The cost of laparoscopic versus open cholecystectomy in a community hospital.
Case-Control Studies; Cholecystectomy; Cholecystectomy/*economics; Community; Fees; Female; Health; Hospital Charges/statistics & numerical data; Hospital Costs/statistics & numerical data; Hospitals; Humans; Insurance; Laparoscopic/*economics; Male; Medicaid/economics; Medical/statistics & numerical data; Medicare/economics; Middle Aged; Ohio; Reimbursement/statistics & numerical data; Retrospective Studies; United States
This retrospective study reviewed the hospital and professional costs, charges, and reimbursements for laparoscopic cholecystectomy (lap chole) and open cholecystectomy (open chole) and compared the two procedures. There was no significant difference in hospital costs between lap and open chole procedures; however, there were marked differences in the categories of costs for each procedure. The mean total (hospital and professional) charge was 8% greater for lap chole. The mean total (hospital and professional) reimbursement for patients with private insurance was 23% greater for lap chole, but no significant difference was seen for patients on Medicare or Medicaid. Lap chole patients returned to work 11 days sooner than open chole patients; this can result in a 69% decrease in short-term disability costs to employers. The clinical variables that significantly affect total charges and reimbursement are discussed.
Vanek V W; Bourguet C C
Surgical endoscopy
1995
1995-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/bf00187776" target="_blank" rel="noreferrer noopener">10.1007/bf00187776</a>
Lacking a Primary Care Physician Is Associated With Increased Suffering in Patients With Severe Mental Illness.
*Health Services Accessibility; *Primary Health Care; Adolescence; Adolescent; Adult; Aged; Community; Comorbid conditions; Cost of Illness; Economic Aspects of Illness; Female; Health outcomes; Health Services Accessibility; Hospitalization; Hospitals; Humans; Life Style; Lifestyle problems; Male; Mental Disorders – Complications; Mental Disorders – Psychosocial Factors; Mental Disorders – Therapy; Mental Disorders/complications/*psychology/*therapy; Middle Age; Middle Aged; Preventative services; Primary Health Care; Psychological – Etiology; Psychological – Psychosocial Factors; Psychological/etiology/*psychology; Retrospective Design; Retrospective Studies; Stress; Young Adult
We evaluated the relationship between lack of a primary care physician (PCP) and patients with severe mental illness (SMI), who have poorer health and experience more suffering. Using a blinded retrospective record review of 137 patients with SMI, divided between inpatients (n = 70) and outpatients (n = 67), we compared the two groups to determine if lack of a PCP is associated with increased suffering and worse overall health. We included history of preventive services, having a PCP, and comorbid conditions. Multiple linear regressions determined the relationship between lacking a PCP and lifestyle problems, lack of preventive care, and Burden of Suffering. We found that in SMI patients, lack of a PCP is associated with increased lifestyle problems, lacking preventive care, increased Burden of Suffering and cervical dysplasia. Health policy changes are needed to improve outcomes for patients with SMI by increasing access to PCPs and preventive services.
Olsen Cynthia G; Boltri John M; Amerine Jenna; Clasen Mark E
The journal of primary prevention
2017
2017-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s10935-017-0490-7" target="_blank" rel="noreferrer noopener">10.1007/s10935-017-0490-7</a>
Laparoscopic cholecystectomy in a community hospital: experience with 600 laparoscopic cholecystectomies.
Cholecystectomy; Cholecystectomy/statistics & numerical data; Community; Female; Hospitals; Humans; Intraoperative Complications/epidemiology; Laparoscopic/mortality/*statistics & numerical data; Male; Middle Aged; Postoperative Complications/epidemiology; Retrospective Studies; Teaching
We reviewed 600 patients who underwent laparoscopic cholecystectomy (LC) in a teaching community hospital from May 1990 to August 1992. The safety, efficacy, morbidity, and mortality of LC, as performed by one surgeon or under his direct supervision, were studied. Five hundred forty-eight patients (91.3%) were treated electively; 52 (8.7%) were admitted for acute cholecystitis (41) or gallstone pancreatitis (11). Mean operating time was 54 min, with a range of 20 to 145 min. Twenty-four (4%) patients required conversion to traditional (open) cholecystectomy. Operative cholangiograms were completed in 106 patients. These revealed choledocholithiasis in 7. Five hundred thirty-seven patients (89.5%) were discharged within 24 h and 564 (94%) within 48 h. The overall morbidity of 9.2% compared favorably with both open and laparoscopic series previously reported. Three patients (0.5%) had small lacerations of the anterior wall of the common duct. Two were recognized and repaired immediately. The third patient came for treatment on the fifth postoperative day and was stented by a T-tube. There was 1 death in this group–a myocardial infarction on postoperative day 4.
Williams G B; Silverman R S
Journal of laparoendoscopic surgery
1994
1994-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/lps.1994.4.101" target="_blank" rel="noreferrer noopener">10.1089/lps.1994.4.101</a>
The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey.
