جستجوی مقالات مرتبط با کلیدواژه « patient outcomes » در نشریات گروه « پزشکی »

Internal rotation (IR) remains unpredictable following reverse total shoulder arthroplasty (rTSA). This study aimed to determine if increasing IR limits range of motion in other planes, and to determine pre- and intra-operative factors associated with post-operative IR.
A retrospective analysis of a single surgeon’s primary rTSA with a single implant was undertaken, excluding patients with acute fracture or infection. A lesser tuberosity osteotomy (LTO) or subscapularis peel tenotomy was performed and repaired at the surgeon’s discretion. One hundred sixty rTSA were included; 142 (88.8%) had documented IR both pre-operatively and at one-year follow-up. Variables were collected to determine their effect on IR at the 1-year follow-up point. A multivariate logistic regression was used to determine independent predictors of sufficient IR.
Average age was 69.8 (range: 55-86) years and 55% (88/160) were female. Preoperatively, 20.4% of patients (29/142) had sufficient IR. This improved to 32.4% (46/142) one year following surgery, p<0.001). Factors associated with sufficient post-operative IR were female sex (p=0.05), decreasing body mass index (p=0.04), pre-operative IR (p=0.01), preoperative external rotation (ER) in adduction (p<0.001), radiographic evidence of LTO healing (p=0.02), increased one-year postoperative forward elevation (p<0.001), and increased one-year postoperative ER (p<0.001). Increased postoperative IR did not adversely affect forward elevation or ER. On multivariate analysis, higher preoperative IR and one-year postoperative forward elevation were independently associated with sufficient one-year postoperative IR.
IR following rTSA continues to be modest and unpredictable. Independent predictors of sufficient post-operative internal rotation were higher preoperative IR and one-year postoperative forward elevation. In a Grammont-style rTSA system, humeral version, glenosphere lateralization, and glenosphere size do not appear to impact IR. Importantly, achieving sufficient IR does not come at the expense of other planes of motion.
Level of evidence: III

Perioperative dexamethasone is an effective anti-emetic and systemic analgesic in total hip arthroplasty (THA) that may reduce opioid consumption and enhance rapid recovery. However, there is no consensus on the optimal perioperative dosing that is safe and effective for faster rehabilitation and improved pain control while maintaining safe blood glucose levels.

A retrospective review of 101 primary THA patients at a single institution who received perioperative dexamethasone was conducted. Patients were stratified by dexamethasone induction dosage (10 mg as high, <6mg as low) and whether a repeat dose was given 16-24 hours postoperatively. Age, gender, BMI, diabetes status, and ASA were controlled between groups. The pain was evaluated with inpatient morphine milligram equivalents (MME) requirements and visual analog scale (VAS) at 8, 16, and 24 hours postoperatively. Mobility was assessed by inpatient ambulation distance, Boston AM-PAC mobility score, and percentage of gait assistance as determined by a physical therapist. Secondary outcomes included postoperative nausea and vomiting (PONV) limiting therapy sessions, PONV requiring breakthrough anti-emetics, glucose levels, surgical site infection, wound healing complications, and discharge destination.

Compared to patients receiving one dose of high or low dexamethasone, patients receiving two dosages of high-dose dexamethasone had significantly further ambulation distance and lower percentage of gait assistance on postoperative day 2. A generalized linear model also predicted that any repeat dexamethasone, regardless of dosage, significantly improved ambulation distance and gait assistance compared to the one-dose cohort. There was no statistically significant difference between VAS scores, MME requirements, PONV, postoperative glucose levels >200, discharge destination, or risk of infection between groups.

A repeat high-dose dexamethasone, the morning after surgery, may improve percentage of gait assistance and ambulation endurance on postoperative day two. There was no risk of uncontrolled glucose levels or infections compared to receiving one dose of dexamethasone at induction. Level of evidence: III

Clinical decision support systems (CDSSs) interventions were used to improve the life quality and safety in patients and also to improve practitioner performance, especially in the field of medication. Therefore, the aim of the paper was to summarize the available evidence on the impact, outcomes and significant factors on the implementation of CDSS in the field of medicine.

This study is a systematic literature review. PubMed, Cochrane Library, Web of Science, Scopus, EMBASE, and ProQuest were investigated by 15 February 2017. The inclusion requirements were met by 98 papers, from which 13 had described important factors in the implementation of CDSS, and 86 were medicated-related. We categorized the system in terms of its correlation with medication in which a system was implemented, and our intended results were examined. In this study, the process outcomes (such as; prescription, drug-drug interaction, drug adherence, etc.), patient outcomes, and significant factors affecting the implementation of CDSS were reviewed.

