Background and aims: The purpose of this study was to investigate differences in the frequency of renally inappropriate medications (RIMs) in outpatient and inpatient among three institutions.
Methods: We collected prescription and renal function data for patients over 65 years of age from the drug department system. We selected 50 kinds of the most frequently used medicines which require dose adjustment according to a patient's renal function.
Results: Outpatient RIM was seen in 611 cases (6.17%), and inpatient prescription RIM was seen in 317 cases (5.29%), showing a significant difference between the groups (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.02-1.35). However, in a multivariate analysis, when the renal function was included, that difference between outpatients and inpatients became insignificant (OR 1.16, 95% CI 0.98-1.37). The distribution of prescription with or without RIM in outpatient and inpatient settings depended on the CKD stage. Outpatients with a better CKD stage (stage 1-3) had a higher rate of RIM than inpatients, while patients with a worse CKD stage (stage 4 or 5) had a higher rate of RIM than outpatients.
Conclusion: The rate of RIM in outpatients tends to be high, and attention should be paid to RIM in inpatients with a severe CKD stage.
{"title":"Renally inappropriate medications in elderly outpatients and inpatients with an impaired renal function.","authors":"Shotaro Kobayashi, Norio Sugama, Hiroyuki Nagano, Masahiro Takahashi, Akifumi Kushiyama","doi":"10.1080/21548331.2023.2173412","DOIUrl":"https://doi.org/10.1080/21548331.2023.2173412","url":null,"abstract":"<p><strong>Background and aims: </strong>The purpose of this study was to investigate differences in the frequency of renally inappropriate medications (RIMs) in outpatient and inpatient among three institutions.</p><p><strong>Methods: </strong>We collected prescription and renal function data for patients over 65 years of age from the drug department system. We selected 50 kinds of the most frequently used medicines which require dose adjustment according to a patient's renal function.</p><p><strong>Results: </strong>Outpatient RIM was seen in 611 cases (6.17%), and inpatient prescription RIM was seen in 317 cases (5.29%), showing a significant difference between the groups (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.02-1.35). However, in a multivariate analysis, when the renal function was included, that difference between outpatients and inpatients became insignificant (OR 1.16, 95% CI 0.98-1.37). The distribution of prescription with or without RIM in outpatient and inpatient settings depended on the CKD stage. Outpatients with a better CKD stage (stage 1-3) had a higher rate of RIM than inpatients, while patients with a worse CKD stage (stage 4 or 5) had a higher rate of RIM than outpatients.</p><p><strong>Conclusion: </strong>The rate of RIM in outpatients tends to be high, and attention should be paid to RIM in inpatients with a severe CKD stage.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9202932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.1080/21548331.2023.2176041
Krishna C Daiya, Caroline M Sierra
Objectives: Literature regarding clinical benefits of dornase alfa (DNase) in pediatric patients without cystic fibrosis is lacking. In December 2020, the study institution implemented restrictions to limit DNase use in this patient population. The primary objective was adherence to DNase ordering restrictions. Secondary objectives included length of stay, respiratory function, and use of inhaled mucolytic agents.
Methods: This single-center retrospective chart review included patients less than 18 years of age who received DNase one year prior to through one year after order restriction implementation. Data collected included patient demographics and respiratory clinical parameters. Dosing regimens for DNase, n-acetylcysteine, and hypertonic saline were collected, as well as changes in length of stay (LOS) and adherence to ordering restrictions.
Results: Of 101 total DNase orders, 45 were placed after implementation of ordering restrictions and 16 (36%) met all ordering criteria. Hospital and intensive care unit (ICU) LOS after implementation of restrictions were not significantly different (p = 0.767 and p = 0.219, respectively). There was no significant change in patients' mean oxygenation index (p = 0.252) or FiO2% (p = 0.113) 24 hours after DA administration.
Conclusion: Respiratory function did not significantly change after DNase administration. Implementing restrictions on DNase did not impact intensive care unit or hospital LOS. Adherence to DNase ordering restrictions could be improved.
