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Background Thrombectomy‐Capable Stroke Center (TSC) certification was created to improve timely access to mechanical thrombectomy (MT), where travel to a Comprehensive Stroke Center (CSC) would entail prolonged transport time. No study... more
Background Thrombectomy‐Capable Stroke Center (TSC) certification was created to improve timely access to mechanical thrombectomy (MT), where travel to a Comprehensive Stroke Center (CSC) would entail prolonged transport time. No study has evaluated the quality of MT and stroke care at TSCs compared with CSCs. Methods We compared performance for 3 MT measures for all TSCs and CSCs certified by The Joint Commission in 2019 and 2020: (1) time from arrival to skin puncture, (2) the percentage of patients who achieved Thrombolysis in Cerebral Infarction ≥2B perfusion, and (3) the proportion of patients with symptomatic hemorrhagic transformation following MT. Wilcoxon ranked‐sum tests and signed‐rank tests were used to compare TSCs and CSCs within years and changes in performance from 2019 to 2020. Results The median time from arrival to skin puncture was 75.8 minutes for CSCs compared with 106.1 minutes for TSCs in 2019 ( P <0.001) and 74.8 minutes for CSCs compared with 91.7 minutes for TSCs in 2020 ( P <0.001). For TSCs, the median time was 11.2 minutes lower in 2020 compared with 2019 ( P <0.005). There were no differences in the median proportion of patients who had Thrombolysis in Cerebral Infarction ≥ ${\text{Thrombolysis in Cerebral Infarction}} \ge $ 2b perfusion achieved for CSCs compared with TSCs in 2019 (85.2% versus 84.3%, respectively; P =0.87) or 2020 (86.9% versus 88.6%, respectively; P =0.73). Rates of symptomatic hemorrhagic complications were similar. Conclusions Times from arrival to skin puncture were longer at TSCs compared with CSCs, although this difference narrowed significantly in 2020. This improvement and the similar rates of successful MT and complications at TSCs and CSCs support current recommendations to transport patients with suspected large‐vessel occlusion to a TSC if a CSC is >30 minutes longer transport time. However, routing decisions for suspected large‐vessel occlusion must be made at a local level based on the performance data for TSCs and CSCs.
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As the initial step in examining the metabolic basis for acetate intolerance, we have tested the hypothesis that excessive adenosine triphosphate (ATP) degradation occurs during hemodialysis against acetate dialysate (compared with the... more
As the initial step in examining the metabolic basis for acetate intolerance, we have tested the hypothesis that excessive adenosine triphosphate (ATP) degradation occurs during hemodialysis against acetate dialysate (compared with the degree of degradation occurring during dialysis against bicarbonate dialysate). Seven patients undergoing long-term dialysis were infused with carbon 14--labeled 8-adenine, and their response to dialysis against acetate was compared with their response to dialysis against bicarbonate. The following changes were observed. During dialysis against acetate, the mean dialysate uric acid--to-creatinine ratio levels were significantly higher than the mean levels observed after dialysis against bicarbonate (p less than 0.001). The mean dialysate uric acid radioactivity--to-creatinine ratio and inosine, hypoxanthine, and xanthine radioactivity--to-creatinine ratio levels were significantly increased during dialysis against acetate (p less than 0.001). There was no significant change in plasma venous hypoxanthine level, but during dialysis against acetate, the arterial hypoxanthine levels (3.7 +/- 1.6 mumol/L) at 60 minutes were significantly higher than the levels observed after dialysis against bicarbonate (1.4 +/- 0.5 mumol/L) (p less than 0.01). These data provide evidence that excessive ATP degradation occurs during hemodialysis against acetate but not during hemodialysis against bicarbonate dialysate.
