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pubmed: Quality of care



NCBI: db=pubmed; Term=(("quality assurance, health care"[MeSH Terms] OR "quality indicators, health care"[MeSH Terms] OR "quality of health care"[MeSH Terms] OR "total quality management"[MeSH Terms]) AND quality[TI]) AND English[Lang] AND "adult"[MeSH Te



 



Sex-based differences in quality of care and outcomes in a health system using a standardized STEMI protocol.
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Sex-based differences in quality of care and outcomes in a health system using a standardized STEMI protocol.

Am Heart J. 2017 Sep;191:30-36

Authors: Wei J, Mehta PK, Grey E, Garberich RF, Hauser R, Bairey Merz CN, Henry TD

Abstract
BACKGROUND: Recent data from the National Cardiovascular Data Registry indicate that women with ST-segment-elevation myocardial infarction (STEMI) continue to have higher mortality and reported delays in treatment compared with men. We aimed to determine whether the sex difference in mortality exists when treatment disparities are reduced.
METHODS: Using a prospective regional percutaneous coronary intervention (PCI)-based STEMI system database with a standardized STEMI protocol, we evaluated baseline characteristics, treatment, and clinical outcomes of STEMI patients stratified by sex.
RESULTS: From March 2003 to January 2016, 4,918 consecutive STEMI patients presented to the Minneapolis Heart Institute at Abbott Northwestern Hospital regional STEMI system including 1,416 (28.8%) women. Compared with men, women were older (68.4 vs 60.9 years) with higher rates of hypertension (66.7% vs 55.7%), diabetes (21.7% vs 17.4%), and cardiogenic shock (11.5% vs 8.0%) (all P < .001). Pre-revascularization medications and PCI were performed with same frequencies, but women were less likely to receive statin or antiplatelet therapy at discharge. After age adjustment, women had similar in-hospital mortality to men (5.1% vs 4.8%, P = .60) despite slightly longer door-to-balloon time (95 vs 92 minutes, P = .004). Five-year follow-up confirmed absence of a sex disparity in age-adjusted survival post-STEMI.
CONCLUSIONS: Previously reported treatment disparities between men and women are diminished in a regional PCI-based STEMI system using a standardized STEMI protocol. No sex differences in short-term or long-term age-adjusted mortality are present in this registry despite some treatment disparities. These results suggest that STEMI health care disparities and mortality in women can be improved using STEMI protocols and systems.

PMID: 28888267 [PubMed - indexed for MEDLINE]




A priori-defined diet quality indices, biomarkers and risk for type 2 diabetes in five ethnic groups: the Multiethnic Cohort.
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A priori-defined diet quality indices, biomarkers and risk for type 2 diabetes in five ethnic groups: the Multiethnic Cohort.

Br J Nutr. 2017 Aug;118(4):312-320

Authors: Jacobs S, Boushey CJ, Franke AA, Shvetsov YB, Monroe KR, Haiman CA, Kolonel LN, Le Marchand L, Maskarinec G

Abstract
Dietary indices have been related to risk for type 2 diabetes (T2D) predominantly in white populations. The present study evaluated this association in the ethnically diverse Multiethnic Cohort and examined four diet quality indices in relation to T2D risk, homoeostatic model assessment-estimated insulin resistance (HOMA-IR) and biomarkers of dyslipidaemia, inflammation and adipokines. The T2D analysis included 166 550 white, African American, Native Hawaiian, Japanese American and Latino participants (9200 incident T2D cases). Dietary intake was assessed at baseline using a quantitative FFQ and T2D status was based on three self-reports and confirmed by administrative data. Biomarkers were assessed about 10 years later in a biomarker subcohort (n 10 060). Sex- and ethnicity-specific hazard ratios were calculated for the Healthy Eating Index-2010 (HEI-2010), the alternative HEI-2010 (AHEI-2010), the alternate Mediterranean diet score (aMED) and the Dietary Approaches to Stop Hypertension (DASH). Multivariable-adjusted means of biomarkers were compared across dietary index tertiles in the biomarker subcohort. The AHEI-2010, aMED (in men only) and DASH scores were related to a 10-20 % lower T2D risk, with the strongest associations in whites and the direction of the relationships mostly consistent across ethnic groups. Higher scores on the four indices were related to lower HOMA-IR, TAG and C-reactive protein concentrations, not related to leptin, and the DASH score was directly associated with adiponectin. The AHEI-2010 and DASH were directly related to HDL-cholesterol in women. Potential underlying biological mechanisms linking diet quality and T2D risk are an improved lipid profile and reduced systemic inflammation and, with regards to DASH alone, an improved adiponectin profile.