We found evidence that the use of medication-related CDSS improves clinical outcomes. Also, significant results were obtained regarding the reduction of prescription errors, and the improvement in quality and safety of medication prescribed.

The results of this study show that, although computer systems such as CDSS may cause errors, in most cases, it has helped to improve prescribing, reduce side effects and drug interactions, and improve patient safety. Although these systems have improved the performance of practitioners and processes, there has not been much research on the impact of these systems on patient outcomes.

Shortened versions of validated PRO measures of coping strategies e.g. PSEQ-2, may facilitatescreening and monitoring of psychological conditions such as depression and anxiety. The primary researchquestion in this study assesses the sensitivity and specificity of a PSEQ-2 score of less than 10 for importantsymptoms of depression (a PHQ-2 score greater than 2), anxiety (GAD-2 score greater than 2), any impactfulprior episode of psychological trauma, and QuickDASH greater than 49. Secondarily we assess the associationsbetween self-efficacy and other demographic and psychological factors on the magnitude of limitations and painintensity. We performed a retrospective PRO evaluation in 926 adult patients attending upper extremity clinicbetween 1st January 2018 and 31st January 2019. Demographic factors were assessed using electronic medicalrecords and PRO data using an online platform. Patients included 556 (60%) women, 370 (40%) men (mean 51years + 14 (range, 19-88), mostly (n=584, 63%) with safety net insurance. A PSEQ-2 scoring threshold of less than 10 was 81% sensitive for a PHQ-2 score of 3 or greater, 84%sensitive for a GAD-2 score of 3 or greater, 84% sensitive for one or more important psychological traumas, and 82%sensitive for a QuickDASH of 50 or greater. PSEQ-2 less than 10 was independently associated with greater upperextremity limitations (β=11 [6.3 to 17, 95% Confidence interval [C.I], p <0.001) and pain intensity (β=0.92 (0.31 to 1.5,95% C.I) P=0.003) amongst other psychological and demographic factors. A PSEQ-2 score less than 10 might, along with verbal and non-verbal signs of distress, be a usefulway to introduce the use of more sensitive screening questionnaires about anxiety or depression, or open up the option of speaking directly to mental or social health professionals. Future studies are required to test thishypothesis. Level of evidence: III

We implemented a post prescribing review and feedback program to investigate its effect on appropriateness of antimicrobial use and antimicrobial consumption rate.A pre-post interventional study conducted in internal ward of Imam Hossein teaching hospital. For nine months of intervention phase, medical file of all patients who received intravenous antibiotic were reviewed by a clinical pharmacy specialist. Discrepancies from international and local guidelines were discussed with physicians. Outcome measures included appropriateness of antimicrobial usage, length of stay, and broad-spectrum antimicrobial usage rate.A total of 198 antibiotic courses (154 in intervention phase and 44 in pre-intervention phase) were reviewed. One-hundred sixty-seven recommendations in treatment course of 75.3% of patients were made. The most common recommendations were discontinuing antibiotics and changing from intravenous to oral therapy (35% and 22%). The acceptance rate was 80.2%.Rate of discrepancies from guidelines was compared between pre-intervention and two last months of intervention period which showed a significant reduction in antibiotic choosing (47%, P-value < 0.001), de-escalation (48%, P-value < 0.001), on time changing intravenous to oral therapy (60%, P-value < 0.001) and dosing schedule (30%, P-value = 0.003).Hospital length of stay showed a significant reduction from 16.1 days to 11.6 days (P-value < 0.05) between pre-intervention and post-intervention group. Mortality rate was not different in the patients that intervention in their treatment was accepted vs. rejected (P-value = 1.00). There was a reduction trend in consumption rate of Carbapenems, Vancomycin, and Ciprofloxacin.Therefore, prospective audit and feedback program effectively decreased inappropriate treatment and hospital length of stay with no effect on mortality.

