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BMC Anesthesiology Apr 2018Although significant advances in clinical monitoring technology and clinical practice development have taken place in the last several decades, in this editorial we...
Although significant advances in clinical monitoring technology and clinical practice development have taken place in the last several decades, in this editorial we argue that much more still needs to be done. We begin by identifying many of the improvements in perioperative technology that have become available in recent years; these include electroencephalographic depth of anesthesia monitoring, bedside ultrasonography, advanced neuromuscular transmission monitoring systems, and other developments. We then discuss some of the perioperative technical challenges that remain to be satisfactorily addressed, such as products that incorporate poor software design or offer a confusing user interface. Finally we suggest that the journal support initiatives to help remedy this problem by publishing reports on the evaluation of medical equipment as a means to restore the link between clinical research and clinical end-users.
Topics: Anesthesiology; Humans; Monitoring, Physiologic; Patient Care; Perioperative Care
PubMed: 29653517
DOI: 10.1186/s12871-018-0504-x -
Journal of the American Board of Family... Jan 2017The chronic disease model suggests continuity of care and team-based care can improve outcomes for multimorbidity patients and reduce hospitalizations. Continuity of...
PURPOSE
The chronic disease model suggests continuity of care and team-based care can improve outcomes for multimorbidity patients and reduce hospitalizations. Continuity of care following admission has had mixed effects on readmission rates; however, its effect before admission has not been well studied. Increased outpatient care organization and continuity before admission is hypothesized to reduce the odds of readmission.
METHODS
In a cohort of 14,662 primary care patients from a Patient-Centered Medical Home (PCMH) practice, continuity of care in the 12 months before admission was assessed using 3 established metrics; usual provider continuity (UPC), dispersion continuity of care (COC), and sequence continuity (SECON). In addition, because these established metrics may not accurately reflect continuity in planned team-based care, a new metric called visit entropy (VE) was used to quantify the disorganization of visits. Multivariate logistic regression was performed to examine the relationship between readmission within 30 days and continuity while controlling for known readmission risk factors abstracted from an electronic medical record.
RESULTS
Higher VE was associated with readmission (odds ratio, 1.10; 95% confidence interval, 1.02 to 1.19). The continuity measures of UPC, COC, and SECON were not associated with readmission.
CONCLUSIONS
Disorganized medical care, characterized by a higher VE, is associated with higher odds of readmission among hospitalized primary care patients. An association between traditional measures of continuity (UPC, COC, and SECON) and readmission was not found.
Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care; Chronic Disease; Cohort Studies; Continuity of Patient Care; Female; Hospitalization; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Patient Care Team; Patient Readmission; Patient-Centered Care; Treatment Outcome
PubMed: 28062818
DOI: 10.3122/jabfm.2017.01.160186 -
Journal of Hospital Medicine Apr 2016Every year, nearly 5 million adults with cancer are hospitalized. Limited evidence suggests that hospitalization of the cancer patient is associated with adverse... (Review)
Review
Every year, nearly 5 million adults with cancer are hospitalized. Limited evidence suggests that hospitalization of the cancer patient is associated with adverse morbidity and mortality. Hospitalization of the patient with advanced cancer allows for an intense examination of health status in the face of terminal illness and an opportunity for defining goals of care. This experience-based guide reports what is currently known about the topic and outlines a systematic approach to maximizing opportunities, improving quality, and enhancing the well-being of the hospitalized patient with advanced cancer.
Topics: Clinical Competence; Disease Progression; Hospitalists; Hospitalization; Humans; Neoplasms; Patient Care
PubMed: 26588430
DOI: 10.1002/jhm.2511 -
BMC Geriatrics May 2024Hip fracture is very common and it has life-shattering consequences for older persons. After discharge the older persons need help with even basic everyday activities...
BACKGROUND
Hip fracture is very common and it has life-shattering consequences for older persons. After discharge the older persons need help with even basic everyday activities from formal and informal caregivers. In Scandinavia formal care are well-developed however the presence of informal caregivers likely reflect on the amount of formal care and wears on the informal caregivers. This study explore how often and how much informal care (IC) older persons receive after hip fracture.
METHOD
We contacted 244 community-dwelling older persons every two weeks the first twelve weeks after discharge after hip fracture and asked them if they received care from family and/or friends and how much. We used non-parametric statistics and level of significance was 95%.
RESULTS
The proportion of older persons receiving IC was 90% and the median amount of IC was 32 hours (IQR 14-66). The number of older persons who received IC was highest the first four weeks after discharge and so was the amount of hours of IC. The older persons that were high-dependence on IC received a median of 66 (IQR 46-107) hours compared to the low-dependent of 11 hours (IQR 2-20).
CONCLUSION
IC is very frequent, especially the first two to four weeks after discharge. The median IC was 32 hours from discharge to the 12-week follow-up. However, this figure tended to rise for persons with, among other, reduced functionality and those residing with a partner.
IMPLICATIONS
With respect to local differences, the findings in this study are likely applicable to other Scandinavian countries. We strongly suggest that the variation in older person need for informal caregiver be given consideration in the prioritisation of resources.
TRIAL REGISTRATION
This prospective cohort study of informal care, was part of a cluster-randomised stepped-wedge clinical controlled trial. Written consent was obtained required by regional ethics committee S-20200070. Data was collected in accordance with the Danish Data Protection Agency (20-21854).
