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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



 



Initiation of a Transanal Total Mesorectal Excision Program at an Academic Training Program: Evaluating Patient Safety and Quality Outcomes.
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Initiation of a Transanal Total Mesorectal Excision Program at an Academic Training Program: Evaluating Patient Safety and Quality Outcomes.

Dis Colon Rectum. 2017 Dec;60(12):1267-1272

Authors: Maykel JA, Phatak UR, Suwanabol PA, Schlussel AT, Davids JS, Sturrock PR, Alavi K

Abstract
BACKGROUND: Short-term results have shown that transanal total mesorectal excision is safe and effective for patients with mid to low rectal cancers. Transanal total mesorectal excision is considered technically challenging; thus, adoption has been limited to a few academic centers in the United States.
OBJECTIVE: The aim of this study is to describe outcomes after the initiation of a transanal total mesorectal excision program in the setting of an academic colorectal training program.
DESIGN: This is a single-center retrospective review of consecutive patients who underwent transanal total mesorectal excision from December 2014 to August 2016.
SETTING: This study was conducted at an academic center with a colorectal residency program.
PATIENTS: Patients with benign and malignant diseases were selected.
INTERVENTION: All transanal total mesorectal excisions were performed with abdominal and perineal teams working simultaneously.
OUTCOME MEASURES: The primary outcomes measured were pathologic quality, length of hospital stay, 30-day morbidity, and 30-day mortality.
RESULTS: There were 40 patients (24 male). The median age was 55 years (interquartile range, 46.7-63.4) with a median BMI of 29 kg/m (interquartile range, 24.6-32.4). The primary indication was cancer (n = 30), and tumor height from the anal verge ranged from 0.5 to 15 cm. Eighty percent (n = 24) of the patients who had rectal cancer received preoperative chemoradiation. The most common procedures were low anterior resection (67.5%), total proctocolectomy (15%), and abdominoperineal resection (12.5%). Median operative time was 380 minutes (interquartile range, 306-454.4), with no change over time. For patients with malignancy, the mesorectum was complete or nearly complete in 100% of the specimens. A median of 14 lymph nodes (interquartile range, 12-17) were harvested, and 100% of the rectal cancer specimens achieved R0 status. Median length of stay was 4.5 days (interquartile range, 4-7), and there were 6 readmissions (15%). There were no deaths or intraoperative complications.
LIMITATIONS: This study's limitations derive from its retrospective nature and single-center location.
CONCLUSIONS: A transanal total mesorectal excision program can be safely implemented in a major academic medical center. Quality outcomes and patient safety depend on a comprehensive training program and a coordinated team approach. See Video Abstract at http://links.lww.com/DCR/A448.

PMID: 29112562 [PubMed - indexed for MEDLINE]




Integrating HIV Surveillance and Field Services: Data Quality and Care Continuum in King County, Washington, 2010-2015.
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Integrating HIV Surveillance and Field Services: Data Quality and Care Continuum in King County, Washington, 2010-2015.

Am J Public Health. 2017 Dec;107(12):1938-1943

Authors: Hood JE, Katz DA, Bennett AB, Buskin SE, Dombrowski JC, Hawes SE, Golden MR

Abstract
OBJECTIVES: To assess how integration of HIV surveillance and field services might influence surveillance data and linkage to care metrics.
METHODS: We used HIV surveillance and field services data from King County, Washington, to assess potential impact of misclassification of prior diagnoses on numbers of new diagnoses. The relationship between partner services and linkage to care was evaluated with multivariable log-binomial regression models.
RESULTS: Of the 2842 people who entered the King County HIV Surveillance System in 2010 to 2015, 52% were newly diagnosed, 41% had a confirmed prior diagnosis in another state, and 7% had an unconfirmed prior diagnosis. Twelve percent of those classified as newly diagnosed for purposes of national HIV surveillance self-reported a prior HIV diagnosis that was unconfirmed. Partner services recipients were more likely than nonrecipients to link to care within 30 days (adjusted risk ratio [RR] = 1.10; 95% confidence interval [CI] = 1.03, 1.18) and 90 days (adjusted RR = 1.07; 95% CI = 1.01, 1.14) of diagnosis.
CONCLUSIONS: Integration of HIV surveillance, partner services, and care linkage efforts may improve the accuracy of HIV surveillance data and facilitate timely linkage to care.

PMID: 29048962 [PubMed - indexed for MEDLINE]




Version Correction via Eccentric Reaming Compromises Remaining Bone Quality in B2 Glenoids: A Computational Study.
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Version Correction via Eccentric Reaming Compromises Remaining Bone Quality in B2 Glenoids: A Computational Study.

