EP.TU.571Is the pen mightier than the scalpel? Improving the quality and efficiency of Major Trauma ward rounds

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ethlinn Patton ◽  
Dapo Olaleye ◽  
Stella Smith
Keyword(s):  
Adverse Events ◽  
Major Trauma ◽  
Current Practice ◽  
Oral Intake ◽  
Cost Effective ◽  
Poor Quality ◽  
Ward Round ◽  
Before And After ◽  
Ward Rounds ◽  
Gathering Data

Abstract Aims Methods Data was collected retrospectively between October to December 2020. Patient paper notes were reviewed on three dates before and after implementation of the ward round sticker, gathering data from 26 and 27 patients respectively. Data was collected across a series of weeks to ensure a variety of clinicians present on ward round, in order to accurately reflect current practice. Results An improvement in rate of documentation was seen in 10 out of 12 key clinical variables. Some of the largest increases were seen in consideration of VTE status; 96.3% (n = 26) from 7.69% (n = 2), and recording oral intake; 85.2% (n = 23) from 23.1% (n = 6.) Conclusions We know that poor quality documentation is associated with increased rates of adverse events for patients,[1] so it is imperative to address both what is being covered, and how it is being recorded. Staff reported that the use of ward round stickers improved legibility of documentation and made it easier to locate important information. This simple, cost effective intervention has improved the consistency of daily reviews, and streamlined communication within the multidisciplinary team.

Efficacy and safety of routine intravenous iron replacement therapy for chemotherapy-induced anemia in the community setting

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20563-e20563
Author(s):  
K. Sen ◽  
W. C. Taylor ◽  
T. C. Shea ◽  
J. L. Peterson ◽  
J. Logue-Hunter
Keyword(s):  
Adverse Events ◽  
Community Setting ◽  
Oral Intake ◽  
Retrospective Chart Review ◽  
Intravenous Iron ◽  
Cost Effective ◽  
Hemoglobin Level ◽  
Community Practice ◽  
Young Females ◽  
Intravenous Iron Therapy

e20563 Background: Anemia occurs frequently during cancer chemotherapy and contributes to the development of fatigue. Erythropoiesis-stimulating agents (ESAs) are successfully utilized in this setting but recent studies have raised concerns regarding their potentially harmful effects. Iron deficiency, real or functional is a common problem among cancer patients. In addition to bleeding and poor oral intake new studies have hypothesized that cancers as well as chemotherapy can lead to overproduction of the hormone hepcidin that shifts usable iron to the storage pool. We hypothesized that chemotherapy induced anemia (CIN) could be reversed simply by increasing the supply of usable iron by intravenous iron infusion and adopted this practice empirically at our UNC affiliated community practice. Methods: We conducted a retrospective chart review of 50 patients with documented CIN. Each received treatment with intravenous iron preparations to provide between 1,000–4,000 mg of elemental iron over a period of 1–4 weeks based on serum iron and % saturation. The goal was to identify the frequency of transfusion, ESA use, adverse events and overall cost effectiveness of this approach. Results: Intravenous iron therapy (IIT) led to an average 3g/dL increase of hemoglobin in 80% of all patients with a hemoglobin level at or below 10g/dL during chemotherapy. Transfusion could be avoided in 95% cases. Total usage of ESAs to maintain the target hemoglobin level above 10g/dL during chemotherapy was reduced by 50% of the standard recommended dose. Total cost of infusing 1,000 mg of IIT was roughly 60% of a single 40,000 unit dose of erythropoietin. We recorded a 4% incidence of grade I-II and 2% incidence of grade III-IV adverse events but no fatalities. Adverse events were significantly more frequent among young females and Hispanics. Conclusions: A prospective study should be designed to confirm the encouraging result of this review. IIT may become a standard component of anemia management during chemotherapy. It appears to be safe and cost effective, can be given alone or in combination with ESAs and we found it suitable for routine use in community cancer clinics. No significant financial relationships to disclose.

scholarly journals Virtual Ward Round Teaching Pilot - A new education method.

