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Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The new arrangements for the NHS require that health services are procured which meet the identified needs of the population. To reach an agreed understanding of those needs a number of different perspectives must be reconciled--the nature of disease at a population level versus the individual's perception of illness, the general manager's desire to estimate what level of a particular service to provide versus the medical concept of packaging different services to meet a need, the clinical and epidemiological tendency to consider disease processes rather than unclassified symptomatology, and the balance of need and demand. These conflicts are described in relation to ischaemic heart disease. The task is one of complexity, challenge and opportunity.
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PMID:Perspectives on the assessment of need. 212 26

All doctors, and most of their patients, are familiar with the consequences of stroke. In 1985 more than 70,000 men and women over the age of 65 died after a stroke and only one third of the survivors of stroke made a good recovery. It is thus a major source of chronic disability, placing a very heavy burden on patients' relatives and friends and consuming a great deal of NHS resources. The purpose of this Report is to set out guidelines for the clinical, radiological and pathological assessment of stroke, to suggest how to care for and rehabilitate patients who have suffered a stroke, and to evaluate and recommend measures for its prevention. The Report emphasises the need to use standard terms for the clinical description and classification of stroke, and the assessment of degrees of disability. It traces its changing epidemiology in the UK and in other countries and assesses the significance of putative risk factors such as hypertension, smoking, obesity, alcohol, diabetes, serum cholesterol, oral contraceptives and ischaemic heart disease. It sets out the indications for admitting patients to hospital and how they should be investigated, including the value of CT scanning at different intervals after the stroke has occurred. The Report describes the organisational aspects of the care of stroke patients during the acute phase, in the early recovery phase and in the longer term rehabilitation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Stroke. Towards better management. Summary and recommendations of a report of the Royal College of Physicians. 230 9

Mortality among men employed in the health sector was examined using data surrounding the 1971 (1970-2) and 1981 (1979-83) censuses to assess the differences between social classes in the health service and to study changes over a decade. Relative to men in England and Wales, mortality in the 1980s was significantly lower among dentists (standardised mortality ratio 66), doctors (69), opticians (72), and physiotherapists (79) and significantly higher among hospital porters (151), male nurses (118), and ambulancemen (109). Mortality from lung cancer among hospital porters (185) was more than fivefold that seen in doctors (33) and dentists (37). Ischaemic heart disease varied twofold, being lowest in dentists (60) and doctors (70) and highest in hospital porters (138). Over the decade mortality from lung cancer and ischaemic heart disease declined in all groups except hospital porters, ambulancemen, and orderlies. Most groups showed excess deaths from suicides and cirrhosis of the liver. Differences in mortality between health workers in social class I and those in social class IV widened between the 1970s and 1980s and to a greater extent than among the general population. The high mortality of some groups within the NHS, and the fact that differentials between social classes have widened more than in the general population, suggest that the NHS needs to pay more attention to the health of its own staff.
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PMID:Inequalities in health within the health sector. 251 Aug 44

In prospective studies of ischaemic heart disease, data on the incidence of morbidity as well as mortality are critical to the understanding of the natural history of disease. In the Regional Heart Study, 7,735 middle-aged men recruited from general practices in 24 towns in England, Wales and Scotland have been examined, and are being followed for morbidity and mortality for at least five years. This paper explains the methods used and the difficulties encountered in maintaining the flow of information on these subjects and, in particular, discusses the problems of removal and tracing. A network of enquiries, using Family Practitioner Committees, the NHS Central Register and the additional 500 doctors (to date) to whom subjects have transferred, has enabled contact to be maintained. In the first seven towns reviewed at five years from the initial examination, replies have been received from 98 per cent of the original sample still alive and living in Great Britain.
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PMID:Follow-up of subjects in prospective studies based in general practice. 674 39

In 1979, all the known diabetic subjects (849) were identified from a community (population 81851), of whom 717 (85%) were reviewed by a single observer. Using the NHS Central Register, follow-up was completed for 98% of subjects. After 11 years, 306 (42.7%) diabetic subjects had died, of whom 65 were insulin treated and 241 were non-insulin treated. Circulatory disease accounted for 168 (54.9%) deaths, of which 124 (73.8%) were due to ischaemic heart disease. The standardized mortality ratio (SMR) for all causes of death, based on data from England and Wales, was significantly raised for both insulin-treated and non-insulin-treated patients (1.75, 95% CI 1.35 to 2.24 and 1.32, 95% CI 1.15 to 1.50, respectively). SMRs for all cause mortality were significantly greater for diabetic subjects in the 45-64 (SMR, 1.97, 95% CI 1.34 to 2.80), 65-74 (SMR 1.59, 95% CI 1.27 to 1.97 and 75 years and over (SMR 1.26, 95% CI 1.08 to 1.45) age ranges. Using a proportional hazards model, after adjusting for age and gender, systolic blood pressure and vibration threshold were significant predictors of all cause mortality in insulin-treated subjects. For non-insulin-treated subjects, blood glucose, systolic blood pressure, glycated haemoglobin, retinopathy, proteinuria, coronary artery disease, and stroke were significant baseline predictors of mortality. No association was found for serum cholesterol, body mass index, diastolic pressure or cigarette smoking in either treatment group.
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PMID:Mortality in diabetic subjects: an eleven-year follow-up of a community-based population. 789 62

