Cluster-randomized trial to evaluate the effects of a quality improvement program on management of non-ST-elevation acute coronary syndromes: The European Quality Improvement Programme for Acute Coronary Syndromes (EQUIP-ACS).

Background: Registries have shown that quality of care for acute coronary syndromes (ACS) often falls below the standards recommended in professional guidelines. Quality improvement (QI) is a strategy to improve standards of clinical care for patients, but the efficacy of QI for ACS has not been tested in randomized trials.

Methods: We undertook a prospective, cluster-randomized, multicenter, multinational study to evaluate the efficacy of a QI program for ACS.

Improving the management of non-ST elevation acute coronary syndromes: systematic evaluation of a quality improvement programme European QUality Improvement Programme for Acute Coronary Syndrome: the EQUIP-ACS project protocol and design.

Background: Acute coronary syndromes, including myocardial infarction and unstable angina, are important causes of premature mortality, morbidity and hospital admissions. Acute coronary syndromes consume large amounts of health care resources, and have a major negative economic and social impact through days lost at work, support for disability, and coping with the psychological consequences of illness. Several registries have shown that evidence based treatments are under-utilised in this patient population, particularly in high-risk patients.

Recalibration of risk prediction models in a large multicenter cohort of admissions to adult, general critical care units in the United Kingdom.

Objective: To assess the performance of published risk prediction models in common use in adult critical care in the United Kingdom and to recalibrate these models in a large representative database of critical care admissions.

Design: Prospective cohort study.

Setting: A total of 163 adult general critical care units in England, Wales, and Northern Ireland, during the period of December 1995 to August 2003.

Assessment and optimization of mortality prediction tools for admissions to pediatric intensive care in the United kingdom.

Objective: To assess the Pediatric Risk of Mortality (PRISM, PRISM III-12, and PRISM III-24) systems and the Pediatric Index of Mortality (PIM and PIM2) systems for use in comparing the risk-adjusted mortality of children after admission for pediatric intensive care in the United Kingdom.

Methods: All PICUs in the United Kingdom were invited to participate. Predicted probability of PICU mortality was calculated using the published algorithms for PIM, PIM2, and PRISM and compared with observed mortality.

Winter excess mortality in intensive care in the UK: an analysis of outcome adjusted for patient case mix and unit workload.

Objective: To investigate whether mortality in UK intensive care units is higher in winter than in non-winter and to explore the importance of variations in case mix and increased pressure on ICUs.

Design And Setting: Cohort study in 115 adult, general ICUs in England, Wales and Northern Ireland.

Patients And Participants: 113,389 admissions from 1995 to 2000.

Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery.

Objective: To assess whether a nurse led, flow monitored protocol for optimising circulatory status in patients after cardiac surgery reduces complications and shortens stay in intensive care and hospital.

Design: Randomised controlled trial.

Setting: Intensive care unit and cardiothoracic unit of a university teaching hospital.

Impact of exclusion criteria on case mix, outcome, and length of stay for the severity of disease scoring methods in common use in critical care.

Objective: To identify the exclusion criteria for the major severity of disease scoring methods in critical care and to investigate the impact of the exclusion criteria on the case mix, outcomes and length of stay for admissions to intensive care units (ICUs) in England, Wales and Northern Ireland.

Design: Cohort study-analysis of prospectively collected data.

Setting: 127 adult, general (mixed medical/surgical) ICUs in England, Wales and Northern Ireland.

Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance.

Background: Intervention to reduce abdominal aortic aneurysm (AAA) expansion and optimization of screening intervals would improve current surveillance programs. The aim of this study was to characterize AAA growth in a national cohort of patients with AAA both overall and by cardiovascular risk factors.

Methods And Results: In this study, 1743 patients were monitored for changes in AAA diameter by ultrasonography over a mean follow-up of 1.

Characteristics and outcome for admissions to adult, general critical care units with acute severe asthma: a secondary analysis of the ICNARC Case Mix Programme Database.

Introduction: This report describes the case mix, outcome and activity (duration of intensive care unit [ICU] and hospital stay, inter-hospital transfer, and readmissions to the ICU) for admissions to ICUs for acute severe asthma, and investigates the effect of case mix factors on outcome.

Methods: We conducted a secondary analysis of data from a high-quality clinical database (the Intensive Care National Audit and Research Centre [ICNARC] Case Mix Programme Database) of 129,647 admissions to 128 adult, general critical care units across England, Wales and Northern Ireland over the period 1995-2001.

Results: Asthma accounted for 2152 (1.

Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database.

Introduction: The present paper describes the methods of data collection and validation employed in the Intensive Care National Audit & Research Centre Case Mix Programme (CMP), a national comparative audit of outcome for adult, critical care admissions. The paper also describes the case mix, outcome and activity of the admissions in the Case Mix Programme Database (CMPD).

Methods: The CMP collects data on consecutive admissions to adult, general critical care units in England, Wales and Northern Ireland.

Detection, management, and prospects for the medical treatment of small abdominal aortic aneurysms.

Small abdominal aortic aneurysms, up to 5.5 cm in diameter, are very common. Ultrasonography is the most cost-effective method of detecting these aneurysms and keeping them under surveillance, because the natural history is 1 of continued expansion.

Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland.

Objective: To investigate the numbers, clinical characteristics, resource use, and outcomes of admissions who met precise clinical and physiologic criteria for severe sepsis (as defined in the PROWESS trial) in the first 24 hrs in the intensive care unit.

Design: Observational cohort study, with retrospective analysis of prospectively collected data.

Setting: Ninety-one adult general intensive care units in England, Wales, and Northern Ireland between 1995 and 2000.

Simplifying a prognostic model: a simulation study based on clinical data.

Prognostic models are designed to predict a clinical outcome in individuals or groups of individuals with a particular disease or condition. To avoid bias many researchers advocate the use of full models developed by prespecifying predictors. Variable selection is not employed and the resulting models may be large and complicated.