Effectiveness of a Universally Offered Chlamydia and Gonorrhea Screening Intervention in the Pediatric Emergency Department

PurposeAdolescents represent more than half of the newly diagnosed sexually transmitted infections in the U.S. annually. Emergency departments (EDs) may serve as an effective, nontraditional setting to screen for chlamydia/gonorrhea (CT/GC). The objective was to evaluate the effectiveness of a universally offered CT/GC screening program in two pediatric ED settings.MethodsThis was a prospective, delayed start pragmatic study conducted over 18 months in two EDs within the same academic institution among ED adolescents aged 14–21 years with any chief complaint. Using a tablet device, adolescents were confidentially informed of CT/GC screening recommendations and were offered screening. If patients agreed to CT/GC testing, a clinical decision support tool was triggered to inform the provider and order testing. The main and key secondary outcomes were the proportion of CT/GC testing and positive CT/GC test results in each respective ED.ResultsBoth EDs experienced modest but statistically significant increases in CT/GC testing post- versus pre-intervention (main: 11.5% vs. 7.9%; confidence interval [CI]: 2.9–4.2; p < .0001 and satellite: 3.8% vs. 2.6%; 95% CI: .7–1.7; p < .0001). Among those tested, the positivity rate at the main ED did not significantly change post- versus pre-intervention (24.1% vs. 23.2%; 95% CI: ?1.9 to 3.8; p = .71) but significantly decreased at the satellite ED (7.6% vs. 14.8%; 95% CI: ?12.2 to ?2.2; p = .01).ConclusionsA universally offered screening intervention increased the proportion of adolescents who were tested at both EDs and the detection rates for CT/GC at the main ED, but patient acceptance of screening was low.     

Neighborhood risk: Socioeconomic status and hospital admission for pediatric burn patients

BackgroundBurn injury continues to cause significant morbidity and mortality in the US pediatric population. Many studies using inpatient samples have found a relationship between low socioeconomic status (SES) and burn injury. The purpose of our study was to evaluate the association between SES and the likelihood of admission for Emergency Department (ED) visits for pediatric burn injury.Study designA retrospective database review of pediatric ED visits for burn injury from a statewide hospital system, from January 1, 2005 to December 31, 2014. SES was assigned using an eight factor Neighborhood Risk Index (NRI) created from census block group data, with a higher score indicative of lower SES. The outcome measure was ED visits admitted to inpatient care.ResultsWe analyzed a sample of 1845 pediatric ED visits for burn injuries. Most visits were discharged from the ED (88.4%) while 10.5% were admitted to inpatient care and 1.0% were transferred to another hospital. In a multivariable logistic regression model, patients from high risk areas (>75th percentile NRI) had 1.58 higher odds of inpatient admission compared to patients from low risk areas (<75th percentile NRI; 95% CI: 1.08–2.30), after adjusting for age, gender, ethnicity, distance to the hospital, and previous ED visit for burn injury in the past 30 days. In addition, for every 1-mile increase in distance, a child’s likelihood of admission increased by 6% (95% CI: 4–9%).ConclusionsChildren with a burn injury from the highest risk socioeconomic areas in Rhode Island had a higher likelihood of inpatient admission. Further research is needed to determine what factors associated with socioeconomic status impact this finding.     

Emergency Department Observation Versus Readmission Following total Joint Arthroplasty: Can We Avoid the Bundle Buster?

BackgroundAs the Center for Medicare and Medicaid (CMS) moves toward bundled payment plans for total joint arthroplasty (TJA), it becomes necessary to reduce factors that increase cost for an episode of care such as readmissions. The goal of this study is to evaluate the payment for observation stay versus readmission for patients who present to the emergency department.MethodsA retrospective review from 2014-2019 was conducted identifying all Medicare patients who had a primary, elective TJA and visited the ED within 90 days postoperatively. If a readmission was one midnight or less or had an equivalent diagnosis to an observation stay patient, it was characterized as a readmission that could have qualified as an observation stay. Using our institution’s average payment for Medicare readmissions and observations, actual and potential savings were calculated.ResultsSixty-nine out of 523 (13.2%) patients were placed under observation, while 454 (86.8%) patients were readmitted. Eighty-six out of 523 (18.9%) patients qualified for observation status. There was an actual savings of 11.8% by placing patients on observation status and readmission rate was decreased by 13.2%. Savings could have increased by a total of 27.7% and readmissions decreased by a total of 29.6% if all patients who qualified had been placed on observation status.ConclusionAt our institution, the implementation of observation stay has led to a savings of 11.8% and a potential total savings of 27.7%. The rate of readmissions was decreased by 13.2% and had the potential to decrease by a total of 29.6%.     

