through focus groups and in-depth interviews with nurses working in different hospital care settings. The researchers expect to find themes that will contribute to a better understanding of the role of emotions in decision-making. The results of this study have the potential of providing important implications to support nurses in the recognition and management of their emotions during the decision-making process.
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Affiliation(s)
- Debora Rosa
- Center for Nursing Research and Innovation, Giulia VILLA, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Giulia VILLA, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Monica Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Giulia VILLA, Vita-Salute San Raffaele University, Milan, Italy
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Mathews CG, Stambough JB, Stronach B, Siegel ER, Barnes CL, Mears SC. Successful Transition to Same Calendar Day Discharge in Total Joint Arthroplasty at an Academic Center. Arthroplast Today 2024; 27:101354. [PMID: 38524150 PMCID: PMC10958211 DOI: 10.1016/j.artd.2024.101354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 03/26/2024] Open
Abstract
Background There has been a shift toward same-day discharge (SDD) in total joint arthroplasty (TJA) in recent years. Our clinical standard had been next-day discharge, but the COVID pandemic led to a hospital bed shortage, causing us to shift to SDD directly from the Post-Anesthesia Care Unit (PACU). The aim of our project was to investigate if the SDD protocol was successful and if it changed complications or 90-day readmission rates. Our secondary aim was to investigate if the protocol created disparities in patient selection. Methods A retrospective review compared the first 100 patients intended to discharge from PACU to the 100 patients prior to the SDD protocol undergoing elective primary TJA procedures at our academic institution from September 1, 2020, to March 23, 2021. The SDD protocol started on November 19, 2020. Results During this SDD period, 98% (98/100) of patients were successfully discharged from the PACU. The 90-day readmission rate changed from 0% to 2% (P = .4975), and the overall complication rate changed from 2% to 5% (P = .4448). Most complications were manipulation under anesthesia to improve range of motion. Manipulations under anesthesia changed from 1% to 4% (P = .3687). Conclusions The transition to same SDD in TJA at our academic institution was successfully implemented without markedly increasing complications, readmissions, or changing patient selection. The COVID-19 pandemic likely influenced the recovery of patients before and after the protocol. Future studies are needed to validate this data during the post-COVID era.
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Affiliation(s)
- Candler G. Mathews
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey B. Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eric R. Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C. Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C. Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Brouwer JMJL, Wardenaar KJ, Liemburg EJ, Doornbos B, Mulder H, Cath DC. High persistence and low treatment rates of metabolic syndrome in patients with mood and anxiety disorders: A naturalistic follow-up study. J Affect Disord 2024; 354:451-462. [PMID: 38494132 DOI: 10.1016/j.jad.2024.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/21/2024] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patients with affective and anxiety disorders are at risk of metabolic syndrome (MetS) and, consequently, cardiovascular disease and premature death. In this study, the course and treatment of MetS was investigated using longitudinal data from a naturalistic sample of affective- and anxiety-disordered outpatients (Monitoring Outcome of psychiatric PHARmacotherapy [MOPHAR]). METHODS Demographics, clinical characteristics, medication use, and MetS components were obtained for n = 2098 patients at baseline and, in a FU-subsample of n = 507 patients, after a median follow-up (FU) of 11 months. Furthermore, pharmacological treatment rates of MetS were investigated at baseline and FU. Finally, demographic and clinical determinants of change in MetS (component) scores were investigated. RESULTS At baseline, 34.6 % of n = 2098 patients had MetS, 41.4 % of whom received treatment. Of patients with persisting MetS, 46.1 % received treatment for one (or more) MetS component(s) at baseline, and 56.6 % received treatment at FU. Treatment rates of solely elevated blood pressure and reduced HDL-cholesterol did significantly, but modestly, improve. Higher age, male sex, smoking behavior, low education, diabetes, and depressive versus anxiety disorder were predictors of worse outcome at FU on at least one MetS component. LIMITATIONS We did not have data on lifestyle interventions as a form of treatment, which might partly have explained the observed low pharmacotherapeutic treatment rates. CONCLUSION MetS (components) show high persistence rates in affective- and anxiety-disordered patients, and are, despite adequate monitoring, undertreated over time. This indicates that adherence and implementation of monitoring protocols should be crucially improved in psychiatric outpatients in secondary care.
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Affiliation(s)
- Jurriaan M J L Brouwer
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands; GGZ Drenthe Mental Health Services, Assen, the Netherlands; Research School of Behavioral and Cognitive Neurosciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Klaas J Wardenaar
- GGZ Drenthe Mental Health Services, Assen, the Netherlands; Department of Psychiatry, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, Groningen, the Netherlands; Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Edith J Liemburg
- GGZ Drenthe Mental Health Services, Assen, the Netherlands; Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bennard Doornbos
- Lentis Psychiatric Institute, Lentis Research, Groningen, the Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands
| | - Danielle C Cath
- GGZ Drenthe Mental Health Services, Assen, the Netherlands; Research School of Behavioral and Cognitive Neurosciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Reddy S, Schwartzman G, Luu LA, Im G, Flowers RH, Guffey DJ. Differentiating hidradenitis suppurativa flare from infection in the emergency department and recommendations for transitioning care to the outpatient setting. Am J Emerg Med 2024; 79:58-62. [PMID: 38367431 DOI: 10.1016/j.ajem.2024.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/19/2024] Open
Abstract
Hidradenitis suppurativa is a painful and often progressive inflammatory skin condition that presents with papules, nodules, abscesses, and tunnels in the axillary, inframammary and anogenital regions. HS can be difficult to differentiate from a skin infection, such as a bacterial abscess. However, differentiation between the two is important as management of hidradenitis suppurativa often requires long-term follow-up and specialist care. Emergency physicians should be aware of how to differentiate acute hidradenitis suppurativa flares from similarly presenting conditions, particularly skin and soft tissue infection, when encountered in the emergency department and what steps should be taken to adequately bridge care to the outpatient setting.
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Affiliation(s)
- Soumya Reddy
- Department of Dermatology, University of Virginia, Charlottesville, VA, USA.
| | | | - Lydia A Luu
- Department of Dermatology, University of Virginia, Charlottesville, VA, USA
| | - Grace Im
- Department of Dermatology, University of Virginia, Charlottesville, VA, USA
| | - R Hal Flowers
- Department of Dermatology, University of Virginia, Charlottesville, VA, USA
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Poole NM, Lee BR, Kronman MP, Smith MJ, Patel SJ, Olivero R, Wattles BA, Herigon J, Wirtz A, El Feghaly RE. Ambulatory amoxicillin use for common acute respiratory infections during a national shortage: Results from the SHARPS-OP benchmarking collaborative. Am J Infect Control 2024; 52:614-617. [PMID: 38158158 DOI: 10.1016/j.ajic.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
We quantified antibiotic prescribing for ambulatory pediatric acute respiratory illness at 22 institutions in "pre-shortage" (Jan 2019-Sep 2022) and "shortage" (Oct 2022-Mar 2023) periods for amoxicillin. While acute respiratory illness prescribing increased across settings, the proportion of amoxicillin prescriptions decreased. Variation was seen within and between institutions.
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Affiliation(s)
- Nicole M Poole
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Brian R Lee
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pediatrics, University of Missouri Kansas City, Kansas City, MO
| | - Matthew P Kronman
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Michael J Smith
- Duke University Department of Pediatrics and Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC
| | - Sameer J Patel
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago IL
| | - Rosemary Olivero
- Department of Pediatric and Human Development, Michigan State College of Human Medicine; Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Bethany A Wattles
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Joshua Herigon
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pediatrics, University of Missouri Kansas City, Kansas City, MO
| | - Ann Wirtz
- Department of Pharmacy, Children's Mercy Kansas City, Kansas City, MO; Department of Pharmacy, University of Missouri Kansas City, Kansas City, MO
| | - Rana E El Feghaly
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pediatrics, University of Missouri Kansas City, Kansas City, MO.
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Tran QD. Going Beyond Waitlists in Mental Healthcare. Community Ment Health J 2024; 60:629-634. [PMID: 38324069 DOI: 10.1007/s10597-024-01233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/26/2023] [Indexed: 02/08/2024]
Abstract
Managing waitlists for outpatient mental health services particularly in community health settings is difficult to standardize, poses an administrative burden, and are barriers rather than gateways to access to care particularly for low-income communities. While telehealth has initially expanded access to mental healthcare at the onset of the COVID-19 pandemic, it has not resolved the challenges associated with the increasing demand for services and the shortage of available providers. This commentary explores the intricate interconnections between wait times, readiness for and appropriateness of therapy, and engagement in treatment. Drawing on insights from waiting line theory to question the attachment to and utility of waitlists for non-emergency, outpatient mental healthcare, this commentary questions the utility and efficacy of waitlists. Alternative solutions that capitalize on community resources and collaboration and harness patients' agency for change are discussed.
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Affiliation(s)
- Quang D Tran
- Health Equity Research Lab, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA, USA.
- Department of Counseling, Developmental, and Educational Psychology, Boston College, Chestnut Hill, MA, USA.
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Lee MY, Heo KN, Lee S, Ah YM, Shin J, Lee JY. Development and validation of a medication-based risk prediction model for acute kidney injury in older outpatients. Arch Gerontol Geriatr 2024; 120:105332. [PMID: 38382232 DOI: 10.1016/j.archger.2024.105332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/06/2024] [Accepted: 01/13/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Older adults are at an increased risk of acute kidney injury (AKI), particularly in community settings, often due to medications. Effective prevention hinges on identifying high-risk patients, yet existing models for predicting AKI risk in older outpatients are scarce, particularly those incorporating medication variables. We aimed to develop an AKI risk prediction model that included medication-related variables for older outpatients. METHODS We constructed a cohort of 2,272,257 outpatients aged ≥65 years using a national claims database. This cohort was split into a development (70%) and validation (30%) groups. Our primary goal was to identify newly diagnosed AKI within one month of cohort entry in an outpatient context. We screened 170 variables and developed a risk prediction model using logistic regression. RESULTS The final model integrated 12 variables: 2 demographic, 4 comorbid, and 6 medication-related. It showed good performance with acceptable calibration. In the validation cohort, the area under the receiver operating characteristic curve value was 0.720 (95% confidence interval, 0.692-0.748). Sensitivity and specificity were 69.9% and 61.9%, respectively. Notably, the model identified high-risk patients as having a 27-fold increased AKI risk compared with low-risk individuals. CONCLUSION We have developed a new AKI risk prediction model for older outpatients, incorporating critical medication-related variables with good discrimination. This tool may be useful in identifying and targeting patients who may require interventions to prevent AKI in an outpatient setting.
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Affiliation(s)
- Mee Yeon Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Kyu-Nam Heo
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Suhyun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
| | - Jaekyu Shin
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA, United States
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
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Foley R, Kuruvilla J. Identification of a Patient Suitable for CAR-T Cell Therapy in the Outpatient Setting: A Vodcast and Case Example. Oncol Ther 2024:10.1007/s40487-024-00272-9. [PMID: 38662113 DOI: 10.1007/s40487-024-00272-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/05/2024] [Indexed: 04/26/2024] Open
Abstract
Chimeric antigen receptor T cell (CAR-T) therapies targeting the CD19 antigen have been associated with high and durable response rates in patients with diffuse large B cell lymphoma (DLBCL). CAR-T cell therapies are commonly administered in the inpatient setting due to the average onset of cytokine release syndrome within the first 3 days post infusion, but there has been growing interest in delivering CAR-T cell therapies in the outpatient setting to overcome frequent hospital bed shortages and the high cost of inpatient care. Although this approach could improve access whilst catering to patient preference, it requires a multidisciplinary approach as well as careful patient selection. Herein, Dr. Foley and Dr. Kuruvilla discuss the case of a patient presenting with the ideal profile for CAR-T cell therapy referral whilst also determining the key attributes for eligibility from a clinician's perspective. Solutions for successful outpatient management include proper education, caregiver support, and early referral to ensure a timely infusion. In conclusion, outpatient administration of CAR-T cell therapy in patients with DLBCLs should be assessed on a case-by-case basis.A vodcast feature is available for this article.
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Affiliation(s)
- Ronan Foley
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada.
