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[2 cities or: Contrasts within mental deficiency care]

https://arctichealth.org/en/permalink/ahliterature43050
Source
Ugeskr Laeger. 1974 Mar 11;136(11):611-4
Publication Type
Article
Date
Mar-11-1974

Acute hospital admissions from nursing homes: predictors of unwarranted variation?

https://arctichealth.org/en/permalink/ahliterature114995
Source
Scand J Public Health. 2013 Jun;41(4):359-65
Publication Type
Article
Date
Jun-2013
Author
Birgitte Graverholt
Trond Riise
Gro Jamtvedt
Bettina S Husebo
Monica W Nortvedt
Author Affiliation
Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway. bgra@hib.no
Source
Scand J Public Health. 2013 Jun;41(4):359-65
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Beds - statistics & numerical data
Health Facility Size - statistics & numerical data
Homes for the Aged - statistics & numerical data
Hospitalization - statistics & numerical data
Humans
Long-Term Care - statistics & numerical data
Norway
Nursing Homes - statistics & numerical data
Ownership - statistics & numerical data
Risk factors
Suburban Health Services - statistics & numerical data
Abstract
The geriatric nursing home population is frail and vulnerable to sudden changes in their health condition. Very often, these incidents lead to hospitalization, in which many cases represent an unfavourable discontinuity of care. Analysis of variation in hospitalization rates among nursing homes where similar rates are expected may identify factors associated with unwarranted variation.
To 1) quantify the overall and diagnosis specific variation in hospitalization rates among nursing homes in a well-defined area over a two-year period, and 2) estimate the associations between the hospitalization rates and characteristics of the nursing homes.
The acute hospital admissions from 38 nursing homes to two hospitals were identified through ambulance records and linked to hospital patient journals (n = 2451). Overall variation in hospitalization rates for 2 consecutive years was tested using chi-square and diagnosis-specific variation using Systematic Component of Variation. Associations between rates and nursing home characteristics were tested using multiple regression and ANOVA.
Annual hospitalization rates varied significantly between 0.16 and 1.49 per nursing home. Diagnoses at discharge varied significantly between the nursing homes. The annual hospitalization rates correlated significantly with size (r = -0.38) and percentage short-term beds (r = 0.41), explaining 32% of the variation observed (R (2) = 0.319). No association was found for ownership status (r = 0.05) or location of the nursing home (p = 0.52).
A more than nine-fold variation in annual hospitalization rates among the nursing homes in one municipality suggests the presence of unwarranted variation. This finding demands for political action to improve the premises for a more uniform practice in nursing homes.
PubMed ID
23554388 View in PubMed
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All-cause readmission to acute care for cancer patients.

https://arctichealth.org/en/permalink/ahliterature120630
Source
Healthc Q. 2012;15(3):14-6
Publication Type
Article
Date
2012
Author
Hong Ji
Hani Abushomar
Xi-Kuan Chen
Cheng Qian
Darren Gerson
Author Affiliation
Canadian Institute for Health Information (CIHI).
Source
Healthc Q. 2012;15(3):14-6
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Canada
Child
Diagnosis-Related Groups
Female
Follow-Up Studies
Health Facility Size
Humans
Logistic Models
Male
Neoplasms - economics - therapy
Patient Readmission - statistics & numerical data
Quality Improvement
Residence Characteristics
Risk factors
Abstract
A recent Canadian Institute for Health Information report on all-cause readmission identified that cancer patients had higher-than-average readmission rates. This study provides further insight on the experience of cancer patients, exploring the risk factors associated with readmission at patient, hospital and community levels. An analysis showed that patient characteristics, including the reason for initial hospitalization, sex, co-morbidity levels, admission through the emergency department and the number of previous acute care admissions, were associated with readmission for cancer patients. In addition, we found that the readmission rate for these patients varied by hospital size and whether the patients lived in rural or urban locations.
PubMed ID
22986560 View in PubMed
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[Alternative treatment for young drug abusers: National Center for Prevention--a presentation].

