Pediatric Neurosurgery Patients Need More than a Pediatric Neurosurgeon. Part II. A Clinical Report: In the USA Lack of Parent/Caregiver Compliance Interferes with the Patient Care Sequence

2016 ◽  
Vol 51 (5) ◽  
pp. 229-235
Author(s):  
Teresa L. MacGregor ◽  
Hector E. James ◽  
Laurel Everett ◽  
David O. Childers Jr.
Keyword(s):  
Patient Care ◽  
Pediatric Neurosurgery ◽  
Clinical Report ◽  
The Usa

scholarly journals Rapid implementation of Inpatient eConsult Programme addresses new challenges for patient care during COVID-19 pandemic

2021 ◽  
pp. bmjinnov-2020-000557
Author(s):  
Sharon Rikin ◽  
Eric J Epstein ◽  
Inessa Gendlina
Keyword(s):  
Palliative Care ◽  
Infectious Diseases ◽  
Patient Care ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Qualitative Feedback ◽  
The Usa ◽  
New Challenges ◽  
Science Framework ◽  
Context Specific

IntroductionAt the early epicentre of the COVID-19 crisis in the USA, our institution saw a surge in the demand for inpatient consultations for areas impacted by COVID-19 (eg, infectious diseases, nephrology, palliative care) and shortages in personal protective equipment (PPE). We aimed to provide timely specialist input for consult requests during the COVID-19 pandemic by implementing an Inpatient eConsult Programme.MethodsWe used the reach, effectiveness, adoption, implementation and maintenance implementation science framework and run chart analysis to evaluate the reach, adoption and maintenance of the Inpatient eConsult Programme compared with traditional in-person consults. We solicited qualitative feedback from frontline physicians and specialists for programme improvements.ResultsDuring the study period, there were 46 available in-person consult orders and 21 new eConsult orders. At the peak of utilisation, 42% of all consult requests were eConsults, and by the end of the study period, utilisation fell to 20%. Qualitative feedback revealed subspecialties best suited for eConsults (infectious diseases, nephrology, haematology, endocrinology) and influenced improvements to the ordering workflow, documentation, billing and education regarding use.DiscussionWhen offered inpatient eConsult requests as an alternative to in-person consults in the context of a surge in patients with COVID-19, frontline physicians used eConsult requests and decreased use of in-person consults. As the demand for consults decreased and PPE shortages were no longer a major concern, eConsult utilisation decreased, revealing a preference for in-person consultations when possible.ConclusionsLessons learnt can be used to develop and implement inpatient eConsults to meet context-specific challenges at other institutions.

Physician alert: the legal risks associated with ‘on-call’ duties in the USA

2018 ◽  
Vol 94 (1113) ◽  
pp. 411-414
Author(s):  
Zachary R Paterick ◽  
Nachiket J Patel ◽  
Timothy Edward Paterick
Keyword(s):  
Informed Consent ◽  
Medical Treatment ◽  
Patient Care ◽  
Patient Relationship ◽  
Risk Of Falling ◽  
Best Interest ◽  
Legal Risk ◽  
Legal Risks ◽  
The Usa ◽  
Legal Concepts

On-call physicians encounter a diverse aggregate of interfaces with sundry persons concerning patient care that may surface potential legal peril. The duties and obligations of an on-call physician, who must act as a fiduciary to all patients, create a myriad of circumstances where there is a risk of falling prey to legal ambiguities. The understanding of the doctor–patient relationship, the obligations of physicians under the Emergency Medical Treatment and Labor Act, the meaning of medical informed consent and the elements of negligence will help physicians avoid the legal risk associated with the various encounters of being on call. After introducing the legal concepts, we will explore the interactions that may put physicians at legal risk and outline how to mitigate that risk. Being on call is time consuming and arduous. While on call, physicians have a duty to act morally and ethically in the best interest of the patients.

Volunteering in the United States of America

2018 ◽  
Author(s):  
Greg Schneider
Keyword(s):  
United States ◽  
Palliative Care ◽  
Patient Care ◽  
United States Of America ◽  
The United States ◽  
Care Quality ◽  
Direct Patient Care ◽  
Hospice Movement ◽  
The Usa ◽  
Hospice And Palliative Care

Hospice and palliative care volunteering in the United States of America (USA) has changed dramatically since its inception in the late 1960s. Inspired by physician Dame Cicely Saunders, the modern hospice movement officially began in the USA in 1971 with Florence Wald founding the first hospice, Hospice, Inc., a non-profit in New Haven, Connecticut. Then in 1983, the US Congress established the Medicare Hospice Benefit, whose Conditions of Participation (CoPs) mandated that volunteers must provide administrative or direct patient care in an amount that, at a minimum, equals 5 per cent of the total patient care hours expended by all paid hospice employees and contract staff. Hence, every hospice programme must have a volunteer programme in order to receive reimbursement for services rendered. The primary forces currently shaping hospice and palliative care volunteering have been regulations, care quality, skill requirements, liability concerns, and changing business objectives in a highly competitive environment.

