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Lu J, Yang J, Cai X. Weekend admissions and outcomes in patients with pneumonia: a systematic review and meta-analysis. Front Public Health 2024; 11:1248952. [PMID: 38303958 PMCID: PMC10832039 DOI: 10.3389/fpubh.2023.1248952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024] Open
Abstract
Background To document pooled evidence on the association between weekend hospital admissions and the potential risks of mortality, intensive care requirements, and readmission among patients with pneumonia. Methods We performed a systematic search across the PubMed, EMBASE, and Scopus databases. We collected observational studies exploring the association between weekend admissions and outcomes of interest in patients with pneumonia. To analyze the data, we used a random effects model and expressed the effect sizes as pooled odds ratios (ORs) accompanied by their respective 95% confidence intervals (CIs). Results The analysis comprised data from 13 retrospective studies. Compared to patients admitted on weekdays, those admitted during the weekend had a non-statistically significant marginally higher risk of in-hospital mortality (OR, 1.02; 95% CI, 1.00, 1.04) but similar 30-day mortality after admission (OR, 1.03; 95% CI, 0.97, 1.10), and similar risks of admission to intensive care unit (OR, 1.04; 95% CI, 0.98, 1.11) and re-admission (OR, 0.85; 95% CI, 0.65-1.12). Conclusion Our findings do not support the presence of a "weekend effect" in patients with pneumonia. Systematic review registration PROSPERO, identifier CRD42023425802, https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
| | - Jing Yang
- Department of 12 Ward, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Zhejiang, Huzhou, China
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Data-Enhancement Strategies in Weather-Related Health Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020906. [PMID: 35055728 PMCID: PMC8776088 DOI: 10.3390/ijerph19020906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 02/01/2023]
Abstract
Although the relationship between weather and health is widely studied, there are still gaps in this knowledge. The present paper proposes data transformation as a way to address these gaps and discusses four different strategies designed to study particular aspects of a weather–health relationship, including (i) temporally aggregating the series, (ii) decomposing the different time scales of the data by empirical model decomposition, (iii) disaggregating the exposure series by considering the whole daily temperature curve as a single function, and (iv) considering the whole year of data as a single, continuous function. These four strategies allow studying non-conventional aspects of the mortality-temperature relationship by retrieving non-dominant time scale from data and allow to study the impact of the time of occurrence of particular event. A real-world case study of temperature-related cardiovascular mortality in the city of Montreal, Canada illustrates that these strategies can shed new lights on the relationship and outlines their strengths and weaknesses. A cross-validation comparison shows that the flexibility of functional regression used in strategies (iii) and (iv) allows a good fit of temperature-related mortality. These strategies can help understanding more accurately climate-related health.
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Milevski SV, Lloyd M, Janus E, Maguire G, Karunajeewa H. Impact of weekend admission and changes in treating team on patient flow and outcomes in adults admitted to hospital with community-acquired pneumonia. Intern Med J 2021; 51:1681-1690. [PMID: 33647171 DOI: 10.1111/imj.15252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effect of workflow factors, such as timing of admission and changes in treating team, on patient outcomes remains inconclusive. AIMS To investigate the impact of weekend admission and changes in treating team on four pre-defined outcomes in patients admitted to hospital with community-acquired pneumonia (CAP). METHODS We performed an observational cohort study by utilising prospective longitudinal data collected during the IMPROVE-GAP trial, a stepped-wedge randomised study investigating an evidence-based bundle of care in the management of CAP. We assessed the effect of two exposure variables, day of admission and change of treating team, on four pre-specified outcomes: (i) length of stay; (ii) time to clinical stability; (iii) readmission within 30 days; and (iv) mortality at 30 days. Our analysis was restricted to patients with a primary diagnosis of CAP and employed multivariable Cox regression and logistic regression to adjust for potential measured confounders. RESULTS Of 753 participants, 224 (29.7%) were admitted on the weekend and 71 (9.4%) changed treating team during admission. Weekend admissions had significantly longer hospital stays than weekday admissions (hazard ratio (95% confidence interval; P-value) 0.82 (0.70-0.98; 0.03)) and took longer to reach clinical stability (0.80 (0.68-0.95; 0.01)). Change of treating team doubled the odds of readmission at 30 days (odds ratio 1.95 (1.08-3.58; 0.03)). CONCLUSIONS These results suggest workflow factors can negatively impact both health service and patient outcomes. Systems interventions aimed at improving out of hours service and reducing changes in treating team should be considered.
