Measuring quality of care with routine data: avoiding confusion between performance indicators and health outcomes

Objective To investigate the impact of factors outside the control of primary care on performance indicators proposed as measures of the quality of primary care. Design Multiple regression analysis relating admission rates standardised for age and sex for asthma, diabetes, and epilepsy to socioeconomic population characteristics and to the supply of secondary care resources. Setting 90 family health services authorities in England, 1989-90 to 1994-5. Results At health authority level socioeconomic characteristics, health status, and secondary care supply factors explained 45% of the variation in admission rates for asthma, 33% for diabetes, and 55% for epilepsy. When health authorities were ranked, only four of the 10 with the highest age-sex standardised admission rates for asthma in 1994-5 remained in the top 10 when allowance was made for socioeconomic characteristics, health status, and secondary care supply factors. There was also substantial year to year variation in the rates. Conclusion Health outcomes should relate to crude rates of adverse events in the population. These give the best indication of the size of a health problem. Performance indicators, however, should relate to those aspects of care which can be altered by the staff whose performance is being measured

Gaia Data Release 1. Cross-match with external catalogues - Algorithm and results

Although the Gaia catalogue on its own will be a very powerful tool, it is the combination of this highly accurate archive with other archives that will truly open up amazing possibilities for astronomical research. The advanced interoperation of archives is based on cross-matching, leaving the user with the feeling of working with one single data archive. The data retrieval should work not only across data archives, but also across wavelength domains. The first step for seamless data access is the computation of the cross-match between Gaia and external surveys. The matching of astronomical catalogues is a complex and challenging problem both scientifically and technologically (especially when matching large surveys like Gaia). We describe the cross-match algorithm used to pre-compute the match of Gaia Data Release 1 (DR1) with a selected list of large publicly available optical and IR surveys. The overall principles of the adopted cross-match algorithm are outlined. Details are given on the developed algorithm, including the methods used to account for position errors, proper motions, and environment; to define the neighbours; and to define the figure of merit used to select the most probable counterpart. Statistics on the results are also given. The results of the cross-match are part of the official Gaia DR1 catalogue.Comment: 18 pages, 8 figures. Accepted for publication by A&

Studying the evolution of AGB stars in the Gaia epoch

We present asymptotic giant branch (AGB) models of solar metallicity, to allow the interpretation of observations of Galactic AGB stars, whose distances should be soon available after the first release of the Gaia catalogue. We find an abrupt change in the AGB physical and chemical properties, occurring at the threshold mass to ignite hot bottom burning,i.e. $3.5M_{\odot}$. Stars with mass below $3.5 M_{\odot}$ reach the C-star stage and eject into the interstellar medium gas enriched in carbon , nitrogen and $^{17}O$. The higher mass counterparts evolve at large luminosities, between $3\times 10^4 L_{\odot}$ and $10^5 L_{\odot}$. The mass expelled from the massive AGB stars shows the imprinting of proton-capture nucleosynthesis, with considerable production of nitrogen and sodium and destruction of $^{12}C$ and $^{18}O$. The comparison with the most recent results from other research groups are discussed, to evaluate the robustness of the present findings. Finally, we compare the models with recent observations of galactic AGB stars, outlining the possibility offered by Gaia to shed new light on the evolution properties of this class of objects.Comment: 21 pages, 11 figure, 3 tables, accepted for publication in MNRAS (2016 July 11

A systematic review of criteria used to report complications in soft tissue and oncologic surgical clinical research studies in dogs and cats.

ObjectiveTo evaluate reporting of surgical complications and other adverse events in clinical research articles describing soft tissue and oncologic surgery in dogs and cats.Study designSystematic literature review.SampleEnglish-language articles describing soft tissue and oncologic surgeries in client-owned dogs and cats published in peer-reviewed journals from 2013 to 2016.MethodsCAB, AGRICOLA, and MEDLINE databases were searched for eligible articles. Article characteristics relevant to complications were abstracted and summarized, including reported events, definitions, criteria used to classify events according to severity and time frame, and relevant citations.ResultsOne hundred fifty-one articles involving 10 522 animals were included. Canine retrospective case series of dogs predominated. Ninety-two percent of articles mentioned complications in study results, but only 7.3% defined the term complication. Articles commonly described complications according to time frame and severity, but terminology and classification criteria were highly variable, conflicting between studies, or not provided. Most (58%) reported complications could have been graded with a published veterinary adverse event classification scheme, although common intraoperative complications were notable exceptions.ConclusionDefinitions and criteria used to classify and report soft tissue and oncologic surgical complications are often absent, incomplete, or contradictory among studies.Clinical significanceLack of consistent terminology contributes to inadequate communication of important information about surgical complications. Standardization of terminology and consistency in severity scoring will improve comparative evaluation of clinical research results

