Is use of multiple antihypertensive agents to achieve blood pressure control associated with adverse pregnancy outcomes?

Objective: We assessed whether requiring >1 medication for blood pressure control is associated with adverse pregnancy outcomes.

Study Design: Retrospective cohort of 974 singletons with chronic hypertension at a tertiary care center. Subjects on >1 antihypertensive agent were compared with those on one agent <20 weeks gestational age with results stratified by average blood pressure (<140/90 and ⩾140/90 mm Hg) from prenatal visits.

The effect of treatments on the shear modulus of human hair measured by the single fiber torsion pendulum.

Previous studies with the single fiber torsion pendulum have alluded to the ability of this device to selectively measure different regions of a fiber, namely, the core and the sheath. This selective ability of the torsion pendulum was explored further as a means of better understanding treatments effects. First, a substantial reduction in shear modulus was caused by simply abrading the hair fiber surface to remove the cuticle layer.

Fournier's gangrene exposed.

Necrotising fasciitis is a condition associated with significant morbidity and mortality. Fournier's gangrene is a variant of the condition affecting the perineum. Although presentation is usually acute, it may also present in an insidious manner.

Mortality and length of stay in a veterans affairs hospital and private sector hospitals serving a common market.

Objective: To compare severity-adjusted in-hospital mortality and length of stay (LOS) in a Veterans Administration (VA) hospital and private sector hospitals serving the same health care market.

Design: Retrospective cohort study.

Setting: A large VA hospital and 27 private sector hospitals in the same metropolitan area.

Reliability of birth certificate data: a multi-hospital comparison to medical records information.

Objective: To examine the reliability of birth certificate data and determine if reliability differs between teaching and nonteaching hospitals.

Methods: We compared information from birth certificates and medical records in 33,616 women admitted for labor and delivery in 1993-95 to 20 hospitals in Northeast Ohio. Analyses determined the agreement for 36 common data elements, and the sensitivity, specificity, and positive and negative predictive values of birth certificate data, using medical record data as a "gold standard.

The accuracy of diagnosis and procedural codes for patients with upper GI hemorrhage.

Background: Little is known about the accuracy of diagnostic and procedural codes for common gastrointestinal (GI) conditions and endoscopic procedures.

Methods: Eight hundred eighty-two patients with upper GI hemorrhage admitted in 1994 to 1 of 13 regional hospitals were studied. Based on endoscopy reports, the source of hemorrhage, performance of upper endoscopy and use of endoscopic therapy were determined, and we assessed the sensitivity and positive predictive value of discharge codes for measuring the source of hemorrhage and use of upper endoscopy.

Relationships between in-hospital and 30-day standardized hospital mortality: implications for profiling hospitals.

Objective: To examine the relationship of in-hospital and 30-day mortality rates and the association between in-hospital mortality and hospital discharge practices.

Data Sources/study Setting: A secondary analysis of data for 13,834 patients with congestive heart failure who were admitted to 30 hospitals in northeast Ohio in 1992-1994.

Design: A retrospective cohort study was conducted.

Differences in patient-reported processes and outcomes between men and women with myocardial infarction.

Objective: Previous research measuring differences in the care between men and women with myocardial infarction has focused on differences in procedure use and mortality. However, little is known about differences in processes and outcomes that are reported by patients, such as interpersonal processes of care and health status. Our goal was to measure differences in patient-reported measures for men and women who recently were hospitalized with myocardial infarction.

Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience.

Context: Little is known regarding outcomes after intravenous tissue-type plasminogen activator (IV tPA) therapy for acute ischemic stroke outside a trial setting.

Objective: To assess the rate of IV tPA use, the incidence of symptomatic intracerebral hemorrhage (ICH), and in-hospital patient outcomes throughout a large urban community.

Design: Historical prospective cohort study conducted from July 1997 through June 1998.

Racial differences in the utilization of oral anticoagulant therapy in heart failure: a study of elderly hospitalized patients.

To assess racial differences in the use of oral anticoagulant therapy for patients with heart failure, we conducted a cohort study of 30 hospitals in northeast Ohio. For 12,911 Medicare enrollees consecutively admitted in 1992 through 1994 with heart failure, crude and adjusted odds of being on oral anticoagulation were determined. The crude and adjusted odds of being African Americans on oral anticoagulant therapy relative to whites were 0.

