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Sample records for frequent hospital admissions

  1. Substance use treatment barriers for patients with frequent hospital admissions.

    PubMed

    Raven, Maria C; Carrier, Emily R; Lee, Joshua; Billings, John C; Marr, Mollie; Gourevitch, Marc N

    2010-01-01

    Substance use (SU) disorders adversely impact health status and contribute to inappropriate health services use. This qualitative study sought to determine SU-related factors contributing to repeated hospitalizations and to identify opportunities for preventive interventions. Fifty Medicaid-insured inpatients identified by a validated statistical algorithm as being at high-risk for frequent hospitalizations were interviewed at an urban public hospital. Patient drug/alcohol history, experiences with medical, psychiatric and addiction treatment, and social factors contributing to readmission were evaluated. Three themes related to SU and frequent hospitalizations emerged: (a) barriers during hospitalization to planning long-term treatment and follow-up, (b) use of the hospital as a temporary solution to housing/family problems, and (c) unsuccessful SU aftercare following discharge. These data indicate that homelessness, brief lengths of stay complicating discharge planning, patient ambivalence regarding long-term treatment, and inadequate detox-to-rehab transfer resources compromise substance-using patients' likelihood of avoiding repeat hospitalization. Intervention targets included supportive housing, detox-to-rehab transportation, and postdischarge patient support. PMID:19540700

  2. Medicaid patients at high risk for frequent hospital admission: real-time identification and remediable risks.

    PubMed

    Raven, Maria C; Billings, John C; Goldfrank, Lewis R; Manheimer, Eric D; Gourevitch, Marc N

    2009-03-01

    Patients with frequent hospitalizations generate a disproportionate share of hospital visits and costs. Accurate determination of patients who might benefit from interventions is challenging: most patients with frequent admissions in 1 year would not continue to have them in the next. Our objective was to employ a validated regression algorithm to case-find Medicaid patients at high-risk for hospitalization in the next 12 months and identify intervention-amenable characteristics to reduce hospitalization risk. We obtained encounter data for 36,457 Medicaid patients with any visit to an urban public hospital from 2001 to 2006 and generated an algorithm-based score for hospitalization risk in the subsequent 12 months for each patient (0 = lowest, 100 = highest). To determine medical and social contributors to the current admission, we conducted in-depth interviews with high-risk hospitalized patients (scores >50) and analyzed associated Medicaid claims data. An algorithm-based risk score >50 was attained in 2,618 (7.2%) patients. The algorithm's positive predictive value was equal to 0.67. During the study period, 139 high-risk patients were admitted: 60 met inclusion criteria and 50 were interviewed. Fifty-six percent cited the Emergency Department as their usual source of care or had none. Sixty-eight percent had >1 chronic medical conditions, and 42% were admitted for conditions related to substance use. Sixty percent were homeless or precariously housed. Mean Medicaid expenditures for the interviewed patients were $39,188 and $84,040 per patient for the years immediately prior to and following study participation, respectively. Findings including high rates of substance use, homelessness, social isolation, and lack of a medical home will inform the design of interventions to improve community-based care and reduce hospitalizations and associated costs. PMID:19082899

  3. The Impact of Admission Diagnosis on Recurrent or Frequent Hospitalizations in 3 Dementia Subtypes

    PubMed Central

    Chang, Chiung-Chih; Lin, Pin-Hsuan; Chang, Ya-Ting; Chen, Nai-Ching; Huang, Chi-Wei; Lui, Chun-Chung; Huang, Shu-Hua; Chang, Yen-Hsiang; Lee, Chen-Chang; Lai, Wei-An

    2015-01-01

    Abstract Increasing numbers of patients with different types of dementia have resulted in the increasing medical care loads. It is not known whether explanatory factors for recurrent or prolong hospitalization were driven by the subtypes of dementia. We analyzed 203 dementia patients aged >65-year-old with a clinical diagnosis of Alzheimer disease (AD), vascular dementia (VaD), or Parkinsonism-related dementia (PRD). With a 4-year follow-up period, logistic regression analyses were used to identify predictors of dementia diagnosis, cerebrovascular risk factors, chronic systemic diseases, and the etiology for admission for recurrent (>4 times/4 years) or prolonged hospitalization stay (>14 days per hospitalization). There were 48 AD, 96 VaD, and 59 PRD patients that completed the 4-year study. The average length of hospital stay was significant, the shortest in AD and the longest in PRD (P = 0.01), whereas the frequency of hospitalization was not different among 3 dementia subtypes. Although delirium is the most common etiology for admission in the patients, diabetes mellitus (Odds ratio, OR = 2.79, P = 0.02), pneumonia (OR = 11.21, P < 0.001), and fall-related hip fracture (OR = 4.762, P = 0.029) were significantly associated with prolong hospitalization. Patients with coronary artery disease (OR = 9.87, P = 0.02), pneumonia (OR = 84.48, P < 0.001), urinary tract infection (OR = 55.09, P < 0.001), and fall-related fracture (OR = 141.7, P < 0.001) predict recurrent hospitalization. Dementia subtypes did not influence directly on the hospitalization courses. The etiologies for admission carried higher clinical significance, compared with the coexisted systemic diseases. PMID:26579820

  4. The Impact of Admission Diagnosis on Recurrent or Frequent Hospitalizations in 3 Dementia Subtypes: A Hospital-Based Cohort in Taiwan with 4 Years Longitudinal Follow-Ups.

    PubMed

    Chang, Chiung-Chih; Lin, Pin-Hsuan; Chang, Ya-Ting; Chen, Nai-Ching; Huang, Chi-Wei; Lui, Chun-Chung; Huang, Shu-Hua; Chang, Yen-Hsiang; Lee, Chen-Chang; Lai, Wei-An

    2015-11-01

    Increasing numbers of patients with different types of dementia have resulted in the increasing medical care loads. It is not known whether explanatory factors for recurrent or prolong hospitalization were driven by the subtypes of dementia. We analyzed 203 dementia patients aged >65-year-old with a clinical diagnosis of Alzheimer disease (AD), vascular dementia (VaD), or Parkinsonism-related dementia (PRD). With a 4-year follow-up period, logistic regression analyses were used to identify predictors of dementia diagnosis, cerebrovascular risk factors, chronic systemic diseases, and the etiology for admission for recurrent (>4 times/4 years) or prolonged hospitalization stay (>14 days per hospitalization). There were 48 AD, 96 VaD, and 59 PRD patients that completed the 4-year study. The average length of hospital stay was significant, the shortest in AD and the longest in PRD (P = 0.01), whereas the frequency of hospitalization was not different among 3 dementia subtypes. Although delirium is the most common etiology for admission in the patients, diabetes mellitus (Odds ratio, OR = 2.79, P = 0.02), pneumonia (OR = 11.21, P < 0.001), and fall-related hip fracture (OR = 4.762, P = 0.029) were significantly associated with prolong hospitalization. Patients with coronary artery disease (OR = 9.87, P = 0.02), pneumonia (OR = 84.48, P < 0.001), urinary tract infection (OR = 55.09, P < 0.001), and fall-related fracture (OR = 141.7, P < 0.001) predict recurrent hospitalization. Dementia subtypes did not influence directly on the hospitalization courses. The etiologies for admission carried higher clinical significance, compared with the coexisted systemic diseases. PMID:26579820

  5. Appropriateness of hospital admissions in general hospitals in Egypt.

    PubMed

    Al-Tehewy, M; Shehad, E; Al Gaafary, M; Al-Houssiny, M; Nabih, D; Salem, B

    2009-01-01

    We measured the rate of inappropriate admissions, and associated factors, in 3 general hospitals in Egypt. A total of 1191 admissions were reviewed using the Appropriateness Evaluation Protocol for adult patients and the Pediatric Appropriateness Evaluation Protocol for paediatric patients. Inappropriate admissions were 66.3% and 78.9% of admissions in the surgery departments of 2 hospitals compared with 1.9% in the 3rd hospital that followed a specific admission protocol for elective surgery. The paediatrics department had the lowest rates of inappropriate admissions in all hospitals (0%, 1.0% and 1.9%). On logistic regression analysis, the route of admission was the only factor significantly associated with inappropriate admissions in the departments of surgery, obstetrics/gynaecology and internal medicine. PMID:20214126

  6. Emergency re-admissions to hospital due to adverse drug reactions within 1 year of the index admission

    PubMed Central

    Davies, Emma C; Green, Christopher F; Mottram, David R; Rowe, Philip H; Pirmohamed, Munir

    2010-01-01

    AIM The proportion of re-admissions to hospital caused by ADRs is poorly documented in the UK. The aim of this study was to evaluate the impact of ADRs on re-admission to hospital after a period as an inpatient. METHODS One thousand patients consecutively admitted to 12 wards were included. All subsequent admissions for this cohort within 1 year of discharge from the index admission were retrospectively reviewed. RESULTS Of the 1000 patients included, 403 (40.3%, 95% CI 39.1, 45.4%) were re-admitted within 1 year. Complete data were available for 290 (70.2%) re-admitted patients, with an ADR contributing to admission in 60 (20.8%, 95% CI 16.4, 25.6%) patients. Presence of an ADR in the index admission did not predict for an ADR-related re-admission (10.5% vs. 7.2%, P = 0.25), or re-admission overall (47.2% vs. 41.2%, P = 0.15). The implicated drug was commenced in the index admission in 33/148 (22.3%) instances, with 37/148 (25%) commenced elsewhere since the index admission. Increasing age and an index admission in a medical ward were associated with a higher incidence of re-admission ADR. The most frequent causative drugs were anti-platelets and loop diuretics, with bleeding and renal impairment the most frequent ADRs. Over half (52/91, 57.1%) of the ADRs were judged to be definitely or possibly avoidable. CONCLUSIONS One fifth of patients re-admitted to hospital within 1 year of discharge from their index admission are re-admitted due to an ADR. Our data highlight drug and patient groups where interventions are needed to reduce the incidence of ADRs leading to re-admission. PMID:21039769

  7. Possible adverse drug events leading to hospital admission in a Brazilian teaching hospital

    PubMed Central

    Varallo, Fabiana Rossi; Capucho, Helaine Carneiro; da Silva Planeta, Cleópatra; de Carvalho Mastroianni, Patrícia

    2014-01-01

    OBJECTIVES: Drug safety problems can lead to hospital admission. In Brazil, the prevalence of hospitalization due to adverse drug events is unknown. This study aims to estimate the prevalence of hospitalization due to adverse drug events and to identify the drugs, the adverse drug events, and the risk factors associated with hospital admissions. METHOD: A cross-sectional study was performed in the internal medicine ward of a teaching hospital in São Paulo State, Brazil, from August to December 2008. All patients aged ≥18 years with a length of stay ≥24 hours were interviewed about the drugs used prior to hospital admission and their symptoms/complaints/causes of hospitalization. RESULTS: In total, 248 patients were considered eligible. The prevalence of hospitalization due to potential adverse drug events in the ward was 46.4%. Overprescribed drugs and those indicated for prophylactic treatments were frequently associated with possible adverse drug events. Frequently reported symptoms were breathlessness (15.2%), fatigue (12.3%), and chest pain (9.0%). Polypharmacy was a risk factor for the occurrence of possible adverse drug events. CONCLUSION: Possible adverse drug events led to hospitalization in a high-complexity hospital, mainly in polymedicated patients. The clinical outcomes of adverse drug events are nonspecific, which delays treatment, hinders causality analysis, and contributes to the underreporting of cases. PMID:24626940

  8. Qualitative critical incident study of patients’ experiences leading to emergency hospital admission with advanced respiratory illness

    PubMed Central

    Karasouli, Eleni; Munday, Daniel; Bailey, Cara; Staniszewska, Sophie; Hewison, Alistair; Griffiths, Frances

    2016-01-01

    Objectives The high volume of emergency admissions to hospital is a challenge for health systems internationally. Patients with lung cancer and chronic obstructive pulmonary disease (COPD) are frequently admitted to hospital as emergency cases. While the frequency of emergency admission has been investigated, few studies report patient experiences, particularly in relation to the decision-making process prior to emergency admission. We sought to explore patient and carer experiences and those of their healthcare professionals in the period leading up to emergency admission to hospital. Setting 3 UK hospitals located in different urban and rural settings. Design Qualitative critical incident study. Participants 24 patients with advanced lung cancer and 15 with advanced COPD admitted to hospital as emergencies, 20 of their carers and 50 of the health professionals involved in the patients’ care. Results The analysis of patient, carer and professionals’ interviews revealed a detailed picture of the complex processes involved leading to emergency admission to hospital. 3 phases were apparent in this period: self-management of deteriorating symptoms, negotiated decision-making and letting go. These were dynamic processes, characterised by an often rapidly changing clinical condition, uncertainty and anxiety. Patients considered their options drawing on experience, current and earlier advice. Patients tried to avoid admission, reluctantly accepting it, albeit often with a sense of relief, as anxiety increased with worsening symptoms. Conclusions Patients with advanced respiratory illness, and their carers, try to avoid emergency admission, and use logical and complex decision-making before reluctantly accepting it. Clinicians and policy-makers need to understand this complex process when considering how to reduce emergency hospital admissions rather than focusing on identifying and labelling admissions as ‘inappropriate’. PMID:26916687

  9. [Compulsory admission to hospital in Tunisia: a necessary evolution].

    PubMed

    Ellouze, Faten; Lahmar, Aymen; Beji, Rami; Dridi, Anis; Fadhel M'rad, Mohamed

    2015-01-01

    The evolution of the legislation governing compulsory admission to hospital in Tunisia is interesting for two reasons. The country's 2011 revolution notably brought about major changes to the legislative framework, from constitutional through to ordinary laws. At the same time, the current trend for globalisation is also affecting legislation: international laws, treaties and UN charters are imposed on the laws of individual countries. This article looks at how Tunisian law governing compulsory admission to hospital has had to evolve. PMID:26143219

  10. Seasonality of hospital admissions for mental disorders in Hanoi, Vietnam

    PubMed Central

    Trang, Phan Minh; Rocklöv, Joacim; Giang, Kim Bao; Nilsson, Maria

    2016-01-01

    Background Some studies have shown a relationship between seasonality in weather patterns and depressive and behavioural disorders, especially in temperate climate regions. However, there is a lack of studies describing the seasonal patterns of hospital admissions for a variety of mental disorders in tropical and subtropical nations. The aim of this study has been to examine the relationship between seasons and daily hospital admissions for mental disorders in Hanoi, Vietnam. Designs A 5-year database (2008–2012) compiled by Hanoi Mental Hospital covering mental disorder admissions diagnosed by the International Classification of Diseases 10 was analysed. A negative binominal regression model was applied to estimate the associations between seasonality and daily hospital admissions for mental disorders, for all causes and for specific diagnoses. Results The summer season indicated the highest relative risk (RR=1.24, confidence interval (CI)=1.1–1.39) of hospital admission for mental disorders, with a peak in these cases in June (RR=1.46, CI=1.19–1.7). Compared to other demographic groups, males and the elderly (aged over 60 years) were more sensitive to seasonal risk changes. In the summer season, the RR of hospital visits among men increased by 26% (RR=1.26, CI=1.12–1.41) and among the elderly by 23% (RR=1.23, CI=1.03–1.48). Furthermore, when temperatures including minimum, mean, and maximum increased 1°C, the number of cases for mental disorders increased by 1.7%, 2%, and 2.1%, respectively. Conclusion The study results showed a correlation between hospital admission for mental disorders and season. PMID:27566716

  11. Hospital Admissions, Transfers and Costs of Guillain-Barré Syndrome

    PubMed Central

    van Leeuwen, Nikki; Lingsma, Hester F.; Vanrolleghem, Ann M.; Sturkenboom, Miriam C. J. M.; van Doorn, Pieter A.; Steyerberg, Ewout W.; Jacobs, Bart C.

    2016-01-01

    Background Guillain-Barré syndrome (GBS) has a highly variable clinical course, leading to frequent transfers within and between hospitals and high associated costs. We defined the current admissions, transfers and costs in relation to disease severity of GBS. Methods Dutch neurologists were requested to report patients diagnosed with GBS between November 2009 and November 2010. Information regarding clinical course and transfers was obtained via neurologists and general practitioners. Results 87 GBS patients were included with maximal GBS disability score of 1 or 2 (28%), 3 or 4 (53%), 5 (18%) and 6 (1%). Four mildly affected GBS patients were not hospital admitted. Of the 83 hospitalized patients 68 (82%) were initially admitted at a neurology department, 4 (5%) at an ICU, 4 (5%) at pediatrics, 4 (5%) at pediatrics neurology and 3 (4%) at internal medicine. Median hospital stay was 17 days (IQR 11–26 days, absolute range 1–133 days). Transfers between departments or hospitals occurred in 33 (40%) patients and 25 (30%) were transferred 2 times or more. From a cost-effectiveness perspective 21 (25%) of the admissions was suboptimal. Median costs for hospital admission of GBS patients were 15,060 Euro (IQR 11,226–23,683). Maximal GBS disability score was significantly correlated with total length of stay, number of transfers, ICU admission and costs. Conclusions Hospital admissions for GBS patients are highly heterogeneous, with frequent transfers and higher costs for those with more severe disease. Future research should aim to develop prediction models to early identify the most cost-effective allocation in individual patients. PMID:26859880

  12. Daily weather variables and affective disorder admissions to psychiatric hospitals.

    PubMed

    McWilliams, Stephen; Kinsella, Anthony; O'Callaghan, Eadbhard

    2014-12-01

    Numerous studies have reported that admission rates in patients with affective disorders are subject to seasonal variation. Notwithstanding, there has been limited evaluation of the degree to which changeable daily meteorological patterns influence affective disorder admission rates. A handful of small studies have alluded to a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (heat waves in particular), wind direction and sunshine. We used the Kruskal-Wallis test, ARIMA and time-series regression analyses to examine whether daily meteorological variables--namely wind speed and direction, barometric pressure, rainfall, hours of sunshine, sunlight radiation and temperature--influence admission rates for mania and depression across 12 regions in Ireland over a 31-year period. Although we found some very weak but interesting trends for barometric pressure in relation to mania admissions, daily meteorological patterns did not appear to affect hospital admissions overall for mania or depression. Our results do not support the small number of papers to date that suggest a link between daily meteorological variables and affective disorder admissions. Further study is needed. PMID:24599495

  13. Daily weather variables and affective disorder admissions to psychiatric hospitals

    NASA Astrophysics Data System (ADS)

    McWilliams, Stephen; Kinsella, Anthony; O'Callaghan, Eadbhard

    2014-12-01

    Numerous studies have reported that admission rates in patients with affective disorders are subject to seasonal variation. Notwithstanding, there has been limited evaluation of the degree to which changeable daily meteorological patterns influence affective disorder admission rates. A handful of small studies have alluded to a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (heat waves in particular), wind direction and sunshine. We used the Kruskal-Wallis test, ARIMA and time-series regression analyses to examine whether daily meteorological variables—namely wind speed and direction, barometric pressure, rainfall, hours of sunshine, sunlight radiation and temperature—influence admission rates for mania and depression across 12 regions in Ireland over a 31-year period. Although we found some very weak but interesting trends for barometric pressure in relation to mania admissions, daily meteorological patterns did not appear to affect hospital admissions overall for mania or depression. Our results do not support the small number of papers to date that suggest a link between daily meteorological variables and affective disorder admissions. Further study is needed.

  14. The admissions process in two state psychiatric hospitals.

    PubMed

    Solomon, P

    1981-06-01

    In this study, a conceptual model of the factors influencing the admissions process was tested in two state psychiatric hospitals. The factors included in the model fell into four categories: characteristics of patients, characteristics of admitting personnel, system factors, and patient assessment. The attitudes of individuals accompanying an applicant were found to be most important. Patients referred by police, courts, family, friends, or agency personnel were more likely to be admitted than self-referrals. Pathological behaviors that had a significant impact on the admissions process were those that indicated the presence of mental disorder or danger to self or others. The availability of alternatives to hospitalization was not found to be significant, a finding that suggests that admitting personnel, particularly psychiatrists, should be educated about community alternatives if spiraling rates of psychiatric admission are to be reduced. PMID:7262846

  15. A Study of Hospital Admission Rules During Pediatric Residency Training.

    ERIC Educational Resources Information Center

    Ferguson, Jane; Alpert, Joel J.

    1980-01-01

    A survey of U.S. pediatric training programs to determine the role of rules in the hospital admission of pediatric patients is reported. The results support the hypothesis that rules are a widely used teaching tool. The rules relate to such factors as fevers, age, specific diseases, administrative concerns, head traumas, and poisonings. (JMD)

  16. Atmospheric pollutants and hospital admissions due to pneumonia in children

    PubMed Central

    Negrisoli, Juliana; Nascimento, Luiz Fernando C.

    2013-01-01

    OBJECTIVE: To analyze the relationship between exposure to air pollutants and hospitalizations due to pneumonia in children of Sorocaba, São Paulo, Brazil. METHODS: Time series ecological study, from 2007 to 2008. Daily data were obtained from the State Environmental Agency for Pollution Control for particulate matter, nitric oxide, nitrogen dioxide, ozone, besides air temperature and relative humidity. The data concerning pneumonia admissions were collected in the public health system of Sorocaba. Correlations between the variables of interest using Pearson cofficient were calculated. Models with lags from zero to five days after exposure to pollutants were performed to analyze the association between the exposure to environmental pollutants and hospital admissions. The analysis used the generalized linear model of Poisson regression, being significant p<0.05. RESULTS: There were 1,825 admissions for pneumonia, with a daily mean of 2.5±2.1. There was a strong correlation between pollutants and hospital admissions, except for ozone. Regarding the Poisson regression analysis with the multi-pollutant model, only nitrogen dioxide was statistically significant in the same day (relative risk - RR=1.016), as well as particulate matter with a lag of four days (RR=1.009) after exposure to pollutants. CONCLUSIONS: There was an acute effect of exposure to nitrogen dioxide and a later effect of exposure to particulate matter on children hospitalizations for pneumonia in Sorocaba. PMID:24473956

  17. Reducing hospital admissions from nursing homes: a systematic review

    PubMed Central

    2014-01-01

    Background The geriatric nursing home population is vulnerable to acute and deteriorating illness due to advanced age, multiple chronic illnesses and high levels of dependency. Although the detriments of hospitalising the frail and old are widely recognised, hospital admissions from nursing homes remain common. Little is known about what alternatives exist to prevent and reduce hospital admissions from this setting. The objective of this study, therefore, is to summarise the effects of interventions to reduce acute hospitalisations from nursing homes. Methods A systematic literature search was performed in Cochrane Library, PubMed, MEDLINE, EMBASE and ISI Web of Science in April 2013. Studies were eligible if they had a geriatric nursing home study population and were evaluating any type of intervention aiming at reducing acute hospital admission. Systematic reviews, randomised controlled trials, quasi randomised controlled trials, controlled before-after studies and interrupted time series were eligible study designs. The process of selecting studies, assessing them, extracting data and grading the total evidence was done by two researchers individually, with any disagreement solved by a third. We made use of meta-analyses from included systematic reviews, the remaining synthesis is descriptive. Based on the type of intervention, the included studies were categorised in: 1) Interventions to structure and standardise clinical practice, 2) Geriatric specialist services and 3) Influenza vaccination. Results Five systematic reviews and five primary studies were included, evaluating a total of 11 different interventions. Fewer hospital admissions were found in four out of seven evaluations of structuring and standardising clinical practice; in both evaluations of geriatric specialist services, and in influenza vaccination of residents. The quality of the evidence for all comparisons was of low or very low quality, using the GRADE approach. Conclusions Overall, eleven

  18. [Congestive heart failure with frequent hospital readmissions in the elderly].

    PubMed

    Pentimone, F; Del Corso, L

    1993-03-01

    Ten elderly patients with heart failure and frequent hospital readmission within 12 months before the study, were submitted to clinical radiologic, electrocardiographic and echocardiographic evaluation in order to find the causes of readmission. The most frequent factors were found to be non compliance with drug prescriptions and therapy inadequate for the etiology of the heart failure and the kind of cardiac dysfunction. PMID:8482059

  19. Heatwaves and Hospital Admissions for Mental Disorders in Northern Vietnam

    PubMed Central

    Trang, Phan Minh; Rocklöv, Joacim; Giang, Kim Bao; Kullgren, Gunnar; Nilsson, Maria

    2016-01-01

    Studies in high-income countries have shown an association between heatwaves and hospital admissions for mental disorders. It is unknown whether such associations exist in subtropical nations like Vietnam. The study aim was to investigate whether hospital admissions for mental disorders may be triggered, or exacerbated, by heat exposure and heatwaves, in a low- and middle-income country, Vietnam. For this, we used data from the Hanoi Mental Hospital over five years (2008–2012) to estimate the effect of heatwaves on admissions for mental disorders. A zero-inflated negative binomial regression model accounting for seasonality, time trend, days of week, and mean humidity was used to analyse the relationship. Heatwave events were mainly studied as periods of three or seven consecutive days above the threshold of 35°C daily maximum temperature (90th percentile). The study result showed heatwaves increased the risk for admission in the whole group of mental disorders (F00-79) for more persistent heatwaves of at least 3 days when compared with non-heatwave periods. The relative risks were estimated at 1.04 (0.95–1.13), 1.15 (1.005–1.31), and 1.36 (1–1.90) for a one-, three- and seven-day heatwave, respectively. Admissions for mental disorders increased among men, residents in rural communities, and the elderly population during heatwaves. The groups of organic mental disorders, including symptomatic illnesses (F0-9) and mental retardation (F70-79), had increased admissions during heatwaves. The findings are novel in their focus on heatwave impact on mental diseases in a population habituating in a subtropical low- and middle-income country characterized by rapid epidemiological transitions and environmental changes. PMID:27195473

  20. Heatwaves and Hospital Admissions for Mental Disorders in Northern Vietnam.

    PubMed

    Trang, Phan Minh; Rocklöv, Joacim; Giang, Kim Bao; Kullgren, Gunnar; Nilsson, Maria

    2016-01-01

    Studies in high-income countries have shown an association between heatwaves and hospital admissions for mental disorders. It is unknown whether such associations exist in subtropical nations like Vietnam. The study aim was to investigate whether hospital admissions for mental disorders may be triggered, or exacerbated, by heat exposure and heatwaves, in a low- and middle-income country, Vietnam. For this, we used data from the Hanoi Mental Hospital over five years (2008-2012) to estimate the effect of heatwaves on admissions for mental disorders. A zero-inflated negative binomial regression model accounting for seasonality, time trend, days of week, and mean humidity was used to analyse the relationship. Heatwave events were mainly studied as periods of three or seven consecutive days above the threshold of 35°C daily maximum temperature (90th percentile). The study result showed heatwaves increased the risk for admission in the whole group of mental disorders (F00-79) for more persistent heatwaves of at least 3 days when compared with non-heatwave periods. The relative risks were estimated at 1.04 (0.95-1.13), 1.15 (1.005-1.31), and 1.36 (1-1.90) for a one-, three- and seven-day heatwave, respectively. Admissions for mental disorders increased among men, residents in rural communities, and the elderly population during heatwaves. The groups of organic mental disorders, including symptomatic illnesses (F0-9) and mental retardation (F70-79), had increased admissions during heatwaves. The findings are novel in their focus on heatwave impact on mental diseases in a population habituating in a subtropical low- and middle-income country characterized by rapid epidemiological transitions and environmental changes. PMID:27195473

  1. Secondhand smoke is associated with more frequent hospitalizations in children with sickle cell disease.

    PubMed

    Sadreameli, S Christy; Eakin, Michelle N; Robinson, Kayin T; Alade, Rachel O; Strouse, John J

    2016-03-01

    Tobacco smoke exposure has been associated with more frequent hospitalizations in children with sickle cell disease (SCD), but previous studies have not quantified the exposure by objective methods. We enrolled 50 children and young adults with SCD in a retrospective and prospective cohort study and quantified tobacco smoke exposure by objective (salivary cotinine) and survey measures. We used a multivariable negative binomial regression model to evaluate the association between salivary cotinine and hospital admissions. Forty-five percent (22/49) of participants had significant elevation of salivary cotinine (≥ 0.5 ng/ml). The incidence risk ratio (IRR) for hospital admission for those with elevated cotinine was 3.7 (95% CI 1.8-8). Those exposed to secondhand smoke but not primary smokers (cotinine between 0.5 and 10 ng/ml) had a similarly increased risk of hospitalization [IRR 4.3 (95% CI 1.8-10)]. We show that an objective measure of tobacco smoke exposure, salivary cotinine, is strongly associated with the rate of hospital admissions in children and young adults with SCD. This association underscores the importance of screening for tobacco smoke exposure in people with SCD. Further investigation is warranted to determine the mechanisms of and to evaluate interventions to decrease tobacco smoke exposure. Am. J. Hematol. 91:313-317, 2016. © 2015 Wiley Periodicals, Inc. PMID:26690323

  2. [The appropriateness of hospital admissions: reflections for a global approach].

    PubMed

    Pasini, E; Scherillo, M; Ramponi, C

    2000-05-01

    In accordance with a recent definition, appropriateness of medical care is a diagnostic-therapeutic intervention with a correct use of resources and competency, and a procedure that satisfies the request of patients. This definition considers not only the risk/benefit relationship but also the interaction between costs and benefits. In this light, the concept of appropriateness needs a global approach. The identification of the Mission and Vision of the structure, the use of medical guidelines, the distribution of documents which inform patients on the procedures carried out in the hospital and the modalities of access to the structure, the implementation of procedures which define hospital admission and finally the random check of medical records could represent important steps to implement a quality system aimed at guaranteeing the appropriateness of hospital admissions in accordance with the international standards for total quality management ISO 9000. PMID:10834130

  3. Association between atmospheric pollutants and hospital admissions in Lisbon.

    PubMed

    Cruz, A M J; Sarmento, S; Almeida, S M; Silva, A V; Alves, C; Freitas, M C; Wolterbeek, H

    2015-04-01

    Ambient air pollution is recognised as one of the potential environmental risk factors causing health hazards to the exposed population, demonstrated in numerous previous studies. Several longitudinal, ecological and epidemiological studies have shown associations between outdoor levels of outdoor atmospheric pollutants and adverse health effects, especially associated with respiratory and cardiovascular hospital admissions. The aim of this work is to assess the influence of atmospheric pollutants over the hospital admissions in Lisbon, by Ordinary Least Squares Linear Regression. The pollutants (CO, NO, NO2, SO2, O3, PM10 and PM2.5) were obtained from 13 monitoring stations of the Portuguese Environmental Agency, which provide hourly observations. Hospital admission data were collected from the Central Administration of the Health System and were compiled by age: <15, 15-64, >64 years old. The study period was 2006-2008. Results showed significant positive associations between the following: (1) the pollutants CO, NO, NO2, SO2, PM10 and PM2.5 and circulatory diseases for ages between 15 and 64 years (0.5% hospital admissions (HA) increase with 10 μg m(-3) NO increase) and above 64 years (1.0% stroke admission increase with 10 μg m(-3) NO2 increase); (2) the pollutants CO, NO, NO2, SO2, PM10 and PM2.5 and respiratory diseases for ages below 15 years (up to 1.9% HA increase with 10 μg m(-3) pollutant increase); and (3) the pollutants NO, NO2 and SO2 and respiratory diseases for ages above 64 years (1.3% HA increase with 10 μg m(-3) CO increase). PMID:25471710

  4. Increasing malaria hospital admissions in Uganda between 1999 and 2009

    PubMed Central

    2011-01-01

    Background Some areas of Africa are witnessing a malaria transition, in part due to escalated international donor support and intervention coverage. Areas where declining malaria rates have been observed are largely characterized by relatively low baseline transmission intensity and rapid scaling of interventions. Less well described are changing patterns of malaria burden in areas of high parasite transmission and slower increases in control and treatment access. Methods Uganda is a country predominantly characterized by intense, perennial malaria transmission. Monthly pediatric admission data from five Ugandan hospitals and their catchments have been assembled retrospectively across 11 years from January 1999 to December 2009. Malaria admission rates adjusted for changes in population density within defined catchment areas were computed across three time periods that correspond to periods where intervention coverage data exist and different treatment and prevention policies were operational. Time series models were developed adjusting for variations in rainfall and hospital use to examine changes in malaria hospitalization over 132 months. The temporal changes in factors that might explain changes in disease incidence were qualitatively examined sequentially for each hospital setting and compared between hospital settings Results In four out of five sites there was a significant increase in malaria admission rates. Results from time series models indicate a significant month-to-month increase in the mean malaria admission rates at four hospitals (trend P < 0.001). At all hospitals malaria admissions had increased from 1999 by 47% to 350%. Observed changes in intervention coverage within the catchments of each hospital showed a change in insecticide-treated net coverage from <1% in 2000 to 33% by 2009 but accompanied by increases in access to nationally recommended drugs at only two of the five hospital areas studied. Conclusions The declining malaria disease

  5. Hospital admission avoidance through the introduction of a virtual ward.

    PubMed

    Jones, Joanne; Carroll, Andrea

    2014-07-01

    The ageing British population is placing increased demands on the delivery of care in mainstream health-care institutions. While people are living longer, a significant percentage is also living with one or more long-term conditions. These issues, alongside continuing financial austerity measures, require a radical improvement in the care of patients away from hospitals. The Wyre Forest Clinical Commissioning Group introduced a virtual ward model for two main purposes: to save on spiralling costs of hospital admissions, and, secondly, to ensure the preferred wishes of most patients to be cared for and even die at home were achieved. This commentary describes how the virtual ward model was implemented and the impact of preventing unplanned emergency admissions to hospitals. The setting up of enhanced care services and virtual wards in one county is discussed, aiming to highlight success points and potential pitfalls to avoid. The results from the implementation of the virtual ward model show a significant reduction in emergency and avoidable patient admissions to hospital. The success of virtual wards is dependent on integrated working between different health-care disciplines. PMID:25039341

  6. Air pollution and daily hospital admissions in metropolitan Los Angeles.

    PubMed Central

    Linn, W S; Szlachcic, Y; Gong, H; Kinney, P L; Berhane, K T

    2000-01-01

    We used daily time-series analysis to evaluate associations between ambient carbon monoxide, nitrogen dioxide, particulate matter [less than and equal to] 10 microm in aerodynamic diameter (PM(10)), or ozone concentrations, and hospital admissions for cardiopulmonary illnesses in metropolitan Los Angeles during 1992-1995. We performed Poisson regressions for the entire patient population and for subgroups defined by season, region, or personal characteristics, allowing for effects of temporal variation, weather, and autocorrelation. CO showed the most consistently significant (p<0.05) relationships to cardiovascular admissions. A wintertime 25th-75th percentile increase in CO (1.1-2.2 ppm) predicted an increase of 4% in cardiovascular admissions. NO(2), and, to a lesser extent, PM(10) tracked CO and showed similar associations with cardiovascular disease, but O(3) was negatively or nonsignificantly associated. No significant demographic differences were found, although increased cardiovascular effects were suggested in diabetics, in whites and blacks (relative to Hispanics and Asians), and in persons older than 65 years of age. Pulmonary disease admissions associated more with NO(2) and PM(10) than with CO. Pulmonary effects were generally smaller than cardiovascular effects and were more sensitive to the choice of model. We conclude that in Los Angeles, atmospheric stagnation with high primary (CO/NO(2)/PM(10)) pollution, most common in autumn/winter, increases the risk of hospitalization for cardiopulmonary illness. Summer photochemical pollution (high O(3)) apparently presents less risk. Images Figure 1 Figure 2 PMID:10811569

  7. [Big data, Roemer's law and avoidable hospital admissions].

    PubMed

    van der Horst, H E

    2016-01-01

    From an analysis of data from 23 European countries to determine the impact of primary care on avoidable hospital admissions for uncontrolled diabetes it appeared that, contrary to expectation, countries with strong primary care did not have a lower rate of avoidable hospital admission. It is clear that Roemer's law, 'a bed built is a bed filled,' still applies. However, the validity of this sort of analysis can be questioned, as these data are highly aggregated, and registration quality differs between countries. It is also questionable if these datasets can be considered as 'big data' as there are relatively small numbers per country. Big data analyses are useful for discerning patterns and formulating hypotheses, but not for proving causality. An unwanted side effect of this kind of analysis might be that policymakers use these not so valid results to underpin their policy to their advantage. PMID:27484429

  8. Respiratory hospital admissions associated with PM10 pollution in Utah, Salt Lake, and Cache Valleys

    SciTech Connect

    Pope CA, I.I.I. )

    1991-03-01

    This study assessed the association between respiratory hospital admissions and PM10 pollution in Utah, Salt Lake, and Cache valleys during April 1985 through March 1989. Utah and Salt Lake valleys had high levels of PM10 pollution that violated both the annual and 24-h standards issued by the Environmental Protection Agency (EPA). Much lower PM10 levels occurred in the Cache Valley. Utah Valley experienced the intermittent operation of its primary source of PM10 pollution: an integrated steel mill. Bronchitis and asthma admissions for preschool-age children were approximately twice as frequent in Utah Valley when the steel mill was operating versus when it was not. Similar differences were not observed in Salt Lake or Cache valleys. Even though Cache Valley had higher smoking rates and lower temperatures in winter than did Utah Valley, per capita bronchitis and asthma admissions for all ages were approximately twice as high in Utah Valley. During the period when the steel mill was closed, differences in per capita admissions between Utah and Cache valleys narrowed considerably. Regression analysis also demonstrated a statistical association between respiratory hospital admissions and PM10 pollution. The results suggest that PM10 pollution plays a role in the incidence and severity of respiratory disease.

  9. Extensive antibiotic prescription rate among hospitalized patients in Uganda: but with frequent missed-dose days

    PubMed Central

    Kiguba, Ronald; Karamagi, Charles; Bird, Sheila M.

    2016-01-01

    Objectives To describe the patterns of systemic antibiotic use and missed-dose days and detail the prescription, dispensing and administration of frequently used hospital-initiated antibiotics among Ugandan inpatients. Methods This was a prospective cohort of consented adult inpatients admitted on the medical and gynaecological wards of the 1790 bed Mulago National Referral Hospital. Results Overall, 79% (603/762; 95% CI: 76%–82%) of inpatients received at least one antibiotic during hospitalization while 39% (300/762; 95% CI: 36%–43%) had used at least one antibiotic in the 4 weeks pre-admission; 1985 antibiotic DDDs, half administered parenterally, were consumed in 3741 inpatient-days. Two-fifths of inpatients who received at least one of the five frequently used hospital-initiated antibiotics (ceftriaxone, metronidazole, ciprofloxacin, amoxicillin and azithromycin) missed at least one antibiotic dose-day (44%, 243/558). The per-day risk of missed antibiotic administration was greatest on day 1: ceftriaxone (36%, 143/398), metronidazole (27%, 67/245), ciprofloxacin (34%, 39/114) and all inpatients who missed at least one dose-day of prescribed amoxicillin and azithromycin. Most patients received fewer doses than were prescribed: ceftriaxone (74%, 273/371), ciprofloxacin (90%, 94/105) and metronidazole (97%, 222/230). Of prescribed doses, only 62% of ceftriaxone doses (1178/1895), 35% of ciprofloxacin doses (396/1130) and 27% of metronidazole doses (1043/3862) were administered. Seven percent (13/188) of patients on intravenous metronidazole and 6% (5/87) on intravenous ciprofloxacin switched to oral route. Conclusions High rates of antibiotic use both pre-admission and during hospitalization were observed, with low parenteral/oral switch of hospital-initiated antibiotics. Underadministration of prescribed antibiotics was common, especially on the day of prescription, risking loss of efficacy and antibiotic resistance. PMID:26945712

  10. Adverse drug reactions related to hospital admission in Slovak elderly patients.

    PubMed

    Wawruch, Martin; Zikavska, Martina; Wsolova, Ladislava; Kuzelova, Magdalena; Kahayova, Katarina; Strateny, Kamil; Kristova, Viera

    2009-01-01

    The aims of the present study were: to evaluate the prevalence of adverse drug reactions (ADRs) leading to hospitalization in elderly patients; to analyze the drugs which have been identified as having causal relationship with ADRs and to identify risk factors which predispose the patient to such ADRs. The study has been performed in 600 patients aged> or =65 years, hospitalized in a general hospital between 1 December 2003 and 31 March 2005. The ADRs recorded in patient's documentation as one of the reasons for hospital admission were evaluated. ADRs leading to hospital admission were recorded in 47 (7.8%) patients. ADRs in 43 patients represented A-type ADRs which are preventable. The most frequent ADRs were cardiovascular disorders. According to the results of multivariate analysis ischemic heart disease (odds ratio (OR)=4.50; 95% confidence interval (CI)=1.36-14.88), depression (OR, 2.49; 95% CI, 1.08-5.77) and heart failure (OR, 2.08; 95% CI, 1.13-3.81) were the most important patient-related characteristics predicting ADRs leading to hospitalization. The majority of ADRs in elderly patients could be avoided. Regular re-evaluation of the medication as well as taking into account the specific features of elderly patients represent the most important tools for ADR prevention. PMID:18313773

  11. Contribution of ED admissions to inpatient hospital revenue.

    PubMed

    Sacchetti, Alfred; Harris, Russell H; Warden, Todd; Roth, Sandra

    2002-01-01

    Emergency department (ED) practices are traditionally profiled in terms of their patient encounters. Such evaluations reflect a preponderance of outpatient visits while crediting income from admitted patients to traditional hospital-based services. This study evaluates the contribution of ED admissions to inpatient hospital revenue. The study was set at an urban tertiary care community hospital with university affiliation. Information referable to ED patients was collected from the hospital's Universal Billing Code (UB-92)-based patient information warehouse. Data fields referable to hospital charges, insurance type, and disposition were used for analysis of a 1-year period from September 1, 1998 to August 31, 1999. Statistical analysis was through chi square and ANOVA. During the study period 33,174 patients were treated in the ED with 6,671 (20%) admitted to inpatient services. Total hospital charges for all ED patients during this time were $107 million dollars with $9.1 million (8.5%) generated from discharged patients and $98.0 million (91.5%) from admitted ED patients (P <.001). Mean charges for individual discharged patients were $344.10 whereas for individual admitted patients mean charges were $14,692.28. (P <.001) Medicaid and self pay represented 55.4% of the insurance coverage for discharged ED patients whereas these same insurance classes accounted for only 16.3% of admitted patients. (P <.001) Medicare visits accounted for 12.7% of discharged ED patients but 60.7% of admitted patients (P <.001). Total hospital gross revenue for inpatient services for the study period was $288 million of which 34% was contributed from admitted ED patients. ED services represent a major source of inpatient hospital revenue. The recognition of the ED's potential in this area may be lost if income from patients admitted through the ED is credited to traditional hospital-based services. PMID:11781909

  12. Ambient biomass smoke and cardio-respiratory hospital admissions in Darwin, Australia

    PubMed Central

    Johnston, Fay H; Bailie, Ross S; Pilotto, Louis S; Hanigan, Ivan C

    2007-01-01

    Background Increasing severe vegetation fires worldwide has been attributed to both global environmental change and land management practices. However there is little evidence concerning the population health effects of outdoor air pollution derived from biomass fires. Frequent seasonal bushfires near Darwin, Australia provide an opportunity to examine this issue. We examined the relationship between atmospheric particle loadings <10 microns in diameter (PM10), and emergency hospital admissions for cardio-respiratory conditions over the three fire seasons of 2000, 2004 and 2005. In addition we examined the differential impacts on Indigenous Australians, a high risk population subgroup. Methods We conducted a case-crossover analysis of emergency hospital admissions with principal ICD10 diagnosis codes J00–J99 and I00–I99. Conditional logistic regression models were used to calculate odds ratios for admission with 10 μg/m3 rises in PM10. These were adjusted for weekly influenza rates, same day mean temperature and humidity, the mean temperature and humidity of the previous three days, days with rainfall > 5 mm, public holidays and holiday periods. Results PM10 ranged from 6.4 – 70.0 μg/m3 (mean 19.1). 2466 admissions were examined of which 23% were for Indigenous people. There was a positive relationship between PM10 and admissions for all respiratory conditions (OR 1.08 95%CI 0.98–1.18) with a larger magnitude in the Indigenous subpopulation (OR1.17 95% CI 0.98–1.40). While there was no relationship between PM10 and cardiovascular admissions overall, there was a positive association with ischaemic heart disease in Indigenous people, greatest at a lag of 3 days (OR 1.71 95%CI 1.14–2.55). Conclusion PM10 derived from vegetation fires was predominantly associated with respiratory rather than cardiovascular admissions. This outcome is consistent with the few available studies of ambient biomass smoke pollution. Indigenous people appear to be at higher risk

  13. Risk Factors for Inpatient Hospital Admission in Pediatric Burn Patients

    PubMed Central

    Puckett, Yana

    2016-01-01

    Purpose Our objective was to determine the risk factors for inpatient admission of pediatric burn patients. Materials & methods This cross-sectional study uses data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID) for the years of 2003, 2006, 2009, and 2012 to estimate the risk factors for inpatient admission for pediatric patients who sustained a burn injury. Patients who sustained a burn between the ages of 1 and 18 years were included. Results A total of 43,453 patients met inclusion criteria. Of those, 42.3% were Caucasian, 20.1% were African American, and 19.3% were Hispanic. Males comprised 63.5% of the studied population. The month of July was associated with a 31.8% increased chance (p=.011) of being admitted to hospital for a pediatric burn. It was found that patients being admitted had a 32.2% increased chance (p=.002) of a fluid and electrolyte abnormality and a 61.0% increased chance (p=.027) of drug abuse.  Conclusions Pediatric burn patients are more likely to be admitted to the hospital having a fluid and electrolyte abnormality, having a drug abuse status, and/or during the month of July. PMID:27335714

  14. Hospital Preparations for Viral Hemorrhagic Fever Patients and Experience Gained from Admission of an Ebola Patient

    PubMed Central

    Minderhoud, A.L.C. (Ben); Wind, Jelte D.D.; Leenen, Luke P.H.; Hoepelman, Andy I.M.; Ellerbroek, Pauline M.

    2016-01-01

    The Major Incident Hospital of the University Medical Centre of Utrecht has a longstanding history of preparing for the management of highly pathogenic and infectious organisms. An assessment of the hospital’s preparations for an outbreak of viral hemorrhagic fever and its experience during admission of a patient with Ebola virus disease showed that the use of the buddy system, frequent training, and information sessions for staff and their relatives greatly increased the sense of safety and motivation among staff. Differing procedures among ambulance services limited the number of services used for transporting patients. Waste management was the greatest concern, and destruction of waste had to be outsourced. The admission of an Ebola patient proceeded without incident but led to considerable demands on staff. The maximum time allowed for wearing personal protective equipment was 45 minutes to ensure safety, and an additional 20 minutes was needed for recovery. PMID:26812146

  15. Factors affecting hospital admission and length of stay of poisoned patients in the north east of England.

    PubMed

    Thomas, S H; Lewis, S; Bevan, L; Bhattacharyya, S; Bramble, M G; Chew, K; Connolly, J; Dorani, B; Han, K H; Horner, J E; Rodgers, A; Sen, B; Tesfayohannes, B; Wynne, H; Bateman, D N

    1996-11-01

    1. Poisoning is a common reason for presentation to hospital and hospital admission but there is no agreed policy for managing these patients. This study examined the management of patients presenting with poisoning and the factors affecting the probability of hospital admission and prolonged stay. 2. Data on all cases of poisoning presenting to six Accident and Emergency departments in the North East of England over 12 weeks in 1994 was collected prospectively from A&E notes. Length of stay and outcome were recorded from hospital computer records. 3. Overall, 73% of patients were admitted to a medical ward. Probability of admission was not independently affected by age or gender but was increased in those with intentional poisoning (Odds Ratio (OR) 3.3 [95% CI 1.8, 6.1]), a history of self harm (OR 1.7, [1.0, 2.9]) or potentially hazardous poisoning (OR 3.7 [2.1, 6.6]). There were significant variations between hospitals (50-80%) which could not be attributed to case mix. 4. Prolonged stay (> 2 nights) was more common in patients over 65 years (OR 6.8 [2.9, 16.1]), those with intentional poisoning (OR 2.7 [1.1, 6.6]) and those with potentially hazardous poisoning (OR 2.6 [1.4, 4.9]). Mean hospital stay was 1.5 days and varied significantly between hospitals from 0.8 to 2.1 days and this was independent of case mix. 5. There are appreciable variations in the management of poisoning between hospitals which are not explained by patient characteristics. Savings would occur if rates of admission and duration of stay were reduced by those hospitals where admission is more frequent or hospital stay is longer. However, the impact of this on long term morbidity is unknown. PMID:8938488

  16. Day hospital versus admission for acute psychiatric disorders

    PubMed Central

    Marshall, Max; Crowther, Ruth; Sledge, William Hurt; Rathbone, John; Soares-Weiser, Karla

    2014-01-01

    Background Inpatient treatment is an expensive way of caring for people with acute psychiatric disorders. It has been proposed that many of those currently treated as inpatients could be cared for in acute psychiatric day hospitals. Objectives To assess the effects of day hospital versus inpatient care for people with acute psychiatric disorders. Search methods We searched the Cochrane Schizophrenia Group Trials Register (June 2010) which is based on regular searches of MEDLINE, EMBASE, CINAHL and PsycINFO. We approached trialists to identify unpublished studies. Selection criteria Randomised controlled trials of day hospital versus inpatient care, for people with acute psychiatric disorders. Studies were ineligible if a majority of participants were under 18 or over 65, or had a primary diagnosis of substance abuse or organic brain disorder. Data collection and analysis Two review authors independently extracted and cross-checked data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data. We calculated weighted or standardised means for continuous data. Day hospital trials tend to present similar outcomes in slightly different formats, making it difficult to synthesise data. We therefore sought individual patient data so that we could re-analyse outcomes in a common format. Main results Ten trials (involving 2685 people) met the inclusion criteria. We obtained individual patient data for four trials (involving 646 people). We found no difference in the number lost to follow-up by one year between day hospital care and inpatient care (5 RCTs, n = 1694, RR 0.94 CI 0.82 to 1.08). There is moderate evidence that the duration of index admission is longer for patients in day hospital care than inpatient care (4 RCTs, n = 1582, WMD 27.47 CI 3.96 to 50.98). There is very low evidence that the duration of day patient care (adjusted days/month) is longer for patients in day hospital care than inpatient care (3 RCTs, n = 265, WMD 2.34 days

  17. Previous hospital admissions and disease severity predict the use of antipsychotic combination treatment in patients with schizophrenia

    PubMed Central

    2011-01-01

    Background Although not recommended in treatment guidelines, previous studies have shown a frequent use of more than one antipsychotic agent among patients with schizophrenia. The main aims of the present study were to explore the antipsychotic treatment regimen among patients with schizophrenia in a catchment area-based sample and to investigate clinical characteristics associated with antipsychotic combination treatment. Methods The study included 329 patients diagnosed with schizophrenia using antipsychotic medication. Patients were recruited from all psychiatric hospitals in Oslo. Diagnoses were obtained by use of the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Additionally, Global Assessment of Functioning (GAF), Positive and Negative Syndrome Scale (PANSS) and number of hospitalisations and pharmacological treatment were assessed. Results Multiple hospital admissions, low GAF scores and high PANSS scores, were significantly associated with the prescription of combination treatment with two or more antipsychotics. The use of combination treatment increased significantly from the second hospital admission. Combination therapy was not significantly associated with age or gender. Regression models confirmed that an increasing number of hospital admission was the strongest predictor of the use of two or more antipsychotics. Conclusions Previous hospital admissions and disease severity measured by high PANSS scores and low GAF scores, predict the use of antipsychotic combination treatment in patients with schizophrenia. Future studies should further explore the use of antipsychotic drug treatment in clinical practice and partly based on such data establish more robust treatment guidelines for patients with persistently high symptom load. PMID:21812996

  18. Delay in hospital admission of patients with cerebral vein and dural sinus thrombosis.

    PubMed

    Ferro, José M; Lopes, M G; Rosas, M J; Fontes, J

    2005-01-01

    Factors influencing early hospital admission have been described for several stroke types but not for cerebral vein and dural sinus thrombosis (CVT). CVT is more difficult to diagnose than arterial stroke; delay in hospital admission may postpone CVT treatment. The purposes of this study were: (1) to describe the delay between the onset of symptoms and hospital admission of patients with CVT, and (2) to identify the variables that influence that delay. We registered the interval (days) between the onset of symptoms and hospital admission in 91 consecutive patients admitted to 20 Portuguese hospitals between June 1995 and June 1998. We also studied the impact of admission delay on treatments (prescription of anticoagulants and the number of days elapsed between the onset of symptoms and start of anticoagulation and admission). Median admission delay was 4 days. Twenty-two (25%) patients were admitted within 24 h. Two thirds of the patients were admitted within 7 days and 75% within 13 days. In multiple logistic regression analysis, admission within 24 h was positively associated with mental status disorder (delirium or abulia; OR = 4.59; 95% CI = 1.41-14.89) and negatively associated with headache (OR = 0.03; 95% CI = 0.00-0.32). Presentation as isolated intracranial hypertension was associated with admission delay of more than 4 days (OR = 2.63; 95% CI = 0.97-7.14). Papilloedema was associated with an admission delay of more than 13 days (OR = 4.69; 95% CI = 1.61-13.61). There was no association between admission delay and the proportion of anticoagulated patients. The interval between onset of symptoms and start of anticoagulation was shorter in patients admitted earlier (p = 0.0001, for either admission within 24 h, 4 or 13 days). There is a considerable delay until the clinical picture associated with CVT is recognised as justifying hospital admission, especially when patients present with symptoms identical to isolated intracranial hypertension syndrome. PMID

  19. Association between air pollution and hospital admission: Case study at three monitoring stations in Malaysia

    NASA Astrophysics Data System (ADS)

    Zahari, Marina; Zin@Ibrahim, Wan Zawiah Wan; Ismail, Noriszura; Ni, Tan Hui

    2014-06-01

    The relationships between the exposure of pollutants towards hospitalized admission and mortality have been identified in several studies on Asian cities such as Taipei, Bangkok and Tokyo. In Malaysia, evidence on the health risks associated with exposure to pollutants is limited. In this study, daily time-series data were analysed to estimate risks of cardiovascular and respiratory hospitalized admissions associated with particulate matter ≤ 10 μm (PM10), carbon monoxide (CO), nitrogen dioxide, sulphur dioxide, and ozone concentrations in Klang Valley during 2004-2009. Daily counts of hospital admissions for cardiovascular and respiratory outcomes were obtained from eleven hospitals while pollutants data were taken from several air quality monitoring stations located nearest to the hospitals. These data were fitted with Generalised Additive Poisson regression models. Additionally, temperature, humidity, and time data were also included to allow for potential effect of weather and time-varying influences on hospital admissions. CO showed the most significant (P < 0.05) relationship to cardiovascular admissions. An increment of 1 ppm in CO predicted an increase of 4% to 20% in cardiovascular admissions. Respiratory admissions were associated with PM10, which had about 1% increase in risk of admission per 10 ug/m3 increment in PM10. Exposure to CO and PM10 increases the risk of hospitalization for cardiovascular and respiratory illnesses in Klang Valley, Malaysia.

  20. Charges for hospital admissions attributable to health disparities for African-American patients, 1998-2002.

    PubMed Central

    Chumney, Elinor C. G.; Mauldin, Patrick D.; Simpson, Kit N.

    2006-01-01

    OBJECTIVE: Racial disparities exist across most major disease categories, which result in a disproportionately large number of hospital admissions for many conditions. Estimates for the financial impact of the racial admission differences for the State of South Carolina are assessed. METHODS: South Carolina hospital discharge data for 1998-2002 was used for the analysis. The database includes all-payer billing data for inpatient hospital admissions as received on the UB-92 billing file for the covered episode. Charges were inflation adjusted to 2002 constant dollars. RESULTS: For 1998-2002, there were an estimated dollar 1.6 billion in total charges for hospital admissions in South Carolina that were attributed to higher age-adjusted admission rates for African-American patients. In addition, African Americans had consistently higher hospital admission rates for disease categories that are often associated with a failure to obtain ambulatory and preventive care. CONCLUSION: This simple analysis reveals that age-adjusted hospital admission rates for African Americans in South Carolina are higher than for Caucasians, and the gap appears to be widening over time. Given the magnitude of the financial implication, interventions with even a small impact on the conditions underlying the racial disparities in hospital admissions are likely to be cost effective. PMID:16749643

  1. The effects of the 2009 dust storm on emergency admissions to a hospital in Brisbane, Australia

    NASA Astrophysics Data System (ADS)

    Barnett, Adrian G.; Fraser, John F.; Munck, Lynette

    2012-07-01

    In September 2009 an enormous dust storm swept across eastern Australia. Dust is potentially hazardous to health as it interferes with breathing, and previous dust storms have been linked to increased risks of asthma and even death. We examined whether the 2009 Australian dust storm changed the volume or characteristics of emergency admissions to hospital. We used an observational study design, using time series analyses to examine changes in the number of admissions, and case-only analyses to examine changes in the characteristics of admissions. The admission data were from the Prince Charles Hospital, Brisbane, between 1 January 2009 and 31 October 2009. There was a 39% increase in emergency admissions associated with the storm (95% confidence interval: 5, 81%), which lasted for just 1 day. The health effects of the storm could not be detected using particulate matter levels. We found no significant change in the characteristics of admissions during the storm; specifically, there was no increase in respiratory admissions. The dust storm had a short-lived impact on emergency hospital admissions. This may be because the public took effective avoidance measures, or because the dust was simply not toxic, being composed mainly of soil. Emergency departments should be prepared for a short-term increase in admissions during dust storms.

  2. Predictors and Outcomes of Infection-Related Hospital Admissions of Heart Failure Patients

    PubMed Central

    Korenfeld, Roman; Fuchs, Shmuel

    2013-01-01

    Background Infections are one of the most common causes for hospitalization of patients with heart failure (HF). Yet, little is known regarding the prevalence and predictors of different types of acute infections as well as their impact on outcome among this growing population. Methods and Results We identified all patients aged 50 or older with a major diagnosis of HF and at least one echocardiography examination who had been hospitalized over a 10-year period (January 2000 and December 2009). Infection-associated admissions were identified according to discharge diagnoses. Among 9,335 HF patients, 3530 (38%) were hospitalized at least once due to infections. The most frequent diagnoses were respiratory infection (52.6%) and sepsis/bacteremia (23.6%) followed by urinary (15.7%) and skin and soft tissue infections (7.8%). Hospitalizations due to infections compared to other indications were associated with increased 30-day mortality (13% vs. 8%, p<0.0001). These higher mortality rates were predominately related to respiratory infections (OR 1.28 [95% CI 1.09, 1.5]) and sepsis\\bacteremia (OR 3.13 [95% CI 2.6, 3.7]). Important predictors for these serious infections included female gender, chronic obstructive pulmonary disease, past myocardial infarction and echocardiography-defined significant right (RV) but not left ventricular dysfunction. Conclusions Major infection-related hospitalizations are frequent among patients with HF and are associated with increased mortality rates. Elderly female patients with multiple comorbidities and those with severe RV dysfunction are at higher risk for these infections. PMID:24009684

  3. Impact of rotavirus disease in Spain: an estimate of hospital admissions due to rotavirus.

    PubMed

    Visser, L E; Cano Portero, R; Gay, N J; Martínez Navarro, J F

    1999-01-01

    The epidemiology of rotavirus infection in Spain was investigated using information from existing surveillance systems. Reports from laboratories and data on hospital admissions were used to estimate the number of hospital admissions due to rotavirus infection. Between January 1989 and December 1995 there were 8265 reports of rotavirus identification in the Sistema de Información Microbiológica, a voluntary national laboratory surveillance system. Where age was reported, 89.2% were in children under 5 y old. This represents 21.8% of all pathogens identified in faecal specimens in children of this age group. Between January and December 1994 there were 5639 admissions coded as "infectious intestinal disease" and 8225 as "non-infective gastroenteritis" in children under 5 y of age in the Conjunto Mínimo Básico de Datos, an obligatory hospital admissions surveillance system which covers 83% of public hospitals. Using regression analysis of admission data and laboratory reports it was estimated that rotavirus infection accounted for 3519 (25.3%) of the hospital admissions. We estimate that 4239 admissions attributable to rotavirus occurred in children under 5 y of age in Spain in 1994, a rate of 2.5/1000 population in this age group. These estimates are lower than those published for other countries, where the burden of disease is considered high enough to warrant a national vaccination programme. A cost-effectiveness study with Spanish information is essential before embarking on a national vaccination programme. PMID:10088916

  4. The association between depressive symptoms in the community, non-psychiatric hospital admission and hospital outcomes: A systematic review

    PubMed Central

    Prina, A. Matthew; Cosco, Theodore D.; Dening, Tom; Beekman, Aartjan; Brayne, Carol; Huisman, Martijn

    2015-01-01

    Objectives This paper aims to systematically review observational studies that have analysed whether depressive symptoms in the community are associated with higher general hospital admissions, longer hospital stays and increased risk of re-admission. Methods We identified prospective studies that looked at depressive symptoms in the community as a risk factor for non-psychiatric general hospital admissions, length of stay or risk of re-admission. The search was carried out on MEDLINE, PsycINFO, Cochrane Library Database, and followed up with contact with authors and scanning of reference lists. Results Eleven studies fulfilled our inclusion and exclusion criteria, and all were deemed to be of moderate to high quality. Meta-analysis of seven studies with relevant data suggested that depressive symptoms may be a predictor of subsequent admission to a general hospital in unadjusted analyses (RR = 1.36, 95% CI: 1.28–1.44), but findings after adjustment for confounding variables were inconsistent. The narrative synthesis also reported depressive symptoms to be independently associated with longer length of stay, and higher re-admission risk. Conclusions Depressive symptoms are associated with a higher risk of hospitalisation, longer length of stay and a higher re-admission risk. Some of these associations may be mediated by other factors, and should be explored in more details. PMID:25466985

  5. Clinical outcomes and mortality associated with weekend admission to psychiatric hospital

    PubMed Central

    Patel, Rashmi; Chesney, Edward; Cullen, Alexis E.; Tulloch, Alex D.; Broadbent, Matthew; Stewart, Robert; McGuire, Philip

    2016-01-01

    Background Studies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. However, less is known about clinical outcomes among patients admitted to psychiatric hospitals. Aims To investigate whether weekend admission to a psychiatric hospital is associated with worse clinical outcomes. Method Data were obtained from 45 264 consecutive psychiatric hospital admissions. The association of weekend admission with in-patient mortality, duration of hospital admission and risk of readmission was investigated using multivariable regression analyses. Secondary analyses were performed to investigate the distribution of admissions, discharges, in-patient mortality, episodes of seclusion and violent incidents on different days of the week. Results There were 7303 weekend admissions (16.1%). Patients who were aged between 26 and 35 years, female or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals and the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (B coefficient −21.1 days, 95% CI −24.6 to −17.6, P<0.001) and an increased risk of readmission in the 12 months following index admission (incidence rate ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23, P = 0.30) was not greater than for weekday admission. Fewer episodes of seclusion occurred at the weekend but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week. Conclusions Being admitted at the weekend was not associated with an increased risk of in-patient mortality. However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that they may represent a

  6. Impact of childhood trauma on risk of relapse requiring psychiatric hospital admission for psychosis.

    PubMed

    Petros, N; Foglia, E; Klamerus, E; Beards, S; Murray, R M; Bhattacharyya, S

    2016-08-01

    Relapse in psychosis typically necessitates admission to hospital placing a significant financial burden on the health service. Exposure to childhood trauma is associated with an increased risk of psychosis, however, the extent to which this influences relapse is unclear. This report summarises current research investigating the influence of childhood trauma on relapse requiring psychiatric hospital admission for psychosis. Seven studies were included; two revealed a positive association between childhood trauma and relapse admission, two studies found a negative relationship and three found no significant difference. Inconsistent current evidence suggests a need for further research in this area. PMID:27151070

  7. Caregivers' perceptions of coercion in psychiatric hospital admission.

    PubMed

    Ranieri, Veronica; Madigan, Kevin; Roche, Eric; Bainbridge, Emma; McGuinness, David; Tierney, Kevin; Feeney, Larkin; Hallahan, Brian; McDonald, Colm; O'Donoghue, Brian

    2015-08-30

    While knowledge on service users' perspective on their admissions to psychiatric wards has improved substantially in the last decade, there is a paucity of knowledge of the perspectives of caregivers. This study aimed to determine caregiver's perception of the levels of perceived coercion, perceived pressures and procedural justice experienced by service users during their admission to acute psychiatric in-patient units. The perspective of caregivers were then compared to the perspectives of their related service users, who had been admitted to five psychiatric units in Ireland. Caregivers were interviewed using an adapted version of the MacArthur admission experience interview. Sixty-six caregivers participated in this study and the majority were parents. Seventy one percent of service users were admitted involuntarily and nearly half had a diagnosis of schizophrenia or schizoaffective disorder. Caregivers of involuntarily admitted individuals perceived the service users' admission as less coercive than reported by the service users. Caregivers also perceived a higher level of procedural justice in comparison to the level reported by service users. Reducing the disparity of perceptions between caregivers and service users could result in caregivers having a greater understanding of the admission process and why some service users may be reluctant to be admitted. PMID:26163727

  8. Concordance of effects of medical interventions on hospital admission and readmission rates with effects on mortality

    PubMed Central

    Hemkens, Lars G.; Contopoulos-Ioannidis, Despina G.; Ioannidis, John P.A.

    2013-01-01

    Background: Many clinical trials examine a composite outcome of admission to hospital and death, or infer a relationship between hospital admission and survival benefit. This assumes concordance of the outcomes “hospital admission” and “death.” However, whether the effects of a treatment on hospital admissions and readmissions correlate to its effect on serious outcomes such as death is unknown. We aimed to assess the correlation and concordance of effects of medical interventions on admission rates and mortality. Methods: We searched the Cochrane Database of Systematic Reviews from its inception to January 2012 (issue 1, 2012) for systematic reviews of treatment comparisons that included meta-analyses for both admission and mortality outcomes. For each meta-analysis, we synthesized treatment effects on admissions and death, from respective randomized trials reporting those outcomes, using random-effects models. We then measured the concordance of directions of effect sizes and the correlation of summary estimates for the 2 outcomes. Results: We identified 61 meta-analyses including 398 trials reporting mortality and 182 trials reporting admission rates; 125 trials reported both outcomes. In 27.9% of comparisons, the point estimates of treatment effects for the 2 outcomes were in opposite directions; in 8.2% of trials, the 95% confidence intervals did not overlap. We found no significant correlation between effect sizes for admission and death (Pearson r = 0.07, p = 0.6). Our results were similar when we limited our analysis to trials reporting both outcomes. Interpretation: In this metaepidemiological study, admission and mortality outcomes did not correlate, and discordances occurred in about one-third of the treatment comparisons included in our analyses. Both outcomes convey useful information and should be reported separately, but extrapolating the benefits of admission to survival is unreliable and should be avoided. PMID:24144601

  9. Mold sensitization is common amongst patients with severe asthma requiring multiple hospital admissions

    PubMed Central

    O'Driscoll, B Ronan; Hopkinson, Linda C; Denning, David W

    2005-01-01

    Background Multiple studies have linked fungal exposure to asthma, but the link to severe asthma is controversial. We studied the relationship between asthma severity and immediate type hypersensitivity to mold (fungal) and non-mold allergens in 181 asthmatic subjects. Methods We recruited asthma patients aged 16 to 60 years at a University hospital and a nearby General Practice. Patients were categorized according to the lifetime number of hospital admissions for asthma (82 never admitted, 53 one admission, 46 multiple admissions). All subjects had allergy skin prick tests performed for 5 mold allergens (Aspergillus, Alternaria, Cladosporium, Penicillium and Candida) and 4 other common inhalant allergens (D. pteronyssinus, Grass Pollen, Cat and Dog). Results Skin reactivity to all allergens was commonest in the group with multiple admissions. This trend was strongest for mold allergens and dog allergen and weakest for D. pteronyssinus. 76% of patients with multiple admissions had at least one positive mold skin test compared with 16%-19% of other asthma patients; (Chi squared p < 0.0001). Multiple mold reactions were also much commoner in the group with multiple admissions (50% V 5% and 6%; p < 0.0001). The number of asthma admissions was related to the number and size of positive mold skin allergy tests (Spearman Correlation Coefficient r = 0.60, p < 0.0001) and less strongly correlated to the number and size of non-mold allergy tests (r = 0.34, p = 0.0005). Hospital admissions for asthma patients aged 16–40 were commonest during the mold spore season (July to October) whereas admissions of patients aged above 40 peaked in November-February (Chi Squared, p < 0.02). Conclusion These findings support previous suggestions that mold sensitization may be associated with severe asthma attacks requiring hospital admission. PMID:15720706

  10. Heat, Heat Waves, and Hospital Admissions among the Elderly in the United States, 1992–2006

    PubMed Central

    Zanobetti, Antonella; Schwartz, Joel D.; Wellenius, Gregory A.; O’Neill, Marie S.

    2014-01-01

    Background: Heat-wave frequency, intensity, and duration are increasing with global climate change. The association between heat and mortality in the elderly is well documented, but less is known regarding associations with hospital admissions. Objectives: Our goal was to determine associations between moderate and extreme heat, heat waves, and hospital admissions for nonaccidental causes among Medicare beneficiaries ≥ 65 years of age in 114 cities across five U.S. climate zones. Methods: We used Medicare inpatient billing records and city-specific data on temperature, humidity, and ozone from 1992 through 2006 in a time-stratified case-crossover design to estimate the association between hospitalization and moderate [90th percentile of apparent temperature (AT)] and extreme (99th percentile of AT) heat and heat waves (AT above the 95th percentile over 2–8 days). In sensitivity analyses, we additionally considered confounding by ozone and holidays, different temperature metrics, and alternate models of the exposure–response relationship. Results: Associations between moderate heat and hospital admissions were minimal, but extreme heat was associated with a 3% (95% CI: 2%, 4%) increase in all-cause hospital admissions over the subsequent 8 days. In cause-specific analyses, extreme heat was associated with increased hospitalizations for renal (15%; 95% CI: 9%, 21%) and respiratory (4%; 95% CI: 2%, 7%) diseases, but not for cardiovascular diseases. An added heat-wave effect was observed for renal and respiratory admissions. Conclusion: Extreme heat is associated with increased hospital admissions, particularly for renal causes, among the elderly in the United States. Citation: Gronlund CJ, Zanobetti A, Schwartz JD, Wellenius GA, O’Neill MS. 2014. Heat, heat waves, and hospital admissions among the elderly in the United States, 1992–2006. Environ Health Perspect 122:1187–1192; http://dx.doi.org/10.1289/ehp.1206132 PMID:24905551

  11. Main clinical features in patients at their first psychiatric admission to Italian acute hospital psychiatric wards. The PERSEO study

    PubMed Central

    Ballerini, Andrea; Boccalon, Roberto M; Boncompagni, Giancarlo; Casacchia, Massimo; Margari, Francesco; Minervini, Lina; Righi, Roberto; Russo, Federico; Salteri, Andrea; Frediani, Sonia; Rossi, Andrea; Scatigna, Marco

    2007-01-01

    Background Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients in Italian acute hospital psychiatric wards, called SPDCs (Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management). Method Cross-sectional observational multi-center study involving 62 Italian SPDCs (PERSEO – Psychiatric EmeRgency Study and EpidemiOlogy). Results 253 FPA aged <= 40 were identified among 2521 patients admitted to Italian SPDCs over the 5-month study period. About half of FPA patients showed an aggressive behavior as defined by a Modified Overt Aggression Scale (MOAS) score greater than 0 Vs 46% of non-FPA patients (p = 0.3651). The most common was verbal aggression, while about 20% of FPA patients actually engaged in physical aggression against other people. 74% of FPA patients had no diagnosis at admission, while 40% had received a previous psychopharmacological treatment, mainly benzodiazepines and antidepressants. During SPDC stay, diagnosis was established in 96% of FPA patients and a pharmacological therapy was prescribed to 95% of them, mainly benzodiazepines, antipsychotics and mood stabilizers. Conclusion Subjects presenting at their first psychiatric ward admission have often not undergone previous adequate psychiatric assessment and diagnostic procedures. The first hospital admission allows diagnosis and psychopharmacological treatment to be established. In our population, aggressive behaviors were rather frequent, although most commonly verbal. Psychiatric symptoms, as evaluated by psychiatrists and patients, improved

  12. The Frequent Fliers of New Mexico: Hospital Readmissions among the Homeless Population.

    PubMed

    Dirmyer, Victoria F

    2016-07-01

    It is estimated that there are 1.7 million homeless individuals in the United States; 36% are families with children under the age of 18. Due to lack of resources, individuals who are homeless frequent emergency departments for immediate health care needs. The aim of this study was to examine a homeless population over a 3-year time period who were admitted to an Albuquerque area hospital at any time during the time period. A comparison of demographic characteristics as well as hospitalization characteristics between two populations was analyzed: individuals who were homeless and had a 30-day readmission compared to those that did not have a 30-day readmission. There were 850 unique homeless patients that were admitted to an Albuquerque area hospital during the 3-year time period. The mean age was 43.8 years with the majority of the population being male. The 3-year average 30-day readmission rate was 30.1%. Multivariate regression analysis indicated that homeless patients older than 19 years, individuals with more than 1 admission during the time period, and individuals who left against medical advice had increased odds of a 30-day readmission. Individuals who were homeless who were admitted for respiratory conditions or cardiovascular disease had decreased odds of a 30-day readmission compared to patients admitted for neuropsychiatric conditions. In New Mexico, patients who were homeless experienced a high 30-day readmission rate. These results suggest a need for further research into the healthcare needs of this population and how to improve discharge protocols to prevent future readmissions. PMID:27105057

  13. Temporal dynamics of emergency department and hospital admissions of pediatric asthmatics

    NASA Technical Reports Server (NTRS)

    Kimes, Daniel; Levine, Elissa; Timmins, Sidey; Weiss, Sheila R.; Bollinger, Mary E.; Blaisdell, Carol

    2004-01-01

    Asthma is a chronic disease that can result in exacerbations leading to urgent care in emergency departments (EDs) and hospitals. We examined seasonal and temporal trends in pediatric asthma ED (1997-1999) and hospital (1986-1999) admission data so as to identify periods of increased risk of urgent care by age group, gender, and race. All pediatric ED and hospital admission data for Maryland residents occurring within the state of Maryland were evaluated. Distinct peaks in pediatric ED and hospital asthma admissions occurred each year during the winter-spring and autumn seasons. Although the number and timing of these peaks were consistent across age and racial groups, the magnitude of the peaks differed by age and race. The same number, timing, and relative magnitude of the major peaks in asthma admissions occurred statewide, implying that the variables affecting these seasonal patterns of acute asthma exacerbations occur statewide. Similar gross seasonal trends are observed worldwide. Although several environmental, infectious, and psychosocial factors have been linked with increases in asthma exacerbations among children, thus far they have not explained these seasonal patterns of admissions. The striking temporal patterns of pediatric asthma admissions within Maryland, as described here, provide valuable information in the search for causes.

  14. Affective disorders, hospital admissions, and seasonal variation of mania in a subtropical area, southern hemisphere.

