In‐hospital stroke: a multi‐centre prospective registry

Background: In‐hospital strokes (IHS) are relatively frequent. Avoidable delays in neurological assessment have been demonstrated. We study the clinical characteristics, neurological care and mortality of IHS. Methods: Multi‐centre 1‐year prospective study of IHS in 13 hospitals. Demographic and clinical characteristics, admission diagnosis, quality of care, thrombolytic therapy and mortality were recorded. Results: We included 273 IHS patients [156 men; 210 ischaemic strokes (IS), 37 transient ischaemic attacks (TIA) and 26 cerebral haemorrhages]. Mean age was 72 ± 12 years. Cardiac sources of embolism were present in 138 (50.5%), withdrawal of antithrombotic drugs in 77 (28%) and active cancers in 35 (12.8%). Cardioembolic stroke was the most common subtype of IS (50%). Reasons for admission were programmed or urgent surgery in 70 (25%), cardiac diseases in 50 (18%), TIA or stroke in 30 (11%) and other medical illnesses in 71 (26%). Fifty‐two per cent of patients were evaluated by a neurologist within 3 h of stroke onset. Thirty‐three patients received treatment with tPA (15.7%). Thirty‐one patients (14.7%) could not be treated because of a delay in contacting the neurologist. During hospitalization, 50 patients (18.4%) died, 41 of them because of the stroke or its complications. Conclusions: Cardioembolic IS was the most frequent subtype of stroke. Cardiac sources of embolism, active cancers and withdrawal of antithrombotic drugs constituted special risk factors for IHS. A significant proportion of patients were treated with thrombolysis. However, delays in contacting the neurologist excluded a similar proportion of patients from treatment. IHS mortality was high, mostly because of stroke.     

Pre‐hospital notification reduced the door‐to‐needle time for iv t‐PA in acute ischaemic stroke

Background and purpose: Intrahospital delay is the most serious obstacle in thrombolysis in acute ischaemic stroke (AIS). We implemented the pre‐hospital notification system from the emergency medical information system in our metropolitan area to reduce intrahospital delay. Methods: From October 2007, we implemented a 24‐h hotline system between our stroke center and the Korean Emergency Medical Information System in Busan. We compared processing times and clinical outcomes amongst patients after using intravenous tissue type plasminogen activator (iv t‐PA) with and without the hotline system. Results: After the pre‐hospital notification system was implemented, the rate of iv t‐PA use increased from 6.5% to 14.3%. Time of onset in patients with pre‐hospital notification was much longer than in patients without (121.5 ± 34.8 min vs. 74.7 ± 38.5 min, P < 0.01) notification but door‐to‐needle time was significantly reduced (28.9 ± 11.4 min vs. 47.7 ± 22.8 min, P < 0.01). However, there were no significant differences in 90‐day clinical outcomes between the two groups. Conclusions: The pre‐hospital notification system reduced intrahospital processing times which led to increased iv t‐PA use after AIS. However, the improvement of clinical outcomes in thrombolysis might require organization of not only intrahospital processes but of outside processes such as the early recognition and rapid dispatch of patients with suspected AIS.     

One‐year post‐hospital medical costs and relapse rates of bipolar disorder patients in Taiwan: a population‐based study

Tang C‐H, Hsieh MH, Hung S‐T, Lee IH, Lin Y‐J, Yang YK. One‐year post‐hospital medical costs and relapse rates of bipolar disorder patients in Taiwan: a population‐based study.
Bipolar Disord 2010: 12: 859–865. © 2010 The Authors.
Journal compilation © 2010 John Wiley & Sons A/S. Objectives: We examined a nationwide population‐based dataset of patients with bipolar disorder (BD) hospitalized in Taiwan, with our analyses focusing on one‐year medical costs and relapse rates. Methods: The data for this study, covering the years 2006 and 2007, were obtained from the Taiwan National Health Insurance (NHI) claims database. The study sample comprised BD patients who were discharged from hospitals between January 1 and December 31, 2006. Annual medical costs and relapse rates were described; the Kaplan–Meier method and the generalized linear models were carried out to examine the risk factors associated with cases of relapse. Results: The annual medical costs associated with relapses among the study sample were found to be approximately 7.6 times the average per‐capita NHI expenditure in Taiwan in 2006 (US$4,354 versus US$574), with a one‐year relapse rate of 55%. Those patients between 20 and 60 years old with a medication possession ratio of <80 and with depressive episodes during the recruitment period were identified as being at risk of relapse. Conclusion: Bipolar disorder, which is a very costly disease, is associated with both poor medication adherence rates and frequent recurrences. Targeting drug adherence issues during maintenance treatment may well provide a valuable opportunity to reduce the risk of such recurrences.     

Incidence of Parkinson's disease among hospital patients with methamphetamine‐use disorders

Because methamphetamine exposure to experimental animals can damage brain dopamine neurones, we examined whether hospital patients diagnosed with methamphetamine‐related disorders might have greater risk of subsequent admission with a Parkinson's disease diagnosis. This was a population‐based cohort study using all statewide inpatient hospital discharge records from July 1, 1990, through June 30, 2000, in California, USA, in which subjects aged at least 50 years were followed for up to 10 years. Individuals with reported methamphetamine‐related conditions (n = 1,863; ICD‐9 codes 304.4, 305.7, 969.7, and E854.2) were matched on demographic variables and follow‐up time with those with primary appendicitis conditions (n = 9,315). The appendicitis group had a Parkinson's disease incidence rate no different than the rate found among members of a large health maintenance organization in California. Cox regression procedures were used to estimate group differences in the rates of receiving a subsequent inpatient diagnosis of Parkinson's disease (ICD‐9 332.0). The methamphetamine group showed increased risk of a subsequent admission with Parkinson's disease compared with that of the matched appendicitis group (adjusted hazard ratio = 2.65, 95% CI, 1.17–5.98, P= 0.019). Study limitations include a population limited to hospital admissions, an uncertainty regarding diagnostic validity of the ICD‐9 code 332.0 (Parkinson's disease), and a small number of incident cases with suspected Parkinson's disease. We strongly emphasize the preliminary nature of the findings. Nevertheless, these data, requiring replication, provide some evidence that methamphetamine users might be at greater than normal risk for developing Parkinson's disease. © 2010 Movement Disorder Society     

Recorded incidents in a high‐secure hospital: A descriptive analysis

Background Incidents of violence, self‐harm and security are of concern in psychiatric hospitals with regard to both patient and staff welfare. Aim The purpose of this study was to examine the frequency and nature of incidents in all directorates in a high‐security psychiatric hospital. Methods Data were collected from the hospital's incident recording forms for the period 1 June 2007 to 30 September 2008. Results In total, 5658 incidents were recorded, almost all patients (95%) having been involved in at least one incident. Most incidents, however, were in the categories of less serious violence and self‐harm. The rate was 0.89 incidents per patient per month. The women's directorate had a significantly higher frequency of violent or self‐harm incidents than the other directorates (male mental health, learning disability, personality disorder or dangerous and severe personality disorder). Violence was almost equally against fellow patients or staff. It was commonest in communal areas during day‐time hours. Self‐harm was most likely in a patient's own room. Conclusions and implications for practice These findings can inform prevention and management of violence and self‐harm. Dealing with such a large number of incidents is time consuming, even if they are not especially serious. Attention to environmental, as well as individual, issues is recommended. Copyright © 2009 John Wiley & Sons, Ltd.