For patients hospitalized with ACS in England and Wales, there have been substantial reductions in in-hospital mortality rates from 2003 to 2010 across all age groups. The temporal improvements in mortality were similar for sex and type of acute myocardial infarction. Age-dependent inequalities in the management of ACS were apparent.
Objective To estimate the volume and duration of placental transfusion at term.Design Prospective observational study.Setting Maternity unit in Bradford, UK.Population Twenty-six term births.Methods Babies were weighed with umbilical cord intact using digital scales that record an average weight every 2 seconds. Placental transfusion was calculated from the change in weight between birth and either cord clamping or when weighing stopped. Start and end weights were estimated using both a B-spline and inspection of graphs. Weight was converted to volume, 1 ml of blood weighing 1.05 g.Main outcome measures Volume and duration of placental transfusion.Results Twenty-six babies were weighed. Start weights were difficult to determine because of artefacts in the data as the baby was placed on the scales and wrapped. The mean difference in weight was 116 g [95% confidence interval (CI), 72-160 g] using the B-spline and 87 g (95% CI, 64-110 g) using inspection. Converting this to the mean volume of placental transfusion gave 110 ml (95% CI, 69-152 ml) and 83 ml (95% CI, 61-106 ml), respectively. Placental transfusion was usually complete by 2 minutes, but sometimes continued for up to 5 minutes. Based on the B-spline, placental transfusion contributed 32 ml (95% CI, 30-33 ml) per kilogram of birth weight to blood volume, but 24 ml (95% CI, 19-32 ml) based on inspection. This equates to 40% (95% CI, 37-42%) and 30% (24-40%), respectively, of total potential blood volume.Conclusion Inspection of the graphs probably underestimates placental transfusion. For term infants, placental transfusion contributes between one-third and one-quarter of total potential blood volume at birth.
The AMG and MG risk scores, utilised by NICE, demonstrated good performance across a range of indices using MINAP data, but performed less well in higher risk subgroups. Although indices were better for AMG, its application may be constrained by missing predictors.
There was a large variation in DTB times between the best and worst performing hospitals. Although patient-related factors impacted upon DTB times, the volume and proportion of patients undergoing primary PCI were significantly associated with delay and early mortality-hospitals with the highest proportion of primary PCI had the lowest mortality.
Survival rates after AMI have improved. Whereas survival estimates for STEMI patients who did not receive reperfusion therapy were stable, they worsened for NSTEMI patients not receiving coronary angiography.
Background. Standardised mortality ratios (SMR) are often used to depict cardiovascular care. Data missingness, data quality, temporal variation and case-mix can, however, complicate the assessment of clinical performance.
Multidimensional hospital OBCS in AMI survivors are high, discriminate hospital performance more readily than single performance indicators, and significantly inversely predict early and longer-term mortality.
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