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  1. Event rates, hospital utilization, and costs associated with major complications of diabetes: a multicountry comparative analysis.

    Directory of Open Access Journals (Sweden)

    Philip M Clarke

    2010-02-01

    Full Text Available Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries.Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE study (mean age at entry 66 y. The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$, which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%-96% across regions and lowest for nephropathy (15%-26%. The average numbers of days in hospital given at least one admission were greatest for stroke (17-32 d across

  2. Exploring similarities and differences in hospital adverse event rates between Norway and Sweden using Global Trigger Tool

    OpenAIRE

    Deilk?s, Ellen Tveter; Risberg, Madeleine Borgstedt; Haugen, Marion; Lindstr?m, Jonas Christoffer; Nyl?n, Urban; Rutberg, Hans; Michael, Soop

    2017-01-01

    Objectives: In this paper, we explore similarities and differences in hospital adverse event (AE) rates between Norway and Sweden by reviewing medical records with the Global Trigger Tool (GTT). Design: All acute care hospitals in both countries performed medical record reviews, except one in Norway. Records were randomly selected from all eligible admissions in 2013. Eligible admissions were patients 18 years of age or older, undergoing care with an in-hospital stay of at least 24 hours, exc...

  3. The effect of sporting events on emergency department attendance rates in a district general hospital in Northern Ireland.

    Science.gov (United States)

    McGreevy, A; Millar, L; Murphy, B; Davison, G W; Brown, R; O'Donnell, M E

    2010-10-01

    Previous studies have reported a conflicting relationship between the effect of live and televised sporting events on attendance rates to emergency departments (ED). The objectives of this study were to investigate the relationship of major sporting events on emergency department attendance rates and to determine the potential effects of such events on service provision. A retrospective analysis of ED attendances to a district general hospital (DGH) and subsequent admissions over a 24-h period following live and televised sporting activities was performed over a 5-year period. Data were compiled from the hospital's emergency record books including the number of attendances, patient demographics, clinical complaint and outcome. Review patients were excluded. Analysis of sporting events was compiled for live local, regional and national events as well as world-wide televised sporting broadcasts. A total of 137,668 (80,445 men) patients attended from April 2002 to July 2007. Mean attendance rate per day was 80 patients (men = 47). Mean admission rate was 13.6 patients per day. Major sporting events during the study period included; Soccer: 4 FA Cup and 1 World Cup (WC) finals; Rugby: 47 Six Nations, 25 Six nations games involving Ireland, 1 WC final, 2 WC semi-finals, 2 WC quarter-finals and 4 WC games involving Ireland; and Gaelic Football [Gaelic Athletic Association (GAA)]: 5 All-Ireland finals, 11 semi-finals, 11 quarter-finals and 5 provincial finals. There was a significantly higher patient admission rate during the soccer FA Cup final, Rugby Six Nations and games involving Ireland and for GAA semi- and quarter-final games (p = 0.001-0.01). There was no difference identified in total attendance or non-admission rates for sporting events throughout the study period. Although there was no correlation identified between any of these sporting events and total emergency department attendances (r 0.07), multinomial logistic regression demonstrated that FA Cup final (p

  4. Exploring similarities and differences in hospital adverse event rates between Norway and Sweden using Global Trigger Tool.

    Science.gov (United States)

    Deilkås, Ellen Tveter; Risberg, Madeleine Borgstedt; Haugen, Marion; Lindstrøm, Jonas Christoffer; Nylén, Urban; Rutberg, Hans; Michael, Soop

    2017-03-20

    In this paper, we explore similarities and differences in hospital adverse event (AE) rates between Norway and Sweden by reviewing medical records with the Global Trigger Tool (GTT). All acute care hospitals in both countries performed medical record reviews, except one in Norway. Records were randomly selected from all eligible admissions in 2013. Eligible admissions were patients 18 years of age or older, undergoing care with an in-hospital stay of at least 24 hours, excluding psychiatric and care and rehabilitation. Reviews were done according to GTT methodology. Similar contexts for healthcare and similar socioeconomic and demographic characteristics have inspired the Nordic countries to exchange experiences from measuring and monitoring quality and patient safety in healthcare. The co-operation has promoted the use of GTT to monitor national and local rates of AEs in hospital care. 10 986 medical records were reviewed in Norway and 19 141 medical records in Sweden. No significant difference between overall AE rates was found between the two countries. The rate was 13.0% (95% CI 11.7% to 14.3%) in Norway and 14.4% (95% CI 12.6% to 16.3%) in Sweden. There were significantly higher AE rates of surgical complications in Norwegian hospitals compared with Swedish hospitals. Swedish hospitals had significantly higher rates of pressure ulcers, falls and 'other' AEs. Among more severe AEs, Norwegian hospitals had significantly higher rates of surgical complications than Swedish hospitals. Swedish hospitals had significantly higher rates of postpartum AEs. The level of patient safety in acute care hospitals, as assessed by GTT, was essentially the same in both countries. The differences between the countries in the rates of several types of AEs provide new incentives for Norwegian and Swedish governing bodies to address patient safety issues. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please

  5. Effects of Italian smoking regulation on rates of hospital admission for acute coronary events: a country-wide study.

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    Francesco Barone-Adesi

    Full Text Available BACKGROUND: Several studies have reported a reduction in acute coronary events (ACEs in the general population after the enforcement of smoking regulations, although there is uncertainty concerning the magnitude of the effect of such interventions. We conducted a country-wide evaluation of the health effects of the introduction of a smoking ban in public places, using data on hospital admissions for ACEs from the Italian population after the implementation of a national smoking regulation in January 2005. METHODS AND FINDINGS: Rates of admission for ACEs in the 20 Italian regions from January 2002 to November 2006 were analysed using mixed-effect regression models that allowed for long-term trends and seasonality. Standard methods for interrupted time-series were adopted to assess the immediate and gradual effects of the smoking ban. Effect modification by age was investigated, with the assumption that exposure to passive smoking in public places would be greater among young people. In total, 936,519 hospital admissions for ACEs occurred in the Italian population during the study period. A 4% reduction in hospital admissions for ACEs among persons aged less than 70 years was evident after the introduction of the ban (Rate Ratio [RR], 0.96; 95% Confidence Interval [CI], 0.95-0.98. No effect was found among persons aged at least 70 years (RR 1.00; 95% CI 0.99-1.02. Effect modification by age was further suggested by analyses using narrower age categories. CONCLUSIONS: Smoke-free policies can constitute a simple and inexpensive intervention for the prevention of cardiovascular diseases and thus should be included in prevention programmes.

  6. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle.

    Science.gov (United States)

    Starmer, Amy J; Sectish, Theodore C; Simon, Dennis W; Keohane, Carol; McSweeney, Maireade E; Chung, Erica Y; Yoon, Catherine S; Lipsitz, Stuart R; Wassner, Ari J; Harper, Marvin B; Landrigan, Christopher P

    2013-12-04

    Handoff miscommunications are a leading cause of medical errors. Studies comprehensively assessing handoff improvement programs are lacking. To determine whether introduction of a multifaceted handoff program was associated with reduced rates of medical errors and preventable adverse events, fewer omissions of key data in written handoffs, improved verbal handoffs, and changes in resident-physician workflow. Prospective intervention study of 1255 patient admissions (642 before and 613 after the intervention) involving 84 resident physicians (42 before and 42 after the intervention) from July-September 2009 and November 2009-January 2010 on 2 inpatient units at Boston Children's Hospital. Resident handoff bundle, consisting of standardized communication and handoff training, a verbal mnemonic, and a new team handoff structure. On one unit, a computerized handoff tool linked to the electronic medical record was introduced. The primary outcomes were the rates of medical errors and preventable adverse events measured by daily systematic surveillance. The secondary outcomes were omissions in the printed handoff document and resident time-motion activity. Medical errors decreased from 33.8 per 100 admissions (95% CI, 27.3-40.3) to 18.3 per 100 admissions (95% CI, 14.7-21.9; P < .001), and preventable adverse events decreased from 3.3 per 100 admissions (95% CI, 1.7-4.8) to 1.5 (95% CI, 0.51-2.4) per 100 admissions (P = .04) following the intervention. There were fewer omissions of key handoff elements on printed handoff documents, especially on the unit that received the computerized handoff tool (significant reductions of omissions in 11 of 14 categories with computerized tool; significant reductions in 2 of 14 categories without computerized tool). Physicians spent a greater percentage of time in a 24-hour period at the patient bedside after the intervention (8.3%; 95% CI 7.1%-9.8%) vs 10.6% (95% CI, 9.2%-12.2%; P = .03). The average duration of verbal

  7. Hospital deaths and adverse events in Brazil

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    Pavão Ana Luiza B

    2011-09-01

    Full Text Available Abstract Background Adverse events are considered a major international problem related to the performance of health systems. Evaluating the occurrence of adverse events involves, as any other outcome measure, determining the extent to which the observed differences can be attributed to the patient's risk factors or to variations in the treatment process, and this in turn highlights the importance of measuring differences in the severity of the cases. The current study aims to evaluate the association between deaths and adverse events, adjusted according to patient risk factors. Methods The study is based on a random sample of 1103 patient charts from hospitalizations in the year 2003 in 3 teaching hospitals in the state of Rio de Janeiro, Brazil. The methodology involved a retrospective review of patient charts in two stages - screening phase and evaluation phase. Logistic regression was used to evaluate the relationship between hospital deaths and adverse events. Results The overall mortality rate was 8.5%, while the rate related to the occurrence of an adverse event was 2.9% (32/1103 and that related to preventable adverse events was 2.3% (25/1103. Among the 94 deaths analyzed, 34% were related to cases involving adverse events, and 26.6% of deaths occurred in cases whose adverse events were considered preventable. The models tested showed good discriminatory capacity. The unadjusted odds ratio (OR 11.43 and the odds ratio adjusted for patient risk factors (OR 8.23 between death and preventable adverse event were high. Conclusions Despite discussions in the literature regarding the limitations of evaluating preventable adverse events based on peer review, the results presented here emphasize that adverse events are not only prevalent, but are associated with serious harm and even death. These results also highlight the importance of risk adjustment and multivariate models in the study of adverse events.

  8. Adverse outcomes of anticoagulant use among hospitalized patients with chronic kidney disease: a comparison of the rates of major bleeding events between unfractionated heparin and enoxaparin.

    Directory of Open Access Journals (Sweden)

    Fatemeh Saheb Sharif-Askari

    Full Text Available BACKGROUND: Anticoagulation therapy is usually required in patients with chronic kidney disease (CKD for treatment or prevention of thromboembolic diseases. However, this benefit could easily be offset by the risk of bleeding. OBJECTIVES: To determine the incidence of adverse outcomes of anticoagulants in hospitalized patients with CKD, and to compare the rates of major bleeding events between the unfractionated heparin (UFH and enoxaparin users. METHODS: One year prospective observational study was conducted in patients with CKD stages 3 to 5 (estimated GFR, 10-59 ml/min/1.73 m(2 who were admitted to the renal unit of Dubai Hospital. Propensity scores for the use of anticoagulants, estimated for each of the 488 patients, were used to identify a cohort of 117 pairs of patients. Cox regression method was used to estimate association between anticoagulant use and adverse outcomes. RESULTS: Major bleeding occurred in 1 in 3 patients who received anticoagulation during hospitalization (hazard ratio [HR], 4.61 [95% confidence interval [CI], 2.05-10.35]. Compared with enoxaparin users, patients who received anticoagulation with unfractionated heparin had a lower mean [SD] serum level of platelet counts (139.95 [113] × 10(3/µL vs 205.56 [123] × 10(3/µL; P<0.001, and had a higher risk of major bleeding (HR, 4.79 [95% CI, 1.85-12.36]. Furthermore, compared with those who did not receive anticoagulants, patients who did had a higher in-hospital mortality (HR, 2.54 [95% CI, 1.03-6.25]; longer length of hospitalization (HR, 1.04 [95% CI, 1.01-1.06]; and higher hospital readmission at 30 days (HR, 1.79 [95% CI, 1.10-2.91]. CONCLUSIONS: Anticoagulation among hospitalized patients with CKD was significantly associated with an increased risk of bleeding and in-hospital mortality. Hence, intensive monitoring and preventive measures such as laboratory monitoring and/or dose adjustment are warranted.

  9. Monitoring adverse events in hospitals: how safe are hospitals for patients?

    NARCIS (Netherlands)

    Baines, R.J.

    2018-01-01

    This thesis aims to assess trends in adverse event and preventable adverse event rates in hospitals in the Netherlands through the time period 2004 –2012. Furthermore patient safety for specific care processes and patient groups are assessed. Patient safety has been high on the international agenda

  10. HSMR : Comparing Death Rates Across UK Hospitals

    NARCIS (Netherlands)

    Ben Teeuwen; Thuy Ngo; Frans Nauta

    2011-01-01

    The Hospital Standardized Mortality Ratio (HSMR) is a measurement tool that shows hospitals’ death rates. The HSMR compares deaths that occur in hospitals with death ratios that one would normally expect based on patients’ diseases. It is used as a benchmark for adjusted hospital death rates. These

  11. INES rating of radiation protection related events

    International Nuclear Information System (INIS)

    Hort, M.

    2009-01-01

    In this presentation, based on the draft Manual, a short review of the use of the INES rating of events concerning radiation protection is given, based on a new INES User's Manual edition. The presentation comprises a brief history of the scale development, general description of the scale and the main principles of the INES rating. Several examples of the use of the scale for radiation protection related events are mentioned. In the presentation, the term 'radiation protection related events' is used for radiation source and transport related events outside the nuclear installations. (authors)

  12. Nursing magnet hospitals have better CMS hospital compare ratings

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    Robbins RA

    2017-11-01

    Full Text Available Background: There has been conflicting data on whether Nursing Magnet Hospitals (NMH provide better care. Methods: NMH in the Southwest USA (Arizona, California, Colorado, Hawaii, Nevada, and New Mexico were compared to hospitals not designated as NMH using the Centers for Medicare and Medicaid (CMS hospital compare star designation. Results: NMH had higher star ratings than non-NMH hospitals (3.34 + 0.78 vs. 2.86 + 0.83, p<0.001. The hospitals were mostly large, urban non-critical access hospitals. Academic medical centers made up a disproportionately large portion of the NMH. Conclusions: Although NMH had higher hospital ratings, the data may favor non-critical access academic medical centers which are known to have better outcomes.

  13. Adverse events in surgical inpatients: A comparative analysis of public hospitals in Victoria

    OpenAIRE

    Katharina Hauck; Xueyan Zhao; Terri Jackson

    2010-01-01

    We compare adverse event rates for surgical inpatients across 36 public hospitals in the state of Victoria, Australia, conditioning on differences in patient complexity across hospitals. We estimate separate models for elective and emergency patients which stay at least one night in hospitals, using fixed effects complementary log-log models to estimate AEs as a function of patient and episode characteristics, and hospital effects. We use 4 years of patient level administrative hospital data ...

  14. Hospitalized cardiovascular events in patients with diabetic macular edema

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    Nguyen-Khoa Bao-Anh

    2012-07-01

    Full Text Available Abstract Background Microvascular and macrovascular complications in diabetes stem from chronic hyperglycemia and are thought to have overlapping pathophysiology. The aim of this study was to investigate the incidence rate of hospitalized myocardial infarctions (MI and cerebrovascular accidents (CVA in patients with diabetic macular edema (DME compared with diabetic patients without retinal diseases. Methods This was a retrospective cohort study of a commercially insured population in an administrative claims database. DME subjects (n = 3519 and diabetes controls without retinal disease (n = 10557 were matched by age and gender. Healthcare claims were analyzed for the study period from 1 January 2002 to 31 December 2005. Incidence and adjusted rate ratios of hospitalized MI and CVA events were then calculated. Results The adjusted rate ratio for MI was 2.50 (95% CI: 1.83-3.41, p  Conclusion Event rates of MI or CVA were higher in patients with DME than in diabetes controls. This study is one of few with sufficient sample size to accurately estimate the relationship between DME and cardiovascular outcomes.

  15. Variability in case-mix adjusted in-hospital cardiac arrest rates.

    Science.gov (United States)

    Merchant, Raina M; Yang, Lin; Becker, Lance B; Berg, Robert A; Nadkarni, Vinay; Nichol, Graham; Carr, Brendan G; Mitra, Nandita; Bradley, Steven M; Abella, Benjamin S; Groeneveld, Peter W

    2012-02-01

    It is unknown how in-hospital cardiac arrest (IHCA) rates vary across hospitals and predictors of variability. Measure variability in IHCA across hospitals and determine if hospital-level factors predict differences in case-mix adjusted event rates. Get with the Guidelines Resuscitation (GWTG-R) (n=433 hospitals) was used to identify IHCA events between 2003 and 2007. The American Hospital Association survey, Medicare, and US Census were used to obtain detailed information about GWTG-R hospitals. Adult patients with IHCA. Case-mix-adjusted predicted IHCA rates were calculated for each hospital and variability across hospitals was compared. A regression model was used to predict case-mix adjusted event rates using hospital measures of volume, nurse-to-bed ratio, percent intensive care unit beds, palliative care services, urban designation, volume of black patients, income, trauma designation, academic designation, cardiac surgery capability, and a patient risk score. We evaluated 103,117 adult IHCAs at 433 US hospitals. The case-mix adjusted IHCA event rate was highly variable across hospitals, median 1/1000 bed days (interquartile range: 0.7 to 1.3 events/1000 bed days). In a multivariable regression model, case-mix adjusted IHCA event rates were highest in urban hospitals [rate ratio (RR), 1.1; 95% confidence interval (CI), 1.0-1.3; P=0.03] and hospitals with higher proportions of black patients (RR, 1.2; 95% CI, 1.0-1.3; P=0.01) and lower in larger hospitals (RR, 0.54; 95% CI, 0.45-0.66; PCase-mix adjusted IHCA event rates varied considerably across hospitals. Several hospital factors associated with higher IHCA event rates were consistent with factors often linked with lower hospital quality of care.

  16. Variations in hospitalization rates among nursing home residents: the role of discretionary hospitalizations.

    Science.gov (United States)

    Carter, Mary W

    2003-08-01

    To examine variations in hospitalization rates among nursing home residents associated with discretionary hospitalization practices. Quarterly Medicaid case-mix reimbursement data from the state of Massachusetts served as the core data source for this study, which was linked with data from the Medicare Provider Analysis and Review file (MEDPAR) to specify hospitalization status, nursing facility attribute data from the state of Massachusetts to specify facility-level organizational and structural attributes, and data from the Area Resource File (ARF) to specify area market-level attributes. Data spans three years (1991-1993) to produce a longitudinal analytical file containing 72,319 person-quarter-level observations. Two-step, multivariate logistic regression models were estimated for highly discretionary hospitalizations versus those containing less discretion, and low discretionary hospitalizations versus those containing greater amounts of physician discretion. Findings indicate that facility case-mix levels and area hospital bed supply levels contribute to variations in hospitalization rates among nursing home residents. Highly discretionary hospitalizations appear to be most sensitive to patient diagnoses best described as chronic, ambulatory care sensitive conditions. Findings suggest that defining hospitalizations simply in terms of whether an event occurs versus otherwise may obscure valuable information regarding the contribution of various risk factors to highly discretionary versus low discretionary hospitalization rates.

  17. Hospital employee assault rates before and after enactment of the california hospital safety and security act.

    Science.gov (United States)

    Casteel, Carri; Peek-Asa, Corinne; Nocera, Maryalice; Smith, Jamie B; Blando, James; Goldmacher, Suzi; O'Hagan, Emily; Valiante, David; Harrison, Robert

    2009-02-01

    This study examines changes in violent event rates to hospital employees before and after enactment of the California Hospital Safety and Security Act in 1995. We compared pre- and post-initiative employee assault rates in California (n = 116) emergency departments and psychiatric units with those in New Jersey (n = 50), where statewide workplace violence initiatives do not exist. Poisson regression with generalized estimating equations was used to compare assault rates between a 3-year pre-enactment period (1993-1995) and a 6-year post-enactment period (1996-2001) using New Jersey hospitals as a temporal control. Assault rates among emergency department employees decreased 48% in California post-enactment, compared with emergency department employee assault rates in New Jersey (rate ratio [RR] = 0.52, 95% confidence interval [CI]: 0.31, 0.90). Emergency department employee assault rates decreased in smaller facilities (RR = 0.46, 95% CI: 0.21, 0.96) and for-profit-controlled hospitals (RR = 0.39, 95% CI: 0.19, 0.79) post-enactment. Among psychiatric units, for-profit-controlled hospitals (RR = 0.41, 95% CI: 0.19, 0.85) and hospitals located in smaller communities (RR = 0.44, 95% CI: 0.21, 0.92) experienced decreased assault rates post-enactment. Policy may be an effective method to increase safety to health care workers.

  18. The Rising Rate of Rural Hospital Closures.

    Science.gov (United States)

    Kaufman, Brystana G; Thomas, Sharita R; Randolph, Randy K; Perry, Julie R; Thompson, Kristie W; Holmes, George M; Pink, George H

    2016-01-01

    Since 2010, the rate of rural hospital closures has increased significantly. This study is a preliminary look at recent closures and a formative step in research to understand the causes and the impact on rural communities. The 2009 financial performance and market characteristics of rural hospitals that closed from 2010 through 2014 were compared to rural hospitals that remained open during the same period, stratified by critical access hospitals (CAHs) and other rural hospitals (ORHs). Differences were tested using Pearson's chi-square (categorical variables) and Wilcoxon rank test of medians. The relationships between negative operating margin and (1) market factors and (2) utilization/staffing factors were explored using logistic regression. In 2009, CAHs that subsequently closed from 2010 through 2014 had, in general, lower levels of profitability, liquidity, equity, patient volume, and staffing. In addition, ORHs that closed had smaller market shares and operated in markets with smaller populations compared to ORHs that remained open. Odds of unprofitability were associated with both market and utilization factors. Although half of the closed hospitals ceased providing health services altogether, the remainder have since converted to an alternative health care delivery model. Financial and market characteristics appear to be associated with closure of rural hospitals from 2010 through 2014, suggesting that it is possible to identify hospitals at risk of closure. As closure rates show no sign of abating, it is important to study the drivers of distress in rural hospitals, as well as the potential for alternative health care delivery models. © 2015 National Rural Health Association.

  19. Hospitalization rates among economic immigrants to Canada.

    Science.gov (United States)

    Ng, Edward; Sanmartin, Claudia; Manuel, Douglas G

    2017-07-19

    Economic immigrants generally, and economic class principal applicants (ECPAs) specifically, tend to have better health than other immigrants. However, health outcomes vary among subcategories within this group, especially by sex. This study examines hospitalization rates among ECPAs aged 25 to 74 who arrived in Canada between 1980 and 2006 as skilled workers, business immigrants, or live-in caregivers. The analysis used two linked databases to estimate age-standardized hospitalization rates (ASHRs) overall and for leading causes by sex. ASHRs of ECPA subcategories were compared with each other and with those of the Canadian-born population. Logistic regression was used to derive odds ratios for hospitalization among ECPAs, by sex. Male and female ECPAs aged 25 to 74 had significantly lower all-cause ASHRs than did the Canadian-born population in the same age range. This pattern prevailed for each ECPA subcategory and for each disease examined. Compared with skilled workers, business immigrants had lower odds of hospitalization; live-in caregivers who arrived after 1992 had higher odds. Adjustment for education, official language proficiency, and world region reduced the strength of or eliminated these associations. Compared with the Canadian-born population, ECPAs generally had low hospitalization rates. Differences were apparent among ECPA subcategories.

  20. PSA-based evaluation and rating of operational events

    International Nuclear Information System (INIS)

    Gomez Cobo, A.

    1997-01-01

    The presentation discusses the PSA-based evaluation and rating of operational events, including the following: historical background, procedures for event evaluation using PSA, use of PSA for event rating, current activities

  1. Differences in the rates of patient safety events by payer: implications for providers and policymakers.

    Science.gov (United States)

    Spencer, Christine S; Roberts, Eric T; Gaskin, Darrell J

    2015-06-01

    The reduction of adverse patient safety events and the equitable treatment of patients in hospitals are clinical and policy priorities. Health services researchers have identified disparities in the quality of care provided to patients, both by demographic characteristics and insurance status. However, less is known about the extent to which disparities reflect differences in the places where patients obtain care, versus disparities in the quality of care provided to different groups of patients in the same hospital. In this study, we examine whether the rate of adverse patient safety events differs by the insurance status of patients within the same hospital. Using discharge data from hospitals in 11 states, we compared risk-adjusted rates for 13 AHRQ Patient Safety Indicators by Medicare, Medicaid, and Private payer insurance status, within the same hospitals. We used multivariate regression to assess the relationship between insurance status and rates of adverse patient safety events within hospitals. Medicare and Medicaid patients experienced significantly more adverse safety events than private pay patients for 12 and 7 Patient Safety Indicators, respectively (at P patients had significantly lower event rates than private payers on 2 Patient Safety Indicators. Risk-adjusted Patient Safety Indicator rates varied with patients' insurance within the same hospital. More research is needed to determine the cause of differences in care quality received by patients at the same hospital, especially if quality measures are to be used for payment.

  2. COMPARISON OF FOUR METHODS TO DETECT ADVERSE EVENTS IN HOSPITAL

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    Inge Dhamanti

    2015-09-01

    Full Text Available AbstrakDeteksi terjadinya kejadian yang tidak diharapkan (KTD telah menjadi salah satu tantangan dalam keselamatan pasien oleh karena itu metode untuk mendeteksi terjadinya KTD sangatlah penting untuk meningkatkan keselamatan pasien. Tujuan dari artikel ini adalah untuk membandingkan kelebihan dan kekurangan dari beberapa metode untuk mendeteksi terjadinya KTD di rumah sakit, meliputi review rekam medis, pelaporan insiden secara mandiri, teknologi informasi, dan pelaporan oleh pasien. Studi ini merupakan kajian literatur untuk membandingkan dan menganalisa metode terbaik untuk mendeteksi KTD yang dapat diimplementasikan oleh rumah sakit. Semua dari empat metode telah terbukti mampu untuk mendeteksi terjadinya KTD di rumah sakit, tetapi masing-masing metode mempunyai kelebihan dan kekurangan yang perlu diatasi. Tidak ada satu metode terbaik yang akan memberikan hasil terbaik untuk mendeteksi KTD di rumah sakit. Sehingga untuk mendeteksi lebih banyak KTD yang seharusnya dapat dicegah, atau KTD yang telah terjadi, rumah sakit seharusnya mengkombinasikan lebih dari satu metode untuk mendeteksi, karena masing-masing metode mempunyai sensitivitas berbeda-beda.AbstractDetecting adverse events has become one of the challenges in patient safety thus methods to detect adverse events become critical for improving patient safety. The purpose of this paper is to compare the strengths and weaknesses of several methods of identifying adverse events in hospital, including medical records reviews, self-reported incidents, information technology, and patient self-reports. This study is a literature review to compared and analyzed to determine the best method implemented by the hospital. All of four methods have been proved in their ability in detecting adverse events in hospitals, but each method had strengths and limitations to be overcome. There is no ‘best’ single method that will give the best results for adverse events detection in hospital. Thus to

  3. Association of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge

    Science.gov (United States)

    Wang, Yongfei; Lin, Zhenqiu; Normand, Sharon-Lise T.; Ross, Joseph S.; Horwitz, Leora I.; Desai, Nihar R.; Suter, Lisa G.; Drye, Elizabeth E.; Bernheim, Susannah M.; Krumholz, Harlan M.

    2017-01-01

    Importance The Affordable Care Act has led to US national reductions in hospital 30-day readmission rates for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. Whether readmission reductions have had the unintended consequence of increasing mortality after hospitalization is unknown. Objective To examine the correlation of paired trends in hospital 30-day readmission rates and hospital 30-day mortality rates after discharge. Design, Setting, and Participants Retrospective study of Medicare fee-for-service beneficiaries aged 65 years or older hospitalized with HF, AMI, or pneumonia from January 1, 2008, through December 31, 2014. Exposure Thirty-day risk-adjusted readmission rate (RARR). Main Outcomes and Measures Thirty-day RARRs and 30-day risk-adjusted mortality rates (RAMRs) after discharge were calculated for each condition in each month at each hospital in 2008 through 2014. Monthly trends in each hospital’s 30-day RARRs and 30-day RAMRs after discharge were examined for each condition. The weighted Pearson correlation coefficient was calculated for hospitals’ paired monthly trends in 30-day RARRs and 30-day RAMRs after discharge for each condition. Results In 2008 through 2014, 2 962 554 hospitalizations for HF, 1 229 939 for AMI, and 2 544 530 for pneumonia were identified at 5016, 4772, and 5057 hospitals, respectively. In January 2008, mean hospital 30-day RARRs and 30-day RAMRs after discharge were 24.6% and 8.4% for HF, 19.3% and 7.6% for AMI, and 18.3% and 8.5% for pneumonia. Hospital 30-day RARRs declined in the aggregate across hospitals from 2008 through 2014; monthly changes in RARRs were −0.053% (95% CI, −0.055% to −0.051%) for HF, −0.044% (95% CI, −0.047% to −0.041%) for AMI, and −0.033% (95% CI, −0.035% to −0.031%) for pneumonia. In contrast, monthly aggregate changes across hospitals in hospital 30-day RAMRs after discharge varied by condition: HF, 0.008% (95% CI, 0.007% to 0.010%); AMI, −0

  4. The practice of reporting adverse events in a teaching hospital

    Directory of Open Access Journals (Sweden)

    Andréia Guerra Siman

    2017-10-01

    Full Text Available Abstract OBJECTIVE Understanding the practice of reporting adverse events by health professionals. METHOD A qualitative case study carried out in a teaching hospital with participants of the Patient Safety Center and the nursing team. The collection took place from May to December 2015, and was conducted through interviews, observation and documentary research to treat the data using Content Analysis. RESULTS 31 professionals participated in the study. Three categories were elaborated: The practice of reporting adverse events; Barriers in the effective practice of notifications; The importance of reporting adverse events. CONCLUSION Notification was permeated by gaps in knowledge, fear of punishment and informal communication, generating underreporting. It is necessary to improve the interaction between leaders and professionals, with an emphasis on communication and educational practice.

  5. Smoking restrictions and hospitalization for acute coronary events in Germany

    Science.gov (United States)

    Sargent, James D.; Demidenko, Eugene; Malenka, David J.; Li, Zhongze; Gohlke, Helmut

    2013-01-01

    Aims To study the effects of smoking restrictions in Germany on coronary syndromes and their associated costs. Methods and results All German states implemented laws partially restricting smoking in the public and hospitality sectors between August 2007 and July 2008. We conducted a before-and-after study to examine trends for the hospitalization rate for angina pectoris and acute myocardial infarction (AMI) for an insurance cohort of 3,700,384 individuals 30 years and older. Outcome measures were hospitalization rates for coronary syndromes, and hospitalization costs. Mean age of the cohort was 56 years, and two-thirds were female. Some 2.2 and 1.1% persons were hospitalized for angina pectoris and AMI, respectively, during the study period from January 2004 through December 2008. Law implementation was associated with a 13.3% (95% confidence interval 8.2, 18.4) decline in angina pectoris and an 8.6% (5.0, 12.2) decline in AMI after 1 year. Hospitalization costs also decreased significantly for the two conditions—9.6% (2.5, 16.6) for angina pectoris and 20.1% (16.0, 24.2) for AMI at 1 year following law implementation. Assuming the law caused the observed declines, it prevented 1,880 hospitalizations and saved 7.7 million Euros in costs for this cohort during the year following law implementation. Conclusions Partial smoking restrictions in Germany were followed by reductions in hospitalization for angina pectoris and AMI, declines that continued through 1 year following these laws and resulted in substantial cost savings. Strengthening the laws could further reduce morbidity and costs from acute coronary syndromes in Germany. PMID:22350716

  6. Smoking restrictions and hospitalization for acute coronary events in Germany.

    Science.gov (United States)

    Sargent, James D; Demidenko, Eugene; Malenka, David J; Li, Zhongze; Gohlke, Helmut; Hanewinkel, Reiner

    2012-03-01

    To study the effects of smoking restrictions in Germany on coronary syndromes and their associated costs. All German states implemented laws partially restricting smoking in the public and hospitality sectors between August 2007 and July 2008. We conducted a before-and-after study to examine trends for the hospitalization rate for angina pectoris and acute myocardial infarction (AMI) for an insurance cohort of 3,700,384 individuals 30 years and older. Outcome measures were hospitalization rates for coronary syndromes, and hospitalization costs. Mean age of the cohort was 56 years, and two-thirds were female. Some 2.2 and 1.1% persons were hospitalized for angina pectoris and AMI, respectively, during the study period from January 2004 through December 2008. Law implementation was associated with a 13.3% (95% confidence interval 8.2, 18.4) decline in angina pectoris and an 8.6% (5.0, 12.2) decline in AMI after 1 year. Hospitalization costs also decreased significantly for the two conditions-9.6% (2.5, 16.6) for angina pectoris and 20.1% (16.0, 24.2) for AMI at 1 year following law implementation. Assuming the law caused the observed declines, it prevented 1,880 hospitalizations and saved 7.7 million Euros in costs for this cohort during the year following law implementation. Partial smoking restrictions in Germany were followed by reductions in hospitalization for angina pectoris and AMI, declines that continued through 1 year following these laws and resulted in substantial cost savings. Strengthening the laws could further reduce morbidity and costs from acute coronary syndromes in Germany.

  7. Hospital volume and adverse events following esophageal endoscopic submucosal dissection in Japan.

    Science.gov (United States)

    Odagiri, Hiroyuki; Yasunaga, Hideo; Matsui, Hiroki; Matsui, Shigeru; Fushimi, Kiyohide; Kaise, Mitsuru

    2017-04-01

    Background and study aims  Esophageal endoscopic submucosal dissection (ESD) has gradually acquired popularity as a minimally invasive surgery for early cancers not only in Japan, but also in other countries. However, most reported outcomes have been based on relatively small samples of patients from specialized centers. Therefore, the association between hospital volume and the rate of adverse events following esophageal ESD has been poorly understood. Patients and methods  Using a nationwide administrative database in Japan, we identified patients who underwent esophageal ESD between 1 July 2007 and 31 March 2013. Hospital volume was defined as the number of esophageal ESD procedures performed per year at each hospital and was categorized into quartiles. Results  In total, 12 899 esophageal ESD procedures at 699 institutions were identified during the study period. Perforation and perforation-related disorders were observed in 422 patients (3.3 %), and one patient died after perforation. There was a significant association between a lower hospital volume and a higher proportion of adverse events following esophageal ESD. Although not statistically significant, a similar tendency was observed in the occurrence of blood transfusion within 1 week after ESD and all-cause in-hospital death. Multivariable logistic regression analysis showed that hospitals with very high case volumes were less likely to experience adverse events following esophageal ESD than hospitals with very low volumes. Conclusions  The proportion of perforation and perforation-related disorders following esophageal ESD was permissibly low, and there was a linear association between higher hospital volume and lower rates of adverse events following esophageal ESD. © Georg Thieme Verlag KG Stuttgart · New York.

  8. [IBEAS design: adverse events prevalence in Latin American hospitals].

    Science.gov (United States)

    Aranaz-Andrés, J M; Aibar-Remón, C; Limón-Ramírez, R; Amarilla, A; Restrepo, F R; Urroz, O; Sarabia, O; Inga, R; Santivañez, A; Gonseth-García, J; Larizgoitia-Jauregui, I; Agra-Varela, Y; Terol-García, E

    2011-01-01

    To describe the methodological characteristics of the IBEAS study: adverse events prevalence in Latin American hospitals, with the aim of analysing the magnitude, significance and impact of adverse events (AE); to identify the main problems associated with patient safety AE; to increase the capacity of professionals involved in patient safety; and the setting up of patient safety agendas in the participating countries. A patient safety study launched in 35 Latin American hospitals through the analysis of AE in 5 countries: Argentina, Colombia, Costa Rica, Mexico and Peru, using a cross-sectional study using a review of clinical records as the main method. The implications of using a cross-sectional design when studying AE are described, in terms of resources required, internal validity and usefulness related to risk management. The cross-sectional design seems an efficient methodology in terms of time and resources spent, as well as being easy to carry out. Although the cross-sectional design does not review the all hospital episodes, it is able to provide a reliable estimate of prevalence and to support a surveillance system. Because of a possible survival bias, it is likely that the AE which led to hospital admissions will be overestimated, as well as the health related infections or those adverse events which are difficult to identify if the patient is not examined (e.g. contusions). Communication with the ward staff (if the patient is still hospitalised) help in finding the causality and their prevention. Copyright © 2010 SECA. Published by Elsevier Espana. All rights reserved.

  9. Patients' identification and reporting of unsafe events at six hospitals in Japan.

    Science.gov (United States)

    Hasegawa, Tomonori; Fujita, Shigeru; Seto, Kanako; Kitazawa, Takefumi; Matsumoto, Kunichika

    2011-11-01

    Hospitals and other health care organizations have increasingly recognized the need to engage patients as participants in patient safety. A study was conducted to compare patients' and health care staff's identification and reporting of such events. A questionnaire was administered at six hospitals in Japan to outpatients and inpatients from November 2004 through February 2007. Patients were asked to respond to questions about experiences of possibly unsafe events. Patients experiencing such events were then asked about the events and whether they had reported their experience to health care staff. A specialist panel classified reported events as "uneasy-dissatisfying" or "unsafe." The response rates of outpatients and inpatients were 85.4% (1,506/1,764) and 54.3% (1,738/3,198), respectively. Among the respondents (> or = 20 years of age), 125 (8.7%) of the outpatients and 185 (10.9%) of the inpatients experienced uneasy-dissatisfying or unsafe events; 35 (2.4%) of the outpatients and 67 (4.0%) of the inpatients experienced unsafe events, the percent increasing with hospital stay. Only 38 (30.4%) of the outpatients and 62 (33.5%) of the inpatients reported the unsafe events to health care staff Only 17.1% of unsafe events reported by inpatients were identified by the in-house reporting systems of adverse events and near misses. For the uneasy-dissatisfying or unsafe events that patients did not think necessary to report, the patients often felt they were self-evident or easily identifiable by health care staff, had difficulty evaluating the event, did not expect their report to bring any improvement, or even felt that reporting it would create some disadvantage in their medical treatment. Patient reporting programs and in-house reporting systems, among other detection methods, should be regarded as complementary sources of information.

  10. Impact of tornadoes on hospital admissions for acute cardiovascular events.

    Science.gov (United States)

    Silva-Palacios, Federico; Casanegra, Ana Isabel; Shapiro, Alan; Phan, Minh; Hawkins, Beau; Li, Ji; Stoner, Julie; Tafur, Alfonso

    2015-11-01

    There is a paucity of data describing cardiovascular events after tornado outbreaks. We proposed to study the effects of tornadoes on the incidence of cardiovascular events at a tertiary care institution. Hospital admission records from a single center situated in a tornado-prone area three months before and after a 2013 tornado outbreak were abstracted. To control for seasonal variation, we also abstracted data from the same period of the prior year (control). Hospital admissions for cardiovascular events (CVEs) including acute myocardial infarction, stroke and venous thromboembolism (VTE) were summated by zip codes, and compared by time period. There were 22,607 admissions analyzed, of which 6,705 (30%), 7,980 (35%), and 7,922 (35%) were during the pre-tornado, post-tornado, and control time frames, respectively. There were 344 CVE in the controls, 317 CVE in pre-tornado and 364 CVEs in post tornado periods. There was no difference in the prevalence of CVE during the post-tornado season compared with the control (PPR=1.05 95% CI: 0.91 to 1.21, p=0.50) or the pre-tornado season (PPR=0.96, 95% CI: 0.83 to 1.21, p=0.63). In conclusion, tornado outbreaks did not increase the prevalence of cardiovascular events. In contrast to the effect of hurricanes, implementation of a healthcare policy change directed toward the early treatment and prevention of cardiovascular events after tornadoes does not seem warranted. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. FPs lower hospital readmission rates and costs.

    Science.gov (United States)

    Chetty, Veerappa K; Culpepper, Larry; Phillips, Robert L; Rankin, Jennifer; Xierali, Imam; Finnegan, Sean; Jack, Brian

    2011-05-01

    Hospital readmission after discharge is often a costly failing of the U.S. health care system to adequately manage patients who are ill. Increasing the numbers of family physicians (FPs) is associated with significant reductions in hospital readmissions and substantial cost savings.

  12. Culturally responsible curriculum development in hospitality, tourism and events management

    Directory of Open Access Journals (Sweden)

    Erwin Losekoot

    2014-06-01

    Full Text Available This paper considers the importance of the Treaty of Waitangi (1840 to Higher Education in New Zealand and how this influences the educational experience of hospitality, tourism and event management students. The paper reviews the literature on cultural diversity, internationalization and curriculum development, the role of culture in educating domestic and international students, and how the acculturation Higher Education students experience as part of their studies might lead to a deeper understanding of culture and identity in the hospitality workplace. The gap in the literature concerns how a higher education curriculum can assist in the development of cultural awareness and an understanding of historical commitments. The paper therefore identifies a number of key principles which are regarded as essential to the identity of those living in New Zealand/Aotearoa. The paper then goes on to illustrate how these principles could be applied to Higher Education. It suggests that these principles enshrined in the Treaty of Waitangi are also worth considering when creating an inclusive curriculum which supports all hospitality, tourism and events management students, irrespective of ethnic background, culture or upbringing. Finally, this paper proposes a matrix of ‘hooks’ - tools which academics can use to ensure their lectures address the needs of all learners. This matrix is developed from a study of the educational goals of the Principles of the Treaty of Waitangi (ToW, the founding document of this country. This research adds value by creating an awareness of the diverse environment in which academics and students operate, thereby enabling students to develop a cultural sensitivity to the international hospitality industry they will be employed in on graduation.

  13. ANALYSIS OF INPATIENT HOSPITAL STAFF MENTAL WORKLOAD BY MEANS OF DISCRETE-EVENT SIMULATION

    Science.gov (United States)

    2016-03-24

    ANALYSIS OF INPATIENT HOSPITAL STAFF MENTAL WORKLOAD BY MEANS OF DISCRETE -EVENT SIMULATION...in the United States. AFIT-ENV-MS-16-M-166 ANALYSIS OF INPATIENT HOSPITAL STAFF MENTAL WORKLOAD BY MEANS OF DISCRETE -EVENT SIMULATION...UNLIMITED. AFIT-ENV-MS-16-M-166 ANALYSIS OF INPATIENT HOSPITAL STAFF MENTAL WORKLOAD BY MEANS OF DISCRETE -EVENT SIMULATION Erich W

  14. Variability in the measurement of hospital-wide mortality rates.

    Science.gov (United States)

    Shahian, David M; Wolf, Robert E; Iezzoni, Lisa I; Kirle, Leslie; Normand, Sharon-Lise T

    2010-12-23

    Several countries use hospital-wide mortality rates to evaluate the quality of hospital care, although the usefulness of this metric has been questioned. Massachusetts policymakers recently requested an assessment of methods to calculate this aggregate mortality metric for use as a measure of hospital quality. The Massachusetts Division of Health Care Finance and Policy provided four vendors with identical information on 2,528,624 discharges from Massachusetts acute care hospitals from October 1, 2004, through September 30, 2007. Vendors applied their risk-adjustment algorithms and provided predicted probabilities of in-hospital death for each discharge and for hospital-level observed and expected mortality rates. We compared the numbers and characteristics of discharges and hospitals included by each of the four methods. We also compared hospitals' standardized mortality ratios and classification of hospitals with mortality rates that were higher or lower than expected, according to each method. The proportions of discharges that were included by each method ranged from 28% to 95%, and the severity of patients' diagnoses varied widely. Because of their discharge-selection criteria, two methods calculated in-hospital mortality rates (4.0% and 5.9%) that were twice the state average (2.1%). Pairwise associations (Pearson correlation coefficients) of discharge-level predicted mortality probabilities ranged from 0.46 to 0.70. Hospital-performance categorizations varied substantially and were sometimes completely discordant. In 2006, a total of 12 of 28 hospitals that had higher-than-expected hospital-wide mortality when classified by one method had lower-than-expected mortality when classified by one or more of the other methods. Four common methods for calculating hospital-wide mortality produced substantially different results. This may have resulted from a lack of standardized national eligibility and exclusion criteria, different statistical methods, or

  15. Evaluating Hospital Readmission Rates After Discharge From Inpatient Rehabilitation.

    Science.gov (United States)

    Daras, Laura Coots; Ingber, Melvin J; Carichner, Jessica; Barch, Daniel; Deutsch, Anne; Smith, Laura M; Levitt, Alan; Andress, Joel

    2017-08-09

    To examine facility-level rates of all-cause, unplanned hospital readmissions for 30 days after discharge from inpatient rehabilitation facilities (IRFs). Observational design. Inpatient rehabilitation facilities. Medicare fee-for-service beneficiaries (N=567,850 patient-stays). Not applicable. The outcome is all-cause, unplanned hospital readmission rates for IRFs. We adapted previous risk-adjustment and statistical approaches used for acute care hospitals to develop a hierarchical logistic regression model that estimates a risk-standardized readmission rate for each IRF. The IRF risk-adjustment model takes into account patient demographic characteristics, hospital diagnoses and procedure codes, function at IRF admission, comorbidities, and prior hospital utilization. We presented national distributions of observed and risk-standardized readmission rates and estimated confidence intervals to make statistical comparisons relative to the national mean. We also analyzed the number of days from IRF discharge until hospital readmission. The national observed hospital readmission rate by 30 days postdischarge from IRFs was 13.1%. The mean unadjusted readmission rate for IRFs was 12.4%±3.5%, and the mean risk-standardized readmission rate was 13.1%±0.8%. The C-statistic for our risk-adjustment model was .70. Nearly three-quarters of IRFs (73.4%) had readmission rates that were significantly different from the mean. The mean number of days to readmission was 13.0±8.6 days and varied by rehabilitation diagnosis. Our results demonstrate the ability to assess 30-day, all-cause hospital readmission rates postdischarge from IRFs and the ability to discriminate between IRFs with higher- and lower-than-average hospital readmission rates. Published by Elsevier Inc.

  16. The rate of adverse events during IV conscious sedation.

    Science.gov (United States)

    Schwamburger, Nathan T; Hancock, Raymond H; Chong, Chol H; Hartup, Grant R; Vandewalle, Kraig S

    2012-01-01

    Conscious sedation has become an integral part of dentistry; it is often used to reduce anxiety or fear in some patients during oral surgery, periodontal surgery, implant placement, and general dentistry procedures. The purpose of this study was to evaluate the frequency of adverse events during IV conscious sedation provided by credentialed general dentists and periodontists in the United States Air Force (USAF). Sedation clinical records (Air Force Form 1417) from calendar year 2009 were requested from all USAF bases. A total of 1,468 records were reviewed and 19 adverse events were noted in 17 patients. IV complication (infiltration) was the most common adverse event. The overall adverse event rate was 1.3 per 100 patients treated. The results of this study show that moderate sedation provided by general dentists and periodontists in the USAF has a low incidence of adverse events, and conscious sedation remains a viable option for providers for the reduction of anxiety in select patients.

  17. THE PRODUCTION RATE OF SN Ia EVENTS IN GLOBULAR CLUSTERS

    International Nuclear Information System (INIS)

    Washabaugh, Pearce C.; Bregman, Joel N.

    2013-01-01

    In globular clusters, dynamical evolution produces luminous X-ray emitting binaries at a rate about 200 times greater than in the field. If globular clusters also produce SN Ia at a high rate, it would account for many of the SN Ia production in early-type galaxies and provide insight into their formation. Here we use archival Hubble Space Telescope (HST) images of nearby galaxies that have hosted an SN Ia to examine the rate at which globular clusters produce these events. The location of the SN Ia is registered on an HST image obtained before the event or after the supernova (SN) faded. Of the 36 nearby galaxies examined, 21 had sufficiently good data to search for globular cluster hosts. None of the 21 SNe have a definite globular cluster counterpart, although there are some ambiguous cases. This places an upper limit to the enhancement rate of SN Ia production in globular clusters of about 42 at the 95% confidence level, which is an order of magnitude lower than the enhancement rate for luminous X-ray binaries. Even if all of the ambiguous cases are considered as having a globular cluster counterpart, the upper bound for the enhancement rate is 82 at the 95% confidence level, still a factor of several below that needed to account for half of the SN Ia events. Barring unforeseen selection effects, we conclude that globular clusters are not responsible for producing a significant fraction of the SN Ia events in early-type galaxies.

  18. Pooling overdispersed binomial data to estimate event rate.

    Science.gov (United States)

    Young-Xu, Yinong; Chan, K Arnold

    2008-08-19

    The beta-binomial model is one of the methods that can be used to validly combine event rates from overdispersed binomial data. Our objective is to provide a full description of this method and to update and broaden its applications in clinical and public health research. We describe the statistical theories behind the beta-binomial model and the associated estimation methods. We supply information about statistical software that can provide beta-binomial estimations. Using a published example, we illustrate the application of the beta-binomial model when pooling overdispersed binomial data. In an example regarding the safety of oral antifungal treatments, we had 41 treatment arms with event rates varying from 0% to 13.89%. Using the beta-binomial model, we obtained a summary event rate of 3.44% with a standard error of 0.59%. The parameters of the beta-binomial model took the values of 1.24 for alpha and 34.73 for beta. The beta-binomial model can provide a robust estimate for the summary event rate by pooling overdispersed binomial data from different studies. The explanation of the method and the demonstration of its applications should help researchers incorporate the beta-binomial method as they aggregate probabilities of events from heterogeneous studies.

  19. Pooling overdispersed binomial data to estimate event rate

    Directory of Open Access Journals (Sweden)

    Chan K Arnold

    2008-08-01

    Full Text Available Abstract Background The beta-binomial model is one of the methods that can be used to validly combine event rates from overdispersed binomial data. Our objective is to provide a full description of this method and to update and broaden its applications in clinical and public health research. Methods We describe the statistical theories behind the beta-binomial model and the associated estimation methods. We supply information about statistical software that can provide beta-binomial estimations. Using a published example, we illustrate the application of the beta-binomial model when pooling overdispersed binomial data. Results In an example regarding the safety of oral antifungal treatments, we had 41 treatment arms with event rates varying from 0% to 13.89%. Using the beta-binomial model, we obtained a summary event rate of 3.44% with a standard error of 0.59%. The parameters of the beta-binomial model took the values of 1.24 for alpha and 34.73 for beta. Conclusion The beta-binomial model can provide a robust estimate for the summary event rate by pooling overdispersed binomial data from different studies. The explanation of the method and the demonstration of its applications should help researchers incorporate the beta-binomial method as they aggregate probabilities of events from heterogeneous studies.

  20. Improving Accuracy of Influenza-Associated Hospitalization Rate Estimates

    Science.gov (United States)

    Reed, Carrie; Kirley, Pam Daily; Aragon, Deborah; Meek, James; Farley, Monica M.; Ryan, Patricia; Collins, Jim; Lynfield, Ruth; Baumbach, Joan; Zansky, Shelley; Bennett, Nancy M.; Fowler, Brian; Thomas, Ann; Lindegren, Mary L.; Atkinson, Annette; Finelli, Lyn; Chaves, Sandra S.

    2015-01-01

    Diagnostic test sensitivity affects rate estimates for laboratory-confirmed influenza–associated hospitalizations. We used data from FluSurv-NET, a national population-based surveillance system for laboratory-confirmed influenza hospitalizations, to capture diagnostic test type by patient age and influenza season. We calculated observed rates by age group and adjusted rates by test sensitivity. Test sensitivity was lowest in adults >65 years of age. For all ages, reverse transcription PCR was the most sensitive test, and use increased from 65 years. After 2009, hospitalization rates adjusted by test sensitivity were ≈15% higher for children 65 years of age. Test sensitivity adjustments improve the accuracy of hospitalization rate estimates. PMID:26292017

  1. [The strategy and process of out-hospital emergency care of acute cardiovascular events].

    Science.gov (United States)

    Sun, Gang; Wu, Li-e; Li, Qian-ying; Yang, Ye; Wang, Zi-chao; Zhang, Jing-yin; Li, Shu-jun; Yan, Xu-long; Wang, Ming; Zhang, Wen-xiang; Huang, Guan-hua

    2009-06-01

    To study the strategy and process of out-hospital emergency care of acute cardiovascular events. One hundred and eighty-three patients in the Second Affiliated Hospital of Baotou Medical College were prospectively studied. The patients were divided into two groups according to the different ways of out-hospital care, one group consisted of patients who received first-aid care after calling "120" (94 cases), another was self-aid group consisting of patients sent to hospital by relatives (89 cases). The proportion of persons with higher than high school education and better knowledge for emergency care of patients with heart disease in first-aid group was higher than self-aid group (50.0% vs. 29.2%, 83.0% vs. 60.7%, both Pemergency room, they were all treated according to our standard procedure and then registered. All patients were followed up at the end of first and third month after illness. Cardiovascular events were mainly myocardial infarction (61.7%) among 183 patients. There were statistically significant differences between two groups in self-aid response time, first disposal time and out-hospital rescuing time [(32.3+/-5.6) minutes vs. (89.6+/- 8.4) minutes, (47.3+/-7.3) minutes vs. (149.8+/-13.5) minutes, (61.7+/-8.3) minutes vs. [(149.8+/- 13.5) minutes, all P0.05]. Morbidity rate was lower in first-aid group than self-aid group in 1st and 3rd month, respectively (2.1% vs. 9.0%, 4.2% vs. 12.4%, both Pemergency system and procedure can shorten initial disposal time and out-hospital rescuing time, thus improve patients' prognosis. The education level and health knowledge of patients and their relatives directly affect their mode of arriving hospital and prognosis.

  2. Rising rates of hospital admissions for atrial fibrillation

    DEFF Research Database (Denmark)

    Friberg, Jens; Buch, Nina Pernille Gardshodn; Scharling, Henrik

    2003-01-01

    Atrial fibrillation is a common arrhythmia associated with excess morbidity and mortality. We studied temporal changes in hospital admission rates for atrial fibrillation using data from a prospective population-based cohort study spanning 2 decades (the Copenhagen City Heart Study).......Atrial fibrillation is a common arrhythmia associated with excess morbidity and mortality. We studied temporal changes in hospital admission rates for atrial fibrillation using data from a prospective population-based cohort study spanning 2 decades (the Copenhagen City Heart Study)....

  3. Adverse Drug Events and Medication Errors in African Hospitals: A Systematic Review.

    Science.gov (United States)

    Mekonnen, Alemayehu B; Alhawassi, Tariq M; McLachlan, Andrew J; Brien, Jo-Anne E

    2018-03-01

    Medication errors and adverse drug events are universal problems contributing to patient harm but the magnitude of these problems in Africa remains unclear. The objective of this study was to systematically investigate the literature on the extent of medication errors and adverse drug events, and the factors contributing to medication errors in African hospitals. We searched PubMed, MEDLINE, EMBASE, Web of Science and Global Health databases from inception to 31 August, 2017 and hand searched the reference lists of included studies. Original research studies of any design published in English that investigated adverse drug events and/or medication errors in any patient population in the hospital setting in Africa were included. Descriptive statistics including median and interquartile range were presented. Fifty-one studies were included; of these, 33 focused on medication errors, 15 on adverse drug events, and three studies focused on medication errors and adverse drug events. These studies were conducted in nine (of the 54) African countries. In any patient population, the median (interquartile range) percentage of patients reported to have experienced any suspected adverse drug event at hospital admission was 8.4% (4.5-20.1%), while adverse drug events causing admission were reported in 2.8% (0.7-6.4%) of patients but it was reported that a median of 43.5% (20.0-47.0%) of the adverse drug events were deemed preventable. Similarly, the median mortality rate attributed to adverse drug events was reported to be 0.1% (interquartile range 0.0-0.3%). The most commonly reported types of medication errors were prescribing errors, occurring in a median of 57.4% (interquartile range 22.8-72.8%) of all prescriptions and a median of 15.5% (interquartile range 7.5-50.6%) of the prescriptions evaluated had dosing problems. Major contributing factors for medication errors reported in these studies were individual practitioner factors (e.g. fatigue and inadequate knowledge

  4. Association Between Community Social Capital and Hospital Readmission Rates.

    Science.gov (United States)

    Brewster, Amanda L; Lee, Suhna; Curry, Leslie A; Bradley, Elizabeth H

    2018-05-31

    Hospital readmissions remain frequent, and are partly attributable to patients' social needs. The authors sought to examine whether local community levels of social capital are associated with hospital readmission rates. Social capital refers to the connections among members of a society that foster norms of reciprocity and trust, which may influence the availability of support for postdischarge recovery after hospitalization. Associations between hospital-wide, risk-stratified readmission rates for hospitals in the United States (n = 4298) and levels of social capital in the hospitals' service areas were examined. Social capital was measured by an index of participation in associational activities and civic affairs. A multivariate linear regression model was used to adjust for hospital and community factors such as hospital financial performance, race, income, and availability of heath care services. Results showed that higher social capital was significantly associated with lower readmission rates (P social capital in its region, but in areas of low social capital, it may be possible for public or philanthropic sectors to buttress the types of institutions that address nonmedical causes of readmission.

  5. Temporal association between hospitalization and rate of falls after discharge.

    Science.gov (United States)

    Mahoney, J E; Palta, M; Johnson, J; Jalaluddin, M; Gray, S; Park, S; Sager, M

    2000-10-09

    Evidence suggests that acute illness and hospitalization may increase the risk for falls. To evaluate the rate of falls, and associated risk factors, for 90 days following hospital discharge. We consecutively enrolled 311 patients, aged 65 years and older, discharged from the hospital after an acute medical illness and receiving home-nursing services. Patients were assessed within 5 days of discharge for prehospital and current functioning by self-report, and balance, vision, cognition, and delirium by objective measures. Patients were followed up weekly for 13 weeks for falls, injuries, and health care use. The rate of falls was significantly higher in the first 2 weeks after hospitalization (8.0 per 1000 person-days) compared with 3 months later (1.7 per 1000 person-days) (P =.002). Fall-related injuries accounted for 15% of all hospitalizations in the first month after discharge. Independent prehospital risk factors significantly associated with falls included dependency in activities of daily living, use of a standard walker, 2 or more falls, and more hospitalizations in the year prior. Posthospital risk factors included use of a tertiary amine tricyclic antidepressant, probable delirium, and poorer balance, while use of a cane was protective. The rate of falls is substantially increased in the first month after medical hospitalization, and is an important cause of injury and morbidity. Posthospital risk factors may be potentially modifiable. Efforts to assess and modify risk factors should be integral to the hospital and posthospital care of older adults (those aged >/=65 years).

  6. The Relationship between Self-rated Health and Hospital Records

    DEFF Research Database (Denmark)

    Nielsen, Torben Heien

    hospital records. I use both measures separately to control for health in a regression of mortality on wealth. Using only historical and current hospitalization controls for health yields the common result, that SRH is a stronger predictor of mortality than objective health measures. The addition of future...... hospitalizations as controls shows that the estimated gradient on wealth is similar to one in which SRH is the control. The results suggest that SRH is able to capture diseases at prodromal stages and that with a sufficiently long time series of individual records, objective health measures can predict mortality......This paper investigates whether self-rated health (SRH) co-varies with individual hospital records. By linking the Danish Longitudinal Survey on Aging with individual hospital records covering all hospital admissions from 1995-2006, I show that SRH is correlated to historical, current, and future...

  7. The Relationship between Self-Rated Health and Hospital Records

    DEFF Research Database (Denmark)

    Nielsen, Torben Heien

    2013-01-01

    hospital records. I use both measures separately to control for health in a regression of mortality on wealth. Using only historical and current hospitalization controls for health yields the common result, that SRH is a stronger predictor of mortality than objective health measures. The addition of future...... hospitalizations as controls shows that the estimated gradient on wealth is similar to one in which SRH is the control. The results suggest that SRH is able to capture diseases at prodromal stages and that with a sufficiently long time series ofindividual records, objective health measures can predict mortality......This paper investigates whether self-rated health (SRH) co-varies with individual hospital records. By linking the Danish Longitudinal Survey on Aging with individual hospital records covering all hospital admissions from 1995-2006, I show that SRH is correlated to historical, current, and future...

  8. The Relationship between Self-rated Health and Hospital Records

    DEFF Research Database (Denmark)

    Nielsen, Torben Heien

    2016-01-01

    , and future hospital records. I use both measures separately to control for health in a regression of mortality on wealth. Using only historical and current hospitalization controls for health yields the common result that SRH is a stronger predictor of mortality than objective health measures. The addition...... of future hospitalizations as controls shows that the estimated gradient on wealth is similar to one in which SRH is the control. The results suggest that with a sufficiently long time series of individual records, objective health measures can predict mortality to the same extent as global self......This paper investigates whether self-rated health (SRH) covaries with individual hospital records. By linking the Danish Longitudinal Survey on Ageing with individual hospital records covering all hospital admissions from 1995 to 2006, I show that SRH is correlated to historical, current...

  9. Evaluation of misplaced event count rate using a scintillation camera

    International Nuclear Information System (INIS)

    Yanagimoto, Shin-ichi; Tomomitsu, Tatsushi; Muranaka, Akira

    1985-01-01

    Misplaced event count rates were evaluated using an acryl scatter body of various thickness and a gamma camera. The count rate in the region of interest (ROI) within the camera view field, which was thought to represent part of the misplaced event count rate, increased as the thickness of the scatter body was increased to 5 cm, followed by a steep decline in the count rate. On the other hand, the ratio of the count rate in the ROI to the total count rate continuously increased as the thickness of the scatter body was increased. As the thickness of the scatter body was increased, the count rates increased, and the increments of increase were greater in the lower energy region of the photopeak than in the higher energy region. In ranges energy other than the photopeak, the influence of the scatter body on the count rate in the ROI was the greatest at 76 keV, which was the lowest energy we examined. (author)

  10. Stressful life events in childhood and risk of infectious disease hospitalization.

    Science.gov (United States)

    Nielsen, Nete Munk; Hansen, Anne Vinkel; Simonsen, Jacob; Hviid, Anders

    2012-01-01

    Individuals exposed to high levels of stress might have an increased risk of infectious diseases. However, most of the previous studies have been conducted among adults. To examine the effect of childhood stress, we conducted a nationwide cohort study including all Danish children born from 1977 to 2004. Stressful life events (SFLE) included parental death, death of sibling or parental divorce. Outcome was defined as hospitalizations due to less severe (LSID) or severe infectious diseases (SID). Children were followed until the age of 15 years. The association between SFLE and risk of infections was evaluated through rate ratios (RR) comparing infectious disease incidence ratios in children with and without a history of SFLE. Overall, children exposed to SFLE were at 13% increased risk of LSID (RR = 1.13 (1.10-1.15)), but at no increased risk of SID hospitalization (RR = 1.05 (0.97-1.14)). Looking at the specific type of SFLE, parental divorce increased the risk of LSID (RR = 1.11 (1.09-1.14)) and SID hospitalization (1.11 (1.02-1.21)) by 11%, whereas no increased risk of LSID and SID hospitalization was observed following parental death. Finally, a 34% increased risk of LSID hospitalization (RR = 1.34 (1.23-1.45)) was observed following death of sibling, in contrast to no increased risk of SID hospitalization. Childhood exposure to SFLE, especially parental divorce seems to increase the risk of infectious disease hospitalization. Although we cannot determine whether our observations are the result of a biological effect of stress, adoption of unhealthy behaviours or increased likelihood of hospitalization, our findings do have public health relevance as a considerable proportion of the children today will be exposed to SFLE, the majority to parental divorce.

  11. Estimating the effect of a rare time-dependent treatment on the recurrent event rate.

    Science.gov (United States)

    Smith, Abigail R; Zhu, Danting; Goodrich, Nathan P; Merion, Robert M; Schaubel, Douglas E

    2018-05-30

    In many observational studies, the objective is to estimate the effect of treatment or state-change on the recurrent event rate. If treatment is assigned after the start of follow-up, traditional methods (eg, adjustment for baseline-only covariates or fully conditional adjustment for time-dependent covariates) may give biased results. We propose a two-stage modeling approach using the method of sequential stratification to accurately estimate the effect of a time-dependent treatment on the recurrent event rate. At the first stage, we estimate the pretreatment recurrent event trajectory using a proportional rates model censored at the time of treatment. Prognostic scores are estimated from the linear predictor of this model and used to match treated patients to as yet untreated controls based on prognostic score at the time of treatment for the index patient. The final model is stratified on matched sets and compares the posttreatment recurrent event rate to the recurrent event rate of the matched controls. We demonstrate through simulation that bias due to dependent censoring is negligible, provided the treatment frequency is low, and we investigate a threshold at which correction for dependent censoring is needed. The method is applied to liver transplant (LT), where we estimate the effect of development of post-LT End Stage Renal Disease (ESRD) on rate of days hospitalized. Copyright © 2018 John Wiley & Sons, Ltd.

  12. Association of Adverse Events With Antibiotic Use in Hospitalized Patients.

    Science.gov (United States)

    Tamma, Pranita D; Avdic, Edina; Li, David X; Dzintars, Kathryn; Cosgrove, Sara E

    2017-09-01

    Estimates of the incidence of overall antibiotic-associated adverse drug events (ADEs) in hospitalized patients are generally unavailable. To describe the incidence of antibiotic-associated ADEs for adult inpatients receiving systemic antibiotic therapy. Retrospective cohort of adult inpatients admitted to general medicine wards at an academic medical center. At least 24 hours of any parenteral or oral antibiotic therapy. Medical records of 1488 patients were examined for 30 days after antibiotic initiation for the development of the following antibiotic-associated ADEs: gastrointestinal, dermatologic, musculoskeletal, hematologic, hepatobiliary, renal, cardiac, and neurologic; and 90 days for the development of Clostridium difficile infection or incident multidrug-resistant organism infection, based on adjudication by 2 infectious diseases trained clinicians. In 1488 patients, the median age was 59 years (interquartile range, 49-69 years), and 758 (51%) participants were female. A total of 298 (20%) patients experienced at least 1 antibiotic-associated ADE. Furthermore, 56 (20%) non-clinically indicated antibiotic regimens were associated with an ADE, including 7 cases of C difficile infection. Every additional 10 days of antibiotic therapy conferred a 3% increased risk of an ADE. The most common ADEs were gastrointestinal, renal, and hematologic abnormalities, accounting for 78 (42%), 45 (24%), and 28 (15%) 30-day ADEs, respectively. Notable differences were identified between the incidence of ADEs associated with specific antibiotics. Although antibiotics may play a critical role when used appropriately, our findings underscore the importance of judicious antibiotic prescribing to reduce the harm that can result from antibiotic-associated ADEs.

  13. Complications and 30-day hospital readmission rates of patients undergoing tracheostomy: A prospective analysis.

    Science.gov (United States)

    Spataro, Emily; Durakovic, Nedim; Kallogjeri, Dorina; Nussenbaum, Brian

    2017-12-01

    To determine inpatient and outpatient tracheostomy complication rates and 30-day hospital readmission rates, and to assess patient and procedural risk factors associated with complications and readmissions. Prospective cohort study. Adult patients undergoing tracheostomy at a single academic hospital performed by any service, for any indication, were enrolled in this study over the course of 1 year. All patients had complete 30-day follow-up after discharge to determine complication and hospital readmission rates. Logistic regression was used to assess patient and procedural risk factors associated with these events. One hundred patients were enrolled in this study from June 1, 2015, to June 1, 2016. The overall inpatient tracheostomy complication rate was 47% (95% confidence interval [CI], 37%-57%). Inpatient complications were associated with location in the medical intensive care unit and increased length of hospitalization. The outpatient tracheostomy complication rate was 15% (95% CI, 8%-22%). Outpatient complications were associated with having a previous tracheostomy or an awake tracheostomy under local anesthesia. The all-cause 30-day hospital readmission rate was 33% (95% CI, 24%-42%), and the tracheostomy-specific readmission rate was 13% (95% CI, 6%-20%). All-cause readmissions were associated with diabetes, length of hospitalization after tracheostomy, and outpatient complications. The overall mortality rate during the study period was 11% (95% CI, 5%-17%), with one tracheostomy-related death. Patients undergoing tracheostomies are at high risk for both inpatient and outpatient complications, as well for 30-day hospital readmission. Understanding patient and procedural risk factors associated with these events will help guide interventions for quality improvement. 2b. Laryngoscope, 127:2746-2753, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Hospital ownership: a risk factor for nosocomial infection rates?

    Science.gov (United States)

    Schröder, C; Behnke, M; Geffers, C; Gastmeier, P

    2018-03-26

    In some countries, a relationship between hospital ownership and the occurrence of healthcare-associated infection (HCAI) rates has been described. To investigate the association between hospital ownership and occurrence of HCAI in Germany. Five different components of the German national nosocomial infection surveillance system were analysed with regard to the influence of hospital ownership in the period 2014-2016. Endpoints included ventilator-associated pneumonia, central-venous-catheter-associated bloodstream infections, urinary-catheter-associated urinary tract infections, surgical site infections (SSI) following hip prosthesis and colon surgery, meticillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile infections (CDI) and hand rub consumption per 1000 patient-days. Three hospital ownership types (public, non-profit and private) were analysed using univariate and multi-variate methods. The distribution of hospitals according to the three ownership types was similar in all components. In total, 661 intensive care units (ICUs), 149 departments performing colon procedures, and 349 departments performing hip prosthesis were included. In addition, 568 hospitals provided their MRSA rates and 236 provided their CDI rates, and 1833 ICUs and 12,934 non-ICUs provided their hand rub consumption data. In general, the differences between the hospital types were rather small and not significant for the ICUs. In the multi-variate analysis, public hospitals had a lower SSI rate following hip prosthesis (odds ratio 0.80, 95% confidence interval 0.65-0.99). Hospital ownership was not found to have a major influence on the incidence of HCAI in Germany. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  15. Net reclassification index at event rate: properties and relationships.

