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Sample records for acute hospital admissions

  1. Influence of homelessness on acute admissions to hospital.

    PubMed Central

    Lissauer, T; Richman, S; Tempia, M; Jenkins, S; Taylor, B

    1993-01-01

    The aim of this study was to look at the influence of homelessness on acute medical admissions. A prospective case-controlled study was therefore performed on all homeless children admitted through the accident and emergency department over one year, comparing them with the next age matched admission from permanent housing. Assessments made were: whether homelessness or other social factors influenced the doctors' decision to admit; differences in severity of illness; length of stay; and use of primary care. The admitting doctors completed a semi-structured questionnaire during admission about social factors that influenced their decision to admit and graded the severity of the child's illness. The length of hospital stay was recorded. The family's social risk factors and accommodation were assessed at a home visit using a standardised questionnaire and by observation. Seventy homeless children were admitted. Social factors influenced the decision to admit in 77% of homeless children and 43% of controls. More of the homeless children were only mildly ill (33/70) than those from permanent housing (21/70), although three of the homeless children died of overwhelming infections compared with none of the controls. Among homeless families many were recent immigrants (44%). There was a marked increase in socioeconomic deprivation, in major life events in the previous year (median score 3 v 1), and in maternal depression (27% v 8%). Referral to the hospital was made by a general practitioner in only 5/50 (10%) of homeless compared with 18/50 (36%) of controls. Social factors were an important influence on the decision to admit in over three quarters of the homeless children and resulted in admission when less severely ill even when compared with admissions from an inner city population. Even though there was marked social deprivation among the homeless families, the decision to admit was based on vague criteria that need to be further refined. PMID:8259871

  2. Impact of tornadoes on hospital admissions for acute cardiovascular events

    PubMed Central

    Silva-Palacios, Federico; Casanegra, Ana Isabel; Shapiro, Alan; Phan, Minh; Hawkins, Beau; Li, Ji; Stoner, Julie; Tafur, Alfonso

    2016-01-01

    Background There is a paucity of data describing cardiovascular events after tornado outbreaks. We proposed to study the effects of tornadoes on the incidence of cardiovascular events at a tertiary care institution. Population and methods Hospital admission records from a single center situated in a tornado-prone area three months before and after a 2013 tornado outbreak were abstracted. To control for seasonal variation, we also abstracted data from the same period of the prior year (control). Hospital admissions for cardiovascular events (CVEs) including acute myocardial infarction, stroke and venous thromboembolism (VTE) were summated by zip codes, and compared by time period. Results There were 22,607 admissions analyzed, of which 6,705 (30%), 7,980 (35%), and 7,922 (35%) were during the pre-tornado, post-tornado, and control time frames, respectively. There were 344 CVE in the controls, 317 CVE in pre-tornado and 364 CVEs in post tornado periods. There was no difference in the prevalence of CVE during the post-tornado season compared with the control (PPR = 1.05 95% CI: 0.91 to 1.21, p = 0.50) or the pre-tornado season (PPR= 0.96, 95% CI: 0.83 to 1.21, p = 0.63). Conclusion In conclusion, tornado outbreaks did not increase the prevalence of cardiovascular events. In contrast to the effect of hurricanes, implementation of a healthcare policy change directed toward the early treatment and prevention of cardiovascular events after tornadoes does not seem warranted. PMID:26388119

  3. Demographic, seasonal, and spatial differences in acute myocardial infarction admissions to hospital in Melbourne Australia

    PubMed Central

    Loughnan, Margaret E; Nicholls, Neville; Tapper, Nigel J

    2008-01-01

    Background Seasonal patterns in cardiac disease in the northern hemisphere are well described in the literature. More recently age and gender differences in cardiac mortality and to a lesser extent morbidity have been presented. To date spatial differences between the seasonal patterns of cardiac disease has not been presented. Literature relating to seasonal patterns in cardiac disease in the southern hemisphere and in Australia in particular is scarce. The aim of this paper is to describe the seasonal, age, gender, and spatial patterns of cardiac disease in Melbourne Australia by using acute myocardial infarction admissions to hospital as a marker of cardiac disease. Results There were 33,165 Acute Myocardial Infarction (AMI) admissions over 2186 consecutive days. There is a seasonal pattern in AMI admissions with increased rates during the colder months. The peak month is July. The admissions rate is greater for males than for females, although this difference decreases with advancing age. The maximal AMI season for males extends from April to November. The difference between months of peak and minimum admissions was 33.7%. Increased female AMI admissions occur from May to November, with a variation between peak and minimum of 23.1%. Maps of seasonal AMI admissions demonstrate spatial differences. Analysis using Global and Local Moran's I showed increased spatial clustering during the warmer months. The Bivariate Moran's I statistic indicated a weaker relationship between AMI and age during the warmer months. Conclusion There are two distinct seasons with increased admissions during the colder part of the year. Males present a stronger seasonal pattern than females. There are spatial differences in AMI admissions throughout the year that cannot be explained by the age structure of the population. The seasonal difference in AMI admissions warrants further investigation. This includes detailing the prevalence of cardiac disease in the community and examining

  4. Acute and Chronic Effects of Particles on Hospital Admissions in New-England

    PubMed Central

    Kloog, Itai; Coull, Brent A.; Zanobetti, Antonella; Koutrakis, Petros; Schwartz, Joel D.

    2012-01-01

    Background Many studies have reported significant associations between exposure to PM2.5 and hospital admissions, but all have focused on the effects of short-term exposure. In addition all these studies have relied on a limited number of PM2.5 monitors in their study regions, which introduces exposure error, and excludes rural and suburban populations from locations in which monitors are not available, reducing generalizability and potentially creating selection bias. Methods Using our novel prediction models for exposure combining land use regression with physical measurements (satellite aerosol optical depth) we investigated both the long and short term effects of PM2.5 exposures on hospital admissions across New-England for all residents aged 65 and older. We performed separate Poisson regression analysis for each admission type: all respiratory, cardiovascular disease (CVD), stroke and diabetes. Daily admission counts in each zip code were regressed against long and short-term PM2.5 exposure, temperature, socio-economic data and a spline of time to control for seasonal trends in baseline risk. Results We observed associations between both short-term and long-term exposure to PM2.5 and hospitalization for all of the outcomes examined. In example, for respiratory diseases, for every10-µg/m3 increase in short-term PM2.5 exposure there is a 0.70 percent increase in admissions (CI = 0.35 to 0.52) while concurrently for every10-µg/m3 increase in long-term PM2.5 exposure there is a 4.22 percent increase in admissions (CI = 1.06 to 4.75). Conclusions As with mortality studies, chronic exposure to particles is associated with substantially larger increases in hospital admissions than acute exposure and both can be detected simultaneously using our exposure models. PMID:22529923

  5. 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

    2015-11-13

    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.

  6. Acute hospital admission for nursing home residents without cognitive impairment with a diagnosis of cancer.

    PubMed

    Drageset, J; Eide, G E; Harrington, C; Ranhoff, A H

    2015-03-01

    Studies of hospitalisation of cognitively intact nursing home (NH) residents with cancer are scarce. Knowledge about associations between socio-demographic, medical and social support variables and hospital admissions aids in preventing unnecessary admissions. This is part of a prospective study from 2004 to 2005 with follow-up to 2010 for admission rates. We studied whether residents with cancer have more admissions and whether socio-demographic and medical variables and social support subdimensions are associated with admission among cognitively intact NH residents with (n = 60) and without (n = 167) cancer aged ≥65 years scoring ≤0.5 on the Clinical Dementia Rating Scale and residing ≥6 months. We measured social support by face-to-face interview. We identified all respondents through NH medical records for hospital admission, linking their identification numbers to the hospital record system to register all admissions. We examined whether socio-demographic and medical variables (medical records) and social support subscales were associated with the time between inclusion and first admission. Residents with cancer had more admissions (25/60) than those without (53/167) (odds ratio 1.7). Social integration was correlated with admission (P = 0.04) regardless of cancer diagnosis. Residents with cancer had more hospital admissions than those without. Higher social integration gave more admissions independent of cancer diagnosis.

  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. [Acute hospital admissions among nursing home residents--benefits and potential harms].

    PubMed

    Bally, Klaus W; Nickel, Christian

    2013-08-07

    Nursing home residents are often referred by their general practitioners to the emergency department or to a geriatric hospital. Hospitalization is mainly perceived as a burden by elderly people; it may also contribute to a reduction of their mental abilities and functional decline. Reasons for admitting patients from nursing homes include infections, exacerbation of pre-existing cardiovascular disease and falls. GP presence in the nursing home, qualified nursing staff, early diagnosis of infections or acute on chronic episodes of e. g. heart failure and appropriate management of chronic diseases are essential to avoid unnecessary hospitalizations. Furthermore, physicians should identify palliative situations in a timely manner and should be familiar with the patients' preferences regarding hospitalization and place of death.

  9. Investigation of the degree of organisational influence on patient experience scores in acute medical admission units in all acute hospitals in England using multilevel hierarchical regression modelling

    PubMed Central

    Sullivan, Paul

    2017-01-01

    Objectives Previous studies found that hospital and specialty have limited influence on patient experience scores, and patient level factors are more important. This could be due to heterogeneity of experience delivery across subunits within organisations. We aimed to determine whether organisation level factors have greater impact if scores for the same subspecialty microsystem are analysed in each hospital. Setting Acute medical admission units in all NHS Acute Trusts in England. Participants We analysed patient experience data from the English Adult Inpatient Survey which is administered to 850 patients annually in each acute NHS Trusts in England. We selected all 8753 patients who returned the survey and who were emergency medical admissions and stayed in their admission unit for 1–2 nights, so as to isolate the experience delivered during the acute admission process. Primary and secondary outcome measures We used multilevel logistic regression to determine the apportioned influence of host organisation and of organisation level factors (size and teaching status), and patient level factors (demographics, presence of long-term conditions and disabilities). We selected ‘being treated with respect and dignity’ and ‘pain control’ as primary outcome parameters. Other Picker Domain question scores were analysed as secondary parameters. Results The proportion of overall variance attributable at organisational level was small; 0.5% (NS) for respect and dignity, 0.4% (NS) for pain control. Long-standing conditions and consequent disabilities were associated with low scores. Other item scores also showed that most influence was from patient level factors. Conclusions When a single microsystem, the acute medical admission process, is isolated, variance in experience scores is mainly explainable by patient level factors with limited organisational level influence. This has implications for the use of generic patient experience surveys for comparison between

  10. Impact of late hospital admission on the prognosis of patients with acute myocardial infarction.

    PubMed

    Novak, Katarina; Ribicić, Kristijana Novak; Perić, Irena; Batinić, Tonci; Ribicić, Ivan; Stula, Ivana

    2012-09-01

    The objective of this study is to determine the time elapsed from the onset of pain in patients with AMI to their hospital admission (pain to door time) and fibrinolytic administration (door to needle time). The objective is also to determine whether there is a difference between the frequency of fibrinolytic administration to patients and the survival rate of patients with AMI with respect to the location they are transported from. This prospective clinical study included patients manifesting clear clinical, electrocardiographic and biochemical evidence of AMI, according to criteria of ECS (European Society of Cardiology), and who were admitted to the Coronary Care Unit of Split Clinical Hospital in the period from 1 January to 31 December 1999. On the basis of their residence, the patients were divided into three groups: 1. patients from Split and the surrounding area distant up to 15 km from the city; 2. patients from the surrounding area within 15 km from Split, 3. patients living on the islands of Central Dalmatia. 409 patients with AMI were admitted to hospital in the period in question. The first group consisted of 207, the second of 163, and the third of 39 subjects (254:39; p < 0.001). The median time from the onset of pain to hospital admission for all patients with AMI was 7.3 hours, for patients from the islands 13 hours, whereas for those coming from locations distant more than 15 km from Split it amounted to 7.6 hours (p < 0.001). The number of patients that were administered fibrinolysis is extremely low (17.1%) and there is no significant difference in the frequency of fibrinolytic administration between certain patient groups (p > 0.05). Similarly, the mortality rate prior to hospital discharge is high (18.8%) and does not vary among the three studied groups (p > 0.05). The results of this study are in opposition to the assumption that the mortality rate will be lower in patients living in Split and the immediate surroundings when compared to the

  11. Predictors of hypoxaemia in hospital admissions with acute lower respiratory tract infection in a developing country

    PubMed Central

    Weber, M.; Usen, S.; Palmer, A.; Jaffar, S.; Mulholland, E

    1997-01-01

    Accepted 5 November 1996
 Since oxygen has to be given to most children in developing countries on the basis of clinical signs without performing blood gas analyses, possible clinical predictors of hypoxaemia were studied. Sixty nine children between the ages of 2 months and 5 years admitted to hospital with acute lower respiratory tract infection and an oxygen saturation (SaO2) < 90% were compared with 67 children matched for age and diagnosis from the same referral hospital with an SaO2 of 90% or above (control group 1), and 44unreferred children admitted to a secondary care hospital with acute lower respiratory infection (control group 2). Using multiple logistic regression analysis, sleepiness, arousal, quality of cry, cyanosis, head nodding, decreased air entry, nasal flaring, and upper arm circumference were found to be independent predictors of hypoxaemia on comparison of the cases with control group 1.Using a simple model of cyanosis or head nodding or not crying, the sensitivity to predict hypoxaemia was 59%, and the specificity 94% and 93% compared to control groups 1 and 2, respectively; 80% of the children with an SaO2 < 80% were identified by the combination of these signs. Over half of the children with hypoxaemia could be identified with a combination of three signs: extreme respiratory distress, cyanosis, and severely compromised general status. Further prospective validation of this model with other datasets is warranted. No other signs improved the sensitivity without compromising specificity. If a higher sensitivity is required, pulse oximetry has to be used.

 PMID:9166021

  12. 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

  13. Systolic Blood Pressure on Admission and Mortality in Patients Hospitalized With Acute Heart Failure: Observations From the Gulf Acute Heart Failure Registry.

    PubMed

    Al-Lawati, Jawad A; Sulaiman, Kadhim J; Al-Zakwani, Ibrahim; Alsheikh-Ali, Alawi A; Panduranga, Prashanth; Al-Habib, Khalid F; Al-Suwaidi, Jassim; Al-Mahmeed, Wael; Al-Faleh, Hussam; El-Asfar, Abdelfatah; Al-Motarreb, Ahmed; Ridha, Mustafa; Bulbanat, Bassam; Al-Jarallah, Mohammed; Bazargani, Nooshin; Asaad, Nidal; Amin, Haitham

    2016-10-07

    We investigated the role of systolic blood pressure (SBP) in relation to in-hospital and postdischarge mortality in patients admitted with acute heart failure (AHF). The SBP of 4848 patients aged ≥18 years admitted with AHF was categorized into 5 groups: ≤90, 91 to 119, 120 to 139, 140 to 161, and >161 mm Hg. After adjusting for several confounders, multivariate logistic regression models showed that admission SBP was a significant predictor of mortality among both patients with preserved left ventricular function (defined as left ventricular ejection fraction [LVEF] ≥40%) and patients with left ventricular dysfunction (LVEF <40%). The adjusted odds ratios of in-hospital, 3-month, and 1-year mortality in the lowest SBP groups were 7.06 (95% confidence interval [CI]: 3.28-15.20; P < .001), 2.59 (95% CI: 1.35-4.96; P = .004), and 3.10 (95% CI: 2.04-4.72; P < .001) times the odds in the highest admission group (SBP > 161 mm Hg), respectively. We conclude that low admission SBP is an independent predictor of mortality in patients with AHF. The higher the admission SBP, the better the prognosis, regardless of age or LVEF.

  14. Predicting frequent hospital admission risk in Singapore: a retrospective cohort study to investigate the impact of comorbidities, acute illness burden and social determinants of health

    PubMed Central

    Liu, Nan; Wang, Sijia; Thumboo, Julian; Ong, Marcus Eng Hock; Lee, Kheng Hock

    2016-01-01

    Objectives To evaluate the impact of comorbidities, acute illness burden and social determinants of health on predicting the risk of frequent hospital admissions. Design Multivariable logistic regression was used to associate the predictive variables extracted from electronic health records and frequent hospital admission risk. The model's performance of our predictive model was evaluated using a 10-fold cross-validation. Setting A single tertiary hospital in Singapore. Participants All adult patients admitted to the hospital between 1 January 2013 and 31 May 2014 (n=25 244). Main outcome measure Frequent hospital admissions, defined as 3 or more inpatient admissions within 12 months of discharge. Area under the receiver operating characteristic curve (AUC) of the predictive model, and the sensitivity, specificity and positive predictive values for various cut-offs. Results 4322 patients (17.1%) met the primary outcome. 11 variables were observed as significant predictors and included in the final regression model. The strongest independent predictor was treatment with antidepressants in the past 1 year (adjusted OR 2.51, 95% CI 2.26 to 2.78). Other notable predictors include requiring dialysis and treatment with intravenous furosemide during the index admission. The predictive model achieved an AUC of 0.84 (95% CI 0.83 to 0.85) for predicting frequent hospital admission risk, with a sensitivity of 73.9% (95% CI 72.6% to 75.2%), specificity of 79.1% (78.5% to 79.6%) and positive predictive value of 42.2% (95% CI 41.1% to 43.3%) at the cut-off of 0.235. Conclusions We have identified several predictors for assessing the risk of frequent hospital admissions that achieved high discriminative model performance. Further research is necessary using an external validation cohort. PMID:27742630

  15. 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,…

  16. The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care: a comparison of London and New York City.

    PubMed

    Curtis, Sarah; Copeland, Alison; Fagg, James; Congdon, Peter; Almog, Michael; Fitzpatrick, Justine

    2006-03-01

    We report on comparative analyses of small area variation in rates of acute hospital admissions for psychiatric conditions in Greater London around the year 1998 and in New York City (NYC) in 2000. Based on a theoretical model of the factors likely to influence psychiatric admission rates, and using data from the most recent population censuses and other sources, we examine the association with area indicators designed to measure access to hospital beds, socio-economic deprivation, social fragmentation and ethnic/racial composition. We report results on admissions for men and women aged 15-64 for all psychiatric conditions (excluding self-harm), drug-related substance abuse/addiction, schizophrenia and affective disorders. The units of analysis in NYC were 165 five-digit Zip Code Areas and, in London, 760 electoral wards as defined in 1998. The analysis controls for age and sex composition and, as a proxy for access to care, spatial proximity to hospitals with psychiatric beds. Poisson regression modeling incorporating random effects was used to control for both overdispersion in the counts of admissions and for the effects of spatial autocorrelation. The results for NYC and London showed that local admission rates for all types of condition were positively and significantly associated with deprivation and the association is independent of demographic composition or 'access' to beds. In NYC, social fragmentation showed a significant association with admissions due to affective disorders and schizophrenia, and for drug dependency among females. Racial minority concentration was significantly and positively associated with admissions for schizophrenia. In London, social fragmentation was associated positively with admissions for men and women due to schizophrenia and affective disorders. The variable measuring racial/ethnic minority concentration for London wards showed a negative association with admission rates for drug dependency and for affective disorders. We

  17. 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.

  18. Thinking Outside the Box: Treating Acute Heart Failure Outside the Hospital to Improve Care and Reduce Admissions.

    PubMed

    DeVore, Adam D; Allen, Larry A; Eapen, Zubin J

    2015-08-01

    The management of acute heart failure is shifting toward treatment approaches outside of a traditional hospital setting. Many heart failure providers are now treating patients in less familiar health care settings, such as acute care clinics, emergency departments, and skilled nursing facilities. In this review we describe the current pressures driving change in the delivery of acute heart failure and summarize the evidence regarding treatments for acute heart failure outside of the inpatient setting. We also provide considerations for the design of future treatment strategies to be implemented in alternative care settings.

  19. 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

  20. Accuracy of caregivers’ recall of hospital admissions: implications for research

    PubMed Central

    Burakevych, Nataliia; McKinlay, Christopher Joel Dorman; Alsweiler, Jane Marie; Harding, Jane Elizabeth

    2015-01-01

    Aim To determine the accuracy of caregivers’ recall of hospital admissions in early childhood. Methods Prospective cohort study of babies born at risk of neonatal hypoglycaemia at Waikato Hospital, New Zealand, a regional public hospital and sole provider of acute inpatient care to over 100,000 children. Caregivers’ recall of children’s hospital admissions up to 4.5 years were compared with medical records. Accuracy of recall was related to neonatal and socio-demographic characteristics. Results Out of 267 children, 179 (67%) visited hospital and 106 (40%) were admitted at least once. The most frequent reasons for admission were for respiratory (29%) and gastrointestinal (18%) problems. Of 106 children admitted to hospital, 27 (25%) caregivers did not recall the admission and only 37 (35%) accurately recalled the number of admissions. The accuracy of recall was lower for gastrointestinal (38%) and surgical (40%) problems, while recall of respiratory (64%) and ear, nose and throat (60%) admissions was more accurate. Low socio-economic status and multiple admissions were associated with less accurate recall of number of admissions. Conclusion Caregivers do not accurately report hospital admissions. Questionnaire data about use of hospital facilities should be interpreted cautiously, and may not be sufficiently accurate for use in research studies. PMID:26355393

  1. Association of Plasma Pentraxin-3 Levels on Admission with In-hospital Mortality in Patients with Acute Type A Aortic Dissection

    PubMed Central

    Zhou, Qin; Chai, Xiang-Ping; Fang, Zhen-Fei; Hu, Xin-Qun; Tang, Liang

    2016-01-01

    Background: Acute aortic dissection is a life-threatening cardiovascular emergency. Pentraxin-3 (PTX3) is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. This study sought to investigate the association of circulating PTX3 levels with in-hospital mortality in patients with acute Type A aortic dissection (TAAD). Methods: A total of 98 patients with TAAD between January 2012 and December 2015 were enrolled in this study. Plasma concentrations of PTX3 were measured upon admission using a high-sensitivity enzyme-linked immunosorbent assay system. Patients were divided into two groups as patients died during hospitalization (Group 1) and those who survived (Group 2). The clinical, laboratory variables, and imaging findings were analyzed between the two groups, and predictors for in-hospital mortality were evaluated using multivariate analysis. Results: During the hospital stay, 32 (33%) patients died and 66 (67%) survived. The patients who died during hospitalization had significantly higher PTX3 levels on admission compared to those who survived. Pearson's correlation analysis demonstrated that PTX3 correlated positively with high-sensitivity C-reactive protein (hsCRP), maximum white blood cell count, and aortic diameter. Multivariate logistic regression analysis demonstrated that PTX3 levels, coronary involvement, cardiac tamponade, and a conservative treatment strategy are significant independent predictors of in-hospital mortality in patients with TAAD. The receiver operating characteristic curve analysis further illustrated that PTX3 levels on admission were strong predictors of mortality with an area under the curve of 0.89. A PTX3 level ≥5.46 ng/ml showed a sensitivity of 88% and a specificity of 79%, and an hsCRP concentration ≥9.5 mg/L had a sensitivity of 80% and a specificity of 69% for predicting in-hospital mortality. Conclusion: High PTX3 levels on admission are independently

  2. Association between Birth Order and Emergency Room Visits and Acute Hospital Admissions following Pediatric Vaccination: A Self-Controlled Study

    PubMed Central

    Hawken, Steven; Kwong, Jeffrey C.; Deeks, Shelley L.; Crowcroft, Natasha S.; Ducharme, Robin; Manuel, Douglas G.; Wilson, Kumanan

    2013-01-01

    Objective We investigated the association between a child's birth order and emergency room (ER) visits and hospital admissions following 2-,4-,6- and 12-month pediatric vaccinations. Methods We included all children born in Ontario between April 1st, 2006 and March 31st, 2009 who received a qualifying vaccination. We identified vaccinations, ER visits and admissions using health administrative data housed at the Institute for Clinical Evaluative Sciences. We used the self-controlled case series design to compare the relative incidence (RI) of events among 1st-born and later-born children using relative incidence ratios (RIR). Results For the 2-month vaccination, the RIR for 1st-borns versus later-born children was 1.37 (95% CI: 1.19–1.57), which translates to 112 additional events/100,000 vaccinated. For the 4-month vaccination, the RIR for 1st-borns vs. later-borns was 1.70 (95% CI: 1.45–1.99), representing 157 additional events/100,000 vaccinated. At 6 months, the RIR for 1st vs. later-borns was 1.27 (95% CI: 1.09–1.48), or 77 excess events/100,000 vaccinated. At the 12-month vaccination, the RIR was 1.11 (95% CI: 1.02–1.21), or 249 excess events/100,000 vaccinated. Conclusions Birth order is associated with increased incidence of ER visits and hospitalizations following vaccination in infancy. 1st-born children had significantly higher relative incidence of events compared to later-born children. PMID:24324662

  3. Hospital admissions for asthma and acute bronchitis in El Paso, Texas: Do age, sex, and insurance status modify the effects of dust and low wind events?

    PubMed Central

    Staniswalis, Joan G.; Bulathsinhala, Priyangi; Peng, Yanlei; Gill, Thomas E.

    2013-01-01

    Background El Paso County (Texas) is prone to still air inversions and is one of the dust “hot spots” in North America. In this context, we examined the sub-lethal effects of airborne dust and low wind events on human respiratory health (i.e., asthma and acute bronchitis) between 2000 and 2003, when 110 dust and 157 low wind events occurred. Because environmental conditions may not affect everyone the same, we explored the effects of dust and low wind within three age groups (children, adults, and the elderly), testing for effect modifications by sex and insurance status, while controlling for weather and air pollutants. Methods We used a case-crossover design using events matched with referent days on the same day-of-the-week, month, and year with conditional logistic regression to estimate the probability of hospital admission, while controlling for apparent temperature (lag 1), nitrogen dioxide, and particulate matter of 2.5 micrometers or less. Results Children (aged 1–17) were 1.19 (95% confidence interval: 1.00–1.41) times more likely to be hospitalized for asthma three days after a low wind event, and 1.33 (95% CI: 1.01–1.75) times more likely to be hospitalized for acute bronchitis one day after a dust event than on a clear day. Girls were more sensitive to acute bronchitis hospitalizations after dust events (1.83, 95% CI: 1.09–3.08) than boys, but less sensitive than boys to acute bronchitis hospitalizations after low wind events (0.68, 95% CI: 0.46–1.00). We found general trends with regard to dust and low wind events being associated with increased odds of hospitalization for asthma and bronchitis amongst all ages and adults (aged 18–64). Adults covered by Medicaid and adults without health insurance had higher risks of hospitalization for asthma and acute bronchitis after both low wind and dust event Conclusions Results suggest that there were respiratory health effects associated with dust and low wind events in El Paso, with stronger

  4. Hospital admissions for acute myocardial infarction before and after implementation of a comprehensive smoke-free policy in Uruguay: experience through 2010

    PubMed Central

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

    2015-01-01

    Background Comprehensive smoke-free laws have been followed by drops in hospitalisations for acute myocardial infarction (AMI), including in a study with 2 years follow-up for such a law in Uruguay. Methods Multiple linear and negative binomial regressions for AMI admissions (ICD-10 code 121) from 37 hospitals for 2 years before and 4 years after Uruguay implemented a 100% nationwide smoke-free law. Results Based on 11 135 cases, there was a significant drop of −30.9 AMI admissions/month (95% CI −49.8 to −11.8, p=0.002) following implementation of the smoke-free law. The effect of the law did not increase or decrease over time following implementation (p=0.234). This drop represented a 17% drop in AMI admissions following the law (IRR=0.829, 95% CI 0.743 to 0.925, p=0.001). Conclusions Adding two more years of follow-up data confirmed that Uruguay’s smoke-free law was followed by a substantial and sustained reduction in AMI hospitalisations. PMID:25324157

  5. 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

  6. Lunar phases and psychiatric hospital admissions.

    PubMed

    Gorvin, J J; Roberts, M S

    1994-12-01

    To assess the lunar hypothesis as predictive of mental health emergencies and antisocial behavior, the relation of the lunar hypothesis and the occurrence of psychiatric hospital admissions of developmentally disabled adults was examined. The full moon phase of the lunar cycle did not explain a higher rate of hospital admission and accounted for only .007% of the variance. A critique of the methodology in prior research led to the suggestion that more immediate stressors and environmental factors are more plausible contributing factors to hospital admission.

  7. 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

  8. Hospital admissions among male drivers in Denmark

    PubMed Central

    Hannerz, H; Tuchsen, F

    2001-01-01

    OBJECTIVES—To facilitate decisions about interventions and to establish baseline values for future evaluation of preventive efforts, the aim of the present study was to elucidate the disease pattern among male professional drivers in Denmark. The study differentiated between drivers of goods vehicles and drivers of passenger transport.
METHODS—Cohorts of all 20-59 year old Danish male professional drivers in the years 1981, 1986, 1991, and 1994 were formed, to calculate age standardised hospital admission ratios (SHRs) and time trends (1981-97) for many diagnostic aggregations.
RESULTS—SHRs for diseases in practically all systems and organs of the body were higher among professional drivers than they were in the male working population at large. Also drivers of passenger transport, compared with drivers of goods vehicles, had significantly high SHRs due to infectious and parasitic diseases, diseases of the circulatory system, and diseases of the respiratory system, and significantly lower rates of injury. For both driver groups, the SHRs for acute myocardial infarction increased with time whereas the SHR for acute gastritis decreased, and for drivers of passenger transport an increasing SHR for chronic obstructive pulmonary disease, was found over time.
CONCLUSION—Drivers of passenger transport and drivers of goods vehicles differ in their disease patterns. The results support the hypothesis that preventive efforts are needed in both groups, but underline that different strategies are required for different categories of drivers.


Keywords: professional drivers; hospital admissions; surveillance system PMID:11245742

  9. Selection of first-line i.v. antibiotics for acute pyelonephritis in patients requiring emergency hospital admission.

    PubMed

    Yasufuku, Tomihiko; Shigemura, Katsumi; Yamashita, Masuo; Arakawa, Soichi; Fujisawa, Masato

    2011-04-01

    Febrile urinary tract infections (UTIs) often require the intravenous infusion of antibiotics and/or hospitalization. Acute pyelonephritis (AP) is one of the most severe forms of UTI, and the antibiotics we should use as the first line and the risk factors for treatment failure remain controversial. The objective of this study was to investigate the efficacy of i.v. antibiotics selected for the treatment of febrile AP and to examine the risk factors for antibiotic resistance. We set risk factors for antibiotic treatment failure such as age, sex, and the presence of underlying urinary tract disease. We classified all cases into 49 cases of complicated AP and 24 cases of uncomplicated AP according to the presence of underlying urinary tract diseases, and examined the characteristics of the patients and the efficacy of the antibiotics used in this study. We investigated risk factors which relate to initial treatment failure and the duration of antibiotic treatment. Initial antibiotic treatment failure was significantly correlated to C-reactive protein in complicated AP and to positive blood culture in uncomplicated AP. We revealed a significant correlation between the duration of the given antibiotics and diabetes mellitus or positive blood culture in uncomplicated AP, and tazobactam/piperacillin was significantly related to prolongation of antibiotic treatment in complicated AP. In conclusion, in this study, a positive blood culture was the representative risk factor that related to both initial treatment failure and longer duration of the given antibiotics in uncomplicated AP.

  10. Multiple hospital admissions in a calendar year.

    PubMed

    Newton, J; Goldacre, M

    1993-09-01

    Hospital in-patient workload is routinely measured as episodes of care. We report on the extent to which counts of episodes of care differ from counts of patients treated in different specialties and in different age groups. Linked records of hospital care in a population of 1.9 million people, collected over an 11-year period (1976-1986), were analysed. The all-ages multiple admission ratio (the number of admissions per 100 people admitted in the same specialty and year) varied between specialties from 102 to 171. Medical specialties tended to have higher ratios than surgical ones. The influence of age on multiple admission ratios varied between specialties, although in general the ratios increased with increasing age. There were progressive but small increases in multiple admission ratios over the period studied in a number of specialties but, by and large, stability over time was more striking than any change. The information presented could be used to estimate person-based admission rates from available episode-based data where the former are not available. This should be helpful both in managing hospital resources and in purchasing care on behalf of resident populations. Purchasers in particular should be aware of numbers of people being treated as well as the numbers of episodes of care provided.

  11. In-hospital prognosis in non-ST-segment elevation acute coronary syndrome derived using a new risk score based on electrocardiographic parameters obtained at admission.

    PubMed

    Jiménez-Candil, Javier; González Matas, José Manuel; Cruz González, Ignacio; Hernández Hernández, Jesús; Martín, Ana; Pabón, Pedro; Martín, Francisco; Martín-Luengo, Cándido

    2010-07-01

    Several electrocardiographic variables are of prognostic value in non-ST-segment elevation acute coronary syndrome (NSTEACS). From observations in 427 patients, we developed a new risk score (the ECG-RS) based on admission ECG findings that can be used to determine the likelihood of death or recurrent ischemia during hospitalization, which occurred in 36% of patients. Logistic regression analysis, which considered seven electrocardiographic variables and variables from the Thrombolysis in Myocardial Infarction (TIMI) risk score, identified the following significant predictors: corrected QT interval (QTc) > or =450 ms (odds ratio 4.2, P< .001), ST-segment depression >0.5 mm (odds ratio 2.7, P< .001), and left atrial enlargement (odds ratio 1.8, P =.005). After taking the odds ratios into consideration, we awarded 3 points for a QTc > or =450 ms, 2 points for ST-segment depression >0.5 mm, and 1 point for left atrial enlargement. When patients were divided into three groups on the basis of their ECG-RSs (i.e. < or =1, 2-3 and > or =4), the risk of death or recurrent ischemia was significantly different between the groups, at 11%, 27% and 58%, respectively (P< .001). In conclusion, the new ECG-RS provides a simple, rapid and accurate means of determining prognosis in patients with NSTEACS.

  12. 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

  13. Epidemiological trends for hospital admissions for acute rotavirus gastroenteritis in Belgium following the introduction of routine rotavirus vaccination and the subsequent switch from lyophilized to liquid formulation of Rotarix™.

    PubMed

    Raes, M; Strens, D; Kleintjens, J; Biundo, E; Morel, T; Vyse, A

    2016-10-01

    This study describes epidemiological trends for acute rotavirus gastroenteritis (RVGE) in Belgium in children aged ⩽5 years during the period June 2007 to May 2014 after the introduction of routine rotavirus (RV) vaccination. This period encompassed the switch from lyophilized to the liquid formulation of Rotarix™ (GlaxoSmithKline, Belgium) in August 2011. Uptake of RV vaccine remained consistently high throughout the study period with Rotarix the brand most often used. RV was present in 9% (1139/12 511) of hospitalized cases with acute gastroenteritis included in the study. Epidemiological trends for hospital admissions for RVGE remained consistent throughout the study period, with no evidence of any change associated with the switch from lyophilized to liquid formulation of Rotarix. This suggests both formulations perform similarly, with the liquid formulation not inferior regarding ability to reduce hospital admissions for acute RVGE in children aged ⩽5 years. A strong seasonal effect was observed with most RVGE occurring in the winter months but with some variability in intensity, with highest incidence found in those aged 6-24 months. The main observation was the decreased number of hospital admissions for RVGE in Belgium that occurred during winter 2013/2014.

  14. 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

  15. Hospital admissions before and after shipyard closure.

    PubMed Central

    Iversen, L.; Sabroe, S.; Damsgaard, M. T.

    1989-01-01

    To determine the effect of job loss on health an investigation was made of admissions to hospitals in 887 men five years before and three years after the closure of a Danish shipyard. The control group comprised 441 men from another shipyard. The information on hospital admissions was obtained from the Danish national register of patients. The relative risk of admission in the control group dropped significantly in terms of the number of men admitted from the study group from 1.29 four to five years before closure to 0.74 in the three years after closure. This was especially true of admissions due to accidents (1.33 to 0.46) and diseases of the digestive system (4.53 to 1.03). For diseases of the circulatory system, particularly cardiovascular diseases, the relative risk increased from 0.8 to 1.60, and from 1.0 to 2.6 respectively. These changes in risk of illness after redundancy are probably a consequence of a change from the effects of a high risk work environment to the effects of psychosocial stresses such as job insecurity and unemployment. PMID:2511968

  16. 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

  17. Variation in rates of hospital admission for appendicitis in Wales.

    PubMed Central

    West, R R; Carey, M J

    1978-01-01

    In a study designed to investigate the variations in rates of admission to hospital for appendicitis in Wales Hospital Activity Analysis listings were analysed according to the sex and age of the patients and the month and day of the week of admission. The incidence of hospitalisation was greatest among boys aged 10-14 and girls aged 15-19. The number of admissions was higher on weekdays than at weekends, but there were no seasonal variations. Durations of stay differed between the 17 health districts. We conclude that admission rates vary mainly because of differing hospital admission policies. Admission is not wholly governed by the sudden onset of abdominal pain; other factors include the threshold of consultation of each patient, the referral habits of general practitioners, the availability of hospital beds, and the degree to which doctors and patients expect admission. PMID:656866

  18. Home management of hematological patients requiring hospital admission.

    PubMed

    Isaia, Gianluca; Tibaldi, Vittoria; Astengo, Marco; Ladetto, Marco; Marinello, Renata; Bo, Mario; Michelis, Giuliana; Ruatta, Fiorella; Ricauda, Nicoletta Aimonino

    2010-01-01

    The hospital-at-home service (HHS) could be considered as an alternative to the traditional ward for elderly patients. We aimed at evaluating the home management of elderly people requiring transfusions. The ever-increasing demand on acute hospital services requires alternative methods of delivering all aspects of health care. HHS demonstrated to be as efficacious as a traditional ward for elderly and functionally compromised patients. The method was a retrospective descriptive study enrolling patients needing an hospital admission from 1st January 2007 to 31st December 2007 and reporting an hematological discharge's diagnosis as primary or secondary diagnosis. A total of 54 patients were evaluated in this study. Of them, 34 (62.9%) needed a hemocomponent transfusion for a total volume of 112 blood units and 49 platelet pools. Patients requiring at least one blood or platelet transfusion were more functionally compromised and presented a higher level of acute physiology and chronic health evaluation, compared to the non-transfused ones. The conclusion was that hematological subjects mainly the frail ones and functionally highly compromised with acute illnesses could be treated at home as an alternative of the traditional medical ward. This could be the starting point for future studies that will be able to increase the power of hospital-at-home service for this type of patients.

  19. Body pushing, prescription drugs and hospital admission.

    PubMed

    Byard, Roger W; Kenneally, Michaela

    2017-03-15

    A 39-year-old man died of multi-organ failure complicating mixed drug toxicity that included methadone, oxazepam, oxycodone and nitrazepam. His past medical history involved alcohol and poly-substance abuse with chronic self-harm and suicidal ideation. There had been multiple hospital admissions for drug overdoses. At autopsy the most unusual finding was of two packages of 10 tablets each, wrapped in thin plastic film within the rectum. The insertion of drugs into body orifices and cavities has been termed body pushing to distinguish it from body packing where illicit drugs are wrapped and swallowed for transport and smuggling, and body stuffing where small amounts of loosely wrapped or unwrapped drugs are swallowed to conceal evidence from police. This case demonstrates that body pushing may not always involve illicit drugs or attempted concealment from police or customs officials. It appears that the drugs had been hidden to ensure an additional supply during the time of residence in hospital. The extent to which body pushing is currently being used by patients to smuggle drugs into secure medical facilities is yet to be determined.

  20. Comparison between children treated at home and those requiring hospital admission for rotavirus and other enteric pathogens associated with acute diarrhea in Melbourne, Australia.

    PubMed Central

    Pitson, G A; Grimwood, K; Coulson, B S; Oberklaid, F; Hewstone, A S; Jack, I; Bishop, R F; Barnes, G L

    1986-01-01

    The etiology of acute diarrhea in children less than 42 months of age attending one pediatric hospital in Melbourne, Australia, was studied during a 7-month period encompassing the winter of 1984. Pathogens identified in 157 children treated as outpatients with mild disease were compared with those in 232 children hospitalized with severe disease. The pathogens (and frequencies among outpatients and inpatients, respectively) detected were rotaviruses (32.5 and 50.9%), enteric adenoviruses (8.9 and 7.4%), Campylobacter jejuni (7.2 and 1.3%), and Salmonella sp. (4.0 and 1.7%). Electropherotypes of rotavirus strains from outpatients and inpatients were compared. Two strains predominated during the 7 months of this study and were observed with equal frequency from outpatients and inpatients. Rotaviruses of the same electropherotype caused a wide spectrum of disease, with symptoms ranging from mild to severe, life-threatening diarrhea. The similarity of etiological agents identified from children with mild and severe forms of acute diarrhea suggests that the etiology of community enteric illness can be reasonably inferred from the etiology of inpatient disease in children in the same geographic area. During the winter epidemic period, the severity of symptoms associated with rotavirus infection in young children is likely to be determined by the inherent susceptibility of the host rather than by genetic differences in the strains of infecting rotaviruses. Images PMID:3020082

  1. 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

  2. Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment

    PubMed Central

    Ahmed, Vazeer; Palmer, Christopher R; Bennett, Tom J H; Robinson, Susan M

    2012-01-01

    Objectives Reducing emergency admissions is a priority for the NHS. A single hospital's emergency care system was reorganised with the principles of front-loaded investigations, integration of specialties, reduced duplication, earlier decision making by senior clinicians and a combined emergency assessment area. The authors relocated our Medical Assessment Unit into our emergency department in 2006. The authors evaluated changes in admissions and mortality before and after 2006, compared with other similar hospitals. Design Quasi-experimental before and after study using routinely collected data. Setting and participants 1 acute hospital in England, the intervention site, was compared with 23 other English hospitals between 2001 and 2009. Outcome measures Our outcome measures were hospital standardised mortality ratios (HSMRs) for non-elective admissions and standardised admission ratios (SARs). Results The authors observed a statistically and clinically significant decrease in HSMR and SAR. The intervention hospital had the lowest HSMR and SAR of all the hospitals in our sample. This was statistically significant, p=0.0149 and p=0.0002, respectively. Conclusion Integrating emergency care in one location is associated with a meaningful reduction in mortality and emergency admissions to hospital. PMID:22858459

  3. Admission From Nursing Home Residence Increases Acute Mortality After Hip Fractures

    PubMed Central

    van Dijk, Pim A. D.; Bot, Arjan G. J.; Neuhaus, Valentin; Menendez, Mariano E.; Vrahas, Mark S.

    2015-01-01

    Background: Little is known about the effect of preinjury residence on inpatient mortality following hip fracture. This study addressed whether (1) admission from a nursing home residence and (2) admission from another hospital were associated with higher inpatient mortality after a hip fracture. Methods: Using the National Hospital Discharge Survey database, we analyzed an estimated 2 124 388 hip fractures discharges, from 2001 to 2007. Multivariable logistic regression analysis was performed to identify whether admission from a nursing home and admission from another hospital were independent risk factors for inpatient mortality. Our primary null hypothesis is that there is no difference in inpatient mortality rates after hip fracture in patients admitted from a nursing home, compared to other forms of admission. The secondary null hypothesis is that there is no difference in inpatient mortality after hip fracture in patients whose source of admission was another hospital, compared to other sources of admission. Results: Almost 4% of the patients were admitted from a nursing home and 6% from another hospital. The mean age was 79 years and 71% were women. The majority of patients were treated with internal fixation. Admission from a nursing home residence (odds ratio [OR] of 2.1, confidence interval [CI] 1.9-2.3) and prior hospital stay (OR 3.4, CI 3.2-3.7) were associated with a higher risk of inpatient mortality after accounting for other comorbidities and type of treatment. Conclusions: Patients transferred to an acute care hospital from a long-term care facility or another acute care hospital are at particularly high risk of inpatient death. This subset of patients should be considered separately from patients admitted from other sources. Level of Evidence: Prognostic level II. PMID:26328224

  4. 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

  5. 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.

  6. Reduced Admissions for Acute Myocardial Infarction Associated with a Public Smoking Ban: Matched Controlled Study

    ERIC Educational Resources Information Center

    Seo, Dong-Chul; Torabi, Mohammad R.

    2007-01-01

    There has been no research linking implementation of a public smoking ban and reduced incidence of acute myocardial infarction (AMI) among nonsmoking patients. An ex post facto matched control group study was conducted to determine whether there was a change in hospital admissions for AMI among nonsmoking patients after a public smoking ban was…

  7. 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

  8. Usefulness of combining admission brain natriuretic peptide (BNP) plus hospital discharge bioelectrical impedance vector analysis (BIVA) in predicting 90 days cardiovascular mortality in patients with acute heart failure.

    PubMed

    Santarelli, Simona; Russo, Veronica; Lalle, Irene; De Berardinis, Benedetta; Navarin, Silvia; Magrini, Laura; Piccoli, Antonio; Codognotto, Marta; Castello, Luigi Maria; Avanzi, Gian Carlo; Villacorta, Humberto; Precht, Bernardo Luiz Campanário; de Araújo Porto, Pilar Barreto; Villacorta, Aline Sterque; Di Somma, Salvatore

    2016-12-16

    Heart failure is a disease characterized by high prevalence and mortality, and frequent rehospitalizations. The aim of this study is to investigate the prognostic power of combining brain natriuretic peptide (BNP) and congestion status detected by bioelectrical impedance vector analysis (BIVA) in acute heart failure patients. This is an observational, prospective, and a multicentre study. BNP assessment was measured upon hospital arrival, while BIVA analysis was obtained at the time of discharge. Cardiovascular deaths were evaluated at 90 days by a follow up phone call. 292 patients were enrolled. Compared to survivors, BNP was higher in the non-survivors group (mean value 838 vs 515 pg/ml, p < 0.001). At discharge, BIVA shows a statistically significant difference in hydration status between survivors and non-survivors [respectively, hydration index (HI) 85 vs 74, p < 0.001; reactance (Xc) 26.7 vs 37, p < 0.001; resistance (R) 445 vs 503, p < 0.01)]. Discharge BIVA shows a prognostic value in predicting cardiovascular death [HI: area under the curve (AUC) 0.715, 95% confidence interval (95% CI) 0.65-0.76; p < 0.004; Xc: AUC 0.712, 95% CI 0.655-0.76, p < 0.007; R: AUC 0.65, 95% CI 0.29-0.706, p < 0.0247]. The combination of BIVA with BNP gives a greater prognostic power for cardiovascular mortality [combined receiving operating characteristic (ROC): AUC 0.74; 95% CI 0.68-0.79; p < 0.001]. In acute heart failure patients, higher BNP levels upon hospital admission, and congestion detected by BIVA at discharge have a significant predictive value for 90 days cardiovascular mortality. The combined use of admission BNP and BIVA discharge seems to be a useful tool for increasing prognostic power in these patients.

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

    PubMed

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

    2015-01-01

    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 historic (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, whereas a time series analysis using a piecewise linear model approximation was used to estimate the effect of heat intensity 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 vs. a non-heat day, was noted for all-ages and all non-traumatic causes. When considering the effect of heat intensity 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 age groups (<85 years) experience significant risk for nephritis and nephrotic syndromes, acute renal failure, natural heat exposure, chronic obstructive pulmonary disease, and asthma hospitalizations.

  10. 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

  11. 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.

  12. 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.

  13. Effect of extended physiotherapy and high-dose vitamin D on rate of falls and hospital re-admission after acute hip fracture: a randomized controlled trial

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Guidelines for post-fracture care of elderly hip fracture patients are not established despite the significant socio-economic burden of post hip fracture morbidity and mortality. Using a factorial design, we studied the effects of extended physiotherapy (supervised 1 hour per day during acute care p...

  14. Determination of functional prognosis in hospitalized patients following an intensive care admission

    PubMed Central

    Ferreira, Natália A; Lopes, Agnaldo José; Ferreira, Arthur S; Ntoumenopoulos, George; Dias, Jerffesson; Guimaraes, Fernando S

    2016-01-01

    AIM To investigate the factors associated with the functional progress of hospitalized patients following an intensive care admission. METHODS Retrospective study including data from a cohort of 198 hospitalized patients following an intensive care admission and not requiring mechanical ventilation in a single tertiary referral hospital. A generalized linear model was used to identify the main effects of clinical and demographic variables on the outcomes of functionality (KATZ Index of Independence in Activities of Daily Living) and muscle strength (MRC Scale). The covariates identified as independent predictors were analysed using the receiver operating characteristic curves. The analysis differentiated the periods in the intensive care unit (ICU), in the Ward (WARD) and the total time of hospital stay (TOT). RESULTS Considering the functional outcome (ΔKATZ), the variables that significantly contributed to the model (P < 0.05) were the KATZ and MRC on admission, age, sepsis (no), and total length of stay (TLS). Regarding the muscle strength outcome model (ΔMRC), the predictors were MRC on admission, Simplified Acute Physiology Score III, previous stroke, TLS, and sex (female). The variable age (AUC = 0.664) discriminated the ΔKATZICU. The variables age (AUC = 0.712), KATZ in ICU (AUC = 0.590) and on ward admission (AUC = 0.746), and MRC on ward admission (AUC = 0.721) were discriminative for ΔKATZWARD. For ΔKATZTOT the variables KATZ on ICU admission (AUC = 0.621) and TLS (AUC = 0.617) were discriminative. For ΔMRCICU the variables SAPSIII (AUC = 0.661) and MRC on ICU admission (AUC = 0.653) were discriminative. MRC on ICU (AUC = 0.681) and ward admission (AUC = 0.553) were discriminative for ΔMRCWARD. TLS (AUC = 0.649) and MRC on ward admission (AUC = 0.696) discriminative for the ΔMRCTOT. CONCLUSION Specific functional, clinical and demographical variables at ICU admission are associated with the functional prognosis during the hospitalization period

  15. Discharging patients from acute care hospitals.

    PubMed

    Goodman, Helen

    2016-02-10

    Planning for patient discharge is an essential element of any admission to an acute setting, but may often be left until the patient is almost ready to leave hospital. This article emphasises why discharge planning is important and lists the essential principles that should be addressed to ensure that patients leave at an optimum time, feeling confident and safe to do so. Early assessment, early planning and co-ordination of all the teams involved in the patient's care are essential. Effective communication between the various teams and with the patient and their family or carer(s) is necessary. Patients should leave hospital with all the information, medications and equipment they require. Appropriate plans should have been developed and communicated to the receiving community or non-acute team. When patient discharge is effective, complications as a result of extended lengths of hospital stay are prevented, hospital beds are used efficiently and readmissions are reduced.

  16. 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)

  17. Postpartum maternal morbidity requiring hospital admission in Lusaka, Zambia – a descriptive study

    PubMed Central

    Vallely, Lisa; Ahmed, Yusuf; Murray, Susan F

    2005-01-01

    Background Information on the extent of postpartum maternal morbidity in developing countries is extremely limited. In many settings, data from hospital-based studies is hard to interpret because of the small proportion of women that have access to medical care. However, in those areas with good uptake of health care, the measurement of the type and incidence of complications severe enough to require hospitalisation may provide useful baseline information on the acute and severe morbidity that women experience in the early weeks following childbirth. An analysis of health services data from Lusaka, Zambia, is presented. Methods Six-month retrospective review of hospital registers and 4-week cross-sectional study with prospective identification of postpartum admissions. Results Both parts of the study identified puerperal sepsis and malaria as, respectively, the leading direct and indirect causes of postpartum morbidity requiring hospital admission. Puerperal sepsis accounted for 34.8% of 365 postpartum admissions in the 6-month period. Malaria and pneumonia together accounted for one-fifth of all postpartum admissions (14.5% & 6% respectively). At least 1.7% of the postpartum population in Lusaka will require hospital-level care for a maternal morbidity. Conclusions In developing country urban settings with high public health care usage, meticulous review of hospital registers can provide baseline information on the burden of moderate-to-severe postpartum morbidity. PMID:15686592

  18. Stable admission rate for acute asthma in Danish children since 1977.

    PubMed

    Sevelsted, Astrid; Pipper, Christian Bressen; Bisgaard, Hans

    2016-03-01

    Childhood asthma is consistently reported to have increased in recent decades in most westernized countries, but it is unknown if this increase is similar across severities. We aimed to study the time-trend of acute hospital admission and readmission for asthma of school-aged children in the recent 35 years in Denmark. We analyzed time-trends in the national incidence rate of hospitalization for acute severe asthma in children aged 5-15 in Denmark during the 35-year period 1977-2012 in the Danish national registry. Only in-patient admissions with a principal diagnosis of asthma (ICD-8: 493** or ICD-10: J45** or J46**) were included. Among children with asthma hospitalizations, we investigated the risk of readmission beyond 1 month of first admission. Admissions were summarized as rates per thousand person years at risk. The overall time-trend is stable with a rate of one admission per year per thousand children at risk and a per-year incidence rate ratio 0.999 [95 % CI 0.997-1.001]. The rate of any readmission decreased from approximately 20 per thousand children in the eighties to less than 10 in the early nineties before stabilizing at around 10 per thousand children from mid-nineties and onwards. During 35 years of nation-wide follow-up, we find a highly stable incidence rate of first hospital admission for acute severe asthma in children. Moreover, rates of readmission halved during the seventies and stabilized in the last twenty years. In conclusion, our data suggest that the reported increase in childhood asthma is mainly due to less severe cases.

  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. 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).

  1. 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.

