Comparing ischaemic stroke in six European countries. The EuroHOPE register study.

BACKGROUND AND PURPOSE: The incidence of hospitalizations, treatment and case fatality of ischaemic stroke were assessed utilizing a comprehensive multinational database to attempt to compare the healthcare systems in six European countries, aiming also to identify the limitations and make suggestions for future improvements in the between-country comparisons. METHODS: National registers of hospital discharges for ischaemic stroke identified by International Classification of Diseases codes 433-434 (ICD-9) and code I63 (ICD-10), medication purchases and mortality were linked at the patient level in each of the participating countries and regions: Finland, Hungary, Italy, the Netherlands, Scotland and Sweden. Patients with an index admission in 2007 were followed for 1 year. RESULTS: In all, 64,170 patients with a disease code for ischaemic stroke were identified. The number of patients registered per 100,000 European standard population ranged from 77 in Scotland to 407 in Hungary. Large differences were observed in medication use. The age- and sex-adjusted all-cause case fatality amongst hospitalized patients at 1 year from stroke was highest in Hungary at 31.0% (95% confidence interval 30.5-31.5). Regional differences in age- and sex-adjusted 1-year case fatality within countries were largest in Hungary (range 23.6%-37.6%) and smallest in the Netherlands (20.5%-27.3%). CONCLUSIONS: It is feasible to link population-wide register data amongst European countries to describe incidence of hospitalizations, treatment patterns and case fatality of ischaemic stroke on a national level. However, the coverage and validity of administrative register data for ischaemic stroke should be developed further, and population-based and clinical stroke registers should be created to allow better control of case mix.

[Evidence-based medicine in everyday medical practice]. / A bizonyítékokon alapuló orvoslás a mindennapi orvosi gyakorlatban.

Evidence-based medicine indicates continuous and systematic use of the results of clinical research in everyday clinical practice. It is an important aid to avoid biases of medical decisions caused by following subjective opinion, tradition without criticism or extrapolation from observations at molecular or cellular level. The conscientious use of current best evidence in making decisions about the care of individual patient is an important guarantee of quality. The authors present the details of evidence-based medicine, the main steps of exploring and synthesising evidences.

[Quality indicators of hospital care: evaluation of patient care in acute myocardial infarction]. / A kórházi ellátás minóségi indikátorai: az akut myocardialis infarctus kezelésének értékelése.

In the international hospital accreditation programs there is an increasing emphasis on involving performance indicators. The inpatient mortality rate of AMI patients and the usage of thrombolytic therapy are very common, evidence based indicators of these programs. The authors goal was to analyze the applicability of these indicators in the evaluation of the Hungarian hospital care. In Hungary, there is a data collection system on every inpatient case. This database was used to determine the above mentioned two indicators for 1997 and 1998. They calculated by hospital group level, by institutions and by geographic areas crude rates and rates adjusted for age and gender, and for severity using the different DRGs of AMI patients. In these two years the inpatient mortality rates of AMI patients were 20.4% and 21.7%, and the usage of thrombolytic therapy were 9.9% and 11.8%, respectively. Using indirect standardization methodology in the usage of thrombolytic therapy, they found high differences among the counties compared to the national average, the range was 51-199%, and among the institutions 0-306%, respectively. It is clear, that there are huge differences in the curative processes and in the inpatient mortality rates of AMI patients among the hospitals. The differences are developed by chance, there are no close connections either to hospital groups, or to geographical locations. Because of the difficulties of risk adjustment, they suggested that indicators were suitable for benchmarking. It is necessary to implement in the national quality criteria system different indicators for evaluating the patient care, to develop programs for auditing the best and worst hospitals and to introduce standards for assuring the validity of the basic data.

[2-year results of leg amputation in Hungary based on a nationwide data base]. / Az alsó végtag amputáció kétéves eredményei Magyarországon, országos adatbázis alapján.

Authors review nation-wide hospital data of amputees over two years in order to make comparison with similar data gathered about 20 years ago. Data were provided by the National Medical Records Centre and processed by own developed programmes. The quality level of data validity is slightly criticised. The cause of amputation was most often vascular disease, amputees were elderly and large majority of amputation surgery was carried out on the lower limb. The rate of below-knee amputation has gone up favourably over the 20 years, but there are large regional differences within the country. Mortality parameters remarkably exceed those of foreign countries. Regarding compromised data accuracy, still there are ways of exploiting data in favour of quality improvement of care, e.g. improve below-knee amputation rate, reduce mortality. Publication of data can be of bench-marking importance for hospitals by enabling them to compare own results with those of other hospitals, as well as develop and improve performance.

[Distribution and antibiotic resistance of aerobic bacteria isolated from infected wounds caused by burns]. / Egési sebfertözésekböl izolált aerob baktériumok megoszlása és antibiotikum rezisztenciája.