https://arctichealth.org/en/permalink/ahliterature254704
Source
Tidsskr Nor Laegeforen. 1973 Apr 30;93(12):829-34
Publication Type
Article
Date
Apr-30-1973

An audit on guidelines used for the initial management of patients with minor head injuries in Denmark.

https://arctichealth.org/en/permalink/ahliterature209934
Source
Acta Neurochir (Wien). 1997;139(8):743-8
Publication Type
Article
Date
1997
Author
B R Duus
Author Affiliation
Department of Orthopaedic Surgery, Rigshospitalet, University Hospital, Copenhagen, Denmark.
Source
Acta Neurochir (Wien). 1997;139(8):743-8
Date
1997
Language
English
Publication Type
Article
Keywords
Denmark
Head Injuries, Closed - diagnosis - epidemiology - therapy
Health Facility Size - statistics & numerical data
Humans
Medical Audit
Neurologic Examination
Patient Admission - statistics & numerical data
Practice Guidelines as Topic
Quality Assurance, Health Care
Skull Fractures - diagnosis - epidemiology - therapy
Abstract
The purpose of this quality assurance study was to compare the practice used in the management of patients with minor head injuries (MHI) in Denmark with guidelines recommended by Danish neurosurgeons and analyse differences between hospitals in the treatment of patients with MHI. All 68 accident and emergency departments in Denmark covering a population of 5,146,000 inhabitants and 895,000 attenders received a questionnaire containing questions about epidemiological data, the clinical practice and the use of skull x-ray. Ninety-four per cent of the hospitals responded. The number of patients admitted per 100,000 inhabitants per year was the same (mean 235) in large and small hospitals, but in the small hospitals significantly more patients per 100,000 attenders per year were admitted (p
PubMed ID
9309289 View in PubMed
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Are small hospitals with small intensive care units able to treat patients with severe sepsis?

https://arctichealth.org/en/permalink/ahliterature145528
Source
Intensive Care Med. 2010 Apr;36(4):673-9
Publication Type
Article
Date
Apr-2010
Author
Matti Reinikainen
Sari Karlsson
Tero Varpula
Ilkka Parviainen
Esko Ruokonen
Marjut Varpula
Tero Ala-Kokko
Ville Pettilä
Author Affiliation
Department of Intensive Care, North Karelia Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland. matti.reinikainen@pkssk.fi
Source
Intensive Care Med. 2010 Apr;36(4):673-9
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Chi-Square Distribution
Female
Finland - epidemiology
Health Facility Size
Hospital Mortality
Humans
Incidence
Intensive Care Units - organization & administration
Length of Stay - statistics & numerical data
Logistic Models
Male
Middle Aged
Retrospective Studies
Sepsis - mortality - therapy
Survival Analysis
Treatment Outcome
Abstract
To find out whether mortality from sepsis is influenced by the size of the hospital and of the intensive care unit (ICU).
In the Finnsepsis study, 470 patients with severe sepsis were identified. The present study is a retrospective subgroup analysis of the Finnsepsis study. Eighteen patients were excluded because of treatment in more than one ICU. We divided the 24 units into three groups based on hospital size and academic status.
There were no significant differences between the ICU groups in terms of severity of illness. Overall, the hospital mortality rate was 29.2%. In post-operative patients, the hospital mortality rate was 22.9% for patients treated in large ICUs (including university and large non-university hospital ICUs) but 42.3% for patients treated in small ICUs (p = 0.045). In medical patients, no differences in outcomes were found.
Treatment of surgical patients with severe sepsis in small ICUs was associated with increased mortality. Because of the relatively small sample size, further studies are needed to confirm or refute this association.
PubMed ID
20143222 View in PubMed
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Association of automated data collection and data completeness with outcomes of intensive care. A new customised model for outcome prediction.