  2. Outpatient admissions and hospital costs of Syrian refugees in a Turkish university hospital

    PubMed Central

    Tahirbegolli, Bernard; Çavdar, Sabanur; Sümer, Esin Çetinkaya; Akdeniz, Sıdıka I.; Vehid, Suphi

    2016-01-01

    Objectives: To examine the most frequent admitted polyclinics, diagnoses, and the costs of Syrian refugee patient in a Turkish university hospital in the metropolitan city of Istanbul, Western part of Turkey. Methods: Research methodology consist of analyzing outpatient admissions to the Hospital Polyclinics of Faculty of Medicine, Istanbul University, Cerrahpasa, Istanbul, Turkey from January-June 2014. We carried out diagnosis groups as classified in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, and analyzed the hospital cost of first admission through records based in the hospital information system. Results: Median age of 251 Syrian refugee patients is 19 years, inter quartile rate 7-34 years. Patients aged 65 and older compared with those until 18 years and 19 to 64 years aged groups have made statistically significant (p<0.001) less hospital admissions. The Most frequented clinic was the emergency clinic. On June there have been significantly (p<0.001) more admissions compared with other months. The most common diagnoses were diseases of the respiratory system. The costs of per admission was estimated nearly 48 US Dollar/per patient and the total amount of hospital admissions was 12,031.93 US Dollar. Conclusion: On the specified dates, the clinics were mostly frequented from Syrian refugees until 18 years group. The most common presenting symptoms are respiratory diseases and most frequented clinic is emergency. PMID:27381545

  3. Epidemiology of Acute Symptomatic Seizures among Adult Medical Admissions

    PubMed Central

    Nwani, Paul Osemeke; Nwosu, Maduaburochukwu Cosmas; Nwosu, Monica Nonyelum

    2016-01-01

    Acute symptomatic seizures are seizures occurring in close temporal relationship with an acute central nervous system (CNS) insult. The objective of the study was to determine the frequency of presentation and etiological risk factors of acute symptomatic seizures among adult medical admissions. It was a two-year retrospective study of the medical files of adults patients admitted with acute symptomatic seizures as the first presenting event. There were 94 cases of acute symptomatic seizures accounting for 5.2% (95% CI: 4.17–6.23) of the 1,802 medical admissions during the period under review. There were 49 (52.1%) males and 45 (47.9%) females aged between 18 years and 84 years. The etiological risk factors of acute symptomatic seizures were infections in 36.2% (n = 34) of cases, stroke in 29.8% (n = 28), metabolic in 12.8% (n = 12), toxic in 10.6% (n = 10), and other causes in 10.6% (n = 10). Infective causes were more among those below fifty years while stroke was more in those aged fifty years and above. CNS infections and stroke were the prominent causes of acute symptomatic seizures. This is an evidence of the “double tragedy” facing developing countries, the unresolved threat of infectious diseases on one hand and the increasing impact of noncommunicable diseases on the other one. PMID:26904280

  4. Drug related hospital admissions in subspecialities of internal medicine.

    PubMed

    Hallas, J

    1996-04-01

    It is well established in the literature that adverse drug reactions (ADRs) and drug non-compliance contribute substantially to the admissions at medical wards. Some important questions, however, remain unanswered. The purpose of this thesis was to characterise the drug-related hospital admissions (DRH) and to assess the magnitude of the problem seen in relation to the demographic parameters and drug use of the background population. In addition, an attempt was made to reduce the DRH incidence by an intervention program. The scope of the study program was adverse drug reactions, intended self-poisoning, non-compliance, underdosing and interactions. The material included 1999 admissions to six departments of internal medicine at Odense University Hospital. The patients were reviewed prospectively, while they were still in the wards, but use of standardised criteria fOR assessment of drug-ADR causality. With inclusion of a definite, probable and possible causal relationship, ADRs and toxic reactions were found as an important factor in 8.4% of all admissions. The incidense of ADR related admissions was 400 per 100,000 per year for the background population as a whole, but showing a strong increase with age. The drug-specific ADR incidences were generally small compared to the drug sales figures. Non-compliance contributed to 2.0% of admissions with diuretics and anti-asthmatics as the drugs most frequently involved. Two departments were re-investigated after an intervention program, primarily targetting general practitioners. The over-all incidence of DRHs was unaffected by the intervention, but the subset classified as avoidable DRHs showed a significant decline. The case material was subject to a blinded evaluation by an external peer group using the same criteria as the investigators. There was no indication that the observed decline in avoidable DRHs should be explained by a shift in the investigators' assessment of cases. It was concluded that the intervention

  5. Herpes Zoster Associated Hospital Admissions in Italy: Review of the Hospital Discharge Forms

    PubMed Central

    Gabutti, Giovanni; Serenelli, Carlotta; Cavallaro, Alessandra; Ragni, Pietro

    2009-01-01

    In Italy a specific surveillance system for zoster does not exist, and thus updated and complete epidemiological data are lacking. The objective of this study was to retrospectively review the national hospital discharge forms database for the period 1999–2005 using the code ICD9-CM053. In the period 1999–2005, 35,328 hospital admissions have been registered with annual means of 4,503 hospitalizations and 543 day-hospital admissions. The great part of hospitalizations (61.9%) involved subjects older than 65 years; the mean duration of stay was 8 days. These data, even if restricted to hospitalizations registered at national level, confirm the epidemiological impact of shingles and of its complications. PMID:19826547

  6. 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}.

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

    PubMed

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

    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. We studied 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. Time-series analysis was used to evaluate the association between respiratory admissions and daily measures of particulate matter (PM10, PM2.5, and PM10 - 2.5) in urban air, after adjustment for gaseous copollutants (CO, O3, NO2, and SO2) 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. PM10 - 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 microg/m(3) in -day average PM10 - 2.5 concentrations were 1.03 (95% confidence interval: 0.98-1.09) for the first admission, 1.22 (1.10-1.36) for the second admission, and 1.06 (1.02, 1.11) for overall admissions. There was no significant association between PM2.5 and hospital admissions for respiratory disease among the elderly. Our 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) PM10 - 2.5 has a larger effect on respiratory admissions than PM2.5.

  8. 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.

  9. Associations between environmental factors and hospital admissions for sickle cell disease.

    PubMed

    Piel, Frédéric B; Tewari, Sanjay; Brousse, Valentine; Analitis, Antonis; Font, Anna; Menzel, Stephan; Chakravorty, Subarna; Thein, Swee Lay; Inusa, Baba; Telfer, Paul; de Montalembert, Mariane; Fuller, Gary W; Katsouyanni, Klea; Rees, David C

    2017-04-01

    Sickle cell disease is an increasing global health burden. This inherited disease is characterized by a remarkable phenotypic heterogeneity, which can only partly be explained by genetic factors. Environmental factors are likely to play an important role but studies of their impact on disease severity are limited and their results are often inconsistent. This study investigated associations between a range of environmental factors and hospital admissions of young patients with sickle cell disease in London and in Paris between 2008 and 2012. Specific analyses were conducted for subgroups of patients with different genotypes and for the main reasons for admissions. Generalized additive models and distributed lag non-linear models were used to assess the magnitude of the associations and to calculate relative risks. Some environmental factors significantly influence the numbers of hospital admissions of children with sickle cell disease, although the associations identified are complicated. Our study suggests that meteorological factors are more likely to be associated with hospital admissions for sickle cell disease than air pollutants. It confirms previous reports of risks associated with wind speed (risk ratio: 1.06/standard deviation; 95% confidence interval: 1.00-1.12) and also with rainfall (1.06/standard deviation; 95% confidence interval: 1.01-1.12). Maximum atmospheric pressure was found to be a protective factor (0.93/standard deviation; 95% confidence interval: 0.88-0.99). Weak or no associations were found with temperature. Divergent associations were identified for different genotypes or reasons for admissions, which could partly explain the lack of consistency in earlier studies. Advice to patients with sickle cell disease usually includes avoiding a range of environmental conditions that are believed to trigger acute complications, including extreme temperatures and high altitudes. Scientific evidence to support such advice is limited and sometimes

  10. 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

  11. Towards a threshold climate for emergency lower respiratory hospital admissions.

    PubMed

    Islam, Muhammad Saiful; Chaussalet, Thierry J; Koizumi, Naoru

    2017-02-01

    Identification of 'cut-points' or thresholds of climate factors would play a crucial role in alerting risks of climate change and providing guidance to policymakers. This study investigated a 'Climate Threshold' for emergency hospital admissions of chronic lower respiratory diseases by using a distributed lag non-linear model (DLNM). We analysed a unique longitudinal dataset (10 years, 2000-2009) on emergency hospital admissions, climate, and pollution factors for the Greater London. Our study extends existing work on this topic by considering non-linearity, lag effects between climate factors and disease exposure within the DLNM model considering B-spline as smoothing technique. The final model also considered natural cubic splines of time since exposure and 'day of the week' as confounding factors. The results of DLNM indicated a significant improvement in model fitting compared to a typical GLM model. The final model identified the thresholds of several climate factors including: high temperature (≥27°C), low relative humidity (≤ 40%), high Pm10 level (≥70-µg/m(3)), low wind speed (≤ 2 knots) and high rainfall (≥30mm). Beyond the threshold values, a significantly higher number of emergency admissions due to lower respiratory problems would be expected within the following 2-3 days after the climate shift in the Greater London. The approach will be useful to initiate 'region and disease specific' climate mitigation plans. It will help identify spatial hot spots and the most sensitive areas and population due to climate change, and will eventually lead towards a diversified health warning system tailored to specific climate zones and populations.

  12. 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

  13. 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

  14. Helmet legislation and admissions to hospital for cycling related head injuries in Canadian provinces and territories: interrupted time series analysis

    PubMed Central

    Ramsay, Tim; Turgeon, Alexis F; Zarychanski, Ryan

    2013-01-01

    Objective To investigate the association between helmet legislation and admissions to hospital for cycling related head injuries among young people and adults in Canada. Design Interrupted time series analysis using data from the National Trauma Registry Minimum Data Set. Setting Canadian provinces and territories; between 1994 and 2003, six of 10 provinces implemented helmet legislation. Participants All admissions (n=66 716) to acute care hospitals in Canada owing to cycling related injury between 1994 and 2008. Main outcome measure Rate of admissions to hospital for cycling related head injuries before and after the implementation of provincial helmet legislation. Results Between 1994 and 2008, 66 716 hospital admissions were for cycling related injuries in Canada. Between 1994 and 2003, the rate of head injuries among young people decreased by 54.0% (95% confidence interval 48.2% to 59.8%) in provinces with helmet legislation compared with 33.1% (23.3% to 42.9%) in provinces and territories without legislation. Among adults, the rate of head injuries decreased by 26.0% (16.0% to 36.3%) in provinces with legislation but remained constant in provinces and territories without legislation. After taking baseline trends into consideration, however, we were unable to detect an independent effect of legislation on the rate of hospital admissions for cycling related head injuries. Conclusions Reductions in the rates of admissions to hospital for cycling related head injuries were greater in provinces with helmet legislation, but injury rates were already decreasing before the implementation of legislation and the rate of decline was not appreciably altered on introduction of legislation. While helmets reduce the risk of head injuries and we encourage their use, in the Canadian context of existing safety campaigns, improvements to the cycling infrastructure, and the passive uptake of helmets, the incremental contribution of provincial helmet legislation to reduce

  15. Impact of integrated health system changes, accelerated due to an earthquake, on emergency department attendances and acute admissions: a Bayesian change-point analysis

    PubMed Central

    Schluter, Philip J; Hamilton, Greg J; Deely, Joanne M; Ardagh, Michael W

    2016-01-01

    Objective To chart emergency department (ED) attendance and acute admission following a devastating earthquake in 2011 which lead to Canterbury's rapidly accelerated integrated health system transformations. Design Interrupted time series analysis, modelling using Bayesian change-point methods, of ED attendance and acute admission rates over the 2008–2014 period. Setting ED department within the Canterbury District Health Board; with comparison to two other district health boards unaffected by the earthquake within New Zealand. Participants Canterbury's health system services ∼500 000 people, with around 85 000 ED attendances and 37 000 acute admissions per annum. Main outcome measures De-seasoned standardised population ED attendance and acute admission rates overall, and stratified by age and sex, compared before and after the earthquake. Results Analyses revealed five global patterns: (1) postearthquake, there was a sudden and persisting decrease in the proportion of the population attending the ED; (2) the growth rate of ED attendances per head of population did not change between the pre-earthquake and postearthquake periods; (3) postearthquake, there was a sudden and persisting decrease in the proportion of the population admitted to hospital; (4) the growth rate of hospital admissions per head of the population declined between pre-earthquake and postearthquake periods and (5) the most dramatic reduction in hospital admissions growth after the earthquake occurred among those aged 65+ years. Extrapolating from the projected and fitted deseasoned rates for December 2014, ∼676 (16.8%) of 4035 projected hospital admissions were avoided. Conclusions While both necessarily and opportunistically accelerated, Canterbury's integrated health systems transformations have resulted in a dramatic and sustained reduction in ED attendances and acute hospital admissions. This natural intervention experiment, triggered by an earthquake, demonstrated that

  16. Hospital mortality of acute myocardial infarction in the thrombolytic era

    PubMed Central

    Mahon, N; O'Rorke, C; Codd, M; McCann, H; McGarry, K; Sugrue, D

    1999-01-01

    OBJECTIVE—To examine the management and outcome of an unselected consecutive series of patients admitted with acute myocardial infarction to a tertiary referral centre.
DESIGN—A historical cohort study over a three year period (1992-94) of consecutive unselected admissions with acute myocardial infarction identified using the HIPE (hospital inpatient enquiry) database and validated according to MONICA criteria for definite or probable acute myocardial infarction.
SETTING—University teaching hospital and cardiac tertiary referral centre.
RESULTS—1059 patients were included. Mean age was 67 years; 60% were male and 40% female. Rates of coronary care unit (CCU) admission, thrombolysis, and predischarge angiography were 70%, 28%, and 32%, respectively. Overall in-hospital mortality was 18%. Independent predictors of hospital mortality by multivariate analysis were age, left ventricular failure, ventricular arrhythmias, cardiogenic shock, management outside CCU, and reinfarction. Hospital mortality in a small cohort from a non-tertiary referral centre was 14%, a difference largely explained by the lower mean age of these patients (64 years). Five year survival in the cohort was 50%. Only age and left ventricular failure were independent predictors of mortality at follow up.
CONCLUSIONS—In unselected consecutive patients the hospital mortality of acute myocardial infarction remains high (18%). Age and the occurrence of left ventricular failure are major determinants of short and long term mortality after acute myocardial infarction.


Keywords: myocardial infarction; mortality; thrombolysis PMID:10212164

  17. Severe infective keratitis leading to hospital admission in New Zealand

    PubMed Central

    Wong, T; Ormonde, S; Gamble, G; McGhee, C N J

    2003-01-01

    Aim: To identify key risk factors and the management and outcome of severe infective keratitis leading to public hospital admission in New Zealand. Methods: Over a 2 year period, all admissions of presumed infective keratitis to Auckland Hospital were identified. The clinical records of all 103 cases were retrospectively reviewed with respect to clinical features, risk factors, management, and outcomes. Results: The mean time from first symptoms or signs and presentation to hospital was 8.9 (SD 15.5) days. The majority of subjects, 88%, had at least one of the risk factors commonly associated with infective keratitis including previous ocular surgery (30%), contact lens wear (26%), topical corticosteroid use (25%), and ocular trauma (24%). Corneal scraping was performed in 92% and of a total of 105 scrapes, 71% were positive. Bacteria were isolated in all these cases, the majority being Gram positive organisms (72%). The most common isolates identified were coagulase negative Staphylococcus (16%), Propionibacterium acnes (14%), Staphylococcus epidermidis (11%), and Streptococcus pneumoniae (9%). In addition, yeasts were isolated in 5%, fungi in 4%, virus in 2%, and chlamydia in 1%. Importantly, polymicrobial infection accounted for 33% of culture positive cases. Antimicrobial treatment was changed on the basis of culture results in 17 cases (16.5%). Median initial visual and final best corrected visual acuity was 6/36–6/48 (logMAR 0.86) (IQR 0.39–2.00) and 6/12–6/15 (logMAR 0.360) (IQR 0.15–1.70), respectively. Previous ocular surgery and topical corticosteroid use were significantly associated with poorer visual acuity. The mean hospital stay was 5.8 days and the median 4.0 (IQR 2.0–8.0) days. Longer duration of stay was associated with the presence of hypopyon, larger ulcers, previous ocular surgery, and poor visual acuity. Conclusions: Infectious keratitis is an important cause of ocular morbidity. A significant proportion of cases have potentially

  18. Security rules and banned items in psychiatric acute admission wards in Athens, Greece.

    PubMed

    Koukia, Evmorfia; Giannouli, Eleni; Gonis, Nikolaos; Douzenis, Athanassios

    2010-12-01

    Mental health nurses play a key role in maintaining the safety of patients, themselves, and others during hospitalization. The aim of the research was to evaluate the safety measures that are taken by mental health nurses to identify the security policies that exist in acute mental health wards. The Ward Safety and Security Rules Survey was used as a method of data collection. Descriptive analysis and content analysis were carried out in order to identify nurses' practices. The total sample consisted of 172 mental health nurses and nurses' assistants who worked in 14 acute inpatient psychiatric wards in three psychiatric hospitals in the greater area of Athens, Greece. The results show a minimum number of security features existing in the wards. Only one of the 14 wards had an intercom system. In only nine wards, there was a panic alarm in the office, and in eight, an emergency response telephone extension. A wide range of practices were noted concerning banned items and patient searches upon admission and return from leave. The results indicate the significant lack of protocols and specific safety rules to guide nurses' actions across psychiatric acute admission wards in Athens.

  19. Does a home treatment acute relapse prevention strategy reduce admissions for people with mania in bipolar affective disorder?

    PubMed Central

    Murton, Claudia; Cooper, Michael; Dinniss, Stephen; Roberts, Shon; Booth, Nicola; Newell, Paul

    2014-01-01

    Aims and method To assess whether a home treatment team acute relapse prevention (ARP) strategy reduces admissions to hospital with mania. A retrospective design was used to analyse records for manic admissions since 2002. The number and length of admissions and detentions pre- and post-ARP were determined and rates of admissions and detentions calculated from this. Results We found reductions in admission and detention rates following the introduction of the ARP: 0.3 fewer admissions per person per year (95% bootstrap CI 0.09–0.62) and 0.25 fewer detentions per person per year (95% bootstrap CI 0.0–0.48). Wilcoxon signed-rank tests gave P<0.0001. Clinical implications A person-centred care plan such as the ARP which enables quick action in response to relapse-warning signs of mania appears to reduce rates of admission to hospital. The ARP could be used anywhere in the UK and fits with current mental health policy. PMID:25505627

  20. The Ambiguous Effect of GP Competition: The Case of Hospital Admissions.

    PubMed

    Islam, M Kamrul; Kjerstad, Egil

    2016-10-14

    In the theoretical literature on general practitioner (GP) behaviour, one prediction is that intensified competition induces GPs to provide more services resulting in fewer hospital admissions. This potential substitution effect has drawn political attention in countries looking for measures to reduce the growth in demand for hospital care. However, intensified competition may induce GPs to secure hospital admissions a signal to attract new patients and to keep the already enlisted ones satisfied, resulting in higher admission rates at hospitals. Using both static and dynamic panel data models, we aim to enhance the understanding of whether such relations are causal. Results based on ordinary least square (OLS) models indicate that aggregate inpatient admissions are negatively associated with intensified competition both in the full sample and for the sub-sample patients aged 45 to 69, while outpatient admissions are positively associated. Fixed-effect estimations do not confirm these results though. However, estimations of dynamic models show significant negative (positive) effects of GP competition on aggregate inpatient (outpatient) admissions in the full sample and negative effects on aggregate inpatient admissions and emergency admissions for the sub-sample. Thus, intensified GP competition may reduce inpatient hospital admissions by inducing GPs to provide more services, whereas, the alternative hypothesis seems valid for outpatient admissions. © 2016 The Authors. Health Economics Published by John Wiley & Sons, Ltd.

  1. Environmental triggers of hospital admissions for school-age children with asthma in two British cities.

    PubMed

    Julious, Steven A; Jain, Ritika; Mason, Suzanne

    2012-10-01

    Research has reported seasonal peaks in asthma in school age asthmatic children. The study aimed to assess if hospital admissions could be predicted from the possible environmental triggers using data from two British cities: Aberdeen and Doncaster. However, there were no consistent patterns across the two cities with no clear evidence that hospital admissions could be predicted from environmental data.

  2. Utilizing Chinese Admission Records for MACE Prediction of Acute Coronary Syndrome

    PubMed Central

    Hu, Danqing; Huang, Zhengxing; Chan, Tak-Ming; Dong, Wei; Lu, Xudong; Duan, Huilong

    2016-01-01

    Background: Clinical major adverse cardiovascular event (MACE) prediction of acute coronary syndrome (ACS) is important for a number of applications including physician decision support, quality of care assessment, and efficient healthcare service delivery on ACS patients. Admission records, as typical media to contain clinical information of patients at the early stage of their hospitalizations, provide significant potential to be explored for MACE prediction in a proactive manner. Methods: We propose a hybrid approach for MACE prediction by utilizing a large volume of admission records. Firstly, both a rule-based medical language processing method and a machine learning method (i.e., Conditional Random Fields (CRFs)) are developed to extract essential patient features from unstructured admission records. After that, state-of-the-art supervised machine learning algorithms are applied to construct MACE prediction models from data. Results: We comparatively evaluate the performance of the proposed approach on a real clinical dataset consisting of 2930 ACS patient samples collected from a Chinese hospital. Our best model achieved 72% AUC in MACE prediction. In comparison of the performance between our models and two well-known ACS risk score tools, i.e., GRACE and TIMI, our learned models obtain better performances with a significant margin. Conclusions: Experimental results reveal that our approach can obtain competitive performance in MACE prediction. The comparison of classifiers indicates the proposed approach has a competitive generality with datasets extracted by different feature extraction methods. Furthermore, our MACE prediction model obtained a significant improvement by comparison with both GRACE and TIMI. It indicates that using admission records can effectively provide MACE prediction service for ACS patients at the early stage of their hospitalizations. PMID:27649220

  3. 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.

  4. Investigation of bias after data linkage of hospital admissions data to police road traffic crash reports

    PubMed Central

    Cryer, P; Westrup, S; Cook, A; Ashwell, V; Bridger, P; Clarke, C

    2001-01-01

    Research question—Does a database of hospital admission data linked to police road traffic accident (RTA) reports produce less biased information for the injury prevention policymaker, planner, and practitioner than police RTA reports alone? Design—Data linkage study. Study population—Non-fatal injury victims of road traffic crashes in southern England who were admitted to hospital. Data sources—Hospital admissions and police RTA reports. Main outcome measures—The estimated proportion of road traffic crashes admitted to hospital that were included on the linked database; distributions by age, sex, and road user groups: (A) for all RTA injury admissions and (B) for RTA serious injury admissions defined by length of stay or by nature of injury. Results—An estimated 50% of RTA injury admissions were included on the linked database. When assessing bias, admissions data were regarded as the "gold standard". The distributions of casualties by age, sex, and type of road user showed major differences between the admissions data and the police RTA injury data of comparable severity. The linked data showed smaller differences when compared with admissions data. For RTA serious injury admissions, the distributions by age and sex were approximately the same for the linked data compared with admissions data, and there were small but statistically significant differences between the distributions across road user group for the linked data compared with hospital admissions. Conclusion—These results suggest that investigators could be misinformed if they base their analysis solely on police RTA data, and that information derived from the linked database is less biased than that from police RTA data alone. A national linked dataset of road traffic crash data should be produced from hospital admissions and police RTA data for use by policymakers, planners and practitioners. PMID:11565992

  5. Mental and nonmental health hospital admissions among chronically homeless adults before and after supportive housing placement.

    PubMed

    Rieke, Katherine; Smolsky, Ann; Bock, Erin; Erkes, Laura Peet; Porterfield, Erin; Watanabe-Galloway, Shinobu

    2015-01-01

    Individuals experiencing chronic homelessness may utilize hospital services more frequently than the general population. Understanding the benefits of providing permanent supportive housing to these individuals can lead to improved services for this population. This study examined the effect of supportive housing placement on hospital admissions of adults who were homeless. Admissions were examined for a period of one-year pre- and postsupportive housing placement for 23 adults. Results showed a reduction in the number of emergency department admissions and an increase in outpatient admissions during the year following housing placement, indicating that supportive housing may encourage more appropriate use of health care services.

  6. Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit

    PubMed Central

    2011-01-01

    Background Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. Methods/design We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of life, cognitive function

  7. Variation in management of community-acquired pneumonia requiring admission to Alberta, Canada hospitals.

    PubMed Central

    Jin, Y.; Marrie, T. J.; Carriere, K. C.; Predy, G.; Houston, C.; Ness, K.; Johnson, D. H.

    2003-01-01

    Previous studies have shown small area variation in the rate of admission to hospital for patients with community-acquired pneumonia. We determined the rates of admission and length of stay for patients with community-acquired pneumonia in Alberta and the factors influencing admission rates and length of stay. Using hospital abstracts, hospital admissions for community-acquired pneumonia from 1 April 1994 to 31 March 1999 were compared. We classified Alberta hospitals according to geographical regions, by the number of beds, and by number of community-acquired pneumonia cases. There were 12,000 annual hospital discharges for community-acquired pneumonia costing over $40 million per year. The overall in-hospital mortality rate was 12% and the 1 year mortality rate was 26%. Compared with rural hospitals, regional and metropolitan hospitals admitted patients with greater severity of illness as demonstrated by greater in-hospital mortality, cost per case and comorbidity. Age-sex adjusted hospital discharge rates were significantly below the provincial average in both urban regions. Hospital discharge rates for residents in all rural regions and 4 of 5 regions with a regional hospital were significantly higher than the provincial average. After adjusting for comorbidity, the relative risk for a longer length of stay was 22% greater in regional hospitals and about 30% greater in urban hospitals compared to rural hospitals. Seasonal variation in the admission rate was evident, with higher rates in the winter of each year. We conclude that rural hospitals would be likely to benefit from a protocol to help with the admission decision and urban hospitals from a programme to reduce length of stay. PMID:12613744

  8. Inpatient Dermatology: Characteristics of Patients and Admissions in a Tertiary Level Hospital in Eastern India

    PubMed Central

    Sen, Arpita; Chowdhury, Satyendranath; Poddar, Indrasish; Bandyopadhyay, Debabrata

    2016-01-01

    Introduction: Dermatology is primarily a non-acute, outpatient-centered clinical specialty, but substantial number of patients need indoor admission for adequate management. Over the years, the need for inpatient facilities in Dermatology has grown manifold; however, these facilities are available only in some tertiary centers. Aims and Objectives: To analyze the characteristics of the diseases and outcomes of patients admitted in the dermatology inpatient Department of a tertiary care facility in eastern India. Materials and Methods: We undertook a retrospective analysis of the admission and discharge records of all patients, collected from the medical records department, admitted to our indoor facility from 2011 to 2014. The data thus obtained was statistically analyzed with special emphasis on the patient's demographic profile, clinical diagnosis, final outcome, and duration of stay. Results and Analysis: A total of 375 patients were admitted to our indoor facility during the period. Males outnumbered females, with the median age in the 5th decade. Immunobullous disorders (91 patients, 24.27%) were the most frequent reason for admissions, followed by various causes of erythroderma (80 patients, 21.33%) and infective disorders (73 patients, 19.47%). Other notable causes included cutaneous adverse drug reactions, psoriasis, vasculitis, and connective tissue diseases. The mean duration of hospital stay was 22.2±15.7 days; ranging from 1 to 164 days. Majority of patients (312, 83.2%) improved after hospitalization; while 29 (7.73%) patients died from their illness. About 133 patients (35.64%) required referral services during their stay, while 8 patients (2.13%) were transferred to other departments for suitable management. Conclusion: Many dermatoses require inpatient care for their optimum management. Dermatology inpatient services should be expanded in India to cater for the large number of cases with potentially highly severe dermatoses. PMID:27688450

  9. 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

    2015-12-03

    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.

  10. Hospital admissions and exercise capacity decline in patients with COPD.

    PubMed

    Ramon, Maria A; Gimeno-Santos, Elena; Ferrer, Jaume; Balcells, Eva; Rodríguez, Esther; de Batlle, Jordi; Gómez, Federico P; Sauleda, Jaume; Ferrer, Antoni; Barberà, Joan A; Agustí, Alvar; Gea, Joaquim; Rodriguez-Roisin, Robert; Antó, Josep M; Garcia-Aymerich, Judith

    2014-04-01

    Exercise capacity declines with time and is an important determinant of health status and prognosis in patients with chronic obstructive pulmonary disease (COPD). We hypothesised that hospital admissions are associated with exercise capacity decline in these patients. Clinical and functional variables were collected for 342 clinically stable COPD patients. The 6-min walk distance (6MWD) was determined at baseline and after a mean±sd of 1.7±0.3 years. Information on hospitalisations during follow-up was obtained from centralised administrative databases. Linear regression was used to model changes in exercise capacity. Patients were mostly male (92%), with mean±sd age 67.9±8.6 years, post-bronchodilator forced expiratory volume in 1 s 54±17% predicted and baseline 6MWD 433±93 m. During follow-up, 6MWD decreased by 21.9±51.0 m·year(-1) and 153 (45%) patients were hospitalised at least once. Among patients admitted only for COPD-related causes (50% of those ever admitted), the proportion presenting a clinically significant loss of 6MWD was higher than in patients admitted for only nonrespiratory conditions (53% versus 29%, p=0.040). After adjusting for confounders, annual 6MWD decline was greater (26 m·year(-1), 95% CI 13-38 m·year(-1); p<0.001) in patients with more than one all-cause hospitalisation per year, as compared with those with no hospitalisations. Hospitalisations are related to a greater decline in exercise capacity in COPD.

  11. How does active substance use at psychiatric admission impact suicide risk and hospital length-of-stay?

    PubMed

    Miller, Keith A; Hitschfeld, Mario J; Lineberry, Timothy W; Palmer, Brian A

    2016-01-01

    Despite their high prevalence, little is known about the effects of substance use disorders and active substance use on the suicide risk or length-of-stay of psychiatric inpatients. This study examines the relationship between active substance use at the time of psychiatric hospitalization and changes in suicide risk measures and length-of-stay. Admission and discharge ratings on the Suicide Status Form-II-R, diagnoses, and toxicology data from 2,333 unique psychiatric inpatients were examined. Data for patients using alcohol, tetrahydrocannabinol, methamphetamines, cocaine, benzodiazepines, opiates, barbiturates, phencyclidine, and multiple substances on admission were compared with data from 1,426 admissions without substance use. Patients with substance use by toxicology on admission had a 0.9 day shorter length-of-stay compared to toxicology-negative patients. During initial nurse evaluation on the inpatient unit, these patients reported lower suicide measures (i.e., suicidal ideation frequency, overall suicide risk, and wish-to-die). No significant between-group differences were seen at discharge. Patients admitted with a substance use disorder diagnosis had a 1.0 day shorter length-of-stay than those without, while those with a substance use disorder diagnosis and positive toxicology reported the lowest measures of suicidality on admission. These results remained independent of psychiatric diagnosis. For acute psychiatric inpatients, suicide risk is higher and length-of-stay is longer in patients with substance use disorders who are NOT acutely intoxicated compared with patients without a substance use disorder. Toxicology-positive patients are less suicidal on admission and improve faster than their toxicology-negative counterparts. This study gives support to the clinical observation that acutely intoxicated patients may stabilize quickly with regard to suicidal urges and need for inpatient care.

  12. 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

  13. Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals

    ERIC Educational Resources Information Center

    Baldwin, Laura-Mae; MacLehose, Richard F.; Hart, L. Gary; Beaver, Shelli K.; Every,Nathan; Chan,Leighton

    2004-01-01

    Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers.…

  14. In Nonagenarians, Acute Kidney Injury Predicts In-Hospital Mortality, while Heart Failure Predicts Hospital Length of Stay

    PubMed Central

    Chao, Chia-Ter; Lin, Yu-Feng; Tsai, Hung-Bin; Hsu, Nin-Chieh; Tseng, Chia-Lin; Ko, Wen-Je

    2013-01-01

    Background/Aims The elderly constitute an increasing proportion of admitted patients worldwide. We investigate the determinants of hospital length of stay and outcomes in patients aged 90 years and older. Methods We retrospectively analyzed all admitted patients aged >90 years from the general medical wards in a tertiary referral medical center between August 31, 2009 and August 31, 2012. Patients’ clinical characteristics, admission diagnosis, concomitant illnesses at admission, and discharge diagnosis were collected. Each patient was followed until discharge or death. Multivariate logistic regression analysis was utilized to study factors associated with longer hospital length of stay (>7 days) and in-hospital mortality. Results A total of 283 nonagenarian in-patients were recruited, with 118 (41.7%) hospitalized longer than one week. Nonagenarians admitted with pneumonia (p = 0.04) and those with lower Barthel Index (p = 0.012) were more likely to be hospitalized longer than one week. Multivariate logistic regression analysis revealed that patients with lower Barthel Index (odds ratio [OR] 0.98; p = 0.021) and those with heart failure (OR 3.05; p = 0.046) had hospital stays >7 days, while patients with lower Barthel Index (OR 0.93; p = 0.005), main admission nephrologic diagnosis (OR 4.83; p = 0.016) or acute kidney injury (OR 30.7; p = 0.007) had higher in-hospital mortality. Conclusion In nonagenarians, presence of heart failure at admission was associated with longer hospital length of stay, while acute kidney injury at admission predicted higher hospitalization mortality. Poorer functional status was associated with both prolonged admission and higher in-hospital mortality. PMID:24223127

  15. The effect of solar-geomagnetic activity during and after admission on survival in patients with acute coronary syndromes.

    PubMed

    Vencloviene, Jone; Babarskiene, Ruta; Milvidaite, Irena; Kubilius, Raimondas; Stasionyte, Jolanta

    2014-08-01

    A number of studies have established the effects of solar-geomagnetic activity on the human cardio-vascular system. It is plausible that the heliophysical conditions existing during and after hospital admission may affect survival in patients with acute coronary syndromes (ACS). We analyzed data from 1,413 ACS patients who were admitted to the Hospital of Kaunas University of Medicine, Lithuania, and who survived for more than 4 days. We evaluated the associations between active-stormy geomagnetic activity (GMA), solar proton events (SPE), and solar flares (SF) that occurred 0-3 days before and after admission, and 2-year survival, based on Cox's proportional-hazards model, controlling for clinical data. After adjustment for clinical variables, active-stormy GMA on the 2nd day after admission was associated with an increased (by 1.58 times) hazard ratio (HR) of cardiovascular death (HR=1.58, 95 % CI 1.07-2.32). For women, geomagnetic storm (GS) 2 days after SPE occurred 1 day after admission increased the HR by 3.91 times (HR=3.91, 95 % CI 1.31-11.7); active-stormy GMA during the 2nd-3rd day after admission increased the HR by over 2.5 times (HR=2.66, 95 % CI 1.40-5.03). In patients aged over 70 years, GS occurring 1 day before or 2 days after admission, increased the HR by 2.5 times, compared to quiet days; GS in conjunction with SF on the previous day, nearly tripled the HR (HR=3.08, 95 % CI 1.32-7.20). These findings suggest that the heliophysical conditions before or after the admission affect the hazard ratio of lethal outcome; adjusting for clinical variables, these effects were stronger for women and older patients.

  16. The effect of solar-geomagnetic activity during and after admission on survival in patients with acute coronary syndromes

    NASA Astrophysics Data System (ADS)

    Vencloviene, Jone; Babarskiene, Ruta; Milvidaite, Irena; Kubilius, Raimondas; Stasionyte, Jolanta

    2014-08-01

    A number of studies have established the effects of solar-geomagnetic activity on the human cardio-vascular system. It is plausible that the heliophysical conditions existing during and after hospital admission may affect survival in patients with acute coronary syndromes (ACS). We analyzed data from 1,413 ACS patients who were admitted to the Hospital of Kaunas University of Medicine, Lithuania, and who survived for more than 4 days. We evaluated the associations between active-stormy geomagnetic activity (GMA), solar proton events (SPE), and solar flares (SF) that occurred 0-3 days before and after admission, and 2-year survival, based on Cox's proportional-hazards model, controlling for clinical data. After adjustment for clinical variables, active-stormy GMA on the 2nd day after admission was associated with an increased (by 1.58 times) hazard ratio (HR) of cardiovascular death (HR = 1.58, 95 % CI 1.07-2.32). For women, geomagnetic storm (GS) 2 days after SPE occurred 1 day after admission increased the HR by 3.91 times (HR = 3.91, 95 % CI 1.31-11.7); active-stormy GMA during the 2nd-3rd day after admission increased the HR by over 2.5 times (HR = 2.66, 95 % CI 1.40-5.03). In patients aged over 70 years, GS occurring 1 day before or 2 days after admission, increased the HR by 2.5 times, compared to quiet days; GS in conjunction with SF on the previous day, nearly tripled the HR (HR = 3.08, 95 % CI 1.32-7.20). These findings suggest that the heliophysical conditions before or after the admission affect the hazard ratio of lethal outcome; adjusting for clinical variables, these effects were stronger for women and older patients.

  17. Medication knowledge of patients hospitalized for heart failure at admission and after discharge

    PubMed Central

    Custodis, Florian; Rohlehr, Franziska; Wachter, Angelika; Böhm, Michael; Schulz, Martin; Laufs, Ulrich

    2016-01-01

    Background A substantial aspect of health literacy is the knowledge of prescribed medication. In chronic heart failure, incomplete intake of prescribed drugs (medication non-adherence) is inversely associated with clinical prognosis. Therefore, we assessed medication knowledge in a cohort of patients with decompensated heart failure at hospital admission and after discharge in a prospective, cross-sectional study. Methods One hundred and eleven patients presenting at the emergency department with acute decompensated heart failure were included (mean age 78.4±9.2, 59% men) in the study. Patients’ medication knowledge was assessed during individual interviews at baseline, course of hospitalization, and 3 months after discharge. Individual responses were compared with the medical records of the referring general practitioner. Results Median N-terminal prohormone of brain natriuretic peptide plasma concentration in the overall population at baseline was 4,208 pg/mL (2,023–7,101 pg/mL [interquartile range]), 20 patients died between the second and third interview. The number of prescribed drugs increased from 8±3 at baseline to 9±3 after 3 months. The majority of patients did not know the correct number of their drugs. Medication knowledge decreased continuously from baseline to the third interview. At baseline, 37% (n=41) of patients stated the correct number of drugs to be taken, whereas only 18% (n=16) knew the correct number 3 months after discharge (P=0.008). Knowledge was inversely related to N-terminal prohormone of brain natriuretic peptide levels. Conclusion Medication knowledge of patients with acute decompensated heart failure is poor. Despite care in a university hospital, patients’ individual medication knowledge decreased after discharge. The study reveals an urgent need for better strategies to improve and promote the knowledge of prescribed medication in these very high-risk patients. PMID:27877025

  18. Influence of atmospheric states in semi-arid areas on hospital admission in cardio-surgical department.

    PubMed

    Yackerson, Naomy S; Zilberman, Arkadi; Aizenberg, Alexander

    2017-04-01

    The influence of the changes in atmospheric state, typical for areas close to big deserts, on acute myocardial infarction (AMI) was analyzed. Under test was the group of 3256 patients (77 % males, 23 % females), hospitalized in the Cardio-Surgical Department of Soroka Medical Center at Ben-Gurion University (BGU, Israel) during 2000-2008. To explore the relationship between atmospheric parameters and AMI, multivariate regression analysis has been performed. AMI was most frequent in winter to spring and least in summer. The highest number of cases was recorded in December and the lowest in September. Hospital admissions showed a higher prevalence in men than in women; the ratio is 3.3/1.0. About 60 % of males were aged between 45 and 65 years old with maximum ∼55 (21 %), whereas 60 % of women hospital admissions were aged between 65 and 80 years old with maximum ∼72 (24 %). The result suggested that the monthly mean relative humidity at daytime and its overall daily differences, wind speed, and respirable fraction of particulate concentration are associated with the admission for AMI. The results of the study confirm the importance of atmospheric state variability for cardiovascular diseases.

  19. Influence of atmospheric states in semi-arid areas on hospital admission in cardio-surgical department

    NASA Astrophysics Data System (ADS)

    Yackerson, Naomy S.; Zilberman, Arkadi; Aizenberg, Alexander

    2016-10-01

    The influence of the changes in atmospheric state, typical for areas close to big deserts, on acute myocardial infarction (AMI) was analyzed. Under test was the group of 3256 patients (77 % males, 23 % females), hospitalized in the Cardio-Surgical Department of Soroka Medical Center at Ben-Gurion University (BGU, Israel) during 2000-2008. To explore the relationship between atmospheric parameters and AMI, multivariate regression analysis has been performed. AMI was most frequent in winter to spring and least in summer. The highest number of cases was recorded in December and the lowest in September. Hospital admissions showed a higher prevalence in men than in women; the ratio is 3.3/1.0. About 60 % of males were aged between 45 and 65 years old with maximum ˜55 (21 %), whereas 60 % of women hospital admissions were aged between 65 and 80 years old with maximum ˜72 (24 %). The result suggested that the monthly mean relative humidity at daytime and its overall daily differences, wind speed, and respirable fraction of particulate concentration are associated with the admission for AMI. The results of the study confirm the importance of atmospheric state variability for cardiovascular diseases.

  20. Parenteral penicillin for children with meningococcal disease before hospital admission: case-control study

    PubMed Central

    Harnden, Anthony; Ninis, Nelly; Thompson, Matthew; Perera, Rafael; Levin, Michael; Mant, David; Mayon-White, Richard

    2006-01-01

    Objective To explore the impact on mortality and morbidity of parenteral penicillin given to children before admission to hospital with suspected meningococcal disease. Design Retrospective comparison of fatal and non-fatal cases. Setting England, Wales, and Northern Ireland; December 1997 to February 1999. Participants 158 children aged 0-16 years (26 died, 132 survived) in whom a general practitioner had made the diagnosis of meningococcal disease before hospital admission. Results Administration of parenteral penicillin by general practitioners was associated with increased odds ratios for death (7.4, 95% confidence interval 1.5 to 37.7) and complications in survivors (5.0, 1.7 to 15.0). Children who received penicillin had more severe disease on admission (median Glasgow meningococcal septicaemia prognostic score (GMSPS) 6.5 v 4.0, P = 0.002). Severity on admission did not differ significantly with time taken to reach hospital. Conclusions Children who were given parenteral penicillin by a general practitioner had more severe disease on reaching hospital than those who were not given penicillin before admission. The association with poor outcome may be because children who are more severely ill are being given penicillin before admission. PMID:16554335

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

    PubMed Central

    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

  2. Racial disparities in receiving total hip/knee replacement surgery: the effect of hospital admission sources.

    PubMed

    Chen, Jie; Rizzo, John A; Parasuraman, Shreekant; Gunnarsson, Candace

    2013-02-01

    Using a nationally-representative inpatient care dataset (the HCUP National Inpatient Sample from 2002 to 2007) we examined racial disparities in receiving total hip replacement (THR) and total knee replacement (TKR) surgeries. Multivariable logistic regression models revealed that racial minorities were significantly less likely to receive THR or TKR than Whites, controlling for patients' hospital admission source and hospital characteristics. Employing Blinder-Oaxaca decomposition techniques, we found that observed difference in population characteristics explained 55%-67% and 78% of the racial disparities in THR and TKR, respectively. Differences in patients' hospital admission source emerged as the major individual factor associated with these disparities, explaining 57%-77% of racial disparities in THR and 26%-50% of racial disparities in TKR. This study suggests that substantive racial and ethnic disparities exist in utilization of THR and TKR surgery. Observed population characteristics accounted for most of these differences, with hospital admission source being the key factor.

  3. The association between space weather conditions and emergency hospital admissions for myocardial infarction during different stages of solar activity

    NASA Astrophysics Data System (ADS)

    Vencloviene, J.; Antanaitiene, J.; Babarskiene, R.

    2016-11-01

    A number of studies have established the effects of space weather on the human cardio-vascular system. We investigated whether geomagnetic storms (GS), solar proton events (SPEs), and X-class solar flare affect the risk of emergency hospitalization for acute myocardial infarction (MI) separately during declining (2004-2006) and rising (2010-2012) phases of solar activity. The data on hospital admissions for MI were obtained from the computer database of Lithuanian University of Health sciences from January 1, 2004 to December 31, 2012. We evaluated the associations between space weather conditions and the daily number of emergency admissions for MI by Poisson regression, controlling for seasonal variation and weekdays. During 2004-2006, an increase in the risk of hospital admission for MI was observed on days of the daily mean proton >10 MeV flux >100 pfu (by 63%, p<0.001) and on days of GS concomitant with SPE, 1-2 days following these events, and on days of SPE occurring 1-2 days before GS concomitant with SPE (by 26%, p=0.019). During 2010-2012, an increase in the risk of hospital admission for MI was observed on days of the daily mean proton >10 MeV flux >100 pfu (by 52%, p=0.015) and on days of GS and 1-2 days after GS (by 17%, p=0.024). These findings suggest that the impact of hazardous space weather conditions on human health depends of the strength of space storm during the investigated period.

  4. Decreasing avoidable hospital admissions with the implementation of an emergency department case management program.

    PubMed

    Sharieff, Ghazala Q; Cantonis, Matt; Tressler, Michelle; Whitehead, Mary; Russe, Jamie; Lovell, Eric

    2014-01-01

    With the passage of the Affordable Care Act, increased emphasis has been placed on optimizing quality and reducing expenditures. The use of an emergency department case manager (EDCM) is reemerging as an important initiative in the quest to provide high-quality care and decrease unnecessary hospital admissions. A pilot study of the use of EDCMs was conducted in one of the authors' EDs during a 6-month trial period. By using evidence-based criteria, the EDCM helped in real time to verify admission criteria, assisted with inpatient versus outpatient designation, found community alternatives to hospital admission, and initiated discharge planning for patients who required admission and were at high risk for readmission. EDCMs also worked with pharmacists to assist with medication management for patients who required assistance with obtaining prescriptions. Because of the pilot study's success, the authors' health care system will be implementing EDCMs throughout the organization.

  5. Rates of hospital admissions for primary angle closure glaucoma among Chinese, Malays, and Indians in Singapore

    PubMed Central

    Wong, T. Y.; Foster, P.; Seah, S.; Chew, P.

    2000-01-01

    AIM—To estimate the rates of hospital admissions for primary angle closure glaucoma (PACG) in Chinese, Malays, and Indians in Singapore
METHODS—A population-wide hospital discharge database in Singapore was used to identify all hospital admissions with a primary discharge diagnosis of PACG (International Classification of Disease—CM code: 365.2). The Singapore census was used for denominator data.
RESULTS—Between 1993 and 1997 there were 894 hospital admissions for PACG. The mean annual rate of PACG admissions was 11.1 per 100 000 (95% confidence interval (CI), 10.4, 11.8) among people aged 30 years and over. The annual rate was highest for Chinese (age and sex adjusted rate: 12.2 per 100 000), which was twice that of Malays (6.0 per 100 000) and Indians (6.3 per 100 000). Females had two times higher rates than males in all three races (age adjusted relative risk: 2.0, 95% CI: 1.7, 2.3).
CONCLUSION—Malay and Indian people had identical rates of hospital admissions for PACG, which were only half the rates compared with Chinese.

 PMID:10966951

  6. Contribution of creatine kinase MB mass concentration at admission to early diagnosis of acute myocardial infarction.

    PubMed Central

    Bakker, A J; Gorgels, J P; van Vlies, B; Koelemay, M J; Smits, R; Tijssen, J G; Haagen, F D

    1994-01-01

    OBJECTIVE--To assess the diagnostic value at admission of creatine kinase MB mass concentration, alone or in combination with electrocardiographic changes, in suspected myocardial infarction. DESIGN--Prospective study of all consecutive patients admitted within 12 hours after onset of chest pain to a coronary care unit for evaluation of suspected myocardial infarction. SETTING--Large regional hospital. PATIENTS--In 297 patients creatine kinase and creatine kinase MB activities and creatine kinase MB mass concentration were determined. Myocardial infarction according to the criteria of the World Health Organisation was diagnosed in 154 patients and excluded in 143 patients (including 70 with unstable angina pectoris). RESULTS--Sensitivity/specificity for creatine kinase MB mass concentration in patients admitted within 4 hours and 4-12 hours after onset of chest pain were 45%/94% and 76%/79% respectively. Corresponding values for creatine kinase activity were 20%/89% and 59%/83%, and for creatine kinase MB activity 16%/87% and 53%/87%. Raised creatine kinase MB mass concentration was seen in 17% of patients with unstable angina pectoris. Stepwise logistic regression analysis showed that independent predictors of acute myocardial infarction in patients admitted within 4 hours after onset of chest pain were electrocardiographic changes and creatine kinase MB mass concentration on admission; in patients admitted 4-12 hours after the onset of pain independent predictors were electrocardiographic changes and creatine kinase MB mass concentration and activity. CONCLUSION--Creatine kinase MB mass concentration is a more sensitive marker for myocardial infarction than the activity of creatine kinase and its MB isoenzyme. Electrocardiographic changes on admission in combination with creatine kinase MB mass concentration (instead of creatine kinase and creatine kinase MB activities) are best in diagnosing myocardial infarction. PMID:7917680

  7. 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

  8. Incidence of hospital admissions due to adverse drug reactions in France: the EMIR study.

    PubMed

    Bénard-Laribière, Anne; Miremont-Salamé, Ghada; Pérault-Pochat, Marie-Christine; Noize, Pernelle; Haramburu, Françoise

    2015-02-01

    To assess the incidence of hospital admissions related to adverse drug reactions (ADRs) in France and the frequency of preventable ADRs in France, a prospective study was conducted among a representative randomly selected sample of medical wards in public hospitals between December 2006 and June 2007; all patients admitted during a 2-week period were included. An ADR-related hospitalization case was defined as a hospital admission because of an ADR, and an independent committee reviewed and validated all potential cases. Preventability was assessed using the French ADR preventability scale. Data were extrapolated to the population of France. Among 2692 admissions, 97 were related to an ADR (incidence 3.6%, 95% confidence interval, CI [2.8-4.4]). Patients admitted for an ADR were significantly older than those admitted for other reasons (P < 0.001). A third (32.0%) of ADR-related hospitalizations were 'preventable', 16.5% 'potentially preventable'. Drug interactions accounted for 29.9% of ADR-related hospitalizations. The most frequent causes of ADR-related hospitalizations were vascular disorders (20.6%), mainly bleeding complications, central nervous system disorders (11.3%), gastrointestinal disorders, and general disorders (9.3%). Antithrombotic and antineoplastic agents were the most frequently involved (12.6% each), followed by diuretics and analgesics (9.0% each). Vitamin-K-antagonists (VKAs) were the most common drugs associated with admission. The estimated annual number of ADR-related hospitalizations in France was 143 915 (95% CI [112 063-175 766]). ADRs were a significant cause of hospital admission in 2006-2007, in particular those due to VKAs. As new oral anticoagulants (NOACs) have been marketed, more attention needs to be paid to ensure a safe use of antithrombotic agents.

  9. Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry

    PubMed Central

    Mohanan, Padinhare Purayil; Mathew, Rony; Harikrishnan, Sadasivan; Krishnan, Mangalath Narayanan; Zachariah, Geevar; Joseph, Jhony; Eapen, Koshy; Abraham, Mathew; Menon, Jaideep; Thomas, Manoj; Jacob, Sonny; Huffman, Mark D.; Prabhakaran, Dorairaj

    2013-01-01

    Aims There are limited contemporary data on the presentation, management, and outcomes of acute coronary syndrome (ACS) admissions in India. We aimed to develop a prospective registry to address treatment and health systems gaps in the management of ACSs in Kerala, India. Methods and results We prospectively collected data on 25 748 consecutive ACS admissions from 2007 to 2009 in 125 hospitals in Kerala. We evaluated data on presentation, management, and in-hospital mortality and major adverse cardiovascular events (MACE). We created random-effects multivariate regression models to evaluate predictors of outcomes while accounting for confounders. Mean (SD) age at presentation was 60 (12) years and did not differ among ACS types [ST-segment myocardial infarction (STEMI) = 37%; non-STEMI = 31%; unstable angina = 32%]. In-hospital anti-platelet use was high (>90%). Thrombolytics were used in 41% of STEMI, 19% of non-STEMI, and 11% of unstable angina admissions. Percutaneous coronary intervention rates were marginally higher in STEMI admissions. Discharge medication rates were variable and generally suboptimal (<80%). In-hospital mortality and MACE rates were highest for STEMI (8.2 and 10.3%, respectively). After adjustment, STEMI diagnosis (vs. unstable angina) [odds ratio (OR) (95% confidence interval = 4.06 (2.36, 7.00)], symptom-to-door time >6 h [OR = 2.29 (1.73, 3.02)], and inappropriate use of thrombolysis [OR = 1.33 (0.92, 1.91)] were associated with higher risk of in-hospital mortality and door-to-needle time <30 min [OR = 0.44 (0.27, 0.72)] was associated with lower mortality. Similar trends were seen for risk of MACE. Conclusion These data represent the largest ACS registry in India and demonstrate opportunities for improving ACS care. PMID:22961945

  10. Admission levels of C-reactive protein and plasminogen activator inhibitor-1 in patients with acute myocardial infarction with and without cardiogenic shock or heart failure on admission.