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Dubin J, Bains S, LaGreca M, Gilmor RJ, Hameed D, Nace J, Mont M, Lundy DW, Delanois RE. Assessing social disparities in inpatient vs. outpatient arthroplasty: a in-state database analysis. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03922-w. [PMID: 38625425 DOI: 10.1007/s00590-024-03922-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Given the growing emphasis on patient outcomes, including postoperative complications, in total joint arthroplasty (TJA), investigating the rise of outpatient arthroplasty is warranted. Concerns exist over the safety of discharging patients home on the same day due to increased readmission and complication rates. However, psychological benefits and lower costs provide an incentive for outpatient arthroplasty. The influence of social determinants of health disparities on outpatient arthroplasty remains unexplored. One metric that assesses social disparities, including the following individual components: socioeconomic status, household composition, minority status, and housing and transportation, is the Social Vulnerability Index (SVI). As such, we aimed to compare: (1) mean overall SVI and mean SVI for each component and (2) risk factors for total complications between patients undergoing inpatient and outpatient arthroplasty. METHODS Patients who underwent TJA between January 1, 2022 and December 31, 2022 were identified. Data were drawn from the Maryland State Inpatient Database (SID). A total of 7817 patients had TJA within this time period. Patients were divided into inpatient arthroplasty (n = 1429) and outpatient arthroplasty (n = 6338). The mean SVI was compared between inpatient and outpatient procedures for each themed score. The SVI identifies communities that may need support cause by external stresses on human health based on four themed scores: socioeconomic status; household composition and disability; minority status and language; and housing and transportation. The SVI uses the United States Census data to rank census tracts for each individual theme, as well as an overall social vulnerability score. The higher the SVI, the more social vulnerability, or resources needed to thrive in that area. Multivariate logistic regression analyses were performed to identify independent risk factors for total complications following TJA after controlling for risk factors and patient comorbidities. Total complications included: infection, aseptic loosening, dislocation, arthrofibrosis, mechanical complication, pain, and periprosthetic fracture. RESULTS Patients who had inpatient arthroplasty had higher overall SVI scores (0.45 vs. 0.42, P < 0.001). The SVI scores were higher for patients who had inpatient arthroplasty for socioeconomic status (0.36 vs. 0.32, P < 0.001), minority status and language (0.76 vs. 0.74, P < 0.001), and housing and transportation (0.53 vs. 0.50, P < 0.001) compared to outpatient arthroplasty, respectively. There was no difference between inpatient and outpatient arthroplasty for household composition and disability (0.41 vs. 0.41, P = 0.99). When controlling for comorbidities, inpatient arthroplasty [Odds Ratio (OR) 1.91, 95% Confidence Interval (CI) 1.23-2.95, P = 0.004], hypertension (OR 2.11, 95% CI 1.23-3.62, P = 0.007), and housing and transportation (OR 2.00, 95% CI 1.17-3.42, P = 0.012) were independent risk factors for total complications. CONCLUSION Inpatient arthroplasty was associated with increased social disparities across several components of deprivation as well as an independent risk factor total complications following TJA. To the best of our knowledge, this study is the first to examine the negative repercussions of inpatient arthroplasty through the lens of social disparities and can target specific areas for intervention.
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Affiliation(s)
- Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Sandeep Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Mark LaGreca
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Ruby J Gilmor
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - James Nace
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Michael Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Douglas W Lundy
- Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Ronald E Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
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López-Lacort M, Muñoz-Quiles C, Díez-Domingo J, Orrico-Sánchez A. Effectiveness of self-financed rotavirus vaccines on acute gastroenteritis primary care episodes using real-world data in Spain: a propensity score-matched analysis of cohort study. Eur J Pediatr 2024:10.1007/s00431-024-05536-0. [PMID: 38584228 DOI: 10.1007/s00431-024-05536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024]
Abstract
The objective of this study was to estimate, by a novel spatiotemporal approach in an environment of non-funded rotavirus (RV) vaccines, the RV vaccine effectiveness (VE) to prevent acute gastroenteritis primary care (AGE-PC)-attended episodes, demonstrating how indirect protection leads to underestimation of direct VE under high vaccine coverage (VC). This population-based retrospective cohort study used electronic healthcare registries including all children 2 months-5 years old, born from 2009 to 2018 in the Valencia Region (Spain). Direct RV VE preventing AGE-PC episodes was estimated using propensity score matching and Poisson regressions stratified by VC, adjusted by age and calendar season. Indirect VE was estimated by Poisson regression comparing AGE-PC rates in unvaccinated children among the different VC levels. A total of 563,442 children were included for the RV VC estimation; of them, 360,576 were included in the birth-cohort for VE analysis. RV VC showed strong variability among districts and seasons, rising on average from 21% in 2009/2010 to 55% in 2017/2018. The highest direct VE was found in vaccinated children from districts with 0-30% RV VC (16.4%) and the lowest in those from districts with ≥ 70% RV VC (9.7%). The indirect protection in unvaccinated children raised from 6 to 16.6% for those living with 20-30% and ≥ 70% VC, respectively. CONCLUSION Considering that RV is the causative agent in 20% of AGE cases, a direct effectiveness of 82% preventing AGE-PC episodes due to RV could be deduced using a novel spatiotemporal approach. A reduction of 17% of AGE-PC episodes in unvaccinated was observed in areas with VC over 70% because of indirect protection. WHAT IS KNOWN • The effectiveness of RV vaccines preventing hospitalizations due to RV-acute gastroenteritis (RV-AGE) has been extensively studied. However, RV also burdens the primary care (PC) setting, and data on vaccine effectiveness (VE) in preventing AGE-PC visits are scarce. • The RV vaccine distribution in Spain (non-funded), with large differences in vaccine coverage (VC) among healthcare districts, provides an ideal scenario to assess the actual VE in preventing AGE-PC consultations, including the direct and indirect protection. WHAT IS NEW • A direct effectiveness of 82% preventing AGE-PC episodes due to RV could be deduced using a novel spatiotemporal approach. A reduction of 17% of AGE-PC episodes in unvaccinated was observed in areas with high VC because of indirect protection. • These findings, together with existing data on the impact on hospitalizations due to RV-AGE, offer valuable insights for implementing vaccination initiatives in countries that have not yet commenced such programs.
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Affiliation(s)
- Mónica López-Lacort
- Vaccine Research Unit, Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Avda. Cataluña, 21. 46020, Valencia, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Cintia Muñoz-Quiles
- Vaccine Research Unit, Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Avda. Cataluña, 21. 46020, Valencia, Spain.
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
| | - Javier Díez-Domingo
- Vaccine Research Unit, Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Avda. Cataluña, 21. 46020, Valencia, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- Universidad Católica de Valencia San Vicente Mártir, Carrer de Quevedo, 2, 46001, Valencia, Spain
| | - Alejandro Orrico-Sánchez
- Vaccine Research Unit, Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Avda. Cataluña, 21. 46020, Valencia, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- Universidad Católica de Valencia San Vicente Mártir, Carrer de Quevedo, 2, 46001, Valencia, Spain
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Khadhouri S, Guillaumier S, Drummond L, Dreyer B, Clelland C, Jaafari FA. Feasibility of outpatient daycase local anaesthestic Rezūm™ without sedation. BMC Urol 2024; 24:80. [PMID: 38575918 PMCID: PMC10996073 DOI: 10.1186/s12894-024-01471-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Rezūm™ is a relatively new bladder outflow obstruction (BOO) procedure that uses thermal energy through water vapour to cause necrosis of prostatic tissue. The standard delivery of this treatment is in an operating theatre under a general or spinal anaesthetic, or under local anaesthetic with sedation that requires patient monitoring. METHODS We propose an outpatient daycase method of delivering Rezūm™ under local anaesthetic without sedation, using a prostatic local anaesthetic block and cold local anaesthetic gel instillation into the urethra. RESULTS Preliminary results of our first thirteen patients demonstrate the feasibility of this new technique, with a mean pain score of 2.1 out of 10 on a visual analogue scale, a successful trial without catheter in all 13 patients (one patient voided successfully on second trial), a reduction in mean International Prostate Symptom Score (IPSS) from 20.6 to 5.4, and improvement in maximum flow from 8.8 ml/s to 14.4 ml/s. The complications were minor (Clavien-Dindo less than III) and included a UTI, minor bleeding not requiring admission, and retrograde ejaculation. CONCLUSIONS We demonstrate that an outpatient local anaesthetic daycase service without sedation is feasible. This can be delivered in a clinic setting, reduce waiting times for BOO surgery, and increase availability of operating theatre for other general anaesthetic urological procedures.
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Affiliation(s)
- S Khadhouri
- NHS Fife, Kirkcaldy, Scotland, UK.
- University of St Andrews, St Andrews, Scotland, UK.
| | | | | | - B Dreyer
- NHS Fife, Kirkcaldy, Scotland, UK
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12
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In J, Chen B, Bae H, Kinjo S. Postoperative neurocognitive disorders in ambulatory surgery: a narrative review. Korean J Anesthesiol 2024:kja.23952. [PMID: 38566313 DOI: 10.4097/kja.23952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/02/2024] [Indexed: 04/04/2024] Open
Abstract
Postoperative neurocognitive disorders (PoNCDs), such as postoperative delirium and cognitive dysfunction or decline can occur after surgery, especially in older patients. This significantly affects patient morbidity and surgical outcomes. Among various risk factors, recent studies have shown that preoperative frailty is associated with developing these conditions. Although the mechanisms underlying PoNCDs remain unclear, neuroinflammation appears to play an important role in their development. For the prevention and treatment of PoNCDs, medication modification, a balanced diet, and prehabilitation and rehabilitation programs have been suggested. The risk of developing PoNCDs is thought to be lower in ambulatory patients. However, owing to technological advancements, an increasing number of older and sicker patients are undergoing more complex surgeries and are often not closely monitored after discharge. Therefore, equal attention should be paid to all patient populations. This article presents an overview of PoNCDs and highlights issues of particular interest for ambulatory surgery.
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Affiliation(s)
- Junyong In
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Brian Chen
- Rosalind Franklin University Chicago Medical School, North Chicago, United States of America
| | - Hansu Bae
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Sakura Kinjo
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, United States of America
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Grigoryan L, Trautner BW. Antibiotic Stewardship Interventions for Urinary Tract Infections in Outpatient Settings: A Narrative Review. Infect Dis Clin North Am 2024:S0891-5520(24)00008-4. [PMID: 38575491 DOI: 10.1016/j.idc.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Inappropriate antibiotic choice or duration of therapy for urinary tract infections (UTIs) in outpatients is common and is a major contributor to antibiotic overuse. Most studies on outpatient antibiotic stewardship for UTIs follow a pre-design or post-design with a multifaceted intervention; these trials generally have found improvement in appropriateness of antibiotic use for UTI. Audit and feedback was one of the most commonly employed strategies across these trials but may not be sustainable. Future research on antibiotic stewardship for UTIs in outpatients should measure both effectiveness and implementation success.
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Affiliation(s)
- Larissa Grigoryan
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston TX 77098, USA; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, IQuESt (152), 2002 Holcombe Boulevard, Houston, TX 77030, USA
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Zhao X, Pan Y, Hao J, Feng J, Cui Z, Ma H, Huang X. Development and validation of a novel scoring system based on a nomogram for predicting inadequate bowel preparation. Clin Transl Oncol 2024:10.1007/s12094-024-03443-2. [PMID: 38565812 DOI: 10.1007/s12094-024-03443-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND AIMS Adequate bowel preparation (BP) is crucial for the diagnosis of colorectal diseases. Identifying patients at risk of inadequate BP allows for targeted interventions and improved outcomes. We aimed to develop a model for predicting inadequate BP based on preparation-related factors. METHODS Adult outpatients scheduled for colonoscopy between May 2022 and October 2022 were enrolled. One set (N = 913) was used to develop and internally validate the predictive model. The primary predictive model was displayed as a nomogram and then modified into a novel scoring system, which was externally validated in an independent set (N = 177). Inadequate BP was defined as a Boston Bowel Preparedness Scale (BBPS) score of less than 2 for any colonic segment. The model was evaluated by the receiver operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA). RESULTS Independent factors included in the prediction model were stool frequency ≤ 5 (15 points), preparation-to-colonoscopy interval ≥ 5 h (15 points), incomplete dosage (100 points), non-split dose (90 points), unrestricted diet (88 points), no additional water intake (15 points), and last stool appearance as an opaque liquid (0-80 points). The training set exhibited the following performance metrics for identifying BP failure: area under the curve (AUC) of 0.818, accuracy (ACC) of 0.818, positive likelihood ratio (PLR) of 2.397, negative likelihood ratio (NLR) of 0.162, positive predictive value (PPV) of 0.850, and negative predictive value (NPV) of 0.723. In the internal validation set, these metrics were 0.747, 0.776, 2.099, 0.278, 0.866, and 0.538, respectively. The external validation set showed values of 0.728, 0.757, 2.10, 0.247, 0.782, and 0.704, respectively, indicating strong discriminative ability. Calibration curves demonstrated close agreement, and DCA indicated superior clinical benefits at a threshold probability of 0.73 in the training cohort and 0.75 in the validation cohort for this model. CONCLUSIONS This novel scoring system was developed from a prospective study and externally validated in an independent set based on 7 easily accessible variables, demonstrating robust performance in predicting inadequate BP.
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Affiliation(s)
- Xiaxia Zhao
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu, China.
| | - Yanglin Pan
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 Changle West Road, Xi'an, 710032, Shanxi, China
| | - Jinyong Hao
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Jie Feng
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zhongyuan Cui
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Huimin Ma
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Xiaojun Huang
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu, China
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Guy L, Caceres GA, Jackson T, Gorman S, Wilson J, Hsieh Y, Petty D, Harrison S, Pick S. Routine outcomes and evaluation of an 8-week outpatient multidisciplinary rehabilitative therapy program for functional neurological disorder. J Neurol 2024; 271:1873-1884. [PMID: 38091087 DOI: 10.1007/s00415-023-12111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 03/28/2024]
Abstract
OBJECTIVES We report routinely collected outcome data from an 8-week outpatient rehabilitative therapy program. The aims of the intervention were to (1) reduce symptom severity and (2) improve functional mobility in adults with functional neurological disorder (FND). METHODS The program delivered individual physiotherapy, cognitive behavioral therapy (CBT) and self-management sessions, group physiotherapy, and psychoeducation. Outcome measures included the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Work and Social Adjustment Scale (WSAS), 10-Meter Walk Test (10MWT), Timed Up and Go (TUG), and Berg Balance Scale (BBS). Data were analyzed retrospectively in accordance with routine service evaluation. Wilcoxon signed-rank tests assessed changes in outcomes between weeks 1 and 8 for all patients completing treatment (n = 45). For patients who attended the 3-month follow-up (n = 31), Friedman's ANOVA assessed overall change in outcomes over time. Post hoc Wilcoxon signed-rank tests compared pairs of time-points (Weeks 1, 8, and 3-month follow-up). RESULTS Analyses of patients completing the program revealed significant improvements in scores between week 1 and week 8. Excluding the BBS, there were statistically significant improvements in all outcomes between weeks 1 and 8 and between weeks 1 and 3-month follow-up. DISCUSSION This outpatient therapy program provided effective treatment for FND. Patients reported reduced anxiety, depression, and functional impairment, as well as improved performance on most physiotherapy measures.
