Determinants of adverse events in hospitals--the potential role of patient safety culture.

This study investigated two contributing factors in predicting adverse events in hospital settings. We approached this issue using the statistical procedure of hierarchical linear modeling to test for multilevel relationships. We found that the resource intensity of the presenting case was related to the severity level of negative incidents in hospital settings in a large metropolitan center.

Lower extremity peripheral arterial disease in individuals with coronary artery disease: prognostic importance, care gaps, and impact of therapy.

Background: Our objective was to examine the effect of concomitant lower extremity peripheral arterial disease (PAD) on long-term prognosis and pharmacotherapy in patients with coronary artery disease (CAD).

Methods: Prospective cohort study enrolling all patients with angiographically proven CAD between April 1, 2000, and December 31, 2004, in Alberta, Canada.

Results: Of 28,649 patients (mean age 64 years) with CAD, 2509 (9%) had a physician-assigned diagnosis of lower extremity PAD.

An administrative data merging solution for dealing with missing data in a clinical registry: adaptation from ICD-9 to ICD-10.

Background: We have previously described a method for dealing with missing data in a prospective cardiac registry initiative. The method involves merging registry data to corresponding ICD-9-CM administrative data to fill in missing data 'holes'. Here, we describe the process of translating our data merging solution to ICD-10, and then validating its performance.

Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis.

Context: Observational studies have suggested an association between active smoking and the incidence of type 2 diabetes.

Objective: To conduct a systematic review with meta-analysis of studies assessing the association between active smoking and incidence of type 2 diabetes.

Data Sources: A search of MEDLINE (1966 to May 2007) and EMBASE (1980 to May 2007) databases was supplemented by manual searches of bibliographies of key retrieved articles, reviews of abstracts from scientific meetings, and contact with experts.

Early risk of stroke after transient ischemic attack: a systematic review and meta-analysis.

Background: Recent observational studies suggest that the risk for stroke may be high in the first 90 days after transient ischemic attack (TIA). This finding may, however, not be consistent across existing studies assessing stroke risk after TIA. The objectives of our study were to conduct a systematic review and meta-analysis of observational studies estimating the risk of stroke at 2, 30, and 90 days after TIA and to explore clinical and methodological factors that may explain variability in findings across studies.

Coronary dominance and prognosis of patients with acute coronary syndrome.

Background: A number of studies have identified the number of diseased vessels to be an important determinant of survival in patients with acute coronary syndrome (ACS). It is unknown if coronary dominance has an impact on prognosis of these patients. We hypothesized that the prognosis of patients with ACS with left dominance (LD) would be worse than that of patients with right or mixed dominance.

Cross-national comparative performance of three versions of the ICD-10 Charlson index.

Objective: The Charlson comorbidity index has been widely used for risk adjustment in outcome studies using administrative health data. Recently, 3 International Statistical Classification of Diseases, Tenth Revision (ICD-10) translations have been published for the Charlson comorbidities. This study was conducted to compare the predictive performance of these versions (the Halfon, Sundararajan, and Quan versions) of the ICD-10 coding algorithms using data from 4 countries.

Prevalence of chronic kidney disease and survival among aboriginal people.

Globally, it is known that the incidence of end-stage renal disease is higher among Aboriginals, but it is unknown whether this is due to an increased prevalence of chronic kidney disease or other unidentified factors. We studied 658,664 people of non-First Nations and 14,989 people of First Nations and found that the age- and sex-adjusted prevalence of chronic kidney disease was significantly higher among those of non-First Nations compared to those of First Nations (67.5 versus 59.

Determining geographic areas and populations with timely access to cardiac catheterization facilities for acute myocardial infarction care in Alberta, Canada.

Background: This study uses geographic information systems (GIS) as a tool to evaluate and visualize the general accessibility of areas within the province of Alberta (Canada) to cardiac catheterization facilities. Current American and European guidelines suggest performing catheterization within 90 minutes of the first medical contact. For this reason, this study evaluates the populated places that are within a 90 minute transfer time to a city with a catheterization facility.

Real-world replication of randomized controlled trial results for carotid endarterectomy.

Background: The efficacy of carotid endarterectomy (CE) has been shown in randomized clinical trials (RCTs), but doubts remain about whether the results can be replicated in routine clinical practice, especially in asymptomatic patients for whom the absolute risk reduction shown in the trials is small. In particular, a low rate of short-term adverse events is required for the long-term benefits of CE to accrue over time.

Objective: To determine whether the incidence of short-term adverse events after CE met the standards established by the major RCTs and those recommended by major clinical practice guidelines.

Patient satisfaction: evaluating the success of hospital ward redesign.

Patients who were moved from a traditional medical ward to a new state-of-the-art medical ward were surveyed regarding their perceptions of quality during their hospitalization. Respondents rated the environment of the state-of-the-art facility, as well as the overall quality of their hospital stay, more positively. However, fewer differences in perceptions of the quality of the broader hospital environment and little difference in the perceived quality of staff-patient interactions were found.

Mitral insufficiency and morbidity and mortality in left ventricular dysfunction.

Background: Mitral insufficiency is known to occur in a substantial proportion of patients with heart failure. Its relationship with morbidity and mortality is poorly described.