    Science.gov (United States)

    Pencina, Michael J; Steyerberg, Ewout W; D'Agostino, Ralph B

    2017-12-10

    The net reclassification improvement (NRI) is an attractively simple summary measure quantifying improvement in performance because of addition of new risk marker(s) to a prediction model. Originally proposed for settings with well-established classification thresholds, it quickly extended into applications with no thresholds in common use. Here we aim to explore properties of the NRI at event rate. We express this NRI as a difference in performance measures for the new versus old model and show that the quantity underlying this difference is related to several global as well as decision analytic measures of model performance. It maximizes the relative utility (standardized net benefit) across all classification thresholds and can be viewed as the Kolmogorov-Smirnov distance between the distributions of risk among events and non-events. It can be expressed as a special case of the continuous NRI, measuring reclassification from the 'null' model with no predictors. It is also a criterion based on the value of information and quantifies the reduction in expected regret for a given regret function, casting the NRI at event rate as a measure of incremental reduction in expected regret. More generally, we find it informative to present plots of standardized net benefit/relative utility for the new versus old model across the domain of classification thresholds. Then, these plots can be summarized with their maximum values, and the increment in model performance can be described by the NRI at event rate. We provide theoretical examples and a clinical application on the evaluation of prognostic biomarkers for atrial fibrillation. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  16. Percutaneous closure of patent foramen ovale and atrial septal defect in adults: the impact of clinical variables and hospital procedure volume on in-hospital adverse events.

    Science.gov (United States)

    Opotowsky, Alexander R; Landzberg, Michael J; Kimmel, Stephen E; Webb, Gary D

    2009-05-01

    Percutaneous closure of patent foramen ovale/atrial septal defect (PFO/ASD) is an increasingly common procedure perceived as having minimal risk. There are no population-based estimates of in-hospital adverse event rates of percutaneous PFO/ASD closure. We used nationally representative data from the 2001-2005 Nationwide Inpatient Sample to identify patients >or-=20 years old admitted to an acute care hospital with an International Classification of Diseases, Ninth Revision code designating percutaneous PFO/ASD closure on the first or second hospital day. Variables analyzed included age, sex, number of comorbidities, year, same-day use of intracardiac or other echocardiography, same-day left heart catheterization, hospital size and teaching status, PFO/ASD procedural volume, and coronary intervention volume. Outcomes of interest included length of stay, charges, and adverse events. The study included 2,555 (weighted to United States population: 12,544 +/- 1,987) PFO/ASD closure procedures. Mean age was 52.0 +/- 0.4 years, and 57.3% +/- 1.0% were women. Annual hospital volume averaged 40.8 +/- 7.7 procedures (range, 1-114). Overall, 8.2 +/- 0.8% of admissions involved an adverse event. Older patients and those with comorbidities were more likely to sustain adverse events. Use of intracardiac echocardiography was associated with fewer adverse events. The risk of adverse events was inversely proportional to annual hospital volume (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.86-0.96, per 10 procedures), even after limiting the analysis to hospitals performing >or=10 procedures annually (OR 0.91, 95% CI 0.85-0.98). Adverse events were more frequent at hospitals in the lowest volume quintile as compared with the highest volume quintile (13.3% vs 5.4%, OR 2.42, 95% CI 1.55-3.78). The risk of adverse events of percutaneous PFO/ASD closure is inversely correlated with hospital volume. This relationship applies even to hospitals meeting the current guidelines

  17. Reliability of the peer-review process for adverse event rating.

    Directory of Open Access Journals (Sweden)

    Alan J Forster

    Full Text Available Adverse events are poor patient outcomes caused by medical care. Their identification requires the peer-review of poor outcomes, which may be unreliable. Combining physician ratings might improve the accuracy of adverse event classification.To evaluate the variation in peer-reviewer ratings of adverse outcomes; determine the impact of this variation on estimates of reviewer accuracy; and determine the number of reviewers who judge an adverse event occurred that is required to ensure that the true probability of an adverse event exceeded 50%, 75% or 95%.Thirty physicians rated 319 case reports giving details of poor patient outcomes following hospital discharge. They rated whether medical management caused the outcome using a six-point ordinal scale. We conducted latent class analyses to estimate the prevalence of adverse events as well as the sensitivity and specificity of each reviewer. We used this model and Bayesian calculations to determine the probability that an adverse event truly occurred to each patient as function of their number of positive ratings.The overall median score on the 6-point ordinal scale was 3 (IQR 2,4 but the individual rater median score ranged from a minimum of 1 (in four reviewers to a maximum median score of 5. The overall percentage of cases rated as an adverse event was 39.7% (3798/9570. The median kappa for all pair-wise combinations of the 30 reviewers was 0.26 (IQR 0.16, 0.42; Min = -0.07, Max = 0.62. Reviewer sensitivity and specificity for adverse event classification ranged from 0.06 to 0.93 and 0.50 to 0.98, respectively. The estimated prevalence of adverse events using a latent class model with a common sensitivity and specificity for all reviewers (0.64 and 0.83 respectively was 47.6%. For patients to have a 95% chance of truly having an adverse event, at least 3 of 3 reviewers are required to deem the outcome an adverse event.Adverse event classification is unreliable. To be certain that a case

  18. Fast radio burst event rate counts - I. Interpreting the observations

    Science.gov (United States)

    Macquart, J.-P.; Ekers, R. D.

    2018-02-01

    The fluence distribution of the fast radio burst (FRB) population (the `source count' distribution, N (>F) ∝Fα), is a crucial diagnostic of its distance distribution, and hence the progenitor evolutionary history. We critically reanalyse current estimates of the FRB source count distribution. We demonstrate that the Lorimer burst (FRB 010724) is subject to discovery bias, and should be excluded from all statistical studies of the population. We re-examine the evidence for flat, α > -1, source count estimates based on the ratio of single-beam to multiple-beam detections with the Parkes multibeam receiver, and show that current data imply only a very weak constraint of α ≲ -1.3. A maximum-likelihood analysis applied to the portion of the Parkes FRB population detected above the observational completeness fluence of 2 Jy ms yields α = -2.6_{-1.3}^{+0.7 }. Uncertainties in the location of each FRB within the Parkes beam render estimates of the Parkes event rate uncertain in both normalizing survey area and the estimated post-beam-corrected completeness fluence; this uncertainty needs to be accounted for when comparing the event rate against event rates measured at other telescopes.

  19. Complexity rating of abnormal events and operator performance

    International Nuclear Information System (INIS)

    Oeivind Braarud, Per

    1998-01-01

    The complexity of the work situation during abnormal situations is a major topic in a discussion of safety aspects of Nuclear Power plants. An understanding of complexity and its impact on operator performance in abnormal situations is important. One way to enhance understanding is to look at the dimensions that constitute complexity for NPP operators, and how those dimensions can be measured. A further step is to study how dimensions of complexity of the event are related to performance of operators. One aspect of complexity is the operator 's subjective experience of given difficulties of the event. Another related aspect of complexity is subject matter experts ratings of the complexity of the event. A definition and a measure of this part of complexity are being investigated at the OECD Halden Reactor Project in Norway. This paper focus on the results from a study of simulated scenarios carried out in the Halden Man-Machine Laboratory, which is a full scope PWR simulator. Six crews of two licensed operators each performed in 16 scenarios (simulated events). Before the experiment subject matter experts rated the complexity of the scenarios, using a Complexity Profiling Questionnaire. The Complexity Profiling Questionnaire contains eight previously identified dimensions associated with complexity. After completing the scenarios the operators received a questionnaire containing 39 questions about perceived complexity. This questionnaire was used for development of a measure of subjective complexity. The results from the study indicated that Process experts' rating of scenario complexity, using the Complexity Profiling Questionnaire, were able to predict crew performance quite well. The results further indicated that a measure of subjective complexity could be developed that was related to crew performance. Subjective complexity was found to be related to subjective work load. (author)

  20. Text mining electronic health records to identify hospital adverse events

    DEFF Research Database (Denmark)

    Gerdes, Lars Ulrik; Hardahl, Christian

    2013-01-01

    Manual reviews of health records to identify possible adverse events are time consuming. We are developing a method based on natural language processing to quickly search electronic health records for common triggers and adverse events. Our results agree fairly well with those obtained using manu...

  1. Hospitalization Rates Among People With HIV/AIDS in New York City, 2013.

    Science.gov (United States)

    Lazar, Rachael; Kersanske, Laura; Xia, Qiang; Daskalakis, Demetre; Braunstein, Sarah L

    2017-08-01

    Hospitalizations are an important indicator of healthcare quality and access for people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). This study assesses hospitalization rates among people with HIV/AIDS in New York City. We performed a deterministic match between people in the New York City HIV surveillance registry alive as of 1 January 2013 and diagnosed with HIV as of 31 December 2013 and patient-level inpatient hospitalization records during 2013. Event-level data were analyzed to determine characteristics of and reasons for hospitalizations. Primary diagnoses were classified using the International Classification of Diseases, Ninth Revision, Clinical Modification. We estimated hospitalization rates as the number of hospitalizations per 100 person-years for all causes, AIDS-defining illnesses, and non-AIDS-defining infections. Nearly one-fifth of hospitalizations were attributed to non-AIDS-defining infections, whereas AIDS-defining illness diagnoses were infrequent (3.6% of hospitalizations). Other common causes were cardiovascular (10.9%) and substance use (9.8%). The estimated all-cause hospitalization rate was 36.7 per 100 person-years. Higher all-cause hospitalization rates were observed among females (46.8 per 100 person-years), Black and Latino/Hispanic people (41.8 and 39.5 per 100 person-years, respectively), people living in high-poverty neighborhoods (47.4 per 100 person-years), and people with a history of injection drug use (74.9 per 100 person-years). The estimated AIDS-defining illness and non-AIDS-defining infection hospitalization rates were 1.3 and 7.2 per 100 person-years, respectively. People with HIV in New York City were frequently hospitalized. While AIDS-defining illnesses were relatively rare, non-AIDS-defining infection hospitalizations were more common. Disparities in hospitalization rates indicate a need for targeted improved primary care and comorbid disease management. © The Author 2017

  2. [Costs of serious adverse events in a community teaching hospital, in Mexico].

    Science.gov (United States)

    Gutiérrez-Mendoza, Luis Meave; Torres-Montes, Abraham; Soria-Orozco, Manuel; Padrón-Salas, Aldanely; Ramírez-Hernández, María Elizabeth

    2015-01-01

    Serious adverse events during hospital care are a worldwide reality and threaten the safety of the hospitalised patient. To identify serious adverse events related to healthcare and direct hospital costs in a Teaching Hospital in México. A study was conducted in a 250-bed Teaching Hospital in San Luis Potosi, Mexico. Data were obtained from the Quality and Patient Safety Department based on 2012 incidents report. Every event was reviewed and analysed by an expert team using the "fish bone" tool. The costs were calculated since the event took place until discharge or death of the patient. A total of 34 serious adverse events were identified. The average cost was $117,440.89 Mexican pesos (approx. €7,000). The great majority (82.35%) were largely preventable and related to the process of care. Undergraduate medical staff were involved in 58.82%, and 14.7% of patients had suffered adverse events in other hospitals. Serious adverse events in a Teaching Hospital setting need to be analysed to learn and deploy interventions to prevent and improve patient safety. The direct costs of these events are similar to those reported in developed countries. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  3. Characterizing and predicting rates of delirium across general hospital settings.

    Science.gov (United States)

    McCoy, Thomas H; Hart, Kamber L; Perlis, Roy H

    2017-05-01

    To better understand variation in reported rates of delirium, this study characterized delirium occurrence rate by department of service and primary admitting diagnosis. Nine consecutive years (2005-2013) of general hospital admissions (N=831,348) were identified across two academic medical centers using electronic health records. The primary admitting diagnosis and the treating clinical department were used to calculate occurrence rates of a previously published delirium definition composed of billing codes and natural language processing of discharge summaries. Delirium rates varied significantly across both admitting diagnosis group (X 2 10 =12786, pdelirium (86/109764; 0.08%) and neurological admissions the greatest (2851/25450; 11.2%). Although the rate of delirium varied across the two hospitals the relative rates within departments (r=0.96, pdelirium varies significantly across admitting diagnosis and hospital department. Both admitting diagnosis and department of care are even stronger predictors of risk than age; as such, simple risk stratification may offer avenues for targeted prevention and treatment efforts. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Meaningful use of health information technology and declines in in-hospital adverse drug events.

    Science.gov (United States)

    Furukawa, Michael F; Spector, William D; Rhona Limcangco, M; Encinosa, William E

    2017-07-01

    Nationwide initiatives have promoted greater adoption of health information technology as a means to reduce adverse drug events (ADEs). Hospital adoption of electronic health records with Meaningful Use (MU) capabilities expected to improve medication safety has grown rapidly. However, evidence that MU capabilities are associated with declines in in-hospital ADEs is lacking. Data came from the 2010-2013 Medicare Patient Safety Monitoring System and the 2008-2013 Healthcare Information and Management Systems Society (HIMSS) Analytics Database. Two-level random intercept logistic regression was used to estimate the association of MU capabilities and occurrence of ADEs, adjusting for patient characteristics, hospital characteristics, and year of observation. Rates of in-hospital ADEs declined by 19% from 2010 to 2013. Adoption of MU capabilities was associated with 11% lower odds of an ADE (95% confidence interval [CI], 0.84-0.96). Interoperability capability was associated with 19% lower odds of an ADE (95% CI, 0.67- 0.98). Adoption of MU capabilities explained 22% of the observed reduction in ADEs, or 67,000 fewer ADEs averted by MU. Concurrent with the rapid uptake of MU and interoperability, occurrence of in-hospital ADEs declined significantly from 2010 to 2013. MU capabilities and interoperability were associated with lower occurrence of ADEs, but the effects did not vary by experience with MU. About one-fifth of the decline in ADEs from 2010 to 2013 was attributable to MU capabilities. Findings support the contention that adoption of MU capabilities and interoperability spurred by the Health Information Technology for Economic and Clinical Health Act contributed in part to the recent decline in ADEs. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the United States.

  5. Hospital revisit rate after a diagnosis of conversion disorder.

    Science.gov (United States)

    Merkler, Alexander E; Parikh, Neal S; Chaudhry, Simriti; Chait, Alanna; Allen, Nicole C; Navi, Babak B; Kamel, Hooman

    2016-04-01

    To estimate the hospital revisit rate of patients diagnosed with conversion disorder (CD). Using administrative data, we identified all patients discharged from California, Florida and New York emergency departments (EDs) and acute care hospitals between 2005 and 2011 with a primary discharge diagnosis of CD. Patients discharged with a primary diagnosis of seizure or transient global amnesia (TGA) served as control groups. Our primary outcome was the rate of repeat ED visits and hospital admissions after initial presentation. Poisson regression was used to compare rates between diagnosis groups while adjusting for demographic characteristics. We identified 7946 patients discharged with a primary diagnosis of CD. During a mean follow-up of 3.0 (±1.6) years, patients with CD had a median of three (IQR, 1-9) ED or inpatient revisits, compared with 0 (IQR, 0-2) in patients with TGA and 3 (IQR, 1-7) in those with seizures. Revisit rates were 18.25 (95% CI, 18.10 to 18.40) visits per 100 patients per month in those with CD, 3.90 (95% CI, 3.84 to 3.95) in those with TGA and 17.78 (95% CI, 17.75 to 17.81) in those with seizures. As compared to CD, the incidence rate ratio for repeat ED visits or hospitalisations was 0.89 (95% CI, 0.86 to 0.93) for seizure disorder and 0.32 (95% CI 0.31 to 0.34) for TGA. CD is associated with a substantial hospital revisit rate. Our findings suggest that CD is not an acute, time-limited response to stress, but rather that CD is a manifestation of a broader pattern of chronic neuropsychiatric disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. Efficiency and hospital effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems ratings.

    Science.gov (United States)

    Al-Amin, Mona; Makarem, Suzanne C; Rosko, Michael

    2016-01-01

    Efficiency has emerged as a central goal to the operations of health care organizations. There are two competing perspectives on the relationship between efficiency and organizational performance. Some argue that organizational slack is a waste and that efficiency contributes to organizational performance, whereas others maintain that slack acts as a buffer, allowing organizations to adapt to environmental demands and contributing to organizational performance. As value-based purchasing becomes more prevalent, health care organizations are incented to become more efficient and, at the same time, improve their patients' experiences and outcomes. Unused slack resources might facilitate the timely implementation of these improvements. Building on previous research on organizational slack and inertia, we test whether efficiency and other organizational factors predict organizational effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. We rely on data from the American Hospital Association and HCAHPS. We estimate hospital cost-efficiency by Stochastic Frontier Analysis and use regression analysis to determine whether efficiency, competition, hospital size, and other organizational factors are significant predictors of hospital effectiveness. Our findings indicate that efficiency and hospital size have a significant negative association with organizational ability to improve HCAHPS ratings. Although achieving organizational efficiency is necessary for health care organizations, given the changes that are currently occurring in the U.S. health care system, it is important for health care managers to maintain a certain level of slack to respond to environmental demands and have the resources needed to improve their performance.

  7. Rate-limiting events in hyperthermic cell killing

    International Nuclear Information System (INIS)

    Landry, J.; Marceau, N.

    1978-01-01

    The inactivation rate of HeLa cells for temperatures ranging from 41 to 55 0 C and treatment durations varying from 2 to 300 min was analyzed in thermodynamic terms by considering the dependence of cell free energy (ΔG + ) on temperature. Within this temperature range the loss of proliferative capacity exhibits a complex temperature dependence which is characterized by entropy and enthalpy values that gradually decrease as temperature increases. This complex process of heat-induced cell killing was postulated to be the result of a series of reactions, each of them being alternatively rate limiting within a certain temperature range. From this kinetic scheme a mathematical model was derived and, in the case of HeLa cells, the use of a least-squares search parameter procedure (as applied to the derived survival regression function) demonstrated that three such sequential reactions were sufficient to explain all experimental data points obtained within the 41 to 55 0 C range. The proposed model was also shown to be adequate for explaining survival data of HeLa cells exposed to nanosecond heat pulses of infrared laser energy. Considerations of thermodynamic properties of known biochemical reactions suggest plausible rate-limiting events in hyperthermic cell killing

  8. Charity colonoscopy event to commemorate the 185th anniversary of Singapore General Hospital.

    Science.gov (United States)

    Ng, Kheng Hong; Lim, Jit Fong; Ho, Kok Sun; Ooi, Boon Swee; Tang, Choong Leong; Eu, Kong Weng

    2008-03-01

    Colorectal cancer is now the cancer with the highest incidence in Singapore. However, the overall mortality rate is still about 50% because the majority of the patients present at a late stage of disease. A charity event of screening colonoscopy was offered to the public in conjunction with the 185th anniversary of Singapore General Hospital. The aim of this event was to raise awareness about early detection of colorectal cancer and the safety of colonoscopy. We conducted a one-off free screening event for colorectal cancer using colonoscopy. Four hundred and ninety individuals responded to a multimedia advertisement for the event. Of these, 220 individuals were selected for the screening based on National Guidelines for colorectal cancer screening and financial status. One hundred and fifty-two individuals turned up for the colonoscopy. The median age was 55 years (range, 22 to 82), with 84 males. Significant pathology was found in 33% of the individuals (n = 51). Colorectal polyps were detected in 34 individuals (22%). A total of 45 polyps were removed, with 20 hyperplastic polyps and 25 adenomas. Eight out of 25 adenomas were located proximal to the splenic flexure. Rectal cancer was diagnosed in 1 individual (0.6%). One individual had a large dysplastic rectosigmoid ulcer and refused further intervention. There were no significant complications from any of the colonoscopies. Colonoscopy is an invaluable screening modality as it has a high pick-up rate for colorectal polyp and cancer in an asymptomatic population. It is also proven to be safe in our study. It has the added advantage over flexible sigmoidoscopy of detecting a significant number of proximal lesions. Also, therapeutic polypectomy can be performed in the same setting.

  9. Milk Flow Rates from bottle nipples used after hospital discharge.

    Science.gov (United States)

    Pados, Britt Frisk; Park, Jinhee; Thoyre, Suzanne M; Estrem, Hayley; Nix, W Brant

    To test the milk flow rates and variability in flow rates of bottle nipples used after hospital discharge. Twenty-six nipple types that represented 15 common brands as well as variety in price per nipple and store location sold (e.g., Babies R' Us, Walmart, Dollar Store) were chosen for testing. Ten of each nipple type (n = 260 total) were tested by measuring the amount of infant formula expressed in 1 minute using a breast pump. Mean milk flow rate (mL/min) and coefficient of variation (CV) were calculated. Flow rates of nipples within brand were compared statistically. Milk flow rates varied from 1.68 mL/min for the Avent Natural Newborn Flow to 85.34 mL/min for the Dr. Brown's Standard Y-cut. Variability between nipple types also varied widely, from .03 for the Dr. Brown's Standard Level 3 to .37 for MAM Nipple 1 Slow Flow. The extreme range of milk flow rates found may be significant for medically fragile infants being discharged home who are continuing to develop oral feeding skills. The name of the nipple does not provide clear information about the flow rate to guide parents in decision making. Variability in flow rates within nipples of the same type may complicate oral feeding for the medically fragile infant who may not be able to adapt easily to change in flow rates. Both flow rate and variability should be considered when guiding parents to a nipple choice.

  10. Approaches to proton single-event rate calculations

    International Nuclear Information System (INIS)

    Petersen, E.L.

    1996-01-01

    This article discusses the fundamentals of proton-induced single-event upsets and of the various methods that have been developed to calculate upset rates. Two types of approaches are used based on nuclear-reaction analysis. Several aspects can be analyzed using analytic methods, but a complete description is not available. The paper presents an analytic description for the component due to elastic-scattering recoils. There have been a number of studies made using Monte Carlo methods. These can completely describe the reaction processes, including the effect of nuclear reactions occurring outside the device-sensitive volume. They have not included the elastic-scattering processes. The article describes the semiempirical approaches that are most widely used. The quality of previous upset predictions relative to space observations is discussed and leads to comments about the desired quality of future predictions. Brief sections treat the possible testing limitation due to total ionizing dose effects, the relationship of proton and heavy-ion upsets, upsets due to direct proton ionization, and relative proton and cosmic-ray upset rates

  11. Rates of Hospitalization for Dehydration Following Hurricane Sandy in New Jersey.

    Science.gov (United States)

    Swerdel, Joel N; Rhoads, George G; Cosgrove, Nora M; Kostis, John B

    2016-04-01

    Hurricane Sandy, one of the most destructive natural disasters in New Jersey history, made landfall on October 29, 2012. Prolonged loss of electrical power and extensive infrastructure damage restricted access for many to food and water. We examined the rate of dehydration in New Jersey residents after Hurricane Sandy. We obtained data from 2008 to 2012 from the Myocardial Infarction Data Acquisition System (MIDAS), a repository of in-patient records from nonfederal New Jersey hospitals (N=517,355). Patients with dehydration had ICD-9-CM discharge diagnosis codes for dehydration, volume depletion, and/or hypovolemia. We used log-linear modeling to estimate the change in in-patient hospitalizations for dehydration comparing 2 weeks after Sandy with the same period in the previous 4 years (2008-2011). In-patient hospitalizations for dehydration were 66% higher after Sandy than in 2008-2011 (rate ratio [RR]: 1.66; 95% confidence interval [CI]: 1.50, 1.84). Hospitalizations for dehydration in patients over 65 years of age increased by nearly 80% after Sandy compared with 2008-2011 (RR: 1.79; 95% CI: 1.58, 2.02). Sandy was associated with a marked increase in hospitalizations for dehydration. Reducing the rate of dehydration following extreme weather events is an important public health concern that needs to be addressed, especially in those over 65 years of age.

  12. Incidência de eventos adversos cirúrgicos em hospital dia | Incidence of surgical adverse events at a day hospital

    Directory of Open Access Journals (Sweden)

    Eliana Auxiliadora M. Costa

    2017-05-01

    .20%, phlebitis (5.20% and lower limb thrombosis (4.90%. The results of this study confirm that the surgery performed at an outpatient day hospital is related to lower incidences of surgical adverse events; however, a follow-up of patients after discharge is indispensable in order to avoid under and subreporting, that can hide data and identify unrealistic rates.

  13. The Success Rate of Pediatric In-Hospital Cardiopulmonary Resuscitation in Ahvaz Training Hospitals

    Directory of Open Access Journals (Sweden)

    Shideh Assar

    2016-01-01

    Full Text Available Research Objective. This study determined the outcome of cardiopulmonary resuscitation (CPR after in-hospital cardiac arrest and factors influencing it in two training hospitals in Ahvaz. Method. Patients hospitalized in the pediatric wards and exposed to CPR during hospital stay were included in the study (September 2013 to May 2014. The primary outcome of CPR was assumed to be the return of spontaneous circulation (ROSC and the secondary outcome was assumed to be survival to discharge. The neurological outcome of survivors was assessed using the Pediatric Cerebral Performance Category (PCPC method. Results. Of the 279 study participants, 138 patients (49.4% showed ROSC, 81 patients (29% survived for 24 hours after the CPR, and 33 patients (11.8% survived to discharge. Of the surviving patients, 16 (48.5% had favorable neurological outcome. The resuscitation during holidays resulted in fewer ROSC. Multivariate analysis showed that longer CPR duration, CPR by junior residents, growth deficiency, and prearrest vasoactive drug infusion were associated with decreased survival to discharge (p<0.05. Infants and patients with respiratory disease had higher survival rates. Conclusion. The rate of successful CPR in our study was lower than rates reported by developed countries. However, factors influencing the outcome of CPR were similar. These results reflect the necessity of paying more attention to pediatric CPR training, postresuscitation conditions, and expansion of intensive care facilities.

  14. Measuring hand hygiene compliance rates at hospital entrances.

    Science.gov (United States)

    Vaidotas, Marina; Yokota, Paula Kiyomi Onaga; Marra, Alexandre R; Camargo, Thiago Zinsly Sampaio; Victor, Elivane da Silva; Gysi, Deisy Morselli; Leal, Flavio; Santos, Oscar Fernando Pavão dos; Edmond, Michael B

    2015-07-01

    Despite the importance of hand hygiene in the health care setting, there are no studies evaluating hand hygiene compliance at hospital entrances. The study was prospectively performed over a 33-week period from March 30, 2014-November 15, 2014, to evaluate hand hygiene compliance in 2 hospital reception areas. We compared electronic handwash counters with the application of radiofrequency identification (GOJO SMARTLINK) (electronic observer) that counts each activation of alcohol gel dispensers to direct observation (human observer) via remote review of video surveillance. We found low hand hygiene compliance rates of 2.2% (99/4,412) and 1.7% (140/8,277), respectively, at reception areas A and D, detected by direct observation. Using the electronic observer, we measured rates of 17% (15,624/91,724) and 7.1% (51,605/730,357) at reception areas A and D, respectively. For the overall time period of simultaneous electronic and human observation, the human observer captured 1% of the hand hygiene episodes detected by the electronic observer. Our study showed very low hand hygiene compliance in hospital reception areas, and we found an electronic hand hygiene system to be a useful method to monitor hand hygiene compliance. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  15. Dementia and Hospital Readmission Rates: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Sabrina Pickens

    2017-10-01

    Full Text Available Background: Although community-dwelling persons with dementia have an increased risk of hospital readmission, no systematic review has examined the contribution of dementia to readmissions. Summary: We examined articles in English, with no restrictions on publication dates, from Medline, PubMed, PsycINFO, CINAHL, and EMBASE. Keywords used were dementia, Alzheimer disease, frontotemporal lobar degeneration, elderly, frontotemporal dementia, executive function, brain atrophy, frontal lobe atrophy, cognitive impairment, readmission, readmit, rehospitalization, patient discharge, and return visit. Of 404 abstracts identified, 77 articles were retrieved; 12 were included. Four of 5 cohort studies showed significantly increased readmission rates in patients with dementia. On average the absolute increase above the comparison groups was from 3 to 13%. Dementia was not associated with readmission in 7 included case-control studies. Key Message: Findings suggest a small increased risk of hospital readmission in individuals with dementia. More study is needed.

  16. Reducing hospital readmission rates: current strategies and future directions.

    Science.gov (United States)

    Kripalani, Sunil; Theobald, Cecelia N; Anctil, Beth; Vasilevskis, Eduard E

    2014-01-01

    New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up) have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented; single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to postacute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, risk-stratification methods are available. Future work should better define the roles of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel.

  17. Relationship between medication event rates and the Leapfrog computerized physician order entry evaluation tool.

    Science.gov (United States)

    Leung, Alexander A; Keohane, Carol; Lipsitz, Stuart; Zimlichman, Eyal; Amato, Mary; Simon, Steven R; Coffey, Michael; Kaufman, Nathan; Cadet, Bismarck; Schiff, Gordon; Seger, Diane L; Bates, David W

    2013-06-01

    The Leapfrog CPOE evaluation tool has been promoted as a means of monitoring computerized physician order entry (CPOE). We sought to determine the relationship between Leapfrog scores and the rates of preventable adverse drug events (ADE) and potential ADE. A cross-sectional study of 1000 adult admissions in five community hospitals from October 1, 2008 to September 30, 2010 was performed. Observed rates of preventable ADE and potential ADE were compared with scores reported by the Leapfrog CPOE evaluation tool. The primary outcome was the rate of preventable ADE and the secondary outcome was the composite rate of preventable ADE and potential ADE. Leapfrog performance scores were highly related to the primary outcome. A 43% relative reduction in the rate of preventable ADE was predicted for every 5% increase in Leapfrog scores (rate ratio 0.57; 95% CI 0.37 to 0.88). In absolute terms, four fewer preventable ADE per 100 admissions were predicted for every 5% increase in overall Leapfrog scores (rate difference -4.2; 95% CI -7.4 to -1.1). A statistically significant relationship between Leapfrog scores and the secondary outcome, however, was not detected. Our findings support the use of the Leapfrog tool as a means of evaluating and monitoring CPOE performance after implementation, as addressed by current certification standards. Scores from the Leapfrog CPOE evaluation tool closely relate to actual rates of preventable ADE. Leapfrog testing may alert providers to potential vulnerabilities and highlight areas for further improvement.

  18. [Assessing the economic impact of adverse events in Spanish hospitals by using administrative data].

    Science.gov (United States)

    Allué, Natalia; Chiarello, Pietro; Bernal Delgado, Enrique; Castells, Xavier; Giraldo, Priscila; Martínez, Natalia; Sarsanedas, Eugenia; Cots, Francesc

    2014-01-01

    To evaluate the incidence and costs of adverse events registered in an administrative dataset in Spanish hospitals from 2008 to 2010. A retrospective study was carried out that estimated the incremental cost per episode, depending on the presence of adverse events. Costs were obtained from the database of the Spanish Network of Hospital Costs. This database contains data from 12 hospitals that have costs per patient records based on activities and clinical records. Adverse events were identified through the Patient Safety Indicators (validated in the Spanish Health System) created by the Agency for Healthcare Research and Quality together with indicators of the EuroDRG European project. This study included 245,320 episodes with a total cost of 1,308,791,871€. Approximately 17,000 patients (6.8%) experienced an adverse event, representing 16.2% of the total cost. Adverse events, adjusted by diagnosis-related groups, added a mean incremental cost of between €5,260 and €11,905. Six of the 10 adverse events with the highest incremental cost were related to surgical interventions. The total incremental cost of adverse events was € 88,268,906, amounting to an additional 6.7% of total health expenditure. Assessment of the impact of adverse events revealed that these episodes represent significant costs that could be reduced by improving the quality and safety of the Spanish Health System. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  19. Planning of traumatological hospital resources for a major winter sporting event as illustrated by the 2005 Winter Universiad.

    Science.gov (United States)

    Oberladstaetter, J; Kamelger, F S; Rosenberger, R; Dallapozza, Ch; Struve, P; Luger, T; Fink, Ch; Attal, R

    2009-03-01

    The 22nd Student World Winter Games took place in January 2005 in Innsbruck and Seefeld, Austria. Exactly 1,500 athletes of 50 nationalities competed in 69 events in ten winter sports. A total number of 750 functionaries, 800 volunteers and 85,000 spectators participated in the second largest winter sports event behind the Olympic winter games. The aim of this study was to evaluate the needed resources to ensure traumatological care for an event of that size. At the medical "call-center" all consultations, as well as patient data, diagnosis, and medical treatment were recorded using a preset protocol. Further, all patients treated in the University Hospital Innsbruck were registered with an emphasis on trauma patients. Forty-eight of 65 patients transported to the hospital as a result of the Universiade were trauma patients, 37 of whom were athletes. The gender distribution was 34:14 (m:f). Ice hockey players had the highest rate of injury (25% of all injured athletes), followed by alpine skiers (20.8% of injured athletes). The highest ISS was nine. Forty-three patients got ambulatory treatment, five were admitted to the hospital and surgical treatment was conducted in three cases. Mean patient number was 4.8 per day. No additional personnel, structural, or technical hospital resources were needed to accommodate a large winter sports event like the Universiad. Thus, a level-B trauma center with an emergency room and independent traumatological department with around the clock surgical capability seems to be sufficient to provide traumatological care for an event of this size if the possibility of patient transport to a larger facility exists in the case of catastrophic events.

  20. Heart rates in hospitalized children by age and body temperature.

    Science.gov (United States)

    Daymont, Carrie; Bonafide, Christopher P; Brady, Patrick W

    2015-05-01

    Heart rate (HR) is frequently used by clinicians in the hospital to assess a patient's severity of illness and make treatment decisions. We sought to develop percentiles that characterize the relationship of expected HR by age and body temperature in hospitalized children and to compare these percentiles with published references in both primary care and emergency department (ED) settings. Vital sign data were extracted from electronic health records of inpatients temperature measurement pairs from each admission. Measurements from 60% of patients were used to derive the percentile curves, with the remainder used for validation. We compared our upper percentiles with published references in primary care and ED settings. We used 60,863 observations to derive the percentiles. Overall, an increase in body temperature of 1°C was associated with an increase of ∼ 10 beats per minute in HR, although there were variations across age and temperature ranges. For infants and young children, our upper percentiles were lower than in primary care and ED settings. For school-age children, our upper percentiles were higher. We characterized expected HR by age and body temperature in hospitalized children. These percentiles differed from references in primary care and ED settings. Additional research is needed to evaluate the performance of these percentiles for the identification of children who would benefit from further evaluation or intervention for tachycardia. Copyright © 2015 by the American Academy of Pediatrics.

  1. [Detection of adverse events in hospitalized adult patients by using the Global Trigger Tool method].

    Science.gov (United States)

    Guzmán-Ruiz, O; Ruiz-López, P; Gómez-Cámara, A; Ramírez-Martín, M

    2015-01-01

    To identify and characterize adverse events (AE) in an Internal Medicine Department of a district hospital using an extension of the Global Trigger Tool (GTT), analyzing the diagnostic validity of the tool. An observational, analytical, descriptive and retrospective study was conducted on 2013 clinical charts from an Internal Medicine Department in order to detect EA through the identification of 'triggers' (an event often related to an AE). The 'triggers' and AE were located by systematic review of clinical documentation. The AE were characterized after they were identified. A total of 149 AE were detected in 291 clinical charts during 2013, of which 75.3% were detected directly by the tool, while the rest were not associated with a trigger. The percentage of charts that had at least one AE was 35.4%. The most frequent AE found was pressure ulcer (12%), followed by delirium, constipation, nosocomial respiratory infection and altered level of consciousness by drugs. Almost half (47.6%) of the AE were related to drug use, and 32.2% of all AE were considered preventable. The tool demonstrated a sensitivity of 91.3% (95%CI: 88.9-93.2) and a specificity of 32.5% (95%CI: 29.9-35.1). It had a positive predictive value of 42.5% (95%CI: 40.1-45.1) and a negative predictive value of 87.1% (95%CI: 83.8-89.9). The tool used in this study is valid, useful and reproducible for the detection of AE. It also serves to determine rates of injury and to observe their progression over time. A high frequency of both AE and preventable events were observed in this study. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  2. Frequency and predictors of stroke after acute myocardial infarction: specific aspects of in-hospital and postdischarge events.

    Science.gov (United States)

    Hachet, Olivier; Guenancia, Charles; Stamboul, Karim; Daubail, Benoit; Richard, Carole; Béjot, Yannick; Yameogo, Valentin; Gudjoncik, Aurélie; Cottin, Yves; Giroud, Maurice; Lorgis, Luc

    2014-12-01

    . Finally, only 45 postdischarge strokes were recorded. Postdischarge stroke subtypes showed a more heterogeneous distribution of mechanisms. The annual rate of stroke post-AMI remained stable throughout the 10-year study period. The present study describes specific predictors of in-hospital and postdischarge stroke in patients with AMI. It showed a marked increase in the risk of death, both during hospitalization and in the year after AMI. After hospital discharge, stroke remains a rare event and is mostly associated with high cardiovascular risk. © 2014 American Heart Association, Inc.

  3. Validating administrative data for the detection of adverse events in older hospitalized patients

    Directory of Open Access Journals (Sweden)

    Ackroyd-Stolarz S

    2014-08-01

    Full Text Available Stacy Ackroyd-Stolarz,1,2 Susan K Bowles,3–5 Lorri Giffin6 1Performance Excellence Portfolio, Capital District Health Authority, Halifax, Nova Scotia, Canada; 2Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; 3Geriatric Medicine, Capital District Health Authority, Halifax, Nova Scotia, Canada; 4College of Pharmacy and Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; 5Department of Pharmacy at Capital District Health Authority, Halifax, Nova Scotia, Canada; 6South Shore Family Health, Bridgewater, Nova Scotia, Canada Abstract: Older hospitalized patients are at risk of experiencing adverse events including, but not limited to, hospital-acquired pressure ulcers, fall-related injuries, and adverse drug events. A significant challenge in monitoring and managing adverse events is lack of readily accessible information on their occurrence. Purpose: The objective of this retrospective cross-sectional study was to validate diagnostic codes for pressure ulcers, fall-related injuries, and adverse drug events found in routinely collected administrative hospitalization data. Methods: All patients 65 years of age or older discharged between April 1, 2009 and March 31, 2011 from a provincial academic health sciences center in Canada were eligible for inclusion in the validation study. For each of the three types of adverse events, a random sample of 50 patients whose records were positive and 50 patients whose records were not positive for an adverse event was sought for review in the validation study (n=300 records in total. A structured health record review was performed independently by two health care providers with experience in geriatrics, both of whom were unaware of the patient's status with respect to adverse event coding. A physician reviewed 40 records (20 reviewed by each health care provider to establish interrater agreement. Results: A total of 39 pressure ulcers, 56 fall

  4. Hospital Evaluations by Social Media: A Comparative Analysis of Facebook Ratings among Performance Outliers.

    Science.gov (United States)

    Glover, McKinley; Khalilzadeh, Omid; Choy, Garry; Prabhakar, Anand M; Pandharipande, Pari V; Gazelle, G Scott

    2015-10-01

    An increasing number of hospitals and health systems utilize social media to allow users to provide feedback and ratings. The correlation between ratings on social media and more conventional hospital quality metrics remains largely unclear, raising concern that healthcare consumers may make decisions on inaccurate or inappropriate information regarding quality. The purpose of this study was to examine the extent to which hospitals utilize social media and whether user-generated metrics on Facebook(®) correlate with a Hospital Compare(®) metric, specifically 30-day all cause unplanned hospital readmission rates. This was a retrospective cross-sectional study conducted among all U.S. hospitals performing outside the confidence interval for the national average on 30-day hospital readmission rates as reported on Hospital Compare. Participants were 315 hospitals performing better than U.S. national rate on 30-day readmissions and 364 hospitals performing worse than the U.S. national rate. The study analyzed ratings of hospitals on Facebook's five-star rating scale, 30-day readmission rates, and hospital characteristics including beds, teaching status, urban vs. rural location, and ownership type. Hospitals performing better than the national average on 30-day readmissions were more likely to use Facebook than lower-performing hospitals (93.3 % vs. 83.5 %; p Facebook rating was associated with increased odds of the hospital belonging to the low readmission rate group by a factor of 5.0 (CI: 2.6-10.3, p Facebook-related variables. Hospitals with lower rates of 30-day hospital-wide unplanned readmissions have higher ratings on Facebook than hospitals with higher readmission rates. These findings add strength to the concept that aggregate measures of patient satisfaction on social media correlate with more traditionally accepted measures of hospital quality.

  5. No evidence of purported lunar effect on hospital admission rates or birth rates.

    Science.gov (United States)

    Margot, Jean-Luc

    2015-01-01

    Studies indicate that a fraction of nursing professionals believe in a "lunar effect"-a purported correlation between the phases of the Earth's moon and human affairs, such as birth rates, blood loss, or fertility. This article addresses some of the methodological errors and cognitive biases that can explain the human tendency of perceiving a lunar effect where there is none. This article reviews basic standards of evidence and, using an example from the published literature, illustrates how disregarding these standards can lead to erroneous conclusions. Román, Soriano, Fuentes, Gálvez, and Fernández (2004) suggested that the number of hospital admissions related to gastrointestinal bleeding was somehow influenced by the phases of the Earth's moon. Specifically, the authors claimed that the rate of hospital admissions to their bleeding unit is higher during the full moon than at other times. Their report contains a number of methodological and statistical flaws that invalidate their conclusions. Reanalysis of their data with proper procedures shows no evidence that the full moon influences the rate of hospital admissions, a result that is consistent with numerous peer-reviewed studies and meta-analyses. A review of the literature shows that birth rates are also uncorrelated to lunar phases. Data collection and analysis shortcomings, as well as powerful cognitive biases, can lead to erroneous conclusions about the purported lunar effect on human affairs. Adherence to basic standards of evidence can help assess the validity of questionable beliefs.

  6. Impact of type 2 diabetes mellitus on in-hospital-mortality after major cardiovascular events in Spain (2002-2014).

    Science.gov (United States)

    de Miguel-Yanes, José M; Jiménez-García, Rodrigo; Hernández-Barrera, Valentín; Méndez-Bailón, Manuel; de Miguel-Díez, Javier; Lopez-de-Andrés, Ana

    2017-10-10

    Diabetes mellitus has long been associated with cardiovascular events. Nevertheless, the higher burden of traditional cardiovascular risk factors reported in high-income countries is offset by a more widespread use of preventive measures and revascularization or other invasive procedures. The aim of this investigation is to describe trends in number of cases and outcomes, in-hospital mortality (IHM) and length of hospital stay (LHS), of hospital admissions for major cardiovascular events between type 2 diabetes (T2DM) and matched non-diabetes patients. Retrospective study using National Hospital Discharge Database, analyzed in 4 years 2002, 2006, 2010, 2014, in Spain. We included patients (≥ 40 years old) with a primary diagnosis of myocardial infarction, ischemic and hemorrhagic stroke, aortic aneurysm and dissection and acute lower limb ischemia in people with T2DM. Cases were matched with controls (without T2DM) by ICD-9-CM codes, sex, age, province of residence and year. We selected 130,011 matched couples (50,427 with myocardial infarction, 60,236 with stroke, 2599 with aortic aneurysm and dissection and 16,749 with acute lower limb ischemia. Among T2DM patients we found increasing numbers of admissions overtime for stroke (10,794 in 2002 vs 17,559 in 2014), aortic aneurysm and dissection (390 vs 841) and acute lower limb ischemia (3854 vs. 4548). People were progressively older (except for myocardial infarction), had more comorbidities (especially T2DM patients), and were more frequently coded overtime for cardiovascular risk factors (smoking, obesity, hypertension, lipid disorders) and renal diseases. LHS and IHM declined overtime, though IHM only did it significantly in T2DM patients. Multivariable adjustment showed that T2DM patients had a significantly 15% higher mortality rate during admission for myocardial infarction, a 6% higher mortality for stroke, and a 6% higher mortality rate for "all cardiovascular events combined", than non

  7. Collaborative Event-Driven Coverage and Rate Allocation for Event Miss-Ratio Assurances in Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Ozgur Sanli H

    2010-01-01

    Full Text Available Wireless sensor networks are often required to provide event miss-ratio assurance for a given event type. To meet such assurances along with minimum energy consumption, this paper shows how a node's activation and rate assignment is dependent on its distance to event sources, and proposes a practical coverage and rate allocation (CORA protocol to exploit this dependency in realistic environments. Both uniform event distribution and nonuniform event distribution are considered and the notion of ideal correlation distance around a clusterhead is introduced for on-duty node selection. In correlation distance guided CORA, rate assignment assists coverage scheduling by determining which nodes should be activated for minimizing data redundancy in transmission. Coverage scheduling assists rate assignment by controlling the amount of overlap among sensing regions of neighboring nodes, thereby providing sufficient data correlation for rate assignment. Extensive simulation results show that CORA meets the required event miss-ratios in realistic environments. CORA's joint coverage scheduling and rate allocation reduce the total energy expenditure by 85%, average battery energy consumption by 25%, and the overhead of source coding up to 90% as compared to existing rate allocation techniques.

  8. High rate of adverse events following circumcision of young male ...

    African Journals Online (AJOL)

    (94) refusing circumcision by the TK technique; 34 men were randomised to the FG group and 35 to the TK group, and 32 and 24 patients were circumcised by the FG and TK methods respectively, of whom 29 and 19 respectively attended the post-circumcision visit. All 12 adverse event sheets corresponded to the TK group ...

  9. Development and validation of a taxonomy of adverse handover events in hospital settings

    DEFF Research Database (Denmark)

    Andersen, Henning Boje; Siemsen, Inger Margrete D.; Petersen, Lene Funck

    2015-01-01

    Patient Safety Database, 200 events) and 47 interviews with staff conducted at a large hospital in the Capital Region (232 events). The most prevalent causes of adverse events are inadequate competence (30 %), inadequate infrastructure (22 %) and busy ward (18 %). Inter-rater reliability (kappa) was 0.......76 and 0.87 for reports and interviews, respectively. Communication in clinical contexts has been widely recognized as giving rise to potentially hazardous events, and handover situations are particularly prone to failures of communication or unclear allocation of responsibility. The taxonomy provides...... a tool for analyzing adverse handover events to identify frequent causes among reported handover failures. In turn, this provides a basis for selecting safety measures including handover protocols and training programmes....

  10. A perspective from clinical and business ethics on adverse events in hospitalized patients.

    Science.gov (United States)

    Wagner, J T; Meier, C; Higdon, T

    1997-11-01

    Adverse events occur in a significant, but undetermined, number of hospitalized patients. These types of patient injuries are more often the result of faulty systems than human maleficence. A culture exists among health care providers that discourages the reporting of such events and resists the implementation of formal efforts to eliminate them. This resistance serves to perpetuate the problem. Both business and clinical ethics argue that sound reasons exist for hospitals to reduce, if not eliminate, adverse events. To do so is cost effective, particularly in a managed care environment. It is also at the heart of responsible professional behavior. Physicians are afforded an opportunity to be at the forefront in this quality improvement effort.

  11. Do More Hospital Beds Lead to Higher Hospitalization Rates? A Spatial Examination of Roemer’s Law

    Science.gov (United States)

    Delamater, Paul L.; Messina, Joseph P.; Grady, Sue C.; WinklerPrins, Vince; Shortridge, Ashton M.

    2013-01-01

    Background Roemer’s Law, a widely cited principle in health care policy, states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Despite its influence, a surprisingly small body of empirical evidence supports its content. Furthermore, known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer’s Law. We pose the question, “Accounting for space in health care access and use, is there an observable association between the availability of hospital beds and hospital utilization?” Methods We employ an ecological research design based upon the Anderson behavioral model of health care utilization. This conceptual model is implemented in an explicitly spatial context. The effect of hospital bed availability on the utilization of hospital services is evaluated, accounting for spatial structure and controlling for other known determinants of hospital utilization. The stability of this relationship is explored by testing across numerous geographic scales of analysis. The case study comprises an entire state system of hospitals and population, evaluating over one million inpatient admissions. Results We find compelling evidence that a positive, statistically significant relationship exists between hospital bed availability and inpatient hospitalization rates. Additionally, the observed relationship is invariant with changes in the geographic scale of analysis. Conclusions This study provides evidence for the effects of Roemer’s Law, thus suggesting that variations in hospitalization rates have origins in the availability of hospital beds. This relationship is found to be robust across geographic scales of analysis. These findings suggest

  12. Adverse Events Associated with Hospitalization or Detected through the RAI-HC Assessment among Canadian Home Care Clients

    Science.gov (United States)

    Doran, Diane; Hirdes, John P.; Blais, Régis; Baker, G. Ross; Poss, Jeff W.; Li, Xiaoqiang; Dill, Donna; Gruneir, Andrea; Heckman, George; Lacroix, Hélène; Mitchell, Lori; O'Beirne, Maeve; Foebel, Andrea; White, Nancy; Qian, Gan; Nahm, Sang-Myong; Yim, Odilia; Droppo, Lisa; McIsaac, Corrine

    2013-01-01

    Background: The occurrence of adverse events (AEs) in care settings is a patient safety concern that has significant consequences across healthcare systems. Patient safety problems have been well documented in acute care settings; however, similar data for clients in home care (HC) settings in Canada are limited. The purpose of this Canadian study was to investigate AEs in HC, specifically those associated with hospitalization or detected through the Resident Assessment Instrument for Home Care (RAI-HC). Method: A retrospective cohort design was used. The cohort consisted of HC clients from the provinces of Nova Scotia, Ontario, British Columbia and the Winnipeg Regional Health Authority. Results: The overall incidence rate of AEs associated with hospitalization ranged from 6% to 9%. The incidence rate of AEs determined from the RAI-HC was 4%. Injurious falls, injuries from other than fall and medication-related events were the most frequent AEs associated with hospitalization, whereas new caregiver distress was the most frequent AE identified through the RAI-HC. Conclusion: The incidence of AEs from all sources of data ranged from 4% to 9%. More resources are needed to target strategies for addressing safety risks in HC in a broader context. Tools such as the RAI-HC and its Clinical Assessment Protocols, already available in Canada, could be very useful in the assessment and management of HC clients who are at safety risk. PMID:23968676

  13. Direct risk standardisation: a new method for comparing casemix adjusted event rates using complex models.

    Science.gov (United States)

    Nicholl, Jon; Jacques, Richard M; Campbell, Michael J

    2013-10-29

    Comparison of outcomes between populations or centres may be confounded by any casemix differences and standardisation is carried out to avoid this. However, when the casemix adjustment models are large and complex, direct standardisation has been described as "practically impossible", and indirect standardisation may lead to unfair comparisons. We propose a new method of directly standardising for risk rather than standardising for casemix which overcomes these problems. Using a casemix model which is the same model as would be used in indirect standardisation, the risk in individuals is estimated. Risk categories are defined, and event rates in each category for each centre to be compared are calculated. A weighted sum of the risk category specific event rates is then calculated. We have illustrated this method using data on 6 million admissions to 146 hospitals in England in 2007/8 and an existing model with over 5000 casemix combinations, and a second dataset of 18,668 adult emergency admissions to 9 centres in the UK and overseas and a published model with over 20,000 casemix combinations and a continuous covariate. Substantial differences between conventional directly casemix standardised rates and rates from direct risk standardisation (DRS) were found. Results based on DRS were very similar to Standardised Mortality Ratios (SMRs) obtained from indirect standardisation, with similar standard errors. Direct risk standardisation using our proposed method is as straightforward as using conventional direct or indirect standardisation, always enables fair comparisons of performance to be made, can use continuous casemix covariates, and was found in our examples to have similar standard errors to the SMR. It should be preferred when there is a risk that conventional direct or indirect standardisation will lead to unfair comparisons.

  14. Gender Differences in Rating Stressful Events, Depression, and Depressive Cognition.

    Science.gov (United States)

    Sowa, Claudia J.; Lustman, Patrick J.

    1984-01-01

    Administered the Life Stress Questionnaire, the Beck Depression Inventory, and the Automatic Thought Questionnaire to 140 students. Results showed significant sex differences. Men reported more stressful life change, but women rated the impact of stressors more severely and had higher depression. Men exhibited greater distortions in cognitive…

  15. A Hospital Nursing Adverse Events Reporting System Project: An Approach Based on the Systems Development Life Cycle.

    Science.gov (United States)

    Cao, Yingjuan; Ball, Marion

    2017-01-01

    Based on the System Development Life Cycle, a hospital based nursing adverse event reporting system was developed and implemented which integrated with the current Hospital Information System (HIS). Besides the potitive outcomes in terms of timeliness and efficiency, this approach has brought an enormous change in how the nurses report, analyze and respond to the adverse events.

  16. Disaster metrics: quantitative benchmarking of hospital surge capacity in trauma-related multiple casualty events.

    Science.gov (United States)

    Bayram, Jamil D; Zuabi, Shawki; Subbarao, Italo

    2011-06-01

    Hospital surge capacity in multiple casualty events (MCE) is the core of hospital medical response, and an integral part of the total medical capacity of the community affected. To date, however, there has been no consensus regarding the definition or quantification of hospital surge capacity. The first objective of this study was to quantitatively benchmark the various components of hospital surge capacity pertaining to the care of critically and moderately injured patients in trauma-related MCE. The second objective was to illustrate the applications of those quantitative parameters in local, regional, national, and international disaster planning; in the distribution of patients to various hospitals by prehospital medical services; and in the decision-making process for ambulance diversion. A 2-step approach was adopted in the methodology of this study. First, an extensive literature search was performed, followed by mathematical modeling. Quantitative studies on hospital surge capacity for trauma injuries were used as the framework for our model. The North Atlantic Treaty Organization triage categories (T1-T4) were used in the modeling process for simplicity purposes. Hospital Acute Care Surge Capacity (HACSC) was defined as the maximum number of critical (T1) and moderate (T2) casualties a hospital can adequately care for per hour, after recruiting all possible additional medical assets. HACSC was modeled to be equal to the number of emergency department beds (#EDB), divided by the emergency department time (EDT); HACSC = #EDB/EDT. In trauma-related MCE, the EDT was quantitatively benchmarked to be 2.5 (hours). Because most of the critical and moderate casualties arrive at hospitals within a 6-hour period requiring admission (by definition), the hospital bed surge capacity must match the HACSC at 6 hours to ensure coordinated care, and it was mathematically benchmarked to be 18% of the staffed hospital bed capacity. Defining and quantitatively benchmarking the

  17. Serious adverse events in a hospital using early warning score - what went wrong?

    DEFF Research Database (Denmark)

    Petersen, John Asger; Mackel, Rebecca; Antonsen, Kristian

    2014-01-01

    AIM: To evaluate the performance of a new early warning score (EWS) system by reviewing all serious adverse events in our hospital over a 6-month time period. METHOD: All incidents of unexpected death (UD), cardiac arrest (CA) and unanticipated intensive care unit admission(UICU) of adult patients...... of EWS were recorded in 87, 94 and 75% of UICU, CA and UD. Patients were monitored according to the escalation protocol in 13, 31 and 13% of UICU, CA and UD. Nurses escalated care and contacted physicians in 64% and 60% of events of UICU and the corresponding proportions for CO were 58% and 55%. On call...

  18. [The role of patient flow and surge capacity for in-hospital response in mass casualty events].

    Science.gov (United States)

    Sefrin, Peter; Kuhnigk, Herbert

    2008-03-01

    Mass casualty events make demands on emergency services and disaster control. However, optimized in- hospital response defines the quality of definitive care. Therefore, German federal law governs the role of hospitals in mass casualty incidents. In hospital casualty surge is depending on resources that have to be expanded with a practicable alarm plan. Thus, in-hospital mass casualty management planning is recommended to be organized by specialized persons. To minimise inhospital patient overflow casualty surge principles have to be implemented in both, pre-hospital and in-hospital disaster planning. World soccer championship 2006 facilitated the initiation of surge and damage control principles in in-hospital disaster planning strategies for German hospitals. The presented concept of strict control of in-hospital patient flow using surge principles minimises the risk of in-hospital breakdown and increases definitive hospital treatment capacity in mass casualty incidents.

  19. Elevated serum osteoprotegerin levels predict in-hospital major adverse cardiac events in patients with ST elevation myocardial infarction.

    Science.gov (United States)

    Çanga, Aytun; Durakoğlugil, Murtaza Emre; Erdoğan, Turan; Kirbaş, Aynur; Yilmaz, Adnan; Çiçek, Yüksel; Ergül, Elif; Çetin, Mustafa; Kocaman, Sinan Altan

    2012-11-01

    The aim of our study was to investigate whether osteoprotegerin (OPG) is related to in-hospital major adverse cardiac events (MACE) and reperfusion parameters in patients with ST elevation myocardial infarction (STEMI). The OPG/receptor activator of nuclear factor-κB (RANK)/RANK ligand pathway has recently been associated with atherosclerosis. OPG is a predictor of cardiovascular events in patients with acute coronary syndrome. This study included 96 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Two groups with equal number of patients were formed according to median OPG level. The association of OPG levels on admission with post-procedural reperfusion parameters, and in-hospital MACE were investigated. Patients with higher OPG levels displayed higher neutrophil/lymphocyte ratio, admission troponin, admission glucose, and high-sensitive C-reactive protein. Higher OPG levels were associated with increased thrombolysis in myocardial infarction (TIMI) risk score, TIMI risk index, pain to balloon time, need for inotropic support, shock, and MACE, mainly driven by death. Reperfusion parameters were not different between the two groups. TIMI risk score, TIMI risk index, myocardial blush grade, estimated glomerular filtration rate (eGFR), number of obstructed vessels, and OPG significantly predicted adverse cardiac events. Multiple logistic regression analysis revealed OPG as an independent predictor of MACE as well as eGFR, number of obstructed vessels, and corrected TIMI frame count. OPG, a bidirectional molecule displaying both atheroprotective and pro-atherosclerotic properties, is currently known as a marker of inflammation and a predictor of cardiovascular mortality. The present study, for the first time, demonstrated that an increased OPG level is related to in-hospital adverse cardiovascular events after primary PCI in patients with STEMI. Copyright © 2012 Japanese College of Cardiology. Published by Elsevier Ltd

  20. Nuclear and Radiological Event Scale Turns 20. INES Helps Authorities Rate Events and Communicate Their Significance

    International Nuclear Information System (INIS)

    Verlini, Giovanni

    2011-01-01

    Originally developed in the 1990s jointly by IAEA and Nuclear Energy Agency of the Organization for Economic Co-operation and Development (OECD/NEA) and Member States experts, INES was last revised in 2008 to become a more versatile and informative tool. INES is now designed to address events associated with the transport, storage and use of radioactive material and radiation sources, whether they occur at a nuclear installation or not.

  1. High frame-rate neutron radiography of dynamic events

    International Nuclear Information System (INIS)

    Bossi, R.H.; Robinson, A.H.; Barton, J.P.

    1981-01-01

    A system has been developed to perform neutron radiographic analysis of dynamic events having a duration of several milliseconds. The system has been operated in the range of 2000 to 10,000 frames/second. Synchronization has provided high-speed-motion neutron radiographs for evaluation of the firing cycle of 7.62 mm munition rounds within a steel rifle barrel. The system has also been used to demonstrate the ability to produce neutron radiographic movies of two-phase flow. The equipment uses the Oregon State University TRIGA reactor capable of pulsing to 3000 MW peak power, a neutron beam collimator, a scintillator neutron conversion screen coupled to an image intensifier, and a 16 mm high speed movie camera. The peak neutron flux incident at the object position is approximately 4 x 10 11 n/cm 2 s with a pulse, full width at half maximum, of 9 ms. Special studies have been performed on the scintillator conversion screens and on the effects of statistical limitations on the image quality. Modulation transfer function analysis has been used to assist in the evaluation of the system performance

  2. High frame-rate neutron radiography of dynamic events

    International Nuclear Information System (INIS)

    Bossi, R.H.; Robinson, A.H.; Barton, J.P.

    1983-01-01

    A system has been developed to perform neutron radiographic analysis of dynamic events having a duration of several milliseconds. The system has been operated in the range of 2000 to 10,000 frames/second. Synchronization has provided high-speed-motion neutron radiographs for evaluation of the firing cycle of 7.62 mm munition rounds within a steel rifle barrel. The system has also been used to demonstrate the ability to produce neutron radiographic movies of two phase flow. The equipment uses the Oregon State University TRIGA reactor capable of pulsing to 3000 MW peak power, a neutron beam collimator, a scintillator neutron conversion screen coupled to an image intensifier, and a 16 mm high speed movie camera. The peak neutron flux incident at the object position is approximately 4 x 10 11 n/cm 2 s with a pulse, full width at half maximum, of 9 ms. Special studies have been performed on the scintillator conversion screens and on the effects of statistical limitations on the image quality. Modulation transfer function analysis has been used to assist in the evaluation of the system performance. (Auth.)

  3. A Generic Discrete-Event Simulation Model for Outpatient Clinics in a Large Public Hospital

    Directory of Open Access Journals (Sweden)

    Waressara Weerawat

    2013-01-01

    Full Text Available The orthopedic outpatient department (OPD ward in a large Thai public hospital is modeled using Discrete-Event Stochastic (DES simulation. Key Performance Indicators (KPIs are used to measure effects across various clinical operations during different shifts throughout the day. By considering various KPIs such as wait times to see doctors, percentage of patients who can see a doctor within a target time frame, and the time that the last patient completes their doctor consultation, bottlenecks are identified and resource-critical clinics can be prioritized. The simulation model quantifies the chronic, high patient congestion that is prevalent amongst Thai public hospitals with very high patient-to-doctor ratios. Our model can be applied across five different OPD wards by modifying the model parameters. Throughout this work, we show how DES models can be used as decision-support tools for hospital management.

  4. [Medication adverse events: Impact of pharmaceutical consultations during the hospitalization of patients].

    Science.gov (United States)

    Santucci, R; Levêque, D; Herbrecht, R; Fischbach, M; Gérout, A C; Untereiner, C; Bouayad-Agha, K; Couturier, F

    2014-11-01

    The medication iatrogenic events are responsible for nearly one iatrogenic event in five. The main purpose of this prospective multicenter study is to determine the effect of pharmaceutical consultations on the occurrence of medication adverse events during hospitalization (MAE). The other objectives are to study the impact of age, of the number of medications and pharmaceutical consultations on the risk of MAE. The pharmaceutical consultation is associated to a complete reassessment done by both a physician and a pharmacist for the home medication, the hospital treatment (3days after admission), the treatment during chemotherapy, and/or, the treatment when the patient goes back home. All MAE are subject to an advice for the patient, additional clinical-biological monitoring and/or prescription changes. Among the 318 patients, 217 (68%) had 1 or more clinically important MAE (89% drug-drug interaction, 8% dosing error, 2% indication error, 1% risk behavior). The patients have had 1121 pharmaceutical consultations (3.2±1.4/patient). Thus, the pharmaceutical consultations divided by 2.34 the risk of MAE (unadjusted incidence ratio, P≤0.05). Each consultation decreased by 24% the risk of MAE. Moreover, adding one medication increases from 14 to 30% as a risk of MAE on the population. Pharmaceutical consultations during the hospital stay could reduce significantly the number of medication adverse effects. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  5. The effect of major adverse renal cardiovascular event (MARCE) incidence, procedure volume, and unit cost on the hospital savings resulting from contrast media use in inpatient angioplasty.

    Science.gov (United States)

    Keuffel, Eric; McCullough, Peter A; Todoran, Thomas M; Brilakis, Emmanouil S; Palli, Swetha R; Ryan, Michael P; Gunnarsson, Candace

    2018-04-01

    To determine the net economic impact of switching from low-osmolar contrast media (LOCM) to iso-osmolar contrast media (IOCM; iodixanol) in patients undergoing inpatient coronary or peripheral angioplasty in the United States (US). A budget impact model (BIM) was developed from a hospital perspective. Nationally representative procedural and contrast media prevalence rates, along with MARCE (major adverse renal cardiovascular event) incidence and episode-related cost data were derived from Premier Hospital Data (October 2014 to September 2015). A previously estimated relative risk reduction in MARCE associated with IOCM usage (9.3%) was applied. The higher cost of IOCM was included when calculating the net impact estimates at the aggregate, hospital type, and per hospital levels. One-way (±25%) and probabilistic sensitivity analyses identified the model's most important inputs. Based on weighted analysis, 513,882 US inpatient angioplasties and 35,610 MARCE cases were estimated annually. Switching to an "IOCM only" strategy from a "LOCM only" strategy increases contrast media cost, but prevents 2,900 MARCE events. The annual budget impact was an estimated saving of $30.71 million, aggregated across all US hospitals, $6,316 per hospital, or $60 per procedure. Net savings were maintained across all univariate sensitivity analyses. While MARCE/event-free cost differential was the most important factor driving total net savings for hospitals in the Northeast and West, procedural volume was important in the Midwest and rural locations. Switching to an "IOCM only" strategy from a "LOCM only" approach yields substantial net global savings to hospitals, both at the national level and within hospital sub-groups. Hospital administrators should maintain awareness of the factors that are likely to be more influential for their hospital and recognize that purchasing on the basis of lower contrast media cost may result in higher overall costs for patients undergoing inpatient

  6. Risk factors for adverse events after vaccinations performed during the initial hospitalization of infants born prematurely.

    Science.gov (United States)

    Wilińska, Maria; Warakomska, Małgorzata; Głuszczak-Idziakowska, Ewa; Jackowska, Teresa

    There are significant delays in implementing vaccination among preterm infants. Description of the frequency and kinds of adverse events following immunization in preterms. Establishment of the group of preterms who will distinctively be susceptible to adverse events. Demographical, clinical data and the occurrence of adverse events after DTaP, HIB and pneumococcal vaccination among preterms during their initial hospitalization were prospectively collected with the use of an electronic data form between 1st June 2011 and 31st May 2015. The analysis was conducted on 138 patients. The groups were divided according to maturity (I: ≤ GA 28w n=73 and GA 29-36 w n=65). There were no statistically significant differences between the groups in the occurrence of adverse events. Out of the total group, following vaccination apnoea developed in 6 newborns (4%) and activity dysfunctions were observed in 13 newborns (10%). The occurrence of apnoea after vaccination positively correlated with the time of non-invasive ventilation and the occurrence of late infection. There were no statistically significant demographical or clinical risk factors for the development of activity dysfunctions following vaccination. Term vaccination in clinically stable preterm infants is a safe medical procedure. However, long-term non-invasive respiratory support and late infections are risk factors for apnea following vaccinations. In these patients vaccinations should be considered during hospitalization.

  7. A Study of Rate and Predictors of Fall Among Elderly Patients in a University Hospital.

    Science.gov (United States)

    al Tehewy, Mahi Mahmoud; Amin, Ghada Essam; Nassar, Nahla Wassem

    2015-12-01

    Falls represent a serious problem facing hospital-admitted patients, and the severity of fall-related complications rises steadily after the age of 65 years. The aims of this study were (a) to calculate the rate of falls among elderly patients in the internal medicine departments in Ain Shams University Hospital, (b) to identify different predictors and characteristics of falls, and (c) to assess clinical consequences and hospitalization outcomes of falls. An observational longitudinal study has been conducted in Ain Shams University Hospital, where 411 elderly patients admitted to the internal medicine departments were included. Upon admission, the patients were assessed for their risk for falling using the Morse Fall Scale (MFS). Information about their medical condition and drugs administered was obtained. Functional assessment of the patients regarding their ability to perform different daily activities was also performed. The patients were followed up during their stay, and once a fall event occurred, complete details regarding the circumstances and consequences of that event were obtained. The incidence rate of falls was found to be 16.9 per 1000 patient days. The fallers had a significantly high risk for falling according to the MFS (P = 0.02). The MFS was able to predict patients at risk for falling and identified correctly 82.6% of the fallers. The most common medical conditions associated with falls were diabetes (48.7%), hypertension (58.7%), and visual impairment (41.3%). Anemia (P = 0.05) and osteoporosis (P = 0.02) showed a statistically significant difference between the fallers and the nonfallers. Presence of a history of a fall and increased length of hospital stay were highly significant (P = 0.01) factors that predisposed to falls. Logistic regression analysis showed that anemia, osteoporosis, and history of a fall were independent predictors of falls. Most falls had no serious consequences, approximately 18% had contusions, 2% had subdural

  8. Event Rates in Randomized Clinical Trials Evaluating Cardiovascular Interventions and Devices

    NARCIS (Netherlands)

    Mahmoud, Karim D.; Lennon, Ryan J.; Holmes, David R.

    2015-01-01

    Randomized clinical trials (RCTs) are considered the gold standard for evidence-based medicine. However, an accurate estimation of the event rate is crucial for their ability to test clinical hypotheses. Overestimation of event rates reduces the required sample size but can compromise the

  9. [What are hospitals and primary care doing to mitigate the social impact of serious adverse events].

    Science.gov (United States)

    Mira, José Joaquín; Carrillo, Irene; Lorenzo, Susana

    To explore what hospitals and primary care (PC) are doing to reduce the negative social impact of a serious adverse event (AE). We surveyed 195 hospital (n=113) and PC (n=82) managers from eight autonomous communities to explore the level of implementation of five interventions recommended after an AE to protect the reputation of healthcare institutions. Most institutions (70, 45.2% PC, and 85, 54.8% hospitals) did not have a crisis plan to protect their reputation after an AE. Internal (p=0.0001) and external (p=0.012) communications were addressed better in PC than in hospitals. Very few institutions had defined the managers' role in case of an AE (10.7% hospitals versus 6.25% PC). A majority of healthcare institutions have not planned crisis intervention after an AE with severe consequences nor have they defined plans to recover citizens' trust after an AE. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Do inter-hospital comparisons of in-hospital, acute myocardial infarction case-fatality rates serve the purpose of fostering quality improvement? An evaluative study

    Directory of Open Access Journals (Sweden)

    Molenberghs Geert

    2010-12-01

    Full Text Available Abstract Background In-hospital case-fatality rates in patients, admitted for acute myocardial infarction (AMI-CFRs, are internationally used as a quality indicator. Attempting to encourage the hospitals to assume responsibility, the Belgian Ministry of Health decided to stimulate initiatives of quality improvement by means of a limited set of indicators, among which AMI-CFR, to be routinely analyzed. In this study we aimed, by determining the existence of inter-hospital differences in AMI-CFR, (1 to evaluate to which extent Belgian discharge records allow the assessment of quality of care in the field of AMI, and (2 to identify starting points for quality improvement. Methods Hospital discharge records from all the Belgian short-term general hospitals in the period 2002-2005. The study population (N = 46,287 included patients aged 18 years and older, hospitalized for AMI. No unique patient identifier being present, we tried to track transferred patients. We assessed data quality through a comparison of MCD with data from two registers for acute coronary events and through transfer and sensitivity analyses. We compared AMI-CFRs across hospitals, using multivariable logistic regression models. In the main model hospitals, Charlson's co-morbidity index, age, gender and shock constituted the covariates. We carried out two types of analyses: a first one wherein transferred-out cases were excluded, to avoid double counting of patients when computing rates, and a second one with exclusion of all transferred cases, to allow the study of patients admitted into, treated in and discharged from the same hospital. Results We identified problems regarding both the CFR's numerator and denominator. Sensitivity analyses revealed differential coding and/or case management practices. In the model with exclusion of transfer-out cases, the main determinants of AMI-CFR were cardiogenic shock (ORadj 23.0; 95% CI [20.9;25.2], and five-year age groups ORadj 1.23; 95

  11. Do inter-hospital comparisons of in-hospital, acute myocardial infarction case-fatality rates serve the purpose of fostering quality improvement? An evaluative study.

