Community General Hospital Research Articles

Prevalence of transthyretin amyloid cardiomyopathy in patients hospitalised for heart failure with preserved ejection fraction in an LATAM center

Abstract Introduction Transthyretin Amyloid cardiomyopathy (ATTR-CM) usually presents as heart failure with preserved ejection fraction (HFpEF). Its diagnosis has a significant clinical impact, as specific treatment is currently available. Purpose To assess the prevalence of ATTR-CM in patients hospitalised for HFpEF and increased septal thickness in our institution of general community hospital in Latin America (LATAM). Methods Cross-sectional study. Patients hospitalised for HFpEF (>50%) and septal thickness ≥ 12 mm during the period from 8/2019 to 1/2023 were prospectively included. Patients with pacemaker, significant left valve disease and end-stage renal failure (creatinine clearance < 30 ml/min/BSA) were excluded. A pyrophosphate bone scintigraphy (PYP) was planned to be performed in order to assess ATTR-CM. The prevalence of ATTR-CM and its 95% confidence interval were calculated. Results A PYP was performed in 59/82 patients hospitalised for HFpEF. Median age was 85 [IQR 78-88] years, and 54% were women. At admission, 61% (n=36) had atrial fibrillation and the median NT Pro-Bnp was 3536 [1700-7748] pg/mL. The mean left ventricle ejection fraction was 57% (+/- 5%). The prevalence of ATTR-CM diagnosed by PYP was 19% (95% CI 9.7-30.1, n=11). There were no significant clinical differences between patients who performed a PYP and did not. Patients with ATTR-CM had lower blood pressure and higher septal thickness, NT Pro-Bnp and troponin levels compared to patients without ATTR-CM (TABLE). Conclusion In patients admitted for HFpEF and increased septal thickness, the diagnosis of ATTR-CM was relatively common (one of five had ATTR-CM) in our region (LATAM). We believe that systemic assessment with PYP should be performed in patients hospitalised with HFpEF and increased wall thickness.

The Respiratory Adjusted Shock Index at Admission Is a Valuable Predictor of In-Hospital Outcomes for Elderly Emergency Patients with Medical Diseases at a Japanese Community General Hospital.

Background: The respiratory adjusted shock index (RASI) is a risk score whose usefulness in patients with sepsis and trauma has previously been reported. However, its relevance in elderly emergency patients with medical diseases is yet to be clarified. This study assessed the usefulness of the RASI, which can be evaluated without requiring special equipment, to provide objective and rapid emergency responses. Methods: In this retrospective study, we recruited patients with medical diseases, aged 65 years or older, who were transported to the emergency room from Tokushima Prefectural Kaifu Hospital and underwent arterial blood gas testing from 1 January 2022 to 31 December 2023. We investigated the association of the RASI with other indices, including the lactate level, National Early Warning Score 2 (NEWS2), Shock Index (SI), Sequential Organ Failure Assessment (SOFA) score, quick SOFA (qSOFA) score, and systemic inflammatory response syndrome (SIRS). Results: In this study, we included 260 patients (mean age, 86 years), of whom 234 were admitted to the hospital; 27 and 49 patients died within 7 and 30 days of admission, respectively. The RASI was positively correlated with the lactate level, NEWS2, SI, and increase in the SOFA score (p < 0.001). The RASI was higher in patients with a SIRS or qSOFA score ≥ 2 than in those without (p < 0.001). It predicted death within 7 and 30 days of admission with an area under the curve (AUC) of 0.80 (95% confidence interval [CI]: 0.73-0.87), sensitivity of 96.3%, and specificity of 53.6% when the cutoff value was set to 1.58 and with an AUC of 0.73 (95% CI: 0.66-0.81), sensitivity of 69.4%, and specificity of 70.6% when the cutoff value was set to 1.83, respectively. Conclusions: The RASI is a simple indicator that can be used for predicting in-hospital outcomes in elderly emergency patients with medical diseases. Larger prospective studies based on this study are needed.

