scholarly journals Continuity of Caregivers’ Ensuring Medical Care and Care-Transition Preparedness: A Mediation Model

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 277-277
Author(s):  
Nosaiba Rayan-Gharra ◽  
Orly Tonkikh ◽  
Nurit Gur-Yaish
Keyword(s):  
Medical Care ◽  
Informal Caregiver ◽  
Medical Center ◽  
Informal Support ◽  
Care Transition ◽  
Healthcare Team ◽  
Mediation Model ◽  
Essential Factor ◽  
Transition Outcomes ◽  
Baseline Characteristics

Abstract Studies show that informal support provided during hospitalization is essential for communicating with the healthcare team and explaining medical care. Less is known about factors explaining family caregivers' Ensuring and Explaining Medical Care (EEMC) during hospitalization and its impact on care-transition-preparedness of patients in terms of their understanding of the explanations and instructions for continued care. This study examined whether EEMC during the current hospitalization mediates the association between involvement of the caregiver in ensuring and explaining medical care prior the current hospitalization and patients’ care-transition-preparedness for discharge. A prospective cohort study includes 456 internal-medicine-patients at a tertiary medical center in Israel, who were accompanied by an informal caregiver. Involvement in EEMC prior and during the hospitalization, covariates such as health literacy (HL) levels, demographic, health, and functional status were reported by the patients during the hospitalization; and care-transition-preparedness was reported by the patients in a week after discharge. After controlling for covariates, only high HL levels of patients and their caregivers were positively associated with EEMC during hospitalization and care-transition-preparedness (P<0.05). Moreover, mediation analysis indicated significant direct (B(unstandardized)=1.69; p=0.003) and indirect effect (Mediated effect (ME)=1.28; CI= 0.81 to 1.87) of prior involvement in EEMC on care-transition-preparedness through high EEMC during the current hospitalization, controlling for baseline characteristics of patients and their caregivers (total effect: B=2.95; p<0.001). These findings suggest that caregivers' experience and involvement prior the hospitalization may be an essential factor in improving EEMC during the current hospitalization, and in turn improve transition outcomes.

Clinical and epidemicological characteristics of acute rinosinusite by medical document recommended by multidisciplinary polyclinics

2018 ◽  
pp. 24-31
Author(s):  
Al Hariri Mahmoud Jomaa ◽  
S Semenenko ◽  
A Semenenko ◽  
Sergey Zaikov
Keyword(s):  
Statistical Analysis ◽  
Medical Care ◽  
Disease Duration ◽  
Inflammatory Diseases ◽  
Medical Center ◽  
Duration Of Treatment ◽  
Acute Rhinosinusitis ◽  
Diagnostic Center ◽  
Gender And Age ◽  
Clinical Variant

Introduction. Despite the world practice, the problem of inflammatory diseases of the paranasal sinuses is still relevant and has an important social meaning. Despite the fact that rhinosinusitis is one of the most common diseases, the reisvery little accurate data on its epidemiology. Therefore, our goal was to conduct a clinical epidemiological analysis with the establishment of the role of rhinosinusitis in the structure of requests for medical care in multidisciplinary polyclinics. Materials and methods. The data on the prevalence of various forms of sinusitis in the structure of ambulatory-polyclinic patients in the period 2011-2015 have been studied. In patients with acute rhinosinusitis, the following parameters were analyzed: gender and age of patients, duration, clinical variant of the disease, duration of treatment. Results. A clinical and statistical analysis of medical aid appeals at the level of the multidisciplinary outpatient clinic of the Vinnytsia City Clinical Hospital of ambulatory care and the Communal Medical Center "City Medical and Diagnostic Center" of Vinnytsia during 2011-2015. A statistical analysis based on the criterion approach included 896 patients with rinosunsitis. The following parameters have been analyzed: gender and age of patients, duration, clinical variant of the disease, duration of treatment. The conducted researches indicate that in the structure of appeals to the otolaryngologist rhinosinusitis is dominated by acute rhinosinusitis, the frequency of which remained relatively stable for five consecutive years: 133 cases - in 2011, 143 in 2012, 168 in 2013, 150 and 151 in 2014 and 2015, respectively. Among ambulatory polyclinic patients with different clinical variants of sinusitis prevailing persons of young working age. In general, patients with acute bacterial rhinosinusitis in the age group up to 60 years old make up 90.6%, which emphasizes the socioeconomic significance of this pathology. The frequency of treatment with rhinosinusitis is dominated by maxillary sinus lesions. The median duration of treatment was greatest in the case of hemi-sinusitis and polysynytes – 11.27±3.69 and 11.23±3.99 days, respectively, and the lowest in patients with frontal lobe was 9.48±3,76 days (p=0.032). A reduction in the mean duration of treatment for patients during the last three years of observation was observed (p<0.001). Conclusions: The study of the main clinical and epidemiological indicators of rhinosinusitis in the Ukrainian population can be the basis for the in for medplanning of medical care and social activities for this category of otolaryngological patients.

