Significant Variation In Duration Research Articles

Using a patient prompt list to raise concerns in oncology clinics does not necessarily lead to longer consultations.

Head and neck oncology post-treatment consultations form a critical component of care in terms of support and surveillance. They occur frequently in the first few years and can place substantial demands on healthcare resources. However, they provide useful opportunities for patients to raise issues and receive tailored information and support. The aim of this paper was to assess whether completion of a 56-item patient prompt list (PCI - the Patient Concerns Inventory) immediately prior to the consultation significantly increased its duration. This was a pragmatic cluster preference randomised controlled trial of 288 patients with 15 consultant clusters from two sites "using" (n=8) or "not using" (n=7) the PCI. Consultation times were known for 283 patients (136 PCI, 147 non-PCI) who attended their first post-treatment trial consultation a median (IQR) of 103 (70-160) days after the end of treatment. Consultations lasted a median (IQR) of 10 (7-13) minutes (mean 11) in non-PCI patients and a median (IQR) of 11 (8-15) minutes (mean 12) in PCI patients (p=0.07). After adjustment for patient clustering and significant case mix, the 95% confidence interval for the mean difference was between 1.45minutes shorter with the PCI and 2.98minutes longer (p=0.50). There was significant variation in duration by consultant, tumour stage, treatment mode, overall quality of life (QoL), and distress (all p<0.001). In those who completed the PCI, duration increased with the total number of items selected (p<0.001). In conclusion, the inclusion of a prompt list to help facilitate conversation with patients did not make a substantial difference to consultation times.

Evaluating sickness absence duration by musculoskeletal and mental health issues: a retrospective cohort study of Scottish healthcare workers

ObjectivesSickness absence (SA) among healthcare workers is associated with occupational and non-occupational risk factors and impacts employee health, healthcare delivery and patient health. At the same time, healthcare is one...

Ketamine and its combination with pentazocine and meperidine for epidural anaesthesia in dogs

Clinically healthy dogs (15) of either sex aged about 1 year were randomly grouped into 3 with 5 dogs each to study the effect of epidural administration of ketamine alone and in combination with pentazocine and meperidine on clinic – anaesthetic profile in dogs. Ketamine hydrochloride @3 mg/kg b.wt and ketamine @3mg/kg b.wt in combination with pentazocine lactate @ 0.3 mg/kg b.wt and ketamine @ 3mg/kg b.wt in combination with meperidine @ 1mg/kg b.wt were administered epidurally in animals of group 1, 2 and 3, respectively. Marked alteration in rectal temperature, heart rate and respiration rate were recorded at initial intervals of observations in all the groups, however, these values returned towards normalcy by the end of 120 min of observation. Quicker onset of analgesia was recorded in group 2 (3.68±0.22 min) followed by group 3 (3.88±0.17 min) and group 1 (4.08±0.33 min). The duration of analgesia, standing time and recovery time were significantly longer in group 2 and 3 as compared to group 1. None of the groups showed significant variation in duration of recumbency. The treated animals manifested minimum, transient and occasional untoward reactions. It is concluded that pentazocine and meperidine can be given epidurally in combination with ketamine for effective analgesia in dogs.

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.

Renal agenesis and unilateral nephrectomy: what are the risks of living with a single kidney?

The long-term outlook for patients with unilateral renal agenesis or following unilateral nephrectomy in childhood is controversial. Animal studies suggest that the resultant compensatory increase in glomerular filtration might lead to progressive damage to the remaining renal tissue and may generate hypertension. Human studies addressing these concerns are limited in number and are difficult to interpret because they are small, retrospective, or cross sectional with significant variations in duration and completeness of follow-up. The published studies suggest that renal function remains stable for several decades in the majority of subjects. The clinical significance of mild-grade proteinuria and hypertension seen in some patients is unknown. Longitudinal studies are needed to understand the long-term effect and significance of the several pathophysiological changes observed in the solitary kidney.

Critical care nursing education and practice in Canada and Australia: A comparative review

Critical care nursing is an area of policy concern with respect to staffing projections, skill mix and educational preparation in both Canada and Australia. Despite many similarities between the health systems of these two countries, differences exist in both undergraduate and graduate specialty nursing education. In Australia, specialist education is primarily delivered via the tertiary sector as a formalised qualification, whereas the current Canadian model displays significant variation in duration, content, and mode of delivery. This paper provides a comparative perspective on the educational preparation of critical care nurses in these two countries. Consideration of alternative models of specialty nursing education may provide a method to improve recruitment and retention of staff while maintaining quality of care.

