Scandinavian journal of social medicine
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In a trial, patients who came to a hospital Emergency Department (ED) with non-urgent complaints were advised and referred to primary health care outside the hospital. The effect of this was assessed by measuring health care utilization one year before and one year after the referral, using the Stockholm County computerized medical information system and ED medical records. The proportion of the 189 referred patients who visited the ED decreased from 48% to 42%, whereas in a control group of 107 patients the proportion increased from 41% to 51%. ⋯ These frequent ED users did not reduce their ED utilization more than frequent ED users in the control group. The use of health care centres increased in the referred group and was practically unchanged in the control group. However, those referred patients who continued to use the ED still quite often did so for non-urgent complaints.
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A review has been done of the available literature on measles, mumps, rubella and vaccines against these diseases. So far, 17 studies on the same virus strains as those in M-M-R II have been published. The rate of seroconversion is practically 100% for rubella, generally more than 90% for measles and between 40 and 100% for mumps. ⋯ In the only 10-year follow-up published, 14 subjects remained at the end of the period, and the vaccine studied differed from M-M-R II. Large, well-documented studies of MMR vaccination in unselected populations are rare. It must be of crucial importance that the immunity situation is followed up continuously for both vaccinated and non-vaccinated individuals when a mass vaccination programme has been introduced as there will be a risk of outbreaks of diseases mostly among young adults.
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This is an investigation of the impact of an emergency room triage by a medical specialist. The study encompassed patients who came to the medical section of the emergency room of a large university hospital during a two-week study period and a control period of the same length. The result showed that 36% of the patients could be sent home after the triage, thereby reducing the number of chemical tests and ECG examinations significantly (p less than 0.001). ⋯ No effect of the triage on hospital use of out-patient visits to the hospital during a one year follow-up period was noted. The triage procedure was safe for, and accepted by the patients, as was demonstrated by follow-ups involving investigation of the death register and personal interviews. The study shows that triage by a specialist is an effective method for reducing hospital service utilization and shortening patient treatment time.
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The confidence limits for all parameters derived from a 2X2 contingency table are uniquely determined by the limiting matrices that arise from adding or subtracting certain values to or from the four cell entries. Various methods to determine these addends are discussed and a computer program is presented that produces reliable results. The limiting matrices thus produced bypass the more complicated expressions for the standard errors of the many epidemiological parameters that are used to interpret the 2X2 table.