PMID: 28875870 [PubMed - indexed for MEDLINE]




Factors influencing failure to rescue after pancreaticoduodenectomy: a National Surgical Quality Improvement Project Perspective.
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Factors influencing failure to rescue after pancreaticoduodenectomy: a National Surgical Quality Improvement Project Perspective.

J Surg Res. 2017 Jun 15;214:131-139

Authors: Varley PR, Geller DA, Tsung A

Abstract
BACKGROUND: Failure to rescue is the concept of death after a complication, and it is an important factor driving variation in mortality rates after pancreatic surgery. The purpose of this study was to conduct a retrospective review of a large, multi-institutional data set to describe patient-level risk factors for failure to rescue in greater detail.
METHODS: From the American College of Surgeons National Surgical Quality Improvement Program participant use file, 14,557 patients who underwent pancreaticoduodenectomy were identified. Of these, 4514 experienced at least one complication and were therefore at risk for failure to rescue. Multivariable logistic regression models to identify factors independently associated with failure to rescue.
RESULTS: Age, American Society of Anesthesiologists class, ascites and/or varices, and disseminated malignancy were significant independent risk factors for failure to rescue. Participation of a resident was associated with reduced odds of failure to rescue. Patients who experienced an initial complication and then accumulated additional complications were more common in the failure to rescue group (68.6% versus 31.3%, P < 0.001).
CONCLUSIONS: Accumulation of complications after pancreaticoduodenectomy is a significant risk factor for failure to rescue. Pancreatic surgery quality improvement programs should continue developing strategies to identify and intervene on post-pancreatectomy complications, especially in high-risk patients.

PMID: 28624034 [PubMed - indexed for MEDLINE]




Predictors of readmission in nonagenarians: analysis of the American College of Surgeons National Surgical Quality Improvement Project dataset.
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Predictors of readmission in nonagenarians: analysis of the American College of Surgeons National Surgical Quality Improvement Project dataset.

J Surg Res. 2017 Jun 01;213:32-38

Authors: Hothem Z, Baker D, Jenkins CS, Douglas J, Callahan RE, Shuell CC, Long GW, Welsh RJ

Abstract
BACKGROUND: Increased longevity has led to more nonagenarians undergoing elective surgery. Development of predictive models for hospital readmission may identify patients who benefit from preoperative optimization and postoperative transition of care intervention. Our goal was to identify significant predictors of 30-d readmission in nonagenarians undergoing elective surgery.
METHODS: Nonagenarians undergoing elective surgery from January 2011 to December 2012 were identified using the American College of Surgeons National Surgical Quality Improvement Project participant use data files. This population was randomly divided into a 70% derivation cohort for model development and 30% validation cohort. Using multivariate step-down regression, predictive models were developed for 30-d readmission.
RESULTS: Of 7092 nonagenarians undergoing elective surgery, 798 (11.3%) were readmitted within 30 d. Factors significant in univariate analysis were used to develop predictive models for 30-d readmissions. Diabetes (odds ratio [OR]: 1.51, 95% confidence interval [CI]: 1.24-1.84), dialysis dependence (OR: 2.97, CI: 1.77-4.99), functional status (OR: 1.52, CI: 1.29-1.79), American Society of Anesthesiologists class II or higher (American Society of Anesthesiologist physical status classification system; OR: 1.80, CI: 1.42-2.28), operative time (OR: 1.05, CI: 1.02-1.08), myocardial infarction (OR: 5.17, CI: 3.38-7.90), organ space surgical site infection (OR: 8.63, CI: 4.04-18.4), wound disruption (OR: 14.3, CI: 4.80-42.9), pneumonia (OR: 8.59, CI: 6.17-12.0), urinary tract infection (OR: 3.88, CI: 3.02-4.99), stroke (OR: 6.37, CI: 3.47-11.7), deep venous thrombosis (OR: 5.96, CI: 3.70-9.60), pulmonary embolism (OR: 20.3, CI: 9.7-42.5), and sepsis (OR: 13.1, CI: 8.57-20.1), septic shock (OR: 43.8, CI: 18.2-105.0), were included in the final model. This model had a c-statistic of 0.73, indicating a fair association of predicted probabilities with observed outcomes. However, when applied to the validation cohort, the c-statistic dropped to 0.69, and six variables lost significance.
CONCLUSIONS: A reliable predictive model for readmission in nonagenarians undergoing elective surgery remains elusive. Investigation into other determinants of surgical outcomes, including social factors and access to skilled home care, might improve model predictability, identify areas for intervention to prevent readmission, and improve quality of care.

