Outcomes of Upper Gastrointestinal Bleeding at United States Teaching and Non-teaching Hospitals: A National Inpatient Sample Analysis.

BACKGROUND/AIMS: Studies have varied results regarding the impact of the teaching and non-teaching status of hospitals on the outcomes for hospitalized patients with upper gastrointestinal bleeding (UGIB). To evaluate these outcomes, we conducted a retrospective cohort study using the 2014 National Inpatient Sample (NIS) database. METHODS: We included all adult patients who were admitted with the principal diagnosis of UGIB. Patients admitted to rural and urban non-teaching hospitals were classified as non-teaching, whereas those admitted to urban teaching hospitals were classified as teaching. The main outcomes of interest were in-hospital mortality, percentage of patients requiring inpatient endoscopy, and endoscopic therapy, packed red blood cell (PRBC) transfusion, length of stay (LOS), and total hospitalization charges. RESULTS: The study included 132,085 (97%) with nonvariceal UGIB (NVUGIB) and 4,200 (3%) with variceal UGIB (VUGIB). Of them, 62% were managed at teaching hospitals. Compared with admitted patients at non-teaching hospitals, patients with nonvariceal UGIB admitted at teaching hospitals had similar adjusted in-hospital mortality rates (adjusted odds ratio (OR): 0.97, 95% confidence interval (CI): 0.79-1.19), inpatient endoscopy rates (OR: 0.98, 95% CI: 0.91-1.1), and early endoscopy rates (within 24 hours) (OR: 0.98, 95% CI: 0.91-1.1) and lower PRBC transfusion rates (OR: 0.87, 95% CI: 0.79-0.97) but higher endoscopic therapy rates (OR: 1.3, 95% CI: 1.2-1.4), length of stay (mean increase of 0.43 days) (P<0.01), and total hospital charges (mean increase of $4,369) (P<0.01). Patients with variceal UGIB had similar adjusted in-hospital mortality rates (OR: 1.2, 95% CI: 0.61-2.3), inpatient endoscopy rates (OR: 0.97, 95% CI: 0.67-1.4), early endoscopy rates (within 24 hours) (OR: 0.97, 95% CI: 0.67-1.4), endoscopic therapy rates (OR: 2.5, 95% CI: 0.54- 11.2), and total hospital charges (P=0.45), and lower PRBC transfusion rates (OR: 0.63, 95% CI: 0.45-0.88) but higher length of stay (mean increase of 0.69 days) (P=0.02). CONCLUSIONS: Patients with nonvariceal UGIB treated at US teaching hospitals and non-teaching hospitals have similar mortality, rates of in-hospital endoscopy, and early endoscopy, but teaching hospitals have higher rates of in-hospital therapeutic endoscopy, length of stay, and total hospital charges. There was no difference in any of the outcomes for variceal gastrointestinal (GI) bleeding treated at teaching hospitals compared with those treated at non-teaching hospitals, except for length of stay, which was higher among patients admitted to teaching hospitals compared to those admitted to non-teaching hospitals.

Hospital teaching status and patient outcomes in intestinal obstruction surgery: A comparative analysis.

Objectives: Surgery at large teaching hospitals is reportedly associated with more favourable outcomes. However, these results are not uniformly consistent across all surgical patients. This study aimed to assess potential disparities in clinical outcomes by hospital type for patients with intestinal obstruction. Material and Methods: 2018 NIS was queried for all adult non-elective admissions for intestinal obstruction. Hospitals were classified as either smallmedium non-teaching hospitals or large teaching hospitals. Multivariate regression analyses were used to assess the association between hospital type and inpatient mortality, access to surgery, admission duration, non-home discharges, hospital costs, and postoperative complications. Results: After adjustments, admission to large teaching hospitals was not associated with a reduction in inpatient mortality (AOR= 0.73; 95% CI= 0.41- 1.31; p= 0.29), lower likelihood of surgery (AOR= 0.93; 95% CI= 0.58-1.48; p= 0.76) or increased chance of early surgery (p= 0.97). Patients admitted to large teaching hospitals had shorter hospital stays (p= 0.002) and were less likely to be discharged to other acute care hospitals (AOR= 0.94; 95% CI= 0.80-0.94; p= 0.04). Admission to large teaching hospitals was not associated with a reduction in perioperative complications (AOR= 1.04; 95% CI= 0.80- 1.28; p= 0.91) or significantly higher hospital costs (mean increase= 1518; 95% CI= 1891-4927; p= 0.38). Conclusion: Admission to large teaching hospitals does not necessarily result in better patient outcomes. Merely considering the teaching status of the hospital in isolation cannot explain the diverse outcomes observed for this condition.

Trends in performance of hospital outpatient procedures and associated 30-day costs among Medicare beneficiaries from 2011 to 2018.

