2010 January 06

The hospitalist model: does it enhance health care quality?

J Health Care Finance Start a Discussion »

Jan 062010

The hospitalist model: does it enhance health care quality?

J Health Care Finance. 2009;35(3):22-34

Authors: Harrison JP, Curran L

This study used logistic regression to examine those organizations using the hospitalist model for inpatient care. The study found that organizations using the hospitalist model are located in communities with higher per capita income, fewer uninsured, and more Medicare managed care. Hospitals using hospitalists have higher occupancy rates, a shorter length of stay, and better quality of care. In addition, they are larger and have a wider range of clinical services. From a managerial perspective, this study demonstrates a correlation between the hospitalist model and reduced length of stay and enhanced quality.

PMID: 19891205 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Gender differences in aminoglycoside induced nephrotoxicity: a prospective, hospital-based study.

Curr Clin Pharmacol Start a Discussion »

Jan 062010

Gender differences in aminoglycoside induced nephrotoxicity: a prospective, hospital-based study.

Curr Clin Pharmacol. 2009 Sep;4(3):229-32

Authors: Sweileh WM

AIM: Impact of gender on aminoglycoside induced nephrotoxicity is still controversial and inconclusive. The objective of this study was to investigate the nephrotoxic potential of amikacin (AK) and gentamicin (GM) in male and female hospitalized patients. METHODOLOGY: A one-year, non-interventional prospective study of patients administered either GM or AK. The study was carried out at the internal medicine department of Al-Watani governmental hospital. Nephrotoxicity was defined as a blood creatinine (Cr) increase of > or = 0.5 mg/ dL from the basal (normal) Cr level. Data were entered and analyzed using SPSS 16. RESULTS: A total of 94 patients were identified (GM, n = 45 and AK, n = 49). Male and female patients on GM had comparable characteristics except that males had significantly higher number of co-existing chronic diseases. No gender differences were observed in gentamicin induced nephrotoxicity (37% in males versus 33.3% in females, P = 0.8). Male and female patients on AK were also comparable in demographic and clinical characteristics. However, significant differences in gender susceptibility were observed with AK induced nephrotoxicity (31.6% in females versus 6.7% in males, P = 0.043). Pattern of serum creatinine changes in patients on GM were comparable between males and females. However, in females on AK, s.cr levels were rising sharply after the fourth day compared with that in male patients on AK. CONCLUSION: Gender differences in aminoglycoside induced nephrotoxicty were seen with AK where females were more vulnerable to nephrotoxicity. Such gender differences did not exist with GM.

PMID: 19500072 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Concomitant Staphylococcus aureus bacteriuria is associated with complicated S. aureus bacteremia.

J Infect Start a Discussion »

Jan 062010

Concomitant Staphylococcus aureus bacteriuria is associated with complicated S. aureus bacteremia.

J Infect. 2009 Oct;59(4):240-6

Authors: Pulcini C, Matta M, Mondain V, Gaudart A, Girard-Pipau F, Mainardi JL, Dellamonica P

OBJECTIVES: To identify factors associated with complicated Staphylococcus aureus bacteremia (SAB) in adults. METHODS: Prospective observational multicenter study during 2 years in Nice University Hospital and during 6 months in the Hôpital Européen Georges Pompidou, Paris, including all adult inpatients with SAB assessed by an Infectious Diseases (ID) specialist. RESULTS: We included 104 SAB (79 in Nice and 25 in Paris), of which 45 were complicated, including 18 endocarditis and 23 bone and joint infections. A concomitant urine sample was performed in 65% of the cases, showing S. aureus bacteriuria 23/68 (34%) times. Blood cultures were drawn 48-96h after an appropriate antibiotic therapy had been started in 70 of the 104 cases (67%) and were positive in 28 cases (40%). CONCLUSIONS: The 3 following factors were found to be associated with complicated SAB in univariate analysis: community acquisition (56% vs 26%, P=0.002), concomitant bacteriuria (47% vs 19%, P=0.016) and persistent bacteremia (55% vs 26%, P=0.016). This last factor was associated with endocarditis, but not with other complications such as bone and joint infections.

PMID: 19666050 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

African Americans show increased risk for pressure ulcers: a retrospective analysis of acute care hospitals in America.

Wound Repair Regen Start a Discussion »

Jan 062010

African Americans show increased risk for pressure ulcers: a retrospective analysis of acute care hospitals in America.

