New Product Decisions - The Process and Outcome for a Community Health System

2011 ◽  
Vol 16 (2) ◽  
pp. 74-84 ◽  
Author(s):  
Jose Delp ◽  
Lynn Hadaway
Keyword(s):  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Negative Impact ◽  
Relevant Literature ◽  
Outcome Data ◽  
Passive Safety ◽  
Radiology Department ◽  
Complication Rates ◽  
Safety Mechanism ◽  
Catheter System

Abstract Purpose: To compare patient outcomes and evaluate safety features and costs associated with a new catheter system and securement dressing. Background: The need to improve dwell times for short peripheral catheters and reduce complication rates, along with improvements in clinical practice in radiology and enhanced staff safety were driving factors leading to a change in peripheral catheters and securement systems. Review of Relevant Literature: Several reports of catheter stabilization devices have shown improved clinical outcomes with their use. Currently available studies on this new catheter system include one small evaluation and a randomized trial comparing a traditional round hub catheter coupled with a supplemental securement device and the new catheter system with an integrated stabilization platform combined with a securement dressing. Passive safety mechanisms on peripheral catheters may produce fewer needlestick injuries than mechanisms requiring the user to activate the device. Methods: After a learning period, the following seven months were designated the intervention period. Outcome data from the same seven-month period of the preceding year were used for comparison. The data were divided into scheduled and unscheduled restarts. Data from two hospitals are reported separately and in combination. Data from the two periods were analyzed for equivalence or noninferiority. Results: Clinical outcomes for both periods are virtually equivalent, demonstrating that one system is not inferior to the other regarding catheter complications. However the catheter system with the integrated stabilization platform was less costly and safer due to a passive safety mechanism. Problems with high pressure injection in the radiology department were also solved with the new catheter system. Conclusions: While any product change can be a challenging experience, we accomplished these changes in an orderly manner without negative impact on patient outcomes and reducing costs. Improvements in radiology were also attributed to these changes, along with enhanced staff safety. Implications for Practice: The catheter designed with an integrated stabilization platform, a pre-attached extension set, and a passive safety mechanism produced benefits for radiology staff without negatively affecting patient outcomes in other clinical areas. These product changes were implemented in an organized manner and involved all stakeholders in the process.

scholarly journals An evaluation of the effectiveness of induction programmes on foundation doctor preparedness: a rapid review of the literature

2021 ◽  
Author(s):  
Monika Patel ◽  
Jasmine Patel
Keyword(s):  
Patient Outcomes ◽  
Negative Impact ◽  
Relevant Literature ◽  
Vital Role ◽  
Rapid Review ◽  
Future Research ◽  
Junior Doctors ◽  
Medical Graduates ◽  
Data Control ◽  
The Uk

AbstractThere is an increase in mortality when medical graduates replace the previous cohort of foundation doctors. As of 2012, it is now mandatory for new doctors in the UK to participate in induction training in order to ease this transition and reduce the negative impact on patient outcomes. However, there is no guidance on how best to deliver these induction programmes. This review aims to evaluate the effectiveness of several induction programmes to provide insight on this. Medline and Scopus were searched for relevant literature using keywords. Duplicates were removed and inclusion criteria were created to screen the remaining literature. Five studies were included in this review and they were all quality appraised using the Medical Education Research Study Quality Instrument. Different hospital trusts utilised varying induction programmes. The most common method of assessing their effectiveness involved exploring preparedness in junior doctors post-induction through surveys. Patient outcome, anxiety levels and knowledge were also measured. Induction programmes play a vital role in preparing new foundation doctors for practice and thus improving patient outcomes. Although there may be trust-specific variation, some elements of the programme should be standardised to ensure basic requirements are met universally. New doctors should be assessed on aspects of the programme after completion to increase confidence and knowledge. Organisational considerations such as costs and staff availability need to be taken into account. The quality of future research papers could be improved through inclusion of baseline data, control groups, multi-centred studies and outcomes higher on Kirkpatrick’s hierarchy.