Tranexamic acid versus oxytocin prophylaxis in reducing post-partum blood loss, in low-risk pregnant women: TRANOXY STUDY, a phase III randomized clinical trial

To assess the equivalence of tranexamic acid (TRAN) versus synthetic oxytocin (OXY) in reducing post-partum blood loss, in full-term patients (37-42 weeks), at low risk of post-partum hemorrhage, with vaginal childbirth. Phase III, randomized (1:1), open-label, longitudinal, multi-center, prospective clinical trial (Prot. n 63209, ClinicalTrials.gov Identifier: NCT02775773). From January 7, 2020, to June 30, 2023, a total of 256 women were enrolled at two general urban community hospitals in Italy, serving a multi-ethnic patient population with National Health Insurance. The primary outcome was to explore a potential equivalence between the two treatments (OXY and TRAN) in preventing total blood loss. Therefore, we randomized 231 women into two groups: Group A (OXY), 127 women who were administered 10UI intramuscularly within 5min from childbirth; Group B (TRAN), 104 women to whom 1-g slow intravenous infusion was administered within 5min from childbirth. At the time of delivery, mean blood loss for OXY group versus TRAN group was 269.12mL versus 263.88mL, respectively, with equivalence between the two groups. Similarly, there was equivalence in total blood loss between the OXY and the TRAN group (397.66mL versus 405.64mL, respectively. No statistical differences between Hb levels at admission and discharge in the two groups were reported. No difference was found in terms of additional uterotonic and surgical therapies between the two groups of patients. Neither group showed thrombotic complications at check-up performed after 7 days or after a questionnaire regarding adverse effects, subjected after 40 days. The study shows the equivalence of tranexamic acid versus synthetic oxytocin in post-partum blood loss prophylaxis in term patients at low risk of PPH with vaginal childbirth. The safety profiles of OXY and TRAN were similar. None.

Usefulness of Palliative Prognostic Index, Objective Prognostic Score, and Neutrophil-Lymphocyte Ratio/Albumin Ratio As Prognostic Indicators for Patients Without Cancer Receiving Home-Visit Palliative Care: A Pilot Study at a Community General Hospital.

Although the palliative prognostic index (PPI), objective prognostic score (OPS), and neutrophil-lymphocyte ratio/albumin ratio (NLR/Alb) are well-known prognostic indicators for cancer patients, they do not provide clarity when it comes to predicting prognosis in patients without cancer who receive home-visit palliative care. The aim of this study was to determine whether PPI, OPS, and NLR/Alb can predict prognosis for patients without cancer who received home-visit palliative care. This is a retrospective study. We recruited 58 patients without cancer who received home-visit palliative care from Tokushima Prefectural Kaifu Hospital, Japan, and died at home or at the hospital within seven days of admission between January 2009 and March 2023. The PPI, OPS, and NLR/Alb of the study patients were evaluated at regular intervals, and statistical analysis was performed on the relationship between these indices and the time to death. Simple regression analysis showed that PPI, OPS, and NLR/Alb were negatively correlated with the period until death (p < 0.001). The survival curves of the groups classified according to PPI, OPS, and NLR/Alb were significantly stratified. The predictive capacities of PPI, OPS, and NLR/Alb for death within 21 days were as follows: PPI (area under the curve [AUC]: 0.71; sensitivity: 59%; specificity: 68%), OPS (AUC: 0.73; sensitivity: 88%; specificity: 47%), and NLR/Alb (AUC: 0.72; sensitivity: 72%; specificity: 73%). PPI, OPS, and NLR/Alb were useful in predicting the survival period and short-term prognosis within 21 days for patients without cancer who received home-visit palliative care.

Causes of In-Hospital Death and Pharmaceutical Associations with Age of Death during a 10-Year Period (2011-2020) in Individuals with and without Diabetes at a Japanese Community General Hospital.

Since diabetes and its complications have been thought to exaggerate cardiorenal disease, resulting in a short lifespan, we investigated causes of death and lifespans in individuals with and without diabetes at a Japanese community general hospital during the period from 2011 to 2020. Causes of death and age of death in individuals with and those without diabetes were compared, and associations between medications used and age of death were statistically analyzed. A total of 2326 deaths were recorded during the 10-year period. There was no significant difference between the mean ages of death in individuals with and those without diabetes. Diabetic individuals had higher rates of hepato-pancreatic cancer and cardio-renal failure as causes of death. The prescription rates of antihypertensives, antiplatelets, and statins in diabetic individuals were larger than those in non-diabetic individuals. Furthermore, the use of sulfonyl urea or glinides and insulin was independently and inversely associated with the age of death. In conclusion, individuals with diabetes were treated with comprehensive pharmaceutical interventions and had life spans comparable to those of individuals without diabetes. This study's discovery of an inverse relationship between the use of insulin secretagogues or insulin and the age of death suggests that the prevention of life-threatening hypoglycemia is crucial for individuals with diabetes.

