Biomedical subjects

Cindy J Wong

Publications and source records attributed to Cindy J Wong.

5 recordsLinked to original sources

PubMed2006

Disparities between two common data sources on hospital nurse staffing.

PURPOSE: To compare nurse staffing measures derived from two widely used data sources: the American Hospital Association (AHA) Annual Survey of Hospitals and the California Office for Statewide Health Planning and Development (OSHPD). DESIGN: Descriptive cross-sectional study with measures of nurse staffing level and skill mix constructed from each database for 372 nonfederal, acute care hospitals in California. METHODS: Discrepancies in nurse staffing estimates between the two databases were examined. Relationships of nurse staffing with risk-adjusted patient outcomes (decubitus ulcer, failure to rescue, and mortality) were assessed through multivariate analyses and compared for nursing measures derived from the two databases. FINDINGS: For small, rural, or nonteaching hospitals, AHA reported substantially higher registered nurse (RN) hours per patient day than did OSHPD. RN proportion among licensed nurses matched most closely in the two databases. RN hours per patient day derived from both databases showed significant inverse relationships with decubitus ulcer and mortality, and the association was stronger for the measure based on the OSHPD data. RN proportion derived from the OSHPD data was significantly associated with all three patient outcomes, but the AHA measure had a significant relationship only with decubitus ulcer. CONCLUSIONS: Compared with the AHA survey, the OSHPD data on hospital nurse staffing appear to be more complete and also were more closely associated with patient outcomes. Efforts to refine the AHA survey as a national database for nurse staffing will significantly enhance the capacity for monitoring nurse workforce and its effect on quality of care.

American Hospital Association↗

PubMed2005

Further psychometric property development of the Menopause-Specific Quality of Life questionnaire and development of a modified version, MENQOL-Intervention questionnaire.

OBJECTIVES: To develop the 1996 MENQOL questionnaire further with advice regarding summary score computation, missing-data management, readability, recall period and assessment of the vasomotor domain reliability and construct validity. To develop a modified version, the MENQOL-Intervention questionnaire, for use where certain treatment side effects could negatively impact the quality of life. METHODS: MENQOL-Intervention modifications involved the addition of three items to the physical domain. For both questionnaires, psychometric property assessment was embedded in two randomized controlled trials of menopause interventions. Test-retest reliability and Cronbach's alpha were computed for all domains as was construct validity of the vasomotor domain for both questionnaires. RESULTS: The vasomotor intraclass correlation coefficient was 0.73 for the MENQOL-Intervention over 1 week and 0.78 for the MENQOL over 1 month. The altered physical domain of the MENQOL-Intervention questionnaire continued to show strong test-retest reliability and Cronbach's alpha consistent with the MENQOL. The MENQOL-Intervention demonstrated excellent face validity with high construct validity for the vasomotor domain of 0.78-0.80. For both instruments, comparisons of the vasomotor domains to hot flash scores, although statistically significant, were only moderate at 0.56 and 0.49. CONCLUSIONS: Both the MENQOL and the MENQOL-Intervention questionnaires show strong psychometric properties. We recommend using the MENQOL-Intervention questionnaire where intervention side effects might negatively impact a woman's quality of life. For both questionnaires, a summary score can be calculated.

Breast↗

PubMed2003

RBC transfusion requirements after allogeneic marrow transplantation: impact of the before-transplant Hb level on transfusion and early survival.

