Статті в журналах: "Inpatient teaching"

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Ping Tsao, C. I. "Faculty Psychiatrist on Inpatient Teaching Service." Academic Psychiatry 34, no. 3 (April 29, 2010): 189. http://dx.doi.org/10.1176/appi.ap.34.3.189.

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Phy, Michael P., Kenneth P. Offord, Dennis M. Manning, John B. Bundrick, and Jeanne M. Huddleston. "Increased Faculty Presence on Inpatient Teaching Services." Mayo Clinic Proceedings 79, no. 3 (March 2004): 332–36. http://dx.doi.org/10.4065/79.3.332.

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Knight, M., D. Pultinas, S. Collins, C. Sellig, D. C. Freeman, C. Strimaitis, N. Simms, and R. R. Silver. "Teaching Mindfulness on an Inpatient Psychiatric Unit." Mindfulness 5, no. 3 (December 4, 2012): 259–67. http://dx.doi.org/10.1007/s12671-012-0175-5.

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Xue, Yun, Jasmine Rana, and Susan Burgin. "Teaching & Learning Tips 10: Interspecialty teaching through inpatient dermatology consults." International Journal of Dermatology 57, no. 8 (July 9, 2018): 985–88. http://dx.doi.org/10.1111/ijd.13876.

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Tunde-Ayinmode, Mosunmola, Mani Rajagopalan, and John Little. "Attitudes of psychiatric inpatients to medical student interviews." Australasian Psychiatry 10, no. 3 (September 2002): 275–78. http://dx.doi.org/10.1177/103985620201000316.

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Objective: The aim was to assess the attitudes of psychiatric inpatients to medical student interviews. Method: Psychiatric inpatients' experiences of being interviewed by fourth and fifth year medical students were ascertained through the use of a semi-structured questionnaire. Results: The majority of patients reported a positive interaction with medical students. Conclusion: Psychiatric inpatient involvement in medical student teaching was favourably received by patients in a rural area mental health service setting.

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Ghiya, Ronak D., Harris Lin, Trina Dorrah, and Michael Ladogana. "Reducing Unnecessary Inpatient Labs in a Teaching Hospital." Journal of the National Medical Association 112, no. 5 (October 2020): S32. http://dx.doi.org/10.1016/j.jnma.2020.09.077.

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Mathews, Dwight, Lisa Levin, Yevgeniy Latyshev, Mailha Ahmed, Sameen Rahman, and Ziauddin Ahmed. "194 Inadequate Inpatient ESRD Care in Teaching Hospital." American Journal of Kidney Diseases 57, no. 4 (April 2011): B65. http://dx.doi.org/10.1053/j.ajkd.2011.02.197.

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Kalinowski, Agnieszka, Kristin S. Raj, and Belinda S. Bandstra. "Teaching Practice-Based Learning on Inpatient Psychiatric Services." Academic Psychiatry 44, no. 1 (October 22, 2019): 86–89. http://dx.doi.org/10.1007/s40596-019-01113-y.

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Foxx, R. M., Martha S. Kyle, Gerald D. Faw, and Ronald G. Bittle. "Teaching a Problem Solving Strategy to Inpatient Adolescents:." Child & Family Behavior Therapy 11, no. 3-4 (December 21, 1989): 71–88. http://dx.doi.org/10.1300/j019v11n03_05.

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Tamez-Pérez, H. E., D. L. Quintanilla-Flores, S. L. Proskauer-Peña, J. G. González-González, M. I. Hernández-Coria, L. A. Garza-Garza, and A. L. Tamez-Peña. "Inpatient hyperglycemia: Clinical management needs in teaching hospital." Journal of Clinical & Translational Endocrinology 1, no. 4 (December 2014): 176–78. http://dx.doi.org/10.1016/j.jcte.2014.09.004.

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Houchens, Nathan, Molly Harrod, Karen E. Fowler, Stephanie Moody, and Sanjay Saint. "How Exemplary Inpatient Teaching Physicians Foster Clinical Reasoning." American Journal of Medicine 130, no. 9 (September 2017): 1113.e1–1113.e8. http://dx.doi.org/10.1016/j.amjmed.2017.03.050.

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De la Garza-Ramos, Rafael, Amit Jain, Khaled M. Kebaish, Ali Bydon, Peter G. Passias, and Daniel M. Sciubba. "Inpatient morbidity and mortality after adult spinal deformity surgery in teaching versus nonteaching hospitals." Journal of Neurosurgery: Spine 25, no. 1 (July 2016): 15–20. http://dx.doi.org/10.3171/2015.11.spine151021.

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OBJECTIVE The goal of this study was to compare inpatient morbidity and mortality after adult spinal deformity (ASD) surgery in teaching versus nonteaching hospitals in the US. METHODS The Nationwide Inpatient Sample was used to identify surgical patients with ASD between 2002 and 2011. Only patients > 21 years old and elective cases were included. Patient characteristics, inpatient morbidity, and inpatient mortality were compared between teaching and nonteaching hospitals. A multivariable logistic regression analysis was performed to examine the effect of hospital teaching status on surgical outcomes. RESULTS A total of 7603 patients were identified, with 61.2% (n = 4650) in the teaching hospital group and 38.8% (n = 2953) in the nonteaching hospital group. The proportion of patients undergoing revision procedures was significantly different between groups (5.2% in teaching hospitals vs 3.9% in nonteaching hospitals, p = 0.008). Likewise, complex procedures (defined as fusion of 8 or more segments and/or osteotomy) were more common in teaching hospitals (27.3% vs 21.7%, p < 0.001). Crude overall complication rates were similar in teaching hospitals (47.9%) compared with nonteaching hospitals (49.8%, p = 0.114). After controlling for patient characteristics, case complexity, and revision status, patients treated at teaching hospitals were significantly less likely to develop a complication when compared with patients treated at a nonteaching hospital (OR 0.89; 95% CI 0.82–0.98). The mortality rate was 0.4% in teaching hospitals and < 0.4% in nonteaching hospitals (p = 0.210). CONCLUSIONS Patients who undergo surgery for ASD at a teaching hospital may have significantly lower odds of complication development compared with patients treated at a nonteaching hospital.