Research Interests: Chemistry, Dialysis, Medicine, Humans, Internal Medicine, and 15 moreFemale, Pubmed, Hemodialysis, Male, Clinical Sciences, Aged, Middle Aged, Uric Acid, Copper Acetates, Clinical Biochemistry & Clinical Laboratory Medicine, Bicarbonate, Creatinine, Renal Dialysis, Adenosine Triphosphate, and Bicarbonates
A radiotelemetric technique for monitoring canine gastrointestinal function with clinical and research applications is described. Continuous gastrointestinal pH profiles for base-line (fasted) and postprandial states were recorded for a... more
A radiotelemetric technique for monitoring canine gastrointestinal function with clinical and research applications is described. Continuous gastrointestinal pH profiles for base-line (fasted) and postprandial states were recorded for a 6-hour test period in 4 Beagles, using a radiotelemetric device (Heidelberg capsule). Base-line gastric pH values were between 0.9 and 2.5 during the first 30 minutes, with a mean +/- SEM of 1.5 +/- 0.04. Postprandial gastric pH values varied between 0.5 and 3.5 during the first 30 minutes, with a mean of 2.1 +/- 0.04. Base-line duodenal pH values during the initial 5 minutes after gastric emptying varied from 4.5 to 7.5 with a mean of 6.1 +/- 0.1, and for the initial 60-minute post-gastric emptying, pH ranged from 4.5 to greater than 8.0 (beyond capsule calibration limit) with a mean of 6.7 +/- 0.05. The pH tended to increase linearly with time during the initial 60 minutes in the intestine. Mean gastric residence time of the capsule was 74 +/- 26.5 minutes in the fasted state (range 0 to 240 minutes). Postprandially, the capsule remained in the stomach for the duration of the 6-hour observation period.
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Research Interests: Electrophysiology, Medicine, Humans, Epinephrine, Female, and 13 moreMale, Anesthesia, Recurrence, Clinical Sciences, Middle Aged, Public health systems and services research, Time Factors, Circulation, Verapamil, Atenolol, supraventricular tachycardia, Stress Physiological, and Cardiovascular medicine and haematology
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This was a descriptive replication study comparing 2083 home health agencies accredited by The Joint Commission (TJC) and 8695 non-TJC-accredited home health agencies over a 3-year period using the Centers for Medicare and Medicaid... more
This was a descriptive replication study comparing 2083 home health agencies accredited by The Joint Commission (TJC) and 8695 non-TJC-accredited home health agencies over a 3-year period using the Centers for Medicare and Medicaid Services Home Health Compare data set. Metrics included the star ratings and 17 quality measures. A longitudinal model was used to determine differences between TJC-accredited and non-TJC-accredited organizations on the quality measures. Categorical differences in star ratings were analyzed using a Cochran-Mantel-Haenszel test. TJC-accredited home health agencies had better average ratings than non-TJC-accredited home health agencies for each of the 3 years (3.4 vs 3.2, p < .001). When categories were collapsed to evaluate differences, the analysis revealed that a significantly larger proportion of TJC-accredited facilities were clustered within the higher ratings (41% for TJC-accredited vs 32% for non-TJC-accredited), and fewer TJC-accredited organizations were clustered within the lower ratings (22% for TJC-accredited vs 30% for non-TJC-accredited; p < .001). Two claims-based outcome measures (hospitalization and emergency room visits) were consistent with the original study in which TJC-accredited home health organizations had statistically significant lower rates across all 3 years studied, compared to non-TJC-accredited HHAs. This replication study validates and extends the generalizability of the findings from the original study.
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We administered the Bear-Fedio inventory to normal controls and to patients with epilepsy, chronic pain, and psychiatric disorders. The trait scores showed progressive increase with the severity of psychiatric symptoms. There were no... more
We administered the Bear-Fedio inventory to normal controls and to patients with epilepsy, chronic pain, and psychiatric disorders. The trait scores showed progressive increase with the severity of psychiatric symptoms. There were no statistically significant differences between epileptic patients with diffuse spike wave discharges and those with focal temporal EEG abnormalities. Also, there were no significant differences in patients with left versus right temporal foci. The inventory is markedly influenced by intellectual factors and, to some extent, by gender and anticonvulsant drug levels, especially those of carbamazepine. The test in its current form measures overall psychopathology rather than a specific syndrome.
