Duration Of Readmissions Research Articles

A randomized controlled trial of a postdischarge nursing intervention for patients with decompensated cirrhosis.

Few randomized trials have evaluated the effect of postdischarge interventions for patients with liver cirrhosis. This study assessed the effects of a postdischarge intervention on readmissions and mortality in patients with decompensated liver cirrhosis. We conducted a randomized controlled trial at a specialized liver unit. Adult patients admitted with complications of liver cirrhosis were eligible for inclusion. Participants were allocated 1:1 to standard follow-up or a family-focused nurse-led postdischarge intervention between December 1, 2019, and October 31, 2021. The 6-month intervention consisted of a patient pamphlet, 3 home visits, and 3 follow-up telephone calls by a specialized liver nurse. The primary outcome was the number of readmissions due to liver cirrhosis. Of the 110 included participants, 93% had alcohol as a primary etiology. We found no significant differences in effects in the primary outcomes such as time to first readmission, number of patients readmitted, and duration of readmissions or in the secondary outcomes like health-related quality of life and 6- and 12-month mortality. A post hoc exploratory analysis showed a significant reduction in nonattendance rates in the intervention group (RR: 0.28, 95% CI: 0.13-0.54, p=0.0004) and significantly fewer participants continuing to consume alcohol in the intervention group (p=0.003). After 12 months, the total number of readmissions (RR: 0.76, 95% CI: 0.59-0.96, p=0.02) and liver-related readmissions (RR: 0.55, 95% CI: 0.36-0.82, p=0.003) were reduced in the intervention group. A family-focused postdischarge nursing intervention had no significant effects on any of the primary or secondary outcomes. In a post hoc exploratory analysis, we found reduced 6-month nonattendance and alcohol consumption rates, as well as reduced 12-month readmission rates in the intervention group.

The Questionable Burden of AB0 Incompatible Kidney Transplantation

Abstract Background AB0 incompatible kidney transplantation has become a genuine treatment for end-stage renal disease. Non-inferiority in long term graft function compared to AB0 compatible transplantation has been shown. However, the assumed burden due to complications owing to increased immunosuppression inherent to AB0 incompatible transplantation has not yet been quantified. Aims The aim of the study was to determine if AB0 incompatible recipients have additional morbidity and whether this burden is justified or whether kidney paired donation programs should be advocated. Methods From January 2000 to March 2020 46 AB0 incompatible living kidney transplantations were performed. Patients were matched with AB0 compatible recipients according to sex, age, underlying disease, year of transplantation, and duration of dialysis. Number and duration of readmissions, surgical complication rates according to Clavien-Dindo and its comprehensive complication index (CCI), kidney function, occurrence of new onset diabetes, as well as tumor incidence were analyzed. Results Readmission rate was not higher in AB0 incompatible recipients. The median difference in length of hospital stay for readmissions, CCI during primary hospital stay, and CCI for readmissions at 3, 6, 12 and >12 months after transplantation were comparable. Incidence of tumor and new onset diabetes after transplantation was not increased in incompatible recipients. Conclusions AB0 incompatible recipients do not suffer from a higher burden compared to AB0 compatible recipients. We currently recommend not delaying transplantation in AB0 incompatible pairs.

Cytomegalovirus infection and rehospitalization rates after allogeneic hematopoietic stem cell and solid organ transplantation: a retrospective cohort study using German claims data

PurposeThis study aimed to describe the cytomegalovirus (CMV) infection rate, rehospitalizations, and comorbidities following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and solid organ transplantation (SOT).MethodsPatients who received allo-HSCT or SOT in 01/07/2015–30/06/2018 were identified using anonymized German claims data. The transplantation-related hospital admission date was defined as the index date, and patients were followed for up to 12 months (or death, first event relevant). The frequency of CMV infections (confirmed outpatient/inpatient diagnoses, ICD-10-GM codes: B25.-/B27.1) and the rate, number, and duration of all-cause rehospitalizations in the follow-up period were evaluated.ResultsA total of 226 allo-HSCT and 250 SOT patients were identified (mean age 52.8 years, 38.9% female). During the 12 months after transplantation, 29.2% of allo-HSCT patients and 16.8% of SOT patients received a CMV diagnosis. The majority of these diagnoses were given during the initial hospitalization or within the following 3 months. Across transplantation types, CMV patients had more hospital readmission days per patient-year (allo-HSCT 93.3 vs. 49.4, p = 0.001; SOT 42.0 vs. 20.7, p = 0.005), with a longer mean duration of readmissions (allo-HSCT 22.4 vs. 15.4 days, p < 0.001; SOT 11.6 vs. 7.5 days, p = 0.003). Comorbidity burden in transplantation patients was substantial, with several diagnoses being significantly more common among patients with CMV vs. non-CMV. One-year mortality did not differ significantly between patients with/without CMV.ConclusionBurden of transplant recipients with CMV in terms of rehospitalizations and comorbidities is substantial, highlighting the need for improved CMV prevention and treatment.

