Income, poverty, and opportunity Smeeding, Timothy M; Bergh, Andreas; Freund, Elizabeth A ...
Social science quarterly,
12/2005, Volume:
86, Issue:
Supp
Journal Article
Objective
Mortality and complication rates after total hip replacement (THR) are inversely associated with the volume of THRs performed at hospitals and by individual surgeons. It is not clear, ...however, why a higher volume of such procedures is associated with better outcomes. We evaluated the contribution of hospital structural characteristics to the volume–outcome relationship in THR by examining the rates and predictors of postoperative complications.
Methods
We analyzed data pertaining to 5,211 Medicare patients who underwent primary THR in 1995 or 1996 at 167 hospitals in Colorado, Pennsylvania, and Ohio. Data were derived from several sources, including Medicare Part A and Part B claims, the American Board of Medical Specialties, a hospital survey regarding institution‐specific characteristics and structural aspects of the care setting, and the American Hospital Association 1995 Annual Survey. Multivariate models were constructed to determine whether hospital structure or surgeon‐associated factors may underlie the relationship between volume of THRs and the occurrence of perioperative orthopedic adverse events, defined as deep wound infection or hip dislocation within 90 days of surgery.
Results
Of the patients studied, 2.6% experienced an orthopedic adverse event after THR. Sixty‐nine percent fewer events occurred in hospitals where >100 THRs in Medicare patients were performed annually, compared with hospitals where ≤25 THRs were performed. In univariate analyses, several hospital‐level factors were associated with a reduced (∼50%) risk of adverse events, including private (versus public) ownership, membership in the Council of Teaching Hospitals, presence of any residency training program, availability of a dedicated orthopedic nursing unit, and existence of operating rooms with laminar flow exhaust systems. However, the only hospital‐level factor associated with adverse events in multivariate models was the use of laminar flow exhaust systems. When surgeon volume was added to the models, it was the strongest predictor of adverse events, with hospital volume and hospital‐level factors having no appreciable association with adverse events.
Conclusion
Hospital‐level factors were not independent predictors of the association between hospital volume and orthopedic adverse events. The volume of THRs performed by individual surgeons is the most important determinant of orthopedic complications and should be considered in efforts to improve THR outcomes.
Accuracy of computerized nutrient databases is an important consideration in selecting a nutrient analysis system. We project compared the nutrient content of daily menus calculated from 4 ...microcomputer programs to chemical analysis of menus analyzed for the Dietary Approaches to Stop Hypertension (DASH) trial. Thirty-six menus were entered at 2 independent DASH sites using the ESHA Food Processor, Minnesota Nutrition Data System, Moore's Extended Nutrient Database, and Nutritionist IV databases. Food prepared according to these menus was chemically analyzed at the Food Analysis Laboratory Control Center at Virginia Polytechnic Institute and State University, Department of Biochemistry, Blacksburg. Estimates for 13 nutrients were compared: energy, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, carbohydrate, protein, cholesterol, calcium, potassium, magnesium, iron, and sodium. The overall intraclass correlation between the 2 sites’ data entry was 0.998; thus, values were averaged for analyses. Databases varied significantly in their mean deviations from chemical analyses values for saturated, monounsaturated, and polyunsaturated fatty acids, potassium, magnesium, and iron (
P<.05); however, these differences were small (<10%). Absolute deviations, which estimate the combined effect of bias and precision, were significantly different among databases for energy, saturated fatty acids, and polyunsaturated acids. Absolute differences from the laboratory values varied by <15%, except for iron. All 4 databases were comparable in accuracy and precision and performed well. Criteria for database selection depends not only on overall database accuracy, especially for nutrients of interest, but also on the ease of use of the program, relevant features of the associated software, and cost.
J Am Diet Assoc. 1999;99(suppl):S45–S53.
Salvage chemotherapy followed by high dose autologous stem cell transplantation (HD-ASCT) is the standard of care for patients who have relapsed or refractory Hodgkin Lymphoma (HL). Few trials have ...had long-term follow-up post HD-ASCT in the ABVD era of treatment. We reviewed 95 consecutive patients who received HD-ASCT for relapsed or refractory HL following ABVD failure between 1990 and 2006 at the University of Rochester. Median follow-up for survivors was 8.2 years. All patients received HD-ASCT following up-front ABVD (or equivalent) failure. At 5 years, overall survival (OS) and event-free survival (EFS) were 54% and 37%, respectively. In total, 54 patients have died; 37 of these patients died directly of HL. Notably, there were 19 deaths > 3 years post HD-ASCT and 13 of these late deaths are directly attributable to HL. Furthermore, there were 51 documented relapses, 9 of which occurred >3 years post HD-ASCT. In contrast to other studies, we did not observe a plateau in EFS following transplantation. Patients appear to be at continuous risk of recurrence beyond 3 years after HD-ASCT. Our results emphasize the importance of long-term follow-up for both toxicity and recurrence, and have important implications in defining success of post-transplant maintenance strategies.
Early adulthood in cross-national perspective Fussell, Elizabeth; Iacovou, Maria; Lippman, Laura ...
The Annals of the American Academy of Political and Social Science,
03/2002, Volume:
580
Journal Article
PDF