BACKGROUND: United States healthcare has increasingly transitioned to outpatient care delivery. The degree to which Academic Medical Centers (AMCs) have been able to shift surgical procedures from inpatient to outpatient settings despite higher patient complexity is unknown. METHODS: This observational study used a 20% sample of fee-for-service Medicare beneficiaries age 65 and older undergoing eight elective procedures from 2011 to 2018 to model trends in procedure site (hospital outpatient vs. inpatient) and 30-day standardized Medicare costs, overall and by hospital teaching status. RESULTS: Of the 1,222,845 procedures, 15.9% occurred at AMCs. There was a 2.42% per-year adjusted increase (95% CI 2.39%-2.45%; p < .001) in proportion of outpatient hospital procedures, from 68.9% in 2011 to 85.4% in 2018. Adjusted 30-day standardized costs declined from $18,122 to $14,353, (-$560/year, 95% CI -$573 to -$547; p < .001). Patients at AMCs had more chronic conditions and higher predicted annual mortality. AMCs had a lower proportion of outpatient procedures in all years compared to non-AMCs, a difference that was statistically significant but small in magnitude. AMCs had higher costs compared to non-AMCs and a lesser decline over time (p < .001 for the interaction). AMCs and non-AMCs saw a similar decline in 30-day mortality. CONCLUSIONS: There has been a substantial shift toward outpatient procedures among Medicare beneficiaries with a decrease in total 30-day Medicare spending as well as 30-day mortality. Despite a higher complexity population, AMCs shifted procedures to the outpatient hospital setting at a similar rate as non-AMCs. IMPLICATIONS: The trend toward outpatient procedural care and lower spending has been observed broadly across AMCs and non-AMCs, suggesting that Medicare beneficiaries have benefited from more efficient delivery of procedural care across academic and community hospitals.

Who benefits from resuscitative thoracotomies following penetrating trauma: The patient or the learner?

BACKGROUND: Resuscitative thoracotomy (RT) is a salvage procedure following traumatic cardiac arrest. We aim to evaluate RT trends and outcomes in adults with cardiac arrest following penetrating trauma to determine the effect on mortality in this population. Further, we aim to estimate the effect of hospital teaching status on the performance of resuscitative thoracotomies and mortality. METHODS: We reviewed the National Trauma Data Bank (2017-2021) for adults (≥16 years old) with penetrating trauma and prehospital cardiac arrest, stratified by the performance of a RT. We performed multivariable logistic regressions to estimate the effect of RT on mortality and the effect of hospital teaching status on the performance of resuscitative thoracotomies and mortality. RESULTS: 13,115 patients met our inclusion criteria. RT occurred in 12.7% (n = 1,664) of patients. Rates of RT trended up over the study period. Crude mortality was similar in RT and Non-RT patients (95.6% vs. 94.5%, p = 0.07). There was no statistically significant difference in the adjusted odds of mortality based on RT status (OR 0.82, 95%CI 0.56-1.21). University-teaching hospitals had an adjusted odds ratio of 1.68 (95% CI 1.31-2.17) for performing a RT than non-teaching hospitals. There was no difference in the adjusted odds of mortality in patients that underwent RT based on hospital teaching status. CONCLUSION: Despite up-trending rates, a resuscitative thoracotomy may not improve mortality in adults with penetrating, traumatic cardiac arrest. University teaching hospitals are nearly twice as likely to perform a RT than non-teaching hospitals, with no subsequent improvement in mortality.

Application of scenario simulation teaching model of multimorbidity co-treatment in standardized training for general practice residents / 中华全科医师杂志

From February 1 to April 30, 2021, 48 general practice resident physicians in the First Affiliated Hospital of Naval Medical University were randomly divided into study group and control group with 24 in each group. The common comorbidities of the community-dwelling elderly, namely diabetes, diabetic retinopathy and osteoporosis were selected as teaching cases. The residents in control group received conventional teaching, while the scenario simulation teaching model of multicomorbity co-treatment was applied for the study group. The teaching effect, satisfaction and self-efficacy scores were compared between two groups. After training, the knowledge levels, the mastery of referral indicators and the performance of fundus ophthalmoscopy in the study group were significantly better than those in the control group ( t=2.27, 6.34, 4.09; P<0.05). They were (80.96±11.27) vs. (73.96±10.09), (10.33±2.41) vs. (6.38±1.88), (70.27±10.44) vs. (63.50±7.98), and students′ satisfaction and self-efficacy evaluation were higher than those of the observation group (all P<0.05). It is suggested that the simulation teaching of multi-disease co-treatment scenario is more beneficial than the traditional teaching to improve the comprehensive care ability of standardized training physicians in general practice for patients with chronic disease.