scholarly journals Minority status and readmissions: a moderated mediation model of caregivers’ health literacy

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 917-917
Author(s):  
Nosaiba Rayan-Gharra ◽  
Nurit Gur-Yaish ◽  
Ksenya Shulyaev
Keyword(s):  
Health Literacy ◽  
Native Speakers ◽  
Medical Center ◽  
Informal Caregivers ◽  
Moderated Mediation ◽  
Minority Status ◽  
Mediation Model ◽  
Clinical Encounters ◽  
Moderated Mediation Model ◽  
Time Of Admission

Abstract Family caregivers help patients to understand informa¬tion during clinical encounters. Less is known about factors that may affect family caregiver’s Ensuring and Explaining Medical Care (EEMC) during hospitalization and its impact on improved health outcomes. This study examined whether EEMC during hospitalization mediated the association between minority status of patients and 30-day-readmissions, and whether levels of Health Literacy (HL) of caregivers moderated this mediated association. A prospective cohort study of 517 internal medicine patients, Hebrew (general population, coded as 0) and Russian, or Arabic native speakers (minority status, coded as 1), at a tertiary medical center in central Israel, who were accompanied by an informal caregiver. EEMC and HL were patients’ self-reported. 30-day-readmissions were retrieved from the healthcare organization. Logistic regression indicated that minority status was not associated with 30-day readmission when the mediator ICEEMC was not included (B=0.98; p&gt;0.05). However, moderated mediation analysis indicated significant direct (B=-1.08; p=0.003) and indirect effect of minority status on readmission through high ICEEMC during hospitalization among patients who had informal caregivers with high HL level (Mediated effect (ME)=−0.62; CI= -1.07 to -0.29) but not among ones with low HL level (ME= 0.37; CI=-0.24 to 1.06). These findings suggest that caregivers’ high HL may be an essential factor in improving EEMC among minorities. Identifying informal caregivers with high HL level at time of admission to the hospital, and encouraging their involvement during patients’ hospital stay, might be a useful strategy to improve transitions and reducing 30-day readmission, especially among minority patients.

PRIMARY MEDICAL CARE AND MEDICAL RESEARCH TRAINING

PEDIATRICS ◽  
1973 ◽  
Vol 52 (6) ◽  
pp. 768-772
Author(s):  
David G. Nathan
Keyword(s):  
Child Health ◽  
Medical Research ◽  
Medical Care ◽  
Maternal And Child Health ◽  
Medical Literature ◽  
Research Training ◽  
Medical Center ◽  
Academic Programs ◽  
Primary Medical Care ◽  
And Child Health

Dr. Cicely Williams delivered a challenging Blackfan Lecture, reproduced elsewhere in this issue of the Journal,1 at the Children's Hospital Medical Center on May 30, 1973. It should be carefully studied by all pediatricians, and particularly by pediatricians involved in academic programs. Dr. Williams speaks with the experience and wisdom gathered during more than 50 years of service to the field of maternal and child health and with unimpeachable academic credentials. She first described kwashiorkor in the Western medical literature in 1931. Dr. Williams' message to academic pediatrics is loud and clear. It may be paraphrased in the following manner: "Be off," she states, "with your ultrascience, your superspecialists and your rapt attention to the few with so called interesting illnesses.

THE ROAD AHEAD TO BETTER MEDICAL CARE FOR CHILDREN

PEDIATRICS ◽  
1950 ◽  
Vol 6 (3) ◽  
pp. 553-556
Keyword(s):  
Child Health ◽  
Medical Care ◽  
Medical Center ◽  
Point Of View ◽  
Medical Services ◽  
High Quality ◽  
The Road ◽  
Provide Child Care ◽  
Ultimate Objective ◽  
The Many

