Subject(s)
Health Policy , Health Services , Cross-Cultural Comparison , Health Resources , Humans , Norway , Societies, Medical , SwedenABSTRACT
The principles of total quality management (TQM) were used to improve the infant metabolic screening program in a large urban hospital. Three quality indicators needed improvement; unsatisfactory specimen quality, delayed delivery to the state laboratory for testing, and specimen slips missing the date of collection. A multidisciplinary team identified the root causes of the poor quality and implemented remedies. Dramatic improvement in three infant screening indicators occurred within a 4-month period. Evaluation of the three indicators continued for the following 3-year period. Quality improvement programs that involve a multidisciplinary approach benefit the patient and staff and may reduce costs.
Subject(s)
Metabolism, Inborn Errors/prevention & control , Neonatal Screening/organization & administration , Total Quality Management/organization & administration , Blood Specimen Collection/standards , Humans , Infant, Newborn , Maternal-Child Nursing , Metabolism, Inborn Errors/blood , Patient Care Team , Professional Staff CommitteesSubject(s)
Cardiac Surgical Procedures , Cardiovascular Diseases/epidemiology , Adolescent , Adult , Age Factors , Aged , Community Health Services , Female , Humans , Male , Middle Aged , Referral and Consultation , Statistics as Topic , SwedenSubject(s)
Hypertension/economics , Costs and Cost Analysis , Humans , Regional Medical Programs/economics , SwedenABSTRACT
The coronary arteriographic findings and prognosis in a series of 486 non-surgically treated patients were analyzed. A semiselective injection was used. The number and causes of deaths were obtained from the census registry after a follow-up period of 7--12 years. The material comprised normal arteriograms in 26% of the patients, wall irregularities at most in 17%, obstruction of at least half the diameter in 37%, and unclassifiable arteriograms in 19%. A mean of 1.8 obstructed arteries per patient was found in the group with obstructive arterial lesions and among these patients the left anterior descending artery was most often engaged. In the same group the cardiac mortality at seven years was 20%. There were no significant differences between deceased and survivors with regard to clinical data. The arteriograms themselves offered more information about the prognosis. Normal arteries or wall irregularities at most implied excellent prognosis with regard to death in coronary heart disease. The seven-year mortality was 36% among patients with coronary artery occlusions, which is significantly higher than 14% among those with arterial stenosis. Materials from the USA and Canada have displayed a much higher mortality than our study in spite of comparable arteriographic findings.
Subject(s)
Coronary Angiography , Coronary Disease/diagnostic imaging , Adolescent , Adult , Aged , Coronary Disease/mortality , Female , Follow-Up Studies , Humans , Male , Middle Aged , PrognosisABSTRACT
A number of 597 patients with acute myocardial infarction (AMI) were treated with continuous ECG monitoring of the heart rhythm in a coronary care unit for at least three days. We found 84 patients with heart block, 39 with complete, 29 with at most second degree and 16 with at most first degree heart block. The treatment was primarily conservative; 22 of the 39 patients with complete heart block were given isoproterenol and two received temporary pacemakers. Survival was traced over two years in the whole patient group with myocardial infarctions. Heart block implied a worsened prognosis over the two years, but survival was independent of the degree of heart block. Among those with complete heart block, survival did not differ from that of a comparable patient series from Copenhagen, where all patients were given pacemakers. This does not support indiscriminate artificial pacing of patients with AMI and complete heart block. Our results ought to be controlled in a randomized study.
Subject(s)
Heart Block/complications , Myocardial Infarction/complications , Aged , Female , Heart Block/drug therapy , Heart Block/mortality , Heart Block/therapy , Humans , Isoproterenol/therapeutic use , Male , Middle Aged , Myocardial Infarction/mortality , Myocardial Infarction/therapy , Pacemaker, Artificial , PrognosisABSTRACT
A total of 140 patients given permanent pacemaker 1963--73 were followed during three years with regard to survival. Indication of pacemaker implantation was AV block in 82% and disturbed consciousness in 84%. The first half of the series had a survival equal to that of the second half. The survival was 86, 73 and 64% and the excess mortality, which is above normal, was 9, 16 and 20% after one, two and three years, respectively. Concepts of fractional life-time and death-time were developed. These express the proportion of the total observation time that is life and death, respectively. The fractional life-time was 0.80 and the fractional death-time 0.20. The excess death-time was 0.12 (12%) of the total observation time. Mortality, survival, life-time and death-time were compared in three studies, the present one and two from Denmark. The great similarities were obvious. An estimation of the unpaced survival during three years, based on studies of AV block before the pacemaker era, indicated the great benefit of pacemaker treatment.
