Pub Date : 2016-10-19DOI: 10.1080/21548331.2016.1260997
Tyler Webster, Prashant Vaishnava, K. Eagle
ABSTRACT Dual anti-platelet therapy denotes a regimen of aspirin plus a P2Y12 receptor inhibitor, clopidogrel, prasugrel, or ticagrelor. Such therapy is a cornerstone of medical management following acute coronary syndromes and is imperative following percutaneous coronary interventions. While there is uncertainty about the optimal duration of dual antiplatelet therapy following percutaneous coronary intervention, the new 2016 American College of Cardiology/American Heart Association Guidelines suggest that for patients with stable ischemic heart disease at least six months of such therapy following a drug eluting stent and one month following a bare metal stent should be implemented. In patients with acute coronary syndrome including non-ST elevation and ST elevation myocardial infarction it is recommended to extend dual antiplatelet therapy treatment to one year in both drug eluting stent and bare metal stent groups. There may be latitude for earlier discontinuation in appropriately selected patients; extended dual antiplatelet therapy beyond one year may be beneficial in others. Herein, we describe current guidelines and evidence supporting if and when dual antiplatelet therapy should be interrupted for surgery for patients who have undergone percutaneous coronary intervention.
{"title":"Perioperative management of dual anti-platelet therapy","authors":"Tyler Webster, Prashant Vaishnava, K. Eagle","doi":"10.1080/21548331.2016.1260997","DOIUrl":"https://doi.org/10.1080/21548331.2016.1260997","url":null,"abstract":"ABSTRACT Dual anti-platelet therapy denotes a regimen of aspirin plus a P2Y12 receptor inhibitor, clopidogrel, prasugrel, or ticagrelor. Such therapy is a cornerstone of medical management following acute coronary syndromes and is imperative following percutaneous coronary interventions. While there is uncertainty about the optimal duration of dual antiplatelet therapy following percutaneous coronary intervention, the new 2016 American College of Cardiology/American Heart Association Guidelines suggest that for patients with stable ischemic heart disease at least six months of such therapy following a drug eluting stent and one month following a bare metal stent should be implemented. In patients with acute coronary syndrome including non-ST elevation and ST elevation myocardial infarction it is recommended to extend dual antiplatelet therapy treatment to one year in both drug eluting stent and bare metal stent groups. There may be latitude for earlier discontinuation in appropriately selected patients; extended dual antiplatelet therapy beyond one year may be beneficial in others. Herein, we describe current guidelines and evidence supporting if and when dual antiplatelet therapy should be interrupted for surgery for patients who have undergone percutaneous coronary intervention.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"44 1","pages":"237 - 241"},"PeriodicalIF":0.0,"publicationDate":"2016-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2016.1260997","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60073654","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 : 2016-10-19DOI: 10.1080/21548331.2016.1265416
D. Celentani, M. di Cuia, M. Imazio, F. Gaita
ABSTRACT Pericardial diseases are relatively common in clinical practice either as isolated diseases or part of an underlying or systemic disease. Recent advances in the diagnosis and treatment have greatly improved the clinical management and lead to consensus documents on multimodality imaging and new guidelines on the diagnosis and therapy of pericardial diseases. The aim of the present paper is to summarize available evidence in order to provide an updated and comprehensive review on the recent advances in the management of pericardial diseases.
