Objective. To evaluate organ donation (OD) policy, appropriate comparisons between different OD programs are required. The objective of this research was to investigate alternative methods of measuring national rates of OD using publicly available data and examine the implications of using each method as a measure of performance. / Method. We used 7 measures to calculate deceased OD rates, based on 7 different denominators. Data were collected from OD organizations and the World Health Organization. OD rates for each measure were calculated for 10 countries for the years 2001--2004. Relative rates were calculated using Spain as the standard. / Results. We found variations in relative rates across the proposed measures. Regardless of the measure used Spain excelled. / Conclusion. If the purpose of the OD rate is to identify the top performer internationally, it may not matter which measure is used providing this is done with an understanding of its limitations.

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 5 uppsatser.

No description available.

Sparse information is available concerning use of emergency departments (EDs) by the elderly in rural areas. We reviewed records of all patients seeking care at EDs of three rural hospitals during 7 days in October 1991. We found that elderly people did not use EDs in proportion to their numbers in the community (15.2% versus 19.3%). Compared with younger ED patients, more elderly patients required an ambulance (40.8% versus 10.7%), more needed hospitalization (38.4% versus 11.9%), and their ED stays were longer (140 minutes versus 89 minutes). Falls/injuries (18.7%) and cardiac illness (18.1%) were the most frequent reasons for ED visits by the elderly, and relatively few (2.8%) had confusion. More elderly patients arrived during daytime hours than during the night, and more on weekends than weekdays. Also, we found no difference between patients in the 65- to 74-year-old age group and those aged 75 years and older.

Submitted in partial fulfillment of the requirement for the degree Master of Science in Emergency Medicine in the Faculty of Health Sciences at the University of Witwatersrand , July 2013 / Background Deliberate self-poisoning (DSP) remains a common method employed for suicide worldwide. Despite its frequent occurrence and the high cost required in its management, only few studies have been carried out on this subject in South Africa. Inadequate research into DSP in South Africa is a great concern as this may inadvertently result in an inadequate knowledge of health professionals on the general approach to victims presenting at emergency departments. This may consequently result in a poor clinical outcome of these cases. This study was aimed at determining the demographics of DSP cases presenting to the emergency department (ED) of Pelonomi hospital and also to enquire into the drugs/agents commonly used, reasons for DSP and the clinical outcome of these cases. Method This was a retrospective, descriptive study which was carried out by going through the hospital clinical records covering a period of eighteen months (1st January 2010 – 30th June 2011). The demographics and deliberate self-poisoning-related information were then collected, using a data collection form. The data was thereafter analysed by using descriptive statistics, calculated for continuous data. Frequencies and percentages were calculated for categorical data. Results Of the 212 DSP cases reviewed, 66% were female. Most patients (86.8%) were single and 65.6% were unemployed. DSP occurred more in the age-group of 20-39 years (68.8%). Majority of the DSP cases (84.4%) occurred in areas associated with poor socio-economic status.Paracetamol was the drug used by majority of these patients (21.7%) for DSP. Other common agents/drugs used were antidepressants (9.4%), antiretrovirals (ARVs) (9.9%) and household chemicals (19.3%). 85 patients (40.1%) took more than one drug/agent. Out of the 81 patients who had the reason for their poisoning stated, 40 patients had relationship disharmony (32 unmarried, 8 married). 15 patients had family issues which mainly resulted from conflicts with parents and grandparents. The medical reasons found amongst 5 patients were HIV infection, cancer and dental problems. Unemployment and post traumatic stress disorder following rape were the other reasons for DSP. The psychosocial problems of 10 patients were not specified. Majority of the patients (59.9%) were discharged in stable conditions. Low GCS (≤8) and hypothermia were common clinical features occurring amongst patients that got admitted. Conclusion DSP is still a common phenomenon, majorly amongst females in the age-group of 20-39 years, with poor quality of life. Relationship disharmony is the most common reason for poisoning. Drug/agents used can only be curtailed to a minimal extent. Prevention through early detection of vulnerable patients and early psychological management should be our goal.

Forensic psychiatry in South Africa came to be in the 1970’s following the introduction of the Mental Health Act of 1973 and the Criminal Procedures Act of 1977. Forensic psychiatric units offer psychiatric observation for defendants referred from the courts, as well as providing indefinite detention, for the purpose of treatment and rehabilitation, of those who have been declared unfit to stand trial and/or not criminally responsible due to a mental illness or defect. State patients are mentally ill offenders whose charges involved serious violence. Ultimately these state patients are released back into the community. There is a paucity of South African literature regarding the outcome of state patients.

Indiana University-Purdue University Indianapolis (IUPUI) / The force-moment systems of orthodontic T-loops have been widely described and investigated. A simpler triangular loop spring design has been employed in the graduate orthodontic clinic at Indiana University School of Dentistry. To date, no investigators have specifically examined and compared the force systems generated by these two loop configurations. The objective of this study was to compare the force systems generated by a T-loop and two different geometric shapes of triangular loops. A sample of 20 T-loops and 40 triangular loop springs were studied. The triangular loops were constructed in two different geometric configurations (n = 20 in each group) utilizing the same linear amount of wire as used in the T-loop fabrication. One set of triangular loops was the same height as the T-loop (isosceles shape); the other set was the same width as the T-loop (equilateral shape). Force and moment components along three mutually perpendicular axes (x, y, and z) were analyzed, with particular emphasis on the force system generated in the sagittal plane. The force-moment systems generated upon mesio-distal (x axis) activation were measured by a transducer connected to a computer for data collection and analysis. Statistical analysis utilized repeated measures of variance models (ANOVA). Multiple comparisons were made using Fisher's Protected Least Significant Differences at a 95-percent overall confidence level. On initial ligation, there were no significant differences between the loops in the M/F ratios in the sagittal plane (p = 0.75). For all other activation distances, the equilateral triangular loops produced greater M/F ratios than both the isosceles and T-loops (p = 0.0001), and the isosceles triangular loops generated greater M/F ratios than the T-loops (p < 0.0035).

