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Jacobs, Lenworth M., and Karyl J. Burns. "American College of Surgeons Comprehensive Education Institute: Hartford Hospital." Journal of Surgical Education 67, no. 5 (September 2010): 341–43. http://dx.doi.org/10.1016/j.jsurg.2010.05.022.
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Lewis, Aaron M., Salvador Sordo, Leonard J. Weireter, Michelle A. Price, Leopoldo Cancio, Rachelle B. Jonas, Daniel L. Dent, Mark T. Muir, and Jayson D. Aydelotte. "Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma." American Surgeon 82, no. 12 (December 2016): 1227–31. http://dx.doi.org/10.1177/000313481608201231.
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Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals’ and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.
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Shariff-Marco, Salma, Libby Ellis, Juan Yang, Jocelyn Koo, Esther M. John, Theresa H. M. Keegan, Iona Cheng, et al. "Hospital Characteristics and Breast Cancer Survival in the California Breast Cancer Survivorship Consortium." JCO Oncology Practice 16, no. 6 (June 2020): e517-e528. http://dx.doi.org/10.1200/op.20.00064.
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INTRODUCTION: Racial/ethnic disparities in breast cancer survival are well documented, but the influence of health care institutions is unclear. We therefore examined the effect of hospital characteristics on survival. METHODS: Harmonized data pooled from 5 case-control and prospective cohort studies within the California Breast Cancer Survivorship Consortium were linked to the California Cancer Registry and the California Neighborhoods Data System. The study included 9,701 patients with breast cancer who were diagnosed between 1993 and 2007. First reporting hospitals were classified by hospital type—National Cancer Institute (NCI) –designated cancer center, American College of Surgeons (ACS) Cancer Program, other—and hospital composition of the neighborhood socioeconomic status and race/ethnicity of patients with cancer. Multivariable Cox proportional hazards models adjusted for clinical and patient-level prognostic factors were used to examine the influence of hospital characteristics on survival. RESULTS: Fewer than one half of women received their initial care at an NCI-designated cancer center (5%) or ACS program (38%) hospital. Receipt of initial care in ACS program hospitals varied by race/ethnicity—highest among non-Latina White patients (45%), and lowest among African Americans (21%). African-American women had superior breast cancer survival when receiving initial care in ACS hospitals versus other hospitals (non-ACS program and non–NCI-designated cancer center; hazard ratio, 0.67; 95% CI, 0.55 to 0.83). Other hospital characteristics were not associated with survival. CONCLUSION: African American women may benefit significantly from breast cancer care in ACS program hospitals; however, most did not receive initial care at such facilities. Future research should identify the aspects of ACS program hospitals that are associated with higher survival and evaluate strategies by which to enhance access to and use of high-quality hospitals, particularly among African American women.
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Wright, James R. "The American College of Surgeons, Minimum Standards for Hospitals, and the Provision of High-Quality Laboratory Services." Archives of Pathology & Laboratory Medicine 141, no. 5 (May 1, 2017): 704–17. http://dx.doi.org/10.5858/arpa.2016-0348-hp.
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Context.— The first major project of the American College of Surgeons (Chicago, Illinois), founded in 1913, was implementing Minimum Standards for Hospitals. The 1918 standard (1) established medical staff organizations in hospitals; (2) restricted membership to licensed practitioners in good standing; (3) mandated that the medical staff work with hospital administration to develop and adopt regulations and policies governing their professional work; (4) required standardized, accessible medical records; and (5) required availability of diagnostic and therapeutic facilities. One hundred years ago, these were radical expectations. Objectives.— To describe the origin, “marketing,” and voluntary adoption of the 1918 standards, and to describe how the evolution of those standards profoundly affected laboratory medicine after 1926. Design.— Available primary and secondary historical sources were reviewed. Results.— The college had no legal mandate, so it used a highly consultative approach, funded by its membership and the Carnegie Foundation (New York, New York), to establish the Minimum Standards, followed by a nonthreatening mechanism to determine which hospitals met them. Simultaneously, the college educated the public to fuel their expectations. Compliance by more than 100-bed hospitals in the United States and Canada, although entirely voluntary, rose from negligible when first implemented in 1918 to more than 90% in only a few years. From 1922 to 1926, the American Society for Clinical Pathology (Chicago, Illinois) worked creatively with the college to establish Minimum Standards for “adequate” laboratory services. Conclusions.— The birth and implementation of this program exemplifies how a consultative approach with full engagement of grassroots stakeholders facilitated a voluntary, rapid, sweeping North America–wide change-management process. This program eventually evolved into the Joint Commission (Oakbrook Terrace, Illinois).
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Spencer, Michael K., and T. Yee Khong. "Conformity to Guidelines for Pathologic Examination of the Placenta." Archives of Pathology & Laboratory Medicine 127, no. 2 (February 1, 2003): 205–7. http://dx.doi.org/10.5858/2003-127-205-ctgfpe.
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Abstract Context.—The College of American Pathologists developed a consensual guideline for placental examination that included indications for the submission of placentas for pathologic examination. The adherence to this guideline is not known. Objectives.—To identify the number of placentas that were and that should have been examined by a tertiary-care hospital according to the College of American Pathologists' practice guideline and to compare the indications listed by medical staff on their pathology request forms with the clinical events recorded on the hospital's databases. Design.—Data from the hospital computer databases and from pathology request forms were collected for all 987 deliveries occurring at a tertiary-level maternity hospital from April through June 2000. Results.—Fewer than 20% of placentas were examined, but about 50% should have been. Maternal fever and suspected neonatal infection were the indications with the lowest examination rates. Neonatal indications were infrequently listed. Conclusions.—This hospital examined approximately one third of the placentas that should have been examined. When the placentas were examined, the medical staff often failed to appropriately list the indications on their pathology request forms.
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Mettlin, Curtis J., Gerald P. Murphy, JoAnne Sylvester, Rosemary F. McKee, Monica Morrow, and David P. Winchester. "Results of hospital cancer registry surveys by the American College of Surgeons." Cancer 80, no. 9 (November 1, 1997): 1875–81. http://dx.doi.org/10.1002/(sici)1097-0142(19971101)80:9<1875::aid-cncr29>3.0.co;2-1.
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Raj, Leah, Samuel David Maidman, and Bhavin B. Adhyaru. "Inpatient management of acute decompensated heart failure." Postgraduate Medical Journal 96, no. 1131 (September 12, 2019): 33–42. http://dx.doi.org/10.1136/postgradmedj-2019-136742.
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Acute decompensated heart failure (ADHF) is the leading cause of hospital admissions in patients older than 65 years. These hospitalisations are highly risky and are associated with poor outcomes, including rehospitalisation and death. The management of ADHF is drastically different from that of chronic heart failure as inpatient treatment consists primarily of haemodynamic stabilisation, symptom relief and prevention of short-term morbidity and mortality. In this review, we will discuss the strategies put forth in the most recent American College of Cardiology/American Heart Association and Heart Failure Society of America guidelines for ADHF as well as the evidence behind these recommendations.
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Catalano Jr, Edward W., Stephen Gerard Ruby, Michael L. Talbert, and Douglas G. Knapman. "College of American Pathologists Considerations for the Delineation of Pathology Clinical Privileges." Archives of Pathology & Laboratory Medicine 133, no. 4 (April 1, 2009): 613–18. http://dx.doi.org/10.5858/133.4.613.
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Abstract Context.—The Joint Commission (JC) established new medical staff privileging requirements effective January 2008. The new requirements include the development of ongoing professional practice evaluation (OPPE) and focused professional practice evaluation (FPPE) processes and incorporate the general competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and systems-based practice jointly developed by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS). The College of American Pathologists makes resources available to assist members and their facilities in implementing the new requirements and improving patient care. Objectives.—To review the general requirements for privileging and identify how they may apply to pathologists, to identify currently available activities and metrics that may be useful in addressing these requirements, and to present identified concepts, activities, and metrics for consideration by pathologists and hospitals for their adaptation into the policies and procedures that address the new JC physician privileging requirements. Design.—Review available pathology privileging documentation that addressed the previous JC requirements, review the new requirements, and search for and review available and applicable resources, activities, and metrics. Results.—Common pathology activities and metrics can be incorporated into the privileging processes. Current and new activities and metrics can be incorporated or developed to address the 6 ACGME/ABMS “General Competencies.” Conclusion.—Each hospital has unique privileging and physician evaluation requirements. Providing concepts, activities, and metrics for pathologists and hospitals to consider in pathology privileging will help implement the OPPE and FPPE processes and meet medical staff privileging requirements.
