Comparison of wound complications between one-stage and two-stage brachiobasilic arteriovenous fistula: A meta-analysis.

Research assessing the outcome of brachiobasilic arteriovenous fistulas (BB-AVF) after a one- and two-stage technique was conducted. A strict review of the comprehensive literature up to May 2023 was carried out using four databases-PubMed，Embase, Cochrane Library and web of science. Inclusion and exclusion criteria developed for the study were then applied to assess the quality of the literature, it was decided to review 12 interrelated studies.95% confidence intervals (Cl) and odds ratios (OR) were calculated using fixed effects models. The data were meta-analysed using RevMan 5.3 software. The results showed that two-stage technique with BB-AVF reduced surgical site haematoma (SSH) formation, (OR, 2.28; 95% CI, 1.24-4.17, p = 0.008), and also reduced surgical site wound infection (SSWI) (OR, 1.86; 95% CI, 1.17-2.94, p = 0.008). There are, however, several small sample sizes in the selected studies for this meta-analysis, so caution should be used when processing their values. There are more high-quality studies with large sample sizes that should be considered for future meta-analyses.

An intervention to improve inpatient medication management: a before and after study.

AIM: To optimise medication administration, prevent medication errors and improve inpatient safety. BACKGROUND: Interventions are needed to reduce medication-related errors and to improve patient safety. METHOD: A five-point management intervention strategy was developed and implemented. A quasi-experimental design was used to examine its effects. RESULTS: Comparing pre-intervention data with post-intervention data, the rate of accurate compliance with medication policies and procedures increased from 86.7% (645/744 doses observed) to 97.5% (725/744). The success rate of medication administration procedures increased from 94.0% (466/496 doses observed) to 96.8% (480/496). Nurse-initiated medication error reports/total medication error reports increased from 77.1% (101/131) to 95.1% (58/61). Rate of inpatient satisfaction with medication increased from 92.1% (3427/3720) to 98.3% (3656/3720). Complaints related to nursing medication administration decreased from 23 to 6 (73.9% reduction). CONCLUSION: The five-point management intervention strategy improved inpatient medication safety: medication errors were reduced, nurses' awareness and skills of medication safety enhanced, inpatient satisfaction improved. However, randomised controlled trials are needed to test its effectiveness. IMPLICATIONS FOR NURSING MANAGEMENT: A systematic approach is vital to address the issues of medication errors and patient safety.

[The interventions effect-assessment of the workers exposed to N, N-dimethylformamide by percutaneous in a synthetic leather factory].

OBJECTIVE: To assess the effects of interventions on synthetic leather workers exposed to N, N-dimethylformamide (DMF) by skin. METHODS: Twenty-six workers exposed to DMF were recruited. The level of DMF in ambient or handwash solution and N-methylformamide (NMF) in end-shift urine samples were detected before interventions and after interventions for six months. RESULTS: After interventions the levels of DMF in ambient reduced 52.7% from (63.27 +/- 52.67) mg/m3 to (29.95 +/- 23.79) mg/m3. The levels of NMF in urine samples reduced 17.9% from (2.07 +/- 0.32) mg/g Cr to (1.70 +/- 0.29) mg/g Cr (P < 0.01). The mean level of DMF in handwash solution reduced 53.4% from 0.88 +/- 0.40 mg to 0.41 +/- 0.81 mg. CONCLUSION: This study showed that the multi-intervention measures (engineering control, personal protection and health promotion) should be used for the synthetic leather workers occupationally exposed to DMF.

Association of a Care Coordination Model With Health Care Costs and Utilization: The Johns Hopkins Community Health Partnership (J-CHiP).

