1,721,089 research outputs found
An assessment of failure to rescue derived from routine NHS data as a nursing sensitive patient safety indicator (report to Policy Research Programme)
No full textObjectives: This study aims to assess the potential for deriving 2 mortality based failure to rescue indicators and a proxy measure, based on exceptionally long length of stay, from English hospital administrative data by exploring change in coding practice over time and measuring associations between failure to rescue and factors which would suggest indicators derived from these data are valid.Design: Cross sectional observational study of routinely collected administrative data.Setting: 146 general acute hospital trusts in England.Participants: Discharge data from 66,100,672 surgical admissions (1997 to 2009).Results: Median percentage of surgical admissions with at least one secondary diagnosis recorded increased from 26% in 1997/8 to 40% in 2008/9. The failure to rescue rate for a hospital appears to be relatively stable over time: inter-year correlations between 2007/8 and 2008/9 were r=0.92 to r=0.94. No failure to rescue indicator was significantly correlated with average number of secondary diagnoses coded per hospital. Regression analyses showed that failure to rescue was significantly associated (p<0.05) with several hospital characteristics previously associated with quality including staffing levels. Higher medical staffing (doctors + nurses) per bed and more doctors relative to the number of nurses were associated with lower failure to rescue. Conclusion: Coding practice has improved, and failure to rescue can be derived from English administrative data. The suggestion that it is particularly sensitive to nursing is not clearly supported. Although the patient population is more homogenous than for other mortality measures, risk adjustment is still required
Is " failure to rescue" derived from administrative data in England a nurse sensitive patient safety indicator for surgical care? Observational study
No full textBackground: '. Failure to rescue' - death after a treatable complication - is used as a nursing sensitive quality indicator in the USA. It is associated with the size of the nursing workforce relative to patient load, for example patient to nurse ratio, although assessments of nurse sensitivity have not previously considered other staff groups. This study aims to assess the potential to derive failure to rescue and a proxy measure, based on long length of stay, from English hospital administrative data. By exploring change in coding practice over time and measuring associations between failure to rescue and factors including staffing, we assess whether two measures of failure to rescue are useful nurse sensitive indicators. Design: Cross sectional observational study of routinely collected administrative data. Participants: Discharge data from 66,100,672 surgical admissions to 146 general acute hospital trusts in England (1997-2009). Results: Median percentage of surgical admissions with at least one secondary diagnosis recorded increased from 26% in 1997/1998 to 40% in 2008/2009. Regression analyses showed that mortality based failure to rescue rates were significantly associated (p<0.05) with several hospital characteristics previously associated with quality, including staffing levels. Lower rates of failure to rescue were associated with a greater number of nurses per bed and doctors per bed in a bivariate analysis. Higher total clinically qualified staffing (doctors. +. nurses) per bed and a higher number of doctors relative to the number of nurses were both associated with lower mortality based failure to rescue in the fully adjusted analysis (p<0.05); however, the extended stay based measure showed the opposite relationship. Conclusion: Failure to rescue can be derived from English administrative data and may be a valid quality indicator. This is the first study to assess the association between failure to rescue and medical staffing. The suggestion that it is particularly sensitive to nursing is not clearly supported, nor is the suggestion that the number of patients with an extended hospital stay is a good proxy.</p
A Nationwide study on trends in hospital admissions for major cardiovascular events and procedures among people with and without diabetes in England, 2004-2009
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Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
No full text“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
No full textWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
No full textWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
The surgical epidemiology of frailty in the colorectal cancer population
No full textThe purpose of this thesis was to examine the surgical epidemiology of frailty in the colorectal cancer (CRC) population.
In order to achieve this, firstly I have explored the current literature for the use of frailty definitions and associated outcomes as a background to this research work. A lack of a universal, operational definition for frailty was found and this presents an issue in the management planning of these patients. The magnitude of CRC-frailty as a problem has been demonstrated using incidence and prevalence. The impact of CRC-frailty has been scrutinised by a methodical investigation of adverse outcomes, who may or may not undergo resectional surgery.
Thus, the logical next step and indeed, the key pillar to this thesis, has been to create and validate a frailty assessment risk prediction tool that has superior discriminatory power compared to current frailty measurements. This is an entirely novel endeavour in that: Big Data from a healthcare administrative dataset has been used, it is the largest cohort of this type of patients in a study that has ever been documented in the scientific literature and, it has been developed by the use of robust and complex, numerous iterations of multiple logistic regression. This is a unique and sizeable contribution to the scientific body of evidence and has the potential to hugely benefit clinical practice.
Further, I have analysed the variation in healthcare utilisation by the frail in order to obtain an understanding of the pressure on healthcare services and inform public spending. The literature about prehabilitation, as a possible means to improve outcomes in this vulnerable group, has been investigated.
“Ageing is not lost youth but a new state of opportunity and strength” (Betty Friedan 1921-2006). To improve outcomes nationally, it is vital that we strengthen our understanding of CRC-frailty.Open Acces
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