*Antibiotics; *Antimicrobial stewardship; *Infections; *Surgery; Academic Medical Centers; Anti-Infective Agents/*therapeutic use; Antibiotic Prophylaxis; Antiinfective Agents – Therapeutic Use; Antimicrobial Stewardship/*methods; Audit; Communicable Diseases; Community; Cross Sectional Studies; Cross-Sectional Studies; Culture; Data Analysis Software; Descriptive Statistics; Education; Female; Global Health/trends; Hospitals; Human; Humans; Infection – Prevention and Control; Infection Control – Methods; International Agencies; Intraabdominal Infections/*drug therapy; Male; Medical Organizations; Medical Practice; Microbiology; Multidisciplinary Care Team; Operative; Policy Making; Postoperative Complications/*drug therapy; Preoperative Care; Resource Allocation; Rural Areas; Specialization; Surgery; Surgical Wound Infection – Therapy; Surveys and Questionnaires; Urban Areas
BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. METHODS: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. RESULTS: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p \textless 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). CONCLUSION: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.
Sartelli Massimo; Labricciosa Francesco M; Barbadoro Pamela; Pagani Leonardo; Ansaloni Luca; Brink Adrian J; Carlet Jean; Khanna Ashish; Chichom-Mefire Alain; Coccolini Federico; Di Saverio Salomone; May Addison K; Viale Pierluigi; Watkins Richard R; Scudeller Luigia; Abbo Lilian M; Abu-Zidan Fikri M; Adesunkanmi Abdulrashid K; Al-Dahir Sara; Al-Hasan Majdi N; Alis Halil; Alves Carlos; Araujo da Silva Andre R; Augustin Goran; Bala Miklosh; Barie Philip S; Beltran Marcelo A; Bhangu Aneel; Bouchra Belefquih; Brecher Stephen M; Cainzos Miguel A; Camacho-Ortiz Adrian; Catani Marco; Chandy Sujith J; Jusoh Asri Che; Cherry-Bukowiec Jill R; Chiara Osvaldo; Colak Elif; Cornely Oliver A; Cui Yunfeng; Demetrashvili Zaza; De Simone Belinda; De Waele Jan J; Dhingra Sameer; Di Marzo Francesco; Dogjani Agron; Dorj Gereltuya; Dortet Laurent; Duane Therese M; Elmangory Mutasim M; Enani Mushira A; Ferrada Paula; Esteban Foianini J; Gachabayov Mahir; Gandhi Chinmay; Ghnnam Wagih Mommtaz; Giamarellou Helen; Gkiokas Georgios; Gomi Harumi; Goranovic Tatjana; Griffiths Ewen A; Guerra Gronerth Rosio I; Haidamus Monteiro Julio C; Hardcastle Timothy C; Hecker Andreas; Hodonou Adrien M; Ioannidis Orestis; Isik Arda; Iskandar Katia A; Kafil Hossein S; Kanj Souha S; Kaplan Lewis J; Kapoor Garima; Karamarkovic Aleksandar R; Kenig Jakub; Kerschaever Ivan; Khamis Faryal; Khokha Vladimir; Kiguba Ronald; Kim Hong B; Ko Wen-Chien; Koike Kaoru; Kozlovska Iryna; Kumar Anand; Lagunes Leonel; Latifi Rifat; Lee Jae G; Lee Young R; Leppaniemi Ari; Li Yousheng; Liang Stephen Y; Lowman Warren; Machain Gustavo M; Maegele Marc; Major Piotr; Malama Sydney; Manzano-Nunez Ramiro; Marinis Athanasios; Martinez Casas Isidro; Marwah Sanjay; Maseda Emilio; McFarlane Michael E; Memish Ziad; Mertz Dominik; Mesina Cristian; Mishra Shyam K; Moore Ernest E; Munyika Akutu; Mylonakis Eleftherios; Napolitano Lena; Negoi Ionut; Nestorovic Milica D; Nicolau David P; Omari AbdelKarim H; Ordonez Carlos A; Paiva Jose-Artur; Pant Narayan D; Parreira Jose G; Pedziwiatr Michal; Pereira Bruno M; Ponce-de-Leon Alfredo; Poulakou Garyphallia; Preller Jacobus; Pulcini Celine; Pupelis Guntars; Quiodettis Martha; Rawson Timothy M; Reis Tarcisio; Rems Miran; Rizoli Sandro; Roberts Jason; Pereira Nuno Rocha; Rodriguez-Bano Jesus; Sakakushev Boris; Sanders James; Santos Natalia; Sato Norio; Sawyer Robert G; Scarpelini Sandro; Scoccia Loredana; Shafiq Nusrat; Shelat Vishalkumar; Sifri Costi D; Siribumrungwong Boonying; Soreide Kjetil; Soto Rodolfo; de Souza Hamilton P; Talving Peep; Trung Ngo Tat; Tessier Jeffrey M; Tumbarello Mario; Ulrych Jan; Uranues Selman; van Goor Harry; Vereczkei Andras; Wagenlehner Florian; Xiao Yonghong; Yuan Kuo-Ching; Wechsler-Fordos Agnes; Zahar Jean-Ralph; Zakrison Tanya L; Zuckerbraun Brian; Zuidema Wietse P; Catena Fausto
World journal of emergency surgery : WJES
2017
2017
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1186/s13017-017-0145-2" target="_blank" rel="noreferrer noopener">10.1186/s13017-017-0145-2</a>
Evaluation and use of a rapid Staphylococcus aureus assay by an antimicrobial stewardship program.
