Admission Rate Of Patients Research Articles

Seasonal Admission Rates of Geriatric Patients with Musculoskeletal Problems to Physical Therapy and Rehabilitation Clinics

Seasonal variations in the admission rates of geriatric patients with musculoskeletal problems to physical therapy and rehabilitation clinics were examined in this study. Totally 2257 patients (1802, 79.84% female; 455, 20.16% male) over the age of 65 years (mean age 72.32±5.67years) who were admitted to Duygu Private Hospital and Burcu Private Physical Therapy Branch Center in Istanbul were included. Monthly admissions and seasonal distribution were retrospectively calculated for 2 years. Admission rates of females were higher than for males in all seasons; females presented mostly in spring (33.1%), whereas males presented mostly in autumn (30.3%). Examination of monthly and seasonal admission identified gender-based differences according to months (p=0.007) and seasons (p=0.018). Monthly and seasonal admission rates according to age groups showed similar distribution of monthly (p=0.406) and seasonal (p=0.327) admissions. These findings suggest that, due to climatic conditions in Istanbul, seasons with significant temperature changes affected musculoskeletal symptoms and that future studies should further analyze this subject.

Ten Years of Frequent Users in an Urban Emergency Department

Introduction: The purpose of this study was to determine if differences could be detected in the presentation patterns and admission rates among frequent emergency department users (FEDU) of an urban emergency department over a 10-year period.Methods: This was an institutional review board approved, retrospective review of all patients who presented to the ED 5 or more times for 3 distinct time periods: “year 0” 11/98–10/99, “year 5” 11/03– 10/04, and “year 10” 11/08–10/9. FEDU were grouped into those with 5–9, 10–14, 15–19, and ≥ 20 visits per year. Variables analyzed included number of visits, disposition, and insurance status. We performed comparisons using Kolmogorov-Smirnov and chi-square tests. A p<0.05 was considered significant.Results: We found a a 66% increase in FEDU patients over the decade studied, with a significant increase in both the number of FEDU in each visit frequency category over the 3 time periods (p<0.001), as well as the total number of visits by each group of FEDU (p<0.001). The proportion of FEDU visits for the 5–9 group resulting in admission increased from 25.9% to 29% from year 0 to year 10 (p<0.001), but not for the other visit groups. In comparing admission rates between FEDU groups, the admission rate for the 5–9 group was significantly higher than the ≥ 20 group for the year 5 time period (p<0.001) and the year 10 time period (p<0.001) and showed a similar trend, but not significant, at year 0 (p=0.052). The overall hospital admission rate for emergency patients over the same time span remained stable at 22–24%. The overall proportion of uninsured FEDU was stable over the decade studied, while the uninsured rate for the overall ED population for the same time periods increased.Conclusion: The results demonstrate the FEDU population is not a homogeneous group of patients. Increased attention to differences among FEDU groups is necessary in order to plan more effective interventions.

Daily Pain Is Unrelated to Admission Rate in Adult Patients with Sickle Cell Disease