Application of multi-disciplinary team nursing model enhances recovery after surgery for total hip arthroplasty and total knee arthroplasty.

To explore the effect of a multidisciplinary team (MDT) nursing model based on enhanced recovery after surgery (ERAS) in total hip arthroplasty (THA)/total knee arthroplasty (TKA) and evaluate its application in the perioperative period of patients. A retrospective analysis was conducted on 100 patients with THA/TKA treated at Shaoxing Second Hospital Medical Community General Hospital from January 2021 to December 2023. The patients were divided into an observation group (n = 50) and a control group (n = 50) based on the nursing method employed. The control group received traditional perioperative nursing, while the observation group received an MDT nursing model intervention based on the ERAS concept. Visual analogue scale (VAS) scores were recorded at 6, 24, and 72 hours post-surgery. Additionally, postoperative activities, hospitalization duration, and postoperative complications were documented. Differences in knee joint range of motion (ROM), hip Harris score, psychological stress response score, and quality of life score between the two groups before and one month after surgery were analyzed. At 6, 24, and 72 hours post-surgery, patients in the observation group had significantly lower VAS scores compared to those in the control group (all P < 0.05). The observation group had an earlier first-time mobilization (P < 0.05). The length of hospitalization and hospitalization cost were significantly lower in the observation group than in the control group (both P < 0.05). The incidence rates of postoperative adverse reactions were 22.00% in the control group and 6.00% in the observation group (P < 0.05). One month post-surgery, the observation group showed significantly greater ROM, lower psychological stress and reaction scores, and higher Harris score and quality of life score compared to the control group (all P < 0.05). The MDT nursing model based on ERAS concept for THA/TKA perioperative patients effectively alleviates postoperative pain, promotes early activity, shortens hospital stay, reduces hospital cost, decreases the incidence of complications, restores joint function, enhances quality of life, and reduces psychological stress.

Abstract 16845: Heart Failure Hospitalist Service Line Have Decrease All Cause Readmission, Length of Stay and Cost at 3 UPMC Hospitals in Central Pennsylvania in 2022

Introduction: Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days. Methods: Patients with both primary diagnosis HF at UPMC Harrisburg/West Shore/Community General totaled to 1574 in 2022. Hospitalist, Cardiologist, teaching service N= 547 (36%); CHF hospitalist Team N=1027 (64%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups for 2022. Results: All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all other providers (Hospitalist, Cardiologist, teaching service) is 32%. HF Hospitalist team at 3 UPMC hospitals had lower 30 day all cause readmission rates: 8.46%. All other providers length of stay was 7.7 days while length of stay while on HF hospitalist service was 6.3 days. Potential cost savings to UPMC hospitals greater than $2.3 million dollars since start of HF Hospitalist service line. Conclusions: HF patients rarely have a consistent provider when readmitted. To address this health care priority at a system level, UPMC Central Pennsylvania’s strategy of creating a HF hospitalist service line has shown to be a unique method to not only develop trusting relationships with our patients but also attain impressive results. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. At this community-based healthcare system, HF Hospitalist outcomes include decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 5yrs of the HF Hospitalist service line now at 3 hospitals at UPMC.

How Safety Culture Surveys Influence the Quality and Safety of Healthcare Organisations.

Objectives Safety culture surveys have been widely used in healthcare for more than two decades predominantly as a tool for measuring the level of safety culture (as defined as the beliefs and attitudes that staff express about how their organisation ought to work and how it does in fact work).However, there is the potential for the survey process itself to influence the safety culture and working practices in departments and organisations.The objective of this study was to identify the mechanism by which these changes might occur. Design, setting and participants Mixed methods combining qualitative semi-structured interviews and quantitative scores from patient safety surveys. This evaluation was conducted across general practice, community and acute hospitals in two NHS regions in England; South West and Greater Manchester. The study was undertaken between 2015 and 2018during the implementation of a series of Patient Safety Collaboratives. Safety, Communication, Operational Reliability, and Engagement (SCORE) surveys were administered in 15 units, followed by a staff debriefing and a second SCORE survey. Semi-structured interviews were conducted with clinicians (n=61). Results from the first and second surveys were compared in order to test for differences in responses. Sixty-one semi-structured interviews were conducted across participating units and thematically analysed. Analysis and results Results from the first and second surveys were compared using chi-squared and Fisher's exact tests. Sixty-one semi-structured interviews were conducted across participating units and thematically analysed. There was little change in responses between the first and second SCORE surveys.Within general practicethere was some improvement in responses in three survey domains; however, these differences were not conclusive. The qualitative interview data demonstrated a beneficial effect on safety culture. Staff stated that the survey debriefings created a new safe space where problems could be discussed and improvement plans created. Conclusions Safety culture surveys can improve safety culture within departments if they are followed by a process that includes debriefing the staff and working with them to develop improvement plans.