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Affiliation(s)
- Lisette Guy
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Gabriella A Caceres
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Temeika Jackson
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sean Gorman
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jennifer Wilson
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Yvonne Hsieh
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Demelza Petty
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Simon Harrison
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Susannah Pick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK.
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Cavelti M, Seiffert N, Lerch S, Koenig J, Reichl C, Kaess M. Differential outcomes of outpatient only versus combined inpatient/outpatient treatment in early intervention for adolescent borderline personality disorder. Eur Child Adolesc Psychiatry 2024; 33:1005-1016. [PMID: 37166520 PMCID: PMC11032290 DOI: 10.1007/s00787-023-02222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
Clinical guidelines for adults with borderline personality disorder (BPD) recommend outpatient psychotherapy as first-line treatment. Little is known whether this recommendation is also applicable to adolescents. The current study examined the relationship between treatment setting and the outcome of early intervention for adolescents with BPD pathology. One-hundred and seventy-eight adolescents from a specialized outpatient clinic were assessed at baseline, and at 1- and 2-year follow-up. Sixty-three participants who received inpatient treatment during the first year were assigned to the "combined inpatient/outpatient group", 115 participants to the "outpatient only group". Generalized linear and mixed models with inverted probability weights to adjust for baseline differences were applied to examine the impact of group on clinical changes over time. Both groups demonstrated a significant decrease in BPD features, depressive symptoms, psychopathological distress, non-suicidal self-injury (NSSI), suicidal thoughts, suicide attempts, and overall illness severity, and a significant increase in quality of life and psychosocial functioning from baseline to follow-up 2. The decrease in NSSI and overall illness severity, and the increase in psychosocial functioning from baseline to follow-up 1 were greater in the outpatient only group, with comparable improvements between groups from follow-up 1 to follow-up 2. Both outpatient treatment and combined outpatient/inpatient treatment resulted in clinical improvements over time, with some indication for faster changes in the outpatient only setting. The findings provide preliminary evidence that the recommendation of outpatient psychotherapy as the first-line treatment for BPD also holds true for adolescents.
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Affiliation(s)
- Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Nora Seiffert
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland.
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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Keulen MH, Bemelmans YF, Boonen B, Hendrickx RP, Heyligers IC, Schotanus MG. Perioperative Differences Between Outpatient and Inpatient Pathways Following Hip and Knee Arthroplasty. Arthroplast Today 2024; 26:101343. [PMID: 38450396 PMCID: PMC10915506 DOI: 10.1016/j.artd.2024.101343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/04/2023] [Accepted: 02/03/2024] [Indexed: 03/08/2024] Open
Abstract
Background Optimization of clinical pathways and logistics led to the introduction of outpatient joint arthroplasty of the hip and knee. Nevertheless, little is known about what these current protocols look like and how they differ from "standard" inpatient protocols. This study aimed to find preoperative, intraoperative, and postoperative differences between outpatient and inpatient pathways. Methods A questionnaire (ranging between 23 and 37 items) was developed and administered by email to orthopedic surgeons who were a member of the Dutch Hip Society and Dutch Knee Society. Survey response rate was 38% (N = 117). Results No significant differences were found in preoperative pathway characteristics. The administration regime for tranexamic acid significantly differed between outpatient and inpatient pathways (P < .001 and P = .002 for hip and knee arthroplasty, respectively), with outpatient pathways using a combined (eg, oral and intravenous) administration regime more frequently. The perioperative antibiotic prophylaxis regime also significantly differed between outpatient and inpatient pathways (P < .001 and P = .014, respectively), with outpatient pathways more frequently incorporating fewer antibiotic doses. Same-day postoperative mobilization significantly less often occurred if surgery took place later that day in inpatient hip arthroplasty pathways (24%; P = .034). Postoperative hemoglobin-check occurred significantly more often on indication in outpatient than in inpatient hip and knee arthroplasty pathways (∼75% vs ∼25%; P = .001). Conclusions Few intraoperative and postoperative differences in outpatient and inpatient pathways were found and probably mainly relied on logistical grounds. Nonetheless, findings suggested that outpatient pathways tended to be more up-to-date and innovative than inpatient pathways.
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Affiliation(s)
- Mark H.F. Keulen
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center Heerlen and Sittard-Geleen, Geleen, The Netherlands
| | - Yoeri F.L. Bemelmans
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center Heerlen and Sittard-Geleen, Geleen, The Netherlands
| | - B. Boonen
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center Heerlen and Sittard-Geleen, Geleen, The Netherlands
| | - Roel P.M. Hendrickx
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center Heerlen and Sittard-Geleen, Geleen, The Netherlands
| | - Ide C. Heyligers
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Martijn G.M. Schotanus
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center Heerlen and Sittard-Geleen, Geleen, The Netherlands
- Faculty of Health, Medicine & Life Sciences, School of Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
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Grégory J, Ronot M, Laurent V, Chabrot P, de Baere T, Chevallier P, Vilgrain V, Aubé C. French Interventional Radiology Centers' Uptake of Transradial Approach and Outpatient Hepatocellular Carcinoma Intra-Arterial Treatments. Cardiovasc Intervent Radiol 2024; 47:432-440. [PMID: 37930400 DOI: 10.1007/s00270-023-03578-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/01/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE This study aims to investigate the uptake of transradial approach (TRA) and outpatient setting for transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) in the treatment of hepatocellular carcinoma (HCC) among French interventional radiology centers. MATERIALS AND METHODS This cross-sectional study was based on a 34-question survey assessing center activity, radial access, and outpatient care. The survey was developed by a working group, tested by two external experts, and distributed to active members of two French radiological societies via a web-based self-reporting questionnaire in March 2022. The survey remained open for eight weeks, with two reminder emails sent to non-responders. Only one answer per center was considered. RESULTS Of the 44 responding centers, 39% (17/44) performed TRA for TACE and/or TARE, with post-procedure patient comfort as main motivation. Among the 27 centers not performing TRA, 33% (9/27) reported a lack of technical experience, but all 27 intended to adopt TRA within two years. Only six centers performed TACE or TARE in an outpatient setting. Reasons limiting its implementation included TACE for HCC not being a suitable intervention (61%, 27/44) and organizational barriers (41%, 18/44). Among centers not performing outpatient TACE or TARE, 34% (13/38) said "No," 34% (13/38) said "Maybe," and 32% (12/38) said "Yes" when asked about adopting it within two years. CONCLUSION French interventional radiologists have low TRA uptake for HCC treatment, but TRA adoption potential exists. Respondents were uncertain about performing TACE or TARE in an outpatient setting within a 2-year horizon.
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Affiliation(s)
- Jules Grégory
- Université Paris Cité, Paris, France.
- Radiology Department, Hôpital Beaujon, AP-HP.Nord, FHU MOSAIC, 100 boulevard du Général Leclerc, 92210, Clichy, France.
- Inserm INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004, Paris, France.
| | - Maxime Ronot
- Université Paris Cité, Paris, France
- Radiology Department, Hôpital Beaujon, AP-HP.Nord, FHU MOSAIC, 100 boulevard du Général Leclerc, 92210, Clichy, France
- Centre de Recherche sur L'Inflammation, Inserm, U1149, 75006, Paris, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, Université de Lorraine, 54500, Vandoeuvre-Lès-Nancy, France
| | - Pascal Chabrot
- Department of Radiology, University Hospital Center, Hospital Gabriel Montpied, 58, Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Thierry de Baere
- Department of Interventional Radiology, Gustave RoussyUniversité Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Patrick Chevallier
- Department of Diagnosis and Interventional Imaging, University Hospital of Nice, 151 Route de Saint Antoine de Ginestière, 06200, Nice, France
| | - Valérie Vilgrain
- Université Paris Cité, Paris, France
- Radiology Department, Hôpital Beaujon, AP-HP.Nord, FHU MOSAIC, 100 boulevard du Général Leclerc, 92210, Clichy, France
- Centre de Recherche sur L'Inflammation, Inserm, U1149, 75006, Paris, France
| | - Christophe Aubé
- Département de Radiologie, centre hospitalier universitaire d'Angers, 4 rue Larrey, 49 933, Angers, France
- Laboratoire HIFIH, UPRES 3859, Université d'Angers, 49 045, Angers, France
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Guo S, Monginot S, Jin R, Alibhai SMH, Norman R. Improving timeliness to initial assessment in a geriatric oncology clinic: A quality improvement project. J Geriatr Oncol 2024; 15:101707. [PMID: 38326124 DOI: 10.1016/j.jgo.2024.101707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/12/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Selynne Guo
- Department of Medicine, University of Calgary, Canada.
| | - Susie Monginot
- Department of Nursing, Princess Margaret Cancer Centre, University Health Network, Canada
| | - Rana Jin
- Department of Nursing, Princess Margaret Cancer Centre, University Health Network, Canada
| | - Shabbir M H Alibhai
- Department of Geriatric Medicine, Princess Margaret Cancer Centre, University Health Network/Sinai Health System, Canada; University of Toronto, Canada
| | - Richard Norman
- University of Toronto, Canada; Department of Geriatric Medicine, University Health Network/Sinai Health System, Canada
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Landreneau JP, Agarwal D, Witkowski E, Meireles O, Flanders K, Hutter M, Gee D. Safety and cost of performing laparoscopic sleeve gastrectomy with same day discharge at a large academic hospital. Surg Endosc 2024; 38:2212-2218. [PMID: 38379004 DOI: 10.1007/s00464-024-10673-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/30/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most common surgical treatment for morbid obesity. While certain specialized ambulatory surgery centers offer LSG on an outpatient basis, patients undergoing LSG at most academic centers are admitted to hospital for initial postoperative convalescence and monitoring. Our institution has begun to offer LSG with same-day discharge (SDD) in select patients. We aimed to compare the perioperative outcomes and costs for patients undergoing LSG with inpatient admission versus SDD. METHODS All patients enrolled in the SDD program from December 2020 through July 2022 were identified from a prospectively maintained database. Patients enrolled in this pathway were analyzed on an intention-to-treat basis even if ultimately admitted postoperatively. Propensity scoring was used to match these patients 1:1 to those with planned inpatient recovery based on age, BMI, and ASA classification. RESULTS Seventy-five patients were enrolled in the LSG with SDD program during the study period. Among these, 62 patients (82.7%) had successful immediate postoperative discharge. Reasons for cancelation of planned SDD included anxiety (n = 5), pain (n = 3), nausea (n = 2), and one patient each with hypotension, urinary retention, and bleeding. After matching, there were no differences in age, BMI, or ASA classification in a comparison group of patients with planned inpatient recovery. There were no differences in perioperative complications. There were no readmissions or requirements for outpatient intravenous fluids among patients with SDD, compared to n = 3 (4.0%) and n = 2 (2.7%) in the inpatient cohort, respectively. The total perioperative cost for patients undergoing LSG with planned SDD was 6.8% less than those with inpatient recovery. CONCLUSION With appropriate protocols, LSG with same-day discharge can safely be performed at large academic surgery centers without increased morbidity or need for additional services in the perioperative period. SDD may be associated with decreased costs and allows for more efficient hospital bed allocation.
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Affiliation(s)
- Joshua P Landreneau
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
| | - Divyansh Agarwal
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Elan Witkowski
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Ozanan Meireles
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Karen Flanders
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Matthew Hutter
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Denise Gee
- Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
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Fried S, Bar-Shai A, Frydman S, Freund O. Transition of care interventions to manage severe COVID-19 in the ambulatory setting: a systematic review. Intern Emerg Med 2024; 19:765-775. [PMID: 38104299 DOI: 10.1007/s11739-023-03493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Severe COVID-19, with the need in supplemental oxygen and hospitalization, leads to major burden on patients and healthcare systems. As a result, safe and effective ambulatory treatment strategies for severe COVID-19 are of urgent need. In this systematic review, we aimed to evaluate interventions to transition care to the ambulatory setting for patients with active severe COVID-19 that required supplemental oxygen. METHODS We searched Medline, Scopus, Web of Science, and DOAJ databases to identify articles with original data published until the 1st of April 2023. Characteristics and outcomes of interventions to transition care to home management were reviewed. Given the heterogeneous settings and outcomes studied, a meta-analysis was not performed. RESULTS Of the 235 studies identified, 11 observational studies, with 2645 patients, were included. The interventions were initiated from the emergency department, observation units or inpatient units, and included continuous home telemonitoring (n = 8), mobile applications (n = 2), and patient-initiated medical contact (n = 3). Included patients had an overall short length of hospital stay, high readmission rates, and positive patients' feedback. There was a lack of prospective controlled data and cost-effectiveness analyses. CONCLUSION Our findings highlight the potential in treating severe COVID-19 at the ambulatory setting and the lack of high-quality data in this field. Dedicated medical teams, adjusted monitoring methods, improving clinical trajectory, and correct inclusion settings are needed for safe and effective transition of care.
