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Admission avoidance

Louise S Deeks, Sam Kosari, Katja Boom, Gregory M Peterson, Aaron Maina, Ravi Sharma, Mark Naunton
Background : Asthma is principally managed in general practice. Appropriate prescribing and medication use are essential, so general practice pharmacists appear suitable to conduct asthma management consultations. This pilot study aimed to evaluate the asthma management role of a pharmacist in general practice. Methods : Analysis of an activity diary and stakeholder interviews were conducted to identify interventions in asthma management; determine whether asthma control changed following pharmacist input; and determine acceptability of asthma management review by a pharmacist in one general practice in Canberra, Australia...
October 15, 2018: Pharmacy (Basel, Switzerland)
Mateu Seguí Díaz
Dipeptidyl peptidase-4 inhibitors form part of the group of incretin derivatives and conse-quently have a specific mechanism of action. The incretin effect avoids the adverse ef-fects of classic drugs (sulphonylureas) and provides specific benefits for their use in as-sociation with other drugs and in special situations. Because they have a low risk of pro-ducing hypoglycaemia or weight gain, these inhibitors are useful in combination with other oral antidiabetic drugs and even with insulin, although this latter combination may increase the risk of hypoglycaemia...
June 2018: Semergen
Emmanuel Bugarin-Estrada, Andrés Gómez-De León, Yadith Karina López-García, Erik Alejandro Díaz-Chuc, José Manuel Priesca-Marín, Guillermo J Ruiz-Argüelles, José Carlos Jaime-Pérez, David Gómez-Almaguer
BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is a hematologic disease that can be fatal if not treated early. We aimed to describe the clinical characteristics of Mexican patients with idiopathic TTP. STUDY DESIGN AND METHODS: We conducted a retrospective study, including all adult patients diagnosed with idiopathic TTP from 2011 to 2017 in two Mexican centers. We further compared our results with the published literature. RESULTS: Twenty patients were included; 70% were female, with a median age of 38...
October 15, 2018: Journal of Clinical Apheresis
Vicente Muedra, Lucrecia Moreno, Vicente Rodilla, Cristina Arce, Fermi Montó, Águeda Blázquez, Paloma Pérez, Pilar D'Ocón
Introduction: Decreased antithrombin (AT) activity in patients scheduled for cardiovascular surgery under cardiopulmonary bypass (CPB) is related to increased postoperative complications and hospitalization time. Indirect evidence suggests that glucocorticoids mitigate this decreased AT activity. To better understand the beneficial effects of AT we have analyzed: (i) the clinical relevance of acute dexamethasone (DX) administration before cardiac surgery on AT activity, (ii) the modulation by DX of AT expression in human endothelial cells (hECs), (iii) the activity of AT on migration and angiogenesis of hECs, or on angiogenesis of rat aorta...
2018: Frontiers in Pharmacology
Evan C Carlos, Chloe E Peters, Daniel A Wollin, Brenton B Winship, Leah G Davis, Jingqiu Li, Charles D Scales, Samuel H Eaton, Glenn M Preminger, Michael E Lipkin
PURPOSE: Emergency department(ED) visits after ureteroscopy(URS) are costly and inconvenient. To better understand those at risk, we aim to identify patient demographic, medical and surgical factors associated with 30-day ED presentation following URS for urolithiasis with particular attention paid to those with a history of a psychiatric diagnosis(PD). MATERIALS AND METHODS: We retrospectively reviewed 1576 cases on 1395 adults who underwent stone-related URS over 3 years at two hospitals...
October 11, 2018: Journal of Urology
Brenda Lynch, Anthony P Fitzgerald, Paul Corcoran, Claire Buckley, Orla Healy, John Browne
BACKGROUND: Many emergency admissions are deemed to be potentially avoidable in a well-performing health system. OBJECTIVE: To measure the impact of population and health system factors on county-level variation in potentially avoidable emergency admissions in Ireland over the period 2014-2016. METHODS: Admissions data were used to calculate 2014-2016 age-adjusted emergency admission rates for selected conditions by county of residence. Negative binomial regression was used to identify which a priori factors were significantly associated with emergency admissions for these conditions and whether these factors were also associated with total/other emergency admissions...
October 12, 2018: BMJ Quality & Safety
M J Connolly, J B Broad, T Bish, X Zhang, D Bramley, N Kerse, K Bloomfield, M Boyd
INTRODUCTION: The complexity of care required by many older people living in long-term care (LTC) facilities poses challenges that can lead to potentially avoidable referrals to a hospital emergency department (ED). The Aged Residential Care Intervention Project (ARCHIP) ran an implementation study to evaluate a multidisciplinary team (MDT) intervention supporting LTC facility staff to decrease potentially avoidable ED presentations by residents. METHODS: ARCHIP (conducted in 21 facilities [1,296 beds] with previously noted high ED referral rates) comprised clinical coaching for LTC facility staff by a gerontology nurse specialist (GNS) and an MDT (facility senior nurse, resident's general practitioner, GNS, geriatrician, pharmacist) review of selected high-risk residents' care-plans...
