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

Active trachoma and community use of sanitation, Ethiopia.

OBJECTIVE: To investigate, in Amhara, Ethiopia, the association between prevalence of active trachoma among children aged 1-9 years and community sanitation usage. METHODS: Between 2011 and 2014, prevalence of trachoma and household pit latrine usage were measured in five population-based cross-sectional surveys. Data on observed indicators of latrine use were aggregated into a measure of community sanitation usage calculated as the proportion of households with a latrine in use. All household members were examined for clinical signs, i.e. trachomatous inflammation, follicular and/or intense, indicative of active trachoma. Multilevel logistic regression was used to estimate prevalence odds ratios (OR) and 95% confidence intervals (CI), adjusting for community, household and individual factors, and to evaluate modification by household latrine use and water access. FINDINGS: In surveyed areas, prevalence of active trachoma among children was estimated to be 29% (95% CI: 28-30) and mean community sanitation usage was 47% (95% CI: 45-48). Despite significant modification (p < 0.0001), no pattern in stratified ORs was detected. Summarizing across strata, community sanitation usage values of 60 to < 80% and ≥ 80% were associated with lower prevalence odds of active trachoma, compared with community sanitation usage of < 20% (OR: 0.76; 95% CI: 0.57-1.03 and OR: 0.67; 95% CI: 0.48-0.95, respectively). CONCLUSION: In Amhara, Ethiopia, a negative correlation was observed between community sanitation usage and prevalence of active trachoma among children, highlighting the need for continued efforts to encourage higher levels of sanitation usage and to support sustained use throughout the community, not simply at the household level

Prediction of Low Community Sanitation Coverage Using Environmental and Sociodemographic Factors in Amhara Region, Ethiopia.

This study developed and validated a model for predicting the probability that communities in Amhara Region, Ethiopia, have low sanitation coverage, based on environmental and sociodemographic conditions. Community sanitation coverage was measured between 2011 and 2014 through trachoma control program evaluation surveys. Information on environmental and sociodemographic conditions was obtained from available data sources and linked with community data using a geographic information system. Logistic regression was used to identify predictors of low community sanitation coverage (< 20% versus ≥ 20%). The selected model was geographically and temporally validated. Model-predicted probabilities of low community sanitation coverage were mapped. Among 1,502 communities, 344 (22.90%) had coverage below 20%. The selected model included measures for high topsoil gravel content, an indicator for low-lying land, population density, altitude, and rainfall and had reasonable predictive discrimination (area under the curve = 0.75, 95% confidence interval = 0.72, 0.78). Measures of soil stability were strongly associated with low community sanitation coverage, controlling for community wealth, and other factors. A model using available environmental and sociodemographic data predicted low community sanitation coverage for areas across Amhara Region with fair discrimination. This approach could assist sanitation programs and trachoma control programs, scaling up or in hyperendemic areas, to target vulnerable areas with additional activities or alternate technologies

Association of community sanitation usage with soil-transmitted helminth infections among school-aged children in Amhara Region, Ethiopia.

BACKGROUND: Globally, in 2010, approximately 1.5 billion people were infected with at least one species of soil-transmitted helminth (STH), Ascaris lumbricoides, Trichuris trichiura, hookworm (Ancylostoma duodenale and Necator americanus). Infection occurs through ingestion or contact (hookworm) with eggs or larvae in the environment from fecal contamination. To control these infections, the World Health Organization recommends periodic mass treatment of at-risk populations with deworming drugs. Prevention of these infections typically relies on improved excreta containment and disposal. Most evidence of the relationship between sanitation and STH has focused on household-level access or usage, rather than community-level sanitation usage. We examined the association between the proportion of households in a community with latrines in use and prevalence of STH infections among school-aged children. METHODS: Data on STH prevalence and household latrine usage were obtained during four population-based, cross-sectional surveys conducted between 2011 and 2014 in Amhara, Ethiopia. Multilevel regression was used to estimate the association between the proportion of households in the community with latrines in use and presence of STH infection, indicated by > 0 eggs in stool samples from children 6-15 years old. RESULTS: Prevalence of STH infection was estimated as 22% (95% CI: 20-24%), 14% (95% CI: 13-16%), and 4% (95% CI: 4-5%) for hookworm, A. lumbricoides, and T. trichiura, respectively. Adjusting for individual, household, and community characteristics, hookworm prevalence was not associated with community sanitation usage. Trichuris trichuria prevalence was higher in communities with sanitation usage ≥ 60% versus sanitation usage < 20%. Association of community sanitation usage with A. lumbricoides prevalence depended on household sanitation. Community sanitation usage was not associated with A. lumbricoides prevalence among households with latrines in use. Among households without latrines in use, A. lumbricoides prevalence was higher comparing communities with sanitation usage ≥ 60% versus < 20%. Households with a latrine in use had lower prevalence of A. lumbricoides compared to households without latrines in use only in communities where sanitation usage was ≥ 80%. CONCLUSIONS: We found no evidence of a protective association between community sanitation usage and STH infection. The relationship between STH infection and community sanitation usage may be complex and requires further study

