Browsing School, Graduate by Subject "Outcome Assessment (Health Care)"
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The Association of Statin Intake and Healing of Apical Periodontitis After Root Canal TreatmentThe aim of this study was to analyze the association between statin intake and apical periodontitis healing after root canal treatment. Patients who self-reported statin use during the treatment and patients who reported never taking statins were included. All who received treatment on a tooth with a periapical radiolucency in the Postgraduate Endodontics Clinic, University of Maryland School of Dentistry (2011-2014) were invited for a two to five-year follow-up examination. Sixty teeth were examined, in 30 patients taking statins and 30 not taking statins (control). Healing was determined using the periapical index. Two calibrated endodontists assessed outcomes blinded to preoperative status. Fisher's Exact Test (FET) showed a significant difference in healing at the two-year or greater follow-up in patients taking statins compared to those who did not (93.0% vs. 70%, FET, p=.02). This study revealed a significant association between statin intake and healing of apical periodontitis after root canal treatment.
Comparing Hospital-Onset Bacteremia to Central Line Associated Bloodstream Infection as a Hospital Quality MeasureBackground Central Line Associated Bloodstream Infections (CLABSI) rates are a benchmark for hospital quality despite problems with surveillance bias and inter-observer variability and subjectivity. The rate of Hospital-onset bacteremia (HOB) may offer significant advantages over CLABSI; including being more objective and un-biased. Methods We conducted a multisite cohort study via the Society for Healthcare Epidemiology of America (SHEA) research network to examine the relationship between HOB and CLABSI rates and compare ability of each to distinguish between hospitals. Hospitals reported total CLABSIs, central line days, HOBs, patient days, and total blood cultures performed for each ICU and completed a survey relating to CLABSI reporting. Mixed-effect Poisson regression was used to evaluate HOB as a predictor for CLABSI. Standardized infection ratios (SIR) for HOB and CLABSI for medical and neonatal ICUs were calculated using the pooled mean rates of the study sample as the benchmark. Results We obtained data for 79 ICUs from 15 hospitals within the US and Canada. From January 2012 to December 2013, 627 CLABSIs, 11 024 HOB, 464 224 central line days and 959 647 ICU patient days were reported. HOB was a strong predictor of CLABSI; a change in the rate of HOB of 1 predicted a relative change of 2.2% in CLABSI rate. Standardized infection ratios for HOB and CLABSI for medical and neonatal ICUs showed large confidence intervals that overlapped with each other for the CLABSI measure with 14 of 18 (77.7%) CLABSI 95% confidence intervals containing the null value of 1, compared to only 6 of 18 (33.3%) HOB 95% confidence intervals (p-value 0.02, fisher's exact test). CLABSI reporting requires 15.8 hours of nurse time per month. Conclusions In this multicenter study, HOB rates were strongly predictive of CLABSI rates. HOB can be collected automatically saving nurse time and provide better discrimination hospital quality than CLABSI.
Outcomes of Older Adults Admitted to a Level I Trauma CenterBackground: The outcomes of injury and the associated risk factors among older adults are poorly understood. Objective: To examine the associations of pre-existing medical conditions (PMCs) and mechanism of injury (MOI) with the outcomes and to estimate the impact of injury upon long-term mortality of older adults. Methods: Injured older adults admitted to the Shock Trauma Center, University of Maryland Medical Center, between July 1, 1995 and November 30, 2008 were followed until the end of 2008. Logistic regression and Cox proportional hazard models were fit to analyze the outcomes. Standardized mortality ratios (SMRs) and relative survival ratios (RSRs), comparing the observed to the expected proportion of Maryland older adult population were calculated. Results: Among 6,162 injured older adults, 27% developed in-hospital complications, 15% (N=918) died within 30 days of admission, and 43% (N=2,323) of those who were discharged died during the follow-up. Hypertension, prior myocardial infarction, congestive heart failure, and chronic obstructive pulmonary disease (COPD) were associated with increased odds of in-hospital complications, with adjusted ORs ranging from 1.2 (95% confidence interval (CI): 1.1-1.5) to 2.2 (95% CI: 1.6-3.0). Hypertension was associated with lower odds (OR=0.7, 95% CI: 0.6-0.8) while COPD with increased odds of 30-day mortality (OR=1.5, 95% CI: 1.1-2.1). All PMCs, except hypertension, were associated with increased hazard of death after discharge (adjusted hazard ratios range: 1.1-1.7). MVC injuries were associated with higher odds of complications than fall injuries (adjusted ORs range: 1.3-2.2). Older adults with MVC injuries had lower odds of 30-day mortality (OR=0.8, 95% CI: 0.6-0.9) and a lower hazard of death after discharge (HR=0.6, 95% CI: 0.6-0.7). SMR was 4.5 (95% CI: 4.1-4.8) at 6 months and 1.4 (95% CI: 1.2-1.5) between 5-10 years after discharge. The RSR was 91.0% (95% CI: 90.1%-91.9%) at 6 months and 72.6% (95% CI: 69.3%-75.8%) at 10 years after discharge. Conclusions: The associations between PMCs and outcomes are disease-specific. Older adults sustaining MVC injuries have a better survival compared to those sustaining fall injuries. The impact of injury on mortality is most evident during the first 6 months after discharge and can last as long as 10 years.