{"title":"Recent advances in the management of pericardial diseases","authors":"D. Celentani, M. di Cuia, M. Imazio, F. Gaita","doi":"10.1080/21548331.2016.1265416","DOIUrl":"https://doi.org/10.1080/21548331.2016.1265416","url":null,"abstract":"ABSTRACT Pericardial diseases are relatively common in clinical practice either as isolated diseases or part of an underlying or systemic disease. Recent advances in the diagnosis and treatment have greatly improved the clinical management and lead to consensus documents on multimodality imaging and new guidelines on the diagnosis and therapy of pericardial diseases. The aim of the present paper is to summarize available evidence in order to provide an updated and comprehensive review on the recent advances in the management of pericardial diseases.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"44 1","pages":"266 - 273"},"PeriodicalIF":0.0,"publicationDate":"2016-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2016.1265416","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60073675","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 : 2016-10-19DOI: 10.1080/21548331.2016.1259543
Colin T Iberti, A. Briones, Erin Gabriel, A. Dunn
ABSTRACT Objectives: Hospitalized vascular surgery patients have multiple severe comorbidities, poor functional status, and high perioperative cardiac risk. Thus they may be ideal patients for a collaborative care model. However, there is little evidence for a comanagement model on clinical outcomes. Methods: The two-year pre-post study consisted of a comanagement model where a hospitalist actively participated in the medical care of American Society of Anesthesiologist Physical Status Classification scale 3 or 4 vascular surgery patients. Outcomes were in-hospital mortality, length of stay, 30-day readmission rate, pain scores, and patient safety metrics. Results: With comanagement, patient complications decreased from 3.5 to 2.2 events per 1000 patients. (p = 0.045). Mortality decreased from 2.01% to 1.00% (p = 0.049), corresponding to a decrease in the risk-adjusted observed to expected mortality rate ratio from 1.22 to 0.53 (p = 0.01). Patient reported pain scores improved; more patients in the comanagement cohort expressed no pain (72% vs 82.8%; p = 0.01) and there were reductions in reports of mild and moderate pain. There was no significant difference in the risk-adjusted length of stay (observed to expected ratio 0.83 to 0.88 for the pre-intervention and comanagement groups, respectively, p = 0.48). The 30-day readmission rate was unchanged (21.9 vs 20.6% p = 0.44). Patients in the intervention period were more clinically complex, as evidenced by the greater case mix index (2.21 vs 2.44). Conclusions: After two years of implementation, our comanagement service reduced complications, mortality, and pain scores among high-risk vascular surgery patients.
目的:血管外科住院患者存在多种严重合并症，功能状态差，围手术期心脏风险高。因此，他们可能是合作护理模式的理想患者。然而，很少有证据表明临床结果的管理模式。方法:采用一名住院医师积极参与美国麻醉医师协会身体状态分类量表3、4例血管手术患者医疗护理的管理模式，进行为期两年的前后研究。结果包括住院死亡率、住院时间、30天再入院率、疼痛评分和患者安全指标。结果:通过管理，患者并发症从每1000例患者3.5例下降到2.2例。(p = 0.045)。死亡率从2.01%降至1.00% (p = 0.049)，对应于经风险调整的观察死亡率与预期死亡率之比从1.22降至0.53 (p = 0.01)。患者报告的疼痛评分改善;管理组中更多的患者没有疼痛(72% vs 82.8%;P = 0.01)，轻度和中度疼痛的报告有所减少。经风险调整后的住院时间没有显著差异(干预前组和管理组的观察比和预期比分别为0.83和0.88,p = 0.48)。30天再入院率不变(21.9 vs 20.6% p = 0.44)。干预期患者的临床复杂程度更高，病例混合指数更高(2.21 vs 2.44)。结论:经过两年的实施，我们的管理服务降低了高危血管手术患者的并发症、死亡率和疼痛评分。
{"title":"Hospitalist-vascular surgery comanagement: effects on complications and mortality","authors":"Colin T Iberti, A. Briones, Erin Gabriel, A. Dunn","doi":"10.1080/21548331.2016.1259543","DOIUrl":"https://doi.org/10.1080/21548331.2016.1259543","url":null,"abstract":"ABSTRACT Objectives: Hospitalized vascular surgery patients have multiple severe comorbidities, poor functional status, and high perioperative cardiac risk. Thus they may be ideal patients for a collaborative care model. However, there is little evidence for a comanagement model on clinical outcomes. Methods: The two-year pre-post study consisted of a comanagement model where a hospitalist actively participated in the medical care of American Society of Anesthesiologist Physical Status Classification scale 3 or 4 vascular surgery patients. Outcomes were in-hospital mortality, length of stay, 30-day readmission rate, pain scores, and patient safety metrics. Results: With comanagement, patient complications decreased from 3.5 to 2.2 events per 1000 patients. (p = 0.045). Mortality decreased from 2.01% to 1.00% (p = 0.049), corresponding to a decrease in the risk-adjusted observed to expected mortality rate ratio from 1.22 to 0.53 (p = 0.01). Patient reported pain scores improved; more patients in the comanagement cohort expressed no pain (72% vs 82.8%; p = 0.01) and there were reductions in reports of mild and moderate pain. There was no significant difference in the risk-adjusted length of stay (observed to expected ratio 0.83 to 0.88 for the pre-intervention and comanagement groups, respectively, p = 0.48). The 30-day readmission rate was unchanged (21.9 vs 20.6% p = 0.44). Patients in the intervention period were more clinically complex, as evidenced by the greater case mix index (2.21 vs 2.44). Conclusions: After two years of implementation, our comanagement service reduced complications, mortality, and pain scores among high-risk vascular surgery patients.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"44 1","pages":"233 - 236"},"PeriodicalIF":0.0,"publicationDate":"2016-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2016.1259543","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60073999","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 : 2016-10-19DOI: 10.1080/21548331.2016.1258292
