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Sharon A Greenberg, Pinchas Halpern, Tomer Ziv-Baran, Ronni Gamzu
BACKGROUND AND AIM: In 2011 the Israeli Ministry of Health (MOH) instructed hospitals to limit occupancy in the internal medicine wards to 120%, which was followed by a nationwide reduction in hospitalization rates. We examined how readmission and mortality rates changed in the five years following the changes in occupancy rates and hospitalization rates. METHODS: All visits to the Tel Aviv Medical Center internal Emergency Medicine Department (ED) in 2010, 2014 and 2016 were captured, with exclusion of visits by patients below 16 of age and patients with incomplete or faulty data...
November 20, 2018: Israel Journal of Health Policy Research
Tucker F Johnson, Waleed Brinjikji, Derrick A Doolittle, Alex A Nagelschneider, Brian T Welch, Amy L Kotsenas
PURPOSE: This resident-driven quality improvement project was undertaken to assess the effectiveness of structured reporting to reduce revision rates for afterhours reports dictated by residents. METHODS: The first part of the study assessed baseline revision rates for head and neck CT angiography (CTA) examinations dictated by residents during afterhours call. A structured report was subsequently created based on templates on the RSNA informatics reporting website and critical findings that should be assessed for on all CTA examinations...
April 12, 2018: Current Problems in Diagnostic Radiology
Adam M Hall, Henry T Stelfox, Xioaming Wang, Guanmin Chen, Danny J Zuege, Peter Dodek, Allan Garland, Damon C Scales, Luc Berthiaume, David A Zygun, Sean M Bagshaw
BACKGROUND: Admission to the intensive care unit (ICU) outside daytime hours has been shown to be variably associated with increased morbidity and mortality. We aimed to describe the characteristics and outcomes of patients admitted to the ICU afterhours (22:00-06:59 h) in a large Canadian health region. We further hypothesized that the association between afterhours admission and mortality would be modified by indicators of strained ICU capacity. METHODS: This is a population-based cohort study of 12,265 adults admitted to nine ICUs in Alberta from June 2012 to December 2014...
April 17, 2018: Critical Care: the Official Journal of the Critical Care Forum
Sven Wegner, Mino D C Belle, Alun T L Hughes, Casey O Diekman, Hugh D Piggins
Suprachiasmatic nuclei (SCN) neurons contain an intracellular molecular circadian clock and the Cryptochromes (CRY1/2), key transcriptional repressors of this molecular apparatus, are subject to post-translational modification through ubiquitination and targeting for proteosomal degradation by the ubiquitin E3 ligase complex. Loss-of-function point mutations in a component of this ligase complex, Fbxl3, delay CRY1/2 degradation, reduce circadian rhythm strength, and lengthen the circadian period by ∼2.5 h...
August 16, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Rosemary McKenzie, Michelle Williamson
BACKGROUND: Telephone triage and advice services (TTAS) have become commonplace in western health care systems particularly as an aid to patient access and demand management in the after hours period. In 2011 an after hours general practitioner (GP) helpline was established as a supplementary service to existing 24-h nurse-TTAS in Australia. Callers to the service in the after hours period who are triaged by a nurse as needing to see a GP immediately or within 24 h may speak with a GP on the line to obtain further assessment and advice...
April 22, 2016: BMC Health Services Research
Shivani Chaudhry, Irfan Dhalla, Gerald Lebovic, Patrik Rogalla, Timothy Dowdell
OBJECTIVES: The objectives of our study were to assess trends in afterhours medical imaging utilization for emergency department (ED) and inpatient (IP) patient populations from 2006-2013, including analysis by modality and specialty and with adjustment for patient volume. METHODS: For this retrospective study, we reviewed the number of CT, MRI, and ultrasound studies performed for the ED and IP patients during the afterhours time period (5pm - 8am on weekdays and 24 hours on weekends and statutory holidays) from 2006-2013 at three different Canadian academic hospitals...