Clin Orthop Relat Res. 2017 Dec;475(12):3090-3099

Authors: Chen X, Reddy AS, Kontaxis A, Choi DS, Wright T, Dines DM, Warren RF, Berhouet J, Gulotta LV

Abstract
BACKGROUND: Version correction via eccentric reaming reduces clinically important retroversion in Walch type B2 glenoids (those with substantial glenoid retroversion and a second, sclerotic neoglenoid cavity) before total shoulder arthroplasty (TSA). Clinically, an increased risk of glenoid component loosening in B2 glenoids was hypothesized to be the result of compromised glenoid bone quality attributable to eccentric reaming. However, no established guidelines exist regarding how much version correction can be applied without compromising the quality of glenoid bone.
QUESTIONS/PURPOSES: (1) How does version correction correlate to the reaming depth and the volume of resected bone during eccentric reaming of B2 glenoids? (2) How does version correction affect the density of the remaining glenoid bone? (3) How does version correction affect the spatial distribution of high-quality bone in the remaining glenoid?
METHODS: CT scans of 25 patients identified with Walch type B2 glenoids (age, 68 ± 9 years; 14 males, 11 females) were selected from a cohort of 111 patients (age, 69 ± 10 years; 50 males, 61 females) with primary shoulder osteoarthritis who underwent TSA. Virtual TSA with version corrections of 0°, 5°, 10°, and 15° was performed on 25 CT-reconstructed three-dimensional models of B2 scapulae. After simulated eccentric reaming at each version correction angle, bone density (Hounsfield units [HUs]) was analyzed in five adjacent 1-mm layers under the reamed glenoid surface. Remaining high-quality bone (> 650 HUs) distribution in each 1-mm layer at different version corrections was observed on spatial distribution maps.
RESULTS: Larger version corrections required more bone resection, especially from the anterior glenoid. Mean bone densities in the first 1-mm bone bed under the reamed surface were lower with 10° (523.3 ± 79.9 HUs) and 15° (479.5 ± 81.0 HUs) version corrections relative to 0° (0°, 609.0 ± 103.9 HUs; mean difference between 0° and 15°, 129.5 HUs [95% CI, 46.3-212.8 HUs], p < 0.001; mean difference between 0° and 10°, 85.7 HUs [95% CI, 8.6-162.9 HUs], p = 0.021) version correction. Similar results were observed for the second 1-mm bone bed. Spatial distribution maps qualitatively showed a decreased frequency of high-quality bone in the anterior glenoid as version correction increased.
CONCLUSIONS: A version correction as low as 10° was shown to reduce the density of the glenoid bone bed for TSA glenoid fixation in our computational study that simulated reaming on CT-reconstructed B2 glenoid models. Increased version correction resulted in gradual depletion of high-quality bone from the anterior region of B2 glenoids.
CLINICAL RELEVANCE: This computational study of eccentric reaming of the glenoid before TSA quantitatively showed glenoid bone quality is sensitive to version correction via simulated eccentric reaming. The bone density results of our study may benefit surgeons to better plan TSA on B2 glenoids needing durable bone support, and help to clarify goals for development of precision surgical tools.

PMID: 28948516 [PubMed - indexed for MEDLINE]




The effects of a common stainless steel orthodontic bracket on the diagnostic quality of cranial and cervical 3T- MR images: a prospective, case-control study.
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The effects of a common stainless steel orthodontic bracket on the diagnostic quality of cranial and cervical 3T- MR images: a prospective, case-control study.

Dentomaxillofac Radiol. 2017 Aug;46(6):20170051

Authors: Cassetta M, Pranno N, Stasolla A, Orsogna N, Fierro D, Cavallini C, Cantisani V

Abstract
OBJECTIVES: To evaluate the effect of orthodontic stainless steel brackets and two different types of archwires on the diagnostic quality of 3-T MR images.
METHODS: This prospective, case-control study was conducted following Strengthening the Reporting of Observational Studies in Epidemiology guidelines. The recruitment was conducted among orthodontic patients. 80 subjects, requiring MRI for the presence of temporomandibular disorders, were enrolled and divided into four groups: 20 patients using aligners (control group); 20 patients with stainless steel brackets without archwires; 20 patients with stainless steel brackets and nickel-titanium archwires; and 20 patients with stainless steel brackets and stainless steel archwires. Two experts in neuroradiology evaluated the images to determine the amount of distortion in 6 regions and 48 districts. A score was subjectively assigned according to a modified receiver operating characteristic method of distortion classification. Any disagreement was resolved through consensus seeking; when this was not possible, a third neuroradiologist was consulted. The following statistical methods were used: descriptive statistics, Cohen's kappa coefficient (k), Kruskal-Wallis test, pairwise comparisons using the Dunn-Bonferroni approach. The significance was set at p ≤ 0.05.
RESULTS: The presence of stainless steel brackets with or without archwires negatively influenced MRI of the cervical region, paranasal sinuses, head and neck region, and cervical vertebrae but did not influence MRI of brain and temporomandibular joint regions.
CONCLUSIONS: Patients with a stainless steel multibracket orthodontic appliance should remove it before cervical vertebrae, cervical region, paranasal sinuses, and head and neck MRI scans. The brain and temporomandibular joint region MRI should not require the removal of such appliances.

