Psychiatric symptoms and their association with sleep disturbances in intensive care unit survivors.

Background: Sleep disturbances in critically ill patients are associated with poorer long-term clinical outcomes and quality of life. Studies are needed to better characterize associations and risk factors for persistent sleep disturbances after intensive care unit (ICU) discharge. Psychiatric disorders are frequently associated with sleep disturbances, but the role of psychiatric symptoms in sleep disturbances in ICU survivors has not been well-studied.

Predicting postoperative delirium severity in older adults: The role of surgical risk and executive function.

Objectives: Delirium is an important postoperative complication, yet predictive risk factors for postoperative delirium severity remain elusive. We hypothesized that the NSQIP risk calculation for serious complications (NSQIP-SC) or risk of death (NSQIP-D), and cognitive tests of executive function (Trail Making Tests A and B [TMTA and TMTB]), would be predictive of postoperative delirium severity. Further, we demonstrate how advanced statistical techniques can be used to identify candidate predictors.

US Physicians' Work Motivation and Their Occupational Health: A National Survey of Practicing Physicians.

Background: Poor occupational health among physicians poses a serious risk both to physicians themselves and the patients under their care. Prior research has found that occupational health among nonphysicians is associated with both degree and type of work motivation.

Objective: The main purpose of this article was to assess the association between physician work motivation and their occupational health.

Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults.

Background: Mobile health technology can improve medication safety for older adults, for instance, by educating patients about the risks associated with anticholinergic medication use.

Objective: This study's objective was to test the usability and feasibility of Brain Buddy, a consumer-facing mobile health technology designed to inform and empower older adults to consider the risks and benefits of anticholinergics.

Methods: Twenty-three primary care patients aged ≥60 years and using anticholinergic medications participated in summative, task-based usability testing of Brain Buddy.

Perioperative Risk Factors for Postoperative Delirium in Patients Undergoing Esophagectomy.

Background: Postoperative delirium affects up to 50% of patients undergoing esophagectomy and is associated with negative outcomes. The perioperative risk factors for delirium in this population are not well understood. We conducted this study to assess perioperative risk factors for postoperative delirium among esophagectomy patients.

Deprescribing in the Pharmacologic Management of Delirium: A Randomized Trial in the Intensive Care Unit.

Objective: Benzodiazepines and anticholinergics are risk factors for delirium in the intensive care unit (ICU). We tested the impact of a deprescribing intervention on short-term delirium outcomes.

Design: Multisite randomized clinical trial.

Inhaled nitric oxide to treat intermediate risk pulmonary embolism: A multicenter randomized controlled trial.

Objective: To test the hypothesis that adjunctive inhaled NO would improve RV function and viability in acute PE.

Methods: This was a randomized, placebo-controlled, double blind trial conducted at four academic hospitals. Eligible patients had acute PE without systemic arterial hypotension but had RV dysfunction and a treatment plan of standard anticoagulation.

An Alternative Payment Model To Support Widespread Use Of Collaborative Dementia Care Models.

The current US system of reimbursement for dementia care does not support the complex biospychosocial needs of families living with Alzheimer disease and related dementias. We propose an alternative payment system for dementia care that would provide insurance coverage for evidence-based, collaborative dementia care models. This payment model involves a per member per month payment for care management services that would target community-dwelling beneficiaries living with dementia and evidence-based education and support programs for unpaid caregivers.

Impact of Participation in a Telestroke Network on Clinical Outcomes.

Background: A telestroke program, known as the Remote Evaluation for Acute Ischemic Stroke program, has been implemented in Georgia since 2003. This study examined whether a hospital's participation in a telestroke network was associated with improvement in clinical outcomes and quality indicators.

Methods And Results: An observational study was conducted using data from the Georgia Coverdell Acute Stroke Registry between September 2005 and September 2016 for patients aged ≥18 years with ischemic stroke.

Screening for psychosocial distress among patients with cancer: implications for clinical practice, healthcare policy, and dissemination to enhance cancer survivorship.

Accreditation standards are at the forefront of evolving healthcare systems, setting metrics for high-quality care. Healthcare outcomes (health, experience, cost, provider satisfaction/burn out) are becoming mutual goals of the patient, provider, payer, and healthcare system. Achieving high-quality outcomes in cancer care necessitates collaboration among interdisciplinary teams of clinical providers, administrators, patient advocates, caregivers, and researchers.

Assessing the Effect of Clinical Inertia on Diabetes Outcomes: a Modeling Approach.

Background: There are an increasing number of newer and better therapeutic options in the management of diabetes. However, a large proportion of diabetes patients still experience delays in intensification of treatment to achieve appropriate blood glucose targets-a phenomenon called clinical inertia. Despite the high prevalence of clinical inertia, previous research has not examined its long-term effects on diabetes-related health outcomes and mortality.