    PubMed

    Kerr-Corrêa, F; Souza, L B; Calil, H M

    1998-01-01

    Hospital admissions (n = 15,450) to a state psychiatric hospital in Botucatu, São Paulo State, Brazil, over a 10-year period (1982-1991) were reviewed. 157 (1%) patients received a probable diagnosis of affective disorder according to DSM-III-R criteria. Among them, 46% had been diagnosed by the staff psychiatrists, and their diagnoses were sustained by the researchers, whereas 54% were diagnosed only by one of the researchers (F.K.C.). These last patients had previously received a diagnosis of paranoid schizophrenia or unspecified psychosis (ICD-9). Most of the patients with affective disorders were bipolar: 72 and 8%, respectively, presented manic and depressive episodes. Thus, only 20% received a diagnosis of major depression. A seasonal pattern in hospital admission was observed only for mania in women, their episodes occurring more often (p < 0.02) in spring and summer. No significant seasonal pattern in hospital admission for depression was found. PMID:9730786

  15. Assessment and prediction of short term hospital admissions: the case of Athens, Greece

    NASA Astrophysics Data System (ADS)

    Kassomenos, P.; Papaloukas, C.; Petrakis, M.; Karakitsios, S.

    The contribution of air pollution on hospital admissions due to respiratory and heart diseases is a major issue in the health-environmental perspective. In the present study, an attempt was made to run down the relationships between air pollution levels and meteorological indexes, and corresponding hospital admissions in Athens, Greece. The available data referred to a period of eight years (1992-2000) including the daily number of hospital admissions due to respiratory and heart diseases, hourly mean concentrations of CO, NO 2, SO 2, O 3 and particulates in several monitoring stations, as well as, meteorological data (temperature, relative humidity, wind speed/direction). The relations among the above data were studied through widely used statistical techniques (multivariate stepwise analyses) and Artificial Neural Networks (ANNs). Both techniques revealed that elevated particulate concentrations are the dominant parameter related to hospital admissions (an increase of 10 μg m -3 leads to an increase of 10.2% in the number of admissions), followed by O 3 and the rest of the pollutants (CO, NO 2 and SO 2). Meteorological parameters also play a decisive role in the formation of air pollutant levels affecting public health. Consequently, increased/decreased daily hospital admissions are related to specific types of meteorological conditions that favor/do not favor the accumulation of pollutants in an urban complex. In general, the role of meteorological factors seems to be underestimated by stepwise analyses, while ANNs attribute to them a more important role. Comparison of the two models revealed that ANN adaptation in complicate environmental issues presents improved modeling results compared to a regression technique. Furthermore, the ANN technique provides a reliable model for the prediction of the daily hospital admissions based on air quality data and meteorological indices, undoubtedly useful for regulatory purposes.

  16. Determinants of hospital admission among HIV-positive people in British Columbia

    PubMed Central

    Weber, A E; Yip, B; O'Shaughnessy, M V; Montaner, J S; Hogg, R S

    2000-01-01

    BACKGROUND: This study was initiated to evaluate the demographic and clinical determinants of admission to hospital among HIV-positive men and women receiving antiretroviral therapy in British Columbia. METHODS: The analysis was restricted to participants enrolled in the HIV/AIDS Drug Treatment Program between September 1992 and March 1997 who had completed an annual participant survey, had a viral load determination and had signed a consent form allowing electronic access to their inpatient hospital records. A record linkage was conducted with the BC Ministry of Health to obtain all records of hospital admissions from April 1991 to March 1997. Statistical analyses were carried out using parametric and nonparametric methods and multivariate logistic analyses. RESULTS: The study sample comprised 947 participants (859 men, 88 women). Of these, 165 (17%) were admitted to hospital during the study period from May 1, 1996, to Mar. 31, 1997. The median number of admissions was 1 (interquartile range [IQR] 1-2 admissions), and the median length of stay per admission was 3 days (IQR 1-8 days). Admission to hospital was associated with being unemployed (82% of those admitted v. 58% of those not admitted), being an injection drug user (24% v. 17%), reporting a fair or poor health status (46% v. 29%) and having a physician experienced in the management of HIV/AIDS (31% v. 24%). Examination of clinical determinants demonstrated that hospital admission was associated with a previous admission (72% v. 46%), a high viral load (median 74,000 v. 14,000 HIV-1 RNA copies/mL), a low CD4 count (median 0.16 v. 0.27 x 10(9)/L) and an AIDS diagnosis (44% v. 24%). Multivariate logistic regression analysis revealed that being admitted to hospital was independently associated with being unemployed (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.66-4.20), having been previously admitted to hospital (OR 2.30, 95% CI 1.53-3.46), having a high viral load at baseline (OR 1.45, 95% CI 1

  17. Hospital admissions before the age of 2 years in Western Australia.

    PubMed Central

    Read, A W; Gibbins, J; Stanley, F J; Morich, P

    1994-01-01

    A linked data file of birth records and hospital admissions was used to investigate inpatient hospital morbidity before 2 years of age for all non-Aboriginal and Aboriginal children born in Western Australia in 1986. Of the non-Aboriginal children, 31.8% were admitted to hospital at least once before the age of 2 years, with an overall admission rate of 526/1000 live births; the corresponding figures for Aboriginal children were 68.7% and 2797. The mean number of days in hospital for each non-Aboriginal child admitted was 7.4, and 26.5 for Aboriginal children. Of the total cohort, 21% of non-Aboriginal and 20% of Aboriginal children were admitted only once, and 4% of non-Aboriginal and 36% of Aboriginal children were admitted at least three times; 23% of non-Aboriginal and 24% of Aboriginal children were admitted for only one major disease category, and 1% of non-Aboriginal and 16% of Aboriginal children were in at least four categories. The highest admission rates and highest percentages of the cohort admitted were for gastrointestinal and respiratory diseases and social admissions. These results illustrate the importance for both descriptive and analytical research of relating admissions to hospital for the total population to the individual child, and of using clinically relevant disease classifications. PMID:8135564

  18. The impact of primary care organization on avoidable hospital admissions for diabetes in 23 countries

    PubMed Central

    Van Loenen, Tessa; Faber, Marjan J.; Westert, Gert P.; Van den Berg, Michael J.

    2016-01-01

    Objective Diabetes is a so-called ambulatory care sensitive condition. It is assumed that by appropriate and timely primary care, hospital admissions for complications of such conditions can be avoided. This study examines whether differences between countries in diabetes-related hospitalization rates can be attributed to differences in the organization of primary care in these countries. Design Data on characteristics of primary care systems were obtained from the QUALICOPC study that includes surveys held among general practitioners and their patients in 34 countries. Data on avoidable hospitalizations were obtained from the OECD Health Care Quality Indicator project. Negative binomial regressions were carried out to investigate the association between characteristics of primary care and diabetes-related hospitalizations. Setting A total of 23 countries. Subjects General practitioners and patients. Main outcome measures Diabetes-related avoidable hospitalizations. Results Continuity of care was associated with lower rates of diabetes-related hospitalization. Broader task profiles for general practitioners and more medical equipment in general practice were associated with higher rates of admissions for uncontrolled diabetes. Countries where patients perceive better access to care had higher rates of hospital admissions for long-term diabetes complications. There was no association between disease management programmes and rates of diabetes-related hospitalization. Hospital bed supply was strongly associated with admission rates for uncontrolled diabetes and long-term complications. Conclusions Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related hospitalizations. Hospital bed supply appeared to be a very important factor in this relationship. Apparently, it takes more than strong primary care to avoid hospitalizations. Key pointsCountries with elements of strong primary care do not necessarily have lower rates of

  19. Religious coping and hospital admissions among adults with sickle cell disease

    PubMed Central

    Bediako, Shawn M.; Lattimer, Lakshmi; Haywood, Carlton; Ratanawongsa, Neda; Lanzkron, Sophie; Beach, Mary Catherine

    2011-01-01

    Although a well-established literature implicates religiosity as a central element of the African American experience, little is known about how individuals from this group utilize religion to cope with specific health-related stressors. The present study examined the relation between religious coping and hospital admissions among a cohort of 95 adults with sickle cell disease—a genetic blood disorder that, in the United States, primarily affects people of African ancestry. Multiple regression analyses indicated that positive religious coping uniquely accounted for variance in hospital admissions after adjusting for other demographic and diagnostic variables. Specifically, greater endorsement of positive religious coping was associated with significantly fewer hospital admissions (β = −.29, P<.05). These results indicate a need for further investigation of the roles that religion and spirituality play in adjustment to sickle cell disease and their influence on health care utilization patterns and health outcomes. PMID:20812027

  20. From hospital admission to independent living: is prediction possible?

    PubMed

    Lipskaya-Velikovsky, Lena; Kotler, Moshe; Easterbrook, Adam; Jarus, Tal

    2015-04-30

    An integral component of recovery from mental illness is being able to engage in everyday activities. This ability is often restricted among people with schizophrenia. Although functional deficits are addressed during hospitalization, the ability to predict daily functioning based on information gathered during hospitalization has not been well established. This study examines whether measurements completed during hospitalization can be useful for predicting independent living within the community. Inpatients with schizophrenia (N=104) were enrolled in the study and assessed for cognitive functioning, functional capacity and symptoms. They were approached again 6 months after discharge to evaluate their functioning with respect to everyday life Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL). Functional capacity during hospitalization predicted 26.8% of ADL functioning and 38.8% of IADL functioning. ADL was best predicted by the severity of negative symptoms, cognitive functioning, and the number of hospitalizations (51.2%), while IADL was best predicted by functional capacity, cognition, and number of hospitalizations (60.1%). This study provides evidence that evaluations during hospitalization can be effective, and demonstrates the advantage of a holistic approach in predicting daily functioning. When a holistic approach is not practical, a functional capacity measurement may serve as an effective predictor. PMID:25747682

  1. Air pollution and hospital admissions for asthma in a tropical city: Kaohsiung, Taiwan

    SciTech Connect

    Shang-Shyue Tsai; Meng-Hsuan Cheng; Hui-Fen Chiu; Trong-Neng Wu; Chun-Yuh Yang

    2006-07-15

    This study was undertaken to determine whether there is an association between air pollutants levels and hospital admissions for asthma in Kaohsiung, Taiwan. Hospital admissions for asthma and ambient air pollution data for Kaohsiung were obtained for the period from 1996 through 2003. The relative risk of hospital admission was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single-pollutant models, on warm days ({>=}25{sup o}C) statistically significant positive associations were found in all pollutants except sulfur dioxide. On cool days ({<=} 25{sup o}C) all pollutants were significantly associated with asthma admissions. For the two pollutant models, CO and O{sub 3} were significant in combination with each of the other four pollutants on warm days. On cool days NO{sub 2} remained statistically significant in all the two-pollutant models. This study provides evidence that higher levels of ambient pollutants increase the risk of hospital admissions for asthma.

  2. Effects of diurnal temperature range on cardiovascular and respiratory hospital admissions in Korea.

    PubMed

    Lim, Youn-Hee; Hong, Yun-Chul; Kim, Ho

    2012-02-15

    The effects of heat and cold waves have been studied as risk factors for cardiovascular and respiratory diseases. However, few studies have examined the effect of diurnal temperature changes on health. We hypothesized that the diurnal temperature range (DTR) may affect the rate of hospital admissions for cardiovascular- and respiratory-related diseases, and therefore investigated the risk of hospital admissions of cardiovascular (stroke, myocardial infarction, ischemic heart disease, cardiac failure, cardiac disease, and arrhythmia) and respiratory (asthma, chronic obstructive pulmonary disease, and pneumonia) diseases attributable to DTR in four metropolitan areas in Korea during 2003-2006. The area-combined effects of DTR on some cardiovascular and respiratory diseases were significantly increased by an increment of DTR. In particular, the effects on cardiac failure and asthma were significant with the percentage change of hospital admissions per 1 °C increment of DTR at 3.0% (95% CI, 1.4-4.6) and 1.1% (95% CI, 0.1-2.0), respectively, among 9 diseases. For those 75 years and older, the DTR effect on asthma admissions was greater than in those aged under 75 years. These results support the hypothesis of a positive association between DTR and cardiovascular and respiratory hospital admission. PMID:22281041

  3. Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data

    PubMed Central

    Cowling, Thomas E; Harris, Matthew; Watt, Hilary; Soljak, Michael; Richards, Emma; Gunning, Elinor; Bottle, Alex; Macinko, James; Majeed, Azeem

    2016-01-01

    Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. Objective To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department. Methods Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. Results The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Conclusions Among hospital inpatients admitted as an emergency, patients

  4. Childhood Malaria Admission Rates to Four Hospitals in Malawi between 2000 and 2010

    PubMed Central

    Okiro, Emelda A.; Kazembe, Lawrence N.; Kabaria, Caroline W.; Ligomeka, Jeffrey; Noor, Abdisalan M.; Ali, Doreen; Snow, Robert W.

    2013-01-01

    Introduction The last few years have witnessed rapid scaling-up of key malaria interventions in several African countries following increases in development assistance. However, there is only limited country-specific information on the health impact of expanded coverage of these interventions. Methods Paediatric admission data were assembled from 4 hospitals in Malawi reflecting different malaria ecologies. Trends in monthly clinical malaria admissions between January 2000 and December 2010 were analysed using time-series models controlling for covariates related to climate and service use to establish whether changes in admissions can be related to expanded coverage of interventions aimed at reducing malaria infection. Results In 3 of 4 sites there was an increase in clinical malaria admission rates. Results from time series models indicate a significant month-to-month increase in the mean clinical malaria admission rates at two hospitals (trend P<0.05). At these hospitals clinical malaria admissions had increased from 2000 by 41% to 100%. Comparison of changes in malaria risk and ITN coverage appear to correspond to a lack of disease declines over the period. Changes in intervention coverage within hospital catchments showed minimal increases in ITN coverage from <6% across all sites in 2000 to maximum of 33% at one hospital site by 2010. Additionally, malaria transmission intensity remained unchanged between 2000–2010 across all sites. Discussion Despite modest increases in coverage of measures to reduce infection there has been minimal changes in paediatric clinical malaria cases in four hospitals in Malawi. Studies across Africa are increasingly showing a mixed set of impact results and it is important to assemble more data from more sites to understand the wider implications of malaria funding investment. We also caution that impact surveillance should continue in areas where intervention coverage is increasing with time, for example Malawi, as decline may

  5. Hospital Admission following Induced Abortion in Eastern Highlands Province, Papua New Guinea – A Descriptive Study

    PubMed Central

    Vallely, Lisa M.; Homiehombo, Primrose; Kelly-Hanku, Angela; Kumbia, Antonia; Mola, Glen D. L.; Whittaker, Andrea

    2014-01-01

    Background In Papua New Guinea abortion is restricted under the Criminal Code Act. While safe abortions should available in certain situations, frequently they are not available to the majority of women. Sepsis from unsafe abortion is a leading cause of maternal mortality. Our findings form part of a wider, mixed methods study designed to identify complications requiring hospital treatment for post abortion care and to explore the circumstances surrounding unsafe abortion. Methods Through a six month prospective study we identified all women presenting to the Eastern Highlands Provincial Hospital following spontaneous and induced abortions. We undertook semi-structured interviews with women and reviewed individual case notes, extracting demographic and clinical information. Findings Case notes were reviewed for 56% (67/119) of women presenting for post abortion care. At least 24% (28/119) of these admissions were due to induced abortion. Women presenting following induced abortions were significantly more likely to be younger, single, in education at the time of the abortion and report that the baby was unplanned and unwanted, compared to those reporting spontaneous abortion. Obtained illegally, misoprostol was the method most frequently used to end the pregnancy. Physical and mechanical means and traditional herbs were also widely reported. Conclusion In a country with a low contraceptive prevalence rate and high unmet need for family planning, all reproductive age women need access to contraceptive information and services to avoid, postpone or space pregnancies. In the absence of this, women are resorting to unsafe means to end an unwanted pregnancy, putting their lives at risk and putting an increased strain on an already struggling health system. Women in this setting need access to safe, effective means of abortion. PMID:25329982

  6. Paediatric admissions to the British military hospital at Camp Bastion, Afghanistan

    PubMed Central

    Arul, GS; Reynolds, J; DiRusso, S; Scott, A; Bree, S; Templeton, P; Midwinter, MJ

    2012-01-01

    INTRODUCTION International humanitarian law requires emergency medical support for both military personnel and civilians, including children. Here we present a detailed review of paediatric admissions with the pattern of injury and the resources they consume. METHODS All paediatric admissions to the hospital at Camp Bastion between 1 January and 29 April 2011 were analysed prospectively. Data collected included time and date of admission, patient age and weight, mechanism of injury, extent of wounding, treatment, length of hospital stay and discharge destination. RESULTS Eighty-five children (65 boys and 17 girls, median age: 8 years, median weight: 20kg) were admitted. In 63% of cases the indication for admission was battle related trauma and in 31% non-battle trauma. Of the blast injuries, 51% were due to improvised explosive devices. Non-battle emergencies were mainly due to domestic burns (46%) and road traffic accidents (29%). The most affected anatomical area was the extremities (44% of injuries). Over 30% of patients had critical injuries. Operative intervention was required in 74% of cases. The median time to theatre for all patients was 52 minutes; 3 patients with critical injuries went straight to theatre in a median of 7 minutes. A blood transfusion was required in 27 patients; 6 patients needed a massive transfusion. Computed tomography was performed on 62% of all trauma admissions and 40% of patients went to the intensive care unit. The mean length of stay was 2 days (range: 1–26 days) and there were 7 deaths. CONCLUSIONS Paediatric admissions make up a small but significant part of admissions to the hospital at Camp Bastion. The proportion of serious injuries is very high in comparison with admissions to a UK paediatric emergency department. The concentration of major injuries means that lessons learnt in terms of teamwork, the speed of transfer to theatre and massive transfusion protocols could be applied to UK paediatric practice. PMID:22524930

  7. Admission to psychiatric hospital in the early and late postpartum periods: Scottish national linkage study

    PubMed Central

    Langan Martin, Julie; McLean, Gary; Cantwell, Roch; Smith, Daniel J

    2016-01-01

    Objective To describe weekly admission rates for affective and non-affective psychosis, major depression and other psychiatric disorders in the early and late postpartum periods. To assess the impact of socioeconomic status, age and parity on admission rates. Methods Scottish maternity records were linked to psychiatric hospital admissions. 3290 pregnancy-related psychiatric admissions were assessed. Weekly admission rates were calculated for the pregnancy period, early postpartum period (6 weeks after birth) and late postpartum period (up to 2 years after birth), and compared with pre-pregnancy rates (up to 2 years before pregnancy). Admission rates were generated by calculating the total number of admissions for each time period divided by the number of weeks in the period. Incidence rate ratios (IRRs) were generated for each time period, using deprivation, age, parity and record of previous psychiatric hospital care-adjusted Poisson regression models. Results Women from more deprived social quintiles accounted for the largest proportion of admissions across all time periods. Compared with pre-pregnancy period, admission rates fell during pregnancy, increased markedly during the early postpartum period, and remained elevated for 2 years after childbirth. Within the most affluent quintile, admission IRRs were higher in the early postpartum period (IRR=1.29, 95% CI 1.02 to 1.59) than in the late postpartum period (IRR=0.87, 95% CI 0.74 to 0.98). For the late postpartum period, there was a positive association between higher maternal age and admission IRRs (ages 20–35 years, IRR=1.35, 95% CI 1.16 to 1.54 and age>40 years IRR=1.72, 95% CI 1.41 to 2.09). Conclusions Rates of psychiatric admission fell during pregnancy and increased in the early postpartum period (particularly during the first 2 weeks after birth), and remained elevated above baseline during the 2-year late postpartum period. An understanding of how social deprivation, age and parity

  8. Influences on hospital admission for asthma in south Asian and white adults: qualitative interview study

    PubMed Central

    Griffiths, Chris; Kaur, Gurmit; Gantley, Madeleine; Feder, Gene; Hillier, Sheila; Goddard, Jill; Packe, Geoff

    2001-01-01

    Objective To explore reasons for increased risk of hospital admission among south Asian patients with asthma. Design Qualitative interview study using modified critical incident technique and framework analysis. Setting Newham, east London, a deprived area with a large mixed south Asian population. Participants 58 south Asian and white adults with asthma (49 admitted to hospital with asthma, 9 not admitted); 17 general practitioners; 5 accident and emergency doctors; 2 out of hours general practitioners; 1 asthma specialist nurse. Main outcome measures Patients' and health professionals' views on influences on admission, events leading to admission, general practices' organisation and asthma strategies, doctor-patient relationship, and cultural attitudes to asthma. Results South Asian and white patients admitted to hospital coped differently with asthma. South Asians described less confidence in controlling their asthma, were unfamiliar with the concept of preventive medication, and often expressed less confidence in their general practitioner. South Asians managed asthma exacerbations with family advocacy, without systematic changes in prophylaxis, and without systemic corticosteroids. Patients describing difficulty accessing primary care during asthma exacerbations were registered with practices with weak strategies for asthma care and were often south Asian. Patients with easy access described care suggesting partnerships with their general practitioner, had better confidence to control asthma, and were registered with practices with well developed asthma strategies that included policies for avoiding hospital admission. Conclusions The different ways of coping with asthma exacerbations and accessing care may partly explain the increased risk of hospital admission in south Asian patients. Interventions that increase confidence to control asthma, confidence in the general practitioner, understanding of preventive treatment, and use of systemic corticosteroids in

  9. Increased hospital admissions associated with extreme-heat exposure in King County, Washington, 1990-2010

    PubMed Central

    Isaksen, Tania Busch; Yost, Michael G.; Hom, Elizabeth K.; Ren, You; Lyons, Hilary; Fenske, Richard A.

    2016-01-01

    Increased morbidity and mortality have been associated with extreme heat events, particularly in temperate climates. Few epidemiologic studies have considered the impact of extreme heat events on hospitalization rates in the Pacific Northwest region. This study quantifies the historical (May to September 1990-2010) heat-morbidity relationship in the most populous Pacific Northwest County -King County, Washington. A relative risk (RR) analysis was used to explore the association between heat and all non-traumatic hospitalizations on 99th percentile heat days, while a time series analysis using a piece-wise linear model approximation was used to estimate the effect that heat’s intensity has on hospitalizations, adjusted for temporal trends and day of the week. A non-statistically significant 2% [95% CI: 1.02 (0.98, 1.05)] increase in hospitalization risk, on a heat day versus a non-heat day, was noted for all-ages, all non-traumatic causes. When considering the effect heat intensity has on admissions, we found a statistically significant 1.59% (95% CI: 0.9%, 2.29%) increase in admissions per degree increase in humidex above 37.4 °C. Admissions stratified by cause and age produced statistically significant results with both relative risk and time series analyses for nephritis and nephrotic syndromes, acute renal failure and natural heat exposure hospitalizations. This study demonstrates that heat, expressed as humidex, is associated with increased hospital admissions. When stratified by age and cause of admission, the non-elderly (less than 85) age groups experience significant risk for: nephritis and nephrotic syndromes, acute renal failure, natural heat exposure, COPD and asthma hospitalizations. PMID:25719287

  10. Diabetes mellitus in Addis Ababa, Ethiopia: admissions, complications and outcomes in a large referral hospital

    PubMed Central

    Harries, A. D.; Ade, S.; Tayler-Smith, K.; Ali, E.; Firdu, N.; Yifter, H.

    2015-01-01

    Setting: The Black Lion Referral Hospital, Addis Ababa, Ethiopia. Objective: To document indications for admission, complications and outcomes of patients with diabetes mellitus (DM) admitted between 2010 and 2013. Design: A descriptive retrospective study using medical files. Results: Of 8048 admissions, 523 (6.5%) had DM; of these, 418 medical records were retrieved: 301 (72%) patients had type 2 and 104 (28%) type 1 disease, with male sex (62%) and older age (median age 60 years) being features of type 2 disease. Main admission diagnoses for type 2 disease were diabetic foot ulcer (39%) and cardiovascular disease (21%); for type 1 disease, it was diabetic ketoacidosis (62%). Hypertension, neuropathy, nephropathy, retinopathy and diabetic foot accounted for 85% of the 756 existing complications. Overall in-patient mortality was 21%. Of the 89 deaths, 77 occurred among patients with type 2 disease; the main indications for admission were diabetic foot ulcer/gangrene and cardiovascular disease. Conclusion: DM, especially type 2 DM, is an important cause of admission to Ethiopia’s largest referral hospital. Many patients had already developed disease-related complications at admission, and mortality was high. There is a need to improve awareness about and care for DM in Ethiopia. PMID:26400605

  11. Equestrian injuries: a five year review of hospital admissions in British Columbia, Canada

    PubMed Central

    Sorli, J.

    2000-01-01

    Aim—To determine the demographics of hospital admissions and mortality associated with equestrian activities in the 33 000 riders in British Columbia (BC). Method—Analysis of admission data from the Ministry of Health for the years 1991–96, review of information obtained from the Office of the Chief Coroner, and comparison of data from Canadian Hospitals Injury Reporting and Prevention Program. Results—The mean number of admissions per year was 390. Head injury was the most common cause of admission to hospital (20%) in BC. Females most often required admission (62%). Teenagers and children have a higher incidence of head injuries than the general population. The injury rate was 0.49/1000 hours of riding. There were three deaths per year, 1/10 000 riders; 60% were caused by head injury and females predominated. Conclusion—Head injuries and other serious injuries occur with equestrian activities and it is important for doctors, instructors, and parents to promote the use of appropriate safety equipment, including helmets, especially for children. PMID:10728545

  12. Factors Associated with Inpatient Hospital (Re)admissions in Medicare Beneficiaries in Need of Food Assistance.

    PubMed

    Sattler, Elisabeth Lilian Pia; Lee, Jung Sun; Young, Henry N

    2015-01-01

    Little is known about pathways underlying inpatient hospital (re)admissions in older adults unable to meet basic needs. This study examined the factors associated with (re)admissions in a sample of low-income older Medicare beneficiaries in need of food assistance in Georgia in 2008 (N = 892, mean age 75.4 ± 8.8 years, 30.3% Black, 68.5% female). About 35.3% of the sample experienced 1 + hospital (re)admissions. (Re)admissions were significantly more likely in individuals who requested Older Americans Act Nutrition Program Home Delivered Meals services (OR 2.3; 95% CI 1.4, 3.8), had more outpatient emergency room visits (1 visit: OR 2.1; 95% CI 1.4, 3.1; 2+ visits: OR 3.6; 95% CI 2.4, 5.4), and experienced greater multimorbidity (OR 1.6; 95% CI 1.4, 3.1). Support for home and community-based services may be critical in reducing potentially avoidable inpatient hospital (re)admissions. PMID:26106990

  13. Trends in hospital admissions for obstructive lung disease from 2000 to 2010 in Portugal.

    PubMed

    Vieira, Rafael; Fonseca, João Almeida; Lopes, Fernando; Freitas, Alberto

    2016-07-01

    The burden of hospitalisations for obstructive lung diseases (OLD) has not been sufficiently studied. We aimed to characterise the hospitalisations for OLD from 2000 to 2010 in all Portuguese public hospitals. We analysed hospital discharges with a diagnosis of OLD regarding the patients' gender, age, residence and comorbidities. Of the 120 399 hospital admissions with a principal diagnosis of OLD, COPD (ICD-9-CM 491.x, 492.x, 496) was responsible for 81%. The change in patients discharged with OLD as a principal diagnosis was only 1% from 2000 to 2010 and did not change for COPD. Hospital admissions and deaths for COPD and other OLD increased with age and were more common in men than women. In-hospital mortality for COPD decreased 34.1% from 2000 to 2010, while the median length of stay was fairly constant at 8 days. Respiratory failure, insufficiency and/or arrest, and pneumonia, are the principal diagnoses often associated with COPD. When both pneumonia and COPD were diagnosed there was an increasing trend to classify pneumonia as the principal diagnosis (64.4%-72.9%), a sign that may lead to underestimation of COPD hospitalisations. In summary, a considerable decrease in in-hospital COPD mortality was observed while hospital admissions and the length of stay did not change substantially. These results suggest that better healthcare or other factors may be counteracting the expected increase of the burden of COPD. PMID:27296823

  14. Clinical Audit of COPD Patients Requiring Hospital Admissions in Spain: AUDIPOC Study

    PubMed Central

    Pozo-Rodríguez, Francisco; López-Campos, Jose Luis; Álvarez-Martínez, Carlos J.; Castro-Acosta, Ady; Agüero, Ramón; Hueto, Javier; Hernández-Hernández, Jesús; Barrón, Manuel; Abraira, Victor; Forte, Anabel; Sanchez Nieto, Juan Miguel; Lopez-Gabaldón, Encarnación; Cosío, Borja G.; Agustí, Alvar

    2012-01-01

    Backgrounds AUDIPOC is a nationwide clinical audit that describes the characteristics, interventions and outcomes of patients admitted to Spanish hospitals because of an exacerbation of chronic obstructive pulmonary disease (ECOPD), assessing the compliance of these parameters with current international guidelines. The present study describes hospital resources, hospital factors related to case recruitment variability, patients’ characteristics, and adherence to guidelines. Methodology/Principal Findings An organisational database was completed by all participant hospitals recording resources and organisation. Over an 8-week period 11,564 consecutive ECOPD admissions to 129 Spanish hospitals covering 70% of the Spanish population were prospectively identified. At hospital discharge, 5,178 patients (45% of eligible) were finally included, and thus constituted the audited population. Audited patients were reassessed 90 days after admission for survival and readmission rates. A wide variability was observed in relation to most variables, hospital adherence to guidelines, and readmissions and death. Median inpatient mortality was 5% (across-hospital range 0–35%). Among discharged patients, 37% required readmission (0–62%) and 6.5% died (0–35%). The overall mortality rate was 11.6% (0–50%). Hospital size and complexity and aspects related to hospital COPD awareness were significantly associated with case recruitment. Clinical management most often complied with diagnosis and treatment recommendations but rarely (<50%) addressed guidance on healthy life-styles. Conclusions/Significance The AUDIPOC study highlights the large across-hospital variability in resources and organization of hospitals, patient characteristics, process of care, and outcomes. The study also identifies resources and organizational characteristics associated with the admission of COPD cases, as well as aspects of daily clinical care amenable to improvement. PMID:22911875

  15. Hazards of Hospitalization: Residence Prior to Admission Predicts Outcomes

    ERIC Educational Resources Information Center

    Friedman, Susan M.; Mendelson, Daniel A.; Bingham, Karilee W.; McCann, Robert M.

    2008-01-01

    Purpose: Previous studies investigating adverse outcomes of hospitalized elders have focused on community-dwelling patients. Given the rapid growth of populations living in other settings, such as assisted living facilities, it is important to understand whether these patients are at higher risk of experiencing specific adverse outcomes during…

  16. The Impact of Profitability of Hospital Admissions on Mortality

    PubMed Central

    Lindrooth, Richard C; Konetzka, R Tamara; Navathe, Amol S; Zhu, Jingsan; Chen, Wei; Volpp, Kevin

    2013-01-01

    Background Fiscal constraints faced by Medicare are leading to policies designed to reduce expenditures. Evidence of the effect of reduced reimbursement on the mortality of Medicare patients discharged from all major hospital service lines is limited. Methods We modeled risk-adjusted 30-day mortality of patients discharged from 21 hospital service lines as a function of service line profitability, service line time trends, and hospital service line and year-fixed effects. We simulated the effect of alternative revenue-neutral reimbursement policies on mortality. Our sample included all Medicare discharges from PPS-eligible hospitals (1997, 2001, and 2005). Results The results reveal a statistically significant inverse relationship between changes in profitability and mortality. A $0.19 average reduction in profit per $1.00 of costs led to a 0.010–0.020 percentage-point increase in mortality rates (p < .001). Mortality in newly unprofitable service lines is significantly more sensitive to reduced payment generosity than in service lines that remain profitable. Policy simulations that target service line inequities in payment generosity result in lower mortality rates, roughly 700–13,000 fewer deaths nationally. Conclusions The policy simulations raise questions about the trade-offs implicit in universal reductions in reimbursement. The effect of reduced payment generosity on mortality could be mitigated by targeting highly profitable services only for lower reimbursement. PMID:23346946

  17. Causes and incidence of 30 day hospital re-admissions after primary TKJR

    PubMed Central

    Mortimer, John; van Dalen, John

    2016-01-01

    Objective: 30 day re-admission of patients following TKJR is estimated between 0.9-9.9%. It’s a cause of significant cost to the healthcare system and marks significant patient morbidity. Aim: The aim of this study is to describe the causes and incidence of patient re-admission to hospital within 30 days of a primary total knee joint replacement between 2009-2015 in a single centre. Methods: In a retrospective cohort study, computerized records were used to evaluated the causes and incidence of patient re-admission within 30 days of discharge following primary TKJR. Results: The total 30 day Re-admission rate was 5.0%. Medical causes for re-admission accounted for 29% of re-admissions. 34% were attributed to non-specific pain/swelling. Infection was attributed to 26%. 29% of patients presented with wound problems, either infective or non-infective. The total incidence of re-operation at 30 days was 0.77%. Conclusions: Our rate of re-admission is consistent with previous studies in the literature. Many patients were found to have no specific cause for re-admission. This suggests it may be possible to further reduce re-admission rates with improved patient education and management of common post-operative symptoms such as pain and swelling. Infection remains a common complication; fortunately the majority superficial infections are successfully treated with antibiotics and few requiring a washout operation. Medical complications account for almost a third showing the importance of good management of patient medical co-morbidities and risk factors.

  18. Evaluating Psychiatric Hospital Admission Decisions for Children in Foster Care: An Optimal Classification Tree Analysis

    ERIC Educational Resources Information Center

    Snowden, Jessica A.; Leon, Scott C.; Bryant, Fred B.; Lyons, John S.

    2007-01-01

    This study explored clinical and nonclinical predictors of inpatient hospital admission decisions across a sample of children in foster care over 4 years (N = 13,245). Forty-eight percent of participants were female and the mean age was 13.4 (SD = 3.5 years). Optimal data analysis (Yarnold & Soltysik, 2005) was used to construct a nonlinear…

  19. Coarse Particulate Air Pollution Associated with Increased Risk of Hospital Admissions for Respiratory Diseases in a Tropical City, Kaohsiung, Taiwan.

    PubMed

    Cheng, Meng-Hsuan; Chiu, Hui-Fen; Yang, Chun-Yuh

    2015-10-01

    This study was undertaken to determine whether there was an association between coarse particles (PM₂.₅-₁₀) levels and frequency of hospital admissions for respiratory diseases (RD) in Kaohsiung, Taiwan. Hospital admissions for RD including chronic obstructive pulmonary disease (COPD), asthma, and pneumonia, and ambient air pollution data levels for Kaohsiung were obtained for the period from 2006 to 2010. The relative risk of hospital admissions for RD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single pollutant model (without adjustment for other pollutants), increased rate of admissions for RD were significantly associated with higher coarse PM levels only on cool days (<25 °C), with a 10 µg/m³ elevation in PM₂.₅-₁₀ concentrations associated with a 3% (95% CI = 1%-5%) rise in COPD admissions, 4% (95% CI = 1%-7%) increase in asthma admissions, and 3% (95% CI = 2%-4%) rise in pneumonia admissions. No significant associations were found between coarse particle levels and the number of hospital admissions for RD on warm days. In the two-pollutant models, PM₂.₅-₁₀ levels remained significantly correlated with higher rate of RD admissions even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. This study provides evidence that higher levels of PM₂.₅-₁₀ enhance the risk of hospital admissions for RD on cool days. PMID:26501308

  20. The relationship of respiratory and cardiovascular hospital admissions to the southern California wildfires of 2003

    PubMed Central

    Delfino, R J; Brummel, S; Wu, J; Stern, H; Ostro, B; Lipsett, M; Winer, A; Street, D H; Zhang, L; Tjoa, T; Gillen, D L

    2014-01-01

    Objective There is limited information on the public health impact of wildfires. The relationship of cardiorespiratory hospital admissions (n = 40 856) to wildfire-related particulate matter (PM2.5) during catastrophic wildfires in southern California in October 2003 was evaluated. Methods Zip code level PM2.5 concentrations were estimated using spatial interpolations from measured PM2.5, light extinction, meteorological conditions, and smoke information from MODIS satellite images at 250 m resolution. Generalised estimating equations for Poisson data were used to assess the relationship between daily admissions and PM2.5, adjusted for weather, fungal spores (associated with asthma), weekend, zip code-level population and sociodemographics. Results Associations of 2-day average PM2.5 with respiratory admissions were stronger during than before or after the fires. Average increases of 70 μg/m3 PM2.5 during heavy smoke conditions compared with PM2.5 in the pre-wildfire period were associated with 34% increases in asthma admissions. The strongest wildfire-related PM2.5 associations were for people ages 65– 99 years (10.1% increase per 10 μg/m3 PM2.5, 95% CI 3.0% to 17.8%) and ages 0–4 years (8.3%, 95% CI 2.2% to 14.9%) followed by ages 20–64 years (4.1%, 95% CI 20.5% to 9.0%). There were no PM2.5–asthma associations in children ages 5–18 years, although their admission rates significantly increased after the fires. Per 10 μg/m3 wildfire-related PM2.5, acute bronchitis admissions across all ages increased by 9.6% (95% CI 1.8% to 17.9%), chronic obstructive pulmonary disease admissions for ages 20–64 years by 6.9% (95% CI 0.9% to 13.1%), and pneumonia admissions for ages 5–18 years by 6.4% (95% CI 21.0% to 14.2%). Acute bronchitis and pneumonia admissions also increased after the fires. There was limited evidence of a small impact of wildfire-related PM2.5 on cardiovascular admissions. Conclusions Wildfire-related PM2.5 led to increased respiratory

  1. The impact of heat, cold, and heat waves on hospital admissions in eight cities in Korea

    NASA Astrophysics Data System (ADS)

    Son, Ji-Young; Bell, Michelle L.; Lee, Jong-Tae

    2014-01-01

    Although the impact of temperature on mortality is well documented, relatively fewer studies have evaluated the associations of temperature with morbidity outcomes such as hospital admissions, and most studies were conducted in North America or Europe. We evaluated weather and hospital admissions including specific causes (allergic disease, asthma, selected respiratory disease, and cardiovascular disease) in eight major cities in Korea from 2003 to 2008. We also explored potential effect modification by individual characteristics such as sex and age. We used hierarchical modeling to first estimate city-specific associations between heat, cold, or heat waves and hospitalizations, and then estimated overall effects. Stratified analyses were performed by cause of hospitalization, sex, and age (0-14, 15-64, 65-74, and ≥75 years). Cardiovascular hospitalizations were significantly associated with high temperature, whereas hospitalizations for allergic disease, asthma, and selected respiratory disease were significantly associated with low temperature. The overall heat effect for cardiovascular hospitalization was a 4.5 % (95 % confidence interval 0.7, 8.5 %) increase in risk comparing hospitalizations at 25 to 15 °C. For cold effect, the overall increase in risk of hospitalizations comparing 2 with 15 °C was 50.5 (13.7, 99.2 %), 43.6 (8.9, 89.5 %), and 53.6 % (9.8, 114.9 %) for allergic disease, asthma, and selected respiratory disease, respectively. We did not find statistically significant effects of heat waves compared with nonheat wave days. Our results suggest susceptible populations such as women and younger persons. Our findings provide suggestive evidence that both high and low ambient temperatures are associated with the risk of hospital admissions, particularly in women or younger person, in Korea.

  2. Factors influencing hospital admissions and emergency department visits among children with complex chronic conditions: a qualitative study of parents' and providers' perspectives.

    PubMed

    Hudson, Shannon M; Newman, Susan D; Hester, William H; Magwood, Gayenell S; Mueller, Martina; Laken, Marilyn A

    2014-03-01

    Children with complex chronic conditions (CCC) have greater health care needs and use rates than children in general. Elevated health care use includes more frequent hospital admissions, longer hospital stays, and greater health care expenses. Prior studies have examined population characteristics associated with increased hospital admissions, emergency department (ED) use, and general healthcare use, yet few studies have investigated these events from the parents' or health care providers' point of view. The purpose of this study was to explore parents/caregivers' and health care providers' perceptions of the factors placing infants and young children with CCC at risk for or protecting them against hospital admissions and ED visits. Parents or primary caregivers participated in interviews, and health care providers in pediatric acute care, pediatric primary care, and emergency care participated in focus groups. Interview and focus group data were analyzed using directed content analysis and an ecological risk and protective factors model. The analysis revealed that parents/caregivers and health care providers described risk factors and protective factors on multiple ecological levels surrounding the child with CCC. This article presents these findings, which add to current knowledge of factors influencing hospital admissions and ED visits and may be used to inform interventions addressing high health care utilization in this population. This article concludes with the implications of the findings for future research and nursing practice. PMID:24423943

  3. Preparedness for admission of patients with suspected Ebola virus disease in European hospitals: a survey, August-September 2014.

    PubMed

    de Jong, M D; Reusken, C; Horby, P; Koopmans, M; Bonten, M; Chiche, Jd; Giaquinto, C; Welte, T; Leus, F; Schotsman, J; Goossens, H

    2014-01-01

    In response to the Ebola virus disease (EVD) outbreak in West Africa, the World Health Organization has advised all nations to prepare for the detection, investigation and management of confirmed and suspected EVD cases in order to prevent further spread through international travel. To gain insights into the state of preparedness of European hospitals, an electronic survey was circulated in August–September 2014 to 984 medical professionals representing 736 hospitals in 40 countries. The survey addressed the willingness and capacity to admit patients with suspected EVD as well as specific preparedness activities in response to the current Ebola crisis. Evaluable responses were received from representatives of 254 (32%) hospitals in 38 countries, mostly tertiary care centres, of which 46% indicated that they would admit patients with suspected EVD. Patient transfer agreements were in place for the majority of hospitals that would not admit patients. Compared with non-admitting hospitals, admitting hospitals were more frequently engaged in various preparedness activities and more often contained basic infrastructural characteristics such as admission rooms and laboratories considered important for infection control, but some gaps and concerns were also identified. The results of this survey help to provide direction towards further preparedness activities and prioritisation thereof. PMID:25496571

  4. An investigation of factors associated with psychiatric hospital admission despite the presence of crisis resolution teams

    PubMed Central

    Cotton, Mary-Anne; Johnson, Sonia; Bindman, Jonathan; Sandor, Andrew; White, Ian R; Thornicroft, Graham; Nolan, Fiona; Pilling, Stephen; Hoult, John; McKenzie, Nigel; Bebbington, Paul

    2007-01-01

    Background Crisis resolution teams (CRTs) provide a community alternative to psychiatric hospital admission for patients presenting in crisis. Little is known about the characteristics of patients admitted despite the availability of such teams. Methods Data were drawn from three investigations of the outcomes of CRTs in inner London. A literature review was used to identify candidate explanatory variables that may be associated with admission despite the availability of intensive home treatment. The main outcome variable was admission to hospital within 8 weeks of the initial crisis. Associations between this outcome and the candidate explanatory variables were tested using first univariate and then multivariate analysis. Results Patients who were uncooperative with initial assessment (OR 10.25 95% CI-4.20–24.97), at risk of self-neglect (OR 2.93 1.42–6.05), had a history of compulsory admission (OR 2.64 1.07–6.55), assessed outside usual office hours (OR 2.34 1.11–4.94) and/or were assessed in hospital casualty departments (OR 3.12 1.55–6.26), were more likely to be admitted. Other than age, no socio-demographic features or diagnostic variables were significantly associated with risk of admission. Conclusion With the introduction of CRTs, inpatient wards face a significant challenge, as patients who cooperate little with treatment, neglect themselves, or have previously been compulsorily detained are especially likely to be admitted. The increased risk of admission associated with casualty department assessment may be remediable. PMID:17910756

  5. Emergency department utilization, hospital admissions, and physician visits among elderly African American persons.

    PubMed

    Bazargan, M; Bazargan, S; Baker, R S

    1998-02-01

    This study uses a theoretical model of health services utilization to examine (a) emergency department utilization, (b) hospital admissions, and (c) office-based physician visits among a sample of 998 low-income elderly African American persons. Poisson Regression analysis was used to estimate the parameters specified in the Andersen behavioral model. Some of the more interesting results include the following: (a) a greater frequency of emergency room visits among respondents with a lower level of accessibility to physician services, (b) a lack of a significant relationship between some chronic illnesses such as diabetes and heart problems and the frequency of office-based physician visits, (c) a greater number of hospital admissions among insured persons, and (d) a significant impact of the health locus of control indexes on all three types of health care utilization. The results of this study challenge the assumption that hospital and emergency use are the results of nondiscretionary behavior. PMID:9499651

  6. Physician impact on hospital admission and on mortality rates in the Medicare population.

    PubMed Central

    Krakauer, H; Jacoby, I; Millman, M; Lukomnik, J E

    1996-01-01

    OBJECTIVE. We assess the effect of variations in the supply and specialty distribution of physicians on admission rates for ambulatory care-sensitive conditions (ACS) and for all causes, and on mortality rates among Medicare beneficiaries of various health care service areas (HCSA). DATA SOURCES. For the Medicare beneficiaries, sources were the Health Care Financing Administration's 1992 enrollment and impatient (Part A) files for a 5 percent sample of that population; for the overall populations and for the medical resources of the HCSAs, the Area Resource File. STUDY DESIGN. This observational, cross-sectional study employed multiple linear regression to assess the influence of population characteristics and of the supply of physicians on hospital admissions, and Poisson regression in the analysis of the factors that affect mortality. PRINCIPAL FINDINGS. Physician supply levels vary nearly fourfold or more when comparing the top and bottom deciles of the HCSAs, Medicare admissions for ACS conditions vary about threefold, and admission rates for all causes and mortality rates vary about 1.5-fold. Physician supply levels and distributions have very little influence on ACS admission rates, and even less on the admissions for all causes and on mortality, except in HCSAs with very low physician supply levels (one-fourth the national average or less). However, these HCSAs account for only about 1 percent of the U.S. population. CONCLUSIONS. Physician supply levels and the proportions of specialists and generalists have negligible effects on health status as measured by mortality rates and by rates of admission for all causes and for conditions presumed to be sensitive to the adequacy of ambulatory care. Reductions in admissions for such conditions are not likely to be achieved through broadening of insurance to levels that exist under Medicare, nor through increases in the supply of physicians, nor, conversely, through a reduction in any presumed oversupply of

  7. Air pollution and hospital admissions for respiratory conditions in Rome, Italy.

    PubMed

    Fusco, D; Forastiere, F; Michelozzi, P; Spadea, T; Ostro, B; Arcà, M; Perucci, C A

    2001-06-01

    Most of the evidence regarding the association between particulate air pollution and emergency room visits or hospital admissions for respiratory conditions and asthma comes from the USA. European time-series analyses have suggested that gaseous air pollutants are important determinants of acute hospitalization for respiratory conditions, at least as important as particulate mass. The association between daily mean levels of suspended particles and gaseous pollutants (sulphur dioxide, nitrogen dioxide, carbon monoxide, ozone) was examined. The daily emergency hospital admissions for respiratory conditions in the metropolitan area of Rome during 1995-1997 were also recorded. Daily counts of hospital admissions for total respiratory conditions (43 admissions day(-1)), acute respiratory infections including pneumonia (18 day(-1)), chronic obstructive pulmonary disease (COPD) (13 day(-1)), and asthma (4.5 day(-1)) among residents of all ages and among children (0-14 yrs) were analysed. The generalized additive models included spline smooth functions of the day of study, mean temperature, mean humidity, influenza epidemics, and indicator variables for day of the week and holidays. Total respiratory admissions were significantly associated with same-day level of NO2 (2.5% increase per interquartile range (IQR) change, 22.3 microg x m(-3)) and CO (2.8% increase per IQR, 1.5 mg x m(-3)). No effect was found for particulate matter and SO2, whereas O3 was associated with admissions only among children (lag 1, 5.5% increase per IQR, 23.9 microg x m3). The effect of NO2 was stronger on acute respiratory infections (lag 0, 4.0% increase) and on asthma among children (lag 1, 10.7% increase). The admissions for all ages for asthma and COPD were associated only with same-day level of CO (5.5% and 4.3% increase, respectively). Multipollutant models confirmed the role of CO on all respiratory admissions, including asthma and COPD, and that of NO2 on acute respiratory infections

  8. Associations between Extreme Precipitation and Gastrointestinal-Related Hospital Admissions in Chennai, India

    PubMed Central

    O’Neill, Marie S.; Li, Shi; Mukherjee, Bhramar; Hu, Howard; Ghosh, Santu; Balakrishnan, Kalpana

    2013-01-01

    Background: Understanding the potential links between extreme weather events and human health in India is important in the context of vulnerability and adaptation to climate change. Research exploring such linkages in India is sparse. Objectives: We evaluated the association between extreme precipitation and gastrointestinal (GI) illness-related hospital admissions in Chennai, India, from 2004 to 2007. Methods: Daily hospital admissions were extracted from two government hospitals in Chennai, India, and meteorological data were retrieved from the Chennai International Airport. We evaluated the association between extreme precipitation (≥ 90th percentile) and hospital admissions using generalized additive models. Both single-day and distributed lag models were explored over a 15-day period, controlling for apparent temperature, day of week, and long-term time trends. We used a stratified analysis to explore the association across age and season. Results: Extreme precipitation was consistently associated with GI-related hospital admissions. The cumulative summary of risk ratios estimated for a 15-day period corresponding to an extreme event (relative to no precipitation) was 1.60 (95% CI: 1.29, 1.98) among all ages, 2.72 (95% CI: 1.25, 5.92) among the young (≤ 5 years of age), and 1.62 (95% CI: 0.97, 2.70) among the old (≥ 65 years of age). The association was stronger during the pre-monsoon season (March–May), with a cumulative risk ratio of 6.50 (95% CI: 2.22, 19.04) for all ages combined compared with other seasons. Conclusions: Hospital admissions related to GI illness were positively associated with extreme precipitation in Chennai, India, with positive cumulative risk ratios for a 15-day period following an extreme event in all age groups. Projected changes in precipitation and extreme weather events suggest that climate change will have important implications for human health in India, where health disparities already exist. Citation: Bush KF, O

  9. Pneumonia and influenza, and respiratory and circulatory hospital admissions in Belgium: a retrospective database study

    PubMed Central

    2014-01-01

    Background Influenza infections can lead to viral pneumonia, upper respiratory tract infection or facilitate co-infection by other pathogens. Influenza is associated with the exacerbation of chronic conditions like diabetes and cardiovascular disease and consequently, these result in acute hospitalizations. This study estimated the number, proportions and costs from a payer perspective of hospital admissions related to severe acute respiratory infections. Methods We analyzed retrospectively, a database of all acute inpatient stays from a non-random sample of eleven hospitals using the Belgian Minimal Hospital Summary Data. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification was used to identify and diagnose cases of pneumonia and influenza (PI), respiratory and circulatory (RC), and the related complications. Results During 2002–2007, we estimated relative hospital admission rates of 1.69% (20960/1237517) and 21.79% (269634/1237517) due to primary PI and RC, respectively. The highest numbers of hospital admissions with primary diagnosis as PI were reported for the elderly patient group (n = 10184) followed by for children below five years of age (n = 3451). Of the total primary PI and RC hospital admissions, 56.14% (11768/20960) and 63.48% (171172/269634) of cases had at least one possible influenza-related complication with the highest incidence of complications reported for the elderly patient group. Overall mortality rate in patients with PI and RC were 9.25% (1938/20960) and 5.51% (14859/269634), respectively. Average lengths of hospital stay for PI was 11.6 ± 12.3 days whereas for RC it was 9.1 ± 12.7 days. Annual average costs were 20.2 and 274.6 million Euros for PI and RC hospitalizations. Average cost per hospitalization for PI and RC were 5779 and 6111 Euros (2007), respectively. These costs increased with the presence of complications (PI: 7159, RC: 7549 Euros). Conclusion The clinical and

  10. Duration of Hospital Admission and the Need for Empirical Antipseudomonal Therapy

    PubMed Central

    Elligsen, M.; Walker, S. A. N.; Simor, A.

    2012-01-01

    To reduce selective pressure for antimicrobial resistance, empirical use of antipseudomonal antibiotics is often reserved for patients with late-onset hospital-acquired infections. We examined the likelihood of isolating Pseudomonas aeruginosa as a function of time from hospital admission. We conducted a retrospective cohort study of all positive bacterial cultures in a tertiary-care hospital between March 2010 and November 2011. The primary outcome was the proportion of positive cultures yielding P. aeruginosa. Multivariable logistic regression was employed to assess the impact of time from admission on the likelihood of isolating P. aeruginosa, after adjusting for other important risk factors. A total of 7,668 positive cultures were obtained from 4,108 unique patients during the study interval, including 633 (8.3%) yielding P. aeruginosa. The probability of isolating P. aeruginosa increased linearly from 79/2,044 (3.9%) positive cultures obtained on admission to 153/664 (23%) in the 10th week of admission or beyond. The unadjusted odds ratio was 1.002/day (95% confidence interval [CI], 1.0016 to 1.0028; P < 0.0001); the adjusted odds ratio (aOR) was 1.0007/day (95% CI, 1.0001 to 1.0013; P = 0.02). Other important predictors of P. aeruginosa isolation included respiratory specimen type (aOR, 13.8; 95% CI, 9.1 to 21.1), recent hospital admission (aOR,1.8; 95% CI, 1.4 to 2.3), prior P. aeruginosa isolation during current admission (aOR, 4.9; 95% CI, 3.7 to 6.4), and prior antipseudomonal (aOR, 1.9; 95% CI, 1.4 to 2.5) or nonantipseudomonal (aOR, 1.8; 95% CI, 1.4 to 2.4) antibiotic exposure. It was determined that as time from admission increases, there is a linear increase in the likelihood of P. aeruginosa isolation. Any guidelines which distinguish early from late hospital-acquired infection must consider the implications of time point selection on the likelihood of inadequate P. aeruginosa empirical coverage. PMID:22675131

  11. Trends in hospital admission rates for whooping cough in England across five decades: database studies

    PubMed Central

    Hoang, Uy; Goldacre, Michael J

    2014-01-01

    Objectives Our aim was to report on trends in hospitalisation rates for pertussis in England from the 1960s to 2011; and to provide context for the recent unexpected activity of Bordetella pertussis in the UK. Design A retrospective analysis of English national Hospital Episode Statistics (HES, 1968–2011) and the Oxford Record Linkage Study (ORLS, 1963–2011) for people admitted to hospital with whooping cough. Setting England and the Oxford Record Linkage Study area. Main outcome measures Age- and gender-specific hospital admission rates, and summary age- and sex-standardised rates, for people aged under 25 years per 100,000 population in each age group. Results Admission rates declined from the 1960s to the early 1970s. For example, the standardised rates were 12.8 (95% confidence interval 11.2–14.5) per 100,000 in England in 1968 and 4.0 (3.0–4.9) per 100,000 in 1973. They then increased to reach 45.0 (41.4–48.6) per 100,000 in 1978 and 47.4 (43.7–51.1) in 1982. From the late 1980s, admission rates continued to decline, falling to between 1 and 4 per 100,000 in each of the years between 2003 and 2011. While the trend in hospital admissions closely followed that in notifications, the annual ratio between these two measures was not consistent ranging from 1.07 (95% confidence interval 1.00–1.14) to 4.03 (3.79–4.27) notifications per admission over the last 10 years. Conclusions Epidemics of whooping cough in the late 1970s and early 1980s were associated with a significant rise in hospital admission rates. Current admission rates are low, by historical comparison. Vaccine programmes must continue to be fully implemented in order to improve control of pertussis activity. PMID:24526463

  12. Trauma admissions to the Intensive care unit at a reference hospital in Northwestern Tanzania

    PubMed Central

    2011-01-01

    Background Major trauma has been reported to be a major cause of hospitalization and intensive care utilization worldwide and consumes a significant amount of the health care budget. The aim of this study was to describe the characteristics and treatment outcome of major trauma patients admitted into our ICU and to identify predictors of outcome. Methods Between January 2008 and December 2010, a descriptive prospective study of all trauma admissions to a multidisciplinary intensive care unit (ICU) of Bugando Medical Centre in Northwestern Tanzania was conducted. Results A total of 312 cases of major trauma were admitted in the ICU, representing 37.1% of the total ICU admissions. Males outnumbered females by a ratio of 5.5:1. Their median age was 27 years. Trauma admissions were almost exclusively emergencies (95.2%) and came mainly from the Accident and Emergency (60.6%) and Operating room (23.4%). Road traffic crash (RTC) was the most common cause of injuries affecting 70.8% of patients. Two hundred fourteen patients (68.6%) required surgical intervention. The overall ICU length of stay (LOS) for all trauma patients ranged from 1 to 59 days (median = 8 days). The median ICU length of hospital stay (LOS) for survivors and non-survivors were 8 and 5 days respectively. (P = 0.002). Mortality rate was 32.7%. Mortality rate of trauma patients was significantly higher than that of all ICU admissions (32.7% vs. 18.8%, P = 0.0012). According to multivariate logistic regression analysis, multiple injuries, severe head injuries and burns were responsible for a longer mean ICU stay (P < 0.001) whereas admission Glasgow Coma Score < 9, systolic blood pressure < 90 mmHg, injury severity core >16, prolonged duration of loss of consciousness, delayed ICU admission (0.028), the need for ventilatory support and finding of space occupying lesion on computed tomography scan significantly influenced mortality (P < 0.001). Conclusion Trauma resulting from road traffic crashes is a

  13. Incidence and Risk Factors for Neonatal Tetanus in Admissions to Kilifi County Hospital, Kenya

    PubMed Central

    Ibinda, Fredrick; Bauni, Evasius; Kariuki, Symon M.; Fegan, Greg; Lewa, Joy; Mwikamba, Monica; Boga, Mwanamvua; Odhiambo, Rachael; Mwagandi, Kiponda; Seale, Anna C.; Berkley, James A.; Dorfman, Jeffrey R.; Newton, Charles R. J. C.

    2015-01-01

    Background Neonatal Tetanus (NT) is a preventable cause of mortality and neurological sequelae that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunisation rates and unhygienic cord care practices. We aimed to determine changes in the incidence of NT, characterize and investigate the associated risk factors and mortality in a prospective cohort study including all admissions over a 15-year period at a County hospital on the Kenyan coast, a region with relatively high historical NT rates within Kenya. Methods We assessed all neonatal admissions to Kilifi County Hospital in Kenya (1999–2013) and identified cases of NT (standard clinical case definition) admitted during this time. Poisson regression was used to examine change in incidence of NT using accurate denominator data from an area of active demographic surveillance. Logistic regression was used to investigate the risk factors for NT and factors associated with mortality in NT amongst neonatal admissions. A subset of sera from mothers (n = 61) and neonates (n = 47) were tested for anti-tetanus antibodies. Results There were 191 NT admissions, of whom 187 (98%) were home deliveries. Incidence of NT declined significantly (Incidence Rate Ratio: 0.85 (95% Confidence interval 0.81–0.89), P<0.001) but the case fatality (62%) did not change over the study period (P = 0.536). Younger infant age at admission (P = 0.001) was the only independent predictor of mortality. Compared to neonatal hospital admittee controls, the proportion of home births was higher among the cases. Sera tested for antitetanus antibodies showed most mothers (50/61, 82%) had undetectable levels of antitetanus antibodies, and most (8/9, 89%) mothers with detectable antibodies had a neonate without protective levels. Conclusions Incidence of NT in Kilifi County has significantly reduced, with reductions following immunisation campaigns. Our results suggest immunisation efforts are effective if

  14. Trends in Hospital Admission and Surgical Procedures Following ED visits for Diverticulitis

    PubMed Central

    Greenwood-Ericksen, Margaret B.; Havens, Joaquim M.; Ma, Jiemin; Weissman, Joel S.; Schuur, Jeremiah D.

    2016-01-01

    , while ED admission rates and surgical rates declined, with comorbidity, sociodemographic factors predicting hospitalization. Future work should focus on determining if these differences reflect increased disease prevalence, increased diagnosis, or changes in management. PMID:27429691

  15. Frequent Emergency Department Visits and Hospitalizations Among Homeless People With Medicaid: Implications for Medicaid Expansion

    PubMed Central

    Bharel, Monica; Zhang, Jianying; O’Connell, Elizabeth; Clark, Robin E.

    2015-01-01

    Objectives. We examined factors associated with frequent hospitalizations and emergency department (ED) visits among Medicaid members who were homeless. Methods. We included 6494 Massachusetts Medicaid members who received services from a health care for the homeless program in 2010. We used negative binomial regression to examine variables associated with frequent utilization. Results. Approximately one third of the study population had at least 1 hospitalization and two thirds had 1 or more ED visits. More than 70% of hospitalizations and ED visits were incurred by only 12% and 21% of these members, respectively. Homeless individuals with co-occurring mental illness and substance use disorders were at greatest risk for frequent hospitalizations and ED visits (e.g., incidence rate ratios [IRRs] = 2.9–13.8 for hospitalizations). Individuals living on the streets also had significantly higher utilization (IRR = 1.5). Conclusions. Despite having insurance coverage, homeless Medicaid members experienced frequent hospitalizations and ED visits. States could consider provisions under the Patient Protection and Affordable Care Act (e.g., Medicaid expansion and Health Homes) jointly with housing programs to meet the needs of homeless individuals, which may improve the quality and cost effectiveness of care. PMID:26447915

  16. Long-term exposure to traffic pollution and hospital admissions in London.

    PubMed

    Halonen, Jaana I; Blangiardo, Marta; Toledano, Mireille B; Fecht, Daniela; Gulliver, John; Anderson, H Ross; Beevers, Sean D; Dajnak, David; Kelly, Frank J; Tonne, Cathryn

    2016-01-01

    Evidence on the effects of long-term exposure to traffic pollution on health is inconsistent. In Greater London we examined associations between traffic pollution and emergency hospital admissions for cardio-respiratory diseases by applying linear and piecewise linear Poisson regression models in a small-area analysis. For both models the results for children and adults were close to unity. In the elderly, linear models found negative associations whereas piecewise models found non-linear associations characterized by positive risks in the lowest and negative risks in the highest exposure category. An increased risk was observed among those living in areas with the highest socioeconomic deprivation. Estimates were not affected by adjustment for traffic noise. The lack of convincing positive linear associations between primary traffic pollution and hospital admissions agrees with a number of other reports, but may reflect residual confounding. The relatively greater vulnerability of the most deprived populations has important implications for public health. PMID:26476693

  17. European hospital adherence to GOLD recommendations for chronic obstructive pulmonary disease (COPD) exacerbation admissions.

    PubMed

    Roberts, C Michael; Lopez-Campos, Jose Luis; Pozo-Rodriguez, Francisco; Hartl, Sylvia

    2013-12-01

    Understanding how European care of chronic obstructive pulmonary disease (COPD) admissions vary against guideline standards provides an opportunity to target appropriate quality improvement interventions. In 2010-2011 an audit of care against the 2010 'Global initiative for chronic Obstructive Lung Disease' (GOLD) standards was performed in 16 018 patients from 384 hospitals in 13 countries. Clinicians prospectively identified consecutive COPD admissions over a period of 8 weeks, recording clinical care measures on a web-based data tool. Data were analysed comparing adherence to 10 key management recommendations. Adherence varied between hospitals and across countries. The lack of available spirometry results and variable use of oxygen and non-invasive ventilation (NIV) are high impact areas identified for improvement. PMID:23729193

  18. Extreme weather and air pollution effects on cardiovascular and respiratory hospital admissions in Cyprus.

    PubMed

    Tsangari, H; Paschalidou, A K; Kassomenos, A P; Vardoulakis, S; Heaviside, C; Georgiou, K E; Yamasaki, E N

    2016-01-15

    In many regions of the world, climatic change is associated with increased extreme temperatures, which can have severe effects on mortality and morbidity. In this study, we examine the effect of extreme weather on hospital admissions in Cyprus, for inland and coastal areas, through the use of synoptic weather classifications (air mass types). In addition, the effect of particulate air pollution (PM10) on morbidity is examined. Our results show that two air mass types, namely (a) warm, rainy days with increased levels of water vapour in the atmosphere and (b) cold, cloudy days with increased levels of precipitation, were associated with increased morbidity in the form of hospital admissions. This was true both for cardiovascular and respiratory conditions, for all age groups, but particularly for the elderly, aged over 65. Particulate air pollution was also associated with increased morbidity in Cyprus, where the effect was more pronounced for cardiovascular diseases. PMID:26519584

  19. Impacts of hot and cold temperature extremes on hospital admissions for cardiovascular diseases

    NASA Astrophysics Data System (ADS)

    Davídkovová, H.; Kyselý, J.; Kříž, B.

    2010-09-01

    Elevated mortality associated with high ambient temperatures in summer represents one of the main impacts of weather extremes on human society. Increases in mortality during heat waves were examined in many European countries; much less is known about the effects of heat waves on morbidity, measured for example by the number of hospital admissions. Relatively less understood is also cold-related mortality and morbidity in winter, when the relationships between weather and human health are more complex, less direct, and confounded by other factors such as epidemics of influenza/acute respiratory infections. The present study examines links between hot and cold temperature extremes and daily hospital admissions for cardiovascular diseases in the population of the Czech Republic over 1994-2007. We make use of a recently completed database of all admissions for cardiovascular diseases to hospitals in the area of the Czech Republic since 1994, with a detailed classification of diseases and detailed information concerning each patient (in total 1,467,675 hospital admissions over 1994-2007). The main goals of the study are (i) to identify excess/deficit morbidity during and after periods of heat waves in summer and cold spells in winter, (ii) to compare the links for individual diseases (e.g. acute myocardial infarction, I21; angina pectoris, I20; cerebral infarction, I63; brain ischemia, I64) and to identify those diagnoses that are most closely linked to weather, (iii) to identify population groups most vulnerable to temperature extremes, and (iv) to compare the links to temperature extremes for morbidity and mortality. Periods when morbidity data were affected by epidemics of influenza and acute respiratory infections in winter were excluded from the analysis.

  20. Declining Statewide Trends in Motor Vehicle Crashes and Injury-Related Hospital Admissions

    PubMed Central

    Dischinger, Patricia C.; Ryb, Gabriel E.; Kufera, Joseph A.; Ho, Shiu M.

    2013-01-01

    Numbers of crashes, rates of police-reported injury severity, and hospital admission rates were calculated for the ten year period between 2001 and 2010 in Maryland. Comparisons were made for two 5-year periods of 2001–2005 and 2006–2010. Crash characteristics remained similar for the two five-year periods, but there was a significant increase in occupant age. Declines in police-reported injury severity were noted for each of four age groups: 16–29, 30–54, 55–64, and 65+, with smaller declines among older occupants. In addition, there were significant declines in hospital admissions, comparing the two time periods. Although reductions in crashes may be attributable to various roadway, behavioral, and other safety improvement efforts, reductions in hospital admission rates most likely reflect major improvements in crashworthiness implemented during the past decade. For those admitted to hospitals, significant increases in injury severity were noted between the first and second time periods. There was an association between age and ISS, a measure of total bodily injury, with the highest ISS scores noted for the youngest and oldest groups (16–29 and 55+, respectively). In addition, there was a significant increase in the mean age over time, from 39 in 2001 to 43 in 2010, p<.001. In general, the incidence and severity of injuries increased for all body regions. There was also a significant increase in hospital mortality, although length of hospital stay remained the same. Given these trends, increased efforts need to focus on both injury prevention and treatment for the increasing population of older, sometimes frail, vehicle occupants. PMID:24406962

  1. Declining statewide trends in motor vehicle crashes and injury-related hospital admissions.

    PubMed

    Dischinger, Patricia C; Ryb, Gabriel E; Kufera, Joseph A; Ho, Shiu M

    2013-01-01

    Numbers of crashes, rates of police-reported injury severity, and hospital admission rates were calculated for the ten year period between 2001 and 2010 in Maryland. Comparisons were made for two 5-year periods of 2001-2005 and 2006-2010. Crash characteristics remained similar for the two five-year periods, but there was a significant increase in occupant age. Declines in police-reported injury severity were noted for each of four age groups: 16-29, 30-54, 55-64, and 65+, with smaller declines among older occupants. In addition, there were significant declines in hospital admissions, comparing the two time periods. Although reductions in crashes may be attributable to various roadway, behavioral, and other safety improvement efforts, reductions in hospital admission rates most likely reflect major improvements in crashworthiness implemented during the past decade. For those admitted to hospitals, significant increases in injury severity were noted between the first and second time periods. There was an association between age and ISS, a measure of total bodily injury, with the highest ISS scores noted for the youngest and oldest groups (16-29 and 55+, respectively). In addition, there was a significant increase in the mean age over time, from 39 in 2001 to 43 in 2010, p<.001. In general, the incidence and severity of injuries increased for all body regions. There was also a significant increase in hospital mortality, although length of hospital stay remained the same. Given these trends, increased efforts need to focus on both injury prevention and treatment for the increasing population of older, sometimes frail, vehicle occupants. PMID:24406962

  2. Social Welfare Centers Protect Outpatients with Mood Disorders from Risk of Hospital Admission

    PubMed Central

    Han, Kyu-Tae; Jang, Suk Yong; Park, Sohee; Cho, Kyung Hee; Yoo, Ki-Bong; Choi, Young; Park, Eun-Cheol

    2016-01-01

    Background South Korea faces difficulties in the management of mental disorders, and those difficulties are expected to gradually worsen. Therefore, we analyzed the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders. Methods We used data from the National Health Insurance Service National Sample Cohort 2002–2013, which included all medical claims filed for the 50,160 patients who were newly diagnosed with a mood disorder among the 1,025,340 individuals in a nationally representative sample. We performed a logistic regression analysis using generalized estimating equation (GEE) models to examine the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders (ICD-10: F3). Results There was a 3.9% admission rate among a total of 99,533 person-years. Outpatients who lived in regions with more social welfare centers were less likely to be admitted to a hospital (per increase of five social welfare centers per 100,000 people; OR: 0.958; 95% CI: 0.919–0.999). Social welfare centers had an especially strong protective effect on patients with relatively mild mood disorders and those who were vulnerable to medical expenditures. Conclusions Considering the protective role of social welfare centers in managing patients with mood disorders, health-policy makers need to consider strategies for activating mental healthcare. PMID:26745728

  3. Vulnerabilities to Temperature Effects on Acute Myocardial Infarction Hospital Admissions in South Korea

    PubMed Central

    Kwon, Bo Yeon; Lee, Eunil; Lee, Suji; Heo, Seulkee; Jo, Kyunghee; Kim, Jinsun; Park, Man Sik

    2015-01-01

    Most previous studies have focused on the association between acute myocardial function (AMI) and temperature by gender and age. Recently, however, concern has also arisen about those most susceptible to the effects of temperature according to socioeconomic status (SES). The objective of this study was to determine the effect of heat and cold on hospital admissions for AMI by subpopulations (gender, age, living area, and individual SES) in South Korea. The Korea National Health Insurance (KNHI) database was used to examine the effect of heat and cold on hospital admissions for AMI during 2004–2012. We analyzed the increase in AMI hospital admissions both above and below a threshold temperature using Poisson generalized additive models (GAMs) for hot, cold, and warm weather. The Medicaid group, the lowest SES group, had a significantly higher RR of 1.37 (95% CI: 1.07–1.76) for heat and 1.11 (95% CI: 1.04–1.20) for cold among subgroups, while also showing distinctly higher risk curves than NHI for both hot and cold weather. In additions, females, older age group, and those living in urban areas had higher risks from hot and cold temperatures than males, younger age group, and those living in rural areas. PMID:26580643

  4. Vulnerabilities to Temperature Effects on Acute Myocardial Infarction Hospital Admissions in South Korea.

    PubMed

    Kwon, Bo Yeon; Lee, Eunil; Lee, Suji; Heo, Seulkee; Jo, Kyunghee; Kim, Jinsun; Park, Man Sik

    2015-11-01

    Most previous studies have focused on the association between acute myocardial function (AMI) and temperature by gender and age. Recently, however, concern has also arisen about those most susceptible to the effects of temperature according to socioeconomic status (SES). The objective of this study was to determine the effect of heat and cold on hospital admissions for AMI by subpopulations (gender, age, living area, and individual SES) in South Korea. The Korea National Health Insurance (KNHI) database was used to examine the effect of heat and cold on hospital admissions for AMI during 2004-2012. We analyzed the increase in AMI hospital admissions both above and below a threshold temperature using Poisson generalized additive models (GAMs) for hot, cold, and warm weather. The Medicaid group, the lowest SES group, had a significantly higher RR of 1.37 (95% CI: 1.07-1.76) for heat and 1.11 (95% CI: 1.04-1.20) for cold among subgroups, while also showing distinctly higher risk curves than NHI for both hot and cold weather. In additions, females, older age group, and those living in urban areas had higher risks from hot and cold temperatures than males, younger age group, and those living in rural areas. PMID:26580643

  5. Chemical Properties of Air Pollutants and Cause-Specific Hospital Admissions among the Elderly in Atlanta, Georgia

    PubMed Central

    Zanobetti, Antonella; Schwartz, Joel; Coull, Brent A.

