Longer-term case fatality was similarly high in patients with angina and in survivors of AMI, about 5% a year. Furthermore, half the patients experienced a fatal or non-fatal event within five years. These data may strengthen the case for aggressive secondary prevention in all patients presenting with acute coronary syndrome.
Although hospital discharge rates for acute myocardial infarction are falling, 1-4 no contemporary studies compare temporal trends in these rates for angina and other types of chest pain. We examined recent trends in population discharge rates for myocardial infarction, angina, and chest pain ("suspected acute coronary syndromes") between 1990 and 2000.
Pancreatic cancer is associated with a very poor prognosis; however, in selected patients, resection may improve survival. Several recent reports have demonstrated that concentration of treatment activity for patients with pancreatic cancer has resulted in improved outcomes. The aim of this study was to ascertain if there was any evidence of benefit for specialised care of patients with pancreatic cancer in Scotland. Records of patients diagnosed with pancreatic cancer during the period 1993 -1997 were identified. Three indicators of co-morbidity were calculated for each patient. Operative procedures were classified as resection, other surgery or biliary stent. Prior to analysis, consultants were assigned as specialist pancreatic surgeons, clinicians with an interest in pancreatic disease or nonspecialists. Data were analysed with regard to 30-day mortality and survival outcome. The final study population included 2794 patients. The 30-day mortality following resection was 8%, and hospital or consultant volume did not affect postoperative mortality. The 30-day mortality rate following palliative surgical operations was 20%, and consultants with higher case loads or with a specialist pancreatic practice had significantly fewer postoperative deaths (P ¼ 0.014 and 0.002, respectively). For patients undergoing potentially curative or palliative surgery, the adjusted hazard of death was higher in patients with advanced years, increased co-morbidity, metastatic disease, and was lower for those managed by a specialist (RHR 0.63, 95% CI 0.50 -0.78) or by a clinician with an interest in pancreatic disease (RHR 0.63,. The risk of death 3 years after diagnosis of pancreatic cancer is higher among patients undergoing surgical intervention by nonspecialists. Specialisation and concentration of cancer care has major implications for the delivery of health services.
The risk of suicide in cancer patients has been reported as elevated in several countries. These patients are exposed to many medicines that may confuse or provide a means for harm, potentially also increasing their risk from accidents. Ratios of observed/ expected numbers of hospital admission and death events relating to deliberate self-harm (DSH) and accidents were calculated in the 5 years from a cancer diagnosis in Scotland 1981Scotland -1995 to the matched general population. The relative risk (RR) of suicide was 1.51 (95% confidence interval (CI): 1.29 -1.76). The RR of hospital admissions for DSH was not significantly increased, suggesting a strong suicidal intent in DSH acts in cancer patients. Accidental poisonings and all other accidents were both increased (RR death ¼ 3.69, 95% CI: 2.10 -6.00; and 1.58, 95% CI: 1.48 -1.69, respectively) (RR hospital admissions ¼ 1.32, 95% CI: 1.19 -1.47; and 1.55, 95% CI: 1.53 -1.57, respectively). The association of only certain tumour types (e.g. respiratory) with suicide and accidental poisoning, and a broad range of tumour types with an elevated risk of all other accidents, suggests accidental poisoning categories may be a common destination for code shifting of some DSH events. A previous history of DSH or accidents, significantly increased the RR of suicide or fatal accidents, respectively (RR suicide ¼ 14.86 (95% CI: 4.69 -34.97) vs 1.16 (95% CI: 0.84 -1.55)) (RR accidental death ¼ 3.37 (95% CI: 2.53 -4.41) vs 1.29 (95% CI: 1.12 -1.49)). Within 5 years of a cancer diagnosis, Scottish patients are at increased RR of suicide and fatal accidents, and increased RR of hospital admissions for accidents. Some of these accidents, particularly accidental poisonings, may contain hidden deliberate acts. Previous DSH or accidents are potential markers for those most at risk, in whom to target interventional techniques.
Background Many organisations and individuals have a role in injury prevention. However, the majority of these organisations have a multitude of roles, and staff dealing with injury prevention are frequently geographically or professionally isolated. Aims/Objectives/Purpose The Injury Observatory for Britain and Ireland (IOBI) is an innovative collaboration between the Association of Public Health Observatories and several academic institutions across the UK and Ireland. IOBI supports injury practitioners by providing an accessible injury prevention evidence base. Methods IOBI emerged from a series of informal meetings of interested professionals in 2004–2005. Being a virtual organisation, IOBI has neither a base nor core funding, though many of the constituent organisations receive funding from central or devolved government agencies. The IOBI website http://www.injuryobservatory.net, established in 2007, supports practitioners by providing access to a range of injury related materials. IOBI launched a free e-newsletter in 2008, Injury Prevention News (IPN, http://www.injuryobservatory.net/_newsletters.html), which is published tri-annually. Results/Outcomes IOBI members convene two or three times a year to share knowledge, discuss good practice, and to collaborate on injury projects. Key outcomes include: development of a specification enabling comparative analysis of inpatient data across the five countries, a comparative analysis of injury related mortality in the UK and Ireland, organising two national conferences, development of IPN. Significance/Contribution to the Field IOBI demonstrates the need for a forum for injury prevention collaboration in the British Isles. Its success will ultimately be judged by the extent to which it stimulates an increase in injury prevention practice and research.
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