THE road to better child health has been discussed in relation to the doctor and his training, health services and their distribution. We have dealt with the unavoidable question of costs. Particular attention has been given to some of the advantages and dangers of decentralization of pediatric education and services. Each of the various subjects has been discussed from the point of view of its bearing on the ultimate objective of better health for all children and the steps necessary to attain this goal. Now, we may stand back from the many details of the picture, view the whole objectively and note its most outstanding features. First is the fact that the improvement of child health depends primarily upon better training for all doctors who provide child care, general practitioners as well as specialists. This is the foundation without which the rest of the structure cannot stand. The second dominant fact is the need for extending to outlying and isolated areas the high quality medical care of the medical centers, without at the same time diluting the service or training at the center. The road to better medical care, therefore, begins at the medical center and extends outward through a network of integrated community hospitals and health centers, finally reaching the remote and heretofore isolated areas. Inherent in all medical schools is a unique potential for rendering medical services as well as actually training physicians. The very nature of medical education—whereby doctors in training work under the tutelage of able specialists in the clinic, hospital ward, and out-patient department—provides medical services of high quality to people in the neighboring communities.

scholarly journals Implemented Interventionsat the Naef K. Basile Cancer Institute to Protect Patients and Medical Personnel From COVID Infections: Effectiveness and Patient Satisfaction

2021 ◽  
Vol 11 ◽  
Author(s):  
Jean El Cheikh ◽  
Samantha El Warrak ◽  
Nohra Ghaoui ◽  
Farouk Al Chami ◽  
Maya Shahbaz ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Medical Care ◽  
Medical Center ◽  
Treatment Protocol ◽  
Patient Centered ◽  
Oncology Patients ◽  
Oncology Patient ◽  
Safety Measures ◽  
Viral Spread ◽  
First Case

BackgroundThe Coronavirus Disease 2019 (COVID-19) was declared a pandemic by WHO in March 2020. The first case of COVID-19 was identified in Lebanon on the 21st of February 2020, amid a national economic crisis. As the numbers of cases increased, ICU admissions and mortality rose, which led hospitals across Lebanon to take certain safety measures to contain the virus. The Naef K. Basile Cancer Institute (NKBCI) at the American University of Beirut Medical Center handles oncology outpatient visits and outpatient treatment protocol infusions. The aim of this study is to evaluate the efficacy of the safety measures put forth by the NKBCI early in the pandemic.MethodsOncology patients are amongst the immunosuppressed population, who are at greatest risk of contracting COVID-19 and consequently suffering its complications. In this manuscript, we evaluated the precautionary measures implemented at the NKBCI of AUBMC from March 1st to May 31st of 2020, by surveying oncology patients on the telephone who had live and virtual appointments in both the oncology outpatient clinics and infusion unit. We conducted a prospective study of 670 oncology patients who had appointments at the NKBCI during this period and used their answers to draw responses about patient satisfaction towards those safety measures.ResultsOur results involved 387 responses of oncology patients who visited the NKBCI during the period of March 1st to May 31st of 2020. 99% of our respondents gave a rating of good to excellent with these new measures. The option of online consultation was given to 35% in the hematology group compared to 19% in those with solid tumors (p=0.001). From the total, 15% of patients opted for the telemedicine experience as a new implemented strategy to provide patient-centered medical care. Of this group of patients, 22% faced problems with connectivity and 19% faced problems with online payment.ConclusionNKBCI was competent in following the WHO guidelines in protecting the oncology patient population. Feedback collected from the surveys will be taken into account by the committee of the NKBCI to develop new safety measures that can better control viral spread while providing patient-centered medical care.

Epidural analgesia is associated with earlier gastrointestinal transit after radical cystectomy but does not reduce the incidence of postoperative ileus: A retrospective cohort study

2021 ◽  
pp. 205141582110515
Author(s):  
Julian Knoerlein ◽  
Sebastian Heinrich ◽  
Kai Kaufmann ◽  
Wolfgang Schultze-Seemann ◽  
Wolfgang Baar ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Radical Cystectomy ◽  
Postoperative Ileus ◽  
Medical Center ◽  
Gastrointestinal Transit ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Baseline Characteristics ◽  
Time Required ◽  
First 90 Days

Objective: To compare the effect of combined epidural thoracic analgesia and general anaesthesia (CEGA) in radical cystectomy (RC) with respect to the return of gastrointestinal passage, the incidence of paralytic postoperative ileus (POI) compared to general anaesthesia (GA) only. Patients and methods: We conducted a retrospective review using the electronic medical records of 236 patients who underwent RCs between July 2011 and September 2018 at the Medical Center – University of Freiburg. Results: A CEGA was administered to 202 patients, while 34 patients received only GA. The baseline characteristics of patients with and without CEGA showed no significant differences. CEGA will decrease the time required for return of gastrointestinal transit as measured by time to first defecation by about 13 hours. In the first 90 days after surgery, 82 (34.7%) patients had a POI. There was no significant difference between complications in the CEGA and GA groups. Conclusion: A CEGA accelerates the return of the gastrointestinal transit but does not reduce the incidence of postoperative ileus. Level of evidence: 2b

