Hospital practice最新文献

{"title":"Do we really know how much we are feeding our patients?","authors":"Susan L. Gonya, M. Baram","doi":"10.1080/21548331.2015.1115714","DOIUrl":"https://doi.org/10.1080/21548331.2015.1115714","url":null,"abstract":"Abstract Background: Nutrition support is important in critical illness, and accurate recording is particularly important to determine whether nutritional goals are met both from a caloric and volume perspective. Objective: To assess accuracy of enteral feeding records, to increase nursing education and to improve nutritional documentation. Methods: An uncontrolled, prospective, pre- and post-intervention study was completed as part of a quality improvement initiative. This study was performed in a 950-bed university hospital (Philadelphia, Pennsylvania) and focused in a 25-bed, closed intensive care unit (ICU) with a multidisciplinary rounding team of intensivist, nurse, pharmacist, dietitian and respiratory therapist. Nurse researchers reviewed 188 patient electronic medical records (EMR) and compared the data to volume data saved on enteral feeding pump. Data analysis revealed inconsistencies between the pump readings and EMR. The need for a prospective intervention was recognized and implementation of this intervention included pump calibration and teaching modules aimed at improving enteral feeding protocols. During post-intervention, another 234 records were reviewed. Results: The intervention of an education program reduced the documented discrepancy between the pump readings and charted volumes from 44 to 33%. A correlation analysis also showed a tighter relationship post-intervention (rpost = 0.84 vs. rpre = 0.76, both had a p < 0.01). Conclusion: This study highlights the importance of accurate nutritional monitoring in the ICU and demonstrates that educational interventions can improve enteral feeding protocols. Pump calibrations, frequent interrogation and vigilant nutritional documentation can improve enteral nutrition delivery. Future studies are needed to determine if the effects are sustainable and if further education will further improve documentation and delivery.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"43 1","pages":"277 - 283"},"PeriodicalIF":0.0,"publicationDate":"2015-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2015.1115714","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60072321","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}

{"title":"The use of volume-assured pressure support noninvasive ventilation in acute and chronic respiratory failure: a practical guide and literature review","authors":"Mark Pluym, Asad Kabir, A. Gohar","doi":"10.1080/21548331.2015.1110475","DOIUrl":"https://doi.org/10.1080/21548331.2015.1110475","url":null,"abstract":"Abstract Noninvasive positive pressure ventilation (NPPV) is an important tool in the management of acute and chronic respiratory failure. Traditionally, continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP) have been the most commonly utilized modes for these purposes. Newer hybrid modes of NPPV, such as average volume-assured pressure support (VAPS), combine the properties of both volume- and pressure-controlled NPPV and represent another tool in the treatment of acute and chronic respiratory failure. Evidence demonstrating the superiority of VAPS over BPAP is sparse, but there have been studies that have demonstrated comparable efficacy between the two modes. The use of VAPS in acute hypercapnic respiratory failure has shown better clearance of CO2 compared to BPAP, due to its property of delivering a more assured tidal volume. This, however, did not lead to a decrease in hospital-days or improved mortality, relative to BPAP. The studies evaluating VAPS for chronic respiratory failure involve small sample sizes but have shown some promise. The benefits noted with VAPS, however, did not translate into increased survival, decreased hospitalizations or improved quality of life compared to BPAP. The limited evidence available suggests that VAPS is equally effective in treating acute and chronic respiratory failure compared to BPAP. Overall, the evidence to suggest superiority of one mode over the other is lacking. There is a need for larger studies before firm conclusions can be made.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"43 1","pages":"299 - 307"},"PeriodicalIF":0.0,"publicationDate":"2015-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2015.1110475","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60072271","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}