https://arctichealth.org/en/permalink/ahliterature126503
Source
Acta Anaesthesiol Scand. 2012 Oct;56(9):1114-22
Publication Type
Article
Date
Oct-2012
Author
M. Reinikainen
P. Mussalo
S. Hovilehto
A. Uusaro
T. Varpula
A. Kari
V. Pettilä
Author Affiliation
Department of Intensive Care, North Karelia Central Hospital, Joensuu, Finland. matti.reinikainen@pkssk.?
Source
Acta Anaesthesiol Scand. 2012 Oct;56(9):1114-22
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Algorithms
Automatic Data Processing - methods
Benchmarking
Child
Data Collection - methods
Data Interpretation, Statistical
Female
Finland - epidemiology
Forecasting - methods
Health Facility Size
Hospital Mortality
Humans
Intensive Care - statistics & numerical data
Male
Middle Aged
Models, Statistical
Patient Discharge
Probability
Prospective Studies
Quality Improvement
Severity of Illness Index
Treatment Outcome
Young Adult
Abstract
The Finnish Intensive Care Consortium coordinates a national intensive care benchmarking programme. Clinical information systems (CISs) that collect data automatically are widely used. The aim of this study was to explore whether the severity of illness-adjusted hospital mortality of Finnish intensive care unit (ICU) patients has changed in recent years and whether the changes reflect genuine improvements in the quality of care or are explained by changes in measuring severity of illness.
We retrospectively analysed data collected prospectively to the database of the Consortium. During the years 2001-2008, there were 116,065 admissions to the participating ICUs. We excluded readmissions, cardiac surgery patients, patients under 18 years of age and those discharged from an ICU to another hospital's ICU. The study population comprised 85,547 patients. The Simplified Acute Physiology Score II (SAPS II) was used to measure severity of illness and to calculate standardised mortality ratios (SMRs, the number of observed deaths divided by the number of expected deaths).
The overall hospital mortality rate was 18.4%. The SAPS II-based SMRs were 0.74 in 2001-2004 and 0.64 in 2005-2008. The severity of illness-adjusted odds of death were 24% lower in 2005-2008 than in 2001-2004. One fifth of this computational difference could be explained by differences in data completeness and the automation of data collection with a CIS.
The use of a CIS and improving data completeness do decrease severity-adjusted mortality rates. However, this explains only one fifth of the improvement in measured outcomes of intensive care in Finland.
PubMed ID
22384799 View in PubMed
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Association of ICU size and annual case volume of renal replacement therapy patients with mortality.

