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1.
Sean D. Rundell Adam P. Goode Pradeep Suri Patrick J. Heagerty Bryan A. Comstock Janna L. Friedly Laura S. Gold Zoya Bauer Andrew L. Avins Srdjan S. Nedeljkovic David R. Nerenz Larry Kessler Jeffrey G. Jarvik 《Archives of physical medicine and rehabilitation》2017,98(1):43-50
Objective
To examine if a comorbid diagnosis of knee or hip osteoarthritis (OA) in older adults with new back pain visits is associated with long-term patient-reported outcomes and back-related health care use.Design
Prospective cohort study.Setting
Three integrated health systems forming the Back pain Outcomes using Longitudinal Data cohort.Participants
Participants (N=5155) were older adults (≥65y) with a new visit for back pain and a complete electronic health record data.Interventions
Not applicable; we obtained OA diagnoses using diagnostic codes in the electronic health record 12 months prior to the new back pain visit.Main Outcome Measures
The Roland-Morris Disability Questionnaire (RDQ) and the EuroQol-5D (EQ-5D) were key patient-reported outcomes. Health care use, measured by relative-value units (RVUs), was summed for the 12 months after the initial visit. We used linear mixed-effects models to model patient-reported outcomes. We also used generalized linear models to test the association between comorbid knee or hip OA and total back-related RVUs.Results
Of the 5155 participants, 368 (7.1%) had a comorbid knee OA diagnosis, and 94 (1.8%) had a hip OA diagnosis. Of the participants, 4711 (91.4%) had neither knee nor hip OA. In adjusted models, the 12-month RDQ score was 1.23 points higher (95% confidence interval [CI], 0.72–1.74) for patients with knee OA and 1.26 points higher (95% CI, 0.24–2.27) for those with hip OA than those without knee or hip OA, respectively. A lower EQ-5D score was found among participants with knee OA (.02 lower; 95% CI, ?.04 to ?.01) and hip OA diagnoses (.03 lower; 95% CI, ?.05 to ?.01) compared with those without knee or hip OA, respectively. Comorbid knee or hip OA was not significantly associated with total 12-month back-related resource use.Conclusions
Comorbid knee or hip OA in older adults with a new back pain visit was associated with modestly worse long-term disability and health-related quality of life. 相似文献2.
David A. Alter Bing Yu Ravi R. Bajaj Paul I. Oh 《Mayo Clinic proceedings. Mayo Clinic》2017,92(4):500-511
Objectives
To examine the relationship between cardiac rehabilitation participation and health service expenditures in Ontario, Canada.Patients and Methods
A total of 6284 patients referred to cardiac rehabilitation between April 1, 2003, and December 31, 2010, were linked to 6284 matched cardiac rehabilitation eligible nonreferred controls and followed over a 3-year period across multiple linked administrative databases to identify health service utilization expenditures and mortality. All patients had previous cardiac hospitalizations within the preceding year. Four cardiac rehabilitation eligible groups of patients were balanced using propensity score weights: (1) no referral; (2) no participation; (3) low participation levels (ie, attending <67% of prescheduled classes); and (4) high participation levels (ie, attending ≥67% prescheduled classes). Each group of patients was balanced in age, sex, geography, socioeconomic status, previous hospitalizations, ambulatory care conditions, cardiovascular risk factors, comorbidities, and previous health care expenditures. Generalized linear models were used to examine differences in health service expenditures (from all sources including hospitalizations, physician visits, diagnostic tests, and drugs for those older than 65 years) per “eligible day alive” over the 3-year period.Results
Compared with the nonreferred population, health service expenditures followed a dose-response relationship and were lowest in patients who had the highest cardiac rehabilitation programmatic participation levels (P<.001). Cost differences across groups separated early, remained divergent, and applied to all components of health care expenditures (P<.001). Sensitivity analyses confirmed that the findings were not secondary to reverse causality.Conclusion
Participation in cardiac rehabilitation is associated with lower long-term health service utilization expenditures within a publicly funded health care system. 相似文献3.
