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Admission avoidance

Lizza Parts, Malin Holzmann, Mikael Norman, Pelle G Lindqvist
OBJECTIVE: Admission CTG is a short fetal heart rate (FHR) tracing recorded immediately at hospital admission to avoid unnecessary delay in action among pregnancies complicated by pre-existent fetal distress. There are different opinions regarding the value of the admission CTG, especially in low risk pregnancies. STUDY DESIGN: A retrospective validation study from Karolinska University Hospital, Jan 2011 to June 2015 (total number of deliveries = 40,061). All women who underwent emergency cesarean section within one hour of admittance due to suspected fetal distress were identified...
July 30, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Sarita March, Jessica Keim-Malpass
PURPOSE: Children with hypoplastic left heart syndrome (HLHS) experience numerous vulnerabilities during transitions from hospital to home during their first year of life. This paper examines the parents' responses to the situations they experience during the initial interstage transition as described through illness blogs. DESIGN AND METHODS: A qualitative descriptive design through inductive theme development using thematic analysis was performed for this study...
August 11, 2018: Journal for Specialists in Pediatric Nursing: JSPN
Yu Kwong Wong, Marium Khan
A 28-year-old Pakistani man with previously treated latent tuberculosis (TB) presented with a 3-month history of productive cough, fever, drenching night sweats, anorexia, sore throat and tender left cervical lymphadenopathy. Extensive biochemical and microbiological tests, and imaging studies were all inconclusive. Lymph node biopsy revealed the diagnosis of Kikuchi-Fujimoto disease (KFD). He had persistent fever and anorexia during admission despite supportive measures which resolved quickly on starting prednisolone...
August 10, 2018: BMJ Case Reports
Tal Weissbach, Ishai Heusler, Michal Ovadia, Liron David, Yair Daykan, Faye Schreiber, Tal Biron-Shental
OBJECTIVE: To correlate the duration of Category II cardiotocograms (CTG) with adverse neonatal outcomes associated with perinatal asphyxia and determine the duration before fetal compromise. STUDY DESIGN: This retrospective, observational study used electronic medical record data from a cohort of 271 patients, delivered by C-section due to non-reassuring fetal heart rate, at a tertiary medical center, from 2015 through 2017. Duration of Category II CTG, variability, tachycardia and deceleration frequency were analyzed and correlated to immediate postnatal outcomes...
July 30, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Mark J Peters, Rachel Agbeko, Peter Davis, Nigel Klein, Zohra Zenasi, Amy Jones, Christine Mackerness, Susan George, Paul Veys, Samiran Ray, Paul R Mouncey, David A Harrison, Kathy Rowan
OBJECTIVES: Previous trials in adults with impaired immunity and respiratory failure suggest that early noninvasive ventilation avoids endotracheal intubation and improves survival. No randomized clinical trials have addressed this question in children. DESIGN: We undertook an open, parallel-group randomized trial in three pediatric hospitals. SUBJECTS: Children with impaired immunity and acute respiratory failure defined as tachypnoea (> 90th centile); a new requirement for supplemental oxygen; and new chest radiograph infiltrates...
August 7, 2018: Pediatric Critical Care Medicine
Peter J Huckfeldt, Robert L Kane, Zhiyou Yang, Gabriella Engstrom, Ruth Tappen, Carolina Rojido, David Newman, Bernardo Reyes, Joseph G Ouslander
OBJECTIVES: To determine whether degree of implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) program is associated with number of hospitalizations and emergency department (ED) visits of skilled nursing facility (SNF) residents. DESIGN: Secondary analysis from a randomized controlled trial. SETTING: SNFs from across the United States (N=264). PARTICIPANTS: Two hundred of the SNFs from the randomized trial that provided baseline and intervention data on INTERACT use...
August 10, 2018: Journal of the American Geriatrics Society
Louis Ehwerhemuepha, Stacey Finn, Michael Rothman, Cyril Rakovski, William Feaster
OBJECTIVES: To develop a model to assist clinicians in reducing 30-day unplanned pediatric readmissions and to enhance understanding of risk factors leading to such readmissions. METHODS: Data consisting of 38 143 inpatient clinical encounters at a tertiary pediatric hospital were retrieved, and 50% were used for training on a multivariate logistic regression model. The pediatric Rothman Index (pRI) was 1 of the novel candidate predictors considered. Multivariate model selection was conducted by minimization of Akaike Information Criteria...
