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The relation between changes in inpatient workload, measured as increases or decreases in the number of inpatients admitted from the waiting list, and the overall length of the waiting list was studied. Overall trends in admissions from the waiting list, the influence of seasonal patterns, and the impact of industrial action on admissions were also studied. The hypothesis was that when admissions from the waiting list increased the length of the waiting list would decrease and vice versa. No such simple relation was found. In fact, if anything, as the number of admissions from the waiting list increased so did the length of the waiting list. This result could be due to inconsistencies in compiling waiting list data or to the use of waiting lists to improve organisational efficiency. It is also possible, and perhaps likely, that the ability to meet need in admitting patients to hospital influences patients and their doctors to translate previously unmet need into demand for hospital services. 相似文献
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Meiland F 《Tijdschrift voor gerontologie en geriatrie》2002,33(2):53-55
The waiting list for nursing home admission is expected to remain unacceptably long. A study of the use and of possibly problematic consequences of the waiting list was described in a thesis. Despite long mean waiting periods and many problems (depressive symptoms, experiences of burden) already at the start of the waiting period, the majority of the informal caregivers were satisfied with the waiting times. This may be explained by a reticence to nursing home admission and by enlistment to the waiting list "out of precaution". Both a long and a short waiting period could be experienced as too long. Waiting list figures give insufficient insight in the "real" demand for nursing home care and in problematic waiting periods. 相似文献
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Anthony Alment 《BMJ (Clinical research ed.)》1987,294(6576):898-899
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The discrepancy between the length of the waiting list and eventual admissions from the waiting list was investigated by comparing data from two different sources of routine statistics in the Oxford region. It was estimated that about 28% of the waiting list comprised patients who were not eventually admitted to hospital within the region. 相似文献
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C Richmond 《CMAJ》1996,154(3):378-381
Health care: public, private or both? In Great Britain, about 13% of the population is covered by private health insurance, and everyone else is served by the public health care system known as the National Health Service, or NHS. Caroline Richmond, who examined the impact of private medical practice in Britain, says people become private patients for one compelling reason: to avoid the NHS''s notoriously long waiting lists for surgery. According to Professor Alan Maynard, a health care researcher, the mainstays of the private sector are the "three h''s" --hips, hernias and hemorrhoids-- along with some elective surgery, particularly in gynecology and opthalmology. Another small sector focuses on fertility regulation and cosmetic surgery. Although the levels are not monitored closely, physician consultants are not permitted to earn more than 10% of their income from private practice. 相似文献
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OBJECTIVE--To establish and compare the characteristics of older (greater than or equal to 70 years) and younger patients with chest pain selected to undergo coronary angiography and by analysis of their subsequent management to assess the value of coronary angiography for older patients with chest pain. DESIGN--Retrospective analysis of clinical case notes and coronary angiography reports. SETTING--Cardiology department with referral population of one million in an Edinburgh hospital. PATIENTS--134 consecutive patients with chest pain aged 70 years or over investigated by coronary angiography between 1978 and 1988; 134 randomly selected patients aged under 70 investigated over the same period. MAIN OUTCOME MEASURES--Clinical and angiographic features at time of angiography and management after angiography. RESULTS--Older patients represented a small, but increasing, proportion of those investigated. Older patients had more severe symptoms at the time of angiography, were taking more antianginal drugs, and had had their symptoms for longer than younger patients. At angiography more older patients had triple vessel coronary disease, left main stem stenosis, or left ventricular impairment. After angiography similar proportions of older and younger patients underwent coronary artery surgery, with more elderly patients requiring urgent operation; although operative mortality was higher for elderly patients, symptomatic benefit was similar to that in younger patients. CONCLUSIONS--Older patients with angina selected to undergo coronary angiography and subsequent coronary surgery have more severe symptoms and underlying cardiac disease. Earlier referral and investigation might yield a population with lower operative risk. Selection of patients for coronary angiography and coronary artery surgery should be based on the potential for benefit and should avoid "agism." 相似文献
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Vural A Pershukov IV Batyraliev TA Niiazova-Karben ZA Suleĭmanova T Peresypko MK Petrakova LN 《Vestnik rentgenologii i radiologii》2005,(6):27-31