Impact of the multiplex molecular FilmArray Respiratory Panel on antibiotic prescription and clinical management of immunocompromised adults with suspected acute respiratory tract infections: A retrospective before–after study

This study aimed to assess the impact of the implementation of a rapid multiplex molecular FilmArray Respiratory Panel (FRP) on the medical management of immunocompromised patients from a community general hospital. We conducted a single-center, retrospective, and before–after study. Two periods were evaluated: before the implementation of the FRP (pre-FRP) from April 2017 to May 2018 and after the implementation of the FRP (post-FRP) from January to July 2019. The inclusion criteria were immunocompromised patients over 18 years of age with suspected acute respiratory illness tested by conventional diagnostic methods (pre-FRP) or the FilmArray™ Respiratory Panel v1.7 (post-FRP). A total of 142 patients were included, 64 patients in the pre-FRP and 78 patients in the post-FRP. The positive detection rate was significantly higher in the post-FRP (63% vs. 10%, p<0.01). There were more patients receiving antimicrobial treatment in the pre-FRP compared with the post-FRP period (94% vs. 68%, p<0.01). A decrease in beta-lactam (89% vs. 61%, p<0.01) and macrolide (44% vs. 13%, p<0.01) prescriptions were observed in the post-FRP. No differences were observed in oseltamivir use (22% vs. 13%, p=0.14), changes in antimicrobial treatment, hospital admission rate, days-reduction in droplet isolation precautions, hospital length of stay (LOS), admission to intensive care unit (ICU), LOS in ICU, treatment failure and 30-day mortality. The implementation of the FRP impacted patient care by improving diagnostic yield and optimizing antimicrobial treatment in immunocompromised adult patients.

Delayed Presentation and Referral Time from General Practitioners Contribute to Increased Complicated Appendicitis during the Initial COVID-19 Pandemic Period in Japan.

This study aims to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the situation of acute appendicitis (AA) with respect to patients' and general practitioners' behaviors in a general community hospital in Japan. The surgical outcomes and periods from symptom onset to medical presentation besides practitioners' referral time for consecutive AA patients were compared between the control (January 2016 to March 2020) and COVID-19 periods (April 2020 to April 2021). Eighty-three patients who underwent emergency surgery for AA were reviewed. Complicated appendicitis significantly increased in the COVID-19 period (63.6% vs. 31.2%, P = 0.023). In the COVID-19 period, the time from symptom onset to the medical presentation (2.2 vs. 0.9 days, P < 0.001) was significantly longer than in the control period. Among the patients who first presented to a general practitioner, the referral time from the practitioner to our hospital was significantly longer in the COVID-19 period (1.6 vs. 0.7 days, P = 0.017). Furthermore, among patients with a fever of higher than 38°C at medical presentation, the time from symptom onset to medical presentation was significantly longer in the COVID-19 period (3.0 vs. 0.7 days, P = 0.015). There was no difference in severe postoperative complications. Hesitation to seek surgical treatment for AA was seen in both the patients and practitioners in the COVID-19 period. The delay in surgical treatment presumably led to the increase in severe AA. In a pandemic era, timely care for emergent conditions is a crucial challenge.

A key exchange system for secure data coordination in healthcare systems

To explore the coordination problem of the “gatekeeper” medical system, a referral game model between general hospitals and community hospitals within the system was established. Two non-competitive and competitive systems methods were modeled. The optimal referral threshold strategy and contract form under the service payment contract cooperation model. The conclusion shows that reducing the service cost of unit personnel in the system can effectively improve the system utility. Introducing competition can reduce the referral rate and promote the first consultation in community hospitals. The service payment contracts of non-competitive and competitive systems under different scales are feasible to achieve system coordination. The coordination efficiency of small-scale settings in competitive strategies is higher than that of large-scale environments. In the design of medical systems, competition cannot be avoided. Existing, setting up multiple small competing hospitals can bring higher social efficiency.