    PubMed

    Akkus, Mehmet Necdet; Polat, Gurbuz; Yurtdas, Mustafa; Akcay, Burak; Ercetin, Neslihan; Cicek, Dilek; Doven, Oben; Sucu, Nehir

    2009-01-01

    Scarce data exist on the relationship of C-reactive protein (CRP) or plasminogen activator inhibitor-1 (PAI-1) to the occurrence of heart failure (HF) or cardiogenic shock (CS) after acute myocardial infarction (AMI) and on the relationship between these biomarkers and mortality in CS patients. Thus, we compared high-sensitivity CRP and PAI-1 antigen plasma levels on admission among 3 age- and gender-matched AMI patients groups (consisting of 60 patients with CS, 60 with HF, and 60 without HF on admission), after determining that PAI-1 levels did not vary significantly diurnally in these groups by comparing the data among subgroups which were divided according to admission time within the groups. For CS patients, we also conducted regression analyses to examine the relations of these biomarkers to mortality. CRP levels both in CS (P < 0.001) and HF (P < 0.05) patients were significantly higher compared to those without HF, PAI-1 levels in CS patients were significantly higher compared to both those with (P < 0.05) and without HF (P > 0.01), and CRP and PAI-1 were independent predictors of in-hospital (Odds ratio [OR] = 6.12, 95% confidence intervals [95%CI] = 1.47-25.54 and OR = 5.92, 95%CI = 1.31-26.77, respectively) and 1-year mortality (OR = 5.53, 95%CI = 1.21-25.17 and OR = 5.48, 95%CI = 1.09-27.52, respectively) in CS patients. In conclusion, at admission, CRP is associated with the occurrence of CS and HF and PAI-1 is associated with the occurrence of CS after AMI, and they are of prognostic value in CS complicating AMI.

  11. 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.

  12. Investigation of the Association Between Alcohol Outlet Density and Alcohol-Related Hospital Admission Rates in England: Study Protocol

    PubMed Central

    Holmes, John; Green, Mark; Strong, Mark; Pearson, Tim; Meier, Petra

    2016-01-01

    Background Availability of alcohol is a major policy issue for governments, and one of the availability factors is the density of alcohol outlets within geographic areas. Objective The aim of this study is to investigate the association between alcohol outlet density and hospital admissions for alcohol-related conditions in a national (English) small area level ecological study. Methods This project will employ ecological correlation and cross-sectional time series study designs to examine spatial and temporal relationships between alcohol outlet density and hospital admissions. Census units to be used in the analysis will include all Lower and Middle Super-Output Areas (LSOAs and MSOAs) in England (53 million total population; 32,482 LSOAs and 6781 MSOAs). LSOAs (approximately 1500 people per LSOA) will support investigation at a fine spatial resolution. Spatio-temporal associations will be investigated using MSOAs (approximately 7500 people per MSOA). The project will use comprehensive coverage data on alcohol outlets in England (from 2003, 2007, 2010, and 2013) from a commercial source, which has estimated that the database includes 98% of all alcohol outlets in England. Alcohol outlets may be classified into two broad groups: on-trade outlets, comprising outlets from which alcohol can be purchased and consumed on the premises (eg, pubs); and off-trade outlets, in which alcohol can be purchased but not consumed on the premises (eg, off-licenses). In the 2010 dataset, there are 132,989 on-trade and 51,975 off-trade outlets. The longitudinal data series will allow us to examine associations between changes in outlet density and changes in hospital admission rates. The project will use anonymized data on alcohol-related hospital admissions in England from 2003 to 2013 and investigate associations with acute (eg, admissions for injuries) and chronic (eg, admissions for alcoholic liver disease) harms. The investigation will include the examination of conditions that

  13. Air pollution and emergency hospital admissions for cardiovascular diseases in Valencia, Spain

    PubMed Central

    Ballester, F; Tenias, J; Perez-Hoyos, S

    2001-01-01

    STUDY OBJECTIVE—To estimate the short-term association between air pollution levels and emergency hospital admissions for cardiovascular diseases in Valencia, within 1994-1996 period.
DESIGN—Daily levels of air pollution and emergency admissions for cardiovascular diseases were related to using an ecological time series design. The number of admissions was obtained from the hospital records database. Selected groups of causes were all cardiovascular diseases, heart admissions, and admissions for cerebrovascular diseases. The number of admissions for digestive diseases was used as control. Pollutants were black smoke, sulphur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone (O3). Magnitude of association was estimated by Poisson autoregresive regression. Estimations were calculated according the hottest (May to October) and the coldest (November to April) periods.
SETTING—City of Valencia, Spain, about 750 000 inhabitants.
PARTICIPANTS—People being admitted to the two major hospitals in the city, with a catchment area of nearly 400 000 inhabitants.
MAIN RESULTS—For the whole period, a significant association for SO2-24 h was found so a rise in its levels of 10 µg/m3 was associated with an increment of 3% (95%CI 0.4 to 5.7%) in the expected number of cardiovascular admissions. A significant association for black smoke, SO2-24 h, SO2-1 h, and CO-1 h was found in the hottest semester. All these associations were verified with a lag of two days. The estimates of the associations for particles, SO2, and CO were affected by the inclusion of the other pollutants in their models. NO2 was independently associated with cerebrovascular admissions. There were no significant associations between air pollution and admissions for digestive diseases.
CONCLUSIONS—Current levels of air pollution and emergency cardiovascular admissions are significantly related in Valencia.


Keywords: air pollution; cardiovascular disease

  14. Hospital Admissions for Malnutrition and Dehydration in Patients With Dementia.

    PubMed

    Marshall, Katherine A; Burson, Rosanne; Gall, Kristyn; Saunders, Mitzi M

    2016-01-01

    Dehydration and malnutrition are commonly experienced by patients with dementia and can result in hospitalizations and decreased quality of life. The purpose of this study was to explore and describe retrospectively, the incidence and correlations of variables that may precede hospitalizations for dehydration/malnutrition in the community-dwelling patient with dementia. Data from the Outcome and Assessment Information Set (OASIS) Start of Care (SOC) on 44 patients served by a Michigan home care agency were retrieved for analysis. This study did not reveal any single or collection of variables that would predict risk for hospitalization for dehydration/malnutrition. With the lack of specific predictors of hospitalization related to dehydration and malnutrition, clinicians need to place high priority on risk-lowering strategies and preventive education for patients, family, and caregivers.

  15. 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

  16. 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

  17. Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment

    PubMed Central

    Åström, Christofer; Orru, Hans; Rocklöv, Joacim; Strandberg, Gustav; Ebi, Kristie L; Forsberg, Bertil

    2013-01-01

    Objectives Respiratory diseases are ranked second in Europe in terms of mortality, prevalence and costs. Studies have shown that extreme heat has a large impact on mortality and morbidity, with a large relative increase for respiratory diseases. Expected increases in mean temperature and the number of extreme heat events over the coming decades due to climate change raise questions about the possible health impacts. We assess the number of heat-related respiratory hospital admissions in a future with a different climate. Design A Europe-wide health impact assessment. Setting An assessment for each of the EU27 countries. Methods Heat-related hospital admissions under a changing climate are projected using multicity epidemiological exposure–response relationships applied to gridded population data and country-specific baseline respiratory hospital admission rates. Times-series of temperatures are simulated with a regional climate model based on four global climate models, under two greenhouse gas emission scenarios. Results Between a reference period (1981–2010) and a future period (2021–2050), the total number of respiratory hospital admissions attributed to heat is projected to be larger in southern Europe, with three times more heat attributed respiratory hospital admissions in the future period. The smallest change was estimated in Eastern Europe with about a twofold increase. For all of Europe, the number of heat-related respiratory hospital admissions is projected to be 26 000 annually in the future period compared with 11 000 in the reference period. Conclusions The results suggest that the projected effects of climate change on temperature and the number of extreme heat events could substantially influence respiratory morbidity across Europe. PMID:23355662

  18. 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

  19. [Survey on the cost of the admission process of nursing technicians in a teaching hospital].

    PubMed

    Okano, Helena Isuku Horibe; Castilho, Valeria

    2007-09-01

    This study was aimed at contributing to the cost management of the admission process of nursing technicians by mapping and measuring the direct cost of the main activities in this process. The exploratory, retrospective, documental study on the modality of case study was carried out at the Educational Support Service of the University of São Paulo's Hospital Universitário. The admission process was divided into five sub-processes: planning, recruiting, selection, hiring and admission training. Results showed that the direct total cost of the admission process was R$ 6359.90, and that, within the sub-processes, selection was the one that consumed most resources--R$ 3416.40, amounting to 53.72% of the total. Each hired candidate cost R$ 635.99.

  20. 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

  1. Future projections of child oral-related hospital admission rates in Western Australia.

    PubMed

    Alsharif, Alla; Kruger, Estie; Tennant, Marc

    2016-01-11

    This study aimed to project the hospital admission rates of Western Australian children for oral conditions, with a particular focus on dental caries, embedded and impacted teeth, and pulp and periapical conditions through to the year 2026. Two methods were used to generate projection data through to the year 2026, using the Western Australian Hospital Morbidity Dataset for the period 1999-2000 to 2008-2009. The projected admission rate increase in those children aged 14 years and younger from 2000 to 2026 was 43%. The admission rates are expected to more than double over time (7317 cases in 2026 compared to only 3008 cases in 2000) for those children living in metropolitan areas. Dental caries, embedded and impacted teeth, and pulp and periapical conditions will remain the top (mostly) preventable causes of admission throughout this time. Anticipating the future burden of oral-related hospital admissions in children, in terms of expected numbers of cases, is vital for optimising the resource allocation for early diagnosis, prevention and treatment. A concerted effort will be required by policymakers and oral healthcare communities to effect substantial change for the future.

  2. 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…

  3. 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

  4. Impact of admission blood glucose on outcomes of nondiabetic patients with acute ST-elevation myocardial infarction (from the German Acute Coronary Syndromes [ACOS] Registry).

    PubMed

    Naber, Christoph K; Mehta, Rajendra H; Jünger, Claus; Zeymer, Uwe; Wienbergen, Harm; Sabin, Georg V; Erbel, Raimund; Senges, Jochen; Gitt, Anselm

    2009-03-01

    High blood glucose in patients with acute coronary syndromes have been associated with adverse short-term outcomes in patients without diabetes. However, the relation of admission glucose to long-term outcomes in these patients was less well established. Accordingly, consecutive patients with ST-elevation myocardial infarction (STEMI) without diabetes enrolled at 155 sites from July 2000 to November 2002 in the ACOS Registry were evaluated. Patients were categorized into tertiles based on admission blood glucose. Clinical end points of interest were 1-year mortality and composite of death, reinfarction, stroke, or rehospitalization (major adverse cardiac clinical events [MACCEs]) in the hospital and after discharge. Of 5,866 patients with STEMI, 36.9% had blood glucose <120 mg/dl; 33.1%, 120 to 150 mg/dl; and 30.0%, >150 mg/dl. Admission blood glucose was significantly related to increased risk of not only in-hospital events (death, glucose >150 vs <120 mg/dl, adjusted odds ratio [OR] 2.86, 95% confidence interval [CI] 2.13 to 3.82, p <0.0001; and MACCE, >150 vs <120 mg/dl, adjusted OR 1.88, 95% CI 1.52 to 2.33; p <0.0001), but this increased risk persisted beyond the acute phase during 1-year follow-up of a mean 380 days (median 387; death, glucose >150 vs <120 mg/dl, adjusted OR 1.46, 95% CI 1.04 to 2.03, p <0.0001; and MACCE, >150 vs <120 mg/dl, adjusted OR 1.31, 95% CI 1.00 to 1.71, p <0.0001). In conclusion, high blood glucose at admission to the hospital independently correlated with short- and midterm mortality in patients with STEMI.

  5. [Air pollution and hospital admission trends of children with bronchial obstruction in Tuzla Canton].

    PubMed

    Hadzć, Devleta; Mladina, Nada; Ljuca, Farid; Bazardzanović, Mustafa

    2009-01-01

    The prevalence of bronchial obstruction in children is continuously increasing at any age. Many studies have found associations between increase of respiratory diseases and air pollution. The aim of this paper was to establish possible connection between children hospital admission trends for bronchial obstruction and levels of measured concentration of air pollution agents in Tuzla Canton area. The results of investigation demonstrated that the distribution of hospital admissions of children with bronchial obstruction was different regarding place of inhabitants and season. Spatial distribution demonstrated that the highest number of children treated for bronchial obstruction was from Tuzla, Lukavac and Zivinice. The incidence of patients from these municipalities was significantly above the participation of these municipalities in total population. Seasonal distribution of hospital admissions of children with bronchial obstruction was different for single municipalities of Tuzla Canton and for different seasons. Air pollutants, sulfur oxide and dust deposition were significantly higher for heating season compared to season without heating. There is a link between frequency of hospital admission for bronchial obstruction and level of measured air pollutants.

  6. INFLUENCE OF ALTERNATIVE PM COMPONENTS IN MASS ASSOCIATIONS WITH PHILADELPHIA, PA MORTALITY AND HOSPITAL ADMISSIONS

    EPA Science Inventory

    Epidemiological analyses of hospital admissions and mortality data have indicated that adverse human health effects are associated with present-day ambient particualte matter (PM) pollution levels. However, the PM mass measurement is chemically non-specific, ignoring the fact th...

  7. Appendicectomies performed >48 hours after admission to a dedicated acute general surgical unit

    PubMed Central

    March, B; Gillies, D

    2014-01-01

    Introduction Acute general surgical units (AGSUs) are changing the way in which acute appendicitis is managed. In the AGSU at John Hunter Hospital, some patients wait more than 48 hours from admission to undergo an appendicectomy, usually because they are not unwell enough to precipitate an operation before that time. We analysed this subgroup of appendicectomy patients to determine how effectively they are being managed and how this might be improved. Methods A retrospective review of prospectively collected data was conducted of all patients who received an appendicectomy while admitted under the AGSU at John Hunter Hospital in the five years between January 2009 and December 2013. Results A total of 1,039 appendicectomies were performed in the study period, with 81 patients (7.8%) waiting >48 hours for their operation (delayed appendicectomy group). Overall, the negative appendicectomy (NA) rate was 21.6%; the NA rate in delayed appendicectomies was 50.62% and a non-therapeutic operation occurred in 47% of this group (n=38). No significant difference was found in the incidence of perforation/gangrenous appendicitis between patients having surgery in <48 hours and the delayed appendicectomy groups (11.2% vs 9.9%, p=0.85). A combination of negative diagnostic imaging result, a normal white cell count and normal C-reactive protein (ie a negative ‘triple test’) was the best predictor of a negative appendicectomy (p=0.0158, negative predictive value: 0.91, 95% confidence interval: 0.59–0.99), in the delayed appendicectomy group. Conclusions In the delayed appendicectomy group, the incidence of perforation/gangrenous appendicitis was not significantly different from that found in patients having appendicectomy performed sooner. However, the NA and non-therapeutic operation rates were unacceptably high. An appendix triple test can improve diagnostic accuracy significantly without an unacceptable rise in the rates of perforation/gangrenous appendicitis. PMID

  8. A Study to Determine if a Difference Exists Among the Cumulative Incidence of Acute Respiratory Disease Hospital Admissions of Three Groups of Army Basic Trainees as Defined by the Design of Barracks in Which They Are Housed

    DTIC Science & Technology

    1989-08-01

    disease of recruits.’ Reviews of studies by numerous authors-Buescher,1 6 Evans,16 Fraser," Grayston, " Rosenbaum,ŕ Meiklejohn ,20 and Van Der Veen,21...than in that of other populations. Meiklejohn conducted surveillance of febrile upper respi- ratory diseases in the Air Force recruit population at...2, 29-37. ’"Buescher, pp. 772-73, 778. "Evans, pp. 806, 812. "Fraser and Pare, p. 675. 1’J. Thomas Grayston and E. Russell Alexander , "Acute Res

  9. Prevalence and risk factors for medication reconciliation errors during hospital admission in elderly patients.

    PubMed

    Rodríguez Vargas, Blanca; Delgado Silveira, Eva; Iglesias Peinado, Irene; Bermejo Vicedo, Teresa

    2016-10-01

    Background Care transitions are risk points for medication discrepancies, especially in the elderly. Objective This study was undertaken to assess prevalence and describe medication reconciliation errors during admission in elderly patients and to analyze associated risk factors. We also evaluate the effect of these errors on the length of hospital stay. Setting General surgery, orthopedics, internal medicines and infectious diseases departments of a 1070-bed Spanish teaching hospital. Method This is a prospective observational study. Patients >65 years and taking ≥5 medications were randomly selected from those admitted to hospital. The pharmacist obtained the best possible medication history based on medical records, medical notes from patients' previous admissions to hospital, "brown bag" review, community care prescriptions, and comprehensive patient interviews. It was compared to current inpatient prescription to detect unintentional discrepancies (discrepancy with no apparent clinical explanation), which were reported to the physician. When the physician accepted the discrepancy by changing the medication order, it was recorded as a medication reconciliation error and classified by type of error. Several variables were analyzed as possible risk/protective factors. Main outcome measure Is prevalence of medication reconciliation errors at admission. Results Reconciliation was performed on 206 patients. Medication reconciliation errors occurred in 49.5 % (102/206) of patients. 1996 medications were recorded, and 359 had unintentional discrepancies (56.0 % (201/359) medication reconciliation errors). The most common was omission (65.1 %). Identified risk factors were as follows: physician experience, number of pre-admission prescribed medications, and previous surgeries. Computerized order entry system was a protective factor. Conclusion Medication reconciliation errors occur in almost half of the elderly patients at admission, especially omissions. Risk

  10. Urban-rural variation in mortality and hospital admission rates for unintentional injury in Ireland

    PubMed Central

    Boland, M; Staines, A; Fitzpatrick, P; Scallan, E

    2005-01-01

    Objective: To explore urban-rural differences in the mortality and hospital admission rates for unintentional injuries in the Republic of Ireland. Design: Standardised mortality ratios (SMRs) in residents of urban and non-city areas (called rural areas) from all causes of unintentional injury were calculated using Central Statistics Office mortality data from 1980–2000. Hospital admission data (Hospital In-Patient Enquiry) from 1993–2000 were used to calculate standardised hospital admission ratios (SARs) in urban and rural residents. Population data were obtained from the 1981, 1986, 1991, and 1996 censuses. Results: The rate of unintentional injury mortality was significantly higher in rural residents for all-cause unintentional injury mortality (SMR 103.0, 95% confidence interval 101 to 105), and specifically for deaths related to motor vehicle trauma (MVT), drowning, machinery, and firearms. There were significantly higher SMRs in urban residents for falls and poisoning. The rate of unintentional injury hospital admission was significantly higher in rural residents for all-cause unintentional injury (SAR 104.6, 95% confidence interval 104 to 105) and specifically for injuries from falls, MVT, being struck by or against an object, injuries in pedal cyclists, fire/burn injuries, and machinery injuries. SARs were significantly higher in residents of urban areas for poisoning and injuries in pedestrians. Conclusions: There are urban-rural differences in mortality and admissions for injuries in Ireland. Possible reasons for the higher rural mortality rates are higher case fatality in MVT and rural exposure to hazardous farm machinery, firearms, and open areas of water. This information could assist in targeting prevention programmes under the proposed National Injury Prevention Strategy. PMID:15691988

  11. Impact of haze and air pollution-related hazards on hospital admissions in Guangzhou, China.

    PubMed

    Zhang, Zili; Wang, Jian; Chen, Lianghua; Chen, Xinyu; Sun, Guiyuan; Zhong, Nanshan; Kan, Haidong; Lu, Wenju

    2014-03-01

    Guangzhou is a metropolitan in south China with unique pollutants and geographic location. Unlike those in western countries and the rest of China, the appearance of haze in Guangzhou is often (about 278 days per year on average of 4 years). Little is known about the influence of these hazes on health. In this study, we investigated whether short-term exposures to haze and air pollution are associated with hospital admissions in Guangzhou. The relationships between haze, air pollution, and daily hospital admissions during 2008-2011 were assessed using generalized additive model. Studies were categorized by gender, age, season, lag, and disease category. In haze episodes, an increase in air pollutant emissions corresponded to 3.46 (95 % CI, 1.67, 5.27) increase in excessive risk (ER) of total hospital admissions at lag 1, 11.42 (95 % CI, 4.32, 18.99) and 11.57 (95 % CI, 4.38, 19.26) increases in ERs of cardiovascular illnesses at lags 2 and 4 days, respectively. As to total hospital admissions, an increase in NO2 was associated with a 0.73 (95 % CI, 0.11, 1.35) and a 0.28 (95 % CI, 0.11, 0.46) increases in ERs at lag 5 and lag 05, respectively. For respiratory illnesses, increases in NO2 was associated with a 1.94 (95 % CI, 0.50, 3.40) increase in ER at lag 0, especially among chronic obstructive pulmonary disease. Haze (at lag1) and air pollution (for NO2 at lag 5 and for SO2 at lag3) both presented more drastic effects on the 19 to 64 years old and in the females. Together, we demonstrated that haze pollution was associated with total and cardiovascular illnesses. NO2 was the sole pollutant with the largest risk of hospital admissions for total and respiratory diseases in both single- and multi-pollutant models.

  12. 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.

  13. Use of a Patient Portal During Hospital Admissions to Surgical Services

    PubMed Central

    Robinson, Jamie R.; Davis, Sharon E.; Cronin, Robert M.; Jackson, Gretchen P.

    2016-01-01

    Patient portal research has focused on medical outpatient settings, with little known about portal use during hospitalizations or by surgical patients. We measured portal adoption among patients admitted to surgical services over two years. Surgical services managed 37,025 admissions of 31,310 unique patients. One-fourth of admissions (9,362, 25.3%) involved patients registered for the portal. Registration rates were highest for admissions to laparoscopic/gastrointestinal (55%) and oncology/endocrine (50%) services. Portal use occurred during 1,486 surgical admissions, 4% of all and 16% of those registered at admission. Inpatient portal use was associated with patients who were white, male, and had longer lengths of stay (p < 0.01). Viewing health record data and secure messaging were the most commonly used functions, accessed in 4,836 (72.9%) and 1,626 (24.5%) user sessions. Without specific encouragement, hospitalized surgical patients are using our patient portal. The surgical inpatient setting may provide opportunities for patient engagement using patient portals. PMID:28269956

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

    PubMed

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

    2014-11-01

    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.

  15. Rubicon crossed in acute hospital design?

    PubMed

    Baillie, Jonathan

    2008-06-01

    With construction work now underway on the new pound sterling 227 million PFI-funded Pembury Hospital near Tunbridge Wells in Kent, Jonathan Baillie talks to John Cooper of architects Anshen + Allen, who is convinced that this exciting new acute facility will become the first of a new generation of 100% single-bedroom hospitals in the UK.

  16. The value of admission glycosylated hemoglobin level in patients with acute myocardial infarction

    PubMed Central

    Cakmak, Mahmut; Cakmak, Nazmiye; Cetemen, Sebnem; Tanriverdi, Halil; Enc, Yavuz; Teskin, Onder; Kilic, I Dogu

    2008-01-01

    BACKGROUND: Glycosylated hemoglobin (HbA1c) level on admission is a prognostic factor for mortality in patients with and without diabetes after myocardial infarction. In the present study, the authors examined the relationship between admission HbA1c level and myocardial perfusion abnormalities in patients with acute myocardial infarction. METHODS: One hundred consecutive patients with acute myocardial infarction who were treated with thrombolytic therapy were included in the present prospective study. Blood glucose and HbA1c levels of all patients were measured within 3 h of admission. Patients were divided into three groups according to HbA1c level: 4.5% to 6.4% (n=25), 6.5% to 8.5% (n=28) and higher than 8.5% (n=47). All patients then underwent exercise thallium-201 imaging and coronary angiography to determine ischemic scores and the number of diseased coronary arteries four weeks after admission. RESULTS: Seven patients died within the four-week follow-up period. There was a significant relationship between admission HbA1c level and mortality (P=0.009). Furthermore, there was a significant relationship between HbA1c level and total ischemic scores in patients with acute myocardial infarction (r=0.482; P=0.001). Ischemic scores increased as HbA1c levels increased in patients with acute myocardial infarction. CONCLUSIONS: The results demonstrated that admission plasma glucose and HbA1c levels are prognostic factors associated with mortality after acute myocardial infarction. PMID:18464942

  17. A prospective study of adverse drug reactions as a cause of admission to a paediatric hospital

    PubMed Central

    MARTÍNEZ-MIR, I.; GARCÍA-LÓPEZ, M.; PALOP, V.; FERRER, J. M.; ESTAÑ, L.; RUBIO, E.; MORALES-OLIVAS, F. J.

    1996-01-01

    1A total of 512 consecutive paediatric hospital admissions of children 2 years old or less were evaluated to assess the extent and pattern of admission caused by suspected adverse drug reactions (ADRs). The proportion of suspected ADRs related to hospital admissions was 4.3%. 2The organ-systems most commonly implicated were the central nervous system (40.5%), digestive system (16.7%), and skin and appendages (14.3%). Together, they accounted for 71.5% of admissions attributed to ADRs. The most common clinical manifestations inducing admission were convulsions (4 cases), dizziness (4), vomiting (3), and tremor, fever, itching and apnoea (2 cases each). 3The four classes of drugs most frequently suspected in admissions due to ADRs were respiratory drugs (35%), anti-infective agents (25%), drugs active on the central nervous system (15%) and drugs used in dermatology (10%). The most common drugs related to ADRs were a combination of chlorpheniramine, diphenhydramine, phenylephrine, guaiphenesin and salicylic acid (4 cases), followed by fenoterol, adrenaline, paracetamol, DTP vaccine and antipolio vaccine (2 cases each). 4There were no significant differences between children older and younger than 1 year (odds ratio 0.89; 95% CI 0.37–2.17) or between the sexes as regards hospital admittance due to suspected ADRs (odds ratio 1.94; 95% CI 0.72–5.42). 5The results of this kind of study may be influenced by patterns of drug utilization. Nevertheless, the lack of specific studies of drug effects in young children makes it desirable to carry out pharmacoepidemiological studies in this age group. PMID:8877022

  18. Perceived quality of an alternative to acute hospitalization: an analytical study at a community hospital in Hallingdal, Norway.

    PubMed

    Lappegard, Øystein; Hjortdahl, Per

    2014-10-01

    There is growing international interest in the geography of health care provision, with health care providers searching for alternatives to acute hospitalization. In Norway, the government has recently legislated for municipal authorities to develop local health services for a selected group of patients, with a quality equal to or better than that provided by hospitals for emergency admissions. General practitioners in Hallingdal, a rural district in southern Norway, have for several years referred acutely somatically ill patients to a community hospital, Hallingdal sjukestugu (HSS). This article analyzes patients' perceived quality of HSS to demonstrate factors applicable nationally and internationally to aid in the development of local alternatives to general hospitals. We used a mixed-methods approach with questionnaires, individual interviews and a focus group interview. Sixty patients who were taking part in a randomized, controlled study of acute admissions at HSS answered the questionnaire. Selected patients were interviewed about their experiences and a focus group interview was conducted with representatives of local authorities, administrative personnel and health professionals. Patients admitted to HSS reported statistically significant greater satisfaction with several care aspects than those admitted to the general hospital. Factors highlighted by the patients were the quiet and homelike atmosphere; a small facility which allowed them a good overall view of the unit; close ties to the local community and continuity in the patient-staff relationship. The focus group members identified some overarching factors: an interdisciplinary and holistic approach, local ownership, proximity to local general practices and close cooperation with the specialist health services at the hospital. Most of these factors can be viewed as general elements relevant to the development of local alternatives to acute hospitalization both nationally and internationally. This

  19. Prognostic value of on admission arterial PCO2 in hospitalized patients with community-acquired pneumonia

    PubMed Central

    Yassin, Zeynab; Saadat, Mohammad; Abtahi, Hamidreza; Rahimi Foroushani, Abbas

    2016-01-01

    Background There is little data about the correlation between the outcome of community acquired pneumonia (CAP) and the hypercapnic type respiratory failure. In this study we prospectively investigated the prognostic significance of first arterial CO2 tension in patients hospitalized with CAP. Methods In this prospective study patients with CAP, admitted to a general hospital were included. PaCO2 was measured for each subject in an arterial blood sample drawn in the first 2 hours and its correlations with three major outcomes were evaluated: intensive care unit (ICU) admission, duration of admission and mortality in 30 days. Results A total of 114 patients (mean age: 60.9±18.3; male: 51.8%) diagnosed with CAP were included. Significant relationship was not found between PaCO2 and mortality (P=0.544) or ICU admission (P=0.863). However advanced age, associated CHF, high BUN levels, high CURB-65 scores, associated pleural effusion in chest X-ray and being admitted to the ICU (P=0.012, 0.004, 0.003, <0.001, 0.045 and <0.001 respectively) were all significant prognostic factors of higher mortality risks. Prognostic factors for ICU admission were a history of malignancy (P=0.004), higher CURB-65 (P<0.001) scores and concomitant pleural effusion (P=0.028) in chest X-ray. Hypercapnic patients hospitalized for longer duration compared with normocapnic subjects. Furthermore, patients with lower pH (P=0.041) and pleural effusions (P=0.002) were hospitalized longer than the others. Conclusions There was less prominent prognostic value regarding on-admission PaCO2 in comparison to other factors such as CURB-65. Considering the inconsistent results of surveys conducted on prognostic value of PaCO2 for CAP outcomes, further investigations are required to reach a consensus on this matter. PMID:27867552

  20. The choice of alternatives to acute hospitalization: a descriptive study from Hallingdal, Norway

    PubMed Central

    2013-01-01

    Background Hallingdal is a rural region in southern Norway. General practitioners (GPs) refer acutely somatically ill patients to any of three levels of care: municipal nursing homes, the regional community hospital or the local general hospital. The objective of this paper is to describe the patterns of referrals to the three different somatic emergency service levels in Hallingdal and to elucidate possible explanations for the differences in referrals. Methods Quantitative methods were used to analyse local patient statistics and qualitative methods including focus group interviews were used to explore differences in referral rates between GPs. The acute somatic admissions from the six municipalities of Hallingdal were analysed for the two-year period 2010–11 (n = 1777). A focus group interview was held with the chief municipal medical officers of the six municipalities. The main outcome measure was the numbers of admissions to the three different levels of acute care in 2010–11. Reflections of the focus group members about the differences in admission patterns were also analysed. Results Acute admissions at a level lower than the local general hospital ranged from 9% to 29% between the municipalities. Foremost among the local factors affecting the individual doctor’s admission practice were the geographical distance to the different places of care and the GP’s working experience in the local community. Conclusion The experience from Hallingdal demonstrates that GPs use available alternatives to hospitalization but to varying degrees. This can be explained by socio-demographic factors and factors related to the medical reasons for admission. However, there are also important local factors related to the individual GP and the structural preparedness for alternatives in the community. PMID:23800090

  1. Blood Leukocyte Count on Admission Predicts Cardiovascular Events in Patients with Acute Non-ST Elevation Myocardial Infarction.

    PubMed

    Dharma, Surya; Hapsari, Rosmarini; Siswanto, Bambang B; van der Laarse, Arnoud; Jukema, J Wouter

    2015-06-01

    We aim to test the hypothesis that blood leukocyte count adds prognostic information in patients with acute non-ST-elevation myocardial infarction (non-STEMI). A total of 585 patients with acute non-STEMI (thrombolysis in myocardial infarction risk score ≥ 3) were enrolled in this cohort retrospective study. Blood leukocyte count was measured immediately after admission in the emergency department. The composite of death, reinfarction, urgent revascularization, and stroke during hospitalization were defined as the primary end point of the study. The mean age of the patients was 61 ± 9.6 years and most of them were male (79%). Using multivariate Cox regression analysis involving seven variables (history of smoking, hypertension, heart rate > 100 beats/minute, serum creatinine level > 1.5 mg/dL, blood leukocyte count > 11,000/µL, use of β-blocker, and use of angiotensin-converting enzyme inhibitor), leukocyte count > 11,000/µL demonstrated to be a strong predictor of the primary end point (hazard ratio = 3.028; 95% confidence interval = 1.69-5.40, p < 0.001). The high blood leukocyte count on admission is an independent predictor of cardiovascular events in patients with acute non-STEMI.

  2. 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

  3. [Medicines reconciliation at hospital admission into an electronic prescribing program].

    PubMed

    Villamayor-Blanco, Lucía; Herrero-Poch, Leticia; De-Miguel-Bouzas, Jose Carlos; Freire Vazquez, M Carmen

    2016-09-01

    Objetivo: Describir y analizar los resultados obtenidos durante un año con un nuevo procedimiento de conciliación de la medicación al ingreso hospitalario basado en un programa de prescripción electrónica asistida. Método: Estudio observacional, prospectivo, no aleatorizado y no controlado de 12 meses de duración, en el que se incluyeron todos los pacientes que ingresaron, durante ese año, en un hospital general concertado de 450 camas. Para la conciliación de la medicación se utilizó el programa de prescripción electrónica como medio para el abordaje multidisciplinar (enfermería, médicos y farmacéuticos). La conciliación se realizó al ingreso hospitalario y se midieron los errores de conciliación. Resultados: Se incluyeron 23.701 pacientes, conciliándose 53.920 medicamentos, de los cuales no tenían discrepancias 48.744 (90,4%) y 5.176 (9,6%) presentaban discrepancias: 4.731 (8,8 % de los fármacos) justificadas y 445 (0,8% de los fármacos) no justificadas. La mayor parte de las discrepancias no justificadas, (n = 310; 69,7%) se debieron a errores en el registro de la medicación domiciliaria al ingreso: medicación no registrada o errores de medicamentos, dosis, frecuencia o vía de administración, omisiones de prescripción, 23,6% (n = 105) y duplicidades, 6,7% (n = 30). En ningún caso el error de conciliación llegó al paciente. Conclusiones: Mediante las ayudas informáticas incluidas en el programa de prescripción electrónica asistida y el abordaje multidisciplinar del proceso de conciliación se consigue realizar la conciliación de la medicación al ingreso en el 98% de los pacientes en el momento del ingreso, evidenciando errores de conciliación solo en el 1,3% de los pacientes.

  4. Admission white blood cell count predicts short-term clinical outcomes in patients with uncomplicated Stanford type B acute aortic dissection

    PubMed Central

    Chen, Zhao-Ran; Huang, Bi; Lu, Hai-Song; Zhao, Zhen-Hua; Hui, Ru-Tai; Yang, Yan-Min; Fan, Xiao-Han

    2017-01-01

    Objectives Inflammation has been shown to be related with acute aortic dissection (AAD). The present study aimed to evaluate the association of white blood cell counts (WBCc) on admission with both in-hospital and long-term all-cause mortality in patients with uncomplicated Stanford type B AAD. Methods From 2008 to 2010, a total of 377 consecutive patients with uncomplicated type B AAD were enrolled and then followed up. Clinical data and WBCc on admission were collected. The primary end points were in-hospital death and long-term all-cause death. Results The in-hospital death rate was 4.2%, and the long-term all-cause mortality rate was 6.9% during a median follow-up of 18.9 months. WBCc on admission was identified as a risk factor for in-hospital death by univariate Cox regression analysis as both a continuous variable and a categorical variable using a cut off of 11.0 × 109 cell/L (all P < 0.05). After adjusting for age, sex and other risk factors, elevated admission WBCc was still a significant predictor for in-hospital death as both a continuous variable [hazard ratio (HR): 1.052, 95% CI: 1.024–1.336, P = 0.002] and a categorical variable using a cut off of 11.0 × 109 cell/L (HR: 2.056, 95% CI: 1.673–5.253, P = 0.034). No relationship was observed between WBCc on admission and long-term all-cause death. Conclusions Our results indicate that elevated WBCc upon admission might be used as a predictor for increased risk of in-hospital death in uncomplicated type B AAD. There might be no predictive value of WBCc for the long-term survival of type B AAD. PMID:28270842

  5. 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.

  6. Reduction in hospital admissions for pneumonia in non-institutionalised elderly people as a result of influenza vaccination: a case-control study in Spain.

    PubMed Central

    Puig-Barberà, J; Márquez-Calderón, S; Masoliver-Fores, A; Lloria-Paes, F; Ortega-Dicha, A; Gil-Martín, M; Calero-Martínez, M J

    1997-01-01

    OBJECTIVE: To estimate the effectiveness of influenza vaccine in preventing hospital admission for pneumonia in non-institutionalised elderly people. DESIGN: This was a case-control study. SETTING: All three public hospitals in the Castellón area of Spain. PARTICIPANTS: Cases were people aged 65 or more not living in an institution who were admitted to hospital for pneumonia between November 15, 1994 and March 31, 1995. Each case was matched with two sex matched control subjects aged 65 years or older admitted to hospital in the same week for acute abdominal surgical conditions or trauma. The sampling of incident cases was consecutive. Eighty three cases and 166 controls were identified and included in the study. MEASUREMENTS: Trained interviewers completed a questionnaire for each subject on the vaccination status, smoking habits, previous diseases, health care use, social contacts, family background, the vaccination status of the family carer, home characteristics, and socioeconomic status. RESULTS: The adjusted odds ratio of the influenza vaccination preventing admission to hospital for pneumonia was 0.21 (95% confidence interval 0.09, 0.55). The variables which best explained the risk of being a case were age, intensity of social contacts, health care use, previous diseases, and the existence of a vaccinated family carer. CONCLUSIONS: Influenza vaccination reduced significantly hospital admissions for pneumonia in non-institutionalised elderly people. PMID:9425463

  7. Association between PM10 and respiratory hospital admissions in different seasons in heavily polluted Lanzhou City.

    PubMed

    An, Xingqin; Yan, Tao; Mi, Shengquan; Sun, Zhaobin; Hou, Qing

    2015-01-01

    Exposure-response relationship between particulate matter less than 10 μm in diameter (PM10) and human health in different seasons from 2001 to 2005 was examined based on hospital admissions data of respiratory system diseases from four major hospitals in Lanzhou, China. To quantify associations of respiratory system diseases with multiple air pollutants and meteorological conditions, a semiparametric generalized additive model was used in the authors' study by implementing daily ambient sulfur dioxide, nitrogen dioxide, and PM10 data collected from the Lanzhou Environmental Monitoring Station and daily meteorological data from Lanzhou Meteorological Bureau. Results showed that daily averaged PM10 increased per interquartile range the hospital admissions number of respiratory diseases by 3.3% in spring, 1.4% in summer, 3.6% in autumn, and 4.0% in winter from a single-pollutant model, or 3.1%, 1.4%, 3.0%, and 4.0% from a multi-pollutant model, respectively. The effect of PM10 on respiratory hospital admissions was lowest in summer and highest in winter. The relative risks of PM10 on female or the elderly (≥ 65 yrs.) were higher, showing a stronger association of PM10 with respiratory diseases in female and elderly groups than in males and people younger than 65.

  8. Analysis of the medication reconciliation process conducted at hospital admission.

    PubMed

    Contreras Rey, María Beatriz; Arco Prados, Yolanda; Sánchez Gómez, Ernesto

    2016-06-01

    fueron y en 93 (29,8%) la aceptación no procedía por un cambio en la situación del paciente. Las mayores oportunidades de mejora se identificaron en los servicios de Digestivo, Medicina Interna y Cirugía General y en los grupos terapéuticos: sangre y órganos hematopoyéticos, sistema cardiovascular y sistema nervioso. Conclusiones: En nuestro hospital solo una tercera parte de las intervenciones fueron aceptadas y reconocidas como errores de conciliación. No obstante, la conciliación de la medicación al ingreso realizada por un farmacéutico mostró ser útil en la identificación y prevención de errores de medicación. Un mejor entendimiento de los casos en los que las intervenciones no fueron aceptadas podría mejorar el resultado en el futuro.

  9. [Nutrition status on pediatric admissions in Spanish hospitals; DHOSPE study].

    PubMed

    Moreno Villares, José Manuel; Varea Calderón, Vicente; Bousoño García, Carlos; Lama Moré, Rosa; Redecillas Ferreiro, Susana; Peña Quintana, Luis

    2013-01-01

    La desnutrición en los pacientes hospitalizados tiene repercusiones clínicas y se asocia con peores resultados: inmunodepresión, retraso en la cicatrización de las heridas, atrofia muscular, prolongación del ingreso hospitalario y mayor mortalidad. La tasa de desnutrición al ingreso en el paciente pediátrico varía con los estudios, aunque parece inferior a lo que ocurre en el paciente adulto. Sin embargo, es una población de mayor riesgo de desarrollar desnutrición durante el ingreso. Se precisa, por tanto, encontrar una buena herramienta de cribado nutricional. Objetivo: Como primer paso para alcanzar ese objetivo se realizó un estudio de ámbito nacional para determinar la tasa de desnutrición en el ingreso. Material y métodos: Se trató de un estudio transversal, multicéntrico realizado en 32 hospitales españoles entre junio y septiembre de 2011 en pacientes < 17 años que ingresaran en el hospital por un periodo > 48 horas. Se midieron peso y talla y se pasó el cuestionario STAMP en el momento del ingreso y a los 7, 14 días o en el momento del alta. El estado nutricional se clasificó de acuerdo con el índice de Waterlow para peso y talla. El estudio fue aprobado por el Comité Ético de Investigación de cada uno de los hospitales y se requirió la firma del consentimiento informado antes de su inclusión en el estudio. Resultados: 991 pacientes participaron en el estudio. La edad media fue de 5 años (DE: 4,6), distribuidos de forma uniforme entre todas las edades. Se encontró desnutrición moderada o grave en el 7,8% y sobrepeso-obesidad en el 37,9% de los ingresados. Encontramos una situación nutricional significativamente peor para todos los grupos de edad en función de la enfermedad de base. No encontramos correlación entre la desnutrición y la edad, o los niveles de albúmina sérica. Comentarios: Esta es la primera encuesta nacional para estudiar la prevalencia de desnutrición en el momento del ingreso. La cifra encontrada, 8

  10. Risk factors of admission for acute colonic diverticulitis in a population-based cohort study: The North Trondelag Health Study, Norway

    PubMed Central

    Jamal Talabani, Aras; Lydersen, Stian; Ness-Jensen, Eivind; Endreseth, Birger Henning; Edna, Tom-Harald

    2016-01-01

    AIM To assess risk factors of hospital admission for acute colonic diverticulitis. METHODS The study was conducted as part of the second wave of the population-based North Trondelag Health Study (HUNT2), performed in North Trondelag County, Norway, 1995 to 1997. The study consisted of 42570 participants (65.1% from HUNT2) who were followed up from 1998 to 2012. Of these, 22436 (52.7%) were females. The cases were defined as those 358 participants admitted with acute colonic diverticulitis during follow-up. The remaining participants were used as controls. Univariable and multivariable Cox regression analyses was used for each sex separately after multiple imputation to calculate HR. RESULTS Multivariable Cox regression analyses showed that increasing age increased the risk of admission for acute colonic diverticulitis: Comparing with ages < 50 years, females with age 50-70 years had HR = 3.42, P < 0.001 and age > 70 years, HR = 6.19, P < 0.001. In males the corresponding values were HR = 1.85, P = 0.004 and 2.56, P < 0.001. In patients with obesity (body mass index ≥ 30) the HR = 2.06, P < 0.001 in females and HR = 2.58, P < 0.001 in males. In females, present (HR = 2.11, P < 0.001) or previous (HR = 1.65, P = 0.007) cigarette smoking increased the risk of admission. In males, breathlessness (HR = 2.57, P < 0.001) and living in rural areas (HR = 1.74, P = 0.007) increased the risk. Level of education, physical activity, constipation and type of bread eaten showed no association with admission for acute colonic diverticulitis. CONCLUSION The risk of hospital admission for acute colonic diverticulitis increased with increasing age, in obese individuals, in ever cigarette smoking females and in males living in rural areas. PMID:28082819

  11. Future respiratory hospital admissions from wildfire smoke under climate change in the Western US

    NASA Astrophysics Data System (ADS)

    Coco Liu, Jia; Mickley, Loretta J.; Sulprizio, Melissa P.; Yue, Xu; Peng, Roger D.; Dominici, Francesca; Bell, Michelle L.

    2016-12-01

    Background. Wildfires are anticipated to be more frequent and intense under climate change. As a result, wildfires may emit more air pollutants that can harm health in communities in the future. The health impacts of wildfire smoke under climate change are largely unknown. Methods. We linked projections of future levels of fine particulate matter (PM2.5) specifically from wildfire smoke under the A1B climate change scenario using the GEOS-Chem model for 2046-2051, present-day estimates of hospital admission impacts from wildfire smoke, and future population projections to estimate the change in respiratory hospital admissions for persons ≥65 years by county (n = 561) from wildfire PM2.5 under climate change in the Western US. Results. The increase in intense wildfire smoke days from climate change would result in an estimated 178 (95% confidence interval: 6.2, 361) additional respiratory hospital admissions in the Western US, accounting for estimated future increase in the elderly population. Climate change is estimated to impose an additional 4990 high-pollution smoke days. Central Colorado, Washington and southern California are estimated to experience the highest percentage increase in respiratory admissions from wildfire smoke under climate change. Conclusion. Although the increase in number of respiratory admissions from wildfire smoke seems modest, these results provide important scientific evidence of an often-ignored aspect of wildfire impact, and information on their anticipated spatial distribution. Wildfires can cause serious social burdens such as property damage and suppression cost, but can also raise health problems. The results provide information that can be incorporated into development of environmental and health policies in response to climate change. Climate change adaptation policies could incorporate scientific evidence on health risks from natural disasters such as wildfires.

  12. Prevalence and characteristics of adverse drug reactions at admission to hospital: a prospective observational study

    PubMed Central

    Chan, Sze Ling; Ang, Xiaohui; Sani, Levana L.; Ng, Hong Yen; Winther, Michael D.; Liu, Jian Jun; Brunham, Liam R.

    2016-01-01

    Aims Adverse drug reactions (ADRs) contribute to poorer patient outcomes and additional burden to the healthcare system. However, data on the true burden, relevant types and drugs causing ADRs are lacking. The aim of this study was to determine the prevalence of ADR‐related hospitalization in the general adult population in Singapore and to investigate their characteristics. Methods We prospectively recruited 1000 adult patients with unplanned admission to a large tertiary‐care hospital. Two independent reviewers evaluated all suspected ADRs for causality, type, severity and avoidability. The prevalence of ADR‐related hospitalization was calculated based on ‘definite’ and ‘probable’ ADRs. Logistic regression was used to evaluate predictors for having an ADR at admission. Results The prevalence of all ADRs at admission was 12.4% (95% CI: 10.5–14.6%) and ADRs causing admission was 8.1% (95% CI: 6.5–10.0%). The most common ADRs were gastrointestinal‐related. The most common drug category causing ADRs were cardiovascular drugs. Patients with ADRs had a longer length of stay than those who did not (median 4 vs. 3 days, P = 1.70 × 10−3). About 30% of ADRs at admission were caused by at least one drug with a clinical annotation in the Pharmacogenomics KnowledgeBase (PharmGKB), suggesting that some of these ADRs may have been predicted by pharmacogenetic testing. Conclusions We have quantified the burden and characteristics of clinically impactful ADRs in the Singaporean general adult population. Our results will provide vital information for efforts in reducing ADRs through targeted vigilance, patient education and pharmacogenomics in Singapore. PMID:27640819

  13. Forecasting asthma-related hospital admissions in London using negative binomial models.

    PubMed

    Soyiri, Ireneous N; Reidpath, Daniel D; Sarran, Christophe

    2013-05-01

    Health forecasting can improve health service provision and individual patient outcomes. Environmental factors are known to impact chronic respiratory conditions such as asthma, but little is known about the extent to which these factors can be used for forecasting. Using weather, air quality and hospital asthma admissions, in London (2005-2006), two related negative binomial models were developed and compared with a naive seasonal model. In the first approach, predictive forecasting models were fitted with 7-day averages of each potential predictor, and then a subsequent multivariable model is constructed. In the second strategy, an exhaustive search of the best fitting models between possible combinations of lags (0-14 days) of all the environmental effects on asthma admission was conducted. Three models were considered: a base model (seasonal effects), contrasted with a 7-day average model and a selected lags model (weather and air quality effects). Season is the best predictor of asthma admissions. The 7-day average and seasonal models were trivial to implement. The selected lags model was computationally intensive, but of no real value over much more easily implemented models. Seasonal factors can predict daily hospital asthma admissions in London, and there is a little evidence that additional weather and air quality information would add to forecast accuracy.

  14. Small primary care physician practices have low rates of preventable hospital admissions.

    PubMed

    Casalino, Lawrence P; Pesko, Michael F; Ryan, Andrew M; Mendelsohn, Jayme L; Copeland, Kennon R; Ramsay, Patricia Pamela; Sun, Xuming; Rittenhouse, Diane R; Shortell, Stephen M

    2014-09-01

    Nearly two-thirds of US office-based physicians work in practices of fewer than seven physicians. It is often assumed that larger practices provide better care, although there is little evidence for or against this assumption. What is the relationship between practice size--and other practice characteristics, such as ownership or use of medical home processes--and the quality of care? We conducted a national survey of 1,045 primary care-based practices with nineteen or fewer physicians to determine practice characteristics. We used Medicare data to calculate practices' rate of potentially preventable hospital admissions (ambulatory care-sensitive admissions). Compared to practices with 10-19 physicians, practices with 1-2 physicians had 33 percent fewer preventable admissions, and practices with 3-9 physicians had 27 percent fewer. Physician-owned practices had fewer preventable admissions than hospital-owned practices. In an era when health care reform appears to be driving physicians into larger organizations, it is important to measure the comparative performance of practices of all sizes, to learn more about how small practices provide patient care, and to learn more about the types of organizational structures--such as independent practice associations--that may make it possible for small practices to share resources that are useful for improving the quality of care.

  15. Short-term exposure to ambient ozone and stroke hospital admission: A case-crossover analysis.

    PubMed

    Montresor-López, Jessica A; Yanosky, Jeff D; Mittleman, Murray A; Sapkota, Amir; He, Xin; Hibbert, James D; Wirth, Michael D; Puett, Robin C

    2016-01-01

    We evaluated the association between short-term exposure to ambient ozone air pollution and stroke hospital admissions among adult residents of South Carolina (SC). Data on all incident stroke hospitalizations from 2002 to 2006 were obtained from the SC Office of Research and Statistics. Ozone exposure data were obtained from the US Environmental Protection Agency's Hierarchical Bayesian Model. A semi-symmetric bidirectional case-crossover design was used to examine the association between ozone exposure on lag days 0-2 (0 to 2 days before admission) and stroke hospitalization. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). No significant associations were observed between short-term ozone exposure and hospitalization for all stroke (e.g., lag day 0: OR=0.98; 95% CI=0.96, 1.00) or ischemic stroke (lag day 0: OR=0.98; 95% CI=0.96, 1.01). Risk of hospitalization for hemorrhagic stroke appeared to be higher among African Americans than European Americans; however, the majority of these associations did not reach statistical significance. Among adults in SC from 2002 to 2006, there was no evidence of an association between ozone exposure and risk of hospitalization for all stroke or ischemic stroke; however, African Americans may have an increased risk of hemorrhagic stroke.

  16. The impact of airborne particulate matter on pediatric hospital admissions for pneumonia among Jinan children: a case-crossover study.

    PubMed

    Lv, Chenguang; Wang, Xianfeng; Pang, Na; Wang, Lanzhong; Wang, Yuping; Xu, Tengfei; Zhang, Yu; Zhou, Tianran; Li, Wei

    2016-12-14

    This study aims to examine the effect of short-term changes in the concentration of particulate matter ≤2.5 µm (PM2.5) and ≤ 10 µm (PM10) on pediatric hospital admissions for pneumonia in Jinan, China. It explored confoundings factos of weather, season, and chemical pollutants. Information on pediatric hospital admissions for pneumonia in 2014 was extracted from the database of Jinan Qilu Hospital. The relative risk of pediatric hospital admissions for pneumonia was assessed using a case-crossover approach, controlling weather variables, day of the week, and seasonality. The single-pollutant model demonstrated that increased risk of pediatric hospital admissions for pneumonia was significantly associated with elevated PM2.5 concentrations the day before hospital admission and elevated PM10 concentrations two days before hospital admission. An increment of 10 μg/m(3) in PM2.5 and PM10 were correlated with a 6% (95% CI 1.02-1.10) and 4% (95% CI 1.00-1.08) rise in number of admissions for pneumonia, respectively. In two pollutant models, PM2.5 and PM10 remained significant after inclusion of sulfur dioxide or nitrogen dioxide but not carbon monoxide. This study demonstrated short-term exposure to atmospheric particulate matter (PM2.5/PM10) may be an important determinant of pediatric hospital admissions for pneumonia in Jinan, China. This study demonstrated short-term exposure to atmospheric particulate matter (PM2.5/PM10) may be an important determinant of pediatric hospital admissions for pneumonia in Jinan, China and suggested the relevance of pollutant exposure levels and their effects. As a specific group, children are sensitive to airborne particulate matter. This study estimated the short-term effects attribute to other air pollutants to provide references for relevant studies.

