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Admission avoidance

Maria Papadakaki, Angelos Tsalkanis, Markos Sarris, George Pierrakos, Ottavia Eleonora Ferraro, Maria-Angeliki Stamouli, Chiara Orsi, Dietmar Otte, Georgia Tzamalouka, Timo Lajunen, Türker Özkan, Anna Morandi, Charalampos Gnardellis, Joannes Chliaoutakis
INTRODUCTION: This study aimed to assess the physical, psychological, and economic burden shouldered by severely injured two-wheel users in three European countries as well as the cost resulting from their hospitalization. METHODS: A total of seven public hospitals were involved in three countries: Greece, Italy, and Germany. Participants enrolled during a 12-month period starting in April 2013. Eligibility criteria included an injury sustained at Road Traffic Crashes (RTC) irrespective of the type of vehicle, hospitalization 1 day in the Intensive Care Unit (ICU) or sub-ICU, and age 18 years or over...
December 2018: Journal of Safety Research
Cali E Johnson, Joyce Peralta, Lindsey Lawrence, Alice Issai, Fred A Weaver, Sung W Ham
PURPOSE: System-based practice with an emphasis on quality improvement (QI) is a recent initiative for the American College of Surgeons and a core-competency for surgical trainees. Few surgical training programs have a curriculum for hospital-based QI. METHODS: Our vascular surgery service implemented several QI initiatives focused on decreasing length of stay (LOS) by targeting resident education and engagement. Residents were educated on terminology and processes impacting hospital and CMS QI metrics such as Medicare geometric mean LOS (CMS GMLOS) and diagnostic-related groups (DRG) with complication or comorbidity (CC/MCC) coding...
December 12, 2018: Journal of Surgical Education
Emmanuel Andrès, Samy Talha, Abrar-Ahmad Zulfiqar, Mohamed Hajjam, Sylvie Ervé, Jawad Hajjam, Bernard Gény, Amir Hajjam El Hassani
BACKGROUND: This is a narrative review of both the literature and Internet pertaining to telemedicine projects within the field of heart failure, with special attention placed on remote monitoring of second-generation projects and trials, particularly in France. RESULTS: Since the beginning of the 2000's, several telemedicine projects and trials focused on chronic heart failure have been developed. The first telemedicine projects (e.g., TEN-HMS, BEAT-HF, Tele-HF, and TIM-HF) primarily investigated telemonitoring or for the older ones, telephone follow-up...
December 13, 2018: Journal of Clinical Medicine
C M McHugh, M Harron, A Kilcullen, P O’Connor, N Burns, A Toolan, E O’Mahony
Anorexia nervosa affects 0.5% of the population (90% female) with the highest mortality of any psychiatric illness, usually suicide, or cardiovascular or neurological sequelae of either malnutrition or refeeding syndrome. The latter two conditions occur in the inpatient setting, carry a high mortality and are thoroughly avoidable with careful informed clinical management. This paper provides an overview of the service and care of these patients in a general hospital setting in Ireland. In response to a number of acute presentations a cross discipline Pop-up Eating Disorder Unit (psychiatrist, physician, dietician, nurse) was established in Sligo University Hospital in 2014 and has experience of 20 people treated according to the MARSIPAN guideline (Management of Really Sick Inpatients with Anorexia Nervosa)...
September 10, 2018: Irish Medical Journal
Igor Larrañaga, Panos Stafylas, Ane Fullaondo, Gian Matteo Apuzzo, Javier Mar
Introduction: An integrated health and social care program for patients with heart failure (HF) was implemented at the Friuli-Venezia Giulia deployment site as part of the SmartCare European project. The objective of this study was to validate 2 different decision modeling techniques used to perform the economic evaluation. Methods: Data were collected during the SmartCare project which enrolled 108 patients with HF and followed for more than 6 months. The techniques used were Markov and discrete event simulation models...
January 2018: Health Services Research and Managerial Epidemiology
(no author information available yet)
OBJECTIVEManaging penetrating military brain injuries in a war zone setting is different than managing common civilian penetrating brain injuries. Triage, i.e., deciding on which patients to treat or not treat, and which to be flown back home, is essential to avoid wasting valuable limited resources. In this study the authors aim to identify reliable predictors of mortality and poor outcome to help develop a protocol for treating their patients in the battlefield. They also demonstrate all the lessons learned from their collective experience regarding some of the controversial management issues...
December 1, 2018: Neurosurgical Focus
Claus Kjær Pedersen, Carsten Stengaard, Hanne Søndergaard, Karen Kaae Dodt, Jakob Hjort, Morten Thingemann Bøtker, Christian Juhl Terkelsen
BACKGROUND: Suspicion of acute myocardial infarction (AMI) is among the most common reasons for admission to hospital in Denmark. Owing to this suspicion, an estimated 50,000 patients are admitted every year. Only 15-20% are finally diagnosed with AMI, whereas 40% are discharged after rule-out of AMI and without initiation of any treatment or need for further admission. In patients discharged after rule-out, the current diagnostic protocol, using consecutive troponin measurements, results in an average length of stay (LOS) of 8-12 h...
