Research institute tries to ease brain drain by bringing researchers back to Canada.

The lack of research opportunities in Canada and the large number of them in the US have cost Canada some of its brightest young researchers. The Robarts Research Institute in London, Ont., is trying to reverse that trend by bringing some of these researchers back home. However, Dr. Mark Poznansky says the repatriation efforts will mean little if research budgets keep getting cut in Canada. He says the budget of the Medical Research Council of Canada is barely adequate for today's needs.     

University center and community hospital: problems in integration.

This study of health care in Chicago and its suburbs deals with a dilemma faced by many university hospitals located in our nation's metropolitan areas. Because of a massive displacement of population from the city to its suburban ring, some of the major medical centers in Chicago's inner zone have experienced a leveling-off of inpatient admissions. In contrast, outer zone and suburban community hospitals are in need of referral sources with specialized personnel and equipment to accommodate growing admissions. This imbalance would be corrected in a regional network based on an exchange of clients and services. A case study of the University of Chicago Medical Center highlights the tensions, strains, and resistances which inhibit the development of such a system and thus raises questions about the role of the research and teaching hospital in regional health care planning.     

Clean-air video will interest MDs who treat patients with allergies, respiratory problems.

Canada Mortgage and Housing Corporation wants physicians to help raise public awareness abut the importance of indoor air quality to health. Physicians across Canada are being sent a colourful poster that calls attention to indoor air pollution and ways to make a home healthier, included are order forms for the Clean Air Guide and a companion video, This Clean House.     

Ethics of research with psychiatric patients: principles, problems and the primary responsibilities of researchers.

In this paper some of the general issues surrounding recently published guidelines for the practice of research ethics committees are outlined, concentrating in particular on the difficulties raised by research with psychiatric patients. Research is distinguished from ordinary clinical practice by the intention to advance knowledge. So defined, research with psychiatric patients should be governed by the same four principles as research with any other group--knowledge, necessity, benefit and consent. In applying these principles, however, particularly the principle of consent, many acute difficulties are raised by psychiatric patients. A number of proposals for addressing these difficulties are discussed. It is suggested that, notwithstanding the value of published guidelines, and the help that may be available from research ethics committees, the primary responsibility for maintaining high standards of practice in research rests with research workers themselves.     

Alberta hospital tries to boost revenue by attracting gastroplasty patients from US.

The fate of a surgical weight-reduction program at the 25-bed hospital in Cardston, Alta., is in limbo as Alberta's Conservative government decides whether it will allow the hospital to keep profits made by performing gastroplasty on American patients last year. Cardston Municipal Hospital, which has had more than 1200 Canadian banded-gastroplasty patients since 1979, began recruiting American patients from Montana and Idaho last year. However, rumours that the Klein government will reduce the regional health authority's operating budget by an amount equal to the hospital's profit have jeopardized the program's future. The hospital first marketed the program in the US to cushion short-falls in government funding.     

Continuous emotional support during labor in a US hospital. A randomized controlled trial

The continuous presence of a supportive companion (doula) during labor and delivery in two studies in Guatemala shortened labor and reduced the need for cesarean section and other interventions. In a US hospital with modern obstetric practices, 412 healthy nulliparous women in labor were randomly assigned to a supported group (n = 212) that received the continuous support of a doula or an observed group (n = 200) that was monitored by an inconspicuous observer. Two hundred four women were assigned to a control group after delivery. Continuous labor support significantly reduced the rate of cesarean section deliveries (supported group, 8%; observed group, 13%; and control group, 18%) and forceps deliveries. Epidural anesthesia for spontaneous vaginal deliveries varied across the three groups (supported group, 7.8%; observed group, 22.6%; and control group, 55.3%). Oxytocin use, duration of labor, prolonged infant hospitalization, and maternal fever followed a similar pattern. The beneficial effects of labor support underscore the need for a review of current obstetric practices.     

Queuing for coronary angiography during severe supply-demand mismatch in a US public hospital: analysis of a waiting list registry.

CONTEXT: Adverse cardiac events have been reported in patients waiting for either coronary surgery or angioplasty. However, data on the risk of adverse events while awaiting coronary angiography are limited, and none are available from a US population. OBJECTIVE: To quantify cardiac outcomes in patients waiting for elective coronary angiography. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of 381 adult outpatients (mean [SD] age, 55 [12] years; 64% male; 61% white) on a waiting list for coronary angiography at a US tertiary care public teaching hospital during 1993-1994. MAIN OUTCOME MEASURES: Rates of cardiac death, nonfatal myocardial infarction, and hospitalizations for unstable angina or heart failure as a function of amount of time spent on a waiting list. RESULTS: Sixty-six patients were dropped from the waiting list but were included in the study analysis. During a mean (SD) follow-up of 8.4 (6.5) months, cardiac death, myocardial infarction, and hospitalization occurred in 6 (1.6%), 4 (1.0%), and 26 (6.8%) patients, respectively. The probability of events was minimal in the first 2 weeks and increased steadily between 3 and 13 weeks. By Cox multivariate analysis, 2 variables independently identified an increased risk of adverse events: a strongly positive treadmill exercise electrocardiogram or positive stress imaging result at referral (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.22-4.16; P=.01) and the use of 2 to 3 anti-ischemic medications (OR, 1.98; 95% CI, 1.19-3.96; P=.04). Among 311 patients who ultimately underwent angiography, those with adverse events had a higher prevalence of coronary disease (96% vs 60%; P<.001), more frequently required revascularization (93% vs 53%; P<.001), and had longer hospital stays (mean [SD], 6.2 [4.3] vs 1.3 [0.7] days; P=.001). CONCLUSION: Our data suggest that in a cohort referred for coronary angiography, delaying the procedure places some patients at risk for death, myocardial infarction, unplanned hospitalization, a longer hospital stay, and, potentially, a poorer prognosis. Waits longer than 2 weeks should be avoided, and patients with strongly positive stress test results and those who require 2 to 3 anti-ischemic medications should be prioritized for early intervention.     

Should children with minor medical problems be sent to hospital? A study of infant care practices within families.

The admission of children to hospital for minor medical problems is frequently influenced by family and social circumstances. This study compared the infant care practices of families of children admitted to hospital for gastroenteritis (n = 76) and families caring for children with gastroenteritis at home (n = 76). Mothers of children who were admitted to hospital were more likely to use medical sources of advice on parenting and less likely to use other non-family sources than home care mothers. They also received less support in the education/entertainment of their children from fathers. There were many similarities between the two groups, including the high level of behaviour problems of the children and the relatively low level of involvement of fathers in child care tasks. Both of these factors serve to increase stress on mothers to the point where they may be unable to cope with a sick child at home.