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Sample records for hospitalizations fatality rate

  1. Meningococcal meningitis: clinical and laboratorial characteristics, fatality rate and variables associated with in-hospital mortality

    Directory of Open Access Journals (Sweden)

    Vanessa L. Strelow

    Full Text Available ABSTRACT Meningococcal meningitis is a public health problem. The aim of this study was to describe the clinical characteristics of patients with meningococcal meningitis, and to identify associated factors with mortality. This was a retrospective study, between 2006 and 2011, at a referral center in São Paulo, Brazil. Logistic regression analysis was used to identify factors associated with mortality. We included 316 patients. The median age was 16 years (IQR: 7–27 and 60% were male. The clinical triad: fever, headache and neck stiffness was observed in 89% of the patients. The cerebrospinal triad: pleocytosis, elevated protein levels and low glucose levels was present in 79% of patients. Factors associated with mortality in the multivariate model were age above 50 years, seizures, tachycardia, hypotension and neck stiffness. The classic clinical and laboratory triads of meningococcal meningitis were variable. The fatality rate was low. Age, seizures and shock signs were independently associated with mortality.

  2. 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.

  3. 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

  4. 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

  5. States with low non-fatal injury rates have high fatality rates and vice-versa.

    Science.gov (United States)

    Mendeloff, John; Burns, Rachel

    2013-05-01

    State-level injury rates or fatality rates are sometimes used in studies of the impact of various safety programs or other state policies. How much does the metric used affect the view of relative occupational risks among U.S. states? This paper uses a measure of severe injuries (fatalities) and of less severe injuries (non-fatal injuries with days away from work, restricted work, or job transfer-DART) to examine that issue. We looked at the correlation between the average DART injury rate (from the BLS Survey of Occupational Injuries and Illnesses) and an adjusted average fatality rate (from the BLS Census of Fatal Occupational Injuries) in the construction sector for states for 2003-2005 and for 2006-2008. The RAND Human Subjects Protection Committee determined that this study was exempt from review. The correlations between the fatal and non-fatal injury rates were between -0.30 and -0.70 for all construction and for the subsector of special trade contractors. The negative correlation was much smaller between the rate of fatal falls from heights and the rate of non-fatal falls from heights. Adjusting for differences in the industry composition of the construction sector across states had minor effects on these results. Although some have suggested that fatal and non-fatal injury rates should not necessarily be positively correlated, no one has suggested that the correlation is negative, which is what we find. We know that reported non-fatal rates are influenced by workers' compensation benefits and other factors. Fatality rates appear to be a more valid measure of risk. Efforts to explain the variations that we find should be undertaken. Copyright © 2012 Wiley Periodicals, Inc.

  6. Non-fatal suicidal behaviour at the Johannesburg General Hospital ...

    African Journals Online (AJOL)

    Non-fatal suicidal behaviour at the Johannesburg General Hospital. ... African Journal of Psychiatry ... Patients who threaten deliberate self-harm and who have a history of previous NFSB, past psychiatric illness and physical or sexual abuse, are at a higher risk of this behaviour as compared to the general population.

  7. Repeat non-fatal suicidal behaviour at Johannesburg Hospital

    Directory of Open Access Journals (Sweden)

    M YH Moosa

    2005-12-01

    Full Text Available Objective. To describe the characteristics of non-fatal suicide behaviour (NFSB in a group of patients and to determine factors, if any, that may be associated with repetition of this behaviour. Method. The study included all patients treated for NFSB at Johannesburg Hospital during the period August 2002 - October 2002. The information was gathered by means of a structured questionnaire designed to evaluate characteristics of the behaviour. Results. The study sample comprised 43 patients with NFSB (mean age 29.7 years, range of 16 - 75 years, of whom 26 (60% were female. Sixty-three per cent of the patients overdosed with medication and 33% ingested household poisons. Events that precipitated the event included relationship problems (70%, illness (12%, financial difficulties (9%, and depressed mood (9%. In 65% of patients the behaviour was impulsive. Factors associated with non-fatal repetition included being in the 18 - 30-year age group (76% (χ2 = 6.74, p < 0.05; being female (90% (χ2 = 4.75, p < 0.05; having children (90% (χ2 = 4.72, p < 0.05; a past psychiatric history (50% (χ2 = 4.08, p < 0.05; and the current attempt deemed medically serious (50% (χ2 = 6.67, p < 0.05. Conclusions. NFSB is a major problem in South Africa and the incidence is still increasing. Hospital-based interventions following admission are recommended to reduce repeat attempts in such patients. Significant factors associated with non-fatal repetition include among others, a history of a previous medically serious attempt and/or a known psychiatric illness.

  8. Presentations of patients of poisoning and predictors of poisoning-related fatality: Findings from a hospital-based prospective study

    Directory of Open Access Journals (Sweden)

    Lin Hung-Jung

    2008-01-01

    Full Text Available Abstract Background Poisoning is a significant public health problem worldwide and is one of the most common reasons for visiting emergency departments (EDs, but factors that help to predict overall poisoning-related fatality have rarely been elucidated. Using 1512 subjects from a hospital-based study, we sought to describe the demographic and clinical characteristics of poisoning patients and to identify predictors for poisoning-related fatality. Methods Between January 2001 and December 2002 we prospectively recruited poisoning patients through the EDs of two medical centers in southwest Taiwan. Interviews were conducted with patients within 24 hours after admission to collect relevant information. We made comparisons between survival and fatality cases, and used logistic regressions to identify predictors of fatality. Results A total of 1512 poisoning cases were recorded at the EDs during the study period, corresponding to an average of 4.2 poisonings per 1000 ED visits. These cases involved 828 women and 684 men with a mean age of 38.8 years, although most patients were between 19 and 50 years old (66.8%, and 29.4% were 19 to 30 years. Drugs were the dominant poisoning agents involved (49.9%, followed by pesticides (14.5%. Of the 1512 patients, 63 fatalities (4.2% occurred. Paraquat exposure was associated with an extremely high fatality rate (72.1%. The significant predictors for fatality included age over 61 years, insufficient respiration, shock status, abnormal heart rate, abnormal body temperature, suicidal intent and paraquat exposure. Conclusion In addition to well-recognized risk factors for fatality in clinical settings, such as old age and abnormal vital signs, we found that suicidal intent and ingestion of paraquat were significant predictors of poisoning-related fatality. Identification of these predictors may help risk stratification and the development of preventive interventions.

  9. Measles Case Fatality Rate in Bihar, India, 2011–12

    Science.gov (United States)

    Murhekar, Manoj V.; Ahmad, Mohammad; Shukla, Hemant; Abhishek, Kunwar; Perry, Robert T.; Bose, Anindya S.; Shimpi, Rahul; Kumar, Arun; Kaliaperumal, Kanagasabai; Sethi, Raman; Selvaraj, Vadivoo; Kamaraj, Pattabi; Routray, Satyabrata; Das, Vidya Nand; Menabde, Nata; Bahl, Sunil

    2014-01-01

    Background Updated estimates of measles case fatality rates (CFR) are critical for monitoring progress towards measles elimination goals. India accounted for 36% of total measles deaths occurred globally in 2011. We conducted a retrospective cohort study to estimate measles CFR and identify the risk factors for measles death in Bihar–one of the north Indian states historically known for its low vaccination coverage. Methods We systematically selected 16 of the 31 laboratory-confirmed measles outbreaks occurring in Bihar during 1 October 2011 to 30 April 2012. All households of the villages/urban localities affected by these outbreaks were visited to identify measles cases and deaths. We calculated CFR and used multivariate analysis to identify risk factors for measles death. Results The survey found 3670 measles cases and 28 deaths (CFR: 0.78, 95% confidence interval: 0.47–1.30). CFR was higher among under-five children (1.22%) and children belonging to scheduled castes/tribes (SC/ST, 1.72%). On multivariate analysis, independent risk factors associated with measles death were age Measles CFR in Bihar was low. To further reduce case fatality, health authorities need to ensure that SC/ST are targeted by the immunization programme and that outbreak investigations target for vitamin A treatment of cases in high risk groups such as SC/ST and young children and ensure regular visits by health-workers in affected villages to administer vitamin A to new cases. PMID:24824641

  10. Population-based characteristics of fatal and hospital admissions for poisoning in Fiji: TRIP Project-11

    Science.gov (United States)

    Peiris-John, Roshini; Kafoa, Berlin; Wainiqolo, Iris; Reddy, Ravi Krishnan; McCaig, Eddie; Ameratunga, Shanthi N

    2013-01-01

    This study investigated the incidence and characteristics of poisoning fatalities and hospital admissions among indigenous Fijians and Indians in Viti Levu, Fiji. Individuals with a mechanism of injury classified as poisoning were identified using the Fiji injury surveillance in hospitals system, a population-based registry established for 12 months in Viti Levu, and analysed using population-based denominators. The mean annual rates of fatalities and hospitalisations were 2.3 and 26.0 per 100 000, respectively. Over two-thirds of poisonings occurred among people of Indian ethnicity. Most intentional poisoning admissions occurred among women (58.3%) and in 15–29-year-old individuals (73.8%). Unintentional poisoning admission rates were highest among Indian boys aged 0–14 years. While over 75% of events occurred at home, the substances involved were not systematically identified. The findings indicate the need for a strategy that addresses the differing contexts across age group, gender and ethnicity, and a lead agency responsible for implementing and monitoring its effectiveness. PMID:23353079

  11. New Jersey motorcycle fatality rates : final report, December 2009.

    Science.gov (United States)

    2009-12-01

    Motorcycle crashes have been increasing in recent years, more than doubling since 1991. In 2007 there were 84 fatal motorcycle crashes in New Jersey. This report describes the methods and findings of an investigation of motorcycle crashes in New Jers...

  12. Subarachnoid haemorrhage in Sweden 1987-2002 : regional incidence and case fatality rates

    NARCIS (Netherlands)

    Koffijberg, H.; Buskens, E.; Granath, F.; Adami, J.; Ekbom, A.; Rinkel, G. J. E.; Blomqvist, P.

    Background: Incidence estimates of subarachnoid haemorrhage (SAH) in Sweden vary, which may be caused by regional variations. Reliable estimates of age-specific case fatality rates are lacking. We analysed regional incidence rates and case fatality rates of SAH in Sweden. Methods: The Swedish

  13. Acute Myocardial Infarction Population Incidence and Mortality Rates, and 28-day Case-fatality in Older Adults. The REGICOR Study.

    Science.gov (United States)

    Vázquez-Oliva, Gabriel; Zamora, Alberto; Ramos, Rafel; Marti, Ruth; Subirana, Isaac; Grau, María; Dégano, Irene R; Marrugat, Jaume; Elosua, Roberto

    2017-11-22

    Our aims were to determine acute myocardial infarction (AMI) incidence and mortality rates, and population and in-hospital case-fatality in the population older than 74 years; variability in clinical characteristics and AMI management of hospitalized patients, and changes in the incidence and mortality rates, case-fatality, and management by age groups from 1996 to 1997 and 2007 to 2008. A population-based AMI registry in Girona (Catalonia, Spain) including individuals with suspected AMI older than 34 years. The incidence rate increased with age from 169 and 28 cases/100 000 per year in the group aged 35 to 64 years to 2306 and 1384 cases/100 000 per year in the group aged 85 to 94 years, in men and women, respectively. Population case-fatality also increased with age, from 19% in the group aged 35 to 64 years to 84% in the group aged 85 to 94 years. A lower population case-fatality was observed in the second period, mainly explained by a lower in-hospital case-fatality. The use of invasive procedures and effective drugs decreased with age but increased in the second period in all ages up to 84 years. Acute myocardial infarction incidence, mortality, and case-fatality increased exponentially with age. There is still a gap in the use of invasive procedures and effective drugs between younger and older patients. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  14. Crash Fatality Rates After Recreational Marijuana Legalization in Washington and Colorado.

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    Aydelotte, Jayson D; Brown, Lawrence H; Luftman, Kevin M; Mardock, Alexandra L; Teixeira, Pedro G R; Coopwood, Ben; Brown, Carlos V R

    2017-08-01

    To evaluate motor vehicle crash fatality rates in the first 2 states with recreational marijuana legalization and compare them with motor vehicle crash fatality rates in similar states without recreational marijuana legalization. We used the US Fatality Analysis Reporting System to determine the annual numbers of motor vehicle crash fatalities between 2009 and 2015 in Washington, Colorado, and 8 control states. We compared year-over-year changes in motor vehicle crash fatality rates (per billion vehicle miles traveled) before and after recreational marijuana legalization with a difference-in-differences approach that controlled for underlying time trends and state-specific population, economic, and traffic characteristics. Pre-recreational marijuana legalization annual changes in motor vehicle crash fatality rates for Washington and Colorado were similar to those for the control states. Post-recreational marijuana legalization changes in motor vehicle crash fatality rates for Washington and Colorado also did not significantly differ from those for the control states (adjusted difference-in-differences coefficient = +0.2 fatalities/billion vehicle miles traveled; 95% confidence interval = -0.4, +0.9). Three years after recreational marijuana legalization, changes in motor vehicle crash fatality rates for Washington and Colorado were not statistically different from those in similar states without recreational marijuana legalization. Future studies over a longer time remain warranted.

  15. Quantifying ground impact fatality rate for small unmanned aircraft

    DEFF Research Database (Denmark)

    La Cour-Harbo, Anders

    2018-01-01

    is based on a standard stochastic model, and employs a parameterized high fidelity ground impact distribution model that accounts for both aircraft specifications, parameter uncertainties, and wind. The method also samples the flight path to create an almost continuous quantification of the risk......One of the major challenges of conducting operation of unmanned aircraft, especially operations beyond visual line-of-sight (BVLOS), is to make a realistic and sufficiently detailed risk assessment. An important part of such an assessment is to identify the risk of fatalities, preferably...... in a quantitative way since this allows for comparison with manned aviation to determine whether an equivalent level of safety is achievable. This work presents a method for quantifying the probability of fatalities resulting from an uncontrolled descent of an unmanned aircraft conducting a BVLOS flight. The method...

  16. 29 CFR 1904.39 - Reporting fatalities and multiple hospitalization incidents to OSHA.

    Science.gov (United States)

    2010-07-01

    ... to OSHA. 1904.39 Section 1904.39 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY... fatalities and multiple hospitalization incidents to OSHA. (a) Basic requirement. Within eight (8) hours... Administration (OSHA), U.S. Department of Labor, that is nearest to the site of the incident. You may also use...

  17. Microcephaly Case Fatality Rate Associated with Zika Virus Infection in Brazil: Current Estimates.

    Science.gov (United States)

    Cunha, Antonio José Ledo Alves da; de Magalhães-Barbosa, Maria Clara; Lima-Setta, Fernanda; Medronho, Roberto de Andrade; Prata-Barbosa, Arnaldo

    2017-05-01

    Considering the currently confirmed cases of microcephaly and related deaths associated with Zika virus in Brazil, the estimated case fatality rate is 8.3% (95% confidence interval: 7.2-9.6). However, a third of the reported cases remain under investigation. If the confirmation rates of cases and deaths are the same in the future, the estimated case fatality rate will be as high as 10.5% (95% confidence interval: 9.5-11.7).

  18. Non-fatal suicidal behaviour at the Johannesburg General Hospital

    African Journals Online (AJOL)

    Adele

    2004-10-12

    Oct 12, 2004 ... served high rates are increasing on an international scale. Figures from the World ... They include high self-esteem and social “con- nectedness”, especially ..... Rosenberg ML, Smith JC, Davidson LE, et al. The emergence of ...

  19. Intergenerational differences in occupational injury and fatality rates among Canada's immigrants.

    Science.gov (United States)

    Tiagi, R

    2016-12-01

    Empirical evidence on occupational injury and/or fatality rates among Canada's immigrants has been largely mixed and has almost exclusively focused on the first generation. Over time, as immigrants assimilate into the economy, future generations may be expected to work in less hazardous occupations compared with prior generations. There has been no prior analysis of the differences in occupational injury and fatality rates among later generations. To analyse whether there are intergenerational differences in occupational injury and fatality rates among the first, second and third (or more) immigrant generations in Canada. Data drawn from the 2011 National Household Survey and the Association of Workers' Compensation Boards of Canada were used to determine the difference in occupational injury and fatality rates between the first or the third generation and the second generation, using a Poisson regression framework. Second-generation immigrants worked in jobs with lower occupational injury rates compared with the first generation and the third generation (or more). Similar results were observed for occupational fatality rates. Second-generation immigrants worked in less hazardous jobs compared with the first generation and compared with the third (or more) generations. These results suggest that the second generation may not face the same economic hurdles and challenges, in terms of workplace injuries or fatalities, as those faced by the first or third (or more) generations of immigrants. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. The effectiveness of automatic belts in reducing fatality rates in Toyota Cressidas.

    Science.gov (United States)

    Nash, C E

    1989-12-01

    Toyota Cressidas have had motor driven automatic belts since 1981. Their observed use rates have been consistently close to 100%. This paper compares fatality rates in Toyota Cressidas with those in the similar Nissan Maximas (which are equipped with three-point manual belts) using the latest data from the Fatal Accident Reporting System. After making adjustments for differences in the average ages of front seat occupants of the two fleets, the Toyotas have a fatality rate that is about three-quarters that of the Nissans. From this, the fatality-reducing effectiveness for the Toyota automatic belts is estimated to be 40% with an uncertainty of +/- 8%. This effectiveness estimate is consistent with earlier estimates of automatic belt effectiveness.

  1. Effect of mobile phone proliferation on crash notification times and fatality rates.

    Science.gov (United States)

    Stickles, Jimmy L; Kempema, James M; Brown, Lawrence H

    2018-01-01

    The purpose of this study was to evaluate whether increased proliferation of mobile telephones has been associated with decreased MVC notification times and/or decreased MVC fatality rates in the United States (US). We used World Bank annual mobile phone market penetration data and US Fatality Analysis Reporting System (FARS) fatal MVC data for 1994-2014. For each year, phone proliferation was measured as mobile phones per 100 population. FARS data were used to calculate MVC notification time (time EMS notified - time MVC occurred) in minutes, and to determine the MVC fatality rate per billion vehicle miles traveled (BVMT). We used basic vector auto-regression modeling to explore relationships between changes in phone proliferation and subsequent changes in median and 90th percentile MVC notification times, as well as MVC fatality rates. From 1994 to 2014, larger year-over-year increases in phone proliferation were associated with larger decreases in 90th percentile notification times for MVCs occurring during daylight hours (p=0.004) and on the national highway system (p=0.046) two years subsequent, and crashes off the national highway system three years subsequent (p=0.023). There were no significant associations between changes in phone proliferation and subsequent changes in median crash notification times, nor with subsequent changes in MVC fatality rates. Between 1994 and 2014 increased mobile phone proliferation in the U.S. was associated with shorter 90th percentile EMS notification times for some subgroups of fatal MVCs, but not with decreases in median notification times or overall MVC fatality rates. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. [The estimated incidence and case fatality rate of ischemic and hemorrhagic cerebrovascular disease in 2002 in Catalonia].

    Science.gov (United States)

    Marrugat, Jaume; Arboix, Adrià; García-Eroles, Lluís; Salas, Teresa; Vila, Joan; Castell, Conxa; Tresserras, Ricard; Elosua, Roberto

    2007-06-01

    The aim of this study was to obtain an estimate of the incidence of cerebrovascular disease (CVD) in the Spanish population in 2002. The study involved data on patients aged over 24 years for the year 2002 contained in both the death register and the Minimum Basic Data Set from 65 of the 84 Catalan general hospitals (i.e., 90.7% of all acute hospital beds in Catalonia). Total and age-adjusted mortality rates, cumulative incidence, and hospitalization rates, and the 28-day case fatality rate for CVD in the Catalan population were calculated after cases of traumatic and transient disease had been excluded. The unadjusted CVD mortality rate per 100,000 population aged over 24 years in Catalonia was 92 in men and 119 in women. The age-adjusted rates were 58 (95% confidence interval or CI, 56-61) and 43 (95% CI, 41-44), respectively. The cumulative incidence of CVD per 100,000 population was 218 (95% CI, 214-221) in men and 127 (95% CI, 125-128) in women. The unadjusted 28-day case fatality rate in the population was 36.2%: 30.3% in men and 42.0% in women. Some 62.5% of patients (57.2% of men and 66.4% of women) died from CVD outside hospital. These findings indicate that CVD mortality and incidence rates in Catalonia are among the lowest in developed countries. More than half of the deaths that took place within 28 days after the onset of symptoms occurred outside hospital.

  3. Economic and cultural correlates of road-traffic accident fatality rates in OECD countries.

    Science.gov (United States)

    Gaygisiz, Esma

    2009-10-01

    The relationships between economic conditions, cultural characteristics, personality dimensions, intelligence scores, and road-traffic accident mortality rates were investigated in 30 member and five accession countries of the Organisation for Economic Co-operation and Development (OECD). Economic indicators included the Gross Domestic Product (GDP) per capita, the unemployment rate, and the Gini index. Cultural variables included five Hofstede's cultural dimensions, seven Schwartz cultural value dimensions, NEO-PI-R scales, and the intelligence quotient (IQ). The results showed positive associations between favorable economic conditions (high income per capita, high employment rate, and low income inequality) and high traffic safety. Countries with higher road-traffic accident fatality rates were characterized by higher power distance and uncertainty avoidance as well as embeddedness and emphasis on social hierarchy. Countries with lower road-traffic accident fatality rates were more individualistic, egalitarian, and emphasized autonomy of individuals. Conscientiousness (from NEO-PI-R) and IQ correlated negatively with road-traffic accident fatalities.

  4. Effectiveness of antilock braking systems in reducing motorcycle fatal crash rates.

    Science.gov (United States)

    Teoh, Eric R

    2011-04-01

    Overbraking and underbraking have been shown to be common factors in motorcycle crashes. Antilock braking systems (ABS) prevent wheels from locking during braking and may make riders less reluctant to apply full braking force. The objective of this study was to evaluate the effect of ABS in fatal motorcycle crashes. Motorcycle drivers involved in fatal crashes per 10,000 registered vehicle years were compared for 13 motorcycle models with optional ABS and those same models without the option during 2003-2008. Motorcycles with optional ABS were included only if the presence of the option could be identified from the vehicle identification number. The rate of fatal motorcycle crashes per 10,000 registered vehicle years was 37 percent lower for ABS models than for their non-ABS versions. ABS appears to be highly effective in preventing fatal motorcycle crashes based on some early adopters of motorcycle ABS technology.

  5. Inpatient case fatality rates improvements in children under 5 ...

    African Journals Online (AJOL)

    Africa (SA),[2] and contribute significantly to the under-5 mortality rate. In 2015, pneumonia ... under-5 deaths (excluding perinatal causes), accounting for 16% and ... Corresponding author: L Bamford (lesley.bamford@health.gov.za). Data on ...

  6. Comparing avian and bat fatality rate estimates among North American wind energy projects

    Energy Technology Data Exchange (ETDEWEB)

    Smallwood, Shawn

    2011-07-01

    Full text: Wind energy development has expanded rapidly, and so have concerns over bird and bat impacts caused by wind turbines. To assess and compare impacts due to collisions, investigators use a common metric, fatalities/MW/year, but estimates of fatality rates have come from various wind turbine models, tower heights, environments, fatality search methods, and analytical methods. To improve comparability and asses large-scale impacts, I applied a common set of assumptions and methods to data in fatality monitoring reports to estimate fatality rates of birds and bats at 71 wind projects across North America (52 outside the Altamont Pass Wind Resource Area, APWRA). The data were from wind turbines of 27 sizes (range 0.04-3.00 MW) and 28 tower heights (range 18.5-90 m), and searched at 40 periodic intervals (range 1-90 days) and out to 20 distances from turbines (range 30-126 m). Estimates spanned the years 1982 to 2010, and involved 1-1,345 turbines per unique combination of project, turbine size, tower height, and search methodology. I adjusted fatality rates for search detection rates averaged from 425 detection trials, and for scavenger removal rates based on 413 removal trials. I also adjusted fatality rates for turbine tower height and maximum search radius, based on logistic functions fit to cumulative counts of carcasses that were detected at 1-m distance intervals from the turbine. For each tower height, I estimated the distance at which cumulative carcass counts reached an asymptote, and for each project I calculated the proportion of fatalities likely not found due to the maximum search radius being short of the model-predicted distance asymptote. I used the same estimator in all cases. I estimated mean fatalities/MW/year among North American wind projects at 12.6 bats (80% CI: 8.1-17.1) and 11.1 birds (80% CI: 9.5-12.7), including 1.6 raptors (80% CI: 1.3-2.0), and excluding the Altamont Pass I estimated fatality rates at 17.2 bats (80% CI: 9

  7. A review of fatal accident incidence rate trends in fishing international

    DEFF Research Database (Denmark)

    Jensen, Olaf; Pétursdóttir, G; Abrahamsen, Annbjørg

    2014-01-01

    Background. Injury prevention in fishing is one of the most important occupational health challenges. The aim was to describe and compare internationally the trends of the fatal injury incidence rates and to discuss the impact of the implemented safety programs. Methods. The review is based...... on journal articles and reports from the maritime authorities in Poland, UK, Norway, Iceland, Denmark, US and Alaska and Canada. The original incidence rates were recalculated as per 1000 person-years for international comparison of the trends. Results. The risk of fatal accidents in fishing in the northern...... countries has been reduced by around 50% to an average of about 1 per 1000 person-years. Norway and Canada keep the lowest rates with around 0.5 and 0.25 per 1000 person-years. About half of the fatal injuries are related to vessel disasters and drowning. The safety programs seem to have good effects still...

  8. Pulmonary embolism incidence and fatality trends in chinese hospitals from 1997 to 2008: a multicenter registration study.

    Directory of Open Access Journals (Sweden)

    Yuanhua Yang

    Full Text Available BACKGROUND: There has not been sufficient evidence to support the Asians being less susceptible to pulmonary embolism (PE than other ethnicities, because the prevalence of PE/deep venous thrombosis (DVT in different racial and ethnic groups has not been carefully studied until recently except in Caucasians. To test the hypothesis that the Chinese population has a lower risk for PE, this study comprehensively assessed the hospital-based incidence and case fatality rates for PE during the 1997-2008 in China. METHODS: A registration study of patients with suspected PE syndromes admitted to 60 level-3 hospitals involved in the National Cooperative Project for the Prevention and Treatment of Venous Thromboembolism (NCPPT was conducted from January 1997 to December 2008. The only exclusion criterion was an age of less than 18 years. Helical computed tomography scan, ventilation-perfusion lung scintigraphy or pulmonary angiography was carried out before or after hospitalization. All images were reviewed and evaluated independently by two specialists. RESULTS: A total of 18,206 patients were confirmed with PE from 16,972,182 hospital admissions. The annual incidence was 0.1% (95% CI: 0.1% to 0.2%. The overall incidence of PE in male patients (0.2%, 95% CI: 0.1% to 0.3% was higher than that in female patients (0.1% and 95% CI: 0.0% to 0.1%. An increasing incidence gradient for PE was noticed from Southern to Northern China. In addition, the case fatality rate was apparently decreasing: 25.1% (95% CI: 16.2% to 36.9% in 1997 to 8.7% (95% CI: 3.5% to 15.8% in 2008. CONCLUSIONS: Our findings suggest the relatively stable PE incidence and decreasing fatality trends in Chinese hospitals may be partially attributable to the implementation of the NCCPT and suggest the government should reevaluate the severity of PE so that health resources for the prevention, diagnosis and treatment of PE could be used to their fullest.

  9. On case-fatality rate: review and hypothesis.

    Science.gov (United States)

    Yoshikura, Hiroshi

    2012-07-01

    The relationship between log cumulative number of patients (X) and that of deaths (Y) in an epidemic follows the equation logY = klogX - klogN(0), where k is a constant determining the slope and N(0) is the value of X when Y = 1. Diseases with k = 1 are Ebola hemorrhagic fever, avian influenza H5N1, cholera, and hand, foot, and mouth disease; those with k > 1 are the influenza H1N1 2009 pandemic in countries other than Mexico and the SARS epidemic in some countries; and those with k Mexico. Epidemics with k > 1 can be simulated by postulating two subpopulations (normal population [NP] and vulnerable population [VP]), where the epidemic proceeds at higher speed and at higher mortality in VP than in NP. Epidemics with k 1 was simulated using parameters that are fractions of subpopulations NP or VP from the total population (f) and NP- or VP-specific patient multiplication (M) and mortality (D) rates. An epidemic with k < 1 was simulated using parameters that are fractions of HVV- or LVV-infected human populations (f), and HVV- or LVV-specific M and D.

  10. Case fatality ratio and mortality rate trends of community-onset Staphylococcus aureus bacteraemia

    DEFF Research Database (Denmark)

    Tom, S; Galbraith, J C; Valiquette, L

    2014-01-01

    Lethal outcomes can be expressed as a case fatality ratio (CFR) or as a mortality rate per 100 000 population per year (MR). Population surveillance for community-onset methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) Staphylococcus aureus bacteraemia was conducted in Canada, Austral...

  11. 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

  12. Fatal air embolism in hospital confirmed by autopsy and postmortem computed tomography.

    Science.gov (United States)

    Edler, Carolin; Klein, Anke; Püschel, Klaus; Schröder, Ann Sophie

    2018-06-01

    Vascular air embolism is caused by penetration of air into veins or arteries through a surgical wound or other connection between the external and internal aspects of the body. Vascular air embolism has various causes, and iatrogenic air embolisms are the most frequently described. We report a case of fatal air embolism in an 83-year-old woman who was admitted to hospital. At the time of the incident, she was alone in her ward receiving an intravenous infusion of antibiotics via a peripheral line in her right forearm. She was also inhaling air through a mask, which was connected via a tubing system to a compressed air connection in the wall behind her bed. Autopsy and postmortem computed tomography (PMCT) findings are presented. The case illustrates the high diagnostic value of PMCT, which is an effective procedure for detecting the presence of air or gas.

  13. The work-related fatal injury study: numbers, rates and trends of work-related fatal injuries in New Zealand 1985-1994.

    Science.gov (United States)

    Feyer, A M; Langley, J; Howard, M; Horsburgh, S; Wright, C; Alsop, J; Cryer, C

    2001-01-26

    To determine the number and rates of work-related fatal injuries by employment status, occupation, industry, age and gender in New Zealand 1985-1994. Potential cases of work-related injury deaths of persons aged 15-84 years were identified from the national electronic mortality data files. Main exclusions were deaths due to suicide and deaths due to motor vehicle crashes. The circumstances of the deaths of each fatal incident meeting inclusion criteria were then reviewed directly from coronial files to determine work-relatedness. The rate of work-related fatal injury in New Zealand was 5.03/100000 workers per year for the study period. There was a significant decline in crude rate over the study period. However, this was in substantial part accounted for by changes in occupation and industry mix. Older workers, male workers, self-employed workers, and particular occupational groups, all had substantially elevated rates. Agricultural and helicopter pilots, forestry workers and fishery workers had the highest rates. Farmers, forestry workers, and fishery workers also had high numbers of deaths, together accounting for nearly 40% of all deaths. This study has demonstrated that work-related fatal injury remains a pressing problem for New Zealand. Several areas in urgent need of prevention efforts were highlighted.

  14. Characteristics of fatal and hospital admissions for burns in Fiji: a population-based study (TRIP Project-2).

    Science.gov (United States)

    Taoi, Mable; Wainiqolo, Iris; Kafoa, Berlin; Kool, Bridget; Naisaki, Asilika; McCaig, Eddie; Ameratunga, Shanthi

    2012-08-01

    Over 95% of burn deaths are estimated to occur in low-and-middle-income countries. However, the epidemiology of burn-related injuries in Pacific Island Countries is unclear. This study investigated the incidence and demographic characteristics associated with fatal and hospitalised burns in Fiji. This cross-sectional study utilised the Fiji Injury Surveillance in Hospital database to estimate the population-based incidence and contextual characteristics associated with burns resulting in death or hospital admission (≥12h) during a 12-month period commencing 1st October 2005. 116 people were admitted to hospital or died as a result of burns during the study period accounting for an overall annual incidence of 17.8/100,000 population, and mortality rate of 3.4/100,000. Most (92.2%) burns occurred at home, and 85.3% were recorded as unintentional. Burns were disproportionately higher among Fijian children compared with Fijian-Indian children with the converse occurring in adulthood. In adults, Indian women were at particularly high risk of death from self-inflicted burns as a consequence of 'conflict situations'. Burns are a significant public health burden in Fiji requiring prevention and management strategies informed by important differences in the context of these injuries among the major ethic groups of the country. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

  15. Trends in fatalities due to poisoning at Umtata General Hospital, Mthatha (1993–2005

    Directory of Open Access Journals (Sweden)

    Banwari L. Meel

    2009-08-01

    Full Text Available Poisoning is a common method of committing suicide in this region of South Africa. Females generally ingest poisons but it is increasingly becoming common in males too. This is a record review of autopsies carried out at the Umtata (Mthatha General Hospital mortuary, which forms part of the teaching hospital of the Walter Sisulu University Medical School. There were 10 230 unnatural deaths between 1993 and 2005. Of these deaths, 161 (1.6% were deaths due to poisoning. There was a marked increase in death by poisoning from 2.5% in 1993 to 13.7% in 2004. The highest percentage (17.4% of poison-related deaths was in 2001, and the lowest (2.5% was in 1993 and 1994. About two-thirds of victims (66% were males, and more than half of the victims (51.5% were in the 11 to 30 age group. There is an increasing trend in fatalities due to poisoning at Umtata General Hospital, Mthatha.

  16. Nursing magnet hospitals have better CMS hospital compare ratings

    Directory of Open Access Journals (Sweden)

    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.

  17. Influence of Referral Pathway on Ebola Virus Disease Case-Fatality Rate and Effect of Survival Selection Bias

    DEFF Research Database (Denmark)

    Rudolf, Frauke; Damkjær, Mads; Lunding, Suzanne

    2017-01-01

    Case-fatality rates in Ebola treatment centers (ETCs) varied widely during the Ebola virus disease (EVD) outbreak in West Africa. We assessed the influence of referral pathway on ETC case-fatality rates with a retrospective cohort of 126 patients treated at the Mathaska ETC in Port Loko, Sierra...... Leone. The patients consisted of persons who had confirmed EVD when transferred to the ETC or who had been diagnosed onsite. The case-fatality rate for transferred patients was 46% versus 67% for patients diagnosed onsite (p = 0.02). The difference was mediated by Ebola viral load at diagnosis...

