Despite limited evidence from randomized trials, perioperative treatment with beta-blockers is now widely advocated. We assessed the use of and their association in-hospital mortality in routine clinical practice.We conducted a retrospective cohort study patients 18 years age or older who underwent major noncardiac surgery 2000 2001 at 329 hospitals throughout United States. used propensity-score matching to adjust for differences between received those did not receive such therapy compared...

To assess trends in number of hospitalizations, outcomes, and costs severe sepsis the United States.Temporal study using Nationwide Inpatient Sample.Adult patients with (defined as a diagnosis organ dysfunction) diagnosed between 2003 2007.We determined weighted frequency hospitalized sepsis. We calculated age- sex-adjusted population-based mortality rates for per 100,000 population also used logistic regression to adjust in-hospital patient characteristics. inflation-adjusted...

A LEADING CAUSE of morbidity and mortality among US adults, resulting in more than 1 million annual hospital admissions accounting for $10.5 billion aggregate costs. 1,2Given its public health significance, pneumonia has been the target quality improvement activities nearly 2 decades.This began with publication clinical practice guidelines early 1990s, 3 was followed by a series statewide national initiatives, 4 recently included reporting pay-for-performance programs led Joint Commission...

Background: The relationship between surgeon and hospital procedure volumes clinical outcomes in total joint arthroplasty has long fueled a debate over regionalization of care. At the same time, numerous policy initiatives are focusing on improving quality by incentivizing surgeons to adhere evidence-based processes purpose this study was evaluate independent contributions volume, standardization care short-term postoperative resource utilization lower-extremity arthroplasty. Methods: An...

BACKGROUND Children may be hospitalized at general hospitals or freestanding children's hospitals. Knowledge about how inpatient care differs these is important to inform national research and quality efforts. OBJECTIVE To describe the volume characteristics of pediatric hospitalizations acute in United States. DESIGN, PATIENTS, AND SETTING Cross‐sectional study States among children <18 years, excluding in‐hospital births, using Healthcare Cost Utilization Project's 2012 Kids' Inpatient...

Small clinical trials have shown that noninvasive ventilation (NIV) is efficacious in reducing the need for intubation and improving short-term survival among patients with severe exacerbations of chronic obstructive pulmonary disease (COPD). Little known, however, about effectiveness NIV routine practice.To compare outcomes COPD treated to those invasive mechanical (IMV).This was a retrospective cohort study 25 628 hospitalized exacerbation who received on first or second hospital day at...

<h3>Importance</h3> Meta-analyses have suggested that initiating pulmonary rehabilitation after an exacerbation of chronic obstructive disease (COPD) was associated with improved survival, although the number patients studied small and heterogeneity high. Current guidelines recommend enroll in hospital discharge. <h3>Objective</h3> To determine association between initiation within 90 days discharge 1-year survival. <h3>Design, Setting, Patients</h3> This retrospective, inception cohort...

The hospitalist model is rapidly altering the landscape for inpatient care in United States, yet evidence about clinical and economic outcomes of by hospitalists derived from a small number single-hospital studies examining practices few physicians.We conducted retrospective cohort study 76,926 patients 18 years age or older who were hospitalized between September 2002 June 2005 pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, acute exacerbation chronic...

OBJECTIVE Cystic fibrosis–related diabetes (CFRD) without fasting hyperglycemia (CFRD FH−) is not associated with microvascular or macrovascular complications, leading to controversy about the need for treatment. The Fibrosis Related Diabetes Therapy (CFRDT) Trial sought determine whether therapy improves BMI in these patients. RESEARCH DESIGN AND METHODS A three-arm multicenter randomized trial compared 1 year of premeal insulin aspart, repaglinide, oral placebo subjects cystic fibrosis who...

Acute exacerbation of chronic obstructive pulmonary disease (COPD) is 1 the 10 leading causes hospitalization among adults in United States.To evaluate quality care provided to patients hospitalized for acute exacerbations COPD and determine whether hospital or patient characteristics influence treatment.Retrospective cohort study.360 hospitals throughout States.69,820 COPD.Adherence diagnosis treatment recommendations contained guidelines produced by American College Physicians Chest...

