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Objective: To design and implement a needs assessment process that identifies gaps in caring for critically ill patients in a community hospital.
Design, Setting, Subjects: This mixed-method study was conducted between June 2011 and February 2012. A conceptual framework, centered on the critically ill patient, guided the design and selection of the data collection instruments. Different perspectives sampled included regional leaders, healthcare professionals at the community hospital and its referral hospital, as well as family members of patients who had received care at the community ICU. Data sources included interviews (n = 22), walk-throughs (n = 5), focus groups (n = 31), database searches, context questionnaires (n = 8), family surveys (n = 16), and simulations (n = 13).
Interventions: None.
Measurements And Main Results: Nine needs were identified. At the community hospital, needs identified included lack of access to human resources, gaps in expertise, poor patient flow and ICU bed use, communication, lack of educational opportunities, and gaps in end-of-life care and interprofessional teamwork. Needs were also identified in the interhospital interaction between the community and referral hospitals, which included an inadequate hospital network and gaps in transfer and repatriation of patients. The methodology uncovered the causes and widespread impact of each need and how they interacted with one another. Proposed solutions by the participants are presented including both organizational and educational/clinical solutions.
Conclusions: This study captured needs in a complex, interprofessional, interhospital context, which can be targeted with tailored interventions to improve patient outcomes in a community hospital. Furthermore, this study provides a preliminary framework and rigorous methodology to performing a needs assessment in this setting.
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http://dx.doi.org/10.1097/CCM.0000000000000036 | DOI Listing |
Am J Community Psychol
December 2024
Loyola University Chicago, Chicago, Illinois, USA.
The purpose of this study was to utilize mixed methods to evaluate the initial implementation of a system of care (SOC) developed and implemented from a community organizing framework. Surveys were conducted with partners (navigators, community partners, parents) to examine changes pre- and post-implementation of the SOC. Surveys assessed care coordination, effectiveness of communication across organizations, quality of services and relationships, barriers, health-related stressors, and distrust.
View Article and Find Full Text PDFClin Trials
December 2024
Cancer Research UK Southampton Clinical Trials Unit, MP131, Southampton General Hospital, University of Southampton, Southampton, UK.
Unlocking the power of personalised medicine in oncology hinges on the integration of clinical trial data with translational data (i.e. biospecimen-derived molecular information).
View Article and Find Full Text PDFLiver Int
January 2025
Division of Gastroenterology-Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Introduction: Racial/ethnic disparities have been previously reported in renal and hepatic disease care; however, acute kidney injury (AKI) in the setting of cirrhosis (hepatorenal syndrome [HRS]-AKI) despite its complexity requiring a multidisciplinary approach, remains understudied.
Methods: To identify unique associations of clinical and sociodemographic factors with mortality and length of stay (LOS) among patients hospitalised with HRS-AKI, hierarchical regression analysis was conducted, along with a mediation analysis to estimate how race-related differences in in-hospital mortality were influenced by payer type, area household income, and clinical severity.
Results: Black patients demonstrated a significantly higher odds of in-hospital mortality, compared to their white counterparts, adjusting for (1) sex and age, (2) sex, age, payer type, and area household income and (3) sex, age, and clinical severity [OR 1.
Front Immunol
December 2024
Department of Intensive Care Unit, Peking University International Hospital, Beijing, China.
Background: The escalating demographic shift towards an aging population and the widespread occurrence of immunological diseases have contributed to an elevation in the frequency of community-acquired infections. Notably, among these infections, community-acquired bloodstream infections (CABSI) stand out due to their significant lethality. Detailed medical history inquiries, assessment of underlying immune status, detection of the source of infection, and initial precise identification and treatment of the infectious agents can improve the prognosis of CABSI.
View Article and Find Full Text PDFMed Cannabis Cannabinoids
November 2024
Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand.
Introduction: Diabetic peripheral neuropathy (DPN) represents a prevalent neurological complication affecting millions of patients globally. This clinical investigation evaluated the therapeutic efficacy and safety profile of a novel transdermal medical cannabis formulation (THC:CBD:CBN) in treating painful DPN of the lower extremities.
Methods: This phase III, double-blind, placebo-controlled, randomized clinical trial was conducted at Don Chan Hospital, Thailand, enrolling 100 participants over a 12-week intervention period.
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