Efficacy of clozapine for long-stay patients with treatment-resistant schizophrenia: 4-year observational study.

AimSupporting patients upon discharge following prolonged hospitalization in private psychiatric hospitals in Japan have long been an issue. This study evaluated the efficacy of clozapine in treating long‐stay patients with treatment‐resistant schizophrenia to reduce the frequency and duration of readmissions postdischarge.MethodsWe retrospectively examined the length and frequency of hospitalizations of long‐stay and non‐long‐stay patients with schizophrenia who were introduced to clozapine at our hospital.ResultsComparing participants’ medical records 2 years before and after the introduction of clozapine, we identified a significant decrease in both length and frequency of hospitalizations in all patients who were introduced to clozapine. In long‐stay patients, the length and frequency of hospitalization were significantly reduced. However, compared to non‐long‐stay patients, the period from introduction of clozapine to discharge was longer and the dose of clozapine was higher. Thus, it is necessary to take time to evaluate the therapeutic effects for long‐stay patients.ConclusionThe results showed that clozapine is helpful for patients with treatment‐resistant schizophrenia, who are considered difficult to treat and discharge in Japan.

Early Recognition Method – Amplifying relapse management in community mental health care; a comprehensive study of the effects on relapse and readmission

This naturalistic multicenter study explored the relationship between participating in the Early Recognition Method (ERM) intervention and relapse, defined as spending at least one night at a psychiatric ward. The intervention was tailored to adult patients with schizophrenia or bipolar disorder in an outpatient mental health care setting.Before the intervention, the staff received training in application of the strategy. The ERM strategy is protocolized and includes identification and monitoring of individual early warning signs and development of a personal plan of action. The study showed a reduction in mean number and duration of readmissions during the period the patients participated in the intervention, compared to an equal pre-intervention period. For patients with bipolar disorder the reduction was statistical significant. The difference in outcome between the two diagnostic groups suggests that further tailoring of the application of the ERM strategy might improve the relapse prevention outcome.

Reducing the rate of psychiatric re-admissions in bipolar disorder using smartphones-The RADMIS trial.

The MONARCA I and II trials were negative but suggested that smartphone-based monitoring may increase quality of life and reduce perceived stress in bipolar disorder (BD). The present trial was the first to investigate the effect of smartphone-based monitoring on the rate and duration of readmissions in BD. This was a randomized controlled single-blind parallel-group trial. Patients with BD (ICD-10) discharged from hospitalization in the Mental Health Services, Capital Region of Denmark were randomized 1:1 to daily smartphone-based monitoring including a feedback loop (+ standard treatment) or to standard treatment for 6 months. Primary outcomes: the rate and duration of psychiatric readmissions. We included 98 patients with BD. In ITT analyses, there was no statistically significant difference in rates (hazard rate: 1.05, 95% CI: 0.54; 1.91, p=0.88) or duration of readmission between the two groups (B: 3.67, 95% CI: -4.77; 12.11, p=0.39). There was no difference in scores on the Hamilton Depression Rating Scale (B=-0.11, 95% CI: -2.50; 2.29, p=0.93). The intervention group had higher scores on the Young Mania Rating Scale (B: 1.89, 95% CI: 0.0078; 3.78, p=0.050). The intervention group reported lower levels of perceived stress (B: -7.18, 95% CI: -13.50; -0.86, p=0.026) and lower levels of rumination (B: -6.09, 95% CI: -11.19; -1.00, p=0.019). Smartphone-based monitoring did not reduce rate and duration of readmissions. There was no difference in levels of depressive symptoms. The intervention group had higher levels of manic symptoms, but lower perceived stress and rumination compared with the control group.