Hillary R. Bogner Heather F. de Vries McClintock Jibby E. Kurichi Pui L. Kwong Dawei Xie Sean Hennessy Joel E. Streim Margaret G. Stineman 《Archives of physical medicine and rehabilitation》2017,98(1):1-10
Objective
To examine how patient satisfaction with care coordination and quality and access to medical care influence functional improvement or deterioration (activity limitation stage transitions), institutionalization, or death among older adults.Design
National representative sample with 2-year follow-up.Setting
Medicare Current Beneficiary Survey from calendar years 2001 to 2008.Participants
Community-dwelling adults (N=23,470) aged ≥65 years followed for 2 years.Interventions
Not applicable.Main Outcome Measures
A multinomial logistic regression model taking into account the complex survey design was used to examine the association between patient satisfaction with care coordination and quality and patient satisfaction with access to medical care and activities of daily living (ADL) stage transitions, institutionalization, or death after 2 years, adjusting for baseline socioeconomics and health-related characteristics.Results
Out of 23,470 Medicare beneficiaries, 14,979 (63.8% weighted) remained stable in ADL stage, 2508 (10.7% weighted) improved, 3210 (13.3% weighted) deteriorated, 582 (2.5% weighted) were institutionalized, and 2281 (9.7% weighted) died. Beneficiaries who were in the top quartile of satisfaction with care coordination and quality were less likely to be institutionalized (adjusted relative risk ratio [RRR], .68; 95% confidence interval [CI], .54–.86). Beneficiaries who were in the top quartile of satisfaction with access to medical care were less likely to functionally deteriorate (adjusted RRR, .87; 95% CI, .79–.97), be institutionalized (adjusted RRR, .72; 95% CI, .56–.92), or die (adjusted RRR, .86; 95% CI, .75–.98).Conclusions
Knowledge of patient satisfaction with medical care and risk of functional deterioration may be helpful for monitoring and addressing disability-related health care disparities and the effect of ongoing policy changes among Medicare beneficiaries. 相似文献4.
Naiane Teixeira Bastos de Oliveira Sandra Maria Sbeghen Ferreira Freitas Fernanda Ferreira Fuhro Maurício Antônio da Luz Cesar Ferreira Amorim Cristina Maria Nunes Cabral 《Archives of physical medicine and rehabilitation》2017,98(1):88-95
Objective
To determine the amplitude of the electromyographic activity of trunk muscles during Pilates exercises in women with and without chronic low back pain (LBP).Design
Case-control study.Setting
University physical therapy clinic.Participants
Women (N=60) divided into an LBP group and a control group.Interventions
Not applicable.Main Outcome Measures
Amplitude of the electromyographic activity (root mean square values) of the gluteus maximus and external oblique muscles collected during 3 Pilates exercises: Shoulder Bridge performed on the mat, and Hip Roll and Breathing performed in equipment. Pain intensity was assessed in the LBP group.Results
The amplitude of the electromyographic activity was similar between groups (P≥.05). For both groups, the amplitude of the gluteus maximus was higher in the Shoulder Bridge exercise compared with the Hip Roll with 2 springs (control group: mean difference [MD]=.18; 95% confidence interval [CI], .05–.41; LBP group: MD=.29; 95% CI, .16–.31) and the Breathing exercise (control group: MD=?.40; 95% CI, ?.55 to ?.26; LBP group: MD=?.36; 95% CI, ?.52 to ?.20). The amplitude of the external oblique muscle was higher in the Shoulder Bridge compared with the Hip Roll with 2 springs (control group: MD=.13; 95% CI, .05–.21; LBP group: MD=.18; 95% CI, .03–.33). Pain intensity increased after exercises, but this increase was lower for the mat exercises.Conclusions
Similar muscle activation between groups was found. The findings suggest that mat exercises caused less pain and a greater difference in the amplitude of muscle activation compared with the equipment-based exercises. 相似文献5.