PS-P07-5: PHARMACEUTICAL INFLUENCES ON IN-HOSPITAL DEATH IN PATIENTS WITH AND THOSE WITHOUT DIABETES AT A JAPANESE COMMUNITY GENERAL HOSPITAL

Background: Diabetes mellitus (DM) is associated with increased risks of cancers, cardiovascular disease (CVD), liver disease and death. In recent years, cardiovascular and metabolic medications have been developed for reducing cardiovascular events and mortality. We examined mortality statistics by cause of in-hospital death in patients with DM and patients without DM and we analyzed the effects of cardiovascular and metabolic medications on the lifespans of patients in a Japanese community general hospital during the past decade. Methods: We performed a retrospective analysis of cause of death in hospitalized patients at Anan Medical Center, a community general hospital in Tokushima, Japan, during the period from 2011 to 2020. Information on clinical characteristics of the patients including age at death, cause of death, complications and medications used was obtained from medical records. Statistical comparisons were performed in patients with DM and those without DM. Multivariate analysis was also carried out to determine the effects of medications on age at death. Results: A total of 2336 deaths were recorded during the 10-year period. The mean age at death was not significantly different between diabetic and nondiabetic patients for both sexes (78.9 (DM) vs. 79.6 (non DM) years in males and 82.5 (DM) vs. 83.6 (non DM) years in females). The rates of hepato-pancreatic cancer and cardio-renal failure as a cause of death were significantly higher in patients with DM than in patients without DM (p &lt; 0.01 and p &lt; 0.05, respectively). The incidences of hepato-renal failure, CVD, hypertension and dyslipidemia as comorbidities were significantly higher in diabetic patients than in nondiabetic patients (all p &lt; 0.01). The percentages of patients taking antihypertensive, antiplatelet, diuretic and statin medications were higher in diabetic patients than in nondiabetic patients (all p &lt; 0.01). Multivariate analysis of medications for determinants of age at death showed that insulin was a negative contributor in diabetic patients. On the other hand, the use of an angiotensin receptor blocker (ARB)/angiotensin-converting enzyme inhibitor (ACEi) or Ca antagonists was a positive correlator for longevity in all of the subjects including diabetic and nondiabetic patients. Conclusions: In our community general hospital, DM had no influence on age at death. It is possible that comprehensive treatment for DM and its complications eliminates the difference between lifespans of individuals with DM and those without DM. In addition, treatment of hypertension with ARB/ACEi or Ca antagonists was positively associated with the longevity of Japanese community subjects.

Australian hospital paediatricians and nurses' perspectives and practices for influenza vaccine delivery in children with medical comorbidities.

Influenza vaccination of children with medical comorbidities is critical due their increased risks for severe influenza disease. In Australia, hospitals are an avenue for influenza vaccine delivery to children with comorbidities but are not always effectively utilised. Qualitative enquiry sought to ascertainment the barriers and enablers for influenza vaccination recommendation, delivery, and recording of these children at Australian hospitals. Semi-structured interviews and discussion group sessions were conducted with paediatricians and nurses at four tertiary paediatric specialist hospitals and two general community hospitals in three Australian states. Transcripts from interviews and group sessions were inductively analysed for themes. The Capability, Opportunity, Motivation, and Behaviour (COM-B) model was used to explore the elements of each theme and identify potential interventions to increase influenza vaccination recommendation and delivery behaviours by providers. Fifteen discussion sessions with 28 paediatricians and 26 nurses, and nine in-depth interviews (five paediatricians and four nurses) were conducted. Two central thematic domains were identified: 1. The interaction between hospital staff and parents/patients for influenza vaccine recommendation, and 2. Vaccination delivery and recording in the hospital environment. Six themes across these domains emerged detailing the importance of dedicated immunisation services, hospital leadership, paediatricians' vaccine recommendation role, the impact of comorbidities, vaccination recording, and cocooning vaccinations. Supportive hospital leadership, engaged providers, and dedicated immunisation services were identified as essential for influenza vaccination of children with comorbidities in Australian hospital. Recommendation of influenza vaccination for Australian children with comorbidities is impacted by the beliefs of paediatricians and the perceived impact of influenza disease on children's comorbidities. Dedicated immunisation services and supportive hospital leadership were drivers for influenza vaccine delivery at hospitals. Future interventions targeting hospital-based influenza vaccine delivery for children with comorbidities should take a rounded approach targeting providers' attitudes, the hospital environment and leadership support.

