2021 Publications
Inadequate Support. Reply.
N Engl J Med
The authors reply: We thank Castellaneta for highlighting the important relationship between serum ascorbic acid levels and smoking. The incidence of hypovitaminosis C is three times as high in patients who smoke as it is in patients who do not smoke. This deficiency is caused by a combination of inadequate intake of vitamin C and the direct effects of tobacco on vitamin C absorption...
The authors reply: We thank Castellaneta for highlighting the important relationship between serum ascorbic acid levels and smoking. The incidence of hypovitaminosis C is three times as high in patients who smoke as it is in patients who do not smoke. This deficiency is caused by a combination of inadequate intake of vitamin C and the direct effects of tobacco on vitamin C absorption...
Support opportunities for second victims lessons learned: a qualitative study of the top 20 US News and World Report Honor Roll Hospitals
BioMed Central
Background: Second Victim Programs (SVPs) provide support for healthcare providers involved in a near-miss, medical error, or adverse patient outcomes. Little is known about existence and structure of SVPs in top performing US hospitals. Methods: We performed a prospective study and interviewed individuals representing SVPs from 20 US News and World Report (USNWR)...
Background: Second Victim Programs (SVPs) provide support for healthcare providers involved in a near-miss, medical error, or adverse patient outcomes. Little is known about existence and structure of SVPs in top performing US hospitals. Methods: We performed a prospective study and interviewed individuals representing SVPs from 20 US News and World Report (USNWR)...
Best Practices for Education and Training of Resuscitation Teams for In-Hospital Cardiac Arrest
Circ Cardiovasc
Background: Survival outcomes following in-hospital cardiac arrest vary significantly across hospitals. Research suggests clinician education and training may play a role. We sought to identify best practices related to the education and training of resuscitation teams. Methods: We conducted a descriptive qualitative analysis of semistructured interview data obtained from in-depth site visits...
Background: Survival outcomes following in-hospital cardiac arrest vary significantly across hospitals. Research suggests clinician education and training may play a role. We sought to identify best practices related to the education and training of resuscitation teams. Methods: We conducted a descriptive qualitative analysis of semistructured interview data obtained from in-depth site visits...
Sustainability of a program to reduce unnecessary urethral catheter use at a Veterans Affairs hospital
Infect Control Hosp Epidemiol
We assessed the long-term sustainability of a quality improvement intervention to reduce urethral catheter use at a Veterans Affairs (VA) hospital. During the 8 years after the initial intervention, point-prevalence surveillance showed that urethral catheter use continued to decrease (OR, 0.91; 95% CI, 0.86–0.97; P = .003) and that appropriateness of catheter use remained unchanged.
We assessed the long-term sustainability of a quality improvement intervention to reduce urethral catheter use at a Veterans Affairs (VA) hospital. During the 8 years after the initial intervention, point-prevalence surveillance showed that urethral catheter use continued to decrease (OR, 0.91; 95% CI, 0.86–0.97; P = .003) and that appropriateness of catheter use remained unchanged.
Antimicrobial stewardship and bamlanivimab: Opportunities for outpatient preauthorization?
Infect Control Hosp Epidemiol
To the Editor—Preauthorization is a fundamental action of antimicrobial stewardship programs (ASPs). ASPs have played essential roles in coronavirus disease 2019 (COVID-19) response efforts since the onset of the pandemic. For instance, ASPs have implemented the preauthorization of remdesivir throughout its path from an experimental...
To the Editor—Preauthorization is a fundamental action of antimicrobial stewardship programs (ASPs). ASPs have played essential roles in coronavirus disease 2019 (COVID-19) response efforts since the onset of the pandemic. For instance, ASPs have implemented the preauthorization of remdesivir throughout its path from an experimental...
Antibiotic Overuse After Hospital Discharge: A Multi-hospital Cohort Study
Clin Infect Dis
Antibiotics are commonly prescribed to patients as they leave the hospital. We aimed to create a comprehensive metric to characterize antibiotic overuse after discharge among hospitalized patients treated for pneumonia or urinary tract infection (UTI), and to determine whether overuse varied across hospitals and conditions. Methods: In a retrospective cohort study of hospitalized...
Antibiotics are commonly prescribed to patients as they leave the hospital. We aimed to create a comprehensive metric to characterize antibiotic overuse after discharge among hospitalized patients treated for pneumonia or urinary tract infection (UTI), and to determine whether overuse varied across hospitals and conditions. Methods: In a retrospective cohort study of hospitalized...
A “Fluid” Diagnosis (Clinical Problem-Solving)
N Engl J Med
A 61-year-old woman presented to an emergency department in Michigan after a syncopal episode. She reported a 3-week history of fatigue, malaise, and generalized weakness. Laboratory evaluation revealed new anemia with a hematocrit of 19.7% and a white-cell count of 16,100 per cubic millimeter, with 39% blast cells in peripheral blood. She received a diagnosis of acute myeloid leukemia...
A 61-year-old woman presented to an emergency department in Michigan after a syncopal episode. She reported a 3-week history of fatigue, malaise, and generalized weakness. Laboratory evaluation revealed new anemia with a hematocrit of 19.7% and a white-cell count of 16,100 per cubic millimeter, with 39% blast cells in peripheral blood. She received a diagnosis of acute myeloid leukemia...
Peripheral intravenous catheter failure: A secondary analysis of risks from 11,830 catheters
Int J Nurs Stud
Background: Peripheral intravenous catheters are an essential medical device which are prone to complications and failure. Objectives: Identify patient, provider and device risk factors associated with all-cause peripheral intravenous catheter failure as well as individual complications: phlebitis, infiltration/occlusion, and dislodgement to improve patient outcomes. Design: Secondary analysis...
Background: Peripheral intravenous catheters are an essential medical device which are prone to complications and failure. Objectives: Identify patient, provider and device risk factors associated with all-cause peripheral intravenous catheter failure as well as individual complications: phlebitis, infiltration/occlusion, and dislodgement to improve patient outcomes. Design: Secondary analysis...
Benzodiazepine Prescribing from VA and Medicare to Dually Enrolled Older Veterans: A Retrospective Cohort Study
J Gen Intern Med
Background: There has been a reduction in BZD prescribing in the Veterans Affairs (VA) health care system since 2013. It is unknown whether the decline in VA-dispensed BZDs has been offset by Medicare Part D prescriptions. Objectives: To examine (1) whether, accounting for Part D, declines in BZD prescribing to older Veterans remain; (2) patient characteristics associated with obtaining...