Comparing the demographic data and outcomes of septic shock patients presenting to teaching or non-teaching metropolitan hospitals in the United States.

BACKGROUND: Studies looking at the effect of hospital teaching status on septic shock related in-hospital mortality are lacking. The aim of this study was to examine the effect of hospital teaching status on mortality in septic shock patients in the United States. METHODS: This was a retrospective observational study, using the Nationwide Emergency Department Sample Database (released in 2018). All patients with septic shock were included. Complex sample logistic regression was performed to assess the impact of hospital teaching status on patient mortality. RESULTS: A total of 388,552 septic shock patients were included in the study. The average age was 66.93 years and 51.7% were males. Most of the patients presented to metropolitan teaching hospitals (68.2%) and 31.8% presented to metropolitan non-teaching hospitals. Septic shock patients presenting to teaching hospitals were found to have a higher percentage of medical comorbidities, were more likely to be intubated and placed on mechanical ventilation (50.5% vs. 46.9%) and had a longer average length of hospital stay (12.47 d vs. 10.20 d). Septic shock patients presenting to teaching hospitals had greater odds of in-hospital mortality compared to those presenting to metropolitan non-teaching hospitals (adjusted odd ratio [OR]=1.295, 95% confidence interval [CI]: 1.256-1.335). CONCLUSION: Septic shock patients presenting to metropolitan teaching hospitals had significantly higher risks of mortality than those presenting to metropolitan non-teaching hospitals. They also had higher rates of intubation and mechanical ventilation as well as longer lengths of hospital stay than those in non-teaching hospitals.

Situación actual, inquietudes y necesidades de los tutores de formación especializada de farmacia hospitalaria / Specialized training in hospital pharmacy: an overview of the concerns, needs and current situation of resident tutors

Objetivo: Conocer las necesidades formativas y de recursos de lostutores de formación especializada de farmacia hospitalaria de España,así como su motivación y satisfacción con la docencia.Método: Se realizó, mediante Google-forms®, una encuesta dirigida atutores de farmacia hospitalaria durante enero-marzo de 2019 con preguntas generales (tutor, hospital, servicio) y específicas (medios disponibles,actividades docentes, satisfacción con la docencia, necesidades formativas). Se realizó un análisis exploratorio univariante para estudiar posiblesfactores relacionados con la satisfacción y la motivación docente.Resultados: Respondieron 83 tutores (tasa de respuesta: 52,8%),de 15/17 comunidades autónomas. El número de residentes/año-tutorresultó 4 (rango intercuartílico = 2-4). El 96,4% realizan entrevistas (trimestrales [65,1%]-ninguna [3,6%]. También se ocupan principalmente dela gestión de rotaciones externas [97,6%], planificación de rotaciones [97,6%] y la evaluación anual [96,4%]). El 17,1% dispone de horas parala docencia insuficientes para el 71,4%. Un 70,7% de los tutores deocho comunidades autónomas con normativa sobre el tiempo de liberación carecen de dicho tiempo. Los tutores se declararon mayoritariamentesatisfechos con la docencia (66,7%) y motivados (63,0%). (AU)

Objective: To provide new insight into the training needs and resourcesrequired by hospital pharmacy resident tutors in Spain, as well as into theirlevel of motivation and satisfaction with their teaching.Method: Google Forms® was used to design a survey addressed to hospital pharmacy resident tutors between January and March 2019. Theysurvey consisted of generic (tutor, hospital, service) and specific questions(available resources, teaching activities, teaching satisfaction, trainingneeds). A univariate exploratory analysis was conducted to study possiblefactors related to teaching satisfaction and motivation.Results: Replies were received from 83 tutors (rate of response:52.8%), from 15/17 Spanish regions. The annual resident/tutor ratio was4 (IQR = 2-4). A total of 96.4% of tutors conducted interviews, of whom65.1% did so quarterly. Other activities included the management of external training rotations (97.6%), planning of rotations (97.6%) and annual appraisals (96.4%). Only 17.1% of respondents were given time off theirregular duties for their tutorship work, with 71.4% stating that the time theywere allowed was insufficient. A total of 70.7% of tutors from eight Spanish regions where the granting of protected time was regulated said werenot given any time off for their teaching endeavors. Most tutors declaredto be satisfied (66.7%) and motivated (63%) with their teaching work. (AU)

Does Hospital Teaching Status Matter? Impact of Hospital Teaching Status on Pattern and Incidence of 90-day Readmissions After Primary Total Hip Arthroplasty.

