Acute Exacerbation Of Chronic Disease Research Articles

Improve disaster response by planning for and logistically supporting acute exacerbations of chronic diseases.

Provide a more effective medical response by emphasizing the management of acute exacerbations of chronic diseases in disasters. Disaster victims need treatment for their acute exacerbations of and ongoing chronic medical conditions, medication refills, mental health resources, and have an expectation that medical facilities will provide resources beyond medical care. Medical response is more efficient, cost effective, and effectual when these considerations are supported.

LOCKED IN SUFFERING: UNLOCKING HOPE AND IMPROVING CARE FOR ELDER INMATES: A CALL FOR ACTION

Abstract Our program will focus on several key areas, including care for hospitalized inmates, the importance of providing comprehensive care for all prisoners as mandated by 8th amendment, and the importance of identifying inmates facing end of life who would benefit from compassionate release. We will begin with a discussion on the challenges faced by elder inmates and address their unique physical, psychosocial and spiritual needs. With a growing population of aging prisoners, it is critical that we examine the healthcare and social services required to ensure that they receive adequate care. Next, we will explore the differences in healthcare provision for inmates versus non-inmates who are hospitalized. The presentation will examine the acute exacerbation of chronic disease, ethical considerations and legal requirements involved in providing care to both populations. We will also discuss the importance of interdisciplinary care for incarcerated individuals, which requires collaboration among medical providers, mental health professionals, social workers, chaplains and other specialists. Our panel of experts will share their experiences and provide insights on how this approach can improve health outcomes and reduce recidivism rates after release . Finally, we will hear from advocates who are working to ensure that all prisoners receive adequate healthcare and social services, They will share strategies for improving access to care, reducing health disparities, and addressing the unique needs of incarcerated elders Our symposium provides a unique opportunity to explore and share insights on how we can work together to improve the health and wellbeing of incarcerated individuals.

Renal, cardiovascular, and respiratory outcomes associated with climate change

PurposeEnvironmental exposure such as declining air quality and increasing temperatures can exert detrimental effects on human health, including acute exacerbations of chronic diseases. We aim to investigate the association between these exposures and acute health outcomes in a rural Colorado community. MethodsMeteorological and adult emergency department (ED) visit data were retrospectively collected (2013–2017). Daily environmental exposure data included PM10, maximum daily temperature (MDT), and mean humidity and precipitation. Total daily counts of ED diagnoses for myocardial infarction, congestive heart failure, urolithiasis, and exacerbation of COPD and asthma, were calculated during the study period. Time series models using generalized estimating equations were fit for each disease and included all four environmental factors. ResultsBetween 2013 and 2017, asthma and COPD exacerbation accounted for 30.8% and 25.4% of all ED visits (n = 5113), respectively. We found that for every 5°C increase in MDT, the rate of urolithiasis visits increased by 13% (95% CI: 2%, 26%) and for every 10 μg/m3 increase in 3-day moving average PM10, the rate of urolithiasis visits increased by 7% (95% CI: 1%, 13%). The magnitude of association between 3-day moving average PM10 and rate of urolithiasis visits increased with increasing MDT. Associations between climate and other health outcomes were not statistically significant. ConclusionsThis retrospective study on ED visits is one of the first to investigate the impact of several environmental exposures on adverse health outcomes in a rural community. Research into mitigating the negative impacts of these environmental exposures on health outcomes is needed.

Exacerbation of Renal, Cardiovascular, and Respiratory Outcomes Associated with Changes in Climate.

