Search

Overdiagnosis of Clostridioides difficile (C. difficile) is associated with increased hospital length of stay, antibiotic overuse, unnecessary infection prevention efforts and excess costs. This study evaluated a paper-based bedside C. difficile screening tool on the number of C. difficile laboratory tests performed and number of C. difficile infection (CDI) diagnoses. Nurses used the tool to determine whether stool should be sent for C. difficile testing. The tool provided indications for stool testing. We collected data on the number of C. difficile stool tests performed and CDI diagnoses for nine months before (PreT) and after (PostT) tool implementation in the hospital. We found a 31% reduction in the mean monthly number of C. difficile tests performed (37 PreT to 25 PostT) and a 56% reduction in CDI diagnoses (19 PreT to 8 PostT). This study demonstrates the success of using nurses and a bedside tool to decrease inappropriate C. difficile testing. This intervention has implications for patient management, infection prevention and cost containment. This low-cost paper-based tool may be helpful for the 25% of hospitals in the USA not using clinical decision support in their electronic health record (EHR), as well as for hospitals outside the United States who may not have access to EHRs. [ABSTRACT FROM AUTHOR]

While a growing body of research has examined immigrants' health generally, less is known specifically about the impact of immigration policy on the health of Chinese immigrants, the second-largest foreign-born population in the United States. This is due, in part, to the lack of methodologically well-trained, cross-cultural researchers who have both the cultural and linguistic expertise and health knowledge to engage with Chinese immigrant populations. This paper addresses this gap by examining Chinese cross-cultural researchers' roles in the qualitative phase of the Research on ImmiGrant HealTh and State policy (RIGHTS) project, which sought to assess how immigration policies shaped Chinese and other immigrants' experiences in healthcare and other related sectors in California. We used reflexivity to assess Chinese cross-cultural researchers' positionality of insiderness and outsiderness and its influence on the process of data collection (i.e., recruitment, conducting interviews, transcription, and translation). Our reflexivity guides the assessment of the opportunities (e.g., expanding the recruitment pool, engaging participants more effectively in interviews, ensuring data integrity, and discussing heterogeneity within the Chinese immigrant community) and challenges (e.g., the difficulty of recruiting low-income and undocumented immigrants, addressing participants' in-depth thoughts, the time-consuming nature of transcription and translation, and the assessment of power dynamics) in conducting immigrant health research with the Chinese community. These results highlight the need for cross-cultural researchers to help build trusting relationships with ethnic-minority communities, thus gaining new insights and advancing knowledge within the field of ethnic minority health research. These insights can guide future investigations of Chinese and other immigrant communities as research on immigration policy and health expands. [ABSTRACT FROM AUTHOR]

Background: Knowledge of patient characteristics, surgical fixation, graft choice, outcomes, and concurrent injuries of revision anterior cruciate ligament reconstruction (ACLR) is limited. Purpose: To describe the current cohort of revision ACLR captured by a community registry and the outcomes observed in the registered patients. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent revision ACLR registered between February 2005 and June 2014, by 200 surgeons in 46 hospitals, were evaluated. The Kaiser Permanente ACLR Registry (KPACLRR) collected data intraoperatively and postoperatively using paper forms, electronic medical records, administrative claims data, and patient-reported outcomes. The KPACLRR cohort was longitudinally followed, and outcomes were prospectively ascertained. Outcomes (ie, revisions, subsequent operative procedures, deep surgical site infections, and deep venous thrombosis) were adjudicated via a chart review. Descriptive statistics were employed. Results: Of 2019 patients who underwent revision ACLR, at a median follow-up of 2.2 years (interquartile range, 1.0-3.8 years), 212 (10.5%) required subsequent operative procedures, and 86 (4.3%) were revised a second time. At the time of revision, 55.1% of the patients had at least 1 concurrent meniscal injury, and 26% of those were repairable. Cartilage injuries were present in 42.0% of patients. Deep surgical site infections occurred in 12 patients (0.6%), deep venous thrombosis occurred in 5 patients (0.3%), and 1 patient (0.1%) had a pulmonary embolism. Conclusion: Revision ACLR can be performed with a low short-term revision rate and relatively few complications. At the time of revision, nearly half of these patients had an irreparable meniscal injury, and slightly less than half had a cartilage injury. A large community-based ACLR registry is useful in informing surgeons of current treatment practices, prevalence of concurrent injuries, and outcomes associated with the procedures, especially infrequent procedures such as revision ACLR. [ABSTRACT FROM AUTHOR]

Background/Context: Across the United States, secondary school curricula are intensifying as a growing proportion of students enroll in high-level academic math courses. In many districts, this intensification process occurs as early as eighth grade, where schools are effectively constraining their mathematics curricula by restricting course offerings and placing more students into Algebra I. This paper provides a quantitative single-case research study of policy-driven curricular intensification in one California school district. Research Questions: (1a) What effect did 8th eighth grade curricular intensification have on mathematics course enrollment patterns in Towering Pines Unified schools? (2b) How did the distribution of prior achievement in Towering Pines math classrooms change as the district constrained the curriculum by universalizing 8th eighth grade Algebra? (3c) Did 8th eighth grade curricular intensification improve students' mathematics achievement? Setting: Towering Pines is an immigrant enclave in the inner-ring suburbs of a major metropolitan area. The district's 10 middle schools together enroll approximately 4,000 eighth graders each year. The districts' students are ethnically diverse and largely economically disadvantaged. The study draws upon administrative data describing 8th eighth graders in the district in the 2004-20-05 through 2007-20-08 school years. Intervention/Program/Practice: During the study period, Towering Pines dramatically intensified middle school students' math curricula: In the 2004-20-05 school year 32 % of the district's 8th eighth graders enrolled in Algebra or a higher- level mathematics course; by the 2007-20-08 school year that proportion had increased to 84%. Research Design: We use an interrupted time-series design, comparing students' 8th eighth grade math course enrollments, 10th grade math course enrollments, and 10th grade math test scores across the four cohorts, controlling for demographics and prior achievement. Findings/Results: We find that students' odds of taking higher level mathematics courses increased as this district implemented the state's Algebra mandate. However, even as the district implemented a constrained curriculum strategy, mathematics achievement growth between 6th sixth and 10th grade slowed and the achievement advantages associated with 8th eighth grade Algebra declined. Conclusions/Recommendations: Our analyses suggest that curricular intensification increased the inclusiveness and decreased the selectivity of the mathematics tracking regime in Towering Pines middle schools. However, the findings suggest that this constrained curriculum strategy may have may have unintended negative consequences for student achievement. [ABSTRACT FROM AUTHOR]