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Immediate effects of the initial FDA notification on the use of surgical mesh for pelvic organ prolapse surgery in medicare beneficiaries.
Reynolds WS, Gold KP, Ni S, Kaufman MR, Dmochowski RR, Penson DF
(2013) Neurourol Urodyn 32: 330-5
MeSH Terms: Age Factors, Aged, Aged, 80 and over, Biological Dressings, Cohort Studies, Female, Humans, Hysterectomy, Inpatients, International Classification of Diseases, Medicare, Middle Aged, Outpatients, Pelvic Organ Prolapse, Suburethral Slings, Surgical Mesh, United States, United States Food and Drug Administration, Urologic Surgical Procedures
Show Abstract · Added March 5, 2014
AIMS - Prompted by increased reports of complications with the use of mesh for pelvic organ prolapse (POP) surgery, the FDA issued an initial public health notification (PHN) in 2008. We proposed to determine if the numbers of POP cases augmented with surgical mesh performed in U.S. Medicare beneficiaries changed relative to this PHN.
METHODS - Using administrative healthcare claims for beneficiaries enrolled in the U.S. Medicare program from 2008 to 2009, we identified women who underwent POP surgery with and without surgical mesh by procedural and diagnosis coding. In addition to comparing cases with and without mesh, we also calculated rates (number of cases per 100,000 female beneficiaries) and compared these relative to the timing of the PHN.
RESULTS - We identified 104,185 POP procedures, of which 27,839 (26.7%) included mesh material and 76,346 (73.3%) did not. Between the last three quarters of 2008 and the first three of 2009, the rates of mesh cases increased (40.3-42.1, P < 0.001) and those without mesh decreased (115.5-111.4, P < 0.001). Inpatient procedures decreased and outpatient procedures increased for both those with and without mesh augmentation. For inpatient procedures, the relative use of biologic graft and synthetic mesh material did not vary over the study period.
CONCLUSIONS - A substantial number of Medicare beneficiaries underwent mesh POP procedures in 2008-2009. However, despite the PHN cautioning about potential mesh complications, the numbers of mesh cases continued to rise in the immediate period after the PHN.
Copyright © 2012 Wiley Periodicals, Inc.
0 Communities
2 Members
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19 MeSH Terms
Cultivating quality: early postoperative ambulation: back to basics.
Kibler VA, Hayes RM, Johnson DE, Anderson LW, Just SL, Wells NL
(2012) Am J Nurs 112: 63-9
MeSH Terms: Academic Medical Centers, Adult, Early Ambulation, Female, Humans, Inpatients, Length of Stay, Male, Middle Aged, Nurse's Role, Postoperative Care, Postoperative Complications, Postoperative Period, Recovery of Function, Rectal Diseases, Tennessee, Treatment Outcome, Urologic Diseases
Added March 20, 2014
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18 MeSH Terms
A strategy for optimizing staffing to improve the timeliness of inpatient phlebotomy collections.
Morrison AP, Tanasijevic MJ, Torrence-Hill JN, Goonan EM, Gustafson ML, Melanson SE
(2011) Arch Pathol Lab Med 135: 1576-80
MeSH Terms: Academic Medical Centers, Boston, Humans, Inpatients, Outcome Assessment, Health Care, Personnel Staffing and Scheduling, Phlebotomy, Statistics as Topic, Time Factors, Workflow
Show Abstract · Added November 7, 2019
CONTEXT - The timely availability of inpatient test results is a key to physician satisfaction with the clinical laboratory, and in an institution with a phlebotomy service may depend on the timeliness of blood collections. In response to safety reports filed for delayed phlebotomy collections, we applied Lean principles to the inpatient phlebotomy service at our institution. Our goal was to improve service without using additional resources by optimizing our staffing model.
OBJECTIVE - To evaluate the effect of a new phlebotomy staffing model on the timeliness of inpatient phlebotomy collections.
