Diagnoses and clinical features associated with high risk for unplanned readmission in vascular surgery. A cohort study

Background: Readmission rate is an established health quality indicator. Preventable readmissions bear an unnecessary, high cost on the healthcare system. An analysis performed by the National Centre for Health Outcomes Development (NCHOD) has demonstrated an increasing trend in emergency readmissions in the UK. Vascular surgery has been reported to have high readmission rates second only to congestive heart failure. This study aims to identify diagnoses and other clinical risk factors for high unplanned readmission rates. This may be the first step to sparing both the health care system and patients of unnecessary readmissions. Results: The overall 30 day readmission rate for Leeds Vascular Institute was 8.8%. The two diagnoses with the highest readmission rates were lower limb ischaemia and diabetic foot sepsis. The readmission rate for medical reasons was overwhelmingly higher than for surgical reasons (6.5% and 2.3% respectively). The most common medical diagnoses were renal disease and COPD. The majority of the patients readmitted under the care of vascular surgery required further surgical treatment. Conclusion: Vascular units should focus on holistic and multidisciplinary treatment of lower limb ischaemia and diabetic foot sepsis, in order to prevent readmissions. Furthermore, the early involvement and input of physicians in the treatment of vascular patients with renal disease and COPD may be appropriate

Arbetsmiljö och säkerhet : På mindre företag inom byggindustrin

The accident frequency in the construction industry has shown a downward trend every year but this trend was broken 2010th. It is often lack of precautionary measures within work environment and safety that is the cause of accidents. The big construction companies understand the importance of precautionary measures within work environment and safety, as they spend a lot of money and time on that matter. By examining the work environment and the safety of the small construction companies you can see how they work. The report will presents how these small companies work with work environment and safety, and also how they follow the safety instructions that are available and how they make use of safety equipment. By making use of interviews with staff in small construction companies, information has been collected about how they work with work environment and safety, and how they experience them. An interview with inspector at Swedish Work Environment Authority has been done to get their point of view of the small construction companies. The results show that small construction companies can get better at planning the work environment before construction begins. The constructions sites were kept clean to avoid falls. It appeared that they sometimes didn’t use harness at small jobs on the roof, but on larger work on the roof they used scaffolds. The reason to the sloppiness of not following the safety rules were time pressure and fast pace

Studies on blood pressure, pulse rate, laboratory parameters, blood and plasma viscosity in 55 patients with impaired glucose tolerance (borderline diabetics)

Abstract  As a substudy to a broader investigation concerning clinical parameters in patients with impaired glucose tolerance blood and plasma viscosity were studied in 55 patients in ages from 39 to 81 years (mean age 62,4 years).  These patients were selected from a large health study in southern Swedenwhere they presented with impaired glucose tolerance but without signs of  vascular disease.  At the time of our study these 55 patients were still not, 20 years after their first oral glucose tolerance test, classified as ouvert diabetes. Our intention was to study effects of  minor disturbances of glucose tolerance on blood rheology.  The patients had a laboratory profile close to that of patients with ouvert type 2 diabetes. Compared to a ontrol group of healthy individuals they had higher values for blood and plasma viscosity at all shear rates (p&lt;0.001), higher values for b-glucose, ESR, triglycerides, s-GT  (p&lt;0.05-0.005) and lower values for s-creatinine p&lt;0.001). It was also found that diastolic pressure, both at rest and after exercise, was positively correlated to plasma viscosity. This holds true also for systolic arm pressure. Pulse rate at rest and after exercise showed a negative correlation to blood rheology parameters. The pool of data is very large and further analyses are under way. So far our data show that even minor abnormalities of glucose metabolism are harmful and create a risk for vascular disease.             </p