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May, Todd A., Mary Clancy, Jeff Critchfield, Fern Ebeling, Anita Enriquez, Carmel Gallagher, Jim Genevro, et al. "Reducing Unnecessary Inpatient Laboratory Testing in a Teaching Hospital." American Journal of Clinical Pathology 126, no. 2 (August 2006): 200–206. http://dx.doi.org/10.1309/wp59ym73l6cegx2f.

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Koo, Douglas J., Tabitha N. Goring, Leonard B. Saltz, Marina Kerpelev, Chhavi B. Kumar, Cori Salvit, Helen H. Chung, Ghassan K. Abou-Alfa, Steven C. Martin, and Barbara C. Egan. "Hospitalists on an Inpatient Tertiary Care Oncology Teaching Service." Journal of Oncology Practice 11, no. 2 (March 2015): e114-e119. http://dx.doi.org/10.1200/jop.2014.000661.

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Dhaliwal, Gurpreet. "Bringing High-Value Care to the Inpatient Teaching Service." JAMA Internal Medicine 174, no. 7 (July 1, 2014): 1021. http://dx.doi.org/10.1001/jamainternmed.2014.2012.

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Mazotti, Lindsay A., Arpana R. Vidyarthi, Robert M. Wachter, Andrew D. Auerbach, and Patricia P. Katz. "Impact of duty-hour restriction on resident inpatient teaching." Journal of Hospital Medicine 4, no. 8 (October 2009): 476–80. http://dx.doi.org/10.1002/jhm.448.

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Santy, Patricia A., and Stephen G. Bryant. "Teaching Clinical Psychopharmacology on an Inpatient Psychiatric Research Center." Journal of Clinical Pharmacology 34, no. 3 (March 1994): 215–21. http://dx.doi.org/10.1002/j.1552-4604.1994.tb03988.x.

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Zimnicki, Katherine M. "Preoperative Teaching and Stoma Marking in an Inpatient Population." Journal of Wound, Ostomy and Continence Nursing 42, no. 2 (2015): 165–69. http://dx.doi.org/10.1097/won.0000000000000111.

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19

Oyewumi, L. K. "Inpatient adolescent psychiatry in a teaching hospital in Nigeria." Acta Psychiatrica Scandinavica 80, no. 6 (December 1989): 639–43. http://dx.doi.org/10.1111/j.1600-0447.1989.tb03037.x.

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Finlayson, Greg, Diane Watson, and Philip Jacobs. "The Relative Cost of Inpatient Care in Manitoba's Largest Hospitals." Healthcare Management Forum 15, no. 4_suppl (December 2002): 47–52. http://dx.doi.org/10.1016/s0840-4704(10)60182-2.

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Comparative information from 1991/92 to 1997/98 regarding an indicator of the relative financial performance of teaching, urban community and major rural hospitals in Manitoba is presented. Results suggest that the acuity and complexity of patients in teaching and urban community hospitals was similar in 1997/98, and that teaching facilities had higher inpatient care costs in all time periods, even after accounting for differences in case-mix, physician remuneration, capital expenditures and the direct costs of teaching programs.

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Miloslavsky, Eli M., Kathleen Degnan, Jenna McNeill, and Jakob I. McSparron. "Use of Fellow as Clinical Teacher (FACT) Curriculum for Teaching During Consultation: Effect on Subspecialty Fellow Teaching Skills." Journal of Graduate Medical Education 9, no. 3 (June 1, 2017): 345–50. http://dx.doi.org/10.4300/jgme-d-16-00464.1.

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ABSTRACT Background Subspecialty consultation in inpatient care is increasing. Teaching by subspecialty fellows in a consultation setting may be an important source of work-based learning for students and residents. However, teaching and evaluation of learners in this context may be challenging due to personal and systems-based barriers. Objective We developed and evaluated a framework designed to overcome barriers to teaching and to improve fellow teaching skills during inpatient consultation. Methods The PARTNER (Partner with resident, Assess the learner, Reinforce positives, Teaching objectives, New knowledge, Execute recommendations, Review) framework was delivered to rheumatology and pulmonary and critical care medicine fellows at 3 academic medical centers as part of a 2-session Fellow as Clinical Teacher (FACT) curriculum. Fellows' teaching skills were evaluated using an objective structured teaching exercise (OSTE) pre- and postcurriculum, and at the end of the academic year. Self-assessment surveys were used to evaluate fellows' self-perception of teaching skills. Results Twelve of 16 eligible fellows (75%) participated in the program and completed 73 OSTE cases. Teaching skills measured by OSTEs and self-assessment surveys improved after administration of the FACT curriculum. There was no significant skill decay at the end-of-year evaluation. The curriculum was rated highly, and 73% (8 of 11) of fellows stated they would teach more frequently as a result of the intervention. Conclusions The FACT curriculum was practical and feasible, and significantly improved fellows' teaching skills teaching during inpatient consultation.

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Mikhail, Sameh, Alice Hinton, Evan John Wuthrick, Kyle Perry, Robert Merritt, Terence Marques Williams, Darwin Conwell, Tanios S. Bekaii-Saab, and Somashekar Krishna. "Management of dysphagia in esophageal cancer (EC): A population-based study." Journal of Clinical Oncology 34, no. 4_suppl (February 1, 2016): 100. http://dx.doi.org/10.1200/jco.2016.34.4_suppl.100.