Background: There has been a reduction in BZD prescribing in the Veterans Affairs (VA) health care system since 2013. It is unknown whether the decline in VA-dispensed BZDs has been offset by Medicare Part D prescriptions. Objectives: To examine (1) whether, accounting for Part D, declines in BZD prescribing to older Veterans remain; (2) patient characteristics associated with obtaining...
A Practical Guide for Building Collaborations Between Clinical Researchers and Engineers: Lessons Learned From a Multidisciplinary Patient Safety Project
J Patient Saf
Objectives: Engineering and operations research have much to contribute to improve patient safety, especially within complex, highly regulated, and constantly evolving hospital environments. Despite new technologies, clinical checklists, and alarm systems, basic challenges persist that impact patient safety, such as how to improve communication between healthcare providers to prevent...
Objectives: Engineering and operations research have much to contribute to improve patient safety, especially within complex, highly regulated, and constantly evolving hospital environments. Despite new technologies, clinical checklists, and alarm systems, basic challenges persist that impact patient safety, such as how to improve communication between healthcare providers to prevent...
Revisiting handoffs: an opportunity to prevent error
Diagnosis
To the Editor: It’s 5 PM on Monday, the last day of a grueling 7-day stretch on the hospital medicine service. Exhausted, I open my e-mail and begin typing handoff to the oncoming provider. I finish with a "45-year old male with rheumatoid arthritis (RA) on immunosuppressants with chronic joint pain, admitted yesterday with acute bilateral knee (right knee more swollen and painful...
To the Editor: It’s 5 PM on Monday, the last day of a grueling 7-day stretch on the hospital medicine service. Exhausted, I open my e-mail and begin typing handoff to the oncoming provider. I finish with a "45-year old male with rheumatoid arthritis (RA) on immunosuppressants with chronic joint pain, admitted yesterday with acute bilateral knee (right knee more swollen and painful...
Race, Ethnicity, and 60-Day Outcomes After Hospitalization With COVID-19
J Am Med Dir Assoc
Objective: To examine racial and ethnic disparities in clinical, financial, and mental health outcomes within a diverse sample of hospitalized COVID-19–positive patients in the 60 days postdischarge. Design: A cross-sectional study. Setting and Participants: A total of 2217 adult patients who were hospitalized with a COVID-19–positive diagnosis as evidenced by test (reverse-transcriptase...
Objective: To examine racial and ethnic disparities in clinical, financial, and mental health outcomes within a diverse sample of hospitalized COVID-19–positive patients in the 60 days postdischarge. Design: A cross-sectional study. Setting and Participants: A total of 2217 adult patients who were hospitalized with a COVID-19–positive diagnosis as evidenced by test (reverse-transcriptase...
It’s like sending a message in a bottle: A qualitative study of the consequences of one-way communication technologies in hospitals
J Am Med Inform Assoc
Objective: We examine how physicians and nurses use available communication technologies and identify the implications for communication and patient care based on the theory of workarounds. Materials and Methods: We conducted a qualitative study at 4 U.S. hospitals during 2017. Researchers spent 2 weeks at each hospital conducting unit-based observation, shadowing, interviews...
Objective: We examine how physicians and nurses use available communication technologies and identify the implications for communication and patient care based on the theory of workarounds. Materials and Methods: We conducted a qualitative study at 4 U.S. hospitals during 2017. Researchers spent 2 weeks at each hospital conducting unit-based observation, shadowing, interviews...
Variation in Scheduling and Receipt of Primary Care Follow-up After Hospitalization for COVID-19 in Michigan
J Gen Intern Med
Patients hospitalized for coronavirus disease (COVID-19) commonly experience new or worsened systemic or cardiopulmonary symptoms, such as fatigue, dyspnea, and weakness. These symptoms may persist for weeks, limit the return to normal activities, and contribute to re-hospitalization. In May 2020, the term “long COVID” was coined to describe the life-altering impacts of COVID-19...
Patients hospitalized for coronavirus disease (COVID-19) commonly experience new or worsened systemic or cardiopulmonary symptoms, such as fatigue, dyspnea, and weakness. These symptoms may persist for weeks, limit the return to normal activities, and contribute to re-hospitalization. In May 2020, the term “long COVID” was coined to describe the life-altering impacts of COVID-19...
To Each Villain Its Plot: The Case of Candida auris
Ann Intern Med
Candida auris is not the first nor will it be the last emerging pathogen, but it poses unique challenges because of its physiology, its epidemiology, and the unique clinical settings in which it manifests. Only recently recognized as an opportunistic pathogen of major clinical importance and endowed with a puzzling evolutionary history, C auris shares many characteristics with other...
Candida auris is not the first nor will it be the last emerging pathogen, but it poses unique challenges because of its physiology, its epidemiology, and the unique clinical settings in which it manifests. Only recently recognized as an opportunistic pathogen of major clinical importance and endowed with a puzzling evolutionary history, C auris shares many characteristics with other...
When planning meets reality: COVID-19 interpandemic survey of Michigan Nursing Homes
Am J Infect Control
Background: Nursing home (NH) populations have borne the brunt of morbidity and mortality of COVID-19. We surveyed Michigan NHs to evaluate preparedness, staffing, testing, and adaptations to these challenges. Methods: Interpandemic survey responses were collected May 1-12, 2020. We used Pearson's Chi-squared test, Fisher's exact test, and logistic regression to evaluate relationships.
Background: Nursing home (NH) populations have borne the brunt of morbidity and mortality of COVID-19. We surveyed Michigan NHs to evaluate preparedness, staffing, testing, and adaptations to these challenges. Methods: Interpandemic survey responses were collected May 1-12, 2020. We used Pearson's Chi-squared test, Fisher's exact test, and logistic regression to evaluate relationships.
Variation in Provider Connectedness Associates With Outcomes of Inflammatory Bowel Diseases in an Analysis of Data From a National Health System
Clin Gastroenterol Hepatol
Inflammatory bowel diseases (IBD) often require multidisciplinary care with tight coordination among providers. Provider connectedness, a measure of the relationship among providers, is an important aspect of care coordination that has been linked to higher quality care. We aimed to assess variation in provider connectedness among medical centers, and to understand...