The authors assessed the in-hospital and long-term (up to 6 months) results of coronary stenting conducted just after diagnostic coronarography during a common procedure in patients with stable angina pectoris on effort. The 2001-2002 study included 2277 patients. The clinical indications for catheterization were Functional Classes II-IV stable angina on effort in 83 % of patients and silent ischemia in 17%. The study excluded patients with previous coronarography, acute coronary syndrome on admission, renal failure, left ventricular ejection fraction <30%, and left trunk stenosis. All the patients received aspirin and clopidogrel before catheterization. RESULTS: 57% of patients had multivessel disease; full revascularization was performed in 59% of the patients with multivessel disease. The coronary intervention was successful in 100% of cases. Significant in-hospital events (myocardial infarction without Q wave) were in 1.2% of cases. The mean length of hospital stay was 2.9 +/- 2.4 days. The rate of stent thrombosis for as long as 30 days was 0.2%. Recurrent angina and/or positive exercise tests were in 12% during 6 months. CONCLUSION: immediate stening is effective and safe in most patients with stable angina during diagnostic catheterization. It does not increase immediate and late complications. 相似文献
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Isabelle Danner-Boucher Véronique Loppinet Aurore Boxus Claire Dary Anne Brigitte Lambert Marine Prieur Céline Vallet Adrien Tissot 《Orphanet journal of rare diseases》2018,13(1):11
Background
In 2010, the time on the lung transplant waiting list in Nantes University Hospital (NUH) was 9.2 months, compared to a French national median of about 4 months. The NUH transplant unit performs both heart and lung transplantations, which can be seen as competing activities. To fix the problem, the adult Cystic Fibrosis (CF) team decided to engage in the French CF Quality Improvement Program (QIP PHARE-M) in 2012. The objectives were: i) To reduce the time on the lung transplant waiting list at the Nantes Transplant Unit by increasing the number of lung transplants per year twhile maintaining a 5-year survival rate above the French national average. ii) To improve the organization of the lung transplant access process and the quality of the waiting time for patients.Methods
A quality controller was involved as the QIP referent to coach the CF quality team, analyze the pre-transplant process, and set up meaningful measures. Benchmarking was performed with other transplant units, and staff discussions were held with the Transplant Team (TT) to assess the outcomes of rejected donor lungs. Negotiations were made with the hospital administration. Plan, Do, Study and Act cycles were used to redesign the pre-transplant assessment in connection with the CF centers (CFC) referring patients to the NUH transplant unit.Results
i) The flow of patients has been reorganized, decreasing the time spent in surgical intensive care by increasing the number of beds in the intensive care unit, and a chest physician has been recruited ii) The number of organs rejected has been reduced iii) Lung transplant activity has increased to 20–25 transplants per year, and the median waiting time was reduced to 3.5 months for patients transplanted in 2014 and to 1.85 months for patients transplanted in 2015 iv) Added-value activities including education, information, and psychosocial support are now offered to patients during the waiting time.Conclusion
The QIP PHARE-M, including coaching by a quality-engineer, has helped our adult CF center address its specific lung transplant issues and redesign the lung transplant process for both local patients and patients referred by other CFC.14.
The length of time that patients spend on waiting lists is a topic of current concern. Calculating the proportion of patients who have been on a waiting list for a long time by taking a census of patients on the list at a single point in time will tend to yield a higher estimate than that obtained by calculating waiting times of patients admitted to hospital during a period of time. To illustrate this point the waiting times of patients in the Oxford region as measured by SBH 203 returns ("census" data) were compared with those as measured by the Hospital Activity Analysis ("event" data). As expected, the SBH 203 census returns showed a higher proportion of patients who had waited over a year compared with the "event" measure of all admissions. This difference, which is analagous to the difference between prevalence and incidence in epidemiology, should be considered when using data from these sources to calculate waiting times. 相似文献
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In order to evaluate the microsocial factors affecting quality of life in stroke victims, 100 survivors of ischemic stroke and the same number of their relevant family members (key persons, controls) were interviewed using Stroke Specific Quality of Life Scale (SS-QOL) questionnaire. Total SS-QOL score did not differ significantly between post-stroke patients and key persons (z=0.64, P=0.524). Relevant family members ranked the patients' family (P=0.022) and social role (P=0.08), and their mobility (P=0.09) slightly higher than the patients themselves. However, male patients rated their "family role" (z=-2.82, P=0.005), "mobility" (z=-2.28, P=0.023) and "social role" (z=-1.86, P=0.063) higher than their female peers. Recent (< or =33 months) and remote (>33 months after the ischemic accident) stroke patients did not differ substantially in total SS-QOL score, social role and hand function assessment but in mobility (z=-1.90, P=0.057) and family role estimation (z=-2.47, P=0.014) the difference was in favor of recent stroke patients. The domain scores and total SS-QOL score did not differ by gender between recent stroke patients and their controls either. It is concluded that assessment of general functioning and global quality of life among post-stroke patients provided by relevant patients'family members could be accepted with confidence. Male patients slightly overestimate their mobility and social role. No significant impact of post-stroke time span on quality of life estimation was observed. 相似文献
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Darío Antolín-Amérigo Luis Manso Marco Caminati Belén de la Hoz Caballer Inmaculada Cerecedo Alfonso Muriel Mercedes Rodríguez-Rodríguez José Barbarroja-Escudero María José Sánchez-González Beatriz Huertas-Barbudo Melchor Alvarez-Mon 《Clinical and molecular allergy : CMA》2016,14(1):4