The objective of this study was to evaluate trends in hospitalization, cost, and short-term outcomes acute respiratory failure (ARF) between 2001 2009 the United States.Using Nationwide Inpatient Sample we identified cases ARF based on International Classification for Diseases, Ninth Revision, Clinical Modification codes. We calculated weighted frequencies hospitalizations by year estimated population-adjusted incidence mortality rates. used logistic regression examine hospital rates over...

Osteoporosis affects 4-6 million (13%-18%) postmenopausal white women in the United States. Most studies to date on risk factors for osteoporosis have considered body mass index (BMI) only as a possible confounder. In this study, we assess direct relationship between BMI and osteoporosis.We conducted cross-sectional study among aged 50-84 years referred by their physicians bone mineral density (BMD) examination at Baystate Medical Center October 1998 September 2000. was determined prior BMD...

Although osteoporosis treatment can dramatically reduce fracture risk, rates of after hip remain low. In-hospital initiation recommended medications has improved outcomes in heart disease; hospitalization for may represent a similar opportunity improvement. The objective this study was to examine in-hospital with combination calcium and vitamin D (Cal+D) antiresorptive or bone-forming patients hospitalized fracturesObservational cohort.Three hundred eighteen hospitals the United...

Current guidelines recommend pulmonary rehabilitation (PR) after hospitalization for a chronic obstructive disease (COPD) exacerbation, but little is known about its adoption or factors associated with participation.

<b>Objectives</b> To examine the association between income inequality and risk of mortality readmission within 30 days hospitalization. <b>Design</b> Retrospective cohort study Medicare beneficiaries in United States. Hierarchical, logistic regression models were developed to estimate (measured at US state level) a patient's readmission, while sequentially controlling for patient, hospital, other state, patient socioeconomic characteristics. We considered 0.05 unit increase Gini coefficient...

Chinese translation Background: Adults who use wheelchairs have difficulty accessing physicians and receive less preventive care than their able-bodied counterparts. Objective: To learn about the accessibility of medical surgical subspecialist practices for patients with mobility impairment. Design: A telephone survey was used to try make an appointment a fictional patient obese hemiparetic, wheelchair, could not self-transfer from chair examination table. Setting: 256 endocrinology,...

Importance: Single-site studies have described an association between use of selective serotonin reuptake inhibitors (SSRIs) and adverse outcomes surgery.Multicenter including a broad range surgical procedures that explore rare outcomes, such as bleeding mortality, account for indications administration SSRIs are needed.Objective: To determine whether perioperative is associated with surgery in national sample patients.Design: Retrospective study patients 18 years or older who underwent...

Heart failure (HF) inpatient mortality prediction models can help clinicians make treatment decisions and researchers conduct observational studies; however, published have not been validated in external populations.We compared the performance of 7 that predict patients hospitalized with acute decompensated heart failure: 4 HF-specific developed from 3 clinical databases (ADHERE [Acute Decompensated Failure National Registry], EFFECT study [Enhanced Feedback for Effective Cardiac Treatment],...

Rationale: Although clinical trials have found that pulmonary rehabilitation (PR) can reduce the risk of readmissions after hospitalization for a chronic obstructive disease (COPD) exacerbation, less is known about PR’s impact in routine practice. Objectives: To evaluate association between initiation PR within 90 days discharge and rehospitalization(s). Methods: We analyzed retrospective cohort Medicare beneficiaries (66 years age or older) hospitalized COPD 2014 who survived at least 30...

Participation in physical activity during pregnancy may reduce the risk of maternal and fetal disorders. However, few studies have validated questionnaires for use pregnancy, a time characterized by different patterns than nonpregnancy. Therefore, aim this study was to assess validity reliability Kaiser Physical Activity Survey (KPAS) pregnancy.The KPAS, adapted from Baecke survey, designed specifically women. Unique features KPAS include assessment multiple domains (household/caregiving,...

Factors influencing gestational weight gain are incompletely understood, particularly among Hispanic women. We assessed medical, sociodemographic, behavioral, and psychosocial predictors of overall gain, as well gains below, within, or above the range recommended by Institute Medicine (IOM) within a prospective study 770 (predominantly Puerto Rican) prenatal care patients at large tertiary facility in Western Massachusetts. One third women gained range, 22% 45% range. In multivariate...