Pre-discharge factors predicting readmissions of psychiatric patients: a systematic review of the literature.

ObjectiveMaturity‐onset diabetes of the young type 13 (MODY13), a rare type of monogenic diabetes, is often misdiagnosed as type 1 or type 2 diabetes. To improve early diagnosis and precise treatment, we performed a systematic review and analysis of the literature about MODY13.MethodsPubMed, Cochrane, Embase, China National Knowledge Infrastructure (CNKI), Chinese BioMedical (CBM) Literature Database, and Wanfang Database were searched using the following search terms: “MODY13,” “KCNJ11 maturity‐onset diabetes of the young,” “KCNJ11‐MODY,” “maturity‐onset diabetes of the young type 13,” and “neonatal diabetes mellitus KCNJ11.” The demography, clinical characteristics, and gene mutations of patients were expressed with descriptive statistical methods.ResultsA total of 33 reports were included in this study, including 75 patients and 28 types of mutations. Thirty‐six patients were male. The mean onset age was 25.20 ± 15.26 years. The averages of recorded body mass index, glycated hemoglobin (HbA1c), and fasting C‐peptide were 23.45 ± 4.56kg/m2, 10.07 ± 1.96%, and 0.31 ± 0.23nmol/L, respectively. Most of the mutation sites were located in the cytosolic region of N‐ and C‐terminal domains of Kir6.2. Seven patients were reported to have diabetic chronic complications.ConclusionMODY13 was diagnosed later than other types of MODY and was associated with low fasting C‐peptide. Mutation sites of MODY13 were mostly concentrated in N‐ and C‐terminal intracellular domains. The majority of KCNJ11 gene mutations causing MODY 13 were from G to A. The incidence rates of chronic complications were lower than type 1 and type 2 diabetes.

Background:Arteriovenous malformations (AVMs) of the corpus callosum (CC) are rare entities. We performed a systematic review of the available literature to better define the natural history, patient characteristics, and treatment options for these lesions.Methods:A MEDLINE, Google Scholar, and The Cochrane Library search were performed for studies published through June 2015. Data from all eligible studies were used to examine epidemiology, natural history, clinical features, treatment strategies, and outcomes of patients with CC-AVMs. A systematic review and pooled analysis of the literature were performed.Results:Our search yielded 37 reports and 230 patients. Mean age at presentation was 26.8 years (±13.12 years). AVMs were most commonly located in the splenium (43%), followed by the body (31%), and then the genu (23%) of the CC. A Spetzler-Martin grade of III was the most common (37%). One hundred eighty-seven (81.3%) patients presented with hemorrhage, 91 (40%) underwent microsurgical excision, and 87 (38%) underwent endovascular embolization. Radiosurgery was performed on 57 (25%) patients. Complete obliteration of the AVM was achieved in 102 (48.1%) patients and approximately twice as often when microsurgery was performed alone or in combination with other treatment modalities (94% vs. 49%; P < 0.001). Mean modified Rankin Scale (mRS) at presentation was 1.54 and mean mRS at last follow-up was 1.31. This difference was not statistically significant (P = 0.35).Conclusion:We present an analysis of the pooled data in the form of a systematic review focusing on management of CC-AVMs. This review aims to provide a valuable tool to aid in decision making when dealing with this particular subtype of AVM.

BackgroundHigh levels of hospital readmission (rehospitalisation rates) is widely used as indicator of a poor quality of care. This is sometimes also referred to as recidivism or heavy utilization. Previous studies have examined a number of factors likely to influence readmission, although a systematic review of research on post-discharge factors and readmissions has not been conducted so far. The main objective of this review was to identify frequently reported post-discharge factors and their effects on readmission rates.MethodsStudies on the association between post-discharge variables and readmission after an index discharge with a main psychiatric diagnosis were searched in the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey and Google Scholar. Relevant articles published between January 1990 and June 2014 were included. A systematic approach was used to extract and organize in categories the information about post-discharge factors associated with readmission rates.ResultsOf the 760 articles identified by the initial search, 80 were selected for this review which included a total number of 59 different predictors of psychiatric readmission. Subsequently these were grouped into four categories: 1) individual vulnerability factors, 2) aftercare related factors, 3) community care and service responsiveness, and 4) contextual factors and social support. Individual factors were addressed in 58 papers and were found to be significant in 37 of these, aftercare factors were significant in 30 out of the 45 papers, community care and social support factors were significant in 21 out of 31 papers addressing these while contextual factors and social support were significant in all seven papers which studied them.ConclusionsThis review represents a first attempt at providing an overview of post-discharge factors previously studied in association with readmission. Hence, by mapping out the current research in the area, it highlights the gaps in research and it provides guidance future studies in the area.