  18. Fatal pulmonary embolism in hospitalized patients. Clinical diagnosis versus pathological confirmation

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    Cláudio Tinoco Mesquita

    1999-09-01

    Full Text Available OBJECTIVE - To assess the incidence of fatal pulmonary embolism (FPE, the accuracy of clinical diagnosis, and the profile of patients who suffered an FPE in a tertiary University Hospital. METHODS - Analysis of the records of 3,890 autopsies performed at the Department of General Pathology from January 1980 to December 1990. RESULTS - Among the 3,980 autopsies, 109 were cases of clinically suspected FPE; of these, 28 cases of FPE were confirmed. FPE accounted for 114 deaths, with clinical suspicion in 28 cases. The incidence of FPE was 2.86%. No difference in sex distribution was noted. Patients in the 6th decade of life were most affected. The following conditions were more commonly related to FPE: neoplasias (20% and heart failure (18.5%. The conditions most commonly misdiagnosed as FPE were pulmonary edema (16%, pneumonia (15% and myocardial infarction (10%. The clinical diagnosis of FPE showed a sensitivity of 25.6%, a specificity of 97.9%, and an accuracy of 95.6%. CONCLUSION - The diagnosis of pulmonary embolism made on clinical grounds still has considerable limitations.

  19. Subway-Related Trauma: An Urban Public Health Issue with a High Case-Fatality Rate.

    Science.gov (United States)

    Rodier, Simon G; DiMaggio, Charles J; Wall, Stephen; Sim, Vasiliy; Frangos, Spiros G; Ayoung-Chee, Patricia; Bukur, Marko; Tandon, Manish; Todd, S Rob; Marshall, Gary T

    2018-05-09

    Between 1990 and 2003, there were 668 subway-related fatalities in New York City. However, subway-related trauma remains an understudied area of injury-related morbidity and mortality. The objective of this study was to characterize the injuries and events leading up to the injuries of all patients admitted after subway-related trauma. We conducted a retrospective case series of subway-related trauma at a Level I trauma center from 2001 to 2016. Descriptive epidemiology of patient demographics, incident details, injuries, and outcomes were analyzed. Over 15 years, 254 patients were admitted for subway-related trauma. The mean (standard error of the mean) age was 41 (1.0) years, 80% were male (95% confidence interval [CI] 74-84%) and median Injury Severity Score was 14 (interquartile range [IQR] 5-24). The overall case-fatality rate was 10% (95% CI 7-15%). The most common injuries were long-bone fractures, intracranial hemorrhage, and traumatic amputations. Median length of stay was 6 days (IQR 1-18 days). Thirty-seven percent of patients required surgical intervention. At the time of injury, 55% of patients (95% CI 49-61%) had a positive urine drug or alcohol screen, 16% (95% CI 12-21%) were attempting suicide, and 39% (95% CI 33-45%) had a history of psychiatric illness. Subway-related trauma is associated with a high case-fatality rate. Alcohol or drug intoxication and psychiatric illness can increase the risk of this type of injury. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. Poisson regression approach for modeling fatal injury rates amongst Malaysian workers

    International Nuclear Information System (INIS)

    Kamarulzaman Ibrahim; Heng Khai Theng

    2005-01-01

    Many safety studies are based on the analysis carried out on injury surveillance data. The injury surveillance data gathered for the analysis include information on number of employees at risk of injury in each of several strata where the strata are defined in terms of a series of important predictor variables. Further insight into the relationship between fatal injury rates and predictor variables may be obtained by the poisson regression approach. Poisson regression is widely used in analyzing count data. In this study, poisson regression is used to model the relationship between fatal injury rates and predictor variables which are year (1995-2002), gender, recording system and industry type. Data for the analysis were obtained from PERKESO and Jabatan Perangkaan Malaysia. It is found that the assumption that the data follow poisson distribution has been violated. After correction for the problem of over dispersion, the predictor variables that are found to be significant in the model are gender, system of recording, industry type, two interaction effects (interaction between recording system and industry type and between year and industry type). Introduction Regression analysis is one of the most popular

  1. Is the contribution of alcohol to fatal traumatic brain injuries being underestimated in the acute hospital setting?

    LENUS (Irish Health Repository)

    O'Toole, O

    2011-04-05

    Alcohol consumption in Ireland has nearly doubled during the period 1989-2001. To evaluate the relationship of alcohol to fatal head injuries in the acute hospital setting we created a data base of all fatal traumatic brain injuries in the Department of Neuropathology at Beaumont Hospital over a ten year period (1997-2006 inclusive). 498 cases were identified (351 males: 147 females). Fatalities were highest in males aged 19-25 years (N=101) and 51-70 years (N=109). Falls (N=210) and road traffic accidents (N=183) were the commonest modes of presentation. 36\\/210 (17%) falls had positive blood alcohol testing, 9\\/210 (4.3%) had documentation of alcohol in notes but no testing, 35\\/210 (16.7%) tested negative for alcohol and 130\\/210 (61.9%) were not tested. The RTA group (N=183) comprised drivers (n=79), passengers (n=47) and pedestrians (n=57). 65\\/79 (82.2%) of drivers were males aged 19-25 years. Blood alcohol was only available in 27\\/79 (34.1%) drivers and was positive in 13\\/27 (48.1%). 14\\/75 (18.7%) pedestrians were tested for alcohol, 4\\/14 (28.6%) were positive. Overall 142\\/183 (77.6%) of the RTA group were not tested. The contribution of alcohol to fatal traumatic brain injuries is probably being underestimated due to omission of blood alcohol concentration testing on admission to hospital. Absence of national guidelines on blood alcohol testing in the emergency department compounds the problem.

  2. Reduction in Fatalities, Ambulance Calls, and Hospital Admissions for Road Trauma After Implementation of New Traffic Laws

    Science.gov (United States)

    Chan, Herbert; Brasher, Penelope; Erdelyi, Shannon; Desapriya, Edi; Asbridge, Mark; Purssell, Roy; Macdonald, Scott; Schuurman, Nadine; Pike, Ian

    2014-01-01

    Objectives. We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010). Methods. We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls. Results. In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI] = 15.3, 26.4) and in hospital admissions (8.0%; 95% CI = 0.6, 14.9) and ambulance calls (7.2%; 95% CI = 1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI = 34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving. Conclusions. These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported. PMID:25121822

  3. 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.

  4. 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.

  5. 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.

  6. Fatal septicemia linked to transmission of MRSA clonal complex 398 in hospital and nursing home, Denmark

    DEFF Research Database (Denmark)

    Nielsen, Rikke Thoft; Kemp, Michael; Holm, Anette

    2016-01-01

    We describe 2 fatal cases of methicillin-resistant Staphylococcus aureus (MRSA) clonal complex 398 septicemia in persons who had no contact with livestock. Whole-genome sequencing of the isolated MRSA strains strongly suggest that both were of animal origin and that the patients had been infected...

  7. Incidence and 30-day case fatality rate of first-ever stroke in urban Nigeria: the prospective community based Epidemiology of Stroke in Lagos (EPISIL) phase II results.

    Science.gov (United States)

    Danesi, Mustapha A; Okubadejo, Njideka U; Ojini, Frank I; Ojo, Oluwadamilola O

    2013-08-15

    Stroke is a leading cause of death worldwide and a major contributor to global disease burden. Although epidemiologic information from a community perspective is important in determining the magnitude of the burden in specific regions, and directing equitable distribution of health resources, data on the incidence of stroke in developing countries in Africa are scarce. To determine the current incidence rate and short-term (30-day) case fatality rate (CFR) of stroke in urban Nigeria, and provide age-adjusted and gender-specific incidence rates to enable comparison with global populations. The study was a prospective community-based stroke registry enrolling hospitalized and non-hospitalized first-ever in a lifetime stroke cases presenting at all health facilities (hospitals, homeopathic caregivers, physiotherapy clinics) located in the designated community. Pre-hospitalization deaths due to stroke were not included in our study. The study was conducted between January 1st and December 31st 2007 in Surulere Local Government Area of Lagos State, south western Nigeria, a mixed-income urban locality with a population of approximately 750,000 based on data from the National Population Commission. Stroke was defined using the World Health Organization (WHO) clinical criteria. Case fatality at 30-days post stroke was determined at follow-up on 160 hospitalized stroke cases. 189 first-ever strokes, comprised of 112 men and 77 women (mean±SD age 58.5±13.5 years) were documented, giving a crude incidence rate of 25.2 per 100,000 per year (95% confidence interval 21.6- 28.8). The gender-specific rates were 28.3/100,000 and 21.3/100,000 for males and females respectively. The age-adjusted incidence rate was 54.08 per 100,000 per year (adjusted to the WHO New World Population). Hospitalization rate was 84.6%, while the CFR (hospitalized) was 16.2%. The stroke incidence in this urban sub-Saharan African community remains lower than that in emerging and developed economies

  8. Relationship between pedestrian headform tests and injury and fatality rates in vehicle-to-pedestrian crashes in the United States.

    Science.gov (United States)

    Mueller, Becky; Farmer, Charles; Jermakian, Jessica; Zuby, David

    2013-11-01

    Pedestrian protection evaluations have been developed to encourage vehicle front-end designs that mitigate the consequences of vehicle-to-pedestrian crashes. The European New Car Assessment Program (Euro NCAP) evaluates pedestrian head protection with impacts against vehicle hood, windshield, and A-pillars. The Global Technical Regulation No. 9 (GTR 9), being evaluated for U.S. regulation, limits head protection evaluations to impacts against vehicle hoods. The objective of this study was to compare results from pedestrian head impact testing to the real-world rates of fatal and incapacitating injuries in U.S. pedestrian crashes. Data from police reported pedestrian crashes in 14 states were used to calculate real-world fatal and in- capacitating injury rates for seven 2002-07 small cars. Rates were 2.17-4.04 per 100 pedestrians struck for fatal injuries and 10.45-15.35 for incapacitating injuries. Euro NCAP style pedestrian headform tests were conducted against windshield, A-pillar, and hoods of the study vehicles. When compared with pedestrian injury rates, the vehicles' Euro NCAP scores, ranging 5-10 points, showed strong negative correlations (-0.6) to injury rates, though none were statistically significant. Data from the headform impacts for each of the study vehicles were used to calculate that vehicle's predicted serious injury risk. The predicted risks from both the Euro NCAP and GTR 9 test zones showed high positive correlations with the pedestrian fatal and incapacitating injury rates, though few were statistically significant. Whether vehicle stiffness is evaluated on all components of vehicle front ends (Euro NCAP) or is limited to hoods (GTR 9), softer vehicle components correspond to a lower risk of fatality.

  9. A national cholera epidemic with high case fatality rates--Kenya 2009.

    Science.gov (United States)

    Loharikar, Anagha; Briere, Elizabeth; Ope, Maurice; Langat, Daniel; Njeru, Ian; Gathigi, Lucy; Makayotto, Lyndah; Ismail, Abdirizak M; Thuranira, Martin; Abade, Ahmed; Amwayi, Samuel; Omolo, Jared; Oundo, Joe; De Cock, Kevin M; Breiman, Robert F; Ayers, Tracy; Mintz, Eric; O'Reilly, Ciara E

    2013-11-01

    Cholera remains endemic in sub-Saharan Africa. We characterized the 2009 cholera outbreaks in Kenya and evaluated the response. We analyzed surveillance data and estimated case fatality rates (CFRs). Households in 2 districts, East Pokot (224 cases; CFR = 11.7%) and Turkana South (1493 cases; CFR = 1.0%), were surveyed. We randomly selected 15 villages and 8 households per village in each district. Healthcare workers at 27 health facilities (HFs) were surveyed in both districts. In 2009, cholera outbreaks caused a reported 11 425 cases and 264 deaths in Kenya. Data were available from 44 districts for 6893 (60%) cases. District CFRs ranged from 0% to 14.3%. Surveyed household respondents (n = 240) were aware of cholera (97.5%) and oral rehydration solution (ORS) (87.9%). Cholera deaths were reported more frequently from East Pokot (n = 120) than Turkana South (n = 120) households (20.7% vs. 12.3%). The average travel time to a HF was 31 hours in East Pokot compared with 2 hours in Turkana South. Fewer respondents in East Pokot (9.8%) than in Turkana South (33.9%) stated that ORS was available in their village. ORS or intravenous fluid shortages occurred in 20 (76.9%) surveyed HFs. High CFRs in Kenya are related to healthcare access disparities, including availability of rehydration supplies.

  10. 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.

  11. The case-fatality rate of meningococcal disease in Catalonia, 1990-1997.

    Science.gov (United States)

    Domínguez, Angela; Cardeñosa, Neus; Pañella, Helena; Orcau, Angels; Companys, Maria; Alseda, Miquel; Oviedo, Manuel; Carmona, Glòria; Minguell, Sofia; Salleras, Lluis

    2004-01-01

    The objective was to analyse the case-fatality rate (CFR) of meningococcal disease (MD) in Catalonia, Spain. A retrospective study was carried out. Clinical histories of cases of MD reported for the period 1990-1997 in Catalonia were reviewed. For all cases, the variables gender, age, clinical type, y of presentation, province, phenotype and death by meningococcal disease were collected. The association between death and the other variables was studied by bivariate and unconditional logistic regression analysis. In the 2343 cases studied there were 146 deaths (6.2%) due to meningococcal disease. The CFR was higher in females (OR: 1.5, 95%CI: 1.1-2.1), in the 20 to 49 y (OR: 2.4, 95%CI: 1.2-4.9) and > or = 50 y (OR: 5.3, 95%CI: 2.8-10.1) age groups, in cases with septicaemia (OR: 2.4, 95%CI: 1.6-3.5), in the cases produced by serogroup A (OR: 4.7, 95%CI: 1.0-23.4) and in cases occurring during 1993 (OR: 2.1, 95%CI: 1.1-4.1) or in the province of Lleida (OR: 2.9, 95%CI: 1.2-7.2). In the multivariate analysis, death was associated with the 20-49 y age group (OR: 3.9, 95%CI: 1.8-8.4), the > or = 50 y age group (OR: 7.3, 95%CI: 3.6-14.7), septicaemia (OR: 3.1; 95%CI: 2.0-4.7) and residing in the province of Lleida (OR: 3.2; 95%CI: 1.2-8.5). The CFR of meningococcal disease in Catalonia was not associated with the emergent phenotype C:2b:P1.2,5 strain, which caused an outbreak in other regions of Spain.

  12. 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

  13. The association between serum potassium at hospital admission and the case-fatality rate of leptospirosis in men Associação entre potássio sérico na admissão hospitalar e letalidade da leptospirose em homens

    Directory of Open Access Journals (Sweden)

    Antonio Alberto LOPES

    2001-08-01

    Full Text Available Severe leptospirosis affects predominantly males and presents a high susceptibility to hypokalemic acute renal failure. As hypokalemia and hyperkalemia induce severe complications, it is important to evaluate if the initial serum potassium is an independent risk factor for death in leptospirosis. The medical records of 1016 patients hospitalized with the diagnosis of leptospirosis were reviewed. The analysis was restricted to 442, according to the following criteria: male, 18 years or older, information about death or hospital discharge and recorded values of serum potassium, serum creatinine and duration of symptoms at admission. Potassium values lower than 3.5 mEq/L (hypoK, 3.5-5 mEq/L (normoK and above 5 mEq/L (hyperK were detected in 180, 245 and 17 patients, respectively. The death rate increased with serum potassium: 11.1% in the hypoK, 14.7% in the normoK and 47.1% in the hyperK group (p = 0.002. In a logistic regression model (normoK as referent, including age, creatinine and duration of symptoms, hypoK was not associated with increased death rate (odds ratio (OR = 0.80; p > 0.1. On the other hand, hyperK showed a significant association with increased risk of death (OR = 3.95, p = 0.021. In conclusion, in this sample of men with leptospirosis initial serum potassium was positively and independently correlated with the risk of in-hospital death.Leptospirose grave afeta predominantemente os homens e apresenta alta susceptibilidade para insuficiência renal aguda com hipocalemia. Como hipocalemia e hipercalemia induzem complicações graves, é importante avaliar se o potássio sérico é um independente fator de risco de morte na leptospirose. Foram revistos os prontuários de 1016 pacientes internados com o diagnóstico de leptospirose. A análise foi restrita a 442, obedecendo os seguintes critérios: sexo masculino, idade igual ou superior a 18 anos, informação sobre morte ou alta hospitalar e registro dos valores do potássio s

  14. Type A behavior pattern, accident optimism and fatalism: an investigation into non-compliance with safety work behaviors among hospital nurses.

    Science.gov (United States)

    Ugwu, Fabian O; Onyishi, Ike E; Ugwu, Chidi; Onyishi, Charity N

    2015-01-01

    Safety work behavior has continued to attract the interest of organizational researchers and practitioners especially in the health sector. The goal of the study was to investigate whether personality type A, accident optimism and fatalism could predict non-compliance with safety work behaviors among hospital nurses. One hundred and fifty-nine nursing staff sampled from three government-owned hospitals in a state in southeast Nigeria, participated in the study. Data were collected through Type A Behavior Scale (TABS), Accident Optimism, Fatalism and Compliance with Safety Behavior (CSB) Scales. Our results showed that personality type A, accident optimism and fatalism were all related to non-compliance with safety work behaviors. Personality type A individuals tend to comply less with safety work behaviors than personality type B individuals. In addition, optimistic and fatalistic views about accidents and existing safety rules also have implications for compliance with safety work behaviors.

  15. Road crash fatality rates in France: a comparison of road user types, taking account of travel practices.

    Science.gov (United States)

    Bouaoun, Liacine; Haddak, Mohamed Mouloud; Amoros, Emmanuelle

    2015-02-01

    Travel practices are changing: bicycle and motorized two-wheeler (MTW) use are rising in some of France's large cities. These are cheaper modes of transport and therefore attractive at a time of economic crisis, but they also allow their users to avoid traffic congestion. At the same time, active transport modes such as walking and cycling are encouraged because they are beneficial to health and reduce pollution. It is therefore important to find out more about the road crash risks of the different modes of transport. To do this, we need to take account of the number of individuals who use each, and, even better, their travel levels. We estimated the exposure-based fatality rates for road traffic crashes in France, on the basis of the ratio between the number of fatalities and exposure to road accident risk. Fatality data were obtained from the French national police database of road traffic casualties in the period 2007-2008. Exposure data was estimated from the latest national household travel survey (ENTD) which was conducted from April 2007 to April 2008. Three quantities of travel were computed for each mode of transport: (1) the number of trips, (2) the distance traveled and (3) the time spent traveling. Annual fatality rates were assessed by road user type, age and sex. The overall annual fatality rates were 6.3 per 100 million trips, 5.8 per billion kilometers traveled and 0.20 per million hours spent traveling. The fatality rates differed according to road user type, age and sex. The risk of being killed was 20 to 32 times higher for motorized two-wheeler users than for car occupants. For cyclists, the risk of being killed, both on the basis of time spent traveling and the number of trips was about 1.5 times higher than for car occupants. Risk for pedestrians compared to car occupants was similar according to time spent traveling, lower according to the number of trips and higher according to the distance traveled. People from the 17-20 and 21-29 age

  16. Risk factors for near-fatal asthma. A case-control study in hospitalized patients with asthma.

    Science.gov (United States)

    Turner, M O; Noertjojo, K; Vedal, S; Bai, T; Crump, S; Fitzgerald, J M

    1998-06-01

    We prospectively recruited patients admitted to the hospital with severe asthma to comprehensively evaluate the association of historical and physiologic features with the risk of near-fatal asthma (NFA). A case-control study design was used. All patients admitted with NFA (cases) were identified prospectively and compared with asthma patients admitted during the same period without respiratory failure (controls). Nineteen cases (age: 40.2 +/- 12.0 yr) (mean +/- SD) and 80 controls (age: 36 +/- 13.5 yr) were enrolled. Duration of asthma, gender, smoking status, ethnicity, and prevalence of atopy were similar in the case and control groups. More than 80% of patients in both groups reported worsening symptoms for more than 48 h before admission, and more than 50% were worse for longer than 7 d. There was no difference in degree of airways obstruction or bronchial hyperresponsiveness (PC20). Perception of dyspnea was similar in the cases and controls, but among cases the males had greater impairment than the females (Borg score: 1.9 +/- 1. 4 versus 3.9 +/- 1.2: p = 0.05). Univariate analysis identified a history of previous mechanical ventilation (OR: 27.5; 95% CI: 6.60 to 113.7), admission to the intensive care unit (ICU) (OR: 9.9; 95% CI: 3.0 to 32.9), history of worse asthma during January and February (OR: 3.5; 95% CI: 1.0 to 11.8), and use of air-conditioning (OR: 15.0; 95% CI: 1.3 to 166) as risk factors for NFA. Of concern was the dependence of most patients (59.8%) on the emergency department (ED) for initial care, and the small number of cases (16%) in which patients visited a physician before admission to the hospital. We have confirmed risk factors identified previously in retrospective studies of fatal and NFA, and have also shown that hospitalized patients with asthma, irrespective of severity of their asthma, share several characteristics, especially in terms of their failure to respond to worsening asthma.

  17. 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.

  18. Wind energy development: Methods to assess bird and bat fatality rates post-construction

    Science.gov (United States)

    Huso, Manuela; Dalthorp, Daniel; Miller, T J; Bruns, Dawn

    2016-01-01

    Monitoring fatalities at wind energy facilities after they have been constructed can provide valuable information regarding impacts of wind power development on wildlife. The objective of this monitoring is to estimate abundance of a super-population of carcasses that entered the area within a designated period of time. By definition, the population is not closed and carcasses can enter as they are killed through collision with turbines, and leave as they are removed by scavengers or decompose to a point where they are not recognizable. In addition, the population is not inherently mobile, but can only change location through some external force. A focus on number of animal carcasses comprising the super-population, combined with peculiar traits that resist classic assumptions, distinguish fatality estimation at wind-power facilities from more classic abundance estimates that can be addressed through mark-recapture techniques or other well-known abundance estimators. We review the available methods to estimate the super-population of carcasses at wind power facilities. We discuss the role of these estimates in determining appropriate levels of minimization and mitigation of impacts to individual species of concern. We discuss the potential to extrapolate these measurements to reflect the cumulative effect of the industry on individual species. Finally, we suggest avenues of research needed to strengthen our understanding of the effect wind power development has, and might have in the future, on wildlife on this continent and worldwide.

  19. Effects of the Occupational Safety and Health Administration's control of hazardous energy (lockout/tagout) standard on rates of machinery-related fatal occupational injury.

    Science.gov (United States)

    Bulzacchelli, Maria T; Vernick, Jon S; Webster, Daniel W; Lees, Peter S J

    2007-10-01

    To evaluate the impact of the United States' federal Occupational Safety and Health Administration's control of hazardous energy (lockout/tagout) standard on rates of machinery-related fatal occupational injury. The standard, which took effect in 1990, requires employers in certain industries to establish an energy control program and sets minimum criteria for energy control procedures, training, inspections, and hardware. An interrupted time-series design was used to determine the standard's effect on fatality rates. Machinery-related fatalities, obtained from the National Traumatic Occupational Fatalities surveillance system for 1980 through 2001, were used as a proxy for lockout/tagout-related fatalities. Linear regression was used to control for changes in demographic and economic factors. The average annual crude rate of machinery-related fatalities in manufacturing changed little from 1980 to 1989, but declined by 4.59% per year from 1990 to 2001. However, when controlling for demographic and economic factors, the regression model estimate of the standard's effect is a small, non-significant increase of 0.05 deaths per 100 000 production worker full-time equivalents (95% CI -0.14 to 0.25). When fatality rates in comparison groups that should not have been affected by the standard are incorporated into the analysis, there is still no significant change in the rate of machinery-related fatalities in manufacturing. There is no evidence that the lockout/tagout standard decreased fatality rates relative to other trends in occupational safety over the study period. A possible explanation is voluntary use of lockout/tagout by some employers before introduction of the standard and low compliance by other employers after.

  20. Effects of the Occupational Safety and Health Administration's control of hazardous energy (lockout/tagout) standard on rates of machinery‐related fatal occupational injury

    Science.gov (United States)

    Bulzacchelli, Maria T; Vernick, Jon S; Webster, Daniel W; Lees, Peter S J

    2007-01-01

    Objective To evaluate the impact of the United States' federal Occupational Safety and Health Administration's control of hazardous energy (lockout/tagout) standard on rates of machinery‐related fatal occupational injury. The standard, which took effect in 1990, requires employers in certain industries to establish an energy control program and sets minimum criteria for energy control procedures, training, inspections, and hardware. Design An interrupted time‐series design was used to determine the standard's effect on fatality rates. Machinery‐related fatalities, obtained from the National Traumatic Occupational Fatalities surveillance system for 1980 through 2001, were used as a proxy for lockout/tagout‐related fatalities. Linear regression was used to control for changes in demographic and economic factors. Results The average annual crude rate of machinery‐related fatalities in manufacturing changed little from 1980 to 1989, but declined by 4.59% per year from 1990 to 2001. However, when controlling for demographic and economic factors, the regression model estimate of the standard's effect is a small, non‐significant increase of 0.05 deaths per 100 000 production worker full‐time equivalents (95% CI −0.14 to 0.25). When fatality rates in comparison groups that should not have been affected by the standard are incorporated into the analysis, there is still no significant change in the rate of machinery‐related fatalities in manufacturing. Conclusions There is no evidence that the lockout/tagout standard decreased fatality rates relative to other trends in occupational safety over the study period. A possible explanation is voluntary use of lockout/tagout by some employers before introduction of the standard and low compliance by other employers after. PMID:17916891

  1. 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.

  2. 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.

  3. Bronchial mucosal tolerance following high dose rate endobronchial brachytherapy: clinical and laboratory correlates in late complication assessment of fatal hemoptysis

    International Nuclear Information System (INIS)

    Chen, Y.Y.; McDonald, S.; Nakamura, C.; Philips, A.; Ojomo, Karanita; Hernady, E.; Williams, J. P.; Smudzin, T.; Johnstone, D.; Feins, R.; Speiser, B.L.; Rubin, P.

    1996-01-01

    Purpose: This study reviews treatment related late complications following high dose rate endobronchial brachytherapy (HDR-EB) for primary lung cancers. Radiation dose contribution from HDR-EB treatment alone, or combined HDR-EB and external beam (EBRT) were analyzed in relation to the linear representation of the tracheobronchial anatomy. Results were presented in a dose volume histogram (DVH) analysis for the risk estimate of late complications from HDR-EB. Bronchial mucosal tolerance is estimated from the clinical experience study and histopathologic changes in laboratory animals treated with HDR-EB. Methods: 1.) There were forty one patients with primary lung cancer received HDR-EB as part of the radiation treatment between December 1990 and June 1994. Six of these developed late complications manifested as either fatal hemoptysis or endobronchial deposition of fibrinous material/bronchial stenosis. Treatment planning films were reviewed to map the volume treated with HDR-EB and EBRT along the tracheobronchial segments. DVH was constructed and compared for patients with and without late complications. Other clinical parameters of interest which were analyzed included: dose per fraction, EBRT total dose, HDR total dose, combined EBRT and HDR total dose, number of catheters per treatment, and points of prescriptions for HDR-EB. 2.) Forty four New Zealand White rabbits underwent HDR-EB of the major airway to a treatment length of 2 cm (1 cm above and below the carina) to a single fraction dose of 10 Gy, 30 Gy, or 50 Gy. Histopathologic changes were examined at 7, 14, 28, and 56 days post-treatment and compared with the control rabbits which received no irradiation. Results: 1.) The late complication rate is 14.5% with three patients developing fibrinous deposits/bronchial stenosis and four patients who experienced fatal hemoptysis in a total of six patients. There is a significant difference in DVH of HDR-EB treatment in the tracheobronchial high dose region

  4. 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

  5. Fatal poisonings in Oslo: a one-year observational study.

    Science.gov (United States)

    Bjornaas, Mari A; Teige, Brita; Hovda, Knut E; Ekeberg, Oivind; Heyerdahl, Fridtjof; Jacobsen, Dag

    2010-06-06

    Acute poisonings are common and are treated at different levels of the health care system. Since most fatal poisonings occur outside hospital, these must be included when studying characteristics of such deaths. The pattern of toxic agents differs between fatal and non-fatal poisonings. By including all poisoning episodes, cause-fatality rates can be calculated. Fatal and non-fatal acute poisonings in subjects aged > or =16 years in Oslo (428 198 inhabitants) were included consecutively in an observational multi-centre study including the ambulance services, the Oslo Emergency Ward (outpatient clinic), and hospitals, as well as medico-legal autopsies from 1st April 2003 to 31st March 2004. Characteristics of fatal poisonings were examined, and a comparison of toxic agents was made between fatal and non-fatal acute poisoning. In Oslo, during the one-year period studied, 103 subjects aged > or =16 years died of acute poisoning. The annual mortality rate was 24 per 100 000. The male-female ratio was 2:1, and the mean age was 44 years (range 19-86 years). In 92 cases (89%), death occurred outside hospital. The main toxic agents were opiates or opioids (65% of cases), followed by ethanol (9%), tricyclic anti-depressants (TCAs) (4%), benzodiazepines (4%), and zopiclone (4%). Seventy-one (69%) were evaluated as accidental deaths and 32 (31%) as suicides. In 70% of all cases, and in 34% of suicides, the deceased was classified as drug or alcohol dependent. When compared with the 2981 non-fatal acute poisonings registered during the study period, the case fatality rate was 3% (95% C.I., 0.03-0.04). Methanol, TCAs, and antihistamines had the highest case fatality rates; 33% (95% C.I., 0.008-0.91), 14% (95% C.I., 0.04-0.33), and 10% (95% C.I., 0.02-0.27), respectively. Three per cent of all acute poisonings were fatal, and nine out of ten deaths by acute poisonings occurred outside hospital. Two-thirds were evaluated as accidental deaths. Although case fatality rates were

  6. Investigation of elevated case-fatality rate in poliomyelitis outbreak in Pointe Noire, Republic of Congo, 2010.

    Science.gov (United States)

    Gregory, Christopher J; Ndiaye, Serigne; Patel, Minal; Hakizamana, Elisaphan; Wannemuehler, Kathleen; Ndinga, Edouard; Chu, Susan; Talani, Pascal; Kretsinger, Katrina

    2012-11-15

    Multiple cases of paralysis, often resulting in death, occurred among young adults during a wild poliovirus (WPV) type 1 outbreak in Pointe Noire, Republic of Congo, in 2010. We conducted an investigation to identify factors associated with fatal outcomes among persons with poliomyelitis in Pointe Noire. Polio cases were defined as acute flaccid paralysis (AFP) cases reported from 7 October to 7 December 2010 with either a stool specimen positive for WPV or clinically classified as polio-compatible. Data were obtained from medical records, hospital databases, AFP case investigation forms and, when possible, via interviews with persons with polio or surrogates using a standard questionnaire. A total of 369 polio cases occurred in Pointe Noire between 7 October and 7 December 2010. Median age was 22 years for nonsurvivors and 18 years for survivors (P = .01). Small home size, as defined by ≤2 rooms, use of a well for drinking water during a water shortage, and age ≥15 years were risk factors for death in multivariate analysis. Consideration should be given during polio risk assessment planning and outbreak response to water/sanitation status and potential susceptibility to polio in older children and adults. Serosurveys to estimate immunity gaps in older age groups in countries at high risk of polio importation might be useful to guide preparedness and response planning.

  7. First-Ever Stroke and Transient Ischemic Attack Incidence and 30-Day Case-Fatality Rates in a Population-Based Study in Argentina

    DEFF Research Database (Denmark)

    Bahit, M Cecilia; Coppola, Mariano L; Riccio, Patricia M

    2016-01-01

    BACKGROUND AND PURPOSE: Epidemiological data about stroke are scarce in low- and middle-income Latin-American countries. We investigated annual incidence of first-ever stroke and transient ischemic attack (TIA) and 30-day case-fatality rates in a population-based setting in Tandil, Argentina....... METHODS: We prospectively identified all first-ever stroke and TIA cases from overlapping sources between January 5, 2013, and April 30, 2015, in Tandil, Argentina. We calculated crude and standardized incidence rates. We estimated 30-day case-fatality rates. RESULTS: We identified 334 first-ever strokes.......1% (95% CI, 14.2-36.6) for intracerebral hemorrhage, and 1.9% (95% CI, 0.4-5.8) for TIA. CONCLUSIONS: This study provides the first prospective population-based stroke and TIA incidence and case-fatality estimate in Argentina. First-ever stroke incidence was lower than that reported in previous Latin...

  8. 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.

  9. The association of graduated driver licensing with miles driven and fatal crash rates per miles driven among adolescents.

    Science.gov (United States)

    Zhu, Motao; Cummings, Peter; Zhao, Songzhu; Coben, Jeffrey H; Smith, Gordon S

    2015-04-01

    Graduated driver licensing (GDL) laws are associated with reduced crash rates per person-year among adolescents. It is unknown whether adolescents crash less per miles driven or drive less under GDL policies. We used data from the US National Household Travel Survey and Fatality Analysis Reporting System for 1995-1996, 2001-2002 and 2008-2009. We compared adolescents subject to GDL laws with those not by estimating adjusted IRRs for being a driver in a crash with a death per person-year (aIRRpy) and per miles driven (aIRRm), and adjusted miles driven ratios (aMR) controlling for changes in rates over time. Comparing persons subject to GDL policies with those not, 16 year olds had fewer fatal crashes per person-year (aIRRpy 0.63, 95% CI 0.47 to 0.91), drove fewer miles (aMR 0.79, 95% CI 0.63 to 0.98) and had lower crash rates per miles driven (aIRRm 0.83, 95% CI 0.65 to 1.06). For age 17, the aIRRpy was 0.83 (95% CI 0.60 to 1.17), the aMR 0.80 (95% CI 0.63 to 1.03) and the aIRRm 1.03 (95% CI 0.80 to 1.35). For age 18, the aIRRpy was 0.93 (95% CI 0.72 to 1.19), the aMR 0.92 (95% CI 0.77 to 1.09) and the aIRRm 1.01 (95% CI 0.84 to 1.23). If these associations are causal, GDL laws reduced crashes per person-year by about one-third among 16 year olds; half the reduction was due to fewer crashes per miles driven and half to less driving. For ages 17 and 18, there was no evidence of reduced crash rates per miles driven. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. 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

  11. Maternal mortality in a rural tanzanian hospital: fatal Jarisch-Herxheimer reaction in a case of relapsing fever in pregnancy.

    NARCIS (Netherlands)

    Rustenhoven-Spaans, I.; Melkert, P.; Nelissen, E.J.T.; van Roosmalen, J.; Stekelenburg, J.

