Comparison of the effects of treatment of acute myocardial infarction in a coronary unit and on a general medical ward

During 1968, 400 cases of proven acute myocardial infarction were admitted to the Toronto General Hospital (mortality 25.0%).Approximately half the patients who survived their stay in the Emergency Department were admitted to the Coronary Unit (mortality 15.6%) while the other half, because of lack of beds in the Coronary Unit, were treated on a general medical ward (mortality 26.5%). More elderly patients (> 70) were admitted to the medical wards and contributed to the higher mortality.The frequency of successful resuscitation following cardiac arrest was twice as great in the Coronary Unit as on the medical wards. Antiarrhythmic drugs given in the Coronary Unit with the assistance of the electrocardiographic monitor did not influence the early mortality. Digitalis was used more frequently on the medical wards, but did not appear to exert an unfavourable effect on survival.     

Changing pattern in a general practitioner obstetric unit.

Over the past nine years in Watford the proportion of hospital confinements has increased and domiciliary confinements have almost ceased. The proportion of patients originally booked into the general practitioner obstetric unit and subsequently transferred to the consultant unit has increased. Most patients are transferred during pregnancy, and the numbers transferred in labour are decreasing. The proportion of GPs attending their patients for delivery is low: local practitioners appear to be prepared for the consultant unit to supervise delivery with the practitioner co-operating in antenatal and postnatal care and family planning. There seems little doubt that the success of GP units depends on the enthusiasm and interest of individual practitioners.     

Phylogenetic analysis of a nosocomial transmission of hepatitis B virus at a paediatric haematology ward

A nosocomial Hepatitis B virus (HBV) outbreak at a paediatric onco-haematology unit was investigated using molecular biological methods to determine the origin of the infections. The National Reference Laboratory of Hepatitis Viruses received seven HBsAg positive sera from patients and one from the brother of a patient. A fragment of the preS1/preS2/S genes from all samples was amplified, the PCR products were sequenced and a rooted phylogenetic tree was constructed. All nucleotide sequences from the different patients were very similar and 6 of the 8 sequences were identical, suggesting a common origin of the infections. These sequences were closely related to those amplified from a nosocomial HBV epidemic in another hospital in Hungary. The on-scene investigation revealed several malpractices. The two hospital departments had close connections and some of the patients were treated in both institutions. Present report underlines the importance of developing screening protocols for hepatitis viruses and that of the introduction of regular training programs for health care professionals in the field of hospital hygiene.     

Vaccination status of infants discharged from a neonatal intensive care unit.

OBJECTIVE: To determine the vaccination rate among infants discharged from a neonatal intensive care unit (NICU) and factors affecting that rate. DESIGN: Cross-sectional survey conducted when the children were 12 to 18 months of age. SETTING: NICU at the Royal University Hospital, Saskatoon, Sask. PARTICIPANTS: All 395 infants discharged from the NICU between Jan. 1 and June 30, 1992. MAIN OUTCOME MEASURES: Vaccination rate, ethnic background (native or non-native), place of residence (urban or rural), health status (number of days spent in the NICU), reasons for delay in or incomplete vaccinations (those involving parents'' responsibility, infant illness or contraindications). RESULTS: Of the 395 infants, 20 (5.0%) had died and incomplete information was available for 30 (7.6%). Complete data were available for 345 (87.3%). Of the infants for whom data were available, 8 (2.3%) had never been vaccinated and 142 (41.2%) had a delayed vaccination schedule or had not completed their scheduled vaccinations. Only 195 (56.6%) of the infants had received a full vaccination series. Non-native ethnic background was a predictor of completed vaccinations (odds ratio [OR] 5.40, 95% confidence interval [CI] 3.05 to 9.52). In a univariate model, urban area of residence was not a significant predictor of vaccination status, but when ethnic background was controlled for in a multivariate logistic regression analysis, urban area of residence was found to be inversely associated with completed vaccinations (OR 0.34, 95% CI 0.15 to 0.79). The number of days the child had spent in the NICU was not a significant predictor of vaccination status. CONCLUSION: The vaccination rate of infants discharged from the NICU is not optimal. Urban native children appears to be at risk of not being vaccinated. Non-native infants are five times more likely than native infants to have completed all of their scheduled vaccinations. Methods to improve the rate of completed vaccinations, especially for native children, must be sought and tested.     

A rehabilitation ward in a district general hospital: first three years' experience.