{"title":"Use of dornase alfa in pediatric patients without cystic fibrosis.","authors":"Krishna C Daiya, Caroline M Sierra","doi":"10.1080/21548331.2023.2176041","DOIUrl":"https://doi.org/10.1080/21548331.2023.2176041","url":null,"abstract":"<p><strong>Objectives: </strong>Literature regarding clinical benefits of dornase alfa (DNase) in pediatric patients without cystic fibrosis is lacking. In December 2020, the study institution implemented restrictions to limit DNase use in this patient population. The primary objective was adherence to DNase ordering restrictions. Secondary objectives included length of stay, respiratory function, and use of inhaled mucolytic agents.</p><p><strong>Methods: </strong>This single-center retrospective chart review included patients less than 18 years of age who received DNase one year prior to through one year after order restriction implementation. Data collected included patient demographics and respiratory clinical parameters. Dosing regimens for DNase, n-acetylcysteine, and hypertonic saline were collected, as well as changes in length of stay (LOS) and adherence to ordering restrictions.</p><p><strong>Results: </strong>Of 101 total DNase orders, 45 were placed after implementation of ordering restrictions and 16 (36%) met all ordering criteria. Hospital and intensive care unit (ICU) LOS after implementation of restrictions were not significantly different (p = 0.767 and p = 0.219, respectively). There was no significant change in patients' mean oxygenation index (p = 0.252) or FiO2% (p = 0.113) 24 hours after DA administration.</p><p><strong>Conclusion: </strong>Respiratory function did not significantly change after DNase administration. Implementing restrictions on DNase did not impact intensive care unit or hospital LOS. Adherence to DNase ordering restrictions could be improved.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9563132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Nigeria is considering making Universal Health Coverage (UHC) a common policy goal to ensure that citizens have access to high-quality healthcare services without crippling debt. Globally, there is an acute shortage of human resources for Health (HRH), and the most significant burden is borne by low-income countries, especially in sub-Saharan Africa. This shortage has considerably constrained the achievement of health-related development goals and impeded accelerated progress toward universal health coverage. We examine the existing human resource capacity and the distribution of health facilities in Lagos state in this study, discussing the implications of our findings.
Methods: The study is descriptive using secondary data analysis. We leverage census-based primary data collected by NOIPoll on health facility assessments in Lagos state. The collected data was analyzed using counts, ratios, rates, and percentages.
Results: We observe a ratio of 5,014 people to 1 general medical doctor, 2,942 people to 1 specialist, 2,165 people to 1 nurse, and 5,117 people to 1 midwife, which are far higher than the WHO recommendation. We also observe that the ratio of nurses to general medical practitioners is 2.2:1 in urban areas and 2.7:1 in rural. In contrast, the ratio of nurses to specialist medical doctors is 1.3:1 in the urban area and 1.5:1 in the rural areas of Lagos state. The overall nurse per general medical practitioner ratio is 2.3:1 and 1.4:1 for specialist medical doctors. 77.2% of the health facilities surveyed were in the urban areas, with private-for-profit facilities accounting for 82.9%, government facilities accounting for 15.4%, and NGOs/faith clinics accounting for 1.7%. Primary healthcare facilities account for 75.3% of the facilities surveyed, secondary and tertiary facilities account for 24.6% and 0.08%, respectively. Alimosho LGA has the most health facilities (77.38% PHCs, and 22.62% SHCs) and staff strength specifically for general medical practitioners, specialists, nurses, and midwives (16.9%, 19.9%, 16.7%, 17.1%, respectively). Eti-Osa LGA has the best density ratio for generalist doctors, specialist doctors, and nurses per 10,000 (4.42, 12.96, and 11.34 respectively), while Ikeja has the best midwife population density ratio 5.46 per 10,000 population.
Conclusion: The distribution of health personnel and facilities in Lagos State is not equitable, with evident variation between rural and urban areas. This inequitable distribution could affect the physical distance of health facilities to residents, leading to decreased utilization, ultimately poor health outcomes, and impaired access. Much like child mortality, maternal mortality also exhibits a correlation with healthcare worker density. As the physician density increases linearly, the maternal mortality rate decreases exponentially. However, due to the low number of healthcare
