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Background: The current state of health care encompasses highly acute, complex patients, managed with ever-changing technology. The ability to function proficiently in critical care relies on knowledge, technical skills, and interprofessional teamwork. Integration of these factors can improve patient outcomes. Simulation provides "hands-on" practice and allows for the integration of teamwork into knowledge/skill training. However, simulation can require a significant investment of time, effort, and financial resources. The Institute of Medicine recommendations from 2015 include "strengthening the evidence base for interprofessional education (IPE)" and "linking IPE with changes in collaborative behavior." In one surgical-trauma-burn intensive care unit (STBICU), no IPE existed. The highly acute and diverse nature of the patients served by the unit highlights the importance of appropriate training. This is heightened during critical event situations where patients deteriorate rapidly and the team intervenes swiftly. Purpose: The aims of this study were to (1) evaluate knowledge retention and analyze changes in perceptions of teamwork among nurses and resident physicians in a STBICU setting after completion of an interprofessional critical event simulation and (2) provide insight for future interprofessional simulations (IPSs), including the ideal frequency of such training, associated cost, and potential effect on nursing turnover. Design: A comparison-cohort pilot study was developed to evaluate knowledge retention and analyze changes in perceptions of teamwork. Methods: A 1-hour critical event IPS was held for nurses and resident physicians in a STBICU setting. A traumatic brain injury patient with elevated intracranial pressure, rapid deterioration, and cardiac arrest was utilized for the simulation scenario. The simulation required the team to use interventions to reduce elevated intracranial pressure and then perform cardiac resuscitation according to Advanced Cardiac Life Support guidelines. A semistructured debriefing guided by the TENTS tool highlighted important aspects of teamwork. Participants took knowledge and Teamwork Skills Scale (TSS) pretests, posttests, and 1-month posttests. Mean scores were calculated for each time point (pre, post, and 1-month post), and paired t tests were used to evaluate changes. Results: Mean knowledge test and TSS scores both significantly increased after the simulation and remained significantly elevated at 1-month follow-up. Participants recommended retraining intervals of 3 to 6 months. Cost of each simulation was estimated to be $324.44. Analysis of nursing turnover rates did not demonstrate a statistically significant reduction in turnover; however, confounding factors were not controlled for. Conclusion: Significant improvements on both knowledge test and TSS scores demonstrate the effectiveness of the intervention, and retention of the information gained and teamwork skills learned. Participants valued the intervention and recommended to increase the frequency of training. Future studies should develop a framework for "best practice" IPS, analyze the relationship with nursing turnover, and ultimately seek correlations between IPS and improved patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To characterize trends in the acute management (within 30 days) after lateral ankle sprain (LAS) in the United States. Design: Descriptive epidemiology study. Patients: Of note, 825 718 ankle sprain patients were identified; 96.2% were patients with LAS. Seven percent had an associated fracture and were excluded from the remaining analysis. Setting: Primary and tertiary care settings. Interventions: We queried a database of national health insurance records for 2007 to 2011 by ICD-9 codes for patients with LAS while excluding medial and syndesmotic sprains and any LAS with an associated foot or ankle fracture. Main Outcome Measures: The percentage of patients to receive specific diagnostic imaging, orthopedic devices, or physical therapy treatments within 30 days of the LAS diagnosis and the associated costs. Results: Over two-thirds of patients with LAS without an associated fracture received radiographs, 9% received an ankle brace, 8.1% received a walking boot, 6.5% were splinted, and 4.8% were prescribed crutches. Only 6.8% received physical therapy within 30 days of their LAS diagnosis, 94.1% of which performed therapeutic exercise, 52.3% received manual therapy, and 50.2% received modalities. The annual cost associated with physician visits, diagnostic imaging, orthopedic devices, and physical therapy was 152 million USD, 81.5% was from physician evaluations, 7.9% from physical therapy, 7.2% from diagnostic imaging, and 3.4% from orthopedic devices. Conclusions: Most patients with LAS do not receive supervised rehabilitation. The small proportion of patients with LAS to receive physical therapy get rehabilitation prescribed in accordance with clinical practice guidelines. The majority (>80%) of the LAS financial burden is associated with physician evaluations. [ABSTRACT FROM AUTHOR]