Inflammatory bowel diseases (IBD) often require multidisciplinary care with tight coordination among providers. Provider connectedness, a measure of the relationship among providers, is an important aspect of care coordination that has been linked to higher quality care. We aimed to assess variation in provider connectedness among medical centers, and to understand...
Functional and Cognitive Decline Among Older Adults After High-risk Surgery
Ann Surg
Objective: The aim of this study was to determine whether older adults are at higher risk of lasting functional and cognitive decline after surgery, and the impact of decline on survival and healthcare use. Summary Background Data: Patient-centered outcomes after surgery are poorly characterized. Methods: Using data from the Health and Retirement Study linked with Medicare, we matched...
Objective: The aim of this study was to determine whether older adults are at higher risk of lasting functional and cognitive decline after surgery, and the impact of decline on survival and healthcare use. Summary Background Data: Patient-centered outcomes after surgery are poorly characterized. Methods: Using data from the Health and Retirement Study linked with Medicare, we matched...
Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges
Curr Infect Dis Rep
The goal of this article is to highlight how and why urinalyses and urine cultures are misused, review quality improvement interventions to optimize urine culture utilization, and highlight how to implement successful, sustainable interventions to improve urine culture practices in the acute care setting. Recent Findings: Quality improvement initiatives aimed at reducing inappropriate...
The goal of this article is to highlight how and why urinalyses and urine cultures are misused, review quality improvement interventions to optimize urine culture utilization, and highlight how to implement successful, sustainable interventions to improve urine culture practices in the acute care setting. Recent Findings: Quality improvement initiatives aimed at reducing inappropriate...
Association Between Hospital Resuscitation Team Leader Credentials and Survival Outcomes for In-hospital Cardiac Arrest
Mayo Clin Proc Innov Outcomes
Objective: To assess whether survival rates for in-hospital cardiac arrest (IHCA) vary across hospitals depending on whether resuscitations are typically led by an attending physician, a physician trainee, or a nonphysician. Patients and Methods: In 2018, we conducted a survey of hospitals participating in the national Get with the Guidelines – Resuscitation registry for IHCA. Using...
Objective: To assess whether survival rates for in-hospital cardiac arrest (IHCA) vary across hospitals depending on whether resuscitations are typically led by an attending physician, a physician trainee, or a nonphysician. Patients and Methods: In 2018, we conducted a survey of hospitals participating in the national Get with the Guidelines – Resuscitation registry for IHCA. Using...
Influences of Physical Layout and Space on Patient Safety and Communication in Ambulatory Oncology Practices: A Multisite, Mixed Method Investigation
HERD
Objective: To examine how physical layouts and space in ambulatory oncology practices influence patient safety and clinician communication. Background: Ambulatory oncology practices face unique challenges in delivering safe care. With increasing patient volumes, these settings require additional attention to support patient safety and efficient clinical work processes. Methods: ...
Objective: To examine how physical layouts and space in ambulatory oncology practices influence patient safety and clinician communication. Background: Ambulatory oncology practices face unique challenges in delivering safe care. With increasing patient volumes, these settings require additional attention to support patient safety and efficient clinical work processes. Methods: ...
Preparing nursing homes for a second wave of coronavirus disease 2019 (COVID-19)
Infect Control Hosp Epidemiol
Among deaths related to coronavirus disease 2019 (COVID-19) in the United States, 40% have been linked to nursing homes. Nursing homes commonly have limited access to infection prevention and control (IPC) experts, and they are set up so that IPC duties are performed by a nursing home staff member or an infection preventionist with other responsibilities and little protected time. During...
Among deaths related to coronavirus disease 2019 (COVID-19) in the United States, 40% have been linked to nursing homes. Nursing homes commonly have limited access to infection prevention and control (IPC) experts, and they are set up so that IPC duties are performed by a nursing home staff member or an infection preventionist with other responsibilities and little protected time. During...
Feeling better on hemodialysis: user-centered design requirements for promoting patient involvement in the prevention of treatment complications
J Am Med Inform Assoc
Objective: Hemodialysis patients frequently experience dialysis therapy sessions complicated by intradialytic hypotension (IDH), a major patient safety concern. We investigate user-centered design requirements for a theory-informed, peer mentoring-based, informatics intervention to activate patients toward IDH prevention. Methods: We conducted observations (156 hours) and...
Objective: Hemodialysis patients frequently experience dialysis therapy sessions complicated by intradialytic hypotension (IDH), a major patient safety concern. We investigate user-centered design requirements for a theory-informed, peer mentoring-based, informatics intervention to activate patients toward IDH prevention. Methods: We conducted observations (156 hours) and...
Infection prevention practices in the United States, the Netherlands, Switzerland, and Japan: Results from national surveys
Infect Control Hosp Epidemiol
Objective: To assess the extent to which evidence-based practices are regularly used in acute care hospitals in different countries. Design: Cross-sectional survey study. Participants and setting: Infection preventionists in acute care hospitals in the United States (US), the Netherlands, Switzerland, and Japan. Methods: Data collected from hospital surveys distributed between 2015...
Objective: To assess the extent to which evidence-based practices are regularly used in acute care hospitals in different countries. Design: Cross-sectional survey study. Participants and setting: Infection preventionists in acute care hospitals in the United States (US), the Netherlands, Switzerland, and Japan. Methods: Data collected from hospital surveys distributed between 2015...
A Review of Prenatal Care Delivery to Inform the Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Panel
Obstet Gynecol
OBJECTIVE: To perform a literature review of key aspects of prenatal care delivery to inform new guidelines. DATA SOURCES: A comprehensive review of Ovid MEDLINE, Elsevier's Scopus, Google Scholar, and ClinicalTrials.gov. METHODS OF STUDY SELECTION:
We included studies addressing components of prenatal care delivery (visit frequency, routine pregnancy assessments, and...
OBJECTIVE: To perform a literature review of key aspects of prenatal care delivery to inform new guidelines. DATA SOURCES: A comprehensive review of Ovid MEDLINE, Elsevier's Scopus, Google Scholar, and ClinicalTrials.gov. METHODS OF STUDY SELECTION:
We included studies addressing components of prenatal care delivery (visit frequency, routine pregnancy assessments, and...
The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Prenatal Care Recommendations
Obstet Gynecol
To describe MiPATH (the Michigan Plan for Appropriate Tailored Healthcare in pregnancy) panel process and key recommendations for prenatal care delivery. METHODS: We conducted an appropriateness study using the RAND Corporation and University of California Los Angeles Appropriateness Method, a modified e-Delphi process, to develop MiPATH recommendations using...