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Affiliation(s)
- Sabrina Fried
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel-Aviv, Israel
| | - Amir Bar-Shai
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel-Aviv, Israel
| | - Shir Frydman
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Weizmann 6, Tel-Aviv, Israel
| | - Ophir Freund
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel-Aviv, Israel.
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Weizmann 6, Tel-Aviv, Israel.
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22
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Santamaria M, Stöcker A, Hoffmann J, Mause L, Ohnhäuser T, Scholten N. Infection Concerns and Economic Burden: Dentists' Cancellations During COVID-19. Int Dent J 2024; 74:276-283. [PMID: 37973523 PMCID: PMC10988247 DOI: 10.1016/j.identj.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/22/2023] [Accepted: 09/20/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES During the COVID-19 pandemic, dental appointments were cancelled or postponed by both patients and dentists. This study investigated the associations between German dentists' concerns on cross infection and their emotional burden due to personal economic impact on dentist-initiated appointment cancellations. METHODS Data were collected using an anonymous cross-sectional online survey of outpatient physicians in Germany from March through April 2020. Dental treatments were divided into 3 treatment categories (plannable treatments, acute treatments without COVID-19-like symptoms, and acute treatments with COVID-19-like symptoms). Descriptive analyses and multivariate logistic regression models were performed. RESULTS A sample of 269 self-employed dentists was considered. Cancellations of prophylaxis appointments were reported by 82% of dentists, whilst 49% reported cancellations of appointments for acute complaints with simultaneous patient-side COVID-19-like symptoms. Further, 58% of respondents stated high or very high concerns about COVID-19 self-infection; 81% stated to be emotionally burdened by the personal economic impact. Dentists' concern of infecting themselves significantly decreased the likelihood of maintaining appointments, with odds ratios of 0.635 (95% confidence interval [CI], 0.426 to 0.932) for plannable treatments and 0.587 (95% CI, 0.367 to 0.916) for treatments of patients with acute complaints and simultaneous COVID-19-like symptoms. In addition, there was a significant negative association between dentists who reported emotional distress due to personal economic impact and the likelihood to maintain appointments, with odds ratios of 0.291 (95% CI, 0.123 to 0.695) for plannable treatments and 0.231 (95% CI, 0.053; 0.706) for treatments of patients without acute complaints and simultaneous COVID-19-like symptoms. CONCLUSION Dentists' fear of infecting themselves with COVID-19 played a role in terms of practice-related appointment cancellations. Dentists differentiated their appointment cancellations according to different treatment categories and patient needs. If dental care is to be maintained in pandemic times, physicians' personal factors such as concerns about infection and perceived pandemic-related personal economic impact need to be considered.
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Affiliation(s)
- Morena Santamaria
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany
| | - Arno Stöcker
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair for Quality Development in Rehabilitation, Cologne, Germany.
| | - Jan Hoffmann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany
| | - Laura Mause
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany
| | - Tim Ohnhäuser
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany
| | - Nadine Scholten
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany
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Zhang T, Mohsen M, Abbaticchio A, Battistella M. Patients' experiences of medication management while navigating ongoing care between outpatient services: A qualitative case study of patients on hemodialysis. Explor Res Clin Soc Pharm 2024; 13:100418. [PMID: 38374965 PMCID: PMC10875289 DOI: 10.1016/j.rcsop.2024.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024] Open
Abstract
Background Patients on hemodialysis have complex medical diagnoses and medication regimens, requiring access to numerous health services and consultation with various healthcare providers. While interprofessional collaboration can optimize care among hemodialysis patients, these patients commonly experience medication-related problems and frequent hospitalizations resulting from miscommunications and mismanagement of medications. Objectives This study aims to capture the lived experiences of patients on hemodialysis to reveal their medication management needs as they navigate ongoing care between various outpatient services. Methods A qualitative methodology was used to explore the perspectives of hemodialysis patients. One-on-one, in-person, semi-structured interviews were conducted at an outpatient hemodialysis clinic located inside an urban teaching hospital. English-speaking adults 18 years and older who have been followed at the clinic for at least three months were selected through random, convenience sampling. Interviews were recorded and transcribed verbatim. Patients were recruited and data were collected iteratively and continued until data saturation was reached. Data was analyzed through the lens of the Picker Principles of Patient Centered Care using a general inductive approach. Results A total of nine interviews were conducted. Two major themes, medication management and care navigation, were identified. Though patients had a wealth of knowledge about their medications, and they were motivated to self-manage their medications to enhance their well-being, they experienced barriers with medication management. Patients further expressed challenges with navigating care and spoke of the importance of having good rapport with healthcare providers who are attentive to their needs. Conclusions The results revealed a need for improved support for self-care and interprofessional collaboration to possibly reduce the burden of medications and care fragmentation experienced by patients and improve continuity of care for patients.
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Affiliation(s)
- Tracy Zhang
- Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
- Department of Nephrology, Toronto General Hospital – University Health Network, Ontario, Canada
| | - Mai Mohsen
- Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
- Department of Nephrology, Toronto General Hospital – University Health Network, Ontario, Canada
| | - Angelina Abbaticchio
- Department of Nephrology, Toronto General Hospital – University Health Network, Ontario, Canada
| | - Marisa Battistella
- Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
- Department of Nephrology, Toronto General Hospital – University Health Network, Ontario, Canada
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24
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Vicente-Escrig E, Bonastre PT, Barrueta OI, Izquierdo MM, Fernández-Llamazares CM, Morillo-Verdugo R. [Translated article] Analysis 2016-2021 of the development of the MAPEX outpatient pharmaceutical care Project by Regions in Spain. Farm Hosp 2024; 48:T64-T69. [PMID: 38151407 DOI: 10.1016/j.farma.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE To analyse the evolution of the MAPEX Project (Strategic Map of Pharmaceutical Care for Outpatients) by regions in Spain, through the results of the comparative situation survey between 2016 and 2021. METHODS A committee of national experts belonging to the Spanish Society of Hospital Pharmacy prepared the MAPEX Survey on the situation of Outpatient Units, which consisted of 43 specific questions on aspects related to structure, context, integration, processes, results and training, teaching, and investigation. It was carried out in 2 periods, one in 2016 and another in 2021 (with 3 additional questions in 2021, related to the progress of the MAPEX initiative and the priority lines to follow). A comparative analysis of results was carried out at the national level and by regions in Spain. RESULTS 141 hospitals participated in 2016 and 138 in 2021, with representation from the 17 autonomous communities. The analysis of the results shows significant improvements in all the dimensions of the survey, with variability between the different regions. Among the most important improvements, the development and consolidation of telepharmacy stood out, the greater specialisation of pharmacists by areas of knowledge and their integration into multidisciplinary teams. The improvement of the healthcare model was considered the greatest advance at a general level (65%), and remote pharmaceutical care at the hospital level (48.2%). Priority lines of work were considered the expansion and practical application of the pharmaceutical care methodology (66.4%), research (58.4%), and training in all MAPEX initiatives (53.3%). CONCLUSIONS The implementation and development of the MAPEX initiatives has had a positive impact on the evolution in all healthcare areas of pharmaceutical care for outpatients. The situation survey makes it possible to identify by regions the significant points for improvement, as well as those areas to be developed through strengthening and corrective actions. The expansion of the project in the coming years will mean progress toward excellence in care and in the improvement of health results.
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Affiliation(s)
| | | | - Olatz Ibarra Barrueta
- Servicio de Farmacia, Hospital Universitario Galdakao-Usansolo, Osi Barrualde Galdakao, Spain
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25
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Bunting SR, Wang G, Yu R, Hazra A. Availability of Testing for Sexually Transmitted Infections and HIV in U.S. Outpatient Mental Healthcare Settings. AIDS Behav 2024; 28:1029-1038. [PMID: 37882953 DOI: 10.1007/s10461-023-04211-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/27/2023]
Abstract
People with mental illnesses experience higher incidence of sexually transmitted illnesses (STIs) and HIV, and estimates show fewer than 50% have received testing. The purpose of this study was to examine the prevalence of STI/HIV testing among United States outpatient mental healthcare service providers. Data from the National Mental Health Services Survey (NMHSS) was used to determine the rates of STI and HIV testing amongst 9,267 outpatient mental healthcare service providers in the U.S. Regression analyses were used to assess whether the likelihood a service provider offered STI or HIV testing was associated with service provider characteristics (facility type, services offered, accepted payments) and state-level incidence of STIs and HIV. We found 7.79% and 6.64% of outpatient mental healthcare service providers provided STI and HIV testing, respectively, with lowest rates in community mental health centers and partial hospitalization facilities. Providing dual-diagnosis for severe mental illness and substance use disorders was an independent predictor of STI testing (aOR = 2.17, [1.72-2.75] and HIV testing (aOR = 2.61, [2.07-3.30]. Higher state-level incidence of STIs and HIV were associated with higher rates of STI testing (β = 0.28, p = .047) and HIV testing (β = 0.48, p < .001). Preventing STIs and HIV among patients living with mental illness is a key priority of multiple national initiatives. Despite this, fewer than 10% of outpatient mental healthcare service providers responding to the NMHSS offered STI and HIV testing. Existing service co-delivery models may be one promising method for implementing STI/HIV testing within outpatient mental health settings.
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Affiliation(s)
- Samuel R Bunting
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL, USA.
| | - Gary Wang
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Roger Yu
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Aniruddha Hazra
- Section of Infectious Disease and Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
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26
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Vicente-Escrig E, Taberner Bonastre P, Ibarra Barrueta O, Murillo Izquierdo M, Fernández-Llamazares CM, Morillo-Verdugo R. Analysis 2016-2021 of the development of the MAPEX outpatient pharmaceutical care Project by regions in Spain. Farm Hosp 2024; 48:64-69. [PMID: 37749003 DOI: 10.1016/j.farma.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Analyse the evolution of the MAPEX Project (Strategic Map of Pharmaceutical Care for Outpatients) by regions in Spain, through the results of the comparative situation survey between the years 2016 and 2021. METHODS A committee of national experts belonging to the Spanish Society of Hospital Pharmacy prepared the MAPEX Survey on the situation of Outpatient Units, which consisted of 43 specific questions on aspects related to structure, context, integration, processes, results and training, teaching and investigation. It was carried out in two periods, one in 2016 and another in 2021 (with 3 additional questions in 2021, related to the progress of the MAPEX initiative and the priority lines to follow). A comparative analysis of results was carried out at the national level and by regions in Spain. RESULTS 141 hospitals participated in 2016 and 138 in 2021, with representation from the 17 autonomous communities. The analysis of the results shows significant improvements in all the dimensions of the survey, with variability between the different regions. Among the most important improvements, the development and consolidation of telepharmacy stood out, the greater specialization of pharmacists by areas of knowledge and their integration into multidisciplinary teams. The improvement of the healthcare model was considered the greatest advance at a general level (65%), and remote pharmaceutical care at the hospital level (48.2%). Priority lines of work were considered the expansion and practical application of the pharmaceutical care methodology (66.4%), research (58.4%), and training in all MAPEX initiatives (53.3%). CONCLUSIONS The implementation and development of the MAPEX initiatives has had a positive impact on the evolution in all healthcare areas of pharmaceutical care for outpatients. The situation survey makes it possible to identify by regions the significant points for improvement, as well as those areas to be developed through strengthening and corrective actions. The expansion of the project in the coming years will mean progress towards excellence in care and in the improvement of health results.
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Affiliation(s)
| | | | - Olatz Ibarra Barrueta
- Servicio de Farmacia, Hospital Universitario Galdakao-Usansolo, Osi Barrualde Galdakao, España
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27
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Furulund E, Madebo T, Druckrey-Fiskaaen KT, Vold JH, Nordbotn MH, Dahl E, Dyrstad SM, Lid TG, Fadnes LT. Integrated exercise program in opioid agonist therapy clinics and effect on psychological distress: study protocol for a randomized controlled trial (BAReAktiv). Trials 2024; 25:155. [PMID: 38424609 PMCID: PMC10905828 DOI: 10.1186/s13063-024-07993-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/16/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Substance use disorder is associated with unhealthy lifestyle choices, resulting in adverse social and health consequences. People with opioid use disorder receiving opioid agonist therapy, in particular, have high morbidity and reduced quality of life. Physical activity is recommended as an adjunctive treatment for people with substance use disorder, but there is minimal evidence from randomized controlled trials on the effects of this among people with substance use disorder receiving opioid agonist therapy. METHODS BAReAktiv is a multicentre randomized controlled trial. The study aims to recruit 324 patients receiving opioid agonist therapy (parallel groups randomized 1:1 to integrated exercise intervention or control, superiority trial). A 16-week group-based integrated exercise intervention with workouts twice a week. The exercise program consists of endurance and resistance training. The target group will be patients 18 years and older receiving opioid agonist therapy in outpatient clinics in several centers in Western Norway. The primary outcome of the study is the effect on psychological distress measured by Hopkins' symptom checklist with ten items. Secondary outcome measures include physical functioning assessed with a 4-min step test, activity level, fatigue symptoms, quality of life, and changes in inflammation markers. This study will provide improved knowledge on the effects of an integrated exercise program in opioid agonist therapy. DISCUSSION Systematically integrating exercise programs for people receiving opioid agonist therapy could lead to a shift towards a stronger focus on health behaviors in outpatient care. Integrating exercise could benefit patient recovery and reduce disease burden. Further scale-up will be considered if the provided exercise program is safe and effective. TRIAL REGISTRATION ClinicalTrials.gov. NCT05242848. Registered on February 16, 2022.