August 9, 2018: Hospital Pediatrics
Lisa M Kalisch Ellett, Renly Lim, Nicole L Pratt, Mhairi Kerr, Emmae N Ramsay, Tammy V LeBlanc, John D Barratt, Elizabeth E Roughead
BACKGROUND: The Australian Government Department of Veterans' Affairs (DVA) Veterans' Medicines Advice and Therapeutics Education Services (Veterans' MATES) programme conducted two intervention (March 2009, follow-up intervention June 2012) both of which aimed to reduce hypnotic use among Australian veterans. We evaluated the effectiveness of the interventions, and estimated the associated health consequences. METHODS: Both interventions targeted veterans who had been dispensed hypnotics prior to the intervention...
August 9, 2018: BMC Health Services Research
Elisenda Gómez-Angelats, Carolina Sánchez
Chronic obstructive pulmonary disease (COPD) is the second leading cause of emergency department (ED) admissions to hospital, and nearly a third of patients with acute exacerbation (AE) of COPD are re-admitted to hospital within 28 days after discharge. It has been suggested that nearly a third of COPD admissions could be avoided through the implementation of evidence-based care interventions. A COPD discharge bundle is a set of evidence-based practices, aimed at improving patient outcomes after discharge from AE COPD; body of evidence supports the usefulness of discharge care bundles after AE of COPD, although there is a lack of consensus of what interventions should be implemented...
August 7, 2018: Medical Sciences: Open Access Journal
Jacob Folse, Charles E Hill, Matthew L Graves, George V Russell, Josie Hydrick, LaRita C Jones, William H Replogle, Patrick F Bergin, Clay A Spitler
OBJECTIVES: To evaluate all patients who received gentamicin for open fracture treatment and determine the incidence of, and risk factors for, kidney injury in this population. DESIGN: Retrospective, Case Control SETTING:: Single institution; Level 1 trauma center PATIENTS/PARTICIPANTS:: A retrospective chart review identified patients who received gentamicin for open fracture antibiotic treatment from January 2008-December 2012. Overall, 371 patients met inclusion criteria and were categorized into 2 groups using RIFLE criteria: normal kidney function (74...
July 30, 2018: Journal of Orthopaedic Trauma
Fátima Higuera-de-la-Tijera, Alfredo I Servín-Caamaño, Francisco Salas-Gordillo, José L Pérez-Hernández, Juan M Abdo-Francis, Jaime Camacho-Aguilera, Sai N Alla, Fiacro Jiménez-Ponce
Background and Aim: Variceal bleeding is the second most important precipitating factor related to the development of episodic hepatic encephalopathy; but to date there are no recommendations to prevent this complication. The aim of this study was to compare if primary prophylaxis with lactulose or L-ornithine L-aspartate or rifaximin, in cirrhotic patients with variceal bleeding, is better than placebo for avoiding the development of hepatic encephalopathy. Methods: A randomized, double-blind, placebo-controlled clinical trial (ClinicalTrials...
2018: Canadian Journal of Gastroenterology & Hepatology
Elizabeth A Chu, Evan Kaminer
Epiploic appendagitis is a rare cause of acute abdomen that often manifests with acute onset of pain in the left or right lower quadrant. Its symptoms can mimic and be mistaken for acute diverticulitis, appendicitis, or omental infarction. In this case report, we discuss a 65-year-old woman who presented with sharp right upper and lower quadrant abdominal pain, for which she had an emergent abdominal computed tomography (CT) scan. On CT images, epiploic appendagitis will appear as oval lesions with a central area of fat attenuation, accompanied by surrounding inflammation...
June 2018: Radiology case reports
Miriam J Johnson, Ann Hutchinson
PURPOSE OF REVIEW: Breathlessness is one of the most common reasons for presentation at the emergency department (ED). The present review summarizes work published from 2017, which focuses on the symptom of breathlessness in its own right rather than as a signpost to diagnosis in relation to presentation to the ED. RECENT FINDINGS: Seven relevant papers are included in the present review. Five describe the epidemiology of breathlessness presentation showing: a prevalence of approximately 5% all ED presentations, a high likelihood of hospital admission especially for those with heart failure, breathlessness as a predictor of re-presentation...
