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Results for “data auditing”

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At least 379 records · Page 21Linked to original sources

PubMed2001

An audit of blood cross-match ordering practices at the Aga Khan University Hospital: first step towards a Maximum Surgical Blood Ordering Schedule.

OBJECTIVE: In the absence of an explicit maximum blood order policy, ordering for blood transfusion is frequently based on subjective anticipation of blood loss instead of evidence based estimates of average requirement in a particular procedure. This study was done to assess current practice and the feasibility of a prospective randomized work to develop practice guidelines. METHOD: We audited transfusion data for elective surgical procedures in our hospital during the last 2 years. Cross-matched to transfused ratio (C/T ratio) and Transfusion Index (Ti) for each of the elective surgical procedures was performed during the study period. C/T ratio is used as a measure of the efficiency of blood ordering practice. It should ideally be between 2 and 2.5. We compared our results with the ideal. RESULTS: Data was analyzed for 32 elective surgical procedures in 2131 patients. Majority (2079) (97.56%) of the patients had C/T ratios higher than 2.5. Only 12 in 450 (21.11%) patients, had a Transfusion Index (Ti) higher than 0.5. There were 13 procedures in which both C/T ratio was greater than 2.5 and Ti less than or equal to 0.5. CONCLUSION: In vast majority of elective surgical procedures routine cross match is not necessary. We propose a draft Maximum Surgical Blood Ordering Schedule (MSBOS). It provides guidelines for frequently performed elective surgical procedures by recommending the maximum number of units of blood to be cross-matched preoperatively. Implementation of MSBOS will result in about 60% reduction of cost to the patients.

Blood Banks↗

PubMedDate not supplied

Eating problems and weight loss for patients with head and neck cancer: a chart review from diagnosis until one year after treatment.

This descriptive study aimed to examine the occurrence and treatment of eating problems, and their causes and consequences during the trajectory of care for patients with head and neck cancer treated with radiotherapy. The method used was a review of patient records, conducted by means of an audit instrument developed for the study. The instrument audits demographic data and documented eating problems, their causes and consequences, and undertaken interventions in medical and nursing records from diagnosis until 1 year after completion of treatment. Data were collected prior to treatment, each week during radiotherapy and at the follow-up visits to the physician 1, 6, and 12 months after completion of treatment. The results show that eating problems were common before treatment started, and at the end of radiotherapy every patient suffered from eating problems. One year after treatment the majority still had eating problems. Weight loss occurred early during radiotherapy and became aggravated after treatment, but was not treated to an adequate extent. Implications of this study are that nutritional interventions must be initiated before the treatment starts and they need to be ongoing after completion of treatment.

Adult↗

PubMed2005

Psychological services for people with stroke: compliance with the U.K. National Clinical Guidelines.

BACKGROUND: The UK National Clinical Guidelines for Stroke (2000) include recommendations on psychological services. The third National Sentinel Audit of Stroke was completed in 2001-2002. OBJECTIVES: To examine the extent to which UK stroke services complied with the national guidelines. DESIGN: Use of three retrospective case note audits of hospital admissions, covering the period from admission to six months after discharge, and audits of how stroke services were organized. SETTING: Hospitals within England, Wales, Northern Ireland, the Channel Islands and the Isle of Man. SUBJECTS: Stroke patients admitted consecutively within a three-month time frame. MAIN MEASURES: Compliance with the guidelines on mood disorders and cognitive impairments, and changes between audits. RESULTS: The 2001-2002 audit provided data on 60% of possible participants, from 145 hospitals and 5152 patients. Compliance with the guideline to screen for mood disturbance was poor; the median patient compliance rate of hospitals was 50%. More hospitals (88%) had a locally agreed cognitive assessment protocol in 2001-2002 than in 1998 (68%) and in 1999 (82%). However, actual rates of screening for cognitive difficulties were lower than implied by the existence of a local protocol. There were no strong case-mix associates of mood and cognitive screening. Access to clinical psychologists was poor. Mood and cognitive assessment rates were not much better for stroke units with access to clinical psychologists than for units without access (mood: p = 0.6, cognition: p = 0.09). CONCLUSIONS: Although compliance with some of the guidelines has improved, many areas in current psychological services for stroke urgently need attention.

