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Objective: To evaluate how electronic data management systems affect data use practices in antiretroviral therapy (ART) programs within local health districts, and individual health facilities., Methods: We used a data quality audit to establish a baseline of the quality of data in the electronic register alongside in-depth interviews with health workers and managers, to understand perceptions of data quality, data use by facility staff and challenges affecting data use., Results: The findings provide a four-level continuum of data use that can be applied to other settings and recommendations for optimising facility-level data use., Conclusion: By defining four levels of data use our findings suggest the potential to encourage a structured process of moving from passive data use, to more active and engaged data use, where data could be used to anticipate patient behaviour and link that behaviour to differentiated care plans., (© 2018 John Wiley & Sons Ltd.)

Objective: The objective of this study was to investigate variation in practice surrounding elective cardiac catheterization in patients with single-ventricle (SV) congenital heart disease., Design: Patient and procedural characteristics and outcomes during SV catheterization were collected prospectively from eight centers using a web-based registry (Congenital Cardiac Catheterization Project on Outcomes). We attempted to identify a population of elective procedures by limiting the cohort in case type and timing. Cases were then stratified by stage of SV palliation (pre-bidirectional cavopulmonary anastomosis [pre-BCPA], pre-Fontan and post-Fontan) and limited by age. Subcohort analysis was performed by mode of airway management (assisted vs. spontaneous ventilation). Institutional variation was assessed., Results: Between 2/2007 and 6/2010, 1459 (10.1%) of 14 467 cases in the registry met the inclusion and exclusion criteria, including 326 pre-BCPA, 571 pre-Fontan and 562 post-Fontan procedures. Median patient age was 0.4 (interquartile range 0.3, 0.5), 2.6 (1.0, 3.4) and 9.6 (5.2, 15.4) years and weight was 5.6 (4.8, 6.4), 12.2 (10.5, 14), and 26.3 (16.6, 51.8) kg in the pre-BCPA, pre-Fontan and post-Fontan cohorts, respectively. Cases were more commonly diagnostic in the pre-BCPA cohort (57%) whereas they were more commonly interventional in the pre-Fontan (69%) and post-Fontan (77%) cohorts. At least one adverse event (AE) occurred in 210 cases (14.4%) overall, including 20% of pre-BCPA, 11% of pre-Fontan and 14% of post-Fontan catheterizations. Mode of airway management was associated with statistically significant, but clinically small differences in hemodynamic measures in the pre- and post-Fontan cohorts, but not in the pre-BCPA group. Considerable practice variation exists across centers with variability in airway management, AE rate, case type, interventions performed and fluoroscopy time, in all SV cohorts., Conclusions: Elective catheterization in SV patients, frequently performed with intervention, is common among US congenital cardiac centers. However, important variation in practice exists during these procedures in SV patients, at all stages of palliation., (© 2015 Wiley Periodicals, Inc.)

The term "biker couple" is becoming an increasingly common site in emergency departments. The purpose of this study was to identify orthopaedic and non-orthopaedic injury patterns among this unique patient group. A 14-year (1993-2006) retrospective review of a Level I Trauma Institute Registry was performed. Patient demographic and injury data were obtained from 21 confirmed biker couples (n=42). Nineteen of 21 biker couple pairs (90.5%) included a male driver and a female passenger. Drivers were more likely to have a positive blood alcohol concentration/toxicology test. Drivers had a greater incidence of scapular and rib fractures than passengers. Both drivers and passengers who sustained scapular fractures had a greater incidence of clavicle, rib, pelvis, and fibula fractures. Drivers with scapular fractures had a greater incidence of thoracic spine fractures, while passengers with scapular fractures had a greater incidence of arm-forearm-wrist-hand, femur, tibia, and foot-ankle fractures. Overall, biker couple drivers and passengers did not differ for head injury, pulmonary system, road rash, aortic injury or visceral injury. Both drivers and passengers with scapular fractures had a greater incidence of head injuries, and passengers had a greater incidence of pulmonary system, visceral injury and road rash. Both drivers and passengers who were not wearing a helmet had a greater incidence of head injuries. Unhelmeted drivers were more likely to sustain head injury than passengers. When a scapular fracture was present both drivers and passengers had a greater incidence of head injuries. Prospective investigations are needed to better delineate the precise mechanisms for these injury patterns.