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Palliative care concentrates on reducing the severity of disease symptoms, rather than providing a cure. The goal is to prevent and relieve suffering and to improve the quality of life for people facing serious, complex illness. It is therefore critical in the palliative environment that caregivers are able to make recommendations to patients and families based on reasonable assessments of amount of suffering and quality of life. This research uses statistical methods of evaluation and prediction as well as simulation to create a multiple criteria model of survival rates, survival likelihoods, and quality of life assessments. The results have been reviewed by caregivers and are seen to provide a solid analytical base for patient recommendations.

In this paper, a theoretical and applied understanding is brought to the study of acute myocardial infarction [AMI] care‐seeking behavior. The time between the onset of an AMI and the initiation of definitive medical care is presently the single most important factor impeding reduced mortality and improved morbidity from thrombolytic therapy. It is suggested that the acknowledged, yet relatively neglected, area of emotional response is a key element in understanding why individuals may delay seeking definitive health care services following the onset of AMI symptoms. Emotionally significant dimensions of the care‐seeking process and a model for intervention to reduce morbidity and mortality are presented.

Radial basis function (RBF) neural networks form an essential category of architectures of neurocomputing. They exhibit interesting and useful properties of stable and fast learning associated with significant generalization capabilities. This successful performance of RBF neural networks can be attributed to the use of a collection of properly selected RBFs. In this way this category of the networks strongly relies on some domain knowledge about a classification problem at hand. Following this vein, this study introduces fuzzy clustering, and fussy isodata, in particular, as an efficient tool aimed at constructing receptive fields of RBF neural networks. It is shown that the functions describing these fields are completely derived as a by‐product of fuzzy clustering and do not require any further tedious refinements. The efficiency of the design is illustrated with the use of synthetic two‐dimensional data as well as real‐world highly dimensional ECG patterns. The classification of the latter data set clearly points out advantages of RBF neural networks in pattern recognition problems.

Following a high‐profile publicity campaign across South Tyneside aimed at professionals and patients, 52.4 per cent of all patients admitted with suspected myocardial infarction during a six‐month period received 300mg of aspirin. Twelve months later GPs’ performance had improved from 25 per cent to 52.9 per cent of patients directly admitted by GPs being prescribed aspirin when first seen. Following a definite myocardial infarction 78.4 per cent of patients were discharged taking 75mg of aspirin, with no valid reason for omission in 6.6 per cent of patients. Six months after discharge 71.8 per cent of patients were still taking aspirin. Twelve months later 90 per cent of discharged patients were taking aspirin. GP PACT data showed a marked increase in prescribing 75mg aspirin during the period. The use of a publicity campaign to disseminate the message to both professionals and patients has resulted in a beneficial increase in aspirin prescribing for myocardial infarction across the district.

This article describes the fundamentals of the “model of integrated patient pathways” (“mipp”) and its mode of action as a tool for quality improvement and cost management in health care. The model is based on three pillars: construction, implementation and benchmarking. Transparency of processes and costs become available from interdisciplinary construction of care pathways via an Access database. The article provides details and lessons learned from applying the model to the pathway “Acute Myocardial Infarction”. A robust approach for delivering quality in a cost‐conscious world is uncovered, which lends itself to benchmarking and has limitless scope for quality improvements.

There is strong evidence for the use of HMG Co‐A reductase inhibitors (statins) for secondary prevention after myocardial infarction. Previous surveys suggest sub‐optimal use of such secondary prevention measures. The national service framework (NSF) for coronary heart disease (CHD) has now set new standards for preventing and treating CHD. In our audit of 182 survivors of myocardial infarction in 1999, 86.2 per cent had cholesterols measured on admission, but only 39 per cent had statins prescribed on discharge. Our data provide information about base‐line practice for the year immediately preceding the publication of the NSF and indicate that the average district general hospital may have a long way to go to meet the target set by the NSF.

November 13, 1969 National Insurance — Industrial injuries benefit — Disablement benefit — Functions of statutory and medical authorities — Industrial accident followed by two physical impairments — Medical authorities awarding disablement benefit based on only one loss of faculty and rejecting heart condition found by statutory authorities to be causally connected with accident — Statutory provision that “decision of any claim” “shall be final” — Whether medical authorities bound by decision of statutory authorities on nature of injury in determining injury benefit claim — When onus of proof on applicant — National Insurance Act, 1965 (c. 51), s. 75 — National Insurance Act, 1966 (c. 6), s. 8 (l)(a) — National Insurance (Industrial Injuries) Act, 1965 (c. 52), ss. 11 (1), 12(1), Sch. 4.

Reviews available literature on gender bias and the process of medical care. Current findings point to possible gender bias in treatment protocols for kidney and cardiac patients. Other clinical conditions have not been studied. Identifies methodological challenges to such research and discusses the need for further research.

The purpose of this paper is to determine whether process quality indicators for acute myocardial infarction (AMI) one associated with outcome indicators (hospital mortality and early readmission).

A retrospective cohort study was conducted among patients discharged from three Swiss university hospitals with a primary or secondary International Classification of Diseases, 10th revision (ICD‐10) AMI code in 1999. A total of 1,129 patients' records were abstructed. Demographic characteristics and risk factors at admission were recorded. The main ECG and laboratory findings were further abstracted as well as hospital and discharge management and treatment. The main outcome measure was process quality indicators derived from evidence‐based guidelines, and hospital mortality and early readmissions.

After exclusions, 577 patients with AMI were eligible for this study. The mean (SD) age was 68.2 (13.9). In the assessment of quality indicators patients with potential contra‐indications were excluded. Among cohorts of “ideal candidates” for specific interventions, aspirin was not prescribed within 24 hours after admission in 33 (6.2 percent) patients. Among those, 17 (51.5 percent) died (p<0.0001). The adjusted OR for no aspirin after admission was 3.61 (95 percent CI 1.11‐11.77) for hospital mortality. Further, 78 (19.5 percent) patients did not receive β‐blockers at discharge. Among them nine (11.5 percent) were readmitted (p=0.133). The adjusted OR for no β‐blockers at discharge was 2.15 (95 percent CI 0.86‐5.41) for readmissions. Among patients with AMI, not prescribing aspirin within 24 hours after admission was associated with hospital mortality. However, process indicators derived from evidence‐based guidelines were not related to early readmission in this study.

The paper stresses the importance of clinicians confronting their decisions with recommendations of evidence‐based guidelines for the management and treatment of AMI patients.