背景:尼日利亚正在考虑将全民健康覆盖(UHC)作为一项共同政策目标,以确保公民能够获得高质量的医疗保健服务,而不会造成严重债务。在全球范围内,卫生人力资源严重短缺,最严重的负担由低收入国家承担,特别是在撒哈拉以南非洲。这种短缺在很大程度上限制了与卫生有关的发展目标的实现,阻碍了在实现全民健康覆盖方面的加速进展。在本研究中,我们考察了拉各斯州现有的人力资源能力和卫生设施的分布,讨论了我们研究结果的含义。方法:采用二次资料分析方法进行描述性研究。我们利用NOIPoll收集的关于拉各斯州卫生设施评估的基于人口普查的原始数据。收集的数据使用计数、比率、比率和百分比进行分析。结果:全科医生和专科医生的比例分别为5014比1,专科医生和专科医生的比例分别为2942比1,护士和助产士的比例分别为2165比1,助产士和助产士的比例分别为5117比1,远远高于世界卫生组织推荐的比例。我们还观察到,护士与全科医生的比例在城市地区为2.2:1,在农村地区为2.7:1。相比之下,拉各斯州城市地区护士与专科医生的比例为1.3:1,农村地区为1.5:1。护士与全科医生的比率为2.3:1,专科医生为1.4:1。77.2%的受访卫生机构位于城市地区,其中私营营利性机构占82.9%,政府机构占15.4%,非政府组织/信仰诊所占1.7%。初级卫生保健设施占调查设施的75.3%,二级和三级卫生保健设施分别占24.6%和0.08%。Alimosho地方政府拥有最多的卫生设施(77.38%的初级保健中心和22.62%的初级保健中心)和专门为全科医生、专家、护士和助产士服务的工作人员(分别为16.9%、19.9%、16.7%和17.1%)。etii - osa LGA的全科医生、专科医生和护士的人口密度比最佳(分别为每万人4.42、12.96和11.34),而Ikeja的助产士人口密度比最佳(每万人5.46)。结论:拉各斯州卫生人员和设施分布不公平,城乡差异明显。这种不公平的分配可能会影响卫生设施与居民之间的实际距离,导致利用率下降,最终导致健康结果不佳,并妨碍获得服务。与儿童死亡率非常相似,孕产妇死亡率也与卫生保健工作者密度相关。随着医生密度线性增加,产妇死亡率呈指数级下降。然而,由于拉各斯州的卫生保健工作者人数少,在分娩期间经常没有医生、护士和助产士,导致婴儿、新生儿和孕产妇死亡人数增加。因此,政府应在该州的设施和人员分布中采用全民健康覆盖战略,以充分覆盖和优化设施的性能。此外,该州一些地区需要增加投资,以改善获得三级保健设施的机会,并利用私营部门的能力。
{"title":"Evaluation of healthcare facilities and personnel distribution in Lagos State: implications on universal health coverage.","authors":"Maxwell Obubu, Nkata Chuku, Alozie Ananaba, Firdausi Umar Sadiq, Emmanuel Sambo, Oluwatosin Kolade, Tolulope Oyekanmi, Kehinde Olaosebikan, Oluwafemi Serrano","doi":"10.1080/21548331.2023.2170651","DOIUrl":"https://doi.org/10.1080/21548331.2023.2170651","url":null,"abstract":"<p><strong>Background: </strong>Nigeria is considering making Universal Health Coverage (UHC) a common policy goal to ensure that citizens have access to high-quality healthcare services without crippling debt. Globally, there is an acute shortage of human resources for Health (HRH), and the most significant burden is borne by low-income countries, especially in sub-Saharan Africa. This shortage has considerably constrained the achievement of health-related development goals and impeded accelerated progress toward universal health coverage. We examine the existing human resource capacity and the distribution of health facilities in Lagos state in this study, discussing the implications of our findings.</p><p><strong>Methods: </strong>The study is descriptive using secondary data analysis. We leverage census-based primary data collected by NOIPoll on health facility assessments in Lagos state. The collected data was analyzed using counts, ratios, rates, and percentages.</p><p><strong>Results: </strong>We observe a ratio of 5,014 people to 1 general medical doctor, 2,942 people to 1 specialist, 2,165 people to 1 nurse, and 5,117 people to 1 midwife, which are far higher than the WHO recommendation. We also observe that the ratio of nurses to general medical practitioners is 2.2:1 in urban areas and 2.7:1 in rural. In contrast, the ratio of nurses to specialist medical doctors is 1.3:1 in the urban area and 1.5:1 in the rural areas of Lagos state. The overall nurse per general medical practitioner ratio is 2.3:1 and 1.4:1 for specialist medical doctors. 77.2% of the health facilities surveyed were in the urban areas, with private-for-profit facilities accounting for 82.9%, government facilities accounting for 15.4%, and NGOs/faith clinics accounting for 1.7%. Primary healthcare facilities account for 75.3% of the facilities surveyed, secondary and tertiary facilities account for 24.6% and 0.08%, respectively. Alimosho LGA has the most health facilities (77.38% PHCs, and 22.62% SHCs) and staff strength specifically for general medical practitioners, specialists, nurses, and midwives (16.9%, 19.9%, 16.7%, 17.1%, respectively). Eti-Osa LGA has the best density ratio for generalist doctors, specialist doctors, and nurses per 10,000 (4.42, 12.96, and 11.34 respectively), while Ikeja has the best midwife population density ratio 5.46 per 10,000 population.</p><p><strong>Conclusion: </strong>The distribution of health personnel and facilities in Lagos State is not equitable, with evident variation between rural and urban areas. This inequitable distribution could affect the physical distance of health facilities to residents, leading to decreased utilization, ultimately poor health outcomes, and impaired access. Much like child mortality, maternal mortality also exhibits a correlation with healthcare worker density. As the physician density increases linearly, the maternal mortality rate decreases exponentially. However, due to the low number of healthcare","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9216009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01DOI: 10.1080/21548331.2022.2144066
Shweta Varade, Abinayaa Ravichandran, Erafat Rehim, Hussam Yacoub, Rose Duncan, Hope Kincaid, Megan C Leary, John Castaldo
Objectives: In the United States, approximately 18-25% of carotid duplex ultrasound (CUS) studies are ordered to assess patients with non-lateralizing neurological complaints such as syncope, blurry vision, lightheadedness, headache, and altered mental status. The purpose of this study is to evaluate the benefit of CUS in the evaluation of patients presenting with non-lateralizing signs or symptoms.