  17. 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.

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

    PubMed

    Haverkort, J J Mark; Minderhoud, A L C Ben; Wind, Jelte D D; Leenen, Luke P H; Hoepelman, Andy I M; Ellerbroek, Pauline M

    2016-02-01

    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.

  19. Impact of electronic medication reconciliation at hospital admission on clinician workflow.

    PubMed

    Vawdrey, David K; Chang, Nancy; Compton, Audrey; Tiase, Vicky; Hripcsak, George

    2010-11-13

    Many hospitals have experienced challenges with accomplishing the Joint Commission's National Patient Safety Goal for medication reconciliation. Our institution implemented a fully electronic process for performing and documenting medication reconciliation at hospital admission. The process used a commercial EHR and relied on a longitudinal medication list called the "Outpatient Medication Profile" (OMP). Clinician compliance with documenting medication reconciliation was difficult to achieve, but approached 100% after a "hard-stop" reminder was implemented. We evaluated the impact of the process at a large urban academic medical center. Before the new process was adopted, the average number of medications contained in the OMP for a patient upon admission was <2. One year after adoption, the average number had increased to 4.7, and there were regular updates made to the list. Updating the OMP was predominantly done by physicians, NPs, and PAs (94%), followed by nurses (5%) and pharmacists (1%).

  20. 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.

  1. 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.

  2. Susceptibility to penicillin derivatives among third-generation cephalosporin-resistant Enterobacteriaceae recovered on hospital admission.

    PubMed

    Mischnik, Alexander; Baumert, Philipp; Hamprecht, Axel; Rohde, Anna; Peter, Silke; Feihl, Susanne; Knobloch, Johannes; Gölz, Hanna; Kola, Axel; Obermann, Birgit; Querbach, Christiane; Willmann, Matthias; Gebhardt, Friedemann; Tacconelli, Evelina; Gastmeier, Petra; Seifert, Harald; Kern, Winfried V

    2017-01-01

    As part of the multicenter Antibiotic Therapy Optimisation Study-the largest study on the prevalence of third-generation cephalosporin-resistant Enterobacteriaceae carriage upon hospital admission-minimum inhibitory concentration values were generated for ampicillin/sulbactam, amoxicillin/clavulanic acid, piperacillin/tazobactam, mecillinam, mecillinam/clavulanic acid, and temocillin against third-generation cephalosporin-resistant Escherichia coli, Klebsiella species and Enterobacter species.

  3. Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome.

    PubMed

    Fairclough, Emily; Cairns, Eleanor; Hamilton, Jennifer; Kelly, Clive

    2009-02-01

    The modified early warning score (MEWS) was developed as a track and trigger tool for the prompt identification of seriously ill patients on an acute medical ward. This paper examines its value in the setting of an acute medical admissions unit (MAU) and compares it to biochemical markers of acute and chronic disease. Three hundred unselected acute admissions to the MAU of the Queen Elizabeth Hospital, Gateshead, were assessed. Correlations between MEWS score and C-reactive protein (CRP) and albumin separately were assessed, and then the relationship between MEWS and the CRP/albumin ratio across the age spectrum was examined. The findings demonstrated a strong correlation between the MEWS score and CRP/albumin ratio (r=0.88, p<0.001) across the whole age spectrum. Length of stay correlated poorly with MEWS (r=0.08) and CRP/albumin ratio (r=0.15). Overall mortality was 5% and was predicted by both tools, with a MEWS score of >4 (relative risk (RR)=7.8) outperforming a CRP/albumin of >2 (RR=2.6). MEWS remains the gold standard for assessing outcome in acute medical admissions, but does have limitations in the elderly (those aged over 70 years). A raised CRP/albumin ratio was less sensitive for overall mortality than MEWS. It did, however, appear to be of greater value in the elderly, especially in those with acute exacerbations of chronic disease. Neither test accurately predicted length of stay.

  4. 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

  5. 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

  6. Nutrition survey in an elderly population following admission to a tertiary care hospital

    PubMed Central

    Azad, N; Murphy, J; Amos, S S; Toppan, J

    1999-01-01

    BACKGROUND: Malnutrition in elderly patients in institutions has become an issue of clinical concern, but it remains largely unrecognized in acute care hospitals. The demonstrated benefits of intervention emphasize the need for routine nutritional assessment. The objectives of this study were to determine the prevalence of malnutrition in elderly patients admitted to a tertiary care centre and to test the sensitivity and specificity of 3 nutrition screening tools. METHODS: Between July and November 1996 patients 65 years and older were consecutively recruited from the general medicine, orthopedics, general surgery and neurosciences services of The Ottawa Hospital--General Campus within 72 hours of admission. They were interviewed using 3 nutritional screening tools: one developed by Chandra and colleagues (Chandra), the Nutrition Screening Initiative (NSI) and the Mini Nutritional Assessment (MNA). A detailed nutrition assessment was then undertaken, which included anthropometric assessment, laboratory tests, determination of risk factors and assessment of dietary intake. A dietitian blinded to the screening results classified each patient as being well nourished, at risk for malnutrition or malnourished. The prevalence of malnutrition was assessed, and screening results were compared with the results of the detailed nutrition assessment for sensitivity and specificity. RESULTS: In total, 160 patients (86 women) were recruited. Detailed nutrition assessments were completed for 152 patients, of which 62 (40.8%) were found to be well nourished, 67 (44.1%) at moderate risk for malnutrition and 23 (15.1%) malnourished. Matched comparisons showed that, of the 23 malnourished patients, 1 was found to be at high risk for malnutrition using the Chandra screening tool, 9 using the NSI and 4 using the MNA, giving sensitivities of 32%, 54% and 57%, and specificities of 85%, 61% and 69%, respectively. INTERPRETATION: Given the high rate of malnutrition or risk of malnutrition

  7. Exploring Reasons for Bed Pressures in Winnipeg Acute Care Hospitals

    ERIC Educational Resources Information Center

    Menec, Verena H.; Bruce, Sharon; MacWilliam, Leonard R.

    2005-01-01

    Hospital overcrowding has plagued Winnipeg and other Canadian cities for years. This study explored factors related to overcrowding. Hospital files were used to examine patterns of hospital use from fiscal years 1996/1997 to 1999/2000. Chart reviews were conducted to examine appropriateness of admissions and hospital stays during one pressure…

  8. 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

  9. Acute effects of aircraft noise on cardiovascular admissions - an interrupted time-series analysis of a six-day closure of London Heathrow Airport caused by volcanic ash.

    PubMed

    Pearson, Tim; Campbell, Michael J; Maheswaran, Ravi

    2016-08-01

    Acute noise exposure may acutely increase blood pressure but the hypothesis that acute exposure to aircraft noise may trigger cardiovascular events has not been investigated. This study took advantage of a six-day closure of a major airport in April 2010 caused by volcanic ash to examine if there was a decrease in emergency cardiovascular hospital admissions during or immediately after the closure period, using an interrupted daily time-series study design. The population living within the 55dB(A) noise contour was substantial at 0.7 million. The average daily admission count was 13.9 (SD 4.4). After adjustment for covariates, there was no evidence of a decreased risk of hospital admission from cardiovascular disease during the closure period (relative risk 0.97 (95% CI 0.75-1.26)). Using lags of 1-7 days gave similar results. Further studies are needed to investigate if transient aircraft noise exposure can trigger acute cardiovascular events.

  10. 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…

  11. Coagulopathy and Shock on Admission is Associated with Mortality for Children with Traumatic Injuries at Combat Support Hospitals

    DTIC Science & Technology

    2012-01-01

    to US military combat support hospitals in Afghanistan and Iraq: Learning from the first 2000 admissions. J Trauma 2009; 67:762–768 7. Niles SE...25:579–581 11. Hindy -Francois C, Meyer P, Blanot S, et al: Admission base deficit as a long-term prognostic factor in severe pediatric trau- ma

  12. 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

  13. Effect of air pollution control on mortality and hospital admissions in Ireland.

    PubMed

    Dockery, Douglas W; Rich, David Q; Goodman, Patrick G; Clancy, Luke; Ohman-Strickland, Pamela; George, Prethibha; Kotlov, Tania

    2013-07-01

    During the 1980s the Republic of Ireland experienced repeated severe pollution episodes. Domestic coal burning was a major source of this pollution. In 1990 the Irish government introduced a ban on the marketing, sale, and distribution of coal in Dublin. The ban was extended to Cork in 1995 and to 10 other communities in 1998 and 2000. We previously reported decreases in particulate black smoke (BS*) and sulfur dioxide (SO2) concentrations, measured as total gaseous acidity, in Dublin after the 1990 coal ban (Clancy et al. 2002). In the current study we explored and compared the effectiveness of the sequential 1990, 1995, and 1998 bans in reducing community air pollution and in improving public health. We compiled records of daily BS, total gaseous acidity (SO2), and counts of cause-specific deaths from 1981 to 2004 for Dublin County Borough (1990 ban), county Cork (1995 ban), and counties Limerick, Louth, Wexford, and Wicklow (1998 ban). We also compiled daily counts of hospital admissions for cardiovascular, respiratory, and digestive diagnoses for Cork County Borough (1991 to 2004) and counties Limerick, Louth, Wexford, and Wicklow (1993 to 2004). We compared pre-ban and post-ban BS and SO2 concentrations for each city. Using interrupted time-series methods, we estimated the change in cause-specific, directly standardized mortality rates in each city or county after the corresponding local coal ban. We regressed weekly age- and sex-standardized mortality rates against an indicator of the post- versus pre-ban period, adjusting for influenza epidemics, weekly mean temperature, and a season smooth of the standardized mortality rates in Coastal counties presumably not affected by the bans. We compared these results with similar analyses in Midlands counties also presumably unaffected by the bans. We also estimated the change in cause-specific, directly standardized, weekly hospital admissions rates normalized for underreporting in each city or county after the 1995

  14. 77 FR 34326 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-11

    ... 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident... Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term...

  15. 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

  16. 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

  17. Impact of acute and chronic hyperglycemia on in-hospital outcomes of patients with acute myocardial infarction.

    PubMed

    Fujino, Masashi; Ishihara, Masaharu; Honda, Satoshi; Kawakami, Shoji; Yamane, Takafumi; Nagai, Toshiyuki; Nakao, Kazuhiro; Kanaya, Tomoaki; Kumasaka, Leon; Asaumi, Yasuhide; Arakawa, Tetsuo; Tahara, Yoshio; Nakanishi, Michio; Noguchi, Teruo; Kusano, Kengo; Anzai, Toshihisa; Goto, Yoichi; Yasuda, Satoshi; Ogawa, Hisao

    2014-12-15

    This study was undertaken to assess the impact of acute hyperglycemia (acute-HG) and chronic hyperglycemia (chronic-HG) on short-term outcomes in patients with acute myocardial infarction (AMI). This study consisted of 696 patients with AMI. Acute-HG was defined as admission plasma glucose ≥200 mg/dl and chronic-HG as hemoglobin A1c ≥6.5%. Acute-HG was associated with higher peak serum creatine kinase (4,094 ± 4,594 vs 2,526 ± 2,227 IU/L, p <0.001) and in-hospital mortality (9.8% vs 1.6%, p <0.001). On the contrary, there was no significant difference in peak creatine kinase (2,803 ± 2,661 vs 2,940 ± 3,181 IU/L, p = 0.59) and mortality (3.3 vs 3.7%, p = 0.79) between patients with chronic-HG and those without. Multivariate analysis showed that admission plasma glucose was an independent predictor of in-hospital mortality (odds ratio 1.15, 95% confidence interval 1.05 to 1.27, p <0.001), but hemoglobin A1c was not. When only patients with acute-HG were analyzed, chronic-HG was associated with a significantly smaller infarct size (3,221 ± 3,001 vs 5,904 ± 6,473 IU/L, p <0.001) and lower in-hospital mortality (5.5 vs 18.9%, p = 0.01). In conclusion, these results suggested that acute-HG, but not chronic-HG, was associated with adverse short-term outcomes after AMI. Paradoxically, in patients with acute-HG, chronic-HG might abate the adverse effects of acute-HG.

  18. Impact of North Carolina's motorcycle helmet law on hospital admissions and charges for care of traumatic brain injuries.

    PubMed

    Naumann, Rebecca B; Marshall, Stephen W; Proescholdbell, Scott K; Austin, Anna; Creppage, Kathleen

    2015-04-01

    BACKGROUND North Carolina requires motorcyclists of all ages to wear federally approved safety helmets. The purpose of this article is to estimate the impact of this state law in terms of hospital admissions for traumatic brain injury (TBI) and associated hospital charges. METHODS Hospital admissions of North Carolina motorcyclists with TBIs and associated hospital charges in 2011 were extracted from the North Carolina Hospital Discharge Data system. We estimated hospital admissions and charges for the same year under the counterfactual condition of North Carolina without a universal motorcycle helmet law by using various substitutes (Florida, Pennsylvania, and South Carolina residents treated in North Carolina). RESULTS North Carolina's universal helmet law prevented an estimated 190 to 226 hospital admissions of North Carolina motorcyclists with TBI in 2011. Averted hospital charges to taxpayer-funded sources (ie, government and public charges) were estimated to be between $9.5 million and $11.6 million for 2011, and total averted hospital charges for 2011 were estimated to be between $25.3 million and $31.0 million. LIMITATIONS Cost estimates are limited to inpatients during the initial period of hospital care. This study was unable to capture long-term health care costs and productivity losses incurred by North Carolina's TBI patients and their caregivers. CONCLUSIONS North Carolina's universal motorcycle helmet law generates health and economic benefits for the state and its taxpayers.

  19. 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

  20. Predicting AKI in emergency admissions: an external validation study of the acute kidney injury prediction score (APS)

    PubMed Central

    Hodgson, L E; Dimitrov, B D; Roderick, P J; Venn, R; Forni, L G

    2017-01-01

    Objectives Hospital-acquired acute kidney injury (HA-AKI) is associated with a high risk of mortality. Prediction models or rules may identify those most at risk of HA-AKI. This study externally validated one of the few clinical prediction rules (CPRs) derived in a general medicine cohort using clinical information and data from an acute hospitals electronic system on admission: the acute kidney injury prediction score (APS). Design, setting and participants External validation in a single UK non-specialist acute hospital (2013–2015, 12 554 episodes); four cohorts: adult medical and general surgical populations, with and without a known preadmission baseline serum creatinine (SCr). Methods Performance assessed by discrimination using area under the receiver operating characteristic curves (AUCROC) and calibration. Results HA-AKI incidence within 7 days (kidney disease: improving global outcomes (KDIGO) change in SCr) was 8.1% (n=409) of medical patients with known baseline SCr, 6.6% (n=141) in those without a baseline, 4.9% (n=204) in surgical patients with baseline and 4% (n=49) in those without. Across the four cohorts AUCROC were: medical with known baseline 0.65 (95% CIs 0.62 to 0.67) and no baseline 0.71 (0.67 to 0.75), surgical with baseline 0.66 (0.62 to 0.70) and no baseline 0.68 (0.58 to 0.75). For calibration, in medicine and surgical cohorts with baseline SCr, Hosmer-Lemeshow p values were non-significant, suggesting acceptable calibration. In the medical cohort, at a cut-off of five points on the APS to predict HA-AKI, positive predictive value was 16% (13–18%) and negative predictive value 94% (93–94%). Of medical patients with HA-AKI, those with an APS ≥5 had a significantly increased risk of death (28% vs 18%, OR 1.8 (95% CI 1.1 to 2.9), p=0.015). Conclusions On external validation the APS on admission shows moderate discrimination and acceptable calibration to predict HA-AKI and may be useful as a severity marker when HA-AKI occurs

  1. Mortality and Revascularization following Admission for Acute Myocardial Infarction: Implication for Rural Veterans

    ERIC Educational Resources Information Center

    Abrams, Thad E.; Vaughan-Sarrazin, Mary; Kaboli, Peter J.

    2010-01-01

    Introduction: Annually, over 3,000 rural veterans are admitted to Veterans Health Administration (VA) hospitals for acute myocardial infarction (AMI), yet no studies of AMI have utilized the VA rural definition. Methods: This retrospective cohort study identified 15,870 patients admitted for AMI to all VA hospitals. Rural residence was identified…

  2. 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

  3. 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.

  4. Time Trends in Hospital Admissions for Bronchiectasis: Analysis of the Spanish National Hospital Discharge Data (2004 to 2013)

    PubMed Central

    Sánchez-Muñoz, Gema; López de Andrés, Ana; Jiménez-García, Rodrigo; Carrasco-Garrido, Pilar; Hernández-Barrera, Valentín; Pedraza-Serrano, Fernando; Puente-Maestu, Luis; de Miguel-Díez, Javier

    2016-01-01

    Objective To analyze changes in the incidence, diagnostic procedures, comorbidity, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) for patients with bronchiectasis who were hospitalized in Spain over a 10-year period. Methods We included all admissions for patients diagnosed with bronchiectasis as primary or secondary diagnosis during 2004–2013. Results 282,207 patients were admitted to the study. After controlling for possible confounders, we observed a significant increase in the incidence of hospitalizations over the study period when bronchiectasis was a secondary diagnosis. When bronchiectasis was the primary diagnosis we observed a significant decline in the incidence. In all cases, this pathology was more frequent in males, and the average age and comorbidity increased significantly during the study period (p<0.001). When bronchiectasis was the primary diagnosis, the most frequent secondary diagnosis was Pseudomonas aeruginosa infection. When bronchiectasis was the secondary diagnosis, the most frequent primary diagnosis was COPD. IHM was low, tending to decrease from 2004 to 2013 (p<0.05). The average LOHS decreased significantly during the study period in both cases (p<0.001). The mean cost per patient decreased in patients with bronchiectasis as primary diagnosis, but it increased for cases of bronchiectasis as secondary diagnosis (p<0.001). Conclusions Our results reveal an increase in the incidence of hospital admissions for patients with bronchiectasis as a secondary diagnosis from 2004 to 2013, as opposed to cases of bronchiectasis as the primary diagnosis. Although the average age and comorbidity significantly increased over time, both IHM and average LOHS significantly decreased. PMID:27622273

  5. 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

  6. The incidence of viral-associated diarrhea after admission to a pediatric hospital.

    PubMed

    Ford-Jones, E L; Mindorff, C M; Gold, R; Petric, M

    1990-04-01

    For determination of the incidence of viral-associated diarrhea after admission to a pediatric hospital, all patients admitted to general pediatrics, cardiology, and neurosurgery wards without diarrhea between January 1 and July 31, 1985 were followed 5 days per week for presence of diarrhea, etiologic agent, and possible risk factors. A total of 1,530 patients were followed for 3,642 days. Of these patients, 69 developed 80 nosocomial diarrhea episodes after 72 hours in hospital for a nosocomial diarrhea rate of 4.5 infected children per 100 admissions. Of 358 patients with an infected roommate, 37 (10.3%) developed nosocomial diarrhea. Etiologic agents recognized included rotavirus (43%), calicivirus (16%), astrovirus (14%), minreovirus (12%), adenovirus (8%), Salmonella sp. (4%), and parvo/picornavirus (3%). The nosocomial diarrhea rate by age was: 0-11 months, 8.8%; 12-35 months, 3.6%; and 36 months or more, 0.6%. The rate by length of stay was: 3-7 days, 8.4%; 8-14 days, 10.4%; 15-21 days, 7.9%; and 22 days or more, 8.8%, and by number of roommates/1,000 patient-days it was: 0-1, 15.7; 2 to 3, 27.7; and 4 or more, 45.2. Patients who acquired diarrhea were more likely to be diapered (9.6% vs. 1.8%, p less than 0.001). Playroom use was not significantly different in the two groups. A total of 64 patients developed diarrhea within 72 hours of admission (community diarrhea rate = 4.2). Nosocomial viral-associated diarrhea is almost exclusively a disease of diapered children less than age 36 months and occurs at any time during hospital stay. It is more common in multibed rooms, but does occur in single-bed rooms.

  7. Association of Hyperglycemia with In-Hospital Mortality and Morbidity in Libyan Patients with Diabetes and Acute Coronary Syndromes

    PubMed Central

    Benamer, Sufyan; Eljazwi, Imhemed; Mohamed, Rima; Masoud, Heba; Tuwati, Mussa; Elbarsha, Abdulwahab M.

    2015-01-01

    Objective Hyperglycemia on admission and during hospital stay is a well-established predictor of short-term and long-term mortality in patients with acute myocardial infarction. Our study investigated the impact of blood glucose levels on admission and in-hospital hyperglycemia on the morbidity and mortality of Libyan patients admitted with acute coronary syndromes (acute myocardial infarction and unstable angina). Methods In this retrospective study, the records of patients admitted with acute coronary syndrome to The 7th Of October Hospital, Benghazi, Libya, between January 2011 and December 2011 were reviewed. The level of blood glucose on admission, and the average blood glucose during the hospital stay were recorded to determine their effects on in-hospital complications (e.g. cardiogenic shock, acute heart failure, arrhythmias, and/or heart block) and mortality. Results During the study period, 121 patients with diabetes were admitted with acute coronary syndrome. The mortality rate in patients with diabetes and acute coronary syndrome was 12.4%. Patients with a mean glucose level greater than 200mg/dL had a higher in-hospital mortality and a higher rate of complications than those with a mean glucose level ≤200mg/dL (27.5% vs. 2.6%, p<0.001 and 19.7% vs. 45.5%, p=0.004, respectively). There was no difference in in-hospital mortality between patients with a glucose level at admission ≤140mg/dL and those admitted with a glucose level >140mg/dL (6.9% vs. 14.3%; p=0.295), but the rate of complications was higher in the latter group (13.8% vs. 34.1%; p=0.036). Patients with admission glucose levels >140mg/dL also had a higher rate of complications at presentation (26.4% vs. 6.9%; p=0.027). Conclusion In patients with diabetes and acute coronary syndrome, hyperglycemia during hospitalization predicted a worse outcome in terms of the rates of in-hospital complications and in-hospital mortality. Hyperglycemia at the time of admission was also associated with

  8. Indications to Hospital Admission and Isolation of Children With Possible or Defined Tuberculosis

    PubMed Central

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

    2015-01-01

    Abstract 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

  9. 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

  10. Impact of a measles immunisation campaign on measles admissions to a Natal hospital.

    PubMed

    Abdool Karim, S S; Abdool Karim, Q; Chamane, M

    1991-12-07

    During May and June 1990, a national mass measles immunisation campaign was undertaken in South Africa. This study is an assessment of the impact of the campaign on measles admissions to a provincial referral hospital that has specifically designated wards for children with communicable diseases. Data from the measles ward admissions book for the 18 months before the campaign (1 January 1989-30 June 1990) and 6 months after the campaign (1 July 1990-31 December 1990) were compared. Since the campaign, the average number of measles admissions has declined by 64.4% from 87 to 31 per month (P less than 0.01). Before the campaign, 21.3% of measles patients admitted were aged 7-9 months compared with 27.6% after the campaign, highlighting the urgent need to improve the measles vaccination coverage in this age group. An analysis of the geographical source of patients showed that measles continued to occur after the campaign in most of the areas where it existed before the campaign. It is concluded that important gains have been achieved by the campaign. These will be rapidly eroded and epidemics of measles may occur if measles vaccination efforts wane and slump back to pre-campaign levels. It is important to capitalise on the momentum generated through the campaign by continuing to support efforts of existing health care services to improve and maintain high levels of measles immunisation coverage.

  11. Seasonal Variations in Hospital Admissions for ST-Elevation Myocardial Infarction in New Zealand

    PubMed Central

    Swampillai, Janice; Wijesinghe, Namal; Sebastian, Cherian; Devlin, Gerard P

    2012-01-01

    Background Increased numbers of ST Elevation Myocardial Infarction (STEMI) admissions have been observed during winter in many countries. Our aim was to assess if seasonal variation of STEMI was present in the Waikato region of New Zealand. Methods Case notes of patients admitted to Waikato hospital with STEMI between July 1998 and December 2007 were analysed. The incidence of STEMI during summer (December to February), autumn (March to May), winter (June to August) and spring (September to November) were calculated. The individuals were divided into 2 age groups of ≤ 70 and > 70 years of age. Results A total of 3,569 patients (mean age 66.9 ± 14.1 years, 64% men) were included. STEMI presentation during winter was significantly higher compared with summer (35 ± 13 versus 27.3 ± 11.3 cases per month, P < 0.02) with 3 additional STEMI admissions per fortnight during winter months. The increase in STEMI in winter was more apparent in patients > 70 years of age, with an 8.5% increase in winter admissions compared to summer (P < 0.01). There was no significant difference in the incidence of STEMI between other seasons. Conclusion There is a higher incidence of STEMI during winter in the Waikato region compared with summer. This increased incidence is particularly pronounced in patients over 70 years of age. Further investigations are necessary to elicit potential causes.

  12. Mortality and hospital admission rates for unintentional nonfire-related carbon monoxide poisoning across Canada: a trend analysis

    PubMed Central

    Weichenthal, Scott; Wong, Joan; Smith-Doiron, Marc; Dugandzic, Rose; Kosatsky, Tom

    2015-01-01

    Background The epidemiology of mortality and morbidity from carbon monoxide poisoning in Canada has received little attention. Our objective was to evaluate trends in mortality and hospital admission rates for unintentional nonfire-related carbon monoxide poisoning across Canada. Methods Age- and sex-standardized mortality (1981–2009) and hospital admission (1995–2010) rates by age group, sex and site of carbon monoxide exposure were calculated for each province and for all of Canada. We quantified the long-term trends by calculating the average annual percent change. Multivariable Poisson regression was used to estimate incidence rate ratios (IRRs) of carbon monoxide poisoning across age groups, sex and month of occurrence. Results In Canada, there were 1808 unintentional nonfire-related carbon monoxide poisoning deaths between 1981 and 2009 and 1984 admissions to hospital between 1995 and 2010. Average annual decreases of 3.46% (95% confidence interval [CI] –4.59% to –2.31%) and 5.83% (95% CI –7.79% to –3.83%) were observed for mortality and hospital admission rates, respectively. Mortality (IRR 5.31, 95% CI 4.57 to 6.17) and hospital admission (IRR 2.77, 95% CI 2.51 to 3.03) rates were elevated in males compared with females. Decreased trends in the rates were observed for all sites of carbon monoxide exposure, but the magnitude of this decrease was lowest in residential environments. Deaths and admissions to hospital were most frequent from September to April, with peaks in December and January. Interpretation Mortality and hospital admission rates for unintentional nonfire-related carbon monoxide poisoning in Canada have declined steadily. Continued efforts should focus on reducing carbon monoxide poisoning during the cooler months and in residential environments. PMID:26389101

  13. Effects of Coarse Particulate Matter on Emergency Hospital Admissions for Respiratory Diseases: A Time-Series Analysis in Hong Kong

    PubMed Central

    Qiu, Hong; Tian, Linwei; Wang, Xiaorong; Tse, Lap Ah; Tam, Wilson; Wong, Tze Wai

    2012-01-01

    Background: Many epidemiological studies have linked daily counts of hospital admissions to particulate matter (PM) with an aerodynamic diameter ≤ 10 μm (PM10) and ≤ 2.5 μm (PM2.5), but relatively few have investigated the relationship of hospital admissions with coarse PM (PMc; 2.5–10 μm aerodynamic diameter). Objectives: We conducted this study to estimate the health effects of PMc on emergency hospital admissions for respiratory diseases in Hong Kong after controlling for PM2.5 and gaseous pollutants. Methods: We conducted a time-series analysis of associations between daily emergency hospital admissions for respiratory diseases in Hong Kong from January 2000 to December 2005 and daily PM2.5 and PMc concentrations. We estimated PMc concentrations by subtracting PM2.5 from PM10 measurements. We used generalized additive models to examine the relationship between PMc (single- and multiday lagged exposures) and hospital admissions adjusted for time trends, weather conditions, influenza outbreaks, PM2.5, and gaseous pollutants (nitrogen dioxide, sulfur dioxide, and ozone). Results: A 10.9-μg/m3 (interquartile range) increase in the 4-day moving average concentration of PMc was associated with a 1.94% (95% confidence interval: 1.24%, 2.64%) increase in emergency hospital admissions for respiratory diseases that was attenuated but still significant after controlling for PM2.5. Adjusting for gaseous pollutants and altering models assumptions had little influence on PMc effect estimates. Conclusion: PMc was associated with emergency hospital admissions for respiratory diseases in Hong Kong independent of PM2.5 and gaseous pollutants. Further research is needed to evaluate health effects of different components of PMc. PMID:22266709

  14. The efficacy of fetal fibronectin testing in minimising hospital admissions, length of hospital stay and cost savings in women presenting with symptoms of pre-term labour.

    PubMed

    Dutta, D; Norman, J E

    2010-01-01

    The following review includes a number of studies on the effect of fetal fibronectin (fFN) testing and non-testing, as well as the positive and negative test results, some combining with transvaginal ultrasonographic measurement of cervical length primarily to reduce hospital admissions and length of hospital stay (with associated reduction in health service costs), in women presenting to hospital with symptoms of pre-term labour. English language medical literature was analysed using the search parameters: fetal fibronectin, cervical length, preterm labour, hospital admissions and length of stay. A total of 19 studies were included. Ten of these discussed the role of fFN in decreasing hospital admissions, transfers, length of stay and interventions like corticosteroids and tocolytics. Seven studies demonstrated a correlation of fFN testing with an actual estimate of cost savings of health resources. Five studies explored the combined predictability of fetal fibronectin and cervical length with regards to pre-term labour.

  15. Hospital admissions for lower respiratory tract infections among infants in the Canadian Arctic: a cohort study

    PubMed Central

    Banerji, Anna; Panzov, Val; Young, Michael; Robinson, Joan; Lee, Bonita; Moraes, Theo; Mamdani, Muhammad; Giles, B. Louise; Jiang, Depeng; Bisson, Danny; Dennis, Marguerite; Morel, Johanne; Hall, Judith; Hui, Charles; Paes, Bosco; Mahony, James B.

    2016-01-01

    Background: It is unknown whether this burden of disease of lower respiratory tract infections is comparable across the Canadian Arctic. The objectives of this surveillance study were to compare the rates of hospital admission for lower respiratory tract infection and the severity of infection across Arctic Canada, and to describe the responsible viruses. Methods: We performed a prospective multicentre surveillance study of infants less than 1 year of age admitted in 2009 with lower respiratory tract infection to all hospitals (5 regional, 4 tertiary) in the Northwest Territories, Nunavut and Nunavik to assess for regional differences. Nasopharyngeal aspirates were processed by means of a polymerase chain reaction respiratory viral panel, testing for 20 respiratory viruses and influenza A (H1N1). The role of coinfection was assessed by means of regression analysis for length of stay (short: < 7 d; long: > 14 d). Outcomes compared included rates of lower respiratory tract infection, respiratory syncytial virus infection, transfer to tertiary hospital and severe lower respiratory tract infection (respiratory failure, intubation and mechanical ventilation, and/or cardiopulmonary resuscitation). Results: There were 348 admissions for lower respiratory tract infection in the population of interest in 2009. Rates of admission per 1000 live births varied significantly, from 39 in the Northwest Territories to 456 in Nunavik (p < 0.001). The rates of tertiary admissions and severe lower respiratory tract infection per 1000 live births in the Northwest Territories were 5.6 and 1.4, respectively, compared to 55.9 and 17.1, respectively, in Nunavut and 52.0 and 20.0, respectively, in Nunavik (p ≤ 0.001). Respiratory syncytial virus was the most common virus identified (124 cases [41.6% of those tested]), and coinfection was detected in 51 cases (41.1%) of infection with this virus. Longer length of stay was associated with coinfection (odds ratio [OR] 2.64) and underlying

  16. Developing a programme for medication reconciliation at the time of admission into hospital.

    PubMed

    Giménez Manzorro, Álvaro; Zoni, Ana Clara; Rodríguez Rieiro, Cristina; Durán-García, Esther; Trovato López, Alejandro Nicolás; Pérez Sanz, Cristina; Bodas Gutiérrez, Patricia; Jiménez Muñoz, Ana Belén

    2011-08-01

    The aim of this article is to describe the methods used to develop the medication reconciliation programme implemented in a tertiary care hospital, and to discuss the main problems encountered and lessons learned during the process. A quasi-experimental study was carried out, analysing discrepancies between routine medication and drugs prescribed in the hospital, before and after an electronic reconciliation tool was introduced at admission. This tool was integrated into the computerized provider order entry system. The implementation of the electronic reconciliation tool has shown a reduction of the rate of discrepancies, decreasing from 7.24% (CI 95% 6.0-8.5) before the intervention to 4.18% (CI 95% 3.2-5.1) afterwards. Projects like this are costly, but this study has made it possible to detect numerous areas where interventions could be useful and proved the importance of a medication reconciliation programme.

  17. Rates and relative risk of hospital admission among women in violent intimate partner relationships.

    PubMed Central

    Kernic, M A; Wolf, M E; Holt, V L

    2000-01-01

    OBJECTIVES: This study assessed the history of hospitalization among women involved in violent intimate relationships. METHODS: In this 1-year retrospective cohort study, female residents of King County, Washington, who were aged 18 to 44 years and who had filed for a protection order were compared with nonabused women in the same age group. Outcome measures included overall and diagnosis-specific hospital admission rates and relative risk of hospitalization associated with abuse. RESULTS: Women known to be exposed to a violent intimate relationship were significantly more likely to be hospitalized with any diagnosis (age-specific relative risks [RRs] ranging from 1.2 to 2.1), psychiatric diagnoses (RR = 3.6, 95% confidence interval [CI] = 2.8, 4.6), injury and poisoning diagnoses (RR = 1.8, 95% CI = 1.2, 2.8), digestive system diseases (RR = 1.9, 95% CI = 1.3, 2.9), and diagnoses of assault (RR = 4.9, 95% CI = 1.1, 22.1) or attempted suicide (RR = 3.7, 95% CI = 1.6, 9.2) in the year before filing a protection order. CONCLUSIONS: This study showed an increased relative risk of both overall and diagnosis-specific hospitalizations among abused women. Intimate partner violence has a significant impact on women's health and use of health care. PMID:10983199

  18. Admission Risk Score to Predict Inpatient Pediatric Mortality at Four Public Hospitals in Uganda

    PubMed Central

    Mpimbaza, Arthur; Sears, David; Sserwanga, Asadu; Kigozi, Ruth; Rubahika, Denis; Nadler, Adam; Yeka, Adoke; Dorsey, Grant

    2015-01-01

    Mortality rates among hospitalized children in many government hospitals in sub-Saharan Africa are high. Pediatric emergency services in these hospitals are often sub-optimal. Timely recognition of critically ill children on arrival is key to improving service delivery. We present a simple risk score to predict inpatient mortality among hospitalized children. Between April 2010 and June 2011, the Uganda Malaria Surveillance Project (UMSP), in collaboration with the National Malaria Control Program (NMCP), set up an enhanced sentinel site malaria surveillance program for children hospitalized at four public hospitals in different districts: Tororo, Apac, Jinja and Mubende. Clinical data collected through March 2013, representing 50249 admissions were used to develop a mortality risk score (derivation data set). One year of data collected subsequently from the same hospitals, representing 20406 admissions, were used to prospectively validate the performance of the risk score (validation data set). Using a backward selection approach, 13 out of 25 clinical parameters recognizable on initial presentation, were selected for inclusion in a final logistic regression prediction model. The presence of individual parameters was awarded a score of either 1 or 2 based on regression coefficients. For each individual patient, a composite risk score was generated. The risk score was further categorized into three categories; low, medium, and high. Patient characteristics were comparable in both data sets. Measures of performance for the risk score included the receiver operating characteristics curves and the area under the curve (AUC), both demonstrating good and comparable ability to predict deathusing both the derivation (AUC =0.76) and validation dataset (AUC =0.74). Using the derivation and validation datasets, the mortality rates in each risk category were as follows: low risk (0.8% vs. 0.7%), moderate risk (3.5% vs. 3.2%), and high risk (16.5% vs. 12.6%), respectively. Our

  19. Impact on mortality following first acute myocardial infarction of distance between home and hospital: cohort study

    PubMed Central

    Wei, L; Lang, C C; Sullivan, F M; Boyle, P; Wang, J; Pringle, S D; MacDonald, T M

    2008-01-01

    Objective: To investigate the effect of distance between home and acute hospital on mortality outcome of patients experiencing an incident myocardial infarction (MI). Design: Cohort study using a record linkage database. Setting: Tayside, Scotland, UK. Patients: 10 541 patients with incident acute MI between 1994 and 2003 were identified from Tayside hospital discharge data and from death certification data. Main outcome measures: MI mortality in the community, all-cause mortality in hospital and all-cause mortality during follow-up. Results: 4133 subjects died following incident MI in the community (that is, were not hospitalised), 6408 patients survived to be hospitalised and 1010 of these (15.8%) died in hospital. Of 5398 discharged from hospital, 1907 (35.3%) died during a median of 3.2 years of follow-up. After adjustment for rurality and other known risk factors, distance between home and admitting hospital was significantly associated with increased mortality both before hospital admission (adjusted odds ratio (OR), 2.05, 95% CI 1.00 to 4.21 for >9 miles and 1.46, 1.09 to 1.95 for 3–9 miles when compared to <3 miles) and after hospitalisation (adjusted hazard ratio (HR) 1.90, 1.19 to 3.02 and 1.27, 0.96 to 1.68). However, there was no effect of distance on in-hospital mortality (adjusted OR 0.95, 0.45 to 2.03 and 1.02, 0.66 to 1.58). Conclusion: The distance between home and hospital of admission may predict mortality in subjects experiencing a first acute MI. This association was found both before and after hospitalisation. Further studies are needed to explore the reasons for this association. However these data provide support for policies that locate services for acute MI closer to where patients live. PMID:17984217

  20. Monotherapy With Major Antihypertensive Drug Classes and Risk of Hospital Admissions for Mood Disorders

    PubMed Central

    Boal, Angela H.; Smith, Daniel J.; McCallum, Linsay; Muir, Scott; Touyz, Rhian M.; Dominiczak, Anna F.

    2016-01-01

    Major depressive and bipolar disorders predispose to atherosclerosis, and there is accruing data from animal model, epidemiological, and genomic studies that commonly used antihypertensive drugs may have a role in the pathogenesis or course of mood disorders. In this study, we propose to determine whether antihypertensive drugs have an impact on mood disorders through the analysis of patients on monotherapy with different classes of antihypertensive drugs from a large hospital database of 525 046 patients with follow-up for 5 years. There were 144 066 eligible patients fulfilling the inclusion criteria: age 40 to 80 years old at time of antihypertensive prescription and medication exposure >90 days. The burden of comorbidity assessed by Charlson and Elixhauser scores showed an independent linear association with mood disorder diagnosis. The median time to hospital admission with mood disorder was 847 days for the 299 admissions (641 685 person-years of follow-up). Patients on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers had the lowest risk for mood disorder admissions, and compared with this group, those on β-blockers (hazard ratio=2.11; [95% confidence interval, 1.12–3.98]; P=0.02) and calcium antagonists (2.28 [95% confidence interval, 1.13–4.58]; P=0.02) showed higher risk, whereas those on no antihypertensives (1.63 [95% confidence interval, 0.94–2.82]; P=0.08) and thiazide diuretics (1.56 [95% confidence interval, 0.65–3.73]; P=0.32) showed no significant difference. Overall, our exploratory findings suggest possible differential effects of antihypertensive medications on mood that merits further study: calcium antagonists and β-blockers may be associated with increased risk, whereas angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be associated with a decreased risk of mood disorders. PMID:27733585

  1. 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

  2. Comparison of the clinical characteristics and treatment outcomes of patients requiring hospital admission to treat eosinophilic and neutrophilic exacerbations of COPD

    PubMed Central

    Kang, Hye Seon; Rhee, Chin Kook; Kim, Sung Kyoung; Kim, Jin Woo; Lee, Sang Haak; Yoon, Hyung Kyu; Ahn, Joong Hyun; Kim, Yong Hyun

    2016-01-01

    Purpose We compared the clinical characteristics and treatment outcomes of patients with eosinophilic and neutrophilic COPD exacerbations requiring hospital admission. Patients and methods This was a retrospective multicenter study performed between January 2010 and December 2014. In all, 1,688 COPD patients admitted via the outpatient clinics or emergency departments of six university hospitals were enrolled. The patients were grouped by complete blood counts: eosinophilic group, >2% peripheral blood eosinophils, and neutrophilic group, >65% peripheral blood neutrophils or >11,000 leukocytes/mL. The patients with radiographic evidence of pneumonia at the time of admission, those with lung cancer, those admitted for treatment of other medical problems, and those who chronically used steroids were excluded. Results A total of 605 patients hospitalized with COPD exacerbations (177 eosinophilic and 380 neutrophilic) were included. Pulmonary functions, including the forced expiratory volume in 1 second and forced vital capacity, were better in patients with eosinophilic exacerbations. Treatment outcomes, including the rate of admission to the intensive care unit and mortality, were poorer in patients with neutrophilic exacerbations (4.5% vs 12.4%, P=0.004; 1.1% vs 4.5%, P=0.043, respectively). Congestive heart failure (odds ratio [OR] =3.40, 95% confidence interval [CI]: 1.28–9.01) and neutrophilic exacerbation (OR = 2.81, 95% CI: 1.21–6.52) were independent risk factors for intensive care unit admission. Conclusion COPD patients with neutrophilic exacerbations experienced worse clinical outcomes than did those with eosinophilic exacerbations. The peripheral blood eosinophil count may be a useful predictor of clinical progress during hospitalization of COPD patients with acute exacerbations. PMID:27757029

  3. 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

  4. An increase in the burden of neonatal admissions to a rural district hospital in Kenya over 19 years

    PubMed Central

    2010-01-01

    Background Most of the global neonatal deaths occur in developing nations, mostly in rural homes. Many of the newborns who receive formal medical care are treated in rural district hospitals and other peripheral health centres. However there are no published studies demonstrating trends in neonatal admissions and outcome in rural health care facilities in resource poor regions. Such information is critical in planning public health interventions. In this study we therefore aimed at describing the pattern of neonatal admissions to a Kenyan rural district hospital and their outcome over a 19 year period, examining clinical indicators of inpatient neonatal mortality and also trends in utilization of a rural hospital for deliveries. Methods Prospectively collected data on neonates is compared to non-neonatal paediatric (≤ 5 years old) admissions and deliveries' in the maternity unit at Kilifi District Hospital from January 1st 1990 up to December 31st 2008, to document the pattern of neonatal admissions, deliveries and changes in inpatient deaths. Trends were examined using time series models with likelihood ratios utilised to identify indicators of inpatient neonatal death. Results The proportion of neonatal admissions of the total paediatric ≤ 5 years admissions significantly increased from 11% in 1990 to 20% by 2008 (trend 0.83 (95% confidence interval 0.45 -1.21). Most of the increase in burden was from neonates born in hospital and very young neonates aged < 7days. Hospital deliveries also increased significantly. Clinical diagnoses of neonatal sepsis, prematurity, neonatal jaundice, neonatal encephalopathy, tetanus and neonatal meningitis accounted for over 75% of the inpatient neonatal admissions. Inpatient case fatality for all ≤ 5 years declined significantly over the 19 years. However, neonatal deaths comprised 33% of all inpatient death among children aged ≤ 5 years in 1990, this increased to 55% by 2008. Tetanus 256/390 (67%), prematurity 554

  5. Nutritional Status of Chronic Obstructive Pulmonary Disease Patients Admitted in Hospital With Acute Exacerbation

    PubMed Central

    Gupta, Barkha; Kant, Surya; Mishra, Rachna; Verma, Sanjay

    2010-01-01

    Background Patients with Chronic Obstructive Pulmonary Disease (COPD) are frequently hospitalized with an acute exacerbation. Patients with COPD often lose weight. Consequently, deterioration in nutritional status (loss of lean body mass) is a likely repercussion of acute exacerbation in hospitalized COPD patients. The study was carried out to assess the nutritional status of COPD patients with acute exacerbation, during the period of hospital admission, and to evaluate the relationships between the nutritional indices and the pulmonary function parameters. Methods A cross sectional observation study constituting 83 COPD patients consecutively hospitalized with acute exacerbation on accrual during a period of one year. Lung function was measured by routine spirometry. Nutritional status was assessed by the measurement of anthropometric parameters. Hospital outcome was also assessed. Statistical analysis was performed using SPSS version 16.0 Independent t-tests and Pearsons correlation coefficient was used. Results Mean body weight was 50.03 ± 9.23 kg. Subjects had approximately 5 kg weight loss in previous six months. All the subjects had low BMI (19.38 ± 3.10) and MUAC (21.18 ± 2.31) that was significantly below the predicted levels. The correlation between body weight and FEV1/FVC% was good (r = 0.648, p = 0.003). BMI was negatively correlated (r = - 0.0103, p= 0.03) with duration of hospital stay. Conclusions The high prevalence of malnutrition among hospitalized COPD patients with acute exacerbation is related to their lung function and hospital outcome such as duration of hospital stay. Keywords Nutritional status; COPD; Acute exacerbation; Hospitalization PMID:21811522

  6. Is there a relationship between admission blood glucose level following acute poisoning and clinical outcome?

    PubMed Central

    Sabzghabaee, Ali Mohammad; Eizadi-Mood, Nastaran; Gheshlaghi, Farzad; Adib, Nooshin; Safaeian, Leila

    2011-01-01

    Introduction The aim of this study was to investigate the relationship between the admission blood glucose level following acute poisoning, severity of acute poisoning and clinical outcome. Material and methods This prospective study was conducted on 345 deliberate self-poisoning patients. Standard demographic and clinical information; admission blood glucose level; poisoning severity score and outcome were recorded. Patients with a history of diabetes mellitus, receipt of pre-sampling intravenous dextrose solution or glucocorticoids, and poisoning with toxic agents which produce hyper- or hypoglycaemia were excluded. Results Mean age of the patients was 27.5 ±8.6 years. Females outnumbered males (57.9%). Oral ingestion of more than one drug (46.7%) and opiates (14.2%) were the main causes of poisoning. Blood glucose values ranged from 50 mg/dl to 396 mg/dl. Hyper- and hypoglycaemia were observed in 23.8% and 13.91% respectively. A total of 24.41% and 22.92% of the patients in hyper- and hypoglycaemic groups had grade 3 and 4 severity score in comparison with 4.18% in the normoglycaemic group. Development of complications and death were 14.64% and 10.42% in patients with hyper- and hypoglycaemia versus 3.73% in patients with normoglycaemia. A significant difference between normoglycaemic and hyperglycaemic patients in the severity of poisoning and clinical outcome was observed (P < 0.001). Conclusions Admission blood glucose levels may have a relationship with the severity of poisoning and clinical outcome following acute poisoning. PMID:22291737

  7. Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review

    PubMed Central

    2014-01-01

    Background Residents of long-term care facilities have a high risk of acute care admission. Estimates of the frequency of inappropriate transfers vary substantially throughout the studies and various assessment tools have been used. The purpose of this study is to systematically review and describe the internationally existing assessment tools used for determining appropriateness of hospital admissions among long-term care residents. Method Systematic review of the literature of two databases (PubMed and CINAHL®). The search covered seven languages and the period between January 2000 and December 2012. All quantitative studies were included if any assessment tool for appropriateness of hospital and/or emergency department admission of long-term care residents was used. Two pairs of independent researchers extracted the data. Results Twenty-nine articles were included, covering study periods between 1991 and 2009. The proportion of admissions considered as inappropriate ranged from 2% to 77%. Throughout the studies, 16 different assessment tools were used; all were based on expert opinion to some extent; six also took into account published literature or interpretation of patient data. Variation between tools depended on the concepts studied, format and application, and aspects evaluated. Overall, the assessment tools covered six aspects: specific medical diagnoses (assessed by n = 8 tools), acuteness/severity of symptoms (n = 7), residents’ characteristics prior to admission (n = 6), residents’ or families’ wishes (n = 3), existence of a care plan (n = 1), and availability or requirement of resources (n = 10). Most tools judged appropriateness based on one fulfilled item; five tools judged appropriateness based on a balance of aspects. Five tools covered only one of these aspects and only six considered four or more aspects. Little information was available on the psychometric properties of the tools. Conclusions Most assessment tools

  8. Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment

    PubMed Central

    Hosking, Fay J; Harris, Tess; DeWilde, Stephen; Beighton, Carole; Shah, Sunil M; Cook, Derek G

    2017-01-01

    Background Annual health checks for adults with intellectual disability (ID) have been incentivised by National Health Service (NHS) England since 2009, but it is unclear what impact they have had on important health outcomes such as emergency hospitalisation. Methods An evaluation of a ‘natural experiment’, incorporating practice and individual-level designs, to assess the effectiveness of health checks for adults with ID in reducing emergency hospital admissions using a large English primary care database. For practices, changes in admission rates for adults with ID between 2009–2010 and 2011–2012 were compared in 126 fully participating versus 68 non-participating practices. For individuals, changes in admission rates before and after the first health check for 7487 adults with ID were compared with 46 408 age-sex-practice matched controls. Incident rate ratios (IRRs) comparing changes in admission rates are presented for: all emergency, preventable emergency (for ambulatory care sensitive conditions (ACSCs)) and elective emergency. Results Practices with high health check participation showed no change in emergency admission rate among patients with ID over time compared with non-participating practices (IRR=0.97, 95% CI 0.78 to 1.19), but emergency admissions for ACSCs did fall (IRR=0.74, 0.58 to 0.95). Among individuals with ID, health checks had no effect on overall emergency admissions compared with controls (IRR=0.96, 0.87 to 1.07), although there was a relative reduction in emergency admissions for ACSCs (IRR=0.82, 0.69 to 0.99). Elective admissions showed no change with health checks in either analysis. Conclusions Annual health checks in primary care for adults with ID did not alter overall emergency admissions, but they appeared influential in reducing preventable emergency admissions. PMID:27312249

  9. 75 FR 60640 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-01

    ... Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY... Rehabilitation and Respiratory Care Services; Medicaid Program: Accreditation for Providers of Inpatient... ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

  10. [Management of suspected cases of malaria before admission to a district hospital in Burkina Faso].