A. Amin
ABSTRACT Cryptogenic strokes are responsible for significant morbidity and mortality. Identifying the underlying cause of cryptogenic stroke is imperative for appropriate short and long-term management of these patients. In particular, detecting atrial fibrillation in cryptogenic stroke patients may shed insight into the cause of the index stroke, but is also important to identify an important cause of secondary stroke. There is accumulating evidence indicating that monitoring for durations beyond the guideline recommended 30 day-period results in greater atrial fibrillation yield. This article reviews current guidelines and practices for the diagnosis of cryptogenic stroke, as well as outpatient cardiac monitoring options available, and focuses on the role that hospitalists have to play in the care of these patients.
{"title":"Role of hospitalists in the diagnosis of atrial fibrillation for the management of cryptogenic stroke patients","authors":"A. Amin","doi":"10.1080/21548331.2016.1258292","DOIUrl":"https://doi.org/10.1080/21548331.2016.1258292","url":null,"abstract":"ABSTRACT Cryptogenic strokes are responsible for significant morbidity and mortality. Identifying the underlying cause of cryptogenic stroke is imperative for appropriate short and long-term management of these patients. In particular, detecting atrial fibrillation in cryptogenic stroke patients may shed insight into the cause of the index stroke, but is also important to identify an important cause of secondary stroke. There is accumulating evidence indicating that monitoring for durations beyond the guideline recommended 30 day-period results in greater atrial fibrillation yield. This article reviews current guidelines and practices for the diagnosis of cryptogenic stroke, as well as outpatient cardiac monitoring options available, and focuses on the role that hospitalists have to play in the care of these patients.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"44 1","pages":"274 - 278"},"PeriodicalIF":0.0,"publicationDate":"2016-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2016.1258292","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60073988","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 : 2016-10-19DOI: 10.1080/21548331.2016.1254559
M. Beck, Davin Okerblom, Anika Kumar, S. Bandyopadhyay, L. Scalzi
ABSTRACT Objective: To determine if a lean intervention improved emergency department (ED) throughput and reduced ED boarding by improving patient discharge efficiency from a tertiary care children’s hospital. Methods: The study was conducted at a tertiary care children’s hospital to study the impact lean that changes made to an inpatient pediatric service line had on ED efficiency. Discharge times from the general pediatrics’ service were compared to patients discharged from all other pediatric subspecialty services. The intervention was multifaceted. First, team staffing reconfiguration permitted all discharge work to be done at the patient’s bedside using a new discharge checklist. The intervention also incorporated an afternoon interdisciplinary huddle to work on the following day’s discharges. Retrospectively, we determined the impact this had on median times of discharge order entry, patient discharge, and percent of patients discharged before noon. As a marker of ED throughput, we determined median hour of day that admitted patients left the ED to move to their hospital bed. As marker of ED congestion we determined median boarding times. Results: For the general pediatrics service line, the median discharge order entry time decreased from 1:43pm to 11:28am (p < 0.0001) and the median time of discharge decreased from 3:25pm to 2:25pm (p < 0.0001). The percent of patients discharged before noon increased from 14.0% to 26.0% (p < 0.0001). The discharge metrics remained unchanged for the pediatric subspecialty services group. Median ED boarding time decreased by 49 minutes (p < 0.0001). As a result, the median time of day admitted patients were discharged from the ED was advanced from 5 PM to 4 PM. Conclusion: Lean principles implemented by one hospital service line improved patient discharge times enhanced patient ED throughput, and reduced ED boarding times.