Materials and methods: We conducted a retrospective analysis to assess the degree and laterality of carotid stenosis among patients with non-lateralizing neurological complaints who underwent CUS interpreted by certified vascular neurologists over a period of 3 years. The primary endpoint was to identify the prevalence of moderate-to-severe carotid artery stenosis among 280 patients who met inclusion criteria.
Results: A total of 17.7% of CUS studies were ordered for non-lateralizing symptoms. Two hundred and sixty-one patients (93.21%) had either normal imaging or mild carotid stenosis of <50%. Nineteen patients (6.79%) were found to have stenosis of ≥50%. In this subgroup, age and known preexisting carotid artery atherosclerotic disease were the only variables found to have a statistically significant association with the level of stenosis found on CUS. Two patients with asymptomatic stenosis of >70% underwent a revascularization procedure.
Conclusion: At least 17.7% of CUS studies were completed for non-lateralizing symptoms. The study is of low-yield with the prevalence of moderate-to-severe stenosis being comparable to that in the general asymptomatic population. We conclude that there is minimal clinical value in the use of CUS to investigate non-lateralizing neurological complaints, resulting in unnecessary healthcare costs.
{"title":"The role of carotid ultrasound in patients with non-lateralizing neurological complaints.","authors":"Shweta Varade, Abinayaa Ravichandran, Erafat Rehim, Hussam Yacoub, Rose Duncan, Hope Kincaid, Megan C Leary, John Castaldo","doi":"10.1080/21548331.2022.2144066","DOIUrl":"https://doi.org/10.1080/21548331.2022.2144066","url":null,"abstract":"<p><strong>Objectives: </strong>In the United States, approximately 18-25% of carotid duplex ultrasound (CUS) studies are ordered to assess patients with non-lateralizing neurological complaints such as syncope, blurry vision, lightheadedness, headache, and altered mental status. The purpose of this study is to evaluate the benefit of CUS in the evaluation of patients presenting with non-lateralizing signs or symptoms.</p><p><strong>Materials and methods: </strong>We conducted a retrospective analysis to assess the degree and laterality of carotid stenosis among patients with non-lateralizing neurological complaints who underwent CUS interpreted by certified vascular neurologists over a period of 3 years. The primary endpoint was to identify the prevalence of moderate-to-severe carotid artery stenosis among 280 patients who met inclusion criteria.</p><p><strong>Results: </strong>A total of 17.7% of CUS studies were ordered for non-lateralizing symptoms. Two hundred and sixty-one patients (93.21%) had either normal imaging or mild carotid stenosis of <50%. Nineteen patients (6.79%) were found to have stenosis of ≥50%. In this subgroup, age and known preexisting carotid artery atherosclerotic disease were the only variables found to have a statistically significant association with the level of stenosis found on CUS. Two patients with asymptomatic stenosis of >70% underwent a revascularization procedure.</p><p><strong>Conclusion: </strong>At least 17.7% of CUS studies were completed for non-lateralizing symptoms. The study is of low-yield with the prevalence of moderate-to-severe stenosis being comparable to that in the general asymptomatic population. We conclude that there is minimal clinical value in the use of CUS to investigate non-lateralizing neurological complaints, resulting in unnecessary healthcare costs.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10701973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01Epub Date: 2022-11-24DOI: 10.1080/21548331.2022.2144055
Yousif M Hydoub, Karen M Fischer, Kristine T Hanson, Trevor J Coons, Laurie L Wilshusen, Tafi L Vista, Gretchen A Colbenson, M Caroline Burton, Elizabeth B Habermann, Sagar B Dugani
Background: Routinely collected patient experience scores may inform risk of patient outcomes. The objective of the study was to evaluate the risk of hospital admission within 30-days following third-party receipt of the patient experience survey and guide interventions.
Methods: In this retrospective cohort study, we analyzed Hospital Consumer Assessment of Healthcare Providers and Systems surveys, January 2016-July 2019, from an institution's 20 hospitals in four U.S. states. Surveys were routinely sent to patients using census sampling. We analyzed surveys received ≤60 days following discharge from patients living ≤60 miles of any of the institution's hospitals. The exposures were 19 survey items. The outcome was hospital admission within 30 days after third-party receipt of the survey. We evaluated the association of favorable (top-box) vs unfavorable (non-top-box) score for survey items with risk of 30-day hospital admission in models including patient and hospitalization characteristics and reported adjusted odds ratios (aOR [95% confidence interval]).