Preterm birth occurs in 12% of all births in the United States. Preterm labor precedes approximately half of these births. Tocolysis is used in the short term to prolong pregnancy long enough to administer corticosteroids and/or facilitate transfer to a tertiary care center. A number of agents have been used for this therapy, which will be discussed in the following chapter. [ABSTRACT FROM AUTHOR]

Progestogens are a promising treatment in the prevention of spontaneous preterm birth in high-risk women. In women with a prior history of spontaneous preterm delivery and in women with a sonographic shortened cervix, there is considerable evidence supporting a benefit of progestogen therapy in the reduction of preterm delivery. In women with multifetal gestations, progestogen therapy has not been shown to be beneficial. Data are inconclusive in women with arrested preterm labor. Questions remain about the mechanism of progestogen action, the optimal type of progestogen, the best mode of administration, and the ideal dosing regimen. [ABSTRACT FROM AUTHOR]

The article discusses Osteoporosis, which is characterized by low bone mass with microarchitectural disruption and skeletal fragility, common in aging women due to progressive post-menopausal bone loss. It suggests that with Bone mass density (BMD) screening and fractural risk assessment (FRAX), healthcare providers can implement effective intervention before fracture occurs. It also provides information on pharmacological and lifestyle therapy.

The article presents a cohort study which evaluates the cost-effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome (FBSS) among workers' compensation recipients. The study was participated by 158 FBS patients which were enrolled into three treatment entities such as trial SCS with or without permanent device implant, pain clinic evaluation with or without treatment, and the usual care. The study concluded that SCS is not cost-effective since SCS has high procedure cost.

The article discusses the cost of end-of-life care and assesses the "Consumers Reports'" hospital aggressiveness scale according to the American Heart Association and American College of Cardiology standards for public reporting of efficiency measures. It looks at the causes of variability in care including social care, defensive care, desperation care, limbo care and supply-sensitive care. Data on end-of-life measures for selected hospitals and alternate measures, including risk adjusted cost savings and avoidance of nonrecommended care, were compared.

The article examines the role of antibiotic costs on the cost-effectiveness of Pelvic Inflammatory Disease (PID) therapy in the U.S. To estimate the incremental cost-effectiveness of the outpatient antibiotic regimens for PID, researchers used a Markov decision model to calculate incremental costs per Quality Adjusted Life Year (QALY). They discovered that antibiotic costs vary between $43 (ceftriaxone and doxycycline) and $188 (ofloxacin/metronidazole). They hypothesize that if the more expensive of these antibiotics decreases the relative risk of PID complications by 1%, then ofloxacin/metronidazole costs $30,200 per QALY gained.

The article reports on a study that analyzed the cost effectiveness of cervical infection treatment strategies for high-risk women in Madagascar. It aims to compare effectivity and economy through a Markov decision tree analysis of the combinations of presumptive treatment (PT), risk-based treatment (RB) and laboratory/risk-based treatment (LB) policies applied on the first and three-month follow-up visits of the patients. It found that the PT-PT and RB-PT are more costly and more effective. Sustained RB-PT was determined as the best approach for gonorrhea and chlamydial infections. It concluded that the national guidelines are reasonable for resource-scarce Madagascar.