Anemia and chronic kidney disease are associated with poor outcomes in heart failure patients

BACKGROUND: Chronic kidney disease (CKD) has been linked to higher heart failure (HF) risk. Anemia is a common consequence of CKD, and recent evidence suggests that anemia is a risk factor for HF. The purpose of this study was to examine among patients with HF, the association between CKD, anemia and inhospital mortality and early readmission. METHODS: We performed a retrospective cohort study in two Swiss university hospitals. Subjects were selected based the presence of ICD-10 HF codes in 1999. We recorded demographic characteristics and risk factors for HF. CKD was defined as a serum creatinine ≥ 124 956;mol/L for women and ≥ 133 μmol/L for men. The main outcome measures were inhospital mortality and thirty-day readmissions. RESULTS: Among 955 eligible patients hospitalized with heart failure, 23.0% had CKD. Twenty percent and 6.1% of individuals with and without CKD, respectively, died at the hospital (p < 0.0001). Overall, after adjustment for other patient factors, creatinine and hemoglobin were associated with an increased risk of death at the hospital, and hemoglobin was related to early readmission. CONCLUSION: Both CKD and anemia are frequent among older patients with heart failure and are predictors of adverse outcomes, independent of other known risk factors for heart failure

Methodological issues in observational studies of obesity and mortality

Obesity has important health hazards, and the epidemic seems to be growing in developed countries. There is scientific evidence for higher risk of earlier death among the obese. However, most evidence of the effects of obesity on mortality comes from observational studies. The aim of this manuscript is to review some of the most important issues in designing, analyzing and interpreting analytic studies of the effects of obesity on mortality. Key issues are clarity in the definition of the effect under study, confounding, measurement error and a phenomenon sometimes termed reverse causality in which obesity causes some diseases, but some of the diseases also affect adiposity and mortalit

Self-reported visual impairment, physical activity and all-cause mortality: The HUNT Study

Aims: To examine the associations of self-reported visual impairment and physical activity (PA) with all-cause mortality. Methods: This prospective cohort study included 65,236 Norwegians aged ⩾20 years who had participated in the Nord-Trøndelag Health Study (HUNT2, 1995−1997). Of these participants, 11,074 (17.0%) had self-reported visual impairment (SRVI). The participants’ data were linked to Norway’s Cause of Death Registry and followed throughout 2012. Hazard ratios and 95% confidence intervals (CI) were assessed using Cox regression analyses with age as the time-scale. The Cox models were fitted for restricted age groups (<60, 60−84, ⩾85 years). Results: After a mean follow-up of 14.5 years, 13,549 deaths were identified. Compared with adults with self-reported no visual impairment, the multivariable hazard ratios among adults with SRVI were 2.47 (95% CI 1.94–3.13) in those aged <60 years, 1.22 (95% CI 1.13–1.33) in those aged 60–84 years and 1.05 (95% CI 0.96–1.15) in those aged ⩾85 years. The strength of the associations remained similar or stronger after additionally controlling for PA. When examining the joint associations, the all-cause mortality risk of SRVI was higher for those who reported no PA than for those who reported weekly hours of PA. We found a large, positive departure from additivity in adults aged <60 years, whereas the departure from additivity was small for the other age groups. Conclusions: Adults with SRVI reporting no PA were associated with an increased all-cause mortality risk. The associations attenuated with age

A longitudinal study of physical activity and menstrual cycle characteristics in healthy Norwegian women – The Nord-Trøndelag Health Study

Background: Long menstrual cycles have been associated with anovulation, infertility and spontaneous abortion. Elite athletes have been found at risk of menstrual dysfunction. We evaluated the longitudinal association between leisure time physical activity (LTPA) and menstrual function in healthy non-athletic women. Methods: A population-based health survey (HUNT 1) was conducted during 1984-1986 in Nord-Trøndelag county, Norway, with follow-up in 1995-1997 (HUNT 2). The current study included 3,097 women, <45 years old in HUNT 2. LTPA was assessed by questionnaire in HUNT 1, and menstrual function by questionnaire in HUNT 2. Data focused on overall occurrence of menstrual disorders in the population. Results were adjusted for age, education, psychological health, smoking and alcohol intake. Additional analyses included BMI as a potential confounder. Results: The median cycle length was 30 days and median number of days bleeding was 5. In women with normal cycle length, mean (SD) cycle length and duration of bleeding was 29.3 (2.8) and 5.6 (1.7) respectively. Cycle length increased with higher frequency of LTPA for women >25 years old. Women, 20-25 years old at baseline who were active most days had increased odds of short cycles, more bleeding days and increased odds of having irregular cycles, OR=4.7; 95% CI = 1.2-18.0). Number of bleeding days decreased with longer duration (p<0.05) and higher intensity (p=0.065) in young women. Adjustment for BMI did not affect the results. Conclusion: Leisure time physical activity may affect menstrual function, although in our study, the results were modified by age