Abstract 1016▪▪This icon denotes a clinically relevant abstract Background and aimsSickle cell disease is characterised by frequent episodes of vaso-occlusive pain resulting in frequent health care utilisation and cumulating organ damage. Disease severity is often quantified by the number of hospital admissions. However, sickle cell patients frequently experience episodes of pain without health care utilisation. In the present study, we analysed whether daily self-reported sickle cell pain in adult patients is related to disease severity quantified by frequency of hospital admission or disease severity defined by genotype. MethodsWe conducted a prospective cohort study in order to analyse daily pain in adult sickle cell patients in a tertiary teaching hospital in the Netherlands. Patients were divided in having severe (HbSS/HbS-β0) or milder (HbSC/HbS-β+) disease according to genotype. Daily pain was assessed for a period of 6 months by the use of pain diaries. Pain intensity was measured with different validated pain assessment instruments (Visual Analog Scale (VAS), McGill Pain Questionnaire and Brief Pain Inventory). Daily pain scores were correlated with genotype and frequency of hospital admission. Results110 consecutive outpatients with sickle cell disease were approached. 16 patients were excluded for different reasons (pregnancy, unable to fill in a diary or declined participation), 19 patients missed their appointments in the outpatient clinic and 26 patients completed less than a month of their diaries. 49 patients (mean age 33 years (SD 12.6); 67% female) completed at least two month of the diaries (response rate: 65%). No differences in disease severity according to genotype or age were observed between responders/non-responders.Pain was reported in 18% of the total 5016 patient-days. Overall median pain intensity was 3.6 (VAS). 41% of the patients reported pain in 5% or fewer diary days and 5% of all patients reported pain in more than 95% of the days. The frequency of hospital admission was unrelated to self-reported pain and no difference in daily pain was observed between patients with severe or milder disease according to genotype. Furthermore, lab results (hemoglobin and fetal hemoglobin levels, leukocyte counts, lactate dehydrogenase (LDH) and the presence of alfa-thalassemia) were not associated with daily pain. ConclusionsUsing daily pain diaries, adult sickle cell patients report pain in 18% of their total diary days. Interestingly, our patient population reported less daily pain in comparison to daily pain in adults reported previously (over 50%). Daily pain appeared to be unrelated to disease severity according to genotype or defined by frequency of hospital admission. Our results further stress that daily pain is an important problem in sickle cell patients and appears to be unrelated to the traditional definitions of disease severity. Disclosures:No relevant conflicts of interest to declare.

Ambulatory care program for patients presenting with acute urinary retention secondary to benign prostatic hyperplasia

We analyze the clinical and economical outcomes of an ambulatory care program for the management of patients presenting to the emergency department with acute urinary retention (AUR). A standardized ambulatory care program for managing male patients presenting with AUR was established in October 2007. Prospective data collected in 194 ambulatory patients from January to December 2008 were compared to a historical cohort of 168 patients who were managed by in-patient care from October 2006 to September 2007 for their clinical and economic outcomes. For the historical cohort, the mean length of hospital stay was 4.67±3.34 days and the trial without catheterization (TWOC) success rate was 66.1%. Two patients (1.2%) developed dizziness after using α(1)-blockers. For the patients in the ambulatory care program, the mean duration of catheterization was 4.72±2.26 days and the TWOC success rate was 69.1%. There were four unplanned admissions (2.1%) among the patients who were managed under the ambulatory care program; three of them had catheter-related complications (i.e., hematuria and urinary tract infection) and one developed dizziness after the use of alfuzosin. All of them were managed accordingly and no unfavorable sequelae were resulted. This new program reduced hospital admission rate of male patients presenting with AUR by 59.1%. It leads to significant cost reduction of USD 375,614.3 in our hospital in year 2008. The ambulatory care program reduced the hospital admission rate and reduced cost without jeopardizing the TWOC success rate and safety in the management of patients presenting with AUR.

The effects of daily weather variables on psychosis admissions to psychiatric hospitals

Several studies have noted seasonal variations in admission rates of patients with psychotic illnesses. However, the changeable daily meteorological patterns within seasons have never been examined in any great depth in the context of admission rates. A handful of small studies have posed interesting questions regarding a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (especially heat waves) and sunshine. In this study, we used simple non-parametric testing and more complex ARIMA and time-series regression analysis to examine whether daily meteorological patterns (wind speed and direction, barometric pressure, rainfall, sunshine, sunlight and temperature) exert an influence on admission rates for psychotic disorders across 12 regions in Ireland. Although there were some weak but interesting trends for temperature, barometric pressure and sunshine, the meteorological patterns ultimately did not exert a clinically significant influence over admissions for psychosis. Further analysis is needed.

Area characteristics and admission rates of people with schizophrenia and affective disorders in a German rural catchment area.