September 2018: Current Opinion in Supportive and Palliative Care
Rosie Mc Colgan, David M Dalton, Hugh P O'Sullivan, James A Sproule
OBJECTIVES: Nationally, 5% of the population have been prescribed topical lidocaine patches (TLPs). These patches cost €77-230 per month. The only licensed indication for TLP is post-herpetic neuralgia (PHN). It has not proven to be effective for any other indication including musculoskeletal and post-surgical pain. It is estimated that only 5-10% of patients on TLP have PHN. The aim of this study was to audit the number of inpatients currently prescribed TLP-appropriately and inappropriately-and to examine the prescribing patterns...
July 31, 2018: Irish Journal of Medical Science
Carsten Tschöpe, Alessio Alogna, Frank Spillmann, Alessandro Faragli, Gunther Schmidt, Florian Blaschke, Uwe Kühl, Ewa Hertel, Monika Willner, Daniel Morris, Heiner Post, Michel Noutsias, Burkert Pieske, Florian Krackhardt
BACKGROUND: Recent clinical trials have shown that pulmonary artery pressure-guided therapy via the CardioMEMS™ system reduces the risk of recurrent hospitalizations in chronic heart failure (HF) patients. The CardioMEMS™ pressure sensor is percutaneously implanted in a branch of the pulmonary artery and allows telemetric pressure monitoring via a receiver. According to the most recent ESC guidelines, this technology has currently a class IIb indication in patients with class III New York Heart Association symptoms and a previous hospitalization for congestive heart failure within the last year, regardless of ejection fraction...
July 31, 2018: BMC Cardiovascular Disorders
Rodney A Sparapani, Lisa E Rein, Sergey S Tarima, Tourette A Jackson, John R Meurer
Much of survival analysis is concerned with absorbing events, i.e., subjects can only experience a single event such as mortality. This article is focused on non-absorbing or recurrent events, i.e., subjects are capable of experiencing multiple events. Recurrent events have been studied by many; however, most rely on the restrictive assumptions of linearity and proportionality. We propose a new method for analyzing recurrent events with Bayesian Additive Regression Trees (BART) avoiding such restrictive assumptions...
July 28, 2018: Biostatistics
Ellen Ingrid Schafheutle, Tom Fegan, Darren M Ashcroft
Background Unplanned hospital admissions (UHAs) for chronic obstructive pulmonary disease (COPD) are a major burden on health services. Effective medicines management is crucial to avoid such admissions but little is known about the role of social networks in supporting medicines-taking. Objective To examine the activities and strategies recently discharged COPD patients and their social network members (SNMs) utilise to manage their medicines. Setting COPD patients recently discharged from an acute NHS Trust in Northwest England...
July 28, 2018: International Journal of Clinical Pharmacy
Javier Arístegui Fernández, Eduardo González Pérez-Yarza, María José Mellado Peña, Carlos Rodrigo Gonzalo de Liria, Teresa Hernández Sampelayo, Juan José García García, Jesús Ruiz Contreras, David Moreno Pérez, Elisa Garrote Llanos, José Tomás Ramos Amador, Carlos Gustavo Cilla Eguiluz, María Méndez Hernández
INTRODUCTION: There are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. METHODS: A retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2́flu seasons (2014-2015 and 2015-2016)...
July 25, 2018: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
Yu Sunny Kang, Nancy A Miller, Huey-Ming Hm Tzeng, Ting Zhang
INTRODUCTION: Despite policy efforts to reduce unwanted nursing home (NH) admissions, NH residents increasingly are being admitted from hospitals, with a significant share diagnosed with mental health disorders. OBJECTIVES: We examined interactive effect of Black race and mental health disorder's impact on older patients' (age 65 and older) NH admission upon hospital discharge. MATERIAL AND METHODS: We analyzed 186,646 older patients using pooled data from the 2007 through 2010 National Hospital Discharge Survey...
July 5, 2018: Archives of Gerontology and Geriatrics
John E Jesus, Kenneth D Marshall, Chadd K Kraus, Arthur R Derse, Eileen F Baker, Jolion McGreevy
BACKGROUND: Whether emergency physicians should utilize critical care resources for patients with advance care planning directives is a complex question. Because the cost of intensive care unit (ICU)-level care, in terms of human suffering and financial burden, can be considerable, ICU-level care ought to be provided only to those patients who would consent and who would benefit from it. OBJECTIVES: In this article, we discuss the interplay between clinical indications, patient preferences, and advance care directives, and make recommendations about what the emergency physician must consider when deciding whether a patient with an advance care planning document should be admitted to the ICU...
July 24, 2018: Journal of Emergency Medicine
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