scholarly journals Epidural Anesthesia-Analgesia and Patient Outcomes: A Perspective

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Christopher L. Wu ◽  
Jamie D. Murphy
Keyword(s):  
Patient Outcomes ◽  
Epidural Anesthesia ◽  
Postoperative Analgesia ◽  
Future Research ◽  
Patient Centered

The use of perioperative epidural anesthesia-analgesia may confer many benefits including superior postoperative analgesia, decreased morbidity, and improvement in patient-centered outcomes. We will review our group’s work on perioperative epidural anesthesia-analgesia on patient outcomes and discuss future research in this area

scholarly journals Defining indocyanine green fluorescence to assess anastomotic perfusion during gastrointestinal surgery: systematic review

BJS Open ◽  
2021 ◽  
Vol 5 (2) ◽  
Author(s):  
M D Slooter ◽  
M S E Mansvelders ◽  
P R Bloemen ◽  
S S Gisbertz ◽  
W A Bemelman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Indocyanine Green ◽  
Patient Outcomes ◽  
Gastrointestinal Surgery ◽  
Fluorescence Angiography ◽  
Future Research ◽  
Fluorescence Signal ◽  
Pixel Intensity ◽  
Indocyanine Green Fluorescence ◽  
Quantitative Parameters

Abstract Background The aim of this systematic review was to identify all methods to quantify intraoperative fluorescence angiography (FA) of the gastrointestinal anastomosis, and to find potential thresholds to predict patient outcomes, including anastomotic leakage and necrosis. Methods This systematic review adhered to the PRISMA guidelines. A PubMed and Embase literature search was performed. Articles were included when FA with indocyanine green was performed to assess gastrointestinal perfusion in human or animals, and the fluorescence signal was analysed using quantitative parameters. A parameter was defined as quantitative when a diagnostic numeral threshold for patient outcomes could potentially be produced. Results Some 1317 articles were identified, of which 23 were included. Fourteen studies were done in patients and nine in animals. Eight studies applied FA during upper and 15 during lower gastrointestinal surgery. The quantitative parameters were divided into four categories: time to fluorescence (20 studies); contrast-to-background ratio (3); pixel intensity (2); and numeric classification score (2). The first category was subdivided into manually assessed time (7 studies) and software-derived fluorescence–time curves (13). Cut-off values were derived for manually assessed time (speed in gastric conduit wall) and derivatives of the fluorescence–time curves (Fmax, T1/2, TR and slope) to predict patient outcomes. Conclusion Time to fluorescence seems the most promising category for quantitation of FA. Future research might focus on fluorescence–time curves, as many different parameters can be derived and the fluorescence intensity can be bypassed. However, consensus on study set-up, calibration of fluorescence imaging systems, and validation of software programs is mandatory to allow future data comparison.

scholarly journals Current Evidence and Future Perspectives on the Effective Practice of Patient-Centered Laboratory Medicine

2015 ◽  
Vol 61 (4) ◽  
pp. 589-599 ◽  
Author(s):  
Mike J Hallworth ◽  
Paul L Epner ◽  
Christoph Ebert ◽  
Corinne R Fantz ◽  
Sherry A Faye ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Clinical Effectiveness ◽  
Laboratory Medicine ◽  
Current Evidence ◽  
Patient Centered ◽  
Definition Of ◽  
Current Utilization ◽  
Measures Of Effectiveness ◽  
The Impact ◽  
Primary Measure

AbstractBACKGROUNDSystematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally.CONTENTThis review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding. It also identifies deficiencies in current utilization, suggests potential solutions, and offers a vision of a future in which laboratory medicine is used optimally to support patient care.SUMMARYTo maximize the value of laboratory medicine, work is required in 5 areas: (a) improved utilization of existing and new tests; (b) definition of new roles for laboratory professionals that are focused on optimizing patient outcomes by adding value at all points of the diagnostic brain-to-brain cycle; (c) development of standardized protocols for prospective patient-centered studies of biomarker clinical effectiveness or extraanalytical process effectiveness; (d) benchmarking of existing and new tests in specified situations with commonly accepted measures of effectiveness; (e) agreed definition and validation of effectiveness measures and use of checklists for articles submitted for publication. Progress in these areas is essential if we are to demonstrate and enhance the value of laboratory medicine and prevent valuable information being lost in meaningless data. This requires effective collaboration with clinicians, and a determination to accept patient outcome and patient experience as the primary measure of laboratory effectiveness.

scholarly journals Patient Centered Medical Home transformation at an academic medical center

2015 ◽  
Vol 5 (1) ◽  
pp. 34
Author(s):  
Randy Wexler ◽  
Jennifer Lehman ◽  
Mary Jo Welker
Keyword(s):  
Family Medicine ◽  
Patient Outcomes ◽  
Medical Home ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lessons Learned ◽  
Patient Centered Medical Home ◽  
Model Of Care ◽  
Patient Centered ◽  
Academic Medical