Adult↗

PubMed2003

Performance indicators for hospital services for older people.

BACKGROUND: standardised assessment is recommended in geriatric practice to improve patient care and generate quality data for audit and research. High level indicators used to measure performance of rehabilitation units suggested that more patients were discharged to long-term residential care from one of two hospitals in a Health Authority in South East England. OBJECTIVES: to test whether the information provided by standardised assessment could inform performance indicators used to compare outcomes between hospitals. DESIGN: prospective observational study. SUBJECTS: consecutive patients admitted for rehabilitation to two general geriatric rehabilitation wards in each of two nearby district general hospitals. METHODS: patients were assessed using standard tools (Barthel and Abbreviated Mental Test score) and various scales of the interRAI MDS assessment system (mental and physical functioning, pressure ulcers, continence, falls, mood), within a week of admission and up to one week before discharge. Place of residence prior to admission and discharge destination were determined. RESULTS: on bivariate analysis there was a significant difference in discharge to residential and nursing homes between hospitals. Results from multivariate logistic regression analysis showed an increased risk for institutionalisation at discharge for women [odds ratio 2.42 (95% CI 1.41-4.14)] and patients with impaired cognitive function [odds ratio 1.53 (95% CI 1.28-1.82) for each point increase in MDS cognitive performance scale] and physical function [odds ratio 1.15 (95% CI 1.08-1.22) for each point increase in MDS short ADL scale]. Barthel and Abbreviated Mental Test showed similar odds ratios. Hospital did not remain a significant predictor of discharge destination following adjustment for patients' physical and cognitive function. CONCLUSIONS: comparisons of outcomes between hospitals could be misleading unless informed by standardised data on physical and mental functioning of rehabilitation patients.

Activities of Daily Living↗

PubMed1998

ENT day surgery in England and Wales--an audit by the Royal College of Surgeons (Eng.) Comparative Audit Service.

An audit of day surgery was carried out by the Royal College of Surgeons (Eng.) Comparative Audit service. Data from 121 respondents on over 3,962 day cases were analysed from both retrospective information and from prospective individual patient proformas. The day surgery rate is 31 per cent. The variability of facilities for day-surgery, the timing of lists, type of anaesthetic used and case-mix are discussed. Outcome and the reasons for admission to an overnight bed are analysed. The overall admission rate was found to be 2.8 per cent (range 0.6-19.5 per cent between consultants). Seventy per cent of ENT day-surgery was performed on morning lists which have a lower admission rate than afternoon lists. The main reasons for admission are vomiting 30 per cent, haemorrhage 20 per cent and inadequate recovery from anaesthetic 22 per cent. A more detailed analysis of reasons for admission were given for tonsillectomy, adenoidectomy, FESS, and grommets. Recommendations are given which might increase the scope of safe day-surgery and reduce admission rate.

Aged↗

PubMed2005

Functional status of patients before liver transplantation as a predictor of posttransplant mortality.