{"title":"Lean intervention improves patient discharge times, improves emergency department throughput and reduces congestion","authors":"M. Beck, Davin Okerblom, Anika Kumar, S. Bandyopadhyay, L. Scalzi","doi":"10.1080/21548331.2016.1254559","DOIUrl":"https://doi.org/10.1080/21548331.2016.1254559","url":null,"abstract":"ABSTRACT Objective: To determine if a lean intervention improved emergency department (ED) throughput and reduced ED boarding by improving patient discharge efficiency from a tertiary care children’s hospital. Methods: The study was conducted at a tertiary care children’s hospital to study the impact lean that changes made to an inpatient pediatric service line had on ED efficiency. Discharge times from the general pediatrics’ service were compared to patients discharged from all other pediatric subspecialty services. The intervention was multifaceted. First, team staffing reconfiguration permitted all discharge work to be done at the patient’s bedside using a new discharge checklist. The intervention also incorporated an afternoon interdisciplinary huddle to work on the following day’s discharges. Retrospectively, we determined the impact this had on median times of discharge order entry, patient discharge, and percent of patients discharged before noon. As a marker of ED throughput, we determined median hour of day that admitted patients left the ED to move to their hospital bed. As marker of ED congestion we determined median boarding times. Results: For the general pediatrics service line, the median discharge order entry time decreased from 1:43pm to 11:28am (p < 0.0001) and the median time of discharge decreased from 3:25pm to 2:25pm (p < 0.0001). The percent of patients discharged before noon increased from 14.0% to 26.0% (p < 0.0001). The discharge metrics remained unchanged for the pediatric subspecialty services group. Median ED boarding time decreased by 49 minutes (p < 0.0001). As a result, the median time of day admitted patients were discharged from the ED was advanced from 5 PM to 4 PM. Conclusion: Lean principles implemented by one hospital service line improved patient discharge times enhanced patient ED throughput, and reduced ED boarding times.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"44 1","pages":"252 - 259"},"PeriodicalIF":0.0,"publicationDate":"2016-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2016.1254559","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60073502","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 : 2016-03-14DOI: 10.1080/21548331.2016.1159908
Bhuvanesh Govind, E. Gnass, G. Merli, L. Eraso
ABSTRACT Heparin is one of the most widely prescribed medications. Cutaneous reactions distant to the injection site are rare and under-reported in the literature. We present an elderly man with history of CNS lymphoma who underwent treatment of a deep venous thrombosis with enoxaparin and subsequently developed well demarcated bullous lesions within days of heparin initiation. The exact pathophysiology is not well understood. Hemorrhagic bullous dermatosis is a rare cutaneous reaction that is temporally associated with the initiation of heparin products. The handful of cases thus far suggest that regression of these seemingly benign lesions may or may not be associated with dose reduction or discontinuation of heparin products and typically occur within a few weeks. Elderly age appears to be one potential risk factor for development of these rare asymptomatic lesions. Malignancy may have some contributing factor and differentiation between this rare cutaneous manifestation from heparin products and other dermatological findings in patients with malignancy is key. Because of the asymptomatic and self-limiting nature of hemorrhagic bullous dermatoses in the setting of heparin product use, we presume that the reported incidence does not reflect true clinical practice.