Diabetes is the leading cause of end stage renal disease (ESRD) worldwide.
We compared the clinical outcomes in diabetic patients on hemodialysis (HD) with non-diabetics.
Patients and Adult maintenance HD patients (N= 532) from 9 HD facilities were enrolled to this prospective cohort study in September 2012. Causes of death, hospitalization, and HD exit were recorded in a median 28 months follow up period.
Results. Forty-one percent of patients were diabetic. Diabetic patients compared to non-diabetics had significantly higher age (62.2 ± 11.2 versus 53.1 ± 16.7 years), lower dialysis duration (median: 23 versus 30 months), more cardiovascular comorbidities (64% versus 28%) , higher C-reactive protein (CRP) levels (median: 3.80 versus 2.25 mg/L), lower serum albumin (3.86 ± 0.35 versus 3.93 ± 0.35 g/dL), lower intact parathyroid hormone (iPTH) (median: 272 versus 374 ρg/mL), higher serum triglyceride (167 ± 91 versus 139 ± 67 mg/dL) and low density lipoprotein (LDL) (82.5 ± 24.5 versus 77.5 ± 23.8 mg/dL), and worse short form health survey (SF36) score (45.7 ± 20.9 versus 52.7 ± 20.5). Annual admission rate was higher in diabetics (median: 0.86 versus 0.43) and diabetic foot involved 16% of their admissions. Transplantation rate was 4 and 9 per 100 patient years in diabetics and non-diabetics, respectively. Death rate was two folds higher in diabetics (24 versus 12 per 100 patient years). Cardiovascular diseases ( ± infections/other causes) comprised 80.5% of death in diabetics and 54.5% in non-diabetics. In Cox regression proportional hazard multivariate analysis, hazard risk of death in diabetics was 1.9 times higher than non-diabetics.
Clinical outcomes and health related quality of life (HRQOL) are much worse in diabetic compared to non-diabetic HD patients mainly due to more frequent of cardiovascular diseases (CVDs).

Context: Many nursing educational approaches have been applied on patients with heart failure (HF) to improve their outcomes. The results of these approaches on outcomes of patients with HF remain controversial..
Evidence Acquisition: The aim of this study was to highlight the importance of nursing education to improve the outcomes of patients with HF, such as self-care behaviour, quality of life, mortality, readmission and hospitalization rates. A systematic review was conducted in the MEDLINE database on investigations punished from 2000 to 2012. The search terms used were self-care, heart failure, nursing, and education. A total of 22 studies complied with the eligibility criteria for this review..
The findings of the reviewed studies showed that self-care behaviour of patients who received nursing education improved significantly. No significant improvement was noticed in the health-related quality of life. Additionally, there was no significant reduction in readmission, hospitalization and mortality rates of patients after implementing this educational process..
The effectiveness of nursing education on self-care behaviour of HF patients was clearly demonstrated. Methodological differences in development and implementation of education programs, made the comparison between the results of the studies difficult..

Today, because of the complications and costs reduction, non pharmacologic approaches such as music therapy have been the focus of researchers in different patients. This study aimed to determine the effects of music therapy on out-comes of patients undergoing coronary angiography (pain, stress, anxiety) as a sys-tematic review. This is a review study focused on the question "What are the effects of music therapy on physical-psychological outcomes in angiography?” In this systematic review the Keywords; Music Therapy, angiography, Patient Outcomes, Stress, Anxiety and Pain were searched in PubMed, CINAHL/Nursing Science Direct and Scopus data bases between 2006 to 2014. Then according to the articles relevancy to the research topic and opinion of research group members, related articles and contents were selected and analyzed. Among 217 articles, 10 totally relevant articles in English were chosen. accordingly, depending on the type, duration, repetition frequency and patient selection the use of music therapy increases the relaxation and reduces stress and anxiety in patients and also reduces the need for sedative in patients undergoing heart invasive procedures. Music therapy is a safe and effective measure in reducing and improving psychological outcomes and anxiety in patients undergoing coronary angiography. Therefore the use of non-pharmacological approaches can be considered by caregivers in clinical environments.

Due to the reduction of side effect costs, nowadays, non-pharmacological approaches such as massage therapy have been put to center attention by therapists. As a structured review, this research was undertaken with the objective of determining the effects of massage therapy on the patients’ outcomes (pain, stress, anxiety and depression) occurring after heart surgeries. In this Literature review, Searching was done by using keywords such as Massage Therapy, CABG, Patient Outcomes (Pain, Stress, Anxiety and Depression) at Academic databases such as PubMed, CINAHL/Nursing, Science Direct, and Scopus, during the years 2004 to 2014. Next, based on the relevance of the articles to the subject of our study and the opinions from the research team, relevant and appropriate articles were selected and analyzed contextually. Among 174 papers, 8 fully related papers to the subject of the research were ultimately selected. Massage therapy can lead to a reduction of pain, stress and anxiety in patients, as well as the reduction of need for sedatives in patients in line for heart surgeries. Massage therapy is a safe and effective therapy in reducing and recovering psychological outcomes and pain in patients undergoing heart surgeries. Hence, the use of such non pharmacological approaches can be appealing to Clinical caregivers.