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Affiliation(s)
- Einar Furulund
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Tesfaye Madebo
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Respiratory Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Karl Trygve Druckrey-Fiskaaen
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jørn Henrik Vold
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Mette Hegland Nordbotn
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
| | - Eivin Dahl
- Department of Addiction, Stavanger University Hospital, Stavanger, Norway
| | - Sindre M Dyrstad
- Department of Education and Sport Science, University of Stavanger, Stavanger, Norway
| | - Torgeir Gilje Lid
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Lars T Fadnes
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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28
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Abstract
BACKGROUND While most adult ERCPs are performed on an outpatient basis, pediatric ERCPs are typically performed on an inpatient basis, or with ERCP followed by at least one night inpatient admission. We have begun performing a substantial proportion of our pediatric ERCPs on an outpatient basis, using our clinical judgment to guide the decision process. In the present study, we compare patient characteristics, indications, and adverse events associated with outpatient vs. inpatient ERCP. METHODS Using our endoscopy database, we identified patients 18 years of age and under who underwent ERCP from 2019 to 2021. Demographics, hospitalization status, indications, findings, interventions, as well as available adverse event and clinical outcomes data were analyzed. RESULTS 147 ERCP procedures were performed during the study period by one of two interventional endoscopists. A subset of 51 (34.7%) patients underwent outpatient ERCP. Comparison of the two groups (outpatient vs. inpatient ERCP) was notable for no statistically significant difference in patient age, range of indications, or proportion of index vs. subsequent ERCP. Overall rates of ERCP-associated adverse events were low and there was no statistically significant difference between adverse events in patients who underwent outpatient vs. inpatient ERCP. CONCLUSION We analyzed outpatient and inpatient pediatric ERCP patient demographics and ERCP characteristics to identify factors that guide decision to determine whether pediatric ERCPs are performed on an outpatient vs. inpatient basis. There was no significant difference in adverse events associated with outpatient vs. inpatient pediatric ERCPs, attesting to the safety of outpatient ERCP for this subset of patients in the studied context. This is an area worthy of future prospective and multi-center study.
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Affiliation(s)
- Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Lucille Packard Children's Hospital at Stanford, Stanford, CA, 94305, USA
| | - Andrew Yong-Jueen Liman
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Lucille Packard Children's Hospital at Stanford, Stanford, CA, 94305, USA
| | - Roberto Gugig
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Lucille Packard Children's Hospital at Stanford, Stanford, CA, 94305, USA.
- Lucille Packard Children's Hospital at Stanford, 730 Welch Rd, Palo Alto, CA, 94304, USA.
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29
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Mohammed SA, Cotta MO, Assefa GM, Erku D, Sime F. Barriers and facilitators for the implementation and expansion of outpatient parenteral antimicrobial therapy: a systematic review. J Hosp Infect 2024; 147:1-16. [PMID: 38423135 DOI: 10.1016/j.jhin.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) has been expanding in recent years and serves as a viable solution in reducing the shortage of hospital beds. However, the wider implementation of OPAT faces numerous challenges. This review aimed to assess implementation barriers and facilitators of OPAT services. Studies describing barriers and facilitators of the OPAT service were retrieved from PubMed, Scopus, MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science Proceedings, International Pharmaceutical Abstracts and PsycINFO. All types of study designs published in the English language were included. Studies that did not mention any barrier or facilitator, did not differentiate OPAT and inpatient, focused on specific antimicrobials or diseases, and made no distinction between parenteral and other treatments were excluded. Qualitative analysis was performed using the 'best-fit' framework approach and the Consolidated Framework for Implementation Research (CFIR). The review was PROSPERO registered (CRD42023441083). A total of 8761 studies were screened for eligibility and 147 studies were included. Problems in patient selection, lack of awareness, poor communication and co-ordination, lack of support, lack of structured service and inappropriate prescriptions were identified. OPAT provides safe, effective and efficient treatment while maintaining patients' privacy and comfort, resulting in less daily life disruption, and reducing the risk of infection. Satisfaction and preference for OPAT were very high. Initiatives in strengthening OPAT such as antimicrobial stewardship and telemedicine are beneficial. Challenges to and facilitators of OPAT were identified among patients, health professionals, OPAT service providers and healthcare administrators. Understanding them is crucial to designing targeted initiatives for successful OPAT service implementation.
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Affiliation(s)
- S A Mohammed
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - M O Cotta
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
| | - G M Assefa
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - D Erku
- Centre for Applied Health Economics, Griffith University, Nathan, Australia
| | - F Sime
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
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30
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Nakanishi H, Wang R, Miangul S, Kim GE, Segun-Omosehin OA, Bourdakos NE, Than CA, Johnson BE, Chen H, Gillis A. Clinical outcomes of outpatient thyroidectomy: A systematic review and single-arm meta-analysis. Am J Surg 2024:S0002-9610(24)00135-1. [PMID: 38443270 DOI: 10.1016/j.amjsurg.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The aim of this meta-analysis is to investigate the safety of outpatient thyroidectomy based on 24-h and same-day discharge criteria. METHODS CENTRAL, Embase, PubMed, and Scopus were searched. A meta-analysis of selected studies was performed. The review was registered prospectively with PROSPERO (CRD42022361134). RESULTS Thirty-one studies met the eligibility criteria, with a total of 74328 patients undergoing thyroidectomy in an outpatient setting based on 24-h discharge criteria. Overall postoperative complications after outpatient thyroidectomies were 5.7% (95%CI: 0.049-0.065; I2 = 97.3%), consisting of hematoma (0.4%; 95%CI: 0.003-0.005; I2 = 83.4%), recurrent laryngeal nerve injury (0.4%; 95%CI: 0.003-0.006; I2 = 93.5%), and hypocalcemia (1.6%; 95%CI: 0.012-0.019; I2 = 93.7%). The rate of readmission was 1.1% (95%CI: 0.007-0.015; I2 = 95.4%). Results were similar for same-day criteria. CONCLUSIONS Our analysis demonstrated that outpatient thyroidectomy is a safe procedure in the management of thyroid disease for selected patients.
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Affiliation(s)
- Hayato Nakanishi
- St George's University of London, London, SW17 0RE, UK; University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | - Rongzhi Wang
- Department of Surgery, University of Alabama at Birmingham. Birmingham, AL, USA
| | - Shahid Miangul
- St George's University of London, London, SW17 0RE, UK; University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | - Grace E Kim
- Division of Emergency Medicine, NorthShore University Health System, Chicago, IL, USA
| | - Omotayo A Segun-Omosehin
- St George's University of London, London, SW17 0RE, UK; University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | - Natalie E Bourdakos
- St George's University of London, London, SW17 0RE, UK; University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | - Christian A Than
- St George's University of London, London, SW17 0RE, UK; University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus; School of Biomedical Sciences, The University of Queensland, St Lucia, 4072, Australia
| | - Benjamin E Johnson
- Division of Surgery, NorthShore University Health System, Chicago, IL, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham. Birmingham, AL, USA
| | - Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham. Birmingham, AL, USA.
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31
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Wingo MT, Andersen CA, Bornstein SL, Huber JM, Szostek JH, Wieland ML. Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2023. Am J Med 2024:S0002-9343(24)00099-8. [PMID: 38403180 DOI: 10.1016/j.amjmed.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Abstract
The expansive scope of internal medicine can make it challenging for clinicians to stay informed about new literature that changes practice. Guideline updates and synthesis of relevant evidence can facilitate incorporation of advancements into clinical practice. The titles and abstracts from the seven general medicine journals with highest impact factors and relevance to outpatient internal medicine were reviewed by six internal medicine physicians. Coronavirus disease 19 research was excluded. The New England Journal of Medicine (NEJM), The Lancet, Journal of the American Medical Association (JAMA), The British Medical Journal (BMJ), Annals of Internal Medicine, JAMA Internal Medicine, and Mayo Clinic Proceedings were reviewed. Additionally, article synopsis collections and databases were evaluated: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based Medicine, McMaster ACCESSSS/DynaMed Evidence Alerts, and Cochrane Reviews. A modified Delphi method was used to gain consensus based on clinical relevance to outpatient internal medicine, potential impact on practice, and strength of evidence. Article qualities and importance were debated until consensus was reached. Clusters of articles pertinent to the same topic were considered together. In total, seven practice-changing articles were included.
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Affiliation(s)
- Majken T Wingo
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Carl A Andersen
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Shari L Bornstein
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jill M Huber
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jason H Szostek
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Mark L Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN
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Oke O, Sullivan KM, Hom J, Svec D, Weng Y, Shieh L. Quality improvement project to reduce medicare 1-day write-offs due to inappropriate admission orders. BMC Health Serv Res 2024; 24:204. [PMID: 38355492 PMCID: PMC10868014 DOI: 10.1186/s12913-024-10594-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND We identified that Stanford Health Care had a significant number of patients who after discharge are found by the utilization review committee not to meet Center for Mediare and Medicaid Services (CMS) 2-midnight benchmark for inpatient status. Some of the charges incurred during the care of these patients are written-off and known as Medicare 1-day write-offs. This study which aims to evaluate the use of a Best Practice Alert (BPA) feature on the electronic medical record, EPIC, to ensure appropriate designation of a patient's hospitalization status as either inpatient or outpatient in accordance with Center for Medicare and Medicaid services (CMS) 2 midnight length of stay benchmark thereby reducing the number of associated write-offs. METHOD We incorporated a best practice alert (BPA) into the Epic Electronic Medical Record (EMR) that would prompt the discharging provider and the case manager to review the patients' inpatient designation prior to discharge and change the patient's designation to observation when deemed appropriate. Patients who met the inclusion criteria (Patients must have Medicare fee-for-service insurance, inpatient length of stay (LOS) less than 2 midnights, inpatient designation as hospitalization status at time of discharge, was hospitalized to an acute level of care and belonged to one of 37 listed hospital services at the time of signing of the discharge order) were randomized to have the BPA either silent or active over a three-month period from July 18, 2019, to October 18, 2019. RESULT A total of 88 patients were included in this study: 40 in the control arm and 48 in the intervention arm. In the intervention arm, 8 (8/48, 16.7%) had an inpatient status designation despite potentially meeting Medicare guidelines for an observation stay, comparing to 23 patients (23/40, 57.5%) patients in the control group (p = 0.001). The estimated number of write-offs in the control arm was 17 (73.9%, out of 23 inpatient patients) while in the intervention arm was 1 (12.5%, out of 8 inpatient patient) after accounting for patients who may have met inpatient criteria for other reasons based on case manager note review. CONCLUSION This is the first time to our knowledge that a BPA has been used in this manner to reduce the number of Medicare 1-day write-offs.
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Affiliation(s)
| | | | - Jason Hom
- Stanford University School of Medicine, Palo Alto, California, USA
| | - David Svec
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Yingjie Weng
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California, USA
| | - Lisa Shieh
- Stanford University School of Medicine, Palo Alto, California, USA
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Liem SS, Jivanji D, Brown S, Demus T, Chang SP, Lopez O, Bhandari A, Pereira JF. Feasibility of same-day discharge of robotic-assisted laparoscopic radical prostatectomy with pelvic lymph node dissection. World J Urol 2024; 42:72. [PMID: 38324022 DOI: 10.1007/s00345-023-04764-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/25/2023] [Indexed: 02/08/2024] Open
Abstract
PURPOSE Prostate cancer is one of the most common oncologic diseases. Outpatient robotic-assisted laparoscopic radical prostatectomy (RALP) has gained popularity due to its ability to minimize patient costs while maintaining low complication rates. Few studies have analyzed the possibility of performing outpatient RALP specifically in patients undergoing concurrent pelvic lymph node dissections (PLND). METHODS Using the National Surgical Quality Improvement Program Database (NSQIP), we identified total number of RALP, stratified into inpatient and outpatient groups including those with and without PLND from 2016 to 2021. Baseline characteristics, intraoperative and postoperative complications, and unplanned readmission rates were summarized. Proportions of outpatient procedures were calculated to assess adoption of outpatient protocol. RESULTS Between 2016 and 2021, a total of 58,527 RALP were performed, 3.7% (2142) outpatient and 96.3% inpatient. Altogether, patients undergoing outpatient RALP without PLND were more likely to have hypertension (52.6% vs. 46.3%, p < 0.01). Patients undergoing outpatient RALP without PLND were more likely to have sepsis or urinary tract infections (3.4% vs. 1.9%, p = 0.04) when compared to outpatient RALP with PLND. Cardiopulmonary, renal, thromboembolic complications, and 30-day events such as unplanned readmission, reoperation rates, and mortality were similar in both groups. However, among multivariate analysis regarding 30-day readmission and complications, there were no significant differences between outpatient RALP with or without PLND. CONCLUSION Patients undergoing outpatient RALP without PLND were more likely to have baseline hypertension and higher rates of postoperative infection, when compared to outpatient RALP with PLND. No significant differences were seen regarding 30-day readmission or complications on multivariate analysis.