2020 ◽  
Author(s):  
Mayven Tien Li Siow ◽  
Alexander Myles Robertson ◽  
Austin Begbey
Keyword(s):  
Medical Students ◽  
Teaching Experience ◽  
Cost Effective ◽  
Ward Round ◽  
New Graduates ◽  
King's College ◽  
Consultation Skills ◽  
Ward Rounds ◽  
New Education ◽  
Real Patients

Abstract BACKGROUND Final year medical students at King’s College London undergo an 8-week module to enable transition to Foundation Year 1 (FY1). New graduates often cite ward rounds as a challenge and we undertook this pilot to enhance skills not formally incorporated into the curriculum. A teaching session simulating a ward round for final year medical students was piloted at Tunbridge Wells Hospital. METHODS Two-hour teaching sessions were facilitated by medical trainees on a one-to-one basis, where students would see several real patients under direct supervision and conduct a simulated ward round. Facilitators gave feedback on students’ consultation skills after the session. RESULTS Quantitative feedback from students was 97% positive overall, and comments showed that students felt the session increased their confidence. Facilitators agreed that the session was good way to help the transition to becoming a real doctor and found it beneficial to get teaching experience themselves. CONCLUSION Ward rounds are an integral part of daily life as a new doctor. However, previous studies have shown that final-year students lack ward round skills, and that this can be improved by simulation. This pilot shows that it is feasible and cost-effective to simulate a ward round involving real patients and thereby preparing students to step up when the time comes.

Аpplying of high-frequency monopolar diathermocoagulation in the treatment of chronic pulpitis

2020 ◽  
Vol 1 (12) ◽  
pp. 40-42
Author(s):  
F. Yu. Daurova ◽  
D. I. Tomaeva ◽  
S. V. Podkopaeva ◽  
Yu. A. Taptun
Keyword(s):  
Root Canal ◽  
High Frequency ◽  
Antibacterial Effect ◽  
Comparison Group ◽  
Poor Quality ◽  
Endodontic Treatment ◽  
Root Canals ◽  
The Third ◽  
Before And After

Relevance: the reason for the development of complications in endodontic treatment is poor-quality instrumental treatment root canals.Aims: a study of the animicrobial action and clinical efficacy of high-frequency monopolar diathermocoagulation in the treatment of chronic forms of pulpitis.Materials and methods: 102 patients with various chronic forms of pulpitis were divided into three groups of 34 patients each. In the first two groups, high-frequency monopolar diathermocoagulation was used in endodontic treatment in different modes. In the third group, endodontic treatment was carried out without the use of diathermocoagulation (comparison group). The root canal microflora in chronic pulpitis in vivo was studied twice-before and after diathermocoagulation.Results: it was established that high-frequency monopolar diathermocoagulation in the effect mode is 3, power is 4 (4.1 W) and effect is 4, power is 4 (5.4 W) with an exposure time of 3 seconds, it has a pronounced antibacterial effect on all presented pathogenic microflora obtained from the root canals of the teeth.

scholarly journals Algorithmic prediction of failure modes in healthcare

2020 ◽  
Author(s):  
Ayala Kobo-Greenhut ◽  
Ortal Sharlin ◽  
Yael Adler ◽  
Nitza Peer ◽  
Vered H Eisenberg ◽  
...  
Keyword(s):  
Adverse Events ◽  
Failure Modes ◽  
Medical Center ◽  
Hazard Analysis ◽  
Working Hours ◽  
Hazard Identification ◽  
Patient Identification ◽  
Complete Identification ◽  
Before And After ◽  
Fmea Method

