Cost-effectiveness of screening for chronic hepatitis C infection in the United States.

Background: Hepatitis C virus (HCV) is the most common chronic blood-borne infection in the United States and will become an increasing source of morbidity and mortality with aging of the infected population. Our objective was to develop decision analytic models to explore the cost-effectiveness of screening in populations with varying prevalence of HCV and risks for fibrosis progression.

Methods: We developed a Markov state transition model to examine screening of an asymptomatic community-based population in the United States.

Clinicians' Attitudes Towards an Antimicrobial Stewardship Program at a Children's Hospital.

Background: In pediatrics, limited data are available on how to develop and implement an antimicrobial stewardship program (ASP). In addition, no data exist on clinicians' impression of such programs. The objectives of this study were to describe the development and implementation of an ASP in a children's hospital and to describe the thoughts and attitudes of the clinicians interacting with the ASP.

Impact of a Prospective-Audit-With-Feedback Antimicrobial Stewardship Program at a Children's Hospital.

Background: The emergence of antibiotic-resistant organisms and the lack of development of new antimicrobials have made it imperative that additional strategies be developed to maintain the effectiveness of these existing antibiotics. The objective of this study was to describe the impact of a prospective-audit-with-feedback antimicrobial stewardship program (ASP) on antibiotic use in a children's hospital.

Method: A quasi-experimental study design with a control group was performed to assess the impact of a prospective-audit-with-feedback ASP.

Morbidity and effectiveness of laparoscopic sleeve gastrectomy, adjustable gastric band, and gastric bypass for morbid obesity.

LSG, LAGB, and LRYGB are all safe and effective modern surgical options for the treatment of morbid obesity. Recent quality improvement successes in bariatric surgical care delivery have resulted in low mortality and morbidity after these procedures. All seem to result in sustained weight loss and improvement in weight-related comorbidities, although appropriate long-term outcomes data for all procedure types are needed.

Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

Background: The risk of stroke varies considerably across different groups of patients with atrial fibrillation (AF). Antithrombotic prophylaxis for stroke is associated with an increased risk of bleeding. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios.

Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

Background: This guideline addresses the management of patients who are receiving anticoagulant or antiplatelet therapy and require an elective surgery or procedure.

Methods: The methods herein follow those discussed in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines article of this supplement.

Methodology for the development of antithrombotic therapy and prevention of thrombosis guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

Background: To develop the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: ACCP Evidence-Based Clinical Practice Guidelines (AT9), the American College of Chest Physicians (ACCP) assembled a panel of clinical experts, information scientists, decision scientists, and systematic review and guideline methodologists.

Methods: Clinical areas were designated as articles, and a methodologist without important intellectual or financial conflicts of interest led a panel for each article. Only panel members without significant conflicts of interest participated in making recommendations.

The cost-effectiveness of screening for chronic hepatitis B infection in the United States.

Background: Hepatitis B virus (HBV) continues to cause significant morbidity and mortality in the United States. Current guidelines suggest screening populations with a prevalence of ≥2%. Our objective was to determine whether this screening threshold is cost-effective and whether screening lower-prevalence populations might also be cost-effective.

Moving the tipping point: the decision to anticoagulate patients with atrial fibrillation.

Background: The rate of ischemic stroke associated with traditional risk factors for patients with atrial fibrillation has declined over the past 2 decades. Furthermore, new and potentially safer anticoagulants are on the horizon. Thus, the balance between risk factors for stroke and benefit of anticoagulation may be shifting.

Risk Factors and Outcomes for Vancomycin-Resistant Enterococcus Bloodstream Infection in Children.

Background and objective. Enterococcal bloodstream infections (BSIs) cause morbidity and mortality in children. This study aims to describe the epidemiological characteristics of enterococcal BSI, to determine the risk factors for vancomycin-resistant Enterococcus (VRE) BSI, and to compare outcomes of VRE BSI and vancomycin-susceptible Enterococcus (VSE) BSI in this population.

Longitudinal analysis of genitourinary and bowel symptoms in prostate cancer patients following brachytherapy.

Objectives: Multiple options with similar cure rates exist for men with localized adenocarcinoma of the prostate. Therefore, treatment-related morbidity is a major consideration for treatment selection. We present a descriptive, longitudinal analysis of genitourinary and bowel symptoms following treatment in a brachytherapy registry at the University of Cincinnati.

Should we test for CYP2C9 before initiating anticoagulant therapy in patients with atrial fibrillation?

Background: Genetic variants of the warfarin sensitivity gene CYP2C9 have been associated with increased bleeding risk during warfarin initiation. Studies also suggest that such patients remain at risk throughout treatment.

Objective: Would testing patients with non-valvular atrial fibrillation (AF) for CYP2C9 before initiating warfarin improve outcomes?

