To investigate whether the daily workload per nurse (Oulu Patient Classification (OPCq)/nurse) as measured by the RAFAELA system correlates with different types of patient safety incidents and with patient mortality, and to compare the results with regressions based on the standard patients/nurse measure.
We obtained data from 36 units from four Finnish hospitals. One was a tertiary acute care hospital, and the three others were secondary acute care hospitals.
Patients' nursing intensity (249?123 classifications), nursing resources, patient safety incidents and patient mortality were collected on a daily basis during 1?year, corresponding to 12?475 data points. Associations between OPC/nurse and patient safety incidents or mortality were estimated using unadjusted logistic regression models, and models that adjusted for ward-specific effects, and effects of day of the week, holiday and season.
Main outcome measures were patient safety incidents and death of a patient.
When OPC/nurse was above the assumed optimal level, the adjusted odds for a patient safety incident were 1.24 (95% CI 1.08 to 1.42) that of the assumed optimal level, and 0.79 (95% CI 0.67 to 0.93) if it was below the assumed optimal level. Corresponding estimates for patient mortality were 1.43 (95% CI 1.18 to 1.73) and 0.78 (95% CI 0.60 to 1.00), respectively. As compared with the patients/nurse classification, models estimated on basis of the RAFAELA classification system generally provided larger effect sizes, greater statistical power and better model fit, although the difference was not very large. Net benefits as calculated on the basis of decision analysis did not provide any clear evidence on which measure to prefer.
We have demonstrated an association between daily workload per nurse and patient safety incidents and mortality. Current findings need to be replicated by future studies.
Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden - email@example.com.
A previous small-sample (N.=150) Rasch analysis of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) suggested problems regarding response categories and redundant items that need confirmation in larger samples with more severe strokes.
The aim of this study was to evaluate the measurement properties of the SwePASS in patients with acute stroke.
A multicenter, cross-sectional study.
Two stroke units in Western Sweden.
The study cohort included 250 consecutive inpatients undergoing rehabilitation after acute stroke.
The SwePASS assessments were performed once within the first four days after admission to the stroke units. The data were analyzed according to the Rasch measurement model regarding targeting, model fit, reliability, response category function, local dependence and differential item functioning.
Postural control of 250 patients (median age, 76.5 years) was assessed with the SwePASS within median of two days after admission to the stroke units. The SwePASS covered a continuum of different levels of postural control, but had suboptimal targeting with insufficient representation of lower and higher levels of postural control. The reliability was high, the item fit statistics were generally acceptable and there was no differential item functioning by sex, age and stroke localization. However, response categories did not function as expected for four of the 12 SwePASS items and five items exhibited local dependency.
The SwePASS exhibited several promising measurement properties. To improve the scale, poor targeting, illogical response categories and local dependency should be addressed.
The SwePASS provides valuable clinical information regarding postural control in the acute phase after stroke.
The objective was to evaluate the responsiveness of the Endometriosis Health Profile-30 (EHP-30) questionnaire in a Swedish sample.
Forty-two patients with endometriosis were included in a prospective observational study.
The changes on the EHP-30 questionnaire after pertubation treatment were compared with the patients' self-estimated change in pain intensity. The responsiveness to change was evaluated with effect sizes and significance of change (paired t-test). The changes in scores between those who improved / not improved were compared with independent t-test.
The changes in the scores were significant for all dimensions on the core questionnaire (p = 0.04-0.0002) for improved patients in contrast to the patients in the stable group where there were no significant changes in any dimension (p = 0.16-0.63). The effect sizes were large (> 0.8) on all core scales except for self-image (0.51) for the improved patients and small on all scales in the non-improved (stable) group (- 0.17-0.35). There were significant differences between the improved and the stable group considering change in most of the core EHP-30 scores.
The EHP-30 is responsive to improvement on all core scales and is acceptable, understandable, and applicable in this Swedish sample.
The high prevalence of COPD in the Russian Federation has been demonstrated in several epidemiological studies. However, there are still no data on the clinical characteristics of these patients according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups and phenotypes, which could provide additional understanding of the burden of COPD, routine clinical practice, and ways to improve the treatment of patients with COPD in Russia.
SUPPORT was an observational multicenter study designed to obtain data about the distribution of patients with previously diagnosed COPD according to the severity of bronchial obstruction, symptom severity, risk of exacerbation, COPD phenotypes, and treatment of COPD. We included patients with a previous diagnosis of COPD who visited one of 33 primary-care centers for any reason in 23 cities in Russia.
Among the 1,505 patients with a previous diagnosis of COPD who attended the primary-care centers and were screened for the study, 1,111 had a spirometry-confirmed diagnosis and were included in the analysis. Up to 53% of the patients had severe or very severe COPD (GOLD stages III-IV), and 74.3% belonged to the GOLD D group. The majority of patients were frequent exacerbators (exacerbators with chronic bronchitis [37.3%], exacerbators without chronic bronchitis [14%]), while 35.8% were nonexacerbators and 12.9% had asthma-COPD overlap. Among the GOLD D group patients, >20% were treated with only short-acting bronchodilators.
COPD is still misdiagnosed in primary care in Russia. COPD patients in primary care are usually GOLD D with frequent exacerbations and are often treated with only short-acting bronchodilators.