scholarly journals Hospital Medicine and Perioperative Care: A Framework for High-Quality, High-Value Collaborative Care

2017 ◽  
Vol 12 (4) ◽  
pp. 277-282 ◽  
Author(s):  
Rachel E Thompson ◽  
Kurt Pfeifer ◽  
Paul J Grant ◽  
Cornelia Taylor ◽  
Barbara Slawski ◽  
...  
Keyword(s):  
Collaborative Care ◽  
Perioperative Care ◽  
Hospital Medicine ◽  
High Quality

The effectiveness of the bone bridge transtibial amputation technique: A systematic review of high-quality evidence

2016 ◽  
Vol 41 (3) ◽  
pp. 219-226 ◽  
Author(s):  
Jason T Kahle ◽  
M Jason Highsmith ◽  
John Kenney ◽  
Tim Ruth ◽  
Paul A Lunseth ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Literature Review ◽  
Acute Care ◽  
Perioperative Care ◽  
Clinical Relevance ◽  
High Quality ◽  
Subjective Analysis ◽  
Bone Bridge ◽  
Quality Evidence

Background:This literature review was undertaken to determine if commonly held views about the benefits of a bone bridge technique are supported by the literature.Methods:Four databases were searched for articles pertaining to surgical strategies specific to a bone bridge technique of the transtibial amputee. A total of 35 articles were identified as potential articles. Authors included methodology that was applied to separate topics. Following identification, articles were excluded if they were determined to be low quality evidence or not pertinent.Results:Nine articles were identified to be pertinent to one of the topics: Perioperative Care, Acute Care, Subjective Analysis and Function. Two articles sorted into multiple topics. Two articles were sorted into the Perioperative Care topic, 4 articles sorted into the Acute Care topic, 2 articles into the Subjective Analysis topic and 5 articles into the Function topic.Discussion:There are no high quality (level one or two) clinical trials reporting comparisons of the bone bridge technique to traditional methods. There is limited evidence supporting the clinical outcomes of the bone bridge technique. There is no agreement supporting or discouraging the perioperative and acute care aspects of the bone bridge technique. There is no evidence defining an interventional comparison of the bone bridge technique.Conclusion:Current level III evidence supports a bone bridge technique as an equivalent option to the non-bone bridge transtibial amputation technique. Formal level I and II clinical trials will need to be considered in the future to guide clinical practice.Clinical relevanceClinical Practice Guidelines are evidence based. This systematic literature review identifies the highest quality evidence to date which reports a consensus of outcomes agreeing bone bridge is as safe and effective as alternatives. The clinical relevance is understanding bone bridge could additionally provide a mechanistic advantage for the transtibial amputee.

Training and certification for hospital medicine programs support the essential role of hospitalists for complex multi-morbid patients in acute care

2021 ◽  
Vol 7 (3) ◽  
pp. 125-131
Author(s):  
Vandad Yousefi ◽  
William Coke ◽  
James Eisner
Keyword(s):  
Health Care ◽  
Acute Care ◽  
Essential Role ◽  
Health Care Organizations ◽  
Care Delivery ◽  
Quality Care ◽  
Hospital Medicine ◽  
High Quality ◽  
The World

The current COVID-19 pandemic has resulted in significant strain on acute care delivery in Canada and around the world. It has highlighted the importance of hospitals rapidly increasing their resources to meet the capacity demands brought on by a disruptive change. Hospital medicine teams have become central to many acute care sites, caring for increasingly complex hospitalized patients. We believe that the ongoing implementation of hospitalist teams of generalist physicians is critical in ensuring that health care organizations are well positioned to provide high-quality care in uncertain times. We also highlight the need for adequate training and certification for physicians who aim to work as part of such programs.

scholarly journals Why is reporting quality improvement so hard? A qualitative study in perioperative care

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e030269 ◽  
Author(s):  
Emma Leanne Jones ◽  
Mary Dixon-Woods ◽  
Graham P Martin
Keyword(s):  
Quality Improvement ◽  
Perioperative Care ◽  
Reporting Quality ◽  
Qualitative Interview ◽  
High Quality ◽  
Research Reporting ◽  
Journal Editors ◽  
Suboptimal Care ◽  
Qualitative Interview Study ◽  
Study Participants

