Healthcare utilisation among patients discharged from hospital after intensive care.

Surviving critical illness can be life-changing and presents new healthcare challenges for patients after hospital discharge. This feasibility study aimed to examine healthcare service utilisation for patients discharged from hospital after intensive care unit stay. Following Ethics Committee approval, patients aged 18 years and older were recruited over three months. Those admitted after cardiac surgery, discharged to another facility or against medical advice were excluded. Patients were informed of the study by post and followed-up by telephone at two and six months after discharge. General practitioners were also contacted (44% responded). Among 187 patients discharged from hospital, 11 died, 25 declined to participate and 39 could not be contacted. For 112 patients (60%) who completed a survey, the majority (82%) went home from hospital and were cared for by their partner (53%). More than half of the patients (58%) reported taking the same number of medications after intensive care unit stay but 30% took more (P = 0.023). While there was no change in the number of visits to the general practitioner for 64% of patients, 29% reported an increase after intensive care unit stay. At six months, 40% of responders who were not retired were unemployed. Discharge summary surveys revealed 39 general practitioners (71%) were satisfied with details of ongoing healthcare needs. Twenty-one general practitioners wrote comments: 10 reported insufficient information about ongoing needs/rehabilitation and two reported no mention of intensive care unit stay. Survivors of critical illness had increased healthcare needs and despite most returning home, had a low workforce participation rate. This requires further investigation to maximise the benefits of survival from critical illness.

Nutritional consequences of modified vertical gastroplasty in obese subjects.

BACKGROUND: Gastroplasty results in a considerable reduction in food intake and dramatic weight loss. This is likely to have a nutritional impact, although it is expected that this may be minimised by good advice and supplement use. METHODS: Twenty six obese subjects were studied in detail before and after modified long vertical gastroplasty (MLVG), in a setting where comprehensive nutritional advice on symptom avoidance was readily available and multivitamin supplements advised. Nutritional intake and anthropometry were measured preoperatively and at 2, 5 (n = 22) and 12 months (n = 11) postoperatively. RESULTS: Mean weight loss was 13%, 22% and 31% of initial body weight at the respective time points. Energy intake (EI) was significantly reduced postoperatively, with the mean protein intake being only 40 g/d. At 2 months, mean intakes of iron, calcium and zinc from food were 40%, 71% and 39%, respectively, of the Australian recommended dietary intake (RDI), and iron and zinc intake remained below half the RDI at 5 months. Only regular adherence to the vitamin/mineral supplement, brought iron and calcium intakes close to RDI, but zinc remained low. Haemoglobin and serum ferritin concentrations did not alter significantly and remained within the reference range, but serum folate fell significantly between 5 months and 12 months. By 5 months, 60% of subjects never regurgitated or regurgitated less than once a week. Fresh bread was the least tolerated food. Frequency of regurgitation was not correlated with adequacy of nutrient intake. CONCLUSIONS: The results emphasise the need for regular follow-up of MLVG patients, and nutritional advice which includes diet quality as well as symptom management, and regular intake of the vitamin/mineral supplement for at least a year postoperatively. Low protein intakes, however, remain of potential long-term concern.

Hypoplastic enamel, onycholysis, and hypohidrosis inherited as an autosomal dominant trait. A review of ectodermal dysplasia syndromes.

A syndrome consisting of a hypocalcified-hypoplastic enamel, onycholysis with subungual hyperkeratosis, seborrheic dermatitis of the scalp, and hypofunction of the sweat glands with rough dry skin is inherited as an autosomal dominant trait in a kindred of Caucasian ancestry.