The effect of smartphone-based monitoring and treatment on the rate and duration of psychiatric readmission in patients with unipolar depressive disorder: The RADMIS randomized controlled trial

BackgroundPatients with unipolar depressive disorder are frequently hospitalized, and the period following discharge is a high-risk-period. Smartphone-based treatments are receiving increasing attention among researchers, clinicians, and patients. We aimed to investigate whether a smartphone-based monitoring and treatment system reduces the rate and duration of readmissions, more than standard treatment, in patients with unipolar depressive disorder following hospitalization. MethodsWe conducted a pragmatic, investigator-blinded, randomized controlled trial. The intervention group received a smartphone-based monitoring and treatment system in addition to standard treatment. The system allowed patients to self-monitor symptoms and access psycho-educative information and cognitive modules. The patients were allocated a study-nurse who, based on the monitoring data, guided and supported them. The control group received standard treatment. The trial lasted six months, with outcome assessments at 0, 3, and 6 months. ResultsWe included 120 patients with unipolar depressive disorder (ICD-10). Intention-to-treat analyses showed no statistically significant differences in time to readmission (Log-Rank p=0.9) or duration of readmissions (B=-16.41,95%CI:-47.32;25.5,p=0.3) (Primary outcomes). There were no differences in clinically rated depressive symptoms (p=0.6) or functioning (p=0.1) (secondary outcomes). The intervention group had higher levels of recovery (B=7,29, 95%CI:0.82;13,75,p=0.028) and a tendency towards higher quality of life (p=0.07), wellbeing (p=0,09) satisfaction with treatment (p=0.05) and behavioral activation (p=0.08) compared with the control group (tertiary outcomes). LimitationsPatients and study-nurses were unblinded to allocation. ConclusionsWe found no effect of the intervention on primary or secondary outcomes. In tertiary outcomes, patients in the intervention group reported higher levels of recovery compared to the control group.

Early detection of metastatic colorectal cancer patients who could benefit from specialist palliative care: a prediction model

Introduction: Palliative care is usually provided by healthcare professionals from all disciplines as part of the pallet of care tasks that they provide for their patients. More recently, a strong recommendation for the provision of specialist palliative care came from the WHO and the European Association of Palliative Care EAPC although this was based on a descriptive analysis of the available studies at that time Centeno et al., 2016. Furthermore, the review of Gaertner et al. 2017 showed that specialist palliative care was associated with a positive effect on quality of life and most effective if provided in an early stage Gaertner et al., 2017. In the Spaarne Gasthuis, a large teaching hospital in the Netherlands, a specialist palliative care team SPCT was assembled in 2015. In this study we will evaluate the quality of care provided by the SPCT for a restricted group of patients with metastatic colorectal cancer. In addition, predictive factors will be explored that could help to identify in an early stage, those patients who could be eligible for the specialist palliative care. The aims of this study are: 1. To assess the differences in treatment, number and duration of re-admissions, complications between metastatic colorectal cancer patients who were or were not consulted by the SPCT in the Spaarne Gasthuis in 2016. 2. To identity potential predictive variables that could identify in an early stage, metastatic colorectal cancer patients who are eligible for the SPCT. Methods: In this retrospective cohort study, all metastatic colorectal cancer patients aged ≥ 18 years who were diagnosed in the Spaarne Gasthuis in 2016 were eligible to be included in the study database. All patients were screened and evaluated for participation in the advanced care procedure of the SPCT. In total, there were about 45 metastatic colorectal cancer patients who were eligible for specialist palliative care and were consulted by the SPCT. Those metastatic colorectal cancer patients who were not eligible for the SPCT about 500 will also be included in the study database. A study database was constructed with the following independent variables: age, sex, date of diagnosis, diagnosis, treatment drug, dose, duration, complications, pain-scores, weight loss, liver function laboratory data, anemia, changes in defecation pattern, hematochezia blood in stool, number and duration of re-admissions. Data will be collected from patient files. Statistical analyses: Rates, average, median, percentages and standard deviations will be analyzed for the total group, the SPCT group, and the non-SPCT group. For the dichotomous outcome variable “SPCT or not”, univariate analyses will be performed to identify variables that are associated with eligibility for the SPCT using logistic regression. Next, to develop a prediction model, variables with a p-value