November 2018: Maturitas
Timothy J P Batchelor, Neil J Rasburn, Etienne Abdelnour-Berchtold, Alessandro Brunelli, Robert J Cerfolio, Michel Gonzalez, Olle Ljungqvist, René H Petersen, Wanda M Popescu, Peter D Slinger, Babu Naidu
Enhanced recovery after surgery is well established in specialties such as colorectal surgery. It is achieved through the introduction of multiple evidence-based perioperative measures that aim to diminish postoperative organ dysfunction while facilitating recovery. This review aims to present consensus recommendations for the optimal perioperative management of patients undergoing thoracic surgery (principally lung resection). A systematic review of meta-analyses, randomized controlled trials, large non-randomized studies and reviews was conducted for each protocol element...
October 9, 2018: European Journal of Cardio-thoracic Surgery
Coleman Kishamawe, Susan F Rumisha, Irene R Mremi, Veneranda M Bwana, Mercy G Chiduo, Isolide S Massawe, Leonard E G Mboera
OBJECTIVE: To determine the causes, patterns and trends of respiratory diseases-related deaths in hospitals of Tanzania 2006-2015. METHODS: Retrospective study involving 39 hospitals. Medical records of patients who died in hospital were retrieved, reviewed and analysed. Sources of data were hospital admission registers, death registers, and International Classification of Diseases report forms. Information on demographic characteristics, date of death, the immediate underlying cause of death and co-morbid conditions was collected...
October 10, 2018: Tropical Medicine & International Health: TM & IH
Elizabeth Kemigisha, Deborah Nanjebe, Yap Boum, Céline Langendorf, Said Aberrane, Dan Nyehangane, Fabienne Nackers, Yolanda Mueller, Rémi Charrel, Richard A Murphy, Anne-Laure Page, Juliet Mwanga-Amumpaire
Acute central nervous system (CNS) infections in children in sub-Saharan Africa are often fatal. Potential contributors include late presentation, limited diagnostic capacity and inadequate treatment. A more nuanced understanding of treatment practices with a goal of optimizing such practices is critical to prevent avoidable case fatality. We describe empiric antimicrobial treatment, antibiotic resistance and treatment adequacy in a prospective cohort of 459 children aged two months to 12 years hospitalised for suspected acute CNS infections in Mbarara, Uganda, from 2009 to 2012...
2018: PloS One
Jenny Hallgren, Anna K Dahl Aslan
Introduction: Hospital readmissions of older persons are common and often associated with complex health problems. The objectives were to analyze risk factors for readmission within 30 days from hospital discharge. Methods: A prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA) was conducted. During 9 years of follow-up, information on hospitalizations, readmissions and associated diagnoses were obtained from national registers...
2018: European Geriatric Medicine
Holger Keil, Detlev Reimers, Manuel Lingner, Thomas Kammermeyer, Jochen Franke, Paul A Grützner, Matthias Münzberg, Michael Kreinest
BACKGROUND: In professional motorbike racing falls with high velocities are common. Nonetheless, severe injuries or deaths are rare when compared to regular road traffic. METHOD: In this study, falls in all courses of the largest German race series IDM*Superbike between 2007 and 2013 were analyzed regarding injury patterns and hospital admissions. All races were accompanied by a medical team, including at least one physician who assessed every patient. RESULTS: 728 falls were included...
October 1, 2018: Journal of Sports Medicine and Physical Fitness
Sue Tucker, Deborah Buck, Brenda Roe, Jane Hughes, David Challis
AIM: To synthesize the evidence relating to the ability of specialist care home support services to prevent the hospital admission of older care home residents, including hospital admission at the end-of-life. DESIGN: Systematic review and narrative synthesis. METHODS: Ten electronic databases will be searched from 2010 to 31st December, 2018 using pre-determined search terms. All studies of specialist healthcare services to meet care home residents' physical healthcare needs which provide outcome data on hospital admission or place of death compared with usual care will be included...
