- © 2004 Canadian Medical Association or its licensors
Waiting lists for cardiac bypass surgery
A triage system is integral to the prioritization of patients when demand for health care services exceeds capacity to deliver them. Cardiac bypass surgery is an example of a procedure that requires patients to queue for their opportunity. Unfortunately, patients sometimes die while they are on the waiting list. Although the normal triage process assigns priority to the sickest patients, Hill makes a case for operating on lower-risk patients first. Using a mathematical model, he demonstrates that overall survival rates would improve if priority were given to healthier patients. In an accompanying commentary, Naylor and colleagues argue that this mathematical model is invalidated by its failure to take real-life variables into account.
Perinatal death and day of the week at birth
Studies from Australia and the United States in the early 1980s revealed that the risks of neonatal death were 29% and 27% higher respectively on Saturdays and Sundays than on weekdays. To examine the effect of being born on a weekend in Canada, Luo and colleagues collected data on over 3 million births between 1985 and 1998. They found that infants born on weekends had slightly higher risks of stillbirth and early neonatal death but that those higher risks disappeared after adjustment for gestational age.
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Adverse events after hospital discharge
Previous studies have shown that discharged patients have a high risk of experiencing an adverse event secondary to treatment received in hospital. For many reasons, it is imperative that physicians understand the nature of this risk. Forster and colleagues studied patients who were discharged from a general internal medical service at an academic hospital. They found that 23; experienced an adverse event and that 6% had a preventable adverse event. Of all adverse events, 72% were related to medications. A univariate analysis revealed that female sex, type 2 diabetes mellitus and pneumonia were independent predictors of the occurrence of an adverse event.
In an accompanying commentary, Baker and Norton stress the importance of a smooth transition between hospital-based and community-based care in preventing adverse events in patients discharged from hospital.
Hyponatremia
Hyponatremia is a common electrolyte problem with numerous causes. Yeates and colleagues revisit the management of hyponatremia and present a simplified approach to the problem. Although most algorithms focus on serum osmolality or extracellular fluid status as the first step in differentiating the types of hyponatremia and determining treatment, the authors present an algorithm that initially focuses on the severity of the disturbance and on accompanying clinical features.
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