Comparison of two surveys of hospitalization: the National Hospital Discharge Survey and the NHANES I Epidemiologic Followup Study

Objectives This report compares hospitalization data from the NHANES I Epidemiologic Followup Study (NHEFS) with data from the National Hospital Discharge Survey (NHDS), the benchmark for hospitalization in the United States, for men and women 35 years and older for the period 1971\ue2\u20ac\u201c87. The comparison is intended to help analysts evaluate the validity and generality of analyses based on the NHEFS. Methods Hospital stays per 1,000 population and average lengths of stay are compared year by year for each age-sex group and for the entire period. Regression analyses test for differences between the two surveys by age and sex, and for differences in trends over time and the effect of the Medicare program\ue2\u20ac\u2122s prospective hospital payment system. Results Hospital stays per 1,000 population were lower in NHEFS than in NHDS in all age-sex groups at the beginning of the period, but the differences had almost disappeared by 1987. Lengths of stay, although somewhat longer in NHEFS, matched NHDS more closely. Differentials by age and sex were similar in the two surveys for both hospital stays per 1,000 population and length of hospital stay. With its extensive information on baseline risk factors, the NHEFS offers a unique opportunity to study determinants of hospitalization in a representative sample of U.S. adults. The evaluation presented here suggests two points for researchers who want to use the NHEFS. First, including age as a control should largely correct for differences in age distribution between NHEFS and NHDS. Second, a time trend should also be included to capture the effects of several factors that caused the count of stays to be low in the early years of NHEFS followup.[L.B. Russell, E. Milan, and R. Jagannathan]."September 1997."Also available via the World Wide Web.Includes bibliographical references (p. 11)

Refinements in Mathematical Models to Predict Aneurysm Growth and Rupture

The growth of aneurysms and eventually their likelihood of rupture depend on the determination of the stress and strain within the aneurysm wall and the exact reproduction of its geometry. A numerical model is developed to analyze pulsatile flow in abdominal aortic aneurysm (AAA) models using real physiological resting and exercise waveforms. Both laminar and turbulent flows are considered. Interesting features of the flow field resulting from using realistic physiological waveforms are obtained for various parameters using finite element methods. Such parameters include Reynolds number, size of the aneurysm (D d), and flexibility of the aneurysm wall. The effect of non-Newtonian behavior of blood on hemodynamic stresses is compared with Newtonian behavior, and the non-Newtonian effects are demonstrated to be significant in realistic flow situations. Our results show that maximum turbulent fluid shear stress occurs at the distal end of the AAA model. Furthermore, turbulence is found to have a significant effect on the pressure distribution along AAA wall for both physiological waveforms. Related experimental work in which a bench top aneurysm model is developed is also discussed. The experimental model provides a platform to validate the numerical model. This work is part of our ongoing development of a patient-specific tool to guide clinician decision making and to elucidate the contribution of blood flow-induced stresses to aneurysm growth and eventual rupture. These studies indicate that accurately modeling the physiologic features of real aneurysms and blood is paramount to achieving our goal.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74685/1/annals.1383.033.pd

Experimental assessment of head losses through elliptical and sharp-edged orifices

Due to the European electricity market liberalization and the appearance of other renewable electricity producers, an increase of installed peak power capacity is relevant to provide larger amount of electricity in a shorter turbine duration. When the discharge increase is not too large, it is frequently efficient to place an orifice at the entrance of the existing surge tank. Actually, the surge tank modifications have to be designed case-by-case. The introduction of head losses helps to manage maximum and minimum water level following the management of downstream discharge control and transient events. It allows to keep the same safety level. The placed orifice should commonly produce asymmetric losses. It is important to note that target head losses are evaluated with a unidimensional numerical model which performs transient simulation for relevant flow directions in the whole water way system and hydropower plant. A previous study performed by the authors focused on the effects of sharp-edged orifice parameters. This research carries out the analysis of corresponding elliptical orifices to tested sharp-edged orifices. The goal is to evaluate the head loss modification in both directions due to the shape change

Home-based therapy programmes for upper limb functional recovery following stroke