October 5, 2018: Journal of Advanced Nursing
Anne Kjær Schmidt, Bård Lilleeng, Valborg Baste, Thomas Mildestvedt, Sabine Ruths
OBJECTIVE: To evaluate the use of a small municipality acute bed unit (MAU) in rural Norway resulting from the Coordination reform regarding occupancy-rate, patient characteristics and healthcare provided during the first four years of operation. Further, to investigate whether implementation of the new municipal service avoided acute hospital admissions. DESIGN: Observational study. SETTING: A two-bed municipal acute bed unit. SUBJECTS: All patients admitted to the unit between 2013 and 2016...
October 5, 2018: Scandinavian Journal of Primary Health Care
Deepa K Chellappa, Linda V DeCherrie, Christian Escobar, Diana Gregoriou, Kevin G Munjal
Prior to being referred to the emergency department (ED), patients such as the frail elderly often call their primary care physician. However, the on-call primary care physician or covering provider does not always have the tools to make an accurate and safe assessment over the phone or to treat patients remotely. This often results in preventable transport to an ED, avoidable admissions and iatrogenic events. An opportunity exists to reduce unnecessary ED referrals by enhancing the capabilities of the on-call primary care physician...
October 2018: Internal Medicine Journal
Maziar Gholampour Dehaki, Sana Niknam, Rasoul Azarfarin, Hooman Bakhshandeh, Mohammad Mahdavi
Blood priming is needed for cardiopulmonary bypass (CPB) in neonates and infants to avoid exceeding hemodilution; however, transfusion-related inflammation affects post-CPB outcomes in infant open-heart surgery. Procalcitonin, a newly detected inflammatory moderator and a sensitive parameter for predicting pulmonary dysfunction secondary to CPB, rises after CPB. We hypothesized that the hemofiltration of priming blood before CPB might decrease inflammatory mediators in the blood and post-CPB inflammatory replications, thereby improving the respiratory function after CPB in infants...
October 5, 2018: Artificial Organs
Marcos Javier Cuerva, Patricia García-Casarrubios, Laura García-Calvo, Mónica Gutiérrez-Simon, Polan Ordás, Fernando Magdaleno, José Luis Bartha
INTRODUCTION: The aim of this study was to test the hypothesis that transperineal ultrasound can be used to decide whether to admit a pregnant woman due to labor. MATERIAL AND METHODS: In this analytical cross-sectional observational study, transperineal ultrasound was performed on pregnant women with intact membranes who came to the hospital due to contractions. A decision was made to admit women due to labor based on the ultrasound measurements. The ultrasound measurements were used to determine cervical dilation, the angle of progression, and fetal head position...
October 4, 2018: Acta Obstetricia et Gynecologica Scandinavica
Mukul Bhattarai, Tamer Hudali, Robert Robinson, Mohammad Al-Akchar, Carrie Vogler, Youssef Chami
Researchers are extensively searching for modifiable risk factors including high-risk medications such as anticoagulation to avoid rehospitalisation. The influence of oral anticoagulant therapy on hospital readmission is not known. We investigated the impact of warfarin and direct oral anticoagulants (DOACs) on all cause 30-day hospital readmission retrospectively in an academic centre. We study the eligible cohort of 1781 discharges over 2-year period. Data on age, gender, diagnoses, 30-day hospital readmission, discharge medications and variables in the HOSPITAL score (Haemoglobin level at discharge, Oncology at discharge, Sodium level at discharge, Procedure during hospitalisation, Index admission, number of hospital Admissions, Length of stay) and LACE index (Length of stay, Acute/emergent admission, Charlson comorbidity index score, Emergency department visits in previous 6 months), which have higher predictability for readmission were extracted and matched for analysis...
October 2, 2018: BMJ evidence-based medicine
Edgardo Abalos, Lelia Duley, D Wilhelm Steyn, Celina Gialdini
BACKGROUND: Antihypertensive drugs are often used in the belief that lowering blood pressure will prevent progression to more severe disease, and thereby improve pregnancy outcome. This Cochrane Review is an updated review, first published in 2001 and subsequently updated in 2007 and 2014. OBJECTIVES: To assess the effects of antihypertensive drug treatments for women with mild to moderate hypertension during pregnancy. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials...
October 1, 2018: Cochrane Database of Systematic Reviews
Gabriela Orsak, Kate Starnes, Gerald Ledlow
The current study sought to examine the return on investment (ROI) of a mobile pediatric asthma clinic in a rural region with small metropolitan statistical areas, in terms of reduced costs attributed to preventable emergency department visits, inpatient admission, school absenteeism, cost of education, and parent work absenteeism. For fiscal years 2015 and 2016, an average return of $1.32 and a community ROI of $1.45 was estimated. Estimated benefits were $445,125.00 and cost avoidance was $263,853.01. A mobile pediatric asthma clinics operating in less densely populated regions is able to yield a positive ROI...
October 2, 2018: Hospital Topics
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