{"title":"Current and developing strategies for monitoring and reversing direct oral anticoagulants in patients with non-valvular atrial fibrillation","authors":"A. Sarma, R. Giugliano","doi":"10.1080/21548331.2015.1103190","DOIUrl":"https://doi.org/10.1080/21548331.2015.1103190","url":null,"abstract":"Abstract Objective: In light of the increasing clinical utilization of the direct oral anticoagulants (DOACs) among patients with non-valvular atrial fibrillation, this review evaluates strategies for monitoring and reversing the anticoagulant effect of these agents. Methods: We summarize the data currently available for laboratory monitoring and reversal of DOACs. Relevant literature was identified using search terms pertaining to oral anticoagulants, reversal agents, and laboratory monitoring using Pubmed, clinicaltrials.gov, and abstracts from recent major cardiovascular meetings. Results: Significant user appeal for the DOACs stems from the reliable pharmacokinetics of these agents, which render routine laboratory monitoring unnecessary for general use, as well as lower rates of bleeding as compared to warfarin. However, readily available laboratory tests have not been clinically validated for use with these agents. The ability to measure the anticoagulant effect of a DOAC in selected situations (e.g. serious bleeding, overanticoagulation, emergent procedures, and compliance monitoring) remains an unmet clinical need. Further, there is a paucity of data to guide treatment in patients receiving DOACs who experience a serious hemorrhage. Conclusion: While evidence-based recommendations cannot be definitively provided for management of DOAC-related bleeding events at present, several targeted reversal agents are currently in development, and hold promise for solving this important clinical problem.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"43 1","pages":"258 - 267"},"PeriodicalIF":0.0,"publicationDate":"2015-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2015.1103190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60071721","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}

{"title":"Cost-effectiveness of edoxaban for the treatment of venous thromboembolism based on the Hokusai-VTE study","authors":"R. Preblick, W. Jacqueline Kwong, Richard H. White, Samuel Z. Goldhaber","doi":"10.1080/21548331.2015.1099412","DOIUrl":"https://doi.org/10.1080/21548331.2015.1099412","url":null,"abstract":"Abstract Objective: Venous thromboembolism (VTE) is associated with almost 300,000 deaths per year in the United States. Novel oral anticoagulants (NOACs) offer an alternative to warfarin-based therapy without monitoring requirements and with fewer drug and food interactions. Edoxaban, a direct Xa inhibitor, is approved by the Food and Drug Administration (FDA), based upon results of the Hokusai-VTE Phase 3 trial. The trial demonstrated that edoxaban administered once daily after initial treatment with heparin was non-inferior in reducing the risk of VTE recurrence and caused significantly less major and clinically relevant non-major (CRNM) bleeding compared to warfarin. The objective of this study was to evaluate the cost-effectiveness of edoxaban versus warfarin for the treatment of adults with VTE. Methods: A cost-effectiveness model was developed using patient-level data from the Hokusai-VTE trial, clinical event costs from real-world databases, and drug acquisition costs for warfarin of $0.36 and edoxaban of $9.24 per tablet. Results: From a U.S. health-care delivery system perspective, the incremental cost-effectiveness ratio (ICER) was $22,057 per quality adjusted life year (QALY) gained. Probabilistic sensitivity analysis showed that edoxaban had an ICER <$50,000 per QALY gained relative to warfarin in 67% of model simulations. The result was robust to variation in key model parameters including the cost and disutility of warfarin monitoring. Conclusion: Despite its higher drug acquisition cost, edoxaban is a cost-effective alternative to warfarin for the treatment of VTE.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"43 1","pages":"249 - 257"},"PeriodicalIF":0.0,"publicationDate":"2015-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2015.1099412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60071984","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}

