Safety of bedside placement of tunneled dialysis catheter in COVID-19 patients

2020 ◽  
pp. 112972982097626
Author(s):  
Tarik Hanane ◽  
James Lane ◽  
Eduardo Mireles-Cabodevila ◽  
Anita J Reddy ◽  
Jonathan J Taliercio ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Renal Replacement Therapy ◽  
Ultrasound Guidance ◽  
Standard Of Care ◽  
Anatomical Landmarks ◽  
Dialysis Catheter ◽  
Anatomic Landmarks ◽  
High Incidence ◽  
Fluoroscopy Guidance

COVID-19 patients admitted to the ICU have high incidence of AKI requiring prolonged renal replacement therapy and often necessitate the placement of a tunneled dialysis catheter (TDC). We describe our experience with two cases of COVID-19 patients who underwent successful bedside placement of TDC under ultrasound guidance using anatomical landmarks without fluoroscopy guidance. Tunneled dialysis catheter placement under direct fluoroscopy remains the standard of care; but in well selected patients, placement of tunneled dialysis catheter at the bedside using anatomic landmarks without fluoroscopy can be safely and successfully performed without compromising the quality of care and avoid transfer of COVID-19 infected patients outside the ICU.

scholarly journals The Effect of Drug Pricing on Outpatient Payments and Treatment for Three Soil-Transmitted Helminth Infections in the United States, 2010–2017

2021 ◽  
Author(s):  
Heesoo Joo ◽  
Junsoo Lee ◽  
Brian A. Maskery ◽  
Chanhyun Park ◽  
Jonathan D. Alpern ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Prescription Drug ◽  
Parasitic Infection ◽  
Standard Of Care ◽  
The United States ◽  
Parasitic Infections ◽  
Treatment Pathways ◽  
Drug Prices ◽  
The Impact

The price of certain antiparasitic drugs (e.g., albendazole and mebendazole) has dramatically increased since 2010. The effect of these rising prices on treatment costs and use of standard of care (SOC) drugs is unknown. To measure the impact of drug prices on overall outpatient cost and quality of care, we identified outpatient visits associated with ascariasis, hookworm, and trichuriasis infections from the 2010 to 2017 MarketScan Commercial Claims and Encounters and Multi-state Medicaid databases using Truven Health MarketScan Treatment Pathways. Evaluation was limited to members with continuous enrollment in non-capitated plans 30 days prior, and 90 days following, the first diagnosis. The utilization of SOC prescriptions was considered a marker for quality of care. The impact of drug price on the outpatient expenses was measured by comparing the changes in drug and nondrug outpatient payments per patient through Welch’s two sample t-tests. The total outpatient payments per patient (drug and nondrug), for the three parasitic infections, increased between 2010 and 2017. The increase was driven primarily by prescription drug payments, which increased 20.6–137.0 times, as compared with nondrug outpatient payments, which increased 0.3–2.2 times. As prices of mebendazole and albendazole increased, a shift to alternative SOC and non-SOC drug utilization was observed. Using parasitic infection treatment as a model, increases in prescription drug prices can act as the primary driver of increasing outpatient care costs. Simultaneously, there was a shift to alternative SOC, but also to non-SOC drug treatment, suggesting a decrease in quality of care.

Southwest Regional Genitourinary Physicians' Audit Group: setting regional benchmarks for patient satisfaction

2003 ◽  
Vol 14 (9) ◽  
pp. 622-624 ◽  
Author(s):  
Rachel Challenor
Keyword(s):  
Patient Satisfaction ◽  
Quality Of Care ◽  
Analogue Scale ◽  
Standard Of Care ◽  
Group Setting ◽  
Monitoring Process ◽  
Genitourinary Medicine

The Southwest Regional Genitourinary Physicians' Audit Group conducted a survey to determine regional benchmarks for patient satisfaction with quality of care received in genitourinary medicine (GUM) clinics. Eight clinics participated, producing 1747 responses. Most patients were very satisfied with the standard of care in southwest GUM clinics resulting in high regional averages (74-90% very satisfied - score 5 on linear analogue scale 1-5). Revalidation/appraisal guidance suggests that physicians should actively participate in validated surveys relevant to their practice to provide evidence of relationships with patients. This questionnaire (with suggested improvements) may be used as part of that monitoring process.

scholarly journals QS ENDO Real – A Study by the German Endometriosis Research Foundation (SEF) on the Reality of Care for Patients with Endometriosis in Germany, Austria and Switzerland

2020 ◽  
Vol 80 (02) ◽  
pp. 179-189 ◽  
Author(s):  
Felix Zeppernick ◽  
Magdalena Zeppernick ◽  
Elisabeth Janschek ◽  
Monika Wölfler ◽  
Sebastian Bornemann ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Quality Indicators ◽  
Premenopausal Women ◽  
Standard Of Care ◽  
Classification Systems ◽  
Deep Infiltrating Endometriosis ◽  
Social Security Systems ◽  
Current State ◽  
German Speaking