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Affiliation(s)
- Spencer S Liem
- Department of Urology, Mount Sinai Medical Center, 4302 Alton Road, Suite 540, Miami Beach, FL, 33140, USA
| | - Dhaval Jivanji
- Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA
| | - Shimron Brown
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Timothy Demus
- Department of Urology, Mount Sinai Medical Center, 4302 Alton Road, Suite 540, Miami Beach, FL, 33140, USA
| | - Shuwei Peter Chang
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Olga Lopez
- Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA
| | - Akshay Bhandari
- Department of Urology, Mount Sinai Medical Center, 4302 Alton Road, Suite 540, Miami Beach, FL, 33140, USA
| | - Jorge F Pereira
- Department of Urology, Mount Sinai Medical Center, 4302 Alton Road, Suite 540, Miami Beach, FL, 33140, USA.
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Kleipool SC, van Rutte PWJ, Vogel M, Bonjer HJ, de Castro SMM, van Veen RN. Feasibility of same-day discharge after laparoscopic sleeve gastrectomy in the Netherlands. Surg Endosc 2024; 38:872-879. [PMID: 38082016 DOI: 10.1007/s00464-023-10590-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/11/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND There is a trend towards laparoscopic sleeve gastrectomy (SG) with same-day discharge (SDD), as an efficient healthcare pathway to alleviate the burden on clinical capacity. This approach seems to be safe, if patients are carefully selected. In our bariatric center, a protocol for Roux-en-Y gastric bypass with SDD has already been successfully implemented. The aim of this study was to evaluate feasibility of applying the same SDD protocol for SG. METHODS A single-center prospective feasibility study was conducted at a high-volume bariatric center. Low-risk patients who were scheduled for primary SG were included. Strict criteria were used for approval upon SDD. The primary outcome was the rate of successful SDD without readmission within 48 h. Secondary outcomes included short-term complications, emergency department visits, readmissions, and mortality. RESULTS Fifty patients were included in the study, of whom 45 were successfully discharged on the same day of the surgery. Nausea and vomiting were the most common reasons for overnight hospitalization (three patients). One patient was readmitted within the first 48 h due to a mild complication related to bleeding, resulting in a success rate of 88% for SDD without readmission within 48 h. No severe complications or mortality were reported in the cohort. CONCLUSION Our SDD protocol for SG has demonstrated feasibility, with a high success rate of SDD and no severe complications. Strict conditions should be met for the safe implementation of a SDD protocol, including careful patient selection and the establishment of a safety net to detect early complications.
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Affiliation(s)
- Suzanne C Kleipool
- Department of Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - Pim W J van Rutte
- Department of Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Marlou Vogel
- Department of Anesthesiology, OLVG Hospital, Amsterdam, The Netherlands
| | - H Jaap Bonjer
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Steve M M de Castro
- Department of Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Ruben N van Veen
- Department of Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
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Yan Y, Jin Y, Cao Y, Chen C, Zhao X, Xia H, Yan L, Si Y, Zou J. Development and validation of a novel nomogram model to assess the risk of gastric contents in outpatients undergoing elective sedative gastrointestinal endoscopy procedures. Clin Res Hepatol Gastroenterol 2024; 48:102277. [PMID: 38159677 DOI: 10.1016/j.clinre.2023.102277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Gastric contents may contribute to patients' aspiration during anesthesia. Ultrasound can accurately assess the risk of gastric contents in patients undergoing sedative gastrointestinal endoscopy (GIE) procedures, but its efficiency is limited. Therefore, developing an accurate and efficient model to predict gastric contents in outpatients undergoing elective sedative GIE procedures is greatly desirable. METHODS This study retrospectively analyzed 1501 patients undergoing sedative GIE procedures. Gastric contents were observed under direct gastroscopic vision and suctioned through the endoscope. High-risk gastric contents were defined as having solid content or liquid volume > 25 ml and pH < 2.5; otherwise, they were considered low-risk gastric contents. Univariate analysis and multivariate analysis were used to select the independent risk factors to predict high-risk gastric contents. Based on the selected independent risk factors, we assigned values to each independent risk factor and established a novel nomogram. The performance of the nomogram was verified in the testing cohort by the metrics of discrimination, calibration, and clinical usefulness. In addition, an online accessible web calculator was constructed. RESULTS We found BMI, cerebral infarction, cirrhosis, male, age, diabetes, and gastroesophageal reflux disease were risk factors for gastric contents. The AUROCs were 0.911 and 0.864 in the development and testing cohort, respectively. Moreover, the nomogram showed good calibration ability. Decision curve analysis and Clinical impact curve demonstrated that the predictive nomogram was clinically useful. The website of the nomogram was https://medication.shinyapps.io/dynnomapp/. CONCLUSIONS This study demonstrates that clinical variables can be combined with algorithmic techniques to predict gastric contents in outpatients. Nomogram was constructed from routine variables, and the web calculator had excellent clinical applicability to assess the risk of gastric contents accurately and efficiently in outpatients, assist anesthesiologists in assessment and identify the most appropriate patients for ultrasound.
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Affiliation(s)
- Yuqing Yan
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China; Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yuzhan Jin
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China; Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yuanyuan Cao
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chen Chen
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiuxiu Zhao
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huaming Xia
- Nanjing Xiaheng Network System Co., Ltd., Nanjing, China
| | - Libo Yan
- Jiangsu Kaiyuan Pharmaceutical Co., Ltd., Nanjing, China
| | - Yanna Si
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China.
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Ferrafiat V, Wachtel L, Dhossche D, Hauptman A. Catatonia is an outpatient reality. What do we do now? Schizophr Res 2024; 264:233-235. [PMID: 38183961 DOI: 10.1016/j.schres.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/15/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Vladimir Ferrafiat
- Section de Psychiatrie du Développement Mental (SPDM-EMDM), Service des Troubles du Spectre de l'Autisme & apparentés, Département de Psychiatrie, centre hospitalier universitaire vaudois (CHUV), Switzerland; Faculté de biologie et de médecine, UNIL, Université de Lausanne, Switzerland
| | - Lee Wachtel
- Kennedy Krieger Institute, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Dirk Dhossche
- Inland Northwest Behavioral Health, Spokane, WA, USA
| | - Aaron Hauptman
- Kennedy Krieger Institute, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA.
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Madsen J, Vila C, Anand P, Lau KHV. Social Work in Outpatient Neurology at a Safety-Net Hospital: A 200-Hour Profile. J Immigr Minor Health 2024; 26:247-252. [PMID: 37676447 DOI: 10.1007/s10903-023-01533-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/08/2023]
Abstract
Social work plays a critical role in preventive health and mitigation of healthcare disparities, but few studies focus on its role in multi-specialty clinics serving marginalized populations. We aimed to characterize the role of outpatient neurology social work at an urban, safety-net hospital. In December 2021, we introduced a dedicated social worker to a neurology clinic primarily caring for an underserved patient population. We logged and characterized the first 200 consecutive hours of patient encounters, classifying interventions based on a recently popularized 10-category scheme in social work literature derived from natural language processing and machine learning algorithms. We characterized 125 encounters with neurology patients referred to social work. The neurology social worker spent the greatest amount of time on care coordination (40%), followed by housing insecurity (14%) and applications and reporting (11%). Interventions that required the most time per case included housing (129 min), applications and reporting (120 min), care coordination (96 min). The majority of interventions were directly related to the patient's underlying neurologic disorder, highlighting the importance of a neurology-specific social worker. Embedding a social worker in a multi-specialty neurology clinic may address many of the root causes of neurologic health disparities.
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Affiliation(s)
- Jennifer Madsen
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Neurology C-3, Boston, MA, 02118, USA
| | - Cayla Vila
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Neurology C-3, Boston, MA, 02118, USA
| | - Pria Anand
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Neurology C-3, Boston, MA, 02118, USA
| | - K H Vincent Lau
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Neurology C-3, Boston, MA, 02118, USA.
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Jose JT, Tierney ESS. Outpatient Pediatric Cardiology Follow-Up of Patients with Multisystem Inflammatory Syndrome in Children (MIS-C): A Single-Institution, Medium-Term Follow-Up Study. Pediatr Cardiol 2024; 45:401-409. [PMID: 37749261 DOI: 10.1007/s00246-023-03298-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
We are continuing to learn about the multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection. There are many published studies regarding the acute management of MIS-C; however, there is still much to learn regarding the long-term outcomes of patients with MIS-C. In this study, we report the outcomes of patients admitted at our institution with MIS-C and the follow-up practices in Pediatric Cardiology over the last three years. We included patients who were admitted at Lucile Packard Children's Hospital between January 1, 2020 and October 31, 2022, who met the CDC criteria for MIS-C, and were followed in the Pediatric Cardiology Outpatient Clinic at our institution. There were 25 patients who met our inclusion criteria. Eighteen patients (72%) had their initial follow-up visit within 1-2 weeks of discharge and seven patients (28%) had their initial follow-up visit within 4-6 weeks of discharge. Six patients out of the 25 (24%) had decreased left ventricular ejection fraction (LVEF < 50%) during their hospitalization. No patients had left main coronary artery aneurysm (z-score > 2.5), two patients (8%) had proximal right coronary artery aneurysm (z-score > 2.5), and one patient (4%) had left anterior descending coronary artery aneurysm (z-score > 2.5) during hospitalization. Patients who were admitted with the diagnosis of MIS-C showed normalization of left ventricular dysfunction at their initial follow-up visit as early as 2-4 weeks after discharge. In this cohort of MIS-C patients, a 4-6-week window for the first follow-up visit after discharge seems reasonable.
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Affiliation(s)
- Jerin Tresa Jose
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, 750 Welch Road, Palo Alto, CA, 94304, USA.
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, 750 Welch Road, Palo Alto, CA, 94304, USA
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Laiu S, McMahon C, Rolnik DL. Inpatient versus outpatient management of prenatally diagnosed vasa praevia: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 293:156-166. [PMID: 38057179 DOI: 10.1016/j.ejogrb.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/15/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Vasa praevia is a serious pregnancy complication that is potentially life-threatening for the fetus. The possible benefits of prophylactic hospital admission of asymptomatic women diagnosed with vasa praevia antenatally remain unclear. This study aims to compare the pregnancy outcomes of inpatient versus outpatient management in women with a prenatal diagnosis of vasa praevia. METHODS A systematic search of four electronic databases was conducted and two reviewers independently screened studies for eligibility. The inclusion criteria incorporated studies with prenatally diagnosed vasa praevia, a distinction on whether women were managed as inpatients and/or outpatients and where perinatal mortality was recorded as an outcome. The primary outcome of the study was perinatal mortality with additional outcomes of perinatal morbidity, need for emergency caesarean and antenatal steroid administration. Reporting of the results followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTS The search produced 2,300 studies with ten of these studies included in the qualitative synthesis and four included in the quantitative analysis. There was no significant difference in perinatal mortality (OR 1.12, 95 % CI 0.10-12.07, p = 0.93, I2 = 0 %) or morbidity between women managed as inpatients or outpatients. The prophylactic inpatient group had higher rates of earlier gestational delivery and antenatal corticosteroid administration (OR 10.78, 95 % CI 1.07-108.74, p = 0.04, I2 = 82 %), but lower rates of emergency caesareans (OR 0.35, 95 % CI 0.17-0.72, p = 0.004, I2 = 0 %). CONCLUSION There were no significant differences in perinatal mortality or morbidity rates observed between inpatient and outpatient management of asymptomatic women with antenatally diagnosed vasa praevia. However, outpatient management is associated with prolonged gestation, a decrease in antenatal corticosteroid administration, and higher odds of emergency caesarean. Outpatient management of prenatally diagnosed vasa praevia seems appropriate for carefully selected asymptomatic women.
