Comparative analysis of perinatal outcomes among different typesof deliveries in term pregnancies in a reference maternity of Southeast Brazil.

OBJECTIVE: To compare the perinatal outcomes of women undergoing an elective cesarean section (CS) with those who had an emergency CS during the labor. DESIGN: Retrospective cohort study. SETTING: Hospital Estadual Azevedo Lima (HEAL), Niteroi, Brazil. METHODS: We analysed elective CS, emergent CS and vaginal delivery as dependent variables and neonatal data (admission in intensive care unit) as independent variables. Using the Statement of Live Birth during a three-month period, all patients who had their children after 38 complete weeks of pregnancy were selected. χ2 test and Student t-tests were applied to compare the groups. RESULTS: When patients who had vaginal delivery were compared with those who had an elective CS, we observed 219 normal deliveries with 1.8% of hospitalizations in neonatal intensive care units (NICU), and 88 patients of elective CS with 2.3% of admissions in closed units (p = 0.401). We had a sample of 108 newborns delivered by CS during the labor with 8.3% rate of hospitalization in NICU versus 1.8% of 219 newborns delivered vaginally (p = 0.005). CONCLUSION: The worst perinatal outcomes occurred when emergency CS were performed.

Outcomes analysis for hearing conservation programs.

In health care, an increasing interest in accountability for outcomes, proof of quality care, and cost effectiveness is forcing many practitioners, including audiologists, in the direction of using outcomes analysis to provide proof of performance in their practices. Critical to the conduct of outcomes analysis are the selection of valid outcomes metrics and application of appropriate statistical processes. Modeling of clinical protocols is a useful exercise for developing outcomes data and data management standards. The authors describe the implications for wider use of outcomes modeling once the Health Insurance Portability and Accountability Act (HIPAA) administrative simplification law is implemented. This legislation will set up a wholly new administrative data set that has strong potential to provide outcomes metrics to a variety of Audiology practices. The modeling exercise described here was originally intended to derive assessment outcomes for evaluating hearing conservation program effectiveness in military populations from an administrative database implemented within the Military Health System starting in 1997. The outcomes modelers, however, soon realized the broader applicability of modeling techniques for other special populations and Audiology practices, particularly with the oncoming startup of HIPAA legislative mandates. The modeling exercise demonstrates a process of structuring standard health-care codes to produce outcomes data for epidemiologic and cost analyses, thereby providing better information to guide health-care practices toward improving quality and cost effectiveness. This information in time series should also provide a record of continuous quality improvement. The authors present a general hearing surveillance protocol for evaluating occupational hearing loss. The protocol is used as a specific instance to demonstrate the shaping of an outcomes metrics model. This same process can be applied more generally when used to model outcomes data from other audiology practices. Implementation of the administrative data model described here began at more than 400 Department of Defense (DOD) medical treatment facilities worldwide as of October 1, 1999. The exercise of developing similar outcomes metrics for newborn hearing screening programs, school hearing conservation programs, and other clinical and rehabilitative audiology practices in the civilian sector remains to be done.

Frequency information in the auditory brainstem response evoked by tonal transients.

The auditory brainstem response (ABR) is a composite of potentials generated by neural activity stemming from several regions of the cochlea. A derivation technique is described for reducing the contributions to the ABR that arise from frequencies outside of the frequency band of interest. The technique treats averaged waveforms in an algebraic manner and uses a method of successive substitutions to obtain a derived waveform. The recorded and derived ABR waveforms were analyzed with respect to changes of latency and morphology. The behavior of the waveform components of the derived regional responses was in accord with the data of other studies in which narrow-band responses were derived from waveforms produced by high-pass masking of click stimuli. Frequency information was thus extracted from the ABR without the simultaneous presence of other stimuli as in masking-based derivations. The method of successive substitutions used with brief transient stimuli of different frequencies appears to yield derived ABRs that reflect activity from different cochlear regions.