    2011-01-01

    Background: Health risks differ by fine particle (aerodynamic diameter ≤ 2.5 μm) component, although with substantial variability. Traditional methods to assess component-specific risks are limited, suggesting the need for alternative methods. Objectives: We examined whether the odds of daily hospital admissions differ by pollutant chemical properties. Methods: We categorized pollutants by chemical properties and examined their impacts on the odds of daily hospital admissions among Medicare recipients > 64 years of age in counties in Atlanta, Georgia, for 1998–2006. We analyzed data in two stages. In the first stage we applied a case-crossover analysis to simultaneously estimate effects of 65 pollutants measured in the Aerosol Research and Inhalation Epidemiology Study on cause-specific hospital admissions, controlling for temperature and ozone. In the second stage, we regressed pollutant-specific slopes from the first stage on pollutant properties. We calculated uncertainty estimates using a bootstrap procedure. We repeated the two-stage analyses using coefficients from first-stage models that included single pollutants plus ozone and meteorological variables only. We based our primary analyses on exposures on day of admission. Results: We found that 24-hr transition metals and alkanes were associated with increased odds [0.26%; 95% confidence interval (CI), 0.02–0.48; and 0.37%; 95% CI, 0.04–0.72, respectively] of hospital admissions for cardiovascular disease (CVD). Transition metals were significantly associated with increased hospital admissions for ischemic heart disease, congestive heart failure, and atrial fibrillation. Increased respiratory-related hospital admissions were significantly associated with alkanes. Aromatics and microcrystalline oxides were significantly associated with decreased CVD- and respiratory-related hospital admissions. Conclusions: The two-stage approach showed transition metals to be consistently associated with increased

  6. Monitoring Child Abuse and Neglect at a Population Level: Patterns of Hospital Admissions for Maltreatment and Assault

    ERIC Educational Resources Information Center

    O'Donnell, Melissa; Nassar, Natasha; Leonard, Helen; Mathews, Richard; Patterson, Yvonne; Stanley, Fiona

    2010-01-01

    Objectives: To investigate the prevalence, trends, and characteristics of maltreatment and assault related hospital admissions and deaths among children; and identify common injuries and conditions associated with these admissions using routinely collected morbidity and mortality data. Methods: A retrospective cohort study of all children aged…

  7. Hospital admissions for acute myocardial infarction before and after implementation of a comprehensive smoke-free policy in Uruguay

    PubMed Central

    Sebrié, Ernesto Marcelo; Sandoya, Edgardo; Hyland, Andrew; Bianco, Eduardo; Glantz, Stanton A; Cummings, K Michael

    2012-01-01

    Background Stimulated by the WHO Framework Convention on Tobacco Control, many countries in Latin America adopted comprehensive smoke-free policies. In March 2006, Uruguay became the first Latin American country to adopt 100% smoke-free national legislation, which ended smoking in all indoor public places and workplaces, including restaurants and bars. The objective of this study was to evaluate trends in hospital admissions for cardiovascular disease 2 years before and 2 years after the policy was implemented in Uruguay. Methods Reports of hospital admissions for acute myocardial infarction (AMI) (International Classification of Disease-10 I21) from 37 hospitals (79% of all hospital admissions in the country), representing the period 2 years before and 2 years after the adoption of a nationwide smoke-free policy in Uruguay (between 1 March 2004 and 29 February 2008), were reviewed. A time series analysis was undertaken to compare the average monthly number of events of hospital admission for AMI before and after the smoke-free law. Results A total of 7949 hospital admissions for AMI were identified during the 4-year study period. Two years after the smoke-free policy was enacted, hospital admissions for AMI fell by 22%. The same pattern and roughly the same magnitude of reduction in AMI admissions were observed for patients seen in public and private hospitals, men, women and people aged 40–65 years and older than 65 years. Conclusions The national smoke-free policy implemented in Uruguay in 2006 was associated with a significant reduction in hospital admissions for AMI. PMID:22337557

  8. A qualitative examination of inappropriate hospital admissions and lengths of stay

    PubMed Central

    Hammond, Christina L; Pinnington, Lorraine L; Phillips, Margaret F

    2009-01-01

    Background Research has shown that a number of patients, with a variety of diagnoses, are admitted to hospital when it is not essential and can remain in hospital unnecessarily. To date, research in this area has been primarily quantitative. The purpose of this study was to explore the perceived causes of inappropriate or prolonged lengths of stay and focuses on a specific population (i.e., patients with long term neurological conditions). We also wanted to identify interventions which might avoid admission or expedite discharge as periods of hospitalisation pose particular risks for this group. Methods Two focus groups were conducted with a convenience sample of eight primary and secondary care clinicians working in the Derbyshire area. Data were analysed using a thematic content approach. Results The participants identified a number of key causes of inappropriate admissions and lengths of stay, including: the limited capacity of health and social care resources; poor communication between primary and secondary care clinicians and the cautiousness of clinicians who manage patients in community settings. The participants also suggested a number of strategies that may prevent inappropriate admissions or reduce length of stay (LoS), including: the introduction of new sub-acute care facilities; the introduction of auxiliary nurses to support specialist nursing staff and patient held summaries of specialist consultations. Conclusion Clinicians in both the secondary and primary care sectors acknowledged that some admissions were unnecessary and some patients remain in hospital for a prolonged period. These events were attributed to problems with the current capacity or structuring of services. It was noted, for example, that there is a shortage of appropriate therapeutic services and that the distribution of beds between community and sub-acute care should be reviewed. PMID:19265547

  9. Payment Reform Pilot In Beijing Hospitals Reduced Expenditures And Out-Of-Pocket Payments Per Admission.

    PubMed

    Jian, Weiyan; Lu, Ming; Chan, Kit Yee; Poon, Adrienne N; Han, Wei; Hu, Mu; Yip, Winnie

    2015-10-01

    In 2009 China announced plans to reform provider payment methods at public hospitals by moving from fee-for-service (FFS) to prospective and aggregated payment methods that included the use of diagnosis-related groups (DRGs) to control health expenditures. In October 2011 health policy makers selected six Beijing hospitals to pioneer the first DRG payment system in China. We used hospital discharge data from the six pilot hospitals and eight other hospitals, which continued to use FFS and served as controls, from the period 2010-12 to evaluate the pilot's impact on cost containment through a difference-in-differences methods design. Our study found that DRG payment led to reductions of 6.2 percent and 10.5 percent, respectively, in health expenditures and out-of-pocket payments by patients per hospital admission. We did not find evidence of any increase in hospital readmission rates or cost shifting from cases eligible for DRG payment to ineligible cases. However, hospitals continued to use FFS payments for patients who were older and had more complications than other patients, which reduced the effectiveness of payment reform. Continuous evidence-based monitoring and evaluation linked with adequate management systems are necessary to enable China and other low- and middle-income countries to broadly implement DRGs and refine payment systems. PMID:26438752

  10. Medical causes of admissions to hospital among adults in Africa: a systematic review

    PubMed Central

    Etyang, Anthony O.; Scott, John Anthony Gerard

    2013-01-01

    Background Despite the publication of several studies on the subject, there is significant uncertainty regarding the burden of disease among adults in sub-Saharan Africa (sSA). Objectives To describe the breadth of available data regarding causes of admission to hospital, to systematically analyze the methodological quality of these studies, and to provide recommendations for future research. Design We performed a systematic online and hand-based search for articles describing patterns of medical illnesses in patients admitted to hospitals in sSA between 1950 and 2010. Diseases were grouped into bodily systems using International Classification of Disease (ICD) guidelines. We compared the proportions of admissions and deaths by diagnostic category using χ2. Results Thirty articles, describing 86,307 admissions and 9,695 deaths, met the inclusion criteria. The leading causes of admission were infectious and parasitic diseases (19.8%, 95% confidence interval [CI] 19.6–20.1), respiratory (16.2%, 95% CI 16.0–16.5) and circulatory (11.3%, 95% CI 11.1–11.5) illnesses. The leading causes of death were infectious and parasitic (17.1%, 95% CI 16.4–17.9), circulatory (16%, 95% CI 15.3–16.8) and digestive (16.2%, 95% CI 15.4–16.9). Circulatory diseases increased from 3.9% of all admissions in 1950–59 to 19.9% in 2000–2010 (RR 5.1, 95% CI 4.5–5.8, test for trend p<0.00005). The most prevalent methodological deficiencies, present in two-thirds of studies, were failures to use standardized case definitions and ICD guidelines for classifying illnesses. Conclusions Cardiovascular and infectious diseases are currently the leading causes of admissions and in-hospital deaths in sSA. Methodological deficiencies have limited the usefulness of previous studies in defining national patterns of disease in adults. As African countries pass through demographic and health transition, they need to significantly invest in clinical research capacity to provide an accurate

  11. Apparent Temperature and Cause-Specific Emergency Hospital Admissions in Greater Copenhagen, Denmark

    PubMed Central

    Wichmann, Janine; Andersen, Zorana; Ketzel, Matthias; Ellermann, Thomas; Loft, Steffen

    2011-01-01

    One of the key climate change factors, temperature, has potentially grave implications for human health. We report the first attempt to investigate the association between the daily 3-hour maximum apparent temperature (Tappmax) and respiratory (RD), cardiovascular (CVD), and cerebrovascular (CBD) emergency hospital admissions in Copenhagen, controlling for air pollution. The study period covered 1 January 2002−31 December 2006, stratified in warm and cold periods. A case-crossover design was applied. Susceptibility (effect modification) by age, sex, and socio-economic status was investigated. For an IQR (8°C) increase in the 5-day cumulative average of Tappmax, a 7% (95% CI: 1%, 13%) increase in the RD admission rate was observed in the warm period whereas an inverse association was found with CVD (−8%, 95% CI: −13%, −4%), and none with CBD. There was no association between the 5-day cumulative average of Tappmax during the cold period and any of the cause-specific admissions, except in some susceptible groups: a negative association for RD in the oldest age group and a positive association for CVD in men and the second highest SES group. In conclusion, an increase in Tappmax is associated with a slight increase in RD and decrease in CVD admissions during the warmer months. PMID:21829550

  12. Coarse Particulate Air Pollution Associated with Increased Risk of Hospital Admissions for Respiratory Diseases in a Tropical City, Kaohsiung, Taiwan

    PubMed Central

    Cheng, Meng-Hsuan; Chiu, Hui-Fen; Yang, Chun-Yuh

    2015-01-01

    This study was undertaken to determine whether there was an association between coarse particles (PM2.5–10) levels and frequency of hospital admissions for respiratory diseases (RD) in Kaohsiung, Taiwan. Hospital admissions for RD including chronic obstructive pulmonary disease (COPD), asthma, and pneumonia, and ambient air pollution data levels for Kaohsiung were obtained for the period from 2006 to 2010. The relative risk of hospital admissions for RD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single pollutant model (without adjustment for other pollutants), increased rate of admissions for RD were significantly associated with higher coarse PM levels only on cool days (<25 °C), with a 10 µg/m3 elevation in PM2.5–10 concentrations associated with a 3% (95% CI = 1%–5%) rise in COPD admissions, 4% (95% CI = 1%–7%) increase in asthma admissions, and 3% (95% CI = 2%–4%) rise in pneumonia admissions. No significant associations were found between coarse particle levels and the number of hospital admissions for RD on warm days. In the two-pollutant models, PM2.5–10 levels remained significantly correlated with higher rate of RD admissions even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. This study provides evidence that higher levels of PM2.5–10 enhance the risk of hospital admissions for RD on cool days. PMID:26501308

  13. Inpatient Readmissions and Emergency Department Visits within 30 Days of a Hospital Admission

    PubMed Central

    Brennan, Jesse J.; Chan, Theodore C.; Killeen, James P.; Castillo, Edward M.

    2015-01-01

    Introduction Inpatient hospital readmissions have become a focus for healthcare reform and cost-containment efforts. Initiatives targeting unanticipated readmissions have included care coordination for specific high readmission diseases and patients and health coaching during the post-discharge transition period. However, little research has focused on emergency department (ED) visits following an inpatient admission. The objective of this study was to assess 30-day ED utilization and all-cause readmissions following a hospital admission. Methods This was a retrospective study using inpatient and ED utilization data from two hospitals with a shared patient population in 2011. We assessed the 30-day ED visit rate and 30-day readmission rate and compared patient characteristics among individuals with 30-day inpatient readmissions, 30-day ED discharges, and no 30-day visits. Results There were 13,449 patients who met the criteria of an index visit. Overall, 2,453 (18.2%) patients had an ED visit within 30 days of an inpatient stay. However, only 55.6% (n=1,363) of these patients were admitted at one of these 30-day visits, resulting in a 30-day all-cause readmission rate of 10.1%. Conclusion Approximately one in five patients presented to the ED within 30 days of an inpatient hospitalization and over half of these patients were readmitted. Readmission measures that incorporate ED visits following an inpatient stay might better inform interventions to reduce avoidable readmissions. PMID:26759647

  14. Population-based characteristics of fatal and hospital admissions for poisoning in Fiji: TRIP Project-11.

    PubMed

    Peiris-John, Roshini; Kafoa, Berlin; Wainiqolo, Iris; Reddy, Ravi Krishnan; McCaig, Eddie; Ameratunga, Shanthi N

    2013-10-01

    This study investigated the incidence and characteristics of poisoning fatalities and hospital admissions among indigenous Fijians and Indians in Viti Levu, Fiji. Individuals with a mechanism of injury classified as poisoning were identified using the Fiji injury surveillance in hospitals system, a population-based registry established for 12 months in Viti Levu, and analysed using population-based denominators. The mean annual rates of fatalities and hospitalisations were 2.3 and 26.0 per 100 000, respectively. Over two-thirds of poisonings occurred among people of Indian ethnicity. Most intentional poisoning admissions occurred among women (58.3%) and in 15-29-year-old individuals (73.8%). Unintentional poisoning admission rates were highest among Indian boys aged 0-14 years. While over 75% of events occurred at home, the substances involved were not systematically identified. The findings indicate the need for a strategy that addresses the differing contexts across age group, gender and ethnicity, and a lead agency responsible for implementing and monitoring its effectiveness. PMID:23353079

  15. Epidemiology of Orthopaedic Trauma Admissions Over One Year in a District General Hospital in England

    PubMed Central

    Taylor, A; Young, A

    2015-01-01

    Introduction : Admission to district general hospitals in England has undergone change in recent years due to both an aging population and the reconfiguration of the major trauma network throughout the United Kingdom. Methods : We utilised a retrospective cohort study to analyse the epidemiology over a 12-month period at a district general hospital. Data was collected and divided into groups: upper limb, lower limb, vertebral disc disease, vertebral fracture, cellulitis without bone involvement and deep infection including metalwork. Results : 2817 patients were admitted over the 12-month period. There were 893 upper limb fractures, 1511 lower limb fractures, 126 vertebral disc disease, 55 vertebral fractures, 108 cellulitis without bone involvement and 124 deep infections with 19 admissions not specified due to coding. AN average of 242 patients were admitted each month with the majority admitted during the summer months. Conclusion : Although fractures make up the majority of the reason for which a person is admitted, there are also many other injuries/morbidities, which may necessitate admission. There is an increasing incidence of elderly osteoporotic fractures in females, which is balancing out the previously more common fractures seen in younger adults and adolescents. PMID:26069514

  16. Proximity to coke works and hospital admissions for respiratory and cardiovascular disease in England and Wales

    PubMed Central

    Aylin, P; Bottle, A; Wakefield, J; Jarup, L; Elliott, P

    2001-01-01

    BACKGROUND—The incidence of hospital admissions for respiratory and cardiovascular diseases in areas close to operating coke works in England and Wales was investigated.
METHODS—A small area study using distance from source as a proxy for exposure was undertaken in subjects aged 65 or over and children under 5 years within 7.5 km of four coke works (1991 estimated populations 87 760 and 43 932, respectively). The main outcome measures were emergency hospital admissions in 1992/3-1994/5 with a primary diagnosis of coronary heart disease (ICD 410-414), stroke (ICD 431-438), all respiratory diseases (ICD 460-519), chronic obstructive pulmonary disease (ICD 491-492), and asthma (ICD 493) in those aged 65 or over, and all respiratory and asthma admissions in children under 5 years of age.
RESULTS—At age 65 or over the combined estimate of relative risk with proximity to coke works (per km) ranged from 0.99 (95% CI 0.90to 1.09) for chronic obstructive pulmonary disease to 1.03 (95% CI 0.94 to 1.13) for asthma. For children under 5 years the combined estimate of risk was 1.08 (95% CI 0.98 to 1.20) for all respiratory disease and 1.07 (95% CI 0.98 to 1.18) for asthma. There was evidence of significant heterogeneity in risk estimates between coke work groups, especially in children under 5 years (p<0.001 and p=0.004 for respiratory disease and asthma, respectively). For the Teesside coke works in North East England the relative risk with proximity (per km) was 1.09 (95% CI 1.06 to 1.12) for respiratory disease and 1.09 (95% CI 1.04 to 1.15) for asthma.
CONCLUSIONS—No evidence overall was found for an association between hospital admissions and living near operational coke works in England and Wales. Trends of a higher risk of hospital admission for respiratory disease and asthma among children with proximity to the Teesside plant require further investigation.

 PMID:11182017

  17. Risk Factors for Psychiatric Hospital Admission for Participants in California's Full-Service Partnership Program.

    PubMed

    Penkunas, Michael J; Hahn-Smith, Stephen

    2016-08-01

    This study investigated the demographic and clinical predictors of psychiatric hospitalization during the first 2 years of treatment for adults participating in the full-service partnership (FSP) program, based on Assertive Community Treatment, in a large county in northern California. Clinical and demographic characteristics, data on prior hospitalizations, length of enrollment, and living situation for 328 FSP participants were collected from the county's internal billing system and the California Department of Health Care Services. In univariate models, the probability of hospitalization varied by diagnosis, age, and hospitalization history. In the multivariate model, younger age and frequent hospitalization prior to enrollment predicted hospitalization during enrollment. Findings support prior research on hospital recidivism and may be beneficial in refining future strategies for meeting the needs of adults with serious mental illness. PMID:25527223

  18. Rising United States Hospital Admissions for Acute Bacterial Skin and Skin Structure Infections: Recent Trends and Economic Impact

    PubMed Central

    Kaye, Keith S.; Patel, Dipen A.; Stephens, Jennifer M.; Khachatryan, Alexandra; Patel, Ayush; Johnson, Kenneth

    2015-01-01

    Background The number of ambulatory patients seeking treatment for skin and skin structure infections (SSSI) are increasing. The objective of this study is to determine recent trends in hospital admissions and healthcare resource utilization and identify covariates associated with hospital costs and mortality for hospitalized adult patients with a primary SSSI diagnosis in the United States. Methods We performed a retrospective cross-sectional analysis (years 2005–2011) of data from the US Healthcare Cost and Utilization Project National Inpatient Sample. Recent trends, patient characteristics, and healthcare resource utilization for patients hospitalized with a primary SSSI diagnosis were evaluated. Descriptive and bivariate analyses were conducted to assess patient and hospital characteristics. Results A total of 1.8% of hospital admissions for the years 2005 through 2011 were for adult patients with a SSSI primary diagnosis. SSSI-related hospital admissions significantly changed during the study period (P < .001 for trend) ranging from 1.6% (in 2005) to 2.0% (in 2011). Mean hospital length of stay (LOS) decreased from 5.4 days in the year 2005 to 5.0 days in the year 2011 (overall change, P < .001) with no change in hospital costs. Patients with postoperative wound infections had the longest hospital stays (adjusted mean, 5.81 days; 95% confidence interval (CI), 5.80–5.83) and highest total costs (adjusted mean, $9388; 95% CI, $9366-$9410). Year of hospital admission was strongly associated with mortality; infection type, all patient refined diagnosis related group severity of illness level, and LOS were strongly associated with hospital costs. Conclusions Hospital admissions for adult patients in the United States with a SSSI primary diagnosis continue to increase. Decreasing hospital inpatient LOS and mortality rate may be due to improved early treatment. Future research should focus on identifying alternative treatment processes for patients with SSSI

  19. Expiratory flow limitation relates to symptoms during COPD exacerbations requiring hospital admission

    PubMed Central

    Jetmalani, Kanika; Timmins, Sophie; Brown, Nathan J; Diba, Chantale; Berend, Norbert; Salome, Cheryl M; Wen, Fu-Qiang; Chen, Peng; King, Gregory G; Farah, Claude S

    2015-01-01

    Background Expiratory flow limitation (EFL) is seen in some patients presenting with a COPD exacerbation; however, it is unclear how EFL relates to the clinical features of the exacerbation. We hypothesized that EFL when present contributes to symptoms and duration of recovery during a COPD exacerbation. Our aim was to compare changes in EFL with symptoms in subjects with and without flow-limited breathing admitted for a COPD exacerbation. Subjects and methods A total of 29 subjects with COPD were recruited within 48 hours of admission to West China Hospital for an acute exacerbation. Daily measurements of post-bronchodilator spirometry, resistance, and reactance using the forced oscillation technique and symptom (Borg) scores until discharge were made. Flow-limited breathing was defined as the difference between inspiratory and expiratory respiratory system reactance (EFL index) greater than 2.8 cmH2O·s·L−1. The physiological predictors of symptoms during recovery were determined by mixed-effect analysis. Results Nine subjects (31%) had flow-limited breathing on admission despite similar spirometry compared to subjects without flow-limited breathing. Spirometry and resistance measures did not change between enrolment and discharge. EFL index values improved in subjects with flow-limited breathing on admission, with resolution in four patients. In subjects with flow-limited breathing on admission, symptoms were related to inspiratory resistance and EFL index values. In subjects without flow-limited breathing, symptoms related to forced expiratory volume in 1 second/forced vital capacity. In the whole cohort, EFL index values at admission was related to duration of stay (Rs=0.4, P=0.03). Conclusion The presence of flow-limited breathing as well as abnormal respiratory system mechanics contribute independently to symptoms during COPD exacerbations. PMID:25999709

  20. Hospital admissions as a function of temperature, other weather phenomena and pollution levels in an urban setting in China

    PubMed Central

    Goggins, William B; Yue, Janice SK; Lee, Poyi

    2013-01-01

    Abstract Objective To explore the relationship between weather phenomena and pollution levels and daily hospital admissions (as an approximation to morbidity patterns) in Hong Kong Special Administrative Region (SAR), China, in 1998–2009. Methods Generalized additive models and lag models were constructed with data from official sources on hospital admissions and on mean daily temperature, mean daily wind speed, mean relative humidity, daily total global solar radiation, total daily rainfall and daily pollution levels. Findings During the hot season, admissions increased by 4.5% for every increase of 1 °C above 29 °C; during the cold season, admissions increased by 1.4% for every decrease of 1 °C within the 8.2–26.9 °C range. In subgroup analyses, admissions for respiratory and infectious diseases increased during extreme heat and cold, but cardiovascular disease admissions increased only during cold temperatures. For every increase of 1 °C above 29 °C, admissions for unintentional injuries increased by 1.9%. During the cold season, for every decrease of 1 °C within the 8.2–26.9 °C range, admissions for cardiovascular diseases and intentional injuries rose by 2.1% and 2.4%, respectively. Admission patterns were not sensitive to sex. Admissions for respiratory diseases rose during hot and cold temperatures among children but only during cold temperatures among the elderly. In people aged 75 years or older, admissions for infectious diseases rose during both temperature extremes. Conclusion In Hong Kong SAR, hospitalizations rise during extreme temperatures. Public health interventions should be developed to protect children, the elderly and other vulnerable groups from excessive heat and cold. PMID:23940405

  1. Hospital Admissions for Stroke among the Very Old in the USA

    PubMed Central

    Tabereaux, Paul B.; Brass, Lawrence M.; Concato, John; Bravata, Dawn M.

    2008-01-01

    Background We sought to describe the proportion of acute ischemic stroke admissions for very old patients (≥85 years), compare the characteristics of very old versus younger patients and identify factors among very old patients associated with adverse outcomes. Methods The 2000 Healthcare Cost and Utilization Project data included acute ischemic stroke hospitalizations for patients ≥45 years. The combined outcome was in-hospital mortality or discharge to a long-term care facility. Results Among 15,020 stroke hospitalizations, 20.4% were for very old patients. The outcome rate was higher in hospitalizations for very old patients (2,176/3,058, 71.2%; versus 5,748/11,962, 48%; p < 0.0001). More hospitalizations for very old patients were for women (73.5 versus 55.1%; p < 0.0001), fewer for Blacks (6.1 versus 12.3%; p < 0.0001) and fewer at teaching hospitals (30.4 versus 36.2%; p < 0.0001). Among very old patients, factors that were independently associated with the outcome included: age [years; adjusted OR = 1.02 (95% CI = 1.000–1.05)], female gender [1.4 (1.18–1.68)], atrial fibrillation [1.37 (1.15–1.63)], acute myocardial infarction [1.68 (1.20–2.35)], respiratory failure [3.59 (1.60–8.05)] and teaching hospital admission [0.82 (0.69–0.98)]. Similar results were observed in the hospitalizations for younger patients. The adjusted OR for the outcome displayed geographic disparities in both age groups, but the pattern of the geographic variation was not similar between the two age groups. Conclusions The very old constitute a substantial proportion of stroke hospitalizations. Hospitalizations for very old patients are more likely to end in death or discharge to a long-term care facility than hospitalizations for younger patients. The pattern of geographic disparity in poststroke adverse outcomes differs between younger and very old patients. PMID:18645263

  2. The effect of coarse ambient particulate matter on first, second, and overall hospital admissions for respiratory disease among the elderly

    SciTech Connect

    Yue Chen; Qiuying Yang; Daniel Krewski; Richard T. Burnett; Yuanli Shi; Kimberlyn M. McGrail

    2005-11-01

    The objective of this article is to examine differences in the effect of ambient particulate matter on first, second, and overall hospital admissions for respiratory disease among the elderly. 8989 adults 65 yr of age or older living in the greater Vancouver area who were admitted to hospital for any acute respiratory disease (ICD-9 codes 460-519) between June 1, 1995, and March 31, 1999 were studied. Time-series analysis was used to evaluate the association between respiratory admissions and daily measures of particulate matter (PM{sub 10}, PM{sub 2.5}, and PM{sub 10-2.5} in urban air, after adjustment for gaseous copollutants (CO, O{sub 3}, NO{sub 2}, and SO{sub 2}) and meteorological variables. Repeated admissions for respiratory disease were common among the elderly. Approximately 30% of the subjects were readmitted to hospital after the first admission; 9% had more than 2 admissions for respiratory disease during the 4-yr study period. PM{sub 10-2.5} was significantly associated with the second and overall admissions for respiratory disease, but not with the first admission. The adjusted relative risks for an increment of 4.2 {mu} g/m{sup 3} in-day average PM{sub 10-2.5} concentrations were 1.03 for the first admission, 1.22 for the second admission, and 1.06 for overall admissions. There was no significant association between PM{sub 2.5} and hospital admissions for respiratory disease among the elderly. The data suggest that (1) people with a history of respiratory admissions are at a higher risk of respiratory disease in relation to particulate air pollution in urban areas, (2) analyses based on overall rather than repeated hospital admissions lead to lower estimates of the risk of respiratory disease associated with particulate air pollution, and (3) PM{sub 10-2.5} has a larger effect on respiratory admissions than PM{sub 2.5}.

  3. Complications Requiring Hospital Admission and Causes of In-Hospital Death over Time in Alcoholic and Nonalcoholic Cirrhosis Patients

    PubMed Central

    Kim, Hee Yeon; Kim, Chang Wook; Choi, Jong Young; Lee, Chang Don; Lee, Sae Hwan; Kim, Moon Young; Jang, Byoung Kuk; Woo, Hyun Young

    2016-01-01

    Background/Aims Data on the epidemiology of alcoholic cirrhosis, especially in Asian countries, are limited. We compared the temporal evolution of patterns of alcoholic and nonalcoholic cirrhosis over the last decade. Methods We retrospectively examined the inpatient datasets of five referral centers during 2002 and 2011. The study included patients who were admitted due to specific complications of liver cirrhosis. We compared the causes of hospital admissions and in-hospital deaths between patients with alcoholic and nonalcoholic cirrhosis. Results Among the included 2,799 hospitalizations (2,165 patients), 1,496 (1,143 patients) were from 2002, and 1,303 (1,022 patients) were from 2011. Over time, there was a reduction in the rate of hepatic encephalopathy (HE) as a cause of hospitalization and an increase in the rate of hepatocellular carcinoma. Deaths that were attributable to HE or spontaneous bacterial peritonitis (SBP) significantly decreased, whereas those due to hepatorenal syndrome (HRS) significantly increased over time in patients with alcoholic cirrhosis. However, in patients with nonalcoholic cirrhosis, hepatic failure and HRS remained the principal causes of in-hospital death during both time periods. Conclusions The major causes of in-hospital deaths have evolved from acute cirrhotic complications, including HE or SBP to HRS in alcoholic cirrhosis, whereas those have remained unchanged in nonalcoholic cirrhosis during the last decade. PMID:26087788

  4. A Nationwide Analysis of Outcomes of Weekend Admissions for Intracerebral Hemorrhage Shows Disparities Based on Hospital Teaching Status

    PubMed Central

    Patel, Achint A.; Benjo, Alexandre; Pathak, Ambarish; Kar, Jitesh; Jani, Vishal B.; Annapureddy, Narender; Agarwal, Shiv Kumar; Sabharwal, Manpreet S.; Simoes, Priya K.; Konstantinidis, Ioannis; Yacoub, Rabi; Javed, Fahad; El Hayek, Georges; Menon, Madhav C.; Nadkarni, Girish N.

    2015-01-01

    Background and Purpose: With the “weekend effect” being well described, the Brain Attack Coalition released a set of “best practice” guidelines in 2005, with the goal to uniformly provide standard of care to patients with stroke. We attempted to define a “weekend effect” in outcomes among patients with intracranial hemorrhage (ICH) over the last decade, utilizing the Nationwide Inpatient Sample (NIS) data. We also attempted to analyze the trend of such an effect. Materials and Methods: We determined the association of ICH weekend admissions with hospital outcomes including mortality, adverse discharge, length of stay, and cost compared to weekday admissions using multivariable logistic regression. We extracted our study cohort from the NIS, the largest all-payer data set in the United States. Results: Of 485 329 ICH admissions from 2002 to 2011, 27.5% were weekend admissions. Overall, weekend admissions were associated with 11% higher odds of in-hospital mortality. When analyzed in 3-year groups, excess mortality of weekend admissions showed temporal decline. There was higher mortality with weekend admissions in nonteaching hospitals persisted (odds ratios 1.16, 1.13, and 1.09, respectively, for 3-year subgroups). Patients admitted during weekends were also 9% more likely to have an adverse discharge (odds ratio 1.09; 95% confidence interval: 1.07-1.11; P < .001) with no variation by hospital status. There was no effect of a weekend admission on either length of stay or cost of care. Conclusion: Nontraumatic ICH admissions on weekends have higher in-hospital mortality and adverse discharge. This demonstrates need for in-depth review for elucidating this discrepancy and stricter adherence to standard-of-care guidelines to ensure uniform care. PMID:27053981

  5. Diversity of Bacterial Communities on Four Frequently Used Surfaces in a Large Brazilian Teaching Hospital

    PubMed Central

    Pereira da Fonseca, Tairacan Augusto; Pessôa, Rodrigo; Felix, Alvina Clara; Sanabani, Sabri Saeed

    2016-01-01

    Frequently used hand-touch surfaces in hospital settings have been implicated as a vehicle of microbial transmission. In this study, we aimed to investigate the overall bacterial population on four frequently used surfaces using a culture-independent Illumina massively parallel sequencing approach of the 16S rRNA genes. Surface samples were collected from four sites, namely elevator buttons (EB), bank machine keyboard buttons (BMKB), restroom surfaces, and the employee biometric time clock system (EBTCS), in a large public and teaching hospital in São Paulo. Taxonomical composition revealed the abundance of Firmicutes phyla, followed by Actinobacteria and Proteobacteria, with a total of 926 bacterial families and 2832 bacterial genera. Moreover, our analysis revealed the presence of some potential pathogenic bacterial genera, including Salmonella enterica, Klebsiella pneumoniae, and Staphylococcus aureus. The presence of these pathogens in frequently used surfaces enhances the risk of exposure to any susceptible individuals. Some of the factors that may contribute to the richness of bacterial diversity on these surfaces are poor personal hygiene and ineffective routine schedules of cleaning, sanitizing, and disinfecting. Strict standards of infection control in hospitals and increased public education about hand hygiene are recommended to decrease the risk of transmission in hospitals among patients. PMID:26805866

  6. Diversity of Bacterial Communities on Four Frequently Used Surfaces in a Large Brazilian Teaching Hospital.

    PubMed

    Pereira da Fonseca, Tairacan Augusto; Pessôa, Rodrigo; Felix, Alvina Clara; Sanabani, Sabri Saeed

    2016-02-01

    Frequently used hand-touch surfaces in hospital settings have been implicated as a vehicle of microbial transmission. In this study, we aimed to investigate the overall bacterial population on four frequently used surfaces using a culture-independent Illumina massively parallel sequencing approach of the 16S rRNA genes. Surface samples were collected from four sites, namely elevator buttons (EB), bank machine keyboard buttons (BMKB), restroom surfaces, and the employee biometric time clock system (EBTCS), in a large public and teaching hospital in São Paulo. Taxonomical composition revealed the abundance of Firmicutes phyla, followed by Actinobacteria and Proteobacteria, with a total of 926 bacterial families and 2832 bacterial genera. Moreover, our analysis revealed the presence of some potential pathogenic bacterial genera, including Salmonella enterica, Klebsiella pneumoniae, and Staphylococcus aureus. The presence of these pathogens in frequently used surfaces enhances the risk of exposure to any susceptible individuals. Some of the factors that may contribute to the richness of bacterial diversity on these surfaces are poor personal hygiene and ineffective routine schedules of cleaning, sanitizing, and disinfecting. Strict standards of infection control in hospitals and increased public education about hand hygiene are recommended to decrease the risk of transmission in hospitals among patients. PMID:26805866

  7. Health conditions in a cohort of New Zealand Vietnam veterans: hospital admissions between 1988 and 2009

    PubMed Central

    Cox, Brian; Broughton, John; Tong, Darryl

    2015-01-01

    Objectives To inform the provision of support to veterans by analysing hospital discharge data, thereby identifying which conditions show an excess risk, require specific management strategies and deserve further investigation. Setting Tertiary level care, including all public and private New Zealand hospitals. Participants All New Zealand Vietnam veterans with service between 1964 and 1972. Primary outcome measures Standardised hospitalisation ratios (SHRs) were calculated based on the number of first observed hospital admissions for a condition, those expected being based on New Zealand national hospitalisation rates. Results The SHR for all causes of hospitalisation was 1.18, 95% CI 1.15 to 1.21, with modest increases for the major common causes, cardio and cerebrovascular disease. Admission rates for chronic renal failure and chronic obstructive pulmonary disease were highest in the 2006–2009 time period. The highest statistically significant hospitalisation risk was for alcohol-related mental disorder, SHR 1.91, 99% CI 1.39 to 2.43. Conclusions Chronic renal failure has limited attribution to veteran service but along with chronic obstructive pulmonary disease has the potential to have high costs both to the individual and the health system. We suggest that routine surveillance of veterans by way of a ‘flag’ in national and primary care databases would facilitate the recognition of service-related conditions and the appropriate provision of healthcare. PMID:26656012

  8. Air pollution and hospital admissions for respiratory diseases in Lanzhou, China.

    PubMed

    Tao, Yan; Mi, Shengquan; Zhou, Shuhong; Wang, Shigong; Xie, Xiaoyun

    2014-02-01

    Lanzhou is among the most seriously air-polluted cities in China as a whole, due to its unique topography, climate, industrial structure and so on. We studied the relationship between different air pollution and respiratory hospitalizations from 2001 to 2005, the total of respiratory hospital admissions were 28,057. The data were analyzed using Poisson regression models after controlling for the long time trend for air pollutants, the "day of week" effect and confounding meteorological factors. Three air pollutants (PM10, SO2, NO2) had a lag effect, the lag was 3-5 days for PM10, 1-3 days for SO2 and 1-4 days for NO2. The relative risks were calculated for increases in the inter-quartile range of the pollutants (139 μg/m(3) in PM10, 61 μg/m(3) in SO2 and 31 μg/m(3) in NO2). Results showed that there were significant associations between air pollutants and respiratory hospital admissions, and stronger effects were observed for females and aged ≥65 yrs in Lanzhou. PMID:24286694

  9. New strategies to identify patients harbouring antibiotic-resistant bacteria at hospital admission.

    PubMed

    Tacconelli, E

    2006-02-01

    Nosocomial infections caused by antibiotic-resistant bacteria are associated with high morbidity and mortality worldwide. Most prevention strategies focus on cross-transmission, but the endemic state inside the hospital is also maintained through the influx of patients colonised or infected with antibiotic-resistant bacteria, balanced by the efflux of colonised patients following discharge. Epidemiological research has demonstrated that eradication can be achieved by preventing the influx of resistant bacteria. The presence of a central venous catheter and a history of methicillin-resistant Staphylococcus aureus (MRSA) infection or colonisation are associated significantly with methicillin-resistant staphylococcal bacteraemia at admission. Previous antibiotic therapy and transfer from long-term care facilities or nursing homes are associated with bacteraemia caused by methicillin-resistant coagulase-negative staphylococci, while skin ulcer and cellulites are independent risk-factors for MRSA bacteraemia. A scoring system using point values has been developed and validated to identify patients positive for vancomycin-resistant enterococci at admission. Six variables were identified: age > 60 years (2 points); hospitalisation in the previous year (3); use of two or more antibiotics during the previous 30 days (3); transfer from another hospital or long-term care facility (3); a requirement for chronic haemodialysis (2); and a previous history of MRSA infection (4). With a point score cut-off of > or = 10, the specificity of this prediction rule is 98%. Knowledge of variables identifying patients at high risk for being colonised or infected with antibiotic-resistant bacteria may assist clinicians in targeting preventive measures and streamlining the use of vancomycin. Current studies are analysing risk-factors for harbouring multiresistant Gram-negative bacteria at hospital admission. PMID:16441446

  10. No Evidence of Purported Lunar Effect on Hospital Admission Rates or Birth Rates

    PubMed Central

    Margot, Jean-Luc

    2015-01-01

    Background Studies indicate that a fraction of nursing professionals believe in a “lunar effect”—a purported correlation between the phases of the Earth’s moon and human affairs, such as birth rates, blood loss, or fertility. Purpose This article addresses some of the methodological errors and cognitive biases that can explain the human tendency of perceiving a lunar effect where there is none. Approach This article reviews basic standards of evidence and, using an example from the published literature, illustrates how disregarding these standards can lead to erroneous conclusions. Findings Román, Soriano, Fuentes, Gálvez, and Fernández (2004) suggested that the number of hospital admissions related to gastrointestinal bleeding was somehow influenced by the phases of the Earth’s moon. Specifically, the authors claimed that the rate of hospital admissions to their bleeding unit is higher during the full moon than at other times. Their report contains a number of methodological and statistical flaws that invalidate their conclusions. Reanalysis of their data with proper procedures shows no evidence that the full moon influences the rate of hospital admissions, a result that is consistent with numerous peer-reviewed studies and meta-analyses. A review of the literature shows that birth rates are also uncorrelated to lunar phases. Conclusions Data collection and analysis shortcomings, as well as powerful cognitive biases, can lead to erroneous conclusions about the purported lunar effect on human affairs. Adherence to basic standards of evidence can help assess the validity of questionable beliefs. PMID:25756232

  11. Hospital Admission Rates for a Racially Diverse Low-Income Cohort of Patients With Diabetes: The Urban Diabetes Study

    PubMed Central

    Robbins, Jessica M.; Webb, David A.

    2006-01-01

    Objective. We sought to determine the frequency and costs of hospitalization and to assess possible racial/ethnic disparities in a large cohort of low-income patients with diabetes who had received primary care at municipal health clinics. Methods. Administrative data from Philadelphia Health Care Centers were linked with discharge data from Pennsylvania hospitals for March 1993 through December 2001. We tested differences in hospitalization rates and mean hospital charges by age, gender, and race/ethnicity. Results. A total of 18 800 patients with diabetes experienced 30 528 hospital admissions, for a hospitalization rate of 0.35 per person-year. Rates rose with age and with the interaction of male gender and age. Rates for non-Hispanic Whites were higher than those for African Americans, whereas those for Hispanics, Asian Americans, and “others” were lower. Patients who were hospitalized at least 5 times made up 10.5% of the study population and accounted for 64% of hospital admissions and hospital charges in this cohort. Conclusions. Hospitalization rates for this low-income cohort with access to primary care and pharmacy services were comparable to those of other diabetic patient populations, suggesting that reducing financial barriers to care may have benefited these patients. A subgroup of patients with multiple hospitalizations accounted for the majority of hospital admissions. PMID:16735627

  12. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions

    PubMed Central

    Zhao, Jinhui; Martin, Gina; Macdonald, Scott; Vallance, Kate; Treno, Andrew; Ponicki, William; Tu, Andrew; Buxton, Jane

    2013-01-01

    Objectives. We investigated whether periodic increases in minimum alcohol prices were associated with reduced alcohol-attributable hospital admissions in British Columbia. Methods. The longitudinal panel study (2002–2009) incorporated minimum alcohol prices, density of alcohol outlets, and age- and gender-standardized rates of acute, chronic, and 100% alcohol-attributable admissions. We applied mixed-method regression models to data from 89 geographic areas of British Columbia across 32 time periods, adjusting for spatial and temporal autocorrelation, moving average effects, season, and a range of economic and social variables. Results. A 10% increase in the average minimum price of all alcoholic beverages was associated with an 8.95% decrease in acute alcohol-attributable admissions and a 9.22% reduction in chronic alcohol-attributable admissions 2 years later. A Can$ 0.10 increase in average minimum price would prevent 166 acute admissions in the 1st year and 275 chronic admissions 2 years later. We also estimated significant, though smaller, adverse impacts of increased private liquor store density on hospital admission rates for all types of alcohol-attributable admissions. Conclusions. Significant health benefits were observed when minimum alcohol prices in British Columbia were increased. By contrast, adverse health outcomes were associated with an expansion of private liquor stores. PMID:23597383

  13. Association between antipsychotic/antidepressant drug treatments and hospital admissions in schizophrenia assessed using a mental health case register

    PubMed Central

    Cardinal, Rudolf N; Savulich, George; Mann, Louisa M; Fernández-Egea, Emilio

    2015-01-01

    Background: The impact of psychotropic drug choice upon admissions for schizophrenia is not well understood. Aims: To examine the association between antipsychotic/antidepressant use and time in hospital for patients with schizophrenia. Methods: We conducted an observational study, using 8 years’ admission records and electronically generated drug histories from an institution providing secondary mental health care in Cambridgeshire, UK, covering the period 2005–2012 inclusive. Patients with a coded ICD-10 diagnosis of schizophrenia were selected. The primary outcome measure was the time spent as an inpatient in a psychiatric unit. Antipsychotic and antidepressant drugs used by at least 5% of patients overall were examined for associations with admissions. Periods before and after drug commencement were compared for patients having pre-drug admissions, in mirror-image analyses correcting for overall admission rates. Drug use in one 6-month calendar period was used to predict admissions in the next period, across all patients, in a regression analysis accounting for the effects of all other drugs studied and for time. Results: In mirror-image analyses, sulpiride, aripiprazole, clozapine, and olanzapine were associated with fewer subsequent admission days. In regression analyses, sulpiride, mirtazapine, venlafaxine, and clozapine–aripiprazole and clozapine–amisulpride combinations were associated with fewer subsequent admission days. Conclusions: Use of these drugs was associated with fewer days in hospital. Causation is not implied and these findings require confirmation by randomized controlled trials. PMID:27336041

  14. Seasonality of Admissions for Mania: Results From a General Hospital Psychiatric Unit in Pondicherry, India

    PubMed Central

    Sarkar, Siddharth

    2015-01-01

    Introduction: Bipolar disorder is affected by variables that modulate circadian rhythm, including seasonal variations. There is evidence of a seasonal pattern of admissions of mania in various geographical settings, though its timing varies by region and climate. Variables such as age and gender have been shown to affect seasonality in some studies. Methodology: Data on monthly admission patterns for mania at a general hospital psychiatry unit in Pondicherry, India, were collected for 4 years (2010–2013) and analyzed for seasonality and seasonal peaks. The effects of age and gender were analyzed separately. Results: There was overall evidence of a seasonal pattern of admissions for mania (P < .01, Friedman test for seasonality), with a peak beginning during the rainy season and ending before summer (P < .0.1, Ratchet circular scan test). Male sex (P < .005, Ratchet circular scan test) and age > 25 years (P < .005, Ratchet circular scan test) were specifically associated with this seasonal peak. Discussion: The effect of seasons on mania is complex and is modulated by a variety of variables. Our study is consistent with earlier research findings: a greater degree of seasonality for mania in men. It is possible that climatic and individual variables interact to determine seasonal patterns in bipolar disorder in a given setting. PMID:26644962

  15. Air pollution from biomass burning and asthma hospital admissions in a sugar cane plantation area in Brazil

    PubMed Central

    Arbex, Marcos Abdo; Martins, Lourdes Conceição; de Oliveira, Regiani Carvalho; Pereira, Luiz Alberto Amador; Arbex, Flávio Ferlin; Cançado, José Eduardo Delfini; Saldiva, Paulo Hilário Nascimento; Braga, Alfésio Luís Ferreira

    2007-01-01

    Objective To evaluate the association between the total suspended particles (TSPs) generated from preharvest sugar cane burning and hospital admission due to asthma (asthma hospital admissions) in the city of Araraquara. Design An ecological time‐series study. Total daily records of asthma hospital admissions (ICD 10th J15) were obtained from one of the main hospitals in Araraquara, São Paulo State, Brazil, from 23 March 2003 to 27 July 2004. The daily concentration of TSP (μg/m3) was obtained using Handi‐vol equipment (Energética, Brazil) placed in downtown Araraquara. The local airport provided the daily mean figures of temperature and humidity. The daily number of asthma hospital admissions was considered as the dependent variable in Poisson's regression models and the daily concentration of TSP was considered the independent variable. The generalised linear model with natural cubic spline was adopted to control for long‐time trend. Linear terms were used for weather variables. Results TSP had an acute effect on asthma admissions, starting 1 day after TSP concentrations increased and remaining almost unchanged for the next four days. A 10 μg/m3 increase in the 5‐day moving average (lag1–5) of TSP concentrations was associated with an increase of 11.6% (95% CI 5.4 to 17.7) in asthma hospital admissions. Conclusion Increases in TSP concentrations were definitely associated with asthma hospital admissions in Araraquara and, despite using sugar cane alcohol to reduce air pollution from automotive sources in large Brazilian urban centres, the cities where sugar cane is harvested pay a high toll in terms of public health. PMID:17435205

  16. The potential economic value of screening hospital admissions for Clostridium difficile.

    PubMed

    Bartsch, S M; Curry, S R; Harrison, L H; Lee, B Y

    2012-11-01

    Asymptomatic Clostridium difficile carriage has a prevalence reported as high as 51-85 %; with up to 84 % of incident hospital-acquired infections linked to carriers. Accurately identifying carriers may limit the spread of Clostridium difficile. Since new technology adoption depends heavily on its economic value, we developed an analytic simulation model to determine the cost-effectiveness screening hospital admissions for Clostridium difficile from the hospital and third party payer perspectives. Isolation precautions were applied to patients testing positive, preventing transmission. Sensitivity analyses varied Clostridium difficile colonization rate, infection probability among secondary cases, contact isolation compliance, and screening cost. Screening was cost-effective (i.e., incremental cost-effectiveness ratio [ICER] ≤ $50,000/QALY) for every scenario tested; all ICER values were ≤ $256/QALY. Screening was economically dominant (i.e., saved costs and provided health benefits) with a ≥10.3 % colonization rate and ≥5.88 % infection probability when contact isolation compliance was ≥25 % (hospital perspective). Under some conditions screening led to cost savings per case averted (range, $53-272). Clostridium difficile screening, coupled with isolation precautions, may be a cost-effective intervention to hospitals and third party payers, based on prevalence. Limiting Clostridium difficile transmission can reduce the number of infections, thereby reducing its economic burden to the healthcare system. PMID:22752150

  17. Residential exposure to aircraft noise and hospital admissions for cardiovascular diseases: multi-airport retrospective study

    PubMed Central

    Correia, Andrew W; Peters, Junenette L; Levy, Jonathan I; Melly, Steven

    2013-01-01

    Objective To investigate whether exposure to aircraft noise increases the risk of hospitalization for cardiovascular diseases in older people (≥65 years) residing near airports. Design Multi-airport retrospective study of approximately 6 million older people residing near airports in the United States. We superimposed contours of aircraft noise levels (in decibels, dB) for 89 airports for 2009 provided by the US Federal Aviation Administration on census block resolution population data to construct two exposure metrics applicable to zip code resolution health insurance data: population weighted noise within each zip code, and 90th centile of noise among populated census blocks within each zip code. Setting 2218 zip codes surrounding 89 airports in the contiguous states. Participants 6 027 363 people eligible to participate in the national medical insurance (Medicare) program (aged ≥65 years) residing near airports in 2009. Main outcome measures Percentage increase in the hospitalization admission rate for cardiovascular disease associated with a 10 dB increase in aircraft noise, for each airport and on average across airports adjusted by individual level characteristics (age, sex, race), zip code level socioeconomic status and demographics, zip code level air pollution (fine particulate matter and ozone), and roadway density. Results Averaged across all airports and using the 90th centile noise exposure metric, a zip code with 10 dB higher noise exposure had a 3.5% higher (95% confidence interval 0.2% to 7.0%) cardiovascular hospital admission rate, after controlling for covariates. Conclusions Despite limitations related to potential misclassification of exposure, we found a statistically significant association between exposure to aircraft noise and risk of hospitalization for cardiovascular diseases among older people living near airports. PMID:24103538

  18. Comparing Exposure Metrics for the Effects of Fine Particulate Matter on Emergency Hospital Admissions

    PubMed Central

    Mannshardt, Elizabeth; Sucic, Katarina; Jiao, Wan; Dominici, Francesca; Frey, H. Christopher; Reich, Brian; Fuentes, Montserrat

    2013-01-01

    A crucial step in an epidemiological study of the effects of air pollution is to accurately quantify exposure of the population. In this paper, we investigate the sensitivity of the health effects estimates associated with short-term exposure to fine particulate matter with respect to three potential metrics for daily exposure: ambient monitor data, estimated values from a deterministic atmospheric chemistry model, and stochastic daily average human exposure simulation output. Each of these metrics has strengths and weaknesses when estimating the association between daily changes in ambient exposure to fine particulate matter and daily emergency hospital admissions. Monitor data is readily available, but is incomplete over space and time. The atmospheric chemistry model output is spatially and temporally complete, but may be less accurate than monitor data. The stochastic human exposure estimates account for human activity patterns and variability in pollutant concentration across microenvironments, but requires extensive input information and computation time. To compare these metrics, we consider a case study of the association between fine particulate matter and emergency hospital admissions for respiratory cases for the Medicare population across three counties in New York. Of particular interest is to quantify the impact and/or benefit to using the stochastic human exposure output to measure ambient exposure to fine particulate matter. Results indicate that the stochastic human exposure simulation output indicates approximately the same increase in relative risk associated with emergency admissions as using a chemistry model or monitoring data as exposure metrics. However, the stochastic human exposure simulation output and the atmospheric chemistry model both bring additional information which helps to reduce the uncertainly in our estimated risk. PMID:23942393

  19. Improving quality of care and reducing unnecessary hospital admissions: a literature review.

    PubMed

    Means, Tracy

    2016-06-01

    As the UK population lives to older ages, with more complex health and social care needs, there comes a time when going to live in a care home might be essential for a frail, older person. Residents and their families expect high-quality care in return for the costs of their placements, but often find this is not the case ( Help the Aged, 2006 ). In order to improve quality in care homes, the Lincolnshire Community Health Services NHS Trust are piloting a care home support team. The new service aims to provide education and training to an unpredictable workforce, with the addition of regular ward rounds in care homes to ensure more proactive care for residents, in order to reduce unnecessary hospital admissions and improve the quality of care offered. This article looks at the literature relating to education and training for staff in care homes to support this service. It also aims to use the reviewed articles to identify specific training and education needed to improve quality of care for residents and reduce avoidable hospital admissions. PMID:27270196

  20. Temporal association between hospital admissions for asthma in Birmingham and ambient levels of sulphur dioxide and smoke.

    PubMed Central

    Walters, S.; Griffiths, R. K.; Ayres, J. G.

    1994-01-01

    BACKGROUND--A study was performed to determine whether daily and weekly variations in the levels of smoke and sulphur dioxide (SO2) in Birmingham are related to hospital admissions for asthma and acute respiratory diseases. METHODS--Daily numbers of hospital admissions for asthma (ICD code 493) and acute respiratory conditions (ICD 466, 480-486, 490-496) for residents of Birmingham between 1988 and 1990 were obtained from West Midlands RHA Körner inpatient data. Average daily levels of sulphur dioxide and smoke were obtained from Birmingham City Council for the same period, together with daily meteorological summaries from the Department of Geography, University of Birmingham. With the exception of one day, all air pollution measurements remained within current EC guide levels. Data were divided into seasons and the relation between hospital admissions and pollutant levels were explored by stepwise least squares regression models. Meteorological variables (temperature, pressure, humidity) were entered into the model if they showed significant association with hospital admissions during the season in question. Analysis was undertaken for daily (same day and lagged by two days) and weekly pollutant levels. Admissions were lagged behind pollution levels to allow for delayed effects of pollutants. RESULTS--The mean daily level of smoke was 12.7 micrograms/m3 and of SO2 was 39.1 micrograms/m3, with maxima of 188.3 micrograms/m3 and 126.3 micrograms/m3, respectively. Significant associations were found between hospital admissions for respiratory disease lagged by two days, and smoke and SO2 levels during winter. Associations between admissions for asthma and smoke and SO2 levels were significant at the 5% level. These were independent of temperature, pressure, and humidity. Stepwise regression including both pollutants showed that smoke, but not SO2, was a significant independent predictor of hospital admissions for both asthma and all respiratory conditions. During

  1. Association between annual river flood pulse and paediatric hospital admissions in the Mekong Delta area.

    PubMed

    Phung, Dung; Huang, Cunrui; Rutherford, Shannon; Chu, Cordia; Wang, Xiaoming; Nguyen, Minh

    2014-11-01

    The Mekong Delta is the most vulnerable region to extreme climate and hydrological conditions however the association between these conditions and children's health has been little studied. We examine the association between annual river flood pulse and paediatric hospital admissions in a Vietnam Mekong Delta city. Daily paediatric hospital admissions (PHA) were collected from the City Paediatric Hospital, and daily river water level (RWL) and meteorological data were retrieved from the Southern Regional Hydro-Meteorological Centre from 2008 to 2011. We evaluated the association between annual river flood pulse (>=90th percentile of RWL) and PHA using the Poisson distributed lag model, controlling for temperature, relative humidity, day of week, seasonal and long-term trends. The seasonal pattern of PHA was examined using harmonic and polynomial regression models. The cumulative risk ratios estimated for a 15-day period following an extreme RWL was 1.26 (95%CI, 1.2-1.38) for all age groups, 1.27 (95%CI, 1.23-1.30) for under five-years and 1.15 (95%CI, 1.07-1.20) for school-aged children, 1.24 (95%CI, 1.21-1.27) for all-causes, 1.18 (95%CI, 1.12-1.21) for communicable infection, 1.66 (95%CI, 1.57-1.74) for respiratory infection and 1.06 (95%CI, 1.01-1.1) for other diseases. The peak PHA risk is in the September-October period corresponding to the highest RWL, and the PHA-RWL association was modified by temperature. An increase in PHA is significantly associated with annual river flood, and the pattern of PHA is seasonally correspondent to the RWL. These findings combined with projected changes in climate conditions suggest important implications of climate change for human health in the Mekong Delta region. PMID:25282279

  2. Mortality and Incidence of Hospital Admissions for Stroke among Brazilians Aged 15 to 49 Years between 2008 and 2012

    PubMed Central

    Adami, Fernando; Figueiredo, Francisco Winter dos Santos; Paiva, Laércio da Silva; de Sá, Thiago Hérick; Santos, Edige Felipe de Sousa; Martins, Bruno Luis; Valenti, Vitor Engrácia; de Abreu, Luiz Carlos

    2016-01-01

    Introduction The objective was to analyze rates of stroke-related mortality and incidence of hospital admissions in Brazilians aged 15 to 49 years according to region and age group between 2008 and 2012. Methods Secondary analysis was performed in 2014 using data from the Hospital and Mortality Information Systems and the Brazilian Institute of Geography and Statistics. Stroke was defined by ICD, 10th revision (I60–I64). Crude and standardized mortality (WHO reference) and incidence of hospital admissions per 100,000 inhabitants, stratified by region and age group, were estimated. Absolute and relative frequencies; and linear regression were also used. The software used was Stata 11.0. Results There were 35,005 deaths and 131,344 hospital admissions for stroke in Brazilians aged 15–49 years old between 2008 and 2012. Mortality decreased from 7.54 (95% CI 7.53; 7.54) in 2008 to 6.32 (95% CI 6.31; 6.32) in 2012 (β = -0.27, p = 0.013, r2 = 0.90). During the same time, incidence of hospital admissions stabilized: 24.67 (95% CI 24.66; 24.67) in 2008 and 25.11 (95% CI 25.10; 25.11) in 2012 (β = 0.09, p = 0.692, r2 = 0.05). There was a reduction in mortality in all Brazilian regions and in the age group between 30 and 49 years. Incidence of hospitalizations decreased in the South, but no significant decrease was observed in any age group. Conclusion We observed a decrease in stroke-related mortality, particularly in individuals over 30 years old, and stability of the incidence of hospitalizations; and also regional variation in stroke-related hospital admission incidence and mortality among Brazilian young adults. PMID:27332892

  3. Ethnic variations in compulsory detention and hospital admission for psychosis across four UK Early Intervention Services.

    PubMed

    Mann, Farhana; Fisher, Helen L; Major, Barnaby; Lawrence, Jo; Tapfumaneyi, Andrew; Joyce, John; Hinton, Mark F; Johnson, Sonia

    2014-09-01

    BackgroundSubstantial ethnic variations have been found in incidence, pathways to care and outcomes in psychosis. It is unknown whether these remain as marked in the presence of specialist Early Intervention Services (EIS) for psychosis. We present the first UK study exploring ethnic differences in compulsory detention and hospitalization rates for EIS patients. We investigated whether the excess rates of compulsory admission for people from Black groups have persisted following nationwide introduction of EIS. We also explored variations in compulsory admission for other ethnic groups, and differences by gender and diagnosis.MethodsFour inner-city London EIS teams gathered data from first-presentation psychosis patients between 2004¿2009 using the MiData audit tool. Clinical, sociodemographic and pathways to care data were recorded regarding adult patients from eight different ethnic groups at entry to EIS and one year later.ResultsBlack African EIS service users had odds of being detained and of being hospitalised three times greater than White British patients, even after adjustment for confounders. This was most marked in Black African women (seven to eight times greater odds than White British women). A post-hoc analysis showed that pathways to care and help-seeking behaviour partially explained these differences.ConclusionThese findings suggest EIS input in its current form has little impact on higher admission and detention rates in certain Black and minority groups. There is a need to tackle these differences and engage patients earlier, focusing on the needs of men and women from the most persistently affected groups. PMID:25214411

  4. Medicare Home Visit Program Associated With Fewer Hospital And Nursing Home Admissions, Increased Office Visits.

    PubMed

    Mattke, Soeren; Han, Dan; Wilks, Asa; Sloss, Elizabeth

    2015-12-01

    Clinical home visit programs for Medicare beneficiaries are a promising approach to supporting aging in place and avoiding high-cost institutional care. Such programs combine a comprehensive geriatric assessment by a clinician during a home visit with referrals to community providers and health plan resources to address uncovered issues. We evaluated UnitedHealth Group's HouseCalls program, which has been offered to Medicare Advantage plan members in Arkansas, Georgia, Missouri, South Carolina, and Texas since January 2008. We found that, compared to non-HouseCalls Medicare Advantage plan members and fee-for-service beneficiaries, HouseCalls participants had reductions in admissions to hospitals (1 percent and 14 percent, respectively) and lower risk of nursing home admission (0.67 percent and 1.3 percent, respectively). In addition, participants' numbers of office visits--chiefly to specialists--increased 2-6 percent (depending on the comparison group). The program's effects on emergency department use were mixed. These results indicate that a thorough home-based clinical assessment of a member's health and home environment combined with referral services can support aging in place, promote physician office visits, and preempt costly institutional care. PMID:26643635

  5. Winter circulation weather types and hospital admissions for respiratory diseases in Galicia, Spain.

    PubMed

    Royé, D; Taboada, J J; Martí, A; Lorenzo, M N

    2016-04-01

    The link between various pathologies and atmospheric conditions has been a constant topic of study over recent decades in many places across the world; knowing more about it enables us to pre-empt the worsening of certain diseases, thereby optimizing medical resources. This study looked specifically at the connections in winter between respiratory diseases and types of atmospheric weather conditions (Circulation Weather Types, CWT) in Galicia, a region in the north-western corner of the Iberian Peninsula. To do this, the study used hospital admission data associated with these pathologies as well as an automatic classification of weather types. The main result obtained was that weather types giving rise to an increase in admissions due to these diseases are those associated with cold, dry weather, such as those in the east and south-east, or anticyclonic types. A second peak was associated with humid, hotter weather, generally linked to south-west weather types. In the future, this result may help to forecast the increase in respiratory pathologies in the region some days in advance. PMID:26307637

  6. Analysis of the Spatial Variation of Hospitalization Admissions for Hypertension Disease in Shenzhen, China

    PubMed Central

    Wang, Zhensheng; Du, Qingyun; Liang, Shi; Nie, Ke; Lin, De-nan; Chen, Yan; Li, Jia-jia

    2014-01-01

    In China, awareness about hypertension, the treatment rate and the control rate are low compared to developed countries, even though China’s aging population has grown, especially in those areas with a high degree of urbanization. However, limited epidemiological studies have attempted to describe the spatial variation of the geo-referenced data on hypertension disease over an urban area of China. In this study, we applied hierarchical Bayesian models to explore the spatial heterogeneity of the relative risk for hypertension admissions throughout Shenzhen in 2011. The final model specification includes an intercept and spatial components (structured and unstructured). Although the road density could be used as a covariate in modeling, it is an indirect factor on the relative risk. In addition, spatial scan statistics and spatial analysis were utilized to identify the spatial pattern and to map the clusters. The results showed that the relative risk for hospital admission for hypertension has high-value clusters in the south and southeastern Shenzhen. This study aimed to identify some specific regions with high relative risk, and this information is useful for the health administrators. Further research should address more-detailed data collection and an explanation of the spatial patterns. PMID:24394218

  7. Winter circulation weather types and hospital admissions for respiratory diseases in Galicia, Spain

    NASA Astrophysics Data System (ADS)

    Royé, D.; Taboada, J. J.; Martí, A.; Lorenzo, M. N.

    2016-04-01

    The link between various pathologies and atmospheric conditions has been a constant topic of study over recent decades in many places across the world; knowing more about it enables us to pre-empt the worsening of certain diseases, thereby optimizing medical resources. This study looked specifically at the connections in winter between respiratory diseases and types of atmospheric weather conditions (Circulation Weather Types, CWT) in Galicia, a region in the north-western corner of the Iberian Peninsula. To do this, the study used hospital admission data associated with these pathologies as well as an automatic classification of weather types. The main result obtained was that weather types giving rise to an increase in admissions due to these diseases are those associated with cold, dry weather, such as those in the east and south-east, or anticyclonic types. A second peak was associated with humid, hotter weather, generally linked to south-west weather types. In the future, this result may help to forecast the increase in respiratory pathologies in the region some days in advance.

  8. Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia.

    PubMed Central

    Bickler, S. W.; Sanno-Duanda, B.

    2000-01-01

    INTRODUCTION: There is a paucity of published data on the type of conditions that require surgery among children in sub-Saharan Africa. Such information is necessary for assessing the impact of such conditions on child health and for setting priorities to improve paediatric surgical care. METHODS: Described in the article is a 29-month prospective study of all children aged < 15 years who were admitted to a government referral hospital in the Gambia from January 1996 to May 1998. RESULTS: A total of 1726 children were admitted with surgical problems. Surgical patients accounted for 11.3% of paediatric admissions and 34,625 total inpatient days. The most common admission diagnoses were injuries (46.9%), congenital anomalies (24.3%), and infections requiring surgery (14.5%). The diagnoses that accounted for the greatest number of inpatient days were burns (18.8%), osteomyelitis (15.4%), fractures (12.7%), soft tissue injuries (3.9%), and head injuries (3.4%). Gambian children were rarely admitted for appendicitis and never admitted for hypertrophic pyloric stenosis. The leading causes of surgical deaths were burns, congenital anomalies, and injuries other than burns. DISCUSSION: Prevention of childhood injuries and better trauma management, especially at the primary and secondary health care levels, should be the priorities for improving paediatric surgical care in sub-Saharan Africa. Surgical care of children should be considered an essential component of child health programmes in developing countries. PMID:11143193

  9. Clinical Profiles Related to Timing of Death, Including In-Hospital Deaths Before Admission, in Patients With ST-Elevation Myocardial Infarction.

    PubMed

    Bogaty, Peter; L'Allier, Philippe L; Segal, Eli; Rinfret, Stéphane; Racine, Normand; Harvey, Richard; Ross, Dave; Maire, Sébastien; Kouz, Simon; Carroll, Céline; Boothroyd, Lucy J; Kezouh, Abbas; Azzi, Leila; Brown, Kevin A; Nasmith, James; Lambert, Laurie J

    2016-02-01

    Patients with ST-elevation myocardial infarction (STEMI) who die in hospital before inpatient admission are generally not included in clinical studies and registries, and the clinical profiles of patients who die earlier versus later are not well defined. We aimed to characterize all patients with STEMI who arrived at emergency departments in the province of Quebec (Canada) based on inpatient admission status and when they died. All patients who presented with symptoms and core laboratory-confirmed STEMI or left bundle branch block during 6 months in 82 hospitals in Quebec were included. Death certificates were used to identify nonadmitted deaths. Of the 2017 patients with STEMI, 340 (16.9%) died within 1 year. Of the latter, 63 (18.5%) were nonadmitted deaths (group A), 179 (52.6%) were deaths after admission but within 30 days (group B), and 98 (28.8%) were deaths after 30 days to 1 year (group C). Group A was younger and most often hemodynamically unstable, followed for both features by B then C. Earliest presentation from symptom onset and most frequent ambulance use were found in group A, followed by B, then C. Presenting electrocardiogram (ECG) features were most severe in A, then B, then C (more arrhythmias, more anterior STEMI, more leads with ST elevation, and higher ST elevation). Patients who died earliest had the least frequency of previous myocardial infarction, coronary revascularization, vascular disease, and heart failure, and the least noncardiac co-morbidity. In conclusion, patients with STEMI dying in hospital before inpatient admission contributed substantially to overall STEMI mortality. Although dying patients who presented earlier had severer presenting clinical profiles, they were paradoxically younger and had less co-morbidity. Previous co-morbidities may favor adaptive protective mechanisms on initial presentation with STEMI. PMID:26721650

  10. Quetiapine may reduce hospital admission rates in patients with mental health problems and alcohol addiction.

    PubMed

    Kong, C; Chiu, W; Davies, A; Keating, J

    2013-01-01

    A 64-year-old man presented with 40 years history of chronic alcohol excess. On average, he had six hospital admissions a year with alcohol-related problems for at least a 10-year period. In 2009, he considered reducing his alcohol intake. He was noted to have mood disturbances, was seen by a psychogeriatrician who diagnosed bipolar disorder. He tried various bipolar medications including lithium and sodium valproate which was unsuccessful. He was then started on quetiapine 600 mg a day in divided doses. Subsequently this has not only controlled the bipolar disorder but also resulted in significant reduction in alcohol intake. He now shares a bottle of wine with his wife while in the past he was consuming a bottle of scotch daily. This case illustrates the benefits of quetiapine in assisting with this man's addiction to alcohol. PMID:23925678

  11. The effect of primary organic particles on emergency hospital admissions among the elderly in 3 US cities

    PubMed Central

    2013-01-01

    Background Fine particle (PM2.5) pollution related to combustion sources has been linked to a variety of adverse health outcomes. Although poorly understood, it is possible that organic carbon (OC) species, particularly those from combustion-related sources, may be partially responsible for the observed toxicity of PM2.5. The toxicity of the OC species may be related to their chemical structures; however, few studies have examined the association of OC species with health impacts. Methods We categorized 58 primary organic compounds by their chemical properties into 5 groups: n-alkanes, hopanes, cyclohexanes, PAHs and isoalkanes. We examined their impacts on the rate of daily emergency hospital admissions among Medicare recipients in Atlanta, GA and Birmingham, AL (2006–2009), and Dallas, TX (2006–2007). We analyzed data in two stages; we applied a case-crossover analysis to simultaneously estimate effects of individual OC species on cause-specific hospital admissions. In the second stage we estimated the OC chemical group-specific effects, using a multivariate weighted regression. Results Exposures to cyclohexanes of six days and longer were significantly and consistently associated with increased rate of hospital admissions for CVD (3.40%, 95%CI = (0.64, 6.24%) for 7-d exposure). Similar increases were found for hospitalizations for ischemic heart disease and myocardial infarction. For respiratory related hospital admissions, associations with OC groups were less consistent, although exposure to iso-/anteiso-alkanes was associated with increased respiratory-related hospitalizations. Conclusions Results suggest that week-long exposures to traffic-related, primary organic species are associated with increased rate of total and cause-specific CVD emergency hospital admissions. Associations were significant for cyclohexanes, but not hopanes, suggesting that chemical properties likely play an important role in primary OC toxicity. PMID:23981468

  12. Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings

    PubMed Central

    Alexandrov, Anne W.; Coleman, Kisha C.; Palazzo, Paola; Shahripour, Reza Bavarsad; Alexandrov, Andrei V.

    2016-01-01

    Background: In the USA, stable intravenous tissue plasminogen activator (IV tPA) patients have traditionally been cared for in an intensive care unit (ICU). We examined the safety of using an acuity-adaptable stroke unit (SU) to manage IV tPA patients. Methods: We conducted an observational study of consecutive patients admitted to our acuity-adaptable SU over the first 3 years of operation. Safety was assessed by symptomatic intracerebral hemorrhage (sICH) rates, systemic hemorrhage (SH) rates, tPA-related deaths, and transfers from SU to ICU; cost savings and length of stay (LOS) were determined. Results: We admitted 333 IV tPA patients, of which 302 were admitted directly to the SU. A total of 31 (10%) patients had concurrent systemic hemodynamic or pulmonary compromise warranting direct ICU admission. There were no differences in admission National Institutes of Health Stroke Scale scores between SU and ICU patients (9.0 versus 9.5, respectively). Overall sICH rate was 3.3% (n = 10) and SH rate was 2.9 (n = 9), with no difference between SU and ICU patients. No tPA-related deaths occurred, and no SU patients required transfer to the ICU. Estimated hospital cost savings were US$362,400 for ‘avoided’ ICU days, and hospital LOS decreased significantly (p = 0.001) from 9.8 ± 15.6 days (median 5) in year 1, to 5.2 ± 4.8 days (median 3) by year 3. Conclusions: IV tPA patients may be safely cared for in a SU when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for monitoring may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit. PMID:27366237

  13. Hospital length of stay in individuals with schizophrenia with and without cocaine-positive urine drug screens at hospital admission.

    PubMed

    Wu, Hanjing Emily; Mohite, Satyajit; Ngana, Ikenna; Burns, Wilma; Shah, Nurun; Schneider, Laurie; Schmitz, Joy M; Lane, Scott D; Okusaga, Olaoluwa O

    2015-01-01

    Despite the high prevalence of cocaine use disorder (CUD) in individuals with schizophrenia, current understanding of the effect of cocaine on psychiatric hospital length of stay (LOS) in individuals with schizophrenia is limited. We therefore retrospectively examined the medical records of 5106 hospital admissions due to exacerbation of schizophrenia. Linear regression and t-test were used to compare LOS between individuals with schizophrenia with cocaine-positive urine drug test results and those with negative test results. Individuals with schizophrenia who were also positive for cocaine had shorter LOS from both unadjusted (geometric mean LOS, 8.07 ± 1.92 vs. 11.83 ± 1.83 days; p < 0.001) and adjusted (β = 0.69; confidence interval, 0.63-0.76; p < 0.001) analyses. Our results suggest that individuals with schizophrenia who also have comorbid CUD may require shorter inpatient treatment during periods of exacerbation of symptoms. Replication of this finding has relevance in treatment planning and resource allocation for the subpopulation of individuals with schizophrenia who also have stimulant use disorders. PMID:25489749

  14. A Study on Hospital Admissions For Eye Trauma in Kashan, Iran

    PubMed Central

    Movahedinejad, Tayebeh; Adib-Hajbaghery, Mohsen; Zahedi, Mohammad Reza

    2016-01-01

    Background Eye trauma is among the most common reasons for referral to hospital emergency departments and ophthalmologists’ offices. It also is a common cause of vision loss worldwide. However, few studies are available on the changes in the epidemiology of eye trauma in Iran in recent years. Objectives This study aimed to investigate the characteristics of hospital admissions for eye trauma in Kashan from August 2011 to February 2014. Patients and Methods A cross-sectional study was carried out on the hospital records of all patients with eye trauma who were admitted to Kashan’s Matini hospital between August 2011 and February 2014. Having an eye trauma and being hospitalized for at least one day was selected as the criteria for inclusion in the study. The data were then recorded on a checklist devised by the researcher. After entering the data into the SPSS software, descriptive statistics (i.e., percentage, frequency, mean, and standard deviation) were calculated for all variables. Chi-square, Fisher’s exact test, and Mann-Whitney U test were used to analyze the data. Results In total, 200 patients with eye trauma had been hospitalized in Matini Hospital between August 2011 and February 2014. Of these patients, 86% were males, 40% were in the age range of 20-39 years, 68% lived in urban areas, and 21% of those in employment were manual and industrial workers. Approximately 38.5% of eye traumas had occurred in the work place; 72.5% of patients had penetrating injuries and 98% of cases were injured in one eye. More injuries occurred in the cornea (25.5%) than elsewhere in the eye, and 75.5% of patients were treated surgically. Among all variables, only the type of trauma (P = 0.009) and cause of trauma (P = 0.004) were significantly related to the patients’ gender. Conclusions Eye trauma was prevalent among males, young people, urban residents, and manual and industrial workers. As the eyes play a vital role in daily life, communication, and work

  15. Tuberculosis in hospitalized patients: clinical characteristics of patients receiving treatment within the first 24 h after admission*

    PubMed Central

    Silva, Denise Rossato; da Silva, Larissa Pozzebon; Dalcin, Paulo de Tarso Roth

    2014-01-01

    Objective: To evaluate clinical characteristics and outcomes in patients hospitalized for tuberculosis, comparing those in whom tuberculosis treatment was started within the first 24 h after admission with those who did not. Methods: This was a retrospective cohort study involving new tuberculosis cases in patients aged ≥ 18 years who were hospitalized after seeking treatment in the emergency room. Results: We included 305 hospitalized patients, of whom 67 (22.0%) received tuberculosis treatment within the first 24 h after admission ( ≤24h group) and 238 (88.0%) did not (>24h group). Initiation of tuberculosis treatment within the first 24 h after admission was associated with being female (OR = 1.99; 95% CI: 1.06-3.74; p = 0.032) and with an AFB-positive spontaneous sputum smear (OR = 4.19; 95% CI: 1.94-9.00; p < 0.001). In the ≤24h and >24h groups, respectively, the ICU admission rate was 22.4% and 15.5% (p = 0.258); mechanical ventilation was used in 22.4% and 13.9% (p = 0.133); in-hospital mortality was 22.4% and 14.7% (p = 0.189); and a cure was achieved in 44.8% and 52.5% (p = 0.326). Conclusions: Although tuberculosis treatment was initiated promptly in a considerable proportion of the inpatients evaluated, the rates of in-hospital mortality, ICU admission, and mechanical ventilation use remained high. Strategies for the control of tuberculosis in primary care should consider that patients who seek medical attention at hospitals arrive too late and with advanced disease. It is therefore necessary to implement active surveillance measures in the community for earlier diagnosis and treatment. PMID:25029651

  16. Factors Associated with Severity and Hospital Admission of Motor-Vehicle Injury Cases in a Southern European Urban Area

    PubMed Central

    Cirera, Eva; Plasència, Antoni; Ferrando, Josep; Seguí-Gomez, Maria

    1998-01-01

    BACKGROUND The knowledge of injury severity as a result of motor-vehicle (MV) crashes is a key tool to identify and evaluate prevention activities. Hospital and emergency department (ED) records are a useful source of information to measure injury severity. OBJECTIVES To describe the main characteristics of injured people admitted to ED as a result of a MV crash, and to assess factors related to injury severity and hospital admission. METHODS Cross-sectional design. Subjects were MV injury patients admitted to seven EDs in Barcelona from January 1994 to June 1996. The data analyzed were obtained from the information routinely transmitted from the EDs to the Municipal Institute of Health, based on the processing of ED logs. Univariate and bivariate descriptive statistical analyses were performed, as well as multiple logistic regressions. RESULTS 60.7% of patients were males, 73.7% were younger than 40 years of age, while 42.2% were motorcycle and moped users and 25.2% were pedestrians. After adjusting for other variables, these three last user groups were at a higher risk of a more severe injury (OR=1.4; OR=1.5 and OR=1.7 respectively) and showed a higher likelihood of a hospital admission (OR=1.9; OR= 1.7 and OR= 2.1). Patients arriving at the hospital during night-time (OR=2.1) and in hospitals C or D (OR= 2.2 and OR= 2.3 respectively) were also at a higher risk of a hospital admission. CONCLUSIONS The study underscores that in Barcelona, pedestrians and two-wheel vehicle occupants, besides accounting for two-thirds of traffic injury cases, are also the user’s subgroups with a higher risk of a more severe injury as well as a higher chance of admission. The results also point out that decision criteria on the patient need for hospitalization may vary substantially among hospitals in the case of trauma patients.

  17. Six-month outcomes following an emergency hospital admission for older adults with co-morbid mental health problems indicate complexity of care needs

    PubMed Central

    Bradshaw, Lucy E.; Goldberg, Sarah E.; Lewis, Sarah A.; Whittamore, Kathy; Gladman, John R. F.; Jones, Rob G.; Harwood, Rowan H.