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Stringfield, Sarah, Stefan Holubar, and Samuel Eisenstein. "Using the National Surgical Quality Improvement Project (NSQIP) to Perform Clinical Research in Colon and Rectal Surgery." Clinics in Colon and Rectal Surgery 32, no. 01 (January 2019): 041–53. http://dx.doi.org/10.1055/s-0038-1673353.
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AbstractThe American College of Surgeons' National Surgical Quality Improvement Project (ACS-NSQIP) is probably the most well-known surgical database in North American and worldwide. This clinical database was first proposed by Dr. Clifford Ko, a colorectal surgeon, to the ACS, and NSQIP first started collecting data ca. 2005 with the intent of comparing hospitals (benchmarking) and for hospital-level quality improvement projects. Since then, its popularity has grown from just a few participating hospitals in the United States to more than 708 participating hospitals worldwide, and collaboration allows regional or disease-specific data sharing. Importantly, from a methodological perspective, as the number of hospitals has grown so has the hospital heterogeneity and thus generalizability of the results and conclusions of the individual studies. In this article, we will first briefly present the structure of the database (aka the Participant User File) and other important methodological considerations specific to performing clinical research. We will then briefly review and summarize the approximately 60 published colectomy articles and 30 published articles on proctectomy. We will conclude with future directions relevant to colorectal clinical research.
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Henderson, David K. "Position Paper: The HIV-Infected Healthcare Worker." Infection Control & Hospital Epidemiology 11, no. 12 (December 1990): 647–56. http://dx.doi.org/10.1086/646116.
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Consensus statements bearing on issues related to healthcare workers (HCWs) who are, or may be, infected by the human immunodeficiency virus (HIV) have been developed by the Centers for Disease Control (CDC), the American Medical Association (AMA), the American Academy of Pediatrics, the American Hospital Association (AHA), the American Academy of Orthopedic Surgeons, the American College of Obstetricians and Gynecologists8 and the British working groups. In general, these organizations conclude that few, if any, special procedures are required to accommodate an HIV-infected HCW. All except one oppose routine screening of HCWs for HIV infection; all except one oppose broad practice proscriptions for HIV-infected HCWs. Only one of these consensus statements focuses on the HIV-infected HCW. None address important related questions that confront hospitals and other healthcare institutions. These issues are difficult to resolve because: 1) there are insufficient data to establish a scientific basis for their solution; 2) the questions involve medicolegal, ethical or public relations issues that are beyond the usual scope of scientific consensus body recommendations; and/or 3) the situations occur infrequently. Nevertheless, in actual hospital practice, decisions about these questions, at least occasionally, must be made.
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Harden, Cynthia L. "Introducing New Guidelines on Sudden Unexpected Death in Epilepsy." US Endocrinology 13, no. 02 (2017): 65. http://dx.doi.org/10.17925/use.2017.13.02.65.
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Cynthia L Harden, MD, received her medical degree at the University of Wisconsin. She trained in internal medicine at Mount Sinai St Luke’s Hospital and neurology at Mount Sinai Hospital, both in New York City, and in clinical neurophysiology at Albert Einstein College of Medicine in the Bronx. She served most of her career at Weill Cornell College of Medicine, where she became Professor of Neurology. Dr Harden serves as Chair of the Guideline Development, Dissemination and Implementation Subcommittee of the American Academy of Neurology (AAN). In 2016, she was also elected Chair of AAN’s Epilepsy Section for a 2-year term.
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Harden, Cynthia L. "Introducing New Guidelines on Sudden Unexpected Death in Epilepsy." US Neurology 13, no. 02 (2017): 65. http://dx.doi.org/10.17925/usn.2017.13.02.65.
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Cynthia L Harden, MD, received her medical degree at the University of Wisconsin. She trained in internal medicine at Mount Sinai St Luke’s Hospital and neurology at Mount Sinai Hospital, both in New York City, and in clinical neurophysiology at Albert Einstein College of Medicine in the Bronx. She served most of her career at Weill Cornell College of Medicine, where she became Professor of Neurology. Dr Harden serves as Chair of the Guideline Development, Dissemination and Implementation Subcommittee of the American Academy of Neurology (AAN). In 2016, she was also elected Chair of AAN’s Epilepsy Section for a 2-year term.
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Khan, Md Mizanur Rahman, Md Abdul Wahab, Md Muaz Yasin, and Farzana Zafreen. "Appropriateness of Referral for Upper Gastrointestinal Endoscopy in a Tertiary Care Hospital." Journal of Armed Forces Medical College, Bangladesh 14, no. 2 (March 10, 2020): 152–55. http://dx.doi.org/10.3329/jafmc.v14i2.45897.
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Introduction: Upper gastrointestinal endoscopy (UGE) allows physicians to directly schedule endoscopic procedures for their patients without prior consultation. Evaluation of appropriateness of endoscopic procedures is associated with costs and benefits.
Objectives: To assess the appropriateness of the use of UGE in an open-access setting in Bangladesh.
Materials and Methods: This cross-sectional multicenter study was conducted among 300 patients referred for UGE at Dhaka Medical College Hospital and Shaheed Suhrawardi Medical College and Hospital from January 2016 to June 2016. The American Society for Gastrointestinal Endoscopy (ASGE) guidelines was used to assess the appropriateness of referral. The participants were selected by purposive nonprobability sampling and a pre-tested questionnaire was used for data collection.
Results: Out of 300 respondents 62.3% was male. History of smoking was more in male and taking NSAIDs were more in the female. In UGE 46.7% revealed normal findings but majority 53.3% had some pathology. About 86% cases, UGE was found appropriate according to ASGE guideline and majority appropriate cases 37.3% were referred by internal medicine specialist. Appropriateness of referral among different physicians was not statistically significant.
Conclusion: Appropriateness of referral for UGE performed in tertiary care level hospitals in an open-access setting like Bangladesh was satisfactory.
Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 152-155
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Spaulding, Aaron, Rachel Paul, and Dorin Colibaseanu. "Comparing the Hospital-Acquired Condition Reduction Program and the Accreditation of Cancer Program: A Cross-sectional Study." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 55 (January 1, 2018): 004695801877029. http://dx.doi.org/10.1177/0046958018770294.
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Under the Hospital-Acquired Condition Reduction Program (HACRP), introduced by the Affordable Care Act, the Centers for Medicare and Medicaid must reduce reimbursement by 1% for hospitals that rank among the lowest performing quartile in regard to hospital-acquired conditions (HACs). This study seeks to determine whether Accredited Cancer Program (ACP) hospitals (as defined by the American College of Surgeons) score differently on the HACRP metrics than nonaccredited cancer program hospitals. This study uses data from the 2014 American Hospital Association Annual Survey database, the 2014 Area Health Resource File, the 2014 Medicare Final Rule Standardizing File, and the FY2017 HACRP database (Medicare Hospital Compare Database). The association between ACPs, HACs, and market characteristics is assessed through multinomial logistic regression analysis. Odds ratios and 95% confidence intervals are reported. Accredited cancer hospitals have a greater risk of scoring in the Worse outcome category of HAC scores, vs Middle or Better outcomes, compared with nonaccredited cancer hospitals. Despite this, they do not have greater odds of incurring a payment reduction under the HACRP measurement system. While ACP hospitals can likely improve scores, questions concerning the consistency of the message between ACP hospital quality and HACRP quality need further evaluation to determine potential gaps or issues in the structure or measurement. ACP hospitals should seek to improve scores on domain 2 measures. Although ACP hospitals do likely see more complex patients, additional efforts to reduce surgical site infections and related HACs should be evaluated and incorporated into required quality improvement efforts. From a policy perspective, policy makers should carefully evaluate the measures utilized in the HACPR.
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Alexeevich, Andreev Alexander, and Anton Petrovich Ostroushko. "Harvey Williams Cushing - founder of anesthetic monitoring, pioneer of neurosurgery (to the 150th of birthday." Journal of Experimental and Clinical Surgery 12, no. 1 (March 2, 2019): 84. http://dx.doi.org/10.18499/2070-478x-2019-12-1-84-84.