IntroductionHepatic encephalopathy (HE) is a significant complication of cirrhosis, known to be associated with hospital readmission. However, few new serological indicators associated with readmission in HE patients have been identified and reported. The objective of our study was to identify simple and effective predictors reated to readmission in HE patients.Materials and methodsWe conducted a retrospective study at a single center on adult patients admitted with HE from January 2018 to December 2022. The primary endpoint was the first liver-related readmission within 30, 90, and 180 days, and we collected electronic medical records from our hospital for sociodemographic, clinical, and hospitalization characteristics. We utilized logistic regression analysis and multiple linear regression analysis to determine the predictors that were associated with the readmission rate and the length of the first hospitalization.ResultsA total of 424 patients were included in the study, among whom 24 (5.7%), 63 (14.8%), and 92 (21.7%) were readmitted within 30, 90, and 180 days, respectively. Logistic regression analysis showed that insurance status, alcoholic liver disease (ALD), ascites, the model for end-stage liver disease (MELD) score, and neutrophil-to-lymphocyte ratio (NLR) were significantly associated with 30-, 90-, and 180-day readmissions. Age and hepatocellular carcinoma (HCC) were predictors of 90- and 180-day readmissions. ALD was identified as a unique predictor of readmission in men, while hypertension was a predictor of 180-day readmission in women. Variceal bleeding, chronic kidney disease, and MELD score were associated with the length of the first hospitalization.ConclusionsNLR at discharge was identified as a significant predictor of 30-, 90- and 180-day readmissions in patients with HE. Our findings suggest that incorporating NLR into routine clinical assessments could improve the evaluation of the prognosis of liver cirrhosis.

The purpose of this project was to organize the variables associated with the hospital readmission of patients with heart failure (HF) into a usable framework to inform clinical practice and facilitate administrative decision making. An integrated, systematic review of the literature was used as the research approach. A content analysis of the sample (31 research reports from the years 1986-2004) yielded multiple factors associated with the hospital readmission of HF patients. Factors and their definitions were extracted, grouped into like categories, and eventually classified into 5 domains-demographic, physiologic, psychosocial, patient functioning, and resource utilization. The resulting framework has clinical, research, and administrative implications in the delivery of care to HF patients.

Prevalence and Predictors of Readmissions in Patients With Hypertrophic Cardiomyopathy and Atrial Fibrillation/Flutter

BackgroundPalatal perforations not associated with syndromes or neoplasms are rare lesions whose frequency has increased recently. However, their clinical and demographic characteristics have not been fully described. Therefore, this report aimed to establish the demographic and clinical characteristics of patients with non-syndromic and non-neoplastic palatal perforations. Material and MethodsThe file of an oral medicine teaching clinic from January 2004 to December 2018 was reviewed to identify and isolate all cases with a diagnosis of palatal perforation. Cases with a diagnosis of palatal perforation related to congenital alteration, syndrome, or neoplasia were excluded. Age, sex, medical history, and diagnosis were obtained from the clinical history. In addition, a systematic review of the literature was performed using a PICO strategy. MEDLINE electronic databases from January 1990 to December 2018 were systematically reviewed using the combination of keywords with Boolean terms “OR” (palatal perforation, destruction of the palate) and “AND” (drugs, cocaine, mycosis, syphilis, mucormycosis, tuberculosis, trauma). The PRISMA guide was used to identify the different results of the literature search and article selection process. Case reports and case series were included. ResultsFive cases of non-syndromic, non-neoplastic palatal perforations were identified. All cases were male with a mean age of 42 years. Two cases were related to cocaine use, 2 cases were caused by mucormycosis, and one case by trauma. As for the systematic literature review, 51 non-neoplastic and non-syndromic cases were collected. The cases showed a male predominance, with a mean age of 41 years. The most frequent etiology was chronic cocaine use followed by mucormycosis. ConclusionsSince cocaine use and type II Diabetes Mellitus, risk factors related to non-syndromic and non-neoplastic palatal perforations, have shown a worldwide increase, the clinician should be alert to make an early diagnosis and initiate appropriate treatment. Key words:Palatal perforation, cocaine-induced, mucormycosis, mycotic infection, drug users.

