Pub Date : 2019-08-08DOI: 10.1080/21548331.2019.1677408
A. McCague, J. Bautista
ABSTRACT Objective: We sought to determine a benchmark for our blood glucose monitoring and compare our data to published data. Methods: Natividad Medical Center is a 172-bed rural hospital located in Salinas, California. Point of care blood glucose (POC-BG) data was extracted from our EMR for all ICU patients greater than 18 years of age between January 2014 and May 2018. Patient day-weighted mean POC-BGs were calculated for each patient by calculating the average POC-BG per day for each patient. Proportion measurements for each of our measurements groups were recorded (>180 mg/dL, <70 mg/dL, >250 mg/dL and <50 mg/dL). Monthly averages were plotted for visual comparison. Benchmarks were calculated by using 2x Standard Deviation for each measurement group. Results: A total of 3164 patients were found with 21,006 POC-BG measurements. The average POC-BG was 136 mg/dL and median 119 mg/dL. Proportion measurements of monthly day-weighted mean POC-BGs ranged from 0–1.2%, 5.3–44.8%, 0–0.3% and 0.6–16.5%, respectively for less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL. A 2x Standard Deviation was used to calculate our benchmark cut offs which provides a 95% confidence interval and includes 97.5% when neglecting the lower range. Our calculated benchmark values are 1.2, 38.2, 0.19, and 13.1% respectively for measurement groups less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL. Conclusion: Here we present data from a small rural hospital in the Western United States. We calculated benchmarks that could be used to track our ongoing hyper/hypoglycemia improvement projects. We found that when compared to published data, our hyper/hypoglycemia data was comparable to national data.
{"title":"Benchmarking blood sugar control in the small rural intensive care unit","authors":"A. McCague, J. Bautista","doi":"10.1080/21548331.2019.1677408","DOIUrl":"https://doi.org/10.1080/21548331.2019.1677408","url":null,"abstract":"ABSTRACT Objective: We sought to determine a benchmark for our blood glucose monitoring and compare our data to published data. Methods: Natividad Medical Center is a 172-bed rural hospital located in Salinas, California. Point of care blood glucose (POC-BG) data was extracted from our EMR for all ICU patients greater than 18 years of age between January 2014 and May 2018. Patient day-weighted mean POC-BGs were calculated for each patient by calculating the average POC-BG per day for each patient. Proportion measurements for each of our measurements groups were recorded (>180 mg/dL, <70 mg/dL, >250 mg/dL and <50 mg/dL). Monthly averages were plotted for visual comparison. Benchmarks were calculated by using 2x Standard Deviation for each measurement group. Results: A total of 3164 patients were found with 21,006 POC-BG measurements. The average POC-BG was 136 mg/dL and median 119 mg/dL. Proportion measurements of monthly day-weighted mean POC-BGs ranged from 0–1.2%, 5.3–44.8%, 0–0.3% and 0.6–16.5%, respectively for less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL. A 2x Standard Deviation was used to calculate our benchmark cut offs which provides a 95% confidence interval and includes 97.5% when neglecting the lower range. Our calculated benchmark values are 1.2, 38.2, 0.19, and 13.1% respectively for measurement groups less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL. Conclusion: Here we present data from a small rural hospital in the Western United States. We calculated benchmarks that could be used to track our ongoing hyper/hypoglycemia improvement projects. We found that when compared to published data, our hyper/hypoglycemia data was comparable to national data.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"177 - 180"},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1677408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45051617","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 : 2019-08-08DOI: 10.1080/21548331.2019.1656991
N. van Helmond, Cecilia G Freeman, Christina Hahnen, Nilanjan Haldar, Jacquelyn N Hamati, Dylan M Bard, Vignesh Murali, G. Merli, J. Joseph
ABSTRACT Objectives: Handheld medical devices and smartwatches that measure BP without a cuff have recently become available. Since these measurements are relatively more user-friendly than conventional cuff-based measurements they may aid in more frequent BP monitoring. We investigated the accuracy and precision of two popular cuff-less devices: the Everlast smartwatch and the BodiMetrics Performance Monitor. Methods: We enrolled 127 patients from the Thomas Jefferson University Hospital Preadmission Testing Center. Research staff were trained to measure BP according to manufacturer guidelines for the investigational devices. The Everlast smartwatch provides measurements of systolic (SBP) and diastolic (DBP) BP, whereas the Bodimetrics only provides SBP. Reference BP measurements were obtained using a hospital-grade automated sphygmomanometer. After 5 minutes of quiet sitting, four standard and three investigational BP measurements were taken with sixty seconds in between each measurement. The reference BP value was calculated by determining the average of the 2 standard BP measurements that bounded the investigational measurements. We thus determined 3 comparison pairs for each investigational device in each subject. We calculated the mean (SD) of the absolute difference between the respective investigational devices and the reference for SBP and DBP. Results: Data from 42 individuals was excluded because of variation in standard BP measurements per prespecified rules. Of 85 participants used for analysis, 36 (42%) were women, the mean (SD) age was 53 (21) years, 32 (38%) self-reported hypertension, and 97% of these (n = 31) reported taking antihypertensive medications. The average differences between the Everlast watch and reference were 16.9 (13.5) mm Hg for SBP and 8.3 (6.1) mm Hg for DBP. The average difference between the Bodimetrics performance monitor and the reference was 5.3 (4.7) mm Hg for SBP. Conclusions: The Everlast smartwatch and the BodiMetrics Performance Monitor we tested are not accurate enough to be used as BP measurement devices.