    PubMed

    Yaméogo, T M; Kyelem, C G; Bamba, S; Savadogo, L B; Sombié, I; Traoré, A-Z; Sanon, D; Ouédraogo, S M; Guiguemdé, T G

    2014-01-01

    After widespread use and misuse of antimalarial drugs led to the emergence of resistance, new guidelines for malaria treatment with artemisinine-based combination therapy (ACT) were introduced in Burkina Faso in 2005. To describe the management (drug therapy and other practices) of patients with suspected malaria before their admission to the district hospital of Dô, seven years later. This cross-sectional study was conducted during admission to the district hospital, during the low season for malaria, from December 2010 to May 2011. It included all patients aged 6 months or older diagnosed with suspected malaria according to the criteria of the national malaria control program, excluding those with severe comorbidities. The study included 476 suspected cases, 422 (88.7%) uncomplicated and 54 (11.3%) complicated. They accounted for 7.9% of all admissions. Their mean age was 14.4 years, and 35.3% (n = 168) were younger than 5 years. Only 23 (4.8%) had first consulted in a primary health care facility; 346 (72.7%) had used initial self-medication (or, more precisely in some cases, parental administration of medication without medical consultation). Overall, 435 (91.4%) came directly to the district hospital, 331 (76.1%) of them after self-medication; 10 (2.1%) had first consulted a traditional healer. The practice of self-medication did not differ according to age, gender, or complications (p>0.05). The drugs used for self-medication were mainly antipyretics (94.5%) and antimalarials (16.8%); the latter included ACT (39.6%), quinine (19.0%), and non-recommended antimalarial agents (41.4%). During the malaria low season, the treatment itinerary of suspected malaria cases is marked by equal use of ACT and non-recommended antimalarials for self-medication and minimal use of the primary level of care. A study underway of this management and these itineraries during the epidemic season may provide more data about use of ACT, the last armament against malaria in drug

  11. Index Blood Tests and National Early Warning Scores within 24 Hours of Emergency Admission Can Predict the Risk of In-Hospital Mortality: A Model Development and Validation Study

    PubMed Central

    Mohammed, Mohammed A.; Rudge, Gavin; Watson, Duncan; Wood, Gordon; Smith, Gary B.; Prytherch, David R.; Girling, Alan; Stevens, Andrew

    2013-01-01

    Background We explored the use of routine blood tests and national early warning scores (NEWS) reported within ±24 hours of admission to predict in-hospital mortality in emergency admissions, using empirical decision Tree models because they are intuitive and may ultimately be used to support clinical decision making. Methodology A retrospective analysis of adult emergency admissions to a large acute hospital during April 2009 to March 2010 in the West Midlands, England, with a full set of index blood tests results (albumin, creatinine, haemoglobin, potassium, sodium, urea, white cell count and an index NEWS undertaken within ±24 hours of admission). We developed a Tree model by randomly splitting the admissions into a training (50%) and validation dataset (50%) and assessed its accuracy using the concordance (c-) statistic. Emergency admissions (about 30%) did not have a full set of index blood tests and/or NEWS and so were not included in our analysis. Results There were 23248 emergency admissions with a full set of blood tests and NEWS with an in-hospital mortality of 5.69%. The Tree model identified age, NEWS, albumin, sodium, white cell count and urea as significant (p<0.001) predictors of death, which described 17 homogeneous subgroups of admissions with mortality ranging from 0.2% to 60%. The c-statistic for the training model was 0.864 (95%CI 0.852 to 0.87) and when applied to the testing data set this was 0.853 (95%CI 0.840 to 0.866). Conclusions An easy to interpret validated risk adjustment Tree model using blood test and NEWS taken within ±24 hours of admission provides good discrimination and offers a novel approach to risk adjustment which may potentially support clinical decision making. Given the nature of the clinical data, the results are likely to be generalisable but further research is required to investigate this promising approach. PMID:23734195

  12. The association between normal-range admission potassium levels in Israeli patients with acute coronary syndrome and early and late outcomes

    PubMed Central

    Shlomai, Gadi; Berkovitch, Anat; Pinchevski-Kadir, Shiran; Bornstein, Gil; Leibowitz, Avshalom; Goldenberg, Ilan; Grossman, Ehud

    2016-01-01

    Abstract Abnormal serum potassium levels are associated with an increased risk of ventricular arrhythmias and mortality in patients with acute myocardial infarction (AMI). The aim of the present study was to evaluate whether different levels of serum potassium, within the normal range, are associated with worse outcomes. The present study comprised 1277 patients with AMI and normal-range admission potassium levels (3.5–5.2 mEq/L), who were enrolled and prospectively followed up in the Acute Coronary Syndrome Israeli Survey between 2010 and 2013. Patients were divided into 4 quartiles based on admission potassium levels; “normal-low” (K ≥ 3.5 and K ≤ 3.9), “normal-moderate” (K > 3.9 and K ≤ 4.18), “normal-high” (K > 4.18 and K ≤ 4.45), and “normal-very high” (K > 4.45 and K ≤ 5.2). We analyzed the association between admission serum potassium levels and 7 days in-hospital complication rates, and 30-day and 1-year all-cause mortality rates. Patients with “normal-very high” potassium displayed increased frequency of baseline clinical risk factors and experienced a higher rate of acute kidney injury during hospitalization compared with the “normal-low” group (7.7% vs 2.4%; P = 0.002). However, the rate of in-hospital ventricular arrhythmias was similar across the range of admission potassium levels (overall P = 0.26), Multivariate analysis showed that compared with “low-normal” potassium values, patients with “normal-very high” potassium levels experienced increased risk for 30-days (adjusted hazard ratio 2.88, 95% confidence interval 1.05–7.87, P = 0.039) and 1-year all-cause mortality (adjusted hazard ratio 1.98, 95% confidence interval 1.05–3.75, P = 0.034). In patients admitted with AMI, admission serum potassium levels of 4.45 to 5.2 mEq/L are not associated with in-hospital ventricular arrhythmias, but are associated with increased short and long-term mortality. PMID:27281080

  13. Cause-Specific Risk of Hospital Admission Related to Extreme Heat in Older Adults

    PubMed Central

    Bobb, Jennifer F.; Obermeyer, Ziad; Wang, Yun; Dominici, Francesca

    2015-01-01

    IMPORTANCE Heat exposure is known to have a complex set of physiological effects on multiple organ systems, but current understanding of the health effects is mostly based on studies investigating a small number of prespecified health outcomes such as cardiovascular and respiratory diseases. OBJECTIVES To identify possible causes of hospital admissions during extreme heat events and to estimate their risks using historical data. DESIGN, SETTING, AND POPULATION Matched analysis of time series data describing daily hospital admissions of Medicare enrollees (23.7 million fee-for-service beneficiaries [aged ≥65 years] per year; 85% of all Medicare enrollees) for the period 1999 to 2010 in 1943 counties in the United States with at least 5 summers of near-complete (>95%) daily temperature data. EXPOSURES Heat wave periods, defined as 2 or more consecutive days with temperatures exceeding the 99th percentile of county-specific daily temperatures, matched to non–heat wave periods by county and week. MAIN OUTCOMES AND MEASURES Daily cause-specific hospitalization rates by principal discharge diagnosis codes, grouped into 283 disease categories using a validated approach. RESULTS Risks of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke were statistically significantly higher on heat wave days relative to matched non–heat wave days, but risk of hospitalization for congestive heart failure was lower (P < .05). Relative risks for these disease groups were 1.18 (95% CI, 1.12–1.25) for fluid and electrolyte disorders, 1.14 (95% CI, 1.06–1.23) for renal failure, 1.10 (95% CI, 1.04–1.16) for urinary tract infections, 1.06 (95% CI, 1.00–1.11) for septicemia, and 2.54 (95% CI, 2.14–3.01) for heat stroke. Absolute risk differences were 0.34 (95% CI, 0.22–0.46) excess admissions per 100 000 individuals at risk for fluid and electrolyte disorders, 0.25 (95% CI, 0.12–0.39) for renal failure, 0

  14. 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

  15. Clinical pharmacist-led program on medication reconciliation implementation at hospital admission: experience of a single university hospital in Croatia

    PubMed Central

    Marinović, Ivana; Marušić, Srećko; Mucalo, Iva; Mesarić, Jasna; Bačić Vrca, Vesna

    2016-01-01

    Aim To evaluate the clinical pharmacist-led medication reconciliation process in clinical practice by quantifying and analyzing unintentional medication discrepancies at hospital admission. Methods An observational prospective study was conducted at the Clinical Department of Internal Medicine, University Hospital Dubrava, during a 1-year period (October 2014 – September 2015) as a part of the implementation of Safe Clinical Practice, Medication Reconciliation of the European Network for Patient Safety and Quality of Care Joint Action (PASQ JA) project. Patients older than 18 years taking at least one regular prescription medication were eligible for inclusion. Discrepancies between pharmacists' Best Possible Medication History (BPMH) and physicians' admission orders were detected and communicated directly to the physicians to clarify whether the observed changes in therapy were intentional or unintentional. All discrepancies were discussed by an expert panel and classified according to their potential to cause harm. Results In 411 patients included in the study, 1200 medication discrepancies were identified, with 202 (16.8%) being unintentional. One or more unintentional medication discrepancy was found in 148 (35%) patients. The most frequent type of unintentional medication discrepancy was drug omission (63.9%) followed by an incorrect dose (24.2%). More than half (59.9%) of the identified unintentional medication discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration in the patient. Conclusion Around 60% of medication errors were assessed as having the potential to threaten the patient safety. Clinical pharmacist-led medication reconciliation was shown to be an important tool in detecting medication discrepancies and preventing adverse patient outcomes. This standardized medication reconciliation process may be widely applicable to other health care organizations and clinical settings. PMID:28051282

  16. 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.

  17. 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

  18. Analysis of the spatial variation of hospitalization admissions for hypertension disease in Shenzhen, China.

    PubMed

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

    2014-01-03

    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.

  19. 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

  20. Principal components and generalized linear modeling in the correlation between hospital admissions and air pollution

    PubMed Central

    de Souza, Juliana Bottoni; Reisen, Valdério Anselmo; Santos, Jane Méri; Franco, Glaura Conceição

    2014-01-01

    OBJECTIVE To analyze the association between concentrations of air pollutants and admissions for respiratory causes in children. METHODS Ecological time series study. Daily figures for hospital admissions of children aged < 6, and daily concentrations of air pollutants (PM10, SO2, NO2, O3 and CO) were analyzed in the Região da Grande Vitória, ES, Southeastern Brazil, from January 2005 to December 2010. For statistical analysis, two techniques were combined: Poisson regression with generalized additive models and principal model component analysis. Those analysis techniques complemented each other and provided more significant estimates in the estimation of relative risk. The models were adjusted for temporal trend, seasonality, day of the week, meteorological factors and autocorrelation. In the final adjustment of the model, it was necessary to include models of the Autoregressive Moving Average Models (p, q) type in the residuals in order to eliminate the autocorrelation structures present in the components. RESULTS For every 10:49 μg/m3 increase (interquartile range) in levels of the pollutant PM10 there was a 3.0% increase in the relative risk estimated using the generalized additive model analysis of main components-seasonal autoregressive – while in the usual generalized additive model, the estimate was 2.0%. CONCLUSIONS Compared to the usual generalized additive model, in general, the proposed aspect of generalized additive model − principal component analysis, showed better results in estimating relative risk and quality of fit. PMID:25119940

  1. 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.

  2. Hospital Management of Acute Decompensated Heart Failure.

    PubMed

    Abdo, Ashraf S

    2017-03-01

    Heart failure (HF) is one of the leading causes of hospitalizations for elderly adults in the United States. One in 5 Americans will be >65 years of age by 2050. Because of the high prevalence of HF in this group, the number of Americans requiring hospitalization for this disorder is expected to rise significantly. We reviewed the most recent and ongoing studies and recommendations for the management of patients hospitalized due to decompensated HF. The Acute Decompensated Heart Failure National Registry, together with the 2013 American College of Cardiology Foundation and American Heart Association heart failure guidelines, earlier retrospective and prospective studies including the Diuretic Optimization Strategies Evaluation (DOSE), the Trial of Intensified vs Standard Medical Therapy in the Elderly Patients With Congestive Heart Failure (TIME-CHF), the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF), the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) and the Comparison of Medical, Pacing and Defibrillation Therapies in Heart Failure (COMPANION) trial were reviewed for current practices pertaining to these patients. Gaps in our knowledge of optimal use of patient-specific information (biomarkers and comorbid conditions) still exist.

  3. Longitudinal Impact of the Smoking Ban Legislation in Acute Coronary Syndrome Admissions

    PubMed Central

    Sousa, P.; Matias-Dias, C.; Pinto, F. J.

    2017-01-01

    Background and Purpose. The association between smoking and CV has been proved; however smoking is still the first preventable cause of death in the EU. We aim to evaluate the potential impact of the smoke ban on the number of ACS events in the Portuguese population. In addition, we evaluate the longitudinal effects of the smoking ban several years after its implementation. Methods. We analyzed the admission rate for ACS before and after the ban using data from hospital admission. Monthly crude rate was computed, using the Portuguese population as the denominator. Data concerning the proportion of smokers among ACS patients were obtained from the NRACS. Interrupted time series were used to assess changes over time. Results. A decline of −5.8% was found for ACS crude rate after the smoking ban. The decreasing trend was observed even after years since the law. The effect of the ban was higher in men and for people over 65 years. The most significant reduction of ACS rate was found in Lisbon. Conclusions. Our results suggest that smoking ban is related to a decline in ACS admissions, supporting the importance of smoke legislation as a public health measure, contributing to the reduction of ACS rate. PMID:28265574

  4. Effect of pharmaceutical care on medication adherence and hospital admission in patients with chronic obstructive pulmonary disease (COPD): a randomized controlled study

    PubMed Central

    Wei, Li; Yang, Xinyun; Li, Jie; Liu, Lianghui; Luo, Hongying; Zheng, Zeguang

    2014-01-01

    Background Poor adherence leads to a high rate of exacerbation and poor health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). However, few strategies are acceptable and effective in improving medication adherence. We investigated whether pharmaceutical care by clinical pharmacists could reinforce medication adherence to reduce exacerbation and improve HRQoL. Methods A randomized controlled study was carried out at The First Affiliated Hospital of Guangzhou Medical University from February 2012 to January 2014. Non-adherence patients were randomly assigned to receive pharmaceutical care or to usual care. The pharmaceutical care consisted of individualized education and a series of telephone counseling for 6 months provided by clinical pharmacists. Medication adherence was measured by pill counts plus direct interview at 1- and 6-month pharmaceutical care and one-year follow-up. Severe exacerbations were defined as events that led to hospitalization for acute COPD attack. An interview was conducted to investigate hospital admissions and evaluate severe exacerbations at one-year follow-up. HRQoL was measured by St George’s Respiratory Questionnaire at 6 months. Results At 6-month pharmaceutical care and one-year follow-up, the pharmaceutical care group exhibited higher medication adherence than the usual care group (73.4±11.1 vs. 55.7±11.9, P=0.016 and 54.4±12.5 vs. 66.5±8.6, P=0.039, respectively). There are 60 acute exacerbations resulted in a hospital admission in the usual group while 37 ones in the pharmaceutical care group during one-year follow-up (P=0.01). Hospital admissions due to acute exacerbation in the pharmaceutical care group were 56.3% less than the usual care group (P=0.01). There was a significant difference in the symptoms and impact subscales respectively at 6-month pharmaceutical care between two groups (P=0.032, P=0.018). Conclusions Individualized pharmaceutical care improved medication

  5. Tobacco Stained Fingers and Its Association with Death and Hospital Admission: A Retrospective Cohort Study

    PubMed Central

    John, Gregor; Genné, Daniel

    2015-01-01

    Background Among smokers, the presence of tobacco stains on fingers has recently been associated with a high prevalence of tobacco related conditions and alcohol abuse. Objective we aimed to explore tobacco stains as a marker of death and hospital readmission. Method Seventy-three smokers presenting tobacco-tar staining on their fingers and 70 control smokers were followed during a median of 5.5 years in a retrospective cohort study. We used the Kaplan-Meier survival analysis and the log-rank test to compare mortality and hospital readmission rates among smokers with and smokers without tobacco stains. Multivariable Cox models were used to adjust for confounding factors: age, gender, pack-year unit smoked, cancer, harmful alcohol use and diabetes. The number of hospital admissions was compared through a negative binomial regression and adjusted for the follow-up time, diabetes, and alcohol use. Results Forty-three patients with tobacco-stained fingers died compared to 26 control smokers (HR 1.6; 95%CI: 1.0 to 2.7; p 0.048). The association was not statistically significant after adjustment. Patients with tobacco-stained fingers needed a readmission earlier than smokers without stains (HR 2.1; 95%CI: 1.4 to 3.1; p<0.001), and more often (incidence rate ratio (IRR) 1.6; 95%CI: 1.1 to 2.1). Associations between stains and the first hospital readmission (HR 1.6; 95%CI: 1.0 to 2.5), and number of readmissions (IRR 1.5; 95%CI: 1.1 to 2.1) persisted after adjustment for confounding factors. Conclusions Compared to other smokers, those presenting tobacco-stained fingers have a high unadjusted mortality rate and need early and frequent hospital readmission even when controlling for confounders. PMID:26375287

  6. 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

  7. Capturing religious identity during hospital admission: a valid practice in our increasingly secular society?

    PubMed

    Glenister, David; Prewer, Martin

    2016-10-21

    Objective Most major Victorian hospitals include religious identity in routine admission demographic questions. However, approximately 20% of admissions do not have their religious identity recorded. At the Royal Melbourne Hospital this missing 20% was surveyed throughout 2014-15 for two reasons: (1) to enable patient care; and (2) to provide an insight into the significance of religious identity for patients. There is scarce literature on this subject, so the present mixed-methods study, including a qualitative component, will start to bridge the gap.Methods Mixed methods, cross-sectional survey.Results The quantitative component of the study found that religious identity was important for a significant proportion of our diverse population and that, in general, demographics were congruent with Australian Bureau of Statistics (ABS) census figures. The qualitative component also revealed significant complexity behind religious identity labels, which the census is unable to capture, providing an insight into the requirements of our growing multicultural population.Conclusions This study illustrates that religious identity is important for a majority of Royal Melbourne's culturally diverse inpatients. This data would seem to give the practice of collecting religious identity data on admission new credence, especially as our culturally and linguistically diverse populations increase. In order to understand these nuances and provide appropriate care, skilled spiritual screening and assessment would appear to be not optional, but rather necessary in our increasingly complex healthcare future.What is known about the topic? A search of the literature using related terms (religious, religion, spiritual identity, care) revealed that there is scarce literature on the subject of religious identity and its importance and meaning to patients.What does this paper add? This mixed methods study approaches the issue of the importance of religious identity from the patient

  8. Respiratory Hospital Admissions before and after Closure of a Major Industry in the Lower Hunter Region, Australia

    PubMed Central

    Sajjadi, SA; Bridgman, HA

    2011-01-01

    Background: Many epidemiological studies reported significant associations between air pollution and respiratory hospital admissions. Proximity of industries to the residential areas may have considerable impacts on air quality and subsequently public health. This paper describes the indirect impacts of closing a large steel industry, Broken Hill Proprietary (BHP), in the Lower Hunter region, Australia. Methods: The number of hospital admissions for a group of respiratory diseases including all respiratory disease, Chronic Obstructive Pulmonary Disease (COPD) and asthma were incorporated in this study. The study location comprised the entire Lower Hunter, Newcastle, as the closest location, and Port Stephens, as the most distant area to the industry. Two series of data set for 3.5 years before and after industry closure allowed a comparison of daily hospital admissions. Mixed Model was employed to calculate significant changes in the time series by month. Results: While the rest of the disease categories decreased, COPD 65+ increased after BHP closure. All-age asthma in Newcastle showed the highest decrease whereas the least difference was observed for respiratory disease in Port Stephens. The decrease of admission rates was generally more significant in Newcastle, where the industry was operating, than in the other areas. Conclusion: Inconsistent results challenged the publically viewed significant role of BHP closure on public health. The study expected consistent decreases of respiratory admissions after industry closure; however, the district results suggested some impacts on community health. Incompatible findings could be attributable to other factors that dominated the possible impacts of BHP closure. PMID:23113085

  9. Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases

    PubMed Central

    Mole, Damian J; Gungabissoon, Usha; Johnston, Philip; Cochrane, Lynda; Hopkins, Leanne; Wyper, Grant M A; Skouras, Christos; Dibben, Chris; Sullivan, Frank; Morris, Andrew; Ward, Hester J T; Lawton, Andrew M; Donnan, Peter T

    2016-01-01

    Objectives Acute pancreatitis (AP) can initiate systemic complications that require support in critical care (CC). Our objective was to use the unified national health record to define the epidemiology of AP in Scotland, with a specific focus on deterministic and prognostic factors for CC admission in AP. Setting Health boards in Scotland (n=4). Participants We included all individuals in a retrospective observational cohort with at least one episode of AP (ICD10 code K85) occurring in Scotland from 1 April 2009 to 31 March 2012. 3340 individuals were coded as AP. Methods Data from 16 sources, spanning general practice, community prescribing, Accident and Emergency attendances, hospital in-patient, CC and mortality registries, were linked by a unique patient identifier in a national safe haven. Logistic regression and gamma models were used to define independent predictive factors for severe AP (sAP) requiring CC admission or leading to death. Results 2053 individuals (61.5% (95% CI 59.8% to 63.2%)) met the definition for true AP (tAP). 368 patients (17.9% of tAP (95% CI 16.2% to 19.6%)) were admitted to CC. Predictors of sAP were pre-existing angina or hypertension, hypocalcaemia and age 30–39 years, if type 2 diabetes mellitus was present. The risk of sAP was lower in patients with multiple previous episodes of AP. In-hospital mortality in tAP was 5.0% (95% CI 4.1% to 5.9%) overall and 21.7% (95% CI 19.9% to 23.5%) in those with tAP necessitating CC admission. Conclusions National record-linkage analysis of routinely collected data constitutes a powerful resource to model CC admission and prognosticate death during AP. Mortality in patients with AP who require CC admission remains high. PMID:27311912

  10. 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

  11. 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

  12. Use of a control chart to monitor diarrhoea admissions: a quality improvement exercise in West Kalimantan Provincial Hospital, Pontianak, Indonesia.

    PubMed

    Purba, M

    1999-09-01

    Data on the number of admissions for diarrhoea each week to the West Kalimantan Provincial Hospital, Pontianak, Indonesia over a 5 year period, 1992-1996, were collected. After cleaning and exclusion of extreme values, transformation was then performed to ensure that the data were free of special cause variation and normally distributed. A control chart was then constructed to provide an 'early warning' system for hospital authorities in order to facilitate the management of the epidemic and to improve patient care.

  13. 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.

  14. 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…

  15. Short Term Effects of Particle Exposure on Hospital Admissions in the Mid-Atlantic States: A Population Estimate

    PubMed Central

    Kloog, Itai; Nordio, Francesco; Zanobetti, Antonella; Coull, Brent A.; Koutrakis, Petros; Schwartz, Joel D.

    2014-01-01

    Background Many studies report significant associations between PM2.5 (particulate matter <2.5 micrometers) and hospital admissions. These studies mostly rely on a limited number of monitors which introduces exposure error, and excludes rural and suburban populations from locations where monitors are not available, reducing generalizability and potentially creating selection bias. Methods Using prediction models developed by our group, daily PM2.5 exposure was estimated across the Mid-Atlantic (Washington D.C., and the states of Delaware, Maryland, New Jersey, Pennsylvania, Virginia, New York and West Virginia). We then investigated the short-term effects of PM2.5 exposures on emergency hospital admissions of the elderly in the Mid-Atlantic region.We performed case-crossover analysis for each admission type, matching on day of the week, month and year and defined the hazard period as lag01 (a moving average of day of admission exposure and previous day exposure). Results We observed associations between short-term exposure to PM2.5 and hospitalization for all outcomes examined. For example, for every 10-µg/m3 increase in short-term PM 2.5 there was a 2.2% increase in respiratory diseases admissions (95% CI = 1.9 to 2.6), and a 0.78% increase in cardiovascular disease (CVD) admission rate (95% CI = 0.5 to 1.0). We found differences in risk for CVD admissions between people living in rural and urban areas. For every10-µg/m3 increase in PM 2.5 exposure in the ‘rural’ group there was a 1.0% increase (95% CI = 0.6 to 1.5), while for the ‘urban’ group the increase was 0.7% (95% CI = 0.4 to 1.0). Conclusions Our findings showed that PM2.5 exposure was associated with hospital admissions for all respiratory, cardio vascular disease, stroke, ischemic heart disease and chronic obstructive pulmonary disease admissions. In addition, we demonstrate that our AOD (Aerosol Optical Depth) based exposure models can be successfully applied to epidemiological

  16. 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

  17. 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

  18. 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.

  19. Can the US minimum data set be used for predicting admissions to acute care facilities?

    PubMed

    Abbott, P A; Quirolgico, S; Candidate, D; Manchand, R; Canfield, K; Adya, M

    1998-01-01

    This paper is intended to give an overview of Knowledge Discovery in Large Datasets (KDD) and data mining applications in healthcare particularly as related to the Minimum Data Set, a resident assessment tool which is used in US long-term care facilities. The US Health Care Finance Administration, which mandates the use of this tool, has accumulated massive warehouses of MDS data. The pressure in healthcare to increase efficiency and effectiveness while improving patient outcomes requires that we find new ways to harness these vast resources. The intent of this preliminary study design paper is to discuss the development of an approach which utilizes the MDS, in conjunction with KDD and classification algorithms, in an attempt to predict admission from a long-term care facility to an acute care facility. The use of acute care services by long term care residents is a negative outcome, potentially avoidable, and expensive. The value of the MDS warehouse can be realized by the use of the stored data in ways that can improve patient outcomes and avoid the use of expensive acute care services. This study, when completed, will test whether the MDS warehouse can be used to describe patient outcomes and possibly be of predictive value.

  20. Effectiveness of Hospital Functions for Acute Ischemic Stroke Treatment on In-Hospital Mortality: Results From a Nationwide Survey in Japan

    PubMed Central

    Iwamoto, Tetsuya; Hashimoto, Hideki; Horiguchi, Hiromasa; Yasunaga, Hideo

    2015-01-01

    Background Though evidence is limited in Japan, clinical controlled studies overseas have revealed that specialized care units are associated with better outcomes for acute stoke patients. This study aimed to examine the effectiveness of hospital functions for acute care of ischemic stroke on in-hospital mortality, with statistical accounting for referral bias. Methods We derived data from a large Japanese claim-based inpatient database linked to the Survey of Medical Care Institutions and Hospital Report data. We compared the mortality of acute ischemic stroke patients (n = 41 476) in hospitals certified for acute stroke treatment with that in non-certified institutions. To adjust for potential referral bias, we used differential distance to hospitals from the patient’s residence as an instrumental variable and constructed bivariate probit models. Results With the ordinary probit regression model, in-hospital mortality in certified hospitals was not significantly different from that in non-certified institutions. Conversely, the model with the instrumental variable method showed that admission to certified hospitals reduced in-hospital mortality by 30.7% (P < 0.001). This difference remained after adjusting for hospital size, volume, staffing, and intravenous use of tissue plasminogen activator. Conclusions Comparison accounting for referral selection found that certified hospital function for acute ischemic stroke care was associated with significantly lower in-hospital mortality. Our results indicate that organized stroke care—with certified subspecialty physicians and around-the-clock availability of personnel, imaging equipment, and emergency neurosurgical procedures in an intensive stroke care unit—is effective in improving outcomes in acute ischemic stroke care. PMID:26165489

  1. Selected enteropathogens and clinical course in children hospitalized with severe acute gastroenteritis in Barbados

    PubMed Central

    Kumar, Alok; Browne, Chantelle; Scotland, Shauna; Krishnamurthy, Kandamaran; Nielsen, Anders L

    2014-01-01

    Objectives The primary aim of this study was to determine the prevalence of selected bacterial and viral enteropathogens in children hospitalized with acute gastroenteritis and the secondary aim was to characterize the clinical course and the outcome. Methodology A retrospective audit of children (<15 years) admitted with acute gastroenteritis during January 2008 to October 2010. Stool samples were analyzed for bacterial pathogens and for the Rotavirus. Demographics, clinical presentations, hospital course and outcome were extracted from the admission records. Results There were 571 children hospitalized with acute gastroenteritis, which accounted for 11% of all medical hospitalization in children. Overall, 42.9% of these children were ≤12 months in age. Stool test result was documented in 46.6% of children hospitalized with gastroenteritis and an enteropathogen was isolated in 36.8% of cases with documented stool test result. Non-typhoidal Salmonella species was the most commonly isolated enteropathogen accounting for 21.1% of all the documented cases. Rotavirus was identified as an etiological agent in 9.0%. Of the 56 children who had non-typhoidal salmonella gastroenteritis, 54(96.4%) were younger than 5 years. The median duration of hospitalization was 2 days (Range 1 day to 9 days). There were no deaths. Conclusion Non-typhoidal salmonella was the most common enteropathogen isolated and this was followed by the Rotavirus. PMID:25780359

  2. Hypocapnia and Hypercapnia Are Predictors for ICU Admission and Mortality in Hospitalized Patients With Community-Acquired Pneumonia

    PubMed Central

    Laserna, Elena; Sibila, Oriol; Aguilar, Patrick R.; Mortensen, Eric M.; Anzueto, Antonio; Blanquer, Jose M.; Sanz, Francisco; Rello, Jordi; Marcos, Pedro J.; Velez, Maria I.; Aziz, Nivin

    2012-01-01

    Objective: The purpose of our study was to examine in patients hospitalized with community-acquired pneumonia (CAP) the association between abnormal Paco2 and ICU admission and 30-day mortality. Methods: A retrospective cohort study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of CAP. Arterial blood gas analyses were obtained with measurement of Paco2 on admission. Multivariate analyses were performed using 30-day mortality and ICU admission as the dependent measures. Results: Data were abstracted on 453 subjects with a documented arterial blood gas analysis. One hundred eighty-nine patients (41%) had normal Paco2 (35-45 mm Hg), 194 patients (42%) had a Paco2 < 35 mm Hg (hypocapnic), and 70 patients (15%) had a Paco2 > 45 mm Hg (hypercapnic). In the multivariate analysis, after adjusting for severity of illness, hypocapnic patients had greater 30-day mortality (OR = 2.84; 95% CI, 1.28-6.30) and a higher need for ICU admission (OR = 2.88; 95% CI, 1.68-4.95) compared with patients with normal Paco2. In addition, hypercapnic patients had a greater 30-day mortality (OR = 3.38; 95% CI, 1.38-8.30) and a higher need for ICU admission (OR = 5.35; 95% CI, 2.80-10.23). When patients with COPD were excluded from the analysis, the differences persisted between groups. Conclusion: In hospitalized patients with CAP, both hypocapnia and hypercapnia were associated with an increased need for ICU admission and higher 30-day mortality. These findings persisted after excluding patients with CAP and with COPD. Therefore, Paco2 should be considered for inclusion in future severity stratification criteria to appropriate identified patients who will require a higher level of care and are at risk for increased mortality. PMID:22677348

  3. Acute Surgical Unit at Auckland City Hospital: a descriptive analysis.

    PubMed

    Hsee, Li; Devaud, Marcelo; Middelberg, Lisa; Jones, Wayne; Civil, Ian

    2012-09-01

    Lack of timely assessment and access to acute operating rooms is a worldwide problem and also exists in New Zealand hospitals. To address these issues, an Acute Surgical Unit (ASU) was set up at Auckland City Hospital (ACH) in January 2009. This service has evolved and been modified to address the specific needs of acute surgical patients of ACH. Despite initial challenges inherent to setting up a new service, the Unit has been in steady operation and enhanced its performance over time. This paper is a descriptive analysis of the design of the ACH ASU and discusses some of the indications for streamlining acute surgical services at a large tertiary metropolitan hospital in New Zealand. Performance of the ASU has shown benefits for acute patients and the Hospital. The acute surgical rotation has also been beneficial for surgical training.

  4. Patient outcomes following after-hours and weekend admissions for cardiovascular disease in a tertiary hospital in Calabar, Nigeria

    PubMed Central

    Ansa, Victor; Njideoffor, Uchenna; Nworah,, Charles; Odigwe, Clement; Otu, Akaninyene; Oku, Affiong

    2016-01-01

    Summary Background There are various reports of higher mortality rates occurring after admissions over the weekend and during after-hours. This study aimed to determine if there was a difference in mortality rates occurring during the weekend and after-hours among cardiovascular admissions in a tertiary hospital in Nigeria. Methods A review of cardiovascular admissions (including stroke) was carried out at the University of Calabar Teaching Hospital in Nigeria from January 2010 to December 2013. All admissions to the medical wards from the emergency department and medical out-patient department clinics during the study period were included. Results A total of 339 patients were studied and stroke was the commonest type of cardiovascular disease (CVD) admitted (187; 55.2%). Hypertension was the commonest cause of heart failure (70; 48.6%). Presentation to hospital during after-hours and length of stay of more than 14 days were significant predictors of death (OR: 3.37; 0.22). Conclusion An increase in CVD mortality rates occurred during after-hours, most likely a consequence of uneven staffing patterns and poor access to equipment. Healthcare providers in Nigeria need to consider remedies to this with a view to reducing excess mortality rates. PMID:27080145

  5. 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 predictor of the number of self-harm admissions to general hospitals(B = 1.52, p < .01). Dysregulation predicted self-harm directly (B = 0.28, p < .05), and also through PTSD [corrected]. 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.

  6. Usefulness of Serum Triiodothyronine (T3) to Predict Outcomes in Patients Hospitalized With Acute Heart Failure.

    PubMed

    Rothberger, Gary D; Gadhvi, Sonya; Michelakis, Nickolaos; Kumar, Amit; Calixte, Rose; Shapiro, Lawrence E

    2017-02-15

    Thyroid hormone plays an important role in cardiac function. Low levels of serum triiodothyronine (T3) due to nonthyroidal illness syndrome may have adverse effects in heart failure (HF). This study was designed to assess the ability of T3 to predict in-hospital outcomes in patients with acute HF. In total, 137 patients without thyroid disease or treatment with drugs which affect TH levels, who were hospitalized with acute HF were prospectively enrolled and studied. TH levels were tested upon hospital admission, and outcomes were compared between patients with low (<2.3 pg/ml) and normal (≥2.3 pg/ml) free T3 levels as well as between those with low (<0.6 ng/ml) and normal (≥0.6 ng/ml) total T3 levels. Low free T3 correlated with an increased length of stay in the hospital (median 11 vs 7 days, p <0.001) and higher rates of intensive care unit admission (31.8% vs 16.9%, p = 0.047), with a trend toward increased need for invasive mechanical ventilation (9.0% vs 1.4%, p = 0.056). Low total T3 correlated with an increased length of stay in the hospital (median 11 vs 7 days, p <0.001) and increased need for invasive mechanical ventilation (9.8% vs 1.3%, p = 0.045). In conclusion, low T3 predicts worse hospital outcomes in patients with acute HF and can be useful in the risk stratification of these patients.

  7. Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality

    PubMed Central

    Sobolev, Boris G; Fradet, Guy; Hayden, Robert; Kuramoto, Lisa; Levy, Adrian R; FitzGerald, Mark J

    2008-01-01

    Background Many health care systems now use priority wait lists for scheduling elective coronary artery bypass grafting (CABG) surgery, but there have not yet been any direct estimates of reductions in in-hospital mortality rate afforded by ensuring that the operation is performed within recommended time periods. Methods We used a population-based registry to identify patients with established coronary artery disease who underwent isolated CABG in British Columbia, Canada. We studied whether postoperative survival during hospital admission for CABG differed significantly among patients who waited for surgery longer than the recommended time, 6 weeks for patients needing semi-urgent surgery and 12 weeks for those needing non-urgent surgery. Results Among 7316 patients who underwent CABG, 97 died during the same hospital admission, for a province-wide death rate at discharge of 1.3%. The observed proportion of patients who died during the same admission was 1.0% (27 deaths among 2675 patients) for patients treated within the recommended time and 1.5% (70 among 4641) for whom CABG was delayed. After adjustment for age, sex, anatomy, comorbidity, calendar period, hospital, and mode of admission, patients with early CABG were only 2/3 as likely as those for whom CABG was delayed to experience in-hospital death (odds ratio 0.61; 95% confidence interval [CI] 0.39 to 0.96). There was a linear trend of 5% increase in the odds of in-hospital death for every additional month of delay before surgery, adjusted OR = 1.05 (95% CI 1.00 to 1.11). Conclusion We found a significant survival benefit from performing surgical revascularization within the time deemed acceptable to consultant surgeons for patients requiring the treatment on a semi-urgent or non-urgent basis. PMID:18803823

  8. Home or hospital for people with dementia and one or more other multimorbidities: What is the potential to reduce avoidable emergency admissions? The HOMEWARD Project Protocol

    PubMed Central

    Voss, S; Black, S; Brandling, J; Buswell, M; Cheston, R; Cullum, S; Kirby, K; Purdy, S; Solway, C; Taylor, H; Benger, J

    2017-01-01

    Introduction Older people with multimorbidities frequently access 999 ambulance services. When multimorbidities include dementia, the risk of ambulance use, accident and emergency (A&E) attendance and hospital admission are all increased, even when a condition is treatable in the community. People with dementia tend to do poorly in the acute hospital setting and hospital admission can result in adverse outcomes. This study aims to provide an evidence-based understanding of how older people living with dementia and other multimorbidities are using emergency ambulance services. It will also provide evidence of how paramedics make decisions about taking this group of patients to hospital, and what resources would allow them to make more person-focused decisions to enable optimal patient care. Methods and analysis Phase 1: retrospective data analysis: quantitative analysis of ambulance service data will investigate: how often paramedics are called to older people with dementia; the amount of time paramedics spend on scene and the frequency with which these patients are transported to hospital. Phase 2: observational case studies: detailed case studies will be compiled using qualitative methods, including non-participant observation of paramedic decision-making, to understand why older people with multimorbidities including dementia are conveyed to A&E when they could be treated at home or in the community. Phase 3: needs analysis: nominal groups with paramedics will investigate and prioritise the resources that would allow emergency, urgent and out of hours care to be effectively delivered to these patients at home or in a community setting. Ethics and dissemination Approval for the study has been obtained from the Health Research Authority (HRA) with National Health Service (NHS) Research Ethics Committee approval for phase 2 (16/NW/0803). The dissemination strategy will include publishing findings in appropriate journals, at conferences and in newsletters. We will

  9. 77 FR 60315 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-03

    ...-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific...

  10. 78 FR 15882 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-13

    ...-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific...

  11. 77 FR 63751 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-17

    ...; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific Providers and for Ambulatory...

  12. Hospitals with briefer than average lengths of stays for common surgical procedures do not have greater odds of either re-admission or use of short-term care facilities.

    PubMed

    Dexter, F; Epstein, R H; Dexter, E U; Lubarsky, D A; Sun, E C

    2017-03-01

    We considered whether senior hospital managers and department chairs need to be concerned that small reductions in average hospital length of stay (LOS) may be associated with greater rates of re-admission, use of home health care, and/or transfers to short-term care facilities. The 2013 United States Nationwide Readmissions Database was used to study surgical Diagnosis Related Groups (DRG) with 1) national median LOS ≥3 days and 2) ≥10 hospitals in the database that each had ≥100 discharges for the DRG. Dependent variables were considered individually: 1) re-admission within 30 days of discharge, 2) discharge disposition to home health care, and/or 3) discharge disposition of transfer to short-term care facility (i.e., inpatient rehabilitation hospital or skilled nursing facility). While controlling for DRG, each one-day decrease in hospital median LOS was associated with an odds of re-admission nationwide of 0.95 (95% confidence interval [CI] 0.92-0.99; P=0.012), odds of disposition upon discharge being home care of 0.95 (95% CI 0.83-1.10; P=0.64), and odds of transfer to short-term care facility of 0.68 (95% CI 0.54-0.85; P=0.0008). Results were insensitive to the addition of patient-specific data. In the USA, patients at hospitals with briefer median LOS across multiple common surgical procedures did not have a greater risk for either hospital re-admission within 30 days of discharge or transfer to an inpatient rehabilitation hospital or a skilled nursing facility. The generalisable implication is that, across many surgical procedures, DRG-based financial incentives to shorten hospital stays seem not to influence post-acute care decisions.

  13. 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

  14. 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

  15. Very Long-Term Prognostic Role of Admission BNP in Non-ST Segment Elevation Acute Coronary Syndrome

    PubMed Central

    Bassan, Fernando; Bassan, Roberto; Esporcatte, Roberto; Santos, Braulio; Tura, Bernardo

    2016-01-01

    Background BNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known. Objective To determine the very long-term prognostic role of B-type natriuretic peptide (BNP) for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Methods A cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9.34-year follow-up for all-cause mortality. Results Unstable angina was diagnosed in 52.2%, and non-ST segment elevation myocardial infarction, in 47.8%. Median admission BNP was 81.9 pg/mL (IQ range = 22.2; 225) and mortality rate was correlated with increasing BNP quartiles: 14.3; 16.1; 48.2; and 73.2% (p < 0.0001). ROC curve disclosed 100 pg/mL as the best BNP cut-off value for mortality prediction (area under the curve = 0.789, 95% CI= 0.723-0.854), being a strong predictor of late mortality: BNP < 100 = 17.3% vs. BNP ≥ 100 = 65.0%, RR = 3.76 (95% CI = 2.49-5.63, p < 0.001). On logistic regression analysis, age >72 years (OR = 3.79, 95% CI = 1.62-8.86, p = 0.002), BNP ≥ 100 pg/mL (OR = 6.24, 95% CI = 2.95-13.23, p < 0.001) and estimated glomerular filtration rate (OR = 0.98, 95% CI = 0.97-0.99, p = 0.049) were independent late-mortality predictors. Conclusions BNP measured at hospital admission in patients with NSTEACS is a strong, independent predictor of very long-term all-cause mortality. This study allows raising the hypothesis that BNP should be measured in all patients with NSTEACS at the index event for long-term risk stratification. PMID:26840056

  16. Functional Changes during Hospital Stay in Older Patients Admitted to an Acute Care Ward: A Multicenter Observational Study

    PubMed Central

    De Buyser, Stefanie L.; Petrovic, Mirko; Taes, Youri E.; Vetrano, Davide L.; Corsonello, Andrea; Volpato, Stefano; Onder, Graziano

    2014-01-01

    Objectives Changes in physical performance during hospital stay have rarely been evaluated. In this study, we examined functional changes during hospital stay by assessing both physical performance and activities of daily living. Additionally, we investigated characteristics of older patients associated with meaningful in-hospital improvement in physical performance. Methods The CRiteria to assess appropriate Medication use among Elderly complex patients project recruited 1123 patients aged ≥65 years, consecutively admitted to geriatric or internal medicine acute care wards of seven Italian hospitals. We analyzed data from 639 participating participants with a Mini Mental State Examination score ≥18/30. Physical performance was assessed by walking speed and grip strength, and functional status by activities of daily living at hospital admission and at discharge. Meaningful improvement was defined as a measured change of at least 1 standard deviation. Multivariable logistic regression models predicting meaningful improvement, included age, gender, type of admission (through emergency room or elective), and physical performance at admission. Results Mean age of the study participants was 79 years (range 65–98), 52% were female. Overall, mean walking speed and grip strength performance improved during hospital stay (walking speed improvement: 0.04±0.20 m/s, p<0.001; grip strength improvement: 0.43±5.66 kg, p = 0.001), no significant change was observed in activities of daily living. Patients with poor physical performance at admission had higher odds for in-hospital improvement. Conclusion Overall, physical performance measurements show an improvement during hospital stay. The margin for meaningful functional improvement is larger in patients with poor physical function at admission. Nevertheless, most of these patients continue to have poor performance at discharge. PMID:24820733

  17. An analysis of admissions from 155 United States hospitals to determine the influence of weather on stroke incidence.

    PubMed

    Cowperthwaite, Matthew C; Burnett, Mark G

    2011-05-01

    Weather is the most frequently proposed factor driving apparent seasonal trends in stroke admissions. Here, we present the largest study of the association between weather and ischemic stroke in the USA to date. We consider admissions to 155 United States hospitals in 20 states during the five-year period from 2004 to 2008. The data set included 196,439 stroke admissions, which were classified as ischemic (n=98,930), hemorrhagic (n=18,960), or transient ischemic attack (n=78,549). Variations in stroke admissions were tested to determine if they tracked seasonal and transient weather patterns over the same time period. Using autocorrelation analyses, no significant seasonal changes in stroke admissions were observed over the study period. Using time-series analyses, no significant association was observed between any weather variable and any stroke subtype over the five-year study. This study suggests that seasonal associations between weather and stroke are highly confounded, and an association between weather and stroke is virtually non-existent. Therefore, previous studies reporting an association between specific weather patterns and stroke should be interpreted with caution.

  18. 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.

  19. Outcomes associated with acute exacerbations of chronic obstructive pulmonary disorder requiring hospitalization

    PubMed Central

    Gaude, Gajanan S; Rajesh, BP; Chaudhury, Alisha; Hattiholi, Jyothi

    2015-01-01

    Background: Acute exacerbations of chronic obstructive pulmonary disorder (AECOPD) are known to be associated with increased morbidity and mortality and have a significant socioeconomic impact. The factors that determine frequent hospital readmissions for AECOPD are poorly understood. The present study was done to ascertain failures rates following AECOPD and to evaluate factors associated with frequent readmissions. Materials and Methods: We conducted a prospective study among 186 patients with COPD with one or more admissions for acute exacerbations in a tertiary care hospital. Frequency of previous re-admissions for AECOPD in the past year, and clinical characteristics, including spirometry were ascertained in the stable state both before discharge and at 6-month post-discharge. Failure rates following treatment were ascertained during the follow-up period. All the patients were followed up for a period of 2 years after discharge to evaluate re-admissions for the AECOPD. Results: Of 186 COPD patients admitted for AECOPD, 54% had one or more readmission, and another 45% had two or more readmissions over a period of 2 years. There was a high prevalence of current or ex-heavy smokers, associated co-morbidity, underweight patients, low vaccination prevalence and use of domiciliary oxygen therapy among COPD patients. A total of 12% mortality was observed in the present study. Immediate failure rates after first exacerbation was observed to be 34.8%. Multivariate analysis showed that duration >20 years (OR = 0.37; 95% CI: 0.10-0.86), use of Tiotropium (OR = 2.29; 95% CI: 1.12-4.69) and use of co-amoxiclav during first admission (OR = 2.41; 95% CI: 1.21-4.79) were significantly associated with higher immediate failure rates. The multivariate analysis for repeated admissions revealed that disease duration >10 years (OR = 0.50; 95% CI: 0.27-0.93), low usage of inhaled ICS + LABA (OR = 2.21; 95% CI: 1.08-4.54), and MRC dyspnea grade >3 (OR = 2.51; 95% CI: 1.08-5.82) were

  20. Respiratory syncytial virus (RSV) in infants hospitalized for acute lower respiratory tract disease: incidence and associated risks.

    PubMed

    Riccetto, Adriana Gut Lopes; Ribeiro, José Dirceu; Silva, Marcos Tadeu Nolasco da; Almeida, Renata Servan de; Arns, Clarice Weis; Baracat, Emílio Carlos Elias

    2006-10-01

    Respiratory syncytial virus (RSV) is one of the main causes of acute lower respiratory tract infections worldwide. We examined the incidence and associated risks for RSV infection in infants hospitalized in two university hospitals in the state of São Paulo. We made a prospective cohort study involving 152 infants hospitalized for acute lower respiratory tract infections (ALRTI) in two university hospitals in Campinas, São Paulo, Brazil, between April and September 2004. Clinical and epidemiological data were obtained at admission. RSV was detected by direct immunofluorescence of nasopharyngeal secretions. Factors associated with RSV infection were assessed by calculating the relative risk (RR). The incidence of RSV infection was 17.5%. Risk factors associated with infection were: gestational age less than 35 weeks (RR: 4.17; 95% confidence interval (CI) 2.21-7.87); birth weight less than or equal to 2,500 grams (RR: 2.69; 95% CI 1.34-5.37); mother's educational level less than five years of schooling (RR: 2.28; 95% CI 1.13-4.59) and pulse oximetry at admission to hospital lower than 90% (RR: 2.19; 95% CI 1.10-4.37). Low birth weight and prematurity are factors associated with respiratory disease due to RSV in infants. Low educational level of the mother and poor socioeconomic conditions also constitute risk factors. Hypoxemia in RSV infections at admission indicates potential severity and a need for early oxygen therapy.

  1. Traumatic brain injury in Portugal: trends in hospital admissions from 2000 to 2010.

    PubMed

    Dias, Celeste; Rocha, João; Pereira, Eduarda; Cerejo, António

    2014-01-01

    Introdução: O traumatismo crânio-encefálico tem um impacto sócio-económico considerável, sendo uma importante causa de mobimortalidade, frequentemente causador de incapacidade permanente. Procuramos caracterizar a utilização dos recursos de saúde de adultos com traumatismo crânio-encefálico em Portugal entre 2000-2010. Material e Métodos: Estudo retrospectivo de registos de adultos com código ICD9 de traumatismo crânio-encefálico incluídos na Base-de-Dados Nacional de Grupos Diagnósticos Homogéneos de 2000-2010. Realizamos uma análise estatística descritiva e avaliamos as tendências durante a década. Resultados: Analisamos 72 865 admissões em 111 hospitais, 64,1% do sexo masculino, idade média de 57,9 ± 21,8 anos (18-107). Encontramos uma diminuição no número de traumatismo crânio-encefálico em pacientes jovens e um aumento nos mais velhos. O número de acidentes de trânsito diminuiu e o número de quedas aumentou. Houve um aumento de traumatismos crânio-encefálicos moderados-graves internados: 47,2% em 2000 / 80% em 2010. O número de admissões em Cuidados Intensivos quase duplicou (15,8% vs 29,5%), assim como o número de procedimentos neurocirúrgicos efectuados (8,2% vs 15,2%). A mortalidade total aumentou de 7,1% para 10,6%. Discussão: A diminuição do traumatismo crânio-encefálico observada pode estar associada com as campanhas de prevenção rodoviária, melhoria da rede rodoviária e políticas de saúde. O aumento da mortalidade poderá ser explicado pelo melhor atendimento pré-hospitalar, permitindo que casos mais graves cheguem ao hospital com vida e, embora tratados com mais frequência em Cuidados Intensivos e exigindo procedimentos neurocirúrgicos, vêm a falecer. Por outo lado, o aumento da idade dos doentes presumivelmente com maiores co-morbilidades associadas ao envelhecimento também estará a contribuir para a maior mortalidade. Conclusão: O traumatismo crânio-encefálico em Portugal está a mudar

  2. 75 FR 34614 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-17

    ..., 2010 unless otherwise footnoted).'' c. Third column, the title, ``Table 4J.--Out-Migration Adjustment...) Out-Migration Adjustment for Acute Care Hospitals--FY 2010 (April 1, 2010 through September 30, 2010...: Table 4J--(Abbreviated) Out-Migration Adjustment for Acute Care Hospitals--FY 2010 (April 1,...

  3. Relating weather types to asthma-related hospital admissions in New York State.

    PubMed

    Lee, Cameron C; Sheridan, Scott C; Lin, Shao

    2012-12-01

    Many previous studies have looked into the relationship between asthma and individual weather variables, but comparatively few have looked at this relationship using holistic weather types (WTs). Utilizing the Spatial Synoptic Classification, this research considers up to 6 days of lag time while investigating the asthma-to-WT relationship in two age groups (under 18 and 18 and over) throughout New York State. Results indicate that a cold and dry WT in autumn corresponds to increased asthma admissions and spike days in admissions in New York City (NYC) for the school-aged population, while hot and dry WTs in summer correspond to spike days in asthma admissions in both age groups. However, results vary considerably for other regions, seasons and WTs, and spike day analysis yields clearer results than the analysis of total anomalous admissions. When stratified by multiple regions and age groups, the sample size of daily asthma admissions is a limiting factor outside of NYC.

  4. 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.

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

    PubMed

    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.

  6. The Effects of Hospital Length of Stay on Readmissions for Children With Newly Diagnosed Acute Lymphoblastic Leukemia.

    PubMed

    Wedekind, Mary F; Dennis, Robyn; Sturm, Mollie; Koch, Terah; Stanek, Joseph; O'Brien, Sarah H

    2016-07-01

    Although regimens for induction therapy in children with acute lymphoblastic leukemia (ALL) are similar across the United States, typical practice with regard to inpatient length of stay (LOS) varies by institution. US children's hospitals were categorized by typical induction LOS; and readmissions, pediatric intensive care unit (PICU) admissions, and average adjusted charges were compared for the first 30 days from initial admission. Using Pediatric Health Information System data, we extracted ALL induction admissions from 2007 to 2013. We categorized hospitals into 3 categories based on median LOS: short (≤7 d), medium (8 to 15 d), or long (≥16 d). Median LOS varied from 5 to 31 days across hospitals. Thirty-day median inpatient costs per patient ranged from $32 K for short LOS, $40 K for medium LOS, and $47 K for long LOS. Compared with short LOS hospitals (n=14), medium LOS (n=8) and long LOS hospitals (n=8) had lower odds of PICU readmissions (odds ratio [OR], 0.68; P=0.0124 and OR, 0.31; P<0.001, respectively), and long LOS hospitals had lower odds of any readmission (OR, 0.44; P<0.0001). Average LOS for children with newly diagnosed ALL varies widely by institution. Children's hospitals that typically admit new ALL patients for >7 days have fewer PICU readmissions but substantial increase in total induction inpatient costs.

  7. 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.

  8. Referral pathways for patients with TIA avoiding hospital admission: a scoping review

    PubMed Central

    Evans, Bridie Angela; Ali, Khalid; Bulger, Jenna; Ford, Gary A; Jones, Matthew; Moore, Chris; Porter, Alison; Pryce, Alan David; Quinn, Tom; Seagrove, Anne C; Whitman, Shirley; Rees, Nigel

    2017-01-01

    Objective To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital. Design Scoping review. Data sources PubMed, CINAHL Web of Science, Scopus. Study selection Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services. Data extraction We screened studies for eligibility and extracted data from relevant studies. Data were analysed to describe setting, assessment and referral processes, treatment, implementation and outcomes. Results 8 international studies were identified, mostly cohort designs. 4 pathways were used by family doctors and 3 pathways by emergency department physicians. No pathways used by paramedics were found. Referrals were made to specialist clinic either directly or via a 24-hour helpline. Practitioners identified TIA symptoms and risk of further events using a checklist including the ABCD2 tool or clinical assessment. Antiplatelet medication was often given, usually aspirin unless contraindicated. Some patients underwent tests before referral and discharge. 5 studies reported reduced incident of stroke at 90 days, from 6–10% predicted rate to 1.3–2.1% actual rate. Between 44% and 83% of suspected TIA cases in these studies were referred through the pathways. Conclusions Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalisation of patients with TIA. No pathways for paramedical use were reported. We will use results of this scoping review to inform development of a paramedical referral pathway to be tested in a feasibility trial. Trial registration number ISRCTN85516498. Stage: pre-results. PMID:28196949

  9. 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

  10. Surgical management of pneumothorax: significance of effective admission or communication strategies between the district general hospitals and specialized unit.