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Affiliation(s)
- Stefan V Milevski
- General Internal Medicine Unit, Western Health, Melbourne, Victoria, Australia
| | - Melanie Lloyd
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School - Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Janus
- General Internal Medicine Unit, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School - Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Graeme Maguire
- General Internal Medicine Unit, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School - Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Harin Karunajeewa
- General Internal Medicine Unit, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School - Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
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Mounsey LA, Chang PP, Sueta CA, Matsushita K, Russell SD, Caughey MC. In-Hospital and Postdischarge Mortality Among Patients With Acute Decompensated Heart Failure Hospitalizations Ending on the Weekend Versus Weekday: The ARIC Study Community Surveillance. J Am Heart Assoc 2019; 8:e011631. [PMID: 31319746 PMCID: PMC6761634 DOI: 10.1161/jaha.118.011631] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Hospital staffing is usually reduced on weekends, potentially impacting inpatient care and postdischarge coordination of care for patients with acute decompensated heart failure (ADHF). However, investigations of in‐hospital mortality on the weekend versus weekday, and post‐hospital outcomes of weekend versus weekday discharge are scarce. Methods and Results Hospitalizations for ADHF were sampled by stratified design from 4 US areas by the Community Surveillance component of the ARIC (Atherosclerosis Risk in Communities) study. ADHF was classified by a standardized computer algorithm and physician review of the medical records. Discharges or deaths on Saturday, Sunday, or national holidays were considered to occur on the “weekend.” In‐hospital mortality was compared between hospitalizations ending on a weekend versus weekday. Post‐hospital (28‐day) mortality was compared among patients discharged alive on a weekend versus weekday. From 2005 to 2014, 39 699 weighted ADHF hospitalizations were identified (19% terminating on a weekend). Demographics, comorbidities, length of stay, and guideline‐directed therapies were similar for patients with hospitalizations ending on a weekend versus weekday. In‐hospital death doubled on the weekend compared with weekday (12% versus 6%) and was not attenuated by adjustment for potential confounders (odds ratio, 2.37; 95% CI, 1.93–2.91). There was no association between weekend discharge and 28‐day mortality among patients discharged alive. Conclusions The risk of in‐hospital death among patients admitted with ADHF appears to be doubled on the weekends when hospital staffing is usually reduced. However, among patients discharged alive, hospital discharge on a weekend is not adversely associated with mortality. See Editorial Mehta and Pandey
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Affiliation(s)
| | | | - Carla A Sueta
- University of North Carolina School of Medicine Chapel Hill NC
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Masselot P, Chebana F, Bélanger D, St-Hilaire A, Abdous B, Gosselin P, Ouarda TBMJ. Aggregating the response in time series regression models, applied to weather-related cardiovascular mortality. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 628-629:217-225. [PMID: 29438931 DOI: 10.1016/j.scitotenv.2018.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/04/2018] [Accepted: 02/02/2018] [Indexed: 06/08/2023]
Abstract
In environmental epidemiology studies, health response data (e.g. hospitalization or mortality) are often noisy because of hospital organization and other social factors. The noise in the data can hide the true signal related to the exposure. The signal can be unveiled by performing a temporal aggregation on health data and then using it as the response in regression analysis. From aggregated series, a general methodology is introduced to account for the particularities of an aggregated response in a regression setting. This methodology can be used with usually applied regression models in weather-related health studies, such as generalized additive models (GAM) and distributed lag nonlinear models (DLNM). In particular, the residuals are modelled using an autoregressive-moving average (ARMA) model to account for the temporal dependence. The proposed methodology is illustrated by modelling the influence of temperature on cardiovascular mortality in Canada. A comparison with classical DLNMs is provided and several aggregation methods are compared. Results show that there is an increase in the fit quality when the response is aggregated, and that the estimated relationship focuses more on the outcome over several days than the classical DLNM. More precisely, among various investigated aggregation schemes, it was found that an aggregation with an asymmetric Epanechnikov kernel is more suited for studying the temperature-mortality relationship.
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Affiliation(s)
- Pierre Masselot
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada.
