Death and quality in cardiac surgery

Clinical Risk ◽  
2010 ◽  
Vol 16 (4) ◽  
pp. 130-134 ◽  
Author(s):  
Samer AM Nashef
Keyword(s):  
Cardiac Surgery ◽  
Clinical Performance ◽  
Statistical Significance ◽  
Surgical Care ◽  
Quality Monitoring ◽  
Risk Models ◽  
Actual Outcome ◽  
The Difference ◽  
Care Evaluation

Quality monitoring in medicine was a neglected field until the last two decades. Doctors traditionally did their best, but how good that was could not be evaluated. This situation remains in some areas of medicine, but specialties with clearly-defined interventions and outcomes have progressed in quality of care evaluation, and cardiac surgery leads the way. Measuring the risk of an intervention allows prediction of the outcome and is essential for quality monitoring: without knowing the predicted outcome, the actual outcome cannot be evaluated. Cardiac surgery risk models like EuroSCORE and others have been adopted worldwide, so that measuring risk-adjusted performance is now an integral part of the delivery of good cardiac surgical care. When mortality for a procedure is higher for one surgeon (or hospital) than another, this can be due to one of three reasons, or a combination of the three: the difference is due to chance, or variation in risk profile, or better and safer service. We now have the tools to distinguish between the above factors. We can also observe performance over time: cusum curves plot the performance of surgeons and hospitals by showing hypothetical ‘lives saved’. This provides early warning of deterioration in performance before a problem reaches statistical significance. With the appropriate tools, it is possible not only to identify a problem, but also to anticipate and thus prevent a problem from happening. Monitoring clinical performance is an exciting and rewarding field for future development, and one that will yield real improvements in patient outcomes.

The Quality Analysis of Hallux Valgus Videos on YouTube

2021 ◽  
Author(s):  
Enes Sari ◽  
Levent FAZLI Umur
Keyword(s):  
Hallux Valgus ◽  
Information Quality ◽  
Statistical Significance ◽  
Poor Quality ◽  
Quality Analysis ◽  
Accurate Information ◽  
Youtube Videos ◽  
The Mean ◽  
The Difference

BACKGROUND:The aim of this study was to evaluate the information quality of YouTube videos on hallux valgus. METHODS:A YouTube search was performed using the keyword 'hallux valgus' to determine the first 300 videos related to hallux valgus. A total of 54 videos met our inclusion criteria and evaluated for information quality by using DISCERN, Journal of the American Medical Association (JAMA) and hallux valgus information assessment (HAVIA) scores. Number of views, time since the upload date, view rate, number of comments, number of likes, number of dislikes, video power index (VPI) values were calculated to determine video popularity. Video length (sec), video source and video content were also noted. The relation between information quality and these factors were statistically evaluated. RESULTS:The mean DISCERN score was 30.35{plus minus}11.56 (poor quality) (14-64), the mean JAMA score was 2.28{plus minus}0.96 (1-4), and the mean HAVIA score was 3.63{plus minus}2.42 (moderate quality) (0.5-8.5). Although videos uploaded by physicians had higher mean DISCERN, JAMA, and HAVIA scores than videos uploaded by non-physicians, the difference was not statistically significant. Additionally, view rates and VPI values were higher for videos uploaded by health channels, but the difference did not reach statistical significance. A statistically significant positive correlation was found between video length and DISCERN (r= 0.294, p= 0.028), and HAVIA scores (r= 0.326, p= 0.015). CONCLUSIONS:This present study demonstrated that the quality of information available on YouTube videos about hallux valgus was low and insufficient. Videos containing accurate information from reliable sources are needed to educate patients on hallux valgus, especially in less frequently mentioned topics such as postoperative complications and healing period.

