Value-based Care
Study: More nurses lead to fewer patient deaths & readmissions, shorter hospital stays, and savings
13 May, 2021 | 05:55h | UTCNews release: More nurses lead to fewer patient deaths & readmissions, shorter hospital stays, and savings – The Lancet
Original study: Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals (free registration required)
Commentary on Twitter
NEW—More nurses lead to fewer patient deaths and readmissions, shorter hospital stays, and cost-savings for hospitals, suggests study of recent Australian state policy to introduce a minimum ratio of one nurse to four patients for day shifts. Read https://t.co/zTZNt8viPU. pic.twitter.com/B812I0P6N2
— The Lancet (@TheLancet) May 12, 2021
Most COVID-19 patients receiving home-based hospital care did not require escalation to traditional hospital setting – Approximately 1 in 5 were admitted within 14 days. Higher oxygen saturation was associated with decreased odds of transfer, whereas higher comorbidity burden was associated with increased risk.
12 May, 2021 | 08:50h | UTCOriginal study: Factors Associated With Risk for Care Escalation Among Patients With COVID-19 Receiving Home-Based Hospital Care – Annals of Internal Medicine
Related: Pandemic Boosts an Old Idea—Bringing Acute Care to the Patient
RCT: An internet-delivered cognitive behavioral therapy (CBT) program followed by in-person CBT if necessary is noninferior to in-person CBT for the treatment of obsessive-compulsive disorder symptoms in children and adolescents.
12 May, 2021 | 08:39h | UTCEffect of an Internet-Delivered Stepped-Care Program vs In-Person Cognitive Behavioral Therapy on Obsessive-Compulsive Disorder Symptoms in Children and Adolescents: A Randomized Clinical Trial – JAMA (free for a limited period)
News release: Online CBT effective against OCD symptoms in the young – Karolinska Institutet
Perspective | Top five priorities for a new ICU director during the first year.
12 May, 2021 | 08:33h | UTCTop Five Priorities for a New ICU Director During the First Year – ICU Management & Practice
COVID has pushed medical research into remote trials, benefiting patients and scientists
5 May, 2021 | 08:38h | UTC
Pathway for enhanced recovery after spinal surgery – a systematic review of evidence for use of individual components
5 May, 2021 | 08:26h | UTCSee also: Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery – Best Practice & Research Clinical Anaesthesiology AND Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations – The Spine Journal AND Enhanced Recovery After Surgery (ERAS) Society Guidelines
Commentary on Twitter (thread – click for more)
Enhanced recovery after spine surgery (ERSS) is a multi-modal and trans-disciplinary approach to achieving the best outcomes in our patients. Key components supported by data (1/2) ⬇️ #orthotwitter #neurosurgery #surgery #outcomeshttps://t.co/t4VanByVyA
— Ruwan Ratnayake MD (@ratnayakemd) April 1, 2021
Highly Recommended (video): The Culture Of Medicine Kills Doctors And Patients (w/Dr. Robert Pearl)
3 May, 2021 | 05:32h | UTCThe Culture Of Medicine Kills Doctors And Patients (w/Dr. Robert Pearl) – ZDoggMD
Randomized trial: Admission Avoidance Hospital at Home + Geriatric Assessment led to similar outcomes compared to hospital admission for older persons
3 May, 2021 | 05:13h | UTCIs Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons? A Randomized Trial – Annals of Internal Medicine (link to abstract – $ for full-text)
Related: Pandemic Boosts an Old Idea—Bringing Acute Care to the Patient
Pre-post study: A hospital quality improvement intervention significantly reduced the rates of cesarean delivery for nulliparous, term, singleton, vertex births
29 Apr, 2021 | 08:21h | UTCHospital Quality Improvement Interventions, Statewide Policy Initiatives, and Rates of Cesarean Delivery for Nulliparous, Term, Singleton, Vertex Births in California – JAMA (free for a limited period)
Editorial: Initiatives to Reduce Cesarean Delivery Rates for Low-risk First Births – JAMA
Commentary on Twitter (thread – click for more)
"Rates of cesarean delivery for NTSV births in California decreased [from 26% to 22.8%] in the setting of a coordinated hospital-level collaborative and statewide initiatives designed to support vaginal birth.