Wound Repair Regen. 2009 Sep-Oct;17(5):678-84

Authors: Fogerty M, Guy J, Barbul A, Nanney LB, Abumrad NN

In an earlier study, we reported a significantly increased risk of pressure ulcer hospital discharge diagnoses in African Americans, higher age groups, and those with certain medical conditions. The objectives of the present study were to: (a) investigate the demographics associated with a higher odds ratio (OR) in African Americans and (b) determine whether African Americans have different rates of medical risk factors. The 2003 Nationwide Inpatient Sample database was queried. Patients with pressure ulcers were identified by discharge diagnoses using ICD-9 codes 707.0-707.09. Discharge diagnosis was examined using the agency for healthcare research and quality clinical classifications software (CCS). The present study used identified CCS discharge diagnoses present in at least 5% of all patients, with an OR>2. African Americans exhibited a higher incidence of an OR>2 for 28 identified CCS risk factors for pressure ulcers. The pressure ulcer diagnoses tended to occur at younger ages in African Americans. No significant differences were noted in African Americans with pressure ulcers when a subanalysis was conducted by zip code income quartile, region of the country, or teaching status of the hospital. Hospitalized African Americans exhibit an age-dependent, higher prevalence of pressure ulcers compared with Caucasians. Socioeconomic factors tracked within the Nationwide Inpatient Sample do not provide an explanation for this phenomenon.

PMID: 19671125 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Sleep quality and sleep disturbing factors of inpatients in a Chinese general hospital.

J Clin Nurs Start a Discussion »

Jan 062010

Sleep quality and sleep disturbing factors of inpatients in a Chinese general hospital.

J Clin Nurs. 2009 Sep;18(17):2521-9

Authors: Lei Z, Qiongjing Y, Qiuli W, Sabrina K, Xiaojing L, Changli W

AIMS AND OBJECTIVE: This study was undertaken to determine sleep quality and sleep disturbing factors of inpatients and to compare the perception of sleep disturbing factors between nurses and inpatients in a Chinese general hospital. BACKGROUND: Sleep aids patients' recovery. A variety of factors affect inpatients' sleep quality. Current research on inpatients' sleep quality in China is limited and narrowly focuses on patients in intensive care units or older patients. DESIGN: Survey. METHODS: This research was conducted in a Chinese general hospital. The Pittsburgh Sleep Quality Index and self-designed questionnaires were used to examine inpatients' sleep quality and compare perceptions of sleep disturbing factors between 397 inpatients and 101 nurses. The following statistical methods were used to evaluate the data: chi-square test, logistic regression analysis and Z statistic. RESULTS: Patients reported poor sleep quality (45.6%) during hospitalisation and a reduction in sleep quality after hospitalisation (57.4%). The chi-square and logistic regression analysis showed that the main sleep disturbing factors were worries about illness, discomfort associated with diseases, using the toilet at night and noise from nurses' shoes. There was a significant difference in the perception of sleep quality and sleep disturbing factors between inpatients and nurses. CONCLUSION: This study demonstrates that most inpatients reported sleeping problems stemming from multiple sources. Additionally, there was a significant difference in the perception of sleep disturbing factors between nurses and inpatients. RELEVANCE TO CLINICAL PRACTICE: Our survey shows that most nurses are aware of inpatients' poor sleep quality. However, many patients continue to suffer from poor sleep during hospitalisation because of a wide range of sleep disturbing factors. This suggests that nurses need to be better educated and trained to minimise sleep disturbing factors and improve sleep quality of inpatients.

PMID: 19694879 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Central nervous system medication changes and falls in nursing home residents.

Geriatr Nurs Start a Discussion »

Jan 062010

Central nervous system medication changes and falls in nursing home residents.

Geriatr Nurs. 2009 Sep-Oct;30(5):334-40

Authors: Sorock GS, Quigley PA, Rutledge MK, Taylor J, Luo X, Foulis P, Wang MC, Varadhan R, Bellantoni M, Baker SP

We investigated the role of changes in 6 mutually exclusive medication categories on the risk of falling in nursing home residents. The 6 categories were: gastrointestinal, hypoglycemics, antibiotics, central nervous system (CNS) acting, cardiovascular disease agents, and analgesics. A change was defined as a new start, a dose change, an as-needed dose, or a discontinuation. Incident reports were used to determine the fall date and time. Medication records were abstracted to identify the date of changes before the date of each fall. The 158 residents who fell had 419 recorded falls during 2002 and 2003; they were on average 80.5 years old (SD 8.1; range 65-103), and 67% were men. Within 1-3 days of a change in any CNS medication (antipsychotic, sedative, antidepressant, or antiseizure), the fall risk (odds ratio) increased 3.4-fold (95% confidence interval 1.2-9.5) using 7-9 days prior as comparable control days. No changes in other medication categories had a significant effect on fall risk. These data suggest that the risk of falls among nursing home residents is significantly elevated within 3 days of a CNS medication change.

PMID: 19818269 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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