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News Article | April 19, 2017
Site: www.eurekalert.org

Journal of the American College of Surgeons study found no difference in complications or readmissions when comparing outpatient with hospital-stay groups VIDEO:  In the first study of its kind, a research team at a large, urban public safety net hospital found that outpatient laparoscopic appendectomy (surgical removal of the appendix) is safe... view more CHICAGO (April 19, 2017): Laparoscopic surgical procedures have many benefits over traditional open operations, like decreased length of stay at the hospital, less postoperative pain for patients, and earlier resumption of an oral diet. As a result, many laparoscopic procedures have been transitioned to outpatient ones. In the first study of its kind, a research team at a large, urban public safety net hospital found that outpatient laparoscopic appendectomy (surgical removal of the appendix) is safe for patients and results in shorter hospital stays and decreased health care costs, according to study results published as an "article in press" on the Journal of the American College of Surgeons website ahead of print publication. Those in the outpatient group were also satisfied with the outpatient protocol, survey results showed. Within the last few years, research findings from hospitals exploring the feasibility of outpatient laparoscopic appendectomy have been published, but senior study author Glenn Ault, MD, FACS, said he had not seen any from an urban safety net hospital system. Dr. Ault is the chief of service for the division of colorectal surgery at LAC+USC Medical Center, Los Angeles, Calif., where this study was conducted. It is a county teaching hospital that principally takes care of an underserved population, study authors wrote. "We work in an environment of limited resources, so we're always trying to think about how to deliver care with the resources we have. There are a lot of challenges we have in our patient population," Dr. Ault said. The team wanted to find out if the outpatient treatment strategy would succeed without worsening outcomes or satisfaction by using a well-defined protocol and giving clear instructions to patients. From 2014-2016, all patients age 18 and older who underwent laparoscopic appendectomy for acute, uncomplicated appendicitis were enrolled in the study, Dr. Ault explained. During its first year, researchers documented standard baseline perioperative practice for the control group. All data was collected prospectively. Researchers then introduced a protocol for patients who met strict intraoperative and discharge criteria to be discharged from the post-anesthesia care unit (PACU). Discharge criteria included normal vital signs; adequate pain control; ability to urinate, ambulate, and tolerate oral intake; and an assessment by a physician that the patient was stable for discharge. After a transition period of one month, data was collected for one year from the outpatient group. The two groups were analyzed for differences in demographics, length of stay, nursing transitions, complications, readmissions, and patient satisfaction. Results from 351 patients were analyzed comparing 178 in the inpatient (control) group with 173 in the outpatient group. Dr. Ault noted that patients were given information about the study, and they were told they could go home from the PACU if the intraoperative findings confirmed the diagnosis of uncomplicated appendicitis. If the appendix was ruptured or gangrenous, or if the patients didn't meet discharge criteria, they understood they would require hospital admission for further observation. Patients scheduled a postoperative clinic follow-up appointment and were asked to provide a phone number to be contacted for a postoperative survey. Dr. Ault said the survey was a major strength of this study, as he had not seen any other studies that took patient satisfaction data into account. Of the 173 people in the outpatient group, 113 (65 percent) went home. The rest did not go home for reasons including lack of transportation, not passing discharge criteria, concern for intraoperative findings, other medical conditions, and homelessness. Researchers found that the outpatient group had statistically significant older patients (age 36 vs. 32), shorter operative time (69 minutes vs. 83 minutes), longer time in the PACU (242 minutes vs. 141 minutes), fewer nursing transitions (four vs. six), and shorter postoperative length of stay (nine hours vs. 19 hours). Authors wrote there was no difference in complications, post-discharge ER visits, or readmissions. No one in the outpatient group who was sent home from the PACU had postoperative complications or required readmission. Satisfaction survey responses from both groups showed no statistically significant difference, and the median response scores of both groups were the same. Study authors were not able to calculate cost savings for this protocol because the hospital operates under a Medicaid waiver instead of billing for each specific charge, Dr. Ault explained. However, they cited previous literature that estimates a day of hospitalization at $1,900. Survey questions to the outpatient group asking if they were satisfied with the protocol and if they would want it again yielded positive reviews, the study authors wrote. "We wanted to make sure the patients felt they were receiving appropriate care and nothing was missed in the process," Dr. Ault said. He added that the results of this study have changed the practice at his hospital--outpatient laparoscopic appendectomy is now the norm. "The main message is that we need to continually look for efficiencies and cost savings in a health care environment that is going to become increasingly restrictive," Dr. Ault said. "We have to look for ways to be efficient with the resources that we have." Other study authors are: David R. Rosen, MD; Kenji Inaba, MD, FACS; Paul J. Oh, BA; Adam C. Gutierrez, BA; Aaron M. Strumwasser, MD; Subarna Biswas, MD; and Melody Cala, MSN, FNP-C. A video summary of study highlights can be viewed at: https:/ "FACS" designates that a surgeon is a Fellow of the American College of Surgeons. Citation: Outpatient Laparoscopic Appendectomy: Feasible in a Public County Hospital? Journal of the American College of Surgeons. About the American College of Surgeons The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit http://www. .