    Science.gov (United States)

    Aelvoet, Willem; Terryn, Nathalie; Molenberghs, Geert; De Backer, Guy; Vrints, Christiaan; van Sprundel, Marc

    2010-12-08

    In-hospital case-fatality rates in patients, admitted for acute myocardial infarction (AMI-CFRs), are internationally used as a quality indicator. Attempting to encourage the hospitals to assume responsibility, the Belgian Ministry of Health decided to stimulate initiatives of quality improvement by means of a limited set of indicators, among which AMI-CFR, to be routinely analyzed. In this study we aimed, by determining the existence of inter-hospital differences in AMI-CFR, (1) to evaluate to which extent Belgian discharge records allow the assessment of quality of care in the field of AMI, and (2) to identify starting points for quality improvement. Hospital discharge records from all the Belgian short-term general hospitals in the period 2002-2005. The study population (N = 46,287) included patients aged 18 years and older, hospitalized for AMI. No unique patient identifier being present, we tried to track transferred patients. We assessed data quality through a comparison of MCD with data from two registers for acute coronary events and through transfer and sensitivity analyses. We compared AMI-CFRs across hospitals, using multivariable logistic regression models. In the main model hospitals, Charlson's co-morbidity index, age, gender and shock constituted the covariates. We carried out two types of analyses: a first one wherein transferred-out cases were excluded, to avoid double counting of patients when computing rates, and a second one with exclusion of all transferred cases, to allow the study of patients admitted into, treated in and discharged from the same hospital. We identified problems regarding both the CFR's numerator and denominator.Sensitivity analyses revealed differential coding and/or case management practices. In the model with exclusion of transfer-out cases, the main determinants of AMI-CFR were cardiogenic shock (OR(adj) 23.0; 95% CI [20.9;25.2]), and five-year age groups OR(adj) 1.23; 95% CI [1.11;1.36]). Sizable inter-hospital and inter

  12. Adverse events in cardiac surgery, a mixed methods retrospective study in an Italian teaching hospital.

    Science.gov (United States)

    Bellandi, Tommaso; Tartaglia, Riccardo; Forni, Silvia; D'Arienzo, Sara; Tulli, Giorgio

    2017-08-01

    Adverse events (AEs) are a major concern in surgery, but the evidence in cardiac surgery is limited, especially on the contributory factors. According to the data of the National Outcomes Program, a unit was selected to conduct a mixed methods investigation into the incidence, type, and cause of AE, given its mortality rate that was double the national average on coronary artery bypass grafting, valve reparation, and replacement. A retrospective investigation on the performance of a cardiac surgery, combining the routinely collected data on process and outcome measures with a 2-stage structured review of 280 medical records performed by 3 expert clinicians, with the support of a methodologist. At least one risk had been verified in 137 of 280 cases (48.9%, 95% CI, 43.1-54.8). The total number of AE was 42, with an incidence of 15% (95% CI, 10.8-20.2) and a preventability of 80.9% (95% CI, 69.1-92.8). In 11.9% of AE, the consequence is death, disability in 40.5%, and extended hospital stay in 69% of the cases. Adverse events are associated with problems in care management at the ward (89/137, 64.9%, 95% CI, 56.9-72.9), followed by surgical complications (46/137, 33.6%, 95% CI, 25.7-41.5) and infection/sepsis (32/137, 23.4%, 95% CI, 16.3-30.4). An active error was made by the health care workers in 31 of 42 cases with AE, either during the decision making or during the execution of an action. A total of 36 AEs were due to deficiencies attributed to organizational factors and 31 were linked to poor teamwork. The mixed methods approach demonstrated how a deep understanding of AE and poor performance may emerge thanks to the combination of routinely available data and experts' evaluations. The main limitation of this study is its focus on the cardiac surgery rather than on the entire process of care. The evaluation could have been integrated with on-site observations and the analysis of reported incidents. © 2017 John Wiley & Sons, Ltd.

  13. Association Between Medicare Summary Star Ratings for Patient Experience and Clinical Outcomes in US Hospitals

    Directory of Open Access Journals (Sweden)

    Stephen Trzeciak MD, MPH

    2016-03-01

    Full Text Available Objective: In 2015, the Centers for Medicare and Medicaid Services (CMS released new summary star ratings for US hospitals based on patient experience. We aimed to test the association between CMS patient experience star ratings and clinical outcomes. Methods: We analyzed risk-adjusted data for more than 3000 US hospitals from CMS Hospital Compare using linear regression. Results: We found that better patient experience was associated with favorable clinical outcomes. Specifically, a higher number of stars for patient experience had a statistically significant association with lower rates of many in-hospital complications. A higher patient experience star rating also had a statistically significant association with lower rates of unplanned readmissions to the hospital within 30 days. Conclusion: Better patient experience according to the CMS star ratings is associated with favorable clinical outcomes. These results support the inclusion of patient experience data in the framework of how hospitals are paid for services.

  14. Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model

    DEFF Research Database (Denmark)

    Mogensen, Christian Backer; Ankersen, Ejnar Skytte; Lindberg, Mats J

    2018-01-01

    . CONCLUSIONS: The GP based HaH model was more effective than the hospital specialist model in avoiding hospital admissions within 7 days among elderly patients with an acute medical condition with no differences in mental or physical recovery rates or deaths between the two models. REGISTRATION: No. NCT......BACKGROUND: Hospital at home (HaH) is an alternative to acute admission for elderly patients. It is unclear if should be cared for a primarily by a hospital intern specialist or by the patient's own general practitioner (GP). The study assessed whether a GP based model was more effective than...... Denmark, including + 65 years old patients with an acute medical condition that required acute hospital in-patient care. The patients were randomly assigned to hospital specialist based model or GP model of HaH care. Five physical and cognitive performance tests were performed at inclusion and after 7...

  15. Optimizing patient flow in a large hospital surgical centre by means of discrete-event computer simulation models.

    Science.gov (United States)

    Ferreira, Rodrigo B; Coelli, Fernando C; Pereira, Wagner C A; Almeida, Renan M V R

    2008-12-01

    This study used the discrete-events computer simulation methodology to model a large hospital surgical centre (SC), in order to analyse the impact of increases in the number of post-anaesthetic beds (PABs), of changes in surgical room scheduling strategies and of increases in surgery numbers. The used inputs were: number of surgeries per day, type of surgical room scheduling, anaesthesia and surgery duration, surgical teams' specialty and number of PABs, and the main outputs were: number of surgeries per day, surgical rooms' use rate and blocking rate, surgical teams' use rate, patients' blocking rate, surgery delays (minutes) and the occurrence of postponed surgeries. Two basic strategies were implemented: in the first strategy, the number of PABs was increased under two assumptions: (a) following the scheduling plan actually used by the hospital (the 'rigid' scheduling - surgical rooms were previously assigned and assignments could not be changed) and (b) following a 'flexible' scheduling (surgical rooms, when available, could be freely used by any surgical team). In the second, the same analysis was performed, increasing the number of patients (up to the system 'feasible maximum') but fixing the number of PABs, in order to evaluate the impact of the number of patients over surgery delays. It was observed that the introduction of a flexible scheduling/increase in PABs would lead to a significant improvement in the SC productivity.

  16. Determinants of hospital fall rate trajectory groups: a longitudinal assessment of nurse staffing and organizational characteristics.

    Science.gov (United States)

    Everhart, Damian; Schumacher, Jessica R; Duncan, R Paul; Hall, Allyson G; Neff, Donna F; Shorr, Ronald I

    2014-01-01

    Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time. The aim of this study was to determine whether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups. We conducted a 54-month (July 2006-December 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators (2007). We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression. A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95% confidence interval [CI] [0.85, 0.99]), Magnet status (OR = 0.49, 95% CI [0.35, 0.70]), and bed size greater than 300 beds (OR = 0.70, 95% CI [0.51, 0.94]) were significantly less likely to be categorized in the "consistently high" fall rate group. Over this 54-month period, hospitals were categorized into three groups based on long-term fall rates. Hospital-level factors differed among these three groups. This suggests that there may be hospitals in which "best practices" for fall prevention might be identified. In addition, administrators may be able

  17. Preventing drug-related adverse events following hospital discharge: the role of the pharmacist

    Directory of Open Access Journals (Sweden)

    Nicholls J

    2017-02-01

    Full Text Available Justine Nicholls,1 Craig MacKenzie,1 Rhiannon Braund2 1Dunedin Hospital Pharmacy, 2School of Pharmacy, University of Otago, Dunedin, New Zealand Abstract: Transition of care (ToC points, and in particular hospital admission and discharge, can be associated with an increased risk of adverse drug events (ADEs and other drug-related problems (DRPs. The growing recognition of the pharmacist as an expert in medication management, patient education and communication makes them well placed to intervene. There is evidence to indicate that the inclusion of pharmacists in the health care team at ToC points reduces ADEs and DRPs and improves patient outcomes. The objectives of this paper are to outline the following using current literature: 1 the increased risk of medication-related problems at ToC points; 2 to highlight some strategies that have been successful in reducing these problems; and 3 to illustrate how the role of the pharmacist across all facets of care can contribute to the reduction of ADEs, particularly for patients at ToC points. Keywords: pharmacist, adverse drug events, drug-related problems, transitions of care, hospital discharge

  18. Boarding is associated with higher rates of medication delays and adverse events but fewer laboratory-related delays.

    Science.gov (United States)

    Sri-On, Jiraporn; Chang, Yuchiao; Curley, David P; Camargo, Carlos A; Weissman, Joel S; Singer, Sara J; Liu, Shan W

    2014-09-01

    Hospital crowding and emergency department (ED) boarding are large and growing problems. To date, there has been a paucity of information regarding the quality of care received by patients boarding in the ED compared with the care received by patients on an inpatient unit. We compared the rate of delays and adverse events at the event level that occur while boarding in the ED vs while on an inpatient unit. This study was a secondary analysis of data from medical record review and administrative databases at 2 urban academic teaching hospitals from August 1, 2004, through January 31, 2005. We measured delayed repeat cardiac enzymes, delayed partial thromboplastin time level checks, delayed antibiotic administration, delayed administration of home medications, and adverse events. We compared the incidence of events during ED boarding vs while on an inpatient unit. Among 1431 patient medical records, we identified 1016 events. Emergency department boarding was associated with an increased risk of home medication delays (risk ratio [RR], 1.54; 95% confidence interval [CI], 1.26-1.88), delayed antibiotic administration (RR, 2.49; 95% CI, 1.72-3.52), and adverse events (RR, 2.36; 95% CI, 1.15-4.72). On the contrary, ED boarding was associated with fewer delays in repeat cardiac enzymes (RR, 0.17; 95% CI, 0.09-0.27) and delayed partial thromboplastin time checks (RR, 0.54; 95% CI, 0.27-0.96). Compared with inpatient units, ED boarding was associated with more medication-related delays and adverse events but fewer laboratory-related delays. Until we can eliminate ED boarding, it is critical to identify areas for improvement. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Hospital differences in rates of cesarean deliveries in the Sardinian region: An observational study

    Directory of Open Access Journals (Sweden)

    Massimo Cannas

    2014-11-01

    Full Text Available Background: The rates of cesarean deliveries have been increasing steadily in several European countries in recent decades, with Italy having the second-highest rate (38% in 2010, causing concern and debate about the appropriateness of many interventions. Moreover, some recent studies suggest that rates of common obstetric interventions are not homogeneous across hospitals, maybe not only because of patient case mix but also possibly because of different hospital practices and cultures. Thus, it is important to investigate whether the variation in rates of cesarean sections can be traced back to patient characteristics or whether it depends upon context variables at the hospital level. Objective and method: Using official hospital abstracts on deliveries that occurred in Sardinia over a two-year period, we implement multilevel logistic regression models in order to assess whether the observed differences in cesarean rates across hospitals can be justified by case-mix differences across hospitals. Results: The between-hospital variation in rates of cesarean delivery is estimated to be 0.388 in the model with only the intercept and 0.382 in the model controlling for the mother’s clinical and sociodemographic characteristics. Conclusions: The results show that taking into account the individual characteristics of delivered mothers is not enough to justify the observed variation across hospital rates, suggesting the important role of unobserved variables at the hospital level in determining cesarean section rates.

  20. Study rates U.S. hospitals vs. other nations, industries.

    Science.gov (United States)

    Burda, D

    1991-10-07

    American hospitals generally are further along with their total quality management programs than their Canadian counterparts but lag behind companies in other U.S. industries, according to a comprehensive international study that examined four industries--healthcare, automotive, banking and computer--in four countries--the United States, Canada, Germany and Japan.

  1. Choosing Appropriate Theories for Understanding Hospital Reporting of Adverse Drug Events, a Theoretical Domains Framework Approach.

    Science.gov (United States)

    Shalviri, Gloria; Yazdizadeh, Bahareh; Mirbaha, Fariba; Gholami, Kheirollah; Majdzadeh, Reza

    2018-01-01

    Adverse drug events (ADEs) may cause serious injuries including death. Spontaneous reporting of ADEs plays a great role in detection and prevention of them; however, underreporting always exists. Although several interventions have been utilized to solve this problem, they are mainly based on experience and the rationale for choosing them has no theoretical base. The vast variety of behavioural theories makes it difficult to choose appropriate theory. Theoretical domains framework (TDF) is suggested as a solution. The objective of this study was to select the best theory for evaluating ADE reporting in hospitals based on TDF. We carried out three focus group discussions with hospital pharmacists and nurses, based on TDF questions. The analysis was performed through five steps including coding discussions transcript, extracting beliefs, selecting relevant domains, matching related constructs to the extracted beliefs, and determining the appropriate theories in each domain. The theory with the highest number of matched domains and constructs was selected as the theory of choice. A total of six domains were identified relevant to ADE reporting, including "Knowledge", "Skills", "Beliefs about consequences", "Motivation and goals", "Environmental context and resources" and "Social influences". We found theory of planned behavior as the comprehensive theory to study factors influencing ADE reporting in hospitals, since it was relevant theory in five out of six relevant domains and the common theory in 55 out of 75 identified beliefs. In conclusion, we suggest theory of planned behavior for further studies on designing appropriate interventions to increase ADE reporting in hospitals.

  2. The impact of HMO penetration on the rate of hospital cost inflation, 1985-1993.

    Science.gov (United States)

    Gaskin, D J; Hadley, J

    1997-01-01

    This paper provides evidence that growth in health maintenance organization (HMO) enrollment slows hospital cost inflation. During the period 1985-1993, hospitals in areas with high rates of HMO penetration and growth had a slower rate of growth in expenses (8.3%) than hospitals in low penetration areas (11.2%). From 1992-1993, HMO growth lowered the rate of hospital cost inflation by .34 to 3.40 percentage points, depending on the base-year level and the annual change in HMO penetration. Declines in Medicare Prospective Payment System (PPS) margins also lowered hospital cost inflation; over the time period, annual hospital cost inflation was reduced by .38 percentage points. The estimates imply that the cumulative effect of HMO growth on hospital costs has been a $56.2 billion reduction (in 1993 dollars).

  3. The Relationship between Place of Residence and Hospitalization Rate in the Biggest Referral Hospital of the Northwest according to Hospitalization Wards

    Directory of Open Access Journals (Sweden)

    Amin Talebpour

    2016-06-01

    Full Text Available ​ Background and objectives: In accordance with the global pattern, the urban population in Iran is higher than the rural population. But, are the statistics of using hospitalization services in public hospitals in these two categories similar to this pattern? This study seeks to determine the effect of place of residence on hospitalization rate by examining annual hospitalization statistics of the country’s biggest referral hospital in the northwest. Material and Methods: The method used in this study is cross-sectional and all cases of hospitalization in Imam Reza Hospital as the northwest’s biggest referral hospital were picked by available sampling method. The cases of 30260 hospitalized patients were examined through direct observation and items extracted from their files were recorded in the checklist. In order to determine the relations between the variables, K2 test was applied and the P-value was considered less than 0.05 The obtained data were analyzed by SPSS.16 software. Results: Results indicated that the frequency distribution of patients in terms of their urban or rural residence did not yield any significant difference (P>0/05. Results also showed that the highest hospitalization rate for urban patients was 16.1% (3305 individuals in surgery ward while it was 14.2% (1384 individuals for rural patients in orthopedic ward. The least significant statistical difference between urban and rural hospitalization rates was observed in renal ward with 72.9% (1162 individual urban patients and 27.1% (432 individuals rural patients of total patients hospitalized in this ward. The most significant statistical difference between urban and rural hospitalization rates was observed in ICU with 44.9% (297 individuals urban patients and 55.1% (365 individuals rural patients of the total patients hospitalized in this ward. Conclusion: A relative comparison among illnesses in urban and rural populations, aside from illnesses caused by trauma

  4. Efficacy of a hospital-wide environmental cleaning protocol on hospital-acquired methicillin-resistant Staphylococcus aureus rates.

    Science.gov (United States)

    Watson, Paul Andrew; Watson, Luke Robert; Torress-Cook, Alfonso

    2016-07-01

    Environmental contamination has been associated with over half of methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in hospitals. We explored if a hospital-wide environmental and patient cleaning protocol would lower hospital acquired MRSA rates and associated costs. This study evaluates the impact of implementing a hospital-wide environmental and patient cleaning protocol on the rate of MRSA infection and the potential cost benefit of the intervention. A retrospective, pre-post interventional study design was used. The intervention comprised a combination of enhanced environmental cleaning of high touch surfaces, daily washing of patients with benzalkonium chloride, and targeted isolation of patients with active infection. The rate of MRSA infection per 1000 patient days (PD) was compared with the rate after the intervention (Steiros Algorithm ® ) was implemented. A cost-benefit analysis based on the number of MRSA infections avoided was conducted. The MRSA rates decreased by 96% from 3.04 per 1000 PD to 0.11 per 1000 PD ( P reduction in MRSA infections, avoided an estimated $1,655,143 in healthcare costs. Implementation of this hospital-wide protocol appears to be associated with a reduction in the rate of MRSA infection and therefore a reduction in associated healthcare costs.

  5. Initiating Event Rates at U.S. Nuclear Power Plants. 1988 - 2013

    International Nuclear Information System (INIS)

    Schroeder, John A.; Bower, Gordon R.

    2014-01-01

    Analyzing initiating event rates is important because it indicates performance among plants and also provides inputs to several U.S. Nuclear Regulatory Commission (NRC) risk-informed regulatory activities. This report presents an analysis of initiating event frequencies at U.S. commercial nuclear power plants since each plant's low-power license date. The evaluation is based on the operating experience from fiscal year 1988 through 2013 as reported in licensee event reports. Engineers with nuclear power plant experience staff reviewed each event report since the last update to this report for the presence of valid scrams or reactor trips at power. To be included in the study, an event had to meet all of the following criteria: includes an unplanned reactor trip (not a scheduled reactor trip on the daily operations schedule), sequence of events starts when reactor is critical and at or above the point of adding heat, occurs at a U.S. commercial nuclear power plant (excluding Fort St. Vrain and LaCrosse), and is reported by a licensee event report. This report displays occurrence rates (baseline frequencies) for the categories of initiating events that contribute to the NRC's Industry Trends Program. Sixteen initiating event groupings are trended and displayed. Initiators are plotted separately for initiating events with different occurrence rates for boiling water reactors and pressurized water reactors. p-values are given for the possible presence of a trend over the most recent 10 years.

  6. A Comprehensive Program to Reduce Rates of Hospital-Acquired Pressure Ulcers in a System of Community Hospitals.

    Science.gov (United States)

    Englebright, Jane; Westcott, Ruth; McManus, Kathryn; Kleja, Kacie; Helm, Colleen; Korwek, Kimberly M; Perlin, Jonathan B

    2018-03-01

    The prevention of hospital-acquired pressure ulcers (PrUs) has significant consequences for patient outcomes and the cost of care. Providers are challenged with evaluating available evidence and best practices, then implementing programs and motivating change in various facility environments. In a large system of community hospitals, the Reducing Hospital Acquired-PrUs Program was developed to provide a toolkit of best practices, timely and appropriate data for focusing efforts, and continuous implementation support. Baseline data on PrU rates helped focus efforts on the most vulnerable patients and care situations. Facilities were empowered to use and adapt available resources to meet local needs and to share best practices for implementation across the system. Outcomes were measured by the rate of hospital-acquired PrUs, as gathered from patient discharge records. The rate of hospital-acquired stage III and IV PrUs decreased 66.3% between 2011 and 2013. Of the 149 participating facilities, 40 (27%) had zero hospital-acquired stage III and IV PrUs and 77 (52%) had a reduction in their PrU rate. Rates of all PrUs documented as present on admission did not change during this period. A comparison of different strategies used by the most successful facilities illustrated the necessity of facility-level flexibility and recognition of local workflows and patient demographics. Driven by the combination of a repository of evidence-based tools and best practices, readily available data on PrU rates, and local flexibility with processes, the Reducing Hospital Acquired-PrUs Program represents the successful operationalization of improvement in a wide variety of facilities.

  7. Notifications of hospital events to outpatient clinicians using health information exchange: a post-implementation survey

    Directory of Open Access Journals (Sweden)

    Richard Altman

    2013-09-01

    Full Text Available Background The trend towards hospitalist medicine can lead to disjointed patient care. Outpatient clinicians may be unaware of patients’ encounters with a disparate healthcare system. Electronic notifications to outpatient clinicians of patients’ emergency department (ED visits and inpatient admissions and discharges using health information exchange can inform outpatient clinicians of patients’ hospital-based events.Objective Assess outpatient clinicians’ impressions of a new, secure messaging-based, patient event notification system.Methods Twenty outpatient clinicians receiving notifications of hospital-based events were recruited and 14 agreed to participate. Using a semi-structured interview, clinicians were asked about their use of notifications and the impact on their practices.Results Nine of 14 interviewed clinicians (64% thought that without notifications, they would have heard about fewer than 10% of ED visits before the patient’s next visit. Nine clinicians (64% thought that without notifications, they would have heard about fewer than 25% of inpatient admissions and discharges before the patient’s next visit. Six clinicians (43% reported that they call the inpatient team more often because of notifications. Eight users (57% thought that notifications improved patient safety by increasing their awareness of the patients’ clinical events and their medication changes. Key themes identified were the importance of workflow integration and a desire for more clinical information in notifications.Conclusions The notification system is perceived by clinicians to be of value. These findings should instigate further message-oriented use of health information exchange and point to refinements that can lead to even greater benefits.

  8. Cardiovascular events and hospital resource utilization pre- and post-transcatheter mitral valve repair in high-surgical risk patients.

    Science.gov (United States)

    Vemulapalli, Sreekanth; Lippmann, Steven J; Krucoff, Mitchell; Hernandez, Adrian F; Curtis, Lesley H; Foster, Elyse; Qasim, Atif; Wang, Andrew; Glower, Donald D; Feldman, Ted; Hammill, Bradley G

    2017-07-01

    MitraClip is an approved therapy for mitral regurgitation (MR); however, health care resource utilization pre- and post-MitraClip remains understudied. Patients with functional and degenerative MR at high surgical risk in the EVEREST II High-Risk Registry and REALISM Continued-Access Study were linked to Medicare data. Pre- and post-MitraClip all-cause death, stroke, myocardial infarction, heart failure (HF), and bleeding hospitalizations were identified. Inpatient costs, adjusted to 2010 US dollars, were calculated, and event rate ratios and cost ratios were estimated with multivariable modeling. Among 403 linked patients, the mean age was 80 years, 60% were male, mean baseline left ventricular ejection fraction was 49.6%, 83.3% were New York Heart Association class III/IV, 78.2% were MR grade 3+/4+, and 63.3% had functional MR. All-cause hospitalization decreased from 1,854 to 1,435/1,000 person-years (Pproviders seeking to reduce HF hospitalizations and associated Medicare costs may consider MitraClip among appropriate patients likely to survive 1 year. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Cost-effectiveness of omega-3 fatty acid supplements in parenteral nutrition therapy in hospitals: a discrete event simulation model.

    Science.gov (United States)

    Pradelli, Lorenzo; Eandi, Mario; Povero, Massimiliano; Mayer, Konstantin; Muscaritoli, Maurizio; Heller, Axel R; Fries-Schaffner, Eva

    2014-10-01

    A recent meta-analysis showed that supplementation of omega-3 fatty acids in parenteral nutrition (PN) regimens is associated with a statistically and clinically significant reduction in infection rate, and length of hospital stay (LOS) in medical and surgical patients admitted to the ICU and in surgical patients not admitted to the ICU. The objective of this present study was to evaluate the cost-effectiveness of the addition of omega-3 fatty acids to standard PN regimens in four European countries (Italy, France, Germany and the UK) from the healthcare provider perspective. Using a discrete event simulation scheme, a patient-level simulation model was developed, based on outcomes from the Italian ICU patient population and published literature. Comparative efficacy data for PN regimens containing omega-3 fatty acids versus standard PN regimens was taken from the meta-analysis of published randomised clinical trials (n = 23 studies with a total of 1502 patients), and hospital LOS reduction was further processed in order to split the reduction in ICU stay from that in-ward stays for patients admitted to the ICU. Country-specific cost data was obtained for Italian, French, German and UK healthcare systems. Clinical outcomes included in the model were death rates, nosocomial infection rates, and ICU/hospital LOS. Probabilistic and deterministic sensitivity analyses were undertaken to test the reliability of results. PN regimens containing omega-3 fatty acids were more effective on average than standard PN both in ICU and in non-ICU patients in the four countries considered, reducing infection rates and overall LOS, and resulting in a lower total cost per patient. Overall costs for patients receiving PN regimens containing omega-3 fatty acids were between €14 144 to €19 825 per ICU patient and €5484 to €14 232 per non-ICU patient, translating into savings of between €3972 and €4897 per ICU patient and savings of between €561 and €1762 per non

  10. "Against the silence": Development and first results of a patient survey to assess experiences of safety-related events in hospital

    Directory of Open Access Journals (Sweden)

    Schwappach David LB

    2008-03-01

    Full Text Available Abstract Background Involvement of patients in the detection and prevention of safety related events and medical errors have been widely recommended. However, it has also been questioned whether patients at large are willing and able to identify safety-related events in their care. The aim of this study was to develop and pilot test a brief patient safety survey applicable to inpatient care in Swiss hospitals. Methods A survey instrument was developed in an iterative procedure. The instrument asks patients to report whether they have experienced specific undesirable events during their hospital stay. The preliminary version was developed together with experts and tested in focus groups with patients. The adapted survey instrument was pilot-tested in random samples of patients of two Swiss hospitals (n = 400. Responders to the survey that had reported experience of any incident were sampled for qualitative interviews (n = 18. Based on the interview, the researcher classified the reported incidents as confirmed or discarded. Results The survey was generally well accepted in the focus groups and interviews. In the quantitative pilot test, 125 patients returned the survey (response rate: 31%. The mean age of responders was 55 years (range 17–91, SD 18 years and 62.5% were female. The 125 participating patients reported 94 "definitive" and 34 "uncertain" events. 14% of the patients rated any of the experienced events as "serious". The definitive and uncertain events reported with highest frequency were phlebitis, missing hand hygiene, allergic drug reaction, unavailability of documents, and infection. 23% of patients reported some or serious concerns about their safety. The qualitative interviews indicate that both, the extent of patients' uncertainty in the classification of events and the likelihood of confirmation by the interviewer vary very much by type of incident. Unexpectedly, many patients reported problems and incidents related to food

  11. Organization of pulse-height analysis programs for high event rates

    Energy Technology Data Exchange (ETDEWEB)

    Cohn, C E [Argonne National Lab., Ill. (USA)

    1976-09-01

    The ability of a pulse-height analysis program to handle high event rates can be enhanced by organizing it so as to minimize the time spent in interrupt housekeeping. Specifically, the routine that services the data-ready interrupt from the ADC should test whether another event is ready before performing the interrupt return.

  12. Using Rapid Improvement Events for Disaster After-Action Reviews: Experience in a Hospital Information Technology Outage and Response.

    Science.gov (United States)

    Little, Charles M; McStay, Christopher; Oeth, Justin; Koehler, April; Bookman, Kelly

    2018-02-01

    The use of after-action reviews (AARs) following major emergency events, such as a disaster, is common and mandated for hospitals and similar organizations. There is a recurrent challenge of identified problems not being resolved and repeated in subsequent events. A process improvement technique called a rapid improvement event (RIE) was used to conduct an AAR following a complete information technology (IT) outage at a large urban hospital. Using RIE methodology to conduct the AAR allowed for the rapid development and implementation of major process improvements to prepare for future IT downtime events. Thus, process improvement methodology, particularly the RIE, is suited for conducting AARs following disasters and holds promise for improving outcomes in emergency management. Little CM , McStay C , Oeth J , Koehler A , Bookman K . Using rapid improvement events for disaster after-action reviews: experience in a hospital information technology outage and response. Prehosp Disaster Med. 2018;33(1):98-100.

  13. Impact of hyperglycemia on morbidity and mortality, length of hospitalization and rates of re-hospitalization in a general hospital setting in Brazil

    Directory of Open Access Journals (Sweden)

    Leite Silmara AO

    2010-07-01

    Full Text Available Abstract Background Hyperglycemia in hospitalized patients is known to be related to a higher incidence of clinical and surgical complications and poorer outcomes. Adequate glycemic control and earlier diagnosis of type 2 diabetes during hospitalization are cost-effective measures. Methods This prospective cohort study was designed to determine the impact of hyperglycemia on morbidity and mortality in a general hospital setting during a 3-month period by reviewing patients' records. The primary purposes of this trial were to verify that hyperglycemia was diagnosed properly and sufficiently early and that it was managed during the hospital stay; we also aimed to evaluate the relationship between in-hospital hyperglycemia control and outcomes such as complications during the hospital stay, extent of hospitalization, frequency of re-hospitalization, death rates and number of days in the ICU (Intensive Care Unit after admission. Statistical analyses utilized the Kruskall-Wallis complemented by the "a posteriori" d.m.s. test, Spearman correlation and Chi-squared test, with a level of significance of 5% (p Results We reviewed 779 patient records that fulfilled inclusion criteria. The patients were divided into 5 groups: group (1 diabetic with normal glycemic levels according to American Diabetes Association criteria for in-hospital patients (n = 123; group (2 diabetics with hyperglycemia (n = 76; group (3 non-diabetics with hyperglycemia (n = 225; group (4diabetics and non-diabetics with persistent hyperglycemia during 3 consecutive days (n = 57 and group (5 those with normal glucose control (n = 298. Compared to patients in groups 1 and 5, patients in groups 2, 3 and 4 had significantly higher mortality rates (17.7% vs. 2.8% and Intensive Care Unit admissions with complications (23.3% vs. 4.5%. Patients in group 4 had the longest hospitalizations (mean 15.5 days, and group 5 had the lowest re-hospitalization rate (mean of 1.28 hospitalizations. Only

  14. Hospitality and Inclusion Logistics of a Spotlight Event: An Insiders Look at the 2016 DNC in Philadelphia

    Directory of Open Access Journals (Sweden)

    Leora Halpern Lanz

    2016-10-01

    Full Text Available The 2016 Democratic National Convention held in Philadelphia, Pennsylvania prioritized hospitality efforts and incorporated inclusion and diversity as its theme. These strategies helped to create a successful spotlight event, benefiting the city of Philadelphia and its hospitality industry.

  15. National trends in heart failure hospitalization rates in Slovenia 2004-2012.

    Science.gov (United States)

    Omersa, Daniel; Farkas, Jerneja; Erzen, Ivan; Lainscak, Mitja

    2016-11-01

    Heart failure (HF) hospitalization rates are decreasing in western Europe, but little is known about trends in central and east European countries. We analysed the Slovenian national hospitalization database to determine the burden of HF hospitalization. The Slovenian National Hospital Discharge Registry was searched for HF hospitalizations between 2004 and 2012 in patients aged ≥20 years. A total of 55 531 main HF hospitalizations (43 636 first HF hospitalizations) in 34 406 patients (median age 78 years, 55% female) were recorded. The most common co-morbidities were arterial hypertension (54.3%), atrial fibrillation (40.6%), diabetes mellitus (24.5%), and ischaemic heart disease (21.9%). The number of age-standardized main and first HF hospitalizations per 100 000 population decreased from 249 to 232 (7.1%, P = 0.002) and from 467 to 435 (6.8%, P = 0.074), respectively. Crude main and first HF hospitalization rates increased from 249 to 298 (19.8%, P Slovenia, standardized HF hospitalization rates have decreased but the crude HF hospitalization burden has increased. Readmissions were associated with established cardiovascular risk factors. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

  16. [Caesarean section in german hospitals: validity of hospital quality report data for monitoring C-section rates].

    Science.gov (United States)

    Junghänel, K; Renz-Polster, H; Jarczok, M N; Hornemann, A; Böhler, T; De Bock, F

    2015-04-01

    It is not known if "hospital quality reports" (HQR) document Caesarean (C-) section rates at the hospital level accurately enough for use as a reliable data source when it comes to explaining regional variations of C-sections in Germany by factors at the hospital level. We aimed to answer this question using HQR from hospitals in Baden-Württemberg as data source. Diagnostic and procedure codes from HQR for the year 2008 (HQRdata), were used to calculate numbers of births, numbers of C-sections, and rates of births by C-section (CSR) for 94 of 97 hospitals in Baden-Württemberg. These numbers were compared to internal hospital (IH) data delivered upon request by 80 of 97 hospitals and stemming from vital statistics, birth registry forms, or external quality assurance datasets. There was no difference in the number of births between HQR data and IH data, but the number of C-sections and the CSR differed significantly (pCSR calculated using HQR data was 4.9 ± 17.9% higher than CSR from IH data (absolute difference 1.5 ± 5.8%). The correlation between the 2 data sources was moderate (r=0.73). Only 55% of the variance in IH data-based CSR was explained by HQR data. The proportion between highest and lowest CSR in hospitals in Baden-Württemberg was 4.9 for HQR data and 3.6 for IH data. There are significant and relevant differences between C-section rates based on ei-ther HQR or IH data. This questions routine data from HQR for 2008 as a reliable data source for research work. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Medical emergencies in the imaging department of a university hospital: event and imaging characteristics.

    Science.gov (United States)

    van Tonder, F C; Sutherland, T; Smith, R J; Chock, J M E; Santamaria, J D

    2013-01-01

    We aimed to describe the characteristics of medical emergencies that occurred in the medical imaging department (MID) of a university hospital in Melbourne, Australia. A database of 'Respond Medical Emergency Team (MET)' and 'Respond Blue' calls was retrospectively examined for the period June 2003 to November 2010 in relation to events that occurred in the MID. The hospital medical imaging database was also examined in relation to these events and, where necessary, patients' notes were reviewed. Ethics approval was granted by the hospital ethics review board. There were 124 medical emergency calls in the MID during the study period, 28% Respond Blue and 72% Respond MET. Of these 124 calls, 26% occurred outside of usual work hours and 12% involved cardiac arrest. The most common reasons for the emergency calls were seizures (14%) and altered conscious state (13%). Contrast anaphylaxis precipitated the emergency in 4% of cases. In 83% of cases the emergency calls were for patients attending the MID for diagnostic imaging, the remainder being for a procedure. Of the scheduled imaging techniques, 45% were for computed tomography. The scheduled imaging was abandoned due to the emergency in 12% of cases. When performed, imaging informed patient management in 34% of cases in diagnostic imaging and in all cases in the context of image-guided procedures. Medical emergency calls in the MID often occurred outside usual work hours and were attributed to a range of medical problems. The emergencies occurred in relation to all imaging techniques and imaging informed patient management in many cases. Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.

  18. High Variability in Nosocomial Clostridium difficile Infection Rates Across Hospitals After Colorectal Resection.

    Science.gov (United States)

    Aquina, Christopher T; Probst, Christian P; Becerra, Adan Z; Hensley, Bradley J; Iannuzzi, James C; Noyes, Katia; Monson, John R T; Fleming, Fergal J

    2016-04-01

    Hospital-acquired Clostridium difficile infection is associated with adverse patient outcomes and high medical costs. The incidence and severity of C. difficile has been rising in both medical and surgical patients. Our aim was to assess risk factors and variation associated with the development of nosocomial C. difficile colitis among patients undergoing colorectal resection. This was a retrospective cohort study. The study included segmental colectomy and proctectomy cases in New York State from 2005 to 2013. The study cohort included 150,878 colorectal resections. Patients with a documented previous history of C. difficile infection or residence outside of New York State were excluded. A diagnosis of C. difficile colitis either during the index hospital stay or on readmission within 30 days was the main measure. C. difficile colitis occurred in 3323 patients (2.2%). Unadjusted C. difficile colitis rates ranged from 0% to 11.3% among surgeons and 0% to 6.8% among hospitals. After controlling for patient, surgeon, and hospital characteristics using mixed-effects multivariable analysis, significant unexplained variation in C. difficile rates remained present across hospitals but not surgeons. Patient factors explained only 24% of the total hospital-level variation, and known surgeon and hospital-level characteristics explained an additional 8% of the total hospital-level variation. Therefore, ≈70% of the hospital variation in C. difficile infection rates remained unexplained by captured patient, surgeon, and hospital factors. Furthermore, there was an ≈5-fold difference in adjusted C. difficile rates across hospitals. A limited set of hospital and surgeon characteristics was available. Colorectal surgery patients appear to be at high risk for C. difficile infection, and alarming variation in nosocomial C. difficile infection rates currently exists among hospitals after colorectal resection. Given the high morbidity and cost associated with C. difficile colitis

  19. In Hospital Stroke Mortality: Rates and Determinants in Southwestern Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Adel A. Alhazzani

    2018-05-01

    Full Text Available Objectives: The present study analyzed in-hospital first-time stroke mortality in southwestern Saudi Arabia over one-year to assess the in-hospital stroke case fatality rate, mortality rate and explore the factors associated with in-hospital stroke mortality. Study Design: Hospital based follow-up study. Methods: First-time stroke patients admitted to all hospitals in Asser region over one-year period (January through December 2016 were included in the study. Data about personal characteristics, pre-stroke history and clinical criteria, on admission clinical criteria, in-hospital complications and survival status were collected. The last reported Aseer region population was used to calculate age and sex stroke mortality rate per 100,000 population/year. Hazard ratios (HR and concomitant 95% confidence intervals (95% CI were computed using multivariate Cox regression survival analysis. Kaplan-Meier curve survival analysis for stroke patients were plotted. Results: A total of 121 in-hospital deaths out of 1249 first-time stroke patients giving an overall case fatality rate (CFR of 9.7%. Non-significant difference with gender and age were observed in CFR. Overall, in-hospital stroke mortality rate was 5.58 per 100,000/year. Males and elders showed a significantly higher mortality rates. Multivariable Cox regression analyses revealed pre-stroke smoking (HR = 2.36, pre-stroke hypertension (HR = 1.77, post-stroke disturbed consciousness (HR = 6.86, poor mobility (HR = 2.60 and developing pulmonary embolism (HR = 2.63 as significant predictors of in-hospital stroke mortality. Conclusions: In Southwestern Saudi Arabia, the in-hospital stroke mortality rate is higher in men and increases with aging. The prognosis of acute stroke could be improved by smoking cessation, better control of hypertension and prevention of in hospital complication particularly pulmonary embolism.

  20. Venous thrombotic events in hospitalized children and adolescents with inflammatory bowel disease.

    Science.gov (United States)

    Nylund, Cade M; Goudie, Anthony; Garza, Jose M; Crouch, Gary; Denson, Lee A

    2013-05-01

    Adults with inflammatory bowel disease (IBD) have an increased risk of venous thrombotic events (TEs). We sought to evaluate the risk for TE in children and adolescents with IBD using a large population database. The triennial Healthcare Cost and Utilization Project Kids' Inpatient Database was used in a retrospective cohort study of hospitalized children in the United States across 1997, 2000, 2003, 2006, and 2009. Billing codes were used to identify discharges with Crohn disease, ulcerative colitis, pulmonary embolism, deep vein thrombosis, thrombophlebitis, thrombosis of intracranial venous sinus, Budd-Chiari syndrome, and portal vein thrombosis. A logistic regression model was fitted to quantify the increased risk of TE in children with IBD, while adjusting for other risk factors of thrombosis. The total weighted number of pediatric discharges was 7,448,292, and 68,394 (0.92%) were identified with IBD. The incidence of any TE in a hospitalized child or adolescent with IBD was 117.9/10,000 with a relative risk (95% confidence interval) of 2.36 (2.15-2.58). The adjusted odds ratio for any TE in a patient with IBD without surgery was 1.22 (1.08-1.36). Risk factors for TE among patients with IBD include older age, central venous catheter, parenteral nutrition, and an identified hypercoagulable condition. There is an increasing trend of TE in both the IBD and non-IBD patients. Hospitalized children and adolescents with IBD are at increased risk for TE. Conservative methods of TE prevention including hydration, mobilization, or pneumatic devices should be considered in hospitalized patients with IBD.

  1. High survival rates and associated factors among ebola virus disease patients hospitalized at donka national hospital, conakry, Guinea.

    Science.gov (United States)

    Qureshi, Adnan I; Chughtai, Morad; Bah, Elhadj Ibrahima; Barry, Moumié; Béavogui, Kézély; Loua, Tokpagnan Oscar; Malik, Ahmed A

    2015-02-01

    Anecdotal reports suggesting that survival rates among hospitalized patients with Ebola virus disease in Guinea are higher than the 29.2% rate observed in the current epidemic in West Africa. Survival after symptom onset was determined using Kaplan Meier survival methods among patients with confirmed Ebola virus disease treated in Conakry, Guinea from March 25, 2014, to August 5, 2014. We analyzed the relationship between survival and patient factors, including demographics and clinical features. Of the 70 patients analyzed [mean age ± standard deviation (SD), 34 ± 14.1; 44 were men], 42 were discharged alive with a survival rate among hospitalized patients of 60% (95% confidence interval, 41.5-78.5%). The survival rate was 28 (71.8%) among 39 patients under 34 years of age, and 14 (46.7%) among 30 patients aged 35 years or greater (p = 0.034). The rates of myalgia (3 of 42 versus 7 of 28, p = 0.036) and hiccups (1 of 42 versus 5 of 28, p = 0.023) were significantly lower among patients who survived. Our results provide insights into a cohort of hospitalized patients with Ebola virus disease in whom survival is prominently higher than seen in other cohorts of hospitalized patients.

  2. A Bayes linear Bayes method for estimation of correlated event rates.

    Science.gov (United States)

    Quigley, John; Wilson, Kevin J; Walls, Lesley; Bedford, Tim

    2013-12-01

    Typically, full Bayesian estimation of correlated event rates can be computationally challenging since estimators are intractable. When estimation of event rates represents one activity within a larger modeling process, there is an incentive to develop more efficient inference than provided by a full Bayesian model. We develop a new subjective inference method for correlated event rates based on a Bayes linear Bayes model under the assumption that events are generated from a homogeneous Poisson process. To reduce the elicitation burden we introduce homogenization factors to the model and, as an alternative to a subjective prior, an empirical method using the method of moments is developed. Inference under the new method is compared against estimates obtained under a full Bayesian model, which takes a multivariate gamma prior, where the predictive and posterior distributions are derived in terms of well-known functions. The mathematical properties of both models are presented. A simulation study shows that the Bayes linear Bayes inference method and the full Bayesian model provide equally reliable estimates. An illustrative example, motivated by a problem of estimating correlated event rates across different users in a simple supply chain, shows how ignoring the correlation leads to biased estimation of event rates. © 2013 Society for Risk Analysis.

  3. Reduced in-hospital survival rates of out-of-hospital cardiac arrest victims with obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Blom, M T; Warnier, M J; Bardai, A

    2013-01-01

    ) had comparable survival to ER (75% vs. 78%, OR 0.9 [95% CI: 0.6-1.3]) and to hospital admission (56% vs. 57%, OR 1.0 [0.7-1.4]). However, survival to hospital discharge was significantly lower among OPD patients (21% vs. 33%, OR 0.6 [0.4-0.9]). Multivariate regression analysis among patients who were...... with obstructive pulmonary disease (OPD) have a lower survival rate after OHCA than non-OPD patients. METHODS: We performed a community-based cohort study of 1172 patients with non-traumatic OHCA with ECG-documented VT/VF between 2005 and 2008. We compared survival to emergency room (ER), to hospital admission...... admitted to hospital (OPD: n=100, no OPD: n=561) revealed that OPD was an independent determinant of reduced 30-day survival rate (39% vs. 59%, adjusted OR 0.6 [0.4-1.0, p=0.035]). CONCLUSION: OPD-patients had lower survival rates after OHCA than non-OPD patients. Survival to ER and to hospital admission...

  4. Changing trends in hospitalization rates associated with psychosis: Spain, 1980-2009.

    Science.gov (United States)

    Medel-Herrero, Alvaro; Amate, J M; Saz-Parkinson, Z; Gómez-Beneyto, M

    2015-12-01

    To analyze the prevalence of hospitalization attributable to psychosis in Spain over the last three decades. Longitudinal analysis (1980-2009) of age-adjusted hospital discharges rates associated with psychosis (ICD9 290-8) in all Spanish hospitals. Spanish Hospital Morbidity Survey. The hospitalization rate associated with psychotic episodes had been gradually increasing since 1980 until 2004; an abrupt turnaround observed in 2004 marks the beginning of a steady decline in the rate. The turning point described is not observed for each of the psychotic diagnoses separately analyzed. However, it is clearly seen when data are grouped in diagnosis-related groups (organic-psychosis, functional psychosis and substance-induced psychosis) since the time course of the diseases within the major diagnostic groups are interrelated as evidenced by shared turning points which collectively display a common time course pattern. Main hospital indicators and antipsychotic drug prescriptions were analyzed for any possible turning point in mid-2000s. Psychiatric hospital beds and length of stays remained stable by 2004; the hospitalizations associated with non-psychotic psychiatric pathologies show no turning point in 2004. However, an abrupt change on antipsychotic drug prescriptions is precisely observed in 2004. After decades of linear growth, hospitalizations for psychotic patients begin to decline in 2004, coinciding with the start of last generation atypical antipsychotic drug consumption in Spain. Some of the psychotic diagnostic rates evolve in an interrelated manner which calls into question the diagnosis and nosological boundaries between some of these pathologies.

  5. Trends in Hospitalization Rates and Outcomes of Endocarditis among Medicare Beneficiaries

    Science.gov (United States)

    Bikdeli, Behnood; Wang, Yun; Kim, Nancy; Desai, Mayur M.; Quagliarello, Vincent; Krumholz, Harlan M.

    2015-01-01

    Objectives To determine the hospitalization rates and outcomes of endocarditis among older adults. Background Endocarditis is the most serious cardiovascular infection and is especially common among older adults. Little is known about recent trends for endocarditis hospitalizations and outcomes. Methods Using Medicare inpatient Standard Analytic Files, we identified all Fee-For-Service beneficiaries aged ≥65 years with a principal or secondary diagnosis of endocarditis from 1999-2010. We used Medicare Denominator Files to report hospitalizations per 100,000 person-years. Rates of 30-day and 1-year mortality were calculated using Vital Status Files. We used mixed-effects models to calculate adjusted rates of hospitalization and mortality and to compare the results before and after 2007, when the American Heart Association revised recommendations for endocarditis prophylaxis. Results Overall, 262,658 beneficiaries were hospitalized with endocarditis. The adjusted hospitalization rate increased from 1999-2005, reaching 83.5 per 100,000 person-years in 2005, and declined during 2006-2007. After 2007, the decline continued, reaching 70.6 per 100,000 person-years in 2010. Adjusted 30-day and 1-year mortality rates ranged from 14.2% to 16.5% and from 32.6% to 36.2%, respectively. There were no consistent changes in adjusted rates of 30-day and 1-year mortality after 2007. Trends in rates of hospitalization and outcomes were consistent across demographic subgroups. Adjusted rates of hospitalization and mortality declined consistently in the subgroup with principal diagnosis of endocarditis. Conclusions Our study highlights the high burden of endocarditis among older adults. We did not observe an increase in adjusted rates of hospitalization or mortality associated with endocarditis after publication of the 2007 guidelines. PMID:23994421

  6. Cecal Intubation Rate During Colonoscopy at a Tertiary Hospital in ...

    African Journals Online (AJOL)

    2016-06-14

    Jun 14, 2016 ... diseases, and for colorectal cancer screening program. Complete colonoscopy is therefore crucial for the success of any screening program. One important measure of the quality of colonoscopy is the cecal intubation rate (CIR). Aim: This was to assess the CIR at our endoscopy unit and evaluate the factors ...

  7. Cecal intubation rate during colonoscopy at a tertiary hospital in ...

    African Journals Online (AJOL)

    Background: Colonoscopy is useful in the diagnosis, treatment of colorectal diseases, and for colorectal cancer screening program. Complete colonoscopy is therefore crucial for the success of any screening program. One important measure of the quality of colonoscopy is the cecal intubation rate (CIR). Aim: This was to ...

  8. Hospitalization Rate and Population-Based Incidence of Hospitalization for Community-Acquired Pneumonia Among Children in Suzhou, China.

    Science.gov (United States)

    Shan, Wei; Shi, Ting; Zhang, Xiyan; Xue, Jian; Wang, Yin; Yu, Jia; Huang, Yukai; Lin, Sheng; Zhao, Genming; Tian, Jianmei; Zhang, Tao

    2018-03-22

    Data on hospitalization burden of CAP in children is very limited in China. This study aimed to estimate the hospitalization rate and population-based incidence of hospitalization of CAP for children <15 years of age in Suzhou, China. This was a retrospective study of children hospitalized in Soochow University Affiliated Children's Hospital (SCH) from January 2010 to December 2014. Children who were residents of downtown Suzhou, 29 days to <15 years of age, with discharge diagnosis codes (ICD-10) including J09 to J18 and J20 to J22 were included. All-cause clinical community-acquired pneumonia (CCAP) and radiographically confirmed pneumonia (RCAP) were identified based on individual medical chart review. The hospitalization rate (HR) and population-based cumulative incidence of hospitalization (HI) were calculated. Among 184,734 children <15 years old admitted to SCH during the study period, 31,302 children were identified as having CCAP, and 24,218 (77.4%) children confirmed as having RCAP. CCAP hospitalization occurred year round and peaked during winter and early spring. The overall HRs for CCAP and RCAP were 189.0 (95%CI, 187.1-190.9) and 146.2 (95%CI, 144-148) per 1,000 hospitalizations respectively, and the HIs per 100,000 children annually were CCAP, 3,235.8 (95%CI, 3207.3-3264.2) and RCAP, 2,503.5 (95%CI, 2,478.3-2,528.6). For children <5 years old, the HR for CCAP was 248.4 (95%CI, 245.9-250.9) and RCAP 194.0 (95%CI, 191.4-196.3) per 1,000 hospitalizations; the HI for CCAP was 6,956.2 (95%CI: 6,892.8-7,019.6) and 5,431.9 (95%CI: 5,375.4-5,488.4) per 100,000 children for RCAP. The highest HR and HI were observed in children 29 days to <6 months old: HR for CCAP was 407.4 (95%CI: 400.9-413.9) per 1,000 hospitalizations and HI for CCAP was 11,203.7 (95%CI: 11,026.8-11,380.6) per 100,000 children annually. There is a considerable burden of CAP among children <15 years of age in Suzhou, particularly among children 29 days to <6 months of age and during winter

  9. Super-Eddington Accretion in Tidal Disruption Events: the Impact of Realistic Fallback Rates on Accretion Rates

    Science.gov (United States)

    Wu, Samantha; Coughlin, Eric R.; Nixon, Chris

    2018-04-01

    After the tidal disruption of a star by a massive black hole, disrupted stellar debris can fall back to the hole at a rate significantly exceeding its Eddington limit. To understand how black hole mass affects the duration of super-Eddington accretion in tidal disruption events, we first run a suite of simulations of the disruption of a Solar-like star by a supermassive black hole of varying mass to directly measure the fallback rate onto the hole, and we compare these fallback rates to the analytic predictions of the "frozen-in" model. Then, adopting a Zero-Bernoulli Accretion flow as an analytic prescription for the accretion flow around the hole, we investigate how the accretion rate onto the black hole evolves with the more accurate fallback rates calculated from the simulations. We find that numerically-simulated fallback rates yield accretion rates onto the hole that can, depending on the black hole mass, be nearly an order of magnitude larger than those predicted by the frozen-in approximation. Our results place new limits on the maximum black hole mass for which super-Eddington accretion occurs in tidal disruption events.

  10. Can better infrastructure and quality reduce hospital infant mortality rates in Mexico?

    Science.gov (United States)

    Aguilera, Nelly; Marrufo, Grecia M

    2007-02-01

    Preliminary evidence from hospital discharges hints enormous disparities in infant hospital mortality rates. At the same time, public health agencies acknowledge severe deficiencies and variations in the quality of medical services across public hospitals. Despite these concerns, there is limited evidence of the contribution of hospital infrastructure and quality in explaining variations in outcomes among those who have access to medical services provided at public hospitals. This paper provides evidence to address this question. We use probabilistic econometric methods to estimate the impact of material and human resources and hospital quality on the probability that an infant dies controlling for socioeconomic, maternal and reproductive risk factors. As a measure of quality, we calculate for the first time for Mexico patient safety indicators developed by the AHRQ. We find that the probability to die is affected by hospital infrastructure and by quality. In this last regard, having been treated in a hospital with the worse quality incidence doubles the probability to die. This paper also presents evidence on the contribution of other risk factors on perinatal mortality rates. The conclusions of this paper suggest that lower infant mortality rates can be reached by implementing a set of coherent public policy actions including an increase and reorganization of hospital infrastructure, quality improvement, and increasing demand for health by poor families.

  11. Impact of whole-genome duplication events on diversification rates in angiosperms.

    Science.gov (United States)

    Landis, Jacob B; Soltis, Douglas E; Li, Zheng; Marx, Hannah E; Barker, Michael S; Tank, David C; Soltis, Pamela S

    2018-03-01

    Polyploidy or whole-genome duplication (WGD) pervades the evolutionary history of angiosperms. Despite extensive progress in our understanding of WGD, the role of these events in promoting diversification is still not well understood. We seek to clarify the possible association between WGD and diversification rates in flowering plants. Using a previously published phylogeny spanning all land plants (31,749 tips) and WGD events inferred from analyses of the 1000 Plants (1KP) transcriptome data, we analyzed the association of WGDs and diversification rates following numerous WGD events across the angiosperms. We used a stepwise AIC approach (MEDUSA), a Bayesian mixture model approach (BAMM), and state-dependent diversification analyses (MuSSE) to investigate patterns of diversification. Sister-clade comparisons were used to investigate species richness after WGDs. Based on the density of 1KP taxon sampling, 106 WGDs were unambiguously placed on the angiosperm phylogeny. We identified 334-530 shifts in diversification rates. We found that 61 WGD events were tightly linked to changes in diversification rates, and state-dependent diversification analyses indicated higher speciation rates for subsequent rounds of WGD. Additionally, 70 of 99 WGD events showed an increase in species richness compared to the sister clade. Forty-six of the 106 WGDs analyzed appear to be closely associated with upshifts in the rate of diversification in angiosperms. Shifts in diversification do not appear more likely than random within a four-node lag phase following a WGD; however, younger WGD events are more likely to be followed by an upshift in diversification than older WGD events. © 2018 Botanical Society of America.

  12. Incidence of patient safety events and process-related human failures during intra-hospital transportation of patients: retrospective exploration from the institutional incident reporting system.

    Science.gov (United States)

    Yang, Shu-Hui; Jerng, Jih-Shuin; Chen, Li-Chin; Li, Yu-Tsu; Huang, Hsiao-Fang; Wu, Chao-Ling; Chan, Jing-Yuan; Huang, Szu-Fen; Liang, Huey-Wen; Sun, Jui-Sheng

    2017-11-03

    Intra-hospital transportation (IHT) might compromise patient safety because of different care settings and higher demand on the human operation. Reports regarding the incidence of IHT-related patient safety events and human failures remain limited. To perform a retrospective analysis of IHT-related events, human failures and unsafe acts. A hospital-wide process for the IHT and database from the incident reporting system in a medical centre in Taiwan. All eligible IHT-related patient safety events between January 2010 to December 2015 were included. Incidence rate of IHT-related patient safety events, human failure modes, and types of unsafe acts. There were 206 patient safety events in 2 009 013 IHT sessions (102.5 per 1 000 000 sessions). Most events (n=148, 71.8%) did not involve patient harm, and process events (n=146, 70.9%) were most common. Events at the location of arrival (n=101, 49.0%) were most frequent; this location accounted for 61.0% and 44.2% of events with patient harm and those without harm, respectively (pprocess step was the preparation of the transportation team (n=91, 48.9%). Contributing unsafe acts included perceptual errors (n=14, 7.5%), decision errors (n=56, 30.1%), skill-based errors (n=48, 25.8%), and non-compliance (n=68, 36.6%). Multivariate analysis showed that human failure found in the arrival and hand-off sub-process (OR 4.84, pprocess at the location of arrival and prevent errors other than omissions. Long-term monitoring of IHT-related events is also warranted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Regional variation in hospital admission rates in the Netherlands, Belgium, Northern France and Nordrhein-Westfalen.

    NARCIS (Netherlands)

    Noordt, M. van; Zee, J. van der; Groenewegen, P.P.

    1992-01-01

    For the analysis of regional variations in hospital admission rates a model was set up, including both supply and demand indicators. Data were gathered for regions in four health care systems (the Dutch, Belgian, French and German), for 1982, 1979, 1974 (France 1982 only). Hospital bed supply proved

  14. Wide variation in hospital and physician payment rates evidence of provider market power.

    Science.gov (United States)

    Ginsburg, Paul B

    2010-11-01

    Wide variation in private insurer payment rates to hospitals and physicians across and within local markets suggests that some providers, particularly hospitals, have significant market power to negotiate higher-than-competitive prices, according to a new study by the Center for Studying Health System Change (HSC). Looking across eight health care markets--Cleveland; Indianapolis; Los Angeles; Miami; Milwaukee; Richmond, Va.; San Francisco; and rural Wisconsin--average inpatient hospital payment rates of four large national insurers ranged from 147 percent of Medicare in Miami to 210 percent in San Francisco. In extreme cases, some hospitals command almost five times what Medicare pays for inpatient services and more than seven times what Medicare pays for outpatient care. Variation within markets was just as dramatic. For example, the hospital with prices at the 25th percentile of Los Angeles hospitals received 84 percent of Medicare rates for inpatient care, while the hospital with prices at the 75th percentile received 184 percent of Medicare rates. The highest-priced Los Angeles hospital with substantial inpatient claims volume received 418 percent of Medicare. While not as pronounced, significant variation in physician payment rates also exists across and within markets and by specialty. Few would characterize the variation in hospital and physician payment rates found in this study to be consistent with a highly competitive market. Purchasers and public policy makers can address provider market power, or the ability to negotiate higher-than-competitive prices, through two distinct approaches. One is to pursue market approaches to strengthen competitive forces, while the other is to constrain payment rates through regulation.

  15. Complication rates of ostomy surgery are high and vary significantly between hospitals.

    Science.gov (United States)

    Sheetz, Kyle H; Waits, Seth A; Krell, Robert W; Morris, Arden M; Englesbe, Michael J; Mullard, Andrew; Campbell, Darrell A; Hendren, Samantha

    2014-05-01

    Ostomy surgery is common and has traditionally been associated with high rates of morbidity and mortality, suggesting an important target for quality improvement. The purpose of this work was to evaluate the variation in outcomes after ostomy creation surgery within Michigan to identify targets for quality improvement. This was a retrospective cohort study. The study took place within the 34-hospital Michigan Surgical Quality Collaborative. Patients included were those undergoing ostomy creation surgery between 2006 and 2011. We evaluated hospital morbidity and mortality rates after risk adjustment (age, comorbidities, emergency vs elective, and procedure type). A total of 4250 patients underwent ostomy creation surgery; 3866 procedures (91.0%) were open and 384 (9.0%) were laparoscopic. Unadjusted morbidity and mortality rates were 43.9% and 10.7%. Unadjusted morbidity rates for specific procedures ranged from 32.7% for ostomy-creation-only procedures to 47.8% for Hartmann procedures. Risk-adjusted morbidity rates varied significantly between hospitals, ranging from 31.2% (95% CI, 18.4-43.9) to 60.8% (95% CI, 48.9-72.6). There were 5 statistically significant high-outlier hospitals and 3 statistically significant low-outlier hospitals for risk-adjusted morbidity. The pattern of complication types was similar between high- and low-outlier hospitals. Case volume, operative duration, and use of laparoscopic surgery did not explain the variation in morbidity rates across hospitals. This work was limited by its retrospective study design, by unmeasured variation in case severity, and by our inability to differentiate between colostomies and ileostomies because of the use of Current Procedural Terminology codes. Morbidity and mortality rates for modern ostomy surgery are high. Although this type of surgery has received little attention in healthcare policy, these data reveal that it is both common and uncommonly morbid. Variation in hospital performance provides an

  16. The Effects of Hospital-Level Factors on Patients' Ratings of Physician Communication.

    Science.gov (United States)

    Al-Amin, Mona; Makarem, Suzanne C

    2016-01-01

    The quality of physician-patient communication influences patient health outcomes and satisfaction with healthcare delivery. Yet, little is known about contextual factors that influence physicians' communication with their patients. The main purpose of this article is to examine organizational-level factors that influence patient perceptions of physician communication in inpatient settings. We used the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and American Hospital Association data to determine patients' ratings of physician communication at the hospital level, and to collect information about hospital-level factors that can potentially influence physician communication. Our sample consisted of 2,756 hospitals. We ran a regression analysis to determine the predictors of poor physician communication, measured as the percentage of patients in a hospital who reported that physicians sometimes or never communicated well. In our sample of hospitals, this percentage ranged between 0% and 21%, with 25% of hospitals receiving poor ratings from more than 6% of patients. Three organizational factors had statistically significant negative associations with physician communication: for-profit ownership, hospital size, and hospitalists providing care in the hospital, On the other hand, the number of full-time-equivalent physicians and dentists per 10,000 inpatient days, physician ownership of the hospital, Medicare share of inpatient days, and public ownership were positively associated with patients' ratings of physician communication. Physician staffing levels are an understudied area in healthcare research. Our findings indicate that physician staffing levels affect the quality of physician communication with patients. Moreover, for-profit and larger hospitals should invest more in physician communication given the role that HCAHPS plays in value-based purchasing.

  17. Accounting For Patients' Socioeconomic Status Does Not Change Hospital Readmission Rates.

    Science.gov (United States)

    Bernheim, Susannah M; Parzynski, Craig S; Horwitz, Leora; Lin, Zhenqiu; Araas, Michael J; Ross, Joseph S; Drye, Elizabeth E; Suter, Lisa G; Normand, Sharon-Lise T; Krumholz, Harlan M

    2016-08-01

    There is an active public debate about whether patients' socioeconomic status should be included in the readmission measures used to determine penalties in Medicare's Hospital Readmissions Reduction Program (HRRP). Using the current Centers for Medicare and Medicaid Services methodology, we compared risk-standardized readmission rates for hospitals caring for high and low proportions of patients of low socioeconomic status (as defined by their Medicaid status or neighborhood income). We then calculated risk-standardized readmission rates after additionally adjusting for patients' socioeconomic status. Our results demonstrate that hospitals caring for large proportions of patients of low socioeconomic status have readmission rates similar to those of other hospitals. Moreover, readmission rates calculated with and without adjustment for patients' socioeconomic status are highly correlated. Readmission rates of hospitals caring for patients of low socioeconomic status changed by approximately 0.1 percent with adjustment for patients' socioeconomic status, and only 3-4 percent fewer such hospitals reached the threshold for payment penalty in Medicare's HRRP. Overall, adjustment for socioeconomic status does not change hospital results in meaningful ways. Project HOPE—The People-to-People Health Foundation, Inc.

  18. Structured sedation programs in the emergency department, hospital and other acute settings: protocol for systematic review of effects and events.

    Science.gov (United States)

    McCoy, Siobhán; Wakai, Abel; Blackburn, Carol; Barrett, Michael; Murphy, Adrian; Brenner, Maria; Larkin, Philip; Crispino-O'Connell, Gloria; Ratnapalan, Savithiri; O'Sullivan, Ronan

    2013-10-01

    The use of procedural sedation outside the operating theatre has increased in hospital settings and has gained popularity among non-anesthesiologists. Sedative agents used for procedural pain, although effective, also pose significant risks to the patient if used incorrectly. There is currently no universally accepted program of education for practitioners using or introducing procedural sedation into their practice. There is emerging literature identifying structured procedural sedation programs (PSPs) as a method of ensuring a standardized level of competency among staff and reducing risks to the patient. We hypothesize that programs of education for healthcare professionals using procedural sedation outside the operating theatre are beneficial in improving patient care, safety, practitioner competence and reducing adverse event rates. Electronic databases will be systematically searched for studies (randomized and non-randomized) examining the effectiveness of structured PSPs from 1966 to present. Database searches will be supplemented by contact with experts, reference and citation checking, and a grey literature search. No language restriction will be imposed. Screening of titles and abstracts, and data extraction will be performed by two independent reviewers. All disagreements will be resolved by discussion with an independent third party. Data analysis will be completed adhering to procedures outlined in the Cochrane Handbook of Systematic Reviews of Interventions. If the data allows, a meta-analysis will be performed. This review will cohere evidence on the effectiveness of structured PSPs on sedation events and patient outcomes within the hospital and other acute care settings. In addition, it will examine key components identified within a PSP associated with patient safety and improved patient outcomes. PROSPERO registration number: CRD42013003851.

  19. Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths - United States, 2001 – 2010

    Data.gov (United States)

    U.S. Department of Health & Human Services — In general, total combined rates for traumatic brain injury (TBI)-related emergency department (ED) visits, hospitalizations and deaths have increased over the past...

  20. Average Rate of Heat-Related Hospitalizations in 23 States, 2001-2010

    Data.gov (United States)

    U.S. Environmental Protection Agency — This map shows the 2001–2010 average rate of hospitalizations classified as “heat-related” by medical professionals in 23 states that participate in CDC’s...

  1. Can use of an administrative database improve accuracy of hospital-reported readmission rates?

    Science.gov (United States)

    Edgerton, James R; Herbert, Morley A; Hamman, Baron L; Ring, W Steves

    2018-05-01

    Readmission rates after cardiac surgery are being used as a quality indicator; they are also being collected by Medicare and are tied to reimbursement. Accurate knowledge of readmission rates may be difficult to achieve because patients may be readmitted to different hospitals. In our area, 81 hospitals share administrative claims data; 28 of these hospitals (from 5 different hospital systems) do cardiac surgery and share Society of Thoracic Surgeons (STS) clinical data. We used these 2 sources to compare the readmissions data for accuracy. A total of 45,539 STS records from January 2008 to December 2016 were matched with the hospital billing data records. Using the index visit as the start date, the billing records were queried for any subsequent in-patient visits for that patient. The billing records included date of readmission and hospital of readmission data and were compared with the data captured in the STS record. We found 1153 (2.5%) patients who had STS records that were marked "No" or "missing," but there were billing records that showed a readmission. The reported STS readmission rate of 4796 (10.5%) underreported the readmission rate by 2.5 actual percentage points. The true rate should have been 13.0%. Actual readmission rate was 23.8% higher than reported by the clinical database. Approximately 36% of readmissions were to a hospital that was a part of a different hospital system. It is important to know accurate readmission rates for quality improvement processes and institutional financial planning. Matching patient records to an administrative database showed that the clinical database may fail to capture many readmissions. Combining data with an administrative database can enhance accuracy of reporting. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  2. Gamma-ray dose rate increase at rainfall events and their air-mass origins

    International Nuclear Information System (INIS)

    Iyogi, Takashi; Hisamatsu, Shun'ichi; Inaba, Jiro

    2007-01-01

    The environmental γ-ray dose rate and precipitation rates were measured at our institute, in Rokkasho, Aomori, Japan. We analyzed 425 rainfall events in which the precipitation rate was over 0.5 mm from April through November during the years 2003 to 2005. Backward trajectories for 5 d starting from 1000 m above Rokkasho at the time of the maximum dose rate in a rainfall event, were calculated by using the HYSPLIT model of the NOAA Air Resources Laboratory. The trajectories for 5 d were classified by visual inspection according to the passage areas; Pacific Ocean, Asian Continent and Japan Islands. The increase of cumulative environmental γ-ray dose during a rainfall event was plotted against the precipitation in the event, and their relationship was separately examined according to the air-mass passage area, i.e. origin of the air-mass. Our results showed that the origin of air-mass was an important factor affecting the increase of environmental γ-ray dose rate by rainfall. (author)

  3. A Discrete Events Delay Differential System Model for Transmission of Vancomycin-Resistant Enterococcus (VRE) in Hospitals

    Science.gov (United States)

    2010-09-19

    estimated directly form the surveillance data Infection control measures were implemented in the form of health care worker hand - hygiene before and after...hospital infections , is used to motivate possibilities of modeling nosocomial infec- tion dynamics. This is done in the context of hospital monitoring and...model development. Key Words: Delay equations, discrete events, nosocomial infection dynamics, surveil- lance data, inverse problems, parameter

  4. Rates for parallax-shifted microlensing events from ground-based observations of the galactic bulge

    International Nuclear Information System (INIS)

    Buchalter, A.; Kamionkowski, M.