Outcomes and the quality of care for patients hospitalized with heart failure

[Abstract] OBJECTIVE: The purpose of this study was to determine whether process quality indicators derived from evidence-based guidelines for heart failure patients were associated with outcome indicators (hospital mortality and readmissions). DESIGN: A retrospective cohort-study among patients discharged with a primary or secondary International Classification of Disease, 10th revision (ICD-10) heart failure code from 1 January to 31 December 1999. SETTING: The study was implemented in three Swiss academic medical centers. STUDY PARTICIPANTS: Records of 1634 patients hospitalized with heart failure were abstracted. Demographic characteristics, risk factors, symptoms and findings at admission, and discharge characteristics were recorded. Main outcome measure. Process quality indicators were derived from evidence-based guidelines, related to appropriate management and treatment of heart failure patients. Hospital mortality was measured in a chart abstraction process. Thirty-day readmissions were calculated using administrative data from hospitals. RESULTS: Among the three hospitals, 1153 patients with heart failure were eligible for this study. Mean age was 75.3 years (standard deviation 12.7) and 45.7% of patients were female. Ventricular function (VF) was determined in 69% of patients. The adjusted odds-ratios (OR) for the VF not determined were 1.74 [95% confidence interval (CI) 1.06-2.84] for hospital mortality and 0.75 (95% CI 0.47-1.18) for 30-day readmissions. Among patients with left ventricular systolic dysfunction and no contraindication to angiotensin-converting enzyme inhibitor (ACEI), 54% were prescribed target-dose ACEI or angiotensin receptor blockers at discharge, 32% received ACEI at less then target dose, and 14% received no ACEI at discharge. Adjusted ORs (95% CI) for readmissions were 0.89 (0.28-2.84) for no ACEI and 1.17 (0.56-2.43) for less than target ACEI compared with target dose. CONCLUSIONS: Among patients with heart failure, the determination of VF was associated with hospital mortality. However, process indicators derived from evidence-based guidelines were not related to early readmissions in three Swiss university hospitals. [Authors]]]> Aged ; Heart Failure, Congestive ; Inpatients ; Outcome Assessment (Health Care) ; Quality of Health Care oai:serval.unil.ch:BIB_5C9DB98439FA 2022-05-07T01:18:41Z <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_5C9DB98439FA Le Christ au miroir de la photographie contemporaine (1981-2011) Dietschy, N. Université de Lausanne, Faculté des lettres info:eu-repo/semantics/doctoralThesis phdthesis 2012 <![CDATA[Depuis une trentaine d'années, les représentations de la figure de Jésus se sont multipliées en photographie. De la séquence narrative du photographe américain Duane Michals (Christ in New York, 1981) au chemin de croix de Wim Delvoye (Viae Crucis, 2006), en passant par la série I.N.R.I. (1997-98) de Bettina Rheims, les Photographies apocryphes (1994-98) d'Olivier Christinat, les Seven Bible Scenes (1998) de Rauf Mamedov, Ecce homo (1996-98) d'Elisabeth Ohlson, Jesus is my Homeboy (2003) de David LaChapelle ou encore South Soudan (2006) de Vanessa Beecroft, l'intérêt pour la figure christique dans le champ profane est incontestable. Le phénomène dépasse d'ailleurs les frontières géographiques, culturelles et confessionnelles.¦Cette thèse de doctorat réunit un important fonds iconographique qui démontre l'intérêt actuel pour la figure du Christ et la grande diversité des démarches et des profils des artistes. Cet important corpus est analysé selon trois perspectives. La première partie est consacrée au médium photographique, à ses liens étroits avec la sainte Face depuis le cliché du suaire de Turin en 1898, et depuis l'ambitieux projet photographique (1898) de Fred Holland Day qui incame le Christ dans ses nombreuses réinterprétations de la vie de Jésus.¦La deuxième partie de ce travail interroge l'emploi des formules iconographiques chrétiennes archétypales et questionne les références christiques utilisées par les artistes au travers de poses, d'attitudes, de gestes repris de chefs-d'oeuvre de l'art religieux, tant dans le domaine de la photographie d'art que dans la publicité ou la photographie de presse. L'usage du texte, la place des Ecritures dans les projets actuels sont aussi abordés, notamment autour de la question de la possibilité de raconter la vie de Jésus et des stratégies de mises en scène employées pour traduire les récits en images.¦Enfin, la dernière partie porte plus particulièrement sur les usages de la figure de Jésus, souvent alter ego de l'artiste, mais surtout porte-parole. À la suite des luttes socio- politiques des années 1970, la figure de Jésus est réinvestie par les minorités et Jésus incarne alors les combats d'artistes qui se réapproprient la représentation du Christ pour qu'elle corresponde à l'image qu'ils voient dans leur propre miroir (ex. Renee Cox, Yo Mama's Last Supper, 1996). Cet usage revendicateur, souvent doublé d'un goût non dissimulé pour la provocation (ex. Andres Serrano, Piss Christ, 1987), a souvent suscité la polémique. La question de la réception des oeuvres constitue un point essentiel de cette recherche qui tâche d'analyser la figure christique au miroir de la photographie contemporaine et qui conclut que le Christ est en réalité miroir des artistes eux-mêmes