Length of hospital stay and postdischarge mortality in patients with pulmonary embolism: a statewide perspective

BACKGROUND: The optimal length of stay (LOS) for patients with pulmonary embolism (PE) is unknown. Although reducing LOS is likely to save costs, the effects on patient safety are unclear. We sought to identify patient and hospital factors associated with LOS and assess whether LOS was associated with postdischarge mortality. METHODS: We evaluated patients discharged with a primary diagnosis of PE from 186 acute care hospitals in Pennsylvania (January 2000 through November 2002). We used discrete survival models to examine the association between (1) patient and hospital factors and the time to discharge and (2) LOS and postdischarge mortality within 30 days of presentation, adjusting for patient and hospital factors. RESULTS: Among 15 531 patient discharges with PE, the median LOS was 6 days, and postdischarge mortality rate was 3.3%. In multivariate analysis, patients from Philadelphia were less likely to be discharged on a given day (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.73-0.93), as were black patients (OR, 0.88; 95% CI, 0.82-0.94).The odds of discharge decreased notably with greater patient severity of illness and in patients without private health insurance. Adjusted postdischarge mortality was significantly higher for patients with an LOS of 4 days or less (OR, 1.55; 95% CI, 1.21-2.00) relative to those with an LOS of 5 to 6 days. CONCLUSIONS: Several hospital and patient factors were independently associated with LOS. Patients with a very short LOS had greater postdischarge mortality relative to patients with a typical LOS, suggesting that physicians may inappropriately select patients with PE for early discharge who are at increased risk of complications

El proceso de sucesión en la empresa familiar

La majoria dels experts coincideixen en definir l’empresa familiar com l’empresa a la que el capital, la gestió y el govern estan en mans de una o mes famílies que exerceixen control sobre ella. El punt mes important que diferencia l’empresa familiar de la no familiar es el propòsit de la continuïtat, que es dona en a les empreses familiars, a través de l’entrada de les successives generacions. Aquesta continuïtat es materialitza amb l’èxit del procés successori que dona lloc a la nova generació. La complexitat d’aquest tipus d’empreses deriva de la unió de les dos entitats que la formen, empresa i família. Aquesta unió suposa la combinació d’assumptes purament empresarials amb altres de caràcter més personal. La unió de tots dos interessos dins de l’empresa suposa una important font de conflictes i problemes per a l’organització. A mesura que la família es fa més gran els problemes també creixen, i les relacions entre la família i la empresa es fan més difícils i complicades. Es per això que l’empresa ha d’actuar amb temps i avançar-se a les futures dificultats que puguin presentar-se a l’organització, tractant d’evitar-les, fent servir les eines de que disposa. Per assegurar el èxit del procés successori i evitar futurs problemes interns, l’empresa, i sobretot el predecessor, han de manejar i definir de forma correcta el marc legal i el marc familiar que emmarquen les seves relacions. En primer lloc, el marc legal ha d’assegurar la bona comunicació entre la família i l’empresa, per així, evitar futurs malentesos. A través d’òrgans com el Consell d’Administració i la Junta General d’Accionistes l’empresa reforça aspectes com la unitat i el compromís, que son tan necessaris en moments de canvi generacional. Per una altra banda, el marc familiar ha de vetllar pel manteniment dels valors propis de la família que el predecessor ha inculcat al llarg dels anys, i que han servit de guia tant a l’empresa com a la família. El marc familiar el defineixen eines com el Protocol Familiar, que regula i gestiona les relacions entre la família, l’empresa i els propietaris de la organització. El òrgan encarregat de controlar el compliment d’allò pactat en el Protocol i d’encarregar-se del bon funcionament del marc familiar es el Consell de Família.

Reducció de despeses ineficients i sostenibilitat de l'Estat del Benestar: el cas de Catalunya