Results: Among 40,162 respondents (mean age ± standard deviation: 68.1 ± 14.0 years), 49.8% were women and 4.3% had 30-day hospital admission. Patients with 30-day hospital admission, compared to those not admitted, were more likely to be discharged from a medical service line (62.9% vs 42.3%; P < 0.001) and have a higher Elixhauser index. Favorable vs unfavorable score for hospital rating was associated with lower odds of 30-day hospital admission in the overall cohort (0.88 [0.77-0.99]; P = 0.04), medical service line (0.81 [0.70-0.94]; P = 0.007), and upper tertile of Elixhauser index (0.79 [0.67-0.92]; P = 0.003). Favorable score for recommend hospital was associated with lower odds of 30-day hospital admission in the medical service line (0.83 [0.71-0.97]; P = 0.02) but for others (e.g. cleanliness of hospital environment) showed no association.
Conclusion: In routinely collected patient experience scores, favorable hospital rating was associated with lower odds of 30-day hospital admission and may inform risk stratification and interventions. Evidence-based survey items linked to patient outcomes may also inform future surveys.
{"title":"Multisite analysis of patient experience scores and risk of hospital admission: a retrospective cohort study.","authors":"Yousif M Hydoub, Karen M Fischer, Kristine T Hanson, Trevor J Coons, Laurie L Wilshusen, Tafi L Vista, Gretchen A Colbenson, M Caroline Burton, Elizabeth B Habermann, Sagar B Dugani","doi":"10.1080/21548331.2022.2144055","DOIUrl":"10.1080/21548331.2022.2144055","url":null,"abstract":"<p><strong>Background: </strong>Routinely collected patient experience scores may inform risk of patient outcomes. The objective of the study was to evaluate the risk of hospital admission within 30-days following third-party receipt of the patient experience survey and guide interventions.</p><p><strong>Methods: </strong>In this retrospective cohort study, we analyzed Hospital Consumer Assessment of Healthcare Providers and Systems surveys, January 2016-July 2019, from an institution's 20 hospitals in four U.S. states. Surveys were routinely sent to patients using census sampling. We analyzed surveys received ≤60 days following discharge from patients living ≤60 miles of any of the institution's hospitals. The exposures were 19 survey items. The outcome was hospital admission within 30 days after third-party receipt of the survey. We evaluated the association of favorable (top-box) vs unfavorable (non-top-box) score for survey items with risk of 30-day hospital admission in models including patient and hospitalization characteristics and reported adjusted odds ratios (aOR [95% confidence interval]).</p><p><strong>Results: </strong>Among 40,162 respondents (mean age ± standard deviation: 68.1 ± 14.0 years), 49.8% were women and 4.3% had 30-day hospital admission. Patients with 30-day hospital admission, compared to those not admitted, were more likely to be discharged from a medical service line (62.9% vs 42.3%; <i>P</i> < 0.001) and have a higher Elixhauser index. Favorable vs unfavorable score for <i>hospital rating</i> was associated with lower odds of 30-day hospital admission in the overall cohort (0.88 [0.77-0.99]; <i>P</i> = 0.04), medical service line (0.81 [0.70-0.94]; <i>P</i> = 0.007), and upper tertile of Elixhauser index (0.79 [0.67-0.92]; <i>P</i> = 0.003). Favorable score for <i>recommend hospital</i> was associated with lower odds of 30-day hospital admission in the medical service line (0.83 [0.71-0.97]; <i>P</i> = 0.02) but for others (e.g. <i>cleanliness of hospital environment</i>) showed no association.</p><p><strong>Conclusion: </strong>In routinely collected patient experience scores, favorable <i>hospital rating</i> was associated with lower odds of 30-day hospital admission and may inform risk stratification and interventions. Evidence-based survey items linked to patient outcomes may also inform future surveys.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9928911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10735127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01DOI: 10.1080/21548331.2022.2150416
Lauren Raff, Carlton Moore, Evan Raff
Objectives: Rapid response (RR) systems are associated with decreased hospital mortality. Systemic biases and inequities can negatively impact RR outcomes. Language barriers between patients and providers are associated with worse outcomes, but it is unknown if language barriers are associated with RR outcomes.
Methods: We analyzed all adult hospitalized patients who experienced a RR over one year (January 2020 to December 2020) at a tertiary care academic medical center. We used an objective scoring system to establish disease severity at the time of the event. We then compared disease severity and outcomes for patients who are primary language Spanish (PLS) and primary language English (PLE) using both univariable and multivariable analyses.
Results: Of 1133 patients, 42 identified as PLS and 1091 as PLE. In multivariable analyses, PLS patients had significantly higher disease severity scores, as measured by deterioration index score (8.2, p = 0.021) at the time of their rapid responses. PLS patients also had 18.5% increase in length of stay (LOS) after RRs and this disparity was not mitigated when controlling for disease severity at the time of RRs. PLS was not a significant predictor for hospital mortality after RRs.
Conclusions: Our study found that PLS patients had increased disease severity at the time of RRs and increased LOS after RRs. However, the disparity in LOS was not mitigated when controlling for disease severity at the time of RRs. These findings suggest that language barriers may cause both delays in activation of RR systems, as well as the care provided during and after RRs.