DESIGN - We compared the median time of morning blood collections and average number of safety reports filed for delayed phlebotomy collections during a 6-month preimplementation period and 5-month postimplementation period.
RESULTS - The median time of morning collections was 17 minutes earlier after implementation (7:42 am preimplementation; interquartile range, 6:27-8:48 am; versus 7:25 am postimplementation; interquartile range, 6:20-8:26 am). The frequency of safety reports filed for delayed collections decreased 80% from 10.6 per 30 days to 2.2 per 30 days.
CONCLUSION - Reallocating staff to match the pattern of demand for phlebotomy collections throughout the day represents a strategy for improving the performance of an inpatient phlebotomy service.
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10 MeSH Terms
Automated identification of postoperative complications within an electronic medical record using natural language processing.
Murff HJ, FitzHenry F, Matheny ME, Gentry N, Kotter KL, Crimin K, Dittus RS, Rosen AK, Elkin PL, Brown SH, Speroff T
(2011) JAMA 306: 848-55
MeSH Terms: Automation, Cross-Sectional Studies, Diagnosis-Related Groups, Electronic Health Records, Hospitalization, Hospitals, Veterans, Humans, Information Storage and Retrieval, Inpatients, International Classification of Diseases, Myocardial Infarction, Natural Language Processing, Patient Discharge, Pneumonia, Population Surveillance, Postoperative Complications, Pulmonary Embolism, Quality Indicators, Health Care, Renal Insufficiency, Safety, Sensitivity and Specificity, Sepsis, Surgical Procedures, Operative, United States, Venous Thrombosis
Show Abstract · Added March 5, 2014
CONTEXT - Currently most automated methods to identify patient safety occurrences rely on administrative data codes; however, free-text searches of electronic medical records could represent an additional surveillance approach.
OBJECTIVE - To evaluate a natural language processing search-approach to identify postoperative surgical complications within a comprehensive electronic medical record.
DESIGN, SETTING, AND PATIENTS - Cross-sectional study involving 2974 patients undergoing inpatient surgical procedures at 6 Veterans Health Administration (VHA) medical centers from 1999 to 2006.
MAIN OUTCOME MEASURES - Postoperative occurrences of acute renal failure requiring dialysis, deep vein thrombosis, pulmonary embolism, sepsis, pneumonia, or myocardial infarction identified through medical record review as part of the VA Surgical Quality Improvement Program. We determined the sensitivity and specificity of the natural language processing approach to identify these complications and compared its performance with patient safety indicators that use discharge coding information.
RESULTS - The proportion of postoperative events for each sample was 2% (39 of 1924) for acute renal failure requiring dialysis, 0.7% (18 of 2327) for pulmonary embolism, 1% (29 of 2327) for deep vein thrombosis, 7% (61 of 866) for sepsis, 16% (222 of 1405) for pneumonia, and 2% (35 of 1822) for myocardial infarction. Natural language processing correctly identified 82% (95% confidence interval [CI], 67%-91%) of acute renal failure cases compared with 38% (95% CI, 25%-54%) for patient safety indicators. Similar results were obtained for venous thromboembolism (59%, 95% CI, 44%-72% vs 46%, 95% CI, 32%-60%), pneumonia (64%, 95% CI, 58%-70% vs 5%, 95% CI, 3%-9%), sepsis (89%, 95% CI, 78%-94% vs 34%, 95% CI, 24%-47%), and postoperative myocardial infarction (91%, 95% CI, 78%-97%) vs 89%, 95% CI, 74%-96%). Both natural language processing and patient safety indicators were highly specific for these diagnoses.
CONCLUSION - Among patients undergoing inpatient surgical procedures at VA medical centers, natural language processing analysis of electronic medical records to identify postoperative complications had higher sensitivity and lower specificity compared with patient safety indicators based on discharge coding.
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25 MeSH Terms
A pilot study: pain, fatigue and stress in maternal relatives of adolescent female psychiatric inpatients assessed for juvenile primary fibromyalgia syndrome.