    2013-01-01

    Background: two-thirds of older patients admitted as an emergency to a general hospital have co-existing mental health problems including delirium, dementia and depression. This study describes the outcomes of older adults with co-morbid mental health problems after an acute hospital admission. Methods: a follow-up study of 250 patients aged over 70 admitted to 1 of 12 wards (geriatric, medical or orthopaedic) of an English acute general hospital with a co-morbid mental health problem and followed up at 180 days. Results: twenty-seven per cent did not return to their original place of residence after the hospital admission. After 180 days 31% had died, 42% had been readmitted and 24% of community residents had moved to a care home. Only 31% survived without being readmitted or moving to a care home. However, 16% spent >170 of the 180 days at home. Significant predictors for poor outcomes were co-morbidity, nutrition, cognitive function, reduction in activities of daily living ability prior to admission, behavioural and psychiatric problems and depression. Only 42% of survivors recovered to their pre-acute illness level of function. Clinically significant behavioural and psychiatric symptoms were present at follow-up in 71% of survivors with baseline cognitive impairment, and new symptoms developed frequently in this group. Conclusions: the variable, but often adverse, outcomes in this group implies a wide range of health and social care needs. Community and acute services to meet these needs should be anticipated and provided for. PMID:23800454

  18. Trend study on the association between hospital admissions and the health of Dutch older adults (1995–2009)

    PubMed Central

    Galenkamp, Henrike; Deeg, Dorly J H; de Jongh, Renate T; Kardaun, Jan W P F; Huisman, Martijn

    2016-01-01

    Objectives An increase in hospital admission rates in older people may reflect improved access to healthcare, but also declining health trends in the older population. Owing to a lack of individual-level data, the latter possibility has received little attention. The current study examines associations between health status and hospitalisation rates of older adults in the Netherlands. Design Observational individual-level data linked to hospital register data. Setting Data from 1995 to 2009 from the nationally representative Longitudinal Aging Study Amsterdam were linked to the Dutch Hospital Discharge Register. Participants A total of 5681 observations of 2520 respondents across 4 measurement points (each with a follow-up of 36 months; ages 65–88 years). Outcome measures The contribution of health, demographic, psychosocial and lifestyle characteristics to time trends in hospitalisation was assessed in multivariate models. Results Between 1995 and 2009, the percentage with 1 or more overnight admissions (planned or acute) increased slightly from 38.1% to 39.7%. This was due to an increase in acute admission only (22.2–27.0%). Increased prevalences of chronic diseases, functional limitations and polypharmacy accounted for part of the observed increase in acute admissions. In addition, a more than doubled prevalence of day admissions over time was observed (12.3–28.3%), a trend that was unrelated to changes in individual characteristics. Conclusions This trend study showed a contribution of declines in population health to increases in acute hospital admissions. Since these declines did not provide a full explanation, healthcare reforms and increases in treatment possibilities in this period are likely to have contributed as well. PMID:27531734

  19. Utilization and Expenditure of Hospital Admission in Patients with Autism Spectrum Disorder: National Health Insurance Claims Database Analysis

    ERIC Educational Resources Information Center

    Lin, Jin-Ding; Hung, Wen-Jiu; Lin, Lan-Ping; Lai, Chia-Im

    2011-01-01

    There were not many studies to provide information on health access and health utilization of people with autism spectrum disorders (ASD). The present study describes a general profile of hospital admission and the medical cost among people with ASD, and to analyze the determinants of medical cost. A retrospective study was employed to analyze…

  20. Epidemiology of Hospital Admissions with Influenza during the 2013/2014 Northern Hemisphere Influenza Season: Results from the Global Influenza Hospital Surveillance Network

    PubMed Central

    Puig-Barberà, Joan; Natividad-Sancho, Angels; Trushakova, Svetlana; Sominina, Anna; Pisareva, Maria; Ciblak, Meral A.; Badur, Selim; Yu, Hongjie; Cowling, Benjamin J.; El Guerche-Séblain, Clotilde; Mira-Iglesias, Ainara; Kisteneva, Lidiya; Stolyarov, Kirill; Yurtcu, Kubra; Feng, Luzhao; López-Labrador, Xavier; Burtseva, Elena

    2016-01-01

    Background The Global Influenza Hospital Surveillance Network was established in 2012 to obtain valid epidemiologic data on hospital admissions with influenza-like illness. Here we describe the epidemiology of admissions with influenza within the Northern Hemisphere sites during the 2013/2014 influenza season, identify risk factors for severe outcomes and complications, and assess the impact of different influenza viruses on clinically relevant outcomes in at-risk populations. Methods Eligible consecutive admissions were screened for inclusion at 19 hospitals in Russia, Turkey, China, and Spain using a prospective, active surveillance approach. Patients that fulfilled a common case definition were enrolled and epidemiological data were collected. Risk factors for hospitalization with laboratory-confirmed influenza were identified by multivariable logistic regression. Findings 5303 of 9507 consecutive admissions were included in the analysis. Of these, 1086 were influenza positive (534 A(H3N2), 362 A(H1N1), 130 B/Yamagata lineage, 3 B/Victoria lineage, 40 untyped A, and 18 untyped B). The risk of hospitalization with influenza (adjusted odds ratio [95% confidence interval]) was elevated for patients with cardiovascular disease (1.63 [1.33–2.02]), asthma (2.25 [1.67–3.03]), immunosuppression (2.25 [1.23–4.11]), renal disease (2.11 [1.48–3.01]), liver disease (1.94 [1.18–3.19], autoimmune disease (2.97 [1.58–5.59]), and pregnancy (3.84 [2.48–5.94]). Patients without comorbidities accounted for 60% of admissions with influenza. The need for intensive care or in-hospital death was not significantly different between patients with or without influenza. Influenza vaccination was associated with a lower risk of confirmed influenza (adjusted odds ratio = 0.61 [0.48–0.77]). Conclusions Influenza infection was detected among hospital admissions with and without known risk factors. Pregnancy and underlying comorbidity increased the risk of detecting influenza

  1. Trends in hospital admission rates for anorexia nervosa in Oxford (1968–2011) and England (1990–2011): database studies

    PubMed Central

    Holland, Josephine; Hall, Nick; Yeates, David GR

    2015-01-01

    Objectives To report on long-term trends in hospital admission rates for anorexia nervosa using two English datasets. Design We used data on hospital day-case and inpatient care across five decades in the Oxford Record Linkage Study (ORLS), and similar data for all England from 1990. We analysed rates of admission for anorexia nervosa in people aged 10–44 years, using hospital episodes (counting every admission) and first-recorded admissions (counting only the first record for each person). Setting Former Oxford NHS Region; and England. Participants None; anonymous statistical records were used. Results In the longstanding ORLS, the age-standardised first-recorded admission rate for women was 2.7 (95% confidence interval 1.6–3.8) per 100,000 female population aged 10–44 years in 1968–1971; 2.7 (2.1–3.3) in 1992–1996; and 6.3 (5.5–7.2) in 2007–2011. Male rates were zero in the 1960s; 0.07 (0.0–0.1) per 100,000 men in 1992–1996; and 0.4 (0.2–0.6) in 2007–2011. In England, female rates increased from 4.2 (4.0–4.4) in 1998–2001 to 6.9 (6.7–7.1) in 2007–2011; and the corresponding male rates were 0.2 (0.1–0.3) and 0.5 (0.4–0.6). Episode-based admission rates rose more than person-based rates. The highest rates by far were in girls and women aged 15–19 years. Conclusions In recent years, anorexia nervosa has become a greater burden on secondary care: not only have admission rates increased but so too have multiple admissions per person with anorexia nervosa. The increase in admission rates might reflect an increase in prevalence rates of anorexia nervosa in the general population, but other explanations, including lower clinical thresholds for admission, are possible and are discussed. PMID:26609127

  2. Simple prescribing errors and allergy documentation in medical hospital admissions in Australia and New Zealand.

    PubMed

    Barton, Lorna; Futtermenger, Judith; Gaddi, Yash; Kang, Angela; Rivers, Jon; Spriggs, David; Jenkins, Paul F; Thompson, Campbell H; Thomas, Josephine S

    2012-04-01

    This study aimed to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient's hospital admission. Four public or private acute care hospitals across Australia and New Zealand each audited 200 patients' drug charts. Patient demographics, pharmacist review and pre-defined prescribing errors were recorded. At least one simple error was present on the medication charts of 672/715 patients, with a linear relationship between the number of medications prescribed and the number of errors (r = 0.571, p < 0.001). The four sites differed significantly in the prevalence of different types of simple prescribing errors. Pharmacists were more likely to review patients aged > or = 75 years (39.9% vs 26.0%; p < 0.001) and those with more than 10 drug prescriptions (39.4% vs 25.7%; p < 0.001). Patients reviewed by a pharmacist were less likely to have inadequate documentation of allergies (13.5% vs 29.4%, p < 0.001). Simple prescribing errors are common, although their nature differs from site to site. Clinical pharmacists target patients with the most complex health situations, and their involvement leads to improved documentation. PMID:22586784

  3. Length of Hospital Stay Prediction at the Admission Stage for Cardiology Patients Using Artificial Neural Network.

    PubMed

    Tsai, Pei-Fang Jennifer; Chen, Po-Chia; Chen, Yen-You; Song, Hao-Yuan; Lin, Hsiu-Mei; Lin, Fu-Man; Huang, Qiou-Pieng

    2016-01-01

    For hospitals' admission management, the ability to predict length of stay (LOS) as early as in the preadmission stage might be helpful to monitor the quality of inpatient care. This study is to develop artificial neural network (ANN) models to predict LOS for inpatients with one of the three primary diagnoses: coronary atherosclerosis (CAS), heart failure (HF), and acute myocardial infarction (AMI) in a cardiovascular unit in a Christian hospital in Taipei, Taiwan. A total of 2,377 cardiology patients discharged between October 1, 2010, and December 31, 2011, were analyzed. Using ANN or linear regression model was able to predict correctly for 88.07% to 89.95% CAS patients at the predischarge stage and for 88.31% to 91.53% at the preadmission stage. For AMI or HF patients, the accuracy ranged from 64.12% to 66.78% at the predischarge stage and 63.69% to 67.47% at the preadmission stage when a tolerance of 2 days was allowed. PMID:27195660

  4. Incidence, causes and severity of injuries in Aquitaine, France: a community-based study of hospital admissions and deaths.

    PubMed Central

    Tiret, L; Garros, B; Maurette, P; Nicaud, V; Thicoipe, M; Hatton, F; Erny, P

    1989-01-01

    This paper reports the results of a study of injuries conducted during a one-year period within a defined geographic population of 2.7 million persons (Aquitaine, France). Cases were defined as unintentional or intentional injuries, either resulting in immediate death before reaching hospital or requiring hospital admission. During the one-year period, 1,181 deaths were registered and 8,190 hospital admissions occurred during the sample periods. The three leading causes of injury were falls (40 per cent), traffic accidents (27 per cent), and poisonings (15 per cent). The overall incidence of injuries was 136 per 10,000 person years. Incidence by sex and age was assessed for the main external causes. The ratios of nonfatal to fatal cases were calculated by sex and age and by external cause. The origin of the injury was suicide in 14 per cent of cases and assault or homicide in 3 per cent. The severity of injuries, assessed using an automatic computation of the Injury Severity Score (ISS), ranged from 1 to 66 with a mean of 6.9. Substantial variations of ISS were observed according to external cause. At the 8th day following admission, 31 per cent of hospital-treated patients were still hospitalized and 0.8 per cent had died in hospital. The outcome correlated well with the ISS. PMID:2916718

  5. Association of cannabis use with hospital admission and antipsychotic treatment failure in first episode psychosis: an observational study

    PubMed Central

    Wilson, Robin; Jackson, Richard; Ball, Michael; Shetty, Hitesh; Broadbent, Matthew; Stewart, Robert; McGuire, Philip; Bhattacharyya, Sagnik

    2016-01-01

    Objective To investigate whether cannabis use is associated with increased risk of relapse, as indexed by number of hospital admissions, and whether antipsychotic treatment failure, as indexed by number of unique antipsychotics prescribed, may mediate this effect in a large data set of patients with first episode psychosis (FEP). Design Observational study with exploratory mediation analysis. Setting Anonymised electronic mental health record data from the South London and Maudsley NHS Foundation Trust. Participants 2026 people presenting to early intervention services with FEP. Exposure Cannabis use at presentation, identified using natural language processing. Main outcome measures admission to psychiatric hospital and clozapine prescription up to 5 years following presentation. Mediator Number of unique antipsychotics prescribed. Results Cannabis use was present in 46.3% of the sample at first presentation and was particularly common in patients who were 16–25, male and single. It was associated with increased frequency of hospital admission (incidence rate ratio 1.50, 95% CI 1.25 to 1.80), increased likelihood of compulsory admission (OR 1.55, 1.16 to 2.08) and greater number of days spent in hospital (β coefficient 35.1 days, 12.1 to 58.1). The number of unique antipsychotics prescribed, mediated increased frequency of hospital admission (natural indirect effect 1.09, 95% CI 1.01 to 1.18; total effect 1.50, 1.21 to 1.87), increased likelihood of compulsory admission (natural indirect effect (NIE) 1.27, 1.03 to 1.58; total effect (TE) 1.76, 0.81 to 3.84) and greater number of days spent in hospital (NIE 17.9, 2.4 to 33.4; TE 34.8, 11.6 to 58.1). Conclusions Cannabis use in patients with FEP was associated with an increased likelihood of hospital admission. This was linked to the prescription of several different antipsychotic drugs, indicating clinical judgement of antipsychotic treatment failure. Together, this suggests that cannabis use might be

  6. Outcomes and Resource Use of Sepsis-associated Stays by Presence on Admission, Severity, and Hospital Type

    PubMed Central

    Ashton, Carol M.; Kiehne, Lisa B.; Nicolas, Juan C.; Rose, Alexis L.; Shirkey, Beverly A.; Masud, Faisal; Wray, Nelda P.

    2016-01-01

    Objective: To establish a baseline for the incidence of sepsis by severity and presence on admission in acute care hospital settings before implementation of a broad sepsis screening and response initiative. Methods: A retrospective cohort study using hospital discharge abstracts of 5672 patients, aged 18 years and above, with sepsis-associated stays between February 2012 and January 2013 at an academic medical center and 5 community hospitals in Texas. Results: Sepsis was present on admission in almost 85% of cases and acquired in-hospital in the remainder. The overall inpatient death rate was 17.2%, but was higher in hospital-acquired sepsis (38.6%, medical; 29.2%, surgical) and Stages 2 (17.6%) and 3 (36.4%) compared with Stage 1 (5.9%). Patients treated at the academic medical center had a higher death rate (22.5% vs. 15.1%, P<0.001) and were more costly ($68,050±184,541 vs. $19,498±31,506, P<0.001) versus community hospitals. Conclusions: Greater emphasis is needed on public awareness of sepsis and the detection of sepsis in the prehospitalization and early hospitalization period. Hospital characteristics and case mix should be accounted for in cross-hospital comparisons of sepsis outcomes and costs. PMID:26759980

  7. Incidence and consequence of acute kidney injury in unselected emergency admissions to a large acute UK hospital trust

    PubMed Central

    2014-01-01

    Background AKI is common among hospital in-patients and places a huge financial burden on the UK National Health Service, causing increased length of hospital stay and use of critical care services, with increased requirement for complex interventions including dialysis. This may account for up to 0.6% of the total Health Service budget. To investigate the incidence and consequences of AKI, all unselected emergency admissions to a large acute UK single centre University Teaching Hospital over two separate 7 day periods were reviewed. Methods A retrospective audit of 745 case records was undertaken (54.6% male) including laboratory data post-discharge or death, with classification of AKI by RIFLE, AKIN and AKIB criteria. Participants were included whether admitted via their general practitioners, the emergency department, or as tertiary specialty transfers. Outcome measures were presence or absence of AKI recorded using each of the three AKI criteria, length of hospital stay (LOS), admission to, and LOS in critical care, and mortality. The most severe grade of AKI only, at any time during the admission, was recorded to prevent double counting. Renal outcome was determined by requirement for renal replacement therapy (RRT), and whether those receiving RRT remained dialysis dependent or not. Results AKI incidence was 25.4% overall. With approximately one third present on admission and two thirds developing post admission. The AKI group had LOS almost three times higher than the non AKI group (10 vs 4 days). Requirement for critical care beds was 8.1% in the AKI group compared to 1.7% in non AKI group. Overall mortality was 5.5%, with the AKI group at 11.4% versus 3.3% in the non AKI group. Conclusions AKI in acute unselected hospital admissions is more common than existing literature suggests, affecting 25% of unselected admissions. In many this is relatively mild and may resolve spontaneously, but is associated with increased LOS, likelihood of admission to

  8. Association between air pollution and daily mortality and hospital admission due to ischaemic heart diseases in Hong Kong

    NASA Astrophysics Data System (ADS)

    Tam, Wilson Wai San; Wong, Tze Wai; Wong, Andromeda H. S.

    2015-11-01

    Ischaemic heart disease (IHD) is one of the leading causes of death worldwide. The effects of air pollution on IHD mortalities have been widely reported. Fewer studies focus on IHD morbidities and PM2.5, especially in Asia. To explore the associations between short-term exposure to air pollution and morbidities and mortalities from IHD, we conducted a time series study using a generalized additive model that regressed the daily numbers of IHD mortalities and hospital admissions on daily mean concentrations of the following air pollutants: nitrogen dioxide (NO2), particulate matter with an aerodynamic diameter less than 10 μm (PM10), particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5), ozone (O3), and sulfur dioxide (SO2). The relative risks (RR) of IHD deaths and hospital admissions per 10 μg/m3 increase in the concentration of each air pollutant were derived in single pollutant models. Multipollutant models were also constructed to estimate their RRs controlling for other pollutants. Significant RRs were observed for all five air pollutants, ranging from 1.008 to 1.032 per 10 μg/m3 increase in air pollutant concentrations for IHD mortality and from 1.006 to 1.021 per 10 μg/m3 for hospital admissions for IHD. In the multipollutant model, only NO2 remained significant for IHD mortality while SO2 and PM2.5 was significantly associated with hospital admissions. This study provides additional evidence that mortalities and hospital admissions for IHD are significantly associated with air pollution. However, we cannot attribute these health effects to a specific air pollutant, owing to high collinearity between some air pollutants.

  9. Spreading a Medical Home Redesign: Effects on Emergency Department Use and Hospital Admissions

    PubMed Central

    Reid, Robert J.; Johnson, Eric A.; Hsu, Clarissa; Ehrlich, Kelly; Coleman, Katie; Trescott, Claire; Erikson, Michael; Ross, Tyler R.; Liss, David T.; Cromp, DeAnn; Fishman, Paul A.

    2013-01-01

    PURPOSE The patient-centered medical home (PCMH) is being rapidly deployed in many settings to strengthen US primary care, improve quality, and control costs; however, evidence supporting this transformation is still lacking. We describe the Group Health experience in attempting to replicate the effects on health care use seen in a PCMH prototype clinic via a systemwide spread using Lean as the change strategy. METHODS We used an interrupted time series analysis with a patient-month unit of analysis over a 4-year period that included baseline, implementation, and stabilization periods for 412,943 patients. To account for secular trends across these periods, we compared changes in use of face-to-face primary care visits, emergency department visits, and inpatient admissions with those of a nonequivalent comparison group of patients served by community network practices. RESULTS After accounting for secular trends among network patients, patients empaneled to the PCMH clinics had 5.1% and 6.7% declines in primary care office visits in early and later stabilization years, respectively, after the implementation year. This trend was accompanied by a 123% increase in the use of secure electronic message threads and a 20% increase in telephone encounters. Declines were also seen in emergency department visits at 1 and 2 years (13.7% and 18.5%) compared with what would be expected based on secular trends in network practices. No statistically significant changes were found for hospital admissions. CONCLUSIONS The Group Health experience shows it is possible to reduce emergency department use with PCMH transformation across a diverse set of clinics using a clear change strategy (Lean) and sufficient resources and supports. PMID:23690382

  10. Seasonal Changes in Hospital Admissions for Pulmonary Embolism in Metropolitan Areas of Tokyo (from the Tokyo Cardiovascular Care Unit Network).

    PubMed

    Mizuno, Atsushi; Takeuchi, Ayano; Yamamoto, Takeshi; Tanabe, Yasuhiro; Obayashi, Toru; Takayama, Morimasa; Nagao, Ken

    2015-12-15

    Although several studies have shown the relation between temperature/atmospheric pressure and pulmonary embolism (PE), their results are inconsistent. Furthermore, diurnal temperature range (DTR) and diurnal pressure range (DPR) were not fully evaluated for their associations with hospital admissions for PE. Study subjects comprised cases of 1,148 PE treated at institutions belonging to the Tokyo Cardiovascular Care Unit Network from January 2005 to December 2012. Patient data were combined with a variety of daily local climate parameters obtained from the Japan Meteorological Agency. Every 1°C increase in the DTR at lag0 corresponded to an increased relative risk of hospital admission for PE (odds ratio [OR] 1.036, 95% confidence interval [CI] 1.003 to 1.070). In the cooler season (November to April), an increase of 1 hPa (barometric pressure) in the DPR at lag4 and lag5 was associated with an increased relative risk of hospital admission for PE (OR 1.042, 95% CI 1.007 to 1.077 and OR 0.952, 95% CI 0.914 to 0.992, respectively). An increase in the PE hospitalization rate was seen only in the cool season. Using a metropolitan database, we showed that DTR and DPR have different impacts on hospital admissions for PE. In conclusion, we found that an increase in the DTR increases the PE hospitalization rate, especially during the cooler season. The impact of DTR and DPR on PE incidence and related hospitalizations needs to be further evaluated. PMID:26602077

  11. A Use Case to Support Precision Medicine for Frequently Hospitalized Older Adults with Polypharmacy.

    PubMed

    Cabrera, Manuel; Finkelstein, Joseph

    2016-01-01

    Polypharmacy in older adults results in multiple negative clinical consequences including increased risk of hospital readmissions. Precision medicine may provide tools to optimize complex medication regimens however its potential in older adults with polypharmacy is unknown. We carried out pharmacogenetic testing in an older adult with multiple chronic conditions and polypharmacy who was concerned about frequent readmissions despite receiving guideline-concordant care and being adherent to medication regimen. The testing identified patients' CYP2D6 rapid metabolizer status. This may have resulted in decreased exposure to Carvedilol which was primary drug for CHF management in this patient. Additional nine drug-drug interactions were identified during personalized drug regimen review. We concluded that, though precision medicine has enormous potential in older adults with polypharmacy, the complexity of pharmacogenetic information requires innovative informatics solutions to support optimal workflows, decision support, and medication optimization and management in order to fully utilize its potential in routine clinical care. PMID:27570642

  12. A Use Case to Support Precision Medicine for Frequently Hospitalized Older Adults with Polypharmacy

    PubMed Central

    Cabrera, Manuel; Finkelstein, Joseph

    2016-01-01

    Polypharmacy in older adults results in multiple negative clinical consequences including increased risk of hospital readmissions. Precision medicine may provide tools to optimize complex medication regimens however its potential in older adults with polypharmacy is unknown. We carried out pharmacogenetic testing in an older adult with multiple chronic conditions and polypharmacy who was concerned about frequent readmissions despite receiving guideline-concordant care and being adherent to medication regimen. The testing identified patients’ CYP2D6 rapid metabolizer status. This may have resulted in decreased exposure to Carvedilol which was primary drug for CHF management in this patient. Additional nine drug-drug interactions were identified during personalized drug regimen review. We concluded that, though precision medicine has enormous potential in older adults with polypharmacy, the complexity of pharmacogenetic information requires innovative informatics solutions to support optimal workflows, decision support, and medication optimization and management in order to fully utilize its potential in routine clinical care. PMID:27570642

  13. Costs of most frequent nursing activities in highly dependent hospitalized patients.

    PubMed

    Lima, Antônio Fernandes Costa; Castilho, Valéria; Fugulin, Fernanda Maria Togeiro; Silva, Belisa; Ramin, Natália Siqueira; Melo, Talita de Oliveira

    2012-01-01

    This quantitative study aimed to identify the costs of the most frequent nursing activities in highly dependent hospitalized patients at a medical clinic. The non-probabilistic convenience sample corresponded to 607 observations regarding oral feeding activities (OF), blood pressure verification (BP) / heart rate (HR), body temperature checking (BTC), performance of intimate hygiene and management of feeding probe. The costs identified corresponded to R$2.40 (SD±2.64) for OF feeding; R$1.26 (SD±0.48) to verify the BP/HR; R$1.17 (SD±0.46) for BTC; R$15.59 (SD±8.62) to perform intimate hygiene and R$5.95 (SD±2.13) for management of feeding probe. This study will facilitate cost management, with a view to avoiding waste related to unnecessary resource consumption and establish a correlation between costs and care delivery results. PMID:23174832

  14. ACE Inhibitor and Angiotensin Receptor-II Antagonist Prescribing and Hospital Admissions with Acute Kidney Injury: A Longitudinal Ecological Study

    PubMed Central

    Tomlinson, Laurie A.; Abel, Gary A.; Chaudhry, Afzal N.; Tomson, Charles R.; Wilkinson, Ian B.; Roland, Martin O.; Payne, Rupert A.

    2013-01-01

    Background ACE Inhibitors (ACE-I) and Angiotensin-Receptor Antagonists (ARAs) are commonly prescribed but can cause acute kidney injury (AKI) during intercurrent illness. Rates of hospitalization with AKI are increasing. We aimed to determine whether hospital AKI admission rates are associated with increased ACE-I/ARA prescribing. Methods and Findings English NHS prescribing data for ACE-I/ARA prescriptions were matched at the level of the general practice to numbers of hospital admissions with a primary diagnosis of AKI. Numbers of prescriptions were weighted for the demographic characteristics of general practices by expressing prescribing as rates where the denominator is Age, Sex, and Temporary Resident Originated Prescribing Units (ASTRO-PUs). We performed a mixed-effect Poisson regression to model the number of admissions for AKI occurring in each practice for each of 4 years from 1/4/2007. From 2007/8-2010/11, crude AKI admission rates increased from 0.38 to 0.57 per 1000 patients (51.6% increase), and national annual ACE-I/ARA prescribing rates increased by 0.032 from 0.202 to 0.234 (15.8% increase). There was strong evidence (p<0.001) that increases in practice-level prescribing of ACE-I/ARA over the study period were associated with an increase in AKI admission rates. The increase in prescribing seen in a typical practice corresponded to an increase in admissions of approximately 5.1% (rate ratio = 1.051 for a 0.03 per ASTRO-PU increase in annual prescribing rate, 95%CI 1.047-1.055). Using the regression model we predict that 1,636 (95%CI 1,540-1,780) AKI admissions would have been avoided if prescribing rates were at the 2007/8 level, equivalent to 14.8% of the total increase in AKI admissions. Conclusion In this ecological analysis, up to 15% of the increase in AKI admissions in England over a 4-year time period is potentially attributable to increased prescribing of ACE-I and ARAs. However, these findings are limited by the lack of patient level

  15. Borderline Personality Disorder and Posttraumatic Stress Disorder at Psychiatric Discharge Predict General Hospital Admission for Self-Harm.

    PubMed

    Mellesdal, Liv; Gjestad, Rolf; Johnsen, Erik; Jørgensen, Hugo A; Oedegaard, Ketil J; Kroken, Rune A; Mehlum, Lars

    2015-12-01

    We investigated whether posttraumatic stress disorder (PTSD) was predictor of suicidal behavior even when adjusting for comorbid borderline personality disorder (BPD) and other salient risk factors. To study this, we randomly selected 308 patients admitted to a psychiatric hospital because of suicide risk. Baseline interviews were performed within the first days of the stay. Information concerning the number of self-harm admissions to general hospitals over the subsequent 6 months was retrieved through linkage with the regional hospital registers. A censored regression analysis of hospital admissions for self-harm indicated significant associations with both PTSD (β = .21, p < .001) and BPD (β = .27, p < .001). A structural model comprising two latent BPD factors, dysregulation and relationship problems, as well as PTSD and several other variables, demonstrated that PTSD was an important correlate of the number of self-harm admissions to general hospitals (B = 1.52, p < .01). Dysregulation was associated directly with self-harm (B = 0.28, p < .05), and also through PTSD. These results suggested that PTSD and related dysregulation problems could be important treatment targets for a reduction in the risk of severe self-harm in high-risk psychiatric patients. PMID:26581019

  16. Reducing variation in hospital admissions from the emergency department for low-mortality conditions may produce savings.

    PubMed

    Sabbatini, Amber K; Nallamothu, Brahmajee K; Kocher, Keith E

    2014-09-01

    The emergency department (ED) is now the primary source for hospitalizations in the United States, and admission rates for all causes differ widely between EDs. In this study we used a national sample of ED visits to examine variation in risk-standardized hospital admission rates from EDs and the relationship of this variation to inpatient mortality for the fifteen most commonly admitted medical and surgical conditions. We then estimated the impact of variation on national health expenditures under different utilization scenarios. Risk-standardized admission rates differed substantially across EDs, ranging from 1.03-fold for sepsis to 6.55-fold for chest pain between the twenty-fifth and seventy-fifth percentiles of the visits. Conditions such as chest pain, soft tissue infection, asthma, chronic obstructive pulmonary disease, and urinary tract infection were low-mortality conditions that showed the greatest variation. This suggests that some of these admissions might not be necessary, thus representing opportunities to improve efficiency and reduce health spending. Our data indicate that there may be sizeable savings to US payers if differences in ED hospitalization practices could be narrowed among a few of these high-variation, low-mortality conditions. PMID:25201672

  17. Risk of Care Home Placement following Acute Hospital Admission: Effects of a Pay-for-Performance Scheme for Dementia

    PubMed Central

    Kasteridis, Panagiotis; Goddard, Maria; Jacobs, Rowena; Santos, Rita; Rodriguez-Sanchez, Beatriz; McGonigal, Gerard

    2016-01-01

    Introduction The Quality and Outcomes Framework, or QOF, rewards primary care doctors (GPs) in the UK for providing certain types of care. Since 2006, GPs have been paid to identify patients with dementia and to conduct an annual review of their mental and physical health. During the review, the GP also assesses the carer’s support needs, including impact of caring, and ensures that services are co-ordinated across care settings. In principle, this type of care should reduce the risk of admission to long-term residential care directly from an acute hospital ward, a phenomenon considered to be indicative of poor quality care. However, this potential effect has not previously been tested. Methods Using English data from 2006/07 to 2010/11, we ran multilevel logit models to assess the impact of the QOF review on the risk of care home placement following emergency admission to acute hospital. Emergency admissions were defined for (a) people with a primary diagnosis of dementia and (b) people with dementia admitted for treatment of an ambulatory care sensitive condition. We adjusted for a wide range of potential confounding factors. Results Over the study period, 19% of individuals admitted to hospital with a primary diagnosis of dementia (N = 31,120) were discharged to a care home; of those admitted for an ambulatory care sensitive condition (N = 139,267), the corresponding figure was 14%. Risk factors for subsequent care home placement included older age, female gender, vascular dementia, incontinence, fall, hip fracture, and number of comorbidities. Better performance on the QOF review was associated with a lower risk of care home placement but only when the admission was for an ambulatory care sensitive condition. Conclusions The QOF dementia review may help to reduce the risk of long-term care home placement following acute hospital admission. PMID:27227403

  18. Anemia, Blood Transfusion Requirements and Mortality Risk in Human Immunodeficiency Virus-Infected Adults Requiring Acute Medical Admission to Hospital in South Africa

    PubMed Central

    Kerkhoff, Andrew D.; Lawn, Stephen D.; Schutz, Charlotte; Burton, Rosie; Boulle, Andrew; Cobelens, Frank J.; Meintjes, Graeme

    2015-01-01

    Background. Morbidity and mortality remain high among hospitalized patients infected with human immunodeficiency virus (HIV) in sub-Saharan Africa despite widespread availability of antiretroviral therapy. Severe anemia is likely one important driver, and some evidence suggests that blood transfusions may accelerate HIV progression and paradoxically increase short-term mortality. We investigated the relationship between anemia, blood transfusions, and mortality in a South African district hospital. Methods. Unselected consecutive HIV-infected adults requiring acute medical admission to a Cape Town township district hospital were recruited. Admission hemoglobin concentrations were used to classify anemia severity according to World Health Organization/AIDS Clinical Trials Group criteria. Vital status was determined at 90 days, and Cox regression analyses were used to determine independent predictors of mortality. Results. Of 585 HIV-infected patients enrolled, 578 (98.8%) were included in the analysis. Anemia was detected in 84.8% of patients and was severe (hemoglobin, 6.5–7.9 g/dL) or life-threatening (hemoglobin, <6.5 g/dL) in 17.3% and 13.3%, respectively. Within 90 days of the date of admission, 13.5% (n = 78) patients received at least 1 blood transfusion with red cell concentrate and 77 (13.3%) patients died. In univariable analysis, baseline hemoglobin and receipt of blood transfusion were associated with increased mortality risk. However, in multivariable analysis, neither hemoglobin nor receipt of a blood transfusion were independently associated with greater mortality risk. Acquired immune deficiency syndrome-defining illnesses other than tuberculosis and impaired renal function independently predicted mortality. Conclusions. Newly admitted HIV-infected adults had a high prevalence of severe or life-threatening anemia and blood transfusions were frequently required. However, after adjustment for confounders, blood transfusions did not confer an

  19. Trends and ethnic differences in hospital admissions and mortality for congestive heart failure in the elderly in Singapore, 1991 to 1998

    PubMed Central

    Ng, T P; Niti, M

    2003-01-01

    Objectives: To describe trends in hospital admissions and mortality from congestive heart failure in the elderly population aged 65 years and over in Singapore, 1991 to 1998. Design: Analysis of trends and population subgroup differences in rates of hospital admission and mortality for a primary diagnosis of congestive heart failure, classified as ICD-9, codes 428, 402.0, 402.11, and 402.91. Setting: The state of Singapore (multiethnic population of three million: Chinese 77%, Malay 14%, Indian 8%). Results: Congestive heart failure accounted for 4.5% of all hospital admissions and 2.5% of overall mortality in this age group. Age adjusted hospital admission rates for congestive heart failure increased by 38% (from 85.4 per 10 000 in 1991 to 110.3 per 10 000 in 1998), while mortality decreased by 20% (from 7.3 per 10 000 in 1991 to 6.1 per 10 000 in 1998). The decline in mortality was greater in women than in men. There were no sex differences in the rates of hospital admission, but there were significant ethnic differences in admissions and mortality. Thus hospital admissions for congestive heart failure were about 35% higher in both Malays and Indians than in Chinese; and mortality was 3.5 times higher in Malays, but was about the same in Indians and Chinese. Over the period studied, mortality from congestive heart failure declined in both Chinese and Indians, but rose in Malays. The increases in hospital admissions were similar in both sexes and all ethnic groups. Conclusions: An increasing rate of hospital admission accompanied by declining mortality from congestive heart failure is occurring in elderly people in this Asian multiethnic population. However, there are pronounced ethnic differences, with both Malays and Indians showing higher hospital admission rates than Chinese, and Malays showing a rising mortality as opposed to the falling mortality in the other ethnic groups. PMID:12860859

  20. External validation of the Hospital-patient One-year Mortality Risk (HOMR) model for predicting death within 1 year after hospital admission

    PubMed Central

    van Walraven, Carl; McAlister, Finlay A.; Bakal, Jeffrey A.; Hawken, Steven; Donzé, Jacques

    2015-01-01

    Background: Predicting long-term survival after admission to hospital is helpful for clinical, administrative and research purposes. The Hospital-patient One-year Mortality Risk (HOMR) model was derived and internally validated to predict the risk of death within 1 year after admission. We conducted an external validation of the model in a large multicentre study. Methods: We used administrative data for all nonpsychiatric admissions of adult patients to hospitals in the provinces of Ontario (2003–2010) and Alberta (2011–2012), and to the Brigham and Women’s Hospital in Boston (2010–2012) to calculate each patient’s HOMR score at admission. The HOMR score is based on a set of parameters that captures patient demographics, health burden and severity of acute illness. We determined patient status (alive or dead) 1 year after admission using population-based registries. Results: The 3 validation cohorts (n = 2 862 996 in Ontario, 210 595 in Alberta and 66 683 in Boston) were distinct from each other and from the derivation cohort. The overall risk of death within 1 year after admission was 8.7% (95% confidence interval [CI] 8.7% to 8.8%). The HOMR score was strongly and significantly associated with risk of death in all populations and was highly discriminative, with a C statistic ranging from 0.89 (95% CI 0.87 to 0.91) to 0.92 (95% CI 0.91 to 0.92). Observed and expected outcome risks were similar (median absolute difference in percent dying in 1 yr 0.3%, interquartile range 0.05%–2.5%). Interpretation: The HOMR score, calculated using routinely collected administrative data, accurately predicted the risk of death among adult patients within 1 year after admission to hospital for nonpsychiatric indications. Similar performance was seen when the score was used in geographically and temporally diverse populations. The HOMR model can be used for risk adjustment in analyses of health administrative data to predict long-term survival among hospital patients

  1. Severe Iron Deficiency Anemia in Infants and Young Children, Requiring Hospital Admission

    PubMed Central

    Lundblad, Kristin; Rosenberg, Jonathan; Mangurten, Henry; Angst, Denise B.

    2016-01-01

    Objective. This study evaluated patient characteristics, milk intake, and associated lab findings of children 6 months to 5 years old, admitted to a children’s hospital with severe iron-deficiency anemia (IDA). Methods. A chart review was conducted on patients admitted with microcytic anemia (hemoglobin concentration less than 7 g/dL), accompanied by a low serum ferritin and/or low serum iron level between January 2000 and December 2006. Results. A total of 18 children with severe IDA were evaluated. Many had parents with private insurance and jobs. Almost all children drank >24 ounces of milk daily. Hemoglobin on admission was 3.8 g/dL, and the mean of the patients’ mean corpuscular volume was 52.8 fL. Median iron levels were 4 µg/dL. Conclusions. Severe IDA is still prevalent in children, yet physicians may not perform necessary testing. The devastating long-term effects of severe IDA should prompt clinicians to screen for severe IDA in children regardless of absent risk factors. PMID:27335995

  2. Air pollution and hospital emergency room admissions for chronic obstructive pulmonary disease in Valencia, Spain.

    PubMed

    Tenías, José Maria; Ballester, Ferran; Pérez-Hoyos, Santiago; Rivera, María Luisa

    2002-01-01

    The short-term relationship between levels of air pollution and emergency room admissions for chronic obstructive pulmonary disease was assessed in Valencia, Spain. The design was an ecological time-series study in which daily variation in air pollution was related to emergency chronic obstructive pulmonary disease visits to one of the city's hospitals. The pollutants under investigation were Black Smoke, sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone. The degree of association was analyzed with Poisson autoregressive regression, for which trend, seasonal patterns, temperature, humidity, days of the week, and incidence of influenza were controlled. Increases of 10 microg/m3 in ozone levels (lag 5) and of 1 mg/m3 in carbon monoxide (lag 1) were associated with increases of 6.1% (95% confidence interval [CI] = 2.2%, 10.1%) and of 3.9% (95% CI = 1.4%, 6.6%), respectively, in the expected chronic obstructive pulmonary disease cases. There was no significant association for the remainder of the pollutants. The described effects persisted even when the authors used models of differing specifications and when generalized additive models were used. The authors concluded that the results of this investigation, together with results of earlier research, demonstrate the significant effect of pollution on various health indicaors within Valencia. PMID:12071359

  3. Adverse Drug Reactions Causing Admission to Medical Wards: A Cross-Sectional Survey at 4 Hospitals in South Africa.

    PubMed

    Mouton, Johannes P; Njuguna, Christine; Kramer, Nicole; Stewart, Annemie; Mehta, Ushma; Blockman, Marc; Fortuin-De Smidt, Melony; De Waal, Reneé; Parrish, Andy G; Wilson, Douglas P K; Igumbor, Ehimario U; Aynalem, Getahun; Dheda, Mukesh; Maartens, Gary; Cohen, Karen

    2016-05-01

    Limited data exist on the burden of serious adverse drug reactions (ADRs) in sub-Saharan Africa, which has high HIV and tuberculosis prevalence. We determined the proportion of adult admissions attributable to ADRs at 4 hospitals in South Africa. We characterized drugs implicated in, risk factors for, and the preventability of ADR-related admissions.We prospectively followed patients admitted to 4 hospitals' medical wards over sequential 30-day periods in 2013 and identified suspected ADRs with the aid of a trigger tool. A multidisciplinary team performed causality, preventability, and severity assessment using published criteria. We categorized an admission as ADR-related if the ADR was the primary reason for admission.There were 1951 admissions involving 1904 patients: median age was 50 years (interquartile range 34-65), 1057 of 1904 (56%) were female, 559 of 1904 (29%) were HIV-infected, and 183 of 1904 (10%) were on antituberculosis therapy (ATT). There were 164 of 1951 (8.4%) ADR-related admissions. After adjustment for age and ATT, ADR-related admission was independently associated (P ≤ 0.02) with female sex (adjusted odds ratio [aOR] 1.51, 95% confidence interval [95% CI] 1.06-2.14), increasing drug count (aOR 1.14 per additional drug, 95% CI 1.09-1.20), increasing comorbidity score (aOR 1.23 per additional point, 95% CI 1.07-1.41), and use of antiretroviral therapy (ART) if HIV-infected (aOR 1.92 compared with HIV-negative/unknown, 95% CI 1.17-3.14). The most common ADRs were renal impairment, hypoglycemia, liver injury, and hemorrhage. Tenofovir disoproxil fumarate, insulin, rifampicin, and warfarin were most commonly implicated, respectively, in these 4 ADRs. ART, ATT, and/or co-trimoxazole were implicated in 56 of 164 (34%) ADR-related admissions. Seventy-three of 164 (45%) ADRs were assessed as preventable.In our survey, approximately 1 in 12 admissions was because of an ADR. The range of ADRs and implicated drugs reflect South Africa's high HIV

  4. Short-Term Effects of Coarse Particulate Matter on Hospital Admissions for Cardiovascular Diseases: A Case-Crossover Study in a Tropical City.

    PubMed

    Chen, Ying-Chen; Weng, Yi-Hao; Chiu, Ya-Wen; Yang, Chun-Yuh

    2015-01-01

    This study was undertaken to determine whether there was an association between coarse particles (PM2.5-10) levels and frequency of hospital admissions for cardiovascular diseases (CVD) in Kaohsiung, Taiwan. Hospital admissions for CVD, including ischemic heart disease (IHD), stroke, congestive heart failure (CHF), and arrhythmias, and ambient air pollution data levels for Kaohsiung were obtained for the period 2006-2010. The relative risk of hospital admissions for CVD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), increased rates of admissions for CVD were significantly associated with higher coarse PM levels only on cool days (< 25°C), with a 10-μg/m(3) elevation in PM2.5-10 concentrations associated with a 3% (95% CI = 2-4%) rise in IHD admissions, 5% (95% CI = 4-6%) increase in stroke admissions, 3% (95% CI = 1-6%) elevation in CHF admissions, and 3% (95% CI = 0-6%) rise in arrhythmias admissions. No significant associations were found between coarse particle levels and number of hospital admissions for CVD on warm days. In the two-pollutant models, PM2.5-10 levels remained significantly correlated with higher rate of CVD admissions even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. Compared to the effect estimate associated with a 10-μg/m(3) increase in PM2.5 levels, effect estimates of frequency of CVD-related admissions associated with a 10-μg/m(3) rise in coarse PM levels were weaker. This study provides evidence that higher levels of PM2.5-10 enhance the risk of hospital admissions for CVD. PMID:26408041

  5. Clinical Prediction Rule for Patient Outcome after In-Hospital CPR: A New Model, Using Characteristics Present at Hospital Admission, to Identify Patients Unlikely to Benefit from CPR after In-Hospital Cardiac Arrest

    PubMed Central

    Merja, Satyam; Lilien, Ryan H; Ryder, Hilary F

    2015-01-01

    BACKGROUND Physicians and patients frequently overestimate likelihood of survival after in-hospital cardiopulmonary resuscitation. Discussions and decisions around resuscitation after in-hospital cardiopulmonary arrest often take place without adequate or accurate information. METHODS We conducted a retrospective chart review of 470 instances of resuscitation after in-hospital cardiopulmonary arrest. Individuals were randomly assigned to a derivation cohort and a validation cohort. Logistic Regression and Linear Discriminant Analysis were used to perform multivariate analysis of the data. The resultant best performing rule was converted to a weighted integer tool, and thresholds of survival and nonsurvival were determined with an attempt to optimize sensitivity and specificity for survival. RESULTS A 10-feature rule, using thresholds for survival and nonsurvival, was created; the sensitivity of the rule on the validation cohort was 42.7% and specificity was 82.4%. In the Dartmouth Score (DS), the features of age (greater than 70 years of age), history of cancer, previous cardiovascular accident, and presence of coma, hypotension, abnormal PaO2, and abnormal bicarbonate were identified as the best predictors of nonsurvival. Angina, dementia, and chronic respiratory insufficiency were selected as protective features. CONCLUSIONS Utilizing information easily obtainable on admission, our clinical prediction tool, the DS, provides physicians individualized information about their patients’ probability of survival after in-hospital cardiopulmonary arrest. The DS may become a useful addition to medical expertise and clinical judgment in evaluating and communicating an individual’s probability of survival after in-hospital cardiopulmonary arrest after it is validated by other cohorts. PMID:26448686

  6. Hospital admission rates for asthma and respiratory disease in the West Midlands: their relationship to air pollution levels.

    PubMed Central

    Walters, S.; Phupinyokul, M.; Ayres, J.

    1995-01-01

    BACKGROUND--A study was undertaken to determine the relationship between hospital admissions for asthma and all respiratory conditions in electoral wards in the West Midlands and ambient levels of smoke, sulphur dioxide, and nitrogen dioxide, and to establish whether the relationship is independent of social deprivation and ethnicity, and is different for young children and older individuals. METHODS--Data on hospital admissions for acute respiratory conditions were obtained by electoral ward from the West Midlands Regional Health Authority Information Department Körner inpatient data including asthma (ICD 493) and all acute respiratory disease (466, 480-486, 490-496) for the period April 1988 to March 1990. The population for each electoral ward, percentage of ward population that was from non-white ethnic groups, and Townsend deprivation score were all calculated from 1991 census information. Data on smoke and sulphur dioxide (SO2) levels were obtained for 24 wards in Birmingham, Coventry, Wolverhampton, Dudley, Stafford, and Burton-on-Trent, and on nitrogen dioxide (NO2) levels from 39 wards in the same local authority areas. All were background urban sites and most participated in the Warren Spring national quality control programme for SO2 and smoke monitoring. Indirect age-sex standardised hospitalisation rates (SHR) for all respiratory conditions and asthma were calculated using the 1991 rates for the West Midlands RHA as the standard. Multivariate regression models were used to assess the relationship between individual pollutants and the SHR. The Townsend score and percentage of the population from non-white ethnic groups were included in all models to adjust for ethnicity and socioeconomic deprivation. RESULTS--The SHR for asthma varied almost fourfold across the region, and all respiratory SHR showed more than three fold variation. Bivariate regression revealed both Townsend score and percentage of non-white individuals to be associated with SHR for

  7. Use of hospital services by age and comorbidity after an index heart failure admission in England: an observational study

    PubMed Central

    Goudie, Rosalind; Cowie, Martin R

    2016-01-01

    Objectives To describe hospital inpatient, emergency department (ED) and outpatient department (OPD) activity for patients in the year following their first emergency admission for heart failure (HF). To assess the proportion receiving specialist assessment within 2 weeks of hospital discharge, as now recommended by guidelines. Design Observational study of national administrative data. Setting All acute NHS hospitals in England. Participants 82 241 patients with an index emergency admission between April 2009 and March 2011 with a primary diagnosis of HF. Main outcome measures Cardiology OPD appointment within 2 weeks and within a year of discharge from the index admission; emergency department (ED) and inpatient use within a year. Results 15.1% died during the admission. Of the 69 848 survivors, 19.7% were readmitted within 30 days and half within a year, the majority for non-HF diagnoses. 6.7% returned to the ED within a week of discharge, of whom the majority (77.6%) were admitted. The two most common OPD specialties during the year were cardiology (24.7% of the total appointments) and anticoagulant services (12.5%). Although half of all patients had a cardiology appointment within a year, the proportion within the recommended 2 weeks of discharge was just 6.8% overall and varied by age, from 2.4% in those aged 90+ to 19.6% in those aged 18–45 (p<0.0001); appointments in other specialties made up only some of the shortfall. More comorbidity at any age was associated with higher rates of cardiology OPD follow-up. Conclusions Patients with HF are high users of hospital services. Postdischarge cardiology OPD follow-up rates fell well below current National Institute for Health and Care Excellence guidelines, particularly for the elderly and those with less comorbidity. PMID:27288372

  8. The effects of daily weather variables on psychosis admissions to psychiatric hospitals

    NASA Astrophysics Data System (ADS)

    McWilliams, Stephen; Kinsella, Anthony; O'Callaghan, Eadbhard

    2013-07-01

    Several studies have noted seasonal variations in admission rates of patients with psychotic illnesses. However, the changeable daily meteorological patterns within seasons have never been examined in any great depth in the context of admission rates. A handful of small studies have posed interesting questions regarding a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (especially heat waves) and sunshine. In this study, we used simple non-parametric testing and more complex ARIMA and time-series regression analysis to examine whether daily meteorological patterns (wind speed and direction, barometric pressure, rainfall, sunshine, sunlight and temperature) exert an influence on admission rates for psychotic disorders across 12 regions in Ireland. Although there were some weak but interesting trends for temperature, barometric pressure and sunshine, the meteorological patterns ultimately did not exert a clinically significant influence over admissions for psychosis. Further analysis is needed.

  9. Improving Mental Status Questionnaire (MSQ) completion on admission to the Acute Surgical Receiving Unit (ASRU), Ninewells Hospital, Dundee

    PubMed Central

    Okwemba, Sylvia; Copeland, Lauren

    2014-01-01

    Delirium is common yet poorly identified in the UK. Early recognition is a key prognostic factor; delay here being associated with: increased mortality, increased morbidity, prolonged hospital stay, long term disability, and increased risk of developing dementia. Improvement in the diagnosis and management of delirium has scope to improve patient care, clinical outcomes, and ultimately an improved patient experience. As patients aged ≥75 years are at an increased risk of developing delirium, we focused the improvement project to this age group. The baseline data demonstrated that the average ≥75 year-old patient admitted to the Acute Surgical Receiving Unit (ASRU) at Ninewells Hospital had 5.4 out of 12 predisposing and precipitating risk factors for delirium; thus there was great potential for delirium to develop in these patients. During the analysis of the baseline data it became clear that we could not go ahead and implement the initial proposed improvement as the completion of the mental status questionnaire (MSQ) was inconsistent and low at 14.99%. Completion of the MSQ is vital in establishing any cognitive deficit at admission, and for providing a baseline for the continuing admission. As a consequence of this, we had to shift the main aim of the improvement project from improving the identification, diagnosis, and management of delirium, to improving the completion rate of the MSQ in our target age group. Consultations with members of the admission team were held to determine ways of improving the MSQ completion rate. It became clear that the completion of the MSQ relied on clinical staff remembering all 10 questions that constitute the test. The main intervention to facilitate improvement involved affixing a sticker with all 10 questions of the MSQ within the admissions document. The main aim was to increase the percentage of cognitive screening by the Mental State Questionnaire (MSQ) to 95% in patients aged ≥75 on admission to ASRU at Ninewells

  10. Effects of sudden air pressure changes on hospital admissions for cardiovascular diseases in Prague, 1994-2009

    NASA Astrophysics Data System (ADS)

    Plavcová, Eva; Kyselý, Jan

    2014-08-01

    Sudden weather changes have long been thought to be associated with negative impacts on human health, but relatively few studies have attempted to quantify these relationships. We use large 6-h changes in atmospheric pressure as a proxy for sudden weather changes and evaluate their association with hospital admissions for cardiovascular diseases (CVD). Winter and summer seasons and positive and negative pressure changes are analysed separately, using data for the city of Prague (population 1.2 million) over a 16-year period (1994-2009). We found that sudden pressure drops in winter are associated with significant rise in hospital admissions. Increased CVD morbidity was observed neither for pressure drops in summer nor pressure increases in any season. Analysis of synoptic weather maps shows that large pressure drops in winter are associated with strong zonal flow and rapidly moving low-pressure systems with centres over northern Europe and atmospheric fronts affecting western and central Europe. Analysis of links between passages of strong atmospheric fronts and hospital admissions, however, shows that the links disappear if weather changes are characterised by frontal passages. Sudden pressure drops in winter are associated also with significant excess CVD mortality. As climate models project strengthening of zonal circulation in winter and increased frequency of windstorms, the negative effects of such weather phenomena and their possible changes in a warmer climate of the twenty-first century need to be better understood, particularly as their importance in inducing excess morbidity and mortality in winter may increase compared to cold spells.

  11. Survival to admission after out-of-hospital cardiac arrest in Seoul, South Korea

    PubMed Central

    Kim, Jin-Hue; Uhm, Tai-Hwan

    2014-01-01

    Purpose Out-of-hospital cardiac arrest (OHCA) data derived according to the Utstein Style guidelines was used to try to determine factors influencing survival to admission (STA) and epidemiological rates of OHCA. Patients and methods This was an observational study of all age groups based on data from prehospital care reports in Seoul, South Korea. The collected data were reported according to the Utstein Style template for OHCA and analyzed in order to compare STA with non-STA. Univariate analysis was conducted using a binomial logistic regression model to identify predictors associated with trauma patients. Results Eighty-three (4.8%) OHCA survivors were admitted to the emergency department with carotid pulse. The median time from arrest to emergency medical personnel defibrillation was statistically significantly shorter in STA cases (8.0 minutes) than in non-STA cases (12.0 minutes; P<0.001). Factors independently associated with better prognosis in terms of trauma patients were female sex (odds ratio [OR]: 0.67; 95% confidence interval [95% CI]: 0.50–0.91; P=0.01), arrest at home (OR: 0.36; 95% CI: 0.27–0.49; P<0.001), and witnessed arrest (OR: 2.64; 95% CI: 1.94–3.39; P<0.001). Conclusion Early basic life support, performed by either a layperson or emergency medical personnel, had a positive effect on STA. Male sex, arrest outside of the home, and witnessed arrest are significantly associated with trauma. PMID:27147881

  12. Airborne particles are a risk factor for hospital admissions for heart and lung disease.

    PubMed Central

    Zanobetti, A; Schwartz, J; Dockery, D W

    2000-01-01

    We examined the association between particulate matter [less than/equal to] 10 microm; (PM(10)) and hospital admission for heart and lung disease in ten U.S. cities. Our three goals were to determine whether there was an association, to estimate how the association was distributed across various lags between exposure and response, and to examine socioeconomic factors and copollutants as effect modifiers and confounders. We fit a Poisson regression model in each city to allow for city-specific differences and then combined the city-specific results. We examined potential confounding by a meta-regression of the city-specific results. Using a model that considered simultaneously the effects of PM(10) up to lags of 5 days, we found a 2.5% [95% confidence interval (CI), 1.8-3. 3] increase in chronic obstructive pulmonary disease, a 1.95% (CI, 1. 5-2.4) increase in pneumonia, and a 1.27% increase (CI, 1-1.5) in CVD for a 10 microg/m(3) increase in PM(10). We found similar effect estimates using the mean of PM(10) on the same and previous day, but lower estimates using only PM(10) for a single day. When using only days with PM(10) < 50 mg/m(3), the effect size increased by [greater/equal to] 20% for all three outcomes. These effects are not modified by poverty rates or minority status. The results were stable when controlling for confounding by sulfur dioxide, ozone, and carbon monoxide. These results are consistent with previous epidemiology and recent mechanistic studies in animals and humans. PMID:11102299

  13. Symptom-related emergency department visits and hospital admissions during ambulatory cancer treatment

    PubMed Central

    Siefert, Mary Lou; Blonquist, Traci M; Berry, Donna L; Hong, Fangxin

    2016-01-01

    Background People with cancer experience symptoms related to the disease and treatments. Symptom distress has a negative impact on quality of life (QoL). Attending to symptoms and side effects of treatment promotes safe and effective delivery of therapies and may prevent or reduce emergency department visits (EDVs) and unplanned hospital admissions (HAs). There is limited evidence examining symptom-related EDVs or HAs (sx-EDV/HAs) and interventions in ambulatory oncology patients. Objective To examine factors associated with sx-EDV/HAs in ambulatory oncology patients receiving chemotherapy and/or radiation. Methods This secondary analysis used data from a randomized controlled trial of ambulatory oncology patients (n = 663) who received the web-based Electronic Self-Report Assessment - Cancer intervention (symptom self-monitoring, tailored education, and communication coaching) or usual care with symptom self-monitoring alone. Group differences were described by summary statistics and compared by t test. Factors associated with the odds of at least 1 sx-EDV/HA were modeled using logistic regression. Results 98 patients had a total of 171 sx-EDV/HAs with no difference between groups. Higher odds of at least 1 sx-EDV/HA were associated with socioeconomic and clinical factors. The multivariable model indicated that work status, education level, treatment modality, and on-treatment Symptom Distress Scale-15 scores were significantly associated with having at least 1 sx-EDV/HA. Limitations This is a secondary analysis not sized to determine cause and effect. The results have limited generalizability. Conclusion Most patients did not experience an sx-EDV/HA. Demographic and clinical factors predicted an sx-EDV/HA. Funding National Institute of Nursing Research, National Institutes of Health, R01 NR008726; 2008–2011 PMID:27119127

  14. Comparison of emergency department and hospital admissions data for air pollution time-series studies

    PubMed Central

    2012-01-01

    Background Emergency department (ED) visit and hospital admissions (HA) data have been an indispensible resource for assessing acute morbidity impacts of air pollution. ED visits and HAs are types of health care visits with similarities, but also potentially important differences. Little previous information is available regarding the impact of health care visit type on observed acute air pollution-health associations from studies conducted for the same location, time period, outcome definitions and model specifications. Methods As part of a broader study of air pollution and health in St. Louis, individual-level ED and HA data were obtained for a 6.5 year period for acute care hospitals in the eight Missouri counties of the St. Louis metropolitan area. Patient demographic characteristics and diagnostic code distributions were compared for four visit types including ED visits, HAs, HAs that came through the ED, and non-elective HAs. Time-series analyses of the relationship between daily ambient ozone and PM2.5 and selected cardiorespiratory outcomes were conducted for each visit type. Results Our results indicate that, compared with ED patients, HA patients tended to be older, had evidence of greater severity for some outcomes, and had a different mix of specific outcomes. Consideration of ‘HA through ED’ appeared to more effectively select acute visits than consideration of ‘non-elective HA’. While outcomes with the strongest observed temporal associations with air pollutants tended to show strong associations for all visit types, we found some differences in observed associations for ED visits and HAs. For example, risk ratios for the respiratory disease-ozone association were 1.020 for ED visits and 1.004 for ‘HA through ED’; risk ratios for the asthma/wheeze-ozone association were 1.069 for ED visits and 1.106 for ‘HA through ED’. Several factors (e.g. age) were identified that may be responsible, in part, for the differences in observed

  15. Air pollution and hospital admissions for ischemic heart disease in persons with congestive heart failure or arrhythmia.

    PubMed Central

    Mann, Jennifer K; Tager, Ira B; Lurmann, Fred; Segal, Mark; Quesenberry, Charles P; Lugg, Marlene M; Shan, Jun; Van Den Eeden, Stephen K

    2002-01-01

    We examined whether ischemic heart disease (IHD) hospital admissions were associated with air pollutants in those with and without secondary diagnoses of arrhythmia (ARR) or congestive heart failure (CHF). We assessed the occurrence of increased vulnerability among persons with these conditions to daily variations in ozone, carbon monoxide, nitrogen dioxide, or particulate matter less than or equal to 10 micro m in aerodynamic diameter (PM10). The study population consisted of members of a large health maintenance organization residing in the South Coast Air Basin of California from 1988 to 1995. After adjustment for day of week, study year, and smoothing splines for day of study, temperature, and relative humidity, CO and NO2 were both associated with admissions with the greatest effects for CO. A 1-ppm increase in 8-hr average CO was associated with a 3.60% [95% confidence interval (CI), 1.62-5.63%] increase in same-day IHD admissions in persons with a secondary diagnosis of CHF, a 2.99% (95% CI, 1.80-4.19%) increase in persons with a secondary diagnosis of ARR, and a 1.62% (95% CI, 0.65-2.59%) increase in IHD admissions in persons without either secondary diagnosis. Air pollution was most strongly associated with myocardial infarction hospital admissions. The vulnerability of the secondary CHF subgroup may be due to a greater prevalence of myocardial infarction primary diagnoses and not the modifying effect of CHF. This study suggests that people with IHD and accompanying CHF and/or ARR constitute a sensitive subgroup in relation to the effects of criteria ambient air pollutants associated with motor vehicle combustion. PMID:12460805

  16. Retrospective evaluation of urological admissions to emergency service of a training and research hospital

    PubMed Central

    Topaktaş, Ramazan; Altın, Selçuk; Aydın, Cemil; Akkoç, Ali; Yılmaz, Yakup

    2014-01-01

    Objective: Many patients consult emergency services with urological complaints. The aim of this study was to investigate the epidemiology, clinical presentation and treatments of urological emergency cases in a training and research hospital. Material and methods: We retrospectively evaluated urological emergency patients referred to the emergency unit between July 2012 and July 2013 according to age, gender, affected organ, radiological imaging techniques and treatment. Results: Among 141.844 emergency cases, 3.113 (2.19%) were urological emergencies and 53.2% of the patients were male (mean age: 49.1), and 46.8% of them were female (median age: 42.8). The most frequent illness was genitourinary infection constituting 41.2% of the cases followed by renal colic (36.9%). Among the urological emergencies 483 (15.5%) patients were hospitalized and 152 surgical operations were performed. The mostly performed procedure was the placement of a suprapubic catheter in 34 patients constituting (22.3%) of the cases. Totally eight patients were referred to another experienced health center due to different reasons. Conclusion: Most of the urological emergency patients do not require emergency surgical interventions however, timely identification and management of urological emergencies with in-depth clinical evaluation are important to prevent late complications. Therefore the doctors working in emergency services must be heedful of urological emergencies. PMID:26328181

  17. Short-term effects of fine particulate air pollution on hospital admissions for cardiovascular diseases: a case-crossover study in a tropical city.

    PubMed

    Chang, Chih-Ching; Chen, Pei-Shih; Yang, Chun-Yuh

    2015-01-01

    This study was undertaken to determine whether there was an association between fine particles (PM2.5) levels and hospital admissions for cardiovascular diseases (CVD) in Kaohsiung, Taiwan. Hospital admissions for CVD (including ischemic heart disease [IHD], stroke, congestive heart failure [CHF], and arrhythmias) and ambient air pollution data for Kaohsiung were obtained for the period from 2006-2010. The relative risk of hospital admissions for CVD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), elevated number of admissions for CVD were significantly associated with higher PM2.5 levels only on cool days (<25°C), with an interquartile range rise associated with a 47% (95% CI = 39-56%), 48% (95% CI = 40-56%), 47% (95% CI = 34-61%), and 51% (95% CI = 34-70%) increase in IHD, stroke, CHF, and arrhythmias admissions, respectively. No significant associations between PM2.5 and hospital admissions for CVD were observed on warm days. In the two-pollutant models, PM2.5 levels remained significant even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. This study provides evidence that higher levels of PM2.5 enhance the risk of hospital admissions for CVD in Kaohsiung, Taiwan. PMID:25674828

  18. Is Reactive Dengue NS1Antigen Test a Warning Call for Hospital Admissions?

    PubMed Central

    Kamalakannan, Banupriya; Thulasingam, Mahalakshmy; Sampath, Srinivasan

    2016-01-01

    M/IgG MAC ELISA was predominantly positive in convalescent phase sera. There were six deaths (2.3%) and the common causes of poor outcome were multiorgan failure, encephalopathy and refractory shock. Conclusion NS1 Ag assay is a useful early diagnostic marker for dengue fever but cannot be used as an early predictor of severe dengue infection. The criteria for admission in hospitals of cases of dengue fever should be based on clinical warning signs rather than positive NS1 Antigen test. PMID:27190911

  19. Population Based Trends in the Incidence of Hospital Admission for the Diagnosis of Hepatorenal Syndrome: 1998–2011

    PubMed Central

    Suneja, Manish; Tang, Fan; Cavanaugh, Joseph E.; Polgreen, Linnea A.; Polgreen, Philip M.

    2016-01-01

    Background and Objectives. Hepatorenal syndrome carries a high risk of mortality. Understanding the incidence and mortality trends in hepatorenal syndrome will help inform future studies regarding the safety and efficacy of potential therapeutic interventions. Design and Methods. We conducted a retrospective cohort study using the Nationwide Inpatient Sample. We identified hospitalizations from January 1998–June 2011 with a primary diagnosis of hepatorenal syndrome. To characterize the incidence trends in monthly hepatorenal syndrome hospitalizations, we fit a piecewise linear model with a change point at January 2008. We examined hospital and patient characteristics before and after the change point. Results. Hospital admissions with a diagnosis of hepatorenal syndrome increased markedly between September of 2007 and March of 2008. Comparing patients who were admitted with a diagnosis of hepatorenal syndrome prior to 2008 with those after 2008, we found that length of stay increased while the mortality of patients admitted for hepatorenal syndrome decreased. Conclusion. The revision of the diagnostic criteria for hepatorenal syndrome may have contributed to the increase in the incidence of admissions for hepatorenal syndrome. However, the changes in the principles of hepatorenal syndrome management may have also contributed to the increase in incidence and lower mortality. PMID:27144022

  20. Insurance status and admission to hospital for head injuries: are we part of a two-tiered medical system?

    PubMed

    Svenson, J E; Spurlock, C W

    2001-01-01

    Previous studies have shown an association between insurance status and use of resources for inpatient care. We sought to assess whether insurance status influences decisions regarding the evaluation and treatment of head injured patients in the emergency department (ED). Head injured patients were identified from ED data from 4 hospitals reporting to the Kentucky Emergency Medical Services Information System. Multiple regression analysis using admission, ED length of stay, and ED charges as outcome variables was then performed. From 216,137 ED visits there were 8,591 (4%) head injured patients identified from the database. Eliminating those with revisits, transfers to another hospital in the database, and isolated facial lacerations, there were 3,821 cases. Controlling for age, hospital, race, primary diagnosis, and indicators of severity of the injury, insurance status was significantly associated with hospital admission. Those uninsured were the least likely to be admitted (OR 0.41; 95% CI (0.31, 0.50), whereas those with public insurance had an intermediate probability (OR 0.50 95% CI (0.37, 0.68) as compared with those with private insurance. Similarly, ED charges were lower for Medicaid patients than insured patients ($880) and tended to be slightly lower for uninsured patients ($1,043) than insured patients ($1,141) (P =.001). Length of stay in the ED was shorter for publicly insured patients (179 minutes) than uninsured (186 minutes) and privately insured patients (192 minutes) (P =.001). The extent of evaluation and admission for head injured patients is associated with insurance status. This creates a dual standard of care for patients. Practitioners should work to standardize the evaluation of patients independent of paying status. PMID:11146011

  1. Effect of tele health care on exacerbations and hospital admissions in patients with chronic obstructive pulmonary disease: a randomized clinical trial

    PubMed Central

    Ringbæk, Thomas; Green, Allan; Laursen, Lars Christian; Frausing, Ejvind; Brøndum, Eva; Ulrik, Charlotte Suppli

    2015-01-01

    Background and objective Tele monitoring (TM) of patients with chronic obstructive pulmonary disease (COPD) has gained much interest, but studies have produced conflicting results. Our aim was to investigate the effect of TM with the option of video consultations on exacerbations and hospital admissions in patients with severe COPD. Materials and methods Patients with severe COPD at high risk of exacerbations were eligible for the study. Of 560 eligible patients identified, 279 (50%) declined to participate. The remaining patients were equally randomized to either TM (n=141) or usual care (n=140) for the 6-month study period. TM comprised recording of symptoms, saturation, spirometry, and weekly video consultations. Algorithms generated alerts if readings breached thresholds. Both groups received standard care. The primary outcome was number of hospital admissions for exacerbation of COPD during the study period. Results Most of the enrolled patients had severe COPD (forced expiratory volume in 1 second <50%pred in 86% and ≥hospital admission for COPD in the year prior to enrollment in 45%, respectively, of the patients). No difference in drop-out rate and mortality was found between the groups. With regard to the primary outcome, no significant difference was found in hospital admissions for COPD between the groups (P=0.74), and likewise, no difference was found in time to first admission or all-cause hospital admissions. Compared with the control group, TM group patients had more moderate exacerbations (ie, treated with antibiotics/corticosteroid, but not requiring hospital admission; P<0.001), whereas the control group had more visits to outpatient clinics (P<0.001). Conclusion Our study of patients with severe COPD showed that TM including video consultations as add-on to standard care did not reduce hospital admissions for exacerbated COPD, but TM may be an alternative to visits at respiratory outpatient clinics. Further studies are needed to establish the

  2. From the emergency department to the general hospital: hospital ownership and market factors in the admission of the seriously mentally ill.

    PubMed

    Shen, Jay J; Cochran, Christopher R; Moseley, Charles B

    2008-01-01

    General hospitals are becoming the safety net provider for the seriously mentally ill (SMI) in the United States, but these patients are faced with a number of potential barriers when accessing these hospitals. Hospital ownership and market forces are two potential organizational and healthcare system barriers that may affect the SMI patient's access, because the psychiatric and medical services they need are unprofitable services. This study examines the relationship among hospital ownership, market forces, and admission of the SMI patient from the emergency department into the general hospital. This was a cross-sectional study of a large sample of SMI patients from the 2002 State Inpatient Datasets for five states. Multiple logistic regression was applied in the multivariable analysis. After controlling for patient, hospital, and county covariates and when compared with not-for-profit hospitals, public hospitals were more likely to admit while investor-owned hospitals were less likely to admit SMI patients. Hospitals in competitive markets were less likely to admit while hospitals with capitation revenues were slightly less likely to admit these patients. Policy options that can address this "market failure" include strengthening the public psychiatric inpatient care system, making private health insurance coverage of the SMI more equitable, revising Medicare prospective payment system to better reimburse the treatment of the SMI, and allowing not-for-profit hospitals to count care of the SMI as a community benefit. Results of this study will be useful to healthcare managers searching for ways to reduce unnecessary administrative costs while continuing to maintain the level of administrative activities required for the provision of safe, effective, and high-quality care. PMID:18720688

  3. Pediatric hospital admissions from influenza A (H1N1) in Brazil: effects of the 2010 vaccination campaign.

    PubMed

    Marcos, Ana Carolina Cavalcanti; Pelissoni, Fernanda D'Angelo Monteiro; Cunegundes, Kelly Simone Almeida; Abramczyk, Marcelo Luiz; Bellei, Nancy Cristina Junqueira; Sanches, Nivea Aparecida Pissaia; Moraes-Pinto, Maria Isabel de

    2012-10-01

    lIn 2009, the influenza A (H1N1) virus spread rapidly around the world, causing the first pandemic of the 21st Century. In 2010, there was a vaccination campaign against this new virus subtype to reduce the morbidity and mortality of the disease in some countries, including Brazil. Herein, we describe the clinical and epidemiological characteristics of patients under 19 years of age who were hospitalized with confirmed influenza A (H1N1) infection in 2009 and 2010. We retrospectively reviewed files from the pediatric patients who were admitted to a university hospital with real-time polymerase chain reaction (RT-PCR) confirmed influenza A (H1N1) infection in 2009 and 2010. There were 37 hospitalized patients with influenza A (H1N1) in 2009 and 2 in 2010. In 2009, many of the hospitalized children had an underlying chronic disease and a lower median age than those not hospitalized. Of the hospitalized patients, 78% had a chronic disease, primarily pneumopathy (48%). The main signs and symptoms of influenza were fever (97%), cough (76%), and dyspnea (59%). Complications occurred in 81% of the patients. The median length of hospitalization was five days; 27% of the patients required intensive care, and two died. In 2010, two patients were hospitalized with influenza A (H1N1): one infant with adenovirus co-infection who had received one previous H1N1 vaccine dose and presented with respiratory sequelae and a 2-month-old infant who had a hospital-acquired infection. An impressive reduction in hospital admissions was observed in 2010 when the vaccination campaign took place in Brazil. PMID:23070350

  4. Hospital admissions from birth to early adolescence and early-life risk factors: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study

    PubMed Central

    Menezes, Ana M. B.; Noal, Ricardo B.; Cesar, Juraci A.; Hallal, Pedro C.; Araújo, Cora Luiza; Dumith, Samuel C.; Barros, Fernando C.; Victora, Cesar G.