December 12, 2018: Trials
Elzo Pereira Pinto Junior, Líllian de Queiroz Costa, Silvia Morgana Araujo de Oliveira, Maria Guadalupe Medina, Rosana Aquino, Marcelo Gurgel Carlos da Silva
This study analyses expenditure trends in Hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs) in children. It is an ecological time-series study, including hospitalizations of children under five in Bahia, between 2000 and 2012. We calculate the annual ACSC rates, as well as the total and average expenditure on these hospitalizations. We construct linear regression analysis models for the temporal trends. Between 2000 and 2012, 810,831 ACSC hospitalizations for the under-fives were recorded in Bahia...
December 2018: Ciência & Saúde Coletiva
Joshua L Rein, Steven G Coca
Acute kidney injury (AKI) is a major public health problem that complicates 10-40% of hospital admissions. Importantly, AKI is independently associated with increased risk of progression to chronic kidney disease, end stage renal disease, cardiovascular events, and increased risk of in-hospital and long-term mortality. The chloride content of intravenous fluid has garnered much attention over the last decade, and its association with excess use and adverse outcomes including AKI. Numerous studies show that changes in serum chloride concentration, independent of serum sodium and bicarbonate, are associated with increased risk of AKI, morbidity, and mortality...
December 12, 2018: American Journal of Physiology. Renal Physiology
Ashruta Patel, Gary Daniels
BACKGROUND: Factitious disorder causing hypoglycemia is a psychiatric condition in which patients deliberately use blood sugar lowering medications to cause severe symptoms for the purposes of hospitalization or other primary gains. CASE PRESENTATION: We report a case of factitious hypoglycemia in a 19-year-old foster care adolescent female who presented to the Emergency Department with recurrent hypoglycemic episodes, to the degree that the patient required large amounts of dextrose and further management by intensive care unit hospitalization...
December 11, 2018: BMC Emergency Medicine
Kah P Lau, Adeleke D Adewumi
Background Ageing is associated with changes in physiology, functional ability, declined in cognition and multiple co-morbidities. Alterations in pharmacodynamic and pharmacokinetic aspects also occur. Medications can improve the quality of life in people with multiple co-morbidities; polypharmacy and ageing could increase risks of medication misadventures and adverse events leading to hospital admissions. Medication management services (MedsCheck, Diabetes MedsCheck and Home Medication Review) were implemented in Australia to: increase patients' knowledge about their medicines, increase patients' confidence in using their medicines, and reduce avoidable hospital admissions...
December 11, 2018: International Journal of Clinical Pharmacy
Katie Jane Sheehan, Adrian R Levy, Boris Sobolev, Pierre Guy, Michael Tang, Lisa Kuramoto, Jason M Sutherland, Lauren Beaupre, Suzanne N Morin, Edward Harvey, Nick Bradley
OBJECTIVE: We describe steps to operationalise a published conceptual framework for a contiguous hospitalisation episode using acute care hospital discharge abstracts. We then quantified the degree of bias induced by a first abstract episode, which does not account for hospital transfers. DESIGN: Retrospective observational study. SETTING: All acute care hospitals in nine Canadian provinces. PARTICIPANTS: We retrieved acute hospitalisation discharge abstracts for 189 448 patients aged 65 years and older admitted to acute care with hip fracture between 2003 and 2013...
December 6, 2018: BMJ Open
Angelos G Kolias, Ellie Edlmann, Eric P Thelin, Diederik Bulters, Patrick Holton, Nigel Suttner, Kevin Owusu-Agyemang, Yahia Z Al-Tamimi, Daniel Gatt, Simon Thomson, Ian A Anderson, Oliver Richards, Peter Whitfield, Monica Gherle, Karen Caldwell, Carol Davis-Wilkie, Silvia Tarantino, Garry Barton, Hani J Marcus, Aswin Chari, Paul Brennan, Antonio Belli, Simon Bond, Carole Turner, Lynne Whitehead, Ian Wilkinson, Peter J Hutchinson
BACKGROUND: Chronic subdural haematoma (CSDH) is a common neurosurgical condition, typically treated with surgical drainage of the haematoma. However, surgery is associated with mortality and morbidity, including up to 20% recurrence of the CSDH. Steroids, such as dexamethasone, have been identified as a potential therapy for reducing recurrence risk in surgically treated CSDHs. They have also been used as a conservative treatment option, thereby avoiding surgery altogether. The hypothesis of the Dex-CSDH trial is that a two-week course of dexamethasone in symptomatic patients with CSDH will lead to better functional outcome at six months...
