Trends in special (high-security) hospitals. 1: Referrals and admissions.
(65/2057)
BACKGROUND: Special hospitals in England provide psychiatric care and treatment in high security. Their future is often questioned. AIMS: To test for variation in demand for high-security psychiatric services over one 10-year period. METHOD: This study was from the special hospitals' case registers and hospital records. The main measures were numbers and annual rates for referrals and beds offered; the Mental Health Act 1983 (MHA) classification of mental disorder; adjusted population rates by health region; admission episodes; legal category of detention; admission source and type of offence. RESULTS: Referrals to special hospitals showed no decrease during the 10 years; an apparent increase may reflect underrecording before 1992. Admissions fell by about 16% over the 10 years, but with regional variation. Women, civil cases, admissions under the MHA classifications of psychopathic disorder or mental impairment and directly from a court on a hospital order were most affected. There was an increase in admissions of pre-trial and sentenced male prisoners, and of transferred hospital order patients from other hospitals. CONCLUSIONS: There is continuing demand from all parts of the country for high-security hospital beds. The smaller numbers admitted appear to include more demanding cases. (+info)
Trends in special (high-security) hospitals. 2: Residency and discharge episodes, 1986-1995.
(66/2057)
BACKGROUND: It has been argued that many patients in special hospital beds do not need to be there. In the 1990s there were initiatives to discharge women and people with learning difficulties. AIMS: To test for trends in special hospital discharges and to examine annual resident cohorts. METHOD: This study was from case registers and hospital records. The main measures were numbers and annual rates for referrals and beds offered; the Mental Health Act 1983 (MHA) classification of mental disorder; adjusted population rates by region; admission episodes; legal category of detention; admission source and type of offence. RESULTS: The median annual number of residents was 1859 (range 1697-1910), with an 8% fall for the period. This particularly affected people in mental impairment categories. Numbers were sustained in the male mental illness groups. Discharges, mainly to other institutions, increased. There was no overall change over the 10 years in length of stay for treatment, but successive admission cohorts from 1986 did show some reduction, even with solely remand order cases excluded. CONCLUSIONS: Service planners need a longitudinal perspective on service use. Trends over 10 years to both fewer admissions and more discharges have reduced the special hospital population, but despite new treatments for schizophrenia, men under mental illness classification, as well as transfer from other secure settings, have gone against this trend. (+info)
Mild hypercholesterolemia and premature heart disease: do the national criteria underestimate disease risk?
(67/2057)
OBJECTIVES: To determine the frequency of hospital admissions for acute coronary syndrome in young adults and to examine the risk factors that predispose to the development of premature heart disease. BACKGROUND: Significant coronary heart disease (CHD) is considered rare in the young adult. Current guidelines do not recommend treatment of mild cholesterol abnormalities for primary prevention of CHD in the young. METHODS: This is a large case series of 449 adults (< or =50 years) admitted to the hospital with acute coronary syndrome. A history of cardiovascular risk factors and lipid profile were recorded. The presence and extent of CHD were established. RESULTS: Mean patient age was 44 +/- 6 years. Documented CHD was present in 61% of hospital admissions. Multivariate analysis revealed that history of hypercholesterolemia, history of smoking and diabetes were independently associated with premature CHD. The fasting lipid profiles were only borderline to mildly abnormal. Serum total cholesterol, low-density lipoprotein (LDL) and triglyceride levels were not different in cases compared with control subjects. Nearly half (49%) of those with LDL levels of > or =160 mg/dl had only one additional risk factor or none. Despite this, a history of hypercholesterolemia had independent and incremental value on other risk factors for the likelihood of premature CHD. CONCLUSIONS: The magnitude of hospital admissions relating to premature CHD is high. In this population, the presence of borderline or mild hypercholesterolemia has significant effects on the development of premature CHD. These observations have significant implications in the development of guidelines for primary prevention of premature CHD. (+info)
Echocardiographic predictors of clinical outcome in patients with left ventricular dysfunction enrolled in the SOLVD registry and trials: significance of left ventricular hypertrophy. Studies of Left Ventricular Dysfunction.