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Research Interests: Cardiology, Electrophysiology, Medicine, Prospective studies, Humans, and 15 moreInternal Medicine, Female, Male, Clinical Sciences, Middle Aged, Coronary heart disease, Public health systems and services research, Time Factors, Circulation, Coronary Artery Disease, Sensitivity and Specificity, Ventricular Tachycardia, Ventricular Fibrillation, Tachycardia, and Cardiovascular medicine and haematology(Internal Medicine, Female, Male, Clinical Sciences, Middle Aged, Coronary heart disease, Public health systems and services research, Time Factors, Circulation, Coronary Artery Disease, Sensitivity and Specificity, Ventricular Tachycardia, Ventricular Fibrillation, Tachycardia, and Cardiovascular medicine and haematology)
(Internal Medicine, Female, Male, Clinical Sciences, Middle Aged, Coronary heart disease, Public health systems and services research, Time Factors, Circulation, Coronary Artery Disease, Sensitivity and Specificity, Ventricular Tachycardia, Ventricular Fibrillation, Tachycardia, and Cardiovascular medicine and haematology)
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Summary: In a therapy‐resistant epileptic population with partial complex seizures with or without secondary generalization, addition of flunarizine to existing therapy was accompanied by a significant reduction in complex partial and... more
Summary: In a therapy‐resistant epileptic population with partial complex seizures with or without secondary generalization, addition of flunarizine to existing therapy was accompanied by a significant reduction in complex partial and tonic‐clonic seizures. This result did not appear to be due to serial effects or changes in the plasma levels of the co‐medication. Side effects were rare. The serum flunarizine levels (13.8 ng/ml; range, 3–32.5 ng/ml) were lower than previously reported on a daily dose of 10 mg. This may reflect increased metabolism due to induction of liver enzymes by the co‐medication. Given this finding, together with the low incidence of side effects, a further study is required to determine whether higher blood levels would give an improved degree and incidence of seizure reduction.RÉSUMÉDans une population ďépileptiques avec crises partielles complexes, avec ou sans généralisation secondaire, résistant au traitement, Ľadjonction de flunarizine au traitement en cours s'est accompagnée ďune réduction significative des crises partielles complexes et des crises tonico‐cloniques. Ce résultat ne parait pas être dûà des effets sériels ni à des modifications des niveaux plasmatiques de la comédication. Les effets collatÉraux ont Eaté rares. Les niveaux sériques de flunarizine (13,8 ng/ml, extrêmes 3 à 32,5 ng/ml) étaient plus bas que ceux précédemment rapportés avec une dose quotidienne de 10 mg. Ceci peut refléter une augmentation du métabolisme due àĽinduction des enzymes hépatiques par la comédication. En raison de ces résultats et de la faible incidence des effets secondaires ďautres études sont nécessaires pour déterminer si des niveaux sanguins plus éléves donneraient une meilleure réduction des crises.RESUMENEn una población resistente a la terapeútica de ataques par‐ciales complejos, oon o sin generalización secundaria, la incorporación de flunarizina a la terapia previa se acompañó de una reducción significativa de los ataques parciales complejos y tónico‐clónicos. Este resultado no parecía haber sido debido a efectos seriados o a cambios en los niveles plasmálicos de la comédicacion. Los efectos secundarios fueron raros. Los niveles séricos de flunarizina (13.8 ng/ml; rango 3–32.5 ng/ml) fueron más bajos que los previamenle publicados con una dosis diaria de 10 mg. Esto puede refleiar un incremento del metabolismo debido a la unducción de enzimas hepáticas por la co‐medicación. Aceptado este hallazgo, unido a la escasa incidencia de efectos secundarios. se debe proceder a un estudio posterior para determinar si niveles séricos más elevados producingían una majoría del grado e incidencia de la reducción de los ataques.ZUSAMMENFASSUNGBei Patienten mit therapieresistenter Epilepsie und partial‐komplexen Anfällen mit oder ohne sekundáre Generalisation führte die Zulage von Flunarizin zu der bestehenden Therapie zu einer signifikanten Reduktion der komplex‐partialen und tonisch‐klonischen Anfälle. Diese Ergebnisse schienen nicht Folge einer Serienwirkung oder von Veränderungen der Plasma‐Spiegel der Co‐Medikation zu sein. Nebenwirkungen waren selten. Die Serum Flunarizin‐Spiegel (13.8 ng/ml; Schwankungen zwischen 3 und 32,5 ng/ml) waren niedriger als die früher bei täglichen Dosen von 10 mg berichleten. Das mag Folge des er‐höhten Stoffwechsels aufgrund einer lnduktion der Leberen‐zyme durch die Co‐Medikation sein. Aufgrund dieser Befunde und der geringen Nebenwirkungen ist eine weitere Untersuchung gerechtfertigt, um festzustellen, ob höhere Blutspiegel eine stär‐kere Reduktion von Schwere und Häufigkeit der Anfälle ermö‐glichen.
