Current medical reimbursement realities may limit the time an anesthesiologist can spend assessing complicated patients preoperatively. Third-party payers increasingly demand admission of sick patients for complex operative procedures on the day of surgery. These patients are often evaluated and counseled in outpatient preanesthesia consultation clinics several days before surgery by busy, semi...

BACKGROUND Optimal care of multiple trauma patients has to be at a high level around the clock. Trauma care algorithms and guidelines are available, yet it remains unclear if the time of admission to the trauma room affects the quality of care and outcomes. Hence the present study intends to compare the quality of trauma room care of multiple severely injured patients at a level-1 trauma center...

In 2006 Massachusetts enacted a major health care reform aimed at achieving near-universal coverage in the state. While other studies have found that this reform substantially affected the use of health services in general, the impact of the reform on children is largely unexplored.1 Children are of special interest to policymakers because it is widely believed that better health in early child...

This paper proposes a strategy for defining indicators to assess the quality of the process of health care, based on the identification of the objectives of the care being delivered and on the verification of whether the technical guidelines for the procedures are being enforced. The article goes on to apply the proposed methodology to the process of health care during childbirth, based on a pe...

BACKGROUND This study aimed to evaluate the factors that influence breastfeeding throughout the hospital stay, including prenatal preparation, early skin-to-skin contact directly after delivery, rooming-in, feeding before the first breastfeed, time to first breastfeed, and postpartum support. This study also aimed to verify whether these factors were significant after adjusting for the mother's...

We highlight primary care innovations gathered from high-functioning primary care practices, innovations we believe can facilitate joy in practice and mitigate physician burnout. To do so, we made site visits to 23 high-performing primary care practices and focused on how these practices distribute functions among the team, use technology to their advantage, improve outcomes with data, and make...

In order to identify the reasons for early weaning in Teheran, we interviewed 900 mothers using a systematic randomized sampling method. A total of 15% of the mothers were illiterate, 93% were housewives, and 97% had given birth in hospitals. Only 3% of the newborns benefited from rooming-in facilities in hospital, and 68% were bottle-fed while still in hospital. In 3.1% of cases the mother had...

BACKGROUND We studied late preterm and term infants who were admitted to our neonatal care unit in a tertiary hospital for unexpected episodes of cyanosis that occurred during rooming-in for evaluation of their frequency, most frequent associated diseases, and documentation of the diagnostic clinical approach. METHODS We carried out a retrospective study of infants with a gestational age ≥35 ...

BACKGROUND Despite increased incidence of neonatal abstinence syndrome (NAS) over the past decade, minimal data exist on benefits of parental presence at the bedside on NAS outcomes. OBJECTIVE To examine the association between rates of parental presence and NAS outcomes. METHODS This was a retrospective, single-center cohort study of infants treated pharmacologically for NAS using a roomin...