To describe MiPATH (the Michigan Plan for Appropriate Tailored Healthcare in pregnancy) panel process and key recommendations for prenatal care delivery. METHODS: We conducted an appropriateness study using the RAND Corporation and University of California Los Angeles Appropriateness Method, a modified e-Delphi process, to develop MiPATH recommendations using...
The impact of team familiarity on intra and postoperative cardiac surgical outcomes
Surgery
Familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes. Methods: Adult cardiac surgical procedures (n = 4,445) involving intraoperative providers were evaluated at a tertiary hospital between 2016 and 2020. Team familiarity (mean of prior cardiac surgeries performed by participating...
Familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes. Methods: Adult cardiac surgical procedures (n = 4,445) involving intraoperative providers were evaluated at a tertiary hospital between 2016 and 2020. Team familiarity (mean of prior cardiac surgeries performed by participating...
The Role of Spirituality and Religion in Physician and Trainee Wellness
J Gen Intern Med
Burnout in medicine is a substantial problem with adverse consequences for both physicians and the patients who they treat. In our efforts to combat burnout, we must consider every tool at our disposal, since a complex problem requires a multifaceted approach. Recognizing that many physicians derive meaning from spirituality and religion, attempts to improve physician and trainee wellness...
Burnout in medicine is a substantial problem with adverse consequences for both physicians and the patients who they treat. In our efforts to combat burnout, we must consider every tool at our disposal, since a complex problem requires a multifaceted approach. Recognizing that many physicians derive meaning from spirituality and religion, attempts to improve physician and trainee wellness...
Investing in the Future: A Role for Professional Societies to Prepare the Next Generation of Healthcare Leaders Through Curriculum Development and Dissemination
Clin Infect Dis
Professional societies serve many functions that benefit constituents; however, few professional societies have undertaken the development and dissemination of formal, national curricula to train the future workforce while simultaneously addressing significant healthcare needs. The Infectious Diseases Society of America (IDSA) has developed 2 curricula for the specific purpose of training...
Professional societies serve many functions that benefit constituents; however, few professional societies have undertaken the development and dissemination of formal, national curricula to train the future workforce while simultaneously addressing significant healthcare needs. The Infectious Diseases Society of America (IDSA) has developed 2 curricula for the specific purpose of training...
When COVID-19 Strikes Your Hospital
Ann Intern Med
As a hospitalist on the front lines of COVID-19, I know firsthand how the homeostasis of a hospital is altered when community cases of COVID-19 increase. For example, emergency departments immediately enact novel pathways and protocols for triage, evaluation, and admission. Hospitals begin to assess and enhance inpatient capacity, often by opening units not traditionally used for general...
As a hospitalist on the front lines of COVID-19, I know firsthand how the homeostasis of a hospital is altered when community cases of COVID-19 increase. For example, emergency departments immediately enact novel pathways and protocols for triage, evaluation, and admission. Hospitals begin to assess and enhance inpatient capacity, often by opening units not traditionally used for general...
Updates on Infection Control in Alternative Health Care Settings
Infect Dis Clinics
Patients increasingly receive care from a large spectrum of different settings, placing them at risk for exposure to pathogens by many different sources. Each health care environment has its own specific challenges, and thus infection control programs must be tailored to each specific setting. High-turnover outpatient settings may require additional considerations, such as establishing patient triage...
Patients increasingly receive care from a large spectrum of different settings, placing them at risk for exposure to pathogens by many different sources. Each health care environment has its own specific challenges, and thus infection control programs must be tailored to each specific setting. High-turnover outpatient settings may require additional considerations, such as establishing patient triage...
Commentary: Special care considerations in older adults hospitalized with COVID-19
Aging Health Res
COVID-19 is caused by the SARS-CoV-2 virus. Patients may be completely asymptomatic or present with a spectrum of symptoms from mild cough to severe pneumonia. These myriad clinical phenotypes and severity are particularly evident in older adults. Data from the Centers for Disease Control and Prevention (CDC) demonstrate that older adults are responsible for 40% of...
COVID-19 is caused by the SARS-CoV-2 virus. Patients may be completely asymptomatic or present with a spectrum of symptoms from mild cough to severe pneumonia. These myriad clinical phenotypes and severity are particularly evident in older adults. Data from the Centers for Disease Control and Prevention (CDC) demonstrate that older adults are responsible for 40% of...
Antimicrobial prescribing practices at a tertiary-care center in patients diagnosed with COVID-19 across the continuum of care
Infect Control Hosp Epidemiol
In a single-center review of antibiotic prescribing in COVID-19 patients, 10% of patients received antimicrobials, and inpatients encounters had the highest rate and spectrum of prescribing. Prescribing rate, spectrum, and duration appeared to increase with disease severity in inpatients. Antimicrobial prescribing in patients managed in ambulatory encounters was less common.
In a single-center review of antibiotic prescribing in COVID-19 patients, 10% of patients received antimicrobials, and inpatients encounters had the highest rate and spectrum of prescribing. Prescribing rate, spectrum, and duration appeared to increase with disease severity in inpatients. Antimicrobial prescribing in patients managed in ambulatory encounters was less common.
Clinicians Report Barriers and Facilitators to High-Quality Ambulatory Oncology Care
Cancer Nurs
Ambulatory oncology practices treat thousands of Americans on a daily basis with high-risk and high-cost antineoplastic agents. However, we know relatively little about these diverse practices and the organizational structures influencing care delivery. Objective: The aim of this study was to examine clinician-reported factors within ambulatory oncology practices that affect care...
Ambulatory oncology practices treat thousands of Americans on a daily basis with high-risk and high-cost antineoplastic agents. However, we know relatively little about these diverse practices and the organizational structures influencing care delivery. Objective: The aim of this study was to examine clinician-reported factors within ambulatory oncology practices that affect care...
Diagnosis Patterns and Stress Testing Trends After Implementing High-Sensitivity Troponin Assay
Am J Manag Care
High-sensitivity troponin T (hsTnT) testing was approved in the United States to better facilitate diagnosis of acute coronary syndrome (ACS). Although hsTnT has been widely studied internationally, the impact of hsTnT on discharge diagnoses and health care utilization within the United States is less known. We sought to evaluate the effects of implementing hsTnT on diagnosis patterns and stress...