    2013-01-01

    Relapsing fever is a disease caused by one of the species of Borrelia. It is often misdiagnosed as malaria and can have fatal complications such as the Jarisch-Herxheimer reaction (JHR) after the commencement of treatment with antibiotics. A 19-year-old Tanzanian woman was admitted after a term home

  12. Maternal mortality in a rural Tanzanian hospital: fatal Jarisch-Herxheimer reaction in a case of relapsing fever in pregnancy

    NARCIS (Netherlands)

    Rustenhoven-Spaan, Ilona; Melkert, Peter; Nelissen, Ellen; van Roosmalen, Jos; Stekelenburg, Jelle

    2013-01-01

    Relapsing fever is a disease caused by one of the species of Borrelia. It is often misdiagnosed as malaria and can have fatal complications such as the Jarisch-Herxheimer reaction (JHR) after the commencement of treatment with antibiotics. A 19-year-old Tanzanian woman was admitted after a term home

  13. 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)....

  14. 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.

  15. 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).

  16. 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...

  17. 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...

  18. 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...

  19. 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.

  20. 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.

  1. 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.

  2. Trends in the Fractures and Fatalities of Farmyard Injuries in Ireland: A 10 year analysis

    LENUS (Irish Health Repository)

    Lee, MJ

    2017-01-01

    The farming and agricultural sector remains one of Ireland’s primary industries. Fatality rates remain higher than the European average. The aim of this study was to analyze the national trend in hospital in-patient admissions for farmyard related fractures and related fatalities in Ireland from 2005 to 2014. Relevant socioeconomic trends were used for comparison. There were 2,064 farm-related fractures and 187 fatalities recorded over the same period. Despite a decrease in incidence of farmyard fractures over 2005-2014, fatality rates have increased indicating the alarming continued occupational hazards and severity of sustained injuries.

  3. Fatal outcomes among patients on maintenance haemodialysis in sub-Saharan Africa: a 10-year audit from the Douala General Hospital in Cameroon.

    Science.gov (United States)

    Halle, Marie Patrice; Ashuntantang, Gloria; Kaze, Francois Folefack; Takongue, Christian; Kengne, Andre-Pascal

    2016-11-03

    End-Stage Renal disease (ESRD) is associated with increased morbidity and mortality. We assessed the occurrence, time-trend and determinants of fatal outcomes of haemodialysis-treated ESRD patients over a 10-year period in a major referral hospital in Cameroon. Medical records of ESRD patients who started chronic haemodialysis at the Douala General Hospital between 2002 and 2012 were reviewed. Baseline characteristics and fatal outcomes on dialysis were recorded. Accelerated-failure time and logistic regression models were used to investigate the determinants of death. A total of 661 patients with 436 (66 %) being men were included in the study. Mean age at dialysis initiation was 46.3 ± 14.7 years. The median [25 th -75 th percentiles] duration on dialysis was 187 [34-754] days. A total of 297 (44.9 %) deaths were recorded during follow-up with statistical difference over the years (p risk of mortality, relative to hypertension alone. Mortality in dialysis is excessively high in this setting. Because most of these premature deaths are potentially preventable, additional efforts are needed to offset the risk and maximise the benefits from the ongoing investments of the government to defray the cost of haemodialysis. Potential actions include sensitisation of the population and healthcare practitioners, early detection and referral of individuals with CKD; and additional subsidies to support the cost of managing co-morbidities in patients with CKD in general.

  4. Age trajectories of stroke case fatality

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Andersen, Zorana Jovanovic; Andersen, Klaus Kaae

    2011-01-01

    Mortality rates level off at older ages. Age trajectories of stroke case-fatality rates were studied with the aim of investigating prevalence of this phenomenon, specifically in case-fatality rates at older ages....

  5. Maternal mortality in a rural Tanzanian hospital: fatal Jarisch-Herxheimer reaction in a case of relapsing fever in pregnancy.

    Science.gov (United States)

    Rustenhoven-Spaan, Ilona; Melkert, Peter; Nelissen, Ellen; van Roosmalen, Jos; Stekelenburg, Jelle

    2013-10-01

    Relapsing fever is a disease caused by one of the species of Borrelia. It is often misdiagnosed as malaria and can have fatal complications such as the Jarisch-Herxheimer reaction (JHR) after the commencement of treatment with antibiotics. A 19-year-old Tanzanian woman was admitted after a term home delivery that day. She presented with a 2 day history of fever, headache, general body malaise and vomiting. She was misdiagnosed as having severe malaria and was treated with quinine. The blood slide showed Borrelia duttoni. The patient continued treatment with procaine penicillin fortified for relapsing fever. Several hours later the woman died, probably due to JHR. This case of a patient with relapsing fever who died from a JHR stresses the importance of adequate diagnosis and treatment which should include careful monitoring, especially for the first hours after starting antibiotics.

  6. 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.

  7. Femme fatale

    Directory of Open Access Journals (Sweden)

    Francisco Javier Tardío Gastón

    2011-12-01

    Full Text Available Our history is full of myths and topics. Therefore the image of femme fatale is frequent in the works of all periods and places. The author of this article first analyzes how the history and literature consistently showed and defined these women, and then presents examples that come from ancient Greece. The art is powered by their power of seduction and the article explains how this femme fatale appeared in literature and film. The article concludes with a brief overview of various arguments concerning women and feminism, present in the literary criticism.

  8. 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/

  9. Islamic fatalism

    Directory of Open Access Journals (Sweden)

    Helmer Ringgren

    1967-02-01

    Full Text Available The author sketches the historical background, then the teaching of the Koran, and finally, the development of the typical Islamic fatalism. The fatalism of Islam has to be viewed against the background of the ideas of pre-Islamic Arabia. Unfortunately, there is no other evidence from this epoch that a few poems on a very restricted range of topics which have been able to survive Islamic censure. The conventional and stereotyped character of these poems makes it difficult to decide to what extent they reflect commonly accepted views or the ideas of a certain group. In any case, they present a picture of the pagan Arab which is extremely idealized and formed after a rigid pattern. Historically speaking, Islamic 'fatalism' is the result of a combination of pre-Islamic fatalism and Muhammad's belief in God's omnipotence. From another point of view it is an interpretation of destiny that expresses man's feeling of total dependence, not on an impersonal power or universal order, but on an omnipotent God.

  10. 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.

  11. 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.

  12. Global incidence and case fatality rate of pulmonary embolism following major surgery: a protocol for a systematic review and meta-analysis of cohort studies.

    Science.gov (United States)

    Temgoua, Mazou N; Tochie, Joel Noutakdie; Noubiap, Jean Jacques; Agbor, Valirie Ndip; Danwang, Celestin; Endomba, Francky Teddy A; Nkemngu, Njinkeng J

    2017-12-04

    Pulmonary embolism (PE) is a life-threatening condition common after major surgery. Although the high incidence (0.3-30%) and mortality rate (16.9-31%) of PE in patients undergoing major surgical procedures is apparent from findings of contemporary observational studies, there is a lack of a summary and meta-analysis data on the epidemiology of postoperative PE in this same regard. Hence, we propose to conduct the first systematic review to summarise existing data on the global incidence, determinants and case fatality rate of PE following major surgery. Electronic databases including MEDLINE, EMBASE, SCOPUS, WHO global health library (including LILACS), Web of Science and Google scholar from inception to April 30, 2017, will be searched for cohort studies reporting on the incidence, determinants and case fatality rate of PE occurring after major surgery. Data from grey literature will also be assessed. Two investigators will independently perform study selection and data extraction. Included studies will be evaluated for risk of bias. Appropriate meta-analytic methods will be used to pool incidence and case fatality rate estimates from studies with identical features, globally and by subgroups of major surgical procedures. Random-effects and risk ratio with 95% confidence interval will be used to summarise determinants and predictors of mortality of PE in patients undergoing major surgery. This systematic review and meta-analysis will provide the most up-to-date epidemiology of PE in patients undergoing major surgery to inform health authorities and identify further research topics based on the remaining knowledge gaps. PROSPERO CRD42017065126.

  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. Clinical Features of Fatal Asthma

    Directory of Open Access Journals (Sweden)

    Chiung-Zuei Chen

    2006-05-01

    Full Text Available To characterize the clinical features of fatal asthma, we retrospectively analyzed the clinical characteristics of patients who died of an acute asthma attack in our hospital during a 15-year period from 1989 to 2003. Twelve patients had fatal asthma during this period, including eight who were dead on arrival in the emergency room (ER and three who died within 1 hour of admission to the ER. Patients were categorized into three groups according to the clinical presentations during the fatal attack: (1 rapid (< 3 hours decompensation in four patients; (2 gradual development of respiratory failure over several days in two patients; and (3 acute deterioration after unstable asthma lasting several days in six patients. All patients in groups 1 and 2 had reported previous near-fatal attacks. The proportion of young patients was highest in group 3, with half of them (3/6 younger than 35 years of age. Only one patient in group 3 had had a previous near-fatal attack. Five of the seven patients, with previous near-fatal attacks, had a pattern of decompensation during their fatal attack that was similar to their previous attacks. In conclusion, nearly all patients with fatal asthma in this study died outside of the hospital or within 1 hour after admission to the ER. Patients had patterns of decompensation during the fatal attack that were similar to those of their previous attacks. Early detection of warning signs, early admission to the ER, adequate treatment, and extremely close observation of patients, especially within 1 hour after ER arrival, may prevent or decrease the incidence of fatal asthmatic attack.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. Extended investigation on road fatality in Brunei.

    Science.gov (United States)

    Yusof, N B; Hoque, M A; Steele, M C; Yong, S Y

    2018-06-08

    Road fatality is one of the leading causes of death in Brunei with 79 deaths in 1993, the highest ever recorded. The Brunei government has been trying to reduce this by implementing new traffic measures and successfully reduced fatalities to 24 fatalities in 2014. Yearly road fatality has been fluctuating, but there has been a declining tendency overall. The aim of this study is to investigate road fatality in Brunei by extending the research. We developed a multiple regression model and carried out an analysis on road fatality in Brunei. Our analysis indicates that the road fatality appears to rise depending on the increase in the number of young drivers between 15 to 24 years and the number of unemployed people. Comparisons of Brunei road fatality rate per 10,000 vehicles are made with some other countries and we conclude that Brunei has approximately the same rate as Australia in 2014.

  2. Global earthquake fatalities and population

    Science.gov (United States)

    Holzer, Thomas L.; Savage, James C.

    2013-01-01

    Modern global earthquake fatalities can be separated into two components: (1) fatalities from an approximately constant annual background rate that is independent of world population growth and (2) fatalities caused by earthquakes with large human death tolls, the frequency of which is dependent on world population. Earthquakes with death tolls greater than 100,000 (and 50,000) have increased with world population and obey a nonstationary Poisson distribution with rate proportional to population. We predict that the number of earthquakes with death tolls greater than 100,000 (50,000) will increase in the 21st century to 8.7±3.3 (20.5±4.3) from 4 (7) observed in the 20th century if world population reaches 10.1 billion in 2100. Combining fatalities caused by the background rate with fatalities caused by catastrophic earthquakes (>100,000 fatalities) indicates global fatalities in the 21st century will be 2.57±0.64 million if the average post-1900 death toll for catastrophic earthquakes (193,000) is assumed.

  3. 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

  4. A one-year observational study of all hospitalized and fatal acute poisonings in Oslo: epidemiology, intention and follow-up.

    Science.gov (United States)

    Lund, Cathrine; Teige, Brita; Drottning, Per; Stiksrud, Birgitte; Rui, Tor Olav; Lyngra, Marianne; Ekeberg, Oivind; Jacobsen, Dag; Hovda, Knut Erik

    2012-10-09

    Up to date information on poisoning trends is important. This study reports the epidemiology of all hospitalized acute poisonings in Oslo, including mortality, follow-up referrals, and whether the introduction of over-the-counter sales of paracetamol outside pharmacies had an impact on the frequency of poisonings. All acute poisonings of adults (≥16 years) treated at the five hospitals in Oslo from April 2008 to April 2009 were included consecutively in an observational cross-sectional multicentre study. A standardized form was completed by the treating physician, which covered the study aims. All deaths by poisoning in and outside hospitals were registered at the Institute of Forensic Medicine. There were 1065 hospital admissions of 912 individuals; 460 (50%) were male, and the median age was 36 years. The annual incidence was 2.0 per 1000. The most frequent toxic agents were ethanol (18%), benzodiazepines (15%), paracetamol (11%), and opioids (11%). Physicians classified 46% as possible or definite suicide attempts, 37% as accidental overdoses with substances of abuse (AOSA), and 16% as other accidents. Twenty-four per cent were discharged without any follow-up and the no follow-up odds were highest for AOSA. There were 117 deaths (eight in hospital), of which 75% were males, and the median age was 41 years. Thus, the annual mortality rate was 25 per 100 000 and the in-hospital mortality was 0.8%. Opioids were the most frequent cause of death. The incidence of hospitalized acute poisonings in Oslo was similar to that in 2003 and there was an equal sex distribution. Compared with a study performed in Oslo in 2003, there has been an increase in poisonings with a suicidal intention. The in-hospital mortality was low and nine out of ten deaths occurred outside hospitals. Opioids were the leading cause of death, so preventive measures should be encouraged among substance abusers. The number of poisonings caused by paracetamol remained unchanged after the

  5. 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.

  6. 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.

  7. 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...

  8. 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

  9. Stroke incidence and 30-day and six-month case fatality rates in Udine, Italy: a population-based prospective study.

    Science.gov (United States)

    Janes, Francesco; Gigli, Gian Luigi; D'Anna, Lucio; Cancelli, Iacopo; Perelli, Anna; Canal, Giessica; Russo, Valentina; Zanchettin, Barbara; Valente, Mariarosaria

    2013-10-01

    Stroke incidence in high-income countries is reported to decrease, and new data on stroke incidence and outcome are needed to design stroke services and to ameliorate stroke management. This study is part of a two-year prospective community-based registry of all cerebrovascular events in the district of Udine (153,312 inhabitants), Friuli-Venezia Giulia region, northeast of Italy, between 1 April 2007 and 31 March 2009. Overlapping sources for case finding were used, combining hot and cold pursuit. We identified 784 stroke cases, 640 (81.6%) incident. The crude overall annual incidence rate per 100,000 residents was 256 (95% confidence interval 241-271) for all strokes and 209 (95% confidence interval 195-223) for first-ever strokes. Incidence rate for first-ever strokes was 181 (95% confidence interval 155-211) after adjustment to the 2007 Italian population and 104 (95% confidence interval 88-122) compared with the European standard population. Incidence rates for first-ever strokes was 215 (196-235) for women, 202 (183-223) for men. Crude annual incidence rates per 100,000 population were 167 (153-178) for ischemic stroke, 31 (26-37) for intracerebral hemorrhage, 8.1 (5.7-11.4) for sub-arachnoid hemorrhage, and 4.6 (2.8-7.1) for undetermined stroke. Overall case fatality rates for first-ever stroke were 20.6% at 28 days and 30.2% at 180 days. Our study shows incidence rates higher than previously reported in our region but not supporting the view of higher incidence rates in Northern than in Southern Italy. Results contribute to time-trends analysis on epidemiology, useful for dimensioning services in Italy and show the persistence of a gap between the outcome of stroke in Italy and that of the best performing European countries, urging to adopt better stroke management plans. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

  10. 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.

  11. 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.

  12. Significant decline in case fatality after acute myocardial infarction in Denmark--a population-based study from 1994 to 2001

    DEFF Research Database (Denmark)

    Abildstrom, Steen Z; Rasmussen, Søren; Madsen, Mette

    2002-01-01

    OBJECTIVE: We evaluated trends in in-hospital case fatality after acute myocardial infarction (AMI) in Denmark and analysed changes in the hospitalization rate for AMI. DESIGN: National population-based registries were used to identify patients (> or =30 years) who were admitted for their first AMI...... from 1994 to 2001. RESULTS: The annual relative decline in case-fatality rate was constant at 10.5% (95% confidence interval (CI) 9.5-11.5%). The decline was similar for both genders at all ages. The hospitalization rate decreased from 1994 to 1999 at an annual average of 4.3% (95% CI 3.......4-5.1%). In 2000 and 2001 the average annual increase was 7-8%. CONCLUSION: The case-fatality rate after AMI declined significantly in Denmark, similar to other Western countries, but the level is still higher than that of the USA. The increasing hospitalization rate coincided with changes in risk factors...

  13. 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).

  14. 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

  15. 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.

  16. 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.

  17. Case-fatality of COPD exacerbations: a meta-analysis and statistical modeling approach

    DEFF Research Database (Denmark)

    Hoogendoorn, M; Hoogenveen, R T; Rutten-van Mölken, M P

    2010-01-01

    %-confidence interval. The meta-analysis based on six studies that fulfilled the inclusion criteria resulted in a weighted average case-fatality rate of 15.6% (95%CI:10.9%-20.3%), ranging from 11.4% to 19.0% for the individual studies. A severe COPD exacerbation requiring hospitalization not only results...

  18. 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

  19. 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.

  20. [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.

  1. 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

  2. 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.

  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. 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.

  10. 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

  11. Incidence of paediatric fatal and non-fatal low speed vehicle run over events in Queensland, Australia: eleven year analysis

    Science.gov (United States)

    2014-01-01

    Background The purpose of this study was to estimate the incidence of fatal and non-fatal Low Speed Vehicle Run Over (LSVRO) events among children aged 0–15 years in Queensland, Australia, at a population level. Methods Fatal and non-fatal LSVRO events that occurred in children resident in Queensland over eleven calendar years (1999-2009) were identified using ICD codes, text description, word searches and medical notes clarification, obtained from five health related data bases across the continuum of care (pre-hospital to fatality). Data were manually linked. Population data provided by the Australian Bureau of Statistics were used to calculate crude incidence rates for fatal and non-fatal LSVRO events. Results There were 1611 LSVROs between 1999–2009 (IR = 16.87/100,000/annum). Incidence of non-fatal events (IR = 16.60/100,000/annum) was 61.5 times higher than fatal events (IR = 0.27/100,000/annum). LSVRO events were more common in boys (IR = 20.97/100,000/annum) than girls (IR = 12.55/100,000/annum), and among younger children aged 0–4 years (IR = 21.45/100000/annum; 39% or all events) than older children (5–9 years: IR = 16.47/100,000/annum; 10–15 years IR = 13.59/100,000/annum). A total of 896 (56.8%) children were admitted to hospital for 24 hours of more following an LSVRO event (IR = 9.38/100,000/annum). Total LSVROs increased from 1999 (IR = 14.79/100,000) to 2009 (IR = 18.56/100,000), but not significantly. Over the 11 year period, there was a slight (non –significant) increase in fatalities (IR = 0.37-0.42/100,000/annum); a significant decrease in admissions (IR = 12.39–5.36/100,000/annum), and significant increase in non-admissions (IR = 2.02-12.77/100,000/annum). Trends over time differed by age, gender and severity. Conclusion This is the most comprehensive, population-based epidemiological study on fatal and non-fatal LSVRO events to date. Results from this study indicate

  12. 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.

  13. 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

  14. Nordic ski jumping fatalities in the United States: a 50-year summary.

    Science.gov (United States)

    Wright, J R

    1988-06-01

    Nordic ski-jumping fatalities are rare events. Six jumping fatalities have occurred in the United States during the past 50 years. The fatality rate for nordic ski jumping, estimated to be roughly 12 fatalities/100,000 participants annually, appears to be within the range of fatality rates for other "risky" outdoor sports. Cervical fractures appear to be the most frequent fatal ski-jumping injury.

  15. 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.

  16. 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.

  17. 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...

  18. 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...

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. 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)

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

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    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.

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

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    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)

  6. 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)

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

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    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

  8. 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

  9. Fatal consequences of synergistic anticoagulation

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    Sen P

    2018-05-01

    Full Text Available Objective: Novel oral anticoagulants (NOACs are increasingly being preferred by clinicians (and patients because they have a wide therapeutic window and therefore do not require monitoring of anticoagulant effect. Herein, we describe the unfortunate case of a patient who had fatal consequences as a result of switching from warfarin to rivaroxaban. Case Summary: A 90-year-old Caucasian woman, with atrial fibrillation on chronic anticoagulation with warfarin, was admitted to the hospital for pneumonia. She was treated with levofloxacin. In the same admission, her warfarin was switched to rivaroxaban. On Day 3 after the switch, her INR was found to be 6, and she developed a cervical epidural hematoma from C2 to C7. She ultimately developed respiratory arrest, was put on comfort care and died. Discussion: Rivaroxaban and warfarin are known to have a synergistic anticoagulant effect, usually seen shortly after switching. Antibiotics also increase the effects of warfarin by the inhibition of metabolizing isoenzymes. It is hypothesized that these two effects led to the fatal cervical spinal hematoma. Conclusion: The convenience of a wide therapeutic window and no requirement of laboratory monitoring makes the NOACs a desirable option for anticoagulation. However, there is lack of data and recommendations on how to transition patients from Warfarin to NOACs or even how to transition from one NOAC to another. Care should be taken to ensure continuous monitoring of anticoagulation when stopping, interrupting or switching between NOACS to avoid the possibility of fatal bleeding and strokes.

  10. 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...

  11. 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.

  12. 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

  13. 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

  14. 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

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

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    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.

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

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    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

  17. Hospitalised and Fatal Head Injuries in Viti Levu, Fiji: Findings from an Island-Wide Trauma Registry (TRIP 4)

    Science.gov (United States)

    Kool, Bridget; Raj, Naina; Wainiqolo, Iris; Kafoa, Berlin; McCaig, Eddie; Ameratunga, Shanthi

    2012-01-01

    Background Globally, head injury is a substantial cause of mortality and morbidity. A disproportionately greater burden is borne by low- and middle-income countries. The incidence and characteristics of fatal and hospitalised head injuries in Fiji are unknown. Methods Using prospective data from the Fiji Injury Surveillance in Hospital system, the epidemiology of fatal and hospitalised head injuries was investigated (2004–2005). Results In total, 226 hospital admissions and 50 fatalities (66% died prior to admission) with a principal diagnosis of head injury were identified (crude annual rates of 34.7 and 7.7/100,000, respectively). Males were more likely to die and be hospitalised as a result of head injury than females. The highest fatality rate was among those in the 30–44-year age group. Road traffic crashes were the leading causes of injuries resulting in death (70%), followed by ‘hit by person or object’ and falls (14% each). Among people admitted to hospital, road traffic crashes (34.5%) and falls (33.2%) were the leading causes of injury. The leading cause of head injuries in children was falls, in 15–29-year-olds road traffic crashes, and in adults aged 30–44 years or 45 years and older ‘hit by person or object’. Among the two major ethnic groups, Fijians had higher rates of falls and ‘hit by person or object’ and Indians higher rates for road traffic crashes. There were no statistically significant differences between the overall rates of head injuries or the fatal and non-fatal rates among Fijians or Indians by gender following age standardisation to the total Fijian national population. Conclusion Despite underestimating the overall burden, this study identified head injury to be a major cause of death and hospitalisation in Fiji. The predominance of males and road traffic-related injuries is consistent with studies on head injuries conducted in other low- and middle-income countries. The high fatality rate among those aged 30–44

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. Trends in Stroke Incidence and 28-Day Case Fatality in a Nationwide Stroke Registry of a Multiethnic Asian Population.

    Science.gov (United States)

    Tan, Chuen Seng; Müller-Riemenschneider, Falk; Ng, Sheryl Hui Xian; Tan, Pei Zheng; Chan, Bernard P L; Tang, Kok-Foo; Ahmad, Aftab; Kong, Keng He; Chang, Hui Meng; Chow, Khuan Yew; Koh, Gerald Choon-Huat; Venketasubramanian, Narayanaswamy

    2015-10-01

    This study investigated trends in stroke incidence and case fatality overall and according to sex, age, ethnicity, and stroke subtype in a multiethnic Asian population. The Singapore Stroke Registry identifies all stroke cases in all public hospitals using medical claims, hospital discharge summaries, and death registry data. Age-standardized incidence rates and 28-day case-fatality rates were calculated for individuals aged ≥15 years between 2006 and 2012. To estimate the annual percentage change of the rates, a linear regression model was fitted to the log rates, and a Wald test was performed to test for trend. P values Chinese (-2.64; 95% CI, -3.15 to -2.13), Indians (-3.78; 95% CI, -5.93 to -1.58), and others (-12.73; 95% CI, -18.93 to -6.06) compared with Malays (2.58; 95% CI, 1.17 to 4.02); and in ischemic stroke subtype (ischemic: -2.43; 95% CI, -3.13 to -1.73; hemorrhagic: -1.02; 95% CI, -2.04 to 0.01). Subgroup-specific findings for case fatality were similar. This is the first countrywide hospital-based registry study in a multiethnic Asian population, and it revealed marked overall reductions in stroke incidence and case fatality. However, it also identified important population groups with less favorable trends, especially younger adults and those of Malay ethnicity. © 2015 American Heart Association, Inc.

  5. 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...

  6. 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.

  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. The Life Saving Effects of Hospital Proximity

    DEFF Research Database (Denmark)

    Bertoli, Paola; Grembi, Veronica

    We assess the lifesaving effect of hospital proximity using data on fatality rates of road-traffic accidents. While most of the literature on this topic is based on changes in distance to the nearest hospital triggered by hospital closures and use OLS estimates, our identification comes from......) increases the fatality rate by 13.84% on the sample average. This is equal to a 0.92 additional death per every 100 accidents. We show that OLS estimates provide a downward biased measure of the real effect of hospital proximity because they do not fully solve spatial sorting problems. Proximity matters...... more when the road safety is low; the emergency service is not properly organized, and the nearest hospital has lower quality standards....

  9. 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

  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. 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.

  13. [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.

  14. Diferença de letalidade hospitalar do infarto agudo do miocárdio entre homens e mulheres submetidos a angioplastia primária Difference in the case-fatality rate of acute myocardial infarction between men and women submitted to primary angioplasty

    Directory of Open Access Journals (Sweden)

    Luiz Carlos Santana Passos

    1998-10-01

    Full Text Available OBJETIVO: Comparar a letalidade hospitalar (LH de homens e mulheres submetidos a angioplastia transluminal coronária primária (ATCP como estratégia de reperfusão no infarto agudo do miocárdio (IAM. MÉTODOS: Estudo de coorte retrospectivo baseado em informações de prontuários médicos de pacientes hospitalizados devido a IAM em hospital de referência para doença coronária, utilizando preferencialmente a ATCP como técnica de reperfusão miocárdica precoce. Foram incluídos 83 pacientes, 35 (42% mulheres e 48 (58% homens, que preencheram critérios para reperfusão miocárdica precoce. RESULTADOS: A média de idade das mulheres foi superior a dos homens (66±10 vs 58±11 anos; pPURPOSE: To compare the in-hospital case-fatality rate of men and women submitted to percutaneous transluminal coronary angioplasty (PTCA as a strategy of reperfusion in acute myocardial infarction (MI. METHODS: A retrospective cohort study based on information abstracted from medical records of MI patients admitted to a hospital where PTCA is used as the prefered method for early myocardial reperfusion. A total of 83 patients, 35 (42% women and 48 (58% men, who met the criteria for early myocardial reperfusion was included in the analysis. RESULTS: The mean age of women was higher than that of men (66±10 vs 58±11 years; p<0.001. The women also had a higher frequency of diabetes mellitus (37.1% vs 6.4%; p<0.001. Despite these differences in age and in the frequency of diabetes mellitus, the percentage of patients in whom the PTCA was considered successful was similar between men (83.3% and women (82.3%. The case-fatality rate was also similar between men and women; 14.6% and 14.3%, respectively. CONCLUSION: The possibility that the excess risk of death in women with MI may be reduced and even eliminated with the use of PTCA, supports to the need for the development of a clinical trial to assess this question.

  15. 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

  16. 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

  17. No to fatalism

    International Nuclear Information System (INIS)

    Pecqueur, Michel

    1980-01-01

    By saying 'No to fatalism', M. Pecqueur is forming the wish that the recent awarness of the energy situation, far from bringing about resignation, speeds up the implementation of the indispensable measures on which the economic and political stability of the world depends in the decade ahead [fr

  18. Fatal dengue hemorrhagic fever in adults: emphasizing the evolutionary pre-fatal clinical and laboratory manifestations.

    Directory of Open Access Journals (Sweden)

    Ing-Kit Lee

    Full Text Available BACKGROUND: A better description of the clinical and laboratory manifestations of fatal patients with dengue hemorrhagic fever (DHF is important in alerting clinicians of severe dengue and improving management. METHODS AND FINDINGS: Of 309 adults with DHF, 10 fatal patients and 299 survivors (controls were retrospectively analyzed. Regarding causes of fatality, massive gastrointestinal (GI bleeding was found in 4 patients, dengue shock syndrome (DSS alone in 2; DSS/subarachnoid hemorrhage, Klebsiella pneumoniae meningitis/bacteremia, ventilator associated pneumonia, and massive GI bleeding/Enterococcus faecalis bacteremia each in one. Fatal patients were found to have significantly higher frequencies of early altered consciousness (≤24 h after hospitalization, hypothermia, GI bleeding/massive GI bleeding, DSS, concurrent bacteremia with/without shock, pulmonary edema, renal/hepatic failure, and subarachnoid hemorrhage. Among those experienced early altered consciousness, massive GI bleeding alone/with uremia/with E. faecalis bacteremia, and K. pneumoniae meningitis/bacteremia were each found in one patient. Significantly higher proportion of bandemia from initial (arrival laboratory data in fatal patients as compared to controls, and higher proportion of pre-fatal leukocytosis and lower pre-fatal platelet count as compared to initial laboratory data of fatal patients were found. Massive GI bleeding (33.3% and bacteremia (25% were the major causes of pre-fatal leukocytosis in the deceased patients; 33.3% of the patients with pre-fatal profound thrombocytopenia (<20,000/µL, and 50% of the patients with pre-fatal prothrombin time (PT prolongation experienced massive GI bleeding. CONCLUSIONS: Our report highlights causes of fatality other than DSS in patients with severe dengue, and suggested hypothermia, leukocytosis and bandemia may be warning signs of severe dengue. Clinicians should be alert to the potential development of massive GI bleeding

  19. 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.

  20. 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.

  1. 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.

  2. 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...

  3. 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

  4. Impact of on-site cardiac catheterization on resource utilization and fatal and non-fatal outcomes after acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Richard Hugues

    2006-11-01

    Full Text Available Abstract Background Patterns of care for acute myocardial infarction (AMI strongly depend on the availability of on-site cardiac catheterization facilities. Although the management found at hospitals without on-site catheterization does not lead to increased mortality, little it known about its impact on resource utilization and non-fatal outcomes. Methods We identified all patients (n = 35,289 admitted with a first AMI in the province of Quebec between January 1, 1996 and March 31, 1999 using population-based administrative databases. Medical resource utilization and non-fatal and fatal outcomes were compared among patients admitted to hospitals with and without on-site cardiac catheterization facilities. Results Cardiac catheterization and PCI were more frequently performed among patients admitted to hospitals with catheterization facilities. However, non-invasive procedures were not used more frequently at hospitals without catheterization facilities. To the contrary, echocardiography [odds ratio (OR, 2.04; 95% confidence interval (CI, 1.93–2.16] and multi-gated acquisition imaging (OR, 1.24; 95% CI, 1.17–1.32 were used more frequently at hospitals with catheterization, and exercise treadmill testing (OR, 1.02; 95% CI, 0.91–1.15 and Sestamibi/Thallium imaging (OR, 0.93; 95% CI, 0.88–0.98 were used similarly at hospitals with and without catheterization. Use of anti-ischemic medications and frequency of emergency room and physician visits, were similar at both types of institutions. Readmission rates for AMI-related cardiac complications and mortality were also similar [adjusted hazard ratio, recurrent AMI: 1.02, 95% CI, 0.89–1.16; congestive heart failure: 1.02; 95% CI, 0.90–1.15; unstable angina: 0.93; 95% CI, 0.85–1.02; mortality: 0.99; 95% CI, 0.93–1.05]. Conclusion Although on-site availability of cardiac catheterization facilities is associated with greater use of invasive cardiac procedures, non-availability of

  5. 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.

  6. 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

  7. A Rare Fatal Complication of Llizarov Procedure.

    Science.gov (United States)

    Sikary, Asit Kumar; Kumar, Mahesh; Dhaka, Shivani; Subramanian, Arulselvi

    2018-03-01

    Ilizarov process is used for the management of multiple fractures, polytrauma conditions, cosmetic limb lengthening, and fracture malunion. Complications associated with the process are nerve palsy, joint contracture, premature or delayed osseous consolidation, a nonunion and permanent stiffness of the joint, pin tract infection, edema, and transient paresthesia, etc. In our case, there was a fatal complication. A 25-year-old African lady underwent the Ilizarov procedure for femur lengthening in a hospital in New Delhi, India. During her first distraction process, she suddenly collapsed at the hospital and could not be revived. At postmortem, a small hematoma was seen around the surgically fractured area. On histopathology of internal organs, fat globules were present in the vasculature of brain and lungs. Cause of death was opined as due to fat embolism. This is the first case reported of a fatal fat embolism following Ilizarov procedure for limb lengthening in a healthy adult. © 2018 American Academy of Forensic Sciences.

  8. 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%.

  9. 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%

  10. 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...

  11. 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

  12. 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

  13. 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

  14. Risk factors for fatality among confirmed adult dengue inpatients in Singapore: a matched case-control study.

    Directory of Open Access Journals (Sweden)

    Tun-Linn Thein

    Full Text Available OBJECTIVES: To identify demographic, clinical and laboratory risk factors for death due to dengue fever in adult patients in Singapore. METHODS: Multi-center retrospective study of hospitalized adult patients with confirmed dengue fever in Singapore between 1 January 2004 and 31 December 2008. Non-fatal controls were selected by matching age and year of infection with fatal cases. World Health Organization 1997, 2009 criteria were applied to define dengue hemorrhagic fever (DHF, warning signs and severe dengue. Statistical significance was assessed by conditional logistic regression modeling. RESULTS: Significantly more fatal cases than matched controls had pre-existing co-morbid conditions, and presented with abdominal pain/tenderness. Median pulse rates were significantly higher while myalgia was significantly less frequent in cases. . Fatal cases also had higher leucocyte counts, platelet counts, serum sodium, potassium, urea, creatine and bilirubin levels on admission compared to controls. There was no statistical significant difference between the prevalence of DHF and hematocrit level among cases and controls. Multivariate analysis showed myalgia and leucocyte count at presentation were independent predictors of fatality (adjusted odds ratios 0.09 and 2.94 respectively. None of the controls was admitted to intensive care unit (ICU or given blood transfusion, while 71.4% and 28.6% of fatal cases received ICU admission and blood transfusion. CONCLUSIONS: Absence of myalgia and leucocytosis on admission were independently associated with fatality in our matched case-control study. Fatalities were also commonly associated with co-morbidities and clinicians should be alarmed if dengue patients fulfilled severe dengue case definition on admission.