Background: Primary care is playing an ever increasing role in the design and implementation of new models of healthcare focused on achieving policy ends as put forth by government at both the state and federal level. The Patient Centered Medical Home (PCMH) model is a leading design in this endeavor.Objective: We sought to transform family medicine offices at an academic medical center into the PCMH model of care with improvements in patient outcomes as the end result.Results: Transformation to the PCMH model of care resulted in improved rates of control of diabetes and hypertension and improved prevention measures such as smoking cessation, mammograms, Pneumovax administration, and Tdap vaccination. Readmission rates also improved using a care coordination model.Conclusions: It is possible to transform family medicine offices at academic medical centers in methods consistent with newer models of care such as the PCMH model and to improve patient outcomes. Lessons learned along the way are useful to any practice or system seeking to undertake such transformation.

scholarly journals An Overview on Patient-Centered Clinical Services

2021 ◽  
Vol 4 (2) ◽  
pp. 157-170
Author(s):  
Gaurav Joshi ◽  
Atul Kabra ◽  
Nishant Goutam ◽  
Alka Sharma
Keyword(s):  
Patient Outcomes ◽  
Clinical Pharmacist ◽  
Healthcare Systems ◽  
Clinical Services ◽  
Drug Related Problems ◽  
Patient Centered ◽  
Health Quality ◽  
Health Quality Of Life ◽  
The One

Drug-related problems (DRPs) had often been a concern in the system that needed to be detected, avoided, and addressed as soon as possible. The need for a clinical pharmacist becomes even more important. He is the one who can not only share the load but also be an important part of the system by providing required advice. They fill out the patient's pharmacotherapy reporting form and notify the medical team's head off any drug-related issues. General practitioners register severe adverse drug reactions (ADRs) yearly. As a result of all of this, a clinical pharmacist working in and around the healthcare system is expected to advance the pharmacy industry. Its therapy and drugs can improve one's health quality of life by curing, preventing, or diagnosing a disease, sign, or symptom. The sideshows, on the other hand, do much harm. Because of the services they offer, clinical pharmacy has grown in popularity. To determine the overall effect and benefits of the emergency department (ED) clinical pharmacist, a systematic review of clinical practice and patient outcomes will be needed. A clinical pharmacist's anatomy, toxicology, pharmacology, and medicinal chemistry expertise significantly improves a patient's therapy enforcement. It is now important to examine the failure points of healthcare systems as well as the individuals involved.

scholarly journals Clinical Lycanthropy, Neurobiology, Culture: A Systematic Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Sélim Benjamin Guessoum ◽  
Laelia Benoit ◽  
Sevan Minassian ◽  
Jasmina Mallet ◽  
Marie Rose Moro
Keyword(s):  
Systematic Review ◽  
Evaluation System ◽  
Psychotic Disorders ◽  
Right Hemisphere ◽  
Case Reports ◽  
Future Research ◽  
Patient Centered ◽  
Efficient Treatment ◽  
Cultural Aspects ◽  
Centered Care

Background: Culture can affect psychiatric disorders. Clinical Lycanthropy is a rare syndrome, described since Antiquity, within which the patient has the delusional belief of turning into a wolf. Little is known on its clinical or therapeutic correlates.Methods: We conducted a systematic review (PRISMA) on PubMed and Google Scholar, until January 2021. Case reports, data on neurobiological hypotheses, and cultural aspects were included. Language was not restricted to English.Results: Forty-three cases of clinical lycanthropy and kynanthropy (delusion of dog transformation) were identified. Associated diagnoses were: schizophrenia, psychotic depression, bipolar disorder, and other psychotic disorders. Antipsychotic medication may be an efficient treatment for this rare transnosographic syndrome. In case of depression or mania, the treatment included antidepressants or mood regulators. The neuroscientific hypotheses include the conception of clinical lycanthropy as a cenesthopathy, as a delusional misidentification of the self-syndrome, as impairments of sensory integration, as impairments of the belief evaluation system, and right hemisphere anomalies. Interestingly, there is a clinical overlap between clinical lycanthropy and other delusional misidentification syndromes. Clinical lycanthropy may be a culture-bound syndrome that happens in the context of Western cultures, myths, and stories on werewolves, and today's exposure to these narratives on cultural media such as the internet and the series. We suggest the necessity of a cultural approach for these patients' clinical assessment, and a narrative and patient-centered care.Conclusions: Psychiatric transtheoretical reflections are needed for complementaristic neurobiological and cultural approaches of complex delusional syndromes such as clinical lycanthropy. Future research should include integrative frameworks.

