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Biomedical subjects

T W Meade

Publications and source records attributed to T W Meade.

246 records · Page 14Linked to original sources
PubMed1968

Recent history of ischaemic heart disease and duodenal ulcer in doctors.

Data are presented on the incidence of ischaemic (coronary) heart disease and duodenal ulcer among the several thousand male medical practitioners aged 35-64 holding immediate sickness benefit policies with the Medical Sickness Annuity and Life Assurance Society Limited. Three periods are considered: 1947-50, 1957-60, and 1961-5.The incidence of first clinical episodes of ischaemic heart disease in the doctors altered little between 1947-50 and 1957-60 but increased in 1961-5. Comparison of the late 1940s with the early 1960s shows a 60% rise of incidence at ages 45-54 but little change at other ages. Cases first presenting as "sudden" death increased between 1947-50 and 1961-5 by 111% at 45-54, and again changed little at 55-64. In two other occupational groups that have been studied-bus conductors and insurance salesmen-the increase of incidence was greater than for the doctors at 45-54 and it occurred also over 55 years of age. The increase from 1947-50 to 1961-5 in mortality during all episodes of ischaemic heart disease was the same in the doctors as in the male population of England and Wales at 45-54, but at 55-64 it was less.The results in the doctors are not due to alterations over the period in length of sickness absence, or underwriting policy, or of the nomenclature used on the certificates.Well-documented changes in the smoking habits of doctors may be partly responsible for what appears to have been a relatively favourable experience of ischaemic heart disease from 1947-50 to 1961-5, especially at ages 55-64.Incidence of duodenal ulcer at ages 35-64 declined steadily in this population of doctors from 1947-50 to 1961-5. The decline is very likely to be real.

Adult↗
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Reduction in hospital readmission stay of elderly patients by a community based hospital discharge scheme: a randomised controlled trial.

STUDY OBJECTIVE: To compare a community support scheme using care attendants with standard aftercare for their effects on independence and morale of elderly patients discharged from hospital and on their use of health and social services. DESIGN: Randomised controlled study of cohort of patients over 75 discharged to their own homes. SETTING: District general hospital and community. PATIENTS: Total of 903 patients (mean age 82, 25% over 85). INTERVENTIONS: Total of 464 patients received support from care attendants on first day at home and for up to 12 hours a week for two weeks. Support comprised practical care, help with rehabilitation, and organising social help. The remaining 439 patients received standard aftercare. END POINT: Difference between two groups of 7% in hospital readmission rates or one point on activities of daily living scale (power 80%, significance level 5%). MEASUREMENTS AND MAIN RESULTS: Three months after the initial discharge 763 patients were interviewed (84%). There were no significant differences between the two groups in physical independence (activities of daily living scale), in measures of morale (Philadelphia scale), or in death rates. Hospital readmission rates within 18 months of discharge, however, were significantly higher in the control group and they spent more days in hospital (mean; control group 30.6 days, support group 17.1 days; p = 0.014). Of the patients living alone who were followed up for 18 months 21 (15%) receiving standard aftercare were readmitted more than twice compared with 6 (5%) supported by care attendants (p less than 0.01). CONCLUSIONS: If the findings are confirmed, and the policy extended to all patients over the age of 75 living alone, an average health district might expect either to save about 23 hospital beds at a net annual saving of about pounds 220,000 in the short term or to increase available beds by this number.

Activities of Daily Living↗