  15. 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

  16. 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

  17. 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.

  18. 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.

  19. 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.

  20. Fatal falls in the US construction industry, 1990 to 1999.

    Science.gov (United States)

    Derr, J; Forst, L; Chen, H Y; Conroy, L

    2001-10-01

    The Occupational Safety and Health Administration's (OSHA's) Integrated Management Information System (IMIS) database allows for the detailed analysis of risk factors surrounding fatal occupational events. This study used IMIS data to (1) perform a risk factor analysis of fatal construction falls, and (2) assess the impact of the February 1995 29 CFR Part 1926 Subpart M OSHA fall protection regulations for construction by calculating trends in fatal fall rates. In addition, IMIS data on fatal construction falls were compared with data from other occupational fatality surveillance systems. For falls in construction, the study identified several demographic factors that may indicate increased risk. A statistically significant downward trend in fatal falls was evident in all construction and within several construction categories during the decade. Although the study failed to show a statistically significant intervention effect from the new OSHA regulations, it may have lacked the power to do so.

  1. Urban sprawl as a risk factor in motor vehicle occupant and pedestrian fatalities.

    Science.gov (United States)

    Ewing, Reid; Schieber, Richard A; Zegeer, Charles V

    2003-09-01

    We sought to determine the association between urban sprawl and traffic fatalities. We created a sprawl index by applying principal components analysis to data for 448 US counties in the largest 101 metropolitan areas. Regression analysis was used to determine associations between the index and traffic fatalities. For every 1% increase in the index (i.e., more compact, less sprawl), all-mode traffic fatality rates fell by 1.49% (P Urban sprawl was directly related to traffic fatalities and pedestrian fatalities. Subsequent studies should investigate relationships at a finer geographic scale and should strive to improve on the measure of exposure used to adjust pedestrian fatality rates.

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. Fatal accidents among Danes with multiple sclerosis

    DEFF Research Database (Denmark)

    Brønnum-Hansen, Henrik; Hansen, Thomas; Koch-Henriksen, Nils

    2006-01-01

    We compared the rate of fatal accidents among Danes with multiple sclerosis (MS) with that of the general population. The study was based on linkage of the Danish Multiple Sclerosis Registry to the Cause of Death Registry and covered all 10174 persons in whom MS was diagnosed during the period 19...... for deaths from burns (SMR = 8.90) and suffocation (SMR = 5.57). We conclude that persons with MS are more prone to fatal accidents than the general population. The excess risk is due not to traffic accidents but to burns and suffocation.......-1996. The end of follow-up was 1 January 1999. We calculated standardized mortality ratios (SMRs) for various types of fatal accidents. A total of 76 persons (48 men and 28 women) died from accidents, whereas the expected number of fatalities from such causes was 55.7 (31.4 men and 24.3 women). Thus, the risk...... for death from accidents among persons with MS was 37% higher than that of the general population (SMR = 1.37). We found no significant excess risk for fatal road accidents (SMR = 0.80). The risk for falls was elevated (SMR = 1.29) but not statistically significantly so. The risks were particularly high...

  7. 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

  8. Quasi-likelihood generalized linear regression analysis of fatality risk data.

    Science.gov (United States)

    2009-01-01

    Transportation-related fatality risks is a function of many interacting human, vehicle, and environmental factors. Statistically valid analysis of such data is challenged both by the complexity of plausible structural models relating fatality rates t...

  9. 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

  10. 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

  11. Genetic influences on incidence and case-fatality of infectious disease.

    Directory of Open Access Journals (Sweden)

    Liselotte Petersen

    Full Text Available BACKGROUND: Family, twin and adoption studies suggest that genetic susceptibility contributes to familial aggregation of infectious diseases or to death from infections. We estimated genetic and shared environmental influences separately on the risk of acquiring an infection (incidence and on dying from it (case fatality. METHODS: Genetic influences were estimated by the association between rates of hospitalization for infections and between case-fatality rates of adoptees and their biological full- and half- siblings. Familial environmental influences were investigated in adoptees and their adoptive siblings. Among 14,425 non-familial adoptions, granted in Denmark during the period 1924-47, we selected 1,603 adoptees, who had been hospitalized for infections and/or died with infection between 1977 and 1993. Their siblings were considered predisposed to infection, and compared with non-predisposed siblings of randomly selected 1,348 adoptees alive in 1993 and not hospitalized for infections in the observation period. The risk ratios presented were based on a Cox regression model. RESULTS: Among 9971 identified siblings, 2829 had been hospitalised for infections. The risk of infectious disease was increased among predisposed compared with non-predisposed in both biological (1.18; 95% confidence limits 1.03-1.36 and adoptive siblings (1.23; 0.98-1.53. The risk of a fatal outcome of the infections was strongly increased (9.36; 2.94-29.8 in biological full siblings, but such associations were not observed for the biological half siblings or for the adoptive siblings. CONCLUSION: Risk of getting infections appears to be weakly influenced by both genetically determined susceptibility to infection and by family environment, whereas there appears to be a strong non-additive genetic influence on risk of fatal outcome.

  12. 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...

  13. 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

  14. 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

  15. Can we reduce workplace fatalities by half?

    Science.gov (United States)

    Koh, David Soo Quee

    2012-06-01

    Singapore, an island republic of over 5 million inhabitants, has 3.1 million workers. Most are employed in the service, finance and tourist/transport industry. Significant numbers work in manufacturing, construction and heavy industry. Following a series of construction and shipyard accidents with multiple deaths in 2004, the government announced its intention to reduce workplace fatalities from 4.9 to 2.5 per 100,000 by 2015. There was strong political will to achieve this target. The strategic approaches were to build workplace safety and health (WSH) capabilities; implement legislative changes with enforcement; promote benefits of WSH and recognize best practices, and enhance partnership with stakeholders. The anticipated outcomes were to reduce workplace fatality and injury rates; have WSH as an integral part of business; and establish a progressive and pervasive WSH culture. With these measures, the workplace fatality rate declined from 4.9/100,000 in 2004, to 2.2/100,000 in 2010. However, other confounding factors could also account for this decline, and have to be considered. The next target, announced by Singapore's Prime Minister in 2008, is to further reduce the workplace fatality rate to 1.8/100,000 by 2018, and to have "one of the best workplace safety records in the world".

  16. Can We Reduce Workplace Fatalities by Half?

    Directory of Open Access Journals (Sweden)

    David Soo Quee Koh

    2012-06-01

    Full Text Available Singapore, an island republic of over 5 million inhabitants, has 3.1 million workers. Most are employed in the service, finance and tourist/transport industry. Significant numbers work in manufacturing, construction and heavy industry. Following a series of construction and shipyard accidents with multiple deaths in 2004, the government announced its intention to reduce workplace fatalities from 4.9 to 2.5 per 100,000 by 2015. There was strong political will to achieve this target. The strategic approaches were to build workplace safety and health (WSH capabilities; implement legislative changes with enforcement; promote benefits of WSH and recognize best practices, and enhance partnership with stakeholders. The anticipated outcomes were to reduce workplace fatality and injury rates; have WSH as an integral part of business; and establish a progressive and pervasive WSH culture. With these measures, the workplace fatality rate declined from 4.9/100,000 in 2004, to 2.2/100,000 in 2010. However, other confounding factors could also account for this decline, and have to be considered. The next target, announced by Singapore’s Prime Minister in 2008, is to further reduce the workplace fatality rate to 1.8/100,000 by 2018, and to have “one of the best workplace safety records in the world”.

  17. 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…

  18. 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...

  19. 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...

  20. Fatal occupational injuries in Taiwan, 1994-2005.

    Science.gov (United States)

    Ho, Shu-Chen; Wang, Li-Yu; Ho, Chi-Kung; Yang, Chun-Yuh

    2010-04-01

    This study examines the trends in rates of fatal occupational injuries in Taiwan by demographic group and occupation for 1994-2005. Data on deaths due to injuries at work from 1994 through 2005 were obtained from the Department of Health which is responsible for the death registration system in Taiwan. Employment data, which were used as the denominators of fatality rates in this study, were retrieved from the Directorate-General of Budget and Accounting Statistics 'Employment and Earnings' database. A Poisson regression model was used to examine the trends in rates of fatal occupational injuries in various occupations while controlling for demographic characteristics. Overall fatal occupational injury rates declined during the study period among all demographic groups and occupations. Adjusted annual changes in rates of fatal injuries ranged from a decrease of 13.6% a year in machine operators/related workers to a decrease of 35.9% in clerks. The annual decrement was faster for males than for females and for older workers compared to young workers. Despite declining rates, the number of fatal occupational injuries in Taiwan remains significant because of the growing work force. Future research should focus on the disparities in fatal injury trends.

  1. Incidences and variations of hospital acquired venous thromboembolism in Australian hospitals: a population-based study.

    Science.gov (United States)

    Assareh, Hassan; Chen, Jack; Ou, Lixin; Hillman, Ken; Flabouris, Arthas

    2016-09-22

    Data on hospital-acquired venous thromboembolism (HA-VTE) incidence, case fatality rate and variation amongst patient groups and health providers is lacking. We aim to explore HA-VTE incidences, associated mortality, trends and variations across all acute hospitals in New South Wales (NSW)-Australia. A population-based study using all admitted patients (aged 18-90 with a length of stay of at least two days and not transferred to another acute care facility) in 104 NSW acute public and private hospitals during 2002-2009. Poisson mixed models were used to derive adjusted rate ratios (IRR) in presence of patient and hospital characteristics. Amongst, 3,331,677 patients, the incidence of HA-VTE was 11.45 per 1000 patients and one in ten who developed HA-VTE died in hospital. HA-VTE incidence, initially rose, but subsequently declined, whereas case fatality rate consistently declined by 22 % over the study period. Surgical patients were 128 % (IRR = 2.28, 95 % CI: 2.19-2.38) more likely to develop HA-VTE, but had similar case fatality rates compared to medical patients. Private hospitals, in comparison to public hospitals had a higher incidence of HA-VTE (IRR = 1.76; 95 % CI: 1.42-2.18) for medical patients. However, they had a similar incidence (IRR = 0.91; 95 % CI: 0.75-1.11), but a lower mortality (IRR = 0.59; 95 % CI: 0.47-0.75) amongst surgical patients. Smaller public hospitals had a lower HA-VTE incidence rate compared to larger hospitals (IRR  1.71). Hospitals with a lower reported HA-VTE incidence tended to have a higher HA-VTE case fatality rate. Despite the decline in HA-VTE incidence and case fatality, there were large variations in incidents between medical and surgical patients, public and private hospitals, and different hospital groups. The causes of such differences warrant further investigation and may provide potential for targeted interventions and quality improvement initiatives.

  2. 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.

  3. 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

  4. 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.

  5. Fatal Neonatal Herpes Simplex Infection Likely from Unrecognized Breast Lesions.

    Science.gov (United States)

    Field, Scott S

    2016-02-01

    Type 1 herpes simplex virus (HSV-1) is very prevalent yet in rare circumstances can lead to fatal neonatal disease. Genital acquisition of type 2 HSV is the usual mode for neonatal herpes, but HSV-1 transmission by genital or extragenital means may result in greater mortality rates. A very rare scenario is presented in which the mode of transmission was likely through breast lesions. The lesions were seen by nurses as well as the lactation consultant and obstetrician in the hospital after delivery of the affected baby but not recognized as possibly being caused by herpes. The baby died 9 days after birth with hepatic failure and disseminated intravascular coagulation. Peripartum health care workers need to be aware of potential nongenital (including from the breast[s]) neonatal herpes acquisition, which can be lethal. © The Author(s) 2015.

  6. Community Poverty and Child Abuse Fatalities in the United States.

    Science.gov (United States)

    Farrell, Caitlin A; Fleegler, Eric W; Monuteaux, Michael C; Wilson, Celeste R; Christian, Cindy W; Lee, Lois K

    2017-05-01

    Child maltreatment remains a problem in the United States, and individual poverty is a recognized risk factor for abuse. Children in impoverished communities are at risk for negative health outcomes, but the relationship of community poverty to child abuse fatalities is not known. Our objective was to evaluate the association between county poverty concentration and rates of fatal child abuse. This was a retrospective, cross-sectional analysis of child abuse fatalities in US children 0 to 4 years of age from 1999 to 2014 by using the Centers for Disease Control and Prevention Compressed Mortality Files. Population and poverty statistics were obtained from US Census data. National child abuse fatality rates were calculated for each category of community poverty concentration. Multivariate negative binomial regression modeling assessed the relationship between county poverty concentration and child abuse fatalities. From 1999 to 2014, 11 149 children 0 to 4 years old died of child abuse; 45% (5053) were poverty concentration had >3 times the rate of child abuse fatalities compared with counties with the lowest poverty concentration (adjusted incidence rate ratio, 3.03; 95% confidence interval, 2.4-3.79). Higher county poverty concentration is associated with increased rates of child abuse fatalities. This finding should inform public health officials in targeting high-risk areas for interventions and resources. Copyright © 2017 by the American Academy of Pediatrics.

  7. Firearm Legislation and Fatal Police Shootings in the United States.

    Science.gov (United States)

    Kivisto, Aaron J; Ray, Bradley; Phalen, Peter L

    2017-07-01

    To examine whether stricter firearm legislation is associated with rates of fatal police shootings. We used a cross-sectional, state-level design to evaluate the effect of state-level firearm legislation on rates of fatal police shootings from January 1, 2015, through October 31, 2016. We measured state-level variation in firearm laws with legislative scorecards from the Brady Center, and for fatal police shootings we used The Counted, an online database maintained by The Guardian. State-level firearm legislation was significantly associated with lower rates of fatal police shootings (incidence rate ratio = 0.961; 95% confidence interval = 0.939, 0.984). When we controlled for sociodemographic factors, states in the top quartile of legislative strength had a 51% lower incidence rate than did states in the lowest quartile. Laws aimed at strengthening background checks, promoting safe storage, and reducing gun trafficking were associated with fewer fatal police shootings. Legislative restrictions on firearms are associated with reductions in fatal police shootings. Public Health Implications. Although further research is necessary to determine causality and potential mechanisms, firearm legislation is a potential policy solution for reducing fatal police shootings in the United States.

  8. [Fatal occupational accidents in Lombardy].

    Science.gov (United States)

    Pianosi, G

    1995-01-01

    All fatal occupational accidents compensated in Lombardy from 1984 to 1989 were analyzed (1259 cases): significant differences between geographical distribution of fatal occupational accidents and workers were observed. Males accounted for about 95% of fatalities; an excess of cases was shown in both young and elderly workers. Death was the consequence of injuries involving most frequently the head, thorax and spinal cord. An excess of fatalities was observed in agriculture and, at a lower level, in manufacturing industries; small enterprises were involved in approximately 25% of fatalities occurring in the manufacturing industries and services. Employers were the victims of fatal accidents in 50% of cases in agriculture and in 70% of cases in craft industries. Construction, agriculture and transport accounted for about 50% of all fatalities. About 50% of fatal occupational accidents were related to vehicle use: the victim was the driver in the majority of cases, sometimes the victim was run over by a vehicle or fell from a vehicle. The results agree with some previous observations (e.g.: sex and age distribution; construction, agriculture and transport as working activities at high accident risk); but some original observations have emerged, in particular about the frequency of employers as victims and the role of vehicles in the genesis of fatal occupational accidents. If further studies confirm these latter observations, important developments could follow in preventive action design and implementation.

  9. 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...

  10. [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

  11. Cathelicidin Insufficiency in Patients with Fatal Leptospirosis.

    Science.gov (United States)

    Lindow, Janet C; Wunder, Elsio A; Popper, Stephen J; Min, Jin-Na; Mannam, Praveen; Srivastava, Anup; Yao, Yi; Hacker, Kathryn P; Raddassi, Khadir; Lee, Patty J; Montgomery, Ruth R; Shaw, Albert C; Hagan, Jose E; Araújo, Guilherme C; Nery, Nivison; Relman, David A; Kim, Charles C; Reis, Mitermayer G; Ko, Albert I

    2016-11-01

    Leptospirosis causes significant morbidity and mortality worldwide; however, the role of the host immune response in disease progression and high case fatality (>10-50%) is poorly understood. We conducted a multi-parameter investigation of patients with acute leptospirosis to identify mechanisms associated with case fatality. Whole blood transcriptional profiling of 16 hospitalized Brazilian patients with acute leptospirosis (13 survivors, 3 deceased) revealed fatal cases had lower expression of the antimicrobial peptide, cathelicidin, and chemokines, but more abundant pro-inflammatory cytokine receptors. In contrast, survivors generated strong adaptive immune signatures, including transcripts relevant to antigen presentation and immunoglobulin production. In an independent cohort (23 survivors, 22 deceased), fatal cases had higher bacterial loads (P = 0.0004) and lower anti-Leptospira antibody titers (P = 0.02) at the time of hospitalization, independent of the duration of illness. Low serum cathelicidin and RANTES levels during acute illness were independent risk factors for higher bacterial loads (P = 0.005) and death (P = 0.04), respectively. To investigate the mechanism of cathelicidin in patients surviving acute disease, we administered LL-37, the active peptide of cathelicidin, in a hamster model of lethal leptospirosis and found it significantly decreased bacterial loads and increased survival. Our findings indicate that the host immune response plays a central role in severe leptospirosis disease progression. While drawn from a limited study size, significant conclusions include that poor clinical outcomes are associated with high systemic bacterial loads, and a decreased antibody response. Furthermore, our data identified a key role for the antimicrobial peptide, cathelicidin, in mounting an effective bactericidal response against the pathogen, which represents a valuable new therapeutic approach for leptospirosis.

  12. Cathelicidin Insufficiency in Patients with Fatal Leptospirosis.

    Directory of Open Access Journals (Sweden)

    Janet C Lindow

    2016-11-01

    Full Text Available Leptospirosis causes significant morbidity and mortality worldwide; however, the role of the host immune response in disease progression and high case fatality (>10-50% is poorly understood. We conducted a multi-parameter investigation of patients with acute leptospirosis to identify mechanisms associated with case fatality. Whole blood transcriptional profiling of 16 hospitalized Brazilian patients with acute leptospirosis (13 survivors, 3 deceased revealed fatal cases had lower expression of the antimicrobial peptide, cathelicidin, and chemokines, but more abundant pro-inflammatory cytokine receptors. In contrast, survivors generated strong adaptive immune signatures, including transcripts relevant to antigen presentation and immunoglobulin production. In an independent cohort (23 survivors, 22 deceased, fatal cases had higher bacterial loads (P = 0.0004 and lower anti-Leptospira antibody titers (P = 0.02 at the time of hospitalization, independent of the duration of illness. Low serum cathelicidin and RANTES levels during acute illness were independent risk factors for higher bacterial loads (P = 0.005 and death (P = 0.04, respectively. To investigate the mechanism of cathelicidin in patients surviving acute disease, we administered LL-37, the active peptide of cathelicidin, in a hamster model of lethal leptospirosis and found it significantly decreased bacterial loads and increased survival. Our findings indicate that the host immune response plays a central role in severe leptospirosis disease progression. While drawn from a limited study size, significant conclusions include that poor clinical outcomes are associated with high systemic bacterial loads, and a decreased antibody response. Furthermore, our data identified a key role for the antimicrobial peptide, cathelicidin, in mounting an effective bactericidal response against the pathogen, which represents a valuable new therapeutic approach for leptospirosis.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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

  18. Paraquat: A fatal poison

    Directory of Open Access Journals (Sweden)

    J Shashibhushan

    2015-01-01

    Full Text Available Paraquat (1, 1′-dimethyl-4, 4′-dipyridylium is a bipyridilium herbicide used widely in our country and is a highly toxic compound. This compound is very notorious to cause rapid development of renal, liver, and respiratory failure with very high mortality due to lack of specific antidote and dearth of high-quality evidence-based treatment. Respiratory system involvement is the most common cause of death in these people. We hereby report a fatal case of a 30-year-old male with a history of paraquat consumption. The patient developed oliguric renal failure, deterioration of liver function, and acute respiratory distress syndrome over next few days. Different treatment modalities were tried to manage patient′s condition. In this case, none of the strategies worked well, and death ensued due to multi-organ dysfunction syndrome.

  19. 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.

  20. 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.

  1. 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...

  2. Spatial clustering of fatal, and non-fatal, suicide in new South Wales, Australia: implications for evidence-based prevention.

    Science.gov (United States)

    Torok, Michelle; Konings, Paul; Batterham, Philip J; Christensen, Helen

    2017-10-06

    Rates of suicide appear to be increasing, indicating a critical need for more effective prevention initiatives. To increase the efficacy of future prevention initiatives, we examined the spatial distribution of suicide deaths and suicide attempts in New South Wales (NSW), Australia, to identify where high incidence 'suicide clusters' were occurring. Such clusters represent candidate regions where intervention is critically needed, and likely to have the greatest impact, thus providing an evidence-base for the targeted prioritisation of resources. Analysis is based on official suicide mortality statistics for NSW, provided by the Australian Bureau of Statistics, and hospital separations for non-fatal intentional self-harm, provided through the NSW Health Admitted Patient Data Collection at a Statistical Area 2 (SA2) geography. Geographical Information System (GIS) techniques were applied to detect suicide clusters occurring between 2005 and 2013 (aggregated), for persons aged over 5 years. The final dataset contained 5466 mortality and 86,017 non-fatal intentional self-harm cases. In total, 25 Local Government Areas were identified as primary or secondary likely candidate regions for intervention. Together, these regions contained approximately 200 SA2 level suicide clusters, which represented 46% (n = 39,869) of hospital separations and 43% (n = 2330) of suicide deaths between 2005 and 2013. These clusters primarily converged on the Eastern coastal fringe of NSW. Crude rates of suicide deaths and intentional self-harm differed at the Local Government Areas (LGA) level in NSW. There was a tendency for primary suicide clusters to occur within metropolitan and coastal regions, rather than rural areas. The findings demonstrate the importance of taking geographical variation of suicidal behaviour into account, prior to development and implementation of prevention initiatives, so that such initiatives can target key problem areas where they are likely to have

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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.

  8. Adult and paediatric mortality patterns in a referral hospital in Liberia 1 year after the end of the war.

    Science.gov (United States)

    Huerga, Helena; Vasset, Brigitte; Prados, Elisa

    2009-05-01

    The aim of this study was to describe and analyse hospital mortality patterns after the Liberian war. Data were collected retrospectively from January to July 2005 in a referral hospital in Monrovia, Liberia. The overall fatality rate was 17.2% (438/2543) of medical admissions. One-third of deaths occurred in the first 24h. The adult fatality rate was 23.3% (241/1034). Non-infectious diseases accounted for 56% of the adult deaths. The main causes of death were meningitis (16%), stroke (14%) and heart failure (10%). Associated fatality rates were 48%, 54% and 31% respectively. The paediatric fatality rate was 13.1% (197/1509). Infectious diseases caused 66% of paediatric deaths. In infants or =1 month old were respiratory infections (27%), malaria (23%) and severe malnutrition (16%). Associated fatality rates were 12%, 10% and 19%. Fatality rates were similar to those found in other sub-Saharan countries without a previous conflict. Early deaths could decrease through recognition and early referral of severe cases from health centres to the hospital and through assessment and priority treatment of these patients at arrival.

  9. 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

  10. 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.

  11. 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....

  12. 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

  13. 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.

  14. Fatal Drownings in Fiji.

    Science.gov (United States)

    Murray, Kathryn; Carter, Peter

    2017-01-01

    Drowning is a newly comprehended public health concern in Fiji. Defined as "the process of experiencing respiratory impairment from submersions or immersion in liquid," drowning has been identified as one of Fiji's 5 leading causes of death for those aged 1 to 29 years. The aim of this article was to develop the most parsimonious model that can be used to explain the number of monthly fatal drowning cases in Fiji. Based on a cross-section of 187 drowning incidents from January 2012 to April 2015, this observational study found the number of monthly drownings in Fiji was significantly affected by monthly rainfall ( P = .008, 95% confidence interval = 0.10-0.62) and the number of days comprising public holidays/weekends ( P = .018, 95% confidence interval = 0.06-0.60). Furthermore, the multiple coefficient of determination ( r 2 = .4976) indicated that almost half the variation in drownings was explained by rainfall and public holidays/weekend periods. Inadequate supervision, an inability to identify or carry out safe rescue techniques, and limited water-safety knowledge were identified as common risk factors. To overcome this preventable cause of death, technically guided interventions need to be actively embedded into a range of government policies and community health promotions, disaster management, and education programs.

  15. Non-Fatal Suicidal Behaviors in Adolescents

    OpenAIRE

    Jena, S.; Sidhartha, T.

    2004-01-01

    In the USA, suicide ranked as the third leading cause of death for adolescents in 1999. Non-fatal suicidal behaviours are suicidal thought, specific suicidal plan and suicide attempt. Prospective studies have emphasized the high subsequent suicide rates in clinically presenting suicide attempters. This study was planned to critically review the existing international literature on this area, and compare, if possible, with the Indian data. Both electronic and manual search for published and un...

  16. 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.

  17. Implementation of Molecular Surveillance After a Cluster of Fatal Toxoplasmosis at 2 Neighboring Transplant Centers.

    Science.gov (United States)

    Isa, Flonza; Saito, Kohta; Huang, Yao-Ting; Schuetz, Audrey; Babady, N Esther; Salvatore, Steven; Pessin, Melissa; van Besien, Koen; Perales, Miguel-Angel; Giralt, Sergio; Sepkowitz, Kent; Papanicolaou, Genovefa A; Soave, Rosemary; Kamboj, Mini

    2016-08-15

    After a cluster of fatal toxoplasmosis among stem cell transplant recipients at 2 hospitals, surveillance with polymerase chain reaction (PCR) (blood) was instituted. Rate of reactivation among seropositive recipients was 2.2 and 16%. Parasitemia was successfully managed with preemptive treatment. For seropositive recipients unable to take prophylaxis, toxoplasma PCR surveillance should be routinely performed. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  18. New evidence concerning fatal crashes of passenger vehicles before and after adding antilock braking systems.

    Science.gov (United States)

    Farmer, C M

    2001-05-01

    Fatal crash rates for passenger cars and vans were compared for the last model year before four-wheel antilock brakes were introduced and the first model year for which antilock brakes were standard equipment. A prior study, based on fatal crash experience through 1995, reported that vehicle models with antilock brakes were more likely than identical but 1-year-earlier models to be involved in crashes fatal to their own occupants, but were less likely to be involved in crashes fatal to occupants of other vehicles. Overall, there was no significant effect of antilocks on the likelihood of fatal crashes. Similar analyses, based on fatal crash experience during 1996-98, yielded very different results. During 1996-98, vehicles with antilock brakes were again less likely than earlier models to be involved in crashes fatal to occupants of other vehicles, but they were no longer overinvolved in crashes fatal to their own occupants.

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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

  5. 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

  6. [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

  7. Macroeconomic fluctuations and motorcycle fatalities in the U.S.

    Science.gov (United States)

    French, Michael T; Gumus, Gulcin

    2014-03-01

    The effects of business cycles on health outcomes in general, and on traffic fatalities in particular, have received much attention recently. In this paper, we focus on motorcycle safety and examine the impact of changing levels of economic activity on fatal crashes by motorcyclists in the United States. We analyze state-level longitudinal data with 1,104 state/year observations from the 1988-2010 Fatality Analysis Reporting System (FARS). Using the extensive motorcycle crash characteristics available in FARS, we examine not only total fatality rates but also rates decomposed by crash type, day, time, and the level of the motorcycle operator's blood alcohol content. Our results are consistent with much of the existing literature showing that traffic fatality rates are pro-cyclical. The estimates suggest that a 10% increase in real income per capita is associated with a 10.4% rise in the total motorcycle fatality rate. Along with potential mechanisms, policymakers and public health officials should consider the effects of business cycles on motorcycle safety. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Allegheny County Fatal Accidental Overdoses

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Fatal accidental overdose incidents in Allegheny County, denoting age, gender, race, drugs present, zip code of incident and zip code of residence. Zip code of...

  9. 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.

  10. Clinical Features of and Risk Factors for Fatal Ebola Virus Disease, Moyamba District, Sierra Leone, December 2014–February 2015

    Energy Technology Data Exchange (ETDEWEB)

    Haaskjold, Yngvar Lunde [Haukeland Univ. Hospital, Bergen (Norway); Bolkan, Hakon Angell [St. Olav Hospital, Trondheim (Norway); Krogh, Kurt Osthuus [St. Olav Hospital, Trondheim (Norway); Jongopi, James [Moyamba District Hospital (Sierra Leone); Lundeby, Karen Marie [Oslo Univ. Hospital (Norway); Mellesmo, Sindre [St. Olav Hospital, Trondheim (Norway); Garces, Pedro San Jose [Medicos del Mundo, Madrid (Spain); Josendal, Ola [Haukeland Univ. Hospital, Bergen (Norway); Opstad, Asmund [Haraldsplass Diaconal Hospital, Bergen (Norway); Svensen, Erling [Haukeland Univ. Hospital, Bergen (Norway); Univ. of Bergen (Norway); Fuentes, Luis Matias Zabala [Medicos del Mundo, Madrid (Spain); Kamara, Alfred Sandy [Moyamba District Hospital (Sierra Leone); Riera, Melchor [Hospital Son Espases, Palma de Mallorca (Spain); Izquierdo, Javier Arranz [Medicos del Mundo, Madrid (Spain); Inst. de Investigacion de Palma (Spain); Roberts, David P. [MRIGlobal, Rockville, MD (United States); Stamper, Paul D. [MRIGlobal, Rockville, MD (United States); Austin, Paula [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Moosa, Alfredo J. [Moyamba District Hospital (Sierra Leone); Marke, Dennis [Moyamba District Hospital (Sierra Leone); Hassan, Shoaib [Public Health (Pakistan); Berg, Ase [Stavanger Univ. Hospital (Norway); Blomberg, Bjorn [Haukeland Univ. Hospital, Bergen (Norway); Univ. of Bergen (Norway)

    2016-09-01

    The current outbreak of Ebola virus disease (EVD) in West Africa has infected more than 28,000 people, killed more than 11,000 and disrupted social life. We studied retrospectively the clinical presentation and risk factors for fatal outcome among the 31 Ebola virus (EBV) positive patients admitted to the Ebola Treatment Center (ETC) in Moyamba District, Sierra Leone. We found a higher rate of bleeding manifestations than reported elsewhere during the current outbreak. Significant predictors for fatal outcome were shorter time from onset to admission, male sex, high viral load on initial lab test, severe pain, diarrhea, bloody stools, and development of other bleeding manifestations during hospital admission. Awareness of risk factors for fatal outcome could be used to identify patients in need of more intensive medical support. The lack of fever in as much as a third of EVD cases may have implications for temperature screening practices and case definitions.

  11. 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.

  12. 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.

  13. Fatal and non-fatal injury outcomes: results from a purposively sampled census of seven rural subdistricts in Bangladesh.

    Science.gov (United States)

    Alonge, Olakunle; Agrawal, Priyanka; Talab, Abu; Rahman, Qazi S; Rahman, Akm Fazlur; Arifeen, Shams El; Hyder, Adnan A

    2017-08-01

    90% of the global burden of injuries is borne by low-income and middle-income countries (LMICs). However, details of the injury burden in LMICs are less clear because of the scarcity of data and population-based studies. The Saving of Lives from Drowning project, implemented in rural Bangladesh, did a census on 1·2 million people to fill this gap. This Article describes the epidemiology of fatal and non-fatal injuries from the study. In this study, we used data from the baseline census conducted as part of the Saving of Lives from Drowning (SoLiD) project. The census was implemented in 51 unions from seven purposively sampled rural subdistricts of Bangladesh between June and November, 2013. Sociodemographic, injury mortality, and morbidity information were collected for the whole population in the study area. We analysed the data for descriptive measures of fatal and non-fatal injury outcomes. Age and gender distribution, socioeconomic characteristics, and injury characteristics such as external cause, intent, location, and body part affected were reported for all injury outcomes. The census covered a population of 1 169 593 from 270 387 households and 451 villages. The overall injury mortality rate was 38 deaths per 100 000 population per year, and 104 703 people sustained major non-fatal injuries over a 6-month recall period. Drowning was the leading external cause of injury death for all ages, and falls caused the most number of non-fatal injuries. Fatal injury rates were highest in children aged 1-4 years. Non-fatal injury rates were also highest in children aged 1-4 years and those aged 65 years and older. Males had more fatal and non-fatal injuries than females across all external causes except for burns. Suicide was the leading cause of injury deaths in individuals aged 15-24 years, and more than 50% of the suicides occurred in females. The home environment was the most common location for most injuries. The burden of fatal and non-fatal injuries

  14. 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.

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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

  20. 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.

  1. 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.

  2. 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...

  3. 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.

  4. 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.

  5. 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.

  6. 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...

  7. 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.

  8. A fatal elephant attack.

    Science.gov (United States)

    Hejna, Petr; Zátopková, Lenka; Safr, Miroslav

    2012-01-01

    A rare case of an elephant attack is presented. A 44-year-old man working as an elephant keeper was attacked by a cow elephant when he tripped over a foot chain while the animal was being medically treated. The man fell down and was consequently repeatedly attacked with elephant tusks. The man sustained multiple stab injuries to both groin regions, a penetrating injury to the abdominal wall with traumatic prolapse of the loops of the small bowel, multiple defects of the mesentery, and incomplete laceration of the abdominal aorta with massive bleeding into the abdominal cavity. In addition to the penetrating injuries, the man sustained multiple rib fractures with contusion of both lungs and laceration of the right lobe of the liver, and comminuted fractures of the pelvic arch and left femoral body. The man died shortly after he had been received at the hospital. The cause of death was attributed to traumatic shock. © 2011 American Academy of Forensic Sciences.

  9. 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.

  10. [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.

  11. 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

  12. The Effect of Child Access Prevention Laws on Non-Fatal Gun Injuries

    OpenAIRE

    Jeff DeSimone; Sara Markowitz

    2005-01-01

    Many states have passed child access prevention (CAP) laws, which hold the gun owner responsible if a child gains access to a gun that is not securely stored. Previous CAP law research has focused exclusively on gun-related deaths even though most gun injuries are not fatal. We use annual hospital discharge data from 1988-2001 to investigate whether CAP laws decrease non-fatal gun injuries. Results from Poisson regressions that control for various hospital, county and state characteristics, i...

  13. 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

  14. [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.

  15. 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...

  16. 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.