麻醉科专科护士岗位胜任力评价指标体系的构建

目的 构建适合我国的麻醉科专科护士岗位胜任力评价指标体系,为麻醉科专科护士培养及评价提供参考.方法 通过文献回顾法、小组讨论法、德尔菲专家函询法以及层次分析法,确定麻醉科专科护士岗位胜任力各级评价指标及权重.结果 麻醉科专科护士岗位胜任力评价指标体系包含专业知识、专业技术、专业能力、管理能力和个人特质5项一级指标和38项二级指标.两轮函询专家积极系数分别为89.47％和94.12％,专家权威系数分别为0.865和0.889,肯德尔协调系数分别为0.182、0.237(均P＜0.01).结论 构建的麻醉科专科护士岗位胜任力评价指标体系,可作为麻醉科专科护士岗位胜任力水平的测评工具,为麻醉科专科护士培训、考核及任用提供参考.     

Sandwich联合案例教学法在神经内科临床实习中的应用

目的 探讨Sandwich联合以案例为基础的教学法在神经内科临床实习中的应用效果,为进一步优化教学方法提供参考.方法 以98名神经内科实习护理本科生为对象,按照实习病区分为对照组与观察组各49名.对照组采用传统教学法进行教学,观察组在对照组基础上采用Sandwich联合以案例为基础的教学法.出科前比较两组理论考试成绩及对教学方法的评价.结果 观察组理论考试成绩及教学满意评分显著高于对照组(P＜0.05,P＜0.01).结论 Sandwich联合以案例为基础的教学法可有促进学生对理论知识的掌握,提高教学效果.     

The associations of medical marijuana policies with opioid‐related health care utilization

ObjectiveTo examine the associations between medical marijuana policies and opioid‐related hospitalizations and emergency department visits.Data SourcesWe utilized quarterly rates of hospital discharge data from the Healthcare Cost and Utilization Project''s (HCUP) Fast Stats Database from 2005 to 2016 along with state‐level sociodemographic data from US Census Bureau and Bureau of Labor Statistics and opioid‐related state health policy data from publicly available sources for the analysis.Study DesignAnalyses were carried out using a difference‐in‐differences regression approach. We estimate heterogeneous effects of medical marijuana policies such as initial policy, presence of active dispensary, and home cultivation on opioid‐related hospitalizations and emergency department visits related to opioids.Data Collection/Extraction MethodsPublicly available secondary data were collected, linked, and analyzed. Observations with missing values for explanatory variables were excluded from the analysis.Principal FindingsRegression results indicate that type of medical marijuana policy has varying effects on opioid‐related hospitalizations and emergency department visits. States that allow home cultivation of medical marijuana experienced significant positive associations with opioid‐related hospitalizations and emergency department visits, while no effect was observed with medical marijuana dispensaries. Moreover, recreational marijuana policies were positively associated with opioid‐related hospitalizations.ConclusionsThe findings indicate that the effects of medical marijuana policies on opioid‐related hospitalizations and emergency department visits vary depending on the type of medical marijuana policy. Our findings indicate that the implementation of home cultivation of marijuana is positively associated with hospitalizations and emergency department visits related to opioids, suggesting that easier access to marijuana among opioid users may result in adverse health conditions that need treatment.     

手部肌腱吻合术后康复

目的作者自2000年初至2004年7月进行手部肌腱吻合120例,随访120例,手部肌腱吻合术后进行程序化的康复训练,方法肌腱吻合法均采用3-0或4-0聚丙烯单针缝线、改良的Bunnell、Kessler和肌腱编制缝合法,患者肌腱均为I期手术吻合,术后伤口I/乙愈合105例、II/乙15例,手部肌腱吻合术后均采用程序化的康复训练, 结果对手部肌腱吻合术后的患者进行程序化的康复训练,取得良好的效果. 结论本康复训练程序目前已逐渐形成我院的治疗常规,并逐步推广和普及.     

专科医院住院部各科医疗质量综合评价的初步探讨

目的：探讨专科医院住院各科工作情况综合评价方法,向临床科室提供医疗质量信息,促进医疗质量的提高。方法：以医院工作报表为数据来源,用秩和比法从诊疗质量,工作强度和经济效益三方面量化科室医疗质量考核指标。结果：综合数能更全面、有效、合理地评价住部各科医疗质量优劣等级,提出科室改进的指标。结论：此评价方法简便,实用,有利于深化院内改革,强化行政部门管理。