Malgrat que el debat de l’Estat del Benestar està en el bell mig de l’actualitat política i econòmica des de fa uns quants anys amb graus ben diversos i aproximacions diferents, la darrera gran crisi ha disparat com mai la seva actualitat. Fins el present moment, amb algunes notables excepcions, totes les tendències han conduit a desenvolupar l’Estat del Benestar fins a extrems insostenibles. Això té explicacions múltiples i variades com les que s’aborden al llarg del present text. Aquestes tendències tenen una dinàmica econòmica i social pròpia que s’ha constatat amb força durant els darrers anys. Fa unes dues dècades que aquest debat va ser encetat amb profunditat per pocs països, però amb conclusions estimulants. Suècia és l’exemple més reeixit. La reforma duta a terme en el país nòrdics és una referència de primer ordre per molts estudiosos del tema i hauria de ser font d’inspiració per a la resta de països. Seguidament, hem volgut descriure, de forma complementària i des d’una perspectiva econòmica i jurídica, un fenomen estrictament lligat al desenvolupament imparable de l’Estat del Benestar, el de la burocratització. La reflexió d’acadèmics d’escoles en diferents i, en particular, els de la Public Choice proporcionen una visió rica i complexa, que entenem fonamental per avaluar els problemes que se’n deriven. Finalment, dins el marc de la Hisenda Pública i entrant en l’estudi concret del cas català, hem volgut endinsar-nos en l’anàlisi del pressupost. Essent com és una eina indispensable per avaluar el conjunt de polítiques econòmiques i socials d’un país. Aquesta anàlisi es duu a terme des d’una doble perspectiva: la primera, mitjançant un estudi comparatiu de l’evolució del Pressupost de la Generalitat dels darrers anys i, en segon terme, el canvi que el Pressupost 2011 materialitza aquest any, prefigura el de l’any 2012 i les principals crítiques de l’oposició. Queden oberts els camins envers els possibles canvis. De fet, res està definitivament escrit, però la pretensió d’aquest treball és modesta i, alhora, clara. Sense embuts, si volem mantenir un grau de benestar sostenible, és fonamental deixar de banda l’actual concepció de l’Estat del Benestar i començar a treballar per implementar els profunds canvis necessaris que donin pas a l’únic model que, a parer nostre, aconseguirà que això sigui possible: la Societat del Benestar. Una concepció actual del paper que ha de tenir l’Estat, de caràcter liberal i, alhora, social.

Hospital admission counts and rates for injuries in Republic of Ireland, Northern Ireland, England, Scotland and Wales

Number of hospital discharges and age-standardised discharge rates for emergency hospital admissions for injury by sex and type of injury for the following regions and year:Republic of Ireland 2006Northern Ireland 2006England 2006/07Scotland 2006/07Wales 2006 Numbers and rates are based on official hospital statistics from each region. All regions use International Classification of Disease (ICD) version 10 for hospital discharges in these years. Only emergency inpatient hospital spells with an ICD 10 code in the range S000-T739, T750-T759, T780-T789 (in any diagnostic position) and an ICD10 external cause code in the range V01-Y36 (in any diagnostic position) were included. A hospital spell is an unbroken period of time that a person spends as an inpatient in a hospital. The person may change consultant and/or specialty during a spell but is counted only once. See http://www.injuryobservatory.net/analysis-of-inpatient-admissions-data-f... for more details.

Els Robatoris silenciosos a Sant Cugat del Vallès : conseqüència d'un determinat model urbanístic?

Robatoris a l’interior d’habitatges n’hi ha hagut sempre amb més o menys intensitat. Fins fa poc modus operandi tradicional consistia en assaltar aquells habitatges on hi pogués haver béns de cert valor econòmic, durant períodes d’estiu i aprofitant sempre l’absència dels seus propietaris. Va ser a mitjan de l’any 2006 quan l’anomenada primera i segona corona metropolitana van començar a patir una onada de robatoris on el tret comú denominador era que el qui assaltaven actuaven quan els propietaris dormien i actuaven amb una manca d’escrúpols a l’hora d’emprar la violència si aquests esdespertaven. Més tard aquests tipus de delicte es va estendre a tot el territori català, principalment a les comarques de Tarragona i de Girona. El que té de nou aquesta forma delictiva és que es realitza el robatori amb els habitants de la casa a dins, normalment dormint. Per tant ja no és un delicte únicament contra la propietat sinó també contra la llibertat de les persones i, si s’utilitza violència contra els propietaris dels habitatges, contra la seva integritat física. La forma de cometre aquests delictes va fer que es coneguessin com a robatoris silenciosos, terme que va passar de l’àmbit policial a l’àmbit periodístic, o potser va ser al revés.

Health at a glance: Europe 2012.

