Characteristics of patients with shingles admitted to a district general hospital.

Little is known about why some patients with shingles are admitted to hospital. We reviewed 72 case notes from a list of 80 patients admitted to hospital with shingles over a six-year period. Pain was the main complaint of the patients admitted, most of whom were elderly and lived alone. The commonest site of involvement in hospital admissions was the eye (herpes zoster ophthalmicus). Diagnosis of shingles was made after admission in 12 patients, eight of whom had originally been diagnosed as having an acute medical or surgical condition. We conclude that the prodromal phase of shingles may lead to misdiagnosis.     

Management of asthma in hospital: a prospective audit

In a prospective study of management of asthma in hospital patients with acute asthma admitted to a single hospital over a calendar year were surveyed. Altogether 157 out of 194 admissions (81%) were studied. The patients (16 of whom had been admitted twice and one three times) were interviewed at home about two weeks after discharge, and their hospital records were reviewed. When interviewed an appreciable proportion of patients said that their asthma had been poorly controlled after their discharge from the hospital: 54 reported regular sleep disturbance due to wheeze, 78 tightness of the chest in the morning, and 77 wheeze after climbing one flight of stairs. Patients had been described on admission as having had symptoms of deteriorating asthma for a median of three days. Closer questioning of 71 patients, however, elicited that 50 had had regular symptoms indicating poor control for weeks or months. Most patients did not know how their drugs worked, and many did not have an appropriate plan of action in the event of a further attack. In all the cases studied 114 patients were treated with oral corticosteroids, only 70 had had their previous maintenance treatment increased at the time of discharge, and 107 had a follow up appointment booked for an average of three and a half weeks after discharge. These findings show that undersupervision and undertreatment of patients with asthma are common and not confined to those dying of the condition.     

Acute colitis in a district general hospital

A review of all patients who had been admitted to hospital with acute ulcerative colitis in one health district between 1975 and 1984 showed that 96 had required 114 admissions with acute colitis: 42% (40) were admitted during their first attack, and 20% (19) required urgent surgery. A further nine patients underwent surgery after responding initially to intensive medical treatment that did not check the attack. There were no deaths from acute colitis. Thirteen patients underwent elective surgery for ulcerative colitis, and there were no deaths. The prognosis for acute colitis in district general hospitals has improved.     

Follow-up care after acute myocardial infarction.

OBJECTIVE: To examine the medical care received by patients following discharge from hospital after acute myocardial infarction (AMI). SETTING AND DESIGN: Community-based cross-sectional survey. PATIENTS: 2836 consecutive patients aged 25-64 years living in the Perth Statistical Division who were admitted to hospital with AMI during 1984-1988. After one reminder the response rate was 71%. RESULTS: Half of all respondents were in full-time employment at the time of their AMI. At follow-up this had fallen to a third. Over 80% of patients visited a cardiologist after AMI, with half remaining under consultant care to the time of survey. However, one in five patients reported no follow-up care at the time of survey. Seventy-three per cent of patients reported undergoing at least one exercise stress test after AMI, with 61% undergoing angiography, 16% angioplasty and 24% coronary bypass surgery. Large proportions of the patients accurately reported being prescribed beta-blockers and antiplatelet agents. The pattern of prescribing at discharge corresponded closely with the use of cardioactive agents at the time of survey and with drugs reported to have been taken continuously since discharge to the time of survey. CONCLUSIONS: These data suggest that follow-up care after AMI is both comprehensive and widespread. Such care may have contributed significantly to the overall decline in mortality from ischaemic heart disease.     

Mortality in the elderly during respite hospital care.

This study examined the mortality in the elderly during 243 respite hospital admissions. Sixty-four dependent elderly patients entered a regular respite care scheme and were admitted to hospital for a period of 4 weeks out of every 12 weeks. The mortality rate in hospital was one death per 976 days, in comparison to one death per 1296 days at home. This small increase in mortality should not deprive patients and their carers from access to respite care.     