| | - Fateh Chebana
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada
| | - Diane Bélanger
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada; Centre Hospitalier Universitaire de Québec, Centre de Recherche, Québec, Canada
| | - André St-Hilaire
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada
| | - Belkacem Abdous
- Université Laval, Département de Médecine Sociale et Préventive, Québec, Canada
| | - Pierre Gosselin
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada; Centre Hospitalier Universitaire de Québec, Centre de Recherche, Québec, Canada; Institut National de Santé Publique du Québec (INSPQ), Québec, Canada
| | - Taha B M J Ouarda
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada
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Roberts CM, Lowe D, Skipper E, Steiner MC, Jones R, Gelder C, Hurst JR, Lowrey GE, Thompson C, Stone RA. Effect of time and day of admission on hospital care quality for patients with chronic obstructive pulmonary disease exacerbation in England and Wales: single cohort study. BMJ Open 2017; 7:e015532. [PMID: 28882909 PMCID: PMC5588982 DOI: 10.1136/bmjopen-2016-015532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 05/23/2017] [Accepted: 06/29/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate if observed increased weekend mortality was associated with poorer quality of care for patients admitted to hospital with chronic obstructive pulmonary disease (COPD) exacerbation. DESIGN Prospective case ascertainment cohort study. SETTING 199 acute hospitals in England and Wales, UK. PARTICIPANTS Consecutive COPD admissions, excluding subsequent readmissions, from 1 February to 30 April 2014 of whom 13 414 cases were entered into the study. MAIN OUTCOMES Process of care mapped to the National Institute for Health and Care Excellence clinical quality standards, access to specialist respiratory teams and facilities, mortality and length of stay, related to time and day of the week of admission. RESULTS Mortality was higher for weekend admissions (unadjusted OR 1.20, 95% CI 1.00 to 1.43), and for case-mix adjusted weekend mortality when calculated for admissions Friday morning through to Monday night (adjusted OR 1.19, 95% CI 1.00 to 1.43). Median time to death was 6 days. Some clinical processes were poorer on Mondays and during normal working hours but not weekends or out of hours. Specialist respiratory care was less available and less prompt for Friday and Saturday admissions. Admission to a specialist ward or high dependency unit was less likely on a Saturday or Sunday. CONCLUSIONS Increased mortality observed in weekend admissions is not easily explained by deficiencies in early clinical guideline care. Further study of out-of-hospital factors, specialty care and deaths later in the admission are required if effective interventions are to be made to reduce variation by day of the week of admission.
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Affiliation(s)
- Christopher Michael Roberts
- Barts Health, Queen Mary University of London, London, UK
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, London, UK
| | - Derek Lowe
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, London, UK
| | - Emma Skipper
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, London, UK
| | - Michael C Steiner
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, London, UK
- Respiratory Biomedical Sciences Research Unit, Institute for Lung Health, Glenfield Hospital NHS Trust, Leicester, Leicestershire, United Kingdom
| | - Rupert Jones
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, London, UK
- Clinical Trials & Health Research - Institute of Translational & Stratified Medicine, Plymouth University, Plymouth, Devon, United Kingdom
| | - Colin Gelder
- Department of respiratory medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Warwickshire, United Kingdom
| | - John R Hurst
- UCL Respiratory, University College London, London, London, United Kingdom
| | - Gillian E Lowrey
- Department of respiratory medicine, Derby Teaching Hospitals NHS Foundation Trust, Derby, Derbyshire, United Kingdom
| | | | - Robert A Stone
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, London, UK
- Somerset Lung Centre, Musgrove Park Hospital, Taunton, Somerset, UK
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In-hospital elderly mortality and associated factors in 12 Italian acute medical units: findings from an exploratory longitudinal study. Aging Clin Exp Res 2017; 29:517-527. [PMID: 27155980 DOI: 10.1007/s40520-016-0576-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Given the progressive demographic ageing of the population and the National Health System reforms affecting care at the bedside, a periodic re-evaluation of in-hospital mortality rates and associated factors is recommended. AIMS To describe the occurrence of in-hospital mortality among patients admitted to acute medical units and associated factors. Two hypotheses (H) were set as the basis of the study: patients have an increased likelihood to die H1: at the weekend when less nursing care is offered; H2: when they receive nursing care with a skill-mix in favour of Nursing Aides instead of Registered Nurses. METHODS Secondary analysis of a prospective study of patients >65 years consecutively admitted in 12 Italian medical units. Data on individual and nursing care variables were collected and its association with in-hospital mortality was analysed by stepwise logistic regression analysis. RESULTS In-hospital mortality occurrence was 6.8 %, and 37 % of the patients died during the weekend. The logistic regression model explained 34.3 % (R 2) of the variance of in-hospital mortality: patients were six times (95 % CI = 3.632-10.794) more likely at risk of dying at weekends; those with one or more AEDs admissions in the last 3 months were also at increased risk of dying (RR 1.360, 95 % CI = 1.024-1.806) as well as those receiving more care from family carers (RR = 1.017, 95 % CI = 1.009-1.025). At the nursing care level, those patient receiving less care by RNs at weekends were at increased risk of dying (RR = 2.236, 95 % CI = 1.270-3.937) while those receiving a higher skill-mix, thus indicating that more nursing care was offered by RNs instead of NAs were at less risk of dying (RR = 0.940, 95 % CI = 0.912-0.969). CONCLUSIONS Within the limitations of this secondary analysis, in addition to the role of some clinical factors, findings suggest redesigning acute care at weekends ensuring consistent care both at the hospital and at the nursing care levels.