    1997-01-01

    The parallax effect in ground-based microlensing (ML) observations consists of a distortion to the standard ML light curve arising from the Earth's orbital motion. This can be used to partially remove the degeneracy among the system parameters in the event timescale, t 0 . In most cases, the resolution in current ML surveys is not accurate enough to observe this effect, but parallax could conceivably be detected with frequent follow-up observations of ML events in progress, providing the photometric errors are small enough. We calculate the expected fraction of ML events where the shape distortions will be observable by such follow-up observations, adopting Galactic models for the lens and source distributions that are consistent with observed microlensing timescale distributions. We study the dependence of the rates for parallax-shifted events on the frequency of follow-up observations and on the precision of the photometry. For example, we find that for hourly observations with typical photometric errors of 0.01 mag, 6% of events where the lens is in the bulge, and 31% of events where the lens is in the disk (or ∼10% of events overall), will give rise to a measurable parallax shift at the 95% confidence level. These fractions may be increased by improved photometric accuracy and increased sampling frequency. While long-duration events are favored, the surveys would be effective in picking out such distortions in events with timescales as low as t 0 ∼20 days. We study the dependence of these fractions on the assumed disk mass function and find that a higher parallax incidence is favored by mass functions with higher mean masses. Parallax measurements yield the reduced transverse speed, v, which gives both the relative transverse speed and lens mass as a function of distance. We give examples of the accuracies with which v may be measured in typical parallax events. (Abstract Truncated)

  5. Regression analysis of mixed recurrent-event and panel-count data with additive rate models.

    Science.gov (United States)

    Zhu, Liang; Zhao, Hui; Sun, Jianguo; Leisenring, Wendy; Robison, Leslie L

    2015-03-01

    Event-history studies of recurrent events are often conducted in fields such as demography, epidemiology, medicine, and social sciences (Cook and Lawless, 2007, The Statistical Analysis of Recurrent Events. New York: Springer-Verlag; Zhao et al., 2011, Test 20, 1-42). For such analysis, two types of data have been extensively investigated: recurrent-event data and panel-count data. However, in practice, one may face a third type of data, mixed recurrent-event and panel-count data or mixed event-history data. Such data occur if some study subjects are monitored or observed continuously and thus provide recurrent-event data, while the others are observed only at discrete times and hence give only panel-count data. A more general situation is that each subject is observed continuously over certain time periods but only at discrete times over other time periods. There exists little literature on the analysis of such mixed data except that published by Zhu et al. (2013, Statistics in Medicine 32, 1954-1963). In this article, we consider the regression analysis of mixed data using the additive rate model and develop some estimating equation-based approaches to estimate the regression parameters of interest. Both finite sample and asymptotic properties of the resulting estimators are established, and the numerical studies suggest that the proposed methodology works well for practical situations. The approach is applied to a Childhood Cancer Survivor Study that motivated this study. © 2014, The International Biometric Society.

  6. Variation in rates of breast cancer surgery: A national analysis based on French Hospital Episode Statistics.

    Science.gov (United States)

    Rococo, E; Mazouni, C; Or, Z; Mobillion, V; Koon Sun Pat, M; Bonastre, J

    2016-01-01

    Minimum volume thresholds were introduced in France in 2008 to improve the quality of cancer care. We investigated whether/how the quality of treatment decisions in breast cancer surgery had evolved before and after this policy was implemented. We used Hospital Episode Statistics for all women having undergone breast conserving surgery (BCS) or mastectomy in France in 2005 and 2012. Three surgical procedures considered as better treatment options were analyzed: BCS, immediate breast reconstruction (IBR) and sentinel lymph node biopsy (SLNB). We studied the mean rates and variation according to the hospital profile and volume. Between 2005 and 2012, the volume of breast cancer surgery increased by 11% whereas one third of the hospitals no longer performed this type of surgery. In 2012, the mean rate of BCS was 74% and similar in all hospitals whatever the volume. Conversely, IBR and SLNB rates were much higher in cancer centers (CC) and regional teaching hospitals (RTH) [IBR: 19% and 14% versus 8% on average; SLNB: 61% and 47% versus 39% on average]; the greater the hospital volume, the higher the IBR and SLNB rates (p < 0.0001). Overall, whatever the surgical procedure considered, inter-hospital variation in rates declined substantially in CC and RTH. We identified considerable variation in IBR and SLNB rates between French hospitals. Although more complex and less standardized than BCS, most clinical guidelines recommended these procedures. This apparent heterogeneity suggests unequal access to high-quality procedures for women with breast cancer. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Adverse Event Rates Associated with Transforaminal and Interlaminar Epidural Steroid Injections: A Multi-Institutional Study.

    Science.gov (United States)

    El-Yahchouchi, Christine A; Plastaras, Christopher T; Maus, Timothy P; Carr, Carrie M; McCormick, Zachary L; Geske, Jennifer R; Smuck, Matthew; Pingree, Matthew J; Kennedy, David J

    2016-02-01

    Transforaminal epidural steroid injections (TFESI) have demonstrated efficacy and effectiveness in treatment of radicular pain. Despite little evidence of efficacy/effectiveness, interlaminar epidural steroid injections (ILESI) are advocated by some as primary therapy for radicular pain due to purported greater safety. To assess immediate and delayed adverse event rates of TFESI and ILESI injections at three academic medical centers utilizing International Spine Intervention Society practice guidelines. Quality assurance databases from a Radiology and two physical medicine and rehabilitation (PM&R) practices were interrogated. Medical records were reviewed, verifying immediate and delayed adverse events. There were no immediate major adverse events of neurologic injury or hemorrhage in 16,638 consecutive procedures in all spine segments (14,956 TFESI; 1,682 ILESI). Vasovagal reactions occurred in 1.2% of procedures, more frequently (P = 0.004) in TFESI (1.3%) than ILESI (0.5%). Dural punctures occurred in 0.06% of procedures, more commonly after ILESI (0.2% vs 0.04%, P = 0.006). Delayed follow up on PM&R patients (92.5% and 78.5, next business day) and radiology patients (63.1%, 2 weeks) identified no major adverse events of neurologic injury, hemorrhage, or infection. There were no significant differences in delayed minor adverse event rates. Central steroid response (sleeplessness, flushing, nonpositional headache) was seen in 2.6% of both TFESI and ILESI patients. 2.1% of TFESI and 1.8% of ILESI patients reported increased pain. No long-term sequelae were seen from any immediate or delayed minor adverse event. Both transforaminal and ILESI are safely performed with low immediate and delayed adverse event rates when informed by evidence-based procedural guidelines. By demonstrating comparable safety, this study suggests that the choice between ILESI and TFESIs can be based on documented efficacy and effectiveness and not driven by safety concerns.

  8. Impact of Discharge Timings of Healthy Newborns on the Rates and Etiology of Neonatal Hospital Readmissions

    International Nuclear Information System (INIS)

    Habib, H.S.

    2013-01-01

    Objective: To evaluate the effect of early hospital discharge after initial birth hospitalization on the rate and etiology of hospital readmissions during the neonatal period. Study Design: Cross-sectional analytical study. Place and Duration of Study: King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from October 2008 to September 2011. Methodology: Full-term normal newborns were included in this study, and all infants showing any features that would increase the chances of readmission were excluded. Initial birth hospitalization and readmission in the neonatal period were analyzed. Data was collected from the Discharge Abstract Database. Results: Overall, 12,728 normal newborns were delivered during the study period. Vaginally delivered infants were discharged early (within 48 hours), while those delivered via caesarean section had longer hospital stays (mean length of stay: 1.1 and 2.8 days, respectively). There were 166 readmissions, wherein the leading cause was neonatal sepsis (37.3%) followed by neonatal jaundice (26.5%). The readmission rate in early discharged (142 out of 9927) was significantly higher (p = 0.017) as compared to newborns who were discharged late after birth (24 out of 2801). Etiology of readmissions was not affected by discharge timings. Conclusion: Hospital discharge of neonates within 48 hours after delivery is counterproductive and significantly increases the risk for hospital readmission during the neonatal period. The pre-dominance of sepsis-related cases observed here indicates the need to explore its causes and determine an optimal prevention and management strategy. (author)

  9. High cardiovascular event rates in patients with asymptomatic carotid stenosis: the REACH Registry

    DEFF Research Database (Denmark)

    Aichner, F T; Topakian, R; Alberts, M J

    2009-01-01

    BACKGROUND AND PURPOSE: Data on current cardiovascular event rates in patients with asymptomatic carotid artery stenosis (ACAS) are sparse. We compared the 1-year outcomes of patients with ACAS > or =70% versus patients without ACAS in an international, prospective cohort of outpatients with or a...

  10. Measurement Differences from Rating Posttraumatic Stress Disorder Symptoms in Response to Differentially Distressing Traumatic Events

    Science.gov (United States)

    Elhai, Jon D.; Fine, Thomas H.

    2012-01-01

    The authors explored differences in posttraumatic stress disorder (PTSD) symptoms as a result of rating symptoms from two separate, differentially distressing traumatic events. In an initial sample of 400 nonclinical participants, the authors inquired through a web survey about previous psychological trauma, instructing participants to nominate…

  11. Ratings of Severity of Life Events by Ninth-Grade Students.

    Science.gov (United States)

    Hutton, Jerry B.; And Others

    1987-01-01

    Special education, basic, and honors ninth-grade students (n=60) rated the severity of stress for each of the life events on the Source of Stress Inventory (Chandler, 1981). There was a significant positive relationship between the Chandler rankings (teachers and mental health workers) and the student rankings. (Author/NB)

  12. Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE).

    Science.gov (United States)

    Furman, Mark I; Gore, Joel M; Anderson, Fredrick A; Budaj, Andrzej; Goodman, Shaun G; Avezum, Avaro; López-Sendón, José; Klein, Werner; Mukherjee, Debabrata; Eagle, Kim A; Dabbous, Omar H; Goldberg, Robert J

    2004-01-01

    To examine the association between elevated leukocyte count and hospital mortality and heart failure in patients enrolled in the multinational, observational Global Registry of Acute Coronary Events (GRACE). Elevated leukocyte count is associated with adverse hospital outcomes in patients presenting with acute myocardial infarction (AMI). The association of this prognostic factor with hospital mortality and heart failure in patients with other acute coronary syndromes (ACS) is unclear. We examined the association between admission leukocyte count and hospital mortality and heart failure in 8269 patients presenting with an ACS. This association was examined separately in patients with ST-segment elevation AMI, non-ST-segment elevation AMI, and unstable angina. Leukocyte count was divided into 4 mutually exclusive groups (Q): Q1 12,000. Multiple logistic regression analysis was performed to examine the association between elevated leukocyte count and hospital events while accounting for the simultaneous effect of several potentially confounding variables. Increasing leukocyte count was significantly associated with hospital death (adjusted odds ratio [OR] 2.8, 95% CI 2.1-3.6 for Q4 compared to Q2 [normal range]) and heart failure (OR 2.7, 95% CI 2.2-3.4) for patients presenting with ACS. This association was seen in patients with ST-segment elevation AMI (OR for hospital death 3.2, 95% CI 2.1-4.7; OR for heart failure 2.4, 95% CI 1.8-3.3), non-ST-segment elevation AMI (OR for hospital death 1.9, 95% CI 1.2-3.0; OR for heart failure 1.7, 95% CI 1.1-2.5), or unstable angina (OR for hospital death 2.8, 95% CI 1.4-5.5; OR for heart failure 2.0, 95% CI 0.9-4.4). In men and women of all ages with the spectrum of ACS, initial leukocyte count is an independent predictor of hospital death and the development of heart failure.

  13. Plastic surgeons' self-reported operative infection rates at a Canadian academic hospital.

    Science.gov (United States)

    Ng, Wendy Ky; Kaur, Manraj Nirmal; Thoma, Achilleas

    2014-01-01

    Surgical site infection rates are of great interest to patients, surgeons, hospitals and third-party payers. While previous studies have reported hospital-acquired infection rates that are nonspecific to all surgical services, there remain no overall reported infection rates focusing specifically on plastic surgery in the literature. To estimate the reported surgical site infection rate in plastic surgery procedures over a 10-year period at an academic hospital in Canada. A review was conducted on reported plastic surgery surgical site infection rates from 2003 to 2013, based on procedures performed in the main operating room. For comparison, prospective infection surveillance data over an eight-year period (2005 to 2013) for nonplastic surgery procedures were reviewed to estimate the overall operative surgical site infection rates. A total of 12,183 plastic surgery operations were performed from 2003 to 2013, with 96 surgical site infections reported, corresponding to a net operative infection rate of 0.79%. There was a 0.49% surgeon-reported infection rate for implant-based procedures. For non-plastic surgery procedures, surgical site infection rates ranged from 0.04% for cataract surgery to 13.36% for high-risk abdominal hysterectomies. The plastic surgery infection rate at the study institution was found to be site infection rates. However, these results do not report patterns of infection rates germane to procedures, season, age groups or sex. To provide more in-depth knowledge of this topic, multicentre studies should be conducted.

  14. A study on radiographic repeat rate data of several hospitals in Jeddah

    Energy Technology Data Exchange (ETDEWEB)

    Al-Malki, M.A.; Abulfaraj, W.H.; Bhuiyan, S.I.; Kinsara, A.A

    2003-07-01

    Radiographic repeat rate data in diagnostic radiology in King Fahad Hospital (KFH), King Abdulaziz Hospital (KAH), and Maternity and Children Hospital (MCH) in Jeddah, Saudi Arabia, have been studied. The study provided valuable information to suggest preventive measures to reduce repeats. The variables included in the study are exposure techniques, examination types, total number of films used, number of films repeated, the film sizes, gender, the age groups of the patients, and reason for repetition. The total number of examinations in all three hospitals is 6001 using 8887 films on 5412 patients. The average repeat rate was 7.93%, where the individual hospital repeat rates were 9.57% in the MCH, 7.84% in KAH and 7.44% in KFH. The repeat rate for children and infants was found to be undesirable. The quality assurance (QA) programme can effectively reduce the unnecessary exposure and can identify the cause of the exposure. The overexposure, underexposure and position fault were the foremost contributors for repeats and constitute 32.91%, 28.94% and 22.98% of the total respectively. The QA study identified that human error and equipment malfunction are the major contributors to these causes of repeats. The highest repetition rate was for pelvis, 13.64%, followed by skull, 11.59%, and abdomen, 10.41%. It is estimated that the total area of wasted film in all three hospitals is 74.3 m{sup 2}. As per the average repeat rate, the cost of repeat films in the entire kingdom per year has been projected to be about US$1.82 million (SR 6.83 million) in the government hospitals only. Based on the findings of this study a set of recommendations have been prescribed for the radiology department to reduce the repeat rate and to improve the safety culture. (author)

  15. A study on radiographic repeat rate data of several hospitals in Jeddah

    International Nuclear Information System (INIS)

    Al-Malki, M.A.; Abulfaraj, W.H.; Bhuiyan, S.I.; Kinsara, A.A.

    2003-01-01

    Radiographic repeat rate data in diagnostic radiology in King Fahad Hospital (KFH), King Abdulaziz Hospital (KAH), and Maternity and Children Hospital (MCH) in Jeddah, Saudi Arabia, have been studied. The study provided valuable information to suggest preventive measures to reduce repeats. The variables included in the study are exposure techniques, examination types, total number of films used, number of films repeated, the film sizes, gender, the age groups of the patients, and reason for repetition. The total number of examinations in all three hospitals is 6001 using 8887 films on 5412 patients. The average repeat rate was 7.93%, where the individual hospital repeat rates were 9.57% in the MCH, 7.84% in KAH and 7.44% in KFH. The repeat rate for children and infants was found to be undesirable. The quality assurance (QA) programme can effectively reduce the unnecessary exposure and can identify the cause of the exposure. The overexposure, underexposure and position fault were the foremost contributors for repeats and constitute 32.91%, 28.94% and 22.98% of the total respectively. The QA study identified that human error and equipment malfunction are the major contributors to these causes of repeats. The highest repetition rate was for pelvis, 13.64%, followed by skull, 11.59%, and abdomen, 10.41%. It is estimated that the total area of wasted film in all three hospitals is 74.3 m 2 . As per the average repeat rate, the cost of repeat films in the entire kingdom per year has been projected to be about US$1.82 million (SR 6.83 million) in the government hospitals only. Based on the findings of this study a set of recommendations have been prescribed for the radiology department to reduce the repeat rate and to improve the safety culture. (author)

  16. Determination of Rate and Causes of Wastage of Blood and Blood Products in Iranian Hospitals

    Directory of Open Access Journals (Sweden)

    Rafat Mohebbi Far

    2014-06-01

    Full Text Available OBJECTIVE: The purpose of this study was to determine the rate and causes of wastage of blood and blood products (packed red cells, plasma, platelets, and cryoprecipitate in Qazvin hospitals. METHODS: The study was conducted in all hospitals in Qazvin, including 5 teaching hospitals, 2 social welfare hospitals, 3 private hospitals, 1 charity hospital, and 1 military hospital. This descriptive study was based on available data from hospital blood banks in the province of Qazvin. The research instrument was a 2-part questionnaire. The first part was related to demographic characteristics of hospitals and the second part elicited information about blood and blood component wastage. The collected data were then analyzed using descriptive statistic methods and SPSS 11.5. RESULTS: Blood wastage may occur for a number of reasons, including time expiry, wasted imports, blood medically or surgically ordered but not used, stock time expired, hemolysis, or miscellaneous reasons. Data indicated that approximately 77.9% of wasted pack cell units were wasted for the reason of time expiry. Pack cell wastage in hospitals is reported to range from 1.93% to 30.7%. Wastage at all hospitals averaged 9.8% among 30.913 issued blood products. Overall blood and blood product (packed red cells, plasma, platelets, and cryoprecipitate wastage was 3048 units and average total wastage per participant hospital for all blood groups was 254 units per year. CONCLUSION: Blood transfusion is an essential part of patient care. The blood transfusion system has made significant advancements in areas such as donor management, storage of blood, cross-matching, rational use of blood, and distribution. In order to improve the standards of blood banks and the blood transfusion services in Iran, comprehensive standards have been formulated to ensure better quality control in collection, storage, testing, and distribution of blood and its components for the identified major factors

  17. The bacterial contamination rate of glucose meter test strips in the hospital setting

    Science.gov (United States)

    Al-Rubeaan, Khalid A.; Saeb, Amr T. M.; AlNaqeb, Dhekra M.; AlQumaidi, Hamed M.; AlMogbel, Turki A.

    2016-01-01

    Objectives: To assess the rate of bacterial contamination of the multi-use vial and single-use packed glucose meter strips, and to identify the type and frequency of various bacterial contamination in different hospital wards. Methods: This prospective observational study was conducted by a team from the Strategic Center for Diabetes Research in 7 general hospitals in the Central region of Saudi Arabia during the period from August to September 2014 to assess the bacterial contamination rate of the unused strips. A total of 10,447 strips were cultured using proper agar media and incubated both aerobically and anaerobically. Results: The total bacterial contamination rate for the multi-use vials glucose strips was 31.7%, while single-use packed strips were not contaminated at all. Ministry of Health hospitals had the highest contamination rates compared with other hospitals. Critical, obstetric, and surgical wards had the highest bacterial isolates number, where most were in the risk group 3 according to the National Institute of Health guidelines. Staphylococcus species were the most common bacteria found. Conclusion: Glucose meter strips should be recognized as a source of bacterial contamination that could be behind serious hospital acquired infections. The hospital infection control team should adopt proper measures to implement protocols for glucose meter cleaning and glucose strips handling. PMID:27570855

  18. A method for estimating failure rates for low probability events arising in PSA

    International Nuclear Information System (INIS)

    Thorne, M.C.; Williams, M.M.R.

    1995-01-01

    The authors develop a method for predicting failure rates and failure probabilities per event when, over a given test period or number of demands, no failures have occurred. A Bayesian approach is adopted to calculate a posterior probability distribution for the failure rate or failure probability per event subsequent to the test period. This posterior is then used to estimate effective failure rates or probabilities over a subsequent period of time or number of demands. In special circumstances, the authors results reduce to the well-known rules of thumb, viz: 1/N and 1/T, where N is the number of demands during the test period for no failures and T is the test period for no failures. However, the authors are able to give strict conditions on the validity of these rules of thumb and to improve on them when necessary

  19. Can preventable adverse events be predicted among hospitalized older patients? The development and validation of a predictive model.

    NARCIS (Netherlands)

    Steeg, L. van de; Langelaan, M.; Wagner, C.

    2014-01-01

    Objective: To develop and validate a predictive model for preventable adverse events (AEs) in hospitalized older patients, using clinically important risk factors that are readily available on admission. Design: Data from two retrospective patient record review studies on AEs were used. Risk factors

  20. New onset of insomnia in hospitalized patients in general medical wards: incidence, causes, and resolution rate

    OpenAIRE

    Ho, An; Raja, Bronson; Waldhorn, Richard; Baez, Valentina; Mohammed, Idiris

    2017-01-01

    ABSTRACT Background: Insomnia is common in hospitalized patients. However, no study has examined new onset of insomnia in patients without a prior history of insomnia. Objectives: Incidence of new onset of insomnia in inpatients, associated factors and resolution rate after 2 weeks. Method: This is a prospective observational study conducted at a community hospital. We used the Insomnia Severity Index questionnaire to screen for insomnia in all patients located in the general medical floors f...

  1. Hospital cost-containment strategies that earn the respect of rating agencies.

    Science.gov (United States)

    Dopoulos, Jason

    2016-01-01

    To confirm that hospitals have the necessary structures and strategies in place to reduce costs and secure future market share, credit rating agencies analyze a variety of quantitative and qualitative criteria, including: Salaries and benefits, bad debt, age of plant and depreciation, and other line items that may point to inefficiencies in a hospital's expense structure. Cost-benefit analyses, strategic plans, and leadership qualities that show the long-term value of expense cuts, capital investments, and mergers and acquisitions. Cost-effective and clinically appropriate shifts in a hospital's outpatient-to-inpatient ratio. Liquidity and market share.

  2. Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis.

    Science.gov (United States)

    Whitney, Robin L; Bell, Janice F; Tancredi, Daniel J; Romano, Patrick S; Bold, Richard J; Joseph, Jill G

    2017-11-01

    Purpose Among individuals with advanced cancer, frequent hospitalization increasingly is viewed as a hallmark of poor-quality care. We examined hospitalization rates and individual- and hospital-level predictors of rehospitalization among individuals with advanced cancer in the year after diagnosis. Methods Individuals diagnosed with advanced breast, colorectal, non-small-cell lung, or pancreatic cancer from 2009 to 2012 (N = 25,032) were identified with data from the California Cancer Registry (CCR). After linkage with inpatient discharge data, multistate and log-linear Poisson regression models were used to calculate hospitalization rates and to model rehospitalization in the year after diagnosis, accounting for survival. Results In the year after diagnosis, 71% of individuals with advanced cancer were hospitalized, 16% had three or more hospitalizations, and 64% of hospitalizations originated in the emergency department. Rehospitalization rates were significantly associated with black non-Hispanic (incidence rate ratio [IRR], 1.29; 95% CI, 1.17 to 1.42) and Hispanic (IRR, 1.11; 95% CI, 1.03 to 1.20) race/ethnicity; public insurance (IRR, 1.37; 95% CI, 1.23 to 1.47) and no insurance (IRR, 1.17; 95% CI, 1.02 to 1.35); lower socioeconomic status quintiles (IRRs, 1.09 to 1.29); comorbidities (IRRs, 1.13 to 1.59); and pancreatic (IRR, 2.07; 95% CI, 1.95 to 2.20) and non-small-cell lung (IRR, 1.69; 95% CI, 1.54 to 1.86) cancers versus colorectal cancer. Rehospitalization rates were significantly lower after discharge from a hospital that had an outpatient palliative care program (IRR, 0.90; 95% CI, 0.83 to 0.97) and were higher after discharge from a for-profit hospital (IRR, 1.33; 95% CI, 1.14 to 1.56). Conclusion Individuals with advanced cancer experience a heavy burden of hospitalization in the year after diagnosis. Efforts to reduce hospitalization and provide care congruent with patient preferences might target individuals at higher risk. Future work might

  3. Mortality Rates of Traumatic Traffic Accident Patients at the University Hospital

    Directory of Open Access Journals (Sweden)

    Atilla Senih MAYDA

    2014-05-01

    Full Text Available The aim of the study is to estimate hospitalization and mortality rates in patients admitted to the University Hospital due to traffic accidents, and to determine the mean cost of the applicants in the hospital due to traffic accident. In this retrospective study data were obtained from the records of a university research and practice hospital. There were 802 patients admitted to emergency and other outpatient clinics of the University Hospital because of traffic accidents throughout the year 2012. Out of these patients, 166 (20.7% were hospitalized, and the annual mortality rate was 0.87%. The total cost was 322,545.2 euro and 402.2 euro per patient. Road traffic accident detection reports covered only the numbers of fatal injuries and injuries that happened at the scene of accidents. Determination of the number of the dead and wounded with overall mortality rate would be supposed to reveal the magnitude of public health problem caused by traffic accidents.

  4. The impact of varicella vaccination on varicella-related hospitalization rates: global data review.

    Science.gov (United States)

    Hirose, Maki; Gilio, Alfredo Elias; Ferronato, Angela Esposito; Ragazzi, Selma Lopes Betta

    2016-09-01

    to describe the impact of varicella vaccination on varicella-related hospitalization rates in countries that implemented universal vaccination against the disease. we identified countries that implemented universal vaccination against varicella at the http://apps.who.int/immunization_monitoring/globalsummary/schedules site of the World Health Organization and selected articles in Pubmed describing the changes (pre/post-vaccination) in the varicella-related hospitalization rates in these countries, using the Keywords "varicella", "vaccination/vaccine" and "children" (or) "hospitalization". Publications in English published between January 1995 and May 2015 were included. 24 countries with universal vaccination against varicella and 28 articles describing the impact of the vaccine on varicella-associated hospitalizations rates in seven countries were identified. The US had 81.4% -99.2% reduction in hospitalization rates in children younger than four years after 6-14 years after the onset of universal vaccination (1995), with vaccination coverage of 90%; Uruguay: 94% decrease (children aged 1-4 years) in six years, vaccination coverage of 90%; Canada: 93% decrease (age 1-4 years) in 10 years, coverage of 93%; Germany: 62.4% decrease (age 1-4 years) in 8 years, coverage of 78.2%; Australia: 76.8% decrease (age 1-4 years) in 5 years, coverage of 90%; Spain: 83.5% decrease (age <5 years) in four years, coverage of 77.2% and Italy 69.7% -73.8% decrease (general population), coverage of 60%-95%. The publications showed variations in the percentage of decrease in varicella-related hospitalization rates after universal vaccination in the assessed countries; the results probably depend on the time since the implementation of universal vaccination, differences in the studied age group, hospital admission criteria, vaccination coverage and strategy, which does not allow direct comparison between data. Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por

  5. The impact of varicella vaccination on varicella-related hospitalization rates: global data review

    Directory of Open Access Journals (Sweden)

    Maki Hirose

    Full Text Available Abstract Objective: To describe the impact of varicella vaccination on varicella-related hospitalization rates in countries that implemented universal vaccination against the disease. Data source: We identified countries that implemented universal vaccination against varicella at the http://apps.who.int/immunization_monitoring/globalsummary/schedules site of the World Health Organization and selected articles in Pubmed describing the changes (pre/post-vaccination in the varicella-related hospitalization rates in these countries, using the Keywords "varicella", "vaccination/vaccine" and "children" (or "hospitalization". Publications in English published between January 1995 and May 2015 were included. Data synthesis: 24 countries with universal vaccination against varicella and 28 articles describing the impact of the vaccine on varicella-associated hospitalizations rates in seven countries were identified. The US had 81.4%–99.2% reduction in hospitalization rates in children younger than four years, 6–14 years after the onset of universal vaccination (1995, with vaccination coverage of 90%; Uruguay: 94% decrease (children aged 1–4 years in six years, vaccination coverage of 90%; Canada: 93% decrease (age 1–4 years in 10 years, coverage of 93%; Germany: 62.4% decrease (age 1–4 years in 8 years, coverage of 78.2%; Australia: 76.8% decrease (age 1–4 years in 5 years, coverage of 90%; Spain: 83.5% decrease (age <5 years in four years, coverage of 77.2% and Italy 69.7%–73.8% decrease (general population, coverage of 60%–95%. Conclusions: The publications showed variations in the percentage of decrease in varicella-related hospitalization rates after universal vaccination in the assessed countries; the results probably depend on the time since the implementation of universal vaccination, differences in the studied age group, hospital admission criteria, vaccination coverage and strategy, which does not allow direct comparison between

  6. [Incidence rate of adverse reaction/event by Qingkailing injection: a Meta-analysis of single rate].

    Science.gov (United States)

    Ai, Chun-ling; Xie, Yan-ming; Li, Ming-quan; Wang, Lian-xin; Liao, Xing

    2015-12-01

    To systematically review the incidence rate of adverse drug reaction/event by Qingkailing injection. Such databases as the PubMed, EMbase, the Cochrane library, CNKI, VIP WanFang data and CBM were searched by computer from foundation to July 30, 2015. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and cross check data. Then, Meta-analysis was performed by using the R 3.2.0 software, subgroup sensitivity analysis was performed based on age, mode of medicine, observation time and research quality. Sixty-three studies involving 9,793 patients with Qingkailing injection were included, 367 cases of adverse reactions/events were reported in total. The incidence rate of adverse reaction in skin and mucosa group was 2% [95% CI (0.02; 0.03)]; the digestive system adverse reaction was 6% [95% CI(0.05; 0.07); the injection site adverse reaction was 4% [95% CI (0.02; 0.07)]. In the digestive system as the main types of adverse reactions/events, incidence of children and adults were 4.6% [0.021 1; 0.097 7] and 6.9% [0.053 5; 0.089 8], respectively. Adverse reactions to skin and mucous membrane damage as the main performance/event type, the observation time > 7 days and ≤ 7 days incidence of 3% [0.012 9; 0.068 3] and 1.9% [0.007 8; 0.046 1], respectively. Subgroup analysis showed that different types of adverse reactions, combination in the incidence of adverse reactions/events were higher than that of single drug, the difference was statistically significant (P reactions occur, and clinical rational drug use, such as combination, age and other fators, and the influence factors vary in different populations. Therefore, clinical doctors for children and the elderly use special care was required for a clear and open spirit injection, the implementation of individualized medication.

  7. Unfamiliar voice identification: Effect of post-event information on accuracy and voice ratings

    Directory of Open Access Journals (Sweden)

    Harriet Mary Jessica Smith

    2014-04-01

    Full Text Available This study addressed the effect of misleading post-event information (PEI on voice ratings, identification accuracy, and confidence, as well as the link between verbal recall and accuracy. Participants listened to a dialogue between male and female targets, then read misleading information about voice pitch. Participants engaged in verbal recall, rated voices on a feature checklist, and made a lineup decision. Accuracy rates were low, especially on target-absent lineups. Confidence and accuracy were unrelated, but the number of facts recalled about the voice predicted later lineup accuracy. There was a main effect of misinformation on ratings of target voice pitch, but there was no effect on identification accuracy or confidence ratings. As voice lineup evidence from earwitnesses is used in courts, the findings have potential applied relevance.

  8. Intervention analysis of introduction of rotavirus vaccine on hospital admissions rates due to acute diarrhea

    Directory of Open Access Journals (Sweden)

    Maria de Lourdes Teixeira Masukawa

    2014-10-01

    Full Text Available The aim of this study is to investigate the impact of rotavirus vaccine on hospitalization rates for acute diarrhea in children younger than 5 years old after the introduction of the vaccine in 2006. A descriptive analytical observational study was carried out of the hospitalization rates occurred between 2000 and 2011 in 22 Regional Health Centers of Paraná State, Brazil. The effect of the vaccine was assessed by applying the SARIMA/Box-Jenkins time series methodology of intervention analysis, which allows verifying the slopes of the series are different after the introduction of the vaccine and estimating the magnitude of these effects for children younger than five years of age, by age group, for each region center. It was verified a statistically significant reduction by center/month on hospitalization rates for children 1 year old and younger, with averages of 47% and 58%, respectively, in December 2011.

  9. Cesarean Delivery Rates Vary 10-Fold Among US Hospitals; Reducing Variation May Address Quality, Cost Issues

    Science.gov (United States)

    Kozhimannil, Katy Backes; Law, Michael R.; Virnig, Beth A.

    2013-01-01

    Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordination of maternity care, more data collection and measurement, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting. PMID:23459732

  10. Spectral analysis of time series of events: effect of respiration on heart rate in neonates

    International Nuclear Information System (INIS)

    Van Drongelen, Wim; Williams, Amber L; Lasky, Robert E

    2009-01-01

    Certain types of biomedical processes such as the heart rate generator can be considered as signals that are sampled by the occurring events, i.e. QRS complexes. This sampling property generates problems for the evaluation of spectral parameters of such signals. First, the irregular occurrence of heart beats creates an unevenly sampled data set which must either be pre-processed (e.g. by using trace binning or interpolation) prior to spectral analysis, or analyzed with specialized methods (e.g. Lomb's algorithm). Second, the average occurrence of events determines the Nyquist limit for the sampled time series. Here we evaluate different types of spectral analysis of recordings of neonatal heart rate. Coupling between respiration and heart rate and the detection of heart rate itself are emphasized. We examine both standard and data adaptive frequency bands of heart rate signals generated by models of coupled oscillators and recorded data sets from neonates. We find that an important spectral artifact occurs due to a mirror effect around the Nyquist limit of half the average heart rate. Further we conclude that the presence of respiratory coupling can only be detected under low noise conditions and if a data-adaptive respiratory band is used

  11. LIMITS ON THE EVENT RATES OF FAST RADIO TRANSIENTS FROM THE V-FASTR EXPERIMENT

    International Nuclear Information System (INIS)

    Wayth, Randall B.; Tingay, Steven J.; Deller, Adam T.; Brisken, Walter F.; Thompson, David R.; Wagstaff, Kiri L.; Majid, Walid A.

    2012-01-01

    We present the first results from the V-FASTR experiment, a commensal search for fast transient radio bursts using the Very Long Baseline Array (VLBA). V-FASTR is unique in that the widely spaced VLBA antennas provide a discriminant against non-astronomical signals and a mechanism for the localization and identification of events that is not possible with single dishes or short baseline interferometers. Thus, far V-FASTR has accumulated over 1300 hr of observation time with the VLBA, between 90 cm and 3 mm wavelength (327 MHz-86 GHz), providing the first limits on fast transient event rates at high radio frequencies (>1.4 GHz). V-FASTR has blindly detected bright individual pulses from seven known pulsars but has not detected any single-pulse events that would indicate high-redshift impulsive bursts of radio emission. At 1.4 GHz, V-FASTR puts limits on fast transient event rates comparable with the PALFA survey at the Arecibo telescope, but generally at lower sensitivities, and comparable to the 'fly's eye' survey at the Allen Telescope Array, but with less sky coverage. We also illustrate the likely performance of the Phase 1 SKA dish array for an incoherent fast transient search fashioned on V-FASTR.

  12. Pharmacotherapy for adverse events reduces the length of hospital stay in patients admitted to otolaryngology ward: a single arm intervention study.

    Directory of Open Access Journals (Sweden)

    Akio Suzuki

    Full Text Available To determine whether adverse events extend the duration of hospitalization, and to evaluate the effectiveness of medical intervention in ameliorating adverse events and reducing the prolonged hospital stay associated with adverse events.A single arm intervention study was conducted from October 2012 to March 2014 in the otolaryngology ward of a 614-bed, university-affiliated hospital. Adverse events were monitored daily by physicians, pharmacists and nurses, and recorded in the electronic medical chart for each patient. Appropriate drug management of adverse events was performed by physicians in liaison with pharmacists. The Kaplan-Meier method was used to assess the length of hospitalization of patients who underwent medical intervention for adverse events.Of 571 patients admitted to the otolaryngology ward in a year, 219 patients (38.4% experienced adverse events of grade ≥2. The duration of hospitalization was affected by the grade of adverse events, with a mean duration of hospital stay of 9.2, 17.2, 28.3 and 47.0 days for grades 0, 1, 2, and 3-4, respectively. Medical intervention lowered the incidence of grade ≥2 adverse events to 14.5%. The length of hospitalization was significantly shorter in patients who showed an improvement of adverse events after medical intervention than those who did not (26.4 days vs. 41.6 days, hazard ratio 1.687, 95% confidence interval: 1.260-2.259, P<0.001. A multivariate Cox proportional hazard analysis indicated that insomnia, constipation, nausea/vomiting, infection, non-cancer pain, oral mucositis, odynophagia and neutropenia were significant risk factors for prolongation of hospital stay.Patients who experienced adverse events are at high risk of prolonged hospitalization. Medical intervention for adverse events was found to be effective in reducing the length of hospital stay associated with adverse events.

  13. Nonstationarities in the occurrence rates of flood events in Portuguese watersheds

    Directory of Open Access Journals (Sweden)

    A. T. Silva

    2012-01-01

    Full Text Available An exploratory analysis on the variability of flood occurrence rates in 10 Portuguese watersheds is made, to ascertain if that variability is concurrent with the principle of stationarity. A peaks-over-threshold (POT sampling technique is applied to 10 long series of mean daily streamflows and to 4 long series of daily rainfall in order to sample the times of occurrence (POT time data of the peak values of those series. The kernel occurrence rate estimator, coupled with a bootstrap approach, was applied to the POT time data to obtain the time dependent estimated occurrence rate curves, λˆ(t, of floods and extreme rainfall events. The results of the analysis show that the occurrence of those events constitutes an inhomogeneous Poisson process, hence the occurrence rates are nonstationary. An attempt was made to assess whether the North Atlantic Oscillation (NAO casted any influence on the occurrence rate of floods in the study area. Although further research is warranted, it was found that years with a less-than-average occurrence of floods tend to occur when the winter NAO is in the positive phase, and years with a higher occurrence of floods (more than twice the average tend to occur when the winter NAO is in the negative phase. Although the number of analyzed watersheds and their uneven spatial distribution hinders the generalization of the findings to the country scale, the authors conclude that the mathematical formulation of the flood frequency models relying on stationarity commonly employed in Portugal should be revised in order to account for possible nonstationarities in the occurrence rates of such events.

  14. Evaluation of Survival Rate and Effective Factors in Acute Myocardial Infarction Patients in Emam Hospital (Year 2000

    Directory of Open Access Journals (Sweden)

    M Maghsoodloo

    2002-09-01

    Full Text Available Introduction: For the time being we have considered that the myocardial infarction is an increasing event in Islamic Republic of Iran and there are many procedures and methods which can help us to diminish the number of death from this ongoing event. The main aim of this research is to determine the survival rate in those patients who have had acute myocardial infarction and the association of it with different variables. Methods and Materials: The present research is a descriptive case-series study which evaluates the 100 cases of acute myocardial infarction who had been admitted in Tehran Emam Khomeini Hospital during the year 1999. Results: The mean age of patients was 57 years. The peak of attack rates was in spring and autumn. Investigating of the past history of these patients reviled that 41 percent had been smokers, 63.5 percent have had the history of previous ischemic heart disease, 41 percent have had hyper cholestrolemia, 34 percent had hypertension, 18 percent had diabetes mellitus, 9 percent had mitral rigurgitation and 9 percent had heart block. The Survival rate in our study has been calculated 68 percent in first 28 days of disease. Conclusion: In our study we concluded that there is significant correlation between survival rate and past history of hypertension, ischemic heart disease, tobacco smoking and clip classification.

  15. Developing models for the prediction of hospital healthcare waste generation rate.

    Science.gov (United States)

    Tesfahun, Esubalew; Kumie, Abera; Beyene, Abebe

    2016-01-01

    An increase in the number of health institutions, along with frequent use of disposable medical products, has contributed to the increase of healthcare waste generation rate. For proper handling of healthcare waste, it is crucial to predict the amount of waste generation beforehand. Predictive models can help to optimise healthcare waste management systems, set guidelines and evaluate the prevailing strategies for healthcare waste handling and disposal. However, there is no mathematical model developed for Ethiopian hospitals to predict healthcare waste generation rate. Therefore, the objective of this research was to develop models for the prediction of a healthcare waste generation rate. A longitudinal study design was used to generate long-term data on solid healthcare waste composition, generation rate and develop predictive models. The results revealed that the healthcare waste generation rate has a strong linear correlation with the number of inpatients (R(2) = 0.965), and a weak one with the number of outpatients (R(2) = 0.424). Statistical analysis was carried out to develop models for the prediction of the quantity of waste generated at each hospital (public, teaching and private). In these models, the number of inpatients and outpatients were revealed to be significant factors on the quantity of waste generated. The influence of the number of inpatients and outpatients treated varies at different hospitals. Therefore, different models were developed based on the types of hospitals. © The Author(s) 2015.

  16. The Informational Content of Credit Ratings in Brazil: An Event Study

    Directory of Open Access Journals (Sweden)

    Flávia Cruz de Souza Murcia

    2014-03-01

    Full Text Available This study analyzes the effect of credit rating announcements on stock returns in the Brazilian market during 1997-2011. We conducted an event study using a sample of 242 observations of listed companies, 179 from Standard and Poor’s and 63 from Moody’s, to analyze stock market reaction. Abnormal returns have been computed using the Market Model and CAPM for three windows: three days (-1, +1, 11 days (-5, +5 and 21 days (-10, +10. We find statistically significant abnormal returns in days -1 and 0 for all the three types of rating announcement tested: initial rating, downgrades and upgrades. For downgrades, consisted with prior studies, our results also showed negative abnormal returns for all practically all windows tested. Overall, our findings evidence the rating announcements do have information content, as it impacts stock returns causing abnormal returns, especially when they bring ‘bad news’ to the market.

  17. Preventable Hospitalization Rates and Neighborhood Poverty among New York City Residents, 2008-2013.

    Science.gov (United States)

    Bocour, Angelica; Tria, Maryellen

    2016-12-01

    Knowing which demographic groups have higher rates of preventable hospitalizations can help identify geographic areas where improvements in primary care access and quality can be made. This study assessed whether preventable hospitalization rates by neighborhood poverty decreased from 2008 to 2013 and whether the gap between very high and low poverty neighborhoods changed. We examined trends in age-adjusted preventable hospitalization rates and rate ratios by neighborhood poverty overall and by sex using JoinPoint regression. Prevention Quality Indicators (PQIs) developed by the Agency for Healthcare Research and Quality were applied to inpatient hospitalization data from the New York State Department of Health's Statewide Planning and Research Cooperative System. PQIs were classified into composites. From 2008 to 2013, preventable hospitalization rates per 100,000 adults across each poverty group decreased. For very high poverty neighborhoods (ZIP codes with ≥30 % of persons living below the federal poverty level (FPL)), there were significant decreases overall (3430.56 to 2543.10, annual percent change [APC] = -5.91 %), for diabetes (676.15 to 500.83, APC = -5.75 %), respiratory (830.78 to 660.29, APC = -4.85 %), circulatory (995.69 to 701.81, APC = -7.24 %), and acute composites (928.18 to 680.17, APC = -5.62 %). The rate ratios also decreased over time; however, in 2013, the rates for very high poverty neighborhoods were two to four times higher than low poverty neighborhoods (ZIP codes with still exist. These findings underscore the need to ensure adequate access to quality and timely primary care among individuals living in high poverty neighborhoods.

  18. Chest compression rates and survival following out-of-hospital cardiac arrest.

    Science.gov (United States)

    Idris, Ahamed H; Guffey, Danielle; Pepe, Paul E; Brown, Siobhan P; Brooks, Steven C; Callaway, Clifton W; Christenson, Jim; Davis, Daniel P; Daya, Mohamud R; Gray, Randal; Kudenchuk, Peter J; Larsen, Jonathan; Lin, Steve; Menegazzi, James J; Sheehan, Kellie; Sopko, George; Stiell, Ian; Nichol, Graham; Aufderheide, Tom P

    2015-04-01

    Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions/min. A recent clinical study reported optimal return of spontaneous circulation with rates between 100 and 120/min during cardiopulmonary resuscitation for out-of-hospital cardiac arrest. However, the relationship between compression rate and survival is still undetermined. Prospective, observational study. Data is from the Resuscitation Outcomes Consortium Prehospital Resuscitation IMpedance threshold device and Early versus Delayed analysis clinical trial. Adults with out-of-hospital cardiac arrest treated by emergency medical service providers. None. Data were abstracted from monitor-defibrillator recordings for the first five minutes of emergency medical service cardiopulmonary resuscitation. Multiple logistic regression assessed odds ratio for survival by compression rate categories (compression fraction and depth, first rhythm, and study site. Compression rate data were available for 10,371 patients; 6,399 also had chest compression fraction and depth data. Age (mean±SD) was 67±16 years. Chest compression rate was 111±19 per minute, compression fraction was 0.70±0.17, and compression depth was 42±12 mm. Circulation was restored in 34%; 9% survived to hospital discharge. After adjustment for covariates without chest compression depth and fraction (n=10,371), a global test found no significant relationship between compression rate and survival (p=0.19). However, after adjustment for covariates including chest compression depth and fraction (n=6,399), the global test found a significant relationship between compression rate and survival (p=0.02), with the reference group (100-119 compressions/min) having the greatest likelihood for survival. After adjustment for chest compression fraction and depth, compression rates between 100 and 120 per minute were associated with greatest survival to hospital discharge.

  19. The fluoridation of drinking water and hip fracture hospitalization rates in two Canadian communities.

    Science.gov (United States)

    Suarez-Almazor, M E; Flowerdew, G; Saunders, L D; Soskolne, C L; Russell, A S

    1993-05-01

    The purpose of this study was to compare hip fracture hospitalization rates between a fluoridated and a non-fluoridated community in Alberta, Canada: Edmonton, which has had fluoridated drinking water since 1967, and Calgary, which considered fluoridation in 1991 but is currently revising this decision. Case subjects were all individuals aged 45 years or older residing in Edmonton or Calgary who were admitted to hospitals in Alberta between January 1, 1981, and December 31, 1987, and who had a discharge diagnosis of hip fracture. Edmonton rates were compared with Calgary rates, with adjustment for age and sex using the Edmonton population as a standard. The hip fracture hospitalization rate for Edmonton from 1981 through 1987 was 2.77 per 1000 person-years. The age-sex standardized rate for Calgary was 2.78 per 1000 person-years. No statistically significant difference was observed in the overall rate, and only minor differences were observed within age and sex subgroups, with the Edmonton rates being higher in males. These findings suggest that fluoridation of drinking water has no impact, neither beneficial nor deleterious, on the risk of hip fracture.

  20. Annual changes in rotavirus hospitalization rates before and after rotavirus vaccine implementation in the United States.

    Science.gov (United States)

    Shah, Minesh P; Dahl, Rebecca M; Parashar, Umesh D; Lopman, Benjamin A

    2018-01-01

    Hospitalizations for rotavirus and acute gastroenteritis (AGE) have declined in the US with rotavirus vaccination, though biennial peaks in incidence in children aged less than 5 years occur. This pattern may be explained by lower rotavirus vaccination coverage in US children (59% to 73% from 2010-2015), resulting in accumulation of susceptible children over two successive birth cohorts. Retrospective cohort analysis of claims data of commercially insured US children aged rotavirus and for AGE from the 2002-2015 rotavirus seasons were examined. Median age and rotavirus vaccination coverage for biennial rotavirus seasons during pre-vaccine (2002-2005), early post-vaccine (2008-2011) and late post-vaccine (2012-2015) years. Age-stratified hospitalization rates decreased from pre-vaccine to early post-vaccine and then to late post-vaccine years. The clearest biennial pattern in hospitalization rates is the early post-vaccine period, with higher rates in 2009 and 2011 than in 2008 and 2010. The pattern diminishes in the late post-vaccine period. For rotavirus hospitalizations, the median age and the difference in age between biennial seasons was highest during the early post-vaccine period; these differences were not observed for AGE hospitalizations. There was no significant difference in vaccination coverage between biennial seasons. These observations provide conflicting evidence that incomplete vaccine coverage drove the biennial pattern in rotavirus hospitalizations that has emerged with rotavirus vaccination in the US. As this pattern is diminishing with higher vaccine coverage in recent years, further increases in vaccine coverage may reach a threshold that eliminates peak seasons in hospitalizations.

  1. 42 CFR 412.328 - Determining and updating the hospital-specific rate.

    Science.gov (United States)

    2010-10-01

    ... of stay for each transfer case by the geometric mean length of stay for the DRG (but in no case using... rate. (c) Case-mix adjustment—(1) Determining transfer-adjusted case mix value. Step 1: For base year... received as of June 30, 1991 to determine the hospital's transfer-adjusted case-mix value. For base year...

  2. The readmission rates in patients with versus those without diabetes mellitus at an urban teaching hospital.

    Science.gov (United States)

    Sonmez, Halis; Kambo, Varinder; Avtanski, Dimiter; Lutsky, Larry; Poretsky, Leonid

    2017-12-01

    We examined the 30-day hospital readmission rates and their association with the admission diagnosis and the length of stay (LOS) in patients with diabetes versus those without diabetes mellitus (DM) in an urban teaching hospital. In this retrospective study, we compared the 30-day readmission rates in patients with DM (n=16,266) versus those without DM (n=86,428) at an urban teaching hospital between January 1, 2013, and September 30, 2015. In individuals with a secondary diagnosis of DM, we analyzed the relationship between readmission rates and the ten most common Medicare Severity Diagnosis Related Groups (MS-DRGs). Additionally, we examined the relationship between the LOS and readmission rates in patients with diabetes and those without DM. The 30-day readmission rates adjusted for age and gender were higher in patients with DM compared to those without DM (15.3% vs. 8.4%, respectively, readmissions was present both in patients with a primary or a secondary diagnosis of DM. For the secondary diagnosis of DM, statistically significant difference was present for two out of the ten most common DRGs (DRG # 313 [chest pain], and # 392 [esophagitis, gastroenteritis, and miscellaneous digestive disorders], p=0.045 and 0.009, respectively). There was a direct correlation between LOS and readmission rates in both patients with diabetes and those without DM (preadmission rates are higher in patients with DM compared to patients without DM. DM is an independent risk factor for hospital readmissions. The readmission rates correlate directly with LOS in both patients with diabetes and those without DM. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

    Science.gov (United States)

    Aiken, Linda H; Rafferty, Anne Marie; Bruyneel, Luk; McHugh, Matthew; Maier, Claudia B; Moreno-Casbas, Teresa; Ball, Jane E; Ausserhofer, Dietmar; Sermeus, Walter

    2017-01-01

    Objectives To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. Design Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. Setting Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. Participants Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals. Main outcome measures Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. Results Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80nurses is associated with an 11% increase in the odds of death. In our hospital sample, there were an average of six caregivers for every 25 patients, four of whom were professional nurses. Substituting one nurse assistant for a professional nurse for every 25 patients is associated with a 21% increase in the odds of dying. Conclusions A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages. PMID:28626086

  4. Estimating rate of occurrence of rare events with empirical bayes: A railway application

    International Nuclear Information System (INIS)

    Quigley, John; Bedford, Tim; Walls, Lesley

    2007-01-01

    Classical approaches to estimating the rate of occurrence of events perform poorly when data are few. Maximum likelihood estimators result in overly optimistic point estimates of zero for situations where there have been no events. Alternative empirical-based approaches have been proposed based on median estimators or non-informative prior distributions. While these alternatives offer an improvement over point estimates of zero, they can be overly conservative. Empirical Bayes procedures offer an unbiased approach through pooling data across different hazards to support stronger statistical inference. This paper considers the application of Empirical Bayes to high consequence low-frequency events, where estimates are required for risk mitigation decision support such as as low as reasonably possible. A summary of empirical Bayes methods is given and the choices of estimation procedures to obtain interval estimates are discussed. The approaches illustrated within the case study are based on the estimation of the rate of occurrence of train derailments within the UK. The usefulness of empirical Bayes within this context is discussed

  5. Events

    Directory of Open Access Journals (Sweden)

    Igor V. Karyakin

    2016-02-01

    Full Text Available The 9th ARRCN Symposium 2015 was held during 21st–25th October 2015 at the Novotel Hotel, Chumphon, Thailand, one of the most favored travel destinations in Asia. The 10th ARRCN Symposium 2017 will be held during October 2017 in the Davao, Philippines. International Symposium on the Montagu's Harrier (Circus pygargus «The Montagu's Harrier in Europe. Status. Threats. Protection», organized by the environmental organization «Landesbund für Vogelschutz in Bayern e.V.» (LBV was held on November 20-22, 2015 in Germany. The location of this event was the city of Wurzburg in Bavaria.

  6. Work stress and patient safety: observer-rated work stressors as predictors of characteristics of safety-related events reported by young nurses.

    Science.gov (United States)

    Elfering, A; Semmer, N K; Grebner, S

    This study investigates the link between workplace stress and the 'non-singularity' of patient safety-related incidents in the hospital setting. Over a period of 2 working weeks 23 young nurses from 19 hospitals in Switzerland documented 314 daily stressful events using a self-observation method (pocket diaries); 62 events were related to patient safety. Familiarity of safety-related events and probability of recurrence, as indicators of non-singularity, were the dependent variables in multilevel regression analyses. Predictor variables were both situational (self-reported situational control, safety compliance) and chronic variables (job stressors such as time pressure, or concentration demands and job control). Chronic work characteristics were rated by trained observers. The most frequent safety-related stressful events included incomplete or incorrect documentation (40.3%), medication errors (near misses 21%), delays in delivery of patient care (9.7%), and violent patients (9.7%). Familiarity of events and probability of recurrence were significantly predicted by chronic job stressors and low job control in multilevel regression analyses. Job stressors and low job control were shown to be risk factors for patient safety. The results suggest that job redesign to enhance job control and decrease job stressors may be an important intervention to increase patient safety.

  7. Age and Sex Differences in Rates of Influenza-Associated Hospitalizations in Hong Kong.

    Science.gov (United States)

    Wang, Xi-Ling; Yang, Lin; Chan, Kwok-Hung; Chan, King-Pan; Cao, Pei-Hua; Lau, Eric Ho-Yin; Peiris, J S Malik; Wong, Chit-Ming

    2015-08-15

    Few studies have explored age and sex differences in the disease burden of influenza, although men and women probably differ in their susceptibility to influenza infections. In this study, quasi-Poisson regression models were applied to weekly age- and sex-specific hospitalization numbers of pneumonia and influenza cases in the Hong Kong SAR, People's Republic of China, from 2004 to 2010. Age and sex differences were assessed by age- and sex-specific rates of excess hospitalization for influenza A subtypes A(H1N1), A(H3N2), and A(H1N1)pdm09 and influenza B, respectively. We found that, in children younger than 18 years, boys had a higher excess hospitalization rate than girls, with the male-to-female ratio of excess rate (MFR) ranging from 1.1 to 2.4. MFRs of hospitalization associated with different types/subtypes were less than 1.0 for adults younger than 40 years except for A(H3N2) (MFR = 1.6), while all the MFRs were equal to or higher than 1.0 in adults aged 40 years or more except for A(H1N1)pdm09 in elderly persons aged 65 years or more (MFR = 0.9). No MFR was found to be statistically significant (P < 0.05) for hospitalizations associated with influenza type/subtype. There is some limited evidence on age and sex differences in hospitalization associated with influenza in the subtropical city of Hong Kong. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Birth rates and pregnancy complications in adolescent pregnant women giving birth in the hospitals of Thailand.

    Science.gov (United States)

    Butchon, Rukmanee; Liabsuetrakul, Tippawan; McNeil, Edward; Suchonwanich, Yolsilp

    2014-08-01

    To determine the rates of births in adolescent pregnant women in diferent regions of Thailand and assess the rates of complications occurring at pregnancy, childbirth, and postpartum in women admitted in the hospitals ofThailand. The secondary analysis of data from pregnant women aged 10 to 49 years, who were admitted to hospitals and recorded in the National Health Security Office database between October 2010 and September 2011 was carried out. Adolescent birth rate by the regions and rate of complications ofpregnancy, delivery, and postpartum by age groups were analyzed. Highest birth rate was found among women aged 19 years (58.3 per 1, 000 population). The distribution of adolescent births varied across regions of Thailand, which was high in central region. Rate of preterm delivery was highest (10%) in adolescent aged 10 to 14 years. Rate of diabetes mellitus (6%), preeclampsia (4%), and postpartum hemorrhage (3%) among women aged 35 to 49 years were substantially higher than those among women aged 34 years or less. Adolescent birth rate varied across regions of Thailand. Complications occurred differently by ages of women. Holistic policy and planning strategies for proper prevention and management among pregnant women in different age groups are needed

  9. Compact Binary Mergers and the Event Rate of Fast Radio Bursts

    Science.gov (United States)

    Cao, Xiao-Feng; Yu, Yun-Wei; Zhou, Xia

    2018-05-01

    Fast radio bursts (FRBs) are usually suggested to be associated with mergers of compact binaries consisting of white dwarfs (WDs), neutron stars (NSs), or black holes (BHs). We test these models by fitting the observational distributions in both redshift and isotropic energy of 22 Parkes FRBs, where, as usual, the rates of compact binary mergers (CBMs) are connected with cosmic star formation rates by a power-law distributed time delay. It is found that the observational distributions can well be produced by the CBM model with a characteristic delay time from several tens to several hundreds of megayears and an energy function index 1.2 ≲ γ ≲ 1.7, where a tentative fixed spectral index β = 0.8 is adopted for all FRBs. Correspondingly, the local event rate of FRBs is constrained to {(3{--}6)× {10}4{f}{{b}}-1({ \\mathcal T }/270{{s}})}-1{({ \\mathcal A }/2π )}-1 {Gpc}}-3 {yr}}-1 for an adopted minimum FRB energy of E min = 3 × 1039 erg, where f b is the beaming factor of the radiation, { \\mathcal T } is the duration of each pointing observation, and { \\mathcal A } is the sky area of the survey. This event rate, about an order of magnitude higher than the rates of NS–NS/NS–BH mergers, indicates that the most promising origin of FRBs in the CBM scenario could be mergers of WD–WD binaries. Here a massive WD could be produced since no FRB was found to be associated with an SN Ia. Alternatively, if all FRBs can repeat on a timescale much longer than the period of current observations, then they could also originate from a young active NS that forms from relatively rare NS–NS mergers and accretion-induced collapses of WD–WD binaries.

  10. Incidence, hospital costs and in-hospital mortality rates of surgically treated patients with traumatic cranial epidural hematoma

    Directory of Open Access Journals (Sweden)

    Atci Ibrahim Burak

    2017-12-01

    Full Text Available Background: In this study, the patients who were operated in two clinics due to traumatic cranial epidural hematoma (EDH were assessed retrospectively and the factors that increase the costs were tried to be revealed through conducting cost analyses. Methods: The patients who were operated between 2010 and 2016 with the diagnosis of EDH were assessed in terms of age, sex, trauma etiology, Glasgow coma scale (GCS at admission, the period from trauma to hospital arrival, trauma-related injury in other organs, the localization of hematoma, the size of hematoma, length of stay in the intensive care unit (ICU, length of antibiotherapy administration, number of consultations conducted, total cost of in-hospital treatments of the patients and prognosis. Results: Distribution of GCS were, between 13-15 in 18 (36% patients, 9-13 in 23 (46% patients and 3-8 in 9 (18% patients. The reasons for emergency department admissions were fall from high in 29 (58% patients, assault in 11 (22% patients and motor vehicle accident in 10 (20% patients. The average cost per ICU stay was 2838 $ (range=343-20571 $. The average cost per surgical treatment was 314 $. ICU care was approximately 9 times more expensive than surgical treatment costs. The mortality rate of the study cohort was 14% (7 patients. Conclusion: The prolonged period of stay in the ICU, antibiotherapy and repeat head CTs increase the costs for patients who are surgically treated for EDH.

  11. Assessing the nosocomial infections' rate and the antibiotic resistance pattern among the patient hospitalized in beheshti hospital during 2013

    Directory of Open Access Journals (Sweden)

    Manijeh Kadkhodaei

    2018-01-01

    Full Text Available Aims: Nosocomial infection is associated with increased mortality, morbidity, and length of stay. Detection of infection, identify the etiology of bacterial antibiotic resistance pattern, is necessary given the widespread use of antibiotics and antibiotic-resistant organisms. Materials and Methods: This cross-sectional study was done on 288 patients admitted to the Beheshti Hospitals in Kashan based on NNIS definitions according to the state of Health and Medical education. In this study infections and antibiotic resistance symptoms were found. Data analyses were performed with Chi-square test. Results: Among the 288 patients studied, with mean out of hospital infection was 0.80%. Most cases of infection associated were pneumonia. The highest rates of infection were in the Intensive Care Unit (ICU with 51.7%. Nosocomial infection in ICU wards was associated with increased mortality and morbidity. The most common types were ventilator-associated pneumonia. Among the microorganisms, negative Gram was seen more. The common pathogens were including Acinetobacter, Escherichia coli, and Klebsiella. Antimicrobial resistance was generally increasing and had emerged from selective pressure from antibiotic use and transmission through health staff. Conclusion: This study showed a correlation between antibiotic use and resistance of microorganisms is significant. Hence, it seems that reducing aggressive acts and conduct hygiene education and monitoring act of antibiotics is necessary to prevent antibiotic resistance.

  12. RFID-based information visibility for hospital operations: exploring its positive effects using discrete event simulation.

    Science.gov (United States)

    Asamoah, Daniel A; Sharda, Ramesh; Rude, Howard N; Doran, Derek

    2016-10-12

    Long queues and wait times often occur at hospitals and affect smooth delivery of health services. To improve hospital operations, prior studies have developed scheduling techniques to minimize patient wait times. However, these studies lack in demonstrating how such techniques respond to real-time information needs of hospitals and efficiently manage wait times. This article presents a multi-method study on the positive impact of providing real-time scheduling information to patients using the RFID technology. Using a simulation methodology, we present a generic scenario, which can be mapped to real-life situations, where patients can select the order of laboratory services. The study shows that information visibility offered by RFID technology results in decreased wait times and improves resource utilization. We also discuss the applicability of the results based on field interviews granted by hospital clinicians and administrators on the perceived barriers and benefits of an RFID system.

  13. Eye Donation Awareness and Conversion Rate in Hospital Cornea Retrieval Programme in a Tertiary Hospital of Central India.

    Science.gov (United States)

    Sharma, Bhavana; Shrivastava, Ulka; Kumar, Kavita; Baghel, Rajendra; Khan, Farhana; Kulkarni, Shridhar

    2017-08-01

    Corneal blindness accounts for 6-8 million blinds in the world. In India, it is estimated that there are approximately 6.8 million people who have vision less than 6/60 in at least one eye due to corneal diseases. This study was done to assess the awareness about eye donation amongst attendants of critically ill and deceased patients, their willingness to donate eyes, the efficacy of grief counselling by Eye Donation Counsellors (EDC), its impact on the conversion rate and the reasons for poor donation rate. This prospective hospital based study was done in 554 participants (guardians of critically ill and deceased subjects) to understand the awareness of eye donation. Factors related to willingness for eye donation that influenced conversion to actual donation were evaluated. Data was analysed with tests for statistical significance: Chi square test; pdonation, time taken for motivation remained less than 12 hours, which was statistically significant (Chi square=106. pdonation in comparison to those who were unaware in a ratio of 2:1. Grief counsellors (57.5%) had the most influence among the causes that were facilitators of donation. Utilizing the services of eye donation counsellors is a promising way to motivate the guardians of deceased. Increasing the awareness in society, rendering simple assistances to next of kin and speeding the medico legal formalities can go a long way in increasing the conversion rate and hence actual donation.

  14. [Who is rehospitalized in a psychiatric hospital? Psychiatric hospitalization rates and social indicators in the Zurich canton (Switzerland)].

    Science.gov (United States)

    Rüesch, P; Meyer, P C; Hell, D

    2000-03-01

    There are two approaches in the research on the relation between social conditions and mental disorder: The ecological approach is concerned with characteristics of the social composition of a certain geographical area and their relation to the frequency of disorders, whereas for the individualistic view variables of the psychosocial background of the individual are of interest. This study is on the risk for psychiatric admission (first and re-admission). While considering variables of the social context of the community as well as of the background of the individual, it tries to take into account both the ecological and the individualistic view of the relationship between social conditions and (treated) mental disorder. The sample of the study includes data of 4021 psychiatric inpatients treated in 1997 in one of the seven psychiatric hospitals of the Swiss canton of Zurich as well as data of social context of the 171 communities of the canton of Zurich. The psychiatric first and re-admission rates of the community can be predicted by the following variables of its social context: 1. pro portion of foreigners, 2. urban character of the living area, 3. population density. Two other variables are of relevance only for the prediction of first admissions: 4. proportion of one-person households and 5. local tax rate. However, further results of the study show that correlations between variables of the social context and psychiatric admission rate of the community cannot be interpreted as risks for the individual.

  15. Adverse events associated with meropenem versus imipenem/cilastatin therapy in a large retrospective cohort of hospitalized infants.

    Science.gov (United States)

    Hornik, Christoph P; Herring, Amy H; Benjamin, Daniel K; Capparelli, Edmund V; Kearns, Gregory L; van den Anker, John; Cohen-Wolkowiez, Michael; Clark, Reese H; Smith, P Brian

    2013-07-01

    Carbapenems are commonly used in hospitalized infants despite a lack of complete safety data and associations with seizures in older children. We compared the incidence of adverse events in hospitalized infants receiving meropenem versus imipenem/cilastatin. We conducted a retrospective cohort study of 5566 infants treated with meropenem or imipenem/cilastatin in neonatal intensive care units managed by the Pediatrix Medical Group between 1997 and 2010. Multivariable conditional logistic regression was performed to evaluate the association between carbapenem therapy and adverse events, controlling for infant factors and severity of illness. Adverse events were more common with use of meropenem compared with imipenem/cilastatin (62.8/1000 infant days versus 40.7/1000 infant days, P imipenem/cilastatin (adjusted odds ratio 0.96; 95% confidence interval: 0.68, 1.32). The incidence of death, as well as the combined outcome of death or seizure, was lower with meropenem use-odds ratio 0.68 (0.50, 0.88) and odds ratio 0.77 (0.62, 0.95), respectively. In this cohort of infants, meropenem was associated with more frequent but less severe adverse events when compared with imipenem/cilastatin.

  16. Association between Search Behaviors and Disease Prevalence Rates at 18 U.S. Children's Hospitals.

    Science.gov (United States)

    Daniel, Dennis; Wolbrink, Traci; Logvinenko, Tanya; Harper, Marvin; Burns, Jeffrey

    2017-10-01

    Background Usage of online resources by clinicians in training and practice can provide insight into knowledge gaps and inform development of decision support tools. Although online information seeking is often driven by encountered patient problems, the relationship between disease prevalence and search rate has not been previously characterized. Objective This article aimed to (1) identify topics frequently searched by pediatric clinicians using UpToDate (http://www.uptodate.com) and (2) explore the association between disease prevalence rate and search rate using data from the Pediatric Health Information System. Methods We identified the most common search queries and resources most frequently accessed on UpToDate for a cohort of 18 children's hospitals during calendar year 2012. We selected 64 of the most frequently searched diseases and matched ICD-9 data from the PHIS database during the same time period. Using linear regression, we explored the relationship between clinician query rate and disease prevalence rate. Results The hospital cohort submitted 1,228,138 search queries across 592,454 sessions. The majority of search sessions focused on a single search topic. We identified no consistent overall association between disease prevalence and search rates. Diseases where search rate was substantially higher than prevalence rate were often infectious or immune/rheumatologic conditions, involved potentially complex diagnosis or management, and carried risk of significant morbidity or mortality. None of the examined diseases showed a decrease in search rate associated with increased disease prevalence rates. Conclusion This is one of the first medical learning needs assessments to use large-scale, multisite data to identify topics of interest to pediatric clinicians, and to examine the relationship between disease prevalence and search rate for a set of pediatric diseases. Overall, disease search rate did not appear to be associated with hospital

  17. Improved meal presentation increases food intake and decreases readmission rate in hospitalized patients.

    Science.gov (United States)

    Navarro, Daniela Abigail; Boaz, Mona; Krause, Ilan; Elis, Avishay; Chernov, Karina; Giabra, Mursi; Levy, Miriam; Giboreau, Agnes; Kosak, Sigrid; Mouhieddine, Mohamed; Singer, Pierre

    2016-10-01

    Reduced food intake is a frequent problem at a hospital setting, being a cause and/or consequence of malnutrition. Food presentation can affect food intake and induce nutritional benefit. To investigate the effect of improved meal presentation supported by gastronomy expertise on the food intake in adults hospitalized in internal medicine departments. Controlled before and after study. Two hundred and six newly hospitalized patients in internal medicine departments were included and divided in two groups, a) control: receiving the standard lunch from the hospital and b) experimental: receiving a lunch improved in terms of presentation by the advices received by the Institut Paul Bocuse, Ecully, Lyon, France together with the hospital kitchen of the Beilinson Hospital, without change in the composition of the meal. The amount of food left at the participants' plates was estimated using the Digital Imaging Method, which consisted in photographing the plates immediately to previous tray collection by the researcher. In addition, the nutritionDay questionnaire was used to measure other variables concerned to their food intake during hospitalization. Charlson Comorbidity Index was calculated. There was no significant difference between the groups regarding demography or Charlson Comorbidity Index. Patients who received the meal with the improved presentation showed significantly higher food intake than those who received the standard meal, despite reported loss in appetite. Participants from the experimental group left on their plate less starch (0.19 ± 0.30 vs. 0.52 + 0.41) (p  0.05). Both of the groups were asked how hungry they were before the meal and no significance was shown. More participants from the experimental group reported their meal to be tasty in comparison to those in the control group (49.5% vs. 33.7% p < 0.005). Length of stay was not different but readmission rate decreased significantly in the study group (p < 0.02) from 31.2% to 13

  18. Syncope During Competitive Events: Interrogating Heart Rate Monitor Watches May Be Useful!

    Science.gov (United States)

    Thabouillot, Oscar; Bostanci, Kevin; Bouvier, Francois; Dumitrescu, Nicolae; Stéfuriac, Maria; Paule, Philippe; Roche, Nicolas-Charles

    2017-12-01

    This is a case report of a 45-year-old man who reported complete amnesia during the very first kilometer of a 10-km run. He was wearing a heart rate monitor (HRM). The interrogation of his HRM watch showed 200 bpm tachycardia beginning in the first kilometer and increasing up to 220 bpm during the last kilometer. The patient was asked to wear a Holter-monitor (Holter Research Laboratory; Helena, Montana USA) electrocardiogram (ECG) while practicing a training session. This examination allowed for the diagnosis of an adrenergic paroxysmal atrial fibrillation (AF) with an impressive auriculo-ventricular conduction over 260 bpm. This case highlights that non-medical devices, such as connected watches, can be helpful to diagnose arrhythmias. Thabouillot O , Bostanci K , Bouvier F , Dumitrescu N , Stéfuriac M , Paule P , Roche NC . Syncope during competitive events: interrogating heart rate monitor watches may be useful! Prehosp Disaster Med. 2017;32(6):691-693.