Forty-six patients who were investigated in 1979-80 for chest pain, and found to have normal or insignificantly narrowed coronary arteries on coronary angiography, were followed up after a mean interval of 11.4 years. Patients were interviewed and given standardized questionnaires covering chest pain and other physical symptoms, psychiatric morbidity, and functional capacity. Medical records for the follow-up period were reviewed, as were death certificates and post-mortem reports, where appropriate. All patients (100%) were traced to death or their current address. Four had died (11.4 year survival rate 91%), one from ischaemic heart disease. Continuing chest pain was reported by 74%, and in 16 patients (38%), chest pain was either frequent, severe or both. A poor outcome for chest pain was associated with other physical symptoms and increased psychiatric morbidity, which for the entire cohort was higher than at 1 year after angiography. Twenty-six patients (58%) had received further hospital treatment for chest pain, including, in six patients, further coronary angiography. Twenty-nine survivors (71%) were taking cardiac medication, 12 (29%) were unable to work for medical reasons, and levels of functional disability were similar to those found in patients with myocardial infarction or angina. This study confirms the findings of previous studies with shorter follow-up intervals. Mortality was low, but high levels of chest pain, psychological distress, and functional incapacity persisted long after angiography. Patients reported many physical symptoms other than chest pain, and had made heavy use of medical resources. For many patients, reassurance after angiography had been ineffective, and the prognosis was poor. Early identification and effective management of such patients could offer the NHS substantial savings.
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PMID:Psychosocial outcome and use of medical resources in patients with chest pain and normal or near-normal coronary arteries: a long-term follow-up study. 825 73

A retrospective cohort study was carried out of new referrals to transient ischaemic attack (TIA) clinics in Glasgow. The aims of the study were to describe the profile of referrals and to assess the odds ratios for TIA, minor stroke or amaurosis fugax of both cardiovascular risk factors and clinical features. In total, data were collected for 813 new referrals in a period of six months. Thirteen point eight percent of referrals were from other Health Boards. The overall referral rate among residents of Greater Glasgow NHS Board was 165.6 per 100,000 per year. About 20% of referrals were made by clinicians in secondary care. The specialties from which referrals were most commonly made were accident and emergency, general medicine, ophthalmology and geriatric assessment. The most common risk factors in patients referred were hypertension (52.9%), smoking (31.7%), ischaemic heart disease (22.7%) and former smokers (22.4%). The most common clinical features were hemiparesis (13.3%), weakness of an upper limb (8.7%), vertigo (7.9%) and dysphasia (7.3%). In 48.7% of cases, a non-cerebrovascular diagnosis was made. Separate multivariate models were established for risk factors and clinical features. In the model for risk factors, five factors were significant for risk of TIA, stroke or amaurosis fugax. These were hyperlipidaemia, age over 64 years, hypertension, smoking and ex-smoking. In the model for clinical features, five factors were also significant. These were visual field defect, speech defact, facial weakness and hemiparesis.
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PMID:Epidemiological aspects of referral to TIA clinics in Glasgow. 1737 16

Currently less than half of the estimated number of people with dementia in England receive a formal diagnosis of dementia or have contact with specialist dementia services. Case finding focused on high risk groups may be an effective way to identify the undiagnosed. This joint Surrey Downs Clinical Commissioning Group and Surrey and Borders NHS Foundation Trust quality improvement project aimed to increase the rate of dementia diagnosis across Surrey Downs using specialist link nurses (SLNs). Thirty three GP surgeries covering the entire Surrey Downs area took part in the project. Individuals at high risk of developing dementia were identified from GP electronic disease registers, and were offered screening at their GP practices by SLNs, using a combination of mini cognitive test (Mini-Cog) and functional assessment questionnaire (FAQ). Suitable individuals who screened positive were seen by their GP and where appropriate referred to secondary care services for further evaluation. Based on the presence of risk factors, 6657 (11.9%) people were identified from a total population of 55 845 over 65s, and 1980 (29.7%) completed the screening assessment. Three hundred and fifty eight (18.1%) individuals screened positive and were referred to their GP, who referred 205 (57.2%) of them to the memory services for further assessment. Of those referred, 164 (80%) had a comprehensive specialist assessment. Forty one (20%) declined further assessment, and their GPs were informed. The mean age of the cohort who completed the comprehensive assessment was 82.3 years (SD=4.26), and were predominantly white and male. Fifty four (32.9%) had mild cognitive disorder (MCD), and 101 (61.6%) patients were diagnosed with dementia. The most common dementia was mixed type (43; 42.6%), followed by Alzheimer's dementia (32; 31.7%). The most common risk factor among patients with cognitive impairment (MCD or dementia) was hypertension (69; 44.5 %), followed by ischemic heart disease (64, 41.3%). Nurse led case finding for cognitive impairment in a high risk population identifies people with dementia who are not yet formally diagnosed. The combined use of brief instruments to assess cognitive functioning and functional capabilities is helpful in identifying individuals with possible dementia.
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PMID:Targeted case finding for dementia in primary care: Surrey Downs dementia diagnosis project. 2689 84