{"title":"The accuracy of blood pressure measurement by a smartwatch and a portable health device","authors":"N. van Helmond, Cecilia G Freeman, Christina Hahnen, Nilanjan Haldar, Jacquelyn N Hamati, Dylan M Bard, Vignesh Murali, G. Merli, J. Joseph","doi":"10.1080/21548331.2019.1656991","DOIUrl":"https://doi.org/10.1080/21548331.2019.1656991","url":null,"abstract":"ABSTRACT Objectives: Handheld medical devices and smartwatches that measure BP without a cuff have recently become available. Since these measurements are relatively more user-friendly than conventional cuff-based measurements they may aid in more frequent BP monitoring. We investigated the accuracy and precision of two popular cuff-less devices: the Everlast smartwatch and the BodiMetrics Performance Monitor. Methods: We enrolled 127 patients from the Thomas Jefferson University Hospital Preadmission Testing Center. Research staff were trained to measure BP according to manufacturer guidelines for the investigational devices. The Everlast smartwatch provides measurements of systolic (SBP) and diastolic (DBP) BP, whereas the Bodimetrics only provides SBP. Reference BP measurements were obtained using a hospital-grade automated sphygmomanometer. After 5 minutes of quiet sitting, four standard and three investigational BP measurements were taken with sixty seconds in between each measurement. The reference BP value was calculated by determining the average of the 2 standard BP measurements that bounded the investigational measurements. We thus determined 3 comparison pairs for each investigational device in each subject. We calculated the mean (SD) of the absolute difference between the respective investigational devices and the reference for SBP and DBP. Results: Data from 42 individuals was excluded because of variation in standard BP measurements per prespecified rules. Of 85 participants used for analysis, 36 (42%) were women, the mean (SD) age was 53 (21) years, 32 (38%) self-reported hypertension, and 97% of these (n = 31) reported taking antihypertensive medications. The average differences between the Everlast watch and reference were 16.9 (13.5) mm Hg for SBP and 8.3 (6.1) mm Hg for DBP. The average difference between the Bodimetrics performance monitor and the reference was 5.3 (4.7) mm Hg for SBP. Conclusions: The Everlast smartwatch and the BodiMetrics Performance Monitor we tested are not accurate enough to be used as BP measurement devices.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":" 10","pages":"211 - 215"},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1656991","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41311146","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 : 2019-08-08DOI: 10.1080/21548331.2019.1664883
F. Pakdil, Nasibeh Azadeh-Fard, A. E. Esatoğlu
ABSTRACT Objective: Monitoring length of stay (LOS) can help medical decision makers identify areas of potential improvements and improve resource management, which results in better quality of care for patients. This study aims to monitor process performance at hospitals by implementing a statistical process control (SPC) approach on LOS. Methods: The study focuses on diabetic inpatients admitted to hospitals in two national healthcare systems. The data used in this study were collected from two hospitals: (1) a 500-bed teaching hospital in Southwest Virginia in the U.S., and (2) a 1100-bed teaching and research hospital located in Ankara, Turkey. I-MR charts were used to analyze the datasets and monitor the variations of LOS. Results: The results of I-MR charts showed that LOS was longer in Turkey than the U.S. LOS was skewed toward minimum values in the U.S. whereas it was spread out in Turkey. The average LOS was 3.27 days (STD = 2.30) in the U.S. while it was 7.28 days (STD = 4.56) in Turkey. The differences in two national healthcare systems may be reflected in the LOS variable. Conclusion: This study implements a control chart-based approach to monitor LOS and detect prolonged hospitalization for diabetic patients. As presented in I-MR charts, there are abnormal LOS observations in each data set. The decision makers and caregivers must analyze I-MR charts to identify either common or special causes of variation. Each abnormal LOS requires a detailed patient-centric analysis. Care providers and decision makers can investigate the root causes of abnormal LOS for each patient by further exploring the characteristics of diabetic patients who had abnormal LOS at hospitals, such as age, preexisting conditions, or the type of medical procedure conducted on each patient.