    PubMed

    Aslam, Muhammad I; Martin-Ucar, Antonio E; Nakas, Apostolos; Waller, David A

    2011-11-01

    A preoperative delay in emergency surgery for spontaneous pneumothorax is associated with a poor outcome after surgery and a prolonged hospital stay. To reduce preoperative delays, all tertiary referrals from district general hospitals to our thoracic surgery unit were processed through a 'clinical decisions unit' (CDU). Prior to the establishment of the CDU, these patients were added to a waiting list for a surgical bed. This study has reviewed the effect of this change in admission policy on the efficiency of treatment for non-elective spontaneous pneumothorax. An intergroup comparison (pre-CDU group vs. post-CDU group) was made of the following parameters: referral to transfer time, transfer to surgery time and length of inpatient stay in the referring and tertiary hospitals. There were no significant differences in gender, diagnosis, treatment in the referring hospitals, postoperative clinical outcome, or indications for or type of surgery. The total length of inpatient stay in the referring and tertiary hospitals was significantly reduced for the post-CDU group (12 vs. 15 days; P<0.001), which was attributed to the earlier transfer of patients (18 vs. 78 hours; P<0.001) hours. Allowing surgical access to a traditional medical admission unit is therefore, cost-effective and significantly improves the efficiency of non-elective pneumothorax surgery.

  11. Angioedema Related to Angiotensin-Converting Enzyme Inhibitors: Attack Severity, Treatment, and Hospital Admission in a Prospective Multicenter Study.

    PubMed

    Javaud, Nicolas; Achamlal, Jallal; Reuter, Paul-George; Lapostolle, Frédéric; Lekouara, Akim; Youssef, Mustapha; Hamza, Lilia; Karami, Ahmed; Adnet, Frédéric; Fain, Olivier

    2015-11-01

    The number of cases of acquired angioedema related to angiotensin converting enzyme inhibitors induced (ACEI-AAE) is on the increase, with a potential concomitant increase in life-threatening attacks of laryngeal edema. Our objective was to determine the main characteristics of ACEI-AAE attacks and, in doing so, the factors associated with likelihood of hospital admission from the emergency department (ED) after a visit for an attack.A prospective, multicenter, observational study (April 2012-December 2014) was conducted in EDs of 4 French hospitals in collaboration with emergency services (SAMU 93) and a reference center for bradykinin-mediated angioedema. For each patient presenting with an attack, emergency physicians collected demographic and clinical presentation data, treatments, and clinical course. They recorded time intervals from symptom onset to ED arrival and to treatment decision, from ED arrival to specific treatment with plasma-derived C1-inhibitor (C1-INH) or icatibant, and from specific treatment to onset of symptom relief. Attacks requiring hospital admission were compared with those not requiring admission.Sixty-two eligible patients with ACEI-AAE (56% men, median age 63 years) were included. Symptom relief occurred significantly earlier in patients receiving specific treatment than in untreated patients (0.5 [0.5-1.0] versus 3.9 [2.5-7.0] hours; P < 0.0001). Even though icatibant was injected more promptly than plasma-derived C1-INH, there, however, was no significant difference in median time to onset of symptom relief between the 2 drugs (0.5 [0.5-1.3] versus 0.5 [0.4-1.0] hours for C1-INH and icatibant, respectively, P = 0.49). Of the 62 patients, 27 (44%) were admitted to hospital from the ED. In multivariate analysis, laryngeal involvement and progressive swelling at ED arrival were independently associated with admission (Odds ratio [95% confidence interval] = 6.2 [1.3-28.2] and 5.9 [1.3-26.5], respectively). A favorable course

  12. Door locking and exit security measures on acute psychiatric admission wards.

    PubMed

    Nijman, H; Bowers, L; Haglund, K; Muir-Cochrane, E; Simpson, A; Van Der Merwe, M

    2011-09-01

    Locking the exit doors of psychiatric wards is believed to reduce the risk of patients absconding. The aims of the study were to investigate both the prevalence of door locking and other exit security measures on UK admission wards, as well as whether door locking appears to be effective in keeping inpatients in. A cross-sectional survey on 136 acute psychiatric wards in the UK was conducted, in which a range of data on patients, staff, and conflict and containment events, including door locking and absconding, were collected from shift to shift during a period of 6 months. About one-third of the participating wards (30%) operated with their ward exit door permanently locked, whereas another third (34%) never locked the ward door. Univariate analyses suggested little association between exit security measures and absconding. A more robust multilevel statistical analysis, however, did indicate a reduction of about 30% of absconding rates when the ward door was locked the entire shift. Although locking the ward door does seem to reduce absconding to a certain extent, it far from completely prevents it. As it may be unrealistic to strive for a 100% absconding-proof ward, alternative measures for door locking to prevent absconding are discussed.

  13. The European positional paper on rhinosinusitis and nasal polyps: has the introduction of guidance on the management of sinus disease affected uptake of surgery and acute admissions for sinusitis?

    PubMed

    Cosway, Ben; Tomkinson, Alun; Owens, David

    2013-03-01

    Rhinosinusitis is a common condition with adults experiencing 2-5 episodes per year. The European Positional Paper on Rhinosinusitis and Nasal Polyps (EP3OS) published in 2005 and updated in 2007 provided evidence-based guidelines on the management of sinus disease promoting a conservative approach to treatment. This study examines the effect of EP3OS on sinus surgery uptake and acute admissions for sinusitis in England and Wales. A retrospective study using the national electronic health databases of England (Hospital Episodes Statistics, HES online) and Wales (Patient Episodes Database of Wales, PEDW) was undertaken from 2000 to 2010 using the OPCS-4 codes E12-E17 (sinus surgery) and ICD10 code J01 (acute admission for sinusitis). Data were analysed for effect following the introduction of the EP3OS in 2005 using linear regression and Chi squared analysis. 116,370 sinus procedures and 10,916 acute admissions for sinusitis were made during the study period. No significant decrease in sinus surgery procedures occurred following the introduction of the EP3OS as may have been expected (p > 0.05), although subgroup analysis suggested a significant increase in Wales (p < 0.05). In addition, significant increases in acute admissions for sinusitis were observed following the introduction of EP3OS (p < 0.05). However, subgroup analysis suggested this was not the case in Wales (p > 0.05). The EP3OS appears to have had little impact on the rates of sinus surgery but more conservative approaches to managing of sinus disease may have led to an increase in acute admissions. Further research is required to investigate whether changes in practice were adopted.

  14. Contrasting patterns of hospital admissions and mortality during heat waves: are deaths from circulatory disease a real excess or an artifact?

    PubMed

    Mastrangelo, Giuseppe; Hajat, Shakoor; Fadda, Emanuela; Buja, Alessandra; Fedeli, Ugo; Spolaore, Paolo

    2006-01-01

    In old subjects exposed to extreme high temperature during a heat wave, studies have consistently reported an excess of death from cardio- or cerebro-vascular disease. By contrast, dehydration, heat stroke, acute renal insufficiency, and respiratory disease were the main causes of hospital admission in the two studies carried out in elderly during short spells of hot weather. The excess of circulatory disease reported by mortality studies, but not by morbidity studies, could be explained by the hypothesis that deaths from circulatory disease occur rapidly in isolated people before they reach a hospital. Since the contrasting patterns of hospital admission and mortality during heat waves could also be due to chance (random variation over time and space in the spectrum of diseases induced by extreme heat), and bias (poor quality of diagnosis on death certificate and other artifacts), it should be confirmed by a concurrent study of mortality and morbidity. Many heat-related diseases may be preventable with adequate warning and an appropriate response to heat emergencies, but preventive efforts are complicated by the short time interval that may elapse between high temperatures and death. Therefore, prevention programs must be based around rapid identification of high-risk conditions and persons. The effectiveness of the intervention measures must be formally evaluated. If cardio- and cerebro-vascular diseases are rapidly fatal health outcomes with a short time interval between exposure to high temperature and death, deaths from circulatory disease might be an useful indicator in evaluating the effectiveness of a heat watch/warning system.

  15. Risk-standardized Acute Admission Rates Among Patients With Diabetes and Heart Failure as a Measure of Quality of Accountable Care Organizations: Rationale, Methods, and Early Results

    PubMed Central

    Spatz, Erica S.; Lipska, Kasia J.; Dai, Ying; Bao, Haikun; Lin, Zhenqiu; Parzynski, Craig S.; Altaf, Faseeha K.; Joyce, Erin K.; Montague, Julia A.; Ross, Joseph S.; Bernheim, Susannah M.; Krumholz, Harlan M.; Drye, Elizabeth E.

    2017-01-01

    Background Population-based measures of admissions among patients with chronic conditions are important quality indicators of Accountable Care Organizations (ACOs), yet there are challenges in developing measures that enable fair comparisons among providers. Methods Based on consensus standards for outcome measure development and with expert and stakeholder input on methods decisions, we developed and tested two models of risk-standardized acute admission rates (RSAARs) for patients with diabetes and heart failure using 2010–2012 Medicare claims data. Model performance was assessed with deviance R-squared; score reliability was tested with intraclass correlation coefficient. We estimated RSAARs for 114 Shared Savings Program ACOs in 2012 and we assigned ACOs to 3 performance categories: no different, worse than, and better than the national rate. Results The diabetes and heart failure cohorts included 6.5 and 2.6 million Medicare fee-for-service (FFS) beneficiaries aged ≥65 years, respectively. Risk-adjustment variables were age, comorbidities and condition-specific severity variables, but not socioeconomic status or other contextual factors. We selected hierarchical negative binomial models with the outcome of acute, unplanned hospital admissions per 100 person-years. For the diabetes and heart failure measures respectively, the models accounted for 22% and 12% of the deviance in outcomes and score reliability was 0.89 and 0.77. For the diabetes measure, 51 (44.7%) ACOs were no different, 45 (39.5%) were better, and 18 (15.8%) were worse than the national rate. The distribution of performance for the heart failure measure was: 61 (53.5%);,37 (32.5%) and 16 (14.0%), respectively. Conclusion Measures of RSAARs for patients with diabetes and heart failure meet criteria for scientific soundness and reveal important variation in quality across ACOs. PMID:26918404

  16. [Rad-Esito: new informational debt as integration of hospital discharge cards for acute patients].

    PubMed

    Rini, F; Piscioneri, C; Consolante, C; Fara, G M; Marino, M G; Conte, A; Maurici, M

    2009-01-01

    Since the January 2008 the tracking of additional information about hospital discharge card's content has been activated in Latium. The new data, noticed by RAD-Esito card, regard the hospitalizations for acute myocardial infarction, femoral neck fracture and coronary artery bypass surgery. This study's objective has been to evaluate the quality of the data collected with the new card, at the end of the 1st semester of experimentation, concerning two institutes of care of Latium (Region of Central Italy), the Casilino Polyclinic (ASL Rome B) and the Anzio-Nettuno hospital (Assembled Hospitals, ASL Rome H). Furthermore, any significant correlation's existence between variables for acute myocardial infarction and femoral fracture with the mortality rate and an increased average hospitalization period has been statistically verified. In acute myocardial infarction mortality is significantly related to a low systolic blood pressure (<130 mmHg) at admission (p < 0.02) and to having no surgical intervention instead of transcutaneous transluminal coronary angioplastic surgery (p < 0.0001); in this case there is also an increased average hospitalization period (p < 0.03). In femoral neck fracture mortality is significantly related to having a conservative surgery instead of fracture reduction or prosthesis implantation (p < 0.0002).This study's preliminary results show how the integration of the hospital informative flow with the new clinical variables will be able to allow the promotion of the quality in the coding of the diagnosis and procedures, according to the current international innovations. This additional information will also be able to support the regional appropriateness and outcome of the treatments evaluation programs.

  17. Retrospective observational study of trends in hospital admissions for idiopathic pulmonary fibrosis in Spain (2004–2013) using administrative data

    PubMed Central

    Pedraza-Serrano, Fernando; López de Andrés, Ana; Jiménez-García, Rodrigo; Jiménez-Trujillo, Isabel; Hernández-Barrera, Valentín; Sánchez-Muñoz, Gema; Puente-Maestu, Luis; de Miguel-Díez, Javier

    2017-01-01

    Objective To assess changes in incidence, diagnostic procedures, comorbidity profiles, length of hospital stay (LOHS), economic costs and in-hospital mortality (IHM) associated with idiopathic pulmonary fibrosis (IPF). Methods We identified patients hospitalised with IPF in Spain from 2004 to 2013. Data were collected from the National Hospital Discharge Database. Results The study population comprised 22 214 patients. Overall crude incidence increased from 3.82 to 6.98 admissions per 100 000 inhabitants from 2004 to 2013 (p<0.05). The percentage of lung biopsies decreased significantly from 10.68% in 2004 to 9.04% in 2013 (p<0.05). The percentage of patients with a Charlson comorbidity index ≥2 was 15.14% in 2004, increasing to 26.95% in 2013 (p<0.05). IHM decreased from 14.77% in 2004 to 13.72% in 2013 (adjusted OR 0.98; 95% CI 0.97 to 0.99). Mean LOHS was 11.87±11.18 days in 2004, decreasing to 10.20±11.12 days in 2013 (p<0.05). The mean cost per patient increased from €4838.51 in 2004 to €5410.90 in 2013 (p<0.05). Conclusions The frequency of hospital admissions for IPF increased during the study period, as did healthcare costs. However, IHM and LOHS decreased. PMID:28193850

  18. S(p)O(2) values in acute medical admissions breathing air--implications for the British Thoracic Society guideline for emergency oxygen use in adult patients?

    PubMed

    Smith, Gary B; Prytherch, David R; Watson, Duncan; Forde, Val; Windsor, Alastair; Schmidt, Paul E; Featherstone, Peter I; Higgins, Bernie; Meredith, Paul

    2012-10-01

    S(p)O(2) is routinely used to assess the well-being of patients, but it is difficult to find an evidence-based description of its normal range. The British Thoracic Society (BTS) has published guidance for oxygen administration and recommends a target S(p)O(2) of 94-98% for most adult patients. These recommendations rely on consensus opinion and small studies using arterial blood gas measurements of saturation (S(a)O(2)). Using large datasets of routinely collected vital signs from four hospitals, we analysed the S(p)O(2) range of 37,593 acute general medical inpatients (males: 47%) observed to be breathing room air. Age at admission ranged from 16 to 105 years with a mean (SD) of 64 (21) years. 19,642 admissions (52%) were aged <70 years. S(p)O(2) ranged from 70% to 100% with a median (IQR) of 97% (95-98%). S(p)O(2) values for males and females were similar. In-hospital mortality for the study patients was 5.27% (range 4.80-6.27%). Mortality (95% CI) for patients with initial S(p)O(2) values of 97%, 96% and 95% was 3.65% (3.22-4.13); 4.47% (3.99-5.00); and 5.67% (5.03-6.38), respectively. Additional analyses of S(p)O(2) values for 37,299 medical admissions aged ≥18 years provided results that were distinctly different to those upon which the current BTS guidelines based their definition of normality. Our findings suggest that the BTS should consider changing its target saturation for actively treated patients not at risk of hypercapnic respiratory failure to 96-98%.

  19. Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study

    PubMed Central

    Howard, R; Avery, A; Howard, P; Partridge, M

    2003-01-01

    Objective: To describe the drugs and types of medicine management problems most frequently associated with preventable drug related admissions to an acute medical admissions unit. Design: Observation study. Setting: Medical admissions unit in a teaching hospital in Nottingham, UK. Participants: 4093 patients seen by pharmacists on the medical admissions unit between 1 January and 30 June 2001. Main outcome measures: Proportion of admissions that were drug related and preventable, classification of the underlying causes of preventable drug related admissions, and identification of drugs most commonly associated with preventable drug related admissions. Results: Of the admissions seen by pharmacists, 265 (6.5%) were judged to be drug related and 178 (67%) of these were judged to be preventable. Preventable admissions were mainly due to problems with prescribing (63 cases (35%)), monitoring (46 cases (26%)), and adherence to medication (53 cases (30%)). The drugs most commonly implicated were NSAIDs, antiplatelets, antiepileptics, hypoglycaemics, diuretics, inhaled corticosteroids, cardiac glycosides, and beta-blockers. Conclusions: Potentially preventable drug related morbidity was associated with 4.3% of admissions to a medical admissions unit. In 91% of cases these admissions were related to problems with either prescribing, monitoring, or adherence. PMID:12897361

  20. Evidence for a persistent, major excess in all cause admissions to hospital in children with type-1 diabetes: results from a large Welsh national matched community cohort study

    PubMed Central

    Sayers, Adrian; Thayer, Daniel; Harvey, John N; Luzio, Stephen; Atkinson, Mark D; French, Robert; Warner, Justin T; Dayan, Colin M; Wong, Susan F; Gregory, John W

    2015-01-01

    Objectives To estimate the excess in admissions associated with type1 diabetes in childhood. Design Matched-cohort study using anonymously linked hospital admission data. Setting Brecon Group Register of new cases of childhood diabetes in Wales linked to hospital admissions data within the Secure Anonymised Information Linkage Databank. Population 1577 Welsh children (aged between 0 and 15 years) from the Brecon Group Register with newly-diagnosed type-1 diabetes between 1999–2009 and 7800 population controls matched on age, sex, county, and deprivation, randomly selected from the local population. Main outcome measures Difference in all-cause hospital admission rates, 30-days post-diagnosis until 31 May 2012, between participants and controls. Results Children with type-1 diabetes were followed up for a total of 12 102 person years and were at 480% (incidence rate ratios, IRR 5.789, (95% CI 5.34 to 6.723), p<0.0001) increased risk of hospital admission in comparison to matched controls. The highest absolute excess of admission was in the age group of 0–5 years, with a 15.4% (IRR 0.846, (95% CI 0.744 to 0.965), p=0.0061) reduction in hospital admissions for every 5-year increase in age at diagnosis. A trend of increasing admission rates in lower socioeconomic status groups was also observed, but there was no evidence of a differential rate of admissions between men and women when adjusted for background risk. Those receiving outpatient care at large centres had a 16.1% (IRR 0.839, (95% CI 0.709 to 0.990), p=0.0189) reduction in hospital admissions compared with those treated at small centres. Conclusions There is a large excess of hospital admissions in paediatric patients with type-1 diabetes. Rates are highest in the youngest children with low socioeconomic status. Factors influencing higher admission rates in smaller centres (eg, “out of hours resources”) need to be explored with the aim of targeting modifiable influences on admission rates. PMID

  1. The effect of testosterone and a nutritional supplement on hospital admissions in under-nourished, older people

    PubMed Central

    2011-01-01

    Background Weight loss and under-nutrition are relatively common in older people, and are associated with poor outcomes including increased rates of hospital admissions and death. In a pilot study of 49 undernourished older, community dwelling people we found that daily treatment for one year with a combination of testosterone tablets and a nutritional supplement produced a significant reduction in hospitalizations. We propose a larger, multicentre study to explore and hopefully confirm this exciting, potentially important finding (NHMRC project grant number 627178). Methods/Design One year randomized control trial where subjects are allocated to either oral testosterone undecanoate and high calorie oral nutritional supplement or placebo medication and low calorie oral nutritional supplementation. 200 older community-dwelling, undernourished people [Mini Nutritional Assessment score <24 and either: a) low body weight (body mass index, in kg/m2: <22) or b) recent weight loss (>7.5% over 3 months)]. Hospital admissions, quality-adjusted life years, functional status, nutritional health, muscle strength, body composition and other variables will be assessed. Discussion The pilot study showed that combined treatment with an oral testosterone and a supplement drink was well tolerated and safe, and reduced the number of people hospitalised and duration of hospital admissions in undernourished, community dwelling older people. This is an exciting finding, as it identifies a treatment which may be of substantial benefit to many older people in our community. We now propose to conduct a multi-centre study to test these findings in a substantially larger subject group, and to determine the cost effectiveness of this treatment. Trial registration Australian Clinical Trial Registry: ACTRN 12610000356066 PMID:22023735

  2. The role of rhinovirus in children hospitalized for acute respiratory disease, Santa Fe, Argentina.

    PubMed

    Rudi, Juan Manuel; Molina, Fabiana; Díaz, Rocío; Bonet, Virginia; Ortellao, Lucila; Cantarutti, Diego; Gómez, Alejandra; Pierini, Judith; Cociglio, Raquel; Kusznierz, Gabriela

    2015-12-01

    Human rhinoviruses (HRVs) were historically considered upper airway pathogens. However, they have recently been proven to cause infections in the lower respiratory tract, resulting in hospitalization of children with pneumonia, bronchiolitis, and chronic pulmonary obstruction. In this report, HRV frequency and seasonality are described together with patient clinical-epidemiological aspects. From a total of 452 surveyed samples, the HRV nucleic acids was detected in 172 (38.1%) and found in every month of the study year. 60% of inpatients with acute respiratory infection (ARI) associated with HRV were under 6 months of age and 31% had a clinical history, being preterm birth and recurrent wheezing the prevailing conditions. The most frequent discharge diagnoses were pneumonia (35.2%), bronchiolitis (32.4%), and bronchitis (12.4%). Fifteen point nine percent of patients required admission into intensive care units. The results obtained in this study demonstrated the association between HRV and children hospitalizations caused by ARI.

  3. Trajectories of disability among older persons before and after a hospitalization leading to a skilled nursing facility admission

    PubMed Central

    Buurman, Bianca M.; Han, Ling; Murphy, Terrence E.; Gahbauer, Evelyne A.; Leo-Summers, Linda; Allore, Heather G.; Gill, Thomas M.

    2015-01-01

    Objectives To identify distinct sets of disability trajectories in the year before and after a Q-SNF admission, evaluate the associations between the pre- and post-Q-SNF disability trajectories, and determine short-term outcomes (readmission, mortality). Design, setting and participants Prospective cohort study including 754 community-dwelling older persons, 70+ years, and initially nondisabled in their basic activities of daily living. The analytic sample included 394 persons, with a first hospitalization followed by a Q-SNF admission between 1998–2012. Main outcomes and measures Disability in the year before and after a Q-SNF admission using 13 basic, instrumental and mobility activities. Secondary outcomes included 30-day readmission and 12-month mortality. Results The mean (SD) age of the sample was 84.9(5.5) years. We identified three disability trajectories in the year before a Q-SNF admission: minimal disability (37.3% of participants) mild disability (44.6%), and moderate disability (18.2%). In the year after a Q-SNF admission, all participants started with moderate to severe disability scores. Three disability trajectories were identified: substantial improvement (26.0% of participants), minimal improvement (36.5%), and no improvement (37.5%). Among participants with minimal disability pre-Q-SNF, 52% demonstrated substantial improvement; the other 48% demonstrated minimal improvement (32%) or no improvement (16%) and remained moderately to severely disabled in the year post-Q-SNF. Among participants with mild disability pre-Q-SNF, 5% showed substantial improvement, whereas 95% showed little to no improvement. Of participants with moderate disability pre-Q-SNF, 15% remained moderately disabled showing little improvement, whereas 85% showed no improvement. Participants who transitioned from minimal disability pre-Q-SNF to no improvement post-Q-SNF had the highest rates of 30-day readmission and 12-month mortality (rate/100 person days 1.3 [95% CI 0.6–2

  4. Hospital readmission from post-acute care facilities: risk factors, timing, and outcomes

    PubMed Central

    Burke, Robert E.; Whitfield, Emily A.; Hittle, David; Min, Sung-joon; Levy, Cari; Prochazka, Allan V.; Coleman, Eric A.; Schwartz, Robert; Ginde, Adit A.

    2016-01-01

    Objectives Hospital discharges to post-acute care (PAC) facilities have increased rapidly. This increase may lead to more hospital readmissions from PAC facilities, which are common and poorly understood. We sought to determine the risk factors and timing for hospital readmission from PAC facilities and evaluate the impact of readmission on patient outcomes. Design Retrospective analysis of Medicare Current Beneficiary Survey (MCBS) from 2003–2009. Setting The MCBS is a nationally-representative survey of beneficiaries matched with claims data. Participants Community-dwelling beneficiaries who were hospitalized and discharged to a PAC facility for rehabilitation. Intervention/Exposure Potential readmission risk factors included patient demographics, health utilization, active medical conditions at time of PAC admission, and PAC characteristics. Measurements Hospital readmission during the PAC stay, return to community residence, and all-cause mortality. Results Of 3246 acute hospitalizations followed by PAC facility stays, 739 (22.8%) included at least 1 hospital readmission. The strongest risk factors for readmission included impaired functional status (HR 4.78, 95% CI 3.21–7.10), markers of increased acuity such as need for intravenous medications in PAC (1.63, 1.39–1.92), and for-profit PAC ownership (1.43, 1.21–1.69). Readmitted patients had a higher mortality rate at both 30 days (18.9 vs. 8.6%, p<0.001) and 100 days (39.9 vs. 14.5%, p<0.001) even after adjusting for age, comorbidities, and prior health care utilization (30 days: OR 2.01, 95% CI 1.60–2.54; 100 days: OR 3.79, 95% CI 3.13–4.59). Conclusions Hospital readmission from PAC facilities is common and associated with a high mortality rate. Readmission risk factors may signify inadequate transitional care processes or a mismatch between patient needs and PAC resources. PMID:26715357

  5. Comparing the validity of different measures of illness severity: a hospital-level analysis for acute myocardial infarction.

    PubMed

    Gandjour, Afschin; Ku-Goto, Meei-Hsiang; Ho, Vivian

    2012-08-01

    The aim of the study is to assess the validity of three measures of illness severity (prior year's hospital expenditures, Charlson and Elixhauser indices), by analysing the effect of introducing report cards on hospitals treating patients with acute myocardial infarction (AMI). Medicare claims data were obtained for 1992-1997 for AMI patients aged 65+. We used differences-in-differences regression analysis to assess the impact of report cards introduced in New Jersey and Pennsylvania on the illness severity of AMI patients with and without coronary artery bypass graft (CABG) surgery (relative to states without report cards). The analysis was conducted at the hospital level. For validation we used raw mortality and re-admission trends for AMI patients. While prior hospital expenditures suggest a considerable change in the illness severity of AMI patients in Pennsylvania relative to other states, raw mortality and re-admission trends in Pennsylvania are relatively consistent with the trend in the rest of the USA. In line with raw mortality and re-admission data, the Charlson and Elixhauser indices do not imply a considerable change in the severity of AMI patients in Pennsylvania. For CABG patients, illness severity - as measured by all three severity measurement methods - decreased after introduction of report cards, particularly in Pennsylvania. In conclusion, for AMI patients the Charlson and Elixhauser indices are a more valid measure of illness severity than prior year's hospital expenditures. After report cards were introduced, healthier AMI patients were more likely to receive CABG surgery, while sicker patients were avoided.

  6. Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure.

    PubMed

    Mokart, Djamel; Lambert, Jérôme; Schnell, David; Fouché, Louis; Rabbat, Antoine; Kouatchet, Achille; Lemiale, Virginie; Vincent, François; Lengliné, Etienne; Bruneel, Fabrice; Pene, Frederic; Chevret, Sylvie; Azoulay, Elie

    2013-08-01

    Acute respiratory failure (ARF) is the leading reason for intensive care unit (ICU) admission in patients with cancer. The aim of this study was to identify early predictors of death in patients with cancer admitted to the ICU for ARF who were not intubated at admission. We conducted analysis of a prospective randomized controlled trial including 219 patients with cancer with ARF in which day-28 mortality was a secondary endpoint. Mortality at day 28 was 31.1%. By multivariate analysis, independent predictors of day-28 mortality were: age (odds ratio [OR] 1.30/10 years, 95% confidence interval [CI] [1.01-1.68], p = 0.04), more than one line of chemotherapy (OR 2.14, 95% CI [1.08-4.21], p = 0.03), time between respiratory symptoms onset and ICU admission > 2 days (OR 2.50, 95% CI [1.25-5.02], p = 0.01), oxygen flow at admission (OR 1.07/L, 95% CI [1.00-1.14], p = 0.04) and extra-respiratory symptoms (OR 2.84, 95%CI [1.30-6.21], p = 0.01). After adjustment for the logistic organ dysfunction (LOD) score at admission, only time between respiratory symptoms onset and ICU admission > 2 days and LOD score were independently associated with day-28 mortality. Determinants of death include both factors non-amenable to change, and delay in ARF management. These results suggest that early intensive care management of patients with cancer with ARF may translate to better survival.

  7. The Change in Body Weight During Hospitalization Predicts Mortality in Patients With Acute Decompensated Heart Failure

    PubMed Central

    Komaki, Tomo; Miura, Shin-ichiro; Arimura, Tadaaki; Shiga, Yuhei; Morii, Joji; Kuwano, Takashi; Imaizumi, Satoshi; Kitajima, Ken; Iwata, Atsushi; Morito, Natsumi; Yahiro, Eiji; Fujimi, Kanta; Matsunaga, Akira; Saku, Keijiro

    2017-01-01

    Background In our experience, the change in body weight (BW) during hospitalization varies greatly in patients with acute decompensated heart failure (HF). Since the clinical significance of a change in BW is not clear, we investigated whether a change in BW could predict mortality. Methods We retrospectively enrolled 130 patients (72 males; aged 68 ± 10 years) who were hospitalized due to acute decompensated HF and followed for 2 years after discharge. The change in the BW index during hospitalization (ΔBWI) was calculated as (BW at hospital admission minus BW at hospital discharge)/body surface area at hospital discharge. Results The patients were divided into quartiles according to ΔBWI, and the 2-year mortality rates in the quartiles with the lowest, second, third and highest ΔBWI were 18.8%, 12.1%, 3.1% and 9.1%, respectively. In a multivariate Cox proportional hazards analysis after adjusting for variables with a P value less than 0.05, ΔBWI was independently associated with 2-year mortality (P = 0.0002), and the quartile with the lowest ΔBWI had a higher relative risk (RR) for 2-year mortality than the quartile with the highest ΔBWI (RR: 7.46, 95% confidence interval: 1.03 - 53.99, P = 0.04). Conclusion In conclusion, ΔBWI was significantly associated with 2-year mortality after discharge, which indicates that ΔBWI might be a simple predictor of prognosis in acute decompensated HF. PMID:28179967

  8. Ambient PM2.5 and risk of hospital admissions: Do risks differ for men and women?

    PubMed Central

    Bell, Michelle L.; Son, Ji-Young; Peng, Roger D.; Wang, Yun; Dominici, Francesca

    2015-01-01

    Background While strong evidence exists for associations between fine particles (PM2.5) and health, less is known about whether associations differ by sex. Methods We used Bayesian hierarchical modeling to estimate associations between PM2.5, based on ambient monitors, and risk of cause-specific cardiovascular and respiratory hospitalizations for about 12.6 million Medicare beneficiaries (≥65 years) residing in 213 U.S. counties for 1999–2010. Results Point estimates were higher for women than men for almost all causes of hospitalization. PM2.5 risks were higher for women than men for respiratory tract infection, cardiovascular, and heart rhythm disturbance admissions. A 10 μg/m3 increase in same-day PM2.5 was associated with a 1.13% increased risk of heart rhythm disturbance admissions for women (95% posterior interval: 0.63%, 1.63%), and 0.03% for men (95% PI: −0.48%, 0.55%). Differences remained after stratification by age and season. Conclusions Women may be more susceptible to PM2.5-related hospitalizations for some respiratory and cardiovascular causes. PMID:25906368

  9. Impact of short-term temperature variability on emergency hospital admissions for schizophrenia stratified by season of birth

    NASA Astrophysics Data System (ADS)

    Zhao, Desheng; Zhang, Xulai; Xu, Zhiwei; Cheng, Jian; Xie, Mingyu; Zhang, Heng; Wang, Shusi; Li, Kesheng; Yang, Huihui; Wen, Liying; Wang, Xu; Su, Hong

    2016-08-01

    Diurnal temperature range (DTR) and temperature change between neighboring days (TCN) are important meteorological indicators closely associated with global climate change. However, up to date, there have been no studies addressing the impacts of both DTR and TCN on emergency hospital admissions for schizophrenia. We conducted a time-series analysis to assess the relationship between temperature variability and daily schizophrenia onset in Hefei, an inland city in southeast China. Daily meteorological data and emergency hospital admissions for schizophrenia from 2005 to 2014 in Hefei were collected. After stratifying by season of birth, Poisson generalized linear regression combined with distributed lag nonlinear model (DLNM) was used to examine the relationship between temperature variability and schizophrenia, adjusting for long-term trend and seasonality, mean temperature, and relative humidity. Our analysis revealed that extreme temperature variability may increase the risk for schizophrenia onset among patients born in spring, while no such association was found in patients born in summer and autumn. In patients born in spring, the relative risks of extremely high DTR comparing the 95th and 99th percentiles with the reference (50th, 10 °C) at 3-day lag were 1.078 (95 % confidence interval (CI) 1.025-1.135) and 1.159 (95 % CI 1.050-1.279), respectively. For TCN effects, only comparing 99th percentile with reference (50th, 0.7 °C) was significantly associated with emergency hospital admissions for schizophrenia (relative risk (RR) 1.111, 95 % CI 1.002-1.231). This study suggested that exposure to extreme temperature variability in short-term may trigger later days of schizophrenia onset for patients born in spring, which may have important implications for developing intervention strategies to prevent large temperature variability exposure.

  10. Health Risks among Enlisted Males in the U.S. Navy: Race and Ethnicity as Correlates of Hospital Admissions.

    DTIC Science & Technology

    1983-11-01

    4.8 6.6 3.0 0.4* Venereal disease 1.046 4.5 5.2 3.9 299 12.3 15.4 9.1 2.7* Sarcoidosis 130 0.6 0.8 0.0 136 6.1 9.0 4.1 10.2* Viral hepatitis 2,584...displayed a significantly greater risK for sarcoidosis and venereal diseases. No significant differences were found in hospital admissions between the two

  11. Why are patients with acute stroke admitted to hospital?

    PubMed Central

    Bamford, J; Sandercock, P; Warlow, C; Gray, M

    1986-01-01

    Data on 515 consecutive patients registered with the Oxfordshire Community Stroke Project were used to compare the characteristics of those patients who were admitted to hospital within one month after their first stroke with those who remained in the community during that time. Twenty eight patients had their stroke while in hospital for other conditions, and of the remaining 487, 266 were admitted. Though patients with a severe neurological deficit were significantly more likely to be admitted, 47 out of 202 such patients were managed in the community. In a substudy of 162 consecutive patients the general practitioners' reasons for either arranging admission to hospital or continuing with community care in the first week after the stroke were ascertained. Sixty patients were admitted. The only reason for admission was diagnostic uncertainty in five cases (though this was a contributing factor in 25) and to provide nursing or general, non-medical care in 25. Patients who lived alone were more likely to be admitted. All 12 patients who presented directly to the casualty department were admitted, though only five had had a severe stroke. A stroke service that provides a facility for rapid outpatient and domiciliary diagnosis as well as a rapidly acting domiciliary nursing team might reduce the number of patients with stroke admitted to hospital without adversely affecting the quality of patient care: this should be properly evaluated. PMID:3085852

  12. National audit of acute severe asthma in adults admitted to hospital. Standards of Care Committee, British Thoracic Society.

    PubMed Central

    Pearson, M G; Ryland, I; Harrison, B D

    1995-01-01

    OBJECTIVE--To ascertain the standard of care for hospital management of acute severe asthma in adults. DESIGN--Questionnaire based retrospective multicentre survey of case records. SETTING--36 hospitals (12 teaching and 24 district general hospitals) across England, Wales, and Scotland. PATIENTS--All patients admitted with acute severe asthma between 1 August and 30 September 1990 immediately before publication of national guidelines for asthma management. MAIN MEASURES--Main recommendations of guidelines for hospital management of acute severe asthma as performed by respiratory and non-respiratory physicians. RESULTS--766 patients (median age 41 (range 16-94) years) were studied; 465 (63%) were female and 448 (61%) had had previous admissions for asthma. Deficiencies were evident for each aspect of care studied, and respiratory physicians performed better than non-respiratory physicians. 429 (56%) patients had had their treatment increased in the two weeks preceding the admission but only 237 (31%) were prescribed oral steroids. Initially 661/766 (86%) patients had peak expiratory flow measured and recorded but only 534 (70%) ever had arterial blood gas tensions assessed. 65 (8%) patients received no steroid treatment in the first 24 hours after admission. Variability of peak expiratory flow was measured before discharge in 597/759 (78%) patients, of whom 334 (56%) achieved good control (variability < 25%). 47 (6%) patients were discharged without oral or inhaled steroids; 182/743 (24%) had no planned outpatient follow up and 114 failed to attend, leaving 447 (60%) seen in clinic within two months. Only 57/629 (8%) patients were recorded as having a written management plan. CONCLUSIONS--The hospital management of a significant minority of patients deviates from recommended national standards and some deviations are potentially serious. Overall, respiratory physicians provide significantly better care than non-respiratory physicians. PMID:10142032

  13. Effect of ambient temperature on Australian northern territory public hospital admissions for cardiovascular disease among indigenous and non-indigenous populations.

    PubMed

    Webb, Leanne; Bambrick, Hilary; Tait, Peter; Green, Donna; Alexander, Lisa

    2014-02-13

    Hospitalisations are associated with ambient temperature, but little is known about responses in population sub-groups. In this study, heat responses for Indigenous and non-Indigenous people in two age groups were examined for two categories of cardiac diseases using daily hospital admissions from five Northern Territory hospitals (1992-2011). Admission rates during the hottest five per cent of days and the coolest five per cent of days were compared with rates at other times. Among 25-64 year olds, the Indigenous female population was more adversely affected by very hot days than the non-Indigenous female population, with admission rates for ischaemic heart disease (IHD) increasing by 32%. People older than 65 were more sensitive to cold, with non-Indigenous male admissions for heart failure increasing by 64%, and for IHD by 29%. For older Indigenous males, IHD admissions increased by 52% during cold conditions. For older non-Indigenous females, increases in admissions for heart failure were around 50% on these cold days, and 64% for older Indigenous females. We conclude that under projected climate change conditions, admissions for IHD amongst younger Indigenous people would increase in hot conditions, while admissions among elderly people during cold weather may be reduced. The responses to temperature, while showing significant relationships across the Northern Territory, may vary by region. These variations were not explored in this assessment.

  14. Differences in hospital admissions for males and females in northern Uganda in the period 1992-2004: a consideration of gender and sex differences in health care use.

    PubMed

    Accorsi, Sandro; Fabiani, Massimo; Nattabi, Barbara; Ferrarese, Nicoletta; Corrado, Bruno; Iriso, Robert; Ayella, Emintone O; Pido, Bongomin; Yoti, Zabulon; Corti, Dominique; Ogwang, Martin; Declich, Silvia

    2007-09-01

    To inform our understanding of male and female health care use, we assessed sex differences in hospital admissions by diagnosis and for in-patient mortality using discharge records for 210319 patients admitted to the Lacor Hospital in northern Uganda in the period 1992-2004. These differences were interpreted using a gender framework. The overall number of admissions was similar by sex, yet differences emerged among age groups. In children (0-14 years), malaria was the leading cause of admission, and the distribution of diseases was similar between sexes. Among 15-44 year olds, females had more admissions, overall, and for malaria, cancer and anaemia, in addition to delivery and gynaeco-obstetrical conditions (25.7% of female admissions). Males had more admissions for injuries, liver disease and tuberculosis in the same age group. In older persons (>or=45 years), women had more admissions for cancer, hypertension, malaria and diarrhoea, while, as for the previous age group, males had more admissions for injuries, liver disease and tuberculosis. This study provides insight into sex- and gender-related differences in health. The analysis and documentation of these differences are crucial for improving service delivery and for assessing the achievement of the dual goals of improving health status and reducing health inequalities.

  15. Palliative care need and management in the acute hospital setting: a census of one New Zealand Hospital

    PubMed Central

    2013-01-01

    Background Improving palliative care management in acute hospital settings has been identified as a priority internationally. The aim of this study was to establish the proportion of inpatients within one acute hospital in New Zealand who meet prognostic criteria for palliative care need and explore key aspects of their management. Methods A prospective survey of adult hospital inpatients (n = 501) was undertaken. Case notes were examined for evidence that the patient might be in their last year of life according to Gold Standards Framework (GSF) prognostic indicator criteria. For patients who met GSF criteria, clinical and socio-demographic information were recorded. Results Ninety-nine inpatients met GSF criteria, representing 19.8% of the total census population. The patients’ average age was 70 years; 47% had a primary diagnosis of cancer. Two thirds had died within 6 months of their admission. Seventy-eight of the 99 cases demonstrated evidence that a palliative approach to care had been adopted; however documentation of discussion about goals of care was very limited and only one patient had evidence of an advance care plan. Conclusion One fifth of hospital inpatients met criteria for palliative care need, the majority of whom were aged >70 years. Whilst over three quarters were concluded to be receiving care in line with a palliative care approach, very little documented evidence of discussion with patients and families regarding end of life issues was evident. Future research needs to explore how best to support ‘generalist’ palliative care providers in initiating, and appropriately recording, such discussions. PMID:23537092

  16. Hospital admissions for respiratory system diseases in adults with intellectual disabilities in Southeast London: a register-based cohort study

    PubMed Central

    Chang, Chin-Kuo; Chen, Chih-Yin; Broadbent, Mathew; Stewart, Robert; O'Hara, Jean

    2017-01-01

    Background Intellectual disability (ID) carries a high impact on need for care, health status and premature mortality. Respiratory system diseases contribute a major part of mortality among people with ID, but remain underinvestigated as consequent morbidities. Methods Anonymised electronic mental health records from the South London and Maudsley Trust (SLaM) were linked to national acute medical care data. Using retrospective cohort and matched case–control study designs, adults with ID receiving SLaM care between 1 January 2008 and 31 March 2013 were identified and compared with local catchment residents for respiratory system disease admissions. Standardised admission ratios (SARs) were first calculated, followed by a comparison of duration of hospitalisation with respiratory system disease between people with ID and age-matched and gender-matched random counterparts modelled using linear regression. Finally, the risk of readmission for respiratory system disease was analysed using the Cox models. Results For the 3138 adults with ID identified in SLaM, the SAR for respiratory system disease admissions was 4.02 (95% CI 3.79 to 4.26). Compared with adults without ID, duration of hospitalisation was significantly longer by 2.34 days (95% CI 0.03 to 4.64) and respiratory system disease readmission was significantly elevated (HR=1.35; 95% CI 1.17 to 1.56) after confounding adjustment. Conclusions Respiratory system disease admissions in adults with ID are more frequent, of longer duration and have a higher likelihood of recurring. Development and evaluation of potential interventions to the preventable causes of respiratory diseases should be prioritised. PMID:28360254

  17. Are some areas more equal than others? Socioeconomic inequality in potentially avoidable emergency hospital admissions within English local authority areas

    PubMed Central

    Asaria, Miqdad; Barratt, Helen; Raine, Rosalind; Cookson, Richard

    2016-01-01

    Objectives Reducing health inequalities is an explicit goal of England’s health system. Our aim was to compare the performance of English local administrative areas in reducing socioeconomic inequality in emergency hospital admissions for ambulatory care sensitive chronic conditions. Methods We used local authority area as a stable proxy for health and long-term care administrative geography between 2004/5 and 2011/12. We linked inpatient hospital activity, deprivation, primary care, and population data to small area neighbourhoods (typical population 1500) within administrative areas (typical population 250,000). We measured absolute inequality gradients nationally and within each administrative area using neighbourhood-level linear models of the relationship between national deprivation and age–sex-adjusted emergency admission rates. We assessed local equity performance by comparing local inequality against national inequality to identify areas significantly more or less equal than expected; evaluated stability over time; and identified where equity performance was steadily improving or worsening. We then examined associations between change in socioeconomic inequalities and change in within-area deprivation (gentrification). Finally, we used administrative area-level random and fixed effects models to examine the contribution of primary care to inequalities in admissions. Results Data on 316 administrative areas were included in the analysis. Local inequalities were fairly stable between consecutive years, but 32 areas (10%) showed steadily improving or worsening equity. In the 21 improving areas, the gap between most and least deprived fell by 3.9 admissions per 1000 (six times the fall nationally) between 2004/5 and 2011/12, while in the 11 areas worsening, the gap widened by 2.4. There was no indication that measured improvements in local equity were an artefact of gentrification or that changes in primary care supply or quality contributed to changes in

  18. 76 FR 51475 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-18

    ...We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010......

  19. 75 FR 50041 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-16

    ...We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain provisions of the Affordable Care Act and other legislation. In addition, we describe the changes to the amounts and factors used to determine......

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

    PubMed

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

    2015-03-21

    Contexte : Hôpital de référence du Black Lion, Addis Ababa, Ethiopie.Objectif : Documenter les indications d’admission, les complications et le devenir des patients atteints de diabète (DM) admis à l’hôpital entre 2010 et 2013.Schéma : Etude descriptive rétrospective sur dossiers médicaux.Résultats : Sur 8048 admissions, 523 (6,5%) avaient un DM et parmi eux, 418 dossiers médicaux ont été retrouvés : 301 (72%) patients avaient un DM de type 2 et 104 (28%) avaient un DM de type 1 ; les hommes (62%) et les personnes âgées (âge médian 60 ans) étaient caractéristiques du type 2. Les diagnostics d’admission les plus fréquents du type 2 étaient l’ulcère diabétique du pied (39%) et les problèmes cardiovasculaires (21%), et celui du type 1, l’acidocétose diabétique (62%). L’hypertension, les neuropathies, les néphropathies, la rétinopathie et le pied diabétique représentaient 85% des 756 complications existantes. La mortalité totale des patients admis a été de 21%. Sur ces 89 décès, 77 patients étaient de type 2 avec comme indications principales d’admission l’ulcère diabétique du pied/la gangrène et les problèmes cardiovasculaires.Conclusion : Le DM, surtout de type 2, est une cause importante d’admission dans le plus grand hôpital de référence du pays. De nombreux patients avaient déjà développé des complications liées au DM lors de l’admission, et la mortalité a été élevée. Il est nécessaire d’améliorer la connaissance et les soins relatifs au DM en Ethiopie.

  1. Predictors of care home and hospital admissions and their costs for older people with Alzheimer's disease: findings from a large London case register

    PubMed Central

    Knapp, Martin; Chua, Kia-Chong; Broadbent, Matthew; Chang, Chin-Kuo; Fernandez, Jose-Luis; Milea, Dominique; Romeo, Renee; Lovestone, Simon; Spencer, Michael; Thompson, Gwilym; Stewart, Robert; Hayes, Richard D

    2016-01-01

    Objectives To examine links between clinical and other characteristics of people with Alzheimer's disease living in the community, likelihood of care home or hospital admission, and associated costs. Design Observational data extracted from clinical records using natural language processing and Hospital Episode Statistics. Statistical analyses examined effects of cognition, physical health, mental health, sociodemographic factors and living circumstances on risk of admission to care home or hospital over 6 months and associated costs, adjusting for repeated observations. Setting Catchment area for South London and Maudsley National Health Service Foundation Trust, provider for 1.2 million people in Southeast London. Participants Every individual with diagnosis of Alzheimer's disease seen and treated by mental health services in the catchment area, with at least one rating of cognition, not resident in care home at time of assessment (n=3075). Interventions Usual treatment. Main outcome measures Risk of admission to, and days spent in three settings during 6-month period following routine clinical assessment: care home, mental health inpatient care and general hospital inpatient care. Results Predictors of probability of care home or hospital admission and/or associated costs over 6 months include cognition, functional problems, agitation, depression, physical illness, previous hospitalisations, age, gender, ethnicity, living alone and having a partner. Patterns of association differed considerably by destination. Conclusions Most people with dementia prefer to remain in their own homes, and funding bodies see this as cheaper than institutionalisation. Better treatment in the community that reduces health and social care needs of Alzheimer's patients would reduce admission rates. Living alone, poor living circumstances and functional problems all raise admission rates, and so major cuts in social care budgets increase the risk of high-cost admissions which older

  2. 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.

  3. Predictors of Recurrent Hospital Admission for Patients Presenting With Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    PubMed Central

    Bradford, Annabel L.; Crider, Courtney Champagne; Xu, Xizheng; Naqvi, Syed Hasan

    2017-01-01

    Background Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are two serious, preventable complications of diabetes mellitus. Analysis of variables associated with recurrent DKA and HHS admission has the potential to improve patient outcomes by identifying possible areas for intervention. The aim of this study was to evaluate potential predictors of recurrent DKA or HHS admission. Methods This was a retrospective case-control study of 367 patients presenting during a 5-year period with DKA or HHS at a US tertiary academic medical center. Six potential readmission risk factors identified via literature review were coded as “1” if present and “0” if absent. Readmission odds ratios (ORs) for each risk factor and for the combined score of significant risk factors were calculated by logistic regression. Results Readmission odds were significantly increased for patients with age < 35, history of depression or substance/alcohol abuse, and self-pay/publicly funded insurance. HbA1C > 10.6% on admission and ethnic minority status did not significantly increase readmission odds, with inadequate study power for these variables. A total “ABCD” score, based on Age (< 35 years), Behavioral health (depression), insurance Coverage (self-pay/publicly funded insurance), and Drug/alcohol abuse, also had a significant effect on readmission odds. Conclusions Consideration of individual risk factors and the use of a scoring system based on objective predictors of recurrent DKA and HHS admission could be of value in helping identify patients with high readmission risk, allowing interventions to be targeted most effectively to reduce readmission rates, associated morbidity, and mortality. PMID:27924173

  4. Methicillin-resistant Staphylococcus aureus infection or colonization present at hospital admission: multivariable risk factor screening to increase efficiency of surveillance culturing.

    PubMed

    Haley, Clinton C; Mittal, Deepa; Laviolette, Amanda; Jannapureddy, Sai; Parvez, Najma; Haley, Robert W

    2007-09-01

    Identifying methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection present at admission has become important in reducing subsequent nosocomial transmission, but the most efficient surveillance methods remain to be defined. We performed anterior nares surveillance cultures of all patients upon admission to and discharge from the general internal medicine floor in our community hospital over a 7-week period, and patients completed a questionnaire on MRSA risk factors. Of the 401 patients, 41 (10.2%) had MRSA upon admission. Of the 48 risk measures analyzed, 10 were significantly associated with admission MRSA, and 7 of these were independently associated in stepwise logistic regression analysis. Factor analysis identified eight latent variables that contained most of the predictive information in the 48 risk measures. Repeat logistic regression analysis including the latent variables revealed three independent risk measures for admission MRSA: a nursing home stay (relative risk [RR], 6.18; 95% confidence interval [95% CI], 3.56 to 10.72; P < 0.0001), prior MRSA infection (RR, 3.97; 95% CI, 1.94 to 8.12; P = 0.0002), and the third latent variable (factor 3; RR, 3.14; 95% CI, 1.56 to 6.31; P = 0.0013), representing the combined effects of homelessness, jail stay, promiscuity, intravenous drug use, and other drug use. Multivariable models had greater sensitivity at detecting admission MRSA than any single risk measure and allowed detection of 78% to 90% of admission MRSA from admission surveillance cultures on 46% to 58% of admissions. If confirmed in additional studies, multivariable questionnaire screening at admission might identify a subset of admissions for surveillance cultures that would more efficiently identify most admission MRSA.

  5. Effects of Particulate Matter and Its Chemical Constituents on Elderly Hospital Admissions Due to Circulatory and Respiratory Diseases

    PubMed Central

    Ferreira, Tatiane Morais; Forti, Maria Cristina; de Freitas, Clarice Umbelino; Nascimento, Felipe Parra; Junger, Washington Leite; Gouveia, Nelson

    2016-01-01

    Various fractions of particulate matter have been associated with increased mortality and morbidity. The purpose of our study is to analyze the associations between concentrations of PM2.5, PM2.5–10, PM10 and their chemical constituents (soluble ions) with hospital admissions due to circulatory and respiratory diseases among the elderly in a medium-sized city in Brazil. A time series study was conducted using Poisson regression with generalized additive models adjusted for confounders. Statistically significant associations were identified between PM10 and PM2.5–10 and respiratory diseases. Risks of hospitalization increased by 23.5% (95% CI: 13.5; 34.3) and 12.8% (95% CI: 6.0; 20.0) per 10 μg/m3 of PM2.5-10 and PM10, respectively. PM2.5 exhibited a significant association with circulatory system diseases, with the risk of hospitalization increasing by 19.6% (95% CI: 6.4; 34.6) per 10 μg/m3. Regarding the chemical species; SO42−, NO3−, NH4+ and K+ exhibited specific patterns of risk, relative to the investigated outcomes. Overall, SO42− in PM2.5–10 and K+ in PM2.5 were associated with increased risk of hospital admissions due to both types of diseases. The results agree with evidence indicating that the risks for different health outcomes vary in relation to the fractions and chemical composition of PM10. Thus, PM10 speciation studies may contribute to the establishment of more selective pollution control policies. PMID:27669280

  6. 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

  7. 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.

  8. 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

  9. A randomized trial of a standard dose of Edmonston-Zagreb measles vaccine given at 4.5 months of age: effect on total hospital admissions.