High-sensitivity troponin T (hsTnT) testing was approved in the United States to better facilitate diagnosis of acute coronary syndrome (ACS). Although hsTnT has been widely studied internationally, the impact of hsTnT on discharge diagnoses and health care utilization within the United States is less known. We sought to evaluate the effects of implementing hsTnT on diagnosis patterns and stress...
Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study
BMJ Qual Saf
How quickly physicians respond to communications from bedside nurses is important for the delivery of safe inpatient care. Delays in physician responsiveness can impede care or contribute to patient harm. Understanding contributory factors to physician responsiveness can provide insights to promote timely physician response, possibly improving communication to ensure safe...
How quickly physicians respond to communications from bedside nurses is important for the delivery of safe inpatient care. Delays in physician responsiveness can impede care or contribute to patient harm. Understanding contributory factors to physician responsiveness can provide insights to promote timely physician response, possibly improving communication to ensure safe...
International recommendations for a vascular access minimum dataset: a Delphi consensus-building study
BMJ Qual Saf
Data regarding vascular access device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a vascular access minimum dataset. Methods: A modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel) was...
Data regarding vascular access device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a vascular access minimum dataset. Methods: A modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel) was...
Comment on: Use of peripherally inserted central catheters (PICCs) in ICU patients
J Crit Care
We thank our colleagues from Brussels for their thoughtful comments on vascular access in the ICU. We are in full agreement regarding the risks associated with PICC use in hospitalized patients. Previous studies have shown a two-fold increase in the risk of venous thromboembolism with PICCs compared to traditional central venous catheters (CVCs). Additionally, data...
We thank our colleagues from Brussels for their thoughtful comments on vascular access in the ICU. We are in full agreement regarding the risks associated with PICC use in hospitalized patients. Previous studies have shown a two-fold increase in the risk of venous thromboembolism with PICCs compared to traditional central venous catheters (CVCs). Additionally, data...
Did Clostridioides difficile testing and infection rates change during the COVID-19 pandemic?
Anaerobe
Testing for and incidence of Clostridioides difficile infection (CDI) was examined at a single center before and during the first surge of the COVID-19 pandemic. Incidence of CDI remained stable but testing statistically significantly decreased during the first surge despite an increase in antibiotic use. There were no new CDI-focused antimicrobial stewardship interventions introduced during this time.
Testing for and incidence of Clostridioides difficile infection (CDI) was examined at a single center before and during the first surge of the COVID-19 pandemic. Incidence of CDI remained stable but testing statistically significantly decreased during the first surge despite an increase in antibiotic use. There were no new CDI-focused antimicrobial stewardship interventions introduced during this time.
Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study
BMJ Qual Saf
Peripherally inserted central catheters (PICCs) provide reliable intravenous access for delivery of parenteral therapy. Yet, little is known about PICC care practices or how they vary across hospitals. We compared PICC-related processes across hospitals with different insertion delivery models. Methods: We used a descriptive qualitative methodology and a naturalist philosophy, with site visits to...
Peripherally inserted central catheters (PICCs) provide reliable intravenous access for delivery of parenteral therapy. Yet, little is known about PICC care practices or how they vary across hospitals. We compared PICC-related processes across hospitals with different insertion delivery models. Methods: We used a descriptive qualitative methodology and a naturalist philosophy, with site visits to...
Feeling better on hemodialysis: user-centered design requirements for promoting patient involvement in the prevention of treatment complications
J Am Med Inform Assoc
Hemodialysis patients frequently experience dialysis therapy sessions complicated by intradialytic hypotension (IDH), a major patient safety concern. We investigate user-centered design requirements for a theory-informed, peer mentoring-based, informatics intervention to activate patients toward IDH prevention. Methods: We conducted observations (156 hours) and interviews (n = 28)...
Hemodialysis patients frequently experience dialysis therapy sessions complicated by intradialytic hypotension (IDH), a major patient safety concern. We investigate user-centered design requirements for a theory-informed, peer mentoring-based, informatics intervention to activate patients toward IDH prevention. Methods: We conducted observations (156 hours) and interviews (n = 28)...
Appropriate vascular access for patients with cancer
Lancet
Questions as to how best to meet vascular access needs and safety requirements when caring for patients with cancer occur daily in clinical practice, yet evidence for which methods are optimal is poor. In cancer, use of vascular devices such as peripherally inserted central catheters (PICCs), Hickman-type tunnelled catheters (eg, Hickman), or totally implanted ports (PORTs) is common...
Questions as to how best to meet vascular access needs and safety requirements when caring for patients with cancer occur daily in clinical practice, yet evidence for which methods are optimal is poor. In cancer, use of vascular devices such as peripherally inserted central catheters (PICCs), Hickman-type tunnelled catheters (eg, Hickman), or totally implanted ports (PORTs) is common...
Variation in COVID-19 characteristics, treatment and outcomes in Michigan: an observational study in 32 hospitals
BMJ Open
Objective: To describe patient characteristics, symptoms, patterns of care and outcomes for patients hospitalised with COVID-19 in Michigan. Design: Multicentre retrospective cohort study. Setting: 32 acute care hospitals in the state of Michigan. Participants Patients discharged (16 March–11 May 2020) with suspected or confirmed COVID-19 were identified. Trained abstractors collected...
Objective: To describe patient characteristics, symptoms, patterns of care and outcomes for patients hospitalised with COVID-19 in Michigan. Design: Multicentre retrospective cohort study. Setting: 32 acute care hospitals in the state of Michigan. Participants Patients discharged (16 March–11 May 2020) with suspected or confirmed COVID-19 were identified. Trained abstractors collected...
Seasonal Patterns in Incidence and Antimicrobial Resistance of Common Bacterial Pathogens in Nursing Home Patients and Their Rooms
Front Public Health
Colonization is the main precursor to infection, which may lead to adverse clinical outcomes among older adults in nursing homes (NHs). Understanding seasonal changes in the local burden of common bacterial pathogens is key to implementing appropriate and cost-effective infection prevention measures in this resource-constrained healthcare environment. It is thus surprising that...
Colonization is the main precursor to infection, which may lead to adverse clinical outcomes among older adults in nursing homes (NHs). Understanding seasonal changes in the local burden of common bacterial pathogens is key to implementing appropriate and cost-effective infection prevention measures in this resource-constrained healthcare environment. It is thus surprising that...