ObjectivesQuality improvement (QI) may help to avert or mitigate the risks of suboptimal care, but it is often poorly reported in the healthcare literature. We aimed to identify the influences on reporting QI in the area of perioperative care, with a view to informing improvements in reporting QI across healthcare.DesignQualitative interview study.SettingHealthcare and academic organisations in Australia, Europe and North America.ParticipantsStakeholders involved in or influencing the publication, writing or consumption of reports of QI studies in perioperative care.ResultsForty-two participants from six countries took part in the study. Participants included 15 authors (those who write QI reports), 12 consumers of QI reports (practitioners who apply QI research in practice), 11 journal editors and 4 authors of reporting guidelines. Participants identified three principal challenges in achieving high-quality QI reporting. First, the broad scope of QI reporting—ranging from small local projects to multisite research across different disciplines—causes uncertainty about where QI work should be published. Second, context is fundamental to the success of a QI intervention but is difficult to report in ways that support replication and development. Third, reporting is adversely affected by both proximal influences (such as lack of time to write up QI) and more distal, structural influences (such as norms about the format and content of biomedical research reporting), leading to incomplete reporting of QI findings.ConclusionsDivergent terminology and understandings of QI, along with existing reporting norms and the challenges of capturing context adequately yet succinctly, make for challenges in reporting QI. We offer suggestions for improvement.

scholarly journals A role for hospital medicine in perioperative care

2018 ◽  
Vol 25 ◽  
pp. 196
Author(s):  
Rachel E. Thompson ◽  
David Seeley ◽  
Jason Shiffermiller
Keyword(s):  
Perioperative Care ◽  
Hospital Medicine

Evidence-based out-of-hours hospital medicine

2018 ◽  
Vol 94 (1116) ◽  
pp. 588-595
Author(s):  
Gordon Arthur George McKenzie
Keyword(s):  
First Principles ◽  
Diagnostic Tests ◽  
Hospital Medicine ◽  
General Ward ◽  
Junior Doctors ◽  
Evidence Based ◽  
Hypnotics And Sedatives ◽  
Consensus Guidelines ◽  
High Quality ◽  
Out Of Hours

Out-of-hours (OOH) hospital ward cover is generally provided by junior doctors and is typified by heavy workloads, reduced staff numbers and various non-urgent nurse-initiated requests. The present inefficiencies and management problems with the OOH service are reflected by the high number of quality improvement projects recently published. In this narrative review, five common situations peculiar to the OOH general ward setting are discussed with reference to potential areas of inefficiency and unnecessary management steps: (1) prescription of hypnotics and sedatives; (2) overnight fluid therapy; (3) fever; (4) overnight hypotension and (5) chasing outstanding routine diagnostic tests. It is evident that research and consensus guidelines for many clinical situations in the OOH setting are a neglected arena. Many recommendations made herein are based on expert opinion or first principles. In contrast, the management of significant abnormalities in outstanding blood results is based on well-established guidelines using high-quality systematic reviews.

scholarly journals Fluid management in patients undergoing neurosurgery

2021 ◽  
Author(s):  
Taeha Ryu
Keyword(s):  
Fluid Therapy ◽  
Perioperative Care ◽  
Management Practices ◽  
Fluid Management ◽  
Perioperative Period ◽  
High Quality ◽  
Serum Osmolarity ◽  
Neurosurgical Patients ◽  
Considerable Debate ◽  
Perioperative Fluid Management

Fluid management is an important component of perioperative care for patients undergoing neurosurgery. The primary goal of fluid management in neurosurgery is the maintenance of normovolemia and prevention of serum osmolarity reduction. To maintain normovolemia, it is important to administer fluids in appropriate amounts following appropriate methods, and to prevent a decrease in serum osmolarity, the choice of fluid is essential. There is considerable debate about the choice and optimal amounts of fluids administered in the perioperative period. However, there is little high-quality clinical research on fluid therapy for patients undergoing neurosurgery. This review will discuss the choice and optimal amounts of fluids in neurosurgical patients based on the literature, recent issues, and perioperative fluid management practices.