Studies in urban areas identified environmental risk factors for mental illness, but little research on this topic has been performed in rural areas. Hospital admission rates were computed for 174 rural municipalities in the catchment area of the state psychiatric hospital in Günzburg in years 2006 to 2009 and combined with structural and socio-economic data. Relationships of overall and diagnosis-specific admission rates with municipality characteristics were analysed by means of negative binomial regression models. Admission rates of patients with a diagnosis of schizophrenia and affective disorder combined decrease with increasing population growth, population density, average income and green areas, while admission rates are positively correlated with commuter balance, income inequality, unemployment rates and traffic areas. Admission rates for schizophrenia are negatively related to population growth, average income and agricultural areas, but positively related to mobility index, income inequality and unemployment rate. Admission rates for affective disorders are negatively related to population growth, population density, average income and green areas, while higher admission rates are correlated with commuter balance, high income inequality, unemployment rate and traffic-related areas. Effects of wealth, economic inequality, population density and structural area characteristics influence psychiatric admission rates also in rural areas.

The impact of early emergency department allied health intervention on admission rates in older people: a non-randomized clinical study

BackgroundThis study sought to determine whether early allied health intervention by a dedicated Emergency Department (ED) based team, occurring before or in parallel with medical assessment, reduces hospital admission rates amongst older patients presenting with one of ten index problems.MethodsA prospective non-randomized trial in patients aged sixty five and over, conducted in two Australian hospital EDs. Intervention group patients, receiving early comprehensive allied health input, were compared to patients that received no allied health assessment. Propensity score matching was used to compare the two groups due to the non-randomized nature of the study. The primary outcome was admission to an inpatient hospital bed from the ED.ResultsOf five thousand two hundred and sixty five patients in the trial, 3165 were in the intervention group. The admission rate in the intervention group was 72.0% compared to 74.4% in the control group. Using propensity score probabilities of being assigned to either group in a conditional logistic regression model, this difference was of borderline statistical significance (p = 0.046, OR 0.88 (0.76-1.00)). On subgroup analysis the admission rate in patients with musculoskeletal symptoms and angina pectoris was less for those who received allied health intervention versus those who did not. This difference was significant.ConclusionsEarly allied health intervention in the ED has a significant but modest impact on admission rates in older patients. The effect appears to be limited to a small number of common presenting problems.

Discharged on Supplemental Oxygen From an Emergency Department in Patients With Bronchiolitis

Bronchiolitis is the most common reason for hospital admission in patients aged <1 year. Admissions have been increasing with hypoxia frequently cited as the determinant. Home oxygen (O(2)) has been shown to be feasible, although safety data are lacking. The objective of this study was to evaluate the impact of a home O(2) clinical care protocol on admission rates in patients with bronchiolitis from the pediatric emergency department. We performed a retrospective chart review of patients with bronchiolitis who presented to a children's hospital pediatric emergency department (altitude 1600 m) between 2005 and 2009. Patients between the ages of 1 and 18 months were included in the analysis. Patients requiring baseline O(2) were excluded. We calculated the percentage of patients discharged on O(2) and their readmission rates. We reviewed charts of patients who were admitted after home O(2) for adverse outcomes. We also compared rates of admission before and after initiation of the protocol. In this study, 4194 illnesses were analyzed; 2383 (57%) were discharged on room air, 649 (15%) were discharged on O(2), and 1162 (28%) were admitted. Of those discharged on room air, 4% were subsequently admitted, and 6% of those discharged on O(2) were admitted. There were no ICU admissions or need for advanced airway management in those patients discharged on O(2). Our overall admission rates for bronchiolitis dropped from a rate of 40% to 31%. Home O(2) is an effective way to decrease hospital admissions in a select group of patients with bronchiolitis.