PMID: 28452576 [PubMed - indexed for MEDLINE]




The Effects of Training Institution Practice Costs, Quality, and Other Characteristics on Future Practice.
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The Effects of Training Institution Practice Costs, Quality, and Other Characteristics on Future Practice.

Ann Fam Med. 2017 Mar;15(2):140-148

Authors: Phillips RL, Petterson SM, Bazemore AW, Wingrove P, Puffer JC

Abstract
PURPOSE: Medicare beneficiary spending patterns reflect those of the 306 Hospital Referral Regions where physicians train, but whether this holds true for smaller areas or for quality is uncertain. This study assesses whether cost and quality imprinting can be detected within the 3,436 Hospital Service Areas (HSAs), 82.4 percent of which have only 1 teaching hospital, and whether sponsoring institution characteristics are associated.
METHODS: We conducted a secondary, multi-level, multivariable analysis of 2011 Medicare claims and American Medical Association Masterfile data for a random, nationally representative sample of family physicians and general internists who completed residency between 1992 and 2010 and had more than 40 Medicare patients (3,075 physicians providing care to 503,109 beneficiaries). Practice and training locations were matched with Dartmouth Atlas HSAs and categorized into low-, average-, and high-cost spending groups. Practice and training HSAs were assessed for differences in 4 diabetes quality measures. Institutional characteristics included training volume and percentage of graduates in rural practice and primary care.
RESULTS: The unadjusted, annual, per-beneficiary spending difference between physicians trained in high- and low-cost HSAs was $1,644 (95% CI, $1,253-$2,034), and the difference remained significant after controlling for patient and physician characteristics. No significant relationship was found for diabetes quality measures. General internists were significantly more likely than family physicians to train in high-cost HSAs. Institutions with more graduates in rural practice and primary care produced lower-spending physicians.
CONCLUSIONS: The "imprint" of training spending patterns on physicians is strong and enduring, without discernible quality effects, and, along with identified institutional features, supports measures and policy options for improved graduate medical education outcomes.

PMID: 28289113 [PubMed - indexed for MEDLINE]




Psychometric Validation of a Brief Self-report Measure of Diet Quality: The DASH-Q.
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Psychometric Validation of a Brief Self-report Measure of Diet Quality: The DASH-Q.

J Nutr Educ Behav. 2017 Feb;49(2):92-99.e1

Authors: Warren-Findlow J, Reeve CL, Racine EF

Abstract
OBJECTIVE: The Dietary Approaches to Stop Hypertension (DASH) diet is recommended for primary and secondary prevention of cardiovascular chronic diseases. This study describes the development, internal consistency, and validation (predictive and convergent) of a population-based, self-report measure (the DASH Quality [DASH-Q]) to assess adherence to the DASH diet among adults.
DESIGN: Cross-sectional online surveys to evaluate the psychometric properties of the DASH-Q.
PARTICIPANTS: US adults consisting of a national sample (n = 407) and a Southern university sample (n = 405).
MAIN OUTCOME MEASURES: Diet quality scores.
ANALYSIS: Item and scale psychometric properties were examined using corrected item total correlations and principal component analysis. The authors validated the DASH-Q by examining associations with an existing self-report nutrition scale and other nutrition-related behaviors.
RESULTS: The DASH-Q yielded acceptable internal consistency (α = .77-.83) in both samples. The DASH-Q scores correlated moderately to strongly with all nutrition-related criteria (P < .01), suggesting evidence of predictive and convergent validity. Less than 15% of either sample reported high diet quality.
CONCLUSIONS AND IMPLICATIONS: The DASH-Q had sufficient psychometric robustness for use as a population-based measure. The DASH-Q is recommended as an easily used measure of DASH adherence for populations that need to modify their diet to manage chronic illness.

PMID: 27818038 [PubMed - indexed for MEDLINE]




A Longitudinal Study of Predictors of Housing Stability, Housing Quality, and Mental Health Functioning Among Single Homeless Individuals Staying in Emergency Shelters.
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A Longitudinal Study of Predictors of Housing Stability, Housing Quality, and Mental Health Functioning Among Single Homeless Individuals Staying in Emergency Shelters.