Humans; Time Factors; Microbial Sensitivity Tests; Sensitivity and Specificity; Prospective Studies; Hospitals; Anti-Bacterial Agents/administration & dosage/*pharmacology; Bacteriological Techniques; False Negative Reactions; Methicillin-Resistant Staphylococcus aureus/*isolation & purification; Staphylococcal Infections/*diagnosis/microbiology; Staphylococcus aureus/*isolation & purification; Cell Culture Techniques; Chromatography; Human; Funding Source; Community; Affinity; Observational Methods; Biological Assay – Methods; Methicillin-Resistant Staphylococcus Aureus – Analysis
PURPOSE: The performance of a rapid test for methicillin-resistant Staphylococcus aureus (MRSA) in a large community hospital was investigated. METHODS: A prospective observational study was conducted to evaluate an immunochromatographic assay (Alere PBP2a Culture Colony Test, Alere Scarborough, Inc.) for rapid differentiation of MRSA and methicillin-susceptible S. aureus (MSSA) strains using isolates cultured overnight on common laboratory media. S. aureus isolates cultured for 12-24 hours were tested with the assay, which detects penicillin-binding protein 2a (PBP2a) and provides results in six minutes. The test results were compared with data from standard overnight antimicrobial susceptibility testing to determine the assay's sensitivity and specificity. Changes in therapy associated with use of the rapid assay were evaluated. RESULTS: Over an 11-month period, 661 inpatient isolates from mostly nonhematologic sites were tested. There were six false-negative results, indicating assay sensitivity of 98.4%, with no false positives (specificity of 100%). Eight invalid test results were documented. During designated evaluation periods, a total of 169 patient cases involving PBP2a testing were reviewed by the hospital's antimicrobial stewardship pharmacist. In 63 of those cases (37%), changes in therapy were implemented on the day of test result posting. Interventions often involved switching patients from inappropriate to appropriate MRSA therapy or optimizing MRSA- or MSSA-targeted therapy. CONCLUSION: An assay for quickly differentiating between MRSA and MSSA was highly sensitive, highly specific, and inexpensive in actual hospital use and led to rapid prescription of appropriate antistaphylococcal therapy 24-48 hours after culture specimens were collected.
Trienski Tamara L; Barrett Heather L; Pasquale Timothy R; DiPersio Joseph R; File Thomas M Jr
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
2013
2013-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2146/ajhp130118" target="_blank" rel="noreferrer noopener">10.2146/ajhp130118</a>
Nosocomial fungemia in a large community teaching hospital.
Adult; Humans; Middle Aged; Retrospective Studies; Teaching; Amphotericin B/therapeutic use; *Cross Infection; Candidiasis/complications/drug therapy/*etiology/mortality; Hematologic Diseases/complications/drug therapy/*etiology/mortality; Sepsis/complications; Community; *Hospitals
This report reviews 48 episodes of hospital-acquired fungemia that occurred over a four-year period at a large community teaching hospital. The incidence of hospital-acquired fungemia increased eightfold during the study period. Candida albicans (58%), Candida tropicalis (25%), and Candida parapsilosis (15%) were the most common fungal pathogens isolated from blood cultures. Twenty-one patients (44%) had concomitant bacteremia. Intravascular catheters (100%), antibiotic administration (98%), urinary catheters (81%), surgical procedures (65%), parenteral alimentation (60%), and corticosteroid administration (54%) were the most common predisposing factors. The overall mortality rate was 75%. Hospitalization on the medical service, age greater than 60 years, and hospital stay less than 100 days were associated with a significantly increased mortality rate.
Harvey R L; Myers J P
Archives of Internal Medicine
1987
1987-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1001/archinte.147.12.2117" target="_blank" rel="noreferrer noopener">10.1001/archinte.147.12.2117</a>
Elapsed time from symptom onset and acute myocardial infarction in a community hospital.
Humans; Middle Aged; Time Factors; Aged; Cohort Studies; Prognosis; Hospitals; Thrombolytic Therapy; Electrocardiography; Risk; Heart Arrest/etiology; Heart Ventricles; *Myocardial Infarction/diagnosis/therapy; *Patient Admission; Angina Pectoris/complications; Chest Pain/etiology; Coronary Artery Bypass; Tachycardia/etiology; Community; Angioplasty; Balloon; Coronary
STUDY OBJECTIVE: Previous reports have emphasized that thrombolytic therapy for acute myocardial infarction should be initiated within three or four hours of symptom onset to obtain the best clinical outcomes. However, our clinical impression was that late arrivers, who often do not receive thrombolytic therapy, have a good short-term prognosis. Therefore, we investigated the relationships among the elapsed time from symptom onset, thrombolytic therapy, and short-term prognosis in acute myocardial infarction patients. The research hypothesis was that late arrivers have a better in-hospital prognosis because they have less severe disease that may involve spontaneous thrombolysis. DESIGN: Observational cohort study based on reviewing medical records and emergency department service logs. SETTING: 500-bed teaching hospital with medical school affiliation in northeastern Ohio. TYPE OF PARTICIPANTS: Four hundred consecutive patients with acute infarction confirmed by chest pain and positive ECGs or elevated cardiac enzymes. MEASUREMENTS AND MAIN RESULTS: Patients arriving early (elapsed time less than or equal to 1.5 hours) were more likely to be in Killip class III or IV (P = .04) or to have hypotension (P = .0004); and they experienced twofold increased odds of ventricular tachycardia (P = .007), cardiac arrest (P = .03), or death (P = .01). Patients arriving late (elapsed time greater than 3.5 hours) were more likely to have a history of angina (P = .002) and had a better short-term prognosis. CONCLUSIONS: Time of ED arrival after onset of acute myocardial infarction symptoms distinguishes two patient groups that differ in their risk of in-hospital complications. Late arrivers have better short-term prognoses and less (acutely) severe disease, and may have less need for thrombolytic therapy because of possible spontaneous thrombolysis. Patients with prior angina may need education on seeking care if their symptoms change.
