Common Reason For Hospitalization Research Articles

Cognitive behavioral therapy in patients with sickle cell disease.

Sickle cell disease (SCD) is an inherited autosomal recessive disorder. In the United States, most individuals with SCD are African Americans, withan incidence of 1 in 400 to 1 in 500 live births. SCD is a lifelong disorder with no known cure. SCD causes anemia, frequent painful episodes, and reduced life ex- pectancy. The most disturbing clinical problem associated with SCD is severe pain episodes, the most common reason for hospitalization. Pharmacological interventions have been the mainstream for treatment; however, psychological interventions such as cognitive behavioral therapy (CBT) may complement current medical treatment, lead- ing to better coping and overall improved quality of life. In a quasi-experimental one-group pretest-posttest study, 9 African American individuals with SCD completed 3 weekly educational sessions learning CBT methods. Participants demonstrated increased frequency of use of CBT methods post-intervention, including diverting attention, coping self-statements, and behavioral activities, leading to better pain control. However, quality of life and role limitation did not show significant improvement. CBT may be beneficial to those suffering from SCD when combined with conventional treatment options; however, there are still barriers to incorporating psychological interventions into practice. CBT shows promise for individuals with chronic conditions such as SCD, but more investigation into its efficacy is needed with larger sample sizes over longer periods of time.

Seasonal influence on the renal function in hospitalized elderly patients

BackgroundElderly adults are more vulnerable to heat-induced illness because of dysfunctional thermoregulatory mechanisms, chronic dehydration, medications, and diseases involving the systems that regulate body temperature. We hypothesized that extensive loss of fluids in a hot and dry climate in the summer months may lead to impaired renal function in elderly patients. The aim of the study was to determine the impact of the season of admission on renal function and the development of acute kidney injury in elderly patients. MethodsA retrospective observational cohort study on all patients older than 65 with creatinine level≤2.0mg/dL who were hospitalized twice (in the summer and in winter) in 2010–2011. The outcome was incidence of acute kidney injury. ResultsThe study cohort included 1107 consecutive patients hospitalized in the summer and in the winter months. The biochemical parameters of impaired renal function were more prominent in the summer as compared to the winter months in the whole cohort of patients and especially in patients with hypertension, diabetes mellitus and heart failure, and in patients treated with thiazide diuretics, ACE-inhibitors and ARBs. The most common reason for hospitalization in patients developing AKI in the summer was febrile disease and sepsis and in the winter heart, failure. ConclusionsExtensive fluids loss in a hot and dry climate in the summer months leads to mild impaired renal function in elderly patients. However, this influence is not clinically significant probably due to compensatory mechanisms for the preservation of renal function.

Infections of Diabetic Foot Ulcers With Methicillin-Resistant Staphylococcus aureus

Infected diabetic foot is the most common reason for hospitalization and complications in patients with type 2 diabetes mellitus (DM2). Methicillin-resistant Staphylococcus aureus (MRSA) is frequently isolated from such lesions, and its presence is growing, seriously deteriorating the infected patient's quality of life. The aim of this study was to assess the prevalence of MRSA as well as other microbiota in 100 patients diagnosed with (DM2) and with infected foot ulcers at the Hospital General de Mexico. The main results obtained show a prevalence of Staphylococcus aureus (42%), followed by Escherichia coli (36%) and, in lower percentages, other bacteria. MRSA was predominant (34%), and we conclude that the use of cefoxitin instead of oxacillin as the first-choice antibiotic has an advantage because it is a better inducer of methicillin-resistance expression.

Endoscopic management of nonvariceal upper gastrointestinal bleeding: state of the art.

Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common reasons for hospitalization and a major cause of morbidity and mortality worldwide. Recently developed endoscopic devices and supporting apparatuses can achieve endoscopic hemostasis with greater safety and efficiency. With these advancements in technology and technique, gastroenterologists should have no concerns regarding the management of acute upper GI bleeding, provided that they are well prepared and trained. However, when endoscopic hemostasis fails, endoscopy should not be continued. Rather, endoscopists should refer patients to radiologists and surgeons without any delay for evaluation regarding the appropriateness of emergency interventional radiology or surgery.