This second edition of Health at a Glance: Europe presents a set of key indicators of health and health systems in 35 European countries, including the 27 European Union member states, 5 candidate countries and 3 EFTA countries. The selection of indicators is based largely on the European Community Health Indicators (ECHI) shortlist, a list of indicators that has been developed by the European Commission to guide the development and reporting of health statistics. It is complemented by additional indicators on health expenditure and quality of care, building on the OECD expertise in these areas. Contents: Introduction 12 Chapter 1. Health status 15 1.1. Life expectancy and healthy life expectancy at birth 1.2. Life expectancy and healthy life expectancy at age 65 1.3. Mortality from all causes 1.4. Mortality from heart disease and stroke 1.5. Mortality from cancer 1.6. Mortality from transport accidents 1.7. Suicide 1.8. Infant mortality 1.9. Infant health: Low birth weight 1.10. Self-reported health and disability 1.11. Incidence of selected communicable diseases 1.12. HIV/AIDS 1.13. Cancer incidence 1.14. Diabetes prevalence and incidence 1.15. Dementia prevalence 1.16. Asthma and COPD prevalence Chapter 2. Determinants of health 49 2.1. Smoking and alcohol consumption among children 2.2. Overweight and obesity among children 2.3. Fruit and vegetable consumption among children 2.4. Physical activity among children 2.5. Smoking among adults 2.6. Alcohol consumption among adults 2.7. Overweight and obesity among adults 2.8. Fruit and vegetable consumption among adults Chapter 3. Health care resources and activities 67 3.1. Medical doctors 3.2. Consultations with doctors 3.3. Nurses 3.4. Medical technologies: CT scanners and MRI units 3.5. Hospital beds 3.6. Hospital discharges 3.7. Average length of stay in hospitals 3.8. Cardiac procedures (coronary angioplasty) 3.9. Cataract surgeries 3.10. Hip and knee replacement 3.11. Pharmaceutical consumption 3.12. Unmet health care needs Chapter 4. Quality of care 93 Care for chronic conditions 4.1. Avoidable admissions: Respiratory diseases 4.2. Avoidable admissions: Uncontrolled diabetes Acute care 4.3. In-hospital mortality following acute myocardial infarction 4.4. In-hospital mortality following stroke Patient safety 4.5. Procedural or postoperative complications 4.6. Obstetric trauma Cancer care 4.7. Screening, survival and mortality for cervical cancer 4.8. Screening, survival and mortality for breast cancer 4.9. Screening, survival and mortality for colorectal cancer Care for communicable diseases 4.10. Childhood vaccination programmes 4.11. Influenza vaccination for older people Chapter 5. Health expenditure and financing 117 5.1. Coverage for health care 5.2. Health expenditure per capita 5.3. Health expenditure in relation to GDP 5.4. Health expenditure by function. 5.5. Pharmaceutical expenditure 5.6. Financing of health care 5.7. Trade in health services Bibliography 133 Annex A. Additional information on demographic and economic context 143 Most European countries have reduced tobacco consumption via public awareness campaigns, advertising bans and increased taxation. The percentage of adults who smoke daily is below 15% in Sweden and Iceland, from over 30% in 1980. At the other end of the scale, over 30% of adults in Greece smoke daily. Smoking rates continue to be high in Bulgaria, Ireland and Latvia (Figure 2.5.1). Alcohol consumption has also fallen in many European countries. Curbs on advertising, sales restrictions and taxation have all proven to be effective measures. Traditional wine-producing countries, such as France, Italy and Spain, have seen consumption per capita fall substantially since 1980. Alcohol consumption per adult rose significantly in a number of countries, including Cyprus, Finland and Ireland (Figure 2.6.1).This resource was contributed by The National Documentation Centre on Drug Use.

Reversible acquired epileptic frontal syndrome and CSWS suppression in a child with congenital hemiparesis treated by hemispherotomy.

A boy with a right congenital hemiparesis due to a left pre-natal middle cerebral artery infarct developed focal epilepsy at 33 months and then an insidious and subsequently more rapid, massive cognitive and behavioural regression with a frontal syndrome between the ages of 4 and 5 years with continuous spike-waves during sleep (CSWS) on the EEG. Both the epilepsy and the CSWS were immediately suppressed by hemispherotomy at the age of 5 years and 4 months. A behavioural-cognitive follow-up prior to hemispherotomy, an per-operative EEG and corticography and serial post-operative neuropsychological assessments were performed until the age of 11 years. The spread of the epileptic activity to the "healthy" frontal region was the cause of the reversible frontal syndrome. A later gradual long-term but incomplete cognitive recovery, with moderate mental disability was documented. This outcome is probably explained by another facet of the epilepsy, namely the structural effects of prolonged epileptic discharges in rapidly developing cerebral networks which are, at the same time undergoing the reorganization imposed by a unilateral early hemispheric lesion. Group studies on the outcome of children before and after hemispherectomy using only single IQ measures, pre- and post-operatively, may miss particular epileptic cognitive dysfunctions as they are likely to be different from case to case. Such detailed and rarely available complementary clinical and EEG data obtained in a single case at different time periods in relation to the epilepsy, including per-operative electrophysiological findings, may help to understand the different cognitive deficits and recovery profiles and the limits of full cognitive recovery.