  17. Analyzing temozolomide medication errors: potentially fatal.

    Science.gov (United States)

    Letarte, Nathalie; Gabay, Michael P; Bressler, Linda R; Long, Katie E; Stachnik, Joan M; Villano, J Lee

    2014-10-01

    The EORTC-NCIC regimen for glioblastoma requires different dosing of temozolomide (TMZ) during radiation and maintenance therapy. This complexity is exacerbated by the availability of multiple TMZ capsule strengths. TMZ is an alkylating agent and the major toxicity of this class is dose-related myelosuppression. Inadvertent overdose can be fatal. The websites of the Institute for Safe Medication Practices (ISMP), and the Food and Drug Administration (FDA) MedWatch database were reviewed. We searched the MedWatch database for adverse events associated with TMZ and obtained all reports including hematologic toxicity submitted from 1st November 1997 to 30th May 2012. The ISMP describes errors with TMZ resulting from the positioning of information on the label of the commercial product. The strength and quantity of capsules on the label were in close proximity to each other, and this has been changed by the manufacturer. MedWatch identified 45 medication errors. Patient errors were the most common, accounting for 21 or 47% of errors, followed by dispensing errors, which accounted for 13 or 29%. Seven reports or 16% were errors in the prescribing of TMZ. Reported outcomes ranged from reversible hematological adverse events (13%), to hospitalization for other adverse events (13%) or death (18%). Four error reports lacked detail and could not be categorized. Although the FDA issued a warning in 2003 regarding fatal medication errors and the product label warns of overdosing, errors in TMZ dosing occur for various reasons and involve both healthcare professionals and patients. Overdosing errors can be fatal.

  18. Fatal acute pulmonary injury associated with everolimus.

    Science.gov (United States)

    Depuydt, Pieter; Nollet, Joke; Benoit, Dominique; Praet, Marleen; Caes, Frank

    2012-03-01

    To report a case of fatal alveolar hemorrhage associated with the use of everolimus in a patient who underwent a solid organ transplant. In a 71-year-old cardiac transplant patient, cyclosporine was replaced with everolimus because of worsening renal function. Over the following weeks, the patient developed nonproductive cough and increasing dyspnea. His condition deteriorated to acute respiratory failure with hemoptysis, requiring hospital admission. Bilateral patchy alveolar infiltrates were apparent on chest X-ray and computed tomography. Cardiac failure was ruled out and empiric antimicrobial therapy was initiated. Additional extensive workup could not document opportunistic infection. Everolimus was discontinued and high-dose corticosteroid therapy was initiated. Despite this, the patient required invasive mechanical ventilation and died because of refractory massive hemoptysis. Autopsy revealed diffuse alveolar hemorrhage. Everolimus is a mammalian target of rapamycin inhibitor approved for use as an immunosuppressant and antineoplastic agent. Its main advantage over calcineurin inhibitors (tacrolimus and cyclosporine) is a distinct safety profile. Although it has become clear that everolimus induces pulmonary toxicity more frequently than initially thought, most published cases thus far represented mild and reversible disease, and none was fatal. Here, we report a case of pulmonary toxicity developing over weeks following the introduction of everolimus, in which a fatal outcome could not be prevented by drug withdrawal and corticosteroid treatment. The association of everolimus and this syndrome was probable according to the Naranjo probability scale. This case indicates that with the increasing use of everolimus, clinicians should be aware of the rare, but life-threatening manifestation of pulmonary toxicity.

  19. 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).

  20. 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

  1. 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.

  2. 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...

  3. 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...

  4. 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...

  5. 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

  6. 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

  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. 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.

  10. 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.

  11. Occupational fatalities due to electrocutions in the construction industry.

    Science.gov (United States)

    Janicak, Christopher A

    2008-01-01

    Occupational fatalities due to contact with electricity account for approximately 9% of all deaths in the construction industry and is the fourth leading cause of death in this industry. Differences in the proportions of electrocutions in the construction industry are significantly different from other industries based upon the age of the worker and the source of the electricity. This study found that, in the construction industry, the proportion of occupational fatalities due to contact with electric current is significantly higher for workers in the 16 to 19 years old age group. Contact with overhead power lines occurred more frequently with younger workers, while contact with electric wiring, transformers, and related equipment was found to occur more frequently with older workers. The proportion of fatalities due to this event was also found to account for a significantly greater proportion of fatalities in the construction industry overall. The proportions of electrocution fatalities in the construction industry were found to be significantly higher for younger workers when compared to all other industries. Focusing prevention measures toward younger workers who work near overhead power lines could have a significant impact upon death rates. For older workers, the focus should be on those who work on or near transformers, electrical wiring, and components. Across the construction industry, implementation of effective lockout-tagout programs, and verification of energy isolation, can prevent approximately 125 fatalities per year in the construction industry.

  12. 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.

  13. 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.

  14. Fatal Primary Meningoencephalitis Caused By Naegleria Fowleri

    International Nuclear Information System (INIS)

    Shariq, A.; Afridi, F. I.; Farooqi, B. J.; Husaain, A.; Ahmed, S.

    2014-01-01

    Naegleria fowleri is a free living parasite which habitats in fresh water reservoirs. It causes a fatal nervous system infection known as primary amoebic meningoencephalitis by invading through cribriform plate of nose and gaining entry into brain. We report a case of primary amoebic meningoencephalitis caused by Naegleria fowleri in Karachi, Pakistan, in a 42 years old male poultry farm worker having no history of swimming. Clinical course was fulminant and death occurred within one week of hospital admission. Naegleria fowleri was detected by wet mount technique in the sample of cerebrospinal fluid collected by lumbar puncture of patient. This is a serious problem and requires immediate steps to prevent general population to get affected by this lethal neurological infection. (author)

  15. 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

  16. Patterns of malaria-related hospital admissions and mortality among Malawian children: an example of spatial modelling of hospital register data

    Directory of Open Access Journals (Sweden)

    Kleinschmidt Immo

    2006-10-01

    Full Text Available Abstract Background Malaria is a leading cause of hospitalization and in-hospital mortality among children in Africa, yet, few studies have described the spatial distribution of the two outcomes. Here spatial regression models were applied, aimed at quantifying spatial variation and risk factors associated with malaria hospitalization and in-hospital mortality. Methods Paediatric ward register data from Zomba district, Malawi, between 2002 and 2003 were used, as a case study. Two spatial models were developed. The first was a Poisson model applied to analyse hospitalization and minimum mortality rates, with age and sex as covariates. The second was a logistic model applied to individual level data to analyse case-fatality rate, adjusting for individual covariates. Results and conclusion Rates of malaria hospitalization and in-hospital mortality decreased with age. Case fatality rate was associated with distance, age, wet season and increased if the patient was referred to the hospital. Furthermore, death rate was high on first day, followed by relatively low rate as length of hospital stay increased. Both outcomes showed substantial spatial heterogeneity, which may be attributed to the varying determinants of malaria risk, health services availability and accessibility, and health seeking behaviour. The increased risk of mortality of children referred from primary health facilities may imply inadequate care being available at the referring facility, or the referring facility are referring the more severe cases which are expected to have a higher case fatality rate. Improved prognosis as the length of hospital stay increased suggest that appropriate care when available can save lives. Reducing malaria burden may require integrated strategies encompassing availability of adequate care at primary facilities, introducing home or community case management as well as encouraging early referral, and reinforcing interventions to interrupt malaria

  17. Fatal crashes of passenger vehicles before and after adding antilock braking systems.

    Science.gov (United States)

    Farmer, C M; Lund, A K; Trempel, R E; Braver, E R

    1997-11-01

    Fatal crash rates of passenger cars and vans were compared for the last model year before four-wheel antilock brakes were introduced and the first model year for which antilock brakes were standard equipment. Vehicles selected for analysis had no other significant design changes between the model years being compared, and the model years with and without antilocks were no more than two years apart. The overall fatal crash rates were similar for the two model years. However, the vehicles with antilocks were significantly more likely to be involved in crashes fatal to their own occupants, particularly single-vehicle crashes. Conversely, antilock vehicles were less likely to be involved in crashes fatal to occupants of other vehicles or nonoccupants (pedestrians, bicyclists). Overall, antilock brakes appear to have had little effect on fatal crash involvement. Further study is needed to better understand why fatality risk has increased for occupants of antilock vehicles.

  18. 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

  19. 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.

  20. 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.

  1. Fatal occupational accidents in Danish fishing vessels 1989-2005

    DEFF Research Database (Denmark)

    Laursen, Lise Hedegaard; Hansen, Henrik L; Jensen, Olaf

    2008-01-01

    training for all fishermen and improved safety measures are needed, especially in the underscored areas of sea disasters concerning small vessels and occupational accidents on big vessels. Better registration of time at risk for fishermen is needed to validate the effect of the safety measures......./capsizing due to stability changes in rough weather and collisions; 39 fatal occupational accidents mainly occurred on the larger inspection obligated trawlers during fishing. In the remaining 14 other fatal accidents, the main causal factors were difficult embarking/disembarking conditions by darkness...... in foreign ports and alcohol intoxication. In the period 1995-2005, the overall incidence rate was 10 per 10,000 fishermen per year with no down-going trend during that period. The fatal accident rates are still too high, despite the efforts to reduce the risk. Increased focus on regular and repeated safety...

  2. 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.

  3. 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.

  4. 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.

  5. Fatal motorcycle accidents and alcohol

    DEFF Research Database (Denmark)

    Larsen, C F; Hardt-Madsen, M

    1987-01-01

    A series of fatal motorcycle accidents from a 7-year period (1977-1983) has been analyzed. Of the fatalities 30 were operators of the motorcycle, 11 pillion passengers and 8 counterparts. Of 41 operators 37% were sober at the time of accident, 66% had measurable blood alcohol concentration (BAC......); 59% above 0.08%. In all cases where a pillion passenger was killed, the operator of the motorcycle had a BAC greater than 0.08%. Of the killed counterparts 2 were non-intoxicated, 2 had a BAC greater than 0.08%, and 4 were not tested. The results advocate that the law should restrict alcohol...... consumption by pillion passengers as well as by the motorcycle operator. Suggestions made to extend the data base needed for developing appropriate alcohol countermeasures by collecting sociodemographic data on drivers killed or seriously injured should be supported....

  6. Road Accidents and Road Fatalities in Denmark from 1968 to 2004

    DEFF Research Database (Denmark)

    Orozova-Bekkevold, Ivanka; Hels, Tove; Bernhoft, Inger Marie

    2008-01-01

    The purpose of this article is to describe the road accidents and road fatalities in Denmark in the period 1968-2004. Only accidents registered by the police were used. Crude and gender & age specific fatality rates (counts per 1,000,000 inhabitants) were estimated for all road users...... and for bicyclists. The accident and fatality rates have decreased by around 70% from 1968 to 2004, while the motorisation rate has increased by approximately 90%. The sharpest decrease in the fatality rate was observed among the youngest (below 18 years old) and the older (above 64) road users. Gender related...... and actions targeted to improve road safety have indeed led to a significant reduction in injury accidents and fatalities. Further research and more detailed data, especially on traffic volume and individual exposure are necessary in order to investigate properly a causal relation between the number...

  7. 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.

  8. 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.

  9. Fatal injuries to teenage construction workers in the US.

    Science.gov (United States)

    Suruda, Anthony; Philips, Peter; Lillquist, Dean; Sesek, Richard

    2003-11-01

    The construction industry is second only to agriculture in the annual number of fatal injuries in workers less than 18 years of age. We examined fatal injury reports for youth and adult workers to determine risk factors for injury and applicability of existing child labor regulations. The US Occupational Safety & Health Administration (OSHA) investigation data for fatal work injuries from 1984 through 1998 were reviewed with respect to type of event, employer characteristics, and apparent violations of existing child labor laws under the Fair Labor Standards Act (FLSA). We also examined whether the employer met exemption criteria for federal enforcement of child labor or OSHA regulations. The fatality rate for teenage construction workers age 19 and younger was 12.1 per 100,000 per year, slightly less than for adult workers. Teenage workers who were fatally injured were more likely than adults to have been employed at non-union construction firms (odds ratio (OR) = 4.96, P worker. Fatalities in teenagers were more likely to occur in special construction trades such as roofing. Among fatalities in workers less than 18 years of age, approximately one-half (49%) of the 76 fatal injuries were in apparent violation of existing child labor regulations. We estimated that in 41 of the 76 cases (54%) the employer's gross annual income exceeded the $500,000 threshold for federal enforcement of child labor laws. Only 28 of 76 cases (37%) were at construction firms with 11 or more employees, which are subject to routine OSHA inspections. Fatal injuries in teenage construction workers differed from those in adults in that they were more likely to be at small, non-union firms of which a substantial proportion were exempt from federal enforcement of child labor laws and from routine OSHA inspections. Safety programs for young construction workers should include small, non-union construction firms and those in special construction trades such as roofing. We did not identify

  10. 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.

  11. 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.

  12. A case-crossover study of sleep, fatigue, and other transient exposures at workplace and the risk of non-fatal occupational injuries among the employees of an Italian academic hospital

    Directory of Open Access Journals (Sweden)

    Francesca Valent

    2016-12-01

    Full Text Available Objectives: Transient exposure with acute effect has been shown to affect the risk of occupational injuries in various industrial settings and at the healthcare workplace. The objective of this study has been to identify transient exposures related to occupational injury risk in an Italian teaching hospital. Material and Methods: A case-crossover study was conducted among the employees of the University Hospital of Udine who reported an occupational injury, commuting accident, or incident involving biological risk in a 15-month period in the years 2013 and 2014. The matched-pair interval approach was used to assess the role of acute sleep deprivation whereas the usual frequency approach was used for other 13 transient exposures. Results: Sleep hours were not associated with the risk of injuries whereas a significant risk increase was associated with fatigue, rush, distraction, emergency situations, teaching to or being taught by someone, non-compliant patients, bloody operative/work field, excess noise, complex procedures, and anger. Conclusions: We identified transient exposures that increased the risk of occupational injuries in an Italian teaching hospital, providing indications for interventions to increase workers’ safety at the healthcare workplace. Int J Occup Med Environ Health 2016;29(6:1001–1009

  13. [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.

  14. The profile of wounding in civilian public mass shooting fatalities.

    Science.gov (United States)

    Smith, Edward Reed; Shapiro, Geoff; Sarani, Babak

    2016-07-01

    The incidence and severity of civilian public mass shootings (CPMS) continue to rise. Initiatives predicated on lessons learned from military woundings have placed strong emphasis on hemorrhage control, especially via use of tourniquets, as means to improve survival. We hypothesize that both the overall wounding pattern and the specific fatal wounds in CPMS events are different from those in military combat fatalities and thus may require a new management strategy. A retrospective study of autopsy reports for all victims involved in 12 CPMS events was performed. Civilian public mass shootings was defined using the FBI and the Congressional Research Service definition. The site of injury, probable site of fatal injury, and presence of potentially survivable injury (defined as survival if prehospital care is provided within 10 minutes and trauma center care within 60 minutes of injury) was determined independently by each author. A total 139 fatalities consisting of 371 wounds from 12 CPMS events were reviewed. All wounds were due to gunshots. Victims had an average of 2.7 gunshots. Relative to military reports, the case fatality rate was significantly higher, and incidence of potentially survivable injuries was significantly lower. Overall, 58% of victims had gunshots to the head and chest, and only 20% had extremity wounds. The probable site of fatal wounding was the head or chest in 77% of cases. Only 7% of victims had potentially survivable wounds. The most common site of potentially survivable injury was the chest (89%). No head injury was potentially survivable. There were no deaths due to exsanguination from an extremity. The overall and fatal wounding patterns following CPMS are different from those resulting from combat operations. Given that no deaths were due to extremity hemorrhage, a treatment strategy that goes beyond use of tourniquets is needed to rescue the few victims with potentially survivable injuries. Prognostic/epidemiologic study, level IV

  15. The New Zealand child work-related fatal injury study: 1985-1998.

    Science.gov (United States)

    Lilley, Rebbecca; Feyer, Anne-Marie; Langley, John; Wren, John

    2004-05-21

    To estimate the numbers and rates of work-related fatal injury for children under the age of 15 years. Potential cases of work-related injury deaths of persons aged workplace work-related fatalities were identified. The vast majority of children identified were fatally injured while a bystander to another person's work. Workplace bystander involvement was found to vary by age, with the majority of workers identified aged 10-14 years old. With a third of all fatalities, the agricultural industry was the most common industry for workplace work-related fatalities in children. In the period 1985-94, children New Zealand's total workplace bystander deaths. Children contribute significantly to the overall burden of work-related fatal injury in New Zealand, especially as bystanders to other people's work. The high contribution to bystander deaths by children aged <15 years suggests that hazard control in certain work settings is lacking.

  16. Fatal accidents at railway level crossings in Great Britain 1946-2009.

    Science.gov (United States)

    Evans, Andrew W

    2011-09-01

    This paper investigates fatal accidents and fatalities at level crossings in Great Britain over the 64-year period 1946-2009. The numbers of fatal accidents and fatalities per year fell by about 65% in the first half of that period, but since then have remained more or less constant at about 11 fatal accidents and 12 fatalities per year. At the same time other types of railway fatalities have fallen, so level crossings represent a growing proportion of the total. Nevertheless, Britain's level crossing safety performance remains good by international standards. The paper classifies level crossings into three types: railway-controlled, automatic, and passive. The safety performance of the three types of crossings has been very different. Railway-controlled crossings are the best-performing crossing type, with falling fatal accident rates. Automatic crossings have higher accident rates per crossing than railway controlled or passive crossings, and the accident rates have not decreased. Passive crossings are by far the most numerous, but many have low usage by road users. Their fatal accident rate has remained remarkably constant over the whole period at about 0.9 fatal accidents per 1000 crossings per year. A principal reason why fatal accidents and fatalities have not fallen in the second half of the period as they did in the first half is the increase in the number of automatic crossings, replacing the safer railway controlled crossings on some public roads. However, it does not follow that this replacement was a mistake, because automatic crossings have advantages over controlled crossings in reducing delays to road users and in not needing staff. Based on the trends for each type of crossing and for pedestrian and non-pedestrian accidents separately, in 2009 a mean of about 5% of fatal accidents were at railway controlled crossings, 52% were at automatic crossings, and 43% were at passive crossings. Fatalities had similar proportions. About 60% of fatalities were

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. 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 ...

  2. 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.

  3. 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.

  4. 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)

  5. On the road again: traffic fatalities and auto insurance minimums

    Directory of Open Access Journals (Sweden)

    Pavel A. Yakovlev

    2018-03-01

    Full Text Available Prior research on policy-induced moral hazard effects in the auto insurance market has focused on the impact of compulsory insurance, no-fault liability, and tort liability laws on traffic fatalities. In contrast, this paper examines the moral hazard effect of a previously overlooked policy variable: minimum auto insurance coverage. We hypothesize that state-mandated auto insurance minimums may “over-insure” some drivers, lowering their incentives to drive carefully. Using a longitudinal panel of American states from 1982 to 2006, we find that policy-induced increases in auto insurance minimums are associated with higher traffic fatality rates, ceteris paribus.

  6. Fatal Gastrointestinal Perforations in sudden death cases in Last 10 ...

    African Journals Online (AJOL)

    Pathology unit of University Malaya, Kuala Lumpur in the year 2006 by reviewing the autopsy reports. There were 61 cases of GIT perforation out of 5579 autopsies conducted during a period of ten years (1996-2005). The incidence rate of fatal gastrointestinal perforation was 1.09% during this period. Out of these 61 cases, ...

  7. 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.

  8. Determination of the Main Influencing Factors on Road Fatalities Using an Integrated Neuro-Fuzzy Algorithm

    Directory of Open Access Journals (Sweden)

    Amir Masoud Rahimi

    Full Text Available Abstract This paper proposed an integrated algorithm of neuro-fuzzy techniques to examine the complex impact of socio-technical influencing factors on road fatalities. The proposed algorithm could handle complexity, non-linearity and fuzziness in the modeling environment due to its mechanism. The Neuro-fuzzy algorithm for determination of the potential influencing factors on road fatalities consisted of two phases. In the first phase, intelligent techniques are compared for their improved accuracy in predicting fatality rate with respect to some socio-technical influencing factors. Then in the second phase, sensitivity analysis is performed to calculate the pure effect on fatality rate of the potential influencing factors. The applicability and usefulness of the proposed algorithm is illustrated using the data in Iran provincial road transportation systems in the time period 2012-2014. Results show that road design improvement, number of trips, and number of passengers are the most influencing factors on provincial road fatality rate.

  9. Fatal occupational injuries among non-governmental employees in Malaysia.

    Science.gov (United States)

    Abas, Adinegara Bin Lutfi; Mohd Said, Datuk Abd Razzak B; Aziz Mohammed, Mohammed Azman B; Sathiakumar, Nalini

    2013-01-01

    In Malaysia, surveillance of fatal occupational injuries is fragmented. We therefore analyzed an alternative data source from Malaysia's Social Security organization, the Pertubuhan Keselamatan Sosial (PERKESO). We conducted a secondary data analysis of the PERKESO database comprised of 7 million employees from 2002 to 2006. Overall, the average annual incidence was 9.2 fatal occupational injuries per 100,000 workers. During the 5-year period, there was a decrease in the absolute number of fatal injuries by 16% and the incidence by 34%. The transportation sector reported the highest incidence of fatal injuries (35.1/100,000), followed by agriculture (30.5/100,000) and construction (19.3/100,000) sectors. Persons of Indian ethnicity were more likely to sustain fatal injuries compared to other ethnic groups. Government and industry should develop rigorous strategies to detect hazards in the workplace, especially in sectors that continuously record high injury rates. Targeted interventions emphasizing worker empowerment coupled with systematic monitoring and evaluation is critical to ensure success in prevention and control measures. Copyright © 2012 Wiley Periodicals, Inc.

  10. Fatal Occupational Injuries among Non-governmental Employees in Malaysia

    Science.gov (United States)

    Abas, Adinegara bin Lutfi; Mohd Said, Datuk Abd. Razzak B.; Aziz Mohammed, Mohammed Azman B.; Sathiakumar, Nalini

    2012-01-01

    Background In Malaysia, surveillance of fatal occupational injuries is fragmented. We therefore analyzed an alternative data source from Malaysia’s Social Security organization, the PERKESO. Methods We conducted a secondary data analysis of the PERKESO database comprised of 7 million employees from 2002 to 2006. Results Overall, the average annual incidence was 9.2 fatal occupational injuries per 100,000 workers. During the five-year period, there was a decrease in the absolute number of fatal injuries by 16% and the incidence by 34%. The transportation sector reported the highest incidence of fatal injuries (35.1/100,000), followed by agriculture (30.5/100,000) and construction (19.3/100,000) sectors. Persons of Indian ethnicity were more likely to sustain fatal injuries compared to other ethnic groups. Conclusions Government and industry should develop rigorous strategies to detect hazards in the workplace, especially in sectors that continuously record high injury rates. Targeted interventions emphasizing worker empowerment coupled with systematic monitoring and evaluation is critical to ensure success in prevention and control measures. PMID:22544443

  11. Non-fatal self-poisoning in Sri Lanka: associated triggers and motivations.

    Science.gov (United States)

    Rajapakse, Thilini; Griffiths, Kathleen Margaret; Christensen, Helen; Cotton, Sue

    2015-11-24

    Attempted or non-fatal self-poisoning is common in Sri Lanka. To date, most preventive strategies have focused on limitation of access to toxic pesticides, which has reduced the rates of fatal self-poisoning. However the ongoing phenomenon of non-fatal self-poisoning indicates the need for exploration of alternate preventive strategies. Self-poisoning in Sri Lanka has been described as impulsive, with little premeditation, but the motivations associated with this act have not been studied in depth. This research describes the triggers and motivations associated with non-fatal self-poisoning in Sri Lanka. It is anticipated that the findings would help guide future preventive strategies. Two studies were carried out, at Teaching Hospital Peradeniya, Sri Lanka, each using a different methodology - Study 1 consisted of qualitative semi-structured interviews, and Study 2 was a cross sectional survey. Both studies were conducted among those who had recently attempted self-poisoning, and explored associated triggers and motivations associated with the act of self-poisoning. There was no overlap between participants of the two studies. A total of 24 persons participated in the semi-structured interviews (Study 1), and 921 took part in the cross-sectional survey (Study 2). Interpersonal conflict was the most common trigger prior to the act of non-fatal self-poisoning. A mixture of motivations was associated with the act of self-poisoning, including intent to die, to escape, and difficulty tolerating distress associated with interpersonal conflict. Development of interpersonal skills and interpersonal problem solving skills, particularly in adolescents and young people, emerges as a key primary preventive strategy. Further, there is value in exploring and helping people to develop more adaptive strategies to cope with emotional distress associated with interpersonal conflict. While distress tolerance and interpersonal skill training strategies used in the West may be

  12. Typhoid fever complicated by intestinal perforation: a persisting fatal disease requiring surgical management

    NARCIS (Netherlands)

    Butler, T.; Knight, J.; Nath, S. K.; Speelman, P.; Roy, S. K.; Azad, M. A.

    1985-01-01

    In Bangladesh, clinical records of 323 patients with typhoid fever were reviewed to study the incidence, fatality, and optimal therapy of the complication of intestinal perforation. Fifteen patients (4.6%) developed intestinal perforation. Case-fatality rates were six of nine patients treated

  13. Incidence Rate of Community-Acquired Sepsis Among Hospitalized Acute Medical Patients-A Population-Based Survey

    DEFF Research Database (Denmark)

    Henriksen, Daniel Pilsgaard; Laursen, Christian B; Jensen, Thøger Gorm

    2015-01-01

    to the hospital. DESIGN:: Population-based survey. SETTING:: Medical emergency department from September 1, 2010, to August 31, 2011. PATIENTS:: All patients were manually reviewed using a structured protocol in order to identify the presence of infection. Vital signs and laboratory values were collected...... to define the presence of systemic inflammatory response syndrome and organ dysfunction. MEASUREMENTS AND MAIN RESULTS:: Incidence rate of sepsis of any severity. Among 8,358 admissions to the medical emergency department, 1,713 patients presented with an incident admission of sepsis of any severity, median...... on symptoms and clinical findings at arrival, incidence rates of patients admitted to a medical emergency department with sepsis and severe sepsis are more frequent than previously reported based on discharge diagnoses....

  14. 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

  15. [BACTERIA WITHOUT BORDERS: A HIGH CARRIAGE RATE OF ANTIBIOTIC-RESISTANT BACTERIA AMONG SYRIAN CHILDREN HOSPITALIZED IN GALILEE MEDICAL CENTER].

    Science.gov (United States)

    Faour Kassem, Diana; Shahar, Naama; Ocampo, Smadar; Bader, Tarif; Zonis, Zeev; Glikman, Daniel

    2017-05-01

    As the civil war in Syria enters its fifth year, the Israeli government continues to provide humanitarian aid to Syrian civilians in Israeli hospitals. Many wounded Syrian children are treated at the Galilee Medical Center (GMC). Due to the patients' incomplete medical history and increasing infection rates in Syria, contact isolation and screening cultures for multi-drug resistant bacteria (MDR's) are conducted upon admission for all Syrian children. To describe the rate of MDR carriage in Syrian children and compare it to hospitalized Israeli children. Prospective collection of screening culture data of Syrian patients admitted to GMC between 6/2013-11/2014 and comparison with Israeli children admitted between 1-3/2014. Extended-spectrum beta- lactamase-producing Enterobateriaceae (ESBL), Vancomycin-resistant Enterococcus (VRE), Carbapenem-resistant Enterobacteriaceae (CRE), and Methicillin-resistant Staphylococcus aureus (MRSA) were considered MDR's. Of 47 pediatric Syrian patients, 41 were severely wounded. MDR's were found in 37 (79%) children; most of the isolates were ESBL+ Escherichia coli. Over half of the ESBL's were resistant to additional antibiotics such as sulfa and quinolones; no resistance to amikacin was found. In comparison, in 6 of 40 (15%) Israeli children, MDR's (all ESBL's) were found (p<0.001). In hospitalized Syrian children, contact isolation and screening cultures for MDR's have an important role in the prevention of nosocomial transmission and establishment of empiric antimicrobial protocols. In suspected infections in Syrian children, amikacin and carbapenems are the antimicrobials of choice. MDR's are carried to a lesser extent in Israeli children but due to their importance, further largescale research is needed.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Impact of a multicomponent hand hygiene intervention strategy in reducing infection rates at a university hospital in Saudi Arabia.

    Science.gov (United States)

    Al Kuwaiti, Ahmed

    2017-09-01

    Few studies have reported the correlation between hand hygiene (HH) practices and infection rates in Saudi Arabia. This work was aimed to study the effect of a multicomponent HH intervention strategy in improving HH compliance and reducing infection rates at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia between January 2014 and December 2016. A yearlong multicomponent HH intervention, which included various strategies recommended by the World Health Organization, was introduced. HH compliance among staff and infection rates observed in the inpatient wards were assessed and compared at pre- and post-interventional phases. There was a significant increase in mean HH compliance from 50.17% to 71.75% after the intervention ( P  infection (HAI) and catheter-associated urinary tract infection (CAUTI) rates decreased from 3.37 to 2.59 and from 3.73 to 1.75, respectively ( P  infection rates. Further studies on cost-effectiveness of such a model could augment to these findings.

  18. Understanding fatal older road user crash circumstances and risk factors.

    Science.gov (United States)

    Koppel, Sjaan; Bugeja, Lyndal; Smith, Daisy; Lamb, Ashne; Dwyer, Jeremy; Fitzharris, Michael; Newstead, Stuart; D'Elia, Angelo; Charlton, Judith

    2018-02-28

    This study used medicolegal data to investigate fatal older road user (ORU) crash circumstances and risk factors relating to four key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. The Coroners Court of Victoria's Surveillance Database was searched to identify coronial records with at least one deceased ORU in the state of Victoria, Australia, for 2013-2014. Information relating to the ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. The average rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI] 6.0-10.2), which was more than double the average rate of fatal middle-aged road user crashes (3.6, 95% CI 2.5-4.6). There was a significant relationship between age group and deceased road user type (χ 2 (15, N = 226) = 3.56, p road" (87.0%), on roads that were paved (94.2%), dry (74.2%), and had light traffic volume (38.3%). Road user error was identified by the police and/or coroner for the majority of fatal ORU crashes (57.9%), with a significant proportion of deceased ORU deemed to have "misjudged" (40.9%) or "failed to yield" (37.9%). Road user error was the most significant risk factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the Victorian road system to fully accommodate road user errors. Initiatives related to safer roads and roadsides, vehicles, and speed zones, as well as behavioral approaches, are key areas of priority for targeted activity to prevent fatal older road user crashes in the future.

  19. Survival rates and predictors of survival among colorectal cancer patients in a Malaysian tertiary hospital.

    Science.gov (United States)

    Magaji, Bello Arkilla; Moy, Foong Ming; Roslani, April Camilla; Law, Chee Wei

    2017-05-18

    Colorectal cancer is the third most commonly diagnosed malignancy and the fourth leading cause of cancer-related death globally. It is the second most common cancer among both males and females in Malaysia. The economic burden of colorectal cancer is likely to increase over time owing to its current trend and aging population. Cancer survival analysis is an essential indicator for early detection and improvement in cancer treatment. However, there was a scarcity of studies concerning survival of colorectal cancer patients as well as its predictors. Therefore, we aimed to determine the 1-, 3- and 5-year survival rates, compare survival rates among ethnic groups and determine the predictors of survival among colorectal cancer patients. This was an ambidirectional cohort study conducted at the University Malaya Medical Centre (UMMC) in Kuala Lumpur, Malaysia. All Malaysian citizens or permanent residents with histologically confirmed diagnosis of colorectal cancer seen at UMMC from 1 January 2001 to 31 December 2010 were included in the study. Demographic and clinical characteristics were extracted from the medical records. Patients were followed-up until death or censored at the end of the study (31st December 2010). Censored patients' vital status (whether alive or dead) were cross checked with the National Registration Department. Survival analyses at 1-, 3- and 5-year intervals were performed using the Kaplan-Meier method. Log-rank test was used to compare the survival rates, while Cox proportional hazard regression analysis was carried out to determine the predictors of 5-year colorectal cancer survival. Among 1212 patients, the median survival for colorectal, colon and rectal cancers were 42.0, 42.0 and 41.0 months respectively; while the 1-, 3-, and 5-year relative survival rates ranged from 73.8 to 76.0%, 52.1 to 53.7% and 40.4 to 45.4% respectively. The Chinese patients had the lowest 5-year survival compared to Malay and Indian patients. Based on the 814

  20. Subtrochanteric Femur Fractures in an Irish Trauma Centre over 9 years: How the Impact of Hospital Coding on Diagnosis of Subtrochanteric Femur Fractures Leads to Inaccurate Occurrence Rates

    LENUS (Irish Health Repository)

    Coveney, EI

    2018-06-01

    Our aim was to assess the occurrence rates of subtrochanteric femur fractures in an orthopaedic tertiary referral centre and to assess the correlation of patient’s actual diagnosis with national hospital inpatient enquiry data.

  1. Characteristics of small areas with high rates of hospital-treated self-harm: deprived, fragmented and urban or just close to hospital? A national registry study.

    LENUS (Irish Health Repository)

    O'Farrell, I B

    2014-10-15

    Previous research has shown an inconsistent relationship between the spatial distribution of hospital treated self-harm and area-level factors such as deprivation and social fragmentation. However, many of these studies have been confined to urban centres, with few focusing on rural settings and even fewer studies carried out at a national level. Furthermore, no previous research has investigated if travel time to hospital services can explain the area-level variation in the incidence of hospital treated self-harm.

  2. Occupational fatality risks in the United States and the United Kingdom.

    Science.gov (United States)

    Mendeloff, John; Staetsky, Laura

    2014-01-01

    There are very few careful studies of differences in occupational fatality rates across countries, much less studies that try to account for those differences. We compare the rate of work injury fatalities (excluding deaths due to highway motor vehicle crashes and those due to violence) identified by the US Census of Fatal Occupational Injuries in recent years with the number reported to the Health and Safety Executive in the United Kingdom (UK) and by other European Union (EU) members through Eurostat. In 2010, the fatality rate in the UK was about 1/3 the rate in the US. In construction the rate was about ¼ the US rate, a difference that had grown substantially since the 1990s. Several other EU members had rates almost as low as the UK rate. Across EU countries, lower rates were associated with high-level management attention to safety issues and to in-house preparation of "risk assessments." Although work fatality rates have declined in the US, fatality rates are much lower and have declined faster in recent years in the UK. Efforts to find out the reasons for the much better UK outcomes could be productive. © 2013 Wiley Periodicals, Inc.

  3. Evaluation of pneumococcal vaccination rates after vaccine protocol changes and nurse education in a tertiary care teaching hospital.