Relationship between adductor pollicis muscle thickness and subjective global assessment in a cardiac intensive care unit.

Objective To verify the relationship between the adductor pollicis muscle thickness test and the subjective global assessment and to correlate it with other anthropometric methods.Methods This observational cross-sectional study was conducted in the intensive care unit of a cardiology hospital in the state of Rio Grande do Sul, Brazil. The hospitalized patients underwent subjective global assessment and adductor pollicis muscle thickness tests on both hands, along with measurement of the right calf circumference. Laboratory parameters, length of stay, vital signs and electronic medical record data and tests were all collected.Results The study population included 83 patients, of whom 62% were men. The average age was 68.6 ± 12.5 years. The most common reason for hospitalization was acute myocardial infarction (34.9%), and the most common pathology was systolic blood pressure (63.9%), followed by diabetes mellitus (28.9%). According to subjective global assessment classifications, 62.7% of patients presented no nutritional risk, 20.5% were moderately malnourished and 16.9% were severely malnourished. Women had a higher nutritional risk, according to both the subjective global assessment and the adductor pollicis muscle thickness test, the cutoff for which was < 6.5mm (54.8%; p = 0.001). The pathology presenting the greatest nutritional risk was congestive heart failure (p = 0.001). Evaluation of the receiver operating characteristic (ROC) curve between adductor pollicis muscle thickness and subjective global assessment showed the accuracy of the former, with an area of 0.822.Conclusion Adductor pollicis muscle thickness proved to be a good method for evaluating nutritional risk.

Multiple Myeloma Vaccination Patterns from a Large Health System: An Example of Cancer Care Delivery Research (CCDR)

BackgroundWe have a poor understanding of the vaccination immune response and outcomes in multiple myeloma (MM). As MM patients (Pts) are living longer and therapies are immunomodulatory there is an unmet medical need to further characterize the role of the immune system. A common reason for hospitalization or death in MM Pts is infection. As an initial step in MM Cancer Care Delivery Research (CCDR), we evaluated the current vaccination practice patterns in MM Pts at Aurora Health Care using the EMR and data analytics.MethodsAn IRB approved study reviewed MM Pts from 5/15/2012 to 5/15/2014. Data collected included demographics, influenza (FV) and pneumonia vaccination (PV) history, hospitalization episodes, cost associated with hospitalization, and admission and discharge diagnoses. Pts were considered PV positive if vaccinated within 5 years prior to study with any PV type. FV was none (no FV in 2012-2014), optimal [FV in 2012 and (2013 or 2014)], or suboptimal [FV in 2012 or (2013 or 2014)]. Data was analyzed using SAS and STATA 12.ResultsA total of 1131 MM Pts were identified. Race included 70% white, 13% black, and 17% mixed, other or information not available. MM median age at diagnosis was 71 and only 4% (47) had prior autologous stem cell transplantation. PV rate was 30%. FV was 55% none, 24% suboptimal and 20% optimal. There was no statistically significant difference in the rate of PV and FV when stratified vs age, gender, and race. Over two years there were a total of 662 hospitalization events involving 317 MM Pts. The total cost of hospitalization was approx $35M. The average charge per hospitalized patient was $110K (range: $2K -1.3M) with an average $52K per hospitalization encounter (range: 2K – 648K). The rate of PV and FV vaccination among Pts with index hospitalization is significantly higher than non-hospitalized patients. There was no difference in hospitalization cost based on vaccination status. (See Table 1)DiscussionVaccination rates were low and did not correlate with hospital outcomes. This may be explained as a limitation for a retrospective EMR analysis without accounting for temporal relationship of vaccines – i.e. possible vaccination after admission. Alternatively, this may indicate that our current methods of vaccination in MM are not effective. Other limitations include need for a more granular review of treatment regimens and infectious complications. Additional surrogate markers are needed to understand the effect of vaccines and the immune system on health care outcomes such as hospitalizations, cost, and survival. This will be addressed in prospective registries and immunologic studies at our center and may be queried at other health systems.Table 1 –Vaccination Status and HospitalizationsVaccination Status%Hospitalization Events, %Hospitalization Charge, $PV – No70%20%$16MPV – Yes30%52%$18MFV – None55%16%$9MFV – Suboptimal24%42%$13MFV - Optimal20%43%$12M DisclosuresNo relevant conflicts of interest to declare.