    2013-01-01

    The aim of this prospective analysis was to describe the cumulative incidence of hospital admissions in the first year of life and between 1 and 11 years of age and to explore associated factors. Hospital admissions were collected through regular monitoring in the first year of life, and through maternal report on admissions between 1 and 11 years. Analyses were stratified by sex and adjusted for confounding factors. 18.1% of children were hospitalized in the first year of life, and 30.7% between ages 1 and 11 years. Among boys, hospital admission in the first year was associated with low family income, paternal smoking during pregnancy, preterm delivery, and low birthweight. Among girls, in addition to the variables described for boys, black/mixed skin color was also a risk factor for hospital admission. For admissions between 1 and 11 years of age, low family income and gestational age ≥ 37 weeks were found to be significant risk factors. PMID:20963296

  5. Long-term PM2.5 Exposure and Neurological Hospital Admissions in the Northeastern United States

    PubMed Central

    Kioumourtzoglou, Marianthi-Anna; Schwartz, Joel D.; Weisskopf, Marc G.; Melly, Steven J.; Wang, Yun; Dominici, Francesca; Zanobetti, Antonella

    2015-01-01

    Background Long-term exposure to fine particles (particulate matter ≤ 2.5 μm; PM2.5) has been consistently linked to heart and lung disease. Recently, there has been increased interest in examining the effects of air pollution on the nervous system, with evidence showing potentially harmful effects on neurodegeneration. Objective Our objective was to assess the potential impact of long-term PM2.5 exposure on event time, defined as time to first admission for dementia, Alzheimer’s (AD), or Parkinson’s (PD) diseases in an elderly population across the northeastern United States. Methods We estimated the effects of PM2.5 on first hospital admission for dementia, AD, and PD among all Medicare enrollees ≥ 65 years in 50 northeastern U.S. cities (1999–2010). For each outcome, we first ran a Cox proportional hazards model for each city, adjusting for prior cardiopulmonary-related hospitalizations and year, and stratified by follow-up time, age, sex, and race. We then pooled the city-specific estimates by employing a random effects meta-regression. Results We followed approximately 9.8 million subjects and observed significant associations of long-term PM2.5 city-wide exposure with all three outcomes. Specifically, we estimated a hazard ratio (HR) of 1.08 (95% CI: 1.05, 1.11) for dementia, an HR of 1.15 (95% CI: 1.11, 1.19) for AD, and an HR of 1.08 (95% CI: 1.04, 1.12) for PD admissions per 1-μg/m3 increase in annual PM2.5 concentrations. Conclusions To our knowledge, this is the first study to examine the relationship between long-term exposure to PM2.5 and time to first hospitalization for common neurodegenerative diseases. We found strong evidence of association for all three outcomes. Our findings provide the basis for further studies, as the implications of such exposures could be crucial to public health. Citation Kioumourtzoglou MA, Schwartz JD, Weisskopf MG, Melly SJ, Wang Y, Dominici F, Zanobetti A. 2016. Long-term PM2.5 exposure and neurological

  6. Thirty day hospital re-admissions in patients with non ST-segment elevation acute myocardial infarction

    PubMed Central

    Tisminetzky, Mayra; McManus, David D.; Erskine, Nathaniel; Saczynski, Jane S.; Yarzebski, Jorge; Granillo, Edgard; Gore, Joel; Goldberg, Robert

    2015-01-01

    Background Limited data exist about relatively recent trends in the magnitude and characteristics of patients who are rehospitalized shortly after admission for a non ST-segment elevation acute myocardial infarction (NSTEMI). This observational study describes decade-long trends (1999-2009) in the magnitude and characteristics of patients readmitted to the hospital within 30 days of hospitalization for an incident (initial) episode of NSTEMI. Methods We reviewed the medical records of 2,249 residents of the Worcester (MA) metropolitan area who were hospitalized for an initial NSTEMI in 6 biennial periods between 1999 and 2009 at 3 central MA medical centers. Results The average age of our study population was 72 years, 90% were white, and 46% were women. The proportion of patients who were readmitted to the hospital for any cause within 30 days after discharge for a NSTEMI remained unchanged between 1999 and 2009 (approximately 15%) in both crude and multivariable adjusted analyses. Slight declines were observed for cardiovascular disease-related 30-day readmissions over the ten-year study period. Women, elderly patients, those with multiple chronic comorbidities, a prolonged index hospitalization, and patients who developed heart failure during their index hospitalization were at higher risk for being readmitted within 30-days than respective comparison groups. Conclusions Thirty day hospital readmission rates after hospital discharge for a first NSTEMI remained stable between 1999 and 2009. We identified several groups at higher risk for hospital readmission in whom further surveillance efforts and/or tailored educational and treatment approaches remain needed. PMID:25660250

  7. A retrospective study of the impact of a telephone alert service (Healthy Outlook) on hospital admissions for patients with chronic obstructive pulmonary disease

    PubMed Central

    Sarran, Christophe; Halpin, David; Levy, Mark L; Prigmore, Samantha; Sachon, Patrick

    2014-01-01

    Background: Healthy Outlook is a service delivered by the UK Met Office directly to patients with chronic obstructive pulmonary disease (COPD) that has been in place since 2006. Its objective is to reduce the severity and length of COPD exacerbations, hence improving the quality of life and life expectancy. Aims: To assess the effect of the Healthy Outlook service on hospital admission rates of all general practitioners that have used the service. Methods: Control practices were selected for each of the 661 participating practices. The number of hospital admissions for each practice was extracted from the Hospital Episode Statistics database. The differences in admission rates per practice between the first year of use of the Healthy Outlook service and the previous year were compared by paired t-test analyses. Results: For admissions with a primary diagnosis of COPD, the difference between participating and control practices was −0.8% (95% confidence interval (CI)=−1.8 to 0.2%; P=0.13). For admissions with a primary or co-morbid diagnosis of COPD, the difference was −2.3% (95% CI=−4.2 to −0.4%; P=0.02). Conclusions: Participation in the Healthy Outlook service reduces hospital admission rates for patients coded on discharge with COPD (including co-morbid). PMID:25340279

  8. Discharged from a mental health admission ward: is it safe to go home? A review on the negative outcomes of psychiatric hospitalization

    PubMed Central

    Loch, Alexandre Andrade

    2014-01-01

    Before psychiatry emerged as a medical discipline, hospitalizing individuals with mental disorders was more of a social stigmatizing act than a therapeutic act. After the birth of the mental health disciplines, psychiatric hospitalization was legitimized and has proven to be indispensable, preventing suicides and helping individuals in need. However, despite more than a century passing since this legitimization occurred, psychiatric hospitalization remains a controversial issue. There is the question of possible negative outcomes after a psychiatric admission ceases to take its protective effect, and even of whether the psychiatric admission itself is related to a negative setback after discharge. This review aims to summarize some of the most important negative outcomes after discharge from a psychiatric institution. These experiences were organized into two groups: those after a brief psychiatric hospitalization, and those after a long-stay admission. The author further suggests possible ways to minimize these adversities, emphasizing the need of awareness related to this important issue. PMID:24812527

  9. Recorded categories of non-principal diagnoses in Victorian public hospital transient ischaemic attack and stroke admissions.

    PubMed

    Nadathur, Shymala G

    2008-01-01

    Information about the number and types of non-principal diagnoses (NPDs) would make an important contribution to prediction of outcome and hence patient management. The study reported here is based on analysis of three fiscal years of the Victorian public hospital transient ischaemic attack (TIA) and stroke admissions. The incidence of NPDs and co-occurrence of NPD-associated prefix categories (that identify the onset or relevance of each condition to the episode) are described in each of the broad stroke subtypes. The distributions of length of stay and in-hospital deaths in the cohorts without and with NPDs and in the various prefix categories are determined. The study also compares the age and gender distribution in the various subpopulations of interest. The importance of collecting complete and accurate data on nature of NPDs and its potential in describing the complexity of presentation are discussed. PMID:18941264

  10. Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital: a cross-sectional study of chronic alcohol dependency and acute alcohol intoxication

    PubMed Central

    Vardy, J; Keliher, T; Fisher, J; Ritchie, F; Bell, C; Chekroud, M; Clarey, F; Blackwood, L; Barry, L; Paton, E; Clark, A; Connelly, R

    2016-01-01

    Objectives Alcohol is responsible for a proportion of emergency admissions to hospital, with acute alcohol intoxication and chronic alcohol dependency (CAD) implicated. This study aims to quantify the proportion of hospital admissions through our emergency department (ED) which were thought by the admitting doctor to be (largely or partially) a result of alcohol consumption. Setting ED of a UK tertiary referral hospital. Participants All ED admissions occurring over 14 weeks from 1 September to 8 December 2012. Data obtained for 5497 of 5746 admissions (95.67%). Primary outcome measures Proportion of emergency admissions related to alcohol as defined by the admitting ED clinician. Secondary outcome measures Proportion of emergency admissions due to alcohol diagnosed with acute alcohol intoxication or CAD according to ICD-10 criteria. Results 1152 (21.0%, 95% CI 19.9% to 22.0%) of emergency admissions were thought to be due to alcohol. 74.6% of patients admitted due to alcohol had CAD, and significantly greater than the 26.4% with ‘Severe’ or ‘Very Severe’ acute alcohol intoxication (p<0.001). Admissions due to alcohol differed to admissions not due to alcohol being on average younger (45 vs 56 years, p<0.001) more often male (73.4% vs 45.1% males, p<0.001) and more likely to have a diagnosis synonymous with alcohol or related to recreational drug use, pancreatitis, deliberate self-harm, head injury, gastritis, suicidal ideation, upper gastrointestinal bleeds or seizures (p<0.001). An increase in admissions due to alcohol on Saturdays reflects a surge in admissions with acute alcohol intoxication above the weekly average (p=0.003). Conclusions Alcohol was thought to be implicated in 21% of emergency admissions in this cohort. CAD is responsible for a significantly greater proportion of admissions due to alcohol than acute intoxication. Interventions designed to reduce alcohol-related admissions must incorporate measures to tackle CAD. PMID:27324707

  11. Healthcare resource implications of hypoglycemia-related hospital admissions and inpatient hypoglycemia: retrospective record-linked cohort studies in England

    PubMed Central

    McEwan, Philip; Larsen Thorsted, Brian; Wolden, Michael; Jacobsen, Judith; Evans, Marc

    2015-01-01

    Objective Using a retrospective cohort study, the mean length of hospital stay (LoS) and total per-patient expenditure for hypoglycemia requiring admission to hospital were estimated. In a separate matched retrospective cohort study, the effect of inpatient hypoglycemia on LoS, expenditure, and risk of all-cause mortality while admitted was investigated. Methods The cohorts consisted of patients aged ≥18 years with a diagnosis of type 1 or 2 diabetes between January 1, 2002 and October 30, 2012 in the Clinical Practice Research Datalink database, who had initiated insulin treatment and had a recording of hypoglycemia in the same period. In the matched retrospective cohort study, exposed patients (who experienced hypoglycemia in hospital) were case-matched with patients who did not experience hypoglycemia during admission (unexposed). Generalized linear regression was used to estimate LoS. Risk of all-cause mortality was evaluated via logistic regression. Results In the retrospective cohort study (1131 patients), mean LoS was 5.46 (95% CI 4.62 to 6.45) days for type 1 diabetes, and 5.04 (95% CI 4.46 to 5.71) days for type 2 diabetes. Mean cost per admission was £1034 (95% CI £855 to £1253). In the matched retrospective cohort study (1079 pairs of patients), exposed patients had a mean LoS of 11.91 days (95% CI 10.96 to 12.94 days) versus 4.80 (95% CI 4.41 to 5.23) for unexposed patients, p<0.0001. Exposed patients had a higher mortality risk compared with unexposed patients (OR 1.439 (95% CI 1.060to 1.952), p=0.0195). Total average per-patient cost for exposed patients was GBP (£)2235, 40% (p<0.0001) higher than total average admission cost in unexposed patients. Conclusions Hypoglycemia has a significant negative impact on patient outcomes, healthcare resource use, and expenditure. PMID:25815204

  12. Does Admission to Medicine or Orthopaedics Impact a Geriatric Hip Patient’s Hospital Length of Stay?

    PubMed Central

    Greenberg, Sarah E.; VanHouten, Jacob P.; Lakomkin, Nikita; Ehrenfeld, Jesse; Jahangir, Amir Alex; Boyce, Robert H.; Obremksey, William T.; Sethi, Manish K.

    2016-01-01

    Objectives The aim of our study was to determine the association between admitting service, medicine or orthopaedics, and length of stay (LOS) for a geriatric hip fracture patient. Design Retrospective. Setting Urban level 1 trauma center. Patients/Participants Six hundred fourteen geriatric hip fracture patients from 2000 to 2009. Interventions Orthopaedic surgery for geriatric hip fracture. Main Outcome Measurements Patient demographics, medical comorbidities, hospitalization length, and admitting service. Negative binomial regression used to determine association between LOS and admitting service. Results Six hundred fourteen geriatric hip fracture patients were included in the analysis, of whom 49.2% of patients (n = 302) were admitted to the orthopaedic service and 50.8% (3 = 312) to the medicine service. The median LOS for patients admitted to orthopaedics was 4.5 days compared with 7 days for patients admitted to medicine (P < 0.0001). Readmission was also significantly higher for patients admitted to medicine (n = 92, 29.8%) than for those admitted to orthopaedics (n = 70, 23.1%). After controlling for important patient factors, it was determined that medicine patients are expected to stay about 1.5 times (incidence rate ratio: 1.48, P < 0.0001) longer in the hospital than orthopaedic patients. Conclusions This is the largest study to demonstrate that admission to the medicine service compared with the orthopaedic service increases a geriatric hip fractures patient’s expected LOS. Since LOS is a major driver of cost as well as a measure of quality care, it is important to understand the factors that lead to a longer hospital stay to better allocate hospital resources. Based on the results from our institution, orthopaedic surgeons should be aware that admission to medicine might increase a patient’s expected LOS. PMID:26371621

  13. Inpatient Diabetes Education Is Associated With Less Frequent Hospital Readmission Among Patients With Poor Glycemic Control

    PubMed Central

    Healy, Sara J.; Black, Dawn; Harris, Cara; Lorenz, Andrew; Dungan, Kathleen M.

    2013-01-01

    OBJECTIVE To explore the relationship between inpatient diabetes education (IDE) and hospital readmissions in patients with poorly controlled diabetes. RESEARCH DESIGN AND METHODS Patients with a discharge diagnosis of diabetes (ICD-9 code 250.x) and HbA1c >9% who were hospitalized between 2008 and 2010 were retrospectively identified. All-cause first readmissions were determined within 30 days and 180 days after discharge. IDE was conducted by a certified diabetes educator or trainee. Relationships between IDE and hospital readmission were analyzed with stepwise backward logistic regression models. RESULTS In all, 2,265 patients were included in the 30-day analysis and 2,069 patients were included in the 180-day analysis. Patients who received IDE had a lower frequency of readmission within 30 days than did those who did not (11 vs. 16%; P = 0.0001). This relationship persisted after adjustment for sociodemographic and illness-related factors (odds ratio 0.66 [95% CI 0.51–0.85]; P = 0.001). Medicaid insurance and longer stay were also independent predictors in this model. IDE was also associated with reduced readmissions within 180 days, although the relationship was attenuated. In the final 180-day model, no IDE, African American race, Medicaid or Medicare insurance, longer stay, and lower HbA1c were independently associated with increased hospital readmission. Further analysis determined that higher HbA1c was associated with lower frequency of readmission only among patients who received a diabetes education consult. CONCLUSIONS Formal IDE was independently associated with a lower frequency of all-cause hospital readmission within 30 days; this relationship was attenuated by 180 days. Prospective studies are needed to confirm this association. PMID:23835695

  14. Drinking water quality and hospital admissions of elderly people for gastrointestinal illness in Eastern Massachusetts, 1998-2008.

    PubMed

    Beaudeau, Pascal; Schwartz, Joel; Levin, Ronnie

    2014-04-01

    We used a Poisson regression to compare daily hospital admissions of elderly people for acute gastrointestinal illness in Boston against daily variations in drinking water quality over an 11-year period, controlling for weather, seasonality and time trends. The Massachusetts Water Resources Authority (MWRA), which provides non-filtered water to 1.5 million people in the greater Boston area, changed its disinfection method from chlorination to ozonation during the study period so we were also able to evaluate changes in risk associated with the change in disinfection method. Other available water quality data from the MWRA included turbidity, fecal coliforms, UV-absorbance, and planktonic algae and cyanobacteriae concentrations. Daily weather, rainfall data and water temperature were also available. Low water temperature, increases in turbidity and, to a lesser extent, in fecal coliform and cyanobacteriae were associated with a higher risk of hospital admissions, while the shift from chlorination to ozonation has possibly reduced the health risk. The MWRA complied with US drinking water regulations throughout the study period. PMID:24486855

  15. Reduction in Fatalities, Ambulance Calls, and Hospital Admissions for Road Trauma After Implementation of New Traffic Laws

    PubMed Central

    Chan, Herbert; Brasher, Penelope; Erdelyi, Shannon; Desapriya, Edi; Asbridge, Mark; Purssell, Roy; Macdonald, Scott; Schuurman, Nadine; Pike, Ian

    2014-01-01

    Objectives. We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010). Methods. We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls. Results. In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI] = 15.3, 26.4) and in hospital admissions (8.0%; 95% CI = 0.6, 14.9) and ambulance calls (7.2%; 95% CI = 1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI = 34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving. Conclusions. These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported. PMID:25121822

  16. eWasted time: Redundant work during hospital admission and discharge.

    PubMed

    MacMillan, Thomas E; Slessarev, Marat; Etchells, Edward

    2016-03-01

    Potential unintended consequences of health information technology include fragmentation of workflow and redundant work. We could not identify any prior direct observation studies that quantified redundant work related to health information technology in the clinical setting. Our objective was to quantify redundant work during admission and discharge to our general internal medicine service at an academic medical center. We performed a time and motion study at Sunnybrook Health Sciences Centre in Toronto, Canada. We observed 13 clinicians performing an admission or a discharge, and the type and length of each task was recorded using an Apple iPad tablet. We identified redundant tasks related to health information technology and calculated the time spent completing these tasks. We found that 22 percent of clinician time was spent on redundant tasks. Our finding highlights the importance of workflow and software integration when implementing health information technology. PMID:24916568

  17. The Bromhead Care Home Service: the impact of a service for care home residents with dementia on hospital admission and dying in preferred place of care.

    PubMed

    Garden, Gill; Green, Suzanne; Pieniak, Susan; Gladman, John

    2016-04-01

    People with dementia have worse outcomes associated with hospital admission, are more likely to have interventions and are less likely to be offered palliative care than people without dementia. Advance care planning for care home residents has been shown to reduce hospital admissions without increasing mortality. Studies have shown that staff confidence in managing delirium, a common reason for admission, improves with training. A service combining education for care home staff and advance care planning for care home residents with dementia was introduced to care homes in Boston, UK. There were improvements in staff confidence in recognition, prevention, management and knowledge of factors associated with delirium and dysphagia. 92% of carers rated the service >9/10. Admissions fell by 37% from baseline in the first year and 55% in the second and third years. All but one resident died in the preferred place of care. PMID:27037378

  18. Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network

    PubMed Central

    2012-01-01

    Background Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. Method We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. Results We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR – Patients at risk of readmission and ACG – Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. Conclusions Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don’t change. PMID:22682525

  19. Impact of psychiatrists' qualifications on the rate of compulsory admissions.

    PubMed

    Eytan, Ariel; Chatton, Anne; Safran, Edith; Khazaal, Yasser

    2013-03-01

    Despite efforts to reduce coercion in psychiatry, involuntary hospitalizations remain frequent, representing more than half of all admissions in some European regions. Since October 2006, only certified psychiatrists are authorized to require a compulsory admission to our facility, while before all physicians were, including residents. The aim of the present study is to assess the impact of this change of procedure on the proportion compulsory admissions. All medical records of patients admitted respectively 4 months before and 4 month after the implementation of the procedure were retrospectively analyzed. This search retrieved a total of 2,227 hospitalizations for 1,584 patients. The overall proportions of compulsory and voluntary admissions were 63.9 % and 36.1 % respectively. The average length of stay was 32 days (SD ± 64.4). During the study period, 25 % of patients experienced two hospitalizations or more. The most frequent patients' diagnoses were affective disorders (30 %), psychotic disorders (18.4 %) and substance abuse disorders (15.7 %). Compared with the period before October 2006, patients hospitalized from October 2006 up were less likely to be hospitalized on a compulsory basis (OR = 0.745, 95 % CI: 0.596-0.930). Factors associated with involuntary admission were young age (20 years or less), female gender, a diagnosis of psychotic disorder and being hospitalized for the first time. Our results strongly suggest that limiting the right to require compulsory admissions to fully certified psychiatrists can reduce the rate of compulsory versus voluntary admissions. PMID:22585110

  20. Hospital Mental Health Admissions in Women after Unsuccessful Infertility Treatment and In Vitro Fertilization: An Australian Population-Based Cohort Study

    PubMed Central

    Stewart, Louise M.; Holman, C. D’Arcy J.; Semmens, James B.; Preen, David; Mai, Qun; Hart, Roger

    2015-01-01

    Objective To examine the association between in vitro fertilization (IVF) and later admission to hospital with a mental health diagnosis in women who remained childless after infertility treatment. Methods This was a population-based cohort study using linked administrative hospital and registry data. The study population included all women commencing hospital treatment for infertility in Western Australia between the years 1982 and 2002 aged 20–44 years at treatment commencement who did not have a recorded birth by the end of follow-up (15 August 2010) and did not have a hospital mental health admission prior to the first infertility admission (n=6,567). Of these, 2,623 women had IVF and 3,944 did not. We used multivariate Cox regression modeling of mental health admissions and compared women undergoing IVF treatment with women having infertility treatment but not IVF. Results Over an average of 17 years of follow-up, 411 women in the cohort were admitted to hospital with a mental health diagnosis; 93 who had IVF and 318 who did not. The unadjusted hazard ratio (HR) for a hospital mental health admission comparing women who had IVF with those receiving other infertility treatment was 0.50 (95% confidence interval [CI] 0.40–0.63). After adjustment for age, calendar year and socio-economic status the HR was 0.56 (95% CI 0.44–0.71). Conclusions IVF treatment is associated with a reduced risk of hospital mental health admissions in women after unsuccessful infertility treatment. This may be explained by the healthy cohort effect. PMID:25807258

  1. The influence of the winter North Atlantic Oscillation index on hospital admissions through diseases of the circulatory system in Lisbon, Portugal

    NASA Astrophysics Data System (ADS)

    Almendra, Ricardo; Santana, Paula; Vasconcelos, João; Silva, Giovani; Gonçalves, Fábio; Ambrizzi, Tércio

    2016-07-01

    The aim of this paper is to analyze the relationship between North Atlantic Oscillation (NAO), meteorological variables, air pollutants, and hospital admissions due to diseases of circulatory systems in Lisbon (Portugal) during winter months (2003-2012). This paper is one of the few studies analyzing the impact of NAO on health through its influence on thermal stress and air pollution and is the first to be conducted in Lisbon. This study uses meteorological data (synthetized into a thermal comfort index), air pollutant metrics, and the NAO index (all clustered in 10-day cycles to overcome daily variability of the NAO index). The relationship between morbidity, thermal comfort index, NAO index, and air pollutants was explored through several linear models adjusted to seasonality through a periodic function. The possible indirect effect between the NAO index and hospital admissions was tested, assuming that NAO (independent variable) is affecting hospital admissions (outcome variable) through thermal discomfort and/or pollution levels (tested as individual mediators). This test was conducted through causal mediation analysis and adjusted for seasonal variation. The results from this study suggest a possible indirect relationship between NAO index and hospital admissions. Although NAO is not significantly associated with hospital admissions, it is significantly associated with CO, PM2.5, NO, and SO2 levels, which in turn increase the probability of hospitalization. The discomfort index (built with temperature and relative humidity) is significantly associated with hospital admissions, but its variability is not explained by the NAO index. This study highlights the impacts of the atmospheric circulation patterns on health. Furthermore, understanding the influence of the atmospheric circulation patterns can support the improvement of the existing contingency plans.

  2. Hospital admissions in Alicante (Spain): a comparative analysis of foreign citizens from high-income countries, immigrants from low-income countries, and Spanish citizens

    PubMed Central

    2013-01-01

    Background Over the last decade, the number of foreign citizens (FCs) in Spain has increased. There is no doubt that their health has become a relevant subject from the point of view of public healthcare. Our study aimed to describe hospital admission rates, diagnoses at hospital discharge, and mortality during hospital admissions in FCs from high-income countries (FCHICs), FCs from low-income countries (FCLICs), and autochthonous citizens (ACs). Methods A cross-sectional study was performed at two public hospitals in the city of Alicante (Spain) and its surrounding area. Utilization rates were estimated. Multivariate analysis adjusting for age and sex was performed on hospital admission rates, diagnoses at hospital discharge, service of admission, and mortality during hospital admission in FCHICs and FCLICs compared with ACs (adjusted odds ratio [AOR] with 95% confidence intervals [CI]). Results 42,839 patients ≥15 years were discharged from the hospitals. The utilization rate was lower in FCs than ACs, whose crude rate ratio was 0.676 (95% CI: 0.656-0.696). FCHICs had more risk of being diagnosed at discharge in the categories of the circulatory system (AOR: 1.55; 95% CI: 1.35-1.77), neoplasms (AOR: 1.21; 95% CI: 1.03-1.42), and injury and poisoning (AOR: 1.33; 95% CI: 1.11-1.58). FCLICs had more risk of being diagnosed in the categories of pregnancy, childbirth & puerperium (AOR: 1.33; 95% CI: 1.29-1.59), and injury and poisoning (AOR: 1.19; 95% CI: 1.03-1.36), and less risk in the mental disorder category (AOR: 0.32; 95% CI: 0.22-0.45). The length of hospitalization (in days) was lower in FCLICs (median: 3; IQR: 2–6) than both ACs (median: 4; IQR: 2–8) and FCHICs (median: 4; IQR: 2–8) (p < 0.001). The mortality rates on admission of ACs, FCHICs, and FCLICs were 4.2%, 3.3%, and 1.3%, respectively, but after adjusting for age and sex, the mortality rate risks were similar in FCHICs and FCLICs. Conclusion First, FCs utilized hospitalization less when

  3. Better health-related quality of life (mental component summary), having a higher level of education, and being less than 75 years of age are predictors of hospital admission among cognitively intact nursing home residents: a 5-year follow-up study

    PubMed Central

    Drageset, Jorunn; Eide, Geir Egil; Ranhoff, Anette Hylen

    2016-01-01

    Objective To study whether health-related quality of life (HRQOL), activities of daily living (ADL), and anxiety and depression symptoms affect the risk of hospital admission and potential interactions with having a cancer diagnosis. Methods This study was a prospective observational study with 5-year follow-up and analyzed the follow-up data on hospital admissions until 2010 using baseline data from 227 cognitively intact nursing home (NH) residents (60 of whom had cancer) in 2004–2005. Data on HRQOL were collected by using the Short Form-36 Health Survey, divided into physical component summary (PCS) and mental component summary (MCS), and symptoms of anxiety and depression were collected by using the Hospital Anxiety and Depression Scale (HADS). ADL were obtained from registered observation and sociodemographic variables, diagnoses, and hospital admissions from the NH records. Personal identification numbers were linked to the record systems of the hospitals, thereby registering all hospital admissions. We analyzed the time elapsing between inclusion and the first hospital admission. Results Residents with higher HRQOL (MCS) had significantly more hospital admissions after adjustment for age, sex, marital status, education, and comorbidity. HRQOL (PCS), ADL, depression, and anxiety symptoms were not associated with hospital admissions. Cancer increased the risk after adjustment for all other risk factors but did not increase the effects of MCS, PCS, ADL, or depression or anxiety symptoms. Having a higher level of education and being less than 75 years of age were associated with hospitalization. The residents diagnosed with cancer had the most days in hospital related to diseases of the respiratory system and cancer, and diseases of the circulatory and respiratory systems were more frequent among the residents without a cancer diagnosis. Conclusion Better self-reported HRQOL (MCS) was associated with hospital admissions, whereas self-reported HRQOL (PCS), ADL

  4. Acute Psychiatric Hospital Admissions of Adults and Elderly Adults with Mental Retardation.

    ERIC Educational Resources Information Center

    Pary, Robert J.

    1993-01-01

    Examination of the records of 240 inpatients with mental retardation and 7 with autism discharged from a university hospital indicated that elderly adults had more medical problems than did adults, more elderly adults were transferred to a state hospital, and the most common diagnosis in both adults and elderly adults was chronic schizophrenia,…

  5. The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people

    PubMed Central

    Gahbauer, Evelyne A; Han, Ling; Allore, Heather G

    2015-01-01

    Objective To evaluate the role of intervening hospital admissions on trajectories of disability in the last year of life. Design Prospective cohort study. Setting Greater New Haven, Connecticut, United States, from March 1998 to June 2013. Participants 552 decedents from a cohort of 754 community living people, aged 70 years or older, who were initially non-disabled in four essential activities of daily living: bathing, dressing, walking, and transferring. Main outcome measure Occurrence of admissions to hospital and severity of disability (range 0-4), ascertained during monthly interviews for more than 15 years. Results In the last year of life, six distinct trajectories of disability were identified, from least disabled to most disabled: 95 participants (17.2%) had no disability, 61 (11.1%) had catastrophic disability, 53 (9.6%) had accelerated disability, 61 (11.1%) had progressively mild disability, 127 (23.0%) had progressively severe disability, and 155 (28.1%) had persistently severe disability. 392 (71.0%) participants had at least one hospital admission and 248 (44.9%) had multiple hospital admissions. For each trajectory the course of disability closely tracked the monthly prevalence of hospital admission. In a set of multivariable models that included several potential confounders, hospital admission in a given month had a strong independent effect on the severity of disability, in both relative and absolute terms. The largest absolute effect was observed for catastrophic disability, with a mean increase in disability score of 1.9 (95% confidence interval 1.5 to 2.4) in the setting of a hospital admission, corresponding to a rate ratio (or relative effect) of 2.0 (95% confidence interval 1.5 to 2.7). Conclusions In the last year of life, acute hospital admissions play an important role in the disabling process. Knowledge about the course of disability before these intervening events may facilitate clinical decision making at the end of life. For older

  6. Reassessing the high proportion of involuntary psychiatric hospital admissions in South Korea.

    PubMed

    Bola, John R; Park, Eon-Ha; Kim, Seong-Yeon

    2011-10-01

    The 2007 WHO-AIMS report on the mental health system of South Korea documented progress towards a national mental health plan, protection of human rights, and growth of community based services. Yet concern was expressed that the high proportion of involuntary to total psychiatric hospitalizations (92%) may indicate an excessively coercive system. Involuntary hospitalization in Korea rose from 117 to 132 (per 100,000) between 2000 and 2006. In 2000, the median rate in the European Union (EU) was 74 per 100,000 (Range: 6-218). While Korea's involuntary hospitalization rate is within the EU range, its proportion of involuntary hospitalizations is three times that of the highest EU country (30%, Sweden). Underdevelopment of voluntary psychiatric services and culturally mandated family referrals resulting in involuntary hospitalization are apparent reasons for the high proportion of involuntary hospitalizations. Population-based rates per 100,000 more accurately describe involuntary hospitalization than the proportion (ratio) measure used in the WHO-AIMS reports. PMID:21416122

  7. A multi-year study of air pollution and respiratory hospital admissions in three New York State metropolitan areas: results for 1988 and 1989 summers

    SciTech Connect

    Thurston, G.D.; Ito, K.; Kinney, P.L.; Lippmann, M. )

    1992-10-01

    As part of a multi-year study of air pollution and respiratory hospital admissions in the Buffalo, Albany, and New York City, New York, metropolitan areas, filter samples were collected daily at suburban air monitoring sites and analyzed for their content of particulate phase aerosol strong acidity (i.e., hydrogen ion, H+) and sulfate (SO4 =). In addition, daily hospital admissions for respiratory causes, other community air pollutant measurements (e.g., ozone, O3), and meteorological data (e.g., temperature) were also obtained for these metropolitan areas. The summer months (June-August) were selected for analysis because that is when the highest H+ (and O3) are usually experienced at these sites, and because these months are rarely complicated by other major influences (e.g., high pollen counts). Thus, any pollution-admissions relationships were expected to be most clearly discernible in this season. Prior to the health effects analysis, the summer admissions and environmental data were first detrended to eliminate long-wave autocorrelations, and day-of-week effects were removed via regression. Cross-correlations of the filtered 1988 and 1989 admissions and environmental data revealed strong associations between elevated summer haze pollution (i.e., H+, SO4 =, and O3) and increased total respiratory and asthma admissions on the same day and/or on subsequent days in Buffalo and New York City, especially during the summer of 1988 (when pollution levels were more extreme). Regression analyses indicated that the pollution-admissions associations remained significant (p < 0.05) even after the simultaneous inclusion of lagged daily maximum temperature. Mean effects calculations for these cities indicated that summertime haze can play a significant role in the occurrence of respiratory admissions in that season: accounting for an average 6 to 24% of 1988 Buffalo and NYC asthma admissions. O3 consistently had the highest mean effects estimates.

  8. Predicting admissions and time spent in hospital over a decade in a population-based record linkage study: the EPIC-Norfolk cohort

    PubMed Central

    Hayat, Shabina; Khaw, K T

    2016-01-01

    Objective To quantify hospital use in a general population over 10 years follow-up and to examine related factors in a general population-based cohort. Design A prospective population-based study of men and women. Setting Norfolk, UK. Participants 11 228 men and 13 786 women aged 40–79 years in 1993–1997 followed between 1999 and 2009. Main outcomes measures Number of hospital admissions and total bed days for individuals over a 10-year follow-up period identified using record linkage; five categories for admissions (from zero to highest ≥7) and hospital bed days (from zero to highest ≥20 nights). Results Over a period of 10 years, 18 179 (72.7%) study participants had at least one admission to hospital, 13.8% with 7 or more admissions and 19.9% with 20 or more nights in hospital. In logistic regression models with outcome ≥7 admissions, low education level OR 1.14 (1.05 to 1.24), age OR per 10-year increase 1.75 (1.67 to 1.82), male sex OR 1.32 (1.22 to 1.42), manual social class 1.22 (1.13 to 1.32), current cigarette smoker OR 1.53 (1.37 to 1.71) and body mass index >30 kg/m² OR 1.41 (1.28 to 1.56) all independently predicted the outcome with p<0.0001. Results were similar for those with ≥20 hospital bed days. A risk score constructed using male sex, manual social class, no educational qualifications; current smoker and body mass index >30 kg/m², estimated percentages of the cohort in the categories of admission numbers and hospital bed days in stratified age bands with twofold to threefold differences in future hospital use between those with high-risk and low-risk scores. Conclusions The future probability of cumulative hospital admissions and bed days appears independently related to a range of simple demographic and behavioural indicators. The strongest of these is increasing age with high body mass index and smoking having similar magnitudes for predicting risk of future hospital usage. PMID:26792216

  9. Air Pollution and Acute Myocardial Infarction Hospital Admission in Alberta, Canada: A Three-Step Procedure Case-Crossover Study

    PubMed Central

    Wang, Xiaoming; Kindzierski, Warren; Kaul, Padma

    2015-01-01

    Adverse associations between air pollution and myocardial infarction (MI) are widely reported in medical literature. However, inconsistency and sensitivity of the findings are still big concerns. An exploratory investigation was undertaken to examine associations between air pollutants and risk of acute MI (AMI) hospitalization in Alberta, Canada. A time stratified case-crossover design was used to assess the transient effect of five air pollutants (carbon monoxide (CO), nitrogen dioxide (NO2), nitric oxide (NO), ozone (O3) and particulate matter with an aerodynamic diameter ≤2.5 (PM2.5)) on the risk of AMI hospitalization over the period 1999–2009. Subgroups were predefined to see if any susceptible group of individuals existed. A three-step procedure, including univariate analysis, multivariate analysis, and bootstrap model averaging, was used. The multivariate analysis was used in an effort to address adjustment uncertainty; whereas the bootstrap technique was used as a way to account for regression model uncertainty. There were 25,894 AMI hospital admissions during the 11-year period. Estimating health effects that are properly adjusted for all possible confounding factors and accounting for model uncertainty are important for making interpretations of air pollution–health effect associations. The most robust findings included: (1) only 1-day lag NO2 concentrations (6-, 12- or 24-hour average), but not those of CO, NO, O3 or PM2.5, were associated with an elevated risk of AMI hospitalization; (2) evidence was suggested for an effect of elevated risk of hospitalization for NSTEMI (Non-ST Segment Elevation Myocardial Infarction), but not for STEMI (ST segment elevation myocardial infarction); and (3) susceptible subgroups included elders (age ≥65) and elders with hypertension. As this was only an exploratory study there is a need to replicate these findings with other methodologies and datasets. PMID:26167938

  10. Effectiveness of a Surgery Admission Unit for patients undergoing major elective surgery in a tertiary university hospital

    PubMed Central

    2010-01-01

    Background The increasing demand on hospitalisation, either due to elective activity from the waiting lists or due to emergency admissions coming from the Emergency Department (ED), requires looking for strategies that lead to effective bed management. The aim of this study was to evaluate the effectiveness of a surgery admission unit for major elective surgery patients who were admitted for same-day surgery. Methods We included all patients admitted for elective surgery in a university tertiary hospital between the 1st of September and the 31st of December 2006, as well as those admitted during the same period of 2008, after the introduction of the Surgery Admission Unit. The main outcome parameters were global length of stay, pre-surgery length of stay, proportion of patients admitted the same day of the surgery and number of cancellations. Differences between the two periods were evaluated by the T-test and Chi-square test. Significance at P < 0.05 was assumed throughout. Results We included 6,053 patients, 3,003 during 2006 and 3,050 patients during 2008. Global length of stay was 6.2 days (IC 95%:6.4-6) in 2006 and 5.5 days (IC 95%:5.8-5.2) in 2008 (p < 0.005). Pre-surgery length of stay was reduced from 0.46 days (IC 95%:0.44-0.48) in 2006 to 0.29 days (IC 95%:0.27-0.31) in 2008 (p < 0.005). The proportion of patients admitted for same-day surgery was 67% (IC 95%:69%-65%) in 2006 and 76% (IC 95%:78%-74%) in 2008 (p < 0.005). The number of cancelled interventions due to insufficient preparation was 31 patients in 2006 and 7 patients in 2008. Conclusions The implementation of a Surgery Admission Unit for patients undergoing major elective surgery has proved to be an effective strategy for improving bed management. It has enabled an improvement in the proportion of patients admitted on the same day as surgery and a shorter length of stay. PMID:20096114

  11. Expenses related to hospital admissions for the elderly in Brazil: perspectives of a decade

    PubMed Central

    da Silveira, Rodrigo Eurípedes; Santos, Álvaro da Silva; de Sousa, Mariana Campos; Monteiro, Taciana Silva Alves

    2013-01-01

    ABSTRACT Objective: To describe the profile of morbidities and expenses related to hospitalization of the elderly compared to the adult population (20 to 59 years). Methods: A descriptive, cross-sectional investigation of hospitalizations of the elderly (60 years or older) in Brazil during the period from 2002 to 2011, with data from DATASUS and based on ICD-10. Results: Although the highest number of hospitalizations were in the adult age range, the expenses were greater with the elderly, and in this case especially with mental and behavioral disorders, musculoskeletal and connective tissue diseases, followed by circulatory diseases and external causes. Conclusion: The results suggest the adoption of more comprehensive policies and increased investment in health promotion, disease prevention, and appropriate and suitable treatment for the most prevalent diseases in the elderly, particularly in primary care. PMID:24488394

  12. Referral patterns after a seizure admission in an English region: an opportunity for effective intervention? An observational study of routine hospital data

    PubMed Central

    Grainger, Ruth; Pearson, Michael; Dixon, Peter; Devonport, Elizabeth; Timoney, Michelle; Bodger, Keith; Kirkham, Jamie; Marson, Anthony

    2016-01-01

    Objectives To identify emergency seizure admissions to hospital and their subsequent access to specialist outpatient services. Design Algorithmic analysis of anonymised routine hospital data over 7 years using specialist follow-up by 3 months as the target outcome. Population All adults resident in Merseyside and Cheshire, England. Main Outcomes Whether, and when, access to the specialist advice that might prevent further admissions was offered. Results 1.4% of all emergency medical admissions are as a result of seizure. In the following 12 months 35% were readmitted and experienced a mean of 2.3 emergency department visits. Only 27% (48% of those already known to specialists and 13% of those not known) were offered appointments. Subsequent attendance at a specialist clinic is more likely if already known to a clinic, if aged <35 years, if female, or required a longer spell in hospital. Extrapolation from other work suggests 100 000 bed days per annum could be saved. Conclusions Most seizure admissions are not being referred for the help that could prevent future admissions. The majority of those that are referred are not seen within an appropriate time frame. Our service structures are not providing an optimum service for people with epilepsy. PMID:26792220

  13. Re-admissions to hospital and patient satisfaction among patients with chronic obstructive pulmonary disease after telemedicine video consultation - a retrospective pilot study

    PubMed Central

    2014-01-01

    Background Chronic obstructive pulmonary disease (COPD) is a major cause of acute hospital admissions. The main object of our study was to evaluate the effects of telemedicine video-consultation (TVC) on the frequency of hospital re-admissions due to COPD exacerbations. Our secondary aim was to assess the impact of TVC on the length of re-admission stays within 6 and 12 months follow up after TVC. Patient satisfaction was also evaluated. Methods The study was a retrospective observational study of COPD patients who after hospital discharge or during outpatient treatment for acute COPD exacerbations, were monitored for 2 weeks by TVC at home by a specialist nurse at the hospital during a pilot project period. Retrospectively, we compared the frequencies (chi-square test) and durations of hospital re-admissions (paired t-test) due to COPD exacerbations within 6 and 12 months follow up after TVC to comparable events 6 and 12 months prior to TVC. Results Among 99 patients followed for 6 months after TVC, 56 were followed for totally 12 months. The number of patients re-admitted and the number of re-admissions due to COPD exacerbations were not reduced within 6 or 12 months post-TVC, as compared to 6 and 12 months pre-TVC. The mean length of re-admission stays within 12 months post-TVC was markedly reduced as compared to pre-TVC. Patients hospitalised the last 6 and 12 months pre-TVC, had significantly shorter re-admission stays, p = 0.033 and p = 0.001, respectively. Patient satisfaction was high. Conclusion Despite the failure to demonstrate reduced frequency of re-admissions within 6 and 12 months post-TVC, the re-admission length within 12 months post-TVC was markedly reduced as compared to pre-TVC. The patient satisfaction was high. Future prospective, randomised, controlled trials must be performed before TVC can be recommended in COPD management. PMID:24475774

  14. CHILDHOOD RESPIRATORY SYMPTOMS, HOSPITAL ADMISSIONS, AND LONG-TERM EXPOSURE TO AIRBORNE PARTICULATE MATTER

    EPA Science Inventory

    The effects of long-term exposure to air pollution on respiratory symptoms and respiratory hospitalization (for asthma, bronchitis or pneumonia) were assessed in a cross-sectional study of children (ages 7--11 years, N=667) living in a moderately industrialized city in Central Sl...

  15. Ambient Coarse Particulate Matter and Hospital Admissions in the Medicare Cohort Air Pollution Study, 1999–2010

    PubMed Central

    Powell, Helen; Krall, Jenna R.; Wang, Yun; Bell, Michelle L.

    2015-01-01

    Background In recent years a number of studies have examined the short-term association between coarse particulate matter (PM10–2.5) and mortality and morbidity outcomes. These studies, however, have produced inconsistent conclusions. Objectives We estimated both the national- and regional-level associations between PM10–2.5 and emergency hospitalizations for both cardiovascular and respiratory disease among Medicare enrollees ≥ 65 years of age during the 12-year period 1999 through 2010. Methods Using air pollution data obtained from the U.S. Environmental Protection Agency air quality monitoring network and daily emergency hospitalizations for 110 large urban U.S. counties assembled from the Medicare Cohort Air Pollution Study (MCAPS), we estimated the association between short-term exposure to PM10–2.5 and hospitalizations using a two-stage Bayesian hierarchical model and Poisson log-linear regression models. Results A 10-μg/m3 increase in PM10–2.5 was associated with a significant increase in same-day cardiovascular hospitalizations [0.69%; 95% posterior interval (PI): 0.45, 0.92]. After adjusting for PM2.5, this association remained significant (0.63%; 95% PI: 0.38, 0.88). A 10-μg/m3 increase in PM10–2.5 was not associated with a significant increase in respiratory-related hospitalizations. Conclusions We found statistically significant evidence that daily variation in PM10–2.5 is associated with emergency hospitalizations for cardiovascular diseases among Medicare enrollees ≥ 65 years of age. This association was robust to adjustment for concentrations of PM2.5. Citation Powell H, Krall JR, Wang Y, Bell ML, Peng RD. 2015. Ambient coarse particulate matter and hospital admissions in the Medicare Cohort Air Pollution Study, 1999–2010. Environ Health Perspect 123:1152–1158; http://dx.doi.org/10.1289/ehp.1408720 PMID:25872223

  16. Association between exposure to particulate matter and hospital admissions for respiratory disease in children

    PubMed Central

    Cesar, Ana Cristina Gobbo; Nascimento, Luiz Fernando C; de Carvalho, João Andrade

    2013-01-01

    The aim of this study was to estimate the association between exposure to particulate matter less than 2.5 microns in diameter and hospitalization for respiratory disease. It was an ecological time series study with daily indicators of hospitalization for respiratory diseases in children up to 10 years old, living in Piracicaba, SP, Southeastern Brazil, between August 1, 2011 and July 31, 2012. A generalized additive Poisson regression model was used. The relative risks were RR = 1.008; 95%CI 1.001;1.016 for lag 1 and RR = 1.009; 95%CI 1.001;1.017 for lag 3. The increment of 10 μg/m3in particulate matter less than 2.5 microns in diameter implies increase in relative risk of between 7.9 and 8.6 percentage points. In conclusion, exposure to particulate matter less than 2.5 microns in diameter was associated with hospitalization for respiratory disease in children. PMID:24626559

  17. Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients.

    PubMed

    Brown, Randall S; Peikes, Deborah; Peterson, Greg; Schore, Jennifer; Razafindrakoto, Carol M

    2012-06-01

    As policy makers seek to slow the growth in Medicare spending, they have appropriately focused attention on beneficiaries with multiple chronic conditions. Many care coordination and disease management programs designed to improve beneficiaries' care and reduce their need for hospitalizations have been tested, but few have been successful. This study, however, found that four of eleven programs that were part of the Medicare Coordinated Care Demonstration reduced hospitalizations by 8-33 percent among enrollees who had a high risk of near-term hospitalization. The six approaches practiced by care coordinators in at least three of the four programs were as follows: supplementing telephone calls to patients with frequent in-person meetings; occasionally meeting in person with providers; acting as a communications hub for providers; delivering evidence-based education to patients; providing strong medication management; and providing timely and comprehensive transitional care after hospitalizations. When care management fees were included, the programs were essentially cost-neutral, but none of these programs generated net savings to Medicare. Our results suggest that incorporating these approaches into medical homes, accountable care organizations, and other policy initiatives could reduce hospitalizations and improve patients' lives. However, the approaches would save money only if care coordination fees were modest and organizations found cost-effective ways to deliver the interventions. PMID:22665827

  18. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis

    PubMed Central

    Nair, Harish; Simões, Eric AF; Rudan, Igor; Gessner, Bradford D; Azziz-Baumgartner, Eduardo; Zhang, Jian Shayne F; Feikin, Daniel R; Mackenzie, Grant A; Moiïsi, Jennifer C; Roca, Anna; Baggett, Henry C; Zaman, Syed MA; Singleton, Rosalyn J; Lucero, Marilla G; Chandran, Aruna; Gentile, Angela; Cohen, Cheryl; Krishnan, Anand; Bhutta, Zulfiqar A; Arguedas, Adriano; Clara, Alexey Wilfrido; Andrade, Ana Lucia; Ope, Maurice; Ruvinsky, Raúl Oscar; Hortal, María; McCracken, John P; Madhi, Shabir A; Bruce, Nigel; Qazi, Shamim A; Morris, Saul S; El Arifeen, Shams; Weber, Martin W; Scott, J Anthony G; Brooks, W Abdullah; Breiman, Robert F; Campbell, Harry

    2013-01-01

    Summary Background The annual number of hospital admissions and in-hospital deaths due to severe acute lower respiratory infections (ALRI) in young children worldwide is unknown. We aimed to estimate the incidence of admissions and deaths for such infections in children younger than 5 years in 2010. Methods We estimated the incidence of admissions for severe and very severe ALRI in children younger than 5 years, stratified by age and region, with data from a systematic review of studies published between Jan 1, 1990, and March 31, 2012, and from 28 unpublished population-based studies. We applied these incidence estimates to population estimates for 2010, to calculate the global and regional burden in children admitted with severe ALRI in that year. We estimated in-hospital mortality due to severe and very severe ALRI by combining incidence estimates with case fatality ratios from hospital-based studies. Findings We identified 89 eligible studies and estimated that in 2010, 11·9 million (95% CI 10·3–13·9 million) episodes of severe and 3·0 million (2·1–4·2 million) episodes of very severe ALRI resulted in hospital admissions in young children worldwide. Incidence was higher in boys than in girls, the sex disparity being greatest in South Asian studies. On the basis of data from 37 hospital studies reporting case fatality ratios for severe ALRI, we estimated that roughly 265 000 (95% CI 160 000–450 000) in-hospital deaths took place in young children, with 99% of these deaths in developing countries. Therefore, the data suggest that although 62% of children with severe ALRI are treated in hospitals, 81% of deaths happen outside hospitals. Interpretation Severe ALRI is a substantial burden on health services worldwide and a major cause of hospital referral and admission in young children. Improved hospital access and reduced inequities, such as those related to sex and rural status, could substantially decrease mortality related to such infection

  19. Diagnoses, problems and healthcare interventions amongst older people with an unscheduled hospital admission who have concurrent mental health problems: a prevalence study

    PubMed Central

    2014-01-01

    Background Frail older people with mental health problems including delirium, dementia and depression are often admitted to general hospitals. However, hospital admission may cause distress, and can be associated with complications. Some commentators suggest that their healthcare needs could be better met elsewhere. Methods We studied consecutive patients aged 70 or older admitted for emergency medical or trauma care to an 1800 bed general hospital which provided sole emergency medical and trauma services for its local population. Patients were screened for mental health problems, and those screening positive were invited to take part. 250 participants were recruited and a sub-sample of 53 patients was assessed by a geriatrician for diagnoses, impairments and disabilities, healthcare interventions and outstanding needs. Results Median age was 86 years, median Mini-Mental State Examination score at admission was 16/30, and 45% had delirium. 19% lived in a care home prior to admission. All the patients were complex. A wide range of main admission diagnoses was recorded, and these were usually complicated by falls, immobility, pain, delirium, dehydration or incontinence. There was a median of six active diagnoses, and eight active problems. One quarter of problems was unexplained. A median of 13 interventions was recorded, and a median of a further four interventions suggested by the geriatrician. Those with more severe cognitive impairment had no less medical need. Conclusions This patient group, admitted to hospital in the United Kingdom, had numerous healthcare problems, and by implication, extensive healthcare needs. Patients with simpler conditions were not identified, but may have already been rapidly discharged or redirected to non-hospital services by the time assessments were made. To meet the needs of this group outside the hospital would need considerable investment in medical, nursing, therapy and diagnostic facilities. In the meantime, acute hospitals

  20. Differential Effects of Temperature Extremes on Hospital Admission Rates for Respiratory Disease between Indigenous and Non-Indigenous Australians in the Northern Territory.

    PubMed

    Green, Donna; Bambrick, Hilary; Tait, Peter; Goldie, James; Schultz, Rosalie; Webb, Leanne; Alexander, Lisa; Pitman, Andrew

    2015-12-01

    The health gap between Indigenous and non-Indigenous Australians may be exacerbated by climate change if temperature extremes have disproportionate adverse effects on Indigenous people. To explore this issue, we analysed the effect of temperature extremes on hospital admissions for respiratory diseases, stratified by age, Indigenous status and sex, for people living in two different climates zones in the Northern Territory during the period 1993-2011. We examined admissions for both acute and chronic respiratory diagnoses, controlling for day of the week and seasonality variables. Our analysis showed that: (1) overall, Indigenous hospital admission rates far exceeded non-Indigenous admission rates for acute and chronic diagnoses, and Top End climate zone admission rates exceeded Central Australia climate zone admission rates; (2) extreme cold and hot temperatures were associated with inconsistent changes in admission rates for acute respiratory disease in Indigenous and non-Indigenous children and older adults; and (3) no response to cold or hot temperature extremes was found for chronic respiratory diagnoses. These findings support our two hypotheses, that extreme hot and cold temperatures have a different effect on hospitalisations for respiratory disease between Indigenous and non-Indigenous people, and that these health risks vary between the different climate zones. We did not, however, find that there were differing responses to temperature extremes in the two populations, suggesting that any increased vulnerability to climate change in the Indigenous population of the Northern Territory arises from an increased underlying risk to respiratory disease and an already greater existing health burden. PMID:26633456

  1. Short-term relationships between emergency hospital admissions for respiratory and cardiovascular diseases and fine particulate air pollution in Beirut, Lebanon.

    PubMed

    Nakhlé, Myriam Mrad; Farah, Wehbeh; Ziadé, Nelly; Abboud, Maher; Salameh, Dominique; Annesi-Maesano, Isabella

    2015-04-01

    High levels of major outdoor air pollutants have been documented in Lebanon, but their health effects remain unknown. The Beirut Air Pollution and Health Effects study aimed to determine the relationship between short-term variations in ambient concentrations of particulate matter (PM10 and PM2.5) and emergency hospital admissions in the city of Beirut, and whether susceptible groups are more greatly affected. An autoregressive Poisson model was used to evaluate the association between daily concentrations of particulate matter and respiratory and cardiovascular emergency hospital admissions after controlling for confounders. All variables were measured during 1 year from January 2012 to December 2012. Relative risks of admissions for respiratory and cardiovascular diseases were calculated for an increase in 10 μg.m(-3) of pollutant concentrations. Total respiratory admissions were significantly associated with the levels of PM10 (1.012 [95% CI 1.004-1.02]) per 10 μg.m(-3) rise in daily mean pollutant concentration for PM10 and 1.016 [95% CI 1.000-1.032] for PM2.5 on the same day. With regard to susceptible groups, total respiratory admissions were associated with PM2.5 and PM10 within the same day in children (relative risk (RR), 1.013 and 1.014; 95% confidence interval, 0.985-1.042 and 1.000-1.029 for PM2.5 and PM10, respectively). Moreover, a nearly significant association was found between particles and total circulatory admissions for adults and elderly groups in the same day. These results are similar to other international studies. Therefore, air pollution control is expected to reduce the number of admissions of these diseases in Lebanon. PMID:25792024

  2. Differential Effects of Temperature Extremes on Hospital Admission Rates for Respiratory Disease between Indigenous and Non-Indigenous Australians in the Northern Territory

    PubMed Central

    Green, Donna; Bambrick, Hilary; Tait, Peter; Goldie, James; Schultz, Rosalie; Webb, Leanne; Alexander, Lisa; Pitman, Andrew

    2015-01-01

    The health gap between Indigenous and non-Indigenous Australians may be exacerbated by climate change if temperature extremes have disproportionate adverse effects on Indigenous people. To explore this issue, we analysed the effect of temperature extremes on hospital admissions for respiratory diseases, stratified by age, Indigenous status and sex, for people living in two different climates zones in the Northern Territory during the period 1993–2011. We examined admissions for both acute and chronic respiratory diagnoses, controlling for day of the week and seasonality variables. Our analysis showed that: (1) overall, Indigenous hospital admission rates far exceeded non-Indigenous admission rates for acute and chronic diagnoses, and Top End climate zone admission rates exceeded Central Australia climate zone admission rates; (2) extreme cold and hot temperatures were associated with inconsistent changes in admission rates for acute respiratory disease in Indigenous and non-Indigenous children and older adults; and (3) no response to cold or hot temperature extremes was found for chronic respiratory diagnoses. These findings support our two hypotheses, that extreme hot and cold temperatures have a different effect on hospitalisations for respiratory disease between Indigenous and non-Indigenous people, and that these health risks vary between the different climate zones. We did not, however, find that there were differing responses to temperature extremes in the two populations, suggesting that any increased vulnerability to climate change in the Indigenous population of the Northern Territory arises from an increased underlying risk to respiratory disease and an already greater existing health burden. PMID:26633456

  3. Relationships of physiologically equivalent temperature and hospital admissions due to I30-I51 other forms of heart disease in Germany in 2009-2011.

    PubMed

    Shiue, Ivy; Perkins, David R; Bearman, Nick

    2016-04-01

    We aimed to understand relationships of the weather as biometeorological and hospital admissions due to other forms of heart disease by subtypes, which have been paid less attention, in a national setting in recent years. This is an ecological study. Ten percent of daily hospital admissions of the included hospitals (n = 1618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified I30-I51 other forms of heart disease by the International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that have covered 13 German states, including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure, were obtained and generated into physiologically equivalent temperature (PET). Admissions due to other diseases of pericardium, nonrheumatic mitral valve disorders, nonrheumatic aortic valve disorders, cardiomyopathy, atrioventricular and left bundle-branch block, other conduction disorders, atrial fibrillation and flutter, and other cardiac arrhythmias peaked when PET was between 0 and 10 °C. Complications and ill-defined descriptions of heart disease admissions peaked at PET 0 °C. Cardiac arrest and heart failure admissions peaked when PET was between 0 and -10 °C while the rest did not vary significantly. A common drop of admissions was found when PET was above 10 °C. More medical resources could have been needed for heart health on days when PETs were <10 °C than on other days. Adaptation to such weather change for medical professionals and the general public would seem to be imperative. PMID:26620859

  4. Patterns of traumatic injury in New York City prisoners requiring hospital admission.

    PubMed

    Henning, Justin; Frangos, Spiros; Simon, Ronald; Pachter, H Leon; Bholat, Omar S

    2015-01-01

    Bellevue Hospital's prison ward cares for male prisoners requiring medical attention that exceeds the capabilities of New York City Department of Correction (NYC-DOC) infirmaries. This study evaluated the injury patterns that occur in this patient population. Data were collected on consecutive prisoners transferred from NYC-DOC for traumatic injuries from June 1, 2003, to June 1, 2006, and analyzed by retrospective chart review. Overall, 251 patients were evaluated for traumatic injuries. Injury mechanisms were violent (75.7%), nonviolent (23.5%), and self-inflicted (0.8%). Of the 241 (96%) patients admitted, 213 (84.9%) required operative intervention. The most common injuries were mandible fractures (46.5%) and facial fractures (14.9%). PMID:25559630

  5. The effect of solar-geomagnetic activity during hospital admission on coronary events within 1 year in patients with acute coronary syndromes

    NASA Astrophysics Data System (ADS)

    Vencloviene, J.; Babarskiene, R.; Milvidaite, I.; Kubilius, R.; Stasionyte, J.

    2013-12-01

    Some evidence indicates the deterioration of the cardiovascular system during space storms. It is plausible that the space weather conditions during and after hospital admission may affect the risk of coronary events in patients with acute coronary syndromes (ACS). We analyzed the data of 1400 ACS patients who were admitted to the Hospital Lithuanian University of Health Sciences, and who survived for more than 4 days. We evaluated the associations between geomagnetic storms (GS), solar proton events (SPE), and solar flares (SF) that occurred 0-3 days before and after hospital admission and the risk of cardiovascular death (CAD), non-fatal ACS, and coronary artery bypass grafting (CABG) during a period of 1 year; the evaluation was based on the multivariate logistic model, controlling for clinical data. After adjustment for clinical variables, GS occurring in conjunction with SF 1 day before admission increased the risk of CAD by over 2.5 times. GS 2 days after SPE occurred 1 day after admission increased the risk of CAD and CABG by over 2.8 times. The risk of CABG increased by over 2 times in patients admitted during the day of GS and 1 day after SPE. The risk of ACS was by over 1.63 times higher for patients admitted 1 day before or after solar flares.

  6. Age, Spatial, and Temporal Variations in Hospital Admissions with Malaria in Kilifi County, Kenya: A 25-Year Longitudinal Observational Study

    PubMed Central

    Mogeni, Polycarp; Williams, Thomas N.; Nyundo, Christopher; Bauni, Evasius; Omedo, Irene; Njuguna, Patricia; Newton, Charles R.; Osier, Faith; Berkley, James A.; Hammitt, Laura L.; Awuondo, Ken; Mturi, Neema; Snow, Robert W.; Noor, Abdisalan; Marsh, Kevin; Bejon, Philip

    2016-01-01

    Background Encouraging progress has been seen with reductions in Plasmodium falciparum malaria transmission in some parts of Africa. Reduced transmission might lead to increasing susceptibility to malaria among older children due to lower acquired immunity, and this has implications for ongoing control strategies. Methods and Findings We conducted a longitudinal observational study of children admitted to Kilifi County Hospital in Kenya and linked it to data on residence and insecticide-treated net (ITN) use. This included data from 69,104 children aged from 3 mo to 13 y admitted to Kilifi County Hospital between 1 January 1990 and 31 December 2014. The variation in malaria slide positivity among admissions was examined in logistic regression models using the following predictors: location of the residence, calendar time, the child’s age, ITN use, and the enhanced vegetation index (a proxy for soil moisture). The proportion of malaria slide-positive admissions declined from 0.56 (95% confidence interval [CI] 0.54–0.58) in 1998 to 0.07 (95% CI 0.06–0.08) in 2009 but then increased again through to 0.24 (95% CI 0.22–0.25) in 2014. Older children accounted for most of the increase after 2009 (0.035 [95% CI 0.030–0.040] among young children compared to 0.22 [95% CI 0.21–0.23] in older children). There was a nonlinear relationship between malaria risk and prevalence of ITN use within a 2 km radius of an admitted child’s residence such that the predicted malaria positive fraction varied from ~0.4 to <0.1 as the prevalence of ITN use varied from 20% to 80%. In this observational analysis, we were unable to determine the cause of the decline in malaria between 1998 and 2009, which pre-dated the dramatic scale-up in ITN distribution and use. Conclusion Following a period of reduced transmission, a cohort of older children emerged who have increased susceptibility to malaria. Further reductions in malaria transmission are needed to mitigate the increasing

  7. Anthropogenic Factors Are the Major Cause of Hospital Admission of a Threatened Species, the Grey-Headed Flying Fox (Pteropus poliocephalus), in Victoria, Australia.

    PubMed

    Scheelings, Titus Franciscus; Frith, Sarah Elizabeth

    2015-01-01

    To determine the reasons for presentation and outcomes of hospitalised grey-headed flying foxes (Pteropus poliocephalus) in Victoria, Australia, a retrospective analysis was performed on 532 records from two wildlife hospitals. Cases were categorised based on presenting signs and outcomes determined. Anthropogenic factors (63.7%) were a major cause of flying fox admissions with entanglement in fruit netting the most significant risk for bats (36.8%). Overall the mortality rate for flying fox admissions was 59.3%. This study highlights the effects of urbanisation on wild animal populations and a need for continued public education in order to reduce morbidity and mortality of wildlife, especially threatened species. PMID:26207984

  8. Anthropogenic Factors Are the Major Cause of Hospital Admission of a Threatened Species, the Grey-Headed Flying Fox (Pteropus poliocephalus), in Victoria, Australia

    PubMed Central

    Scheelings, Titus Franciscus; Frith, Sarah Elizabeth

    2015-01-01

    To determine the reasons for presentation and outcomes of hospitalised grey-headed flying foxes (Pteropus poliocephalus) in Victoria, Australia, a retrospective analysis was performed on 532 records from two wildlife hospitals. Cases were categorised based on presenting signs and outcomes determined. Anthropogenic factors (63.7%) were a major cause of flying fox admissions with entanglement in fruit netting the most significant risk for bats (36.8%). Overall the mortality rate for flying fox admissions was 59.3%. This study highlights the effects of urbanisation on wild animal populations and a need for continued public education in order to reduce morbidity and mortality of wildlife, especially threatened species. PMID:26207984

  9. Impact of Market Competition on Continuity of Care and Hospital Admissions for Asthmatic Children: A Longitudinal Analysis of Nationwide Health Insurance Data 2009-2013

    PubMed Central

    Cho, Kyoung Hee; Park, Eun-Cheol; Nam, Young Soon; Lee, Seon-Heui; Nam, Chung Mo; Lee, Sang Gyu

    2016-01-01

    Background Ambulatory care-sensitive conditions, including asthma, can be managed with timely and effective outpatient care, thereby reducing the need for hospitalization. Objective This study assessed the relationship between market competition, continuity of care (COC), and hospital admissions in asthmatic children according to their health care provider. Methods A longitudinal design was employed with a 5-year follow-up period, between 2009 and 2013, under a Korean universal health insurance program. A total of 253 geographical regions were included in the analysis, according to data from the Korean Statistical Office. Data from 9,997 patients, aged ≤ 12 years, were included. We measured the COC over a 5-year period using the Usual Provider Continuity (UPC) index. Random intercept models were calculated to assess the temporal and multilevel relationship between market competition, COC, and hospital admission rate. Results Of the 9,997 patients, 243 (2.4%) were admitted to the hospital in 2009. In the multilevel regression analysis, as the Herfindahl–Hirschman Index increased by 1,000 points (denoting decreased competitiveness), UPC scores also increased (ß = 0.001; p < 0.0001). In multilevel logistic regression analysis, the adjusted odds ratio (OR) for hospital admissions for individuals with lower COC scores (≥ 2 ambulatory visits and a UPC index score of < 1) was 3.61 (95% CI: 2.98–4.38) relative to the reference group (≥ 2 ambulatory visits and a UPC index score of 1). Conclusions Market competition appears to reduce COC; decreased COC was associated with a higher OR for hospital admissions. PMID:26958850

  10. The Core of Care Management: The Role of Authentic Relationships in Caring for Patients with Frequent Hospitalizations.

    PubMed

    Grinberg, Charlotte; Hawthorne, Margaret; LaNoue, Marianna; Brenner, Jeffrey; Mautner, Dawn

    2016-08-01

    In the movement to improve the health of patients with multiple chronic conditions and vulnerabilities, while reducing the need for hospitalizations, care management programs have garnered wide attention and support. The qualitative data presented in this paper sheds new light on key components of successful chronic care management programs. By going beyond a task- and temporal-based framework, this analysis identifies and defines the importance of "authentic healing relationships" in driving individual and systemic change. Drawing on the voices of 30 former clients of the Camden Coalition of Healthcare Providers, the investigators use qualitative methods to identify and elaborate the core elements of the authentic healing relationship-security, genuineness, and continuity-a relationship that is linked to patient motivation and active health management. Although not readily found in the traditional health care delivery system, these authentic healing relationships present significant implications for addressing the persistent health-related needs of patients with frequent hospitalizations. (Population Health Management 2016;19:248-256). PMID:26565379

  11. The Core of Care Management: The Role of Authentic Relationships in Caring for Patients with Frequent Hospitalizations

    PubMed Central

    Hawthorne, Margaret; LaNoue, Marianna; Brenner, Jeffrey

    2016-01-01

    Abstract In the movement to improve the health of patients with multiple chronic conditions and vulnerabilities, while reducing the need for hospitalizations, care management programs have garnered wide attention and support. The qualitative data presented in this paper sheds new light on key components of successful chronic care management programs. By going beyond a task- and temporal-based framework, this analysis identifies and defines the importance of “authentic healing relationships” in driving individual and systemic change. Drawing on the voices of 30 former clients of the Camden Coalition of Healthcare Providers, the investigators use qualitative methods to identify and elaborate the core elements of the authentic healing relationship—security, genuineness, and continuity—a relationship that is linked to patient motivation and active health management. Although not readily found in the traditional health care delivery system, these authentic healing relationships present significant implications for addressing the persistent health-related needs of patients with frequent hospitalizations. (Population Health Management 2016;19:248–256) PMID:26565379

  12. Hospital admissions of hypertension, angina, myocardial infarction and ischemic heart disease peaked at physiologically equivalent temperature 0°C in Germany in 2009-2011.

    PubMed

    Shiue, Ivy; Perkins, David R; Bearman, Nick

    2016-01-01

    We aimed to understand and to provide evidence on relationships of the weather as biometeorological and hospital admissions due to hypertension, angina, myocardial infarction and ischemic heart disease in a national setting in recent years that might help indicate when to expect more admissions for health professionals and the general public. This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified I11 hypertensive heart disease, I13 hypertensive heart and renal disease, I15 secondary hypertension, I20 angina pectoris, I21 acute myocardial infarction and I25 chronic ischemic heart disease by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that covered 13 German States including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). Two-way fractional-polynomial prediction was plotted with 95% confidence intervals. Hospital admissions of hypertension, angina, myocardial infarction, heart disease peaked in winter and early spring when PETs were around 0°C. Admissions had an apparent drop when PETs reached 10°C. More medical resources could have been needed on days when PETs were around 0°C than on other days. While adaptation to such weather change for health professionals and the general public would seem to be imperative, future research with a longitudinal monitoring would still be needed. PMID:26286805

  13. Inequality in Diabetes-Related Hospital Admissions in England by Socioeconomic Deprivation and Ethnicity: Facility-Based Cross-Sectional Analysis

    PubMed Central

    Nishino, Yoshitaka; Gilmour, Stuart; Shibuya, Kenji

    2015-01-01

    Objective To investigate the effect of social deprivation and ethnicity on inpatient admissions due to diabetes in England. Design Facility-based cross-sectional analysis. Setting National Health Service (NHS) trusts in England reporting inpatient admissions with better than 80% data reporting quality from 2010–2011 (355 facilities). Participants Non-obstetric patients over 16 years old in all NHS facilities in England. The sample size after exclusions was 5,147,859 all-cause admissions. Main Outcome Measures The relative risk of inpatient admissions and readmissions due to diabetes adjusted for confounders. Results There were 445,504 diabetes-related hospital admissions in England in 2010, giving a directly (age-sex) standardized rate of 1049.0 per 100,000 population (95% confidence interval (CI): 1046.0–1052.1). The relative risk of inpatient admission in the most deprived quintile was 2.08 times higher than that of the least deprived quintile (95% CI: 2.02–2.14), and the effect of deprivation varied across ethnicities. About 30.1% of patients admitted due to diabetes were readmitted at least once due to diabetes. South Asians showed 2.62 times (95% CI: 2.51 – 2.74) higher admission risk. Readmission risk increased with IMD among white British but not other ethnicities. South Asians showed slightly lower risk of readmission than white British (0.86, 95% CI: 0.80 – 0.94). Conclusions More deprived areas had higher rates of inpatient admissions and readmissions due to diabetes. South Asian British showed higher admission risk and lower readmission risk than white British. However, there was almost no difference by ethnicity in readmission due to diabetes. Higher rates of admission among deprived people may not necessarily reflect higher prevalence, but higher admission rates in south Asian British may be explained by their higher prevalence because their lower readmission risk suggests no inequality in primary care to prevent readmission. Better

  14. Fine Particulate Matter Pollution and Hospital Admissions for Respiratory Diseases in Beijing, China.

    PubMed

    Xiong, Qiulin; Zhao, Wenji; Gong, Zhaoning; Zhao, Wenhui; Tang, Tao

    2015-09-01

    Fine particulate matter has become the premier air pollutant of Beijing in recent years, enormously impacting the environmental quality of the city and the health of the residents. Fine particles with aerodynamic diameters of 0~0.3 μm, 0.3~0.5 μm, and 0.5~1.0 μm, from the yeasr 2007 to 2012, were monitored, and the hospital data about respiratory diseases during the same period was gathered and calculated. Then the correlation between respiratory health and fine particles was studied by spatial analysis and grey correlation analysis. The results showed that the aerial fine particulate matter pollution was mainly distributed in the Zizhuyuan sub-district office. There was a certain association between respiratory health and fine particles. Outpatients with respiratory system disease in this study area were mostly located in the southeastern regions (Balizhuang sub-district office, Ganjiakou sub-district office, Wanshoulu sub-district office, and Yongdinglu sub-district office) and east-central regions (Zizhuyuan sub-district office and Shuangyushu sub-district office) of the study area. Correspondingly, PM₁ (particulate matter with aerodynamic diameter smaller than 1.0 um) concentrations in these regions were higher than those in any other regions. Grey correlation analysis results showed that the correlation degree of the fine particle concentration with the number of outpatients is high, and the smaller fine particles had more obvious effects on respiratory system disease than larger particles. PMID:26402691

  15. Fine Particulate Matter Pollution and Hospital Admissions for Respiratory Diseases in Beijing, China

    PubMed Central

    Xiong, Qiulin; Zhao, Wenji; Gong, Zhaoning; Zhao, Wenhui; Tang, Tao

    2015-01-01

    Fine particulate matter has become the premier air pollutant of Beijing in recent years, enormously impacting the environmental quality of the city and the health of the residents. Fine particles with aerodynamic diameters of 0~0.3 μm, 0.3~0.5 μm, and 0.5~1.0 μm, from the yeasr 2007 to 2012, were monitored, and the hospital data about respiratory diseases during the same period was gathered and calculated. Then the correlation between respiratory health and fine particles was studied by spatial analysis and grey correlation analysis. The results showed that the aerial fine particulate matter pollution was mainly distributed in the Zizhuyuan sub-district office. There was a certain association between respiratory health and fine particles. Outpatients with respiratory system disease in this study area were mostly located in the southeastern regions (Balizhuang sub-district office, Ganjiakou sub-district office, Wanshoulu sub-district office, and Yongdinglu sub-district office) and east-central regions (Zizhuyuan sub-district office and Shuangyushu sub-district office) of the study area. Correspondingly, PM1 (particulate matter with aerodynamic diameter smaller than 1.0 um) concentrations in these regions were higher than those in any other regions. Grey correlation analysis results showed that the correlation degree of the fine particle concentration with the number of outpatients is high, and the smaller fine particles had more obvious effects on respiratory system disease than larger particles. PMID:26402691

  16. Characteristics of admissions and variations in the use of basic investigations, treatments and outcomes in Kenyan hospitals within a new Clinical Information Network

    PubMed Central

    Ayieko, Philip; Ogero, Morris; Makone, Boniface; Julius, Thomas; Mbevi, George; Nyachiro, Wycliffe; Nyamai, Rachel; Were, Fred; Githanga, David; Irimu, Grace; English, Mike

    2016-01-01

    Background Lack of detailed information about hospital activities, processes and outcomes hampers planning, performance monitoring and improvement in low-income countries (LIC). Clinical networks offer one means to advance methods for data collection and use, informing wider health system development in time, but are rare in LIC. We report baseline data from a new Clinical Information Network (CIN) in Kenya seeking to promote data-informed improvement and learning. Methods Data from 13 hospitals engaged in the Kenyan CIN between April 2014 and March 2015 were captured from medical and laboratory records. We use these data to characterise clinical care and outcomes of hospital admission. Results Data were available for a total of 30 042 children aged between 2 months and 15 years. Malaria (in five hospitals), pneumonia and diarrhoea/dehydration (all hospitals) accounted for the majority of diagnoses and comorbidity was found in 17 710 (59%) patients. Overall, 1808 deaths (6%) occurred (range per hospital 2.5%–11.1%) with 1037 deaths (57.4%) occurring by day 2 of admission (range 41%–67.8%). While malaria investigations are commonly done, clinical health workers rarely investigate for other possible causes of fever, test for blood glucose in severe illness or ascertain HIV status of admissions. Adherence to clinical guideline-recommended treatment for malaria, pneumonia, meningitis and acute severe malnutrition varied widely across hospitals. Conclusion Developing clinical networks is feasible with appropriate support. Early data demonstrate that hospital mortality remains high in Kenya, that resources to investigate severe illness are limited, that care provided and outcomes vary widely and that adoption of effective interventions remains slow. Findings suggest considerable scope for improving care within and across sites. PMID:26662925

  17. Re-evaluating the need for hospital admission and observation of pediatric traumatic brain injury after a normal head CT.