  19. Standard and Nonstandard Neutrino-Nucleus Reactions Cross Sections and Event Rates to Neutrino Detection Experiments

    Directory of Open Access Journals (Sweden)

    D. K. Papoulias

    2015-01-01

    Full Text Available In this work, we explore ν-nucleus processes from a nuclear theory point of view and obtain results with high confidence level based on accurate nuclear structure cross sections calculations. Besides cross sections, the present study includes simulated signals expected to be recorded by nuclear detectors and differential event rates as well as total number of events predicted to be measured. Our original cross sections calculations are focused on measurable rates for the standard model process, but we also perform calculations for various channels of the nonstandard neutrino-nucleus reactions and come out with promising results within the current upper limits of the corresponding exotic parameters. We concentrate on the possibility of detecting (i supernova neutrinos by using massive detectors like those of the GERDA and SuperCDMS dark matter experiments and (ii laboratory neutrinos produced near the spallation neutron source facilities (at Oak Ridge National Lab by the COHERENT experiment. Our nuclear calculations take advantage of the relevant experimental sensitivity and employ the severe bounds extracted for the exotic parameters entering the Lagrangians of various particle physics models and specifically those resulting from the charged lepton flavour violating μ-→e- experiments (Mu2e and COMET experiments.

  20. Exploring the relationship between analgesic event rate and pain intensity in kidney stone surgery: A Repeated Time to Event Pilot Study

    DEFF Research Database (Denmark)

    Juul, Rasmus Vestergaard; Pedersen, Katja Venborg; Christrup, Lona Louring

    III-60 Rasmus Juul Exploring the relationship between analgesic event rate and pain intensity in kidney stone surgery: A Repeated Time to Event Pilot Study RV Juul(1), KV Pedersen(2, 4), LL Christrup(1), AE Olesen(1, 3), AM Drewes(3), PJS Osther(4), TM Lund(1) 1) Department of Drug Design...... a relationship with pain intensity has not yet been established. The aim of this pilot study was to discuss how best to investigate the relationship between RTTE hazard of analgesic events and pain intensity in postoperative pain. Methods: Data was available from 44 patients undergoing kidney stone surgery......). Gompertz and exponential distribution models were evaluated. Post-hoc linear mixed effect modelling was performed between estimated RTTE hazard and observed NRS using the lme4 package in R (3). Results: A Gompertz distribution model adequately described data, with a baseline event rate of 0.64h-1 (RSE 25...

  1. Indoor acrolein emission and decay rates resulting from domestic cooking events

    Science.gov (United States)

    Seaman, Vincent Y.; Bennett, Deborah H.; Cahill, Thomas M.

    2009-12-01

    Acrolein (2-propenal) is a common constituent of both indoor and outdoor air, can exacerbate asthma in children, and may contribute to other chronic lung diseases. Recent studies have found high indoor levels of acrolein and other carbonyls compared to outdoor ambient concentrations. Heated cooking oils produce considerable amounts of acrolein, thus cooking is likely an important source of indoor acrolein. A series of cooking experiments were conducted to determine the emission rates of acrolein and other volatile carbonyls for different types of cooking oils (canola, soybean, corn and olive oils) and deep-frying different food items. Similar concentrations and emission rates of carbonyls were found when different vegetable oils were used to deep-fry the same food product. The food item being deep-fried was generally not a significant source of carbonyls compared to the cooking oil. The oil cooking events resulted in high concentrations of acrolein that were in the range of 26.4-64.5 μg m -3. These concentrations exceed all the chronic regulatory exposure limits and many of the acute exposure limits. The air exchange rate and the decay rate of the carbonyls were monitored to estimate the half-life of the carbonyls. The half-life for acrolein was 14.4 ± 2.6 h, which indicates that indoor acrolein concentrations can persist for considerable time after cooking in poorly-ventilated homes.

  2. Are Facebook user ratings associated with hospital cost, quality and patient satisfaction? A cross-sectional analysis of hospitals in New York State.

    Science.gov (United States)

    Campbell, Lauren; Li, Yue

    2018-02-01

    Hospital care costs are high while quality varies across hospitals. Patient satisfaction may be associated with better clinical quality, and social media ratings may offer another opportunity to measure patient satisfaction with care. To test if Facebook user ratings of hospitals are associated with existing measures of patient satisfaction, cost and quality. Data were obtained from Centers for Medicare and Medicaid Services Hospital Compare, the Hospital Inpatient Prospective Payment System impact files and the Area Health Resource File for 2015. Information from hospitals' Facebook pages was collected in July 2016. Multivariate linear regression was used to test if there is an association between Facebook user ratings (star rating and adjusted number of 'likes') and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction measures, the 30-day all-cause readmission rate, and the Medicare spending per beneficiary (MSPB) ratio. One hundred and thirty-six acute care hospitals in New York State in 2015. An increase in the Facebook star rating is associated with significant increases in 21/23 HCAHPS measures (p≤0.003). An increase in the adjusted number of 'likes' is associated with very small increases in 3/23 HCAHPS measures (pFacebook user ratings are not associated with the 30-day all-cause readmission rate or the Medicare spending per beneficiary ratio. Results demonstrate an association between HCAHPS patient satisfaction measures and Facebook star ratings. Adjusted number of 'likes' may not be a useful measure of patient satisfaction. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Success Rate of Trabeculectomy in Primary Glaucoma at Cicendo Eye Hospital on January–December 2013

    Directory of Open Access Journals (Sweden)

    Erva Monica Saputro

    2016-03-01

    Full Text Available Background: Trabeculectomy is a surgical therapy for glaucoma to preserve visual function by lowering intraocular pressure (IOP. In some studies, the success of trabeculectomy in lowering IOP is greater than medication. Success is defined by IOP <21 mmHg, with or without glaucoma medication. Primary glaucoma based on the mechanism of aquous humor outflow is divided into primary open-angle glaucoma (POAG and primary angle-closure glaucoma (PACG. This study aimed to know the success rate of trabeculectomy in POAG and PACG. Methods: This study was a descriptive study conducted at Cicendo Eye Hospital using medical record of POAG and PACG patients who underwent trabeculectomy surgery on January–December 2013 with minimal one month follow-up. Data collection was conducted during September 2014. Data processed in this study were 100 eyes from 76 patients with diagnosis POAG and PACG. Results: The success rate for trabeculectomy in POAG was 79% and PACG was 86%, failure (IOP ≥ 21 mmHg 21% in POAG, and 14% in PACG for period 2013 at Cicendo Eye Hospital. Conclusions: The success rate of trabeculectomy at Cicendo Eye Hospital is good in one month, with or without glaucoma medication after surgery.

  4. Medical costs, Cesarean delivery rates, and length of stay in specialty hospitals vs. non-specialty hospitals in South Korea.

    Directory of Open Access Journals (Sweden)

    Seung Ju Kim

    Full Text Available Since 2011, specialty hospitals in South Korea have been known for providing high- quality care in specific clinical areas. Much research related to specialty hospitals and their performance in many such areas has been performed, but investigations about their performance in obstetrics and gynecology are lacking. Thus, we aimed to compare specialty vs. non-specialty hospitals with respect to mode of obstetric delivery, especially the costs and length of stay related to Cesarean section (CS procedures, and to provide evidence to policy-makers for evaluating the success of hospitals that specialize in obstetric and gynecological (OBGYN care.We obtained National Health Insurance claim data from 2012 to 2014, which included information from 418,141 OBGYN cases at 214 hospitals. We used a generalized estimating equation model to identify a potential association between the likelihood of CS at specialty hospitals compared with other hospitals. We also evaluated medical costs and length of stay in specialty hospitals according to type of delivery.We found that 150,256 (35.9% total deliveries were performed by CS. The odds ratio of CS was significantly lower in specialty hospitals (OR: 0.95, 95% CI: 0.93-0.96compared to other hospitals Medical costs (0.74% and length of stay (1% in CS cases increased in specialty hospitals, although length of stay following vaginal delivery was lower (0.57% in specialty hospitals compared with other hospitals.We determined that specialty hospitals are significantly associated with a lower likelihood of CS delivery and shorter length of stay after vaginal delivery. Although they are also associated with higher costs for delivery, the increased cost could be due to the high level of intensive care provided, which leads to improve quality of care. Policy-makers should consider incentive programs to maintain performance of specialty hospitals and promote efficiency that could reduce medical costs accrued by patients.

  5. Event Rates, Hospital Utilization, and Costs Associated with Major Complications of Diabetes: A Multicountry Comparative Analysis

    OpenAIRE

    Clarke, Philip M.; Glasziou, Paul; Patel, Anushka; Chalmers, John; Harrap, Stephen B.; Woodward, Mark Phillip; Salomon, Joshua A.

    2010-01-01

    Editors' Summary Background Worldwide, nearly 250 million people have diabetes, and this number is increasing rapidly. Diabetes is characterized by dangerous amounts of sugar (glucose) in the blood. Blood sugar levels are normally controlled by insulin, a hormone produced by the pancreas. Blood sugar control fails in people with diabetes because they make no insulin (type 1 diabetes) or, more commonly, because the fat and muscle cells that usually respond to insulin by removing excess sugar f...

  6. The Effect of Significant International Sports Events on Qualified Detoxification Treatment Outcome - Do Drop-Out Rates Change during UEFA European Championship?

    Directory of Open Access Journals (Sweden)

    Yvonne Sofin

    Full Text Available No previous studies have evaluated the influence of significant international sports events on qualified detoxification treatment outcome. This prospective study examines the impact of the 2012 UEFA European Football Championship on inpatient treatment outcome of alcohol dependent patients. Hospital admission and premature drop-out rates of consecutively admitted alcohol dependent patients were determined before, during and immediately after the UEFA Championship in the year 2012. The admission rate of male patients increased significantly after the European Football Championship had ended whereas for female patients, no change in admission rate was found. Daily average discharge rate was calculated. No statistically relevant differences between the treatment days before, during and after the UEFA Championship was found for the discharges. During the tournament, exclusively male patients dropped out. Our results are consistent with an interpretation of an association between European Football Championship and detoxification treatment outcome. Further research to replicate and extend our findings is necessary.

  7. Hospitals

    Data.gov (United States)

    Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...

  8. The influence of disturbance events on survival and dispersal rates of Florida box turtles

    Science.gov (United States)

    Dodd, C.K.; Ozgul, A.; Oli, M.K.

    2006-01-01

    Disturbances have the potential to cause long-term effects to ecosystem structure and function, and they may affect individual species in different ways. Long-lived vertebrates such as turtles may be at risk from such events, inasmuch as their life histories preclude rapid recovery should extensive mortality occur. We applied capture–mark–recapture models to assess disturbance effects on a population of Florida box turtles (Terrapene carolina bauri) on Egmont Key, Florida, USA. Near the midpoint of the study, a series of physical disturbances affected the island, from salt water overwash associated with several tropical storms to extensive removal of nonindigenous vegetation. These disturbances allowed us to examine demographic responses of the turtle population and to determine if they affected dispersal throughout the island. Adult survival rates did not vary significantly either between sexes or among years of the study. Survival rates did not vary significantly between juvenile and adult turtles, or among years of the study. Furthermore, neither adult nor juvenile survival rates differed significantly between pre- and post-disturbance. However, dispersal rates varied significantly among the four major study sites, and dispersal rates were higher during the pre-disturbance sampling periods compared to post-disturbance. Our results suggest few long-term effects on the demography of the turtle population. Florida box turtles responded to tropical storms and vegetation control by moving to favorable habitats minimally affected by the disturbances and remaining there. As long as turtles and perhaps other long-lived vertebrates can disperse to non-disturbed habitat, and high levels of mortality do not occur in a population, a long life span may allow them to wait out the impact of disturbance with potentially little effect on long-term population processes.

  9. Wireless AE Event and Environmental Monitoring for Wind Turbine Blades at Low Sampling Rates

    Science.gov (United States)

    Bouzid, Omar M.; Tian, Gui Y.; Cumanan, K.; Neasham, J.

    Integration of acoustic wireless technology in structural health monitoring (SHM) applications introduces new challenges due to requirements of high sampling rates, additional communication bandwidth, memory space, and power resources. In order to circumvent these challenges, this chapter proposes a novel solution through building a wireless SHM technique in conjunction with acoustic emission (AE) with field deployment on the structure of a wind turbine. This solution requires a low sampling rate which is lower than the Nyquist rate. In addition, features extracted from aliased AE signals instead of reconstructing the original signals on-board the wireless nodes are exploited to monitor AE events, such as wind, rain, strong hail, and bird strike in different environmental conditions in conjunction with artificial AE sources. Time feature extraction algorithm, in addition to the principal component analysis (PCA) method, is used to extract and classify the relevant information, which in turn is used to classify or recognise a testing condition that is represented by the response signals. This proposed novel technique yields a significant data reduction during the monitoring process of wind turbine blades.

  10. ANALYSIS OF PREVALENCE, HOSPITALIZATION RATE AND MORTALITY LEVELS RELATED TO GASTROINTESTINAL DISORDERS IN THE MOSCOW REGION

    Directory of Open Access Journals (Sweden)

    A. N. Gurov

    2015-01-01

    Full Text Available Rationale: According to prognosis made by World Health Organization experts, by mid-21st century gastrointestinal disorders will be among the leaders, partially due to lifestyle of a modern man (stress, unhealthy diet, lack of physical exercise, unhealthy habits, environmental pollution, genetically modified and low quality foods.Aim: To provide informational support of activities aimed at improvement of organization of medical care to patients with gastrointestinal disorders and at further development of specialized gastroenterological care to the population of the Moscow Region, its better availability and higher efficacy and quality.Materials and methods: We calculated and analyzed gastrointestinal morbidity in 2014 (according to referrals among the main age categories (children, adolescents, adults of the population of the Moscow Region, as well as hospitalization rates and in-hospital mortality. The information was taken from the Federal Statistical Surveillance report forms # 12 and # 14.Results: In 2014, the highest prevalence of gastrointestinal disorders was registered in adolescents, being by 42.7% higher than that in adults and by 11.7% higher than that in children. The leading causes of referrals in all age categories were gastritis and duodenitis, as well as gall bladder and bile tract disorders. The structure of morbidity was characterized by a high proportion of pancreatic disorders, stomach and duodenal ulcers in adults. The rate of hospitalizations due to gastrointestinal disorders was 17.8 cases per 1000 patients, being 17.4‰ in adults and 19.8‰ in children and adolescents. The main reasons for hospitalization in adults were diseases of pancreas (23.9% of all hospitalization due to gastrointestinal disorders, gall bladder and bile tract disorders (16.3%. In children and adolescents, the main reasons for hospitalizations were intestinal disorders (36.4%, gastritis and duodenitis (17.9%. In-hospital mortality from

  11. The U.S. Twin Delivery Volume and Association with Cesarean Delivery Rates: A Hospital-Level Analysis.

    Science.gov (United States)

    Easter, Sarah Rae; Robinson, Julian N; Carusi, Daniela; Little, Sarah E

    2018-03-01

     The objective of this study was to test whether hospitals experienced in twin delivery have lower rates of cesarean delivery for twins.  We divided obstetric hospitals in the 2011 National Inpatient Sample by quartile of annual twin deliveries and compared twin cesarean delivery rates between hospitals with weighted linear regression. We used Pearson's coefficients to correlate a hospital's twin cesarean delivery rate to its overall cesarean delivery and vaginal birth after cesarean (VBAC) rates.  Annual twin delivery volume ranged from 1 to 506 across the 547 analyzed hospitals with a median of 10 and mode of 3. Adjusted rates of cesarean delivery were independent of delivery volume with a rate of 75.5 versus 74.8% in the lowest and highest volume hospitals ( p  = 0.09 across quartiles). A hospital's cesarean delivery rate for twins moderately correlated with the overall cesarean rate ( r  = 0.52, p  < 0.01) and inversely correlated with VBAC rate ( r  =  - 0.42, p  < 0.01).  Most U.S. obstetrical units perform a low volume of twin deliveries with no decrease in cesarean delivery rates at higher volume hospitals. Twin cesarean delivery rates correlate with other obstetric parameters such as singleton cesarean delivery and VBAC rates suggesting twin cesarean delivery rate is more closely related to a hospital's general obstetric practice than its twin delivery volume. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. 2Kx2K resolution element photon counting MCP sensor with >200 kHz event rate capability

    CERN Document Server

    Vallerga, J V

    2000-01-01

    Siegmund Scientific undertook a NASA Small Business Innovative Research (SBIR) contract to develop a versatile, high-performance photon (or particle) counting detector combining recent technical advances in all aspects of Microchannel Plate (MCP) detector development in a low cost, commercially viable package that can support a variety of applications. The detector concept consists of a set of MCPs whose output electron pulses are read out with a crossed delay line (XDL) anode and associated high-speed event encoding electronics. The delay line anode allows high-resolution photon event centroiding at very high event rates and can be scaled to large formats (>40 mm) while maintaining good linearity and high temporal stability. The optimal sensitivity wavelength range is determined by the choice of opaque photocathodes. Specific achievements included: spatial resolution of 200 000 events s sup - sup 1; local rates of >100 events s sup - sup 1 per resolution element; event timing of <1 ns; and low background ...

  13. Antibiotics-related adverse events in the infectious diseases department of a French teaching hospital: a prospective study.

    Science.gov (United States)

    Courjon, J; Pulcini, C; Cua, E; Risso, K; Guillouet, F; Bernard, E; Roger, P-M

    2013-12-01

    Antibiotics are a significant cause of adverse events (AE), but few studies have focused on prescriptions in hospitalized patients. In infectious diseases departments, the high frequency and diversity of antibiotics prescribed makes AE post-marketing monitoring easier. The aim of our study was to assess the incidence and type of AE in the infectious diseases department of a French teaching tertiary-care hospital. The main characteristics of each hospitalization, including all antibiotics prescribed and any significant AE were recorded prospectively in the medical dashboard of the department. We included all patients having suffered an AE due to systemic antibiotics between January 2008 and March 2011. Among the 3963 hospitalized patients, 2682 (68%) received an antibiotic and 151/2682 (5.6%) suffered an AE. Fifty-two (34%) AE were gastrointestinal disorders, 32 (21%) dermatological, 20 (13%) hepatobiliary, 16 (11%) renal and urinary disorders, 13 (9%) neurological and 11 (7%) blood disorders. Rifampin, fosfomycin, cotrimoxazole and linezolid were the leading causes of AE. Sixty-two percent of the antibiotics causing an AE were stopped and 38% were continued (including 11% with a dose modification). Patients suffering from AE had an increased length of stay (18 vs 10 days, P antibiotic when several options are possible.

  14. Soft error rate analysis methodology of multi-Pulse-single-event transients

    International Nuclear Information System (INIS)

    Zhou Bin; Huo Mingxue; Xiao Liyi

    2012-01-01

    As transistor feature size scales down, soft errors in combinational logic because of high-energy particle radiation is gaining more and more concerns. In this paper, a combinational logic soft error analysis methodology considering multi-pulse-single-event transients (MPSETs) and re-convergence with multi transient pulses is proposed. In the proposed approach, the voltage pulse produced at the standard cell output is approximated by a triangle waveform, and characterized by three parameters: pulse width, the transition time of the first edge, and the transition time of the second edge. As for the pulse with the amplitude being smaller than the supply voltage, the edge extension technique is proposed. Moreover, an efficient electrical masking model comprehensively considering transition time, delay, width and amplitude is proposed, and an approach using the transition times of two edges and pulse width to compute the amplitude of pulse is proposed. Finally, our proposed firstly-independently-propagating-secondly-mutually-interacting (FIP-SMI) is used to deal with more practical re-convergence gate with multi transient pulses. As for MPSETs, a random generation model of MPSETs is exploratively proposed. Compared to the estimates obtained using circuit level simulations by HSpice, our proposed soft error rate analysis algorithm has 10% errors in SER estimation with speed up of 300 when the single-pulse-single-event transient (SPSET) is considered. We have also demonstrated the runtime and SER decrease with the increment of P0 using designs from the ISCAS-85 benchmarks. (authors)

  15. Recurrence rate of clostridium difficile infection in hospitalized pediatric patients with inflammatory bowel disease.

    Science.gov (United States)

    Kelsen, Judith R; Kim, Jason; Latta, Dan; Smathers, Sarah; McGowan, Karin L; Zaoutis, Theodore; Mamula, Petar; Baldassano, Robert N

    2011-01-01

    The incidence and associated morbidity of Clostridium difficile (CD) infection has been increasing at an alarming rate in North America. Clostridium difficile-associated diarrhea (CDAD) is the leading cause of nosocomial diarrhea in the USA. Patients with CDAD have longer average hospital admissions and additional hospital costs. Evidence has demonstrated that patients with inflammatory bowel disease (IBD) have a higher incidence of CD in comparison to the general population. The aim of this study was to compare the rate of recurrence of CD in hospitalized pediatric patients with IBD compared to hospitalized controls. The secondary aim was to evaluate whether infection with CD resulted in a more severe disease course of IBD. This was a nested case control retrospective study of hospitalized pediatric patients. Diagnosis of CD was confirmed with stool Toxin A and B analysis. The following data were obtained from the medical records: demographic information, classification of IBD including location of disease, IBD therapy, and prior surgeries. In addition, prior hospital admissions within 1 year and antibiotic exposure were recorded. The same information was recorded following CD infection. Cases were patients with IBD and CD; two control populations were also studied: patients with CD but without IBD, and patients with IBD but without CD. For aim 1, a total of 111 eligible patients with IBD and CD infection and 77 eligible control patients with CD infection were included. The rate of recurrence of CD in the IBD population was 34% compared to 7.5% in the control population (P < 0.0001). In evaluating the effect of CD infection on IBD disease severity, we compared the 111 IBD patients with CD to a second control population of 127 IBD patients without CD. 57% of IBD-CD patients were readmitted with an exacerbation of disease within 6 months of infection with CD and 67% required escalation of therapy following CD infection, compared to 30% of IBD patients without CD (P

  16. Pilot Quality Control Program for Brachytherapy of Low Dose Rate at the General Hospital of Mexico

    Science.gov (United States)

    Álvarez R., J. T.; Tovar M., V.; Salinas, B.; Hernández O., O.; Santillán B., L.; Molero M., C.; Montoya M., J.

    2004-09-01

    We describe the pilot quality control program for brachytherapy of low dose rate proposed to be used in the Radiotherapy Department at the General Hospital of Mexico. The program consists of three parts: a) development of calibration procedures, performed in terms of air-kerma strength for calibration of 137Cs and 192Ir brachytherapy sources, and for the calibration of well-type ionization chambers for 137Cs, b) performance of localisation and reconstruction techniques for radioactive sources with a Baltas' phantom. The results obtained for the media deviation , are in the optimum level, ± 0.5 mm hospital. It consists on the characterisation of a TLD-100 powder dosimetry system at SSDL: The calibration curves for powder response (nC or nC/ mg) vs Dw and the control charts for the Harshaw 3500 reader were obtained. The statistical validation of the calibration curve by normality of the residuals and the lack of fit tests were realised. In the other hand, TLD's were irradiated in the hospital to a nominal Dw = 2 Gy with sources of 137Cs. The percent deviations Δ%, between the Dw imparted by the Hospital and the determined by SSDL, are 1.2% Δ⩽ 6.5 % which are consistent with the expanded uncertainty U% for DW, 5.6 U% 10%.

  17. Pilot Quality Control Program for Brachytherapy of Low Dose Rate at the General Hospital of Mexico

    International Nuclear Information System (INIS)

    Alvarez R, J.T.; Tovar M, V.; Salinas, B.; Hernandez O, O.; Santillan B, L.; Molero M, C.; Montoya M, J.

    2004-01-01

    We describe the pilot quality control program for brachytherapy of low dose rate proposed to be used in the Radiotherapy Department at the General Hospital of Mexico. The program consists of three parts: a) development of calibration procedures, performed in terms of air-kerma strength for calibration of 137Cs and 192Ir brachytherapy sources, and for the calibration of well-type ionization chambers for 137Cs, b) performance of localisation and reconstruction techniques for radioactive sources with a Baltas' phantom. The results obtained for the media deviation , are in the optimum level, ± 0.5 mm < ± 1.0 mm; the confidence limit Δ, is in the emergency level, Δ=3.2 mm. c) verification of absorbed dose to water DW, given by the hospital. It consists on the characterisation of a TLD-100 powder dosimetry system at SSDL: The calibration curves for powder response (nC or nC/ mg) vs Dw and the control charts for the Harshaw 3500 reader were obtained. The statistical validation of the calibration curve by normality of the residuals and the lack of fit tests were realised. In the other hand, TLD's were irradiated in the hospital to a nominal Dw = 2 Gy with sources of 137Cs. The percent deviations Δ%, between the Dw imparted by the Hospital and the determined by SSDL, are 1.2% Δ≤ 6.5 % which are consistent with the expanded uncertainty U% for DW, 5.6 U% 10%

  18. Changes in hospitalization rate and mortality after acute myocardial infarction in Denmark after diagnostic criteria and methods changed

    DEFF Research Database (Denmark)

    Abildstrøm, Steen Zabell; Rasmussen, Søren; Madsen, Mette

    2004-01-01

    AIMS: To analyse the effect of the change in diagnostic criteria for acute myocardial infarction (AMI) and the use of troponin as a diagnostic marker on the hospitalization rate and mortality of hospitalized AMI patients from 1994 to 2001. METHODS AND RESULTS: Patients (> or =30 years) admitted...... for their first AMI were identified using the National Patient Registry in Denmark. We registered when each hospital introduced troponin as a diagnostic marker. The reported hospitalization rate decreased until 1998 and then increased substantially from 1999 to 2001 from 3472 to 4163 per million inhabitants (19.......9%) for men and from 1648 to 2020 per million inhabitants (22.6%) for women. Troponin use was associated with a significant 14% increase in hospitalization rate in this period [rate ratio 1.14, 95% confidence interval (CI) 1.11-1.18]. The effect of troponin was greatest among patients 70 years and older (rate...

  19. Composition and production rate of pharmaceutical and chemical waste from Xanthi General Hospital in Greece

    International Nuclear Information System (INIS)

    Voudrias, Evangelos; Goudakou, Lambrini; Kermenidou, Marianthi; Softa, Aikaterini

    2012-01-01

    Highlights: ► We studied pharmaceutical and chemical waste production in a Greek hospital. ► Pharmaceutical waste comprised 3.9% w/w of total hazardous medical waste. ► Unit production rate for total pharmaceutical waste was 12.4 ± 3.90 g/patient/d. ► Chemical waste comprised 1.8% w/w of total hazardous medical waste. ► Unit production rate for total chemical waste was 5.8 ± 2.2 g/patient/d. - Abstract: The objective of this work was to determine the composition and production rates of pharmaceutical and chemical waste produced by Xanthi General Hospital in Greece (XGH). This information is important to design and cost management systems for pharmaceutical and chemical waste, for safety and health considerations and for assessing environmental impact. A total of 233 kg pharmaceutical and 110 kg chemical waste was collected, manually separated and weighed over a period of five working weeks. The total production of pharmaceutical waste comprised 3.9% w/w of the total hazardous medical waste produced by the hospital. Total pharmaceutical waste was classified in three categories, vial waste comprising 51.1%, syringe waste with 11.4% and intravenous therapy (IV) waste with 37.5% w/w of the total. Vial pharmaceutical waste only was further classified in six major categories: antibiotics, digestive system drugs, analgesics, hormones, circulatory system drugs and “other”. Production data below are presented as average (standard deviation in parenthesis). The unit production rates for total pharmaceutical waste for the hospital were 12.4 (3.90) g/patient/d and 24.6 (7.48) g/bed/d. The respective unit production rates were: (1) for vial waste 6.4 (1.6) g/patient/d and 13 (2.6) g/bed/d, (2) for syringe waste 1.4 (0.4) g/patient/d and 2.8 (0.8) g/bed/d and (3) for IV waste 4.6 (3.0) g/patient/d and 9.2 (5.9) g/bed/d. Total chemical waste was classified in four categories, chemical reagents comprising 18.2%, solvents with 52.3%, dyes and tracers with 18.2% and

  20. Primary coronary angioplasty in 9,434 patients during acute myocardial infarction: predictors of major in- hospital adverse events from 1996 to 2000 in Brazil

    Directory of Open Access Journals (Sweden)

    Mattos Luiz Alberto

    2002-01-01

    Full Text Available OBJECTIVE: To verify the results after the performance of primary coronary angioplasty in Brazil in the last 4 years. METHODS: During the first 24 hours of acute myocardial infarction onset, 9,434 (12.2% patients underwent primary PTCA. We analyzed the success and occurrence of major in-hospital events, comparing them over the 4-year period. RESULTS: Primary PTCA use increased compared with that of all percutaneous interventions (1996=10.6% vs. 2000=13.1%; p<0.001. Coronary stent implantation increased (1996=20% vs. 2000=71.9%; p<0.001. Success was greater (1998=89.5% vs. 1999=92.5%; p<0.001. Reinfarction decreased (1998=3.9% vs. 99=2.4% vs. 2000=1.5%; p<0.001 as did emergency bypass surgery (1996=0.5% vs. 2000=0.2%; p=0.01. In-hospital deaths remained unchanged (1996=5.7% vs. 2000=5.1%, p=0.53. Balloon PTCA was one of the independent predictors of a higher rate of unsuccessful procedures (odds ratio 12.01 [CI=95%] 1.58-22.94, and stent implantation of lower mortality rates (odds ratio 4.62 [CI=95%] 3.19-6.08. CONCLUSION: The success rate has become progressively higher with a significant reduction in reinfarction and urgent bypass surgery, but in-hospital death remains nearly unchanged. Coronary stenting was a predictor of a lower death rate, and balloon PTCA was associated with greater procedural failure.

  1. Large-scale deployment of the Global Trigger Tool across a large hospital system: refinements for the characterisation of adverse events to support patient safety learning opportunities.

    Science.gov (United States)

    Good, V S; Saldaña, M; Gilder, R; Nicewander, D; Kennerly, D A

    2011-01-01

    The Institute for Healthcare Improvement encourages use of the Global Trigger Tool to objectively determine and monitor adverse events (AEs). Baylor Health Care System (BHCS) is an integrated healthcare delivery system in North Texas. The Global Trigger Tool was applied to BHCS's eight general acute care hospitals, two inpatient cardiovascular hospitals and two rehabilitation/long-term acute care hospitals. Data were collected from a monthly random sample of charts for each facility for patients discharged between 1 July 2006 and 30 June 2007 by external professional nurse auditors using an MS Access Tool developed for this initiative. In addition to the data elements recommended by Institute for Healthcare Improvement, BHCS developed fields to permit further characterisation of AEs to identify learning opportunities. A structured narrative description of each identified AE facilitated text mining to further characterise AEs. INITIAL FINDINGS: Based on this sample, AE rates were found to be 68.1 per 1000 patient days, or 50.8 per 100 encounters, and 39.8% of admissions were found to have ≥1 AE. Of all AEs identified, 61.2% were hospital-acquired, 10.1% of which were associated with a National Coordinating Council - Medical Error Reporting and Prevention harm score of "H or I" (near death or death). To enhance learning opportunities and guide quality improvement, BHCS collected data-such as preventability and AE source-to characterise the nature of AEs. Data are provided regularly to hospital teams to direct quality initiatives, moving from a general focus on reducing AEs to more specific programmes based on patterns of harm and preventability.

  2. [ORION®: a simple and effective method for systemic analysis of clinical events and precursors occurring in hospital practice].

    Science.gov (United States)

    Debouck, F; Rieger, E; Petit, H; Noël, G; Ravinet, L

    2012-05-01

    Morbimortality review is now recommended by the French Health Authority (Haute Autorité de santé [HAS]) in all hospital settings. It could be completed by Comités de retour d'expérience (CREX), making systemic analysis of event precursors which may potentially result in medical damage. As commonly captured by their current practice, medical teams may not favour systemic analysis of events occurring in their setting. They require an easy-to-use method, more or less intuitive and easy-to-learn. It is the reason why ORION(®) has been set up. ORION(®) is based on experience acquired in aeronautics which is the main precursor in risk management since aircraft crashes are considered as unacceptable even though the mortality from aircraft crashes is extremely low compared to the mortality from medical errors in hospital settings. The systemic analysis is divided in six steps: (i) collecting data, (ii) rebuilding the chronology of facts, (iii) identifying the gaps, (iv) identifying contributing and influential factors, (v) proposing actions to put in place, (vi) writing the analysis report. When identifying contributing and influential factors, four kinds of factors favouring the event are considered: technical domain, working environment, organisation and procedures, human factors. Although they are essentials, human factors are not always considered correctly. The systemic analysis is done by a pilot, chosen among people trained to use the method, querying information from all categories of people acting in the setting. ORION(®) is now used in more than 400 French hospital settings for systemic analysis of either morbimortality cases or event precursors. It is used, in particular, in 145 radiotherapy centres for supporting CREX. As very simple to use and quasi-intuitive, ORION(®) is an asset to reach the objectives defined by HAS: to set up effective morbi-mortality reviews (RMM) and CREX for improving the quality of care in hospital settings. By helping the

  3. ORIONR: A simple and effective method for systemic analysis of clinical events and precursors occurring in hospital practice

    International Nuclear Information System (INIS)

    Debouck, F.; Petit, H.; Ravinet, L.; Rieger, E.; Noel, G.

    2012-01-01

    Purpose. - Morbi-mortality review is now recommended by the French Health Authority (Haute Autorite de sante [HAS]) in all hospital settings. It could be completed by Comites de retour d'experience (CREX), making systemic analysis of event precursors which may potentially result in medical damage. As commonly captured by their current practice, medical teams may not favour systemic analysis of events occurring in their setting. They require an easy-to-use method, more or less intuitive and easy-to-learn. It is the reason why ORION R has been set up. Methods. - ORION R is based on experience acquired in aeronautics which is the main precursor in risk management since aircraft crashes are considered as unacceptable even though the mortality from aircraft crashes is extremely low compared to the mortality from medical errors in hospital settings. The systemic analysis is divided in six steps: (i) collecting data, (ii) rebuilding the chronology of facts, (iii) identifying the gaps, (iv) identifying contributing and influential factors, (v) proposing actions to put in place, (vi) writing the analysis report. When identifying contributing and influential factors, four kinds of factors favouring the event are considered: technical domain, working environment, organisation and procedures, human factors. Although they are essentials, human factors are not always considered correctly. The systemic analysis is done by a pilot, chosen among people trained to use the method, querying information from all categories of people acting in the setting. Results. - ORION R is now used in more than 400 French hospital settings for systemic analysis of either morbi-mortality cases or event precursors. It is used, in particular, in 145 radiotherapy centres for supporting CREX. Conclusion. - As very simple to use and quasi-intuitive, ORION R is an asset to reach the objectives defined by HAS: to set up effective morbi-mortality reviews (RMM) and CREX for improving the quality of care in

  4. Exposure to extreme heat and precipitation events associated with increased risk of hospitalization for asthma in Maryland, U.S.A.

    Science.gov (United States)

    Soneja, Sutyajeet; Jiang, Chengsheng; Fisher, Jared; Upperman, Crystal Romeo; Mitchell, Clifford; Sapkota, Amir

    2016-04-27

    Several studies have investigated the association between asthma exacerbations and exposures to ambient temperature and precipitation. However, limited data exists regarding how extreme events, projected to grow in frequency, intensity, and duration in the future in response to our changing climate, will impact the risk of hospitalization for asthma. The objective of our study was to quantify the association between frequency of extreme heat and precipitation events and increased risk of hospitalization for asthma in Maryland between 2000 and 2012. We used a time-stratified case-crossover design to examine the association between exposure to extreme heat and precipitation events and risk of hospitalization for asthma (ICD-9 code 493, n = 115,923). Occurrence of extreme heat events in Maryland increased the risk of same day hospitalization for asthma (lag 0) by 3 % (Odds Ratio (OR): 1.03, 95 % Confidence Interval (CI): 1.00, 1.07), with a considerably higher risk observed for extreme heat events that occur during summer months (OR: 1.23, 95 % CI: 1.15, 1.33). Likewise, summertime extreme precipitation events increased the risk of hospitalization for asthma by 11 % in Maryland (OR: 1.11, 95 % CI: 1.06, 1.17). Across age groups, increase in risk for asthma hospitalization from exposure to extreme heat event during the summer months was most pronounced among youth and adults, while those related to extreme precipitation event was highest among ≤4 year olds. Exposure to extreme heat and extreme precipitation events, particularly during summertime, is associated with increased risk of hospitalization for asthma in Maryland. Our results suggest that projected increases in frequency of extreme heat and precipitation event will have significant impact on public health.

  5. Eventos adversos a antibióticos em pacientes internados em um hospital universitário Adverse events to antibiotics in inpatients of a university hospital

    Directory of Open Access Journals (Sweden)

    Estela Louro

    2007-12-01

    Full Text Available OBJETIVO: Antibióticos são os medicamentos que mais causam eventos adversos, gerando problemas aos pacientes e custos adicionais ao sistema de saúde. Assim, objetivou-se analisar a ocorrência de eventos adversos a antibióticos em pacientes internados em um hospital. MÉTODOS: Realizou-se monitoramento intensivo do uso de antibióticos em pacientes adultos internados no município de Maringá, Paraná, de setembro de 2002 a fevereiro de 2003. Foram pesquisadas variáveis relativas aos medicamentos em uso, em particular aos antibióticos e aos eventos adversos. Com base em critérios para a avaliação do uso correto dos antibióticos, os eventos observados foram classificados como reações adversas, erros de medicação e "quase erros". Para relação de causalidade entre a administração do fármaco e o surgimento dos eventos utilizou-se o algoritmo de Naranjo. RESULTADOS: Foram acompanhados 87 pacientes e identificados 91 eventos adversos, sendo três deles (3,3% reações adversas a medicamentos, sete (7,7% erros de medicação, e 81 (89,0% "quase erros". As reações a medicamentos ocorreram devido ao uso de quinolonas e foram consideradas "prováveis" utilizando-se o algoritmo de Naranjo. Os sete erros de medicação ocorreram devido a quatro prescrições incorretas de dose e três interações medicamentosas. CONCLUSÕES: Os resultados sugerem que a falta de conhecimento do medicamento ou a falta de informação sobre o paciente no momento da prescrição tenham sido os principais fatores envolvidos na ocorrência das reações a medicamentos.OBJECTIVE: Antibiotics are the most common drugs causing adverse events and they lead to problems to patients and additional costs of the health system. The aim of the study was to evaluate the occurrence of adverse events to antibiotics in inpatients of a hospital. METHODS: An extensive drug monitoring was conducted in adult inpatients taking antibiotics in the city of Maringá, Southern

  6. Increasing arterial oxygen partial pressure during cardiopulmonary resuscitation is associated with improved rates of hospital admission.

    Science.gov (United States)

    Spindelboeck, Walter; Schindler, Otmar; Moser, Adrian; Hausler, Florian; Wallner, Simon; Strasser, Christa; Haas, Josef; Gemes, Geza; Prause, Gerhard

    2013-06-01

    As recent clinical data suggest a harmful effect of arterial hyperoxia on patients after resuscitation from cardiac arrest (CA), we aimed to investigate this association during cardiopulmonary resuscitation (CPR), the earliest and one of the most crucial phases of recirculation. We analysed 1015 patients who from 2003 to 2010 underwent out-of-hospital CPR administered by emergency medical services serving 300,000 inhabitants. Inclusion criteria for further analysis were nontraumatic background of CA and patients >18 years of age. One hundred and forty-five arterial blood gas analyses including oxygen partial pressure (paO2) measurement were obtained during CPR. We observed a highly significant increase in hospital admission rates associated with increases in paO2 in steps of 100 mmHg (13.3 kPa). Subsequently, data were clustered according to previously described cutoffs (≤ 60 mmHg [8 kPa

  7. Twinning rate in a sample from a Brazilian hospital with a high standard of reproductive care

    Directory of Open Access Journals (Sweden)

    Gloria Maria Duccini Dal Colletto

    Full Text Available CONTEXT: Epidemiological studies on twin births have been motivated mostly by the positive correlation between twinning rate and human fertility, prematurity, low birth weight, increased risk of infant death and long term risk for morbidity. OBJECTIVE: This paper intends to estimate the incidence of multiple births in a private hospital in Brazil with a high standard of reproductive care, and to evaluate the effects of maternal age, gestation order and assisted fertilization on twinning rate. DESIGN: Retrospective analysis. SETTING: First-class tertiary private hospital, São Paulo, Brazil. PARTICIPANTS: The multiple birth rate was investigated among 7,997 deliveries from 1995 to 1998, including 7,786 singletons, 193 twins, 17 triplets and one quadruplet. RESULTS: The rates per 1,000 dizygotic and monozygotic pairs and for triplets were estimated as 19.51, 4.50 and 2.13, respectively. The dizygotic and triplet rates were the highest observed in Brazil up to the present day. The twinning rate among primigravidae older than 30 years was very high (45.02 per 1,000 and was due to a disproportionately high frequency of dizygotic pairs. The triplet rate was also very high among the mothers of this age group (5.71 per 1,000. These facts are strong indicators that these women were the ones most frequently submitted to assisted reproductive techniques. The mean maternal age of the studied population was about six years higher than that estimated for mothers in the general population of southeastern Brazil. Primigravidae aged under 30 years as well as multigravidae showed similar twinning rates, which were almost 20 per 1,000. Among the deliveries of multigravidae older than 30 years, an unusually high frequency of monozygotic twins was observed (7.04 per 1,000, probably as a consequence of the residual effect of long-term use of oral contraceptives. CONCLUSIONS: The dizygotic twinning rate increased from 13.51 to 28.98 per 1,000 over the four years

  8. Testosterone Deficiency Increases Hospital Readmission and Mortality Rates in Male Patients with Heart Failure

    International Nuclear Information System (INIS)

    Santos, Marcelo Rodrigues dos; Sayegh, Ana Luiza Carrari; Groehs, Raphaela Vilar Ramalho; Fonseca, Guilherme; Trombetta, Ivani Credidio; Barretto, Antônio Carlos Pereira; Arap, Marco Antônio; Negrão, Carlos Eduardo; Middlekauff, Holly R.; Alves, Maria-Janieire de Nazaré Nunes

    2015-01-01

    Testosterone deficiency in patients with heart failure (HF) is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown. We investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF. Total testosterone (TT) and free testosterone (FT) were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66) and normal testosterone (NT; n = 44) groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography in a subpopulation of 27 patients. Length of hospital stay was longer in the LT group compared to in the NT group (37 ± 4 vs. 25 ± 4 days; p = 0.008). Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001). In the single-predictor analysis, TT (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.58–4.85; p = 0.02) predicted hospital readmission within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67–8.10; p = 0.009) and readmission within 90 days (HR, 3.27; 95% CI, 1.23–8.69; p = 0.02) predicted increased mortality. Neurohumoral activation, as estimated by MSNA, was significantly higher in the LT group compared to in the NT group (65 ± 3 vs. 51 ± 4 bursts/100 heart beats; p < 0.001). These results support the concept that LT is an independent risk factor for hospital readmission within 90 days and increased mortality in patients with HF. Furthermore, increased MSNA was observed in patients with LT

  9. Testosterone Deficiency Increases Hospital Readmission and Mortality Rates in Male Patients with Heart Failure

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Marcelo Rodrigues dos; Sayegh, Ana Luiza Carrari; Groehs, Raphaela Vilar Ramalho; Fonseca, Guilherme [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil); Trombetta, Ivani Credidio [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil); Universidade Nove de Julho (UNINOVE) (Brazil); Barretto, Antônio Carlos Pereira [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil); Arap, Marco Antônio [Faculdade de medicina da Universidade de São Paulo - Urologia (Brazil); Negrão, Carlos Eduardo [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil); Escola de Educação Física e Esporte da Universidade de São Paulo, São Paulo, SP (Brazil); Middlekauff, Holly R. [Division of Cardiology - David Geffen School of Medicine - University of California (United States); Alves, Maria-Janieire de Nazaré Nunes, E-mail: janieire.alves@incor.usp.br [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil)

    2015-09-15

    Testosterone deficiency in patients with heart failure (HF) is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown. We investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF. Total testosterone (TT) and free testosterone (FT) were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66) and normal testosterone (NT; n = 44) groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography in a subpopulation of 27 patients. Length of hospital stay was longer in the LT group compared to in the NT group (37 ± 4 vs. 25 ± 4 days; p = 0.008). Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001). In the single-predictor analysis, TT (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.58–4.85; p = 0.02) predicted hospital readmission within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67–8.10; p = 0.009) and readmission within 90 days (HR, 3.27; 95% CI, 1.23–8.69; p = 0.02) predicted increased mortality. Neurohumoral activation, as estimated by MSNA, was significantly higher in the LT group compared to in the NT group (65 ± 3 vs. 51 ± 4 bursts/100 heart beats; p < 0.001). These results support the concept that LT is an independent risk factor for hospital readmission within 90 days and increased mortality in patients with HF. Furthermore, increased MSNA was observed in patients with LT.

  10. Testosterone Deficiency Increases Hospital Readmission and Mortality Rates in Male Patients with Heart Failure

    Directory of Open Access Journals (Sweden)

    Marcelo Rodrigues dos Santos

    2015-01-01

    Full Text Available Background: Testosterone deficiency in patients with heart failure (HF is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown. Objective: We investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF. Methods: Total testosterone (TT and free testosterone (FT were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66 and normal testosterone (NT; n = 44 groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA was recorded by microneurography in a subpopulation of 27 patients. Results: Length of hospital stay was longer in the LT group compared to in the NT group (37 ± 4 vs. 25 ± 4 days; p = 0.008. Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001. In the single-predictor analysis, TT (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.58–4.85; p = 0.02 predicted hospital readmission within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67–8.10; p = 0.009 and readmission within 90 days (HR, 3.27; 95% CI, 1.23–8.69; p = 0.02 predicted increased mortality. Neurohumoral activation, as estimated by MSNA, was significantly higher in the LT group compared to in the NT group (65 ± 3 vs. 51 ± 4 bursts/100 heart beats; p < 0.001. Conclusion: These results support the concept that LT is an independent risk factor for hospital readmission within 90 days and increased mortality in patients with HF. Furthermore, increased MSNA was observed in patients with LT.

  11. Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care.

    Science.gov (United States)

    Springer, Bryan D; Odum, Susan M; Vegari, David N; Mokris, Jeffrey G; Beaver, Walter B

    2017-01-01

    This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. All patients completed a telephone survey. Seven inpatients and 16 outpatients required hospital readmission or an unplanned episode of care following hospital discharge. Readmission rates were higher for TKA than THA. The authors found no statistical differences in 30-day readmission or unplanned care episodes. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Return on experience after the declaration of an event in interventional radiology at Strasbourg University Hospitals

    International Nuclear Information System (INIS)

    2010-03-01

    This document reports investigation performed after information of the French Nuclear Safety authority (ASN) by Strasbourg University Hospitals of the fact that patients presented undesired effects after X-ray treatments. Inspections aimed at analyzing the circumstances and the causes of these effects, and at examining the implemented corrective actions. No technical failure has been detected on the apparatus, but an insufficient attention to dose optimization and to follow-on has been highlighted. Some failures have been identified in traceability of maintenance operations, in training, and in adjustment optimization. Corrective actions are described, and some comments are made, inspired from this experience

  13. Trend and forecasting rate of cancer deaths at a public university hospital using univariate modeling

    Science.gov (United States)

    Ismail, A.; Hassan, Noor I.

    2013-09-01

    Cancer is one of the principal causes of death in Malaysia. This study was performed to determine the pattern of rate of cancer deaths at a public hospital in Malaysia over an 11 year period from year 2001 to 2011, to determine the best fitted model of forecasting the rate of cancer deaths using Univariate Modeling and to forecast the rates for the next two years (2012 to 2013). The medical records of the death of patients with cancer admitted at this Hospital over 11 year's period were reviewed, with a total of 663 cases. The cancers were classified according to 10th Revision International Classification of Diseases (ICD-10). Data collected include socio-demographic background of patients such as registration number, age, gender, ethnicity, ward and diagnosis. Data entry and analysis was accomplished using SPSS 19.0 and Minitab 16.0. The five Univariate Models used were Naïve with Trend Model, Average Percent Change Model (ACPM), Single Exponential Smoothing, Double Exponential Smoothing and Holt's Method. The overall 11 years rate of cancer deaths showed that at this hospital, Malay patients have the highest percentage (88.10%) compared to other ethnic groups with males (51.30%) higher than females. Lung and breast cancer have the most number of cancer deaths among gender. About 29.60% of the patients who died due to cancer were aged 61 years old and above. The best Univariate Model used for forecasting the rate of cancer deaths is Single Exponential Smoothing Technique with alpha of 0.10. The forecast for the rate of cancer deaths shows a horizontally or flat value. The forecasted mortality trend remains at 6.84% from January 2012 to December 2013. All the government and private sectors and non-governmental organizations need to highlight issues on cancer especially lung and breast cancers to the public through campaigns using mass media, media electronics, posters and pamphlets in the attempt to decrease the rate of cancer deaths in Malaysia.

  14. Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Hospital Readmission Rates Following Hip and Knee Arthroplasty.

    Science.gov (United States)

    Martsolf, Grant R; Barrett, Marguerite L; Weiss, Audrey J; Kandrack, Ryan; Washington, Raynard; Steiner, Claudia A; Mehrotra, Ateev; SooHoo, Nelson F; Coffey, Rosanna

    2016-08-17

    Readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasingly used to measure hospital performance. Readmission rates that are not adjusted for race/ethnicity and socioeconomic status, patient risk factors beyond a hospital's control, may not accurately reflect a hospital's performance. In this study, we examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following THA and TKA. We calculated 2 sets of risk-adjusted readmission rates by (1) using the Centers for Medicare & Medicaid Services standard risk-adjustment algorithm that incorporates patient age, sex, comorbidities, and hospital effects and (2) adding race/ethnicity and socioeconomic status to the model. Using data from the Healthcare Cost and Utilization Project, 2011 State Inpatient Databases, we compared the relative performances of 1,194 hospitals across the 2 methods. Addition of race/ethnicity and socioeconomic status to the risk-adjustment algorithm resulted in (1) little or no change in the risk-adjusted readmission rates at nearly all hospitals; (2) no change in the designation of the readmission rate as better, worse, or not different from the population mean at >99% of the hospitals; and (3) no change in the excess readmission ratio at >97% of the hospitals. Inclusion of race/ethnicity and socioeconomic status in the risk-adjustment algorithm led to a relative-performance change in readmission rates following THA and TKA at socioeconomic status in risk-adjusted THA and TKA readmission rates used for hospital accountability, payment, and public reporting. Prognostic Level III. See instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  15. A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: the EURHOBOP project.

    Science.gov (United States)

    Dégano, Irene R; Subirana, Isaac; Torre, Marina; Grau, María; Vila, Joan; Fusco, Danilo; Kirchberger, Inge; Ferrières, Jean; Malmivaara, Antti; Azevedo, Ana; Meisinger, Christa; Bongard, Vanina; Farmakis, Dimitros; Davoli, Marina; Häkkinen, Unto; Araújo, Carla; Lekakis, John; Elosua, Roberto; Marrugat, Jaume

    2015-03-01

    Hospital performance models in acute myocardial infarction (AMI) are useful to assess patient management. While models are available for individual countries, mainly US, cross-European performance models are lacking. Thus, we aimed to develop a system to benchmark European hospitals in AMI and percutaneous coronary intervention (PCI), based on predicted in-hospital mortality. We used the EURopean HOspital Benchmarking by Outcomes in ACS Processes (EURHOBOP) cohort to develop the models, which included 11,631 AMI patients and 8276 acute coronary syndrome (ACS) patients who underwent PCI. Models were validated with a cohort of 55,955 European ACS patients. Multilevel logistic regression was used to predict in-hospital mortality in European hospitals for AMI and PCI. Administrative and clinical models were constructed with patient- and hospital-level covariates, as well as hospital- and country-based random effects. Internal cross-validation and external validation showed good discrimination at the patient level and good calibration at the hospital level, based on the C-index (0.736-0.819) and the concordance correlation coefficient (55.4%-80.3%). Mortality ratios (MRs) showed excellent concordance between administrative and clinical models (97.5% for AMI and 91.6% for PCI). Exclusion of transfers and hospital stays ≤1day did not affect in-hospital mortality prediction in sensitivity analyses, as shown by MR concordance (80.9%-85.4%). Models were used to develop a benchmarking system to compare in-hospital mortality rates of European hospitals with similar characteristics. The developed system, based on the EURHOBOP models, is a simple and reliable tool to compare in-hospital mortality rates between European hospitals in AMI and PCI. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Mind the information gap: fertility rate and use of cesarean delivery and tocolytic hospitalizations in Taiwan.

    Science.gov (United States)

    Ma, Ke-Zong M; Norton, Edward C; Lee, Shoou-Yih D

    2011-12-12

    Physician-induced demand (PID) is an important theory to test given the longstanding controversy surrounding it. Empirical health economists have been challenged to find natural experiments to test the theory because PID is tantamount to strong income effects. The data requirements are both a strong exogenous change in income and two types of treatment that are substitutes but have different net revenues. The theory implies that an exogenous fall in income would lead physicians to recoup their income by substituting a more expensive treatment for a less expensive treatment. This study takes advantages of the dramatic decline in the Taiwanese fertility rate to examine whether an exogenous and negative income shock to obstetricians and gynecologists (ob/gyns) affected the use of c-sections, which has a higher reimbursement rate than vaginal delivery under Taiwan's National Health Insurance system during the study period, and tocolytic hospitalizations. The primary data were obtained from the 1996 to 2004 National Health Insurance Research Database in Taiwan. We hypothesized that a negative income shock to ob/gyns would cause them to provide more c-sections and tocolytic hospitalizations to less medically-informed pregnant women. Multinomial probit and probit models were estimated and the marginal effects of the interaction term were conducted to estimate the impacts of ob/gyn to birth ratio and the information gap. Our results showed that a decline in fertility did not lead ob/gyns to supply more c-sections to less medically-informed pregnant women, and that during fertility decline ob/gyns may supply more tocolytic hospitalizations to compensate their income loss, regardless of pregnant women's access to health information. The exogenous decline in the Taiwanese fertility rate and the use of detailed medical information and demographic attributes of pregnant women allowed us to avoid the endogeneity problem that threatened the validity of prior research. They also

  17. Comparison of brand versus generic antiepileptic drug adverse event reporting rates in the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS).

    Science.gov (United States)

    Rahman, Md Motiur; Alatawi, Yasser; Cheng, Ning; Qian, Jingjing; Plotkina, Annya V; Peissig, Peggy L; Berg, Richard L; Page, David; Hansen, Richard A

    2017-09-01

    Despite the cost saving role of generic anti-epileptic drugs (AEDs), debate exists as to whether generic substitution of branded AEDs may lead to therapeutic failure and increased toxicity. This study compared adverse event (AE) reporting rates for brand vs. authorized generic (AG) vs. generic AEDs. Since AGs are pharmaceutically identical to brand but perceived as generics, the generic vs. AG comparison minimized potential bias against generics. Events reported to the U.S. Food and Drug Administration Adverse Event Reporting System between January 2004 to March 2015 with lamotrigine, carbamazepine, and oxcarbazepine listed as primary or secondary suspect were classified as brand, generic, or AG based on the manufacturer. Disproportionality analyses using the reporting odds ratio (ROR) assessed the relative rate of reporting of labeled AEs compared to reporting these events with all other drugs. The Breslow-Day statistic compared RORs across brand, AG, and other generics using a Bonferroni-corrected Pbrand and generics for all three drugs of interest (Breslow-Day Pbrands and generics have similar reporting rates after accounting for generic perception biases. Disproportional suicide reporting was observed for generics compared with AGs and brand, although this finding needs further study. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Composition and production rate of pharmaceutical and chemical waste from Xanthi General Hospital in Greece.

    Science.gov (United States)

    Voudrias, Evangelos; Goudakou, Lambrini; Kermenidou, Marianthi; Softa, Aikaterini

    2012-07-01

    The objective of this work was to determine the composition and production rates of pharmaceutical and chemical waste produced by Xanthi General Hospital in Greece (XGH). This information is important to design and cost management systems for pharmaceutical and chemical waste, for safety and health considerations and for assessing environmental impact. A total of 233 kg pharmaceutical and 110 kg chemical waste was collected, manually separated and weighed over a period of five working weeks. The total production of pharmaceutical waste comprised 3.9% w/w of the total hazardous medical waste produced by the hospital. Total pharmaceutical waste was classified in three categories, vial waste comprising 51.1%, syringe waste with 11.4% and intravenous therapy (IV) waste with 37.5% w/w of the total. Vial pharmaceutical waste only was further classified in six major categories: antibiotics, digestive system drugs, analgesics, hormones, circulatory system drugs and "other". Production data below are presented as average (standard deviation in parenthesis). The unit production rates for total pharmaceutical waste for the hospital were 12.4 (3.90) g/patient/d and 24.6 (7.48) g/bed/d. The respective unit production rates were: (1) for vial waste 6.4 (1.6) g/patient/d and 13 (2.6) g/bed/d, (2) for syringe waste 1.4 (0.4) g/patient/d and 2.8 (0.8) g/bed/d and (3) for IV waste 4.6 (3.0) g/patient/d and 9.2 (5.9) g/bed/d. Total chemical waste was classified in four categories, chemical reagents comprising 18.2%, solvents with 52.3%, dyes and tracers with 18.2% and solid waste with 11.4% w/w of the total. The total production of chemical waste comprised 1.8% w/w of the total hazardous medical waste produced by the hospital. Thus, the sum of pharmaceutical and chemical waste was 5.7% w/w of the total hazardous medical waste produced by the hospital. The unit production rates for total chemical waste for the hospital were 5.8 (2.2) g/patient/d and 1.1 (0.4) g/exam/d. The respective

  19. 75 FR 71799 - Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates...

    Science.gov (United States)

    2010-11-24

    ...The final rule with comment period in this document revises the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (Affordable Care Act). In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2011. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Affordable Care Act. In this final rule with comment period, we set forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other pertinent ratesetting information for the CY 2011 ASC payment system. These changes are applicable to services furnished on or after January 1, 2011. In this document, we also are including two final rules that implement provisions of the Affordable Care Act relating to payments to hospitals for direct graduate medical education (GME) and indirect medical education (IME) costs; and new limitations on certain physician referrals to hospitals in which they have an ownership or investment interest. In the interim final rule with comment period that is included in this document, we are changing the effective date for otherwise eligible hospitals and critical access hospitals that have been reclassified from urban to rural under section 1886(d)(8)(E) of the Social Security

  20. Discovery of temporal and disease association patterns in condition-specific hospital utilization rates.

    Directory of Open Access Journals (Sweden)

    Julian S Haimovich

    Full Text Available Identifying temporal variation in hospitalization rates may provide insights about disease patterns and thereby inform research, policy, and clinical care. However, the majority of medical conditions have not been studied for their potential seasonal variation. The objective of this study was to apply a data-driven approach to characterize temporal variation in condition-specific hospitalizations. Using a dataset of 34 million inpatient discharges gathered from hospitals in New York State from 2008-2011, we grouped all discharges into 263 clinical conditions based on the principal discharge diagnosis using Clinical Classification Software in order to mitigate the limitation that administrative claims data reflect clinical conditions to varying specificity. After applying Seasonal-Trend Decomposition by LOESS, we estimated the periodicity of the seasonal component using spectral analysis and applied harmonic regression to calculate the amplitude and phase of the condition's seasonal utilization pattern. We also introduced four new indices of temporal variation: mean oscillation width, seasonal coefficient, trend coefficient, and linearity of the trend. Finally, K-means clustering was used to group conditions across these four indices to identify common temporal variation patterns. Of all 263 clinical conditions considered, 164 demonstrated statistically significant seasonality. Notably, we identified conditions for which seasonal variation has not been previously described such as ovarian cancer, tuberculosis, and schizophrenia. Clustering analysis yielded three distinct groups of conditions based on multiple measures of seasonal variation. Our study was limited to New York State and results may not directly apply to other regions with distinct climates and health burden. A substantial proportion of medical conditions, larger than previously described, exhibit seasonal variation in hospital utilization. Moreover, the application of clustering

  1. Hospital staff should use more than one method to detect adverse events and potential adverse events: incident reporting, pharmacist surveillance and local real‐time record review may all have a place

    Science.gov (United States)

    Olsen, Sisse; Neale, Graham; Schwab, Kat; Psaila, Beth; Patel, Tejal; Chapman, E Jane; Vincent, Charles

    2007-01-01

    Background Over the past five years, in most hospitals in England and Wales, incident reporting has become well established but it remains unclear how well reports match clinical adverse events. International epidemiological studies of adverse events are based on retrospective, multi‐hospital case record review. In this paper the authors describe the use of incident reporting, pharmacist surveillance and local real‐time record review for the recognition of clinical risks associated with hospital inpatient care. Methodology Data on adverse events were collected prospectively on 288 patients discharged from adult acute medical and surgical units in an NHS district general hospital using incident reports, active surveillance of prescription charts by pharmacists and record review at time of discharge. Results Record review detected 26 adverse events (AEs) and 40 potential adverse events (PAEs) occurring during the index admission. In contrast, in the same patient group, incident reporting detected 11 PAEs and no AEs. Pharmacy surveillance found 10 medication errors all of which were PAEs. There was little overlap in the nature of events detected by the three methods. Conclusion The findings suggest that incident reporting does not provide an adequate assessment of clinical adverse events and that this method needs to be supplemented with other more systematic forms of data collection. Structured record review, carried out by clinicians, provides an important component of an integrated approach to identifying risk in the context of developing a safety and quality improvement programme. PMID:17301203

  2. High Rates of All-cause and Gastroenteritis-related Hospitalization Morbidity and Mortality among HIV-exposed Indian Infants

    Directory of Open Access Journals (Sweden)

    Tripathy Srikanth

    2011-07-01

    Full Text Available Abstract Background HIV-infected and HIV-exposed, uninfected infants experience a high burden of infectious morbidity and mortality. Hospitalization is an important metric for morbidity and is associated with high mortality, yet, little is known about rates and causes of hospitalization among these infants in the first 12 months of life. Methods Using data from a prevention of mother-to-child transmission (PMTCT trial (India SWEN, where HIV-exposed breastfed infants were given extended nevirapine, we measured 12-month infant all-cause and cause-specific hospitalization rates and hospitalization risk factors. Results Among 737 HIV-exposed Indian infants, 93 (13% were HIV-infected, 15 (16% were on HAART, and 260 (35% were hospitalized 381 times by 12 months of life. Fifty-six percent of the hospitalizations were attributed to infections; gastroenteritis was most common accounting for 31% of infectious hospitalizations. Gastrointestinal-related hospitalizations steadily increased over time, peaking around 9 months. The 12-month all-cause hospitalization, gastroenteritis-related hospitalization, and in-hospital mortality rates were 906/1000 PY, 229/1000 PY, and 35/1000 PY respectively among HIV-infected infants and 497/1000 PY, 107/1000 PY, and 3/1000 PY respectively among HIV-exposed, uninfected infants. Advanced maternal age, infant HIV infection, gestational age, and male sex were associated with higher all-cause hospitalization risk while shorter duration of breastfeeding and abrupt weaning were associated with gastroenteritis-related hospitalization. Conclusions HIV-exposed Indian infants experience high rates of all-cause and infectious hospitalization (particularly gastroenteritis and in-hospital mortality. HIV-infected infants are nearly 2-fold more likely to experience hospitalization and 10-fold more likely to die compared to HIV-exposed, uninfected infants. The combination of scaling up HIV PMTCT programs and implementing proven health

  3. Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non-VA Hospitals?

    Science.gov (United States)

    Weeks, William B.; Lee, Richard E.; Wallace, Amy E.; West, Alan N.; Bagian, James P.

    2009-01-01

    Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine…

  4. 42 CFR 412.75 - Determination of the hospital-specific rate for inpatient operating costs based on a Federal...

    Science.gov (United States)

    2010-10-01

    ... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient Operating Costs § 412.75 Determination of the... methodology set forth in §§ 412.73(c)(15) and 412.73(c)(16). (e) DRG adjustment. The applicable hospital...

  5. 42 CFR 412.79 - Determination of the hospital-specific rate for inpatient operating costs for Medicare-dependent...

    Science.gov (United States)

    2010-10-01

    ... OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient... § 412.73(c)(14) through (c)(16). (e) DRG adjustment. The applicable hospital-specific cost per discharge...

  6. Estimated Glomerular Filtration Rate, Cardiovascular Events and Mortality Across Age Groups Among Individuals Older Than 60 Years in Southern Europe.

    Science.gov (United States)

    Salvador-González, Betlem; Gil-Terrón, Neus; Cerain-Herrero, M Jesús; Subirana, Isaac; Güell-Miró, Roser; Rodríguez-Latre, Luisa M; Cunillera-Puértolas, Oriol; Elosua, Roberto; Grau, Maria; Vila, Joan; Pascual-Benito, Luisa; Mestre-Ferrer, Jordi; Ramos, Rafel; Baena-Díez, José Miguel; Soler-Vila, Maria; Alonso-Bes, Eva; Ruipérez-Guijarro, Laura; Álvarez-Funes, Virtudes; Freixes-Villaró, Esther; Rodríguez-Pascual, Mercedes; Martínez-Castelao, Alberto

    2018-06-01

    Individuals with a decreased estimated glomerular filtration rate (eGFR) are at increased risk of all-cause (ACM) and cardiovascular mortality; there is ongoing debate about whether older individuals with eGFR 45 to 59mL/min/1.73 m 2 are also at increased risk. We evaluated the association between eGFR and ACM and cardiovascular events (CVE) in people aged 60 to 74 and ≥ 75 years in a population with a low coronary disease incidence. We conducted a retrospective cohort study by using primary care and hospital electronic records. We included 130 233 individuals aged ≥ 60 years with creatinine measurement between January 1, 2010 and December 31, 2011; eGFR was estimated by using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. The independent association between eGFR and the risk of ACM and hospital admission due to CVE were determined with Cox and Fine-Gray regressions, respectively. The median was age 70 years, and 56.1% were women; 13.5% had eGFR < 60 (69.7% eGFR 45-59). During a median follow-up of 38.2 months, 6474 participants died and 3746 had a CVE. For ACM and CVE, the HR in older individuals became significant at eGFR < 60. Fully adjusted HR for ACM in the eGFR 45 to 59 category were 1.61; 95%CI, 1.37-1.89 and 1.19; 95%CI, 1.10-1.28 in 60- to 74-year-olds and ≥ 75-year-olds, respectively; for CVE HR were 1.28; 95%CI, 1.08-1.51 and 1.12; 95%CI, 0.99-1.26. In a region with low coronary disease incidence, the risk of death and CVE increased with decreasing eGFR. In ≥ 75-year-olds, the eGFR 45 to 59 category, which had borderline risk for CVE, included many individuals without significant additional risk. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  7. Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care.

    Science.gov (United States)

    Aiken, Linda H; Sloane, Douglas; Griffiths, Peter; Rafferty, Anne Marie; Bruyneel, Luk; McHugh, Matthew; Maier, Claudia B; Moreno-Casbas, Teresa; Ball, Jane E; Ausserhofer, Dietmar; Sermeus, Walter

    2017-07-01

    To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals. Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80nurses is associated with an 11% increase in the odds of death. In our hospital sample, there were an average of six caregivers for every 25 patients, four of whom were professional nurses. Substituting one nurse assistant for a professional nurse for every 25 patients is associated with a 21% increase in the odds of dying. A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please

  8. Comparison of 3 Types of Readmission Rates for Measuring Hospital and Surgeon Performance After Primary Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Bottle, Alex; Loeffler, Mark D; Aylin, Paul; Ali, Adam M

    2018-02-26

    All-cause 30-day hospital readmission is in widespread use for monitoring and incentivizing hospital performance for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, little is known on the extent to which all-cause readmission is influenced by hospital or surgeon performance and whether alternative measures may be more valid. This is an observational study using multilevel modeling on English administrative data to determine the interhospital and intersurgeon variation for 3 readmission metrics: all-cause, surgical, and return-to-theater. Power calculations estimated the likelihood of identifying whether the readmission rate for a surgeon or hospital differed from the national average by a factor of 1.25, 1.5, 2, or 3 times, for both average and high-volume providers. 259,980 THAs and 311,033 TKAs were analyzed. Variations by both surgeons and hospitals were smaller for the all-cause measure than for the surgical or return-to-theater metrics, although statistical power to detect differences was higher. Statistical power to detect surgeon-level rates of 1.25 or 1.5 times the average was consistently low. However, at the hospital level, the surgical readmission measure showed more variation by hospital while maintaining excellent power to detect differences in rates between hospitals performing the average number of THA or TKA cases per year in England. In practice, more outliers than expected from purely random variation were found for all-cause and surgical readmissions, especially at hospital level. The 30-day surgical readmission rate should be considered as an adjunctive measure to 30-day all-cause readmission rate when assessing hospital performance. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Data filtering and expected muon and neutrino event rates in the KM3NeT neutrino telescope

    Energy Technology Data Exchange (ETDEWEB)

    Shanidze, Rezo [ECAP, University of Erlangen-Nuremberg, Erwin-Rommel-Str.1, 91058 Erlangen (Germany); Collaboration: ANTARES-KM3NeT-Erlangen-Collaboration

    2011-07-01

    KM3NeT is a future Mediterranean deep sea neutrino telescope with an instrumented volume of several cubic kilometres. The neutrino and muon events in KM3NeT will be reconstructed from the signals collected from the telescope's photo detectors. However, in the deep sea the dominant source of photon signals are the decays of K40 nuclei and bioluminescence. The selection of neutrino and muon events requires the implementation of fast and efficient data filtering algorithms for the reduction of accidental background event rates. Possible data filtering and triggering schemes for the KM3NeT neutrino telescope and expected muon and neutrino event rates are discussed.