November 2015: Canadian Association of Radiologists Journal, Journal L'Association Canadienne des Radiologistes
C Dustin Waters
PURPOSE: Improved drug-utilization and cost outcomes achieved by a pharmacist-led antimicrobial stewardship program (ASP) are described. SUMMARY: Pharmacists may be tasked to lead ASP development and implementation with little or no support from an infectious diseases (ID) physician and other hospital personnel whose involvement on ASP teams is recommended (e.g., clinical microbiologists, infection control specialists, hospital epidemiologists). Several years ago, Intermountain Healthcare's 325-bed McKay-Dee Hospital in Utah implemented an ASP led by an antimicrobial stewardship pharmacist...
March 15, 2015: American Journal of Health-system Pharmacy: AJHP
Susan D Moffatt-Bruce, Charles H Cook, Steven M Steinberg, Stanislaw P Stawicki
BACKGROUND: Retained surgical items (RSI) are designated as completely preventable "never events". Despite numerous case reports, clinical series, and expert opinions few studies provide quantitative insight into RSI risk factors and their relative contributions to the overall RSI risk profile. Existing case-control studies lack the ability to reliably detect clinically important differences within the long list of proposed risks. This meta-analysis examines the best available data for RSI risk factors, seeking to provide a clinically relevant risk stratification system...
August 2014: Journal of Surgical Research
Kerollos N Wanis, Allison M Hunter, Michael B Harington, Gary Groot
INTRODUCTION: In January 2012 an acute care surgery (ACS) model was introduced at St. Paul's Hospital, Saskatoon, Saskatchewan. The goal of implementing an ACS service was to improve the delivery of care for emergent, non-trauma surgical patients. We examined whether the ACS model improved wait time to surgery, decreased the proportion of surgeries performed after hours, and shortened post-surgical length of stay. We also assessed whether the surgeons working in an ACS system had higher on-call satisfaction than surgeons working in a non- ACS system...
2014: World Journal of Emergency Surgery: WJES
Amer Kaissi, Tom Charland
In the recent decade, retail clinics have emerged to offer routine preventative and acute care services by nonphysician providers, with predictable wait times, more convenient venues, and posted prices. This article evaluates the evolution of retail clinics between 2006 and 2012 and examines the yearly openings and closings of clinics by location, owner, operator, and other important characteristics. The Merchant Medicine database was used. It is the only database of its kind that includes every retail clinic opening and closing since 2006...
October 2013: Health Care Manager
Tilley Pain, Lesley Stainkey, Sue Chapman
This paper describes a medical model to provide in-house GP services to residents of aged-care facilities. Access to GP services for aged-care residents is decreasing, partially due to the changing demographic of the Australian GP workforce. The model we have developed is an in-house GP (AgedCare+GP) trialled in a publicly funded residential aged-care facility (RACF). The service model was based on the GP cooperative used in our after-hours general practice (AfterHours+GP). Briefly, the service model involves rostering a core group of GPs to provide weekly sessional clinics at the RACF...
2014: Australian Journal of Primary Health
Sneha N Anand, Elizabeth S Maywood, Johanna E Chesham, Greg Joynson, Gareth T Banks, Michael H Hastings, Patrick M Nolan
The circadian clock of the suprachiasmatic nucleus (SCN) drives daily rhythms of behavior. Cryptochromes (CRYs) are powerful transcriptional repressors within the molecular negative feedback loops at the heart of the SCN clockwork, where they periodically suppress their own expression and that of clock-controlled genes. To determine the differential contributions of CRY1 and CRY2 within circadian timing in vivo, we exploited the N-ethyl-N-nitrosourea-induced afterhours mutant Fbxl3(Afh) to stabilize endogenous CRY...
April 24, 2013: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Robert Keers, Inti Pedroso, Gerome Breen, Kathy J Aitchison, Patrick M Nolan, Sven Cichon, Markus M Nöthen, Marcella Rietschel, Leonard C Schalkwyk, Cathy Fernandes
BACKGROUND: Disruption of the circadian rhythm is a key feature of bipolar disorder. Variation in genes encoding components of the molecular circadian clock has been associated with increased risk of the disorder in clinical populations. Similarly in animal models, disruption of the circadian clock can result in altered mood and anxiety which resemble features of human mania; including hyperactivity, reduced anxiety and reduced depression-like behaviour. One such mutant, after hours (Afh), an ENU-derived mutant with a mutation in a recently identified circadian clock gene Fbxl3, results in a disturbed (long) circadian rhythm of approximately 27 hours...
