Variations in the quality of care of patients with acute myocardial infarction among Swiss university hospitals

Objectives. The objective of our study was to assess hospital variations in the quality of care delivered to acute myocardial infarction (AMI) patients among three Swiss academic medical centres. Design. Cross-sectional study. Setting. Three Swiss university hospitals. Study participants. We selected 1129 eligible patients discharged from these hospitals from 1 January to 31 December 1999, with a primary or secondary diagnosis code [International Classification of Diseases, 10th revision (ICD-10)] of AMI. We abstracted medical records for information on demographic characteristics, risk factors, symptoms, and findings at admission. We also recorded the main ECG and laboratory findings, as well as hospital and discharge management and treatment. We excluded patients transferred to another hospital and who did not meet the clinical definition of AMI. Main outcome measures. Percentage of patients receiving appropriate intervention as defined by six quality of care indicators derived from clinical practical guidelines. Results. Among 577 eligible patients with AMI in this study, the mean (SD) age was 68.2 (13.9), and 65% were male. In the assessment of the quality indicators we excluded patients who were not eligible for the procedure. Among cohorts of ‘ideal candidates' for specific interventions, 64% in hospital A and 73% in hospital C had reperfusion within 12 hours either with thrombolytics or percutaneous transluminal coronary angioplasty (P = 0.367). Further, in hospitals A, B, and C, respectively 97, 94, and 84% were prescribed aspirin during the initial hospitalization (P = 0.0002), and respectively 68, 91, and 75% received angiotensin converting enzyme inhibitors at discharge in the case of left ventricular systolic dysfunction (P = 0.003). Conclusions. Our results showed important hospital-to-hospital variations in the quality of care provided to patients with AMI between these three university hospital

Is readmission to hospital an indicator of poor process of care for patients with heart failure?

BACKGROUND: Controversy exists about the appropriateness of using readmission as an indicator of the quality of care. A study was undertaken to measure the validity and predictive ability of readmission in this context. METHODS: An evaluation study was performed in patients discharged alive with heart failure from three Swiss academic medical centres. Process quality indicators were derived from evidence based guidelines for the management and treatment of heart failure. Readmissions were calculated from hospital administrative data. The predictive ability of readmissions was evaluated using bivariate and multivariate analyses, and validity by calculating sensitivity, specificity, positive and negative predictive value, using process indicators as the "gold standard". RESULTS: Of 1055 eligible patients discharged alive, 139 (13.2%) were readmitted within 30 days. The adjusted odds ratio (OR) for absence of measurement of left ventricular function was 0.70 (95% CI 0.45 to 1.08) for readmissions. In patients with left ventricular systolic dysfunction, three dose categories of angiotensin converting enzyme inhibitor were examined using ordinal logistic regression. The adjusted OR for these categories was 1.07 (95% CI 0.56 to 2.06) for readmissions. When using process indicators as the gold standard to assess the validity of readmissions, sensitivity ranged from 0.08 to 0.17 and specificity from 0.86 to 0.93. CONCLUSIONS: Readmission did not predict and was not a valid indicator of the quality of care for patients with heart failure admitted to three Swiss university hospitals. [Authors]]]> Cardiac Output, Low ; Patient Readmission ; Quality Indicators, Health Care oai:serval.unil.ch:BIB_CA2C9037E755 2022-05-07T01:27:02Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_CA2C9037E755 Genèse et l'évolution de la grammaire psychologique en Russie Simonato, Elena info:eu-repo/semantics/conferenceObject inproceedings 2008 Actes du colloque "Structure de la proposition", pp. 217-134 Sériot, Patrick (ed.) fre https://serval.unil.ch/resource/serval:BIB_CA2C9037E755.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_CA2C9037E7556 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_CA2C9037E7556 info:eu-repo/semantics/submittedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_CA2DAB6E3398 2022-05-07T01:27:02Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_CA2DAB6E3398 Las "muertas de Ciudad Juárez": construcción e impacto cultural de un acontecimiento serial Kunz, Marco info:eu-repo/semantics/bookPart incollection 2016 Acontecimientos históricos y su productividad cultural en el mundo hispánico, pp. 137-156 Kunz, Marco (ed.) Bornet, Rachel (ed.) Girbés, Salvador (ed.) Schultheiss, Michel (ed.) info:eu-repo/semantics/altIdentifier/isbn/9783643802347 spa oai:serval.unil.ch:BIB_CA2DD7891699 2022-05-07T01:27:02Z openaire documents <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_CA2DD7891699 Late presentation to HIV care despite good access to health services: current epidemiological trends and how to do better. info:doi:10.4414/smw.2016.14348 info:eu-repo/semantics/altIdentifier/doi/10.4414/smw.2016.14348 info:eu-repo/semantics/altIdentifier/pmid/27544642 Darling, K.E. Hachfeld, A. Cavassini, M. Kirk, O. Furrer, H. Wandeler, G. info:eu-repo/semantics/review article 2016 Swiss medical weekly, vol. 146, pp. w14348 info:eu-repo/semantics/altIdentifier/eissn/1424-3997 urn:issn:0036-7672 <![CDATA[In 2014, there were 36.9 million people worldwide living with human immunodeficiency virus (PLWH), of whom 17.1 million did not know they were infected. Whilst the number of new human immunodeficiency virus (HIV) infections has declined globally since 2000, there are still regions where new infection rates are rising, and diagnosing HIV early in the course of infection remains a challenge. Late presentation to care in HIV refers to individuals newly presenting for HIV care with a CD4 count below 350 cells/µl or with an acquired immune deficiency syndrome (AIDS)-defining event. Late presentation is associated with increased patient morbidity and mortality, healthcare costs and risk of onward transmission by individuals unaware of their status. Further, late presentation limits the effectiveness of all subsequent steps in the cascade of HIV care. Recent figures from 34 countries in Europe show that late presentation occurs in 38.3% to 49.8% of patients newly presenting for care, depending on region. In Switzerland, data from patients enrolled in the Swiss HIV Cohort Study put the rate of late presentation at 49.8% and show that patients outside established HIV risk groups are most likely to be late presenters. Provider-initiated testing needs to be improved to reach these groups, which include heterosexual men and women and older patients. The aim of this review is to describe the scale and implications of late presentation using cohort data from Switzerland and elsewhere in Europe, and to highlight initiatives to improve early HIV diagnosis. The importance of recognising indicator conditions and the potential for missed opportunities for HIV testing is illustrated in three clinical case studies