Logue EE; Ognibene A; Marquinez C; Jarjoura D
Annals of emergency medicine
1991
1991-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0196-0644(05)81650-6" target="_blank" rel="noreferrer noopener">10.1016/s0196-0644(05)81650-6</a>
Su1207 Utility of Small Bowel Balloon Enteroscopy: A Community Hospital Experience...Digestive Disease Week (DDW) 2017 American Society for Gastrointestinal Endoscopy (ASGE) Program and Abstracts, Chicago, Illinois, 6-9 May 2017.
Hospitals; Community; Balloon Enteroscopy; Congresses and Conferences
Talat Arslan; Geisler Thomas; Riordan Adam; Elahee Mehreen; Dodig Milan
Gastrointestinal Endoscopy
2017
2017-05-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.gie.2017.03.723" target="_blank" rel="noreferrer noopener">10.1016/j.gie.2017.03.723</a>
PTSD after Traumatic Injury: An Investigation of the Impact of Injury Severity and Peritraumatic Moderators.
Adult; Female; Male; Risk Factors; Hospitals; Midwestern United States; Questionnaires; Descriptive Statistics; Funding Source; P-Value; One-Way Analysis of Variance; Pearson's Correlation Coefficient; Regression; Community; Stress Disorders; Severity of Illness; Severity of Injury; Trauma – Complications; Post-Traumatic – Etiology; Trauma – Etiology
Gabert-Quillen Crystal A; Fallon William; Delahanty Douglas L
Journal of Health Psychology
2011
2011-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1359105310386823" target="_blank" rel="noreferrer noopener">10.1177/1359105310386823</a>
Does functional decline prompt emergency department visits and admission in older patients?
Female; Male; Ohio; Aged; Prospective Studies; Hospitals; Activities of Daily Living; Confidence Intervals; Human; Convenience Sample; Questionnaires; Cross Sectional Studies; Descriptive Statistics; Funding Source; Data Analysis Software; Surveys; Coefficient Alpha; Clinical Assessment Tools; Emergency Service; Community; Geriatric Functional Assessment; 80 and Over; Emergency Care – In Old Age; Functional Status – In Old Age; Health Resource Utilization – In Old Age; Patient Admission – In Old Age
BACKGROUND: Older patients may visit the emergency department (ED) when their illness affects their function. OBJECTIVES: To quantify the function of older ED patients, to assess whether functional decline (FD) had occurred, and to determine whether function contributes to the ED visit and hospital admission. METHODS: The authors performed an institutional review board-approved, prospective, cross-sectional study in a community teaching hospital ED. Eligible patients were older than 74 years of age, with an illness at least 48 hours old. Patients from a nursing facility and those without a proxy who were unable or unwilling to complete the questions were excluded. The Older Americans Resources and Services Questionnaire, which tests seven instrumental activities of daily living (IADL) and seven physical ADLs (PADL), was used. Data are presented as means or proportions with 95% confidence intervals (95% CI), and comparisons as 95% CI for the difference between proportions. RESULTS: The authors enrolled 90 patients (mean age, 81.6 yr [SD +/- 4.9], 40% male). Dependence in at least one IADL was reported by 68% (95% CI = 57% to 77%), and in at least one PADL by 61% (95% CI = 50% to 71%). Functional decline was reported by 74% (95% CI = 64% to 83%). Two thirds of those with IADL decline and three quarters of those with PADL decline said that this contributed to their ED visit. Seventy-seven percent with, and 63% without, IADL decline were admitted (14% difference, 95% CI = -6.1% to 33%). Seventy-nine percent with and 61% without PADL decline were admitted (18% difference, 95% CI = -1.4% to 38%). CONCLUSIONS: Functional decline is common in older ED patients and contributes to ED visits in older patients; its role in admission is unclear.
Wilber S T; Blanda M; Gerson L W
Academic Emergency Medicine
2006
2006-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2006.01.006" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2006.01.006</a>
Reclining chairs reduce pain from gurneys in older emergency department patients: a randomized controlled trial.