BACKGROUND: Given financial and clinical implications of readmissions after total hip arthroplasty (THA) and the potential for varied expenditures related to a hospital's teaching status, this study sought to characterize 90-day hospital readmission patterns and assess likelihood of readmission based on teaching designation of a Medicare beneficiaries' (MB's) index THA hospital. METHODS: Retrospective analysis of 2016-2018 Centers for Medicare and Medicaid Services-linked data identified primary THA hospitalizations and readmissions within 90 days. Hospitals were categorized as teaching or nonteaching (Council of Teaching Hospitals and Health Systems). Chi-squared analysis and Fisher exact test assessed differences between readmission hospitals and the index hospital teaching status. Multivariate logistic regression models estimated risk-adjusted probability of experiencing at least one 90-day readmission. RESULTS: Analysis identified 433,959 index THA admissions with an all-cause 90-day readmission rate of 9.12%. Most readmissions were to the same hospital regardless of index THA hospital teaching status (67.5% index teaching; 68.2% index nonteaching). Crossover in hospital teaching status from the index procedure to readmission location was more common for those with index THA at a teaching hospital (18.9%) than for MBs with index THA performed at a nonteaching hospital (6.2%). Controlling for patient characteristics, no significant relationship was found between 90-day readmission and index hospital teaching status (odds ratio 0.98, confidence interval 0.947-1.011). CONCLUSIONS: Overall, while certain patterns of readmission after the index THA were observed, after controlling for patient characters and comorbidities, there was no significant association between 90-day all-cause readmission and index hospital teaching status.

Visualization of clinical teaching citations using social network analysis.

BACKGROUND: Analyzing the previous research literature in the field of clinical teaching has potential to show the trend and future direction of this field. This study aimed to visualize the co-authorship networks and scientific map of research outputs of clinical teaching and medical education by Social Network Analysis (SNA). METHODS: We Identified 1229 publications on clinical teaching through a systematic search strategy in the Scopus (Elsevier), Web of Science (Clarivate Analytics) and Medline (NCBI/NLM) through PubMed from the year 1980 to 2018.The Ravar PreMap, Netdraw, UCINet and VOSviewer software were used for data visualization and analysis. RESULTS: Based on the findings of study the network of clinical teaching was weak in term of cohesion and the density in the co-authorship networks of authors (clustering coefficient (CC): 0.749, density: 0.0238) and collaboration of countries (CC: 0.655, density: 0.176). In regard to centrality measures; the most influential authors in the co-authorship network was Rosenbaum ME, from the USA (0.048). More, the USA, the UK, Canada, Australia and the Netherlands have central role in collaboration countries network and has the vertex co-authorship with other that participated in publishing articles in clinical teaching. Analysis of background and affiliation of authors showed that co-authorship between clinical researchers in medicine filed is weak. Nineteen subject clusters were identified in the clinical teaching research network, seven of which were related to the expected competencies of clinical teaching and three related to clinical teaching skills. CONCLUSIONS: In order to improve the cohesion of the authorship network of clinical teaching, it is essential to improve research collaboration and co-authorship between new researchers and those who have better closeness or geodisk path with others, especially those with the clinical background. To reach to a dense and powerful topology in the knowledge network of this field encouraging policies to be made for international and national collaboration between clinicians and clinical teaching specialists. In addition, humanitarian and clinical reasoning need to be considered in clinical teaching as of new direction in the field from thematic aspects.

Effect of hospital teaching status on endoscopic retrograde cholangiopancreatography mortality and complications in the USA.

BACKGROUND: Our aim was to assess the differences in outcomes of cholecystitis, pancreatitis, gastrointestinal (GI) bleed, GI perforation, and mortality in teaching versus nonteaching hospitals nationwide among therapeutic and diagnostic ERCPs. We hypothesized that complication rates would be higher in teaching hospitals given greater patient complexity. METHODS: Inpatient diagnostic and therapeutic ERCPs were identified from the National Inpatient Sample (NIS) from 2008 to 2012. The presence of ACGME-approved residency programs is required to qualify as a teaching hospital. Nonteaching urban and rural hospitals were grouped together. We identified hospital stays complicated by pancreatitis, cholecystitis, GI hemorrhage, perforation, and mortality. Logistic regression propensity-matched analysis was performed in SPSS to compare differences in complication rates between teaching and nonteaching hospitals. RESULTS: A total of 1,466,356 weighted cases of inpatient ERCPs were included in this study: of those, 367 and188 were diagnostic, 1,099,168 were therapeutic, 766,230 were at teaching hospitals, and 700,126 were at nonteaching hospitals. Mortality rates were higher in teaching hospitals when compared to nonteaching hospitals for diagnostic (OR 1.266, p < 0.001) and therapeutic ERCPs (OR 1.157, p = 0.001). There was no significant difference in rates of post-ERCP cholecystitis, pancreatitis, or perforation between the two groups. Among diagnostic ERCPs, GI hemorrhage was higher in teaching compared to nonteaching hospitals (OR 1.181, p = 0.003). Likewise, length of stay was increased in teaching hospitals (7.9 vs 6.9 days, p < 0.001, for diagnostic and 6.5 vs 5.8 days, p < 0.001, for therapeutic ERCPs). CONCLUSIONS: In conclusion, teaching hospitals were noted to have a higher mortality rate associated with inpatient ERCPs as well as higher rates of GI hemorrhage in diagnostic ERCPs, which may be due to a higher comorbidity index in those patients admitted to teaching hospitals.