Contextualized Treatment in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year after Discharge

Objective To evaluate the effect of providing a greater percentage of therapy as contextualized treatment on acute traumatic brain injury (TBI) rehabilitation outcomes. Design Propensity score methods are applied to the TBI-Practice-Based Evidence (TBI-PBE) database, a database consisting of multi-site, prospective, longitudinal observational data. Setting Acute inpatient rehabilitation. Participants Patients enrolled in the TBI-PBE study (n=1843), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, receiving their first IRF admission in the US, and consented to follow-up 3 and 9 months post discharge from inpatient rehabilitation. Interventions Not applicable. Main Outcome Measures Participation Assessment with Recombined Tools-Objective- -17, FIMTM Motor and Cognitive scores, Satisfaction with Life Scale and Patient Health Questionnaire-9. Results Increasing the percentage of contextualized treatment during inpatient TBI rehabilitation leads to better outcomes, specifically in regard to community participation. Conclusions Increasing the proportion of treatment provided in the context of real-life activities appears to have a beneficial impact on outcome. Although the effect sizes are small, the results are consistent with other studies supporting functional-based interventions effecting better outcomes. Furthermore, any positive findings, regardless of size or strength, are endorsed as important by consumers (survivors of TBI). While the findings do not imply that decontextualized treatment should not be used, when the therapy goal can be addressed with either approach, the findings suggest that better outcomes may result if the contextualized approach is used

Like-Triple Diabetes as First Manifestation of MODY2 in an Overweight Teenager With Transient Multiple Antibodies. Diabetes Care 2014; 37: e66-e67

Ctr Referencia Estadual Assistencia Ao Diabet & E, Salvador, BA, BrazilUniversidade Federal de São Paulo, Ctr Diabet, São Paulo, BrazilUniversidade Federal de São Paulo, Ctr Diabet, São Paulo, BrazilWeb of Scienc

Clinicopathological characteristics of histiocytic sarcoma affecting the central nervous system in dogs.

BackgroundHistiocytic sarcoma affecting the central nervous system (CNS HS) in dogs may present as primary or disseminated disease, often characterized by inflammation. Prognosis is poor, and imaging differentiation from other CNS tumors can be problematic.ObjectiveTo characterize the clinicopathological inflammatory features, breed predisposition, and survival in dogs with CNS HS.AnimalsOne hundred two dogs with HS, 62 dogs with meningioma.MethodsRetrospective case series. Records were reviewed for results of cerebrospinal fluid (CSF) analysis, CBC, treatment, and outcome data.ResultsPredisposition for CNS HS was seen in Bernese Mountain Dogs, Golden Retrievers, Rottweilers, Corgis, and Shetland Sheepdogs (P ≤ .001). Corgis and Shetland Sheepdogs had predominantly primary tumors; Rottweilers had exclusively disseminated tumors. Marked CSF inflammation was characteristic of primary rather than disseminated HS, and neoplastic cells were detected in CSF of 52% of affected dogs. Increased neutrophil to lymphocyte ratios were seen in all groups relative to controls (P <.008) but not among tumor subtypes. Definitive versus palliative treatment resulted in improved survival times (P < .001), but overall prognosis was poor.Conclusions and clinical importanceClinicopathological differences between primary and disseminated HS suggest that tumor biological behavior and origin may be different. Corgis and Shetland Sheepdogs are predisposed to primary CNS HS, characterized by inflammatory CSF. High total nucleated cell count and the presence of neoplastic cells support the use of CSF analysis as a valuable diagnostic test. Prognosis for CNS HS is poor, but further evaluation of inflammatory mechanisms may provide novel therapeutic opportunities

Individuals with prediabetes identified by HbA1c undergoing coronary angiography have worse cardiometabolic profile than those identified by fasting glucose