BACKGROUND: Risk models for mortality after liver transplantation have poor predictive ability. We examined whether the performance of these risk models can be improved by including information about patients' functional status (i.e., their ability to carry out activities of daily living) in addition to conventional clinical risk factors. METHODS: The UK and Ireland Liver Transplant Audit has data on all liver transplantations carried out in both countries since 1994. We examined the association of functional status measures taken immediately before transplantation on a 5-point scale (modified version of the Eastern Cooperative Oncology Group performance status) and mortality 90 days after transplantation. Logistic regression was used to adjust for other risk factors. RESULTS: Posttransplant mortality increased from 5.3% in patients able to carry out normal activity without restriction (functional status 1) to 24.8% in patients completely reliant on nursing and medical care (functional status 5; P for trend 0.003). This association remained after adjustment for conventional risk factors (adjusted P for trend 0.003). Adjusted odds ratios with functional status 3 (the most frequent functional status) as baseline category were 0.60 (95% confidence interval 0.29-1.25) for functional status 1, 0.70 (0.50-0.97) for functional status 2, 1.00 (0.71-1.41) for functional status 4, and 1.85 (1.07-3.19) for functional status 5. CONCLUSIONS: Considering a patient's functional status or more general measures of a patient's health status before transplantation in addition to conventional clinical factors may help to improve our ability to predict posttransplant survival.

Activities of Daily Living↗

PubMed2004

Pretransplant MELD score and post liver transplantation survival in the UK and Ireland.

It has been shown that the model for end-stage liver disease (MELD) score is an accurate predictor of survival in patients with liver disease without transplantation. Four recent studies carried out in the United States have demonstrated that the MELD score obtained immediately prior to transplantation is also associated with post-transplant patient survival. Our aim was to evaluate how accurately the MELD score predicts 90-day post-transplant survival in adult patients with chronic liver disease in the UK and Ireland. The UK and Ireland Liver Transplant Audit has data on all liver transplants since 1994. We studied survival of 3838 adult patients after first elective liver transplantation according to United Network for Organ Sharing categories of their MELD scores (< or = 10, 11-18, 19-24, 25-35, > or =36). The overall survival at 90-days was 90.2%. The 90-day survival varied according to the United Network for Organ Sharing MELD categories (92.6%, 91.9%, 89.7%, 89.7%, and 70.8%, respectively; P < 0.01). Therefore, only those patients with a MELD score of 36 or higher (3% of the patients) had a survival that was markedly lower than the rest. As a consequence, the ability of the MELD score to discriminate between patients who were dead or alive was poor (c-statistic 0.58). Re-estimating the coefficients in the MELD regression model, even allowing for nonlinear relationships, did not improve its discriminatory ability. In conclusion, in the UK and Ireland the MELD score is significantly associated with post-transplant survival, but its predictive ability is poor. These results are in agreement with results found in the United States. Therefore, the most appropriate system to support patient selection for transplantation will be one that combines a pretransplant survival model (e.g., MELD score) with a properly developed post-transplant survival model.

Adult↗

PubMed2006

UK National Audit of Early Syphilis Management. Case notes audit: diagnosis and treatment.

A national audit of 781 early syphilis cases presenting during 2002-03 in UK genitourinary medicine clinics was conducted in late 2004, organized through the Regional Audit Groups. Data were aggregated by region and National Health Service trust, allowing practice to be compared between regions, between trusts within regions, as well as to national averages and the UK National Guidelines. An enzyme immunoassay was used to diagnose 695 (89%) cases (regional range 18-100%). Use of a non-treponemal test was not recorded for 44 (6%) cases. Dark ground microscopy was used in the diagnosis of only 80 (29%) primary cases. Uptake of HIV testing was 77% (range 69-94%). Nationally, 527 (67%) treatments were parenteral, with almost equal use of benzathine penicillin G for 262 (50%, range 0-97%) cases and procaine penicillin G (PPG) for 260 cases (49%, range 3-100%). There were 14 (5%) treatments with less than the recommended 750 mg dose of PPG. One hundred and five (40%) PPG treatments were with greater than 750 mg and/or for longer than 10 days of which 76 (72%) were for early latent syphilis and/or cases with HIV infection. One hundred and ninety two (86%, range 0-100%) of all oral treatments were with doxycycline. The recommended regimen of 100 mg doxycycline twice daily for 14 days was used for 104 (53%) cases; the other 91 (47%) treatments were with a variety of regimens, mainly treatments with larger doses and/or longer treatment intervals and some combination treatments. Fourteen (2%) cases were not treated; treatment was not reported for seven (0.9%) and not known for 10 (1.3%) cases, who were treated at other centres.