scholarly journals How Returning Aggregate Research Results Impacts Interest in Research Engagement and Planned Actions Relevant to Health Care Decision Making: Cohort Study (Preprint)

2018 ◽  
Author(s):  
Elissa R Weitzman ◽  
Kara M Magane ◽  
Lauren E Wisk
Keyword(s):  
Information Seeking ◽  
Research Participation ◽  
Future Research ◽  
Patient Centered ◽  
Research Results ◽  
Research Engagement ◽  
Patient Reported ◽  
Virtuous Cycle ◽  
Interest In Research ◽  
Reaction Patterns

BACKGROUND Collection of patient-reported outcomes measures (PROs) may augment clinical data and inform health research, improving care, yet approaches to sustaining interest among patient cohorts in research participation are needed. One approach may involve returning aggregate research results (ARRs), which may help patients contextualize personal experiences, prompt conversations with providers or family, and encourage information seeking. This model has been demonstrated for Web-based patient-centered registries. Studies with clinical cohorts may further elucidate the model, its impacts on interest in research participation and planned actions, and potential for participants to experience this as helpful or harmful—gap areas. OBJECTIVE We sought to investigate the impacts of returning ARRs comprising summaries of PROs and clinical metrics to parents of children with rheumatic disease, assessing interest in future research participation among parents who viewed ARRs and plans for acting on returned information. Further, we sought to investigate reactions to viewing ARRs and how these reactions impacted planned actions. METHODS Clinical and PRO data were obtained about children in a national clinical disease registry, summarized, and processed into annotated infographics, comprising ARRs for children’s parents. Parents who viewed ARRs (n=111) were surveyed about the information’s perceived value and their reactions. Reaction patterns were summarized using principal components analysis (PCA), and associations among reaction patterns and interest in research participation and planned actions were estimated using multivariate logistic regression. RESULTS Parental endorsement of the value of ARRs for understanding their child’s condition and making care decisions was high (across 10 topics for which ARRs were shared, 42.2%-77.3% of the parents reported information was “very valuable”). Most (58/111, 52.3%) parents reported being more interested in participating in research after viewing ARRs, with the remainder reporting that their interest levels were unchanged. Reactions to viewing ARRs reflected experiencing validation/affirmation and information burden based on PCA. Reactions were not associated with child demographic or clinical characteristics and PROs, except that parents from households with less education reported greater information burden than those from more educated households (P=.007). In adjusted models, parents with higher validation/affirmation scores had increased odds of reporting heightened interest in research participation (adjusted odds ratio [AOR] 1.97, 95% CI 1.18-3.30), while higher information burden scores were associated with decreased odds of planned discussions with their child (AOR 0.59, 95% CI 0.36-0.95) and increased odds of planned discussions with providers (AOR 1.75, 95% CI 1.02-3.00). CONCLUSIONS Returning ARRs may foster a “virtuous cycle” of research engagement, especially where ARRs are experienced favorably and affect plans to share and discuss ARRs in support of a child’s chronic disease care and treatment. Reactions to ARRs vary with education level, underscoring the need for attention to equity for this model.

scholarly journals Patient Outcomes at 26 Months in the Patient-Centered Medical Home National Demonstration Project

2010 ◽  
Vol 8 (Suppl_1) ◽  
pp. S57-S67 ◽  
Author(s):  
C. R. Jaen ◽  
R. L. Ferrer ◽  
W. L. Miller ◽  
R. F. Palmer ◽  
R. Wood ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Medical Home ◽  
Demonstration Project ◽  
Patient Centered Medical Home ◽  
Patient Centered

Why Causal Inference Matters to Nurses: The Case of Nurse Staffing and Patient Outcomes

2016 ◽  
Vol 21 (2) ◽  
Author(s):  
Deena Costa ◽  
Olga Yakusheva
Keyword(s):  
Causal Inference ◽  
Patient Outcomes ◽  
Nurse Staffing ◽  
Future Research ◽  
Nursing Research ◽  
Cross Sectional ◽  
Meaningful Improvement ◽  
Causal Pathways ◽  
Causal Pathway ◽  
Study Designs

Since the early 1990s researchers have steadily built a broad evidence base for the association between nurse staffing and patient outcomes. However, the majority of the studies in the literature employ designs that are unable to robustly examine causal pathways to meaningful improvement in patient outcomes. A focus on causal inference is essential to moving the field of nursing research forward, and as part of the essential skill-set for all nurses as consumers of research. In this article, we aim to describe the importance of causal inference in nursing research and discuss study designs that are more likely to produce causal findings. We first review the conceptual framework supporting this discussion and then use selected examples from the literature, typifying three key study designs – cross-sectional, longitudinal, and randomized control trials (RCTs). The discussion will illustrate strengths and limitation of existing evidence, focusing on the causal pathway between nurse staffing and outcomes. The article conclusion considers implications for future research.

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