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Harvey Williams Cushing (1869–1939) graduated from Yale College and Harvard Medical School, and worked at the Massachusetts General Hospital of Boston. He created the first anesthesia card, introduced the term “regional anesthesia” into medical practice, described the Cushing triad, and in 1901, the second in the world, performed a successful operation on the pituitary gland for acromegaly. In 1910, he accepted the offer to become the head of the department of surgery at Harvard Medical School and the chief surgeon at Peter Benton Brigham Hospital, located on the campus. In 1933, Cushing moved to Yale, where from 1933 to 1937. was a professor of neurology. In the US, Harvey Williams Cushing is honored as a pioneer of neurosurgery and the greatest neurosurgeon in world history. Cushing developed and improved the technique of many neurosurgical operations, proved the right to the very existence of intracranial surgery as a separate medical specialty. In 1939, he was honored to become an Honorary Member of the Royal Medical College in London. Harvey Williams Cushing died on October 7, 1939 from myocardial infarction. He was awarded honorary degrees in nine American and thirteen European universities; several state orders and medals; as well as many different awards and prizes. Harvey Williams Cushing was a member of the American Philosophical Society, the National Academy of Natural Sciences, and the American Academy of Humanities and Natural Sciences, a foreign member of the Royal Society of London, and also an honorary member of about seventy medical, surgical, and scientific communities in Europe, USA, South America and india.
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Ahmed, Parvez Iftekhar, Shakib Uz Zaman, Ferdous Jahan, Raton Das Gupto, Md Nizamuddin Chowdhury, and Md Firoz Khan. "Pattern of Primary Glomerulonephritis in Dhaka Medical College Hospital, Bangladesh." Bangladesh Journal of Medicine 25, no. 2 (September 21, 2015): 42–46. http://dx.doi.org/10.3329/bjmed.v25i2.25087.
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Glomerulonephritis are categorised into several different pathological patterns, which are broadly grouped into non-proliferative or proliferative types.4 Glomerulonephritis comprises 25-45% cases of end-stage renal disease (ESRD) in developing nations, like Bangladesh.5 This study has been done in Dhaka Medical College Hospital from January 2011 to December 2011 to find out the type of glomerulonephritis among presented glomerulonephritis patients to Inpatient and Outpatient Department of Nephrology aiming to reflect the pattern of glomerulonephritis in Bangladeshi population. The current study duration was 12 months, 128 patients having glomerulonephritis were included in this study. Statistical analysis has been done using the stastical package for social science. In this current study it was observed that most (31.3%) of the patients were in the age group of 31 to 40 years and the mean±SD of age was 32.94±12.66 years ranging from 18 to 70 years. In this current study it was observed that 64.8% was male and 35.2% was female. Male female ratio was 1.8:1. According to type of glomerulonephtis evaluated by histopathology, it was observed that in Non Proliferative Glomerulonephtis: 12(10.61%) is Minimal Change Disease (MCD), 9(7.96%) is Focal Segmental Glomerulosclerosis (FSGS), 25(22.12%) is Membranous Glomerulonephritis (MGN). In Proliferative Glomerulonephtis: Membranoproliferative Glomerulonephtis- 13(11.5%), IgA Nephropathy -13(11.5%), Mesengial Proliferative Glomerulonephtis -14(12.39%), Focal Segmental Proliferative Glomerulonephtis-14(14.2%), Rapidly Progressive Glomerulonephtis (RPGN) - 2 (1.8%). and Chronic Sclerosing Glomerulonephritis is -11(9.7%). In our study to find out the pattern of Primary Glomerulonephritis in Dhaka Medical College Hospital there is almost similar findings in Bangladeshi and South Asian population which is shown in different studies in this region. We have some variation with Western, European, American, Middle East studies which is may be due to the difference in environmental, genetic, racial, social and economic variation.Bangladesh J Medicine Jul 2014; 25 (2) : 42-46
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Rowes, Jeffey. "EMTALA: OIG/HCFA Special Advisory Bulletin Clarifies EMTALA, American College of Emergency Physicians Criticizes it." Journal of Law, Medicine & Ethics 28, no. 1 (2000): 90–92. http://dx.doi.org/10.1111/j.1748-720x.2000.tb00324.x.
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In December 1998, the Office of Inspector General (OIG) and the Health Care Financing Administration (HCFA) solicited comments from health care providers regarding the federal anti-patient dumping statute, the Emergency Medical Treatment and Active Labor Act (EMTALA) (42 USCA §1395dd). EMTALA is a federal health care law of unprecedented breadth—the first universal benefit guaranteed by the federal government. It requires Medicare-participating hospitals with public emergency rooms, emergency physicians, and ancillary surgical and medical specialists to render adequate stabilizing treatment to whoever requests it. The 1998 Special Advisory Bulletin (63 FR 67486-01) sought input on four principal dimensions of EMTALA: (1) the statutory obligation to furnish adequate medical screening to anyone who visits an emergency room; (2) the responsibilities of health care providers towards enrollees of managed care organizations (MCOs); (3) the prior authorization and payment rules for Medicare and Medicaid; and (4) what practices would promote hospital compliance with EMTALA.
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Holly, Cheryl, Stephen M. DiRusso, Sara Nealon Cuff, Thomas H. Sullivan, Joseph Magalski, and John A. Savino. "AMERICAN COLLEGE OF SURGEONS (ACS) TRAUMA CENTER VERIFICATION: IS THERE AN IMPACT ON HOSPITAL PERFORMANCE?" Critical Care Medicine 27, Supplement (December 1999): A153. http://dx.doi.org/10.1097/00003246-199912001-00439.
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Allen, Larry A., and John S. Rumsfield. "The Hospital to Home Quality Improvement Initiative." Spring 9, no. 1 (February 21, 2012): 12–15. http://dx.doi.org/10.15420/usc.2012.9.1.12.
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Hospital to Home (H2H) is a national quality improvement initiative designed to support efforts to reduce unnecessary cardiovascular-related hospital readmissions. Launched in 2009 by the American College of Cardiology and the Institute for Healthcare Improvement, H2H acts as a clearinghouse for clinical providers and healthcare institutions to share strategies for optimizing transitions of care from the inpatient to the outpatient setting. The program centers around three core concepts: patient understanding of, and access to, medications; routine early follow-up with a healthcare provider following discharge; and comprehension of signs and symptoms that require medical attention, and how to seek urgent care in a timely manner. H2H has begun to offer toolkits, instructional webinars, and surveys to further develop these core concepts; it is also launching ‘challenge projects’ such as ‘Mind Your Meds’ or ‘See You in 7’. To date, there are more than 1,000 unique hospitals enrolled from all 50 states. Individuals and institutions can learn more by registering online (at www.h2hquality.org).
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Kardos, Steven V., Brian Shuch, Peter Schulam, Quoc-Dien Trinh, Maxine Sun, Nathan D. Shippee, Jesse D. Sammon, and Simon P. Kim. "Association of partial nephrectomy and presence of robotic surgery for kidney cancer in the United States." Journal of Clinical Oncology 32, no. 4_suppl (February 1, 2014): 484. http://dx.doi.org/10.1200/jco.2014.32.4_suppl.484.
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484 Background: While hospital and surgeon characteristics are associated with the type of nephrectomy performed for renal cell carcinoma (RCC), it is unknown whether hospital presence of robotic surgery increases the likelihood of patients receiving partial nephrectomy (PN). Therefore, we evaluate the relationship of PN and hospital presence of robotic surgery from a population-based cohort in the U.S. Methods: After merging the Nationwide Inpatient Sample (NIS) and the American Hospital Association (AHA) survey from 2006 to 2008, we identified 21,999 patients who underwent either PN or radical nephrectomy (RN) for RCC. The primary outcome of this study was the type of nephrectomy performed. Multivariable logistic regression was used to identify hospital characteristics associated with receipt of PN, after adjusting for patient case mix. Results: Overall, we identified 4,832 (22.0%) and 16,347 (88.0%) patients who were surgically treated for RCC with PN and RN, respectively. On multivariable analysis, patients undergoing surgery were more likely to receive PN at academic (OR: 2.77;p<0.001), urban (OR: 3.66; p<0.001), and American College of Surgeon (ACOS) designated cancer centers (OR: 1.10; p<0.05) compared to non-academic, rural, and non-designated hospitals, respectively. After adjusting for patient and hospital characteristics, patients undergoing surgery at hospitals with presence of robotic surgery were also associated with higher adjusted odds ratios for receipt of PN compared to those treated at hospitals without the presence of this advanced treatment technology (OR: 1.28; p<0.001). Conclusions: While academic status and urban locations are established characteristics influencing the type of nephrectomy performed for RCC, ACOS cancer center designation and hospital presence of robotic surgery were also associated with higher use of PN. Our results are informative in identifying key hospital characteristics which may facilitate greater adoption of PN.
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Cameron, Lita, Julie Johnston, Arnelle Sparman, Leif D. Nelin, Narendra Singh, and Andrea Hunter. "Guyana’s paediatric training program: a global health partnership for medical education." Canadian Medical Education Journal 8, no. 2 (April 20, 2017): e11-17. http://dx.doi.org/10.36834/cmej.36839.