PO-0323 Audit On Care Of The Febrile Child

Background and objectives Feverish illness in children is a common reason for hospitalisation. Guidance has been issued by NICE as fever can be a diagnostic challenge. The aim of this audit was to determine if the NICE guideline was being adhered to within the Emergency Department and, if not, where improvement was needed. Methods This was a retrospective audit reviewing the charts for all children under five years of age attending the Emergency Department within a one month period. These charts were selected using the audit function of the ‘Symphony’ system. A total of 50 charts were included in the audit. Pyrexia was defined as temperature greater than 37.8 Results 70% were assessed out of hours. 62% had a fever for 62% failed to complete a traffic light category for the child. Only 30% mentioned hydration status. Only 6% assessed for lymphadenopathy. Only 6% documented joint examination. Of those children only reviewed by junior medical staff 44% sought advice from senior colleagues. 66% of children were admitt.ed to the hospital. 70% of those discharged from the Emergency department were given a safety net in terms of when to return to hospital. 98% of children discharged from the Emergency department did not return within the following week. Conclusion Increased awareness of the NICE guidelines will help improve documentation and ensure that disease specific clinical signs are considered and diagnostic uncertainty is minimised. All cases should be discussed with senior colleagues.

PO-0839 Capnography In Patients With Severe Neurological Impairment

<h3>Background</h3> Respiratory disease is a common reason for hospitalisation and mortality in persons with severe intellectual and developmental disability. Assessment of acute respiratory decompensation and differentiating it from chronic pathology is a frequently encountered challenge. Partial pressure of CO2 is commonly used as an aid in this setting. <h3>Aim</h3> To evaluate baseline end tidal CO2 (EtCO2) levels using non-invasive side stream capnometry and to identify factors correlated with higher capnometry readings in this patient population. <h3>Methods</h3> This was a prospective, case controlled, cross sectional study to assess differences of baseline EtCO2 values between neurologically impaired patients and healthy individuals. Patient’s demographic and clinical data were recorded. Variables correlating with higher EtCO2 readings and those that may predict clinically meaningful difference among neurologically impaired patients were evaluated. <h3>Results</h3> Seventy eight patients and 53 healthy individuals were included. The mean (±SD) EtCO2 values were higher for neurologically impaired patients as compared to healthy individuals (39.14 ± 3.59 and 37.11 ± 1.88 mmHg respectively; p &lt; 0.0001), and highest among patients using antipsychotic medications (41.53 ± 5.257 mmHg). Kyphoscoliosis and the use of antipsychotic drugs were the major factors to increase EtCO² levels. <h3>Conclusion</h3> Knowing the patient’s baseline EtCO2 value, as well as baseline oximetry, could guide treatment decisions, when assessing the patient’s oxygenation and ventilation during acute respiratory illness. Future research can shed light on the utility of capnometry and clinical implications of higher baseline EtCO² values among neurologically impaired patients.

Symptom Burden in Patients Hospitalized for Decompensated Heart Failure

Heart failure (HF) is one of the most common reasons for hospitalization and the leading cause of 30-day readmissions. There is great interest in developing strategies to reduce hospital utilization in this large and growing patient population. Aside from classic HF symptoms of dyspnea and fatigue, other symptoms reported include decreased appetite, pain and anxiety. These symptoms may be amenable to treatment and patients hospitalized with HF may benefit from intensive symptom management in the form of palliative care.

Hospitalizations of adults with intellectual disability in academic medical centers.

Individuals with intellectual disability (ID) represent a small but important group of hospitalized patients who often have complex health care needs. Individuals with ID experience high rates of hospitalization for ambulatory-sensitive conditions and high rates of hospitalizations in general, even when in formal community care systems; however, no research was found on the common reasons for which this population is hospitalized. Academic medical centers often treat the most complex patients, and data from these centers can provide insight into the needs of patient populations with complex needs. The purpose of this study was to analyze descriptive data from the UHC (formerly known as the University Healthsystem Consortium; an alliance of 115 U.S. academic medical centers and 300 of their affiliated hospitals) regarding common reasons for hospitalization, need for intensive care, and common hospitalization outcome measures of length of stay and complications for adult (age ≥ 18) patients with ID. Findings indicate the need for specific attention to the needs of hospitalized patients with ID.