Abstract Background Preventing medical errors is crucial, especially during crises like the COVID-19 pandemic. Failure Modes and Effects Analysis (FMEA) is the most widely used prospective hazard analysis in healthcare. FMEA relies on brainstorming by multi-disciplinary teams to identify hazards. This approach has two major weaknesses: significant time and human resource investments, and lack of complete and error-free results. Objectives To introduce the algorithmic prediction of failure modes in healthcare (APFMH) and to examine whether APFMH is leaner in resource allocation in comparison to the traditional FMEA and whether it ensures the complete identification of hazards. Methods The patient identification during imaging process at the emergency department of Sheba Medical Center was analyzed by FMEA and APFMH, independently and separately. We compared between the hazards predicted by APFMH method and the hazards predicted by FMEA method; the total participants’ working hours invested in each process and the adverse events, categorized as ‘patient identification’, before and after the recommendations resulted from the above processes were implemented. Results APFMH is more effective in identifying hazards (P < 0.0001) and is leaner in resources than the traditional FMEA: the former used 21 h whereas the latter required 63 h. Following the implementation of the recommendations, the adverse events decreased by 44% annually (P = 0.0026). Most adverse events were preventable, had all recommendations been fully implemented. Conclusion In light of our initial and limited-size study, APFMH is more effective in identifying hazards (P < 0.0001) and is leaner in resources than the traditional FMEA. APFMH is suggested as an alternative to FMEA since it is leaner in time and human resources, ensures more complete hazard identification and is especially valuable during crisis time, when new protocols are often adopted, such as in the current days of the COVID-19 pandemic.

scholarly journals The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee Arthroplasty

2021 ◽  
Vol 10 (5) ◽  
pp. 971
Author(s):  
Kristoff Hammerich ◽  
Jens Pollack ◽  
Alexander F. Hasse ◽  
André El Saman ◽  
René Huber ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Clinical Success ◽  
Cost Effective ◽  
Revision Total Knee Arthroplasty ◽  
Rotational Stability ◽  
X Rays ◽  
Free Interval ◽  
Major Disadvantage ◽  
Cost Effective Approach ◽  
Before And After

Background: A major disadvantage of current spacers for two-stage revision total knee arthroplasty (R-TKA) is the risk of (sub-) luxation during mobilization in the prosthesis-free interval, limiting their clinical success with detrimental consequences for the patient. The present study introduces a novel inverse spacer, which prevents major complications, such as spacer (sub-) luxations and/or fractures of spacer or bone. Methods: The hand-made inverse spacer consisted of convex tibial and concave femoral components of polymethylmethacrylate bone cement and was intra-operatively molded under maximum longitudinal tension in 5° flexion and 5° valgus position. Both components were equipped with a stem for rotational stability. This spacer was implanted during an R-TKA in 110 knees with diagnosed or suspected periprosthetic infection. Postoperative therapy included a straight leg brace and physiotherapist-guided, crutch-supported mobilization with full sole contact. X-rays were taken before and after prosthesis removal and re-implantation. Results: None of the patients experienced (sub-) luxations/fractures of the spacer, periprosthetic fractures, or soft tissue compromise requiring reoperation. All patients were successfully re-implanted after a prosthesis-free interval of 8 weeks, except for three patients requiring an early exchange of the spacer due to persisting infection. In these cases, the prosthetic-free interval was prolonged for one week. Conclusion: The inverse spacer in conjunction with our routine procedure is a safe and cost-effective alternative to other articulating or static spacers, and allows crutch-supported sole contact mobilization without major post-operative complications. Maximum longitudinal intra-operative tension in 5° flexion and 5° valgus position appears crucial for the success of surgery.

scholarly journals 400 - Effects of Computerized Cognitive Training with an Elderly Community Sample

2020 ◽  
Vol 32 (S1) ◽  
pp. 116-116
Author(s):  
M Pires ◽  
A Antunes ◽  
C Gameiro ◽  
C Pombo
Keyword(s):  
Older Adults ◽  
Cognitive Training ◽  
New Technologies ◽  
Community Sample ◽  
Cost Effective ◽  
Well Being ◽  
Control Group ◽  
Depression Symptoms ◽  
Intensive Training ◽  
Before And After