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Guyana is a low-middle income country on the northern coast of South America between Venezuela and Suriname. Guyana has relatively high child mortality and a notable gap in health care provision. As of 2011, there were no paediatricians in the public sector where approximately 90% of the population seek care. In response to this unmet need, Guyanese diaspora living in Canada, in partnership with Canadian paediatricians and the main teaching hospital, Georgetown Public Hospital Corporation (GPHC), developed a Master’s program in paediatrics. The postgraduate program was designed with adapted training objectives from the Royal College of Physicians and Surgeons of Canada and the American Board of Paediatrics. Innovative strategies to overcome the lack of qualified paediatric faculty in Guyana included web-conferencing and a volunteer North American paediatric faculty presence at GPHC with a goal of 1-2 weeks every month. By November 2016, 10 graduates will have passed through a rigorous program of assessment including a two-day final examination with an objective structured clinical examination (OSCE) component.
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Ahmed, Nasim, David Kountz, and Yenhong Kuo. "African–American and Caucasian mortalities are the same after traumatic injury: pair matched analysis from a national data." Trauma Surgery & Acute Care Open 5, no. 1 (March 2020): e000436. http://dx.doi.org/10.1136/tsaco-2019-000436.
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BackgroundAfrican–Americans have worse outcomes than Caucasians in many clinical conditions studied, including trauma. We sought to analyze if mortality is different in these groups through analysis of a national data set.MethodsRecent data from the national Trauma Quality Improvement Program were assessed with analysis, including all African–American or Caucasian patients who were brought to level I or level II trauma centers for care. Propensity scores were calculated for each African–American patient using age, sex, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), injury type, insurance information and American College of Surgeons trauma level. The primary outcome of this study was in-hospital mortality, and the secondary outcomes were hospital length of stay and discharge disposition.ResultsA total of 82 150 (13.65%) out of 601 768 patients who qualified for the inclusion in the study were African–American. The remaining 519 618 (86.35%) were Caucasian. The median age (IQR) of the patients was 54 (33 to 72) years old, and approximately two-thirds of the patients were male. The median ISS and GCS score were 12 (9 to 17) and 15 (15 to 15), respectively. More than 90% of patients sustained blunt injuries. Overall, there was no significant difference found in overall in-hospital mortality between Caucasians and African–American patients (3% vs. 2.9%, p=0.2); however, the median (95% CI) hospital length of stay was 1 day longer in African–American patients compared with Caucasian patients (5 (5.5) vs. 4 (4.4), p<0.001). When the discharged destinations between the two groups were compared, a higher proportion of Caucasians were discharged to home without services (66% vs. 33%).ConclusionOur study showed that trauma mortalites among African–American and Caucasians are the same. Efforts to mitigate the ethnic and racial biases in the delivery of healthcare should continue, and these results (no differences in mortality) should be validated in other clinical settings.Level of evidenceLevel II.
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Abrams, Jeanne, and James R. Wright. "Martha Wollstein: A pioneer American female clinician-scientist." Journal of Medical Biography 28, no. 3 (January 26, 2018): 168–74. http://dx.doi.org/10.1177/0967772017743068.
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Martha Wollstein was not only the first fully specialized pediatric perinatal pathologist practicing exclusively in a North America children’s hospital, she also blazed another pathway as a very early pioneer female clinician-scientist. Wollstein provided patient care at Babies Hospital of New York City from 1891 until her retirement in 1935, and also simultaneously worked for many years as a basic scientist at the prestigious Rockefeller Institute for Medical Research. Wollstein published over 65 papers, many frequently cited, during her career on a wide range of topics including pediatric and infectious diseases. Wollstein was a rare female in the field of pathology in an era when just a relatively small number of women became doctors in any medical specialty. Wollstein was born into an affluent Jewish American family in New York City in 1868 and graduated from the Women’s Medical College in 1889. This paper explores her family support and ethnic and religious background, which helped facilitate her professional success. During her time, she was recognized internationally for her research and was respected for her medical and scientific skills; unfortunately today her important career has been largely forgotten.
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Haworth, Navine G., and Linda K. Jones. "Student and new graduate perception of hospital versus institutional clinic for clinical educational experience." Journal of Chiropractic Education 33, no. 2 (February 20, 2019): 125–32. http://dx.doi.org/10.7899/jce-18-13.
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Objective: To explore final-year students and new graduates from 2 North American chiropractic colleges regarding perceptions of the clinical educational experience in a hospital vs the institutional clinical setting. Methods: A qualitative exploratory descriptive design was used for this research. Students and new graduates were invited to participate from a United States and Canadian chiropractic college. Semistructured interviews were conducted with 49 students and 14 new graduates lasting 60 minutes. Content analysis of the transcribed interviews was undertaken. Results: The data identified that there were advantages and disadvantages to having clinical education in both settings. For instance, the hospital setting had a more varied patient case mix (making it more complex and challenging for their clinical skills development), the pace was faster, and there was more evidence-based practice. This compared to the college clinics, which tended to be slower paced and had less variation, students were required to build a patient base, and patient demographics resembled that expected in private practice. Each environment was considered a unique clinical learning experience. Conclusion: Access and opportunity in both clinical environments is considered optimal in regards to providing a broad and varied student clinical experience. Exclusivity to one may not provide the best preparation for the professional context. As most graduate opportunities are private practice, the institutional clinical environment will provide a sufficient clinical teaching and learning environment to support the professional needs. A combination of these environments is considered ideal for the graduate.
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Hawkins, Joy L., Charles P. Gibbs, Miriam Orleans, Gallice Martin-Salvaj, and Brenda Beaty. "Obstetric Anesthesia Work Force Survey, 1981 versus 1992." Anesthesiology 87, no. 1 (July 1, 1997): 135–43. http://dx.doi.org/10.1097/00000542-199707000-00018.
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Background In 1981, with support from the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists, anesthesia and obstetric providers were surveyed to identify the personnel and methods used to provide obstetric anesthesia in the United States. The survey was expanded and repeated in 1992 with support from the same organizations. Methods Comments and questions from the American Society of Anesthesiologists Committee on Obstetrical Anesthesia and the American College of Obstetricians and Gynecologists Committee on Obstetric Practice were added to the original survey instrument to include newer issues while allowing comparison with data from 1981. Using the American Hospital Association registry of hospitals, hospitals were differentiated by number of births per year (stratum I, > or = 1,500 births; stratum II, 500-1,499 births; stratum III, < 500 births) and by U.S. census region. A stratified random sample of hospitals was selected. Two copies of the survey were sent to the administrator of each hospital, one for the chief of obstetrics and one for the chief of anesthesiology. Results Compared with 1981 data, there was an overall reduction in the number of hospitals providing obstetric care (from 4,163 to 3,545), with the decrease occurring in the smallest units (56% of stratum III hospitals in 1981 compared with 45% in 1992). More women received some type of labor analgesia and there was a 100% increase in the use of epidural analgesia. However, regional analgesia was unavailable in 20% of the smallest hospitals. Spinal analgesia for labor was used in 4% of parturients. In 1981, obstetricians provided 30% of epidural analgesia for labor; they provided only 2% in 1992. Regional anesthesia was used for 78-85% (depending on strata) of patients undergoing cesarean section, resulting in a marked decrease in the use of general anesthesia. Anesthesia for cesarean section was provided by nurse anesthetists without the medical direction of an anesthesiologist in only 4% of stratum I hospitals but in 59% of stratum III hospitals. Anesthesia personnel provided neonatal resuscitation in 10% of cesarean deliveries compared with 23% in 1981. Conclusions Compared with 1981, analgesia is more often used by parturients during labor, and general anesthesia is used less often in patients having cesarean section deliveries. In the smallest hospitals, regional analgesia for labor is still unavailable to many parturients, and more than one half of anesthetics for cesarean section are provided by nurse anesthetists without medical direction by an anesthesiologist. Obstetricians are less likely to personally provide epidural analgesia for their patients. Anesthesia personnel are less involved in newborn resuscitation.
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Wright, James R., and Jeanne Abrams. "Philip Hillkowitz The “Granddaddy of Medical Technologists” and Cofounder of the American Society for Clinical Pathologists and the Jewish Consumptives' Relief Society." Archives of Pathology & Laboratory Medicine 142, no. 1 (January 1, 2018): 127–38. http://dx.doi.org/10.5858/arpa.2017-0075-hp.
