ABSTRACT
PROBLEM: Super-utilizers comprise 4.5% to 8% of all ED patients, but account for 21% to 28% of all ED visits. Excessive use of the emergency department contributes to increased health care costs, recurrent and unnecessary ED workup, decreased emergency readiness, and reduced staff morale. METHODS: The impact of personalized care plan implementation was evaluated using a within-subjects pre-post design. The number of ED visits for each enrolled patient (N = 65) were analyzed before and after personalized care plan enrollment at 90, 180, and 365 days. A post-hoc analysis was completed for each ED visit that resulted in a disposition of discharge. Total and average charges from the ED visits were analyzed to determine the intervention's effect on health care expenditure. Staff was anonymously surveyed to assess perceived efficacy and level of satisfaction with the intervention before completion of data collection. RESULTS: Median ED visits had a statistically significant decrease over 90, 180, and 365 days. There was also a decrease in median, average, and total ED charges for all time points. ED staff perceived the personalized care plans to be an effective intervention and were satisfied with their implementation. DISCUSSION: Personalized care plans effectively decreased the number of ED visits, reduced health care expenditure, and were well-received by the staff.
Subject(s)
Emergency Service, Hospital/statistics & numerical data , Health Expenditures/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Patient Care Planning , Adult , Attitude of Health Personnel , Female , Humans , Job Satisfaction , Male , MinnesotaABSTRACT
Ultraviolet B (UVB) irradiation causes adverse effects on the skin. Corn silk contains flavonoids and other bioactive compounds and antioxidants, which may prevent skin photoaging through antioxidant and anti-inflammatory effects. We aimed to investigate the potential photoprotective effects of dietary corn silk on UVB-induced skin damage in mice and the mechanisms behind these effects on human skin cells. Oral administration of corn silk water extract (CS) (2 or 4 g/kg/day) for 19 weeks decreased epidermal thickness, wrinkle formation, and positive staining for PCNA, Ki67, and 8-OHdG, and increased collagen staining in UVB-irradiated SKH-1 hairless mice compared with controls. The pro-inflammatory NF-κB target genes (IL-1ß, iNOS, and COX-2) and MMP-9 expressions were lower in the CS groups, and TGF-ß/Smad signaling increased. Low skin lipid peroxidation and blood DNA oxidation levels and high blood glutathione were detected. Antioxidant transcription factor Nrf2-related catalase and SOD1 proteins and glutaredoxin mRNA levels increased. The results of CS extract treatment and UVB irradiation in HaCaT cells showed the same results in Nrf2 and NF-κB target genes. An LC-MS/MS analysis showed that the CS extract contained potential antioxidants, which might have contributed to its anti-photoaging effects in tissues and cells. CS extract may reduce UVB-induced skin damage through antioxidant and anti-inflammatory mechanisms.
Subject(s)
Antioxidants/administration & dosage , Silk/administration & dosage , Skin Aging/drug effects , Ultraviolet Rays/adverse effects , Zea mays/chemistry , Administration, Oral , Animals , Antioxidants/chemistry , Antioxidants/pharmacology , Cell Line , Chromatography, Liquid , Disease Models, Animal , Flavonoids/chemistry , Humans , Lipid Peroxidation/drug effects , Mice , Mice, Hairless , NF-E2-Related Factor 2/metabolism , NF-kappa B/metabolism , Silk/chemistry , Silk/pharmacology , Tandem Mass SpectrometryABSTRACT
BACKGROUND/AIMS: Epidural analgesia improves postoperative outcome, and should benefit patients undergoing hepatectomy for cancer. However, the combination of underlying disease, surgery, and blood loss after hepatectomy may lead to hemostatic changes that, theoretically, increase the risk of epidural hematoma. To quantify these changes, we retrospectively reviewed the records of 229 patients at the Prince of Wales Hospital, Hong Kong. METHODOLOGY: We analyzed the hemostatic parameters of those in whom there were complete data (n=143) up to postoperative day 3. RESULTS: We found considerable derangements in the international normalized ratio (INR), prothrombin time, activated partial thromboplastin time (aPTT), and platelet counts, with peak derangements occurring around postoperative day 2. The amount of liver resected and the preoperative Model for End-Stage Liver Disease score were predictors of peak INR > or = 1.5 in the postoperative period. CONCLUSIONS: We conclude that commonly measured hemostatic parameters are deranged after hepatectomy for cancer. Because of the complex cancer- and surgery-related hemostatic changes, whether these changes indeed indicate increased risk of neuraxial hematoma associated with neuraxial blocks is unclear. We also found that most Chinese patients were managed adequately with patient-controlled intravenous morphine. Clinicians contemplating neuraxial block on patients undergoing hepatectomy for cancer must weigh the potential risks and benefits.