Background
Emergency department crowding has led to innovative “front end” care models to safely and efficiently care for medium and lower acuity patients. In the United States, most treatment algorithms rely on the emergency severity index (ESI) triage tool to sort patients. However, there are no objective criteria used to differentiate ESI 3 patients.Objective
We seek to derive and validate a model capable of predicting patient discharge disposition (DD) using variables present on arrival to the emergency department for ESI 3 patients.Methods
Our retrospective cohort study included adult patients with an ESI triage designation 3 treated in an academic emergency department over the course of 2 successive years (2013–2015). The main outcome was DD. Two datasets were used in the modeling process. One dataset, the derivation dataset (n = 25,119), was used to develop the statistical model, while the second dataset, the validation dataset (n = 24,639), was used to evaluate the statistical model's prediction performance.Results
All variables included in the derivation model were uniquely associated with DD status (p < 0.001). We assessed multivariate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for age (2.50 [95% CI 2.35–2.65]), arrival mode (1.85 [95% CI 1.74–1.96]), heart rate (1.31 [95% CI 1.26–1.37]), sex (1.35 [95% CI 1.28–1.43]), oxygen saturation (1.06 [95% CI 1.01–1.10]), temperature (1.10 [95% CI 1.06–1.15]), systolic blood pressure (1.18 [95% CI 1.12–1.25]), diastolic blood pressure (1.16 [95% CI 1.09–1.22]), respiratory rate (1.05 [95% CI 1.01–1.10]), and pain score (1.13 [95% CI 1.06–1.21]). The validation C-statistic was 0.73.Conclusion
We derived and validated a model and created a nomogram with acceptable discrimination of ESI 3 patients on arrival for purposes of predicting DD. Incorporating these variables into the care of these patients could improve patient flow by identifying patients who are likely to be discharged. 相似文献6.
Objective
To address the association between exercise capacity and the onset of dementia, Alzheimer disease, and cognitive impairment.Patients and Methods
For 6104 consecutive veteran patients (mean ± SD age: 59.2±11.4 years) referred for treadmill exercise testing, the combined end point of dementia, Alzheimer disease, and cognitive impairment was abstracted from the Veterans Affairs computerized patient record system.Results
After mean ± SD follow-up of 10.3±5.5 years, 353 patients (5.8%) developed the composite end point at a mean ± SD age of 76.7±10.3 years. After correction for confounders in multivariate Cox proportional hazards regression, higher age at exercise testing (hazard ratio [HR]=1.08; 95% CI, 1.07-1.09; P<.001), current smoking (HR=1.44; 95% CI, 1.08-1.93; P=.01), and exercise capacity (HR=0.92; 95% CI, 0.89-0.96; P<.001) emerged as predictors of cognitive impairment. Each 1–metabolic equivalent increase in exercise capacity conferred a nearly 8% reduction in the incidence of cognitive impairment. Meeting the recommendations for daily activity was not associated with a delay in onset of cognitive impairment (HR=1.07; 95% CI, 0.86-1.32; P=.55).Conclusion
Exercise capacity is strongly associated with cognitive function; the inverse association between fitness and cognitive impairment provides an additional impetus for health care providers to promote physical activity. 相似文献7.
Simon D.S. Fraser Anthony Fenton Scott Harris Adam Shardlow Sophie Liabeuf Ziad A. Massy Anne Burmeister Colin A. Hutchison Martin Landray Jonathan Emberson Phil Kalra James P. Ritchie Paul Cockwell Maarten W. Taal 《Mayo Clinic proceedings. Mayo Clinic》2017,92(11):1671-1681
Objective
To clarify the associations between polyclonal serum free light chain (sFLC) levels and adverse outcomes in patients with chronic kidney disease (CKD) by conducting a systematic review and individual patient data meta-analyses.Patients and Methods
On December 28, 2016, we searched 4 databases (MEDLINE, Embase, CINAHL, and PubMed) and conference proceedings for studies presenting independent analyses of associations between sFLC levels and mortality or progression to end-stage renal disease (ESRD) in patients with CKD. Study quality was assessed in 5 domains: sample selection, measurement, attrition, reporting, and funding.Results
Five prospective cohort studies were included, judged moderate to good quality, involving 3912 participants in total. In multivariable meta-analyses, sFLC (kappa+lambda) levels were independently associated with mortality (5 studies, 3680 participants; hazard ratio [HR], 1.04 [95% CI, 1.03-1.06] per 10 mg/L increase in sFLC levels) and progression to ESRD (3 studies, 1848 participants; HR, 1.01 [95% CI, 1.00-1.03] per 10 mg/L increase in sFLC levels). The sFLC values above the upper limit of normal (43.3 mg/L) were independently associated with mortality (HR, 1.45 [95% CI, 1.14-1.85]) and ESRD (HR, 3.25 [95% CI, 1.32-7.99]).Conclusion
Higher levels of sFLCs are independently associated with higher risk of mortality and ESRD in patients with CKD. Future work is needed to explore the biological role of sFLCs in adverse outcomes in CKD, and their use in risk stratification. 相似文献8.