Importance: The Johns Hopkins Community Health Partnership was created to improve care coordination across the continuum in East Baltimore, Maryland. Objective: To determine whether the Johns Hopkins Community Health Partnership (J-CHiP) was associated with improved outcomes and lower spending. Design, Setting, and Participants: Nonrandomized acute care intervention (ACI) and community intervention (CI) Medicare and Medicaid participants were analyzed in a quality improvement study using difference-in-differences designs with propensity score-weighted and matched comparison groups. The study spanned 2012 to 2016 and took place in acute care hospitals, primary care clinics, skilled nursing facilities, and community-based organizations. The ACI analysis compared outcomes of participants in Medicare and Medicaid during their 90-day postacute episode with those of a propensity score-weighted preintervention group at Johns Hopkins Community Health Partnership hospitals and a concurrent comparison group drawn from similar Maryland hospitals. The CI analysis compared changes in outcomes of Medicare and Medicaid participants with those of a propensity score-matched comparison group of local residents. Interventions: The ACI bundle aimed to improve transition planning following discharge. The CI included enhanced care coordination and integrated behavioral support from local primary care sites in collaboration with community-based organizations. Main Outcomes and Measures: Utilization measures of hospital admissions, 30-day readmissions, and emergency department visits; quality of care measures of potentially avoidable hospitalizations, practitioner follow-up visits; and total cost of care (TCOC) for Medicare and Medicaid participants. Results: The CI group had 2154 Medicare beneficiaries (1320 [61.3%] female; mean age, 69.3 years) and 2532 Medicaid beneficiaries (1483 [67.3%] female; mean age, 55.1 years). For the CI group's Medicaid participants, aggregate TCOC reduction was $24.4 million, and reductions of hospitalizations, emergency department visits, 30-day readmissions, and avoidable hospitalizations were 33, 51, 36, and 7 per 1000 beneficiaries, respectively. The ACI group had 26 144 beneficiary-episodes for Medicare (13 726 [52.5%] female patients; mean patient age, 68.4 years) and 13 921 beneficiary-episodes for Medicaid (7392 [53.1%] female patients; mean patient age, 52.2 years). For the ACI group's Medicare participants, there was a significant reduction in aggregate TCOC of $29.2 million with increases in 90-day hospitalizations and 30-day readmissions of 11 and 14 per 1000 beneficiary-episodes, respectively, and reduction in practitioner follow-up visits of 41 and 29 per 1000 beneficiary-episodes for 7-day and 30-day visits, respectively. For the ACI group's Medicaid participants, there was a significant reduction in aggregate TCOC of $59.8 million and the 90-day emergency department visit rate decreased by 133 per 1000 episodes, but hospitalizations increased by 49 per 1000 episodes and practitioner follow-up visits decreased by 70 and 182 per 1000 episodes for 7-day and 30-day visits, respectively. In total, the CI and ACI were associated with $113.3 million in cost savings. Conclusions and Relevance: A care coordination model consisting of complementary bundled interventions in an urban academic environment was associated with lower spending and improved health outcomes.

Development and applications of an outcomes assessment framework for care management programs in learning health systems.

PURPOSE: To develop and apply an outcomes assessment framework (OAF) for care management programs in health care delivery settings. BACKGROUND: Care management (CM) refers to a regimen of organized activities that are designed to promote health in a population with particular chronic conditions or risk profiles, with focus on the triple aim for populations: improving the quality of care, advancing health outcomes, and lowering health care costs. CM has become an integral part of a care continuum for population-based health care management. To sustain a CM program, it is essential to assure and improve CM effectiveness through rigorous outcomes assessment. To this end, we constructed the OAF as the foundation of a systematic approach to CM outcomes assessment. INNOVATIONS: To construct the OAF, we first systematically analyzed the operation process of a CM program; then, based on the operation analysis, we identified causal relationships between interventions and outcomes at various implementation stages of the program. This set of causal relationships established a roadmap for the rest of the outcomes assessment. Built upon knowledge from multiple disciplines, we (1) formalized a systematic approach to CM outcomes assessment, and (2) integrated proven analytics methodologies and industrial best practices into operation-oriented CM outcomes assessment. CONCLUSION: This systematic approach to OAF for assessing the outcomes of CM programs offers an opportunity to advance evidence-based care management. In addition, formalized CM outcomes assessment methodologies will enable us to compare CM effectiveness across health delivery settings.

Weekly TP regimen as a postoperative adjuvant chemotherapy for completely resected breast cancer in China: final result of a phase II trial.

OBJECTIVES: To investigate the safety and long-term survival with weekly paclitaxel combined with cisplatin (wTP) as a postoperative adjuvant chemotherapy regimen for breast cancer. METHODS: Patients with breast cancer were treated postoperatively with paclitaxel 40 mg/m2 intravenously on days 1, 8 and 15, cisplatin 25 mg/ m2 also intravenously on days 1,8 and 15, repeated every 21-28 days as a cycle. Toxicity and survival rate were evaluated after chemotherapy. RESULTS: Between September 1993 and August 2001, 20 patients were enrolled. Median age was 52 years (range, 35-71 years). According to the TNM stage system, all patients were staged II or III. Median number of chemotherapy cycles was 3 (range, 1-6), and 10 patients received 4 to 6 cycles of wTP. After a median follow-up of 83 months, 2 deaths and 6 relapses were documented. The five year overall survival rate was 90%. All patients could be evaluated with regard to toxicity. No treatment related deaths were recorded. Neutropenia occurred in 75% of patients during treatment, all recovering after G-CSF injection. Other symptoms included nausea/vomiting, elevation of transaminase, urea nitrogen/creatinine and alopecia. CONCLUSIONS: wTP is safe and effective at the doses tested. However, a randomized clinical trial is needed to compare wTP with other conventional adjuvant regimens of breast cancer postoperatively.