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View Diary: Nationality: Street Prophets Open Thread (31 comments)

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  •  Not necessarily (7+ / 0-)

    It sounds like the hospital uses the best practice currently recommended.  Urgent stent installing is now the standard in all London heart centres - patients are assessed by paramedics and are taken direct to a specialist centre with the aim of having the stent in within 3 hours of the attack, the procedure is explained here.

    Doing this rather than waiting for longer assessments both saves lives and speeds recovery. The London figures are something like a 95% recovery rate so your mother may be in for a lot more years listening to bitching.

    We will work, we will play, we will laugh, we will live. We will not waste one moment, nor sacrifice one bit of our freedom, because of fear.

    by Lib Dem FoP on Fri Jan 17, 2014 at 01:54:55 PM PST

    [ Parent ]

    •  Thanks for that comment! (1+ / 0-)
      Recommended by:
      Alexandra Lynch

      Nice link too.

      Folks heading home 3 or 4 days after heart surgery. Wow!

      •  Ups and downs (1+ / 0-)
        Recommended by:
        Marko the Werelynx

        There are of course up front cost implications. Ambulance paramedics need the training and equipment to assess whether the patient is a candidate for angioplasty/stent installation. (In the UK emergency ambulances are run by local NHS trusts) The heart centres have to have suitably qualified staff, usually at least one a "consultant" level available full time (hence the limited number of heart centres compared to hospitals with wider A&E  Departments (ER rooms). "Clotbuster" drugs are cheaper.

        Outside the major cities it's not always possible to have the specialist centres or for them to be staffed 24/7 so different areas of England are assessing the suitability of the regimen. It is also counter-intuitive for patients and relatives for nearer hospitals without the specialism to be ignored.

        On the other hand there are huge ups, increased survival rate being the main one as far as the patient is concerned. Waiting to see if drugs work often makes the position worse and a bypass rather than a stent may be needed. Another group will require stents anyway. For the NHS those shorter in-hospital stays and better outcomes mean lower costs overall.

        The idea is a win win if it can be implemented. I can see there may well be problems introducing the complete package if you have ambulance staff working for private, competing, companies are only trained and equipped to "scoop and run". The on-call operating staff are costly so you may well find the insurance companies are hostile (do they agree to a more expensive treatment if the benefits are over a period of years by which the patient could have changed insurer?)  

        With "single payer" (strictly speaking the NHS is not but I'll use the term as shorthand) you can offset initial higher costs with long term savings. Another example is the recommendation that two different blood pressure drugs, likely together with a statin, should be prescribed to hypertension patients. The extra cost is offset by lower and later incidence of events like strokes over something like a 10 year period.

        Of course these sorts of ideas are not popular with the drugs companies. Using another example; they would much prefer to sell a lifetime's worth of antacids and acid suppressants to stomach ulcer patients than a week's course of a couple of generic antibiotics to clear up the H. Pylori infection which is the most likely cause. (Some produced a "new drug" using the generic antibiotics in combination but much more expensive to try to retain income.)

        We will work, we will play, we will laugh, we will live. We will not waste one moment, nor sacrifice one bit of our freedom, because of fear.

        by Lib Dem FoP on Sat Jan 18, 2014 at 05:41:51 AM PST

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        •  I think the Czech Republic (0+ / 0-)

          would have a hard time implementing that system. I think we're pretty much "scoop and run" at this point. But it's a small country and sweeping changes are less difficult to adopt.

          In the US I'm guessing that the care for profit system isn't going to see much reason to implement a system of specialized heart centers.

          •  I love Prague (1+ / 0-)
            Recommended by:
            Marko the Werelynx

            I visited there for the country's accession to the EU. A quite emotional moment when the Czechs around me stopped being "foreigners" and became fellow citizens at the stroke of midnight. Most definitely no longer a "people of who we know nothing" in "a far away country" to paraphrase Chamberlain.  

            We will work, we will play, we will laugh, we will live. We will not waste one moment, nor sacrifice one bit of our freedom, because of fear.

            by Lib Dem FoP on Sat Jan 18, 2014 at 12:26:10 PM PST

            [ Parent ]

            •  Oog, Chamberlain (0+ / 0-)

              I hadn't realized that his speech at Heston Airport, waving them papers, was on my birthday.

              Found this lovely quote over there too:

              "No doubt the Jews aren't a lovable people; I don't care about them myself; but that is not sufficient to explain the Pogrom."

              Letter to a sister, Chamberlain Papers (30 July 1939)

              What a twit.
              Or should I say "twat?"

              Would I be right in guessing that you're based in the UK? And from the spelling of "centre" a native? The Lib Dem part of your username didn't escape me either.

              I've been in London a couple of times. We have some old family friends over somewhere on the West Side.

              I don't remember folks making much of a fuss about the actual hour when the CZ joined the EU. The actual day was under Klaus' watch and he was always against the Union. I think most people saw great potential in joining the EU but I don't really recall the mood at the time. Could be I wasn't in Prague at all that day. Like tonight, I'm out in the country. How were the celebrations? Whereabouts in Prague were you?

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