Health trends最新文献

The quality of patient data routinely collected in hospitals is rarely assessed, though by repute it may often be incomplete and inaccurate. To explore their completeness and accuracy, patient data separately collected by a hospital Patient Administration System (PAS) and by a departmental Clinical Information System (CIS) used by clinicians were compared. The results indicate that, although both systems appear to record reliably demographic and administrative data, PAS data are more complete than CIS data. Moreover clinicians and medical records staff seem to use classifications of diagnoses and procedures in profoundly different ways. More attention should be paid to the need to assess and improve data quality. The development of a shared database, used and validated by medical records staff and clinicians alike, may be the best way to achieve this.

This paper describes the findings from a programme in central Nottingham, which aimed to provide non-institutionalised health services to single homeless people. The results show a high degree of acceptance of the programme by such people. It is argued that involvement in existing mainstream health services is particularly appropriate for the growing number of young people who are homeless, and for whom there is hope of rehabilitation within the community.

The concept that total parenteral nutrition (TPN) has to be administered centrally is increasingly recognised to be mistaken: for most patients, peripheral parenteral nutrition provides satisfactory nutritional support. Use of the peripheral route avoids the risks of central venous cannulation--but is it more cost-effective? In a randomized clinical study we examined the costs of TPN in 51 patients who underwent a mean of 8 days of intravenous feeding and conclude that the use of peripheral parenteral nutrition may lead to cost savings.

An audit of routine cataract surgery in our hospital was carried out by examining records of 340 adult patients who underwent such surgery during October 1990. The category of intended accommodation (day case or inpatient), operative details, post-operative course and management were recorded, along with the outcome measures of visual acuity (unaided and corrected) and refractive error (spherical equivalent and cylinder). The costs of treatment, including post-operative management, were calculated for each patient. The results indicate that day case surgery under local anaesthesia was the most cost-effective method of cataract surgery, with no detrimental effect on clinical outcome.

A survey was undertaken in Leicestershire of 25 carers of patients suffering from Huntington's Disease. The needs of families suffering from a late onset hereditary disease cross many service boundaries, thus providing a challenge for service providers. The results of the survey show that the service provision for people caring for patients with this disease are poor, particularly the availability and difficulty in access of some services. Two of the carers' most basic needs were for better residential care for their relatives and access to a source of long-term follow-up.

There have been dramatic changes in residential and nursing care of elderly people in the community over the last decade. Despite this, little is known about how these institutions compare in terms of: the quality of care they provide to residents; the dependency of the residents; or the manpower levels and qualifications of the staff employed. This study was undertaken with the aim of comparing the public and private sectors providing care to elderly people. A random selection of institutions was invited to participate, including private residential and nursing homes, Social Services homes and National Health Services long-term care wards. The findings show that the dependency of residents in the public sector was greater than in the private sector, with more mentally confused, incontinent and socially disengaged residents in the public sector. The staff to resident ratio in public institutions did not differ significantly from the private sector. Overall scores of quality of care were similar. Nevertheless, these scores masked important differences between the sectors, eg poorer buildings and facilities characterised the National Health Service units. Fewer activities and therapies, but a better ambience, was noted in the private nursing homes. These results suggest that the outcome of a policy to transfer the most heavily dependent patients from the care of the public sector could increasingly burden the private sector. This would result increase the proportion of highly dependent residents, with no clear provision for improved staff ratios, quality of care or training of staff.

This paper reports an examination of the incidence of chronic lung disease in premature infants admitted to the neonatal intensive care unit at Liverpool Maternity Hospital. From January 1980 to December 1989 details were obtained for these infants such as gestation, weight, sex, survival to discharge and ventilatory support received. The findings show that a total of 242 infants had developed chronic lung disease; one-third of these were born in 1988 or 1989. Logistic regression suggests that chronic lung disease was significantly associated with being male, low birthweight, low gestation, surviving to discharge, and being born in 1988 or 1989. Among infants at 'high risk' of this condition, mortality had significantly decreased and the incidence had significantly increased. This increase is not fully explained by changes in the population admitted during the last decade. A rising workload should be anticipated in terms of the specialised follow-up and care required by these babies.

Case-mix measurement is a basic requirement of clinical and resource management systems within health care organisations, and offers a potentially useful tool for the setting and monitoring of contracts. Ambulatory care has particular problems in the construction of appropriate case-mix measures, and day-case surgery provides an opportunity to test two existing measures, one inpatient (Diagnostic Related Groups) and one ambulatory (Ambulatory Visit Groups). These grouping systems were applies to the same data to compare the case-mix patterns that they produce. The findings show that the ambulatory visit group appear to have advantages over the diagnostic group with respect to their underlying assumptions and labelling of the groups; in particular, they assign greater weight to procedures. However, diagnostic groups are more developed, easier to use, more familiar and allow direct comparisons with inpatient care. Nevertheless, a proper evaluation of these issues requires further data collection and analysis, together with a fundamental examination of the uses of ambulatory case-mix.

This annual article is intended to help young doctors and dentists make informed decisions about their career paths, in the light of the current prospects of obtaining a career post in any specialty. Regional details of the national figures presented here may be obtained through individual Regional postgraduate deans, Health Authorities and clinical tutors. This article summarises the most recent figures available, and comparison with previous articles in this series may help to identify employment trends.

A survey of 31 district general hospitals found a large variation in hours of medical and nursing time available per inpatient episode in general medicine and its associated specialties. These differences could not be attributed to case-mix variation or severity. The application of weightings to different grades of nursing and medical staff had little effect on either the rankings of hospitals by staff hours per episode, or the overall degree of variation in staffing levels. The results show no evidence to suggest that hospitals with relatively low levels for one category of staff are compensated by relatively high levels of another. It would appear that those hospitals with high levels for one category of staff are also well provided for the others. This evidence of inequality may reflect historic patterns of resource allocation that recent manpower policies might seek to redress. Studies of the relationship between staffing levels and quality of patient care should be undertaken before adopting a policy of labour redistribution.