Disparity In Duration Research Articles

PHP6 - Racial Disparity In Duration Of Patients' Visits To The Emergency Department: Teaching Versus Non-Teaching Hospitals

Racial disparity in duration of patients’ visits to emergency departments (EDs) have not been well documented. This study explores the racial disparity in duration of routine visits to EDs at teaching and non-teaching hospitals. Retrospective data analyses and multivariate regression analyses were performed to investigate the racial disparity in duration of routine ED visits at teaching and non-teaching hospitals. Duration for each visit was computed by taking the difference between admission and discharge times. The Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) were used in the analyses. The data include 4.3 million routine ED visits encountered in Arizona, Massachusetts, and Utah during 2008. SEDD provide detailed diagnoses, procedures, total charges, patient demographics, and admission and discharge time for each visit. We linked SEDD files with American Hospital Association Annual Survey Database, Trauma Information Exchange Program Database and Area Resource File to obtain hospital and area level characteristics. The mean duration for a routine ED visit was 238 minutes at teaching hospitals and 175 minutes at non-teaching hospitals. There were significant variations in duration of routine ED visits across race groups at teaching and non-teaching hospitals. The risk-adjusted results show that the mean duration of routine ED visits for black/African American and Asian patients when compared to visits for white patients was shorter by 10.0 and 3.4 percent, respectively, at teaching hospitals; and longer by 3.6 and 13.8 percent, respectively, at non-teaching hospitals. Hispanic patients experienced 8.7 percent longer ED stays when compared to white patients at non-teaching hospitals. There is significant racial disparity in the duration of routine ED visits, especially in non-teaching hospitals where non-white patients experience longer ED stays compared to white patients. The variation in duration of routine ED visits at teaching hospitals when compared to non-teaching hospitals was smaller across race groups.

Racial Disparity in Duration of Patient Visits to the Emergency Department: Teaching Versus Non-teaching Hospitals

Introduction:The sources of racial disparity in duration of patients’ visits to emergency departments (EDs) have not been documented well enough for policymakers to distinguish patient-related factors from hospital- or area-related factors. This study explores the racial disparity in duration of routine visits to EDs at teaching and non-teaching hospitals.Methods:We performed retrospective data analyses and multivariate regression analyses to investigate the racial disparity in duration of routine ED visits at teaching and non-teaching hospitals. The Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) were used in the analyses. The data include 4.3 million routine ED visits encountered in Arizona, Massachusetts, and Utah during 2008. We computed duration for each visit by taking the difference between admission and discharge times.Results:The mean duration for a routine ED visit was 238 minutes at teaching hospitals and 175 minutes at non-teaching hospitals. There were significant variations in duration of routine ED visits across race groups at teaching and non-teaching hospitals. The risk-adjusted results show that the mean duration of routine ED visits for Black/African American and Asian patients when compared to visits for white patients was shorter by 10.0 and 3.4%, respectively, at teaching hospitals; and longer by 3.6 and 13.8%, respectively, at non-teaching hospitals. Hispanic patients, on average, experienced 8.7% longer ED stays when compared to white patients at non-teaching hospitals.Conclusion:There is significant racial disparity in the duration of routine ED visits, especially in non-teaching hospitals where non-White patients experience longer ED stays compared to white patients. The variation in duration of routine ED visits at teaching hospitals when compared to non-teaching hospitals was smaller across race groups.