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Context.— In the early 20th century, the future of hospital-based clinical pathology practice was uncertain and this situation led to the formation of the American Society for Clinical Pathologists in 1922. Philip Hillkowitz, MD, and Ward Burdick, MD, were its cofounders. No biography of Hillkowitz exists. Objective.— To explore the life, beliefs, and accomplishments of Philip Hillkowitz. Design.— Available primary and secondary historical sources were reviewed. Results.— Hillkowitz, the son of a Russian rabbi, immigrated to America as an 11-year-old child in 1885. He later attended medical school in Cincinnati, Ohio, and then moved to Colorado, where he began his clinical practice, which transitioned into a clinical pathology practice. In Denver, he met Charles Spivak, MD, another Jewish immigrant and together they established the Jewish Consumptives' Relief Society, an ethnically sensitive tuberculosis sanatorium that flourished in the first half of the 20th century because of its national fundraising network. In 1921, Hillkowitz and Burdick, also a Denver-based pathologist, successively organized the pathologists in Denver, followed by the state of Colorado. Early the next year, they formed the American Society for Clinical Pathologists (ASCP). Working with the American College of Surgeons, the ASCP put hospital-based practice of clinical pathology on solid footing in the 1920s. Hillkowitz then established and oversaw the ASCP Board of Registry of Medical Technologists. Conclusions.— Philip Hillkowitz changed the directions of clinical pathology and tuberculosis treatment in 20th century America, while simultaneously serving as a successful ethnic power broker within both the American Jewish and Eastern European immigrant communities.
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Snow, Vincenza, Dennis Beck, Tina Budnitz, Doriane C. Miller, Jane Potter, Robert L. Wears, Kevin B. Weiss, and Mark V. Williams. "Transitions of Care Consensus Policy Statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine." Journal of General Internal Medicine 24, no. 8 (April 3, 2009): 971–76. http://dx.doi.org/10.1007/s11606-009-0969-x.
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Sharma, Nirmala, and Durga BC. "Screening of Diabetes in Pregnancy at Nepalgunj Medical College Teaching Hospital Kohalpur." Journal of Nepalgunj Medical College 18, no. 2 (August 9, 2021): 63–67. http://dx.doi.org/10.3126/jngmc.v18i2.38911.
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Introduction: Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance of variable severity or hyperglycemia occuring for the first time during pregnancy but the glucose intolerance reverting back to normal after the puerperium. According to American Diabetic Association, approximately 7% of all pregnancy are complicated by Gestational Diabetes Mellitus, resulting in more than two lakhs cases annually and the prevalence may range from 1-14% of all pregnancies. Gestational Diabetes Mellitus usually develop in the second trimester and carries grave prognosis both for mother and fetus. So screening of diabetes is necessary for early detection of diabetes and prevention of further progression. Aims: Screening of impaired glucose tolerance and gestational diabetes mellitus by glucose challenge test (GCT) and oral glucose tolerance test (OGTT) at 24-28 weeks of pregnancy. Methods: This study was conducted in Nepalgunj Medical College Teaching Hospital over one year period taking 98 pregnant women who came to ANC (Antenatal Check up) out patient department. Screening for diabetes was done giving 50 gm of oral glucose (glucose challenge test) to the pregnant women at 24-28 weeks of gestational age. Results: The incidence of Impaired glucose tolerance and gestational diabetes in this study population was 4.1% and 1% respectively. Conclusion: Screening of Diabetes mellitus in Second trimester of pregnancy is important investigation to be done to prevent the mother and the fetus from many upcoming complications of diabetes.
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Snow, Vincenza, Dennis Beck, Tina Budnitz, Doriane C. Miller, Jane Potter, Robert L. Wears, Kevin B. Weiss, and Mark V. Williams. "Transitions of Care Consensus Policy Statement: American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College of Emergency Physicians, and Society for Academic Emergency Medicine." Journal of Hospital Medicine 4, no. 6 (July 2009): 364–70. http://dx.doi.org/10.1002/jhm.510.
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Black, Jonathan D., John A. Girotto, Karina E. Chapman, and Adam J. Oppenheimer. "When My Child Was Born: Cross-Cultural Reactions to the Birth of a Child with Cleft Lip and/or Palate." Cleft Palate-Craniofacial Journal 46, no. 5 (September 2009): 545–48. http://dx.doi.org/10.1597/08-151.1.
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Objective: To compare across cultures the maternal reactions toward the birth of children with cleft lip and/or palate. Design: An adaptation of When My Child Was Born, a Likert-type scale designed to assess reactions to the birth of a child, was used to survey the target populations. Setting: The surveys were administered between February 2006 and February 2008 at four hospitals: the Faculty of Medicine Hospital, Chiang Mai, Thailand; Sappasitprasong Hospital, Ubon Ratchathani, Thailand; the No. 5 Affiliated Hospital to Xinjiang Medical College, Urumqi, China; and Santa Monica Hospital, Pereira, Colombia. Participants: Thai (n = 22), Chinese (n = 25), Uygur (n = 15), and Colombian (n = 36) biological mothers completed the survey. A historical cohort of American mothers (n = 99) was used for comparison. Main Outcome Measure(s): The primary study outcome measure was the mean maternal affect score, which was calculated from the individual responses of study participants. Results: The mean maternal affect scores for the Thai, Chinese, Uygur, and Colombian mothers were 3.68 ± 0.38, 2.97 ± 0.52, 3.40 ± 0.47, and 3.51 ± 0.61, respectively. The American cohort score was 3.44 ± 0.67. Analysis of variance testing indicated that these groups were not equal (p < .0001). There were statistically significant differences between groups (p < .05). Conclusions: Maternal reactions to the birth of cleft children are different across cultures. These differences must be considered when administering care on international surgical missions.
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Santillan, Mark K., Richard C. Becker, David A. Calhoun, Allen W. Cowley, Joseph T. Flynn, Justin L. Grobe, Theodore A. Kotchen, et al. "Team Science: American Heart Association’s Hypertension Strategically Focused Research Network Experience." Hypertension 77, no. 6 (June 2021): 1857–66. http://dx.doi.org/10.1161/hypertensionaha.120.16296.
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In 2015, the American Heart Association awarded 4-year funding for a Strategically Focused Research Network focused on hypertension composed of 4 Centers: Cincinnati Children’s Hospital, Medical College of Wisconsin, University of Alabama at Birmingham, and University of Iowa. Each center proposed 3 integrated (basic, clinical, and population science) projects around a single area of focus relevant to hypertension. Along with scientific progress, the American Heart Association put a significant emphasis on training of next-generation hypertension researchers by sponsoring 3 postdoctoral fellows per center over 4 years. With the center projects being spread across the continuum of basic, clinical, and population sciences, postdoctoral fellows were expected to garner experience in various types of research methodologies. The American Heart Association also provided a number of leadership development opportunities for fellows and investigators in these centers. In addition, collaboration was highly encouraged among the centers (both within and outside the network) with the American Heart Association providing multiple opportunities for meeting and expanding associations. The area of focus for the Cincinnati Children’s Hospital Center was hypertension and target organ damage in children utilizing ambulatory blood pressure measurements. The Medical College of Wisconsin Center focused on epigenetic modifications and their role in pathogenesis of hypertension using human and animal studies. The University of Alabama at Birmingham Center’s areas of research were diurnal blood pressure patterns and clock genes. The University of Iowa Center evaluated copeptin as a possible early biomarker for preeclampsia and vascular endothelial function during pregnancy. In this review, challenges faced and successes achieved by the investigators of each of the centers are presented.
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Elmaaty, Mahmoud A., Ahmed A. Elberry, Raghda R. Hussein, Doaa M. Khalil, and Amani E. Khalifa. "Applicability of American College of Clinical Pharmacy (ACCP) competencies to clinical pharmacy practice in Egypt." Pharmacy Practice 18, no. 3 (September 6, 2020): 1951. http://dx.doi.org/10.18549/10.18549/pharmpract.2020.3.1951.
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Background: The American College of Clinical Pharmacy (ACCP) prepared clinical pharmacist competencies that have specific recommendations. Recently, many efforts to advance clinical pharmacy services in Egypt exist. The literature revealed that no country has assessed the extent of applicability of ACCP competencies in its current pharmacy practice setting. Egyptian pharmacists can provide feedback about applicability of such competencies in clinical pharmacy settings in Egypt.
Objective: The objective of this study was to investigate the extent to which ACCP competencies were implemented by Egyptian clinical pharmacists and therefore evaluate development of clinical pharmacy practice in Egypt. The study also investigated factors affecting the applicability of such competencies in the current clinical pharmacy practice setting in Egypt.
Methods: Four hundred and ninety-five randomly selected clinical pharmacists from several hospitals were invited to participate in a cross sectional survey using a self-administered validated questionnaire composed of 31 questions classified into six domains. This questionnaire was designed to determine the pharmacists’ perception about applicability of ACCP competencies to clinical pharmacy practice in Egypt.