G91 US National Perspective on Hospitalisations of Children with Pre-existing Tracheostomy

Aims(1) To describe the reasons, duration, and cost of hospitalisations in children with pre-existing tracheostomy, (2) to assess how many of these hospitalisations might be avoidable.MethodsThis is a retrospective cohort...

Capnography in patients with severe neurological impairment

Respiratory disease is a common reason for hospitalization and mortality in persons with severe intellectual and developmental disability. Capnography is the measurement and numerical display of end-tidal carbon dioxide (EtCO2). This was a prospective, case controlled, cross sectional study to assess differences of baseline EtCO2 values between neurologically impaired patients and healthy individuals. 86 neurologically impaired patients were evaluated in the study group. Their mean age ± SD was 25.65 ± 10.48 years with 41% males. 53 healthy children and young adults were evaluated in the control group. Their mean age ± SD was 21.95 ± 10.38 years with 54.7% males. Patients with severe neurological impairment had higher baseline EtCO2 values than healthy individuals. Kyphoscoliosis and the use of antipsychotic drugs were the major factors to increase EtCO2 levels. Knowing the patient's baseline EtCO2 value, as well as baseline oximetry, could guide treatment decisions, when assessing the patient's oxygenation and ventilation during acute respiratory illness, and can potentially prevent unnecessary laboratory and imaging investigations as well as over treatment. Future research can shed light on the utility of capnometry and clinical implications of higher baseline EtCO2 values among neurologically impaired patients.

Aging causes a slowing in ciliary beat frequency, mediated by PKCε

The elderly are at much higher risk for developing pneumonia than younger individuals. Pneumonia is a leading cause of death and is the third most common reason for hospitalization in the elderly. One reason that elderly people may be more susceptible to pneumonia is a breakdown in the lung's first line of defense, mucociliary clearance. Cilia beat in a coordinated manner to propel out invading microorganisms and particles. Ciliary beat frequency (CBF) is known to slow with aging, however, little is known about the mechanism(s) involved. We compared the CBF in BALB/c and C57BL/6 mice aged 2, 12, and 24 mo and found that CBF diminishes with age. Cilia in the mice at age 12 and 24 mo retained their ability to be stimulated by the β2 agonist procaterol. To help determine the mechanism of ciliary slowing, we measured protein kinase C alpha and epsilon (PKCα and PKCε) activity. There were no activity differences in PKCα between the mice aged 2, 12, or 24 mo. However, we demonstrated a significantly higher PKCε activity in the mice at 12 and 24 mo than the in the mice 2 mo of age. The increase in activity is likely due to a nearly threefold increase in PKCε protein in the lung during aging. To strengthen the connection between activation of PKCε and ciliary slowing, we treated tracheas of mice at 2 mo with the PKCε agonist 8-[2-(2-pentylcyclopropylmethyl)-cyclopropyl]-octanoic acid (DCP-LA). We noted a similar decrease in baseline CBF, and the cilia remained sensitive to stimulation with β2 agonists. The mechanisms for the slowing of baseline CBF have not been previously determined. In this mouse model of aging we were able to show that decreases in CBF are related to an increase in PKCε activity.

Illness in Travelers Returned From Brazil: The GeoSentinel Experience and Implications for the 2014 FIFA World Cup and the 2016 Summer Olympics

Brazil will host the 2014 FIFA World Cup and the 2016 Olympic and Paralympic Games, events that are expected to attract hundreds of thousands of international travelers. Travelers to Brazil will encounter locally endemic infections as well as mass event-specific risks. We describe 1586 ill returned travelers who had visited Brazil and were seen at a GeoSentinel Clinic from July 1997 through May 2013. The most common travel-related illnesses were dermatologic conditions (40%), diarrheal syndromes (25%), and febrile systemic illness (19%). The most common specific dermatologic diagnoses were cutaneous larva migrans, myiasis, and tungiasis. Dengue and malaria, predominantly Plasmodium vivax, were the most frequently identified specific causes of fever and the most common reasons for hospitalization after travel. Dengue fever diagnoses displayed marked seasonality, although cases were seen throughout the year. Among the 28 ill returned travelers with human immunodeficiency virus (HIV) infection, 11 had newly diagnosed asymptomatic infection and 9 had acute symptomatic HIV. Our analysis primarily identified infectious diseases among travelers to Brazil. Knowledge of illness in travelers returning from Brazil can assist clinicians to advise prospective travelers and guide pretravel preparation, including itinerary-tailored advice, vaccines, and chemoprophylaxis; it can also help to focus posttravel evaluation of ill returned travelers. Travelers planning to attend mass events will encounter other risks that are not captured in our surveillance network.