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100 Background: Dysphagia is associated with significant morbidity in patients (pts) with EC. Our study is the first report of national trends in hospitalizations due to EC and dysphagia, with special emphasis on nutritional interventions and related outcomes. Methods: The analysis included all adult inpatients with EC and dysphagia in the Nationwide Inpatient Sample from 2002-2012. We examined temporal trends and performed multivariate analysis for key outcomes; controlling for demographics, hospital factors, comorbidities, and interventions. Results: Among 509,593 hospitalizations involving pts with EC, 12,205 were related to dysphagia. The percentage of all hospitalizations for EC (1.52 vs. 3.28%; p < 0.001) and EC with dysphagia (0.0025 vs. 0.0059%, p < 0.001) doubled over the study period. Among all pts with EC, inpatient mortality for EC with dysphagia was 4.39%. Mean length of stay (LOS) and cost of hospitalization were 8.1 days and $15,171, respectively. Feeding tube (FT) placement was performed in 27 % of pts, esophageal stenting in 13% and peripheral nutrition (TPN) was used in 11%. The incidence of stent placement was higher in urban teaching hospitals (33%) vs. urban non-teaching (21%) or rural nonteaching hospitals (17%). On multivariate analysis, placement of FT and stents was associated with comparable inpatient mortality and LOS, but TPN was associated with higher mortality (OR 2.25; 95% CI 1.93, 2.62) and prolonged LOS (+3.4 days, CI 2.79, 3.97). Compared to FT, stents (+ $3,042, CI 432, 5,652) and TPN (+ $10,573, CI 8,766, 12,380) resulted in higher cost of hospitalization. More pts developed sepsis on TPN (6.1%) compared to FT (2.5%) or stents (1.8%). Inpatient mortality associated with any nutritional intervention was lower in urban teaching compared to rural nonteaching hospitals (0.71; CI 0.65, 0.79). Conclusions: Hospitalizations for EC and dysphagia are increasing and mortality in such pts is high and multifactorial. TPN is associated with sepsis and mortality in this setting. Nutritional intervention practices and possibly outcomes vary significantly based on hospital type. This finding should be further explored to better define the most appropriate interventions and treatment setting for this patient population.

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Maddison, André R., Shiraz Malik, and Andrew Smaggus. "Inpatient Palliative Care Consultations From a Canadian Clinical Teaching Unit." Journal of Palliative Care 33, no. 4 (June 8, 2018): 204–8. http://dx.doi.org/10.1177/0825859718781363.

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Inpatient palliative care consultation has been demonstrated to improve quality of life as well as decrease hospital readmissions, intensive care unit transfers, and hospital costs for people with a life limiting illness. The clinical teaching units (CTUs) at London Health Sciences Centre (LHSC) routinely admit patients with noncurable cancer as well as end-stage heart, lung, liver, or kidney disease. However, the use of inpatient palliative care consultations for CTU patients remains unexamined. We conducted a descriptive study of all patients referred from LHSC CTU from both University and Victoria hospital to inpatient palliative care over a 1-year period from August 2013 to July 2014. The purpose of this study was to characterize the population and identify possible areas for quality improvement. In a 1-year period, 638 patients were referred from CTU to the inpatient palliative care consultation service. Of referrals, 55% died during their admission. Based on data collected, we conclude that many patients are referred early in their admission to CTU and patients are referred for a variety of noncancer diseases, suggesting knowledge and appreciation of the benefit of early palliative care consultation for malignant and nonmalignant disease. However, when further analyzed, there is indication that patients with noncancer diagnoses are referred statistically significantly later than those with a cancer diagnosis. The CTUs are sites of core medical training, and therefore, it is imperative that we model early integration of palliative care in order to continue to improve care of patients at end of life.

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Bedi, Prabhjot Singh, Manoj P. Rai, Justin D. Kaner, Samanjit Kaur Kandola, Ahmad Alratroot, Mark Mujer, Supratik Rayamajhi, et al. "Patterns of Inpatient Care and Outcomes for Multiple Myeloma in 2014: A National Inpatient Sample Analysis." Blood 132, Supplement 1 (November 29, 2018): 4748. http://dx.doi.org/10.1182/blood-2018-99-115847.

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Abstract Introduction: Multiple myeloma (MM) requires hospitalization for chemotherapy, stem cell transplantation, and for disease or treatment-related complications. Although there is data regarding overall incidence and mortality of MM, less is known about the patterns of hospital utilization and inpatient mortality. The purpose of this study was to describe the characteristics of patients hospitalized in 2014 for a primary diagnosis of MM, and factors associated with length of stay (LOS) and inpatient mortality. Methods: We performed a retrospective cohort analysis of the National Inpatient Sample 2014 Database (HCUP-NIS). Patients were included in the study if they had a principal diagnosis of MM and were aged 18 years or older. We used descriptive statistics to characterize the cohort in terms of personal demographic factors (i.e., age, race, sex, insurance type, community-level income level), hospital characteristics (i.e., size, region, teaching status, and urban or rural location), and admission timing (i.e., weekend or weekday). We performed univariate analyses and multivariate analysis using these variables to determine the associations with LOS and mortality. All analyses apply the HCUP-NIS weights. Results: The cohort comprised 16,890 patients. Most were white (63.7%), males (54.7%), and aged 61 years or older (64.8%). Nearly half (49.2%) were insured by Medicare. Hospitalizations were uniformly distributed across socioeconomic groups based on median household income by zip code. Care was delivered most often in large hospitals (69%) and urban teaching hospitals (81.5%). The greatest proportion of patients received care in the South (37.2%) and the least in the West (15.7%). Mean hospital charge was $ 113272 (95% CI $104651 to $121893) and net total hospital charge was $1.9 billion. The mean LOS was 11.4 days (95% CI 10.87 to 12.015). On multivariate analysis LOS was longer with increased Charlson index (AMD 0.77, 95% CI 0.56 to 0.98, p<0.01), BMT (AMD 9.25, 95% CI 8.30 to 10.20, p<0.01) and type of hospital (urban AMD 1.48, 95% CI 0.27 to 2.68, p=0.017, teaching AMD 1.42, 95% CI 0.63 to 2.22, p<0.01). Shorter LOS was observed for patients from areas with median household incomes in the 26th-50th and 51st-75th percentiles (AMD -0.97 95% CI -1.70 to -0.25, p=0.008 and AMD -0.99, 95% CI -1.74 to -0.24, p=0.009 respectively) compared to the lowest quartile, and in the Midwest (AMD -1.77, 95% CI -2.8 to -0.75, p=0.001). Mortality was associated with patient age (OR 1.03, 95% CI 1.02 to 1.05, p<0.01) and Charlson index (OR 1.24, 95% CI 1.14 to 1.35, p<0.01), being uninsured or self pay compared to Medicare (OR 3.14, 95% CI 1.36 to 7.25, p=0.007 and OR 6.43, 95% CI 1.31 to 31.54, p=0.022), and hospital type (urban OR 1.48 95% CI 0.27 to 2.68, p=0.017, teaching OR 1.42, 95% CI 0.63 to 2.22, p<0.01). Discussion: Socioeconomic factors appear to be associated with LOS and inpatient mortality in patients with MM, while patient factors such as age and frailty play a smaller role. Urban and teaching hospitals are associated with longer LOS and higher mortality, but this may reflect, in part, the referral of patients for more intensive treatment in these sites. Indigent patients tend to have more comorbidities which may have confounded our findings of increased mortality in this subgroup. Further elucidation of these relationships could help inform health resource planning in the future. Table. Table. Disclosures Marks: Seattle Genetics: Equity Ownership; Heron: Membership on an entity's Board of Directors or advisory committees; Lilly: Membership on an entity's Board of Directors or advisory committees; Odonate: Membership on an entity's Board of Directors or advisory committees; UPMC: Employment.

