ABSTRACT
Benign smooth muscle cell proliferation commonly involves a variety of body organs, yet is a rare finding in the spermatic cord or paratesticular tissue of the male genital tract. Here we discuss a case of smooth muscle hyperplasia of the epididymis which presented as an intrascrotal mass. This is a very rare condition and should be considered in the differential diagnosis of any paratesticular mass.
ABSTRACT
OBJECTIVES: The Community Care (Delayed Discharges, etc.) Act, 2003 was aimed at reducing the number of patients whose discharge from hospital was delayed, incorporating financial incentives based on a model from Sweden. The Act permitted NHS hospital trusts to charge local authority Social Service Departments for delays they were deemed responsible for and was accompanied by grants aimed at supporting improvements in the transfer of care. This study aims to assess how far the subsequent reduction in delays has been due to the operation of the Act, and to evaluate the extent that the legislation increased efficiency across health and social care. DESIGN: Analysis and interpretation of a range of official routine health statistics plus unpublished performance data. Setting Data on patients delayed in hospital in England from 2001-2002 to 2006-2007 and trends in hospital activity. MAIN OUTCOME MEASURES: Trend analysis of health statistics and performance data relating to delayed discharges and other relevant indicators. Results Although there has been an overall reduction in delayed discharges, this trend predates the implementation of the Act. Overall, bed- days lost to delayed discharges accounted for only a small proportion of all bed-days - 1.6% in 2006-2007, and over the period studied the causes of the majority of delays were attributed to the NHS (68%). CONCLUSIONS: These findings indicate little evidence to support the policy of charging social services to improve public sector efficiency. The focus on reducing delays should be set in the context of the wider health economy. There are a number of pressures to reduce the time patients spend in hospital including fewer beds and increasing numbers of admissions, plus a rise in emergency readmission rates is noted. There are few good data available to monitor the impact of earlier discharge, such as on the quality and availability of post-discharge care.