Stroke Prevention in Non-Valvular Atrial Fibrillation

1997 ◽  
Vol 17 (03) ◽  
pp. 166-169
Author(s):  
Judith O’Brien ◽  
Wendy Klittich ◽  
J. Jaime Caro
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Care Home ◽  
Relevant Literature ◽  
Clinical Trial Data ◽  
Outcome Data ◽  
Sensitivity Analyses ◽  
Bleeding Events ◽  
Discharge Data ◽  
The Cost

SummaryDespite evidence from 6 major clinical trials that warfarin effectively prevents strokes in atrial fibrillation, clinicians and health care managers may remain reluctant to support anticoagulant prophylaxis because of its perceived costs. Yet, doing nothing also has a price. To assess this, we carried out a pharmacoe-conomic analysis of warfarin use in atrial fibrillation. The course of the disease, including the occurrence of cerebral and systemic emboli, intracranial and other major bleeding events, was modeled and a meta-analysis of the clinical trials and other relevant literature was carried out to estimate the required probabilities with and without warfarin use. The cost of managing each event, including acute and subsequent care, home care equipment and MD costs, was derived by estimating the cost per resource unit, the proportion consuming each resource and the volume of use. Unit costs and volumes of use were determined from established US government databases, all charges were adjusted using cost-to-charge ratios, and a 3% discount rate was applied to costs incurred beyond the first year. The proportions of patients consuming each resource were estimated by fitting a joint distribution to the clinical trial data, stroke outcome data from a recent Swedish study and aggregate ICD-9 specific, Massachusetts discharge data. If nothing is done, 3.2% more patients will suffer serious emboli annually and the expected annual cost of managing a patient will increase by DM 2,544 (1996 German Marks), from DM 4,366 to DM 6,910. Extensive multiway sensitivity analyses revealed that the higher price of doing nothing persists except for very extreme combinations of inputs unsupported by literature or clinical standards. The price of doing nothing is thus so high, both in health and economic terms, that cost-consciousness as well as clinical considerations mandate warfarin prophylaxis in atrial fibrillation.

scholarly journals Uncemented versus cemented arthroplasty after metal-on-metal total hip replacement in patients with femoral neck fractures: a retrospective study

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110122
Author(s):  
Wenlu Liu ◽  
Huanyi Lin ◽  
Xianshang Zeng ◽  
Meiji Chen ◽  
Weiwei Tang ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Clinical Outcomes ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Femoral Neck Fractures ◽  
Harris Hip Score ◽  
Complication Rates ◽  
Total Hip ◽  
Metal On Metal

Objective To compare the clinical outcomes of primary metal-on-metal total hip replacement (MoM-TR) converted to uncemented total hip replacement (UTR) or cemented total hip replacement (CTR) in patients with femoral neck fractures (AO/OTA: 31B/C). Methods Patient data of 234 UTR or CTR revisions after primary MoM-TR failure from March 2007 to January 2018 were retrospectively identified. Clinical outcomes, including the Harris hip score (HHS) and key orthopaedic complications, were collected at 3, 6, and 12 months following conversion and every 12 months thereafter. Results The mean follow-up was 84.12 (67–100) months for UTR and 84.23 (66–101) months for CTR. At the last follow-up, the HHS was better in the CTR- than UTR-treated patients. Noteworthy dissimilarities were correspondingly detected in the key orthopaedic complication rates (16.1% for CTR vs. 47.4% for UTR). Statistically significant differences in specific orthopaedic complications were also detected in the re-revision rate (10.3% for UTR vs. 2.5% for CTR), prosthesis loosening rate (16.3% for UTR vs. 5.9% for CTR), and periprosthetic fracture rate (12.0% for UTR vs. 4.2% for CTR). Conclusion In the setting of revision of failed primary MoM-TR, CTR may demonstrate advantages over UTR in improving functional outcomes and reducing key orthopaedic complications.

scholarly journals 92 Negative impact of socioeconomic deprvation on clinical outcomes after cryoablation for atrial fibrillation - 18-month study

2021 ◽  
Author(s):  
Yee Cheng Lau ◽  
Oana Cimpeanu ◽  
Krystalina Yih Tyng Sim ◽  
Gillian E Marshall ◽  
Gareth J Padfield ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Negative Impact

scholarly journals Overview of Robotic Technology in Spine Surgery

2021 ◽  
pp. 155633162110266
Author(s):  
Ram K. Alluri ◽  
Fedan Avrumova ◽  
Ahilan Sivaganesan ◽  
Avani S. Vaishnav ◽  
Darren R. Lebl ◽  
...  
Keyword(s):  
Economic Impact ◽  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Spine Surgery ◽  
Screw Placement ◽  
Complication Rates ◽  
Robotic Technology ◽  
Pedicle Screw Placement ◽  
The Past ◽  
Compare And Contrast