Intracranially extending temporomandibular joint (TMJ) lesions may be radiologically misinterpreted as primary intracranial or skull base pathologies, leading to diagnostic delays or inappropriate management. This systematic review aimed to characterize the clinical and imaging features of such TMJ lesions and evaluate the impact of radiologic misclassification. We also aimed to develop a diagnostic framework for when to consider an intracranially extending TMJ lesion, based on clinical and radiologic features. A comprehensive search of MEDLINE, Scopus, and EMBASE, conducted in accordance with PRISMA guidelines, yielded 2255 records. After screening with predetermined inclusion and exclusion criteria, 128 studies involving 152 patients were included in the final analysis. Statistical analyses were performed using STATA software. We also identified 3 patient cases through our institutional neuroradiology practice who were clinically and radiologically assessed for intracranially extending TMJ lesions. Patients had symptoms for an average of 34 months before diagnosis (47% women, mean age 50 years). The most common pathologies were pigmented villonodular synovitis/tenosynovial giant-cell tumor (43%) and synovial chondromatosis (24%). Neurologic symptoms were reported in 48% of cases, most frequently hearing loss (70%). Nearly one-third (33%) of cases with an imaging differential did not list a TMJ pathology (18/55). In cases with accurate imaging diagnosis, 90% had both CT and MRI performed. Most lesions were nonenhancing (CT 83%, MRI 75%) and demonstrated no adjacent brain edema (96%). In 2 cases, a TMJ ganglion cyst and pseudogout were misdiagnosed as intracranial tumors, resulting in unnecessary intervention, including repeat craniotomy and radiotherapy. There were inherent biases of case report literature, including variability in the reporting of the imaging and clinical features, management, and follow-up. TMJ lesions with intracranial extension often present with nonspecific symptoms and can mimic extra-axial tumors, leading to misdiagnosis on imaging. Recognition of hallmark imaging features, including lack of parenchymal invasion and distinct imaging patterns, may help improve radiologic accuracy and prevent overtreatment. We propose a diagnostic framework outlining when to suspect intracranially extending TMJ lesions based on clinical and imaging features, and how to avoid common diagnostic pitfalls.

Clinical Features, Natural History, and Outcomes of Intraneural Perineuriomas: A Systematic Review of the Literature

Post-COVID syndrome. A case series and comprehensive review

0432: Six minute walk test: predictor of hospital readmission in patients with chronic heart failure

Introduction: Decompensated liver cirrhosis is reported to be the 12th leading cause of death in the U.S. with estimated deaths of 38,0000 annually. The readmission rate among patients with decompensated cirrhosis is estimated to be as high as 20-37% at 30 days in various single center studies. Information at a national level on 30-day readmission rate, its causes, predictors and mortality in patients with decompensated cirrhosis is lacking. Objectives: The aims of this study were to investigate the 30 day readmission rate, its causes and predictors and mortality in patients with decompensated liver cirrhosis. Methods: We utilized the Nationwide Readmission Database, Healthcare Cost and Utilization Project for a cross-sectional study of hospitalizations in the United States. Patients discharged with a primary diagnosis of decompensated liver cirrhosis in 2013 were included. Demographics, Elixhauser comorbidity scores, hospital characteristics, readmission rates and hospitalization outcomes were collected. Validated ICD-9 codes were used to capture patients. Multivariate logistic and linear regression models were fit to study the predictors of 30 day readmissions. Results: There were 39,913 patients admitted with a diagnosis of decompensated liver cirrhosis during the study period; of these 11,863 (30%) were readmitted at 30-days. Patients with low-income (OR: 1.08; CI: 1.01- 1.16), possessing medicaid (OR: 1.30 CI: 1.1-1.45) or Medicare (OR: 1.26; CI: 1.12-1.45) were more likely to readmit. On index admission, patients with Elixhauser comorbidity >3 (OR: 1.19; CI: 1.09-1.29) with hepatic encephalopathy (HE) (OR: 1.18; CI: 1.08-1.29), hepatorenal syndrome (HRS), (OR: 1.29; CI: 1.05-1.57), ascites (OR: 1.78; CI: 1.62-1.95) and hepatocellular carcinoma (HCC) (OR: 1.35; CI: 1.12-1.63) were more likely to be readmitted at 30-days. Moreover, patients discharged to home health care or left against medical advice were also more likely to be readmitted at 30-days (Table 1). In-hospital mortality was 2.7% and 9.4% at 30-days readmission and overall during 2013, respectively.Table: Table. Multivariate predictors of 30-day readmission in patients with decompensated liver cirrhosisConclusion: Approximately one third of patient with decompensated cirrhosis were readmitted with 30 days. Increased number of co-morbidity and presence of ascites, HRS, HCC and HE accounts for increased number of 30-days readmissions. A better understanding of predictors of 30-days readmission may guide strategies to decrease readmission among these patients.