Acute intoxications: Differences in management between six Dutch hospitals

Context. Acute intoxications are frequently seen in Dutch hospitals. Based on single-centre studies and the fact that there are no clear guidelines, we hypothesised that hospital admission of acute intoxications may vary. Furthermore, decontamination treatment of poisonings may differ between hospitals, as earlier studies showed that adherence to international guidelines concerning decontamination may be poor. Objective. We aim to identify possible variations in Dutch hospital admission and decontamination treatment of patients with acute intoxications. Materials and methods. Data on acute intoxications was retrospectively collected from patient records from the emergency departments of six Dutch hospitals. All patients older than 14 years who presented between 1 January 2008 and 31 December 2008 were included in the study. Results. The percentage of suicide attempts differed significantly between the hospitals (25–73%, p < 0.0001) as equally the percentage of intoxications with drugs of abuse (18–61%, p < 0.0001). Marked differences in admission rates were found (27–78%, p < 0.0001) and these differences remained even when intoxications because of suicide attempts and drugs of abuse were analysed separately (admission rate of 52–87%, p < 0.0001 and 8–71%, p < 0.0001 respectively). Reported consultation with the National Poisons Information Centre differed between hospitals (range 0% to 80–100%). No statistical differences were found between hospitals for the use of activated charcoal (16.1–42.5%, p = 0.037). Gastric lavage was used infrequently in all hospitals. (6.6–16.7%, p = 0.614). Discussion and conclusion. The admission rate of patients with an acute intoxication varies considerably, especially in the case of intoxications with drugs of abuse. Consultations with the National Poisons Information Centre differed between the six hospitals. Rates of decontamination did not vary, which may indicate adherence to guidelines by the American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. National guidelines or admission algorithms may reduce variations in poisoning management and make the care for these patients more efficient.

Prognosis in Patients Having Chronic Obstructive Pulmonary Disease with Significant Coronary Artery Lesion Angina

Background/AimsMany studies have investigated angina and its relationship with chronic obstructive pulmonary disease (COPD). However, angina was diagnosed only by noninvasive tests or only by clinical symptoms in most of these studies. The aim of this study was to compare the prognosis, including rate of hospitalization and death from significant coronary artery lesion and nonsignificant coronary artery lesion angina, in patients with COPD.MethodsPatients with COPD who underwent coronary angiography (CAG) due to angina were reviewed retrospectively at a tertiary referral hospital. COPD is defined as post-bronchodilator forced expiratory volume in 1 sec/forced vital capacity (FEV1/FVC) of < 70%. A significant coronary lesion is defined as at least 50% diameter stenosis of one major epicardial artery in CAG.ResultsIn total, 113 patients were enrolled. Mean follow-up duration was 39 ± 21 months. Of the patients, 52 (46%) had mild COPD and 48 (42%) had moderate COPD. Sixty-nine (61%) patients had significant stenosis in CAG. The death rate in the follow-up period was 2.21 per 100 patient-years. No significant difference was observed among the all-cause mortality rate, admission rate, or intensive care unit admission rate in patients who had COPD with or without significant coronary artery disease. Pneumonia or acute exacerbation of COPD was the most common cause of admission.ConclusionsIn patients having COPD with angina who underwent CAG, no significant difference was observed in mortality or admission events depending on the presence of a significant coronary artery lesion during the 2-year follow-up period.

Admission Rate of Patients with Most Common Psychiatric Disorders in Relation to Seasons and Climatic Factors During 2010/2011

Introduction:Climate and its impact on human health and mental illness have been in the focus of the research since years in the field.Aim:The aim of the research is to study the admissions rate to the psychiatric clinic in correlation to seasons and climate.Material and method:The research was conducted in a Psychiatric clinic of the Clinical Center in Sarajevo. Randomly selected subjects (aged 5-89 years, 1316 males and 1039 females) N=2355, were interviewed by the Structural Clinical Interview (SCID) which generated DSM-IV. In this retrospective-prospective, clinicalepidemiological study subjects were divided into groups according to type of disorders. Correlation between the impact of seasons and the rate of admissions to a Psychiatric clinic was analyzed. Certain data were taken from Federal Hydrometeorological Institute in Sarajevo of the climatic situation for period of the study.Results and conclusions:Of the total number of subjects who were admitted to the clinic in the period of 2010/2011 the most common diagnoses were F10-F19, F20-F29, F30-F39, F40-F48, and the suicide attempts as the separate entity. It was found correlation between certain seasons and the effects of the certain weather parameters at an increased admission rate of subjects with the certain diseases.