Jennifer N. Baldwin Marnee J. McKay Claire E. Hiller Elizabeth J. Nightingale Niamh Moloney Joshua Burns 《Archives of physical medicine and rehabilitation》2017,98(1):72-79
Objectives
To provide reference data for the Cumberland Ankle Instability Tool (CAIT) and to investigate the prevalence and correlates of perceived ankle instability in a large healthy population.Design
Cross-sectional observational study.Setting
University laboratory.Participants
Self-reported healthy individuals (N=900; age range, 8–101y, stratified by age and sex) from the 1000 Norms Project.Interventions
Not applicable.Main Outcome Measures
Participants completed the CAIT (age range, 18–101y) or CAIT-Youth (age range, 8–17y). Sociodemographic factors, anthropometric measures, hypermobility, foot alignment, toes strength, lower limb alignment, and ankle strength and range of motion were analyzed.Results
Of the 900 individuals aged 8 to 101 years, 203 (23%) had bilateral and 73 (8%) had unilateral perceived ankle instability. The odds of bilateral ankle instability were 2.6 (95% confidence interval [CI], 1.7–3.8; P<.001) times higher for female individuals, decreased by 2% (95% CI, 1%–3%; P=.001) for each year of increasing age, increased by 3% (95% CI, 0%–6%; P=.041) for each degree of ankle dorsiflexion tightness, and increased by 4% (95% CI, 2%–6%, P<.001) for each centimeter of increased waist circumference.Conclusions
Perceived ankle instability was common, with almost a quarter of the sample reporting bilateral instability. Female sex, younger age, increased abdominal adiposity, and decreased ankle dorsiflexion range of motion were independently associated with perceived ankle instability. 相似文献9.
10.
Liselotte N. Dyrbye Colin P. West Christine A. Sinsky Lindsey E. Goeders Daniel V. Satele Tait D. Shanafelt 《Mayo Clinic proceedings. Mayo Clinic》2017,92(10):1486-1493
Objective
To determine whether state medical licensure application questions (MLAQs) about mental health are related to physicians' reluctance to seek help for a mental health condition because of concerns about repercussions to their medical licensure.Methods
In 2016, we collected initial and renewal medical licensure application forms from 50 states and the District of Columbia. We coded MLAQs related to physicians' mental health as “consistent” if they inquired only about current impairment from a mental health condition or did not ask about mental health conditions. We obtained data on care-seeking attitudes for a mental health problem from a nationally representative convenience sample of 5829 physicians who completed a survey between August 28, 2014, and October 6, 2014. Analyses explored relationships between state of employment, MLAQs, and physicians' reluctance to seek formal medical care for treatment of a mental health condition because of concerns about repercussions to their medical licensure.Results
We obtained initial licensure applications from 51 of 51 (100%) and renewal applications from 48 of 51 (94.1%) medical licensing boards. Only one-third of states currently have MLAQs about mental health on their initial and renewal application forms that are considered consistent. Nearly 40% of physicians (2325 of 5829) reported that they would be reluctant to seek formal medical care for treatment of a mental health condition because of concerns about repercussions to their medical licensure. Physicians working in a state in which neither the initial nor the renewal application was consistent were more likely to be reluctant to seek help (odds ratio, 1.21; 95% CI, 1.07-1.37; P=.002 vs both applications consistent).Conclusion
Our findings support that MLAQs regarding mental health conditions present a barrier to physicians seeking help. 相似文献11.