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Research Interests: Cardiology, Medicine, Humans, Internal Medicine, Female, and 13 moreMale, Anesthesia, Clinical Sciences, Adult, Public health systems and services research, Circulation, Neural pathways, Propranolol, Atropine, Vagus Nerve, atrioventricular node, Wolff-Parkinson-White Syndrome, and Cardiovascular medicine and haematology
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Right ventricular refractory periods obtained using atrial and ventricular pacing with an atrioventricular (AV) interval of 160 ms were compared with those obtained with an AV interval of 0 ms in a group of 53 patients. The mean right... more
Right ventricular refractory periods obtained using atrial and ventricular pacing with an atrioventricular (AV) interval of 160 ms were compared with those obtained with an AV interval of 0 ms in a group of 53 patients. The mean right ventricular effective refractory periods were longer at an AV interval of 160 ms than at an AV interval of 0 ms at pacing cycle lengths of 600 (mean 2.5 +/- 1.8 ms difference) and 400 ms (mean 3.8 +/- 2.4 ms difference; P less than 0.01). In a subset of 10 patients, left ventricular volumes measured by two-dimensional echocardiography demonstrated that pacing with an AV interval of 160 ms was associated with a higher end-diastolic volume and stroke volume than pacing with an AV interval of 0 ms (P less than 0.001). Autonomic blockade did not alter the relationship between AV interval and ventricular refractoriness. We conclude that 1) right ventricular refractory periods are shorter at an AV interval of 0 ms than at an AV interval of 160 ms; 2) these differences are not caused by changes in autonomic tone but are associated with differences in ventricular volumes; and 3) if precise determinations of ventricular refractoriness are desired, then the timing of atrial systole should be controlled by atrial pacing.
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Research Interests: Health Sciences, Cardiology, Medicine, Electrocardiography, Humans, and 15 moreInternal Medicine, Placebo, Female, Male, Ambulatory, Aged, Middle Aged, Adult, Time Factors, Ejection Fraction, Heart Ventricles, Piperidines, Random Allocation, Clinical Trials as Topic, and Cardiovascular medicine and haematology
Widely acknowledged is the disproportionate number of COVID-19 cases among nursing home residents. This observational study examined the relationship between accreditation status and COVID-19 case rates in states where the numbers and... more
Widely acknowledged is the disproportionate number of COVID-19 cases among nursing home residents. This observational study examined the relationship between accreditation status and COVID-19 case rates in states where the numbers and proportions of Joint Commission accredited facilities made such comparisons possible (Illinois (IL), Florida (FL), and Massachusetts (MA)). COVID-19 data were accessed from the Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare Public Use File, which included retrospective COVID-19 data submitted by nursing homes to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network. The outcome variable was the total number of nursing home-identified COVID-19 cases from June 2020 to January 2021. Joint Commission accreditation status was the independent variable. Mediating factors included state, and county-level case rates. Increases in the county rate had a significant association with higher nursing home COVID-1...