Prospective evaluation of an ED observation unit protocol for trauma activation patients

BackgroundThe University of Utah emergency department (ED) observation unit (EDOU) cares for over 2500 patients each year, with a significant portion of these patients being trauma activation patients. We evaluated the safety and efficacy of our EDOU trauma protocol and described patient characteristics and outcomes of trauma patients managed in an EDOU. MethodsWe performed a prospective observational study of all trauma patients admitted to the EDOU over a 1-year period. Patient disposition, interventions, and adverse events during observation were recorded. Thirty-day follow-up was performed by telephone and chart review to evaluate for missed injuries, repeat hospitalizations, or repeat traumatic events. ResultsA total of 259 trauma patients were admitted to the EDOU during the study period and were contacted at least 30 days after discharge. There were no deaths, intubations, or other adverse events. At 30-day follow-up, there was 1 missed injury, which did not result in an adverse outcome. Ten patients were reevaluated in the ED or required hospitalization for events occurring after their initial EDOU stay but related to their initial trauma evaluation. The inpatient admission rate from the EDOU was 10.4%, and 3.1% of patients reported another traumatic event during the 30-day follow-up period. ConclusionsThere were no adverse outcomes in trauma patients admitted to the EDOU, and our inpatient admission rate was within the generally accepted admission rate for patients in observation status. The EDOU appears to be a safe alternative to inpatient admission for the evaluation of minimally injured trauma activation patients.

Impact of pharmaceutical care on health outcomes in patients with COPD

Chronic obstructive pulmonary disease (COPD) treatment goals are often not achieved despite the availability of many effective treatments. Furthermore, clinical pharmacist interventions to improve clinical and humanistic outcomes in COPD patients have not yet been explored and few randomized controlled trials have been reported to evaluate the impact of pharmaceutical care on health outcomes in patients with COPD. The aim of the present study was to evaluate the impact of pharmaceutical care intervention, with a strong focus on self-management, on a range of clinical and humanistic outcomes in patients with COPD. Outpatient COPD Clinic at the Royal Medical Services Hospital. In a randomised, controlled, prospective clinical trial, a total of 133 COPD patients were randomly assigned to intervention or control group. A structured education about COPD and management of its symptoms was delivered by the clinical pharmacist for patients in the intervention group. Patients were followed up at 6 months during a scheduled visit. Effectiveness of the intervention was assessed in terms of improvement in health-related quality of life, medication adherence, disease knowledge and healthcare utilization. Data collected at baseline and at the 6 month assessment was coded and entered into SPSS(®) software version 17 for statistical analysis. A P value of <0.05 was considered statistically significant. The primary outcome measure was health-related quality of life improvement. All other data collected including healthcare utilization, COPD knowledge and medication adherence formed secondary outcome measures. A total of 66 patients were randomized to the intervention group and 67 patients were randomized to the control group. Although the current study failed to illustrate significant improvement in health-related quality of life parameters, the results indicated significant improvements in COPD knowledge (P < 0.001), medication adherence (P < 0.05), medication beliefs (P < 0.01) and significant reduction in hospital admission rates (P < 0.05) in intervention patients when compared with control group patients at the end of the study. The enhanced patient outcomes as a result of the pharmaceutical care programme in the present study demonstrate the value of an enhanced clinical pharmacy service in achieving the desired health outcomes for patients with COPD.

POD-03.03 Increased Cardiac Admission Rates in Prostate Cancer Patients Treated with Androgen Deprivation Therapy in England

Androgen deprivation therapy (ADT) has been shown to improve the overall quality of life in prostate cancer patients but does carry significant side effects including deleterious effects on cardiovascular health. US publications have shown a link between cardiovascular morbidity and ADT. This is an important area and there is no current UK data published on this subject.