Demyelination in mild cognitive impairment suggests progression path to Alzheimer's disease.

The preclinical Alzheimer's disease (AD) - amnestic mild cognitive impairment (MCI) - is manifested by phenotypes classified into exclusively memory (single-domain) MCI (sMCI) and multiple-domain MCI (mMCI). We suggest that typical MCI-to-AD progression occurs through the sMCI-to-mMCI sequence as a result of the extension of initial pathological processes. To support this hypothesis, we assess myelin content with a Magnetization Transfer Ratio (MTR) in 21 sMCI and 21 mMCI patients and in 42 age-, sex-, and education-matched controls. A conjunction analysis revealed MTR reduction shared by sMCI and mMCI groups in the medial temporal lobe and posterior structures including white matter (WM: splenium, posterior corona radiata) and gray matter (GM: hippocampus; parahippocampal and lingual gyri). A disjunction analysis showed the spread of demyelination to prefrontal WM and insula GM in executive mMCI. Our findings suggest that demyelination starts in the structures affected by neurofibrillary pathology; its presence correlates with the clinical picture and indicates the method of MCI-to-AD progression. In vivo staging of preclinical AD can be developed in terms of WM/GM demyelination.

Acquired auditory agnosia in childhood and normal sleep electroencephalography subsequently diagnosed as Landau-Kleffner syndrome: a report of three cases.

Aim  We report three cases of Landau-Kleffner syndrome (LKS) in children (two females, one male) in whom diagnosis was delayed because the sleep electroencephalography (EEG) was initially normal. Method  Case histories including EEG, positron emission tomography findings, and long-term outcome were reviewed. Results  Auditory agnosia occurred between the age of 2 years and 3 years 6 months, after a period of normal language development. Initial awake and sleep EEG, recorded weeks to months after the onset of language regression, during a nap period in two cases and during a full night of sleep in the third case, was normal. Repeat EEG between 2 months and 2 years later showed epileptiform discharges during wakefulness and strongly activated by sleep, with a pattern of continuous spike-waves during slow-wave sleep in two patients. Patients were diagnosed with LKS and treated with various antiepileptic regimens, including corticosteroids. One patient in whom EEG became normal on hydrocortisone is making significant recovery. The other two patients did not exhibit a sustained response to treatment and remained severely impaired. Interpretation  Sleep EEG may be normal in the early phase of acquired auditory agnosia. EEG should be repeated frequently in individuals in whom a firm clinical diagnosis is made to facilitate early treatment.

GestAMic : Treball Fi de Carrera - Interacció Humana amb els Ordinadors

El TFC és un estudi de millores a implantar pel que fa a usabilitat en una aplicació anomenada GestAMic mitjançant els coneixements adquirits en la assignatura d'IHO.GestAMic (Gestió d'Actius de Microinformàtica) és una eina que conté tota la base de dades de l'inventari d'actius del parc microinformàtic (CMDB) del Grup VW a Espanya, l'eina és gestionada per T-Systems Iberia. Aquesta aplicació permet fer-ne Altes, Baixes, Modificacions i Consultes dels actius sobre la CMDB.

Regional Health and Social Care Personal and Public Involvement Forum: Annual Update Report 2012/13

Personal and Public Involvement (PPI) is an essential component in the delivery of truly person centred services.�It is also a statutory duty.�The PHA has leadership responsibilities in respect of the implementation of PPI across HSC.�One of the ways in which the PHA discharges that leadership function, is through the Regional HSC PPI Forum.�This body brings together all HSC organisations, working alongside service users and carers, to bring a focus on involvement.�It promotes the sharing of best practice, identifies and tackles issues of common concern and providers a platform for the active participation of service users and carers.� Each year in response to a Priorities for Action (PFA) target, the PHA, working with HSC partners, service users and carers in the Forum, develop an Annual Report on PPI work taken forward through the Forum.The report for 2012/13 details progress in a number of important areas such as training, development of standards etc.

Weekend versus weekday admission and mortality after acute pulmonary embolism.