A crisis team for the mentally ill: the effect on patients, relatives and admissions

A Crisis Team staffed by eight psychiatric nurses provided a 24-hour service to the seriously and chronically mentally ill who were experiencing psychiatric crisis. Immediate and continuing help was provided to patients and their relatives in their homes. Effects on patients, relatives and hospital admissions were studied. The sample consisted of 69 patients seen during a three-month study period. Six months later, 80% of patients and 73% of their relatives were interviewed by an independent psychologist. Of the sample, 80% had previous psychiatric admissions and were diagnosed as suffering from one of the functional psychoses--mainly schizophrenia or manic depression. The crises that led to the Team's interventions were mostly psychotic episodes and aggressive or suicidal behaviours; 47% occurred at night. Hospital records confirmed reports from staff, patients and relatives that the Team had halved admissions. Most patients and relatives were "very satisfied" with the treatment received from the Team and considered it had helped "greatly". They especially liked the home visits, the 24-hour availability and the friendly staff who provided them with support, medication and where needed, accommodation. In spite of the interventions of the Team, some 40% of patients were admitted during the research period, and at follow-up most were still experiencing symptoms and difficulties. Relatives, more than patients, expressed a need for additional rehabilitation and easier access to hospital, especially for those severely ill patients whom they found too difficult to live with. While the work of the Crisis Team proved highly beneficial for both patients and relatives, and reduced hospital admissions by half during the study period, it is clear that there is still a need for long-term support and rehabilitation.     

The use of sedative-hypnotic drugs in a university teaching hospital.

We reviewed the charts of 476 patients admitted to a university teaching hospital to determine whether sedative-hypnotic drugs (SHDs) were being used excessively and to examine the use of SHDs as hypnotics. The frequency of medical and surgical indications for barbiturates and benzodiazepines or other minor tranquillizers as well as the use of such drugs were compared among different groups of patients and specialty wards. Of the patients 29% had a regular order and 40% had a PRN order; only 77% of the PRN orders were administered. A total of 215 patients (45%) received an SHD during their hospital stay, and 160 (34%) received the drug as a hypnotic. Medical indications accounted for 49% of the regular orders but only 2% of the PRN orders; moreover, 89% of all the PRN orders were for insomnia. On average, patients receiving SHDs as hypnotics were older (p less than 0.05) and stayed longer in hospital (p less than 0.01) than those who did not; however, no patient on the geriatric or pediatric ward received an SHD as a hypnotic during the hospital stay. The differences in use between patient groups may have been influenced by orientation of ward staff. Physicians should review their rationale for prescribing hypnotics and avoid routine orders on admission.     

Differences between "geriatric" and "medical" patients aged 75 and over.

We analysed the characteristics of patients aged 75 and over admitted to the geriatric and general medical wards over a three month period in a teaching hospital. Patients admitted to the geriatric wards were slightly older, were more often female, more likely to be admitted during the day and during a week day, more likely to have been seen by their own general practitioner, had more chronic and multiple illness with non-specific presentations, and stayed longer in hospital. Referring doctors seem to discriminate between patients needing geriatric care and those more suitable for general medical care, but there is an overlap in the characteristics of the two groups.     

Does the presence of heart failure alter prescribing of drug therapy after myocardial infarction? A multicentre study

OBJECTIVE: To evaluate the use of cardiovascular medications in patients with and without heart failure after myocardial infarction (MI). DESIGN AND SETTING: Multicentre study of drug therapy for patients with MI in 16 major metropolitan teaching hospitals in Australia over a 1-month period at each hospital in the period November 2004 - March 2005. PARTICIPANTS: 479 patients admitted consecutively to the individual hospitals. MAIN OUTCOME MEASURES: Proportion of patients with and without heart failure who were prescribed key cardiovascular medications after MI. RESULTS: 116 of the 479 patients admitted for MI (24.2%) had heart failure at some point during their hospitalisation. Patients with heart failure were older (68 v 63 years; P < 0.05), more likely to be women (34% v 24%; P < 0.05) and a higher proportion had diabetes (26% v 21%). There was significantly reduced prescribing of beta-blockers, clopidogrel and statins for patients with heart failure compared with those without heart failure. Mineralocorticoid receptor antagonist use was low (< 10%) in the former group. CONCLUSIONS: We found reduced prescribing of some prognostically relevant medications for patients with heart failure. For beta-blockers, this may be explained by the greater clinical instability in patients with heart failure. Given the absolute benefit of drug therapy in patients with heart failure after MI, our findings suggest suboptimal prescribing in Australian teaching hospital practice.     