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Thepurposeofthis study was todetermine whether there isaccentuated antagonism between sympathetic andvagal effects onventricular refractory periods (VRPs) inhumans. Theeffects of0.04mg/kgofatropine on theright ventricular effective... more
Thepurposeofthis study was todetermine whether there isaccentuated antagonism between sympathetic andvagal effects onventricular refractory periods (VRPs) inhumans. Theeffects of0.04mg/kgofatropine on theright ventricular effective andfunctional refractory periods were determined inthesetting of,3-adrenergic blockade bypropranolol (0. 15mg/kgloading dose, then0.1 mg/mincontinuous infusion, group 1)andinthesetting of/3-adrenergic stimulation by25or 50 ng/kg/min isoproterenol (groups 2and3,respectively). Groups 4to6served ascontrol groups.Ingroup 4,VRPsweredetermined onthree occasions separated by10mineachintheabsence ofdrug. VRPs also weredetermined on twooccasions after infusion ofpropranolol (group 5)or25ng/kg/min of isoproterenol (group 6).Groups 1to4consisted of10subjects each, andgroups5and6consisted of five subjects each. VRPsweredetermined withtheuseofbasic drive cycle lengths of600,500,400, and350msec.Because ofsinus tachycardia, sufficient dataforcomparison ofgroups1to3were ...
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Many disease states decrease intracellular adenosine triphosphate (ATP) levels and elevate body fluid purine levels. The use of specific metabolic substrates may reverse this process. This study was designed to test the hypothesis that... more
Many disease states decrease intracellular adenosine triphosphate (ATP) levels and elevate body fluid purine levels. The use of specific metabolic substrates may reverse this process. This study was designed to test the hypothesis that beta-hydroxybutyrate, a substrate for ATP synthesis, decreases body fluid purine levels during interventions that induce ATP degradation. Decreases in these purine levels are metabolic markers for diminished ATP degradation. Two human models for stimulating ATP degradation were used to test the hypothesis. Rapid fructose infusion causes acute degradation of hepatic ATP, and ischemic exercise stimulates ATP consumption in skeletal muscle. The activity of beta-hydroxybutyrate was used in combination with phosphate, another important substrate for ATP synthesis. The studies were performed during a low-phosphate state in 10 normal subjects and during a high-phosphate state in 7 normal subjects. Metabolic variables, such as serum or urinary phosphate level...
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As the initial step in examining the metabolic basis for acetate intolerance, we have tested the hypothesis that excessive adenosine triphosphate (ATP) degradation occurs during hemodialysis against acetate dialysate (compared with the... more
As the initial step in examining the metabolic basis for acetate intolerance, we have tested the hypothesis that excessive adenosine triphosphate (ATP) degradation occurs during hemodialysis against acetate dialysate (compared with the degree of degradation occurring during dialysis against bicarbonate dialysate). Seven patients undergoing long-term dialysis were infused with carbon 14--labeled 8-adenine, and their response to dialysis against acetate was compared with their response to dialysis against bicarbonate. The following changes were observed. During dialysis against acetate, the mean dialysate uric acid--to-creatinine ratio levels were significantly higher than the mean levels observed after dialysis against bicarbonate (p less than 0.001). The mean dialysate uric acid radioactivity--to-creatinine ratio and inosine, hypoxanthine, and xanthine radioactivity--to-creatinine ratio levels were significantly increased during dialysis against acetate (p less than 0.001). There wa...