Results: The response rate was 64% as 317 out of 495 pharmacists completed the questionnaire. These pharmacists were categorized according to age; gender; qualifications; years of previous work experience, years since BSc. and type of hospitals they are currently working at. Analysis of data revealed the professionalism domain to have the highest percentage of acceptance among pharmacists, while the system-based care & population health domain had the lowest percentage of acceptance. Results also showed that qualifications of participants did not affect their response in three domains; “Direct Patient Care”, “Systems-based Care & Population Health” and “Continuing Professional Development” (p=0.082, 0.081, 0.060), respectively. Nevertheless, qualifications of participants did affect their response in the other three domains; “Pharmacotherapy Knowledge”, “Communication” and “Professionalism” (p<0.05). The age of pharmacists, gender, years of previous work experience, and graduation year did not affect their responses in all six domains. The type of hospital they are currently working at, though, affected their responses where, there was a highly statistically significant increase of the mean score of all domains among participants working at the NGOs/private hospitals compared to governmental hospitals (p<0.001).
Conclusions: Egyptian pharmacists generally apply high percentage of ACCP competencies but the provided clinical pharmacy services need to be improved through applying the standards of best practice.
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Russell, Thomas R., and R. Scott Jones. "American College of Surgeons Remains Committed to Patient Safety." American Surgeon 72, no. 11 (November 2006): 1005–9. http://dx.doi.org/10.1177/000313480607201105.
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Since 1913 the American College of Surgeons has addressed patient safety as a top priority, so they are pleased to contribute this article offering the College's perspective on this critical subject. More specifically, this piece reviews the College's perennial efforts to ensure surgeons and hospitals access to scientifically verifiable standards, availability of effective quality improvement tools, and a better understanding of errors in care. Additionally, they examine the cultural changes required within surgery and provide an overview of the College's recent initiatives in research, accreditation, and education.
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Alali, Aziz S., David Gomez, Victoria McCredie, Todd G. Mainprize, and Avery B. Nathens. "Understanding Hospital Volume–Outcome Relationship in Severe Traumatic Brain Injury." Neurosurgery 80, no. 4 (January 28, 2017): 534–42. http://dx.doi.org/10.1093/neuros/nyw098.
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Abstract BACKGROUND: The hospital volume–outcome relationship in severe traumatic brain injury (TBI) population remains unclear. OBJECTIVE: To examine the relationship between volume of patients with severe TBI per hospital and in-hospital mortality, major complications, and mortality following a major complication (ie, failure to rescue). METHODS: In a multicenter cohort study, data on 9255 adults with severe TBI were derived from 111 hospitals participating in the American College of Surgeons Trauma Quality Improvement Program over 2009-2011. Hospitals were ranked into quartiles based on their volume of severe TBI during the study period. Random-intercept multilevel models were used to examine the association between hospital quartile of severe TBI volume and in-hospital mortality, major complications, and mortality following a major complication after adjusting for patient and hospital characteristics. In sensitivity analyses, we examined these associations after excluding transferred cases. RESULTS: Overall mortality was 37.2% (n = 3447). Two thousand ninety-eight patients (22.7%) suffered from 1 or more major complication. Among patients with major complications, 27.8% (n = 583) died. Higher-volume hospitals were associated with lower mortality; the adjusted odds ratio of death was 0.50 (95% confidence interval: 0.29-0.85) in the highest volume quartile compared to the lowest. There was no significant association between hospital-volume quartile and the odds of a major complication or the odds of death following a major complication. After excluding transferred cases, similar results were found. CONCLUSION: High-volume hospitals might be associated with lower in-hospital mortality following severe TBI. However, this mortality reduction was not associated with lower risk of major complications or death following a major complication.
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Sherman, Laurence A. "Impact of Nucleic Acid Testing for Human Immunodeficiency Virus and Hepatitis C Virus on Blood Product Availability, Outdating, and Patient Safety." Archives of Pathology & Laboratory Medicine 126, no. 12 (December 1, 2002): 1463–66. http://dx.doi.org/10.5858/2002-126-1463-ionatf.
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Abstract Context.—Limited data are available about the impact of nucleic acid testing for human immunodeficiency virus and hepatitis C virus in donated blood as part of a nationwide investigational study that affected greater than 90% of the blood supply. Objective.—To assess the impact of nucleic acid testing on supply, outdating, and patient safety. Design.—Participants in the College of American Pathologists 2001 American Association of Blood Banks/College of American Pathologists Viral Marker C survey were asked questions about supply, outdating, and implementation of a full quarantine of blood pending nucleic acid testing results. The number of respondents for each question ranged from 197 to 219 for blood centers and from 462 to 504 for hospitals. Results.—Shortages were more common for platelets (29% and 23% of blood centers and hospitals, respectively) than for red blood cells (13%, 11%). Similarly, outdating of platelets (13%, 11%) was more common than outdating of red blood cells; outdating of red blood cells was negligible for both blood centers and hospitals. Forty-two percent of blood centers did not meet the mid 2000 target date for quarantining red blood cells, and 18% were not quarantining as of September 2001. The hospital figures were 66% not quarantining in mid 2000 and 39% not quarantining as of September 2001. Higher proportions of centers and hospitals were not quarantining platelets at these 2 dates. Conclusions.—Unfavorable trends in both blood shortages and outdating were attributed to nucleic acid testing. Greater effects may have been masked by delayed implementation of full quarantine nationwide. This delay meant continued patient risk, and lack of full benefit, in a trial that was in effect a national standard. In the future, added systems will be needed for similar new endeavors to ensure uniformity of care and to avoid shortages.
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Sherwood, Melody, and Todd M. Brown. "The Role of Cardiac Rehabilitation in Heart Failure Patients." Spring 9, no. 1 (February 21, 2012): 61–65. http://dx.doi.org/10.15420/usc.2012.9.1.61.
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The benefit of cardiac rehabilitation (cr) in patients with heart failure is controversial. current American college of cardiology (Acc) and American heart Association (AhA) guidelines for the management of patients with heart failure list exercise training as a class i indication. however, data from clinical trials are mixed, and the current American Association of cardiovascular and Pulmonary rehabilitation (AAcVPr), Acc, and AhA performance measures for the referral to, and delivery of, cr services do not list heart failure as a qualifying cardiovascular disease event for which referral to outpatient cr should occur prior to hospital discharge. in this article, we review the data supporting the benefits of exercise training and formal cr programs in patients with heart failure.
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Huo, Michael H., and Alex C. Spyropoulos. "The eighth American college of chest physicians guidelines on venous thromboembolism prevention: implications for hospital prophylaxis strategies." Journal of Thrombosis and Thrombolysis 31, no. 2 (August 5, 2010): 196–208. http://dx.doi.org/10.1007/s11239-010-0500-6.
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Saha, Subhranil, Munmun Koley, ER Mahoney, Judith Hibbard, Shubhamoy Ghosh, Goutam Nag, Rajib Purkait, et al. "Patient Activation Measures in a Government Homeopathic Hospital in India." Journal of Evidence-Based Complementary & Alternative Medicine 19, no. 4 (June 27, 2014): 253–59. http://dx.doi.org/10.1177/2156587214540175.
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The American Patient Activation Measure–22 questionnaire (PAM-22) quantifies the knowledge, skills, and confidence essential to manage own health and health care. It is a central concept in chronic illness care models, but studied sparsely in homeopathic hospitals. PAM-22 was translated into Bengali and a cross-sectional study was undertaken in chronically ill 417 patients visiting the outpatient clinic of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, India. Response rate was 90.41%. Data were analyzed using Rasch rating scale model with Winsteps. Activation score was 54.7 ± 8.04 or 62.13% of maximum score. PAM scores differed significantly by age, education, income, and health status ( P < .05). The items had good data quality fit statistics and good range of difficulty. The construct unidimensionality was confirmed by good model fits for Rasch model and principal component analysis of residuals found no meaning structure. The questionnaire showed acceptable psychometrics. Patient activation was moderate and needs to be improved.
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D, Indu, Asha K P, Manoj Kumar S, and Anuja U. "Proportion of Osteoarthritis Knee among Older Adults Presenting with Knee Complaints as Assessed Using American College of Rheumatology (ACR) Criteria at A Tertiary Care Hospital, Kollam." Healthline 12, no. 1 (March 31, 2021): 10–14. http://dx.doi.org/10.51957/healthline_174_2020.