(68/2057)
OBJECTIVES: To assess the relation of left ventricular (LV) and left atrial (LA) dimensions, ejection fraction (EF) and LV mass to subsequent clinical outcome of patients with LV dysfunction enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) Registry and Trials. BACKGROUND: Data are lacking on the relation of LV mass to prognosis in patients with LV dysfunction and on the interaction of LV mass with other measurements of LV size and function as they relate to clinical outcome. METHODS: A cohort of 1,172 patients enrolled in the SOLVD Trials (n = 577) and Registry (n = 595) had baseline echocardiographic measurements and follow-up for 1 year. RESULTS: After adjusting for age, New York Heart Association (NYHA) functional class, Trial vs. Registry and ischemic etiology, a 1-SD difference in EF was inversely associated with an increased risk of death (risk ratio, 1.62; p = 0.0008) and cardiovascular (CV) hospitalization (risk ratio, 1.59; p = 0.0001). Consequently, the other echo parameters were adjusted for EF in addition to age, NYHA functional class, Trial vs. Registry and ischemic etiology. A 1-SD difference in LV mass was associated with increased risk of death (risk ratio of 1.3, p = 0.012) and CV hospitalization (risk ratio of 1.17, p = 0.018). Similar results were observed with the LA dimension (mortality risk ratio, 1.32; p < 0.02; CV hospitalizations risk ratio, 1.18; p < 0.04). Likewise, LV mass > or =298 g and LA dimension > or =4.17 cm were associated with increased risk of death and CV hospitalization. An end-systolic dimension >5.0 cm was associated with increased mortality only. A protective effect of EF was noted in patients with LV mass > or =298 g (those in the group with EF >35% had lower mortality) but not in the group with LV mass <298 g. CONCLUSIONS: In patients with LV dysfunction enrolled in the SOLVD Registry and Trials, increasing levels of hypertrophy are associated with adverse events. A protective effect of EF was noted in patients with LV mass > or =298 g (those in the group with EF >35% fared better) but not in the group with LV mass <298 g. These data support the development and use of drugs that can inhibit hypertrophy or alter its characteristics. (+info)
Patients and procedures in short-stay independent hospitals in England and Wales, 1997-1998.
(69/2057)
BACKGROUND: Private hospitals' activities are not routinely reported, so what services they provide and for whom is not known. This study describes the clientele and case-mix of independent hospitals in England and Wales in 1997-1998. METHOD: Person, clinical and funding data were collected on samples of patients admitted to 215 of 221 independent hospitals open in 1997-1998. Sample numbers were weighted to reflect sampling duration, region, season and non-response. RESULTS: A total of 37,434 sampled records represented 828,422 admissions: 406,843 in-patients (5 per cent fewer than in 1992-1993) and 421,580 day cases (69 per cent more); 806,509 were residents of England and Wales (up 24 per cent); 16,628 came from overseas (down 20 per cent). Numbers increased in all age groups except children; 25 per cent were 65 or over (18 per cent in 1992-1993). The commonest procedures were abortion (11 per cent), endoscopy of the gastro-intestinal tract (10 per cent) or joints (5 per cent), lens operations (5 per cent), hernia repairs (3 per cent), and other common National Health Service (NHS) elective operations. The NHS funded 84,561 patients (11 per cent of the total) including 41,942 non-abortion cases (6 per cent). A total of 540,996 (76 per cent) paid through insurance; 119,101 (17 per cent) were self-funded including 30 per cent of the over-75s. Ninety-five per cent of patients went home, 0.3 per cent died and 0.2 per cent were transferred to NHS hospitals. CONCLUSIONS: Demand for short-stay independent hospital care is rising. The clientele is becoming older, and readier to pay out of pocket. Clinical activity is mainly surgical and similar to NHS elective surgical demand. One year's caseload equals 10 weeks' elective admissions to NHS hospitals, in that sense relieving the NHS. The scale of transfer to NHS hospitals (three per day) is small. (+info)
The link between major risk factors and important categories of admission in an ageing cohort.