Background: With an increased focus on home-based stroke services and the undertaking of programmes, targeted at upper limb recovery within clinical practice, a systematic review of home-based therapy programmes for individuals with upper limb impairment following stroke was required. Objectives: To determine the effects of home-based therapy programmes for upper limb recovery in patients with upper limb impairment following stroke. Search methods: We searched the Cochrane Stroke Group's Specialised Trials Register (May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to May 2011), EMBASE (1980 to May 2011), AMED (1985 to May 2011) and six additional databases. We also searched reference lists and trials registers. Selection criteria: Randomised controlled trials (RCTs) in adults after stroke, where the intervention was a home-based therapy programme targeted at the upper limb, compared with placebo, or no intervention or usual care. Primary outcomes were performance in activities of daily living (ADL) and functional movement of the upper limb. Secondary outcomes were performance in extended ADL and motor impairment of the arm. Data collection and analysis: Two review authors independently screened abstracts, extracted data and appraised trials. We undertook assessment of risk of bias in terms of method of randomisation and allocation concealment (selection bias), blinding of outcome assessment (detection bias), whether all the randomised patients were accounted for in the analysis (attrition bias) and the presence of selective outcome reporting. Main results: We included four studies with 166 participants. No studies compared the effects of home-based upper limb therapy programmes with placebo or no intervention. Three studies compared the effects of home-based upper limb therapy programmes with usual care. Primary outcomes: we found no statistically significant result for performance of ADL (mean difference (MD) 2.85; 95% confidence interval (CI) -1.43 to 7.14) or functional movement of the upper limb (MD 2.25; 95% CI -0.24 to 4.73)). Secondary outcomes: no statistically significant results for extended ADL (MD 0.83; 95% CI -0.51 to 2.17)) or upper limb motor impairment (MD 1.46; 95% CI -0.58 to 3.51). One study compared the effects of a home-based upper limb programme with the same upper limb programme based in hospital, measuring upper limb motor impairment only; we found no statistically significant difference between groups (MD 0.60; 95% CI -8.94 to 10.14). Authors' conclusions: There is insufficient good quality evidence to make recommendations about the relative effect of home-based therapy programmes compared with placebo, no intervention or usual care

Improving delirium care in the intensive care unit: The design of a pragmatic study

<p>Abstract</p> <p>Background</p> <p>Delirium prevalence in the intensive care unit (ICU) is high. Numerous psychotropic agents are used to manage delirium in the ICU with limited data regarding their efficacy or harms.</p> <p>Methods/Design</p> <p>This is a randomized controlled trial of 428 patients aged 18 and older suffering from delirium and admitted to the ICU of Wishard Memorial Hospital in Indianapolis. Subjects assigned to the intervention group will receive a multicomponent pharmacological management protocol for delirium (PMD) and those assigned to the control group will receive no change in their usual ICU care. The primary outcomes of the trial are (1) delirium severity as measured by the Delirium Rating Scale revised-98 (DRS-R-98) and (2) delirium duration as determined by the Confusion Assessment Method for the ICU (CAM-ICU). The PMD protocol targets the three neurotransmitter systems thought to be compromised in delirious patients: dopamine, acetylcholine, and gamma-aminobutyric acid. The PMD protocol will target the reduction of anticholinergic medications and benzodiazepines, and introduce a low-dose of haloperidol at 0.5-1 mg for 7 days. The protocol will be delivered by a combination of computer (artificial intelligence) and pharmacist (human intelligence) decision support system to increase adherence to the PMD protocol.</p> <p>Discussion</p> <p>The proposed study will evaluate the content and the delivery process of a multicomponent pharmacological management program for delirium in the ICU.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00842608">NCT00842608</a></p

Effectiveness of physiotherapy exercise following total knee replacement: Systematic review and meta-analysis

© 2015 Artz et al. Background: Rehabilitation, with an emphasis on physiotherapy and exercise, is widely promoted after total knee replacement. However, provision of services varies in content and duration. The aim of this study is to update the review of Minns Lowe and colleagues 2007 using systematic review and meta-analysis to evaluate the effectiveness of post-discharge physiotherapy exercise in patients with primary total knee replacement. Methods: We searched MEDLINE, Embase, PsycInfo, CINAHL and Cochrane CENTRAL to October 4th 2013 for randomised evaluations of physiotherapy exercise in adults with recent primary knee replacement. Outcomes were: patient-reported pain and function, knee range of motion, and functional performance. Authors were contacted for missing data and outcomes. Risk of bias and heterogeneity were assessed. Data was combined using random effects meta-analysis and reported as standardised mean differences (SMD) or mean differences (MD). Results: Searches identified 18 randomised trials including 1,739 patients with total knee replacement. Interventions compared: physiotherapy exercise and no provision; home and outpatient provision; pool and gym-based provision; walking skills and more general physiotherapy; and general physiotherapy exercise with and without additional balance exercises or ergometer cycling. Compared with controls receiving minimal physiotherapy, patients receiving physiotherapy exercise had improved physical function at 3-4 months, SMD -0.37 (95% CI -0.62, -0.12), and pain, SMD -0.45 (95% CI -0.85, -0.06). Benefit up to 6 months was apparent when considering only higher quality studies. There were no differences for outpatient physiotherapy exercise compared with home-based provision in physical function or pain outcomes. There was a short-term benefit favouring home-based physiotherapy exercise for range of motion flexion. There were no differences in outcomes when the comparator was hydrotherapy, or when additional balancing or cycling components were included. In one study, a walking skills intervention was associated with a long-term improvement in walking performance. However, for all these evaluations studies were under-powered individually and in combination. Conclusion: After recent primary total knee replacement, interventions including physiotherapy and exercise show short-term improvements in physical function. However this conclusion is based on meta-analysis of a few small studies and no long-term benefits of physiotherapy exercise interventions were identified. Future research should target improvements to long-term function, pain and performance outcomes in appropriately powered trials

