No abstract

No abstract

Hypothesis: We hypothesized that patients with diabetes mellitus (DM) have worse outcomes following trauma compared with patients without a history of DM. Design: Retrospective data analysis of the Pennsylvania Trauma Systems Foundation database that compiles data from 27 accredited trauma centers in Pennsylvania. Setting: We used the Pennsylvania Trauma Systems Foundation database of 295 561 patients to compare outcomes in patients with DM vs those in patients who did not have DM. Patients: A total of 12 489 patients with DM from January 1984 to December 2002 were matched by sex, age, and Injury Severity Score with 12 489 patients who did not have DM. Main Outcome Measures: Differences in the length of hospital stay, intensive care unit stay, ventilatory assistance days, complications, and mortality rates. Results: Patients with DM spent more days in the intensive care unit and receiving ventilator support. They were more likely to have a complication (23.0% in the DM group vs 14.0% in the non-DM group [odds ratio, 1.80; 95% confidence interval, 1.69-1.92]). No difference in mortality rates or length of hospital stay was noted. Conclusion: Patients with DM exposed to trauma have greater hospital morbidity resulting from longer intensive care unit stay, increased ventilator support, and more complications.

No abstract

Background-Despite evidence that diabetes is costly and devastating, the health care system is poorly equipped to meet the challenges of chronic disease care. The Penn State Institute of Diabetes & Obesity is evaluating a model of managing Type 2 DM which includes nurse case management (NCM) and motivational interviewing (MI) to foster behavior change. The primary care intervention is designed to improve patients' self care and to reduce clinical inertia through provider use of standardized clinical guidelines to achieve better diabetes outcomes.

To evaluate the impact of Computerized Provider Order Entry (CPOE) on workplace stress and overall job performance, as perceived by medical students, housestaff, attending physicians and nurses, after CPOE implementation at Penn State-Milton S. Hershey Medical Center, an academic tertiary care facility, in 2005. Using an online survey, the authors studied attitudes towards CPOE among 862 health care professionals. The main outcome measures were job performance and perceived stress levels. Statistical analyses were conducted using the Statistical Analytical Software (SAS Inc, Carey, NC). A total of413 respondents completed the entire survey (47.9 % response rate). Respondents in the younger age group were more familiar with the system, used it more frequently, and were more satisfied with it. Interns and residents were the most satisfied groups with the system, while attending physicians expressed the least satisfaction. Attending physicians and fellows found the system least user friendly compared with other groups, and also tended to express more stress and frustration with the system. Participants with previous CPOE experience were more familiar with the system, would use the system more frequently and were more likely to perceive the system as user friendly. User satisfaction with CPOE increases by familiarity and frequent use of the system. Improvement in system characteristics and avoidance of confusing terminology and inconsistent display of data is expected to enhance user satisfaction. Training in the use of CPOE should start early, ideally integrated into medical and nursing school curricula and form a continuous, long-term and user-specific process. This is expected to increase familiarity with the system, reducing stress and leading to improved user satisfaction and to subsequent enhanced safety and efficiency.

No abstract

To use decision analysis to compare the costs associated with minimally invasive parathyroidectomy (MIP) and bilateral neck exploration (BNE) in patients with primary hyperparathyroidism with regard to treatment of incidental synchronous thyroid disease. Design: We developed a decision tree model to evaluate the cost of managing thyroid pathology in primary hyperparathyroidism with the following 3 approaches: MIP, MIP with preoperative ultrasonography, and routine BNE with intraoperative thyroid evaluation. We tested the robustness of the optimal decision with sensitivity analyses. Setting: A tertiary care academic medical center. Main Outcome Measure: Total costs from a provider perspective. Results: Minimally invasive parathyroidectomy without an active search for thyroid abnormalities was determined to have the lowest expected cost ($5275 per patient). Parathyroid surgery with routine preoperative thyroid ultrasonography and further thyroid treatment as indicated had an expected cost of $5910 per patient. Bilateral neck exploration with intraoperative thyroid evaluation and treatment of the thyroid gland had an expected cost of $5916 per patient. Sensitivity analyses confirmed the robustness of the results across a reasonable range of surgical and imaging costs. Conclusions: Minimally invasive parathyroidectomy is not contraindicated on the basis of cost by an inability to screen for synchronous thyroid disease. In addition, ultrasonographic screening of the thyroid glands of patients undergoing MIP is not cost prohibitive and, in fact, is less costly than BNE. Ultrasonography has the added advantage of confirming the location of the offending parathyroid.