Challenges and solutions: Pandemic 2009 H1N1 influenza A in a pediatric emergency department

The purpose of this study was to describe the impact of the 2009 H1N1 influenza pandemic on a pediatric emergency department (ED) at a freestanding children's hospital in the summer and fall of 2009. In July 2009, active prospective surveillance for influenza-like illness (ILI) was performed on a daily basis of patients presenting to the ED of Arkansas Children's Hospital. The Centers for Disease Control and Prevention definition of ILI was used. Records of daily ILI volume were kept. A retrospective review of admissions from the ED to the inpatient service was done for patients with ILI and non-ILI. In addition, comparisons of monthly patient census for the months involved were compared with historical census data. When public schools started in mid-August 2009, there was a rapid and dramatic increase in the number of patients with ILI seen in the pediatric ED. Within 3 weeks, as many as 120 patients with ILI per day were being seen in the ED. The month of September 2009 was the highest census month ever recorded in this ED. The admission rate of the patients with ILI was lower than patients with non-ILI between September and November 2009 (10.8 percent vs 14.8 percent). The 2009 H1N1 influenza pandemic resulted in unprecedented patient volumes in this pediatric ED; however, patient acuity (based on admission rate) for patients with ILI was lower than patients with non-ILI. Pandemic influenza can overwhelm emergency care resources, even when the overall severity of illness is relatively low.

Effectiveness of multifunction paediatric short‐stay units: a French multicentre study

To describe the characteristics of the activities of multifunction paediatric 'short-stay units' (SSU) including observation unit (OU), medical assessment and planning unit (MAPU) and holding unit (HU), to evaluate their effectiveness and to explore predictors of inappropriate admissions for OU patients. Admissions to nine French paediatric SSUs were analysed. The main outcome measures were SSU length of stay with associated outcome for all patients and appropriate admission rate for OU patients. Of 1084 patients included in the study, 66% were OU patients (n = 718), 21% MAPU patients (n = 225) and 13% HU patients (n = 141). The OU patients constituted the majority of the SSU admissions. The appropriate OU admission rates ranged from 52% to 86%. Head trauma and seizure were the conditions with the highest appropriate OU admission rates (82%). Age <1 year, and need for IV fluids or medications, CT-Scan or MRI and cardiorespiratory monitoring were associated with an increased risk of inappropriate OU admission. Eighteen per cent of the MAPU patients and 5% of the HU patients were discharged home within 24 h. By providing extended and easily available facilities for diagnostics and early treatment for a wide range of sick children, the French paediatric SSU is an effective model for 'observation medicine' in emergency department-managed units. The experience and principles may be applicable to similar units in other health care systems.

The Impact of Discharging Minimally Injured Trauma Patient: Does Age Play a Role in Trauma Admission?

Age is suggested as a triage criteria for transfer to a trauma center, despite poor outcomes after similar injury regardless of trauma center level. The effect of differential triage based on age to a trauma center has not been evaluated. We hypothesized that there would be a difference in the admission rates of geriatric patients compared with the rest of the adult trauma population independent of injury severity. Records of 1,970 adult patients evaluated by the trauma team at a Level I trauma center and discharged directly from the emergency department were reviewed. Data abstracted included demographics, injuries, and physiologic information. These data were compared with 3,232 trauma patients admitted over the same time period who had similar information abstracted via record review. χ analysis of the admission rates of geriatric patients was performed, followed by a binomial logistic regression to determine factors that affected the odds of admission. A total of 451 (8.68%) patients were 65 years or older; 62.2% of the total population was admitted. Significantly more geriatric patients (82%) were admitted (χ = 126.24; p < 0.001). Multivariate analysis showed that age, head injury, Injury Severity Score, Glasgow Coma Scale, and initial blood pressure were significant independent factors in predicting hospital admission (p < 0.001). Age alone is associated with increased odds of being admitted to the hospital, independent of injury severity and other physiologic parameters. This has implications for trauma centers that see a significant proportion of geriatric trauma patients and for trauma systems that must prepare for the "aging of America."