https://arctichealth.org/en/permalink/ahliterature122133
Source
Acta Anaesthesiol Scand. 2012 Oct;56(9):1175-82
Publication Type
Article
Date
Oct-2012
Author
S T Vaara
M. Reinikainen
K-M Kaukonen
V. Pettilä
Author Affiliation
Intensive Care Units, Division of Anaesthesia and Intensive Care Medicine, Department of Surgery, Helsinki University Central Hospital, Finland. suvi.vaara@helsinki.?
Source
Acta Anaesthesiol Scand. 2012 Oct;56(9):1175-82
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
APACHE
Acute Kidney Injury - mortality - therapy
Aged
Critical Illness - mortality - therapy
Female
Finland - epidemiology
Health Facility Size
Hospital Mortality
Hospitals, University
Humans
Intensive Care Units - classification - organization & administration - statistics & numerical data
Logistic Models
Male
Middle Aged
Renal Replacement Therapy - mortality - statistics & numerical data
Retrospective Studies
Risk Adjustment
Treatment Outcome
Abstract
We aimed to reveal whether the size of an intensive care unit (ICU) or its annual case volume of patients treated with renal replacement therapy (RRT) for acute kidney injury (AKI) is associated with hospital mortality.
This was a retrospective cohort study in the Finnish Intensive Care Consortium (FICC) database in 2007-2008. We divided the 23 FICC-member ICUs first into small or large according to ICU size, and second into low, medium, or high-volume tertiles according to annual case volume of patients with RRT. We compared crude hospital mortality, Simplified Acute Physiology Score (SAPS) II-, and case-mix-adjusted hospital mortality in small vs. large ICUs and in low- or medium-volume vs. high-volume ICUs.
The median (interquartile range) annual case volume of patients with RRT for AKI per one ICU was 25 (19-45). Patients in small or low-volume ICUs were older and less severely ill. Crude and SAPS II -adjusted hospital mortality rates were significantly higher in small ICUs but not significantly different in case volume tertiles. After adjusting for age, severity of illness, intensity of care, propensity to receive RRT, and day of RRT initiation, treatment in low or medium volume ICUs was associated with an increased risk for hospital mortality.
Crude and adjusted hospital mortality rates of patients treated with RRT for AKI were higher in small ICUs. Patients treated in high-volume ICUs had a decreased adjusted risk for hospital mortality compared to those in low-or medium volume ICUs.
PubMed ID
22845741 View in PubMed
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Source
Acta Neurochir (Wien). 2011 Jun;153(6):1237-43; author reply 1245
Publication Type
Article
Date
Jun-2011
Author
Ole Solheim
Johan Cappelen
Source
Acta Neurochir (Wien). 2011 Jun;153(6):1237-43; author reply 1245
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Adult
Brain Neoplasms - mortality - surgery
Centralized Hospital Services - standards
Cerebellar Neoplasms - mortality - surgery
Child
Child, Preschool
Clinical Competence - standards
Craniotomy - mortality
Cross-Cultural Comparison
Female
Health Facility Size - standards
Humans
Infant
Male
Medulloblastoma - mortality - surgery
Neuroectodermal Tumors, Primitive - mortality - surgery
Norway
Postoperative Complications - mortality
Quality Indicators, Health Care - standards
Registries
Specialties, Surgical
Survival Analysis
Notes
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Comment On: Acta Neurochir (Wien). 2011 Jun;153(6):1231-621547494
PubMed ID
21541685 View in PubMed
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Birth in Bella Bella: emergence and demise of a rural family medicine birthing service.

https://arctichealth.org/en/permalink/ahliterature142863
Source
Can Fam Physician. 2010 Jun;56(6):e233-40
Publication Type
Article
Date
Jun-2010
Author
Alexandra Iglesias
Stuart Iglesias
David Arnold
Author Affiliation
Family Medicine, University of Toronto in Ontario, Canada. ali.iglesias@utoronto.ca
Source
Can Fam Physician. 2010 Jun;56(6):e233-40
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Birth Certificates
Birthing Centers - statistics & numerical data
British Columbia
Cesarean Section - statistics & numerical data
Data Collection
Female
Health Facility Closure
Health Facility Size
Health Services, Indigenous - statistics & numerical data
Hospitals, Community
Humans
Maternal Health Services - utilization
Perinatal mortality
Pregnancy
Pregnancy outcome
Registries - statistics & numerical data
Rural Health Services - statistics & numerical data
Abstract
To explore a once successful rural maternity care program and the variables surrounding its closure.
Analysis of archived logbook data, reports, and communications with medical staff.
Bella Bella, a Heiltsuk First Nation community on British Columbia's central coast.
Every patient delivering at the Bella Bella hospital since 1928.
We extracted delivery rates, cesarean section rates, and local perinatal and maternal mortality rates from the hospital logbooks. In 2003, a consultant's report reviewed the viability of surgical and maternity care services in Bella Bella; this was also reviewed. Finally, several personal communications with past and present medical staff added to an understanding of the issues that initially sustained and, in the end, closed the local maternity care program.
Bella Bella had an intrapartum service with operative backup, and intervention and perinatal mortality rates were comparable to national data. There was only 1 maternal death in 80 years of intrapartum service. In the 1990 s, with sparse cesarean section coverage, more mothers were obliged to travel to referral centres, until an eventual closure of the intrapartum care service in 2001.
Bella Bella provided safe and comprehensive maternity care until, in the context of an insufficient supply of family medicine generalists trained in anesthesia, surgery, and maternity care, the service closed.
Notes
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PubMed ID
20547506 View in PubMed
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111 records – page 1 of 12.