Lommel K, Bamford J, Jhavari M, Martin C, Crofford L
(2011) Int J Adolesc Med Health 23: 59-63
MeSH Terms: Adolescent, Adult, Chi-Square Distribution, Demography, Family, Fatigue, Female, Fibromyalgia, Humans, Inpatients, Pain, Pain Measurement, Pilot Projects, Statistics, Nonparametric, Stress, Psychological, Surveys and Questionnaires
Show Abstract · Added September 18, 2013
BACKGROUND - This study was designed to assess the presence of pain and impaired functioning in the maternal relatives of adolescent females in an inpatient adolescent psychiatric population. We compared the relatives of adolescents who met the criteria for juvenile primary fibromyalgia syndrome (JPFS) to relatives of adolescents who did not meet the criteria for JPFS.
METHODS - A total of 55 biological maternal relatives of adolescent females admitted to a psychiatric unit were recruited to participate in the study. Participants completed four self-administered questionnaires: Multidimensional Fatigue Inventory, Fibromyalgia Impact Questionnaire, Medical Outcomes Survey (SF36v2), and the EPIFUND Health Survey.
RESULTS - The maternal relatives of adolescents who met the criteria for JPFS did not score higher than the maternal relatives of adolescents who did not meet the criteria for JPFS. However, all maternal relatives consistently scored higher on self-reported measures of pain, impaired functioning, fatigue, and fibromyalgia symptoms than the average patient diagnosed with fibromyalgia or a chronic pain syndrome.
CONCLUSION - Mood disorders and pain disorders share genetic risk factors and vulnerability. Future research is needed to further delineate other factors impacting the maternal caregivers' functioning. These could include stress associated with an adolescent child with psychiatric issues severe enough to warrant hospitalization.
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16 MeSH Terms
Healthcare utilization and cost of pneumococcal disease in the United States.
Huang SS, Johnson KM, Ray GT, Wroe P, Lieu TA, Moore MR, Zell ER, Linder JA, Grijalva CG, Metlay JP, Finkelstein JA
(2011) Vaccine 29: 3398-412
MeSH Terms: Adolescent, Adult, Aged, Child, Child, Preschool, Delivery of Health Care, Health Care Costs, Humans, Infant, Inpatients, Middle Aged, Models, Economic, Otitis Media, Outpatients, Pneumococcal Infections, Sepsis, Sinusitis, United States, Young Adult
Show Abstract · Added July 27, 2018
BACKGROUND - Streptococcus pneumoniae continues to cause a variety of common clinical syndromes, despite vaccination programs for both adults and children. The total U.S. burden of pneumococcal disease is unknown.
METHODS - We constructed a decision tree-based model to estimate U.S. healthcare utilization and costs of pneumococcal disease in 2004. Data were obtained from the 2004-2005 National (Hospital) Ambulatory Medical Care Surveys (outpatient visits, antibiotics) and the National Hospital Discharge Survey (hospitalization rates), and CDC surveillance data. Other assumptions regarding the incidence of each syndrome due to pneumococcus, expected health outcomes, and healthcare utilization were derived from literature and expert opinion. Healthcare and time costs used 2007 dollars.
RESULTS - We estimate that, in 2004, pneumococcal disease caused 4.0 million illness episodes, 22,000 deaths, 445,000 hospitalizations, 774,000 emergency department visits, 5.0 million outpatient visits, and 4.1 million outpatient antibiotic prescriptions. Direct medical costs totaled $3.5 billion. Pneumonia (866,000 cases) accounted for 22% of all cases and 72% of pneumococcal costs. In contrast, acute otitis media and sinusitis (1.5 million cases each) comprised 75% of cases but only 16% of direct medical costs. Patients ≥ 65 years old, accounted for most serious cases and the majority of direct medical costs ($1.8 billion in healthcare costs annually). In this age group, pneumonia caused 242,000 hospitalizations, 1.4 million hospital days, 194,000 emergency department visits, 374,000 outpatient visits, and 16,000 deaths. However, if work loss and productivity are considered, the cost of pneumococcal disease among younger working adults (18-<50) nearly equaled those ≥ 65.