scholarly journals The value of head circumference measurements after 36 months of age: a clinical report and review of practice patterns

2015 ◽  
Vol 16 (2) ◽  
pp. 186-194 ◽  
Author(s):  
Hector E. James ◽  
Anthony A. Perszyk ◽  
Teresa L. MacGregor ◽  
Philipp R. Aldana
Keyword(s):  
Head Circumference ◽  
Assessment Tool ◽  
Pediatric Neurosurgery ◽  
Head Size ◽  
Lead Author ◽  
Clinical Report ◽  
Same Sex ◽  
Measuring Head ◽  
Standard Of Practice ◽  
The University

OBJECT The cranium is documented to grow from birth through adolescence. The standard of practice in primary care is measuring head circumference and plotting growth using curves that stop at 36 months. The authors report the importance of their experience with measuring head circumference in the child and same-sex parent beyond 36 months. METHODS In the University of Florida genetics and pediatric neurosurgery clinics, head circumference is measured and plotted on growth charts through 18 years of age. Circumference and rate of growth over time are compared with those of the same-sex parent. A diagnostic workup is initiated if there is a discrepancy with the patient's head circumference or if there is significant change in the growth rate of the cranium. RESULTS Between January 2004 and December 2007, the lead author examined 190 patients referred by pediatricians and/or pediatric subspecialists because of the concerns regarding head size of the child. Neuroimaging was performed in 70% of the patients prior to referral. None of the patients had their head size compared with that of their same-sex parent prior to referral. On assessing referring physician responses as to why the same-sex parents, head measurements were not pursued prior to imaging or referral to the specialists, the results were: 1) only have head circumference sheets to 36 months of age (n = 28); 2) the American Academy of Pediatrics does not recommend it (n = 3); and 3) the head stops growing at 36 months of age (n = 2). CONCLUSIONS Pediatricians and pediatric subspecialists need instruction on head circumference measurement in children from infancy through adolescence, and when indicated, in comparison with the head size of the same-sex parent. This measurement may be an effective and inexpensive assessment tool.

Pediatric neurosurgery at Texas Children’s Hospital: the legacy of Dr. William R. Cheek

2021 ◽  
pp. 1-7
Author(s):  
Nisha Gadgil ◽  
Ganesh Rao ◽  
Raymond Sawaya ◽  
Daniel Yoshor ◽  
Lucia Ruggieri ◽  
...  
Keyword(s):  
Patient Care ◽  
Pediatric Neurosurgery ◽  
Care Education ◽  
Children's Hospital ◽  
The Past ◽  
Children’S Hospital

Texas Children’s Hospital opened its doors in 1954, and since that time the institution has remained dedicated to a three-part mission: patient care, education, and research. Dr. William R. Cheek developed an early interest in pediatric neurosurgery, which led to his efforts in building and developing a service at Texas Children’s Hospital at a time when the field was just emerging. His work with other early pioneers in the field led to the establishment of organized societies, educational texts, and governing bodies that have led to significant advances in the field over the past 50 years.

Advanced Registered Nurse Practitioners and Physician Assistants in the Practice of Pediatric Neurosurgery: A Clinical Report

2011 ◽  
Vol 47 (5) ◽  
pp. 359-363 ◽  
Author(s):  
Hector E. James ◽  
Teresa L. MacGregor ◽  
Richard A. Postlethwait ◽  
Paul B. Hofrichter ◽  
Phillip R. Aldana
Keyword(s):  
Nurse Practitioners ◽  
Registered Nurse ◽  
Pediatric Neurosurgery ◽  
Physician Assistants ◽  
Clinical Report

scholarly journals Quality assessment of weekend discharge: a systematic review and meta-analysis

2020 ◽  
Vol 32 (6) ◽  
pp. 347-355
Author(s):  
Chia-Yu Chiu ◽  
David Oria ◽  
Peter Yangga ◽  
Dasol Kang
Keyword(s):  
Patient Care ◽  
Meta Analysis ◽  
Emergency Department Visits ◽  
Weekend Effect ◽  
Cochrane Library ◽  
Quality Of Patient Care ◽  
Significant Difference ◽  
The Usa

Abstract Purpose Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have higher mortality rates compared with weekdays, which has been identified as the ‘weekend effect.’ However, discharges on weekends are also linked with quality of care, and have been evaluated in the recent decade with different dimensions. This meta-analysis aims to discuss weekend discharges associated with 30-day readmission, 30-day mortality, 30-day emergency department visits and 14-day follow-up visits compared with weekday discharges. Data sources PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched from January 2000 to November 2019. Study selection Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Only studies published in English were reviewed. The random-effects model was applied to assess the effects of heterogeneity among the selected studies. Data extraction Year of publication, country, sample size, number of weekday/weekend discharges, 30-day readmission, 30-day mortality, 30-day ED visits and 14-day appointment follow-up rate. Results of data synthesis There are 20 studies from seven countries, including 13 articles from America, in the present meta-analysis. There was no significant difference in odds ratio (OR) in 30-day readmission, 30-day mortality, 30-day ED visit, and 14-day follow-up between weekday and weekend. However, the OR for 30-day readmission was significantly higher among patients in the USA, including studies with high heterogeneity. Conclusion In the USA, the 30-day readmission rate was higher in patients who had been discharged on the weekend compared with the weekday. However, interpretation should be cautious because of data limitation and high heterogeneity. Further intervention should be conducted to eliminate any healthcare inequality within the healthcare system and to improve the quality of patient care.