{"title":"The role of language barriers on efficacy of rapid response teams.","authors":"Lauren Raff, Carlton Moore, Evan Raff","doi":"10.1080/21548331.2022.2150416","DOIUrl":"https://doi.org/10.1080/21548331.2022.2150416","url":null,"abstract":"<p><strong>Objectives: </strong>Rapid response (RR) systems are associated with decreased hospital mortality. Systemic biases and inequities can negatively impact RR outcomes. Language barriers between patients and providers are associated with worse outcomes, but it is unknown if language barriers are associated with RR outcomes.</p><p><strong>Methods: </strong>We analyzed all adult hospitalized patients who experienced a RR over one year (January 2020 to December 2020) at a tertiary care academic medical center. We used an objective scoring system to establish disease severity at the time of the event. We then compared disease severity and outcomes for patients who are primary language Spanish (PLS) and primary language English (PLE) using both univariable and multivariable analyses.</p><p><strong>Results: </strong>Of 1133 patients, 42 identified as PLS and 1091 as PLE. In multivariable analyses, PLS patients had significantly higher disease severity scores, as measured by deterioration index score (8.2, p = 0.021) at the time of their rapid responses. PLS patients also had 18.5% increase in length of stay (LOS) after RRs and this disparity was not mitigated when controlling for disease severity at the time of RRs. PLS was not a significant predictor for hospital mortality after RRs.</p><p><strong>Conclusions: </strong>Our study found that PLS patients had increased disease severity at the time of RRs and increased LOS after RRs. However, the disparity in LOS was not mitigated when controlling for disease severity at the time of RRs. These findings suggest that language barriers may cause both delays in activation of RR systems, as well as the care provided during and after RRs.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10806008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01DOI: 10.1080/21548331.2023.2166746
Sydney Boike, Mikael Mir, Holly Olson, Delaney Cole, Ibtisam Rauf, Salim Surani, Syed Anjum Khan
The effects of the 2019 novel coronavirus, SARS-CoV-2, and its associated pandemic are complex and widespread. It has permeated all aspects of daily life around the world. Unsurprisingly, it also had significant impacts on proceedings within hospitals around the world as well. Most notably, the multiple waves of the pandemic have each had untoward effects on surgical productivity within hospital systems. More specifically, the disruption of surgical procedures has impacted both emergent and elective cases. In the context of emergent procedures, hospital systems have had to reevaluate how they define 'emergent,' forcing them to determine which cases could not be rescheduled versus those that could. Elective procedures, on the other hand, were nearly halted altogether in the initial pandemic waves. If these were not completely stopped in some places, then they were greatly reduced. This paper will serve to describe the effect the pandemic has had on the proceedings of both elective and emergent surgeries. It will also describe how we have reevaluated and changed the way we define 'emergent' surgeries and describe the potential implications of this. We will also describe literature that speaks to the implications of the delay of elective procedures. Additionally, the cost implications of fewer surgical procedures performed will be discussed. Finally, we will describe literature that has established protocols for scheduling surgeries in waves of the pandemic, how these have evolved over time, and how they have created confusion for hospital systems navigating the pandemic.
{"title":"Perioperative management of emergency and elective surgeries during the pandemic.","authors":"Sydney Boike, Mikael Mir, Holly Olson, Delaney Cole, Ibtisam Rauf, Salim Surani, Syed Anjum Khan","doi":"10.1080/21548331.2023.2166746","DOIUrl":"https://doi.org/10.1080/21548331.2023.2166746","url":null,"abstract":"<p><p>The effects of the 2019 novel coronavirus, SARS-CoV-2, and its associated pandemic are complex and widespread. It has permeated all aspects of daily life around the world. Unsurprisingly, it also had significant impacts on proceedings within hospitals around the world as well. Most notably, the multiple waves of the pandemic have each had untoward effects on surgical productivity within hospital systems. More specifically, the disruption of surgical procedures has impacted both emergent and elective cases. In the context of emergent procedures, hospital systems have had to reevaluate how they define 'emergent,' forcing them to determine which cases could not be rescheduled versus those that could. Elective procedures, on the other hand, were nearly halted altogether in the initial pandemic waves. If these were not completely stopped in some places, then they were greatly reduced. This paper will serve to describe the effect the pandemic has had on the proceedings of both elective and emergent surgeries. It will also describe how we have reevaluated and changed the way we define 'emergent' surgeries and describe the potential implications of this. We will also describe literature that speaks to the implications of the delay of elective procedures. Additionally, the cost implications of fewer surgical procedures performed will be discussed. Finally, we will describe literature that has established protocols for scheduling surgeries in waves of the pandemic, how these have evolved over time, and how they have created confusion for hospital systems navigating the pandemic.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10711005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01DOI: 10.1080/21548331.2023.2170613
Braden Vogt, David F Painter, Rodrigo Saad Berreta, Anagha Lokhande, Ankur D Shah