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LI, Qin, ZhiGui JIN, and FeiHua WU. "Experience and exploration of interns teaching in hospital inpatient dispensary." Pharmaceutical Care and Research 15, no. 6 (December 31, 2015): 426–62. http://dx.doi.org/10.5428/pcar20150608.

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Grewal, Dilraj S., Elizabeth Chiang, Elizabeth Wong, Nicholas J. Volpe, and Paul J. Bryar. "Adult Ophthalmology Inpatient Consults at a Tertiary Care Teaching Hospital." Ophthalmology 121, no. 7 (July 2014): 1489–91. http://dx.doi.org/10.1016/j.ophtha.2014.01.010.

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Gore, Teresa N., Tanya Looney Johnson, and Chih-hsuan Wang. "Teaching Nursing Leadership: Comparison of Simulation versus Traditional Inpatient Clinical." International Journal of Nursing Education Scholarship 12, no. 1 (January 1, 2015): 55–63. http://dx.doi.org/10.1515/ijnes-2014-0054.

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AbstractNurse educators claim accountability to ensure their students are prepared to assume leadership responsibilities upon graduation. Although front-line nurse leaders and nurse executives feel new graduates are not adequately prepared to take on basic leadership roles, professional nursing organizations such as the American Nurses Association (ANA) and the Association of Colleges of Nursing (AACN) deem leadership skills are core competencies of new graduate nurses. This study includes comparison of a leadership-focused multi-patient simulation and the traditional leadership clinical experiences in a baccalaureate nursing leadership course. The results of this research show both environments contribute to student learning. There was no statistical difference in the overall score. Students perceived a statistically significant difference in communication with patients in the traditional inpatient environment. However, the students perceived a statistical significant difference in teaching–learning dyad toward simulation.

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Beckman, Thomas J., Mark C. Lee, Charles H. Rohren, and V. Shane Pankratz. "Evaluating an instrument for the peer review of inpatient teaching." Medical Teacher 25, no. 2 (January 2003): 131–35. http://dx.doi.org/10.1080/0142159031000092508.

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Williams, Maribeth P., Charlie Michaudet, Yang Yang, Kimberly Lynch, and Peter J. Carek. "Impact of Inpatient Consults by a Family Medicine Teaching Service." Southern Medical Journal 112, no. 1 (January 2019): 21–24. http://dx.doi.org/10.14423/smj.0000000000000911.

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Zeidman, Jessica, Meridale Baggett, and Daniel P. Hunt. "Can one-minute preceptor and SNAPPS improve your inpatient teaching?" Journal of Hospital Medicine 10, no. 2 (January 28, 2015): 131–32. http://dx.doi.org/10.1002/jhm.2307.

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Losh, David P., Larry B. Mauksch, Richard W. Arnold, Theresa M. Maresca, Michael G. Storck, Raye R. Maestas, and Erika Goldstein. "Teaching Inpatient Communication Skills to Medical Students: An Innovative Strategy." Academic Medicine 80, no. 2 (February 2005): 118–24. http://dx.doi.org/10.1097/00001888-200502000-00002.

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Spiering, Mary, Svitlana Kostyuk, Tenzin Dolkar, and Katherine De Jesus. "Inpatient Heart Failure Teaching: Bringing Focused Education to the Bedside." Heart & Lung 43, no. 4 (July 2014): 373. http://dx.doi.org/10.1016/j.hrtlng.2014.06.024.

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Mahmood, Syed K., Emily J. Campbell, Hui Zheng, and James M. Richter. "Su1560 Analysis of Inpatient Bowel Preparation At a Teaching Hospital." Gastrointestinal Endoscopy 79, no. 5 (May 2014): AB321. http://dx.doi.org/10.1016/j.gie.2014.02.304.

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Dalal, Rahul S., Ravy K. Vajravelu, James D. Lewis, and Gary R. Lichtenstein. "Hospitalization Outcomes for Inflammatory Bowel Disease in Teaching vs Nonteaching Hospitals." Inflammatory Bowel Diseases 25, no. 12 (April 30, 2019): 1974–82. http://dx.doi.org/10.1093/ibd/izz089.

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Teaching hospitals are known for higher inpatient costs compared to community centers. We therefore assessed the impact of hospital teaching status on IBD hospitalization outcomes and found that increased resource utilization is driven by disease complexity, not hospital teaching status.

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Liu, On Ying, Theodore Malmstrom, Patricia Burhanna, and Miriam B. Rodin. "The Evolution of an Inpatient Palliative Care Consultation Service in an Urban Teaching Hospital." American Journal of Hospice and Palliative Medicine® 34, no. 1 (July 11, 2016): 47–52. http://dx.doi.org/10.1177/1049909115610077.

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Background: Research on inpatient palliative medicine reports quality-of-life outcomes and selected “hard” outcomes including pain scores, survival, and readmissions. Objective: This case study reports the evolution of an inpatient palliative consultation (IPC) team to show how IPC induces culture change in a hospital that previously had no palliative care. Design: Retrospective chart review. Setting: A Catholic university-affiliated, inner-city hospital. Population: A total of 1700 consecutive adult inpatients from May 2009 to October 2013. Measures: Consultation records enumerated demographics, code status, powers of attorney, referring physician, reason for consultation, and discharge destination. Deidentified data were uploaded to a spreadsheet. Simple descriptive statistics were calculated. Results: Requests originated from internal medicine (24%), geriatrics (21%), neurology (including stroke and neurosurgery, 14.3%), medical intensive care unit (MICU, 12.2%), and hematology–oncology (10.3%). The MICU consults increased 17.6% over time. The numbers of consults nearly doubled after trainees began rounding with the service. Hospice discharges increased by 9.2%. Palliative management of in-hospital expirations increased 2- to 3-fold. The most common consultation requests were for pain and nonpain symptoms, establishing goals of care for patients experiencing clinical decline and convening family meetings in cases of divided judgment. Conclusion: We describe the evolution of palliative care in a safety-net hospital. Medicine services which are largely resident run adopted early. Specialty services that are attending driven adopted later. We believe house staff and nurses were the initial change agents. The number of consultations increased when house staff and students began rotating on the service suggesting unmet demand due to the limited supply of providers.