    PubMed

    Plackett, Timothy P; Asturias, Sabrina; Tadlock, Matthew; Wright, Franklin; Ton-That, Hieu; Demetriades, Demetrios; Esposito, Thomas; Inaba, Kenji

    2015-10-01

    There is no consensus on the optimal management of pediatric patients with suspected trauma brain injury and a normal head CT. This study characterizes the clinical outcomes of patients with a normal initial CT scan of the head. A retrospective chart review of pediatric blunt trauma patients who underwent head CT for closed head injury at two trauma centers was performed. Charts were reviewed for demographics, neurologic function, CT findings, and complications. 631 blunt pediatric trauma patients underwent a head CT. 63% had a negative CT, 7% had a non-displaced skull fracture, and 31% had an intracranial hemorrhage and/or displaced skull fracture. For patients without intracranial injury, the mean age was 8 years, mean ISS was 5, and 92% had a GCS of 13-15 on arrival. All patients with an initial GCS of 13-15 and no intracranial injury were eventually discharged to home with a normal neurologic exam and no patient required craniotomy. Not admitting those children with an initial GCS of 13-15, normal CT scan, and no other injuries would have saved 1.8 ± 1.5 hospital days per patient. Pediatric patients who have sustained head trauma, have a negative CT scan, and present with a GCS 13-15 can safely be discharged home without admission. PMID:25957025

  18. Prevalence of deep vein thrombosis (DVT) in non-surgical patients at hospital admission.

    PubMed

    Lawall, Holger; Hoffmanns, Wibke; Hoffmanns, Phillip; Rapp, Uli; Ames, Michael; Pira, Alessandro; Paar, W Dieter; Bramlage, Peter; Diehm, Curt

    2007-10-01

    Venous thromboembolism (VTE) is known as a common complication in surgical and non-surgical patients. We hypothesized that according to the underlying risk factors and the acute illness, the prevalence ofVTE in non-surgical patients admitted to hospital is widely underestimated. For three months each patient admitted to the department of internal medicine with an acute illness, but without known deep venous thrombosis (DVT) was investigated by ultrasound compression sonography. Patients' history, risk factors and extent of immobilisation were documented. In patients with newly detected DVT D-dimer and fibrinogen were measured as well as computer tomography scans performed. Follow-up investigations of the DVT population were performed at four weeks and three months. Six hundred seventeen patients (49.3% men) were included. In 16 patients (men = 7) a previously unknown thrombosis (2.6%) was detected, mainly in patients with acute cardio-pulmonary disease (56%) and the elderly (mean age 75.6 years). Eight patients had femoro-popliteal (50.0%), four a femoral (25.0%), and four a popliteal vein thrombosis (25.0%). Five had pulmonary embolism (31.3%). In patients with DVT D-dimer was 875 +/- 1,228 mg/l, fibrinogen 568 +/- 215 mg/dl and C-reactive-protein 58.54 +/- 73.65 mg/dl. One patient died from sepsis during hospitalisation, one died from sudden cardiac death at home. None of the other 14 surviving patients relapsed. The study shows a 2.6% risk for DVT in outpatients with acute illness admitted to the department of internal medicine. These data demonstrate the high risk of DVT is in non-surgical patients. Early prophylaxis has to be considered in internal medicine patients especially in the elderly. PMID:17938799

  19. Demographic and socioeconomic inequalities in the risk of emergency hospital admission for violence: cross-sectional analysis of a national database in Wales

    PubMed Central

    Fone, David; Gartner, Andrea; Bellis, Mark A

    2016-01-01

    Objectives To investigate the risk of emergency hospital admissions for violence (EHAV) associated with demographic and socioeconomic factors in Wales between 2007/2008 and 2013/2014, and to describe the site of injury causing admission. Design Database analysis of 7 years’ hospital admissions using the Patient Episode Database for Wales (PEDW). Setting and participants Wales, UK, successive annual populations ∼2.8 million aged 0–74 years. Primary outcome The first emergency admission for violence in each year of the study, defined by the International Classification of Diseases V.10 (ICD-10) codes for assaults (X85-X99, Y00-Y09) in any coding position. Results A total of 11 033 admissions for assault. The majority of admissions resulted from head injuries. The overall crude admission rate declined over the study period, from 69.9 per 100 000 to 43.2 per 100 000, with the largest decrease in the most deprived quintile of deprivation. A generalised linear count model with a negative binomial log link, adjusted for year, age group, gender, deprivation quintile and settlement type, showed the relative risk was highest in age group 18–19 years (RR=6.75, 95% CI 5.88 to 7.75) compared with the reference category aged 10–14 years. The risk decreased with age after 25 years. Risk of admission was substantially higher in males (RR=4.55, 95% CI 4.31 to 4.81), for residents of the most deprived areas of Wales (RR=3.60, 95% CI 3.32 to 3.90) compared with the least deprived, and higher in cities (RR=1.37, 95% CI 1.27 to 1.49) and towns (RR=1.32, 95% CI 1.21 to 1.45) compared with villages. Conclusions Despite identifying a narrowing in the gap between prevalence of violence in richer and poorer communities, violence remains strongly associated with young men living in areas of socioeconomic deprivation. There is potential for a greater reduction, given that violence is mostly preventable. Recommendations for reducing inequalities in the risk of

  20. Why are some patients admitted to psychiatric hospital while others are not? A study assessing risk during the admission interview and relationship to outcome.

    PubMed

    Hunt, Glenn E; O'Hara-Aarons, Maureen; O'Connor, Nick; Cleary, Michelle

    2012-04-01

    The aim of this study was to determine what patient characteristics are used to decide whether a patient is or is not admitted to a psychiatric hospital, and what happens to those not admitted. A further aim was to determine if high levels of risk on admission predict seclusions, length of stay, or readmission within 28 days. Data were collected prospectively on consecutive presentations to an admission office via case notes and electronic databases. Eighty percent (100/127) of the adults presenting to the admission office over a typical month were admitted to hospital. Patients were more likely to be admitted if they were experiencing psychosis or exacerbation of schizophrenia, referred by other doctors or mental health teams, had a legal reason for referral, or if they were homeless. There was no association between risk for violence or suicide and seclusion rates, length of stay, or being readmitted within 28 days. It was reassuring to find that 85% of those not admitted were referred to other mental health providers, and none required admission over the following month. This study found high rates of seclusion and readmissions within 1 year, which requires further study to find strategies to reduce these rates. PMID:22039923

  1. Association between Atmospheric Fine Particulate Matter and Hospital Admissions for Chronic Obstructive Pulmonary Disease in Southwestern Taiwan: A Population-Based Study

    PubMed Central

    Hwang, Su-Lun; Guo, Su-Er; Chi, Miao-Ching; Chou, Chiang-Ting; Lin, Yu-Ching; Lin, Chieh-Mo; Chou, Yen-Li

    2016-01-01

    Objectives: This paper reports on the findings of a population-based study to evaluate the relationship between atmospheric fine particulate matter (PM2.5) levels and hospital admissions for chronic obstructive pulmonary disease (COPD) in southwestern Taiwan over a three-year period, 2008–2010. Methods: Data on hospital admissions for COPD and PM2.5 levels were obtained from the National Health Insurance Research database (NHIRD) and the Environmental Protection Administration from 2008 to 2010, respectively. The lag structure of relative risks (RRs) of hospital admissions for COPD was estimated using a Poisson regression model. Results: During the study period, the overall average hospitalization rate of COPD and mean 24-h average level of PM2.5 was 0.18% and 39.37 μg/m3, respectively. There were seasonal variations in PM2.5 concentrations in southwestern Taiwan, with higher PM2.5 concentrations in both spring (average: 48.54 μg/m3) and winter (49.96 μg/m3) than in summer (25.89 μg/m3) and autumn (33.37 μg/m3). Increased COPD admissions were significantly associated with PM2.5 in both spring (February–April) and winter (October–January), with the relative risks (RRs) for every 10 μg/m3 increase in PM2.5 being 1.25 (95% CI = 1.22–1.27) and 1.24 (95% CI = 1.23–1.26), respectively, at a lag zero days (i.e., no lag days). Lag effects on COPD admissions were observed for PM2.5, with the elevated RRs beginning at lag zero days and larger RRs estimates tending to occur at longer lags (up to six days, i.e., lag 0–5 days). Conclusions: In general, findings reveal an association between atmospheric fine particulate matter (PM2.5) and hospital admissions for COPD in southwestern Taiwan, especially during both spring and winter seasons. PMID:27023589

  2. Short-term Effect of Fine Particulate Matter on Children’s Hospital Admissions and Emergency Department Visits for Asthma: A Systematic Review and Meta-analysis

    PubMed Central

    Choi, Won-Jun

    2016-01-01

    Objectives: No children-specified review and meta-analysis paper about the short-term effect of fine particulate matter (PM2.5) on hospital admissions and emergency department visits for asthma has been published. We calculated more precise pooled effect estimates on this topic and evaluated the variation in effect size according to the differences in study characteristics not considered in previous studies. Methods: Two authors each independently searched PubMed and EMBASE for relevant studies in March, 2016. We conducted random effect meta-analyses and mixed-effect meta-regression analyses using retrieved summary effect estimates and 95% confidence intervals (CIs) and some characteristics of selected studies. The Egger’s test and funnel plot were used to check publication bias. All analyses were done using R version 3.1.3. Results: We ultimately retrieved 26 time-series and case-crossover design studies about the short-term effect of PM2.5 on children’s hospital admissions and emergency department visits for asthma. In the primary meta-analysis, children’s hospital admissions and emergency department visits for asthma were positively associated with a short-term 10 μg/m3 increase in PM2.5 (relative risk, 1.048; 95% CI, 1.028 to 1.067; I2=95.7%). We also found different effect coefficients by region; the value in Asia was estimated to be lower than in North America or Europe. Conclusions: We strengthened the evidence on the short-term effect of PM2.5 on children’s hospital admissions and emergency department visits for asthma. Further studies from other regions outside North America and Europe regions are needed for more generalizable evidence. PMID:27499163

  3. Hospital admissions due to diseases of arteries and veins peaked at physiological equivalent temperature -10 to 10 °C in Germany in 2009-2011.

    PubMed

    Shiue, Ivy; Perkins, David R; Bearman, Nick

    2016-04-01

    We aimed to understand relationships of the weather as biometeorological and hospital admissions due to diseases of arteries and veins by subtypes, which have been scarcely studied, in a national setting in recent years. This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1,618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified I70-I79 Diseases of arteries, arterioles and capillaries and I80-I89 Diseases of veins, lymphatic vessels and lymph nodes by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that covered 13 German states including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). Two-way fractional-polynomial prediction was plotted with 95 % confidence intervals. For most of the subtypes from diseases of arteries and veins, hospital admissions slightly peaked in spring and dropped when PET was at 10 °C. There were no other large differences across 12 months. Admissions of peripheral vascular diseases, arterial embolism and thrombosis, phlebitis and thrombophlebitis, oesophageal varices and nonspecific lymphadenitis peaked when PET was between 0 and -10 °C, while others peaked when PET was between 0 and 10 °C. More medical resources could have been needed on days when PETs were at -10 to 10 °C than on other days. Adaptation to such weather change for health professionals and the general public would seem to be imperative. PMID:26631019

  4. Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis

    PubMed Central

    Huntley, A L; Johnson, R; King, A; Morris, R W; Purdy, S

    2016-01-01

    Objectives The aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (non-RCTs, NRCTs) is to investigate the effectiveness and related costs of case management (CM) for patients with heart failure (HF) predominantly based in the community in reducing unplanned readmissions and length of stay (LOS). Setting CM initiated either while as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community. Participants Adults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries. Intervention CM based on nurse coordinated multicomponent care which is applicable to the primary care-based health systems. Primary and secondary outcomes Primary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary healthcare resources. Results 22 studies were included: 17 RCTs and 5 NRCTs. 17 studies described hospital-initiated CM (n=4794) and 5 described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 (95% CI 0.60 to 0.92), p=0.008) and LOS (mean difference −1.28 days (95% CI −2.04 to −0.52), p=0.001) in favour of CM compared with usual care. 9 trials described cost data of which 6 reported no difference between CM and usual care. There were 4 studies of community-initiated CM versus usual care (2 RCTs and 2 NRCTs) with only the 2 NRCTs showing a reduction in admissions. Conclusions Hospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. 9 trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission. PMID:27165648

  5. Aerosol Optical Depth As a Measure of Particulate Exposure Using Imputed Censored Data, and Relationship with Childhood Asthma Hospital Admissions for 2004 in Athens, Greece

    PubMed Central

    Higgs, Gary; Sterling, David A; Aryal, Subhash; Vemulapalli, Abhilash; Priftis, Kostas N; Sifakis, Nicolas I

    2015-01-01

    An understanding of human health implications from atmosphere exposure is a priority in both the geographic and the public health domains. The unique properties of geographic tools for remote sensing of the atmosphere offer a distinct ability to characterize and model aerosols in the urban atmosphere for evaluation of impacts on health. Asthma, as a manifestation of upper respiratory disease prevalence, is a good example of the potential interface of geographic and public health interests. The current study focused on Athens, Greece during the year of 2004 and (1) demonstrates a systemized process for aligning data obtained from satellite aerosol optical depth (AOD) with geographic location and time, (2) evaluates the ability to apply imputation methods to censored data, and (3) explores whether AOD data can be used satisfactorily to investigate the association between AOD and health impacts using an example of hospital admission for childhood asthma. This work demonstrates the ability to apply remote sensing data in the evaluation of health outcomes, that the alignment process for remote sensing data is readily feasible, and that missing data can be imputed with a sufficient degree of reliability to develop complete datasets. Individual variables demonstrated small but significant effect levels on hospital admission of children for AOD, nitrogen oxides (NOx), relative humidity (rH), temperature, smoke, and inversely for ozone. However, when applying a multivari-able model, an association with asthma hospital admissions and air quality could not be demonstrated. This work is promising and will be expanded to include additional years. PMID:25987842

  6. Aerosol optical depth as a measure of particulate exposure using imputed censored data, and relationship with childhood asthma hospital admissions for 2004 in athens, Greece.

    PubMed

    Higgs, Gary; Sterling, David A; Aryal, Subhash; Vemulapalli, Abhilash; Priftis, Kostas N; Sifakis, Nicolas I

    2015-01-01

    An understanding of human health implications from atmosphere exposure is a priority in both the geographic and the public health domains. The unique properties of geographic tools for remote sensing of the atmosphere offer a distinct ability to characterize and model aerosols in the urban atmosphere for evaluation of impacts on health. Asthma, as a manifestation of upper respiratory disease prevalence, is a good example of the potential interface of geographic and public health interests. The current study focused on Athens, Greece during the year of 2004 and (1) demonstrates a systemized process for aligning data obtained from satellite aerosol optical depth (AOD) with geographic location and time, (2) evaluates the ability to apply imputation methods to censored data, and (3) explores whether AOD data can be used satisfactorily to investigate the association between AOD and health impacts using an example of hospital admission for childhood asthma. This work demonstrates the ability to apply remote sensing data in the evaluation of health outcomes, that the alignment process for remote sensing data is readily feasible, and that missing data can be imputed with a sufficient degree of reliability to develop complete datasets. Individual variables demonstrated small but significant effect levels on hospital admission of children for AOD, nitrogen oxides (NOx), relative humidity (rH), temperature, smoke, and inversely for ozone. However, when applying a multivari-able model, an association with asthma hospital admissions and air quality could not be demonstrated. This work is promising and will be expanded to include additional years. PMID:25987842

  7. The Association of Tobacco Control Policies and the Risk of Acute Myocardial Infarction Using Hospital Admissions Data

    PubMed Central

    Jan, Carmen; Lee, Marcos; Roa, Reina; Herrera, Víctor; Politis, Michael; Motta, Jorge

    2014-01-01

    Objective To evaluate the association of a nationwide comprehensive smoking ban (CSB) and tobacco tax increase (TTI) on the risk of acute myocardial infarctions (AMI) in Panama for the period of 2006 – 2010 using hospital admissions data. Methods Data of AMI cases was gathered from public and private hospitals in the country for the period of January 1, 2006 to December 31, 2010. The number of AMI cases was calculated on a monthly basis. The risk of AMI was estimated for the pre-CSB period (January 2006 to April 2008) and was used as a reference point. Three post-intervention periods were examined: (1) post-CSB from May 2008 to April 2009 (12 months); (2) post-CSB from May 2009 to November 2009 (7 months); and (3) post-TTI from December 2009 to December 2010 (13 months). Relative risks (RR) of AMI were estimated for each post intervention periods by using a Poisson regression model. Mortality registries for the country attributed to myocardial infarction (MI) were obtained from January 2001 to December 2012. The annual percentage change (APC) of the number of deaths from MI was calculated using Joinpoint regression analysis. Results A total sample size of 2191 AMI cases was selected (monthly mean number of cases 36.52±8.24 SD). Using the pre-CSB as a reference point (RR = 1.00), the relative risk of AMI during the first CSB period, the second CSB period and post-TTI were 0.982, 1.049, and 0.985, respectively. The APC of deaths from MI from January 2001 to April 2008 was 0.5%. From January 2001 to June 2010 the APC trend was 0.47% and from July 2010 to December 2012 the APC was –0.3%. Conclusions The implementation of a CSB and TTI in Panama were associated with a decrease in tobacco consumption and a reduction of the RR of AMI. PMID:24520421

  8. PREVALENCE OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS FROM NOSE AND THROAT OF PATIENTS ON ADMISSION TO MEDICAL WARDS OF DR SOETOMO HOSPITAL, SURABAYA, INDONESIA.

    PubMed

    Kuntaman, K; Hadi, Usman; Setiawan, Firman; Koendori, Eko Budi; Rusli, Musofa; Santosaningsih, Dewi; Severin, Juliette; Verbrugh, Henri A

    2016-01-01

    Epidemiological data of methicillin resistant Staphylococcus aureus (MRSA) carriage in Indonesian hospitals are still scarce. These data are required for health management of infectious diseases in order to control hospital MRSA. The carriage rate of MRSA in nose and throat of patients on admission to Dr Soetomo Hospital Surabaya, Indonesia was 8.1% of 643 patients, 5.4% from throat, 3.9% from nose and 1.2% from both sites. Prevalence of MRSA among patients admitted to surgical and non-surgical ward was not different (8.2% and 8.0%, respectively). Although MRSA prevalence in Indonesian hospitals is low compared to many other countries worldwide, appropriate health strategies will be needed to be implemented if this infection is to be controlled. PMID:27086426

  9. Alcohol and risk of admission to hospital for unintentional cutting or piercing injuries at home: a population-based case-crossover study

    PubMed Central

    2011-01-01

    Background Cutting and piercing injuries are among the leading causes of unintentional injury morbidity in developed countries. In New Zealand, cutting and piercing are second only to falls as the most frequent cause of unintentional home injuries resulting in admissions to hospital among people aged 20 to 64 years. Alcohol intake is known to be associated with many other types of injury. We used a case-crossover study to investigate the role of acute alcohol use (i.e., drinking during the previous 6 h) in unintentional cutting or piercing injuries at home. Methods A population-based case-crossover study was conducted. We identified all people aged 20 to 64 years, resident in one of three regions of the country (Greater Auckland, Waikato and Otago), who were admitted to public hospital within 48 h of an unintentional non-occupational cutting or piercing injury sustained at home (theirs or another's) from August 2008 to December 2009. The main exposure of interest was use of alcohol in the 6-hour period before the injury occurred and the corresponding time intervals 24 h before, and 1 week before, the injury. Other information was collected on known and potential confounders. Information was obtained during face-to-face interviews with cases, and through review of their medical charts. Results Of the 356 participants, 71% were male, and a third sustained injuries from contact with glass. After adjustment for other paired exposures, the odds ratio for injury after consuming 1 to 3 standard drinks of alcohol during the 6-hour period before the injury (compared to the day before), compared to none, was 1.77 (95% confidence interval 0.84 to 3.74), and for four or more drinks was 8.68 (95% confidence interval 3.11 to 24.3). Smokers had higher alcohol-related risks than non-smokers. Conclusions Alcohol consumption increases the odds of unintentional cutting or piercing injury occurring at home and this risk increases with higher levels of drinking. PMID:22070787

  10. Effect of a Multidisciplinary Approach for the Management of Patients With Atrial Fibrillation in the Emergency Department on Hospital Admission Rate and Length of Stay.

    PubMed

    Ptaszek, Leon M; White, Benjamin; Lubitz, Steven A; Carnicelli, Anthony P; Heist, E Kevin; Ellinor, Patrick T; Machado, Monique; Wasfy, Jason H; Ruskin, Jeremy N; Armstrong, Katrina; Brown, David F; Biddinger, Paul D; Mansour, Moussa

    2016-07-01

    Management of atrial fibrillation (AF) in the emergency department (ED) is variable because of the absence of universally adopted treatment guidelines. To address potentially preventable hospital admissions and prolonged length of stay, an AF treatment pathway was co-developed by physicians from the cardiac electrophysiology service and the department of emergency medicine at our institution. The impact of this AF pathway on patient outcomes was evaluated with a prospective, observational study conducted in a single tertiary care center from July 1, 2013, to June 30, 2014. The primary study outcome was the rate of hospital admission. The secondary outcomes were duration of ED visit and inpatient length of stay. The 94 patients treated according to the AF pathway during the study period were less likely to be admitted than the 265 patients who received routine care (16% vs 80%, p <0.001). For admitted patients, the mean length of stay was shorter for patients treated according to the AF pathway (32 vs 85 hours, p = 0.002). The time spent in the ED was longer for patients in the AF pathway (16 vs 85 hours, p <0.001). Utilization of a multidisciplinary pathway for management of AF in the ED led to a significant reduction in the rate of hospital admission. Patients who were admitted after receiving care according to the AF pathway had a shorter length of stay. In conclusion, utilization of a multidisciplinary AF pathway resulted in a 5-fold reduction in admission rate and >2-fold reduction length of stay for admitted patients. PMID:27206910

  11. Effect of particulate matter air pollution on hospital admissions and medical visits for lung and heart disease in two southeast Idaho cities.

    PubMed

    Ulirsch, Gregory V; Ball, Louise M; Kaye, Wendy; Shy, Carl M; Lee, Carolyn V; Crawford-Brown, Douglas; Symons, Michael; Holloway, Tracey

    2007-08-01

    Few, if any, published time series studies have evaluated the effects of particulate matter air exposures by combining hospital admissions with medical visit data for smaller populations. We investigated the relationship between daily particulate matter (<10 microm in aerometric diameter or PM10) exposures with admissions and medical visits (emergency room, urgent care, and family practice) for respiratory and cardiovascular disease in Pocatello and Chubbuck, Idaho (population about 60,000), from November 1994 through March 2000. Within generalized linear models, time, weather, influenza, and day-of-week effects were controlled. In single-pollutant models, respiratory disease admissions and visits increased (7.1-15.4% per 50 microg/m3 PM10) for each age group analyzed, with the highest increases in two groups, children and especially the elderly. Statistical analyses suggest that the results probably did not occur by chance. Sensitivity analyses did not provide strong evidence that the respiratory disease effect estimates were sensitive to reasonable changes in the final degrees of freedom choice for time and weather effects. No strong evidence of confounding by NO2 and SO2 was found from results of multi-pollutant models. Ozone and carbon monoxide data were not available to include multi-pollutant models, but evidence suggests that they were not a problem. Unexpectedly, evidence of an association between PM10 with cardiovascular disease was not found, possibly due to the lifestyles of the mostly Mormon study population. Successful time series analyses can be performed on smaller populations if diverse, centralized databases are available. Hospitals that offer urgent or other primary care services may be a rich source of data for researchers. Using data that potentially represented a wide-range of disease severity, the findings provide evidence that evaluating only hospital admissions or emergency room visit effects may underestimate the overall morbidity due to

  12. Risk factors associated with NSAID-induced upper gastrointestinal bleeding resulting in hospital admissions: A cross-sectional, retrospective, case series analysis in valencia, spain

    PubMed Central

    Marco, José Luis; Amariles, Pedro; Boscá, Beatriz; Castelló, Ana

    2007-01-01

    Abstract Background NSAIDs are a significant cause of drug-related hospital admissions and deaths. The therapeutic effects of NSAIDs have been associated with the risk for developing adverse events, mainly in the gastrointestinal tract. Objectives The focus of this study was to identify the most common risk factors associated with NSAID-induced upper gastrointestinal bleeding (UGIB) resulting in hospital admissions. A secondary end point was the relationship between use of gastroprotective treatment and relevant risk factors to NSAID-induced UGIB in the selected population. Methods This study was a cross-sectional, retrospective, case-series analysis of NSAID-induced UGIB resulting in hospital admission to the Requena General Hospital, Valencia, Spain, occurring from 1997 to 2005. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify UGIB admissions associated with NSAIDs. To estimate the probability of association between UGIB and the use of NSAIDs, the Naranjo adverse drug reaction probability was used. Patients were categorized as high-risk to develop UGIB if they met ≥1 of the following risk criteria (relevant risk factors): aged ≥65 years (age risk factor); peptic ulcer disease or NSAID gastropathy occurring in the year before their hospital admission (history risk factor); and concomitant use of other NSAIDs, systemic corticoids, oral anticoagulants, or platelet aggregation inhibitors (concomitant medication risk factor). Patients were categorized as candidates to use gastroprotections if they met ≥1 of the relevant risk factors. Patients were categorized as users of gastroprotective treatment if they used proton pump inhibitors, histamine H2-receptor antagonists, or misoprostol at hospital admission. Results This study comprised 209 cases of NSAID-induced UGIB (129 men, 80 women: mean [SD] age, 71.5 [13.8] years; 128 [61.2%] receiving acetyl salicylic acid [ASA], with 72 [34.4%] receiving low

  13. The impact of source contribution uncertainty on the effects of source-specific PM2.5 on hospital admissions: a case study in Boston, MA.

    PubMed

    Kioumourtzoglou, Marianthi-Anna; Coull, Brent A; Dominici, Francesca; Koutrakis, Petros; Schwartz, Joel; Suh, Helen

    2014-07-01

    Epidemiologic studies of particulate sources and adverse health do not account for the uncertainty in the source contribution estimates. Our goal was to assess the impact of uncertainty on the effect estimates of particulate sources on emergency cardiovascular (CVD) admissions. We examined the effects of PM2.5 sources, identified by positive matrix factorization (PMF) and absolute principle component analysis (APCA), on emergency CVD hospital admissions among Medicare enrollees in Boston, MA, during 2003-2010, given stronger associations for this period. We propagated uncertainty in source contributions using a block bootstrap procedure. We further estimated average across-methods source-specific effect estimates using bootstrap samples. We estimated contributions for regional, mobile, crustal, residual oil combustion, road dust, and sea salt sources. Accounting for uncertainty, same-day exposures to regional pollution were associated with an across-methods average effect of 2.00% (0.18, 3.78%) increase in the rate of CVD admissions. Weekly residual oil exposures resulted in an average 2.12% (0.19, 4.22%) increase. Same-day and 2-day exposures to mobile-related PM2.5 were also associated with increased admissions. Confidence intervals when accounting for the uncertainty were wider than otherwise. Agreement in PMF and APCA results was stronger when uncertainty was considered in health models. Accounting for uncertainty in source contributions leads to more stable effect estimates across methods and potentially to fewer spurious significant associations. PMID:24496220

  14. A tale of two cities: effects of air pollution on hospital admissions in Hong Kong and London compared.

    PubMed

    Wong, Chit-Ming; Atkinson, Richard W; Anderson, H Ross; Hedley, Anthony Johnson; Ma, Stefan; Chau, Patsy Yuen-Kwan; Lam, Tai-Hing

    2002-01-01

    The causal interpretation of reported associations between daily air pollution and daily admissions requires consideration of residual confounding, correlation between pollutants, and effect modification. If results obtained in Hong Kong and London--which differ in climate, lifestyle, and many other respects--were similar, a causal association would be supported. We used identical statistical methods for the analysis in each city. Associations between daily admissions and pollutant levels were estimated using Poisson regression. Nonparametric smoothing methods were used to model seasonality and the nonlinear dependence of admissions on temperature, humidity, and influenza admissions. For respiratory admissions (> or = 65 years of age), significant positive associations were observed with particulate matter < 10 microm in aerodynamic diameter (PM(10), nitrogen dioxide, sulfur dioxide, and ozone in both cities. These associations tended to be stronger at shorter lags in Hong Kong and at longer lags in London. Associations were stronger in the cool season in Hong Kong and in the warm season in London, periods during which levels of humidity are at their lowest in each city. For cardiac admissions (all ages) in both cities, significant positive associations were observed for PM(10), NO(2), and SO(2) with similar lag patterns. Associations tended to be stronger in the cool season. The associations with NO(2) and SO(2) were the most robust in two-pollutant models. Patterns of association for pollutants with ischemic heart disease were similar in the two cities. The associations between O(3) and cardiac admissions were negative in London but positive in Hong Kong. We conclude that air pollution has remarkably similar associations with daily cardiorespiratory admissions in both cities, in spite of considerable differences between cities in social, lifestyle, and environmental factors. The results strengthen the argument that air pollution causes detrimental short

  15. Associations of PM2.5 Constituents and Sources with Hospital Admissions: Analysis of Four Counties in Connecticut and Massachusetts (USA) for Persons ≥ 65 Years of Age

    PubMed Central

    Ebisu, Keita; Leaderer, Brian P.; Gent, Janneane F.; Lee, Hyung Joo; Koutrakis, Petros; Wang, Yun; Dominici, Francesca; Peng, Roger D.

    2013-01-01

    Background: Epidemiological studies have demonstrated associations between short-term exposure to PM2.5 and hospital admissions. The chemical composition of particles varies across locations and time periods. Identifying the most harmful constituents and sources is an important health and regulatory concern. Objectives: We examined pollutant sources for associations with risk of hospital admissions for cardiovascular and respiratory causes. Methods: We obtained PM2.5 filter samples for four counties in Connecticut and Massachusetts and analyzed them for PM2.5 elements. Source apportionment was used to estimate daily PM2.5 contributions from sources (traffic, road dust, oil combustion, and sea salt as well as a regional source representing coal combustion and other sources). Associations between daily PM2.5 constituents and sources and risk of cardiovascular and respiratory hospitalizations for the Medicare population (> 333,000 persons ≥ 65 years of age) were estimated with time-series analyses (August 2000–February 2004). Results: PM2.5 total mass and PM2.5 road dust contribution were associated with cardiovascular hospitalizations, as were the PM2.5 constituents calcium, black carbon, vanadium, and zinc. For respiratory hospitalizations, associations were observed with PM2.5 road dust, and sea salt as well as aluminum, calcium, chlorine, black carbon, nickel, silicon, titanium, and vanadium. Effect estimates were generally robust to adjustment by co-pollutants of other constituents. An interquartile range increase in same-day PM2.5 road dust (1.71 μg/m3) was associated with a 2.11% (95% CI: 1.09, 3.15%) and 3.47% (95% CI: 2.03, 4.94%) increase in cardiovascular and respiratory admissions, respectively. Conclusions: Our results suggest some particle sources and constituents are more harmful than others and that in this Connecticut/Massachusetts region the most harmful particles include black carbon, calcium, and road dust PM2.5. Citation: Bell ML, Ebisu K

  16. NT-proBNP and Its Correlation with In-Hospital Mortality in the Very Elderly without an Admission Diagnosis of Heart Failure

    PubMed Central

    Spannella, Francesco; Giulietti, Federico; Fedecostante, Massimiliano; Giordano, Piero; Gattafoni, Pisana; Espinosa, Emma; Busco, Franco; Piccinini, Gina; Dessì-Fulgheri, Paolo

    2016-01-01

    Background The diagnosis of heart failure (HF) is often difficult and underestimated in very elderly comorbid patients, especially when an echocardiographic evaluation is not available or feasible. Aim: to evaluate NT-proBNP values and their correlation with in-hospital mortality in a population of very elderly hospitalized for medical conditions other than HF. Methods We performed a prospective observational study on 403 very elderly admitted to an Internal Medicine and Geriatrics Department. Exclusion criterion was an admission diagnosis of HF. Patients with at least one symptom or sign compatible with HF were tested for NT-proBNP. NT-proBNP values < 300 pg/ml were considered as an age-independent exclusion criterion for HF (high negative predictive value), while NT-proBNP values ≥ 1800 pg/ml were considered as a diagnostic criterion. Main comorbidities and laboratory parameters were considered to adjust regression analyses between NT-proBNP and in-hospital mortality. Results NT-proBNP values ≥ 1800 pg/ml were present in 61.0% of patients and 32.8% of patients laid between 300 ≤ NT-proBNP < 1800 pg/ml values. NT-proBNP values were associated with the main indices of disease severity/organ failure considered such as reduced eGFR, reduced albumin and elevated CRP. NT-proBNP values ≥ 1800 pg/ml and ln(NT-proBNP) values were significantly associated with in-hospital mortality independently from the main comorbidities and lab parameters considered. The patients, who were already taking ACE inhibitors/Angiotensin Receptor Blockers before admission, showed lower in-hospital mortality. Conclusions Testing for NT-proBNP should be strongly recommended in the hospitalized very elderly, because of the very high prevalence of underlying HF and its impact on in-hospital mortality, to identify an underlying cardiac involvement that requires appropriate treatment. PMID:27077910

  17. Effects of short-term exposure to air pollution on hospital admissions of young children for acute lower respiratory infections in Ho Chi Minh City, Vietnam.

    PubMed

    Le, Truong Giang; Ngo, Long; Mehta, Sumi; Do, Van Dzung; Thach, T Q; Vu, Xuan Dan; Nguyen, Dinh Tuan; Cohen, Aaron

    2012-06-01

    There is emerging evidence, largely from studies in Europe and North America, that economic deprivation increases the magnitude of morbidity and mortality related to air pollution. Two major reasons why this may be true are that the poor experience higher levels of exposure to air pollution, and they are more vulnerable to its effects--in other words, due to poorer nutrition, less access to medical care, and other factors, they experience more health impact per unit of exposure. The relations among health, air pollution, and poverty are likely to have important implications for public health and social policy, especially in areas such as the developing countries of Asia where air pollution levels are high and many live in poverty. The aims of this study were to estimate the effect of exposure to air pollution on hospital admissions of young children for acute lower respiratory infection (ALRI*) and to explore whether such effects differed between poor children and other children. ALRI, which comprises pneumonia and bronchiolitis, is the largest single cause of mortality among young children worldwide and is responsible for a substantial burden of disease among young children in developing countries. To the best of our knowledge, this is the first study of the health effects of air pollution in Ho Chi Minh City (HCMC), Vietnam. For these reasons, the results of this study have the potential to make an important contribution to the growing literature on the health effects of air pollution in Asia. The study focused on the short-term effects of daily average exposure to air pollutants on hospital admissions of children less than 5 years of age for ALRI, defined as pneumonia or bronchiolitis, in HCMC during 2003, 2004, and 2005. Admissions data were obtained from computerized records of Children's Hospital 1 and Children's Hospital 2 (CH1 and CH2) in HCMC. Nearly all children hospitalized for respiratory illnesses in the city are admitted to one of these two pediatric

  18. Oral Polio Vaccination and Hospital Admissions With Non-Polio Infections in Denmark: Nationwide Retrospective Cohort Study

    PubMed Central

    Sørup, Signe; Stensballe, Lone G.; Krause, Tyra G.; Aaby, Peter; Benn, Christine S.; Ravn, Henrik

    2016-01-01

    Background. Live vaccines may have nonspecific beneficial effects on morbidity and mortality. This study examines whether children who had the live-attenuated oral polio vaccine (OPV) as the most recent vaccine had a different rate of admissions for infectious diseases than children with inactivated diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine (DTaP-IPV-Hib) or live measles-mumps-rubella vaccine (MMR) as their most recent vaccine. Methods. A nationwide, register-based, retrospective cohort study of 137 403 Danish children born 1997–1999, who had received 3 doses of DTaP-IPV-Hib, were observed from 24 months (first OPV dose) to 36 months of age. Results. Oral polio vaccine was associated with a lower rate of admissions with any type of non-polio infection compared with DTaP-IPV-Hib as most recent vaccine (adjusted incidence rate ratio [IRR], 0.85; 95% confidence interval [CI], .77–.95). The association was separately significant for admissions with lower respiratory infections (adjusted IRR, 0.73; 95% CI, .61–.87). The admission rates did not differ for OPV versus MMR. Conclusions. Like MMR, OPV was associated with fewer admissions for lower respiratory infections than having DTaP-IPV-Hib as the most recent vaccination. Because OPV is now being phased-out globally, further studies of the potential beneficial nonspecific effects of OPV are warranted. PMID:26885538

  19. Oral Polio Vaccination and Hospital Admissions With Non-Polio Infections in Denmark: Nationwide Retrospective Cohort Study.

    PubMed

    Sørup, Signe; Stensballe, Lone G; Krause, Tyra G; Aaby, Peter; Benn, Christine S; Ravn, Henrik

    2016-01-01

    Background.  Live vaccines may have nonspecific beneficial effects on morbidity and mortality. This study examines whether children who had the live-attenuated oral polio vaccine (OPV) as the most recent vaccine had a different rate of admissions for infectious diseases than children with inactivated diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine (DTaP-IPV-Hib) or live measles-mumps-rubella vaccine (MMR) as their most recent vaccine. Methods.  A nationwide, register-based, retrospective cohort study of 137 403 Danish children born 1997-1999, who had received 3 doses of DTaP-IPV-Hib, were observed from 24 months (first OPV dose) to 36 months of age. Results.  Oral polio vaccine was associated with a lower rate of admissions with any type of non-polio infection compared with DTaP-IPV-Hib as most recent vaccine (adjusted incidence rate ratio [IRR], 0.85; 95% confidence interval [CI], .77-.95). The association was separately significant for admissions with lower respiratory infections (adjusted IRR, 0.73; 95% CI, .61-.87). The admission rates did not differ for OPV versus MMR. Conclusions.  Like MMR, OPV was associated with fewer admissions for lower respiratory infections than having DTaP-IPV-Hib as the most recent vaccination. Because OPV is now being phased-out globally, further studies of the potential beneficial nonspecific effects of OPV are warranted. PMID:26885538

  20. Implementation of a Trauma Service Activation and Admission Policy for Very Elderly Trauma Patients: Impact on Hospital Efficiency and Patient Outcomes.

    PubMed

    Kalina, Michael

    2016-06-01

    Very elderly trauma patients (VETs) were routinely admitted to nonsurgical services at our institution; therefore, a trauma service activation and admission policy was implemented. Our goal was to determine policy success and impact on efficiency and outcomes. VETs, defined as trauma patients aged >89 years, admitted before and after policy implementation were reviewed. Demographics included age, gender, Injury Severity Score, Glasgow Coma Score, admission diagnosis, mechanism of injury, admission service, and comorbidities. Efficiency included intensive care unit length of stay (ICU-LOS) and hospital length of stay (H-LOS). Outcomes included complications, discharge disposition, and mortality. Statistical analysis included Chi square, Fisher's exact test, and regression analyses, significance denoted by P < 0.05. 375 VETs were investigated. Demographic analysis revealed differences in Injury Severity Score (9.4 + 5.4 vs 7.2 + 4.0, P < 0.001), coronary artery disease (2.1% vs 38.2%, P < 0.001), neurologic disease (7.4% vs 28.24%, P < 0.001), and intracranial hemorrhage (15.6% vs 6.1%, P = 0.01). The most common mechanism of injury and admission diagnosis was fall and femur fracture. VETs admitted to the trauma service increased from 28.3 per cent to 40.5 per cent, P = 0.02. Efficiency analysis revealed differences in ICU-LOS (4.0 + 4.2 days vs 0.7 + 1.3 days, P < 0.001) and H-LOS (7.3 + 4.9 days vs 6.3 + 5.5 days, P = 0.005). Outcomes analysis revealed differences in pneumonia (0.8% vs 5.3%, P = 0.01), acute respiratory distress syndrome (0% vs 2.3%, P = 0.04), discharge to skilled nursing facility (75.8% vs 57.3%, P < 0.001), but no difference in mortality. Regression analyses revealed that trauma service admission was associated with decreased ICU-LOS and H-LOS. The trauma service activation and admission policy for VETs led to improved hospital efficiency. PMID:27305879

  1. A Telephone Support Program to Reduce Costs and Hospital Admissions for Patients at Risk of Readmissions: Lessons from an Evaluation of a Complex Health Intervention.

    PubMed

    Morello, Renata T; Barker, Anna L; Watts, Jennifer J; Bohensky, Megan A; Forbes, Andrew B; Stoelwinder, Johannes

    2016-06-01

    This study aimed to evaluate the effectiveness of a telephone health coaching and support service provided to members of an Australian private health insurance fund-Telephonic Complex Care Program (TCCP)-on hospital use and associated costs. A case-control pre-post study design was employed using propensity score matching. Private health insurance members (n=273) who participated in TCCP between April and December 2012 (cases) were matched (1:1) to members who had not previously been enrolled in the program or any other disease management programs offered by the insurer (n=232). Eligible members were community dwelling, aged ≥65 years, and had 2 or more hospital admissions in the 12 months prior to program enrollment. Preprogram variables that estimated the propensity score included: participant demographics, diagnoses, and hospital use in the 12 months prior to program enrollment. TCCP participants received one-to-one telephone support, personalized care plan, and referral to community-based services. Control participants continued to access usual health care services. Primary outcomes were number of hospital admission claims and total benefits paid for all health care utilizations in the 12 months following program enrollment. Secondary outcomes included change in total benefits paid, hospital benefits paid, ancillary benefits paid, and total hospital bed days over the 12 months post enrollment. Compared with matched controls, TCCP did not appear to reduce health care utilization or benefits paid in the 12 months following program enrollment. However, program characteristics and implementation may have impacted its effectiveness. In addition, challenges related to evaluating complex health interventions such as TCCP are discussed. (Population Health Management 2016;19:187-195). PMID:26237303

  2. Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission--a randomized trial.

    PubMed

    Kristoffersen, K B; Søgaard, O S; Wejse, C; Black, F T; Greve, T; Tarp, B; Storgaard, M; Sodemann, M

    2009-05-01

    Recent studies have suggested that procalcitonin (PCT) is a safe marker for the discrimination between bacterial and viral infection, and that PCT-guided treatment may lead to substantial reductions in antibiotic use. The present objective was to evaluate the effect of a single PCT measurement on antibiotic use in suspected lower respiratory tract infections (LRTIs) in a Danish hospital setting. In a randomized, controlled intervention study, 223 adult patients admitted to the hospital because of suspicion of LRTI were included with 210 patients available for analysis. Patients were randomized to either PCT-guided treatment or standard treatment. Antibiotic treatment duration in the PCT group was based on the serum PCT value at admission. The cut-off point for recommending antibiotic treatment was PCT > or =0.25 microg/L. Physicians could overrule treatment guidelines. The mean duration of hospital stay was 5.9 days in the PCT group vs. 6.7 days in the control group (p 0.22). The mean duration of antibiotic treatment during hospitalization in the PCT group was 5.1 days on average, as compared to 6.8 days in the control group (p 0.007). In a subgroup analysis of chronic obstructive pulmonary disease patients, the mean length of stay was reduced from 7.1 days in the control group to 4.8 days in the PCT group (p 0.009). It was concluded that the determination of a single PCT value at admission in patients with suspected LRTIs can lead to a reduction in the duration of antibiotic treatment by 25% without compromising outcome. No effect on the length of hospital stay was found. PMID:19416298

  3. Indications to Hospital Admission and Isolation of Children With Possible or Defined Tuberculosis: Systematic Review and Proposed Recommendations for Pediatric Patients Living in Developed Countries. [Corrected].

    PubMed

    Lo Vecchio, Andrea; Bocchino, Marialuisa; Lancella, Laura; Gabiano, Clara; Garazzino, Silvia; Scotto, Riccardo; Raffaldi, Irene; Assante, Luca Rosario; Villani, Alberto; Esposito, Susanna; Guarino, Alfredo

    2015-12-01

    Tuberculosis (TB) is a re-emerging health problem in developed countries. This paper is part of large guidelines on the global management of TB in children, by a group of scientific societies. It describes the indications to hospitalization of children with suspected or diagnosed TB, the isolation measures, hospital discharge, and re-admission into the community. Using the Consensus Conference method, relevant publications in English were identified by means of a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception until 31 December 2014. Available data on indications to hospitalization were mainly indirect and largely derived from observational studies. They include: (1) host-related risk factors, the main being age <12 months, immune deficiencies, and malnutrition; (2) TB-related clinical conditions that resemble those of pneumonia but also include drug-resistance; and (3) social and logistic conditions. The latter are based on opinion and depend on local conditions. Analysis of the literature showed that patients hospitalized with suspected pulmonary TB should be put in precautionary respiratory isolation regardless of their age while they await diagnosis. The general conditions for re-admission into the community are at least 14 days of effective treatment and negative microscopic tests of 3 consecutive samples in previously microscopically positive patients. This is the first paper that provides indications to hospitalization of children with TB. Most recommendations are generally applicable in all developed countries. Some might need an adaptation to local setting, epidemiological, parameters, and availability of specific health-care facilities. PMID:26683914

  4. Desert Dust Outbreaks in Southern Europe: Contribution to Daily PM10 Concentrations and Short-Term Associations with Mortality and Hospital Admissions

    PubMed Central

    Stafoggia, Massimo; Zauli-Sajani, Stefano; Pey, Jorge; Samoli, Evangelia; Alessandrini, Ester; Basagaña, Xavier; Cernigliaro, Achille; Chiusolo, Monica; Demaria, Moreno; Díaz, Julio; Faustini, Annunziata; Katsouyanni, Klea; Kelessis, Apostolos G.; Linares, Cristina; Marchesi, Stefano; Medina, Sylvia; Pandolfi, Paolo; Pérez, Noemí; Querol, Xavier; Randi, Giorgia; Ranzi, Andrea; Tobias, Aurelio; Forastiere, Francesco

    2015-01-01

    Background: Evidence on the association between short-term exposure to desert dust and health outcomes is controversial. Objectives: We aimed to estimate the short-term effects of particulate matter ≤ 10 μm (PM10) on mortality and hospital admissions in 13 Southern European cities, distinguishing between PM10 originating from the desert and from other sources. Methods: We identified desert dust advection days in multiple Mediterranean areas for 2001–2010 by combining modeling tools, back-trajectories, and satellite data. For each advection day, we estimated PM10 concentrations originating from desert, and computed PM10 from other sources by difference. We fitted city-specific Poisson regression models to estimate the association between PM from different sources (desert and non-desert) and daily mortality and emergency hospitalizations. Finally, we pooled city-specific results in a random-effects meta-analysis. Results: On average, 15% of days were affected by desert dust at ground level (desert PM10 > 0 μg/m3). Most episodes occurred in spring–summer, with increasing gradient of both frequency and intensity north–south and west–east of the Mediterranean basin. We found significant associations of both PM10 concentrations with mortality. Increases of 10 μg/m3 in non-desert and desert PM10 (lag 0–1 days) were associated with increases in natural mortality of 0.55% (95% CI: 0.24, 0.87%) and 0.65% (95% CI: 0.24, 1.06%), respectively. Similar associations were estimated for cardio-respiratory mortality and hospital admissions. Conclusions: PM10 originating from the desert was positively associated with mortality and hospitalizations in Southern Europe. Policy measures should aim at reducing population exposure to anthropogenic airborne particles even in areas with large contribution from desert dust advections. Citation: Stafoggia M, Zauli-Sajani S, Pey J, Samoli E, Alessandrini E, Basagaña X, Cernigliaro A, Chiusolo M, Demaria M, Díaz J, Faustini A

  5. Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial

    PubMed Central

    Hanley, Janet; McCloughan, Lucy; Todd, Allison; Krishan, Ashma; Lewis, Stephanie; Stoddart, Andrew; van der Pol, Marjon; MacNee, William; Sheikh, Aziz; Pagliari, Claudia; McKinstry, Brian

    2013-01-01

    Objective To test the effectiveness of telemonitoring integrated into existing clinical services such that intervention and control groups have access to the same clinical care. Design Researcher blind, multicentre, randomised controlled trial. Setting UK primary care (Lothian, Scotland). Participants Adults with at least one admission for chronic obstructive pulmonary disease (COPD) in the year before randomisation. We excluded people who had other significant lung disease, who were unable to provide informed consent or complete the study, or who had other significant social or clinical problems. Interventions Participants were recruited between 21 May 2009 and 28 March 2011, and centrally randomised to receive telemonitoring or conventional self monitoring. Using a touch screen, telemonitoring participants recorded a daily questionnaire about symptoms and treatment use, and monitored oxygen saturation using linked instruments. Algorithms, based on the symptom score, generated alerts if readings were omitted or breached thresholds. Both groups received similar care from existing clinical services. Main outcome measures The primary outcome was time to hospital admission due to COPD exacerbation up to one year after randomisation. Other outcomes included number and duration of admissions, and validated questionnaire assessments of health related quality of life (using St George’s respiratory questionnaire (SGRQ)), anxiety or depression (or both), self efficacy, knowledge, and adherence to treatment. Analysis was intention to treat. Results Of 256 patients completing the study, 128 patients were randomised to telemonitoring and 128 to usual care; baseline characteristics of each group were similar. The number of days to admission did not differ significantly between groups (adjusted hazard ratio 0.98, 95% confidence interval 0.66 to 1.44). Over one year, the mean number of COPD admissions was similar in both groups (telemonitoring 1.2 admissions per person

  6. Asthma prescribing, ethnicity and risk of hospital admission: an analysis of 35,864 linked primary and secondary care records in East London.

    PubMed

    Hull, Sally A; McKibben, Shauna; Homer, Kate; Taylor, Stephanie Jc; Pike, Katy; Griffiths, Chris

    2016-01-01

    Inappropriate prescribing in primary care was implicated in nearly half of asthma deaths reviewed in the UK's recent National Review of Asthma Deaths. Using anonymised EMIS-Web data for 139 ethnically diverse general practices (total population 942,511) extracted from the North and East London Commissioning Support Unit, which holds hospital Secondary Uses Services (SUS)-linked data, we examined the prevalence of over-prescribing of short-acting β2-agonist inhalers (SABA), under-prescribing of inhaled corticosteroid (ICS) inhalers and solo prescribing of long-acting β2-agonists (LABA) to assess the risk of hospitalisation for people with asthma for 1 year ending August 2015. In a total asthma population of 35,864, multivariate analyses in adults showed that the risk of admission increased with greater prescription of SABA inhalers above a baseline of 1-3 (4-12 SABA: odds ratio (OR) 1.71; 95% confidence interval (CI) 1.20-2.46, ⩾13 SABA: OR 3.22; 95% CI 2.04-5.07) with increasing British Thoracic Society step (Step 3: OR 2.90; 95% CI 1.79-4.69, Step 4/5: OR 9.42; 95% CI 5.27-16.84), and among Black (OR 2.30; 95% CI 1.64-3.23) and south Asian adult populations (OR 1.83; 95% CI 1.36-2.47). Results in children were similar, but risk of hospitalisation was not related to ethnic group. There is a progressive risk of hospital admission associated with the prescription of more than three SABA inhalers a year. Adults (but not children) from Black and South Asian groups are at an increased risk of admission. Further work is needed to target care for these at-risk groups. PMID:27537194

  7. Asthma prescribing, ethnicity and risk of hospital admission: an analysis of 35,864 linked primary and secondary care records in East London

    PubMed Central

    Hull, Sally A; McKibben, Shauna; Homer, Kate; Taylor, Stephanie JC; Pike, Katy; Griffiths, Chris

    2016-01-01

    Inappropriate prescribing in primary care was implicated in nearly half of asthma deaths reviewed in the UK’s recent National Review of Asthma Deaths. Using anonymised EMIS-Web data for 139 ethnically diverse general practices (total population 942,511) extracted from the North and East London Commissioning Support Unit, which holds hospital Secondary Uses Services (SUS)–linked data, we examined the prevalence of over-prescribing of short-acting β2-agonist inhalers (SABA), under-prescribing of inhaled corticosteroid (ICS) inhalers and solo prescribing of long-acting β2-agonists (LABA) to assess the risk of hospitalisation for people with asthma for 1 year ending August 2015. In a total asthma population of 35,864, multivariate analyses in adults showed that the risk of admission increased with greater prescription of SABA inhalers above a baseline of 1–3 (4–12 SABA: odds ratio (OR) 1.71; 95% confidence interval (CI) 1.20–2.46, ⩾13 SABA: OR 3.22; 95% CI 2.04–5.07) with increasing British Thoracic Society step (Step 3: OR 2.90; 95% CI 1.79–4.69, Step 4/5: OR 9.42; 95% CI 5.27–16.84), and among Black (OR 2.30; 95% CI 1.64–3.23) and south Asian adult populations (OR 1.83; 95% CI 1.36–2.47). Results in children were similar, but risk of hospitalisation was not related to ethnic group. There is a progressive risk of hospital admission associated with the prescription of more than three SABA inhalers a year. Adults (but not children) from Black and South Asian groups are at an increased risk of admission. Further work is needed to target care for these at-risk groups. PMID:27537194

  8. The impact of 9/11 on the association of ambient air pollution with daily respiratory hospital admissions in a Canada-US border city, Windsor, Ontario.

    PubMed

    Luginaah, Isaac; Fung, Karen Y; Gorey, Kevin M; Khan, Shahedul

    2006-08-01

    The 11 September 2001 (9/11) terrorist attacks in the United States resulted in long lines of trucks at the border crossing in Windsor, Ontario. Public concern about the potential impact of these trucks spewing toxic pollutants into the air drew attention to the need to investigate the impact of 9/11 on the daily levels of air pollutants and respiratory hospitalization. In this study, significant increases in respiratory admissions were found one month and 6 months post-9/11. Mean daily respiratory admission was also significantly higher than the same period one year earlier and one year later. SO(2) and CO concentration levels were found to be generally higher after 9/11 than one year before and immediately before. Relative risk estimates of respiratory hospitalization after 9/11 showed that SO(2) (RR̂ = 1.15 for two-day, RR̂ = 1.18 for three-day, and RR̂ = 1.21 for five-day averages), NO(2) (RR̂ = 1.10 for current day), and COH (RR̂ = 1.09 for current day, RR̂ = 1.10 for two-day average) had the most significant effects after 9/11. These results suggest the need for more stringent regulatory efforts in air quality in the region in response to the changing transportation dynamics at this Canada-US border crossing. PMID:21234298

  9. The Global Contribution of Outdoor Air Pollution to the Incidence, Prevalence, Mortality and Hospital Admission for Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

    PubMed Central

    Song, Qingkun; Christiani, David C.; Wang, Xiaorong; Ren, Jun

    2014-01-01

    Objective: This study aimed to investigate the quantitative effects of outdoor air pollution, represented by 10 µg/m3 increment of PM10, on chronic obstructive pulmonary disease in China, United States and European Union through systematic review and meta-analysis. Methods: Publications in English and Chinese from PubMed and EMBASE were selected. The Cochrane Review Handbook of Generic Inverse Variance was used to synthesize the pooled effects on incidence, prevalence, mortality and hospital admission. Results: Outdoor air pollution contributed to higher incidence and prevalence of COPD. Short-term exposure was associated with COPD mortality increased by 6%, 1% and 1% in the European Union, the United States and China, respectively (p < 0.05). Chronic PM exposure produced a 10% increase in mortality. In a short-term exposure to 10 µg/m3 PM10 increment COPD mortality was elevated by 1% in China (p < 0.05) and hospital admission enrollment was increased by 1% in China, 2% in United States and 1% in European Union (p < 0.05). Conclusions: Outdoor air pollution contributes to the increasing burdens of COPD.10 µg/m3 increase of PM10 produced significant condition of COPD death and exacerbation in China, United States and European Union. Controlling air pollution will have substantial benefit to COPD morbidity and mortality. PMID:25405599

  10. Frequency of Intensive Care Unit admission after elective interventional neuroradiological procedures under general anesthesia in a tertiary care hospital

    PubMed Central

    Shamim, Faisal; Asghar, Ali; Karam, Karima

    2015-01-01

    Background: The aim of this study was to determine the frequency of patients admitted to Intensive Care Unit (ICU) after elective interventional neuroradiology (INR) procedures under general anesthesia. Materials and Methods: We retrospectively evaluated 121 patients underwent INR procedures performed with general anesthesia within a 5-year period. Information including demographics, aneurysm/arteriovenous malformations pathology (ruptured or un-ruptured), preoperative neurological status, co-morbidities, complications during procedure and postoperative admission in ICU were recorded on a predesigned form. Results: Elective INR procedure for both ruptured (n = 29, 24%) and un-ruptured (n = 85, 70.25%) aneurysms was performed. Rate of postoperative admission in ICU was significantly high in patients with preoperative ruptured aneurysm (P < 0.01). High rate of neurological deficit, sub-arachnoid hemorrhage (SAH) and hypertension in patients were significant factors of postoperative admission in ICU (P < 0.05). Out of 24 patients, 12 were admitted to ICU postoperatively because of procedure-related complications and 11 were sent due to preexisting significant co-morbidities with added complication of SAH. Conclusion: The authors conclude that patients without major co-morbidities, intraoperative complications, or complex aneurysm morphology can be safely observed in a regular ward rather than being admitted to the ICU. PMID:25558194

  11. Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study.

    PubMed

    Woo, Jung Hoon; Grinspan, Zachary; Shapiro, Jason; Rhee, Sang Youl

    2016-01-01

    The Korean National Health Insurance, which provides universal coverage for the entire Korean population, is now facing financial instability. Frequent emergency department (ED) users may represent a medically vulnerable population who could benefit from interventions that both improve care and lower costs. To understand the nature of frequent ED users in Korea, we analyzed claims data from a population-based national representative sample. We performed both bivariate and multivariable analyses to investigate the association between patient characteristics and frequent ED use (4+ ED visits in a year) using claims data of a 1% random sample of the Korean population, collected in 2009. Among 156,246 total ED users, 4,835 (3.1%) were frequent ED users. These patients accounted for 14% of 209,326 total ED visits and 17.2% of $76,253,784 total medical expenses generated from all ED visits in the 1% data sample. Frequent ED users tended to be older, male, and of lower socio-economic status compared with occasional ED users (p < 0.001 for each). Moreover, frequent ED users had longer stays in the hospital when admitted, higher probability of undergoing an operative procedure, and increased mortality. Among 8,425 primary diagnoses, alcohol-related complaints and schizophrenia showed the strongest positive correlation with the number of ED visits. Among the frequent ED users, mortality and annual outpatient department visits were significantly lower in the alcohol-related patient subgroup compared with other frequent ED users; furthermore, the rate was even lower than that for non-frequent ED users. Our findings suggest that expanding mental health and alcohol treatment programs may be a reasonable strategy to decrease the dependence of these patients on the ED. PMID:26809051

  12. Pattern of Frequent But Nontargeted Pharmacologic Thromboprophylaxis for Hospitalized Patients With Cancer at Academic Medical Centers: A Prospective, Cross-Sectional, Multicenter Study

    PubMed Central

    Zwicker, Jeffrey I.; Rojan, Adam; Campigotto, Federico; Rehman, Nadia; Funches, Renee; Connolly, Gregory; Webster, Jonathan; Aggarwal, Anita; Mobarek, Dalia; Faselis, Charles; Neuberg, Donna; Rickles, Frederick R.; Wun, Ted; Streiff, Michael B.; Khorana, Alok A.

    2014-01-01

    Purpose Hospitalized patients with cancer are considered to be at high risk for venous thromboembolism (VTE). Despite strong recommendations in numerous clinical practice guidelines, retrospective studies have shown that pharmacologic thromboprophylaxis is underutilized in hospitalized patients with cancer. Patients and Methods We conducted a prospective, cross-sectional study of hospitalized patients with cancer at five academic hospitals to determine prescription rates of thromboprophylaxis and factors influencing its use during hospitalization. Results A total of 775 patients with cancer were enrolled across five academic medical centers. Two hundred forty-seven patients (31.9%) had relative contraindications to pharmacologic prophylaxis. Accounting for contraindications to anticoagulation, the overall rate of pharmacologic thromboprophylaxis was 74.2% (95% CI, 70.4% to 78.0%; 392 of 528 patients). Among the patients with cancer without contraindications for anticoagulation, individuals hospitalized with nonhematologic malignancies were significantly more likely to receive pharmacologic thromboprophylaxis than those with hematologic malignancies (odds ratio [OR], 2.34; 95% CI, 1.43 to 3.82; P = .007). Patients with cancer admitted for cancer therapy were significantly less likely to receive pharmacologic thromboprophylaxis than those admitted for other reasons (OR, 0.37; 95% CI, 0.22 to 0.61; P < .001). Sixty-three percent of patients with cancer classified as low risk, as determined by the Padua Scoring System, received anticoagulant thromboprophylaxis. Among the 136 patients who did not receive anticoagulation, 58.8% were considered to be high risk by the Padua Scoring System. Conclusion We conclude that pharmacologic thromboprophylaxis is frequently administered to hospitalized patients with cancer but that nearly one third of patients are considered to have relative contraindications for prophylactic anticoagulation. Pharmacologic thromboprophylaxis in

  13. Patient characteristics associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records

    PubMed Central

    Hunter, L C; Lee, R J; Butcher, I; Weir, C J; Fischbacher, C M; McAllister, D; Wild, S H; Hewitt, N; Hardie, R M

    2016-01-01

    Objectives To investigate patient characteristics of an unselected primary care population associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Design Retrospective open cohort using pseudonymised electronic primary care data linked to secondary care data. Setting Primary care; Lothian (population approximately 800 000), Scotland. Participants Data from 7002 patients from 72 general practices with a COPD diagnosis date between 2000 and 2008 recorded in their primary care record. Patients were followed up until 2010, death or they left a participating practice. Main outcome measures First and subsequent admissions for AECOPD (International Classification of Diseases (ICD) 10 codes J44.0, J44.1 in any diagnostic position) after COPD diagnosis in primary care. Results 1756 (25%) patients had at least 1 AECOPD admission; 794 (11%) had at least 1 readmission and the risk of readmission increased with each admission. Older age at diagnosis, more severe COPD, low body mass index (BMI), current smoking, increasing deprivation, COPD admissions and interventions for COPD prior to diagnosis in primary care, and comorbidities were associated with higher risk of first AECOPD admission in an adjusted Cox proportional hazards regression model. More severe COPD and COPD admission prior to primary care diagnosis were associated with increased risk of AECOPD readmission in an adjusted Prentice-Williams-Peterson model. High BMI was associated with a lower risk of first AECOPD admission and readmission. Conclusions Several patient characteristics were associated with first AECOPD admission in a primary care cohort of people with COPD but fewer were associated with readmission. Prompt diagnosis in primary care may reduce the risk of AECOPD admission and readmission. The study highlights the important role of primary care in preventing or delaying a first AECOPD admission. PMID:26801463

  14. Associations of short-term exposure to traffic-related air pollution with cardiovascular and respiratory hospital admissions in London, UK

    PubMed Central

    Samoli, Evangelia; Atkinson, Richard W; Analitis, Antonis; Fuller, Gary W; Green, David C; Mudway, Ian; Anderson, H Ross; Kelly, Frank J

    2016-01-01

    Objectives There is evidence of adverse associations between short-term exposure to traffic-related pollution and health, but little is known about the relative contribution of the various sources and particulate constituents. Methods For each day for 2011–2012 in London, UK over 100 air pollutant metrics were assembled using monitors, modelling and chemical analyses. We selected a priori metrics indicative of traffic sources: general traffic, petrol exhaust, diesel exhaust and non-exhaust (mineral dust, brake and tyre wear). Using Poisson regression models, controlling for time-varying confounders, we derived effect estimates for cardiovascular and respiratory hospital admissions at prespecified lags and evaluated the sensitivity of estimates to multipollutant modelling and effect modification by season. Results For single day exposure, we found consistent associations between adult (15–64 years) cardiovascular and paediatric (0–14 years) respiratory admissions with elemental and black carbon (EC/BC), ranging from 0.56% to 1.65% increase per IQR change, and to a lesser degree with carbon monoxide (CO) and aluminium (Al). The average of past 7 days EC/BC exposure was associated with elderly (65+ years) cardiovascular admissions. Indicated associations were higher during the warm period of the year. Although effect estimates were sensitive to the adjustment for other pollutants they remained consistent in direction, indicating independence of associations from different sources, especially between diesel and petrol engines, as well as mineral dust. Conclusions Our results suggest that exhaust related pollutants are associated with increased numbers of adult cardiovascular and paediatric respiratory hospitalisations. More extensive monitoring in urban centres is required to further elucidate the associations. PMID:26884048

  15. Hospital admissions for severe mental illness in England: Changes in equity of utilisation at the small area level between 2006 and 2010

    PubMed Central

    White, Jonathan; Gutacker, Nils; Jacobs, Rowena; Mason, Anne

    2014-01-01

    Severe Mental Illness (SMI) encompasses a range of chronic conditions including schizophrenia, bipolar disorder and psychoses. Patients with SMI often require inpatient psychiatric care. Despite equity being a key objective in the English National Health Service (NHS) and in many other health care systems worldwide, little is known about the socio-economic equity of hospital care utilisation for patients with SMI and how it has changed over time. This analysis seeks to address that gap in the evidence base. We exploit a five-year (2006–2010) panel dataset of admission rates at small area level (n = 162,410). The choice of control variables was informed by a systematic literature search. To assess changes in socio-economic equity of utilisation, OLS-based standardisation was first used to conduct analysis of discrete deprivation groups. Geographical inequity was then illustrated by plotting standardised and crude admission rates at local purchaser level. Lastly, formal statistical tests for changes in socio-economic equity of utilisation were applied to a continuous measure of deprivation using pooled negative binomial regression analysis, adjusting for a range of risk factors. Our results suggest that one additional percentage point of area income deprivation is associated with a 1.5% (p < 0.001) increase in admissions for SMI after controlling for population size, age, sex, prevalence of SMI in the local population, as well as other need and supply factors. This finding is robust to sensitivity analyses, suggesting that a pro-poor inequality in utilisation exists for SMI-related inpatient services. One possible explanation is that the supply or quality of primary, community or social care for people with mental health problems is suboptimal in deprived areas. Although there is some evidence that inequity has reduced over time, the changes are small and not always robust to sensitivity analyses. PMID:25262312

  16. The formation and design of the 'Acute Admission Database'- a database including a prospective, observational cohort of 6279 patients triaged in the emergency department in a larger Danish hospital

    PubMed Central

    2012-01-01

    Background Management and care of the acutely ill patient has improved over the last years due to introduction of systematic assessment and accelerated treatment protocols. We have, however, sparse knowledge of the association between patient status at admission to hospital and patient outcome. A likely explanation is the difficulty in retrieving all relevant information from one database. The objective of this article was 1) to describe the formation and design of the 'Acute Admission Database', and 2) to characterize the cohort included. Methods All adult patients triaged at the Emergency Department at Hillerød Hospital and admitted either to the observationary unit or to a general ward in-hospital were prospectively included during a period of 22 weeks. The triage system used was a Danish adaptation of the Swedish triage system, ADAPT. Data from 3 different data sources was merged using a unique identifier, the Central Personal Registry number; 1) Data from patient admission; time and date, vital signs, presenting complaint and triage category, 2) Blood sample results taken at admission, including a venous acid-base status, and 3) Outcome measures, e.g. length of stay, admission to Intensive Care Unit, and mortality within 7 and 28 days after admission. Results In primary triage, patients were categorized as red (4.4%), orange (25.2%), yellow (38.7%) and green (31.7%). Abnormal vital signs were present at admission in 25% of the patients, most often temperature (10.5%), saturation of peripheral oxygen (9.2%), Glasgow Coma Score (6.6%) and respiratory rate (4.8%). A venous acid-base status was obtained in 43% of all patients. The majority (78%) had a pH within the normal range (7.35-7.45), 15% had acidosis (pH < 7.35) and 7% had alkalosis (pH > 7.45). Median length of stay was 2 days (range 1-123). The proportion of patients admitted to Intensive Care Unit was 1.6% (95% CI 1.2-2.0), 1.8% (95% CI 1.5-2.2) died within 7 days, and 4.2% (95% CI 3.7-4.7) died within

  17. Shocking Admission

    ERIC Educational Resources Information Center

    Hoover, Eric; Millman, Sierra

    2007-01-01

    Marilee Jones's career had been a remarkable success. She joined Massachusetts Institute of Technology's (MIT's) admissions office in 1979, landing a job in Cambridge at a time when boys ruled the sandbox of the admissions profession. Her job was to help MIT recruit more women, who then made up less than one-fifth of the institute's students. She…

  18. Incidence, characteristics and risk factors of adverse drug reactions in hospitalized children – a prospective observational cohort study of 6,601 admissions

    PubMed Central

    2013-01-01

    Background Adverse drug reactions (ADRs) are an important cause of harm in children. Current data are incomplete due to methodological differences between studies: only half of all studies provide drug data, incidence rates vary (0.6% to 16.8%) and very few studies provide data on causality, severity and risk factors of pediatric ADRs. We aimed to determine the incidence of ADRs in hospitalized children, to characterize these ADRs in terms of type, drug etiology, causality and severity and to identify risk factors. Methods We undertook a year-long, prospective observational cohort study of admissions to a single UK pediatric medical and surgical secondary and tertiary referral center (Alder Hey, Liverpool, UK). Children between 0 and 16 years 11 months old and admitted for more than 48 hours were included. Observed outcomes were occurrence of ADR and time to first ADR for the risk factor analysis. Results A total of 5,118 children (6,601 admissions) were included, 17.7% of whom experienced at least one ADR. Opiate analgesics and drugs used in general anesthesia (GA) accounted for more than 50% of all drugs implicated in ADRs. Of these ADRs, 0.9% caused permanent harm or required admission to a higher level of care. Children who underwent GA were at more than six times the risk of developing an ADR than children without a GA (hazard ratio (HR) 6.40; 95% confidence interval (CI) 5.30 to 7.70). Other factors increasing the risk of an ADR were increasing age (HR 1.06 for each year; 95% CI 1.04 to 1.07), increasing number of drugs (HR 1.25 for each additional drug; 95% CI 1.22 to 1.28) and oncological treatment (HR 1.90; 95% CI 1.40 to 2.60). Conclusions ADRs are common in hospitalized children and children who had undergone a GA had more than six times the risk of developing an ADR. GA agents and opiate analgesics are a significant cause of ADRs and have been underrepresented in previous studies. This is a concern in view of the increasing number of pediatric short

  19. Meta-analysis of the association between short-term exposure to ambient ozone and respiratory hospital admissions

    NASA Astrophysics Data System (ADS)

    Ji, Meng; Cohan, Daniel S.; Bell, Michelle L.

    2011-04-01

    Ozone is associated with health impacts including respiratory outcomes; however, results differ across studies. Meta-analysis is an increasingly important approach to synthesizing evidence across studies. We conducted meta-analysis of short-term ozone exposure and respiratory hospitalizations to evaluate variation across studies and explore some of the challenges in meta-analysis. We identified 136 estimates from 96 studies and investigated how estimates differed by age, ozone metric, season, lag, region, disease category, and hospitalization type. Overall results indicate associations between ozone and various kinds of respiratory hospitalizations; however, study characteristics affected risk estimates. Estimates were similar, but higher, for the elderly compared to all ages and for previous day exposure compared to same day exposure. Comparison across studies was hindered by variation in definitions of disease categories, as some (e.g., asthma) were identified through >= 3 different sets of ICD codes. Although not all analyses exhibited evidence of publication bias, adjustment for publication bias generally lowered overall estimates. Emergency hospitalizations for total respiratory disease increased by 4.47% (95% interval: 2.48, 6.50%) per 10 ppb 24 h ozone among the elderly without adjustment for publication bias and 2.97% (1.05, 4.94%) with adjustment. Comparison of multi-city study results and meta-analysis based on single-city studies further suggested publication bias.

  20. Drug related admissions to medical wards

    PubMed Central

    Hallas, Jesper; Gram, Lars F.; Grodum, Ellen; Damsbo, Niels; Brøsen, Kim; Haghfelt, Torben; Harvald, Bent; Beck-Nielsen, Jørgen; Worm, Jørgen; Birger Jensen, Kurt; Davidsen, Otto; Frandsen, Niels E.; Hagen, Claus; Andersen, Morten; Frølund, Flemming; Kromann-Andersen, Hans; Schou, Jens

    1992-01-01

    1 In total 1999 consecutive admissions to six medical wards were subjected to a prospective high-intensity drug event monitoring scheme to assess the extent and pattern of admissions caused by adverse drug reactions (ADRs) or dose related therapeutic failures (TF), in a population-based design. The wards were sub-specialised in general medicine, geriatrics, endocrinology, cardiology, respiratory medicine and gastroenterology. 2 Considering definite, probable and possible drug events, the prevalence of drug related hospital admissions was 11.4% of which 8.4% were caused by ADRs and 3.0% by TFs. There were large inter-department differences. 3 The six classes of drugs most frequently involved in admissions caused by ADRs were anti-rheumatics and analgesics (27%), cardiovascular drugs (23%), psychotropic drugs (14%), anti-diabetics (12%), antibiotics (7%), and corticosteroids (5%). Non-compliance accounted for 66% of the TFs with diuretics and anti-asthmatics most frequently involved. 4 The pattern of drugs involved in ADRs was compared with the regional drug sales statistics. Drugs with a particularly high rate of ADR related admissions per unit dispensed were nitrofurantoin and insulin (617 and 182 admissions per 1,000,000 defined daily doses), while low rates were seen for diuretics and benzodiazepines (10 and 7 admissions per 1,000,000 defined daily doses). Confidence intervals were wide. 5 Patients who had their therapy prescribed by a hospital doctor had a slightly higher prevalence of drug events than those who were treated by a general practitioner (12.6% vs 11.8%). The reverse applied for drug events assessed as avoidable (3.3% vs 4.6%). Although these differences were not statistically significant, it may suggest general practitioners as the appropriate target for interventive measures. 6 Only one ADR was reported to The Danish Committee on Adverse Drug Reactions, indicating a severe under-reporting and a potential for gross selectivity. The data collection

  1. Disparities among 2009 Pandemic Influenza A (H1N1) Hospital Admissions: A Mixed Methods Analysis – Illinois, April–December 2009

    PubMed Central

    Soyemi, Kenneth; Medina-Marino, Andrew; Sinkowitz-Cochran, Ronda; Schneider, Amy; Njai, Rashid; McDonald, Marian; Glover, Maleeka; Garcia, Jocelyn; Aiello, Allison E.

    2014-01-01

    During late April 2009, the first cases of 2009 pandemic influenza A (H1N1) (pH1N1) in Illinois were reported. On-going, sustained local transmission resulted in an estimated 500,000 infected persons. We conducted a mixed method analysis using both quantitative (surveillance) and qualitative (interview) data; surveillance data was used to analyze demographic distribution of hospitalized cases and follow-up interview data was used to assess health seeking behavior. Invitations to participate in a telephone interview were sent to 120 randomly selected Illinois residents that were hospitalized during April–December 2009. During April–December 2009, 2,824 pH1N1 hospitalizations occurred in Illinois hospitals; median age (interquartile range) at admission was 24 (range: 6–49) years. Hospitalization rates/100,000 persons for blacks and Hispanics, regardless of age or sex were 2–3 times greater than for whites (blacks, 36/100,000 (95% Confidence Interval ([95% CI], 33–39)); Hispanics, 35/100,000 [95%CI,32–37] (; whites, 13/100,000[95%CI, 12–14); p<0.001). Mortality rates were higher for blacks (0.9/100,000; p<0.09) and Hispanics (1/100,000; p<0.04) when compared with the mortality rates for whites (0.6/100,000). Of 33 interview respondents, 31 (94%) stated that they had heard of pH1N1 before being hospitalized, and 24 (73%) did not believed they were at risk for pH1N1. On average, respondents reported experiencing symptoms for 2 days (range: 1–7) before seeking medical care. When asked how to prevent pH1N1 infection in the future, the most common responses were getting vaccinated and practicing hand hygiene. Blacks and Hispanics in Illinois experienced disproportionate pH1N1 hospitalization and mortality rates. Public health education and outreach efforts in preparation for future influenza pandemics should include prevention messaging focused on perception of risk, and ensure community wide access to prevention messages and practices. PMID:24776852

  2. Effect of photochemical smog associated with synoptic weather patterns on cardiovascular and respiratory hospital admissions in metropolitan Taipei.

    PubMed

    Lai, Li-Wei

    2012-01-01

    This study focuses on the relationship between photochemical smog (PS) (hourly ozone conc. >100 ppb), PS-related diseases, and the synoptic weather patterns during 2005-2009 in metropolitan Taipei. The results show that compared to respiratory ailments (ICD code 460-519) and asthma (ICD code 493), cardiovascular ailments (ICD code 390-459) were more clearly influenced by PS events. On the PS event day, the number of admissions of babies, children, and adults increased by 0.04 [95% CI 0.01-0.06], 0.03 [95% CI 0.00-0.07], and 1.12 [95% CI 0.36-1.89] (P < 0.05), respectively. The investigation showed that more than 70% of the PS events were associated primarily with the peripheral circulation of typhoons, Pacific pressure, and discrete Pacific pressure. PS events are a threat to public health. To avoid the ill effects of air pollution, residents should be informed about the daily weather patterns and air quality. PMID:22098558

  3. Who is less likely to die in association with improved National Emergency Access Target (NEAT) compliance for emergency admissions in a tertiary referral hospital?