PMID: 28601329 [PubMed - indexed for MEDLINE]




Bone Density, Microarchitecture, and Tissue Quality After Long-Term Treatment With Tenofovir/Emtricitabine or Abacavir/Lamivudine.
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Bone Density, Microarchitecture, and Tissue Quality After Long-Term Treatment With Tenofovir/Emtricitabine or Abacavir/Lamivudine.

J Acquir Immune Defic Syndr. 2017 Jul 01;75(3):322-327

Authors: Güerri-Fernández R, Molina-Morant D, Villar-García J, Herrera S, González-Mena A, Guelar A, Trenchs-Rodríguez M, Díez-Pérez A, Knobel H

Abstract
OBJECTIVES: HIV infection has been associated with reduced bone mineral density (BMD). Antiretroviral therapy (ART) has a deleterious effect on BMD, but its effect on bone fragility is not clear. The objective of this study is to analyze the BMD, microarchitecture, and tissue quality of bone in patients receiving long-term tenofovir- or abacavir-based ART.
DESIGN: We conducted a cross-sectional study in patients with HIV undergoing tenofovir or abacavir ART for more than 5 years.
METHODS: We measured BMD using dual X-ray absorptiometry ,bone michroarchitecture using trabecular bone score (TBS), and bone tissue quality using microindentation. TBS is a dual X-ray absorptiometry-based software that is more highly correlated with bone fragility than BMD. Microindentation (BMSi) directly assesses bone quality at the tissue level.
RESULTS: A total of 63 patients were included in this study, with 36 belonging to the TDF-FTC group and 27 to the ABC-3TC group. Patients receiving TDF-FTC treatment showed lower BMD values than those in the ABC-3TC group. We found no differences in TBS or microindentation between the 2 groups. However, after adjusting for sex, age, body mass index, and 25[OH]vitD we found lower BMSi and thus poorer bone properties in the TDF-FTC group than in the ABC-3TC group [beta coefficient -3.594 (confidence interval: 95% -0.12 to -7.61); P = 0.043].
CONCLUSIONS: Long-term treatment with TDF-FTC leads to impaired bone health, not only in terms of BMD but also in terms of bone quality, another determinant of overall bone strength. To complement BMD-based predictions, these other techniques may also be used to identify patients with excess fracture risk.

PMID: 28418990 [PubMed - indexed for MEDLINE]




Effects of aging on optical quality and visual function.
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Effects of aging on optical quality and visual function.

Clin Exp Optom. 2016 Nov;99(6):518-525

Authors: Martínez-Roda JA, Vilaseca M, Ondategui JC, Aguirre M, Pujol J

Abstract
BACKGROUND: We assessed the effects of aging on visual function and optical quality in a healthy adult population and provide reference values for different age ranges.
METHODS: We conducted a prospective study with 198 healthy volunteers from 31 to 70 years of age. The visual acuity (VA) and contrast sensitivity (CS) at 3, 6, 12 and 18 cycles per degree (cpd) frequencies were assessed, together with values of optical quality and intraocular scattering obtained with a double-pass system (Optical Quality Analysis System - OQAS), specifically the modulation transfer function cutoff frequency (MTFcutoff ), the Strehl ratio, the OQAS values (OV) at contrasts of 100, 20 and nine per cent and the objective scatter index (OSI). We studied the change of these variables with age and obtained standard values for optical quality and intraocular scattering parameters for four age groups: 31 to 40, 41 to 50, 51 to 60 and 61 to 70 years.
RESULTS: We found significant correlations between age and all variables analysed and significant differences among the age groups considered except for CS (3 cpd) (p = 0.067). Ageing particularly affected low-contrast parameters, such as the OV nine per cent and the OSI, which decreased to 37 and 50 per cent of their original values, respectively. The OSI was found to provide high sensitivity and specificity values, when healthy and caratactous eyes were considered. The results suggest that optical deficits are compensated until 50 years of age with sensory and perceptual factors, as smaller changes were found for visual function than for objective measurements of optical quality and intraocular scattering.
CONCLUSIONS: Measures of optical quality assessed by subjective psychophysical and objective techniques varied differently with age. Values obtained for each age group can be used to determine normal limits of optical quality and intraocular scattering for diagnosis of ocular conditions.

PMID: 27452417 [PubMed - indexed for MEDLINE]




Analysis of the causes of surgery-related medical disputes in Taiwan: Need for acute care surgeons to improve quality of care.
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Analysis of the causes of surgery-related medical disputes in Taiwan: Need for acute care surgeons to improve quality of care.

