Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data

BACKGROUND: The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. OBJECTIVE: To determine whether primary care access is associated with the route of emergency admission-via a GP versus via an A and E department. METHODS: Retrospective analysis of national administrative data from English hospitals for 2011-2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access-the percentage of patients able to get a general practice appointment on their last attempt-was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. RESULTS: The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. CONCLUSIONS: Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more likely to have been admitted via a GP (vs an A and E department). This furthers evidence suggesting that access to general practice is related to use of emergency hospital services in England. The relative merits of the two admission routes remain unclear

Hepatic artery pseudoaneurysm ligation after orthotopic liver transplantation-a report of 7 cases

Pseudoaneurysm (PA) is a rare but life-threatening complication of liver transplantation. The authors present their experience on 7 patients treated by ligation of a post-OLT PA. Hepatic artery ligation or embolization was performed from 10 to 70 days after liver transplantation. Of the seven patients, four survived, one developed a biliary stricture, treated by percutaneous ballon dilatation, two died of a complication not related to treatment, and one died of multiple organ failure. © 1992 by Williams & Wilkins

Accessibility instruments for planning practice: A review of European experiences

Although a large body of literature has been produced on the theoretical definitions and measurements of accessibility, the extent to which such indicators are used in planning practice is less clear. This research explores the gap between theory and application by seeking to understand what the new wave of accessibility instruments (AIs) prepared for spatial and transport planning practice purports to offer the users of AIs. Starting from the question of how urban and transport planners are designing AIs, the article analyzes and describes the AIs developed over the last decade (mainly in Europe), offering a structured overview and a clear categorization of how accessibility measures can be applied. The paper identifies AI characteristics, and considers their usability, based on AI developer perceptions

Acute pancreatitis after liver transplantation: incidence and contributing factors

In order to assess the incidence and possible predisposing and contributing factors in the development of acute pancreatitis after liver transplantation, we reviewed the medical records of all 1832 adult patients who underwent 2161 orthotopic liver transplantation (OLTx) procedures in our center between January 1987 and September 1992. Of these patients, 55 (3 % incidence) developed clinical pancreatitis and 247 (13.4 % incidence) developed hyperamylasemia (biochemical pancreatitis). Overall mortality in cases of clinical pancreatitis was 63.6 %. The mortality in cases of hyperamylasemia was similar to that found in the general liver transplant population (i. e., 23 %). A strong correlation was found between pancreatitis after liver transplantation and end-stage liver disease due to hepatitis B (30 % of the cases, P = 0.00001). Extensive surgical dissection around the pancreas (P < 0.05), the type of biliary reconstruction following liver transplantation (P < 0.05), and the number of liver grafts received by the same patient (P = 0.00001) appeared to be possible contributing factors as did the duration of venovenous bypass and the quantity of IV calcium chloride administered intraoperatively

Organizational Citizenship Behavior (OCB) Dan Pengaruhnya Terhadap Keinginan Keluar Dan Kepuasan Kerja Karyawan

This study will investigate how relation among OCB within turnover intention and job satisfaction is and also how is the influence of OCB toward two of those attitudes. The samples of the research are 102 Police members in state &ldquo;X&rdquo; in West Java, by purposive sampling. The examination utilizes with simple regression analysis. The result showed that there is no negative significant relation and influence between OCB and turnover intention, but positive significant relation and influence between OCB and job satisfaction

Future aspects of renal transplantation

New and exciting advances in renal transplantation are continuously being made, and the horizons for organ transplantation are bright and open. This article reviews only a few of the newer advances that will allow renal transplantation to become even more widespread and successful. The important and exciting implications for extrarenal organ transplantation are immediately evident. © 1988 Springer-Verlag

FIC/FEM formulation with matrix stabilizing terms for incompressible flows at low and high Reynolds numbers

The final publication is available at Springer via http://dx.doi.org/10.1007/s00466-006-0060-yWe present a general formulation for incompressible fluid flow analysis using the finite element method. The necessary stabilization for dealing with convective effects and the incompressibility condition are introduced via the Finite Calculus method using a matrix form of the stabilization parameters. This allows to model a wide range of fluid flow problems for low and high Reynolds numbers flows without introducing a turbulence model. Examples of application to the analysis of incompressible flows with moderate and large Reynolds numbers are presented.Peer ReviewedPostprint (author's final draft

Attenuation of ischemic liver injury by prostaglandin E<inf>1</inf> analogue, misoprostol, and prostaglandin I<inf>2</inf> analogue, OP-41483

Background: Prostaglandin has been reported to have protective effects against liver injury. Use of this agent in clinical settings, however, is limited because of drugrelated side effects. This study investigated whether misoprostol, prostaglandin E1 analogue, and OP-41483, prostaglandin I2 analogue, which have fewer adverse effects with a longer half-life, attenuate ischemic liver damage. Study Design: Thirty beagle dogs underwent 2 hours of hepatic vascular exclusion using venovenous bypass. Misoprostol was administered intravenously for 30 minutes before ischemia and for 3 hours after reperfusion. OP-41483 was administered intraportally for 30 minutes before ischemia (2 μg/kg/min) and for 3 hours after reperfusion (0.5 μg/kg/min). Animals were divided into five groups: untreated control group (n = 10); high-dose misoprostol (total 100 μg/kg) group (MP-H, n = 5); middle-dose misoprostol (50 μg/kg) group (MP-M, n = 5); low-dose misoprostol (25 μg/kg) group (MP-L, n = 5); and OP-41483 group (OP, n = 5). Animal survival, hepatic tissue blood flow (HTBF), liver function, and histology were analyzed. Results: Two-week animal survival rates were 30% in control, 60% in MP-H, 100% in MP-M, 80% in MP-L, and 100% in OP. The treatments with prostaglandin analogues improved HTBF, and attenuated liver enzyme release, adenine nucleotrides degradation, and histologic abnormalities. In contrast to the MP-H animals that exhibited unstable cardiovascular systems, the MP- M, MP-L, and OP animals experienced only transient hypotension. Conclusions: These results indicate that misoprostol and OP-41483 prevent ischemic liver damage, although careful dose adjustment of misoprostol is required to obtain the best protection with minimal side effects