Jean‐Christophe Luthi, William M. McClellan, W. Dana Flanders, Stephen R. Pitts and Bernard Burnand
The purpose of this paper is to determine whether process quality indicators for acute myocardial infarction (AMI) one associated with outcome indicators (hospital mortality and…
Abstract
Purpose
The purpose of this paper is to determine whether process quality indicators for acute myocardial infarction (AMI) one associated with outcome indicators (hospital mortality and early readmission).
Design/methodology/approach
A retrospective cohort study was conducted among patients discharged from three Swiss university hospitals with a primary or secondary International Classification of Diseases, 10th revision (ICD‐10) AMI code in 1999. A total of 1,129 patients' records were abstructed. Demographic characteristics and risk factors at admission were recorded. The main ECG and laboratory findings were further abstracted as well as hospital and discharge management and treatment. The main outcome measure was process quality indicators derived from evidence‐based guidelines, and hospital mortality and early readmissions.
Findings
After exclusions, 577 patients with AMI were eligible for this study. The mean (SD) age was 68.2 (13.9). In the assessment of quality indicators patients with potential contra‐indications were excluded. Among cohorts of “ideal candidates” for specific interventions, aspirin was not prescribed within 24 hours after admission in 33 (6.2 percent) patients. Among those, 17 (51.5 percent) died (p<0.0001). The adjusted OR for no aspirin after admission was 3.61 (95 percent CI 1.11‐11.77) for hospital mortality. Further, 78 (19.5 percent) patients did not receive β‐blockers at discharge. Among them nine (11.5 percent) were readmitted (p=0.133). The adjusted OR for no β‐blockers at discharge was 2.15 (95 percent CI 0.86‐5.41) for readmissions. Among patients with AMI, not prescribing aspirin within 24 hours after admission was associated with hospital mortality. However, process indicators derived from evidence‐based guidelines were not related to early readmission in this study.
Originality/value
The paper stresses the importance of clinicians confronting their decisions with recommendations of evidence‐based guidelines for the management and treatment of AMI patients.
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Giada Danesi, Mélody Pralong and Vincent Pidoux
Drawing on ethnographic observations of diabetes (self-)management in French-speaking Switzerland and semi-structured interviews with healthcare practitioners, people living with…
Abstract
Drawing on ethnographic observations of diabetes (self-)management in French-speaking Switzerland and semi-structured interviews with healthcare practitioners, people living with diabetes and their relatives, the chapter aims at shedding light on self-tracking practices of people living with diabetes. It explores the ways people with diabetes measure and learn to recognise body symptoms of hypo- and hyperglycaemia through self-quantification, and act consequently. In particular, the chapter investigates recent medical devices – continuous and flash glucose monitoring systems – that reconfigure the work of health providers and self-care practices. It shows the self-monitoring practices and the resulting self-awareness people living with diabetes develop in interaction with technology and caregivers in order to undertake embodied actions. By pointing out that new technologies have facilitated the access to personal body information and the sharing of it, self-monitoring is also questioned as a form of surveillance, opening up issues of power and control over patients’ behaviours. With regard to this, the chapter illustrates that, occasionally, people with diabetes resist ‘docility’ through micro-powers at the level of everyday life by refusing to engage in their use and by developing personal strategies or ‘tactics’.
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THE June conference at Margate is so near that we must needs be pre‐occupied with it at the moment although two months ago we were able to give an anticipatory description of the…
Abstract
THE June conference at Margate is so near that we must needs be pre‐occupied with it at the moment although two months ago we were able to give an anticipatory description of the programme. The protracted and cold winter, culminating in the most “perishing” April of the century, possibly of any century since the Great Ice Age, seems on the threshold of May to have dissolved at last in warmer weather. Margate is a lady in the sun, but perhaps something else under cloud, and wise people take warm clothes when they visit her. We hope, however, that they will not be necessary and that for some hundreds of our readers Margate air will be an invigorating experience.
AT the present time leisure is a subject which does not attract much serious attention. Sporadic discussions break out now and again among small groups; or it provides a topic for…
Abstract
AT the present time leisure is a subject which does not attract much serious attention. Sporadic discussions break out now and again among small groups; or it provides a topic for the popular press during the ‘silly season’. There is, however, a distinct possibility that in the measurable future an Institute of Leisure Study will be needed.