"The rest of the US had no change."https://t.co/jwKkQZ4nix @cmqcc
— Ben Harder #BlackLivesMatter (@benharder) April 27, 2021
American College of Radiology Releases New and Updated ACR Appropriateness Criteria
27 Apr, 2021 | 09:29h | UTCAmerican College of Radiology Releases New and Updated ACR Appropriateness Criteria
RCT: Intracytoplasmic sperm injection vs. conventional in-vitro fertilization in couples with infertility in whom the male partner has normal total sperm count and motility – no difference in livebirth rates between the strategies
25 Apr, 2021 | 21:14h | UTCIntracytoplasmic sperm injection versus conventional in-vitro fertilisation in couples with infertility in whom the male partner has normal total sperm count and motility: an open-label, randomised controlled trial – The Lancet (link to abstract – $ for full-text)
Commentary on Twitter
🔴New RCT in @TheLancet
⭐In couples with infertility + normal total sperm count and motility ➡️ ICSI did not improve the livebirth rate compared with conventional IVF.
No excuses left to do ICSI for all.
Full text ⬇️https://t.co/6FYX7TeDRN— Rita Vassena (@RitaVassena) April 23, 2021
Opinion | What it Means to be a Medical Conservative
25 Apr, 2021 | 21:06h | UTCWhat it Means to be a Medical Conservative – Stop and Think
Guide to Enhanced Recovery for Cancer Patients Undergoing Liver Surgery
25 Apr, 2021 | 20:53h | UTCSee also: Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations – World Journal of Surgery AND Enhanced Recovery After Surgery (ERAS) Society Guidelines
Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery
22 Apr, 2021 | 08:28h | UTCOpportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery: A Review – JAMA Surgery (free for a limited period)
See also: Enhanced Recovery After Surgery (ERAS) Society Guidelines
A Knee MRI in Half the Time? It’s Possible
21 Apr, 2021 | 06:24h | UTCA Knee MRI in Half the Time? It’s Possible – Diagnostic Imaging
Original study: Five-Minute Five-Sequence Knee MRI Using Combined Simultaneous Multislice and Parallel Imaging Acceleration: Comparison with 10-Minute Parallel Imaging Knee MRI – Radiology (link to abstract – $ for full-text)
Commentary on Twitter
RADIOLOGY New: Dr. Jan Fritz @NYUImaging, 252 adults assessing a 5 min #MRI protocol, excellent results. https://t.co/hcMY34dJSI @radiology_rsna pic.twitter.com/OPdd7NOUWb
— @RadiologyEditor (@RadiologyEditor) April 13, 2021
RCT: Effect of infusion set replacement intervals on catheter-related bloodstream infections – “Infusion set use can be safely extended to 7 days with resultant cost and workload reductions”
20 Apr, 2021 | 05:37h | UTCEffect of infusion set replacement intervals on catheter-related bloodstream infections (RSVP): a randomised, controlled, equivalence (central venous access device)–non-inferiority (peripheral arterial catheter) trial – The Lancet (link to abstract – $ for full-text)
Commentaries on Twitter
If you're an #RN👩⚕️or #infection preventer & it makes you crazy🤯that different hospitals🏥use infusion sets for different durations⏰- READ this massive #RCT in @TheLancet from @AVATAR_grp @UQHealth @UQMedicine @MetroNorthHHS @MenziesHealth & large team https://t.co/lpz1C6ceM2
— Prof Claire Rickard (@Claire_AVATAR) April 18, 2021
Use for 7 vs. 4 days = similar outcomes. Effect of infusion set replacement intervals on catheter-related bloodstream infections (RSVP): a randomised, controlled, equivalence (CV access device)–non-inferiority (peripheral arterial catheter) trial https://t.co/6qaJczu1Cr
— Skeptical Scalpel (@Skepticscalpel) April 16, 2021
Catheter-related bloodstream infections (CRBSIs) account for around 70% of all health care associated bloodstream infections. New trial indicates that 7-day replacement of infusion sets is safe, with resultant cost and workload reductions. https://t.co/ua633FkA3K pic.twitter.com/LfaC6lZYMv
— The Lancet (@TheLancet) April 19, 2021
Perspective | The Confident Generalist: Putting The Primary Care Physician Back At The Center
20 Apr, 2021 | 05:35h | UTCThe Confident Generalist: Putting The Primary Care Physician Back At The Center – Health Affairs
Study Commentary | What if the EHR Age-Adjusts D-dimer for You?