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Affiliation(s)
- Shelene Laiu
- Women's and Newborn, Monash Health, Melbourne, VIC 3168, Australia.
| | - Carine McMahon
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, VIC 3800, Australia
| | - Daniel Lorber Rolnik
- Women's and Newborn, Monash Health, Melbourne, VIC 3168, Australia; Department of Obstetrics & Gynaecology, Monash University, Melbourne, VIC 3800, Australia
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Amen TB, Akosman I, Subramanian T, Johnson MA, Rudisill SS, Song J, Maayan O, Barber LA, Lovecchio FC, Qureshi S. Postoperative racial disparities following spine surgery are less pronounced in the outpatient setting. Spine J 2024:S1529-9430(24)00032-9. [PMID: 38301902 DOI: 10.1016/j.spinee.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND CONTEXT Racial disparities in spine surgery have been thoroughly documented in the inpatient (IP) setting. However, despite an increasing proportion of procedures being performed as same-day surgeries, whether similar differences have developed in the outpatient (OP) setting remains to be elucidated. PURPOSE This study aimed to investigate racial differences in postoperative outcomes between Black and White patients following OP and IP lumbar and cervical spine surgery. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients who underwent IP or OP microdiscectomy, laminectomy, anterior cervical discectomy and fusion (ACDF), or cervical disc replacement (CDR) between 2017 and 2021. OUTCOME MEASURES Thirty-day rates of serious and minor adverse events, readmission, reoperation, non-home discharge, and mortality. METHODS A retrospective review of patients who underwent IP or OP microdiscectomy, laminectomy, anterior cervical discectomy and fusion (ACDF), or cervical disc replacement (CDR) between 2017 and 2021 was conducted using the National Surgical Quality Improvement Program (NSQIP) database. Disparities between Black and White patients in (1) adverse event rates, (2) readmission rates, (3) reoperation rates, (4) non-home discharge rates, (5) mortality rates, (6) operative times, and (7) hospital LOS between Black and White patients were measured and compared between IP and OP surgical settings. Multivariable logistic regression analyses were used to adjust for potential effects of baseline demographic and clinical differences. RESULTS Of 81,696 total surgeries, 49,351 (60.4%) were performed as IP and 32,345 (39.6%) were performed as OP procedures. White patients accounted for a greater proportion of IP (88.2% vs. 11.8%) and OP (92.7% vs. 7.3%) procedures than Black patients. Following IP surgery, Black patients experienced greater odds of serious (OR 1.214, 95% CI 1.077-1.370, p=.002) and minor adverse events (OR 1.377, 95% CI 1.113-1.705, p=.003), readmission (OR 1.284, 95% CI 1.130-1.459, p<.001), reoperation (OR 1.194, 95% CI 1.013-1.407, p=.035), and non-home discharge (OR 2.304, 95% CI 2.101-2.528, p<.001) after baseline adjustment. Disparities were less prominent in the OP setting, as Black patients exhibited greater odds of readmission (OR 1.341, 95% CI 1.036-1.735, p=0.026) but were no more likely than White patients to experience adverse events, reoperation, individual complications, non-home discharge, or death (p>.050 for all). CONCLUSIONS Racial inequality in postoperative complications following spine surgery is evident, however disparities in complication rates are relatively less following OP compared to IP procedures. Further work may be beneficial in elucidating the causes of these differences to better understand and mitigate overall racial disparities within the inpatient setting. These decreased differences may also provide promising indication that progress towards reducing inequality is possible as spine care transitions to the OP setting.
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Affiliation(s)
- Troy B Amen
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Izzet Akosman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Tejas Subramanian
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Mitchell A Johnson
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Samuel S Rudisill
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Junho Song
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Omri Maayan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Lauren A Barber
- Visiting Fellow at St. George and Sutherland Clinical School, University of New South Wales Medicine, Sydney, NSW 2052, Australia
| | | | - Sheeraz Qureshi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Marx T, Khelifi N, Xu I, Ouellet L, Poirier A, Huard B, Mallet M, Bergeron F, Boissinot M, Bergeron MG, Berthelot S. A systematic review of tools for predicting complications in patients with influenza-like illness. Heliyon 2024; 10:e23227. [PMID: 38163091 PMCID: PMC10755309 DOI: 10.1016/j.heliyon.2023.e23227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Objective To identify tools that predict the risk of complications for patients presenting to an outpatient clinic or an emergency department (ED) with influenza-like illness. Methods We searched Medline, Embase, Cochrane Library and CINAHL from inception to July 2023. We included articles reporting on the derivation or validation of a score or algorithm used to stratify the risk of hospitalization or mortality among patients with influenza-like illness in the ED or outpatient clinic. Results Twelve articles reporting on eight scores and six predictive models were identified. For predicting the need for hospitalization, the area under the curve (AUC) of the PMEWS and the CURB-65 ranged respectively from 0.76 to 0.94, and 0.65 to 0.88. The Community Assessment Tool had an AUC of 0.62. For predicting inpatient mortality, AUC was 0.66 for PMEWS and 0.79 for CURB-65, 0.79 for the SIRS criteria and 0.86 for the qSOFA score. Two scores were developed without external validation during the Covid-19 pandemic. The CovHos score and the Canadian Covid discharge score had an AUC ranged from 0.70 to 0.91. The predictive models performed adequately (AUC from 0.76 to 0.92) but will require external validation for clinical use. Tool diversity and study population heterogeneity precluded meta-analysis. Conclusion Although the CURB, PMEWS and qSOFA scores appear to predict accurately the risk of complications of influenza-like illness, none were reliable enough to justify their widespread ED use. Refinement of an existing tool or development of a new tool to optimize the management of these patients is needed.
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Affiliation(s)
- Tania Marx
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec-Université Laval, Québec, Qc, Canada
| | - Nada Khelifi
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec-Université Laval, Québec, Qc, Canada
| | - Isabelle Xu
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec-Université Laval, Québec, Qc, Canada
| | - Laurie Ouellet
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec-Université Laval, Québec, Qc, Canada
| | - Annie Poirier
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec-Université Laval, Québec, Qc, Canada
| | - Benoit Huard
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec-Université Laval, Québec, Qc, Canada
| | - Myriam Mallet
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec-Université Laval, Québec, Qc, Canada
| | - Frédéric Bergeron
- Bibliothèque-Direction des Services-conseils, Université Laval, Québec, Qc, Canada
| | - Maurice Boissinot
- Centre de Recherche en Infectiologie de l'Université Laval, Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Québec, Qc, Canada
| | - Michel G. Bergeron
- Centre de Recherche en Infectiologie de l'Université Laval, Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Québec, Qc, Canada
| | - Simon Berthelot
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec-Université Laval, Québec, Qc, Canada
- Department of Family and Emergency Medicine, Université Laval, Québec, Qc, Canada
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Kasse GE, Humphries J, Cosh SM, Islam MS. Factors contributing to the variation in antibiotic prescribing among primary health care physicians: a systematic review. BMC Prim Care 2024; 25:8. [PMID: 38166736 PMCID: PMC10759428 DOI: 10.1186/s12875-023-02223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Antibiotic resistance is growing globally. The practice of health professionals when prescribing antibiotics in primary health care settings significantly impacts antibiotic resistance. Antibiotic prescription is a complex process influenced by various internal and external factors. This systematic review aims to summarize the available evidence regarding factors contributing to the variation in antibiotic prescribing among physicians in primary healthcare settings. METHODS This systematic review was conducted based on PRISMA guidelines. We included qualitative, quantitative and mixed methods studies that examined factors influencing prescription practice and variability among primary healthcare physicians. We excluded editorials, opinions, systematic reviews and studies published in languages other than English. We searched studies from electronic databases: PubMed, ProQuest Health and Medicine, Web Science, and Scopus. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool (Version 2018). Narrative synthesis was employed to synthesize the result and incorporate quantitative studies. RESULTS Of the 1816 identified studies, 49 studies spanning 2000-2023 were eligible for review. The factors influencing antibiotic prescription practice and variability were grouped into physician-related, patient-related, and healthcare system-related factors. Clinical guidelines, previous patient experience, physician experience, colleagues' prescribing practice, pharmaceutical pressure, time pressure, and financial considerations were found to be influencing factors of antibiotic prescribing practice. In addition, individual practice patterns, practice volume, and relationship with patients were also other factors for the variability of antibiotic prescription, especially for intra-physician prescription variability. CONCLUSION Antibiotic prescription practice in primary health care is a complex practice, influenced by a combination of different factors and this may account for the variation. To address the factors that influence the variability of antibiotic prescription (intra- and inter-physician), interventions should aim to reduce diagnostic uncertainty and provide continuous medical education and training to promote patient-centred care.
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Affiliation(s)
- Gashaw Enbiyale Kasse
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia.
- Department of Clinical Medicine, College of Veterinary Medicine and Animal Science, University of Gondar, Gondar, 196, Ethiopia.
| | - Judy Humphries
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
| | - Suzanne M Cosh
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
| | - Md Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
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Ranasinghe MP, Koh Y, Vogrin S, Nelson CL, Cohen ND, Voskoboinik A, Nanayakkara S, Haikerwal D, Mateevici C, Wharton J, Casey E, Papapostolou S, Costello B. Early Discharge to Clinic-Based Therapy of Patients Presenting With Decompensated Heart Failure (EDICT-HF): Study Protocol for a Multi-Centre Randomised Controlled Trial. Heart Lung Circ 2024; 33:78-85. [PMID: 38158264 DOI: 10.1016/j.hlc.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Acute decompensated heart failure involves a high rate of mortality and complications. Management typically involves a multi-day hospital admission. However, patients often lose part of their function with each successive admission, and are at a high risk for hospital-associated complications such as nosocomial infection. This study aims to determine the safety and efficacy of the management of patients presenting with acute decompensated heart failure to clinic-based therapy vs usual inpatient care using a reproducible management pathway. METHOD An investigator-initiated, prospective, non-inferiority, 1:1 randomised-controlled trial, stratified by left ventricular ejection fraction including 460 patients with a minimum follow-up of 7 days. This is a multi-centre study to be performed in centres across Victoria, Australia. Participants will be patients with either heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), admitted for acute decompensation of heart failure. INTERVENTION Early discharge to an outpatient-based Heart Failure Rapid Access Clinical Review (RACER) in addition to frequent medical/nursing at-home review for patients admitted with decompensated heart failure. RESULTS The primary endpoint will be a non-inferiority assessment of re-hospitalisation at 30 days. Secondary outcomes include superiority assessment of hospitalisation at 30 days, a composite clinical endpoint of major adverse cardiac and cerebrovascular event (MACCE), hospital re-admission or mortality at 3 months, achievement of guideline-directed medical therapy, patient assessment of symptoms (visual-analogue scale quantified as area under curve and Kansas City Cardiomyopathy Questionnaire-12 [KCCQ-12]), attendance at 3-month outpatient follow-up, number of bed stays/clinics attended, proportion of patients free from congestion, change in serum creatinine level, treatment for electrolyte disturbances, time to transition from intravenous to oral diuretics, and health economics analysis (cost-benefit analysis, cost-utility analysis, incremental cost-effectiveness ratio). CONCLUSIONS The Early Discharge to Clinic-Based Therapy of Patients Presenting with Decompensated Heart Failure (EDICT-HF) trial will help determine whether earlier discharge to out-of-hospital care is non-inferior to the usual practice of inpatient care, in patients with heart failure admitted to hospital for acute decompensation, as an alternative model of care.
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Affiliation(s)
- Mark P Ranasinghe
- Western Health, Department of Cardiology, Melbourne, Vic, Australia; The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Vic, Australia
| | - Youlin Koh
- Western Health, Department of Cardiology, Melbourne, Vic, Australia
| | - Sara Vogrin
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Vic, Australia
| | - Craig L Nelson
- Western Health, Division of Chronic and Complex Care, Melbourne, Vic, Australia; Western Health, Department of Nephrology, Melbourne, Vic, Australia
| | - Neale D Cohen
- Baker Heart and Diabetes Institute, Diabetes Clinical Research, Melbourne, Vic, Australia
| | - Aleksandr Voskoboinik
- Western Health, Department of Cardiology, Melbourne, Vic, Australia; Heart Centre, The Alfred Hospital, Melbourne, Vic, Australia
| | | | - Deepak Haikerwal
- Western Health, Department of Cardiology, Melbourne, Vic, Australia
| | - Cristina Mateevici
- Western Health, Ambulatory Care Unit, Melbourne, Vic, Australia; Western Health, Department of Infectious Diseases, Melbourne, Vic, Australia
| | - James Wharton
- Western Health, Ambulatory Care Unit, Melbourne, Vic, Australia
| | - Erin Casey
- Western Health, Division of Chronic and Complex Care, Melbourne, Vic, Australia
| | - Stavroula Papapostolou
- Western Health, Department of Cardiology, Melbourne, Vic, Australia; Heart Centre, The Alfred Hospital, Melbourne, Vic, Australia
| | - Ben Costello
- Western Health, Department of Cardiology, Melbourne, Vic, Australia.
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Heil J, Salzman M, Hunter K, Baston KE, Milburn C, Schmidt R, Haroz R, Ganetsky VS. Evaluation of an injectable monthly extended-release buprenorphine program in a low-barrier specialty addiction medicine clinic. J Subst Use Addict Treat 2024; 156:209183. [PMID: 37879433 DOI: 10.1016/j.josat.2023.209183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Monthly injectable extended-release buprenorphine (XR-BUP) can address several systemic and individual barriers to consistent sublingual buprenorphine treatment for patients with opioid use disorder (OUD). Real-world evaluations of XR-BUP in the outpatient addiction treatment setting are limited. The purpose of this study was to compare 6-month treatment retention and urine drug tests between patients who initiated XR-BUP compared to those who were prescribed but did not initiate XR-BUP in a low-barrier addiction medicine specialty clinic. METHODS We conducted a retrospective cohort study of adults with OUD prescribed XR-BUP between 12/1/2018 and 12/31/2020 in a low-barrier addiction medicine specialty clinic to compare 6-month treatment retention between patients who initiated XR-BUP and those who were prescribed but did not initiate XR-BUP (comparison group). Secondary outcomes included percent of urine toxicology tests negative for non-prescribed opioids. Multivariable logistic regression models evaluated factors associated with 6-month treatment retention and XR-BUP initiation. RESULTS Of the 233 patients prescribed XR-BUP, 148 (63.8 %) identified as non-Hispanic white, 218 (93.6 %) were insured by public insurance (Medicare/Medicaid), and nearly two-thirds were prescribed XR-BUP due to unstable OUD. Approximately 50 % of patients initiated XR-BUP treatment (mean number of injections = 3.7). About 60 % of XR-BUP-treated patients received supplemental sublingual buprenorphine and nearly two-thirds received a 300 mg maintenance dose. Six-month treatment retention was greater in the XR-BUP treatment versus comparison group (70.3 % vs. 36.5 %, p < 0.001). The XR-BUP treatment group had a higher percentage of opioid-negative urine toxicology tests versus the comparison group (67.2 % vs. 36.3 %, p < 0.001). Receipt of XR-BUP was an independent predictor of 6-month treatment retention (OR 5.40, 95 % CI 2.18-13.38). Those prescribed XR-BUP due to unstable OUD had lower odds of treatment retention (OR 0.41, 95 % CI 0.24-0.98) after controlling for receipt of XR-BUP and other variables known to impact retention. CONCLUSIONS XR-BUP improved 6-month treatment retention and resulted in a greater proportion of opioid-negative urine toxicology tests compared to a comparison group of patients who were prescribed but did not initiate XR-BUP. Patients with unstable OUD had lower odds of XR-BUP initiation, suggesting the need for targeted interventions to increase XR-BUP uptake in this high-risk population.