The experience of the first three years'' work on a ward for the rehabilitation of patients was reviewed. Adults with physical disabilities or mixed physical and psychological disabilities, including unstable or deteriorating conditions, were accepted for intensive rehabilitation. Most patients had neurological disorders. The ward policy was that each patient had considerable time with the therapist, maximum personal independence was encouraged, and multidisciplinary staff meetings were held to agree the goals of treatment. Much effort was spent helping patients and relatives to adapt to conditions of progressive disability, but the response to questionnaires suggested that these patients as well as those who did improve received some benefit from being on the ward. Overall the benefits of the intensive rehabilitation that was offered on this ward outweighed those from short stays on medical wards.     

Reflections on neonatal intensive care unit

This article reflects on twelve years spent on a regional neonatal intensive care unit (NICU). The trials and tribulations experienced by parents and staff alike are described together with some of the initiatives developed to mitigate the effects of these. High standards of medical and nursing care, environmental conditions, good communications and a multi-disciplinary approach are all identified as crucial in giving holistic care to the neonate. Finally, the involvement of the professional team is recognised as transient but key in developing in the parents both competence and confidence in their roles for the future.     

Respite care on a children's ward.

In March 1984 a short term respite care facility for handicapped children was opened in a children''s ward catering primarily for acute medical and surgical problems. The facility was based on a four bedded room designed so that if beds became short in the main ward it could revert immediately to the care of acutely sick children. Three nurses were appointed specifically to staff the facility, the nursing budget for the rest of the ward being reduced proportionately. Conversions were funded by charities and some of the conversion work done by volunteers. The main users were totally dependent children aged under 5 with severe mental and physical handicaps. Parents found the service invaluable, and in addition to planned admissions it was usually possible to accept a child at short notice--for example, when some domestic crisis occurred. Only very rarely was admission impossible because of the needs of acutely ill children. A short term respite care facility not only helps parents cope and may provide beneficial experience for a handicapped child but is also a useful training ground for medical students and junior staff.     

A unit for source and protective isolation in a general hospital.

An isolation unit consisting of 12 ventilated cubicles was investigated over 18 months. Out of 462 patients admitted, 262 (57%) required source and 200 (43%) protective isolation. Admissions of patients with staphylococcal sepsis fell from 16 in the first three months to six in the last three months. Staphylococcus aureus was recovered from 12% of nurses'' fingers and often in small numbers from protective clothing and uniforms, but only two patients acquired a strain from a nurse or another patient. Gram-negative bacilli were rarely recovered from hands or protective clothing of nurses, and there was no evidence of spread of infectious diseases. This inexpensive unit, with simple but efficient isolation-nursing techniques, successfully prevented the spread of infection.     

Can children with a psychiatric disorder be treated in a general ward?

Because admission to a regional child and adolescent psychiatric unit is often fraught with difficulties children with psychiatric disorders were admitted to a general children''s ward. Over the four years (1980-4) 24 patients accounted for 31 admissions. Of these, five had feeding disorders (anorexia, bulimia), seven neuroses, three psychoses, four elimination disorders, and five other diagnoses. All the children were later discharged to their homes, most having appreciably improved. Because of the proximity of the hospital to the child''s natural environment work with the families and schools was not interrupted by the admission. The results of this approach are encouraging and could have implications for future planning of services for this category of patients.     

Occurrence of two cases of cryptococcosis within 3 months on the same general medical ward.

Two cases of systemic cryptococcal infection occurred on the same general medical ward within 3 months. The patients had been on the same ward for 5 days. Both had other diseases associated with depression of cellular immune responses had received immunosuppressive drugs.     

Outcome of pregnancies referred to a general practitioner maternity unit in a district hospital.

OBJECTIVE--To audit the outcome of pregnancies booked for confinement in a general practitioner maternity unit in a district general hospital. DESIGN--Retrospective review of case records. SETTING--General practitioner maternity unit in a district general hospital. PATIENTS--685 Women referred to a general practitioner unit in 1987. RESULTS--315 Nulliparous women and 330 multiparous women were booked for confinement; 202 women transferred to consultant care before delivery and a further 104 during labour or after delivery. Recognised risk factors, other than nulliparity, rarely predicted the need for transfer. Confinement in the general practitioner unit was associated with low intervention and good fetal outcomes. CONCLUSIONS--The general practitioner maternity unit provides a safe alternative for confinement in low risk pregnancies. High rates of transfer deny this facility to many women who desire confinement in a low technology environment.