Millennials Seeking Healthcare: Examining the Degree to Which Patients Utilize Online Resources (Preprint)

2021 ◽  
Author(s):  
Landon Arensberg ◽  
Jessica Kalender-Rich ◽  
Jaehoon Lee ◽  
Cheryl Gibson
Keyword(s):  
Medical Care ◽  
Baby Boomers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Age Groups ◽  
Online Reviews ◽  
Online Resources ◽  
Cross Sectional ◽  
Academic Medical ◽  
Us Census

BACKGROUND According to the 2020 US Census, a Silver Tsunami is looming with more than 75.4 million persons aged 57-75 (known as “Baby Boomers”) expected to need more costly medical care. Future estimates, however, indicate a much larger wave of individuals is imminent, given the 83.1 million Millennials approaching adulthood who will be seeking medical care. Because Millennials differ from Baby Boomers in several ways, it is important to understand how this population finds their physician to gain insight into what might influence this decision. OBJECTIVE To determine the extent and influence online resources and reviews have on the younger generation as compared to elder generations. METHODS Between the months of May and July 2020 a cross-sectional paper-based survey was conducted at primary care and geriatric clinics located within a large urban academic medical center in the Midwest. RESULTS A sample of 284 patients completed the survey (44.35 ± 17.54 yrs old [range=18-90], 60.6% female, 57.4% white). Of Millennials (respondents aged 22-38 yrs), 67.2% read online reviews before choosing a physician. Millennials were significantly more likely to read online reviews before choosing a physician (P=0.004) and utilize online resources to search for a new physician (P<.001) than older patients. The majority of millennials were likely to be influenced by both negative reviews (59%) and positive reviews (71.3%). Female patients were more likely to read online reviews and use online resources compared to men, but the differences were not significant. CONCLUSIONS Overall, Millennials are much more likely to research online reviews before choosing a physician. Other generations also use online resources to an extent but tend to use personal referrals. Across all age groups, negative online reviews were less influential in decision-making compared to positive ones. Therefore, a presence on review websites and search engines seems to only benefit one’s medical practice to capture the new wave of patients.

Prevalence of anaphylaxis among adults admitted to critical care for severe asthma exacerbation

2018 ◽  
Vol 35 (10) ◽  
pp. 623-625 ◽  
Author(s):  
Ayobami T Akenroye ◽  
Abayomi Ajala ◽  
Elham Azimi-Nekoo ◽  
Gabriele S de Vos
Keyword(s):  
New York ◽  
Severe Asthma ◽  
Acute Asthma ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Trauma Centre ◽  
Appropriate Care ◽  
Severe Asthma Exacerbation ◽  
Baseline Characteristics ◽  
Level 1

BackgroundIn asthmatics, making a diagnosis of anaphylaxis could be challenging as respiratory symptoms are a common feature of both conditions. Identifying anaphylaxis is important to providing appropriate care. A prior study showed that anaphylaxis is sometimes misdiagnosed as acute asthma in children. We sought to identify the percentage of adults admitted to the intensive care unit (ICU) with asthma exacerbations who met criteria for anaphylaxis.MethodsRetrospective chart review of adults admitted with acute asthma to the ICU at Jacobi Medical Center, a Level 1 trauma centre in Bronx, New York. Study period was January 2012 to December 2014. Using the criteria outlined in the World Allergy Organization’s Anaphylaxis Guidelines, we identified patients who met criteria for anaphylaxis.Results105 patients were identified: 17 were excluded because their main reason(s) for admission was not asthma. 7 (8%) of the 88 cases eligible for the study met diagnostic criteria for anaphylaxis while 3 (3.4%) were highly likely to have had anaphylaxis. The baseline characteristics of the seven patients were similar to that of the overall population studied. They however had shorter onset of symptoms (median (IQR): 3.5 (2–6) vs 24 hours (12–72), p<0.001), were more likely to have been intubated (71%vs31%, p=0.04), received intramuscular epinephrine by the emergency medical services or in the emergency room (86%vs42%, p=0.04) and received antihistamines (28.6%vs1.2%, p=0.02). None of these seven patients died. Only one of the seven patients was prescribed an epinephrine pen injector and referred to an allergist at discharge.ConclusionIn this single-centre retrospective review, 3.4% of adults admitted to the ICU for acute severe asthma also met criteria for anaphylaxis.

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