Reducing the rate and duration of Re-ADMISsions among patients with unipolar disorder and bipolar disorder using smartphone-based monitoring and treatment \u2013 the RADMIS trials: study protocol for two randomized controlled trials

BackgroundUnipolar and bipolar disorder combined account for nearly half of all morbidity and mortality due to mental and substance use disorders, and burden society with the highest health care costs of all psychiatric and neurological disorders. Among these, costs due to psychiatric hospitalization are a major burden. Smartphones comprise an innovative and unique platform for the monitoring and treatment of depression and mania. No prior trial has investigated whether the use of a smartphone-based system can prevent re-admission among patients discharged from hospital. The present RADMIS trials aim to investigate whether using a smartphone-based monitoring and treatment system, including an integrated clinical feedback loop, reduces the rate and duration of re-admissions more than standard treatment in unipolar disorder and bipolar disorder.MethodsThe RADMIS trials use a randomized controlled, single-blind, parallel-group design. Patients with unipolar disorder and patients with bipolar disorder are invited to participate in each trial when discharged from psychiatric hospitals in The Capital Region of Denmark following an affective episode and randomized to either (1) a smartphone-based monitoring system including (a) an integrated feedback loop between patients and clinicians and (b) context-aware cognitive behavioral therapy (CBT) modules (intervention group) or (2) standard treatment (control group) for a 6-month trial period. The trial started in May 2017. The outcomes are (1) number and duration of re-admissions (primary), (2) severity of depressive and manic (only for patients with bipolar disorder) symptoms; psychosocial functioning; number of affective episodes (secondary), and (3) perceived stress, quality of life, self-rated depressive symptoms, self-rated manic symptoms (only for patients with bipolar disorder), recovery, empowerment, adherence to medication, wellbeing, ruminations, worrying, and satisfaction (tertiary). A total of 400 patients (200 patients with unipolar disorder and 200 patients with bipolar disorder) will be included in the RADMIS trials.DiscussionIf the smartphone-based monitoring system proves effective in reducing the rate and duration of re-admissions, there will be basis for using a system of this kind in the treatment of unipolar and bipolar disorder in general and on a larger scale.Trial registrationClinicalTrials.gov, ID: NCT03033420. Registered 13 January 2017. Ethical approval has been obtained.

Risk Factors for Unanticipated Readmissions During the Interstage: A Report From the National Pediatric Cardiology Quality Improvement Collaborative

This study describes unanticipated interstage readmissions in patients with hypoplastic left heart syndrome, identifies independent risk factors for unanticipated interstage readmissions, and evaluates variation in unanticipated readmission rates among collaborative centers. Retrospective data of patients enrolled in the National Pediatric Cardiology Quality Improvement Collaborative registry from July 2008 to July 2013 were analyzed. Risk factors present at the beginning of the interstage were captured. Competing risks time to event analyses determined the association between these factors and unanticipated interstage readmission. Readmission center variation was examined using funnel plots. Unanticipated interstage readmissions occurred in 66% of 815 patients at 50 centers. The median readmission length of stay was 2 days (interquartile range: 0-6) and median time to first readmission was 29 days (interquartile range: 9-63). Most readmissions were prompted by minor changes in clinical status (64%), whereas only 6% were major adverse event readmissions. Independent readmission risk factors included genetic syndrome (HR = 1.40, 95% CI: 1.05-1.88), center volume (small vs large HR = 1.32, CI: 1.04-1.66, medium vs large HR = 1.35, CI: 1.09-1.68), preoperative ventricular dysfunction (HR = 2.02, CI: 1.31-3.10), tricuspid regurgitation (HR = 1.36, CI: 1.08-1.72), duration of circulatory arrest (HR = 0.99, CI: 0.989-0.998), and undergoing Hybrid procedure relative to Norwood/right ventricle to pulmonary artery conduit (HR = 1.40, CI: 1.02-1.93). There was significant center variation in the number of readmissions and duration of readmissions. Unanticipated readmissions are common during the interstage period with notable center variation. However, these readmissions are short and are rarely in response to major adverse events.

Kaleidoscope.