Research Interests: Chemistry, Dialysis, Medicine, Humans, Internal Medicine, and 15 moreFemale, Pubmed, Hemodialysis, Male, Clinical Sciences, Aged, Middle Aged, Uric Acid, Copper Acetates, Clinical Biochemistry & Clinical Laboratory Medicine, Bicarbonate, Creatinine, Renal Dialysis, Adenosine Triphosphate, and Bicarbonates
The purpose of this study was to determine whether there is accentuated antagonism between sympathetic and vagal effects on ventricular refractory periods (VRPs) in humans. The effects of 0.04 mg/kg of atropine on the right ventricular... more
The purpose of this study was to determine whether there is accentuated antagonism between sympathetic and vagal effects on ventricular refractory periods (VRPs) in humans. The effects of 0.04 mg/kg of atropine on the right ventricular effective and functional refractory periods were determined in the setting of beta-adrenergic blockade by propranolol (0.15 mg/kg loading dose, then 0.1 mg/min continuous infusion, group 1) and in the setting of beta-adrenergic stimulation by 25 or 50 ng/kg/min isoproterenol (groups 2 and 3, respectively). Groups 4 to 6 served as control groups. In group 4, VRPs were determined on three occasions separated by 10 min each in the absence of drug. VRPs also were determined on two occasions after infusion of propranolol (group 5) or 25 ng/kg/min of isoproterenol (group 6). Groups 1 to 4 consisted of 10 subjects each, and groups 5 and 6 consisted of five subjects each. VRPs were determined with the use of basic drive cycle lengths of 600, 500, 400, and 350...
Research Interests: Endocrinology, Medicine, Humans, Internal Medicine, Female, and 13 moreMale, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Circulation, Sympathetic Nervous System, Propranolol, Atropine, Vagus Nerve, Isoproterenol, and Cardiovascular medicine and haematology
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of Healthcare Organizations and the Centers for Medi-care and Medicaid Services recently began reporting on quality of care for acute myocardial infarction, conges-tive heart failure, and pneumonia. Methods:We linked performance data... more
of Healthcare Organizations and the Centers for Medi-care and Medicaid Services recently began reporting on quality of care for acute myocardial infarction, conges-tive heart failure, and pneumonia. Methods:We linked performance data submitted for the first half of 2004 toAmericanHospital Association data on hospital characteristics. We created composite scales for each disease and used factor analysis to identify 2 addi-tional composites based on underlying domains of qual-ity.We estimated logistic regressionmodels to examine the relationship between hospital characteristics and quality. Results:Overall, 75.9%of patients hospitalizedwith these conditions received recommended care. Themean com-posite scores and their associated interquartile rangeswere 0.85 (0.81-0.95), 0.64 (0.52-0.78), and 0.88 (0.80-
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Research Interests: Perception, Health Services Research, Attitude change, Medicine, Hospitals, and 11 moreHumans, United States, Theoretical Models, Analysis of Variance, For, Reproducibility of Results, Performance Indicator, Health Care Surveys, Psychology and Cognitive Sciences, Quality of health care, and Medical and Health Sciences
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Objective Given that electronic clinical quality measures (eCQMs) are playing a central role in quality improvement applications nationwide, a stronger evidence base demonstrating their reliability is critically needed. To assess the... more
Objective Given that electronic clinical quality measures (eCQMs) are playing a central role in quality improvement applications nationwide, a stronger evidence base demonstrating their reliability is critically needed. To assess the reliability of electronic health record-extracted data elements and measure results for the Elective Delivery and Exclusive Breast Milk Feeding measures (vs manual abstraction) among a national sample of US acute care hospitals, as well as common sources of discrepancies and change over time. Materials and Methods eCQM and chart-abstracted data for the same patients were matched and compared at the data element and measure level for hospitals submitting both sources of data to The Joint Commission between 2017 and 2019. Sensitivity, specificity, and kappa statistics were used to assess reliability. Results Although eCQM denominator reliability had moderate to substantial agreement for both measures and both improved over time (Elective Delivery: kappa =...
