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Safety of Early Discharge After Coronary Artery Bypass Grafting: A Nationwide Readmissions Analysis.The Annals of Thoracic Surgery Jun 2024We determined the safety of early discharge after coronary artery bypass grafting (CABG) in patients with uncomplicated postoperative courses and compared outcomes to...
BACKGROUND
We determined the safety of early discharge after coronary artery bypass grafting (CABG) in patients with uncomplicated postoperative courses and compared outcomes to routine discharge in a national cohort. We identified preoperative factors associated with readmission following early discharge after CABG.
METHODS
The Nationwide Readmissions Database was queried to identify patients undergoing CABG from 01/2016-12/2018. Patients were stratified based on length of stay (LOS) as early (≤4 days) versus routine (5-10 days) discharge. Patients were excluded with hospital courses indicative of complicated stays (emergent procedures, LOS>10 days, discharge to extended care facility or with home health, index-hospitalization mortality). Propensity-score matching was performed to compare outcomes between cohorts. Multivariable logistic regression models were used to identify factors associated with readmission following early discharge.
RESULTS
A total of 91,861 patients underwent CABG with an uncomplicated postoperative course during the study period (≈20% of CABG population). Of these 31% (28,790/91,861) were discharged early and 69% (63,071/91,861) routine. After propensity-score matching, patients discharged early had lower readmission rates at 30-days, 90-days, and up to one year (P<.001, all). Index-hospitalization cost was lower with early discharge ($26,676 versus $32,859; P<.001). Early discharge was associated with a lower incidence of nosocomial infection at index-hospitalization (0.17% versus 0.81%, P<.001) and readmission from infection (14.5% versus 18%, P=.016).
CONCLUSIONS
Early discharge after uncomplicated CABG can be considered in a highly selective patient population. Early discharge patients are readmitted less frequently than matched routine discharge patients, with a lower incidence of readmission from infection. Appropriate post-discharge processes to facilitate early discharge after CABG should be further pursued.
PubMed: 38950725
DOI: 10.1016/j.athoracsur.2024.05.045 -
Hamostaseologie Jul 2024Claims data are increasingly discussed to evaluate health care for rare diseases (resource consumption, outcomes and costs). Using haemophilia A (HA) as a use case, this...
Claims data are increasingly discussed to evaluate health care for rare diseases (resource consumption, outcomes and costs). Using haemophilia A (HA) as a use case, this analysis aimed to generate evidence for the aforementioned information using German Statutory Health Insurance (SHI) claims data. Claims data (2017-2019) from the German SHI 'AOK Bayern - Die Gesundheitskasse' were used. Patients with ICD-10-GM codes D66 and HA medication were included in descriptive analyses. Severity levels were categorized according to HA medication consumption. In total, 257 patients were identified: mild HA, 104 patients (mean age: 40.0 years; SD: 22.9); moderate HA, 17 patients, (51.2 years; SD: 24.5); severe HA, 128 patients, (34.2 years; SD: 18.5). There were eight patients categorized with inhibitors (37.8 years; SD: 29.6). Psychotherapy was reported among 28.8% (mild) to 32.8% (severe) of patients. Joint disease was documented for 46.2% (mild) to 61.7% (severe) of patients. Mean direct costs per patient per year were 1.34× for mild, 11× for moderate, 81× higher for severe HA patients and 223× higher for inhibitor patients than the mean annual expenditure per AOK Bayern insurant (2019). German SHI data provide comprehensive information. The patient burden in HA is significant with respect to joint disease and psychological stress regardless of the HA severity level. The cost of HA care for patients is high. Large cost ranges suggest that the individual situation of a patient must be considered when interpreting costs. The main limitation of SHI data analysis for HA was the lack of granularity of ICD codes.
PubMed: 38950623
DOI: 10.1055/a-2276-4871 -
Acta Medica Portuguesa Jul 2024
Topics: Portugal; Humans; Medication Reconciliation
PubMed: 38950611
DOI: 10.20344/amp.21620 -
Facts, Views & Vision in ObGyn Jun 2024The NuvaRing®, a hormonal vaginal contraceptive device, has gained widespread usage due to its favourable efficacy and safety profiles. Exceedingly rare instances of...
BACKGROUND
The NuvaRing®, a hormonal vaginal contraceptive device, has gained widespread usage due to its favourable efficacy and safety profiles. Exceedingly rare instances of unintended misplacement in the bladder have been reported. This study presents a review of the literature and the first video report illustrating the extraction of an intravesical NuvaRing®, discussing diagnostic and therapeutic approaches.
