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5-year morbidity among very preterm infants in relation to level of hospital care.

https://arctichealth.org/en/permalink/ahliterature119186
Source
JAMA Pediatr. 2013 Jan;167(1):40-6
Publication Type
Article
Date
Jan-2013
Author
Liisi Rautava
Janne Eskelinen
Unto Häkkinen
Liisa Lehtonen
Author Affiliation
Department of Pediatrics, Turku University Hospital, 20520 Turku, Finland. liisi.rautava@utu.fi
Source
JAMA Pediatr. 2013 Jan;167(1):40-6
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Child, Preschool
Cohort Studies
Female
Finland - epidemiology
Humans
Incidence
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases - epidemiology - etiology - therapy
Intensive Care, Neonatal
Logistic Models
Male
Odds Ratio
Outcome and Process Assessment (Health Care)
Patient transfer
Registries
Secondary Care
Tertiary Care Centers
Tertiary Healthcare
Abstract
To determine whether birth and care in the highest-level hospitals (level III) compared with birth in or postnatal transfer to lower-level hospitals (level II) are associated with 5-year morbidity in very preterm children.
A cohort study.
Finland.
All surviving 5-year-old children born very preterm (gestational age
PubMed ID
23128961 View in PubMed
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Are cuffed peripherally inserted central catheters superior to uncuffed peripherally inserted central catheters? A retrospective review in a tertiary pediatric center.

https://arctichealth.org/en/permalink/ahliterature114120
Source
J Vasc Interv Radiol. 2013 Sep;24(9):1316-22
Publication Type
Article
Date
Sep-2013
Author
Luke M H W Toh
Ertugrul Mavili
Rahim Moineddin
Joao Amaral
Philip R John
Michael J Temple
Dimitri Parra
Bairbre L Connolly
Author Affiliation
Division of Interventional Radiology, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G1X8, Canada. hwtoh@hotmail.com
Source
J Vasc Interv Radiol. 2013 Sep;24(9):1316-22
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Catheter-Related Infections - epidemiology - prevention & control
Catheterization, Central Venous - instrumentation - statistics & numerical data
Central Venous Catheters - statistics & numerical data
Child
Child, Preschool
Equipment Design
Equipment Failure - statistics & numerical data
Equipment Failure Analysis
Female
Hospitals, Pediatric - statistics & numerical data
Humans
Incidence
Infant
Infant, Newborn
Male
Ontario - epidemiology
Retrospective Studies
Risk factors
Tertiary Healthcare - statistics & numerical data
Treatment Outcome
Young Adult
Abstract
To assess the use of cuffed peripherally inserted central catheters (PICCs) compared with uncuffed PICCs in children with respect to their ability to provide access until the end of therapy.
A retrospective review of PICCs inserted between January 2007 and December 2008 was conducted. Data collected from electronic records included patient age, referring service, clinical diagnosis, inserting team (pediatric interventional radiologists or neonatal intensive care unit [NICU] nurse-led PICC team), insertion site, dates of insertion and removal, reasons for removal, and need for a new catheter insertion. A separate subset analysis of the NICU population was performed. Primary outcome measured was the ability of the PICCs to provide access until the end of therapy.
Cuffed PICCs (n = 1,201) were significantly more likely to provide access until the end of therapy than uncuffed PICCs (n = 303) (P = .0002). Catheter removal before reaching the end of therapy with requirement of placement of a new PICC occurred in 26% (n = 311) of cuffed PICCs and 38% (n = 114) of uncuffed PICCs. Uncuffed PICCs had a significantly higher incidence of infections per 1,000 catheter days (P = .023), malposition (P = .023), and thrombus formation (P = .022). In the NICU subset analysis, cuffed PICCs had a higher chance of reaching end of therapy, but this was not statistically significant.
In this pediatric population, cuffed PICCs were more likely to provide access until the end of therapy. Cuffed PICCs were associated with lower rates of catheter infection, malposition, and thrombosis than uncuffed PICCs.
PubMed ID
23648007 View in PubMed
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Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital.