    Science.gov (United States)

    Smith, Jennifer G; Metzger, Nicole L

    2011-11-01

    Pneumococcal vaccination in eligible patients is recommended by the Infectious Disease Society of America and the Centers for Disease Control (CDC) Advisory Committee on Immunization Practices. Because hospitalization provides an opportunity to vaccinate patients at high risk for developing serious pneumonia complications, eligibility screening and administration of the pneumococcal vaccine prior to discharge in qualified patients are evaluated by the Joint Commission and the Centers for Medicare Medicaid Services (CMS) as part of pneumococcal vaccination core quality measures. Among patients with an inpatient diagnosis of pneumonia in 2008, 56% in our 580-bed tertiary care teaching hospital, compared with 84% nationwide, received pneumococcal vaccination. To improve pneumococcal vaccination rates for all patients in the study facility and not just those with pneumonia, a multifaceted intervention including a revised nurse screening tool, rescheduling of the vaccine order, storage of the vaccine in automated dispensing cabinets on the nursing unit, and creation of a vaccine tracking system was developed and implemented between August 2009 and October 2009. To determine the impact of a multifaceted intervention on pneumococcal vaccine screening and administration rates in eligible patients according to the CDC recommendations who were admitted to an internal medicine unit of a tertiary care teaching hospital. All patients aged 18 years or older from 2 internal medicine units were identified during 4-month time intervals before (pre-intervention, April through July 2009) and after (post-intervention, November 2009 through February 2010) implementation of the multifaceted pneumococcal vaccine protocol. Of these, 150 patients from each 4-month period were randomly selected for electronic medical record review. Eligibility for pneumococcal vaccination was derived from the CDC recommendations and consensus of the vaccine steering committee at the study institution; the

  4. Effect of Contract Compliance Rate to a Fourth-Generation Telehealth Program on the Risk of Hospitalization in Patients With Chronic Kidney Disease: Retrospective Cohort Study.

    Science.gov (United States)

    Hung, Chi-Sheng; Lee, Jenkuang; Chen, Ying-Hsien; Huang, Ching-Chang; Wu, Vin-Cent; Wu, Hui-Wen; Chuang, Pao-Yu; Ho, Yi-Lwun

    2018-01-24

    Chronic kidney disease (CKD) is prevalent in Taiwan and it is associated with high all-cause mortality. We have shown in a previous paper that a fourth-generation telehealth program is associated with lower all-cause mortality compared to usual care with a hazard ratio of 0.866 (95% CI 0.837-0.896). This study aimed to evaluate the effect of renal function status on hospitalization among patients receiving this program and to evaluate the relationship between contract compliance rate to the program and risk of hospitalization in patients with CKD. We retrospectively analyzed 715 patients receiving the telehealth care program. Contract compliance rate was defined as the percentage of days covered by the telehealth service before hospitalization. Patients were stratified into three groups according to renal function status: (1) normal renal function, (2) CKD, or (3) end-stage renal disease (ESRD) and on maintenance dialysis. The outcome measurements were first cardiovascular and all-cause hospitalizations. The association between contract compliance rate, renal function status, and hospitalization risk was analyzed with a Cox proportional hazards model with time-dependent covariates. The median follow-up duration was 694 days (IQR 338-1163). Contract compliance rate had a triphasic relationship with cardiovascular and all-cause hospitalizations. Patients with low or very high contract compliance rates were associated with a higher risk of hospitalization. Patients with CKD or ESRD were also associated with a higher risk of hospitalization. Moreover, we observed a significant interaction between the effects of renal function status and contract compliance rate on the risk of hospitalization: patients with ESRD, who were on dialysis, had an increased risk of hospitalization at a lower contract compliance rate, compared with patients with normal renal function or CKD. Our study showed that there was a triphasic relationship between contract compliance rate to the

  5. 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.

  6. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.

    Science.gov (United States)

    2012-08-31

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers

  7. Fatal toxic epidermal necrolysis associated with minoxidil.

    Science.gov (United States)

    Karaoui, Lamis R; Chahine-Chakhtoura, Corinne

    2009-04-01

    Minoxidil is a direct-acting peripheral vasodilator for the treatment of symptomatic hypertension, or refractory hypertension associated with target organ damage, that is not manageable with a diuretic and two other antihypertensive drugs. The most frequent adverse events associated with minoxidil include hypertrichosis and cardiovascular events related to its powerful antihypertensive effect, and less frequently, rashes, bullous eruptions, and Stevens-Johnson syndrome (SJS). Evidence suggests that SJS and toxic epidermal necrolysis (TEN) are variants of a single disease with common causes and mechanisms, but differing severities. Epidermal detachment is mild in SJS, moderate in overlap SJS-TEN, and severe (> 30% of body surface area) in TEN. We describe a case of minoxidil-associated SJS that evolved into fatal TEN. A 69-year-old African-American woman with a history of chronic kidney disease was admitted to the hospital for a cerebrovascular accident and uncontrolled hypertension. On hospital day 12, oral minoxidil was added to her drug regimen. On day 23, she developed a maculopapular rash on her face that gradually diffused to her chest and back. Vesicles and papular lesions extended to her extremities and mucosal membranes; results of a skin biopsy revealed SJS. A positive Nikolsky's sign (blisters spread on application of pressure) was detected. On days 27-31, diffuse bullae developed with rash exacerbation. Skin detachment exceeded 30% and was consistent with TEN. The patient died on day 39. An evaluation of the causality and time course suggested that minoxidil was the most likely culpable drug, with a Naranjo adverse drug reaction probability scale score indicating that the likelihood of the association was possible (score of 3). The mechanism of this reaction has not been well elucidated. It may be related to an impaired clearance of the minoxidil metabolite, or an immune stimulation resulting in apoptosis and epidermis destruction. To our knowledge, this

  8. Challenges in assessing hospital-level stroke mortality as a quality measure: comparison of ischemic, intracerebral hemorrhage, and total stroke mortality rates.

    Science.gov (United States)

    Xian, Ying; Holloway, Robert G; Pan, Wenqin; Peterson, Eric D

    2012-06-01

    Public reporting efforts currently profile hospitals based on overall stroke mortality rates, yet the "mix" of hemorrhagic and ischemic stroke cases may impact this rate. Using the 2005 to 2006 New York state data, we examined the degree to which hospital stroke mortality rankings varied regarding ischemic versus hemorrhagic versus total stroke. Observed/expected ratio was calculated using the Agency for Healthcare Research and Quality Inpatient Quality Indicator software. The observed/expected ratio and outlier status based on stroke types across hospitals were examined using Pearson correlation coefficients (r) and weighted κ. Overall 30-day stroke mortality rates were 15.2% and varied from 11.3% for ischemic stroke and 37.3% for intracerebral hemorrhage. Hospital risk-adjusted ischemic stroke observed/expected ratio was weakly correlated with its own intracerebral hemorrhage observed/expected ratio (r=0.38). When examining hospital performance group (mortality better, worse, or no different than average), disagreement was observed in 35 of 81 hospitals (κ=0.23). Total stroke mortality observed/expected ratio and rankings were correlated with intracerebral hemorrhage (r=0.61 and κ=0.36) and ischemic stroke (r=0.94 and κ=0.71), but many hospitals still switched classification depending on mortality metrics. However, hospitals treating a higher percent of hemorrhagic stroke did not have a statistically significant higher total stroke mortality rate relative to those treating fewer hemorrhagic strokes. Hospital stroke mortality ratings varied considerably depending on whether ischemic, hemorrhagic, or total stroke mortality rates were used. Public reporting of stroke mortality measures should consider providing risk-adjusted outcome on separate stroke types.

  9. Fatal neglect of the elderly.

    Science.gov (United States)

    Ortmann, C; Fechner, G; Bajanowski, T; Brinkmann, B

    2001-01-01

    Maltreatment of the elderly is a common problem that affects more than 3% of the elderly. We report on two cases of fatal neglect. Risk factors of victims and caregivers were analysed in the context of the social history. In both cases, the victims had a dominant personality and the abusers (the sons) had been strictly controlled and formed by the parent. The victims showed typical risk factors such as living together with the abuser, isolation, dependence on care, income and money administration. Initially, the victims declined help from outside and self-neglect occurred. The unemployed perpetrators lived in social isolation and depended financially and mentally on the victims. In both cases no mental illness was present but there was a decrease of social competence. Legal medicine is predominantly involved in fatal cases in connection with external post-mortem examinations and autopsies. Also in the living, the medico-legal expert can assist in the identification of findings in elderly persons in cases of suspected abuse.

  10. [Biochemical diagnostics of fatal opium intoxication].

    Science.gov (United States)

    Papyshev, I P; Astashkina, O G; Tuchik, E S; Nikolaev, B S; Cherniaev, A L

    2013-01-01

    Biochemical diagnostics of fatal opium intoxication remains a topical problem in forensic medical science and practice. We investigated materials obtained in the course of forensic medical expertise of the cases of fatal opium intoxication. The study revealed significant differences between myoglobin levels in blood, urine, myocardium, and skeletal muscles. The proposed approach to biochemical diagnostics of fatal opium intoxication enhances the accuracy and the level of evidence of expert conclusions.

  11. Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome.

    Science.gov (United States)

    Thipmontree, Wilawan; Tantibhedhyangkul, Wiwit; Silpasakorn, Saowaluk; Wongsawat, Ekkarat; Waywa, Duangdao; Suputtamongkol, Yupin

    2016-10-05

    Scrub typhus is endemic in Thailand. Of the 495 patients with acute undifferentiated fever studied in Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand, from June 1, 2011, to December 31, 2012, 146 patients (29.5%) had confirmed scrub typhus. The majority of cases were male, farmers, with the mean (±standard deviation) age of 54.1 ± 15.2 years. A total of 59 patients (40.4%) had eschar lesion. The commonest sites for an eschar in male patients were the perineum, inguinal, and buttock area; whereas in females, it was the head and neck area. Abnormal electrocardiogram was found in 39 of 79 patients (49.4%) with sinus tachycardia being the most frequent finding (17, 21.5%). A total of 73 patients (50%) had at least one complication. Myocarditis was the cause of complete heart block in a scrub typhus patient, and he fully recovered after receiving intravenous chloramphenicol treatment. The case fatality rate was 6.2% (nine deaths).The independent predictors for fatal outcome were age over 65 years (odds ratio [OR] = 14.49, 95% confidence interval [CI] = 1.26-166.44, P = 0.03), acute kidney injury (OR = 12.75, 95% CI = 1.77-92.07, P = 0.01), and hyperbilirubinemia (OR = 24.82, 95% CI = 2.12-286.61, P = 0.01). Early diagnosis and prompt appropriate treatment can improve the patient's outcome. © The American Society of Tropical Medicine and Hygiene.

  12. [A fatal case series of Rocky Mountain spotted fever in Sonora, México].

    Science.gov (United States)

    Delgado-De la Mora, Jesús; Licona-Enríquez, Jesús David; Leyva-Gastélum, Marcia; Delgado-De la Mora, David; Rascón-Alcantar, Adela; Álvarez-Hernández, Gerardo

    2018-03-15

    Rocky Mountain spotted fever is a highly lethal infectious disease, particularly if specific treatment with doxycycline is given belatedly. To describe the clinical profile of fatal Rocky Mountain spotted fever cases in hospitalized patients in the state of Sonora, México. We conducted a cross-sectional study on a series of 47 deaths caused by Rickettsia rickettsii from 2013 to 2016. The diagnosis of Rocky Mountain spotted fever was confirmed in a single blood sample by polymerase chain reaction (PCR) or by a four-fold increase in immunoglobulin G measured in paired samples analyzed by indirect immunofluorescence. Clinical and laboratory characteristics were compared stratifying subjects into two groups: pediatric and adult. There were no differences in clinical characteristics between groups; petechial rash was the most frequent sign (96%), followed by headache (70%) and myalgia (67%). Although that doxycycline was administered before the fifth day from the onset of symptoms, death occurred in 55% of patients. In clinical laboratory, thrombocytopenia, and biomarkers of liver acute failure and acute kidney failure were the most frequent. Rocky Mountain spotted fever remains as one of the most lethal infectious diseases, which may be related not only to the lack of diagnostic suspicion and delayed administration of doxycycline, but to genotypic characteristics of Rickettsia rickettsii that may play a role in the variability of the fatality rate that has been reported in other geographical regions where the disease is endemic.

  13. Fatal motorcycle crashes: a growing public health problem in Cambodia.

    Science.gov (United States)

    Roehler, Douglas R; Ear, Chariya; Parker, Erin M; Sem, Panhavuth; Ballesteros, Michael F

    2015-01-01

    This study examines the risk characteristics of fatal motorcycle crashes in Cambodia over a 5-year period (2007-2011). Secondary data analyses were conducted using the Cambodia Road Crash and Victim Information System, the only comprehensive and integrated road crash surveillance system in the country. Researchers from the Centers for Disease Control and Prevention and Handicap International found that (1) males are dying in motorcycle crashes roughly seven times more frequently than females; (2) motorcyclist fatalities increased by about 30% from 2007 to 2011; (3) the motorcyclist death rates per 100,000 population increased from 7.4 to 8.7 deaths from 2007 to 2011; and (4) speed-related crashes and not wearing motorcycle helmet were commonly reported for motorcyclist fatalities at approximately 50% and over 80% through the study years, respectively. Additionally, this study highlights that Cambodia has the highest motorcycle death rate in South-East Asia, far surpassing Thailand, Malaysia, and Myanmar. By recognising the patterns of fatal motorcycle crashes in Cambodia, local road-safety champions and stakeholders can design targeted interventions and preventative measures to improve road safety among motorcyclists.

  14. Analysis of readmission rates to the intensive care unit after implementation of a rapid response team in a University Hospital.

    Science.gov (United States)

    Bergamasco E Paula, R; Tanita, M T; Festti, J; Queiroz Cardoso, L T; Carvalho Grion, C M

    2017-10-01

    To compare readmission rates to the intensive care unit (ICU) before and after the implementation of a rapid response team (RRT), and to identify risk factors for readmission. A quasi-experimental before-after study was carried out. A University Hospital. All patients discharged from the ICU from January to December 2008 (control group) and from January 2010 to December 2012 (intervention group). Implementation of an RRT. The data included demographic parameters, diagnoses upon admission, ICU readmission, APACHE II, SOFA, and TISS 28 scores, and routine daily assessment by an RRT of patients discharged from the ICU. During the study interval, 380 patients were analyzed in the period prior to the implementation of the RRT and 1361 after implementation. There was a tendency toward decreased readmission rates one year after RRT implementation. The APACHE II score and SOFA score at ICU discharge were independent factors associated to readmission, as well as clinical referral to the ICU. The RRT intervention resulted in a sustained decrease in readmission rates one year after implementation of this service. The use of a specialized team in health institutions can be recommended for ICU survivors. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  15. The Compliance Rates of Hand Hygiene in Intensive Care Unit and Surgical Services at a State Hospital in Turkey

    Directory of Open Access Journals (Sweden)

    Serap Süzük

    2015-12-01

    Full Text Available Objective: The most efficient and most cost effective method for preventing health care associated infections is hand hygiene. Although hand hygiene is the most effective and simple method, compliance rates are very low among health care workers. It was aimed to evaluate the rates of compliance of healthcare workers in a state hospital. Material and Method: In this study, totally 112 healthcare workers (31 doctors and 81 nurses were evaluated with the 5-indication observation method in a period between January and July 2013. Results: A total of 754 (65.9% out of 1.144 cases were resulted in accurate hand washing and hand-rubbing. When the intensive care unit and surgical clinics were evaluated together, it was found that hand hygiene compliance rates were 51.26% in 199 cases and 66.85% in 591 cases for doctors and nurses, respectively. Conclusion: Consequently, we think that pre-informed observations are important training instruments for hand hygiene compliance.

  16. Analysis of Survival Rates Following Primary Surgery of 178 Consecutive Patients with Oral Cancer in a Large District General Hospital.

    Science.gov (United States)

    Stathopoulos, Panagiotis; Smith, William P

    2017-06-01

    The aim of this study is to present the survival rates in patients treated for oral cancer with primary surgery in a large district general hospital. We discuss the influence of the most significant prognostic factors on survival and compare our results with larger centres specializing in the management of oral cancer. All patients diagnosed with oral cancer from 1995 to 2006 and were treated in the Department had their details entered prospectively onto a computerized database. Demographic details of patients, type of treatment, pathological stage of tumor (TNM), local and regional recurrence rate, overall survival, disease specific survival and incidence of involved margins were recorded and calculated. Of the 178 patients, 96 (54 %) were alive and free of oral cancer 5 years after surgery. Forty-four patients died of oral cancer (24.7 %) but 38 (21.3 %) died of other causes. The overall survival rate after primary surgery in relation to stage was: I 84 %, II 71 %, III 36 % and IV 28 %. As almost half of our patients presented with advanced cancer and had discouraging survival rates, we emphasize the need for early recognition of the disease. Advanced disease signifies difficulty in obtaining clear margins which actually indicates a higher recurrence rate. 25 % of our patients died of oral cancer within 5 years of surgery which highlights the poor prognosis that recurrence carries after treatment. Effective educational campaign with purpose to raise oral cancer awareness and earlier referral may result in improvement of survival.

  17. Multivariate analyses to assess the effects of surgeon and hospital volume on cancer survival rates: a nationwide population-based study in Taiwan.

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    Chun-Ming Chang

    Full Text Available BACKGROUND: Positive results between caseloads and outcomes have been validated in several procedures and cancer treatments. However, there is limited information available on the combined effects of surgeon and hospital caseloads. We used nationwide population-based data to explore the association between surgeon and hospital caseloads and survival rates for major cancers. METHODOLOGY: A total of 11,677 patients with incident cancer diagnosed in 2002 were identified from the Taiwan National Health Insurance Research Database. Survival analysis, the Cox proportional hazards model, and propensity scores were used to assess the relationship between 5-year survival rates and different caseload combinations. RESULTS: Based on the Cox proportional hazard model, cancer patients treated by low-volume surgeons in low-volume hospitals had poorer survival rates, and hazard ratios ranged from 1.3 in head and neck cancer to 1.8 in lung cancer after adjusting for patients' demographic variables, co-morbidities, and treatment modality. When analyzed using the propensity scores, the adjusted 5-year survival rates were poorer for patients treated by low-volume surgeons in low-volume hospitals, compared to those treated by high-volume surgeons in high-volume hospitals (P<0.005. CONCLUSIONS: After adjusting for differences in the case mix, cancer patients treated by low-volume surgeons in low-volume hospitals had poorer 5-year survival rates. Payers may implement quality care improvement in low-volume surgeons.

  18. Association of type 2 diabetes with prolonged hospital stay and increased rate of readmission in patients with lower limb cellulitis.

    Science.gov (United States)

    Wijayaratna, S M; Cundy, T; Drury, P L; Sehgal, S; Wijayaratna, S A; Wu, F

    2017-01-01

    Lower limb (LL) cellulitis-related hospitalisations are prevalent in type 2 diabetes subjects. We assess its costs and factors associated with length of stay and readmissions. A retrospective case-control study at an urban hospital servicing a multi-ethnic population in New Zealand, where 7% of the adult population is estimated to have diabetes. Admissions with LL cellulitis in 2008-2013 were identified using coding records. Subsequent hospitalisations after 1 month with the same diagnosis were classified as readmissions. Glycaemic control was assessed by HbA1c measured within 6 months of the index admission. There were 4600 admissions with LL cellulitis in 3636 patients, including 719 patients (20%) with type 2 diabetes. Hospital stay was longer for type 2 diabetes patients (median 5.3 vs 3.0 days, P < 0.001), independent of age, ethnicity and HbA1c. Accompanying LL ulceration was more frequent in type 2 diabetes patients (50% vs 17%, P < 0.001); however, admissions remained longer for type 2 diabetes patients without ulceration (median 3.4 vs 2.8 days, P < 0.001). Readmission rates were also higher in type 2 diabetes patients compared to non-diabetes patients (HR 1.7, P < 0.001), even in the absence of ulceration (HR 2.2, P < 0.001). Age, HbA1c and ethnicity did not distinguish those prone to readmissions in the type 2 diabetes cohort. Type 2 diabetes patients accounted for a fifth of all admissions and one third of the estimated costs. A high proportion of patients with type 2 diabetes was admitted with LL cellulitis. They had significantly longer admissions and higher readmission rates. Age, HbA1c and ethnicity did not predict length of stay or recurrence. © 2016 Royal Australasian College of Physicians.

  19. Nasal and hand carriage rate of methicillin resistant Staphylococcus aureus (MRSA) among health care workers in Mekelle Hospital, North Ethiopia.

    Science.gov (United States)

    Gebreyesus, Araya; Gebre-Selassie, Solomon; Mihert, Adane

    2013-01-01

    Methicillin resistant Staphylococcus aureus (MRSA) is significant major pathogen responsible for hospital and community based infections. The aim of this study was to assess the nasal and hand carriage of methicillin resistant Staphylococcus aureus in health care workers of Mekelle Hospital The study was carried out during November 2010 to January 2011. Swab samples from both anterior nares and hands were taken. The samples were cultured on mannitol salt agar and incubated aerobically at 37 degrees C for 48 hours. Staphylococcus aureus was identified as nmannitol fermenter and coagulase test positive. Antimicrobial susceptibility test for MRSA was done by disk diffusion method using oxacillin disks. Data were analysed using SPSS version 16 software. Out of the 177 health care workers screened, 36 (20.3%) of them were methicillin resistant Staphylococcus aureus carriers in their hand and anterior nares. More females, 25(14.1%) were colonized by methicillin resistant Staphylococcus aureus than males 11 (6.2%) (P = 0.044). Nasal carriage of MRSA of 25 (14.1%) was higher than hand carriage 11 (6.2%) (p resistant Staphylococcus aureus carriage rates of 26 (13.6%) and 4 (2.3%), respectively. The isolated MRSA were resistant to multiple antibiotics. The highest resistance was observed for ampicillin (88.9%) and tetracycline (86.1%). Two (5.6%) of the nasal isolates were vancomycin resistant. Methicillin resistant Staphylococcus aureus carriage among health care workers in this study was high. The carriage rate was higher among nurses and doctors. The MRSA isolates were multi drug resistant to other antibiotics. So, the result of this study emphasizes the need of regular surveillance of health care workers. It also calls a need for an effective infection prevention and control program.

  20. Drowning Mortality and Morbidity Rates in Children and Adolescents 0-19yrs: A Population-Based Study in Queensland, Australia

    Science.gov (United States)

    Wallis, Belinda A.; Watt, Kerrianne; Franklin, Richard C.; Nixon, James W.; Kimble, Roy M.

    2015-01-01

    Objective To redress the lack of Queensland population incidence mortality and morbidity data associated with drowning in those aged 0-19yrs, and to understand survival and patient care. Design, Setting and Participants Retrospective population-based study used data linkage to capture both fatal and non-fatal drowning cases (N = 1299) among children aged 0-19years in Queensland, from 2002-2008 inclusive. Patient data were accessed from pre-hospital, emergency department, hospital admission and death data, and linked manually to collate data across the continuum of care. Main Outcome Measures Incidence rates were calculated separately by age group and gender for events resulting in death, hospital admission, and non-admission. Trends over time were analysed. Results Drowning death to survival ratio was 1:10, and two out of three of those who survived were admitted to hospital. Incidence rates for fatal and non-fatal drowning increased over time, primarily due to an increase in non-fatal drowning. There were non-significant reductions in fatal and admission rates. Rates for non-fatal drowning that did not result in hospitalisation more than doubled over the seven years. Children aged 5-9yrs and 10-14yrs incurred the lowest incidence rates 6.38 and 4.62 (expressed as per 100,000), and the highest rates were among children aged 0-4yrs (all drowning events 43.90; fatal 4.04; non-fatal 39.85–comprising admission 26.69 and non-admission 13.16). Males were over-represented in all age groups except 10-14yrs. Total male drowning events increased 44% over the seven years (P<0.001). Conclusion This state-wide data collection has revealed previously unknown incidence and survival ratios. Increased trends in drowning survival rates may be viewed as both positive and challenging for drowning prevention and the health system. Males are over-represented, and although infants and toddlers did not have increased fatality rates, they had the greatest drowning burden demonstrating

  1. Fatal cocaine intoxication in a body packer

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    Brajković Gordana

    2016-01-01

    Full Text Available Introduction. ‘Body packer’ syndrome with severe intoxication or sudden death may happen in persons who smuggle drugs in their body cavities. In case of lethal outcome when carrying cocaine, it is important, but sometimes difficult to determine whether death was due to intoxication or due to other causes. Therefore, it is necessary not only to quantify cocaine and its metabolites in biological material, but also based on their distribution in body fluids and tissues to conclude whether it is acute intoxication. We described a well-documented case of fatal poisoning in a body packer and post mortem distribution of the drug in biological samples. Case report. A 26-year-old man was brought to hospital with no vital signs. Resuscitation measures started at once, but with no success. Autopsy revealed 66 packets of cocaine in his digestive tract, one of which was ruptured. Hyperemia of the most of all internal organs and pulmonary and brain edema were found. High concentrations of cocaine, its metabolites benzoylecgonine and ecgonine methyl ester, as well as cocaine adulteration levamisole were proven in the post mortem blood and tissues by liquid chromatography-mass spectrometry (LC-MC method with selective-ion monitoring. Conclusion. The ratio of cocaine and its metabolites concentrations in the brain and blood obtained by LC-MS method can be used for forensic confirmation of acute intoxication with cocaine.

  2. Decreasing Risk of Fatal Subarachnoid Hemorrhage and Other Epidemiological Trends in the Era of Coiling Implementation in Australia

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    John Mark Worthington

    2017-08-01

    Full Text Available Background and purposeSubarachnoid hemorrhage (SAH is associated with a high risk of mortality and disability in survivors. We examined the epidemiology and burden of SAH in our population during a time services were re-organized to facilitate access to evidence-based endovascular coiling and neurosurgical care.MethodsSAH hospitalizations from 2001 to 2009, in New South Wales, Australia, were linked to death registrations to June 30, 2010. We assessed the variability of admission rates, fatal SAH rates and case fatality over time and according to patient demographic characteristics.ResultsThere were 4,945 eligible patients admitted to hospital with SAH. The risk of fatal SAH significantly decreased by 2.7% on average per year (95% CI = 0.3–4.9%. Case fatality at 2, 30, 90, and 365 days significantly declined over time. The average annual percentage reduction in mortality ranged from 4.4% for 30-day mortality (95% CI −6.1 to −2.7 (P < 0.001 to 4.7% for mortality within 2 days (−7.1 to −2.2 (P < 0.001 (Table 3. Three percent of patients received coiling at the start of the study period, increasing to 28% at the end (P-value for trend <0.001. Females were significantly more likely to be hospitalized for a SAH compared to males [incident rate ratio (IRR = 1.33, 95% CI = 1.23–1.44] (P < 0.001 and to die from SAH (IRR = 1.40, 95% CI = 1.24–1.59 (P < 0.001. People born in South-East Asia and the Oceania region had a significantly increased risk of SAH, while the risk of fatal SAH was greater in South-East and North-East Asian born residents. People residing in areas of least disadvantage had the lowest risk of hospitalization (IRR = 0.83, 95% CI = 0.74–0.92 and also the lowest risk of fatal SAH (0.81, 95% CI = 0.66–1.00 (P < 0.001 and P = 0.003, respectively. For every 100 SAH admissions, 20 and 15 might be avoided in males and females, respectively, if the risk of SAH in our

  3. Drug involvement in fatal overdoses

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    Christopher J. Ruhm

    2017-12-01

    Full Text Available Death certificate data from the Multiple Cause of Death (MCOD files were analyzed to better understand the drug categories most responsible for the increase in fatal overdoses occurring between 1999 and 2014. Statistical adjustment methods were used to account for the understatement in reported drug involvement occurring because death certificates frequently do not specify which drugs were involved in the deaths. The frequency of combination drug use introduced additional uncertainty and so a distinction was made between any versus exclusive drug involvement. Many results were sensitive to the starting and ending years chosen for examination. Opioid analgesics played a major role in the increased drug deaths for analysis windows starting in 1999 but other drugs, particularly heroin, became more significant for recent time periods. Combination drug use was important for all time periods and needs to be accounted for when designing policies to slow or reverse the increase in overdose deaths.

  4. [Autoerotic fatalities in Greater Dusseldorf].

    Science.gov (United States)

    Hartung, Benno; Hellen, Florence; Borchard, Nora; Huckenbeck, Wolfgang

    2011-01-01

    Autoerotic fatalities in the Greater Dusseldorf area correspond to the relevant medicolegal literature. Our results included exclusively young to middle-aged, usually single men who were found dead in their city apartments. Clothing and devices used showed a great variety. Women's or fetish clothing and complex shackling or hanging devices were disproportionately frequent. In most cases, death occurred due to hanging or ligature strangulation. There was no increased incidence of underlying psychiatric disorders. In most of the deceased no or at least no remarkable alcohol intoxication was found. Occasionally, it may be difficult to reliably differentiate autoerotic accidents, accidents occurring in connection with practices of bondage & discipline, dominance & submission (BDSM) from natural death, suicide or homicide.

  5. Fatal and non-fatal cardiovascular events in a general population prescribed sibutramine in New Zealand: a prospective cohort study.

    Science.gov (United States)

    Harrison-Woolrych, Mira; Ashton, Janelle; Herbison, Peter

    2010-07-01

    The cardiovascular safety of sibutramine is currently under review by medicines regulatory authorities worldwide after the SCOUT (Sibutramine Cardiovascular Outcome Trial) showed an increased risk of cardiovascular events in patients taking sibutramine. Further data regarding the cardiovascular safety of sibutramine in a general population are now required. To quantify the risk of fatal and non-fatal cardiovascular adverse events in a general population prescribed sibutramine in postmarketing use. Observational prospective cohort study of patients dispensed sibutramine during a 3-year period (2001-4) and followed up for at least 1 year after their last prescription. The study included record-linkage to national mortality datasets to identify fatal events. Postmarketing 'real-life' use of sibutramine in a general population in New Zealand. All New Zealand patients dispensed a prescription for sibutramine in a 3-year period (for whom a National Health Identification number could be validated). 15 686 patients were included in the record linkage study for fatal events. A subgroup of 9471 patients was followed up by intensive methods for non-fatal events. (i) Rate of death from all causes and from cardiovascular events; and (ii) rates of non-fatal cardiovascular adverse events. Total exposure to sibutramine for 15 686 patients in the validated cohort was 5431 treatment-years. The rate of death from all causes in this cohort was 0.13 (95% CI 0.05, 0.27) per 100 treatment-years exposure. The rate of death from a cardiovascular event was 0.07 (95% CI 0.02, 0.19) per 100 treatment-years exposure. The most frequent non-fatal cardiovascular events in the intensively followed up cohort were hypertension, palpitations, hypotensive events and tachycardia. Risk of death from a cardiovascular event in this general population of patients prescribed sibutramine was lower than has been reported in other overweight/obese populations. The results of this study suggest that further

  6. 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

  7. Dataset on psychosocial risk factors in cases of fatal and near-fatal physical child abuse

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    Mary Clyde Pierce

    2017-10-01

    Full Text Available This article presents the psychosocial risk factors identified in the cases of 20 children less than four years of age who were victims of fatal or near-fatal physical abuse during a 12 month period in the Commonwealth of Kentucky. These data are related to the article “History, injury, and psychosocial risk factor commonalities among cases of fatal and near-fatal physical child abuse” (Pierce et al., 2017 [1].

  8. The Effectiveness of Drinking and Driving Policies for Different Alcohol-Related Fatalities: A Quantile Regression Analysis

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    Koyin Chang

    2013-09-01

    Full Text Available To understand the impact of drinking and driving laws on drinking and driving fatality rates, this study explored the different effects these laws have on areas with varying severity rates for drinking and driving. Unlike previous studies, this study employed quantile regression analysis. Empirical results showed that policies based on local conditions must be used to effectively reduce drinking and driving fatality rates; that is, different measures should be adopted to target the specific conditions in various regions. For areas with low fatality rates (low quantiles, people’s habits and attitudes toward alcohol should be emphasized instead of transportation safety laws because “preemptive regulations” are more effective. For areas with high fatality rates (or high quantiles, “ex-post regulations” are more effective, and impact these areas approximately 0.01% to 0.05% more than they do areas with low fatality rates.

  9. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules.

    Science.gov (United States)

    2013-08-19

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the

  10. Trends in Respiratory Syncytial Virus and Bronchiolitis Hospitalization Rates in High-Risk Infants in a United States Nationally Representative Database, 1997-2012.

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    Abigail Doucette

    Full Text Available Respiratory syncytial virus (RSV causes significant pediatric morbidity and is the most common cause of bronchiolitis. Bronchiolitis hospitalizations declined among US infants from 2000‒2009; however, rates in infants at high risk for RSV have not been described. This study examined RSV and unspecified bronchiolitis (UB hospitalization rates from 1997‒2012 among US high-risk infants.The Kids' Inpatient Database (KID infant annual RSV (ICD-9 079.6, 466.11, 480.1 and UB (ICD-9 466.19, 466.1 hospitalization rates were estimated using weighted counts. Denominators were based on birth hospitalizations with conditions associated with high-risk for RSV: chronic perinatal respiratory disease (chronic lung disease [CLD]; congenital airway anomalies (CAA; congenital heart disease (CHD; Down syndrome (DS; and other genetic, metabolic, musculoskeletal, and immunodeficiency conditions. Preterm infants could not be identified. Hospitalizations were characterized by mechanical ventilation, inpatient mortality, length of stay, and total cost (2015$. Poisson and linear regression were used to test statistical significance of trends.RSV and UB hospitalization rates were substantially elevated for infants with higher-risk CHD, CLD, CAA and DS without CHD compared with all infants. RSV rates declined by 47.0% in CLD and 49.7% in higher-risk CHD infants; no other declines in high-risk groups were observed. UB rates increased in all high-risk groups except for a 22.5% decrease among higher-risk CHD. Among high-risk infants, mechanical ventilation increased through 2012 to 20.4% and 13.5% of RSV and UB hospitalizations; geometric mean cost increased to $31,742 and $25,962, respectively, and RSV mortality declined to 0.9%.Among high-risk infants between 1997 and 2012, RSV hospitalization rates declined among CLD and higher-risk CHD infants, coincident with widespread RSV immunoprophylaxis use in these populations. UB hospitalization rates increased in all high

  11. Sports members' participation in assessment of incidence rate of injuries in five sports from records of hospital-based clinical treatment

    NARCIS (Netherlands)

    Kingma, J; ten Duis, HJ

    This study is about the incidence rate of sports injuries in five different types of sports, gymnastics, soccer, volleyball, hockey, and basketball, for which 5,154 patients were admitted to the Emergency Unit of the Groningen University Hospital during the period 1990 through 1994. Incidence rate

  12. Surveying the rate of tissue expander complications among reconstructive patients in Hazrat Fatima hospital between 1389-1391

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    Amirasadola Khajerahimi

    2016-05-01

    Full Text Available Background: Tissue expansion is a common reconstructive surgery especially in burned patients. This study has been designed to evaluate the rate of complications of this method in Hazrat Fatima Hospital between 1389-1391. Materials & Methods: In this cross sectional and retrospective study, 150 patients' records have been studied between 1389-1391 years, frequency rate and types of complications related to tissue expander have been surveyed in these patients. Results: Complications have been observed in about 7% of the patients included in this study. Exposure of tissue expander was the most common complication (81.8%. Other complications which are resulted from this issue are capsular contracture and infection. Age was the only factor which had significant relation with increasing complication among the other surveyed factors including age, sex, indication of operation, wound location and duration of anaesthesia.(p=0.033 Conclusion: The incidence of complication in patients that required tissue expander was not high and it was less than 10%. It should be noted that patient selection should be carefully in paediatric group and also strict observance of surgical principles is necessary to avoid complication.