  10. Trends in stroke hospitalisation rates and in-hospital mortality in Aragon, 1998-2010.

    Science.gov (United States)

    Giménez-Muñoz, A; Ara, J R; Abad Díez, J M; Campello Morer, I; Pérez Trullén, J M

    2018-05-01

    Despite the impact of cerebrovascular disease (CVD) on global health, its morbidity and time trends in Spain are not precisely known. The purpose of our study was to characterise the epidemiology and trends pertaining to stroke in Aragon over the period 1998-2010. We conducted a retrospective, descriptive study using the data of the Spanish health system's Minimum Data Set and included all stroke patients admitted to acute care hospitals in Aragon between 1 January 1998 and 31 December 2010. We present data globally and broken down by stroke subtype, sex, and age group. The number of cases increased by 13% whereas age- and sex-adjusted hospitalisation rates showed a significant decrease for all types of stroke (mean annual decrease of 1.6%). Men and women in younger age groups showed opposite trends in hospitalisation rates for ischaemic stroke. Case fatality rate at 28 days (17.9%) was higher in patients with intracerebral haemorrhage (35.8%) than in those with subarachnoid haemorrhage (26.2%) or ischaemic stroke (13%). CVD case fatality showed a mean annual decline of 2.8%, at the expense of the fatality rate of ischaemic stroke, and it was more pronounced in men than in women. Understanding stroke epidemiology and trends at the regional level will help establish an efficient monitoring system and design appropriate strategies for health planning. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Association of Admission to Veterans Affairs Hospitals vs Non-Veterans Affairs Hospitals With Mortality and Readmission Rates Among Older Men Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia.

    Science.gov (United States)

    Nuti, Sudhakar V; Qin, Li; Rumsfeld, John S; Ross, Joseph S; Masoudi, Frederick A; Normand, Sharon-Lise T; Murugiah, Karthik; Bernheim, Susannah M; Suter, Lisa G; Krumholz, Harlan M

    2016-02-09

    Little contemporary information is available about comparative performance between Veterans Affairs (VA) and non-VA hospitals, particularly related to mortality and readmission rates, 2 important outcomes of care. To assess and compare mortality and readmission rates among men in VA and non-VA hospitals. Cross-sectional analysis involving male Medicare fee-for-service beneficiaries aged 65 years or older hospitalized between 2010 and 2013 in VA and non-VA acute care hospitals for acute myocardial infarction (AMI), heart failure (HF), or pneumonia using the Medicare Standard Analytic Files and Enrollment Database together with VA administrative claims data. To avoid confounding geographic effects with health care system effects, we studied VA and non-VA hospitals within the same metropolitan statistical area (MSA). Hospitalization in a VA or non-VA hospital in MSAs that contained at least 1 VA and non-VA hospital. For each condition, 30-day risk-standardized mortality rates and risk-standardized readmission rates for VA and non-VA hospitals. Mean aggregated within-MSA differences in mortality and readmission rates were also assessed. We studied 104 VA and 1513 non-VA hospitals, with each condition-outcome analysis cohort for VA and non-VA hospitals containing at least 7900 patients (men; ≥65 years), in 92 MSAs. Mortality rates were lower in VA hospitals than non-VA hospitals for AMI (13.5% vs 13.7%, P = .02; -0.2 percentage-point difference) and HF (11.4% vs 11.9%, P = .008; -0.5 percentage-point difference), but higher for pneumonia (12.6% vs 12.2%, P = .045; 0.4 percentage-point difference). In contrast, readmission rates were higher in VA hospitals for all 3 conditions (AMI, 17.8% vs 17.2%, 0.6 percentage-point difference; HF, 24.7% vs 23.5%, 1.2 percentage-point difference; pneumonia, 19.4% vs 18.7%, 0.7 percentage-point difference, all P percentage-point difference, -0.22; 95% CI, -0.40 to -0.04) and HF (-0.63; 95% CI, -0.95 to -0.31), and

  12. Forecasting Hospitalization and Emergency Department Visit Rates for Chronic Obstructive Pulmonary Disease. A Time-Series Analysis.

    Science.gov (United States)

    Gershon, Andrea; Thiruchelvam, Deva; Moineddin, Rahim; Zhao, Xiu Yan; Hwee, Jeremiah; To, Teresa

    2017-06-01

    Knowing trends in and forecasting hospitalization and emergency department visit rates for chronic obstructive pulmonary disease (COPD) can enable health care providers, hospitals, and health care decision makers to plan for the future. We conducted a time-series analysis using health care administrative data from the Province of Ontario, Canada, to determine previous trends in acute care hospitalization and emergency department visit rates for COPD and then to forecast future rates. Individuals aged 35 years and older with physician-diagnosed COPD were identified using four universal government health administrative databases and a validated case definition. Monthly COPD hospitalization and emergency department visit rates per 1,000 people with COPD were determined from 2003 to 2014 and then forecasted to 2024 using autoregressive integrated moving average models. Between 2003 and 2014, COPD prevalence increased from 8.9 to 11.1%. During that time, there were 274,951 hospitalizations and 290,482 emergency department visits for COPD. After accounting for seasonality, we found that monthly COPD hospitalization and emergency department visit rates per 1,000 individuals with COPD remained stable. COPD prevalence was forecasted to increase to 12.7% (95% confidence interval [CI], 11.4-14.1) by 2024, whereas monthly COPD hospitalization and emergency department visit rates per 1,000 people with COPD were forecasted to remain stable at 2.7 (95% CI, 1.6-4.4) and 3.7 (95% CI, 2.3-5.6), respectively. Forecasted age- and sex-stratified rates were also stable. COPD hospital and emergency department visit rates per 1,000 people with COPD have been stable for more than a decade and are projected to remain stable in the near future. Given increasing COPD prevalence, this means notably more COPD health service use in the future.

  13. Classification of Tattoo Complications in a Hospital Material of 493 Adverse Events.

    Science.gov (United States)

    Serup, Jørgen; Sepehri, Mitra; Hutton Carlsen, Katrina

    2016-01-01

    Tattooing is a global trend. Clinical knowledge of complications is based on case reports collected over a century. Larger cohorts reflecting complications associated with contemporary trends are lacking. The study was a retrospective review of a consecutive cohort of patients with tattoo complications diagnosed in the "Tattoo Clinic" of Bispebjerg University Hospital in Copenhagen, Denmark, from 2008 to 2015, based on patient history and systematic clinical examination. A total of 493 tattoo complications in 405 patients were studied. Overall, 184 (37%) presented allergic reactions with plaque elevation in 32.2%, excessive hyperkeratosis in 3.7%, and ulceration in 1.4%, predominantly observed in red tattoos and nuances of red; 66 (13%) presented papulo-nodular reactions, mainly observed in black tattoos (considered non-allergic) and due to pigment agglomeration; 53 (11%) had bacterial infections; 46 (9%) were psycho-social complications; 144 (30%) belonged to several specific diagnostic entities, including photosensitivity, pain syndrome, and lymphopathy. We found no cases of cutaneous or other malignancies. Sarcoidosis was primarily seen in black tattoos and was a common associated disease, found in 23 reactions (5%), compared to the background population. The study introduces a new concept of classification of tattoo complications based on simple tools such as patient history and objective findings supplemented with histology. The study reflects complications originating from presently used tattoo inks, often with organic pigments. The introduced classification has been submitted to the World Health Organisation (WHO) as a proposal to the 11th revision of the International Classification of Diseases. © 2016 S. Karger AG, Basel.

  14. Prevalent Rate of Nonalbuminuric Renal Insufficiency and Its Association with Cardiovascular Disease Event in Korean Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Hye Won Lee

    2016-12-01

    Full Text Available BackgroundNonalbuminuric renal insufficiency is a unique category of diabetic kidney diseases. The objectives of the study were to evaluate prevalent rate of nonalbuminuric renal insufficiency and to investigate its relationship with previous cardiovascular disease (CVD event in Korean patients with type 2 diabetes mellitus (T2DM.MethodsLaboratory and clinical data of 1,067 subjects with T2DM were obtained and reviewed. Study subjects were allocated into four subgroups according to the CKD classification. Major CVD events were included with coronary, cerebrovascular, and peripheral vascular events.ResultsNonalbuminuric stage ≥3 CKD group, when compared with albuminuric stage ≥3 CKD group, had shorter diabetic duration, lower concentrations of glycated hemoglobin, high density lipoprotein cholesterol, and high-sensitivity C-reactive protein, lower prevalent rates of retinopathy and previous CVD, and higher rate of treatment with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers. Nonalbuminuric stage ≥3 CKD group showed a greater association with prior CVD events than no CKD group; however, albuminuric stage ≥3 CKD group made addition to increase prevalence of prior CVD events significantly when CKD categories were applied as covariates. Association of prior CVD events, when compared with normal estimated glomerular filtration rate (eGFR and nonalbuminuria categories, became significant for declined eGFR, which was higher for eGFR of <30 mL/min/1.73 m2, and albuminuria.ConclusionThe results show that subjects with nonalbuminuric stage ≥3 CKD is significantly interrelated with occurrence of prior CVD events than those with normal eGFR with or without albuminuria. Comparing with normal eGFR and nonalbuminuria categories, the combination of increased degree of albuminuria and declined eGFR is becoming significant for the association of prior CVD events.

  15. Next-to-next-leading order correction to 3-jet rate and event-shape ...

    Indian Academy of Sciences (India)

    portunity to test QCD by measuring the energy dependence of different ... event shape data was not satisfactory largely due to the scale uncertainty of the pertur- .... )3 d ¯C dy. + O. ( α4 s. ) . (5). Here the event-shape distribution is normalized to the ..... [1] A Gehrmann-De Ridder, T Gehrmann, E W N Glover and G Heinrich, J.

  16. The effect of whole-blood donor adverse events on blood donor return rates.

    Science.gov (United States)

    Newman, Bruce H; Newman, Daniel T; Ahmad, Raffat; Roth, Arthur J

    2006-08-01

    Some blood donation-related adverse events (AEs) can negatively impact the blood donor return rate (BDRR) and decrease donor retention. One-thousand randomly selected whole-blood donors were interviewed 3 weeks after a 525-mL index whole-blood donation for seven AEs. The number of return visits and duration of follow-up were recorded for each of the 1000 donors. A negative binomial regression analysis was used to determine the contribution of the four most common AEs to the BDRR, and interactions between these AEs were also evaluated. The four most common AEs were bruise alone (15.1%), sore arm "alone" (7.0%), fatigue "alone" (5.1%), and donor reaction "alone" (4.2%), where "alone" is defined to also include donors who had a bruise but no other AE. The estimated BDRR for donations without AEs was 1.32 visits per year. The estimated BDRRs for the four most common AEs were: bruise alone, 1.32 visits per year; sore arm alone, 1.30 visits per year (2% reduction in BDRR); fatigue alone, 1.06 visits per year (20% reduction in BDRR); and donor reaction alone, 0.87 visits per year (34% reduction in BDRR). The BDRR for donor reaction, fatigue, and sore arm together was 0.20 visits per year (85% reduction in BDRR). Donor reaction had the most negative impact on the BDRR. There appears to be a synergistic effect between donor reaction, fatigue, and sore arm. Theoretically, amelioration of some AEs has the potential to improve BDRRs.

  17. Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status

    OpenAIRE

    Melani Carla; Fateh-Moghadam Pirous; dell'Omo Marco; de Giacomi Giovanna; Bena Antonella; Cooke Robin MT; Curti Stefania; Baldasseroni Alberto; Mattioli Stefano; Biocca Marco; Buiatti Eva; Campo Giuseppe; Zanardi Francesca; Violante Francesco S

    2008-01-01

    Abstract Background Carpal tunnel syndrome (CTS) is a socially relevant condition associated with biomechanical risk factors. We evaluated age-sex-specific incidence rates of in-hospital cases of CTS in central/northern Italy and explored relations with marital status. Methods Seven regions were considered (overall population, 14.9 million) over 3–6-year periods between 1997 and 2002 (when out-of-hospital CTS surgery was extremely rare). Incidence rates of in-hospital cases of CTS were estima...

  18. Benzodiazepine Use During Hospitalization: Automated Identification of Potential Medication Errors and Systematic Assessment of Preventable Adverse Events.

    Directory of Open Access Journals (Sweden)

    David Franklin Niedrig

    Full Text Available Benzodiazepines and "Z-drug" GABA-receptor modulators (BDZ are among the most frequently used drugs in hospitals. Adverse drug events (ADE associated with BDZ can be the result of preventable medication errors (ME related to dosing, drug interactions and comorbidities. The present study evaluated inpatient use of BDZ and related ME and ADE.We conducted an observational study within a pharmacoepidemiological database derived from the clinical information system of a tertiary care hospital. We developed algorithms that identified dosing errors and interacting comedication for all administered BDZ. Associated ADE and risk factors were validated in medical records.Among 53,081 patients contributing 495,813 patient-days BDZ were administered to 25,626 patients (48.3% on 115,150 patient-days (23.2%. We identified 3,372 patient-days (2.9% with comedication that inhibits BDZ metabolism, and 1,197 (1.0% with lorazepam administration in severe renal impairment. After validation we classified 134, 56, 12, and 3 cases involving lorazepam, zolpidem, midazolam and triazolam, respectively, as clinically relevant ME. Among those there were 23 cases with associated adverse drug events, including severe CNS-depression, falls with subsequent injuries and severe dyspnea. Causality for BDZ was formally assessed as 'possible' or 'probable' in 20 of those cases. Four cases with ME and associated severe ADE required administration of the BDZ antagonist flumazenil.BDZ use was remarkably high in the studied setting, frequently involved potential ME related to dosing, co-medication and comorbidities, and rarely cases with associated ADE. We propose the implementation of automated ME screening and validation for the prevention of BDZ-related ADE.

  19. Utilization of Workflow Process Maps to Analyze Gaps in Critical Event Notification at a Large, Urban Hospital.

    Science.gov (United States)

    Bowen, Meredith; Prater, Adam; Safdar, Nabile M; Dehkharghani, Seena; Fountain, Jack A

    2016-08-01

    Stroke care is a time-sensitive workflow involving multiple specialties acting in unison, often relying on one-way paging systems to alert care providers. The goal of this study was to map and quantitatively evaluate such a system and address communication gaps with system improvements. A workflow process map of the stroke notification system at a large, urban hospital was created via observation and interviews with hospital staff. We recorded pager communication regarding 45 patients in the emergency department (ED), neuroradiology reading room (NRR), and a clinician residence (CR), categorizing transmissions as successful or unsuccessful (dropped or unintelligible). Data analysis and consultation with information technology staff and the vendor informed a quality intervention-replacing one paging antenna and adding another. Data from a 1-month post-intervention period was collected. Error rates before and after were compared using a chi-squared test. Seventy-five pages regarding 45 patients were recorded pre-intervention; 88 pages regarding 86 patients were recorded post-intervention. Initial transmission error rates in the ED, NRR, and CR were 40.0, 22.7, and 12.0 %. Post-intervention, error rates were 5.1, 18.8, and 1.1 %, a statistically significant improvement in the ED (p workflow process maps. The workflow process map effectively defined communication failure parameters, allowing for systematic testing and intervention to improve communication in essential clinical locations.

  20. [Hospitalization rate in relation to severe complications of transrectal prostate biopsy: About 2715 patients biopsied].

    Science.gov (United States)

    Tamarelle, B; Perrin, P; Devonec, M; Paparel, P; Ruffion, A

    To identify hospitalizations directly related to a complication occurring within 30 days following a transrectal prostate biopsy (PBP). Overall hospitalization rates, mortality rates, potential predisposing factors for complications. Single-center study including all patients who underwent PBP between January 2005 and January 2012. Any hospitalization occurring within 30 days of the PBP for urgent motive was considered potentially attributable to biopsy. We identified the reason for hospitalization with direct complications (urinary infection or fever, rectal bleeding, bladder caillotage, retention) and indirect (underlying comorbidities decompensation) of the biopsy. The contributing factors were anticoagulant or antiplatelet treatment well as waning immunity factors (corticosteroid therapy, HIV, chemotherapy or immunodulateur). Among 2715 men who underwent PBP, there were 120 (4.4%) hospitalizations including 28 (1.03%) caused by the biopsy. Twenty-five (0.92%) were related to a direct complication of biopsy: 14 (56%) for urinary tract infection or fever including 1 hospitalization in intensive care, 5 (20%) for rectal bleeding which required several transfusions 1, 10 (40%) urinary retention and 3 (0.11%) for an indirect complication (2 coronary syndromes and 1 respiratory failure). Several direct complications were associated in 3 cases. Only two hospitalizations associated with rectal bleeding were taking an antiplatelet or anticoagulant. There was no association between hospitalization for urinary tract infections and a decreased immune status. The first death observed in our study occurred at D31 of pulmonary embolism (advanced metastatic patient with bladder cancer). Twenty (60.6%) patients urgently hospitalized did not have prostate cancer. Within this large sample of patients the overall rate of hospitalization due to the realization of a PBP was 1%. It has not been found predictive of complications leading to hospitalization. 4. Copyright © 2016

  1. Black/white differences in very low birth weight neonatal mortality rates among New York City hospitals.

    Science.gov (United States)

    Howell, Elizabeth A; Hebert, Paul; Chatterjee, Samprit; Kleinman, Lawrence C; Chassin, Mark R

    2008-03-01

    We sought to determine whether differences in the hospitals at which black and white infants are born contribute to black/white disparities in very low birth weight neonatal mortality rates in New York City. We performed a population-based cohort study using New York City vital statistics records on all live births and deaths of infants weighing 500 to 1499 g who were born in 45 hospitals between January 1, 1996, and December 31, 2001 (N = 11 781). We measured very low birth weight risk-adjusted neonatal mortality rates for each New York City hospital and assessed differences in the distributions of non-Hispanic black and non-Hispanic white very low birth weight births among these hospitals. Risk-adjusted neonatal mortality rates for very low birth weight infants in New York City hospitals ranged from 9.6 to 27.2 deaths per 1000 births. White very low birth weight infants were more likely to be born in the lowest mortality tertile of hospitals (49%), compared with black very low birth weight infants (29%). We estimated that, if black women delivered in the same hospitals as white women, then black very low birth weight mortality rates would be reduced by 6.7 deaths per 1000 very low birth weight births, removing 34.5% of the black/white disparity in very low birth weight neonatal mortality rates in New York City. Volume of very low birth weight deliveries was modestly associated with very low birth weight mortality rates but explained little of the racial disparity. Black very low birth weight infants more likely to be born in New York City hospitals with higher risk-adjusted neonatal mortality rates than were very low birth weight infants, contributing substantially to black-white disparities.

  2. Assessment of Measurement Tools of Observation Rate of Nursing Handover Standards in Clinical Wards of Hospital

    Directory of Open Access Journals (Sweden)

    Saadi Amini

    2015-08-01

    Full Text Available Background and objectives : In health centers, clinical information of patient is transferred among care staffs regularly. One of the common cases in information transferring is during the time of nurses’ handover in hospital which performing it correctly will help schedule patient care, providing safety and facilitating exact transferring of information. The aim of this study is investigating validity and reliability of assessment of observance rate of shift handover in clinical wards checklist. Material and Methods : In order to determine the reliability of checklist, two experts panel meetings were held with the presence of 10 experts in clinical field that in those meetings the reliability was investigated with discussion and consensus of participants. Checklist validity was investigated through pilot study in 4 wards of 4 hospitals and calculated by Kronbach- alpha method with 28 cases of shifts handover in morning, noon, and night shift. Results : In studying reliability, the primary checklist was divided into two checklists: patient handover, equipments and ward handover that included 27 and 72 items, respectively. The reliability of patient handover checklist was verified with 0.9155 Kronbach-alpha and that of equipments and ward handover was verified with 0.8779 Kronbach-alpha. Conclusion : Verifying checklists by mentioned scientific and statistical methods showed that these are very powerful instruments that can be used as one of the assessment tools of shift handover in clinical wards to be used towards promoting received services by customers of healthcare system.

  3. Evaluating the Rate of Compliance with Radiation Protection Standards in Shohada Teaching Hospital -Tabriz

    Directory of Open Access Journals (Sweden)

    Faramarz Pourasghar

    2016-01-01

    Full Text Available ​ Background and Objectives : If proper diagnosis is regarded as the basis of modern medicine, medical radiography is the foundation of medical diagnosis. Properly applied radiography helps physicians to diagnose problems. On one side, using it to improve quality of life is essential but on the other hand, its hazards are obvious. A reasonable usage and according to protection standards are the best way to benefit its advantages and reduce the hazards. Material and Methods : This cross-sectional study was conducted by a researcher-made check list that its validity and reliability were confirmed by experts. It was performed as direct observation in Shohada teaching hospital. Collected data were entered into Excel software and analyzed applying descriptive statistics. Results : The results indicated that compliance with protection standards regarding staff protection ranged from 73.6 to 100 percent and it ranged from 0 to 99.2 percent regarding patient protection. Compliance with protection standards concerning the availability of the devices was lower than average but it was rated higher than average regarding environmental protection. Conclusion : In general, not all protection standards for radiological diagnostic tests are followed at the radiology ward in the shohada teaching hospital. Continuous training courses and increasing staff and patients' awareness might resolve this problem.

  4. Prediction of hospital mortality by changes in the estimated glomerular filtration rate (eGFR).

    LENUS (Irish Health Repository)

    Berzan, E

    2015-03-01

    Deterioration of physiological or laboratory variables may provide important prognostic information. We have studied whether a change in estimated glomerular filtration rate (eGFR) value calculated using the (Modification of Diet in Renal Disease (MDRD) formula) over the hospital admission, would have predictive value. An analysis was performed on all emergency medical hospital episodes (N = 61964) admitted between 1 January 2002 and 31 December 2011. A stepwise logistic regression model examined the relationship between mortality and change in renal function from admission to discharge. The fully adjusted Odds Ratios (OR) for 5 classes of GFR deterioration showed a stepwise increased risk of 30-day death with OR\\'s of 1.42 (95% CI: 1.20, 1.68), 1.59 (1.27, 1.99), 2.71 (2.24, 3.27), 5.56 (4.54, 6.81) and 11.9 (9.0, 15.6) respectively. The change in eGFR during a clinical episode, following an emergency medical admission, powerfully predicts the outcome.

  5. Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital

    Science.gov (United States)

    Jenkins, Paul J; McDonald, David A; Van Der Meer, Robert; Morton, Alec; Nugent, Margaret; Rymaszewski, Lech A

    2017-01-01

    Objective Healthcare faces the continual challenge of improving outcome while aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway. Design Discrete event simulation was used to model and analyse cost and resource utilisation with an activity-based costing approach. Data for a full comparison before the process change was unavailable so we used a modelling approach, comparing a virtual fracture clinic (VFC) with a simulated traditional fracture clinic (TFC). Setting The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study. Outcome measures Our study focused exclusively on patients with non-operative trauma attending emergency department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries are presented in association with activity costs from the models. Results Patients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face (f2f) attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p≤0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI 21.74 to 23.92) per patient compared with £36.81 (95% CI 35.65 to 37.97) for the TFC pathway. Conclusions Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional f2f clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings

  6. Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital.

    Science.gov (United States)

    Anderson, Gillian H; Jenkins, Paul J; McDonald, David A; Van Der Meer, Robert; Morton, Alec; Nugent, Margaret; Rymaszewski, Lech A

    2017-09-07

    Healthcare faces the continual challenge of improving outcome while aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway. Discrete event simulation was used to model and analyse cost and resource utilisation with an activity-based costing approach. Data for a full comparison before the process change was unavailable so we used a modelling approach, comparing a virtual fracture clinic (VFC) with a simulated traditional fracture clinic (TFC). The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study. Our study focused exclusively on patients with non-operative trauma attending emergency department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries are presented in association with activity costs from the models. Patients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face (f2f) attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p≤0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI 21.74 to 23.92) per patient compared with £36.81 (95% CI 35.65 to 37.97) for the TFC pathway. Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional f2f clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings. © Article author(s) (or their employer(s) unless otherwise

  7. Trends in readmission rates for safety net hospitals and non-safety net hospitals in the era of the US Hospital Readmission Reduction Program: a retrospective time series analysis using Medicare administrative claims data from 2008 to 2015.

    Science.gov (United States)

    Salerno, Amy M; Horwitz, Leora I; Kwon, Ji Young; Herrin, Jeph; Grady, Jacqueline N; Lin, Zhenqiu; Ross, Joseph S; Bernheim, Susannah M

    2017-07-13

    To compare trends in readmission rates among safety net and non-safety net hospitals under the US Hospital Readmission Reduction Program (HRRP). A retrospective time series analysis using Medicare administrative claims data from January 2008 to June 2015. We examined 3254 US hospitals eligible for penalties under the HRRP, categorised as safety net or non-safety net hospitals based on the hospital's proportion of patients with low socioeconomic status. Admissions for Medicare fee-for-service patients, age ≥65 years, discharged alive, who had a valid five-digit zip code and did not have a principal discharge diagnosis of cancer or psychiatric illness were included, for a total of 52 516 213 index admissions. Mean hospital-level, all-condition, 30-day risk-adjusted standardised unplanned readmission rate, measured quarterly, along with quarterly rate of change, and an interrupted time series examining: April-June 2010, after HRRP was passed, and October-December 2012, after HRRP penalties were implemented. 58.0% (SD 15.3) of safety net hospitals and 17.1% (SD 10.4) of non-safety net hospitals' patients were in the lowest quartile of socioeconomic status. The mean safety net hospital standardised readmission rate declined from 17.0% (SD 3.7) to 13.6% (SD 3.6), whereas the mean non-safety net hospital declined from 15.4% (SD 3.0) to 12.7% (SD 2.5). The absolute difference in rates between safety net and non-safety net hospitals declined from 1.6% (95% CI 1.3 to 1.9) to 0.9% (0.7 to 1.2). The quarterly decline in standardised readmission rates was 0.03 percentage points (95% CI 0.03 to 0.02, preadmission rates for safety net hospitals have decreased more rapidly than those for non-safety net hospitals. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Infection Rate in 1033 Elective Neurosurgical Procedures at a University Hospital in South China.

    Science.gov (United States)

    Zhu, Hongwei; Liu, Xiyao; Wang, Zhanxiang

    2017-09-01

    Objective  Infection following surgery is a serious complication, especially in neurosurgery. The aim of the study is to report the change of incidence rates of infection in patients undergoing elective neurosurgical procedures at a university hospital in South China as well as the risk factors. Material and Methods  The medical records and postoperative courses for patients undergoing 1,033 neurosurgical procedures from 2008 to 2014 were reviewed retrospectively to determine the incidence of neurosurgical infection, the identity of the offending organisms, and the factors associated with infection. Results  A total of 33 patients (40 cases) experienced postoperative infection representing 3.19% of the study population. Twenty cases were incision infections (1.94%), and 20 were cranial/spinal infections (1.94%) including 15 intracranial infections and 5 intraspinal infections. The 2.4-fold greater incidence of postoperative infection in 2008 to 2010 was compared with that in 2011 to 2014 with perioperative antibiotic prophylaxis ( p neurosurgery (1.08%). The most common offending organism was Staphylococcus aureus (27.5%). Foreign body implantation, operative time > 4 hours, and cerebrospinal fluid (CSF) leak (13 infections in 158 patients; p <0.001) were risk factors for infections ( p <0.05). Conclusion  The neurosurgical infection rate is usually low with perioperative antibiotic prophylaxis even in developing countries. Less foreign body implantation, shorter operative times, and controlling CSF leak could reduce infection rates. Georg Thieme Verlag KG Stuttgart · New York.

  9. Hospitals

    DEFF Research Database (Denmark)

    Mullins, Michael

    2013-01-01

    The challenge could be briefly seen in these terms: hospitals as places for treatment where there’s a technology focus and hospitals for healing where there’s a human focus. In the 60s - 70s wave of new hospital building, an emphasis on technology can be seen. It’s time to move from the technology...... focus. It is not enough to consider only the factors of function within architecture, hygiene, economy and logistics. We also need to look at aspects of aesthetics, bringing nature into the building, art, color, acoustics, volume and space as we perceive them. Contemporary methods and advances...... placed, accessible, provided with plenty of greenery, and maximize sensory impressions, providing sounds, smells, sight and the possibility to be touched. This is a very well documented area I can say. Hygiene, in terms of architecture can give attention to hand wash facilities and their positioning...

  10. The effect of patients’ time of arrival at the hospital on the rate of Thrombolytic therapy

    Directory of Open Access Journals (Sweden)

    Toba Kazemi

    2013-01-01

    Full Text Available The honorable editor-in-chief of the Journal of ARYA We read with interest the article of Dr. Maleki that has recently been published.1 We conducted a similar study in Birjand Vali-e-Asr Hospital in 2009-2010. This study was done on 125 patients with STEMI with a mean age of 59.2 ± 11.9 years. In this study, 65.6% of patients underwent thrombolytic therapy. This showed a crucial increase compared to the previous study in Birjand in 2003 that showed 17.3% of patients underwent thrombolytic therapy.2 Mean door to needle time was 74.8 ± 42.7 minutes (median 60 minutes. Thrombolytic therapy showed no difference for difference in sex (69.4% in males, and 51.9% in females, P = 0.08. However, in working staff (86.7% in employees, and 51.2% in farmers/workers, P = 0.003, in highly educated individuals (92.3% at university level, and 45.5% illiterate, P < 0.001, and in citizens (73.2% in urban, and 51.2% in rural citizens, P = 0.01 there was a higher percentage of thrombolytic therapy. The main reason for this difference between them is earlier arrival to the hospital since the onset of symptoms. The arrival time in the city's residents was 166.7 ± 179.6 minutes, but for villagers it was 221.6 ± 112 minutes (P = 0.001. Furthermore, the rate of thrombolytic therapy during the night was not significantly different compared to the rest of the day (73% during morning, 62.9% during afternoon, and 62.3% during night, P = 0.52. The patient's arrival time to the hospital at night was not different compared to the rest of the day (166.9 ± 174.7 minutes in the morning shift, and 148.2 ± 85.2 minutes during the night shift, P = 0.63. Visiting patients during the night shift was similar to other shifts; visit by intern was 12.3 ± 9.1 minutes during the morning shift, and 14.1 ± 9.3 minutes during the night shift (P = 0.73. The rate of thrombolytic therapy in our study was similar to the study by Dr. Maleki;1 however, door to needle time was longer. In our

  11. PFA-100-measured aspirin resistance is the predominant risk factor for hospitalized cardiovascular events in aspirin-treated patients: A 5-year cohort study.

    Science.gov (United States)

    Chen, H Y; Chou, P

    2018-04-01

    Aspirin therapy is the clinical gold standard for the prevention of cardiovascular events. However, cardiovascular events still develop in some patients undergoing aspirin therapy. Many laboratory methods exist for measuring aspirin resistance. Using the platelet Function Analyzer (PFA)-100 system, we aimed to determine the effect of aspirin resistance on hospitalized cardiovascular events (hCVE) in a 5-year follow-up cohort. We also sought to determine the impact of aspirin resistance on the relationship between common cardiovascular risk factors and cardiovascular hospitalization. Aspirin resistance was evaluated in aspirin-treated patients from the outpatient department. A total of 465 patients during a 5-year follow-up period were included in this study. The primary endpoint of the study was hospitalization for any acute cardiovascular event. The prevalence and associated risk factors of acute cardiovascular events were evaluated. Aspirin resistance was prevalent in 91 (20.0%) of 465 patients. Prior hospitalization history of cardiovascular events was highly associated with aspirin resistance (P = .001). At the 5-year follow-up, cardiovascular events were found to have developed in 11 patients (8 stroke and 3 myocardial infarction) who exhibited aspirin resistance (12.1%) and in 9 (4 stroke and 5 myocardial infarction) patients who did not exhibit aspirin resistance (2.4%) (P resistance and cardiovascular events (adjusted odds ratio 4.28; 95% CI: 1.64-11.20; P = .03). PFA-100 measurements of aspirin resistance correlate with hCVE, as evidenced by both the past medical history and the 5-year follow-up. The logistic regression analysis results showed that aspirin resistance plays a larger role in hospitalized cardiovascular disease than do other cardiovascular risk factors. © 2017 John Wiley & Sons Ltd.

  12. Variation in Primary Cesarean Delivery Rates by Individual Physician within a Single Hospital Laborist Model

    Science.gov (United States)

    METZ, Torri D.; ALLSHOUSE, Amanda A.; GILBERT, Sara A Babcock; DOYLE, Reina; TONG, Angie; CAREY, J. Christopher

    2016-01-01

    Background Laborist practice models are associated with lower cesarean delivery rates than individual private practice models in several studies; however, this effect is not uniform. Further exploration of laborist models may help us better understand the observed reduction in cesarean delivery rates in some hospitals with implementation of a laborist model. Objective Our objective was to evaluate the degree of variation in primary cesarean delivery rates by individual laborists within a single institution employing a laborist model. In addition, we sought to evaluate whether differences in cesarean delivery rates resulted in different maternal or short-term neonatal outcomes. Study Design At this teaching institution, one laborist (either a generalist or maternal-fetal medicine attending physician) is directly responsible for labor and delivery management during each shift. No patients are followed in a private practice model nor are physicians incentivized to perform deliveries. We retrospectively identified all laborists who delivered nulliparous, term women with cephalic singletons at this institution from 2007-14. Overall and individual primary cesarean delivery rates were reported as percentages with exact Pearson 95% CI. Laborists were grouped by tertile as having low, medium or high cesarean delivery rates. Characteristics of the women delivered, indications for cesarean delivery, and short-term neonatal outcomes were compared between these groups. A binomial regression model of cesarean delivery was estimated, where the relative rates of each laborist compared to the lowest-unadjusted laborist rate were calculated; a second model was estimated to adjust for patient-level maternal characteristics. Results Twenty laborists delivered 2,224 nulliparous, term women with cephalic singletons. The overall cesarean delivery rate was 24.1% (95% CI 21.4-26.8). In an unadjusted binomial model, the overall effect of individual laborist was significant (pcesarean

  13. The effectiveness of the solidary care ahead of events that follow the chronicle illness process of the hospitalized child

    Directory of Open Access Journals (Sweden)

    Alexandra Maria Alves

    2006-08-01

    Full Text Available Article of research that objectified to identify how the nurses carrie through the solidary care front to the alterations in the evolution of the hospitalized child that lead to the chronicle illness process. The methodology is qualitative through the exploratory- description method. The subjects had been nine assisstencial nurses who act in pediatric units of a great hospital of Curitiba-PR wich is reference in the pediatric area in all Brazil. For the collection of the information we used the half-structuralized interview. To accomplish the analysis of the depositions we followed the content analysis proposal by Bardin (1991. The ethical rules had been followed in agreement to the Resolution 196/96. All the subjects had signed the term of content of written informed consent. After the transcription of the interviews that had been recorded, we initiate the categorization. Three Units of Context and six Units of Meaning had been apprehended.The Units of Context include the perception of the chronicle illness process of the hospitalized child by the nurse; the perception of the nursing actions of solidary care by the family and, pointing characteristics that interpose the solidary care. For the analysis of the depositions it was possible to perceive that the lack of familiar structure is visible, therefore the child remains long time in the hospital, modifying its daily routine, affecting the family and changing its routine, that is, coexisting with the chronicle illness process imposes alterations in the existing space and temporality of the child. The family and child need support supplied by the nurse in solidary care. The solidary care is perceived by the bond, interest, contact, dialogue, support, the presence, the listening, for the empathy, reliable transmission and hope. It can be established with multiprofessional work, preparation of the team, knowledge, availability, respect for the other. The solidary care is a process, an event that

  14. General programmable Level-1 trigger with 3D-Flow assembly system for calorimeters of different sizes and event rates

    International Nuclear Information System (INIS)

    Crosetto, D.

    1992-12-01

    Experience demonstrates that fine tuning on the trigger of an experiment is often achieved only after running the experiment and analyzing the first data acquired. It is desirable that identification and, consequently, selection of interesting events be made on a more refined identification of particles. Use of an innovative parallel-processing system architecture together with an instruction set allows identification of objects (particles) among the data coming from a calorimeter in a programmable manner, utilizing the information related to their shape in two- or three-dimensional form, rather than applying only a programmable threshold proportional to their energy. The architecture is flexible, allowing execution of simple algorithms as well as complex pattern recognition algorithms. It is scalable in the sense that the same hardware can be used for small or large calorimeters having a slow or fast event rate. The simple printed circuit board (accommodating 16 x 3D-Flow processors) on a 4 in. x 4 in. board described herein uses the same hardware to build a large Level-1 programmable trigger (by interconnecting many boards in a matrix array) and is capable of implementing simple or complex pattern recognition algorithms at different event input rates (by cascading boards one on top of another). With the same hardware one can build low-cost, programmable Level-1 triggers for a small and low-event-rate calorimeter, or high-performance, programmable Level-1 triggers for a large calorimeter capable of sustaining up to 60 million events per second

  15. What are key determinants of hospital admissions, readmission rate and day case rate within the South African medical schemes population?

    Directory of Open Access Journals (Sweden)

    Nondumiso Gugu Khumalo

    2012-06-01

    Full Text Available  BACKGROUND: In South Africa, private hospitals absorb a high proportion of the total health expenditure on private health care. Between 2008-2010 private hospital expenditure which includes ward fees, theatre fees, consumables, medicines and per diem arrangements consumed between 40.5% and 40.9% of the total benefits paid by medical schemes from the risk pool, whilst in-hospital managed care fees ranged between 1.8% and 2.8% for the equivalent years.OBJECTIVE: The aim of this paper is to highlight key factors contributing to utilisation of hospital services within the medical schemes population and to recommend “appropriate” and cost effective strategies on hospital utilisation management.METHODS: A cross sectional survey informed by retrospective analysis of quantitative data was used. Researchers also triangulated quantitative data with systematic review of literature.RESULTS: The results show that demographic indicators such as age profile, dependency ratio, pensioner ratio and prevalence of chronic conditions are not the only key factors influencing hospital admissions, but rather the effectiveness of each medical scheme in containing hospital admissions is also influenced by available technical capacity on utilisation review and audit as well as the managed care methodology including the philosophy underpinning benefit option design.CONCLUSION: This study highlights the importance of “value based” managed care programs linked to benefit option design in health care utilisation management. The choice of one managed care program over the other often leads to tradeoffs whereby unintended consequences emanate. Medical schemes are therefore encouraged to continuously review their managed care programs to ensure value for money as well as better access and health outcomes.http://dx.doi.org/10.7175/fe.v13i2.207

  16. The contribution of staff call light response time to fall and injurious fall rates: an exploratory study in four US hospitals using archived hospital data

    Directory of Open Access Journals (Sweden)

    Tzeng Huey-Ming

    2012-03-01

    Full Text Available Abstract Background Fall prevention programs for hospitalized patients have had limited success, and the effect of programs on decreasing total falls and fall-related injuries is still inconclusive. This exploratory multi-hospital study examined the unique contribution of call light response time to predicting total fall rates and injurious fall rates in inpatient acute care settings. The conceptual model was based on Donabedian's framework of structure, process, and health-care outcomes. The covariates included the hospital, unit type, total nursing hours per patient-day (HPPDs, percentage of the total nursing HPPDs supplied by registered nurses, percentage of patients aged 65 years or older, average case mix index, percentage of patients with altered mental status, percentage of patients with hearing problems, and call light use rate per patient-day. Methods We analyzed data from 28 units from 4 Michigan hospitals, using archived data and chart reviews from January 2004 to May 2009. The patient care unit-month, defined as data aggregated by month for each patient care unit, was the unit of analysis (N = 1063. Hierarchical multiple regression analyses were used. Results Faster call light response time was associated with lower total fall and injurious fall rates. Units with a higher call light use rate had lower total fall and injurious fall rates. A higher percentage of productive nursing hours provided by registered nurses was associated with lower total fall and injurious fall rates. A higher percentage of patients with altered mental status was associated with a higher total fall rate but not a higher injurious fall rate. Units with a higher percentage of patients aged 65 years or older had lower injurious fall rates. Conclusions Faster call light response time appeared to contribute to lower total fall and injurious fall rates, after controlling for the covariates. For practical relevance, hospital and nursing executives should consider

  17. Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study.

    Science.gov (United States)

    Jensen, Magnus T; Pereira, Marta; Araujo, Carla; Malmivaara, Anti; Ferrieres, Jean; Degano, Irene R; Kirchberger, Inge; Farmakis, Dimitrios; Garel, Pascal; Torre, Marina; Marrugat, Jaume; Azevedo, Ana

    2018-03-01

    The purpose of this study was to investigate the relationship between heart rate at admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Consecutive ACS patients admitted in 2008-2010 across 58 hospitals in six participant countries of the European Hospital Benchmarking by Outcomes in ACS Processes (EURHOBOP) project (Finland, France, Germany, Greece, Portugal and Spain). Cardiogenic shock patients were excluded. Associations between heart rate at admission in categories of 10 beats per min (bpm) and in-hospital mortality were estimated by logistic regression in crude models and adjusting for age, sex, obesity, smoking, hypertension, diabetes, known heart failure, renal failure, previous stroke and ischaemic heart disease. In total 10,374 patients were included. In both STEMI and NSTE-ACS patients, a U-shaped relationship between admission heart rate and in-hospital mortality was found. The lowest risk was observed for heart rates between 70-79 bpm in STEMI and 60-69 bpm in NSTE-ACS; risk of mortality progressively increased with lower or higher heart rates. In multivariable models, the relationship persisted but was significant only for heart rates >80 bpm. A similar relationship was present in both patients with or without diabetes, above or below age 75 years, and irrespective of the presence of atrial fibrillation or use of beta-blockers. Heart rate at admission is significantly associated with in-hospital mortality in patients with both STEMI and NSTE-ACS. ACS patients with admission heart rate above 80 bpm are at highest risk of in-hospital mortality.

  18. Planned home compared with planned hospital births: Mode of delivery and Perinatal mortality rates, an observational study

    NARCIS (Netherlands)

    Kooy, J. (Jacoba); E. Birnie (Erwin); S. Denktaş (Semiha); E.A.P. Steegers (Eric); G.J. Bonsel (Gouke)

    2017-01-01

    textabstractBackground: To compare the mode of delivery between planned home versus planned hospital births and to determine if differences in intervention rates could be interpreted as over- or undertreatment. Methods: Intervention and perinatal mortality rates were obtained for 679,952 low-risk

  19. Breast reconstruction rate and profile in a Singapore patient population: a National University Hospital experience.

    Science.gov (United States)

    Sim, Nadia; Soh, Sharon; Ang, Chuan Han; Hing, Chor Hoong; Lee, Han Jing; Nallathamby, Vigneswaran; Yap, Yan Lin; Ong, Wei Chen; Lim, Thiam Chye; Lim, Jane

    2017-05-15

    Breast reconstruction is an integral part of breast cancer management, with the aim of restoring a breast to its natural form. There is increasing awareness among women that it is a safe procedure and its benefits extend beyond aesthetics. Our aim was to establish the rate of breast reconstruction and provide an overview of the patients who underwent breast reconstruction at National University Hospital (NUH), Singapore. We evaluated factors, such as ethnicity, age, time and type of implant, for their impact on a patient's decision to proceed with breast reconstruction. We retrospectively reviewed the medical records of women who had breast cancer and underwent breast surgery at NUH between 2001 and 2010. The breast reconstruction rate in this study was 24.3%. There were 241 patients who underwent breast reconstruction surgeries (including delayed and immediate procedures) among 993 patients for whom mastectomies were done for breast cancer. Chinese patients were the largest ethnic group who underwent breast reconstruction after mastectomy (74.3%). Within a single ethnic patient group, Malay women had the largest proportion of women undergoing breast reconstruction (60.0%). The youngest woman in whom cancer was detected in our study was aged 20 years. Malay women showed the greatest preference for autologous tissue breast reconstruction (92.3%). The median age at cancer diagnosis of our cohort was 46 years. We noted increases in the age of patients undergoing breast reconstruction and the proportion of breast reconstruction cases over the ten-year study period.

  20. Tracking Real-Time Changes in Working Memory Updating and Gating with the Event-Based Eye-Blink Rate

    NARCIS (Netherlands)

    Rac-Lubashevsky, R.; Slagter, H.A.; Kessler, Y.

    2017-01-01

    Effective working memory (WM) functioning depends on the gating process that regulates the balance between maintenance and updating of WM. The present study used the event-based eye-blink rate (ebEBR), which presumably reflects phasic striatal dopamine activity, to examine how the cognitive

  1. BCG Vaccination at Birth and Rate of Hospitalization for Infection Until 15 Months of Age in Danish Children

    DEFF Research Database (Denmark)

    Stensballe, Lone Graff; Ravn, Henrik; Birk, Nina Marie

    2018-01-01

    Background: The bacillus Calmette-Guérin (BCG) vaccine against tuberculosis might reduce the non-tuberculosis-related child mortality rate in low-income settings. We tested the hypothesis that BCG vaccination at birth would reduce early childhood hospitalization for infection in Denmark, a high...... analysis, we observed 588 hospitalizations for infection (mean, 0.28 hospitalization per child) among the 2129 children allocated to receive the BCG vaccine and 595 hospitalizations for infection (mean, 0.28 hospitalization per child) among the 2133 children allocated to the control group (hazard ratio [HR...... months in Danish children. In future studies, the role of maternal BCG-vaccination, premature birth, and cesarean delivery needs further exploration....

  2. Role of duration of catheterization and length of hospital stay on the rate of catheter-related hospital-acquired urinary tract infections

    Directory of Open Access Journals (Sweden)

    Al-Hazmi H

    2015-03-01

    Full Text Available Hamdan Al-HazmiDivision of Urology, Department of Surgery, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi ArabiaObjective: Our aim is to prove that duration of catheterization and length of hospital stay (LOS are associated with the rate of hospital-acquired urinary tract infections (UTI, while taking into account type of urinary catheter used, the most common organisms found, patient diagnosis on admission, associated comorbidities, age, sex, precautions that should be taken to avoid UTI, and comparison with other studies.Methods: The study was done in a university teaching hospital with a 920-bed capacity; this hospital is a tertiary care center in Riyadh, Saudi Arabia. The study was done on 250 selected patients during the year 2010 as a retrospective descriptive study. Patients were selected as purposive sample, all of them having been exposed to urinary catheterization; hospital-acquired UTI were found in 100 patients. Data were abstracted from the archived patients' files in the medical record department using the annual infection control logbook prepared by the infection control department. The data collected were demographic information about the patients, clinical condition (diagnosis and the LOS, and possible risk factors for infection such as duration of catheterization, exposure to invasive devices or surgical procedures, and medical condition.Results: There was a statistically significant association between the rate of UTI and duration of catheterization: seven patients had UTI out of 46 catheterized patients (15% at 3 days of catheterization, while 30 patients had UTI out of 44 catheterized patients (68% at 8 days of catheterization (median 8 days in infected patients versus 3 days in noninfected patients; P-value <0.05, which means that the longer the duration of catheterization, the higher the UTI rate. There was a statistically significant association between the rate of UTI and LOS

  3. Impact of a prevention bundle on Clostridium difficile infection rates in a hospital in the Southeastern United States.

    Science.gov (United States)

    Davis, Bionca M; Yin, Jingjing; Blomberg, Doug; Fung, Isaac Chun-Hai

    2016-12-01

    We sought to assess the impact of a multicomponent prevention program on hospital-acquired Clostridium difficile infections in a hospital in the Southeastern United States. We collected retrospective data of 140 patients from years 2009-2014 and applied the Poisson regression model for analysis. We did not find any significant associations of increased risk of Clostridium difficile infections for the preintervention group. Further studies are needed to test multifaceted bundles in hospitals with high infection rates. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Robust event-triggered MPC with guaranteed asymptotic bound and average sampling rate

    NARCIS (Netherlands)

    Brunner, F.D.; Heemels, W.P.M.H.; Allgower, F.

    2017-01-01

    We propose a robust event-triggered model predictive control (MPC) scheme for linear time-invariant discrete-time systems subject to bounded additive stochastic disturbances and hard constraints on the input and state. For given probability distributions of the disturbances acting on the system, we

  5. Next-to-next-leading order correction to 3-jet rate and event-shape ...

    Indian Academy of Sciences (India)

    The coupling constant, , was measured by two different methods: first by employing the three-jet observables. Combining all the data, the value of as at next-to-next leading order (NNLO) was determined to be 0.117 ± 0.004(hard) ± 0.006(theo). Secondly, from the event-shape distributions, the strong coupling constant, ...

  6. Influence of Intensified Supervision by Health Care Inspectorates on Online Patient Ratings of Hospitals: A Multilevel Study of More Than 43,000 Online Ratings

    NARCIS (Netherlands)

    Kool, R.B.; Kleefstra, S.M.; Borghans, H.J.; Atsma, F.; Belt, T.H. van de

    2016-01-01

    BACKGROUND: In the Netherlands, hospitals with quality or safety issues are put under intensified supervision by the Dutch Health Care Inspectorate, which involves frequent announced and unannounced site visits and other measures. Patient rating sites are an upcoming phenomenon in health care.

  7. Impact of stroke unit in a public hospital on length of hospitalization and rate of early mortality of ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Maria Sheila G. Rocha

    2013-10-01

    Full Text Available We ascertained whether a public health stroke unit reduces the length of hospitalization, the rate of inpatient fatality, and the mortality rate 30 days after the stroke. Methods We compared a cohort of stroke patients managed on a general neurology/medical ward with a similar cohort of stroke patients managed in a str oke unit. The in-patient fatality rates and 30-day mortality rates were analyzed. Results 729 patients were managed in the general ward and 344 were treated at a comprehensive stroke unit. The in-patient fatality rates were 14.7% for the general ward group and 6.9% for the stroke unit group (p<0.001. The overall mortality rate 30 days after stroke was 20.9% for general ward patients and 14.2% for stroke unit patients (p=0.005. Conclusions We observed reduced in-patient fatalities and 30-day mortality rates in patients managed in the stroke unit. There was no impact on the length of hospitalization.

  8. Design of a medical record review study on the incidence and preventability of adverse events requiring a higher level of care in Belgian hospitals

    Directory of Open Access Journals (Sweden)

    Vlayen Annemie

    2012-08-01

    Full Text Available Abstract Background Adverse events are unintended patient injuries that arise from healthcare management resulting in disability, prolonged hospital stay or death. Adverse events that require intensive care admission imply a considerable financial burden to the healthcare system. The epidemiology of adverse events in Belgian hospitals has never been assessed systematically. Findings A multistage retrospective review study of patients requiring a transfer to a higher level of care will be conducted in six hospitals in the province of Limburg. Patient records are reviewed starting from January 2012 by a clinical team consisting of a research nurse, a physician and a clinical pharmacist. Besides the incidence and the level of causation and preventability, also the type of adverse events and their consequences (patient harm, mortality and length of stay will be assessed. Moreover, the adequacy of the patient records and quality/usefulness of the method of medical record review will be evaluated. Discussion This paper describes the rationale for a retrospective review study of adverse events that necessitate a higher level of care. More specifically, we are particularly interested in increasing our understanding in the preventability and root causes of these events in order to implement improvement strategies. Attention is paid to the strengths and limitations of the study design.

  9. Development and validation of a Thai stressful life events rating scale for patients with a diagnosis of schizophrenic methamphetamine abuse

    Directory of Open Access Journals (Sweden)

    Ek-uma Imkome

    2017-04-01

    Full Text Available This study aimed to psychometrically test a Thai Stressful Life Events Rating Scale (TSLERS. Factor analysis was done on data collected from 313 patients with schizophrenia and methamphetamine abuse in Thailand from April to May, 2015. Results identified the following problems impacting physical and mental health: social relationship and social concerns, money, family life, life security, and career. Evaluation of the psychometric scale properties demonstrated acceptable validity and reliability. TSLERS provided scientific and empirical data about stressful life events of patients with schizophrenia and methamphetamine abuse, and was suitable for stress detection and suggesting further innovations.

  10. Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery

    DEFF Research Database (Denmark)

    Andersen, Jens; Hjort-Jakobsen, Dorthe; Christiansen, P. S.

    2007-01-01

    BACKGROUND: Initial programmes of fast-track open colonic surgery with a planned 2-day postoperative hospital stay have had a high readmission rate (about 20 per cent). The aim of this large, consecutive series was to compare readmission rates after a fast-track open colonic surgery programme....... There was no difference in type and incidence of morbidity between the two periods. CONCLUSION: Readmission after fast-track open colonic resection was reduced by planning discharge 3 instead of 2 days after surgery, with the same discharge criteria. Copyright (c) 2007 British Journal of Surgery Society Ltd. Published...... from August 2004. All patients were examined 8 and 30 days after surgery. RESULTS: Readmission rates fell from 20.1 per cent in 408 patients with a planned 2-day hospital stay (period 1) to 11.3 per cent in 133 patients with a planned 3-day hospital stay (period 2) (P

  11. A Quality Improvement Approach to Reducing the Caesarean section Surgical Site Infection Rate in a Regional Hospital

    LENUS (Irish Health Repository)

    O’ Hanlon, M

    2016-09-01

    Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.

  12. A video event trigger for high frame rate, high resolution video technology

    Science.gov (United States)

    Williams, Glenn L.

    1991-12-01

    When video replaces film the digitized video data accumulates very rapidly, leading to a difficult and costly data storage problem. One solution exists for cases when the video images represent continuously repetitive 'static scenes' containing negligible activity, occasionally interrupted by short events of interest. Minutes or hours of redundant video frames can be ignored, and not stored, until activity begins. A new, highly parallel digital state machine generates a digital trigger signal at the onset of a video event. High capacity random access memory storage coupled with newly available fuzzy logic devices permits the monitoring of a video image stream for long term or short term changes caused by spatial translation, dilation, appearance, disappearance, or color change in a video object. Pretrigger and post-trigger storage techniques are then adaptable for archiving the digital stream from only the significant video images.

  13. Impact of Disease Prevalence Adjustment on Hospitalization Rates for Chronic Ambulatory Care-Sensitive Conditions in Germany.

    Science.gov (United States)

    Pollmanns, Johannes; Romano, Patrick S; Weyermann, Maria; Geraedts, Max; Drösler, Saskia E

    2018-04-01

    To explore effects of disease prevalence adjustment on ambulatory care-sensitive hospitalization (ACSH) rates used for quality comparisons. County-level hospital administrative data on adults discharged from German hospitals in 2011 and prevalence estimates based on administrative ambulatory diagnosis data were used. A retrospective cross-sectional study using in- and outpatient secondary data was performed. Hospitalization data for hypertension, diabetes, heart failure, chronic obstructive pulmonary disease, and asthma were obtained from the German Diagnosis Related Groups (DRG) database. Prevalence estimates were obtained from the German Central Research Institute of Ambulatory Health Care. Crude hospitalization rates varied substantially across counties (coefficients of variation [CV] 28-37 percent across conditions); this variation was reduced by prevalence adjustment (CV 21-28 percent). Prevalence explained 40-50 percent of the observed variation (r = 0.65-0.70) in ACSH rates for all conditions except asthma (r = 0.07). Between 30 percent and 38 percent of areas moved into or outside condition-specific control limits with prevalence adjustment. Unadjusted ACSH rates should be used with caution for high-stakes public reporting as differences in prevalence may have a marked impact. Prevalence adjustment should be considered in models analyzing ACSH. © Health Research and Educational Trust.

  14. Assessment of the health care waste generation rates and its management system in hospitals of Addis Ababa, Ethiopia, 2011

    Directory of Open Access Journals (Sweden)

    Debere Mesfin Kote

    2013-01-01

    Full Text Available Abstract Background Healthcare waste management options are varying in Ethiopia. One of the first critical steps in the process of developing a reliable waste management plan requires a widespread understanding of the amount and the management system. This study aimed to assess the health care waste generation rate and its management system in some selected hospitals located in Addis Ababa, Ethiopia. Methods Six hospitals in Addis Ababa, (three private and three public, were selected using simple random sampling method for this work. Data was recorded by using an appropriately designed questionnaire, which was completed for the period of two months. The calculations were based on the weights of the health care wastes that were regularly generated in the selected hospitals over a one week period during the year 2011. Average generation indexes were determined in relation to certain important factors, like the type of hospitals (public vs private. Results The median waste generation rate was found to be varied from 0.361- 0.669 kg/patient/day, comprised of 58.69% non-hazardous and 41.31% hazardous wastes. The amount of waste generated was increased as the number of patients flow increased (rs=1. Public hospitals generated high proportion of total health care wastes (59.22% in comparison with private hospitals (40.48%. The median waste generation rate was significantly vary between hospitals with Kruskal-Wallis test (X2=30.65, p=0.0001. The amount of waste was positively correlated with the number of patients (p Conclusion These findings revealed that the management of health care waste at hospitals in Addis Ababa city was poor.

  15. The trend of pressure ulcer prevalence rates in German hospitals: results of seven cross-sectional studies.

    Science.gov (United States)

    Kottner, Jan; Wilborn, Doris; Dassen, Theo; Lahmann, Nils

    2009-05-01

    Pressure ulcer prevalence rates provide useful information about the magnitude of this health problem. Only limited information on pressure ulcers in Germany was available before 2001. The purpose of this study was to compare results of seven pressure ulcer prevalence surveys which were conducted annually between 2001 and 2007 and to explore whether pressure ulcer prevalence rates decreased. The second aim was to evaluate if the measured prevalence rates of our sample could be generalised for all German hospitals. Results of seven point pressure ulcer prevalence studies conducted in 225 German hospitals were analysed. Chi-square tests, chi-square trend tests and one-way ANOVA to assess differences and trends across the years were applied. The sample was stratified according to pressure ulcer risk and speciality. Finally, study samples were compared with the potential population. In total data of 40,247 hospital patients were analysed. The overall pressure ulcer prevalence rate in German hospitals was 10.2%. Patient samples of each year were comparable regarding gender, age and pressure ulcer risk. Pressure ulcer prevalence rates decreased from 13.9% (year 2001) to 7.3% (year 2007) (pcare units remained stable. With some limitations our study results are representative for all hospitals within Germany. It is highly probable that the decrease of prevalence rates was due to an increased awareness of the pressure ulcer problem in Germany and subsequent efforts to improve pressure ulcer prevention and treatment. The quality of clinical practice regarding pressure ulcer prevention and treatment has improved. However, pressure ulcers are still relevant and require attention. In 2007, one out of 10 hospital patients who were at pressure ulcer risk had at least one pressure related skin damage.

  16. [Adverse events self-declaration system and influenza vaccination coverage of healthcare workers in a tertiary hospital].

    Science.gov (United States)

    Velasco Munoz, Cesar; Sequera, Víctor-Guillermo; Vilajeliu, Alba; Aldea, Marta; Mena, Guillermo; Quesada, Sebastiana; Varela, Pilar; Olivé, Victoria; Bayas, José M; Trilla, Antoni

    2016-02-19

    During the influenza vaccination campaign 2011-2012 we established a self-declaration system of adverse events (AEs) in healthcare workers (HCW). The aim of this study is to describe the vaccinated population and analyse vaccination coverage and self-declared AEs after the voluntary flu vaccination in a university hospital in Barcelona. Observational study. We used the HCW immunization record to calculate the vaccination coverage. We collected AEs using a voluntary, anonymous, self-administered survey during the 2011-2012 flu vaccination campaign. We performed a logistic regression model to determine the associated factors to declare AEs. The influenza vaccination coverage in HCW was 30.5% (n=1,507/4,944). We received completed surveys from 358 vaccinated HCW (23.8% of all vaccinated). We registered AEs in 186 respondents to the survey (52.0% of all respondents). Of these, 75.3% (n=140) reported local symptoms after the flu vaccination, 9.7% (n=18) reported systemic symptoms and 15.1% (n=28) both local and systemic symptoms. No serious AEs were self-reported. Female sex and aged under 35 were both factors associated with declaring AEs. Our self-reporting system did not register serious AEs in HCW, resulting in an opportunity to improve HCW trust in flu vaccination. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  17. Utility of heart rate turbulence and T-Wave alternans to assess risk for Re-admission and cardiac death in hospitalized heart failure patients.

    Science.gov (United States)

    Yamada, Shinya; Yoshihisa, Akiomi; Sato, Yu; Sato, Takamasa; Kamioka, Masashi; Kaneshiro, Takashi; Oikawa, Masayoshi; Kobayashi, Atsushi; Suzuki, Hitoshi; Ishida, Takafumi; Takeishi, Yasuchika

    2018-05-18

    Heart failure (HF) patients have a higher risk of recurrent HF and cardiac death, and electrical remodeling is considered to be an important factor for HF progression. The present study aimed to validate the utility of electrocardiogram and Holter monitoring for the risk stratification of HF patients. Our study comprised 215 patients (144 males, mean age 62 years) who had been hospitalized due to acute decompensated HF. Electrocardiogram (QRS duration and QTc interval) and 24-hour Holter monitoring (heart rate variability, heart rate turbulence and T-wave alternans [TWA]) were performed in stable condition before discharge. The clinical characteristics and outcomes were then investigated. During a median follow-up period of 2.7 years, there were 83 (38.6%) cardiac events (re-hospitalization due to worsening HF [n = 51] or cardiac death [n = 32]). The patients with cardiac events had a lower turbulence slope (TS) and higher TWA compared to those without cardiac events (TS, 3.0±5.5 ms/RR vs. 5.3±5.6 ms/RR, P = 0.001; TWA, 66.1±19.6 μV vs. 54.7±15.1 μV, P < 0.001). Univariable analysis showed that TS, TWA, QRS duration, and QTc interval were associated with cardiac events (P = 0.004, P < 0.001, P = 0.037 and P = 0.024, respectively), while the multivariable analysis after the adjustment of multiple confounders showed that TS and TWA were independent predictive factors of cardiac events with a hazard ratio of 0.936 and 1.015 (95% confidence interval [CI]: 0.860-0.974, P = 0.006; and 95% CI: 1.003-1.027, p = 0.016), respectively. The measurement of TS and TWA is useful for assessing risk for re-hospitalization and cardiac death in HF patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  18. Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: a population-based birth cohort study

    Science.gov (United States)

    Laine, Katariina; Hassan, Sahar; Fosse, Erik; Lieng, Marit; Zimmo, Kaled; Anti, Marit; Sørum Falk, Ragnhild; Vikanes, Åse

    2018-01-01

    Objective To assess the differences in rates and odds for emergency caesarean section among singleton pregnancies in six governmental Palestinian hospitals. Design A prospective population-based birth cohort study. Setting Obstetric departments in six governmental Palestinian hospitals. Participants 32 321 women scheduled to deliver vaginally from 1 March 2015 until 29 February 2016. Methods To assess differences in sociodemographic and antenatal obstetric characteristics by hospital, χ2 test, analysis of variance and Kruskal-Wallis test were applied. Logistic regression was used to estimate differences in odds for emergency caesarean section, and ORs with 95% CIs were assessed. Main outcome measures The primary outcome was the adjusted ORs of emergency caesarean section among singleton pregnancies for five Palestinian hospitals as compared with the reference (Hospital 1). Results The prevalence of emergency caesarean section varied across hospitals, ranging from 5.8% to 22.6% among primiparous women and between 4.8% and 13.1% among parous women. Compared with the reference hospital, the ORs for emergency caesarean section were increased in all other hospitals, crude ORs ranging from 1.95 (95% CI 1.42 to 2.67) to 4.75 (95% CI 3.49 to 6.46) among primiparous women. For parous women, these differences were less pronounced, crude ORs ranging from 1.37 (95% CI 1.13 to 1.67) to 2.99 (95% CI 2.44 to 3.65). After adjustment for potential confounders, the ORs were reduced but still statistically significant, except for one hospital among parous women. Conclusion Substantial differences in odds for emergency caesarean section between the six Palestinian governmental hospitals were observed. These could not be explained by the studied sociodemographic or antenatal obstetric characteristics. PMID:29500211

  19. Evaluation of an ultraviolet room disinfection protocol to decrease nursing home microbial burden, infection and hospitalization rates.

    Science.gov (United States)

    Kovach, Christine R; Taneli, Yavuz; Neiman, Tammy; Dyer, Elaine M; Arzaga, Alvin Jason A; Kelber, Sheryl T

    2017-03-03

    The focus of nursing home infection control procedures has been on decreasing transmission between healthcare workers and residents. Less evidence is available regarding whether decontamination of high-touch environmental surfaces impacts infection rates or resident outcomes. The purpose of this study was to examine if ultraviolet disinfection is associated with changes in: 1) microbial counts and adenosine triphosphate counts on high-touch surfaces; and 2) facility wide nursing home acquired infection rates, and infection-related hospitalization. The study was conducted in one 160-bed long-term care facility. Following discharge of each resident, their room was cleaned and then disinfected using a newly acquired ultraviolet light disinfection device. Shared living spaces received weekly ultraviolet light disinfection. Thirty-six months of pretest infection and hospitalization data were compared with 12 months of posttest data. Pre and posttest cultures were taken from high-touch surfaces, and luminometer readings of adenosine triphosphate were done. Nursing home acquired infection rates were analyzed relative to hospital acquired infection rates using analysis of variance procedures. Wilcoxon signed rank tests, The Cochran's Q, and Chi Square were also used. There were statistically significant decreases in adenosine triphosphate readings on all high-touch surfaces after cleaning and disinfection. Culture results were positive for gram-positive cocci or rods on 33% (n = 30) of the 90 surfaces swabbed at baseline. After disinfectant cleaning, 6 of 90 samples (7.1%) tested positive for a gram-positive bacilli, and after ultraviolet disinfection 4 of the 90 samples (4.4%) were positive. There were significant decreases in nursing home acquired relative to hospital-acquired infection rates for the total infections (p = .004), urinary tract infection rates (p = .014), respiratory system infection rates (p = .017) and for rates of infection of the skin

  20. [Do laymen understand information about hospital quality? An empirical verification using risk-adjusted mortality rates as an example].

    Science.gov (United States)

    Sander, Uwe; Kolb, Benjamin; Taheri, Fatemeh; Patzelt, Christiane; Emmert, Martin

    2017-11-01

    The effect of public reporting to improve quality in healthcare is reduced by the limited intelligibility of information about the quality of healthcare providers. This may result in worse health-related choices especially for older people and those with lower levels of education. There is, as yet, little information as to whether laymen understand the concepts behind quality comparisons and if this comprehension is correlated with hospital choices. An instrument with 20 items was developed to analyze the intelligibility of five technical terms which were used in German hospital report cards to explain risk-adjusted death rates. Two online presentations of risk-adjusted death rates for five hospitals in the style of hospital report cards were developed. An online survey of 353 volunteers tested the comprehension of the risk-adjusted mortality rates and included an experimental hospital choice. The intelligibility of five technical terms was tested: risk-adjusted, actual and expected death rate, reference range and national average. The percentages of correct answers for the five technical terms were in the range of 75.0-60.2%. Between 23.8% and 5.1% of the respondents were not able to answer the question about the technical term itself. The least comprehensible technical terms were "risk-adjusted death rate" and "reference range". The intelligibility of the 20 items that were used to test the comprehension of the risk-adjusted mortality was between 89.5% and 14.2%. The two items that proved to be least comprehensible were related to the technical terms "risk-adjusted death rate" and "reference range". For all five technical terms it was found that a better comprehension correlated significantly with better hospital choices. We found a better than average intelligibility for the technical terms "actual and expected death rate" and for "national average". The least understandable were "risk-adjusted death rate" and "reference range". Since the self

  1. Sample Size Estimation for Negative Binomial Regression Comparing Rates of Recurrent Events with Unequal Follow-Up Time.

    Science.gov (United States)

    Tang, Yongqiang

    2015-01-01

    A sample size formula is derived for negative binomial regression for the analysis of recurrent events, in which subjects can have unequal follow-up time. We obtain sharp lower and upper bounds on the required size, which is easy to compute. The upper bound is generally only slightly larger than the required size, and hence can be used to approximate the sample size. The lower and upper size bounds can be decomposed into two terms. The first term relies on the mean number of events in each group, and the second term depends on two factors that measure, respectively, the extent of between-subject variability in event rates, and follow-up time. Simulation studies are conducted to assess the performance of the proposed method. An application of our formulae to a multiple sclerosis trial is provided.

  2. Tailored support for type 2 diabetes patients with an acute coronary event after discharge from hospital: design and development of a randomised controlled trial.

    NARCIS (Netherlands)

    Kasteleyn, M.J.; Gorter, K.J.; Stellato, R.K.; Rijken, M.; Nijpels, G.; Rutten, G.E.H.M.

    2014-01-01

    Background: Type 2 diabetes mellitus patients with an acute coronary event (ACE) experience decreased quality of life and increased distress. According to the American Diabetes Association, discharge from the hospital is a time of increased distress for all patients. Tailored support specific to

  3. Tailored support for type 2 diabetes patients with an acute coronary event after discharge from hospital - design and development of a randomised controlled trial

    NARCIS (Netherlands)

    Kasteleyn, M.J.; Gorter, K.J.; Stellato, R.K.; Rijken, M.; Nijpels, G.; Rutten, G.E.H.M.

    2014-01-01

    Background: Type 2 diabetes mellitus patients with an acute coronary event (ACE) experience decreased quality of life and increased distress. According to the American Diabetes Association, discharge from the hospital is a time of increased distress for all patients. Tailored support specific to

  4. Do co-intoxicants increase adverse event rates in the first 24 hours in patients resuscitated from acute opioid overdose?