Effectiveness of a Multicomponent Intervention to Reduce Multidrug-Resistant Organisms in Nursing Homes: A Cluster Randomized Clinical Trial
JAMA Netw Open
In this cluster randomized clinical trial of 6 nursing homes, including 245 patients, a multicomponent intervention consisting of enhanced barrier precautions, chlorhexidine bathing, microbial surveillance, and staff engagement statistically significantly reduced the odds of multidrug-resistant organism contamination in patients’ environments.
In this cluster randomized clinical trial of 6 nursing homes, including 245 patients, a multicomponent intervention consisting of enhanced barrier precautions, chlorhexidine bathing, microbial surveillance, and staff engagement statistically significantly reduced the odds of multidrug-resistant organism contamination in patients’ environments.
As the Story Unfolds (Clinical Care Conundrum)
J Hosp Med
A 78-year-old woman presented to the ambulatory care clinic for a painful tongue mass. She noticed the mass 2 months prior to presentation, and it had not grown in the interim. She had left-sided jaw pain when opening her mouth and persistent left-sided otalgia. In the evaluation of tongue masses, ulcerations, or other surface abnormalities, exclusion of squamous cell carcinoma is...
A 78-year-old woman presented to the ambulatory care clinic for a painful tongue mass. She noticed the mass 2 months prior to presentation, and it had not grown in the interim. She had left-sided jaw pain when opening her mouth and persistent left-sided otalgia. In the evaluation of tongue masses, ulcerations, or other surface abnormalities, exclusion of squamous cell carcinoma is...
The Impact of the Affordable Care Act Medicaid Expansion on Racial/Ethnic and Sex Disparities in HIV Testing: National Findings from the Behavioral Risk Factor Surveillance System
J Gen Intern Med
Over half of Americans have not been tested for HIV in their lifetime, and over a third of all HIV diagnoses are made less than a year before progression to AIDS. The Affordable Care Act (ACA) Medicaid expansion of 2014 had potential to improve HIV and other health screenings. We assessed the differential impacts of Medicaid expansion on racial/ethnic and racial/ethnic-sex disparities in HIV...
Over half of Americans have not been tested for HIV in their lifetime, and over a third of all HIV diagnoses are made less than a year before progression to AIDS. The Affordable Care Act (ACA) Medicaid expansion of 2014 had potential to improve HIV and other health screenings. We assessed the differential impacts of Medicaid expansion on racial/ethnic and racial/ethnic-sex disparities in HIV...
Usability Evaluation of a Tablet-Based Intervention to Prevent Intradialytic Hypotension in Dialysis Patients During In-Clinic Dialysis: Mixed Methods Study
JMIR Hum Factors
Patients on hemodialysis receive dialysis thrice weekly for about 4 hours per session. Intradialytic hypotension (IDH)—low blood pressure during hemodialysis—is a serious but common complication of hemodialysis. Although patients on dialysis already participate in their care, activating patients toward IDH prevention may reduce their risk of IDH. Interactive, technology-based...
Patients on hemodialysis receive dialysis thrice weekly for about 4 hours per session. Intradialytic hypotension (IDH)—low blood pressure during hemodialysis—is a serious but common complication of hemodialysis. Although patients on dialysis already participate in their care, activating patients toward IDH prevention may reduce their risk of IDH. Interactive, technology-based...
Predictors of engagement in an internet-based cognitive behavioral therapy program for veterans with chronic low back pain
Transl Behav Med
Internet-based interventions for chronic pain have demonstrated efficacy and may address access barriers to care. Participant characteristics have been shown to affect engagement with these programs; however, limited information is available about the relationship between participant characteristics and engagement with internet-based programs for self-management of chronic...
Internet-based interventions for chronic pain have demonstrated efficacy and may address access barriers to care. Participant characteristics have been shown to affect engagement with these programs; however, limited information is available about the relationship between participant characteristics and engagement with internet-based programs for self-management of chronic...
To PICC or not to PICC? A cross-sectional survey of vascular access practices in the ICU
J Crit Care
Vascular access patterns in the intensive care unit (ICU) have shifted from non-tunneled central venous catheters (CVCs) towards peripherally inserted central catheters (PICCs). We evaluated perceptions of critical care practitioners regarding these devices and variation in evidence-based practice.
Vascular access patterns in the intensive care unit (ICU) have shifted from non-tunneled central venous catheters (CVCs) towards peripherally inserted central catheters (PICCs). We evaluated perceptions of critical care practitioners regarding these devices and variation in evidence-based practice.
Patients’ Adaptations After Acute Respiratory Distress Syndrome: A Qualitative Study
Am J Crit Care
Many patients confront physical, cognitive, and emotional problems after acute respiratory distress syndrome (ARDS). No proven therapies for these problems exist, and many patients manage new disability and recovery with little formal support. Eliciting patients’ adaptations to these problems after hospitalization may identify opportunities to improve recovery. To explore how patients adapt...
Many patients confront physical, cognitive, and emotional problems after acute respiratory distress syndrome (ARDS). No proven therapies for these problems exist, and many patients manage new disability and recovery with little formal support. Eliciting patients’ adaptations to these problems after hospitalization may identify opportunities to improve recovery. To explore how patients adapt...
The Non-Veteran Experience at Veterans Affairs Medical Centers During the COVID-19 Pandemic: a Survey-Based Study
J Gen Intern Med
In April 2020, the VA Ann Arbor Healthcare System (AAVA) and the VA Detroit Medical Center (DVA) began caring for non-Veteran patients in the midst of the COVID-19 pandemic,1,2 subsequently caring for the second and third most non-Veteran patients in the nation, respectively. In a first-of-its-kind study, we sought to understand non-Veteran perceptions of the quality of care provided at...
In April 2020, the VA Ann Arbor Healthcare System (AAVA) and the VA Detroit Medical Center (DVA) began caring for non-Veteran patients in the midst of the COVID-19 pandemic,1,2 subsequently caring for the second and third most non-Veteran patients in the nation, respectively. In a first-of-its-kind study, we sought to understand non-Veteran perceptions of the quality of care provided at...
Empiric Antibacterial Therapy and Community-onset Bacterial Coinfection in Patients Hospitalized With Coronavirus Disease 2019 (COVID-19): A Multi-hospital Cohort Study
Clin Infect Dis
Antibacterials may be initiated out of concern for bacterial coinfection in coronavirus disease 2019 (COVID-19). We determined prevalence and predictors of empiric antibacterial therapy and community-onset bacterial coinfections in hospitalized patients with COVID-19.A randomly sampled cohort of 1705 patients hospitalized with COVID-19 in 38 Michigan hospitals between 3/13/2020...