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Research Interests: Program Evaluation, Algorithms, Health Planning, Medicine, Software, and 15 moreHumans, Program Development, United States, Missing Data, Sample Size, Surgical Site Infection, Regression Model, Sensitivity and Specificity, Coronary artery bypass surgery, Data Validation, Software Package, Surgical wound infection, Time window, Protected Health Information, and Coronary Artery Bypass(Humans, Program Development, United States, Missing Data, Sample Size, Surgical Site Infection, Regression Model, Sensitivity and Specificity, Coronary artery bypass surgery, Data Validation, Software Package, Surgical wound infection, Time window, Protected Health Information, and Coronary Artery Bypass)
(Humans, Program Development, United States, Missing Data, Sample Size, Surgical Site Infection, Regression Model, Sensitivity and Specificity, Coronary artery bypass surgery, Data Validation, Software Package, Surgical wound infection, Time window, Protected Health Information, and Coronary Artery Bypass)
Research Interests: Evidence Based Medicine, Performance Measurement, Performance, Health Services Research, Medicine, and 15 moreLogistic Regression, Heart Failure, Humans, Smoking Cessation, Hospital administration, Acute Myocardial Infarction, Myocardial Infarction, Oxford university, Performance Indicator, Performance Measure, Guideline Adherence, Psychology and Cognitive Sciences, Patient discharge, Quality of health care, and Medical and Health Sciences(Logistic Regression, Heart Failure, Humans, Smoking Cessation, Hospital administration, Acute Myocardial Infarction, Myocardial Infarction, Oxford university, Performance Indicator, Performance Measure, Guideline Adherence, Psychology and Cognitive Sciences, Patient discharge, Quality of health care, and Medical and Health Sciences)
(Logistic Regression, Heart Failure, Humans, Smoking Cessation, Hospital administration, Acute Myocardial Infarction, Myocardial Infarction, Oxford university, Performance Indicator, Performance Measure, Guideline Adherence, Psychology and Cognitive Sciences, Patient discharge, Quality of health care, and Medical and Health Sciences)
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Multiple studies demonstrate a consistent pattern of improvement on quality measures among health care organizations after they begin collecting and reporting data. This study compared results on psychiatric performance measures among... more
Multiple studies demonstrate a consistent pattern of improvement on quality measures among health care organizations after they begin collecting and reporting data. This study compared results on psychiatric performance measures among cohorts of hospitals with different characteristics that elected to begin reporting on the measures at various points in time. Quarterly reporting of Hospital-Based Inpatient Psychiatric Services (HBIPS) measures to the Joint Commission was used to examine trends in performance among four hospital cohorts that began reporting in 2009 (N=243), 2011 (N=139), 2014 (N=137), or 2015 (N=372). The HBIPS measures address admission screening, restraint and seclusion use, justification of use of multiple antipsychotic medications, and discharge planning. Comparisons were based upon initial quarters of data reported and change rates. After adjustment for covariates, the analyses showed that all cohorts significantly improved across quarters for admission screenin...
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ABSTRACT
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Gastric and duodenal pH levels were measured in 79 healthy, elderly men and women (mean +/- SD = 71 +/- 5 years) under both fasted and fed conditions using the Heidelberg capsule technique. The pH was recorded for 1 hr in the fasted... more
Gastric and duodenal pH levels were measured in 79 healthy, elderly men and women (mean +/- SD = 71 +/- 5 years) under both fasted and fed conditions using the Heidelberg capsule technique. The pH was recorded for 1 hr in the fasted state, a standard liquid and solid meal of 1000 cal was given over 30 min, then the pH was measured for 4 hr postprandially. Results are given as medians and interquartile ranges: fasted gastric pH, 1.3 (1.1-1.6); gastric pH during the meal, 4.9 (3.9-5.5); fasted duodenal pH, 6.5 (6.2-6.7); and duodenal pH during the meal, 6.5 (6.4-6.7). Although fasted gastric pH, fasted duodenal pH, and duodenal pH during the meal differ statistically from those observed in young subjects, the differences are not expected to be clinically significant in terms of drug absorption for the majority of elderly subjects. Following a meal, gastric pH decreased from a peak pH of 6.2 (5.8-6.7) to pH 2.0 within 4 hr in most subjects. This rate of return was considerably slower t...