{"title":"Monitoring length of stay through control charts: a comparative study of diabetic patients","authors":"F. Pakdil, Nasibeh Azadeh-Fard, A. E. Esatoğlu","doi":"10.1080/21548331.2019.1664883","DOIUrl":"https://doi.org/10.1080/21548331.2019.1664883","url":null,"abstract":"ABSTRACT Objective: Monitoring length of stay (LOS) can help medical decision makers identify areas of potential improvements and improve resource management, which results in better quality of care for patients. This study aims to monitor process performance at hospitals by implementing a statistical process control (SPC) approach on LOS. Methods: The study focuses on diabetic inpatients admitted to hospitals in two national healthcare systems. The data used in this study were collected from two hospitals: (1) a 500-bed teaching hospital in Southwest Virginia in the U.S., and (2) a 1100-bed teaching and research hospital located in Ankara, Turkey. I-MR charts were used to analyze the datasets and monitor the variations of LOS. Results: The results of I-MR charts showed that LOS was longer in Turkey than the U.S. LOS was skewed toward minimum values in the U.S. whereas it was spread out in Turkey. The average LOS was 3.27 days (STD = 2.30) in the U.S. while it was 7.28 days (STD = 4.56) in Turkey. The differences in two national healthcare systems may be reflected in the LOS variable. Conclusion: This study implements a control chart-based approach to monitor LOS and detect prolonged hospitalization for diabetic patients. As presented in I-MR charts, there are abnormal LOS observations in each data set. The decision makers and caregivers must analyze I-MR charts to identify either common or special causes of variation. Each abnormal LOS requires a detailed patient-centric analysis. Care providers and decision makers can investigate the root causes of abnormal LOS for each patient by further exploring the characteristics of diabetic patients who had abnormal LOS at hospitals, such as age, preexisting conditions, or the type of medical procedure conducted on each patient.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"196 - 202"},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1664883","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41340674","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 : 2019-08-08DOI: 10.1080/21548331.2019.1670476
Graham Hale, L. Sakkal, Taki Galanis
ABSTRACT Pylephlebitis is a rare condition that is characterized by an infected thrombus of the portal vein system and was traditionally associated with a high mortality rate prior to the introduction of antibiotics. This report details a 77-year-old Chinese male found to have a splenic vein thrombosis, Parvimonas micra bacteremia, and a polymicrobial splenic abscess. The patient was treated with abscess drainage and a 6 week course of intravenous antibiotics, and a direct oral anticoagulant, apixaban 2.5 mg twice daily. To our knowledge, this is the second documented case of pylephlebitis treated with apixaban. Here, we summarize our experience treating this case of pylephlebitis and briefly report on the existing body of literature.