A Nationwide Analysis of Popliteal Vascular Injuries and Outcomes by Hospital Teaching Status.

BACKGROUND: Popliteal artery injuries are the second most common arterial injuries below the inguinal ligament. We aimed to compare outcomes in patients with popliteal injuries by hospital teaching status utilizing the National Trauma Data Bank Research Data Set (NTDB-RDS) 2013-2016. METHODS: Four-year retrospective study using the NTDB-RDS, evaluating popliteal vascular injuries. Patients were divided by popliteal injury type and teaching status into; nonteaching hospital (NTH), community teaching (CTH), or University teaching (UTH). Demographics and outcome measures were compared between groups. Risk-adjusted mortality odds ratios (ORs) were calculated. Significance was defined as P < 0.05. RESULTS: 3,577,168 patients were in the NTDB-RDS, with 1120 having a popliteal injury, (incidence = 0.03%). There was no significant difference in the amputation rate between patients treated in NTHs, CTHs, or UTHs (P > 0.05). There was no significant difference in the raw mortality rate between patients treated in NTHs, CTHs, or UTHs. After adjusting for confounders; compared to NTH, the odds ratio for mortality for popliteal artery injuries in the CTH group was significantly higher (OR: 15.95, 95% CI: 1.19-213.84), and for the UTH group the mortality was also significantly higher (OR: 5.74, 95% CI: 0.45-72.95). CONCLUSIONS: The incidence of popliteal vascular injuries was 0.03% for 2013-2016. Patients with popliteal artery injuries treated at community teaching hospitals have a 16 times higher risk of mortality and at university teaching hospitals have a 5.7 times higher risk of mortality than patients treated at nonteaching hospitals.

Surgical 'Safari' vs. Educational Program: Experience with International Cardiac Surgery Missions in Nigeria.

INTRODUCTION: In any country, the development and growth of open-heart surgery parallel stable political climate, economic growth, good leadership, and prudent fiscal management. These were lacking in Nigeria, which was under a military rule. The enthronement of democratic rule, in 1999, has caused desirable changes. The objective of this study is to report our experience with foreign cardiac teams that visited the National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, for seven years, in order to restart its open-heart surgery program. METHODS: To achieve the desired open-heart surgery training, our center received regular and frequent visits from foreign cardiac teams who would perform open-heart surgery with the local team. RESULTS: During the period of seven years, a total of 266 open-heart operations involving both adults and children were performed, with a mean of 38 cases per year; 150 (54.4%) males and 116 (43.6%) females were treated, with a ratio of 1.0:0.8. Six different teams visited the center at different periods. CONCLUSION: After these years of cardiac missions to our center, the experience of the local team, especially the surgeons, is far from desirable because each team visit usually lasted about a week or two and each team, with exception of the CardioStart International/William Novick Global Cardiac Alliance, adopted the surgical 'safari' method.

Surgical 'safari' vs. educational program: experience with international cardiac surgery missions in nigeria

Abstract Introduction: In any country, the development and growth of open-heart surgery parallel stable political climate, economic growth, good leadership, and prudent fiscal management. These were lacking in Nigeria, which was under a military rule. The enthronement of democratic rule, in 1999, has caused desirable changes. The objective of this study is to report our experience with foreign cardiac teams that visited the National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, for seven years, in order to restart its open-heart surgery program. Methods: To achieve the desired open-heart surgery training, our center received regular and frequent visits from foreign cardiac teams who would perform open-heart surgery with the local team. Results: During the period of seven years, a total of 266 open-heart operations involving both adults and children were performed, with a mean of 38 cases per year; 150 (54.4%) males and 116 (43.6%) females were treated, with a ratio of 1.0:0.8. Six different teams visited the center at different periods. Conclusion: After these years of cardiac missions to our center, the experience of the local team, especially the surgeons, is far from desirable because each team visit usually lasted about a week or two and each team, with exception of the CardioStart International/William Novick Global Cardiac Alliance, adopted the surgical 'safari' method.

The Impact of Hospital Teaching Status on Colonoscopy Perforation Risk: A National Inpatient Sample Study.