BACKGROUND: Optimal management of acute pulmonary embolism (PE) requires medical expertise, diagnostic testing, and therapies that may not be available consistently throughout the entire week. We sought to assess whether associations exist between weekday or weekend admission and mortality and length of hospital stay for patients hospitalized with PE. METHODS AND RESULTS: We evaluated patients discharged with a primary diagnosis of PE from 186 acute care hospitals in Pennsylvania (January 2000 to November 2002). We used random-effect logistic models to study the association between weekend admission and 30-day mortality and used discrete survival models to study the association between weekend admission and time to hospital discharge, adjusting for hospital (region, size, and teaching status) and patient factors (race, insurance, severity of illness, and use of thrombolytic therapy). Among 15 531 patient discharges with PE, 3286 patients (21.2%) had been admitted on a weekend. Patients admitted on weekends had a higher unadjusted 30-day mortality rate (11.1% versus 8.8%) than patients admitted on weekdays, with no difference in length of stay. Patients admitted on weekends had significantly greater adjusted odds of dying (odds ratio 1.17, 95% confidence interval 1.03 to 1.34) than patients admitted on weekdays. The higher mortality among patients hospitalized on weekends was driven by the increased mortality rate among the most severely ill patients. CONCLUSIONS: Patients with PE who are admitted on weekends have a significantly higher short-term mortality than patients admitted on weekdays. Quality-improvement efforts should aim to ensure a consistent approach to the management of PE 7 days a week.

Los col·loquis de la insigne ciutat de Tortosa, de Crisfòfor Despuig

Aquest treball té per finalitat facilitar el coneixement d'una obra cabdal de la literatura catalana; entendre'n el context temporal -el Renaixement i les seues convulsions polítiques, religioses i culturals, l'època del concili de Trento- i espacial -Tortosa, la Corona d'Aragó, l'Imperi espanyol-, per tal de situar-la dins d'unes coordenades espaciotemporals que facilitin la comprensió de l'obra per a estudiants i estudiosos.

Absonifibula estuarina sp. n. (Monogenea: Diclidophoridae) parasite of juvenile Cynoscion guatucupa (Osteichthyes) from southwestern Atlantic Ocean

Absonifibula estuarina sp. n. (Diclidophoridae, Absonifibulinae), is described from the gills of juvenile striped weakfish, Cynoscion guatucupa (Cuvier), from the southwestern Atlantic, Argentinean coast. This marine fish migrates to estuarine areas to spawn where exclusively juveniles are found parasitized; adult fish in marine water were never found to be parasitized by this monogenean. A. estuarina sp. n. is characterized mainly by the pedunculate clamps dissimilar in size, the shape of anterior jaw with sclerite 'a' attached to a sub-trapezoidal lamellate extension and fused to sclerites 'c' and 'd'. It differs from Absonifibula bychowskyi Lawler & Overstreet, 1976, the only known species of the genus, in the shape and arrangement of the genital corona, which is armed with six similar hooks disposed in circle and the sub-trapezoidal shape of lamellate extension ('b'). The restriction to juvenile sciaenids is a shared feature among the Absonifibulinae indicating an estuary-dependent life cycle.

Natural evidence for rapid abiogenic hydrothermal generation of CH4

Although recent hydrothermal experiments imply that abiogenic methane (CH4) generation from hydrothermal reduction of CO2 can occur, evidence from natural systems was still lacking. Based on the chemical and isotopic equilibrium signatures of low-temperature fumarolic gas discharges, we are able to provide hard evidence for its natural occurrence, namely in three subduction-related bi-phase hydrothermal systems of the Mediterranean, whose temperatures range from 260 to 470 degrees C. The attainment of equilibrium and the time spans of recent volcanic dormancy allowed us to calculate minimum rates for chemical and isotopic equilibration. These are significantly higher than those previously reported and might be due to the presence of a saturated water vapor phase in the investigated systems. The fact that nature provides conditions enabling relatively fast production of hydrocarbons from CO2 strongly supports the concerns that were recently raised from laboratory experiments. These address the use of the carbon isotope composition of reduced carbon in Archean sediments as a tracer of early life and the occurrence of CH4 on extraterrestrial planets as a bioindicator. In view of the potential role of abiogenic CH4 as a precursor of life, we also present an estimate of abiogenic hydrothermal CH4 fluxes throughout the Archean. It is not expected that these fluxes exceeded 80 Mt/yr during the past 4.0 Ga. This, however, would have been enough to facilitate HCN production on the prebiotic Earth. (C) 2007 Elsevier Ltd. All rights reserved.