As robotics in spine surgery has progressed over the past 2 decades, studies have shown mixed results on its clinical outcomes and economic impact. In this review, we highlight the evolution of robotic technology over the past 30 years, discussing early limitations and failures. We provide an overview of the history and evolution of currently available spinal robotic platforms and compare and contrast the available features of each. We conclude by summarizing the literature on robotic instrumentation accuracy in pedicle screw placement and clinical outcomes such as complication rates and briefly discuss the future of robotic spine surgery.

scholarly journals Radiológiai osztályon dolgozó szakdolgozók kiégési szintje Magyarországon

2019 ◽  
Vol 160 (27) ◽  
pp. 1070-1077 ◽  
Author(s):  
Dávid Sipos ◽  
Veronika Varga ◽  
Attila András Pandur ◽  
András Kedves ◽  
Melinda Petőné Csima ◽  
...  
Keyword(s):  
Healthcare System ◽  
Emotional Exhaustion ◽  
Negative Impact ◽  
Maslach Burnout Inventory ◽  
Three Dimensions ◽  
Radiology Department ◽  
Online Questionnaire ◽  
Descriptive Data ◽  
Cross Sectional ◽  
Work Related

Abstract: Introduction: Burnout can have a wide negative impact on the quality and the effectiveness of the health care system. The aim of our research was to assess the burnout level of the radiology department workers in Hungary. Method: Our quantitative, cross-sectional, descriptive data collection lasted from June to September 2018 using an online questionnaire. Simple, non-random sampling was carried out among radiology department workers in Hungary. In addition to our self-made questionnaire which included socio-demographic and work-related questions, an internationally validated Maslach Burnout Inventory questionnaire was sent out. Results: After data cleaning, a total number of 404 (n = 404) respondents were included in the statistical analysis. The majority of the respondents works in county hospital, the average year spent in the healthcare system was 18.3 (SD 13,7). The sample’s values at the depersonalization and emotional exhaustion dimension were slightly elevated in contrast to the average values. Educational level, age and years spent in the healthcare system had a significant influence on all the three dimensions of burnout (p≤0.05). The group of workers being 31–35 years old and the group of those who spent 16–20 years in the healthcare system are considered to be the most compromised groups in all the three dimensions of burnout. Respondents with master degree had significantly lower emotional exhaustion values than their colleagues. Conclusion: The increased value of the depersonalization and the emotional exhaustion can be an indicator for employers. Our results are similar like described in the international literature. Orv Hetil. 2019; 160(27): 1070–1077.

scholarly journals Enteral resorbable diet versus standard diet in primary sphincter reconstruction: a prospective randomised trial

2021 ◽  
Author(s):  
Andreas Joos ◽  
Dieter Bussen ◽  
Christian Galata ◽  
Christoph Reißfelder ◽  
Alexander Herold ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Healing Rate ◽  
Negative Impact ◽  
Randomised Trial ◽  
Sample Size Calculation ◽  
Standard Diet ◽  
Complication Rates ◽  
Significance Level ◽  
Sphincter Reconstruction ◽  
Prospective Randomised Trial

Abstract Aim Bowel movements after reconstructive anorectal surgery may negatively affect surgical outcome. This study was aimed to assess any differences between a standard diet (SD) and the enteral resorbable diet (ED) in terms of operative outcomes and patient tolerance after fistulectomy with primary sphincter reconstruction. Method Adult patients undergoing elective fistulectomy with primary sphincter reconstruction for anorectal and rectovaginal fistulas were eligible for inclusion. Patients were intraoperatively randomised to receive either the ED and peristalsis-inhibiting medication (ED) or a SD. The primary endpoint was the healing rate. Secondary endpoints included continence scores, complications and quality of life. Sample size calculation resulted in the analysis of 60 patients to detect a difference in fistula recurrence of 30% with 70% power and a 5% significance level. Results Sixty-six patients (24 women) were prospectively and randomly assigned to the ED (n = 34: 51%) or a SD (n = 32; 48%); mean age was 47 (18-74) years. The primary healing rate was 64 out of 66 patients (96%). No statistical difference in healing rate was seen between the groups. However, patient satisfaction was significantly higher in the SD group (P < 0.0001). Conclusions Fistulectomy with primary sphincter reconstruction is a safe method with low complication rates. Postoperative stool behaviour has no significant influence on the healing rate but has a significant negative impact on patient satisfaction. Therefore, maintaining a standard diet seems to be preferable following reconstructive anal surgery. Trial registration The trial was registered with the German Clinical Trials Register (DRKS00020524).