Exposure to environmental variables including declining air quality and increasing temperatures can exert detrimental effects on human health including acute exacerbations of chronic diseases. We aim to investigate the association between these exposures and acute health outcomes in a rural community in Colorado. Meteorological and adult emergency department visit data were retrospectively collected (2013-2017); for asthma outcomes, additional data were available (2003-2017). Daily environmental exposure data included PM10, maximum daily temperature (MDT), and mean humidity and precipitation. Total daily counts of emergency department (ED) diagnoses for myocardial infarction, congestive heart failure, urolithiasis, and exacerbation of chronic obstructive pulmonary disease (COPD) and asthma, were calculated during the study period. Time series models using generalized estimating equations were fit for each disease and included all four environmental factors. Between 2013 and 2017, asthma and COPD exacerbation accounted for 30.8% and 25.4% of all ED visits (n=5,113), respectively. We found that for every 5˚C increase in MDT, the rate of urolithiasis visits increased by 13% (95% CI: 2%, 26%) and for every 10μg/m3 increase in 3-day moving average PM10, the rate of urolithiasis visits increased by 7% (95% CI: 1%, 13%). The magnitude of association between 3-day moving average PM10 and rate of urolithiasis visits increased with increasing MDT. The rate of asthma exacerbation significantly increased as 3-day, 7-day, and 21-day moving average PM10 increased. This retrospective study on ED visits is one of the first to investigate the impact of several environmental exposures on adverse health outcomes in a rural community. Research into mitigating the negative impacts of these environmental exposures on health outcomes is needed.

COVID-19 vaccination coverage and its cognitive determinants among older adults in Shanghai, China, during the COVID-19 epidemic.

This study aimed to examine the coverage of coronavirus disease 2019 (COVID-19) vaccination and its cognitive determinants among older adults. A cross-sectional study was conducted using a questionnaire to conduct a survey among 725 Chinese older adults aged 60 years and above in June 2022, 2 months after the mass COVID-19 outbreak in Shanghai, China. The questionnaire covered demographic characteristics, COVID-19 vaccination status, internal risk perception, knowledge, and attitude toward the efficacy and safety of COVID-19 vaccines. The vaccination rate was 78.3% among the surveyed individuals. Self-reported reasons for unwillingness to get vaccinated (multiple selections) were "concerns about acute exacerbation of chronic diseases after vaccination (57.3%)" and "concerns regarding vaccine side effects (41.4%)." Compared to the unvaccinated group, the vaccinated group tended to have a higher score in internal risk perception (t = 2.64, P < 0.05), better knowledge of COVID-19 vaccines (t = 5.84, P < 0.05), and a more positive attitude toward the efficacy and safety of COVID-19 vaccines (t = 7.92, P < 0.05). The path analysis showed that the cognitive effect on vaccination behavior is relatively large, followed by the internal risk perception, and then the attitude toward COVID-19 vaccines. The more knowledgeable the participants were about COVID-19 vaccines, the more likely they were to receive the COVID-19 vaccines. In the multivariate logistic regression, the increased coverage of COVID-19 vaccination was associated with reduced age (OR = 0.53 95% CI 0.43-0.66, P < 0.001), being a resident in other places than Shanghai (OR = 0.40, 95% CI 0.17-0.92, P < 0.05), a shorter time of lockdown (OR = 0.33, 95% CI 0.13-0.83, P < 0.05), a history of other vaccines (OR = 2.58, 95% CI 1.45-4.60, P < 0.01), a fewer number of chronic diseases (OR = 0.49, 95% CI 0.38-0.62, P < 0.001), better knowledge about COVID-19 vaccines (OR = 1.60, 95% CI 1.17-2.19, P < 0.01), and a positive attitude toward COVID-19 vaccines (OR = 9.22, 95% CI 4.69-18.09, P < 0.001). Acquiring accurate knowledge and developing a positive attitude toward COVID-19 vaccines are important factors associated with COVID-19 vaccination. Disseminating informed information on COVID-19 vaccines and ensuring efficacious communication regarding their efficacy and safety would enhance awareness about COVID-19 vaccination among older adults and consequently boost their vaccination coverage.

Attempting to Bridge the Gap: Comparison of Clinical Characteristics, Ultrasound, and Final Surgical Pathology of Emergency Department vs Outpatient Clinic Patients Undergoing Cholecystectomy