Anti-Bacterial Agents↗

PubMed2004

Monitoring surgical treatment of screen-detected breast lesions in Italy.

The object of this study was to assess quality of care and adherence to treatment guidelines of screen-detected lesions in Italy using a new audit system. Data on screen-detected cases surgically treated in 1997 were collected using a system (QT 2.3) developed within the Italian Group for Planning and Evaluating Mammographic Screening Programmes (GISMa) and the European Breast Cancer Screening Network. Results of 18 performance parameters were considered compared with the reference standards. In 1997, 515 lesions (335 invasive, 60 in situ and 120 benign) in 496 patients were collected from 14 departments in the Central and Northern area of Italy. The 18 indicators were analysed and grouped according to six quality objectives. Some results were good and others were excellent, such as intraoperative identification, breast conservation surgery, adequate axillary procedures and completeness of pathology reports, but most of them failed: waiting times, preoperative diagnosis, employment of frozen section on small lesions and avoiding axillary procedures in ductal carcinoma-in-situ. This work is a first attempt in Italy to evaluate and uniform the criteria adopted for quality control of breast cancer treatment, using a standardised system. Some results are good or excellent, the overall level of compliance with quality indicators is not satisfactory and corrective actions should be undertaken for a number of issues. A continuous monitoring should be performed and appropriate action taken in order to verify the effectiveness of the corrective actions and to provide screen-detected patients with the best quality of care.

Breast Neoplasms↗

PubMed1997

Are immunizations an incentive for well-child visits?

OBJECTIVE: To assess the beliefs of parents and the visit patterns of their children to determine whether immunizations act as an incentive to use well-child care. DESIGN AND METHODS: Medical record audits provided data on immunizations and well-child visits. Two questions from a parent interview were used to identify 4 groups of parents: (1) motivated and (2) unmotivated to keep a well-child care appointment regardless of whether immunizations are scheduled, (3) vaccine-motivated and (4) checkup-motivated (parents who were influenced negatively by the prospect of receiving vaccinations). The percentage of children with a visit at each age window for well-child visits and the percentage up-to-date for their immunizations at given ages were compared across the 4 groups. The 4 groups were also compared for other parental attitudes about immunizations and well-child visits, and on sociodemographic and access characteristics. RESULTS: Most (73.3%) of the 502 parents surveyed were classified as motivated and 5% as unmotivated to keep a well-child care appointment regardless of whether an immunization was scheduled. Only 18.3% were categorized as vaccine-motivated and 3.4% as checkup-motivated. For all 4 groups, there was no discernible difference in attendance between immunization and nonimmunization visits. Attendance in the windows for well-child visits and percentage of children up-to-date on immunizations declined with increasing age. CONCLUSIONS: In this inner-city population, attendance patterns at visits did not support the incentive hypothesis. This finding should reassure clinicians that providing immunizations outside of regular well-child care visits will not necessarily decrease attendance at visits for well-child care.

Baltimore↗

PubMed2006

Prediction of embryo developmental potential and pregnancy based on early stage morphological characteristics.

OBJECTIVE: To analyze the association between morphological details at different stages of culture with blastocyst development, with an aim to improve selection for transfer. DESIGN: Retrospective audit of data. SETTING: Tertiary referral center and university hospital. PATIENT(S): Two hundred sixty-eight couples underwent 357 treatment cycles. INTERVENTION(S): Oocyte pickups for IVF or intracytoplasmic sperm injection (ICSI) after ovarian stimulation. Embryos were individually cultured and examined on days 0-2 for morphological details and developmental characteristics, and selected for transfer, freezing, or further culture. MAIN OUTCOME MEASURES: The association of blastocyst development and pregnancy with morphological characteristics. RESULT(S): Five morphological characteristics (appearance of the cytoplasm, pronuclei and nucleoli, cytoplasmic deficit, and developmental rate) showed the strongest association with blastocyst development. By combining information from all days of culture into a cumulative score, prediction was greatly improved, compared to only using day 2 morphology. Cytoplasmic dysmorphisms of the oocyte, including accumulation of smooth endoplasmic reticulum, were associated with poor developmental performance. Differential weighting of these characteristics was included in a new embryo scoring system, which showed a strong correlation with implantation. CONCLUSION(S): Weighting individual morphological characteristics of zygotes and embryos and combining them into a cumulative embryo score can improve selection of embryos for transfer.

Adult↗

PubMed2005

The frequency and timing of respiratory depression in 1524 postoperative patients treated with systemic or neuraxial morphine.

STUDY OBJECTIVE: To describe the frequency and timing of intravenous patient-controlled analgesia (IV-PCA) or neuraxial morphine-induced postoperative respiratory depression. DESIGN: Audit of data captured by routine quality assurance of the acute pain protocols that were implemented by nurses performing routine postoperative care. SETTING: The surgical wards of a university-affiliated, 700-bed, tertiary hospital. PATIENTS AND INTERVENTIONS: In real time, the data of all patients enrolled into our Acute Pain Service (APS) were entered and stored in the APS database. Thereafter, patients who had received IV morphine via a PCA device or neuraxial morphine between January 1999 and December 2002 were isolated. From this subset, all patients in whom a respiratory rate (RR) less than 10 breaths per minute was recorded were retrieved. MEASUREMENTS AND MAIN RESULTS: From a total of 4500 patients, IV or neuraxial morphine was administered to 1524 patients. Eighteen (1.2%) cases of an RR less than 10 breaths per minute were recorded (13 patients, 4 patients, and 1 patient in the IV-PCA, daily epidural morphine, and single-dose intrathecal morphine groups, respectively). A direct correlation between intraoperative fentanyl administration and postoperative respiratory depression was demonstrated between the IV-PCA (P = 0.03) and epidural groups (P = 0.05). The time from IV-PCA initiation or last neuraxial morphine administration until the diagnosis of respiratory depression ranged between 2 hours and 31.26 hours and 2 hours and 12.15 hours, respectively. Ten (55.6%) patients received naloxone. CONCLUSION: Morphine-induced respiratory depression may occur at any time during the APS admission. However, the optimal frequency of intermittent RR monitoring is unknown. Furthermore, because multiple variables (age, sex, prior opioid administration, site of operation) may affect morphine-induced respiratory depression, further investigation must be performed to determine the ideal monitoring protocol.

Adolescent↗

PubMed2003

Cardiac surgery in Australian octogenarians: 1996-2001.

BACKGROUND: The number of octogenarians receiving cardiac surgery is increasing. Concerns regarding the outcomes and significant expense required to provide this service have not been addressed because no prospective medium term outcomes of Australian octogenarians have been published. METHODS: Prospective analysis was undertaken of octogenarians having cardiac surgery from 1996 to 2001 in three hospitals of moderate case volume (400 patients per year) by: in-hospital audit and data acquisition, 1-year direct patient follow up in rooms, and a final follow up in late 2001 directly with the patient either in rooms or via telephone questionnaire. RESULTS: Sixty-four patients had cardiac surgery. All patients were severely disabled by symptoms (CCVS: III-IV, NYHA: III-IV) preoperatively, 14% were advised not to proceed with a surgical option but did so. Total operative in-hospital mortality was 6.3% (elective: 0%, urgent: 10.5%, P = 0.05), major complications were few 10.9% (seven patients; stroke: 1.6%, deep sternal infection: 1.6%, myocardial infarction: 1.6%, reoperation: 4.8%). At 1 year, despite 95% being free of significant cardiovascular symptoms (CCVS/NYHA: I-II), nearly one in five (19%) would not have proceeded with the surgery. However, at the final follow up (mean time: 2.8 years), freedom from cardiovascular symptoms remained high (95%), 94% remained independent and their quality of life was significantly better than before surgery. Although 59% suffered worsening of additional medical conditions, these conditions had a minor impact on their quality of life. Ninety-eight per cent would recommend cardiac surgery. Actuarial survival for all patients and for hospital survivors at 4 years was 67.9 +/- 4.1% and 74.2 +/- 4%, respectively. CONCLUSION: Medium-term follow up of Australian octogenarians who were offered cardiac surgery revealed that 94% remain independent and with an excellent quality of life. Age alone must not be a barrier to access to cardiac surgery.

Aged↗

PubMed2001

Beta blocker prescribing differences in patients with and without diabetes following a first myocardial infarction.

AIMS: To document the prescribed usage of beta blockers in patients with and without diabetes mellitus discharged from hospital following a first myocardial infarction. METHODS: All patients with diabetes and a group of patients matched for age and sex without diabetes, admitted with a documented first myocardial infarction during the period 1995-1999 at the Royal Liverpool University Hospital, Liverpool, UK were audited. RESULTS: Data were available on 201 patients with diabetes and 199 patients without diabetes. No significant differences existed between the diabetic and non-diabetic groups for age and sex. Twenty-three per cent of patients with diabetes were prescribed a beta blocker compared to 52% of non-diabetic patients (P < 0.01). Patients with diabetes had a higher frequency of perceived contraindications than patients without diabetes (36 vs. 27%, P < 0.001). Thirty-five per cent of patients with diabetes and 18% of non-diabetic patients had no contraindication to the use of beta blocker but were not prescribed one (P < 0.001). CONCLUSIONS: Although beta blockers can provide useful benefits in patients with diabetes following a myocardial infarction, this study suggests that a significant proportion of patients with diabetes and without a contraindication to treatment are still not receiving beta blockers after myocardial infarction.

Adrenergic beta-Antagonists↗

PubMed2001

Aorto-uni-iliac endograft for complex aortoiliac aneurysms compared with tube/bifurcation endografts: results of the EVT/Guidant trials.

OBJECTIVE: Our objective was to present the results of the multicenter EVT/Guidant aorto-uni-iliac trial and to compare them with the tube, bifurcated graft, and open control series in regard to patient demographics, medical comorbidity, 30-day morbidity/mortality, and outcome at 1 year. METHODS: One hundred twenty-one patients not eligible for tube or bifurcated endografts were entered into the aorto-uni-iliac trial (A-I). These were compared with 153 patients in a tube (T) group, 268 patients in a bifurcated endograft (BI) group, and 111 patients in an open control (C) group. All data were audited and independently analyzed for presentation to the Food and Drug Administration. RESULTS: Group demographics were similar with the following exceptions. Aneurysm diameter was significantly less in the T group (51.2 mm) but similar for the A-I (57 mm), BI (54.6 mm), and C (55.6 mm) groups (P < .001). There were more male patients in all endograft groups (A-I 92.6%, BI 89.5%, T 85.6% vs 76.6% for C, P = .002). Peripheral arterial occlusion was present more frequently in the A-I group (25.6% vs 13.8% BI, 10.5% T, and 10.8% C, P = .003). However, no differences were found in mean age, incidence of coronary artery disease, and American Society of Anesthesiologists III/IV classification. Implantation was achieved in 94.2% of the A-I group, 90.3% of the BI group, and 92% of the T group. No significant difference was seen in the operative mortality rate (4.2% A-I, 2.6% BI, O% T, 2.7% C). Postoperative cardiac complications were similar for the A-I (22%) and C (20.7%) groups but significantly less for the BI and T groups (13.4% and 10.5%, P = .019), whereas pulmonary problems were significantly reduced in all endograft groups (A-I 11.9%, BI 10.1%, and T 7.2% vs 22.5% for C, P = .002). Transient renal dysfunction occurred in 6.8% of the A-I group and 8.2% of the BI group but in only 3.3% of the T group and 1.8% of the C group (P = .028). Operating time was significantly longer for the A-I group than for the BI, T, or C groups (258 minutes vs 156, 179, and 174 minutes). Median blood loss, intensive care unit use, and hospital stays were markedly and significantly reduced in all endograft groups compared with the control group. The incidences of type I endoleak at 1 year were 2.4% A-I, 2.3% BI, and 3.8% T, and no ruptures occurred in any of the patients treated with endografts. No femoral-femoral graft thromboses occurred in the A-I group. CONCLUSION: Despite the fact that patients with combined aortic and iliac aneurysms have a more complex repair requirement and have an increased rate of comorbidity, the results are competitive with endovascular repair of aortic aneurysm by tube and bifurcated graft systems and are associated with a lower morbidity than open operation.

Aged↗

PubMed2006

Neurosurgical trainees operative experience before and after introduction of the New Deal for junior doctors.

To compare operative experience before and after implementation of the New Deal to reduce junior doctors working hours, operative data was audited over a 6-month period. The three registrars with national training numbers in our unit were placed on two virtual working patterns to determine what their operative experience would have been over that 6-month period. Comparison with a 1980s trainee over a similar period was also made. Trainees on a 1:3 rota would have performed more emergency operations [32 (28 - 38)], than those on a partial shift [1:6 with following day off, 16 (13 - 23)]. Particular examples include trauma craniotomies 13 (9 - 15) versus 6 (3 - 11) and CSF diversion, 9 (2 - 13) versus 4 (2 - 7). Although trainees on a 1:3 on call rota would have had more emergency operative experience over the same period of time, less common procedures, such as lumber decompression for cauda equina syndrome, were equally distributed between both groups. Trainees doing the partial shift would have lost 18 (12 - 24) elective cases over the same period as a result of enforced absence following periods of duty. These included posterior fossa, complex spinal, benign and rare cranial procedures. The increasingly common option of employing juniors on a full shift rota would have an even greater impact on training. Trainees are unavailable for elective training on night shift and then for a compensatory period afterwards, doubling the time spent away from formal surgical training. Indiscriminate reduction in working hours by enforced absence for compensatory rest has a potentially deleterious impact on elective training. By reducing the out of hours commitment trainees have a reduced, but possibly acceptable, exposure to emergency neurosurgery without impact on elective training.

Clinical Competence↗

PubMedDate not supplied

Intensive care research coordinators: who are they and what do they do? Results of a binational survey.

Research coordinators in intensive care are a growing specialty about which little is known. This cross-sectional study surveyed the Australia and New Zealand Intensive Care Research Coordinators' Group (n = 49) regarding demographics, education, employment history, job structure, and role content. Most research coordinators were highly qualified and experienced nurses who undertake pharmaceutical trials, multicenter projects, departmental medical and nursing research, audits and data registries, and their own projects.

Adult↗

PubMed1979

Variations in surgery in Ontario.

In 1974 there was five-to eight-fold variation in the frequency with which tonsillectomy, colectomy, hysterectomy, cholecystectomy and appendectomy were performed in Ontario's 49 counties. All five procedures were resource sensitive; over 50 per cent of the variation in rates was explained by numbers of acute care treatment beds and physicians. Generally, counties with high or low rates for any one procedure had corresponding rates for the other four. The highest rates were found in less populous rural eastern Ontario counties, while university teaching centers ranked among the lowest for all five operations although they had the highest ratios of beds, general practitioners and surgeons. Linkages between university medical centers and community hospitals, widespread dissemination of surgical rate data, surgical audit and review of surgical indications and practices in university centers and community hospitals are proposed to aid in rationalizing surgical practices in Ontario.

Analysis of Variance↗