Articles: outcome-assessment-health-care.
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Comparative Study
Associations between published quality ratings of skilled nursing facilities and outcomes of medicare beneficiaries with heart failure.
Nursing Home Compare quality ratings are designed to allow patients, families, and clinicians to compare facilities based on quality, but associations of the current measures with important clinical outcomes are not known. Our study examined associations between ratings and readmission and mortality among Medicare beneficiaries admitted to a skilled nursing facility with a primary diagnosis of heart failure. ⋯ Publicly reported Nursing Home Compare quality ratings of Medicare-certified skilled nursing facilities were modestly associated with 90-day readmission and mortality among Medicare beneficiaries discharged to these facilities after hospitalization for heart failure.
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Worldviews Evid Based Nurs · Feb 2012
Outcomes and challenges in implementing hourly rounds to reduce falls in orthopedic units.
Patient falls remain a common adverse event in acute care facilities. Findings from research into structured nursing rounds interventions (SNRIs) indicate promise as a fall prevention practice. Translating, adapting, and sustaining SNRI in real world clinical practices is an important next step. ⋯ Findings illuminate the multiple challenges in translational research. SNRI appeared to reduce fall rates initially, but fidelity to the SNRI implementation and documentation was variable and fall reduction gains appeared lost 1 year later. Nurses expressed the importance of balancing intervention fidelity and individualizing patient interventions.
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Anadolu Kardiyol Derg · Feb 2012
Impact of emergency services and ambulance type on pain-to-balloon time in the acute myocardial infarction: an observational study.
The objective of this study was to evaluate the role of first contact emergency departments and ambulances on transport duration, pain-to-balloon time, door-to-balloon time and first contact-to-balloon time in acute myocardial infarction (AMI) patients. ⋯ Physicians and healthcare professionals in first contact emergency departments and ambulance type appear to be factors in the increased pain-to-balloon time. AMI patients are often initially admitted to PCI-incapable centers, leading to delayed admission to PCI-capable centers and increased pain-to-balloon time.
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This article provides the rationale for the approach to making recommendations primarily used in four articles of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines: orthopedic surgery, nonorthopedic surgery, nonsurgical patients, and stroke. Some of the early clinical trials of antithrombotic prophylaxis with a placebo or no treatment group used symptomatic VTE and fatal PE to measure efficacy of the treatment. These trials suggest a benefit of thromboprophylaxis in reducing fatal PE. ⋯ In this article, we review the merits and limitations of four approaches to estimating reduction in symptomatic thrombosis: (1) direct measurement of symptomatic thrombosis, (2) use of asymptomatic events for relative risks and symptomatic events from randomized controlled trials for baseline risk, (3) use of baseline risk estimates from studies that did not perform surveillance and relative effect from asymptomatic events in randomized controlled trials, and (4) use of available data to estimate the proportion of asymptomatic events that will become symptomatic. All approaches have their limitations. The optimal choice of approach depends on the nature of the evidence available.
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Since its introduction in 1994, autologous chondrocyte implantation (ACI) has become an established surgical treatment for symptomatic isolated cartilage defects of the knee. Success rates vary between 80 and 95% and the clinical outcome seems to depend on various individual factors. The aim of the present review article is to summarise factors that affect clinical outcome following ACI for treatment of symptomatic cartilage defects of the knee based upon the scientific literature available on this topic. ⋯ Knowledge of all relevant parameters that influence clinical outcome following ACI is essential in order to achieve an optimal clinical outcome in patients with cartilage defects of the knee. This paper presents a review of the scientific literature available which focuses on the questions as to what parameters influence the outcome of a patient following ACI for treatment of cartilage defects of the knee. No isolated factors could be identified that influence the outcome following ACI alone, but it seems that clinical outcome is influenced by many different parameters. These parameters should be considered carefully, at the time of decision about what kind of treatment is applied. Furthermore, the patient should be informed especially about those parameters which can be influenced by him-/herself in order to create good prerequisites for the surgical treatment.