AIM: This article reviews recent studies on the relationship between patient volume, level of care, and peri- or neonatal outcome for term and preterm infants. METHODS: A PubMed search was performed using various combinations of keywords related to neonates, patient volume and outcome published since 2000. RESULTS: Two studies on term infants showed that perinatal mortality in Norway and Germany was 2 - 3 times higher for term infants born in institutions with less than 500, and 40 - 80 % higher in those with
BACKGROUND: The clinical risk index for babies (CRIB) is a score given to extremely small prematures as a tool for expressing initial sickness. It was developed in order to compare results among different neonatal intensive care units (NICUs). MATERIAL AND METHODS: The CRIB score was determined for prematures with birth weight
To identify risk factors for harm due to self-neglect or behaviors related to disorientation in cognitively impaired seniors who live alone that can be used in primary care.
Inception cohort followed prospectively for 18 months.
Participants were referred by their primary care physicians and community service agencies or were patients of several medical units of a large teaching hospital.
One hundred thirty-nine community-residing participants, aged 65 and older who scored less than 131 on the Dementia Rating Scale and lived alone.
Baseline Mini-Mental State Examination (MMSE); a social resources questionnaire; presence of chronic obstructive pulmonary disease (COPD), cerebrovascular disease, diabetes mellitus, Charlson Comorbidity Index, and medication use were examined as predictors of incident harm. Informants and primary care physicians provided information about the nature of any harm at 3-month intervals over an 18-month period. An incident of harm was included if it occurred as the result of self-neglect or behaviors related to disorientation, resulted in physical injury or property loss or damage, and required emergency community interventions.
Based on the consensual agreement of four raters, 21.6% had an incident of harm. The proportional hazards model was highly significant (P
Comment In: J Am Geriatr Soc. 2004 Sep;52(9):1576-715341566
Sexual Abuse: Family Education & Treatment Program, Thistletown Regional Centre for Children and Adolescents, Ontario Ministry of Community, Family and Children's Services, Toronto, Ontario, Canada. firstname.lastname@example.org
The Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR) is an empirically guided checklist designed to assist clinicians to estimate the short-term risk of a sexual reoffense for youth aged 12-18 years of age. The ERASOR provides objective coding instructions for 25 risk factors (16 dynamic and 9 static). To investigate the psychometric properties, risk ratings were collected from 28 clinicians who evaluated 136 adolescent males (aged 12-18 years) following comprehensive, clinical assessments. Preliminary psychometric data (i.e., interrater agreement, item-total correlation, internal consistency) were found to be supportive of the reliability and item composition of the tool. ERASOR ratings also significantly discriminated adolescents based on whether or not they had previously been sanctioned for a prior sexual offense.
In a mailed survey and qualitative interviews, it was observed that community pharmacists and public health authorities believe that pharmacists should play a significant role in the prevention and management of osteoporosis and the risk of falls. However, pharmacists acknowledge a wide gap between their ideal and actual levels of involvement.
The aim of this study was to explore perceptions of community pharmacists and public health authorities regarding the role of pharmacists in providing services in relation to osteoporosis and risk of falls and the barriers to providing them.
Using a modified five-step version of Dillman's tailored design method, a questionnaire was mailed to a random sample of 1,250 community pharmacists practicing in Montreal (Quebec, Canada) and surrounding areas. A similar questionnaire was sent to public health officers in these regions. Additionally, telephone interviews were conducted with regional and ministry level public health officers.
Of the 1,250 pharmacists contacted, 28 were ineligible. In all, 571 of 1,222 (46.7 %) eligible community pharmacists and all the public health officers returned the questionnaire. Six public health officers (five regional and one at ministry level) were interviewed. Most pharmacists believed they should be involved in screening for osteoporosis (46.6 %) and risk of falls (50.3 %); however, fewer reported actually being involved in such services (17.4 % and 19.2 %, respectively). In their view, the main barriers to providing these services in current practice were lack of time (78.8 %), lack of clinical tools (65.4 %), and lack of coordination with other healthcare professionals (54.5 %). Public health authorities also thought community pharmacists should play a significant role in providing osteoporosis and fall risk services. However, few community pharmacist-mediated activities are in place in the participating regions.
Although community pharmacists and public health authorities believe pharmacists should play a significant role with regard to osteoporosis and the risk of falls, they acknowledge a wide gap between the ideal and actual levels of pharmacist involvement.