BACKGROUND: Colonoscopy has been widely used as a diagnostic tool for many conditions, including inflammatory bowel disease and colorectal cancer. Colonoscopy complications include perforation, hemorrhage, abdominal pain, as well as anesthesia risk. Although rare, perforation is the most dangerous complication that occurs in the immediate post-colonoscopy period with an estimated risk of less than 0.1%. Studies on colonoscopy perforation risk between teaching hospitals and non-teaching hospitals are scarce. METHODS: The National Inpatient Sample database was queried for patients who underwent inpatient colonoscopy between January 2010 and December 2014 in teaching versus non-teaching facilities in order to study their perforation rates. Our study population included 257,006 patients. Univariate regression was performed, and the positive results were analyzed using a multivariate regression module. RESULTS: Teaching hospitals had a higher risk of perforation (odds ratio 1.23, confidence interval 1.07 - 1.42, P = 0.004). Perforation rates were higher in females, patients with inflammatory bowel disease and dilatation of strictures. Polypectomy did not yield any statistical difference between the study groups. Other factors such as African-American ethnicity appeared to have a lower risk. CONCLUSION: Perforation rates are higher in teaching hospitals. More studies are needed to examine the difference and how to mitigate the risks.

Hospital teaching status associated with reduced inpatient mortality and perioperative complications in surgical neuro-oncology.

PURPOSE: Studies have demonstrated that higher surgical volumes correlate with improved neurosurgical outcomes yet none exist evaluating the effects of hospital teaching status on the surgical neuro-oncology patient. We present the first analysis comparing brain tumor surgery perioperative outcomes at academic and non-teaching centers. METHODS: Brain tumor surgeries in the Nationwide Inpatient Sample (NIS) from 1998 to 2014 were identified. A teaching hospital, defined by the NIS, must have ≥ 1 Accreditation Council of Graduate Medical Education (ACGME) approved residency programs, Council of Teaching Hospitals membership, or have a ratio ≥ 0.25 of full-time residents to hospital beds. Annual treatment trends were stratified by hospital teaching status, assessing yearly caseload with linear regression. Multivariable logistic regression determined predictors of inpatient mortality/complications. Hospitals were further divided into quartiles by case volume and teaching status was compared in each. RESULTS: Teaching hospitals (THs) exhibited an average annual increase in brain tumor surgeries (+ 1057/year, p < 0.0001). In multivariable analysis, teaching status was associated with decreased risk of mortality (OR 0.82, p = 0.0003) and increased likelihood of discharge home (OR 1.21, p < 0.0001). In subgroup analysis, within the highest hospital quartile by caseload, higher mortality rates and lower routine discharges were again seen at non-teaching hospitals (NTHs) (p = 0.0002 and p = 0.0016, respectively). CONCLUSION: THs are performing more brain tumor surgeries over time with lower rates of inpatient mortality and perioperative complications even after controlling for hospital case volume. These results suggest a shift in neuro-oncology practice patterns favoring THs to optimize patient outcomes especially at the highest volume centers.

Avaliação dos efeitos da educação permanente para enfermagem em uma organização hospitalar / Evaluación de los efectos de la educación permanente para enfermeros en una organización hospitalaria / Assessment of continuing education effects for nursing in a hospital organization

Resumo Objetivo Avaliar os efeitos de um programa de educação permanente em enfermagem de uma organização hospitalar. Métodos Estudo avaliativo, cuja coleta de dados ocorreu de maio a setembro de 2016 a partir da aplicação de instrumento tipo Likert aos 147 profissionais de enfermagem participantes de um programa de educação permanente de um hospital de ensino do Sul do Brasil. Utilizou-se uma plataforma eletrônica, Quicktapsurvey®, com uso de tablets. Os dados foram analisados por meio dos softwares R e Statistical Package for the Social Scienses®. Resultados Houve efeito positivo, indicando que os conhecimentos e habilidades adquiridos nas ações educativas propostas pelo programa de educação permanente foram transferidos para o contexto do trabalho. Conclusão A utilização do instrumento de avaliação mostrou-se efetivo para apoiar o planejamento e execução do programa no cenário da pesquisa e pode contribuir para outras organizações hospitalares em situações semelhantes.

Resumen Objetivo Evaluar los efectos de un programa de educación permanente en enfermeros de una organización hospitalaria. Métodos Estudio evaluativo, cuya recolección de datos ocurrió de mayo a septiembre de 2016, mediante la aplicación de instrumento tipo Likert a los 147 profesionales de enfermería participantes de un programa de educación permanente de un hospital universitario del sur de Brasil. Se utilizó una plataforma electrónica, Quicktapsurvey®, con uso de tablets. Los datos fueron analizados por medio de los softwares R y Statistical Package for the Social Scienses®. Resultados Hubo efecto positivo, que indicó que los conocimientos y habilidades adquiridos con las acciones educativas propuestas en el programa de educación permanente fueron transferidos al contexto de trabajo. Conclusión La utilización del instrumento de evaluación demostró ser efectivo para apoyar la planificación y ejecución del programa en el contexto de la investigación y puede contribuir para otras organizaciones hospitalarias en situaciones semejantes.

