Hospital practice (1995)
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Hospital practice (1995) · Dec 2014
Multicenter StudyAbility of nurse clinicians to predict unplanned returns to hospital within thirty days of discharge.
To evaluate the ability of nurse clinician discharge flow coordinators (DFCs) to identify medical patients at risk of unplanned return to the hospital emergency department within 30 days of discharge and whether a higher predicted risk of return was correlated with preventability. ⋯ In a large urban center, experienced nurse clinician DFCs were able to predict 30-day emergency department returns with reasonable accuracy. They were also able to identify the returns to the hospital that were most likely to be preventable. Our data suggests that DFCs can be used to target patients identified as having an increased probability of return with interventions that may be able to reduce the burden of return to hospital.
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Cancer-related pain is a significant cause of morbidity in those affected by both primary and metastatic disease. Although oral, transdermal, and parenteral opioid medications are an integral part of the World Health Organization's analgesic ladder, their use may be limited by side effects. Fortunately, there are advanced interventional pain management strategies effective in reducing pain in the cancer patient while mitigating the aforementioned side effects. ⋯ Peripheral nerve blocks and catheter placement at the brachial and lumbosacral plexus or peripheral nerves treat cancer pain associated with the upper and lower limbs, whereas paravertebral and intercostal blocks treat cancer pain associated with the chest wall and ribs. Finally, alternate drug delivery methods such as intrathecal drug delivery systems concentrate medication at central opioid receptors without affecting the peripheral receptors implicated in unwanted side effects. This article provides an overview of these interventions, including indications, contraindications, and potential complications of advanced interventional pain management options available for the treatment of intractable cancer-related pain.
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Hospital practice (1995) · Dec 2014
ReviewTestosterone replacement therapy: who to evaluate, what to use, how to follow, and who is at risk?
Hypogonadism, defined as a low serum testosterone in the presence of signs and symptoms, is common, particularly in aging men. Testosterone supplementation therapy (TST) is the standard treatment for male hypogonadism. It has been demonstrated to have a significant impact on the signs and symptoms of hypogonadism, but there are concerns about the increase in TST and its potential adverse effects, particularly cardiovascular effects. ⋯ Hypogonadism is common, particularly in aging men. Symptomatic individuals who have no contraindications to TST should be offered treatment. A careful assessment of treatment response after adequate titration and duration of therapy as well as monitoring for adverse effects is essential in treating patients for hypogonadism. Although hypogonadism is associated with increased all-cause and cardiovascular-related mortality, controversy exists regarding the impact of TST on cardiovascular risk, highlighting the need for further studies.
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Hospital practice (1995) · Dec 2014
ReviewRisk factors for postoperative pulmonary complications: an update of the literature.
Perioperative medicine is a growing area of research that brings together internists, anesthesiologists, surgeons, and hospitalists. A medical team approach to ensure the best possible patient outcomes has fostered collaborative strategies across disciplines. ⋯ Effective strategies to identify and reduce risks of pulmonary complications can improve patient outcomes. We review the new literature (2013 to early 2014) in the field of perioperative pulmonary medicine that reports new strategies to improve outcomes in the area of perioperative pulmonary care.
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Hospital practice (1995) · Dec 2014
Implementation of a mandated venous thromboembolism clinical order set improves venous thromboembolism core measures.
Venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis, is a major cause of morbidity and mortality. It results in approximately 300 000 deaths in the United States each year, and two thirds of VTE events are hospital acquired. However, VTE prophylaxis for hospitalized patients remains suboptimal. ⋯ This study demonstrates that a mandated physician VTE order set ensures that nearly all patients will be stratified for VTE risk and provided with prophylaxis based on their risk category. Adhering to the evidence-based clinical practice guidelines from the American College of Chest Physicians is effective in improving prophylaxis and decreasing the rate of hospital-acquired VTE in hospitalized patients, and in decreasing the rate of preventable VTE cases based on the Joint Commission's core measure 6.