Jeremy Anderson

Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study

Abstract Objectives: To determine whether earlier clinical intervention by a medical emergency team prompted by clinical instability in a patient could reduce the incidence of and mortality from unexpected cardiac arrest in hospital. Design: A non-randomised, population based study before (1996) and after (1999) introduction of the medical emergency team. Setting: 300 bed tertiary referral teaching hospital. Participants: All patients admitted to the hospital in 1996 (n=19 317) and 1999 (n=22 847). Interventions: Medical emergency team (two doctors and one senior intensive care nurse) attended clinically unstable patients immediately with resuscitation drugs, fluid, and equipment. Response activated by the bedside nurse or doctor according to predefined criteria. Main outcome measures: Incidence and outcome of unexpected cardiac arrest. Results: The incidence of unexpected cardiac arrest was 3.77 per 1000 hospital admissions (73 cases) in 1996 (before intervention) and 2.05 per 1000 admissions (47 cases) in 1999 (after intervention), with mortality being 77% (56 patients) and 55% (26 patients), respectively. After adjustment for case mix the intervention was associated with a 50% reduction in the incidence of unexpected cardiac arrest (odds ratio 0.50, 95% confidence interval 0.35 to 0.73). Conclusions: In clinically unstable inpatients early intervention by a medical emergency team significantly reduces the incidence of and mortality from unexpected cardiac arrest in hospital. What is already known on this topic In most studies mortality from unexpected cardiac arrest in hospital exceeds 50% Such events are usually preceded by signs of clinical deterioration in the hours before cardiac arrest What this paper adds Early intervention by a medical emergency team significantly reduced the incidence of and mortality from unexpected cardiac arrest in hospital

Prevalence of South Australia's online health seekers

Objective:To determine the proportion of South Australians accessing online health care information, predictive characteristics of online health seekers, nature of the information sought and consumer behaviour.

The Effect on Hospital Admissions of Psychiatric Case Management Involving General Practitioners: Preliminary Results

A two year follow-up of two matched groups of subjects with chronic severe mental illness was performed in order to evaluate a new psychiatric case management system. One group (n=59) received care through psychiatric case management, using an assertive community treatment model that directly involved general practitioners. The other group, matched for age, sex, diagnostic group and number of hospital admissions, received standard outpatient care. Comparing the two years before and after case management, the experimental group showed a dramatic fall in inpatient admission days while the control group admission days remained the same (median difference in admission days across matched subject pairs = 64.5, 95% C.I. from 134.5 to 16). The experimental group remained out of hospital longer before first readmission (Kaplan-Meier survival analysis, P=0.002). This type of case management programme can shorten or prevent admissions to psychiatric hospitals of patients with chronic mental illness, and increase their time before readmission.

Cognitive impairment in geriatric chronic schizophrenic patients: a cross-national study in New York and London.

Severe cognitive impairment has been reported in large numbers of geriatric chronic schizophrenic patients in the US, with this impairment also being related to severe negative symptoms and adaptive deficits. It is not clear if this impairment is related to the particular environment of the American state hospitals and would not generalize to other countries. In this study, a sample composed of geriatric (age > 70) chronic schizophrenic patients in London, who were assessed by the Team for Assessment of Psychiatric Services (TAPS) (N = 137), and a group of geriatric chronic schizophrenic patients in a New York psychiatric center (N = 86) were compared for the severity of cognitive impairment and on measures of adaptive functioning. Patients received essentially identical Mini‐Mental State Examination (MMSE) scores, but differed on 3/4 measures of adaptive functioning. The correlations among all four aspects of adaptive deficit and MMSE scores were very similar in the two samples, suggesting that cognitive deficits and their relationship with adaptive impairments are relatively invariant across different psychiatric systems of care, while adaptive functioning deficits are more variable and possibly more influenced by environmental factors. These data add to previous results suggesting that cognitive impairment is a common feature in poor outcome geriatric patients with schizophrenia.

Comment: ‘As Simple as Possible, but not Simpler’

The preceding article by Mellsop el al. describes an innovative approach to service delivery that claims to decrease the length of stay of psychiatric inpatients by using the same staff to provide both inpatient and outpatient treatment. The authors state that their success enabled the closure of 12 beds ‘as a result of the efficiencies generated by integration’. This is noteworthy for several reasons. Mental health service research, the study of the effects of service change on patient outcomes, is not common in Australasia. Links between research programs and practice change are rarer still. However, we have some difl3culties with their report that have stimulated us to consider issues in both mental health service research in general and in this research in particular.

Mental health outcome evaluation

as such, provide useful lessons on the use of psychotropic drugs. If there is a criticism of this section, albeit a minor one, it is that for the most part these vignettes/puzzlers relate to drug–drug pharmacokinetic interactions with a sprinkling of pharmacodynamic effects. In my opinion, this does not detract from the value of volume. For the most part, the vignettes are a very useful teaching tool illustrating the importance of the hepatic P4 5 0 isozyme system and the interactions which occur with some of the newer agents and their clinical consequences. Each chapter is extensively referenced and statements in the Q and A, and vignette sections are supported by referring to original literature. This is a useful volume well worth a library purchase. As noted by the author, the ‘mercurial nature of psychopharmacology creates a daily struggle for those who practice and teach it’. It is the very nature of the topic that ensures this volume will not remain contemporaneous for long, but will require subsequent editions.