Female Choice and the Consistency of Courtship Feeding in Black‐horned Tree Crickets Oecanthus nigricornis Walker (Orthoptera: Gryllidae: Oecanthinae)

Courtship feeding in insects is often strongly correlated with insemination duration and therefore provides a potential postcopulatory episode of sexual selection. We tested whether courtship feeding and other courtship traits in the black‐horned tree cricket Oecanthus nigricornis showed sufficient consistency potentially to respond to sexual selection by testing whether they differed significantly among males. Duration of courtship feeding differed among males when measured repeatedly and this caused significant differences in the duration of spermatophore attachment, a trait that determines the maximum duration of insemination and thus has important fitness consequences in crickets. We also partitioned variance in courtship behaviour between the sexes to test whether differences in courtship behaviour were attributable primarily to males, females or both sexes. Duration of spermatophore attachment was controlled by females and therefore represents a mechanism of female mate choice. Significant variation in duration of spermatophore attachment was associated with differences between individuals of both sexes. Differences among males indicate that females agree in their preference of certain males whereas differences among females indicate that females differ in their receptivity to postcopulatory courtship and insemination. The fact that differences among males in duration of spermatophore attachment were due to significant differences solely in the period of courtship feeding indicates that postcopulatory female choice was mediated through courtship feeding. Whether males manipulate female choices by allocating more or fewer resources requires further testing, but we found that males court some females more vigorously than others after females dismount. The number of previous mates had opposite effects on the duration of courtship feeding for the sexes, decreasing it for males but increasing it for females, and we discuss the possible causes of these results.

Quantitative analysis of tonal calls from five odontocete species, examining interspecific and intraspecific variation

Whistle vocalizations of five odontocete cetaceans, the false killer whale P. crassidens, short-finned pilot whale G. macrorhynchus, long-finned pilot whale G. melas, white-beaked dolphin L. albirostris and Risso's dolphin G. griseus, were analysed and summarized quantitatively. Recordings were acquired from a number of locations and encounters. Significant differences were found between species and, to a lesser extent, between locations. The calls of the two pilot whale species are distinct despite their close relatedness, and similar size and morphology. This may be due to selection pressures to maintain distinctiveness. The variance was partitioned into between-species, between-location (within species) and within-location factors. For the frequency variables, variation between-species is high relative to variation between locations. Thus geographic variation is a relatively minor effect, compared to the many processes which cause interspecific differences. The within-location component includes such factors as social context, behaviour and group composition. This component is of a similar magnitude to the between-species component, indicating that whistles vary considerably with these factors. Significant between-location differences may be attributable to these confounding factors. For whistle duration, most of the variation occurred within location. There is less significant variation in duration across species compared with the frequency measures. This study highlights the need to collect samples across all potential strata whenever possible, and provides a framework for future, more comprehensive work.

Quantitative analysis of tonal calls from five odontocete species, examining interspecific and intraspecific variation

AbstractWhistle vocalizations of five odontocete cetaceans, the false killer whale P. crassidens, short‐finned pilot whale G. macrorhynchus, long‐finned pilot whale G. melas, white‐beaked dolphin L. albirostris and Risso's dolphin G. griseus, were analysed and summarized quantitatively. Recordings were acquired from a number of locations and encounters. Significant differences were found between species and, to a lesser extent, between locations. The calls of the two pilot whale species are distinct despite their close relatedness, and similar size and morphology. This may be due to selection pressures to maintain distinctiveness. The variance was partitioned into between‐species, between‐location (within species) and within‐location factors. For the frequency variables, variation between‐species is high relative to variation between locations. Thus geographic variation is a relatively minor effect, compared to the many processes which cause interspecific differences. The within‐location component includes such factors as social context, behaviour and group composition. This component is of a similar magnitude to the between‐species component, indicating that whistles vary considerably with these factors. Significant between‐location differences may be attributable to these confounding factors. For whistle duration, most of the variation occurred within location. There is less significant variation in duration across species compared with the frequency measures. This study highlights the need to collect samples across all potential strata whenever possible, and provides a framework for future, more comprehensive work.

Time and intensity cues to prosodic features of sentences

Profoundly deaf persons hear only time and intensity variations in amplified speech and must rely on lipreading to perceive speech segments [N. Erber, J. Acoust. Soc. Am. 51, 1224–1227 (1972)]. These persons may perceive prosodic features of sentences by hearing. It is not known whether linguistically significant variations in duration and intensity of speech segments are perceived by reference to the inherent duration of those segments and thus, are dependent upon intelligibility. Subjects responded to three sentence tests wherein the sentences differed in either phrase‐structure, major constituent boundary (MCB), or contrastive stress. Responses were by forced choice to the prosodic features; subjects were not required to identify words. Stimuli were presented under audition‐alone, vision‐alone, and audiovisual conditions. The acoustic signal was noise, amplitude modulated by the sentence materials. The audiovisual condition resulted in highest mean scores. Identifying phrase‐structure, audition‐alone scores were near chance levels. Vision‐alone and audiovisual scores were close in value, suggesting that time and intensity cues supplemented visual cues to a small extent. Identifying MCB location, vision‐alone scores were near chance levels. Audition‐alone scores were equivalent to audiovisual scores, suggesting that time and intensity variations provided primary cues. Identifying contrastive stress location, score data suggested that the acoustic signal allowed detection of contrastive stress and the exact word was located with visual cues. These results indicate that an unintelligible speech signal may supplement lipreading by providing certain prosodic information, increasing perceptual strategies available to profoundly deaf persons.