scholarly journals DO PROBIOTICS HAVE ANY FUTURE IN NEONATOLOGY? (ANALYSIS OF THE LATEST DATA. PART I) T. K. Znamenska, O. V. Vorobiova

2021 ◽  
Vol 11 (2(40)) ◽  
pp. 53-59
Author(s):  
T.K. Znamenska ◽  
O.V. Vorobiova
Keyword(s):  
Intensive Care Unit ◽  
Working Group ◽  
Meta Analysis ◽  
Probiotic Strain ◽  
Large Individual ◽  
Clinical Report ◽  
Premature Newborns ◽  
Negative Results ◽  
The Usa ◽  
Meta Analyses

From year to year prescription of probioticsremains a controversial issue both in medicine for adults andpediatrics. Some doctors make a positive conclusion about theeffectiveness of probiotics, while large individual tests beinga part of meta-analyses show negative results pointing that acertain probiotic strain has no influence on a patient. It’s betterto avoid excessively negative or positive conclusions CRTabout probiotics. The issue of using probiotics in newborns isespecially acute among neonatologists. The aim of this articleis the analysis of the latest data on the possibility of usingprobiotics in newborns.In 2021 the clinical report about the use of probiotics inpremature newborns in the USA was published (ААР committeeon fetus and newborns issue). It pointed out that the numberof premature newborns who get prescriptions for probiotics,namely in the USA, is steadily increasing despite significantdifferences in combinations of probiotic drugs and absenceof pharmaceutical class of probiotic products. Accordingto the latest source of database in the USA, around 10% ofnewborns with extremely low gestational age get a certaintype of probiotics while being in the intensive care unit fornewborns with different variations among the units. Despitethe fact that lots of doctors argue their usual use of probioticsin premature newborns, other groups, including ESPGHANand АРР are more cautious admitting the main restrictions ofmany researches, methodological differences in the design ofa research and guidelines along with the conclusion that theeffectiveness of probiotics may vary widely.Recently the ESPGHAN working group on probiotics andprebiotics has published the document on using an approachof network meta-analysis of finding strains with the largestpotential of effectiveness to prevent major diseases inpremature newborns. Following this the ESPGHAN committeeon feeding issue and the ESPGHAN working group onprobiotics and prebiotics have an aim to develop a documentwhich can serve as a guidance for possible use of probiotics inpremature newborns the positions of which we will consider inthe second part of the article.

scholarly journals Trauma center funding: time for an update

2021 ◽  
Vol 6 (1) ◽  
pp. e000596
Author(s):  
Heather M Grossman Verner ◽  
Brian A Figueroa ◽  
Marcos Salgado Crespo ◽  
Manuel Lorenzo ◽  
Joseph D Amos
Keyword(s):  
Patient Care ◽  
Trauma Care ◽  
Statistical Significance ◽  
Pairwise Comparison ◽  
Steady Increase ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Trauma Service ◽  
The Usa ◽  
Level I

BackgroundUncompensated care (UC) is healthcare provided with no payment from the patient or an insurance provider. UC directly contributes to escalating healthcare costs in the USA and potentially impacts patient care. In Texas, there has been a steady increase in the number of trauma centers and UC volumes without an increase in trauma funding of UC. The method of calculating UC trauma funds in Texas is imprecise as it is driven by Medicaid volumes and not actual trauma care costs.MethodsFive years of annual trauma UC disbursement reports from the Texas Department of State Health Services were used to determine changes in UC economic considerations for level I, II, and III trauma centers in the largest urban trauma service areas (TSAs). Data for UC costs, compensation, and TSA demographics were used to assess variations. Statistical significance was determined using a Kruskal-Wallis test with Dunn’s pairwise comparison post-hoc analysis and logistic regression.ResultsTSA-E (Dallas-Fort Worth area) has 33% of the level I trauma centers in Texas (n=6) and yet serves only 27% of the total state population across 14 metropolitan and 5 non-metropolitan counties. Since 2015, TSA-E has shown higher UC costs (p<0.02) and lower reimbursement (p<0.01) than the second largest urban hub, TSA-Q (Houston area). TSA-E level I trauma centers trended towards decreased UC reimbursements.DiscussionThe unregulated expansion of trauma centers in Texas has led to an unprecedented increase in hospitals participating in trauma care. The unbalanced allocation of UC funding could lead to further economic instability, compromise resource allocation, and negatively impact patient care in an already fragile healthcare environment.Level of evidenceLevel IV; Retrospective economic analysis and evaluation.

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