{"title":"Pylephlebitis treated with apixaban","authors":"Graham Hale, L. Sakkal, Taki Galanis","doi":"10.1080/21548331.2019.1670476","DOIUrl":"https://doi.org/10.1080/21548331.2019.1670476","url":null,"abstract":"ABSTRACT Pylephlebitis is a rare condition that is characterized by an infected thrombus of the portal vein system and was traditionally associated with a high mortality rate prior to the introduction of antibiotics. This report details a 77-year-old Chinese male found to have a splenic vein thrombosis, Parvimonas micra bacteremia, and a polymicrobial splenic abscess. The patient was treated with abscess drainage and a 6 week course of intravenous antibiotics, and a direct oral anticoagulant, apixaban 2.5 mg twice daily. To our knowledge, this is the second documented case of pylephlebitis treated with apixaban. Here, we summarize our experience treating this case of pylephlebitis and briefly report on the existing body of literature.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"192 - 195"},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1670476","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48526461","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 : 2019-08-08DOI: 10.1080/21548331.2019.1674586
Charlene Kalani, Elizabeth Awudi, T. Alexander, G. Udeani, S. Surani
ABSTRACT Purpose: There is limited clinical data evaluating anticoagulation with the direct oral anticoagulants (DOACs) in morbidly obese patients. We sought to examine the efficacy in preventing stroke or other systemic embolic events and safety of apixaban, dabigatran, and rivaroxaban, in comparison to warfarin in patients with either a body-mass index (BMI) over 40 kg/m2 and/or a weight over 120 kg. Methods: After approval from IRB, we collected retrospective data from our institution’s records on 180 patients. We analyzed the rates of stroke and systemic embolic events as defined as ischemic stroke, pulmonary embolism (PE), deep vein thrombosis (DVT), and myocardial infarction (MI) as well as major bleeding in morbidly obese patients receiving apixaban, dabigatran, or rivaroxaban in comparison to warfarin for anticoagulation due to nonvalvular atrial fibrillation, postoperative thrombus prophylaxis, or DVT/PE treatment and/or reduction in risk for recurrence. Results: The final analysis included 90 patients in both arms. Fifty-two percent (n = 41) of patients in the DOAC group were on apixaban therapy, 12% (n = 11) on dabigatran, and 37% (n = 33) on rivaroxaban. The average BMI and weight in the DOAC group were 46.7 kg/m2 and 139.3 kg, respectively. In the warfarin group, average BMI and weight were 45.8 kg/m2 and 135.9 kg, respectively. There were 11 patients who developed a stroke or thromboembolic event in the DOAC group and 10 in the warfarin group (OR 1.11, 95% confidence interval [CI] 0.45–2.78; p = 0.82). The events in the DOAC group consisted of three patients who developed ischemic stroke, three patients who developed DVTs, one who developed a PE, and four patients who developed MIs. There were two major bleeding events in the DOAC group and three events in the warfarin group (p = 0.65). Conclusions: Anticoagulation therapy with DOACs in morbidly obese patients may be a safe and effective alternative to warfarin for prevention of stroke or systemic embolic events. However, additional studies are necessary to confirm these findings.
{"title":"Evaluation of the efficacy of direct oral anticoagulants (DOACs) in comparison to warfarin in morbidly obese patients","authors":"Charlene Kalani, Elizabeth Awudi, T. Alexander, G. Udeani, S. Surani","doi":"10.1080/21548331.2019.1674586","DOIUrl":"https://doi.org/10.1080/21548331.2019.1674586","url":null,"abstract":"ABSTRACT Purpose: There is limited clinical data evaluating anticoagulation with the direct oral anticoagulants (DOACs) in morbidly obese patients. We sought to examine the efficacy in preventing stroke or other systemic embolic events and safety of apixaban, dabigatran, and rivaroxaban, in comparison to warfarin in patients with either a body-mass index (BMI) over 40 kg/m2 and/or a weight over 120 kg. Methods: After approval from IRB, we collected retrospective data from our institution’s records on 180 patients. We analyzed the rates of stroke and systemic embolic events as defined as ischemic stroke, pulmonary embolism (PE), deep vein thrombosis (DVT), and myocardial infarction (MI) as well as major bleeding in morbidly obese patients receiving apixaban, dabigatran, or rivaroxaban in comparison to warfarin for anticoagulation due to nonvalvular atrial fibrillation, postoperative thrombus prophylaxis, or DVT/PE treatment and/or reduction in risk for recurrence. Results: The final analysis included 90 patients in both arms. Fifty-two percent (n = 41) of patients in the DOAC group were on apixaban therapy, 12% (n = 11) on dabigatran, and 37% (n = 33) on rivaroxaban. The average BMI and weight in the DOAC group were 46.7 kg/m2 and 139.3 kg, respectively. In the warfarin group, average BMI and weight were 45.8 kg/m2 and 135.9 kg, respectively. There were 11 patients who developed a stroke or thromboembolic event in the DOAC group and 10 in the warfarin group (OR 1.11, 95% confidence interval [CI] 0.45–2.78; p = 0.82). The events in the DOAC group consisted of three patients who developed ischemic stroke, three patients who developed DVTs, one who developed a PE, and four patients who developed MIs. There were two major bleeding events in the DOAC group and three events in the warfarin group (p = 0.65). Conclusions: Anticoagulation therapy with DOACs in morbidly obese patients may be a safe and effective alternative to warfarin for prevention of stroke or systemic embolic events. However, additional studies are necessary to confirm these findings.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"181 - 185"},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1674586","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47607790","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 : 2019-08-08DOI: 10.1080/21548331.2019.1677032
L. Lagunes, A. Rey-Pérez
ABSTRACT A high prevalence of invasive candidiasis has been reported in recent years. Patients admitted to an intensive care unit are at the highest risk for invasive candidiasis, mostly due to the severity of their disease, immune-suppressive states, prolonged length of stay, broad-spectrum antibiotics, septic shock, and Candida colonization. Intraabdominal candidiasis comprises a range of clinical manifestations, from just the suspicion based on clinical scenario to fever, leukocytosis, increase in biomarkers to the isolation of the responsible microorganism. In critically ill patients with IAC prompt treatment and adequate source control remains the ultimate goal.