A phase Ib/IIa study of combination therapy with gemcitabine and Atu027 in patients with locally advanced or metastatic pancreatic adenocarcinoma.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 385-385 ◽  
Author(s):  
Beate Schultheis ◽  
Dirk Strumberg ◽  
Jan Kuhlmann ◽  
Martin Wolf ◽  
Karin Link ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Combination Therapy ◽  
Statistical Significance ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Small Patient Number ◽  
The Difference ◽  
Grade 3

385 Background: Atu027 is a liposomally formulated short interfering RNA with anti-metastatic activity, which silences expression of protein kinase N3 (PKN3) in the vascular endothelium. PKN3 acts as a Rho effector downstream of PI3K. This trial was designed to assess safety, pharmacokinetics and efficacy of Atu027 in combination with gemcitabine in advanced pancreatic carcinoma (APC). Methods: 23 patients (pts) with APC stage 3 or 4 were enrolled and randomly assigned to different Atu027 dosing schedules (arm 1: 0.253mg/kg once weekly, n = 11; arm 2: 0.253mg/kg twice-weekly, n = 12) but identical gemcitabine regimen. Response was evaluated according to RECIST 1.1. Quality of life was assessed with EORTC questionnaire QLQ-C30. Results: Combination therapy with Atu027 and gemcitabine was given up to 7.8 months until progression. Grade 3 adverse events (AEs) were reported by 9/11 pts (82%) in arm 1 and 11/12 pts (92%) in arm 2. Grade 4 AEs were reported by two pts in each arm. Interestingly, there was a difference in median progression free survival (mPFS) between the two treatment arms. Arm 1 showed an mPFS of 1.8 [95%CI: 0.4-5.5] months vs. 5.3 [95%CI: 1.5-6.0] months in arm 2, p= 0.399. In a post-hoc analysis of metastatic disease only, the difference in mPFS between the two arms reached statistical significance (1.6 [95%CI:0.4-2.1] vs 2.9 [95%CI:1.0-7.3] months, n = 9 vs 10, p= 0.025). Disease control during treatment was achieved in 4/11 (36%) pts in arm 1 and in 7/12 (58%) pts in arm 2. New lesions occurred in all (6/6) pts in arm 1 who had at least one RECIST re-evaluation but only 5/10 pts (50%) in arm 2. In quality of life analysis, pts in the once-weekly arm showed a stable global health status while pts in the twice-weekly arm reported an improvement (0-100 score change from baseline: -2.3 vs +21.6 after one cycle, N = 7 vs 7). Conclusions: Combination of Atu027 with gemcitabine for the treatment of APC is safe and was well tolerated. Despite the small patient number, there is a clear signal that twice-weekly Atu027 dosing might be superior to the once-weekly regimen. These results suggest efficacy of Atu027 and warrant further investigation with Atu027 added to standard of care in APC. Clinical trial information: NCT01808638.

scholarly journals Guidelines on constructing funnel plots for quality indicators: A case study on mortality in intensive care unit patients

2017 ◽  
Vol 27 (11) ◽  
pp. 3350-3366 ◽  
Author(s):  
Ilona WM Verburg ◽  
Rebecca Holman ◽  
Niels Peek ◽  
Ameen Abu-Hanna ◽  
Nicolette F de Keizer
Keyword(s):  
Intensive Care ◽  
Quality Indicators ◽  
Quality Indicator ◽  
Clinical Performance ◽  
Institutional Characteristics ◽  
Funnel Plots ◽  
Using Data ◽  
Care Evaluation

Funnel plots are graphical tools to assess and compare clinical performance of a group of care professionals or care institutions on a quality indicator against a benchmark. Incorrect construction of funnel plots may lead to erroneous assessment and incorrect decisions potentially with severe consequences. We provide workflow-based guidance for data analysts on constructing funnel plots for the evaluation of binary quality indicators, expressed as proportions, risk-adjusted rates or standardised rates. Our guidelines assume the following steps: (1) defining policy level input; (2) checking the quality of models used for case-mix correction; (3) examining whether the number of observations per hospital is sufficient; (4) testing for overdispersion of the values of the quality indicator; (5) testing whether the values of quality indicators are associated with institutional characteristics; and (6) specifying how the funnel plot should be constructed. We illustrate our guidelines using data from the Dutch National Intensive Care Evaluation registry. We expect that our guidelines will be useful to data analysts preparing funnel plots and to registries, or other organisations publishing quality indicators. This is particularly true if these people and organisations wish to use standard operating procedures when constructing funnel plots, perhaps to comply with the demands of certification.

scholarly journals A Survey on Attitude Towards Quality Monitoring System of Linguistic Landscape