The International Association of HealthCare Professionals is pleased to welcome Lucy Burciaga, MD, to their prestigious organization with her upcoming publication in The Leading Physicians of the World. Dr. Burciaga is a highly-trained and qualified internist with an extensive expertise in all facets of her work. Dr. Lucy Burciaga has been in practice for more than 27 years and is currently serving patients within Carondelet Medical Group in Tucson, Arizona. Dr. Lucy Burciaga’s career in medicine began in 1989 when she graduated with her Medical Degree from the University of Texas Health Science Center in Galveston, Texas. An internship was then completed with Kaiser Permanente, before a residency was completed at Bexar County Hospital in San Antonio, Texas. Dr. Burciaga is board certified by the American Board of Internal Medicine, and is renowned as a specialist in pediatric orthopedics. To keep up to date with the latest advances in her field, Dr. Burciaga maintains a professional membership with the Texas Medical Association, the American Medical Association, and the American College of Osteopathic Pediatricians. She attributes her success to her unwavering dedication and determination. When she is not working, Dr. Burciaga likes to read, visit casinos, and watch football. Learn more about Dr. Burciaga by reading her upcoming publication in The Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics.  Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review.  FindaTopDoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews and areas of expertise.  A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life.  For more information about FindaTopDoc, visit http://www.findatopdoc.com


The International Nurses Association is pleased to welcome Laura K. Marecic, RN, to their prestigious organization with her upcoming publication in the Worldwide Leaders In Healthcare. Laura K. Marecic is a Registered Nurse working for Select Specialty Hospital in Wichita, Kansas. With over 26 years experience in nursing, she is a specialist critical care nurse. Furthermore, she is affiliated with Riverside Health System Hospital and Van Wert County Hospital. Laura received her Nursing Degree from Butler Community College in El Dorado, Kansas in 1990, becoming a Registered Nurse. A believer in continual learning and education, Laura has earned additional certification in Basic Life Support and Advanced Cardiac Life Support, and is also a Certified Medical Surgical Registered Nurse. Throughout her successful career, Laura has gathered a wealth of experience as a critical care nurse. She is a keen reader of the American Journal of Nursing, and maintains a professional membership with the American Association of Critical-Care Nurses. Laura attributes her success to her love of taking care of others. When she is not assisting patients, Laura enjoys riding motorcycles. Learn more Laura K. Marecic here and read her upcoming publication in Worldwide Leaders In Healthcare.


Andrade C.,National Institute of Mental Health and Neuro Sciences | Kumar Rao N.S.,County Hospital
Indian Journal of Psychiatry | Year: 2010

Depression is conventionally viewed as a state of chemical imbalance, and antidepressants are suggested to act through increasing monoaminergic neurotransmission. These views are currently considered simplistic. This article examines the animal and human literature on the neurohistological mechanisms underlying stress, depression and antidepressant treatment. Pathological stress and depression are associated with changes such as loss of dendritic spines, shrinkage of the dendritic tree and loss of synapses in the hippocampus and prefrontal cortex. There is also a decrease in glia. Apoptosis may occur under extreme circumstances. In contrast, there is increased dendritic arborization and synaptogenesis in the amygdala. Antidepressant treatment protects against and even reverses some but not all of these stress-induced neurohistological changes. Pathological stress results in an aberrant neuroplasticity response characterized by abnormally increased activity in the amygdala and by impaired functioning of the hippocampus, prefrontal cortex and downstream structures. This aberrant neuroplasticity response directly explains most of the clinical symptoms of depression. Antidepressant treatment protects against stress-induced pathoplastic neurohistological and neurocognitive changes. Antidepressant treatment also restores functional neuroplasticity in stressed organisms and, thereby, presumably, facilitates re-adaptation through learning and memory mechanisms. Thus, the stress-depression syndrome and the therapeutic and prophylactic efficacy of antidepressant treatments can be explained through a hardwiring analogy. In this context, glutamate is an important neurotransmitter.