  13. Hospital admission and mortality rates in anorexia nervosa: experience from an integrated medical-psychiatric outpatient treatment.

    Science.gov (United States)

    De Filippo, E; Signorini, A; Bracale, R; Pasanisi, F; Contaldo, F

    2000-12-01

    To evaluate the effectiveness of an integrated medical-psychiatric treatment of major eating disorders. Historical cohort study. Outpatient Unit for Protein Energy Malnutrition of the Department of Clinical and Experimental Medicine, "Federico II" University of Naples, time of study: January 1994 to December 1997 PARTICIPANTS: 147 female patients with restrictive or bulimic anorexia nervosa (mean age 19.8 +/- 13.7, BMI 14.7 +/- 2.1 Kg/m2) consecutively attending the outpatient unit between January 1994 and December 1997. Hospitalization and mortality rates were evaluated up to Jan 1999 with a minimum follow-up of 18 months. There were 23 admissions to the Clinical Nutrition ward for 19 patients (i.e. 12.9%) mostly due to severe protein energy malnutrition, and 2 deaths, only 1 strictly related to anorexia (mortality rate 0.7%). Integrated outpatient medical-psychiatric treatment for major eating disorders is an effective and inexpensive procedure that reduces mortality and admissions due to medical complications in the medium term.

  14. Disaster-related fatalities among US citizens traveling abroad.

    Science.gov (United States)

    Partridge, Robert; Bouslough, David; Proano, Lawrence

    2013-01-01

    To describe the locations and risk of death associated with natural disaster fatalities for US citizens traveling abroad. A retrospective database review of US citizen disaster deaths occurring worldwide. None. Information on fatalities due to disasters was abstracted from the US Department of State Web site reporting deaths of US citizens abroad by non-natural causes from October 2002 through June 2012. The main outcome measures were the frequency of disaster deaths and countries where disasters occurred. Descriptive statistics and rates were used to evaluate the study data. There were 7,963 total non-natural deaths of US citizens traveling abroad during the study period. Of these, 163 (2.0 percent) were disaster-related deaths, involving 19 disaster events in 15 countries. Only two disaster-related events resulted in more than two deaths of US travelers-the 2010 earthquake in Haiti causing 121 fatalities (74.2 percent of disaster deaths), and the 2004 tsunami in Thailand causing 22 fatalities (13.5 percent of disaster deaths). The approximate annual mean death rate for US citizen travelers as a result of disaster events is 0.27 deaths/1 million travelers, compared with 1.4 deaths/1 million residents due to disaster annually within the United States. The risk of disaster-related fatality is low for US citizens traveling abroad. Although disaster-related death among travelers is unpredictable, during a period of almost 10 years, there was only one reported death due to disaster in the five countries most frequently visited by US travelers. Further investigation may identify population-, seasonal-, country-, or location-specific risks from which prevention strategies can be developed.

  15. Buses involved in fatal accidents codebook 2008.

    Science.gov (United States)

    2011-03-01

    This report provides documentation for UMTRIs file of Buses Involved in Fatal Accidents (BIFA), 2008, : including distributions of the code values for each variable in the file. The 2008 BIFA file is a census of all : buses involved in a fatal acc...

  16. Buses involved in fatal accidents codebook 2007.

    Science.gov (United States)

    2009-12-01

    This report provides documentation for UMTRIs file of Buses Involved in Fatal Accidents (BIFA), 2007, : including distributions of the code values for each variable in the file. The 2007 BIFA file is a census of all : buses involved in a fatal acc...

  17. Variations over time in the effects of age and sex on hospitalization rates before and after admission to a nursing home: A German cohort study.

    Science.gov (United States)

    Hoffmann, Falk; Allers, Katharina

    2017-08-01

    We examined hospitalization rates for nursing home residents before and after their entry to the home, stratified by sex and age. A cohort study was conducted using data from a large health insurance fund on 127,227 residents aged 65 years and over newly admitted to a nursing home between January 1, 2010, and December 31, 2014. We assessed hospitalization rates and proportions being hospitalized in 6-month intervals one year before nursing home placement and up to 5 years thereafter. Multiple Poisson regression models were fitted to calculate relative risks (RR). Mean age was 84.0 years and 74.6% of the cohort were females. Hospitalization rates were 194.4 per 100 person-years (PY) in the 12 months before entry to the nursing home and 120.0 per 100 PY thereafter. Rates were highest immediately before entry in both sexes. The influence of age was most pronounced in the 12-7 months before entry (RR: 2.37 for 65-74 vs. 95+ years) and declined thereafter (1.29-1.38 up to month 24 after entry). In contrast, the influence of sex was greater after entry (RR: 1.13 for males vs. females in the 12-7 months before and 1.23-1.31 up to month 24 after entry). Hospitalization rates of nursing home residents are much higher in Germany than in other Western countries. We have provided some insight into the influence of age and sex on hospitalization rates, which varied over the period (time before and after entry to the nursing home) analyzed. We urgently recommend that future studies on the hospitalization of residents stratify their analyses by sex, age and period. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. A fatal case of thallium toxicity: challenges in management.

    Science.gov (United States)

    Riyaz, R; Pandalai, S L; Schwartz, M; Kazzi, Z N

    2013-03-01

    Thallium is a highly toxic compound and is occasionally involved in intentional overdoses or criminal poisonings. Accidental poisonings also occur, but are increasingly rare owing to restricted use and availability of thallium. We report a fatal suicidal ingestion of thallium sulfate rodenticide in which multi-dose activated charcoal (MDAC) and Prussian Blue (PB) were both used without changing the outcome. A 36 year old man ingested an unknown amount of thallium sulfate grains from an old rodenticide bottle. He presented to an emergency department (ED) 45 minutes later with abdominal pain and vomiting. On examination he was agitated with a blood pressure of 141/60 mmHg and a heart rate of 146 beats per minute (bpm). He received MDAC during his initial ED management and was started on PB 18 hours post arrival; he was intubated on the following day for airway protection. The patient continued to be tachycardic and hypertensive and subsequently developed renal failure. On hospital day three, the patient developed hypotension that did not respond to fluids. The patient required vasopressors and was transferred to a tertiary care center to undergo continuous renal replacement therapy (CRRT). The patient died shortly after his transfer. His last blood thallium concentration was 5369 mcg/L, a spot urine thallium >2000 mcg/L, and a 24- hour urine thallium was >2000 mcg/L. Though extremely rare, thallium intoxication can be lethal despite early administration of MDAC and use of Prussian blue therapy. Rapid initiation of hemodialysis can be considered in cases of severe thallium poisoning, to remove additional thallium, to correct acid-base disturbance, or to improve renal function.

  19. Decrease in mortality rate and hospital admissions for acute myocardial infarction after the enactment of the smoking ban law in São Paulo city, Brazil.

    Science.gov (United States)

    Abe, Tania M O; Scholz, Jaqueline; de Masi, Eduardo; Nobre, Moacyr R C; Filho, Roberto Kalil

    2017-11-01

    Smoking restriction laws have spread worldwide during the last decade. Previous studies have shown a decline in the community rates of myocardial infarction after enactment of these laws. However, data are scarce about the Latin American population. In the first phase of this study, we reported the successful implementation of the law in São Paulo city, with a decrease in carbon monoxide rates in hospitality venues. To evaluate whether the 2009 implementation of a comprehensive smoking ban law in São Paulo city was associated with a reduction in rates of mortality and hospital admissions for myocardial infarction. We performed a time-series study of monthly rates of mortality and hospital admissions for acute myocardial infarction from January 2005 to December 2010. The data were derived from DATASUS, the primary public health information system available in Brazil and from Mortality Information System (SIM). Adjustments and analyses were performed using the Autoregressive Integrated Moving Average with exogenous variables (ARIMAX) method modelled by environmental variables and atmospheric pollutants to evaluate the effect of smoking ban law in mortality and hospital admission rate. We also used Interrupted Time Series Analysis (ITSA) to make a comparison between the period pre and post smoking ban law. We observed a reduction in mortality rate (-11.9% in the first 17 months after the law) and in hospital admission rate (-5.4% in the first 3 months after the law) for myocardial infarction after the implementation of the smoking ban law. Hospital admissions and mortality rate for myocardial infarction were reduced in the first months after the comprehensive smoking ban law was implemented. 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/.

  20. Substance use among Iranian drivers involved in fatal road accidents

    Directory of Open Access Journals (Sweden)

    Shervin eAssari

    2014-08-01

    Full Text Available Background: Although the problem of substance use among drivers is not limited to a special part of the world, most published epidemiological reports on this topic is from industrial world.Aim: To determine drug use among Iranian adults who were imprisoned for vehicle accidents with fatality. Methods: This study enrolled 51 Iranian adults who were imprisoned for vehicle accidents with fatality. This sample came from a national survey of prisoners. Data was collected at entry to prisons during the last 4 months of 2008 in 7 prisons in different parts of the country. Self reported drug use was registered. Commercial substance use screening tests were also done. Results: Drug test was positive for opioids, cannabis and both in 37.3%, 2.0% and 13.7%, respectively. 29.4% tested positive for benzodiazepines. Using test introduced 23.5% of our sample as drug users, who had declined to report any drug use. Conclusion: Opioids are the most used illicit drug in the case of vehicle accidents with fatality, however, 20% of users do not declare their use. This high rate of drug use in vehicle accidents with fatality reflects the importance of drug use control as a part of injury prevention in Iran. There might be a need for drug screening after severe car accidents.

  1. Violent and Fatal Youth Trauma: Is There a Missed Opportunity?

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    Robert Madlinger, DO

    2012-05-01

    Full Text Available Introduction: Accidents and assaults (homicides are the leading causes of death among the youth of the United States, accounting for 53.3% of deaths among children aged 1 to19 years. Victim recidivism,defined as repeated visits to the emergency department (ED as a victim of violent trauma, is a significantly growing public health problem. As 5-year mortality rates for recidivism are as high as 20%,it is important to determine whether victims with a history of violent trauma are at increased risk for fatal outcome with their next trauma. We hypothesized that victims of violent trauma who have had 1 prior ED visit for violent trauma will have increased odds of fatal outcome.Methods: A retrospective chart review was conducted for patients presenting with penetrating trauma to the ED from January 1, 1999 to December 31, 2009. All patients between the ages of 15 to 25 years who presented to the ED for any penetrating trauma were included. Patients with prior presentations for penetrating trauma were compared to those patients who were first-time presenters to determine the odds ratio of fatal outcome.Results: Overall, 15,395 patients were treated for traumatic presentations. Of these, 1,044 met inclusion criteria. Demographically, 79.4% were Hispanic, 19.4% were African American, and 0.96% were Caucasian. The average age was 21 years, and 98% of the population was male. One hundred and forty-seven (14% had prior presentations, and 897 (86% did not. Forty of the 147 patients (27%with prior presentations had a fatal outcome as compared to 29 patients of the 868 (3% without prior presentations, with odds ratio of 10.8 (95% confidence interval, 6.4–18.1; Pearson v2, P , 0.001. The 5-year mortality rate for those patients with fatal outcomes was calculated at 16.5%.Conclusion: Patients who had prior ED visits for penetrating trauma were at greater risk for fatal outcomes compared to those with no prior visits. Therefore, trauma-related ED visits might

  2. Success rate evaluation of clinical governance implementation in teaching hospitals in Kerman (Iran) based on nine steps of Karsh's model.

    Science.gov (United States)

    Vali, Leila; Mastaneh, Zahra; Mouseli, Ali; Kardanmoghadam, Vida; Kamali, Sodabeh

    2017-07-01

    One of the ways to improve the quality of services in the health system is through clinical governance. This method aims to create a framework for clinical services providers to be accountable in return for continuing improvement of quality and maintaining standards of services. To evaluate the success rate of clinical governance implementation in Kerman teaching hospitals based on 9 steps of Karsh's Model. This cross-sectional study was conducted in 2015 on 94 people including chief executive officers (CEOs), nursing managers, clinical governance managers and experts, head nurses and nurses. The required data were collected through a researcher-made questionnaire containing 38 questions with three-point Likert Scale (good, moderate, and weak). The Karsh's Model consists of nine steps including top management commitment to change, accountability for change, creating a structured approach for change, training, pilot implementation, communication, feedback, simulation, and end-user participation. Data analysis using descriptive statistics and Mann-Whitney-Wilcoxon test was done by SPSS software version 16. About 81.9 % of respondents were female and 74.5 have a Bachelor of Nursing (BN) degree. In general, the status of clinical governance implementation in studied hospitals based on 9 steps of the model was 44 % (moderate). A significant relationship was observed among accountability and organizational position (p=0.0012) and field of study (p=0.000). Also, there were significant relationships between structure-based approach and organizational position (p=0.007), communication and demographic characteristics (p=0.000), and end-user participation with organizational position (p=0.03). Clinical governance should be implemented by correct needs assessment and participation of all stakeholders, to ensure its enforcement in practice, and to enhance the quality of services.

  3. Cirrus Airframe Parachute System and Odds of a Fatal Accident in Cirrus Aircraft Crashes.

    Science.gov (United States)

    Alaziz, Mustafa; Stolfi, Adrienne; Olson, Dean M

    2017-06-01

    General aviation (GA) accidents have continued to demonstrate high fatality rates. Recently, ballistic parachute recovery systems (BPRS) have been introduced as a safety feature in some GA aircraft. This study evaluates the effectiveness and associated factors of the Cirrus Airframe Parachute System (CAPS) at reducing the odds of a fatal accident in Cirrus aircraft crashes. Publicly available Cirrus aircraft crash reports were obtained from the National Transportation Safety Board (NTSB) database for the period of January 1, 2001-December 31, 2016. Accident metrics were evaluated through univariate and multivariate analyses regarding odds of a fatal accident and use of the parachute system. Included in the study were 268 accidents. For CAPS nondeployed accidents, 82 of 211 (38.9%) were fatal as compared to 8 of 57 (14.0%) for CAPS deployed accidents. After controlling for all other factors, the adjusted odds ratio for a fatal accident when CAPS was not deployed was 13.1. The substantial increased odds of a fatal accident when CAPS was not deployed demonstrated the effectiveness of CAPS at providing protection of occupants during an accident. Injuries were shifted from fatal to serious or minor with the use of CAPS and postcrash fires were significantly reduced. These results suggest that BPRS could play a significant role in the next major advance in improving GA accident survival.Alaziz M, Stolfi A, Olson DM. Cirrus Airframe Parachute System and odds of a fatal accident in Cirrus aircraft crashes. Aerosp Med Hum Perform. 2017; 88(6):556-564.

  4. Nasal Carriage Rate of Methicillin Resistant Staphylococcus aureus among Health Care Workers at a Tertiary Care Hospital in Kathmandu, Nepal.

    Science.gov (United States)

    Khatri, S; Pant, N D; Bhandari, R; Shrestha, K L; Shrestha, C D; Adhikari, N; Poudel, A

    2017-01-01

    Methicillin-resistant Staphylococcus aureus is one of the most common causes of nosocomial infections. Due to its multidrug resistant nature; infections due to Methicillin-resistant Staphylococcus aureus are often very difficult to treat. Colonized health care workers are the important sources of Methicillin-resistant Staphylococcus aureus. The objectives of this study were to determine the nasal carriage rate of Methicillin-resistant Staphylococcus aureus among health care workers at Kathmandu Medical College and Teaching Hospital, Nepal and to assess their antimicrobial susceptibility patterns. A cross sectional study was conducted among 252 health care workers from July to November 2013. Mannitol salt agar was used to culture the nasal swabs. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion technique following Clinical and Laboratory Standards Institute guidelines. Methicillin-resistant Staphylococcus aureus strains were confirmed by using cefoxitin disc and by determining the minimum inhibitory concentration of oxacillin by agar dilution method. Of 252 healthcare workers, 46(18.3%) were positive for Staphylococcus aureus among which 19(41.3%) were Methicillin-resistant Staphylococcus aureus carriers. Overall rate of nasal carriage of Methicillin-resistant Staphylococcus aureus was 7.5% (19/252).The higher percentages of lab personnel were nasal carriers of S. aureus (31.6%) and Methicillin-resistant Staphylococcus aureus (10.5%).The percentages of nasal carriage of S. aureus (35.7%) and Methicillin-resistant Staphylococcus aureus (14.3%) were highest in the health care workers from post operative department. Higher percentage of Methicillin-resistant Staphylococcus aureus were susceptible toward amikacin (100%) and vancomycin (100%) followed by cotrimoxazole (84.2%). High rates of nasal carriage of S. aureus and Methicillin-resistant Staphylococcus aureus were observed among the healthcare workers, which indicate the need of

  5. Fatal injuries among grounds maintenance workers: United States, 2003--2008.

    Science.gov (United States)

    2011-05-06

    A total of 1,142 grounds maintenance workers (GMWs) were fatally injured at work during 2003--2008, an average of 190 each year. GMWs accounted for 3.4% of all occupational fatalities, and 31% of those GMWs were Hispanic or Latino. Approximately 83% of the Hispanic or Latino GMWs who died were born outside the United States. In 2008, approximately 1.52 million persons were employed as GMWs, constituting 1.0% of the U.S. workforce. During 2003--2007, an average of 13.3 per 100,000 employed GMWs died each year, compared with an overall rate of 4.0 fatalities per 100,000 U.S. workers. The rate of on-the-job fatal injuries among GMWs has remained elevated relative to other workers for >20 years. This report characterizes events leading to GMW fatalities and differences in fatality characteristics across demographic groups among GMWs, based on an evaluation of 2003--2008 data from the U.S. Department of Labor's Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) program. The report also identifies workplace interventions that might reduce the incidence of fatal injuries. Major events leading to GMW occupational fatalities included transportation incidents (31%), contact with objects and equipment (25%), falls (23%), and traumatic acute exposures to harmful substances or environments (e.g., electrocution and drowning) (16%). To reduce the incidence of such fatalities, employers, trade and worker associations, and policy makers should focus on effective, targeted workplace safety interventions such as frequent hazard identification and training for specific hazards. Diversity among the populations of workers requires use of culture- and language-appropriate training techniques as part of comprehensive injury and illness prevention programs.

  6. Attitudes of Mashhad Public Hospital's Nurses and Midwives toward the Causes and Rates of Medical Errors Reporting.

    Science.gov (United States)

    Mobarakabadi, Sedigheh Sedigh; Ebrahimipour, Hosein; Najar, Ali Vafaie; Janghorban, Roksana; Azarkish, Fatemeh

    2017-03-01

    Patient's safety is one of the main objective in healthcare services; however medical errors are a prevalent potential occurrence for the patients in treatment systems. Medical errors lead to an increase in mortality rate of the patients and challenges such as prolonging of the inpatient period in the hospitals and increased cost. Controlling the medical errors is very important, because these errors besides being costly, threaten the patient's safety. To evaluate the attitudes of nurses and midwives toward the causes and rates of medical errors reporting. It was a cross-sectional observational study. The study population was 140 midwives and nurses employed in Mashhad Public Hospitals. The data collection was done through Goldstone 2001 revised questionnaire. SPSS 11.5 software was used for data analysis. To analyze data, descriptive and inferential analytic statistics were used. Standard deviation and relative frequency distribution, descriptive statistics were used for calculation of the mean and the results were adjusted as tables and charts. Chi-square test was used for the inferential analysis of the data. Most of midwives and nurses (39.4%) were in age range of 25 to 34 years and the lowest percentage (2.2%) were in age range of 55-59 years. The highest average of medical errors was related to employees with three-four years of work experience, while the lowest average was related to those with one-two years of work experience. The highest average of medical errors was during the evening shift, while the lowest were during the night shift. Three main causes of medical errors were considered: illegibile physician prescription orders, similarity of names in different drugs and nurse fatigueness. The most important causes for medical errors from the viewpoints of nurses and midwives are illegible physician's order, drug name similarity with other drugs, nurse's fatigueness and damaged label or packaging of the drug, respectively. Head nurse feedback, peer

  7. 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

  8. Fatal Necrotizing Fasciitis following Episiotomy

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    Faris Almarzouqi

    2015-01-01

    Full Text Available Introduction. Necrotizing fasciitis is an uncommon condition in general practice but one that provokes serious morbidity. It is characterized by widespread fascial necrosis with relative sparing of skin and underlying muscle. Herein, we report a fatal case of necrotizing fasciitis in a young healthy woman after episiotomy. Case Report. A 17-year-old primigravida underwent a vaginal delivery with mediolateral episiotomy. Necrotizing fasciitis was diagnosed on the 5th postpartum day, when the patient was referred to our tertiary care medical center. Surgical debridement was initiated together with antibiotics and followed by hyperbaric oxygen therapy. The patient died due to septic shock after 16 hours from the referral. Conclusion. Delay of diagnosis and consequently the surgical debridement were most likely the reasons for maternal death. In puerperal period, a physician must consider necrotizing fasciitis as a possible diagnosis in any local sings of infection especially when accompanied by fever and/or tenderness. Early diagnosis is the key for low mortality and morbidity.

  9. Impact of a partial smoke-free legislation on myocardial infarction incidence, mortality and case-fatality in a population-based registry: the REGICOR Study.

    Directory of Open Access Journals (Sweden)

    Fernando Agüero

    Full Text Available Coronary heart disease (CHD is the leading cause of death, and smoking its strongest modifiable risk factor. Our aim was to determine the impact of the Spanish 2006 partial smoke-free legislation on acute myocardial infarction (AMI incidence, hospitalization and mortality rates, and 28-day case-fatality in Girona, Spain.Using a population-based registry (the REGICOR Study, we compared population incidence, hospitalization, and mortality rates, and 28-day case-fatality in the pre- and post-ban periods (2002-2005 and 2006-2008, respectively by binomial regression analysis adjusted for confounding factors. We also analyzed the ban's impact on the outcomes of interest using the AMI definitions of the American Heart Association (AHA/European Society of Cardiology (ESC and the World Health Organization (WHO-Monitoring trends and determinants in cardiovascular diseases (MONICA.In the post-ban period, AMI incidence and mortality rates significantly decreased (relative risk [RR] = 0.89; 95% confidence interval [CI] = 0.81-0.97 and RR = 0.82; 95% CI = 0.71-0.94, respectively. Incidence and mortality rates decreased in both sexes, especially in women, and in people aged 65-74 years. Former and non-smokers (passive smokers showed diminished incidence rates. Implementation of the ban was not associated with AMI case-fatality. Models tended to be more significant with the WHO-MONICA than with the AHA/ESC definition.The 2006 Spanish partial smoke-free legislation was associated with a decrease in population AMI incidence and mortality, particularly in women, in people aged 65-74 years, and in passive smokers. These results clarify the association between AMI mortality and the enactment of a partial smoke-free legislation and reinforce the effectiveness of smoking regulations in preventing CHD.

  10. Return-on-Investment (ROI) Analyses of an Inpatient Lay Health Worker Model on 30-Day Readmission Rates in a Rural Community Hospital.

    Science.gov (United States)

    Cardarelli, Roberto; Bausch, Gregory; Murdock, Joan; Chyatte, Michelle Renee

    2017-07-07

    The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs). The BTH program had a -$0.67 ROI if the hospital had only a DRG-based payment model. If the hospital had P4P contracts with payers and 0.1% of its annual operating revenue was at risk, the ROI increased to $7.03 for every $1 spent on the BTH program. However, if the hospital was an ACO as was the case for this study's community hospital, the ROI significantly increased to $38.48 for every $1 spent on the BTH program. The BTH model showed a viable ROI to be considered by community hospitals that are part of an ACO or P4P program. A LHW care transition model may be a cost-effective alternative for impacting excess 30-day readmissions and avoiding associated penalties for hospital systems with a value-based payment model. © 2017 National Rural Health Association.

  11. Multiple challenges of antibiotic use in a large hospital in Ethiopia - a ward-specific study showing high rates of hospital-acquired infections and ineffective prophylaxis.

    Science.gov (United States)

    Gutema, Girma; Håkonsen, Helle; Engidawork, Ephrem; Toverud, Else-Lydia

    2018-05-03

    This project aims to study the use of antibiotics in three clinical wards in the largest tertiary teaching hospital in Ethiopia for a period of 1 year. The specific aims were to assess the prevalence of patients on antibiotics, quantify the antibiotic consumption and identify the main indications of use. The material was all the medical charts (n = 2231) retrieved from three clinical wards (internal medicine, gynecology/obstetrics and surgery) in Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa between September 2013 and September 2014. Data collection was performed manually by four pharmacists. Each medical chart represented one patient. About 60% of the patients were admitted to internal medicine, 20% to each of the other two wards. The number of bed days (BD) was on average 16.5. Antibiotics for systemic use were prescribed to 73.7% of the patients (on average: 2.1 antibiotics/patient) of whom 86.6% got a third or fourth generation cephalosporin (mainly ceftriaxone). The average consumption of antibiotics was 81.6 DDD/100BD, varying from 91.8 in internal medicine and 71.6 in surgery to 47.6 in gynecology/obstetrics. The five most frequently occurring infections were pneumonia (26.6%), surgical site infections (21.5%), neutropenic fever (6.9%), sepsis (6.4%) and urinary tract infections (4.7%). About one fourth of the prescriptions were for prophylactic purposes. Hospital acquired infections occurred in 23.5% of the patients (353 cases of surgical site infection). The prescribing was based on empirical treatment and sensitivity testing was reported in only 3.8% of the cases. In the present study from three wards in the largest tertiary teaching hospital in Ethiopia, three out of four patients were prescribed antibiotics, primarily empirically. The mean antibiotic consumption was 81.6 DDD/100BD. Surgical site infections constituted a large burden of the infections treated in the hospital, despite extensive prescribing of prophylaxis. The findings show

  12. Re-resection rates after breast-conserving surgery as a performance indicator: introduction of a case-mix model to allow comparison between Dutch hospitals.

    Science.gov (United States)

    Talsma, A K; Reedijk, A M J; Damhuis, R A M; Westenend, P J; Vles, W J

    2011-04-01

    Re-resection rate after breast-conserving surgery (BCS) has been introduced as an indicator of quality of surgical treatment in international literature. The present study aims to develop a case-mix model for re-resection rates and to evaluate its performance in comparing results between hospitals. Electronic records of eligible patients diagnosed with in-situ and invasive breast cancer in 2006 and 2007 were derived from 16 hospitals in the Rotterdam Cancer Registry (RCR) (n = 961). A model was built in which prognostic factors for re-resections after BCS were identified and expected re-resection rate could be assessed for hospitals based on their case mix. To illustrate the opportunities of monitoring re-resections over time, after risk adjustment for patient profile, a VLAD chart was drawn for patients in one hospital. In general three out of every ten women had re-surgery; in about 50% this meant an additive mastectomy. Independent prognostic factors of re-resection after multivariate analysis were histological type, sublocalisation, tumour size, lymph node involvement and multifocal disease. After correction for case mix, one hospital was performing significantly less re-resections compared to the reference hospital. On the other hand, two were performing significantly more re-resections than was expected based on their patient mix. Our population-based study confirms earlier reports that re-resection is frequently required after an initial breast-conserving operation. Case-mix models such as the one we constructed can be used to correct for variation between hospitals performances. VLAD charts are valuable tools to monitor quality of care within individual hospitals. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. Renal involvement in fatal cases of chikungunya virus infection.

    Science.gov (United States)

    Mercado, Marcela; Acosta-Reyes, Jorge; Parra, Edgar; Guzmán, Luis; Beltrán, Mauricio; Gasque, Philippe; Mejía-García, Carlos; Viasus, Diego

    2018-06-01

    Information regarding physiopathology and complications in fatal cases of chikungunya virus (CHIKV) is scarce. The aim of this study was to describe the frequency and severity of renal complications in fatal cases associated with CHIKV infection based on the clinical and histopathological features from post-mortem tissue biopsies. This retrospective study included fatal cases associated with CHIKV infection occurring from September 2014 through October 2015, reported to National System for Public Health Surveillance (SIVIGILA) and laboratory-confirmed by the National Institute of Health of Colombia. Medical records from 13 patients were available. Information was collected on history, physical examination, and haematological, biochemical, radiological, and virologic investigation reports. Diagnosis of CHIKV infection was performed by positive CHIKV-PCR on post-mortem tissue in 10 cases, positive CHIKV-PCR in serum in 6 cases and anti-CHIKV virus IgM in 2 cases. Only 3 cases were children (≤5 years old). Four cases had underlying diseases, mainly systemic arterial hypertension. The median value of creatinine at admission was 2.8 mg/dL (interquartile range 1.52-4.51). During hospitalization, 9 cases required ICU admission, 8 vasopressor support and 6 mechanical ventilation. Kidney histopathological findings were mainly acute interstitial nephritis (11 cases), congestion/oedema glomerular (10 cases) and acute tubular necrosis (5 cases). Renal impairment in fatal cases of CHIKV infection is frequent and related mainly to acute interstitial nephritis. These data demonstrate evidence of acquired kidney injuries during CHIKV infection. Copyright © 2018 Elsevier B.V. All rights reserved.

  14. The effect of workplace smoking bans on heart rate variability and pulse wave velocity of non-smoking hospitality workers.

    Science.gov (United States)

    Rajkumar, Sarah; Schmidt-Trucksäss, Arno; Wellenius, Gregory A; Bauer, Georg F; Huynh, Cong Khanh; Moeller, Alexander; Röösli, Martin

    2014-08-01

    To investigate the effect of a change in second-hand smoke (SHS) exposure on heart rate variability (HRV) and pulse wave velocity (PWV), this study utilized a quasi-experimental setting when a smoking ban was introduced. HRV, a quantitative marker of autonomic activity of the nervous system, and PWV, a marker of arterial stiffness, were measured in 55 non-smoking hospitality workers before and 3-12 months after a smoking ban and compared to a control group that did not experience an exposure change. SHS exposure was determined with a nicotine-specific badge and expressed as inhaled cigarette equivalents per day (CE/d). PWV and HRV parameters significantly changed in a dose-dependent manner in the intervention group as compared to the control group. A one CE/d decrease was associated with a 2.3% (95% CI 0.2-4.4; p = 0.031) higher root mean square of successive differences (RMSSD), a 5.7% (95% CI 0.9-10.2; p = 0.02) higher high-frequency component and a 0.72% (95% CI 0.40-1.05; p < 0.001) lower PWV. PWV and HRV significantly improved after introducing smoke-free workplaces indicating a decreased cardiovascular risk.

  15. The legacy of fear: is fear impacting fatal and non-fatal drowning of African American children?

    Science.gov (United States)

    Irwin, Carol C; Irwin, Richard L; Ryan, Timothy D; Drayer, Joris

    2011-01-01

    African American children’s rates for fatal and non-fatal drowning events are alarmingly elevated, with some age groups having three times the rate as compared to White peers. Adequate swimming skills are considered a protective agent toward the prevention of drowning, but marginalized youth report limited swimming ability. This research examined minority children’s and parents/caregivers’ fear of drowning as a possible variable associated with limited swimming ability. Results confirmed that there were significant racial differences concerning the fear of drowning, and adolescent African American females were notably more likely to fear drowning while swimming than any other group. The “fear of drowning” responses by parents/ caregivers of minority children were also significantly different from their White counterparts.

  16. Who chooses, who uses, who rates: the impact of agency on electronic word-of-mouth about hospitals stays.

    Science.gov (United States)

    Drevs, Florian; Hinz, Vera

    2014-01-01

    Patients' agents rather than patients themselves often choose hospitals and rehabilitation centers and evaluate inpatient stays. Thus, online reviews of a hospital may reflect a service experience the patient is not responsible for in two ways. First, a patient may evaluate a hospital that a physician as agent has selected, although he still received the service and is qualified to evaluate it. Second, relatives who may not be directly involved in the inpatient stay may write online reviews, which reflect their own experiences and evaluations. The study analyzes patient satisfaction data in online hospitals reviews and patients' underlying motives for electronic word-of-mouth according to the type of hospital admission and the perspective of the reviewer. The study uses a sample of 822 reviews from an online platform for hospital reviews and primary data generated by an online survey distributed to the writers of these reviews. Patients who choose a hospital themselves write more positive online reviews than those with an other-directed choice. Relatives' online reviews more often deal with negative hospital experiences and are more likely to reflect a desire for retaliation. The study results imply that medical care centers (hospitals and rehabilitation facilities) should pay more attention to agency by focusing on the needs and perceptions of relatives who often act as the critical voice of patients in electronic word-of-mouth behavior.

  17. The distribution of fatal risk in Ontario industries

    International Nuclear Information System (INIS)

    Davis, C.K.; Forbes, W.F.; Hayward, L.M.