2019 ◽  
Vol 7 (3) ◽  
pp. 87
Author(s):  
Bin Lu
Keyword(s):  
Monitoring System ◽  
Evaluation System ◽  
Quality Evaluation ◽  
Quality Monitoring ◽  
Linguistic Landscape ◽  
Development Mode ◽  
The Difference ◽  
Degree Of Participation ◽  
Quality Evaluation System

This study aims at investigating the difference between attitude towards the construction of quality monitoring system on linguistic landscape of Chinese tourism, and the current situation on regional special linguistic landscape program. By analyzing the degree of participation in serving for improvement the quality of local linguistic landscape, this survey carries out quantitative analysis of attitude research on constructing the benchmark indicators, program management, process control and quality evaluation; explores a sustainable development mode on linguistic landscape assessment for national tourism; promotes the formulation, implementation and promotion of the quality monitoring system on linguistic landscape tourism from 520 feedbacks of respondents. And the objectives of this research were to 1) to investigate the attitudes towards social influence and implementation of series of Standards and Guidance for English Translation and Usage in Public Service(2017-2019); 2) to study the factors that influence different attitudes and opinions; 3) to explore quality evaluation system of linguistic landscape, and promote linguistic landscape evaluation indicators and modes. The conclusion is that the governments should construct the common understanding of program mode and collaborative development on quality monitoring system.

scholarly journals Agreement among Four Homocysteine Assays and Results in Patients with Coronary Atherosclerosis and Controls

2000 ◽  
Vol 46 (2) ◽  
pp. 258-264 ◽  
Author(s):  
Harry H Yu ◽  
Rana Joubran ◽  
Muhamad Asmi ◽  
Terence Law ◽  
Anthony Spencer ◽  
...  
Keyword(s):  
Coronary Atherosclerosis ◽  
Clinical Performance ◽  
Statistical Significance ◽  
Coronary Vessels ◽  
Hplc Method ◽  
Smoking History ◽  
Hplc Assay ◽  
Total Homocysteine ◽  
Community Controls ◽  
The Difference

Abstract Background: Hyperhomocysteinemia has been associated with coronary atherosclerosis in many, but not all, prospective and retrospective studies. Some on these inconsistencies may be attributed to methodological variabilities. Methods: In the present study, three newly commercially available assays and one in-house HPLC assay for total homocysteine (tHcy) were utilized in 99 subjects with angiographically documented atherosclerosis and in 91 community controls matched by age, gender, and smoking history. The in-house assay, a modified Fortin and Genest HPLC method, was compared with the Bio-Rad HPLC assay, the Abbott IMx® fluorescence polarization immunoassay, and a Bio-Rad enzyme-linked immunoassay (EIA) microtiter method. Results: Correlation coefficient values between the in-house HPLC assay and the Bio-Rad HPLC, the Abbott IMx, and the Bio-Rad EIA assays were 0.95, 0.96 and 0.90, respectively. Although tHcy concentrations were higher in cases compared with controls by all four methods, the difference reached statistical significance only with the in-house HPLC procedure (median, 13.5 ± 6.7 μmol/L in cases vs 10.9 ± 4.8 μmol/L in controls; P <0.01, adjusting for covariates), where it was an independent predictor of case or control status, along with hypertension, total cholesterol, and triglycerides. The tHcy distributions in cases and controls demonstrated significant overlap. The number of atherosclerotic major coronary vessels was associated with significantly higher tHcy (P <0.01 for trend) in all four methods. Conclusions: The three commercial assays for tHcy differed in analytical and clinical performance. Analytically, the Abbott IMx method showed the best comparability with the in-house assay, but clinically, the three commercial methods were similar and did not distinguish cases from controls.

The Role of Migration in the Variety and Quality of Trade: Evidence from Germany

2016 ◽  
Vol 17 (1) ◽  
pp. 1-25 ◽  
Author(s):  
Antonella Bellino ◽  
Giuseppe Celi
Keyword(s):  
Consumer Goods ◽  
Statistical Significance ◽  
Two Dimensions ◽  
Information Flows ◽  
Information Effect ◽  
Industry Trade ◽  
Migrant Communities ◽  
The Difference