One criticism was that the 12-month follow-up failed to capture a true clinical picture, and that more time was necessary to demonstrate their worth. The team that carried out this original work have now published 3-year data on 330 individuals detained under section of the Mental Health Act,1 randomised on discharge to CTO or voluntary status via Section 17 leave. No improvements in readmission rates, time to first readmission, or duration of readmissions were found for those placed on CTOs. The findings are even more powerful than the original results; CTOs now exist in various forms in over 75 jurisdictions, but no solid scientific evidence has yet been produced to support them. If there are subpopulations for whom (or specific circumstances in which) they work, such characteristics have yet to be delineated. A ‘least restrictive’ principle underpins the Mental Health Act, and a strong rebuttal is needed to justify ongoing CTO use – so-called ‘revolving-door patients' should not be replaced by revolving-door policy.

Using films as a psychoeducation tool for patients with schizophrenia: a pilot study using a quasi-experimental pre-post design.

BackgroundRelapses and, subsequently, readmissions are common in patients with schizophrenia. Psychoeducation has been shown to reduce the number and duration of readmissions. Yet, only little more than 20% of psychiatric patients in German speaking countries receive psychoeducation. Among other reasons, costs may be considered too high by hospitals. The objective of the present study was to test the feasibility of a new cost-efficient approach in the psychoeducation of patients with schizophrenia. In this study, films were used to impart knowledge about the illness to inpatients.MethodsA total of 113 participants were initially included in the study, eleven of which were not included in the final analyses. Six films about the symptoms, diagnosis, causes, warning signs, treatment of schizophrenia and about the influence of family members and friends were shown in a group setting in the presence of nursing staff. All films combined facts, expert opinions, and personal experiences of peers. As the main outcome criterion of this feasibility pilot study, we measured the effects on knowledge. Secondary outcome measures included compliance, insight into illness, side effects, and quality of life. Data were collected directly after the intervention and about half a year afterwards. The number and the duration of readmissions to the hospital were recorded and compared to the number and duration of prior admissions. Patients were also asked to state their subjective opinion about the films. Main data analyses were done using paired t-tests and Wilcoxon signed-rank tests. Secondary analyses also involved ANOVAs and ANCOVAs.ResultsOne hundred and two inpatients were included in the data analyses. Showing the films in the tested setting was shown to be feasible. Knowledge about schizophrenia (p < .001), compliance (ps < .01), insight into illness (p < .01), and quality of life (p < .001) all increased significantly after patients had watched the films and remained stable for at least half a year. A vast majority (84.9%) of the patients found the films to be interesting and informative.ConclusionsUsing films to educate inpatients about schizophrenia is a feasible method that is cost- and time-efficient and well received by the patients.

P154 The Impact Of A Discharge Care Bundle On The 30-day Readmission Rate Following Hospitalisation For Acute Copd Exacerbation

Introduction National audit reports high rates of early readmission following hospitalisation for chronic obstructive pulmonary disease (COPD) exacerbation. Discharge bundles aim to optimise care and reduce readmission. Frimley Park Hospital NHS Foundation Trust interacts with different community respiratory teams across three counties. Aims We hypothesised that a novel COPD discharge bundle would reduce re-admission. We also wished to see if the bundle was effective across multiple community administrations, and in patients with a history of frequent exacerbation. Methods Admissions with a primary COPD diagnostic code and cases referred to the COPD nurse were collated during Q4 2013/14. Patients were classified according to whether they were assessed by the COPD nurse using the discharge bundle. Readmissions within 30-days and 3-months were identified using a hospital clinical database. Readmissions with COPD exacerbation (infective or non-infective) were included, as well as COPD associated lower respiratory tract infection or pneumonia. The database identified frequent severe exacerbators (patients with >1 admission in the previous year), and recorded age and length of stay as surrogates of disease complexity. Results 24 patients were excluded (18 had other diagnoses, 4 died, and 2 lived out of area). Table 1 shows the characteristics of the remaining 156 patients according to whether they completed the bundle. There was no overrepresentation of short (zero or one day) length of stay patients in the group not completing the bundle. 17.5% of patients completing the bundle were re-admitted within 30-days, compared to 34% who did not (p = 0.027). A similar trend was seen at 3-months. No difference was observed in the timing or duration of readmissions. Logistic regression using covariates of age, length of stay, history of frequent severe exacerbation and discharge bundle use, suggested the latter two variables were both independent predictors of re-admission at 30-days: OR 5.70 (95% CI 2.46 to 13.2, p Discussion Two-thirds of patients completed a discharge bundle during the Trust’s busiest quarter for COPD admission. Patients completing the discharge bundle had a significantly lower rate of 30-day readmission.

