Articles: hospitals.
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Multicenter Study
Does screening for pain correspond to high quality care for veterans?
Routine numeric screening for pain is widely recommended, but its association with overall quality of pain care is unclear. ⋯ Despite routine pain screening in VA, providers seldom documented elements considered important to evaluation and treatment of pain. Improving pain care may require attention to all aspects of pain management, not just screening.
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Internal medicine journal · Sep 2010
Multicenter Study Comparative StudyThe four horsemen: clinicopathological correlation in 407 hospital autopsies.
Few previous papers comparing clinical diagnoses with autopsy findings present sensitivities and positive predictive values for individual conditions. The aim of this study is to determine the sensitivity and positive predictive value of current clinical diagnosis both overall and for individual conditions. ⋯ There exists a large burden of clinically undiagnosed and incorrectly diagnosed disease in hospital. Pneumonia, acute myocardial infarction, bowel ischaemia and pulmonary embolism represent important and difficult diagnostic challenges.
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Multicenter Study Comparative Study
Comparison of abdominal damage control surgery in combat versus civilian trauma.
The majority of individuals who perform damage control surgery in the military arena are trained in civilian venues. Therefore, it is important to compare and contrast damage control performed in civilian and military settings. In contrast to civilian trauma, which is primarily caused by blunt injury and addressed at one or two surgical facilities, combat casualties primarily sustain explosion-related injuries and undergo treatment at multiple levels of care across continents. We aimed to compare patients undergoing abdominal damage control surgery across these two very different settings. ⋯ Military and civilian trauma patients who undergo damage control surgery experience similar fascial closure rates despite differing demographics and widely disparate mechanisms of injury. The MP undergoes a greater number of procedures than the CP, but complication rates do not differ between the groups.
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Otolaryngol Head Neck Surg · Jul 2010
Multicenter StudyPreliminary NSQIP results: a tool for quality improvement.
To utilize National Surgical Quality Improvement Program (NSQIP) data to evaluate patient outcomes in otolaryngology-head and neck surgery. ⋯ NSQIP reports form the basis for quality improvement with targeted interventions in areas of concern that result in changes in patient care processes. The reports are composed of outcomes-based, risk-adjusted data that are submitted by participating hospitals and have recently included data for otolaryngology-head and neck surgery. Actions taken based on NSQIP data demonstrate improvements in patient morbidity and mortality, decreased length of stay, and decreased hospital costs. In a time of increased scrutiny of health care costs and outcomes, NSQIP is an important tool for surgeons to improve quality and decrease costs.
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Randomized Controlled Trial Multicenter Study
Study protocol: home-based telehealth stroke care: a randomized trial for veterans.
Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR) intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement. ⋯ For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and increase efficiency. This may be particularly relevant when patients live in remote locations, as is the case for many veterans.