OBJECTIVE
To illustrate an effective method for intravesical NuvaRing® retrieval and raise awareness about this unusual complication.
MATERIALS AND METHODS
A 27-year-old patient with low urinary tract symptoms related to NuvaRing® misplacement underwent diagnostic procedures, including ultrasound and diagnostic cystoscopy. A cystoscopic extraction under general anaesthesia was performed.
MAIN OUTCOME MEASURES
The effectiveness of pelvic ultrasound for diagnosing an intravesical foreign body, successful cystoscopic removal of NuvaRing® from the bladder, and symptom resolution were assessed.
RESULTS
The intravesical NuvaRing® was identified through pelvic ultrasound. During cystoscopy, the ring was detected inside the bladder. Multiple attempts with cystoscopic alligator graspers were made; the NuvaRing® was eventually extracted using transurethral Heiss forceps. The patient experienced minimal blood loss and was discharged the following day, reporting relief from symptoms.
CONCLUSIONS
Unintentional NuvaRing® placement in the bladder is an extremely rare event that healthcare providers should consider when patients present with urinary symptoms and pelvic pain. Pelvic ultrasound is an efficient diagnostic tool, possibly averting the need for further imaging techniques. Cystoscopy remains the preferred method for diagnosis and treatment. This video report illustrates an effective technique for NuvaRing ® extraction, especially when appropriate graspers are unavailable. Adequate instruction on NuvaRing® insertion should always be emphasised.
PubMed: 38950537
DOI: 10.52054/FVVO.16.2.016 -
Facts, Views & Vision in ObGyn Jun 2024Vesico-vaginal fistula (VVF) is a rare but debilitating condition, characterised by an abnormal connection between the bladder and vagina. While obstetric-related cases...
BACKGROUND
Vesico-vaginal fistula (VVF) is a rare but debilitating condition, characterised by an abnormal connection between the bladder and vagina. While obstetric-related cases prevail in developing countries, iatrogenic fistulas are more common in industrialised ones, often resulting from pelvic surgeries.
OBJECTIVES
The optimal timing for surgical correction of VVF remains debated, often leaning towards delayed intervention. Here we report a successful early laparoscopic repair of an iatrogenic VVF following hysterectomy.
MATERIALS AND METHODS
The patient, a 54-year-old woman, presented with VVF after a hysterectomy. The laparoscopic repair was performed promptly upon diagnosis.
MAIN OUTCOME MEASURES
To assess the feasibility and effectiveness of an early repair of a gynaecological-related VVF.
RESULTS
First, cystoscopy identified the bladder edge of the VVF. Second, laparoscopy was performed and the vesico-vaginal dissection was carried out. The excision of the previous stitches and of the fibrotic tissue was undertaken to create free flaps for suturing. The bladder was repaired in a double layer, and a single layer was applied to the vagina. Finally, the omentoplasty was done. The patient was discharged on postoperative day 5. No complications occurred.
CONCLUSIONS
This successful case demonstrates the feasibility and safety of early laparoscopic repair for gynaecological surgery-related vesico-vaginal fistulae. While acknowledging the need for further studies to standardise techniques, this report contributes to the evolving understanding of optimal management for this complex condition.
PubMed: 38950535
DOI: 10.52054/FVVO.16.2.014 -
Oncology Nursing Forum Jun 2024To update the American Society of Clinical Oncology (ASCO)-Oncology Nursing Society (ONS) standards for antineoplastic therapy administration safety in adult and...
PURPOSE
To update the American Society of Clinical Oncology (ASCO)-Oncology Nursing Society (ONS) standards for antineoplastic therapy administration safety in adult and pediatric oncology and highlight current standards for antineoplastic therapy for adult and pediatric populations with various routes of administration and location.
METHODS
ASCO and ONS convened a multidisciplinary Expert Panel with representation of multiple organizations to conduct literature reviews and add to the standards as needed. The evidence base was combined with the opinion of the ASCO-ONS Expert Panel to develop antineoplastic safety standards and guidance. Public comments were solicited and considered in preparation of the final manuscript.
RESULTS
The standards presented here include clarification and expansion of existing standards to include home administration and other changes in processes of ordering, preparing, and administering antineoplastic therapy; the advent of immune effector cellular therapy; the importance of social determinants of health; fertility preservation; and pregnancy avoidance. In addition, the standards have added a fourth verification.