J Chin Med Assoc. 2016 Nov;79(11):609-613

Authors: Hu YH, Wang CY, Huang MS, Lee CH, Wen YS

Abstract
BACKGROUND: This study investigated surgery-related medical disputes and analyzed disease etiologies and the main causes of disputes in order to identify key points for the purpose of improving the quality of surgical patient care in Taiwan.
METHODS: Reports on all surgery-related cases appraised by the Taiwan Witness Examiner Committee of the Department of Health between 2004 and 2008 were reviewed retrospectively by three senior physicians from the emergency department who specialize in both trauma and emergency general surgery. The causes of the various medical disputes were categorized under the following descriptions: operation- or procedure-related complication, anesthesia complication, inappropriate management or decision, delayed diagnosis or misdiagnosis, and unsatisfactory result.
RESULTS: A total of 154 cases were reviewed, of which 39 were trauma-related and 115 were disease-related. The two leading causes of disputes in this review were found to be operation- or procedure-related complications (35.7%) and unsatisfactory results (31.8%), followed by delayed diagnoses or misdiagnoses, inappropriate management, and anesthesia complications. Among these, 74 cases (48.1%) required the care of an acute care surgeon and 40 cases (26.0%) required emergency general surgery intervention.
CONCLUSION: Surgery- or procedure-related complications and unsatisfactory treatment results constituted the major causes of medical disputes in Taiwan. The majority of these cases involved acute care surgery; thus, the establishment of an acute care surgery system should be considered to improve patient care. The management of hemorrhagic shock and incarcerated hernia should be reinforced in future medical training.

PMID: 27580513 [PubMed - indexed for MEDLINE]




The Influence of Voice Sample Length in the Auditory-Perceptual Judgment of Overall Voice Quality.
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The Influence of Voice Sample Length in the Auditory-Perceptual Judgment of Overall Voice Quality.

J Voice. 2017 Mar;31(2):202-210

Authors: Barsties B, Maryn Y

Abstract
OBJECTIVES: The aim of this study was to explore the influence of voice sample lengths (VSLs) on the perceived degree of severity of overall voice quality. To increase a valid judgment in voice quality, a consistent rating is essential to estimate the presence and degree of severity of a voice.
METHODS: Three VSLs were defined by varying only the length of continuous speech followed by constant duration of 3 seconds of the mid-vowel portion sustained vowel [a:]. VSL-1 contained 17 syllables as is used for the Acoustic Voice Quality Index by Maryn et al (2010). VSL-2 consisted of a customized length (ie, with a mean number of 35.5 syllables of the original text, which corresponds to 3 seconds of only-voiced segments in continuous speech). VSL-3 had 93 syllables, which represent a complete phonetically balanced text. An expert panel of five judges rated 100 voice samples with various degrees of hoarseness. In total, three sessions were achieved judging one VSL variant in one session of the 100 voice samples.
RESULTS: The results showed significant differences of auditory-perceptual judgment between VSL-1 and VSL-2 (U = -4.985, P = 0.000), and between VSL-1 and VSL-3 (U = -5.642, P = 0.000). However, judgments of VSL-2 and VSL-3 did not differ significantly (U = -1.785, P = 0.074).
CONCLUSION: Based on these results, it can be concluded that the judgment of VSL-2 is comparable with the judgment of VSL-3. Therefore, speech material for clinical judgment can be reduced to VSL-2 for rating overall voice quality.

PMID: 27539001 [PubMed - indexed for MEDLINE]




Analysis of Temporal Change in Voice Quality After Thyroidectomy: Single-institution Prospective Study.
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Analysis of Temporal Change in Voice Quality After Thyroidectomy: Single-institution Prospective Study.

J Voice. 2017 Mar;31(2):195-201

Authors: Lee DY, Lee KJ, Hwang SM, Oh KH, Cho JG, Baek SK, Kwon SY, Woo JS, Jung KY