Abstract Objective To assess nursing continuing education effects in a hospital organization. Methods An assessment study, whose data collection took place from May to September 2016 from the application of a Likert-type tool to the 147 nursing professionals participating in a continuing education program of a teaching hospital in southern Brazil. Quicktapsurvey®, an electronic platform, was used with tablets. Data were analyzed using software R and Statistical Package for the Social Scienses®. Results There was a positive effect, indicating that the knowledge and skills acquired in the educational actions proposed by the continuing education program were transferred to the work context. Conclusion The use of an assessment tool was effective to support program planning and performance in the research setting and may contribute to other hospital organizations in similar situations.

Leadership potential of physicians in a public teaching hospital in the city of São Paulo / Potencial de liderança em médicos de um hospital público de ensino na cidade de São Paulo

ABSTRACT Objective To analyze the leadership potential of physicians in a public hospital in the city of São Paulo. Methods A descriptive pilot study, in which 40 assistant physicians and medical residents were randomly selected to receive an electronic invitation of the company Caliper Estratégias Humanas do Brasil . To those who accepted it, a link was sent to fill out a personality evaluation focused on the work, comprising 112 alternatives related to 21 domains of 4 performance areas. According to the Caliper Profile Questionnaire, the ipsative measures expressed as a percentage are distributed on a Likert scale, and three categories are established based on behavioral tendencies at work: need for improvement, moderate and high potential. Results A total of 47.5% of physicians invited accepeted taking part in the study. Regarding to leadership, the need for improvement was over 30% among the evaluated physicians. In the interpersonal relationship analysis, only 18.4% of assistant physicians and 37% of medical residents required improvement. The percentage of physicians who needed improvement in problem-solving and decision-making was similar among the assistant and resident physicians (12.6% versus 14%). In the evaluation of personal organization and time management, we obtained similar percentages in assistant physicians and residents who needed improvement (14% in both groups). High potential leadership was observed in these domains (18.4% and 20% for assistant physicians and residents, respectively). Conclusion The physicians assessed presented high leadership potential in 25% of the cases, requiring improvement in the performance domains, such as interpersonal relationship, problem solving, decision-making, personal organization and time management.

RESUMO Objetivo Avaliar o potencial de liderança de médicos ativos de um hospital público na cidade de São Paulo. Métodos Estudo-piloto descritivo, no qual foram selecionados aleatoriamente 40 médicos assistentes e residentes para receberem o link com convite eletrônico da empresa Caliper Estratégias Humanas do Brasil. Aos que o aceitaram, foi encaminhado o link para preenchimento de avaliação de personalidade focada no trabalho, composta por 112 alternativas relativas a 21 domínios de 4 áreas de desempenho. De acordo com Questionário Perfil Caliper, as medidas ipsativas expressas em percentual são distribuídas em uma escala do tipo Likert, e são determinadas três categorias em relação às tendências comportamentais no trabalho: necessidade de aprimoramento, potencial moderado e alto potencial. Resultados A taxa de adesão dos médicos convidados ao estudo foi de 47,5% (19 médicos). No domínio liderança, a necessidade de aprimoramento ultrapassou 30% dos médicos avaliados. No relacionamento interpessoal, apenas 18,4% dos médicos assistentes necessitavam de aprimoramento e, no grupo dos médicos residentes, 37% necessitavam aprimoramento. Para resolução de problemas e tomada de decisões, as percentagens de necessidade de aprimoramento foram semelhantes (12,6% versus 14%). Na avaliação da organização pessoal e da administração do tempo, obtivemos percentagens semelhantes entre médicos assistentes e residentes, com necessidade de aprimoramento (14% nos dois grupos) e alto potencial nestas áreas (18,4% e 20% para médicos assistentes e residentes, respectivamente). Conclusão Os médicos avaliados apresentaram alto potencial de liderança em um quarto dos casos, necessitando aprimoramento nas áreas de desempenhos, como relacionamento interpessoal, resolução de problemas, tomada de decisão, organização pessoal e administração do tempo.

Hospital teaching status and trascatheter aortic valve replacement outcomes in the United States: Analysis of the national inpatient sample.