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The purpose of this study was to determine the maximum shortening of ventricular refractoriness that occurs following an increase in rate and to quantitate the duration of ventricular pacing required to obtain this maximum shortening of... more
The purpose of this study was to determine the maximum shortening of ventricular refractoriness that occurs following an increase in rate and to quantitate the duration of ventricular pacing required to obtain this maximum shortening of refractoriness. The subjects of the study consisted of 41 patients who underwent a clinically indicated electrophysiologic study. Ventricular refractory periods were measured with an extrastimulus (S2) at basic cycle lengths of 600 and 400 ms by Method A (8 beat basic drive trains and 4 second intertrain paue and Method B (drive train duration of 3 minutes, then an S2 after every eighth basic drive beat, with no pause after the S2). In 23 subjects, the mean ventricular effective refractory period determined by Method B was 12 +/- 7 ms (+/- standard deviation) shorter than when determined by Method A at a basic drive cycle length of 600 ms (p less than 0.0001) and 33 +/- 9 ms shorter at a basic drive cycle length of 400 ms (p less than 0.001). In thes...
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The pH in the upper gastrointestinal tract of young, healthy men and women was measured in the fasting state and after administration of a standard solid and liquid meal. Calibrated Heidelberg capsules were used to record the pH... more
The pH in the upper gastrointestinal tract of young, healthy men and women was measured in the fasting state and after administration of a standard solid and liquid meal. Calibrated Heidelberg capsules were used to record the pH continuously over the study period of approximately 6 hr. In the fasted state, the median gastric pH was 1.7 and the median duodenal pH was 6.1. When the meal was administered the gastric pH climbed briefly to a median peak value of 6.7, then declined gradually back to the fasted state value over a period of less than 2 hr. In contrast to the pH behavior in the stomach, feeding a meal caused a reduction in the median duodenal pH to 5.4. In addition, there was considerable fluctuation in the postprandial duodenal pH on an intrasubject basis. The pH in the duodenum did not return to fasted state values within the 4-hr postprandial observation period. There was no tendency for the duodenal pH to be related to the gastric pH in either the fed or fasted phases of...
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In previous articles [M.K. Hart, Qual Manage Health Care. 2004;13(2):99-119 and 2003;12(1):5-19], the author presented control charts applicable for risk-adjusted, time-ordered variables and attribute data. The present article uses... more
In previous articles [M.K. Hart, Qual Manage Health Care. 2004;13(2):99-119 and 2003;12(1):5-19], the author presented control charts applicable for risk-adjusted, time-ordered variables and attribute data. The present article uses Shewhart X and s charts with risk-adjusted variables data to compare length-of-stay data from several healthcare organizations. The comparisons are made on the data both before and after risk adjustment, enabling the impact of risk adjustment to be readily determined.
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Page 1. Laryngoscope 98: October 1988 USE OF BACITRACIN FOR NEUROTOLOGIC SURGERY*f Jack m. Kartush, MD Farmington Hills, MI Steven C. Cannon, MD Ann Arbor, MI Malcolm D. Graham, MD Farmington Hills, MI ...
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Research Interests: Coding, Humans, Deep Vein Thrombosis, United States, Female, and 15 morePulmonary Embolism, Male, Thromboembolism, Clinical Sciences, Aged, Middle Aged, International Classification of Diseases, Adult, Retrospective Studies, Poa, Thrombosis, Administrative Data, Venous thromboembolism, University Hospitals, and Venous Thrombosis
The p chart is widely used in health care and other service organizations as well as in manufacturing to monitor the proportion of observations with some particular characteristic for comparing several sources of data or for tracking a... more
The p chart is widely used in health care and other service organizations as well as in manufacturing to monitor the proportion of observations with some particular characteristic for comparing several sources of data or for tracking a single source of data over time. The conventional approach is to use 3sigma limits found by using the normal approximation to the binomial distribution. This article reviews a method for taking into account the fact that 3sigma limits are not always appropriate, and suggests the use of the exact binomial distribution instead of the normal approximation to eliminate the problems associated with small subgroups. An example with only 4 small subgroups shows that the use of probability control limits and of modified control limits avoids the above problems.