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Transvaginal polytetrafluoroethylene nylon uppers medical procedures regarding pelvic body organ prolapse: 1-year clinical results.
780, 95%CI 1.184-2.677) and ISTH-DIC score (OR = 2.705, 95%CI 1.108-6.606). Using Cox multivariate analysis, factors associated with long-term mortality were delta SOFA (Hazard Ratio (HR) =1.558, 95%CI 1.298-1.870), ISTH-DIC score (HR = 1.381, 95%CI 1.049-1.817), hepatic dysfunction (HR = 7.653, 95%CI 2.031-28.842) and Charlson co-morbidity index (HR = 1.330, 95%CI 1.041-1.699). CONCLUSION The worsening of organ dysfunctions during the first three days of ICU admission as well as intraoperative coagulation disturbances (increased ISTH-DIC score) are independently associated with short and long-term mortality. Co-morbidities (Charlson co-morbidity index) and post-operative hepatic dysfunction were independently associated with long term mortality. Early perioperative bundle strategies should be evaluated in order to improve patient's survival in this specific situation.Nonobstetric surgery during pregnancy occurs in 1% to 2% of pregnant women. Physiologic changes during pregnancy may have an impact when anesthesia is needed. Anesthetic agents commonly used during pregnancy are not associated with teratogenic effects in clinical doses. Surgery-related risks of miscarriage and prematurity need to be elucidated with well-designed studies. Recommended practices include individualized use of intraoperative fetal monitoring and multidisciplinary planning to address the timing and type of surgery, anesthetic technique, pain management, and thromboprophylaxis. Emergency procedures should be performed immediately and elective surgery should be deferred during pregnancy.OBJECTIVE The objective of this study was to examine how pre-Affordable Care Act (ACA) state-level Medicaid expansions affect dual enrollment and utilization of Veterans Health Administration (VA) and Medicaid-funded care. RESEARCH DESIGN We employed difference-in-difference analysis to determine the association between pre-ACA Medicaid expansions in New York and Arizona in 2001 and VA utilization. Participants' dual enrollment in Medicaid and VA, the distribution of their annual hospital admissions and emergency department (ED) visits between VA and Medicaid were dependent variables. Milciclib research buy We controlled for age, race, sex, disease burden, distance to VA facilities and income-based eligibility for VA services. MEASURES Secondary data collected from 1999 to 2006 in 2 states expanding Medicaid and 3 demographically similar nonexpansion states. We obtained residency, enrollment and utilization data from VA's Corporate Data Warehouse and Medicaid Analytic Extract files. RESULTS For low-income Veterans, Medicaid expansion was associated with increased dual enrollment of 4.87 percentage points (99% confidence interval 4.48-5.25), a 4.63-point decline in VA proportion of admissions (-5.87 to -3.38), and a 11.70-point decrease in the VA proportion of ED visits (-13.06 to -10.34). Results also showed increases in the number of total (VA plus Medicaid) annual per-capita hospitalizations and ED visits among the group of VA enrollees most likely to be eligible for expansion. CONCLUSIONS This study shows slight usage shifts when Veterans gain access to non-VA care. It highlights the need to overcome care-coordination challenges among VA patients as states implement ACA Medicaid expansion and policymakers consider additional expansions of public health insurance programs such as Medicare-for-All.BACKGROUND State policies to optimize prescriber use of Prescription Drug Monitoring Programs (PDMPs) have proliferated in recent years. Prominent policies include comprehensive mandates for prescriber use of PDMP, laws allowing delegation of PDMP access to office staff, and interstate PDMP data sharing. Evidence is limited regarding the effects of these policies on adverse opioid-related hospital events. OBJECTIVE The objective of this study was to assess the effects of 3 PDMP policies on adverse opioid-related hospital events among patients with prescription opioid use. RESEARCH DESIGN We examined 2011-2015 data from a large national commercial insurance database of privately insured and Medicare Advantage patients from 28 states with fully operating PDMPs by the end of 2010. We used a difference-in-differences framework to assess the probabilities of opioid-related hospital events and association with the implementation of PDMP policies. The analysis was conducted for adult patients with any prescription opioid use, a subsample of patients with long-term prescription opioid use, and stratified by older (65+) versus younger patients. RESULTS Comprehensive use mandates were associated with a relative reduction in the probability of opioid-related hospital events by 28% among patients with any opioid and 21% among patients with long-term opioid use. Such reduction was greater (in relative terms) among older patients despite the lower rate of these events among older than younger patients. Delegate laws and interstate data sharing were associated with limited change in the outcome. CONCLUSION Comprehensive PDMP use mandates were associated with meaningful reductions in opioid-related hospital events among privately insured and Medicare Advantage adults with prescription opioid use.BACKGROUND Building nursing research data repositories with the goal of comparing and synthesizing results across numerous studies and public sharing of data is still in early stages of development. OBJECTIVES We describe the process of using common data elements to build a data repository for research addressing self-management of chronic conditions. Issues in the development of common data elements, lessons learned in the creation of a combined dataset across seven studies of different chronic condition populations, and recommendations for creating and sharing harmonized nursing research datasets are provided. METHODS In 2014, at initiation of a National Institutes of Health-funded Center of Excellence in Self-Management Research, our center investigators defined a set of common data elements (CDEs) for use in future center-funded pilot studies consisting of populations having different chronic conditions with the intent to combine the study datasets. Over the next 4 years, center investigators were provided with standardized codebooks and data collection protocols for applying the common data elements and data storage.
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