{"title":"Hemorrhagic bullous dermatosis: a rare heparin-induced cutaneous manifestation","authors":"Bhuvanesh Govind, E. Gnass, G. Merli, L. Eraso","doi":"10.1080/21548331.2016.1159908","DOIUrl":"https://doi.org/10.1080/21548331.2016.1159908","url":null,"abstract":"ABSTRACT Heparin is one of the most widely prescribed medications. Cutaneous reactions distant to the injection site are rare and under-reported in the literature. We present an elderly man with history of CNS lymphoma who underwent treatment of a deep venous thrombosis with enoxaparin and subsequently developed well demarcated bullous lesions within days of heparin initiation. The exact pathophysiology is not well understood. Hemorrhagic bullous dermatosis is a rare cutaneous reaction that is temporally associated with the initiation of heparin products. The handful of cases thus far suggest that regression of these seemingly benign lesions may or may not be associated with dose reduction or discontinuation of heparin products and typically occur within a few weeks. Elderly age appears to be one potential risk factor for development of these rare asymptomatic lesions. Malignancy may have some contributing factor and differentiation between this rare cutaneous manifestation from heparin products and other dermatological findings in patients with malignancy is key. Because of the asymptomatic and self-limiting nature of hemorrhagic bullous dermatoses in the setting of heparin product use, we presume that the reported incidence does not reflect true clinical practice.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"27 1","pages":"103 - 107"},"PeriodicalIF":0.0,"publicationDate":"2016-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2016.1159908","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60073286","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 : 2016-03-14DOI: 10.1080/21548331.2016.1166922
P. Barbour, Jill Arroyo, Star High, Lisa B Fichera, Marie M Staska-Pier, Mary Kay McMahon
ABSTRACT Objectives: We set out to demonstrate the benefits of providing long-term care via telehealth for patients with Parkinson’s disease living in continuous care facilities. Methods: A cohort of 16 patients with Parkinson’s disease residing at one of 2 locations of a multi-facility continuous care retirement organization were seen virtually in follow-up over a 3-year period by Telehealth Services at a large, academic, tertiary care hospital in southeastern Pennsylvania. The data collected during that period, studied retrospectively, included demographic information, number of telehealth visits, and UPDRS scores obtained at each visit. Satisfaction and potential cost savings were also reviewed. Results: UPDRS scores declined over the period of observation, from a range of 18-60 at study start to 28-72 at study end. Actual cost savings are difficult to define; however, the cost per telehealth visit at $117.30 was often lower than the facility’s average cost for transporting patients to a visit in the neurologist’s office. Patients, families, subspecialists, and the nursing staff expressed uniformly high satisfaction with telehealth. Conclusion: This model for providing care proved to be sustainable and efficient, and promoted collaboration among the providers at the long-term care facility and those at the remote site. These benefits may be applicable to patients with degenerative disorders in similar settings.
