The aim of the study was to investigate factors of significance for readmission of patients in a department of internal medicine. The study was based on hospital computerized data files. All admissions from the 1st of January to the 31st of December 1995 were included. During that period the department had 6061 admissions of 4152 patients. The readmission rate was 1.46. All patients were followed three months after discharge. Within that period 1119 (27%) of the patients were readmitted. A high frequency of readmission was especially found within the first ten days after discharge. Length of stay in hospital did not influence readmission rate. Women, patients in the age group 71-90 years and patients with chronic diseases were more likely to be readmitted. The demonstrated factors relating to a high readmission rate are difficult to influence. A prospective study including the primary health care system and a clinical evaluation of the patients is needed to examine causes of the high number of readmission within the first ten days after discharge.
OBJECTIVE: To compare the accuracy of axillary dissection with that of axillary node biopsy for staging of lymph nodes in operable breast cancer. DESIGN: Randomised study. SETTING: District hospital, Oestersund, Sweden. SUBJECTS: 200 women with operable breast cancer who presented between 1985-87 and 1989-91. INTERVENTIONS: Women were randomised (n = 100 in each group) to have either axillary dissection (in which all fat tissue was removed from the axilla) or biopsy (in which the lower half of the axillary fat, together with obviously malignant nodes were removed for histopathological examination). MAIN OUTCOME MEASURES: Number of nodes harvested by each method, and number that contained metastases. RESULTS: Nodes that contained metastases were found in 43 of the patients in the dissection group and 46 of those who had undergone biopsy alone. The median (range) yield of nodes in the dissection group was 8.5 (0-16) and in the biopsy group 6 (0-14), p
The annual incidence of clinically diagnosed TC in Malmö was, on an average, 2.4 per 100,000 population during the years 1960-1977. This was 1.2 per 100,000 population lower than the corresponding incidence in the whole of Sweden as reported by the National Cancer Registry. The main reason for the difference was suggested to be inclusion in the official figures of autopsy cases and of cases with a benign diagnosis, rather than a true difference in the prevalence of TC. During the later part of the study an increase in the incidence of differentiated TC of approximately 70% was noted. This was considered to be due to increased health awareness and the availability of medical care, because only the number of tumors with less advanced growth increased. The average annual mortality from TC in Malmö was 0.9 per 100,000, which was 0.4 per 100,000 lower than the corresponding official rate in all of Sweden. The difference was suggested to be mainly due to inclusion in the official figures of persons not dying of TC. The mortality did not change significantly during the period of investigation. The percentage distribution by histologic type of tumors clinically diagnosed (N = 104) was as follows: papillary cancer, 65%; follicular, 21%; medullary, 4%; and anaplastic, 12%. The prognosis as estimated by the life table method was worst for patients with anaplastic TC, followed by those with follicular, papillary, and medullary TC. The validity of using the relationship of the tumor to the thyroid capsule (i.e., intrathyroidal and extrathyroidal growth) as a basis for classification into tumor stages was supported in the present study: the mortality in patients with intrathyroidal tumors was lower than in those with extrathyroidal tumors. The definition of occult TC--TC not larger than 1.5 cm, without regard to the relation to the thyroid capsule--was considered inappropriate and a change in the conception of occult TC was proposed. The presence or absence of node metastases in TC did not seem to have major significance for the prognosis. The significance of age for survival was strongly supported in our study. Deaths from TC clinically diagnosed before the age of 60 were infrequent, whereas the disease after this age increasingly often was fatal. This was partly due to a late onset of anaplastic TC and partly to a higher mortality in older than in younger patients with papillary or follicular TC.(ABSTRACT TRUNCATED AT 400 WORDS)
The object of this study was a financial assessment of a hospital-based palliative support service, to be made by comparing the study group with a matched historical control group and a group of contemporary reference patients. The staff consisted of one full-time nurse supported by a surgeon one half-day per week. The patients in the study group utilized fewer institutional days than the control group, according to such parameters as duration of terminal hospitalization (P
The incidence of recurrence and of hypothyroidism was determined in all new patients treated for thyrotoxicosis during the period 1970-1974 in an unselected, well-defined urban population. A total of 309 patients were followed up for a median time period of 108 (1-192) months. There was a cumulative incidence of 51% recurrence in patients who were treated with antithyroid drugs for Graves' thyrotoxicosis, whereas after surgery or radioiodine treatment there were few recurrences, but 32% and 78% cumulative incidences of hypothyroidism. There were no recurrences after surgery or radioiodine treatment in patients with toxic multinodular goitre or solitary toxic adenoma, but 29% and 40% cumulative incidences of hypothyroidism following radioiodine treatment. Late hypothyroidism occurred after surgery for Graves' thyrotoxicosis, and in all groups treated with radioiodine. Thus it is advisable that all patients with Graves' thyrotoxicosis, regardless of treatment, and all patients with toxic multinodular goitre or solitary toxic adenoma treated with radioiodine, should be followed up for many years, and probably for life.
