67 research outputs found
Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial
Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme
Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial
BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme
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CLIMATE CHANGE AND ECOSYSTEM IMPACTS ASSOCIATED WITH SHIFTS IN THE MID-LATITUDE STORM TRACK IN THE WESTERN UNITED STATES
One of the more robust 21st century projections from the most recent Intergovernmental Panel on Climate Change report (IPCC AR4) is a northward shift in the mean location of the Northern Hemisphere storm track. In the western United States, cool-season precipitation provides most of the water for domestic and industrial consumption, irrigation and power generation. In addition, winter precipitation is particularly effective in recharging soil moisture; as a result, it provides a strong control on the productivity of vegetation and on wildfire. Consequently, there is great interest in understanding 1) how changes in the storm track influence regional climate; 2) spatial and temporal variability in its impact; 3) how well general circulation models simulate the regional climate dynamics that bring precipitation to the West; and 4) whether errors in climate simulation might impact assessment of ecological changes. In order to investigate climate change in the western United States associated with shifts in the storm track, I analyzed the relationship between climate and the Northern Annular Mode (NAM). When the storm track is displaced to the north, there is an earlier transition to warm-season circulation patterns and weather conditions. However, the relationship between the winter NAM and climate is not stable over time. Further analysis identified changes in the correlations between the NAM and tree-ring width, precipitation and temperatures associated with changes in the phase of the Atlantic Multidecadal Oscillation and Pacific Decadal Oscillation. Examining 18 of the IPCC AR4 coupled climate models demonstrated cool-season precipitation errors approaching 300% over western North America. These errors are related to difficulties in representing orography, given the coarse resolution of models, and they may influence the quality of precipitation projections into the future. A simple test using the Köppen classification system found that these precipitation errors lead to underestimating the area of the United States in dryland ecosystem types by up to 89% and consequently allowed for much greater expansion of dryland in the future than is actually likely. These studies suggest that the West is likely to experience greater drought in the future. However, no single tool can yet quantify that change
Nevada State Climate Office Quarterly Report October-December 2019
Quarterly Report and Outlook for notable weather and climate in Nevada through October-December 2019. English Version
Nevada State Climate Office Drought Report February 2022
This report was created by the Nevada State Climate Office to provide a statewide drought summary for February 2022
Nevada State Climate Office Drought Report March 2022
This report was created by the Nevada State Climate Office to provide a statewide drought summary for March 2022
Nevada State Climate Office Quarterly Report January-March 2020
Quarterly Report and Outlook for notable weather and climate in Nevada through January-March 2020. English Version
Nevada State Climate Office Quarterly Report July-September 2019
Quarterly Report and Outlook for notable weather and climate in Nevada through July-September 2019. English Version
Nevada State Climate Office Drought Report June 2021
This report was created by the Nevada State Climate Office to provide a statewide drought summary for June 2021
Nevada State Climate Office Quarterly Report April-June 2020
Quarterly Report and Outlook for notable weather and climate changes in Nevada through April to June 2020. English Version
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