News Article | December 27, 2016
Site: www.marketwired.com

WEST PALM BEACH, FL--(Marketwired - December 27, 2016) - Rennova Health, Inc. ( : RNVA) ( : RNVAZ), a vertically integrated provider of industry-leading diagnostics and supportive software solutions to healthcare providers, announced today that it has entered into an Asset Purchase Agreement and paid a deposit to acquire certain assets related to Scott County Hospital, based in Oneida, Tennessee. Prior to closing in July 2016, Scott County Hospital was classified as a Critical Access Hospital (rural), had 25 beds, operating rooms and a Laboratory that provided a complement of ancillary diagnostic services, as well as an emergency department capable of operating 24/7. The purchase includes a 52,000 sq. ft. hospital building and 6,300 sq. ft. professional building on approximately 4.3 acres. The hospital was one of a group of seven hospitals that entered Chapter 11 bankruptcy in early 2016. Rennova entered into an agreement to acquire the assets out of bankruptcy for approximately $1,000,000, which includes $400,000 owed to a local bank that has a lien on the property. The bankruptcy court issued an order on December 23rd thereby making the purchase agreement effective. Closing of the purchase is expected to take place in early January 2017. The hospital has a number of licenses that need to be reinstated and is party to a number of in-network contracts with payers. Subject to obtaining requisite government and other approvals and licenses, Rennova believes the hospital will reopen in part in the 2nd quarter of 2017 and is working towards having the hospital in full operation by the 3rd quarter of 2017. The hospital had unaudited annual revenues of approximately $12 million for 2015. These revenues were attributable to the typical services of a rural acute care hospital, including emergency room visits, outpatient procedures, diagnostic ancillary tests, physical therapy and inpatient hospital stays. Based on the hospital's historical information, Rennova believes it offers a predictable patient base with predictable revenues as it serves the general healthcare needs of its community and supports local physicians. "This acquisition is further demonstration of Rennova's efforts to grow our business in a direction that will secure more predictable, recurring revenue for the provision of health care services and our state of the art solutions," said Seamus Lagan, CEO of Rennova. "A Rural Critical Access Hospital creates certain opportunities for Rennova to leverage its existing knowledge and services for the benefit of the hospital and surrounding physicians. We have hired specific expertise to oversee this project and believe we can reinstate the majority of the team from the local community that previously operated the hospital successfully. We look forward to proving and expanding this rural hospital model in the coming years." Rennova Health provides industry-leading diagnostics and supportive software solutions to healthcare providers, delivering an efficient, effective patient experience and superior clinical outcomes. Through an ever-expanding group of strategic brands that work in unison to empower customers, we are creating the next generation of healthcare. For more information, please visit www.rennovahealth.com. This press release includes "forward-looking statements" within the meaning of the safe harbor provisions of the United States Private Securities Litigation Reform Act of 1995. Actual results may differ from expectations and, consequently, you should not rely on these forward-looking statements as predictions of future events. Words such as "expect," "estimate," "project," "budget," "forecast," "anticipate," "intend," "plan," "may," "will," "could," "should," "believes," "predicts," "potential," "continue," and similar expressions are intended to identify such forward-looking statements. These forward-looking statements involve significant risks and uncertainties that could cause the actual results to differ materially from the expected results. Additional information concerning these and other risk factors are contained in the Company's most recent filings with the Securities and Exchange Commission. The Company cautions readers not to place undue reliance upon any forward-looking statements, which speak only as of the date made. The Company does not undertake or accept any obligation or undertaking to release publicly any updates or revisions to any forward-looking statements to reflect any change in their expectations or any change in events, conditions or circumstances on which any such statement is based, except as required by law.


Szakacs A.,County Hospital | Szakacs A.,Gothenburg University | Darin N.,Gothenburg University | Hallbook T.,Gothenburg University
Neurology | Year: 2013

Objectives: To assess the incidence of narcolepsy between January 2000 and December 2010 in children in western Sweden and its relationship to the Pandemrix vaccination, and to compare the clinical and laboratory features of these children. Methods: The children were identified from all local and regional pediatric hospitals, child rehabilitation centers, outpatient pediatric clinics, and regional departments of neurophysiology. Data collection was performed with the aid of a standardized data collection form, from medical records and telephone interviews with patients and parents. The laboratory and investigational data were carefully scrutinized. Results:We identified 37 children with narcolepsy. Nine of themhad onset of symptoms before the H1N1 vaccination and 28 had onset of symptoms in relationship to the vaccination. The median age at onset was 10 years. All patients in the postvaccination group were positive for human leukocyte antigen (HLA)-DQB1*0602. Nineteen patients in the postvaccination group, compared with one in the prevaccination group, had a clinical onset that could be dated within 12 weeks. Conclusion: Pandemrix vaccination is a precipitating factor for narcolepsy, especially in combination with HLA-DQB1*0602. The incidence of narcolepsy was 25 times higher after the vaccination compared with the time period before. The children in the postvaccination group had a lower age at onset and a more sudden onset than that generally seen. © 2013 American Academy of Neurology.