INTRODUCTION: After emergency department (ED) discharge for symptomatic cholelithiasis, many patients fail the outpatient clinic (OC) algorithm. Our previous study showed that clinical diagnosis is better at predicting cholecystitis than ultrasound (US) in ED patients. This study compares clinical presentation (CP), US, and final surgical pathology (FSP) in the ED and OC patients undergoing cholecystectomy. METHODS: This retrospective chart review compared ED and OC patients at a single institution with right upper quadrant pain (RUQ) and cholelithiasis who underwent cholecystectomy. CP including duration of pain and Murphy’s sign, laboratory values, US, and FSP were compared. RESULTS: A total of 607 patients underwent cholecystectomy: 299 OC and 308 ED. ED patients were younger, more likely to have RUQ pain >4 hours (90% vs 27.5%), positive Murphy’s sign, leukocytosis, and positive US (30% vs 5% (p < 0.0001)). Although, FSP revealed chronic cholecystitis in a majority of patients including 56% and 72% of ED and OC, respectively, ED patients were more likely to have acute cholecystitis (39.3% vs 4.7%) and less likely to have isolated cholelithiasis (4.6% vs 23% [p < 0.0001]). Among patients with an acute component, RUQ pain >4 hours was more frequently positive than US in both ED (p < 0.0001) and OC (p < 0.02; Table 1). Table 1. - Demographic and Clinical Characteristics Variable Inpatient308 (50.7) Outpatient299 (49.3) p Value Age, mean (+SD) 40.3 (14.5) 47.5(28.0) 0.0001 Pathology, n (%): acute and chronic cholecystitis 76 (24.7) 5 (1.7) <0.0001 Acute cholecystitis 45 (14.6) 10 (3.4) Chronic cholecystitis 173 (56.2) 216 (72.2) Cholelithiasis 14 (4.6) 68 (22.7) Pain history: pain duration ≥ 4 h 276 (90.2) 82 (27.7) <0.0001 Provider + Murphy’s sign 100 (33.3) 18 (6.1) <0.0001 Laboratory tests, n (%): white blood cells >11,000 148 (48.1) 22 (8.2) <0.0001 US findings positive 93 (30.2) 12 (5.0) <0.0001 CONCLUSION: CP and duration of pain is a better predictor than US for cholecystitis in both OC and ED populations. Although chronic cholecystitis on FSP is prevalent in both populations, ED presentation likely represents an acute exacerbation of chronic disease, despite negative US findings, and urgent inpatient cholecystectomy is recommended.

US Navy Ship-Based Disaster Response: Lessons Learned.

Purpose of ReviewThe US Navy has a long history of responding to disasters around the globe. US Navy ships have unique characteristics and capabilities that determine their capacity for a disaster response. This paper discusses common considerations and lessons learned from three distinct disaster missions.Recent FindingsThe 2010 earthquake in Haiti had a robust response with multiple US Navy ship platforms. It was best assessed in three phases: an initial mass casualty response, a subacute response, and a humanitarian response. The 2017 response to Hurricane Maria had a significant focus on treating patients with acute needs secondary to chronic illnesses to decrease the burden on the local healthcare system. The COVID-19 response brought distinctive challenges as it was the first mission where hospital ships were utilized in an infectious disease deployment.SummaryThe first ships to respond to a disaster will need to focus on triage and acute traumatic injury. After this first phase, the ship’s medical assets will need to focus on providing care in a disrupted health care system which most often includes acute exacerbations of chronic disease. Surgeons must be ready to be flexible in their responsibilities, be competent with end-of-life care, and negotiate technical and cultural communication challenges.

Hospitalization at Home for Patients With Acute Exacerbation of Chronic Disease—Further Evidence to Inform Practice

Hospitalization at Home for Patients With Acute Exacerbation of Chronic Disease—Further Evidence to Inform Practice

C-reactive protein/albumin ratio as an indicator of disease activity in Behçet's disease and human leukocyte antigen-B27-associated uveitis.

To explore the role of systemic inflammatory markers as indicators of acute exacerbation of chronic diseases and disease activity in uveitis. This study included 50 patients with Behçet's disease (BD)-associated uveitis and 52 patients with human leukocyte antigen-B27 (HLA-B27)-associated uveitis. Laboratory tests were conducted to measure complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), CRP/albumin ratio (CAR), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) during the uveitis phase and after resolution. The results measured during the two phases were assessed and compared. The mean age of the participants was 41.4 ± 10.8years; 68.6% of the patients were male. In both groups, ESR, CRP, and CAR were significantly higher during the uveitic phase (P < .001). However, the white blood cell count, albumin, NLR, and PLR measured during the uveitic phase and after resolution did not vary significantly (P > .05). ESR and CAR were correlated with the severity of intraocular inflammation. The area under the curve (AUC) of CAR, which was used to predict the presence of uveitis, was 0.801 (95% CI, 0.741-0.861); this value is strong compared with those of other inflammatory biomarkers. CAR is correlated with the severity of intraocular inflammation in BD- and HLA-B27-associated uveitis. Furthermore, CAR appears to be a useful marker of disease activity for uveitis and is the most sensitive marker for discriminating the presence of acute uveitis in patients who have chronic uveitis as a symptom of BD- and HLA-B27-associated diseases.