BACKGROUND: Most patients undergoing allogeneic marrow transplantation (alloBMT) require transfusions of RBCs. A retrospective analysis was performed to evaluate the utilization and risk factors for RBC transfusions including age and sex of recipient, HLA matching between donor and recipient, disease status at time of BMT, the occurrence of GVHD, ABO blood group compatibility, the source of progenitor cells and the Hb level before BMT (PT-Hb). STUDY DESIGN AND METHODS: Data from 519 consecutive patients receiving transplants between January 1995 and March 2000 were reviewed. The number of RBC transfusions was determined for the following periods: 0 to 60, 61 to 120, and 121 to 180 days after BMT. RESULTS: The transfusion requirements were greatest during the first 60 days after BMT and decreased with time. The total number of units transfused to this cohort of patients was 5398, of which 3505 units were utilized within the first 2 months. The mean number +/- SD of units transfused per patient from 0 to 60 days was 6.8 +/- 6.4; 61 to 120 days, 3.2 +/- 5.5; and 121 to 180 days, 2.0 +/- 4.6. An increased transfusion requirement was associated with lower PT-Hb, major ABO mismatch between donor and recipient, BMT in patients with more advanced disease, use of unrelated donors, older age, and female sex by Spearman's correlation analysis. The source of progenitor cells and the development of GVHD did not influence transfusion requirements. Increased mortality during the 6-month period after transplant was associated with lower PT-Hb, use of unrelated donors, advanced disease status at BMT, and sex by Cox regression analysis. In a multivariate model, PT-Hb remained significant when controlling for the other risk factors. CONCLUSION: The PT-Hb was identified as an independent risk factor for RBC transfusions during alloBMT. As well, a lower PT-Hb was found to be an independent risk factor for increased mortality during the 6-month study period.

Adolescent↗

PubMed2002

Transfusion practices for elective orthopedic surgery.

BACKGROUND: Use of blood conservation techniques in elective surgery reduces the risk of infection and transfusion reactions that result from using allogeneic blood products. We examined the transfusion practice and blood conservation strategies for elective orthopedic procedures in 19 Canadian hospitals. METHODS: We reviewed the medical records of patients who underwent total hip or knee joint arthroplasty between June 1998 and January 1999 in a convenience sample of 19 hospitals to determine the pre- and postoperative hemoglobin concentrations, concurrent medical conditions, participation status in an autologous blood donation program, use of other blood conservation techniques, and occurrence of allogeneic and autologous transfusions. Patients were considered eligible for autologous blood donation if they weighed at least 25 kg, were in good general health without major cardiac conditions and had a hemoglobin concentration of at least 110 g/L. RESULTS: We reviewed 4535 medical records. Of the 4422 patients whose eligibility status was known, 2561 (57.9%) were eligible to participate in an autologous blood donation program. Only 842 (18.6%) of the patients predonated blood. Patients who did not predonate blood were older (mean age 70.1 v. 63.8 years) and were more likely to have concomitant medical conditions (60.3% v. 37.9%) than those who did predonate. Overall, 30.6% (95% confidence interval [CI] 29.1%-32.1%) of the patients who did not predonate blood received allogeneic transfusions. For patients who predonated, the rate of allogeneic transfusion was 14.1% (95% CI 11.8%-16.5%). The frequency with which blood conservation techniques other than autologous blood donation were used was minimal (in 2.4% of all cases). INTERPRETATION: The use of blood conservation techniques among hospitals in Canada remains low. Only a minority of eligible patients participated in an autologous blood donation program.

Aged↗

PubMed2002

Combined budesonide and antibiotic therapy for active Crohn's disease: a randomized controlled trial.

BACKGROUND & AIMS: Although antibiotics are frequently used to treat Crohn's disease, this practice is not supported by strong evidence from randomized trials. METHODS: We conducted a double-blind multicenter study of patients with active Crohn's disease of the ileum, right colon, or both. Patients were randomized to receive oral ciprofloxacin and metronidazole, both 500 mg twice daily, or placebo for 8 weeks. All patients received oral budesonide 9 mg once daily. The primary efficacy measure was the proportion of patients in remission at week 8. RESULTS: Of the 134 patients who were randomized, 130 were evaluated for efficacy; 66 received placebo, and 64 received antibiotics. At week 8, 21 patients (33%) assigned to antibiotics were in remission as compared with 25 patients (38%) in the placebo group (P = 0.55; absolute difference, -5%; 95% confidence interval, -21% to 11%). An interaction (P = 0.025) between treatment allocation and disease location on treatment response was identified. Among patients with disease of the colon, 9 of 17 (53%) were in remission after treatment with antibiotics, compared with 4 of 16 (25%) of those who received placebo (P = 0.10). Discontinuation of therapy because of adverse events occurred in 13 of 66 (20%) patients treated with antibiotics, compared with 0 of 68 in the group who received placebo (P < 0.001). CONCLUSIONS: In patients with active Crohn's disease of the ileum, the addition of ciprofloxacin and metronidazole to budesonide is an ineffective intervention, but this antibiotic combination may improve outcome when there is involvement of the colon.

Administration, Oral↗