Although hemodialysis continues to be the dominant form of dialysis in the United States, peritoneal dialysis rates continue to rise both nationally and worldwide. Peritoneal dialysis offers patients increased flexibility due to the ability to dialyze at home, leading to potential quality of life benefits for patients. However, questions exist regarding clinical outcomes in patients on peritoneal dialysis and the literature has not recently been reviewed. This review examines hospitalizations within patients utilizing peritoneal dialysis, including comparison to other dialysis modalities. Much heterogeneity exists within the literature, often explained by patient population. Recent data show all-cause, cardiovascular, and infection-related hospitalizations to be high in patients on peritoneal dialysis, although data variation limits conclusions in comparison to other modalities. This review found there is insufficient evidence to suggest admission rates are different in peritoneal dialysis than in-center hemodialysis. While the rate is similar to infectious causes, most studies report cardiovascular complications to be the leading cause of hospitalization. Some evidence suggests that cardiovascular hospitalizations occur at a higher rate in peritoneal dialysis, but further studies are required. The infection-related hospitalization rate appears to be higher in peritoneal dialysis due to rates of peritonitis, but rates of life-threatening bacteremia are lower. Differences in reporting of hospital days vs. length of stay challenge the interpretability of length of stay data between modalities, but patients on PD may spend more days per year in the hospital. In summary, hospitalization is highly prevalent in patients on peritoneal dialysis and few definitive conclusions can be drawn in comparison to other dialysis modalities. In eligible patient populations who desire increased flexibility, peritoneal dialysis is a reasonable modality choice.
{"title":"Hospitalization in maintenance peritoneal dialysis: a review.","authors":"Braden Vogt, David F Painter, Rodrigo Saad Berreta, Anagha Lokhande, Ankur D Shah","doi":"10.1080/21548331.2023.2170613","DOIUrl":"https://doi.org/10.1080/21548331.2023.2170613","url":null,"abstract":"<p><p>Although hemodialysis continues to be the dominant form of dialysis in the United States, peritoneal dialysis rates continue to rise both nationally and worldwide. Peritoneal dialysis offers patients increased flexibility due to the ability to dialyze at home, leading to potential quality of life benefits for patients. However, questions exist regarding clinical outcomes in patients on peritoneal dialysis and the literature has not recently been reviewed. This review examines hospitalizations within patients utilizing peritoneal dialysis, including comparison to other dialysis modalities. Much heterogeneity exists within the literature, often explained by patient population. Recent data show all-cause, cardiovascular, and infection-related hospitalizations to be high in patients on peritoneal dialysis, although data variation limits conclusions in comparison to other modalities. This review found there is insufficient evidence to suggest admission rates are different in peritoneal dialysis than in-center hemodialysis. While the rate is similar to infectious causes, most studies report cardiovascular complications to be the leading cause of hospitalization. Some evidence suggests that cardiovascular hospitalizations occur at a higher rate in peritoneal dialysis, but further studies are required. The infection-related hospitalization rate appears to be higher in peritoneal dialysis due to rates of peritonitis, but rates of life-threatening bacteremia are lower. Differences in reporting of hospital days vs. length of stay challenge the interpretability of length of stay data between modalities, but patients on PD may spend more days per year in the hospital. In summary, hospitalization is highly prevalent in patients on peritoneal dialysis and few definitive conclusions can be drawn in comparison to other dialysis modalities. In eligible patient populations who desire increased flexibility, peritoneal dialysis is a reasonable modality choice.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9266037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01DOI: 10.1080/21548331.2022.2162297
Shiavax J Rao, Shaikh B Iqbal, Arjun S Kanwal, Wilbert S Aronow, Srihari S Naidu
Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited condition defined by left ventricular wall thickness greater than 15 mm in the absence of other conditions that could explain that degree of hypertrophy. Obstructive HCM associated with left ventricular outflow tract obstruction is defined by an intraventricular systolic pressure gradient greater than or equal to 30 mm Hg. Over the past couple of decades, there has been an expansion of both invasive and pharmacotherapeutic options for patients with HCM, with recent guidelines calling for a melody of invasive and non-invasive treatment strategies. There are several invasive therapies including proven therapies such as alcohol septal ablation and septal myectomy. Novel invasive therapies such as MitraClip, radiofrequency septal ablation and SESAME procedure have more recently been promoted. Pharmacological therapy has also dramatically evolved and includes conventional medications such as beta-blockers, calcium channel blockers, and disopyramide. Mavacamten, a novel cardiac myosin inhibitor, may significantly change management. Other myosin inhibitors and modulators are also being developed and tested in large clinical trials. Given significant phenotypical variability in patients with HCM, clinical management can be challenging, and often requires an individualized approach with a combination of invasive and non-invasive options.