The Revised Identification of Seniors At Risk screening tool predicts readmission in older hospitalized patients: a cohort study

BackgroundThe Identification of Seniors at Risk (ISAR) screening tool is a widely-used risk stratification tool for older adults in the emergency department (ED). Few studies have investigated the use of ISAR to predict outcomes of hospitalized patients. To improve usability a revised version of ISAR (ISAR-R), was developed in a quality improvement project. The ISAR-R is also widely used, although never formally validated. To address these two gaps in knowledge, we aimed to assess the ability of the ISAR-R to predict readmission in a cohort of older adults who were hospitalized (admitted from the ED) and discharged home.MethodsThis was a secondary analysis of data collected in a pre-post evaluation of a patient discharge education tool. Participants were patients aged 65 and older, admitted to hospital via the ED of two general community hospitals, and discharged home from the medical and geriatric units of these hospitals. Patients (or family caregivers for patients with mental or physical impairment) were recruited during their admission. The ISAR-R was administered as part of a short in-hospital interview. Providers were blinded to ISAR-R scores. Among patients discharged home, 90-day readmissions were extracted from hospital administrative data. The primary metrics of interest were sensitivity and negative predictive value. The Area Under the Curve (AUC) was also computed as an overall measure of performance.ResultsOf 711 attempted recruitments, 496 accepted, and ISAR-R was completed for 485. Of these 386 patients were discharged home with a complete ISAR-R, the 90-day readmission rate was 24.9%; the AUC was 0.63 (95% CI 0.57,0.69). Sensitivity and negative predictive value at the recommended cut-point of 2 + were 81% and 87%, respectively. Specificity was low (40%).ConclusionsThe ISAR-R tool is a potentially useful risk stratification tool to predict patients at increased risk of readmission. Its high values of sensitivity and negative predictive value at a cut-point of 2 + make it suitable for rapid screening of patients to identify those suitable for assessment by a clinical geriatric team, who can identify those with geriatric problems requiring further treatment, education, and follow-up to reduce the risk of readmission.

Abstract 14287: Development of an Innovated Heart Failure Hospitalist Program Drives Best Practice and Exceptional Outcomes From 2018-2021

Introduction: Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days. Hypothesis: The UPMC Hospitalist and Cardiology leadership recognized the need to foster consistent inpatient hospitalist providers, which was lacking in the current model. The concept of a dedicated Heart Failure Hospitalist service line emerged. Methods: Patients with both primary HF: UPMC Hospitalist, Cardiologist, teaching service N= 4192 (70%); CHF hospitalist Team N=1785 (30%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups from 2018-2021. Results: All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all providers is 21% from 2018-2021, matching the national average. HF Hospitalist team (only at Harrisburg Hospital) has consistently lower readmission rates: 9% (2018), 8.34% (2019), 8.6% (2020), 6.95% (2021). HF hospitalist length of stay was also consistently lower, by 0.5 to 0.9 days. Potential cost savings to UPMC hospitals is $1.5 million dollars since start of HF Hospitalist service line. Conclusions: Heart failure is a major health care issue. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. The HF Hospitalists provide quality care with frequent daily rounding, optimization of HF medications, providing education to the patient and family to improve treatment plan adherence, as well as engaging in early discussion of palliative and hospice transition. At this community-based healthcare system, HF Hospitalist outcomes include decreasing length of stay; decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 4yrs of the HF Hospitalist service line at UPMC.

