Reducing Cardiovascular Risk for Patients With Diabetes: An Evidence-Based, Population Health Management Program.

Those with diabetes are at an increased risk of cardiovascular disease (CVD). Safety net clinics serve populations that bear a significant burden of disease and disparities and are a key setting in which to focus on reducing CVD. An integrated health system provided funding and technical assistance (TA) to safety net organizations (community health centers and public hospitals) in Northern California to decrease the risk of cardiovascular events for patients with diabetes.

Stratifying Deterioration Risk by Acuity at Admission Offers Triage Insights for Coronavirus Disease 2019 Patients.

Objectives: Triaging patients at admission to determine subsequent deterioration risk can be difficult. This is especially true of coronavirus disease 2019 patients, some of whom experience significant physiologic deterioration due to dysregulated immune response following admission. A well-established acuity measure, the Rothman Index, is evaluated for stratification of patients at admission into high or low risk of subsequent deterioration.

Development and validation of a continuously age-adjusted measure of patient condition for hospitalized children using the electronic medical record.

Awareness of a patient's clinical status during hospitalization is a primary responsibility for hospital providers. One tool to assess status is the Rothman Index (RI), a validated measure of patient condition for adults, based on empirically derived relationships between 1-year post-discharge mortality and each of 26 clinical measurements available in the electronic medical record. However, such an approach cannot be used for pediatrics, where the relationships between risk and clinical variables are distinct functions of patient age, and sufficient 1-year mortality data for each age group simply do not exist.

Sepsis as 2 problems: Identifying sepsis at admission and predicting onset in the hospital using an electronic medical record-based acuity score.

Purpose: Early identification and treatment improve outcomes for patients with sepsis. Current screening tools are limited. We present a new approach, recognizing that sepsis patients comprise 2 distinct and unequal populations: patients with sepsis present on admission (85%) and patients who develop sepsis in the hospital (15%) with mortality rates of 12% and 35%, respectively.

Measuring the modified early warning score and the Rothman index: advantages of utilizing the electronic medical record in an early warning system.

Early detection of an impending cardiac or pulmonary arrest is an important focus for hospitals trying to improve quality of care. Unfortunately, all current early warning systems suffer from high false-alarm rates. Most systems are based on the Modified Early Warning Score (MEWS); 4 of its 5 inputs are vital signs.

Development and validation of a continuous measure of patient condition using the Electronic Medical Record.

Patient condition is a key element in communication between clinicians. However, there is no generally accepted definition of patient condition that is independent of diagnosis and that spans acuity levels. We report the development and validation of a continuous measure of general patient condition that is independent of diagnosis, and that can be used for medical-surgical as well as critical care patients.

Placing clinical variables on a common linear scale of empirically based risk as a step towards construction of a general patient acuity score from the electronic health record: a modelling study.

Objective: To explore the hypothesis that placing clinical variables of differing metrics on a common linear scale of all-cause postdischarge mortality provides risk functions that are directly correlated with in-hospital mortality risk.

Design: Modelling study.

Setting: An 805-bed community hospital in the southeastern USA.

Clinical implications and validity of nursing assessments: a longitudinal measure of patient condition from analysis of the Electronic Medical Record.

Objectives: This study investigates risk of mortality associated with nurses' assessments of patients by physiological system. We hypothesise that nursing assessments of in-patients performed at entry correlate with in-hospital mortality, and those performed just before discharge correlate with postdischarge mortality.

Design: Cohort study of in-hospital and postdischarge mortality of patients over two 1-year periods.

Marital satisfaction across the transition to parenthood.

The purpose of the present study was to discriminate between the 2 dominant perspectives governing research on the nature of marital change over the transition to parenthood. Progress can be made in understanding this transition by recognizing the role of uncontrolled sources of variability in research designs, defining and using control groups, and timing of data collection around the child's arrival, and the authors conducted a study incorporating these methodological refinements. Growth curve analyses were conducted on marital satisfaction data collected twice before and twice after the birth of the 1st child and at corresponding points for voluntarily childless couples (N = 156 couples).

Computed Tomography is Diagnostic in the Cervical Imaging of Helmeted Football Players With Shoulder Pads.

OBJECTIVE: Prospective, observational case series evaluating the value of cervical spine computed tomography (CT) scans in the initial evaluation of a helmeted football player with suspected cervical spine injury. SUBJECTS: Five asymptomatic male football players, fully equipped and immobilized on a backboard. DESIGN: Multiple 3.

MRI is nondiagnostic in cervical spine imaging of the helmeted football player with shoulder pads.

Background: It is currently recommended that helmet and shoulder pads remain in place during the initial clinical and radiographic evaluation of the helmeted athlete with a potential cervical spine injury. The objective of this prospectively designed, single-subject study was to determine whether MRI may play a role in the initial evaluation and management of the helmeted football player with a cervical spine injury.

Methods: One male athlete was fitted using equipment (football helmet [Riddell], shoulder pads [Douglas]) worn during the collegiate season at Lehigh University.

Pursuing perfection: an interview with Don Berwick and Michael Rothman. Interview by Andrea Kabcenell and Jane Roessner.

Don Berwick and Michael Rothman discuss the Pursuing Perfection initiative, which is intended to help health care organizations integrate improvement work into day-to-day life, with systemwide changes in infrastructure, project management, care, and leadership.