Implementation of Computerized Physician Order Entry for Critical Patients in an Academic Emergency Department Is Not Associated With a Change in Mortality Rate.

Implementation of Computerized Physician Order Entry for Critical Patients in an Academic Emergency Department is Not Associated with a Change in Mortality Rate.

West J Emerg Med. 2013 Mar; 14(2): 114-120
Brunette DD, Tersteeg J, Brown N, Johnson V, Dunlop S, Karambay J, Miner J

There is limited literature on the effect of computerized physician order entry (CPOE) on mortality. The objective of our study was to determine if there was a change in mortality among critically ill patients presenting to the emergency department (ED) after the implementation of a CPOE system.This was a retrospective study of all critically ill patients in the ED during the year before and the year after CPOE implementation. The primary outcome measures were mortality in the ED, after admission, and overall. Secondary outcome measures included length of stay in the resuscitation area of the ED, length of hospital stay, and disposition following hospitalization. Patient disposition was used as a marker for neurologic function, and patients were grouped as either being discharged to home vs. nursing home, rehabilitation center, or a long-term healthcare facility. We analyzed data using descriptive statistics, chi- square, and Wilcoxon rank sum tests.There were 2,974 critically ill patients in the year preceding CPOE and 2,969 patients in the year following CPOE implementation. There were no differences in mortality between the two groups in the ED, after admission, or overall. The pre- and post-CPOE mortality rate for the ED, hospital, or overall was 2.52% vs. 2.02% (P = 0.19, 95% confidence interval [CI] -0.3 to 1.3), 7.8% versus 8.29% (P = 0.61, 95% CI -1.9 to 0.9), and 10.32% vs. 10.31% (P = .60, 95% CI -1.5 to 1.6), respectively. There was no difference in hospital length of stay between pre- and post-CPOE patients (3 days versus 3 days), a difference of 0.05 days (95% CI -0.47 to 0.57). Length of stay in the ED resuscitation area was longer in the post-CPOE group (31 versus 32 minutes), a difference of -1.96 minutes (95% CI -3.4 to -0.53). More patients were discharged to home in the pre-CPOE group (66.8% versus 64.3%), a difference of 2.54% (95% CI 0.13% to 4.96%).The implementation of CPOE was not associated with a change in mortality of critically ill ED patients, but was associated with a decrease in proportion of patients discharged to home after hospitalization. HubMed – rehab

GENERALIZED SELF INTERSECTION LOCAL TIME FOR A SUPERPROCESS OVER A STOCHASTIC FLOW.

Ann Probab. 2012 Jul 1; 40(4): 1483-1534
Heuser A

This paper examines the existence of the self-intersection local time for a superprocess over a stochastic flow in dimensions d ? 3, which through constructive methods, results in a Tanaka like representation. The superprocess over a stochastic flow is a superprocess with dependent spatial motion, and thus Dynkin’s proof of existence, which requires multiplicity of the log-Laplace functional, no longer applies. Skoulakis and Adler’s method of calculating moments is extended to higher moments, from which existence follows. HubMed – rehab

Home-Based Versus In-Hospital Cardiac Rehabilitation After Cardiac Surgery: A Nonrandomized Controlled Study.

Phys Ther. 2013 Apr 18;
Scalvini S, Zanelli E, Comini L, Dalla Tomba M, Troise G, Febo O, Giordano A

BACKGROUND: Exercise rehabilitation after cardiac surgery has beneficial effects especially on a long-term basis. Rehabilitative program with telemedicine plus appropriate technology might satisfy the needs of performing rehabilitation at home. OBJECTIVE: To compare exercise capacity after home cardiac telerehabilitation (HBCR) or in-hospital (in-H) rehabilitation in low-medium risk patients (EuroSCORE 0-5) following cardiac surgery. DESIGN: Quasi-experimental study. METHODS: At hospital discharge the study investigators gave patients the option to decide whether to enroll into the HBCR program. Clinical examinations [EKG, echo, chest-X-ray, blood samples] of HBCR patients were collected during 4 weeks of rehabilitation, and exercise capacity [6-minute walking test (6MWT)] was performed before and after rehabilitation. A control group of patients admitted to an in-Hospital rehabilitation program by our Institute was used as a comparator group. HBCR patients were supervised at home by a medical doctor and tele-monitored daily by a nurse and physiotherapist by videoconference. Periodic home visits by health staff were also performed. RESULTS: 100 patients were recruited in the HBCR group. An equal number of patients was selected for the comparator group. At the end of the 4-week study, the two groups showed improvement from their respective baseline values only in the 6MWT (p<0.001). No difference was found in time by group interaction. LIMITATIONS: Because patients self selected to enroll into the HBCR program, and because patients were enrolled from a single clinical center, the results of the study cannot be generalized. CONCLUSIONS: In patient who self-selected HBCR, the program was found to be effective and comparable with the standard in-H rehabilitative approach indicating that rehabilitation following cardiac surgery can be implemented effectively at home when co-administered with an integrated telemedicine service. HubMed – rehab