    PubMed

    Sullivan, Clair; Staib, Andrew; Eley, Rob; Griffin, Bronwyn; Cattell, Rohan; Flores, Judy; Scott, Ian

    2016-04-01

    Objective The aim of the present study was to identify patient and non-patient factors associated with reduced mortality among patients admitted from the emergency department (ED) to in-patient wards in a major tertiary hospital that had previously reported a near halving in mortality in association with a doubling in National Emergency Access Target (NEAT) compliance over a 2-year period from 2012 to 2014. Methods We retrospectively analysed routinely collected data from the Emergency Department Information System (EDIS) and hospital discharge abstracts on all emergency admissions during calendar years 2011 (pre-NEAT interventions) and 2013 (post-NEAT interventions). Patients admitted to short-stay wards and then discharged home, as well as patients dying in the ED, were excluded. Patients included in the study were categorised according to age, time and day of arrival to the ED, mode of transport to the ED, emergency triage category, type of clinical presentation and major diagnostic codes. Results The in-patient mortality rate for emergency admissions decreased from 1.9% (320/17022) in 2011 to 1.2% (202/17162) in 2013 (P<0.001). There was no change from 2011 to 2013 in the percentage of deaths in the ED (0.19% vs 0.17%) or those coded as in-patient palliative care (17.9% vs 22.2%). Although deaths were not associated with age by itself, the mortality rate of older patients admitted to medical wards decreased significantly from 3.5% to 1.7% (P=0.011). A higher mortality rate was seen among patients presenting to ED triage between midnight and 12 noon than at other times in 2011 (2.5% vs 1.5%; P<0.001), but this difference disappeared by 2013 (1.3% vs 1.1%; P=0.150). A similar pattern was seen among patients presenting on weekends versus weekdays: 2.2% versus 1.7% (P=0.038) in 2011 and 1.3% versus 1.1% (P=0.150) in 2013. Fewer deaths were noted among patients with acute cardiovascular or respiratory disease in 2013 than in 2011 (1.7% vs 3.6% and 1.5% vs 3

  4. Why Should I Talk about Emotion? Communication Patterns Associated with Physician Discussion of Patient Expressions of Negative Emotion in Hospital Admission Encounters

    PubMed Central

    Adams, Kristen; Cimino, Jenica EW; Arnold, Robert M.; Anderson, Wendy G.

    2012-01-01

    Objective To describe hospital-based physicians' responses to patients' verbal expressions of negative emotion and identify patterns of further communication associated with different responses. Methods Qualitative analysis of physician-patient admission encounters audio-recorded between August 2008-March 2009 at two hospitals within a university system. A codebook was iteratively developed to identify patients' verbal expressions of negative emotion. We categorized physicians' responses by their immediate effect on further discussion of emotion - focused away (away), focused neither toward nor away (neutral), and focused toward (toward) - and examined further communication patterns following each response type. Results In 79 patients' encounters with 27 physicians, the median expression of negative emotion was 1, range 0–14. Physician responses were 25% away, 43% neutral, and 32% toward. Neutral and toward responses elicited patient perspectives, concerns, social and spiritual issues, and goals for care. Toward responses demonstrated physicians' support, contributing to physician-patient alignment and agreement about treatment. Conclusion Responding to expressions of negative emotion neutrally or with statements that focus toward emotion elicits clinically relevant information and is associated with positive physician-patient relationship and care outcomes. Practice Implications Providers should respond to expressions of negative emotion with statements that allow for or explicitly encourage further discussion of emotion. PMID:22575434

  5. Comparison of CATs, CURB-65 and PMEWS as Triage Tools in Pandemic Influenza Admissions to UK Hospitals: Case Control Analysis Using Retrospective Data

    PubMed Central

    Myles, Puja R.; Nguyen-Van-Tam, Jonathan S.; Lim, Wei Shen; Nicholson, Karl G.; Brett, Stephen J.; Enstone, Joanne E.; McMenamin, James; Openshaw, Peter J. M.; Read, Robert C.; Taylor, Bruce L.; Bannister, Barbara; Semple, Malcolm G.

    2012-01-01

    Triage tools have an important role in pandemics to identify those most likely to benefit from higher levels of care. We compared Community Assessment Tools (CATs), the CURB-65 score, and the Pandemic Medical Early Warning Score (PMEWS); to predict higher levels of care (high dependency - Level 2 or intensive care - Level 3) and/or death in patients at or shortly after admission to hospital with A/H1N1 2009 pandemic influenza. This was a case-control analysis using retrospectively collected data from the FLU-CIN cohort (1040 adults, 480 children) with PCR-confirmed A/H1N1 2009 influenza. Area under receiver operator curves (AUROC), sensitivity, specificity, positive predictive values and negative predictive values were calculated. CATs best predicted Level 2/3 admissions in both adults [AUROC (95% CI): CATs 0.77 (0.73, 0.80); CURB-65 0.68 (0.64, 0.72); PMEWS 0.68 (0.64, 0.73), p<0.001] and children [AUROC: CATs 0.74 (0.68, 0.80); CURB-65 0.52 (0.46, 0.59); PMEWS 0.69 (0.62, 0.75), p<0.001]. CURB-65 and CATs were similar in predicting death in adults with both performing better than PMEWS; and CATs best predicted death in children. CATs were the best predictor of Level 2/3 care and/or death for both adults and children. CATs are potentially useful triage tools for predicting need for higher levels of care and/or mortality in patients of all ages. PMID:22509303

  6. Adverse drug reactions and off-label and unlicensed medicines in children: a prospective cohort study of unplanned admissions to a paediatric hospital

    PubMed Central

    Bellis, Jennifer R; Kirkham, Jamie J; Nunn, Anthony J; Pirmohamed, Munir

    2014-01-01

    Aims To examine the impact of off-label and unlicensed (OLUL) prescribing on adverse drug reactions (ADRs) causing unplanned admissions to a paediatric hospital. Methods Prescription data from a 12 month prospective cohort study of ADRs detected in children admitted to a paediatric hospital were scrutinized. The relative risk for off-label and unlicensed medicines being implicated in an ADR was calculated. Logistic regression analyses were carried out with exposure to off-label and unlicensed medicines and number of off-label and unlicensed medicines administered as predictor variables. Results Off-label and unlicensed medicines were more likely to be implicated in an ADR than authorized medicines (relative risk 1.67, 95% CI 1.38, 2.02, P < 0.001). There was a 25% increase in ADR risk (95% CI 1.16, 1.35, P < 0.001) with each additional authorized medicine and 23% (95% CI 1.10, 1.36, P < 0.001) with each additional off-label or unlicensed medicine. Logistic regression analysis focusing on non-oncology patients demonstrated that the number of authorized medicines (odds ratio 1.33, 95% CI 1.23, 1.44, P < 0.001), but not the number of off-label and unlicensed medicine courses, was a predictor of ADR risk. Conclusions In a heterogeneous population of children admitted to a secondary/tertiary hospital, off-label and unlicensed medicines are more likely to be implicated in an ADR than authorized medicines. This was largely driven by ADRs related to drugs used in oncological practice, where the usage of off-label or unlicensed medicines was associated with a higher ADR risk than in non-oncological areas. PMID:23919928

  7. [The Health Department of Sicily "Regional recommendations for hospital discharge and communication with patients after admission due to a cardiologic event" decree].

    PubMed

    Abrignani, Maurizio Giuseppe; De Luca, Giovanni; Gabriele, Michele; Tourkmani, Nidal

    2014-06-01

    Mortality and rehospitalizations still remain high after discharge for an acute cardiologic event. In this context, hospital discharge represents a potential pitfall for heart disease patients. In the setting of care transitions, the discharge letter is the main instrument of communication between hospital and primary care. Communication, besides, is an integral part of high-quality, patient-centered interventions aimed at improving the discharge process. Inadequate information at discharge significantly affects the quality of treatment compliance and the adoption of lifestyle modifications for an effective secondary prevention. The Health Department of Sicily, in 2013, established a task force with the aim to elaborate "Regional recommendations for hospital discharge and communication with patients after admission due to a cardiologic event", inviting to participate GICR-IACPR and many other scientific societies of cardiology and primary care, as discharge letter and communication are fundamental junctions of care transitions in cardiology. These recommendations have been published as a specific decree and contain: a structured model of discharge letter, which includes all of the parameters characterizing patients at high clinical risk, high thrombotic risk and low risk according to the Consensus document ANMCO/GICR-IACPR/GISE; is thus possible to identify these patients, choosing consequently the most appropriate follow-up pathways. A particular attention has been given to the "Medication Reconciliation" and to the identification of therapeutic targets; an educational Kit, with different forms on cardiac diseases, risk factors, drugs and lifestyle; a check-list about information given to the patient and caregivers. The "Recommendations" represent, in conclusion, the practical realization of the fruitful cooperation between scientific societies and political-administrative institutions that has been realized in Sicily in the last years. PMID:25845093

  8. Shared component modelling as an alternative to assess geographical variations in medical practice: gender inequalities in hospital admissions for chronic diseases

    PubMed Central

    2011-01-01

    Background Small area analysis is the most prevalent methodological approach in the study of unwarranted and systematic variation in medical practice at geographical level. Several of its limitations drive researchers to use disease mapping methods -deemed as a valuable alternative. This work aims at exploring these techniques using - as a case of study- the gender differences in rates of hospitalization in elderly patients with chronic diseases. Methods Design and study setting: An empirical study of 538,358 hospitalizations affecting individuals aged over 75, who were admitted due to a chronic condition in 2006, were used to compare Small Area Analysis (SAVA), the Besag-York-Mollie (BYM) modelling and the Shared Component Modelling (SCM). Main endpoint: Gender spatial variation was measured, as follows: SAVA estimated gender-specific utilization ratio; BYM estimated the fraction of variance attributable to spatial correlation in each gender; and, SCM estimated the fraction of variance shared by the two genders, and those specific for each one. Results Hospitalization rates due to chronic diseases in the elderly were higher in men (median per area 21.4 per 100 inhabitants, interquartile range: 17.6 to 25.0) than in women (median per area 13.7 per 100, interquartile range: 10.8 to 16.6). Whereas Utilization Ratios showed a similar geographical pattern of variation in both genders, BYM found a high fraction of variation attributable to spatial correlation in both men (71%, CI95%: 50 to 94) and women (62%, CI95%: 45 to 77). In turn, SCM showed that the geographical admission pattern was mainly shared, with just 6% (CI95%: 4 to 8) of variation specific to the women component. Conclusions Whereas SAVA and BYM focused on the magnitude of variation and on allocating where variability cannot be due to chance, SCM signalled discrepant areas where latent factors would differently affect men and women. PMID:22188979

  9. The use of digoxin in patients with worsening chronic heart failure: reconsidering an old drug to reduce hospital admissions.

    PubMed

    Ambrosy, Andrew P; Butler, Javed; Ahmed, Ali; Vaduganathan, Muthiah; van Veldhuisen, Dirk J; Colucci, Wilson S; Gheorghiade, Mihai

    2014-05-13

    Digoxin is the oldest cardiac drug still in contemporary use, yet its role in the management of patients with heart failure (HF) remains controversial. A purified cardiac glycoside derived from the foxglove plant, digoxin increases ejection fraction, augments cardiac output, and reduces pulmonary capillary wedge pressure without causing deleterious increases in heart rate or decreases in blood pressure. Moreover, it is also a neurohormonal modulator at low doses. In the pivotal DIG (Digitalis Investigation Group) trial, digoxin therapy was shown to reduce all-cause and HF-specific hospitalizations but had no effect on survival. With the discovery of neurohormonal blockers capable of reducing mortality in HF with reduced ejection fraction, the results of the DIG trial were viewed as neutral, and the use of digoxin declined precipitously. Although modern drug and device-based therapies have dramatically improved the survival of ambulatory patients with HF, outcomes for patients with worsening chronic HF, defined as deteriorating signs and symptoms on standard therapy often leading to unscheduled clinic or emergency department visits or hospitalization, have largely remained unchanged over the past 2 decades. The available data suggest that a therapeutic trial of digoxin may be appropriate in patients with worsening chronic heart failure who remain symptomatic. PMID:24613328

  10. Serum bilirubin value predicts hospital admission in carbon monoxide-poisoned patients. Active player or simple bystander?

    PubMed Central

    Cervellin, Gianfranco; Comelli, Ivan; Buonocore, Ruggero; Picanza, Alessandra; Rastelli, Gianni; Lippi, Giuseppe

    2015-01-01

    OBJECTIVES: Although carbon monoxide poisoning is a major medical emergency, the armamentarium of recognized prognostic biomarkers displays unsatisfactory diagnostic performance for predicting cumulative endpoints. METHODS: We performed a retrospective and observational study to identify all patients admitted for carbon monoxide poisoning during a 2-year period. Complete demographical and clinical information, along with the laboratory data regarding arterial carboxyhemoglobin, hemoglobin, blood lactate and total serum bilirubin, was retrieved. RESULTS: The study population consisted of 38 poisoned patients (23 females and 15 males; mean age 39±21 years). Compared with discharged subjects, hospitalized patients displayed significantly higher values for blood lactate and total serum bilirubin, whereas arterial carboxyhemoglobin and hemoglobin did not differ. In a univariate analysis, hospitalization was significantly associated with blood lactate and total serum bilirubin, but not with age, sex, hemoglobin or carboxyhemoglobin. The diagnostic performance obtained after combining the blood lactate and total serum bilirubin results (area under the curve, 0.90; 95% CI, 0.81-0.99; p<0.001) was better than that obtained for either parameter alone. CONCLUSION: Although it remains unclear whether total serum bilirubin acts as an active player or a bystander, we conclude that the systematic assessment of bilirubin may, alongside lactate levels, provide useful information for clinical decision making regarding carbon monoxide poisoning. PMID:26375565

  11. Association between Air Pollutants and Asthma Emergency Room Visits and Hospital Admissions in Time Series Studies: A Systematic Review and Meta-Analysis

    PubMed Central

    Zheng, Xue-yan; Ding, Hong; Jiang, Li-na; Chen, Shao-wei; Zheng, Jin-ping; Qiu, Min; Zhou, Ying-xue; Chen, Qing; Guan, Wei-jie

    2015-01-01

    Background Air pollution constitutes a significant stimulus of asthma exacerbations; however, the impacts of exposure to major air pollutants on asthma-related hospital admissions and emergency room visits (ERVs) have not been fully determined. Objective We sought to quantify the associations between short-term exposure to air pollutants [ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter ≤10μm (PM10) and PM2.5] and the asthma-related emergency room visits (ERV) and hospitalizations. Methods Systematic computerized searches without language limitation were performed. Pooled relative risks (RRs) and 95% confidence intervals (95%CIs) were estimated using the random-effect models. Sensitivity analyses and subgroup analyses were also performed. Results After screening of 246 studies, 87 were included in our analyses. Air pollutants were associated with significantly increased risks of asthma ERVs and hospitalizations [O3: RR(95%CI), 1.009 (1.006, 1.011); I2 = 87.8%, population-attributable fraction (PAF) (95%CI): 0.8 (0.6, 1.1); CO: RR(95%CI), 1.045 (1.029, 1.061); I2 = 85.7%, PAF (95%CI): 4.3 (2.8, 5.7); NO2: RR(95%CI), 1.018 (1.014, 1.022); I2 = 87.6%, PAF (95%CI): 1.8 (1.4, 2.2); SO2: RR(95%CI), 1.011 (1.007, 1.015); I2 = 77.1%, PAF (95%CI): 1.1 (0.7, 1.5); PM10: RR(95%CI), 1.010 (1.008, 1.013); I2 = 69.1%, PAF (95%CI): 1.1 (0.8, 1.3); PM2.5: RR(95%CI), 1.023 (1.015, 1.031); I2 = 82.8%, PAF (95%CI): 2.3 (1.5, 3.1)]. Sensitivity analyses yielded compatible findings as compared with the overall analyses without publication bias. Stronger associations were found in hospitalized males, children and elderly patients in warm seasons with lag of 2 days or greater. Conclusion Short-term exposures to air pollutants account for increased risks of asthma-related ERVs and hospitalizations that constitute a considerable healthcare utilization and socioeconomic burden. PMID:26382947

  12. Short-Term Effects of Gaseous Pollutants and Particulate Matter on Daily Hospital Admissions for Cardio-Cerebrovascular Disease in Lanzhou: Evidence from a Heavily Polluted City in China

    PubMed Central

    Zheng, Shan; Wang, Minzhen; Wang, Shigong; Tao, Yan; Shang, Kezheng

    2013-01-01

    Panel studies show a consistent association between increase in the cardiovascular hospitalizations with air pollutants in economically developed regions, but little evidence in less developed inland areas. In this study, a time-series analysis was used to examine the specific effects of major air pollutants [particulate matter less than 10 microns in diameter (PM10), sulfur dioxide (SO2), and nitrogen dioxides (NO2)] on daily hospital admissions for cardio-cerebrovascular diseases in Lanzhou, a heavily polluted city in China. We examined the effects of air pollutants for stratified groups by age and gender, and conducted the modifying effect of seasons on air pollutants to test the possible interaction. The significant associations were found between PM10, SO2 and NO2 and cardiac disease admissions, SO2 and NO2 were found to be associated with the cerebrovascular disease admissions. The elderly was associated more strongly with gaseous pollutants than younger. The modifying effect of seasons on air pollutants also existed. The significant effect of gaseous pollutants (SO2 and NO2) was found on daily hospital admissions even after adjustment for other pollutants except for SO2 on cardiac diseases. In a word, this study provides the evidence for the detrimental short-term health effects of urban gaseous pollutants on cardio-cerebrovascular diseases in Lanzhou. PMID:23358231

  13. Depression After First Hospital Admission for Acute Coronary Syndrome: A Study of Time of Onset and Impact on Survival.

    PubMed

    Osler, Merete; Mårtensson, Solvej; Wium-Andersen, Ida Kim; Prescott, Eva; Andersen, Per Kragh; Jørgensen, Terese Sara Høj; Carlsen, Kathrine; Wium-Andersen, Marie Kim; Jørgensen, Martin Balslev

    2016-02-01

    We examined incidence of depression after acute coronary syndrome (ACS) and whether the timing of depression onset influenced survival. All first-time hospitalizations for ACS (n = 97,793) identified in the Danish Patient Registry during 2001-2009 and a reference population were followed for depression and mortality via linkage to patient, prescription, and cause-of-death registries until the end of 2012. Incidence of depression (as defined by hospital discharge or antidepressant medication use) and the relationship between depression and mortality were examined using time-to-event models. In total, 19,520 (20.0%) ACS patients experienced depression within 2 years after the event. The adjusted rate ratio for depression in ACS patients compared with the reference population was 1.28 (95% confidence interval (CI): 1.25, 1.30). During 12 years of follow-up, 39,523 (40.4%) ACS patients and 27,931 (28.6%) of the reference population died. ACS patients with recurrent (hazard ratio (HR) = 1.62, 95% CI: 1.57, 1.67) or new-onset (HR = 1.66, 95% CI: 1.60, 1.72) depression had higher mortality rates than patients with no depression. In the reference population, the corresponding relative estimates for recurrent (HR =1.98, 95% CI: 1.92, 2.05) and new-onset (HR = 2.42, 95% CI: 2.31, 2.54) depression were stronger. Depression is common in ACS patients and is associated with increased mortality independently of time of onset, but here the excess mortality associated with depression seemed to be lower in ACS patients than in the reference population. PMID:26740025

  14. Distinguishing the associations between daily mortality and hospital admissions and nitrogen dioxide from those of particulate matter: a systematic review and meta-analysis

    PubMed Central

    Mills, I C; Atkinson, R W; Anderson, H R; Maynard, R L; Strachan, D P

    2016-01-01

    Objectives To quantitatively assess time-series studies of daily nitrogen dioxide (NO2) and mortality and hospital admissions which also controlled for particulate matter (PM) to determine whether or to what extent the NO2 associations are independent of PM. Design A systematic review and meta-analysis. Methods Time-series studies—published in peer-reviewed journals worldwide, up to May 2011—that reported both single-pollutant and two-pollutant model estimates for NO2 and PM were ascertained from bibliographic databases (PubMed, EMBASE and Web of Science) and reviews. Random-effects summary estimates were calculated globally and stratified by different geographical regions, and effect modification was investigated. Outcome measures Mortality and hospital admissions for various cardiovascular or respiratory diseases in different age groups in the general population. Results 60 eligible studies were identified, and meta-analysis was conducted on 23 outcomes. Two-pollutant model study estimates generally showed that the NO2 associations were independent of PM mass. For all-cause mortality, a 10 µg/m3 increase in 24-hour NO2 was associated with a 0.78% (95% CI 0.47% to 1.09%) increase in the risk of death, which reduced to 0.60% (0.33% to 0.87%) after control for PM. Heterogeneity between geographical region-specific estimates was removed by control for PM (I2 from 66.9% to 0%). Estimates of PM and daily mortality assembled from the same studies were greatly attenuated after control for NO2: from 0.51% (0.29% to 0.74%) to 0.18% (−0.11% to 0.47%) per 10 µg/m3 PM10 and 0.74% (0.34% to 1.14%) to 0.54% (−0.25% to 1.34%) for PM2.5. Conclusions The association between short-term exposure to NO2 and adverse health outcomes is largely independent of PM mass. Further studies should attempt to investigate whether this is a generic PM effect or whether it is modified by the source and physicochemical characteristics of PM. This finding strengthens the argument for

  15. Prediction of Mobility Limitations after Hospitalization in Older Medical Patients by Simple Measures of Physical Performance Obtained at Admission to the Emergency Department

    PubMed Central

    Klausen, Henrik Hedegaard; Petersen, Janne; Beyer, Nina; Andersen, Ove; Jørgensen, Lillian Mørch; Juul-Larsen, Helle Gybel; Bandholm, Thomas

    2016-01-01

    Objective Mobility limitations relate to dependency in older adults. Identification of older patients with mobility limitations after hospital discharge may help stratify treatment and could potentially counteract dependency seen in older adults after hospitalization. We investigated the ability of four physical performance measures administered at hospital admission to identify older medical patients who manifest mobility limitations 30 days after discharge. Design Prospective cohort study of patients (≥65 years) admitted to the emergency department for acute medical illness. During the first 24 hours, we assessed: handgrip strength, 4-meter gait speed, the ability to rise from a chair (chair-stand), and the Cumulated Ambulation Score. The mobility level 30 days after discharge was evaluated using the de Morton Mobility Index. Results A total of 369 patients (77.9 years, 62% women) were included. Of those, 128 (40%) patients had mobility limitations at follow-up. Univariate analyzes showed that each of the physical performance measures was strongly associated with mobility limitations at follow-up (handgrip strength(women), OR 0.86 (0.81–0.91), handgrip strength(men), OR 0.90 (0.86–0.95), gait speed, OR 0.35 (0.26–0.46), chair-stand, OR 0.04 (0.02–0.08) and Cumulated Ambulation Score OR 0.49 (0.38–0.64). Adjustment for potential confounders did not change the results and the associations were not modified by any of the covariates: age, gender, cognitive status, the severity of the acute medical illness, and the Charlson Comorbidity Index. Based on prespecified cut-offs the prognostic accuracy of the four measures for mobility limitation at follow-up was calculated. The sensitivity and specificity were: handgrip strength(women), 56.8 (45.8–67.3), 75.7 (66.8–83.2), handgrip strength(men), 50.0 (33.8–66.2), 80.8 (69.9–89.1), gait speed, 68.4 (58.2–77.4), 81.4 (75.0–86.8), chair-stand 67.8 (58.6–76.1), 91.8 (86.8–95.3), and Cumulated

  16. Statistical Analysis Aiming at Predicting Respiratory Tract Disease Hospital Admissions from Environmental Variables in the City of São Paulo

    PubMed Central

    de Sousa Zanotti Stagliorio Coêlho, Micheline; Luiz Teixeira Gonçalves, Fabio; do Rosário Dias de Oliveira Latorre, Maria

    2010-01-01

    This study is aimed at creating a stochastic model, named Brazilian Climate and Health Model (BCHM), through Poisson regression, in order to predict the occurrence of hospital respiratory admissions (for children under thirteen years of age) as a function of air pollutants, meteorological variables, and thermal comfort indices (effective temperatures, ET). The data used in this study were obtained from the city of São Paulo, Brazil, between 1997 and 2000. The respiratory tract diseases were divided into three categories: URI (Upper Respiratory tract diseases), LRI (Lower Respiratory tract diseases), and IP (Influenza and Pneumonia). The overall results of URI, LRI, and IP show clear correlation with SO2 and CO, PM10 and O3, and PM10, respectively, and the ETw4 (Effective Temperature) for all the three disease groups. It is extremely important to warn the government of the most populated city in Brazil about the outcome of this study, providing it with valuable information in order to help it better manage its resources on behalf of the whole population of the city of Sao Paulo, especially those with low incomes. PMID:20706674

  17. Protein-based profiling of the immune response to uropathogenic Escherichia coli in adult patients immediately following hospital admission for acute cystitis.

    PubMed

    Sundac, Lana; Dando, Samantha J; Sullivan, Matthew J; Derrington, Petra; Gerrard, John; Ulett, Glen C

    2016-08-01

    Urinary tract infections (UTIs) caused by uropathogenic Escherichia coli (UPEC) are common infections in humans. Despite the substantial healthcare cost represented by these infections, the human immune response associated with the infection immediately following the onset of symptoms in patients remains largely undefined. We performed a prospective study aimed at defining the milieu of urinary cytokines in adult inpatients in the 24-48 h period immediately following hospital admission for acute cystitis due to UPEC. Urine samples, analyzed using 27-target multiplex protein assays, were used to generate immune profiles for patients and compared to age- and gender-matched healthy controls. The levels of multiple pro-inflammatory cytokines were significantly elevated in urine as a result of infection, an observation consistent with prior findings in murine models and clinical literature. We also identified significant responses for several novel factors not previously associated with the human response to UTI, including Interleukin (IL)-4, IL-7, IL-9, IL-17A, eotaxin, Granulocyte-macrophage colony-stimulating factor (GM-CSF) and several growth factors. These data establish crucial parallels between the human immune response to UPEC and murine model UTI studies, and emphasize the complex but poorly defined nature of the human immune response to UPEC, particularly in the immediate period following the onset of symptoms for acute cystitis. PMID:27354295

  18. Comparative evaluation of two fully-automated real-time PCR methods for MRSA admission screening in a tertiary-care hospital.

    PubMed

    Hos, N J; Wiegel, P; Fischer, J; Plum, G

    2016-09-01

    We evaluated two fully-automated real-time PCR systems, the novel QIAGEN artus MRSA/SA QS-RGQ and the widely used BD MAX MRSA assay, for their diagnostic performance in MRSA admission screening in a tertiary-care university hospital. Two hundred sixteen clinical swabs were analyzed for MRSA DNA using the BD MAX MRSA assay. In parallel, the same specimens were tested with the QIAGEN artus MRSA/SA QS-RGQ. Automated steps included lysis of bacteria, DNA extraction, real-time PCR and interpretation of results. MRSA culture was additionally performed as a reference method for MRSA detection. Sensitivity values were similar for both assays (80 %), while the QIAGEN artus MRSA/SA QS-RGQ reached a slightly higher specificity (95.8 % versus 90.0 %). Positive (PPVs) and negative predictive values (NPVs) were 17.4 % and 99.4 % for the BD MAX MRSA assay and 33.3 % and 99.5 % for the QIAGEN artus MRSA/SA QS-RGQ, respectively. Total turn-around time (TAT) for 24 samples was 3.5 hours for both assays. In conclusion, both assays represent reliable diagnostic tools due to their high negative predictive values, especially for the rapid identification of MRSA negative patients in a low prevalence MRSA area. PMID:27259711

  19. Predicting Appropriate Admission of Bronchiolitis Patients in the Emergency Department: Rationale and Methods

    PubMed Central

    Stone, Bryan L; Johnson, Michael D; Nkoy, Flory L

    2016-01-01

    Background In young children, bronchiolitis is the most common illness resulting in hospitalization. For children less than age 2, bronchiolitis incurs an annual total inpatient cost of $1.73 billion. Each year in the United States, 287,000 emergency department (ED) visits occur because of bronchiolitis, with a hospital admission rate of 32%-40%. Due to a lack of evidence and objective criteria for managing bronchiolitis, ED disposition decisions (hospital admission or discharge to home) are often made subjectively, resulting in significant practice variation. Studies reviewing admission need suggest that up to 29% of admissions from the ED are unnecessary. About 6% of ED discharges for bronchiolitis result in ED returns with admission. These inappropriate dispositions waste limited health care resources, increase patient and parental distress, expose patients to iatrogenic risks, and worsen outcomes. Existing clinical guidelines for bronchiolitis offer limited improvement in patient outcomes. Methodological shortcomings include that the guidelines provide no specific thresholds for ED decisions to admit or to discharge, have an insufficient level of detail, and do not account for differences in patient and illness characteristics including co-morbidities. Predictive models are frequently used to complement clinical guidelines, reduce practice variation, and improve clinicians’ decision making. Used in real time, predictive models can present objective criteria supported by historical data for an individualized disease management plan and guide admission decisions. However, existing predictive models for ED patients with bronchiolitis have limitations, including low accuracy and the assumption that the actual ED disposition decision was appropriate. To date, no operational definition of appropriate admission exists. No model has been built based on appropriate admissions, which include both actual admissions that were necessary and actual ED discharges that were

  20. The role of noninvasive ventilation in the management and mitigation of exacerbations and hospital admissions/readmissions for the patient with moderate to severe COPD (multimedia activity).

    PubMed

    White, David P; Criner, Gerard J; Dreher, Michael; Hart, Nicholas; Peyerl, Fred W; Wolfe, Lisa F; Chin, Suzette A

    2015-06-01

    As seen in this CME online activity (available at http://journal.cme.chestnet.org/home-niv-copd), COPD is a common and debilitating disease and is currently the third leading cause of death in the United States. The role of noninvasive ventilation (NIV) in the management of severe, hypercapnic COPD has been controversial. However, it was concluded that current data would support the following recommendations. Patients with COPD with a waking Paco2 > 50 to 52 mm Hg, an overnight Paco2 > 55 mm Hg, or both who are symptomatic and compliant with other therapies should be eligible for NIV. In addition, multiple previous hospital admissions for COPD exacerbation, requiring noninvasive/invasive mechanical ventilation, strongly suggest a need for chronic NIV. Patients with COPD with a BMI > 30 kg/m2 respond particularly well to this therapy. When the decision is made to start NIV, this treatment is probably best initiated during a short hospitalization, although this can be accomplished in the clinic, home, or sleep laboratory if well-trained clinicians are available. Newer modes of NIV such as volume-assured pressure support, particularly with autotitrating expiratory positive airway pressure (EPAP), may create the opportunity for home NIV initiation easier for less experienced physicians. Regardless of the mode selected, inspiratory pressures must be in the 20 to 25 cm H2O range to meaningfully increase tidal volume, reduce work of breathing, and, importantly, reduce waking arterial Paco2. EPAP is currently set at 4 to 5 cm H2O, although future technologies may allow this to be individualized to maximally reduce auto-positive end expiratory pressure. The NIV device should have a backup rate although it is controversial as to whether this should be set at a high (18-20 breaths/min) vs a low (8-10 breaths/min) rate. The proper use of NIV in appropriately chosen patients with COPD can improve quality of life and increase survival. Ongoing studies are assessing

  1. Respiratory rate and pulse oximetry derived information as predictors of hospital admission in young children in Bangladesh: a prospective observational study

    PubMed Central

    Garde, Ainara; Zhou, Guohai; Raihana, Shahreen; Dunsmuir, Dustin; Karlen, Walter; Dekhordi, Parastoo; Huda, Tanvir; Arifeen, Shams El; Larson, Charles; Kissoon, Niranjan; Dumont, Guy A; Ansermino, J Mark

    2016-01-01

    Objective Hypoxaemia is a strong predictor of mortality in children. Early detection of deteriorating condition is vital to timely intervention. We hypothesise that measures of pulse oximetry dynamics may identify children requiring hospitalisation. Our aim was to develop a predictive tool using only objective data derived from pulse oximetry and observed respiratory rate to identify children at increased risk of hospital admission. Setting Tertiary-level hospital emergency department in Bangladesh. Participants Children under 5 years (n=3374) presenting at the facility (October 2012–April 2013) without documented chronic diseases were recruited. 1-minute segments of pulse oximetry (photoplethysmogram (PPG), blood oxygen saturation (SpO2) and heart rate (HR)) and respiratory rate were collected with a mobile app. Primary outcome The need for hospitalisation based on expert physician review and follow-up. Methods Pulse rate variability (PRV) using pulse peak intervals of the PPG signal and features extracted from the SpO2 signal, all derived from pulse oximetry recordings, were studied. A univariate age-adjusted logistic regression was applied to evaluate differences between admitted and non-admitted children. A multivariate logistic regression model was developed using a stepwise selection of predictors and was internally validated using bootstrapping. Results Children admitted to hospital showed significantly (p<0.01) decreased PRV and higher SpO2 variability compared to non-admitted children. The strongest predictors of hospitalisation were reduced PRV-power in the low frequency band (OR associated with a 0.01 unit increase, 0.93; 95% CI 0.89 to 0.98), greater time spent below an SpO2 of 98% and 94% (OR associated with 10 s increase, 1.4; 95% CI 1.3 to 1.4 and 1.5; 95% CI 1.4 to 1.6, respectively), high respiratory rate, high HR, low SpO2, young age and male sex. These variables provided a bootstrap-corrected AUC of the receiver operating characteristic

  2. ED navigators prevent unnecessary admissions.

    PubMed

    2012-02-01

    RN Navigators in the emergency department at Montefiore Medical Center work with social workers to prevent unnecessary admissions. Program targets the homeless and patients with tenuous living situations. CMs work with the emergency department staff to identify patients who don't meet admission criteria but can't be safely discharged. The hospital collaborates with a local housing assistance agency which sends a van to transport appropriate patients to a shelter. PMID:22299178

  3. Risk factors of direct heat-related hospital admissions during the 2009 heatwave in Adelaide, Australia: a matched case–control study

    PubMed Central

    Zhang, Ying; Nitschke, Monika; Krackowizer, Antoinette; Dear, Keith; Pisaniello, Dino; Weinstein, Philip; Tucker, Graeme; Shakib, Sepehr; Bi, Peng

    2016-01-01

    Objective The extreme heatwave of 2009 in South Australia dramatically increased morbidity, with a 14-fold increase in direct heat-related hospitalisation in metropolitan Adelaide. Our study aimed to identify risk factors for the excess morbidity. Design A matched case–control study of risk factors was conducted. Setting Patients and matched community controls were interviewed to gather data on demographics, living environment, social support, health status and behaviour changes during the heatwave. Participants Cases were all hospital admissions with heat-related diagnoses during the 5-day heatwave in 2009. Controls were randomly selected from communities. Outcome measures Descriptive analyses, simple and multiple conditional logistic regressions were performed. Adjusted ORs (AORs) were estimated. Results In total, 143 hospital patients and 143 matched community controls were interviewed, with a mean age of 73 years (SD 21), 96% European ethnicity, 63% retired, 36% with high school or higher education, and 8% institutional living. The regression model indicated that compared with the controls, cases were more likely to have heart disease (AOR=13.56, 95% CI 1.27 to 144.86) and dementia (AOR=26.43, 95% CI 1.99 to 350.73). The protective factors included higher education level (AOR=0.48, 95% CI 0.23 to 0.99), having air-conditioner in the bedroom (AOR=0.12, 95% CI 0.02 to 0.74), having an emergency button (AOR=0.09, 95% CI 0.01 to 0.96), using refreshment (AOR=0.10, 95% CI 0.01 to 0.84), and having more social activities (AOR=0.11, 95% CI 0.02 to 0.57). Conclusions Pre-existing heart disease and dementia significantly increase the risk of direct heat-related hospitalisations during heatwaves. The presence of an air-conditioner in the bedroom, more social activities, a higher education level, use of emergency buttons and refreshments reduce the risk during heatwaves. PMID:27256088

  4. Trends in Staphylococcus aureus bacteraemia and impacts of infection control practices including universal MRSA admission screening in a hospital in Scotland, 2006–2010: retrospective cohort study and time-series intervention analysis

    PubMed Central

    Edwards, Becky; López-Lozano, José-Maria; Gould, Ian

    2012-01-01

    Objectives To describe secular trends in Staphylococcus aureus bacteraemia (SAB) and to assess the impacts of infection control practices, including universal methicillin-resistant Staphylococcus aureus (MRSA) admission screening on associated clinical burdens. Design Retrospective cohort study and multivariate time-series analysis linking microbiology, patient management and health intelligence databases. Setting Teaching hospital in North East Scotland. Participants All patients admitted to Aberdeen Royal Infirmary between 1 January 2006 and 31 December 2010: n=420 452 admissions and 1 430 052 acute occupied bed days (AOBDs). Intervention Universal admission screening programme for MRSA (August 2008) incorporating isolation and decolonisation. Primary and secondary measures Hospital-wide prevalence density, hospital-associated incidence density and death within 30 days of MRSA or methicillin-sensitive Staphylococcus aureus (MSSA) bacteraemia. Results Between 2006 and 2010, prevalence density of all SAB declined by 41%, from 0.73 to 0.50 cases/1000 AOBDs (p=0.002 for trend), and 30-day mortality from 26% to 14% (p=0.013). Significant reductions were observed in MRSA bacteraemia only. Overnight admissions screened for MRSA rose from 43% during selective screening to >90% within 4 months of universal screening. In multivariate time-series analysis (R2 0.45 to 0.68), universal screening was associated with a 19% reduction in prevalence density of MRSA bacteraemia (−0.035, 95% CI −0.049 to −0.021/1000 AOBDs; p<0.001), a 29% fall in hospital-associated incidence density (−0.029, 95% CI −0.035 to −0.023/1000 AOBDs; p<0.001) and a 46% reduction in 30-day mortality (−15.6, 95% CI −24.1% to −7.1%; p<0.001). Positive associations with fluoroquinolone and cephalosporin use suggested that antibiotic stewardship reduced prevalence density of MRSA bacteraemia by 0.027 (95% CI 0.015 to 0.039)/1000 AOBDs. Rates of MSSA bacteraemia were not

  5. Reducing admissions with patient group directions.

    PubMed

    Wat, Dennis; Glossage, Elaine; Hampson, Onnor; Sibley, Sarah

    In times of financial restrictions and reform impediments, health services need to invest in resources that provide value for money and reduce hospital admissions. Improving disease management in the community is a primary target for those trying to reduce costs. The second most common cause of emergency admissions to hospital is chronic obstructive pulmonary disease and it has been suggested that more effective treatments and better management of the condition would likely result in an estimated 5% fewer admissions to hospital, saving around pound 15.5m each year. This article discusses how savings could be made by improving care provided in the community. PMID:24834601

  6. An Observational Study of Blood Glucose Levels during Admission and 24 Hours Post-Operation in a Sample of Patients with Traumatic Injury in a Hospital in Kuala Lumpur

    PubMed Central

    Harun @ Haron, Rahmat; Imran, Musa Kamarul; Haspani, Mohammed Saffari Mohammed

    2011-01-01

    Background: Traumatic brain injury (TBI) has been associated with an acute stress response mediated by the sympathoadrenomedullary axis, which can be assessed by measuring blood glucose level. Methods: This prospective observational study was conducted for a year in 2007 among 294 patients who had been treated for TBI in Hospital Kuala Lumpur. Patients fulfilling the set criteria were recruited into the study and data, including blood glucose level and Glasgow Outcome Score at 3-month follow-up, were collected. Results: 294 patients were included in the study: 50 females (17.0%) and 244 males (83.0%). The majority of cases were young adult patients (mean age of 34.2 years, SD 13.0). The mean blood glucose level during admission and post-surgery were 6.26 mmol/L (SD 1.30, n = 294) and 6.66 mmol/L (SD 1.44, n = 261), respectively. Specifically, the mean admission glucose level associated with mild TBI was 5.04 mmol/L (SD 0.71); moderate TBI, 5.78 mmol/L (SD 1.02); and severe TBI, 7.04 mmol/L (SD 1.18). The mean admission glucose level associated with a poor outcome in patients with isolated TBI was 6.98 mmol/L (SD 1.21). Patients with admission glucose of 5.56 mmol/L (SD 1.21) were more likely to have a favourable outcome. Conclusion: Mild, moderate, and severe TBI were associated with an increase in blood glucose levels during admission, and the mean increase in glucose levels is based on the severity of the isolated TBI. Surgical intervention did not cause further significant changes in blood glucose levels. Patients with isolated TBI and minimal increases in blood glucose levels were more likely to have a favourable outcome. PMID:22589675

  7. Patient Admission Preferences and Perceptions

    PubMed Central

    Wu, Clayton; Melnikow, Joy; Dinh, Tu; Holmes, James F.; Gaona, Samuel D.; Bottyan, Thomas; Paterniti, Debora; Nishijima, Daniel K.

    2015-01-01

    Introduction Understanding patient perceptions and preferences of hospital care is important to improve patients’ hospitalization experiences and satisfaction. The objective of this study was to investigate patient preferences and perceptions of hospital care, specifically differences between intensive care unit (ICU) and hospital floor admissions. Methods This was a cross-sectional survey of emergency department (ED) patients who were presented with a hypothetical scenario of a patient with mild traumatic brain injury (TBI). We surveyed their preferences and perceptions of hospital care related to this scenario. A closed-ended questionnaire provided quantitative data on patient preferences and perceptions of hospital care and an open-ended questionnaire evaluated factors that may not have been captured with the closed-ended questionnaire. Results Out of 302 study patients, the ability for family and friends to visit (83%), nurse availability (80%), and physician availability (79%) were the factors most commonly rated “very important,” while the cost of hospitalization (62%) and length of hospitalization (59%) were the factors least commonly rated “very important.” When asked to choose between the ICU and the floor if they were the patient in the scenario, 33 patients (10.9%) choose the ICU, 133 chose the floor (44.0%), and 136 (45.0%) had no preference. Conclusion Based on a hypothetical scenario of mild TBI, the majority of patients preferred admission to the floor or had no preference compared to admission to the ICU. Humanistic factors such as the availability of doctors and nurses and the ability to interact with family appear to have a greater priority than systematic factors of hospitalization, such as length and cost of hospitalization or length of time in the ED waiting for an in-patient bed. PMID:26587095

  8. Hypothetical performance of syndrome-based management of acute paediatric admissions of children aged more than 60 days in a Kenyan district hospital.

    PubMed Central

    English, Mike; Berkley, James; Mwangi, Isiah; Mohammed, Shebbe; Ahmed, Maimuna; Osier, Faith; Muturi, Neema; Ogutu, Bernhards; Marsh, Kevin; Newton, Charles R. J. C.

    2003-01-01

    OBJECTIVE: To investigate whether the outpatient, syndrome-based approach of the Integrated Management of Childhood Illness (IMCI) protocol could be extended to the inpatient arena to give clear and simple minimum standards of care for poorly resourced facilities. METHODS: A prospective, one-year admission cohort retrospectively compared hypothetical performance of syndrome-based management with paediatrician-defined final diagnosis. Admission syndrome definitions were based on local adaptations to the IMCI protocol that encompassed 20 clinical features, measurement of oxygen saturation, and malaria microscopy. FINDINGS: After 315 children with clinically obvious diagnoses (e.g. sickle cell disease and burns) were excluded, 3705 admission episodes were studied. Of these, 2334 (63%) met criteria for at least one severe syndrome (mortality 8% vs <1% for "non-severe" cases), and half of these had features of two or more severe syndromes. No cases of measles were seen. Syndrome-based treatment would have been appropriate (sensitivity >95%) for severe pneumonia, severe malaria, and diarrhoea with severe dehydration, and probably for severe malnutrition (sensitivity 71%). Syndrome-directed treatment suggested the use of broad-spectrum antibiotics in 75/133 (56% sensitivity) children with bacteraemic and 63/71 (89% sensitivity) children with meningitis. CONCLUSIONS: Twenty clinical features, oxygen saturation measurements, and results of malaria blood slides could be used for inpatient, syndrome-based management of acute paediatric admissions. The addition of microscopy of the cerebrospinal fluid and haemoglobin measurements would improve syndrome-directed treatment considerably. This approach might rationalize admission policy and standardize inpatient paediatric care in resource-poor countries, although the clinical detection of bacteraemia remains a problem. PMID:12764512

  9. 42 CFR 456.123 - Admission review process.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Admission review process. 456.123 Section 456.123... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan: Review of Need for Admission 1 § 456.123 Admission review process. The UR plan must provide that— (a)...

  10. Can Computers Simplify Admissions?

    ERIC Educational Resources Information Center

    Bruker, Robert M.

    1978-01-01

    Based on experience with a simplified admissions concept, Southern Illinois University is satisfied that the admissions process has been made easier for prospective students, high school counselors, and admissions staff. The computer does not make decisions regarding admission of a student, but reduced work loads for everyone concerned. (Author)

  11. The Most Frequent Causes of Hospitalization of Iranian Pilgrims in Iraq During a 5-Month Period in 2012, and Their Outcome

    PubMed Central

    Sadeghi, Soleiman; Heidari, Ali; Fazli, Hosein; Rezaei, Mashallah; Sheikhzadeh, Javad

    2015-01-01

    Background: Investigating the prevalence of diseases and causes of hospitalization of Iranian pilgrims in Iraq can be helpful for healthcare programmers in scheduling a healthy and joyful trip for pilgrims and reducing their mortality and morbidity. Objectives: The main purpose of this study was to determine the frequency of Iranian pilgrims’ referral cases to Karbala and Najaf hospitals in Iraq during a 5-month period in 2012. Patients and Methods: In this cross-sectional study, medical records of all patients referred to Iraqi hospitals from Iranian clinics during a 5-month period from 16 January 2012 until 14 June 2012 was recorded. A checklist, including demographic data and diagnostic causes were prepared and completed by general practitioners. Then, the completed forms were checked and delivered to health surveillance supervisors. Results: A total of 177 referral cases from Iranian clinics to Iraqi hospitals were recorded in 5 months. Most of these referrals were due to cardiovascular diseases with 38.6%, then comes trauma with 26.55%, and finally renal failure in need of dialysis with 12.43%. About 80.2% of the patients were discharged, 13% of them were sent to Iran, and 6.2% died. Around 90% of deaths were due to heart diseases. Conclusions: Considering the high prevalence of cardiovascular diseases and fractures in Iranian pilgrims, the necessity of self-care education to diminish such rates is substantial. PMID:26730348

  12. Changes in Admissions, Length of Stay, and Discharge Diagnoses at a Major University-Affiliated Teaching Hospital: Implications for Medical Education.

    ERIC Educational Resources Information Center

    Rosevear, G. Craig; Gary, Nancy E.

    1989-01-01

    A study of changes in hospital care suggests that for medical students and residents to be exposed to the same case mix of clinical disorders seen in the hospital in 1980, they must have experience in the ambulatory setting. (Author/MSE)

  13. An analysis of clinical activity, admission rates, length of hospital stay, and economic impact after a temporary loss of 50% of the non-operative podiatrists from a tertiary specialist foot clinic in the United Kingdom

    PubMed Central

    Gooday, Catherine; Murchison, Rachel; Dhatariya, Ketan

    2013-01-01

    Introduction Podiatrists form an integral part of the multidisciplinary foot team in the treatment of diabetic foot–related complications. A set of unforeseen circumstances within our specialist diabetes foot service in the United Kingdom caused a loss of 50% of our non-operative podiatry team for almost 7 months during 2010. Some of this time was filled by non-specialist community non-operative podiatrists. Methods We assessed the economic impact of this loss by examining data for the 5 years prior to this 7-month interruption, and for the 2 years after ‘normal service’ was resumed. Results Our data show that the loss of the non-operative podiatrists led to a significant rise in the numbers of admissions into hospital, and hospital length of stay also increased. At our institution a single bed day cost is £275. During the time that the numbers of specialist non-operative podiatry staff were depleted, and for up to 6 months after they returned to normal activities, the extra costs increased by just less than £90,000. The number of people admitted directly from specialist vascular and orthopaedic clinics is likely to have increased due to the lack of capacity to manage them in the diabetic foot clinic. Our data were unable to assess these individuals and did not look at the costs saved from avoiding surgery. Thus the actual costs incurred are likely to be higher. Conclusions Our data suggest that specialist non-operative podiatrists involved in the treatment of the diabetic foot may prevent unwarranted hospital admission and increased hospitalisation rates by providing skilled assessment and care in the outpatient clinical settings. PMID:24040488

  14. What works in ‘real life’ to facilitate home deaths and fewer hospital admissions for those at end of life?: results from a realist evaluation of new palliative care services in two English counties

    PubMed Central

    2014-01-01

    Background We evaluated end of life care services in two English counties including: coordination centres, telephone advice line, ‘Discharge in Reach’ nurses, a specialist community personal care team and community nurse educators. Elsewhere, we published findings detailing high family carer satisfaction and fewer hospital admissions, Accident and Emergency attendances and hospital deaths for service users compared to controls. The aim of this paper is to discuss what contributed to those outcomes. Methods Using realist evaluation, data collection included documentation (e.g. referral databases), 15 observations of services and interviews with 43 family carers and 105 professionals. Data were analysed using framework analysis, applying realist evaluation concepts. Findings were discussed at successive team meetings and further data was collected until team consensus was reached. Results Services ‘worked’ primarily for those with cancer with ‘fast track’ funding who were close to death. Factors contributing to success included services staffed with experienced palliative care professionals with dedicated (and sufficient) time for difficult conversations with family carers, patients and/or clinical colleagues about death and the practicalities of caring for the dying. Using their formal and informal knowledge of the local healthcare system, they accessed community resources to support homecare and delivered excellent services. This engendered confidence and reassurance for staff, family carers and patients, possibly contributing to less hospital admissions and A&E attendances and more home deaths. Conclusions With demand for 24-hour end of life care growing and care provision fragmented across health and social care boundaries, services like these that cut across organisational sectors may become more important. They offer an overview to help navigate those desiring a home death through the system. PMID:25075202

  15. Model-based testing for space-time interaction using point processes: An application to psychiatric hospital admissions in an urban area.

    PubMed

    Meyer, Sebastian; Warnke, Ingeborg; Rössler, Wulf; Held, Leonhard

    2016-05-01

    Spatio-temporal interaction is inherent to cases of infectious diseases and occurrences of earthquakes, whereas the spread of other events, such as cancer or crime, is less evident. Statistical significance tests of space-time clustering usually assess the correlation between the spatial and temporal (transformed) distances of the events. Although appealing through simplicity, these classical tests do not adjust for the underlying population nor can they account for a distance decay of interaction. We propose to use the framework of an endemic-epidemic point process model to jointly estimate a background event rate explained by seasonal and areal characteristics, as well as a superposed epidemic component representing the hypothesis of interest. We illustrate this new model-based test for space-time interaction by analysing psychiatric inpatient admissions in Zurich, Switzerland (2007-2012). Several socio-economic factors were found to be associated with the admission rate, but there was no evidence of general clustering of the cases. PMID:27246269

  16. Frequent Prescription of Antibiotics and High Burden of Antibiotic Resistance among Deceased Patients in General Medical Wards of Acute Care Hospitals in Korea

    PubMed Central

    Kwak, Yee Gyung; Moon, Chisook; Kim, Eu Suk; Kim, Baek-Nam

    2016-01-01

    Background Antibiotics are often administered to terminally ill patients until death, and antibiotic use contributes to the emergence of multidrug-resistant organisms (MDROs). We investigated antibiotic use and the isolation of MDROs among patients who died in general medical wards. Methods All adult patients who died in the general internal medicine wards at four acute care hospitals between January and June 2013 were enrolled. For comparison with these deceased patients, the same number of surviving, discharged patients was selected from the same divisions of internal medicine subspecialties during the same period. Results During the study period, 303 deceased patients were enrolled; among them, 265 (87.5%) had do-not-resuscitate (DNR) orders in their medical records. Antibiotic use was more common in patients who died than in those who survived (87.5% vs. 65.7%, P<0.001). Among deceased patients with DNR orders, antibiotic use was continued in 59.6% of patients after obtaining their DNR orders. Deceased patients received more antibiotic therapy courses (two [interquartile range (IQR) 1–3] vs. one [IQR 0–2], P<0.001). Antibiotics were used for longer durations in deceased patients than in surviving patients (13 [IQR 5–23] vs. seven days [IQR 0–18], P<0.001). MDROs were also more common in deceased patients than in surviving patients (25.7% vs. 10.6%, P<0.001). Conclusions Patients who died in the general medical wards of acute care hospitals were exposed to more antibiotics than patients who survived. In particular, antibiotic prescription was common even after obtaining DNR orders in patients who died. The isolation of MDROs during the hospital stay was more common in these patients who died. Strategies for judicious antibiotic use and appropriate infection control should be applied to these patient populations. PMID:26761461

  17. The relationship between asthma admission rates, routes of admission, and socioeconomic deprivation.

    PubMed

    Watson, J P; Cowen, P; Lewis, R A

    1996-10-01

    This study aimed to explore the relationship between hospital admissions for asthma and socioeconomic deprivation. A retrospective study examined one year of hospital admissions for asthma in the West Midlands region of England (n = 10,044), and in one of the region's wealthier districts, Worcester (n = 251). Age standardized admission ratios (SARs) for asthma, and the routes of hospital admission, were compared with the Towns- end Deprivation Index for the place of residence. Asthma SAR was strongly associated with deprivation as measured by the Towns end Index for the district of residence (Spearman rank correlation coefficient rho = 0.65; p = 0.004). Asthma admission rates for all age groups, except those aged over 65 yrs, were higher in poorer districts. A significantly greater proportion of emergency admissions in poorer districts came via Accident and Emergency departments, rather than general practitioner referrals (rho = 0.76; p < 0.001). Within Worcester District, SAR was associated with Townsend Index for the ward of residence (rho = 0.39; p < 0.001). This remained significant after excluding repeat admissions (rho = 0.45; p < 0.001). We conclude that asthma admissions are strongly associated with deprivation in the community. Differences in the health care received during acute exacerbations by asthma patients from different economic backgrounds is likely to be an important factor in this relationship. PMID:8902471

  18. [Trend in the susceptibility of the most frequent bacterial pathogens isolated at Hospital General La Mancha Centro over 2010-2012 period].

    PubMed

    Asencio, María Ángeles; Huertas, María; Carranza, Rafael; Franco, María; Castellanos, Jesús; Barberá, José Ramón; Conde, María del Carmen; Tenías, José María

    2014-12-01

    Introduction. Our objective was to determine the trend of the antimicrobial susceptibility of the most common bacterial pathogens isolated in La Mancha Centro Hospital (MCH) between 2010-2012. Material and methods. Isolates of Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa from patients admitted to MCH were studied. These data and their antibiotic susceptibility were obtained from the database OBSERVA (BioMérieux). Results. The percentages of susceptibility for S. aureus were: 50% methicillin-resistant-S. aureus (MRSA) (higher co-resistance to erythromycin and levofloxacin), 46% erythromycin, 73% clindamycin, 45% levofloxacin, 99% rifampin and 100% cotrimoxazole, glycopeptides, linezolid and daptomycin. Increased resistance in ICU was observed (63% MRSA), with 50% of S. aureus (susceptible and methicillin-resistant strains) with vancomycin MIC values ≥ 0.5 mg/L. E. coli susceptibility: 62% amoxicillin-clavulanate, 55% ciprofloxacin, 60% cotrimoxazole, 84% gentamicin and 95% fosfomycin. K. pneumoniae susceptibility: 74% amoxicillin-clavulanate, 71% ciprofloxacin, 78% cotrimoxazole, 94% gentamicin and 87% fosfomycin. The percentage of BLEE strains was 17% and 21% for E. coli and K. pneumoniae, respectively, without detection of resistance to carbapenems. P. aeruginosa susceptibility: 80% ceftazidime and carbapenems, 63% ciprofloxacin and higher than 90% aminoglycosides. A decreasing trend of susceptibility to ceftazidime and carbapenems was observed in ICU and increasing trend to ciprofloxacin. Conclusions. Resistance percentages were higher in ICU than in the rest of the hospital, highlighting 63% of MRSA strains. Our percentage of BLEE and MRSA strains were higher than the Spanish media. Rifampicin and cotrimoxazole maintain good susceptibility to S. aureus, fosfomycin and aminoglycosides to Enterobacteriaceae and carbapenems to P. aeruginosa. PMID:25536430

  19. Does Serum Bilirubin level on admission predict TIMI flow grade and in-hospital MACE in patients with STEMI undergoing primary PCI.

    PubMed

    Celik, Turgay; Kaya, Mehmet G; Akpek, Mahmut; Yarlioglues, Mikail; Sarli, Bahadir; Topsakal, Ramazan; Gibson, Charles Michael

    2014-03-01

    We evaluated the association of total bilirubin with post-percutaneous coronary intervention (PCI) coronary blood flow and in-hospital major adverse cardiac events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. A total of 536 consecutive patients with STEMI (male 79%, mean age = 59.9 ± 12.6 years) admitted within 6 hours from symptom onset were enrolled. Patients were divided into 2 groups based on the thrombolysis in myocardial infarction (MI) flow grade. In-stent thrombosis, nonfatal MI, and in-hospital mortality were significantly higher in no-reflow group (P = .007, P = .002, and P < .001, respectively). On multivariate regression, the total bilirubin levels remained independent predictors of no-reflow (odds ratio [OR] 1.586, 95% confidence interval [CI] 1.02-2.47; P = .042) and in-hospital MACE (OR 1.399, 95% CI 1.053-1.857; P = .020). Serum bilirubin levels were independently associated with no-reflow and in-hospital MACE in patients with STEMI undergoing primary PCI. PMID:23378197

  20. Seeking the Admission Hybrid

    ERIC Educational Resources Information Center

    Lucido, Jerome A.

    2012-01-01

    When one thinks of seminal publications in college admission, the first piece that comes to mind is B. Alden Thresher's "College Admissions in the Public Interest" (1966). Thresher's work, relevant to this day, is credited with being the foundational document of the admission profession. McDonough and Robertson's 1995 study, commissioned by NACAC,…

  1. Topical non-steroidal anti-inflammatory drugs and admission to hospital for upper gastrointestinal bleeding and perforation: a record linkage case-control study.

    PubMed Central

    Evans, J. M.; McMahon, A. D.; McGilchrist, M. M.; White, G.; Murray, F. E.; McDevitt, D. G.; MacDonald, T. M.

    1995-01-01

    OBJECTIVE--To evaluate the relation between topically applied non-steroidal anti-inflammatory drugs and upper gastrointestinal bleeding and perforation. DESIGN--A case-control study with 1103 patients admitted to hospital for upper gastrointestinal bleeding or perforation between January 1990 and December 1992 (cases). Two different control groups were used, with six community controls and with two hospital controls for each case. Previous exposure to topical and oral non-steroidal anti-inflammatory drugs and ulcer healing drugs was assessed. STUDY POPULATION--The population of 319,465 people who were resident in Tayside and were registered with a Tayside general practitioner between January 1989 and October 1994. A record linkage database containing all data on hospital events and dispensed drugs between 1989 and 1992 was used for this population. MAIN OUTCOME MEASURES--Unadjusted and adjusted odds ratios of exposure in those admitted to hospital compared with controls. RESULTS--Significant unadjusted associations were detected between all three classes of drug and upper gastrointestinal complications. The significant association detected for topical non-steroidal anti-inflammatory drugs was no longer evident in analyses which adjusted for the confounding effect of concomitant exposure to oral anti-inflammatories and ulcer healing drugs (odds ratio = 1.45; 95% confidence interval 0.84 to 2.50 with community controls; 1.06; 0.60 to 1.88 with hospital controls). CONCLUSION--In this study topical non-steroidal anti-inflammatory drugs were not significantly associated with upper gastrointestinal bleeding and perforation after adjustment for the confounding effects of concomitant use of oral anti-inflammatories and ulcer healing drugs. PMID:7613317

  2. Identifying Frequent Users of an Urban Emergency Medical Service Using Descriptive Statistics and Regression Analyses

    PubMed Central

    Norman, Chenelle; Mello, Michael; Choi, Bryan

    2016-01-01

    This retrospective cohort study provides a descriptive analysis of a population that frequently uses an urban emergency medical service (EMS) and identifies factors that contribute to use among all frequent users. For purposes of this study we divided frequent users into the following groups: low- frequent users (4 EMS transports in 2012), medium-frequent users (5 to 6 EMS transports in 2012), high-frequent users (7 to 10 EMS transports in 2012) and super-frequent users (11 or more EMS transports in 2012). Overall, we identified 539 individuals as frequent users. For all groups of EMS frequent users (i.e. low, medium, high and super) one or more hospital admissions, receiving a referral for follow-up care upon discharge, and having no insurance were found to be statistically significant with frequent EMS use (P<0.05). Within the diagnostic categories, 41.61% of super-frequent users had a diagnosis of “primarily substance abuse/misuse” and among low-frequent users a majority, 53.33%, were identified as having a “reoccurring (medical) diagnosis.” Lastly, relative risk ratios for the highest group of users, super-frequent users, were 3.34 (95% CI [1.90–5.87]) for obtaining at least one referral for follow-up care, 13.67 (95% CI [5.60–33.34]) for having four or more hospital admissions and 5.95 (95% CI [1.80–19.63]) for having a diagnoses of primarily substance abuse/misuse. Findings from this study demonstrate that among low- and medium-frequent users a majority of patients are using EMS for reoccurring medical conditions. This could potentially be avoided with better care management. In addition, this study adds to the current literature that illustrates a strong correlation between substance abuse/misuse and high/super-frequent EMS use. For the subgroup analysis among individuals 65 years of age and older, we did not find any of the independent variables included in our model to be statistically significant with frequent EMS use. PMID:26823929

  3. Dressing and Addressing the Mental Patient: The Uses of Clothing in the Admission, Care and Employment of Residents in English Provincial Mental Hospitals, c. 1860–1960

    PubMed Central

    Baur, Nicole; Melling, Joseph

    2014-01-01

    Abstract Scholars of insanity and its historical antecedents have paid very little attention to personal and institutional clothing. Such dress, distributed to patients in mental institutions, has always been inscribed with the conflicting narratives of the period in which it was made and worn. The language of civil and medical authority is more evident than personal choice in the shape and address of the attire. This article examines clothing worn by patients in three Devon mental hospitals during the century before 1960. We consider the ways in which institutional clothing formed part of a hospital regimen of overt control, as well as suiting considerations of economy and employment that figured in these institutions. PMID:26989271

  4. Immigration, moving house and psychiatric admissions.

    PubMed

    Johansson, L M; Sundquist, J; Johansson, S E; Bergman, B

    1998-08-01

    This study was designed to elucidate psychiatric admission rates for native Swedes and foreign-born individuals during the period 1991-1994, when Sweden had a great influx of refugees. During the same period, and even earlier, psychiatric in-patient care had been reduced. Tests of differences between Swedes and foreign-born individuals in first psychiatric admission rates were performed using Poisson regressions, and the risk of a readmission was assessed using a proportional hazard model. Foreign-born individuals and native Swedes, both males and females, showed a similar admission pattern with regard to the number of admissions. Foreign-born males under 55 years of age and foreign-born females under 35 years of age had significantly higher admission rates than native Swedes. In total, native Swedes, both males and females, were hospitalized for a significantly longer period than the foreign-born subjects. About 43% of the patients were readmitted. The risk of a readmission was significantly increased among those with a high rate of internal migration. The high admission rates for young foreign-born individuals might be explained by a high incidence of mental illness owing to the trauma of being violently forced to migrate, acculturation difficulties, or unsatisfactory social circumstances such as high unemployment. The shorter hospitalization time could be due to undertreatment or less serious mental illness. PMID:9718235

  5. Short-term effects of air pollution on a range of cardiovascular events in England and Wales: case-crossover analysis of the MINAP database, hospital admissions and mortality

    PubMed Central

    Milojevic, Ai; Wilkinson, Paul; Armstrong, Ben; Bhaskaran, Krishnan; Smeeth, Liam; Hajat, Shakoor

    2014-01-01

    Objective To inform potential pathophysiological mechanisms of air pollution effects on cardiovascular disease (CVD), we investigated short-term associations between ambient air pollution and a range of cardiovascular events from three national databases in England and Wales. Methods Using a time-stratified case-crossover design, over 400 000 myocardial infarction (MI) events from the Myocardial Ischaemia National Audit Project (MINAP) database, over 2 million CVD emergency hospital admissions and over 600 000 CVD deaths were linked with daily mean concentrations of carbon monoxide (CO), nitrogen dioxide (NO2), particulate matter less than 10 μm in aerodynamic diameter (PM10), particulate matter less than 2.5 μm in aerodynamic diameter (PM2.5) and sulfur dioxide (SO2), and daily maximum of 8-hourly running mean of O3 measured at the nearest air pollution monitoring site to the place of residence. Pollutant effects were modelled using lags up to 4 days and adjusted for ambient temperature and day of week. Results For mortality, no CVD outcome analysed was clearly associated with any pollutant, except for PM2.5 with arrhythmias, atrial fibrillation and pulmonary embolism. With hospital admissions, only NO2 was associated with a raised risk: CVD 1.7% (95% CI 0.9 to 2.6), non-MI CVD 2.0% (1.1 to 2.9), arrhythmias 2.9% (0.6 to 5.2), atrial fibrillation 2.8% (0.3 to 5.4) and heart failure 4.4% (2.0 to 6.8) for a 10th–90th centile increase. With MINAP, only NO2 was associated with an increased risk of MI, which was specific to non-ST-elevation myocardial infarction (non-STEMIs): 3.6% (95% CI 0.4 to 6.9). Conclusions This study found no clear evidence for pollution effects on STEMIs and stroke, which ultimately represent thrombogenic processes, though it did for pulmonary embolism. The strongest associations with air pollution were observed with selected non-MI outcomes. PMID:24952943

  6. Predictors of emergency room visits or acute hospital admissions prior to death among hospice palliative care clients in Ontario: a retrospective cohort study

    PubMed Central

    2014-01-01

    Background Hospice palliative care (HPC) is a philosophy of care that aims to relieve suffering and improve the quality of life for clients with life-threatening illnesses or end of life issues. The goals of HPC are not only to ameliorate clients’ symptoms but also to reduce unneeded or unwanted medical interventions such as emergency room visits or hospitalizations (ERVH). Hospitals are considered a setting ill-prepared for end of life issues; therefore, use of such acute care services has to be considered an indicator of poor quality end of life care. This study examines predictors of ERVH prior to death among HPC home care clients. Methods A retrospective cohort study of a sample of 764 HPC home care clients who received services from a community care access centre (CCAC) in southern Ontario, Canada. All clients were assessed using the Resident Assessment Instrument for Palliative Care (interRAI PC) as part of normal clinical practice between April 2008 and July 2010. The Andersen-Newman framework for health service utilization was used as a conceptual model for the basis of this study. Logistic regression and Cox regression analyses were carried out to identify predictors of ERVH. Results Half of the HPC clients had at least one or more ERVH (n = 399, 52.2%). Wish to die at home (OR = 0.54) and advanced care directives (OR = 0.39) were protective against ERVH. Unstable health (OR = 0.70) was also associated with reduced probability, while infections such as prior urinary tract infections (OR = 2.54) increased the likelihood of ERVH. Clients with increased use of formal services had reduced probability of ERVH (OR = 0.55). Conclusions Findings of this study suggest that predisposing characteristics are nearly as important as need variables in determining ERVH among HPC clients, which challenges the assumption that need variables are the most important determinants of ERVH. Ongoing assessment of HPC clients is essential in reducing ERVH

  7. 42 CFR 412.3 - Admissions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES General Provisions § 412.3 Admissions. (a) For... patient history and comorbidities, the severity of signs and symptoms, current medical needs, and the...

  8. 42 CFR 412.3 - Admissions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES General Provisions § 412.3 Admissions. (a) For... patient history and comorbidities, the severity of signs and symptoms, current medical needs, and the...

  9. HIV and/or AIDS-related deaths and modifiable risk factors: A descriptive study of medical admissions at Oshakati Intermediate Hospital in Northern Namibia

    PubMed Central

    Mgori, N.K.

    2015-01-01

    Background High rates of HIV infection have decreased life expectancy in many African countries. Regardless of worldwide efforts to escalate treatment, care and prevention strategies, the number of deaths due to AIDS-related disorders is still high. Local healthcare workers suspect that there are modifiable factors in the care of HIV and/or AIDS patients which can be identified and improved. Aim To describe the HIV and/or AIDS-related causes of adult mortality and identify modifiable factors amongst patients admitted to Oshakati Intermediate Hospital, northern Namibia. Methods Data was extracted retrospectively and coded using the modified CoDe protocol for AIDS. Modifiable factors relating to the patient, health system or clinical care were identified using a standardised data collection tool. Results A total of 177 HIV and/or AIDS patients were identified, 94 (53.1%) were male and 120 (68%) had a CD4 count of less than 200 cells/mL. The common HIV-related causes of death were tuberculosis (25.9%), renal failure (15.8%), Pneumocystis jirovecii pneumonia (11.3%), cryptococcal meningitis (9%), HIV wasting syndrome (7.9%) and AIDS-defining malignancy (7.9%). The analysis revealed 281 modifiable factors; patient-related factors were the most common (153 [54.4%]), followed by health system factors (97 [34.5%]) and healthcare personnel factors (31 [11%]). Conclusion Our findings have highlighted the challenges in overall HIV and/or AIDS inpatient care and surrounding primary care facilities. The identification of specific modifiable factors can be used to reduce mortality by providing training as well as rational monitoring, planning and resource allocation.

  10. Technology in International Admissions

    ERIC Educational Resources Information Center

    White, Elizabeth

    2012-01-01

    In a relatively short time, technology applications have become an essential feature of the admissions business. They make the jobs of international admissions professionals easier in many ways, allowing for more robust communication with applicants and counselors, a streamlined application process, and quicker access to information about…

  11. An Admissions Officer's Credentials

    ERIC Educational Resources Information Center

    Chronicle of Higher Education, 2007

    2007-01-01

    Marilee Jones has resigned as a dean of admissions at the Massachusetts Institute of Technology after admitting that she had misrepresented her academic degrees when first applying to work at the university in 1979. As one of the nation's most prominent admissions officers--and a leader in the movement to make the application process less…

  12. What Admissions Officials Think

    ERIC Educational Resources Information Center

    Hoover, Eric

    2008-01-01

    Over the past two decades, college admissions has become a prime-time preoccupation. Most people know at least something about the process, especially if they have a teenager in high school and a college guide on their coffee table. Nonetheless, widespread public misconceptions persist about admissions requirements, the selection process, and the…

  13. 42 CFR 456.122 - Evaluation criteria for admission review.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... provide that— (a) The committee develops written medical care criteria to assess the need for admission... (3) Attended by physicians whose patterns of care are frequently found to be questionable. ... 42 Public Health 4 2014-10-01 2014-10-01 false Evaluation criteria for admission review....

  14. Wide Variability in Emergency Physician Admission Rates: A Target to Reduce Costs Without Compromising Quality

    PubMed Central

    Guterman, Jeffrey J.; Lundberg, Scott R.; Scheib, Geoffrey P.; Gross-Schulman, Sandra G.; Richman, Mark J.; Wang, Chien-Ju; Talan, David A.

    2016-01-01

    Introduction Attending physician judgment is the traditional standard of care for emergency department (ED) admission decisions. The extent to which variability in admission decisions affect cost and quality is not well understood. We sought to determine the impact of variability in admission decisions on cost and quality. Methods We performed a retrospective observational study of patients presenting to a university-affiliated, urban ED from October 1, 2007, through September 30, 2008. The main outcome measures were admission rate, fiscal indicators (Medicaid-denied payment days), and quality indicators (15- and 30-day ED returns; delayed hospital admissions). We asked each Attending to estimate their inpatient admission rate and correlated their personal assessment with actual admission rates. Results Admission rates, even after adjusting for known confounders, were highly variable (15.2%–32.0%) and correlated with Medicaid denied-payment day rates (p=0.038). There was no correlation with quality outcome measures (30-day ED return or delayed hospital admission). There was no significant correlation between actual and self-described admission rate; the range of mis-estimation was 0% to 117%. Conclusion Emergency medicine attending admission rates at this institution are highly variable, unexplained by known confounding variables, and unrelated to quality of care, as measured by 30-day ED return or delayed hospital admission. Admission optimization represents an important untapped potential for cost reduction through avoidable hospitalizations, with no apparent adverse effects on quality. PMID:27625720

  15. Patterns of psychiatric hospitalizations in schizophrenic psychoses within the Northern Finland 1966 Birth Cohort.

    PubMed

    Miettunen, Jouko; Lauronen, Erika; Veijola, Juha; Koponen, Hannu; Saarento, Outi; Isohanni, Matti

    2006-01-01

    We report patterns of hospitalization in schizophrenic psychoses by age 34 in a longitudinal population-based cohort. We test the predictive ability of various demographic and illness-related variables on patterns of hospitalization, with a special focus on the length of the first psychiatric hospitalization. All living subjects of the Northern Finland 1966 Birth Cohort with DSM-III-R schizophrenia (n=88) and other schizophrenia spectrum cases (n=27) by the year 1997 in the Finnish Hospital Discharge Register were followed for an average of 10.5 years. Measures of psychiatric hospitalization included time to re-hospitalization (as continuous and as re-hospitalization within 2 years) and the number of hospital episodes. Length of the first hospitalization, other illness-related and various socio-demographic predictors were used to predict hospitalization patterns. After adjusting for gender, age at first admission and number of hospital days a short (1-14 days) first hospitalization (reference >30 days; adjusted odds ratio 6.39; 95% CI 2.00-20.41) and familial risk of psychosis (OR 3.36; 1.09-10.39) predicted re-hospitalization within 2 years. A short first hospitalization also predicted frequent psychiatric admissions defined as the first three admissions within 3 years (OR 13.77; 3.92-48.36). A short first hospitalization was linked to increased risk of re-hospitalizations. Although short hospitalization is recommended by several guidelines, there may be a group of patients with schizophrenic psychoses in which too short a hospitalization may lead to inadequate treatment response. PMID:16923637

  16. 42 CFR 456.171 - Medicaid agency review of need for admission.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid agency review of need for admission. 456... Hospitals Medical, Psychiatric, and Social Evaluations and Admission Review § 456.171 Medicaid agency review of need for admission. Medical and other professional personnel of the Medicaid agency or...

  17. Help Desk Answers: Do corticosteroids reduce bronchiolitis hospitalizations?

    PubMed

    Jendi, Mohammed R; Scott, Quincy O; Smaga, Sharon A

    2016-05-01

    Corticosteroids alone don't decrease hospital admissions or length of stay among children with bronchiolitis. Combining oral dexamethasone and inhaled epinephrine appears to prevent one hospital admission for every 11 patients treated. PMID:27275940

  18. [Involuntary admission of addict during early pregnancy].

