Articles: outcome-assessment-health-care.
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Physical fitness is an integral part of military readiness, and failure to meet military Physical Fitness Assessment (PFA) standards can severely damage or end careers. Postpartum active duty service members experience a drop in PFA scores and passing rates compared to their pre-pregnancy assessments. Each branch recently extended recovery time to 12 months, but more research is required to see if this change alone is enough to return both active duty and reserve component postpartum personnel to their own preconception PFA outcomes (scores, passing rates, and injury rates) and those of a control group of nullpartum female airmen. ⋯ Even with a 12-month recovery period, postpartum airmen fare worse on all PFA outcome dimensions studied compared to nulliparous airmen and with preconception selves. Perinatal airmen with more experience, education, and access to resources have better PFA outcomes. The U.S. Air Force should consider a comprehensive maternal wellness program including physical fitness programming and medical preventative health accessible to total force perinatal airmen. This would increase operational readiness, retainability, and well-being while decreasing musculoskeletal injuries and associated medical costs.
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Pediatr Crit Care Me · Dec 2024
Hospital-Acquired Complications in Critically Ill Children and PICU Length of Stay, Duration of Respiratory Support, and Economics: Propensity Score Matching in a Single-Center Cohort, 2015-2020.
To identify the health and economic costs of hospital-acquired complications (HACs) in children who require PICU admission. ⋯ In our PICU (2015-2020), the burden of HAC for critically ill children was highest for healthcare-associated infections. Further high-quality evidence regarding HAC prevention and prospective risk assessment could lead to improved patient outcomes and reduced costs.
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Precision in critical care nutrition is paramount, as it focuses nutrition interventions on those patients most likely to benefit, or those who might potentially be harmed. Critical care nutrition must therefore be tailored to individual metabolic needs as determined by factors that control the capacity for tissue homeostasis and anabolic responses. This ideally involves the accurate and timely assessment of macronutrient and micronutrient requirements, a careful evaluation of metabolic response mechanisms and the identification of circumstances that might interfere with the productive utilization of dietary substrates. ⋯ Despite the pressing need to further develop more targeted approaches in critically ill patients, indices of immediate metabolic responses that correlate with favorable clinical outcomes are lacking. In addition, the development of precision approaches might address timely adjustments in protein, energy, or micronutrient supplementation based on evolving clinical conditions. Here, we review why precision tools are needed in critical care nutrition, our progress thus far, as well as promising approaches and technologies by which multidisciplinary healthcare teams can improve quality of care and clinical outcomes by individualizing nutrition interventions.
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Navigating a Foodborne Outbreak: Preparation for Interprofessional Practice is an interactive, competency-based, online educational module demonstrating interprofessional practice among health professionals to improve and protect population health, in the context of a foodborne outbreak. Authors reviewed registration data, pre- and postmodule knowledge assessments, and module evaluations from the 978 medical students and physicians ("medical learners") who completed the module from July 2018 to June 2021, comparing their outcomes as well as assessing potential impacts of the COVID-19 pandemic. Analyses were conducted in 2022 and 2024. ⋯ Medical learners reported high satisfaction with the module. Medical students' agreement with statements about the relevance of the module to their current or future responsibilities and awareness of "how clinical care and public health systems work together to protect the health of populations" increased during the pandemic. The module successfully improved knowledge of clinical-public health collaborations to protect population health and is one model of how to integrate PPH content, including physicians' roles in the public health system, into medical education.
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Randomized Controlled Trial
Simultaneously implementing pathways for improving asthma, pneumonia, and bronchiolitis care for hospitalized children: Protocol for a hybrid effectiveness-implementation, cluster-randomized trial.
Asthma, pneumonia, and bronchiolitis are the top causes of childhood hospitalization in the United States, leading to over 350,000 hospitalizations and ≈$2 billion in costs annually. The majority of these hospitalizations occur in general/community hospitals. Poor guideline adoption by clinicians contributes to poor health outcomes for children hospitalized with these illnesses, including longer recovery time/hospital stay, higher rates of intensive care unit transfer, and increased risk of hospital readmission. A prior single-center study at a children's hospital tested a multicondition clinical pathway intervention (simultaneous implementation of multiple pathways for multiple pediatric conditions) and demonstrated improved clinician guideline adherence and patient health outcomes. This intervention has not yet been studied in community hospitals, which face unique implementation barriers. ⋯ This hybrid trial will lead to a comprehensive understanding of how to pragmatically and sustainably implement a multicondition pathway intervention in community hospitals and an assessment of its effects. Enrollment began in July 2022 and is projected to be completed in September 2024. Primary analysis completion is anticipated in March 2025, with reporting of results following.