Am J Community Psychol. 2016 Sep;58(1-2):123-35

Authors: Aubry T, Duhoux A, Klodawsky F, Ecker J, Hay E

Abstract
The current study examined risk and resilience factors at multiple levels that affect homeless individuals' ability to exit homelessness and achieve housing stability. It also examined the relationship between housing status, housing quality and mental health functioning. The methodology is a longitudinal study of single homeless individuals staying in emergency shelters in a medium-sized Canadian city who were followed for a 2 year period. Data were collected from participants at a baseline interview when they were homeless and at a 2-year follow-up. There were 329 participants interviewed at baseline and 197 (59.9%) participants interviewed at follow-up. Results from a structural equation modelling analysis found that having interpersonal and community resources were predictive of achieving housing stability. Specifically, having a larger social support network, access to subsidized housing, and greater income was related to achieving housing stability. On the other hand, having a substance use problem was a risk factor associated with a failure to achieving housing stability. Being female, feeling personally empowered, having housing that is perceived of being of higher quality were directly predictive of mental health functioning at follow-up. Findings are discussed in the context of previous research and their policy implications.

PMID: 27473922 [PubMed - indexed for MEDLINE]




Assessing the Nutrition Literacy of Parents and Its Relationship With Child Diet Quality.
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Assessing the Nutrition Literacy of Parents and Its Relationship With Child Diet Quality.

J Nutr Educ Behav. 2016 Jul-Aug;48(7):505-509.e1

Authors: Gibbs HD, Kennett AR, Kerling EH, Yu Q, Gajewski B, Ptomey LT, Sullivan DK

Abstract
OBJECTIVE: To estimate the reliability and validity of the Nutrition Literacy Assessment Instrument for Parents (NLit-P) and to investigate relationships among parental nutrition literacy, parental and child body mass index, and child diet quality (Healthy Eating Index).
METHODS: Cross-sectional study of 101 parent-child dyads that collected measures of socioeconomic status, nutrition literacy, 2 24-hour child diet recalls, and body mass index. Reliability of NLit-P was assessed by confirmatory factor analysis. Pearson correlation and multiple linear regression were used.
RESULTS: Fair to substantial reliability was seen across 5 NLit-P domains, whereas Pearson correlations support concurrent validity for the NLit-P related to child diet quality and parental income, age, and educational attainment (P < .001). For every 1% increase in NLit-P, there was a 0.51 increase in child Healthy Eating Index (multivariate coefficient, 0.174; P < .001).
CONCLUSIONS AND IMPLICATIONS: The NLit-P demonstrates potential for measuring parental nutrition literacy, which may be an important educational target for improving child diet quality.

PMID: 27216751 [PubMed - indexed for MEDLINE]




Thirty-Day Complications of Conventional and Computer-Assisted Total Knee and Total Hip Arthroplasty: Analysis of 103,855 Patients in the American College of Surgeons National Surgical Quality Improvement Program Database.
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Thirty-Day Complications of Conventional and Computer-Assisted Total Knee and Total Hip Arthroplasty: Analysis of 103,855 Patients in the American College of Surgeons National Surgical Quality Improvement Program Database.

J Arthroplasty. 2016 Aug;31(8):1674-9

Authors: Aoude AA, Aldebeyan SA, Nooh A, Weber MH, Tanzer M

Abstract
BACKGROUND: Computer-assisted surgery (CAS) has gained popularity in orthopedics for both total knee arthroplasty (TKA) and total hip arthroplasty (THA) in the past decades.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent a primary, unilateral THA and TKA from 2011 to 2013. Multivariate analysis was conducted to compare the postoperative complications in patients whose surgery involved the use of CAS with those by conventional techniques.
RESULTS: We identified 103,855 patients who had THA and TKA in the database between 2011 and 2013. There were higher overall adverse events (odds ratio [OR], 1.40; CI, 1.22-1.59), minor events (OR, 1.38; CI, 1.21-1.58), and requirements for blood transfusion (OR, 1.44; CI, 1.25-1.67) in the conventional group when compared with CAS for TKA. However, rate of reoperation was higher in the CAS group for TKA (OR, 1.60; CI, 1.15-2.25). The results also showed higher overall adverse events (OR, 2.61; CI, 2.09-3.26), minor events (OR, 2.82; CI, 2.24-3.42), and requirements for blood transfusion (OR, 3.41; CI, 2.62-4.44) in the conventional group when compared to CAS for THA. Nevertheless, superficial wound infections (OR, 0.46; CI, 0.26-0.81) were shown to be higher in the CAS group undergoing THA.
CONCLUSION: The use of CAS in THA and TKA reduced the number of minor adverse events in the first 30 days postoperatively. However, CAS was associated with an increased number of reoperations and superficial infections. The clinical benefits and disadvantages of CAS should be considered when determining the potential benefit-cost ratio of this technology.

PMID: 26923496 [PubMed - indexed for MEDLINE]