    PubMed

    Hondius, Adger J K; Stikker, Tineke E; Wennink, J M B Hanneke; Honig, Adriaan

    2012-01-01

    A 30-year-old cocaine-dependent woman was 16 weeks pregnant. Because of possible endangerment of the fetus, an involuntary provisional admission was authorized. Of particular interest is the application of the Dutch Act on Formal Admissions to Psychiatric Hospitals for the primary diagnosis 'addiction' and the fact that the fetus was regarded as a legal 'other'. In severe cases of addiction combined with pregnancy an earlier intervention is needed and arrangement of accelerated legal custody of the newborn before birth should be considered. For the protection of the unborn, we advocate a stricter application of the United Nations Convention on the Rights of the Child. Information for addicted women with preconception counselling can help prevent a compulsory admission. PMID:22258443

  19. Wavelet-based signal analysis for heart failure hospitalization prediction.

    PubMed

    Iakovidis, Dimitris K; Douska, Dimitra; Barba, Evaggelia; Koulaouzidis, George

    2016-01-01

    Heart failure (HF) is commonly a chronic condition associated with frequent hospital admissions. Early knowledge about a possible deterioration of this condition would enable early treatment for the prevention of adverse events and related hospital admissions. In this paper we present a computational method for predictive information extraction from daily physiological signals, which can be obtained by a telemonitoring system with wearable sensors. It is based on wavelet analysis of temporal signal patterns. Experiments with data from patients enrolled in a telemonitoring protocol show that the proposed method is capable of predicting HF hospitalization events one day before they happen, even in the case of low compliance to the protocol. These results indicate a promising perspective towards a monitoring system that would provide improved life quality for HF patients. PMID:27225548

  20. Does a hospital admission in old age denote the beginning of life with a compromised health-related quality of life? A longitudinal study of men and women aged 65 years and above participating in the Stockholm Public Health Cohort

    PubMed Central

    Karampampa, Korinna; Frumento, Paolo; Ahlbom, Anders; Modig, Karin

    2016-01-01

    Objectives The objective of this study was to analyse how hospitalisation after the age of 60 affected individuals' health-related quality of life (HRQoL). The main hypothesis was that a hospital admission in old age can be seen as a proxy of ill health and possibly as a health divider, separating life into a healthy and an unhealthy part. The extent to which this is true depends on which disease individuals face and how functional ability and HRQoL are affected. Settings This was a longitudinal study, based on an older cohort of individuals who participated in the Stockholm Public Health Cohort (SPHC) survey in 2006; the survey took place in Stockholm, Sweden. Information regarding hospitalisations and deaths, which is available through Swedish administrative registers, was linked to the survey from the National Patient Register and Cause of Death Register. Participants 2101 individuals, 65+ years old at inclusion, with no previous hospitalisations at baseline (2006), were followed for 4 years until 2010 (end of follow-up). Primary and secondary outcome measures HRQoL was assessed through a utility index derived from the EuroQol 5D questionnaire, at baseline and at 2010. The change in HRQoL after admission(s) to the hospital was estimated as the difference between the 2010 and 2006 levels using linear regression, also considering several covariates. Results A single hospitalisation did not reduce individuals' HRQoL, either for men or women. On the other hand, multiple any-cause hospitalisations reduced HRQoL between 3.2% and 6.5%. When looking into hospitalisations for specific causes, such as hip fractures, a decrease in HRQoL was observed as well; however, conclusions regarding this were impeded by the small sample size. Conclusions Hospital admissions in old age may indicate a shift from a healthy life to a life of compromised health when considering their frequency and cause over a period of time. PMID:27401358

  1. Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease.

    PubMed

    Wedzicha, Jadwiga A; Brill, Simon E; Allinson, James P; Donaldson, Gavin C

    2013-01-01

    Exacerbations of chronic obstructive pulmonary disease (COPD) are important events that carry significant consequences for patients. Some patients experience frequent exacerbations, and are now recognized as a distinct clinical subgroup, the 'frequent exacerbator' phenotype. This is relatively stable over time, occurs across disease severity, and is associated with poorer health outcomes. These patients are therefore a priority for research and treatment. The pathophysiology underlying the frequent exacerbator phenotype is complex, with increased airway and systemic inflammation, dynamic lung hyperinflation, changes in lower airway bacterial colonization and a possible increased susceptibility to viral infection. Frequent exacerbators are also at increased risk from comorbid extrapulmonary diseases including cardiovascular disease, gastroesophageal reflux, depression, osteoporosis and cognitive impairment. Overall these patients have poorer health status, accelerated forced expiratory volume over 1 s (FEV1) decline, worsened quality of life, and increased hospital admissions and mortality, contributing to increased exacerbation susceptibility and perpetuation of the frequent exacerbator phenotype. This review article sets out the definition and importance of the frequent exacerbator phenotype, with a detailed examination of its pathophysiology, impact and interaction with other comorbidities. PMID:23945277

  2. Causes of Hospitalization among Children Ages Zero to Nine Years Old in the City of São Paulo, Brazil

    PubMed Central

    Ferrer, Ana Paula Scoleze; Sucupira, Ana Cecília Silveira Lins; Grisi, Sandra Josefina Ferraz Ellero

    2010-01-01

    INTRODUCTION: The profile of child morbidity is an important parameter for defining and altering health policies. Studies about infant mortality are more numerous than those on morbidity, especially related to hospital admissions. The objective of this study is to describe the causes of admission in the public health system for children from zero to nine years of age in the city of São Paulo during the years 2002 to 2006 and compare these results to those from the national data. METHOD: Through a cross-sectional study, data were obtained from the Hospital Information System, which is available in the Information System of the Unified Health System - DATASUS. RESULTS: Within the period, 16% of the total admissions corresponded to children from zero to nine years of age, with most of the children being younger than one year of age. In the city of São Paulo, the admission coefficient increased 11%, and in Brazil, it decreased 14%. Respiratory diseases were the main causes of hospitalization. In São Paulo, the second most frequent causes of admission were diseases that originated during the perinatal period (15.9%), and in Brazil, the second most frequent cause of admission was infectious-parasitic diseases (21.7%). Admissions for perinatal diseases increased 32% in São Paulo and 6% in Brazil. While hospitalizations for diarrhea decreased in Brazil, an increase was recorded in the city of São Paulo for children under five years old. CONCLUSIONS: The findings of this study show a paradoxical increase in the number of hospitalizations during an expansion of primary attention, indicating that the rise was not associated with a significant improvement in the quality of service. PMID:20126344

  3. Emergency department Modified Early Warning Score association with admission, admission disposition, mortality, and length of stay

    PubMed Central

    Delgado-Hurtado, Juan J.; Berger, Andrea; Bansal, Amit B.

    2016-01-01

    Background Geisinger Health System implemented the Modified Early Warning Score (MEWS) in 2011 and is fully integrated to the Electronic Medical Record (EMR). Our objective was to assess whether the emergency department (ED) MEWS (auto-calculated by EMR) is associated with admission to the hospital, admission disposition, inpatient mortality, and length of stay (LOS) 4 years after its implementation. Methods A random sample of 3,000 patients’ first encounter in the ED was extracted in the study period (between January 1, 2014 and May 31, 2015). Logistic regression was done to analyze whether mean, maximum, and median ED MEWS is associated with admission disposition, mortality, and LOS. Results Mean, maximum, and median ED MEWS is associated with admission to the hospital, admission disposition, and mortality. It correlates weakly with LOS. Conclusion MEWS can be integrated to the EMR, and the score automatically generated still helps predict catastrophic events. MEWS can be used as a triage tool when deciding whether and where patients should be admitted. PMID:27124174

  4. Delayed Recognition of Deterioration of Patients in General Wards Is Mostly Caused by Human Related Monitoring Failures: A Root Cause Analysis of Unplanned ICU Admissions

    PubMed Central

    Driesen, Babiche E. J. M.; Merten, Hanneke; Ludikhuize, Jeroen; van der Spoel, Johannes I.; Kramer, Mark H. H.; Nanayakkara, Prabath W. B.

    2016-01-01

    Background An unplanned ICU admission of an inpatient is a serious adverse event (SAE). So far, no in depth-study has been performed to systematically analyse the root causes of unplanned ICU-admissions. The primary aim of this study was to identify the healthcare worker-, organisational-, technical,- disease- and patient- related causes that contribute to acute unplanned ICU admissions from general wards using a Root-Cause Analysis Tool called PRISMA-medical. Although a Track and Trigger System (MEWS) was introduced in our hospital a few years ago, it was implemented without a clear protocol. Therefore, the secondary aim was to assess the adherence to a Track and Trigger system to identify deterioration on general hospital wards in patients eventually transferred to the ICU. Methods Retrospective observational study in 49 consecutive adult patients acutely admitted to the Intensive Care Unit from a general nursing ward. 1. PRISMA-analysis on root causes of unplanned ICU admissions 2. Assessment of protocol adherence to the early warning score system. Results Out of 49 cases, 156 root causes were identified. The most frequent root causes were healthcare worker related (46%), which were mainly failures in monitoring the patient. They were followed by disease-related (45%), patient-related causes (7, 5%), and organisational root causes (3%). In only 40% of the patients vital parameters were monitored as was instructed by the doctor. 477 vital parameter sets were found in the 48 hours before ICU admission, in only 1% a correct MEWS was explicitly documented in the record. Conclusions This in-depth analysis demonstrates that almost half of the unplanned ICU admissions from the general ward had healthcare worker related root causes, mostly due to monitoring failures in clinically deteriorating patients. In order to reduce unplanned ICU admissions, improving the monitoring of patients is therefore warranted. PMID:27537689

  5. The functioning of the Cuban home hospitalization programme: a descriptive analysis

    PubMed Central

    De Vos, Pol; Barroso, Isabel; Rodríguez, Armando; Bonet, Mariano; Van der Stuyft, Patrick

    2007-01-01

    Background Over the last decades hospital at home (HaH) programmes have been set up in many, mainly European, countries. The Cuban HaH programme is not hospital driven, but the responsibility of the first line health services, and family doctors play a pivotal role. Methods We analyse the structure and functioning of the Cuban programme. In this descriptive study, information was prospectively collected on HaH patients admitted between July 1st 2001 and June 30th 2002. Results Admission rates varied between areas from 0.014 to 0.035 per person per year (ppy). The < 1y and 1–4y age groups had the highest admission rates. In one area the follow-up of pregnancy problems led to high 15–24y and 25–49y female admission rates (0,070 and 0,058 respectively). Respiratory affections were the most frequent reason for admission (32,6%), followed by early hospital discharge (16,0%) and gynaeco-obstetrical problems (10.8%). The median length of stay varied from 5 to 7 days between regions and from 5 days (early discharge) to 7 days (gynaeco-obstetrical problems) in function of the reason for admission. On average an HaH episode entailed 1.4 and 1.6 contacts per patient-day with the family doctor and nurse respectively. Conclusion Difference in admission criteria in function of geography, distance to the hospital, transport facilities, and staff factors, as well as differences in hospital policy on early discharge explain the observed variability. The programme plays an important role in the integrated approach to quality care in the Cuban health system, but could benefit from more uniform admission criteria. PMID:17540015

  6. The Admissions Equity Struggle

    ERIC Educational Resources Information Center

    Freedman, Eric

    2012-01-01

    It has been a long, litigious road from Heman Sweatt, an African-American mail carrier who wanted to attend the prestigious, all-White law school at the University of Texas at Austin in 1946, to Abigail Fisher, a White high school student who failed to win undergraduate admission to the same university a half-century later. Depending on what the…

  7. Frequent visitors to psychiatric emergency services: staff attitudes and temporal patterns.

    PubMed

    Arfken, Cynthia; Zeman, Lori Lackman; Yeager, Lindsay; Mischel, Edward; Amirsadri, Alireza

    2002-11-01

    Providing quality psychiatric emergency services is becoming more difficult as utilization rates soar, especially by individuals who are frequent visitors. To address this issue, a staff survey and analysis of admission patterns were conducted. Staff were more likely to believe that frequent visitors sought care because they had difficulty accessing alternative services, had basic needs unmet, were substance abusers, wanted inpatient admission, and were noncompliant with treatment plans. The 1999 temporal admission pattern documented that frequent visitors' admissions were higher during the first week of the month and inclement weather. Surprisingly, the infrequent visitors' admissions also were higher during the first week of the month. Together, these findings suggest that, in this urban location, frequent visitors are disadvantaged individuals lacking support and alternative treatment settings who use psychiatric emergency services to meet basic needs. PMID:12404943

  8. Subacute autonomic and sensory neuropathy closely related to cytomegalovirus infection preceded by frequent syncopal attacks.

    PubMed

    Nakao, Koichi; Namekawa, Michito; Kondo, Soichi; Ono, Sayaka; Nakano, Imaharu

    2016-08-31

    A 73-year-old woman who had hypertension developed a slight fever and general malaise with laboratory-proven hepatic dysfunction as well as frequent syncopal attacks 3 months before admission to our hospital. One month later, she developed urinary retention and distal limb numbness. Upon admission, her neurological examination showed reduced limb tendon reflexes, glove and stocking-type numbness, and diminished senses of touch, temperature, pain, and distal leg vibration and position. Serum cytomegalovirus (CMV) IgM antibody and CMV IgG antibody were elevated on admission, and both decreased thereafter, confirming CMV infection. No serum anti-ganglioside antibody was detected. Cerebrospinal fluid revealed a mild pleocytosis and elevated proteins. Compound muscle action potential (CMAP) amplitudes of the tibial and peroneal nerve were slightly reduced. Sensory nerve action potential (SNAP) amplitudes of the median and ulnar nerves were reduced, and sural SNAP was not evoked. Systolic blood pressure dropped 48 mmHg when the patient assumed a standing position from a supine one, demonstrating orthostatic hypotension, and a cold pressor test was abnormal, both indicating an obvious hypofunction of the sympathetic nerve. The postganglionic autonomic nerve appeared to be damaged because the accumulation of [(123)I] meta-iodobenzylguanidine was reduced on myocardial scintigraphy. These findings combined together led us to make a diagnosis of subacute autonomic and sensory neuropathy associated with CMV infection in this case. Following an eventless administration of oral fludrocortisones, intravenous immuno-globulin (IVIg) was given after one month of the hospitalization with a remarkable reduction of the syncope. This case is instructive in two points. One is that there may be a couple of months with syncope alone before the sensory disturbance appearance, and the other is that IVIg may be considerably effective for the patient-annoying syncopes. To our knowledge, this

  9. Vitamin D deficiency at admission is not associated with 90-day mortality in patients with severe sepsis or septic shock: Observational FINNAKI cohort study.

    PubMed

    Ala-Kokko, Tero I; Mutt, Shivaprakash J; Nisula, Sara; Koskenkari, Juha; Liisanantti, Janne; Ohtonen, Pasi; Poukkanen, Meri; Laurila, Jouko J; Pettilä, Ville; Herzig, Karl-Heinz

    2016-01-01

    Introduction Low levels of vitamin D have been associated with increased mortality in patients that are critically ill. This study explored whether vitamin D levels were associated with 90-day mortality in severe sepsis or septic shock. Methods Plasma vitamin D levels were measured on admission to the intensive care unit (ICU) in a prospective multicentre observational study. Results 610 patients with severe sepsis were included; of these, 178 (29%) had septic shock. Vitamin D deficiency (<50 nmol/L) was present in 333 (55%) patients. The 90-day mortality did not differ among patients with or without vitamin D deficiency (28.3% vs. 28.5%, p = 0.789). Diabetes was more common among patients deficient compared to those not deficient in vitamin D (30% vs. 18%, p < 0.001). Hospital-acquired infections at admission were more prevalent in patients with a vitamin D deficiency (31% vs. 16%, p < 0.001). A multivariable adjusted Cox regression model showed that low vitamin D levels could not predict 90-day mortality (<50 nmol/L: hazard ratio (HR) 0.99 (95% CI: 0.72-1.36), p > 0.9; and <25 nmol/L: HR 0.44 (95% CI: 0.22-0.87), p = 0.018). Conclusions Vitamin D deficiency detected upon ICU admission was not associated with 90-day mortality in patients with severe sepsis or septic shock. Key messages In severe sepsis and septic shock, a vitamin D deficiency upon ICU admission was not associated with increased mortality. Compared to patients with sufficient vitamin D, patients with deficient vitamin D more frequently exhibited diabetes, elevated C-reactive protein levels, and hospital-acquired infections upon ICU admission, and they more frequently developed acute kidney injury. PMID:26800186

  10. Forecasting paediatric malaria admissions on the Kenya Coast using rainfall

    PubMed Central

    Karuri, Stella Wanjugu; Snow, Robert W.

    2016-01-01

    Background Malaria is a vector-borne disease which, despite recent scaled-up efforts to achieve control in Africa, continues to pose a major threat to child survival. The disease is caused by the protozoan parasite Plasmodium and requires mosquitoes and humans for transmission. Rainfall is a major factor in seasonal and secular patterns of malaria transmission along the East African coast. Objective The goal of the study was to develop a model to reliably forecast incidences of paediatric malaria admissions to Kilifi District Hospital (KDH). Design In this article, we apply several statistical models to look at the temporal association between monthly paediatric malaria hospital admissions, rainfall, and Indian Ocean sea surface temperatures. Trend and seasonally adjusted, marginal and multivariate, time-series models for hospital admissions were applied to a unique data set to examine the role of climate, seasonality, and long-term anomalies in predicting malaria hospital admission rates and whether these might become more or less predictable with increasing vector control. Results The proportion of paediatric admissions to KDH that have malaria as a cause of admission can be forecast by a model which depends on the proportion of malaria admissions in the previous 2 months. This model is improved by incorporating either the previous month's Indian Ocean Dipole information or the previous 2 months’ rainfall. Conclusions Surveillance data can help build time-series prediction models which can be used to anticipate seasonal variations in clinical burdens of malaria in stable transmission areas and aid the timing of malaria vector control. PMID:26842613

  11. The Probabilistic Admissible Region with Additional Constraints

    NASA Astrophysics Data System (ADS)

    Roscoe, C.; Hussein, I.; Wilkins, M.; Schumacher, P.

    The admissible region, in the space surveillance field, is defined as the set of physically acceptable orbits (e.g., orbits with negative energies) consistent with one or more observations of a space object. Given additional constraints on orbital semimajor axis, eccentricity, etc., the admissible region can be constrained, resulting in the constrained admissible region (CAR). Based on known statistics of the measurement process, one can replace hard constraints with a probabilistic representation of the admissible region. This results in the probabilistic admissible region (PAR), which can be used for orbit initiation in Bayesian tracking and prioritization of tracks in a multiple hypothesis tracking framework. The PAR concept was introduced by the authors at the 2014 AMOS conference. In that paper, a Monte Carlo approach was used to show how to construct the PAR in the range/range-rate space based on known statistics of the measurement, semimajor axis, and eccentricity. An expectation-maximization algorithm was proposed to convert the particle cloud into a Gaussian Mixture Model (GMM) representation of the PAR. This GMM can be used to initialize a Bayesian filter. The PAR was found to be significantly non-uniform, invalidating an assumption frequently made in CAR-based filtering approaches. Using the GMM or particle cloud representations of the PAR, orbits can be prioritized for propagation in a multiple hypothesis tracking (MHT) framework. In this paper, the authors focus on expanding the PAR methodology to allow additional constraints, such as a constraint on perigee altitude, to be modeled in the PAR. This requires re-expressing the joint probability density function for the attributable vector as well as the (constrained) orbital parameters and range and range-rate. The final PAR is derived by accounting for any interdependencies between the parameters. Noting that the concepts presented are general and can be applied to any measurement scenario, the idea

  12. Pre-admission NT-proBNP improves diagnostic yield and risk stratification – the NT-proBNP for EValuation of dyspnoeic patients in the Emergency Room and hospital (BNP4EVER) study

    PubMed Central

    Januzzi, James L; Medvedovski, Margarita; Sharist, Moshe; Shochat, Michael; Ashkar, Jalal; Peschansky, Pavel; Haim, Shmuel Bar; Blondheim, David S; Glikson, Michael; Shotan, Avraham

    2012-01-01

    Background: Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) level is useful to diagnose or exclude acutely decompensated heart failure (ADHF) in dyspnoeic patients presenting to the emergency department (ED). Aim: To evaluate the impact of ED NT-proBNP testing on admission, length of stay (LOS), discharge diagnosis and long-term outcome. Methods: Dyspnoeic patients were randomized in the ED to NT-proBNP testing. Admission and discharge diagnoses, and outcomes were examined. Results: During 17 months, 470 patients were enrolled and followed for 2.0±1.3 years. ADHF likelihood, determined at study conclusion by validated criteria, established ADHF diagnosis as unlikely in 86 (17%), possible in 120 (24%), and likely in 293 (59%) patients. The respective admission rates in these subgroups were 80, 91, and 96%, regardless of blinding, and 61.9% of blinded vs. 74.5% of unblinded ADHF-likely patients were correctly diagnosed at discharge (p=0.029), with similar LOS. 2-year mortality within subgroups was unaffected by test, but was lower in ADHF-likely patients with NT-proBNP levels below median (5000 pg/ml) compared with those above median (p=0.002). Incidence of recurrent cardiac events tracked NT-proBNP levels. Conclusion: ED NT-proBNP testing did not affect admission, LOS, 2-year survival, or recurrent cardiac events among study patients but improved diagnosis at discharge, and allowed risk stratification even within the ADHF-likely group. (ClinicalTrials.gov#NCT00271128) PMID:24062895

  13. Association of Intensive Care Unit Admission With Mortality Among Older Patients With Pneumonia

    PubMed Central

    Valley, Thomas S.; Sjoding, Michael W.; Ryan, Andrew M.; Iwashyna, Theodore J.; Cooke, Colin R.

    2016-01-01

    IMPORTANCE Among patients whose need for intensive care is uncertain, the relationship of intensive care unit (ICU) admission with mortality and costs is unknown. OBJECTIVE To estimate the relationship between ICU admission and outcomes for elderly patients with pneumonia. DESIGN, SETTING, AND PATIENTS Retrospective cohort study of Medicare beneficiaries (aged >64 years) admitted to 2988 acute care hospitals in the United States with pneumonia from 2010 to 2012. EXPOSURES ICU admission vs general ward admission. MAIN OUTCOMES AND MEASURES Primary outcome was 30-day all-cause mortality. Secondary outcomes included Medicare spending and hospital costs. Patient and hospital characteristics were adjusted to account for differences between patients with and without ICU admission. To account for unmeasured confounding, an instrumental variable was used—the differential distance to a hospital with high ICU admission (defined as any hospital in the upper 2 quintiles of ICU use). RESULTS Among 1 112 394 Medicare beneficiaries with pneumonia, 328 404 (30%) were admitted to the ICU. In unadjusted analyses, patients admitted to the ICU had significantly higher 30-day mortality, Medicare spending, and hospital costs than patients admitted to a general hospital ward. Patients (n = 553 597) living closer than the median differential distance (<3.3 miles) to a hospital with high ICU admission were significantly more likely to be admitted to the ICU than patients living farther away (n = 558 797) (36%for patients living closer vs 23%for patients living farther, P < .001). In adjusted analyses, for the 13%of patients whose ICU admission decision appeared to be discretionary (dependent only on distance), ICU admission was associated with a significantly lower adjusted 30-day mortality (14.8%for ICU admission vs 20.5%for general ward admission, P = .02; absolute decrease, −5.7%[95%CI, −10.6%, −0.9%]), yet there were no significant differences in Medicare spending or hospital

  14. Cost analysis of inpatient treatment of anorexia nervosa in adolescents: hospital and caregiver perspectives

    PubMed Central

    Wong, Matthew; Katzman, Debra K.; Akseer, Nadia; Steinegger, Cathleen; Hancock-Howard, Rebecca L.; Coyte, Peter C.

    2015-01-01

    Background Admission to hospital is the treatment of choice for anorexia nervosa in adolescent patients who are medically unstable; however, stays are often prolonged and frequently disrupt normal adolescent development, family functioning, school and work productivity. We sought to determine the costs of inpatient treatment in this population from a hospital and caregiver perspective, and to identify determinants of such costs. Methods We used micro-costing methods for this cohort study involving all adolescent patients (age 12–18 yr) admitted for treatment of anorexia nervosa at a tertiary care child and adolescent eating disorder program in Toronto, between Sept. 1, 2011, and Mar. 31, 2013. We used hospital administrative data and Canadian census data to calculate hospital and caregiver costs. Results We included 73 adolescents in our cohort for cost-analysis. We determined a mean total hospital cost in 2013 Canadian dollars of $51 349 (standard deviation [SD] $26 598) and a mean total societal cost of $54 932 (SD $27 864) per admission, based on a mean length of stay of 37.9 days (SD 19.7 d). We found patient body mass index (BMI) to be the only significant negative predictor of hospital cost (p < 0.001). For every unit increase in BMI, we saw a 15.7% decrease in hospital cost. In addition, we found higher BMI (p < 0.001) and younger age (p < 0.05) to be significant negative predictors of caregiver costs. Interpretation The economic burden of inpatient treatment for adolescents with anorexia nervosa on hospitals and caregivers is substantial, especially among younger patients and those with lower BMI. Recognizing the symptoms of eating disorders early may preclude the need for admission to hospital altogether or result in admissions at higher BMIs, thereby potentially reducing these costs. PMID:26389097

  15. Increased Guillain-Barre syndrome admissions in Shiraz, southern Iran

    PubMed Central

    Safari, Anahid; Heydari, Seyed Taghi; Lankarani, Kamran Bagheri

    2013-01-01

    Background Guillain-Barre syndrome (GBS) is an acute immune-mediated peripheral neuropathy usually after an incident. This study was performed to investigate the basic epidemiologic features of GBS in south of Iran. Methods We studied consecutive patients with GBS in Nemazi Hospital of Shiraz, southern Iran. Demographic characteristics of the subjects, i.e. age, sex, and length of hospital stay were extracted. Information regarding yearly admissions for the entire hospital was also gathered. The prevalence of GBS per 10,000 hospital admissions was calculated and stratified by sex and year. Yearly prevalence was compared using the odds ratio (OR) and 95% confidence intervals (CI). Results From January 2000 to December 2009, 389 (232 males and 157 females) patients with GBS were admitted in our center. The mean age of patients was 29.8 ± 23.0 years and their mean length of hospital stay was 12.9 ± 11.6 days. The overall mortality rate was 6%. The ratio of admissions due to GBS to the total admissions was significantly higher in 2009, the year of an influenza A (H1N1) virus pandemic. Conclusion There appears to be an increase in the incidence of GBS in Shiraz. This is in parallel with the increasing trend of some other autoimmune diseases. PMID:24250891

  16. Evaluation of the sensitivity and specificity of criteria for isolation of patients admitted to a specialized cancer hospital.

    PubMed

    Cataneo, Caroline; Canini, Silvia Rita Marin da Silva; e Castro, Paulo de Tarso Oliveira; Hayashida, Miyeko; Gir, Elucir

    2011-01-01

    Early isolation of patients possibly colonized by multi-resistant microorganisms can minimize their spread, reducing cases of hospital infection and the related costs. This study aimed to identify the sensitivity and specificity of the criteria for isolation of patients admitted to a specialized cancer hospital. Cross-sectional study with a population of 61 patients coming from other hospitals who were admitted to the hospital between March 1st and August 31th, 2009. At the moment of admission, a data collection instrument was filled out and nasal and anal swabs were collected for microbiological culture. Of the 56 patients who met the isolation criteria, 30 (49.2%) presented positive cultures for multi-resistant microorganisms and methicillin-resistant Staphylococcus aureus was the most frequently identified microorganism. Most patients colonized by multi-resistant microorganisms were isolated at the moment of admission. The sensitivity of the isolation criteria was 90% and the specificity was 6.5%. PMID:22030570

  17. A Retrospective Study Investigating the Incidence and Predisposing Factors of Hospital-Acquired Anemia

    PubMed Central

    Kurniali, Peter C.; Curry, Stephanie; Brennan, Keith W.; Shaik, Mohammed; Schwartz, Kenneth A.; McCormack, Elise

    2014-01-01

    Hospitalized patients frequently have considerable volumes of blood removed for diagnostic testing which could lead to the development of hospital-acquired anemia. Low hemoglobin levels during hospitalization may result in significant morbidity for patients with underlying cardiorespiratory and other illnesses. We performed a retrospective study and data was collected using a chart review facilitated through an electronic medical record. A total of 479 patients who were not anemic during admission were included in analysis. In our study, we investigated the incidence of HAA and found that, between admission and discharge, 65% of patients dropped their hemoglobin by 1.0 g/dL or more, and 49% of patients developed anemia. We also found that the decrease in hemoglobin between admission and discharge did not differ significantly with smaller phlebotomy tubes. In multivariate analysis, we found that patients with longer hospitalization and those with lower BMI are at higher risk of developing HAA. In conclusion, our study confirms that hospital-acquired anemia is common. More aggressive strategies such as reducing the frequency of blood draws and expanding the use of smaller volume tubes for other laboratory panels may be helpful in reducing the incidence of HAA during hospitalization. PMID:25587440

  18. A retrospective study investigating the incidence and predisposing factors of hospital-acquired anemia.

    PubMed

    Kurniali, Peter C; Curry, Stephanie; Brennan, Keith W; Velletri, Kim; Shaik, Mohammed; Schwartz, Kenneth A; McCormack, Elise

    2014-01-01

    Hospitalized patients frequently have considerable volumes of blood removed for diagnostic testing which could lead to the development of hospital-acquired anemia. Low hemoglobin levels during hospitalization may result in significant morbidity for patients with underlying cardiorespiratory and other illnesses. We performed a retrospective study and data was collected using a chart review facilitated through an electronic medical record. A total of 479 patients who were not anemic during admission were included in analysis. In our study, we investigated the incidence of HAA and found that, between admission and discharge, 65% of patients dropped their hemoglobin by 1.0 g/dL or more, and 49% of patients developed anemia. We also found that the decrease in hemoglobin between admission and discharge did not differ significantly with smaller phlebotomy tubes. In multivariate analysis, we found that patients with longer hospitalization and those with lower BMI are at higher risk of developing HAA. In conclusion, our study confirms that hospital-acquired anemia is common. More aggressive strategies such as reducing the frequency of blood draws and expanding the use of smaller volume tubes for other laboratory panels may be helpful in reducing the incidence of HAA during hospitalization. PMID:25587440

  19. Predictors of Hospitalization for Injection Drug Users Seeking Care for Soft Tissue Infections

    PubMed Central

    Baernstein, Amy; Binswanger, Ingrid; Bradley, Katharine; Merrill, Joseph O.

    2007-01-01

    BACKGROUND Soft tissue infections (STIs) from injection drug use are a common cause of Emergency Department visits, hospitalizations, and operating room procedures, yet little is known about factors that may predict the need for these costly medical services. OBJECTIVE To describe a cohort of injection drug users seeking Emergency Department care for STIs and to identify risk factors associated with hospitalization. We hypothesized that participants who delayed seeking care would be hospitalized more often than those who did not. DESIGN Cohort study using in-person structured interviews and medical record review. Logistic regression assessed the association between hospital admission and delay in seeking care as well as other demographic, clinical, and psychosocial factors. PARTICIPANTS Injection drug users who sought Emergency Department care for STIs from May 2001 to March 2002. RESULTS Of the 136 participants, 55 (40%) were admitted to the hospital. Delay in seeking care was not associated with hospital admission. Participants admitted for their infection were significantly more likely to be living in a shelter (P = .01) and to report being hospitalized 2 or more times in the past year (P < .01). CONCLUSIONS We identified a subpopulation of injection drug users, mostly living in shelters, who were hospitalized frequently in the past year and who were more likely to be hospitalized for their current infections compared to others. As members of this subpopulation can be easily identified and located, they may benefit from interventions to reduce the health care utilization resulting from these infections. PMID:17356973

  20. [Selection criteria for patient admission to cardiac rehabilitation centers].

    PubMed

    Greco, Cesare; Cacciatore, Giuseppe; Gulizia, Michele; Martinelli, Luigi; Oliva, Fabrizio; Olivari, Zoran; Seccareccia, Fulvia; Temporelli, Pier Luigi; Urbinati, Stefano

    2011-03-01

    Current guidelines state that cardiac rehabilitation is indicated after the acute phase of major cardiovascular diseases and interventions; on the other hand implementation of these indications is difficult because of several barriers, i.e. the number of patients per year with an indication exceeds by far the accommodation offer of cardiac rehabilitation centers; the demand for access to cardiac rehabilitation from acute cardiac care hospitals is low because the attention is focused on the acute phase of cardiac diseases. The present Consensus Document describes the changes in clinical epidemiology of the main cardiovascular diseases, showing that complications are increasingly more frequent in the post-acute phase, especially in the setting of myocardial infarction. The Joint ANMCO/IACPR-GICR Committee defines priority criteria based on clinical risk for admission to cardiac rehabilitation centers as inpatients. This Consensus Document represents, therefore, an important step forward in the search for continuity of care in high-risk patients during the post-acute phase. PMID:21560480

  1. Trauma in elderly patients evaluated in a hospital emergency department in Konya, Turkey: a retrospective study

    PubMed Central

    Kara, Hasan; Bayir, Aysegul; Ak, Ahmet; Akinci, Murat; Tufekci, Necmettin; Degirmenci, Selim; Azap, Melih

    2014-01-01

    Purpose Trauma is a common cause of admission to the hospital emergency department. The purpose of this study was to evaluate the cause of admission, clinical characteristics, and outcomes of patients aged ≥65 years admitted to an emergency department in Turkey because of blunt trauma. Materials and methods Medical records were retrospectively reviewed for 568 patients (314 women and 254 men) aged ≥65 years who were admitted to an emergency department of a tertiary care hospital. Results Trauma was caused by low-energy fall in 379 patients (67%), traffic accident in 79 patients (14%), high-energy fall in 69 patients (12%), and other causes in 41 patients (7%). The most frequent sites of injury were the lower extremity, thorax, upper extremity, and head. The femur was the most frequent fracture site. After evaluation in the emergency department, 377 patients (66%) were hospitalized. There were 31 patients (5%) who died. Risk of hospitalization after trauma was significantly associated with trauma to the lower extremity, thorax, and spine; fractures of the femur and rib; and intracranial injury. Conclusion Emergency department admission after trauma in patients aged ≥65 years is common after low-energy falls, and most injuries occur to the extremities. It is important to focus on prevention of falls to decrease the frequency of trauma in the elderly. PMID:24376346

  2. Predictors of Specialized Inpatient Admissions for Adults with Intellectual Disability

    ERIC Educational Resources Information Center

    Modi, Miti; McMorris, Carly; Palucka, Anna; Raina, Poonam; Lunsky, Yona

    2015-01-01

    Individuals with intellectual disability (ID) have complex mental health needs and may seek specialized ID psychiatric services. This study reports on predictors of specialized inpatient admissions for 234 individuals with ID who received outpatient services at a psychiatric hospital. Overall, from 2007-2012, 55 of the 234 outpatients were triaged…

  3. Do Hospital ICUs Raise Costs without Boosting Survival?

    MedlinePlus

    ... news/fullstory_160334.html Do Hospital ICUs Raise Costs Without Boosting Survival? Study finds common medical conditions ... hospital deaths, use of invasive procedures and hospital costs, their findings showed that ICU admission rates ranged ...

  4. 42 CFR 412.44 - Medical review requirements: Admissions and quality review.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Medical review requirements: Admissions and quality... Capital-Related Costs § 412.44 Medical review requirements: Admissions and quality review. Beginning on... completeness, adequacy, and quality of the services furnished in the hospital. (e) Other medical or...

  5. 42 CFR 412.44 - Medical review requirements: Admissions and quality review.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Medical review requirements: Admissions and quality... Capital-Related Costs § 412.44 Medical review requirements: Admissions and quality review. Beginning on... completeness, adequacy, and quality of the services furnished in the hospital. (e) Other medical or...

  6. 42 CFR 35.7 - Admissions; designation of person to be notified.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Admissions; designation of person to be notified. 35.7 Section 35.7 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.7 Admissions; designation...

  7. 42 CFR 35.7 - Admissions; designation of person to be notified.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Admissions; designation of person to be notified. 35.7 Section 35.7 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.7 Admissions; designation...

  8. 42 CFR 35.7 - Admissions; designation of person to be notified.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Admissions; designation of person to be notified. 35.7 Section 35.7 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.7 Admissions; designation...

  9. 42 CFR 35.6 - Admissions; determination of eligibility for care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.6 Admissions; determination of eligibility for care. Except as may otherwise be provided for specific classes of patients by the regulations... 42 Public Health 1 2013-10-01 2013-10-01 false Admissions; determination of eligibility for...

  10. 42 CFR 35.6 - Admissions; determination of eligibility for care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.6 Admissions; determination of eligibility for care. Except as may otherwise be provided for specific classes of patients by the regulations... 42 Public Health 1 2010-10-01 2010-10-01 false Admissions; determination of eligibility for...

  11. 42 CFR 35.7 - Admissions; designation of person to be notified.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Admissions; designation of person to be notified. 35.7 Section 35.7 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.7 Admissions; designation...

  12. 42 CFR 35.6 - Admissions; determination of eligibility for care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.6 Admissions; determination of eligibility for care. Except as may otherwise be provided for specific classes of patients by the regulations... 42 Public Health 1 2012-10-01 2012-10-01 false Admissions; determination of eligibility for...

  13. 42 CFR 35.6 - Admissions; determination of eligibility for care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.6 Admissions; determination of eligibility for care. Except as may otherwise be provided for specific classes of patients by the regulations... 42 Public Health 1 2014-10-01 2014-10-01 false Admissions; determination of eligibility for...

  14. 42 CFR 35.7 - Admissions; designation of person to be notified.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Admissions; designation of person to be notified. 35.7 Section 35.7 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.7 Admissions; designation...

  15. 42 CFR 35.6 - Admissions; determination of eligibility for care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.6 Admissions; determination of eligibility for care. Except as may otherwise be provided for specific classes of patients by the regulations... 42 Public Health 1 2011-10-01 2011-10-01 false Admissions; determination of eligibility for...

  16. 42 CFR 412.44 - Medical review requirements: Admissions and quality review.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Medical review requirements: Admissions and quality... Capital-Related Costs § 412.44 Medical review requirements: Admissions and quality review. Beginning on..., the following: (a) The medical necessity, reasonableness and appropriateness of hospital...

  17. 42 CFR 412.44 - Medical review requirements: Admissions and quality review.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Medical review requirements: Admissions and quality... Capital-Related Costs § 412.44 Medical review requirements: Admissions and quality review. Beginning on..., the following: (a) The medical necessity, reasonableness and appropriateness of hospital...

  18. Issues in College Admissions Testing.

    ERIC Educational Resources Information Center

    Noble, Julie P.; Camara, Wayne J.

    College admissions tests provide a standardized and objective measure of student achievement and generalized skills. Unlike high school grades or rank, admission tests are a common measure for comparing students who have attended different high schools, completed different courses, received different grades in courses taught by different teachers,…

  19. The Changing College Admissions Scene.

    ERIC Educational Resources Information Center

    Sjogren, Cliff

    1983-01-01

    Discusses the status of college admissions and some of the forces that influenced college admissions policies during each of four three-year periods: the Sputnik Era (1957-60), the Postwar Baby Boom Era (1964-67), the "New Groups" Era (1971-74), and the Stable Enrollment Era (1978-81). (PGD)

  20. Toward More Effective Admissions Interviews.

    ERIC Educational Resources Information Center

    Maly, Nancy J.

    1983-01-01

    Suggests ways to improve college admissions interviews. Discusses the purpose, format, technique, and content, of the interview as well as selling the college, concluding the interview, and writing the final interview report. Emphasizes the benefits of good interviewing skills to admissions officers. (WAS)

  1. Hospital Prices Increase in California, Especially Among Hospitals in the Largest Multi-hospital Systems.

    PubMed

    Melnick, Glenn A; Fonkych, Katya

    2016-01-01

    A surge in hospital consolidation is fueling formation of ever larger multi-hospital systems throughout the United States. This article examines hospital prices in California over time with a focus on hospitals in the largest multi-hospital systems. Our data show that hospital prices in California grew substantially (+76% per hospital admission) across all hospitals and all services between 2004 and 2013 and that prices at hospitals that are members of the largest, multi-hospital systems grew substantially more (113%) than prices paid to all other California hospitals (70%). Prices were similar in both groups at the start of the period (approximately $9200 per admission). By the end of the period, prices at hospitals in the largest systems exceeded prices at other California hospitals by almost $4000 per patient admission. Our study findings are potentially useful to policy makers across the country for several reasons. Our data measure actual prices for a large sample of hospitals over a long period of time in California. California experienced its wave of consolidation much earlier than the rest of the country and as such our findings may provide some insights into what may happen across the United States from hospital consolidation including growth of large, multi-hospital systems now forming in the rest of the rest of the country. PMID:27284126

  2. Revolving-door patients in a public psychiatric hospital in Israel: cross sectional study.

    PubMed

    Oyffe, Igor; Kurs, Rena; Gelkopf, Marc; Melamed, Yuval; Bleich, Avi

    2009-12-01

    AIM. To study social, demographic, clinical, and forensic profiles of frequently re-hospitalized (revolving-door) psychiatric patients. METHODS. The study included all patients (n=183) who were admitted to our hospital 3 or more times during a 2-year period from 1999 through 2000. We compared these patients to 2 control groups of patients who were admitted to our hospital in the same period. For comparison of forensic data, we compared them with all non revolving-door patients (n=1056) registered in the computerized hospital database and for comparison of medical and clinical data we compared them with a random sample of non revolving-door patients (n=98). The sample was sufficiently large to yield high statistical power (above 98%). We collected data on the legal status of the hospitalizations (voluntary or involuntary) and social, demographic, clinical, and forensic information from the forensic and medical records of revolving-door and non revolving-door patients. RESULTS. In the period 1999-2000, 183 revolving-door patients accounted for 771 (37.8%, 4.2 admissions per patient) and 1056 non revolving-door patients accounted for 1264 (62.5%, 1.2 admissions per patient) of the 2035 admissions to our hospital. Involuntary hospitalizations accounted for 23.9% of revolving-door and 76.0% of non revolving-door admissions. Revolving-door patients had significantly shorter mean interval between hospitalizations, showed less violence, and were usually discharged contrary to medical advice. We found no differences in sex, marital status, age, ethnicity, diagnoses, illegal drug and alcohol use, or previous suicide-attempts between the groups. CONCLUSIONS. Revolving-door patients are not necessarily hospitalized for longer time periods and do not have more involuntarily admissions. The main difference between revolving-door and non revolving-door patients is greater self-management of the hospitalization process by shortening the time between voluntary re-admission and

  3. Predicting Inpatient Readmission and Outpatient Admission in Elderly

    PubMed Central

    Lin, Kun-Pei; Chen, Pei-Chun; Huang, Ling-Ya; Mao, Hsiu-Chen; Chan, Ding-Cheng (Derrick)

    2016-01-01

    Abstract Recognizing potentially avoidable hospital readmission and admissions are important health care quality issues. We develop prediction models for inpatient readmission and outpatient admission to hospitals for older adults In the retrospective cohort study with 2 million sampling file of the National Health Insurance Research Database in Taiwan, older adults (aged ≥65 y/o) with a first admission in 2008 were enrolled in the inpatient cohort (N = 39,156). The outpatient cohort included subjects who had ≥1 outpatient visit in 2008 (N = 178,286). Each cohort was split into derivation (3/4) and validation (1/4) data set. Primary outcome of the inpatient cohort: 30-day readmission from the date of discharge. The outpatient cohort included hospital admissions within the 1-year follow-up period. Candidate risk factors include demographics, comorbidities, and previous health care utilizations. Series of logistic regression models were applied with area under the receiver operating curves (AUCs) to identify the best model. Roughly 1 of 7 (14.6%) of the inpatients was readmitted within 30 days, and 1 of 5 (19.1%) of the outpatient cohort was admitted within 1 year. Age, education, use of home health care, and selected comorbidities (e.g., cancer with metastasis) were included in the final model. The AUC of the inpatient readmission model was 0.655 (95% confidence interval [CI] 0.646–0.664) and outpatient admission model was 0.642 (95% CI 0.639–0.646). Predictive performance was maintained in both validation data sets. The goodness-to-fit model demonstrated good calibration in both groups. We developed and validated practical clinical prediction models for inpatient readmission and outpatient admissions for general older adults with indicators easily obtained from an administrative data set. PMID:27100455

  4. The Effects of Air Pollution on Ischemic Stroke Admission Rate

    PubMed Central

    Alimohammadi, Hossein; Fakhri, Sara; Derakhshanfar, Hojjat; Hosseini-Zijoud, Seyed-Mostafa; Safari, Saeed

    2016-01-01

    The present study aimed to determine the relationship between the level of air pollutants and the rate of ischemic stroke (IS) admissions to hospitals. In this retrospective cross-sectional study, stroke admissions (January-March 2012 and 2013) to an emergency department and air pollution and meteorological data were gathered. The relationship between air pollutant levels and hospital admission rates were evaluated using the generalize additive model. In all 379 patients with IS were referred to the hospital (52.5% male; mean age 68.2±13.3 years). Both transient (p<0.001) and long-term (p<0.001) rises in CO level increases the risk of IS. Increased weekly (p<0.001) and monthly (p<0.001) average O3 levels amplifies this risk, while a transient increase in NO2 (p<0.001) and SO2 (p<0.001) levels has the same effect. Long-term changes in PM10 (p<0.001) and PM2.5 (p<0.001) also increase the risk of IS. The findings showed that the level of air pollutants directly correlates with the number of stroke admissions to the emergency department. PMID:26866000

  5. The Effects of Air Pollution on Ischemic Stroke Admission Rate.

    PubMed

    Alimohammadi, Hossein; Fakhri, Sara; Derakhshanfar, Hojjat; Hosseini-Zijoud, Seyed-Mostafa; Safari, Saeed; Hatamabadi, Hamid Reza

    2016-01-01

    The present study aimed to determine the relationship between the level of air pollutants and the rate of ischemic stroke (IS) admissions to hospitals. In this retrospective cross-sectional study, stroke admissions (January-March 2012 and 2013) to an emergency department and air pollution and meteorological data were gathered. The relationship between air pollutant levels and hospital admission rates were evaluated using the generalize additive model. In all 379 patients with IS were referred to the hospital (52.5% male; mean age 68.2±13.3 years). Both transient (p<0.001) and long-term (p<0.001) rises in CO level increases the risk of IS. Increased weekly (p<0.001) and monthly (p<0.001) average O3 levels amplifies this risk, while a transient increase in NO2 (p<0.001) and SO2 (p<0.001) levels has the same effect. Long-term changes in PM10 (p<0.001) and PM2.5 (p<0.001) also increase the risk of IS. The findings showed that the level of air pollutants directly correlates with the number of stroke admissions to the emergency department. PMID:26866000

  6. Using electronic health record systems to optimize admission decisions: the Creatinine case study.

    PubMed

    Ben-Assuli, Ofir; Shabtai, Itamar; Leshno, Moshe

    2015-03-01

    Many medical organizations have implemented electronic health record (EHR) and health information exchange (HIE) networks to improve medical decision-making. This study evaluated the contribution of EHR and HIE networks to physicians by investigating whether health information technology can lead to more efficient admission decisions by reducing redundant admissions in the stressful environment of emergency. Log-files were retrieved from an integrative and interoperable EHR that serves seven main Israeli hospitals. The analysis was restricted to a group of patients seen in the emergency departments who were administered a Creatinine test. The assessment of the contribution of EHR to admission decisions used various statistical analyses and track log-file analysis. We showed that using the EHR contributes to more efficient admission decisions and reduces the number of avoidable admissions. In particular, there was a reduction in readmissions when patient history was viewed. Using EHR can help respond to the international problem of avoidable hospital readmissions. PMID:24692078

  7. Effect of nursing home ownership on hospitalization of long-stay residents: an instrumental variables approach

    PubMed Central

    Grabowski, David C.; Feng, Zhanlian; Rahman, Momotazur; Mor, Vincent

    2014-01-01

    Hospitalizations among nursing home residents are frequent, expensive, and often associated with further deterioration of resident condition. The literature indicates that a substantial fraction of admissions is potentially preventable and that nonprofit nursing homes are less likely to hospitalize their residents. However, the correlation between ownership and hospitalization might reflect unobserved resident differences rather than a causal relationship. Using national minimum data set assessments linked with Medicare claims, we use a national cohort of long-stay residents who were newly admitted to nursing homes within an 18-month period spanning January 1, 2004 and June 30, 2005. After instrumenting for ownership status, we found that IV estimates of the effect of nonprofit ownership on hospitalization are at least as large as the non-instrumented effects, indicating that selection bias does not explain the observed relationship. We also found evidence suggesting the lower rate of hospitalizations among nonprofits was due to a different threshold for transfer. PMID:24234287

  8. Implementation of a Diabetes Educator Care Model to Reduce Paediatric Admission for Diabetic Ketoacidosis

    PubMed Central

    Deeb, Asma; Yousef, Hana; Abdelrahman, Layla; Tomy, Mary; Suliman, Shaker; Attia, Salima; Al Suwaidi, Hana

    2016-01-01

    Introduction. Diabetic Ketoacidosis (DKA) is a serious complication that can be life-threatening. Management of DKA needs admission in a specialized center and imposes major constraints on hospital resources. Aim. We plan to study the impact of adapting a diabetes-educator care model on reducing the frequency of hospital admission of children and adolescents presenting with DKA. Method. We have proposed a model of care led by diabetes educators for children and adolescents with diabetes. The team consisted of highly trained nurses. The model effectiveness is measured by comparing the rate of hospital admission for DKA over 4-year period to the baseline year prior to implementing the model. Results. There were 158 admissions for DKA over a 5-year period. Number of patients followed up in the outpatient diabetes clinics increased from 37 to 331 patients at the start and the end of the study years. Admission rate showed a downward trend over the five-year period. Percentage of admission for DKA is reduced from 210% to 1.8% (P 0.001). Conclusion. Diabetes educator care model is an effective and a sustainable measure to reduce hospital admission for DKA in children and adolescents. PMID:27294150

  9. Frequent Hemodialysis Fistula Infectious Complications

    PubMed Central

    Lok, Charmaine E.; Sontrop, Jessica M.; Faratro, Rose; Chan, Christopher T.; Zimmerman, Deborah Lynn

    2014-01-01

    Background Few studies have examined if infectious arteriovenous access complications vary with the cannulation technique and whether this is modified by dialysis frequency. We compared the infection rate between fistulas cannulated using buttonhole versus stepladder techniques for patients treated with short daily (SDH) or nocturnal hemodialysis at home (NHD). We also compared patients receiving conventional intermittent hemodialysis (CIHD) using stepladder cannulation. Methods Data were prospectively collected from 631 patients dialyzed with a fistula from 2001 to 2010 (Toronto and Ottawa, Canada). We compared the person-time incidence rate of bacteremia and local fistula infections using the exact binomial test. Results Forty-six (7.3%) patients received SDH (≥5 sessions/week, 2-4 h/session), 128 (20.3%) NHD (≥4 sessions/week, ≥5 h/session) and 457 (72%) CIHD (3 sessions/week, ≤4 h/session). Fifty percent of SDH and 72% of NHD patients used the buttonhole technique. There were 39 buttonhole-related bacteremias (rate: 0.196/1,000 fistula days) and at least 2 local buttonhole site infections. Staphylococcus aureus accounted for 85% of the bacteremias. There were 5 (13%) infection-related hospitalizations and 3 (10%) serious metastatic infections, including fistula loss. In comparison, there was 1 possible fistula-related infection in CIHD during follow-up (rate: 0.002/1,000 fistula days). Conclusions The rate of buttonhole-related infections was high among patients on frequent hemodialysis and more than 50 times greater than that among patients on CIHD with the stepladder technique. Most bacteremias were due to S. aureus – with serious consequences. The risks and benefits of buttonhole cannulation require individual consideration with careful monitoring, prophylaxis and management. PMID:25473405

  10. Differential Freshman Admission by Sex

    ERIC Educational Resources Information Center

    Suddick, David E.; McBee, M. Louise

    1974-01-01

    The authors report on a study whose purpose was to determine if, after adjusting for initial differences in high school averages and SAT scores via separate regression equations, differential admissions criterion by sex is justifiable. No justification is found. (RP)

  11. The incidence of admissions for schizophrenia and related psychoses in two cohorts: 1875–1924 and 1994–2010

    PubMed Central

    Le Noury, Joanna; Linden, Stefanie Caroline; Harris, Margaret; Whitaker, Chris; Linden, David; Baker, Darren; Roberts, Anthony P

    2012-01-01

    Objective To investigate changes in incidence of admissions for schizophrenia and related non-affective psychoses in North Wales. Design Data from two epidemiologically complete cohorts of patients presenting for the first time to mental health services in North Wales between 1875–1924 and 1994–2010 are used in this study to map the incidence of hospital admissions for schizophrenia and non-affective psychoses. Setting The North Wales Asylum Denbigh (archived patient case notes) and the North West Wales District General Hospital psychiatric unit. Population 3168 patients admitted to the North Wales Asylum Denbigh between 1875 and 1924 and 355 patients admitted to the District General Hospital psychiatric unit between 1994 and 2010. Results There was an increasing admission incidence for schizophrenia between 1875 and 1900, a higher admission rate in the 1990s for men, followed by a drop in rates of admission for both genders since 2006. Admission incidences switch from parity between the sexes in the historical period to a doubling of the admission rates for men compared with women in the modern period. This admission pattern differs from the admission patterns for affective psychoses or organic disorders. Conclusion There have been changes in the incidence of admissions for schizophrenia in North Wales. PMID:22267688

  12. 44 CFR 68.9 - Admissible evidence.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Admissible evidence. 68.9 Section 68.9 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF... admissible. (b) Documentary and oral evidence shall be admissible. (c) Admissibility of non-expert...

  13. 45 CFR 618.300 - Admission.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 618.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by...

  14. Differentially Private Frequent Subgraph Mining

    PubMed Central

    Xu, Shengzhi; Xiong, Li; Cheng, Xiang; Xiao, Ke

    2016-01-01

    Mining frequent subgraphs from a collection of input graphs is an important topic in data mining research. However, if the input graphs contain sensitive information, releasing frequent subgraphs may pose considerable threats to individual's privacy. In this paper, we study the problem of frequent subgraph mining (FGM) under the rigorous differential privacy model. We introduce a novel differentially private FGM algorithm, which is referred to as DFG. In this algorithm, we first privately identify frequent subgraphs from input graphs, and then compute the noisy support of each identified frequent subgraph. In particular, to privately identify frequent subgraphs, we present a frequent subgraph identification approach which can improve the utility of frequent subgraph identifications through candidates pruning. Moreover, to compute the noisy support of each identified frequent subgraph, we devise a lattice-based noisy support derivation approach, where a series of methods has been proposed to improve the accuracy of the noisy supports. Through formal privacy analysis, we prove that our DFG algorithm satisfies ε-differential privacy. Extensive experimental results on real datasets show that the DFG algorithm can privately find frequent subgraphs with high data utility.

  15. Overlapping of Serotonin Syndrome with Neuroleptic Malignant Syndrome due to Linezolid-Fluoxetine and Olanzapine-Metoclopramide Interactions: A Case Report of Two Serious Adverse Drug Effects Caused by Medication Reconciliation Failure on Hospital Admission.

    PubMed

    Mazhar, Faizan; Akram, Shahzad; Haider, Nafis; Ahmed, Rafeeque

    2016-01-01

    Antipsychotic and antidepressant are often used in combination for the treatment of neuropsychiatric disorders. The concomitant use of antipsychotic and/or antidepressant with drugs that may interact can lead to rare, life-threatening conditions such as serotonin syndrome and neuroleptic malignant syndrome. We describe a patient who has a history of taking two offending drugs that interact with drugs given during the course of hospital treatment which leads to the development of serotonin syndrome overlapped with neuroleptic malignant syndrome. The physician should be aware that both NMS and SS can appear as overlapping syndrome especially when patients use a combination of both antidepressants and antipsychotics. PMID:27433163

  16. Overlapping of Serotonin Syndrome with Neuroleptic Malignant Syndrome due to Linezolid-Fluoxetine and Olanzapine-Metoclopramide Interactions: A Case Report of Two Serious Adverse Drug Effects Caused by Medication Reconciliation Failure on Hospital Admission

    PubMed Central

    Akram, Shahzad; Haider, Nafis; Ahmed, Rafeeque

    2016-01-01

    Antipsychotic and antidepressant are often used in combination for the treatment of neuropsychiatric disorders. The concomitant use of antipsychotic and/or antidepressant with drugs that may interact can lead to rare, life-threatening conditions such as serotonin syndrome and neuroleptic malignant syndrome. We describe a patient who has a history of taking two offending drugs that interact with drugs given during the course of hospital treatment which leads to the development of serotonin syndrome overlapped with neuroleptic malignant syndrome. The physician should be aware that both NMS and SS can appear as overlapping syndrome especially when patients use a combination of both antidepressants and antipsychotics. PMID:27433163

  17. Summary of STARNet: Seamless Transitions and (Re)admissions Network.

    PubMed

    Auger, Katherine A; Simon, Tamara D; Cooperberg, David; Gay, James; Kuo, Dennis Z; Saysana, Michele; Stille, Christopher J; Fisher, Erin Stucky; Wallace, Sowdhamini; Berry, Jay; Coghlin, Daniel; Jhaveri, Vishu; Kairys, Steven; Logsdon, Tina; Shaikh, Ulfat; Srivastava, Rajendu; Starmer, Amy J; Wilkins, Victoria; Shen, Mark W

    2015-01-01

    The Seamless Transitions and (Re)admissions Network (STARNet) met in December 2012 to synthesize ongoing hospital-to-home transition work, discuss goals, and develop a plan to centralize transition information in the future. STARNet participants consisted of experts in the field of pediatric hospital medicine quality improvement and research, and included physicians and key stakeholders from hospital groups, private payers, as well as representatives from current transition collaboratives. In this report, we (1) review the current knowledge regarding hospital-to-home transitions; (2) outline the challenges of measuring and reducing readmissions; and (3) highlight research gaps and list potential measures for transition quality. STARNet met with the support of the American Academy of Pediatrics' Quality Improvement Innovation Networks and the Section on Hospital Medicine. PMID:25489017

  18. Summary of STARNet: Seamless Transitions and (Re)admissions Network

    PubMed Central

    Simon, Tamara D.; Cooperberg, David; Gay, James; Kuo, Dennis Z.; Saysana, Michele; Stille, Christopher J.; Fisher, Erin Stucky; Wallace, Sowdhamini; Berry, Jay; Coghlin, Daniel; Jhaveri, Vishu; Kairys, Steven; Logsdon, Tina; Shaikh, Ulfat; Srivastava, Rajendu; Starmer, Amy J.; Wilkins, Victoria; Shen, Mark W.

    2015-01-01

    The Seamless Transitions and (Re)admissions Network (STARNet) met in December 2012 to synthesize ongoing hospital-to-home transition work, discuss goals, and develop a plan to centralize transition information in the future. STARNet participants consisted of experts in the field of pediatric hospital medicine quality improvement and research, and included physicians and key stakeholders from hospital groups, private payers, as well as representatives from current transition collaboratives. In this report, we (1) review the current knowledge regarding hospital-to-home transitions; (2) outline the challenges of measuring and reducing readmissions; and (3) highlight research gaps and list potential measures for transition quality. STARNet met with the support of the American Academy of Pediatrics’ Quality Improvement Innovation Networks and the Section on Hospital Medicine. PMID:25489017

  19. Admission, Heal Thyself: A Prescription for Reclaiming College Admission as a Profession

    ERIC Educational Resources Information Center

    Jump, Jim

    2004-01-01

    Is college admission a business or a profession? This question is timeless because no issue (with possible exception of the perennial debate about whether admission(s) is singular or plural) sparks as much passion among admission practitioners, and it is timely because many of the controversial issues found in college admission today beg the…

  20. Frequent Itemset Hiding Algorithm Using Frequent Pattern Tree Approach

    ERIC Educational Resources Information Center

    Alnatsheh, Rami

    2012-01-01

    A problem that has been the focus of much recent research in privacy preserving data-mining is the frequent itemset hiding (FIH) problem. Identifying itemsets that appear together frequently in customer transactions is a common task in association rule mining. Organizations that share data with business partners may consider some of the frequent…

  1. Safety in the epilepsy monitoring unit: A retrospective study of 524 consecutive admissions.

    PubMed

    Fahoum, Firas; Omer, Nurit; Kipervasser, Svetlana; Bar-Adon, Tal; Neufeld, Miri

    2016-08-01

    The yield of monitoring patients at an epilepsy monitoring unit (EMU) depends on the recording of paroxysmal events in a timely fashion, however, increasing the risk of safety adverse events (AEs). We aimed to retrospectively study the frequency and risk factors for AE occurrences in all consecutive admissions to an adult EMU in a tertiary medical center. We also compared our findings with published data from other centers. Between January 2011 and June 2014, there were 524 consecutive admissions to the adult EMU at the Tel Aviv Sourasky Medical Center. Adverse events were recorded in 47 (9.0%) admissions. The most common AE was 4-hour seizure cluster (58.7% of AEs) and, in decreasing frequency, AEs related to antiepileptic drugs (AEDs, 11.1%), falls and traumatic injuries (9.5%), intravenous line complications (9.5%), electrode-related (4.8%), status epilepticus (SE, 3.2%), and cardiac (1.6%) and psychiatric (1.6%) complications. There were significantly more AEs among patients with a younger age at disease onset (p=0.005), a history of temporal lobe epilepsy (p=0.046), a history of focal seizures with altered consciousness (p=0.008), a history of SE (p=0.022), use of a vagal nerve stimulator (p=0.039), and intellectual disability (p=0.016) and when the indication for EMU monitoring was noninvasive or invasive presurgical evaluation (p=0.001). Adverse events occurred more frequently when patients had more events in the EMU (p=0.001) and among those administered carbamazepine (p=0.037), levetiracetam (p=0.004), clobazam (p=0.008), and sulthiame (p=0.016). Patients with a history of psychogenic nonepileptic seizures (PNESs) had significantly fewer AEs (p=0.013). Adverse events were not associated with the age, gender, duration of hospitalization or monitoring, AED withdrawal and renewal, seizure frequency by history, presence of major psychiatric comorbidities, abnormal neurological exam, or the presence of a lesion as on brain magnetic resonance imaging. In

  2. Peptic ulcer in hospital

    PubMed Central

    Johnson, H. Daintree

    1962-01-01

    This study corresponds to an estimated 142,250 admissions for peptic ulcer to the wards of National Health Service hospitals in England and Wales during the two years 1956 and 1957. It presents a picture of the incidence and mortality of complications and surgical treatment throughout England and Wales. PMID:14036965

  3. The characteristics of advanced cancer patients followed at home, but admitted to the hospital for the last days of life.

    PubMed

    Mercadante, Sebastiano; Masedu, Francesco; Valenti, Marco; Mercadante, Alessandro; Aielli, Federica

    2016-08-01

    Information regarding advanced cancer patients followed at home who are admitted to the hospital in the last days of life are lacking. The aim of this study was to assess the characteristics of patients who were hospitalized in the last days of life after being assisted by a home palliative care team. The secondary outcome was to identify possible risk factors for hospitalization. The charts were analyzed of a consecutive sample of advanced cancer patients admitted to hospital wards in the last days of life after being followed at home by a palliative care team. Of 550 consecutive patients followed at home, 138 (25.1 %) were admitted to the hospital. Younger patients were more likely to die in the hospital. In a logistic risk analysis adjusted for age, patients with lung and head-neck cancer were more likely to die in the hospital. Patients having a female relative or a female consort as a caregiver were more likely to die at home. CAGE-positive patients (7.25 %), and patients with a shorter period of home assistance were more likely transported to hospital before dying (p = 0.00 and p < 0.024, respectively). The most frequent reason for hospital admission was dyspnea. Admission was more frequent to the oncology ward. Patients who were admitted to the hospital died after a mean of 10.2 days (SD 8.2, range 0-40). This study provides preliminary data on the risk factors of hospitalization at the end of life for advanced cancer patients followed at home. PMID:26895033

  4. Recurrent psychiatric hospitalization.

    PubMed Central

    Voineskos, G.; Denault, S.

    1978-01-01

    Undue emphasis has been placed on rising rates of readmission to psychiatric facilities. After a decade of preoccupation with discharge rates, readmission statistics have been singled out in the last 15 years as the key factor for assessing hospital effectiveness. A study of a group of patients at high risk for recurrent hospitalization revealed that these patients were characterized more by features relating to environmental supports than by diagnosis. The operational definition for recurrent hospitalization (five or more admissions during the 2-year period preceding the latest admission) was effective in identifying this group; this is the first reported instance in which the definition has specified a certain number of admissions within a time-limited period. The findings of this study, as well as of an analysis of case histories and consumer opinion, led to the design of a pilot program for persons undergoing recurrent hospitalization. Readmission statistics are useless or misleading as measures of hospital effectiveness and efficiency; what matters is the way the former patients function in the community after discharge. Rather than simply trying to reduce the readmission rate psychiatric facilities should be examining the types of persons who are hospitalized recurrently to develop programs aimed at improving the functioning of these people in the community. PMID:630483

  5. Quetiapine-induced Priapism Requiring Frequent Emergency Admissions: A Case Report

    PubMed Central

    Jackson, Jon C.; Torrence, Chasity L.

    2014-01-01

    Priapism, a rare but well-known adverse reaction of first and second generation anti-psychotics, has been hypothesized to be associated with blockade of alpha 1 receptors. However, genetic abnormalities or heritability of affected cytochrome P450 alleles has not been ruled out as a causal mechanism. A case is presented with three episodes of priapism within 17 days while taking standard FDA (Food and Drug Administration) approved doses of quetiapine. Cytochrome P450 3A4 genotype testing was performed and resulted with normal enzymatic activity. This case further eliminates enzymatic metabolism as a possible cause of priapism, thus strengthening the alpha one receptor blockade hypothesis. PMID:26793482

  6. Adverse Drug Reactions Causing Admission to Medical Wards

    PubMed Central

    Mouton, Johannes P.; Njuguna, Christine; Kramer, Nicole; Stewart, Annemie; Mehta, Ushma; Blockman, Marc; Fortuin-De Smidt, Melony; De Waal, Reneé; Parrish, Andy G.; Wilson, Douglas P.K.; Igumbor, Ehimario U.; Aynalem, Getahun; Dheda, Mukesh; Maartens, Gary; Cohen, Karen

    2016-01-01

    Abstract Limited data exist on the burden of serious adverse drug reactions (ADRs) in sub-Saharan Africa, which has high HIV and tuberculosis prevalence. We determined the proportion of adult admissions attributable to ADRs at 4 hospitals in South Africa. We characterized drugs implicated in, risk factors for, and the preventability of ADR-related admissions. We prospectively followed patients admitted to 4 hospitals’ medical wards over sequential 30-day periods in 2013 and identified suspected ADRs with the aid of a trigger tool. A multidisciplinary team performed causality, preventability, and severity assessment using published criteria. We categorized an admission as ADR-related if the ADR was the primary reason for admission. There were 1951 admissions involving 1904 patients: median age was 50 years (interquartile range 34–65), 1057 of 1904 (56%) were female, 559 of 1904 (29%) were HIV-infected, and 183 of 1904 (10%) were on antituberculosis therapy (ATT). There were 164 of 1951 (8.4%) ADR-related admissions. After adjustment for age and ATT, ADR-related admission was independently associated (P ≤ 0.02) with female sex (adjusted odds ratio [aOR] 1.51, 95% confidence interval [95% CI] 1.06–2.14), increasing drug count (aOR 1.14 per additional drug, 95% CI 1.09–1.20), increasing comorbidity score (aOR 1.23 per additional point, 95% CI 1.07–1.41), and use of antiretroviral therapy (ART) if HIV-infected (aOR 1.92 compared with HIV-negative/unknown, 95% CI 1.17–3.14). The most common ADRs were renal impairment, hypoglycemia, liver injury, and hemorrhage. Tenofovir disoproxil fumarate, insulin, rifampicin, and warfarin were most commonly implicated, respectively, in these 4 ADRs. ART, ATT, and/or co-trimoxazole were implicated in 56 of 164 (34%) ADR-related admissions. Seventy-three of 164 (45%) ADRs were assessed as preventable. In our survey, approximately 1 in 12 admissions was because of an ADR. The range of ADRs and implicated drugs reflect

  7. Using Multimedia for Admission Recruitment.

    ERIC Educational Resources Information Center

    Gudema, Louis

    1995-01-01

    Multimedia can grab the attention of prospective students in an engaging, appealing way, while giving admission officers the opportunity to deliver information about every facet of campus life. Describes multimedia, its potential, and the production process as well as five current distribution methods. Discusses appropriateness of multimedia for…

  8. Personal Qualities and College Admissions.

    ERIC Educational Resources Information Center

    Willingham, Warren W.; Breland, Hunter M.

    The extent to which personal and academic factors are important in college admission decisions was studied in 1978, based on data on 25,000 applicants to 9 colleges (Colgate University, Williams College, Ohio Wesleyan University, Kenyon College, Kalamazoo College, Occidental College, Hartwick College, University of Richmond, and Bucknell…

  9. College Admissions: Beyond Conventional Testing

    ERIC Educational Resources Information Center

    Sternberg, Robert J.

    2012-01-01

    Standardized admissions tests such as the SAT (originally stood for "Scholastic Aptitude Test") and the ACT measure only a narrow segment of the skills needed to become an active citizen and possibly a leader who makes a positive, meaningful, and enduring difference to the world. The problem with these tests is that they promised, under what have…

  10. Admission Conditions and Graduates' Employability

    ERIC Educational Resources Information Center

    Alexandre, Fernando; Portela, Miguel; Sa, Carla

    2009-01-01

    In a context of increasing competition for students, admission conditions have been used as an instrument in a strategy of differentiation. Such a strategy is guided by short-run concerns, that is, the immediate need to attract more students. This article takes a longer term view, by examining graduates' employability. The authors find that…

  11. Admissions Plan Goes beyond Numbers

    ERIC Educational Resources Information Center

    Hoover, Eric

    2007-01-01

    Northeastern University's Torch Scholars Program is designed to seek out first-generation students who would not qualify under the university's regular admissions process. The scholarships go to motivated students who have shown determination in overcoming personal challenges. Northeastern believes the experiment will enhance the socioeconomic…

  12. Admission to Selective Schools, Alphabetically

    ERIC Educational Resources Information Center

    Jurajda, Stepan; Munich, Daniel

    2010-01-01

    One's position in an alphabetically sorted list may be important in determining access to over-subscribed public services. Motivated by anecdotal evidence, we investigate the importance of the position in the alphabet of Czech students for their admission chances into over-subscribed schools. Empirical evidence based on the population of students…

  13. Winter Weather Frequently Asked Questions

    MedlinePlus

    ... Planning Information on Specific Types of Emergencies Winter Weather Frequently Asked Questions Language: English Español (Spanish) Recommend ... I do if I get stranded in cold weather? Tie a brightly colored cloth to the antenna ...

  14. Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation.

    PubMed Central

    Gunnell, D. J.; Peters, T. J.; Kammerling, R. M.; Brooks, J.

    1995-01-01

    OBJECTIVE--To examine the relations between parasuicide, suicide, psychiatric inpatient admissions, and socioeconomic deprivation. DESIGN--Ecological analysis with data from routine information systems and the 1991 census. SETTING--24 localities in the area covered by the Bristol and District Health Authority (population 817,000), consisting of aggregations of neighbouring wards, with an average population of 34,000. SUBJECTS--6089 subjects aged over 10 years admitted to hospital after parasuicide between April 1990 and March 1994; 997 suicides occurring 1982-91; 4763 subjects aged 10-64 years admitted with acute psychiatric illness between April 1990 and March 1994. RESULTS--Localities varied significantly in standardised admission ratios for parasuicide and standardised mortality ratios for suicide (P < 0.001). Spearman's rank correlation coefficient between the standardised mortality ratio for suicide and standardised admission ratio for parasuicide was 0.73 (95% confidence interval 0.46 to 0.88). Correlation between parasuicide and Townsend score was 0.86 (0.70 to 0.94) and between suicide and Townsend score 0.73 (0.46 to 0.88). The partial correlation coefficient between suicide and parasuicide after the Townsend score was adjusted for was 0.29 (-0.13 to 0.62). The correlation between standardised admission ratio for parasuicide and standardised admission ratio for psychiatric illness was 0.76 (0.51 to 0.89) and between standardised mortality ratio for suicide and standardised admission ratio for psychiatric illness was 0.72 (0.45 to 0.87). CONCLUSION--A strong ecological association exists between suicide and parasuicide, with socioeconomic deprivation accounting for much of this relation. This strong association provides supporting evidence for the importance of social policy measures in attaining Health of the Nation targets on mental health. PMID:7627035

  15. Clinical Findings Leading to the Diagnosis of Sepsis in Neonates Hospitalized in Imam Khomeini and Bu Ali Hospitals, Sari, Iran: 2011-2012

    PubMed Central

    Farhadi, Roya; Yaghobian, Mahbobeh; Saravi, Benyamin Mohseni

    2014-01-01

    Background: One of the important diseases in neonatal period is sepsis. Clinical sign and symptoms in addition to lab tests are the most important way to accurate diagnosis and prevention of mortality. This study was conducted with the aim of determining the most clinical sign and symptoms which leading to diagnosis of sepsis. Materials and Methods: This is a descriptive cross-sectional study. The medical records of patients hospitalized in hospitals of Mazandaran University of Medical Sciences during 2011-2012 were reviewed. Variables were age, sex, birth and admission weight, clinical sign and symptoms, methods of delivery, admission and discharge condition, discharge status, the time elapsed between showing the symptom and admission to hospital, gestational age and the result of cultures. The data were recorded in a checklist and analyzed with SPSS and descriptive statistics. Results: finding showed that 120 patients discharged during period of study with diagnosis of sepsis. Discharged status of 27 (%22/5) were expired. Median age was 1 day with 8 hours SD, length of stay were 12±1 days, gestational age was 34±3 weeks and median birth weight was 2477±977 grams. The median time elapsed between showing the symptom and admission to hospital was 38±31 hours. Blood culture in 10 (%8/3) and urine culture in 8 (%7/6) patients were positive. None of patients have positive lumbar puncture culture. The frequent sign and symptpms in patients were respiratory distress, poor feeding and lethargy. Conclusion: Early diagnosis of neonatal sepsis is not possible only by specific laboratory exams. Clinical sign and symptoms can help us to prediction and diagnosis of neonatal sepsis. Results of this research revealed that it is not clear which one of manifestations was started first or the second because of medical history sheets don’t show this process. PMID:24999128

  16. Association between ozone and respiratory admissions among children and the elderly in Vancouver, Canada.

    PubMed

    Yang, Qiuying; Chen, Yue; Shi, Yuanli; Burnett, Richard T; McGrail, Kimberly M; Krewski, Daniel

    2003-11-01

    In this study, we examine the impact of ozone on daily respiratory admissions in both young children and the elderly in greater Vancouver, British Columbia. Study subjects included children less than 3 yr of age and adults 65 yr of age or over living in greater Vancouver who had acute hospital admissions for any respiratory diseases (ICD-9 codes 460-519) during the 13-yr period 1986-1998. Bidirectional case-crossover analysis was used to investigate associations between ambient ozone and respiratory hospitalizations after adjustment for other pollutants, including carbon monoxide, nitrogen dioxide, sulfur dioxide, and coefficient of haze. Potential effect modification by socioeconomic status as measured by household income was also examined. Respiratory admissions were associated with ozone levels 2, 3, 4, and 5 days prior to admission in both children and the elderly, with the strongest association observed at a lag of 4 days. Odds ratios for hospital admission of 1.22 (95% CI: 1.15-1.30) for children and 1.13 (1.09-1.18) for the elderly, respectively, were found, based on an increment in exposure corresponding to the interquartile range for ozone. Adjusting for other pollutants did not attenuate the ozone effect on respiratory admissions. Nor did socioeconomic status appear to modify the association between ozone and respiratory admissions in either children or the elderly. We concluded that ambient ozone is positively associated with respiratory hospital admission among young children and the elderly in Vancouver, British Columbia. These associations persisted after adjustment for both copollutant exposures and socioeconomic status. PMID:14569494

  17. Advising and Admission: Partners in Enrollment Management.

    ERIC Educational Resources Information Center

    Devine, Joseph E.

    1987-01-01

    Focuses on marketing strategies for college admission and examines the essential interaction between admission and academic units as a means of enhancing retention and producing informed, satisfied consumers/students. (KS)

  18. 49 CFR 1114.1 - Admissibility.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Admissibility. Any evidence which is sufficiently reliable and probative to support a decision under the provisions of the Administrative Procedure Act, or which would be admissible under the general statutes...

  19. 10 CFR 2.708 - Admissions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... admission of the genuineness and authenticity of any relevant document described in or attached to the... document for which an admission of genuineness and authenticity is requested must be delivered with...

  20. A Nationwide Census of ICU Capacity and Admissions in Mongolia

    PubMed Central

    Mendsaikhan, Naranpurev; Begzjav, Tsolmon; Lundeg, Ganbold; Brunauer, Andreas; Dünser, Martin W.

    2016-01-01

    In Mongolia, a Central Asian lower-m