Ohio; Aged; Sensitivity and Specificity; Prospective Studies; Pain Measurement; Patient Satisfaction; Outpatients; Hospitals; Self Report; Confidence Intervals; Human; Descriptive Statistics; Funding Source; Scales; Data Analysis Software; Surveys; Coefficient Alpha; Summated Rating Scaling; Emergency Service; Community; Treatment Outcomes; Emergency Patients; Beds and Mattresses; Interior Design and Furnishings; Patient Positioning; Single-Blind Studies; 80 and Over; Pain – Prevention and Control – In Old Age
OBJECTIVES: Pain related to the gurney is a frequent complaint of older emergency department (ED) patients. The authors hypothesized that these patients may have less pain and higher satisfaction if allowed to sit in a reclining hospital chair. METHODS: A single-blind, randomized controlled trial was performed. Patients 65 years old or older who were able to sit upright, transfer, and engage in normal conversation were eligible. Severely ill or cognitively impaired patients were excluded. Patients were randomized to either remain on the gurney or transfer to the chair after initial evaluation. Patients reported pain at arrival (t0), at one hour (t1), and at two hours (t2) using a 0-10 pain scale, and satisfaction at study completion on a 0-10 scale. The primary outcome was a decrease in pain between t0 and t1 or no pain at both t0 and t1. This outcome was analyzed using a 95% confidence interval for the difference between proportions; exclusion of zero was considered significant. RESULTS: Sixty-six patients in each group were enrolled. There was no difference in demographics between groups, but the chair patients were more likely to have pain at t0 than the gurney patients. More chair patients than gurney patients had a successful primary outcome (97% vs. 76%, 21% difference, 95% CI=10% to 32%). The mean satisfaction score was higher in the chair group than in the gurney group (8.1 vs. 6.0, 2.1 difference, 95% CI=1.4% to 2.8%). CONCLUSIONS: The simple modification of allowing older ED patients to sit in reclining chairs resulted in less pain and higher satisfaction.
Wilber S T; Burger B; Gerson L W; Blanda M
Academic Emergency Medicine
2005
2005-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2005.tb00846.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2005.tb00846.x</a>
Pneumococcal epidemiology among us adults hospitalized for community-acquired pneumonia
Community; Pneumococcus; Pneumonia; Streptococcus
BACKGROUND: Few studies have measured the burden of adult pneumococcal disease after the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into the US infant vaccination schedule. Further, most data regarding pneumococcal serotypes are derived from invasive pneumococcal disease (IPD), which represents only a fraction of all adult pneumococcal disease burden. Understanding which pneumococcal serotypes cause pneumonia in adults is critical for informing current immunization policy. The objective of this study was to measure the proportion of radiographically-confirmed (CXR+) community-acquired pneumonia (CAP) caused by PCV13 serotypes in hospitalized US adults. METHODS: This observational, prospective surveillance study recruited hospitalized adults aged ≥18 years from 21 acute care hospitals across 10 geographically-dispersed cities in the United States between October 2013 and September 2016. Clinical and demographic data were collected during hospitalization. Vital status was ascertained 30 days after enrollment. Pneumococcal serotypes were detected via culture from the respiratory tract and normally-sterile sites (including blood and pleural fluid). Additionally, a novel, Luminex-based serotype-specific urinary antigen detection (UAD) assay was used to detect serotypes included in PCV13. RESULTS: Of 15,572 enrolled participants, 12,055 eligible patients with CXR+CAP were included in the final analysis population. Mean age was 64.1 years and 52.7% were aged ≥65 years. Common comorbidities included chronic obstructive pulmonary disease (43.0%) and diabetes mellitus (28.6%). PCV13 serotypes were detected in 552/12,055 (4.6%) of all patients and 265/6347 (4.2%) of those aged ≥65 years. Among patients aged 18-64 years PCV13 serotypes were detected in 3.8-5.3% of patients depending on their risk status. CONCLUSIONS: After implementation of a pneumococcal conjugate vaccination program in US children, and despite the herd protection observed in US adults, a persistent burden of PCV13-type CAP remains in this population.
Isturiz Raul E; Ramirez Julio; Self Wesley H; Grijalva Carlos G; Counselman Francis L; Volturo Gregory; Ostrosky-Zeichner Luis; Peyrani Paula; Wunderink Richard G; Sherwin Robert; Overcash J Scott; Oliva Senen Pena; File Thomas; Wiemken Timothy L; McLaughlin John M; Pride Michael W; Gray Sharon; Alexander Ronika; Ford Kimbal D; Jiang Qin; Jodar Luis
Vaccine
2019
2019-05
<a href="http://doi.org/10.1016/j.vaccine.2019.04.087" target="_blank" rel="noreferrer noopener">10.1016/j.vaccine.2019.04.087</a>
Preventive care in the emergency department: Should emergency departments institute a falls prevention program for elder patients? A systematic review
accidental falls; aged; community; elders; Emergency Medicine; emergency services; exercise; ficsit trials; fractures; frailty; hospital; injuries; medicine; practice guideline; preventive services; randomized controlled-trial; services; systematic review
Objective: To perform a systematic review of the emergency medicine literature to assess the appropriateness of an intervention to identify, counsel, and refer emergency department (ED) patients > 64 years old who are at high risk for falls. Methods: The systematic review was facilitated through the use of a structured template, a companion explanatory piece, and a grading and methodological scoring system based on published criteria for critical appraisal. A reference librarian did two PubMed searches using the following: ED visits, patients > 64 years old, falls, high risk, and effectiveness of intervention. Emergency Medical Abstracts, Science Citation Index, and the Cochrane Collaboration database were searched. Two team members reviewed the abstracts and selected pertinent articles. References were screened for additional pertinent articles. Results: Twenty-six articles were reviewed. None were ED-based primary or secondary falls prevention in older patients. One randomized controlled trial of an intervention to decrease subsequent falls in elder community-dwelling patients who presented with a fall showed a structured interdisciplinary approach significantly reducing the number of falls. Two ED-based studies showed it was possible to identify ED patients at risk for falls. Conclusions: Based on one randomized controlled trial demonstrating a significant reduction in the risk of further falls, the burden of suffering caused by falls, and other studies demonstrating the value of interventions to reduce the risk of falling, the authors recommend that EDs conduct research to evaluate the effectiveness of clinical interventions to identify, counsel, and refer ED patients > 64 years old who are at high risk for an unintentional fall.