Primary Palliative Care for Emergency Medicine (PRIM-ER): Applying form and function to a theory-based complex intervention

BackgroundEmergency departments are seeing an increase in acute exacerbations of chronic disease in the older-adult population. The delivery of palliative care in the emergency department can increase goal-concordant care at the end-of-life for this population. New interventions in palliative care for emergency medicine require large, pragmatic, complex health interventions due to the heterogeneous and dynamic environment of emergency departments. These complex interventions must balance fidelity with adaptability, while being rooted in theory, to produce an intervention that can be applied in a variety of contexts. MethodsPrimary Palliative Care for Emergency Medicine (PRIM-ER) is a large, pragmatic, complex health intervention. This paper outlines the conceptual theory-based design as well as the study form and functions of PRIM-ER to exemplify how this complex intervention has balanced fidelity with adaptability. ResultsA form and function matrix was created to highlight the key objectives and tailored intervention components of PRIM-ER. Each intervention component was also linked to one or more elements of the Theory of Planned Behavior to support provider behavior change and the delivery of palliative care services and referrals. ConclusionThe application of theory and delineation of forms and functions, as well prospective adaptation monitoring of large complex interventions can support the balance of fidelity with adaptability to encourage successful interventions among a variety of clinical environments.

SYSTEM AND ALGORITHM OF INTELLIGENT BIOMEDICAL SIGNAL PROCESSING AND ANALYSIS FOR HUMAN HEALTH STATUS REMOTE MONITORING SYSTEM

Continuous and steady running of health status remote monitoring systems is essential not to omit episodes of acute exacerbation of chronic disease. Running time of such systems is largely determined by performance capabilities of the patient's wearable system elements. To ensure its long-term operation and efficient performance, the monitoring system must have multilayered structure with the elements realizing recording and picking off biomedical signals, signal processing and analysis, estimation of patient current condition, dynamics of the disease and its prognosis. For this purpose, it is necessary to use smart monitoring algorithms. A specific feature of such algorithms is change of the number of channels used for biomedical signal recording and processing according to the change of patient’s condition. To detect the exacerbation first symptoms by means of the patient's wearable computer, additional channels are activated for recording biomedical signals used to evaluate the expanded complex of diagnostically significant parameters of the disease and their integration when specifying the patient's condition. The system and intelligent monitoring algorithm is tested with the use of heart rate remote control and atrial fibrillation episode detection system. The testing results of the developed system and algorithm are discussed.

Subgroups of High-Cost Medicare Advantage Patients: an Observational Study.

There is a growing focus on improving the quality and value of health care delivery for high-cost patients. Compared to fee-for-service Medicare, less is known about the clinical composition of high-cost Medicare Advantage populations. To describe a high-cost Medicare Advantage population and identify clinically and operationally significant subgroups of patients. We used a density-based clustering algorithm to group high-cost patients (top 10% of spending) according to 161 distinct demographic, clinical, and claims-based variables. We then examined rates of utilization, spending, and mortality among subgroups. Sixty-one thousand five hundred forty-six Medicare Advantage beneficiaries. Spending, utilization, and mortality. High-cost patients (n = 6154) accounted for 55% of total spending. High-cost patients were more likely to be younger, male, and have higher rates of comorbid illnesses. We identified ten subgroups of high-cost patients: acute exacerbations of chronic disease (mixed); end-stage renal disease (ESRD); recurrent gastrointestinal bleed (GIB); orthopedic trauma (trauma); vascular disease (vascular); surgical infections and other complications (complications); cirrhosis with hepatitis C (liver); ESRD with increased medical and behavioral comorbidity (ESRD+); cancer with high-cost imaging and radiation therapy (oncology); and neurologic disorders (neurologic). The average number of inpatient days ranged from 3.25 (oncology) to 26.09 (trauma). Preventable spending (as a percentage of total spending) ranged from 0.8% (oncology) to 9.5% (complications) and the percentage of spending attributable to prescription medications ranged from 7.9% (trauma and oncology) to 77.0% (liver). The percentage of patients who were persistently high-cost ranged from 11.8% (trauma) to 100.0% (ESRD+). One-year mortality ranged from 0.0% (liver) to 25.8% (ESRD+). We identified clinically distinct subgroups of patients within a heterogeneous high-cost Medicare Advantage population using cluster analysis. These subgroups, defined by condition-specific profiles and illness trajectories, had markedly different patterns of utilization, spending, and mortality, holding important implications for clinical strategy.

