Hospitalization data rates

Figure 1 Comparison of the distributions of pneumonia rates (based on patients and on ventilator-days) and ventilator utilization in surgical intensive care units. A and B indicate the specific location of individual hospital unit rates. NNIS Data on Surgical Intensive Care Units, 1987-1995.

The most common reason for lack of rt-PA use in otherwise eligible patients remains, however, delay in presentation to the hospital. The California Acute Stroke Pilot Registry (CASPR) investigators examined the effect of various hypothetical interventions on the rate of rt-PA use. Their data suggested that if all patients with a known time of onset presented to medical attention immediately, the expected overall rate of thrombolytic treatment within 3 hours would have increased from 4.3% to 28.6%. By comparison, the expected rate of treatment that would result from instantaneous prehospital response was 5.5%, from perfect hospital care was 11.5%, and from extension of time window to 6 hours was 8.3%. 

In rodent stroke models, statin pretreatment has been shown to reduce infarct volumes and improve outcomes. Similarly, several clinical studies have shown that prior statin use reduced the severity of acute ischemic stroke and myocardial infarction. Recent studies indicate that beneftt can be achieved even when treatment is initiated after the onset of symptoms. In rodents, atorvastatin and simvastatin have been shown to reduce the growth of ischemic lesions, enhance functional outcome, and induce brain plasticity when administered after stroke onset. A retrospective analysis of the population-based Northern Manhattan Stroke Study (NOMASS) showed that patients using lipid-lowering agents at the time of ischemic stroke have a lower incidence of in-hospital stroke progression and reduced 90-day mortality rates. Retrospective analysis of data of the phase III citicoline trial showed... 

Diarrhea is a well-known complication of antibiotic therapy. Rates of antibiotic-associated diarrhea (AAD) vary from 5 to 25%. Some antibiotics are more likely to cause diarrhea than others, specifically, those that are broad spectrum and those that target anaerobic flora. This paper reviews the effects of antibiotics on the fecal flora as well as host factors which contribute to AAD. Clinical features and treatment of AAD are also described. Prevention of AAD rests on wise antibiotic policies, the use of probiotics and prevention of acquisition in the hospital setting. Data from clinical trials suggest that poorly absorbed antimicrobials might have a decreased risk of causing AAD and Clostridium difficile-associated disease, as concluded from studies of antibiotics used for preoperative bowel decontamination and poorly absorbed antibiotics used for traveler s diarrhea. Controlled trials would prove this but are not yet available. Probiotics may be a good adjunct to poorly absorbed antibiotics to minimize the risk of diarrhea associated with antibiotics. 

All that being said, cost is not the only issue, and decision-makers also need to bear in mind several scientific considerations. Unfortunately, few studies have thus far looked into treatment and treatability of hospital effluents, and therefore the majority of PhC removal rate data reported below are based on studies of UWWs passing through conventional and (biological and chemical) advanced treatment... 

These data suggest that there is more available information for use of lithium than for other mood stabilizers, and that adolescents hospitalized with adolescent-onset, acute mania have rates of response between 50% and 80%. Supplementation with sedating medication appears to be common but not systematically evaluated. Children hospitalized with mania also respond to lithium, but their comorbid disorders often need separate attention. Open trials with DVP in hospitalized adolescents are also supported. There is much less information on CBZ and there are no data on newer anticonvulsants such as lamotrigine, topiramate, or gabapentin. These data are largely consistent with data from studies of hospitalized adults with classic mania. 

Despite overwhelming data supporting the efficacy of ECT treatment for major depression, marked variation in the extent and pattern of its usage continues. Use of ECT declined in the 1970s but then appeared to stabilize or increase in the 1980s (J. W. Thompson et al. 1994]. ECT is used far more commonly in private hospitals than in public institutions and is more commonly administered to older patients and to women. Its more common administration to women may be the result of higher rates of depression in women (J. W. Thompson et al. 1994]. Olfson et al. [1998] similarly reported that ECT is used more often in white persons, those with higher incomes, and the elderly. 

Acute pancreatitis is usually a self-limiting disease, which regresses spontaneously without further complications. However, in about 20% of cases it leads to organ failure and/or local complications and is associated with high morbidity and mortality rates (B15). Therefore, numerous attempts have been made to predict early the severe course of acute pancreatitis and to assess the possibility of complications. Objective identification of the risk of complications or death is essential for selection of those patients who should be hospitalized in the intensive care unit (ICU) and be subjected to more expensive and aggressive investigations. Moreover, it also permits interinstitutional comparison of data stratified for severity at admission and at the time of therapy. 

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