Implementing a closed loop clinical decision support system for sustainable preoperative care.

Unnecessary preoperative testing poses a risk to patient safety, causes surgical delays, and increases healthcare costs. We describe the effects of implementing a fully EHR-integrated closed-loop clinical decision support system (CDSS) for placing automatic preprocedural test orders at two teaching hospitals in Madrid, Spain. Interrupted time series analysis was performed to evaluate changes in rates of preoperative testing after CDSS implementation, which took place from September 2019 to December 2019.

Value-based care as a solution to resolve the open debate on public healthcare outsourcing in Europe: What do the available data say?

Controversy surrounds the current debate regarding the effects of outsourcing health services, as recent studies claim that increased outsourcing leads to reduced costs at the expense of worse patient outcomes. The goal of the value-based model is to enable healthcare systems to create more value for patients, and evidence points to improvements in public health outcomes, patient experience, and health expenditure in systems incorporating components of value-based healthcare. Some emerging evidence indicates promising results for outsourced hospitals which follow a value-based model of healthcare delivery.

Closing the value-based circle in shared decision-making: a digital framework for informing the shared decision-making process through patient reported outcome and experience measures.

Background: The spreading adoption of value-based models of healthcare delivery has incentivized the use of patient-reported outcomes and experience measures (PROMs and PREMs) in clinical practice, with the potential to enrich the decision-making process with patient-reported data.

Methods: This perspective article explores PROs and the shared decision-making (SDM) process as components of value-based healthcare. We describe the potential of PROMs and PREMs within the decision-making process and present a digital framework for informing the shared decision-making process using aggregated data from a healthcare system PROMs and PREMs program, including early results from implementation in hospital network in Madrid, Spain.

Successful Use of Propofol After Failed Palliative Sedation in Patients With Refractory Symptoms.

Propofol is a general anesthetic used in multiple clinical scenarios. Despite growing evidence supporting its use in palliative care, propofol is rarely used in palliative sedation. Reluctance toward the adoption of propofol as a sedative agent is often associated with fear of adverse events such as respiratory arrest.

Risk Factors for Therapeutic Failure and One-Year Mortality in Patients with Intramedullary Nail-Associated Infection after Trochanteric and Subtrochanteric Hip Fracture Repair.

Despite the implications of trochanteric and subtrochanteric intramedullary (IM) nail infection for patients with hip fracture, little is known about risk factors for therapeutic failure and mortality in this population. We performed a retrospective observational analysis including patients diagnosed with trochanteric and subtrochanteric IM nail infection at a Spanish academic hospital during a 10-year period, with a minimum follow-up of 22 months. Of 4044 trochanteric and subtrochanteric IM nail implants, we identified 35 cases of infection during the study period (0.

Effect of an algorithm for automatic placing of standardised test order sets on low-value appointments and attendance rates at four Spanish teaching hospitals: an interrupted time series analysis.

Objective: Reducing backlogs for elective care is a priority for healthcare systems. We conducted an interrupted time series analysis demonstrating the effect of an algorithm for placing automatic test order sets prior to first specialist appointment on avoidable follow-up appointments and attendance rates.

Design: Interrupted time series analysis.

The caregiver's perspective on end-of-life inpatient palliative care: a qualitative study.

Introduction: Understanding patient and caregiver experience is key to providing person-centered care. The palliative care approach includes holistic assessment and whole-person care at the end of life, that also involves the patient's family and loved ones. The aim of this study was to describe the way that family caregivers experienced patients' deaths during their loved ones' last hospital admission, comparing inpatient palliative care (PCU) and non-palliative care (Non-PCU) units.

Using artificial intelligence to reduce orthopedic surgical site infection surveillance workload: Algorithm design, validation, and implementation in 4 Spanish hospitals.

Background: Surgical site infection (SSI) surveillance is a labor-intensive endeavor. We present the design and validation of an algorithm for SSI detection after hip replacement surgery, and a report of its successful implementation in 4 public hospitals in Madrid, Spain.

Methods: We designed a multivariable algorithm, AI-HPRO, using natural language processing (NLP) and extreme gradient boosting to screen for SSI in patients undergoing hip replacement surgery.

Pharmacotherapy options and drug development in managing periprosthetic joint infections in the elderly.

Introduction: Prosthetic joint infections are an increasingly important problem among patients undergoing arthroplasty procedures, and are associated with significant morbidity, reduced quality of life, substantial healthcare costs, and even mortality. Arthroplasties are performed with increasing frequency in elderly patients, who present specific problems.

Areas Covered: Surgical therapy is clearly influenced by the clinical status of the patient, which in some case can contraindicate surgery.

Orthopedic Implant-Associated Infection by Multidrug Resistant .

Introduction: Orthopedic implant-associated infections caused by multidrug-resistant are a growing challenge for healthcare providers due to their increasing incidence and the difficulties of medical and surgical treatment.

Material And Methods: A retrospective observational study of all cases of multidrug resistant orthopedic implant-associated infection diagnosed in a tertiary European hospital from December 2011 to November 2017 was carried out. Clinical records were reviewed using a previously designed protocol.

SDQ Dysregulation Profile and Its Relation to the Severity of Psychopathology and Psychosocial Functioning in a Sample of Children and Adolescents With ADHD.

A substantial number of children and adolescents with ADHD show severe affective and behavioral dysregulation. A dysregulation profile (DP) distinguishes those participants at a higher risk of comorbidity, dysfunction, and a poorer response to treatment. It was identified as high scoring in certain subscales of the Strengths and Difficulties Questionnaire (SDQ-DP).

User profiles of an electronic mental health tool for ecological momentary assessment: MEmind.

Ecological momentary assessment (EMA) is gaining importance in psychiatry. This article assesses the characteristics of patients who used a new electronic EMA tool: the MEmind Wellness Tracker. Over one year, 13811 adult outpatients in our Psychiatry Department were asked to use MEmind.