scholarly journals Sequential transarterial chemoembolization and early radiofrequency ablation improves clinical outcomes for early-intermediate hepatocellular carcinoma in a 10-year single-center comparative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Liangliang Yan ◽  
Yanqiao Ren ◽  
Kun Qian ◽  
Xuefeng Kan ◽  
Hongsen Zhang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Combination Therapy ◽  
Clinical Outcomes ◽  
Transarterial Chemoembolization ◽  
Response Rate ◽  
Multivariable Analysis ◽  
Complication Rates ◽  
Tace Treatment

Abstract Background Transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) are effective treatment methods for unresectable hepatocellular carcinoma (HCC). However, there is still a lack of clinical research on whether early sequential RFA, compared with late combination therapy, can improve the long-term efficacy of initial TACE treatment. Methods This retrospective study investigated a cohort of patients who underwent combination therapy using TACE and RFA (TACE followed by RFA) from January 2010 to January 2020 at our medical centre. A total of 96 patients underwent TACE combined with early RFA (usually during the first hospitalization), which was called TACE + eRFA. Thirty-four patients received 1–2 palliative TACE treatments first and then underwent TACE treatment combined with late RFA (TACE + lRFA). All patients continued to receive palliative TACE treatments after intrahepatic lesion progression until reaching intolerance. The overall survival (OS) rate, time to tumour progression (TTP), tumour response rate and major complication rates were compared between the two groups. Results There were significant differences in the median OS (46 months vs 33 months; P = 0.013), median TTP (28 months vs 14 months; P < 0.00), objective response rate (ORR) (89.6% vs 61.8%, P = 0.000) and disease control rate (DCR) (94.8% vs 73.5% P = 0.002) between the two groups. Multivariable analysis revealed that the Barcelona Clinic Liver Cancer stage was an independent risk factor for OS. Meanwhile, multivariable analysis revealed that TACE + eRFA was associated with an enhanced TTP. Conclusion Early sequential RFA treatment in patients with early-intermediate HCC can improve local tumour control and clinical outcomes while reducing the frequency of TACE treatment. In clinical practice, in HCC patients initially treated with TACE, it is recommended to combine RFA as soon as possible to obtain long-term survival.

POSSIBLE HEALTH CONSEQUENCES FOR NEWBORNS FROM MOTHERS WHO SUFFERED COVID-19 DURING PREGNANCY

2021 ◽  
pp. 35-47
Author(s):  
Tamara G. Denisova ◽  
Adelina I. Sergeeva ◽  
Alexandra S. Grigorieva ◽  
Enje E. Rechapova ◽  
Ivan I. Sergeev ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Negative Impact ◽  
Close Contact ◽  
Relevant Literature ◽  
Clinical Manifestations ◽  
Future Generation ◽  
World Health ◽  
Practical Significance ◽  
Increased Risk ◽  
Coronavirus Infection

According to the WHO statement dated March 11, 2020, the coronavirus infection SARS-CoV-2 has reached the scale of a pandemic and is currently a world health problem. A special group of the population that requires increased attention is pregnant women due to the fact that pneumonia occupies the third place in the structure of indirect causes of maternal mortality. Pregnant women whose immune system has changed appeared to be at an increased risk of infection. Pregnancy is a risk factor for the development of a more severe course of acute respiratory viral diseases and influenza. To date, the issue of intrauterine transmission of coronavirus disease remains completely unexplored, which causes fear among pregnant women for the future generation. Addition of a new coronavirus infection SARS-CoV-2 has a negative impact on pregnancy, childbirth and the postpartum period, the health of newborns, especially in patients with a burdened obstetric history. Pregnancy itself and childbirth do not affect the course of COVID-19, but the infection addition can complicate the course of gestation, causing respiratory distress syndrome, premature birth and spontaneous miscarriages, congenital pneumonia and antenatal death of newborns born from covid-positive mothers. The literature published from December 1, 2019 to July 30, 2021 was searched in several databases, including PubMed, Web of Science, Google Scholar and the WHO COVID-19 database, of which 52 articles were selected for detailed consideration. The relevant literature was searched to understand the issues of infection transmission to newborns from infected mothers and the clinical manifestations of the disease in the former. As a result, it was found that newborns can become infected with SARS-Cov-2 in close contact with infected patients or asymptomatic virus carriers. However, based on the data of modern literature, it is impossible to unequivocally answer the questions posed, more facts are needed to solve the problem. The practical significance of the work is that the results of the study should be used for further studying the consequences of COVID-19 for the health of newborn children.

Sign in / Sign up

Export Citation Format

Share Document