News Article | November 2, 2016
Site: www.businesswire.com

NEW YORK--(BUSINESS WIRE)--Fitch Ratings has affirmed the following Chattanooga-Hamilton County Hospital Authority, TN bonds issued on behalf of Erlanger Health System (EHS) at 'BBB+' : --$149.9 million hospital revenue and refunding bonds series 2014A. The Rating Outlook is Stable. SECURITY The bonds are secured by a pledge of gross revenues and a first mortgage lien on certain system property. KEY RATING DRIVERS SOLID CREDIT PROFILE: EHS ended fiscal 2016 (June 30 year-end) with operating inc


Latic F.,County Hospital
Medicinski arhiv | Year: 2010

Diaphragm injuries are diagnosed in the acute phase of blunt trauma only in 10% of cases--more often they are presented as hernia. Traumatic diaphragmatic hernia presents unique obstacles to a minimal invasive approach. However, with the proper training and equipment, most of these hernias are amenable to laparoscopic approach. These patients can expect the same well-known benefits of laparoscopic approach. We report here the case of a 56-year-old man, admitted to hospital with symptoms of vomiting, abdominal pain and dispnea who sustained blunt abdominal trauma in a high speed motor vehicle accident nine months ago. X-ray and CT scans confirmed suspected strangulated diaphragmatic hernia which contained stomach, colon, majoromentum and spleen in left hemithorax. The urgent laparoscopic procedure was performed--omentum, colon and stomach were taken backthrough diaphragmatic defect but the spleen was tightly fixed in thoracal cavity and splenectomy was performed. The diaphragmatic defect was repaired with interruptured sutures. This case proves that laparoscopic repair of diaphragmatic hernia is effective, but this should be carried out with caution, sometimes it needs additional complex procedure in emergency setting like splenectomy in this case.


Fischer K.,Strandvagen 54 | Fischer K.,County Hospital | Stenberg T.,Specialist Center for Oral Rehabilitation
Clinical Implant Dentistry and Related Research | Year: 2013

Background: Long-term follow-up studies (i.e., over 5 years), focusing on prosthetic outcomes and maintenance of implant-supported reconstructions in the edentulous maxilla, are scarce in the literature. Purpose: The purpose of this study was to evaluate and report 10-year data on outcomes and maintenance of screw-retained implant-supported full-arch casted titanium-resin prostheses in the edentulous maxilla. Materials and Methods: In the randomized control trial cohort of 24 patients, the outcome and maintenance of 23 bridges were registered. Results: One patient dropped out of the study prior to the 10-year control. Of the 23 remaining patients, 21 still had their original frameworks; one framework fractured after 8 years and one was remade after 7 years to create better support for the acrylic. The remaining 23 prostheses showed criteria of success, survival, and failure in 9, 82, and 9%, respectively. Tightening of two assembly screws was necessary in one patient. No detrimental effects were seen because of long cantilever extensions or opposing dentition. A total of 4.7 resin-related complications per prosthesis were observed; tooth fracture was the most common prosthetic complication. There was an indication of greater prevention in the number of resin-related complications with the use of lingual gold onlay compared with a resilient mouth guard, 0.71 and 1.67, respectively per bridge. The bridges were removed and reinserted 0.83 times per patient. No abutment or abutment screw fractures were registered. Conclusion: Fracture or wear of the reconstruction materials were considered predictable risks when using resin-based suprastructure materials. Status of opposing dentition and length of cantilevers did not confer additional risk. The use of a lingual gold onlay indicated prevention of resin-related complications. Future research should focus on the suprastructure materials to predict better overall treatment results of implant-supported full-arch bridges in the edentulous maxilla. © 2013 Wiley Periodicals, Inc.


NEW YORK--(BUSINESS WIRE)--Fitch Ratings has placed the 'AA-' rating on $38,310,000 of limited obligation sales tax bonds, series 2015A (Chilton County Hospital Project) on Rating Watch Negative. SECURITY The bonds are a limited obligation of the authority payable from a first lien on the proceeds of a 1% general sales and use tax levied and imposed within the county. The bonds are also secured by a cash-funded debt service reserve fund (DSRF) equal to maximum annual debt service (MADS). KEY RA

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