{"title":"Multi-modality management of hypertrophic cardiomyopathy.","authors":"Shiavax J Rao, Shaikh B Iqbal, Arjun S Kanwal, Wilbert S Aronow, Srihari S Naidu","doi":"10.1080/21548331.2022.2162297","DOIUrl":"https://doi.org/10.1080/21548331.2022.2162297","url":null,"abstract":"<p><p>Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited condition defined by left ventricular wall thickness greater than 15 mm in the absence of other conditions that could explain that degree of hypertrophy. Obstructive HCM associated with left ventricular outflow tract obstruction is defined by an intraventricular systolic pressure gradient greater than or equal to 30 mm Hg. Over the past couple of decades, there has been an expansion of both invasive and pharmacotherapeutic options for patients with HCM, with recent guidelines calling for a melody of invasive and non-invasive treatment strategies. There are several invasive therapies including proven therapies such as alcohol septal ablation and septal myectomy. Novel invasive therapies such as MitraClip, radiofrequency septal ablation and SESAME procedure have more recently been promoted. Pharmacological therapy has also dramatically evolved and includes conventional medications such as beta-blockers, calcium channel blockers, and disopyramide. Mavacamten, a novel cardiac myosin inhibitor, may significantly change management. Other myosin inhibitors and modulators are also being developed and tested in large clinical trials. Given significant phenotypical variability in patients with HCM, clinical management can be challenging, and often requires an individualized approach with a combination of invasive and non-invasive options.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9281235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01DOI: 10.1080/21548331.2023.2170154
Daniel J Zhou, Sachin Kedar
We thank Drs. Trebach and Hoffman for their thoughtful remarks and use this opportunity to discuss their concerns. We acknowledge the limitations of a single institution-based, retrospective, cohort study and have addressed these in our manuscript extensively [1]. In this practice-based, real-world study, we examined hospital outcomes and thiamine prescription patterns among a diverse group of hospital-based providers who were licensed and credentialed to manage patients with altered mental status from all-causes, including those with hypoglycemia. While we found wide variations in the thiamine prescription patterns (timing, dosage, and route of administration), we are not unique in reporting such variations in clinical practice [2– 6]. It is possible that differences in prescription patterns such as glucose-first vs. thiamine-first or parenteral vs. enteral vs. no thiamine could be the result of disease severity. While we controlled for disease severity using Medicare Severity Diagnosis-Related Group (MS-DRG) weight in our models, it is possible that this measure may not have captured the breadth of clinical severity. Additional analyses of the effects of different dosages on outcomes were not feasible due to wide variations in clinical practice resulting in small patient numbers in groups. We acknowledge the growing evidence for the lack of benefit of supplemental thiamine in critically ill patients [7,8]. It has also been reported that glucose administration before or without thiamine would not acutely worsen the effects of thiamine deficiency unless the glucose administration is prolonged [9]. However, in our study, we found that patients who received glucose before or without thiamine had increased inhospital mortality rate after controlling for disease severity. Based on the results of our study, we cannot in good conscience, argue against the current medical practice (dogma) of administering parenteral thiamine before glucose for critically ill patients with altered mental status from all causes.
{"title":"Authors' reply, re: A response to Zhou et al. regarding thiamine supplementation in altered mental status.","authors":"Daniel J Zhou, Sachin Kedar","doi":"10.1080/21548331.2023.2170154","DOIUrl":"https://doi.org/10.1080/21548331.2023.2170154","url":null,"abstract":"We thank Drs. Trebach and Hoffman for their thoughtful remarks and use this opportunity to discuss their concerns. We acknowledge the limitations of a single institution-based, retrospective, cohort study and have addressed these in our manuscript extensively [1]. In this practice-based, real-world study, we examined hospital outcomes and thiamine prescription patterns among a diverse group of hospital-based providers who were licensed and credentialed to manage patients with altered mental status from all-causes, including those with hypoglycemia. While we found wide variations in the thiamine prescription patterns (timing, dosage, and route of administration), we are not unique in reporting such variations in clinical practice [2– 6]. It is possible that differences in prescription patterns such as glucose-first vs. thiamine-first or parenteral vs. enteral vs. no thiamine could be the result of disease severity. While we controlled for disease severity using Medicare Severity Diagnosis-Related Group (MS-DRG) weight in our models, it is possible that this measure may not have captured the breadth of clinical severity. Additional analyses of the effects of different dosages on outcomes were not feasible due to wide variations in clinical practice resulting in small patient numbers in groups. We acknowledge the growing evidence for the lack of benefit of supplemental thiamine in critically ill patients [7,8]. It has also been reported that glucose administration before or without thiamine would not acutely worsen the effects of thiamine deficiency unless the glucose administration is prolonged [9]. However, in our study, we found that patients who received glucose before or without thiamine had increased inhospital mortality rate after controlling for disease severity. Based on the results of our study, we cannot in good conscience, argue against the current medical practice (dogma) of administering parenteral thiamine before glucose for critically ill patients with altered mental status from all causes.","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9931179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}