https://arctichealth.org/en/permalink/ahliterature106706
Source
J Cancer Res Ther. 2013 Jul-Sep;9(3):397-401
Publication Type
Article
Author
Mohammad Ashraf Wani
S A Tabish
Farooq A Jan
Nazir A Khan
Z A Wafai
K K Pandita
Author Affiliation
Department of Hospital Administration, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India.
Source
J Cancer Res Ther. 2013 Jul-Sep;9(3):397-401
Language
English
Publication Type
Article
Keywords
Antineoplastic Agents - economics - therapeutic use
Costs and Cost Analysis
Health Care Costs
Humans
Inpatients
Neoplasms - drug therapy - economics
Tertiary Healthcare
Abstract
Cancer remains a major health problem in all communities worldwide. Rising healthcare costs associated with treating advanced cancers present a significant economic challenge. It is a need of the hour that the health sector should devise cost-effective measures to be put in place for better affordability of treatments. To achieve this objective, information generation through indigenous hospital data on unit cost of in-patient cancer chemotherapy in medical oncology became imperative and thus hallmark of this study.
The present prospective hospital based study was conducted in Medical Oncology Department of tertiary care teaching hospital.
After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment.
The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96). This includes expenditure incurred both by the hospital and the patient (out of pocket).
The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.
PubMed ID
24125973 View in PubMed
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Early and late outcomes after cardiac retransplantation.

https://arctichealth.org/en/permalink/ahliterature118621
Source
Can J Surg. 2013 Feb;56(1):21-6
Publication Type
Article
Date
Feb-2013
Author
Aya Saito
Richard J Novick
Bob Kiaii
F Neil McKenzie
Mackenzie Quantz
Peter Pflugfelder
Grant Fisher
Michael W A Chu
Author Affiliation
The Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont., Canada.
Source
Can J Surg. 2013 Feb;56(1):21-6
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Adult
Female
Graft Rejection - etiology - surgery
Heart Failure - mortality - surgery
Heart Transplantation - mortality - standards
Humans
Immunosuppressive Agents - administration & dosage
Kaplan-Meier Estimate
Male
Medical Records
Middle Aged
Ontario
Patient Selection
Perioperative Period
Reoperation - mortality - standards
Retrospective Studies
Risk factors
Tertiary Healthcare
Time Factors
Transplantation, Homologous
Treatment Outcome
Abstract
Cardiac retransplantation remains the most viable option for patients with allograft heart failure; however, careful patient selection is paramount considering limited allograft resources. We analyzed clinical outcomes following retransplantation in an academic, tertiary care institution.
Between 1981 and 2011, 593 heart transplantations, including 22 retransplantations were performed at our institution. We analyzed the preoperative demographic characteristics, cause of allograft loss, short- and long-term surgical outcomes and cause of death among patients who had cardiac retransplantations.
Twenty-two patients underwent retransplantation: 10 for graft vascular disease, 7 for acute rejection and 5 for primary graft failure. Mean age at retransplantation was 43 (standard deviation [SD] 15) years; 6 patients were women. Thirteen patients were critically ill preoperatively, requiring inotropes and/or mechanical support. The median interval between primary and retransplantation was 2.2 (range 0-16) years. Thirty-day mortality was 31.8%, and conditional (> 30 d) 1-, 5- and 10-year survival after retransplantation were 93%, 79% and 59%, respectively. A diagnosis of allograft vasculopathy (p = 0.008) and an interval between primary and retransplantation greater than 1 year (p = 0.016) had a significantly favourable impact on 30-day mortality. The median and mean survival after retransplantation were 3.3 and 5 (SD 6, range 0-18) years, respectively; graft vascular disease and multiorgan failure were the most common causes of death.
Long-term outcomes for primary and retransplantation are similar if patients survive the 30-day postoperative period. Retransplantation within 1 year of the primary transplantation resulted in a high perioperative mortality and thus may be a contraindication to retransplantation.
Notes
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PubMed ID
23187039 View in PubMed
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Feasibility of sonographer-administered echocontrast in a large-volume tertiary-care echocardiography laboratory.