    PubMed

    Martins, Cesario L; Benn, Christine S; Andersen, Andreas; Balé, Carlito; Schaltz-Buchholzer, Frederik; Do, Vu An; Rodrigues, Amabelia; Aaby, Peter; Ravn, Henrik; Whittle, Hilton; Garly, May-Lill

    2014-06-01

    Observational studies and trials from low-income countries indicate that measles vaccine has beneficial nonspecific effects, protecting against non-measles-related mortality. It is not known whether measles vaccine protects against hospital admissions. Between 2003 and 2007, 6417 children who had received the third dose of diphtheria, tetanus, and pertussis vaccine were randomly assigned to receive measles vaccine at 4.5 months or no measles vaccine; all children were offered measles vaccine at 9 months of age. Using hospital admission data from the national pediatric ward in Bissau, Guinea-Bissau, we compared admission rates between enrollment and the 9-month vaccination in Cox models, providing admission hazard rate ratios (HRRs) for measles vaccine versus no measles vaccine. All analyses were conducted stratified by sex and reception of neonatal vitamin A supplementation (NVAS). Before enrollment the 2 groups had similar admission rates. Following enrollment, the measles vaccine group had an admission HRR of 0.70 (95% confidence interval [CI], .52-.95), with a ratio of 0.53 (95% CI, .32-.86) for girls and 0.86 (95% CI, .58-1.26) for boys. For children who had not received NVAS, the admission HRR was 0.53 (95% CI, .34-.84), with an effect of 0.30 (95% CI, .13-.70) for girls and 0.73 (95% CI, .42-1.28) for boys (P = .08, interaction test). The reduction in admissions was separately significant for measles infection (admission HRR, 0 [95% CI, 0-.24]) and respiratory infections (admission HRR, 0.37 [95% CI, .16-.89]). Early measles vaccine may have major benefits for infant morbidity patterns and healthcare costs. Clinical trials registration NCT00168558.

  10. Short-term associations of fine particulate matter components and emergency hospital admissions among a privately insured population in Greater Houston

    NASA Astrophysics Data System (ADS)

    Liu, Suyang; Ganduglia, Cecilia M.; Li, Xiao; Delclos, George L.; Franzini, Luisa; Zhang, Kai

    2016-12-01

    A number of time-series studies have associated PM2.5 (particulate matter with aerodynamic diameter less than 2.5 μm) mass and components with various health outcomes. No studies have yet examined the associations between PM2.5 components and hospital admissions among a privately insured population. We estimated the short-term associations between exposure to PM2.5 mass and components and emergency hospital admissions for all-cause and cause-specific diseases in Greater Houston, Texas, during 2008-2013 using Blue Cross Blue Shield Texas claims data. A total of 90,085 emergency hospital admissions were included in this study, with an average of 34 ± 10 admissions per day. We selected 20 PM2.5 components from the U.S. Environmental Protection Agency's Chemical Speciation Network site located in Houston, and then applied Poisson regression models to assess the short-term effects of PM2.5 mass and species on emergency hospital admissions. Effects were estimated without adjustment for other airborne pollutants. PM2.5 mass was not statistically significantly associated with increased all-cause emergency hospital admissions and selected cause-specific admissions. For selected PM2.5 species, we found interquartile range increases in arsenic (0.001 μg/m3) and copper (0.017 μg/m3) were significantly (P < 0.05) associated with increased admissions for stroke, (5.98% [95% confidence interval (CI): 0.73, 11.50%]) and pneumonia (4.07% [95% CI: 0.37, 7.90%]), respectively. Seasonal analysis showed weak variation among PM2.5 mass and components, except that nickel significantly increased all-cause emergency hospital admissions (2.16% [95% CI: 0.21, 4.14%]) during the warm season. Our findings suggest that hospital admissions in the privately insured population are slightly affected by ambient fine particulate matter air pollution.

  11. Factors associated with the hospital admission of consumer product-related injuries treated in U.S. hospital emergency departments.

    PubMed

    Schroeder, Thomas J; Rodgers, Gregory B

    2013-10-01

    While unintentional injuries and hazard patterns involving consumer products have been studied extensively in recent years, little attention has focused on the characteristics of those who are hospitalized after treatment in emergency departments, as opposed to those treated and released. This study quantifies the impact of the age and sex of the injury victims, and other factors, on the likelihood of hospitalization. The analysis focuses on consumer product injuries, and was based on approximately 400,000 injury cases reported through the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System, a national probability sample of U.S. hospital emergency departments. Logistic regression was used to quantify the factors associated with the likelihood of hospitalization. The analysis suggests a smooth U-shaped relationship between the age of the victim and the likelihood of hospitalization, declining from about 3.4% for children under age 5 years to 1.9% for 15-24 year-olds, but then rising to more than 25% for those ages 75 years and older. The likelihood of hospitalization was also significantly affected by the victim's sex, as well as by the types of products involved, fire involvement, and the size and type of hospital at which the injury was treated. This study shows that the probability of hospitalization is strongly correlated with the characteristics of those who are injured, as well as other factors.

  12. Therapy of acute hypertension in hospitalized children and adolescents.

    PubMed

    Webb, Tennille N; Shatat, Ibrahim F; Miyashita, Yosuke

    2014-04-01

    Acute hypertension (HTN) in hospitalized children and adolescents occurs relatively frequently, and in some cases, if not recognized and treated promptly, it can lead to hypertensive crisis with potentially significant morbidity and mortality. In contrast to adults, where acute HTN is most likely due to uncontrolled primary HTN, children and adolescents with acute HTN are more likely to have secondary HTN. This review will briefly cover evaluation of acute HTN and various age-specific etiologies of secondary HTN and provide more in-depth discussion on treatment targets, potential risks of acute HTN therapy, and available pediatric data on intravenous and oral antihypertensive agents, and it proposes treatment schema including unique therapy of specific secondary HTN scenarios.

  13. [Characteristics of acute renal failure in elderly patients admitted to a small town hospital].

    PubMed

    Lou, L M; Boned, B; Gimeno, J A; Beguer, P; Cruz, A; Telmo, S; Lou, M T; Gómez Sánchez, R

    2002-01-01

    We studied the features of acute renal failure (ARF) in elderly patients treated in a hospital, without an intensive care unit, to identify etiological factors and establish adequate preventive measures and treatment. During twelve consecutive months we studied prospectively 99 patients with ARF diagnosed by conventional criteria, an incidence of 1,238 cases per million per year. ARF affected 1.78% of patients admitted to hospital. We analyzed age, sex, serum creatinine, diuresis, etiology, type of ARF, preexisting chronic diseases, treatment, complications and outcome. Preexisting chronic diseases were common, the most frequent being hypertension (54%) and diabetes (39%). Previous treatments for cardiovascular diseases were frequent (angiotensin-renin system blockade 35.4%, diuretics 50.5%). 79% of ARF arose in hospital, 21% outside hospital. ARF was pre-renal in 60%, renal in 31% and post-renal in 9%. 34.7% were caused by volume depletion, 23.4% by low cardiac output and 23.4% by infection. 44.4% of ARF patients had oliguria or anuria latrogenic factors contributed to the ethiology of ARF in 35.3% of patients. Hospital stay was doubled by ARF the presence of ARF and the mortality was 36.4%. The rate was higher in ARF arising in hospital than in ARF acquired before admission. Factors that had a significant influence on the mortality rate were comorbid conditions, oliguroanuria, ARF of renal origin and serum albumin. We conclude that ARF has a high incidence, morbidity and mortality in this elderly population. Volume depletion, associated cardiovascular pathology and pharmacological treatment are important etiological factors in those with ARF outside hospital. Adequate treatment of ARF and avoidance of nephrotoxic medications are necessary in hospital.

  14. 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

    2017-02-01

    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.

  15. The health of irregular and illegal immigrants: analysis of day-hospital admissions in a department of migration medicine.

    PubMed

    Affronti, Mario; Affronti, Andrea; Pagano, Salvatore; Soresi, Maurizio; Giannitrapani, Lydia; Valenti, Miriam; La Spada, Emanuele; Montalto, Giuseppe

    2013-10-01

    It is difficult to trace full details of the path which irregular or illegal immigrants follow when seeking assistance in the network of the various hospital departments and health structures. The aim of this work was to analyze the health needs of immigrant people by reviewing the types of treatment given to them in the day-hospital of our Department of Migration Medicine. Our study analyzed day-hospital admissions between 2003 and 2009. The patient charts used for managing day-hospital activity were adopted in 2002 in conformity with the "OSI project". From these it is possible to draw up a scale picture of the distribution of each pathology in the immigrant population. The sample population consisted of 1,758 subjects, representing 7.4% of potential users. More than half came from Africa, followed by Asia, and then Europe. Gastroenterological diseases ranked first, with dyspeptic syndromes most frequently diagnosed. Infections and parasitic diseases ranked second, and the most frequent diagnoses were sexually transmitted diseases. Third were diseases of the genitourinary system. Metabolic disorders ranked fourth, among them, more than half of the cases were of diabetes mellitus, in patients from south-east Asia. Diseases of the circulatory system were sixth, with hypertension the most frequent pathology. Our data confirm a marked persistence of the phenomenon known as the "healthy immigrant effect" in these types of patients, as well as the prominent role played by "social determinants" in conditioning the health of immigrants, particularly in the case of some infectious diseases.

  16. Hospitalization for acute pyelonephritis in Manitoba, Canada, during the period from 1989 to 1992; impact of diabetes, pregnancy, and aboriginal origin.

    PubMed

    Nicolle, L E; Friesen, D; Harding, G K; Roos, L L

    1996-06-01

    Population-based rates of hospitalization for acute pyelonephritis were estimated over 3 years with use of provincial administrative data on health care. Retrospective review of records of ICD9-CM discharge codes of pyelonephritis and urinary infection was performed in two acute care institutions to validate the discharge diagnosis; 80% of patients with a discharge diagnosis of pyelonephritis and 7% to 20% of patients with a discharge diagnosis of urinary infection met clinical criteria for admission for acute pyelonephritis. Mean rates of hospitalization +/- SD for acute pyelonephritis were 10.86 +/- 0.51 per 10,000 population among women and 3.32 +/- 0.27 per 10,000 population among men. From 18% to 31% of hospitalized women aged 20-39 years pregnant; 36% of 797 hospitalized women and 21% of 402 hospitalized men 40 years of age or older were diabetic. The hospitalization rates among Native American women with treaty status were five to 20 times greater than those among other women, which was partially attributable to a significantly greater frequency of pregnancy and diabetes in the former women. Hospitalization for acute pyelonephritis is common, and pregnancy and diabetes contribute substantially to hospitalization rates. The increased hospitalization rate among Native American women with treaty status is not fully explained by pregnancy or diabetes.

  17. National trends in inpatient admissions following stereotactic radiosurgery and the in-hospital patient outcomes in the United States from 1998 to 2011

    PubMed Central

    Ho, Allen L.; Li, Alexander Y.; Sussman, Eric S.; Pendharkar, Arjun V.; Iyer, Aditya; Thompson, Patricia A.; Tayag, Armine T.; Chang, Steven D.

    2016-01-01

    Purpose This study sought to examine trends in stereotactic radiosurgery (SRS) and in-hospital patient outcomes on a national level by utilizing national administrative data from the Nationwide Inpatient Sample (NIS) database. Methods and materials Using the NIS database, all discharges where patients underwent inpatient SRS were included in our study from 1998 – 2011 as designated by the ICD9-CM procedural codes. Trends in the utilization of primary and adjuvant SRS, in-hospital complications and mortality, and resource utilization were identified and analyzed. Results Our study included over 11,000 hospital discharges following admission for primary SRS or for adjuvant SRS following admission for surgery or other indication. The most popular indication for SRS continues to be treatment of intracranial metastatic disease (36.7%), but expansion to primary CNS lesions and other non-malignant pathology beyond trigeminal neuralgia has occurred over the past decade. Second, inpatient admissions for primary SRS have declined by 65.9% over this same period of time. Finally, as inpatient admissions for SRS become less frequent, the complexity and severity of illness seen in admitted patients has increased over time with an increase in the average comorbidity score from 1.25 in the year 2002 to 2.29 in 2011, and an increase in over-all in-hospital complication rate of 2.8 times over the entire study period. Conclusions As the practice of SRS continues to evolve, we have seen several trends in associated hospital admissions. Overall, the number of inpatient admissions for primary SRS has declined while adjuvant applications have remained stable. Over the same period, there has been associated increase in complication rate, length of stay, and mortality in inpatients. These associations may be explained by an increase in the comorbidity-load of admitted patients as more high-risk patients are selected for admission at inpatient centers while more stable patients are

  18. Faecal shedding of CTX-M-producing Escherichia coli in horses receiving broad-spectrum antimicrobial prophylaxis after hospital admission.

    PubMed

    Damborg, Peter; Marskar, Peter; Baptiste, Keith E; Guardabassi, Luca

    2012-01-27

    The objective of this longitudinal study was to investigate the occurrence and genetic background of faecal Escherichia coli resistant to cefotaxime (CTX) in horses receiving broad-spectrum antimicrobial prophylaxis after admission to a veterinary teaching hospital. The ten horses enrolled in the study were treated with cefquinome either alone (n=4) or in combination with metronidazole (n=3) or other antimicrobial agents (n=3). CTX-resistant coliforms in faeces collected before, during and after treatment were quantified on selective MacConkey agar supplemented with CTX, and a colony isolated randomly from each positive sample was characterized by pulsed-field gel electrophoresis, and by PCR detection and sequencing of bla(TEM), bla(SHV), bla(CTX-M) and bla(CMY). All horses were negative for CTX-resistant coliforms at admission but became positive within the first three days of treatment. The average faecal densities of CTX-resistant coliforms increased significantly following antimicrobial prophylaxis (P<0.001). Genetic characterization of 29 faecal isolates revealed that this effect was due to proliferation of E. coli producing either CTX-M-1 (n=28) or CTX-M-14 (n=1). Five CTX-M-1 isolates produced additional β-lactamases (TEM-1, CMY-34 and the novel variant CMY-53). Shedding of CTX-M-producing E. coli appeared intermittent in four horses and persisted two weeks after antimicrobial treatments in five of six patients tested after discharge from hospital. Nosocomial transmission was suggested by finding five identical CTX-M-1-producing E. coli pulsotypes in multiple horses. The originality of the study lies in the unanticipated high frequency and genetic diversity of CTX-M-producing E. coli observed in the faecal flora of hospitalized patients receiving broad-spectrum antimicrobial prophylaxis.

  19. Barriers to and enablers of physical activity in patients with COPD following a hospital admission: a qualitative study

    PubMed Central

    Thorpe, Olivia; Kumar, Saravana; Johnston, Kylie

    2014-01-01

    Background Chronic obstructive pulmonary disease (COPD) is characterized by a persistent blockage of airflow, prompting episodes of shortness of breath, commonly leading to hospitalization. Hospitalization may lead to a decline in physical activity following discharge. Physical activity has been shown to improve symptoms of COPD and reduce readmissions, and to decrease morbidity and mortality. This study aims to explore, from the perspectives of people with COPD, the barriers to and enablers of participation in physical activity following hospitalization for COPD. Methods This study had a qualitative descriptive design and included semistructured interviews with 28 adult COPD patients who had been admitted to hospital with a primary diagnosis of exacerbation of COPD. Results A plethora of barriers to but fewer enablers of participation in physical activity and pulmonary rehabilitation were identified for this cohort of people. The main barriers identified were health-related (comorbidities, COPD symptoms, and physical injury or illness) environment-related (weather, transport, and finance), and self-related. The main enabling factors reported were access to health professionals and equipment, social support, routine and extracurricular activities, personal goals and motivation, and the effect of physical activity and “feeling better”. Conclusion This research provides a snapshot of the barriers to and enablers of physical activity and pulmonary rehabilitation in people with COPD. It is evident that there are significant barriers which hinder the ability of people with COPD to undertake and continue participation in physical activity and pulmonary rehabilitation. While there are some enablers that may counter these barriers, it is clear that health professionals dealing with people suffering from COPD need to actively recognize and address barriers to physical activity and pulmonary rehabilitation. Hospital admission may create an opportunity for implementation

  20. The effect of seatbelt legislation on hospital admissions with road traffic injuries in an oil-rich, fast-developing country.

    PubMed

    Bener, Abdulbari; Al Humoud, Suhail M Q; Price, Penny; Azhar, Abdulaziz; Khalid, Muayad K; Rysavy, Martin; Crundall, David

    2007-06-01

    The objective of the study was to examine the effect of seat-belt legislation on hospital admissions with road traffic injuries and was designed as a retrospective descriptive study. All motor vehicle crashes recorded during the period 2001 - 2004 were extracted from the Emergency Medical Service Department. Details of the crashes, injuries and safety devices used were studied. The present study revealed that safety belt usage rates have increased from 8% in 2001 to 67% in 2004 among patients admitted to hospital with injury after road traffic crashes. The admission rate of patients with road traffic injuries per 100 000 population reduced by 17.7%. The enforcement of the seat-belt legislation played a vital role in reduction of hospital admissions due to road traffic crashes.

  1. [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.

  2. Trends of hospitalizations, fatality rate and costs for acute myocardial infarction among Spanish diabetic adults, 2001-2006

    PubMed Central

    2010-01-01

    Background Acute myocardial infarction (AMI) is one of the more frequent reasons diabetic patients are admitted to hospital, and there are reports that the long-term prognosis after an AMI is much worse in these patients than in non-diabetic patients. This study aims to compare hospital admissions and costs in Spanish diabetic and non-diabetic subjects due to AMI during the period 2001-2006. Methods We conducted a retrospective study of 6 years of national hospitalization data associated with diabetes using the Minimum Basic Data Set. National hospitalization rates were calculated for AMI among diabetic and non-diabetic adults. Fatality rates, mean hospital stay and direct medical costs related to hospitalization were analyzed. Costs were calculated using Diagnosis-Related Groups for AMI in diabetics and non-diabetics patients. Results During the study period, a total of 307,099 patients with AMI were admitted to Spanish hospitals. Diabetic patients made up 29.6% of the total. The estimated incidence due to AMI in diabetics increased from 54.7 cases per 100,000 in 2001 to 64.1 in 2006. Diabetic patients had significantly higher mortality than nondiabetic patients after adjusting for age, gender, and year (OR 1.11 [95% CI, 1.08-1.14]). The cost among diabetic patients increased by 21.3% from 2001 to 2006. Conclusions Diabetic patients have higher rates of hospital admission and fatality rates during the hospitalization after an AMI than nondiabetic patients. Diabetic adults who have suffered an AMI have a greater than expected increase in direct hospital costs over the period 2001-2006. PMID:20205960

  3. Plasma neutrophil gelatinase-associated lipocalin as a marker for the prediction of worsening renal function in children hospitalized for acute heart failure.

    PubMed

    Elsharawy, Sahar; Raslan, Lila; Morsy, Saed; Hassan, Basheir; Khalifa, Naglaa

    2016-01-01

    Acute heart failure (AHF) is frequently associated with worsening renal function in adult patients. Neutrophil gelatinase-associated lipocalin (NGAL) serves as an early marker for acute renal tubular injury. To assess the role of plasma NGAL in predicting worsening renal function (WRF) in children with AHF, we studied 30 children hospitalized for AHF; children with history of chronic renal disease or on nephrotoxic drugs were excluded. Twenty age- and sex-matched healthy children were included in the study as a control group. Echocardiographic examination was performed on admission. Blood urea nitrogen (BUN), serum creatinine, estimated glomerular filtration rate (eGFR) and plasma NGAL levels were measured on admission and 72 h later. Seventeen (56.6%) patients developed WRF within the three-day follow-up period. At presentation, plasma NGAL level was significantly elevated in children who developed WRF. Admission plasma NGAL level correlated with renal parameters (BUN, creatinine and eGFR) as well as with left ventricular systolic parameters (ejection fraction and fractional shortening). For prediction of WRF, admission plasma, NGAL level>27.5 μg/L had sensitivity and specificity of 90% and 68%, respectively. The area under the receiver-operator curve was higher for NGAL (0.869) than for BUN (0.569) or eGFR (0.684). We conclude that admission plasma NGAL level can predict WRF in children hospitalized for AHF.

  4. 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

  5. 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

  6. Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study

    PubMed Central

    Sivasubramaniam, Vinothan; Patel, Hitesh C; Ozdemir, Baris A; Papadopoulos, Marios C

    2015-01-01

    Objectives Low back pain (LBP), from degenerative lumbar spine disease, represents a significant burden on healthcare resources. Studies worldwide report trends attributable to their country's specific demographics and healthcare system. Considering England's specific medico-socioeconomic conditions, we investigate recent trends in hospital admissions and procedures for LBP, and discuss the implications for the allocation of healthcare resources. Design Retrospective cohort study using Hospital Episode Statistics data relating to degenerative lumbar spine disease in England, between 1999 and 2013. Regression models were used to analyse trends. Outcome measures Trends in the number of admissions and procedures for LBP, mean patient age, gender and length of stay. Results Hospital admissions and procedures have increased significantly over the study period, from 127.09 to 216.16 and from 24.5 to 48.83 per 100 000, respectively, (p<0.001). The increase was most marked in the oldest age groups with a 1.9 and 2.33-fold increase in admissions for patients aged 60–74 and ≥75 years, respectively, and a 2.8-fold increase in procedures for those aged ≥60 years. Trends in hospital admissions were characterised by a widening gender gap, increasing mean patient age, and decreasing mean hospital stay (p<0.001). Trends in procedures were characterised by a narrowing gender gap, increasing mean patient age (p=0.014) and decreasing mean hospital stay (p<0.001). Linear regression models estimate that each hospital admission translates to 0.27 procedures, per 100 000 (95% CI 0.25 to 0.30, r 0.99, p<0.001; r, Pearson's correlation coefficient). Hospital admissions are increasing at 3.5 times the rate of surgical procedures (regression gradient 7.63 vs 2.18 per 100 000/year). Conclusions LBP represents a significant and increasing workload for hospitals in England. These trends demonstrate an increasing demand for specialists involved in the surgical and non

  7. The relationship between organizational culture and performance in acute hospitals.

    PubMed

    Jacobs, Rowena; Mannion, Russell; Davies, Huw T O; Harrison, Stephen; Konteh, Fred; Walshe, Kieran

    2013-01-01

    This paper examines the relationship between senior management team culture and organizational performance in English acute hospitals (NHS Trusts) over three time periods between 2001/2002 and 2007/2008. We use a validated culture rating instrument, the Competing Values Framework, to measure senior management team culture. Organizational performance is assessed using a wide range of routinely collected indicators. We examine the associations between organizational culture and performance using ordered probit and multinomial logit models. We find that organizational culture varies across hospitals and over time, and this variation is at least in part associated in consistent and predictable ways with a variety of organizational characteristics and routine measures of performance. Moreover, hospitals are moving towards more competitive culture archetypes which mirror the current policy context, though with a stronger blend of cultures. The study provides evidence for a relationship between culture and performance in hospital settings.

  8. Relationship Between Severity Classification of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Clinical Outcomes in Hospitalized Patients

    PubMed Central

    Sanjuán, Pilar; Huerta, Arturo; Nieto-Codesido, Irene; Ferreira-Gonzalez, Lucía; Sibila, Oriol; Restrepo, Marcos I

    2017-01-01

    Background Limited data are available regarding the impact of the potential validation of the Canadian Thoracic Society (CTS) guidelines recommendations in classifying patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in simple and complex. The aim of the present study was to assess the CTS recommendations regarding risk stratification on clinical outcomes among patients hospitalized with an AECOPD. Methods We developed a retrospective cohort study of patients admitted to one tertiary hospital with a diagnosis of AECOPD. The main clinical outcome was the percentage of treatment failure. Secondary outcomes were 30-day, 90-day, and 1-year readmission and mortality rate, length of stay in hospital, intensive care unit (ICU) admission rate, time to readmission, and time to death. Multivariate analyses were performed using 1-year mortality rate as the dependent measures. Results One hundred forty-three patients composed the final study population, most of them (106 [74.1%)] classified as complex acute exacerbation (C-AE) of COPD. C-AE patients had similar rate of treatment failure compared with simple acute exacerbation (S-AE) of COPD (31.1% vs. 27%; p = 0.63). There were no differences regarding the length of stay in hospital, ICU admission rate, and 30-day, 90-day, and 1-year readmission rate. C-AE patients had faster declined measures on time to death (691.6 ± 430 days vs. 998.1 ± 355 days; p = 0.02). In the multivariate analysis, after adjusting for comorbidity, lung function and previous treatment, C-AE patients had a significant higher mortality at one year (Odds Ratio [OR] = 4.9 (Confidence Interval [CI] 95%: 1.16-21); p = 0.031). Conclusions In hospitalized patients with an AECOPD, CTS classification, according to the presence of risk factors, was not associated with worse short-term clinical outcomes although it is related with long-term mortality.  PMID:28265524

  9. Examining Outcomes of Acute Psychiatric Hospitalization among Children

    PubMed Central

    Tharayil, Priya R.; Sigrid, James; Morgan, Ronald; Freeman, Kimberly

    2013-01-01

    Within the past two decades, few studies have examined outcomes of acute psychiatric hospitalization among children, demonstrating change in emotional and behavioral functioning. A secondary analysis of pre-test/post-test data collected on 36 children was conducted, using the Target Symptom Rating (TSR). The TSR is a 13-item measure with two subscales – Emotional Problems and Behavioral Problems and was designed for evaluation of outcome among children and adolescents in acute inpatient psychiatric settings. Results of this study, its limitations, and the barriers encountered in the implementation of the TSR scale as part of routine clinical practice are discussed. PMID:23946699

  10. Prevention of deterioration in acutely ill patients in hospital.

    PubMed

    Steen, Colin

    The shift towards providing critical care in general wards has changed the way acutely ill patients are identified, treated and managed in hospital. This requires the expertise of knowledgeable, informed and capable staff. Effective education and appropriate knowledge and skills are required to aid identification of the deteriorating patient and provide prompt, timely and appropriate intervention to prevent further deterioration and possibly death. This article provides information about a systematic approach that will enable healthcare professionals to intervene to prevent deterioration in acutely ill patients.

  11. 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

  12. Air pollution and hospital admissions for respiratory diseases in the subequatorial Amazon: a time series approach.

    PubMed

    Ignotti, Eliane; Hacon, Sandra de Souza; Junger, Washington Leite; Mourão, Dennys; Longo, Karla; Freitas, Saulo; Artaxo, Paulo; Leon, Antônio Carlos Monteiro Ponce de

    2010-04-01

    The objective of the study is to evaluate the effect of the daily variation in concentrations of fine particulate matter (diameter less than 2.5 microm--PM2.5) resulting from the burning of biomass on the daily number of hospitalizations of children and elderly people for respiratory diseases, in Alta Floresta and Tangará da Serra in the Brazilian Amazon in 2005. This is an ecological time series study that uses data on daily number of hospitalizations of children and the elderly for respiratory diseases, and estimated concentration of PM2.5. In Alta Floresta, the percentage increases in the relative risk (%RR) of hospitalization for respiratory diseases in children were significant for the whole year and for the dry season with 3-4 day lags. In the dry season these measurements reach 6% (95%CI: 1.4-10.8). The associations were significant for moving averages of 3-5 days. The %RR for the elderly was significant for the current day of the drought, with a 6.8% increase (95%CI: 0.5-13.5) for each additional 10 microg/m3 of PM2.5. No associations were verified for Tangará da Serra. The PM2.5 from the burning of biomass increased hospitalizations for respiratory diseases in children and the elderly.

  13. 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...

  14. Factors Affecting Recovery Time of Pulmonary Function in Hospitalized Patients With Acute Asthma Exacerbations

    PubMed Central

    Kim, Hyo-Jung; Lee, Jaemoon; Kim, Jung-Hyun; Park, So-Young; Kwon, Hyouk-Soo; Kim, Tae-Bum; Moon, Hee-Bom

    2016-01-01

    Purpose Prolonged recovery time of pulmonary function after an asthma exacerbation is a significant burden on asthmatics, and management of these patients needs to be improved. The aim of this study was to evaluate factors associated with a longer recovery time of pulmonary function among asthmatic patients hospitalized due to a severe asthma exacerbation. Methods We retrospectively reviewed the medical records of 89 patients who were admitted for the management of acute asthma exacerbations. The recovery time of pulmonary function was defined as the time from the date each patient initially received treatment for asthma exacerbations to the date the patient reached his or her previous best FEV1% value. We investigated the influence of various clinical and laboratory factors on the recovery time. Results The median recovery time of the patients was 1.7 weeks. Multiple linear regression analysis revealed that using regular inhaled corticosteroids (ICS) before an acute exacerbation of asthma and concurrent with viral infection at admission were associated with the prolonged recovery time of pulmonary function. Conclusions The prolonged recovery time of pulmonary function after a severe asthma exacerbation was not shown to be directly associated with poor adherence to ICS. Therefore the results indicate that an unknown subtype of asthma may be associated with the prolonged recovery of pulmonary function time after an acute exacerbation of asthma despite regular ICS use. Further prospective studies to investigate factors affecting the recovery time of pulmonary function after an asthma exacerbation are warranted. PMID:27582400

  15. Pre-Stage Acute Kidney Injury Can Predict Mortality and Medical Costs in Hospitalized Patients

    PubMed Central

    Ahn, Shin Young; Chin, Ho Jun; Na, Ki Young; Chae, Dong-Wan; Kim, Sejoong

    2016-01-01

    The significance of minimal increases in serum creatinine below the levels indicative of the acute kidney injury (AKI) stage is not well established. We aimed to investigate the influence of pre-stage AKI (pre-AKI) on clinical outcomes. We enrolled a total of 21,261 patients who were admitted to the Seoul National University Bundang Hospital from January 1, 2013 to December 31, 2013. Pre-AKI was defined as a 25–50% increase in peak serum creatinine levels from baseline levels during the hospital stay. In total, 5.4% of the patients had pre-AKI during admission. The patients with pre-AKI were predominantly female (55.0%) and had a lower body weight and lower baseline levels of serum creatinine (0.63 ± 0.18 mg/dl) than the patients with AKI and the patients without AKI (P < 0.001). The patients with pre-AKI had a higher prevalence of diabetes mellitus (25.1%) and malignancy (32.6%). The adjusted hazard ratio of in-hospital mortality for pre-AKI was 2.112 [95% confidence interval (CI), 1.143 to 3.903]. In addition, patients with pre-AKI had an increased length of stay (7.7 ± 9.7 days in patients without AKI, 11.4 ± 11.4 days in patients with pre-AKI, P < 0.001) and increased medical costs (4,061 ± 4,318 USD in patients without AKI, 4,966 ± 5,099 USD in patients with pre-AKI, P < 0.001) during admission. The adjusted hazard ratio of all-cause mortality for pre-AKI during the follow-up period of 2.0 ± 0.6 years was 1.473 (95% CI, 1.228 to 1.684). Although the adjusted hazard ratio of pre-AKI for overall mortality was not significant among the patients admitted to the surgery department or who underwent surgery, pre-AKI was significantly associated with mortality among the non-surgical patients (adjusted HR 1.542 [95% CI, 1.330 to 1.787]) and the patients admitted to the medical department (adjusted HR 1.384 [95% CI, 1.153 to 1.662]). Pre-AKI is associated with increased mortality, longer hospital stay, and increased medical costs during admission. More attention

  16. Characterisation of metabolic acidosis in Kenyan children admitted to hospital for acute non-surgical conditions.

    PubMed

    Sasi, P; English, M; Berkley, J; Lowe, B; Shebe, M; Mwakesi, R; Kokwaro, G

    2006-05-01

    Metabolic acidosis is associated with most severe malaria deaths in African children, and most deaths occur before maximum antimalarial action is achieved. Thus, specific acidosis treatment may reduce mortality. However, the underlying mechanisms remain poorly understood and no specific interventions have been developed. A detailed characterisation of this acidosis is critical in treatment development. We used the traditional and Stewart's approach to characterise acidosis in consecutive paediatric admissions for malaria and other acute non-surgical conditions to Kilifi District Hospital in Kenya. The overall acidosis prevalence was 21%. Gastroenteritis had the highest prevalence (61%). Both the mean albumin-corrected anion gap and the strong ion gap were high (>13 mmol/l and >0 mmol/l, respectively) in malaria, gastroenteritis, lower respiratory tract infection and malnutrition. Presence of salicylate in plasma was not associated with acidosis but was associated with signs of severe illness (odds ratio 2.11, 95% CI 1.1-4.2). In malaria, mean (95% CI) strong ion gap was 15 (14-7) mmol/l, and lactate, creatinine and inorganic phosphorous explained only approximately 40% of the variability in base excess (adjusted R2 = 0.397). Acidosis may be more common than previously recognised amongst paediatric admissions in Africa and is characterised by the presence of currently unidentified strong anions. In malaria, lactate and ketones, but not salicylate, are associated with acidosis. However, unidentified anions may be more important.

  17. Weekend versus weekday hospital admission and outcomes during hospitalization for patients due to worsening heart failure: a report from Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD).

    PubMed

    Hamaguchi, Sanae; Kinugawa, Shintaro; Tsuchihashi-Makaya, Miyuki; Goto, Daisuke; Tsutsui, Hiroyuki

    2014-05-01

    The day of the week of admission may influence the length of stay and in-hospital death. However, the association between the admission day of the week and in-hospital outcomes has been inconsistent in heart failure (HF) patients among studies reported from Western countries. We thus analyzed this association in HF patients encountered in routine clinical practice in Japan. We studied the characteristics and in-hospital treatment in 1620 patients hospitalized with worsening HF by using the database of the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Patients were divided into two groups according to weekday (n = 1355; 83.6%) or weekend admission (n = 265; 16.4%). The mean age was 70.7 years and 59.4% were male. Etiology was ischemic in 34.0%, and mean left ventricular ejection fraction was 42.5%. Patients admitted on the weekend were significantly older and had more comorbidities, and more severe symptoms and signs of HF on admission. Length of stay was comparable between weekend and weekday admission (35.2 ± 47.0 days vs 33.6 ± 32.0 days, P = 0.591). Crude in-hospital mortality did not differ between patients admitted on the weekend and weekdays (7.5% vs 5.2%, P = 0.136). Even after adjustment for covariates in multivariable modeling with patients admitted on weekday as the reference, in-hospital death was comparable between patients admitted on the weekend and weekdays (adjusted odds ratio 1.125, 95% confidence interval 0.631-2.004, P = 0.691). Among patients hospitalized for worsening HF, admission day of the week did not affect in-hospital death and length of stay.

  18. 76 FR 19365 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-07

    ... Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2011 Final Wage Indices...), HHS. ACTION: Notice. SUMMARY: This notice contains the final fiscal year (FY) 2011 wage indices and... the expiration date for certain geographic reclassifications and special exception wage...

  19. 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

  20. Assessment and provision of rehabilitation among patients hospitalized with acute ischemic stroke in China: Findings from the China National Stroke Registry II.

    PubMed

    Bettger, Janet Prvu; Li, Zixiao; Xian, Ying; Liu, Liping; Zhao, Xingquan; Li, Hao; Wang, Chunxue; Wang, Chunjuan; Meng, Xia; Wang, Anxin; Pan, Yuesong; Peterson, Eric D; Wang, Yilong; Wang, Yongjun

    2017-04-01

    Background Stroke rehabilitation improves functional recovery among stroke patients. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation among patients with acute ischemic stroke. Aims We examined the frequency and determinants of an assessment for rehabilitation among acute ischemic stroke patients from the China National Stroke Registry II. Methods Data for 19,294 acute ischemic stroke patients admitted to 219 hospitals from June 2012 to January 2013 were analyzed. The multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was used to identify patient and hospital factors associated with having a rehabilitation assessment during the acute hospitalization. Results Among 19,294 acute ischemic stroke patients, 11,451 (59.4%) were assessed for rehabilitation. Rates of rehabilitation assessment varied among 219 hospitals (IQR 41.4% vs 81.5%). In the multivariable analysis, factors associated with increased likelihood of a rehabilitation assessment ( p < 0.05) included disability prior to stroke, higher NIHSS on admission, receipt of a dysphagia screen, deep venous thrombosis prophylaxis, carotid vessel imaging, longer length of stay, and treatment at a hospital with a higher number of hospital beds (per 100 units). In contrast, patients with a history of atrial fibrillation and hospitals with higher number of annual stroke discharges (per 100 patients) were less likely to receive rehabilitation assessment during the acute stroke hospitalization. Conclusions Rehabilitation assessment among acute ischemic stroke patients was suboptimal in China. Rates varied considerably among hospitals and support the need to improve adherence to recommended care for stroke survivors.

  1. [Problems in the admission to in-hospital oral surgical care from the patient's viewpoint--results of patient interviews in the hospital for dental and maxillo-facial surgery of the Karl Marx University, Leipzig].

    PubMed

    Erpenbeck, F; Birnbaum, K; Langanke, B; Niemand, B; Thomzyk, I

    1979-06-01

    The author deals with the results from the interviewing of oral surgery patients on their problems concerning the sending and the admission to the hospital, with special attention to the problems of waiting for admission, the familiarization with the clinical environment and the improvement suggestions of the patients. The conclusions concern tasks arising from the medical and dental care for inpatients as well as for outpatients.

  2. A cost effectiveness analysis within a randomised controlled trial of post-acute care of older people in a community hospital

    PubMed Central

    O'Reilly, Jacqueline; Lowson, Karin; Young, John; Forster, Anne; Green, John; Small, Neil

    2006-01-01

    Objective To assess the cost effectiveness of post-acute care for older people in a locality based community hospital compared with a department for care of elderly people in a district general hospital, which admits patients aged over 76 years with acute medical conditions. Design Cost effectiveness analysis within a randomised controlled trial. Setting Community hospital and district general hospital in Yorkshire, England. Participants 220 patients needing rehabilitation after an acute illness for which they required admission to hospital. Interventions Multidisciplinary care in the district general hospital or prompt transfer to the community hospital. Main outcome measures EuroQol EQ-5D scores transformed into quality adjusted life years (QALYs), and health and social service costs over six months from randomisation. Results The mean QALY score for the community hospital group was marginally non-significantly higher than that for the district general hospital group (0.38 v 0.35) at six months after recruitment. The mean (standard deviation) costs per patient of the health and social services resources used were similar for both groups: community hospital group £7233 (euros 10 567; $13 341) (£5031), district general hospital group £7351 (£6229), and these findings were robust to several sensitivity analyses. The incremental cost effectiveness ratio for community hospital care dominated. A cost effectiveness acceptability curve, based on bootstrapped simulations, suggests that at a willingness to pay threshold of £10 000 per QALY, 51% of community hospital cases will be cost effective, which rises to 53% of cases when the threshold is £30 000 per QALY. Conclusion Post-acute care for older people in a locality based community hospital is of similar cost effectiveness to that of an elderly care department in a district general hospital. PMID:16861254

  3. Self-disorders and the Schizophrenia Spectrum: A Study of 100 First Hospital Admissions

    PubMed Central

    Nordgaard, Julie; Parnas, Josef

    2014-01-01

    Introduction: Self-disorders (SD) have been described as a core feature of schizophrenia both in classical and recent psychopathological literature. However, the specificity of SD for the schizophrenia spectrum disorders has never been demonstrated in a diagnostically heterogeneous sample, nor has the concurrent validity of SD been examined. Aim: (1) To examine the specificity of Examination of Anomalous Self-Experiences (EASE) measured SD to the schizophrenia spectrum disorder in first contact inpatients, (2) to explore the internal consistency and factorial structure of the EASE, (3) to assess the concurrent validity of SD by exploring correlations between SD and the canonical psychopathological dimensions of schizophrenia, (4) to explore relations of SD to intelligence, sociodemographic, and extrinsic illness characteristics. Methods: A total of 100 consecutive first admission patients underwent a comprehensive psychopathological examination and an assessment of SD with the EASE scale. The diagnostic distribution of the EASE scores was tested with ANOVA, whereas the relations between the EASE scores and other symptomatic dimensions of schizophrenia were tested with Spearman’s rho. A potential factorial structure and the internal consistency of the EASE scale were also examined. Results: SD aggregated significantly in the schizophrenia spectrum disorders, with no differences between schizophrenia and schizotypal disorders. EASE scores correlated moderately with canonical psychopathological dimensions of schizophrenia. Factor analysis of the EASE disclosed only one factor and the internal consistency of the EASE was excellent. Conclusions: SD aggregate selectively in the schizophrenia spectrum disorders, with similar levels in schizophrenia and schizotypy. The study lends validity to the view of SD as an experiential vulnerability phenotype of the schizophrenia spectrum disorders. PMID:24476579

  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. [Unified National Health System costs in São José dos Campos, São Paulo State, Brazil, for hospital admissions due to external causes].

    PubMed

    Melione, Luís Paulo Rodrigues; Mello-Jorge, Maria Helena Prado de

    2008-08-01

    The objective of this study was to identify direct expenditures for hospitalizations due to external causes in the Unified National Health System (SUS) in the city of São José dos Campos, São Paulo State, Brazil. Admissions to the Dr. José de Carvalho Florence Municipal Hospital resulting from external causes or injuries - ICD-10, chapters XIX and XX respectively - were analyzed for the first semester of 2003. 976 patient admission forms were analyzed, after data evaluation. Admissions with the highest total cost were those resulting from motor vehicle accidents and falls. The highest mean cost for hospitalization for injury was due to motor vehicle accidents (BRL 614.63), followed by assault (BRL 594.90). The highest mean cost for hospitalization due to injury was for cervical fractures (BRL 1,191.42) and head injuries (BRL 1,000.44). Hospitalizations with the highest daily cost were skull and facial fractures (BRL 166.72) and abdominal trauma (BRL 148.26). The study confirmed that motor vehicle accidents, falls, and assault are an important source of costs due to hospitalization for injuries.

  6. Applying quality improvement methods to address gaps in medicines reconciliation at transfers of care from an acute UK hospital

    PubMed Central

    Marvin, Vanessa; Kuo, Shirley; Vaughan, Louella

    2016-01-01

    Objectives Reliable reconciliation of medicines at admission and discharge from hospital is key to reducing unintentional prescribing discrepancies at transitions of healthcare. We introduced a team approach to the reconciliation process at an acute hospital with the aim of improving the provision of information and documentation of reliable medication lists to enable clear, timely communications on discharge. Setting An acute 400-bedded teaching hospital in London, UK. Participants The effects of change were measured in a simple random sample of 10 adult patients a week on the acute admissions unit over 18 months. Interventions Quality improvement methods were used throughout. Interventions included education and training of staff involved at ward level and in the pharmacy department, introduction of medication documentation templates for electronic prescribing and for communicating information on medicines in discharge summaries co-designed with patient representatives. Results Statistical process control analysis showed reliable documentation (complete, verified and intentional changes clarified) of current medication on 49.2% of patients' discharge summaries. This appears to have improved (to 85.2%) according to a poststudy audit the year after the project end. Pharmacist involvement in discharge reconciliation increased significantly, and improvements in the numbers of medicines prescribed in error, or omitted from the discharge prescription, are demonstrated. Variation in weekly measures is seen throughout but particularly at periods of changeover of new doctors and introduction of new systems. Conclusions New processes led to a sustained increase in reconciled medications and, thereby, an improvement in the number of patients discharged from hospital with unintentional discrepancies (errors or omissions) on their discharge prescription. The initiatives were pharmacist-led but involved close working and shared understanding about roles and responsibilities

  7. Citicoline for acute ischemic stroke in Mexican hospitals: a retrospective postmarketing analysis.

    PubMed

    Leon-Jimenez, C; Chiquete, E; Cantu, C; Miramontes-Saldana, M J; Andrade-Ramos, M A; Ruiz-Sandoval, J L

    2010-06-01

    Some neuroprotective agents have shown benefits in animal models, but disappointing results in humans. Citicoline is used in several countries as coadjuvant treatment in acute ischemic stroke (AIS) patients; however, there are no retrospective postmarketing surveillances on the experience of citicoline in Mexico. The aim of this study was to evaluate the correlation between citicoline exposure and functional outcome at discharge and at 30 and 90 days post-stroke, in a retrospective case-control design on systematic descriptive databases from three referral hospitals. Clinical records of 173 consecutively registered patients were analyzed, 86 of whom were treated with citicoline within the first 48 h after AIS and the remaining 87 were untreated, randomly selected controls matched for age (+/- 5 years), gender and NIHSS (+/- 1 point) at hospital admission. Pretreatment conditions were similar between groups. Compared with controls, exposure to citicoline was associated with a significantly lower 30-day mean and median modified Rankin score (in both, P < 0.05). After paired multivariate analyses (controlled for NIHSS, age, gender, hospital arrival in < 24 h, thrombolysis and comorbidities) citicoline was independently associated with a lower 90-day mortality risk (P = 0.047) and with fewer in-hospital complications (mainly infections and sepsis, P = 0.001). In this observational study, citicoline use was associated with a better functional status and lower rates of short-term mortality, possibly due to fewer in-hospital systemic complications. The putative benefits should be interpreted as clinical associations, since this is not a randomized, controlled clinical trial.

  8. 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.

  9. Inverted U-shape relationships of the weather as biometeorological and hospital admissions due to carcinoma in situ and benign neoplasm in Germany in 2009-2011.

    PubMed

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

    2015-06-01

    We aimed to understand the relationships of the weather as biometeorological and hospital admissions due to carcinoma in situ and benign neoplasms, which have been less paid attention to, in a national setting in recent years. 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 D00-D48 in situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behaviour 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). For most subtypes, peaks of admissions were observed in spring and late autumn. There could be four groups of phenomenon among these admissions. To be specific, D06, D16, D21, D24-25, D35 and D39 peaked when PET was at 0 °C. D46 peaked when PET was at 5-10 °C. D03, D04 and D33 had linear relationships. Other admissions peaked when PET was between 0 and 5 °C. All admissions were in common with a drop when PET reached 10 °C or higher. More medical resources could have been needed on days when PETs were at 0-10 °C than on other days. Adaptation to such weather change for medical professionals and the general public would seem to be imperative.

  10. The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital

    PubMed Central

    Andreasen, Jane; Lund, Hans; Aadahl, Mette; Sørensen, Erik E.

    2015-01-01

    Introduction Frail elderly are at higher risk of negative outcomes such as disability, low quality of life, and hospital admissions. Furthermore, a peak in readmission of acutely admitted elderly patients is seen shortly after discharge. An investigation into the daily life experiences of the frail elderly shortly after discharge seems important to address these issues. The aim of this study was to explore how frail elderly patients experience daily life 1 week after discharge from an acute admission. Methods The qualitative methodological approach was interpretive description. Data were gathered using individual interviews. The participants were frail elderly patients over 65 years of age, who were interviewed at their home 1 week after discharge from an acute admission to a medical ward. Results Four main categories were identified: “The system,” “Keeping a social life,” “Being in everyday life,” and “Handling everyday life.” These categories affected the way the frail elderly experienced daily life and these elements resulted in a general feeling of well-being or non-well-being. The transition to home was experienced as unsafe and troublesome especially for the more frail participants, whereas the less frail experienced this less. Conclusion and discussion Several elements and stressors were affecting the well-being of the participants in daily life 1 week after discharge. In particular, contact with the health care system created frustrations and worries, but also physical disability, loneliness, and inactivity were issues of concern. These elements should be addressed by health professionals in relation to the transition phase. Future interventions should incorporate a multidimensional and bio-psycho-social perspective when acutely admitted frail elderly are discharged. Stakeholders should evaluate present practice to seek to improve care across health care sectors. PMID:26037333

  11. Descriptions of Acute Transfusion Reactions in the Teaching Hospitals of Kermanshah University of Medical Sciences, Iran

    PubMed Central

    Payandeh, Mehrdad; Zare, Mohammad Erfan; Kansestani, Atefeh Nasir; Pakdel, Shirin Falah; Jahanpour, Firuzeh; Yousefi, Hoshang; Soleimanian, Farzaneh

    2013-01-01

    Background Transfusion services rely on transfusion reaction reporting to provide patient care and protect the blood supply. Unnecessary discontinuation of blood is a major wastage of scarce blood, as well as man, hours and funds. The aim of the present study was to describe the main characteristics of acute transfusion reactions reported in the 4 hospital of Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran. Material and Methods The study was carried out at 4 teaching hospital of Kermanshah University of Medical Sciences, Kermanshah, Iran, over18 months from April 2010. All adult patients on admission in the hospitals who required blood transfusion and had establish diagnosis and consented were included in the study. Results In the year 2010 until 2012, a total of 6238 units of blood components were transfused. A total of 59 (0.94%) cases of transfusion reaction were reported within this 3 years period. The commonest were allergic reactions which presented with various skin manifestations such as urticarial, rashes and pruritus (49.2%), followed by increase in body temperature of > 1°C from baseline which was reported as febrile non-hemolytic transfusion reaction (37.2%). pain at the transfusion site (6.8%) and hypotension (6.8%). Conclusion It is important that each transfusion of blood components to be monitor carefully. Many transfusion reactions are not recognized, because signs and symptoms mimic other clinical conditions. Any unexpected symptoms in a transfusion recipient should at least be considered as a possible transfusion reaction and be evaluated. Prompt recognition and treatment of acute transfusion reaction are crucial and would help in decreasing transfusion related morbidity and mortality, but prevention is preferable. PMID:24505522

  12. A time comparison study of the New York State Safety Belt Use Law utilizing hospital admission and police accident report information.

    PubMed

    States, J D; Annechiarico, R P; Good, R G; Lieou, J; Andrews, M; Cushman, L; Ingersoll, G

    1990-12-01

    New York state enacted the first safety belt use law in the United States in 1984. We evaluated the effects of the law by reviewing all hospital admissions from motor vehicle crashes in Monroe County, New York. We compared admissions for the 18 months prior to the effective date of the law with those for the 18 months after the law became effective. Police accident reports and hospital records were coupled and intensively reviewed. Motorcyclists, pedestrians, and bicyclists (bicycle collisions with motor vehicles) became controls for the study. Seat belt usage was determined from police and hospital record information. Analysis of the data revealed that safety belt use among patients hospitalized because of motor vehicle accidents increased from 11.2% before the law became effective to 53% after the law became effective. Hospital admissions decreased 11.9% among motor vehicle occupants and increased 2.6% among controls. The ISS decreased from 16.01 to 14.55 for motor vehicle occupants and increased from 14.77 to 15.11 among controls. Among subjects all injuries decreased except injuries of the spine and abdomen, which increased in the postlaw period.

  13. 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

  14. 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.

  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. HIV RELATED ADMISSIONS IN A PSYCHIATRIC HOSPITAL A FIVE YEAR PROFILE

    PubMed Central

    Chandra, P.S.; Krishna, V.A.S.; Ravi, V.; Desai, A.; Puttaram, S.

    1999-01-01

    Recent reports have indicated an increasing prevalence of HIV infection in the mentally ill. Reports have also emphasised the etiological role of HIV infection in psychiatric illness. The aim of this study was to assess the clinical and risk profile of psychiatric inpatients found seropositive for HIV infection. All psychiatric inpatients from a psychiatric hospital who tested positive for HI V infection over a five year period were assessed. The assessments included a detailed clinical history, psychiatric assessment and risk behaviour evaluation. Of the 2283 psychiatric patients tested, 51 were found to be seropositive. 43 patients were included in the study. 30 (69.7%) had a diagnosis of alcohol dependence, of which, 11 patients had comorbid psychiatnc diagnosis in the form of affective disorders (23%) and psychosis (14%). Personality disorders were seen in 9 patients. In 19% the clinical manifestation was considered to be etiologically related to HIV infection. The predominant risk behaviour was in the form of multiple partner heterosexual contacts. In several patients the risk behaviour had occurred during an episode of mental illness or under the influence of alcohol. The study demonstrates the importance of detecting and describing HIV infection and its manifestation among psychiatric patients. PMID:21430804

  17. Hospital Nursing and 30-Day Readmissions among Medicare Patients with Heart Failure, Acute Myocardial Infarction, and Pneumonia

    PubMed Central

    McHugh, Matthew D.; Ma, Chenjuan

    2013-01-01

    Background Provisions of the Affordable Care Act that increase hospitals’ financial accountability for preventable readmissions have heightened interest in identifying system-level interventions to reduce readmissions. Objectives To determine the relationship between hospital nursing; i.e. nurse work environment, nurse staffing levels, and nurse education, and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Method and Design Analysis of linked data from California, New Jersey, and Pennsylvania that included information on the organization of hospital nursing (i.e., work environment, patient-to-nurse ratios, and proportion of nurses holding a BSN degree) from a survey of nurses, as well as patient discharge data, and American Hospital Association Annual Survey data. Robust logistic regression was used to estimate the relationship between nursing factors and 30-day readmission. Results Nearly one-quarter of heart failure index admissions (23.3% [n=39,954]); 19.1% (n=12,131) of myocardial infarction admissions; and 17.8% (n=25,169) of pneumonia admissions were readmitted within 30-days. Each additional patient per nurse in the average nurse’s workload was associated with a 7% higher odds of readmission for heart failure (OR=1.07, [1.05–1.09]), 6% for pneumonia patients (OR=1.06, [1.03–1.09]), and 9% for myocardial infarction patients (OR=1.09, [1.05–1.13]). Care in a hospital with a good versus poor work environment was associated with odds of readmission that were 7% lower for heart failure (OR = 0.93, [0.89–0.97]); 6% lower for myocardial infarction (OR = 0.94, [0.88–0.98]); and 10% lower for pneumonia (OR = 0.90, [0.85–0.96]) patients. Conclusions Improving nurses’ work environments and staffing may be effective interventions for preventing readmissions. PMID:23151591

  18. The effect of funding policy on day of week admissions and discharges in hospitals: the cases of Austria and Canada.

    PubMed

    Leonard, Kevin J; Rauner, Marion S; Schaffhauser-Linzatti, Michaela Maria; Yap, Richard

    2003-03-01

    This paper compares two different funding policies for inpatients, the case-based approach in Austria versus the global budgeting approach in Canada. It examines the impact of these funding policies on length of stay of inpatients as one key measure of health outcome. In our study, six major clinical categories for inpatients are selected in which the day of the week for admission is matched to the particular day of the week of discharge for each individual case. The strategic statistical analysis proves that funding policies have a significant impact on the expected length of stay of inpatients. For all six clinical categories, Austrian inpatients stayed longer in hospitals compared to Canadian inpatients. Moreover, inpatients were not admitted and discharged equally throughout the week. We also statistically prove for certain clinical categories that more inpatients are discharged on certain days such as Mondays or Fridays depending on the funding policy. Our study is unique in the literature and our conclusions indicate that, with the right incentives in place, the length of stay can be decreased and discharge anomalies can be eliminated, which ultimately leads to a decrease in healthcare expenditures and an increase in healthcare effectiveness.