(70/2057)
BACKGROUND: Record linkage of routine hospital data to population-based research findings presents an opportunity to explore the relationships between classical risk factors and hospital activity. METHODS: The objectives of this study were to examine, in Paisley and Renfrew, the effect of risk factor variables on the likelihood of experiencing an acute hospital admission with six major medical conditions. The subjects were 8,349 women and 7,057 men, aged 45-64 in the early to mid-1970s. The main outcome measures were acute hospital admission with principal diagnosis of: any malignant neoplasm; malignant neoplasm of trachea, bronchus and lung; ischaemic heart disease; respiratory disease; cerebrovascular disease; or diabetes mellitus. RESULTS: Smokers were almost eight times more likely to be admitted with lung cancer and, to a lesser extent, were more likely to be admitted for the other conditions investigated with the exception of diabetes mellitus. Forced expiratory volume was also an independent risk factor for admission with lung cancer and strokes. Higher levels of cholesterol were associated with increased risk of admission with ischaemic heart disease but less with cancer (including lung cancer). With the exception of admissions for cerebrovascular disease, deprivation category was found to have no independent effect on the likelihood of experiencing any of the morbidity outcomes examined. CONCLUSIONS: These data confirm that associations first established between risk factors and mortality outcomes (e.g. smoking and lung cancer) are also found between risk factors and hospital admissions for the same causes. This in itself is unremarkable, but the results are of interest for three reasons. First, they illustrate the potential of record linkage to map the effects of risk factors. Second, they demonstrate the size of the effect risk factors have on the risk of admission. Third, they provide a surprising finding that deprivation category does not act as an independent risk factor for the majority of the categories of admission investigated. (+info)
Escherichia coli O157:H7; an economic assessment of an outbreak.
(71/2057)
BACKGROUND: The aim of the study was to assess the impact of an outbreak of Escherichia coli O157:H7 that occurred in 1994 in a rural community, with a population of approximately 107,000, to the west of Edinburgh. METHODS: The impact of the outbreak was assessed during the acute phase of the illness and in the subsequent 12 months. The method involved three surveys of confirmed cases using general practice notes, hospital records and interviews with cases. Key persons involved in the investigation and control of the outbreak were also interviewed. The impact of the illness on cases and their families was estimated and the resources used to treat cases and to control the outbreak were costed and long-term costs projected. RESULTS: There were 71 cases whose ages ranged from 7 months to 84 years. The mortality rate was 1.4 per hundred cases. There were 10 cases of haemolytic uraemic syndrome (HUS) and one case of thrombotic thrombocytopenia purpura (TTP). Two children were on long-term dialysis. Co-morbidity involving the immune system was associated with hospital admission. The illness lasted on average 6.9 weeks. Twenty-six per cent of cases reported symptoms 12 months later. The average cost per HUS case was 62,353 pound sterlings, the TTP case cost 21,422 pound sterlings, non-HUS and non-TTP cases cost 1,030 pound sterlings. The costs of investigating and controlling the outbreak were 171,848 pound sterlings. The costs of cases projected over 30 years were 11.9 million pound sterlings, or 168,032 pound sterlings per case. CONCLUSIONS: The impact on the health of cases was considerable and the costs were high. Every effort should be made to prevent the disease and to identify and control outbreaks quickly. (+info)
Customized fetal weight limits for antenatal detection of fetal growth restriction.
(72/2057)
OBJECTIVE: To define cut-off limits for individually adjustable fetal weight standards for the detection of intrauterine growth restriction. DESIGN: Retrospective study, with the outcome measures small-for-gestational age (SGA) birth weight, operative delivery for fetal distress, umbilical artery pH < 7.15, and admission to the neonatal intensive care unit. SUBJECTS AND METHODS: Two hundred and fifteen women considered to be at increased risk of uteroplacental insufficiency were recruited to a study of serial ultrasound scans. Fetal weights were derived using standard formulae and, retrospectively, weight percentiles were calculated after individual adjustment for maternal height, weight in early pregnancy, ethnic group, parity and fetal sex. INTRODUCTION: One or more antenatal scans indicative of fetal weight below the 10th customized percentile were predictive for a SGA neonate at birth (P < 0.001), operative delivery for fetal distress (P < 0.01) and admission to neonatal intensive care (P < 0.01) but not for a low umbilical artery pH (P = 0.6). Receiver-operator curves showed the optimal customized fetal weight percentile limit for predicting an SGA neonate to be the 18th percentile (sensitivity 83%, specificity 79%, positive predictive value 63% and negative predictive value 92%). For the prediction of operative delivery for fetal distress and admission to neonatal intensive care, the optional customized cut-off value was the 8th percentile. CONCLUSIONS: The assessment of fetal weight using ultrasound and an individually-adjusted standard is predictive of growth restriction and perinatal events associated with hypoxia or diminished reserve. The optimal cut-off value for predicting operative delivery for fetal distress or admission to the neonatal intensive care unit suggests that the 10th customized percentile is a good limit for clinical use. (+info)