    Science.gov (United States)

    Mirakbari, Seyed Mostafa; Innes, Grant D; Christenson, Jim; Tilley, Jessica; Wong, Hubert

    2003-01-01

    Patients frequently arrive in emergency departments (EDs) after being resuscitated from opioid overdose. Autopsy studies suggest that multidrug intoxication is a major risk factor for adverse outcomes after acute heroin overdose in patients. If this is true, there may be high-risk drug combinations that identify patients who require more intensive monitoring and prolonged observation. Our objective was to determine the impact of co-intoxication with alcohol, cocaine, or CNS depressant drugs on short-term adverse event rates in patients resuscitated from acute opioid overdose. Data were extracted from the database of a prospective opioid overdose cohort study conducted between May 1997 and 1999. Patients were prospectively enrolled if they received naloxone for presumed opioid overdose. Investigators gathered clinical, demographic, and other predictor variables, including co-intoxicants used. Patients were followed to identify prespecified adverse outcome events occurring within 24 h, and multiple logistic regression was used to determine the association of concomitant drug use on short-term adverse event rates. Of 1155 patients studied, 58 (5%) had pure opioid overdose and 922 (80%) reported co-intoxicants, including alcohol, cocaine, and CNS depressants. Overall, out of 1056 patients with known outcome status there were 123 major adverse events (11.6%) and 194 minor adverse events (18.4%). After adjustment for age, gender, HIV status, cardiovascular disease, pulmonary disease and diabetes, we found that coadministration of alcohol, cocaine, or CNS depressants, alone or in combination, was not associated with increased risk of death or adverse events during the 24 h follow-up period. In patients resuscitated from acute opioid overdose, short-term outcomes are similar for patients with pure opioid overdose and multidrug intoxications. A history of cointoxication cannot be used to identify high-risk patients who require more intensive ED monitoring or prolonged

  5. Age-specific vibrissae growth rates: a tool for determining the timing of ecologically important events in Steller sea lions

    Science.gov (United States)

    Rea, L.D.; Christ, A.M.; Hayden, A.B.; Stegall, V.K.; Farley, S.D.; Stricker, Craig A.; Mellish, J.E.; Maniscalco, John M.; Waite, J.N.; Burkanov, V.N.; Pitcher, K.W.

    2015-01-01

    Steller sea lions (SSL; Eumetopias jubatus) grow their vibrissae continually, providing a multiyear record suitable for ecological and physiological studies based on stable isotopes. An accurate age-specific vibrissae growth rate is essential for registering a chronology along the length of the record, and for interpreting the timing of ecologically important events. We utilized four methods to estimate the growth rate of vibrissae in fetal, rookery pup, young-of-the-year (YOY), yearling, subadult, and adult SSL. The majority of vibrissae were collected from SSL live-captured in Alaska and Russia between 2000 and 2013 (n = 1,115), however, vibrissae were also collected from six adult SSL found dead on haul-outs and rookeries during field excursions to increase the sample size of this underrepresented age group. Growth rates of vibrissae were generally slower in adult (0.44 ± 0.15 cm/mo) and subadult (0.61 ± 0.10 cm/mo) SSL than in YOY (0.87 ± 0.28 cm/mo) and fetal (0.73 ± 0.05 cm/mo) animals, but there was high individual variability in these growth rates within each age group. Some variability in vibrissae growth rates was attributed to the somatic growth rate of YOY sea lions between capture events (P = 0.014, r2 = 0.206, n = 29).

  6. Semiquantitative SPECT myocardial perfusion with dipyridamole in patients unable to exercise. Event rate during 4 years of follow up

    International Nuclear Information System (INIS)

    Balestrini, V.R.; Arja, V.J.; Sandrin, A.L.; Calvo, G.R.; Gomez Bosh, Z.; Quiroga, W.; Balestrini, C.E.; Joekes, S.

    2002-01-01

    The increasingly numbers of patients (P) that can't reach an adequate level of exercise in order to evaluate CAD, lead us to use pharmacological and technical tools available for this subgroup of P. Aim: evaluate the prognostic significance of myocardial perfusion SPECT imaging with pharmacological stress in P without LBBB, unable to exercise. Material and Methods: 209 P were included. Mean age: 65 years old (39-88), male 66%. Clinical: Pre test likelihood 8: 28%; SDS 0 and SRS 0: 31.7%; SDS 0 + SRS >=1: 21%; SDS >=1: 47.3%. III) Follow up: 13 patients were early re-vascularized induced by SPECT study results, 10 patients get lost and 186 were follow up by a mean 1086 days. Cumulative events rate: 1st year SCE 9.7%, HCE 1.6%; 2nd year SCE 14%, HCE 4.3%; 3rd year SCE 17.7%, HCE 5.4%; 4th year SCE 21%, HCE 5,4%. Scintigraphic indices and events rate relationship are presented. Conclusion: There was a relationship between scintigraphic indices and hard cardiac events. The semiquantitative myocardial perfusion with dipyridamole stress was a safe test and useful to discriminate groups of P with different risk of events

  7. A Generalized Approach to Model the Spectra and Radiation Dose Rate of Solar Particle Events on the Surface of Mars

    Science.gov (United States)

    Guo, Jingnan; Zeitlin, Cary; Wimmer-Schweingruber, Robert F.; McDole, Thoren; Kühl, Patrick; Appel, Jan C.; Matthiä, Daniel; Krauss, Johannes; Köhler, Jan

    2018-01-01

    For future human missions to Mars, it is important to study the surface radiation environment during extreme and elevated conditions. In the long term, it is mainly galactic cosmic rays (GCRs) modulated by solar activity that contribute to the radiation on the surface of Mars, but intense solar energetic particle (SEP) events may induce acute health effects. Such events may enhance the radiation level significantly and should be detected as immediately as possible to prevent severe damage to humans and equipment. However, the energetic particle environment on the Martian surface is significantly different from that in deep space due to the influence of the Martian atmosphere. Depending on the intensity and shape of the original solar particle spectra, as well as particle types, the surface spectra may induce entirely different radiation effects. In order to give immediate and accurate alerts while avoiding unnecessary ones, it is important to model and well understand the atmospheric effect on the incoming SEPs, including both protons and helium ions. In this paper, we have developed a generalized approach to quickly model the surface response of any given incoming proton/helium ion spectra and have applied it to a set of historical large solar events, thus providing insights into the possible variety of surface radiation environments that may be induced during SEP events. Based on the statistical study of more than 30 significant solar events, we have obtained an empirical model for estimating the surface dose rate directly from the intensities of a power-law SEP spectra.

  8. Event-Associated Oxygen Consumption Rate Increases ca. Five-Fold When Interictal Activity Transforms into Seizure-Like Events In Vitro

    Directory of Open Access Journals (Sweden)

    Karl Schoknecht

    2017-09-01

    Full Text Available Neuronal injury due to seizures may result from a mismatch of energy demand and adenosine triphosphate (ATP synthesis. However, ATP demand and oxygen consumption rates have not been accurately determined, yet, for different patterns of epileptic activity, such as interictal and ictal events. We studied interictal-like and seizure-like epileptiform activity induced by the GABAA antagonist bicuculline alone, and with co-application of the M-current blocker XE-991, in rat hippocampal slices. Metabolic changes were investigated based on recording partial oxygen pressure, extracellular potassium concentration, and intracellular flavine adenine dinucleotide (FAD redox potential. Recorded data were used to calculate oxygen consumption and relative ATP consumption rates, cellular ATP depletion, and changes in FAD/FADH2 ratio by applying a reactive-diffusion and a two compartment metabolic model. Oxygen-consumption rates were ca. five times higher during seizure activity than interictal activity. Additionally, ATP consumption was higher during seizure activity (~94% above control than interictal activity (~15% above control. Modeling of FAD transients based on partial pressure of oxygen recordings confirmed increased energy demand during both seizure and interictal activity and predicted actual FAD autofluorescence recordings, thereby validating the model. Quantifying metabolic alterations during epileptiform activity has translational relevance as it may help to understand the contribution of energy supply and demand mismatches to seizure-induced injury.

  9. Higher rate of serious perinatal events in non-Western women in Denmark

    DEFF Research Database (Denmark)

    Christensen, Marianne Brehm; Villadsen, Sarah Fredsted; Weber, Tom

    2016-01-01

    children born at Hvidovre Hospital who died perinatally and included the patient files in a series of case studies. Our data were linked to data from popu­lation-covering registries in Statistics Denmark. Timing, causes of death as well as social, medical and obstetric characteristics of the parents were...... described according to maternal country of origin. Results: This study included 125 perinatal deaths. The data indicated that intrapartum death, death caused by maternal disease, lethal malformation and preterm birth may be more frequent among non-Western than among Danish-born women. Obesity...... in Denmark. Six of 28 perinatal deaths in the non-Western group were intrapartum deaths and warrants further concern. Funding: This project was funded by the Danish Council for Strategic Research as part of the SULIM project. Trial registration: The linkage of data from patient files to data from Statistics...

  10. Higher rate of serious perinatal events in non-Western women in Denmark

    DEFF Research Database (Denmark)

    Brehm Christensen, Marianne; Fredsted Villadsen, Sarah; Weber, Tom

    2016-01-01

    children born at Hvidovre Hospital who died perinatally and included the patient files in a series of case studies. Our data were linked to data from population-covering registries in Statistics Denmark. Timing, causes of death as well as social, medical and obstetric characteristics of the parents were...... described according to maternal country of origin. RESULTS: This study included 125 perinatal deaths. The data indicated that intrapartum death, death caused by maternal disease, lethal malformation and preterm birth may be more frequent among non-Western than among Danish-born women. Obesity...... in Denmark. Six of 28 perinatal deaths in the non-Western group were intrapartum deaths and warrants further concern. FUNDING: This project was funded by the Danish Council for Strategic Research as part of the SULIM project. TRIAL REGISTRATION: The linkage of data from patient files to data from Statistics...

  11. Consumers' use of HCAHPS ratings and word-of-mouth in hospital choice.

    Science.gov (United States)

    Huppertz, John W; Carlson, Jay P

    2010-12-01

    To investigate the impact of the HCAHPS report of patient experiences and word-of-mouth narratives on consumers' hospital choice. Online consumer research panel of U.S. adults ages 18 and older. In an experiment, 309 consumers were randomly assigned to see positive or negative information about a hospital in two modalities: HCAHPS graphs and a relative's narrative e-mail. Then they indicated their intentions to choose the hospital for elective surgery. A simple, one-paragraph e-mail and 10 HCAHPS graphs had similar impacts on consumers' hospital choice. When information was inconsistent between the HCAHPS data and e-mail narrative, one modality attenuated the other's effect on hospital choice. The findings illustrate the power of anecdotal narratives, suggesting that policy makers should consider how HCAHPS data can be affected by word-of-mouth communication. © Health Research and Educational Trust.

  12. Prevalence of epilepsy and seizure disorders as causes of apparent life- threatening event (ALTE) in children admitted to a tertiary hospital.

    Science.gov (United States)

    Anjos, Alessandra Marques dos; Nunes, Magda Lahorgue

    2009-09-01

    To determine the prevalence and describe clinical characteristics of seizure disorders and epilepsy as causes of apparent life- threatening event (ALTE) in children admitted at the emergency and followed in a tertiary hospital. Cross-sectional study with prospective data collection using specific guidelines to determine the etiology of ALTE. During the study, 30 (4.2%) children admitted to the hospital had a diagnosis of ALTE. There was a predominance of males (73%) and term infants (70%). Neonatal neurological disorders and neuropsychomotor development delay were found respectively in 13.4% and 10% of the cases. Etiological investigation revealed that 50% of the cases were idiopathic, and 13.4% were caused by epilepsy or seizure disorders. Although all patients had recurrent ALTE events, epilepsy had not been previously suspected. Epilepsy should be included in the differential diagnosis of ALTE, particularly when events are recurrent.

  13. On the merging rates of envelope-deprived components of binary systems which can give rise to supernova events

    International Nuclear Information System (INIS)

    Tornambe, Amedo

    1989-01-01

    We derive theoretical rates of mergings of envelope-deprived components of binary systems, which can give rise to supernova events. The effects of the various assumptions one is forced to make on the physical properties of the progenitor system and of its evolutionary behaviour through common envelope phases are discussed. Four cases have been analysed: CO-CO, He-CO, He-He double degenerate mergings and He star-CO dwarf merging. (author)

  14. Development and validation of a Thai stressful life events rating scale for patients with a diagnosis of schizophrenic methamphetamine abuse

    OpenAIRE

    Ek-uma Imkome; JintanaYunibhand; Waraporn Chaiyawat

    2017-01-01

    This study aimed to psychometrically test a Thai Stressful Life Events Rating Scale (TSLERS). Factor analysis was done on data collected from 313 patients with schizophrenia and methamphetamine abuse in Thailand from April to May, 2015. Results identified the following problems impacting physical and mental health: social relationship and social concerns, money, family life, life security, and career. Evaluation of the psychometric scale properties demonstrated acceptable validity ...

  15. Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status

    Directory of Open Access Journals (Sweden)

    Melani Carla

    2008-10-01

    Full Text Available Abstract Background Carpal tunnel syndrome (CTS is a socially relevant condition associated with biomechanical risk factors. We evaluated age-sex-specific incidence rates of in-hospital cases of CTS in central/northern Italy and explored relations with marital status. Methods Seven regions were considered (overall population, 14.9 million over 3–6-year periods between 1997 and 2002 (when out-of-hospital CTS surgery was extremely rare. Incidence rates of in-hospital cases of CTS were estimated based on 1 codified demographic, diagnostic and intervention data in obligatory discharge records from all Italian public/private hospitals, archived (according to residence on regional databases; 2 demographic general population data for each region. We compared (using the χscore test age-sex-specific rates between married, unmarried, divorced and widowed subsets of the general population. We calculated standardized incidence ratios (SIRs for married/unmarried men and women. Results Age-standardized incidence rates (per 100,000 person-years of in-hospital cases of CTS were 166 in women and 44 in men (106 overall. Married subjects of both sexes showed higher age-specific rates with respect to unmarried men/women. SIRs were calculated comparing married vs unmarried rates of both sexes: 1.59 (95% confidence interval [95% CI], 1.57–1.60 in women, and 1.42 (95% CI, 1.40–1.45 in men. As compared with married women/men, widows/widowers both showed 2–3-fold higher incidence peaks during the fourth decade of life (beyond 50 years of age, widowed subjects showed similar trends to unmarried counterparts. Conclusion This large population-based study illustrates distinct age-related trends in men and women, and also raises the question whether marital status could be associated with CTS in the general population.

  16. Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status.

    Science.gov (United States)

    Mattioli, Stefano; Baldasseroni, Alberto; Curti, Stefania; Cooke, Robin M T; Bena, Antonella; de Giacomi, Giovanna; dell'Omo, Marco; Fateh-Moghadam, Pirous; Melani, Carla; Biocca, Marco; Buiatti, Eva; Campo, Giuseppe; Zanardi, Francesca; Violante, Francesco S

    2008-10-28

    Carpal tunnel syndrome (CTS) is a socially relevant condition associated with biomechanical risk factors. We evaluated age-sex-specific incidence rates of in-hospital cases of CTS in central/northern Italy and explored relations with marital status. Seven regions were considered (overall population, 14.9 million) over 3-6-year periods between 1997 and 2002 (when out-of-hospital CTS surgery was extremely rare). Incidence rates of in-hospital cases of CTS were estimated based on 1) codified demographic, diagnostic and intervention data in obligatory discharge records from all Italian public/private hospitals, archived (according to residence) on regional databases; 2) demographic general population data for each region. We compared (using the chiscore test) age-sex-specific rates between married, unmarried, divorced and widowed subsets of the general population. We calculated standardized incidence ratios (SIRs) for married/unmarried men and women. Age-standardized incidence rates (per 100,000 person-years) of in-hospital cases of CTS were 166 in women and 44 in men (106 overall). Married subjects of both sexes showed higher age-specific rates with respect to unmarried men/women. SIRs were calculated comparing married vs unmarried rates of both sexes: 1.59 (95% confidence interval [95% CI], 1.57-1.60) in women, and 1.42 (95% CI, 1.40-1.45) in men. As compared with married women/men, widows/widowers both showed 2-3-fold higher incidence peaks during the fourth decade of life (beyond 50 years of age, widowed subjects showed similar trends to unmarried counterparts). This large population-based study illustrates distinct age-related trends in men and women, and also raises the question whether marital status could be associated with CTS in the general population.

  17. Pacific Northwest geomorphology and hydrology: rates and probabilities of selected processes and events

    International Nuclear Information System (INIS)

    Tubbs, D.W.

    1979-01-01

    This report presents results of one of the geomorphological and hydrological studies that have been conducted for the release scenario analysis of the Waste Isolation Safety Assessment Program (WISAP). Three general topics are considered: (1) determination of rates of denudation, (2) estimation of the probability of flooding due to each of several causes, and (3) evaluation of other surface processes that should be considered in the release scenario analysis. The third general topic was ultimately narrowed to the possible effects of landsliding. Rates of erosion are expressed as centimeters per 100 years, except that the original units are retained in figures taken from other sources. Probabilities are also expressed per 100 years

  18. Mortality associated with gastrointestinal bleeding events: Comparing short-term clinical outcomes of patients hospitalized for upper GI bleeding and acute myocardial infarction in a US managed care setting

    Directory of Open Access Journals (Sweden)

    C Mel Wilcox

    2009-03-01

    Full Text Available C Mel Wilcox1, Byron L Cryer2, Henry J Henk3, Victoria Zarotsky3, Gergana Zlateva41University of Alabama, Birmingham, AL, USA; 2University of Texas Southwestern Medical School, Dallas, TX; 3i3 Innovus, Eden Prairie, MN, USA; 4Pfizer, Inc., New York, NY, USA Objectives: To compare the short-term mortality rates of gastrointestinal (GI bleeding to those of acute myocardial infarction (AMI by estimating the 30-, 60-, and 90-day mortality among hospitalized patients.Methods: United States national health plan claims data (1999–2003 were used to identify patients hospitalized with a GI bleeding event. Patients were propensity-matched to AMI patients with no evidence of GI bleed from the same US health plan.Results: 12,437 upper GI-bleed patients and 22,847 AMI patients were identified. Propensity score matching yielded 6,923 matched pairs. Matched cohorts were found to have a similar Charlson Comorbidity Index score and to be similar on nearly all utilization and cost measures (excepting emergency room costs. A comparison of outcomes among the matched cohorts found that AMI patients had higher rates of 30-day mortality (4.35% vs 2.54%; p < 0.0001 and rehospitalization (2.56% vs 1.79%; p = 0.002, while GI bleed patients were more likely to have a repeat procedure (72.38% vs 44.95%; p < 0.001 following their initial hospitalization. The majority of the difference in overall 30-day mortality between GI bleed and AMI patients was accounted for by mortality during the initial hospitalization (1.91% vs 3.58%.Conclusions: GI bleeding events result in significant mortality similar to that of an AMI after adjusting for the initial hospitalization.Keywords: gastrointestinal, bleeding, mortality, acute myocardial infarction, claims analysis

  19. Tracks FAQs: How Can I Tell If Asthma Hospitalization Rates In My Area Are Changing Over Time?

    Centers for Disease Control (CDC) Podcasts

    In this podcast, CDC Tracking experts discuss asthma hospitalization rates and how you can tell if they've changed in your area over time. Do you have a question for our Tracking experts? Please e-mail questions to trackingsupport@cdc.gov.

  20. Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery

    DEFF Research Database (Denmark)

    Andersen, Jens; Hjort-Jakobsen, Dorthe; Christiansen, P. S.

    2007-01-01

    BACKGROUND: Initial programmes of fast-track open colonic surgery with a planned 2-day postoperative hospital stay have had a high readmission rate (about 20 per cent). The aim of this large, consecutive series was to compare readmission rates after a fast-track open colonic surgery programme...... from August 2004. All patients were examined 8 and 30 days after surgery. RESULTS: Readmission rates fell from 20.1 per cent in 408 patients with a planned 2-day hospital stay (period 1) to 11.3 per cent in 133 patients with a planned 3-day hospital stay (period 2) (P ... hospital stay was 2 and 3 days, median stay after readmission was 5 and 5.5 days, and median (mean) total stay was 3 (5.6) and 3 (5.7) days in periods 1 and 2 respectively. The readmission rate in period 2 was lower because there were fewer readmissions for short-term observation or social reasons...

  1. Simultaneous vaccination with MMR and DTaP-IPV-Hib and rate of hospital admissions with any infections

    DEFF Research Database (Denmark)

    Sørup, Signe; Benn, Christine S; Poulsen, Anja

    2016-01-01

    , retrospective, register based cohort study of 520,859 children born in Denmark 1997-2006, who were followed from 15months to 4years of age. Incidence rate ratios (IRRs) of hospital admissions were estimated by Cox regression and adjusted for background factors including exact age. RESULTS: By 2years of age...

  2. 42 CFR 412.78 - Determination of the hospital-specific rate for inpatient operating costs for sole community...

    Science.gov (United States)

    2010-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient Operating... determined using the methodology set forth in §§ 412.73(c)(15) and 412.73(c)(16). (f) DRG adjustment. The...

  3. 42 CFR 412.77 - Determination of the hospital-specific rate for inpatient operating costs for sole community...

    Science.gov (United States)

    2010-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient Operating... update factor is determined using the methodology set forth in § 412.73(c)(12) through (c)(16). (f) DRG...

  4. Delirium subtype identification and the validation of the Delirium Rating Scale--Revised-98 (Dutch version) in hospitalized elderly patients

    NARCIS (Netherlands)

    de Rooij, Sophia E.; van Munster, Barbara C.; Korevaar, Johanna C.; Casteelen, Gerty; Schuurmans, Marieke J.; van der Mast, Roos C.; Levi, Marcel

    2006-01-01

    BACKGROUND: Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. The Dutch version of the Delirium Rating Scale-Revised-98 (DRS-R-98) appears to be a reliable method to classify delirium. The aim of this study was to determine the validity and reliability of the

  5. Tracks FAQs: How Do Heart Attack Hospitalization Rates In My Community Compare With Other Counties Or States?

    Centers for Disease Control (CDC) Podcasts

    In this podcast, CDC Tracking experts discuss how to compare heart attack hospitalization rates in your community with other counties or states. Do you have a question for our Tracking experts? Please e-mail questions to trackingsupport@cdc.gov.

  6. The effect of a smoking ban on hospitalization rates for cardiovascular and respiratory conditions in Prince Edward Island, Canada.

    Directory of Open Access Journals (Sweden)

    Katherine Gaudreau

    Full Text Available This is the first study to have examined the effect of smoking bans on hospitalizations in the Atlantic Canadian socio-economic, cultural and climatic context. On June 1, 2003 Prince Edward Island (PEI enacted a province-wide smoking ban in public places and workplaces. Changes in hospital admission rates for cardiovascular (acute myocardial infarction, angina, and stroke and respiratory (chronic obstructive pulmonary disease and asthma conditions were examined before and after the smoking ban.Crude annual and monthly admission rates for the above conditions were calculated from April 1, 1995 to December 31, 2008 in all PEI acute care hospitals. Autoregressive Integrated Moving Average time series models were used to test for changes in mean and trend of monthly admission rates for study conditions, control conditions and a control province after the comprehensive smoking ban. Age- and sex-based analyses were completed.The mean rate of acute myocardial infarctions was reduced by 5.92 cases per 100,000 person-months (P = 0.04 immediately after the smoking ban. The trend of monthly angina admissions in men was reduced by -0.44 cases per 100,000 person-months (P = 0.01 in the 67 months after the smoking ban. All other cardiovascular and respiratory admission changes were non-significant.A comprehensive smoking ban in PEI reduced the overall mean number of acute myocardial infarction admissions and the trend of angina hospital admissions.

  7. Contemporary statistical procedures (Parametric Empirical Bayes) and nuclear plant event rates

    International Nuclear Information System (INIS)

    Gaver, D.P.; Worledge, D.H.

    1985-01-01

    The conduct of a nuclear power plant probabilistic risk assessment (PRA) recognizes that each of a great many vital components and systems is subject to failure. One aspect of the PRA procedure is to quantify individual item failure propensity, often in terms of the failure rate parameter of an exponential distribution or Poisson process, and then to combine rates so as to effectively infer the probability of plant failure, e.g., core damage. The formal method of combination of such rates involves use of fault-tree analysis. The defensibility of the final fault-tree result depends both upon the adequacy of the failure representations of its components, and upon the correctness and inclusiveness of the fault tree logic. This paper focuses upon the first issue, in particular, upon contemporary proposals for deriving estimates of individual rates. The purpose of the paper is to present, in basically non-mathematical terms, the essential nature of some of these proposals, and an assessment of how they might fit into, and contribute positively to, a more defensible or trustworthy PRA process

  8. On the Mass and Luminosity Functions of Tidal Disruption Flares: Rate Suppression due to Black Hole Event Horizons

    Science.gov (United States)

    van Velzen, S.

    2018-01-01

    The tidal disruption of a star by a massive black hole is expected to yield a luminous flare of thermal emission. About two dozen of these stellar tidal disruption flares (TDFs) may have been detected in optical transient surveys. However, explaining the observed properties of these events within the tidal disruption paradigm is not yet possible. This theoretical ambiguity has led some authors to suggest that optical TDFs are due to a different process, such as a nuclear supernova or accretion disk instabilities. Here we present a test of a fundamental prediction of the tidal disruption event scenario: a suppression of the flare rate due to the direct capture of stars by the black hole. Using a recently compiled sample of candidate TDFs with black hole mass measurements, plus a careful treatment of selection effects in this flux-limited sample, we confirm that the dearth of observed TDFs from high-mass black holes is statistically significant. All the TDF impostor models we consider fail to explain the observed mass function; the only scenario that fits the data is a suppression of the rate due to direct captures. We find that this suppression can explain the low volumetric rate of the luminous TDF candidate ASASSN-15lh, thus supporting the hypothesis that this flare belongs to the TDF family. Our work is the first to present the optical TDF luminosity function. A steep power law is required to explain the observed rest-frame g-band luminosity, {dN}/{{dL}}g\\propto {L}g-2.5. The mean event rate of the flares in our sample is ≈ 1× {10}-4 galaxy‑1 yr‑1, consistent with the theoretically expected tidal disruption rate.

  9. [Prediction value of deceleration capacity of rate and GRACE risk score on major adverse cardiac events in patients with acute myocardial infarction].

    Science.gov (United States)

    Gao, L; Chen, Y D; Shi, Y J; Xue, H; Wang, J L

    2016-07-24

    To investigate the prediction value of deceleration capacity of rate (DC) and GRACE risk score for cardiovascular events in AMI patients. Consecutive AMI patients with sinus rhythm hospitalized in our department during August 2012 to August 2013 were included in this prospective study. 24-hour ECG Holter monitoring was performed within 1 week, and the DC value was analyzed, GRACE risk score was acquired with the application of GRACE risk score calculator. Patients were followed up for more than 1 year and major adverse cardiac events (MACE) were obtained. Analysised the Kaplan Meier survival according to DC and GRACE score risk stratification respectively. A total of 157 patients were enrolled in the study (average age: (58.9±12.7)years old). The average follow-up was (20.54±2.85) months. Mortality during follow-up was significantly higher in patients with DC>2.5 compared to patients with DC≤2.5 (Prisk stratification was 0.898 (95%CI 0.840-0.940, Prisk stratification was 0.786 (95%CI 0.714-0.847, Prisk stratification was 0.708 (95%CI 0.652-0.769, Prisk patients than those with intermediate and low risk patients according to DC risk stratification in intermediate and low risk patients by GRACE risk stratification (Prisk stratification is superior to GRACE risk score on outcome assessment in this AMI patient cohort.

  10. Using preventive home monitoring to reduce hospital admission rates and reduce costs

    DEFF Research Database (Denmark)

    Dinesen, Birthe Irene; Haesum, Lisa K E; Soerensen, Natascha

    2012-01-01

    We studied whether preventive home monitoring of patients with chronic obstructive pulmonary disease (COPD) could reduce the frequency of hospital admissions and lower the cost of hospitalization. Patients were recruited from a health centre, general practitioner (GP) or the pulmonary hospital ward....... They were randomized to usual care or tele-rehabilitation with a telehealth monitoring device installed in their home for four months. A total of 111 patients were suitable for inclusion and consented to be randomized: 60 patients were allocated to intervention and three were lost to follow...... of admissions was €3461 per patient in the intervention group and €4576 in the control group; this difference was not significant. The Kaplan-Meier estimates for time to hospital admission were longer for the intervention group than the controls, but the difference was not significant. Future work requires...

  11. Age-related differences in the rate and diagnosis of 30-day readmission after hospitalization for acute ischemic stroke.

    Science.gov (United States)

    Hirayama, Atsushi; Goto, Tadahiro; Faridi, Mohammad K; Camargo, Carlos A; Hasegawa, Kohei

    2018-01-01

    Background Little is known about the association between age and readmission within 30 days after hospitalization for acute ischemic stroke. Aim To examine the age-related differences in rate and principal reason of 30-day readmissions in patients hospitalized for acute ischemic stroke. Methods In this retrospective, population-based cohort study using State Inpatient Databases from eight US states, we identified all adults hospitalized for acute ischemic stroke. We grouped the patients into four age categories: readmission within 30 days of discharge from the index hospitalization for acute ischemic stroke and the principal diagnosis of 30-day readmission. Results We identified 620,788 hospitalizations for acute ischemic stroke. The overall 30-day readmission rate was 16.6% with an increase with advanced age. Compared to patients aged readmission rate was significantly higher in age 65-74 years (OR 1.19; 95% CI 1.16-1.21), in age 75-84 years (OR 1.29; 95% CI 1.27-1.31), and in ≥ 85 years (OR 1.24; 95% CI 1.22-1.27; all Preadmission rate association between men and women (P interaction  readmissions were assigned stroke-related conditions or rehabilitation care. Compared to younger adults, older adults were more likely to present with non-stroke-related conditions (46.1% in readmission rate after acute ischemic stroke. Compared with younger adults, older adults were more likely to be readmitted for non-stroke-related conditions.

  12. Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures.

    Science.gov (United States)

    Armstrong, Joanne C; Kozhimannil, Katy B; McDermott, Patricia; Saade, George R; Srinivas, Sindhu K

    2016-02-01

    This report describes the development of a measure of low-risk cesarean delivery by the Society for Maternal-Fetal Medicine (SMFM). Safely lowering the cesarean delivery rate is a priority for maternity care clinicians and health care delivery systems. Therefore, hospital quality assurance programs are increasingly tracking cesarean delivery rates among low-risk pregnancies. Two commonly used definitions of "low risk" are available, the Joint Commission (JC) and the Agency for Healthcare Research and Quality (AHRQ) measures, but these measures are not clinically comprehensive. We sought to refine the definition of the low-risk cesarean delivery rate to enhance the validity of the metric for quality measurement. We created this refined definition-called the SMFM definition-and compared it to the JC and AHRQ measures using claims-based data from the 2011 Nationwide Inpatient Sample of >863,000 births in 612 hospitals. Using these definitions, we calculated means and interquartile ranges (25th-75th percentile range) for hospital low-risk cesarean delivery rates, stratified by hospital size, teaching status, urban/rural location, and payer mix. Across all hospitals, the mean low-risk cesarean delivery rate was lowest for the SMFM definition (12.65%), but not substantially different from the JC and AHRQ measures (13.12% and 13.29%, respectively). We empirically examined the SMFM definition to ensure its validity and utility. This refined definition performs similarly to existing measures and has the added advantage of clinical perspective, enhanced face validity, and ease of use. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. High rate of burnout among anaesthesiologists in Belgrade teaching hospitals: Results of a cross-sectional survey.

    Science.gov (United States)

    Milenović, Miodrag; Matejić, Bojana; Vasić, Vladimir; Frost, Elizabeth; Petrović, Nataša; Simić, Dušica

    2016-03-01

    Decisions by anaesthesiologists directly impact the treatment, safety, recovery and quality of life of patients. Physical or mental collapse due to overwork or stress (burnout) in anaesthesiologists may, therefore, be expected to negatively affect patients, departments, healthcare facilities and families. To evaluate the prevalence of burnout among anaesthesiologists in Belgrade public teaching hospitals. A cross-sectional survey. Anaesthesiologists in 10 Belgrade teaching hospitals. Burnout was assessed using Maslach Burnout Inventory-Human Services Survey. The response rate was 76.2% (205/272) with the majority of respondents women (70.7%). The prevalence of total burnout among anaesthesiologists in Belgrade teaching hospitals was 6.34%. Measured level of burnout as assessed by high emotional exhaustion, high depersonalisation and low personal accomplishment was 52.7, 12.2 and 28.8%, respectively. More than a quarter of the studied population responded in each category with symptoms of moderate burnout. We detected that sex, additional academic education, marital status and working conditions were risk factors for emotional exhaustion and depersonalisation. Ageing increased the likelihood of burnout by 21.3% with each additional year. Shorter professional experience and increased educational accomplishment increased the risk of total burnout by 272%. Burnout rates in Belgrade teaching hospitals among anaesthesiologists are higher than in foreign hospitals. Emotional and/or physical breakdowns can have serious effects when these individuals care for patients in extremely stressed situations that may occur perioperatively. Causes for burnout should be examined more closely and means implemented to reverse this process.

  14. Variations in pediatric asthma hospitalization rates and costs between and within Nordic countries

    DEFF Research Database (Denmark)

    Kocevar, Vasilisa Sazonov; Bisgaard, Hans; Jönsson, Linus

    2004-01-01

    BACKGROUND: We assessed variations in hospitalization parameters and costs among asthmatic children in four Nordic countries by geographic location and age groups. METHODS: Cross-sectional, county-level aggregate data on asthma-related hospitalizations in 1999, obtained from public national...... not differ significantly from Sweden. CONCLUSIONS: Large variations in all parameters were observed between and within countries. Given the similarities among the four countries studied, these results may, among other reasons, indicate different efficiencies of the various asthma management plans between...

  15. The reduction of the intrapartum still birth rate at the Queen Victoria Memorial Hospital.

    Science.gov (United States)

    Anderson, I; Chang, A; Renou, P; Wood, C

    1977-06-18

    A significant reduction in intrapartum anoxic fetal deaths has occurred at the Queen Victoria Memorial Hospital over the last ten years. The possible explanations for this include a variety of factors, which may either improve the health of the population presenting to the hospital, or improve obstetric care. Epidemiological evidence suggests that the use of fetal diagnostic techniques has contributed to the reduction of intrapartum anoxic still births.

  16. Individual differences in heart rate variability are associated with the avoidance of negative emotional events.

    Science.gov (United States)

    Katahira, Kentaro; Fujimura, Tomomi; Matsuda, Yoshi-Taka; Okanoya, Kazuo; Okada, Masato

    2014-12-01

    Although the emotional outcome of a choice generally affects subsequent decisions, humans can inhibit the influence of emotion. Heart rate variability (HRV) has emerged as an objective measure of individual differences in the capacity for inhibitory control. In the present study, we investigated how individual differences in HRV at rest are associated with the emotional effects of the outcome of a choice on subsequent decision making using a decision-making task in which emotional pictures appeared as decision outcomes. We used a reinforcement learning model to characterize the observed behaviors according to several parameters, namely, the learning rate and the motivational value of positive and negative pictures. Consequently, we found that individuals with a lower resting HRV exhibited a greater negative motivational value in response to negative pictures, suggesting that these individuals tend to avoid negative pictures compared with individuals with a higher resting HRV. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. Left Ventricular Wall Stress-Mass-Heart Rate Product and Cardiovascular Events in Treated Hypertensive Patients

    DEFF Research Database (Denmark)

    Devereux, Richard B; Bang, Casper N; Roman, Mary J

    2015-01-01

    -varying covariate in Cox models assessing predictors of the LIFE primary composite end point (cardiovascular death, MI, or stroke), its individual components, and all-cause mortality. At baseline, the triple product in both treatment groups was, compared with normal adults, elevated in 70% of patients. During...... more, greater heart rate reduction with atenolol resulted in larger reduction of the triple product. Lower triple product during antihypertensive treatment was strongly, independently associated with lower rates of the LIFE primary composite end point, cardiovascular death, and MI, but not stroke.......In the Losartan Intervention for End Point Reduction in Hypertension (LIFE) study, 4.8 years' losartan- versus atenolol-based antihypertensive treatment reduced left ventricular hypertrophy and cardiovascular end points, including cardiovascular death and stroke. However, there was no difference...

  18. High cardiovascular event rates in patients with asymptomatic carotid stenosis: the REACH Registry

    DEFF Research Database (Denmark)

    Aichner, F T; Topakian, R; Alberts, M J

    2009-01-01

    /absence of ACAS at the time of inclusion. RESULTS: Compared with patients without ACAS (n = 30 329), patients with ACAS (n = 3164) had higher age- and sex-adjusted 1-year rates of transient ischaemic attack (3.51% vs. 1.61%, P ....26%, P = 0.04), cardiovascular death (2.29% vs. 1.52%, P = 0.002), the composite end-point cardiovascular death/myocardial infarction/stroke (6.03% vs. 4.29%, P

  19. Soverign Rating Events and bank Share Prices in the Italian Market

    OpenAIRE

    S. Caselli; G. Gandolfi; M. Soana

    2013-01-01

    The paper examines the spillover effect of Eurozone sovereign rating changes announced by Standard and Poor’s, Moody’s, and Fitch on domestic bank share prices in the period 2002–2012. This spillover effect appears strongly negative in the case of downgrades, but insignificant for upgrades. Bank losses following sovereign downgrades are greater during the financial crisis of 2008 and in the PIIGS countries (Portugal, Ireland, Italy, Greece, and Spain). Surprisingly, announcement of sovereign ...

  20. The tell-tale heart: heart rate fluctuations index objective and subjective events during a game of chess.

    Science.gov (United States)

    Leone, María J; Petroni, Agustín; Fernandez Slezak, Diego; Sigman, Mariano

    2012-01-01

    During a decision-making process, the body changes. These somatic changes have been related to specific cognitive events and also have been postulated to assist decision-making indexing possible outcomes of different options. We used chess to analyze heart rate (HR) modulations on specific cognitive events. In a chess game, players have a limited time-budget to make about 40 moves (decisions) that can be objectively evaluated and retrospectively assigned to specific subjectively perceived events, such as setting a goal and the process to reach a known goal. We show that HR signals events: it predicts the conception of a plan, the concrete analysis of variations or the likelihood to blunder by fluctuations before to the move, and it reflects reactions, such as a blunder made by the opponent, by fluctuations subsequent to the move. Our data demonstrate that even if HR constitutes a relatively broad marker integrating a myriad of physiological variables, its dynamic is rich enough to reveal relevant episodes of inner thought.

  1. A Configurable Event-Driven Convolutional Node with Rate Saturation Mechanism for Modular ConvNet Systems Implementation

    Science.gov (United States)

    Camuñas-Mesa, Luis A.; Domínguez-Cordero, Yaisel L.; Linares-Barranco, Alejandro; Serrano-Gotarredona, Teresa; Linares-Barranco, Bernabé

    2018-01-01

    Convolutional Neural Networks (ConvNets) are a particular type of neural network often used for many applications like image recognition, video analysis or natural language processing. They are inspired by the human brain, following a specific organization of the connectivity pattern between layers of neurons known as receptive field. These networks have been traditionally implemented in software, but they are becoming more computationally expensive as they scale up, having limitations for real-time processing of high-speed stimuli. On the other hand, hardware implementations show difficulties to be used for different applications, due to their reduced flexibility. In this paper, we propose a fully configurable event-driven convolutional node with rate saturation mechanism that can be used to implement arbitrary ConvNets on FPGAs. This node includes a convolutional processing unit and a routing element which allows to build large 2D arrays where any multilayer structure can be implemented. The rate saturation mechanism emulates the refractory behavior in biological neurons, guaranteeing a minimum separation in time between consecutive events. A 4-layer ConvNet with 22 convolutional nodes trained for poker card symbol recognition has been implemented in a Spartan6 FPGA. This network has been tested with a stimulus where 40 poker cards were observed by a Dynamic Vision Sensor (DVS) in 1 s time. Different slow-down factors were applied to characterize the behavior of the system for high speed processing. For slow stimulus play-back, a 96% recognition rate is obtained with a power consumption of 0.85 mW. At maximum play-back speed, a traffic control mechanism downsamples the input stimulus, obtaining a recognition rate above 63% when less than 20% of the input events are processed, demonstrating the robustness of the network. PMID:29515349

  2. A Configurable Event-Driven Convolutional Node with Rate Saturation Mechanism for Modular ConvNet Systems Implementation

    Directory of Open Access Journals (Sweden)

    Luis A. Camuñas-Mesa

    2018-02-01

    Full Text Available Convolutional Neural Networks (ConvNets are a particular type of neural network often used for many applications like image recognition, video analysis or natural language processing. They are inspired by the human brain, following a specific organization of the connectivity pattern between layers of neurons known as receptive field. These networks have been traditionally implemented in software, but they are becoming more computationally expensive as they scale up, having limitations for real-time processing of high-speed stimuli. On the other hand, hardware implementations show difficulties to be used for different applications, due to their reduced flexibility. In this paper, we propose a fully configurable event-driven convolutional node with rate saturation mechanism that can be used to implement arbitrary ConvNets on FPGAs. This node includes a convolutional processing unit and a routing element which allows to build large 2D arrays where any multilayer structure can be implemented. The rate saturation mechanism emulates the refractory behavior in biological neurons, guaranteeing a minimum separation in time between consecutive events. A 4-layer ConvNet with 22 convolutional nodes trained for poker card symbol recognition has been implemented in a Spartan6 FPGA. This network has been tested with a stimulus where 40 poker cards were observed by a Dynamic Vision Sensor (DVS in 1 s time. Different slow-down factors were applied to characterize the behavior of the system for high speed processing. For slow stimulus play-back, a 96% recognition rate is obtained with a power consumption of 0.85 mW. At maximum play-back speed, a traffic control mechanism downsamples the input stimulus, obtaining a recognition rate above 63% when less than 20% of the input events are processed, demonstrating the robustness of the network.

  3. A Configurable Event-Driven Convolutional Node with Rate Saturation Mechanism for Modular ConvNet Systems Implementation.

    Science.gov (United States)

    Camuñas-Mesa, Luis A; Domínguez-Cordero, Yaisel L; Linares-Barranco, Alejandro; Serrano-Gotarredona, Teresa; Linares-Barranco, Bernabé

    2018-01-01

    Convolutional Neural Networks (ConvNets) are a particular type of neural network often used for many applications like image recognition, video analysis or natural language processing. They are inspired by the human brain, following a specific organization of the connectivity pattern between layers of neurons known as receptive field. These networks have been traditionally implemented in software, but they are becoming more computationally expensive as they scale up, having limitations for real-time processing of high-speed stimuli. On the other hand, hardware implementations show difficulties to be used for different applications, due to their reduced flexibility. In this paper, we propose a fully configurable event-driven convolutional node with rate saturation mechanism that can be used to implement arbitrary ConvNets on FPGAs. This node includes a convolutional processing unit and a routing element which allows to build large 2D arrays where any multilayer structure can be implemented. The rate saturation mechanism emulates the refractory behavior in biological neurons, guaranteeing a minimum separation in time between consecutive events. A 4-layer ConvNet with 22 convolutional nodes trained for poker card symbol recognition has been implemented in a Spartan6 FPGA. This network has been tested with a stimulus where 40 poker cards were observed by a Dynamic Vision Sensor (DVS) in 1 s time. Different slow-down factors were applied to characterize the behavior of the system for high speed processing. For slow stimulus play-back, a 96% recognition rate is obtained with a power consumption of 0.85 mW. At maximum play-back speed, a traffic control mechanism downsamples the input stimulus, obtaining a recognition rate above 63% when less than 20% of the input events are processed, demonstrating the robustness of the network.

  4. Variety Is Not the Spice of Life for People with Autism Spectrum Disorders: Frequency Ratings of Central, Variable and Inappropriate Aspects of Common Real-Life Events

    Science.gov (United States)

    Loth, Eva; Happe, Francesca; Gomez, Juan Carlos

    2010-01-01

    This study used a novel rating task to investigate whether high-functioning individuals with autism spectrum disorder (ASD) have difficulties distinguishing essential from variable aspects of familiar events. Participants read stories about everyday events and judged how often central, variable, and inappropriate event-components normally occur in…

  5. Varying Definitions for Periprocedural Myocardial Infarction Alter Event Rates and Prognostic Implications

    Science.gov (United States)

    Idris, Hanan; Lo, Sidney; Shugman, Ibrahim M.; Saad, Yousef; Hopkins, Andrew P.; Mussap, Christian; Leung, Dominic; Thomas, Liza; Juergens, Craig P.; French, John K.

    2014-01-01

    Background Periprocedural myocardial infarction (PMI) has had several definitions in the last decade, including the Society for Cardiovascular Angiography and Interventions (SCAI) definition, that requires marked biomarker elevations congruent with surgical PMI criteria. Methods and Results The aim of this study was to examine the definition‐based frequencies of PMI and whether they influenced the reported association between PMI and increased rates of late death/ myocardial infarction (MI). We studied 742 patients; 492 (66%) had normal troponin T (TnT) levels and 250 (34%) had elevated, but stable or falling, TnT levels. PMI, using the 2007 and the 2012 universal definition, occurred in 172 (23.2%) and in 99 (13.3%) patients, respectively, whereas 19 (2.6%) met the SCAI PMI definition (PPMI using the 2012 definition, occlusion of a side branch ≤1 mm occurred in 48 patients (48.5%) and was the most common angiographic finding for PMI. The rates of death/MI at 2 years in patients with, compared to those without, PMI was 14.7% versus 10.1% (P=0.087) based on the 2007 definition, 16.9% versus 10.3% (P=0.059) based on the 2012 definition, and 29.4% versus 10.7% (P=0.015) based on the SCAI definition. Conclusion In this study, PMI, according to the SCAI definition, was associated with more‐frequent late death/MI, with ≈20% of all patients, who had PMI using the 2007 universal MI definition, not having SCAI‐defined PMI. Categorizing these latter patients as SCAI‐defined no PMI did not alter the rate of death/MI among no‐PMI patients. PMID:25359403

  6. Discharge Processes and 30-Day Readmission Rates of Patients Hospitalized for Heart Failure on General Medicine and Cardiology Services.

    Science.gov (United States)

    Salata, Brian M; Sterling, Madeline R; Beecy, Ashley N; Ullal, Ajayram V; Jones, Erica C; Horn, Evelyn M; Goyal, Parag

    2018-05-01

    Given high rates of heart failure (HF) hospitalizations and widespread adoption of the hospitalist model, patients with HF are often cared for on General Medicine (GM) services. Differences in discharge processes and 30-day readmission rates between patients on GM and those on Cardiology during the contemporary hospitalist era are unknown. The present study compared discharge processes and 30-day readmission rates of patients with HF admitted on GM services and those on Cardiology services. We retrospectively studied 926 patients discharged home after HF hospitalization. The primary outcome was 30-day all-cause readmission after discharge from index hospitalization. Although 60% of patients with HF were admitted to Cardiology services, 40% were admitted to GM services. Prevalence of cardiovascular and noncardiovascular co-morbidities were similar between patients admitted to GM services and Cardiology services. Discharge summaries for patients on GM services were less likely to have reassessments of ejection fraction, new study results, weights, discharge vital signs, discharge physical examinations, and scheduled follow-up cardiologist appointments. In a multivariable regression analysis, patients on GM services were more likely to experience 30-day readmissions compared with those on Cardiology services (odds ratio 1.43 95% confidence interval [1.05 to 1.96], p = 0.02). In conclusion, outcomes are better among those admitted to Cardiology services, signaling the need for studies and interventions focusing on noncardiology hospital providers that care for patients with HF. Copyright © 2018 Elsevier Inc. All rights reserved.

  7. [Impact of nurse, nurses' aid staffing and turnover rate on inpatient health outcomes in long term care hospitals].

    Science.gov (United States)

    Kim, Yunmi; Lee, Ji Yun; Kang, Hyuncheol

    2014-02-01

    This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.

  8. On the merging rates of envelope-deprived components of binary systems which can give rise to supernova events

    Science.gov (United States)

    Tornambe, Amedeo

    1989-08-01

    Theoretical rates of mergings of envelope-deprived components of binary systems, which can give rise to supernova events are described. The effects of the various assumptions on the physical properties of the progenitor system and of its evolutionary behavior through common envelope phases are discussed. Four cases have been analyzed: CO-CO, He-CO, He-He double degenerate mergings and He star-CO dwarf merging. It is found that, above a critical efficiency of the common envelope action in system shrinkage, the rate of CO-CO mergings is not strongly sensitive to the efficiency. Below this critical value, no CO-CO systems will survive for times larger than a few Gyr. In contrast, He-CO dwarf systems will continue to merge at a reasonable rate up to 20 Gyr, and more, also under extreme conditions.

  9. Rates and predictors of depression status among caregivers of patients with COPD hospitalized for acute exacerbations: a prospective study

    Directory of Open Access Journals (Sweden)

    Bernabeu-Mora R

    2016-12-01

    Full Text Available Roberto Bernabeu-Mora,1–3 Gloria García-Guillamón,2 Joaquina Montilla-Herrador,2,3 Pilar Escolar-Reina,2,3 José Antonio García-Vidal,2 Francesc Medina-Mirapeix2,3 1Division of Pneumology, Hospital Morales Meseguer, 2Department of Physical Therapy, University of Murcia, 3Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB, Murcia, Spain Background: Hospitalization is common for acute exacerbation of COPD, but little is known about its impact on the mental health of caregivers. Objective: The aim of this study was to determine the rates and predictors of depressive symptoms in caregivers at the time of hospitalization for acute exacerbation of COPD and to identify the probability and predictors of subsequent changes in depressive status 3 months after discharge. Materials and methods: This was a prospective study. Depression symptoms were measured in 87 caregivers of patients hospitalized for exacerbation at hospitalization and 3 months after discharge. We measured factors from four domains: context of care, caregiving demands, caregiver resources, and patient characteristics. Univariate and multivariate multiple logistic regressions were used to determine the predictors of depression at hospitalization and subsequent changes at 3 months. Results: A total of 45 caregivers reported depression at the time of hospitalization. After multiple adjustments, spousal relationship, dyspnea, and severe airflow limitation were the strongest independent predictors of depression at hospitalization. Of these 45 caregivers, 40% had a remission of their depression 3 months after discharge. In contrast, 16.7% of caregivers who were not depressive at hospitalization became depressive at 3 months. Caregivers caring >20 hours per week for patients with dependencies had decreased odds of remission, and patients having dependencies after discharge increased the odds of caregivers becoming

  10. Extracorporeal Shock-wave Lithotripsy Success Rate and Complications: Initial Experience at Sultan Qaboos University Hospital

    Directory of Open Access Journals (Sweden)

    Mohammed S. Al-Marhoon

    2013-07-01

    Full Text Available Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy with Modularis Vario Siemens in the management of patients with renal and ureteral stones.Methods: Between 2007 and 2009, 225 outpatients were treated with Siemens Modularis Vario lithotripter at Sultan Qaboos University Hospital. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance.Results: Of the 225 initial consecutive patients who underwent extracorporeal shock wave lithotripsy, 192 (85% had renal stones and 33 (15% had ureteric stones. The mean±SD stone size was 11.3 ± 4.5 mm, while the mean age of the patients was 39.9 ± 12.8 years with 68.5% males. The mean renal stone size was 11.6 ± 4.7 mm; a mean of 1.3 sessions was required. The mean ureteric stone size was 9.9 ± 3 mm; and a mean of 1.3 sessions was required. Treatment success (defined as complete clearance of ureteric stones, stone-free or clinically insignificant residual fragments of <4 mm for renal stones was 74% for renal stones and 88% for ureteric stones. Additional extracorporeal shock wave lithotripsy and ureteroscopy were the most adjunctive procedures used for stone clearance. Complications occurred in 74 patients (38.5% with renal stones and 13 patients (39.4% with uretetric stones. The most common complication was loin pain (experienced by 16.7% with renal stones and 21% with ureteric stones. Severe renal colic mandating admission occurred in 2% of patients with renal stones and 6% of patients with ureteric stones. In patients with renal stone, steinstrasse occurred in 3.6% and infection post extracorporeal shock wave lithotripsy in 0.5%. Using Multivariate Logistic Regression analysis, factors found to have significant effect on complete stone clearance were serum creatinine (p=0.004 and the number of

  11. [C-section rate in low-risk women: a useful indicator to compare hospitals attending deliveries with different risks].

    Science.gov (United States)

    Librero, Julián; Peiró, Salvador; Belda, Ana; Calabuig, Julia

    2014-01-01

    the C-section rate has been criticized as a performance indicator for not considering that different hospitals manage deliveries with diverse risks. In this work we explore the characteristics of a new indicator restricted to low C-section risk deliveries. retrospective cohort of all births (n=214,611) in all public hospitals during 2005-2010 in the Valencia Region, Spain (source: minimum basic dataset). A low-risk subpopulation consisting of women under-35, no history of c-section, between 37 and 41 gestational weeks, and with a single fetus, with cephalic presentation and normal weight (2500-3999 g) was constructed. We analyzed variability in the new indicator, its correlation with the crude indicator and, using multilevel logistic regression models, the presence of residual risks. a total of 117 589 births (58.4% of the whole deliveries) were identified as low C-section risk. The c-section rate in these women was 11.9% (24.4% for all deliveries) ranging between hospitals from 7.0% to 28.9%. The c-section rate in low-risk and total deliveries correlated strongly (r=0.88). The remaining risks in the population of low risk did not alter the hospital effect on the c-section rate. the percentage of C-section in low risk women include a high volume of deliveries, correlated with the crude indicator and residual risks are not differentially influenced by hospitals, being a useful indicator for monitoring the quality of obstetric care in the National Health System.

  12. Scaling A Moment-Rate Function For Small To Large Magnitude Events

    Science.gov (United States)

    Archuleta, Ralph; Ji, Chen

    2017-04-01

    Since the 1980's seismologists have recognized that peak ground acceleration (PGA) and peak ground velocity (PGV) scale differently with magnitude for large and moderate earthquakes. In a recent paper (Archuleta and Ji, GRL 2016) we introduced an apparent moment-rate function (aMRF) that accurately predicts the scaling with magnitude of PGA, PGV, PWA (Wood-Anderson Displacement) and the ratio PGA/2πPGV (dominant frequency) for earthquakes 3.3 ≤ M ≤ 5.3. This apparent moment-rate function is controlled by two temporal parameters, tp and td, which are related to the time for the moment-rate function to reach its peak amplitude and the total duration of the earthquake, respectively. These two temporal parameters lead to a Fourier amplitude spectrum (FAS) of displacement that has two corners in between which the spectral amplitudes decay as 1/f, f denotes frequency. At higher or lower frequencies, the FAS of the aMRF looks like a single-corner Aki-Brune omega squared spectrum. However, in the presence of attenuation the higher corner is almost certainly masked. Attempting to correct the spectrum to an Aki-Brune omega-squared spectrum will produce an "apparent" corner frequency that falls between the double corner frequency of the aMRF. We reason that the two corners of the aMRF are the reason that seismologists deduce a stress drop (e.g., Allmann and Shearer, JGR 2009) that is generally much smaller than the stress parameter used to produce ground motions from stochastic simulations (e.g., Boore, 2003 Pageoph.). The presence of two corners for the smaller magnitude earthquakes leads to several questions. Can deconvolution be successfully used to determine scaling from small to large earthquakes? Equivalently will large earthquakes have a double corner? If large earthquakes are the sum of many smaller magnitude earthquakes, what should the displacement FAS look like for a large magnitude earthquake? Can a combination of such a double-corner spectrum and random

  13. Ion-ion coincidence imaging at high event rate using an in-vacuum pixel detector

    Science.gov (United States)

    Long, Jingming; Furch, Federico J.; Durá, Judith; Tremsin, Anton S.; Vallerga, John; Schulz, Claus Peter; Rouzée, Arnaud; Vrakking, Marc J. J.

    2017-07-01

    A new ion-ion coincidence imaging spectrometer based on a pixelated complementary metal-oxide-semiconductor detector has been developed for the investigation of molecular ionization and fragmentation processes in strong laser fields. Used as a part of a velocity map imaging spectrometer, the detection system is comprised of a set of microchannel plates and a Timepix detector. A fast time-to-digital converter (TDC) is used to enhance the ion time-of-flight resolution by correlating timestamps registered separately by the Timepix detector and the TDC. In addition, sub-pixel spatial resolution (principle experiment on strong field dissociative double ionization of carbon dioxide molecules (CO2), using a 400 kHz repetition rate laser system. The experimental results demonstrate that the spectrometer can detect multiple ions in coincidence, making it a valuable tool for studying the fragmentation dynamics of molecules in strong laser fields.

  14. Unintentional carbon monoxide poisoning hospitalization and emergency department counts and rates by county, year, and fire-relatedness among California residents,2000-2007

    Data.gov (United States)

    California Environmental Health Tracking Program — This dataset contains case counts, rates, and confidence intervals of unintentional carbon monoxide poisoning (CO) inpatient hospitalizations and emergency...

  15. Nasal Colonization rate of Staphylococcus aureus strains among Health Care Service Employee’s of Teaching University Hospitals in Yazd

    Directory of Open Access Journals (Sweden)

    Khalili Mohammad Bagher

    2009-10-01

    Full Text Available This study was carried out to find the extent of staphylococcal carriages including Methicillin resistant Staphylococcus aureus MRSA in employee's of teaching university hospitals in Yazd. Nasal swabs of 742 employees in four different medical teaching hospitals in Yazd were collected, and tested for detection of staphylococci strains. Out of 742 employees, 94 (12.7% were carrier of staphylococcus aurus and 57 (11.38% for methicillin resistant Staphylococcus aureus (MRSA respectively. Prevalence of Staphylococci aureus and MRSA in individual hospitals and wards were different. In general the highest carriers were personnel of dialysis ward and the lowest pediatrics wards. Resistance rate of MRSA against Ciprofloxacin, Vancomycin, and Rifampin were found to be as 28.1%, 10.5% and 35.1% respectively.

  16. Accuracy of a Wrist-Worn Wearable Device for Monitoring Heart Rates in Hospital Inpatients: A Prospective Observational Study.

    Science.gov (United States)

    Kroll, Ryan R; Boyd, J Gordon; Maslove, David M

    2016-09-20

    As the sensing capabilities of wearable devices improve, there is increasing interest in their application in medical settings. Capabilities such as heart rate monitoring may be useful in hospitalized patients as a means of enhancing routine monitoring or as part of an early warning system to detect clinical deterioration. To evaluate the accuracy of heart rate monitoring by a personal fitness tracker (PFT) among hospital inpatients. We conducted a prospective observational study of 50 stable patients in the intensive care unit who each completed 24 hours of heart rate monitoring using a wrist-worn PFT. Accuracy of heart rate recordings was compared with gold standard measurements derived from continuous electrocardiographic (cECG) monitoring. The accuracy of heart rates measured by pulse oximetry (Spo2.R) was also measured as a positive control. On a per-patient basis, PFT-derived heart rate values were slightly lower than those derived from cECG monitoring (average bias of -1.14 beats per minute [bpm], with limits of agreement of 24 bpm). By comparison, Spo2.R recordings produced more accurate values (average bias of +0.15 bpm, limits of agreement of 13 bpm, P<.001 as compared with PFT). Personal fitness tracker device performance was significantly better in patients in sinus rhythm than in those who were not (average bias -0.99 bpm vs -5.02 bpm, P=.02). Personal fitness tracker-derived heart rates were slightly lower than those derived from cECG monitoring in real-world testing and not as accurate as Spo2.R-derived heart rates. Performance was worse among patients who were not in sinus rhythm. Further clinical evaluation is indicated to see if PFTs can augment early warning systems in hospitals. ClinicalTrials.gov NCT02527408; https://clinicaltrials.gov/ct2/show/NCT02527408 (Archived by WebCite at  http://www.webcitation.org/6kOFez3on).

  17. The devil is in the details: trends in avoidable hospitalization rates by geography in British Columbia, 1990–2000

    Directory of Open Access Journals (Sweden)

    Penning Margaret J

    2006-08-01

    Full Text Available Abstract Background Researchers and policy makers have focussed on the development of indicators to help monitor the success of regionalization, primary care reform and other health sector restructuring initiatives. Certain indicators are useful in examining issues of equity in service provision, especially among older populations, regardless of where they live. AHRs are used as an indicator of primary care system efficiency and thus reveal information about access to general practitioners. The purpose of this paper is to examine trends in avoidable hospitalization rates (AHRs during a period of time characterized by several waves of health sector restructuring and regionalization in British Columbia. AHRs are examined in relation to non-avoidable and total hospitalization rates as well as by urban and rural geography across the province. Methods Analyses draw on linked administrative health data from the province of British Columbia for 1990 through 2000 for the population aged 50 and over. Joinpoint regression analyses and t-tests are used to detect and describe trends in the data. Results Generally speaking, non-avoidable hospitalizations constitute the vast majority of hospitalizations in a given year (i.e. around 95% with AHRs constituting the remaining 5% of hospitalizations. Comparing rural areas and urban areas reveals that standardized rates of avoidable, non-avoidable and total hospitalizations are consistently higher in rural areas. Joinpoint regression results show significantly decreasing trends overall; lines are parallel in the case of avoidable hospitalizations, and lines are diverging for non-avoidable and total hospitalizations, with the gap between rural and urban areas being wider at the end of the time interval than at the beginning. Conclusion These data suggest that access to effective primary care in rural communities remains problematic in BC given that rural areas did not make any gains in AHRs relative to urban areas

  18. Evaluation of the effect of patient education on rates of falls in older hospital patients: Description of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Hoffmann Tammy

    2009-04-01

    Full Text Available Abstract Background Accidental falls by older patients in hospital are one of the most commonly reported adverse events. Falls after discharge are also common. These falls have enormous physical, psychological and social consequences for older patients, including serious physical injury and reduced quality of life, and are also a source of substantial cost to health systems worldwide. There have been a limited number of randomised controlled trials, mainly using multifactorial interventions, aiming to prevent older people falling whilst inpatients. Trials to date have produced conflicting results and recent meta-analyses highlight that there is still insufficient evidence to clearly identify which interventions may reduce the rate of falls, and falls related injuries, in this population. Methods and design A prospective randomised controlled trial (n = 1206 is being conducted at two hospitals in Australia. Patients are eligible to be included in the trial if they are over 60 years of age and they, or their family or guardian, give written consent. Participants are randomised into three groups. The control group continues to receive usual care. Both intervention groups receive a specifically designed patient education intervention on minimising falls in addition to usual care. The education is delivered by Digital Video Disc (DVD and written workbook and aims to promote falls prevention activities by participants. One of the intervention groups also receives follow up education training visits by a health professional. Blinded assessors conduct baseline and discharge assessments and follow up participants for 6 months after discharge. The primary outcome measure is falls by participants in hospital. Secondary outcome measures include falls at home after discharge, knowledge of falls prevention strategies and motivation to engage in falls prevention activities after discharge. All analyses will be based on intention to treat principle. Discussion

  19. Case-mix adjustment approach to benchmarking prevalence rates of nosocomial infection in hospitals in Cyprus and Greece.

    Science.gov (United States)

    Kritsotakis, Evangelos I; Dimitriadis, Ioannis; Roumbelaki, Maria; Vounou, Emelia; Kontou, Maria; Papakyriakou, Panikos; Koliou-Mazeri, Maria; Varthalitis, Ioannis; Vrouchos, George; Troulakis, George; Gikas, Achilleas

    2008-08-01

    To examine the effect of heterogeneous case mix for a benchmarking analysis and interhospital comparison of the prevalence rates of nosocomial infection. Cross-sectional survey. Eleven hospitals located in Cyprus and in the region of Crete in Greece. The survey included all inpatients in the medical, surgical, pediatric, and gynecology-obstetrics wards, as well as those in intensive care units. Centers for Disease Control and Prevention criteria were used to define nosocomial infection. The information collected for all patients included demographic characteristics, primary admission diagnosis, Karnofsky functional status index, Charlson comorbidity index, McCabe-Jackson severity of illness classification, use of antibiotics, and prior exposures to medical and surgical risk factors. Outcome data were also recorded for all patients. Case mix-adjusted rates were calculated by using a multivariate logistic regression model for nosocomial infection risk and an indirect standardization method.Results. The overall prevalence rate of nosocomial infection was 7.0% (95% confidence interval, 5.9%-8.3%) among 1,832 screened patients. Significant variation in nosocomial infection rates was observed across hospitals (range, 2.2%-9.6%). Logistic regression analysis indicated that the mean predicted risk of nosocomial infection across hospitals ranged from 3.7% to 10.3%, suggesting considerable variation in patient risk. Case mix-adjusted rates ranged from 2.6% to 12.4%, and the relative ranking of hospitals was affected by case-mix adjustment in 8 cases (72.8%). Nosocomial infection was significantly and independently associated with mortality (adjusted odds ratio, 3.6 [95% confidence interval, 2.1-6.1]). The first attempt to rank the risk of nosocomial infection in these regions demonstrated the importance of accounting for heterogeneous case mix before attempting interhospital comparisons.

  20. Hospital visits among women with skeletal-related events secondary to breast cancer and bone metastases: a nationwide population-based cohort study in Denmark

    Directory of Open Access Journals (Sweden)

    Svendsen ML

    2013-03-01

    Full Text Available Marie Louise Svendsen,1 Henrik Gammelager,1 Claus Sværke,1 Mellissa Yong,2 Victoria M Chia,2 Christian F Christiansen,1 Jon P Fryzek1 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Center for Observational Research, Amgen, Thousand Oaks, CA, USA Objective: Skeletal-related events (SREs among women with breast cancer may be associated with considerable use of health-care resources. We characterized inpatient and outpatient hospital visits in a national population-based cohort of Danish women with SREs secondary to breast cancer and bone metastases. Methods: We identified first-time breast cancer patients with bone metastases from 2003 through 2009 who had a subsequent SRE (defined as pathologic fracture, spinal cord compression, radiation therapy, or surgery to bone. Hospital visits included the number of inpatient hospitalizations, length of stay, number of hospital outpatient clinic visits, and emergency room visits. The number of hospital visits was assessed for a pre-SRE period (90 days prior to the diagnostic period, a diagnostic period (14 days prior to the SRE, and a post-SRE period (90 days after the SRE. Patients who experienced more than one SRE during the 90-day post-SRE period were defined as having multiple SREs and were followed until 90 days after the last SRE. Results: We identified 569 women with SREs secondary to breast cancer with bone metastases. The majority of women had multiple SREs (73.1%. A total of 20.9% and 33.4% of women with single and multiple SREs died in the post-SRE period, respectively. SREs were associated with a large number of hospital visits in the diagnostic period, irrespective of the number and type of SREs. Women with multiple SREs generally had a higher number of visits compared to those with a single SRE in the post-SRE period, eg, median length of hospitalization was 5 days (interquartile range 0–15 for women with a single SRE and 13 days (interquartile range 4

  1. 42 CFR 413.40 - Ceiling on the rate of increase in hospital inpatient costs.

    Science.gov (United States)

    2010-10-01

    ... October 1, 2002, is the percentage increase projected by the hospital market basket index. (4) Target... target amount for the previous cost reporting period, updated by the market basket percentage increase... each cost reporting period, the ceiling is determined by multiplying the updated target amount, as...

  2. Hysterectomy in Denmark 1977-2011: Changes in rate, indications, and hospitalization

    DEFF Research Database (Denmark)

    Lykke, Rune; Blaakær, J.; Ottesen, B.

    2013-01-01

    . The indication of pelvic organ prolapse and abnormal uterine bleeding increased while the indication of fibroids decreased. The average age of women at time of hysterectomy increased from 46 years in 1977-1981 to 50 years in 2006-2011. The mean number of hospitalization days was reduced by 75%. Regional...

  3. 42 CFR 419.32 - Calculation of prospective payment rates for hospital outpatient services.

    Science.gov (United States)

    2010-10-01

    ... outpatient services furnished in 1999 would have equaled the base expenditure target calculated in § 419.30... inpatient market basket percentage increase applicable under section 1886(b)(3)(B)(iii) of the Act reduced... 1, 2001 and before April 1, 2001, by the hospital inpatient market basket percentage increase...

  4. Prevalence of Anemia and Its Impact on Mortality and Hospitalization Rate in Predialysis Patients

    NARCIS (Netherlands)

    Voormolen, N.; Grootendorst, D. C.; Urlings, T. A. J.; Boeschoten, E. W.; Sijpkens, Y. W.; Huisman, R. M.; Krediet, R. T.; Dekker, F. W.

    2010-01-01

    Background/Aim: Anemia is associated with increased mortality and morbidity in both early and very late stages of chronic kidney disease (CKD). The aim of this study was to assess whether anemia is a risk factor for mortality or hospitalization in CKD stage 4-5 predialysis patients not yet on

  5. Healthcare waste management in Uganda: management and generation rates in public and private hospitals in Kampala

    NARCIS (Netherlands)

    Mugambe, R.K.; Ssempebwa, J.C.; Tumwesigye, N.M.; Vliet, van B.J.M.; Adedimeji, A.

    2012-01-01

    Aim The aim of this study was to assess the management, characteristics and generation of healthcare waste (HCW) in public and private hospitals in Kampala City, Uganda. Methods We employed mainly qualitative methods through the use of a waste inventory, observations, document review and key

  6. Understanding Design Vulnerabilities in the Physical Environment Relating to Patient Fall Patterns in a Psychiatric Hospital: Seven Years of Sentinel Events.

    Science.gov (United States)

    Bayramzadeh, Sara; Portillo, Margaret; Carmel-Gilfilen, Candy

    2018-05-01

    The influence of the physical environment on patient falls has not been fully explored in psychiatric units, despite this patient population's vulnerability and the critical role of the physical environment in patient safety. The research objective is to describe the spatial and temporal pattern of falls occurrences and their location in relation to the levels of safety continuum model. This article presents an exploratory case study design. Seven years of retrospective data on patient falls, yielding 818 sentinel events, in an 81-bed psychiatric hospital in the United States were collected and analyzed. Data focused on extrinsic factors for falls, emphasizing the physical environment. Through a content analysis of the sentinel event narratives, recorded by the hospital staff, this study explored patient falls related to location and elements of the physical environment. The analysis revealed that 15% of recorded falls were attributed to some aspect of or element within the physical environment. The most typical locations of falls were patient rooms (39%), patient bathrooms (22%), and dayrooms (20%). Also, the results identified patterns of environmental factors that appeared linked to increasing patients' susceptibility to falls. Risk factors included poor nighttime lighting, flooring surfaces that were uneven, and spaces that inadvertently limited visual access and supervision. The physical environment plays an often-unexamined role in fall events and specific locations. These results are deserving of further research on design strategies and applications to reduce patient falls in psychiatric hospital settings.

  7. HCAHPS - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital...

  8. [Thinking about the evolution of caesarean section rate at University Teaching Hospital of Dakar between 1992 and 2001].