  19. Influence of alcohol use on mortality and expenditure during hospital admission: a cross-sectional study

    PubMed Central

    Peng, Shu-Hui; Hsu, Shiun-Yuan; Kuo, Pao-Jen; Rau, Cheng-Shyuan; Cheng, Ya-Ai; Hsieh, Ching-Hua

    2016-01-01

    Objectives This study was designed to investigate the effect of alcohol intoxication on clinical presentation of hospitalised adult trauma patients at a Level I trauma centre using propensity score matching. Design Cross-sectional study. Setting Taiwan. Participants Detailed data of 929 hospitalised adult trauma patients with alcohol intoxication, aged 20–65 years, and 10 104 corresponding patients without alcohol intoxication were retrieved from the Trauma Registry System between 1 January 2009 and 31 December 2014. Alcohol intoxication was defined as a blood alcohol concentration (BAC) ≥50 mg/dL. Main outcome measures In-hospital mortality and expenditure. Results Patients with alcohol intoxication presented with significantly higher short-term mortality (OR: 3.0, 95% CI 2.0 to 4.4; p<0.001) than patients without alcohol intoxication. However, on comparison with propensity score-matched patients with respect to sex, age, comorbidity, Glasgow Coma Scale (GCS), injury region based on Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), alcohol intoxication did not significantly influence mortality (OR: 0.8, 95% CI 0.5 to 1.4; p=0.563). This implied that the higher mortality of alcohol-intoxicated patients was attributable to patient characteristics such as a higher injury severity rather than alcohol intoxication. Even on comparison with sex-matched, age-matched and comorbidity-matched patients without alcohol intoxication, patients with alcohol intoxication still had significantly higher total expenditure (17.4% higher), cost of operation (40.3% higher), cost of examination (52.8% higher) and cost of pharmaceuticals (38.3% higher). Conclusions The associated higher mortality of adult trauma patients with alcohol intoxication was completely attributable to other patient characteristics and associated injury severity rather than the effects of alcohol. However, patients with alcohol intoxication incurred significantly higher expenditure than

  20. Patterns of antibiotic use and risk of hospital admission because of Clostridium difficile infection

    PubMed Central

    Dial, Sandra; Kezouh, Abbas; Dascal, Andre; Barkun, Alan; Suissa, Samy

    2008-01-01

    Background Previous observations have indicated that infection with Clostridium difficile occurs almost exclusively after exposure to antibiotics, but more recent observations have suggested that prior antibiotic exposure may be less frequent among cases of community-acquired disease. Methods We used 2 linked health databases to perform a matched, nested case–control study of elderly patients admitted to hospital with community-acquired C. difficile infection. For each of 836 cases among people 65 years of age or older, we selected 10 controls. We determined the proportion of cases that occurred without prior antibiotic exposure and estimated the risk related to exposure to different antibiotics and the duration of increased risk. Results Of the 836 cases, 442 (52.9%) had no exposure to antibiotics in the 45-day period before the index date, and 382 (45.7%) had no exposure in the 90-day period before the index date. Antibiotic exposure was associated with a rate ratio (RR) of 10.6 (95% confidence interval [CI] 8.9–12.8). Clindamycin (RR 31.8, 95% CI 17.6–57.6), cephalosporins (RR 14.9, 95% CI 10.9–20.3) and gatifloxacin (RR 16.7, 95% CI 8.3–33.6) were associated with the highest risk. The RR for C. difficile infection associated with antibiotic exposure declined from 15.4 (95% CI 12.2–19.3) by about 20 days after exposure to 3.2 (95% CI 2.0–5.0) after 45 days. Use of a proton pump inhibitor was associated with increased risk (RR 1.6, 95% CI 1.3–2.0), as were concurrent diagnoses of inflammatory bowel disease (RR 4.1, 95% CI 2.6–6.6), irritable bowel syndrome (RR 3.4, 95% CI 2.3–5.0) and renal failure (RR 1.7, 95% CI 1.2–2.2). Interpretation Community-acquired C. difficile infection occurred in a substantial proportion of individuals with no recent exposure to antibiotics. Among patients who had been exposed to antibiotics, the risk declined markedly by 45 days after discontinuation of use. PMID:18838451

  1. Waiving the Three-Day Rule: Admissions and Length-of-Stay at Hospitals and Skilled Nursing Facilities did not Increase

    PubMed Central

    Grebla, Regina C.; Keohane, Laura; Lee, Yoojin; Lipsitz, Lewis A.; Rahman, Momotazur; Trivedl, Amal N.

    2015-01-01

    The traditional Medicare program requires an enrollee to have a hospital stay of at least three consecutive calendar days to qualify for coverage of subsequent postacute care in a skilled nursing facility. This long-standing policy, implemented to discourage premature discharges from hospitals, might now be inappropriately lengthening hospital stays for patients who could be transferred sooner. To assess the implications of eliminating the three-day qualifying stay requirement, we compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006–10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined from 6.9 days to 6.7 days for those no longer subject to the qualifying stay but increased from 6.1 to 6.6 days among those still subject to it, for a net decline of 0.7 day when the three-day stay requirement was eliminated. The elimination was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility. These findings suggest that eliminating the three-day stay requirement conferred savings on Medicare Advantage plans and that study of the requirement in traditional Medicare plans is warranted. PMID:26240246

  2. Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.

    PubMed

    Grebla, Regina C; Keohane, Laura; Lee, Yoojin; Lipsitz, Lewis A; Rahman, Momotazur; Trivedi, Amal N

    2015-08-01

    The traditional Medicare program requires an enrollee to have a hospital stay of at least three consecutive calendar days to qualify for coverage of subsequent postacute care in a skilled nursing facility. This long-standing policy, implemented to discourage premature discharges from hospitals, might now be inappropriately lengthening hospital stays for patients who could be transferred sooner. To assess the implications of eliminating the three-day qualifying stay requirement, we compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006-10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined from 6.9 days to 6.7 days for those no longer subject to the qualifying stay but increased from 6.1 to 6.6 days among those still subject to it, for a net decline of 0.7 day when the three-day stay requirement was eliminated. The elimination was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility. These findings suggest that eliminating the three-day stay requirement conferred savings on Medicare Advantage plans and that study of the requirement in traditional Medicare plans is warranted.

  3. 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

  4. [Clinical and epidemiologic characteristics of acute diarrhea in adults at a hospital from Cordoba city].

    PubMed

    Polo Friz, H; Toloza, S; Acosta, H; Toloza, C; Unsain, F; Marconetto, G; Massanet, P; Canova, S; Celli, J; Abdala, O; Gandini, B

    1997-01-01

    The purpose of this work was to assess the clinical and epidemiologic presentation features of adult acute diarrhea in a general hospital form Córdoba City. All the patients older than 14 years old who assisted to the Hospital Nacional de Clínicas Central Guard for acute diarrhea, during the periods: A (15-12-89 to 15-03-90), B (15-12-93 to 15-03-94) and C (15-12-94 to 15-03-95), were included. 594 patients were studied: 337 female (56.7%) and 257 male, 143 in the period A, 250 in B and 201 in C. The means +/- SD age was 34.6 +/- 13.3 and stool loose per day at admission 7.3 +/- 4.7. Eighty six percent of patients presented liquid consistent stool, 89.6% abdominal pain, 44.7% vomiting and 18.8% bloody stools. The rate of patients who consulted Central Guard referring acute diarrhea increased from period A (2.4%) to B (3.61%); p = 0.002 and decreased form B to C (2.85%); p = 0.01. The mean (+/- SD) days transcurred from the beginning of diarrhea episode till consultation was 3.5 +/- 2.7; 2.7 +/- 2.3 y 2.9 +/- 3.5 in the periods A, B and C respectively, statistically significant difference between A and B, p < 0.01. Thirty six percent, 21.1% and 23.1% of patients presented mucus with their stools in the periods A, B and C (p = 0.01), and high temperature 61.1%, 48.1% and 48.5% respectively (p = 0.04). Twenty seven percent of stools samples cultures became positive in the periods A, 17.6% in B and 11.5% in C, statistically significant difference between A and C; p = 0.008. The results show that in a general hospital from Córdoba City the adult acute diarrhea is a frequent cause of consult. In the last years there were modifications in its clinical an epidemiologic presentation features.

  5. Molecular viral epidemiology and clinical characterization of acute febrile respiratory infections in hospitalized children in Taiwan.

    PubMed

    Lee, Chun-Yi; Chang, Yu-Fen; Lee, Chia-Lin; Wu, Meng-Che; Ho, Chi-Lin; Chang, Yu-Chuan; Chan, Yu-Jiun

    2015-11-01

    Acute respiratory infection (ARI) is a leading cause of morbidity and hospitalization in children. To profile the viruses causing ARI in children admitted to a community-based hospital in central Taiwan, a cross-sectional study was conducted on children under 14 years of age that were hospitalized with febrile ARI. Viral etiology was determined using conventional cell culture and a commercial respiratory virus panel fast assay (xTAG RVP), capable of detecting 19 different respiratory viruses and subtype targets. Demographic, clinical, and laboratory data were recorded and analyzed. The RVP fast assay identified at least one respiratory virus in 130 of the 216 specimens examined (60.2%) and rose to 137 (63.4%) by combining the results of cell culture and RVP fast assay. In order of frequency, the etiological agents identified were, rhinovirus/enterovirus (24.6%), respiratory syncytial virus (13.8%), adenovirus (11.5%), parainfluenza virus (9.2%), influenza B (8.4%), influenza A (5.4%), human metapneumovirus (4.6%), human coronavirus (2%), and human bocavirus (2%). Co-infection did not result in an increase in clinical severity. The RVP assay detected more positive specimens, but failed to detect 6 viruses identified by culture. The viral detection rate for the RVP assay was affected by how many days after admission the samples were taken (P = 0.03). In conclusion, Rhinovirus/enterovirus, respiratory syncytial virus, and adenovirus were prevalent in this study by adopting RVP assay. The viral detection rate is influenced by sampling time, especially if the tests are performed during the first three days of hospitalization.

  6. Predictors and in-hospital prognosis of recurrent acute myocardial infarction

    PubMed Central

    Cao, Cheng-Fu; Li, Su-Fang; Chen, Hong; Song, Jun-Xian

    2016-01-01

    Objective To investigate the contributing factors and in-hospital prognosis of patients with or without recurrent acute myocardial infarction (AMI). Methods A total of 1686 consecutive AMI patients admitted to Peking University People's Hospital from January 2010 to December 2015 were recruited. Their clinical characteristics were retrospectively compared between patients with or without a recurrent AMI. Then multivariable logistic regression was used to estimate the predictors of recurrent myocardial infarction. Results Recurrent AMI patients were older (69.3 ± 11.5 vs. 64.7 ± 12.8 years, P < 0.001) and had a higher prevalence of diabetes mellitus (DM) (52.2% vs. 35.0%, P < 0.001) compared with incident AMI patients, they also had worse heart function at admission, more severe coronary disease and lower reperfusion therapy. Age (OR = 1.03, 95% CI: 1.02–1.05; P < 0.001), DM (OR = 1.86, 95% CI: 1.37–2.52; P < 0.001) and reperfusion therapy (OR = 0.74; 95% CI: 0.52–0.89; P < 0.001) were independent risk factors for recurrent AMI. Recurrent AMI patients had a higher in-hospital death rate (12.1% vs. 7.8%, P = 0.039) than incident AMI patients. Conclusions Recurrent AMI patients presented with more severe coronary artery conditions. Age, DM and reperfusion therapy were independent risk factors for recurrent AMI, and recurrent AMI was related with a high risk of in-hospital death. PMID:27928225

  7. Impact of a chronic disease management program on hospital admissions and readmissions in an Australian population with heart disease or diabetes.

    PubMed

    Hamar, G Brent; Rula, Elizabeth Y; Wells, Aaron; Coberley, Carter; Pope, James E; Larkin, Shaun

    2013-04-01

    Chronic disease management programs (CDMPs) were introduced in Australia to reduce unnecessary health care utilization by the growing population with chronic conditions; however, evidence of effectiveness is needed. This study evaluated the impact of a comprehensive CDMP, My Health Guardian (MHG), on rate of hospital admissions, readmissions, and average length of hospital stay (ALOS) for insured individuals with heart disease or diabetes. Primary outcomes were assessed through retrospective comparison of members in MHG (treatment; n=5053) to similar nonparticipating members (comparison; n=23,077) using a difference-in-differences approach with the year before program commencement serving as baseline and the subsequent 12 or 18 months serving as the program periods. All outcomes were evaluated for the total study population and for disease-matched subgroups (heart disease and diabetes). Statistical tests were performed using multivariate regression controlling for age, sex, number of chronic diseases, and past hospitalization status. After both 12 and 18 months, treatment members displayed decreases in admissions (both, P≤0.001) and readmissions (both, P≤0.01), and ALOS after 18 months (P≤0.01) versus the comparison group; magnitude of impact increased over time for these 3 measures. All outcomes for both disease-matched subgroups directionally mirrored the total study group, but the diabetes subgroup did not achieve significance for readmissions or ALOS. Within the treatment group, admissions decreased with increasing care calls to members (12 and 18 months, P<0.0001). These results show that MHG successfully reduced the frequency and duration of hospital admissions and presents a promising approach to reduce the burden associated with hospitalizations in populations with chronic disease.

  8. Improving the efficiency of telephone-based disease management programs: getting the population and the timing right using hospital admission data.

    PubMed

    Watts, Jennifer J; Jolley, Damien; Wainer, Jo; Atchison, Rory

    2012-12-01

    Telephone-based disease management (DM) programs can improve health outcomes and provide a positive return on investment to funders. However, there is scant evidence about how to use hospital admission episode data to identify patients who are most likely to participate in a DM program. The objective of this study was to use hospital admission episode data held by health insurers to determine those factors that predict members with chronic disease joining and remaining in a DM program for at least 6 months. A multivariable logistic regression model was constructed to determine predictors of participating in a DM program for an insured population who had been admitted to hospital for congestive heart failure, coronary artery disease, or chronic obstructive pulmonary disease. The outcome variable was binary: did the member both opt into the DM program and remain in the program for at least 6 months? The study population included 9874 private health fund members. Time from a related hospital admission was a significant predictor, with those offered the program within 3 to 6 months being 71% more likely (95% confidence interval [CI]: 33%, 113%) to participate. The length of time from offer to commencement also was a significant predictor, with those commencing within 3 to 4 months being 75% (95% CI: 44%, 112%) as likely to remain in the program. It is possible to predict which individuals are most likely to participate in a telephone-based DM program using hospital admission episode data. Once individuals are identified, timely commencement of a DM program is an important predictor of success.

  9. High Prevalence of Respiratory Muscle Weakness in Hospitalized Acute Heart Failure Elderly Patients

    PubMed Central

    Verissimo, Pedro; Timenetsky, Karina T.; Casalaspo, Thaisa Juliana André; Gonçalves, Louise Helena Rodrigues; Yang, Angela Shu Yun; Eid, Raquel Caserta

    2015-01-01

    Introduction Respiratory Muscle Weakness (RMW) has been defined when the maximum inspiratory pressure (MIP) is lower than 70% of the predictive value. The prevalence of RMW in chronic heart failure patients is 30 to 50%. So far there are no studies on the prevalence of RMW in acute heart failure (AHF) patients. Objectives Evaluate the prevalence of RMW in patients admitted because of AHF and the condition of respiratory muscle strength on discharge from the hospital. Methods Sixty-three patients had their MIP measured on two occasions: at the beginning of the hospital stay, after they had reached respiratory, hemodynamic and clinical stability and before discharge from the hospital. The apparatus and technique to measure MIP were adapted because of age-related limitations of the patients. Data on cardiac ejection fraction, ECG, brain natriuretic peptide (BNP) levels and on the use of noninvasive ventilation (NIV) were collected. Results The mean age of the 63 patients under study was 75 years. On admission the mean ejection fraction was 33% (95% CI: 31–35) and the BNP hormone median value was 726.5 pg/ml (range: 217 to 2283 pg/ml); 65% of the patients used NIV. The median value of MIP measured after clinical stabilization was -52.7 cmH2O (range: -20 to -120 cmH2O); 76% of the patients had MIP values below 70% of the predictive value. On discharge, after a median hospital stay of 11 days, the median MIP was -53.5 cmH2O (range:-20 to -150 cmH2O); 71% of the patients maintained their MIP values below 70% of the predictive value. The differences found were not statistically significant. Conclusion Elderly patients admitted with AHF may present a high prevalence of RMW on admission; this condition may be maintained at similar levels on discharge in a large percentage of these patients, even after clinical stabilization of the heart condition. PMID:25671566

  10. Nurses' medication administration practices at two Singaporean acute care hospitals.

    PubMed

    Choo, Janet; Johnston, Linda; Manias, Elizabeth

    2013-03-01

    This study examined registered nurses' overall compliance with accepted medication administration procedures, and explored the distractions they faced during medication administration at two acute care hospitals in Singapore. A total of 140 registered nurses, 70 from each hospital, participated in the study. At both hospitals, nurses were distracted by personnel, such as physicians, radiographers, patients not under their care, and telephone calls, during medication rounds. Deviations from accepted medication procedures were observed. At one hospital, the use of a vest during medication administration alone was not effective in avoiding distractions during medication administration. Environmental factors and distractions can impact on the safe administration of medications, because they not only impair nurses' level of concentration, but also add to their work pressure. Attention should be placed on eliminating distractions through the use of appropriate strategies. Strategies that could be considered include the conduct of education sessions with health professionals and patients about the importance of not interrupting nurses while they are administering medications, and changes in work design.

  11. The effect of ozone and PM10 on hospital admissions for pneumonia and chronic obstructive pulmonary disease: a national multicity study.

    PubMed

    Medina-Ramón, Mercedes; Zanobetti, Antonella; Schwartz, Joel

    2006-03-15

    A case-crossover study was conducted in 36 US cities to evaluate the effect of ozone and particulate matter with an aerodynamic diameter of < or =10 microm (PM10) on respiratory hospital admissions and to identify which city characteristics may explain the heterogeneity in risk estimates. Respiratory hospital admissions and air pollution data were obtained for 1986-1999. In a meta-analysis based on the city-specific regression models, several city characteristics were evaluated as effect modifiers. During the warm season, the 2-day cumulative effect of a 5-ppb increase in ozone was a 0.27% (95% confidence interval (CI): 0.08, 0.47) increase in chronic obstructive pulmonary disease admissions and a 0.41% (95% CI: 0.26, 0.57) increase in pneumonia admissions. Similarly, a 10-microg/m(3) increase in PM10 during the warm season resulted in a 1.47% (95% CI: 0.93, 2.01) increase in chronic obstructive pulmonary disease at lag 1 and a 0.84% (95% CI: 0.50, 1.19) increase in pneumonia at lag 0. Percentage of households with central air conditioning reduced the effect of air pollution, and variability of summer apparent temperature reduced the effect of ozone on chronic obstructive pulmonary disease. The study confirmed, in a large sample of cities, that exposure to ozone and PM10 is associated with respiratory hospital admissions and provided evidence that the effect of air pollution is modified by certain city characteristics.

  12. [MALNUTRITION IN THE ELDERLY PATIENT TO HOSPITAL ADMISSION, AN OLD PROBLEM UNSOLVED].

    PubMed

    Rentero Redondo, Lorena; Iniesta Navalón, Carles; Gascón Cánovas, Juan Jose; Tomás Jimenez, Cristina; Sánchez Álvarez, Carmen

    2015-11-01

    Objetivo: determinar la prevalencia de desnutrición en pacientes con edad igual o superior a 65 años al ingreso hospitalario y los factores asociados a su presencia. Analizar el exceso de estancia hospitalaria (EEH), el impacto económico y la tasa de reingresos prematuros asociados a la desnutrición hospitalaria en pacientes de edad avanzada. Material y métodos: estudio retrospectivo realizado en el Hospital Universitario Reina Sofía. Se incluyeron todos los pacientes con edad igual o mayor a 65 años que ingresaron en Medicina Interna durante 2011. Se calculó el tamaño muestral teniendo en cuenta los ingresos del año anterior, y considerando una prevalencia de desnutrición del 50% con un IC 95% y un error del 5%. Para definir el grado de desnutrición se empleó la herramienta Control Nutricional (CONUT), que establece una puntuación basada en la determinación de albúmina, colesterol total y linfocitos. Para determinar los factores asociados a la presencia de desnutrición moderada-grave se realizó un análisis de regresión logística multivariante. Para cada paciente se calculó el EEH, los reingresos prematuros y el coste asociado al EEH. Para todos los análisis se utilizó un dintel de significación estadística de 0,05 y se realizaron con el paquete estadístico SPSS v15.0. Resultados: se incluyeron 310 pacientes, de los cuales el 54,2% fueron mujeres, la edad media fue de 80,1 años (DE: 6,8), con un rango entre 65 y 95 años. En cuanto al diagnóstico al ingreso, el 27,4% correspondían a enfermedades del aparato respiratorio, 22,6% del circulatorio y 11,6% del digestivo. La mediana del Índice de Charlson fue de 2,0, encontrando que el 36,8% de los pacientes presentaban una comorbilidad alta. Las patologías crónicas más prevalentes fueron la diabetes mellitus (44,2%), la enfermedad renal crónica (25,2%) y la demencia (10,6). En relación con el CONUT, el 75,8% de los pacientes presentaban criterios de desnutrición: el 42,6% leve, el 28

  13. Alcohol-Related Diagnoses in Hospital Admissions for All Causes Among Middle-Aged and Older Adults: Trends and Cohort Differences From 1993 to 2010

    PubMed Central

    Sacco, Paul; Unick, George Jay; Kuerbis, Alexis; Koru, A. Güneş; Moore, Alison A.

    2016-01-01

    Objective This aim of this study was to characterize trends in alcohol-related hospital admissions among middle-aged and older adults from 1993 to 2010 in relation to age, gender, race, and cohort membership. Method This study utilized repeated cross-sectional data from the Nationwide Inpatient Sample. Using alcohol-related classified admissions, yearly rates and longitudinal trends of alcohol-related inpatient hospitalizations based on age, period, birth cohort, gender, and race were estimated. Results Among those aged 45 and older, admissions rose from an estimated 610,634 to more than 1,134,876, and rates of any alcohol-related diagnosis also increased from 1993 to 2010. Rates for men were consistently higher than women, and rates for Blacks were higher than Whites. Age was associated with decreasing rates, but post–World War II cohorts displayed higher rates over time. Discussion Rates of alcohol-related admissions are increasing among adults above age 45, which may be a function of cohort effects. Training the health care workforce is crucial to respond to this trend. PMID:25903980

  14. 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

  15. Hospital Performance Indicators and Their Associated Factors in Acute Child Poisoning at a Single Poison Center, Central Saudi Arabia

    PubMed Central

    Alanazi, Menyfah Q.; Al-Jeriasy, Majed I.; Al-Assiri, Mohammed H.; Afesh, Lara Y.; Alhammad, Fahad; Salam, Mahmoud

    2015-01-01

    Abstract Admission rate and length of stay (LOS) are two hospital performance indicators that affect the quality of care, patients’ satisfaction, bed turnover, and health cost expenditures. The aim of the study was to identify factors associated with higher admission rates and extended average LOS among acutely poisoned children at a single poison center, central Saudi Arabia. This is a cross-sectional, poison and medical chart review between 2009 and 2011. Exposures were child characteristics, that is, gender, age, body mass index (BMI), health history, and Canadian 5-level triage scale. Poison incident characteristics were, that is, type, exposure route, amount, form, home remedy, and arrival time to center. Admission status and LOS were obtained from records. Chronic poisoning, plant allergies, and venomous bites were excluded. Bivariate and regression analyses were applied. Significance at P < 0.05. Of the 315 eligible cases, (72%) were toddlers with equal gender distribution, (58%) had normal BMI, and (77%) were previously healthy. Poison substances were pharmaceutical drugs (63%) versus chemical products (37%). Main exposure route was oral (98%). Home remedy was observed in (21.9%), which were fluids, solutes, and/or gag-induced vomiting. Almost (52%) arrived to center >1 h. Triage levels: non-urgent cases (58%), less urgent (11%), urgent (18%), emergency (12%), resuscitative (1%). Admission rate was (20.6%) whereas av. LOS was 13 ± 22 h. After adjusting and controlling for confounders, older children (adj.OR = 1.19) and more critical triage levels (adj.OR = 1.35) were significantly associated with higher admission rates compared to younger children and less critical triage levels (adj.P = 0.006) and (adj.P = 0.042) respectively. Home remedy prior arrival was significantly associated with higher av. LOS (Beta = 9.48, t = 2.99), compared to those who directly visited the center, adj.P = 0.003. Hospital administrators

  16. The ED-inpatient dashboard: Uniting emergency and inpatient clinicians to improve the efficiency and quality of care for patients requiring emergency admission to hospital.

    PubMed

    Staib, Andrew; Sullivan, Clair; Jones, Matt; Griffin, Bronwyn; Bell, Anthony; Scott, Ian

    2016-09-04

    Patients who require emergency admission to hospital require complex care that can be fragmented, occurring in the ED, across the ED-inpatient interface (EDii) and subsequently, in their destination inpatient ward. Our hospital had poor process efficiency with slow transit times for patients requiring emergency care. ED clinicians alone were able to improve the processes and length of stay for the patients discharged directly from the ED. However, improving the efficiency of care for patients requiring emergency admission to true inpatient wards required collaboration with reluctant inpatient clinicians. The inpatient teams were uninterested in improving time-based measures of care in isolation, but they were motivated by improving patient outcomes. We developed a dashboard showing process measures such as 4 h rule compliance rate coupled with clinically important outcome measures such as inpatient mortality. The EDii dashboard helped unite both ED and inpatient teams in clinical redesign to improve both efficiencies of care and patient outcomes.

  17. Duration of Colonization With Klebsiella pneumoniae Carbapenemase-Producing Bacteria at Long-Term Acute Care Hospitals in Chicago, Illinois

    PubMed Central

    Haverkate, Manon R.; Weiner, Shayna; Lolans, Karen; Moore, Nicholas M.; Weinstein, Robert A.; Bonten, Marc J. M.; Hayden, Mary K.; Bootsma, Martin C. J.

    2016-01-01

    Background. High prevalence of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae has been reported in long-term acute care hospitals (LTACHs), in part because of frequent readmissions of colonized patients. Knowledge of the duration of colonization with KPC is essential to identify patients at risk of KPC colonization upon readmission and to make predictions on the effects of transmission control measures. Methods. We analyzed data on surveillance isolates that were collected at 4 LTACHs in the Chicago region during a period of bundled interventions, to simultaneously estimate the duration of colonization during an LTACH admission and between LTACH (re)admissions. A maximum-likelihood method was used, taking interval-censoring into account. Results. Eighty-three percent of patients remained colonized for at least 4 weeks, which was the median duration of LTACH stay. Between LTACH admissions, the median duration of colonization was 270 days (95% confidence interval, 91–∞). Conclusions. Only 17% of LTACH patients lost colonization with KPC within 4 weeks. Approximately half of the KPC-positive patients were still carriers when readmitted after 9 months. Infection control practices should take prolonged carriage into account to limit transmission of KPCs in LTACHs. PMID:27747253

  18. Current use of beta blockers in patients with reactive airway disease who are hospitalized with acute coronary syndromes.

    PubMed

    Olenchock, Benjamin A; Fonarow, Gregg G; Pan, Wenqin; Hernandez, Adrian; Cannon, Christopher P

    2009-02-01

    Beta blockers have a proven benefit in the management of patients with acute coronary syndromes (ACS) and for secondary prevention of coronary events. Current guidelines list such reactive airway diseases (RADs) such as asthma and chronic obstructive pulmonary disease as relative contraindications to beta-blocker use. However, the co-morbid burden of RAD and coronary heart disease is substantial, and data suggest that the treatment benefit of beta blockers is shared by patients with RAD. The Get with the Guidelines (GWTG) database was used to evaluate use of beta blockers within 24 hours of admission and at discharge in patients with ACS with (n = 12,967) and without (n = 81,140) a history of RAD. Data were collected in 435 hospitals between January 2000 and September 2006. A multivariable logistic regression model was used to determine predictors of beta-blocker treatment. In patients with no RAD history, beta-blocker prescription rates were 78.3% at admission and 88.7% at discharge; in patients with a RAD history, rates were 65.6% at admission and 77.2% at discharge. Compared with patients with no history of RAD, patients with a history of RAD were 42% less likely (odds ratio 0.58, confidence interval 0.54 to 0.62, p <0.0001) to receive a beta blocker upon admission and 55% less likely (odds ratio 0.45, confidence interval 0.41 to 0.48, p <0.0001) to receive a beta blocker at discharge in multivariable analysis. Among all other clinical factors, RAD history was the most significant predictor of likelihood of not receiving a beta blocker at admission or discharge. Receipt of beta blockers within 24 hours after admission was associated with a lower in-hospital mortality rate for patients with RAD (odds ratio = 0.52, p <0.001) and for patients without RAD (odds ratio = 0.38, p <0.001). Careful assessment of beta-blocker safety and RAD severity by physicians is needed to improve beta-blocker prescription rates in this large group of patients with ACS.

  19. 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.

  20. 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

  1. 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.

  2. Surveillance for hospitalized acute respiratory infection in Guatemala.

    PubMed

    Verani, Jennifer R; McCracken, John; Arvelo, Wences; Estevez, Alejandra; Lopez, Maria Renee; Reyes, Lissette; Moir, Juan Carlos; Bernart, Chris; Moscoso, Fabiola; Gray, Jennifer; Olsen, Sonja J; Lindblade, Kim A

    2013-01-01

    Acute respiratory infections (ARI) are an important cause of illness and death worldwide, yet data on the etiology of ARI and the population-level burden in developing countries are limited. Surveillance for ARI was conducted at two hospitals in Guatemala. Patients admitted with at least one sign of acute infection and one sign or symptom of respiratory illness met the criteria for a case of hospitalized ARI. Nasopharyngeal/oropharyngeal swabs were collected and tested by polymerase chain reaction for adenovirus, parainfluenza virus types 1,2 and 3, respiratory syncytial virus, influenza A and B viruses, human metapneumovirus, Chlamydia pneumioniae, and Mycoplasma pneumoniae. Urine specimens were tested for Streptococcus pneumoniae antigen. Blood culture and chest radiograph were done at the discretion of the treating physician. Between November 2007 and December 2011, 3,964 case-patients were enrolled. While cases occurred among all age groups, 2,396 (60.4%) cases occurred in children <5 years old and 463 (11.7%) among adults ≥65 years old. Viruses were found in 52.6% of all case-patients and 71.8% of those aged <1 year old; the most frequently detected was respiratory syncytial virus, affecting 26.4% of case-patients. Urine antigen testing for Streptococcus pneumoniae performed for case-patients ≥15 years old was positive in 15.1% of those tested. Among 2,364 (59.6%) of case-patients with a radiograph, 907 (40.0%) had findings suggestive of bacterial pneumonia. Overall, 230 (5.9%) case-patients died during the hospitalization. Using population denominators, the observed hospitalized ARI incidence was 128 cases per 100,000, with the highest rates seen among children <1 year old (1,703 per 100,000), followed by adults ≥65 years old (292 per 100,000). These data, which demonstrate a substantial burden of hospitalized ARI in Guatemala due to a variety of pathogens, can help guide public health policies aimed at reducing the burden of illness and death due to

  3. Hospital admissions. Cold remedies.

    PubMed

    Pascoe, S; Pratt, J

    1998-12-10

    The closure of a casualty department provoked a crisis in Hillingdon in the winter of 1996-97. Worried by the publicity, elderly people contacted the health authority to ask what would happen to them if they became ill. An all-day workshop, attended by elderly people, chief executives, nurses, social workers and representatives from the community health council and ambulance services, led to several initiatives, including a rapid response home service, which helped prevent a crisis last winter.

  4. Comparison of admission random glucose, fasting glucose, and glycated hemoglobin in predicting the neurological outcome of acute ischemic stroke: a retrospective study

    PubMed Central

    Sung, Jia-Ying; Chen, Chin-I; Hsieh, Yi-Chen; Chen, Yih-Ru; Wu, Hsin-Chiao; Chan, Lung; Hu, Chaur-Jong; Hu, Han-Hwa; Chiou, Hung-Yi

    2017-01-01

    Background Hyperglycemia is a known predictor of negative outcomes in stroke. Several glycemic measures, including admission random glucose, fasting glucose, and glycated hemoglobin (HbA1c), have been associated with bad neurological outcomes in acute ischemic stroke, particularly in nondiabetic patients. However, the predictive power of these glycemic measures is yet to be investigated. Methods This retrospective study enrolled 484 patients with acute ischemic stroke from January 2009 to March 2013, and complete records of initial stroke severity, neurological outcomes at three months, and glycemic measures were evaluated. We examined the predictive power of admission random glucose, fasting glucose, and HbA1c for neurological outcomes in acute ischemic stroke. Furthermore, subgroup analyses of nondiabetic patients and patients with diabetes were performed separately. Results Receiver operating characteristic (ROC) analysis revealed that admission random glucose and fasting glucose were significant predictors of poor neurological outcomes, whereas HbA1c was not (areas under the ROC curve (AUCs): admission random glucose = 0.564, p = 0.026; fasting glucose = 0.598, p = 0.001; HbA1c = 0.510, p = 0.742). Subgroup analyses of nondiabetic patients and those with diabetes revealed that only fasting glucose predicts neurological outcomes in patients with diabetes, and the AUCs of these three glycemic measures did not differ between the two groups. A multivariate logistic regression analysis of the study patients indicated that only age, initial stroke severity, and fasting glucose were independent predictors of poor neurological outcomes, whereas admission random glucose and HbA1c were not (adjusted odds ratio: admission random glucose = 1.002, p = 0.228; fasting glucose = 1.005, p = 0.039; HbA1c = 1.160, p = 0.076). Furthermore, subgroup multivariate logistic regression analyses of nondiabetic patients and those with diabetes indicated that none of the three glycemic

  5. National Veterans Health Administration inpatient risk stratification models for hospital-acquired acute kidney injury

    PubMed Central

    Cronin, Robert M; VanHouten, Jacob P; Siew, Edward D; Eden, Svetlana K; Fihn, Stephan D; Nielson, Christopher D; Peterson, Josh F; Baker, Clifton R; Ikizler, T Alp; Speroff, Theodore

    2015-01-01

    Objective Hospital-acquired acute kidney injury (HA-AKI) is a potentially preventable cause of morbidity and mortality. Identifying high-risk patients prior to the onset of kidney injury is a key step towards AKI prevention. Materials and Methods A national retrospective cohort of 1,620,898 patient hospitalizations from 116 Veterans Affairs hospitals was assembled from electronic health record (EHR) data collected from 2003 to 2012. HA-AKI was defined at stage 1+, stage 2+, and dialysis. EHR-based predictors were identified through logistic regression, least absolute shrinkage and selection operator (lasso) regression, and random forests, and pair-wise comparisons between each were made. Calibration and discrimination metrics were calculated using 50 bootstrap iterations. In the final models, we report odds ratios, 95% confidence intervals, and importance rankings for predictor variables to evaluate their significance. Results The area under the receiver operating characteristic curve (AUC) for the different model outcomes ranged from 0.746 to 0.758 in stage 1+, 0.714 to 0.720 in stage 2+, and 0.823 to 0.825 in dialysis. Logistic regression had the best AUC in stage 1+ and dialysis. Random forests had the best AUC in stage 2+ but the least favorable calibration plots. Multiple risk factors were significant in our models, including some nonsteroidal anti-inflammatory drugs, blood pressure medications, antibiotics, and intravenous fluids given during the first 48 h of admission. Conclusions This study demonstrated that, although all the models tested had good discrimination, performance characteristics varied between methods, and the random forests models did not calibrate as well as the lasso or logistic regression models. In addition, novel modifiable risk factors were explored and found to be significant. PMID:26104740

  6. Usefulness of combined white blood cell count and plasma glucose for predicting in-hospital outcomes after acute myocardial infarction.

    PubMed

    Ishihara, Masaharu; Kojima, Sunao; Sakamoto, Tomohiro; Asada, Yujiro; Kimura, Kazuo; Miyazaki, Shunichi; Yamagishi, Masakazu; Tei, Chuwa; Hiraoka, Hisatoyo; Sonoda, Masahiro; Tsuchihashi, Kazufumi; Shinoyama, Nobuo; Honda, Takashi; Ogata, Yasuhiro; Ogawa, Hisao

    2006-06-01

    Admission white blood cell (WBC) count and plasma glucose (PG) have been associated with adverse outcomes after acute myocardial infarction (AMI). This study investigated the joint effect of WBC count and PG on predicting in-hospital outcomes in patients with AMI. WBC count and PG were measured at the time of hospital admission in 3,665 patients with AMI. Patients were stratified into tertiles (low, medium, and high) based on WBC count and PG. Patients with a high WBC count had a 2.0-fold increase in in-hospital mortality compared with those with a low WBC count. Patients with a high PG level had a 2.7-fold increase in mortality compared with those with a low PG level. When a combination of different strata for each variable was analyzed, a stepwise increase in mortality was seen. There was a considerable number of patients with a high WBC count and low PG level or with a low WBC count and high PG level. These patients had an intermediate risk, whereas those with a high WBC count and high PG level had the highest risk, i.e., 4.8-fold increase in mortality, compared with those with a low WBC count and low PG level. Multivariate analysis was performed to assess the predictor for in-hospital mortality using WBC count and PG level as continuous variables and showed that WBC count and PG level were independently associated with in-hospital mortality. These findings suggested that a simple combination of WBC count and PG level might provide further information for predicting outcomes in patients with AMI.

  7. 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.

  8. 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.

  9. Inpatient hospital admission rates for nonmalignant respiratory disease among workers exposed to metal removal fluids at a U.S. automobile manufacturer.

    PubMed

    Reeve, Gordon R; Stout, Allen W; Hands, David; Curry, Emmanuel

    2003-11-01

    This study was undertaken to determine the impact of exposure to metal removal fluids (MRFs) on the respiratory health of exposed workers. The outcome measure selected was the rate of hospital admissions for nonmalignant respiratory disease episodes as determined from healthcare insurance claims data. A cohort of MRF-exposed employees was assembled from 11 manufacturing facilities where MRFs were extensively used in the manufacture of automotive engines, transmissions, and other machined parts. The MRF-exposed cohort included 20,434 employees of such facilities who worked at any time from 1993 through 1997. A non-MRF-exposed cohort was assembled from other employees of the same company during the same time period, but working in warehouse operations and other manufacturing facilities that did not use MRFs or any known respiratory sensitizing agents. The non-exposed cohort included 8681 employees. The crude hospital admission rate for the MRF-exposed cohort was 44 percent higher than that of the non-exposed cohort over the 5-year study period (6.67 vs. 4.62 per 1000 person years at risk, p < 0.05). With age adjustment, the MRF population's rate was still 35 percent higher, and still statistically significant. A nested case-control study was also conducted to determine whether the risk of hospital admission increased with the level of MRF exposure in the population working in MRF plants. The industrial hygiene reconstruction found the levels of exposures of both cases and controls to be very low, with the vast majority of study subjects (more than 90%) having exposures of less than 0.5 mg/m(3). The case-control study did not find any association between increased levels of MRF exposure and risk of hospitalization. The study did document an elevated risk of hospitalization among a sizable population employed in manufacturing operations where MRFs are used.

  10. 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

  11. 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.

  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 PPS on hospital-sponsored post-acute services: a case study of Delaware Medicare providers.

    PubMed

    Kulesher, Robert R; Wilder, Margaret G

    2008-01-01

    Hospitals were the first providers to experience the change in Medicare reimbursement from a cost basis to the prospective payment system (PPS). In the 1980s, this switch was accomplished through the development of diagnosis-related groups, a unique formula for Medicare reimbursement of inpatient hospital services. During that time, the concern was that, with the anticipated reduced payments to hospitals, adverse impacts on Medicare beneficiaries were likely, including premature release of patients from hospital care resulting in medical complications, increased readmissions, prolonged episodes of recuperation, and preventable mortality. The Balanced Budget Act of 1997 (BBA) mandated the implementation of the PPS for Medicare providers of skilled nursing home care and home health care. This change from cost-based reimbursement to PPS raised concerns that these providers would react as hospitals had done-that is, skilled nursing homes might limit their admission of Medicare patients and home health agencies might cut back on visits. As a result of that, hospitals might be faced with providing care for these post-acute patients without receiving additional reimbursement, and these changes in utilization patterns would be of critical importance to both providers and Medicare beneficiaries. This article examines the decisions that providers made in response to the perceived impact of the BBA. Qualitative data were derived from provider interviews. The article concludes with a discussion of how changes in Medicare reimbursement policy have influenced providers of post-acute care services to alter their level of participation in Medicare and the impact this may have on the general public as well as on Medicare beneficiaries.

  14. 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

  15. [Surgical treatment in severe acute pancreatitis. Last 15 years of experience in Emergency County Hospital of Baia Mare].

    PubMed

    Leşe, Mihaela; Tămăşan, Anca; Stoicescu, B; Brânduşe, M; Puia, Ioana; Mare, C; Lazăr, C

    2005-01-01

    The aim of this study is to investigate the particular course of the patients operated for severe acute pancreatitis in a period of 15 years in surgical department of Emergency County Hospital of Baia Mare. Medical records of 202 patients admitted and operated for severe acute pancreatitis, were studied. Follow-up parameters were: age, gender, etiology, moment of operation, the type of operations and postoperative evolution of this patients. In the group of deceased patients alcoholic etiology of pancreatitis was prevailing. Almost a half of patients were operated in the first day of admission. A high number of patients were operated for diagnosis of acute abdomen with intention of exploratory laparotomy. In the last years, besides the usual closed drainage, open drainage and planning drainage were performed. Postoperative mortality is still high. The diagnose of severe acute pancreatitis is difficult in emergency. Global mortality in pancreatitis remains high, especially in the period of enzymatic shock, and is correlated with masculine gender, alcoholic etiology and somewhat with precocity of operation.

  16. Admission to hospital with community-onset bloodstream infection during the 'after hours' is not associated with an increased risk for death.

    PubMed

    Laupland, Kevin B

    2010-12-01

    Several studies conducted in diverse patient populations have found that patients presenting with acute illness during weekends or evening/nights are at increased risk for death. This study was conducted to examine whether patients with community-onset bloodstream infections who are admitted during evenings, nights, and weekends suffer increased mortality rates. All residents within the Calgary area who had first admissions with community-onset bloodstream infections during 2000-2008 were included. One thousand eight hundred and seventy-eight (27%) patients were admitted on a weekend. Among all admissions, 2753 (40%) were during the hours of 08:00-17:59, 1996 (29%) during 18:00-22:59, and 2174 (31%) during 23:00-07:59. More than two-thirds (n = 4867; 70%) of cases were admitted during the 'after hours' (evenings, nights, and/or weekends). The 30-day case-fatality rate was 13% (882/6923) and did not significantly vary between daytime (364/2753; 13%), evening (246/1996; 12%), and night (272/2174; 13%) admissions (p = 0.6), or with patients admitted on weekends as compared to weekdays (252/1878 (13%) vs. 630/5045 (12%); p = 0.3). Admission during the after hours (weekends and evenings/nights) was not associated with increased risk for death in logistic regression analysis (odds ratio 0.99, 95% confidence interval 0.83-1.16; p = 0.88). Admission with community-onset bloodstream infection during the after hours is not associated with adverse outcome in this region.

  17. The Diagnosis and Management of Patients with Renal Colic across a Sample of US Hospitals: High CT Utilization Despite Low Rates of Admission and Inpatient Urologic Intervention

    PubMed Central

    Scales, Charles D.; Lagu, Tara

    2017-01-01

    Objectives Symptomatic ureterolithiasis (renal colic) is a common Emergency Department (ED) complaint. Variation in practice surrounding the diagnosis and management of suspected renal colic could have substantial implications for both quality and cost of care as well as patient radiation burden. Previous literature has suggested that CT scanning has increased with no improvements in outcome, owing at least partially to the spontaneous passage of kidney stones in the majority of patients. Concerns about the rising medical radiation burden in the US necessitate scrutiny of current practices and viable alternatives. Our objective was to use data from a diverse sample of US EDs to examine rates of and variation in the use of CT scanning, admission, and inpatient procedures for patients with renal colic and analyze the influence of patient and hospital factors on the diagnostic testing and treatment patterns for patients with suspected renal colic. Methods We conducted a retrospective cohort study of adult patients who received a diagnosis of renal colic via a visit to an ED at 444 US hospitals participating in the Premier Healthcare Alliance database from 2009–2011. We modeled use of CT, admission, and inpatient urologic intervention as functions of both patient characteristics and hospital characteristics. Results Over the 2-year period, 307,612 patient visits met inclusion criteria. Among these patients, 254,211 (82.6%) had an abdominal CT scan, with 91.5% being non-contrast (“renal protocol”) CT scans. Nineteen percent of visits (58,266) resulted in admission or transfer, and 9.8% of visits (30,239) resulted in a urologic procedure as part of the index visit. On multivariable analysis male patients, Hispanic patients, uninsured patients, and privately insured patients were more likely to have a CT scan performed. Older patients and those covered by Medicare were more likely to be admitted, and once admitted, white patients and privately insured patients were

  18. Chest Compression Injuries Detected via Routine Post-arrest Care in Patients Who Survive to Admission after Out-of-hospital Cardiac Arrest.

    PubMed

    Boland, Lori L; Satterlee, Paul A; Hokanson, Jonathan S; Strauss, Craig E; Yost, Dana

    2015-01-01

    Abstract Objective. To examine injuries produced by chest compressions in out-of-hospital cardiac arrest (OHCA) patients who survive to hospital admission. Methods. A retrospective cohort study was conducted among 235 consecutive patients who were hospitalized after nontraumatic OHCA in Minnesota between January 2009 and May 2012 (117 survived to discharge; 118 died during hospitalization). Cases were eligible if the patient had received prehospital compressions from an emergency medical services (EMS) provider. One EMS provider in the area was using a mechanical compression device (LUCAS(TM)) as standard equipment, so the association between injury and use of mechanical compression was also examined. Prehospital care information was abstracted from EMS run sheets, and hospital records were reviewed for injuries documented during the post-arrest hospitalization that likely resulted from compressions. Results. Injuries were identified in 31 patients (13%), the most common being rib fracture (9%) and intrathoracic hemorrhage (3%). Among those who survived to discharge, the mean length of stay was not statistically significantly different between those with injuries (13.5 days) and those without (10.8 days; p = 0.23). Crude injury prevalence was higher in those who died prior to discharge, had received compressions for >10 minutes (versus ≤10 minutes) and underwent computer tomography (CT) imaging, but did not differ by bystander compressions or use of mechanical compression. After multivariable adjustment, only compression time > 10 min and CT imaging during hospitalization were positively associated with detected injury (OR = 7.86 [95% CI = 1.7-35.9] and 6.30 [95% CI = 2.6-15.5], respectively). Conclusion. In patients who survived OHCA to admission, longer duration of compressions and use of CT during the post-arrest course were associated positively with documented compression injury. Compression-induced injuries detected via routine post-arrest care are

  19. Risk factors for death from asthma, chronic obstructive pulmonary disease, and cardiovascular disease after a hospital admission for asthma

    PubMed Central

    Guite, H.; Dundas, R.; Burney, P.

    1999-01-01

    BACKGROUND—Patients with asthma have an increased risk of death from causes other than asthma. A study was undertaken to identify whether severity of asthma, its treatment, or associated co-morbidity were associated with increased risk of death from other causes.
METHODS—Eighty five deaths from all causes occurring within three years of discharge from hospital in a cohort of 2242 subjects aged 16-64 years admitted for asthma were compared with a random sample of 61 controls aged <45 years and 61 aged ⩾45 years from the same cohort.
RESULTS—Deaths from asthma were associated with a history of clinically severe asthma (OR 6.29 (95% CI 1.84 to 21.52)), chest pain (OR 3.78 (95% CI 1.06 to 13.5)), biochemical or haematological abnormalities at admission (OR 4.12 (95% CI 1.36 to 12.49)), prescription of ipratropium bromide (OR 4.04 (95% CI 1.47 to 11.13)), and failure to prescribe inhaled steroids on discharge (OR 3.45 (95% CI 1.35to 9.10)). Deaths from chronic obstructive pulmonary disease (COPD) were associated with lower peak expiratory flow rates (OR 2.56(95% CI 1.52 to 4.35) for each 50 l/min change), a history of smoking (OR 5.03 (95% CI 1.17 to 21.58)), prescription of ipratropium bromide (OR 7.75 (95% CI 2.21 to 27.14)), and failure to prescribe inhaled steroids on discharge (OR 3.33 (95% CI 0.95 to 11.10)). Cardiovascular deaths were more common among those prescribed ipratropium bromide on discharge (OR 3.55 (95% CI 1.05 to 11.94)) and less likely in those admitted after an upper respiratory tract infection (OR 0.21 (95% CI 0.05 to 0.95)). Treatment with ipratropium bromide at discharge was associated with an increased risk of death from asthma even after adjusting for peak flow, COPD and cardiovascular co-morbidity, ever having smoked, and age at onset of asthma.
CONCLUSIONS—Prescription of inhaled steroids on discharge is important even for those patients with co-existent COPD and asthma. Treatment with ipratropium at discharge is associated

  20. Predictive value of serum uric acid in hospitalized adolescents and adults with acute asthma

    PubMed Central

    Abdulnaby, Nasser Keshar; Sayed, Ashraf Othman; Shalaby, Nehad Mohamed

    2016-01-01

    Background High serum uric acid (sUA) is an indicator of oxidative stress and is linked to tissue hypoxia in asthma. The objective of this case series was to investigate the prognostic role of sUA in patients with acute asthma exacerbations and the link between sUA and spirometric lung tests. Patients and methods This cross-sectional observational study included 120 patients with acute asthma exacerbations and 120 controls, categorized according to peak expiratory flow rate into moderate, and severe and life-threatening asthma. On admission, a detailed history was obtained and investigations were carried out regarding oxygen saturation (SaO2), arterial blood gas, spirometry, sUA, number of asthma exacerbations, smoking status, history of previous hospitalization, intensive care unit admission, and mechanical ventilation. Results The current study revealed higher sUA in asthmatic patients compared with healthy subjects and in severe asthma patients compared with moderate asthma patients (P<0.001). A positive correlation of sUA with asthma severity, number of asthma exacerbations and smoking index (r=0.6, 0.42 and 0.29, respectively, P<0.001) and a negative correlation of sUA with SaO2, partial pressure of arterial oxygen (PaO2), percent predicted forced vital capacity, percent predicted forced expiratory volume (FEV%) and peak expiratory flow rate percent of predicted (PEFR%; r=−0.48, −0.29, −0.44, −0.44 and −0.66, respectively, P<0.001) were observed. Degree of asthma severity, number of asthma exacerbations, and smoking index were significant predictors of high sUA (R2=0.43, P<0.001) in multiple linear regression model 1. SaO2 and PEFR% were significant predictors of high uric acid (R2=0.50, P<0.001) in model 2. The sensitivity and specificity of sUA in predicting severity of asthma at the cutoff point of 6.3 mg/dL were 80% and 90%, respectively. The odds ratios of sUA, number of asthma exacerbations, and asthma duration were 5.4, 1.95 and 1

  1. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial

    PubMed Central

    Morello, Renata T; Wolfe, Rory; Brand, Caroline A; Haines, Terry P; Hill, Keith D; Brauer, Sandra G; Botti, Mari; Cumming, Robert G; Livingston, Patricia M; Sherrington, Catherine; Zavarsek, Silva; Lindley, Richard I; Kamar, Jeannette

    2016-01-01

    Objective To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards. Design Cluster randomised controlled trial. Setting Six Australian hospitals. Participants All patients admitted to 24 acute wards during the trial period. Interventions Participating wards were randomly assigned to receive either the nurse led 6-PACK programme or usual care over 12 months. The 6-PACK programme included a fall risk tool and individualised use of one or more of six interventions: “falls alert” sign, supervision of patients in the bathroom, ensuring patients’ walking aids are within