Dutch researchers found 70.4% of hospital patients reported being awakened from sleep by external causes and staff were part of the reason in more than half of cases, according to a study in JAMA Internal Medicine. Researchers said most of the problems with poor sleep in hospital patients could be addressed by making simple changes in hospital nightly routines, such as dimmed lights, remote alarms and webcams to monitor vital signs.
Analysis of the Change the Management of Patients with Heart Failure registry found gaps in adherence to guideline-recommended treatments for heart failure, a study in the Journal of the American College of Cardiology said. "There is a compelling need for multifaceted quality improvement systems to be implemented in every setting in which patients with heart failure receive care," said senior author Gregg Fonarow of the University of California at Los Angeles.
A study in the journal Circulation found hospitals that have successful cardiac arrest resuscitation teams are more likely to have increased survival rates, compared with other facilities. Characteristics of successful resuscitation teams in top-performing hospitals included having a designated team with clinicians from diverse disciplines, clearly defined responsibilities, improved leadership and communication, and in-depth mock codes.
Emergency department patients had longer stays and more patients left without being seen when nurse staffing was lower, according to a single-center study in the Western Journal of Emergency Medicine. The findings were based on a retrospective review of data from a 2015 nursing shortage at the hospital.
Using the OnePartner health information exchange enabled multispecialty practice Holston Medical Group to identify patients who are "habitual utilizers of services," access data from disparate EHRs across its system and streamline hospital processes, said CIO Wesley Combs. "If you understand value-based medicine and the economics of health care, regarding insurance, risk identification and stratification, it doesn't take any time for an HIE to give a return on investment in value-based contracting -- if you are starting to go at risk," Combs said.
Diabetic patients are at high risk for developing type 2 myocardial infarction when admitted in a decompensated state; they are also at high risk for future cardiovascular events. Acutely decompensated diabetic patients with type 2 myocardial infarction are at increased risk for death and MACE. These patients may also be at risk for undiagnosed coronary artery disease; clinicians should consider cardiac risk stratification before discharge.
Women with recurrent hypertensive disease of pregnancy have increased mortality risks compared with women without recurrent hypertensive disease of pregnancy.
This study examined trends in fatalities and injuries after pedestrian-motor vehicle collisions in the US over a 10-year period and identified risk factors for pedestrian fatalities. During the study period, there were 47,789 pedestrian fatalities and 674,414 injuries, with the highest fatality rates among those aged 85 years and older and the highest injury rates among those aged 15 years to 19 years. Identified risk factors for fatalities were male sex; age ≥65 years; alcohol involvement; and collisions after midnight, at non-intersections, and involving trucks and buses.
While emergency contraception (EC) should be available over-the-counter to persons of all ages, this study highlights persistent barriers to access. Adolescent females inquiring about EC availability are less likely to receive accurate information compared with adolescent males or physicians.
This study investigated whether small-airway function (FEF25%-75%) and fractional exhaled nitric oxide (FENO) can predict bronchial hyperresponsiveness (BHR) in 290 adult patients with chronic cough. Chronic cough patients with BHR showed lower FEF25%-75%, higher fractional exhaled nitric oxide (FENO), and a higher percentage of blood eosinophils than patients without BHR (P < .0001 for all). Optimal cutoff values were 43 ppb for FENO and 78.5% for FEF25%-75%. The combined use of FENO and FEF25%-75% increased the area under receiver operating characteristic curves AUC to 0.843 (95% CI, 0.794-0.892), significantly higher than either FENO (P = .012) or FEF25%-75% (P < .0001) alone. FENO > 43 ppb and FEF25%-75% < 78.5% strongly predicted a positive bronchial provocation test in patients with chronic cough.