Birth Volume and the Quality of Obstetric Care in Rural Hospitals

Childbirth is the most common reason for hospitalization in the United States. Assessing obstetric care quality is critically important for patients, clinicians, and hospitals in rural areas. The study used hospital discharge data from the Statewide Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, for 9 states (Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin) to identify all births in rural hospitals with 10 or more births/year in 2002 (N = 94,356) and 2010 (N = 103,880). Multivariate logistic regression was used to assess the relationship between hospital annual birth volume, measured as low (10-110), medium (111-240), medium-high (241-460) or high (>460), and 3 measures of obstetric care quality (low-risk cesarean rates for term, vertex, and singleton pregnancies with no prior cesarean; nonindicated cesarean; and nonindicated induction) and 2 patient safety measures (episiotomy and perineal laceration). The odds of low-risk and nonindicated cesarean were lower in medium-high and high-volume rural hospitals compared with low-volume hospitals after controlling for maternal demographic and clinical factors. In low-volume hospitals, odds of labor induction without medical indication were higher than in medium-volume hospitals, but not significantly different from medium-high or high-volume hospitals. Odds of episiotomy were greater in medium-high or high-volume hospitals than in low-volume hospitals. The likelihood of perineal laceration did not differ significantly by birth volume. Obstetric quality and safety outcomes vary significantly across rural hospitals by birth volume. Better performance is not consistently associated with either lower or higher volume facilities.

Quality Improvement in Hospital Management of Community-Acquired Pneumonia: Focus on New Strategies and Current Challenges

Community-acquired pneumonia is a common reason for hospitalization and leads to significant morbidity and mortality. There are published evidence-based guidelines for the diagnosis, treatment, and management of community-acquired pneumonia. Many countries, including the US, have developed national, publically reported quality measures related to the treatment of community-acquired pneumonia. This review highlights recent published innovations aimed at improving the quality of care for patients hospitalized for community-acquired pneumonia. Interventions include standardized protocols and pathways, education and feedback from antimicrobial stewardship teams, and automated pharmacy technology. The importance of multidisciplinary collaboration and multidimensional interventions are discussed. Insight into local context and institutional support are essential to understanding the implementation of improvement efforts and these factors should be reported in future publications related to quality improvement.

Dental hospitalization trends in Western Australian children under the age of 15 years: a decade of population‐based study

This study analyzed a decade of dental admission patterns in Western Australian children under the age of 15years, examining associations with sociodemographic characteristics and with particular focus on dental decay and Indigenous children. This retrospective study analyzed the data obtained for 43,937 child patients under the age of 15years hospitalized for an oral-health-related condition, as determined by principal diagnosis (ICD-10AM). Primary place of residency, age, gender, insurance status and Indigenous status were also analyzed. 'Dental caries' and 'embedded and impacted teeth' were the most common reasons for hospitalization among children under the age of 15years. 'Dental caries' were most common in non-Indigenous patients, with 'pulp and periapical' most prevalent in Indigenous patients. The age-standardized rate (ASR) of hospitalization for Indigenous children in the last decade increased to reach that of non-Indigenous children in 2009. Total DRG costs of hospitalization, both public and private, were in excess of AUS $92million over 10years. This study indicates the burden of oral-health-related conditions on Western Australian children and the hospital system, in terms of health and economical impact.

Helical tomotherapy with concurrent chemotherapy in the treatment of anal canal carcinoma: A review of clinical outcomes at a tertiary referral center.

