Bmc Health Serv Res
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For mothers who have just given birth, the postpartum hospital stay is meant to promote an environment where resting, healing and bonding can take place. New mothers, however, face many interruptions throughout the day including multiple visitors and noise caused by medical equipment, corridor conversations and intercom announcements. This paper argues that disruptions and noise on a maternity ward are detrimental to the healing process for new mothers and their newborns and healthcare decision-makers need to act to improve the environment for these patients. This paper also provides recommendations on how to reduce the noise levels, or at least control the noise on a maternity ward, through the implementation of a daily quiet time. ⋯ Hospital disruptions and its negative health effects in particular for new mothers and their children are illustrated in this paper. Hospital noise and interruptions act as a stressor for both new mothers and staff, and can lead to sleep deprivation and detrimental cardiovascular health effects. Sleep deprivation is associated with a number of negative mental and physical health consequences such as decreased immune function, vascular dysfunction and increased sympathetic cardiovascular modulation. Sleep deprivation can also increase the risk of postpartum mental health disorders in new mothers. Some efforts have been made to reduce the disruptions experienced by these patients within a hospital setting. For example, the introduction of a daily quiet time is one way of controlling noise levels and interruptions, however, these have mostly been implemented in intensive care units. Noise and disruptions are a significant problem during postpartum hospital stay. Healthcare institutions are responsible for patient-centered care; a quiet time intervention promises to contribute to a safe, healing environment in hospitals.
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Bmc Health Serv Res · Nov 2014
Comparative StudyData quality audit of the arthroplasty clinical outcomes registry NSW.
The Arthroplasty Clinical Outcomes Registry NSW (ACORN) was initiated in 2012. ACORN is a registry piloting within NSW, Australia with several participating hospitals; it aims to monitor patient-centred outcomes and post-surgical complications after total hip and knee arthroplasty. Using retrospective audit methodology, we aimed to investigate the completeness and accuracy of data in ACORN. ⋯ Levels of data completeness and accuracy were found to be high in the submitted datasets for both hospitals. However, important deficits were identified in the accuracy of patient comorbidities. More specific and clear data definitions, and a more thorough examination of medical records would be possible methods to improve the accuracy of deficient areas.
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Bmc Health Serv Res · Nov 2014
Multicenter Study Comparative StudySafety and effectiveness of a Patient Blood Management (PBM) program in surgical patients--the study design for a multi-centre prospective epidemiologic non-inferiority trial.
Preoperative and hospital-acquired anaemia is common among surgical patients. It is associated with an increased risk of morbidity and mortality and a strong risk factor for allogeneic blood transfusions with their own inherent risks. Patient Blood Management (PBM) concepts aim to increase and preserve autologous erythrocyte volume and to optimise haemotherapy. They thus have great potential to benefit patients. ⋯ This trial will determine whether the implementation of a PBM program is safe and effective in terms of clinical outcome compared to a pre-implementation cohort. This trial is registered at www.clinicaltrials.gov (NCT01820949).
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Bmc Health Serv Res · Nov 2014
Comparative StudyOpioid prescribing patterns for non-malignant chronic pain for rural versus non-rural US adults: a population-based study using 2010 NAMCS data.
Non-malignant chronic pain (NMCP) is one of the most common reasons for primary care visits. Pain management health care disparities have been documented in relation to patient gender, race, and socioeconomic status. Although not studied in relation to chronic pain management, studies have found that living in a rural community in the US is associated with health care disparities. Rurality as a social determinant of health may influence opioid prescribing. We examined rural and non-rural differences in opioid prescribing patterns for NMCP management, hypothesizing that distinct from education, income, racial or gender differences, rural residency is a significant and independent factor in opioid prescribing patterns. ⋯ Our results clearly indicated that rurality is an important factor in opioid prescribing patterns that cannot be ignored and bears further investigation. Further research on the growing concern about the over-prescribing of opioids in the US should now include rurality as a variable in data generation and analysis. Future research should also attempt to document the ecological, sociological and political factors impacting opioid prescribing and care in rural communities. Prescribers and health care policy makers need to critically evaluate the implications of our findings and their relationship to patient needs, best practices in a rural setting, and the overall consequences of increased opioid prescribing on rural communities.
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Bmc Health Serv Res · Nov 2014
Comparative StudyA cost-utility analysis of a rehabilitation service for people living with and beyond cancer.
We conducted a wait-list control randomised trial of an outpatient rehabilitation service for people living with and beyond cancer, delivered in a hospice day care unit. We report the results of an economic evaluation undertaken using the trial data. ⋯ Although the intervention is likely to be cost-effective in some circumstances, there is considerable uncertainty surrounding the decision to implement the service. Further research, informed by a formal value of information analysis, would reduce this uncertainty.