The quality of care delivered and clinical outcomes of care are of paramount importance. Wide variations in the outcome of emergency care have been suggested, but the scale of variation, and the way ...in which outcomes are inter-related are poorly defined and are critical to understand how best to improve services. This study quantifies the scale of variation in three outcomes for a contemporary cohort of patients undergoing emergency medical and surgical admissions. The way in which the outcomes of different diagnoses relate to each other is investigated.
A retrospective study using the English Hospital Episode Statistics 2005-2010 with one-year follow-up for all patients with one of 20 of the commonest and highest-risk emergency medical or surgical conditions. The primary outcome was in-hospital all-cause risk-standardised mortality rate (in-RSMR). Secondary outcomes were 1-year all-cause risk-standardised mortality rate (1 yr-RSMR) and 28-day all-cause emergency readmission rate (RSRR).
2,406,709 adult patients underwent emergency medical or surgical admissions in the groups of interest. Clinically and statistically significant variations in outcome were observed between providers for all three outcomes (p < 0.001). For some diagnoses including heart failure, acute myocardial infarction, stroke and fractured neck of femur, more than 20% of hospitals lay above the upper 95% control limit and were statistical outliers. The risk-standardised outcomes within a given hospital for an individual diagnostic group were significantly associated with the aggregated outcome of the other clinical groups.
Hospital-level risk-standardised outcomes for emergency admissions across a range of specialties vary considerably and cross traditional speciality boundaries. This suggests that global institutional infra-structure and processes of care influence outcomes. The implications are far reaching, both in terms of investigating performance at individual hospitals and in understanding how hospitals can learn from the best performers to improve outcomes.
This systematic review appraises, synthesises, and presents the published evidence on the effect of patient education videos in modifying medication-related health behaviours.
A systematic literature ...review was conducted across 12 databases. Title, abstract and full-text screening was done independently using PICOS. Data extraction results were mapped directly to the Behaviour Change Intervention Functions. Results are reported in accordance with PRISMA 2020.
Out of 583 studies 12 articles from 4 countries were included. Interventions focus on improving patient’s knowledge. Modelling, Enablement, Persuasion, and Training are used in video education development. PASS analysis showed very few well designed studies that allow the reliable determination of behaviour changes.
A reliable or sustained effect of patient education videos in modifying medication-related health behaviours could not be reported due to a lack of robust study design. Modelling, Enablement, Persuasion, and Training are all intervention designs used to target behaviour change often resulting either in a narrative (real people acting) or practice (demonstrating) presentation format.
With the increased use of health education technology, robust, theoretically underpinned studies are urgently needed to evaluate the effectiveness of these interventions in the context of their impact on patient medication-related behaviour change.
OBJECTIVE: To assess the influence of feeding practices, maternal dietary habits and maternal body mass index (BMI) on growth pattern of breast-fed and formula-fed infants. METHODS: This ...cross-sectional study was performed on 50 healthy infants. Twenty-five each breast-fed (BF) and formula-fed (FF) infants along with their mothers were enrolled. The infants’ weight, height, BMI, head circumference and skinfolds (biceps and triceps) were recorded. Infant’s mother weight, height, BMI, mid-arm circumference and skinfolds were also recorded. The mothers filled 24-hours dietary-recall proforma. The 24-hours dietary-recall was then analyzed by windiet® software. RESULTS: Age of infants was 78.40±35.88 days at time of assessment. Height and weight standard deviation score (SDS) was found to be -2.759±3.10 and -0.538±2.05 with SDS of BMI was 1.59±2.30. Mean anthropometric measurements between the two groups were not significantly different except for head circumference (BF=38.12±4.46, FF=40.32±2.34; p-value=0.036). BMI and age of mothers were 26.49±4.93 kg/m2 and 29.54±2.86 years at assessment. Anthropometric analysis of mothers showed an increasing trend of different parameters especially waist circumference (cm) in breast-feeding mothers (lactating=75±15.6, non-lactating=61±18.2, p-value=0.007). Dietary intake of lactating mothers (energy=3032±12 Kcal; % energy intake=125.9±53.3) was more as compared to non-lactating mothers (1878±99 Kcal; % energy intake=78±41.2). Similarly intake of carbohydrates (lactating=414±186, non-lactating=274±175), fats (lactating=109±60.4, non-lactating=66.6±33.7), proteins (lactating=98.2±52.5, non-lactating=60.2±54.2), zinc (lactating=14.64±7.28, non-lactating=8.08±8.53), selenium (lactating=30.4±22.3, non-lactating=4.12±7.64) and dietary fiber (lactating=41.3±19.5, non-lactating=20.4±15.5) were significantly different. CONCLUSION: Growth pattern of both breast-fed and formula-fed infants were not significantly different. Energy intake, percentage energy intake and intake of macronutrients & micronutrients are more in lactating mothers.
Indigenous elders play an important role in transmitting knowledge, values and practices, hence fostering identity-building through intergenerational solidarity. We aimed to verify the association ...between intergenerational solidarity involving Indigenous elders and mental health of Indigenous people living off reserve.
We carried secondary analyses of data for a subsample from the cross-sectional 2012 Aboriginal Peoples Survey (total sample: n = 28,410 Indigenous persons aged ≥6 years old living off reserve; subsample: n = 13,020 aged 18-44 years old). Controlling for age as well as material and social deprivation, we used logistic regressions to verify the association between intergenerational solidarity (proxied as time spent with an elder and potential of turning to an elder or grandparent for support in times of need) and mental health (perceived mental health, mood disorders, anxiety, suicidal thoughts and attempts).