{"title":"What´s new in intraabdominal candidiasis in critically ill patients, a review","authors":"L. Lagunes, A. Rey-Pérez","doi":"10.1080/21548331.2019.1677032","DOIUrl":"https://doi.org/10.1080/21548331.2019.1677032","url":null,"abstract":"ABSTRACT A high prevalence of invasive candidiasis has been reported in recent years. Patients admitted to an intensive care unit are at the highest risk for invasive candidiasis, mostly due to the severity of their disease, immune-suppressive states, prolonged length of stay, broad-spectrum antibiotics, septic shock, and Candida colonization. Intraabdominal candidiasis comprises a range of clinical manifestations, from just the suspicion based on clinical scenario to fever, leukocytosis, increase in biomarkers to the isolation of the responsible microorganism. In critically ill patients with IAC prompt treatment and adequate source control remains the ultimate goal.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"171 - 176"},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1677032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46989725","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}
Introducing a new hobby for other people may inspire them to join with you. Reading, as one of mutual hobby, is considered as the very easy hobby to do. But, many people are not interested in this hobby. Why? Boring is the reason of why. However, this feel actually can deal with the book and time of you reading. Yeah, one that we will refer to break the boredom in reading is choosing shrinks as the reading material.
{"title":"Shrinks.","authors":"H. J. Morowitz","doi":"10.2307/j.ctvh1dj1d.14","DOIUrl":"https://doi.org/10.2307/j.ctvh1dj1d.14","url":null,"abstract":"Introducing a new hobby for other people may inspire them to join with you. Reading, as one of mutual hobby, is considered as the very easy hobby to do. But, many people are not interested in this hobby. Why? Boring is the reason of why. However, this feel actually can deal with the book and time of you reading. Yeah, one that we will refer to break the boredom in reading is choosing shrinks as the reading material.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"14 5 1","pages":"141, 144"},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41599553","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 : 2019-05-27DOI: 10.1080/21548331.2019.1646060
A. Labaf, Mona Ghanbari, M. Jalili, H. Rafiemanesh, Alireza Baratloo
ABSTRACT Introduction: Currently in emergency department (ED) of educational medical centers of Iran there are generally two models for between unit hand-off process based on the time of transferring the responsibility (during stay vs. while departure). There is no comprehensive study available to compare the policies. Thus, the present qualitative study was designed to compare these two methods of hand-off via performing interviews by specialist physicians who involving the process in the hospitals to express the advantages and disadvantages of the two policies from their point of view. Methods: This qualitative study was done by using opinions of experts throughout 2015 and 2016. Interviews were performed using a one-on-one and in-depth semi-structured approach. Before asking the questions, the definitions of the two models of hand-off as well as the aims of the study were briefly explained to the interviewee. Thematic and content analysis strategies were used to identify core concepts and to develop categories. Qualitative content analytical approaches focus on analyzing both the explicit content of a text and the latent content that can be extrapolated from the text. Results: In the present study, a total of 25 individuals were interviewed. The mean age of the participants was 34 years and their mean working experience was 7 years. By analyzing the interviews performed, the results were categorized in four main themes including ‘resident training’, ‘patient management in ED’, ‘quality and process of diagnosis and treatment of patients’ and finally, ‘satisfaction with the process among specialist’. Conclusion: Although the two methods have advantages and disadvantages, it is likely that during stay, model was more favorable than while departure model from the viewpoints of interviewees. However, it seems that choosing any of the methods depends on various situations such as workload, academic matters, availability of resources, etc.
