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Per capita alcohol consumption in relation to alcohol-related hospital admissions in Victoria, Australia, is explored. Higher alcohol consumption correlated with higher disease diagnoses and injuries in the context of alcohol.

Researchers obtained data on patients who were admitted to Norwegian general hospital with a primary diagnosis of anorexia nervosa (AN) or bulimia nervosa (BN) during the period 1990-1994. The hospitals admitted 140-183 women and 11-15 men each year due to these conditions. Male admissions related to AN only, and there were no female (BN) admissions before 1992. Maximum admissions related to seasonality were in early March, and maximum admissions related to latitude were from the middle part of the country. The mean length of hospital stay was 12-19 days.

Too often individuals with long-term-care needs are placed in nursing homes when they might well be better served at a lower level of care. The uneven distribution of residents across settings stems from interacting factors of supply and demand: clinical need; lack of consensus among physicians about what constitutes the best setting for their patients; regulations restricting services in personal care homes. Three sets of clinical criteria identify nursing-home residents according to their appropriateness for lower levels of care. Factors like cost and ability of the patient's family to make informed decisions affect placement as well. Policies for shifting patients to lower levels of care must be carefully designed in order to save costs and ensure that quality of care is retained.

Physicians incompletely record the secondary diagnoses and accompanying illnesses (comorbidities) of hospital patients. Among 162,790 patients 65 years or older who were admitted to California hospitals for a stroke, pneumonia, a heart attack or congestive heart failure, the average number of diagnoses recorded was 5.5 on hospital discharge forms that can hold 25 diagnostic codes. Patients with secondary diagnoses such as cardiac arrest, irregular heart beat, congestive heart failure, pneumonia and respiratory failure had a higher risk of dying in the hospital. Patients with secondary diagnoses of diabetes, hypertension, previous heart attack, chest pain and premature heart beats had a lower risk of dying in the hospital. These conditions normally would be expected to increase the risk of death, but are considered inappropriate comorbidities to certain conditions by Medicare. Physicians may record more secondary diagnoses in the medical records of patients who die than in those of patients who survive. Increasing the number of fields on discharge forms may not ensure more complete medical records.

Payments to hospitals have historically been based on norms derived from statistical analysis of prior hospital experience, not on a clinical evaluation of the expected course of the patients. Patients over 45 years of age who were diagnosed with chronic pulmonary disease (CPD, including chronic obstructive or restrictive pulmonary disease), asthma, and patients who had difficulty breathing or shortness of breath, were included in the study to determine the length of hospital stay they required. Eighty-three patients in two hospitals were observed for complications, critical events, and the need for monitoring. Ninety percent of the patients were free of complications and no longer needed monitoring after six days of hospitalization, but only after 16 days had 90 percent of patients been discharged. There was little correlation between a patient's ideal length of hospitalization and the time allotted for the diagnosis related group (DRG). At the time of admission, information is available to identify those who will need to stay longer, which would help physicians plan better, and communicate better with their patients. Better discharge planning can also reduce hospitalization times, as would alternatives to hospitalization during the time when full medical services are no longer needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

A new diagnostic code has been approved for the palliative care of hospitalized terminally ill patients. This special diagnosis-related group will permit care evaluation of dying patients. It is a step in the right direction that hospital care can be termed palliative, offering comfort instead of ignoring impending death. Good palliative care could reduce requests for physician-assisted suicide, a topic still open to political and ethical debate. Palliative care should also be connected to patients receiving long-term care. Medical technology alone does not meet all human needs, such as dying with dignity.

Physicians should record second diagnoses accurately in patients' medical and hospital records. Second diagnoses that are recorded may help physicians evaluate and treat a patient's illness. A research study found that patients suffering from stroke, heart attack, pneumonia or congestive heart failure who had a second diagnosis of hypertension, chest pain or heart valve disease had higher survival rates than those without these secondary conditions noted on charts. This increase in survival may have a medical explanation, but many physicians are doubtful about this theory. The decision to record second diagnoses on patients' medical records may be difficult because for several reasons. Rules for recording additional diagnoses are broad; rules for using clinical codes to record secondary conditions often are unclear, and physicians are afraid of the legal and ethical implications of recording many secondary conditions. To improve the quality of medical records, rules for recording secondary conditions and using clinical codes in medical records need to be redefined and clarified.