2012: PloS One
Natalie Bradford, Helen Irving, Anthony C Smith, Lee-Anne Pedersen, Anthony Herbert
Families caring for a child with incurable cancer require access to support and advice round the clock. In Brisbane, Australia, an after-hours phone service was established to support these families. This service is operated by oncology clinical nurse consultants (CNCs) experienced in pediatric palliative care. This is the first review of 8 years of activity, totaling 106 patients and 1954 calls. The majority of calls were between parents and CNCs (51%). Updating of the patient's condition (18%) was the primary reason for calls, with support and reassurance (16%), and symptom management of pain (10%) being the other frequent reasons...
May 2012: Journal of Pediatric Oncology Nursing: Official Journal of the Association of Pediatric Oncology Nurses
Dora Von Conrady, Saud Hamza, Dieter Weber, Koorush Kalani, Krishna Epari, Marina Wallace, David Fletcher
BACKGROUND: Acute care surgical teams are a new concept in the provision of emergency general surgery. Juggling emergency patients around the surgeons' and staffs' elective commitments resulted in semi-emergency procedures routinely being delayed. In an era of increasing financial pressure and the recent introduction of 'safe work hours' practices, the need for a new system which optimized available resources became apparent. METHODS: At Fremantle Hospital we developed a new system in a concerted effort to minimize the waiting time for general surgical referrals in the Emergency Department, as well as to move semi-urgent operating from the afterhours to the daytime...
December 2010: ANZ Journal of Surgery
Michael R Cox, Lyn Cook, Jennifer Dobson, Paul Lambrakis, Shanthan Ganesh, Patrick Cregan
The traditional on-call system for the management of acute general surgical admissions is inefficient and outdated. A new model, Acute Surgical Unit (ASU), was developed at Nepean Hospital in 2006. The ASU is a consultant-driven, independent unit that manages all acute general surgical admissions. The team has the same make up 7 days a week and functions the same every day, including weekends and public holidays. The consultant does a 24-h period of on-call, from 7 pm to 7 pm. They are on remote call from 7 pm to 7 am and are in the hospital from 7 am to 7 pm with their sole responsibility being to the ASU...
June 2010: ANZ Journal of Surgery
Kathleen A McGrail, Diane S Morse, Theresa Glessner, Kathryn Gardner
BACKGROUND: Effective physician-nurse collaboration is an important, but incompletely understood determinant of patient and nurse satisfaction, and patient safety. Its impact on physicians has not been described. This study was undertaken to develop a fuller understanding of the collaboration experience and its outcomes. METHODS: Twenty-five medical residents, 32 staff nurses, 5 physician and 5 nurse faculty wrote narratives about successful collaboration; the narratives were then qualitatively analyzed...
February 2009: Journal of General Internal Medicine
E S Maywood, J S O'Neill, A B Reddy, J E Chesham, H M Prosser, C P Kyriacou, S I H Godinho, P M Nolan, M H Hastings
A hierarchy of interacting, tissue-based clocks controls circadian physiology and behavior in mammals. Preeminent are the suprachiasmatic nuclei (SCN): central hypothalamic pacemakers synchronized to solar time via retinal afferents and in turn responsible for internal synchronization of other clocks present in major organ systems. The SCN and peripheral clocks share essentially the same cellular timing mechanism. This consists of autoregulatory transcriptional/posttranslational feedback loops in which the Period (Per) and Cryptochrome (Cry) "clock" genes are negatively regulated by their protein products...
2007: Cold Spring Harbor Symposia on Quantitative Biology
T F Olson
A reporting sub-system currently used by the safety/security department of Richmond Memorial Hospital provides a means to record and disseminate security and safety related activity. This system may easily be adapted to a micro-computer to provide a wide variety of incident analysis and productivity data.
1984: Journal of Healthcare Protection Management
I D Steven
OBJECTIVE: To document aspects of the management of 15 patients with workers' compensation injuries which led to opioid dependence and suggest preventive strategies. METHOD: Details of general practitioner and deputising service visits for a 38-week period, 1 May 1991 - 22 January 1992, were obtained from WorkCover case files and general practitioners' patient records, and claims for reimbursement for afterhours home visits (Item 97) were obtained from the Health Insurance Commission (HIC) for the years 1991, 1992 and 1993...
August 21, 1995: Medical Journal of Australia
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