CONCLUSIONS - Pneumococcal disease remains a substantial cause of morbidity and mortality even in the era of routine pediatric and adult vaccination. Continued efforts are warranted to reduce serious pneumococcal disease, especially adult pneumonia.
Copyright © 2011 Elsevier Ltd. All rights reserved.
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MeSH Terms
Multi-modal intervention for the inpatient management of sickle cell pain significantly decreases the rate of acute chest syndrome.
Reagan MM, DeBaun MR, Frei-Jones MJ
(2011) Pediatr Blood Cancer 56: 262-6
MeSH Terms: Acute Chest Syndrome, Adolescent, Anemia, Sickle Cell, Child, Child, Preschool, Cohort Studies, Education, Medical, Graduate, Female, Hospitalization, Humans, Infant, Inpatients, Internship and Residency, Male, Pain, Pain Management, Patient Education as Topic, Young Adult
Show Abstract · Added November 27, 2013
INTRODUCTION - Pain in children with sickle cell disease (SCD) is the leading cause of acute care visits and hospitalizations. Pain episodes are a risk factor for the development of acute chest syndrome (ACS), contributing to morbidity and mortality in SCD. Few strategies exist to prevent this complication.
METHODS - We performed a before-and-after prospective multi-modal intervention. All children with SCD admitted for pain during the 2-year study period were eligible. The multi-modal intervention included standardized admission orders, monthly house staff education, and one-on-one patient and caregiver education.
RESULTS - A total of 332 admissions for pain occurred during the study period; 159 before the intervention and 173 during the intervention. The ACS rate declined by 50% during the intervention period 25% (39 of 159) to 12% (21 of 173); P = 0.003. Time to ACS development increased from 0.8 days (0.03-5.2) to 1.7 days (0.03-5.8); P = 0.047. No significant difference was found in patient demographics, intravenous fluid amount administered, frequency of normal saline bolus administration, or cumulative opioid amount delivered in the first 24 hr. Patient controlled analgesia-use was more common after the intervention 52% (82 of 159) versus 73% (126 of 173; P = 0.0001) and fewer patients required changes in analgesic dosing within the first 24 hr after admission (26%, 42 of 159 vs. 16%, 28 of 173; P = 0.015).
CONCLUSIONS - A multi-modal intervention to educate and subsequently change physician's behavior likely decreased the rate of ACS in the setting of a single teaching hospital.
Copyright © 2010 Wiley-Liss, Inc.
1 Communities
1 Members
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18 MeSH Terms
Statins for acutely hospitalized patients: randomized controlled trials are long overdue.
Bernard GR
(2010) Crit Care 14: 141
MeSH Terms: Critical Illness, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypercholesterolemia, Inpatients, Randomized Controlled Trials as Topic, Survival Analysis
Show Abstract · Added March 5, 2014
From the earliest studies of statins for control of plasma cholesterol, observations have been made that the reductions in mortality observed occurred in a manner seemingly independent from what could be anticipated from cholesterol lowering alone. Over the last decade, the pleiotropic effects of statins have been increasingly elucidated. Perhaps most intriguing are the effects statins appear to have on the immune system, especially the modulation of diffuse or systemic inflammation. There is a growing body of observational literature suggesting that statins can actually reduce hospital mortality through mechanisms far beyond those that can be explained by reductions in cardiovascular events.
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7 MeSH Terms
Development of inpatient risk stratification models of acute kidney injury for use in electronic health records.