AbstractEndometriosis affects a significant number of young premenopausal women. Quite apart from the medical challenges, endometriosis is a relevant burden for healthcare and social security systems. Standardized quality indicators for the treatment of endometriosis have not previously been systematically verified. The three-stage study QS ENDO was initiated to record and improve the reality and quality of care. One of its aims is to create quality indicators for the diagnosis and treatment of endometriosis. For the first stage of QS ENDO Real, letters were sent to all 1014 gynecological departments in the German-speaking area of Europe (the DACH region) which included a questionnaire as a means of surveying the current state of care. A total of 296 (29.2%) of the centers which received the questionnaire participated in the survey. The subsequent evaluation of the completed questionnaires showed that the majority of patients with endometriosis (around 60%, based on estimates from the data) are not treated in hospitals which have been certified by the SEF. The guidelines recommend the use of specific classification systems (rASRM, ENZIAN) but, depending on the level of care offered by the hospital, only around 44.4 to 66.4% of departments used the rASRM score and only 27% of hospitals used the ENZIAN classification system to describe deep-infiltrating endometriosis. When taking patientsʼ medical history, some centers (6.6 – 17.9%) considered questions about leading symptoms such as dyschezia, dysuria and dyspareunia to be unimportant. QS ENDO Real has made it possible, for the first time, to get an overview of the reality of care provided to patients with endometriosis in the German-speaking areas of Europe. The findings indicate that several of the measures recommended in international guidelines as the gold standard of care are only used to treat some of the patients. In this respect, more efforts will be needed to provide more advanced training. The approach used for treatment must be guideline-based, also in not-certified centers, to improve the quality of care in the treatment of patients with endometriosis.

scholarly journals Clinical mentoring to improve quality of care provided at three NIM-ART facilities: A mixed methods study

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Chris A. Visser ◽  
Jacqueline E. Wolvaardt ◽  
David Cameron ◽  
Gert J.O. Marincowitz
Keyword(s):  
Quality Of Care ◽  
Mixed Methods ◽  
Health Workers ◽  
High Standard ◽  
Standard Of Care ◽  
Undetectable Viral Load ◽  
Mixed Methods Study ◽  
High Level ◽  
Clinical Records

Background: The South African Department of Health implemented the nurse-initiated management of antiretroviral treatment (NIM-ART) programme as a policy to decentralise services. Increasing access to ART through nurse initiation results in significant consequences.Aim: This study evaluated the quality of care provided, the barriers to the effective rollout of antiretroviral services and the role of a clinical mentor.Setting: The study was conducted at three NIM-ART facilities in South Africa. One clinic provided a high standard of care, one had a high defaulter rate, and at the third clinic, treatment failures were missed, and routine bloods were not collected.Methods: A mixed methods study design was used. Data were collected using patient satisfaction surveys, review of clinical records, facility audits, focus group interviews, field notes and a reflection diary.Results: NIM-ART nurses prescribed rationally and followed antiretroviral guidelines.Mortality rates and loss to follow-up rates were lower than those at the surrounding hospitals, and 91.1% of nurse-monitored patients had an undetectable viral load after a year. The quality of care provided was comparable to doctor-monitored care. The facility audits found recurrent shortages of essential drugs. Patients indicated a high level of satisfaction. Salary challenges,excessive workload, a lack of trained nurses and infrastructural barriers were identified as barriers. On-going mentoring and support by a clinical mentor strengthened each of the facilities, facilitated quality improvement and stimulated health workers to address constraints.Conclusion: Clinical mentors are the key to addressing institutional treatment barriers and ensuring quality of patient care.

scholarly journals Integrating Care into Clinical Research

2020 ◽  
Author(s):  
Nicholas James Pasquale
Keyword(s):  
Clinical Trial ◽  
Quality Of Care ◽  
Clinical Research ◽  
Standard Of Care ◽  
Healthcare Setting ◽  
Patient Centered ◽  
Workplace Stressors ◽  
Centered Care ◽  
Area Of Concern

Decreasing errors will further support patient-centered care and improve outcomes. Errors within this healthcare setting are very disruptive to the quality and standard of care that is provided to clinical trial patients. Staff experience, training, as well as workplace stressors all contribute to procurement errors. 75 clinical staff were distributed questionnaires in order to gauge area of concern and in need of improvement. This led to the implementation of a finely tuned resource document for staff to rely on, as well as integrated within the department. The decreased rate of error and increased quality of care is evident.