We investigated the precision of individual risk estimates made using actuarial risk assessment instruments (ARAIs) by discussing some major conceptual issues and then illustrating them by analyzing new data. We used a standard multivariate statistical procedure, logistic regression, to create a new ARAI based on data from a follow-up study of 90 adult male sex offenders. We indexed predictive precision at the group level using confidence intervals for group mean probability estimates, and at the individual level using prediction intervals for individual probability estimates. Consistent with past research, ARAI scores were moderately and significantly predictive of failure in the aggregate, but group probability estimates had substantial margins of error and individual probability estimates had very large margins of error. We conclude that, without major advances in our understanding of the causes of violence, ARAIs cannot be used to estimate the specific probability or absolute likelihood of future violence with any reasonable degree of precision or certainty. The implications for conducting violence risk assessments in forensic mental health are discussed.
RATIONAL, AIMS AND OBJECTIVES: The study aims to determine the extent to which the addition of post-admission information via time-dependent covariates improved the ability of a survival model to predict the daily risk of hospital death.
Using administrative and laboratory data from adult inpatient hospitalizations at our institution between 1 April 2004 and 31 March 2009, we fit both a time-dependent and a time-fixed Cox model for hospital mortality on a randomly chosen 66% of hospitalizations. We compared the predictive performance of these models on the remaining hospitalizations.
All comparative measures clearly indicated that the addition of time-dependent covariates improved model discrimination and prominently improved model calibration. The time-dependent model had a significantly higher concordance probability (0.879 versus 0.811) and predicted significantly closer to the number of observed deaths within all risk deciles. Over the first 32 admission days, the integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were consistently above zero (average IDI of +0.0200 and average NRI of 62.7% over the first 32 days).
The addition of time-dependent covariates significantly improved the ability of a survival model to predict a patient's daily risk of hospital death. Researchers should consider adding time-dependent covariates when seeking to improve the performance of survival models.
The objectives of this study were to classify and analyze perioperative complications following free flap reconstruction in the head and neck and investigate potential predictors of these complications.
A retrospective chart analysis of 304 consecutive free flap reconstructions for defects in the head and neck were examined. Patient and operative characteristics as well as complications were recorded prospectively and analyzed using ordinal logistic regression.
The overall complication rate was 32.6% with a perioperative mortality rate of 0.3%. The flap loss rate was 2.0% and the partial flap necrosis rate was 1.0%. Multivariate analysis demonstrated a significant correlation between perioperative complication and tumor stage as well as reconstruction site.
The rate and grade of complications with free flap reconstruction in the head and neck were found to be low. Higher tumor stage and pharyngoesophageal reconstruction were found to be associated with increased complication grades, whereas preoperative radiation alone and chemoradiation were not. Smoking and alcohol use, age, diabetes mellitus, peripheral vascular disease, and preoperative myocardial infarction as well as preoperative cerebrovascular accident were not found to be associated with increased complications. No statistically significant difference in complication grades was found with different flap types or indications for reconstruction.
Left ventricular systolic function is a key determinant of outcome after ST-segment elevation myocardial infarction (STEMI). The aim of this study was to study speckle-tracking global longitudinal strain (GLS) for early risk evaluation in STEMI and compare it with left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and end-systolic volume index (ESVI).
Five-hundred seventy-six patients underwent echocardiography =24 hours after primary percutaneous coronary intervention for STEMI. The end point was the composite of death, hospitalization with reinfarction, congestive heart failure, or stroke. Associations with outcome were assessed by multivariate Cox regression with adjustment for clinical parameters. Hazard ratios (HRs) for events within the first year are reported per absolute percentage GLS increase.
During a median follow-up period of 24 months, 162 patients experienced at least one event. GLS was associated with the composite end point (adjusted HR, 1.20; 95% confidence interval [CI], 1.12-1.29) and also when controlling for LVEF (adjusted HR, 1.17; 95% CI, 1.07-1.29) and ESVI (adjusted HR, 1.18; 95% CI, 1.08-1.28). Although WMSI was significantly associated with outcome beyond any association accounted for by GLS, a borderline significant association was found after controlling for WMSI (adjusted HR for GLS, 1.10; 95% CI, 1.00-1.21). When GLS or WMSI was known, there was no significant association between LVEF or ESVI and outcome.
In a large population of patients with STEMI, GLS and WMSI were comparable and both superior for early risk assessment compared with volume-based left ventricular function indicators such as LVEF and ESVI. Compared with WMSI, the advantage of GLS is the provision of a semiautomated quantitative measure.