Methods: The mortality and hospitalization for heart failure were retrospectively examined in patients who underwent baseline echocardiography in the Studies Of Left Ventricular Dysfunction (SOLVD) treatment and prevention trials.

Clinical in-stent restenosis with bare metal stents: is it truly a benign phenomenon?

Objective: In-stent restenosis (ISR) remains an important problem following percutaneous coronary intervention (PCI). Although it is generally believed that patients with ISR present with stable angina, this has not been well characterized. The aim of this study was to define the incidence, predictors, timing and clinical presentation of patients with ISR requiring repeat catheterization.

Administrative data outperformed single-day chart review for comorbidity measure.

Objective: The purpose of this article is to compare the Charlson comorbidity index derived from a rapid single-day chart review with the same index derived from administrative data to determine how well each predicted inpatient mortality and nosocomial infection.

Design: Cross-sectional study.

Setting: The study was conducted in the context of the Swiss Nosocomial Infection Prevalence (SNIP) study in six hospitals, canton of Valais, Switzerland, in 2002 and 2003.

Opinions on chelation therapy in patients undergoing coronary angiography: cross-sectional survey.

Background: Chelation therapy is frequently used by patients for the treatment of coronary artery disease. However, relatively little is known about patient attitudes and beliefs that underlie the use of this treatment. The aim of the present study was to document patients' opinions and beliefs about health care decision making, physician and patient communication and relationships, and reasons for using or not using chelation therapy as treatment for coronary artery disease.

Exploring the treatment-risk paradox in coronary disease.

Background: The cause of the "treatment-risk paradox" reported for patients with coronary disease is unknown; however, determining the factors that contribute to this paradox is essential to properly design quality improvement interventions.

Methods: Prospective cohort study enrolling consecutive patients with angiographically proved coronary disease between February 1, 2004, and November 30, 2005, in Alberta.

Results: One month after an angiogram, statins were being taken by 2436 (62.

Injury mortality rates in Native and non-Native children: a population-based study.

Objectives: To examine injury mortality rates in Native and non-Native children in the province of Alberta, Canada, over a 10-year period, temporal trends in injury mortality rates (Native vs. non-Native), as well as relative risks of injury mortality (Native vs. non-Native) by injury mechanism and intent, were calculated.

Lipid-lowering therapy and outcomes in heart failure.

Lipid-lowering therapy, particularly with statins, reduces the risk of cardiovascular mortality; however, there is uncertainty about their efficacy in patients with heart failure, including those without coronary artery stenosis. A clinical database was studied to determine whether lipid-lowering therapy is associated with improved survival in persons with heart failure-with or without concomitant coronary artery stenosis. During an 8-year period, 6060 people with a history of heart failure underwent coronary angiography.

Glycemic control and use of the insulin sliding scale in hospitalized patients with diabetes.

This study assessed the extent of use of the subcutaneous insulin sliding scale (ISS) with hospitalized medical patients and examined the association between ISS use and glucose control. Despite some concerns about efficacy and suitability, the ISS is often used in the hospital studied. Researchers reviewed records of patients with a secondary diagnosis of diabetes who were admitted to the medical teaching unit of a tertiary care hospital.

Living alone, patient sex and mortality after acute myocardial infarction.

Background: Psychosocial factors, including social support, affect outcomes of cardiovascular disease, but can be difficult to measure. Whether these factors have different effects on mortality post-acute myocardial infarction (AMI) in men and women is not clear.

Objective: To examine the association between living alone, a proxy for social support, and mortality postdischarge AMI and to explore whether this association is modified by patient sex.

Clinical and medication profiles stratified by household income in patients referred for diabetes care.

Background: Low income individuals with diabetes are at particularly high risk for poor health outcomes. While specialized diabetes care may help reduce this risk, it is not currently known whether there are significant clinical differences across income groups at the time of referral. The objective of this study is to determine if the clinical profiles and medication use of patients referred for diabetes care differ across income quintiles.

Defining the optimal treatment of locally advanced esophageal cancer: a systematic review and decision analysis.

Background: The objective of this study was to combine systematic review and decision analytic techniques to determine the optimal treatment strategy for patients with locally advanced esophageal cancer.

Methods: We performed a systematic review of all randomized trials of patients with locally advanced esophageal cancer that included one of the following strategies compared with surgery alone: chemoradiotherapy followed by surgery, chemotherapy followed by surgery, or surgery with adjuvant chemoradiotherapy. Using the estimates of relative risk for mortality and overall quality of life we constructed a decision model.

A comprehensive view of sex-specific issues related to cardiovascular disease.

Cardiovascular disease (CVD) is the leading cause of mortality in women. In fact, CVD is responsible for a third of all deaths of women worldwide and half of all deaths of women over 50 years of age in developing countries. The prevalence of CVD risk factor precursors is increasing in children.

Loop diuretics in the management of acute renal failure: a systematic review and meta-analysis.

Background: Loop diuretics are commonly used in critically ill patients with acute renal failure (ARF), but their effect on clinical outcome remains uncertain. We systematically reviewed the literature comparing loop diuretics with control in the management of ARF.

Methods: Studies were identified by search of MEDLINE, EMBASE, and the Cochrane Controlled Clinical Trials Register, and review of proceedings from selected scientific meetings and clinical trial registries, and bibliographies of retrieved citations.