    Science.gov (United States)

    Cissé, C-T; Ngom, P-M; Guissé, A; Faye, E-O; Moreau, J-C

    2004-03-01

    The objective of this study is to answer the question: have we not been doing a lot of caesarean sections at University Teaching Hospital of Dakar? This is an analytic study about caesarean section in 1992, 1996 and 2001; it was a prospective and longitudinal data collection from the epidemiological survey program carried through in Senegal about its obstetrical and surgical cover. For each year concerned, we have analysed caesarean section rate, maternal mortality rate and perinatal mortality rate. To eliminate the random part in observed variation, we used the comparison of proportions observed as a statistical test with a significant threshold less or equal to 5%. Caesarean section has gone from 12% in 1992 to 17.5 in 1996 and 25.2% in 2001. Operative indications are dominated by foeto-pelvic disproportion with an average of 31% and foetal suffering with an average of 25%. The increasing trend has been statistically significant for information's such as foeto-pelvic disproportion and maternal pathologies. The falling trend was statistically significant for indications in relation on relation to foetal suffering and scarred uterus. Gathering information has shown a stabilisation of "obligatory" caesarean rate around 41%, a decrease in "caution" caesarean rate from 50 to 37.2% and an increase in caesarean by "necessity" from 8.6 to 22.4%. The maternal mortality rate among women delivered has fallen from 1.4% to 0.8%, but postoperative surgery morbidity rate was still high around 10%, essentially due to infections. Reading of caesarean section rate has not a significant impact in perinatal prognosis. Today there is an inflation of caesarean section at University Teaching Hospital of Dakar, without any significant loss of the maternal and perinatal mortality rate. The high level of complications due to surgery incite to reverse trends in order to get reasonable rate around 10 to 15% of childbirths.

  9. Agravos provocados por medicamentos em hospitais do Estado do Rio de Janeiro, Brasil Drug adverse events in hospitals in the State of Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Suely Rozenfeld

    2007-02-01

    Full Text Available OBJETIVO: A ocorrência de agravos provocados por medicamentos no meio hospitalar é elevada e gera custos excedentes. O objetivo do estudo foi identificar problemas relacionados a medicamentos ocorridos durante a internação hospitalar e estimar a prevalência desses agravos. MÉTODOS: Estudo retrospectivo realizado no Estado do Rio de Janeiro. Foram analisadas as internações pagas pelo Sistema Único de Saúde entre 1999 e 2002. Os dados foram extraídos do Sistema de Informações Hospitalares. Selecionaram-se as internações que apresentaram um dos códigos da CID-10 (2000 suspeitos de serem agravos provocados por medicamentos, que estivessem nos campos do diagnóstico principal e/ou do diagnóstico secundário. Para as variáveis contínuas estimou-se a média, e o desvio-padrão, sendo a significância estatística entre as diferenças testada por meio de análise de variância (ANOVA, com intervalo de confiança de 95%. RESULTADOS: Foram identificados 3.421 casos equivalentes à freqüência de 1,8 casos/1.000 internações, ocorridos, sobretudo, em homens (64,5%, nos hospitais contratados (34,9% e nos municipais (23,1%, nos leitos de psiquiatria (51,4% e de clínica médica (45,2%, dos quais 84,1% resultaram em alta. A maioria dos agravos foi por reações adversas e de intoxicações e, entre essas categorias, há diferenças significativas (pOBJECTIVE: The occurrence of drug adverse events in hospital settings is high and generates cost excess. The purpose of the study was to identify drug-related events during hospital admissions and to estimate their prevalence. METHODS: A retrospective study was carried out in the State of Rio de Janeiro, Southeastern Brazil. Hospitalizations from the Brazilian Health System's national hospital database during the period between 1999 and 2002 were assessed. Admitted cases including suspected drug adverse event cases with ICD-10 (2000 coding in the main diagnosis and/or secondary diagnosis fields

  10. Tracks FAQs: How Can I Tell If Asthma Hospitalization Rates In My Area Are Changing Over Time?

    Centers for Disease Control (CDC) Podcasts

    2011-06-07

    In this podcast, CDC Tracking experts discuss asthma hospitalization rates and how you can tell if they've changed in your area over time. Do you have a question for our Tracking experts? Please e-mail questions to trackingsupport@cdc.gov.  Created: 6/7/2011 by National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Environmental Health Tracking Branch.   Date Released: 6/7/2011.

  11. Tracks FAQs: How Do Heart Attack Hospitalization Rates In My Community Compare With Other Counties Or States?

    Centers for Disease Control (CDC) Podcasts

    2011-09-01

    In this podcast, CDC Tracking experts discuss how to compare heart attack hospitalization rates in your community with other counties or states. Do you have a question for our Tracking experts? Please e-mail questions to trackingsupport@cdc.gov.  Created: 9/1/2011 by National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Environmental Health Tracking Branch.   Date Released: 9/1/2011.

  12. Comparison of the rates of fight-related trauma admissions in Ramadan and the non-Ramadan months during 8 years in public hospitals in Kermanshah, Iran

    Directory of Open Access Journals (Sweden)

    Gholamreza Mohseni

    2016-12-01

    Full Text Available Introduction: Ramadan is a time when Muslims are expected to be calm and peaceful in daily life both mentally and physiologically. Some people believe that they should try to don’t have be involved in bad and deviant behaviors in Ramadan. As increasing social safety and reducing crime in society are the most important concerns of the authorities , psychologists, sociologists and governments, they are try to find ways to increase the social safety and decrease the crime rates. The aim of this study was to investigate the statisticaltraumas Due to fights and rate of ’deviant behaviors during Ramadan compared to Non-Ramadan months  of the years 2001 to 2008 in public hospitals in the city of Kermanshah, Iran. Method: Our study was a prospective study. It included patients who were involved in four types of traumas including beating, gunshot, falling from height and car-accident during Ramadan and the Non-Ramadan months of the years 2001 to 2008 admitted to the Emergency Trauma Center Departments (ETCDs of Taleghani and Imam Reza Hospitals in Kermanshah, Iran. Results: The study included 168753 patients. 155705 patients (442.34 mean ± 436.77 SD were admitted in Non-Ramadan months and the remaining 13048 patients (407.75 mean ± 427.16 SD in Ramadan month. Based on the results, the average of trauma instances in Non-Ramadan months was higher, but no statistically significant difference was noted between the two groups. We did not observe significant differences for types of traumatic events in Ramadan compared to Non-Ramadan months, but for Non Ramadan months all types of traumatic except gunshot and beating were significant. Conclusion: Although Ramadan is not a special controlling factor for trauma admissions, but it can has an important effect on the reduction of numbers and types of fight-related trauma admissions in ETCD of hospitals.

  13. Trends in hospital admission rates for anorexia nervosa in Oxford (1968-2011) and England (1990-2011): database studies.

    Science.gov (United States)

    Holland, Josephine; Hall, Nick; Yeates, David G R; Goldacre, Michael

    2016-02-01

    To report on long-term trends in hospital admission rates for anorexia nervosa using two English datasets. We used data on hospital day-case and inpatient care across five decades in the Oxford Record Linkage Study (ORLS), and similar data for all England from 1990. We analysed rates of admission for anorexia nervosa in people aged 10-44 years, using hospital episodes (counting every admission) and first-recorded admissions (counting only the first record for each person). Former Oxford NHS Region; and England. None; anonymous statistical records were used. In the longstanding ORLS, the age-standardised first-recorded admission rate for women was 2.7 (95% confidence interval 1.6-3.8) per 100,000 female population aged 10-44 years in 1968-1971; 2.7 (2.1-3.3) in 1992-1996; and 6.3 (5.5-7.2) in 2007-2011. Male rates were zero in the 1960s; 0.07 (0.0-0.1) per 100,000 men in 1992-1996; and 0.4 (0.2-0.6) in 2007-2011. In England, female rates increased from 4.2 (4.0-4.4) in 1998-2001 to 6.9 (6.7-7.1) in 2007-2011; and the corresponding male rates were 0.2 (0.1-0.3) and 0.5 (0.4-0.6). Episode-based admission rates rose more than person-based rates. The highest rates by far were in girls and women aged 15-19 years. In recent years, anorexia nervosa has become a greater burden on secondary care: not only have admission rates increased but so too have multiple admissions per person with anorexia nervosa. The increase in admission rates might reflect an increase in prevalence rates of anorexia nervosa in the general population, but other explanations, including lower clinical thresholds for admission, are possible and are discussed. © The Royal Society of Medicine.

  14. Pulse Rate and Transit Time Analysis to Predict Hypotension Events After Spinal Anesthesia During Programmed Cesarean Labor.

    Science.gov (United States)

    Bolea, Juan; Lázaro, Jesús; Gil, Eduardo; Rovira, Eva; Remartínez, José M; Laguna, Pablo; Pueyo, Esther; Navarro, Augusto; Bailón, Raquel

    2017-09-01

    Prophylactic treatment has been proved to reduce hypotension incidence after spinal anesthesia during cesarean labor. However, the use of pharmacological prophylaxis could carry out undesirable side-effects on mother and fetus. Thus, the prediction of hypotension becomes an important challenge. Hypotension events are hypothesized to be related to a malfunctioning of autonomic nervous system (ANS) regulation of blood pressure. In this work, ANS responses to positional changes of 51 pregnant women programmed for a cesarean labor were explored for hypotension prediction. Lateral and supine decubitus, and sitting position were considered while electrocardiographic and pulse photoplethysmographic signals were recorded. Features based on heart rate variability, pulse rate variability (PRV) and pulse transit time (PTT) analysis were used in a logistic regression classifier. The results showed that PRV irregularity changes, assessed by approximate entropy, from supine to lateral decubitus, and standard deviation of PTT in supine decubitus were found as the combination of features that achieved the best classification results sensitivity of 76%, specificity of 70% and accuracy of 72%, being normotensive the positive class. Peripheral regulation and blood pressure changes, measured by PRV and PTT analysis, could help to predict hypotension events reducing prophylactic side-effects in the low-risk population.

  15. Network Events on Multiple Space and Time Scales in Cultured Neural Networks and in a Stochastic Rate Model.

    Directory of Open Access Journals (Sweden)

    Guido Gigante

    2015-11-01

    Full Text Available Cortical networks, in-vitro as well as in-vivo, can spontaneously generate a variety of collective dynamical events such as network spikes, UP and DOWN states, global oscillations, and avalanches. Though each of them has been variously recognized in previous works as expression of the excitability of the cortical tissue and the associated nonlinear dynamics, a unified picture of the determinant factors (dynamical and architectural is desirable and not yet available. Progress has also been partially hindered by the use of a variety of statistical measures to define the network events of interest. We propose here a common probabilistic definition of network events that, applied to the firing activity of cultured neural networks, highlights the co-occurrence of network spikes, power-law distributed avalanches, and exponentially distributed 'quasi-orbits', which offer a third type of collective behavior. A rate model, including synaptic excitation and inhibition with no imposed topology, synaptic short-term depression, and finite-size noise, accounts for all these different, coexisting phenomena. We find that their emergence is largely regulated by the proximity to an oscillatory instability of the dynamics, where the non-linear excitable behavior leads to a self-amplification of activity fluctuations over a wide range of scales in space and time. In this sense, the cultured network dynamics is compatible with an excitation-inhibition balance corresponding to a slightly sub-critical regime. Finally, we propose and test a method to infer the characteristic time of the fatigue process, from the observed time course of the network's firing rate. Unlike the model, possessing a single fatigue mechanism, the cultured network appears to show multiple time scales, signalling the possible coexistence of different fatigue mechanisms.

  16. The impact of a proactive chronic care management program on hospital admission rates in a German health insurance society.

    Science.gov (United States)

    Hamar, Brent; Wells, Aaron; Gandy, William; Haaf, Andreas; Coberley, Carter; Pope, James E; Rula, Elizabeth Y

    2010-12-01

    Hospital admissions are the source of significant health care expenses, although a large proportion of these admissions can be avoided through proper management of chronic disease. In the present study, we evaluate the impact of a proactive chronic care management program for members of a German insurance society who suffer from chronic disease. Specifically, we tested the impact of nurse-delivered care calls on hospital admission rates. Study participants were insured individuals with coronary artery disease, heart failure, diabetes, or chronic obstructive pulmonary disease who consented to participate in the chronic care management program. Intervention (n  = 17,319) and Comparison (n  = 5668) groups were defined based on records of participating (or not participating) in telephonic interactions. Changes in admission rates were calculated from the year prior to (Base) and year after program commencement. Comparative analyses were adjusted for age, sex, region of residence, and disease severity (stratification of 3 [least severe] to 1 [most severe]). Overall, the admission rate in the Intervention group decreased by 6.2% compared with a 14.9% increase in the Comparison group (P  management care calls can help reduce hospital admissions among German health insurance members with chronic disease.

  17. Analysis of unintended events in hospitals: inter-rater reliability of constructing causal trees and classifying root causes

    NARCIS (Netherlands)

    Smits, M.; Janssen, J.; Vet, de H.C.W.; Zwaan, L.; Timmermans, D.R.M.; Groenewegen, P.P.; Wagner, C.

    2009-01-01

    BACKGROUND: Root cause analysis is a method to examine causes of unintended events. PRISMA (Prevention and Recovery Information System for Monitoring and Analysis: is a root cause analysis tool. With PRISMA, events are described in causal trees and root causes are subsequently classified with the

  18. Analysis of unintended events in hospitals : inter-rater reliability of constructing causal trees and classifying root causes

    NARCIS (Netherlands)

    Smits, M.; Janssen, J.; Vet, R. de; Zwaan, L.; Groenewegen, P.P.; Timmermans, D.

    2009-01-01

    Background. Root cause analysis is a method to examine causes of unintended events. PRISMA (Prevention and Recovery Information System for Monitoring and Analysis) is a root cause analysis tool. With PRISMA, events are described in causal trees and root causes are subsequently classified with the

  19. Analysis of unintended events in hospitals: inter-rater reliability of constructing causal trees and classifying root causes.

    NARCIS (Netherlands)

    Smits, M.; Janssen, J.; Vet, R. de; Zwaan, L.; Timmermans, D.; Groenewegen, P.; Wagner, C.

    2009-01-01

    Background: Root cause analysis is a method to examine causes of unintended events. PRISMA (Prevention and Recovery Information System for Monitoring and Analysis) is a root cause analysis tool. With PRISMA, events are described in causal trees and root causes are subsequently classified with the

  20. Forecasting Advancement Rates to Petty Officer Third Class for U.S. Navy Hospital Corpsmen

    Science.gov (United States)

    2014-06-01

    Lastly, I would like to thank Dr. Tanja Blackstone and David Cashbaugh of Navy Personnel, Research, Studies, and Technology. Your guidance and...Corps, rendering emergency medical treatment to include initial treatment in a combat environment . Qualified Hospital Corpsmen may be assigned the...Retrieved from http://www.navy.mil/submit/display.asp?story_id=66091. R Development Core Team. (2013). R: A language and environment for statistical

  1. The effect of targeted temperature management on coagulation parameters and bleeding events after out-of-hospital cardiac arrest of presumed cardiac cause

    DEFF Research Database (Denmark)

    Jacob, Marrit; Hassager, Christian; Bro-Jeppesen, John

    2015-01-01

    AIMS: Targeted temperature management (TTM) is part of the standard treatment of comatose patients after out-of-hospital cardiac arrest (OHCA) to attenuate neurological injury. In other clinical settings, hypothermia promotes coagulopathy leading to an increase in bleeding and thrombosis tendency......, thrombelastography (TEG), bleeding, and stent thrombosis events. Platelet counts were lower in the TTM33-group compared to TTM36 (p=0.009), but neither standard coagulation nor TEG-parameters showed any difference between the groups. TEG revealed a normocoagulable state in the majority of patients, while...... approximately 20% of the population presented as hypercoagulable. Adverse events included 38 bleeding events, one stent thrombosis, and one reinfarction, with no significant difference between the groups. CONCLUSIONS: There was no evidence supporting the assumption that TTM at 33°C was associated with impaired...

  2. Event rate and reaction time performance in ADHD: Testing predictions from the state regulation deficit hypothesis using an ex-Gaussian model.

    Science.gov (United States)

    Metin, Baris; Wiersema, Jan R; Verguts, Tom; Gasthuys, Roos; van Der Meere, Jacob J; Roeyers, Herbert; Sonuga-Barke, Edmund

    2014-12-06

    According to the state regulation deficit (SRD) account, ADHD is associated with a problem using effort to maintain an optimal activation state under demanding task settings such as very fast or very slow event rates. This leads to a prediction of disrupted performance at event rate extremes reflected in higher Gaussian response variability that is a putative marker of activation during motor preparation. In the current study, we tested this hypothesis using ex-Gaussian modeling, which distinguishes Gaussian from non-Gaussian variability. Twenty-five children with ADHD and 29 typically developing controls performed a simple Go/No-Go task under four different event-rate conditions. There was an accentuated quadratic relationship between event rate and Gaussian variability in the ADHD group compared to the controls. The children with ADHD had greater Gaussian variability at very fast and very slow event rates but not at moderate event rates. The results provide evidence for the SRD account of ADHD. However, given that this effect did not explain all group differences (some of which were independent of event rate) other cognitive and/or motivational processes are also likely implicated in ADHD performance deficits.

  3. Interspecialty communication supported by health information technology associated with lower hospitalization rates for ambulatory care-sensitive conditions.

    Science.gov (United States)

    O'Malley, Ann S; Reschovsky, James D; Saiontz-Martinez, Cynthia

    2015-01-01

    Practice tools such as health information technology (HIT) have the potential to support care processes, such as communication between health care providers, and influence care for "ambulatory care-sensitive conditions" (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization. To date, associations between such primary care practice capabilities and hospitalizations for ambulatory care-sensitive conditions have been primarily limited to smaller, local studies or unique delivery systems rather than nationally representative studies of primary care physicians in the United States. We analyzed a nationally representative sample of 1,819 primary care physicians who responded to the Center for Studying Health System Change's Physician Survey. We linked 3 years of Medicare claims (2007 to 2009) with these primary care physician survey respondents. This linkage resulted in the identification of 123,760 beneficiaries with one or more of 4 ambulatory care-sensitive chronic conditions (diabetes, chronic obstructive pulmonary disease, asthma, and congestive heart failure) for whom these physicians served as the usual provider. Key independent variables of interest were physicians' practice capabilities, including communication with specialists, use of care managers, participation in quality and performance measurement, use of patient registries, and HIT use. The dependent variable was a summary measure of ambulatory care-sensitive hospitalizations for one or more of these 4 conditions. Higher provider-reported levels of communication between primary care and specialist physicians were associated with lower rates of potentially avoidable hospitalizations. While there was no significant main effect between HIT use and ACSC hospitalizations, the associations between interspecialty communication and ACSC hospitalizations were magnified in the presence of higher HIT use. For example, patients in practices with both the

  4. The rate of following infection control principles in educational hospitals of Khorramabad

    Directory of Open Access Journals (Sweden)

    tahereh Toulabi

    2006-11-01

    Results: The degree of following infection control principles in most of the personnel’s was medium (53.7% and in hand washing was low (90%. Wards status about physical environment (47.83%, resources and equipment (78.3% were medium level. Conclusion: Continuous education of personnel in different job categories, using instruments and methods to reduce infection, improvement of resources and equipment and physical environment, establishment of National Nosocomial Infection surveillance system (NNISS, yearly epidemiological investigations and performing regular microbiological cultures are the most important strategies for infection control, that must be performed in educational hospitals.

  5. How many EMA-workshops are needed to collect a representative sample of events in a hospital ward?

    DEFF Research Database (Denmark)

    Edwards, Kasper

    2017-01-01

    The effect modifier assessment (EMA) method (Edwards & Winkel, 2016) is a method for assessing the impact of an intervention and modifiers on a desired outcome e.g. improved work environment. The EMA-method captures events (a change in work) in a ward and for each event asses 1) impact on work...... and diverse tasks. This poses a problem when using the EMA-method and raises the research question of this abstract: How many EMA-workshops are needed to generate a representative collection of events in a ward? Methods Six EMA-workshops each with a full surgical team of six people was conducted in a heart...... on surgery. The ward was organized in three specialties: Heart surgery, Lung surgery and Child heart surgery. Events differed between specialties and therefor it was expected that saturation would be reached after minimum three workshops. The heart center is comparable to other surgical units...

  6. Increasing the labour epidural rate in a state hospital in South Africa ...

    African Journals Online (AJOL)

    Open Access article distributed under the terms of the ... epidural rates improved to 5.16% for the audit period, with 2014 and 2015 rates of 7.44% and 3.89% respectively. ... patients present with pregnancy-related comorbidities such as.

  7. Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study.

    Science.gov (United States)

    van der Kooy, Jacoba; Birnie, Erwin; Denktas, Semiha; Steegers, Eric A P; Bonsel, Gouke J

    2017-06-08

    To compare the mode of delivery between planned home versus planned hospital births and to determine if differences in intervention rates could be interpreted as over- or undertreatment. Intervention and perinatal mortality rates were obtained for 679,952 low-risk women from the Dutch Perinatal Registry (2000-2007). Intervention was defined as operative vaginal delivery and/or caesarean section. Perinatal mortality was defined as the intrapartum and early neonatal mortality rate up to 7 days postpartum. Besides adjustment for maternal and care factors, we included for additional casemix adjustment: presence of congenital abnormality, small for gestational age, preterm birth, or low Apgar score. The techniques used were nested multiple stepwise logistic regression, and stratified analysis for separate risk groups. An intention-to-treat like analysis was performed. The intervention rate was lower in planned home compared to planned hospital births (10.9% 95% CI 10.8-11.0 vs. 13.8% 95% CI 13.6-13.9). Intended place of birth had significant impact on the likelihood to intervene after adjustment (planned homebirth (OR 0.77 95% CI. 0.75-0.78)). The mortality rate was lower in planned home births (0.15% vs. 0.18%). After adjustment, the interaction term home- intervention was significant (OR1.51 95% CI 1.25-1.84). In risk groups, a higher perinatal mortality rate was observed in planned home births. The potential presence of over- or under treatment as expressed by adjusted perinatal mortality differs per risk group. In planned home births especially multiparous women showed universally lower intervention rates. However, the benefit of substantially fewer interventions in the planned home group seems to be counterbalanced by substantially increased mortality if intervention occurs.

  8. Rate of Legionella pneumophila colonization in hospital hot water network after time flow taps installation.

    Science.gov (United States)

    Totaro, M; Valentini, P; Costa, A L; Giorgi, S; Casini, B; Baggiani, A

    2018-01-01

    In hospital water systems legionellae may be resistant to disinfectants in pipework, which is a problem particularly in areas where there is low flow or stagnation of water. We evaluated legionella colonization of a water network of an Italian hospital after time flow taps (TFTs) installation in proximity to dead legs. The water volume flushed was 64 L/day from May 2016, and 192 L/day from December 2016. Before TFTs installation, Legionella pneumophila sg2-14 was detected in all points (4 × 10 4  ± 3.1 × 10 4  cfu/L). All sites remained positive (2.9 × 10 4  ± 1.9 × 10 4  cfu/L) through November 2016. From December 2016 legionella persisted in one point only (2 × 10 2 to 6.8 × 10 3  cfu/L). TFTs with chemical disinfection may reduce legionella colonization associated with dead legs. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  9. Simulation of overpressure events with a Laguna Verde model for the RELAP code to conditions of extended power up rate

    International Nuclear Information System (INIS)

    Rodriguez H, A.; Araiza M, E.; Fuentes M, L.; Ortiz V, J.

    2012-10-01

    In this work the main results of the simulation of overpressure events are presented using a model of the nuclear power plant of Laguna Verde developed for the RELAP/SCDAPSIM code. As starting point we have the conformation of a Laguna Verde model that represents a stationary state to similar conditions to the operation of the power station with Extended Power Up rate (EPU). The transitory of simulated pressure are compared with those documented in the Final Safety Analysis Report of Laguna Verde (FSAR). The results of the turbine shot transitory with and without by-pass of the main turbine are showed, and the event of closes of all the valves of main vapor isolation. A preliminary simulation was made and with base in the results some adjustments were made for the operation with EPU, taking into account the Operation Technical Specifications of the power station. The results of the final simulations were compared and analyzed with the content in the FSAR. The response of the power station to the transitory, reflected in the model for RELAP, was satisfactory. Finally, comments about the improvement of the model are included, for example, the response time of the protection and mitigation systems of the power station. (Author)

  10. The effect of solar-geomagnetic activity during hospital admission on coronary events within 1 year in patients with acute coronary syndromes

    Science.gov (United States)

    Vencloviene, J.; Babarskiene, R.; Milvidaite, I.; Kubilius, R.; Stasionyte, J.

    2013-12-01

    Some evidence indicates the deterioration of the cardiovascular system during space storms. It is plausible that the space weather conditions during and after hospital admission may affect the risk of coronary events in patients with acute coronary syndromes (ACS). We analyzed the data of 1400 ACS patients who were admitted to the Hospital Lithuanian University of Health Sciences, and who survived for more than 4 days. We evaluated the associations between geomagnetic storms (GS), solar proton events (SPE), and solar flares (SF) that occurred 0-3 days before and after hospital admission and the risk of cardiovascular death (CAD), non-fatal ACS, and coronary artery bypass grafting (CABG) during a period of 1 year; the evaluation was based on the multivariate logistic model, controlling for clinical data. After adjustment for clinical variables, GS occurring in conjunction with SF 1 day before admission increased the risk of CAD by over 2.5 times. GS 2 days after SPE occurred 1 day after admission increased the risk of CAD and CABG by over 2.8 times. The risk of CABG increased by over 2 times in patients admitted during the day of GS and 1 day after SPE. The risk of ACS was by over 1.63 times higher for patients admitted 1 day before or after solar flares.

  11. The prognostic significance of respiratory rate in patients with pneumonia: a retrospective analysis of data from 705,928 hospitalized patients in Germany from 2010-2012.

    Science.gov (United States)

    Strauß, Richard; Ewig, Santiago; Richter, Klaus; König, Thomas; Heller, Günther; Bauer, Torsten T

    2014-07-21

    Measurement of the respiratory rate is an important instrument for assessing the severity of acute disease. The respiratory rate is often not measured in routine practice because its clinical utility is inadequately appreciated. In Germany, documentation of the respiratory rate is obligatory when a patient with pneumonia is hospitalized. This fact has enabled us to study the prognostic significance of the respiratory rate in reference to a large medical database. We retrospectively analyzed data from the external quality-assurance program for community-acquired pneumonia for the years 2010-2012. All patients aged 18 years or older who were not mechanically ventilated on admission were included in the analysis. Logistic regression was used to determine the significance of the respiratory rate as a risk factor for in-hospital mortality. 705,928 patients were admitted to the hospital with community-acquired pneumonia (incidence: 3.5 cases per 1000 adults per year). The in-hospital mortality of these patients was 13.1% (92 227 persons). The plot of mortality as a function of respiratory rate on admission was U-shaped and slanted to the right, with the lowest mortality at a respiratory rate of 20/min on admission. If patients with a respiratory rate of 12-20/min are used as a baseline for comparison, patients with a respiratory rate of 27-33/min had an odds ratio (OR) of 1.72 for in-hospital death, and those with a respiratory rate above 33/min had an OR of 2.55. Further independent risk factors for in-hospital death were age, admission from a nursing home, hospital, or rehabilitation facility, chronic bedridden state, disorientation, systolic blood pressure, and pulse pressure. Respiratory rate is an independent risk marker for in-hospital mortality in community-acquired pneumonia. It should be measured when patients are admitted to the hospital with pneumonia and other acute conditions.

  12. SENTINEL EVENTS

    Directory of Open Access Journals (Sweden)

    Andrej Robida

    2004-09-01

    Full Text Available Background. The Objective of the article is a two year statistics on sentinel events in hospitals. Results of a survey on sentinel events and the attitude of hospital leaders and staff are also included. Some recommendations regarding patient safety and the handling of sentinel events are given.Methods. In March 2002 the Ministry of Health introduce a voluntary reporting system on sentinel events in Slovenian hospitals. Sentinel events were analyzed according to the place the event, its content, and root causes. To show results of the first year, a conference for hospital directors and medical directors was organized. A survey was conducted among the participants with the purpose of gathering information about their view on sentinel events. One hundred questionnaires were distributed.Results. Sentinel events. There were 14 reports of sentinel events in the first year and 7 in the second. In 4 cases reports were received only after written reminders were sent to the responsible persons, in one case no reports were obtained. There were 14 deaths, 5 of these were in-hospital suicides, 6 were due to an adverse event, 3 were unexplained. Events not leading to death were a suicide attempt, a wrong side surgery, a paraplegia after spinal anaesthesia, a fall with a femoral neck fracture, a damage of the spleen in the event of pleural space drainage, inadvertent embolization with absolute alcohol into a femoral artery and a physical attack on a physician by a patient. Analysis of root causes of sentinel events showed that in most cases processes were inadequate.Survey. One quarter of those surveyed did not know about the sentinel events reporting system. 16% were having actual problems when reporting events and 47% beleived that there was an attempt to blame individuals. Obstacles in reporting events openly were fear of consequences, moral shame, fear of public disclosure of names of participants in the event and exposure in mass media. The majority of

  13. Combination of High Rate, Real-time GNSS and Accelerometer Observations - Preliminary Results Using a Shake Table and Historic Earthquake Events.

    Science.gov (United States)

    Jackson, Michael; Passmore, Paul; Zimakov, Leonid; Raczka, Jared

    2014-05-01

    One of the fundamental requirements of an Earthquake Early Warning (EEW) system (and other mission critical applications) is to quickly detect and process the information from the strong motion event, i.e. event detection and location, magnitude estimation, and the peak ground motion estimation at the defined targeted site, thus allowing the civil protection authorities to provide pre-programmed emergency response actions: Slow down or stop rapid transit trains and high-speed trains; shutoff of gas pipelines and chemical facilities; stop elevators at the nearest floor; send alarms to hospitals, schools and other civil institutions. An important question associated with the EEW system is: can we measure displacements in real time with sufficient accuracy? Scientific GNSS networks are moving towards a model of real-time data acquisition, storage integrity, and real-time position and displacement calculations. This new paradigm allows the integration of real-time, high-rate GNSS displacement information with acceleration and velocity data to create very high-rate displacement records. The mating of these two instruments allows the creation of a new, very high-rate (200 Hz) displacement observable that has the full-scale displacement characteristics of GNSS and high-precision dynamic motions of seismic technologies. It is envisioned that these new observables can be used for earthquake early warning studies and other mission critical applications, such as volcano monitoring, building, bridge and dam monitoring systems. REF TEK a Division of Trimble has developed the integrated GNSS/Accelerograph system, model 160-09SG, which consists of REF TEK's fourth generation electronics, a 147-01 high-resolution ANSS Class A accelerometer, and Trimble GNSS receiver and antenna capable of real time, on board Precise Point Positioning (PPP) techniques with satellite clock and orbit corrections delivered to the receiver directly via L-band satellite communications. The test we

  14. Fertility rate oF epileptic women at Kenyatta national Hospital

    African Journals Online (AJOL)

    2008-07-07

    Jul 7, 2008 ... multifaceted, and both epilepsy and antiepileptic drug (aeDs) use may alter fertility and pregnancy ... Conclusion: Fertility rate in epileptic women is decreased by two thirds ..... The effect of this bias on our primary aim was.

  15. X-ray film reject rate analysis at eight selected government hospitals ...

    African Journals Online (AJOL)

    admin

    the quality and efficiency of radiology services is imperative. ... principle). One way of achieving this is through a quality assurance program, which includes procedures that help ..... audit of film rejects and repeats rates in a department.

  16. Increasing low birth weight rates: deliveries in a tertiary hospital in istanbul.

    Science.gov (United States)

    Akin, Yasemin; Cömert, Serdar; Turan, Cem; Unal, Orhan; Piçak, Abdülkadir; Ger, Lale; Telatar, Berrin

    2010-09-01

    Prevalence of low birth weight deliveries may vary across different environments. The necessity of determination of regional data prompted this study. Information of all deliveries from January 2004 to December 2008 was obtained from delivery registry records retrospectively. Initial data including birth weight, vital status, sex, maternal age and mode of delivery were recorded using medical files. The frequency of low birth weight, very low birth weight, extremely low birth weight and stillbirth deliveries were determined. Among 19,533 total births, there were 450 (23.04 per 1000) stillbirths. Low birth weight rate was 10.61%. A significant increase in yearly distribution of low birth weight deliveries was observed (Pbirth weight and extremely low birth weight delivery rates were 3.14% and 1.58% respectively. Among 2073 low birth weight infants, 333 (16.06%) were stillbirths. The stillbirth delivery rate and the birth of a female infant among low birth weight deliveries were significantly higher than infants with birth weight ≥2500g (Pbirth weight and maternal age. The rate of cesarean section among low birth weight infants was 49.4%. High low birth weight and stillbirth rates, as well as the increase in low birth weight deliveries over the past five years in this study are striking. For reduction of increased low birth weight rates, appropriate intervention methods should be initiated.

  17. Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk

    DEFF Research Database (Denmark)

    Boyd, Mark A; Mocroft, Amanda; Ryom, Lene

    2017-01-01

    BACKGROUND: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study has developed predictive risk scores for cardiovascular disease (CVD) and chronic kidney disease (CKD, defined as confirmed estimated glomerular filtration rate [eGFR] ≤ 60 ml/min/1.73 m2) events in HIV...

  18. 5 CFR Appendix A to Subpart F of... - List of Events for Which Inclusion of NAFI Service May Affect the Rate of Annuity Payable

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false List of Events for Which Inclusion of... of Part 847—List of Events for Which Inclusion of NAFI Service May Affect the Rate of Annuity Payable... of annuity. CSRS disability retirement Commencing date of annuity. 1 FERS disability retirement First...

  19. Does Prison Crowding Predict Higher Rates of Substance Use Related Parole Violations? A Recurrent Events Multi-Level Survival Analysis.

    Directory of Open Access Journals (Sweden)

    Michael A Ruderman

    Full Text Available This administrative data-linkage cohort study examines the association between prison crowding and the rate of post-release parole violations in a random sample of prisoners released with parole conditions in California, for an observation period of two years (January 2003 through December 2004.Crowding overextends prison resources needed to adequately protect inmates and provide drug rehabilitation services. Violence and lack of access to treatment are known risk factors for drug use and substance use disorders. These and other psychosocial effects of crowding may lead to higher rates of recidivism in California parolees.Rates of parole violation for parolees exposed to high and medium levels of prison crowding were compared to parolees with low prison crowding exposure. Hazard ratios (HRs with 95% confidence intervals (CIs were estimated using a Cox model for recurrent events. Our dataset included 13070 parolees in California, combining individual level parolee data with aggregate level crowding data for multilevel analysis.Comparing parolees exposed to high crowding with those exposed to low crowding, the effect sizes from greatest to least were absconding violations (HR 3.56 95% CI: 3.05-4.17, drug violations (HR 2.44 95% CI: 2.00-2.98, non-violent violations (HR 2.14 95% CI: 1.73-2.64, violent and serious violations (HR 1.88 95% CI: 1.45-2.43, and technical violations (HR 1.86 95% CI: 1.37-2.53.Prison crowding predicted higher rates of parole violations after release from prison. The effect was magnitude-dependent and particularly strong for drug charges. Further research into whether adverse prison experiences, such as crowding, are associated with recidivism and drug use in particular may be warranted.

  20. Does Prison Crowding Predict Higher Rates of Substance Use Related Parole Violations? A Recurrent Events Multi-Level Survival Analysis.

    Science.gov (United States)

    Ruderman, Michael A; Wilson, Deirdra F; Reid, Savanna

    2015-01-01

    This administrative data-linkage cohort study examines the association between prison crowding and the rate of post-release parole violations in a random sample of prisoners released with parole conditions in California, for an observation period of two years (January 2003 through December 2004). Crowding overextends prison resources needed to adequately protect inmates and provide drug rehabilitation services. Violence and lack of access to treatment are known risk factors for drug use and substance use disorders. These and other psychosocial effects of crowding may lead to higher rates of recidivism in California parolees. Rates of parole violation for parolees exposed to high and medium levels of prison crowding were compared to parolees with low prison crowding exposure. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using a Cox model for recurrent events. Our dataset included 13070 parolees in California, combining individual level parolee data with aggregate level crowding data for multilevel analysis. Comparing parolees exposed to high crowding with those exposed to low crowding, the effect sizes from greatest to least were absconding violations (HR 3.56 95% CI: 3.05-4.17), drug violations (HR 2.44 95% CI: 2.00-2.98), non-violent violations (HR 2.14 95% CI: 1.73-2.64), violent and serious violations (HR 1.88 95% CI: 1.45-2.43), and technical violations (HR 1.86 95% CI: 1.37-2.53). Prison crowding predicted higher rates of parole violations after release from prison. The effect was magnitude-dependent and particularly strong for drug charges. Further research into whether adverse prison experiences, such as crowding, are associated with recidivism and drug use in particular may be warranted.

  1. Does Prison Crowding Predict Higher Rates of Substance Use Related Parole Violations? A Recurrent Events Multi-Level Survival Analysis

    Science.gov (United States)

    Ruderman, Michael A.; Wilson, Deirdra F.; Reid, Savanna

    2015-01-01

    Objective This administrative data-linkage cohort study examines the association between prison crowding and the rate of post-release parole violations in a random sample of prisoners released with parole conditions in California, for an observation period of two years (January 2003 through December 2004). Background Crowding overextends prison resources needed to adequately protect inmates and provide drug rehabilitation services. Violence and lack of access to treatment are known risk factors for drug use and substance use disorders. These and other psychosocial effects of crowding may lead to higher rates of recidivism in California parolees. Methods Rates of parole violation for parolees exposed to high and medium levels of prison crowding were compared to parolees with low prison crowding exposure. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using a Cox model for recurrent events. Our dataset included 13070 parolees in California, combining individual level parolee data with aggregate level crowding data for multilevel analysis. Results Comparing parolees exposed to high crowding with those exposed to low crowding, the effect sizes from greatest to least were absconding violations (HR 3.56 95% CI: 3.05–4.17), drug violations (HR 2.44 95% CI: 2.00–2.98), non-violent violations (HR 2.14 95% CI: 1.73–2.64), violent and serious violations (HR 1.88 95% CI: 1.45–2.43), and technical violations (HR 1.86 95% CI: 1.37–2.53). Conclusions Prison crowding predicted higher rates of parole violations after release from prison. The effect was magnitude-dependent and particularly strong for drug charges. Further research into whether adverse prison experiences, such as crowding, are associated with recidivism and drug use in particular may be warranted. PMID:26492490

  2. Does accelerometer feedback on high-quality chest compression improve survival rate? An in-hospital cardiac arrest simulation.

    Science.gov (United States)

    Jung, Min Hee; Oh, Je Hyeok; Kim, Chan Woong; Kim, Sung Eun; Lee, Dong Hoon; Chang, Wen Joen

    2015-08-01

    We investigated whether visual feedback from an accelerometer device facilitated high-quality chest compressions during an in-hospital cardiac arrest simulation using a manikin. Thirty health care providers participated in an in-hospital cardiac arrest simulation with 1 minute of continuous chest compressions. Chest compressions were performed on a manikin lying on a bed according to visual feedback from an accelerometer feedback device. The manikin and accelerometer recorded chest compression data simultaneously. The simulated patient was deemed to have survived when the chest compression data satisfied all of the preset high-quality chest compression criteria (depth ≥51 mm, rate >100 per minute, and ≥95% full recoil). Survival rates were calculated from the feedback device and manikin data. The survival rate according to the feedback device data was 80%; however, the manikin data indicated a significantly lower survival rate (46.7%; P = .015). The difference between the accelerometer and manikin survival rates was not significant for participants with a body mass index greater than or equal to 20 kg/m(2) (93.3 vs 73.3%, respectively; P = .330); however, the difference in survival rate was significant in participants with body mass index less than 20 kg/m(2) (66.7 vs 20.0%, respectively; P = .025). The use of accelerometer feedback devices to facilitate high-quality chest compression may not be appropriate for lightweight rescuers because of the potential for compression depth overestimation. Clinical Research Information Service (KCT0001449). Copyright © 2015 Elsevier Inc. All rights reserved.

  3. [The effect of assertiveness training on communication related factors and personnel turnover rate among hospital nurses].

    Science.gov (United States)

    Kang, Myung Ja; Lee, Haejung

    2006-08-01

    The purpose of this study was to investigate the effects of assertiveness training on nurses' assertive behaviors, interpersonal relations, communication conflicts, conflict management style and personnel turnover rate. A non-equivalent control group pretest-posttest design was used in this study. Nurses were assigned into the experimental or control groups, each consisting of 39 nurses. Data was collected between January to March 2004. An 'Assertiveness Training Program' for Nurses developed by Park was used for the study. To emphasize assertiveness practice, 5 practice sessions utilizing ABCDE principles were added to Park's program. To examine the effects of the program, differences between the two groups in assertive behaviors, interpersonal relations, communication conflicts, conflict management style and personnel turnover rate were analyzed using ANCOVA. The assertiveness training was effective in improving the nurses' assertiveness behaviors, but was not effective in improving interpersonal relations, reducing the subjects' communication conflicts, changing the conflict management style or reducing their personnel turnover rate. There have been many studies about factors affecting nurses' personnel turnover rates, but few have been done about methods of intervention to reduce the personnel turnover rate. Thus, this study provides a significant contribution in attempting such an intervention from nursing management perspectives.

  4. Subtypes and case-fatality rates of stroke: a hospital-based stroke registry in Taiwan (SCAN-IV).

    Science.gov (United States)

    Jeng, J S; Lee, T K; Chang, Y C; Huang, Z S; Ng, S K; Chen, R C; Yip, P K

    1998-04-01

    Stroke data bank can afford important information regarding risk factors, pathogenesis, prognosis, etc. By means of hospital-based stroke registry, we investigated the risk factors and case-fatality rates in different types of stroke and transient ischemic attack (TIA) patients at the National Taiwan University Hospital in 1995. After excluding ineligible patients, 995 patients aged 1-98 years (575 men and 420 women) were recruited. Men predominated in all age groups for stroke and TIA in general except for cerebral hemorrhage (CH) in patients aged or = 45 years. Of these, 676 (67.9%), 41 (4.1%), 228 (22.9%) and 50 (5%) patients were classified in the categories of cerebral infarction (CI), TIA, CH and SAH, respectively. The CI/CH ratio was 2.96. Hypertension remained one of the most important risk factors for CI, CH and TIA patients. Severe extracranial carotid artery stenosis (> or = 50%) was found in 12% of the CI patients and 27% of the TIA patients, but not found in the CH and SAH patients. Of these patients, the 30-day case-fatality rate was 10.9%, highest in SAH (30%), followed by CH (24.1%) and CI (5.6%). There were 41 in-hospital stroke patients who had significantly higher case-fatality rates than the other stroke patients (PTaiwan, there is a secular trend of increasing CI/CH ratios. These findings in Taiwan were compared with those in other populations, including other Asian, Caucasian and black populations. The CI/CH ratios in Asian populations, including Chinese, Japanese and Korean, were much lower than those in Caucasian and black populations. Dietary, environmental and genetic factors probably play important roles in these differences.

  5. Accounting for costs, QALYs, and capacity constraints: using discrete-event simulation to evaluate alternative service delivery and organizational scenarios for hospital-based glaucoma services.

    Science.gov (United States)

    Crane, Glenis J; Kymes, Steven M; Hiller, Janet E; Casson, Robert; Martin, Adam; Karnon, Jonathan D

    2013-11-01

    Decision-analytic models are routinely used as a framework for cost-effectiveness analyses of health care services and technologies; however, these models mostly ignore resource constraints. In this study, we use a discrete-event simulation model to inform a cost-effectiveness analysis of alternative options for the organization and delivery of clinical services in the ophthalmology department of a public hospital. The model is novel, given that it represents both disease outcomes and resource constraints in a routine clinical setting. A 5-year discrete-event simulation model representing glaucoma patient services at the Royal Adelaide Hospital (RAH) was implemented and calibrated to patient-level data. The data were sourced from routinely collected waiting and appointment lists, patient record data, and the published literature. Patient-level costs and quality-adjusted life years were estimated for a range of alternative scenarios, including combinations of alternate follow-up times, booking cycles, and treatment pathways. The model shows that a) extending booking cycle length from 4 to 6 months, b) extending follow-up visit times by 2 to 3 months, and c) using laser in preference to medication are more cost-effective than current practice at the RAH eye clinic. The current simulation model provides a useful tool for informing improvements in the organization and delivery of glaucoma services at a local level (e.g., within a hospital), on the basis of expected effects on costs and health outcomes while accounting for current capacity constraints. Our model may be adapted to represent glaucoma services at other hospitals, whereas the general modeling approach could be applied to many other clinical service areas.

  6. Evaluation of a Broad-Spectrum Partially Automated Adverse Event Surveillance System: A Potential Tool for Patient Safety Improvement in Hospitals With Limited Resources.

    Science.gov (United States)

    Saikali, Melody; Tanios, Alain; Saab, Antoine

    2017-11-21

    The aim of the study was to evaluate the sensitivity and resource efficiency of a partially automated adverse event (AE) surveillance system for routine patient safety efforts in hospitals with limited resources. Twenty-eight automated triggers from the hospital information system's clinical and administrative databases identified cases that were then filtered by exclusion criteria per trigger and then reviewed by an interdisciplinary team. The system, developed and implemented using in-house resources, was applied for 45 days of surveillance, for all hospital inpatient admissions (N = 1107). Each trigger was evaluated for its positive predictive value (PPV). Furthermore, the sensitivity of the surveillance system (overall and by AE category) was estimated relative to incidence ranges in the literature. The surveillance system identified a total of 123 AEs among 283 reviewed medical records, yielding an overall PPV of 52%. The tool showed variable levels of sensitivity across and within AE categories when compared with the literature, with a relatively low overall sensitivity estimated between 21% and 44%. Adverse events were detected in 23 of the 36 AE categories defined by an established harm classification system. Furthermore, none of the detected AEs were voluntarily reported. The surveillance system showed variable sensitivity levels across a broad range of AE categories with an acceptable PPV, overcoming certain limitations associated with other harm detection methods. The number of cases captured was substantial, and none had been previously detected or voluntarily reported. For hospitals with limited resources, this methodology provides valuable safety information from which interventions for quality improvement can be formulated.

  7. Stage discharge curve for Guillemard Bridge streamflow sation based on rating curve method using historical flood event data

    International Nuclear Information System (INIS)

    Ros, F C; Sidek, L M; Desa, M N; Arifin, K; Tosaka, H

    2013-01-01

    The purpose of the stage-discharge curves varies from water quality study, flood modelling study, can be used to project climate change scenarios and so on. As the bed of the river often changes due to the annual monsoon seasons that sometimes cause by massive floods, the capacity of the river will changed causing shifting controlled to happen. This study proposes to use the historical flood event data from 1960 to 2009 in calculating the stage-discharge curve of Guillemard Bridge located in Sg. Kelantan. Regression analysis was done to check the quality of the data and examine the correlation between the two variables, Q and H. The mean values of the two variables then were adopted to find the value of difference between zero gauge height and the level of zero flow, 'a', K and 'n' to fit into rating curve equation and finally plotting the stage-discharge rating curve. Regression analysis of the historical flood data indicate that 91 percent of the original uncertainty has been explained by the analysis with the standard error of 0.085.

  8. Growth rate of late passage sarcoma cells is independent of epigenetic events but dependent on the amount of chromosomal aberrations

    International Nuclear Information System (INIS)

    Becerikli, Mustafa; Jacobsen, Frank; Rittig, Andrea; Köhne, Wiebke; Nambiar, Sandeep; Mirmohammadsadegh, Alireza; Stricker, Ingo; Tannapfel, Andrea; Wieczorek, Stefan; Epplen, Joerg Thomas; Tilkorn, Daniel; Steinstraesser, Lars

    2013-01-01

    Soft tissue sarcomas (STS) are characterized by co-participation of several epigenetic and genetic events during tumorigenesis. Having bypassed cellular senescence barriers during oncogenic transformation, the factors further affecting growth rate of STS cells remain poorly understood. Therefore, we investigated the role of gene silencing (DNA promoter methylation of LINE-1, PTEN), genetic aberrations (karyotype, KRAS and BRAF mutations) as well as their contribution to the proliferation rate and migratory potential that underlies “initial” and “final” passage sarcoma cells. Three different cell lines were used, SW982 (synovial sarcoma), U2197 (malignant fibrous histiocytoma (MFH)) and HT1080 (fibrosarcoma). Increased proliferative potential of final passage STS cells was not associated with significant differences in methylation (LINE-1, PTEN) and mutation status (KRAS, BRAF), but it was dependent on the amount of chromosomal aberrations. Collectively, our data demonstrate that these fairly differentiated/advanced cancer cell lines have still the potential to gain an additional spontaneous growth benefit without external influences and that maintenance of increased proliferative potential towards longevity of STS cells (having crossed senescence barriers) may be independent of overt epigenetic alterations. -- Highlights: Increased proliferative potential of late passage STS cells was: • Not associated with epigenetic changes (methylation changes at LINE-1, PTEN). • Not associated with mutation status of KRAS, BRAF. • Dependent on presence/absence of chromosomal aberrations

  9. Patient safety incident reports related to traditional Japanese Kampo medicines: medication errors and adverse drug events in a university hospital for a ten-year period.

    Science.gov (United States)

    Shimada, Yutaka; Fujimoto, Makoto; Nogami, Tatsuya; Watari, Hidetoshi; Kitahara, Hideyuki; Misawa, Hiroki; Kimbara, Yoshiyuki

    2017-12-21

    Kampo medicine is traditional Japanese medicine, which originated in ancient traditional Chinese medicine, but was introduced and developed uniquely in Japan. Today, Kampo medicines are integrated into the Japanese national health care system. Incident reporting systems are currently being widely used to collect information about patient safety incidents that occur in hospitals. However, no investigations have been conducted regarding patient safety incident reports related to Kampo medicines. The aim of this study was to survey and analyse incident reports related to Kampo medicines in a Japanese university hospital to improve future patient safety. We selected incident reports related to Kampo medicines filed in Toyama University Hospital from May 2007 to April 2017, and investigated them in terms of medication errors and adverse drug events. Out of 21,324 total incident reports filed in the 10-year survey period, we discovered 108 Kampo medicine-related incident reports. However, five cases were redundantly reported; thus, the number of actual incidents was 103. Of those, 99 incidents were classified as medication errors (77 administration errors, 15 dispensing errors, and 7 prescribing errors), and four were adverse drug events, namely Kampo medicine-induced interstitial pneumonia. The Kampo medicine (crude drug) that was thought to induce interstitial pneumonia in all four cases was Scutellariae Radix, which is consistent with past reports. According to the incident severity classification system recommended by the National University Hospital Council of Japan, of the 99 medication errors, 10 incidents were classified as level 0 (an error occurred, but the patient was not affected) and 89 incidents were level 1 (an error occurred that affected the patient, but did not cause harm). Of the four adverse drug events, two incidents were classified as level 2 (patient was transiently harmed, but required no treatment), and two incidents were level 3b (patient was

  10. Sequential Vein Bypass Grafting is Not Associated with an Increase of Either In-hospital or Mid-term Adverse Events in Off-pump Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Fucheng Xiao

    2015-01-01

    Full Text Available Background: The impact of sequential vein bypass grafting on clinical outcomes is less known in off-pump coronary artery bypass grafting (CABG. We aimed to evaluate the effects of sequential vein bypass grafting on clinical outcomes in off-pump CABG. Methods: From October 2009 to September 2013 at the Fuwai Hospital, 127 patients with at least one sequential venous graft were matched with 127 patients of individual venous grafts only, using propensity score matching method to obtain risk-adjusted outcome comparison. In-hospital measurement was composite outcome of in-hospital death, myocardial infarction (MI, stroke, requirement for intra-aortic ballon pump (IABP assistance and prolonged ventilation. Major adverse cardiac events (MACEs: Death, MI or repeat revascularization and angina recurrence were considered as mid-term endpoints. Results: No significant difference was observed among the groups in baseline characteristics. Intraoperative mean blood flow per vein graft was 40.4 ml in individual venous grafts groups versus 59.5 ml in sequential venous grafts groups (P < 0.001. There were no differences between individual and sequential venous grafts groups with regard to composite outcome of in-hospital mortality, MI, stroke, IABP assistance and prolonged ventilation (11.0% vs. 14.2%, P = 0.45. Individual in-hospital measurement also did not differ significantly between the two groups. At about four years follow-up, the survival estimates free from MACEs (92.5% vs. 97.3%, P = 0.36 and survival rates free of angina recurrence (80.9% vs. 85.5%, P = 0.48 were similar among individual and sequential venous grafts groups with a mean follow-up of 22.5 months. In the Cox regression analysis, sequential vein bypass grafting was not identified as an independent predictor of both MACEs and angina recurrence. Conclusions: Compared to individual vein bypass grafting, sequential vein bypass grafting was not associated with an increase of either in-hospital

  11. A novel approach for analyzing data on recurrent events with duration to estimate the combined cumulative rate of both variables over time

    Directory of Open Access Journals (Sweden)

    Sudipta Bhattacharya

    2018-06-01

    Full Text Available Recurrent adverse events, once occur often continue for some duration of time in clinical trials; and the number of events along with their durations is clinically considered as a measure of severity of a disease under study. While there are methods available for analyzing recurrent events or durations or for analyzing both side by side, no effort has been made so far to combine them and present as a single measure. However, this single-valued combined measure may help clinicians assess the wholesome effect of recurrence of incident comprising events and durations. Non-parametric approach is adapted here to develop an estimator for estimating the combined rate of both, the recurrence of events as well as the event-continuation, that is the duration per event. The proposed estimator produces a single numerical value, the interpretation and meaningfulness of which are discussed through the analysis of a real-life clinical dataset. The algebraic expression of variance is derived, asymptotic normality of the estimator is noted, and demonstration is provided on how the estimator can be used in the setup of testing of statistical hypothesis. Further possible development of the estimator is also noted, to adjust for the dependence of event occurrences on the history of the process generating recurrent events through covariates and for the case of dependent censoring. Keywords: Recurrent events, Duration per event, Intensity, Nelson-aalen estimator

  12. Effective Recruitment Challenges Faced by the Hospitality Industry in Bangladesh: A Study on Selected Star Rated Residential Hotels

    Directory of Open Access Journals (Sweden)

    Kazi HUDA

    2014-12-01

    Full Text Available In Human Resource Management (HRM, Recruitment is the first and foremost issue to be considered with full of sincerity, because its role is to create a positive impression about the employer in the job market by ensuring effective stimuli for the job seekers. At the beginning, the study sets a picture that focuses on the importance of effective recruitment in the hospitality sector of Bangladesh and then the study details obligatory determinants of attracting efficient human resource for the development of this sector. The main objective of the paper is to study the status and the scopes of recruitment function in hospitality industry with focus towards star rated residential hotels. This study is based on primary data collection through a formal questionnaire. The questionnaire was of mixed mode with most questions in likert-type scale and few were dichotomous in nature. The key finding of the study is that recruitment is a highly challenging task in hospitality and it is quite evident that attractive compensation package is the key factor to attract potential employees. The need and scope to modernize the recruitment practices along with the line of company and employer branding ideas are also recommended in details. There is a long way to go on the way of conceptualizing and actualizing recruitment functions and practices. A paper like this can help to discuss and debate on the necessity of developing better recruitment cultural and conceptual change in these sectors.

  13. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients.

    LENUS (Irish Health Repository)

    Hamilton, Hilary

    2011-06-13

    Previous studies have not demonstrated a consistent association between potentially inappropriate medicines (PIMs) in older patients as defined by Beers criteria and avoidable adverse drug events (ADEs). This study aimed to assess whether PIMs defined by new STOPP (Screening Tool of Older Persons\\' potentially inappropriate Prescriptions) criteria are significantly associated with ADEs in older people with acute illness.

  14. Public High School Four-Year On-Time Graduation Rates and Event Dropout Rates: School Years 2010-11 and 2011-12. First Look. NCES 2014-391

    Science.gov (United States)

    Stetser, Marie C.; Stillwell, Robert

    2014-01-01

    This National Center for Education Statistics (NCES) First Look report introduces new data for two separate measures of 4-year on-time graduation rates as well as event dropout rates for school year (SY) 2010-11 and SY 2011-12. Specifically this report provides the following: (1) Four-year adjusted cohort graduation rate (ACGR) data reported by…

  15. A comparison of small-area hospitalisation rates, estimated morbidity and hospital access.

    Science.gov (United States)

    Shulman, H; Birkin, M; Clarke, G P

    2015-11-01

    Published data on hospitalisation rates tend to reveal marked spatial variations within a city or region. Such variations may simply reflect corresponding variations in need at the small-area level. However, they might also be a consequence of poorer accessibility to medical facilities for certain communities within the region. To help answer this question it is important to compare these variable hospitalisation rates with small-area estimates of need. This paper first maps hospitalisation rates at the small-area level across the region of Yorkshire in the UK to show the spatial variations present. Then the Health Survey of England is used to explore the characteristics of persons with heart disease, using chi-square and logistic regression analysis. Using the most significant variables from this analysis the authors build a spatial microsimulation model of morbidity for heart disease for the Yorkshire region. We then compare these estimates of need with the patterns of hospitalisation rates seen across the region. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  16. Three-Year Retention Rates of Levetiracetam, Topiramate, and Oxcarbazepine: A Retrospective Hospital-Based Study.

    Science.gov (United States)

    Sunwoo, Jun-Sang; Park, Byeong-Su; Ahn, Seon Jae; Hwang, Sungeun; Park, Chan-Young; Jun, Jin-Sun; Kim, Dong Wook; Lee, Soon-Tae; Jung, Keun-Hwa; Park, Kyung-Il; Chu, Kon; Jung, Ki-Young; Lee, Sang Kun

    We evaluated and compared the 3-year retention rates of levetiracetam (LEV), topiramate (TPM), and oxcarbazepine (OXC) in patients with epilepsy in routine clinical practice. We retrospectively reviewed medical records of patients with epilepsy who were newly prescribed LEV, TPM, or OXC from 2006 to 2010. The retention rates were estimated by the Kaplan-Meier analysis, and independent risk factors for drug discontinuation were analyzed by the Cox regression method. A total of 588 patients were included: LEV (n = 345), TPM (n = 190), and OXC (n = 53). Among them, 82% had focal epilepsy, whereas 14.8% had generalized epilepsy. The 3-year retention rates for LEV, TPM, and OXC, were 81.2%, 78.3%, and 54.7%, respectively. Levetiracetam and TPM had equivalent retention rates, whereas patients remained on OXC for a significantly shorter amount of time (P effects leading to drug withdrawal of OXC (87.5%) was higher than that of LEV (34.4%, P < 0.001) and TPM (52.5%, P = 0.012). The current study suggested that LEV and TPM had comparable retention profiles in the long-term treatment for both focal and generalized epilepsy. Meanwhile, OXC therapy seemed to be relatively less useful because of its poor tolerability.

  17. Evaluation of the images rejection rate in a Spanish hospital: results, corrective actions and results

    International Nuclear Information System (INIS)

    Nunez de Villavicencio de Soto, C.; Jimenez Gonzalez, J.M.; Galvan Gomez, M.; Ortiz Vazquez, E.; Gonzalez Garcia-Parreno, M. M.

    2001-01-01

    In the framework of the implantation of a quality control program in Spanish medical services it was demonstrated that the continuous formation of technical staff has contributed to diminish the rate of images rejection up to less of 5%. It is considered that the individualized specific formation will allow to continue diminishing this value [es

  18. Stillbirth Rate in a Teaching Hospital in South‑Eastern Nigeria: A ...

    African Journals Online (AJOL)

    Intrauterine fetal death or stillbirth is variously defined in different countries, by gestation or birth weight. The varieties of definitions make comparisons of stillbirth rates difficult. In the United Kingdom (UK), a stillbirth is defined as the delivery of a baby with no signs of life after 24 weeks of pregnancy.[1] However, the World ...

  19. Regions of High Out-Of-Hospital Cardiac Arrest Incidence and Low Bystander CPR Rates in Victoria, Australia.

    Science.gov (United States)

    Straney, Lahn D; Bray, Janet E; Beck, Ben; Finn, Judith; Bernard, Stephen; Dyson, Kylie; Lijovic, Marijana; Smith, Karen

    2015-01-01

    Out-of-hospital cardiac arrest (OHCA) remains a major public health issue and research has shown that large regional variation in outcomes exists. Of the interventions associated with survival, the provision of bystander CPR is one of the most important modifiable factors. The aim of this study is to identify census areas with high incidence of OHCA and low rates of bystander CPR in Victoria, Australia. We conducted an observational study using prospectively collected population-based OHCA data from the state of Victoria in Australia. Using ArcGIS (ArcMap 10.0), we linked the location of the arrest using the dispatch coordinates (longitude and latitude) to Victorian Local Government Areas (LGAs). We used Bayesian hierarchical models with random effects on each LGA to provide shrunken estimates of the rates of bystander CPR and the incidence rates. Over the study period there were 31,019 adult OHCA attended, of which 21,436 (69.1%) cases were of presumed cardiac etiology. Significant variation in the incidence of OHCA among LGAs was observed. There was a 3 fold difference in the incidence rate between the lowest and highest LGAs, ranging from 38.5 to 115.1 cases per 100,000 person-years. The overall rate of bystander CPR for bystander witnessed OHCAs was 62.4%, with the rate increasing from 56.4% in 2008-2010 to 68.6% in 2010-2013. There was a 25.1% absolute difference in bystander CPR rates between the highest and lowest LGAs. Significant regional variation in OHCA incidence and bystander CPR rates exists throughout Victoria. Regions with high incidence and low bystander CPR participation can be identified and would make suitable targets for interventions to improve CPR participation rates.

  20. Magnet-related injury rates in children: a single hospital experience.

    Science.gov (United States)

    Agbo, Chioma; Lee, Lois; Chiang, Vincent; Landscahft, Assaf; Kimia, Tomer; Monuteaux, Michael C; Kimia, Amir A

    2013-07-01

    The ingestion of multiple magnets simultaneously or the placement of magnets in both nares can lead to serious injury resulting from the attraction of the magnets across the tissues. The impact of mandatory standards for toys containing magnets has not been thoroughly investigated. The aim of the present study was to describe the emergency department (ED) visit rate for magnet-related injuries. We performed a retrospective study of children evaluated for magnet-related injuries from 1995 to 2012 in an urban tertiary care pediatric ED. We identified cases using a computerized text-search methodology followed by manual chart review. We included children evaluated for magnet ingestion or impaction in the ears, nose, vagina, or rectum. We assessed the type and number of magnets as well as management and required interventions. A Poisson regression model was used to analyze rates of injury over time. We identified 112 cases of magnet injuries. The median patient age was 6 years (IQR 3.5, 10), and 54% were male. Compared to before 2006, the rate for all magnet-related injuries in 2007-2012 (incidence rate ratio 3.44; 95% confidence interval 2.3-5.11) as well as multiple magnet-related injuries (incidence rate ratio 7.54; 95% confidence interval 3.51-16.19) increased. Swallowed magnets accounted for 86% of the injuries. Thirteen patients had endoscopy performed for magnet removal (12%), and 4 (4%) had a surgical intervention. Magnets from toys account for the majority of the injuries. The number of ED visits for magnet-related injuries in children may be rising and are underreported, with an increase in the proportion of multiple magnets involvement. In our case series, mandatory standard for toys had no mitigating effect.

  1. Index of film reject rates of mammographic service of Hospital Geral do Mexico. Strategies and results

    International Nuclear Information System (INIS)

    Jaimes, Uriel; Fabela, Arturo; Ramirez, Raul; Robledo, Rogelio; Verdejo, Maricela

    2001-01-01

    The reject of a radiographic film, not just means to do it again with the consequent increase in the dose to the patient, also means a failure in the service, as factors like fault in the equipment or by humans factors, like the selection of inadequate techniques or the bad positioning of the patient. In both cases, the analysis of the reject measures of radiographic studies, take special importance in the mammographic area, mainly if we consider the radiosensitivity of the tissues in study. This work, shows the methodology and the results of a study carried out in the Oncology Department of the General Hospital of Mexico, the biggest in the state, with the objective of knowing the principal causes of reject of films and establish through the respective analysis, the actions for correcting the detected failures, assuring so, low doses to patient, more precise diagnostic and the reduction of operating costs, that are the main objectives in a Program of Quality Assurance in Radiodiagnostic. (author)

  2. The Rates of Type I X-ray Bursts from Transients Observed with RXTE: Evidence for Black Hole Event Horizons

    Science.gov (United States)

    Remillard, R. A.; Lin, D.; Cooper, R. L.; Narayan, R.

    2005-12-01

    We measure the rates of type I X-ray bursts from a likely complete sample of 37 non-pulsing Galactic X-ray transients observed with the RXTE ASM during 1996-2004. Our strategy is to test the prevailing paradigms for these sources, which are well-categorized in the literature as either neutron-star systems or black hole candidates. Burst rates are measured as a function of the bolometric luminosity, and the results are compared with burst models for neutron stars and for heavy compact objects with a solid surface. We use augmented versions of the models developed by Narayan & Heyl (2002; 2003). For a given mass, we consider a range of conditions in both the radius and the temperature at the boundary below the accretion layer. We find 135 type I bursts in 3.7 Ms of PCA light curves for the neutron-star group, and the burst rate function is generally consistent with the model predictions for bursts from accreting neutron stars. On the other hand, none of the (20) bursts candidates passed spectral criteria for type I bursts in 6.5 Ms of PCA light curves for black-hole binaries and candidates. The burst function upper limits are inconsistent with the predictions of the burst model for heavy compact objects with a solid surface. The consistency probability is found to be below 10-7 for dynamical black-hole binaries, falling to below 10-13 for the additional exposures of black-hole candidates. These results provide indirect evidence that black holes do have event horizons. This research was supported, in part, by NASA science programs.

  3. Predictive value of night-time heart rate for cardiovascular events in hypertension. The ABP-International study.

    Science.gov (United States)

    Palatini, Paolo; Reboldi, Gianpaolo; Beilin, Lawrence J; Eguchi, Kazuo; Imai, Yutaka; Kario, Kazuomi; Ohkubo, Takayoshi; Pierdomenico, Sante D; Saladini, Francesca; Schwartz, Joseph E; Wing, Lindon; Verdecchia, Paolo

    2013-09-30

    Data from prospective cohort studies regarding the association between ambulatory heart rate (HR) and cardiovascular events (CVE) are conflicting. To investigate whether ambulatory HR predicts CVE in hypertension, we performed 24-hour ambulatory blood pressure and HR monitoring in 7600 hypertensive patients aged 52 ± 16 years from Italy, U.S.A., Japan, and Australia, included in the 'ABP-International' registry. All were untreated at baseline examination. Standardized hazard ratios for ambulatory HRs were computed, stratifying for cohort, and adjusting for age, gender, blood pressure, smoking, diabetes, serum total cholesterol and serum creatinine. During a median follow-up of 5.0 years there were 639 fatal and nonfatal CVE. In a multivariable Cox model, night-time HR predicted fatal combined with nonfatal CVE more closely than 24h HR (p=0.007 and =0.03, respectively). Daytime HR and the night:day HR ratio were not associated with CVE (p=0.07 and =0.18, respectively). The hazard ratio of the fatal combined with nonfatal CVE for a 10-beats/min increment of the night-time HR was 1.13 (95% CI, 1.04-1.22). This relationship remained significant when subjects taking beta-blockers during the follow-up (hazard ratio, 1.15; 95% CI, 1.05-1.25) or subjects who had an event within 5 years after enrollment (hazard ratio, 1.23; 95% CI, 1.05-1.45) were excluded from analysis. At variance with previous data obtained from general populations, ambulatory HR added to the risk stratification for fatal combined with nonfatal CVE in the hypertensive patients from the ABP-International study. Night-time HR was a better predictor of CVE than daytime HR. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  4. The relationship between thermal sensation and the rate of hospital admissions for cardiovascular disease in Kermanshah, Iran

    Science.gov (United States)

    Mohammadi, Bakhtiyar; Karimi, Shilan

    2017-11-01

    Climate and weather conditions are the most important factors that influence activities and human health. Bioclimatology/biometeorology are concerned with the study of weather effects on living creatures, including humans, plants, and animals. This research was prepared in order to understand the bioclimatic condition of Kermanshah and its relation to the level of hospital admissions of cardiovascular patients in this city. In addition to the climatic variables, the statistics on the number of daily admissions of cardiovascular patients in Kermanshah during March 27, 2009 to April 30, 2015 was prepared. First, Kermanshah's bioclimatic conditions were identified on a daily basis. Then, the relationship between each of the thermal sensations with the level of hospital admissions of cardiovascular patients in Kermanshah using Levene's test, univariate analysis of variance (ANOVA), Scheffe and Games-Howell post hoc tests was investigated. The results of this study showed that in each index, only very few bioclimatic conditions have had an impact on the increase of hospital admissions of cardiovascular diseases. For example, based on the equivalent temperature index (Tek or EqT), there is a significant relationship between extreme conditions and the rate of cardiovascular admissions. But, however, in the effective temperature index (TE), a significant correlation between warm/hot conditions and an increase in the number of cardiovascular admissions was seen. Based on the predicted mean vote (PMV) and physiological equivalent temperature (PET) indices, cool and cold conditions more than warm and comfort conditions have an effect on the number of hospital admissions of cardiovascular patients. Overall, the obtained results showed that the extreme climatic conditions were directly related to an increase in cardiovascular disease in Kermanshah.

  5. How Newspaper-Article-Events, Other Stock Market Indices, and the Foreign Currency Rate Affect the Philippine Stock Market

    OpenAIRE

    Percival S. Gabriel

    2013-01-01

    Eugene Fama in his “Efficient Market Hypothesis” introduced the term newspaper-article-event. The aim of this paper is to find out if newspaper-article-events which are presented and discussed in newspaper articles and which could collage to create an atmosphere of investment, together with the indices of other stock markets (treated as other events) and the performance of the Philippine Peso against the US Dollar (considered as another event) could affect the closing Philippine Stock Market ...

  6. Incidence Rate of Community-Acquired Sepsis Among Hospitalized Acute Medical Patients-A Population-Based Survey

    DEFF Research Database (Denmark)

    Henriksen, D