BACKGROUND: Evidence suggests that medical service offerings vary by hospital teaching status. However, little is known about how these translate to patient outcomes. We therefore sought to evaluate this gap in knowledge in patients undergoing Transcatheter aortic valve replacement (TAVR) in the United States. METHODS: This study was conducted using the National Inpatient Sample (NIS) in the United States from 2011 to 2014. Teaching status was classified, as teaching vs. nonteaching and endpoints were clinical outcomes, length of stay and cost. Procedure-related complications were identified via ICD-9 coding and analysis was performed via mixed effect model. RESULTS: An estimated 33,790 TAVR procedures were performed in the U.S between 2011 and 2014, out of which 89.3% were in teaching hospitals. Mean (SD) age was 81.4 (8.5) and 47% were females. There was no significant difference between teaching versus nonteaching hospitals in regards to the primary outcome of in-hospital mortality and secondary outcomes of several cardiovascular and other end points except for a high rates of acute kidney injury (AKI) (OR: 1.34 [95% CI, 1.04-1.72]) and lower rate for use of mechanical circulatory support devices in teaching vs. nonteaching centers. The mean length of stay was significantly higher in teaching hospitals (7.7 days) vs. nonteaching hospitals (6.8 days) (P = 0.002) and so was the median cost of hospitalization (USD 50,814 vs. USD 48, 787, P = 0.02) for teaching vs. nonteaching centers. CONCLUSION: Most TAVR related short-term outcomes including all cause in-hospital mortality are about the same in teaching and nonteaching hospitals. However, AKI, length of hospital stay and TAVR related cost were significantly higher in teaching than nonteaching hospitals. There was more use of mechanical circulatory support in nonteaching than teaching hospitals.

Construction of teaching-helping system among hospitals / 基础医学与临床

Quantities of teaching-helping activities are present in among hospitals because of gap in education quali-ty.Effectiveness of those helping activities depends on establishment of a scientific teaching -helping system.Teach-ing-helping system among hospitals is based on the establishment of teaching system of hospital , scientific and scheduled helping process management , and a clear claim of effectiveness .Peking Union Medical College Hospital reviewed its teaching-helping activities and developed a theoretical model of effectiveness of teaching -helping among hospitals .

Eventos adversos por interações medicamentosas potenciais em unidade de terapia intensiva de um hospital de ensino / Adverse events caused by potential drug-drug interactions in an intensive care unit of a teaching hospital

RESUMO Objetivo: Avaliar a existência de interações medicamentosas potenciais na unidade de terapia intensiva de um hospital, com foco nos antimicrobianos. Métodos: Estudo transversal, que analisou prescrições eletrônicas de pacientes da unidade de terapia intensiva de um hospital de ensino, avaliando potenciais interações medicamentosas relacionadas aos antimicrobianos, entre 1º de janeiro e 31 de março de 2014. O consumo dos antimicrobianos foi expresso em dose diária definida por 100 pacientes-dia. A busca e a classificação das interações foram realizadas com base no sistema Micromedex®. Resultados: Foram analisadas prescrições diárias de 82 pacientes, totalizando 656 prescrições. Do total de medicamentos prescritos, 25% eram antimicrobianos, sendo meropenem, vancomicina e ceftriaxona os mais prescritos. Os antimicrobianos mais consumidos, segundo a metodologia de dose diária definida por 100 pacientes-dia, foram cefepime, meropenem, sulfametoxazol + trimetoprima e ciprofloxacino. A média de interações por paciente foi de 2,6. Entre as interações, 51% foram classificadas como contraindicadas ou de gravidade importante. Destacaram-se as interações altamente significativas (valor clínico 1 e 2), com prevalência de 98%. Conclusão: Com o presente trabalho verifica-se que os antimicrobianos são uma classe frequentemente prescrita na unidade de terapia intensiva, apresentando elevada quantidade de interações medicamentosas potenciais, sendo a maior parte das interações considerada altamente significativa.

ABSTRACT Objective: To evaluate the incidence of potential drug-drug interactions in an intensive care unit of a hospital, focusing on antimicrobial drugs. Methods: This cross-sectional study analyzed electronic prescriptions of patients admitted to the intensive care unit of a teaching hospital between January 1 and March 31, 2014 and assessed potential drug-drug interactions associated with antimicrobial drugs. Antimicrobial drug consumption levels were expressed in daily doses per 100 patient-days. The search and classification of the interactions were based on the Micromedex® system. Results: The daily prescriptions of 82 patients were analyzed, totaling 656 prescriptions. Antimicrobial drugs represented 25% of all prescription drugs, with meropenem, vancomycin and ceftriaxone being the most prescribed medications. According to the approach of daily dose per 100 patient-days, the most commonly used antimicrobial drugs were cefepime, meropenem, sulfamethoxazole + trimethoprim and ciprofloxacin. The mean number of interactions per patient was 2.6. Among the interactions, 51% were classified as contraindicated or significantly severe. Highly significant interactions (clinical value 1 and 2) were observed with a prevalence of 98%. Conclusion: The current study demonstrated that antimicrobial drugs are frequently prescribed in intensive care units and present a very high number of potential drug-drug interactions, with most of them being considered highly significant.