Mutation in myosin heavy chain 6 causes atrial septal defect

Atrial septal defect is one of the most common forms of congenital heart malformation. We identified a new locus linked with atrial septal defect on chromosome 14q12 in a large family with dominantly inherited atrial septal defect. The underlying mutation is a missense substitution, I820N, in alpha-myosin heavy chain (MYH6), a structural protein expressed at high levels in the developing atria, which affects the binding of the heavy chain to its regulatory light chain. The cardiac transcription factor TBX5 strongly regulates expression of MYH6, but mutant forms of TBX5, which cause Holt-Oram syndrome, do not. Morpholino knock-down of expression of the chick MYH6 homolog eliminates the formation of the atrial septum without overtly affecting atrial chamber formation. These data provide evidence for a link between a transcription factor, a structural protein and congenital heart disease.

Audit of emergency medical admissions during the winter 1997/1998

OBJECTIVES

To test the hypothesis that a significant cause of rising medical admissions over the Christmas and New Year period is the failure of social and medical systems which support patients at home for most of the year; and to understand the reasons for admission during the winter months of an at risk population and to identify possible avoidable admissions.

DESIGN

Structured interviews were conducted with patients within 48 hours of admission to collect information on home circumstances and contact with social, medical and primary care in the year prior to admission. In cases where the patient was unable to provide this information, case notes and nursing notes were reviewed. Discharge diagnosis was recorded at the end of the study period.

SUBJECTS

Five hundred and thirty nine patients defined as an "at risk group" who were admitted to hospital as emergency medical admissions between 1st December 1997 and 31st January 1998.

RESULTS

Subjects were predominantly female (58%). The major diagnostic groups were cardiac (27%) and respiratory (22%). Respondents indicated no change in primary care in the period preceding their admission, with the exception of day centre support. Sixty seven percent of patients fully interviewed received help from carers, friends or relatives with daily tasks and only seven (3%) reported receiving less input prior to admission. Forty five percent of these patients had seen a GP within the month prior to their admission.

CONCLUSIONS

The study results showed no breakdown in either social or family support. In the group interviewed, the proportion who had experienced any decrease in social support during the period prior to admission was very small.

Implications of policy and management decisions on hospitals: a New Zealand viewpoint

In New Zealand, the effect of resource constraint operates at two levels. In the macrocosm of national politics, there is a tectonic collision between two plates--social equity and a fiscal constraint on government expenditure. In the hospital, these forces are reflected in the frustration of the staff who cannot deliver that which they are trained to deliver, in the distress of those who cannot obtain the care they have been told they need and in the stress on management pushed by forces it cannot control. If there is to be resolution, there must be change on all three fronts--the expectations of professionals and users alike--and the approach of management. Perhaps the needed change in management could be the key to change in the expectations of the other two parties.