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Baid-Agrawal S, Martus P, Feldman H, Kramer H. Weekend versus weekday transplant surgery and outcomes after kidney transplantation in the USA: a retrospective national database analysis. BMJ Open 2016; 6:e010482. [PMID: 27056590 PMCID: PMC4838691 DOI: 10.1136/bmjopen-2015-010482] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine whether kidney transplants performed during a weekend had worse outcomes than those performed during weekdays. DESIGN Retrospective national database study. SETTING United Network for Organ Sharing database of the USA. PARTICIPANTS 136,715 adult recipients of deceased donor single organ kidney transplants in the USA between 4/1994 and 9/2010. MAIN OUTCOME MEASURES The primary outcomes were patient survival and death-censored and overall allograft survival. Secondary outcomes included initial length of hospital stay after transplantation, delayed allograft function, acute rejection within the first year of transplant, and patient and allograft survival at 1 month and at 1 year after transplantation. Cox proportional hazards models were used to evaluate the impact of weekend kidney transplant surgery on primary and secondary outcomes, adjusting for multiple covariates. RESULTS Among the 136,715 kidney recipients, 72.5% underwent transplantation during a regular weekday (Monday-Friday) and 27.5% during a weekend (Saturday-Sunday). No significant association was noted between weekend transplant status and patient survival, death-censored allograft survival or overall allograft survival in the adjusted analyses (HR 1.01 (95% CI 0.92 to 1.04), 1.012 (95% CI 0.99 to 1.034), 1.012 (95% CI 0.984 to 1.04), respectively). In addition, no significant association was noted between weekend transplant status and the secondary outcomes of patient and graft survival at 1 month and 1 year, delayed allograft function or acute rejection within the first year. Results remained consistent across all definitions of weekend status. CONCLUSIONS The outcomes for deceased donor kidney transplantation in the USA are not affected by the day of surgery. The operationalisation of deceased donor kidney transplantation may provide a model for other surgeries or emergency procedures that occur over the weekend, and may help reduce length of hospital stay and improve outcomes.
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Affiliation(s)
- Seema Baid-Agrawal
- Department of Nephrology and Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Clinic of Tuebingen, Tuebingen, Germany
| | - Harold Feldman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
| | - Holly Kramer
- Department of Public Health Sciences and Medicine, Division of Nephrology and Hypertension, Loyola Medical Center, Maywood, Illinois, USA
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Uematsu H, Kunisawa S, Yamashita K, Fushimi K, Imanaka Y. Impact of weekend admission on in-hospital mortality in severe community-acquired pneumonia patients in Japan. Respirology 2016; 21:905-10. [PMID: 27040008 DOI: 10.1111/resp.12788] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/17/2015] [Accepted: 12/26/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Little is known about the consequences of weekend admission on the quality of care in patients with severe community-acquired pneumonia. We compared the outcomes of weekend versus weekdays' admission for these patients on risk-adjusted mortality. METHODS Using a large nationwide administrative database, we analysed patients with severe pneumonia who had been hospitalized in 1044 acute care hospitals between 2012 and 2013. We compared risk-adjusted in-hospital mortality of guideline-concordant care between patients admitted weekdays and patients admitted on weekends. RESULTS The study sample comprised 17 342 patients admitted on weekdays and 6190 patients admitted on weekends. The mortality rate of the weekend admission group was significantly higher than that of the weekday admission group (23.7% vs 20.5%; P < 0.001). Even after adjusting for baseline patient severity and need for urgent care, weekend admissions were associated with higher mortality (odds ratio: 1.10; 95% confidence interval: 1.02-1.19). The implementation rates of guideline-concordant microbiological tests (including sputum cultures and urine antigen tests) were significantly lower in the weekend admission group. These tests were found to be associated with lower in-hospital mortality. CONCLUSION Our findings showed that weekend admission was associated with increased mortality in patients with severe community-acquired pneumonia in Japan. This may have been influenced by lower implementation of microbiological testing.
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Affiliation(s)
- Hironori Uematsu
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuto Yamashita
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Leung CC, Tai LB, Yip I, Tam CM. Higher mortality for weekend admissions: quality of care or selection bias? Eur Respir J 2015; 45:1755-6. [DOI: 10.1183/09031936.00018315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Humbert M, Dinh-Xuan AT, Reeves EL, Broadhead MG, Bullen NJ. The ambition of the European Respiratory Journal: chapter 3. Eur Respir J 2014; 45:1-6. [DOI: 10.1183/09031936.00201614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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