Design: Markov state transition decision model.

Patient-specific decision-making for warfarin therapy in nonvalvular atrial fibrillation: how will screening with genetics and imaging help?

Background And Purpose: Intracerebral hemorrhage (ICH) accounts for a majority of long-term morbidity and mortality associated with bleeding while on warfarin. Both ICH and warfarin-related ICH appear to have a genetic component. Furthermore, advanced neuroimaging using MRI can now identify individuals at increased risk of ICH.

Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data.

Background: Previous multi-institution comparisons of open and laparoscopic Roux-en-Y gastric bypass (ORYGB and LRYGB), and laparoscopic adjustable gastric banding (LAGB) have been limited by the lack of unique current procedural terminology (CPT) codes. Specific codes have been available for LRYGB and LAGB since 2005 and 2006, respectively. We compare the short-term safety of these procedures, using risk-adjusted clinical data from a multi-institutional quality improvement program.

Pediatric patient safety events during hospitalization: approaches to accounting for institution-level effects.

Objective: To determine the rates, patient, and institutional characteristics associated with the occurrence of patient safety indicators (PSIs) in hospitalized children and the degree of statistical difference derived from using three approaches of controlling for institution level effects.

Data Source: Pediatric Health Information System Dataset consisting of all pediatric discharges (<21 years of age) from 34 academic, freestanding children's hospitals for calendar year 2003.

Methods: The rates of PSIs were computed for all discharges.

Liver resection in veterans affairs and selected university medical centers: results of the patient safety in surgery study.

Background: A congressional mandate, which led to the formation of the National Surgical Quality Improvement Program, is now being fulfilled with the publication of general and vascular surgical outcomes comparisons between Veterans Affairs (VA) and university medical centers. A series of National Surgical Quality Improvement Program articles evaluate the effect of hospital type (VA versus university hospitals) on procedure-specific outcomes. This article focuses on liver resections.

Uncommon primary tracheal tumors.

Background: Primary tracheal tumors other than adenoid cystic or squamous cell carcinoma are uncommon and have a heterogeneous histologic appearance. The experience regarding their treatment and long-term outcome is limited, and alternatives to segmental tracheal resection, including endoscopic treatment or radiation, continue to be explored.

Methods: A retrospective analysis was performed of uncommon tracheal tumors among 360 primary tracheal tumors seen over 40 years, excluding adenoid cystic and squamous cell carcinoma.

Maximizing operating room and recovery room capacity in an era of constrained resources.

Hypothesis: Three parallel processing operating rooms (ORs) (concurrent induction and turnover) with a dedicated 3-bed mini-recovery room (mini-postanesthesia care unit [PACU]) will optimize patient throughput and main PACU workload when compared with 4 traditional ORs or 4 parallel processing ORs.

Design: Statistical and mathematical models projected the impact of parallel processing on case throughput and PACU use.

Setting: Academic medical center with 48 traditional ORs using serial induction and turnover and 1 experimental OR, the operating room of the future, with parallel processing.

Implications and cost of pancreatic leak following distal pancreatic resection.

Objectives: Pancreatic stump leak (PL) after elective distal pancreatic resection significantly impacts cost and increases subsequent health care resource utilization. We sought to provide an economic framework for potential interventions aimed at reducing its occurrence.

Design: Retrospective case series and economic evaluation.

Increasing operating room efficiency through parallel processing.

Objective: Because of rising costs and shrinking reimbursements, hospitals must continually find ways to improve efficiency and productivity. This study attempts to increase caseloads in ambulatory surgery operating rooms while maintaining patient satisfaction and safety.

Summary Background Data: In most hospitals, patients move through their operative day in a linear fashion, starting at registration and finishing in the recovery room.

Prescription of nonsteroidal anti-inflammatory drugs and muscle relaxants for back pain in the United States.

Study Design: Secondary analysis of the 2000 Medical Expenditure Panel Survey (MEPS). OBJECTIVE.: To examine national prescription patterns of nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants among individuals with back pain in the United States.

Improving surgical wound classification--why it matters.

Surgical wound classification is an important predictor of the risk of postoperative surgical site infections. Wound classification also is used to analyze clinical, economic, and educational outcomes in national reports on quality. As integral members of the health care team, nurses and physicians need to ensure that their data are correct, consistent, and reliable.

Using intranet-based order sets to standardize clinical care and prepare for computerized physician order entry.

Background: The high cost of computerized physician order entry (CPOE) and physician resistance to standardized care have delayed implementation. An intranet-based order set system can provide some of CPOE's benefits and offer opportunities to acculturate physicians toward standardized care. INTRANET CLINICIAN ORDER FORMS (COF): The COF system at the Medical University of South Carolina (MUSC) allows caregivers to enter and print orders through the intranet at points of care and to access decision support resources.