Abstract
OBJECTIVES: This study analyzed the temporal changes of voice quality after thyroidectomy and assessed the predictive perioperative parameters of postthyroidectomy voice disorder (PTVD).
STUDY DESIGN: This is a prospective cohort study.
METHODS: From March 2011 to July 2014, 559 patients who underwent thyroidectomy with or without central neck dissection were prospectively enrolled. All patients underwent prospective voice evaluation using the subjective and objective comprehensive battery of assessments, preoperatively and postoperatively at 1 week, 1 month, 3 months, 6 months, and 12 months.
RESULTS: Fundamental frequency (F0) was not significantly decreased during the postoperative follow-up. Maximal vocal pitch (MVP) and maximal intensity were not recovered, even at 1 year postoperatively, whereas the Grade, Roughness, Breathiness, Asthenia, Strain scale reached preoperative value at postoperative 3-6 months and voice handicap index at 1 year. Postoperative 1-month MVP was the best predictor for PTVD, and the cut-off value was 80% of preoperative value. Wide surgical extent and high preoperative F0 were the parameters that significantly correlated with PTVD (P = 0.021 and P < 0.001, respectively), and large tumor, higher preoperative MVP, and lower postoperative 1-month F0 were significantly associated with permanent PTVD (P = 0.028, P < 0.001, and P = 0.003, respectively).
CONCLUSIONS: Different recovery patterns of voice parameters should be considered in preoperative counseling. Intensive voice therapy may be needed for patients with the ability to produce higher pitch than normal preoperatively and wide surgical extent.

PMID: 27236862 [PubMed - indexed for MEDLINE]




Subjective Sleep Quality Deteriorates Before Development of Painful Temporomandibular Disorder.
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Subjective Sleep Quality Deteriorates Before Development of Painful Temporomandibular Disorder.

J Pain. 2016 Jun;17(6):669-77

Authors: Sanders AE, Akinkugbe AA, Bair E, Fillingim RB, Greenspan JD, Ohrbach R, Dubner R, Maixner W, Slade GD

Abstract
UNLABELLED: There is good evidence that poor sleep quality increases risk of painful temporomandibular disorder (TMD). However, little is known about the course of sleep quality in the months preceding TMD onset, and whether the relationship is mediated by heightened sensitivity to pain. The Pittsburgh Sleep Quality Index was administered at enrollment into the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) prospective cohort study. Thereafter the Sleep Quality Numeric Rating Scale was administered every 3 months to 2,453 participants. Sensitivity to experimental pressure pain and pinprick pain stimuli was measured at baseline and repeated during follow-up of incident TMD cases (n = 220) and matched TMD-free controls (n = 193). Subjective sleep quality deteriorated progressively, but only in those who subsequently developed TMD. A Cox proportional hazards model showed that risk of TMD was greater among participants whose sleep quality worsened during follow-up (adjusted hazard ratio = 1.73, 95% confidence limits = 1.29, 2.32). This association was independent of baseline measures of sleep quality, psychological stress, somatic awareness, comorbid conditions, nonpain facial symptoms, and demographic characteristics. Poor baseline sleep quality was not significantly associated with baseline pain sensitivity or with subsequent change in pain sensitivity. Furthermore the relationship between sleep quality and TMD incidence was not mediated via baseline pain sensitivity or change in pain sensitivity.
PERSPECTIVE: Subjective sleep quality deteriorates progressively before the onset of painful TMD, but sensitivity to experimental pain does not mediate this relationship. Furthermore, the relationship is independent of potential confounders such as psychological stress, somatic awareness, comorbid conditions, nonpain facial symptoms, and various demographic factors.

PMID: 26902644 [PubMed - indexed for MEDLINE]




Comparison of quality of sleep, depression, and life satisfaction between older adults in nursing homes and long-term care hospitals in Korea.
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Comparison of quality of sleep, depression, and life satisfaction between older adults in nursing homes and long-term care hospitals in Korea.

Geriatr Gerontol Int. 2017 Jan;17(1):142-149

Authors: Kim KH, Hwang EH

Abstract
AIM: The purpose of the present study was to identify the sleep quality, depression, and life satisfaction between nursing home and long-term care hospital residents.
METHODS: Data was collected through a structured questionnaire survey of 61 nursing home residents and 74 long-term care hospital residents. Descriptive statistics, t-test, χ(2) -test, anova, Pearson's correlation were used to analyze the data.
RESULTS: The residents living in a nursing home showed higher subjective health status and sleep quality than long-term care hospital residents. Depression did not show a significant difference between them. However, there was a significant difference in depression score by subjective health status. Sleep quality and depression showed a significant negative correlation for both residents. In terms of depression and life satisfaction, nursing home residents showed a significant negative correlation, and long-term care hospital residents showed a significant positive correlation.
CONCLUSIONS: These results show that environmental management is essential to enhance sleep quality, thus depression and subjective health status will be improved. Geriatr Gerontol Int 2017; 17: 142-149.

PMID: 26534829 [PubMed - indexed for MEDLINE]