Food allergy has increased in developed countries and can have a dramatic effect on quality of life, so as to provoke fatal reactions. We aimed to outline the socioeconomic impact that food allergy exerts in this kind of patients by performing a complete review of the literature and also describing the factors that may influence, to a greater extent, the quality of life of patients with food allergy and analyzing the different questionnaires available. Hitherto, strict avoidance of the culprit food(s) and use of emergency medications are the pillars to manage this condition. Promising approaches such as specific oral or epicutaneous immunotherapy and the use of monoclonal antibodies are progressively being investigated worldwide. However, even that an increasing number of centers fulfill those approaches, they are not fully implemented enough in clinical practice. The mean annual cost of health care has been estimated in international dollars (I$) 2016 for food-allergic adults and I$1089 for controls, a difference of I$927 (95 % confidence interval I$324–I$1530). A similar result was found for adults in each country, and for children, and interestingly, it was not sensitive to baseline demographic differences. Cost was significantly related to severity of illness in cases in nine countries. The constant threat of exposure, need for vigilance and expectation of outcome can have a tremendous impact on quality of life. Several studies have analyzed the impact of food allergy on health-related quality of life (HRQL) in adults and children in different countries. There have been described different factors that could modify HRQL in food allergic patients, the most important of them are perceived disease severity, age of the patient, peanut or soy allergy, country of origin and having allergy to two or more foods. Over the last few years, several different specific Quality of Life questionnaires for food allergic patients have been developed and translated to different languages and cultures. It is important to perform lingual and cultural translations of existent questionnaires in order to ensure its suitability in a specific region or country with its own socioeconomic reality and culture. Tools aimed at assessing the impact of food allergy on HRQL should be always part of the diagnostic work up, in order to provide a complete basal assessment, to highlight target of intervention as well as to evaluate the effectiveness of interventions designed to cure food allergy. HRQL may be the only meaningful outcome measure available for food allergy measuring this continuous burden. 相似文献
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Crespo López M Hornillos Jerez C Bernaldo De Quirós Aragón M Gómez Gutiérrez MM 《Revista espa?ola de geriatría y gerontología》2011,46(6):319-324
Quality of life (QoL) is one of the most important outcome variables in the study of the efficacy of interventions with people with dementia. However, its assessment is difficult 1) because it is a complex construct for which there is no unified theoretical or conceptual approach, and 2) because of the inherent difficulties in the cognitive impairments of the people under study. In this work different methods and instruments to this end are reviewed, and related findings are discussed. It is important to take into account the subjective view of the assessed person, as assessments done by proxies tend to underestimate QoL. In spite of the need for further development in this field, it is concluded that the instrument of choice is the QOL-AD, as it is change-sensitive, it correlates with health measurements, it is translated into several languages and it can be administered to people with low MMSE scores. 相似文献
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Background
In standard reference sources, the incidence of coronary artery disease (CAD) in patients with atrial fibrillation (AF) ranged between 24 and 46.5%. Since then, the incidence of cardiovascular risk factors (CRF) has increased and modern treatment strategies (“pill in the pocket”) are only applicable to patients without structural heart disease. The aim of this study was to investigate the incidence and severity of CAD in patients with AF.Methods
From January 2005 until December 2009, we included 261 consecutive patients admitted to hospital with paroxysmal, persistent or permanent AF in this prospective study. All patients underwent coronary angiography and the Framingham risk score (FRS) was calculated. Patients with previously diagnosed or previously excluded CAD were excluded.Results
The overall incidence of CAD in patients presenting with AF was 34%; in patients >70 years, the incidence of CAD was 41%. The incidence of patients undergoing a percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) was 21%. Patients with CAD were older (73±8 years vs 68±10 years, p = 0.001), had significantly more frequent hypercholesterolemia (60% vs 30%, p<0.001), were more frequent smokers (26% vs 13%, p = 0.017) and suffered from angina more often (37% vs 2%, p<0.001). There was a significant linear trend among the FRS categories in percentage and the prevalence of CAD and PCI/CABG (p<0.0001).Conclusions
The overall incidence of CAD in patients presenting with AF was relatively high at 34%; the incidence of PCI/CABG was 21%. Based upon increasing CRF in the western world, we recommend a careful investigation respecting the FRS to either definitely exclude or establish an early diagnosis of CAD – which could contribute to an early and safe therapeutic strategy considering type Ic antiarrhythmics and oral anticoagulation. 相似文献19.
Lauren C. Bresee Merril L. Knudtson Jianguo Zhang Lynden Crowshoe Sofia B. Ahmed Marcello Tonelli William A. Ghali Hude Quan Braden Manns Gabriel Fabreau Brenda R. Hemmelgarn 《CMAJ》2014,186(10):E372-E380