MULTIPLE BIRTHS: A WAKE-UP CALL

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 797-797
Author(s):  
J. F. L.
Keyword(s):  
Health Care ◽  
Premature Birth ◽  
Birth Defect ◽  
Medical Center ◽  
The United States ◽  
Multiple Births ◽  
Fertility Treatment ◽  
First Year ◽  
Multiple Pregnancies ◽  
Island Jewish Medical

Miss Helen can recall when the Dionne quints were born in 1934, an event as rare and heralded as the birth of a white buffalo. But today, in the United States alone, there are 42 sets of quintuplets with all members living, including the three little girls and two boys born recently at Long Island Jewish Medical Center to Pnina and Shmuel Klaver of Flatbush. Triplets are more plentiful still. About 2500 sets are born annually. Twins and other multiples often delight their families, but they also present challenges for them and society as a whole. Multiples are much more prone to premature birth, a situation that can produce a whopping first-year health care tab—more than $1 billion for all low birth weight multiples, 35% of it borne by Medicare and Medicaid. Birth defect rates are also elevated in multiples. The rate of cerebral palsy, for example, is six times that for singletons, according to one study. And financial and child care burdens are heavier. One side effect: studies show child abuse is more common in families of multiples. . . . There is no data about how many multiple births are the result of fertility treatment. But it is estimated that 25% of pregnancies resulting from fertility treatment are multiple pregnancies.

Discrete Event Simulation and Real Time Locating Systems

2012 ◽  
Vol 4 (4) ◽  
pp. 16-28
Author(s):  
T. Eugene Day ◽  
Ajit N. Babu ◽  
Steven M. Kymes ◽  
Nathan Ravi
Keyword(s):  
Health Care ◽  
Real Time ◽  
Discrete Event Simulation ◽  
Medical Center ◽  
Discrete Event ◽  
Healthcare Delivery ◽  
The United States ◽  
Careful Consideration ◽  
Health Administration ◽  
Event Simulation

The Veteran’s Health Administration (VHA) is the largest integrated health care system in the United States, forming the arm of the Department of Veterans Affairs (VA) that delivers medical services. From a troubled past, the VHA today is regarded as a model for healthcare transformation. The VA has evaluated and adopted a variety of cutting-edge approaches to foster greater efficiency and effectiveness in healthcare delivery as part of their systems redesign initiative. This paper discusses the integration of two health care analysis platforms: Discrete Event Simulation (DES), and Real Time Locating systems (RTLS) presenting examples of work done at the St. Louis VA Medical Center. Use of RTLS data for generation and validation of DES models is detailed, with prescriptive discussion of methodologies. The authors recommend the careful consideration of these relatively new approaches which show promise in assisting systems redesign initiatives across the health care spectrum.

Critical Incident Stress Debriefing for Health Care Workers

1994 ◽  
Vol 28 (4) ◽  
pp. 301-315 ◽  
Author(s):  
Pamela S. Lane
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Critical Incident ◽  
Medical Center ◽  
The United States ◽  
Critical Incident Stress Debriefing ◽  
Critical Incident Stress ◽  
Care Workers ◽  
Stress Debriefing ◽  
The Impact

A critical incident may be defined as a life-threatening crisis that requires rescue or emergency care. These incidents evoke strong emotional responses from health care workers. Some of the responses produced are normal and some are pathological stress and grief reactions. The Critical Incident Stress Debriefing process (CISD) is a model designed to mitigate the impact of such incidents on health care workers, to facilitate their return to routine functioning, and to prevent pathological responses to the trauma that is an inherent aspect of their profession. CISD is relied upon by hospital and emergency rescue professionals throughout the United States. The process was observed at St. Joseph's Hospital and Medical Center/Barrow Neurological Institute in Phoenix. This article examines the development of CISD and explores its implementation at St. Joseph's. Interviews conducted with health care workers who participated in the debriefing process following critical incident deaths are excerpted. Implications for death educators/counselors are discussed.