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O'Callaghan, Sarah, Siobhán Quinn, Eimear Digan, Emma Fox, Rebecca Madden, Carisa Sheridan, Patrick Hogan, and Seán Kennelly. "246 A Clinical Audit of Detection and Management of Sarcopenia in Older Persons’ Specialist Rehabilitation Services in an Academic Teaching Hospital." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.150.

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Abstract Background Sarcopenia, characterised by progressive loss of muscle mass and strength, is associated with increased morbidity, mortality and poorer quality of life. International and European clinical practice guidelines on diagnosis and management of sarcopenia suggest the algorithm: Find Cases through screening, Assess Strength with validated outcome measures, Confirm Diagnosis with muscle quantity analysis and Determine Severity with validated physical performance measures (PPMs). Treatment recommendations include progressive resistance training (PRT) and a protein-rich diet. This audit aimed to investigate our specialist gerontological services’ adherence to these guidelines. Methods Using a custom-designed audit tool, patient medical records (PMRs) were reviewed in two inpatient rehabilitation wards and one Day Hospital (DH). Patients were included if under the care of a geriatrician and reviewed two or more times by a physiotherapist. Results Thirty PMRs were reviewed (18 DH, 12 inpatient). 0% of patients were screened for sarcopenia using a validated screening tool. 83.3% (n=15) of DH patients and 33.3% (n=4) of inpatients underwent a validated strength assessment. 0% of patients underwent muscle quantity analysis. 66.6% (n=12) of DH patients and 33.3% (n=4) of inpatients had validated PPMs performed. Probable sarcopenia was identified in 75% of DH and 100% of inpatients who had PPMs conducted. PRT was prescribed in 94% (n=17) and 50% (n=6) of DH patients and inpatients respectively. 16.6% (n=3) of DH patients and 75% (n=9) of inpatients were referred for nutritional assessment. 100% (n=9) of patients assessed by clinical nutrition were prescribed a high-protein/high-calorie diet. Conclusion This audit demonstrates limitations in identifying and managing sarcopenia as per the most recent international and European clinical practice guidelines. It is recognised that a multi-disciplinary approach is required to improve adherence to these guidelines. A multi-disciplinary sarcopenia management pathway is being implemented to facilitate this. Re-audit is planned to ensure the effectiveness of this pathway.

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Chen, Christopher, Sara DeGregorio, Margaret Soriano, Inga Tolin Lennes, Ryan Thompson, and Timothy Ferris. "Hematology and oncology patient perceptions of inpatient care coordination at an urban academic teaching center." Journal of Clinical Oncology 35, no. 8_suppl (March 10, 2017): 109. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.109.

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109 Background: Outpatient doctors increasingly defer inpatient care to hospital-based physicians. At academic medical centers, inpatient care coordination is further complicated by frequent handoffs between resident teams. Breaks in inpatient care continuity may disproportionately affect hematology and oncology patients, given their often complicated longitudinal histories and specialized problems. We sought to understand hematology and oncology patient perceptions of inpatient care coordination at Massachusetts General Hospital (MGH). Methods: Between July 2014 and June 2015, patients admitted to any MGH service were randomly selected to complete a survey about their perception of inpatient care coordination. In total, 1,783 patients responded. Of these, 158 were admitted to hematology or oncology. Hematology and oncology patient responses were compared to all MGH patient responses using chi-squared analysis, with p values less than or equal to 0.05 used as the threshold for statistical significance. Responses reflect the percentage of patients who chose the “top box” option. Results: Compared to all MGH patients, hematology and oncology patients were significantly more likely to recognize a clearly identified doctor responsible for their care while in the hospital (85% vs 74%, p = 0.003) and to perceive the presence of a responding clinician at all times (79% vs 66%, p = 0.001). Hematology/oncology patients were also much more likely to report seeing their longitudinal MGH doctors while admitted (77% vs 57%, p < 0.001). However, despite more frequent in-person visits by outpatient physicians, significantly fewer hematology/oncology patients reported perceiving that their outpatient doctor receives discharge information (47% vs 64%, p = 0.005). Conclusions: MGH hematology and oncology patients reported stronger inpatient care coordination and higher frequency of outpatient physician visits than MGH patients overall. Nevertheless, patients perceived less frequent coordination of discharge information with outpatient physicians. More research is needed to understand whether patient perceptions of care coordination correlates with clinical and utilization outcomes.

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Olayinka, Olaniyi, Ayotomide Oyelakin, Karthik Cherukupally, Inderpreet Virk, Chiedozie Ojimba, Susmita Khadka, Alexander Maksymenko, et al. "Use of Long-Acting Injectable Antipsychotic in an Inpatient Unit of a Community Teaching Hospital." Psychiatry Journal 2019 (June 13, 2019): 1–5. http://dx.doi.org/10.1155/2019/8629030.