Matheny ME, Miller RA, Ikizler TA, Waitman LR, Denny JC, Schildcrout JS, Dittus RS, Peterson JF
(2010) Med Decis Making 30: 639-50
MeSH Terms: Acute Kidney Injury, Adolescent, Adult, Aged, Area Under Curve, Confidence Intervals, Decision Support Systems, Clinical, Decision Support Techniques, Diagnosis-Related Groups, Disease Progression, Female, Humans, Inpatients, Length of Stay, Logistic Models, Male, Medical Records Systems, Computerized, Middle Aged, Models, Statistical, Neural Networks, Computer, Odds Ratio, Prognosis, ROC Curve, Retrospective Studies, Risk Assessment, Risk Factors, Tennessee, Young Adult
Show Abstract · Added March 7, 2014
OBJECTIVE - Patients with hospital-acquired acute kidney injury (AKI) are at risk for increased mortality and further medical complications. Evaluating these patients with a prediction tool easily implemented within an electronic health record (EHR) would identify high-risk patients prior to the development of AKI and could prevent iatrogenically induced episodes of AKI and improve clinical management.
METHODS - The authors used structured clinical data acquired from an EHR to identify patients with normal kidney function for admissions from 1 August 1999 to 31 July 2003. Using administrative, computerized provider order entry and laboratory test data, they developed a 3-level risk stratification model to predict each of 2 severity levels of in-hospital AKI as defined by RIFLE criteria. The severity levels were defined as 150% or 200% of baseline serum creatinine. Model discrimination and calibration were evaluated using 10-fold cross-validation.
RESULTS - Cross-validation of the models resulted in area under the receiver operating characteristic (AUC) curves of 0.75 (150% elevation) and 0.78 (200% elevation). Both models were adequately calibrated as measured by the Hosmer-Lemeshow goodness-of-fit test chi-squared values of 9.7 (P = 0.29) and 12.7 (P = 0.12), respectively.
CONCLUSIONS - The authors generated risk prediction models for hospital-acquired AKI using only commonly available electronic data. The models identify patients at high risk for AKI who might benefit from early intervention or increased monitoring.
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4 Members
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28 MeSH Terms
Juvenile primary fibromyalgia syndrome in an inpatient adolescent psychiatric population.
Lommel K, Kapoor S, Bamford J, Melguizo MS, Martin C, Crofford L
(2009) Int J Adolesc Med Health 21: 571-9
MeSH Terms: Adolescent, Child, Child Abuse, Demography, Female, Fibromyalgia, Hospitals, Psychiatric, Humans, Inpatients, Prevalence, Syndrome
Show Abstract · Added September 18, 2013
UNLABELLED - The purpose of this study was to identify the clinical and demographic characteristics of adolescent females admitted to a psychiatric hospital who meet the criteria for Juvenile Primary Fibromyalgia Syndrome (JPFS).
METHODS - Participants (n = 62) were adolescent females, ages 12 to 18 years who were admitted to an inpatient psychiatric unit. The participants completed four questionnaires: The Achenbach Youth Self-Report (YSR), the Children's Somatization Inventory (CSI), the Fibromyalgia Impact Questionnaire modified for children (FIQ-C) and the Pain Symptom Questionnaire (PSQ). Then participants were interviewed to assess the Yunus and Masi JPFS criteria. The interview included an examination of 21 (18 bilateral and 3 control) tender points.
RESULTS - Of the 62 adolescent females enrolled, 52% (n = 32) met criteria for JPFS (i.e. JPFS cases). Both the FIQ and CSI scores were significantly elevated for JPFS cases as compared with non-cases (p = .0001 and p = .0012 respectively). Cases of JPFS also scored significantly higher on the anxiety, depression, and conduct disorder scales of the YSR. No between-group differences were found in reports of physical or sexual abuse. However, a consistently higher percentage of JPFS cases reported physical or sexual abuse as a child.
CONCLUSIONS - Juvenile primary fibromyalgia is highly prevalent in an adolescent inpatient psychiatric unit. This possibility should be taken into consideration when chronic complaints of pain are expressed by patients in this setting, especially in those who have conduct-related issues. The connection between JPFS and abuse history requires further investigation.
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11 MeSH Terms