Community-focused programs that promote active and healthy aging can help preserve cognitive capacities, prevent or reverse cognitive deficits. Computer-based cognitive training (CCT) is a promising non-pharmacological, cost -effective and accessible intervention to face the effects of age-related cognitive decline. Previous studies proved CCT to have equal or better efficacy compared to traditional interventions. This comparative multifactorial study aims to test the efficacy of a CCT in a non-randomized community sample of 74 older adults: G1-CCT Experimental group (n=43) (Mean age M=72.21, SD=12.65) and G2- Paper-Pencil Control group (n=31; M=77.94, SD=10.51). Pensioners (97.3%), mostly women (83.8 %) with basic education (51.4%) and without dementia diagnosis, completed a cognitive training program of 17 or 34 group sessions (twice a week). G2 undertook a classic cognitive paper-pencil stimuli tasks. G1, performed, additionally, individual CCT with COGWEB® in a multimodal format (intensive training of attention, calculation, memory, gnosis, praxis, executive functions). Both groups completed Portuguese versions of Mini -Mental State Examination (MMSE),Montreal Cognitive Assessment (MOCA); Geriatric Depressive Scale (GDS); Mini Dependence Assessment (MDA); WHOOQL 5 and Social Support Satisfaction Scale (ESSS) before and after participating in the program. Both groups reported better post-test scores on basic cognitive functions (MMSE, MOCA), Depression symptoms (GDS-30), subjective well-being and quality of life (WHOOQL-5). G1 presented higher MOCA and lower GDS scores before and after CCT, although, group differences become less expressive when interaction effects are considered. Results are in line with findings from past studies, CCT supported by the new technologies, is as a relevant cost-effective therapeutic tool for health professionals working with older adults. Particularly for preventive purposes of neuro-cognitive disorders.

scholarly journals Established an eco-friendly cotton fabric treating process with enhancing anti-wrinkle performance

2021 ◽  
Vol 16 ◽  
pp. 155892502110034
Author(s):  
Xiongfang Luo ◽  
Pei Cheng ◽  
Wencong Wang ◽  
Jiajia Fu ◽  
Weidong Gao
Keyword(s):  
Tensile Strength ◽  
Citric Acid ◽  
Cotton Fabric ◽  
Crosslinking Agent ◽  
Cost Effective ◽  
Waterborne Polyurethane ◽  
Cotton Fabrics ◽  
Wrinkle Resistance ◽  
Before And After ◽  
Strength Retention

This study establishes an eco-friendly anti-wrinkle treating process for cotton fabric. Sodium hydroxide-liquid ammonia pretreatment followed by 6% (w/w) PU100 adding citric acid pad-cure-dry finishing. In this process, citric acid (CA) was used as the fundamental crosslinking agent during finishing because it is a non-formaldehyde based, cost-effective and well wrinkle resistance agent. Environmental-friendly waterborne polyurethane (WPU) was used as an additive to add to the CA finishing solution. Six commercial WPUs were systematically investigated. Fabric properties like wrinkle resistance, tensile strength retention, whiteness, durable press, softness, and wettability were well investigated. Fourier transform infrared spectra and X-ray diffraction spectra were also measured and discussed before and after adding waterborne polyurethane. Tentative mechanism of the interaction among the WPU, CA, and modified cotton fabrics is provided. The effect of cotton fabric pretreatment on fabric performance was also investigated. After the eco-process’s treatment, the fabric wrinkle resistant angle was upgraded to 271 ± 7°, tensile strength retention was maintained at 66.77% ± 3.50% and CIE whiteness was elevated to 52.13 ± 3.21, which are much better than the traditional CA anti-wrinkle finishing based on mercerized cotton fabrics. This study provides useful information for textile researchers and engineers.

scholarly journals STMO-07 Adverse events related to the glioblastoma surgery and their perioperative management in our hospital

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii10-ii10
Author(s):  
Hideki Kashiwagi ◽  
Shinji Kawabata ◽  
Seigo Kimura ◽  
Ryokichi Yagi ◽  
Naokado Ikeda ◽  
...  
Keyword(s):  
Adverse Events ◽  
Venous Thrombosis ◽  
Perioperative Management ◽  
Perioperative Complications ◽  
Epileptic Seizures ◽  
Residual Tumor ◽  
Complete Removal ◽  
Tumor Localization ◽  
Vein Thrombosis ◽  
Before And After