Megan Sutter Laiene Olabarrieta Landa Amilkar Calderón Chagualá Helmer Chacón Peralta Gina Vergara Torres Paul B. Perrin Juan Carlos Arango-Lasprilla 《PM & R》2017,9(1):8-14
Background
Stroke is a primary cause of death and disability in upper-middle–income countries such as Colombia. Given the lack of comprehensive rehabilitation for stroke patients in Colombia, there is a need to assess longitudinal mental health problems poststroke in this region.Objective
To compare the course of mental health in stroke patients to healthy controls over the first year poststroke in Ibague, Colombia.Design
Cross-sectional study.Setting
The Psychological Attention Center of Antonio Nariño University in Ibague, Colombia.Participants
Stroke patients (n = 50) and age- and gender-matched healthy controls (n = 50).Methods
Patients and controls completed self-report Spanish versions of demographic information, injury-related characteristics, and mental health questionnairesMain Outcome Measurements
Outcomes assessed included mental health (depression, anxiety, and stress) at 3, 6, and 12 months poststroke.Results
Hierarchical linear models suggested that stroke patients had worse depression and anxiety over time than controls (P < .001). Among patients, depression and anxiety decreased over time (P < .001), whereas stress increased over time (P < .01). The findings suggest that although anxiety and depression improved over time in stroke patients, their mental health remained significantly lower than that of controls.Conclusions
This is the first study to examine the course of mental health over the first year poststroke in Latin America, specifically in Ibague, Colombia. Despite the improvements in anxiety and depression over the first year poststroke, patient anxiety and depression were still worse in comparison to those in healthy controls. The current findings indicate a need for rehabilitation services in Colombia, especially targeting mental health issues.Level of Evidence
I 相似文献12.
Javaid Nauman Bjarne M. Nes Carl J. Lavie Andrew S. Jackson Xuemei Sui Jeff S. Coombes Steven N. Blair Ulrik Wisløff 《Mayo Clinic proceedings. Mayo Clinic》2017,92(2):218-227
Objective
To assess the predictive value of estimated cardiorespiratory fitness (eCRF) and evaluate the additional contribution of traditional risk factors in cardiovascular disease (CVD) mortality prediction.Participants and Methods
The study included healthy men (n=18,721) and women (n=19,759) aged 30 to 74 years. A nonexercise algorithm estimated cardiorespiratory fitness. Cox proportional hazards models evaluated the primary (CVD mortality) and secondary (all-cause, ischemic heart disease, and stroke mortality) end points. The added predictive value of traditional CVD risk factors was evaluated using the Harrell C statistic and net reclassification improvement.Results
After a median follow-up of 16.3 years (range, 0.04-17.4 years), there were 3863 deaths, including 1133 deaths from CVD (734 men and 399 women). Low eCRF was a strong predictor of CVD and all-cause mortality after adjusting for established risk factors. The C statistics for eCRF and CVD mortality were 0.848 (95% CI, 0.836-0.861) and 0.878 (95% CI, 0.862-0.894) for men and women, respectively, increasing to 0.851 (95% CI, 0.839-0.863) and 0.881 (95% CI, 0.865-0.897), respectively, when adding clinical variables. By adding clinical variables to eCRF, the net reclassification improvement of CVD mortality was 0.014 (95% CI, ?0.023 to 0.051) and 0.052 (95% CI, ?0.023 to 0.127) in men and women, respectively.Conclusion
Low eCRF is independently associated with CVD and all-cause mortality. The inclusion of traditional clinical CVD risk factors added little to risk discrimination and did not improve the classification of risk beyond this simple eCRF measurement, which may be proposed as a practical and cost-effective first-line approach in primary prevention settings. 相似文献13.
14.