{"title":"Risk assessment scores for patients with upper gastrointestinal bleeding and their use in clinical practice","authors":"K. Waddell, A. Stanley","doi":"10.1080/21548331.2015.1103636","DOIUrl":"https://doi.org/10.1080/21548331.2015.1103636","url":null,"abstract":"Abstract Upper gastrointestinal bleeding (UGIB) is a common cause for emergency admission to hospital representing a significant clinical as well as economic burden. UGIB encompasses a wide range of severities from life-threatening exsanguination to minor bleeding that may not require hospital admission. Patients with UGIB are often initially assessed and managed by junior doctors and non-gastroenterologists. Several risk scores have been created for the assessment of these patients, some requiring endoscopic data for calculation and others that are calculable from clinical data alone. A key question in clinical practice is how to accurately identify patients with UGIB at high risk of adverse outcome. Patients considered high risk are more likely to experience adverse outcomes and will require urgent intervention. In contrast, those patients with UGIB who are considered to be low risk could potentially be managed on an outpatient basis. The Glasgow Blatchford Score (GBS) appears best at identifying patients at low risk of requiring intervention or death and therefore may be best for use in clinical practice, allowing outpatient management in low risk cases. There has been some debate as to the optimal GBS cut-off score for safely identifying this low-risk group. Many guidelines suggest that patients with a GBS of zero can be safely managed as outpatients, but more recent studies have suggested that this threshold could potentially be safely increased to ≤1. Most other patients require inpatient endoscopy within 24 h and the full Rockall score remains important for risk assessment following endoscopy, particularly as it includes the endoscopic diagnosis. A minority of patients will require emergency endoscopy following resuscitation, but at present there is no evidence that risk scores can accurately identify this very high-risk group. Studies have shown the latest risk assessment score, the AIMS65, looks promising in the prediction of mortality. However, to date there is no data on the use of the AIMS65 in identifying low risk patients for possible outpatient management.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"43 1","pages":"290 - 298"},"PeriodicalIF":0.0,"publicationDate":"2015-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2015.1103636","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60072541","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}

{"title":"Hyperglycemia grand rounds: descriptive findings of outcomes from a continuing education intervention to improve glycemic control and prevent hypoglycemia in the hospital setting","authors":"E. Moghissi, S. Inzucchi, K. Mann, Boyce Byerly, Laurie Ermentrout, J. J. Juchniewicz, Jocelyn H Ferareza, Natalie Kirkwood","doi":"10.1080/21548331.2015.1103191","DOIUrl":"https://doi.org/10.1080/21548331.2015.1103191","url":null,"abstract":"Hyperglycemia is common in the hospital in-patient setting and is associated with adverse outcomes. Healthcare professionals (HCPs) often fail to use best practices established to manage this condition or to coordinate care among team members. Objectives: The objective of the Hyperglycemia Grand Rounds (HGR) continuing education initiative was to improve knowledge levels in a team setting, leading to improved clinical competence, evidence-based behaviors, and improved patient care. Methods: To achieve that goal, a four-module seminar series was presented to HCPs on-site in a “Grand Rounds” format at healthcare institutions across the United States. Outcomes data included satisfaction, learning, impact, and intent-to-implement measures at event time and at follow-up. At the site level, detailed questionnaires assessed skill gaps and expected outcomes from administrators at the time the modules were scheduled and the impact after modules were completed. Demographic information allowed identification of HCPs receiving maximum benefits; data on barriers to implementation are reported. Results: Seventy-eight percent of participants self-reported a positive impact on competence, performance, or patient outcomes. Forty percent of learners said they intended to make specific changes in practices. Eighty-two percent of administrators confirmed expected changes in their health system. The follow-up study concurred with the initial findings. Conclusion: The HGR was an effective program in improving self-reported competence amongst attendees that could potentially lead to improved care. This descriptive report summarizes outcomes from 1 year of educational efforts to more than 2000 healthcare professionals.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"44 1","pages":"270 - 276"},"PeriodicalIF":0.0,"publicationDate":"2015-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2015.1103191","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60071913","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}

{"title":"To round or not to round: that is the question!","authors":"S. Surani, J. Varon","doi":"10.1080/21548331.2015.1109455","DOIUrl":"https://doi.org/10.1080/21548331.2015.1109455","url":null,"abstract":"Abstract Bedside rounding and clinical examination has been an integral part of medical education and patient care for centuries. With the advent of computers and regulatory requirements for documentation by insurance carriers and third party providers, bedside rounding time has consistently decreased over the past several decades. Several studies have attempted to address the most effective way of bedside rounding, but no definite conclusion has been reached. We suggest multi-center broad base studies of key stakeholders to address this challenging issue.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"43 1","pages":"268 - 269"},"PeriodicalIF":0.0,"publicationDate":"2015-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2015.1109455","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60072190","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}

