The Netherlands journal of medicine
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Letter Case Reports
Dapsone for the treatment of chronic IgA vasculitis (Henoch-Schonlein).
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Comparative Study
The standardised mortality ratio is unreliable for assessing quality of care in rectal cancer.
The standardised mortality ratio (SMR) for rectal or anal cancer was above average in a large tertiary referral centre for locally advanced rectal cancer in the Netherlands. The aim of this study was to investigate whether the increased SMR was indeed related to poor quality of care or whether it could be explained by inadequate adjustment for case-mix factors. ⋯ The increased SMR appeared to be caused by the admission of patients who received palliative care only. Consequently, the SMR is unreliable for the assessment of quality of care in patients with rectal or anal cancer.
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The Early Warning Score (EWS) is used for early detection of deteriorating vital parameters and has been correlated with adverse outcomes. Unfortunately, neither its value on general wards nor the optimal cut-off value have been investigated. We aimed to find the optimal cut-off value for EWS on general wards, and investigated the possibility to raise this value from EWS ≥ 3 without compromising sensitivity too much. ⋯ Raising the EWS threshold to 4 on general wards in the hospital would lead to an unacceptable decrease in sensitivity. Therefore, we recommend that the pre-defined cut-off should remain 3, with the possibility to personalise the threshold.