Weigand J V; Gerson L W
Academic Emergency Medicine
2001
2001-08
Journal Article
<a href="http://doi.org/10.1111/j.1553-2712.2001.tb00214.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2001.tb00214.x</a>
Use of child reports of daily functioning to facilitate identification of psychosocial problems in children
agreement; behavioral-problems; care; community; depression; General & Internal Medicine; informants; management; parent; sample; symptoms
Background: Despite the availability of effective screening measures, physicians fail to identify and manage many children with psychosocial problems. Physicians are most likely to identify children with psychosocial problems when parents voice concerns about their child's functioning. However, few parents express concerns to their child's physician, and children's perspectives of their own functioning are rarely considered. This study evaluated the potential utility of children's reports of their own functioning. Methods: The Child Functioning Scale (CFS) was completed by 107 parents and children and compared with the Pediatric Symptom Checklist (PSC) and physician reports on the psychosocial status of each child. Results: Physicians identified 20% of the children identified by the PSC. Children's self-reported problems on the CFS would have identified 53.3% of these children. Additionally. 11.2% of children who did not meet criteria on the PSC self-reported problems in daily functioning. Conclusion: Collecting information about children's perceptions of their own daily functioning could provide physicians with an additional tool for the assessment of psychosocial problems.
Wildman B G; Kinsman A M; Smucher W D
Archives of Family Medicine
2000
2000-07
Journal Article
<a href="http://doi.org/10.1001/archfami.9.7.612" target="_blank" rel="noreferrer noopener">10.1001/archfami.9.7.612</a>
Oculocutaneous Albinism in Sub-Saharan Africa: Adverse Sun-Associated Health Effects and Photoprotection
Biochemistry & Molecular Biology; Biophysics; care; children; community; Nigeria; northern tanzania; population; program; skin cancer; southern-africa; zimbabwe
Oculocutaneous albinism (OCA) is a genetically inherited autosomal recessive condition. Individuals with OCA lack melanin and therefore are susceptible to the harmful effects of solar ultraviolet radiation, including extreme sun sensitivity, photophobia and skin cancer. OCA is a grave public health issue in sub-Saharan Africa with a prevalence as high as 1 in 1000 in some tribes. This article considers the characteristics and prevalence of OCA in sub-Saharan African countries. Sun-induced adverse health effects in the skin and eyes of OCA individuals are reviewed. Sun exposure behavior and the use of photoprotection for the skin and eyes are discussed to highlight the major challenges experienced by these at-risk individuals and how these might be best resolved.
Wright C Y; Norval M; Hertle R W
Photochemistry and Photobiology
2015
2015-01
Journal Article
<a href="http://doi.org/10.1111/php.12359" target="_blank" rel="noreferrer noopener">10.1111/php.12359</a>
Epidemiology of trauma: Childhood adversities, neighborhood problems, discrimination, chronic strains, life events, and daily hassles among people with a severe mental illness
1st-episode psychosis; adults; Childhood trauma; community; Health; national comorbidity survey; posttraumatic-stress-disorder; prevalence; Psychiatry; quality-of-life; schizophrenia; Serious mental illness; stress; symptoms; world-trade-center
Trauma during childhood and adolescence is a common event among people with a serious psychological disorder. Few studies assess a wide range of stressors for this population. This is surprising given that these stressful events are implicated in poorer outcomes related to course and treatment of mental health problems. This study of 214 people with serious mental illness examines the prevalence of childhood traumas, perceived neighborhood problems, discrimination, chronic strains, negative life events, and daily hassles. We use regression analyses to determine if these stressors are associated with quality of life. Results show that 95% of the sample report at least one childhood adversity. Perceived neighborhood problems, experiences of discrimination, chronic strains, life events, and daily hassles were also common. Examining the relationship between demographic factors and stressors suggests that older respondents, Whites, those who have never been married, and people diagnosed with Schizophrenia reported fewer stressors compared to those who are older, non-White, ever married, or suffering from other types of mental health problems. Finally, three of the six types of stressors were related to lower quality of life and depression. We discuss the implications of these findings for the treatment of severe psychological problems. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
Adams R E; Ritter C; Bonfine N
Psychiatry Research
2015
2015-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.psychres.2015.10.012" target="_blank" rel="noreferrer noopener">10.1016/j.psychres.2015.10.012</a>
Teaching Population Health: A Competency Map Approach To Education
academic-medical-center; community; Education & Educational Research; Health Care Sciences & Services; perspective; public-health
A 2012 Institute of Medicine report is the latest in the growing number of calls to incorporate a population health approach in health professionals' training. Over the last decade, Duke University, particularly its Department of Community and Family Medicine, has been heavily involved with community partners in Durham, North Carolina, to improve the local community's health. On the basis of these initiatives, a group of interprofessional faculty began tackling the need to fill the curriculum gap to train future health professionals in public health practice, community engagement, critical thinking, and team skills to improve population health effectively in Durham and elsewhere. The Department of Community and Family Medicine has spent years in care delivery redesign and curriculum experimentation, design, and evaluation to distinguish the skills trainees and faculty need for population health improvement and to integrate them into educational programs. These clinical and educational experiences have led to a set of competencies that form an organizational framework for curricular planning and training. This framework delineates which learning objectives are appropriate and necessary for each learning level, from novice through expert, across multiple disciplines and domains. The resulting competency map has guided Duke's efforts to develop, implement, and assess training in population health for learners and faculty. In this article, the authors describe the competency map development process as well as examples of its application and evaluation at Duke and limitations to its use with the hope that other institutions will apply it in different settings.