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Background. Individuals with Schizophrenia Spectrum Disorders (SSD) often experience significant impairment in educational, occupational, and psychosocial functioning. The clinical benefit of long-acting injectable antipsychotics (LAIs) in the management of patients with SSD is well established. SSD patients who are nonadherent to treatment have lower disease relapse and readmission rates when prescribed a LAI, compared to oral antipsychotics. Despite the reported advantages of LAIs, their prescription rates in clinical settings remain low. This pilot study aimed to determine the pattern of LAI prescription in psychiatric inpatients of a teaching community hospital in Brooklyn, New York. Methods. A retrospective review of the charts of patients discharged from the psychiatric units of the hospital from September 1, 2017, through September 30, 2017, was conducted. Frequencies and proportions for demographic and disease-related characteristics were calculated. Pertinent continuous variables were recoded into categorical variables. Chi-square-tests or Fisher’s exact tests were performed for categorical variables. The one-sample Shapiro-Wilk test (for sample size < 50) was used to check for the normality of distribution of continuous variables. Statistical significance was defined as p ≤ 0.05. Results. Forty-three (70%) of the patients discharged from the inpatient unit during the study period had SSD and were eligible for a LAI. Their ages ranged from 20 to 71 years (mean = 41 years), and more than two-thirds were male. Less than half of the eligible patients (n = 19; 44%) were prescribed a LAI, most of whom were male (n=16; 84%). An association between age group (patients aged 41 years or younger) and LAI use was observed (p < 0.05), while gender, employment status, living arrangement, length of hospital stay, recent hospitalization, and cooccurring substance use disorder were not. Conclusion. LAI prescription rate at the inpatient psychiatric unit of the hospital was marginally higher than those reported in most studies. Age appears to influence LAI use during the study period. Initiatives that increase LAI prescription rate for all eligible patients admitted to inpatient psychiatric unit should be encouraged.

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Caminiti, Courtney, Lily Deng, Patricia Greenberg, Anthony Scolpino, Catherine Chen, Ellen Yang, and James M. Oleske. "The Impact and Perception of Cell Phone Usage in a Teaching Hospital Setting." Journal of Patient Experience 7, no. 6 (July 17, 2020): 1627–33. http://dx.doi.org/10.1177/2374373519892416.

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Objective: To evaluate perceptions regarding cell phone use in a teaching hospital setting among health care providers, residents, medical students, and patients. Methods: Fifty-three medical students, 41 resident physicians, 32 attending physicians, and 46 nurses working at University Hospital completed a questionnaire about cell phone use practices and their perceptions of cell phone use in the hospital. Forty-three inpatients admitted to medical/surgical units at University Hospital were surveyed at bedside about their perceptions regarding physicians’ cell phone use. Results: All health care providers identified cell phones as a risk to patient confidentiality with no specific group significantly more likely to attribute risk than another. Practitioners were identified as either primarily as inpatient or outpatient practitioners. Inpatient practitioners were significantly more likely to rate cell phones as beneficial to patient care than outpatient practitioners. Physicians were statistically more likely to rate mobile phones as beneficial to patient care as compared to nurses. Among the patient population surveyed, one quarter noted that their physician had used a cell phone in their presence. The majority of those patients observing practitioner cell phone use had reported a beneficial or neutral impact on their care. Significance: Perceived risk of cell phones to patient confidentiality was equal across health care providers surveyed. Physician and medical students were significantly more likely to rate cell phones as beneficial to patients’ care than nurse providers. Patients indicated that their physicians used cell phones in their presence at low rates and reported that the use was either neutral or beneficial to the care they received.

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Pai, Manjunath P., and Susan L. Pendland. "Antifungal Susceptibility Testing in Teaching Hospitals." Annals of Pharmacotherapy 37, no. 2 (February 2003): 192–96. http://dx.doi.org/10.1177/106002800303700205.

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BACKGROUND: An assessment of antifungal susceptibility testing (AST) has not been conducted since the introduction of the National Committee for Clinical Laboratory Standards (NCCLS) M27-A document. OBJECTIVE: To determine AST practices in teaching hospitals. METHODS: A questionnaire was mailed to the heads of 386 randomly assigned microbiology departments from teaching hospitals identified through the 2000 American Hospital Association Guide. Identifiers were used to delineate responders from nonresponders. A reminder letter was mailed 3 weeks after the initial mailing to all nonresponders. The hospital bed-size and number of inpatient days for respondents were obtained through the American Hospital Directory. RESULTS: The questionnaire was returned by 171 (44.3%) institutions. The total and median (range) number of candida isolates were 137 088 and 8.5 (1–145)/1000 inpatient days for the year 2000, respectively. Approximately 1% (1300) of candida isolates, from predominantly blood specimens, underwent AST. AST was reported by 115 (67.2%) hospitals, with testing on site at 27 hospitals and off site for 88 hospitals. NCCLS methodology (80% broth microdilution) was used by 75% of the hospitals performing on-site AST. The median time to obtain AST results was significantly lower when testing was performed on site (3 d) compared with off site (7–10 d). SUMMARY: A large number of candida bloodstream isolates undergoes AST annually. AST results are obtained sooner when performed on site compared with off site.

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Lian, Yaping, Philip Stather, and Manj Gohel. "A comparison of inpatients with leg ulceration using published randomised controlled trials." British Journal of Nursing 29, no. 5 (March 12, 2020): S14—S18. http://dx.doi.org/10.12968/bjon.2020.29.5.s14.

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Background: Leg ulcers are a significant burden and reduce patients' quality of life. In recent years, a plethora of information has been issued regarding leg ulcer management and ‘the demographics of patients affected in the community. However, little is known about the leg ulcer population and how these patients should be managed in acute hospitals. Aim: To compare the demographic data of inpatients with leg ulcers referred to the tissue viability service in a large teaching hospital with data on leg ulcer populations in acute and community settings. Methods: Inpatient demographic data were retrospectively obtained from electronic patient records. A literature search identified studies regarding leg ulcer populations in acute and community settings. Results: The patient population in acute settings is around 10 years older than that in community settings, with much greater levels of comorbidity and higher mortality rates. Conclusion: An improved understanding of inpatients with leg ulcers would allow investigations and interventions to be targeted better, enabling evidence-based, patient-centred referral and care pathways. Further research is required to understand the aetiology and outcomes of leg ulcers for the inpatient population.

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Brewer, Christopher Felix, Dorothy Ip, Emma Drasar, and Poureya Aghakhani. "Reducing inappropriately suspended VTE prophylaxis through a multidisciplinary shared learning programme and electronic prompting." BMJ Open Quality 8, no. 1 (March 2019): e000474. http://dx.doi.org/10.1136/bmjoq-2018-000474.