Trends in Life Expectancy and Its Association with Economic Factors in the Belt and Road Countries-Evidence from 2000⁻2014.

In 2013, China launched the Belt and Road (B&R) Initiative in an effort to promote trade and economic collaboration. This study examined the change in life expectancy (LE) among countries along B&R and studied the impact of economic development on LE. Data from 65 B&R countries from 2000 to 2014 were compiled and analyzed.

The Yale Center for Biomedical Innovation and Technology (CBIT): One Model to Accelerate Impact From Academic Health Care Innovation.

The process of translating academic biomedical advances into clinical care improvements is difficult, risky, expensive, and poorly understood. Notably, many clinicians who identify health care problems do not have the time or expertise to solve the problems, and many academic researchers are unaware of important gaps in clinical care to which their expertise may apply.Recognizing an opportunity to connect people who can identify health care problems with those who can solve them, the Yale Center for Biomedical Innovation and Technology (CBIT) was established in 2014 to educate and enhance the impact of health care innovators.

PPD ACT: an app-based genetic study of postpartum depression.

Postpartum depression (PPD) is one of the most frequent complications of childbirth and particularly is suited to genetic investigation as it is more homogenous than major depression outside of the perinatal period. We developed an iOS app (PPD ACT) to recruit, consent, screen, and enable DNA collection from women with a lifetime history of PPD to sufficiently power genome-wide association studies. In 1 year, we recruited 7344 women with a history of PPD and have biobanked 2946 DNA samples from the US.

Preventing Postoperative Delirium After Major Noncardiac Thoracic Surgery-A Randomized Clinical Trial.

Objectives: To assess the efficacy of haloperidol in reducing postoperative delirium in individuals undergoing thoracic surgery.

Design: Randomized double-blind placebo-controlled trial.

Setting: Surgical intensive care unit (ICU) of tertiary care center.

Implementing the 2016 American Academy of Pediatrics Guideline on Brief Resolved Unexplained Events: The Parent's Perspective.

Objectives: A "brief resolved unexplained event" refers to sudden alterations in an infant's breathing, color, tone, or responsiveness that prompt the parent or caregiver to seek emergency medical care. A recently published clinical practice guideline encourages discharging many of these infants home from the emergency department if they have a benign presentation. The goal is to avoid aggressive inpatient investigations of uncertain benefit.

Patient characteristics associated with screening positive for Alzheimer's disease and related dementia.

Introduction: Screening all older adults for Alzheimer's disease and related dementias (ADRD) in primary care may not be acceptable or feasible. The goal of this study was to identify factors that could optimize screening in primary care and enhance its feasibility.

Methods: This is a cross-sectional study in rural, suburban, and urban primary care practices in Indiana.

Multi-Institutional Survey of Fourth Year Students' Self Assessed Milestone Based Skill Proficiency and Faculty Expectation During an Emergency Medicine Clerk-ship: Implications For Curriculum Development.

This article was migrated. The article was marked as recommended. Emergency medicine milestones suggest skill performance expectations for graduating medical students.

Using the agile implementation model to reduce central line-associated bloodstream infections.

Background: Central line-associated bloodstream infections (CLABSIs) are among the most common hospital-acquired infections and can lead to increased patient morbidity and mortality rates. Implementation of practice guidelines and recommended prevention bundles has historically been suboptimal, suggesting that improvements in implementation methods could further reductions in CLABSI rates. In this article, we describe the agile implementation methodology and present details of how it was successfully used to reduce CLABSI.

Warmer Weather as a Risk Factor for Cellulitis: A Population-based Investigation.

Background: The incidence of cellulitis is highly seasonal and this seasonality may be explained by changes in the weather, specifically, temperature.

Methods: Using data from the Nationwide Inpatient Sample (years 1998 to 2011), we identified the geographic location for 773719 admissions with the primary diagnosis (ICD-9-CM code) of cellulitis and abscess of finger and toe (681.XX) and other cellulitis and abscess (682.

Gamifying Accelerometer Use Increases Physical Activity Levels of Sedentary Office Workers.

Background: Sedentary work is hazardous. Over 80% of all US jobs are predominantly sedentary, placing full-time office workers at increased risk for cardiovascular and metabolic morbidity and mortality. Thus, there is a critical need for effective workplace physical activity interventions.

Unhealthy Behaviors, Prevention Measures, and Neighborhood Cardiovascular Health: A Machine Learning Approach.

This study identifies and ranks predictors of cardiovascular health at the neighborhood level in the United States. We merged the 500 Cities Data and the 2011-2015 American Community Survey to create a new data set that includes sociodemographic characteristics, health behaviors, prevention measures, and cardiovascular health outcomes for more than 28 000 census tracts in the United States. We used random forest to rank predictors of coronary heart disease and stroke.