Spatial accessibility of medical facilities based on green travel mode - Take the central urban area of Wuhan as an example

Based on the concept of “people-oriented”, this paper simulates the green travel mode of Wuhan residents in the main urban area by walking and public transportation (bus and rail) based on the public transportation network and walking network of Wuhan city, combined with the POI data of residential community points and medical public service facilities. ArcGIS network analysis technology was used to quantitatively analyze the spatial accessibility distribution characteristics and qualitatively analyze the problems of medical service facilities in the main city of Wuhan. The spatial accessibility distribution characteristics of the three types of medical service facilities (General hospital, Specialist hospital and community hospital) in Wuhan city were quantitatively and qualitatively analyzed. The conclusions are as follows: under the different green travel mode (walk, by bus or take the subway), the spatial accessibility of the three types of medical facilities in the central urban area of Wuhan is good. The areas with the spatial accessibility of the three types of medical facilities within 15min account for most of the central urban area of Wuhan. However, the spatial accessibility of the three types of medical facilities shows obvious imbalance in the spatial distribution characteristics. The spatial accessibility of three medical facilities in the west of Jianghan district, the north of Jiangan district, the east of Wuchang district and the middle of Hongshan district is poor. And the spatial accessibility in these areas is more than 15min. There are distinct differentiating characteristics in areas with good and bad spatial accessibility. Based on the above analysis results, suggestions and countermeasures are put forward to improve the spatial accessibility of medical public service facilities in the central city of Wuhan.

The State of Heart Failure Care in Canada: Minimal Improvement in Readmissions Over Time Despite an Increased Number of Evidence-Based Therapies

BackgroundAn unanswered question is whether the combination of advances in medical and device therapy over the past decade has translated into improved outcomes for patients with heart failure (HF) in Canada. MethodsThe Canadian Institute for Health Information (CIHI) Hospital Morbidity Database was used to identify hospitalizations for HF among patients aged 18 years and older in Canadian hospitals during fiscal years 2009/2010 and 2018/2019. We assessed interprovincial differences in age, sex, length of stay (LOS), discharge disposition, type of admitting hospital, and most responsible service, for all HF admissions. National and provincial rates of HF admissions and all-cause 30-day readmissions were calculated. ResultsAfter adjusting for age, the rate of HF admissions in Canada was 216 per 100,000 population in 2009/2010 and 2018/2019. The majority of patients with HF were admitted to general internal medicine and community hospitals in both 2009/2010 and 2018/2019. The national, crude, all-cause 30-day readmission rate stayed constant at 20.6%, and the majority of patients were readmitted with the diagnosis of HF in both 2009/2010 (62.5%) and 2018/2019 (59.0%). Median and interquartile range of HF LOS also remained unchanged at 7 days (3-14). ConclusionsThe national rate of HF admissions, 30-day readmissions, and HF LOS have remained unchanged from 2009/2010 to 2018/2019, despite advances in medical and device therapy during this timeframe.

William H. Swatos, Jr.

William H. (Bill) Swatos, Jr. passed away at the Community General Hospital Medical Center in Sterling, Illinois. He was 74 years old. The immediate cause of death was complications from COVID-19.Bill Swatos is familiar to readers of Nova Religio because of his work on the sociology of religion, and especially from his co-edited anthology on prophecy in new religious movements, How Prophecy Lives, with Diana G. Tumminia (2011). He was the first executive director of the Religious Research Association, an organization that he served in that capacity from 1994 to 2015. Overlapping that service were his efforts as executive officer of the Association for the Sociology of Religion (ASR) from 1996 until 2012. In these jobs, Bill handled a myriad of organizational duties. Few models preceded him in this work, and few then or now could exceed his standards for timeliness and efficiency.Professor Swatos received his bachelor’s degree in sociology with honors in 1966 from Transylvania University in Kentucky, and his M.A. (1969) and Ph.D. (1973) in the same subject from the University of Kentucky. Across five decades, often as a visiting professor, he taught sociology, philosophy, and religious studies — along with occasional courses in anthropology, geography, and speech — at a succession of institutions in Florida, Tennessee, and Illinois. In 1982, Bill received a Fulbright grant to perform research and to lecture on religion in Iceland.In addition to administering professional affairs through his management of scholarly associations, Bill Swatos’s working life combined three other simultaneous yet distinct careers: research and writing on the sociology of religion with a noticeable Weberian bent; shepherding sociological articles and books by others into print as an academic editor; and serving Christian believers as a member of the ordained ministry.In the first pursuit, Bill Swatos authored or co-authored eight books, compiled twenty-one anthologies alone or in collaborations, and contributed more than seventy articles and chapters to religious or sociological publishers. He was always careful in his edited volumes not only to feature the work of established figures, but also to encourage and cultivate the participation of rising younger scholars. As an editor, Bill helmed the official journal of the Association for the Sociology of Religion, Sociology of Religion (formerly Sociological Analysis), between 1989 and 1994. After relinquishing that post, he revived and edited for a decade (2005-2015) Religion and the Social Order, the ASR’s long-running book series with Brill Academic Publishers. At the same time, he was managing editor (2004-2016) of the Interdisciplinary Journal of Research on Religion, a pioneering online outlet sponsored by the Institute for Studies of Religion at Baylor University.At the start of his ecclesiastical career, Bill graduated with an M.Div. degree in 1969 from the Episcopal Theological Seminary in Lexington, Kentucky, where he taught classes on Greek and the New Testament. The following year he was ordained to the priesthood in the Episcopal Church and began serving a series of congregations of that denomination. His unit of the Episcopal Church in Illinois, the Diocese of Quincy, in 2008 withdrew in reaction to perceived departures from theological orthodoxy. Bill went with it, and with it he eventually affiliated with the new Anglican Church in North America. With the Anglicans he took charge of historic Christ Church, Limestone, in Hanna City, Illinois, for a decade.Much of what Bill Swatos achieved in life he did behind the scenes, in undertakings that would be noticed only if they were fumbled. Because such mishaps were rare, he risked missing the fullness of credit for all that he accomplished. This is an attempt to suggest why — among scholars, academic readers, conference-goers, and people in the pews — he will be greatly missed.

