Characteristics and outcomes of critically ill Aboriginal and/or Torres Strait Islander patients in North Queensland.

A retrospective cohort analysis of an admission database for the intensive care unit at The Townsville Hospital was undertaken to describe the characteristics and short-term outcomes of critically ill Aboriginal and Torres Strait Islander patients. The Townsville Hospital is the tertiary referral centre for Northern Queensland and services a region in which Aboriginal and Torres Strait Islander people constitute 9.6% of the population. Aboriginal and Torres Strait Islander patients were significantly younger and had higher rates of invasive mechanical ventilation, emergency admissions and transfers from another hospital. Despite these factors, intensive care mortality did not differ between groups (9.4% versus 7.7%, P=0.1). Higher Acute Physiology and Chronic Health Evaluation III-j scores were noted in the Aboriginal and Torres Strait Islander population requiring emergency admission (65 versus 60, P=0.022) but were lower for elective admission (38 versus 42, P <0.001). Despite higher predicted hospital mortality for Aboriginal and Torres Strait Islander patients requiring emergency admission, no significant difference was observed (20.1% versus 19.1%, P=0.656). In a severity adjusted model, Aboriginal and/or Torres Strait Islander status did not statistically significantly alter the risk of death (odds ratio 0.88, 95% confidence interval 0.65, 1.2, P=0.398). Though Aboriginal and Torres Strait Islander patients requiring intensive care differed in admission characteristics, mortality was comparable to other critically ill patients.

Toxic leukoencephalopathy in the intensive care unit.

In this article, we report two cases of acute toxic leukoencephalopathy to highlight this acute clinicoradiological syndrome as an important, although uncommon, consideration in the undifferentiated comatose patient who fails to wake following drug overdose or has unexplained neurology with a history of drug exposure. We then review the current literature and discuss potential differential diagnoses in this setting, along with proposed treatments for this condition. The cases presented demonstrate a more fulminant onset than previously well-defined acute toxic leukoencephalopathy subtypes and highlight the prognostic importance of magnetic resonance imaging in diagnosing a condition from which significant functional recovery seems possible.

Commentary on the Clinton health care plan.

The best that can be said for the plan is that it provides a roadmap for dialogue, and the worst that can be said is that it is a prescription for disaster, states this article. The author's major concern is that the Clinton plan would take away from consumers choice and control over their own health care. He fears that patient health care decisions will be placed in the hands of government-appointed boards, employers, or regional health alliances. What we don't need, claims the author, is a plan that creates more bureaucracies, more paperwork, global budgets, and control over the use and development of drugs and technology.

Two largest national alliances fine-tune strategies as health care environment changes. Interview by Howard J. Anderson.

The nation's two largest alliances of not-for-profit hospitals and systems are refining their roles for the 1990s. American Health Care Systems (AmHS) and Voluntary Hospitals of America (VHA) are moving away from strategies designed for competition in the marketplace of the 1980s, and toward helping their members change the way they deliver health care in their communities. While AmHS is promoting its health care reform proposal, VHA sees its existing 29 regional organizations of hospitals as a potential infrastructure for the development of community-based, integrated networks of care as envisioned in the AHA's reform plan. Experts add that the alliances clearly have to go beyond group purchasing to serve the changing needs of their members.

A capital plan.

A panel of experts responded to the Health Care Financing Administration's proposed capital reimbursement regulations at the recent Annual Conference of the Federation of American Health Systems in Orlando, Florida. What follows are edited versions of some of the panelists--but not all--concerning the issue and HCFA's position.

Birth of a sick or handicapped infant: impact on the family.

The experience of bearing and caring for a sick or handicapped infant is described from the point of view of parents, whose responses were gathered from a clinical study. Implications for the child's development and ways of supporting the family are discussed.