{"title":"Inpatient Glycemic Control in 4 Easy Steps","authors":"A. Rhinehart","doi":"10.3810/HP.2014.04.1112","DOIUrl":"https://doi.org/10.3810/HP.2014.04.1112","url":null,"abstract":"© Hospital Practice, Volume 42, Issue 2, April 2011, ISSN – 2154-8331 143 ResearchSHARE®: www.research-share.com • Permissions: permissions@hosppract.com • Reprints: reprints@hosppract.com Warning: No duplication rights exist for this journal. Only JTE Multimedia, LLC holds rights to this publication. Please contact the publisher directly with any queries. Inpatient Glycemic Control in 4 Easy Steps","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"42 1","pages":"143 - 144"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3810/HP.2014.04.1112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70169003","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}

{"title":"30-Day-or-Sooner Readmissions of Gastrointestinal Medical Oncology Patients Following Cancer Center Inpatient Service Discharge: Characteristics and Preventability","authors":"A. Epstein, Christopher Crosbie, S. Martin, B. Egan, Tabitha N. Goring, D. J. Koo, Chhavi B. Kumar, C. Salvit, M. Capanu, J. Chou, L. Saltz","doi":"10.3810/hp.2014.12.1168","DOIUrl":"https://doi.org/10.3810/hp.2014.12.1168","url":null,"abstract":"Abstract Purpose: The Centers for Medicare and Medicaid Services recently initiated readmission reduction programs for certain noncancer index admissions. Intrinsic to this policy is the assumption that such readmissions are reasonably preventable and are due to inadequate management. For cancer patients, readmission frequency, characteristics, and their preventability have not been extensively evaluated. Methods: We first electronically searched medical records of patients on our gastrointestinal oncology inpatient service to identify patients who had been discharged and then readmitted within 30 days. However, electronic review resulted in insufficient granularity of clinical records. Therefore, 50 of them were randomly selected for exhaustive manual review to assess the reasons for index admission and readmission, the nature of the index admission discharge plan, and whether the readmission was reasonably preventable or not, based on prespecified criteria. Results: Between September 1, 2008, and March 1, 2013, 3995 gastrointestinal medical oncology patients had an index admission, of whom 876 (22%) had ≥ 1 readmission within 30 days. From the 50 manually reviewed records, the most common diagnosis categories for either the index admission or the readmission were infection, pain, and gastrointestinal issues. For 64% of these patients, the diagnoses of the index admission and the readmission were different. Disagreement between the care team and patient/family about the index admission discharge plan was documented in 10%. The readmission was determined to be preventable in 1 (2%) of the 50 manually reviewed cases. Conclusions: Readmissions in this cancer population are common and reflect the refractory nature of these diseases and the high disease burdens. The vast majority of readmissions in this population, by our criteria, were not preventable. Our ongoing research in this vulnerable population includes efforts to better characterize and communicate care options, especially in the cases in which there was disagreement between the care team and patient/family.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"42 1","pages":"34 - 44"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3810/hp.2014.12.1168","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70169062","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}

{"title":"Protecting the Heart From Ischemia: An Update on Ischemic and Pharmacologic Conditioning","authors":"Paul Z. Gerczuk, R. Kloner","doi":"10.3810/hp.2011.08.578","DOIUrl":"https://doi.org/10.3810/hp.2011.08.578","url":null,"abstract":"Abstract The attempt to find treatments that will reduce myocardial cell death during periods of ischemia and subsequent reperfusion has spanned nearly 40 years. Although many therapies have shown promise in animal models, relatively few have been successful in clinical trials. Some of the most effective clinical therapies involve techniques designed to elicit the heart's own innate capacity to protect itself. The ability of the heart to render itself more resistant to ischemia/reperfusion injury was not appreciated until the description of ischemic preconditioning in 1986. Following the discovery that brief, nonlethal episodes of ischemia conditioned the heart to better tolerate a subsequent prolonged episode of ischemia, alternative ways of evoking this endogenous cardioprotection were described. Ischemic postconditioning and remote conditioning are potentially useful tools for protecting ischemic myocardium, and have been shown to be beneficial in small clinical trials. Several pharmacologic agents have the ability to mimic the effects of ischemic conditioning and can also reduce the amount of cell death during ischemia/reperfusion. This article provides the clinician with an overview of the different techniques of ischemic conditioning and how they can protect the myocardium from ischemia/reperfusion injury. Additionally, several pharmacologic agents that can protect the heart in a similar manner are discussed.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"39 1","pages":"35 - 43"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3810/hp.2011.08.578","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70168990","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}