Factors related to rehospitalization within thirty days of discharge after coronary artery bypass grafting

BACKGROUND: Early rehospitalization after coronary artery bypass grafting (CABG) is an expensive and frequently adverse outcome. Rehospitalization rates after various surgical procedures have been used as an indicator of quality of care. Determining the extent to which rehospitalization rates reflect patient case mix and severity of illness rather than quality of care requires detailed information regarding the patients, the care they received, and the reasons for their rehospitalization. METHODS: We conducted a nested case control study comparing 110 CABG patients who were rehospitalized within 30 days after discharge with 224 control patients. Control patients were randomly selected from patients undergoing CABG during the same time frame as the cases and were matched on age, gender, and priority of surgery. A detailed chart review provided information regarding treatment in the postsurgical period, in addition to the preoperative information collected on all CABG patients as part of an ongoing regional prospective study. RESULTS: The overall rehospitalization rate was 13.8%. The most common reasons for rehospitalization included: wound infection (19%), atrial fibrillation (13%), pleural effusion (11%), and thromboembolic event (10%). Preoperative severity of illness and comorbidity accounted for 24% of the total variance. After adjustment for these factors, discharge hematocrit less than 30% (OR = 2.01, p = 0.018) and several discharge medications including: antiarrhythmics (OR = 3.26, p = 0.047), diuretics (OR = 2.18, p = 0.055), beta blockers (OR = 0.44, p = 0.036), and long length of stay (more than 7 days; OR = 2.09, p = 0.029) were the most important predictors of rehospitalization risk. CONCLUSIONS: Although the reasons for rehospitalization after CABG are heterogeneous and related to patient severity of illness as well as comorbid status, several of the most common are potentially preventable and related to quality of care. Rehospitalization was not related to early discharge.     

Effects of diversion and reperfusion of pancreaticobiliary juice on amylase release from isolated rat pancreas

Excitability of functionally different alpha-motoneurons was studied in 62 patients with gunshot injuries of nervous trunks of lower extremities both before and during process of rehabilitation by means of physical factors. The correlation of reactions of spinal cord motoneurons and the degree of injuries of nervous trunks was observed. Neuroapraxia of nervous trunks was accompanied by multidirectional alterations in reflex activity of large and small alpha-motoneurons. It was depressed in axonothermesis and lost in simultaneous full anatomic interruption of ischiatic nerve and trunks of both fibular and tibial nerves. Under influence of physical factors the function of motoneurons was normalized in neuroapraxia and was improved in axonothermesis of nervous trunks.     

Radiation doses in the population of the coastal area of the Kakhovsk Water Reservoir

Central and cerebral hemodynamics was studied using echocardiography and transcranial dopplerography in 200 poststroke patients over 60 in the course of 5-year follow-up. It was established that cardiac hypodynamic syndrome, i.e. continuous or paroxysmal fall of minute blood volume below 3 l, is the most significant contributing factor in the onset of cerebral ischemia. Drugs are recommended for prevention of ischemic stroke. Those lowering cardiac hemodynamic reserve should be excluded in patients at high risk of acute failure of cerebral circulation.     

The inhibition of pitting corrosion of stainless steels by chromate and molybdate ions

The inhibitive effects of chromate and molybdate on pitting corrosion in stainless steel AISI 304 and AISI 316 were studied in acidified chloride solution. The results presented show that these known inhibitors affect both the nucleation of pitting and metastable pitting by reducing the numbers and sizes of these events. This makes attainment of stable pit growth more difficult.     

The generation of surface roughness during slurry erosion-corrosion and its effect on the pitting potential

Results of experiments performed to isolate the effect of surface roughness generated during slurry erosion-corrosion of 304L stainless steel are presented. Surfaces prepared by grinding to different finishes show that increasing the roughness lowers the pitting potential in chloride solution. Subsequent erosion by an aqueous sand slurry then alters this pitting potential (E_p), as measured in the solution phase alone, in a manner dependent on the initial surface roughness. Surfaces which were initially rougher show a pronounced rise in _p after erosion, while those with an initially smoother finish show a fall in E_p after erosion. Measurement of E_p during erosion-corrosion does not fit either process, with values of _Ep lower than those predicted from the surface roughness alone.     

The repassivation of nickel-copper alloys in sulphuric acid

The behaviour of freshly generated electrode surfaces of Ni, Ni-30Cu, Ni-50Cu and Ni-70Cu in 1.0 M H₂SO₄ has been investigated. At low potentials all metals grow a monolayer of film designated as MOH when M is Cu⁺ or Ni⁺. The kinetics of formation of this monolayer follows Tafel's equation. At higher potentials passivation of the metals occurs by film growth under high electric field, with two different sets of high field parameters for different film thicknesses. The rate of film growth for all metals is controlled largely by the nickel oxide component of the film.     

The anodic behaviour of freshly generated α-brass surfaces

Potentiostatic scratching experiments have been carried out on copper and 70-30 brass electrodes in acid and neutral electrolytes. The results are compared with published measurements of stress corrosion crack velocities in α-brass in neutral ammoniacal solutions. The plateau crack velocity at low strain-rates can be accounted for by stoichiometric bare surface oxidation of the alloy components, but at high strain-rates it is necessary to invoke rapid bare surface dezincification. Charge analysis shows that zinc dissolution can occur from several alloy layers at > 5 A cm^?2 without appreciable anodic reaction of copper. Some features of the bare surface electrochemistry of copper are discussed.     

Love and dating experience in early and middle adolescence: grade and gender comparisons

The experience of being "in love" was studied in a sample of 186 early to middle adolescent males and 199 early to middle adolescent females. Results indicated that amount of dating experience of adolescents varied widely at each age. Being "in love" co-occurred with a reciprocal on-going relationship about half the time. Boys fell in love earlier and more often than girls, and both genders seemed to employ an increasingly narrow prototypical conception of being "in love". Qualitative analyses suggested that early and middle adolescents are actively reasoning about the nature and meaning of romantic feelings and experiences. Results are interpreted from the standpoint of psychosocial developmental theory, and implications for interventions with adolescents are discussed.