Antibacterials may be initiated out of concern for bacterial coinfection in coronavirus disease 2019 (COVID-19). We determined prevalence and predictors of empiric antibacterial therapy and community-onset bacterial coinfections in hospitalized patients with COVID-19.A randomly sampled cohort of 1705 patients hospitalized with COVID-19 in 38 Michigan hospitals between 3/13/2020...
The variability in how physicians think: a casebased diagnostic simulation exercise
Diagnosis
Little is known about how physician diagnostic thinking unfolds over time when evaluating patients. We designed a case-based simulation to understand how physicians reason, create differential diagnoses, and employ strategies to achieve a correct diagnosis.
Little is known about how physician diagnostic thinking unfolds over time when evaluating patients. We designed a case-based simulation to understand how physicians reason, create differential diagnoses, and employ strategies to achieve a correct diagnosis.
The Current State of Antifungal Stewardship in Immunocompromised Populations
J Fungi
Inappropriate antifungal use is prevalent and can lead to drug-resistant fungi, expose patients to adverse drug events, and increase healthcare costs. While antimicrobial stewardship programs have traditionally focused on antibiotic use, the need for targeted antifungal stewardship (AFS) intervention has garnered interest in recent years. Despite this, data on AFS in immunocompromised...
Inappropriate antifungal use is prevalent and can lead to drug-resistant fungi, expose patients to adverse drug events, and increase healthcare costs. While antimicrobial stewardship programs have traditionally focused on antibiotic use, the need for targeted antifungal stewardship (AFS) intervention has garnered interest in recent years. Despite this, data on AFS in immunocompromised...
Medication Reconciliation Tool Reduces Errors in Patients Admitted From the ED to Hospital
Am J Med Qual
Medication reconciliation errors are common at the vulnerable transition of admission to hospital.1 These errors can be serious, resulting in adverse drug events and subsequently increased length of stay and mortality.2 The purpose of this study was to determine if a medication reconciliation tool, linked to the electronic health record (EHR) and used by physicians and emergency...
Medication reconciliation errors are common at the vulnerable transition of admission to hospital.1 These errors can be serious, resulting in adverse drug events and subsequently increased length of stay and mortality.2 The purpose of this study was to determine if a medication reconciliation tool, linked to the electronic health record (EHR) and used by physicians and emergency...
Measuring the outsized impact of COVID-19 in the evolving setting of aged care facilities
EClinicalMedicine (from The Lancet)
Care of older adults occurs at nursing homes, long-term care facilities (or care homes), assisted living, senior housing and in the community. There has been an evolution of nursing homes since their conception - such that they now house a variety of populations including –short stay with an intent to go home and long-stay for those with pronounced cognitive and functional disabilities.
Care of older adults occurs at nursing homes, long-term care facilities (or care homes), assisted living, senior housing and in the community. There has been an evolution of nursing homes since their conception - such that they now house a variety of populations including –short stay with an intent to go home and long-stay for those with pronounced cognitive and functional disabilities.
Peripherally Inserted Central catheter iNnovation to reduce Infections and Clots (the PICNIC trial): a randomised controlled trial protocol
BMJ Open
Peripherally inserted central catheters (PICCs) are vital for the delivery of medical therapies, but up to 30% of PICCs are associated with complications such as deep vein thrombosis or infection. The integration of antimicrobial and hydrophobic catheter materials, and pressure-activated valves, into polyurethane PICCs are innovations designed to prevent infective and/or thrombotic...
Peripherally inserted central catheters (PICCs) are vital for the delivery of medical therapies, but up to 30% of PICCs are associated with complications such as deep vein thrombosis or infection. The integration of antimicrobial and hydrophobic catheter materials, and pressure-activated valves, into polyurethane PICCs are innovations designed to prevent infective and/or thrombotic...
Incorporating walking into cognitive behavioral therapy for chronic pain: safety and effectiveness of a personalized walking intervention
J Behav Med
We examined the effectiveness and safety of a walking program offered as part of cognitive behavioral therapy for chronic pain (CBT-CP). Participants were randomized to 10 weeks of CBT-CP, delivered either in person or by interactive voice response. Participants reported pedometer-measured step counts daily throughout treatment and received a weekly goal to increase their steps by 10%...
We examined the effectiveness and safety of a walking program offered as part of cognitive behavioral therapy for chronic pain (CBT-CP). Participants were randomized to 10 weeks of CBT-CP, delivered either in person or by interactive voice response. Participants reported pedometer-measured step counts daily throughout treatment and received a weekly goal to increase their steps by 10%...
Targeted gown and glove use to prevent Staphylococcus aureus acquisition in community-based nursing homes: A pilot study
Infect Control Hosp Epidemiol
To test the feasibility of targeted gown and glove use by healthcare personnel caring for high-risk nursing-home residents to prevent Staphylococcus aureus acquisition in short-stay residents. Design: uncontrolled clinical trial.
To test the feasibility of targeted gown and glove use by healthcare personnel caring for high-risk nursing-home residents to prevent Staphylococcus aureus acquisition in short-stay residents. Design: uncontrolled clinical trial.
An Implementation Framework for the Clinically Indicated Removal Policy for Peripheral Intravenous Catheters
Nurs Care Qual
Equivalent clinical outcomes, lower costs, and fewer invasive procedures have resulted in revised recommendations for the removal of peripheral intravenous catheters (PIVCs) from the traditional 72- to 96-hourly removal to removal based upon clinical indication. Uptake of this evidence-based innovation to health systems is often delayed, in part due to the lack of a guiding...
Equivalent clinical outcomes, lower costs, and fewer invasive procedures have resulted in revised recommendations for the removal of peripheral intravenous catheters (PIVCs) from the traditional 72- to 96-hourly removal to removal based upon clinical indication. Uptake of this evidence-based innovation to health systems is often delayed, in part due to the lack of a guiding...
Dearth of Hospitalist Investigators in Academic Medicine: A Call to Action
J Hosp Med
In their report celebrating the increase in the number of hospitalists from a few hundred in the 1990s to more than 50,000 in 2016, Drs Robert Wachter and Lee Goldman also noted the stunted growth of productive hospital medicine research programs, which presents a challenge to academic credibility in hospital medicine.1 Given the substantial increase in the number of hospitalists over...