To assess the validity of case mix adjustment methods used to derive standardised mortality ratios for hospitals, by examining the consistency of relations between risk factors and mortality across hospitals. DESIGN: Retrospective analysis of routinely collected hospital data comparing observed deaths with deaths predicted by the Dr Foster Unit case mix method. SETTING: Four acute National Health Service hospitals in the West Midlands (England) with case mix adjusted standardised mortality ratios ranging from 88 to 140. PARTICIPANTS: 96 948 (April 2005 to March 2006), 126 695 (April 2006 to March 2007), and 62 639 (April to October 2007) admissions to the four hospitals. MAIN OUTCOME MEASURES: Presence of large interaction effects between case mix variable and hospital in a logistic regression model indicating non-constant risk relations, and plausible mechanisms that could give rise to these effects. RESULTS: Large significant (P<or=0.0001) interaction effects were seen with several case mix adjustment variables. For two of these variables-the Charlson (comorbidity) index and emergency admission-interaction effects could be explained credibly by differences in clinical coding and admission practices across hospitals. CONCLUSIONS: The Dr Foster Unit hospital standardised mortality ratio is derived from an internationally adopted/adapted method, which uses at least two variables (the Charlson comorbidity index and emergency admission) that are unsafe for case mix adjustment because their inclusion may actually increase the very bias that case mix adjustment is intended to reduce. Claims that variations in hospital standardised mortality ratios from Dr Foster Unit reflect differences in quality of care are less than credible.

In der Behandlung der zervikalen Dystonie wird die Therapie mit Botulinumtoxin (BTX) erfolgreich angewendet. Neben dieser Therapie werden von Patienten oft alternative Therapien (CAM [Complementary and Alternative Medicine]) angesprochen und ausprobiert. Diese Studie geht der Frage nach, wie häufig CAM-Therapien genutzt werden, wie deren Wirkung bewertet wird und ob es Prädiktoren für die Therapiewahl gibt. Zur Datenerhebung wurden 265 Fragebögen von zwei Patientengruppen ausgewertet. Gruppe 1 (n=101) bestand aus Patienten der Botulinumtoxinsprechstunde des Universitätsklinikums Leipzig und der Paracelsus Klinik Zwickau. Gruppe 2 (n=165) wurde aus Mitgliedern des Selbsthilfeverbandes Bundesverband-Torticollis e.V. rekrutiert. Bei 86% der Patienten wurde die Therapie mit BTX angewendet. Von den Therapiemöglichkeiten der CAM wurden am häufigsten physikalische Therapien (Massagen n=171) genannt. Am besten bewertet wurden jedoch, neben der BTX-Therapie, spezielle physiotherapeutische sowie psychotherapeutische Verfahren. Die CAM-Therapien wurden häufig in Kombination mit der BTX-Therapie angewendet und von Patienten, deren Erkrankung einen langen chronischen Verlauf vorwies (>10 Jahre). Als Prädiktoren für die Wahl einer CAM-Therapie zeigten sich eine Zugehörigkeit zur Gruppe 2, aufgetretene Nebenwirkungen im Rahmen der BTX-Therapie, männliches Geschlecht und erhöhter Stress bei den Erkrankten. Außerdem fand sich ein signifikanter Unterschied zu einem höheren Bildungsabschnitt und Arbeit in gehobeneren Berufsgruppen bei Patienten, die vermehrt CAM Therapie anwenden. Zusammenfassend wurden CAM-Therapien, neben der Behandlung mit BTX, häufig von den Befragten angewendet. Hohe Zufriedenheitswerte erzielte eine Kombination mit physiotherapeutischen Verfahren oder Psychotherapie. Die Wahl von CAM-Therapien ist von der Erkrankungsdauer, Bildungslage und finanziellen Ressourcen abhängig.

Many epidemiological studies assess the effects of time-dependent exposures, where both the exposure status and its intensity vary over time. The analysis of such studies poses the challenge of modelling the association between complex time-dependent drug exposure and the risk, especially given the uncertainty about the etiological relevance of doses taken in different time periods. / To address this challenge, I developed a flexible method for modelling cumulative effects of time-varying exposures, weighted by recency, represented by time-dependent covariates in the Cox proportional hazards model. The function that assigns weights to doses taken in the past is estimated using cubic regression splines. Models with different number of knots and constraints are estimated. Bootstrap techniques are used to obtain pointwise confidence bands around the weight functions, accounting for both the sampling variation of the regression coefficients, and the uncertainty at the model selection stage, i.e. the additional variance due to a posteriori selection of the number of knots. / To assess the method in simulations, I had to develop and validate a novel algorithm to generate event times conditional on time-dependent covariates and compared it with the algorithms available in the literature. The proposed algorithm extends a previously proposed permutational algorithm to include a rejection sampler. While all the algorithms generated data sets that, once analyzed, provided virtually unbiased estimates with comparable variances, the algorithm that I proposed reduced the computational time by more than 50 per cent relative to alternative methods. I used simulations to systematically investigate the properties of the weighted cumulative dose method. Six different weight functions were considered. Simulations showed that in most situations, the proposed method was able to capture the shape of the true weight functions and to produce estimates of the magnitude of the exposure effect on the risk that were close to those used to generate the data. I finally illustrated the use of the weighted cumulative dose modelling by reassessing the association between the use of selected benzodiazepines and fall-related injuries, using administrative data on a cohort of elderly who initiated their use of benzodiazepines between 1990 and 2004.