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BackgroundVenous thromboembolism (VTE) is a major cause of preventable hospital death, accounting for up to 10% of inpatient mortality. National guidelines recommend that all patients should be regularly assessed for VTE risk, and prescribed mechanical and pharmacological prophylaxis accordingly. While previous studies have focused on improving prescription uptake on admission, there has been relatively little emphasis on the inappropriate suspension of prophylaxis during inpatient stay.ObjectiveThe purpose of this project was to identify the reasons and scale of inappropriate suspension of pharmacological VTE prophylaxis for medical inpatients. We subsequently planned to introduce a number of interventions in order to reduce inappropriate suspension.MethodsAn initial audit of all medical inpatients was carried out to establish the number with inappropriately suspended pharmacological prophylaxis. We then designed a series of educational meetings and electronic prompting interventions to alert prescribers to these errors, followed by re-audit to assess their efficacy.ResultsThe number of patients with inappropriately suspended VTE prophylaxis was significantly reduced following introduction of our intervention strategy.ConclusionsCombined education and electronic email prompts are an effective way of alerting practitioners to reduce inappropriate suspension of VTE prophylaxis. With ongoing teaching and integration of prescribing software alerts, this reduction in VTE prescribing errors could be sustained.

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LeBrett, Wendi, Jenny Sauk, and Berkeley Limketkai. "11 ENTERAL NUTRITION THERAPY IS ASSOCIATED WITH FEWER READMISSIONS AND DEATHS AMONG MALNOURISHED INPATIENTS WITH INFLAMMATORY BOWEL DISEASE." Inflammatory Bowel Diseases 26, Supplement_1 (January 2020): S43—S44. http://dx.doi.org/10.1093/ibd/zaa010.113.

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Abstract Background Malnutrition is a common complication observed in hospitalized patients with inflammatory bowel disease (IBD). Enteral nutrition therapy can be used to support the nutritional needs of inpatients with IBD. However, evidence on the impact of inpatient enteral nutrition on clinical outcomes is equivocal. This study assesses post-hospitalization outcomes associated with enteral nutrition therapy amongst inpatients with IBD in a large nationwide database. Methods We conducted a retrospective propensity score-matched study among IBD inpatients diagnosed with protein-calorie malnutrition using the Nationwide Readmissions Database from 2010–2015. ICD9 codes associated with each admission were used to identify patients who received enteral nutrition. Using propensity score matching, patients who received inpatient enteral nutrition were matched with patients who did not receive enteral nutrition based on the following variables: age, sex, elective admission, patient income, teaching hospital, and hospital urban or rural locality. Primary endpoints included 30-day readmissions, 90-day readmissions, 30-day mortality and 90-day mortality. Results Among the 1,588 IBD patients (822 Crohn’s disease, 755 ulcerative colitis, 11 unclassified IBD) with protein-calorie malnutrition, patients who received enteral nutrition (n=794) had fewer 30-day readmissions (OR 0.73; 95% CI 0.55 – 0.96) and 90-day readmissions (OR 0.77; 95% CI 0.61 – 0.97). None of the patients (0%) in the enteral nutrition group died on a subsequent admission within 30 days of discharge, compared to 6 patients (0.8%) in the control group (p=0.027). Inpatient mortality within 90 days of discharge did not differ significantly between the two groups (0.8%, enteral nutrition vs. 1.6%, control; p=0.086). Discussion Enteral nutrition therapy among IBD inpatients with malnutrition was associated with lower odds of readmission and 30-day mortality, but not 90-day mortality. The findings of our study support the use of enteral nutrition in IBD inpatients and motivate the need for prospective studies assessing the impact of enteral nutritional support in IBD inpatients.

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Shahmanesh, Mohsen, and Charles Lacey. "The clinical load of HIV and AIDS for genitourinary physicians." International Journal of STD & AIDS 9, no. 10 (October 1, 1998): 567–70. http://dx.doi.org/10.1258/0956462981921134.

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We aimed to investigate the extent of genitourinary medicine (GUM) involvement in the clinical management of HIV. A questionnaire survey was conducted on GUM consultants in the UK and the Irish Republic. Clinics were divided into teaching hospitals (THs) undertaking both undergraduate and postgraduate training in GUM, non-teaching training (NTT) centres undertaking specialist training only and non-teaching (NT) centres. Information was obtained on 241 of the 250 consultants on the Royal College of Physician's GUM Committee's records from 117 GUM clinics (including all THs and NTT centres). Four (1 TH and 2 NTT centres) GUM clinics did not see HIV-positive patients, 62 saw 10-99 patients, 18 reported 100-999 and 4 with over 1000 patients attending in 1996. Thirty-five per cent of the 55 THs and NTT centres had over 100 HIV patients. Consultants were involved in the outpatient care of HIV patients in 99.5% and GUM trainees in 85.5% clinics. Overall 47 clinics have their own inpatient HIV beds and 176 consultants (73%) had full (100) or significant (76) input to inpatient HIV management. Only 29% of THs and 12.5% of NTT centres had none or minor input into HIV care. HIV inpatient on-call commitment by the GUM trainees was reported by 64% of training centres. GUM services provide a major input into outpatient and inpatient care of HIV-infected patients in the UK.

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Craven, John L., Peter M. Voore, and George Voineskos. "PRN Medication for Psychiatric Inpatients." Canadian Journal of Psychiatry 32, no. 3 (April 1987): 199–203. http://dx.doi.org/10.1177/070674378703200308.

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Little is known about the extent of the use of prn psychotropic medication in psychiatric inpatient units. A survey of the prn prescription and administration of psychotropic drugs in a psychiatric teaching hospital revealed that a large number of inpatients were prescribed and administered such drugs on a prn basis. Although 50% of the prescriptions were never administered, only 25% were actively discontinued by physicians. A diagnosis of personality disorder was the factor most frequently associated with the rate of prn prescriptions and of administrations. A large number of prn prescriptions had no instructions for indications, minimum time spacing between doses or maximum daily dosage. It is suggested that hospitals monitor the prn use of psychotropic medications in their inpatient units, and explore the reasons for such use. Psychotropic drug use on a prn basis should preferably be reserved for emergencies, and the instructions of prn prescriptions should be clear and detailed.

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Walker, Daniel, Terri Menser, Po-Yin Yen, and Ann McAlearney. "Optimizing the User Experience: Identifying Opportunities to Improve Use of an Inpatient Portal." Applied Clinical Informatics 09, no. 01 (January 2018): 105–13. http://dx.doi.org/10.1055/s-0037-1621732.