Acute medical bed usage by nursing home residents.

An increasing number of elderly patients in nursing home care appears to be presenting to hospital for acute medical admission. A survey of acute hospital care was undertaken to establish accurately the number and character of such admissions. A total of 1300 acute medical beds was surveyed in Northern Ireland in June 1996 and January 1997 on a single day using a standardised proforma. Demographic details, diagnosis and length of admission were recorded. A total of 84 patients over the age of 65 (mean 79.5 years) admitted from nursing home care was identified in June 1996 and a total of 125 (mean 83.3 years) in January 1997. A total of 88 (70%) of admissions in 1997 were accompanied by a general practitioner's letter. The assessing doctor judged that 12 (9.6%) of admissions in 1997 could have had investigations and or treatment reasonably instituted in a nursing home. The proportion of acute medical beds occupied by nursing home residents was 6% in June 1996 rising to 10% in January 1997. The study accurately identifies the significant contribution of nursing home patients to acute medical admissions and the low proportion in whom admission was unnecessary. Closure of long stay hospital facilities should be accompanied by investment in community medical services and also reinvestment in acute hospital care for elderly people.     

Psychiatric morbidity in patients with life-threatening asthma: initial report of a controlled study

Thirteen patients who have suffered a "near-miss" death of asthma have been compared to 36 patients with asthma who had not experienced such an episode. Contrary to expectations, there were no differences between the groups in their levels of psychiatric morbidity, their degree of life-style and social restrictions or in their levels of compliance with prescribed medication. However, both groups did show higher than expected levels of psychiatric morbidity, severe life-style and social restrictions and an unexpectedly-high compliance with prescribed medication. The main psychiatric diagnoses that were noted were anxiety disorders. It is concluded that more comprehensive asthma education and close medical follow-up are likely to improve the physical and psychological health of asthmatic patients. The high-risk patients in this study who received such follow-up have shown hospital-admission rates that have been reduced by a half while maintaining good asthma control. This South Australian longitudinal study is continuing.     

联合毛果芸香碱滴眼液治疗眼外伤房角后退继发性青光眼

目的探讨眼外伤房角后退继发性青光眼患者联合应用毛果芸香碱滴眼液的治疗效果。方法回顾性分析浙江省新昌县中医院2011年1月~2012年12月间22例眼外伤房角后退继发性青光眼患者临床资料。结果治疗后研究组和对照组眼压、瞳孔直径均较治疗前明显改善(P<0.05)。两组患者治疗过程中均无一例发生不良反应,治疗耐受力较好。结论眼外伤房角后退继发性青光眼患者在常规治疗基础上联合应用毛果芸香碱滴眼液治疗效果显著,能降低其眼压,缩小瞳孔,不良反应少,治疗安全性高,值得临床推广和应用。     

Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance

BACKGROUND—Adverse drug reactions and non-compliance are important causes of admissions in the elderly to medical clinics. The contribution of adverse drug reactions and non-compliance to admission by the medical emergency department was analysed.
METHODS—A total of 578 consecutive elderly patients admitted to the medical emergency department were interviewed to determine the percentage of admissions due to adverse drug reactions or non-compliance with medication regimens, their causes, consequences, and predictors.
RESULTS—Eighty three (14.4%) of the 578 admissions were drug related: 39 (6.7%) caused by adverse drug reactions and 44 (7.6%) caused by non-compliance with medication. One hundred ninety two (33.2%) patients had a history of non-compliance. Factors associated with an increased risk of admission because of an adverse drug reaction were patients with diabetes or neoplasms, and patients using numerous different medications. Factors associated with a higher risk of hospitalisation because of non-compliance were poor recall of the medication regimen, seeing numerous physicians, female sex, polypharmacy, drug costs, and switching over to non-conventional forms of treatment.
CONCLUSION—Many elderly admissions are drug related, with non-compliance accounting for a substantial fraction of these. Elderly people at high risk of suffering a drug related medical emergency are identified and suitable interventions may be planned by the healthcare policymakers to target them.