Background: Type 2 diabetes mellitus has well known deleterious effects on coronary artery disease (CAD). the role of milder hyperglycemic states such as prediabetes (PD) on CAD is debatable. Glycated hemoglobin (HbA1c) has recently been advocated as a diagnostic tool for diabetes mellitus (DM) and PD. This study aims to assess the cardiometabolic risk profile and coronary lesions of patients with PD undergoing coronary angiography identified either by fasting plasma glucose (FPG) or HbA1c levels.Methods: We studied 514 individuals without previously known glucose disturbances. Their glycemic status was assessed by FPG and HbA1c (HPLC) and classified according to ADA guidelines, using each parameter independently, as having normal glucose tolerance (N), PD, or DM. CAD was defined as stenosis greater than 50% in one major coronary vessel or branch. Framingham score was calculated.Results: Subjects with PD had a similar frequency of CAD compared do N individuals by both FPG (61 vs. 59.3%) and HbA1c (55.4 vs 61.2%) (p non-significant for linear-by-linear association). PD individuals identified by FPG had worse HOMA2B (mean [95% CI] 65.4 [60.9-69.9] vs. 76.6 [71.4-81.9]) and HOMA2-IR (1.10 [0.98-1.22] vs. 0.80 [0.72-0.89]) when compared to N controls. PD individuals identified by HbA1c had higher frequency of Framingham risk above 20% (25.4 vs 11.8%), arterial hypertension (87.8 vs 72.6%), and dyslipidemia (83.8 vs 72%) compared to N individuals. PD associated with an increased number of coronary lesions only when diagnosed by HbA1c (median [interquartile interval] 2 [0-4] PD versus 1 [0-3.75] N, p = 0.03 for trend).Conclusions: HbA1c was more effective than FPG in identifying individuals with PD associated with high cardiovascular risk profile in a sample of individuals undergoing coronary angiography.Universidade Federal de São Paulo, Endocrinol Unit, Diabet Ctr, São Paulo, BrazilUniv Estado Bahia, Dept Ciencias Vida, Colegiado Med, BR-41150000 Salvador, BA, BrazilCtr Endocrinol Estado Bahia CEDEBA, Salvador, BA, BrazilUniversidade Federal de São Paulo, Endocrinol Unit, Diabet Ctr, São Paulo, BrazilWeb of Scienc

Avalanche boron fusion by laser picosecond block ignition with magnetic trapping for clean and economic reactor

After the very long consideration of the ideal energy source by fusion of the protons of light hydrogen with the boron isotope 11 (boron fusion HB11) the very first two independent measurements of very high reaction gains by lasers basically opens a fundamental breakthrough. The non-thermal plasma block ignition with extremely high power laser pulses above petawatt of picosecond duration in combination with up to ten kilotesla magnetic fields for trapping has to be combined to use the measured high gains as proof of an avalanche reaction for an environmentally clean, low cost and lasting energy source as potential option against global warming. The unique HB11 avalanche reaction is are now based on elastic collisions of helium nuclei (alpha particles) limited only to a reactor for controlled fusion energy during a very short time within a very small volume.Comment: 11 pages, 6 figures, Submitted to Proceedings 2nd Symposium High Power Laser Science and Engineering, 14-18 MARCH 2016, Suzhou/Chin

Deliveries by caesarean sections on request of women: legal-medical evidence

Introduction: In Italy the use of caesarean delivery has a rising trend moving away from European standards appeared on Euro-Peristat on maternal and child health, presenting the highest percentage of use of this procedure with significant regional differences. This study have analyzed the most recent data of a Sicilian reality about normal delivery and caesarean sections carried out in a hospital situated in Messina (Italy). Materials and methods: A total number of 1,573 medical records from 1st January 2011 to 31st December 2013 were analyzed and data gathered were statistically examined to describe general and specific parameters of the sample making use of Epi Info 7.1.4 software (CDC Atlanta – USA). Chi-square test was used to show any statistic differences among studied population. Results: Overall data showed that were carried out 38.27% of spontaneous deliveries, 7.06% of induced labor, and 54.67% of caesarean deliveries. There were no significant statistical differences between recourse to caesarean section and vaginal delivery in relation to nationality, age, level of education and/or work. The enrolled group, based on the parameters examined, was divided into appropriate caesarean section, in 79.49% of cases, inappropriate in 7.20% (mother’s request) and unjustified in 13.31% (with no indication, incomplete medical record). An examination of the anesthetic medical records showed that the caesarean section was considered to be urgent in 31.74% of the cases; however in 17.92% of these cases there is no information in the medical records justifying the use of emergency procedures. Conclusion: The reported data from the study that we conducted, lead to medical-legal and juridical considerations, especially as regards the use of caesarean delivery on the woman request. The complexity of the phenomenon requires the development of a variety of intervention strategies, not only for issues related to the reduction of health care costs, but also with regard to the clinical risk management and medical legal aspects related to the several profiles of professional responsibility