STANDARDS
Standards are provided for which health care organizations and those involved in all aspects of patient care can safely deliver antineoplastic therapy, increase the quality of care, and reduce medical errors.
Topics: Humans; Antineoplastic Agents; Adult; Child; Oncology Nursing; Neoplasms; Patient Safety; Female; United States; Male; Societies, Nursing
PubMed: 38950089
DOI: 10.1188/24.ONF.297-320 -
PloS One 2024To analyze the psychometric properties of the cross-culturally adapted version of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC)...
OBJECTIVE
To analyze the psychometric properties of the cross-culturally adapted version of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) Compact Form Brazil.
METHODS
A methodological study was conducted with 281 adult Primary Health Care users. Data collection took place online. Confirmatory Factor Analysis (CFA) was used to evaluate the psychometric properties of the PREOS-PC after the process of cross-cultural adaptation to the Brazilian context. Internal consistency was evaluated through Cronbach's alpha coefficient (α) and McDonald's omega coefficient (ω).
RESULTS
The sample consisted of 73.3% women. The mean age was 36.1 years (SD = 12.2). Of the 23 items of the PREOS-PC that were eligible for CFA, a model with four correlated domains and 16 items presented satisfactory fit indexes. The domains were Practice Activation (PrA) (four items), Patient Activation (PaA) (two items), Experiences of patient safety events (EPaS) (five items) and Outcomes of patient safety (OPaS) (six items). One domain (GPeS) presented one question with a 0 to 10 response scale and two open questions, which cannot be inserted in the CPA due to the nature of the items, but can be included in the application of the scale, being evaluated individually. In this factorial model, five items (EPaS2, EPaS3, EPaS4, EPaS5, EPaS6 and EPaS8) presented factor loadings ≤ 0.30. The α and ω values demonstrated good internal consistency for all domains of the PREOS-PC.
CONCLUSIONS
The Brazilian version of the PREOS-PC Compact Form Brazil composed of four domains (PrA, PA, EPaS and OPaS) and 16 items presented evidence of validation of its psychometric properties and can be used to evaluate the experiences and results of patient safety in Primary Health Care in the Brazilian context.
Topics: Humans; Female; Brazil; Primary Health Care; Adult; Male; Middle Aged; Psychometrics; Patient Safety; Patient Reported Outcome Measures; Surveys and Questionnaires; Factor Analysis, Statistical; Young Adult
PubMed: 38950012
DOI: 10.1371/journal.pone.0305414 -
Nephrology Nursing Journal : Journal of... 2024ANNA's Administration SPN created this proposal as a clinical practice project to re-evaluate how training and education are provided to individuals working in the...
ANNA's Administration SPN created this proposal as a clinical practice project to re-evaluate how training and education are provided to individuals working in the dialysis setting. This article describes an education initiative based on the escape room methodology to provide a fresh approach on dialysis curriculum.
Topics: Humans; Renal Dialysis; Patient Safety; Nephrology Nursing; Curriculum; United States
PubMed: 38949803
DOI: No ID Found -
Nephrology Nursing Journal : Journal of... 2024The importance of the Life Safety Code (LSC) cannot be understated. The LSC is composed of a set of components, measures, and protocols with the overarching goal of...
The importance of the Life Safety Code (LSC) cannot be understated. The LSC is composed of a set of components, measures, and protocols with the overarching goal of protecting and preserving human life. This article describes the LSC survey process in dialysis facilities. Ensuring the physical plant and its infrastructure is critical for patient safety. The survey tasks, provider, and building management responsibilities are reviewed. Implications for nephrology nursing regarding survey readiness and best practices for an LSC survey are discussed.
Topics: Renal Dialysis; Humans; Patient Safety; Nurse Administrators; Nephrology Nursing; Safety Management; United States
PubMed: 38949802
DOI: No ID Found -
Nephrology Nursing Journal : Journal of... 2024Nurse leaders play a critical part in supporting the safety of patients and their staff. Their guidance in establishing a robust safety culture and engagement in...
Nurse leaders play a critical part in supporting the safety of patients and their staff. Their guidance in establishing a robust safety culture and engagement in preparing their organizations for the survey is important in eliminating patient harm. Ensuring the dialysis facility and staff are survey-ready promotes a culture dedicated to patient wellbeing and safety. This article describes the survey process in dialysis facilities and provides survey tips to guide nurse managers in being survey-ready every day.
Topics: Nurse Administrators; Humans; Surveys and Questionnaires; Renal Dialysis; Nephrology Nursing
PubMed: 38949799
DOI: No ID Found