OBJECTIVE:: Prophylactic hemofiltration has been reported, in one study, to reduce renal complications and death but necessitates additional up-front health care resource deployment in a critical care setting. We sought to explore the potential scope and cost-effectiveness of this strategy. DESIGN:: Economic evaluation using decision analysis. SETTING:: Tertiary or quaternary care hospital. PATIENTS:: Subjects undergoing angiography at risk for developing contrast nephropathy. INTERVENTION:: Prophylactic hemofiltration was compared with intravenous saline. Secondary models incorporated sodium bicarbonate and N-acetylcysteine as comparators. MEASUREMENT AND MAIN RESULTS:: The cost per quality-adjusted life year (QALY) gained with hemofiltration compared with intravenous saline in high-risk subjects (mean serum creatinine, 265 μmol/L) was U.S.$3,900. This finding was sensitive to variations in several important variables. For instance, the cost-effectiveness ratio became less attractive (i.e., >$50,000/QALY) when hemofiltration was used in lower-risk subjects (serum creatinine, <265 μmol/L). The cost-effectiveness remained <$50,000/QALY provided that the relative risk of hemofiltration compared with saline alone was below 0.65 (reported relative risk, 0.10). Although based on indirect comparison of clinical efficacy, when N-acetylcysteine or sodium bicarbonate was used as the comparator, the cost per QALY gained for hemofiltration became markedly less attractive ($50,100 and >$1,000,000), although the relative effectiveness of these three strategies strongly influenced the results. CONCLUSIONS:: Use of prophylactic hemofiltration in patients at high risk for contrast nephropathy may be potentially cost-effective only if certain conditions are satisfied, and its attractiveness is materially diminished when compared to other strategies. As this invasive therapy would entail certain immediate resource outlay, before considering its implementation it is crucial to confirm the clinical effectiveness and health care resource consequences of hemofiltration relative to current standards of care in future studies. [ABSTRACT FROM AUTHOR]

Examines cost and enrollment implications of targeting different source population for an HIV treatment program by researchers from Zambia. Initiatives undertaken by the government to make antiretroviral agent accessible and available to people infected with HIV; Recommendations for an acceleration of patient enrollment; Plausibility for a rapid growth on HIV treatment programs.

PURPOSE: Intraoperative radiation therapy is reportedly effective for local control and pain relief in colorectal cancer. However, this treatment requires a large number of medical personnel, which hinders expanded use of this method. A mobile electron linear accelerator for intraoperative radiation therapy bas been developed and is now commercially available. This report analyzes the applicability of this accelerator to colorectal cancer. The applicability of the mobile accelerator is analyzed based on its specifications by simulating the intraoperative radiation therapy delivered to these patients with a conventional intraoperative radiation therapy unit. METHODS: From 1987 to 1999, 49 colorectal cancer patients underwent 54 surgical resections and received intraoperative radiation therapy to 75 sites. RESULTS: The mean intraoperative radiation therapy dose for colorectal cancer with the conventional unit was 22 (range, 10-30) Gy. The mean electron energy level was 10 (range, 3-30) MEV. Applicator size ranged from 4 to 10 cm in diameter. The mobile accelerator can achieve a dose rate of 10 Gy/min and an applicator unit size range of 3 to 10 cm in diameter, facilitating intraoperative radiation therapy for colorectal cancer. The electron energy limitation (12 MEV at maximum) suggests that the indications for this machine are limited. In our experience, 30 percent of patients received intraoperative radiation therapy with electron energy levels exceeding 12 MEV. Of these cases, 81 percent had macroscopic residual tumor and 69 percent had pain. CONCLUSION: An intraoperative radiation therapy mobile accelerator can cover 72 percent of the irradiation sites covered using our conventional unit. This accelerator is useful for intraoperative radiation therapy with curative intent for patients with no or slight residual tumor. Patients with gross residual tumor and pain may not be suitable. [ABSTRACT FROM AUTHOR]

Abstract: Learn how to properly use continuous lateral rotation therapy, indicated for the prevention and treatment of pulmonary complications, to facilitate positive outcomes. [Nurs Manage 2003:34(8):56A-56D] INSET: Examining a sample CLRT protocol. [ABSTRACT FROM AUTHOR]

The authors reflect on the study by N. Khandelwal and colleagues which shows the challenges in identifying rescue therapies for refractory hypoxemia in acute respiratory distress syndrome (ARDS) patients. They say that the authors describe the outcome of using rescue therapies including inhaled epoprostenol, inhaled nitric oxide, and prone position ventilation. They add that the authors note practical limitations of rescue therapies and cite no difference in their cost analysis.