     

曲伏前列素滴眼液联合微脉冲小梁激光成形术对开角型青光眼患者眼压水平的影响及安全性

目的探讨曲伏前列素滴眼液联合微脉冲小梁激光成形术对开角型青光眼患者眼压水平的影响及安全性。方法选取2018年5月至2019年12月期间我院收治的开角型青光眼患者74例作为研究对象,所有患者均采用微脉冲小梁激光成形术治疗,采用奇偶数方式将患者抽签分为两组,其中偶数患者纳入对照组(n=37,采用马来酸噻吗洛尔滴眼液治疗),奇数患者纳入观察组(n=37,采用曲伏前列素滴眼液治疗),比较两组眼压水平改善情况、眼部血液动力学改善情况及药物的安全性。结果治疗前两组患者眼压水平比较,差异无统计学意义(P0.05);治疗后,两组眼压水平均得以下降,且不同时间段观察组下降幅度均高于对照组(P0.05);治疗前,两组患者眼部视网膜中央动脉及睫状后短动脉的舒张末期血流速度及收缩期峰值血流速度经比较,差异无统计学意义(P0.05);治疗后,两组患者眼部视网膜中央动脉及睫状后短动脉的舒张末期血流速度及收缩期峰值血流速度均得以提升,且观察组提升幅度均高于对照组(P0.05);观察组副作用总发生率为5.41%,与对照组(21.62%)比较,差异有统计学意义(P0.05)。结论开角型青光眼患者采用曲伏前列素滴眼液联合微脉冲小梁激光成形术促使眼压得以下降,改善患者的眼部血液动力学,且副作用更少,值得临床推广及借鉴。     

Outcomes for dialysis patients with end-stage renal failure admitted to an intensive care unit or high dependency unit

OBJECTIVE: To assess the outcomes for chronic dialysis patients requiring admission to an intensive care unit (ICU) or high dependency unit (HDU). DESIGN: Retrospective audit of prospectively collected data from local and national databases. SETTING: The ICU and HDU at a tertiary referral hospital. PARTICIPANTS: 70 chronic dialysis patients admitted between 2001 and 2006. MAIN OUTCOME MEASURES: Unit and hospital mortality, recurrent admission patterns and median survival after discharge from hospital. RESULTS: For patients' last admissions, mortality in the ICU or HDU was 17% and in hospital was 29%. The 12 deaths in the ICU or HDU occurred a median of 18 hours (range, 3-203 hours) after admission, reflecting the severity of their underlying illness. The independent predictors of death in hospital were age and the number of non-renal organ systems failing. Patients with pulmonary oedema had a lower risk of death than patients admitted for other reasons. Although 21 patients accounted for 55 of 104 admissions (53%), recurrent admissions to the ICU or HDU generally occurred during different hospital admissions. They were not associated with a higher risk of death in hospital. Patients discharged home had a median survival of 2.25 years, and a median survival of 3.5 years from starting dialysis. The median survival for patients on dialysis in Australia in general is 4.5 years (Australia and New Zealand Dialysis and Transplant Registry). CONCLUSION: Dialysis patients discharged home after an ICU or HDU admission have survival similar to that of Australian dialysis patients generally.     

Automated Surveillance for Adverse Drug Events at a Community Hospital and an Academic Medical Center