https://arctichealth.org/en/permalink/ahliterature120464
Source
Can J Cardiol. 2013 Mar;29(3):391-5
Publication Type
Article
Date
Mar-2013
Author
Andrew Tang
Soon Kwang Chiew
Roman Rashkovetsky
Harald Becher
Jonathan B Choy
Author Affiliation
University of Alberta, Faculty of Medicine, Edmonton, Alberta, Canada.
Source
Can J Cardiol. 2013 Mar;29(3):391-5
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Alberta
Algorithms
Cardiovascular Diseases - ultrasonography
Contrast Media - administration & dosage
Echocardiography - methods - standards
Efficiency, Organizational
Feasibility Studies
Female
Humans
Inpatients
Laboratories - manpower
Male
Medical Laboratory Personnel
Middle Aged
Outpatients
Patient care team
Professional Competence
Prognosis
Tertiary Healthcare
Time Factors
Abstract
Contrast echocardiography has been shown to improve diagnostic quality, especially in technically difficult patients. However, the learning curve and increased time for preparation and image acquisition have led to low use.
We sought to determine whether the contrast echocardiography procedure performed independently by a specialized, trained sonographer could improve efficiency. In our centre, routine echocardiograms were scheduled for 1 hour, and any study exceeding 1 hour would result in patient booking cancellations. We compared the standard of care, in which a physician or nurse administers echocontrast, with a sonographer-administered program (SAP).
The time to complete contrast echocardiograms was significantly reduced by the SAP strategy (43 min 17 s ± 23 min 42 s vs 1 h 1 min 6 s ± 31 min 0 s, P
PubMed ID
22999191 View in PubMed
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The impact of consultation on length of stay in tertiary care emergency departments.

https://arctichealth.org/en/permalink/ahliterature257031
Source
Emerg Med J. 2014 Feb;31(2):134-8
Publication Type
Article
Date
Feb-2014
Author
Craig Brick
Justin Lowes
Lindsay Lovstrom
Andrea Kokotilo
Cristina Villa-Roel
Patricia Lee
Eddy Lang
Brian H Rowe
Author Affiliation
School of Medicine, University College Cork, , Cork, Ireland.
Source
Emerg Med J. 2014 Feb;31(2):134-8
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Emergency Service, Hospital - statistics & numerical data
Female
Humans
Length of Stay - statistics & numerical data
Male
Middle Aged
Prospective Studies
Referral and Consultation - statistics & numerical data
Regression Analysis
Risk factors
Tertiary Healthcare - statistics & numerical data
Abstract
Consultations in the emergency department (ED) are infrequently studied. This study quantifies the contribution of consultations to ED length of stay (LOS) and examines patient and consultation characteristics associated with prolonged ED LOS.
Prospective cohort study of a convenience sample of shifts by volunteering emergency physicians (EP) at two urban tertiary care Canadian EDs. EPs completed standardised forms on all patients for whom a consultation was requested. Medical chart reviews and secondary analyses of administrative databases were also performed. Factors associated with longer LOS were determined through linear regression modelling.
1180 patients received at least one consultation during study shifts and EPs completed data collection on 841 (71%) of these. Median patient age was 54 years, 53.3% were male, and 2.9% had documented dementia. Admitted patients receiving consultations had a longer overall LOS compared to discharged patients. Median time from triage to consultation request accounted for approximately 28% of the total median LOS in admitted patients compared to 46% for discharged patients. Consultation decision time accounted for 33% and 54% of the LOS for admitted and discharged patients, respectively. Linear regression modelling revealed that advanced age, longer latency between arrival and first consultation request, history of dementia and multiple consultations were significantly associated with longer LOS. Conversely, undergoing procedures while in the ED was associated with a shorter LOS.
Consultation decision time contributes significantly to ED LOS. Further efforts are needed to validate these results in other ED settings and improve this aspect of ED throughput.
PubMed ID
23353666 View in PubMed
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Implementation of a depression screening protocol among respiratory insufficiency patients.

https://arctichealth.org/en/permalink/ahliterature300315
Source
Clin Respir J. 2019 Jan; 13(1):34-42
Publication Type
Journal Article
Date
Jan-2019
Author
Hanna Kerminen
Esa Jämsen
Pirkko Jäntti
Aino K Mattila
Sirpa Leivo-Korpela
Jaakko Valvanne
Author Affiliation
Faculty of Medicine and Life Sciences, The Gerontology Research Centre (GEREC), University of Tampere, Tampere, Finland.
Source
Clin Respir J. 2019 Jan; 13(1):34-42
Date
Jan-2019
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Depression - diagnosis - epidemiology - etiology
Female
Finland - epidemiology
Humans
Male
Mass Screening - methods
Outcome Assessment (Health Care)
Prevalence
Respiratory Insufficiency - complications - epidemiology - psychology
Retrospective Studies
Smoking - epidemiology - psychology
Surveys and Questionnaires
Tertiary Healthcare - standards
Abstract
Unnoticed and untreated depression is prevalent among patients with chronic respiratory insufficiency. Comorbid depression causes suffering and worsens patients' outcomes.
The objective of this evaluation was to assess preliminary outcomes of a depression screening protocol among chronic respiratory insufficiency patients at a tertiary care pulmonary outpatient clinic.
In the depression screening protocol, the patients filled the Depression Scale (DEPS) questionnaire. Patients whose scores suggested depression were offered the opportunity of a further evaluation of mood at a psychiatric outpatient clinic. The outcomes of the protocol were evaluated retrospectively from the patient records.
During the period of evaluation, 238 patients visited the outpatient clinic. DEPS was administered to 176 patients (74%), of whom 60 (34%) scored =9 (out of 30), thus exceeding the cut-off for referral. However, only 13 patients were referred, as the remainder declined the referral. Finally, seven patients were evaluated at the psychiatric clinic, and they all were deemed depressive. Symptoms of depression were most prevalent among patients with a long smoking history, refractory dyspnoea and a history of depression.
Depression screening was positive in a third of the patients. The depression screening protocol improved the detection of depression symptoms, but the effects on the patients' treatment and clinical course were small. Rather than referring patients to a psychiatric unit, the evaluation and management of depression should be undertaken at the pulmonary unit.
PubMed ID
30480876 View in PubMed
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Incomplete colonoscopy: maximizing completion rates of gastroenterologists.