Effects of a mindfulness-based psychoeducation programme for Chinese patients with schizophrenia: 2-year follow-up.

Psychoeducation programmes for people with schizophrenia are shown to reduce relapses but few studies have indicated significant improvements in patients' illness awareness and insight, functioning, symptom severity or rates of readmission to hospital. To examine the effects of a mindfulness-based psychoeducation programme for Chinese people with schizophrenia. A multisite randomised controlled trial was conducted with 107 out-patients with schizophrenia: 36 and 35 received a 6-month mindfulness-based psychoeducation and a conventional psychoeducation programme, respectively, and 35 received routine care alone. Patient outcome measures were psychiatric symptom severity, psychosocial functioning, social support, insight into illness/treatment, and frequency and duration of readmissions to hospital (ClinicalTrials.gov: trial registration NCT01667601). The mindfulness-based psychoeducation group reported significantly greater improvements in psychiatric symptoms, psychosocial functioning, insight into illness/treatment and duration of readmissions to hospital over 24 months when compared with the other two groups. Mindfulness-based psychoeducation appears to be a promising approach to treatment for Chinese patients with schizophrenia.

Re-admissions to hospital within 30 days of hospital discharge with rotavirus gastroenteritis: a UK study on children under 5 years of age

<h3>Aims</h3> To compare the duration of re-admissions in children &lt;5 based on the diagnosis at their prior admission, and examine the impact of co-morbidities. <h3>Methods</h3> UK hospital inpatient data were obtained from the Capse Healthcare Knowledge Systems (CHKS) database from 01/04/2000 to 31/03/2008, for children aged &lt;5 years, with a diagnosis of rotavirus (RVGE) (ICD-10 A08.0) or non-rotavirus gastroenteritis (NRV) (A09*, A08.3-5). The first diagnosis with a seasonal infection, during that admission, was taken as the patient9s main infection. Patients were classified as a primary or secondary patient dependent on whether the infection was the primary or secondary (co-morbid) cause of admission. Admission numbers were based on unique admissions, generated from finished consultant episodes. Patients admitted with RVGE or NRV were tracked backwards for 30 days to identify prior hospital admissions with any cause. <h3>Results</h3> 167,576 admissions with NRV and 19,227 admissions with RVGE occurred; 21,174 (12.6%) and 4,374 (22.7%) were re-admissions respectively. 47.6% of those with NRV were re-admitted within 5 days, and 74.7% of those with RVGE within 5 days. Children re-admitted with RVGE were re-admitted to hospital for a mean period of 5.4 days (SD 20.6), and with NRV for 1.7 days (SD 7.5), co-morbidities increased this length of stay (LOS) by 11.0 days (SD 7.1 p&lt;0.001). Children previously admitted with RVGE or NRV had a significantly shorter hospital LOS (p&lt;0.001 – p=0.002) on readmission than patients previously admitted with any other diagnosis. Children admitted with RVGE or NRV had a significantly longer LOS if their prior diagnosis was a neoplasm (p&lt;0.001). Of those re-admitted with RVGE or NRV, 26.9% had previously been admitted with another gastrointestinal condition (ICD-10 chapter 11 code), and 32.4% with an ICD-10 chapter 18 code (all other category). <h3>Conclusion</h3> Re-admission occurs more frequently with RVGE than with NRV, while also incurring increased LOS. Children re-admitted with co-morbidities have a more complicated clinical course with RVGE and NRV. Universal rotavirus vaccination would substantially benefit vulnerable children through direct or indirect protection and reduce the healthcare resource use resulting from hospital readmissions.

