Effects of surgery on the mental status of older persons. A meta-analytic review

The data bases of 18 empirical studies were combined into one comprehensive data set and subjected to meta-analysis. The following trends were observed: (1) surgery has a significantly decompensating impact on the mental status of older persons, and the average effect size observed is modest (r = .37); (2) for all mental status measures included in the review (cognition, delirium and affect), effect size appears to be significantly moderated by patient age; (3) patient sex may be predictive of the kind of mental impairment that is most likely to occur within an older surgery population, with women manifesting a greater affinity for delirious and men for cognitive decompensation; (4) most existing research within this domain of study is either purely descriptive or anecdotal: of 46 studies reviewed, only 18, or 39.1% of the total published output, were of sufficient methodologic rigor to allow for scientifically valid effect-size computations. The implications of these findings for future research are discussed

Variations and inter-relationship in outcome from emergency admissions in England: a retrospective analysis of Hospital Episode Statistics from 2005-2010.

BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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

Muslim civil society in eastern and western contexts

Contemporary political discourses are replete with references to civil society, which is generally perceived to be a key element of modern society. However, there are varying views on what constitutes civil society. The rule of law- ensuring the equal treatment of all-is generally considered to be a necessary condition for its successful operation. In some opinions, civil society is integral to ideas of liberalism historically emanating from the Enlightenment and cannot be separated from dominant Western views of liberty, individualism, and citizenship (Chambers & Kymlicka, 2002). Such a notion of civil society has led some theorists to declare that it is alien to Islamic values and cannot be adopted into Muslim societies (e.g., Mardin, 1995). However, others disagree with this position (e.g., Hanafi, 2002; Sachedina, 2001; Sajoo, 2004).1