ObjectivesTo compare the rates and nature of ADEs at an academic medical center and a community hospital using a single computerized ADE surveillance system.DesignProspective cohort study of patients admitted to two tertiary care hospitals.Outcome MeasureAdverse drug events identified by automated surveillance and voluntary reporting.MethodsWe implemented an automated surveillance system across an academic medical center and a community hospital. Potential events identified by the computer were reviewed in detail by medication safety pharmacists and scored for causality and severity. Findings were compared between the two hospitals, and with voluntary reports from nurses and pharmacists.ResultsOver the 8 month study period, 25,177 patients were admitted to the university hospital and 8,029 to the community hospital. There were 1,116 ADEs in 900 patients at the university hospital for an overall rate of 4.4 ADEs per 100 admissions. At the community hospital, 399 patients experienced 501 ADEs for a rate of 6.2 events per 100 admissions. Rates of antibiotic-associated colitis, drug-induced hypoglycemia, and anticoagulation-related ADEs were significantly higher at the community hospital compared with the university hospital. Computerized surveillance detected ADEs at a rate 3.6 times that of voluntary reporting at the university hospital and 12.3 times that at the community hospital.ConclusionsOperation of a common automated ADE surveillance system across hospitals permits meaningful comparison of ADE rates in different inpatient settings. Automated surveillance detects ADEs at rates far higher than voluntary reporting, and the difference may be greater in the community hospital setting. Community hospitals may experience higher rates of certain types of ADEs compared with academic medical centers.     

Changing patterns of malaria in south-east Scotland: implications for practitioner awareness and prophylactic advice.

The medical records of all 229 patients with malaria admitted to the Edinburgh City Hospital between 1969 and 1988 were studied retrospectively. A total of 137 were from Africa, 44 from the Indian subcontinent, 19 from the Far East, 18 from New Guinea, 5 from the Middle East and 3 from South America. The number of yearly admissions rose markedly after 1983, mainly due to an increase in Plasmodium falciparum cases. Ninety-four cases (15 with severe parasitaemia) mainly from Kenya and Nigeria were due to P. falciparum infection and 99 to P. vivax. There were no deaths. A seasonal distribution of onset of fever in patients with P. vivax infections originating from the Indian subcontinent showed that most patients presented during the summer. Prophylaxis had generally been irregular or non-existent but many compliant patients may have been receiving an inadequate dose of chloroquine on a mg/kg body weight basis. General practitioners are likely to see at least one case of malaria every 4 years. They are encouraged to seek advice from a specialist unit whenever necessary whether before or after their patient travels abroad. Travellers, in particular to Kenya and Nigeria, and Asian immigrants to the UK returning on holiday to their country of origin should be strongly advised to take regular prophylaxis including on return to the UK.     

氯替泼诺治疗中重度干眼抗炎作用的临床分析

目的观察0．5％氯替泼诺滴眼液治疗中重度干眼病的临床疗效。方法按标准纳入中重度千眼患者40例,回顾性分两组：联合用药组予0．5％氯替泼诺滴眼液和新泪然滴眼液联合用药;单用药组用新泪然滴眼液。在治疗前及治疗后2、4、6周观察眼表疾病指数（OSDI）、泪膜破裂时间（BUT）、泪液分泌实验（SchirmerI试验）、眼表染色评分（OSS评分）、眼压;ELISA测泪液中炎症介质白介素-6（IL-6）的表达。结果治疗2周后,联合用药组OSDI评分均值明显降低,较治疗前差异有显著性（P〈0．05）;治疗2周联合用药组眼表炎症体征减轻;联合用药组BUT均较治疗前延长;两组各时间点的SehirmerI及眼压值无明显变化。结论0．5％氯替泼诺滴眼液通过下降IL-6表达,减轻中重度干眼眼表炎症,安全有效。     

玻璃酸钠联合双氯芬酸钠治疗干眼症的疗效分析

目的分析玻璃酸钠滴眼液联合双氯芬酸钠滴眼液治疗干眼症的疗效。方法将2011年10月至2013年4月收治的70例（140眼）干眼症患者分为观察组（n=35）和对照组（n=35）,观察组患者采用玻璃酸钠滴眼液联合双氯芬酸钠滴眼液治疗,对照组患者采用玻璃酸钠滴眼液治疗。结果观察组治疗总有效率（97．14％）明显高于对照组（P〈0．05）,治疗后观察组的眼部症状评分、Fe、BUT和SIT均显著地优于对照组（P〈0．05）。结论玻璃酸钠滴眼液联合双氯芬酸钠滴眼液治疗干眼症疗效确切,值得临床推广应用。