P-1177 - “Porta aberta” - a psychoeducational programme for bipolar disorders’ patients

Introduction Psychoeducation is currently considered an essential intervention in the management of bipolar disorders. A psychoeducation group programme for patients with bipolar disorders named “Porta Aberta” (Open Door) has been implemented since 2007 at the Day-hospital of our psychiatric department. Objectives and aims To assess the efficacy of group psychoeducation in reducing the average number and duration of readmissions and to determine the individual characteristics (gender, marital status and disorder subtype) that might influence these outcomes. Methods Review of the clinical records of a consecutive sample of patients with bipolar disorders discharged from the inpatient unit, attending at least 4 out 8 programme sessions, and with a one-year follow-up since 2007. Variables assessed were: gender, age, marital status, subtype of bipolar disorder (I or II), and number and duration of psychiatric admissions in the year before and in the year following the programme attendance. Results The 69 patients included were 37.3 ± 10.7 years old, mainly women (68.1%), and single (47.8%). A statistically significant reduction in the average duration of readmissions (24.7 versus 17.3 days, p = .028), and in the average number of readmissions (1.3 versus 0.3, p = .032) was found. Only 15 patients were readmitted. Patient's gender and marital status, as well as disorder subtype had no influence in the results. Conclusions Group psychoeducation is an effective intervention in reducing the number and duration of readmissions in bipolar patients despite gender, marital status and subtype of bipolar disorder.

Duration of Initial Admission and Subsequent Readmission in the First 100 Days Following Reduced Intensity Conditioning Allogeneic Stem Cell Transplantation.

Allogeneic stem cell transplantation (allo-SCT) after a reduced intensity conditioning (RIC) protocol is associated with decreased transplant related organ toxicity and mortality. Some authors have suggested that RIC allo-SCT be performed entirely in the outpatient setting. As a challenge to this hypothesis we examined the short term toxicity following RIC allo-SCT particularly focusing on duration of initial admissions and subsequent readmissions in the first 100 days post transplant. We analysed 104 consecutive RIC allo-SCT (median age: 52, range 19–67 yr; M: 69%, F:31%) performed at our institution between February 2003 and May 2007. All patients had a high risk haematological malignancy (27% Acute Myeloid Leukaemia, 20% Multiple myeloma, 20% Chronic Lymphocytic Leukaemia, 12% Lymphoma, 6% Myelodysplastic syndrome, 6% Acute Lymphoblastic Leukaemia, 6% Chronic Myeloid Leukaemia, 2% other). Conditioning was with fludarabine plus either melphalan, busulphan, cyclophosphamide or low dose TBI (2Gy). T cell depletion in vivo with alemtuzumab was utilised in 64%. Donor was matched related (39%) or unrelated (61%). Source of stem cells was PBSC (80%) or marrow (20%). GVH prophylaxis was CyA either alone or in combination with short term methotrexate. Patients were hospitalised from the beginning of the conditioning regimen until haematological and non-haematological toxicities had resolved. Eleven patients (10%) died before discharge. The median time required for achievement of neutrophil engraftment was 15 days (range 0–56). Four patients died prior to engraftment. Median duration of initial hospital admission was 31 days (range 17–192). In univariate analysis patients with Multiple myeloma were discharged earlier (p=0.001). Patients conditioned with Flu TBI were also discharged earlier (p<0.0001). Unrelated donor RIC allo-SCT were discharged later (p<0.001). Patients receiving alemtuzumab were also discharged later (p<0.001). Readmissions within 100 days of transplant were documented in 50/104 (48%). The most common reasons were non CMV infections (30%), GVHD (22%), CMV reactivation (22%) and progressive disease (9%). Patient diagnosis, stem cell source, donor type, conditioning regimen, T cell depletion and age had no significant bearing on the incidence of readmission in the first 100 days post transplant by multivariate analysis. Transplant related complications (Infections, CMV reactivation, GVHD, TTP) were seen in 73/104 (70%) within 100 days of transplant. Transplant related mortality (TRM) at 100 days was 15%. Patients who required readmission in the first 100 days post transplant had lower OS at 1 year (45% v 73%) than those who did not require readmission (p<0.001). The mean duration of readmissions in the first 100 days post transplant was 15.5 days. This had major financial implications with average bed costs of £7750 per readmission. In summary, although RIC regimens have undoubtedly widened the potential application of allo-SCT they are not without short term toxicity. Although early discharge following RIC allo-SCT has been advocated, our analysis demonstrates that the risk of readmission in the first 100 days post transplant is significant and is associated with increased costs and mortality. A full health economic analysis will be presented including a comparison with full intensity conditioning allo-SCT performed over the same period.

