Surveillance for quality assessment: IV. Surveillance using a hospital information system

Hospital surveillance for infection control purposes is a well-accepted method of following nosocomial infections in U.S. hospitals. However, hospital surveillance is being increasingly performed for nosocomial events in noninfectious areas, such as quality assurance and other areas of outcomes research. For the continued development of hospital surveillance in all these areas, dramatic growth in the amount of information collected will occur. To accommodate this growth and to validate new approaches in these areas, large amounts of data collection will be necessary. Collection of these data will be quite difficult without the creation of clinical hospital data bases in which large amounts of information are collected as a routine part of patient care, not as an elaborate addition to patient care. Automated hospital information systems, such as the HELP system, can facilitate the conduct of ongoing hospital surveillance not only in infection control but also in a broad range of areas, such as quality improvement outcomes research and cost-containment areas.     

Donor availability as the primary determinant of the future of heart transplantation

Heart transplantation has now achieved a therapeutic status similar to that of cadaveric renal transplantation. Depending on patient selection criteria, it is estimated that as many as 15,000 people per year could conceivably benefit from a heart transplant, but the actual number of persons who will benefit is severely constrained by donor supply. Availability of heart donors was estimated based on data obtained on 1,955 organ donors in the United States. The results show that because of age and other contraindications, only 400 to 1,100 viable donor hearts may be available each year. Donor supply is the most critical determinant of the future of heart transplantation since it will dictate the number of transplants performed, the survival of transplant recipients, the total program expenditures associated with heart transplantation, the nature of the legal and ethical issues involved, the number of cardiac transplant programs required to make optimal use of the available donor hearts, and the future role of mechanical circulatory support systems.     

Successful treatment of an infected vascular graft with gentamicin beads

This short report describes the successful healing of an infected axillo-bifemoral graft by the insertion of Gentamicin beads, this technique cannot be recommended for all infected grafts the majority of which will have to be removed and replaced.     

Psychotropic prescribing patterns of nonpsychiatric residents in a general hospital in 1973 and 1982

The findings of a study of the frequency and type of psychotropic drugs that nonpsychiatric residents prescribed for nonpsychiatric patients in a teaching hospital in 1982 were compared with the findings of a similar study in the same hospital nine years earlier. The overall percentage of patients receiving psychotropic drugs remained almost the same, at less than 10 percent. However, in 1982 residents prescribed antidepressants almost four times as often as in 1973, and the use of antianxiety agents decreased. Deficiencies in chart documentation of psychotropic prescribing and the tendency to use conservative dosages remained unchanged from the earlier study.     

Inter-study differences: How should they influence the interpretation and analysis of results?

In determining the role inter-study variation should play in an overview analysis, it is important to consider three factors: which question one is trying to answer; the degree of similarity or dissimilarity of design, and the degree to which heterogeneity of outcomes can be explained. Three questions one might be interested in are: whether treatment can be effective in some circumstances; whether treatment is effective on average, and whether treatment was effective on average in the trials at hand. Under the assumption of no qualitative interaction, the answers to these questions coincide. The O-E analysis most directly answers the third question. Other analyses are suggested when the first question is of interest, using the aspirin post-MI studies as an example.