Main trends of changes in indicators of emergency outpatient care for adult population of the large industrial city

Aim. To study major trends of emergency outpatient visits on the example of the city of Naberezhnye Chelny adult population of different categories by age and sex according to the time indices - the month and day of the week.Methods. 3,393,351 outpatient visits of the Naberezhnye Chelny adult population for 2011-2013 were analyzed.Results. The highest attendance rates of adult population to health organizations providing emergency care in outpatient settings were registered in spring (March, April, May) and in autumn (September, October, November) with a peak attendance in April and October. There is a certain pattern of distribution of cases of outpatient visits for acute exacerbation of chronic diseases, and by the day of the week. Thus, a significant number of patients attended health organizations on Monday (26%). In the following days, their number gradually decreased and reached minimum on Saturday and Sunday. During the study period, the number of outpatient visits for acute exacerbation of chronic diseases by adult population on Monday rose by 12.1%. In the structure of emergency outpatient care, proportion of the diseases of respiratory, musculoskeletal and circulatory systems was the highest. During the study period number of visits for diseases of respiratory system increased by 2.4%, circulatory system - by 1.2%, musculoskeletal system - has not changed.Conclusion. The main workload of medical organizations providing emergency care in outpatient settings is unequally distributed by days of the week and months; there is a need for translating outpatient care on a 7-day work schedule to avoid the maximum load on the outpatient clinic on Monday and in the morning hours as a result of the accumulated over the weekend and night hours incidence.

Telemedicine and wireless devices in heart failure

Telemedicine has the potential to constitute the central element of the future primary care and become an effective means of prevention and early warning of acute exacerbation of chronic diseases. Up to now, the application of telemedicine has found a variety of difficulties, regarding the types and methods of acquisition and transmission of biological signals, the acceptance and cooperation of the patient, etc. The latest technological developments involve the combined use of wireless technologies and smartphones, for the collection and the transmission of data, and specific softwares for their automatic analysis. This paper examines some of the critical aspects in the application of new technologies for heart failure remote management.

Prehospital Management of Evolving Critical Illness by the Primary Care Provider

The factors that limit primary care providers (PCPs) from intervening for adults with evolving, acute, severe illness are less understood than the increasing frequency of management by acute care providers. Rates of prehospital patient management by a PCP and of communication with acute care teams were measured in a multicenter, cross-sectional, descriptive study conducted in all four of the adult medical ICUs of the three hospitals in central Massachusetts that provide tertiary care. Rates were measured for 390 critical care encounters, using a validated instrument to abstract the medical record and conduct telephone interviews. PCPs implemented prehospital management for eight episodes of acute illness among 300 encounters. Infrequent prehospital management by PCPs was attributed to their lack of awareness of the patient's evolving acute illness. Only 21% of PCPs were aware of the acute illness before their patient was admitted to an ICU, and 33% were not aware that their patient was in an ICU. Rates of PCP involvement were not appreciably different among provider groups or by patient age, sex, insurance status, hospital, ICU, or ICU staffing model. We identified lack of PCP awareness of patients' acute illness and high rates of PCP referral to acute care providers as the most frequent barriers to prehospital management of evolving acute illness. These findings suggest that implementing processes that encourage early patient-PCP communication and increase rates of prehospital management of infections and acute exacerbations of chronic diseases could reduce use of acute care services.

