[HSF] Death on waiting list (OT)
prasannasimha
prasannasimha at gmail.com
Tue Apr 17 07:52:38 EDT 2007
6 million people is still less than the population of Bangalore City !!
(Currently 8 million).
(So you can imagine the magnitude of the problem in India which has
become the diabetic capital of the world)
Prasanna
Tina i Mladen Kocica wrote:
> Thanks Dave and others,
>
> I've posted this problem just to provide some evidence, supported by Dave's
> obeservations. We do not CREATE WLs, but we receive them. From whom? From
> the government and from the cardiologists. I am not talking about private
> practice, which (one way or another) is independent from official state
> health care policy. I don't know if you are aware of this, but here, in the
> region of the Eastern Europe (and particularly in Serbia), there is true
> epidemic of serious CVD. Rough numbers are: 5000 surgeries (3 centres, 15
> fully expirienced and 35 less expirienced surgeons, more than 6 million
> population) and 3 times more PCIs annualy (still increasing). Terrible load
> of advanced CAD (still about 60% of all cases), late and difficult valvular
> HD, acute aortic dissections ... Thus, our WLs are crowded with seriously
> ill persons, making our position very difficult, trying to make the most
> appropriate (or any) triage.
> Government is trying to explain that such WLs are common thing in even more
> developed coutries, and I wanted to provide contra argument, because I think
> that main problem is bad organization (small numebr and wrong distribution
> of centres, as well as very small number of surgeons ... Etc). Moreover,
> there is still no private cardiac sugery here. Seems that Francis Robicsek
> was right, asking: "Is cheap medicine good medicine?"
>
> Mladen
>
>
>
>
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>
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of David Harris
> Sent: 16. april 2007 23:41
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Death on waiting list
>
> In South Africa the waiting list in the state hospitals are anything from 4
> to 10 months, depending on the region...very, very frustrating, and I
> estimate the mortality is not more than 10%, from the records we kept. It is
> interesting that the patients already have waited 6 months to a year before
> getting to the cardiology clinic. Patients with mainstems, severe coronary
> disease with ischaemic cardiomyopathy, AS with gradients in the 100`s are
> more often than not still around after a year. They will usually then
> present as emergencies, and then get priority, so usually not die.
>
> In the private sector, where I now do most of my work, the wait depends on
> the surgeon. We are pushed to do healthy elective patients on the same day
> by the cardiologists,but always wait at least until the next day, unless its
> really urgent. We generally try to rather get them home for a few days. It
> is good to let the contrast clear out, and our feeling is that you may get
> less of a surgical inflammatory response by waiting. Just track the
> creatinine and CRP for 3 days.
> We all know about the creat, but watch the CRP go over 150 in some cases.
> Also, there is often an enzyme leak post angio, usually because the
> cardiologist has been trying to wedge in a stent, and this may end up with a
> resus! All without your knowledge. You should hang around the cath lab a
> bit, and see how unstable the cardiologists can make them. So we wait a bit,
> from what we have seen, a few days does more good than harm.
>
> We often comment on how much easier the patients are in private practice,
> and in the state hospital a `routine` case is often referred to as a
> `private patient`.
>
> The long waiting lists are horrific, as patients are often cancelled a few
> times due to more emergent cases jumping the list. The system is a
> reflection of the state spending less money on health, trying to maintain
> control on health systems, and simply the usual consequence of a state run,
> inefficient department.
>
> Dave Harris
>
>
> --- Ben Bidstrup <benjamin.bidstrup at bigpond.com>
> wrote:
>
>
>> But does that give the team time to fully assess the patient?
>>
>>
>>> In Israel the waiting time is about the time it
>>>
>> takes our Blood Bank
>>
>>> to prepare 2 units of cross-matched packed cells...
>>>
>>> Jay Lavee
>>>
>>> ----- Original Message ----- From: "Salerno, Tomas"
>>>
>> <TSalerno at med.miami.edu>
>>
>>> To: <OpenHeart-L at lists.hsforum.com>;
>>>
>> <OpenHeart-L at lists.hsforum.com>
>>
>>> Sent: Monday, April 16, 2007 7:35 AM
>>> Subject: RE: [HSF] Death on waiting list
>>>
>>>
>>>> waiting lists in the USA are in general about one
>>>>
>> hour
>>
>>>> TS
>>>>
>>>> ________________________________
>>>>
>>>> From: openheart-l-bounces at lists.hsforum.com on
>>>>
>> behalf of Tea Acuff
>>
>>>> Sent: Mon 4/16/2007 12:32 AM
>>>> To: OpenHeart-L at lists.hsforum.com
>>>> Subject: Re: [HSF] Death on waiting list
>>>>
>>>>
>>>>
>>>> About the only waiting going on in the United
>>>>
>> States of America (no
>>
>>>> ugly "American" short hand) is over the weekend.
>>>>
>> Excepting the
>>
>>>> Veterans Administration Hospitals of course.
>>>> tea edward acuff junior medical doctor
>>>>
>>>>
>>>> ----- Original Message ----
>>>> From: Tina i Mladen Kocica <kocica at sezampro.yu>
>>>> To: OpenHeart-L at lists.hsforum.com
>>>> Sent: Sunday, April 15, 2007 9:59:59 PM
>>>> Subject: [HSF] Death on waiting list
>>>>
>>>>
>>>> Our heart surgery waiting lists (WL), here in
>>>>
>> Serbia, are permanently
>>
>>>> growing, with today average of about 1000 people
>>>>
>> per centre annualy. It
>>
>>>> seems that we do not make them properly, since
>>>>
>> death rate on WL is also
>>
>>>> permanetly increasing (from 8% three years ago to
>>>>
>> 15% last year).
>>
>>>> Questions:
>>>> 1) General opinion about WL for heart surgery
>>>>
>> (ethics)?
>>
>>>> 2) Criteria? Who makes them?
>>>> 3) Your annual WL load?
>>>> 4) Your WL mortality?
>>>>
>>>> Regards,
>>>> Mladen
>>>>
>>>> Mladen J. Kocica, M.D.
>>>>
>>>> Clinic for Cardiac Surgery
>>>>
>>>> Institute for Cardiovascular Diseases
>>>>
>>>> UC Clinical Centre of Serbia
>>>>
>>>> 8th Kosta Todorovic St.
>>>>
>>>> 11000 Belgrade
>>>>
>>>> Serbia
>>>>
>>>> Tel: + 381 (11) 3670609
>>>>
>>>> Fax: + 381 (11) 3610880
>>>>
>>>> E-mail: <mailto:kocica at sezampro.yu>
>>>>
>> kocica at sezampro.yu
>>
>>>> URL: <http://www.kocica.org/> www.kocica.org
>>>>
>>>> URL: <http://www.ctsnet.org/home/mkocica>
>>>>
>> www.ctsnet.org/home/mkocica
>>
>>>> URL: <http://www.srscvs.org/> www.srscvs.org
>>>>
>>>>
>>>>
>>>>
>>>>
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>>>>
>>>>
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>> --
>> Ben Bidstrup FRACS FRCSEd FEBCTS
>> Consultant Cardiothoracic Surgeon
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> === message truncated ===
>
>
> Dr. David G. Harris, FCS, MMED,
> Cardiothoracic Surgeon
> Suite 207
> Kuils River Private Hospital,
> PO Box 1200, Kuils River, 7579, Cape Town, South Africa.
> Tel +27-21-9006411
> Fax +27-21-9006412 Mobile +27-83-3309587
> _______________________________________________
> OpenHeart-L mailing list
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