Clinicians in resource-poor countries need to identify patients with dengue using readily-available data. The objective of this systematic review was to identify clinical and laboratory features that differentiate dengue fever (DF) and/or dengue haemorrhagic fever (DHF) from other febrile illnesses (OFI) in dengue-endemic populations. Systematic review of the literature from 1990 to 30 October 2007 including English publications comparing dengue and OFI. Among 49 studies reviewed, 34 did not meet our criteria for inclusion. Of the 15 studies included, 10 were prospective cohort studies and five were case-control studies. Seven studies assessed all ages, four assessed children only, and four assessed adults only. Patients with dengue had significantly lower platelet, white blood cell (WBC) and neutrophil counts, and a higher frequency of petechiae than OFI patients. Higher frequencies of myalgia, rash, haemorrhagic signs, lethargy/prostration, and arthralgia/joint pain and higher haematocrits were reported in adult patients with dengue but not in children. Most multivariable models included platelet count, WBC, rash, and signs of liver damage; however, none had high statistical validity and none considered changes in clinical features over the course of illness. Several individual clinical and laboratory variables distinguish dengue from OFI; however, some variables may be dependent on age. No published multivariable model has been validated. Study design, populations, diagnostic criteria, and data collection methods differed widely across studies, and the majority of studies did not identify specific aetiologies of OFIs. More prospective studies are needed to construct a valid and generalizable algorithm to guide the differential diagnosis of dengue in endemic countries.

ObjectiveThe objectives of this review are to discuss: the definition, clinical and biologic features of oligometastatic non-small cell lung cancer (NSCLC), as well as the concept of treating oligoprogression in oligometastatic NSCLC.BackgroundA substantial proportion of patients diagnosed with lung cancer present with metastatic disease, and a large portion of patients who present with localized disease later develop metastases. Oligometastatic NSCLC is defined as an intermediate state between localized and widespread metastatic disease, where there may be a role for curative localized therapy approach by treating the primary tumor and all metastases with radiotherapy or surgery. Despite the increasing application of this approach in patients with lung cancer, the identification of patients who might benefit from this approach is yet to be well characterized.MethodsAfter a systematic review of the literature, a PubMed search was performed using the English language and the key terms: oligometastatic, non-small cell lung cancer (NSCLC), localized consolidative treatment (LCT), biomarkers, biologic features, clinical features. Over 500 articles were retrieved between 1889–2021. A total of 178 papers discussing the definition, clinical and biologic factors leading to oligometastatic NSCLC were reviewed and included in the discussion of this paper.ConclusionsOligometastatic NSCLC is a unique entity. Identifying patients who have oligometastatic NSCLC accurately using a combination of clinical and biologic features and treating them with localized consolidative approach appropriately results in improvement of outcome. Further understanding of the molecular mechanisms driving the formation of oligometastatic NSCLC is an important area of focus for future studies.

Thirty-day Readmissions Among Patients With Cardiogenic Shock Who Underwent Extracorporeal Membrane Oxygenation Support In The United States: Insights From The Nationwide Readmissions Database