Topics: Humans; Hip Fractures; Female; Male; Prospective Studies; Aged, 80 and over; Aged; Caregivers; Cohort Studies; Patient Care; Independent Living; Patient Discharge
PubMed: 38760708
DOI: 10.1186/s12877-024-05040-y -
AMA Journal of Ethics Dec 2023Inpatient admission of unhoused patients from an emergency department is becoming more frequent. Clinicians have ethical obligations to engage early in thorough...
Inpatient admission of unhoused patients from an emergency department is becoming more frequent. Clinicians have ethical obligations to engage early in thorough discharge planning for these vulnerable patients, as discharge to the street or even to a shelter can produce poor health outcomes. This commentary on a case considers factors that influence safe discharge planning and execution, including linkage to follow-up, patient engagement, and multidisciplinary teamwork.
Topics: Humans; Patient Discharge; Continuity of Patient Care; Hospitalization; Inpatients
PubMed: 38085988
DOI: 10.1001/amajethics.2023.866 -
BMJ Open Mar 2017The purpose of this study is to identify existing or potential quality of care indicators (ie, current indicators as well as process and outcome measures) in the acute... (Review)
Review
OBJECTIVE
The purpose of this study is to identify existing or potential quality of care indicators (ie, current indicators as well as process and outcome measures) in the acute or postacute period, or across the continuum of care for older adults with hip fracture.
DESIGN
Scoping review.
SETTING
All care settings.
SEARCH STRATEGY
English peer-reviewed studies published from January 2000 to January 2016 were included. Literature search strategies were developed, and the search was peer-reviewed. Two reviewers independently piloted all forms, and all articles were screened in duplicate.
RESULTS
The search yielded 2729 unique articles, of which 302 articles were included (11.1%). When indicators (eg, in-hospital mortality, acute care length of stay) and potential indicators (eg, comorbidities developed in hospital, walking ability) were grouped by the outcome or process construct they were trying to measure, the most common constructs were measures of mortality (outcome), length of stay (process) and time-sensitive measures (process). There was heterogeneity in definitions within constructs between studies. There was also a paucity of indicators and potential indicators in the postacute period.
CONCLUSIONS
To improve quality of care for patients with hip fracture and create a more efficient healthcare system, mechanisms for the measurement of quality of care across the entire continuum, not just during the acute period, are required. Future research should focus on decreasing the heterogeneity in definitions of quality indicators and the development and implementation of quality indicators for the postacute period.
Topics: Continuity of Patient Care; Hip Fractures; Hospital Mortality; Humans; Length of Stay; Outcome and Process Assessment, Health Care; Patient Care; Quality Indicators, Health Care; Quality of Health Care
PubMed: 28325859
DOI: 10.1136/bmjopen-2016-014769 -
Journal of General Internal Medicine Jan 2017
Topics: Continuity of Patient Care; Humans; Patient Readmission; Patient Transfer
PubMed: 27654038
DOI: 10.1007/s11606-016-3867-z -
Journal of General Internal Medicine Apr 2011Systematic reviews have the potential to inform clinical decisions, yet little is known about the impact of interventions on increasing the use of systematic reviews in... (Review)
Review
BACKGROUND
Systematic reviews have the potential to inform clinical decisions, yet little is known about the impact of interventions on increasing the use of systematic reviews in clinical decision-making.
PURPOSE
To systematically review the evidence on the impact of interventions for seeking, appraising, and applying evidence from systematic reviews in decision-making by clinicians.
DATA SOURCES
Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and LISA were searched from the earliest date available until July 2009.
STUDY SELECTION AND DATA EXTRACTION
Two independent reviewers selected studies for inclusion if the intervention intended to increase seeking, appraising, or applying evidence from systematic reviews by a clinician. Information about the study population, features of each intervention, methods used to measure the use of systematic reviews and those used to measure professional performance or health care outcomes, existence and use of statistical tests, study outcomes, and comparative data were extracted.
DATA SYNTHESIS
A total of 8,104 titles and abstracts were reviewed, leading to retrieval of 189 full-text articles for assessment; five of these studies met all inclusion criteria. All five studies reported on professional performance behavior; none reported on patient health outcomes. One study reported positive outcomes in improving preventive care. Three studies focused on obstetrical care, with two reporting no impact on professional practice change, and one study reporting increases in the use of prophylactic oxytocin and episiotomy. One study found no improvement in the sealant rate of newly erupted molars among dentists in Scotland.
LIMITATIONS
The small number of studies available for examination indicates the difficulty in summarizing and identifying key aspects in successful strategies that encourage clinicians to use systematic reviews in decision-making. Other concerns lay in selective reporting and lack of blinding during data collection.
CONCLUSIONS
The limited empirical data render the strength of evidence weak for the effectiveness and types of interventions that encourage clinicians to use systematic reviews in clinical decision making.
Topics: Decision Making; Evidence-Based Medicine; Humans; Patient Care; Physicians; Review Literature as Topic
PubMed: 20953729
DOI: 10.1007/s11606-010-1506-7 -
Academic Emergency Medicine : Official... Apr 1999
Topics: Adaptation, Psychological; Emergency Medicine; Faculty, Medical; Humans; Job Description; Patient Care; Research Design; Teaching
PubMed: 10230972
DOI: 10.1111/j.1553-2712.1999.tb00383.x -
Fertility and Sterility Dec 2021
Topics: Humans; Job Satisfaction; Patient Care; Physicians; Reproductive Medicine; Work-Life Balance; Workload
PubMed: 34674827
DOI: 10.1016/j.fertnstert.2021.09.019