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Introduction: Osteoarthritis is one of the most prevalent musculoskeletal disorders seen as age increases. Among older individuals it leads to persistent complaints, disability and health care consultations. Objective: To estimate the proportion of osteoarthritis knee using American College Of Rheumatology (ACR) criteria among older individuals presenting with history of persistent knee complaints in a tertiary care setting. Method: A hospital based cross-sectional study was conducted to assess the proportion of osteoarthritis knee among older patients presenting with persistent knee complaints in orthopedic OP of Government Medical College Kollam. A semi-structured questionnaire was used to collect data regarding socio-demographic profile. Assessment of osteoarthritis knee was done Using American College Of Rheumatology (ACR) Criteria. Results: The proportion of osteoarthritis in any knee among older adults was found to be 72%, with bilateral osteoarthritis knee seen in 38.5%. Among those affected, 84% were women. Knee pain, presence of crepitus and bony tenderness were the most common findings among those with OA knee. Conclusion: The proportion of OA knee was found to be higher among the study population. Older age group and females were more prone to osteoarthritis of knee. An estimate of the burden of OA in older patients will help policy makers in planning public health programs to improve their health condition and quality of life.
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Yim, Josephine M., Gregory W. Albers, and Peter H. Vlasses. "Anticoagulant Therapy Monitoring with International Normalized Ratio at us Academic Health Centers." Annals of Pharmacotherapy 30, no. 12 (December 1996): 1390–95. http://dx.doi.org/10.1177/106002809603001205.
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OBJECTIVE: To assess the extent of incorporation of international normalized ratio (INR) reporting in US academic hospitals. DESIGN: Survey of academic hospital clinical laboratories in January 1995. SETTING/PARTICIPANTS: Fifty-eight academic hospital clinical laboratories at institutions that are members of the University HealthSystem Consortium. MAIN OUTCOME MEASURES: The methods for monitoring oral anticoagulant therapy at the surveyed laboratories were determined. The extent of reporting of prothrombin time (PT), PT ratio, INR, and INR therapeutic range was determined. RESULTS: All 58 of the responding hospital clinical laboratories reported INR in patients receiving oral anticoagulation. The median length of time that hospitals had been reporting INR was 24 months (range 3–108). A majority of hospitals continued to report PT values (95%) and PT reference ranges (93%) in addition to INR. Therapeutic INR ranges were reported by only 25 of the laboratories (43%). Of those that report INR ranges, many follow the published recommendations by the American College of Chest Physicians and the Food and Drug Administration. A majority of the hospitals (79%) do not confirm the accuracy of the international sensitivity index (ISI) for their own analyzers. CONCLUSIONS: Contrary to previous reports, academic hospital clinical laboratories have now adopted the more accurate system of reporting INR values in addition to PT values in patients receiving oral anticoagulation. However, better reporting of INR ranges, use of more sensitive thromboplastins, and confirmation of the accuracy of the ISI for local analyses would further improve the monitoring of oral anticoagulation.
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Wright, James R. "The Politics Underlying the Provision of and Changes in Pathology and Laboratory Services in the United States During the Roaring Twenties." Archives of Pathology & Laboratory Medicine 140, no. 9 (May 3, 2016): 983–91. http://dx.doi.org/10.5858/arpa.2016-0113-hp.
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Context.—Prior to 1900, laboratory tests were simple enough to be performed by clinicians on the wards and most pathologists were academicians with little involvement in patient care issues. In the next 2 decades, laboratory test menus expanded rapidly and the increasing complexity of the tests created a potential niche for clinical pathologists (ie, pathologists providing patient-oriented anatomic and clinical pathology services). In the late 1910s and early 1920s, most of these services were provided by mail-order commercial laboratories or state public health laboratories rather than by hospital-based pathologists. Objective.—To describe the political events in the 1920s that would drastically alter the practice of pathology and laboratory medicine and that would have been important to the discipline at the time the Archives of Pathology and Laboratory Medicine was being conceived and first published. Design.—Available primary and secondary historical sources were reviewed. Results.—In the 1920s, clinical pathologists organized, forming the American Society of Clinical Pathologists, and took on the powerful American Medical Association for permitting advertisements by private laboratories in the pages of the Journal of the American Medical Association that listed test prices as if these were commodities. They found a strong partner in the American College of Surgeons, which was attempting to elevate surgical practice by creating minimum standards for hospitals. Through this symbiotic relationship, hospital-based practice was firmly established and the commercial laboratory model faltered. Conclusions.—The Roaring Twenties was the time when the practice of pathology and laboratory medicine evolved into what we recognize today.
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Shuhan, Abdullah Al, Mohammad Sohelur Rahman, Selina Yeasmin, and Md Kabir Uddin Sikder. "Estimation of Radiation Risk on Public Around Shaheed Suhrawardy Medical College Hospital Campus, Dhaka, Bangladesh." ABC Research Alert 9, no. 1 (March 30, 2021): 15–22. http://dx.doi.org/10.18034/abcra.v9i1.513.
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Objective: Ionizing radiation is widely used in the hospital for diagnostic and therapeutic procedures to patients and its usage increasing day by day. The aim of the study is to monitor the real-time radiation around the Shaheed Suhrawardy Medical College (ShSMC) hospital campus and estimation of radiation risk on public.
Method: The real-time radiation monitoring around the ShSMC hospital was performed using digital portable radiation monitoring device (DPRMD). The DPRMD meets all European CE standards and the American “FCC 15 standard”. The DPRMD was placed at 1 meter above the ground on tripod and data collection time for each monitoring point (MP) was 1 hour. Each MP was marked out using Garmin eTrex GPS device. 32 MPs were chosen for collection of the real-time radiation dose rates around the ShSMC hospital campus in October 2020.
Results: The real-time radiation dose rates around the ShSMC hospital campus were ranged from 0.37-3.39 µSv/hr with an average of 1.537 ± 0.359 µSv/hr. The annual effective dose on public were ranged from 1.326 ± 0.551 mSv to 4.902 ± 0.705 mSv with an average of 2.694 ± 0.629 mSv. The excess life-time cancer risk (ELCR) on public health was estimated based on the annual effective dose that ranged from 5.277×10ˆ-3 to 19.503×10ˆ-3 with an average value of 10.72×10ˆ-3 around the ShSMC hospital campus.
Conclusion: Real-time radiation monitoring facilitates to ensure the safety of the radiation workers and the public from undue radiation hazard. The study also gives instant information of improper operation of radiation generating equipments and improper handling of radioactive substances in the hospital.
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McManus, Michael L., and Urbano L. França. "Availability of Inpatient Pediatric Surgery in the United States." Anesthesiology 134, no. 6 (April 8, 2021): 852–61. http://dx.doi.org/10.1097/aln.0000000000003766.
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Background In 2015, the American College of Surgeons began its Children’s Surgery Verification Quality Improvement Program, promulgating standards intended to promote regionalization and improve pediatric surgical care. It was hypothesized that pediatric surgical care was already highly regionalized and concentrated before implementation of the program. This study aimed to demonstrate this by describing the sites and volume of nonambulatory pediatric surgery. Methods A two-part, retrospective, cross-sectional analysis was performed. First, six all-encounter state inpatient data sets (Arkansas, Florida, Kentucky, Maryland, and New York from the Healthcare Cost and Utilization Project and Massachusetts from the Center for Health Information) were used to evaluate all procedures performed within specific hospitals in 2014. Next, a national sample data set (2016 Kids’ Inpatient Database) was used to determine the generalizability of the single state results. All acute care hospital admissions for patients less than 18 yr of age were included to describe the nature and location of all surgical procedures therein by patient age, surgical specialty, procedure type, and hospital service breadth. Results Within the six study states, there were 713 hospitals, of which 635 (89.1%) admitted patients less than 18 yr old, and 516 (72.4%) reported pediatric procedures. Among these, there were 9 specialty hospitals and 39 hospitals with services comparable to independent children’s hospitals. Of 153,587 procedures among 1,065,655 pediatric admissions, 127,869 (83.3%) took place within these 48 centers. This fraction decreased with age (89.9% of patients less than 2 yr old and 68.5% of 15- to 17-yr-olds), varied slightly by specialty, and was similar across states. Outside of specialized centers, teenagers accounted for 47.4% of all procedures. Within the national data sample, the concentration was similar: 8.7% (328 of 3,777) of all hospitals admitting children were responsible for 90.1% (793,905 of 881,049) of all procedures, with little regional variation. Conclusions Before the American College of Surgeons Children’s Surgery Verification Quality Improvement Program, the vast majority of pediatric nonambulatory surgeries were already confined to a small subset of high-capability and specialty centers. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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Jones, Bruce A., Molly K. Walsh, and Stephen G. Ruby. "Hospital Nursing Satisfaction With Clinical Laboratory Services: A College of American Pathologists Q-Probes Study of 162 Institutions." Archives of Pathology & Laboratory Medicine 130, no. 12 (December 1, 2006): 1756–61. http://dx.doi.org/10.5858/2006-130-1756-hnswcl.