About 39 and 9% of the respondents respectively reported having spent time with an elder and would have turned to an elder or grandparent for support in times of need. Women who would not turn to an elder or grandparent for support in times of need were more likely to report fair or poor perceived mental health (OR = 1.69, p = 0.03). Men not spending time with an elder were more likely to experience mood disorders (OR = 1.66, p = 0.004). Women who would not turn to an elder or grandparent for support in times of need were more likely to experience anxiety disorders (OR = 1.57, p = 0.04). Women not spending time with an elder or who would not turn to an elder or grandparent for support in times of need were respectively more likely to have suicidal thoughts (OR = 1.62, p = 0.04) or to have attempted suicide (OR = 3.38, p = 0.04).
Intergenerational solidarity is associated with better mental health outcomes of Indigenous people living off reserve. These results could guide policies and practices that aim to enhance mental health and wellness in Indigenous populations.
The aim of this study was to examine the outcomes of over a decade's experience utilizing preperitoneal ventral hernia repair (PP-VHR).
PP-VHR was first described by our group in 2006, and there have ...been no subsequent reports of outcomes with this technique.
A prospective study of all PP-VHR from January, 2004 to April, 2016 was performed. Multivariate stepwise logistic regression and Cox proportional-hazard models were used to identify predictors of wound complications and hernia recurrence, respectively.
There were 1023 PP-VHRs. Mean age was 57.2 ± 12.6 years, BMI 33.7 ± 11.4 kg/m, defect size 210.0 ± 221.4 cm; 23.7% had diabetes, 13.9% were smokers, 68.7% were recurrent, and 23.6% incarcerated. Component separation was required in 43.6%, and a panniculectomy was performed in 30.0%. Wound complication was present in 27.3% of patients, with 1.7% having a mesh infection. In all, there were 53 (5.2%) hernia recurrences and 36 (3.9%) in the synthetic repairs, with a mean follow-up of 27.0 ± 26.4 months. On multivariate regression (odds ratio or hazard ratio, 95% confidence interval), diabetes (1.9, 1.4-3.0), panniculectomy (2.6, 1.8-3.9), and operations requiring biologic mesh were predictors of wound complications, whereas recurrent hernia repair (2.69, 1.14-6.35), biologic mesh (3.1, 1.67-5.75), and wound complications (3.01, 1.69-5.39) were predictors of hernia recurrence.
An open PP-VHR is a very effective means to repair large, complex, and recurrent hernias resulting in a low recurrence rate. Mesh choice in VHR is important and was associated with hernia recurrence and wound complications in this population.
•Salivary gland cancer is a highly heterogenous disease consisting of 22 subtypes.•In several of the subtypes novel systemic treatment strategies can be rationalized.•Immunohistochemistry and genomic ...profiling can identify targeted therapy options.•This approach can significantly alter the prognosis of salivary gland cancer patients.
Salivary gland cancer (SGC) is a rare malignancy consisting of 22 subtypes with different genetic, histological and clinical characteristics. This rarity and heterogeneity makes systemic treatment of recurrent or metastatic (R/M) disease challenging. Use of chemotherapy is scarcely studied and chemotherapy at best has moderate effects. New therapeutic strategies are therefore warranted, but advances made in SGC are lagging behind on advances made in more common cancers. By unraveling tumor characteristics of SGC, such as genetic alterations and protein expression profiles, therapeutic strategies tailored to the patient’s tumor can be rationalized. This genomic profiling and mapping of immunohistochemical expression profiles is essential in the search for a suitable treatment approach. Thereby, it alleviates the paucity in systemic treatment options and can significantly alter the prognosis of patients with R/M SGC. This review aims to give a comprehensive overview of known genetic alterations and expression profiles amenable for targeted therapy in every histological subtype of SGC. We discuss the remaining knowledge gaps and the implications of these targets for future studies and personalized treatments, thereby aiding clinicians faced with this rare and heterogeneous type of cancer.
This systematic review evaluates all published studies comparing biologic and synthetic meshes in implant-based breast reconstruction (IBBR), to determine which category of mesh produces the most ...favorable outcomes.
Breast cancer is the most common cancer in women globally. Implant-based breast reconstruction is currently the most popular method of postmastectomy reconstruction, and recently, the use of surgical mesh in IBBR has become commonplace. Although there is a long-standing belief among surgeons that biologic mesh is superior to synthetic mesh in terms of surgical complications and patient outcomes, few studies exist to support this claim.
A systematic search of the EMBASE, PubMed, and Cochrane databases was performed in January 2022. Primary literature studies comparing biologic and synthetic meshes within the same experimental framework were included. Study quality and bias were assessed using the validated Methodological Index for Non-Randomized Studies criteria.
After duplicate removal, 109 publications were reviewed, with 12 meeting the predetermined inclusion criteria. Outcomes included common surgical complications, histological analysis, interactions with oncologic therapies, quality of life measures, and esthetic outcomes. Across all 12 studies, synthetic meshes were rated as at least equivalent to biologic meshes for every reported outcome. On average, the studies in this review tended to have moderate Methodological Index for Non-Randomized Studies scores.
This systematic review offers the first comprehensive evaluation of all publications comparing biologic and synthetic meshes in IBBR. The consistent finding that synthetic meshes are at least equivalent to biologic meshes across a range of clinical outcomes offers a compelling argument in favor of prioritizing the use of synthetic meshes in IBBR.
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