Abigail M. Schuh Eileen J. Klein Rebecca J. Allred Ana Christensen Julie C. Brown 《The Journal of emergency medicine》2017,52(2):169-175
Background
Pediatric adnexal torsion is rare, can be challenging to recognize, and may result in ovarian loss.Objective
We sought to identify and compare the defining characteristics of adnexal torsion in premenarchal and postmenarchal girls.Methods
A retrospective cohort study was performed at a tertiary care children's hospital, including patients diagnosed postnatally with adnexal (ovarian or tubal) torsion between 1997 and 2013. Proportions were compared using relative risk regression.Results
Adnexal torsion was found in 59 premenarchal and 43 postmenarchal girls. Abdominal pain was the most common chief complaint (54%). History included reports of pain (96%), vomiting (67%), and fever (19%). Excluding 12 patients with isolated tubal torsion and 19 with a teratoma, there were no statistically significant differences in ovarian loss in premenarchal vs. postmenarchal girls (47% and 25% respectively; relative risk [RR] = 1.8 [95% confidence interval {CI} 0.9–3.8]), left- vs. right-sided torsion (47% and 32%; RR = 1.5 [95% CI 0.8–2.7]), pain duration ≤ 2 days vs. > 2 days (31% and 41%; RR = 0.8 [95% CI 0.4–1.5]; n = 64) and severe pain vs. mild to moderate (38% and 33%; RR = 1.1 [95% CI 0.7–1.5]; n = 56).Conclusions
The diagnosis of pediatric adnexal torsion is difficult and often delayed. Pain and tenderness may not be isolated to a unilateral lower quadrant. Although traditionally considered a postmenarchal problem, in a pediatric academic emergency department adnexal torsion occurred with similar frequency in premenarchal and postmenarchal girls. The potential for organ salvage means that adnexal torsion should be considered in all females presenting with acute abdominal pain regardless of age or menstrual history. 相似文献15.
Richard Ehrlichman Zachary Dezman Joel Klein Jean Jeudy Daniel Lemkin 《The Journal of emergency medicine》2017,52(5):684-689
Background
Computed tomography (CT) is a useful and necessary part of many emergency department (ED) assessments. However, the costs of imaging and the health risks associated with radiation exposure have sparked national efforts to reduce CT ordering in EDs.Study Objective
We analyzed CT ordering habits prior to and following implementation of a feedback tool at a community hospital.Methods
In this intervention study, we identified the CT-ordering habits of physicians and mid-level care providers (physician assistants and nurse practitioners) at baseline and after implementation of a system that sent quarterly feedback reports comparing their ordering habits with those of their peers. Variability in ordering and subgroup analyses by body region were included in these reports.Results
We examined the records of 104,454 patients seen between October 1, 2013 and December 31, 2014. There were 5552 or 21.0% of patients seen during the baseline period that underwent CT imaging. We observed an absolute reduction in imaging of 2.3% (95% confidence interval 1.7–2.8%) after implementation, avoiding approximately $400,000 in costs, 22 days of scanning time, and radiation exposure equivalent to 33,000 chest films annually. These changes occurred across physicians and mid-level providers, regardless of the number years of practice or board certification.Conclusions
Implementation of a feedback mechanism reduced CT use by emergency medicine practitioners, with concomitant reductions in cost and radiation exposure. The change was similar across levels of medical care. Future studies will examine the effect of the feedback reporting system at other institutions in our hospital network. 相似文献16.
Angela Hua Stephen Haight Robert S. Hoffman Alex F. Manini 《The Journal of emergency medicine》2017,52(1):59-65
Background
Drug overdose is the leading cause of injury-related fatality in the United States, and respiratory failure remains a major source of morbidity and mortality.Objectives
We aimed to identify the incidence and risk factors for endotracheal intubation after acute drug overdose.Methods
This secondary data analysis was performed on a 5-year prospective cohort at two urban tertiary-care hospitals. The present study analyzed adult patients with suspected acute drug overdose to derive independent clinical predictors of endotracheal intubation.Results
We analyzed 2497 patients with acute drug overdose, of whom 87 (3.5%) underwent endotracheal intubation. Independent clinical risk factors for endotracheal intubation were: younger age (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.96–0.98), and history of obstructive lung disease (OR 6.6, 95% CI 3.5–12.3); however, heart failure had no association. Patients with obstructive lung disease had significantly more hypercapnia (mean difference 6.8 mm Hg, 95% CI 2.3–11.3) and a higher degree of acidemia (mean pH difference 0.04, 95% CI 0.01–0.07) than patients without obstructive lung disease. Lack of rapid sequence sedative/paralytic was associated with in-hospital fatality. Early complications of endotracheal intubation itself included desaturation (3.4%) and bradycardia (1%).Conclusions
Endotracheal intubation was infrequently performed on patients with acute drug overdose, and complications were rare when performed. Risk factors associated with endotracheal intubation included younger age and prior obstructive lung disease. 相似文献17.