{"title":"Telehealth for patients with Parkinson’s disease: delivering efficient and sustainable long-term care","authors":"P. Barbour, Jill Arroyo, Star High, Lisa B Fichera, Marie M Staska-Pier, Mary Kay McMahon","doi":"10.1080/21548331.2016.1166922","DOIUrl":"https://doi.org/10.1080/21548331.2016.1166922","url":null,"abstract":"ABSTRACT Objectives: We set out to demonstrate the benefits of providing long-term care via telehealth for patients with Parkinson’s disease living in continuous care facilities. Methods: A cohort of 16 patients with Parkinson’s disease residing at one of 2 locations of a multi-facility continuous care retirement organization were seen virtually in follow-up over a 3-year period by Telehealth Services at a large, academic, tertiary care hospital in southeastern Pennsylvania. The data collected during that period, studied retrospectively, included demographic information, number of telehealth visits, and UPDRS scores obtained at each visit. Satisfaction and potential cost savings were also reviewed. Results: UPDRS scores declined over the period of observation, from a range of 18-60 at study start to 28-72 at study end. Actual cost savings are difficult to define; however, the cost per telehealth visit at $117.30 was often lower than the facility’s average cost for transporting patients to a visit in the neurologist’s office. Patients, families, subspecialists, and the nursing staff expressed uniformly high satisfaction with telehealth. Conclusion: This model for providing care proved to be sustainable and efficient, and promoted collaboration among the providers at the long-term care facility and those at the remote site. These benefits may be applicable to patients with degenerative disorders in similar settings.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"44 1","pages":"92 - 97"},"PeriodicalIF":0.0,"publicationDate":"2016-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2016.1166922","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60073482","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 : 2016-03-02DOI: 10.1080/21548331.2016.1155396
C. Harris, L. Cheskin, W. Khaliq, Denis G. Antoine, R. Landis, Emma M. Steinberg, S. Wright
ABSTRACT Objectives: Obesity affects a large proportion of the U.S. population, and hospitalizations may serve as an opportunity to promote weight loss. We sought to determine if multidisciplinary patient-centered inpatient weight loss intervention that included counseling, consults, post-discharge telephone text messages, and primary care follow up was feasible. Methods: We conducted a feasibility study focusing on 25 obese hospitalized patients to understand the issues related to rolling out an intensive intervention. Actual weight loss was a secondary outcome and we compared these 25 patients to 28 control patients who were exposed to usual care; weight change was assessed at 1 and 6 months. Results: Ninety-six percent (24/25) of nutritional consults and 92% (23/25) of physical therapy consults were submitted by hospital providers. All of these doctors were also reminded to counsel their patients about the detrimental health consequences. Fifty-two percent (13/25) and 40% (10/25) were actually seen and counseled by nutrition and physical therapy services respectively, before being discharged. Sixty-eight percent (17/25) received a motivational interviewing counseling session from the principal investigator. All patients were sent text messages and followed with their primary care provider after discharge who received the personalized weight loss discharge instructions that had been given to the patient. The feasibility group lost a mean of 3.0 kg at 6 months and the control group gained an average of 0.20 kg at 6 months post discharge (p = 0.03). Conclusion: Executing a multifaceted weight loss intervention for hospitalized obese patients is feasible, and there may be associated persistent improvements in weight status over time.
【摘要】目的:肥胖影响了很大一部分美国人口，住院治疗可能是促进减肥的一个机会。我们试图确定多学科的以患者为中心的住院患者减肥干预，包括咨询、会诊、出院后电话短信和初级保健随访是否可行。方法:我们对25例肥胖住院患者进行了可行性研究，以了解开展强化干预的相关问题。实际体重减轻是次要结果，我们将这25名患者与28名接受常规护理的对照患者进行比较;在1个月和6个月时评估体重变化。结果:96%(24/25)的营养咨询和92%(23/25)的物理治疗咨询由医院提供者提交。所有这些医生还被提醒要就有害健康的后果向病人提出咨询。52%(13/25)和40%(10/25)的患者在出院前分别接受了营养和物理治疗服务的咨询。68%(17/25)接受了主要研究者的动机性访谈咨询。所有患者都收到了短信，出院后，他们的初级保健提供者收到了发给患者的个性化减肥出院指示。可行性组患者出院后6个月平均体重减轻3.0 kg，对照组患者出院后6个月平均体重增加0.20 kg (p = 0.03)。结论:对住院肥胖患者实施多方面的减肥干预是可行的，并且随着时间的推移，体重状况可能会有持续的改善。