https://arctichealth.org/en/permalink/ahliterature120536
Source
Can J Gastroenterol. 2012 Sep;26(9):589-92
Publication Type
Article
Date
Sep-2012
Author
Mayur Brahmania
Jei Park
Sigrid Svarta
Jessica Tong
Ricky Kwok
Robert Enns
Author Affiliation
Department of Medicine, Division of Gastroenterology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia.
Source
Can J Gastroenterol. 2012 Sep;26(9):589-92
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
British Columbia
Colonic Diseases - diagnosis - therapy
Colonoscopy - adverse effects - instrumentation
Female
Gastroenterology
Humans
Male
Medical Errors
Middle Aged
Retreatment
Retrospective Studies
Risk factors
Tertiary Healthcare
Treatment Failure
Abstract
Cecal intubation is one of the goals of a quality colonoscopy; however, many factors increasing the risk of incomplete colonoscopy have been implicated. The implications of missed pathology and the demand on health care resources for return colonoscopies pose a conundrum to many physicians. The optimal course of action after incomplete colonoscopy is unclear.
To assess endoscopic completion rates of previously incomplete colonoscopies, the methods used to complete them and the factors that led to the previous incomplete procedure.
All patients who previously underwent incomplete colonoscopy (2005 to 2010) and were referred to St Paul's Hospital (Vancouver, British Columbia) were evaluated. Colonoscopies were re-attempted by a single endoscopist. Patient charts were reviewed retrospectively.
A total of 90 patients (29 males) with a mean (± SD) age of 58 ± 13.2 years were included in the analysis. Thirty patients (33%) had their initial colonoscopy performed by a gastroenterologist. Indications for initial colonoscopy included surveillance or screening (23%), abdominal pain (15%), gastrointestinal bleeding (29%), change in bowel habits or constitutional symptoms (18%), anemia (7%) and chronic diarrhea (8%). Reasons for incomplete colonoscopy included poor preparation (11%), pain or inadequate sedation (16%), tortuous colon (30%), diverticular disease (6%), obstructing mass (6%) and stricturing disease (10%). Reasons for incomplete procedures in the remaining 21% of patients were not reported by the referring physician. Eighty-seven (97%) colonoscopies were subsequently completed in a single attempt at the institution. Seventy-six (84%) colonoscopies were performed using routine manoeuvres, patient positioning and a variable-stiffness colonoscope (either standard or pediatric). A standard 160 or 180 series Olympus gastroscope (Olympus, Japan) was used in five patients (6%) to navigate through sigmoid diverticular disease; a pediatric colonoscope was used in six patients (7%) for similar reasons. Repeat colonoscopy on the remaining three patients (3%) failed: all three required surgery for strictures (two had obstructing malignant masses and one had a severe benign obstructing sigmoid diverticular stricture).
Most patients with previous incomplete colonoscopy can undergo a successful repeat colonoscopy at a tertiary care centre with instruments that are readily available to most gastroenterologists. Other modalities for evaluation of the colon should be deferred until a second attempt is made at an expert centre.
Notes
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PubMed ID
22993727 View in PubMed
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Integrated complex care coordination for children with medical complexity: a mixed-methods evaluation of tertiary care-community collaboration.