Amber Rice Jennifer Dudek Toni Gross Tomi St Mars Dale Woolridge 《The Journal of emergency medicine》2017,52(6):894-901
Background
The Emergency Medical Services for Children State Partnership Program, as well as the Institute of Medicine report on pediatric emergency care, encourages recognition of emergency departments (EDs) through categorization and verification systems. Although pediatric verification programs are associated with greater pediatric readiness, clinical outcome data have been lacking to track the effects and patient-centered outcomes by implementing such programs.Objective
To describe pediatric mortality rates prior to and after implementation of a pediatric emergency facility verification system in Arizona.Methods
This was a cross-sectional study conducted using data from ED visits between 2011 and 2014 recorded in the Arizona Hospital Discharge Database. The primary outcome measure was the mortality rate for ED visits by patients under 18 years old. Rates were compared prior to and after facility certification by the Arizona Pediatric Prepared Emergency Care program.Results
The total number of ED visits by children during the study period was 1,928,409. Of these, 1,127,294 were at facilities undergoing certification. For hospitals becoming certified, overall ED mortality rates were 35.2 deaths/100,000 ED visits (95% confidence interval [CI] 29.5–41.7) in the precertification analysis and 34.4 deaths/100,000 ED visits (95% CI 30.4–38.9) in the postcertification analysis. The injury-related ED visit mortality rate for certified hospitals showed a decrease from 40.0 injury-related deaths/100,000 ED visits (95% CI 28.6–54.4) in the precertification analysis to 25.8 injury-related deaths/100,000 ED visits (95% CI 18.7–34.8) in the postcertification analysis.Conclusion
The implementation of the Arizona pediatric ED verification system was associated with a trend toward lower mortality. These results offer a platform for further research on pediatric ED preparedness efforts and their effects on improved patient outcomes. 相似文献18.
19.
Shannon M. Dunlay Steven J. Lippmann Melissa A. Greiner Emily C. O’Brien Alanna M. Chamberlain Robert J. Mentz Mario Sims 《Mayo Clinic proceedings. Mayo Clinic》2017,92(5):699-709
Objective
To assess the associations of perceived discrimination and cardiovascular (CV) outcomes in African Americans (AAs) in the Jackson Heart Study.Patients and Methods
In 5085 AAs free of clinical CV disease at baseline enrolled in the Jackson Heart Study from September 26, 2000, through March 31, 2004, and followed through 2012, associations of everyday discrimination (frequency of occurrences of perceived unfair treatment) and lifetime discrimination (perceived unfair treatment in 9 life domains) with CV outcomes (all-cause mortality, incident coronary heart disease [CHD], incident stroke, and heart failure [HF] hospitalization) were examined using Cox proportional hazards regression models.Results
Higher levels of everyday and lifetime discrimination were more common in participants who were younger and male and had higher education and income, lower perceived standing in the community, worse perceived health care access, and fewer comorbidities. Before adjustment, higher levels of everyday and lifetime discrimination were associated with a lower risk of all-cause mortality, incident CHD, stroke, and HF hospitalization. After adjustment for potential confounders, we found no association of everyday and lifetime discrimination with incident CHD, incident stroke, or HF hospitalization; however, a decrease in all-cause mortality with progressively higher levels of everyday discrimination persisted (hazard ratio per point increase in discrimination measure, 0.90; 95% CI, 0.82-0.99; P=.02). The unexpected association of everyday discrimination and all-cause mortality was partially mediated by perceived stress.Conclusion
We found no independent association of perceived discrimination with risk of incident CV disease or HF hospitalization in this AA population. An observed paradoxical negative association of everyday discrimination and all-cause mortality was partially mediated by perceived stress. 相似文献20.
Christine A. Sinsky Lotte N. Dyrbye Colin P. West Daniel Satele Michael Tutty Tait D. Shanafelt 《Mayo Clinic proceedings. Mayo Clinic》2017,92(11):1625-1635