{"title":"Hospitalists’ utilization of weight loss resources with discharge texts and primary care contact: a feasibility study","authors":"C. Harris, L. Cheskin, W. Khaliq, Denis G. Antoine, R. Landis, Emma M. Steinberg, S. Wright","doi":"10.1080/21548331.2016.1155396","DOIUrl":"https://doi.org/10.1080/21548331.2016.1155396","url":null,"abstract":"ABSTRACT Objectives: Obesity affects a large proportion of the U.S. population, and hospitalizations may serve as an opportunity to promote weight loss. We sought to determine if multidisciplinary patient-centered inpatient weight loss intervention that included counseling, consults, post-discharge telephone text messages, and primary care follow up was feasible. Methods: We conducted a feasibility study focusing on 25 obese hospitalized patients to understand the issues related to rolling out an intensive intervention. Actual weight loss was a secondary outcome and we compared these 25 patients to 28 control patients who were exposed to usual care; weight change was assessed at 1 and 6 months. Results: Ninety-six percent (24/25) of nutritional consults and 92% (23/25) of physical therapy consults were submitted by hospital providers. All of these doctors were also reminded to counsel their patients about the detrimental health consequences. Fifty-two percent (13/25) and 40% (10/25) were actually seen and counseled by nutrition and physical therapy services respectively, before being discharged. Sixty-eight percent (17/25) received a motivational interviewing counseling session from the principal investigator. All patients were sent text messages and followed with their primary care provider after discharge who received the personalized weight loss discharge instructions that had been given to the patient. The feasibility group lost a mean of 3.0 kg at 6 months and the control group gained an average of 0.20 kg at 6 months post discharge (p = 0.03). Conclusion: Executing a multifaceted weight loss intervention for hospitalized obese patients is feasible, and there may be associated persistent improvements in weight status over time.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"44 1","pages":"102 - 98"},"PeriodicalIF":0.0,"publicationDate":"2016-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2016.1155396","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60073155","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 : 2016-02-29DOI: 10.1080/21548331.2016.1149015
L. Shovel, Bryan Max, D. Correll
ABSTRACT Objectives: The purpose of this study was to see if an instructional card, attached to the PCA machine following total hip arthroplasty describing proper use of the device, would positively affect subjects’ understanding of device usage, pain scores, pain medication consumption and satisfaction. Methods: Eighty adults undergoing total hip replacements who had been prescribed PCA were randomized into two study groups. Forty participants received the standard post-operative instruction on PCA device usage at our institution. The other 40 participants received the standard of care in addition to being given a typed instructional card immediately post-operatively, describing proper PCA device use. This card was attached to the PCA device during their recovery period. On post-operative day one, each patient completed a questionnaire on PCA usage, pain scores and satisfaction scores. Results: The pain scores in the Instructional Card group were significantly lower than the Control group (p = 0.024). Subjects’ understanding of PCA usage was also improved in the Instructional Card group for six of the seven questions asked. Conclusion: The findings from this study strongly support that postoperative patient information on proper PCA use by means of an instructional card improves pain control and hence the overall recovery for patients undergoing surgery. In addition, through improved understanding it adds an important safety feature in that patients and potentially their family members and/or friends may refrain from PCA-by-proxy. This article demonstrates that the simple intervention of adding an instructional card to a PCA machine is an effective method to improve patients’ knowledge as well as pain control and potentially increase the safety of the device use.