The Necessity of Nasal Layer Closure in Cleft Palate Repair

Sir:FigureWe read with keen interest the article entitled “Is Nasal Mucoperiosteal Closure Necessary in Cleft Palate Repair?” by Steinbacher et al. (Plast Reconstr Surg. 2011;127:768–773). This potentially groundbreaking concept of single-layer closure in the hard palate region offers a theoretical advantage of lesser midfacial growth disturbances. In addition, there is significant reduction in operating time. However, certain questions need to be clarified before incorporating this concept in “standard of care practice” for cleft palate patients. It is important for the authors to explain why they chose to perform single-layer palatal closure in this retrospective study. Was this group of patients having narrower cleft palatal widths to merit single-layer closure? This is pertinent, as the rate of palatal fistula formation does correlate with the cleft width and available palatal shelf width.1–3 The reason we suggest this selection bias is the considerable difference in surgical duration between the two groups (84 minutes for the single-layer closure group and 135 minutes in those with two-layer closure). Nasal mucosal elevation and closure alone in the hard palatal region is unlikely to account for such a disparity in duration in otherwise comparable group 1 patients. Thus, the application of the “null hypothesis” in this retrospective study without excluding the selection bias relating to palatal and cleft dimensions could have confounded the study results. Another issue relates to the management of lateral oronasal communication after mucoperiosteal flap mobilization in patients undergoing single-layer closure. This communication can be of significant dimensions to close spontaneously in the absence of perfect apposition of the undersurface of sutured palatal flaps to the hard palate bone. This situation is likely in the single-layer closure group patients with a wider cleft or vertically oriented palatal shelves. A prospective, randomized, controlled trial can effectively and convincingly answer the apprehensions regarding the concept put forward by the authors. Ramesh Kumar Sharma, M.Ch., D.N.B.(Plast. Surg.) Surinder Singh Makkar, M.Ch.(Plast. Surg.) Atul Parashar, M.Ch.(Plast. Surg.) Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Categorical perception of Japanese moraic phonemes

This study found that segment duration is perceived categorically in Japanese. Using a speech time-scale modification algorithm, PICOLA plus2, the nonword/kesonato/pronounced by a native Japanese male was manipulated to generate stimulus continua. The durations of /s/, /n/, /a/, and /t/ closure interval were manipulated in four continua. In the first experiment, three stimulus pairs, which had the same disparity in duration were selected from the short, long, and middle region of each continuum. Forty-eight randomized trials were presented to 20 native Japanese, who were asked individually to distinguish the difference of sounds by the ABX method. Pairs from the short and long regions of the continua were not accurately discriminated while pairs from the middle region were. In the second experiment, 44 stimuli were selected from every continuum. They were presented to the subjects for identification in Hiragana (Japanese characters). The second result demonstrated the existence of a moraic phoneme boundary paralleling the discrimination peak in the first experiment. This research concluded that native Japanese perceive the duration of relatively steady-static sounds categorically. And also, it is suggested that native Japanese utilize an automatic duration detection routine.

Analysis of Subfertility Associated with Homozygosity of the Rose Comb Allele in the Male Domestic Fowl

Sperm metabolism and duration of fertility were compared between roosters homozygous (RR) and heterozygous (Rr) for the rose comb allele. In the absence or presence of Ca+2, a motility agonist, the metabolic rate of spermatozoa from RR males was 76 to 77% of that of spermatozoa from Rr males. In the presence of caffeine, the metabolic rate of spermatozoa from RR males was increased significantly (P < .05) to 86% of that of spermatozoa from Rr males. Although intramagnal insemination of ejaculated spermatozoa reduced the disparity in duration of fertility between RR and Rr males, the duration of fertility of RR males was still less than that of Rr males. No difference in duration of fertility was observed following intramagnal insemination of testicular spermatozoa. Subfertility associated with RR males seems to stem from an aberrant activation or regulation of spermatozoal metabolism and not a reduction in absolute metabolic capacity per se.

Neck Sprain

One hundred thirty-six cases of uncomplicated neck sprain were studied to determine the relationship between the great disparity in duration of symptoms and various factors not directly related to the injury. The factors studied were the following: age, sex, race, occupation, marital status, hospitalization, associated medical conditions, habits, roentgenographic findings, extent of car damage, emotional factors, extensiveness of the medical history, treatment, and litigation. Only in the last four factors was there any association with the duration of symptoms that, in this study, varied from complete recovery in three days to persistence of symptoms for more than five years. This great disparity in duration of symptoms was not related to the degree of injury. As one would expect, however, the more severe the injury, the longer was the median duration of workdays lost.

Is the use of sulphonylurea derivatives in the treatment of diabetes mellitus dangerous?

Grouping 651 diabetic deaths according to their treatment with diet alone, with diet and sulphonylurea tablets, with diet and small or large doses of insulin, we cannot discover any significant difference in the duration of diabetes from onset till death between patients treated by diet alone and those treated by diet and hypoglycaemic tablets. The longer duration of insulin-controlled diabetes is mainly due to the younger age of the patients at onset of the disease. Some other factors which may favour insulin treatment are discussed. Neither overweight nor hypertension explains the disparity in duration of diabetes between patients under diet or tablet therapy and others controlled by insulin.