https://arctichealth.org/en/permalink/ahliterature119567
Source
BMC Health Serv Res. 2012;12:366
Publication Type
Article
Date
2012
Author
Eyal Cohen
Ashley Lacombe-Duncan
Karen Spalding
Jennifer MacInnis
David Nicholas
Unni G Narayanan
Michelle Gordon
Ivor Margolis
Jeremy N Friedman
Author Affiliation
Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto M5G 1X8, ON, Canada. eyal.cohen@sickkids.ca
Source
BMC Health Serv Res. 2012;12:366
Date
2012
Language
English
Publication Type
Article
Keywords
Child
Child, Preschool
Chronic Disease - therapy
Community Health Services - organization & administration - standards
Cooperative Behavior
Delivery of Health Care, Integrated - organization & administration - standards
Female
Health Care Costs - statistics & numerical data
Hospitals, Community - organization & administration - standards
Humans
Male
Ontario
Patient-Centered Care - organization & administration - standards
Quality of Health Care
Quality of Life
Tertiary Care Centers - organization & administration - standards
Tertiary Healthcare - organization & administration - standards
Abstract
Primary care medical homes may improve health outcomes for children with special healthcare needs (CSHCN), by improving care coordination. However, community-based primary care practices may be challenged to deliver comprehensive care coordination to complex subsets of CSHCN such as children with medical complexity (CMC). Linking a tertiary care center with the community may achieve cost effective and high quality care for CMC. The objective of this study was to evaluate the outcomes of community-based complex care clinics integrated with a tertiary care center.
A before- and after-intervention study design with mixed (quantitative/qualitative) methods was utilized. Clinics at two community hospitals distant from tertiary care were staffed by local community pediatricians with the tertiary care center nurse practitioner and linked with primary care providers. Eighty-one children with underlying chronic conditions, fragility, requirement for high intensity care and/or technology assistance, and involvement of multiple providers participated. Main outcome measures included health care utilization and expenditures, parent reports of parent- and child-quality of life [QOL (SF-36®, CPCHILD©, PedsQLâ„¢)], and family-centered care (MPOC-20®). Comparisons were made in equal (up to 1 year) pre- and post-periods supplemented by qualitative perspectives of families and pediatricians.
Total health care system costs decreased from median (IQR) $244 (981) per patient per month (PPPM) pre-enrolment to $131 (355) PPPM post-enrolment (p=.007), driven primarily by fewer inpatient days in the tertiary care center (p=.006). Parents reported decreased out of pocket expenses (p
Notes
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PubMed ID
23088792 View in PubMed
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It's About Time: Rapid Implementation of a Hub-and-Spoke Care Delivery Model for Tertiary-Integrated Complex Care Services in a Northern Ontario Community.

https://arctichealth.org/en/permalink/ahliterature298010
Source
Healthc Q. 2018 Jul; 21(2):35-40
Publication Type
Journal Article
Date
Jul-2018
Author
Nathalie Major
Marie Rouleau
Chantal Krantz
Karen Morris
François Séguin
Megan Allard
Jia Lu Lilian Lin
Mary Ellen Salenieks
Roxana Sultan
W Gary Smith
Author Affiliation
A pediatrician and the medical director of the Complex Care Program at the Children's Hospital of Eastern Ontario and Ottawa Children's Treatment Centre. She works on national and provincial initiatives, advising on integrated care models. The focus of her research is on models of care coordination for children with complex chronic conditions.
Source
Healthc Q. 2018 Jul; 21(2):35-40
Date
Jul-2018
Language
English
Publication Type
Journal Article
Keywords
Child
Chronic Disease - therapy
Delivery of Health Care, Integrated - methods - organization & administration
Family
Hospitals, Pediatric - organization & administration
Humans
Ontario
Patient-Centered Care - organization & administration
Rural health services - organization & administration
Tertiary Care Centers - organization & administration
Tertiary Healthcare - organization & administration
Abstract
Children with medical complexity (CMC) in rural and northern communities have more difficulty accessing subspecialty health providers than those in urban centres. This article describes an alignment cascade in which leaders engaged peers and staff to rapidly roll out the implementation of a sustainably designed complex care model, integrated in the Champlain Complex Care Program and delivered in Timmins, Ontario. The Provincial Council for Maternal and Child Health's Complex Care for Kids Ontario (CCKO) strategy supports the implementation and expansion of a hub-and-spoke model of interprofessional complex care for CMC and their families. A nurse practitioner is the primary point of contact for the family and oversees coordination and integration of care; regional CCKO programs are committed to building capacity to provide safe, high-quality care for CMC in communities closer to their homes.
PubMed ID
30474590 View in PubMed
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