{"title":"Advantages and disadvantages of between unit hand-off policies in Iranian hospitals: a qualitative study","authors":"A. Labaf, Mona Ghanbari, M. Jalili, H. Rafiemanesh, Alireza Baratloo","doi":"10.1080/21548331.2019.1646060","DOIUrl":"https://doi.org/10.1080/21548331.2019.1646060","url":null,"abstract":"ABSTRACT Introduction: Currently in emergency department (ED) of educational medical centers of Iran there are generally two models for between unit hand-off process based on the time of transferring the responsibility (during stay vs. while departure). There is no comprehensive study available to compare the policies. Thus, the present qualitative study was designed to compare these two methods of hand-off via performing interviews by specialist physicians who involving the process in the hospitals to express the advantages and disadvantages of the two policies from their point of view. Methods: This qualitative study was done by using opinions of experts throughout 2015 and 2016. Interviews were performed using a one-on-one and in-depth semi-structured approach. Before asking the questions, the definitions of the two models of hand-off as well as the aims of the study were briefly explained to the interviewee. Thematic and content analysis strategies were used to identify core concepts and to develop categories. Qualitative content analytical approaches focus on analyzing both the explicit content of a text and the latent content that can be extrapolated from the text. Results: In the present study, a total of 25 individuals were interviewed. The mean age of the participants was 34 years and their mean working experience was 7 years. By analyzing the interviews performed, the results were categorized in four main themes including ‘resident training’, ‘patient management in ED’, ‘quality and process of diagnosis and treatment of patients’ and finally, ‘satisfaction with the process among specialist’. Conclusion: Although the two methods have advantages and disadvantages, it is likely that during stay, model was more favorable than while departure model from the viewpoints of interviewees. However, it seems that choosing any of the methods depends on various situations such as workload, academic matters, availability of resources, etc.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"78 3","pages":"155 - 162"},"PeriodicalIF":0.0,"publicationDate":"2019-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1646060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41249538","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 : 2019-05-27DOI: 10.1080/21548331.2019.1643728
N. Desai, David K. Cornutt
ABSTRACT Direct oral anticoagulants (DOACs) include dabigatran etexilate, a direct thrombin inhibitor, and specific inhibitors of activated coagulation factor X (FXa; e.g. apixaban, betrixaban, edoxaban, rivaroxaban). DOACs are associated with lower rates of major and fatal bleeding events compared with warfarin. Clinicians may need to achieve rapid reversal of anticoagulation effects of the DOACs in an emergency setting. Idarucizumab and andexanet alfa, which reverse the anticoagulant effects of dabigatran and FXa inhibitors, respectively, are DOAC reversal agents available in the US. Other reversal agents (e.g. ciraparantag for heparins, DOACs) are in development. Alternative nonspecific agents (e.g. fresh frozen plasma, prothrombin complex concentrate) are available. Nonspecific prohemostatic agents can counteract the anticoagulant action of DOACs in emergency situations, when specific reversal agents are unavailable. However, specific reversal agents are efficacious and safe and should be preferred when available. In this review, we discuss practical issues in the initiation of DOAC therapy, situations where reversal may be needed, coagulation assays, reversal agents, and post-reversal complications in the context of published evidence and guidelines.