In their report celebrating the increase in the number of hospitalists from a few hundred in the 1990s to more than 50,000 in 2016, Drs Robert Wachter and Lee Goldman also noted the stunted growth of productive hospital medicine research programs, which presents a challenge to academic credibility in hospital medicine.1 Given the substantial increase in the number of hospitalists over...
Identifying biopsychosocial factors that impact decompressive laminectomy outcomes in veterans with lumbar spinal stenosis: a prospective cohort study
Pain
One in 3 patients with lumbar spinal stenosis undergoing decompressive laminectomy (DL) to alleviate neurogenic claudication do not experience substantial improvement. This prospective cohort study conducted in 193 Veterans aimed to identify key spinal and extraspinal factors that may contribute to a favorable DL outcome. Biopsychosocial factors evaluated pre-DL and 1 year post-DL...
One in 3 patients with lumbar spinal stenosis undergoing decompressive laminectomy (DL) to alleviate neurogenic claudication do not experience substantial improvement. This prospective cohort study conducted in 193 Veterans aimed to identify key spinal and extraspinal factors that may contribute to a favorable DL outcome. Biopsychosocial factors evaluated pre-DL and 1 year post-DL...
Designed to fail? the future of primary care
J Gen Intern Med
Primary care is widely viewed as being in crisis despite its purported central role in addressing population issues related to healthcare cost, quality, access, and equity. Despite this pivotal role, the nature of the clinical practice today has largely emerged by default. We review the evolution of clinical practice in primary care from its genesis in small practices with paper charts and telephonic patient...
Primary care is widely viewed as being in crisis despite its purported central role in addressing population issues related to healthcare cost, quality, access, and equity. Despite this pivotal role, the nature of the clinical practice today has largely emerged by default. We review the evolution of clinical practice in primary care from its genesis in small practices with paper charts and telephonic patient...
Peripherally Inserted Central Catheter Thrombosis After Placement via Electrocardiography vs Traditional Methods
Am J Med
Peripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis. Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown. Prospectively collected data from patients that received peripherally inserted central...
Peripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis. Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown. Prospectively collected data from patients that received peripherally inserted central...
Hunting for a Diagnosis (Clinical Problem-Solving)
N Engl J Med
A 47-year-old man in Michigan presented to the ED with a 1-day history of presyncope, swelling of the eyelids, and diffuse pruritic rash. He reported a 3-week history of postprandial watery bowel movements and a 5-day history of diffuse, crampy abdominal pain.
A 47-year-old man in Michigan presented to the ED with a 1-day history of presyncope, swelling of the eyelids, and diffuse pruritic rash. He reported a 3-week history of postprandial watery bowel movements and a 5-day history of diffuse, crampy abdominal pain.
Needleless connector decontamination for prevention of central venous access device infection: A pilot randomized controlled trial
Am J Infect Control
Central venous access devices (CVADs) risk central line-associated bloodstream infection (CLABSI) which increase costs, morbidity and mortality. The intraluminal infection source can be minimized by needleless connector (NC) decontamination prior to each use using chlorhexidine gluconate (CHG), povidone-iodine, or 70% isopropyl alcohol (IPA). The optimal antiseptic is unknown, although...
Central venous access devices (CVADs) risk central line-associated bloodstream infection (CLABSI) which increase costs, morbidity and mortality. The intraluminal infection source can be minimized by needleless connector (NC) decontamination prior to each use using chlorhexidine gluconate (CHG), povidone-iodine, or 70% isopropyl alcohol (IPA). The optimal antiseptic is unknown, although...
How common are indwelling devices in hospitalized adults? A contemporary point prevalence study in a tertiary care hospital
Am J Infect Control
Healthcare associated infections are associated with indwelling devices. Yet, data regarding prevalence of indwelling devices in noncritically ill hospitalized patients remains scant. Adult, noncritically ill patients on general care, telemetry, and surgical floors at our quaternary care hospital were surveyed on 2 separate days. Data regarding presence of indwelling vascular, urinary, and ...
Healthcare associated infections are associated with indwelling devices. Yet, data regarding prevalence of indwelling devices in noncritically ill hospitalized patients remains scant. Adult, noncritically ill patients on general care, telemetry, and surgical floors at our quaternary care hospital were surveyed on 2 separate days. Data regarding presence of indwelling vascular, urinary, and ...
Environmental Contamination of Contact Precaution and Non-Contact Precaution Patient Rooms in Six Acute Care Facilities
Clin Infect Dis
Environmental contamination is an important source of hospital multidrug-resistant organism (MDRO) transmission. Factors such as patient MDRO contact precautions (CP) status, patient proximity to surfaces, and unit type likely influence MDRO contamination and bacterial bioburden levels on patient room surfaces. Identifying factors associated with environmental contamination in patient...
Environmental contamination is an important source of hospital multidrug-resistant organism (MDRO) transmission. Factors such as patient MDRO contact precautions (CP) status, patient proximity to surfaces, and unit type likely influence MDRO contamination and bacterial bioburden levels on patient room surfaces. Identifying factors associated with environmental contamination in patient...
Partnering with Local Hospitals and Public Health to Manage COVID-19 Outbreaks in Nursing Homes
J Am Geriatr Soc
Almost half of deaths related to COVID-19 in the United States are linked to nursing homes (NHs). We describe among short-term and long-term residents at three NHs in Michigan the outbreak identification process, universal testing, point prevalence of COVID-19, and subsequent containment efforts, outcomes, and challenges.
Almost half of deaths related to COVID-19 in the United States are linked to nursing homes (NHs). We describe among short-term and long-term residents at three NHs in Michigan the outbreak identification process, universal testing, point prevalence of COVID-19, and subsequent containment efforts, outcomes, and challenges.
Novel Assessments of Technical and Nontechnical Cardiac Surgery Quality: Protocol for a Mixed Methods Study
JMIR Res Protocol
Of the 150,000 patients annually undergoing coronary artery bypass grafting, 35% develop complications that increase mortality 5 fold and expenditure by 50%. Differences in patient risk and operative approach explain only 2% of hospital variations in some complications. The intraoperative phase remains understudied as a source of variation, despite its complexity and amenability...
Of the 150,000 patients annually undergoing coronary artery bypass grafting, 35% develop complications that increase mortality 5 fold and expenditure by 50%. Differences in patient risk and operative approach explain only 2% of hospital variations in some complications. The intraoperative phase remains understudied as a source of variation, despite its complexity and amenability...