18 Apr, 2021 | 21:04h | UTCWhat if the EHR Age-Adjusts D-dimer for You? – Journal Feed
Original study: Multi-center implementation of automated age-adjusted D-dimer results reduces unnecessary PE imaging – The American Journal of Emergency Medicine (link to abstract – $ for full-text)
RCT: An Enhanced Recovery After Surgery (ERAS) program in laparoscopic distal gastrectomy provided a faster recovery, a shorter postoperative hospitalization length, and lower medical costs without increasing complication and readmission rates
16 Apr, 2021 | 06:16h | UTCRelated: Consensus guidelines for enhanced recovery after gastrectomy – British Journal of Surgery AND Current status of the “enhanced recovery after surgery” program in gastric cancer surgery – Annals of Gastroenterological Surgery
See also: Enhanced Recovery After Surgery (ERAS) Society Guidelines
Pandemic Boosts an Old Idea—Bringing Acute Care to the Patient
15 Apr, 2021 | 06:51h | UTCPandemic Boosts an Old Idea—Bringing Acute Care to the Patient – JAMA
Related studies: Cohort Study: Selected patients with Covid-19 can be safely discharged on home oxygen, with low mortality and readmission rates AND Association of a Bundled Hospital-at-Home and 30-Day Postacute Transitional Care Program With Clinical Outcomes and Patient Experiences – JAMA Internal Medicine
Viewpoint | Reducing Low-Value Care and Improving Health Care Value
9 Apr, 2021 | 03:23h | UTCReducing Low-Value Care and Improving Health Care Value – JAMA (free for a limited period)
Leadership Essentials for CHEST Medicine Professionals: Models, Attributes, and Styles
6 Apr, 2021 | 01:10h | UTCLeadership Essentials for CHEST Medicine Professionals: Models, Attributes, and Styles – CHEST
Commentary and Summary: Leadership 101 – Commitments, Character, Competencies – Journal Feed
Guide to Enhanced Recovery for Cancer Patients Undergoing Surgery
6 Apr, 2021 | 01:01h | UTCGuide to Enhanced Recovery for Cancer Patients Undergoing Surgery – Annals of Surgical Oncology
See also: Enhanced Recovery After Surgery (ERAS) Society Guidelines
RCT: Discontinuing betalactam treatment after 3 days as good as 8 days of treatment for stable patients with community-acquired pneumonia in non-critical care wards
28 Mar, 2021 | 22:25h | UTC
Commentary on Twitter
Less can be more for pneumonia. In 50% CAP patients was possible stop Abx at 3 days and outcomes were the same @TheLancet https://t.co/Hc1AxyndWS pic.twitter.com/Ypk2uXeDQV
— Michael Marks (@dr_michaelmarks) March 26, 2021
Choosing Wisely: Five things clinicians and patients should question in Neurological Surgery in Children
28 Mar, 2021 | 22:04h | UTCAmerican Academy of Pediatrics – Section on Neurological Surgery – Choosing Wisely
Commentary: Choosing Wisely: 5 Things to Avoid in Pediatric Neurologic Surgery – NEJM Journal Watch
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada