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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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At least 91 records · Page 5Linked to original sources
PubMed2005

Risk adjustment for inter-hospital comparisons of caesarean section rates in Taipei municipal hospitals.

BACKGROUND: This study sets out to determine whether adjustments for specific patient caesarean delivery risk factors have an affect on the assessment of performance rates among the municipal hospitals of Taipei City. METHODS: Analysis of National Health Insurance (NHI) claims data, linked with birth certificate data, was undertaken on a cohort of 27,693 live births in the six general hospitals of the Taipei Medical Hospital System (TMHS) between 1999 and 2001. Using multivariable logistic regression modeling of the risk factors independently associated with caesarean deliveries, an expected caesarean delivery rate was constructed for each of the hospitals. By contrasting observed rates with expected rates to quantify the magnitude of the deviation from average practice, a measurement similar to relative risk (RR) was also constructed for each hospital. RESULTS: The observed rates for two of the six hospitals examined fell within the expected 95% confidence interval (CI), two were above the expected upper limit, and two were below the expected lower limit. The RR ranking of Hospitals A (RR=1.08, CI=1.01-1.15) and C (RR=1.01, CI=1.00-1.03) improved from first to second, and third to fourth, whilst the RR of Hospitals B (RR=1.09, CI=1.05-1.14) and D (RR=1.02, CI=0.99-1.06) worsened from second to first, and fourth to third, respectively. The RR rankings of Hospitals E (RR=0.92, CI=0.88-0.96) and F (RR=0.80, CI=0.77-0.84) were the same as the observed rates. CONCLUSIONS: Caesarean delivery rate profiles, or hospital comparisons without risk adjustment, may be methodologically biased and may lead to unfair judgments by healthcare purchasers.

Adult↗
PubMed1999

[The circulation of anesthetic agents at Edouard-Herriot Hospital].

In order to improve quality, practice evaluation is a major tool for hospital management. For many years anaesthesia has been monitored by some form of quality assurance programme. However, despite the improvement in anaesthetic techniques, major problems persist, particularly with the use of anaesthetic agents. Drug administration is the first cause for malpractice and death in anaesthesia. The aim of this study was to analyse drug circuits in anaesthesia, with special reference to French regulations. In 13 theatres, doctors and nurse anaesthetists were interviewed by a pharmacist with a focus on following items: prescription, preparation, administration, management, storage, conservation, information, and regulations. Results demonstrated that practice organisation and information transfers were mainly by oral route. The low proportion of written information, especially for preoperative prescription, did not comply with regulations. Nurse anaesthetists were the main actors in drug handling. Common practice patterns throughout the hospital were non existing. In each theatre, a storage of usual drugs for four weeks was found, whereas in pharmacies drugs were stocked for a 2-week period only. Standardised and written procedures, as well as pharmaceutical practice guidelines, are essential for decreasing the risk and improving quality. Such a procedure requires the full participation of anaesthetists and nurses.

Anesthetics↗
PubMed1997

Primary PTCA: Possibly the Best, Often the Only Choice for Reperfusion in Acute Myocardial Infarction.

Primary PTCA is at least as effective as intravenous thrombolysis for the management of acute myocardial infarction. When the capability for primary PTCA exists, it is also a very cost-effective treatment, allowing earlier hospital discharge, reduced readmissions and reduced risks of recurrent ischemia and infarction. Finally, many patients with acute myocardial infarction either have contraindications to thrombolysis or fail to fulfill the clinical and ECG criteria for thrombolysis. In these patients, the only possible reperfusion therapy is primary PTCA: it is potentially applicable to all patients with ongoing acute myocardial infarction, without contraindications, which may lead to a substantial increase in the proportion of acute myocardial infarction patients receiving reperfusion therapy. Its use is limited by logistical problems: permanent availability of interventional cardiology facilities and staff, need for secondary transfer of patients from primary care centers. Currently, it appears reasonable to use pre-hospital medical systems as often as possible to triage patients excluded from thrombolysis as well as the most severe thrombolysis-eligible to centers able to perform primary PTCA round the clock, which exist in nearly every large urban center. When the patient is thrombolysis-eligible and is within a center in which interventional facilities and experienced teams are immediately available, both treatments are legitimate, although primary PTCA may be favored both in terms of outcome and cost. Conversely, when the patient has no contraindication to thrombolysis and cannot be treated rapidly in a center with interventional capabilities, thrombolytic therapy should remain the preferred treatment.

Journal Article↗
PubMed2005

Trends and cardiovascular co-morbidities of COPD patients in the Veterans Administration Medical System, 1991-1999.

Persons with Chronic Obstructive Pulmonary Disease (COPD) are at risk for developing other smoking-related complications, including cardiac and vascular diseases. Information about the prevalence and incidence of these conditions is needed to anticipate their occurrence in clinical research. We conducted a cohort study using longitudinal administrative data to describe the prevalence and incidence of cardiovascular (CV) diseases among COPD patients treated by the Veterans Administration Medical System. The COPD cohort included all persons with a diagnosis of COPD admitted to a Veterans Administration Medical System hospital (N = 70,679) or seen in a outpatient clinic (N = 314,209) in fiscal year 1998. Each COPD patient was matched to a Veteran of the same age and gender who did not have a COPD diagnosis, creating a non-COPD cohort for comparison. Among all hospitalized Veterans, the prevalence of COPD steadily increased from 1991 to 1999, although the total number of Veterans hospitalized during this time period decreased by more than one-third. Among COPD patients hospitalized in 1998, the prevalence of coronary artery disease, congestive heart failure, and atrial fibrillation were very high (33.6%, 24.4%, and 14.3%, respectively) and significantly higher than those seen among the matched non-COPD cohort (27.1%, 13.5%, and 10.4%; p < 0.001). Among COPD outpatients, increased complications were found in every CV disease category with rate ratios that were greater than observed among inpatients. We conclude that CV diseases are remarkably prevalent among Veterans with COPD, and their incidence is likely to increase as the Veteran population ages.

Adult↗
PubMed2002

Rudy the robot.

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Equipment Design↗
PubMed1993

Baseball bat assault injuries.

The baseball bat, according to Baltimore City police crime statistics, is a commonly used weapon. To assess the severity of injuries inflicted by this modern-day club, we retrospectively reviewed 75 charts of patients treated at the University of Maryland Medical Systems Hospital for baseball bat injuries from January 1990 through July 1991. Multisystem trauma was documented, with craniocerebral injury being the most frequent and the most frequent cause of death. Of the victims struck on the head, 26% sustained an intracranial hemorrhage. In our series, the history of loss of consciousness and the Glasgow Coma Scale score failed to reliably identify the patients with serious injuries. Seventeen percent of our patients with intracranial hemorrhages had both a negative or uncertain history of loss of consciousness and a normal Glasgow Coma Scale score on arrival.

Adolescent↗
PubMed1997

The importance of negative feedback and consequences of actions in the design of processes.

Like many organizations, Continental Rehabilitation Hospital of San Diego designs and communicates templates and targets for desired changes in behaviors and tracks results. It recognizes and celebrates successes and struggles with its failures. A recent case example demonstrates the importance of generating immediate feedback and consequences as a strategy for increasing effectiveness in changing behavioral patterns.

Anti-Anxiety Agents↗
PubMed1992

Drug usage evaluation of warfarin sodium: the need for improved patient education.

Due to documented problems encountered during therapy, the potential for drug-drug interactions, and possible readmissions due to therapy complications, the Ohio State University Department of Pharmacy decided to conduct a drug usage evaluation (DUE) of warfarin sodium. The results of their DUE are presented below.

Clinical Protocols↗
PubMed1992

Overcoming unit dose drug distribution system logistical problems on a 32-acre campus.

The literature contains numerous articles regarding the implementation of unit dose drug distribution systems, but little has been written concerning the logistical problems sometimes encountered with such systems. This article describes the implementation of a drug distribution system at a psychiatric institution at which the inpatient units are scattered throughout a 32-acre campus.

Hospital Bed Capacity, 100 to 299↗
PubMed1992

Pill poppers.

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Drug Prescriptions↗
PubMed1992

Pharmaceutical service differences between teaching and community hospitals.

The purpose of this study was to inventory the highly specialized units maintained in teaching hospitals and compare and contrast the scope and level of pharmaceutical services provided in teaching and similar-size community hospitals. In 1989, a 30-item questionnaire was mailed to a sample of 120 teaching hospitals. The scope and level of services provided was compared with similar size hospitals in the 1989 American Society of Hospital Pharmacists' survey of hospital-based pharmaceutical services. Teaching hospitals maintain more licensed and occupied beds, are more likely to be a member of a nonprofit multisystem organization, maintain many specialized care units and high speed transportation vehicles, exercise more control over specialized drugs and products, provide a broader array of pharmacy services to ambulatory patient populations, offer a more extensive and broader array of clinical services, maintain more extensive drug information resources, exercise more comprehensive formulary management initiatives, engage in broader diversified service initiatives, and generate 50% more annual pharmacy costs per occupied bed than do similar-sized community hospitals. Teaching hospitals are complex organizations that provide care to patients who require higher levels of pharmaceutical services than those provided in similar-sized community hospitals.

Hospitals, Community↗
PubMed1995

Implementation of a once-daily aminoglycoside program in a large community-teaching hospital.

Recently, there has been an emergence of interest in the use of once-daily aminoglycoside dosing. In an attempt to take advantage of the pharmacodynamic properties of these agents and to reduce the potential for toxicity, a once-daily aminoglycoside program was developed at this institution. This program uses a fixed intravenous dose of 7 mg/kg with dosing interval adjustments based on estimates of creatinine clearance or a single random serum aminoglycoside concentration. Because this automatic conversion program was initiated hospital-wide, more than 2,400 patients received the regimen with no apparent alteration in clinical success and the incidence of toxicity was lower than that previously observed. The purpose of this report was to describe the implementation process and unique features of this hospital-wide once-daily aminoglycoside program in a 850-bed community-teaching hospital.

Aminoglycosides↗
PubMed1975

The unit dose.

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Equipment and Supplies, Hospital↗