Abstract Background: The standard treatment for glioblastoma is surgical resection following chemoradiation therapy. The rate of removal or the amount of residual tumor has some impact on the prognosis of patients with glioblastoma, but the highly invasive nature of this tumor makes complete removal limited to the contrast-enhanced lesions difficult due to its localization. Furthermore, when postoperative seizures and venous thrombosis are included in surgery-related complications, these perioperative adverse events can cause delays in the initiation of chemoradiotherapy and delay the return to work and home, such as prolonged hospitalization and rehabilitation time. Methods: We retrospectively reviewed the perioperative status of the recent 50 consecutive cases with histologically confirmed as glioblastoma at our hospital, the patient background, tumor localization, and perioperative treatment, and so on. Results: The major perioperative complications were ischemic or hemorrhagic complications, epileptic seizures, venous thrombosis, and pneumonia; CTCAE grade 2 or higher, grade 3 or higher, and grade 4 occurred in about 40%, 20%, and 10%, respectively, with some patients having multiple complications. Discussion: Although there was a tendency for ischemic changes around the cavity of the resection as the resection rate increased, most cases were asymptomatic and it seemed to be acceptable if residual brain function could be preserved. Residual tumors tended to show hemorrhagic changes and epileptic seizures because this is thought to be that the tumor was deliberately left in place to preserve function, based on the localization of the tumor. Postoperative FDP levels were useful in predicting the development of deep vein thrombosis and pulmonary artery thromboembolism. Conclusion: Because glioblastoma has short survival time and patient PS before and after surgery varies greatly depending on tumor localization, it is important to consider risk-benefit strategies for each case and to establish a scheme for a seamless transition from perioperative management to the introduction of postoperative therapy and maintenance therapy.

scholarly journals Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001380
Author(s):  
Rasmus Bo Hasselbalch ◽  
Mia Marie Pries-Heje ◽  
Sarah Louise Kjølhede Holle ◽  
Thomas Engstrøm ◽  
Merete Heitmann ◽  
...  
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Primary Outcome ◽  
Multislice Ct ◽  
Cost Effective ◽  
University Hospital ◽  
Before And After ◽  
History Of ◽  
Artery Disease

ObjectiveTo prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG).MethodsThis was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician’s discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk.ResultsIn total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18–48) showed no ischaemic events for patients receiving only MSCT.ConclusionThe CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.

Cost-Effectiveness: Cholinesterase Inhibitors and Memantine in Vascular Dementia

2009 ◽  
Vol 36 (6) ◽  
pp. 735-739 ◽  
Author(s):  
Camilla L. Wong ◽  
Nick Bansback ◽  
Philip E. Lee ◽  
Aslam H. Anis
Keyword(s):  
Cost Effectiveness ◽  
Adverse Events ◽  
Incremental Cost ◽  
Vascular Dementia ◽  
Standard Care ◽  
Cholinesterase Inhibitors ◽  
Cost Effective ◽  
Decision Analysis Model ◽  
Physician Visits ◽  
Cost Effective Treatment

Background:Several randomized controlled trials of cholinesterase inhibitors and memantine in mild to moderate vascular dementia have demonstrated the efficacy of these treatments. However, given these drugs incur considerable cost, the economic argument for their use is less clear.Objective:To determine the incremental cost-effectiveness of cholinesterase inhibitors and memantine for mild to moderate vascular dementia.Design:A decision analysis model using a 24-28 week time horizon was developed. Outcomes of cholinesterase inhibitors and memantine and probabilities of adverse events were extracted from a systematic review. Costs of adverse events, medications, and physician visits were obtained from local estimates. Robustness was tested with probabilistic sensitivity analysis using a Monte Carlo simulation.Interventions:Donepezil 5 mg daily, donepezil 10 mg daily, galantamine 16-24 mg daily, rivastigmine flexible dosing up to 6 mg twice daily, or memantine 10 mg twice daily versus standard care.Main Outcome Measures:Incremental cost-effectiveness ratio (ICER) expressed as cost per unit decrease in the Alzheimer's Disease Assessment Scale-cognitive (ADAS-cog) subscale.Results:Donepezil 10 mg daily was found to be the most cost-effective treatment with an ICER of $400.64 (95%CI, $281.10-$596.35) per unit decline in the ADAS-cog subscale. All other treatments were dominated by donepezil 10 mg, that is, more costly and less effective.Conclusion:From a societal perspective, treatment with cholinesterase inhibitors or memantine was more effective but also more costly than standard care for mild to moderate vascular dementia. The donepezil 10 mg strategy was the most cost-effective and also dominated the other alternatives.

Sign in / Sign up

Export Citation Format

Share Document