Articles: outcome-assessment-health-care.
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Comparative Study
Comparison of the effectiveness of major trauma services provided by tertiary and secondary hospitals in malaysia.
The effectiveness of trauma services provided by three hospitals operating at different levels of care, district general (DGH), tertiary care, and central tertiary, were compared in Malaysia. ⋯ In this study in Malaysia, admission to DGH, older age, and severe injuries are associated with increased odds of fatality.
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Comparative Study
Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale.
The modified Rankin Scale is widely used to assess changes in activity and lifestyle after stroke, but it has been criticized for its subjectivity. The purpose of the present study was to compare conventional assessment on the modified Rankin Scale with assessment through a structured interview. ⋯ Variability and bias between raters in assigning patients to Rankin grades may be reduced by use of a structured interview. Use of a structured interview for the scale could potentially improve the quality of results from clinical studies in stroke.
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Comparative Study
Analysis of medical risk factors and outcomes in patients undergoing open versus endovascular abdominal aortic aneurysm repair.
The emergence of endovascular repair (ER) for infrarenal abdominal aortic aneurysm (AAA) has provided surgeons with a new technique that should ideally improve patient outcomes. To more accurately characterize the advantages of ER versus traditional/open AAA repair (TOR), we compared the preoperative medical risk factors (PMRFs) and perioperative outcomes (PO) of those patients undergoing elective treatment of infrarenal AAA with ER and TOR over a recent 18-month period at our center. ⋯ These results suggest that ER offers improvements in hospital convalescent and operating room times but no beneficial impact on overall morbidity and mortality rates when similar PMRFs exist, especially when used at medical centers where low morbidity and mortality rates are already established for TOR. Other centers performing ER should undertake such an analysis to assess its impact on their patients.
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Recent data suggest that sex hormones may play a role in regulating posttraumatic immunosuppression, leading to gender-based differences in outcome after injuries. This study examined gender-related outcomes in trauma patients. ⋯ Although the incidence of pneumonia was not influenced by gender, female trauma patients had better outcomes than male patients in the younger age group. Outcome in the older age group was not gender-related. Our data support a gender-based difference in outcome after traumatic injuries in younger patients.
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Blunt vascular neck injuries (BVNIs) are rare, often occult, and potentially devastating injuries. The purpose of this study was to identify a high-risk group, which would benefit from screening. ⋯ Screening should be undertaken for patients at increased risk for BVNI: those with risk factors identified in our regression analysis and factors previously reported.