Variations in risk-adjusted cesarean delivery rates according to race and health insurance.

Objective: To assess the association between race and insurance and Cesarean delivery rates after adjusting for clinical risk factors that increase the likelihood of cesarean delivery.

Design: Retrospective cohort study in 21 hospitals in northeast Ohio.

Subjects: 25,697 women without prior cesarean deliveries admitted for labor and delivery January 1993 through June 1995.

Patient assessments of hospital maternity care: a useful tool for consumers?

Objective: To examine three issues related to using patient assessments of care as a means to select hospitals and foster consumer choice-specifically, whether patient assessments (1) vary across hospitals, (2) are reproducible over time, and (3) are biased by case-mix differences.

Data Sources/study Setting: Surveys that were mailed to 27,674 randomly selected patients admitted to 18 hospitals in a large metropolitan region (Northeast Ohio) for labor and delivery in 1992-1994. We received completed surveys from 16,051 patients (58 percent response rate).

Does length of hospital stay during labor and delivery influence patient satisfaction? Results from a regional study.

Objective: To examine the relationship between patients' satisfaction with hospital obstetric care, length of stay, and patients' perceived appropriateness of the length of stay.

Study Design: A cross-sectional study.

Patients And Methods: We surveyed 27,789 women (a 58% response rate) discharged after labor and delivery from 18 hospitals in a large metropolitan region from 1992 through 1994.

Community-wide assessment of intensive care outcomes using a physiologically based prognostic measure: implications for critical care delivery from Cleveland Health Quality Choice.

Study Objectives: To examine the applicability of a previously developed intensive care prognostic measure to a community-based sample of hospitals, and assess variations in severity-adjusted mortality across a major metropolitan region.

Design: Retrospective cohort study.

Setting: Twenty-eight hospitals with 38 ICUs participating in a community-wide initiative to measure performance supported by the business community, hospitals, and physicians.

Early endoscopy in upper gastrointestinal hemorrhage: associations with recurrent bleeding, surgery, and length of hospital stay.

Background: The impact of upper endoscopy in patients with upper gastrointestinal hemorrhage treated in community practice is unknown. Thus we examined the effectiveness of endoscopy performed within 24 hours of admission (early endoscopy).

Methods: Medical records of 909 consecutive hospitalized patients with upper gastrointestinal hemorrhage who underwent endoscopy at 13 hospitals in a large metropolitan area were reviewed.

Racial variation in the use of do-not-resuscitate orders.

Objective: To compare the use of do-not-resuscitate (DNR) orders in African-American and white patients using a large, multisite, community-based sample.

Measurements: Our sample included 90,821 consecutive admissions to 30 hospitals in a large metropolitan region with six nonsurgical conditions from 1993 through 1995. Demographic and clinical data were abstracted from medical records.

Endoscopic practice for upper gastrointestinal hemorrhage: differences between major teaching and community-based hospitals.

Background: Differences in endoscopic practice in major teaching and community hospitals are not known.

Methods: A total of 1031 consecutive patients discharged from 13 hospitals (4 major teaching, 9 others) in 1994 with upper gastrointestinal hemorrhage were studied. Data obtained from chart abstraction included endoscopic findings and therapy and selected outcomes.

Associations between the use of do-not-resuscitate orders and length of stay in patients with stroke.

Objectives: The study sought to describe the association between do-not-resuscitate (DNR) orders and length of hospital stay (LOS), and how the association varies according to in-hospital mortality, timing of the DNR order, and admission severity of illness.

Methods: The authors conducted a retrospective cohort analysis involving standardized review of patients' medical records. The study was performed at 30 acute care hospitals in a large metropolitan area.

Using hospital performance data in quality improvement: the Cleveland Health Quality Choice experience.

Background: Cleveland Health Quality Choice is a regional initiative to assess hospital performance which was implemented in 1989. The project developed and validated CHOICE, a severity adjustment system that includes diagnosis-specific models for medical, surgical, and obstetrical patients which are based on clinical data abstracted from patients' medical records.

Methodology: Since 1992 Cleveland Health Quality Choice has disseminated semi-annual reports that profile hospital mortality rates, lengths of stay, and cesarean section rates using the CHOICE severity adjustment models.