Articles: outcome-assessment-health-care.
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Multicenter Study
Clinical outcome of the metal-on-metal hybrid Corin Cormet 2000 hip resurfacing system: an up to 11-year follow-up study.
This report extends the follow-up for the largest center of the first multicenter US Food and Drug Administration investigational device exemption study on metal-on-metal hip resurfacing arthroplasty up to 11 years. A single surgeon performed 373 hip resurfacing arthroplasties using the hybrid Corin Cormet 2000 system. The Kaplan-Meier survivorship at 11 years was 93% when revision for any reason was used as an end point and 91% if radiographic failures were included. ⋯ Loosening of the cemented femoral components was the most common source of failure and occurred at all follow-up intervals. A learning curve that persisted for at least 200 cases was confirmed. All femoral neck fractures occurred before 6 months postoperatively.
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J Pain Symptom Manage · Apr 2012
Multicenter StudyIs oxycodone efficacy reflected in serum concentrations? A multicenter, cross-sectional study in 456 adult cancer patients.
The relationship between oxycodone and metabolite serum concentrations and clinical effects has not previously been investigated in cancer pain patients. ⋯ This study of patients receiving oxycodone for cancer pain confirms previous observations that there is most likely no association between serum concentrations of opioid analgesics and clinical effects.
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Determine the utility of the neurologic examination in comatose patients from nontraumatic causes in the modern era. ⋯ The clinical neurologic examination remains central to determining prognosis in nontraumatic coma. Additional clinical and diagnostic variables may also aid in outcome prediction for specific disease states.
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Comparative Study
Impact of an emergency department closure on the local emergency medical services system.
On July 12, 2010, Boston Medical Center (BMC), the busiest emergency department (ED) in Massachusetts, with more than 100,000 adult patient visits per year, consolidated its two fully functional EDs into one. In preparation for this consolidation, BMC implemented systems changes to mitigate potential negative effects on both BMC and emergency medical services (EMS) providers, including Boston Emergency Medical Services (Boston EMS), the provider of 9-1-1 EMS to the City of Boston. ⋯ The closure of one ED resulted in a statistically significant increase in turnaround intervals and a significant decrease in ED volume independent of EMS volumes. In the absence of ambulance diversion, ratios of EMS turnaround intervals and EMS volumes according to hospital destination can be used as alternatives to ambulance diversion times to examine the effects of system-level changes such as closure of an ED on an urban EMS system.
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Comparative Study
Mortality after elective colon resection: the search for outcomes that define quality in surgical practice.
Process measures constitute the focal point of surgical quality studies. High levels of compliance with such processes have not correlated with improved outcomes. Wide ranges of reported hospital death rates led us to hypothesize that survival after elective colon resection would be a legitimate outcomes measure for quality of surgical practice. ⋯ Elective colon resection is a safe procedure in both teaching hospitals and nonteaching hospitals, with an impressively homogenous mean mortality rate of 1.56% in teaching hospitals, and 1.38% in nonteaching hospitals. We reject our original hypothesis because the data do not sufficiently discriminate to permit the use of death after elective colon resection as a differentiating quality measure; however, the data do identify individual poor performers. Poor performing institutions/surgeons should seek extramural guidance to improve their outcomes or discontinue performing such operations.