Electron and Photon Scattering on Three-Nucleon Bound States

A big spectrum of processes induced by real and virtual photons on the 3He and 3H nuclei is theoretically investigated through many examples based on nonrelativistic Faddeev calculations for bound and continuum states. The modern nucleon-nucleon potential AV18 together with the three-nucleon force UrbanaIX is used. The single nucleon current is augmented by explicit pi- and rho-like two-body currents which fulfill the current continuity equation together with the corresponding parts of the AV18 potential. We also employ the Siegert theorem, which induces many-body contributions to the current operator. The interplay of these different dynamical ingredients in the various electromagnetic processes is studied and the theory is compared to the experimental data. Overall we find fair to good agreement but also cases of strong disagreement between theory and experiment, which calls for improved dynamics. In several cases we refer the reader to the work of other groups and compare their results with ours. In addition we list a number of predictions for observables in different processes which would challenge this dynamical scenario even more stringently and systematically.Comment: 154 pages, 80 figures includes as ps files, 21 additional figures as jpeg file

The Orphan Receptor CRF2-4 Is an Essential Subunit of the Interleukin 10 Receptor

The orphan receptor CRF2-4 is a member of the class II cytokine receptor family (CRF2), which includes the interferon receptors, the interleukin (IL) 10 receptor, and tissue factor. CRFB4, the gene encoding CRF2-4, is located within a gene cluster on human chromosome 21 that comprises three interferon receptor subunits. To elucidate the role of CRF2-4, we disrupted the CRFB4 gene in mice by means of homologous recombination. Mice lacking CRF2-4 show no overt abnormalities, grow normally, and are fertile. CRF2-4 deficient cells are normally responsive to type I and type II interferons, but lack responsiveness to IL-10. By ∼12 wk of age, the majority of mutant mice raised in a conventional facility developed a chronic colitis and splenomegaly. Thus, CRFB4 mutant mice recapitulate the phenotype of IL-10–deficient mice. These findings suggest that CRF2-4 is essential for IL-10–mediated effects and is a subunit of the IL-10 receptor

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

A pair production telescope for medium-energy gamma-ray polarimetry

We describe the science motivation and development of a pair production telescope for medium-energy (∼5–200 MeV) gamma-ray polarimetry. Our instrument concept, the Advanced Energetic Pair Telescope (AdEPT), takes advantage of the Three-Dimensional Track Imager, a low-density gaseous time projection chamber, to achieve angular resolution within a factor of two of the pair production kinematics limit (∼0.6° at 70 MeV), continuum sensitivity comparable with the Fermi-LAT front detector (<3 × 10−6 MeV cm−2 s−1 at 70 MeV), and minimum detectable polarization less than 10% for a 10 mCrab source in 106 s.submittedVersionFil: Hunter, Stanley D. National Aeronautics and Space Administration. Goddard Space Flight Center; Estados Unidos de América.Fil: Bloser, Peter F. University of New Hampshire. Institute for the Study of Earth, Oceans, and Space. Space Science Center; Estados Unidos de América.Fil: Depaola, Gerardo Osvaldo. Universidad Nacional de Córdoba. Facultad de Matemática, Astronomía y Física; Argentina.Fil: Dion, Michael P. Department of Energy. Office of Science. Pacific Northwest National Laboratory; Estados Unidos de América.Fil: DeNolfo, Georgia A. National Aeronautics and Space Administration. Goddard Space Flight Center; Estados Unidos de América.Fil: Hanu, Andrei. National Aeronautics and Space Administration. Goddard Space Flight Center; Estados Unidos de América.Fil: Iparraguirre, Lorenzo Marcos. Universidad Nacional de Córdoba. Facultad de Matemática, Astronomía y Física; Argentina.Fil: Legere, Jason. University of New Hampshire. Institute for the Study of Earth, Oceans, and Space. Space Science Center; Estados Unidos de América.Fil: Longo, Francesco. Università Degli Studi de Trieste. Dipartimento di fisica; Italia.Fil: McConnell, Mark L. University of New Hampshire. Institute for the Study of Earth, Oceans, and Space. Space Science Center; Estados Unidos de América.Fil: Nowicki, Suzanne F. National Aeronautics and Space Administration. Goddard Space Flight Center; Estados Unidos de América.Fil: Nowicki, Suzanne F. University of Maryland, Baltimore County. Department of Physics; Estados Unidos de América.Fil: Ryan, James M. University of New Hampshire. Institute for the Study of Earth, Oceans, and Space. Space Science Center; Estados Unidos de América.Fil: Son, Seunghee. National Aeronautics and Space Administration. Goddard Space Flight Center; Estados Unidos de América.Fil: Son, Seunghee. University of Maryland, Baltimore County. Department of Physics; Estados Unidos de América.Fil: Stecker, Floyd W. National Aeronautics and Space Administration. Goddard Space Flight Center; Estados Unidos de América.Física de Partículas y Campo