December 4, 2018: Trials
Joël L Lavanchy, Melanie M Holzgang, Tobias Haltmeier, Daniel Candinas, Beat Schnüriger
BACKGROUND: The aim of this study was to assess outcomes of octogenarians undergoing emergency abdominal surgery (EAS). METHODS: Octogenarians undergoing EAS 12/2011-12/2016 were retrospectively analysed. The outcomes were assessed by univariable and multivariable regression analysis. RESULTS: One-hundred-forty patients with a median age of 83.9 years were included. EAS was performed for cholecystitis (27.1%), ileus (22.1%), hollow viscus perforation (16...
November 27, 2018: American Journal of Surgery
Tobias Schmidt, Mintje Bohné, Michael Schlüter, Mitsunobu Kitamura, Peter Wohlmuth, Dimitry Schewel, Jury Schewel, Michael Schmoeckel, Karl-Heinz Kuck, Christian Frerker
AIMS: We sought to assess the impact of different manifestations of heart failure (HF) at baseline on the short- and long-term outcomes of transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS). METHODS AND RESULTS: Of 361 patients undergoing TAVI between May 2013 and April 2015, 185 (51%) showed clinical signs of HF at the time of admission. HF was diagnosed as isolated left ventricular (LV) and biventricular in 63 (34%) and 122 patients (66%), respectively...
December 3, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Michelle B Mulder, Matthew Hernandez, Mohamed D Ray-Zack, Daniel C Cullinane, David Turay, Salina Wydo, Martin Zielinski, Daniel Dante Yeh
BACKGROUND: Gastrografin (GG)-based nonoperative approach is both diagnostic and therapeutic for partial small bowel obstruction (SBO). Absence of X-ray evidence of GG in the colon after 8 h is predictive of the need for operation, and a recent trial used 48 h to prompt operation. We hypothesize that a significant number of patients receiving the GG challenge require >48 h before an effect is seen. METHODS: A post hoc analysis of an Eastern Association for the Surgery of Trauma multi-institutional SBO database was performed including only those receiving GG challenge...
January 2019: Journal of Surgical Research
(no author information available yet)
OBJECTIVETraumatic brain injury (TBI) is a significant cause of morbidity and mortality worldwide. Clinical outcomes in TBI are determined by the severity of injury, which is dependent on the primary and secondary brain injury processes. Whereas primary brain injury lesions are related to the site of impact, secondary brain injury results from physiological changes caused by oxidative stress and inflammatory responses that occur after the primary insult. The aim of this study was to identify important clinical and biomarker profiles that were predictive of recovery after moderate to severe TBI...
November 1, 2018: Journal of Neurosurgery
Mats Holmberg, Henrik Andersson, Karin Winge, Camilla Lundberg, Thomas Karlsson, Johan Herlitz, Birgitta Wireklint Sundström
BACKGROUND: To decrease the morbidity burden of cardiovascular disease and to avoid the development of potentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) are important. The aim of this study has therefore been to explore the possible association between patients' estimated intensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcome before and after arrival in hospital. METHODS: Data was collected both prospectively and retrospectively...
November 28, 2018: BMC Cardiovascular Disorders
Nicola Alberio, Salvatore Cicero, Domenico Gerardo Iacopino, Giuseppe Roberto Giammalva, Massimiliano Visocchi, Alessandro Olivi, Natale Francaviglia, Roberto Battaglia, Angelo Spitaleri, Rita Lipani, Luca Ruggeri, Raffaele Alessandrello, Alessandro Cinquemani, Rosario Maugeri
BACKGROUND: While the incidence of intracerebral haemorrhage (ICH) appear to be increasing over the year, its prognosis still remains dismal . Although no consensus about the management of ICH has be found, minimal invasive surgery should limit - when not avoid - the intra operative parenchymal damage. At this regard, we present a novel modified "home made" approach, aimed to shorten the operative time and minimize the corticectomy and brain manipulation, with our clinical series...
November 24, 2018: World Neurosurgery
Jane V Tehan, Anita Panayiotou, Helen Baxter, Paul Yates, Joanne Tropea, Frances Batchelor
BACKGROUND: People living with dementia (PLWD) are admitted to hospital twice as often as those without dementia, for ambulatory care sensitive conditions (ACSC) that could have been managed in ambulatory and primary care settings. PLWD are at greater risk of poor outcomes during and following hospital admission. Compared to those without dementia, they are almost twice as likely to die in hospital and two to three times more likely to experience an adverse event. Although some hospitalizations are clinically necessary, there may be a proportion related to ACSC that could be potentially avoided with additional support and education for PLWD and their carers...
November 24, 2018: Systematic Reviews
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