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Abstract Context.—Monitoring customer satisfaction is an important and useful quality improvement tool and is required of most clinical laboratories in the United States. Objective.—To survey the level of nursing satisfaction with hospital clinical laboratory services. Design.—Participating laboratories provided information regarding laboratory demographics and practices. These laboratories then surveyed hospital nursing personnel regarding their level of satisfaction with defined aspects of laboratory service. Setting.—College of American Pathologists Q-Probes laboratory quality improvement study in 162 hospital laboratories. Main Outcome Measures.—Nursing overall satisfaction score (ranging from 1, not satisfied, to 5, very satisfied) and satisfaction scores for 13 specific aspects of clinical laboratory services. Results.—One hundred sixty-two institutions submitted data from a total of 7033 nursing surveys. The overall satisfaction score for all institutions ranged from 2.5 to 4.6. The median overall score for all participants was 3.9 (10th percentile, 3.2; 90th percentile, 4.2). Nursing personnel were most satisfied with the accuracy of test results, phlebotomy courtesy toward patients and nursing staff, and notification of abnormal results. They were least satisfied with stat test turnaround time, laboratory management responsiveness and accessibility, phlebotomy responsiveness to service requests, and routine test turnaround time. The most important aspect of laboratory service reported by nursing personnel was stat test turnaround time. Conclusions.—Most nursing personnel are satisfied with the clinical laboratory services that are provided to the patients in their care. Although test result accuracy is very highly regarded, there is room for improvement in several aspects of service, particularly in test turnaround time and laboratory management accessibility and responsiveness.
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Trickey, Amber W., Jeffrey M. Wright, Jean Donovan, H. David Reines, Jonathan M. Dort, Heather A. Prentice, Paula R. Graling, and John J. Moynihan. "Interrater Reliability of Hospital Readmission Evaluations for Surgical Patients." American Journal of Medical Quality 32, no. 2 (July 9, 2016): 201–7. http://dx.doi.org/10.1177/1062860615623854.
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Value-based purchasing initiatives have helped shift attention to the accuracy of hospital readmission information at the most clinically detailed level. The purpose of this study was to determine the interrater reliability (IRR) of surgical experts in assessing surgical inpatient readmissions for categorical causes, relation to index procedure, and potential preventability. Cases were selected from the American College of Surgeons National Surgical Quality Improvement Program local database. Of 1840 cases, 156 patients (8.5%) were readmitted within 30 days of the procedure. Surgical site infection was the most common readmission cause (32%), followed by obstruction or ileus (17%). IRR was moderate for readmission cause (60% agreement, κ = 0.51), substantial for readmission in relation to surgical procedure (92%, κ = 0.70), and lowest for potential preventability of readmissions (57%, κ = 0.18). Results suggest that readmission cause and relation to surgical procedure can be determined with moderate to high degree of IRR, while preventability of readmissions may require stricter definitions to improve IRR.
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Solomon, Daniel, Natasha DeNicola, Yael Feferman, Daniela Feingold, Samantha N. Aycart, Deepa R. Magge, Benjamin J. Golas, Fadi Attiyeh, Daniel M. Labow, and Umut Sarpel. "Assessing the Implementation of American College of Surgeons Quality Indicators for Pancreatic Cancer Across an Integrated Health System." Journal of Oncology Practice 15, no. 8 (August 2019): e739-e745. http://dx.doi.org/10.1200/jop.18.00587.
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PURPOSE: The American College of Surgeons (ACS) recently published quality assurance (QA) indicators for pancreatic cancer care. Implementing quality indicators in a newly formed health system may lead to better patient selection and standardized cancer care. METHODS: Select ACS and internal quality indicators were implemented system wide in 2014. We compared compliance with these measures before and after their implementation at the main hospital and two new affiliate institutions. RESULTS: A total of 506 patients with pancreatic cancer were included. At the main hospital in the pre-QA period, 11 (12.6%) of 87 patients were discussed at our institutional multidisciplinary tumor board meeting; this number rose to 89 (49.7%) of 179 patients ( P < .001) after the implementation. Clinical TNM stage was documented in the electronic medical record in 75 patients (86.2%) in the pre-QA group; this number rose to 170 (94.9%; P = .026) in the post-QA era. External imaging of patients undergoing resection was uploaded in 10 (66.7%) of 15 patient cases in the pre-QA period; this number rose to 33 (93.4%) of 35 ( P = .020). Rates of time from diagnosis to treatment initiation shorter than 60 days were similar between eras (n = 26, 96.3% v n = 57, 95%). Implementation of QA measures at the affiliate institutions did not result in measurable differences. There were no differences in margin-negative resection rate, lymph node yield, or perioperative mortality after QA implementation at any site. CONCLUSION: The implementation of ACS quality indicators at our main hospital was feasible and effective for several measures, without delaying treatment. Instituting these indicators at lower-volume affiliates was more challenging.
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Basak, PM, MMR Khan, MK Rahman, HS Das, Md Nure Alam Siddiqui, M. Akhtarul Islam, M. Towfiqul Islam, MN Islam, Golam Rabbani, and MA Hannan. "Disease severity and colonic involvement of Ulcerative colitis in a tertiary care hospital of Rajshahi Medical College." TAJ: Journal of Teachers Association 28, no. 2 (December 2, 2018): 58–60. http://dx.doi.org/10.3329/taj.v28i2.39080.
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Ulcerative colitis is an idiopathic inflammatory bowel disease characterized by continuous mucosal inflammation that starts in the rectum and extends proximally. Ulcerative colitis is considered frequent in majority of European and North American population and exceptional in most of the developing Asian countries. The present study was designed to estimate the disease severity and colonic involvement of ulcerative colitis in a tertiary care hospital of Rajshahi Medical College. The study population includes of 60 ulcerative colitis patients. Patients were categorized on the basis of disease severity ; moderate : 34, and severe: 26 and involvement of colon: 28 (46.40%) pancolitis, 20 (33.96%) left sided colitis and had 12 (19.61%) proctosigmoiditis.TAJ 2015; 28(2): 58-60
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Joseph, Bellal, Asad Azim, Terence O’Keeffe, Kareem Ibraheem, Narong Kulvatunyou, Andrew Tang, Gary Vercruysse, Randall Friese, Rifat Latifi, and Peter Rhee. "American College of Surgeons Level I trauma centers outcomes do not correlate with patients’ perception of hospital experience." Journal of Trauma and Acute Care Surgery 82, no. 4 (April 2017): 722–27. http://dx.doi.org/10.1097/ta.0000000000001385.
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Roxas, Manuel Francisco T., and Ernes John T. Castro. "Validating the American College of Surgeons (ACS)-NSQIP Surgical Risk Calculator in a Philippine ACS-NSQIP Hospital Collaboration." Journal of the American College of Surgeons 225, no. 4 (October 2017): e23-e24. http://dx.doi.org/10.1016/j.jamcollsurg.2017.07.585.
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Walsh, Julie, and Julie Walsh. "Oliver Sacks." Exchanges: The Interdisciplinary Research Journal 1, no. 1 (October 1, 2013): 1–11. http://dx.doi.org/10.31273/eirj.v1i1.69.
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Renowned neurologist and author Dr Oliver Sacks is a visiting professor at the University of Warwick as part of the Institute of Advanced Study. Dr Sacks was born in London. He earned his medical degree at the University of Oxford (Queen’s College) and the Middlesex Hospital (now UCL), followed by residencies and fellowships at Mt. Zion Hospital in San Francisco and at University of California Los Angeles (UCLA). As well as authoring best-selling books such as Awakenings and The Man Who Mistook His Wife for a Hat, he is clinical professor of neurology at NYU Langone Medical Center in New York. Warwick is part of a consortium led by New York University which is building an applied science research institute, the Center for Urban Science and Progress (CUSP). Dr Sacks recently completed a five-year residency at Columbia University in New York, where he was professor of neurology and psychiatry. He also held the title of Columbia University Artist, in recognition of his contributions to the arts as well as to medicine. He is a fellow of the Royal College of Physicians and the Association of British Neurologists, the American Academy of Arts and Sciences, and the American Academy of Arts and Letters, and has been a fellow of the New York Institute for the Humanities at NYU for more than 25 years. In 2008, he was appointed CBE.