Primary care provider engagement about breast cancer care during treatment: Results from the iCanCare Study.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 101-101
Author(s):  
Lauren P. Wallner ◽  
Paul Abrahamse ◽  
Christopher Ryan Friese ◽  
Steven J. Katz ◽  
Sarah T. Hawley
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Los Angeles ◽  
Collaborative Care ◽  
Cancer Care ◽  
Primary Care Providers ◽  
Current Response ◽  
Care Providers ◽  
Breast Cancer Patients ◽  
High Quality

101 Background: Collaborative care between cancer specialists and primary care providers (PCP) ensures high quality cancer care. Yet, little is known about patient’s perspectives about the level of PCP engagement in and communication about breast cancer (BC) care during treatment. Methods: A weighted random sample of newly diagnosed breast cancer patients in the Georgia and Los Angeles SEER registries were surveyed approximately 6 months after diagnosis (expected final N = 2600, 70% current response rate). PCP BC engagement and communication were defined using 2 outcome measures (categorized as less (never/rarely) vs. more (sometimes/often/always)): how informed the respondent’s PCP was about BC treatment and how often respondents talked with their PCP about their BC care visits. Overall PCP quality was assessed by averaging patient responses (5 categories, never to always) to 5 questions: ease of access to PCP (3 questions) and PCP’s awareness of patient values (2 questions) and categorized as high ( ≥ 4), moderate (3) and low ( < 3). The associations between patient factors and PCP quality with BC engagement and communication were evaluated using multivariable logistic regression. Results: In a preliminary sample (N = 2054), the majority of women reported high PCP quality (63%), high PCP BC engagement (65%) and communication (68%). (Table) Women who reported less PCP BC engagement were more likely to report low PCP quality (OR: 15.7, 95%CI: 9.5, 25.9;) and chemotherapy use (OR: 1.3, 95%CI: 1.1, 1.6), adjusting for age, race, insurance, comorbidities and PCP continuity. The results were similar for PCP communication. Conclusions: Patient perceptions of PCP quality, engagement and communication during BC treatment are high for most women with BC. However, there remains opportunity for improvement in both, as many women report poor engagement and communication despite perceiving high quality primary care. Targeting these patients and their clinicians may be particularly effective in interventions to improve collaborative care in cancer. [Table: see text]

The current state of general paediatric fellowships in Canada

2021 ◽  
Author(s):  
Ali Al Maawali ◽  
Allan Puran ◽  
Sarah Schwartz ◽  
Julie Johnstone ◽  
Zia Bismilla
Keyword(s):  
Size Structure ◽  
Hospital Medicine ◽  
Local Context ◽  
High Quality ◽  
Canadian Universities ◽  
Paediatric Hospital ◽  
Current State ◽  
Paediatric Medicine ◽  
University Planning ◽  
Fellowship Programs

Abstract Introduction The field of Paediatric Medicine has grown tremendously over the last two decades. Several niche areas of practice have emerged, and opportunities for focused training in these areas have grown in parallel. The landscape of ‘General Paediatric Fellowship’ (GPF) Programs in Canada is not well described; this knowledge is needed to promote standardization and high-quality training across Canada. This study explores the structure and components of existing GPFs in Canada and identifies the interest and barriers to providing such programs. Methods A questionnaire was created to explore the landscape of GPF Programs in Canada. Invitations to participate were sent to leaders of General Paediatric Divisions across Canada, with a request to forward the survey to the most appropriate individual to respond within their local context. Results A total of 19 responses (95%) representing 17 different Canadian universities were obtained. Eight universities offered a total of 13 GPF Programs in 2019, with one additional university planning to start a program in the coming year. Existing programs were variable in size, structure and curriculum. Most programs identified as Academic Paediatric Programs, with an overlap in content and structure between Academic Paediatrics and Paediatric Hospital Medicine programs. The majority of respondents felt there was a need for GPF Programs in Canada but cited funding as the most common perceived barrier. Conclusion A growing number of GPF Programs exist in Canada. Current fellowship programs are variable in structure and content. Collaboration between programs is required to advance GPF training in Canada.

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