Sporadic Creutzfeldt-Jakob Disease Presenting with Rapidly Progressing Dementia – A Family Medicine Perspective of Two Case Reports

Dementia is an increasing problem in Singapore’s ageing population with the most common being Alzheimer’s disease, vascular dementia, and mixed dementia. Creutzfeldt-Jakob Disease (CJD) is a fatal neurodegenerative condition that causes rapidly progressive dementia. It is a rare human transmissible prion disease with limited literature in Southeast Asia. In this article, we report 2 patients diagnosed with CJD who presented to primary care with rapidly progressive dementia, behavioral changes, and rapid functional decline. Deterioration of their clinical condition was relentless, and treatment remained palliative and supportive. It is important for family physicians to be cognisant of the clinical manifestations of CJD. We will outline the role of family physicians in the management of patients with CJD in different healthcare settings – general practice, tertiary hospital, community hospital and hospice home care.

Current practice for primary headache disorders and perspectives on peripheral nerve blocks among emergency physicians in Canada: A national survey.

This national postal survey aimed to examine Canadian emergency physicians' practice patterns with respect to drug treatment and perspectives on peripheral nerve blocks. The treatment of primary headache disorders in the emergency department is variable. We surveyed 500 emergency physicians listed in the Canadian Medical Directory according to a modified Dillman's method: an initial invitation was followed by up to four reminders to nonresponders. Physicians were asked questions regarding their frequency of medication administration and perspectives toward peripheral nerve blocks. Of 500 mailed surveys, 468 were delivered and 179 physicians responded (response rate = 38.2%). The majority of physicians were men (92/144, 63.9%); 80.6% (116/144) had been in practice for greater than or equal to 10years with 50.7% (75/148) in a community or district general teaching hospital. Commonly used pharmacotherapies for primary headaches were intravenous dopamine receptor antagonists (69%), co-administration of ketorolac and a dopamine receptor antagonist (54.2%), intravenous fluid boluses (54%), nonsteroidal anti-inflammatory drugs (NSAIDs) alone (53.5%), and acetaminophen (51.4%). Only 80 of 144 physicians (55.6%) reported previous experience with peripheral nerve blocks (95% confidence interval [CI] = 48%-65%). The majority (68/80, 85.0%) agreed peripheral nerve blocks are safe and 55.1% (43/78) agreed they are effective. The vast majority (118/140, 84.3%) would consider peripheral nerve blocks as a first-line treatment option given sufficient evidence from a future trial (95% CI = 78%-90%). NSAIDs alone, as well as dopamine receptor antagonists with or without ketorolac are commonly used for primary headache in Canadian emergency departments. A large proportion of physicians have never used a peripheral nerve block in their practice; among those who have experience with peripheral nerve blocks, the majority find them safe and effective. The majority of respondents would consider peripheral nerve blocks as a first-line treatment option given sufficient evidence from a future trial.