Distribution according to species and genus and resistance to antibacterial agents was studied with 420 bacterial isolates cultured from the wound excretion of 282 burned-infected patients. Of the isolates 68.2% was Gram-positive and 31.8% Gram-negative. This latter high rate may be due to fecal infection as 21% of the burned patients was between the age of 0-4 years. Of the total isolates 38.3% was Staphylococcus aureus, 16.7% coagulase-negative staphylococcus, 10.7% Pseudomonas strain, 6.9% Escherichia coli and 4.8% Klebsiella. Vancomycin resistant Staphylococcus strain was not found. On the other hand 30-35% of the strains was cross-resistant to methicillin- oxacillin-cefuroxim-clindamycin though these agents are the most potent following the vancomycine. Ceftazidime is the most effective agent for Pseudomonas strains being followed by amikacin, carbenicillin, tobramycin and ceftriaxon. Other Gram-negative bacteria showed strongest sensitivity to ceftazidime and ceftriaxone and these are followed by amikacin.

[Incidence and invasive treatment of congenital heart diseases in Hajdu-Bihar county]. / A veleszületett szívhibák incidenciája és invazív kezelése Hajdú-Bihar megyében.

The incidence of congenital heart diseases was evaluated in the period 1994-1998. The number of those who went through therapeutic intervention and those infants dying of congenital heart disease were also assessed. Data were collected retrospectively. During the study period 26,932 live-births occurred in Hajdú-Bihar county and 421 congenital heart disease were diagnosed, 81% of whom were diagnosed under the age of one year. The most frequent diseases were secundum type atrial septal defect, ventricular septal defect and patent ductus arteriosus. 121 therapeutic procedures were performed (109 operations and 12 interventional heart catheterizations). 41 interventions occurred under the age of one and 13 before the age of 28 days. The mean age of children older than 1 year was 6 years at the time of the operation or interventional catheterization. The overall postoperative mortality within 30 days was 8.3%. During the study period 28 infants with significant heart disease died, 20 of whom also had an associated disease (most frequently prematurity). For congenital heart disease 4.5 operations or interventional heart catheterizations were required/1000 live births. The higher rate of diagnosed congenital heart disease is due to the development in diagnostic techniques, especially to Doppler-echocardiography. Owing to the operational waiting list the children's age at the time of operation is higher than optimal. The mortality among infants with heart disease is influenced by many factors, that is why stepping forward is a complex task in this field.

Lower limb amputations during 3 years in Hungary.

We reviewed nationwide hospital data of amputations during 3 years to provide a comparison with similar data gathered about 20 years ago. Data were provided by the National Medical Records Centre and processed by our personally developed programmes. The cause of amputation was most often vascular disease, amputees were usually elderly, and the large majority of amputation surgery was carried out on the lower limb. The rate of transtibial amputation has increased favourably in the last 2 decades, but there are large regional differences within the country. Mortality parameters remarkably exceed those of foreign countries. Although the data accuracy is compromised, there are still ways of exploiting the data in favour of quality improvement of care, e.g. improve transtibial amputation rate, reduce mortality. The publication of data can be of benchmarking importance for hospitals by enabling them to compare their own results with those of other hospitals, as well as to develop and improve performance.

Avoidable mortality. Is it an indicator of quality of medical care in eastern European countries?

Age-standardized time trends (1979-1988) for avoidable mortality in two Eastern European countries (Hungary and Czechoslovakia) and selected developed countries (England and Wales, France, Italy, Japan, Portugal and USA) have been analysed. Mortality from both all avoidable causes and all other causes declined in the selected developed countries during the period of observation, the decline in rates for avoidable causes was faster than that for all other causes. In Hungary and Czechoslovakia the death rates from both groups of causes increased in the first part of the period studied and a decline in mortality from both types of causes could be observed from 1985. As a consequence, the difference in avoidable mortality between the Eastern European countries and the developed countries increased by the end of the observation. Studies on mortality from individual amenable causes showed that the death rates are usually much higher in Hungary and Czechoslovakia than in the developed countries and the differences did not diminish during the period of study. In Hungary and Czechoslovakia the bad pattern of mortality from conditions amenable to medical interventions is believed to reflect, at least in part, the crisis in the health services which these countries have experienced for the past decades.

Teaching public health: an innovative method using computer-based project work.

Restructuring of training in public health in the Hungarian medical schools is being undertaken in the context of a major European Union TEMPUS Joint European Project. Under the aegis of this project a common core curriculum of public health has been developed. As part of the implementation of the curriculum, new approaches to learning are being explored that should enable students to appreciate the nature and magnitude of the major challenges to public health in Hungary and promote the development of their analytic, interpretative and presentational skills. One of the approaches is based on the individual preparation of reports on important public health issues, making use of secondary data from electronic databases (WHO HFA/PC and OECD Health Data) and traditional printed sources (annuals). This method called 'computer-based project work' was introduced in Debrecen in 1992-1993 with a secondary objective to develop basic computing skills. The initial experiences of introducing computer-based project work to the curriculum have been positive. This paper describes a practical example of the implementation of innovative approaches to teaching in a highly traditional setting in Central Europe, and one that provides ideas and encouragement to those facing similar problems in the countries of Central and Eastern Europe and the former Soviet Union.