Impact of Diabetes Mellitus on the Clinical Outcome of Cirrhosis

© 2011, INASL 20 population. Mean age of death being 47.25. Total years lived with disability 311. Considering disability weight of alcoholic cirrhosis as 0.33 and average life expectancy of male Keralites as 72 DALY calculated is 20.95. Conclusion: Alcoholic cirrhosis imparts a huge economic burden on family and society with loss of quality of life and early deaths. Conflict of Interest: None Lactose Intolerance in Liver Cirrhosis Patients SV Rana*, S Sharma*, RK Dhiman**, YK Chawla**, K Singh* Departments of *Gastroenterology and **Hepatology, PGIMER, Chandigarh Background: Malnutrition, characterized by protein and energy deficiency, is considered the most prevalent complication of liver disease. Studies of small bowel mucosa in cirrhosis report a diverse spectrum of histological abnormalities. These include increased mucosal edema, decreased villus to crypt ratio, villus atrophy and decreased total absorptive surface. This may result in decreased lactase activity causing lactose intolerance. Aim: Therefore, this study was planned to evaluate lactose intolerance in patients with liver cirrhosis. Materials and Methods: Lactose intolerance was estimated by using non-invasive lactose hydrogen breath test in 59 patients of liver cirrhosis and 63 ageand sex-matched apparently healthy controls. For lactose hydrogen breath test 25 g lactose dissolved in 250 mL water was given orally to the subjects after taking fasting breath H2 concentration. End expiratory breath was collected every 30 minutes up to 4 hours. H2 concentration was measured by using SC Microlyzer (Quintron, USA). Rise ≥ 20 ppm over baseline value in H2 concentration in two consecutive readings was considered as lactose intolerance. Results: In liver cirrhotic patient, 46 were males and 13 females, while in controls 49 males and 14 females. Out of 59 patients, 27 had viral cirrhosis and 32 had alcoholic cirrhosis. Mean ± SD of age in patients was 45.6 ± 16.4 years and in controls 47.8 ± 15.3 years. Out of 59 patients of liver cirrhosis, 41 (69.5%) were lactose intolerant while in controls 28 (44.4%) out of 63 subjects. The difference was statistically significant (p < 0.01). Lactose intolerance was present in 19 (70.4%) out of 27 viral cirrhosis patients while in 22 (68.75%) out of 32 alcoholic cirrhosis patients. Lactose intolerance was significantly higher in both the groups as compared to control group. Conclusion: This study indicates that lactose intolerance was significantly higher in cirrhotic patients. Conflict of Interest: None Impact of Diabetes Mellitus on the Clinical Outcome of Cirrhosis TM Ramachandran, AR Rajneesh, T Varghese Additional Professor, DM Trainee and Presenting Author, Professor, Department of Gastroenterology, Government Medical College, Calicut, Kerala Objectives: To assess the impact of diabetes mellitus on the natural history, complication rate, hospital admission rate and mortality of cirrhotic patients. Methods: Cirrhotic patients admitted at a tertiary care institution during the period of July 2009 to January 2011 with and without diabetes mellitus were analyzed in a prospective comparative study. The clinical characteristics, various complication rates and hospital admission rates in patients who died as well as survived were analyzed. Pregnant women, Stage IV and V chronic kidney disease, hepatoma and other secondary causes of diabetes were excluded from the study. Results: Of the 199 cirrhotic patients, 106 (53.3%) were diabetic and 93 (46.7%) were non-diabetic. Average age was 57.14 (diabetic) and 53.7 (non-diabetic) years. Mean CTP score was 10 in both groups. Average duration of cirrhosis was 19 months in both groups. Diabetics had a higher prevalence of cryptogenic etiology (p value 0.013) and family history of diabetes (p 0.001). Presentation as acute on chronic liver failure was more in non-diabetic group (p 0.035). Mean albumin value was higher in diabetics (2.72 vs. 2.5; p value 0.017). Number of prior hospital admissions (mean 2.93 vs. 2.17) and number of decompensation episodes (mean 2.96 vs. 2.16) were higher in the diabetic group (p value 0.023). Prevalence of gallstones were common in diabetics (26.41%) compared to non-diabetics (5.37%) (p value 0.001). Frequency of urinary tract infection was higher in the diabetic group (37.7%) vs. non-diabetics (5.3%) (p value 0.001). Frequency of spontaneous bacterial peritonitis was 19.8% (diabetic) and 23.63% (non-diabetics) (p value NS). Frequencies of other infections (pneumonia, tuberculosis, cellulitis, abscess) were also higher in diabetics than non-diabetics. Conclusion: Age, cryptogenic etiology, number of decompensation episodes, number of hospital admissions, serum albumin and gallstones were more in the diabetic group. Urinary tract infection was more common among diabetics whereas spontaneous bacterial peritonitis was present in both groups. Conflict of Interest: None 03_JCEH-Abstract.indd 20 3/18/2011 11:13:04 AM

