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Biomedical subjects

R McDonnell

Publications and source records attributed to R McDonnell.

23 records · Page 2Linked to original sources
PubMed1985

Estimation of life years lost from alcohol-related premature death.

This paper presents estimates of life years and working years lost from alcohol-related premature death in 1983. It is then suggested that since lives saved or changes in the quality of life are outcomes of health care policies, measures of the value of life and quality of life years saved are needed for economic evaluation and efficient decision-making. Three methods of valuing life are outlined and ways of measuring the quality of life years gained from health care interventions are discussed. These methods are still at an early stage of development and are intrinsically complex and contentious. Nevertheless, it is argued that all outcomes of health policies need to be measured in order to make more efficient health care decisions. The estimate of life years lost from alcohol-related premature death presented in this paper is one indicator of the magnitude of this aspect of social cost. An important and natural extension is to assess the outcomes of policies aimed at reducing the number of premature deaths. Such research would greatly improve our knowledge of alcohol misuse and the effects of policies used to alleviate its associated problems.

Adolescent↗
PubMedDate not supplied

Hospital-based stroke care in Ireland: results from one regional register.

BACKGROUND: Most patients with acute stroke are admitted to hospital. If stroke services in this country are to be improved, we need accurate and reliable information about the types of stroke patients being admitted, their present management and outcome. AIMS: To examine the demography, severity, level of investigation, length of stay, mortality and discharge location of prospectively identified consecutive stroke admissions to three general hospitals in South East Dublin. RESULTS: Three hundred and twenty nine consecutive stroke admissions to three general hospitals in South East Dublin were registered using the European Stroke Database over 50 weeks. The mean age was 73.3 years, whilst 20.1% patients were under 65 years. Prior to admission, 90% of patients were community dwelling with 14.9% of patients being dependent in activities of daily living. 22.4% of patients had some depression in level of consciousness on admission. The overall mortality rate was 26.1% whilst 136 (41.3%) were discharged home, 50 (15.2%) went to institutional care and 45 (13.7%) went to non general hospitals secondary rehabilitation units. The mean length of stay was 31.3 days. The combined poor outcome measure (mortality plus percentage of patients discharged to institutional care), was lower in one hospital compared to the other two hospitals (29.3% versus 44.65%, p > or = 0.05) probably reflecting case mix. Stroke accounted for 4.2% of all bed days in the major general hospital in this area. The overall CT scan rate was 84.5%, with 18.2% of CT scans showing a haemorrhagic component and two patients (0.8%) having brain tumours. Carotid doppler examinations were carried out in 37% of patients. CONCLUSION: The results demonstrate the high mortality and prolonged hospital stay for stroke patients in this area and emphasise the need for co-ordinated stroke care and regular audit to ensure most effective use of hospital resources.

Aged↗
PubMedDate not supplied

Prevalence of risk factors for ischaemic stroke and their treatment among a cohort of stroke patients in Dublin.

BACKGROUND: The majority of strokes are due to ischaemia. Risk factors include atrial fibrillation, hypertension and smoking. The incidence can be reduced by addressing these risk factors. This study examines the prevalence of risk factors and their treatment in a cohort of patients with ischaemic stroke registered on a Dublin stroke database. METHODS: Patients admitted to any of three acute hospitals with a diagnosis of stroke during a one-year period in 1997/98 were registered on a database using the European Stroke Database format. Data relating to common risk factors were analysed. RESULTS: There were 238 ischaemic stroke cases registered. The most frequent medical risk factors were: hypertension (45%), atrial fibrillation (27.3%), and previous disabling or non-disabling stroke (33.2%). There was an increasing trend with advancing age for atrial fibrillation (p < 0.001). Some 23% (54/233) were current smokers. A significantly higher proportion of patients with no medical risk factors were smokers or consumed excessive alcohol compared with those who had medical risk factors. CONCLUSION: Medical risk factors for stroke were common among stroke patients and not optimally treated, particularly with regard to atrial fibrillation and previous stroke. Smoking was a major behavioural risk factor among younger patients and much health gain could be achieved in this group through primary prevention strategies.

Adult↗