Early supported discharge services for people with acute stroke

Background: People with stroke conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed that offer people in hospital an early discharge with rehabilitation at home (early supported discharge: ESD). Objectives: To establish if, in comparison with conventional care, services that offer people in hospital with stroke a policy of early discharge with rehabilitation provided in the community (ESD) can: 1) accelerate return home, 2) provide equivalent or better patient and carer outcomes, 3) be acceptable satisfactory to patients and carers, and 4) have justifiable resource implications use. Search methods: We searched the Cochrane Stroke Group Trials Register (January 2017), Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 1) in the Cochrane Library (searched January 2017), MEDLINE in Ovid (searched January 2017), Embase in Ovid (searched January 2017), CINAHL in EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to December 2016), and Web of Science (to January 2017). In an effort to identify further published, unpublished, and ongoing trials we searched six trial registries (March 2017). We also performed citation tracking of included studies, checked reference lists of relevant articles, and contacted trialists. Selection criteria: Randomised controlled trials (RCTs) recruiting stroke patients in hospital to receive either conventional care or any service intervention that has provided rehabilitation and support in a community setting with an aim of reducing the duration of hospital care. Data collection and analysis: The primary patient outcome was the composite end-point of death or long-term dependency recorded at the end of scheduled follow-up. Two review authors scrutinised trials, categorised them on their eligibility and extracted data. Where possible we sought standardised data from the primary trialists. We analysed the results for all trials and for subgroups of patients and services, in particular whether the intervention was provided by a co-ordinated multidisciplinary team (co-ordinated ESD team) or not. We assessed risk of bias for the included trials and used GRADE to assess the quality of the body of evidence. Main results: We included 17 trials, recruiting 2422 participants, for which outcome data are currently available. Participants tended to be a selected elderly group of stroke survivors with moderate disability. The ESD group showed reductions in the length of hospital stay equivalent to approximately six days (mean difference (MD) -5.5; 95% confidence interval (CI) -3 to -8 days; P &lt; 0.0001; moderate-grade evidence). The primary outcome was available for 16 trials (2359 participants). Overall, the odds ratios (OR) for the outcome of death or dependency at the end of scheduled follow-up (median 6 months; range 3 to 12) was OR 0.80 (95% CI 0.67 to 0.95, P = 0.01, moderate-grade evidence) which equates to five fewer adverse outcomes per 100 patients receiving ESD. The results for death (16 trials; 2116 participants) and death or requiring institutional care (12 trials; 1664 participants) were OR 1.04 (95% CI 0.77 to 1.40, P = 0.81, moderate-grade evidence) and OR 0.75 (95% CI 0.59 to 0.96, P = 0.02, moderate-grade evidence), respectively. Small improvements were also seen in participants' extended activities of daily living scores (standardised mean difference (SMD) 0.14, 95% CI 0.03 to 0.25, P = 0.01, low-grade evidence) and satisfaction with services (OR 1.60, 95% CI 1.08 to 2.38, P = 0.02, low-grade evidence). We saw no clear differences in participants' activities of daily living scores, patients subjective health status or mood, or the subjective health status, mood or satisfaction with services of carers. We found low-quality evidence that the risk of readmission to hospital was similar in the ESD and conventional care group (OR 1.09, 95% CI 0.79 to 1.51, P = 0.59, low-grade evidence). The evidence for the apparent benefits were weaker at one- and five-year follow-up. Estimated costs from six individual trials ranged from 23% lower to 15% greater for the ESD group in comparison to usual care. In a series of pre-planned analyses, the greatest reductions in death or dependency were seen in the trials evaluating a co-ordinated ESD team with a suggestion of poorer results in those services without a co-ordinated team (subgroup interaction at P = 0.06). Stroke patients with mild to moderate disability at baseline showed greater reductions in death or dependency than those with more severe stroke (subgroup interaction at P = 0.04). Authors' conclusions: Appropriately resourced ESD services with co-ordinated multidisciplinary team input provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as reducing the length of hospital stay. Results are inconclusive for services without co-ordinated multidisciplinary team input. We observed no adverse impact on the mood or subjective health status of patients or carers, nor on readmission to hospital

Pilot study of the multicentre DISCHARGE trial: image quality and protocol adherence results of computed tomography and invasive coronary angiography (vol 30, pg 1997, 2020)

The original version of this article, published on 16 December 2019, unfortunately contained two mistakes.Cardiovascular Aspects of Radiolog