{"title":"Increasing patient knowledge on the proper usage of a PCA machine with the use of a post-operative instructional card","authors":"L. Shovel, Bryan Max, D. Correll","doi":"10.1080/21548331.2016.1149015","DOIUrl":"https://doi.org/10.1080/21548331.2016.1149015","url":null,"abstract":"ABSTRACT Objectives: The purpose of this study was to see if an instructional card, attached to the PCA machine following total hip arthroplasty describing proper use of the device, would positively affect subjects’ understanding of device usage, pain scores, pain medication consumption and satisfaction. Methods: Eighty adults undergoing total hip replacements who had been prescribed PCA were randomized into two study groups. Forty participants received the standard post-operative instruction on PCA device usage at our institution. The other 40 participants received the standard of care in addition to being given a typed instructional card immediately post-operatively, describing proper PCA device use. This card was attached to the PCA device during their recovery period. On post-operative day one, each patient completed a questionnaire on PCA usage, pain scores and satisfaction scores. Results: The pain scores in the Instructional Card group were significantly lower than the Control group (p = 0.024). Subjects’ understanding of PCA usage was also improved in the Instructional Card group for six of the seven questions asked. Conclusion: The findings from this study strongly support that postoperative patient information on proper PCA use by means of an instructional card improves pain control and hence the overall recovery for patients undergoing surgery. In addition, through improved understanding it adds an important safety feature in that patients and potentially their family members and/or friends may refrain from PCA-by-proxy. This article demonstrates that the simple intervention of adding an instructional card to a PCA machine is an effective method to improve patients’ knowledge as well as pain control and potentially increase the safety of the device use.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"44 1","pages":"71 - 75"},"PeriodicalIF":0.0,"publicationDate":"2016-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2016.1149015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60072793","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 : 2016-02-22DOI: 10.1080/21548331.2016.1149016
Caroline Facey, D. Brooks, J. Boland
ABSTRACT Background: The most dangerous adverse effect of opioids is respiratory depression. Naloxone is used to reverse this, although in patients receiving long-term opioid therapy it can cause acute opioid withdrawal and opioid-refractory pain. Objective: To determine if naloxone is appropriately administered to patients receiving long-term opioid therapy. Methods: This retrospective case series based on chart reviews systematically identified patients over one year in a district general hospital. All patients aged 18 years or older receiving long-term opioid therapy admitted to medicine, surgery or the high dependency unit who were administered naloxone during their admission were included. Results: A total of 1206 patient drug administration records were reviewed. Sixteen patients receiving long-term opioid therapy were administered naloxone. Twelve of these did not have opioid-induced respiratory depression and four did not have respiratory rate and oxygen saturations documented in the medical notes. All naloxone doses administered were higher than those recommended by national guidelines for this patient group. Conclusions: No patient receiving long-term opioid therapy who was administered naloxone had evidence of respiratory depression. More thorough assessment and documentation are needed. Verbal and physical stimulation as well as oxygenation should be considered prior to naloxone administration; this should be followed by close observation, hydration, renal function tests and opioid dose review.
{"title":"Assessment of the appropriateness of naloxone administration to patients receiving long-term opioid therapy","authors":"Caroline Facey, D. Brooks, J. Boland","doi":"10.1080/21548331.2016.1149016","DOIUrl":"https://doi.org/10.1080/21548331.2016.1149016","url":null,"abstract":"ABSTRACT Background: The most dangerous adverse effect of opioids is respiratory depression. Naloxone is used to reverse this, although in patients receiving long-term opioid therapy it can cause acute opioid withdrawal and opioid-refractory pain. Objective: To determine if naloxone is appropriately administered to patients receiving long-term opioid therapy. Methods: This retrospective case series based on chart reviews systematically identified patients over one year in a district general hospital. All patients aged 18 years or older receiving long-term opioid therapy admitted to medicine, surgery or the high dependency unit who were administered naloxone during their admission were included. Results: A total of 1206 patient drug administration records were reviewed. Sixteen patients receiving long-term opioid therapy were administered naloxone. Twelve of these did not have opioid-induced respiratory depression and four did not have respiratory rate and oxygen saturations documented in the medical notes. All naloxone doses administered were higher than those recommended by national guidelines for this patient group. Conclusions: No patient receiving long-term opioid therapy who was administered naloxone had evidence of respiratory depression. More thorough assessment and documentation are needed. Verbal and physical stimulation as well as oxygenation should be considered prior to naloxone administration; this should be followed by close observation, hydration, renal function tests and opioid dose review.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"44 1","pages":"86 - 91"},"PeriodicalIF":0.0,"publicationDate":"2016-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2016.1149016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60072937","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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