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Affiliation(s)
- Jessica Heil
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States
| | - Matthew Salzman
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States; Cooper University Health Care, Department of Emergency Medicine, Division of Addiction Medicine and Medical Toxicology, Camden, NJ, United States
| | - Krystal Hunter
- Cooper University Health Care, Cooper Research Institute, Camden, NJ, United States
| | - Kaitlan E Baston
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States
| | - Christopher Milburn
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States
| | - Ryan Schmidt
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States
| | - Rachel Haroz
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States; Cooper University Health Care, Department of Emergency Medicine, Division of Addiction Medicine and Medical Toxicology, Camden, NJ, United States
| | - Valerie S Ganetsky
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States.
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Xia J, Brownell NK, Fonarow GC, Ziaeian B. New models for heart failure care delivery. Prog Cardiovasc Dis 2024; 82:70-89. [PMID: 38311306 DOI: 10.1016/j.pcad.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/13/2024] [Indexed: 02/10/2024]
Abstract
Heart failure (HF) is a common disease with increasing prevalence around the world. There is high morbidity and mortality associated with poorly controlled HF along with increasing costs and strain on healthcare systems due to a high rate of rehospitalization and resource utilization. Despite the establishment of clear evidence-based guideline directed medical therapies (GDMT) proven to improve HF morbidity and mortality, there remains significant clinical inertia to optimizing HF patients on GDMT. Only a minority of HF patients are prescribed on all four classes of GDMT. To bridge the gap between the vulnerable population of HF patients and lifesaving GDMT, HF implementation is of increasing importance. HF implementation involves strategies and techniques to improve GDMT optimization along with other modalities to improve HF management. HF implementation meets patients where they are, including at the time of acute decompensation in the inpatient setting, at the vulnerable discharge stage, and at the chronic management stage in the outpatient setting. Inpatient HF implementation strategies include protocolized rapid titration of GDMT, site-level audit-and-feedback, virtual GDMT optimization teams, and electronic health record notifications and alerts. Discharge HF implementation strategies include education at patient and provider levels, discharge summaries, and HF transitional programs. Outpatient HF implementation strategies include digital innovations such as electronic health record utilization and mobile applications, population level strategies such as registries and clinical dashboards), changes in HF team structure and member roles, remote monitoring with implanted devices and telemonitoring, and hospital at home care model. With a growing population of HF patients, there is an increasing need for novel and creative HF implementation and monitoring methods.
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Affiliation(s)
- Jeffrey Xia
- Department of Medicine David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Nicholas K Brownell
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
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Frost HM, Hersh AL, Hyun DY. Next Steps in Ambulatory Stewardship. Infect Dis Clin North Am 2023; 37:749-767. [PMID: 37640612 PMCID: PMC10592236 DOI: 10.1016/j.idc.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Most antibiotics are prescribed in ambulatory setting and at least 30% to 50% of these prescriptions are unnecessary. The use of antibiotics when not needed promotes the development of antibiotic resistant organisms and harms patients by placing them at risk for adverse drug events and Clostridioides difficile infections. National guidelines recommend that health systems implement antibiotic stewardship programs in ambulatory settings. However, uptake of stewardship in ambulatory setting has remained low. This review discusses the current state of ambulatory stewardship in the United States, best practices for the successful implementation of effective ambulatory stewardship programs, and future directions to improve antibiotic use in ambulatory settings.
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Affiliation(s)
- Holly M Frost
- Center for Health Systems Research, Denver Health and Hospital Authority, Denver, CO, USA; Department of Pediatrics, Denver Health and Hospital Authority, Denver, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Adam L Hersh
- Division of Infectious Disease, Department of Pediatrics, 295 Chipeta Way, Salt Lake City, UT 8413, USA
| | - David Y Hyun
- Antimicrobial Resistance Project, The Pew Charitable Trusts, 901 East Street NW, Washington, DC 20004-2008, USA
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Li S, Chen M, Wang Y, Li X, Gao G, Luo X, Tang L, Liu X, Wu N. An Effective Malignancy Prediction Model for Incidentally Detected Pulmonary Subsolid Nodules Based on Current and Prior CT Scans. Clin Lung Cancer 2023; 24:e301-e310. [PMID: 37596166 DOI: 10.1016/j.cllc.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION It is challenging to diagnose and manage incidentally detected pulmonary subsolid nodules due to their indolent nature and heterogeneity. The objective of this study is to construct a decision tree-based model to predict malignancy of a subsolid nodule based on radiomics features and evolution over time. MATERIALS AND METHODS We derived a training set (2947 subsolid nodules), a test set (280 subsolid nodules) from a cohort of outpatient CT scans, and a second test set (5171 subsolid nodules) from the National Lung Cancer Screening Trial (NLST). A Computer-Aided Diagnosis system (CADs) automatically extracted 28 preselected radiomics features, and we calculated the feature change rates as the change of the quantitative measure per time unit between the prior and current CT scans. We built classification models based on XGBoost and employed 5-fold cross validation to optimize the parameters. RESULTS The model that combined radiomics features with their change rates performed the best. The Areas Under Curve (AUCs) on the outpatient test set and on the NLST test set were 0.977 (95% CI, 0.958-0.996) and 0.955 (95% CI, 0.930-0.980), respectively. The model performed consistently well on subgroups stratified by nodule diameters, solid components, and CT scan intervals. CONCLUSION This decision tree-based model trained with the outpatient dataset gives promising predictive performance on the malignancy of pulmonary subsolid nodules. Additionally, it can assist clinicians to deliver more accurate diagnoses and formulate more in-depth follow-up strategies.
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Affiliation(s)
- Shaolei Li
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Mailin Chen
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yaqi Wang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiang Li
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | | | | | - Lei Tang
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | | | - Nan Wu
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China.
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Ghoshal S, Salazar C, Duggan J, Howell C, Chen AF, Shah VM. Assessment of Patient Satisfaction and Outcomes After Outpatient Joint Arthroplasty in Academic Medical Centers. Arthroplast Today 2023; 24:101246. [PMID: 38205059 PMCID: PMC10776316 DOI: 10.1016/j.artd.2023.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/26/2023] [Accepted: 09/19/2023] [Indexed: 01/12/2024] Open
Abstract
Background There is limited literature evaluating patient satisfaction and outcomes after outpatient joint arthroplasty procedures in academic medical centers (AMCs). The aims of this study are to determine: (1) patients' desires to repeat their procedures and be discharged on the same day, (2) patient-reported outcome measures (PROMs), (3) time to discharge, (4) readmission rates, and (5) factors that predict PROMs in patients undergoing outpatient joint arthroplasty in AMCs. Methods A prospective survey was completed by 66 total hip arthroplasty (THA), 35 total knee arthroplasty (TKA), and 180 unicondylar knee arthroplasty (UKA) outpatients who underwent surgery from May 2018 to December 2020 in 2 AMCs. The survey consisted of questions regarding hip or knee PROMs (Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement), satisfaction with outpatient procedures and discharges, and reasons for readmissions. Linear regression analysis was conducted with statistical significance set at P < .05. Results 100% of THA, 93.8% of TKA, and 93.0% of UKA outpatients stated that they would re-elect to undergo their respective procedure. Furthermore, 94% of THA, 81% of TKA, and 95% of UKA patients stated they would like same-day discharge again. THA, TKA, and UKA patients reported respective mean PROM scores of 94.7, 89.9, and 86.1. Readmission rates were 1.5%, 0.0%, and 0.5%, for THA, TKA, and UKA, respectively. Conclusions Patients who underwent outpatient joint arthroplasty procedures at 2 AMCs experienced minimal readmissions and reported a high desire to repeat their outpatient procedures.
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Affiliation(s)
- Soham Ghoshal
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Carlos Salazar
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jessica Duggan
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Antonia F. Chen
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Vivek M. Shah
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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Amen TB, Song J, Mai E, Rudisill SS, Bovonratwet P, Subramanian T, Kaidi AK, Maayan O, Qureshi SA, Iyer S. Unplanned readmissions following ambulatory spine surgery: assessing common reasons and risk factors. Spine J 2023; 23:1848-1857. [PMID: 37716549 DOI: 10.1016/j.spinee.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND CONTEXT Although outpatient spine surgery is becoming increasingly popular in the United States, unplanned readmission following outpatient surgery remains a significant postoperative concern. PURPOSE This study aimed to (1) describe the incidence and timing of 30-day unplanned readmission after ambulatory lumbar and cervical spine surgery (2) evaluate the common reasons for readmission, and (3) identify factors associated with readmission in this population. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified in the National Surgical Quality Improvement Program (NSQIP) database. OUTCOME MEASURES Hospital readmission within 30 postoperative days. METHODS Patients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified using the National Surgical Quality Improvement Program (NSQIP) database. Reasons for and timing of unplanned readmissions were recorded. Multivariable poisson regressions were employed to determine any independent predictors of readmission. RESULTS A total of 33,092 ambulatory cervical and 68,115 ambulatory lumbar spine surgery patients were identified. Incidences of 30-day readmission were 3.37% and 3.07% among cervical and lumbar patients, respectively. The most common surgical site-related reasons for readmission included uncontrolled pain, recurrence of disc herniation or major symptom, and postoperative hematoma/seroma. Common nonsurgical site-related reasons included gastrointestinal, neurological, and cardiovascular complications. Factors associated with readmission among cervical patients included age ≥55, BMI ≥35, functional dependence, diabetes, smoking, COPD, and steroid use, whereas factors associated with readmission following lumbar spine surgery included age ≥65, female sex, BMI ≥35, functional dependence, ASA ≥3, diabetes, smoking, COPD, and hypertension (p<.05 for all). CONCLUSION This study highlights the common reasons and factors associated with unplanned readmission following ambulatory spine surgery. Consideration of these factors may be critical to ensuring appropriate patient selection for ambulatory spine surgery.
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Affiliation(s)
- Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA.
| | - Junho Song
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Eric Mai
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Samuel S Rudisill
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Patawut Bovonratwet
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Tejas Subramanian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Austin K Kaidi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Omri Maayan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
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Narendran N, Nilssen PK, Walker CT, Skaggs DL. New technique and case report: Robot-assisted intralaminar screw fixation of spondylolysis in an adolescent. N Am Spine Soc J 2023; 16:100284. [PMID: 38025938 PMCID: PMC10654584 DOI: 10.1016/j.xnsj.2023.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 12/01/2023]
Abstract
Introduction Management of spondylolysis in adolescents is generally successful with conservative management. Uncommonly, surgical fixation is necessary for refractory cases. Direct repair with intralaminar screws is one commonly utilized technique. Recently, less invasive spinal procedures are becoming viable with the enabling of technologies, including robotics. Case description A 14-year-old baseball player and surfer presented with low back pain, diagnosed by MRI as bony edema and stress fractures of the posterior spinal elements. After 18 months, the pain was unresponsive to rest, physical therapy, and bracing. There was no radicular pain or neurologic symptoms. Computed tomography (CT) revealed bilateral, chronic nonhealing pars defects at L5. He underwent outpatient, robot-assisted percutaneous intralaminar fixation with hydroxyapatite-coated screws through a 2 cm skin incision. Outcome On postoperative day 1, the patient reported relief of his preoperative pain and he was ambulating without difficulty. At 2 weeks follow-up, the patient was completely pain free and surfing. At 2 months follow-up, low-dose CT demonstrated partial incorporation of the hydroxyapatite-coated screws, and the patient returned to sports. At 6 months follow-up, the patient had no pain and was swinging his baseball bat with full force. Low-dose CT revealed complete healing of the defects with full incorporation of the hydroxyapatite-coated screws. Conclusions A novel minimally invasive robotic percutaneous approach for direct spondylolysis repair using hydroxyapatite-coated screws is a potential surgical treatment option for non-healing pars defects in adolescent patients.
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Affiliation(s)
- Nakul Narendran
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
| | - Paal K. Nilssen
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
| | - Corey T. Walker
- Department of Neurosurgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
| | - David L. Skaggs
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
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