Of 287 consecutive patients, surgically treated at our department for benign, nontoxic goitre during a six-year period, 261 could be followed up, on average, 8.0 years postoperatively. Unilateral surgical procedures had been used in 199 patients, subtotal thyroidectomy in 62. 29 patients were treated with thyroxine (T4) immediately postoperatively ("recurrence prophylaxis"); in the other patients thyroxine was only given in cases of hypothyroidism (significant increase of s-TSH). 26 patients had a goitre recurrence 0.5-10 years after surgery; of these 3 had got T4 as "recurrence prophylaxis" and 23 had not. There was no significant difference between patients with and without T4 postoperatively regarding the rate of recurrence. Of 55 patients treated with subtotal thyroidectomy, 33 had postoperative latent (n = 26) or manifest (n = 7) hypothyroidism. Only 13 of 177 patients operated on unilaterally developed hypothyroidism; two of these had Hashimoto's thyroiditis. All cases of hypothyreosis except 4 were detected within the first 12 months of follow-up. This study indicates that routine use of thyroxine as prophylaxis against recurrence after surgery for benign nontoxic goitre can be strongly questioned and that the risk of hypothyroidism is high after subtotal thyroidectomy.
A retrospective study of patients with cancer diagnoses treated at a Swedish county hospital was carried out in order to analyse medical care utilization by incurable cancer patients. All 208 patients customarily treated at the Department of General Surgery in Ostersund Hospital for cancer diagnoses during 1 year were included in the study. The main outcome measures were: number of institutional days; admissions; duration of terminal hospitalization. The Department of General Surgery supplied 7570 of all 12,276 (62%) institutional days needed throughout the disease course. The terminal hospitalization (i.e. the period of continuous institutional care ending with the death of the patient) constituted 39% of all institutional days. The duration of the terminal hospitalization seemed to be unrelated to various diagnoses and demographic variables. Patients with cancer of the breast utilized most institutional days/patient (median 80 institutional days) during the disease course. Married patients and patients living within a 40 km radius of the hospital spent significantly more days at the Department of General Surgery during the last 6 months of life than did the unmarried and those living further afield.
Thirty-eight cases of fatal thyroid carcinoma (TC) occurred in a demographically well-defined area of, on an average, 243,000 inhabitants during an 18-year period, corresponding to an annual mortality rate of 0.9 per 100,000. The mortality rate did not change significantly during the period of investigation. All diagnoses were based on autopsy findings and were revised histologically. Ten cases were found to have papillary cancer, 10 follicular, 4 medullary, and 14 anaplastic. The survival time ranged between 0 and 27 years; two patients with medullary cancer died later than 10 years after diagnosis; none of the remaining patients died from the malignant disease later than 9 years after TC diagnosis. Nine of the anaplastic tumors contained elements of differentiated TC, and five patients who died from anaplastic cancer had had a history of goiter for more than 2 years. Insufficient surgical treatment (procedures less than lobectomy) was considered partially responsible for the fatal outcome in 3 of 14 surgically treated patients. Five deaths could be ascribed to complications to treatment. Two patients died postoperatively, two died from late effects of irradiation therapy, and one died in a coma caused by insufficient replacement therapy. The TC diagnosis was a postmortem surprise finding in ten cases.
OBJECTIVES: To study whether there is an increased fracture incidence following thyrotoxicosis. DESIGN: A case-control study. SETTING: Malmö University Hospital, Malmö, Sweden. SUBJECTS: All patients (n = 333) from the population of Malmö who were treated for thyrotoxicosis for the first time during the 5-year period 1970-74. A total of 618 controls were selected from the local municipality registry in Malmö. For each case the aim was to randomly select two age- and gender-specific controls, alive in 1993 and born the same year and month as the case. MAIN OUTCOME MEASURES: Fracture incidence RESULTS: Comparing survivors, there were no differences in the percentage of individuals with fractures (all, fragility, non-fragility) between the patients and the controls. Comparing all individuals and including all fractures, the percentage of individuals with fractures in the entire female patient group (24.6%) was lower (P