Kaprielian V S; Silberberg M; McDonald M A; Koo D; Hull S K; Murphy G; Tran A N; Sheline B L; Halstater B; Martinez-Bianchi V; Weigle N J; de Oliveira J S; Sangvai D; Copeland J; Tilson H H; Scutchfield F D; Michener J L
Academic Medicine
2013
2013-05
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/ACM.0b013e31828acf27" target="_blank" rel="noreferrer noopener">10.1097/ACM.0b013e31828acf27</a>
Incidence Of Staphylococcus Aureus Nasal Colonization And Soft Tissue Infection Among High School Football Players
Athlete; carriage; community; epidemiology; General & Internal Medicine; healthy-children; MRSA; outbreak; population; prevalence; risk-factors; skin; Skin Infection; team
Background: Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections have been documented with increasing frequency in both team and individual sports in recent years. It also seems that the level of MRSA skin and soft tissue infections in the general population has increased. Methods: One hundred ninety athletes from 6 local high school football teams were recruited for this prospective observational study to document nasal colonization and the potential role this plays in skin and soft tissue infections in football players and, in particular, MRSA infections. Athletes had nasal swabs done before their season started, and they filled out questionnaires regarding potential risk factors for skin and soft tissue infections. Those enrolled in the study were then observed over the course of the season for skin and soft tissue infections. Those infected had data about their infections collected. Results: One hundred ninety of 386 available student athletes enrolled in the study. Forty-four of the subjects had nasal colonization with methicillin-susceptible S. aureus, and none were colonized with MRSA. There were 10 skin and soft tissue infections (8 bacterial and 2 fungal) documented over the course of the season. All were treated as outpatients with oral or topical antibiotics, and none were considered serious. Survey data from the preseason questionnaire showed 21% with skin infection, 11% with methicillin-susceptible S. aureus, and none with MRSA infection during the past year. Three reported a remote history of MRSA infection. Conclusions: We documented an overall skin infection rate of 5.3% among high school football players over a single season. Our results suggest that skin and soft tissue infection may not be widespread among high school athletes in northeast Ohio. (J Am Board Fam Med 2011;24:429-435.)
Lear A; McCord G; Peiffer J; Watkins R R; Parikh A; Warrington S
Journal of the American Board of Family Medicine
2011
2011-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.3122/jabfm.2011.04.100286" target="_blank" rel="noreferrer noopener">10.3122/jabfm.2011.04.100286</a>
233. The Epidemiology, Genomics, and Evolution of Staphylococcus aureus in Northeast Ohio.
mortality; epidemiology; prevention; Community; OHIO; inpatients; morbidity; infection; OHIO; genomics; institutional review board; risk reduction; METHICILLIN-resistant staphylococcus aureus; genomics; epidemiology; staphylococcus aureus; AKRON (Ohio); CLEVELAND Clinic Foundation; databases; disclosure; FOOD poisoning; HUMAN ecology; meca gene; methicillin; METHICILLIN-resistant staphylococcus aureus; MICROCOCCACEAE; polymerase chain reaction; staphylococcal protein a; staphylococcus; staphylococcus aureus
Background Infections due to S. aureus result in significant morbidity, mortality, and healthcare expense. We sought to identify the strains of S. aureus causing infections in hospitalized patients in Northeast Ohio and determine whether they are reflective of the S. aureus strains present in the surrounding environment. Methods The study was approved by the Institutional Review Board at Cleveland Clinic Akron General. Clinical S. aureus isolates (n = 300) were cultured and PCR was used to amplify the staphylococcus protein A (spa), Panton–Valentine Leukocidin (PVL), and mecA genes. The clinical spa types were compared with ones from our data base of S. aureus strains previously collected and sequenced from the community and environment in Northeast Ohio. Results A total of 51 spa types were detected from 129 S. aureus clinical isolates (discriminatory index, 0.876; 95% confidence interval [CI], 0.827–0.925; Table 1). The most common spa types were t008 (42/129, 32.6%), t002 (16/129, 12.4%), and t334 (6/129, 4.7%). In comparison, the most frequently detected spa types from the environmental samples were t189 (40/257, 15.6%), t002 (16/257, 6.2%), and t008 (11/257, 4.3%). Among the S. aureus isolates (n = 146), 45 were PVL-positive (30.8%) and 94 (66.7%) carried mecA. Of the 42 t008 (ST8/USA300; a common community-associated strain) isolates, 35 (83.3%) were methicillin-resistant S. aureus (MRSA) (based on the presence of the mecA gene) and 25 (59.5%) were PVL-positive. Thirteen of the sixteen (81.2%) t002 (ST5/USA100; a common hospital-associated strain) were MRSA and only one (6.2%) was PVL-positive. Conclusion There is considerable overlap of S. aureus strains present in clinical samples with those found in the environment. This finding should draw attention to the need for more effective prevention strategies to reduce the risk of transmission of S. aureus, including MRSA, in the environment to humans. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]
Watkins Richard R; Thapaliya Dipendra; Savri Rami; Smith Tara
Open Forum Infectious Diseases
2019
2019-10-02
Journal Article
<a href="http://doi.org/10.1093/ofid/ofz360.308" target="_blank" rel="noreferrer noopener">10.1093/ofid/ofz360.308</a>
How Can We Care for Everyone?
