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At least 343 records · Page 19Linked to original sources
PubMed2002

Outcome of myocardial infarction in patients treated with aspirin is enhanced by pre-hospital administration.

OBJECTIVE: Reducing time to reperfusion therapy is one of the goals in the management of acute myocardial infarction (AMI). We assessed the association between timing of aspirin administration and outcome of patients with AMI. PATIENTS: We studied 922 consecutive AMI patients with ST-segment elevation in Killip class I-III on admission. Patients were divided into two groups based upon the timing of emergency aspirin administration: before (early aspirin users) or after (late aspirin users) hospital admission. RESULTS: Early aspirin users (n = 338; 37%) were younger, less likely to be women, and more likely to smoke (p < 0.006) than late users (n = 584; 63%). Other baseline and clinical characteristics were similar. Early aspirin users were more likely to be treated with thrombolysis or primary percutaneous transluminal coronary angioplasty. Compared with late users, early aspirin users had significantly lower in-hospital complications and lower mortality rates at 7 (2.4 vs. 7.3%, p = 0.002) and 30 days (4.9 vs. 11.1%, p = 0.001). By multivariate adjustment, pre-hospital aspirin was an independent determinant of survival at 7 (odds ratio 0.43; 95% confidence interval 0.18-0.92) and at 30 days (odds ratio, 0.60; 95% confidence interval 0.32-1.08). Survival benefit associated with aspirin persisted for subgroups treated or not with reperfusion therapy. CONCLUSIONS: Outcome of AMI patients treated with aspirin is improved by pre-hospital administration. Our findings suggest that emergency pre-hospital aspirin might facilitate early reperfusion.

Aged↗
PubMed1977

Decision to admit. Criteria for admission and readmission to a Veterans Administration hospital.

Factors related to the decision to hospitalize applicants for psychiatric treatment at a Veterans Administration hospital were explored. For a three-week period, decision makers completed questionnaires following interviews with applicants. It was found that 79% of applicants were "revolving door" patients. These patients were much less likely to be married, and more likely to be homeless and diagnosed as schizophrenic, than patients without previous hospitalizations. A small number of patients were admitted because of characteristics of their illness regardless of their social situations. Patients were not hospitalized on the basis of social or nonpsychiatric criteria alone. A large number were admitted because of a combination of factors, some social in nature and others related to their psychopathology. A social process taking place in the screening interview appeared to have some influence in the decision to admit.

Decision Making↗
PubMed1989

Geographic differences in the use of Veterans Administration hospitals.

This study contrasts the determinants of community hospital utilization with Veterans Administration (VA) hospital utilization using traditional planning variables. The comparisons had some expected and some unanticipated findings. Regional differences in non-VA hospital admissions and bed days are fairly well explained by measures of medical need, provider supply, community alternatives, and sociodemographic characteristics (other than those used as proxies for case mix). However, regional variations in the VA are explained less well by the same classes of variables and the unexplained differences between the two systems do not correspond geographically. This suggests that the two systems have different reasons for regional variation. Further, contrary to expectation, when other predictors are held constant, excess bed capacity in the area does not correlate with lower VA utilization. The study is important as the VA comes under increasing pressure to contain costs. It may well be that the rational planning model attributed to the public sector is less likely to overcome maldistribution than the private sector 'invisible hand'. Policy analysts need to give more attention to the political, bureaucratic determinants of resource allocation before changing eligibility criteria or merging the two systems.

Adult↗