Journal of evaluation in clinical practice
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Multicenter Study
Accuracy of administrative coding in identifying hip and knee primary replacements and revisions.
Hospital discharge notes can be used to identify rates of revisions in hip and knee arthroplasty surgeries if such administrative codes are accurate. In order to trust the data taken from the hospital discharge abstracts it is important to assess their reliability. The purpose of this study is to evaluate the accuracy of the administrative coding used in measuring revision rates for total hip and knee arthroplasty. ⋯ This study demonstrates that ICD-9CM and ICD-10CM codes can be used accurately when analysing hip and knee arthroplasty. This study was conducted in a large tertiary academic centre where a significant number of records analysts are employed; therefore, there should be little inter-hospital error. These results should help researchers understand the potential accuracy of classification for these procedures as part of an audit or quality assurance project.
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Multicenter Study
A new perspective on blame culture: an experimental study.
Recently, a range of different institutions worldwide has identified the 'culture of blame' and the fear of being punished as the principal reasons for the lack of medical error reporting and, consequently, of their reiteration and of the poor quality of patient care. Despite much theoretical debate, there currently exist no experimental studies that directly investigate the presence and pervasiveness of the blame and punishment culture in health care contexts. In order to document empirical evidence for this culture in medicine and nursing, we conducted an experimental study asking physicians and nurses to express their fear of blame or punishment in the context of having made an error that would cause: (i) no; (ii) mild; (iii) severe consequences; or (iv) the death of the patient. ⋯ Given the relevance of these factors in medical error reporting and the evidence that they are so deep-seated not only in senior professionals, but also in students, we argue that an educational approach, together with an organization-based intervention, is desirable to shape cultural attitudes of health care providers in the direction of a 'safety culture'.
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Falls among hospitalized patients are an important patient safety issue. In particular, the incidence of falls and risk of related injuries among the elderly are particularly high. Because the epidemiology of falls is not well scrutinized in Japanese long-term care wards, we evaluated the incidence and risk factors of falls in this setting. ⋯ Many patients on long-term care wards in Japan were elderly and experienced falls during their hospital stay, with consequent injuries. Taking into account the risk factors identified, we need to devise effective strategies to prevent falls and related injuries.
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Studies have challenged the validity and underlying measurement model of the physical and mental component summary scores of the 36-item Short-Form Health Survey in, for example the elderly and people with neurological disorders. However, it is unclear to what extent these observations translate to physical and mental component summary scores derived from the 12-item short form (SF-12) of the 36-item Short-Form Health Survey. This study evaluated the construct validity of the SF-12 in elderly people and people with Parkinson's disease (PD) and stroke. ⋯ These observations challenge the validity and interpretability of SF-12 scores among the elderly, people with PD and stroke survivors. The standard orthogonally weighted SF-12 scoring algorithm is cautioned against. Instead, when the assumed two-dimensional structure is supported in the data, oblique scoring algorithms appear preferable. Failure to consider basic scoring assumptions may yield misleading results.
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Current perspectives concerning clinical decision making favour inclusion of patient preference for therapy. This exploratory study aimed to forge introductory insights into patient preference for outpatient-based rehabilitation after total knee replacement (TKR). ⋯ Patient global satisfaction is similarly high across different modes of outpatient rehabilitation despite differences in perceived benefits. The association between satisfaction and preference potentially indicates that provided the service is deemed high quality, the actual mode of therapy offered is less important to this patient population. Research is required, however, to establish the relationship between preference and outcome, the stability of preference across time, and the effect of multiple rehabilitation exposures on preference. For now, the quality of current uni-modal programmes could be enhanced by incorporation of features typically associated with alternative modes.