AbstractWe explore the migration-trade nexus in the case of Germany over the period 2000-09, disentangling the two dimensions of intra-industry trade (vertical and horizontal). We find that immigration is positively and significantly related to intraindustry trade. However, the magnitude and statistical significance of migration’s impact on trade are considerably higher for horizontal intra-industry trade and increase with the difference in the level of development between Germany and the partner countries. This pattern is consistent with the view that information flows between migrant communities and their country of origin may be more important for consumer goods (where trade in varieties prevails) and that this information effect is more important if trading countries are very different.

scholarly journals Effects of Natural Convalescent Factors Combined with Motor Intelligence Management on Patients’ Blood Pressure

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Shasha Li ◽  
Zhuoming Hu ◽  
Jianping Zhang
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Physical Function ◽  
Statistical Significance ◽  
Blood Pressure Level ◽  
Control Group ◽  
Observation Group ◽  
Research Subjects ◽  
The Difference

To explore the application of natural convalescent factors combined with exercise intelligence management in blood pressure control of patients with hypertension, 102 patients with hypertension who were admitted from January 2017 to August 2019 were selected as the research subjects. According to the odd-even number method, they were divided into two groups with 51 cases in each group. The control group was treated with natural convalescent factor therapy alone, and the observation group was treated with natural convalescent factor combined with motor intelligence management. The application effects of the two groups were compared. Before sports intelligence management, the levels of systolic blood pressure (SBP) in control group and observation group were (145.45 ± 8.44) mmHg (1 mmHg = 0.133 kPa) and (146.55 ± 8.37) mmHg, respectively; the diastolic blood pressure (DBP) levels of the control group and the observation group were (98.47 ± 3.48) mmHg and (98.94 ± 3.48) mmHg, respectively, with no statistical significance ( P > 0.05 ). After the exercise intelligence management, the SBP levels of the control group and the observation group were (132.76 ± 4.48) mmHg and (130.06 ± 2.48) mmHg, respectively. The DBP levels of the control group and the observation group were (85.48 ± 5.38) mmHg and (83.47 ± 3.35) mmHg, respectively. The difference was statistically significant ( P < 0.05 ). The scores of each index of quality of life in the observation group were higher than those in the control group, and the differences of physical function and psychological/mental scores were significant. The scores of physical function in the two groups before administration were (48.36 ± 1.69) and (48.74 ± 1.62), and the differences were not statistically significant ( P > 0.05 ). After management, the physiological function scores of the two groups were (40.32 ± 1.33) and (32.15 ± 1.54) and the difference was statistically significant ( P < 0.05 ). There were no significant differences in the psychological (30.75 ± 1.26)/mental scores (30.26 ± 1.48) between the two groups before management ( P > 0.05 ), but there were significant differences in the psychological (25.30 ± 1.02)/mental scores (18.76 ± 1.36) between the two groups after management ( P < 0.05 ). The combination of natural convalescent factors and intelligent exercise management can effectively control the blood pressure level and improve the quality of life of patients with hypertension, and the clinical application effect is good.

A Comparison of Craniofacial Form in Northern Irish Children with Unilateral Cleft Lip and Palate Treated with Different Primary Surgical Techniques

2004 ◽  
Vol 41 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Chris D. Johnston ◽  
Alan G. Leonard ◽  
Donald J. Burden ◽  
Patrick F. McSherry
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Primary Repair ◽  
Statistical Significance ◽  
Surgical Techniques ◽  
Dental Arch ◽  
Soft Tissue Profile ◽  
Palate Repair ◽  
The Difference

Objective The quality of outcomes in patients with unilateral cleft lip and palate (UCLP) was compared between two senior plastic surgeons. One surgeon carried out a one-stage Wardill-Kilner palate repair. The other surgeon employed a vomer flap hard palate repair followed by a von Langenbeck soft palate closure (Oslo protocol). Design Retrospective analysis. Patients Thirty-four children (mean age 9.7 years) born with complete skeletal UCLP in Northern Ireland from 1983 to 1991 who received primary repair surgery from one of the two surgeons. Main Outcome Measures Cephalometric analysis was used to determine the craniofacial form and soft tissue profile. The quality of the dental arch relationships was independently assessed using the Goslon ranking system. Results Twenty-nine of the 34 subjects had good or satisfactory arch relationships. Comparison between the surgeons revealed that the Wardill-Kilner group had a greater proportion of Goslon grades of greater than 3, indicating poor arch relationships. However, this difference failed to reach statistical significance. There were no significant cephalometric differences between patients treated by the two surgeons. Conclusions Although the difference was not statistically significant, the highest proportion of patients likely to require orthognathic surgery was found in those treated using the Wardill-Kilner technique.

