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PubMed1993

Long-term suppression of recurrent genital herpes with acyclovir. A 5-year benchmark. Acyclovir Study Group.

BACKGROUND AND DESIGN: This multicenter trial (19 sites) was initiated in 1984 in more than 1100 immunocompetent individuals with a history of frequently recurring genital herpes (mean, > or = 12 episodes per year). The first year of this suppressive therapy trial was placebo controlled, with acyclovir being provided for episodic treatment in both groups. Thereafter, patients were treated with open-label acyclovir suppressive therapy on a long-term basis (400 mg twice daily) to continue to assess its long-term safety and efficacy. Complete data are available on 389 of the 430 patients who began the fifth year of the study. RESULTS: Patients were seen quarterly for review of diaries and clinical laboratory evaluations. The percentage of patients recurrence free for any 3-month quarter of the fifth year ranged from 86% to 90%. The mean annual number of recurrences per patient declined from 1.7 during the first year to 0.8 during the fifth year of suppressive therapy. The frequency of false prodromes has also decreased over time. More than 20% of the patients receiving suppressive therapy for 5 years have been recurrence free the entire time. The duration of herpetic outbreaks during suppressive therapy has not changed. CONCLUSION: This study extends the safety and efficacy profile of oral acyclovir in the suppression of genital herpes to 5 years. The majority of the patients were recurrence free on an annual basis during suppressive therapy. Therapy was well tolerated. Acyclovir usage was not associated with serious side effects or cumulative toxicity.

Acyclovir↗
PubMedDate not supplied

Benchmarking patient satisfaction.

Asking the patient is a critical step-but the format of a patient satisfaction survey has a significant impact on your perceptions. Design it carefully.

Health Care Surveys↗
PubMedDate not supplied

The challenge of benchmarking: surgical volume and operative mortality in Veterans Administration Medical Centers.

BACKGROUND: This study examines the relationship between hospital surgical volume and operative modality rate. Emphasis is placed on the role of referral patterns; the effects of variation in patient condition, operative procedures, and hospital characteristics, and the contribution of volume of related procedures, in addition to specific-procedure volume, the definition of operative mortality, and their influence on surgical outcome. METHODS: This cohort study included all Department of Veterans Affairs Medical Centers with surgery programs. All patients in five operation-diagnosis sets (colectomy for cancer, colectomy without cancer, amputation above the knee, coronary artery bypass grafting for old myocardial infarction, and open-heart valvuloplasty), discharged from 1987 through 1989, were assessed to determine the risk-adjusted 30-day postoperative morality rate. RESULTS: Only one of the studied groups, valvuloplasty, demonstrated a significant inverse relationship between hospital surgical volume and operative mortality rate. No additional effect on outcome owing to related procedure volume was noted. CONCLUSIONS: This study demonstrates some of the difficulties in assessing surgical results and that we should be skeptical of the intuitively attractive notion that high annual volumes of operations will necessarily result in improved outcomes. This is congruent with recent literature in which there is no broad-based evidence that hospital surgical volume affects operative mortality rate.

Amputation, Surgical↗