    1986-09-01

    The purpose of this study was to estimate non-radiological risks of occupational fatalities in Ontario industries. The distribution of high-risk occupations was found to vary widely between the different industries for a number of reasons including the fact that insufficient data in some instances resulted in less than desirable reliability. However, in spite of various data limitations, a number of occupations had above average fatal risk rates in several industries, including Material Handlers and Related, N.E.C. (SOC-9319), Welders and Flame Cutters (SOC-8335), Truck Drivers (SOC-9175) and Mechanics and Repairmen, except Electrical (SOC-8589). The majority of occupations had rates below or close to the industry average; however, between 15% and 30% of the occupations in any given industry had fatal risk rates above the industry average. When the number of workers involved in different occupations was considered, between 18% and 40% of workers were in occupations with above average risk. Recommendations for future work are also provided

  18. Road traffic fatalities in selected governorates of Iraq from 2010 to 2013: prospective surveillance.

    Science.gov (United States)

    Leidman, Eva; Maliniak, Maret; Sultan, Abdul-Salam Saleh; Hassan, Ahmed; Hussain, Syed Jaffar; Bilukha, Oleg O

    2016-01-01

    The insurgency tactics that characterize modern warfare, such as suicide car bombs and roadside bombs, have the potential to significantly impact road traffic injuries in conflict affected-countries. As road traffic incidents are one of the top ten causes of death in Iraq, changes in incidence have important implications for the health system. We aimed to describe patterns of road traffic fatalities for all demographic groups and types of road users in Iraq during a period characterized by a resurgence in insurgency activity. Iraqi Ministry of Health routine prospective injury surveillance collects information on all fatal injuries in eight governorates of Iraq: Baghdad, Al-Anbar, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya. From all injury fatalities documented at the coroner office, we analyzed only those attributed to road traffic that occurred between 1 January 2010 and 31 December 2013. Coroners ascertain information from physical examinations, police reports and family members. Analysis included 7,976 road traffic fatalities. Overall, 6,238 (78.2 %) fatalities were male and 2,272 (28.5 %) were children under 18 years of age. The highest numbers of road traffic fatalities were among males 15 to 34 years of age and children of both sexes under 5 years of age. 49.2 % of fatalities occurred among pedestrians. Among children and females, the majority of road traffic fatalities were pedestrians, 69.0 % and 56.6 %, respectively. Fatalities among motorcyclists (3.7 %) and bicyclists (0.4 %) were least common. Rates of road traffic fatalities ranged from 8.6 to 10.7 per 100,000 population. The injury surveillance system provides the first data from a conflict-affected country on road traffic fatalities disaggregated by type of road user. The highest numbers of fatalities were among children and young men. Nearly half of fatalities were pedestrians, a proportion nearly double that of any neighboring country. As insurgency activity increased in

  19. Hospitals' Patterns of Use of Noninvasive Ventilation in Patients With Asthma Exacerbation.

    Science.gov (United States)

    Stefan, Mihaela S; Nathanson, Brian H; Priya, Aruna; Pekow, Penelope S; Lagu, Tara; Steingrub, Jay S; Hill, Nicholas S; Goldberg, Robert J; Kent, David M; Lindenauer, Peter K

    2016-03-01

    Limited data are available on the use of noninvasive ventilation in patients with asthma exacerbations. The objective of this study was to characterize hospital patterns of noninvasive ventilation use in patients with asthma and to evaluate the association with the use of invasive mechanical ventilation and case fatality rate. This cross-sectional study used an electronic medical record dataset, which includes comprehensive pharmacy and laboratory results from 58 hospitals. Data on 13,558 patients admitted from 2009 to 2012 were analyzed. Initial noninvasive ventilation (NIV) or invasive mechanical ventilation (IMV) was defined as the first ventilation method during hospitalization. Hospital-level risk-standardized rates of NIV among all admissions with asthma were calculated by using a hierarchical regression model. Hospitals were grouped into quartiles of NIV to compare the outcomes. Overall, 90.3% of patients with asthma were not ventilated, 4.0% were ventilated with NIV, and 5.7% were ventilated with IMV. Twenty-two (38%) hospitals did not use NIV for any included admissions. Hospital-level adjusted NIV rates varied considerably (range, 0.4-33.1; median, 5.2%). Hospitals in the highest quartile of NIV did not have lower IMV use (5.4% vs 5.7%), but they did have a small but significantly shorter length of stay. Higher NIV rates were not associated with lower risk-adjusted case fatality rates. Large variation exists in hospital use of NIV for patients with an acute exacerbation of asthma. Higher hospital rates of NIV use does not seem to be associated with lower IMV rates. These results indicate a need to understand contextual and organizational factors contributing to this variability. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  20. Understanding the relationship between the Centers for Medicare and Medicaid Services' Hospital Compare star rating, surgical case volume, and short-term outcomes after major cancer surgery.

    Science.gov (United States)

    Kaye, Deborah R; Norton, Edward C; Ellimoottil, Chad; Ye, Zaojun; Dupree, James M; Herrel, Lindsey A; Miller, David C

    2017-11-01

    Both the Centers for Medicare and Medicaid Services' (CMS) Hospital Compare star rating and surgical case volume have been publicized as metrics that can help patients to identify high-quality hospitals for complex care such as cancer surgery. The current study evaluates the relationship between the CMS' star rating, surgical volume, and short-term outcomes after major cancer surgery. National Medicare data were used to evaluate the relationship between hospital star ratings and cancer surgery volume quintiles. Then, multilevel logistic regression models were fit to examine the association between cancer surgery outcomes and both star rankings and surgical volumes. Lastly, a graphical approach was used to compare how well star ratings and surgical volume predicted cancer surgery outcomes. This study identified 365,752 patients undergoing major cancer surgery for 1 of 9 cancer types at 2,550 hospitals. Star rating was not associated with surgical volume (P cancer surgery outcomes (mortality, complication rate, readmissions, and prolonged length of stay). The adjusted predicted probabilities for 5- and 1-star hospitals were 2.3% and 4.5% for mortality, 39% and 48% for complications, 10% and 15% for readmissions, and 8% and 16% for a prolonged length of stay, respectively. The adjusted predicted probabilities for hospitals with the highest and lowest quintile cancer surgery volumes were 2.7% and 5.8% for mortality, 41% and 55% for complications, 12.2% and 11.6% for readmissions, and 9.4% and 13% for a prolonged length of stay, respectively. Furthermore, surgical volume and the star rating were similarly associated with mortality and complications, whereas the star rating was more highly associated with readmissions and prolonged length of stay. In the absence of other information, these findings suggest that the star rating may be useful to patients when they are selecting a hospital for major cancer surgery. However, more research is needed before these ratings can

  1. Fatal poisoning among patients with drug addiction

    DEFF Research Database (Denmark)

    Simonsen, Kirsten Wiese; Christoffersen, Dorte J; Banner, Jytte

    2015-01-01

    INTRODUCTION: Fatal poisonings among drug addicts in Denmark in 2012 were examined. Cause of death, abuse pattern and geographic differences are discussed and data are compared with previous studies. METHODS: All fatal poisonings examined at the three institutes of forensic medicine in Denmark...... on Funen and in South Jutland. Cocaine was most frequently detected in East Denmark, while amphetamine was more frequent in West Denmark. CONCLUSIONS: The number of fatal poisonings among drug addicts has stabilised around 200. The increase in methadone deaths continued and, as in 2007, methadone...... with 2007, indicating that a considerable number of drug addicts also have psychiatric illness. FUNDING: none. TRIAL REGISTRATION: not relevant....

  2. Fatal poisoning among patients with drug addiction

    DEFF Research Database (Denmark)

    Simonsen, K. W.; Christoffersen, D. J.; Banner, J.

    2015-01-01

    Introduction: Fatal poisonings among drug addicts in Denmark in 2012 were examined. Cause of death, abuse pattern and geographic differences are discussed and data are compared with previous studies. Methods: All fatal poisonings examined at the three institutes of forensic medicine in Denmark...... on Funen and in South Jutland. Cocaine was most frequently detected in East Denmark, while amphetamine was more frequent in West Denmark. ConclusionS: The number of fatal poisonings among drug addicts has stabilised around 200. The increase in methadone deaths continued and, as in 2007, methadone...... with 2007, indicating that a considerable number of drug addicts also have psychiatric illness....

  3. Reporting Fatal Neglect in Child Death Review.

    Science.gov (United States)

    Scott, Debbie

    2018-01-01

    Child death reviews are conducted with the aim of preventing child deaths however, definitions, inclusion criteria for the review of child deaths and reporting practices vary across Child Death Review Teams (CDRTs). This article aims to identify a common context and understanding of fatal neglect reporting by reviewing definitional issues of fatal neglect and comparing reporting practice across a number of CDRTs. Providing a consistent context for identifying and reporting neglect-related deaths may improve the understanding of the impact of fatal neglect and the risk factors associated with it and therefore, improve the potential of CDRT review to inform prevention programs, policies, and procedures.

  4. Variation in critical care unit admission rates and outcomes for patients with acute coronary syndromes or heart failure among high- and low-volume cardiac hospitals.

    Science.gov (United States)

    van Diepen, Sean; Bakal, Jeffrey A; Lin, Meng; Kaul, Padma; McAlister, Finlay A; Ezekowitz, Justin A

    2015-02-27

    Little is known about cross-hospital differences in critical care units admission rates and related resource utilization and outcomes among patients hospitalized with acute coronary syndromes (ACS) or heart failure (HF). Using a population-based sample of 16,078 patients admitted to a critical care unit with a primary diagnosis of ACS (n=14,610) or HF (n=1467) between April 1, 2003 and March 31, 2013 in Alberta, Canada, we stratified hospitals into high (>250), medium (200 to 250), or low (<200) volume based on their annual volume of all ACS and HF hospitalization. The percentage of hospitalized patients admitted to critical care units varied across low, medium, and high-volume hospitals for both ACS and HF as follows: 77.9%, 81.3%, and 76.3% (P<0.001), and 18.0%, 16.3%, and 13.0% (P<0.001), respectively. Compared to low-volume units, critical care patients with ACS and HF admitted to high-volume hospitals had shorter mean critical care stays (56.6 versus 95.6 hours, P<0.001), more critical care procedures (1.9 versus 1.2 per patient, <0.001), and higher resource-intensive weighting (2.8 versus 1.5, P<0.001). No differences in in-hospital mortality (5.5% versus 6.2%, adjusted odds ratio 0.93; 95% CI, 0.61 to 1.41) were observed between high- and low-volume hospitals; however, 30-day cardiovascular readmissions (4.6% versus 6.8%, odds ratio 0.77; 95% CI, 0.60 to 0.99) and cardiovascular emergency-room visits (6.6% versus 9.5%, odds ratio 0.80; 95% CI, 0.69 to 0.94) were lower in high-volume compared to low-volume hospitals. Outcomes stratified by ACS or HF admission diagnosis were similar. Cardiac patients hospitalized in low-volume hospitals were more frequently admitted to critical care units and had longer hospitals stays despite lower resource-intensive weighting. These findings may provide opportunities to standardize critical care utilization for ACS and HF patients across high- and low-volume hospitals. © 2015 The Authors. Published on behalf of the American

  5. Non-fatal suicidal behaviour at the Johannesburg General Hospital ...

    African Journals Online (AJOL)

    African Journal of Psychiatry. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 8, No 3 (2005) >. Log in or Register to get access to full text downloads.

  6. The epidemiology of Scottish trauma: A comparison of pre-hospital and in-hospital deaths, 2000 to 2011.

    Science.gov (United States)

    Morrison, Jonathan J; Yapp, Liam Z; Beattie, Anne; Devlin, Eimar; Samarage, Milan; McCaffer, Craig; Jansen, Jan O

    2016-02-01

    To characterise the temporal trends and urban-rural distribution of fatal injuries in Scotland through the analysis of mortality data collected by the National Records of Scotland. The prospectively collected NRS database was queried using ICD-10 codes for all Scottish trauma deaths during the period 2000 to 2011. Patients were divided into pre-hospital and in-hospital groups depending on the location of death. Incidence was plotted against time and linear regression was used to identify temporal trends. A total of 13,100 deaths were analysed. There were 4755 (36.3%) patients in the pre-hospital group with a median age (IQR) of 42 (28-58) years. The predominant cause of pre-hospital death related to vehicular injury (27.8%), which had a decreasing trend over the study period (p = 0.004). In-hospital, patients had a median age of 80 (58-88) years and the majority (67.0%) of deaths occurred following a fall on the level. This trend was shown to increase over the decade of study (p = 0.020). In addition, the incidence of urban incidents remained static, but the rate of rural fatal trauma decreased (p Scottish trauma patients die prior to hospital admission and the predominant mechanism of injury is due to road traffic accidents. This contrasts with in-hospital deaths, which are mainly observed in elderly patients following a fall from standing height. Further research is required to determine the preventability of fatal traumatic injury in Scotland. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  7. Fatal Fentanyl: One Pill Can Kill.

    Science.gov (United States)

    Sutter, Mark E; Gerona, Roy R; Davis, M Thais; Roche, Bailey M; Colby, Daniel K; Chenoweth, James A; Adams, Axel J; Owen, Kelly P; Ford, Jonathan B; Black, Hugh B; Albertson, Timothy E

    2017-01-01

    The current national opioid epidemic is a public health emergency. We have identified an outbreak of exaggerated opioid toxicity caused by fentanyl adulterated tablets purchased on the street as hydrocodone/acetaminophen. Over an 8-day period in late March 2016, a total of 18 patients presented to our institution with exaggerated opioid toxicity. The patients provided a similar history: ingesting their "normal dose" of hydrocodone/acetaminophen tablets but with more pronounced symptoms. Toxicology testing and analysis was performed on serum, urine, and surrendered pills. One of the 18 patients died in hospital. Five patients underwent cardiopulmonary resuscitation, one required extracorporeal life support, three required intubation, and two received bag-valve-mask ventilation. One patient had recurrence of toxicity after 8 hours after naloxone discontinuation. Seventeen of 18 patients required boluses of naloxone, and four required prolonged naloxone infusions (26-39 hours). All 18 patients tested positive for fentanyl in the serum. Quantitative assays conducted in 13 of the sera revealed fentanyl concentrations of 7.9 to 162 ng/mL (mean = 52.9 ng/mL). Pill analysis revealed fentanyl amounts of 600-6,900 μg/pill. The pills are virtually indistinguishable from authentic hydrocodone/acetaminophen tablets and are similar in weight. To date, our county has reported 56 cases of fentanyl opioid toxicity, with 15 fatalities. In our institution, the outbreak has stressed the capabilities and resources of the emergency department and intensive care units. A serious outbreak of exaggerated opioid toxicity caused by fentanyl-adulterated tablets purchased on the street as hydrocodone/acetaminophen is under way in California. These patients required higher dosing and prolonged infusions of naloxone. Additionally, observation periods off naloxone were extended due to delayed, recurrent toxicity. The outbreak has serious ramifications for public health and safety, law

  8. Role of motorcycle type in fatal motorcycle crashes.

    Science.gov (United States)

    Teoh, Eric R; Campbell, Marvin

    2010-12-01

    Motorcycles vary in design and performance capability, and motorcyclists may select certain motorcycle types based on driving preferences. Conversely, motorcycle performance capability may influence the likelihood of risky driving behaviors such as speeding. Both mechanisms may affect fatal crash risk when examined by motorcycle type. Although it was not possible to estimate the effect of each mechanism, the current study analyzed fatal crash data for evidence of motorcycle type differences in risky driving behaviors and risk of driver death. Street legal motorcycles were classified into 10 types based on design characteristics and then further grouped as cruiser/standard, touring, sport touring, sport/unclad sport, supersport, and all others. For each motorcycle type, driver death rates per 10,000 registered vehicle years and the prevalence of fatal crash characteristics such as speeding were analyzed. Differences among motorcycle types concerning the effect of engine displacement were examined using Poisson regression. Overall, driver death rates for supersport motorcycles were four times as high as those for cruiser/standard motorcycles. Fatally injured supersport drivers were most likely to have been speeding and most likely to have worn helmets, but least likely to have been impaired by alcohol compared with drivers of other motorcycle types. The patterns in driver factors held after accounting for the effects of age and gender. Increased engine displacement was associated with higher driver death rates for each motorcycle type. Strong effects of motorcycle type were observed on driver death rates and on the likelihood of risky driving behaviors such as speeding and alcohol impairment. Although the current study could not completely disentangle the effects of motorcycle type and rider characteristics such as age on driver death rates, the effects of both motorcycle type and rider age on the likelihood of risky driving behaviors were observed among fatally

  9. The extent of evidence-based information about child maltreatment fatalities in social science textbooks.

    Science.gov (United States)

    Douglas, Emily M; Serino, Patricia J

    2013-10-01

    Previous research has established that child welfare workers lack important information about child maltreatment fatalities and risk factors leading to death. Further, training has not been associated with improvements in knowledge. The authors assessed the presence of evidence-based information about child maltreatment fatalities and risk factors for death in 24 social science textbooks about child abuse and neglect or child welfare. The results indicate that basic information, such as definitions and incidence rates of child maltreatment fatalities are routinely included in social science textbooks, but information about child, parent, and household risk factors are not, and that inaccurate information is often included. Implications of the findings are discussed.

  10. Perioperative Care and the Importance of Continuous Quality Improvement--A Controlled Intervention Study in Three Tanzanian Hospitals.

    Science.gov (United States)

    Bosse, Goetz; Abels, Wiltrud; Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus-Dieter; Spies, Claudia

    2015-01-01

    Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, pcontrol group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (pcontrol group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach.

  11. Epidemiology and trends in non-fatal self-harm in three centres in England: 2000-2007.

    Science.gov (United States)

    Bergen, Helen; Hawton, Keith; Waters, Keith; Cooper, Jayne; Kapur, Navneet

    2010-12-01

    Self-harm is a common reason for presentation to a general hospital, with a strong association with suicide. Trends in self-harm are an important indicator of community psychopathology, with resource implications for health services and relevance to suicide prevention policy. Previous reports in the UK have come largely from single centres. To investigate trends in non-fatal self-harm in six general hospitals in three centres from the Multicentre Study of Self-harm in England, and to relate these to trends in suicide. Data on self-harm presentations to general hospital emergency departments in Oxford (one), Manchester (three) and Derby (two) were analysed over the 8-year period 1 January 2000 to 31 December 2007. Rates of self-harm declined significantly over 8 years for males in three centres (Oxford: -14%; Manchester: -25%; Derby: -18%) and females in two centres (Oxford: -2% (not significant); Manchester: -13%; Derby: -17%), in keeping with national trends in suicide. A decreasing proportion and number of episodes involved self-poisoning alone, and an increasing proportion and number involved other self-injury (e.g. hanging, jumping, traffic related). Episodes involving self-cutting alone showed a slight decrease in numbers over time. Trends in alcohol use at the time of self-harm and repetition within 1 year were stable. There were decreasing rates of non-fatal self-harm over the study period that paralleled trends in suicide in England. This was reflected mainly in a decline in emergency department presentations for self-poisoning.

  12. Association between community health center and rural health clinic presence and county-level hospitalization rates for ambulatory care sensitive conditions: an analysis across eight US states.

    Science.gov (United States)

    Probst, Janice C; Laditka, James N; Laditka, Sarah B

    2009-07-31

    Federally qualified community health centers (CHCs) and rural health clinics (RHCs) are intended to provide access to care for vulnerable populations. While some research has explored the effects of CHCs on population health, little information exists regarding RHC effects. We sought to clarify the contribution that CHCs and RHCs may make to the accessibility of primary health care, as measured by county-level rates of hospitalization for ambulatory care sensitive (ACS) conditions. We conducted an ecologic analysis of the relationship between facility presence and county-level hospitalization rates, using 2002 discharge data from eight states within the US (579 counties). Counties were categorized by facility availability: CHC(s) only, RHC(s) only, both (CHC and RHC), and neither. US Agency for Healthcare Research and Quality definitions were used to identify ACS diagnoses. Discharge rates were based on the individual's county of residence and were obtained by dividing ACS hospitalizations by the relevant county population. We calculated ACS rates separately for children, working age adults, and older individuals, and for uninsured children and working age adults. To ensure stable rates, we excluded counties having fewer than 1,000 residents in the child or working age adult categories, or 500 residents among those 65 and older. Multivariate Poisson analysis was used to calculate adjusted rate ratios. Among working age adults, rate ratio (RR) comparing ACS hospitalization rates for CHC-only counties to those of counties with neither facility was 0.86 (95% Confidence Interval, CI, 0.78-0.95). Among older adults, the rate ratio for CHC-only counties compared to counties with neither facility was 0.84 (CI 0.81-0.87); for counties with both CHC and RHC present, the RR was 0.88 (CI 0.84-0.92). No CHC/RHC effects were found for children. No effects were found on estimated hospitalization rates among uninsured populations. Our results suggest that CHCs and RHCs may play a

  13. Association between community health center and rural health clinic presence and county-level hospitalization rates for ambulatory care sensitive conditions: an analysis across eight US states

    Directory of Open Access Journals (Sweden)

    Laditka Sarah B

    2009-07-01

    Full Text Available Abstract Background Federally qualified community health centers (CHCs and rural health clinics (RHCs are intended to provide access to care for vulnerable populations. While some research has explored the effects of CHCs on population health, little information exists regarding RHC effects. We sought to clarify the contribution that CHCs and RHCs may make to the accessibility of primary health care, as measured by county-level rates of hospitalization for ambulatory care sensitive (ACS conditions. Methods We conducted an ecologic analysis of the relationship between facility presence and county-level hospitalization rates, using 2002 discharge data from eight states within the US (579 counties. Counties were categorized by facility availability: CHC(s only, RHC(s only, both (CHC and RHC, and neither. US Agency for Healthcare Research and Quality definitions were used to identify ACS diagnoses. Discharge rates were based on the individual's county of residence and were obtained by dividing ACS hospitalizations by the relevant county population. We calculated ACS rates separately for children, working age adults, and older individuals, and for uninsured children and working age adults. To ensure stable rates, we excluded counties having fewer than 1,000 residents in the child or working age adult categories, or 500 residents among those 65 and older. Multivariate Poisson analysis was used to calculate adjusted rate ratios. Results Among working age adults, rate ratio (RR comparing ACS hospitalization rates for CHC-only counties to those of counties with neither facility was 0.86 (95% Confidence Interval, CI, 0.78–0.95. Among older adults, the rate ratio for CHC-only counties compared to counties with neither facility was 0.84 (CI 0.81–0.87; for counties with both CHC and RHC present, the RR was 0.88 (CI 0.84–0.92. No CHC/RHC effects were found for children. No effects were found on estimated hospitalization rates among uninsured populations

  14. Trends in Hospitalization and Mortality Rates Due to Acute Cardiovascular Disease in Castile and León, 2001 to 2015.

    Science.gov (United States)

    López-Messa, Juan B; Andrés-de Llano, Jesús M; López-Fernández, Laura; García-Cruces, Jesús; García-Crespo, Julio; Prieto González, Miryam

    2018-02-01

    To analyze hospitalization and mortality rates due to acute cardiovascular disease (ACVD). We conducted a cross-sectional study of the hospital discharge database of Castile and León from 2001 to 2015, selecting patients with a principal discharge diagnosis of acute myocardial infarction (AMI), unstable angina, heart failure, or acute ischemic stroke (AIS). Trends in the rates of hospitalization/100 000 inhabitants/y and hospital mortality/1000 hospitalizations/y, overall and by sex, were studied by joinpoint regression analysis. A total of 239 586 ACVD cases (AMI 55 004; unstable angina 15 406; heart failure 111 647; AIS 57 529) were studied. The following statistically significant trends were observed: hospitalization: ACVD, upward from 2001 to 2007 (5.14; 95%CI, 3.5-6.8; P < .005), downward from 2011 to 2015 (3.7; 95%CI, 1.0-6.4; P < .05); unstable angina, downward from 2001 to 2010 (-12.73; 95%CI, -14.8 to -10.6; P < .05); AMI, upward from 2001 to 2003 (15.6; 95%CI, 3.8-28.9; P < .05), downward from 2003 to 2015 (-1.20; 95%CI, -1.8 to -0.6; P < .05); heart failure, upward from 2001 to 2007 (10.70; 95%CI, 8.7-12.8; P < .05), upward from 2007 to 2015 (1.10; 95%CI, 0.1-2.1; P < .05); AIS, upward from 2001 to 2007 (4.44; 95%CI, 2.9-6.0; P < .05). Mortality rates: downward from 2001 to 2015 in ACVD (-1.16; 95%CI, -2.1 to -0.2; P < .05), AMI (-3.37, 95%CI, -4.4 to -2, 3, P < .05), heart failure (-1.25; 95%CI, -2.3 to -0.1; P < .05) and AIS (-1.78; 95%CI, -2.9 to -0.6; P < .05); unstable angina, upward from 2001 to 2007 (24.73; 95%CI, 14.2-36.2; P < .05). The ACVD analyzed showed a rising trend in hospitalization rates from 2001 to 2015, which was especially marked for heart failure, and a decreasing trend in hospital mortality rates, which were similar in men and women. These data point to a stabilization and a decline in hospital mortality, attributable to established prevention measures. Copyright © 2017 Sociedad Española de Cardiología. Published by

  15. Calculating the 30-day survival rate in acute myocardial infarction: should we use the treatment chain or the hospital catchment model?

    Directory of Open Access Journals (Sweden)

    Jan Norum

    2017-12-01

    Full Text Available Introduction: Acute myocardial infarction (AMI is a potentially deadly disease and significant efforts have been concentrated on improving hospital performance. A 30-day survival rate has become a key quality of care indicator. In Northern Norway, some patients undergoing AMI are directly transferred to the Regional Cardiac Intervention Center at the University Hospital of North Norway in Tromsø. Here, coronary angiography and percutaneous coronary intervention is performed. Consequently, local hospitals may be bypassed in the treatment chain, generating differences in case mix, and making the treatment chain model difficult to interpret. We aimed to compare the treatment chain model with an alternative based on patients’ place of living. Methods: Between 2013 and 2015, a total of 3,155 patients were registered in the Norwegian Patient Registry database. All patients were categorized according to their local hospital’s catchment area. The method of Guo-Romano, with an indifference interval of 0.02, was used to test whether a hospital was an outlier or not. We adjusted for age, sex, comorbidity, and number of prior hospitalizations. Conclusions: We revealed the 30-day AMI survival figure ranging between 88.0% and 93.5% (absolute difference 5.5% using the hospital catchment method. The treatment chain rate ranged between 86.0% and 94.0% (absolute difference 8.0%. The latter figure is the one published as the National Quality of Care Measure in Norway. Local hospitals may get negative attention even though their catchment area is well served. We recommend the hospital catchment method as the first choice when measuring equality of care.

  16. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

    Science.gov (United States)

    2015-08-17

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  17. Drug involvement of fatally injured drivers

    Science.gov (United States)

    2010-11-01

    While data focusing on the danger of driving under the influence : of alcohol is readily available and often cited, less is : known or discussed about drivers under the influence of : other drugs. The Fatality Analysis Reporting System (FARS), : a ce...

  18. Trucks involved in fatal accidents factbook 2008.

    Science.gov (United States)

    2011-03-01

    This document presents aggregate statistics on trucks involved in traffic accidents in 2008. The : statistics are derived from the Trucks Involved in Fatal Accidents (TIFA) file, compiled by the : University of Michigan Transportation Research Instit...

  19. Buses involved in fatal accidents factbook 2007

    Science.gov (United States)

    2010-03-01

    This document presents aggregate statistics on buses involved in traffic accidents in 2007. The : statistics are derived from the Buses Involved in Fatal Accidents (BIFA) file, compiled by the : University of Michigan Transportation Research Institut...

  20. Trucks involved in fatal accidents factbook 2007.

    Science.gov (United States)

    2010-01-01

    This document presents aggregate statistics on trucks involved in traffic accidents in 2007. The : statistics are derived from the Trucks Involved in Fatal Accidents (TIFA) file, compiled by the : University of Michigan Transportation Research Instit...

  1. NWS Weather Fatality, Injury and Damage Statistics

    Science.gov (United States)

    ... Weather Awareness Floods, Wind Chill, Tornadoes, Heat... Education Weather Terms, Teachers, Statistics government web resources and services. Natural Hazard Statistics Statistics U.S. Summaries 78-Year List of Severe Weather Fatalities Preliminary Hazardous Weather Statistics for 2017 Now

  2. Coffee consumption and risk of fatal cancers.

    Science.gov (United States)

    Snowdon, D A; Phillips, R L

    1984-01-01

    In 1960, the coffee consumption habits and other lifestyle characteristics of 23,912 white Seventh-day Adventists were assessed by questionnaire. Between 1960 and 1980, deaths due to cancer were identified. There were positive associations between coffee consumption and fatal colon and bladder cancer. The group consuming two or more cups of coffee per day had an estimated relative risk (RR) of 1.7 for fatal colon cancer and 2.0 for fatal bladder cancer, compared to the group that consumed less than one cup per day (RR = 1.0). These positive associations were apparently not confounded by age, sex, cigarette smoking, or meat consumption habits. In this study, there were no significant or suggestive associations between coffee consumption and fatal pancreatic, breast, and ovarian cancer, or a combined group of all other cancer sites. PMID:6742274

  3. 49 CFR 219.207 - Fatality.

    Science.gov (United States)

    2010-10-01

    ... TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Post-Accident Toxicological Testing § 219.207 Fatality. (a) In the..., United States Code (but not the agent of the Secretary for purposes of the Federal Tort Claims Act...

  4. Editor's Choice - High Annual Hospital Volume is Associated with Decreased in Hospital Mortality and Complication Rates Following Treatment of Abdominal Aortic Aneurysms: Secondary Data Analysis of the Nationwide German DRG Statistics from 2005 to 2013.

    Science.gov (United States)

    Trenner, Matthias; Kuehnl, Andreas; Salvermoser, Michael; Reutersberg, Benedikt; Geisbuesch, Sarah; Schmid, Volker; Eckstein, Hans-Henning

    2018-02-01

    The aim of this study was to analyse the association between annual hospital procedural volume and post-operative outcomes following repair of abdominal aortic aneurysms (AAA) in Germany. Data were extracted from nationwide Diagnosis Related Group (DRG) statistics provided by the German Federal Statistical Office. Cases with a diagnosis of AAA (ICD-10 GM I71.3, I71.4) and procedure codes for endovascular aortic repair (EVAR; OPS 5-38a.1*) or open aortic repair (OAR; OPS 5-38.45, 5-38.47) treated between 2005 and 2013 were included. Hospitals were empirically grouped to quartiles depending on the overall annual volume of AAA procedures. A multilevel multivariable regression model was applied to adjust for sex, medical risk, type of procedure, and type of admission. Primary outcome was in hospital mortality. Secondary outcomes were complications, use of blood products, and length of stay (LOS). The association between AAA volume and in hospital mortality was also estimated as a function of continuous volume. A total of 96,426 cases, of which 11,795 (12.6%) presented as ruptured (r)AAA, were treated in >700 hospitals (annual median: 501). The crude in hospital mortality was 3.3% after intact (i)AAA repair (OAR 5.3%; EVAR 1.7%). Volume was inversely associated with mortality after OAR and EVAR. Complication rates, LOS, and use of blood products were lower in high volume hospitals. After rAAA repair, crude mortality was 40.4% (OAR 43.2%; EVAR 27.4%). An inverse association between mortality and volume was shown for rAAA repair; the same accounts for the use of blood products. When considering volume as a continuous variate, an annual caseload of 75-100 elective cases was associated with the lowest mortality risk. In hospital mortality and complication rates following AAA repair are inversely associated with annual hospital volume. The use of blood products and the LOS are lower in high volume hospitals. A minimum annual case threshold for AAA procedures might improve

  5. An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: a systematic review.

    Science.gov (United States)

    Mileski, Michael; Topinka, Joseph Baar; Lee, Kimberly; Brooks, Matthew; McNeil, Christopher; Jackson, Jenna

    2017-01-01

    The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions. The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions.

  6. Alcohol Advertising and Motor Vehicle Fatalities

    OpenAIRE

    Henry Saffer

    1994-01-01

    The purpose of this paper is to empirically estimate the effect of alcohol advertising on motor vehicle fatalities. The concept of an industry level advertising response function is developed and other empirical issues in estimating the effects of advertising are reviewed. The data set consists of quarterly observations, from 1986 to 1989, for 75 advertising markets in the United States and includes 1200 observations. Since motor vehicle fatalities and alcohol advertising are jointly determin...

  7. Fatal interstitial lung disease associated with icotinib

    OpenAIRE

    Zhang, Jiexia; Zhan, Yangqing; Ouyang, Ming; Qin, Yinyin; Zhou, Chengzhi; Chen, Rongchang

    2014-01-01

    The most serious, and maybe fatal, yet rare, adverse reaction of gefitinib and erlotinib is drug-associated interstitial lung disease (ILD), which has been often described. However, it has been less well described for icotinib, a similar orally small-molecule tyrosine kinase inhibitor (TKI). The case of a 25-year-old female patient with stage IV lung adenocarcinoma who developed fatal ILD is reported here. She denied chemotherapy, and received palliative treatment with icotinib (125 mg po, th...

  8. Fatal motorcycle accidents in the county of Funen (Denmark)

    DEFF Research Database (Denmark)

    Larsen, C F; Hardt-Madsen, M

    1988-01-01

    A study of motorcycle fatalities in the period 1977-1983 in the county of Funen, Denmark was compared with an analysis of data obtained from the Accident Register at the Odense University Hospital. Among the operators killed one fifth were illegally operating the motorcycle. A remarkable statisti......A study of motorcycle fatalities in the period 1977-1983 in the county of Funen, Denmark was compared with an analysis of data obtained from the Accident Register at the Odense University Hospital. Among the operators killed one fifth were illegally operating the motorcycle. A remarkable...... statistical difference in distribution of accidents involved motorcycles and the total distribution of motorcycles in the county was reported, thus finding an over-representation of heavy motorcycles in the present study. No important differences were found in the distribution of type of accidents compared...... to other studies. In the present study all but one victim were tested for blood-alcohol concentration (BAC). The results differ from previous studies in as much as 50% of the killed operators of an accident involving motorcycles had a BAC above 0.08%. The reported distribution by age, licensing experience...

  9. Traumatic asphyxia--fatal accident in an automatic revolving door.

    Science.gov (United States)

    Cortis, J; Falk, J; Rothschild, M A

    2015-09-01

    Due to continuing modernisation, the number of automatic doors in routine use, including powered revolving doors, has increased in recent years. Automatic revolving doors are found mostly in department stores, airports, railway stations and hospitals. Although safety arrangements and guidelines concerning the installation of automatic doors are in existence, their disregard in conjunction with obsolete or incorrect installation can lead to fatal accidents. In this report, a 19-month-old boy is described whose right arm was caught between the elements of an automatic revolving door. As a direct result of rescue attempts, the child's body was drawn further into the narrow gap between elements of the door. To get the boy's body out of the 4-cm-wide gap between the fixed outer wall of the revolving door and the revolving inner, back-up batteries had to be disconnected so as to stop the electrical motor powering the door. Cardiopulmonary resuscitation was begun immediately after the rescue but was unsuccessful; the child was declared dead at the hospital he was taken to. The cause of death was a combination of compression-related skull and brain injury together with thoracic compression. This case shows an outstanding example of the preventive aspect as a special task of forensic medicine. Additionally, it serves as a warning for the correct installation and use of automatic revolving doors. Even so, small children should not use these doors on their own, but only with an alert companion, so as to prevent further fatal accidents of this sort.

  10. 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