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Background Patient portals specifically designed for the inpatient setting have significant potential to improve patient care. However, little is known about how the users of this technology, the patients, may interact with the inpatient portals. As a result, hospitals have limited ability to design approaches that support patient use of the portal. Objectives This study aims to evaluate the user experience associated with an inpatient portal. Methods We used a Think-Aloud protocol to study user interactions with a commercially available inpatient portal—MyChart Bedside (MCB). Study participants included 19 English-speaking adults over the age of 18 years. In one-on-one sessions, participants narrated their experience using the MCB application and completing eight specific tasks. Recordings were transcribed and coded into three dimensions of the user experience: physical, cognitive, and sociobehavioral. Results Our analysis of the physical experience highlighted the navigational errors and technical challenges associated with the use of MCB. We also found that issues associated with the cognitive experience included comprehension problems that spurred anxiety and uncertainty. Analysis of the sociobehavioral experience suggested that users have different learning styles and preferences for learning including self-guided, handouts, and in-person training. Conclusion Inpatient portals may be an effective tool to improve the patient experience in the hospital. Moreover, making this technology available to inpatients may help to foster ongoing use of technology across the care continuum. However, deriving the benefits from the technology requires appropriate support. We identified multiple opportunities for hospital management to intervene. In particular, teaching patients to use the application by making a variety of instructional materials available could help to reduce several identified barriers to use. Additionally, hospitals should be prepared to manage patient anxiety and increased questioning arising from the availability of information in the inpatient portal application.

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Halabi, Reem, Geoffrey Smith, Marc Sylwestrzak, Brian Clay, Christopher A. Longhurst, and Lina Lander. "The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study." Journal of Medical Internet Research 23, no. 5 (May 19, 2021): e28845. http://dx.doi.org/10.2196/28845.

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With the emergence of the COVID-19 pandemic and shortage of adequate personal protective equipment (PPE), hospitals implemented inpatient telemedicine measures to ensure operational readiness and a safe working environment for clinicians. The utility and sustainability of inpatient telemedicine initiatives need to be evaluated as the number of COVID-19 inpatients is expected to continue declining. In this viewpoint, we describe the use of a rapidly deployed inpatient telemedicine workflow at a large academic medical center and discuss the potential impact on PPE savings. In early 2020, videoconferencing software was installed on patient bedside iPads at two academic medical center teaching hospitals. An internal website allowed providers to initiate video calls with patients in any patient room with an activated iPad, including both COVID-19 and non–COVID-19 patients. Patients were encouraged to use telemedicine technology to connect with loved ones via native apps or videoconferencing software. We evaluated the use of telemedicine technology on patients’ bedside iPads by monitoring traffic to the internal website. Between May 2020 and March 2021, there were a total of 1240 active users of the Video Visits website (mean 112.7, SD 49.0 connection events per month). Of these, 133 (10.7%) connections were made. Patients initiated 63 (47.4%) video calls with family or friends and sent 37 (27.8%) emails with videoconference connection instructions. Providers initiated a total of 33 (24.8%) video calls with the majority of calls initiated in August (n=22, 67%). There was a low level of adoption of inpatient telemedicine capability by providers and patients. With sufficient availability of PPE, inpatient providers did not find a frequent need to use the bedside telemedicine technology, despite a high census of patients with COVID-19. Compared to providers, patients used videoconferencing capabilities more frequently in September and October 2020. We did not find savings of PPE associated with the use of inpatient telemedicine.

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Dashora, Umesh, Mike Sampson, Erwin Castro, Debbie Stanisstreet, Christine Jones, Rowan Hillson, and On behalf of JBDS for Inpatient Care. "The Rowan Hillson Inpatient Safety Award 2018 for the best inpatient diabetes educational programme for healthcare professionals." British Journal of Diabetes 20, no. 2 (December 13, 2020): 151–54. http://dx.doi.org/10.15277/bjd.2020.264.

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Introduction: The annual National Diabetes Inpatient Audit (NaDIA) in the UK continues to show a high incidence of insulin errors in patients admitted to hospital with diabetes. It is clear that new initiatives are urgently required to mitigate this risk.Method: The Joint British Diabetes Societies for Inpatient Care (JBDS-IP) organised the fifth national Rowan Hillson Inpatient Safety Award on the theme of the best inpatient diabetes educational initiative to improve patient safety in hospitals.Result: The winner was Kath Higgins and the team from the University Hospitals of Leicester NHS Trust for their ITS Diabetes – Inpatient Diabetes Training & Support programme – an educational toolkit accessible to medical, nursing and pharmacy staff. Components included face-to-face training, e-learning module, monthly newsletter social media communications with competency document and flashcards. The initiative reduced insulin errors and in-hospital diabetic ketoacidosis. There were two teams in second position. Michael Lloyd and colleagues from St Helens and Knowsley Teaching Hospitals NHS Trust received the award for their individualised and shared insulin prescribing error feedback system, Safe Insulin TipS (SIPS), and multi-professional simulation-based training. Ruth Miller and colleagues in North West London were commended for the project to implement Diabetes 10 Point Training in Acute Hospitals across North West London. This clinically-based teaching programme provided quick training specifically designed for all hospital settings to address the commonest diabetes errors.Conclusion: These and similar schemes need to be developed, promoted and shared to reduce insulin errors in hospitalised patients with diabetes.

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Khthir, MD, CPHQ, CCD, Rodhan. "Approaching Inpatient Glycemic Control Using Six Sigma Methodology." International Journal of Innovative Research in Medical Science 6, no. 04 (April 10, 2021): 288–91. http://dx.doi.org/10.23958/ijirms/vol06-i04/1105.

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Process variation affects almost all healthcare processes. Wide fluctuation of blood glucose values is very common in hospitalized patients and may impact the outcome of care in negative way. The purpose of this article is to illustrate how to study the process variation using Six Sigma approach and how to us it teaching healthcare quality.

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Serling-Boyd, Naomi, and Eli M. Miloslavsky. "Enhancing the Inpatient Consultation Learning Environment to Optimize Teaching and Learning." Rheumatic Disease Clinics of North America 46, no. 1 (February 2020): 73–83. http://dx.doi.org/10.1016/j.rdc.2019.09.003.

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