The Changing Health Care Environment: Implications for Residency Training

PEDIATRICS ◽  
1998 ◽  
Vol 101 (Supplement_3) ◽  
pp. 795-804 ◽  
Author(s):  
Seth Frazier ◽  
Daniel Hyman ◽  
Steven Altschuler
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Delivery System ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Pediatric Care ◽  
Health Care Environment ◽  
The Impact

Throughout the United States, the growth of managed care is forcing pediatric providers (physicians and hospitals) to reconstruct and integrate the health care delivery system with a focus away from the academic center and toward the community. Managed care also is forcing new financing approaches geared toward the assumption of economic risk for patient management and utilization of services. Radical changes in pediatric training programs will be necessary to accommodate the strategic and operational changes being pursued in response to these evolving market forces. These changes, while disruptive, will strengthen the breadth and diversity of graduate medical education and will better prepare trainees for the new delivery system in which they will practice. In this article, we examine how the evolution of managed care is redefining the basic financial and organizational framework for pediatric care and the implications of this redefinition for children's hospitals and academic medical center-based pediatric programs. We draw on our experience in the greater Philadelphia market to illustrate the impact of these changes and discuss one pediatric system's response. Finally, we review the educational opportunities provided by these changes.

Opting for Twins in In Vitro Fertilization

2016 ◽  
Author(s):  
Bonnie Steinbock
Keyword(s):  
Learning Disabilities ◽  
Multiple Pregnancy ◽  
Reproductive Technology ◽  
Multiple Births ◽  
Fertility Treatment ◽  
Ethical Question ◽  
Multiple Pregnancies ◽  
Vitro Fertilization ◽  
Twin Pregnancies

Multiple births are an unfortunate consequence of assisted reproductive technology, causing risks to both fetuses and pregnant women. The central ethical issue raised by multiple pregnancy is the conflict between the fertility patient’s desire to get pregnant and the increased risks to offspring. Although extreme cases in which many embryos are transferred to the woman’s uterus are very rare—and represent negligence—twin pregnancies are still common. Many women undergoing fertility treatment reportedly express a preference for twin pregnancies to reduce the costs and risks of the procedure while increasing their opportunities for having more than one child. However, risks to the offspring are significant and underappreciated, including prematurity, low birth weight, cerebral palsy, and learning disabilities. Even though many multiple pregnancies result in good outcomes, the ethical question is whether the risks are justifiable in order to improve the chances of pregnancy when transfer of a singleton embryo is an available alternative.

Exploring expanded interdisciplinary roles in goals of care conversations in a national goals of care initiative: A qualitative approach

2021 ◽  
pp. 026921632110204
Author(s):  
Jessica E Ma ◽  
Marie Haverfield ◽  
Karl A Lorenz ◽  
David B Bekelman ◽  
Cati Brown-Johnson ◽  
...  
Keyword(s):  
Health Care ◽  
Role Theory ◽  
Medical Center ◽  
Veterans Health Administration ◽  
The United States ◽  
Veterans Health ◽  
Health Administration ◽  
Goals Of Care ◽  
Organizational Role ◽  
Provider Role

Background: The United States Veterans Health Administration National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative throughout the Veterans Health Administration health care system in 2017. This policy encourages goals of care conversations, referring to conversations about patient’s treatment and end-of-life wishes for life-sustaining treatments, among Veterans with serious illnesses. A key component of the initiative is expanding interdisciplinary provider roles in having goals of care conversations. Aim: Use organizational role theory to explore medical center experiences with expanding interdisciplinary roles in the implementation of a goals of care initiative. Design: A qualitative thematic analysis of semi-structured interviews. Setting/participants: Initial participants were recruited using purposive sampling of local medical center champions. Snowball sampling identified additional participants. Participants included thirty-one interdisciplinary providers from 12 geographically diverse initiative pilot and spread medical centers. Results: Five themes were identified. Expanding provider roles in goals of care conversations (1) involves organizational culture change; (2) is influenced by medical center leadership; (3) is supported by provider role readiness; (4) benefits from cross-disciplinary role agreement; and (5) can “overwhelm” providers. Conclusions: Organizational role theory is a helpful framework for exploring interdisciplinary roles in a goals of care initiative. Support and recognition of provider role expansion in goals of care conversations was important for the adoption of a goals of care initiative. Actionable strategies, including multi-level leadership support and the use of interdisciplinary champions, facilitate role change and have potential to strengthen uptake of a goals of care initiative.