W05-03 - A Multi-Centre Pragmatic Trial of Antipsychotic Drug Treatment

The ELAN study is a prospective multi centre observational trial on the effectiveness and safety of long-term antipsychotic treatment of people with schizophrenia or schizoaffective disorders with quetiapine in comparison to olanzapine and risperidone under real world treatment conditions.374 adult persons with schizophrenia or schizoaffective disorder prescribed antipsychotic maintenance therapy with quetiapine, olanzapine or risperidone were included at discharge from inpatient treatment. Psychotropic regimen, psychopathological symptoms, general and cognitive functioning, negative side-effects and quality of life were assessed before discharge and at 6, 12, 18 and 24 month follow-up assessments. Intention-to-treat analyses and crossover analyses were conducted by mixed-effects regression models including random linear time effects and time x treatment effects, controlling for baseline differences and additional psychotropic medication and using propensity scores to control for selection bias.As indicated by significant linear time effects the patients improved with regard to psychopathological symptoms, general functioning, subjective quality of life and cognitive processing speed. No change of extrapyramidal motor side-effects, body mass index or waist circumference was obtained. The lack of any significant time x treatment interaction effects indicated no differences in the safety or effectiveness between the three antipsychotics. Nevertheless, the average hospital admission rate of patients receiving olanzapine was lower in comparison to patients receiving quetiapine or risperidone.

Intensive care management of patients with haematological malignancy

Serious complications are common among patients admitted to hospital with a diagnosis of haematological malignancy, with one British study of 1437 admissions identifying 7% as being complicated by an episode of critical illness. Although most of these episodes did not result in admission to intensive care unit (ICU), an increasing number of patients with a diagnosis of haematological malignancy are being managed within ICU or are receiving critical care input. Complication rates are higher for posthaematopoietic stem cell transplant (HSCT) patients with a recent abstract revealing an overall ICU admission rate for transplant patients of 13.6% among 1671 British patients over a 10 yr period. ICU admission for patients with haematological malignancies, and particularly after bone marrow transplantation, has been associated with very poor outcomes, and in some cases, critical care has been withheld because it was perceived to be futile. Newer studies suggest that ICU outcomes have improved, probably as a result of changes in both haematological treatments and ICU care. Patients with haematological malignancy may develop critical illness either as part of their first presentation with the malignancy or more commonly after chemotherapy or HSCT. Some presentations are specific to each scenario, whereas others may occur in all groups of patients. Respiratory failure is present in approximately half of all referrals to ICU. Between 10% and 50% of the patients have signs of shock, and there is evidence of multiple organ failure in about onefifth. Other causes for admission include neurological failure, gastrointestinal (GI) bleeding, renal failure, and metabolic derangement.