scholarly journals Evaluation of the Validity of SAMe-TT2R2 Score in a Cohort of Venous Thromboembolism Patients Treated With Warfarin

2020 ◽  
Vol 26 ◽  
pp. 107602962094503
Author(s):  
Eman Nawash Alhmoud ◽  
Hazem Elewa ◽  
Mohammed S. Abdul Gelil ◽  
Osama B. Abd El Samad ◽  
Abdelnasser Y. Elzouki
Keyword(s):  
Venous Thromboembolism ◽  
Statistical Significance ◽  
Clinical Factors ◽  
Risk Of Bleeding ◽  
Clinical Events ◽  
Caucasian Origin ◽  
Anticoagulation Control ◽  
The Difference ◽  
Mean Time

Low SAMe-TT2R2 score of <2 was validated as a predictor of optimum anticoagulation control, reflected by mean time in therapeutic range (TTR) above 65% to 70%, among warfarin-treated atrial fibrillation patients. This study aimed to validate the ability of SAMe-TT2R2 score and its individual components in predicting anticoagulation control (mean TTR and clinical events) among a cohort of venous thromboembolism (VTE) patients in Qatar. A total of 295 patients were retrospectively evaluated. There was a trend toward statistical significance in mean TTR between low (<2) and high (≥ 2) SAMe-TT2R2 score groups ( P = .05), a difference that was not sustained when a cutoff of 3 was used (ie, a score of 3 or more). Patients with poor INR control (TTR <70%) were numerically less likely to have SAMe-TT2R2 score of <2 compared with those with good INR control, though the difference was not statistically significant (16.7% vs 83.3%, respectively, P = .4). No thromboembolic events were reported, and no association was found between the score and risk of bleeding. Non-Caucasian origin was the only significant predictor of good anticoagulation in the studied cohort. In conclusion, SAMe-TT2R2 score could not predict quality of anticoagulation control in a cohort of VTE patients treated with warfarin in Qatar. Contribution of other clinical factors and whether a different scoring may yield better prediction of anticoagulation control remains to be tested.

scholarly journals Evaluation of results in coronary surgery using EuroSCORE

2011 ◽  
Vol 139 (1-2) ◽  
pp. 25-29 ◽  
Author(s):  
Bogoljub Mihajlovic ◽  
Svetozar Nicin ◽  
Pavle Kovacevic ◽  
Stamenko Susak ◽  
Lazar Velicki ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Myocardial Revascularization ◽  
Postoperative Mortality ◽  
Surgical Care ◽  
Evaluation Process ◽  
Operative Risk ◽  
Treatment Quality ◽  
Coronary Surgery ◽  
Coronary Patients ◽  
The Difference

Introduction. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) was developed in order to predict operative risk in cardiac surgery and to assess the quality of the cardio-surgical care. Introduction of the uniform terminology in result evaluation process leads to the significant improvement in measuring and evaluation of surgical treatment quality. Objective. The aim of the study was to evaluate our results in isolated coronary surgery using the EuroSCORE. Methods. The study was done respectively by analyzing predicted mortality according to the EuroSCORE model and observed operative risk in 4,675 coronary patients operated at our Clinic during the period 2001-2008. For statistical analyses, the Pearson, Chisquare and ANOVA tests were used. Results. The total postoperative mortality predicted by the EuroSCORE was 2.9?2.25, while the observed one was 2.2%. When the scoring system and observed results were compared over the years, a considerably lower observed mortality was found during the last 4 years. Overall average number of distal anastomoses was 2.62?0.84. During the period 2004-2008, the average number of coronary anastomoses increased over the years reaching the value of 2.77?0.88. The difference is at the level of statistical significance with the trend of further increase. Percentage of the patients with single or double graft myocardial revascularization decreases, while the number of the patients with triple or more bypasses increases. Conclusion. During the last years, the results in isolated coronary surgery have considerably improved. The EuroSCORE overestimates operative risk. In order to improve its predictive value, the model should be recalibrated.

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