scholarly journals P1352ULTRASOUD OR LANDMARKS FOR THE PLACEMENT OF HAEMODIALYSIS CATHETERS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nabil BELLIK
Keyword(s):  
Prospective Study ◽  
Success Rate ◽  
Ultrasound Guidance ◽  
Anatomical Landmark ◽  
University Hospital ◽  
Complication Rates ◽  
Anatomical Landmarks ◽  
Dialysis Catheter ◽  
Ultrasound Guided ◽  
The University

Abstract Background and Aims To compare the success and immediate complication rates of the anatomical landmark method (AL) and the ultrasound guided technique (EG) in the placement of haemodialysis catheters. Method This was a randomized prospective study on 285 patients requiring dialysis catheter in the University Hospital of Bab el Oued between November 2016 and november 2018. Patients were randomized into two groups: EG and AL. The EG group had their catheters inserted under ultrasound guided technique [1], whereas the AL group had their dialysis catheter inserted by anatomical landmarks technique. Data were collected on demography, side of insertion. Outcome measures included successful insertion, successful insertion at the first puncture, number of attempts, and complications. Results A total of 285 procedures (142 EG and 143 AL) were performed during the study. The success rate was 52.4% in the ALT group as compared with 90.1% in the EG group (p <10-6) in the first procedure. First attempt success rate was 24.4% in the AL group as compared with 53.5% in the EG group (p=0.0002). The complication rate was 45.5% in the AL group and 19.7% in the EG group (p <10-6). Conclusion The use of ultrasound guidance in the placement of haemodialysis catheters significantly improves the success rate and success rate at the first puncture and significantly decreases the incidence of catheter insertion complications.

Implementation of a Patient-Reported Outcomes Measure for Patients with Advanced Heart Failure

2020 ◽  
Author(s):  
Leanne Burke
Keyword(s):  
Heart Failure ◽  
Quality Of Care ◽  
Kansas City ◽  
Standard Of Care ◽  
High Morbidity ◽  
Patient Goals ◽  
Standard Clinical Practice ◽  
Patient Reported ◽  
The Impact

Heart failure (HF) is associated with high morbidity, mortality, and substantial cost. Despite treatment advancements, the quality of care and quality of life (QoL) remains suboptimal. Interventions to improve QoL, like palliative care (PC), are lacking. Aligning clinical management and patient goals of care is critical to improving outcomes and highlights patient-centeredness. Strategies to promote patient-centered care, such as utilizing patient-reported outcome measures (PROM), should be standard of care. Purpose/Aims: To improve QoL and quality of care for HF patients by integrating the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) as standard clinical practice. The aims were to use the KCCQ-12 as the new standard of care, evaluate the impact on patients’ QoL and evaluate the impact on quality of care.

scholarly journals Deliver on Your Own: Disrespectful Maternity Care in rural Kenya

2019 ◽  
Author(s):  
Adelaide M Lusambili ◽  
Violet Naanyu ◽  
Terrance J. Wade ◽  
Lindsay Mossman ◽  
Michaela Mantel ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Maternity Care ◽  
Health Workers ◽  
Quality Care ◽  
Sustainable Use ◽  
Standard Of Care ◽  
Respectful Maternity Care ◽  
Mortality And Morbidity ◽  
Using Data

ABSTRACTBackgroundUnder the Free Maternity Policy (FMP), Kenya has witnessed an increase health facility deliveries rather than home deliveries with Traditional Birth Attendants (TBA) resulting in improved maternal and neonatal outcomes. Despite these gains, maternal and infant mortality and morbidity rates in Kenya remain unacceptably high indicating that more work needs to be done.AimUsing data from the Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) project’s qualitative gender assessment, this paper examines and describes women’s experience of disrespectful care during pregnancy, labour and delivery. The goal is to promote improved understanding of actual care conditions in order to develop interventions that can lift the standard of care, increase maternity facility use, and improve health outcomes for both women and newborns.MethodologyWe conducted sixteen focus group discussions (FGDs) with female adolescents, women, men and community health committee members. Twenty four key informants interviews (KII) including religious leaders, local government representatives, Ministry of Health (MOH) and local women’s organizations were conducted. Data were captured through audio recordings and reflective field notes.Research siteKisii and Kilifi Counties in Kenya.FindingsFindings show Nursing and medical care was sometimes disrespectful, humiliatings, uncompassionate, and neglectful. In both sites, male health workers were the most preferred by women as they were friendly and sensitive. Young women were more likely to be abused and women with disabled children were stigmatized.ConclusionsKenya needs to enforce the implementation of the quality of care guidelines for pregnancy and delivery, including respectful maternity care of pregnant women. To make sure these procedures are enforced, measurable benchmarks for maternity care need to be established, and hospitals need to be regularly monitored to make sure they are achieved. Quality of care and compassionate and caring staff may lead to successful and sustainable use of facility care.

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