National burden of antibiotic use for adult rhinosinusitis

National burden of antibiotic use for adult rhinosinusitis

Burden of Seasonal and Pandemic Influenza-Associated Hospitalization during and after 2009 A(H1N1)pdm09 Pandemic in a Rural Community in India

BackgroundInfluenza is vaccine-preventable; however, the burden of severe influenza in India remains unknown. We conducted a population-based study to estimate the incidence of laboratory confirmed influenza-associated hospitalizations in a rural community in western India.MethodsWe conducted active surveillance for hospitalized patients with acute medical illnesses or acute chronic disease exacerbations in Pune during pandemic and post pandemic periods (May 2009–April 2011). Nasal and throat swabs were tested for influenza viruses. A community health utilization survey estimated the proportion of residents hospitalized with respiratory illness at non-study facilities and was used to adjust incidence estimates from facility-based surveillance.ResultsAmong 9,426 hospitalizations, 3,391 (36%) patients were enrolled; 665 of 3,179 (20.9%) tested positive for influenza. Of 665 influenza positives, 340 (51%) were pandemic A(H1N1)pdm09 and 327 (49%) were seasonal, including A/H3 (16%), A/H1 (3%) and influenza B (30%). The proportion of patients with influenza peaked during August 2009 (39%) and 2010 (42%). The adjusted annual incidence of influenza hospitalizations was 46.8/10,000 during pandemic and 40.5/10,000 during post-pandemic period with comparable incidence of A(H1N1)pdm09 during both periods (18.8 and 20.3, respectively). The incidence of both pH1N1 and seasonal hospitalized influenza disease was highest in the 5–29 year olds.ConclusionsWe document the previously unrecognized burden of influenza hospitalization in a rural community following the emergence of influenza A(H1N1)pdm09 viruses in India. During peak periods of influenza activity circulation i.e during the monsoon period, 20% of all hospital admissions in the community had influenza positivity. These findings can inform development of influenza prevention and control strategies in India.

Activating patients with chronic disease for self-management: comparison of self-managing patients with those managing by frequent readmissions to hospital

Understanding the factors that activate people to self-manage chronic disease is important in improving uptake levels. If the many frequent hospital users who present with acute exacerbations of chronic disease were to self-manage at home, some hospital admissions would be avoided. Patient interview and demographic, psychological, clinical and service utilisation data were compared for two groups of patients with chronic disease: those attending self-management services and those who managed by using hospital services. Data were analysed to see whether there were differences that might explain the two different approaches to managing their conditions. The two groups were similar in terms of comorbidity, age, sex, home services, home support and educational level. Self-managing patients were activated by their clinician, accepted their disease, changed their identity, confronted emotions and learnt the skills to self-manage and avoid hospital. Patients who frequently used hospital services to manage their chronic disease were often in denial about their chronic disease, hung on to their identity and expressed little emotional response. However, they reported a stronger sense of coherence and rated their health more highly than self-managing patients. This study shed light on the process of patient activation for self-management. A better understanding of the process of patient activation would encourage clinicians who come into contact with frequently readmitted chronic disease patients to be more proactive in supporting self-management.

What distinguishes clinicians who better support patients for chronic disease self-management?

Many frequent readmissions due to acute exacerbations of chronic disease could be prevented if patients self-managed. This study explored factors involved in patient activation for chronic disease self-management by qualitative analysis of interview data from hospital and community-based clinicians and patients. All clinicians reported that many frequently readmitted patients did not readily take up referral to chronic disease self-management services. This reluctance was compounded by system or access barriers. Clinicians who had a defined role in chronic disease management and patient-centred and behaviour change skills reported that although some patients were more resistant than others, patients could be persuaded to adopt self-management behaviours. Hospital clinicians and GPs were more inclined to attribute blame to clinical, social and personal patient factors, such as difficulty with support at home, social circumstances and reluctance to take responsibility. Investment in extending the skills and role of hospital clinicians and GPs to take a more supportive role in patient uptake of referrals to chronic disease self-management services would reduce hospital readmissions. Improvements in access to chronic disease self-management and GP services are also needed to address failure to take up chronic disease self-management.

Health Care Reform, Health, and Social Justice

Health Care Reform, Health, and Social Justice