An out-patient service for patients suffering from amyotrophic lateral sclerosis (ALS), the ALS-clinic, was established at the Department of Neurology, Haukeland Hospital, in 1990. The number of ALS patients who were hospitalised during the period 1990-1995 was 59, with a mean stay in hospital of 14.8 days. Eleven of the patients died in hospital. The ALS-clinic had 127 consultations during the same period, with a mean of 2.2 consultations per patient. Speech difficulties were the dominating problem at 26 of the consultations. 32 patients experienced feeding difficulties, and a percutaneous endoscopic gastrostomy was performed in nine cases. Respiratory problems dominated in ten patients, but only two of these patients wanted a home ventilator. Various assistive devices were adapted for 16 patients.
Between November 1 and 22, 1985, an outbreak of acute, nonbacterial gastroenteritis occurred in a 600-bed hospital in Toronto, Ontario, Canada. Illness in 635 of 2,379 (27%) staff was characterized by fatigue, nausea, diarrhea, and vomiting and had a median duration of 24-48 hours. The finding of virus-like particles measuring 25-30 nm in six stool specimens and low rates of seroresponse to Norwalk virus (3/39) and Snow Mountain agent (1/6) suggest that a Norwalk-like virus was responsible for the outbreak. The outbreak was of abrupt onset and high incidence, affecting 79 people in a single day. No common food or water exposure could be identified. The attack rate was greatest (69%) for staff who had worked in the Emergency Room. Of 100 patients and their companions who visited the Emergency Room on November 11-12 for unrelated problems, 33 (33%) developed gastroenteritis 24-48 hours after their visit, versus 0 of 18 who visited the Emergency Room on November 8 (p less than 0.001). An analysis of housekeepers who worked at least once during the period from November 9-13, which included those who became ill during the period of November 9-14, showed that the risk of becoming ill was four times greater for those who visited or walked through the Emergency Room than for those who did not (p = 0.028). These data are consistent with the possibility of the airborne spread of a virus.
In order to analyze the possible benefits on the mortality of abdominal aortic aneurysms (AAA) in Viborg county from the establishment of a specialized vascular unit in the county, the periods just before (1986-1988) and just after (1989-1991) the start of the unit were reviewed. Three times as many operations for AAA (104/mill/yr) were carried out after the unit opened. Acute operations increased sevenfold. In 1986-1988 42 persons experienced rupture of AAA. Twenty-six (63%) died outside hospital. Thirteen (32%) died at primary receiving hospitals. Only three patients (7%) were operated. One survived, making the overall mortality 97.5%. The mortality in this period was 187/million persons over 50 years. In 1989-1991 39 persons experienced rupture. Eleven (28%) died outside hospital. Eight (20.5%) died at primary receiving hospitals. One died preoperatively on the vascular unit. Nineteen (49%) reached operation, 13 survived (33%) and six (15.4%) died postoperatively. The overall mortality was 67%, the mortality of AAA was 127/million persons over 50 years. Comparing the two periods, deaths, mortality and overall mortality due to ruptured AAA decreased by 32% after the introduction of the vascular unit.
The authors review experience gained from developing and running a non-intensive stroke unit during the years 1983-91. The number of patients treated per year has increased from 65 to 149. The average length of stay in hospital has dropped from 21 to 15 days. About 87% of the patients had verified stroke, 7% had transient ischemic attacks (TIAs). Other intracranial diseases were found in 3.3%. The mortality rate was low (5%) 48% of the patients were transferred to a rehabilitation centre, 37% were discharged to their homes, with or without out-patient care, and 10% were discharged to nursing homes. Early and systematic investigations and multi-disciplinary rehabilitation in a specialized stroke unit increases the quality of care for patients suffering from stroke. A shorter stay in hospital gives a bonus in the form of reduced health expenditures.
Case reports of 110 patients referred to a neurological dementia clinic were reviewed to evaluate a standardized diagnostic program. The patients were evaluated by a neurologist, a gerontopsychiatrist, and a neuropsychologist. ICD-10 criteria were used. Fifty-two patients had dementia while 58 had not; of these, 27 suffered from other non-dementia diseases and 31 were without dementia or other psychiatric or neurological disease. Thirteen patients with Alzheimer's disease were treated with tacrine. Four patients underwent cobalamin substitution treatment and seven started antidepressant medication. Ten patients received acetylsalicylic acid (150 mg Q.D.) and two a levo-dopa-type drug. Twenty-six patients were followed by gerontopsychiatric district care. Because only 47% of the patients suspected of dementia actually fulfilled dementia criteria, the evaluation suggests that patients suspected of dementia benefit from a standardized diagnostic program in a specialist setting.
Treatment in a stroke unit raises the proportion of stroke patients who are able to live at home, improves functional outcome, reduces the need for institutional care, and brings down mortality. We have evaluated the data on the first 800 patients treated in our stroke unit. Nine patients were incorrectly registered as acute stroke victims and were excluded from the analysis. Hence, 791 patients (429 men, 362 women; mean age 72.3 years range 35-101 years) fulfilled the criteria for acute stroke or TIA. In the group of 654 patients who had suffered an acute stroke, 85 patients (13%) had intracerebral haemorrhage, 439 (67.1%) nonembolic infarction, and 130 (19.9%) embolic infarction. The majority of the patients were discharged to home (55.4%), while 23.6% were discharged to a rehabilitation institution, and 6.1% were discharged to nursing homes. 48 (6.1%) of the patients died during the stay in hospital. The mean time spent in the stroke unit was 12.1 days.