The Evil of Abortion and the Greater Good of the Faith: Negotiating Catholic Survival in the Twentieth-Century American Health Care System

2002 ◽  
Vol 12 (1) ◽  
pp. 91-121 ◽  
Author(s):  
Kathleen M. Joyce
Keyword(s):  
Health Care ◽  
Public Life ◽  
The United States ◽  
First Year ◽  
American Health Care System ◽  
Critical Exploration ◽  
The World ◽  
American Health Care ◽  
Greater Good ◽  
Medicine Education

In 1949, the critic and controversialist Paul Blanshard launched a broadside attack on the Catholic hierarchy in the United States with the publication of American Freedom and Catholic Power, his harshly critical exploration of the Catholic church's involvement in American public life. An instant best-seller, American Freedom and Catholic Power went through eleven printings in its first year and continued to draw new readers throughout the 1950s. Blanshard's mission was to alert Americans to the movements of a Catholic hierarchy that was becoming, he charged, “more and more aggressive in extending the frontiers of Catholic authority into the fields of medicine, education, and foreign policy.” He reserved some of his most stinging commentary for the church's intrusion into the world of medicine.

scholarly journals 730. Severity Of Clostridioides difficile Infection Based On Toxin Analysis, Acid Suppressant Medications and Antibiotics

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S415-S416
Author(s):  
Gayathri Krishnan ◽  
Richa Parikh ◽  
Anna N Witt ◽  
Kulsum Bano ◽  
Sudeepa Bhattacharyya ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Center ◽  
The United States ◽  
Nucleic Acid Amplification ◽  
Clinical Severity ◽  
Toxin Gene ◽  
Antibiotic Exposure ◽  
Toxin B ◽  
Major Health Problem ◽  
Clostridioides Difficile

Abstract Background Clostridioides difficile (C difficile) infection (CDI) is a major health problem in the United States and despite updated guidelines, the laboratory diagnosis remains vexed. A multistep algorithm is recommended to diagnose CDI that includes antigen, toxin and toxin gene Nucleic Acid Amplification (NAAT) assays. This study was done to assess severity of CDI based on toxin B and NAAT statuses. The other objective was to analyze if antibiotics and PPI/H2B (Proton Pump Inhibitors and H2 blockers) affected severity of CDI. Methods Retrospective analysis of all adult patients admitted to a tertiary medical center with diarrhea and a positive C difficile antigen test from 01/2017- 12/2017. From more than 2000 stool samples submitted to the lab, C diff antigen was positive in 265 patients. 191 were diagnosed with CDI based on the 2-step algorithm. Clinical data was available for 168 patients. Severity of CDI was determined based on published guidelines. Fischer’s exact test was used for statistical analysis. Results The mean age at diagnosis was 55.96. Toxin B was detected in 34% (57/168) patients and Toxin NAAT positive in 66% (111/168) patients. 57% of CDI was health care onset compared to 43% with community onset. 42% (72/168) were classified as severe out of which 40.2% (29) were toxin B positive, and 59.8% (43) were NAAT positive. There were no significant differences in severity of CDI based on toxin B and NAAT status (50.9% vs 38.4%, p=0.14). 46% of cases from community vs 39.6% from hospitals were classified as severe CDI (p=0.415). 72% of cases had antibiotic use in the last 30 days. Use of antibiotics was significantly associated with severe CDI (82% vs 64%, p=0.015). 62.5% (105) patients had history of PPI/H2B use and severity was not significantly associated with its use (p=0.872). Conclusion Our study shows that the presence of toxin did not significantly impact the clinical severity of CDI. The use of antibiotics did not affect the presence of toxin although the total number of CDI cases with previous antibiotic exposure was high. Patients who had recent antibiotic exposure were more likely to have severe clinical presentation. More toxin positive cases were health care onset but the effect was not pronounced. Severity of CDI did not significantly depend on health care onset or on exposure to PPI/H2B. Disclosures Atul Kothari, MD, Ansun Biopharma (Consultant)