656 Background: We report the clinical outcomes of patients with anal carcinoma treated with helical tomotherapy (HT) IMRT and concurrent chemotherapy. Methods: From September 2005 to January 2013, 32 patients with squamous cell carcinoma of the anal canal received chemoradiation with HT planned in a consistent manner in parallel to the RTOG 0529 guidelines. Of the patients, 17 (53%) were T1-2, 13 (41%) were T3-T4, 15 (47%) were node positive, and 1 was M1 with para-aortic nodal metastases. There were 7 HIV positive and 3 renal transplant patients. All but 2 patients received 5-fluorouracil and mitomycin C. The median doses to the primary site, involved nodes, and uninvolved nodes were 54 Gy, 50.4 Gy, and 45 Gy, respectively. All acute and late toxicities were scored with the CTCAE v4.0. Results: Median follow-up was 31 months (range 10-97 months). Median length of treatment was 43 days. Twenty-two patients (69%) took a median of 3.5 break days. Acute grade 3-4 hematologic toxicity occurred in 27 patients (84%). There were no grade 4 gastrointestinal or dermatologic toxicities. Eight patients (25%) experienced grade 3 gastrointestinal and dermatologic toxicities. Twenty-one patients (66%) were hospitalized a total of 37 times during chemoradiation or within 90 days of therapy completion. Neutropenic fever was the most common reason for hospitalization, accounting for 30% of admissions. Thirty-one patients were followed for late toxicity with results as follows: 7 patients (23%) had grade 3 gastrointestinal toxicity, 1 patient (3%) had grade 3 dermatologic toxicity, and 3 patients (10%) had grade 3 sexual dysfunction. Nine patients (29%) developed pelvic insufficiency fractures, 5 requiring intervention. The 2-year progression-free and overall survivals were 97% and 97%, respectively. Two patients died; 1 from local progression and 1 from unrelated causes. Conclusions: HT delivering moderate radiation doses consistent with the RTOG 0529 guidelines and chemotherapy paired with aggressive, multidisciplinary management of acute and late toxicities effectively treat squamous cell carcinoma of the anal canal.

Factors affecting mortality in elderly patients hospitalized for nonmalignant reasons.

Elderly population is hospitalized more frequently than young people, and they suffer from more severe diseases that are difficult to diagnose and treat. The present study aimed to investigate the factors affecting mortality in elderly patients hospitalized for nonmalignant reasons. Demographic data, reason for hospitalization, comorbidities, duration of hospital stay, and results of routine blood testing at the time of first hospitalization were obtained from the hospital records of the patients, who were over 65 years of age and hospitalized primarily for nonmalignant reasons. The mean age of 1012 patients included in the study was 77.8 ± 7.6. The most common reason for hospitalization was diabetes mellitus (18.3%). Of the patients, 90.3% had at least a single comorbidity. Whilst 927 (91.6%) of the hospitalized patients were discharged, 85 (8.4%) died. Comparison of the characteristics of the discharged and dead groups revealed that the dead group was older and had higher rates of poor general status and comorbidity. Differences were observed between the discharged and dead groups in most of the laboratory parameters. Hypoalbuminemia, hypertriglyceridemia, hypopotassemia, hypernatremia, hyperuricemia, and high TSH level were the predictors of mortality. In order to meet the health necessities of the elderly population, it is necessary to well define the patient profiles and to identify the risk factors.

Arginine vasopressin as a target in the treatment of acute heart failure.

Congestive heart failure (CHF) is one of the most common reasons for hospitalization in the United States. Despite multiple different beneficial medications for the treatment of chronic CHF, there are no therapies with a demonstrated mortality benefit in the treatment of acute decompensated heart failure. In fact, studies of inotropes used in this setting have demonstrated more harm than good. Arginine vasopressin has been shown to be up regulated in CHF. When bound to the V1a and/or V2 receptors, vasopressin causes vasoconstriction, left ventricular remodeling and free water reabsorption. Recently, two drugs have been approved for use that antagonize these receptors. Studies thus far have indicated that these medications, while effective at aquaresis (free water removal), are safe and not associated with increased morbidity such as renal failure and arrhythmias. Both conivaptan and tolvaptan have been approved for the treatment of euvolemic and hypervolemic hyponatremia. We review the results of these studies in patients with heart failure.