{"title":"Reversal agents for direct oral anticoagulants: considerations for hospital physicians and intensivists","authors":"N. Desai, David K. Cornutt","doi":"10.1080/21548331.2019.1643728","DOIUrl":"https://doi.org/10.1080/21548331.2019.1643728","url":null,"abstract":"ABSTRACT Direct oral anticoagulants (DOACs) include dabigatran etexilate, a direct thrombin inhibitor, and specific inhibitors of activated coagulation factor X (FXa; e.g. apixaban, betrixaban, edoxaban, rivaroxaban). DOACs are associated with lower rates of major and fatal bleeding events compared with warfarin. Clinicians may need to achieve rapid reversal of anticoagulation effects of the DOACs in an emergency setting. Idarucizumab and andexanet alfa, which reverse the anticoagulant effects of dabigatran and FXa inhibitors, respectively, are DOAC reversal agents available in the US. Other reversal agents (e.g. ciraparantag for heparins, DOACs) are in development. Alternative nonspecific agents (e.g. fresh frozen plasma, prothrombin complex concentrate) are available. Nonspecific prohemostatic agents can counteract the anticoagulant action of DOACs in emergency situations, when specific reversal agents are unavailable. However, specific reversal agents are efficacious and safe and should be preferred when available. In this review, we discuss practical issues in the initiation of DOAC therapy, situations where reversal may be needed, coagulation assays, reversal agents, and post-reversal complications in the context of published evidence and guidelines.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"113 - 122"},"PeriodicalIF":0.0,"publicationDate":"2019-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1643728","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47293579","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 : 2019-05-27DOI: 10.1080/21548331.2019.1646074
J. Truchot, Karima Mezaïb, A. Ricard-Hibon, E. Vicaut, Y. Claessens, L. Soulat, J. Milon, A. Serrié, P. Plaisance
ABSTRACT Objective: To determine the mean number of procedural painful episodes per patient, and to retrieve information regarding diagnosis, therapeutic procedures and analgesic management, in patients visiting Emergency Departments (EDs) for minor trauma. Methods: This observational, non-interventional, multicenter study in adult patients was performed in 35 French EDs. All patients entering the EDs for minor trauma on a specified day between noon and 10 pm were registered; consenting patients were included in the study. Pain intensity was assessed using a verbal Numerical Rating Scale from 0 (no pain) to 10 (worst possible pain). An episode was described as painful if the difference in pain intensity between pain just before the procedure and maximal pain during the procedure was ≥2. Two independent nurses recorded data on 1 day in each center. Results: Overall, 909 patients were registered, 422 were included in the study, and complete data for 409 patients (1899 procedures) were available for analysis. The mean number of painful episodes per patient was 1.0 ± 1.3. Fifty-one percent of patients reported at least one painful procedure episode. Twenty-one percent of procedures were considered painful. Clinical examination was the procedure most often reported as painful. No preventive or curative analgesic treatment was reported in 95.1% of procedures. Conclusions: There is a need for improvement in routine pain assessment and, therefore, procedural pain management for ED patients. Specific protocols should be developed for procedural pain management, and teams should be trained especially for procedures usually not considered painful.
{"title":"Assessment of procedural pain in French emergency departments: a multi-site, non-interventional, transverse study in patients with minor trauma injury","authors":"J. Truchot, Karima Mezaïb, A. Ricard-Hibon, E. Vicaut, Y. Claessens, L. Soulat, J. Milon, A. Serrié, P. Plaisance","doi":"10.1080/21548331.2019.1646074","DOIUrl":"https://doi.org/10.1080/21548331.2019.1646074","url":null,"abstract":"ABSTRACT Objective: To determine the mean number of procedural painful episodes per patient, and to retrieve information regarding diagnosis, therapeutic procedures and analgesic management, in patients visiting Emergency Departments (EDs) for minor trauma. Methods: This observational, non-interventional, multicenter study in adult patients was performed in 35 French EDs. All patients entering the EDs for minor trauma on a specified day between noon and 10 pm were registered; consenting patients were included in the study. Pain intensity was assessed using a verbal Numerical Rating Scale from 0 (no pain) to 10 (worst possible pain). An episode was described as painful if the difference in pain intensity between pain just before the procedure and maximal pain during the procedure was ≥2. Two independent nurses recorded data on 1 day in each center. Results: Overall, 909 patients were registered, 422 were included in the study, and complete data for 409 patients (1899 procedures) were available for analysis. The mean number of painful episodes per patient was 1.0 ± 1.3. Fifty-one percent of patients reported at least one painful procedure episode. Twenty-one percent of procedures were considered painful. Clinical examination was the procedure most often reported as painful. No preventive or curative analgesic treatment was reported in 95.1% of procedures. Conclusions: There is a need for improvement in routine pain assessment and, therefore, procedural pain management for ED patients. Specific protocols should be developed for procedural pain management, and teams should be trained especially for procedures usually not considered painful.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"143 - 148"},"PeriodicalIF":0.0,"publicationDate":"2019-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1646074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48643065","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}
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