Neurotrauma From Border Wall Jumping: 6 Years at the Mexican–American Border Wall

Neurosurgery ◽  
2019 ◽  
Vol 85 (3) ◽  
pp. E502-E508 ◽  
Author(s):  
Wyatt L Ramey ◽  
Christina M Walter ◽  
Jeffrey Zeller ◽  
Travis M Dumont ◽  
G Michael Lemole ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Center ◽  
Health Care Systems ◽  
Clinical Status ◽  
The United States ◽  
Spinal Injuries ◽  
Care Utilization ◽  
Radiographic Findings ◽  
Southern Us ◽  
The Us

Abstract BACKGROUND The border between the United States (US) and Mexico is an international boundary spanning 3000 km, where unauthorized crossings occur regularly. We examine patterns of neurotrauma, health care utilization, and financial costs at our level 1 trauma center incurred by patients from wall-jumping into the US. OBJECTIVE To determine the clinical and socioeconomic consequences from neurotrauma as a result of jumping over the US–Mexico border wall. METHODS Medical records of patients at (Banner University of Arizona Medical Center - Tucson) were retrospectively reviewed from January 2012 through December 2017. Demographics, clinical status, radiographic findings, treatment, length of stay, and financial data were analyzed for all patients suffering neurotrauma during that time. RESULTS Over 6 yr, 64 patients sustained cranial or spinal injuries directly from jumping or falling onto US soil from the border wall. Fifty (78%) suffered spinal injuries, 15 (23%) experienced cranial injury, and 1 patient had both. Total medical charges were available in 36 patients and summed $3.6 M, of which 22% was reimbursed, an amount significantly lower than expected from more conventional trauma. Neurotrauma steadily declined over the 6-yr observation period, dropping in 2017 to 6% of rates observed in 2012. CONCLUSION In the Southern US, neurotrauma from unauthorized border crossings occurs commonly as a result of wall-jumping. These injuries represent a clinical and costly extreme of border-related trauma, and future efforts from both sides of the border wall are needed to decrease the detrimental impacts felt both by immigrants and surrounding health care systems.

Bethesda Hospitals' Emergency Preparedness Partnership: A Model for Transinstitutional Collaboration of Emergency Responses

2009 ◽  
Vol 3 (3) ◽  
pp. 168-173 ◽  
Author(s):  
David K. Henderson ◽  
Michael P. Malanoski ◽  
Gene Corapi ◽  
Eugene Passamani ◽  
Cynthia Notobartolo ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Preparedness ◽  
Medical Center ◽  
The United States ◽  
Major Health ◽  
Health Care Institutions ◽  
Complementary Resources ◽  
Clinical Center ◽  
The Creation ◽  
National Disaster

ABSTRACTThe events of September 11, 2001 identified a need for health care institutions to develop flexible, creative, and adaptive response mechanisms in the event of a local, regional, or national disaster. The 3 major health care institutions in Bethesda, MD—the National Naval Medical Center (NNMC), the Suburban Hospital Healthcare System (SHHS), and the National Institutes of Health Clinical Center (NIHCC)—have created a preparedness partnership that outstrips what any of the institutions could provide independently by pooling complementary resources. The creation of the partnership initially was driven by geographic proximity and by remarkably complementary resources. This article describes the creation of the partnership, the drivers and obstacles to creation, and the functioning and initial accomplishments of the partnership. The article argues that similar proximity and resource relationships exist among institutions at academic centers throughout the United States and suggests that this partnership may serve as a template for other similarly situated institutions. (Disaster Med Public Health Preparedness. 2009;3:168–173)

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