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The objective of this study was to measure the efficacy of protection orders (POs) in reducing assault and injury-related outcomes using a matched comparison group and tracking outcomes over time. This study was a retrospective review of police, emergency department, family court, and prosecutor administrative records for a cohort of police-involved female IPV victims; all events over a 4-year study period were abstracted. Victims who obtained POs were compared with a propensity-score-based match group without POs over three time periods: Before, During, and After the issuance of a PO. Having a PO in place was associated with significantly more calls to police for nonassaultive incidents and more police charging requests that were of multiple-count and felony-level. Comparing outcomes, PO victims had police incident rates that were more than double the matched group prior to the PO but dropped to the level of the matched group during and after the order. ED visits dropped over time for both groups. This study confirmed the protective effect of POs, which are associated with reduced police incidents and emergency department visits both during and after the order and reduced police incidents compared with a matched comparison group.

The goal of the quality improvement project reported here was to increase the proportion of peritoneal dialysis (PD) patients receiving adequate dialysis as defined by the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) guidelines. Our approach was to increase the frequency with which we measured PD adequacy and changed prescriptions in response to low adequacy values. We developed 3 indicators, each one subdivided to reflect differences by type of PD and time on PD. Our improvement goal was to achieve the midpoint between baseline performance on those indicators and 100%, equating to a 50% reduction in failure rate (RFR). At baseline, the project included 122 facilities with 1,517 patients (data from October 1999 to March 2000). At re-measurement, we had 117 facilities with 1,372 patients (data from January 2001 to June 2001). In addition to obtaining facility-specific feedback reports, we conducted educational intervention workshops to which all PD providers were invited. After the workshops, "mandatory intervention" facilities submitted improvement plans that were reviewed by the PD Adequacy Work Group to determine if improvement actions were appropriately focused on identified root causes. Not all intervention facilities attended the workshops, and some facilities attended voluntarily. Overall, the Network 5 results showed a statistically significant improvement in measuring PD adequacy (84% baseline to 92% re-measurement), with a corresponding 51% RFR. Improvement in desired levels of adequacy was also statistically significant (55% baseline to 64% re-measurement), with a 21% RFR. Analysis by the intervention group showed that "mandatory intervention" facilities improved more than did "voluntary" facilities in measuring adequacy and in reaching desired levels, and that the differences were statistically significant. Quality improvement efforts that focused on improving the adequacy of PD in Network 5 were accomplished.

We have developed and tested a new method to increase the diagnostic usefulness of measurements of lactate dehydrogenase (LDH; EC 1.1.1.27) isoenzymes. The method estimates the separate contributions from enzymatically distinct organ clusters (e.g., heart/kidney/erythrocyte, liver/muscle, lung) to the total activity of LDH in serum. To test this method, we monitored serum LDH isoenzymes over the entire hospital course of 73 patients admitted to the intensive-care unit with chest pain, myocardial infarction, or serious hemodynamic disturbances. The organ-specific estimates provided useful information beyond measurements of the original isoenzymes. The sensitivity and specificity of this new method in detecting acute myocardial infarction, as well as concomitant disorders involving the liver or lung, are significantly greater than those of other diagnostic indices or pathologists' judgments. Serial plots of the organ-specific estimates may provide additional insight into evolving pathophysiological processes.