Comparison of two Dutch follow-up care models for spinal cord-injured patients and their impact on health problems, re-admissions and quality of care

Objective: To evaluate whether transmural care for people with spinal cord injury living in the community has more impact on health outcomes than traditional follow-up care within the Netherlands. Design: Quasi-experiment with 12 months of follow-up. Setting: Eight Dutch rehabilitation centres. Subjects: Thirty-one patients who received transmural care in two `experimental' rehabilitation centres were compared with a matched sample of 31 patients having received `usual follow-up care' in six other rehabilitation centres. Intervention: The core component of the transmural care consists of a transmural nurse, who `liaises' between former patients living in the community, primary care professionals and the rehabilitation team. The transmural care model provides activities to support patients and their family/partners and activities to promote continuity of care. Main measures: The prevalence of pressure sores and urinary tract infections; the number and duration of re-admissions to hospital and rehabilitation centre due to pressure sores, bladder and bowel problems; and the experienced quality of follow-up care. Results: The transmural care, as implemented, did not influence the health outcomes. The prevalence of pressure sores, urinary tract infections and the number of re-admissions (due to pressure sores, bladder and bowel problems) was respectively 13, 13 and 4 in the intervention group versus 14, 15 and 6 in the usual follow-up care group. Since the transmural care had been incompletely implemented and there were methodological and practical limitations, we formulated no final conclusions regarding its effectiveness. Conclusion: Implementing the transmural care model strictly according to protocol may improve its effectiveness.

Late-Onset Driveline Infections: The Achilles’ Heel of Prolonged Left Ventricular Assist Device Support

A successful left ventricular assist device (LVAD) long-term support in an outpatient setting demands that device-related complications are reduced to a minimum. We hypothesized that late onset driveline infections have serious implications on the anticipated application of LVAD as permanent therapy. Between 1996 and 2005, 73 patients were implanted with the Novacor (World Heart Corp, Ottawa, Ontario, Canada; n = 35) or the HeartMate (Thoratec Corp, Pleasanton, CA; n = 38) as either bridge to transplantation (n = 44) or destination therapy (n = 29). Our analysis focused on patients with late-onset infection (> or = 30 days) of the driveline exit site with prior clinical healing of all incisions. Late driveline infections developed in 17 patients (23%) at a median of 158 days (intraquartile range [IQR]: 68 to 213 days) after implantation. The median duration of support in this subgroup was 400 days (IQR, 283 to 849 days). Despite an aggressive treatment algorithm, repeat surgical revision was needed in 12 patients, up to six times in 2 individuals. In 6 patients, the infection progressed to pump pocket infections that led to urgent heart transplantation (n = 4) or explantation (n = 2). The individual risk that a driveline infection would develop dramatically increased with the duration of support, reaching 94% at 1 year. Multivariate analysis identified duration of support (p < 0.001) and documented trauma at the driveline exit site (p < 0.001) as independent predictors of infection. Number and duration of readmissions to the hospital significantly increased (p < 0.001), and long-term follow-up for survival (4.4 +/- 2.2 years, 100% complete) showed a trend towards impaired outcome after driveline infection (5-year survival: 41% versus 70%, p = 0.10). Long-term LVAD support in the current series was jeopardized by late-onset driveline infections, which occurred in all patients with support duration longer than 1 year. Once driveline infections developed, they were difficult to control and significantly increased morbidity.

Predictability of rehospitalisation over 5 years for schizophrenia, bipolar disorder and depression.

The aim of this study was to examine the rate of rehospitalisation for schizophrenia, bipolar disorder and depression over a 5-year period in Tasmania, and to identify predictors of the number and duration of readmissions. The Tasmanian Mental Health Register was used to study the 5-year pattern of rehospitalisation for all patients admitted to a Tasmanian public psychiatric inpatient facility with a primary diagnosis of schizophrenia, bipolar disorder or depression, in 1983 or 1984. Seventy-one percent of patients receiving a diagnosis of schizophrenia were readmitted in the 5-year period, compared to 59% for bipolar disorder and 48% for depression. For all three diagnoses, the number of prior admissions was a predictor of the number of readmissions and the total number of days spent in hospital in the follow-up period. Age and sex also had significant effects, which varied across diagnostic groups. A substantial proportion of patients hospitalised for schizophrenia, bipolar disorder or schizophrenia were rehospitalised during the next 5 years. Patients with more previous admissions had more readmissions than those with fewer previous admissions.