Medicine; Community; Social Work; Medicine & Public Health; Transgender; Health Psychology; Medical Sociology; Premedical Education; LGBT; Support system
When I first met Charlotte, she was a 15-year-old African American boy named John. I was a white physician working at a community health center in one of the poorest zip codes in Cleveland. John and her mother came in for a well-child exam to get vaccines and complete forms for school. As with all my teenage patients, I talked briefly with John alone to screen for high-risk health behaviors. John disclosed that she had unprotected sex with males, so I gave her condoms and encouraged safe sex. I also told her about confidential minor visits, where she had the option to see me without a parent to address her sexual health issues. After that, John usually came to see me without her mom.
Christina Antenucci
Health Disparities : Weaving A New Understanding Through Case Narratives
2019
1905-07
Journal Article
<a href="http://doi.org/10.1007/978-3-030-12771-8_5" target="_blank" rel="noreferrer noopener">10.1007/978-3-030-12771-8_5</a>
Using the social ecological model to identify drivers of nutrition risk in adult day settings serving East Asian older adults
education; support; united-states; care; impact; guidelines; programs; perspective; community; malnutrition
Adult day care (ADC) centers provide community-based care (including meals) to frail, ethnically diverse older adults, many of whom are at risk for malnutrition. To support the development of interventions to benefit ADC users, the authors aimed to identify barriers and facilitators of healthy nutrition among ADC users born in Vietnam and China. Semi-structured qualitative interviews were conducted among ADC stakeholders to identify barriers and facilitators. Data were analyzed using Braun and Clarke's six-step method and organized within the framework of the Social Ecological Model. Facilitators of good nutrition included adherence to traditional diet at the ADC center, peer networks, and access to ethnic grocers. Poor health, family dynamics, and loneliness all contributed to poor nutrition, as did the restrictive nature of nutrition programs serving ADC users in the United States. Individual, relationship, organizational, community, and policy level factors play a role in ADC users' nutritional status. Targeted nutrition interventions should leverage culturally congruent relationships between ADC users and staff and include advocacy for enhancement of federal programs to support this population.
Sadarangani TR; Johnson JJ; Chong SK; Brody A; Trinh-Shevrin C
Research in Gerontological Nursing
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.3928/19404921-20191210-02" target="_blank" rel="noreferrer noopener">10.3928/19404921-20191210-02</a>
The impact of COVID-19 on coordinated specialty care (CSC) for people with first episode psychosis (FEP): preliminary observations, and recommendations, from the United States, Israel and China
program; community; covid-19; 1st-episode psychosis; first episode psychosis; coordinated specialty care; treatment recommendations
In the wake of COVID-19, mental health providers and treatment programs are adapting rapidly to the challenges in engaging people and delivering treatment with limited guidance. This paper will explore the challenges associated with delivering treatment within coordinated specialty care (CSC) programs for people with first episode psychosis. Suggestions for treatment will take into consideration experiences with stress, changes to the pursuit of work and school, and increased time spent with families. Drawing on the experience of several CSC programs in the United States, Israel, and China, we describe the impact and modifications to the core treatment elements in CSC including medication, family interactions, supported employment and education, individual therapy, peer support and the way they are delivered. The paper includes recommendations based on experiences from CSC programs to help staff members, participants, and family members better identify, prepare, cope and respond to the unique new challenges and suggests modifications that can be made during various stages of the coronavirus pandemic.
Meyer-Kalos PS; Roe D; Gingerich S; Hardy K; Bello I; Hrouda D; Shapiro D; Hayden-Lewis K; Cao L; Hao X; Liang Y; Zhong S; Mueser KT
Counselling Psychology Quarterly
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1080/09515070.2020.1771282" target="_blank" rel="noreferrer noopener">10.1080/09515070.2020.1771282</a>
Feeding the Soul via Creation of a Suborganization to Promote a Sense of Community
Pharmacy faculty commonly report feeling stressed, overwhelmed, exhausted, and burnt out. Women may be disproportionally impacted by personal and professional demands. The purpose of this commentary is to describe one mechanism for creating a suborganization (Circle) that establishes a supportive community to combat burnout and promote professional fulfillment. This commentary is a description of one American Academy of Colleges of Pharmacy (AACP) Women Faculty Special Interest Group (SIG) Circle. The authors describe how one Circle sought to enhance the well-being of its members through the various domains of the Stanford Model of Professional Fulfillment, including personal resilience, workplace efficiency, and creating a culture of well-being. Circles and similar frameworks may be effective tools for combatting burnout, improving fulfillment, and promoting wellness and well-being among women and other groups of faculty.
Caitlin M Gibson
Suzanne Larson
Erin M Behnen
Sara E Dugan
Ashley E Moody
Jamie L Wagner
10.5688/ajpe8927
Am J Pharm Educ
. 2023 Jan;87(1):ajpe8927. doi: 10.5688/ajpe8927. Epub 2022 Mar 22.
2023
English